Chapter 48: Nursing Care of the Child With an Alteration in Metabolism/Endocrine Disorder - ML4

Correct response: "Special cells in a part of your body called the pancreas cannot make a chemical called insulin, which helps control the sugar level in your blood." Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 48: Nursing Care of the Child With an Alteration in Metabolism/Endocrine Disorder, DIABETES MELLITUS, p. 1799. Explanation: When providing instruction to a child, the nurse must consider the developmental age. Type 1 diabetes is a disorder that involves an absolute or relative deficiency of insulin, in contrast to type 2 where insulin production is only reduced. Insulin is produced by beta islet cells in the pancreas. Diabetes insipidus is caused by the pituitary gland not producing enough ADH and is characterized by extreme thirstiness and polyuria. Insufficient growth hormone is also related to dysfunction of the pituitary gland.

A 10-year-old child has been diagnosed with type 1 diabetes mellitus. The child is curious about the cause of the disease and asks the nurse to explain it. Which explanation will the nurse provide? "Special cells in a part of your body called the pancreas cannot make a chemical called insulin, which helps control the sugar level in your blood." "The part of your body called the pancreas is broken and produces too much chemical called glucagon, which makes you really thirsty and have to go to the bathroom a lot." "The pancreas inside your belly makes enough chemical called insulin, but your body does not want to use it to keep your blood sugar level normal." "The alpha and beta cells in your pancreas are fighting against each other; that is why your blood sugar stays high and you need insulin injection."

Correct response: 8.5% Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 48: Nursing Care of the Child With an Alteration in Metabolism/Endocrine Disorder, DIABETES MELLITUS, p. 1803. Explanation: The goal for hemoglobin A1C in children between the ages of 6 and 12 years is less than 8%. Therefore, a result of 8.5% would indicate that additional intervention is needed to achieve the recommended goal.

A 10-year-old child is newly diagnosed with type 1 diabetes. The child's hemoglobin A1C level is being monitored. The nurse determines that additional intervention is needed with the child based on which result? 6.5% 7.5 % 7.0% 8.5%

Correct response: hypocalcemia Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 48: Nursing Care of the Child With an Alteration in Metabolism/Endocrine Disorder, TABLE 48.2 Parathyroid Disorders, p. 1794. Hypoparathyroidism results in low production of PTH which in turn leads to hypocalcemia and hyperphosphatemia.

A child is diagnosed with hypoparathyroidism. Which electrolyte imbalance would the nurse most likely expect to address? hypomagnesemia hyperkalemia hypocalcemia hyponatremia

Correct response: Do not mix this insulin with other insulins. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 48: Nursing Care of the Child With an Alteration in Metabolism/Endocrine Disorder, DIABETES MELLITUS, p. 1801. Glargine (Lantus) is not to be mixed with other insulins. Glargine is usually given in a single dose at bedtime. Insulin should be kept at room temperature; insulin that is administered cold may increase discomfort with the injection. Any vial of insulin that is opened should be discarded after 1 month.

A child is prescribed glargine insulin. What information would the nurse include when teaching the child and parents about this insulin? Do not mix this insulin with other insulins. Store the insulin in the refrigerator until just before giving it. Give the dose first thing in the morning. Discard any opened vials after a week.

Correct response: Regular insulin Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 48: Nursing Care of the Child With an Alteration in Metabolism/Endocrine Disorder, DIABETES MELLITUS, p. 1799. Explanation: Insulin for diabetic ketoacidosis is given intravenously. Only regular insulin can be administered by this route.

A child who has type 1 diabetes mellitus is brought to the emergency department and diagnosed with diabetic ketoacidosis. What treatment would the nurse expect to administer? NPH Regular insulin Lispro Detemir

Correct response: Elevate the subcutaneous tissue before the injection. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 48: Nursing Care of the Child With an Alteration in Metabolism/Endocrine Disorder, DIABETES MELLITUS, p. 1800.

A nurse is reviewing with an 8-year-old how to self-administer insulin. Which of the following is the proper injection technique for insulin injections? Place the needle with the bevel facing down before the injection. Elevate the subcutaneous tissue before the injection. Spread the skin before the injection. Aspirate the syringe for blood return before the injection.

Correct response: "So, hypothyroidism can be treated by exposing our baby to a special light, right?" Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 48: Nursing Care of the Child With an Alteration in Metabolism/Endocrine Disorder, Congenital Hypothyroidism, p. 1789. Explanation: Congenital hypothyroidism can be permanent or transient and may result from a defective thyroid gland or an enzymatic defect in thyroxine synthesis. Only the last question, which refers to phototherapy for physiologic jaundice, indicates that the parents need more information.

After explaining the causes of hypothyroidism to the parents of a newly diagnosed infant, the nurse should recognize that further education is needed when the parents ask which question? "Do you mean that hypothyroidism may be caused by a problem in the way the body makes thyroxine?" "Are you saying that hypothyroidism is caused by a problem in the way the thyroid gland develops?" "So, hypothyroidism can be treated by exposing our baby to a special light, right?" "So, hypothyroidism can be only temporary, right?"

Correct response: Administration of levothyroxine indefinitely Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 48: Nursing Care of the Child With an Alteration in Metabolism/Endocrine Disorder, DRUG GUIDE 48.1 Common Drugs for Endocrine Disorders, p. 1781. Explanation: The treatment for hypothyroidism is oral administration of synthetic thyroid hormone or sodium levothyroxine. A small dose is given at first, and then the dose is gradually increased to therapeutic levels. The child needs to continue taking the synthetic thyroid hormone indefinitely to supplement that which the thyroid does not make. Vitamin K is not needed. Supplemental vitamin D, and not calcium, may be given to prevent the development of rickets when rapid bone growth begins. Supplemental vitamin C is not indicated for this disorder.

Prior to discharging an infant with congenital hypothyroidism to home with the parents, what should the nurse emphasize regarding the care that this child will need going forward? An increased intake of calcium beginning immediately Administration of vitamin C until after growth is complete Vitamin K administration until school age Administration of levothyroxine indefinitely

Correct response: recent weight loss Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 48: Nursing Care of the Child With an Alteration in Metabolism/Endocrine Disorder, COMPARISON CHART 48.3 Type 1 Versus Type 2 Diabetes Mellitus, pp. 1804-1805.

The nurse is assessing a 5-year-old child whose parent reports the child has been vomiting lately, has no appetite, and has had an extreme thirst. Laboratory work for diabetes is being completed. Which symptom would differentiate between type 1 diabetes from type 2 diabetes? blood pressure of 142/92 mm Hg slow healing wounds loose stools recent weight loss

Correct response: The child is allergic to shellfish. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 48: Nursing Care of the Child With an Alteration in Metabolism/Endocrine Disorder, COMMON LABORATORY AND DIAGNOSTIC TESTS 48.1, p. 1777.

The nurse is preparing a child suspected of having a thyroid disorder for a thyroid scan. What information regarding the child should the nurse alert the doctor or nuclear medicine department about? The child wears a medical alert bracelet for diabetes. The child is taking a vitamin supplement. The child is allergic to shellfish. The child has had an MRI of their leg within the past 6 weeks.

Correct response: draws up the short-acting insulin into the syringe first. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 48: Nursing Care of the Child With an Alteration in Metabolism/Endocrine Disorder, DIABETES MELLITUS, p. 1804. Explanation: Drawing up the short-acting insulin first prevents mixing a long-acting form into the vial of short-acting insulin. This maintains the short-acting insulin for an emergency. Insulin is given subcutaneously not intramuscularly. A SQ injection is administered at a 90-degree angle if the person can grasp 2 in (5 cm) of skin. If only 1 in (2.5 cm) of skin can be grasped, then the injection should be given at a 45 degree angle. The needle is sterile. It should not be wiped with an alcohol swab. Only the top of the insulin vial should be wiped with an alcohol swab.

The nurse is teaching a child with type 1 diabetes mellitus to administer insulin. The child is receiving a combination of short-acting and long-acting insulin. The nurse knows that the child has appropriately learned the technique when the child: administers the insulin into a doll at a 30-degree angle. administers the insulin intramuscularly into rotating sites. wipes off the needle with an alcohol swab. draws up the short-acting insulin into the syringe first.

Correct response: Polyuria Polydipsia Polyphagia Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 48: Nursing Care of the Child With an Alteration in Metabolism/Endocrine Disorder, COMPARISON CHART 48.3 Type 1 Versus Type 2 Diabetes Mellitus, p. 1804.

Which findings should the nurse expect to assess when completing the health history of a child admitted for possible type 2 diabetes? Select all that apply. Polyphagia Marked weight loss Polydipsia Polyuria Abrupt onset of symptoms

Correct response: enlarged tongue Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 48: Nursing Care of the Child With an Alteration in Metabolism/Endocrine Disorder, Congenital Hypothyroidism, p. 1789. Explanation: Observation of an enlarged tongue along with an enlarged posterior fontanel and feeding difficulties are key findings for congenital hypothyroidism. The mother would report constipation rather than diarrhea. Auscultation would reveal bradycardia rather than tachycardia, and palpation would reveal cool, dry, and scaly skin.

The nurse is assessing a 1-month-old girl who, according to the mother, doesn't eat well. Which assessment suggests the child has congenital hypothyroidism? warm, moist skin enlarged tongue tachycardia frequent diarrhea

Correct response: The child may have developed leukopenia. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 48: Nursing Care of the Child With an Alteration in Metabolism/Endocrine Disorder, DRUG GUIDE 48.1 Common Drugs for Endocrine Disorders, p. 1781. Explanation: Graves disease is defined as an overproduction of thyroid hormones. Propylthiouracil is used to suppress thyroid function. A complication of Graves disease is leukopenia

A 9-year-old child with Graves disease is seen at the pediatrician's office reporting sore throat and fever. The nurse notes in the history that the child is taking propylthiouracil. Which of the following would concern the nurse? The child needs to be started on an antibiotic drug. The child may have developed leukopenia. The child may not be taking the medication. The child must be participating in sports.

Correct response: Graves disease Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 48: Nursing Care of the Child With an Alteration in Metabolism/Endocrine Disorder, Hyperthyroidism, p. 1791. Explanation: Symptoms of Graves disease include an increased rate of growth; weight loss despite an excellent appetite; hyperactivity; warm, moist skin; tachycardia; fine tremors; an enlarged thyroid gland or goiter; and ophthalmic changes including exophthalmos. These are not symptoms of Cushing disease, diabetes mellitus or SIADH.

A child is brought to the clinic experiencing symptoms of nervousness, tremors, fatigue, increased heart rate and blood pressure. Based on this assessment, the nurse would suspect a diagnosis of which condition? Cushing syndrome hypothyroidism hypertension Graves disease

Correct response: cognitive impairment Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 48: Nursing Care of the Child With an Alteration in Metabolism/Endocrine Disorder, Congenital Hypothyroidism, pp. 1790-1791. Explanation: A newborn with congenital hypothyroidism is lethargic, hypotonic and irritable. Delayed growth is seen as well as decreased mental responsiveness. The newborn has an enlarged tongue and poor sucking ability. Without treatment with the thyroid hormone, the newborn will develop a cognitive impairment and failure to thrive. Blindness, muscle spasticity and dehydration are not symptoms or complications of the disease.

A newborn is born with hypothyroidism. If it is not recognized and treated, what complication is likely? cognitive impairment blindness dehydration muscle spasticity

Correct response: Maintain the child's calcium level at a normal level with calcium replacement as prescribed. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 48: Nursing Care of the Child With an Alteration in Metabolism/Endocrine Disorder, TABLE 48.2 Parathyroid Disorders, p. 1794. Hypoparathyroidism will manifest as a low calcium level, so the nurse would expect the provider to provide a prescription to maintaint the calcium level within normal range. Glucose is not a concern with parathyroid function. A referal would be made to a pediatric endocrinologists, not a gastrointestinal specialist. Phosphorus and calcium have an inverse proportion, so the nurse would recommend a low-phosphorus diet

The nurse is caring for a child diagnosed with low functioning parathyroid. Which is a treatment goal of a child with hypoparathyroidism? Provide the child and parent with a referral to a pediatric gastrointestinal specialist. Maintain the child's calcium level at a normal level with calcium replacement as prescribed. Provide the parents a specific dietary plan for high-phosphorus foods to be eaten. Assure the parents have a plan in place for periods of low glucose levels if noted.

Correct response: oral calcium Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 48: Nursing Care of the Child With an Alteration in Metabolism/Endocrine Disorder, TABLE 48.2 Parathyroid Disorders, p. 1794. Explanation: Medical management for hypoparathyroidism includes intravenous calcium gluconate for acute or severe tetany, then intramuscular or oral calcium as prescribed. IV diuretics is used in treatment of hyperparathyroidism. Oral corticosteroids and oral potassium are not used in the treatment of hypoparathyroidism.

The nurse is caring for a child recently diagnosed with hypoparathyroidism disorder. Which medication would the nurse expect to be ordered? oral calcium oral corticosteroids intravenous diuretic therapy oral potassium

Correct response: insulin Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 48: Nursing Care of the Child With an Alteration in Metabolism/Endocrine Disorder, DIABETES MELLITUS, p. 1799. Explanation: Feedback is seen in endocrine systems that regulate concentrations of blood components such as glucose. Glucose from the ingested lactose or sucrose is absorbed in the intestine and the level of glucose in blood rises. Elevation of blood glucose concentration stimulates endocrine cells in the pancreas to release insulin. Insulin has the major effect of facilitating entry of glucose into many cells of the body; as a result, blood glucose levels fall. When the level of blood glucose falls sufficiently, the stimulus for insulin release disappears and insulin is no longer secreted. Glycogen is stored in the liver and muscles. It is released to provide energy when the blood glucose levels fall. Glucagon is also produced by the pancreas. Its job is to force the liver to release stored insulin when the body has a need for more insulin. The adrenocorticotropic hormone is produced by the anterior pituitary. Its function is to regulate cortisol. This is needed so the adrenal glands can function properly. It also helps the body respond to stress.

The nurse is interpreting the negative feedback system that controls endocrine function. What secretion will the nurse correlate as decreasing while blood glucose levels decrease? adrenocorticotropic hormone insulin glucagon glycogen

Correct response: Type 2 diabetes mellitus Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 48: Nursing Care of the Child With an Alteration in Metabolism/Endocrine Disorder, DIABETES MELLITUS, p. 1801. Explanation: Metformin is the common treatment to manage type 2 DM. Insulin, not oral medication, is the treatment of choice for type 1 DM. Metoclopramide is the treatment for GI reflux. Methylprednisolone is used to treat inflammatory bowel disease.

An elementary school child takes metformin three times each day. Which disorder would the school nurse expect the child to have? Inflammatory bowel disorder Type 1 diabetes mellitus Type 2 diabetes mellitus Gastrointestinal reflux

Correct response: Urine output Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 48: Nursing Care of the Child With an Alteration in Metabolism/Endocrine Disorder, Diabetes Insipidus, p. 1786. Explanation: An infant with the diagnosis of diabetes insipidus has decreased secretion of antidiuretic hormone (ADH). The infant is at risk for dehydration so monitoring urinary output is the most important intervention. The child's oral intake has been ordered. Monitoring a child who is under fluid restriction includes assessing the oral mucosa; however, urine output is the most important assessment for this patient. Vital signs are part of a basic assessment.

A nurse is taking care of an infant with diabetes insipidus. Which assessment data are most important for the nurse to monitor while the infant has a prescription for fluid restriction? Urine output Vital signs Oral intake Oral mucosa

Correct response: a fasting blood glucose greater than 126 mg/dl Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 48: Nursing Care of the Child With an Alteration in Metabolism/Endocrine Disorder, DIABETES MELLITUS, p. 1803. Explanation: A fasting blood glucose greater than 126 mg/dL is diagnostic for diabetes mellitus.

A nurse should recognize that which laboratory result would be most consistent with a diagnosis of diabetes mellitus? a fasting blood glucose less than 126 mg/dl a fasting blood glucose greater than 126 mg/dl glucose in the urine proteinuria

Correct response: Check blood glucose levels. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 48: Nursing Care of the Child With an Alteration in Metabolism/Endocrine Disorder, DIABETES MELLITUS, p. 1803. The nurse must check the insulin level before it can be administered. Once a need is established, then insulin administration becomes the priority intervention. Stress management, glucose checks, and nutritional consultation can all be implemented once therapy with insulin begins.

A pediatric client has just been diagnosed with diabetes mellitus. What would the nurse do first? Administer insulin. Educate the client on stress management. Check blood glucose levels. Regulate nutrition.

Correct response: diabetic ketoacidosis Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 48: Nursing Care of the Child With an Alteration in Metabolism/Endocrine Disorder, DIABETES MELLITUS, p. 1799. Explanation: Insulin deficiency, in association with increased levels of counterregulatory hormones (glucagon, growth hormone, cortisol, catecholamines) and dehydration, is the primary cause of diabetic ketoacidosis, a life-threatening form of metabolic acidosis that is a frequent complication of diabetes. Liver converts triglycerides (lipolysis) to fatty acids, which in turn change to ketone bodies. The accumulation and excretion of ketone bodies by the kidneys is called ketonuria. Glucosuria is glucose that is spilled into the urine.

After teaching a group of students about endocrine disorders, the instructor determines that the teaching was successful when the students identify insulin deficiency, increased levels of counterregulatory hormones, and dehydration as the primary cause of which condition? ketonuria ketone bodies glucosuria diabetic ketoacidosis

Correct response: Assess the client for allergies. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 48: Nursing Care of the Child With an Alteration in Metabolism/Endocrine Disorder, COMMON LABORATORY AND DIAGNOSTIC TESTS 48.1, p. 1777. Explanation: A thyroid scan uses a radionucleotide dye so a client should be assessed for allergies to iodine and shell fish to prevent a possible allergic reaction. The client will not be asleep. There is no need to give the child a bolus of fluid or insert a urinary catheter.

The health care provider has prescribed a thyroid scan to confirm a diagnosis. What intervention should the nurse perform before the examination? Tell the client he or she will be asleep. Insert a urinary catheter. Give the client a bolus of fluids. Assess the client for allergies.

Correct response: Injections of GH Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 48: Nursing Care of the Child With an Alteration in Metabolism/Endocrine Disorder, Growth Hormone Deficiency, p. 1782. Explanation: Growth hormone (GH) deficiency occurs when the anterior pituitary is unable to produce enough hormone for usual growth. Somatotrophin is the name of the growth hormone administered. Administering subcutaneous GH to the child helps correct this deficiency. The GH dosage is 0.2 to 0.3mg/kg given daily. It is not administered orally. Aldosterone causes sodium to be retained and a provocation would be the administration of diuretics to reduce the sodium. Beta cells are found in the heart muscles, smooth muscles, airways, and arteries. They are also found in the pancreas to secrete insulin. None of these cell actions are related to the anterior pituary.

The nurse is caring for a 10-year-old child with growth hormone (GH) deficiency. Which therapy would you anticipate will be prescribed for the child? Short-term aldosterone provocation Oral administration of somatotropin Long-term blocking of beta cells Injections of GH

Correct response: 45 grams Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 48: Nursing Care of the Child With an Alteration in Metabolism/Endocrine Disorder, DIABETES MELLITUS, p. 1802. Explanation: Typically, carbohydrate intake is restricted to 45 grams at each of the three main meals of the day.

The nurse is reviewing the recommended diet with the parents and child who was diagnosed with type 2 diabetes. The nurse determines that the parents and child understand the information when they identify that they will restrict carbohydrate intake to which amount at each of the three main meals?

Correct response: "During exercise we should wait to check blood sugars until after our child completes the activity." Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 48: Nursing Care of the Child With an Alteration in Metabolism/Endocrine Disorder, DIABETES MELLITUS, pp. 1797-1808.

The nurse is teaching glucose monitoring and insulin administration to a child with type 1 diabetes and the parents. Which comment by a parent demonstrates a need for additional teaching? "Blood glucose level, food intake, and activity need to all be considered when calculating insulin dosage." "If our child is sick we should check blood glucose levels more often." "We should check our child's blood glucose levels before meals." "During exercise we should wait to check blood sugars until after our child completes the activity."

Correct response: Low T4 level and high TSH level Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 48: Nursing Care of the Child With an Alteration in Metabolism/Endocrine Disorder, Congenital Hypothyroidism, p. 1789. Explanation: Screening results that show a low T4 level and a high TSH level indicate congenital hypothyroidism and the need for further tests to determine the cause of the disease.

Which results would indicate to the nurse the possibility that a neonate has congenital hypothyroidism? Normal TSH level and high T4 level Low T4 level and high TSH level Normal T4 level and low TSH level High thyroxine (T4) level and low thyroid stimulating hormone (TSH) level

Correct response: Give the crushed medication in a syringe mixed with a small amount of formula. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 48: Nursing Care of the Child With an Alteration in Metabolism/Endocrine Disorder, DRUG GUIDE 48.1 Common Drugs for Endocrine Disorders, p. 1781.

A pediatric nurse is discharging a 1-month-old infant. The infant was diagnosed with congenital hypothyroidism on this admission and will be treated with levothyroxine. The nurse knows it is important to teach the parent about medication administration. Which process will the nurse include in the teaching? Give the crushed medication in a syringe mixed with a small amount of formula. Crush the medication and put it in the full bottle of formula so it tastes better. Explain that this treatment is administered until the child is 3 years of age. Administer the medication every other day.

Correct response: Graves disease Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 48: Nursing Care of the Child With an Alteration in Metabolism/Endocrine Disorder, Assessment, p. 1774. Explanation: Symptoms of Graves disease include an increased rate of growth; weight loss despite an excellent appetite; hyperactivity; warm, moist skin; tachycardia; fine tremors; an enlarged thyroid gland or goiter; and ophthalmic changes including exophthalmos. These are not symptoms of Cushing disease, diabetes mellitus or SIADH.

During an assessment of an adolescent child, the nurse notes that the child has a protuberant tongue, fatigued appearance, poor muscle tone, and exophthalmos. What medical diagnosis would the nurse expect the child to have? Graves disease syndrome of inappropriate antidiuretic hormone secretion (SIADH) diabetes Cushing disease

Correct response: Cushing syndrome Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 48: Nursing Care of the Child With an Alteration in Metabolism/Endocrine Disorder, TABLE 48.3 Other Disorders of the Adrenal Gland, p. 1795. Explanation: Cushing syndrome is a characteristic cluster of signs and symptoms resulting from excessive levels of circulating cortisol. Addison disease is caused by autoimmune destruction of the adrenal cortex, which results in dysfunction of steroidogenesis. Graves disease is the most common form of hyperthyroidism. Turner syndrome is deletion of the entire X chromosome.

The nurse knows that which condition is caused by excessive levels of circulating cortisol? Cushing syndrome Addison disease Turner syndrome Graves disease

Correct response: "My child measures their own medication but sometimes doesn't administer the correct amount." Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 48: Nursing Care of the Child With an Alteration in Metabolism/Endocrine Disorder, DIABETES MELLITUS, p. 1800. Explanation: Insulin reaction (insulin shock, hypoglycemia) is caused by insulin overload, resulting in too-rapid metabolism of the body's glucose. This may be attributable to a change in the body's requirement, carelessness in diet (such as failure to eat proper amounts of food), an error in insulin measurement, or excessive exercise.

The nurse is teaching a group of caregivers of children diagnosed with diabetes mellitus. The nurse is explaining insulin shock and the caregivers make the following statements. Which statement indicates the best understanding of a reason an insulin reaction might occur? "If my child eats as much as their older brother eats they could have an insulin reaction." "My child monitors their glucose levels to keep them from going too high." "My child measures their own medication but sometimes doesn't administer the correct amount." "On the weekends we encourage our child to participate in lots of sports activities and stay busy so they don't have an insulin reaction."

Correct response: Syndrome of inappropriate antidiuretic hormone Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 48: Nursing Care of the Child With an Alteration in Metabolism/Endocrine Disorder, Syndrome of Inappropriate Antidiuretic Hormone, p. 1788. Explanation: Syndrome of inappropriate antidiuretic hormone (SIADH) is a rare condition in which there is overproduction of antidiuretic hormone by the posterior pituitary gland. This results in a decrease in urine production and water intoxication. As sodium levels fall in proportion to water, the child develops hyponatremia or a lowered sodium plasma level. It can be caused by central nervous system infections such as bacterial meningitis. As the hyponatremia grows more severe, coma or seizures occur from brain edema. Diabetes insipidus is characterized by polyuria, not decreased urine production. Hyposecretion of somatotropin, or growth hormone, results in undergrowth; hypersecretion results in overgrowth.

A 12-year-old boy arrives at the emergency room experiencing nausea, vomiting, headache, and seizures. He is diagnosed with bacterial meningitis. Other findings include a decrease in urine production, hyponatremia, and water intoxication. Which pituitary gland disorder would be most associated with these symptoms? Hyposecretion of somatotropin Hypersecretion of somatotropin Diabetes insipidus Syndrome of inappropriate antidiuretic hormone

Correct response: Instruct them to treat the reaction as if it's hypoglycemia, which is more likely. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 48: Nursing Care of the Child With an Alteration in Metabolism/Endocrine Disorder, DIABETES MELLITUS, p. 1797.

The caregivers of a child just diagnosed with diabetes express concern that they won't remember the different signs and symptoms of hyperglycemia and hypoglycemia. As a result, they are afraid they won't handle an emergency correctly. What is the best initial response by the nurse to help ensure the child's safety? Repeat the signs and symptoms over and over until they seem to understand. Give the caregivers educational pamphlets and videos about diabetes. Suggest that the child wear an insulin pump for continuous insulin administration. Instruct them to treat the reaction as if it's hypoglycemia, which is more likely.

Correct response: "Regular exercise will help in the regulation of my child's blood sugar levels." "The insulin dosages will be directly associated to my child's carbohydrate ingestion." "We need to rotate insulin injection sites to prevent complications." Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 48: Nursing Care of the Child With an Alteration in Metabolism/Endocrine Disorder, DIABETES MELLITUS, p. 1802.

The nurse is caring for a 5-year-old child recently diagnosed with type 1 diabetes. When discussing the care and management of the disorder with the child's parents, which statement(s) indicates understanding? Select all that apply. "Regular exercise will help in the regulation of my child's blood sugar levels." "If my child's blood glucose remains stable for a few months, my child can move from injections to pills." "The insulin dosages will be directly associated to my child's carbohydrate ingestion." "We need to rotate insulin injection sites to prevent complications." "When my child is ill and unable to eat, we will need to hold the insulin until the child is able to tolerate fluids."

Correct response: Polyphagia Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 48: Nursing Care of the Child With an Alteration in Metabolism/Endocrine Disorder, COMPARISON CHART 48.3 Type 1 Versus Type 2 Diabetes Mellitus, p. 1804. Explanation: Symptoms of type 1 diabetes mellitus include polyphagia (increased hunger and food consumption), polyuria (dramatic increase in urinary output, probably with enuresis) and polydipsia (increased thirst). Pica is eating nonfood substances.

The nurse is interviewing the caregivers of a child admitted with a diagnosis of type 1 diabetes mellitus. The caregiver states, "She is hungry all the time and eats everything, but she is losing weight." The caregiver's statement indicates the child most likely has: Pica Polyuria Polydipsia Polyphagia

Correct response: A simple blood test to diagnose hypothyroidism is required in most states. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 48: Nursing Care of the Child With an Alteration in Metabolism/Endocrine Disorder, Congenital Hypothyroidism, p. 1789. Explanation: With hypothyroidism there is an insufficent production of the thyroid hormones required to meet the body's metabolic as well as growth and developmental needs. Without these hormones cognitive impairment occurs. Hypothyroidism is diagnosed by a newborn screening procedure. This screening procedure is required by most states. With early diagnosis the condition can be treated by replacing the missing hormones. The later the diagnosis is made, the more irreversable cognitive impairment becomes. At birth a newborn with hypothyroidism will be a poor feeder. Other symptoms, such as lethargy and hypotonicity, become evident after the first month of life. There are not other outward manifestations, such as rashes or appearances, that can be seen. These are not part of the condition.

A newborn was diagnosed as having hypothyroidism at birth. The parent asks the nurse how the disease could be discovered this early. Which is the nurse's best answer? A simple blood test to diagnose hypothyroidism is required in most states. Hypothyroidism is usually detected at birth by the newborn's physical appearance. The newborn is already severely impaired at birth, and this suggests the diagnosis. A newborn has a typical rash at birth that suggests the diagnosis.

Correct response: Risk for situational low self-esteem related to short stature Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 48: Nursing Care of the Child With an Alteration in Metabolism/Endocrine Disorder, Growth Hormone Deficiency, p. 1784. Explanation: Children with short stature tend to report feeling of lower quality of life largely related to discrimination. The nurse may need to remind parents to assign duties and responsibilities to children that match their chronologic age, not their physical size, in order to promote children's feelings of maturity and self-esteem. A child that differs in any way from peers may be the victim of bullying. The nurse should alert the parent to this possibility and assess for this at well-child visits to help protect the child's quality of life. Tissue perfusion is not affected by this disorder. This disorder does not cause impaired skin integrity. There is no overproduction of epinephrine with this disorder.

The nurse is planning care for a school-age child diagnosed with growth hormone deficiency. Which diagnosis should the nurse select to help the child with this health problem? Impaired skin integrity related to overproduction of melanin Ineffective tissue perfusion related to infantile blood vessels Risk for self-directed violence related to oversecretion of epinephrine Risk for situational low self-esteem related to short stature

Correct response: "When they get my son's thyroid levels normal, he won't be so tired." Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 48: Nursing Care of the Child With an Alteration in Metabolism/Endocrine Disorder, Acquired Hypothyroidism, p. 1791. Explanation: Tiredness, fatigue, constipation, cold intolerance and weight gain are all symptoms of hypothyroidism. Nervousness, anxiety, heat intolerance, weight loss and smooth velvety skin are all symptoms of hyperthyroidism.

The nurse is speaking with the parents of a child recently diagnosed with hypothyroidism. Which statement by a parent indicates an understanding of symptoms of this disorder? "Heat intolerance is a caused by low thyroid levels." "When they get my son's thyroid levels normal, he won't be so tired." "Most people with hypothyroidism have smooth, velvety skin." "My son's nervousness may be a symptom of his hypothyroidism."

Correct response: "I can eat two small cookies with each meal." Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 48: Nursing Care of the Child With an Alteration in Metabolism/Endocrine Disorder, DIABETES MELLITUS, p. 1802. Cookies, cakes, candy, potato chips, and crackers are high in sugars and fats and should be eaten in moderation as special treats; they would not be included with each meal. An apple or orange makes a good snack. Nonfat milk is a better option than whole milk. Long-acting carbohydrates should be the largest category of foods eaten

The nurse is teaching a 12-year-old girl with type 2 diabetes mellitus and her parents about dietary measures to control her glucose levels. Which comment by the child indicates a need for additional teaching? "I can eat two small cookies with each meal." "I will be eating more breads and cereals." "I can have an apple or orange for snacks." "I can have nonfat milk to drink."

Correct response: Antidiuretic hormone Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 48: Nursing Care of the Child With an Alteration in Metabolism/Endocrine Disorder, Diabetes Insipidus, p. 1786. Explanation: Diabetes insipidus results from a deficiency in the secretion of antidiuretic hormone (ADH). This hormone, also known as vasopressin, is produced in the hypothalamus and stored in the pituitary gland. Hypopituitarism or dwarfism involves a growth hormone deficiency. Diabetes mellitus involves a disruption in insulin secretion. Thyroxine is a thyroid hormone that if deficient leads to hypothyroidism.

The parents of a child who was diagnosed with diabetes insipidus ask the nurse, "How does this disorder occur?" When responding to the parents, the nurse integrates knowledge that a deficiency of which hormone is involved? Growth hormone Antidiuretic hormone Thyroxine Insulin