Hockenberry 28: Child w/Endocrine Dysfunction

d

A 17-year-old with type 1 diabetes mellitus tells the school nurse about recently starting to drink alcohol with friends on weekends. What is the most appropriate intervention by the nurse? A. Tell the adolescent not to drink alcohol B. Ask the adolescent about the reasons for drinking alcohol C. Recommend counseling so the adolescent understands the serious consequences of alcohol consumption D. Teach the adolescent about the effects of alcohol on type 1 diabetes mellitus and how to prevent problems associated with alcohol intake

d

A chronic diabetic patient has been on insulin injections for the past 3 months. The patient's blood reports show the hemoglobin A1c is 6%. What does the nurse tell the parents? A. "The patient's diabetes is cured; therefore, you need not take insulin henceforth." B. "The patient has high blood glucose, so you need to visit the endocrinologist." C. "The patient has anemia due to deficiency of iron, so the patient needs iron-rich food." D. "The patient's diabetes is under control; please continue the same regimen of treatment."

b

A neonate with a goiter has just been admitted to the newborn nursery. What is one priority nursing intervention? A. Positioning the neonate on the left side B. Having a tracheostomy set at the bedside C. Suctioning the child at least every 5 to 10 minutes D. Explaining to the parents how to place the dressing on the goiter

a

A nurse is caring for a 15-year-old girl who is experiencing polyuria, polydipsia, and polyphagia. The girl is underweight and reports being extremely fatigued over the past 3 days. What disorder is associated with these clinical symptoms? A. Type 1 diabetes B. Type 2 diabetes C. Pheochromocytoma D. Congenital adrenal hyperplasia

d

A school-age child recently diagnosed with type 1 diabetes mellitus asks the nurse if playing soccer, playing baseball, and swimming are still possible. The nurse's response should be based on what knowledge? A. Exercise is contraindicated in the type 1 diabetic child B. The level of activity depends on the type of insulin required C. Soccer and baseball are too strenuous, but swimming is acceptable D. Exercise is not restricted unless indicated by other health conditions

a

An adolescent patient reports constipation, weight gain, and low mood. The patient also feels cold in warm weather. Most of the adolescents in the community have similar symptoms. What does the nurse tell the patient to include in the diet? A. Iodized salt B. Iron-fortified milk C. Essential fatty acids D. Essential amino acids

a

An infant is born with ambiguous genitalia. Tests are being performed to enable sex assignment. The parents tell the nurse that family and friends are asking what caused the baby to be this way. What is this nurse's best response? A. By explaining the disorder so the parents can explain it to others B. By helping the parents understand that no one knows how this occurs C. By encouraging the parents not to worry while the tests are being done D. By suggesting that the parents avoid family and friends until the sex is assigned

c

An infant presents with hypospadias, micropenis, and no palpable gonads. How should the nurse document these findings? A. Atrophy B. Cushing syndrome C. Ambiguous genitalia D. Adrenal insufficiency

a

Cushing syndrome is a characteristic group of manifestations caused by excessive circulation of which hormone? A. Free cortisol B. Thyroid hormone C. Androgen hormones D. Adrenocorticotropic hormone

b

The imbalance of which hormone causes symptoms of warm, moist skin; protruding eyeballs; difficulty breathing; and heat intolerance? A. Insulin B. Thyroid hormone C. Parathyroid hormone D. Antidiuretic hormone

c

The mother of a child with type 1 diabetes mellitus asks why her child cannot avoid all those "shots" and instead take pills as an uncle does. What is the most appropriate response by the nurse? A. "The pills only work with an adult pancreas." B. "The drugs affect fat and protein metabolism, not sugar." C. "Your child needs to have insulin replaced, and the oral hypoglycemics only add to an existing supply of insulin." D. "Perhaps when your child is older the pancreas will produce its own insulin, and then your child can take oral hypoglycemics."

c

The nurse is assessing a 7-year-old girl with precocious puberty who is taking a monthly injection of a synthetic analogue of luteinizing hormone-releasing hormone leuprolide acetate (Lupron Depot). When should treatment be discontinued? A. When growth slows B. When breast development occurs C. At a chronologically appropriate time D. When the targeted adult height is obtained

b

The nurse is caring for a child hospitalized with acute adrenocortical insufficiency. The acute phase seems to be over when ascending flaccid paralysis occurs. What is the most appropriate nursing action? A. Preparing the family for the child's death B. Reassuring the family that this condition is temporary C. Reassuring the family that flaccid paralysis is not problematic D. Preparing the family for the long-term consequences of paralysis

d

The nurse is caring for a patient with pheochromocytoma. The nurse checks the patient's blood pressure, respiratory rate, and blood glucose levels, and palpates the adrenal mass to note its measurements. Which of the actions performed by the nurse needs correction? A. Checking the blood pressure of the patient B. Checking the respiratory rate of the patient C. Measuring the blood glucose levels in the patient D. Palpating the mass to note its measurements in the patient

a

The nurse is planning care for a child with recently diagnosed diabetes insipidus. Which nursing intervention should be planned? A. Encouraging the child to wear medical identification B. Discussing with the child and family ways to limit fluid intake C. Teaching the child and family how to do required urine testing D. Reassuring the child and family that diabetes insipidus is usually not a chronic or life-threatening illness

b

The nurse is reviewing the medical record of a patient who presents with a tumor in an enlarged sella turcica and enlargement of the paranasal sinuses with a normal bone age and a diagnosis of acromegaly. What should the nurse expect to find in the assessment? A. Recessed jaw B. Enlarged jaw C. Lack of facial hair D. Hypoglycemia

ade

The nurse is teaching an adolescent with newly diagnosed type I diabetes ways to minimize discomfort with insulin injections. Which recommendations are helpful in minimizing injection discomfort? Select all that apply. A. Do not reuse needles. B. Inject insulin when it is cold. C. Flex or tense the muscle during injection. D. Remove all bubbles from the syringe before the injection. E. Do not move the direction of the needle-syringe during insertion or withdrawal.

c

The nurse should recognize that when a child develops diabetic ketoacidosis (DKA), treatment will be instituted as described in which of the following statements? A. DKA is best treated at home B. DKA is best treated at a practitioner's office or clinic C. Immediate treatment is required because DKA is a life-threatening situation D. No treatment is required, because DKA is an expected outcome of type 1 diabetes mellitus

a

The nurse suspects that the child has delayed growth. The nurse does not have serial height and weight records to assess the child's growth. What action does the nurse take? A. Asks about the child's growth as compared to siblings. B. Asks the parents about the child's allergy status. C. Asks about the child's height and weight at birth. D. Asks about the child's weight as compared to the siblings.

b

The parents of a child who is on growth hormone replacement therapy are not satisfied with the outcome of the treatment, because the child's height is not increasing. The child is still shorter than school peers. What is the most appropriate action of the nurse? A. Increase the dose of growth hormone to the child. B. Reassure the parents and set realistic expectations. C. Change the route of administration of growth hormone. D. Advise the parents to feed the child a high-protein diet.

d

The parents report that their child has excessive urination, thirst, hunger, irritability, fatigue, flushed skin, headache, blurred vision, and dry skin. The child is diagnosed with type 1 diabetes mellitus. Based on this diagnosis, what should the nurse include in the plan of care? A. Assess the feet for open sores. B. Obtain a urine dipstick for bacteria. C. Administer corticosteroids to decrease inflammation. D. Monitor capillary blood glucose levels before meals and at bedtime.

a

Type 1 diabetes mellitus has just been diagnosed in a teenage boy who is actively involved in sports. What important instruction should the nurse include in the teaching plan? A. Because exercise can lower the blood glucose level, blood glucose needs to be closely monitored. B. Because exercise can increase the blood glucose level, blood glucose needs to be closely monitored. C. Because exercise can increase the blood glucose level, additional insulin should be taken before physical activity. D. Because exercise can lower the blood glucose level, additional insulin should be taken before physical activity.

b

What are the cardinal signs of diabetes insipidus? A. Vascular anomalies B. Polyuria and polydipsia C. Hypotension and dehydration D. Dehydration and diminished urine output

b

What are the clinical manifestations of juvenile hypothyroidism? A. Sleepiness, dry skin, diarrhea B. Dry skin, sparse hair, slowed growth C. Diarrhea, dry skin, decelerated growth D. Constipation, dry skin, enlarged thyroid

d

What endocrine disorder can result from prolonged steroid therapy? A. Goiter B. Addison disease C. Diabetes mellitus D. Cushing syndrome

c

What information should the nurse include when discussing a child's precocious puberty with the parents? A. The child is not yet fertile. B. Sexual interest is usually advanced. C. Dress and activities should be appropriate to the chronologic age. D. The appearance of secondary sex characteristics does not proceed in the usual order.

d

What is the best method for assessing control of diabetes? A. Urine testing B. Patient logbooks C. Self-monitoring of blood glucose D. Glycosylated hemoglobin (hemoglobin A1c) testing

c

What is the current treatment option for children with type 1 diabetes? A. Diet only B. Oral agents C. Insulin and diet D. Diet and oral agents

b

What is the most common cause of secondary hyperparathyroidism? A. Diabetes mellitus B. Chronic renal disease C. Congenital heart disease D. Growth hormone deficiency

a

What is the most important nursing consideration related to congenital hypothyroidism? A. Early identification of the disorder B. Facilitation of parent-infant attachment C. Initiation of referrals for mental retardation D. Help for parents in dealing with the child's future prospects

a

What levels of thyroid hormone (TH) and thyroid-stimulating hormone (TSH) characterize primary congenital hypothyroidism? A. Low level of circulating TH, raised level of TSH at birth B. Low level of circulating TH, low level of TSH at birth C. Low level of circulating TH, normal level of TSH at birth D. High level of circulating TH, increased level of TSH at birth

d

What manifestation of type 2 diabetes helps the nurse to distinguish it from type 1 diabetes? A. Excessive thirst and hunger B. Absence of serum insulin C. Rapid, deep breathing D. Relative insulin deficiency

c

Which condition does the nurse suspect in a patient with anxiety and mental depression, who has facial muscle spasms elicited by tapping the facial nerve in the region of the parotid gland and carpopedal spasm? A. Thyrotoxicosis B. Hyperthyroidism C. Hypoparathyroidism D. Lymphocytic thyroiditis

b

Which condition may be suspected in a child who has dry skin, puffiness around the eyes, sparse hair, and constipation? A. Goiter B. Hypothyroidism C. Hyperparathyroidism D. Type 1 diabetes mellitus

d

Which finding is most often observed with destruction of the pancreatic beta cells? A. Increased insulin secretion in the body B. Decreased growth hormone in the body C. Increased serum thyroxin levels in the body D. Decreased blood glucose levels in the body

b

Which statement best describes Cushing syndrome? A. Treatment involves replacement of cortisol. B. It is caused by excessive production of cortisol. C. The major clinical features are exophthalmia and pigment changes. D. Diagnosis is suspected with findings of hypotension, hyperkalemia, and polyuria.

d

Which statement made by the child indicates the need for further education about how to manage newly diagnosed type 1 diabetes mellitus? A. "I should check my blood glucose levels before meals and at bedtime." B. "It is important to rotate the injection sites to prevent tissue damage." C. "I should check my blood glucose and ketones every 3 hours when I am sick." D. "I can eat cake and candy as long as I give myself extra insulin to compensate."

ce

While reviewing laboratory reports, the nurse finds that the posterior lobe of the patient's pituitary gland is damaged. Which hormones are likely to be imbalanced if this part of the pituitary gland is not functioning properly? Select all that apply. A. Insulin B. Prolactin C. Oxytocin D. Growth hormone E. Antidiuretic hormone