Silvestri, 3/e, ISBN 1-1460-0052-6 Chapter 033 (edited file) !

eta"#li$, %&d#$ri&e, a&d 'astr#i&testi&al (is#rders 10/14/0), *a+e 1 #f 11, 5 ,i+-re(s), 1 .a"le(s), 12 B#/(es)

33: Metabolic, Endocrine, and Gastrointestinal Disorders

PRACTICE QUESTIONS
1. A nurse is caring for an 18-month-old child who has been vomiting. The appropriate position in which to place the child during naps and sleep time is: 1. Side-lying position 2. rone with the face turned to the side !. Supine ". rone with the head elevated Answer: 1 #ationale: The vomiting child should be placed in an upright or side-lying position to prevent aspiration. $ptions 2% !% and " will place the child at ris& for aspiration if vomiting occurs. Test-Ta&ing Strategy: 'se the process of elimination. (liminate options 2 and " first because they are similar. Additionally% these positions would place the child at ris& for aspiration if vomiting occurred. )isuali*e the remaining two positions. $ption ! is also inappropriate and would cause aspiration. #eview appropriate positioning for the child who has been vomiting if you had difficulty with this +uestion. ,evel of -ognitive Ability: Application -lient .eeds: hysiological /ntegrity /ntegrated rocess: .ursing rocess0/mplementation -ontent Area: -hild 1ealth #eference: rice% 2.% 3 4win% 5. 627789. Thompsons pediatric nursing 6:th ed.9. hiladelphia: ;.<. Saunders% pp. 18=-18>. 2. A nurse is monitoring for signs of dehydration in a 1-year-old child who has been hospitali*ed for diarrhea and prepares to ta&e the child?s temperature. ;hich method of temperature measurement would be avoided@ 1. Tympanic 2. AAillary !. #ectal ". (lectronic Answer: ! #ationale: #ectal temperature measurements should be avoided if diarrhea is present. 'se of a rectal thermometer can stimulate peristalsis and cause more diarrhea. AAillary and tympanic measurements of temperature would be acceptable. Bost measurements are done via electronic devices. Test-Ta&ing Strategy: 'se the process of elimination and note the &ey word% avoided. (liminate option " first because most methods of temperature measurement are done using an electronic device. .eAt% note the diagnosis stated in the +uestion. This should direct you to option !. #eview interventions for the child with diarrhea if you had difficulty with this +uestion. ,evel of -ognitive Ability: Application -lient .eeds: hysiological /ntegrity /ntegrated rocess: .ursing rocess0/mplementation -ontent Area: -hild 1ealth

Silvestri, 3/e, ISBN 1-1460-0052-6 Chapter 033 (edited file) !eta"#li$, %&d#$ri&e, a&d 'astr#i&testi&al (is#rders 10/14/0), *a+e 2 #f 11, 5 ,i+-re(s), 1 .a"le(s), 12 B#/(es)

#eference: BcCinney% (.% 5ames% S.% Burray% S.% 3 Ashwill% 5. 627789. Maternal-child nursing 62nd ed.9. St. ,ouis: (lsevier% p. 17:!. !. An infant returns to the nursing unit following a surgical repair of a cleft lip located on the right side of the lip. The best position to place this infant at this time is: 1. $n the right side 2. $n the left side !. rone ". Supine Answer: 2 #ationale: Dollowing cleft lip repair% the infant should be positioned on the side lateral to the repair to prevent contact of the suture lines with the bed linens. /t is best to place the infant on the left side rather than supine immediately after surgery to prevent the ris& of aspiration if the infant vomits. Test-Ta&ing Strategy: 'se the process of elimination. -onsider the anatomical location of the surgical site and the &ey words% right side. Eou should easily be directed to the correct option using these concepts. #eview postoperative positioning techni+ues if you had difficulty with this +uestion. ,evel of -ognitive Ability: Application -lient .eeds: hysiological /ntegrity /ntegrated rocess: .ursing rocess0/mplementation -ontent Area: -hild 1ealth #eference: ,eifer% 4. 6277!9. Introduction to maternity and pediatric nursing 6"th ed.9. hiladelphia: ;.<. Saunders% p. =88. ". A nurse reviews the record of an infant seen in the clinic. The nurse notes that a diagnosis of esophageal atresia with tracheoesophageal fistula 6T(D9 is suspected. The nurse eApects to note which most li&ely clinical manifestation of this condition documented in the record@ 1. Severe proFectile vomiting 2. -oughing at nighttime !. -ho&ing with feedings ". /ncessant crying Answer: ! #ationale: Any child who eAhibits the G! -s%H coughing and cho&ing during feedings% and uneAplained cyanosis% should be suspected of T(D. $ptions 1% 2% and " are not specifically associated with T(D. Test-Ta&ing Strategy: 'se the process of elimination focusing on the diagnosis. #ecalling the G! -sH associated with this disorder will assist in directing you to the correct option. #eview the clinical manifestations associated with this disorder if you had difficulty with this +uestion ,evel of -ognitive Ability: -omprehension -lient .eeds: hysiological /ntegrity /ntegrated rocess: .ursing rocess02ata -ollection -ontent Area: -hild 1ealth #eference: ,eifer% 4. 6277!9. Introduction to maternity and pediatric nursing 6"th ed.9. hiladelphia: ;.<. Saunders% p. =88.

Silvestri, 3/e, ISBN 1-1460-0052-6 Chapter 033 (edited file) !eta"#li$, %&d#$ri&e, a&d 'astr#i&testi&al (is#rders 10/14/0), *a+e 3 #f 11, 5 ,i+-re(s), 1 .a"le(s), 12 B#/(es)

8. A nurse is reviewing the record of a child with a diagnosis of pyloric stenosis. ;hich data would the nurse eApect to note documented in the child?s record@ 1. )omiting large amounts of bile 2. ;atery diarrhea !. /ncreased urine output ". roFectile vomiting Answer: " #ationale: -linical manifestations of pyloric stenosis include proFectile% nonbilious vomiting% irritability% hunger and crying% constipation% and signs of dehydration including a decrease in urine output. Test-Ta&ing Strategy: 'se the process of elimination. -onsidering the anatomical location of this disorder and its potential effects will assist in eliminating options 2 and !. #ecalling that a maFor clinical manifestation is proFectile% nonbilious vomiting will assist in directing you to option ". #eview these clinical manifestations if you had difficulty with this +uestion. ,evel of -ognitive Ability: -omprehension -lient .eeds: hysiological /ntegrity /ntegrated rocess: .ursing rocess02ata -ollection -ontent Area: -hild 1ealth #eference: rice% 2.% 3 4win% 5. 627789. Thompsons pediatric nursing 6:th ed.9. hiladelphia: ;.<. Saunders% pp. 182-18!. =. A nurse reinforces instructions to the mother about dietary measures for a 8-year-old child with lactose intolerance. The nurse tells the mother that which of the following supplements will be re+uired due to the necessity of lactose avoidance in the diet@ 1. Iinc 2. rotein !. -alcium ". Dats Answer: ! #ationale: ,actose intolerance is the inability to tolerate lactose% the sugar found in dairy products. #emoving mil& from the diet can provide relief from symptoms. Additional dietary changes may be re+uired to provide ade+uate sources of calcium and% if the child is an infant% protein and calories. Test-Ta&ing Strategy: Cnowledge that lactose is the sugar found in dairy products will easily direct you to option !% because dairy products contain high sources of calcium. #eview the dietary management for lactose intolerance if you had difficulty with this +uestion. ,evel of -ognitive Ability: Application -lient .eeds: 1ealth romotion and Baintenance /ntegrated rocess: .ursing rocess0/mplementation -ontent Area: -hild 1ealth #eference: ;ong% 2.% 3 1oc&enberry% B. 6277!9. Nursing care of infants and children 6>th ed.9. St. ,ouis: Bosby% p. 8>1. >. A nurse reinforces home care instructions to the parents of a child with celiac disease. ;hich of the following food items would the nurse advise the parents to include in the child?s diet@ 1. #ice

Silvestri, 3/e, ISBN 1-1460-0052-6 Chapter 033 (edited file) !eta"#li$, %&d#$ri&e, a&d 'astr#i&testi&al (is#rders 10/14/0), *a+e 4 #f 11, 5 ,i+-re(s), 1 .a"le(s), 12 B#/(es)

2. #ye toast !. $atmeal ". ;heat bread Answer: 1 #ationale: 2ietary management is the main stay of treatment in celiac disease. All wheat% rye% barley% and oats should be eliminated from the diet and replaced with corn and rice. )itamin supplements% especially fat-soluble vitamins and folate% may be needed in the early period of treatment to correct deficiencies. These restrictions are li&ely to be lifelong% although small amounts of grains may be tolerated after the ulcerations have healed. Test-Ta&ing Strategy: 'se the process of elimination and &nowledge regarding the dietary management in celiac disease to answer this +uestion. #ecalling that corn and rice are substitute food replacements in this disease will direct you to option 1. #eview the dietary management of this disorder if you had difficulty with this +uestion. ,evel of -ognitive Ability: Application -lient .eeds: 1ealth romotion and Baintenance /ntegrated rocess: Teaching0,earning -ontent Area: -hild 1ealth #eference: rice% 2.% 3 4win% 5. 627789. Thompsons pediatric nursing 6:th ed.9. hiladelphia: ;.<. Saunders% p. 2!8. 8. A nurse is caring for a child who is scheduled for an appendectomy. ;hen the nurse reviews the physician?s preoperative orders% which of the following would be +uestioned@ 1. Baintain /) fluids as prescribed. 2. Baintain . $ status. !. Administer a Dleet enema. ". Administer preoperative medication on call to the operating room. Answer: ! #ationale: /n the preoperative period% enemas or laAatives should not be administered. .o heat should be applied to the abdomen because this may increase the chance of perforation secondary to vasodilation. /) fluids would be started and the child would be . $. rescribed preoperative medications most li&ely would be administered on call to the operating room. Test-Ta&ing Strategy: 'se the process of elimination. -onsider the anatomical location and the concern of rupture in this disorder. $ptions 1% 2% and " are standard preoperative measures. $ption ! would place the child at ris& for a perforated appendiA. #eview preoperative care in the child with appendicitis if you had difficulty with this +uestion. ,evel of -ognitive Ability: Analysis -lient .eeds: hysiological /ntegrity /ntegrated rocess: .ursing rocess0/mplementation -ontent Area: -hild 1ealth #eference: rice% 2.% 3 4win% 5. 627789. Thompsons pediatric nursing 6:th ed.9. hiladelphia: ;.<. Saunders% p. 2::. :. A nurse reviews the record of a !-wee&-old infant and notes that the physician has documented a diagnosis of suspected 1irschsprung?s disease. The nurse understands that which of the following symptoms led the mother to see& health care for the infant@ 1. 2iarrhea

Silvestri, 3/e, ISBN 1-1460-0052-6 Chapter 033 (edited file) !eta"#li$, %&d#$ri&e, a&d 'astr#i&testi&al (is#rders 10/14/0), *a+e 5 #f 11, 5 ,i+-re(s), 1 .a"le(s), 12 B#/(es)

2. roFectile vomiting !. #egurgitation of feedings ". Doul-smelling ribbon-li&e stools Answer: " #ationale: -hronic constipation beginning in the first month of life resulting in foul-smelling ribbon-li&e or pellet-li&e stools is a clinical manifestation of this disorder. 2elayed passage or absence of meconium stool in the neonatal period is the cardinal sign. <owel obstruction% especially in the neonatal period% abdominal pain and distention% and failure to thrive are also clinical manifestations. $ptions 1% 2% and ! are incorrect. Test-Ta&ing Strategy: Cnowledge regarding the clinical manifestations associated with 1irschsprung?s disease is re+uired to answer this +uestion. #emember that foul-smelling ribbonli&e or pellet-li&e stools is a clinical manifestation of this disorder. #eview these manifestations if you had difficulty with this +uestion. ,evel of -ognitive Ability: -omprehension -lient .eeds: hysiological /ntegrity /ntegrated rocess: .ursing rocess02ata -ollection -ontent Area: -hild 1ealth #eference: rice% 2.% 3 4win% 5. 627789. Thompsons pediatric nursing 6:th ed.9. hiladelphia: ;.<. Saunders% p. 18=. 17. A nurse is caring for a child with a diagnosis of intussusception. ;hich of the following symptoms would the nurse eApect to note in this child@ 1. <lood and mucus in the stools 2. rofuse proFectile vomiting !. ;atery diarrhea ". #ibbon-li&e stools Answer: 1 #ationale: The child with intussusception classically presents with severe abdominal pain that is crampy and intermittent% causing the child to draw in his or her &nees to the chest. )omiting may be present but it is not proFectile. <right red blood and mucus are passed through the rectum and is commonly described as currant FellyJli&e stools. #ibbon-li&e stools are not a manifestation of this disorder. Test-Ta&ing Strategy: Cnowledge related to the clinical manifestations associated with intussusception is re+uired to answer this +uestion. #ecalling that a classic manifestation is current FellyJli&e stools will assist in directing you to option 1. #eview this disorder if you had difficulty with this +uestion. ,evel of -ognitive Ability: -omprehension -lient .eeds: hysiological /ntegrity /ntegrated rocess: .ursing rocess02ata -ollection -ontent Area: -hild 1ealth #eference: rice% 2.% 3 4win% 5. 627789. Thompsons pediatric nursing 6:th ed.9. hiladelphia: ;.<. Saunders% p. 18". 11. A child with a diagnosis of umbilical hernia has been scheduled for surgical repair in 2 wee&s. The nurse reinforces instructions to the parents about the signs of possible hernial strangulation. The nurse tells the parents that which of the following signs would re+uire

Silvestri, 3/e, ISBN 1-1460-0052-6 Chapter 033 (edited file) !eta"#li$, %&d#$ri&e, a&d 'astr#i&testi&al (is#rders 10/14/0), *a+e 6 #f 11, 5 ,i+-re(s), 1 .a"le(s), 12 B#/(es)

physician notification by the parents@ 1. Dever 2. 2iarrhea !. -onstipation ". )omiting Answer: " #ationale: The parents of a child with an umbilical hernia need to be instructed about the signs of strangulation. These signs include vomiting% pain% and irreducible mass at the umbilicus. The parents should be instructed to contact the physician immediately if strangulation is suspected. Test-Ta&ing Strategy: 'se the definition of the word GstrangulationH to help answer this +uestion. This will assist in eliminating options 1 and 2. Drom the remaining options% &nowledge regarding the signs of strangulation will assist in answering the +uestion. #eview the signs of strangulation if you had difficulty with this +uestion. ,evel of -ognitive Ability: Application -lient .eeds: 1ealth romotion and Baintenance /ntegrated rocess: Teaching0,earning -ontent Area: -hild 1ealth #eference: rice% 2.% 3 4win% 5. 627789. Thompsons pediatric nursing 6:th ed.9. hiladelphia: ;.<. Saunders% p. 182. 12. A nurse reinforces home care instructions to the parents of a child with hepatitis regarding care of the child and the prevention of transmission of the virus. ;hich statement by a parent indicates a need for further instruction@ 1. GDre+uent hand washing is important.H 2. G/ need to clean contaminated household surfaces with bleach.H !. G/ need to provide a well-balanced% high-fat diet to my child.H ". G2iapers should not be changed near any surfaces used to prepare food.H Answer: ! #ationale: The child with hepatitis should consume a well-balanced% low-fat diet to allow the liver to rest. $ptions 1% 2% and " are components of the home care instructions to the family of a child with hepatitis. Test-Ta&ing Strategy: .ote the &ey words% need for further instruction. These words indicate a false response +uestion and that you need to select the incorrect client statement. $ptions 1% 2% and " can be eliminated by using the basic principles related to standard precautions. #eview home care instructions to the parents of a child with hepatitis if you had difficulty with this +uestion. ,evel of -ognitive Ability: -omprehension -lient .eeds: Safe% (ffective -are (nvironment /ntegrated rocess: Teaching0,earning -ontent Area: -hild 1ealth #eference: ,eifer% 4. 627789. Maternity nursing 6:th ed.9. hiladelphia: ;.<. Saunders% p. ==!. 1!. A child is hospitali*ed with a diagnosis of lead poisoning. The nurse assisting in caring for the child would prepare to assist in administering which of the following medications@ 1. Activated charcoal 2. Sodium bicarbonate

Silvestri, 3/e, ISBN 1-1460-0052-6 Chapter 033 (edited file) !eta"#li$, %&d#$ri&e, a&d 'astr#i&testi&al (is#rders 10/14/0), *a+e 0 #f 11, 5 ,i+-re(s), 1 .a"le(s), 12 B#/(es)

!. /pecac syrup ". 2imercaprol 6<A, in $il9 Answer: " #ationale: 2imercaprol 6<A, in $il9 is a chelating agent that is administered to remove lead from the circulating blood and from some tissues and organs for eAcretion in the urine. Sodium bicarbonate may be used in salicylate poisoning. /pecac syrup is used in poisonings to induce vomiting. Activated charcoal is used to decrease absorption in certain poisoning situations. Test-Ta&ing Strategy: Cnowledge regarding the treatment related to lead poisoning is re+uired to answer this +uestion. #emember that dimercaprol 6<A, in $il9 is a chelating agent that is administered to remove lead from the circulating blood and from some tissues and organs for eAcretion in the urine. #eview this treatment if you are unfamiliar with it. ,evel of -ognitive Ability: Application -lient .eeds: hysiological /ntegrity /ntegrated rocess: .ursing rocess0 lanning -ontent Area: -hild 1ealth #eferences: ,eifer% 4. 627789. Maternity nursing 6:th ed.9. hiladelphia: ;.<. Saunders% p. =81. rice% 2.% 3 4win% 5. 627789. Thompsons pediatric nursing 6:th ed.9. hiladelphia: ;.<. Saunders% p. 278. 1". An emergency nurse is caring for a child brought to the emergency room following the ingestion of approAimately one half-bottle of acetylsalicylic acid 6aspirin9. The nurse anticipates that the most li&ely initial treatment will be: 1. The administration of syrup of ipecac 2. The administration of sodium bicarbonate !. The administration of vitamin C ". 2ialysis Answer: 1 #ationale: /nitial treatment of salicylate overdose includes inducing vomiting with syrup of ipecac or gastric lavage. Activated charcoal may be administered to decrease absorption. /) fluids and sodium bicarbonate may be administered to enhance eAcretion but would not be the initial treatment. 2ialysis is used in eAtreme cases if the child is unresponsive to therapy. )itamin C is the antidote for warfarin 6-oumadin9 overdose. Test-Ta&ing Strategy: .ote the &ey word% initial in the stem of the +uestion. This &ey word and &nowledge regarding the treatment for aspirin overdose will assist in directing you to option 1. #emember% initial treatment of salicylate overdose includes inducing vomiting with syrup of /pecac% or gastric lavage. #eview the treatment for this overdose if you had difficulty with this +uestion. ,evel of -ognitive Ability: -omprehension -lient .eeds: hysiological /ntegrity /ntegrated rocess: .ursing rocess0 lanning -ontent Area: -hild 1ealth #eference: ;ong% 2.% 3 1oc&enberry% B. 6277!9. Nursing care of infants and children 6>th ed.9. St. ,ouis: Bosby% pp. =>1-=>2. 18. A licensed practical nurse 6, .9 as&s a nursing assistant to gather supplies in preparation for administering a tepid bath to a child with a fever. The , . intervenes if the nursing assistant

Silvestri, 3/e, ISBN 1-1460-0052-6 Chapter 033 (edited file) !eta"#li$, %&d#$ri&e, a&d 'astr#i&testi&al (is#rders 10/14/0), *a+e ) #f 11, 5 ,i+-re(s), 1 .a"le(s), 12 B#/(es)

obtains which unnecessary item6s9@ 1. ;ashcloths and towels 2. A bottle of alcohol !. Toys ". ,ightweight paFamas Answer: 2 #ationale: Alcohol should never be used for bathing the child with a fever because it can cause rapid cooling% peripheral vasoconstriction% and chilling% thus elevating the temperature further. ;ashcloths can be used to s+uee*e water over the child?s body. Towels are used to dry the child. Toys% especially water toys% can be used to provide distraction during the bath. ,ightweight clothing should be placed on the child after the child is dried. Test-Ta&ing Strategy: 'se the process of elimination. .ote the &ey word% intervenes. This word indicates a false response +uestion and that you need to select the incorrect item. $ptions 1 and " can be easily eliminated first. Drom the remaining options% select option 2 because of the harmful effects of alcohol and the effect of potentially elevating the temperature. #eview the procedure for administering a tepid bath if you had difficulty with this +uestion. ,evel of -ognitive Ability: Application -lient .eeds: hysiological /ntegrity /ntegrated rocess: .ursing rocess0/mplementation -ontent Area: ,eadership0Banagement #eference: rice% 2.% 3 4win% 5. 627789. Thompsons pediatric nursing 6:th ed.9. hiladelphia: ;.<. Saunders% p. !8>. 1=. A cooling blan&et is prescribed for a child with a fever. The nurse prepares to use the cooling blan&et and avoids which of the following@ 1. lacing the cooling blan&et on the bed and covering it with a sheet 2. -hec&ing the s&in condition of the child before% during% and after the use of the cooling blan&et !. Ceeping the child uncovered to assist in reducing the fever ". Ceeping the child dry while on the cooling blan&et to prevent the ris& of frostbite Answer: ! #ationale: ;hile on a cooling blan&et% the child should be covered lightly to maintain privacy and reduce shivering. $ptions 1% 2% and " are important interventions to prevent shivering% frostbite% and s&in brea&down. Test-Ta&ing Strategy: .ote the &ey word% avoids. This word indicates a false response +uestion and that you need to select the incorrect intervention. Cnowledge regarding the physiological response associated with fever will direct you to option !. #eview the procedure associated with the use of a cooling blan&et if you had difficulty with this +uestion. ,evel of -ognitive Ability: Application -lient .eeds: hysiological /ntegrity /ntegrated rocess: .ursing rocess0/mplementation -ontent Area: -hild 1ealth #eferences: BcCinney% (.% 5ames% S.% Burray% S.% 3 Ashwill% 5. 627789. Maternal-child nursing 62nd ed.9. St. ,ouis: (lsevier% pp. :"8-:"=. ;ong% 2.% 3 1oc&enberry% B. 6277!9. Nursing care of infants and children 6>th ed.9. St. ,ouis: Bosby% pp. 11!7-11!1.

Silvestri, 3/e, ISBN 1-1460-0052-6 Chapter 033 (edited file) !eta"#li$, %&d#$ri&e, a&d 'astr#i&testi&al (is#rders 10/14/0), *a+e 1 #f 11, 5 ,i+-re(s), 1 .a"le(s), 12 B#/(es)

1>. A nursing instructor as&s a nursing student about phenyl&etonuria 6 C'9. ;hich statement% if made by the student% indicates an understanding of this disorder@ 1. G C' is an autosomal dominant disorder.H 2. GTreatment includes dietary restriction of tyramine.H !. GAll 87 states re+uire routine screening of all newborns for C'.H ". G C' primarily affects the gastrointestinal system.H Answer: ! #ationale: C' is an autosomal recessive disorder. Treatment includes dietary restriction of phenylalanine inta&e. C' is a genetic disorder that results in central nervous system 6-.S9 damage from toAic levels of phenylalanine in the blood. $ption ! is accurate. Test-Ta&ing Strategy: 'se the process of elimination. #ecalling that C' is a recessive disorder will assist in eliminating option 1. #eading option 2 carefully will direct you to eliminate this option because tyramine is restricted in clients on monoamine oAidase inhibitors% not in C'. #ecalling that C' affects the -.S will direct you to option ! from the remaining options. #eview the characteristics associated with this disorder if you had difficulty with this +uestion. ,evel of -ognitive Ability: -omprehension -lient .eeds: hysiological /ntegrity /ntegrated rocess: Teaching0,earning -ontent Area: -hild 1ealth #eference: ,eifer% 4. 6277!9. Introduction to maternity and pediatric nursing 6"th ed.9. hiladelphia: ;.<. Saunders% p. !!". 18. A school-age child with type 1 diabetes mellitus has soccer practice three afternoons a wee&. The nurse reinforces instructions regarding how to prevent hypoglycemia during practice. The nurse tells the child to: 1. Ta&e half the amount of prescribed insulin on practice days. 2. (at twice the amount normally eaten at lunchtime. !. Ta&e the prescribed insulin at noontime rather than in the morning. ". 2rin& K cup of orange Fuice before soccer practice. Answer: " #ationale: An eAtra snac& of 17 to 18 g of carbohydrate eaten before activities and for every !7 to "8 minutes of activity will prevent hypoglycemia. $ne-half cup of orange Fuice will provide the needed carbohydrate. The child or parents should not be instructed to adFust the amount or time of insulin administration. Beal amounts should not be doubled. Test-Ta&ing Strategy: 'se the process of elimination. $ptions 1 and ! can be eliminated first because insulin dosages and times should not be adFusted. Drom the remaining options% recalling the manifestations and treatment associated with hypoglycemia will direct you to option ". #eview the treatment to prevent hypoglycemia if you had difficulty with this +uestion. ,evel of -ognitive Ability: Application -lient .eeds: 1ealth romotion and Baintenance /ntegrated rocess: Teaching0,earning -ontent Area: -hild 1ealth #eference: rice% 2.% 3 4win% 5. 627789. Thompsons pediatric nursing 6:th ed.9. hiladelphia: ;.<. Saunders% p. 288.

Silvestri, 3/e, ISBN 1-1460-0052-6 Chapter 033 (edited file) !eta"#li$, %&d#$ri&e, a&d 'astr#i&testi&al (is#rders 10/14/0), *a+e 10 #f 11, 5 ,i+-re(s), 1 .a"le(s), 12 B#/(es)

1:. The nurse is reinforcing instructions to an adolescent with type 1 diabetes mellitus regarding insulin administration and rotation sites. ;hich statement% if made by the adolescent% would indicate an understanding of the instructions@ 1. G/ need to use one maFor site for the morning inFection and another maFor site for the evening inFection for 2 to ! wee&s before changing maFor sites.H 2. G/ need to use a different site for each insulin inFection.H !. G/ need to use the same site for 1 month before rotating to another site.H ". G/ should use only my stomach and my thighs for inFections.H Answer: 1 #ationale: To help decrease variations in absorption from day to day% the child should use one location within a maFor site for the morning inFection. The child should then rotate to another site for the evening inFection% and a third site for the bedtime inFection. The child should follow this pattern for a period of 2 to ! wee&s before changing maFor sites. Test-Ta&ing Strategy: 'se the process of elimination. (liminate option " first because of the word Gonly.H Drom the remaining options% it is necessary to &now the physiology associated with absorption of insulin. #eview insulin administration if you had difficulty with this +uestion. ,evel of -ognitive Ability: Analysis -lient .eeds: hysiological /ntegrity /ntegrated rocess: .ursing rocess0(valuation -ontent Area: -hild 1ealth #eference: rice% 2.% 3 4win% 5. 627789. Thompsons pediatric nursing 6:th ed.9. hiladelphia: ;.<. Saunders% pp. 282-28". 27. A mother of a =-year-old with type 1 diabetes mellitus calls the clinic nurse and tells the nurse that the child has been sic&. The mother reports that she chec&ed the child?s urine and it showed positive &etones. ;hich of the following would the nurse instruct the mother to do@ 1. -ome to the clinic immediately. 2. 1old the neAt dose of insulin. !. Administer an additional dose of regular insulin. ". (ncourage the child to drin& calorie-free li+uids. Answer: " #ationale: ;hen the child is sic&% the mother should test for urinary &etones with each voiding. /f &etones are present% li+uids are essential to aid in clearing. The child should be encouraged to drin& calorie-free li+uids. /t is not necessary to bring the child to the clinic immediately. /nsulin doses should not be adFusted or changed. Test-Ta&ing Strategy: 'se the process of elimination. (liminate options 2 and ! first because insulin doses should not be adFusted or changed. Drom the remaining options% note the words Gpositive &etones.H This finding does not re+uire immediate physician referral. #eview home care instructions for the sic& diabetic child if you had difficulty with this +uestion. ,evel of -ognitive Ability: Application -lient .eeds: 1ealth romotion and Baintenance /ntegrated rocess: .ursing rocess0/mplementation -ontent Area: -hild 1ealth #eference: BcCinney% (.% 5ames% S.% Burray% S.% 3 Ashwill% 5. 627789. Maternal-child nursing 62nd ed.9. St. ,ouis: (lsevier% p. 1">8.

Silvestri, 3/e, ISBN 1-1460-0052-6 Chapter 033 (edited file) !eta"#li$, %&d#$ri&e, a&d 'astr#i&testi&al (is#rders 10/14/0), *a+e 11 #f 11, 5 ,i+-re(s), 1 .a"le(s), 12 B#/(es)

LAMN21. Select all interventions for a child with type 1 diabetes mellitus who has a blood glucose level of =7 mg0d,. OOOO4ive the child a teaspoon of honey. OOOO repare to administer glucagon subcutaneously if unconsciousness occurs. OOOO(ncourage the child to ambulate. OOOOAdminister regular insulin. Answers: 4ive the child a teaspoon of honey. repare to administer glucagon subcutaneously if unconsciousness occurs. #ationale: 1ypoglycemia is defined as a blood glucose level below >7 mg0d,. /t occurs as a result of too much insulin% not enough food% or eAcessive activity. /f possible% the nurse should confirm with a blood glucose reading. $ral glucose is administered immediatelyP the rapidreleasing sugar is followed by a compleA carbohydrate and protein% such as a slice of bread or a peanut butter crac&er. An eAtra snac& is given if the neAt meal is not planned for more than !7 minutes or if activity is planned. /f the child becomes unconscious% ca&e frosting or glucose paste is s+uee*ed onto the gums and the blood glucose level is retested if the child does not improve within 18 to 27 minutesP if the reading remains low% additional sugar is administered. /f the child remains unconscious% it may be necessary to administer glucagon and the nurse should be prepared for this intervention. /n the hospital setting% the nurse should be prepared to administer /) deAtrose. (ncouraging the child to ambulate and administering #egular insulin will result in a lowered blood glucose level. Test-Ta&ing Strategy: Docus on the information in the +uestion. #ecalling that a blood glucose level of =7 mg0d, indicates hypoglycemia will assist in determining the correct interventions. #eview the interventions for hypoglycemia if you had difficulty with this +uestion. ,evel of -ognitive Ability: Application -lient .eeds: hysiological /ntegrity /ntegrated rocess: .ursing rocess0/mplementation -ontent Area: -hild 1ealth #eference: rice% 2.% 3 4win% 5. 627789. Thompsons pediatric nursing 6:th ed.9. hiladelphia: ;.<. Saunders% p. 288.