Title: Quiz: Care of the Child with a Metabolic Condition, Communicable Disease, and an Emotional
Course: PRN 0096 Practical Nursing III > Section: Nursing Care of Pediatric Client

Q: The nurse planning to teach a family about Tay-Sachs disease understands the pattern of inheritance for inborn errors of metabolism is usually:
- Autosomal recessive
- Autosomal dominant
- X-linked recessive
- Multifactorial
A: Autosomal recessive
If right: The pattern of inheritance is generally autosomal recessive.
If wrong: The pattern of inheritance is generally autosomal recessive.

Q: The nurse caring for a child with a new diagnosis of type 1 diabetes mellitus plans the care based on the understanding that:
- There is an absolute deficiency of insulin.
- Insufficient quantities of insulin are produced by the pancreas.
- Oral hypoglycemic agents can control it.
- Insulin deficiency is caused by another disease affecting the pancreas.
A: There is an absolute deficiency of insulin.
If right: Type 1 insulin-dependent diabetes mellitus is characterized by an absolute or complete deficiency of insulin.
If wrong: Type 1 insulin-dependent diabetes mellitus is characterized by an absolute or complete deficiency of insulin.

Q: A child receives a combination of regular and NPH insulin at 8:00 AM. At 8:45 AM, when the breakfast trays have not yet arrived from the kitchen, the nurse should:
- Notify the charge nurse.
- Give the patient a snack of graham crackers and milk.
- Ambulate the patient in the hall for a short time.
- Give the patient more insulin according to the sliding scale.
A: Give the patient a snack of graham crackers and milk.
If right: A child who receives regular insulin before meals may have an insulin reaction if food is not eaten within 20 minutes. A snack of graham crackers and milk will prevent an episode of hypoglycemia.
If wrong: A child who receives regular insulin before meals may have an insulin reaction if food is not eaten within 20 minutes. A snack of graham crackers and milk will prevent an episode of hypoglycemia.

Q: Although the type 1 diabetic child had her prescribed insulin at 7:30 AM, the child is complaining of hunger and thirst and is drowsy at noon. The nurse should:
- Administer glucagon immediately and test her blood with a glucometer in 10 minutes.
- Have her eat some peanut butter crackers.
- Give her a cup of orange juice.
- Test her blood with a glucometer and give insulin according to the sliding scale.
A: Test her blood with a glucometer and give insulin according to the sliding scale.
If right: The immediate treatment for hyperglycemia is to give the patient more insulin. Giving more sugar will increase the blood sugar in a hyperglycemic child. Walking exercise will use up even more glucose.
If wrong: The immediate treatment for hyperglycemia is to give the patient more insulin. Giving more sugar will increase the blood sugar in a hyperglycemic child. Walking exercise will use up even more glucose.

Q: The comment made by a school-age child, indicating that he needs more teaching about diabetes mellitus and exercise, is:
- “I carry a piece of hard candy with me in case I start to feel shaky.”
- “I make sure I have emergency money when I have soccer practice or a game.”
- “Sometimes I skip my breakfast when I have a game in the morning.”
- “I play in soccer games that are scheduled after dinner.”
A: “Sometimes I skip my breakfast when I have a game in the morning.”
If right: Blood sugar is high after meals. The child with type 1 diabetes mellitus who skips a meal before exercise is at risk for hypoglycemia.
If wrong: Blood sugar is high after meals. The child with type 1 diabetes mellitus who skips a meal before exercise is at risk for hypoglycemia.

Q: The statement made by a 7-year-old child with diabetes mellitus that indicates a need for more teaching is:
- “My pancreas is sick and needs insulin until it gets better.”
- “I will need to take my insulin every day.”
- “I need to keep a piece of candy in my pocket in case I start to feel shaky.”
- “My mom has to give me insulin shots twice a day.”
A: “My pancreas is sick and needs insulin until it gets better.”
If right: The child with type 1 diabetes mellitus has a complete insulin deficiency and will require lifelong management of this disease. Insulin does not cure the pancreas.
If wrong: The child with type 1 diabetes mellitus has a complete insulin deficiency and will require lifelong management of this disease. Insulin does not cure the pancreas.

Q: A child with diabetes is brought to the emergency department; he is flushed, his skin is dry, and he is drowsy. His father states that the child has been feeling progressively worse since the morning. This child is most likely experiencing:
- Somogyi syndrome
- Insulin shock
- Ketoacidosis
- Water intoxication
A: Ketoacidosis
If right: In ketoacidosis the child’s skin is dry and the face is flushed. Patients appear dehydrated. They may perspire and be restless. The breath has a fruity odor, and there is no rest period between inspiration and expiration.
If wrong: In ketoacidosis the child’s skin is dry and the face is flushed. Patients appear dehydrated. They may perspire and be restless. The breath has a fruity odor, and there is no rest period between inspiration and expiration.

Q: The nurse determines a parent is administering Synthroid correctly when she states:
- “I stopped giving the medication because my daughter was losing her hair.”
- “I am using a different brand now because it costs less money.”
- “I don’t give the medication on the weekends.”
- “I give the medication at 8:00 AM everyday.”
A: “I give the medication at 8:00 AM everyday.”
If right: Synthroid should be given at the same time each day, preferably in the morning.
If wrong: Synthroid should be given at the same time each day, preferably in the morning.

Q: Following a closed head injury, the unconscious 10-year-old child begins to excrete copious amounts of pale urine with an attendant drop in blood pressure. Based on these symptoms, the nurse suspects the development of:
- Diabetes insipidus
- Diabetes mellitus
- Hypothyroidism
- Hyperthyroidism
A: Diabetes insipidus
If right: Diabetes insipidus can be acquired as the result of a head injury or tumor, and suppression of the posterior pituitary causes copious urine output with an attendant drop in BP. The child can become dehydrated very quickly if some remedy is not applied.
If wrong: Diabetes insipidus can be acquired as the result of a head injury or tumor, and suppression of the posterior pituitary causes copious urine output with an attendant drop in BP. The child can become dehydrated very quickly if some remedy is not applied.

Q: When teaching a 12-year-old how to administer insulin, the nurse includes the following instruction:
- Make sure injection sites are 6 inches apart.
- Select an injection site that was recently exercised.
- Inject the needle at a 90-degree angle.
- The injection is given deep into the muscle.
A: Inject the needle at a 90-degree angle.
If right: It is easier for the child to learn to inject the needle at a 90-degree angle.
If wrong: It is easier for the child to learn to inject the needle at a 90-degree angle.

Q: The nurse discussed treatment of hypoglycemia with an adolescent. The nurse determined the adolescent understood the instructions when she verbalized that if her blood sugar is low or if she begins to feel hungry and weak, she will:
- Eat six LifeSavers
- Give herself Lispro insulin
- Have a slice of cheese
- Drink a diet soda
A: Eat six LifeSavers
If right: The immediate treatment of hypoglycemia consists of administering sugar in some form such as orange juice, hard candy, or a commercial product.
If wrong: The immediate treatment of hypoglycemia consists of administering sugar in some form such as orange juice, hard candy, or a commercial product.

Q: The nurse takes into consideration that the child most susceptible to an opportunistic infection is the one taking:
- Anticonvulsants
- A beta-adrenergic agent
- An antibiotic
- Corticosteroids
A: Corticosteroids
If right: Steroids are immunosuppressive drugs that make the child very susceptible to opportunistic infections.
If wrong: Steroids are immunosuppressive drugs that make the child very susceptible to opportunistic infections.

Q: The type of precaution that is necessary when caring for a toddler with varicella is:
- Contact
- Protective
- Airborne infection
- Large droplet infection
A: Airborne infection
If right: Airborne-infection precautions are used for patients with conditions such as tuberculosis, varicella, and rubeola. Small airborne particles caught on floating dust in the room can be inhaled from anywhere in the room.
If wrong: Airborne-infection precautions are used for patients with conditions such as tuberculosis, varicella, and rubeola. Small airborne particles caught on floating dust in the room can be inhaled from anywhere in the room.

Q: The statement made by a sexually active adolescent girl indicating an understanding of the prevention of sexually transmitted diseases is:
- “I always douche after intercourse.”
- “I think you can get a vaccination for STDs now.”
- “I insist that my partner wear a condom.”
- “I am protected because I take the pill.”
A: “I insist that my partner wear a condom.”
If right: The use of condoms to prevent STDs is not considered 100% effective but is recommended for sexual intercourse.
If wrong: The use of condoms to prevent STDs is not considered 100% effective but is recommended for sexual intercourse.

Q: The priority nursing diagnosis for a hospitalized infant who is HIV-positive would be:
- Risk for injury
- Altered nutrition
- Impaired skin integrity
- Risk for infection
A: Risk for infection
If right: The infant who is HIV-positive has impaired immunologic functioning and is at high risk for infection.
If wrong: The infant who is HIV-positive has impaired immunologic functioning and is at high risk for infection.

Q: The nurse would base a response to a parent about how his child got hepatitis A on the information that the child:
- Came in contact with infected blood
- Came in contact with droplets in the air
- Was bitten by a mosquito or a tick
- Ate shrimp while they were in Mexico
A: Ate shrimp while they were in Mexico
If right: Hepatitis A results from ingestion of contaminated water or shellfish.
If wrong: Hepatitis A results from ingestion of contaminated water or shellfish.

Q: A 9-year-old child hospitalized for neutropenia is placed in protective isolation. What is the most appropriate response for the nurse to make when the child asks, “Why do you have to wear a gown and mask when you are in my room?”
- “Nurses and doctors wear gowns and masks because you have a condition that could be spread to others.”
- “The gown and mask are to protect you because you could get an infection very easily.”
- “I’m wearing this because there are a lot of bacteria in the hospital.”
- “I might look scary but you won’t need this after you have had medication for 24 hours.”
A: “The gown and mask are to protect you because you could get an infection very easily.”
If right: Protective isolation is used for patients who are not communicable but have a lowered resistance and are highly susceptible to infection.
If wrong: Protective isolation is used for patients who are not communicable but have a lowered resistance and are highly susceptible to infection.

Q: The nurse is planning to administer immunizations at a well-child visit when a parent reports the 18-month-old child is allergic to eggs. The vaccine that would be contraindicated is:
- Influenza
- Inactivated polio vaccine
- Diphtheria, tetanus, acellular pertussis
- Hepatitis B
A: Influenza
If right: The influenza vaccine should not be given to children who have an allergy to eggs.
If wrong: The influenza vaccine should not be given to children who have an allergy to eggs.

Q: An adolescent is taking tetracycline for a sexually transmitted disease. The nurse would stress in the instruction about this medication to:
- Finish all of the medication.
- Get plenty of fresh air and sunlight.
- The medication should be taken with food.
- Take an antacid if the medication causes an upset stomach.
A: Finish all of the medication.
If right: The nurse would teach the adolescent to take all of the prescribed medication to avoid making the microorganism resistant to tetracyclines.
If wrong: The nurse would teach the adolescent to take all of the prescribed medication to avoid making the microorganism resistant to tetracyclines.

Q: When a parent asks the nurse to describe what is meant by a “learning disability,” the nurse’s most helpful response would be:
- “A child may have difficulty with perception, language, comprehension, or memory.”
- “It is characterized by inattention, impulsiveness, and hyperactivity.”
- “The child’s intellectual ability limits his learning.”
- “The child has difficulty learning because of brain damage.”
A: “A child may have difficulty with perception, language, comprehension, or memory.”
If right: Learning disability is an educational term. Children with learning disabilities may have average to above-average intelligence, but they may experience difficulties in perception, language, comprehension, and conceptualization.
If wrong: Learning disability is an educational term. Children with learning disabilities may have average to above-average intelligence, but they may experience difficulties in perception, language, comprehension, and conceptualization.

Q: What would be the appropriate response to an adolescent who states, “This has been the worst day of my life”?
- “You should focus your mind on positive thoughts.”
- “Everybody has a bad day now and then.”
- “You’re young. What could be so terrible?”
- “Tell me about the worst day in your life.”
A: “Tell me about the worst day in your life.”
If right: The nurse establishes a rapport with the adolescent by acknowledging his or her feelings and giving the adolescent full attention.
If wrong: The nurse establishes a rapport with the adolescent by acknowledging his or her feelings and giving the adolescent full attention.

Q: The nurse answering phone calls at a local suicide prevention hotline would recognize the statement indicating the greatest risk of suicide is:
- “I just needed to talk to someone to keep myself from thinking silly thoughts about killing myself.”
- “My parents aren’t home and won’t be back for 4 hours. That should be enough time for the pills to work. I’ve got a hundred of them.”
- “My dad will be home first, so he’ll find me. So I think I’ll use his gun. I hope he didn’t lock the cabinet.”
- “My girlfriend is here with me. She told me to call because I was talking crazy about killing myself.”
A: “My parents aren’t home and won’t be back for 4 hours. That should be enough time for the pills to work. I’ve got a hundred of them.”
If right: The risk of death increases when there is a definite plan of action, the means are readily available, and the person has few resources for help and support.
If wrong: The risk of death increases when there is a definite plan of action, the means are readily available, and the person has few resources for help and support.

Q: The nurse assesses an early sign of depression in a 15- year-old boy who previously was active in a band, and had saved his money to buy a special guitar when he:
- Gives up the band to spend time with his girlfriend
- Spends all of his time at the library studying in order to qualify for the honor society
- Gives his guitar away and spends his time listening to music in his room
- Withdraws all of his money out of the bank to buy an expensive leather jacket
A: Gives up the band to spend time with his girlfriend
If right: A major depression is characterized by a prolonged behavioral change from baseline that interferes with school, family life, and age-specific activities, frequently signaled by giving prized possessions away.
If wrong: A major depression is characterized by a prolonged behavioral change from baseline that interferes with school, family life, and age-specific activities, frequently signaled by giving prized possessions away.

Q: The nurse explains that the person who is bulimic:
- Is severely underweight
- Alternates binge eating with purging
- Is an introverted perfectionist
- Has extremely close family relationships
A: Alternates binge eating with purging
If right: Bulimia is characterized by alternating binge eating and purge behavior.
If wrong: Bulimia is characterized by alternating binge eating and purge behavior.

Q: The statement made by a parent of an adolescent with anorexia nervosa indicating an understanding of this condition is:
- “There really isn’t anything to worry about. Don’t they say you can never be too thin?”
- “My daughter just doesn’t have much of an appetite.”
- “She is just trying to punish me for divorcing her father.”
- “She seems to see herself as fat, even though her weight is below normal.”
A: “She seems to see herself as fat, even though her weight is below normal.”
If right: Individuals with anorexia nervosa have a disturbed body image, which this parent correctly recognizes.
If wrong: Individuals with anorexia nervosa have a disturbed body image, which this parent correctly recognizes.