NURS 535 FINAL EXAM ACTUAL QUESTIONS AND
SOLUTIONS RATED A+
✔✔Clinical manifestations of CAH - ✔✔Males-precocious genital development
Females-may be born with varying degrees of ambiguous genitalia
-Enlarged clitoris appears as a small phallus
-Fused labia produce sac-like structure without testes
-Internal female sex organs are intact
✔✔Diagnostic evaluation CAH - ✔✔Hormonal studies
Serum electrolyte
US to visualize pelvic organs
Chromosomal typing for positive sex determination and to rule out other genetic
anomalies
✔✔CAH Treatment - ✔✔physiological dose of exogenous corticosteroids
✔✔Phenylketonuria (PKU) - ✔✔An inherited disorder of protein metabolism in which the
absence of an enzyme leads to a toxic buildup of certain compounds, causing
intellectual disability
✔✔PKU Treatment - ✔✔Newborn screening is done by use of Guthrie blood
test at 48 hours
The infant should ingest adequate protein (24 hours of formula or breast milk) prior to
test
Heel stick after 24 hours but no later than 7 days after birth
Treatment is protein restricted diet, mature breast
milk or modified protein hydrolysate formula with
phenylalanine removed
✔✔Type I DM - ✔✔Insulin deficiency leading to metabolic disorder characterized by
hyperglycemia due to autoimmune destruction of beta cells by T lymphocytes
Auto-antibodies against insulin can be present and seen many years before disease
develops)
✔✔Type II DM - ✔✔End organ insulin resistance leading to a metabolic disorder
characterized by hyperglycemia
✔✔Type II DM Treatment - ✔✔Sulfonureas (Glyburide and Glipizide)
-These drugs help the beta cells of the pancreas increase the release insulin
Biguanides (Metformin)
-The "insulin sensitizer" reduces hepatic glucose production
Glitazones (Avandia)
,-Enhances insulin action in skeletal muscle, adipose tissue, and liver; can decrease or
eliminate the need for insulin in type 2 diabetes
Alpha-glucosidase inhibitors (Acarbose)
-Reduces the rate of digestion of complex carbohydrates and the subsequent
absorption of glucose
✔✔Type I vs Type II DM - ✔✔Type I
•Insulin deficiency
•Abrupt onset
•Ketosis prone
•Generally not obese
•Insulin dependent
•Not responsive to oral agents
•Onset usually 18 years or younger
Type II
•Insulin resistance
•Insidious onset
•Not prone to ketosis
•Usually obese
•Non-insulin dependent
•Responsive to oral hypoglycemic medications
•Onset usually adult but seen in obese children and adolescents
✔✔Type 1/11 DM Diagnosis - ✔✔Clinical s/sx of hyperglycemia and acidosis if present
Ketonuria and glucosuria may also be present
Laboratory data:
-Fasting plasma glucose of >126mg/dL
-Random serum glucose >200mg/dL
-Glycosylated hemoglobin value (A1C) elevated
✔✔Illness management in Type I and II DM - ✔✔Continue Insulin Treatment
-Illness often increases the amount of insulin the body needs. Instruct parents that
insulin should never be withheld.
Stay close to the meal plan
-If the child has an upset stomach and can not eat, give clear liquids that contain
carbohydrates
Give plenty of liquids
-Encourage the child to drink-increase fluids
Choose medications wisely
-OTC may contain sugar and/or alcohol
,✔✔Clinical manifestations of DM - ✔✔Hypoglycemia
-Trembling, sweating, tachycardia, pallor, clammy skin
-Personality change, irritability, slurred speech, decreased LOC, seizures
Hyperglycemia
-3 P's-polyuria, polydipsia, polyphagia
-Fatigue, wt loss, blurred vision, emotional labiality, headache, hunger
Ketoacidosis
-Hyperglycemia symptoms PLUS abdominal pain, chest pain, Kussmaul respirations,
N/V, acetone breath, dehydration
-Lethargy, decreased LOC, coma
✔✔Insulin therapy - ✔✔Insulin therapy:
Rapid Acting
Humalog; Novolog
Short-acting insulin (Regular)
Humulin R, Novolin R (Regular Insulin)
Intermediate
Humulin N; Novolin NPH
Combinations: NPH/Regular
Long Acting
Glargine (Lantus)
✔✔Diabetic ketoacidosis - ✔✔Acidity of the blood caused by the presence of ketone
bodies produced when the body is unable to burn sugar; thus, it must burn fat for
energy
✔✔Type I DM Illness Management - ✔✔Check blood glucose and ketone levels
frequently
•Diabetic ketoacidosis is a danger when the child is sick
•To prevent the condition or catch it early check the child's blood glucose levels often
(every few hours) while sick
•Check the urine for ketones several times a day. If vomiting or diarrhea are present,
check ketones more frequently.
✔✔Type I DM - Foods for sick days - ✔✔Fluids: Popsicle, sports drink, soup, fruit juice
Solids: Crackers, graham crackers, toast, mashed potatoes, gelatin dessert
✔✔Long term complications of diabetes - ✔✔1. End stage renal disease
2. Lower limb Amputation
3. Eye Complications
, 4. Neuropathy
5. Retinopathy
6. Nephropathy
✔✔Type I DM Developmental Issues - ✔✔Infant
•Rapid growth
•Continuing brain development
•Trusting relationship with parents
•Erratic eating habits
•Erratic sleep patterns
•Treatment schedule is difficult to keep because of feeding and sleeping patterns
Toddler
•Can participate in some self care
•Look for parental approval while they test their limits
•Show decreased appetite and picky eating habits
•Begin to show more regular sleep patterns
•Difficult to distinguish a low blood sugar reaction from a normal temper tantrum
Preschool
•Peer issues begin to emerge
•Can understand rules
•Can preform more self care including blood tests under parental supervision
•Eating behavior is less erratic
•Very energetic, hypoglycemia can be a problem
•Regular sleep patterns
•May be more challenging to supply with snacks and meals that match what siblings
and friends eat
School age
•Fear of being different from other children
•Can preform most self-care including blood tests and insulin injections
•Eager to learn
•Beginning to understand consequences of their actions
•Tests independent decision making
•Most time spent away from home
Early Adolescence
•Erratic growth which affects insulin requirements
•Glucose control may be erratic in spite of everyone's best efforts
•Concerned about body image
•Greatly influenced by friends
•May change authority
•Development of self esteem
•Beginning to understand abstract concepts
SOLUTIONS RATED A+
✔✔Clinical manifestations of CAH - ✔✔Males-precocious genital development
Females-may be born with varying degrees of ambiguous genitalia
-Enlarged clitoris appears as a small phallus
-Fused labia produce sac-like structure without testes
-Internal female sex organs are intact
✔✔Diagnostic evaluation CAH - ✔✔Hormonal studies
Serum electrolyte
US to visualize pelvic organs
Chromosomal typing for positive sex determination and to rule out other genetic
anomalies
✔✔CAH Treatment - ✔✔physiological dose of exogenous corticosteroids
✔✔Phenylketonuria (PKU) - ✔✔An inherited disorder of protein metabolism in which the
absence of an enzyme leads to a toxic buildup of certain compounds, causing
intellectual disability
✔✔PKU Treatment - ✔✔Newborn screening is done by use of Guthrie blood
test at 48 hours
The infant should ingest adequate protein (24 hours of formula or breast milk) prior to
test
Heel stick after 24 hours but no later than 7 days after birth
Treatment is protein restricted diet, mature breast
milk or modified protein hydrolysate formula with
phenylalanine removed
✔✔Type I DM - ✔✔Insulin deficiency leading to metabolic disorder characterized by
hyperglycemia due to autoimmune destruction of beta cells by T lymphocytes
Auto-antibodies against insulin can be present and seen many years before disease
develops)
✔✔Type II DM - ✔✔End organ insulin resistance leading to a metabolic disorder
characterized by hyperglycemia
✔✔Type II DM Treatment - ✔✔Sulfonureas (Glyburide and Glipizide)
-These drugs help the beta cells of the pancreas increase the release insulin
Biguanides (Metformin)
-The "insulin sensitizer" reduces hepatic glucose production
Glitazones (Avandia)
,-Enhances insulin action in skeletal muscle, adipose tissue, and liver; can decrease or
eliminate the need for insulin in type 2 diabetes
Alpha-glucosidase inhibitors (Acarbose)
-Reduces the rate of digestion of complex carbohydrates and the subsequent
absorption of glucose
✔✔Type I vs Type II DM - ✔✔Type I
•Insulin deficiency
•Abrupt onset
•Ketosis prone
•Generally not obese
•Insulin dependent
•Not responsive to oral agents
•Onset usually 18 years or younger
Type II
•Insulin resistance
•Insidious onset
•Not prone to ketosis
•Usually obese
•Non-insulin dependent
•Responsive to oral hypoglycemic medications
•Onset usually adult but seen in obese children and adolescents
✔✔Type 1/11 DM Diagnosis - ✔✔Clinical s/sx of hyperglycemia and acidosis if present
Ketonuria and glucosuria may also be present
Laboratory data:
-Fasting plasma glucose of >126mg/dL
-Random serum glucose >200mg/dL
-Glycosylated hemoglobin value (A1C) elevated
✔✔Illness management in Type I and II DM - ✔✔Continue Insulin Treatment
-Illness often increases the amount of insulin the body needs. Instruct parents that
insulin should never be withheld.
Stay close to the meal plan
-If the child has an upset stomach and can not eat, give clear liquids that contain
carbohydrates
Give plenty of liquids
-Encourage the child to drink-increase fluids
Choose medications wisely
-OTC may contain sugar and/or alcohol
,✔✔Clinical manifestations of DM - ✔✔Hypoglycemia
-Trembling, sweating, tachycardia, pallor, clammy skin
-Personality change, irritability, slurred speech, decreased LOC, seizures
Hyperglycemia
-3 P's-polyuria, polydipsia, polyphagia
-Fatigue, wt loss, blurred vision, emotional labiality, headache, hunger
Ketoacidosis
-Hyperglycemia symptoms PLUS abdominal pain, chest pain, Kussmaul respirations,
N/V, acetone breath, dehydration
-Lethargy, decreased LOC, coma
✔✔Insulin therapy - ✔✔Insulin therapy:
Rapid Acting
Humalog; Novolog
Short-acting insulin (Regular)
Humulin R, Novolin R (Regular Insulin)
Intermediate
Humulin N; Novolin NPH
Combinations: NPH/Regular
Long Acting
Glargine (Lantus)
✔✔Diabetic ketoacidosis - ✔✔Acidity of the blood caused by the presence of ketone
bodies produced when the body is unable to burn sugar; thus, it must burn fat for
energy
✔✔Type I DM Illness Management - ✔✔Check blood glucose and ketone levels
frequently
•Diabetic ketoacidosis is a danger when the child is sick
•To prevent the condition or catch it early check the child's blood glucose levels often
(every few hours) while sick
•Check the urine for ketones several times a day. If vomiting or diarrhea are present,
check ketones more frequently.
✔✔Type I DM - Foods for sick days - ✔✔Fluids: Popsicle, sports drink, soup, fruit juice
Solids: Crackers, graham crackers, toast, mashed potatoes, gelatin dessert
✔✔Long term complications of diabetes - ✔✔1. End stage renal disease
2. Lower limb Amputation
3. Eye Complications
, 4. Neuropathy
5. Retinopathy
6. Nephropathy
✔✔Type I DM Developmental Issues - ✔✔Infant
•Rapid growth
•Continuing brain development
•Trusting relationship with parents
•Erratic eating habits
•Erratic sleep patterns
•Treatment schedule is difficult to keep because of feeding and sleeping patterns
Toddler
•Can participate in some self care
•Look for parental approval while they test their limits
•Show decreased appetite and picky eating habits
•Begin to show more regular sleep patterns
•Difficult to distinguish a low blood sugar reaction from a normal temper tantrum
Preschool
•Peer issues begin to emerge
•Can understand rules
•Can preform more self care including blood tests under parental supervision
•Eating behavior is less erratic
•Very energetic, hypoglycemia can be a problem
•Regular sleep patterns
•May be more challenging to supply with snacks and meals that match what siblings
and friends eat
School age
•Fear of being different from other children
•Can preform most self-care including blood tests and insulin injections
•Eager to learn
•Beginning to understand consequences of their actions
•Tests independent decision making
•Most time spent away from home
Early Adolescence
•Erratic growth which affects insulin requirements
•Glucose control may be erratic in spite of everyone's best efforts
•Concerned about body image
•Greatly influenced by friends
•May change authority
•Development of self esteem
•Beginning to understand abstract concepts
