Chapter 47: Endocrine Dysfunction

A child with growth hormone (GH) deficiency is receiving GH therapy. What 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

The nurse is implementing care for a school-age child admitted to the pediatric intensive care experiencing symptomology associated with diabetic ketoacidosis (DKA). Which prescribed intervention should the nurse implement first? a. Begin 0.9% saline solution intravenously as prescribed. b. Administer regular insulin intravenously as prescribed. c. Place child on a cardiac monitor. d. Place child on a pulse oximetry monitor.

A: Begin 0.9% saline solution intravenously as prescribed.

The nurse should expect to assess which clinical manifestations in an adolescent with Cushing's syndrome? (Select all that apply.) a. Hyperglycemia b. Hyperkalemia c. Hypotension d. Cushingoid features e. Susceptibility to infections

A: Hyperglycemia D: Cushingoid features E: Susceptibility to infections

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

A: Weigh daily E: Restrict fluids

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

A: thyroid

Which children admitted to the pediatric unit would the nurse monitor closely for development of syndrome of inappropriate antidiuretic hormone (SIADH)? (Select all that apply.) a. A newly diagnosed preschooler with type 1 diabetes. b. A school-age child returning from surgery for removal of a brain tumor. c. An infant with suspected meningitis. d. An adolescent with blunt abdominal trauma following a car accident. e. A school-age child with head trauma.

B: A school-age child returning from surgery for removal of a brain tumor. C: An infant with suspected meningitis. E: A school-age child with head trauma.

Chronic adrenocortical insufficiency is also referred to as what? a. Graves' disease b. Addison's disease c. Cushing's syndrome d. Hashimoto's disease

B: Addison's disease

A neonate born with ambiguous genitalia is diagnosed with congenital adrenogenital hyperplasia. Therapeutic management includes administration of which medication? a. Vitamin D b. Cortisone c. Stool softeners d. Calcium carbonate

B: Cortisone

A nurse is reviewing the laboratory results on a school-age child diagnosed with hypoparathyroidism. Which results are consistent with this condition? a. Decreased serum phosphorus b. Decreased serum calcium c. Increased serum glucose d. Decreased serum cortisol

B: Decreased serum calcium

What is the most appropriate intervention for the parents of a 6-year-old girl with precocious puberty? a. Advise the parents to consider birth control for their daughter. b. Explain the importance of having the child foster relationships with same-age peers. c. Assure the child's parents that there is no increased risk for sexual abuse because of her appearance. d. Counsel parents that there is no treatment currently available for this disorder.

B: Explain the importance of having the child foster relationships with same-age peers.

The nurse is caring for an 11-year-old boy who has recently been diagnosed with diabetes. What 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.

Which laboratory finding confirms that a child with type 1 diabetes is experiencing diabetic ketoacidosis? a. No urinary ketones b. Low arterial pH c. Elevated serum carbon dioxide d. Elevated serum phosphorus

B: Low arterial pH

What should a nurse advise the parents of a child with type 1 diabetes mellitus who is not eating as a result of a minor illness? a. Give the child half his regular morning dose of insulin. b. Substitute simple carbohydrates or calorie-containing liquids for solid foods. c. Give the child plenty of unsweetened, clear liquids to prevent dehydration. d. Take the child directly to the emergency department.

B: Substitute simple carbohydrates or calorie-containing liquids for solid foods.

An adolescent is being seen in the clinic for evaluation of acromegaly. The nurse understands that which event occurs with acromegaly? a. There is a lack of growth hormone (GH) being produced. b. There is excess GH after closure of the epiphyseal plates. c. There is an excess of GH before the closure of the epiphyseal plates. d. There is a lack of thyroid hormone being produced.

B: There is excess GH after closure of the epiphyseal plates.

A child is diagnosed with juvenile hypothyroidism. The nurse should expect to assess which symptoms associated with hypothyroidism? (Select all that apply.) a. Weight loss b. fatigue/sleepiness c. Diarrhea d. Puffiness around the eyes/Dry, thick skin e. Spare hair/Cold intolerance

B: fatigue/sleepiness D: Puffiness around the eyes/Dry, thick skin E: Spare hair/Cold intolerance

Exophthalmos may occur in children with what diagnosis? a. Hypothyroidism b. Hyperthyroidism c. Hypoparathyroidism d. Hyperparathyroidism

B: hyperthyroidism

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

B: posterior pituitary

The nurse is teaching the parents of a child who is receiving propylthiouracil for the treatment of hyperthyroidism (Graves' disease). Which statement 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."

Glucocorticoids, mineralocorticoids, and sex steroids are secreted by which organ? a. Thyroid gland b. Parathyroid glands c. Adrenal cortex d. Anterior pituitary

C: Adrenal cortex

What is the 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 18 years d. Oral agents are often effective for treatment

C: Age at onset is usually younger than 18 years

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, 9.5 years

C: Boys, 9 years; girls, 8 years

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 what information? a. It is a less expensive method of testing. b. It is not as accurate as laboratory testing. c. Children need to learn to manage their diabetes. d. The parents are better able to manage the disease.

C: Children need to learn to manage their diabetes.

The nurse is admitting a toddler with the diagnosis of juvenile hypothyroidism. Which is a common clinical manifestation of this disorder? a. Insomnia b. Diarrhea c. Dry skin d. Accelerated growth

C: Dry skin

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

C: Dry skin

The parents of a child who has just been diagnosed with type 1 diabetes ask about exercise. The nurse should provide the parents with what information to address the child's safety needs? 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.

The nurse is caring for a school-age child with hyperthyroidism (Graves' disease). Which clinical manifestations should the nurse monitor that may indicate a thyroid storm? (Select all that apply.) a. Constipation b. Hypotension c. Hyperthermia d. Tachycardia e. Vomiting

C: Hyperthermia D: Tachycardia E: Vomiting

To help the adolescent deal with diabetes, the nurse must consider which characteristic 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

A nurse is planning care for a school-age child diagnosed with type 1 diabetes. Which insulin preparations are either rapid or short acting? (Select all that apply.) a. Novolin N b. Lantus c. NovoLog d. Novolin R

C: NovoLog D: Novolin R

A child diagnosed with hypopituitarism is being started on growth hormone (GH) therapy. Nursing considerations should be based on which information? 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 the child's lifetime.

C: Replacement therapy requires daily subcutaneous injections.

Which statement best describes idiopathic 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.

What is the priority nursing goal for a 14 year old diagnosed with Graves' disease? a. Relieving constipation b. Allowing the adolescent to make decisions about whether or not to take medication c. Verbalizing the importance of adherence to the medication regimen d. Developing alternative educational goals

C: Verbalizing the importance of adherence to the medication regimen

A child diagnosed with hypoparathyroidism is receiving vitamin D therapy. The parents should be advised to watch for which sign 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

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

D: Frequent urination

The parent of a child diagnosed with diabetes mellitus asks the nurse when urine testing will be necessary. The nurse should explain that urine testing is necessary for which reason? a. Glucose is needed before administration of insulin. b. Glucose is needed 4 times a day. c. Glycosylated hemoglobin is required. d. Ketonuria is suspected.

D: Ketonuria is suspected.

The nurse is caring for a child with suspected diabetes insipidus. Which clinical manifestation would be observable? a. Oliguria b. Glycosuria c. Nausea and vomiting d. Polyuria and polydipsia

D: Polyuria and polydipsia

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

D: Poor wound healing

What are the manifestations of hypoglycemia? a. Lethargy b. Thirst c. Nausea and vomiting d. Shaky feeling and dizziness

D: Shaky feeling and dizziness

Which clinical manifestation may occur in the child who is prescribed methimazole for the treatment of hyperthyroidism (Graves' disease)? a. Seizures b. Enlargement of all lymph glands c. Pancreatitis or cholecystitis d. Sore throat or fever (Lethargy and somnolence)

D: Sore throat or fever (Lethargy and somnolence)

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

D: abdomen

A child eats some sugar cubes after experiencing symptoms of hypoglycemia. This rapid-releasing sugar should be followed by: a. saturated and unsaturated fat. b. fruit juice. c. several glasses of water. d. complex carbohydrate and protein.

D: complex carbohydrate and protein.

A child will start treatment for precocious puberty. This involves injections of which synthetic medication? a. Thyrotropin b. Gonadotropins c. Somatotropic hormone d. Luteinizing hormone-releasing hormone

D: luteinizing hormone-releasing hormone.