Welcome to the Online Nursing Practice Test/Exam about Endocrine. Before you begin answering this questions, I recommend that you read this special offer that will surely help you to pass your NCLEX Licensure Examination:
Situation: The nurse is meeting with the parents of 11 year old Irish, who has recently been diagnosed with insulin dependent mellitus (IDDM).
8. Irish has been hospitalized for the past 3 days. His physiologic condition has been stabilized and he is now on subcutaneous injections of insulin. In developing a plan of care for Irish and his family, which of the following would be the most appropriate nursing diagnosis?
a) parent knowledge deficit related to newly diagnosed illness
b) fluid volume deficit related to hypoglycemia
c) altered nutrition less than body requirements, related to insulin deficiency
d) compromised family coping related to newly diagnosed illness
9. Irish's parents stated that they really do not understands exactly what this disease is. Which of the following is the best way to explain IDDM to them?
a) IDDM is an inborn error in metabolism that makes the child unable to burn, fatty acids without insulin supplement
b) IDDM is a genetic disorder that makes the child unable to metabolize protein without insulin supplements.
c) IDDM is a deficiency in the secretions of insulin by the pancreas, which makes the child unable to metabolize carbohydrates without insulin supplements
d) IDDM is a deficiency in the secretions of the insulin by the gallbladder, which makes the child unable to metabolize carbohydrates without insulin
10. The mother of Irish is preparing a mixed dose of insulin. The nurse is satisfied with the mother's performance when she:
a) draws insulin from bottle of clear insulin first
b) draws insulin from the bottle of delayed acting insulin first
c) fills both syringes with the prescribed insulin dosage then shake the bottle vigorously
d) withdraws the delayed action insulin before withdrawing the short acting insulin
11. Irish complains of nausea, vomiting, diaphoresis and headache. Which of the following nursing interventions should the nurse carry out first?
a) withhold the client's next insulin injection
b) test the client's blood glucose level
c) administer tylenol (acetaminophen) as ordered
d) offer fruit juice, gelatin and chicken bouillon
12. The nurse should not instruct Irish mother that after injection of fast acting insulin at 7 in the morning, Irish should avoid exercising and any strenuous activity.
a) around 9 to 11am
b) after 4 hours
c) between 8am and 9am
d) in the afternoon after taking lunch
13. The nurse also teaches Irish regarding the relationship of her diet, exercise and insulin requirements. Which of the following statements below is wrong information that the nurse should not give Irish?
a) Irish should eat a snack before playing volleyball during P.E
b) Irish should always wear her medic-alert band or ID
c) Irish should go to school clinic to let the nurse give her insulin shots when its time for her medication
d) Irish should always carry a prefilled insulin syringe in her bag with instructions
14. After four months, Irish was brought to the emergency room because she fainted in school during her P.E. class. The nurse should monitor which of the following tests to evaluate the over-all therapeutic compliance of diabetic patient with normal serum hemoglobin?
a) glycosylated hemoglobin
b) fasting blood glucose
c) ketone levels
d) routine serum chemistry profile
ANSWERS AND RATIONALE
8) A
- the most appropriate diagnosis at this point would be knowledge deficit. The parents must be made aware of the nature of their child's illness and the principles of care in order to ensure treatment compliance. Letter B and C is inappropriate as the child's condition is already stable. There is no evidence that family coping is compromised and it is too early to tell if the family is not coping well to the newly diagnosed illness of Irish.
9) C
10) A
- the clear or regular insulin should be withdrawn first before the cloudy insulin or the intermediate insulin
11) B
- the first action to take would be to assess the blood glucose level of the patient to find out if the symptoms are due to abnormal glucose level or other causes.
60-90mg/100ml fasting blood sugar
60-105mg/100ml before meals
140-or less mg/100ml one hour after meals
if hyperglycemic - give insulin
if hypoglycemic - orange juice, sugar, candy
12) A
- the child should avoid exercising during peak hours of insulin action in order to prevent hypoglycemia. Peak action regular insulin occurs after 2-4 hours after administration. For the other types of insulin:
- short acting/regular (clear) - 2-4 hours
- intermediate/lente/NPH (cloudy) - 8-12 hours
- long-acting/ultralente (cloudy) - 18-24 hours
- starting 9 years old, a child has already developed enough finger dexterity to handle a syringe and thus can be taught how to administer her own insulin. If the nurse will see that Irish can and is willing to inject her own insulin, the child need not go to the school clinic. Another important instruction to Irish is to avoid injecting insulin in her arm during P.E. days when she plays volleyball. Exercise increases absorption of insulin. She should, then inject it in her abdomen. If Irene is runner, it would not be advisable to inject it her thigh.
It is important for the child to eat a carbohydrate snack before engaging in sports as exercise increases glucose utilization and make her hypoglycemic
Carrying a medic alert band or ID and prefilled syringe with instructions are important in cases of emergency.
14) A
- the glycosylated hemoglobin shows the patients blood glucose level during the last three months so iti s the best test that would reflect the patient's compliance to therapy and her glucose control.
Fasting blood glucose reflects only the current glucose control
Ketone appears in the urine when blood glucose levels exceed 200 mg'dl
Routine serum chemistry is not necessary in assessing the therapeutic compliance of a diabetic patient.
After you reviewed your answers through its rationale, you can now proceed to the next set of questions: Online Nursing Practice Test/Exam about Endocrine (1-7)
Or go back to the first set of questions: Online Nursing Practice Test/Exam about Endocrine (15-20)
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