Ricci 48 (B)

Question 1

New parents ask the nurse, Why is it necessary for our baby to have the newborn blood test?
The nurse explains that the priority outcome of mandatory newborn screening for inborn errors
of metabolism is

a. Appropriate community referral for affected infants
b. Parental education about raising a special needs child
c.
Early identification of serious genetically transmitted metabolic diseases
d. Early identification of electrolyte imbalances

Answer 1

ANS: C

Feedback
A Community referral is appropriate after a diagnosis is made.

B With early identification and treatment, serious complications such as
intellectual impairment are prevented.

C Early identification of hypothyroidism is basic to the prevention of intellectual
impairment in the child.

D Although electrolyte imbalances could occur with some of the inborn errors of
metabolism, this is not the priority outcome, nor would the newborn screen
detect electrolyte imbalances

Question 2

What is the priority nursing goal for a 14-year-old with Graves disease?

a. Relieving constipation

b. Allowing the adolescent to make decisions about whether or not to take
medication

c. Verbalizing the importance of adherence to the medication regimen

d. Developing alternative educational goals

Answer 2

ANS: C
Feedback
A The adolescent with Graves disease is not constipated.

B Adherence to the medication schedule is important to ensure optimal health and
wellness. Medications should not be skipped and dose regimens should not be
tapered by the child without consultation with the childs medical provider.

C To adhere to the medication schedule, children need to understand that the
medication must be taken two or three times per day.

D The management of Graves disease does not interfere with school attendance
and does not require alternative educational plans.

Question 3

What information provided by the nurse would be helpful to a 15-year-old adolescent taking
methimazole three times a day?
a. Pill dispensers and alarms on her watch can remind her to take the medication as
ordered.
b. She can take the medication when she is nervous and feels she needs it.
c. She can take two pills before school and one pill at dinner, which will be easier
for her to remember.
d. Her mother can be responsible for reminding her when it is time to take her
medication

Answer 3

ANS: A
Feedback
A Methimazole is an antithyroid medication that should be taken three times a
day. Reminders will facilitate taking medication as ordered.

B This medication needs to be taken regularly, not on an as-needed basis.

C The dosage cannot be combined to reduce the frequency of administration.

D Because of the adolescents school schedule and activ

Question 4

Diabetes insipidus is a disorder of the
a. Anterior pituitary
b. Posterior pituitary
c. Adrenal cortex
d. Adrenal medulla

Answer 4

ANS: B

Question 5

Which sign, when exhibited by a hospitalized child, should the nurse recognize as a
characteristic of diabetes insipidus?
a.
Weight gain
b.
Increased urine specific gravity
c.
Increased urination
d.
Serum sodium level of 130 mEq/L

Answer 5

ANS: C
Feedback
A Weight gain results from retention of water when there is an excessive
production of antidiuretic hormone; in diabetes insipidus there is a decreased
production of antidiuretic hormone.

B Concentrated urine is a sign of the syndrome of inappropriate antidiuretic
hormone (SIADH), in which there is an excessive production of antidiuretic
hormone.

C The deficiency of antidiuretic hormone associated with diabetes insipidus
causes the body to excrete large volumes of dilute urine.

D A deficiency of antidiuretic hormone, as with diabetes insipidus, results in an
increased serum sodium concentration (greater than 145 mEq/L).

Question 6

What should the nurse include in the teaching plan for parents of a child with diabetes
www.mynursingtestprep.com
insipidus who is receiving DDAVP?
a.
Increase the dosage of DDAVP as the urine specific gravity (SG) increases.
b.
Give DDAVP only if urine output decreases.
c.
The child should have free access to water and toilet facilities at school.
d.
Cleanse skin before administering the transdermal patch.

Answer 6

ANS: C
Feedback
A DDAVP needs to be given as ordered by the physician. If the parents are
monitoring urine SG at home, they would not increase the medication dose for
increased SG; the physician may order an increased dosage for very dilute urine
with decreased SG.

B DDAVP needs to be given continuously as ordered by the physician.

C The childs teachers should be aware of the diagnosis, and the child should have
free access to water and toilet facilities at school.

D DDAVP is typically given intranasally or by subcutaneous injection. For
nocturnal enuresis, it may be given orally.

Question 7

A child with GH deficiency is receiving GH therapy. What is the best time for the GH to be
administered?
a.
At bedtime
b.
After meals
c.
Before meals
d.
On arising in the morning

Answer 7

ANS: A
Feedback
A Injections are best given at bedtime to more closely approximate the
physiologic release of GH.

B This time does not mimic the physiologic release of the hormone.

C This time does not mimic the physiologic release of the hormone.

D This time does not mimic the physiologic release of the hormone.

Question 8

A nurse is explaining growth hormone deficiency to parents of a child admitted to rule out this
problem. Which metabolic alteration that is related to growth hormone deficiency should the
nurse explain to the parent?
a.
Hypocalcemia
b.
Hypoglycemia
c.
Diabetes insipidus.
d.
Hyperglycemia

Answer 8

ANS: B
Feedback
A Symptoms of hypocalcemia are associated with hypoparathyroidism.

B Growth hormone helps maintain blood sugar at normal levels.

C Diabetes insipidus is a disorder of the posterior pituitary. Growth hormone is
produced by the anterior pituitary.

D Hyperglycemia results from an insufficiency of insulin, which is produced by
the beta cells in the islets of Langerhans in the pancreas

Question 9

At what age is sexual development in boys and girls considered to be precocious?
a.
Boys, 11 years; girls, 9 years
b.
Boys, 12 years; girls, 10 years
c.
Boys, 9 years; girls, 8 years
d.
Boys, 10 years; girls, 9 1/2 years

Answer 9

ANS: C
Feedback
A These ages fall within the expected range of pubertal onset.

B These ages fall within the expected range of pubertal onset.

C Manifestations of sexual development before age 9 in boys and age 8 in girls is
considered precocious and should be investigated.

D These ages fall within the expected range of pubertal onset.

Question 10

What is the most appropriate intervention for the parents of a 6-year-old child with
precocious puberty?
a.
Advise the parents to consider birth control for their daughter.
b.
Explain the importance of having the child foster relationships with same-age
peers.
c.
Assure the childs parents that there is no increased risk for sexual abuse because
of her appearance.
d.
Counsel parents that there is no treatment currently available for this disorder.

Answer 10

ANS: B
Feedback
A Advising the parents of a 6-year-old to put their daughter on birth control is not
appropriate and will not reverse the effects of precocious puberty.

B Despite the childs appearance, the child needs to be treated according to her
chronologic age and to interact with children in the same age-group. An expected outcome is that the child will adjust socially by exhibiting ageappropriate behaviors and social interactions.

C Parents need to be aware that there is an increased risk of sexual abuse for a
child with precocious puberty.

D Treatment for precocious puberty is the administration of gonadotropinreleasing hormone blocker, which slows or reverses the development of
secondary sexual characteristics and slows rapid growth and bone aging.

Question 11

A neonate is displaying mottled skin, has a large fontanel and tongue, is lethargic, and is
having difficulty feeding. The nurse recognizes that this is most suggestive of
a.
Hypocalcemia
b.
Hypothyroidism
c.
Hypoglycemia
d.
Phenylketonuria (PKU)

Answer 11

ANS: B
Feedback
A When hypocalcemia is present, neonates may display twitching, tremors,
irritability, jitteriness, electrocardiographic changes, and, rarely, seizures.

B An infant with hypothyroidism may exhibit skin mottling, a large fontanel, a
large tongue, hypotonia, slow reflexes, a distended abdomen, prolonged
jaundice, lethargy, constipation, feeding problems, and coldness to touch.

C Hypoglycemia causes the neonate to exhibit jitteriness, poor feeding, lethargy,
seizures, respiratory alterations including apnea, hypotonia, high-pitched cry,
bradycardia, cyanosis, and temperature instability.

D Infants with PKU may initially have digestive problems with vomiting, and
they may have a musty or mousy odor to the urine, infantile eczema,
hypertonia, and hyperactive behavior.

Question 12

A common clinical manifestation of juvenile hypothyroidism is
a.
Insomnia
b.
Diarrhea
c.
Dry skin
d.
Accelerated growth

Answer 12

ANS: C
Feedback
A Children with hypothyroidism are usually sleepy.

B Constipation is associated with hypothyroidism.

C Thick, dry skin, mental decline, cold intolerance, and weight gain are associated
with juvenile hypothyroidism.

D Decelerated growth is common in juvenile hypothyroidism.

Question 13

A goiter is an enlargement or hypertrophy of which gland?
a.
Thyroid
b.
Adrenal
c.
Anterior pituitary
d.
Posterior pituitary

Answer 13

ANS: A
Feedback
A A goiter is an enlargement or hypertrophy of the thyroid gland.

B Goiter is not associated with this secretory organ.

C Goiter is not associated with this secretory organ.

D Goiter is not associated with this secretory organ.

Question 14

Exophthalmos (protruding eyeballs) may occur in children with which condition?
a.
Hypothyroidism
b.
Hyperthyroidism
c.
Hypoparathyroidism
d.
Hyperparathyroidism

Answer 14

ANS: B
Feedback
A Hypothyroidism is not associated with exophthalmos.

B Exophthalmos is a clinical manifestation of hyperthyroidism.

C Hypoparathyroidism is not associated with exophthalmos.

D Hyperparathyroidism is not associated with exophthalmos

Question 15

A neonate born with ambiguous genitalia is diagnosed with congenital adrenogenital
hyperplasia. Therapeutic management includes administration of
a.
Vitamin D
b.
Cortisone
c.
Stool softeners
d.
Calcium carbonate

Answer 15

ANS: B
Feedback
A Vitamin D has no role in the therapy of adrenogenital hyperplasia.

B The most common biochemical defect with congenital adrenal hyperplasia is
partial or complete 21-hydroxylase deficiency. With complete deficiency,
insufficient amounts of aldosterone and cortisol are produced so that circulatory
collapse occurs without immediate replacement.

C Stool softeners have no role in the therapy of adrenogenital hyperplasia.

D Calcium carbonate has no role in the therapy of adrenogenital hyperplasia.

Question 16

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.
Blurred vision

Answer 16

ANS: D
Feedback
A Dry skin, weight loss, and dehydration are clinical manifestations of type 1
diabetes mellitus.

B Dry skin, weight loss, and dehydration are clinical manifestations of type 1
diabetes mellitus.

Dry skin, weight loss, and dehydration are clinical manifestations of type 1
diabetes mellitus.

D Fatigue and blurred vision are clinical manifestations of type 1 diabetes
mellitus.

Question 17

17. 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 the knowledge 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.

Answer 17

ANS: C
Feedback
A Blood glucose monitoring is more expensive but provides improved
management.

B It is as accurate as equivalent testing done in laboratories.
C 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.

D 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.

Question 18

What is the best time for the nurse to assess the peak effectiveness of subcutaneously
administered Regular insulin?
a.
Two hours after administration
b.
Four hours after administration
c.
Immediately after administration
d.
Thirty minutes after administration

Answer 18

ANS: A
Feedback
A The peak action for Regular (short-acting) insulin is 2 to 3 hours after subcutaneous administration.

B The duration of Regular (short-acting) insulin is only 3 to 6 hours. Peak action
occurs 2 to 3 hours after the insulin is administered.

C Subcutaneously administered Regular (short-acting) insulin has an onset of
action of 30 to 60 minutes after injection. The effectiveness of subcutaneously
administered, short-acting insulin cannot be assessed immediately after
administration.

D Thirty minutes corresponds to the onset of action for Regular (short-acting)
insulin.

Question 19

What is the best nursing action when a child with type 1 diabetes mellitus is sweating,
trembling, and pale?

a.
Offer the child a glass of water.
b.
Give the child 5 units of regular insulin subcutaneously.
c.
Give the child a glass of orange juice.
d.
Give the child glucagon subcutaneously

Answer 19

ANS: C
Feedback
A A glass of water is not indicated in this situation. An easily digested
carbohydrate is indicated when a child exhibits symptoms of hypoglycemia.

B Insulin would lower blood glucose and is contraindicated for a child with hypoglycemia.

C Four ounces of orange juice is an appropriate treatment for the conscious child
who is exhibiting signs of hypoglycemia.

D Subcutaneous injection of glucagon is used to treat hypoglycemia when the child is unconscious.

Question 19

What is the primary concern for a 7-year-old child with type 1 diabetes mellitus who asks his
mother not to tell anyone at school that he has diabetes?
a.
The childs safety
b.
The privacy of the child
c.
Development of a sense of industry
d.
Peer group acceptance

Answer 19

ANS: A
Feedback
A Safety is the primary issue. School personnel need to be aware of the signs and
symptoms of hypoglycemia and hyperglycemia and the appropriate
interventions.

B Privacy is not a life-threatening concern.

C The treatment of type 1 diabetes should not interfere with the school-age childs
development of a sense of industry.

D Peer group acceptance, along with body image, are issues for the early
adolescent with type 1 diabetes. This is not of greater priority than the childs
safety.

Question 20

Which sign is the nurse most likely to assess in a child with hypoglycemia?
a.
Urine positive for ketones and serum glucose greater than 300 mg/dL
b.
Normal sensorium and serum glucose greater than 160 mg/dL
c.
Irritability and serum glucose less than 60 mg/dL
d.
Increased urination and serum glucose less than 120 mg/dL

Answer 20

ANS: C
Feedback
A Serum glucose greater than 300 mg/dL and urine positive for ketones are
indicative of diabetic ketoacidosis.

B Normal sensorium and serum glucose greater than 160 mg/dL are associated
with hyperglycemia.

C Irritability and serum glucose less than 60 mg/dL are neuroglycopenic
manifestations of hypoglycemia.

D Increased urination is an indicator of hyperglycemia. A serum glucose level less
than 120 mg/dL is within normal limits

Question 21

When would a child diagnosed with type 1 diabetes mellitus most likely demonstrate a
decreased need for insulin?
a.
During the honeymoon phase
b.
During adolescence
c.
During growth spurts
d.
During minor illnesses

Answer 21

ANS: A

Feedback
A During the honeymoon phase, which may last from a few weeks to a year or
longer, the child is likely to need less insulin.

B During adolescence, physical growth and hormonal changes contribute to an
increase in insulin requirements.

C Insulin requirements are typically increased during growth spurts.

D Stress either from illness or from events in the environment can cause hyperglycemia. Insulin requirements are increased during periods of minor
illness.

Question 22

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.
c.
Give the child plenty of unsweetened, clear liquids to prevent dehydration.
d.
Take the child directly to the emergency department.

Answer 22

ANS: B

Feedback
A The child should receive his regular dose of insulin even if he does not have an
appetite.

B A sick-day diet of simple carbohydrates or calorie-containing liquids will
maintain normal serum glucose levels and decrease the risk of hypoglycemia.

C If the child is not eating as usual, he needs calories to prevent hypoglycemia.

D During periods of minor illness, the child with type 1 diabetes mellitus can be
managed safely at home.

Question 23

Which is the nurses best response to the parents of a 10-year-old child newly diagnosed with
type 1 diabetes mellitus who are concerned about the childs continued participation in soccer?
a.
Consider the swim team as an alternative to soccer.
b.
Encourage intellectual activity rather than participation in sports.
c.
It is okay to play sports such as soccer unless the weather is too hot.
d.
Give the child an extra 15 to 30 g of carbohydrate snack before soccer practice.

Answer 23

ANS: D
Feedback
A Soccer is an appropriate sport for a child with type 1 diabetes as long as the
child prevents hypoglycemia by eating a snack.

B Participation in sports is not contraindicated for a child with type 1 diabetes.

C The child with type 1 diabetes may participate in sports activities regardless of
climate.

D Exercise lowers blood glucose levels. A snack with 15 to 30 g of carbohydrates
before exercise will decrease the risk of hypoglycemia.

Question 24

Which comment by a 12-year-old child with type 1 diabetes indicates deficient knowledge?
a.
I rotate my insulin injection sites every time I give myself an injection.
b.
I keep records of my glucose levels and insulin sites and amounts.
c.
Ill be glad when I can take a pill for my diabetes like my uncle does.
d.
I keep Lifesavers in my school bag in case I have a low-sugar reaction.

Answer 24

ANS: C
Feedback
A Rotating injection sites is appropriate because insulin absorption varies at
different sites.

B Keeping records of serum glucose and insulin sites and amounts is appropriate.

C Children with type 1 diabetes will require life-long insulin therapy.

D Prompt treatment of hypoglycemia reduces the possibility of a severe reaction.
Keeping hard candy on hand is an appropriate action.