PEDI CH 26
The nurse is preparing to administer the child's ordered lispro (Humalog) insulin at 0800. When will the child's blood glucose level begin to decline? 0845 0900 0815 0930
0815 Explanation: The onset of rapid acting insulins like lispro (Humalog) is within 15 minutes. The onset of short-acting insulin is 30 to 60 minutes. The onset of intermediate-acting insulin is 1-3 hours, and long-acting insulin's onset is 1-2 hours.
A 12-year-old is being seen in the office and has hyperthyroidism; the nurse knows that the most common cause of hyperthyroidism is: Graves disease Cushing disease Addison disease Plummer disease
Graves disease Hyperthyroidism occurs less often in children than hypothyroidism. Graves disease, the most common cause of hyperthyroidism in children, occurs in 1 in 5,000 children between 11 and 15 years of age.
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? hypertension hypothyroidism Cushing syndrome Graves disease
Graves disease Explanation: Children who develop Graves disease experience nervousness, tremors, and increased heart rate and blood pressure cause by overstimulation of the thyroid gland. Cushing syndrome, hypertension, and hypothyroidism are not associated with these symptoms.
The nurse is assessing a 7-year-old girl with a headache, irritability, and vomiting. Her health history reveals she has had meningitis. Which intervention is priority? Notifying the physician of the neurologic findings. Monitoring urine volume and specific gravity. Restoring fluid balance with IV sodium. Setting up safety precautions to prevent injury.
Notifying the physician of the neurologic findings. Explanation: This child may have syndrome of inappropriate antidiuretic hormone (SIADH). Priority intervention for this child is to notify the physician of the neurologic findings.
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? "Most people with hypothyroidism have smooth, velvety skin." "Heat intolerance is a caused by low thyroid levels." "My son's nervousness may be a symptom of his hypothyroidism." "When they get my son's thyroid levels normal, he won't be so tired."
"When they get my son's thyroid levels normal, he won't be so tired." 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 knows that which condition is caused by excessive levels of circulating cortisol? Turner syndrome Graves disease Addison disease Cushing syndrome
Cushing syndrome 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 the deletion of the entire X chromosome.
The nurse is caring for an 11-year-old child who has type 2 diabetes mellitus. The child has been vomiting for 48 hours and the breath has a fruity odor. The nurse notes that respirations are deep and rapid with a temperature of 102°F (38.9°C). Which intervention would be most appropriate? Test the child's urine to detect the presence of ketones. Prepare for IV insertion. Give the child 25 g of carbohydrates. Give the child 8 ounces of clear liquid.
Prepare for IV insertion. Explanation: The child needs nursing interventions rapidly to change his or her diabetic status. This child should be given an IV with fluids and electrolytes to improve and restore tissue perfusion. Fruity breath and deep and rapid respirations are signs of ketoacidosis (hyperglycemia), which occurs before oral rehydration. The urine may show ketones, but checking the urine is not the priority in this risky situation.
The nurse measures the client's blood glucose level prior to breakfast. The measurement obtained is 130 mg/dl. The orders read to administer 2 units of Humalog insulin for a blood glucose of 100 to 150 mg/dl. How soon should the nurse ensure that the client eats breakfast after receiving insulin? within 5 minutes within 2 hours within 15 to 30 minutes within 60 to 90 minutes
within 15 to 30 minutes Explanation: Humalog is a rapid-acting insulin. The onset of Humalog insulin is within 15 minutes and the peak level is achieved within 30 to 90 minutes; therefore, the client should eat within 15 to 30 minutes to avoid a hypoglycemic reaction.
A 15-year-old adolescent is scheduled for a pelvic ultrasound to evaluate for a possible ovarian cyst. Which instruction by the nurse would be most appropriate? "Drink plenty of fluids because you need to have a full bladder." "You need to remain very still for the entire test." "You won't be able to drink any water before or during the test." "Limit your level of physical activity for one-half hour before the test."
"Drink plenty of fluids because you need to have a full bladder." Explanation: A full bladder is needed for an ultrasound of the pelvic region.
The nurse is educating the parents of a client newly diagnosed with type 1 diabetes. Which statement by the parents indicates additional teaching is needed? "We and our child need to learn to identify carbohydrate, protein, and fat foods." "Our child should eat three meals and midafternoon and bedtime snacks each day." "Our child should not participate in sports or physical activity." "When our child is sick, we may need to check glucose levels more frequently."
"Our child should not participate in sports or physical activity." Explanation: The nurse would provide additional education if the parents state the child should not participate in sports or physical activity. The child with diabetes can, and should, be physically active to maintain proper health and facilitate efficient insulin usage by the body.
The nurse is assessing a child diagnosed with Cushing syndrome. Which statement by the parents demonstrates a need for further teaching? "We need to pay close attention to any wounds our child gets to monitor for adequate healing." "My child's round, full face appearance is reversible with appropriate treatment." "My child may experience excessive weight gain." "This disorder is most likely due to an infection my child had recently."
"This disorder is most likely due to an infection my child had recently."
A child has been prescribed desmopressin acetate for the treatment of diabetes insipidus. The client and the parents ask the nurse how this drug works. What is the correct response by the nurse? Desmopressin acetate is a synthetic form of insulin used to lower your blood sugar. Desmopressin acetate works to help your kidneys work more efficiently. Desmopressin acetate works on your pancreas to stimulate insulin production. Desmopressin acetate is a synthetic antidiuretic hormone that will slow down your urine output.
Desmopressin acetate is a synthetic antidiuretic hormone that will slow down your urine output. Explanation: Desmopressin acetate is a synthetic antidiuretic hormone that promotes reabsorption of water by action on renal tubules; it is used to control diabetes insipidus by decreasing the amount of urine produced.
A child has been prescribed desmopressin acetate for the treatment of diabetes insipidus. The client and the parents ask the nurse how this drug works. What is the correct response by the nurse? Desmopressin acetate works to help your kidneys work more efficiently. Desmopressin acetate works on your pancreas to stimulate insulin production. Desmopressin acetate is a synthetic form of insulin used to lower your blood sugar. Desmopressin acetate is a synthetic antidiuretic hormone that will slow down your urine output.
Desmopressin acetate is a synthetic antidiuretic hormone that will slow down your urine output. Explanation: Desmopressin acetate is a synthetic antidiuretic hormone that promotes reabsorption of water by action on renal tubules; it is used to control diabetes insipidus by decreasing the amount of urine produced.
Rank the different types of insulin based on their duration of action beginning with the shortest to the longest duration.
Lispro Humulin R Humulin N Lantus Explanation: Lispro is a rapid-acting insulin. Humulin R is a short-acting insulin. Humulin N is an intermediate-acting insulin. Lantus is a long-acting insulin.
The nurse is caring for a 4-year-old boy during a growth hormone stimulation test. Which task is priority in the care of this child? Providing a wet washcloth to suck. Educating family about side effects. Monitoring intake and output. Monitoring blood glucose levels.
Monitoring blood glucose levels. Explanation: Monitoring blood glucose levels during this study is the priority task along with observing for signs of hypoglycemia since insulin is given during the test to stimulate release of growth hormone.
The nurse is caring for a 13-year-old girl with delayed puberty. When developing the plan of care for this child, what would be the priority? Involving the child in her therapy to give her a sense of control. Encouraging the parents to discuss their concerns about the disorder. Helping the child discuss her feelings about her condition. Monitoring for therapeutic and side effects of medication.
Monitoring for therapeutic and side effects of medication. Explanation: The child will be receiving hormone supplementation; therefore, monitoring for therapeutic results and possible side effects of medications is key.
The nurse is teaching parents about the pattern of heredity of metabolic conditions. The nurse realizes that further teaching is needed when the parent makes which statement? "Not all metabolic conditions are clinically evident during the neonatal period." "The pattern of heredity for many metabolic conditions is recessive." "The pattern of heredity for all metabolic conditions is dominant." "The pattern of heredity for some metabolic conditions is dominant."
The pattern of heredity for many metabolic conditions is recessive.
A child with a history of diabetes insipidus is admitted with polyuria, polydipsia, and mental confusion. Which is the priority intervention for this child? weigh the client encourage increased fluid intake check vital signs measure urine output
check vital signs Explanation: Central diabetes insipidus is a disorder of the posterior pituitary. The fluid status of the child can be assessed first by assessing the vital signs. The large amounts of fluid loss can cause fluid and electrolyte imbalance that should be corrected. Urine output is important but not the priority. Encouraging fluids will not correct the problem, and weighing the client is not necessary at this time. Diabetes insipidus is managed by decreasing the protein and sodium in the diet and daily replacement of the antidiuretic hormone.
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 diabetic ketoacidosis glucosuria
diabetic ketoacidosis 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. The 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.
A child with Addison disease has been admitted with a history of nausea and vomiting for the past 3 days. The client is receiving IV glucocorticoids. Which interventions would the nurse implement? daily weights glucometer readings as prescribed monitoring of sodium and potassium levels intake and output measurements
glucometer readings as prescribed Explanation: IV glucocorticoids raise the glucose levels by increasing the production of glucose in the liver and decreasing the sensitivity of the cells to insulin. Blood glucose levels must be monitored to detect and manage hyperglycemia. Hyperglycemia may require treatment with insulin. Measuring the intake and output would be done to assess dehydration. Mineralocorticoids influence sodium and water balance. Daily weights are not necessary at this time
The nurse caring for a child who has issues with the anterior pituitary and expects the child to have issues with which hormone? antidiuretic hormone growth hormone oxytocin vasopressin
growth hormone
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? loose stools slow healing wounds blood pressure of 142/92 mm Hg recent weight loss
recent weight loss Explanation: Weight loss is unique to type 1 diabetes, whereas weight gain is associated with type 2. Hypertension is consistent with type 2 diabetes. Both type 1 and type 2 diabetes cause delayed wound healing. The increase in blood glucose in diabetes causes damage to the inner lining of the arteries that cause the arteries to develop plaque and harden. These damages to the blood vessels result in a decrease in the ability of oxygen-rich blood to be transported effectively to the tissues to promote wound healing. Loose stools or repeated loose stools (diarrhea) is a common side effect of the oral medication metformin, which is prescribed for clients with type 2 diabetes. Insulin, the treatment for type 1 diabetes, has constipation as one of the side effects.
A 12-year-old client arrives at the emergency room experiencing nausea, vomiting, headache, and seizures. The client is diagnosed with bacterial meningitis. Other findings include a decrease in urine production, hyponatremia, and water intoxication. Which pituitary gland disorder is most associated with these symptoms? diabetes insipidus (DI) hypersecretion of growth hormone hyposecretion of somatotropin syndrome of inappropriate antidiuretic hormone (SIADH)
syndrome of inappropriate antidiuretic hormone (SIADH) 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.
A 12-year-old client arrives at the emergency room experiencing nausea, vomiting, headache, and seizures. The client is diagnosed with bacterial meningitis. Other findings include a decrease in urine production, hyponatremia, and water intoxication. Which pituitary gland disorder is most associated with these symptoms? hyposecretion of somatotropin diabetes insipidus (DI) syndrome of inappropriate antidiuretic hormone (SIADH) hypersecretion of growth hormone
syndrome of inappropriate antidiuretic hormone (SIADH) 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.
A 9-year-old male is coming into the office to be seen for possible precocious puberty. The nurse would expect that the lab will perform which test? hCG test FSH test IGF-1 test cortisol level
hCG test
A nurse who is caring for a 7-year-old is providing client education to the child and caregiver. Which response by the caregiver demonstrates to the nurse that the caregiver understands the diagnosis of type 1 diabetes mellitus? "Her body fights against the insulin." "Her body doesn't have any insulin." "I will just feed my child healthy foods and sign her up for more sports." "We will just have our child exercise and take medicine to cure this."
"Her body doesn't have any insulin." Explanation: Type 1 diabetes mellitus (DM) is a disorder in which the child's body has a deficiency of insulin; children with type 1 DM cannot produce insulin. Type 2 DM is controlled through diet, medicine, and exercise. Type 2 DM can be prevented through diet and exercise, but type 1 DM cannot. Resistance to insulin is not the primary factor in type 1 DM.
During a visit to the clinic, the adolescent client with hypothyroidism tells the nurse that she takes her levothyroxine "whenever I think about it...sometimes I miss a dose, but not very often." What is the best response by the nurse? "As long as you are missing multiple doses it should be fine. Just as long as you take the levothyroxine at some point each day." "I know it's hard to remember medicines, but it is really important for you to take it before breakfast each day to control your hypothyroidism." "Maybe you could do something to remind yourself to take the medication on a daily basis." "If you forget a dose you can double up the next day. We just want your thyroid level to be maintained since you don't produce enough thyroid hormone."
"I know it's hard to remember medicines, but it is really important for you to take it before breakfast each day to control your hypothyroidism." Explanation: Levothyroxine is a thyroid hormone replacement used to treat hypothyroidism. It is important to maintain a consistent thyroid hormone level by taking the medication at the same time each day (preferably 30 minutes prior to breakfast for best absorption). Toxicity can occur if the dose is doubled. Suggesting the client "do something" to remember does not highlight the importance of taking it correctly.
The nurse is speaking with the parents of a school-aged child recently diagnosed with diabetes regarding the differences between hypoglycemia and hyperglycemia. Which statement by a parent indicates a need for further teaching? "Dry flushed skin may be a sign if high blood sugar." "If my son says he feels shaky, his blood sugar may be low." "When my son's breath smells fruity, it almost always indicates high blood sugar." "If I notice changes in my son like tearfulness or irritability, his blood sugar may be high."
"If I notice changes in my son like tearfulness or irritability, his blood sugar may be high." Explanation: Behavior changes such as tearfulness, irritability, confusion, and slurred speech are indications of hypoglycemia, not hyperglycemia. Tremors and diaphoresis are also indications of low blood sugar. Dry flushed skin, fatigue, weakness, nausea, vomiting, and fruity breath odor are all symptoms of hyperglycemia.
The nurse is teaching the parents of a 3-year-old girl with diabetes insipidus how to administer desmopressin acetate (DDAVP). Which comment indicates further need for teaching? "If she sneezes the medicine out of her nose, I wait until the next dose." "I check the specific gravity of her urine to see if the drug is working." "First I suction her nostrils, if necessary, to help the drug be absorbed." "Once the tube is filled, I hold it closed until I insert it into her nostril."
"If she sneezes the medicine out of her nose, I wait until the next dose." Explanation: The nurse must remind the parents that the medicine should be readministered immediately if the child sneezes. Proper intranasal administration of DDAVP starts with clearing the nostril. The effectiveness of the drug is monitored by checking the specific gravity of the child's urine. Proper administration involves inserting the measured tubing into the bottle, filling it to the proper dosage, holding the tube closed until it is inserted into the child's nostril, then blowing the fluid out of the tube.
The nurse is teaching a group of caregivers of children diagnosed with diabetes. 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." "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." "My child measures their own medication but sometimes doesn't administer the correct amount."
"My child measures their own medication but sometimes doesn't administer the correct amount." 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.
A 9-year-old girl is being evaluated for precocious puberty. What information from the child's mother is consistent with this condition? Select all that apply. "My daughter talks about having headaches all the time." "The teachers at school say she is moody." "My older daughter started her period when she was only 10 years old." "Sometimes at home my daughter gets aggressive with her younger siblings." "My child likes to play with dolls."
"My daughter talks about having headaches all the time." "The teachers at school say she is moody." "Sometimes at home my daughter gets aggressive with her younger siblings." "My older daughter started her period when she was only 10 years old."
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? "My son's nervousness may be a symptom of his hypothyroidism." "Most people with hypothyroidism have smooth, velvety skin." "When they get my son's thyroid levels normal, he won't be so tired." "Heat intolerance is a caused by low thyroid levels."
"When they get my son's thyroid levels normal, he won't be so tired." Explanation: Tiredness, fatigue, constipation, cold intolerance and weight gain are all symptoms of hypothyroidism.
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." "Most people with hypothyroidism have smooth, velvety skin." "My son's nervousness may be a symptom of his hypothyroidism." "When they get my son's thyroid levels normal, he won't be so tired."
"When they get my son's thyroid levels normal, he won't be so tired." 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.
A nurse is reinforcing the diagnosis of constitutional delay by the health provider to a 13-year-old male adolescent. Which is the best approach for this teen? "I would be worried about your short stature too and get a second opinion." "It really doesn't matter how tall your dad is. The physician just looks at your height to make this diagnosis." "You will not need medication because your hormone levels are normal. I would be glad to discuss these findings with you." "If you think you want testosterone shots, then I will get them scheduled for you."
"You will not need medication because your hormone levels are normal. I would be glad to discuss these findings with you." Explanation: This diagnosis of "short stature" or constitutional delay may cause self-esteem issues with male teens. The nurse should explore the teen's feelings. Teens with a delay in puberty usually experience puberty late, so there is no need for a second opinion. Hormone therapy is not given until after age 14.
When collecting data on a child diagnosed with diabetes mellitus, the nurse notes that the child has had weight loss and other symptoms of the disease. The nurse would anticipate which finding in the child's fasting glucose levels? 220 mg/dl 60 mg/dl 100 mg/dl 140 mg/dl
220 mg/dl Explanation: A fasting blood sugar result of 200 mg/dL or more almost certainly is diagnostic for diabetes when other signs, such as polyuria and weight loss despite polyphagia, are present.
The school nurse notes that a child diagnosed with diabetes mellitus is experiencing an insulin reaction and is unable to eat or drink. Which action would be the most appropriate for the school nurse to take? Dissolve a piece of candy in the child's mouth. Request that someone call 911. Anticipate that the child will need intravenous glucose. Administer subcutaneous glucagon.
Administer subcutaneous glucagon. Explanation: If the child having an insulin reaction cannot take a sugar source orally, glucagon should be administered subcutaneously to bring about a prompt increase in the blood glucose level. This treatment prevents the long delay while waiting for a physician to administer IV glucose or for an ambulance to reach the child.
The nurse is providing acute care for an 11-year-old boy with hypoparathyroidism. Which intervention is priority? Monitoring fluid intake and urinary calcium output. Providing administration of calcium and vitamin D. Administering intravenous calcium gluconate as ordered. Ensuring patency of the IV site to prevent tissue damage.
Administering intravenous calcium gluconate as ordered. Explanation: Administering intravenous calcium gluconate, as ordered, will restore normal calcium and phosphate levels as well as relieve severe tetany. Ensuring patency of the IV site to prevent tissue damage due to extravasation or cardiac arrhythmias is an intervention for any child with an IV, and monitoring fluid intake and urinary calcium output are secondary interventions. Providing administration of calcium and vitamin D is an intervention for nonacute symptoms.
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? Vitamin K administration until school age Administration of levothyroxine indefinitely An increased intake of calcium beginning immediately Administration of vitamin C until after growth is complete
Administration of levothyroxine indefinitely 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
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? Administration of levothyroxine indefinitely Vitamin K administration until school age An increased intake of calcium beginning immediately Administration of vitamin C until after growth is complete
Administration of levothyroxine indefinitely 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.
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? Antidiuretic hormone Insulin Growth hormone Thyroxine
Antidiuretic hormone 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.
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 Insulin Thyroxine
Antidiuretic hormone 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.
A newborn exhibits significant jittery movements, convulsions, and apnea. Hypoparathyroidism is suspected. What would the nurse expect to be administered? Calcium gluconate Desmopressin Hydrocortisone Levothyroxine
Calcium gluconate Explanation: Intravenous calcium gluconate is used to treat acute or severe tetany. Hydrocortisone is used to treat congenital adrenal hyperplasia and Addison disease. Desmopressin is used to control diabetes insipidus. Levothyroxine is a thyroid hormone replacement used to treat hypothyroidism.
A newborn exhibits significant jittery movements, convulsions, and apnea. Hypoparathyroidism is suspected. What would the nurse expect to be administered? Desmopressin Hydrocortisone Calcium gluconate Levothyroxine
Calcium gluconate Explanation: Intravenous calcium gluconate is used to treat acute or severe tetany. Hydrocortisone is used to treat congenital adrenal hyperplasia and Addison disease. Desmopressin is used to control diabetes insipidus. Levothyroxine is a thyroid hormone replacement used to treat hypothyroidism.
A woman in her first trimester of pregnancy has just been diagnosed with acquired hypothyroidism. The nurse is alarmed because this condition can lead to which pregnancy complication? Decreased cognitive development of the fetus Spina bifida in the fetus Congenital heart defects in the fetus Gestational diabetes in the mother
Decreased cognitive development of the fetus Explanation: If acquired hypothyroidism exists in a woman during pregnancy, her infant can be born intellectually disabled, because there was not enough iodine present for fetal growth. It is important, therefore, that girls with this syndrome be identified before they reach childbearing age.
A newborn is diagnosed with the salt-losing form of congenital adrenogenital hyperplasia. On what should the nurse focus when assessing this client? Dehydration Hypoglycemia Bleeding tendency Excessive cortisone secretion
Dehydration Explanation: If there is a complete blockage of cortisol formation, aldosterone production will also be deficient. Without adequate aldosterone, salt is not retained by the body, so fluid is not retained.
The nurse is caring for a newborn with 21-OH enzyme deficiency congenital adrenal hyperplasia (CAH). The nurse identifies one goal of the plan of care as being the understanding of the importance of maintaining hormone supplementation. Which outcome criteron demonstrates this goal has been met? The parents fill the prescription for hormone replacement therapy prior to discharge. The parents ask appropriate questions about the planned treatment goals. Prior to discharge the parents state that they understand the medication regimen. During follow-up visits the child demonstrates normal growth and development.
During follow-up visits the child demonstrates normal growth and development.
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? Aspirate the syringe for blood return before the injection. Place the needle with the bevel facing down before the injection. Elevate the subcutaneous tissue before the injection. Spread the skin before the injection.
Elevate the subcutaneous tissue before the injection. Explanation: Insulin injections are always given subcutaneously. Elevating the skin tissue prevents injection into muscles when subcutaneous injections are given.
A newborn is discovered to have congenital adrenogenital hyperplasia. What will the nurse most likely observe when assessing this client? Enlarged clitoris Abnormal facial features Small for gestational age Divergent vision
Enlarged clitoris
The nurse working on a pediatric floor understands the importance of diagnosing inborn errors of metabolism early. A child with a suspected problem must have blood urea nitrogen (BUN) and creatinine testing done. Which is the purpose of these two tests? Evaluate renal function. Detect changes in amino acid patterns. Evaluate metabolism. Evaluate liver function.
Evaluate renal function. Explanation: Tests of BUN and creatinine evaluate renal function. These tests are done to rule out chronic renal failure and to monitor the effects of treatments on the renal system. Tests of ammonia and lactic acid evaluate metabolism. Tests of plasma amino acids detect changes in amino acid pattern, while a liver function panel would help evaluate hepatic function.
When discussing congenital adrenal hyperplasia with a child's parents, the nurse would advise them that administration of which drug is anticipated? Vitamin D Growth hormone Hydrocortisone Calcium
Hydrocortisone Explanation: Congenital adrenal hyperplasia is an autosomal inherited disease. The adrenal glands produce an insufficient supply of the enzymes required for the synthesis of cortisol and aldosterone.
A 12-year-old child is diagnosed with hyperthyroidism. What problem would the nurse anticipate the child may have in school? Noncomprehension of written material Inability to submit neat handwriting assignments Increase in sleepiness by the end of the day Inability to fit legs under a school desk
Inability to submit neat handwriting assignments Explanation: Children with hyperthyroidism are seen in the health care provider's office with the first reports being sleep problems, poor school performance, and distractibility. These children are easily frustrated, get overheated, and fatigued during physical education classes. The disease causes muscle weakness and the child can develop fine tremors, which leads to poor handwriting. The child tends to have an increased rate of growth but the growth is not abnormal so he or she should not have a problem placing the legs under the desk. The child is tired throughout the entire day, not just at the end of the day. The disease does not cause problems with cognitive delays so the child should not have problems with comprehension.
Which results would indicate to the nurse the possibility that a neonate has congenital hypothyroidism? High thyroxine (T4) level and low thyroid stimulating hormone (TSH) level Normal TSH level and high T4 level Normal T4 level and low TSH level Low T4 level and high TSH level
Low T4 level and high TSH level 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.
A 4-year-old child is undergoing a radioimmunoassay of T4 and T3 to determine whether the thyroid is functioning properly. Which factor could abnormally elevate the child's iodine level and thus invalidate the test? Taking phenytoin Low circulating albumin levels Recent consumption of table salt Recent consumption of large amounts of cough medicine
Recent consumption of large amounts of cough medicine Explanation: Radioimmunoassay of T4 and T3 is a specific blood study to determine how much protein-bound iodine (PBI) is present in serum. Ask if a child has recently taken large amounts of cough medicine containing iodide before the study or the PBI level may be abnormally elevated
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 Detemir Regular insulin Lispro
Regular insulin Explanation: Insulin for diabetic ketoacidosis is given intravenously. Only regular insulin can be administered by this route.
An elementary school child takes metformin three times each day. Which disorder would the school nurse expect the child to have? Type 2 diabetes mellitus Gastrointestinal reflux Inflammatory bowel disorder Type 1 diabetes mellitus
Type 2 diabetes mellitus Explanation: Metformin is the common treatment to manage type 2 DM. Insulin, not oral medication, is the treatment of choice for type 1 DM.
The nurse is caring for a school-aged child newly diagnosed with type 1 diabetes mellitus. Which nursing action supports the 2030 National Health Goals to reduce the long-term complications from this disease process? Schedule the child and parents to attend diabetes education classes. Recommend homeschooling so the mother can provide the needed medications. Explain how the child's physical abilities will be affected during school. Discuss admission to a rehabilitation facility to learn self-care with this disease process.
Schedule the child and parents to attend diabetes education classes.
The nurse is caring for a child who is suspected to have a growth hormone deficiency. Which finding after further testing supports this diagnosis? The bone age is found to be two or more deviations below normal. Magnetic resonance imaging shows a brain tumor. Physical examination finds excessive foot and finger growth for age. Computed tomography identifies a tumor on the child's kidney.
The bone age is found to be two or more deviations below normal. Explanation: Diagnostic testing used in children with suspected growth hormone deficiency will indicate bone age to be two or more deviations below normal. The growth hormone is secreted by the pituitary gland not the kidney.
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 may not be taking the medication. The child needs to be started on an antibiotic drug. The child may have developed leukopenia. The child must be participating in sports. SUBMIT ANSWER
The child may have developed leukopenia. 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.
The nurse is assessing an 8-year-old boy who is performing academically at a second-grade level. The mother reports that the boy states feeling weak and tired and has had a weight increase of 6 pounds (13.2 kg) in 3 months. Which additional data would fit with a possible diagnosis of hypothyroidism? Oral cavity assessment shows two of the 6-year molars. The mother reports that the boy is always thirsty. The child has a faint rash on the trunk of the body. The child states that the exam room is cold.
The child states that the exam room is cold. Explanation: Cold intolerance, manifested by the fact that the child was uncomfortably cold in the exam room, is a sign of hypothyroidism
A school-age child is diagnosed as having Cushing syndrome from long-term therapy with oral prednisone. What assessment finding is consistent with this child's diagnosis and treatment? The child is excessively tall for chronologic age. The child is demonstrating signs of hypoglycemia. Child appears pale and fatigued. There are purple striae on the abdomen.
There are purple striae on the abdomen. Explanation: Cushing syndrome is caused by overproduction of the adrenal hormone cortisol. The overproduction of cortisol results in hyperpigmentation, which occurs from the melanin-stimulating properties of ACTH. Purple striae resulting from collagen deficit appear on the child's abdomen.
The nurse is preparing teaching materials for a family whose child is prescribed somatropin for a growth hormone deficiency. What should the nurse instruct the parents about the administration of this medication? This medication must be given by injection. This medication does not interact with any other types of medication. This medication must be given in the morning before school. Hip or knee pain is an expected adverse effect of this medication.
This medication must be given by injection. Explanation: Somatropin is administered by injection. It is best given at the hour of sleep because that is when growth hormone is released.
The nurse is preparing teaching materials for a family whose child is prescribed somatropin for a growth hormone deficiency. What should the nurse instruct the parents about the administration of this medication? Hip or knee pain is an expected adverse effect of this medication. This medication must be given in the morning before school. This medication does not interact with any other types of medication. This medication must be given by injection.
This medication must be given by injection. Explanation: Somatropin is administered by injection. It is best given at the hour of sleep because that is when growth hormone is released. Hip or knee pain could indicate a slipped capital epiphysis and should be reported to the health care provider. The nurse should urge the parents to inform all health care providers that the child is receiving this medication to avoid medication interactions.
A 6-year-old boy has a moon-face, stocky appearance but with thin arms and legs. His cheeks are unusually ruddy. He is diagnosed with Cushing syndrome. What is the most likely cause of this condition in this child? Tumor of the pancreas Tumor of the parathyroid Tumor of the adrenal cortex Tumor of the thyroid
Tumor of the adrenal cortex Explanation: Cushing syndrome is caused by overproduction of the adrenal hormone cortisol; this usually results from increased ACTH production due to either a pituitary or adrenal cortex tumor. The peak age of occurrence is 6 or 7 years. The overproduction of cortisol results in increased glucose production; this causes fat to accumulate on the cheeks, chin, and trunk, causing a moon-faced, stocky appearance. Cortisol is catabolic, so protein wasting also occurs. This leads to muscle wasting, making the extremities appear thin in contrast to the trunk, and loss of calcium in bones (osteoporosis). Other effects include hyperpigmentation (the child's face is unusually red, especially the cheeks).
A child presents to the primary care setting with enuresis, nocturia, increased hunger, weight loss, and increased thirst. What does the nurse suspect? Type 1 diabetes mellitus Hypothyroidism Syndrome of inappropriate diuretic hormone Diabetes insipidus
Type 1 diabetes mellitus Explanation: Signs and symptoms of type 1 diabetes mellitus include polyuria, polydipsia, polyphagia, enuresis, and weight loss.
The nurse is providing education to a 10-year-old child and the child's parents about the computed tomography (CT) scan that has been prescribed for the following day. What information should be included in the teaching provided? Select all that apply. After midnight you will not be able to eat or drink anything until after the test. Loud clicks and thumping sounds may be heard during the test. You will need to lie very still during the test. Your child cannot have the exam if there is any metal in your child's body. This test will let us see your tissues and organs.
You will need to lie very still during the test. This test will let us see your tissues and organs.
A nurse should recognize that which laboratory result would be most consistent with a diagnosis of diabetes mellitus? glucose in the urine proteinuria a fasting blood glucose greater than 126 mg/dl a fasting blood glucose less than 126 mg/dl
a fasting blood glucose greater than 126 mg/dl Explanation: A fasting blood glucose greater than 126 mg/dl is diagnostic for diabetes mellitus.
In a child with diabetes insipidus, which characteristic would most likely be present in the child's health history? gradual onset of personality changes, lethargy, and blurred vision vomiting early in the morning, headache, and decreased thirst delayed closure of the fontanels (fontanelles), coarse hair, and hypoglycemia in the morning abrupt onset of polyuria, nocturia, and polydipsia
abrupt onset of polyuria, nocturia, and polydipsia Explanation: Diabetes insipidus is characterized by deficient secretion of antidiuretic hormone leading to diuresis. Most children with this disorder experience an abrupt onset of symptoms, including polyuria, nocturia, and polydipsia.
The nurse is teaching the parents of a young client who has recently been diagnosed with diabetes insipidus about the disease. The child is not secreting enough of which hormone? thyroid stimulating hormone (TSH) antidiuretic hormone (ADH) luteinizing hormone (LH) adrenocorticotropic hormone (ACTH)
antidiuretic hormone (ADH) Explanation: Central diabetes insipidus (DI), also called neurogenic, vasopressin-sensitive, or hypothalamic DI, is a disorder of the posterior pituitary that results from deficient secretion of antidiuretic hormone (ADH). Nephrogenic DI is a result of the inability of the kidney to respond to ADH. Adrenocorticotropic hormone (ACTH) is secreted by the adrenal gland. Thyroid stimulating hormone (TSH) is secreted by the pituitary gland. Luteinizing hormone (LH) is a reproductive hormone.
An adolescent is found wandering around. The client is confused, sweaty, and pale. Which test will the nurse prepare to perform first? serum ketone testing computed tomography (CT) scan blood toxicology blood glucose level SUBMIT ANSWER
blood glucose level Explanation: It is important to determine a blood glucose level on the adolescent because the adolescent is exhibiting signs of hypoglycemia and needs to be treated quickly.
Assessment of a newborn reveals that the child has hypothyroidism. How does the nurse document this finding? autoimmune thyroiditis secondary hypothyroidism acquired hypothyroidism congenital hypothyroidism
congenital hypothyroidism Explanation: Congenital hypothyroidism is most commonly caused by defective embryonic development of the gland.
A child with growth hormone deficiency is prescribed growth hormone (GH) by subcutaneous injection. When teaching the child's parents about this drug, the nurse would instruct the parents to administer the drug at which frequency? daily, 6 to 7 days a week every 3 days monthly weekly
daily, 6 to 7 days a week Explanation: The parent or the child administers GH by subcutaneous injection usually 6 to 7 days per week (usually daily). It is generally given at bedtime to attempt to mimic the body's natural production and release during sleep.
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 glucosuria ketone bodies diabetic ketoacidosis
diabetic ketoacidosis 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. The 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.
Insulin deficiency, in association with increased levels of counter-regulatory hormones and dehydration, is the primary cause of: ketonuria. glucosuria. ketone bodies. diabetic ketoacidosis.
diabetic ketoacidosis. Explanation: Insulin deficiency, in association with increased levels of counter-regulatory hormones (glucagon, growth hormone, cortisol, catecholamines) and dehydration, is the primary cause of diabetic ketoacidosis (DKA), 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.
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? enlarged tongue tachycardia warm, moist skin frequent diarrhea
enlarged tongue Explanation: Observation of an enlarged tongue along with an enlarged posterior fontanel (fontanelle) and feeding difficulties are key findings for congenital hypothyroidism. The mother would report constipation rather than diarrhea.
A child is admitted to the pediatric medical unit with the diagnosis of syndrome of inappropriate antidiuretic hormone (SIADH). The child experiences the typical signs and symptoms of this disorder. Which concern will the nurse include in care planning? noncompliance because of difficulty coping delayed growth and development risk altered nutrition risk excess fluid volume risk
excess fluid volume risk Explanation: Syndrome of inappropriate antidiuretic hormone (SIADH) occurs when antidiuretic hormone (ADH; vasopressin) is secreted in the presence of low serum osmolality because the feedback mechanism that regulates ADH does not function properly. ADH continues to be released, and this leads to water retention, decreased serum sodium due to hemodilution, and extracellular fluid volume expansion; thus, the priority concern for care planning is the risk for excess fluid volume from edema.
An 8-year-old child is admitted to a medical-surgical unit with a diagnosis of syndrome of inappropriate antidiuretic syndrome (SIADH).
fluid balance, serum sodium, level of consciousness An increase of antidiuretic hormone causes the body to hold onto fluid. The nurse should monitor fluid balance closely when caring for a child diagnosed with syndrome of inappropriate antidiuretic syndrome (SIADH).Fluid retention and shifts can cause changes in level of consciousness. The nurse should monitor the child's level of consciousness closely.The increase of antidiuretic hormone causes the body to hold onto fluid, causing dilutional hyponatremia (decreased serum sodium). The nurse should monitor the child's serum sodium level closely.
A pediatric client has just been diagnosed with diabetes insipidus. What is the primary consideration for this client? headache weight loss fluid replacement polydipsia
fluid replacement Explanation: Children with diabetes insipidus lose tremendous amounts of fluid, so fluid replacement is the priority consideration for this client.
The nurse is assessing a 16-year-old boy who has had long-term corticosteroid therapy. Which finding, along with the use of the corticosteroids, indicates Cushing disease? delayed dentition history of rapid weight gain round, moon-shaped face high weight-to-height ratio
history of rapid weight gain Explanation: A history of rapid weight gain and long-term corticosteroid therapy suggests this child may have Cushing disease, which could be confirmed using an adrenal suppression test. A round, moon-shaped face is common to both Cushing disease and growth hormone deficiency
A child is diagnosed with hypoparathyroidism. Which electrolyte imbalance would the nurse most likely expect to address? hyponatremia hypomagnesemia hyperkalemia hypocalcemia
hypocalcemia Explanation: Hypoparathyroidism results in low production of PTH, which in turn leads to hypocalcemia and hyperphosphatemia.
A 12-year-old child suddenly experiences an extreme drop in blood pressure following discontinuation of prednisone. The child appears gray and has a weak pulse. Which is the priority nursing intervention in this situation? administration of insulin cardiopulmonary resuscitation immediate replacement of cortisol administration of epinephrine
immediate replacement of cortisol Explanation: Insufficiency (hypofunction) of the adrenal gland can occur when corticosteroid therapy such as prednisone that has been maintained at high levels for long periods is abruptly stopped and the gland does not return to usual function.
The nurse is caring for a child recently diagnosed with hypoparathyroidism disorder. Which medication would the nurse expect to be ordered? oral corticosteroids oral potassium oral calcium intravenous diuretic therapy
oral calcium Explanation: Medical management of hypoparathyroidism includes intravenous calcium gluconate for acute or severe tetany, then intramuscular or oral calcium as prescribed.
The nurse is caring for a child recently diagnosed with hypoparathyroidism disorder. Which medication would the nurse expect to be ordered? oral corticosteroids intravenous diuretic therapy oral calcium oral potassium
oral calcium Explanation: Medical management of hypoparathyroidism includes intravenous calcium gluconate for acute or severe tetany, then intramuscular or oral calcium as prescribed. IV diuretics are used in the 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 oral potassium intravenous diuretic therapy
oral calcium Explanation: Medical management of hypoparathyroidism includes intravenous calcium gluconate for acute or severe tetany, then intramuscular or oral calcium as prescribed. IV diuretics are used in the treatment of hyperparathyroidism. Oral corticosteroids and oral potassium are not used in the treatment of hypoparathyroidism.
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 loose stools recent weight loss slow healing wounds
recent weight loss Explanation: Weight loss is unique to type 1 diabetes, whereas weight gain is associated with type 2. Hypertension is consistent with type 2 diabetes. Both type 1 and type 2 diabetes cause delayed wound healing.
The nurse is caring for a 12-year-old girl with hypothyroidism. Which information should be part of the nurse's teaching plan for the child and family? how to maintain fluid intake regimens reporting irritability or anxiety how to recognize vitamin D toxicity administering methimazole with meals
reporting irritability or anxiety Explanation: Side effects of hypothyroidism are restlessness, inability to sleep, or irritability. These should be reported to the physician. Educating how to recognize vitamin D toxicity is necessary for a child with hypoparathyroidism. Teaching parents how to maintain fluid intake regimens is important for a child with diabetes insipidus. Teaching the child and parents to administer methimazole with meals is necessary for hyperthyroidism.
The nurse is caring for a 12-year-old girl with hypothyroidism. Which information should be part of the nurse's teaching plan for the child and family? reporting irritability or anxiety how to recognize vitamin D toxicity administering methimazole with meals how to maintain fluid intake regimens
reporting irritability or anxiety Explanation: Side effects of hypothyroidism are restlessness, inability to sleep, or irritability. These should be reported to the physician. Educating how to recognize vitamin D toxicity is necessary for a child with hypoparathyroidism. Teaching parents how to maintain fluid intake regimens is important for a child with diabetes insipidus. Teaching the child and parents to administer methimazole with meals is necessary for hyperthyroidism.
Which is the best way to control enzyme deficiencies? herbs and natural foods high-protein and low-sodium diet special diet restrictions and synthetic medical foods high-carbohydrate and low-fat diet
special diet restrictions and synthetic medical foods
A 12-year-old client arrives at the emergency room experiencing nausea, vomiting, headache, and seizures. The client is diagnosed with bacterial meningitis. Other findings include a decrease in urine production, hyponatremia, and water intoxication. Which pituitary gland disorder is most associated with these symptoms? diabetes insipidus (DI) syndrome of inappropriate antidiuretic hormone (SIADH) hyposecretion of somatotropin hypersecretion of growth hormone
syndrome of inappropriate antidiuretic hormone (SIADH) 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.
The nurse is assessing a 16-year-old girl who is in the office because she has not started menstruating. Which endocrine gland is most often affected by age-related changes? thyroid parathyroid anterior pituitary adrenal
thyroid Explanation: Many menstrual problems may be symptoms of undiagnosed thyroid conditions. Girls who have either very early or very late menstruation should be evaluated for a potential thyroid problem, as thyroid problems can frequently be a cause of early or delayed puberty and menstruation. Hyperthyroidism in a teenage girl can delay the onset of puberty and onset of menstruation into the mid-teens, in some cases after the age of 15.