HESI case study – Pediatrics – Diabetes Type I (Anya) – Flashcards
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1. According to Erickson, in what stage of development is Anya?
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Initiative vs. guilt
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2. Which immunizations should be administered?
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IPV, MMR, Varicella, DtaP
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3. Which assessment findings are of concern to the nurse?
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- vision results of 20/50 -Ketones +2 in urine -serum glucose of 210 mg/dL
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4. What nursing action provides the most complete health profile for this family?
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genogram and ecomap
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5. The nurse must briefly explain to the parents what is happening in Anya's body. What is the best explanation by the nurse?
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There is a destruction of pancreatic cells, which causes a decrease in insulin production
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6. What approach to care is the most indicative to Anya and her parents?
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Management of care is a collaboration between members of an interdisciplinary team
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7. Anya's initial plan of treatment includes three main elements. What elements are implemented by the interdisciplinary team?
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INsulin therapy, supervision, nutrition
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8. When establishing the nursing plan of care, what is the most significant potential problem related to this new diagnosis?
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risk for hypoglycemia, related to the illness
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9. Considering the potential problem of hypoglycemia, what nursing intervention has the highest priority?
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emphasize the importance of daily blood glucose monitoring
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10. Parents confess they are uncomfortable given the injections for fear of harming Anya. What nursing intervention has the highest priority at this time?
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probe further to ascertain the parent's concern
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11. The nurse must aim her teaching towards Anya and her parents. What element is essential to consider when teaching to Anya?
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Stage of development
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12. When evaluating the effectiveness of parental education, what results demonstrate an understanding of the care of a child with diabetes?
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The parents verbalize the importance of insulin injections.
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13. The insulin therapy protocol used with Anya consists of three insulin injections a day. Which insulin regimen would Anya use at bedtime?
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one dose of intermediate insulin
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14. the parents ask the nurse for the best site to administer Anya's insulin injections. What is the most appropriate answer from the nurse?
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the abdomen is the most appropriate site
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15. Anya's plan also includes adequate nutritional intake. What assessment findings would indicate to the nurse that the client's goal is being met?
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Measure Anya's weight and height on a regularly scheduled basis.
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16. Anya told her parents she has headaches and often feels dizzy. Based on these complaints, what nursing diagnosis has the highest priority?
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risk of hypoglycemia, related to the illness
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17. In presence of this potential problem, what is the best advice to give Anya's parents?
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give the child orange juice
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18. The home-care nurse wants to verify that Anya's family is adequately adapting to Anya's illness and treatment. To elicit this information, what is the most appropriate action by the nurse?
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Discuss with the family about their current lifestyle.
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19. What test does the nurse understand to be the most accurate in establishing if Anya's diabetes is well controlled?
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Glycosylated hemoglobin
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20. Which assessment findings are consistent with this diagnosis?
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nausea, fruity breath, ketonuria
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21. When providing care for Anya, which intervention has the highest priority?
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placing an IV line
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22. Which diagnostic assessment tool will provide the nurse with the most information related to Anya's level of consciousness?
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pediatric coma scale
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23. Anya's dehydration and ketoacidosis are corrected and she is ready to be discharged. When planning for Anya's discharge, what priority topics should the nurse include in the teaching plan?
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-the adjustment of insulin dosages in the presence of illness -detection of signs of hypoglycemia
