Chapter 31: The Child with a Metabolic Condition Nursing School Test Banks

Chapter 31: The Child with a Metabolic Condition

MULTIPLE CHOICE

1. A nurse is planning to teach a family about Tay-Sachs disease. What will the nurse relay about the pattern of inheritance for inborn errors of metabolism?
a. They are usually autosomal recessive.
b. They are usually autosomal dominant.
c. They are usually X-linked recessive.
d. They are usually multifactorial.
ANS: A
The pattern of inheritance is generally autosomal recessive.

DIF: Cognitive Level: Knowledge REF: Page 704 OBJ: 2
TOP: Tay-Sachs KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

2. What occurs as a result of an inadequate secretion of insulin?
a. Protein synthesis is increased.
b. Increased fat breakdown leads to ketonemia.
c. Serum glucose levels are markedly decreased.
d. More rapid conversion and storage of carbohydrates to glucose occurs.
ANS: B
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.

DIF: Cognitive Level: Comprehension REF: Page 706 OBJ: 9
TOP: Diabetes Mellitus KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

3. On what understanding does the nurse plan the care of a child with a new diagnosis of type 1 diabetes mellitus?
a. There is an absolute deficiency of insulin.
b. Insufficient quantities of insulin are produced by the pancreas.
c. Oral hypoglycemic agents can control it.
d. Insulin deficiency is caused by another disease affecting the pancreas.
ANS: A
Type 1 insulin-dependent diabetes mellitus is characterized by an absolute or complete deficiency of insulin.

DIF: Cognitive Level: Comprehension REF: Page 707, Table 31-2
OBJ: 5 TOP: Diabetes Mellitus
KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

4. A child receives a combination of regular and NPH insulin at 8:00 AM. At 8:45 AM the breakfast trays have not yet arrived from the kitchen. What is the best action by the nurse?
a. Notify the charge nurse.
b. Give the patient a snack of graham crackers and milk.
c. Ambulate the patient in the hall for a short time.
d. Give the patient more insulin according to the sliding scale.
ANS: B
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.

DIF: Cognitive Level: Application REF: Page 714, Table 31-6
OBJ: 9 TOP: Prevention of Hypoglycemia
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Reduction of Risk

5. 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. What should the nurse do first?
a. Walk the patient in the hall for 10 minutes.
b. Allow the patient a short nap.
c. Give her a cup of orange juice.
d. Test her blood with a glucometer and give insulin according to the sliding scale.
ANS: C
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.

DIF: Cognitive Level: Application REF: Page 714, Table 31-6
OBJ: 7 TOP: Hypoglycemia
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

6. Which comment made by a school-age child indicates that he needs more teaching about diabetes mellitus and exercise?
a. I carry a piece of hard candy with me in case I start to feel shaky.
b. I make sure I have emergency money when I have soccer practice or a game.
c. Sometimes I skip my breakfast when I have a game in the morning.
d. I play in soccer games that are scheduled after dinner.
ANS: C
Blood glucose is high after meals. The child with type 1 diabetes mellitus who skips a meal before exercise is at risk for hypoglycemia.

DIF: Cognitive Level: Comprehension REF: Page 711, Nursing Care Plan 31-1 | Page 712
OBJ: 9 TOP: Diabetes Mellitus
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

7. Which statement made by a 7-year-old child with type 1 diabetes mellitus indicates a need for more teaching?
a. My pancreas is sick and needs insulin until it is well.
b. I will need to take my insulin every day.
c. I need to keep a piece of candy in my pocket in case I start to feel shaky.
d. My mom has to give me insulin shots twice a day.
ANS: A
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.

DIF: Cognitive Level: Comprehension REF: Page 710 OBJ: 5
TOP: Diabetes Mellitus KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

8. Which general dietary measure should the nurse include in a teaching plan for the child with type 1 diabetes mellitus?
a. Control intake of carbohydrates and consume fewer calories.
b. Focus on complex carbohydrates and eat foods high in fiber.
c. Obtain most calories from proteins and fats.
d. Eat a diet low in fat and low in complex carbohydrates.
ANS: B
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.

DIF: Cognitive Level: Comprehension REF: Page 712 OBJ: 9
TOP: Diet KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

9. 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. What is this child most likely experiencing?
a. Somogyi phenomenon
b. Dawn syndrome
c. Ketoacidosis
d. Water intoxication
ANS: C
In ketoacidosis, the childs 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.

DIF: Cognitive Level: Analysis REF: Page 709, Table 31-4
OBJ: 7 TOP: Ketoacidosis
KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

10. A mother reports that her 4-month-old infant is lethargic, sleeps 18 hours a day, and snores. The nurse recognizes these signs are characteristic of what?
a. Hypothyroidism
b. Hyperthyroidism
c. Type 1 diabetes mellitus
d. Tay-Sachs disease
ANS: A
The infant with hypothyroidism will appear sluggish, and the tongue will be enlarged, causing noisy respiration.

DIF: Cognitive Level: Analysis REF: Page 705 OBJ: 3
TOP: Hypothyroidism KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

11. What is an important consideration for the school-age child taking DDAVP for diabetes insipidus?
a. Observe for signs of water deprivation.
b. Restrict his physical education program.
c. Arrange for the child to use the bathroom when needed.
d. Limit fluid intake other than during the lunch period.
ANS: C
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.

DIF: Cognitive Level: Application REF: Page 705-706
OBJ: 4 TOP: Diabetes Insipidus
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Reduction of Risk

12. Which laboratory result indicates good metabolic control for a child with type 1 diabetes mellitus?
a. Glycosylated hemoglobin value of 8%
b. Fasting blood glucose level less than 140 mg/dL
c. Glucose tolerance test result of 190 mg/dL
d. No glucose or ketones present in the urine
ANS: A
Glycosylated hemoglobin reflects glycemic levels over a period of months. Levels of 6% to 9% represent good metabolic control.

DIF: Cognitive Level: Comprehension REF: Page 709 OBJ: 9
TOP: Hemoglobin A1c KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

13. What condition does the nurse suspect when a child with type 1 diabetes mellitus has hyperglycemia, diaphoresis, and headaches in the morning?
a. Dawn phenomenon
b. Somogyi phenomenon
c. Honeymoon effect
d. Ketoacidosis
ANS: B
The Somogyi phenomenon (rebound hyperglycemia) occurs when the blood glucose level is lowered to the point at which the bodys counter-regulatory hormones are released, producing the symptoms described.

DIF: Cognitive Level: Analysis REF: Page 716 OBJ: 12
TOP: Somogyi Phenomenon KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Physiological Integrity

14. 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?
a. The disease is rare. It is unlikely that you would have a child with Tay-Sachs disease.
b. A screening test can be done to determine if you are a carrier of the gene.
c. The gene for Tay-Sachs disease is transmitted by the father.
d. The cause of Tay-Sachs disease is thought to be an autoimmune response to a virus.
ANS: B
Carriers can be identified by screening tests. Tay-Sachs disease has an autosomal recessive pattern of transmission.

DIF: Cognitive Level: Comprehension REF: Page 704-705
OBJ: 2 TOP: Tay-Sachs Disease
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

15. What statement by a parent leads the nurse to determine a parent is administering levothyroxine (Synthroid) correctly?
a. I stopped giving the medication because my daughter was losing her hair.
b. I am using a different brand now because it costs less money.
c. I dont give the medication on the weekends.
d. I give the medication at 8:00 AM every day.
ANS: D
Synthroid should be given at the same time each day, preferably in the morning.

DIF: Cognitive Level: Comprehension REF: Page 705 OBJ: 2
TOP: Levothyroxine (Synthroid) KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

16. After 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, what does the nurse suspect has developed?
a. Diabetes insipidus
b. Diabetes mellitus
c. Hypothyroidism
d. Hyperthyroidism
ANS: A
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.

DIF: Cognitive Level: Analysis REF: Page 705-706
OBJ: 2 TOP: Diabetes Insipidus
KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

17. The nurse is teaching the parents of a child with diabetes insipidus about water intoxication. The nurse would tell the parents to be alert for what symptom? For
a. Polyuria
b. Cough
c. Weight loss
d. Lethargy
ANS: D
Signs of water intoxication include edema, lethargy, nausea, and central nervous system signs.

DIF: Cognitive Level: Comprehension REF: Page 705-706
OBJ: 2 TOP: Diabetes Insipidus
KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

18. The parents of a child newly diagnosed with diabetes mellitus tell the nurse, Our sons body is resistant to insulin. With what does the nurse recognize this description is consistent?
a. Type 1, insulin-dependent diabetes mellitus
b. Type 2, noninsulin-dependent diabetes mellitus
c. Maturity-onset diabetes of youth
d. Drug-induced diabetes
ANS: B
Type 2, noninsulin-dependent diabetes mellitus is caused by insulin resistance or failure of the body to use the insulin.

DIF: Cognitive Level: Comprehension REF: Page 707 OBJ: 5
TOP: Insulin Resistance KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

19. What does the nurse instruct a 12-year-old to do when teaching how to administer insulin?
a. Make sure injection sites are 6 inches apart.
b. Select an injection site that was recently exercised.
c. Inject the needle at a 90-degree angle.
d. Give the injection deep into the muscle.
ANS: C
Children often find it easier to learn to inject the needle at a 90-degree angle.

DIF: Cognitive Level: Application REF: Page 713 OBJ: 10
TOP: Diabetes Mellitus KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

20. The nurse discussed treatment of hypoglycemia with an adolescent. Which statement by the adolescent leads the nurse to determine the patient understood the instructions?
a. When my blood glucose is low or if I begin to feel hungry and weak, I will eat six LifeSavers.
b. When my blood glucose is low or if I begin to feel hungry and weak, I will give myself Lispro insulin.
c. When my blood glucose is low or if I begin to feel hungry and weak, I will have a slice of cheese.
d. When my blood glucose is low or if I begin to feel hungry and weak, I will drink a diet soda.
ANS: A
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.

DIF: Cognitive Level: Application REF: Page 716 OBJ: 5
TOP: Diabetes Mellitus KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

21. Why does the nurse instruct an 11-year-old diabetic child to use the side of the finger for blood testing?
a. It has fewer capillaries.
b. It is easier to puncture.
c. It is less likely to become infected.
d. It has fewer nerve endings.
ANS: D
The sides of the finger have fewer nerve endings and more capillaries but are not easier to puncture than the fingertip. The risk for infection is remote for either site.

DIF: Cognitive Level: Comprehension REF: Page 710 OBJ: 9
TOP: Finger Stick KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

22. What is the function of an insulin pump?
a. Releases insulin as blood glucose rises
b. Provides continuous infusion of insulin
c. Decreases need for painful glucose monitoring
d. Delivers a prescribed amount of insulin twice a day
ANS: B
The insulin pump that is attached to a subcutaneous tube releases a continuous infusion of insulin.

DIF: Cognitive Level: Knowledge REF: Page 714 OBJ: 9
TOP: Insulin Pump KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

23. The nurse is preparing to administer a long-acting insulin. Which insulin is considered long acting?
a. Lispro
b. Aspart
c. Glargine
d. Regular
ANS: C
Insulin glargine is a long-acting insulin. Regular is short acting. Lispro and Aspart are rapid acting.

DIF: Cognitive Level: Knowledge REF: Page 714, Table 31-6
OBJ: 10 TOP: Insulin KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

MULTIPLE RESPONSE

24. When discussing possible causes of diabetes in children, the nurse mentions chromosomal defects. Which chromosomes are associated with diabetes? (Select all that apply.)
a. 6
b. 7
c. 12
d. 20
e. 21
ANS: A, B, C, D
Defects in chromosomes 6, 7, 12, and 20 and other genetic disorders are associated with diabetes mellitus syndrome.

DIF: Cognitive Level: Knowledge REF: Page 707 OBJ: N/A
TOP: Diabetes Mellitus KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

25. Which food sources are high in soluble fiber? (Select all that apply.)
a. Raw fruits
b. Cooked vegetables
c. Beans
d. Lean meat
e. Bran cereal
ANS: A, C, E
Foods high in soluble fiber include raw fruits, beans, and bran cereal.

DIF: Cognitive Level: Comprehension REF: Page 712 OBJ: 9
TOP: Dietary Fiber Sources KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

26. What does the nurse remind the adolescent with diabetes that soluble fiber in the diet can reduce? (Select all that apply.)
a. Blood glucose
b. Serum cholesterol
c. Incidence of infections
d. Absorption of sugar
e. Insulin requirements
ANS: A, B, D, E
Soluble fiber can reduce blood glucose, serum cholesterol, absorption of sugar, and insulin requirements. It has no effect on infections.

DIF: Cognitive Level: Comprehension REF: Page 712 OBJ: 9
TOP: Fiber in Diet KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

27. Which process(es) does the nurse explain the endocrine system is primarily responsible for controlling? (Select all that apply.)
a. Maturation
b. Reproduction
c. Stress response
d. Sexual identity
e. Growth
ANS: A, B, C, E
The endocrine system governs maturation, reproduction, stress response, and sexual maturity. Sexual identity is a psychosocial response.

DIF: Cognitive Level: Comprehension REF: Page 703 OBJ: 2
TOP: Endocrine System KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Growth and Development

28. The home health nurse is monitoring an 8-month-old child with hypothyroidism taking levothyroxine (Synthroid). Which symptoms does the nurse recognize as signs of overdose? (Select all that apply.)
a. Tachycardia
b. Irritability
c. Vomiting
d. Weight gain
e. Diaphoresis
ANS: A, B, E
All the options with the exception of weight gain and vomiting are indications of overdose of Synthroid. Weight loss is a symptom of overdose, however.

DIF: Cognitive Level: Comprehension REF: Page 706 OBJ: 3
TOP: Levothyroxine (Synthroid) Overdose
KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

29. What makes keeping diabetes in control in an adolescent difficult? (Select all that apply.)
a. Hormonal changes
b. Developmental conflicts
c. Preference for fast food
d. Growth spurts
e. Knowledge of disease
ANS: A, B, C, D
The adolescent who is in a growth spurt and filled with raging hormones resents and denies the need to be dependent on a medication. Medication schedules and diet restrictions do not correlate well with the adolescents lifestyle of eating fast foods. Denial of disease is prevalent in the adolescent.

DIF: Cognitive Level: Comprehension REF: Page 717, Table 31-7
OBJ: 8 TOP: Diabetic Adolescent
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Growth and Development

30. A child with diabetes mellitus is observed to have cold symptoms. What signs and symptoms will alert parents of the possibility of ketoacidosis? (Select all that apply.)
a. Chest congestion
b. Ear pain
c. Fruity breath
d. Hyperactivity
e. Nausea
ANS: C, E
Symptoms of ketoacidosis are compared with those of hypoglycemia. Signs and symptoms include a fruity odor to the breath, nausea, decreased level of consciousness and dehydration. Lab values include ketonuria, decreased serum bicarbonate concentration (decreased CO2 levels) and low pH, and hypertonic dehydration.

DIF: Cognitive Level: Comprehension REF: Page 709 OBJ: 6
TOP: Ketoacidosis KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

31. The nurse is discussing insulin shock with parents of a child recently diagnosed with diabetes mellitus. What will the nurse respond when the parents ask why children are more prone to insulin reactions? (Select all that apply.)
a. The condition is more unstable in children.
b. Parents are often noncompliant.
c. The activities are irregular.
d. They are still growing.
e. Sleep patterns are not established.
ANS: A, C, D
Children are more prone to insulin reactions than adults because of the following: the condition itself is more unstable in young people; they are growing; their activities are more irregular.

DIF: Cognitive Level: Comprehension REF: Page 716 OBJ: 11
TOP: Insulin Shock KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

COMPLETION

32. The nurse reminds the parents of a diabetic with an insulin pump that the tubing of the pump should be changed aseptically every ______ hours.

ANS:
48

The tubing of the insulin pump should be changed every 48 hours.

DIF: Cognitive Level: Knowledge REF: Page 714 OBJ: 9
TOP: Insulin Pump KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

33. The nurse explains that the diagnosis of diabetes is made when the fasting blood glucose level is _______ mg/dL on two separate occasions, and the history is positive for indication of the disease.

ANS:
126

An elevated blood glucose level of 126 mg/dL on two separate occasions is grounds for the diagnosis of diabetes mellitus when the history is positive for the disease.

DIF: Cognitive Level: Comprehension REF: Page 707 OBJ: 9
TOP: Diagnosis of DM KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

34. The nurse assessing a glycosylated hemoglobin (HbA1c) test is aware that this test can evaluate average glucose levels over a period of _____ to _____ months.

ANS:
3; 4

Glucose attaches to the red cells over the life span of the cell and can be read as percentages. An HbA1c reading of 6% to 9% is normal; a reading of 12% or higher is indicative of DM.

DIF: Cognitive Level: Knowledge REF: Page 709 OBJ: 9
TOP: Glycosylated Hemoglobin KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

35. Long-acting types of insulin are seldom given to children because of the danger of ___________________ during sleep.

ANS:
hypoglycemia

Long-acting types of insulin are seldom given to children because of the danger of hypoglycemia during sleep.

DIF: Cognitive Level: Comprehension REF: Page 715 OBJ: 1 | 11
TOP: Insulin administration/Hypoglycemia
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

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