Chapter 29: The Child with Endocrine Dysfunction

Manifestations of hypoglycemia include which of the following? a. Lethargy b. Thirst c. Nausea and vomiting d. Shaky feeling and dizziness

d. Shaky feeling and dizziness Some of the clinical manifestations of hypoglycemia include shaky feelings; dizziness; difficulty concentrating, speaking, focusing, or coordinating; sweating; and pallor.

A child with GH deficiency is receiving GH therapy. When is the best time for the GH to be administered? a. At bedtime b. After meals c. Before meals d. On arising in the morning

a. At bedtime Injections are best given at bedtime to more closely approximate the physiologic release of GH.

Glucocorticoids, mineralocorticoids, and sex steroids are secreted by the: a. thyroid gland. b. parathyroid glands. c. adrenal cortex. d. anterior pituitary.

c. adrenal cortex. These hormones are secreted by the adrenal cortex.

The nurse is caring for an 11-year-old boy who has recently been diagnosed with diabetes. Which of the following should be included in the teaching plan for daily injections? a. The parents do not need to learn the procedure. b. He is old enough to give most of his own injections. c. Self-injections will be possible when he is closer to adolescence. d. He can learn about self-injections when he is able to reach all injection sites.

b. He is old enough to give most of his own injections. School-age children are able to give their own injections.

The nurse is caring for a child with suspected diabetes insipidus. Which of the following clinical manifestations would the nurse expect to observe? a. Oliguria b. Glycosuria c. Nausea and vomiting d. Polyuria and polydipsia

d. Polyuria and polydipsia Excessive urination accompanied by insatiable thirst is the primary clinical manifestation of diabetes. These symptoms may be so severe that the child does little other than drink and urinate.

Type 1 diabetes mellitus is suspected in an adolescent. Which of the following clinical manifestations may be present? a. Moist skin b. Weight gain c. Fluid overload d. Poor wound healing

d. Poor wound healing Poor wound healing may be present in an individual with type 1 diabetes mellitus.

Nursing care of a child diagnosed with syndrome of inappropriate ADH should include which of the following? (Select all that apply.) a. Weigh daily. b. Encourage fluids. c. Turn frequently. d. Maintain nothing by mouth (NPO). e. Restrict fluids.

ANS: A, E Increased secretion of ADH causes the kidney to reabsorb water, which increases fluid volume and decreases serum osmolarity with a progressive reduction in sodium concentration. The immediate management of the child is to restrict fluids. The child should also be weighed at the same time each day.

Which of the following clinical manifestations may occur in the child who is receiving too much propylthiouracil for the treatment of hyperthyroidism (Graves disease)? a. Seizures b. Enlargement of all lymph glands c. Pancreatitis or cholecystitis d. Lethargy and somnolence

d. Lethargy and somnolence Parents should be aware of the signs of hypothyroidism that can occur from overdosage of the drug. The most common manifestations are lethargy and somnolence.

A child eats some sugar cubes after experiencing symptoms of hypoglycemia. This rapid-releasing sugar should be followed by which of the following? a. Fat b. Fruit juice c. Several glasses of water d. Complex carbohydrate and protein

d. Complex carbohydrate and protein Symptoms of hypoglycemia are treated with a rapid-releasing sugar source followed by a complex carbohydrate and protein.

A goiter is an enlargement or hypertrophy of which gland? a. Thyroid b. Adrenal c. Anterior pituitary d. Posterior pituitary

a. Thyroid A goiter is an enlargement or hypertrophy of the thyroid gland

Which of the following is a condition that can result if hypersecretion of GH occurs after epiphyseal closure? a. Dwarfism b. Acromegaly c. Gigantism d. Cretinism

b. Acromegaly Excess GH after closure of the epiphyseal plates results in acromegaly.

Chronic adrenocortical insufficiency is also referred to as: a. Graves disease. b. Addison disease. c. Cushing syndrome. d. Hashimoto disease.

b. Addison disease. Addison disease is chronic adrenocortical insufficiency.

Exophthalmos (protruding eyeballs) may occur in children with which of the following conditions? a. Hypothyroidism b. Hyperthyroidism c. Hypoparathyroidism d. Hyperparathyroidism

b. Hyperthyroidism Exophthalmos is a clinical manifestation of hyperthyroidism.

Diabetes insipidus is a disorder of which of the following? a. Anterior pituitary b. Posterior pituitary c. Adrenal cortex d. Adrenal medulla

b. Posterior pituitary The principal disorder of posterior pituitary hypofunction is diabetes insipidus.

A neonate born with ambiguous genitalia is diagnosed with congenital adrenogenital hyperplasia. Therapeutic management includes administration of: a. vitamin D. b. cortisone. c. stool softeners. d. calcium carbonate.

b. cortisone. Cortisone is administered to suppress the abnormally high secretions of adrenocorticotropic hormone (ACTH). This in turn inhibits the secretion of adrenocorticosteroid, which stems the progressive virilization.

A nasal spray of desmopressin acetate (DDAVP) is used to treat: a. hypopituitarism. b. diabetes insipidus. c. acute adrenocortical insufficiency. d. syndrome of inappropriate ADH.

b. diabetes insipidus. The drug of choice for the treatment of diabetes insipidus is DDAVP, which is a synthetic analog of vasopressin.

The parents of a neonate with adrenogenital hyperplasia tell the nurse that they will be afraid to have any more children. The nurse should explain that: a. it is not hereditary. b. genetic counseling is indicated. c. it can be prevented during pregnancy. d. all future children will have the disorder.

b. genetic counseling is indicated. Some forms of adrenogenital hyperplasia are hereditary and should be referred for genetic counseling. Affected offspring should also be referred for genetic counseling.

Which of the following is considered a cardinal sign of diabetes mellitus? a. Nausea b. Seizures c. Impaired vision d. Frequent urination

d. Frequent urination Hallmarks of diabetes mellitus are glycosuria, polyuria, and polydipsia.

The nurse is teaching the parents of a child who is receiving propylthiouracil for the treatment of hyperthyroidism (Graves disease). Which of the following statements made by the parent indicates a correct understanding of the teaching? a. "I would expect my child to gain weight while taking this medication." b. "I would expect my child to experience episodes of ear pain while taking this medication." c. "If my child develops a sore throat and fever, I should contact the physician immediately." d. "If my child develops the stomach flu, my child will need to be hospitalized."

c. "If my child develops a sore throat and fever, I should contact the physician immediately." Children being treated with propylthiouracil must be carefully monitored for the side effects of the drug. Parents must be alerted that sore throat and fever accompany the grave complication of leukopenia. These symptoms should be immediately reported.

Which of the following is characteristic of the immune-mediated type 1 diabetes mellitus? a. Ketoacidosis is infrequent. b. Onset is gradual. c. Age at onset is usually younger than 20 years. d. Oral agents are often effective for treatment.

c. Age at onset is usually younger than 20 years. The immune-mediated type 1 diabetes mellitus typically has its onset in children or young adults.

At what age is sexual development in boys and girls considered to be precocious? a. Boys, 11 years; girls, 9 years b. Boys, 12 years; girls, 10 years c. Boys, 9 years; girls, 8 years d. Boys, 10 years; girls, 9-1/2 years

c. Boys, 9 years; girls, 8 years Manifestations of sexual development before age 9 in boys and age 8 in girls is considered precocious and should be investigated.

A parent asks the nurse why self-monitoring of blood glucose is being recommended for her child with diabetes. The nurse should base the explanation on which of the following? a. It is a less expensive method of testing. b. It is not as accurate as laboratory testing. c. Children are better able to manage the diabetes. d. The parents are better able to manage the disease.

c. Children are better able to manage the diabetes. Blood glucose self-management has improved diabetes management and can be used successfully by children from the time of diagnosis. Insulin dosages can be adjusted based on blood glucose results.

Which of the following is a common clinical manifestation of juvenile hypothyroidism? a. Insomnia b. Diarrhea c. Dry skin d. Accelerated growth

c. Dry skin Dry skin, mental decline, and myxedematous skin changes are associated with juvenile hypothyroidism.

To help the adolescent deal with diabetes, the nurse must consider which of the following characteristics of adolescence? a. Desire to be unique b. Preoccupation with the future c. Need to be perfect and similar to peers d. Need to make peers aware of the seriousness of hypoglycemic reactions

c. Need to be perfect and similar to peers Adolescence is a time when the individual wants to be perfect and similar to peers. Having diabetes makes adolescents different from their peers.

A child with hypopituitarism is being started on growth hormone (GH) therapy. Nursing considerations should be based on knowledge of which of the following? a. Treatment is most successful if it is started during adolescence. b. Treatment is considered successful if children attain full stature by adulthood. c. Replacement therapy requires daily subcutaneous injections. d. Replacement therapy will be required throughout child's lifetime.

c. Replacement therapy requires daily subcutaneous injections. Additional support is required for children who require hormone replacement therapy, such as preparation for daily subcutaneous injections and education for self-management during the school-age years.

Which of the following statements best describes hypopituitarism? a. Growth is normal during the first 3 years of life. b. Weight is usually more retarded than height. c. Skeletal proportions are normal for age. d. Most of these children have subnormal intelligence.

c. Skeletal proportions are normal for age. In children with hypopituitarism, the skeletal proportions are normal.

A child with hypoparathyroidism is receiving vitamin D therapy. The parents should be advised to watch for which of the following signs of vitamin D toxicity? a. Headache and seizures b. Physical restlessness and voracious appetite without weight gain c. Weakness and lassitude d. Anorexia and insomnia

c. Weakness and lassitude Vitamin D toxicity can be a serious consequence of therapy. Parents are advised to watch for signs, including weakness, fatigue, lassitude, headache, nausea, vomiting, and diarrhea. Renal impairment is manifested through polyuria, polydipsia, and nocturia.

The parents of a child who has just been diagnosed with type 1 diabetes ask about exercise. The nurse should explain that: a. exercise will increase blood glucose. b. exercise should be restricted. c. extra snacks are needed before exercise. d. extra insulin is required during exercise.

c. extra snacks are needed before exercise. Exercise lowers blood glucose levels, which can be compensated for by extra snacks.

Hyperglycemia associated with diabetic ketoacidosis is defined as a blood glucose measurement equal to or greater than: a. 185 mg/dl. b. 220 mg/dl. c. 280 mg/dl. d. 330 mg/dl.

d. 330 mg/dl. Diabetic ketoacidosis is a state of relative insulin insufficiency and may include the presence of hyperglycemia, a blood glucose level greater than or equal to 330 mg/dl.

The nurse is discussing with a child and family the various sites used for insulin injections. Which of the following sites usually has the fastest rate of absorption? a. Arm b. Leg c. Buttock d. Abdomen

d. Abdomen The abdomen has the fastest rate of absorption but the shortest duration.

The parent of a child with diabetes mellitus asks the nurse when urine testing will be necessary. The nurse should explain that urine testing for: a. glucose is needed before administration of insulin. b. glucose is needed four times a day. c. glycosylated hemoglobin is required. d. ketonuria should be done when it is suspected.

d. ketonuria should be done when it is suspected. Urine testing is still performed to detect evidence of ketonuria.

A child will start treatment for precocious puberty. This involves injections of synthetic: a. thyrotropin. b. gonadotropins. c. somatotropic hormone. d. luteinizing hormone-releasing hormone.

d. luteinizing hormone-releasing hormone. Precocious puberty of central origin is treated with monthly subcutaneous injections of luteinizing hormone-releasing hormone.