Question 1

What would be the most appropriate nursing response to a woman who says,"My sister had a child with Tay-Sachs disease,and I want to know if I could have a child with this condition."

Accepted Answer

Carriers can be identified by screening tests.Tay-Sachs disease has an autosomal recessive pattern of transmission.

Question 2

The nurse explains that because of an inadequate secretion of insulin:

Accepted Answer

When insulin is deficient,the body cannot metabolize carbohydrates for energy.The body is also unable to store and use fat properly.Incomplete fat metabolism produces ketone bodies that accumulate in the blood.

Question 3

A child with diabetes is brought to the emergency department.He is flushed and drowsy,and his skin is dry.His father states that the child has been feeling progressively worse since the morning.This child is most likely experiencing:

Accepted Answer

In ketoacidosis,the child's skin is dry,and the face is flushed.Patients appear dehydrated.They may perspire and be restless.The breath has a fruity odor,and there is no rest period between inspiration and expiration.

Question 4

The condition the nurse suspects when a child with type 1 diabetes mellitus has hyperglycemia,diaphoresis,and headaches in the morning is:

Accepted Answer

The Somogyi phenomenon (rebound hyperglycemia)occurs when the blood glucose level is lowered to the point at which the body's counter-regulatory hormones are released,producing the symptoms described.

Question 5

The nurse caring for a child with a new diagnosis of type 1 diabetes mellitus plans the care based on the understanding that:

Accepted Answer

Type 1 insulin-dependent diabetes mellitus is characterized by an absolute or complete deficiency of insulin.

Question 6

The parents of a child newly diagnosed with diabetes mellitus tell the nurse,"Our son's body is resistant to insulin." The nurse recognizes this description as consistent with:

Accepted Answer

Type 2,non-insulin-dependent diabetes mellitus is caused by insulin resistance or failure of the body to use the insulin.

Question 7

The nurse planning to teach a family about Tay-Sachs disease understands the pattern of inheritance for inborn errors of metabolism is usually:

Accepted Answer

The pattern of inheritance is generally autosomal recessive.

Question 8

When teaching a 12-year-old how to administer insulin,the nurse instructs the child to:

Accepted Answer

Children often find it easier to learn to inject the needle at a 90-degree angle.

Question 9

The nurse teaching parents of a child with diabetes insipidus about water intoxication would tell the parents to be alert for:

Accepted Answer

Signs of water intoxication include edema,lethargy,nausea,and central nervous system signs.

Question 10

Although the child with type 1 diabetes had her prescribed insulin at 7:30 AM,the child is complaining of hunger and thirst and is drowsy at 10:30 AM.The nurse should first:

Accepted Answer

The immediate remedy is to give orange juice to raise the blood glucose.Giving more sugar will increase the blood glucose in a hyperglycemic child.Walking exercise will use up even more glucose.The treatment for hyperglycemia is to give the patient more insulin.

Question 11

The general dietary measure to include in a teaching plan for the child with type 1 diabetes mellitus is to:

Accepted Answer

The nutritional needs of a child with diabetes mellitus are essentially the same as those of the nondiabetic child with the exception of the elimination of concentrated carbohydrates such as sugar.Fiber has been shown to reduce blood glucose levels.

Question 12

The laboratory result indicating good metabolic control for a child with type 1 diabetes mellitus is:

Accepted Answer

Glycosylated hemoglobin reflects glycemic levels over a period of months.Levels of 6% to 9% represent good metabolic control.

Question 13

Following a closed head injury,the unconscious 10-year-old child begins to excrete copious amounts of pale urine with an attendant drop in blood pressure (BP).Based on these symptoms,the nurse suspects the development of:

Accepted Answer

Diabetes insipidus can be acquired as the result of a head injury or tumor,and suppression of the posterior pituitary causes copious urine output with an attendant drop in BP.The child can become dehydrated very quickly if some remedy is not applied.

Question 14

The statement made by a 7-year-old child with type 1 diabetes mellitus that indicates a need for more teaching is:

Accepted Answer

The child with type 1 diabetes mellitus has an insulin deficiency and will require lifelong management of this disease.Insulin does not cure the pancreas.

Question 15

A child receives a combination of regular and NPH insulin at 8:00 AM At 8:45 AM,when the breakfast trays have not yet arrived from the kitchen,the nurse should:

Accepted Answer

A child who receives regular insulin before meals may have an insulin reaction if food is not eaten within 20 minutes.A snack of graham crackers and milk will prevent an episode of hypoglycemia.

Question 16

An important consideration for the school-age child taking DDAVP for diabetes insipidus would be:

Accepted Answer

The child with diabetes insipidus needs liberal access to bathrooms and water fountains.Arrangements may have to be made with the school to allow access.

Question 17

The nurse determines a parent is administering levothyroxine (Synthroid)correctly when she states:

Accepted Answer

Synthroid should be given at the same time each day,preferably in the morning.

Question 18

A mother reports that her 4-month-old infant is lethargic,sleeps 18 hours a day,and snores.The nurse recognizes that these signs are characteristic of:

Accepted Answer

The infant with hypothyroidism will appear sluggish,and the tongue will be enlarged,causing noisy respiration.

Question 19

The comment made by a school-age child indicating that he needs more teaching about diabetes mellitus and exercise is:

Accepted Answer

Blood glucose is high after meals.The child with type 1 diabetes mellitus who skips a meal before exercise is at risk for hypoglycemia.

Question 20

The nurse discussed treatment of hypoglycemia with an adolescent.The nurse determined the adolescent understood the instructions when she verbalized that if her blood glucose is low or if she begins to feel hungry and weak,she will:

Accepted Answer

The immediate treatment of hypoglycemia consists of administering sugar in some form such as orange juice,hard candy,or a commercial product.Cheese will eventually raise the blood glucose,but not as quickly as candy.

Quiz 31: The Child with a Metabolic Condition