Diabetes
What statement made by the adolescent will alert the registered nurse (RN) of the need for further education regarding insulin therapy?
A. "I will continue to check my glucose each day as instructed by my provider"
B. "It is important that I remember to rotate the injection sites at least every 2 weeks."
C. "I need to be sure to have a snack at the peak time of my insulin each time I give it."
D. "Now that I am older, I can decide what time of day I will give myself my insulin."
D. This answer is correct because the statement “now that I am older, I can decide what time of day I will give myself my insulin” does require further education. It is important to assist the adolescent in developing self-management, but it is equally important that the adolescent maintain a schedule with insulin administration.
Adolescents want to feel in control of their life/body. Give them choices and autonomy when possible.
While providing an educational class about the complications of diabetes, what cause of diabetic ketoacidosis (DKA) will the registered nurse (RN) teach?
1. Presence of emotional stress
2. recent change in dietary intake
3. recent change in diabetic treatment
4. presence of an infection
4. More glucose without the proper insulin...infection increases the glucose.
*blood sugar increases in periods of illness and stress* make sure to have "sick days" planned. Check blood sugar more frequently. Keep ingesting simple sugars, and it is best to use regular insulin (short acting).
The nurse is caring for a preschool client with leukemia. Which method is most appropriate for providing information about cancer and treatments?
a. focus on showing affection and keeping normal routines
b. use medical play, dolls and activities to help explain what is happening
c. allow the client to connect with other children diagnosed with leukemia
d. ask the healthcare team to relay information directly instead of parental explanations
b. An age-appropriate tool for communication about leukemia and treatments to a preschooler involves the use of medical play with dolls or other activities to help explain what is happening.
Preschoolers also should be reassured that nothing they thought or did caused their cancer, and that they did not “catch” it. Sometimes children this age think they have been bad and that's what caused them to get cancer.
A nurse is assessing a 4-year-old child with suspected celiac disease. Which clinical finding would most likely support this diagnosis?
A. Steatorrhea (fatty, foul-smelling stools) and abdominal distension
B. Frequent urinary tract infections and flank pain
C. Dry cough and wheezing
D. Hyperactivity and weight gain
Correct Answer: A. Steatorrhea (fatty, foul-smelling stools) and abdominal distension
Rationale: Celiac disease causes malabsorption of nutrients, leading to chronic diarrhea, steatorrhea, abdominal distension, and failure to thrive. Other symptoms may include irritability, fatigue, and delayed growth.
How many kg is the child that weighs 20 lbs and 12 ounces? Round to the nearest 10th.
9.4 kg
What statement made by the mother of a child with a diagnosis of diabetes mellitus type I concerning ‘sick-day’ planning will the registered nurse (RN) recognize as an indication of the need for further education of the process by the mother?
A. "If my child is not eating, I will not give any of the daily insulin"
B. "I will check my child's glucose at least every 4 hours while they're ill"
C. "If my child is not able to eat, I will provide fluids that contain sugar like regular soda"
D. "I will notify my child's doctor if my child's glucose stays above 240 and they develop ketones in their urine."
A. insulin is the primary treatment plan for the individual diagnosed with diabetes mellitus type I. The goal of insulin therapy is to maintain the individual’s blood glucose level as close to normal as is possible and to avoid episodes of hypoglycemia. Even when the individual with this diagnosis becomes ill, insulin is still required. While developing a ‘sick-day’ plan, the individual will identify the need to continue with insulin therapy, blood glucose monitoring, and oral intake of fluids and food (as tolerated). It is also important for the individual to know when to notify the healthcare provider concerning the illness.
A nurse is assessing a 13-year-old with type 1 diabetes who has been ill for several days. Which finding is most indicative of diabetic ketoacidosis (DKA)?
A. Warm, moist skin and bradycardia
B. Fruity-scented breath and deep, rapid respirations
C. Pinpoint pupils and decreased respiratory rate
D. Decreased urine output and bradypnea
Correct Answer: B. Fruity-scented breath and deep, rapid respirations
Rationale: DKA is characterized by hyperglycemia, ketone buildup, metabolic acidosis, and dehydration. Kussmaul respirations and fruity (acetone) breath are hallmark signs.
The nurse is educating parents of a pediatric client scheduled to undergo a bone marrow biopsy to evaluate for possible leukemia. Which statement indicates that the parent understands the nurse’s teaching about this procedure?
A. "I am relieved the results will be back in an hour."
B. "I'm nervous about my child having to be under general anesthesia."
C. "I will feed my child a snack 30 minutes prior to the procedure."
D. "I will bring his favorite stuffed animal for him to hold during the procedure."
D. During a bone marrow biopsy, one of the parent’s most important roles is to remain calm and help the child remain calm. Bringing a familiar comfort item from home and holding the child’s hand during the procedure are ways in which parents can help the child through the procedure.
Takes about 2 days for the results to come back. General anesthesia is not used for bone marrow biopsy. Children are given local anesthetics and conscious sedation. Parents should not give any solid foods or non-clear liquids after midnight before test day, and even clear liquids should be withheld at least 2 hours prior to the test.
A nurse is teaching the parents of a child with untreated celiac disease about potential long-term complications. Which statement is correct?
A. Untreated celiac disease can lead to anemia, osteoporosis, and growth delays.
B. Untreated celiac disease primarily causes chronic hypertension.
C. Untreated celiac disease only affects digestion and has no systemic effects.
D. Untreated celiac disease improves spontaneously with age.
Correct Answer: A. Untreated celiac disease can lead to anemia, osteoporosis, and growth delays.
Rationale: Chronic malabsorption of nutrients can lead to iron-deficiency anemia, vitamin D/calcium deficiency (osteopenia/osteoporosis), delayed growth, and other complications.
How many gtt/mL are in micro gtt tubing.
60 gtt/mL
A pediatric nurse is caring for a child with a family history of type 1 diabetes and is discussing preventive strategies with the parents. Which action should the nurse prioritize to help support the child’s overall health?
A. Encourage routine blood glucose screenings and early reporting of symptoms such as excessive thirst or frequent urination.
B. Recommend a low-carbohydrate diet to reduce stress on the pancreas and prevent insulin resistance.
C. Advise delaying the introduction of common allergens like cow’s milk until after age 3 to lower autoimmune risk.
D. Promote regular physical activity and balanced nutrition to strengthen the immune system and reduce the risk of diabetes.
A:Because type 1 diabetes cannot be prevented, the nurse should focus on early detection and monitoring in children at increased risk.
A nurse is reviewing the laboratory results of a 14-year-old with type 1 diabetes who is suspected of having diabetic ketoacidosis (DKA). Which set of lab values would the nurse expect?
A. Blood glucose 90 mg/dL, pH 7.42, bicarbonate 24 mEq/L, positive urine ketones
B. Blood glucose 560 mg/dL, pH 7.15, bicarbonate 10 mEq/L, positive serum ketones
C. Blood glucose 140 mg/dL, pH 7.40, bicarbonate 22 mEq/L, negative serum ketones
D. Blood glucose 400 mg/dL, pH 7.38, bicarbonate 24 mEq/L, negative urine ketones
Correct Answer: B. Blood glucose 560 mg/dL, pH 7.15, bicarbonate 10 mEq/L, positive serum ketones
Rationale: DKA is defined by:
Hyperglycemia (usually >250 mg/dL)
Metabolic acidosis (low pH <7.3 and low bicarbonate <15 mEq/L)
Presence of ketones in blood and urine
Other findings may include elevated anion gap and electrolyte disturbances (like high potassium initially).
A nurse is assessing a 6-year-old child who has been increasingly fatigued and irritable. The parents report frequent nosebleeds, pale skin, and several unexplained bruises on the child’s legs. Which additional finding would support a possible diagnosis of leukemia?
A. Decreased appetite and enlarged lymph nodes
B. Weight gain and flushed skin
C. Bradycardia and increased muscle tone
D. Hyperactivity and frequent nose picking
Correct Answer: A. Decreased appetite and enlarged lymph nodes
Rationale: Common signs and symptoms of childhood leukemia include:
Fatigue, pallor, irritability (from anemia)
Bleeding/bruising (from thrombocytopenia)
Frequent infections (from neutropenia)
Bone or joint pain, lymphadenopathy, hepatosplenomegaly, decreased appetite, and weight loss.
The other answer choices do not align with typical leukemia findings.
A nurse is teaching the parents of a 5-year-old child newly diagnosed with celiac disease about nutrition. Which statement indicates the parents understand the child’s nutrient needs?
A. “Our child will need extra iron, calcium, and fat-soluble vitamins like A, D, E, and K.”
B. “Since gluten causes diarrhea, we should avoid all dairy products to prevent nutrient loss.”
C. “Our child only needs a gluten-free diet; vitamins and minerals are not a concern.”
D. “Vitamin supplements are unnecessary because a child’s diet will always provide enough nutrients.”
Correct Answer: A. “Our child will need extra iron, calcium, and fat-soluble vitamins like A, D, E, and K.”
Rationale: Malabsorption from damaged intestinal villi in celiac disease can lead to deficiencies in iron, calcium, folate, and fat-soluble vitamins (A, D, E, K). Supplementation may be necessary until intestinal healing occurs. Dairy is not inherently prohibited unless lactose intolerance exists (B). A gluten-free diet alone may not correct nutrient deficiencies (C, D).
You have a type 1 DM patient present to the hospital likely in sepsis. The physician places several orders to complete. What should be done FIRST?
1.) Start Insulin
2.) Start antibiotics
3.) Collect cultures
4.) Place foley catheter
3.) collect cultures.
A nurse is caring for a 7-year-old child with type 1 diabetes mellitus who received their scheduled morning dose of insulin. Two hours later, the child becomes pale and diaphoretic, and is complaining of feeling shaky. Which action should the nurse take first?
A. Administer a glucagon injection intramuscularly
B. Provide 4 oz (120 mL) of orange juice
C. Notify the healthcare provider immediately
D. Check the child’s urine for ketones
Correct Answer: B. Provide 4 oz (120 mL) of orange juice
Rationale: The child is exhibiting classic signs of mild to moderate hypoglycemia (pallor, diaphoresis, shakiness). The priority is to quickly raise the blood glucose by giving a fast-acting carbohydrate. Glucagon (A) is used for severe hypoglycemia when the child is unable to swallow or is unconscious. Calling the provider (C) can occur after immediate treatment. Checking for ketones (D) is appropriate when blood glucose is high, not low.
A 10-year-old child with type 1 diabetes is admitted with DKA. Which intervention should the nurse perform first?
A. Begin an IV infusion of regular insulin
B. Administer an IV bolus of sodium bicarbonate
C. Start IV fluids to correct dehydration
D. Give subcutaneous long-acting insulin
Correct Answer: C. Start IV fluids to correct dehydration
Rationale: The priority initial intervention in DKA is fluid resuscitation to restore intravascular volume and improve perfusion. Insulin therapy is started only after fluids have been initiated to avoid worsening shock or cerebral edema. Bicarbonate is rarely used unless severe acidosis (pH < 6.9).
A nurse is caring for a 7-year-old child with leukemia who is receiving chemotherapy. The child’s absolute neutrophil count (ANC) is 300. The parent brings in a bag of the child’s favorite snacks from home and asks if their younger sibling can visit after school. Which action should the nurse take first?
A. Allow the sibling to visit if they are feeling well
B. Inspect the snacks to ensure they are individually packaged and not fresh produce
C. Remind the parent that all visitors must perform hand hygiene before entering
D. Explain that only adults are allowed to visit during chemotherapy
C (hand hygiene for visitors) addresses immediate, high-risk exposure from anyone entering the room.
This risk is constant and affects every interaction.
A visitor could unknowingly transmit a life-threatening infection.
B (inspect snacks) addresses a lower and more specific risk that only affects one item at one moment.
Visitors are allowed if healthy and must perform strict hand hygiene
A 10-year-old child with advanced leukemia is extremely thin, has noticeable muscle wasting, fatigue, and loss of appetite, even though they are receiving adequate calories. What term best describes this condition?
A. Anorexia
B. Cachexia
C. Marasmus
D. Kwashiorkor
Correct Answer: B. Cachexia
Rationale: Cachexia is a metabolic syndrome seen in chronic illnesses or cancer, characterized by muscle wasting, weight loss, fatigue, and loss of appetite, even when caloric intake is adequate.
Anorexia (A) is loss of appetite, but does not include the systemic muscle wasting of cachexia.
Marasmus (C) is severe malnutrition due to caloric deficiency, usually in infants.
Kwashiorkor (D) is protein deficiency with edema and fatty liver, also usually in children with insufficient protein intake.
A 10-year-old child receiving chemotherapy for leukemia has a temperature of 100.6°F (38.1°C) and an absolute neutrophil count (ANC) of 400/mm³. Which action should the nurse take first?
A. Administer the child’s scheduled acetaminophen to reduce fever
B. Place the child on neutropenic precautions and notify the provider immediately
C. Encourage the child to drink fluids and rest in the room
D. Allow siblings to visit to maintain normal social interaction
Correct Answer: B. Place the child on neutropenic precautions and notify the provider immediately
Rationale: A child with severe neutropenia and fever is at high risk for life-threatening infection (febrile neutropenia). Immediate action includes infection prevention and notifying the provider. Antipyretics may mask infection, and visitors or routine fluid encouragement are secondary.
The parents of an 8-year-old child newly diagnosed with type 1 diabetes are anxious about giving insulin injections at home. Which teaching strategy would best help the child gain confidence and reduce fear of injections?
A. Have the parents give all injections to ensure accuracy.
B. Delay having the child participate until they are older.
C. Allow the child to choose the injection site and help with steps as appropriate.
D. Use the same injection site each day to make it more predictable.
Correct Answer: C. Allow the child to choose the injection site and help with steps as appropriate.
Rationale: Allowing the child to participate promotes independence, control, and confidence, which are important for long-term diabetes management. Using the same site can lead to lipohypertrophy, and parents should encourage gradual child involvement instead of delaying it.
A nurse is caring for a 12-year-old child receiving treatment for DKA. Which assessment finding should the nurse report to the provider immediately?
A. Blood glucose decreasing at a rate of 75 mg/dL per hour
B. Complaints of headache and sudden confusion
C. Mild abdominal pain and thirst
D. Urine output of 1.5 mL/kg/hr
Correct Answer: B. Complaints of headache and sudden confusion
Rationale: Headache and mental status changes during DKA treatment may indicate cerebral edema, a life-threatening complication. Glucose should decrease gradually (50–100 mg/dL/hr); rapid drops increase the risk of cerebral edema.
A nurse is teaching the parents of a 6-year-old recently diagnosed with acute lymphoblastic leukemia (ALL) about the child’s upcoming chemotherapy regimen. The parents ask why the provider is prescribing several different chemotherapy drugs instead of just one. Which response by the nurse is most appropriate?
A. “Using multiple chemotherapy drugs reduces the chance of side effects developing.”
B. “Different chemotherapy drugs target cancer cells at various stages of growth, which increases effectiveness.”
C. “Giving multiple chemotherapy drugs at once allows for higher doses to be used safely.”
D. “Children’s bodies metabolize one drug too quickly, so they need several to slow it down.”
Correct Answer: B. Different chemotherapy drugs target cancer cells at various stages of growth, which increases effectiveness.
Rationale: Combination chemotherapy is used because:
It attacks cancer cells at different points in the cell cycle
It helps prevent drug resistance from developing
It allows for lower doses of each drug, which reduces the severity of side effects
Option A is incorrect because multiple drugs can actually increase the number of possible side effects (though often less severe).
Option C is incorrect because combination therapy allows lower, not higher, individual doses.
Option D is incorrect and not based on pharmacologic principles.
A 7-year-old child with leukemia is receiving chemotherapy and has a low absolute neutrophil count (ANC). The healthcare provider orders filgrastim (Neupogen). What is the primary purpose of this medication?
A. Stimulate red blood cell production to prevent anemia
B. Increase platelet production to prevent bleeding
C. Stimulate white blood cell production to reduce infection risk
D. Reduce nausea and vomiting associated with chemotherapy
Correct Answer: C. Stimulate white blood cell production to reduce infection risk
Rationale: Filgrastim is a granulocyte colony-stimulating factor (G-CSF) that stimulates the bone marrow to produce neutrophils, decreasing the risk of infection in patients with chemotherapy-induced neutropenia.
It does not affect red blood cells (A) or platelets (B).
It is not an antiemetic (D).
A 9-year-old child is receiving chemotherapy for acute lymphoblastic leukemia. The nurse notes the child has petechiae on the legs, a platelet count of 18,000/mm³, and reports fatigue and dizziness. Which action should the nurse implement first?
A. Encourage the child to play outside to increase appetite
B. Administer prescribed filgrastim (Neupogen)
C. Implement bleeding precautions and assess for active bleeding
D. Provide a high-protein snack to improve energy
Correct Answer: C. Implement bleeding precautions and assess for active bleeding
Rationale: The child’s severely low platelet count (<20,000/mm³) puts them at high risk for spontaneous bleeding. Priority nursing care includes bleeding precautions, close assessment for hemorrhage, and minimizing trauma. Filgrastim increases neutrophils, not platelets. Outdoor play and snacks do not address the immediate bleeding risk.