Child Health - Metabolic/Endocrine

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nursedaisy98
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256698
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Child Health - Metabolic/Endocrine
Updated:
2014-04-20 10:41:14
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NCLEX RN
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Child Health
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Metabolic/Endocrine
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  1. A school-age child with type 1 diabetes mellitus has soccer practice three afternoons a week. The school nurse provides instructions regarding how to prevent hypoglycemia during practice. Which should the school nurse tell the child to do? 
    1. Eat twice the amount normally eaten at lunchtime. 
    2. Take half the amount of prescribed insulin on practice days. 
    3. Take the prescribed insulin at noontime rather than in the morning. 
    4. Eat a small box of raisins or drink a cup of orange juice before soccer practice.
    4. Eat a small box of raisins or drink a cup of orange juice before soccer practice.
  2. The mother of a 6-year-old child who has type 1 diabetes mellitus calls a clinic nurse and tells the nurse that the child has been sick. The mother reports that she checked the child's urine and it was positive for ketones. The nurse should instruct the mother to take which action? 
    1. Hold the next dose of insulin. 
    2. Come to the clinic immediately. 
    3. Encourage the child to drink liquids. 
    4. Administer an additional dose of regular insulin.
    3. Encourage the child to drink liquids.
  3. A health care provider prescribes an intravenous (IV) solution of 5% dextrose and half-normal saline (0.45%) with 40 mEq of potassium chloride for a child with hypotonic dehydration. The nurse performs which priority assessment before administering this IV prescription? 
    1. Obtains a weight 
    2. Takes the temperature 
    3. Takes the blood pressure 
    4. Checks the amount of urine output
    4. Checks the amount of urine output
  4. An adolescent client with type 1 diabetes mellitus is admitted to the emergency department for treatment of diabetic ketoacidosis. Which assessment findings should the nurse expect to note? 
    1. Sweating and tremors 
    2. Hunger and hypertension 
    3. Cold, clammy skin and irritability 
    4. Fruity breath odor and decreasing level of consciousness
    4. Fruity breath odor and decreasing level of consciousness
  5. A mother brings her 3-week-old infant to a clinic for a phenylketonuria rescreening blood test. The test indicates a serum phenylalanine level of 1 mg/dL. The nurse reviews this result and makes which interpretation? 
    1. It is positive. 
    2. It is negative. 
    3. It is inconclusive. 
    4. It requires rescreening at age 6 weeks.
    2. It is negative.
  6. A child with type 1 diabetes mellitus is brought to the emergency department by the mother, who states that the child has been complaining of abdominal pain and has been lethargic. Diabetic ketoacidosis is diagnosed. Anticipating the plan of care, the nurse prepares to administer which type of intravenous (IV) infusion? 
    1. Potassium infusion 
    2. NPH insulin infusion 
    3. 5% dextrose infusion 
    4. Normal saline infusion
    4. Normal saline infusion
  7. The nurse has just administered ibuprofen (Motrin) to a child with a temperature of 38.8° C (102° F). The nurse should also take which action? 
    1. Withhold oral fluids for 8 hours. 
    2. Sponge the child with cold water. 
    3. Plan to administer salicylate (aspirin) in 4 hours. 
    4. Remove excess clothing and blankets from the child.
    4. Remove excess clothing and blankets from the child.
  8. A child has fluid volume deficit. The nurse performs an assessment and determines that the child is improving and the deficit is resolving if which finding is noted? 
    1. The child has no tears. 
    2. Urine specific gravity is 1.030. 
    3. Urine output is less than 1 mL/kg/hour. 
    4. Capillary refill is less than 2 seconds.
    4. Capillary refill is less than 2 seconds.
  9. The nurse should implement which interventions for a child older than 2 years with type 1 diabetes mellitus who has a blood glucose level of 60 mg/dL? Select all that apply. 
    1. Administer regular insulin. 
    2. Encourage the child to ambulate. 
    3. Give the child a teaspoon of honey. 
    4. Provide electrolyte replacement therapy intravenously. 
    5. Wait 30 minutes and confirm the blood glucose reading. 
    6. Prepare to administer glucagon subcutaneously if unconsciousness occurs.
    • 3. Give the child a teaspoon of honey. 
    • 6. Prepare to administer glucagon subcutaneously if unconsciousness occurs.
  10. A pediatric nurse educator provides a teaching session to the nursing staff regarding phenylketonuria. Which statement should the nurse educator include in the session? 
    1. "Treatment includes dietary restriction of tyramine." 
    2. "Phenylketonuria is an autosomal dominant disorder." 
    3. "Phenylketonuria primarily affects the gastrointestinal system." 
    4. "All 50 states require routine screening of all newborn infants for phenylketonuria."
    4. "All 50 states require routine screening of all newborn infants for phenylketonuria."
  11. A home care nurse is teaching an adolescent with type 1 diabetes mellitus about insulin administration and rotation sites. Which statement, if made by the adolescent, would indicate effective teaching? 
    1. "I should use only my stomach and my thighs for injections." 
    2. "I need to use a different major site for each insulin injection." 
    3. "I need to use one major site for 2 to 3 weeks before changing major sites." 
    4. "I need to use the same major site for 1 month before rotating to another site."
    3. "I need to use one major site for 2 to 3 weeks before changing major sites."
  12. A 6-year-old child with diabetes mellitus and the child's mother come to the health care clinic for a routine examination. The nurse evaluates the data collected during this visit to determine if the child has been euglycemic since the last visit. Which information is the most significant indicator of euglycemia? 
    1. Daily glucose monitor log 
    2. Glycosylated hemoglobin (hemoglobin A1c) 
    3. Dietary history for the previous week 
    4. Fasting blood glucose performed on the day of the clinic visit
    2. Glycosylated hemoglobin (hemoglobin A1c)
  13. A child's fasting blood glucose levels range between 100 and 120 mg/dL daily. The before-dinner blood glucose levels are between 120 and 130 mg/dL, with no reported episodes of hypoglycemia. Mixed insulin is administered before breakfast and before dinner. The nurse should make which interpretation about these findings? 
    1. Exercise should be increased to reduce blood glucose levels. 
    2. Insulin doses are appropriate for food ingested and activity level. 
    3. Dietary needs are being met for adequate growth and development. 
    4. Dietary intake should be increased to avoid hypoglycemic reactions.
    2. Insulin doses are appropriate for food ingested and activity level.
  14. The home care nurse is visiting a child newly diagnosed with diabetes mellitus. The nurse is instructing the child and parents regarding actions to take if hypoglycemic reactions occur. The nurse should tell the child to take which action? 
    1. Administer glucagon immediately if shakiness is felt. 
    2. Drink 8 ounces of diet cola at the first sign of weakness. 
    3. Report to a hospital emergency department if the blood glucose is 60 mg/dL. 
    4. Carry hard candies whenever leaving home in case a hypoglycemic reaction occurs.
    4. Carry hard candies whenever leaving home in case a hypoglycemic reaction occurs.
  15. The nurse is teaching the parents of a child with growth hormone deficiency about preparing and administering synthetic growth hormone to the child. Which statement, if made by the parents, would indicate an understanding of the procedure? 
    1. "We will rotate injection sites."
    2. "We will give the injection weekly on Monday." 
    3. "We will administer the injection every morning." 
    4. "We will store the mixed growth hormone in the medicine cabinet."
    1. "We will rotate injection sites." 2."We will give the injection weekly on Monday."
  16. An adolescent with diabetes receives 30 units of Humulin N insulin at 7:00 am. In accordance with the peak insulin action time, the nurse would monitor for a hypoglycemic episode at what time? 
    1. At bedtime 
    2. At midmorning 
    3. Before supper 
    4. After breakfast
    3. Before supper
  17. The nurse is teaching the parent of a preschool child how to administer the child's insulin injection. The child will be receiving 2 units of Humulin R insulin and 12 units of Humulin N insulin every morning. How should the nurse instruct the parents to prepare the insulin? 
    1. Draw the insulin into separate syringes. 
    2. Draw the Humulin R insulin first and then the Humulin N insulin into the same syringe. 
    3. Draw the Humulin N insulin first and then the Humulin R insulin into the same syringe. 
    4. Check blood glucose first, and if the result is between 80 and 120 mg/dL, withhold the insulin injection.
    2. Draw the Humulin R insulin first and then the Humulin N insulin into the same syringe.
  18. The clinic nurse is assessing a child for dehydration. The nurse determines that the child is moderately dehydrated if which finding is noted on assessment? 
    1. Oliguria 
    2. Flat fontanels 
    3. Pale skin color 
    4. Moist mucous membranes
    1. Oliguria
  19. An adolescent is examined in the hospital emergency department after taking an overdose of acetylsalicylic acid (aspirin). The adolescent has rapid breathing, nausea and vomiting, and lethargy. The health care provider prescribes arterial blood specimens for blood gas analysis to be drawn. Aspirin toxicity is suspected when the blood gas results are reported as which value? 
    1. pH 7.50, Pco2 60, HCO3 30 
    2. pH 7.44, Pco2 30, HCO3 21 
    3. pH 7.29, Pco2 29, HCO3 19 
    4. pH 7.33, Pco2 52, HCO3 28
    3. pH 7.29, Pco2 29, HCO3 19
  20. An adolescent with type 1 diabetes mellitus is attending a dance in the school gym. The adolescent suddenly becomes flushed and complains of hunger and dizziness. The school nurse, who is present at the dance, takes the child to the nurse's office and performs a blood glucose level test that shows 60 mg/dL. Which is the initial nursing intervention? 
    1. Call the child's mother. 
    2. Assist the child with administering regular insulin. 
    3. Give the child ½ cup of a sugar-sweetened carbonated beverage. 
    4. Call an ambulance to take the child to the hospital emergency department.
    3. Give the child ½ cup of a sugar-sweetened carbonated beverage.
  21. A nursing student is caring for an infant with a respiratory infection and is monitoring for signs of dehydration. The nursing instructor asks the student to identify the most reliable method of determining fluid loss. Which statement by the student indicates an understanding of the method to determine fluid loss? 
    1. Monitor body weight. 
    2. Obtain a temperature. 
    3. Monitor intake and output. 
    4. Assess the mucous membranes.
    1. Monitor body weight.
  22. A nurse is caring for a hospitalized child who is receiving a continuous infusion of intravenous (IV) potassium for the treatment of dehydration. Which assessment finding requires the need to notify the health care provider? 
    1. Weight increase of 0.5 kg 
    2. Temperature of 100.8° F rectally 
    3. A decrease in urine output to 0.5 mL/kg/hr 
    4. Blood pressure (BP) unchanged from baseline
    3. A decrease in urine output to 0.5 mL/kg/hr
  23. An adolescent with type 1 diabetes mellitus has been chosen for the school's cheerleading squad. The adolescent visits the school nurse to obtain information regarding adjustments needed in the treatment plan for diabetes. What should the school nurse instruct the student to do? 
    1. Eat half the amount of food normally eaten. 
    2. Take two times the amount of prescribed insulin on practice and game days. 
    3. Eat six graham crackers or drink a cup of orange juice prior to practice or game time. 
    4. Take the prescribed insulin 1 hour prior to practice or game time rather than in the morning.
    3. Eat six graham crackers or drink a cup of orange juice prior to practice or game time.
  24. The nurse has been caring for an adolescent newly diagnosed with type 1 diabetes mellitus. The nurse provides instructions to the adolescent regarding the administration of insulin. The nurse should include which instruction? 
    1. Use only the stomach and thighs for injections. 
    2. Rotate each insulin injection site on a daily basis. 
    3. Use the same site for injections for 1 month before rotating to another site. 
    4. Use one major site for the morning injection and another site for the evening injection for 2 to 3 weeks before changing major sites.
    4. Use one major site for the morning injection and another site for the evening injection for 2 to 3 weeks before changing major sites.
  25. A nursing student is caring for a hospitalized child who has hypotonic dehydration. The nursing instructor asks the student to describe this type of dehydration. Which statement by the student indicates that the student understands the physiology associated with this type of dehydration? 
    1. "It causes the serum sodium level to rise above 150 mEq/L." 
    2."It occurs when water and electrolytes are lost in the same proportion." 
    3. "It occurs when the loss of electrolytes is greater than the loss of water." 
    4. "It occurs when the loss of water is greater than the loss of electrolytes."
    3. "It occurs when the loss of electrolytes is greater than the loss of water."
  26. A nurse is caring for an infant with gastroenteritis who is being treated for dehydration. The nurse reviews the health record and notes that the health care provider has documented that the infant is mildly dehydrated. Which assessment finding should the nurse expect to note in mild dehydration? 
    1. Anuria 
    2. Pale skin color 
    3. Sunken fontanels 
    4. Dry mucous membranes
    2. Pale skin color
  27. A nurse is talking to the parents of a child newly diagnosed with diabetes mellitus. Which statement by the parents indicates an understanding of preventing and managing hypoglycemia? 
    1. "I will give 8 oz of diet cola at the first sign of weakness." 
    2. "I will administer glucagon immediately if shakiness is felt." 
    3. "I will report to the emergency department if the blood glucose level is 65 mg/dL." 
    4. "I will carry a glucose source when leaving home in case of a hypoglycemic reaction."
    4. "I will carry a glucose source when leaving home in case of a hypoglycemic reaction."

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