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Flashcards in Chapter 29 Deck (17):

The newborn diagnosed with phenylketonuria (PKU) will require long-term follow-up to assess for the development of
a. obesity.
b. diabetes insipidus.
c. respiratory distress.
d. mental retardation.

Ans: D
PKU, an inborn error of metabolism, may lead to mental retardation if early intervention is not performed.
Obesity is not associated with PKU.
Diabetes insipidus is not associated with PKU.
Respiratory distress is not associated with PKU.


A breastfed newborn has just been diagnosed with galactosemia. The therapeutic management for this newborn is to
a. stop breastfeeding.
b. add amino acids to the breast milk.
c. substitute a lactose-containing formula for breast milk.
d. give the appropriate enzyme along with breast milk.

Ans: A
All milk- and lactose-containing formulas, including breast milk, must be stopped during infancy. Soy protein is the formula of choice for newborns and infants with galactosemia.
Breast milk should not be used in newborns and infants with galactosemia.
The formula used for a newborn and infant with galactosemia cannot contain lactose.
Breast milk should not be used in newborns and infants with galactosemia.


What statement should the nurse include when discussing a child's precocious puberty with the parents?
a. The child is not yet fertile.
b. Sexual interest is usually advanced.
c. Dress and activities should be appropriate to the chronologic age.
d. The appearance of secondary sex characteristics does not proceed in the usual order.

Ans: C
Development of the secondary sex characteristics proceeds in the usual order.
Functioning sperm or ova may be produced, making the child fertile.
Heterosexual interest is usually appropriate to the chronologic age.
Because of the child's early sexual maturation, both the family and child require extensive teaching. Included in this teaching is the information that the child should be engaged in activities according to his or her chronologic age.


The nurse is planning care for a child recently diagnosed with diabetes insipidus. Which nursing intervention should be planned?
Encourage the child to wear medical identification. Correct
Discuss with the child and family ways to limit fluid intake.
Teach the child and family how to do required urine testing.
Reassure the child and family that diabetes insipidus is usually not a chronic or life-threatening illness.

Ans: A
Because of the unstable nature of the child's fluid and electrolyte balance, wearing a medical alert bracelet or carrying a medical identification card is an extremely important intervention.
With diabetes insipidus, the child should have unrestricted access to fluids because the child will characteristically have polyuria due to a hyposecretion of antidiuretic hormone.
No urine testing is required with diabetes insipidus. This disorder should not be confused with diabetes mellitus.
Diabetes insipidus is both lifelong and life-threatening. Medication must be taken and the effects monitored closely.


What is the most important nursing consideration related to congenital hypothyroidism?
a. Early identification of the disorder
b. Facilitation of parent–infant attachment
c. Initiation of referrals for mental retardation
d. Help for parents in dealing with the child's future prospects

Ans: A
Early diagnosis of congenital hypothyroidism is imperative. Because brain growth is complete by 2 to 3 years of age, the thyroid hormone deficiency must be detected and replacement therapy begun as soon as possible to prevent long-term or life-threatening complications.
The promotion of parent–infant attachment is important with all infants.
With appropriate intervention, the child may not have any developmental deficit.
With appropriate intervention, the child may not have any developmental deficit.


A neonate with a goiter has just been admitted to the newborn nursery. A priority nursing intervention is to
a. position the neonate on the left side.
b. explain to the parents how to place the dressing on the goiter.
c. have a tracheostomy set at bedside.
d. suction at least every 5 to 10 minutes.

Ans: C
The goiter puts the infant at risk for respiratory failure. Preparations are made for emergency ventilation, including having a tracheostomy set at the bedside.
Placing the neonate in a side-lying position is not indicated. Hyperextension of the child's neck may facilitate breathing.
No dressing is indicated in a neonate who has a goiter.
There is no indication for suctioning in a neonate with goiter.


What is the most common cause of secondary hyperparathyroidism?
a. Diabetes mellitus
b. Chronic renal disease
c. Congenital heart disease
d. Growth hormone deficiency

Ans: B
Chronic renal disease is the most common cause of secondary hyperparathyroidism. The parathyroid gland plays an integral role in the maintenance of calcium in the body, as do the kidneys.
Diabetes mellitus does not contribute to secondary hypoparathyroidism.
Congenital heart disease does not contribute to secondary hypoparathyroidism.
Growth hormone deficiency does not contribute to secondary hypoparathyroidism


The nurse is caring for a child hospitalized with acute adrenocortical insufficiency. The acute phase seems to be over when ascending flaccid paralysis occurs. What is the most appropriate nursing action?
a. Reassure the family that this condition is temporary.
b. Reassure the family that flaccid paralysis is not problematic.
c. Prepare the family for impending death.
d. Prepare the family for the long-term consequences of paralysis.

Ans: A
During the recovery phase, paralysis may develop. It is a temporary, quickly reversible clinical manifestation.
Flaccid paralysis is problematic if not reversible. Flaccidity can indicate impending death in a child with neurologic deficits but is not associated with adrenocortical insufficiency.
Ascending flaccid paralysis is a reversible condition when associated with adrenocortical insufficiency.
Paralysis is a temporary, quickly reversible clinical manifestation.


Which statement best describes Cushing syndrome?
a. It is caused by excessive production of cortisol.
b. The major clinical features are exophthalmia and pigmentary changes.
c. Treatment involves replacement of cortisol.
d. Diagnosis is suspected with findings of hypotension, hyperkalemia, and polyuria.

Ans: A
Cushing syndrome is a description of the clinical manifestations caused by too much circulating cortisol.
Exophthalmia and pigmentary changes are manifestations of hyperthyroidism, not Cushing syndrome.
The treatment for Cushing syndrome involves the reduction of circulating cortisol. If the cause is a pituitary tumor, surgery is indicated.
Hypertension and hypokalemia—not hypotension, hyperkalemia, or polyuria—are expected findings with Cushing syndrome.


An infant is born with ambiguous genitalia. Tests are being done to assist in gender assignment. The parents tell the nurse that family and friends are asking what caused the baby to be this way. What should the nurse's explanation include?
a. Explain the disorder so that the parents can explain it to others.
b. Help the parents understand that no one knows how this occurs.
c. Suggest that the parents avoid family and friends until the gender is assigned.
d. Encourage the parents not to worry while the tests are being done.

Ans: A
Explaining the disorder to the parents so that they can explain it to others is the most therapeutic approach while the parents await the gender assignment of their child.
Ambiguous genitalia are caused by decreased enzyme activity required for adrenocortical production of cortisol.
Avoidance of family and friends is impractical and would isolate the family from their support system while awaiting test results.
The parents will be concerned. Telling the parents not to worry without giving them specific alternative actions will not be effective.


Which physiologic alteration is characterized by destruction of pancreatic beta cells that produce insulin?
a. Type 1 diabetes
b. Type 2 diabetes
c. Impaired glucose tolerance
d. Gestational diabetes

Ans: A
Type 1 diabetes is characterized by destruction of the insulin-producing pancreatic beta cells.
Type 2 diabetes is a result of insulin resistance.
The insulin-producing pancreatic beta cells are destroyed in type 1 diabetes and are not associated with impaired glucose tolerance.
Gestational diabetes occurs during pregnancy and is not associated with the destruction of pancreatic beta cells that produce insulin.


The mother of a child with type 1 diabetes mellitus asks why her child cannot avoid all those "shots" and take pills as an uncle does. The most appropriate response by the nurse is
a. "The pills work with an adult pancreas only."
b. "The drugs affect fat and protein metabolism, not sugar."
c. "Your child needs to have insulin replaced, and the oral hypoglycemics only add to an existing supply of insulin."
d. "Perhaps when your child is older, the pancreas will produce its own insulin, and then your child can take oral hypoglycemics."

Ans: C
In type 1 diabetes, the beta cells have been destroyed. It is necessary to supply the insulin no longer produced by the beta cells.
The oral medications have different modes of action that supplement insulin production by the pancreas, decreasing insulin resistance or affecting liver production of glucose. They are not insulin substitutes and are primarily used in type 2 diabetes mellitus.
Oral hypoglycemics can supplement insulin production by the pancreas, decrease insulin resistance, or affect the liver production of glucose.
In type 1 diabetes, the beta cells have been destroyed. Without a pancreatic beta cell transplant, it is unlikely that insulin would be produced.


A school-age child recently diagnosed with type 1 diabetes mellitus asks the nurse if playing soccer, playing baseball, and swimming are still possible. The nurse's response should be based on knowledge that
a. Exercise is contraindicated in the type 1 diabetic child
b. Soccer and baseball are too strenuous, but swimming is acceptable
c. Exercise is not restricted unless indicated by other health conditions
d. The level of activity depends on the type of insulin required

Ans: C
Exercise is encouraged for children with type 1 diabetes because it lowers blood glucose levels. Insulin and meal requirements require careful monitoring to ensure the child has sufficient energy for exercise.
Exercise is highly encouraged. The decrease in blood glucose can be accommodated by having snacks available.
Sports are encouraged, with insulin and food adjusted for the exercise. The child needs to be cautioned to monitor responses to the exercise.
The level of activity does not depend on the type of insulin used. Long-acting and short-acting insulin may both be used to provide coverage for the training and sporting events.


The nurse should recognize that when a child develops diabetic ketoacidosis (DKA), treatment will be instituted as described in which of the following statements?
a. No treatment is required, because DKA is an expected outcome of type 1 diabetes mellitus
b. Immediate treatment is required because DKA is a life-threatening situation
c. DKA is best treated at home
d. DKA is best treated at a practitioner's office or clinic

Ans: B
DKA is the complete state of insulin deficiency. It is a medical emergency that must be diagnosed and treated immediately. The child is usually admitted to an intensive care unit for assessment, intravenous insulin administration, and fluid and electrolyte replacement.
DKA is a medical emergency needing prompt assessment and intervention, usually in an intensive care environment. It is not an expected outcome of type 1 diabetes mellitus.
DKA is a medical emergency that requires hospitalization, usually in an intensive care unit.
DKA is a medical emergency that requires hospitalization, usually in an intensive care unit.


During the summer, many children are more physically active. What changes in the management of the child with type 1 diabetes mellitus should be expected as a result of more exercise?
a. Increased food intake
b. Decreased food intake
c. Increased risk of hyperglycemia
d. Decreased risk of insulin shock

Ans: A
Food intake should be increased in the summer when the child is more active. During races and other competitions, more food may be required than at other practice times to maintain a balance between glucose and exogenously administered insulin.
The child will require increased food on days of increased activity.
The increased activity lowers blood glucose levels.
Blood sugars must be monitored closely to avoid administering too much insulin during a time of reduced need.


A 17-year-old with type 1 diabetes mellitus tells the school nurse about recently starting to drink alcohol with friends on weekends. The most appropriate intervention by the nurse is to
a. tell the adolescent not to drink alcohol.
b. ask the adolescent about the reasons for drinking alcohol.
c. teach the adolescent about the effects of alcohol on type 1 diabetes mellitus and how to prevent problems associated with alcohol intake.
d. recommend counseling so that the adolescent understands the serious consequences of alcohol consumption.

Ans: C
The nurse is taking a proactive approach. The adolescent is provided with information to facilitate the management of the illness.
Telling someone not to drink will not help should the person choose to continue drinking.
Asking the adolescent why the drinking is occurring will provide information to the nurse but will not address the information that the adolescent needs to have about managing the disease.
Counseling can be included in the teaching plan.


The nurse is teaching an adolescent, newly diagnosed with type I diabetes, ways to minimize discomfort with insulin injections. Which interventions are helpful in minimizing injection discomfort? (Select all that apply.)
a. Do not reuse needles
b. Inject insulin when it is cold
c. Flex or tense the muscle during injection
d. Remove all bubbles from the syringe prior to injection
e. Do not move the direction of the needle-syringe during insertion or withdrawal

Ans: A, D, E