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Maternal child Ch. 47 (DM Focused)
Terms in this set (18)
Manifestations of hypoglycemia include:
c. Nausea and vomiting.
d. Shaky feeling and dizziness.
Test Bank - Maternal Child Nursing Care by Perry (6th Edition, 2017) 802
Some of the clinical manifestations of hypoglycemia include shaky feelings; dizziness; difficulty
concentrating, speaking, focusing, and coordinating; sweating; and pallor. Lethargy, thirst, and nausea and
vomiting are manifestations of hyperglycemia
Which symptom is considered a cardinal sign of diabetes mellitus?
c. Impaired vision
d. Frequent urination
Hallmarks of diabetes mellitus are glycosuria, polyuria, and polydipsia. Nausea and seizures are not clinical
manifestations of diabetes mellitus. Impaired vision is a long-term complication of the disease.
Diabetes insipidus is a disorder of the:
a. Anterior pituitary.
b. Posterior pituitary.
c. Adrenal cortex.
d. Adrenal medulla.
The principal disorder of posterior pituitary hypofunction is diabetes insipidus. The anterior pituitary produces
hormones such as growth hormone, thyroid-stimulating hormone, adrenocorticotropic hormone, gonadotropin, prolactin, and melanocyte-stimulating hormone. The adrenal cortex produces aldosterone, sex hormones, and
glucocorticoids. The adrenal medulla produces catecholamines.
The nurse is caring for a child with suspected diabetes insipidus. Which clinical manifestation would she or
he expect to observe?
c. Nausea and vomiting
d. Polyuria and polydipsia
Excessive urination accompanied by insatiable thirst is the primary clinical manifestation of diabetes. These
symptoms may be so severe that the child does little other than drink and urinate. Oliguria is decreased urine
production and is not associated with diabetes insipidus. Glycosuria is associated with diabetes mellitus. Nausea and vomiting are associated with inappropriate antidiuretic hormone secretion.
What is characteristic of the immune-mediated type 1 diabetes mellitus?
a. Ketoacidosis is infrequent.
b. Onset is gradual.
c. Age at onset is usually younger than 18 years.
d. Oral agents are often effective for treatment
The immune-mediated type 1 diabetes mellitus typically has its onset in children or young adults. Peak
incidence is between the ages of 10 and 15 years. Infrequent ketoacidosis, gradual onset, and treatment with
oral agents are more consistent with type 2 diabetes.
A parent asks the nurse why self-monitoring of blood glucose is being recommended for her child with
diabetes. The nurse should base the explanation on knowing that:
a. It is a less expensive method of testing.
b. It is not as accurate as laboratory testing.
c. Children are better able to manage the diabetes.
d. The parents are better able to manage the disease.
Blood glucose self-management has improved diabetes management and can be used successfully by children
from the time of diagnosis. Insulin dosages can be adjusted based on blood sugar results. Blood glucose
monitoring is more expensive but provides improved management. It is as accurate as equivalent testing done
Test Bank - Maternal Child Nursing Care by Perry (6th Edition, 2017) 801
in laboratories. The ability to self-test allows the child to balance diet, exercise, and insulin. The parents are
partners in the process, but the child should be taught how to manage the disease
Type 1 diabetes mellitus is suspected in an adolescent. Which clinical manifestation may be present?
a. Moist skin
b. Weight gain
c. Fluid overload
d. Poor wound healing
Poor wound healing is often an early sign of type 1 diabetes mellitus. Dry skin, weight loss, and dehydration
are clinical manifestations of type 1 diabetes mellitus.
. The parents of a child who has just been diagnosed with type 1 diabetes ask about exercise. The nurse
should explain that:
a. Exercise will increase blood glucose.
b. Exercise should be restricted.
c. Extra snacks are needed before exercise.
d. Extra insulin is required during exercise.
Exercise lowers blood glucose levels, which can be compensated for by extra snacks. Exercise is encouraged
and not restricted unless indicated by other health conditions. Extra insulin is contraindicated because exercise
decreases blood glucose levels.
A child eats some sugar cubes after experiencing symptoms of hypoglycemia. This rapid-releasing sugar
should be followed by:
a. Saturated and unsaturated fat.
b. Fruit juice.
c. Several glasses of water.
d. Complex carbohydrate and protein.
Symptoms of hypoglycemia are treated with a rapid-releasing sugar source followed by a complex
carbohydrate and protein. Saturated and unsaturated fat, fruit juice, and several glasses of water do not provide
the child with complex carbohydrate and protein necessary to stabilize the blood sugar.
The nurse is caring for an 11-year-old boy who has recently been diagnosed with diabetes. What should be
included in the teaching plan for daily injections?
a. The parents do not need to learn the procedure.
b. He is old enough to give most of his own injections.
c. Self-injections will be possible when he is closer to adolescence.
d. He can learn about self-injections when he is able to reach all injection sites
School-age children are able to give their own injections. Parents should participate in learning and giving the
insulin injections. He is already old enough to administer his own insulin. The child is able to use thighs, abdomen, part of the hip, and arm. Assistance can be obtained if other sites are used
What should a nurse advise the parents of a child with type 1 diabetes mellitus who is not eating as a result
of a minor illness?
a. Give the child half his regular morning dose of insulin.
b. Substitute simple carbohydrates or calorie-containing liquids for solid foods.
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c. Give the child plenty of unsweetened, clear liquids to prevent dehydration.
d. Take the child directly to the emergency department.
A sick-day diet of simple carbohydrates or calorie-containing liquids will maintain normal serum glucose
levels and decrease the risk of hypoglycemia. The child should receive his regular dose of insulin even if he
does not have an appetite. If the child is not eating as usual, he needs calories to prevent hypoglycemia. During
periods of minor illness, the child with type 1 diabetes mellitus can be managed safely at home
The nurse is discussing various sites used for insulin injections with a child and her family. Which site
usually has the fastest rate of absorption?
The abdomen has the fastest rate of absorption but the shortest duration. The arm has a fast rate of absorption
but short duration. The leg has a slow rate of absorption but a long duration. The buttock has the slowest rate of
absorption and the longest duration.
Which laboratory finding confirms that a child with type 1 diabetes is experiencing diabetic ketoacidosis?
a. No urinary ketones
b. Low arterial pH
c. Elevated serum carbon dioxide
d. Elevated serum phosphorus
Severe insulin deficiency produces metabolic acidosis, which is indicated by a low arterial pH. Urinary
ketones, often in large amounts, are present when a child is in diabetic ketoacidosis. Serum carbon dioxide is
decreased in diabetic ketoacidosis. Serum phosphorus is decreased in diabetic ketoacidosis.
The parent of a child with diabetes mellitus asks the nurse when urine testing will be necessary. The nurse
should explain that urine testing is necessary for which?
a. Glucose is needed before administration of insulin.
b. Glucose is needed four times a day.
c. Glycosylated hemoglobin is required.
d. Ketonuria is suspected.
Urine testing is still performed to detect evidence of ketonuria. Urine testing for glucose is no longer indicated
because of the poor correlation between blood glucose levels and glycosuria. Glycosylated hemoglobin
analysis is performed on a blood sample.
To help the adolescent deal with diabetes, the nurse must consider which characteristic of adolescence?
a. Desire to be unique
b. Preoccupation with the future
c. Need to be perfect and similar to peers
d. Need to make peers aware of the seriousness of hypoglycemic reactions
Adolescence is a time when the individual wants to be perfect and similar to peers. Having diabetes makes
adolescents different from their peers. Adolescents do not wish to be unique; they desire to fit in with the peer
group and are usually not future oriented. Forcing peer awareness of the seriousness of hypoglycemic reactions
would further alienate the adolescent with diabetes. The peer group would focus on the differences
The nurse is implementing care for a school-age child admitted to the pediatric intensive care in diabetic
ketoacidosis (DKA). Which prescribed intervention should the nurse implement first?
a. Begin 0.9% saline solution intravenously as prescribed.
b. Administer regular insulin intravenously as prescribed.
c. Place child on a cardiac monitor.
d. Place child on a pulse oximetry monitor.
All patients with DKA experience dehydration (10% of total body weight in severe ketoacidosis) because of
the osmotic diuresis, accompanied by depletion of electrolytes (sodium, potassium, chloride, phosphate, and
magnesium). The initial hydrating solution is 0.9% saline solution. Insulin therapy should be started after the
initial rehydration bolus because serum glucose levels fall rapidly after volume expansion. The child should be
placed on the cardiac and pulse oximetry monitors after the rehydrating solution has been initiated.
A nurse is planning care for a school-age child with type 1 diabetes. Which insulin preparations are rapid
and short acting (Select all that apply)?
a. Novolin N
d. Novolin R
ANS: C, D
Rapid-acting insulin (e.g., NovoLog) reaches the blood within 15 minutes after injection. The insulin peaks 30
to 90 minutes later and may last as long as 5 hours. Short-acting (regular) insulin (e.g., Novolin R) usually
reaches the blood within 30 minutes after injection. The insulin peaks 2 to 4 hours later and stays in the blood
for about 4 to 8 hours. Intermediate-acting insulins (e.g., Novolin N) reach the blood 2 to 6 hours after
Test Bank - Maternal Child Nursing Care by Perry (6th Edition, 2017) 809
injection. The insulins peak 4 to 14 hours later and stay in the blood for about 14 to 20 hours. Long-acting
insulin (e.g., Lantus) takes 6 to 14 hours to start working. It has no peak or a very small peak 10 to 16 hours
after injection. The insulin stays in the blood between 20 and 24 hours.
The clinic nurse is reviewing hemoglobin A1c
levels on several children with type 1 diabetes. Hemoglobin
levels of less than _____ % are a goal for children with type 1 diabetes. Record your answer as a whole
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