Chapter 33: The Child with Endocrine Dysfunction
The parent of a 10-year-old child with diabetes asks the nurse why home blood glucose monitoring is being recommended. The nurse should base the explanation on which of the following? It is an easier method of testing. Parents are better able to manage the diabetes. Children have a greater sense of control over the diabetes. Fewer visits to the primary care provider will be necessary.
Children have a greater sense of control over the diabetes. Blood glucose monitoring affords the child a greater sense of control. The immediate feedback allows for regulation of insulin doses. Home blood glucose monitoring provides a more accurate assessment of control than urine testing. Although the parents are involved in the management, a 10-year-old child should take responsibility for testing. The same number of visits will be necessary, but the blood glucose monitoring will enable better control.Level of cognitive ability: AnalysisArea of client needs: Physiologic Integrity/Physiologic AdaptationIntegrated process: Teaching/LearningREF: p. 1524
Which of the following should the nurse include when discussing a child's precocious puberty with the parents? The child is not yet fertile. Heterosexual interest is usually advanced. Dress and activities should be appropriate to chronologic age. Appearance of secondary sexual characteristics does not proceed in the usual order.
Dress and activities should be appropriate to chronologic age. Because of the early sexual maturation of the child, both the family and child require extensive teaching. Included in this is the information that the child should be engaged in activities according to chronologic age. Functioning sperm or ova may be produced, thereby making the child fertile at an early age. Heterosexual interest is usually appropriate to chronologic age. Development of the secondary sexual characteristics proceeds in the usual order.Level of cognitive ability: AnalysisArea of client needs: Psychosocial Integrity/Coping and AdaptationIntegrated process: Teaching/LearningREF: p. 1502
A 13-year-old girl is brought to the clinic with the complaint of insomnia and hyperactivity. Other symptoms include gradual weight loss despite a good appetite; warm, flushed, and moist skin; and unusually fine hair. These manifestations are most suggestive of which of the following? Hypothyroidism Hyperthyroidism Hypoparathyroidism Hyperparathyroidism
Hyperthyroidism These symptoms are suggestive of hyperthyroidism. Other symptoms include academic difficulties resulting from a short attention span and an inability to sit still, unexplained fatigue and sleeplessness, and difficulty with fine motor skills. Hypothyroidism is seen with decelerated growth from chronic deprivation of thyroid hormone. Other manifestations are myxedematous skin changes (dry skin, puffiness around the eyes, sparse hair), constipation, sleepiness, and mental decline. Early manifestations of hypoparathyroidism may be anxiety and mental depression followed by paresthesia and evidence of heightened neuromuscular excitability. Hyperparathyroidism results in hypercalcemia, which can be manifested by a change in behavior, gastrointestinal symptoms, and cardiac irregularities.Level of cognitive ability: ComprehensionArea of client needs: Physiologic Integrity/Physiologic AdaptationIntegrated process: Nursing Process: AssessmentREF: p. 1505
Which of the following statements best describes Cushing syndrome? It is caused by excessive production of cortisol. Treatment involves replacement of cortisol. The major clinical features are exophthalmia and pigmentary changes. The diagnosis is suspected with findings of hypotension, hyperkalemia, and polyuria.
It is caused by excessive production of cortisol. Cushing syndrome is a description of the clinical manifestations caused by too much circulating cortisol. In children, this is caused by a tumor or excessive and prolonged steroid therapy. The treatment is reduction of circulating cortisol. If the cause is a pituitary tumor, surgery is indicated. Exophthalmia is a manifestation of hyperthyroidism, not Cushing syndrome. Hypertension and hypokalemia are expected findings.Level of cognitive ability: ComprehensionArea of client needs: Physiologic Integrity/Physiologic AdaptationIntegrated process: Nursing Process: AssessmentREF: p. 1514
Which of the following is the primary clinical manifestation of diabetes insipidus? Oliguria Glycosuria Nausea, vomiting Polyuria, polydipsia
Polyuria, polydipsia Diabetes insipidus results from the hyposecretion of antidiuretic hormone. Because insufficient amounts are produced, excessive amounts of urine are produced. When allowed access to fluids, the child maintains balance with an almost insatiable thirst. Oliguria is diminished urinary output. Children with diabetes insipidus have increased urinary output. Glycosuria is not a manifestation of diabetes insipidus. It may be a manifestation of diabetes mellitus. Nausea and vomiting are not manifestations of diabetes insipidus. They can occur with oversecretion of antidiuretic hormone.Level of cognitive ability: ComprehensionArea of client needs: Physiologic Integrity/Physiologic AdaptationIntegrated process: Nursing Process: AssessmentREF: p. 1503
The nurse is caring for a child hospitalized with acute adrenocortical insufficiency. Because of the sudden, severe nature of the disease, the family needs a great deal of emotional support. The most appropriate nursing action is which of the following? Prepare the family for the child's impending death. Prepare the family for each procedure. Prepare the family for the long-term consequences of paralysis. Reassure the family that flaccid paralysis is not problematic.
Prepare the family for each procedure. By preparing the family for each procedure, the nurse is showing sensitivity to the family's emotional needs. Acute adrenocortical insufficiency is a reversible condition when associated with adrenocortical insufficiency. Flaccid paralysis is problematic if not reversible.Level of cognitive ability: AnalysisArea of client needs: Physiologic Integrity/Physiologic AdaptationIntegrated process: Teaching/LearningREF: p. 1512
Which of the following statements best describes hypopituitarism? Skeletal proportions are normal for age. Weight is usually more retarded than height. Growth is normal during the first 3 years of life. Most of these children have subnormal intelligence.
Skeletal proportions are normal for age. Skeletal proportions are normal for age, but these children appear young for their age. Growth in height is usually more delayed than in weight. Growth is normal for the first year of age, and then these children follow a slowed growth curve. Most of the children have normal intelligence. Often they are considered precocious because their educational ability seems to exceed their size. Emotional problems are common because of their small stature.Level of cognitive ability: ComprehensionArea of client needs: Physiologic Integrity/Physiologic AdaptationIntegrated process: Nursing Process: AssessmentREF: p. 1496
A school-age child recently diagnosed with type 1 diabetes mellitus asks the nurse if he can still play soccer, play baseball, and swim. The nurse's response should be based on knowledge that exercise is contraindicated. the level of activity depends on the type of insulin required. exercise is not restricted unless indicated by other health conditions. soccer and baseball are too strenuous, but swimming is acceptable.
exercise is not restricted unless indicated by other health conditions. Exercise is encouraged for children with diabetes because it lowers blood glucose levels. Insulin and meal requirements require careful monitoring to ensure that the child has sufficient energy for exercise. Exercise is highly encouraged. The decrease in blood glucose can be accommodated by having snacks available. The level of activity is not dependent on the type of insulin used. Long- and short-acting insulin both may be used to compensate for the effects of training and sporting events. Sports are encouraged to help regulate the insulin, and food should be adjusted according to the amount of exercise. The child needs to be cautioned to monitor responses to the exercise.Level of cognitive ability: AnalysisArea of client needs: Physiologic Integrity/Physiologic AdaptationIntegrated process: Teaching/LearningREF: p. 1527
The nurse should recognize that when a child develops diabetic ketoacidosis, this is which of the following? Expected outcome Best treated at home A life-threatening situation Best treated at practitioner's office or clinic
A life-threatening situation Diabetic ketoacidosis is the state of complete insulin deficiency. It is a medical emergency that must be diagnosed and treated. The child is usually admitted to an intensive care unit for assessment, insulin administration, and fluid and electrolyte replacement. Diabetic ketoacidosis is a medical emergency needing prompt assessment and intervention, usually in an intensive care environment.Level of cognitive ability: AnalysisArea of client needs: Physiologic Integrity/Physiologic AdaptationIntegrated process: Teaching/Learning; Nursing Process: EvaluationREF: p. 1530
