PEDS IMMUNE/ENDO SHERPATH

A 22-month-old infant comes to the clinic, and the mother requests a human immunodeficiency virus (HIV) test. Which test would help to rule out infection in this child? One negative HIV antibody measurement Two negative HIV antibody measurements from separate specimens Three negative HIV antibody measurements from separate specimens Four negative HIV antibody measurements from separate specimens

Two negative HIV antibody measurements from separate specimens HIV antibody measurements are appropriate to use for a child over the age of 18 months; two negative antibody measurements from separate specimens will rule out an infection.

The nurse is assessing several pediatric patients diagnosed with inborn error of metabolism. Which complications of these conditions should the nurse expect to note? Match each disorder to the associated complication. Vomiting/diarrhea after feeding secondary to inability to digest sugar Sweet/fruity odor of urine, feeding difficulties Nerve cell destruction leading to developmental delay Increased amino acid in blood, complication is intellectual deficits

Vomiting/diarrhea after feeding secondary to inability to digest sugar Galactosemia Sweet/fruity odor of urine, feeding difficulties Maple Syrup Urine Disease Nerve cell destruction leading to developmental delay Tay-Sachs Disease Increased amino acid in blood, complication is intellectual deficits PKU

An adolescent patient was recently diagnosed with Type 2 DM. The nurse knows that learning has taken place when the child makes which statement related to prevention? "My dad has type 1 DM. This increases my risk of having diabetes." "Being overweight puts me at risk. Even if I lose weight, I cannot change this risk." "Being overweight with abnormal lipid levels increases my risk of having type 2 diabetes." "Being Native American puts me at risk for developing Type 2 DM. I should have HbA1c testing done on an annual basis."

"Being overweight with abnormal lipid levels increases my risk of having type 2 diabetes." Being overweight with two additional risk factors poses a risk. Dyslipidemia is one of those risk factors.

The nurse is caring for a 2-year-old patient who is positive for human immunodeficiency virus (HIV). The patient's mother asks the nurse why the health care provider has ordered a blood test for an HIV RNA assay when the patient has already been diagnosed with HIV. Which nursing education is appropriate for the patient? "HIV RNA assays after diagnosis are used to help diagnose secondary infections." "HIV RNA assays after diagnosis are used to monitor the patient's response to treatment." "HIV RNA assays after diagnosis are used to determine whether treatment can be safely discontinued." "HIV RNA assays after diagnosis are used to ensure that the initial diagnosis was not based on a false-positive test result."

"HIV RNA assays after diagnosis are used to monitor the patient's response to treatment." The number of copies of the HIV virus in the patient's bloodstream, known as the viral burden and measured by means of an HIV RNA assay, can help determine the patient's response to the prescribed treatment.

Which assessment questions should be included when obtaining the health history of a child with SIADH? Select all that apply. "Has your child had a recent infection?" "Does your child have a history of a malignancy?" "Does your child get a lot of exercise?" "Does your child experience excessive thirst?" "Does your child have a genetic mutation?"

"Has your child had a recent infection?" Childhood SIADH is usually related to an underlying cause, such as an infection. "Does your child have a history of a malignancy?" Childhood SIADH is usually related to an underlying cause, such as a malignancy.

The mother of a patient with nasal congestion, fatigue, and frequent sneezing states that this is the second time in the last 3 months that her child has had these symptoms. She requests that the child receive an allergy test to identify what is causing the recurring symptoms. Which statement would indicate the need for further education about signs and symptoms of allergic rhinitis? "He has a wrinkle on the bridge of his nose." "The symptoms get worse after he plays outside." "His drainage was clear, but this morning it turned yellow." "I've been putting lip balm on his mouth because it's very dry."

"His drainage was clear, but this morning it turned yellow." Yellow nasal discharge is most often a symptom of nasopharyngitis, whereas in allergic rhinitis rhinorrhea is typically clear. This statement would indicate the need for further education about symptoms of allergic rhinitis.

Which statement best describes the challenge regarding random blood sampling for hormone levels? "Hormone secretion can vary throughout the day." "Hormones are present at a low level, so more than one sample is needed." "It is difficult to collect random blood samples at various times during the day." "Hormones are secreted mostly at night and random tests are generally done at the provider's office during the day."

"Hormone secretion can vary throughout the day." Hormones are secreted at various times during the day or on a circadian rhythm and therefore random samples are difficult to interpret. Taking a random measurement does not provide the needed details; serial blood sampling identifies the peak or trough level of the hormone, providing a more accurate interpretation.

Which statements best describe the main functions of hormones? Select all that apply. "Hormones play a role in growth." "Hormones play a role in reproduction." "Hormones regulate blood flow." "Hormones play a role in regulating metabolism." "Hormones play a role in delivering oxygen to cells."

"Hormones play a role in growth." Hormones are necessary to help regulate growth; therefore, this statement best describes their function. The endocrine system and the autonomic nervous system can regulate growth through the actions of hormones controlled by the hypothalamic-pituitary axis. "Hormones play a role in reproduction." Hormones do have a major role in reproduction, including the ability to conceive. Therefore, this statement best describes the main is on function of hormones. The endocrine system and the autonomic nervous system can regulate reproduction through the actions of hormones controlled by the hypothalamic-pituitary axis. "Hormones play a role in regulating metabolism." Hormones have a vital role in the regulation of metabolism, and therefore this statement best describes their main function. The endocrine system and the autonomic nervous system can regulate, metabolism through the actions of hormones controlled by the hypothalamic-pituitary axis.

The nurse has taught a patient with type 2 diabetes mellitus about the clinical manifestations and evaluates that learning has occurred if the patient makes which statement? "I can expect that my blood sugars will increase when I am sick or under stress." "If I follow the diabetic diet, I will be able to control my symptoms of both hyperglycemia and hypoglycemia." "This darkening of the skin on the back of my neck is a result of high blood sugars and is nothing to worry about." "I understand that yeast infection, frequent urination, and high levels of energy are common in the diabetic patient."

"I can expect that my blood sugars will increase when I am sick or under stress." Infection, injury, surgery, and times of stress are among things that will increase blood glucose levels.

The nurse determines that teaching has been effective when the mother makes which statements about administering levothyroxine (Synthroid) to her infant child? Select all that apply. "I will give the medication with meals three times a day." "I can mix the medication in a small amount of applesauce for my infant." "Levothyroxine therapy will help resolve the symptoms of diarrhea, and weight loss." "I can dissolve levothyroxine in a small amount of water and administer by syringe to the infant." "I understand the dose of levothyroxine may change as my child grows." "I understand the dose of the medication is changed based on lab values."

"I can mix the medication in a small amount of applesauce for my infant." While levothyroxine is better given on an empty stomach, if the child cannot swallow the tablet, the tablet can be crushed and mixed with a small amount of food such as applesauce. "I can dissolve levothyroxine in a small amount of water and administer by syringe to the infant." Dissolving the medication in a small amount of water is appropriate for the neonate who is not taking solid food or medications. "I understand the dose of levothyroxine may change as my child grows." The dose of levothyroxine varies with the weight and age of the child. As the child grows, the dose of the medication may increase. "I understand the dose of the medication is changed based on lab values." The dose of levothyroxine is titrated to maintain T4 in the upper half of the normal range and to maintain TSH in the normal range for age.

A patient is speaking to the nurse about a recent diagnosis of hyperthyroidism. Which statements by the patient demonstrate an understanding of the disease? Select all that apply. "I may have trouble concentrating." "I should not play dodge ball during gym." "I will need to take levothyroxine to treat this disorder." "I will need to take methimazole to treat this disorder." "I can expect fatigue and weight gain with this disorder."

"I may have trouble concentrating." The statement, "I am having trouble concentrating," is a statement expected by patients with hyperthyroidism. Nervousness, irritably, and having trouble concentrating are common symptoms. "I should not play dodge ball during gym." The statement, "I cannot play dodge ball during gym," suggests the patient understands the importance of limiting contact sports. Since the patient with hyperthyroidism is at increased risk for injury, contact physical activity should be avoided. This will help decrease the possibility of damage to the liver. "I will need to take methimazole to treat this disorder." The statement, "I will need to take methimazole to treat this disorder," is one expected from a patient with hyperthyroidism. Methimazole, an antithyroid agent, works by inhibiting the production of thyroid hormone.

While meeting with an adolescent to address diabetes management, which statement by the adolescent regarding compliance with insulin usage would be concerning to the nurse? "I don't really understand the risks/complications of hypoglycemia, but I can tell when my blood sugar is low and I need to eat a snack." "I roll out of bed 10 minutes before my ride comes in the morning. Sometimes I don't have time for breakfast." "I used to skip my insulin dose when going out with friends. Now that I am a senior in high school, I understand the risk of letting my blood sugars get too high." "After my freshman orientation yesterday, my mom talked to me about what I think about taking more responsibility with managing my diabetes."

"I roll out of bed 10 minutes before my ride comes in the morning. Sometimes I don't have time for breakfast." Even though adolescent with diabetes mellitus are functionally able to perform diabetes management tasks far sooner than they can cognitively understand the implications of the action or consequences of omitting the action, this behavior is cause for concern as the adolescent does not mention the need for either blood glucose monitoring or the need for breakfast.

A home care nurse is teaching a parent and 16-year-old patient with type 1 diabetes mellitus about insulin administration and rotating sites. Which statement, if made by the patient, would indicate effective teaching? "I rotate sites between areas of my abdomen and arms." "I will use a 90-degree angle of injection with a 1/2-inch needle." "Insulin is given parenterally because the taste of an oral pill is awful." "Since giving injections into my right abdomen is more comfortable to me, I will use that side routinely."

"I rotate sites between areas of my abdomen and arms." Sites are rotated to prevent areas of adipose hypertrophy (fatty lumps), which interfere with insulin absorption and decrease variation in absorption. Preferred sites include back of upper arms, top and outer portion of thighs, abdomen, and hip.

A 10-year-old child with a suspected endocrine disorder is being seen at the clinic. The nurse discusses stimulation testing with the child's parent. Which statement by the parent indicates effective teaching? "My child's stimulation test requires blood samples over three days." "Stimulation testing requires blood sampling that will give us the size and the location of a tumor, if present." "My child's stimulation test requires a blood sample scheduled for 11 a.m. I will be able to pick up my older child from kindergarten at noon." "I understand that my child will need to stay at the clinic for several hours to have blood drawn at specific times after the releasing agent is given."

"I understand that my child will need to stay at the clinic for several hours to have blood drawn at specific times after the releasing agent is given." With stimulation testing, a releasing factor or another agent is given to trigger the release or inhibition of a specific hormone. Serial blood sampling identifies the peak or trough level of the hormone, aiding in more accurate interpretation.

The nurse manager is providing an in-service to new parents on PKU screenings. After teaching has been completed, which statement by the parents would indicate a need for further teaching? "Neonatal symptoms are not identified immediately after birth." "It is best to complete the screening 48-72 hours after birth." "If my infant has a positive screening result, that means that my child will have PKU for life." "The screening for PKU is completed in a panel with other congenital metabolic abnormalities."

"If my infant has a positive screening result, that means that my child will have PKU for life." A positive screen is only the first diagnostic procedure, and further diagnostic evaluation is needed to verify the diagnosis. Therefore, the parents' statement is incorrect because an infant with a positive screening does not necessarily have PKU.

A child has been diagnosed with Type 1 Diabetes Mellitus (DM) and the parent asks the nurse what this means. What is the best response by the nurse? "The child is at risk of DKA because of low blood sugar." "You do not have to worry about hypoglycemia with your child." "It is normal to have a variation in the blood glucose level, but now the sugar will be maintained at an elevated level." "In the absence of insulin, the child is unable to metabolize fats, proteins, and carbohydrates and use them for energy."

"In the absence of insulin, the child is unable to metabolize fats, proteins, and carbohydrates and use them for energy." Because insulin-secreting beta cells of pancreas are destroyed by inflammation, a child with Type I DM is unable to produce and secrete insulin. This response is an appropriate, concise explanation of pathophysiology of DM type 1.

Which statements best explain the principle of negative feedback within the endocrine system? Select all that apply. "It acts to maintain homeostasis." "It is not used to control the release of hormones." "It is an uncontrolled reaction, leading to endocrine disorders." "It is a regulatory mechanism by which a specific stimulus causes an opposite reaction when stimulated." "It is a regulatory mechanism by which a specific stimulus causes amplification of the action causing the stimulus."

"It acts to maintain homeostasis." Negative feedback works to maintain homeostasis within a system. Specific to the endocrine system, as the hormonal secretion rises, the secretion and production of its stimulating hormone decrease. "It is a regulatory mechanism by which a specific stimulus causes an opposite reaction when stimulated." Specific to the endocrine system, negative feedback occurs when an increasing level of a specific hormone inhibits the system responsible for releasing that hormone.

A mother who is positive for human immunodeficiency virus (HIV) asks a nurse about the types of HIV tests available for her 12-month-old infant. She said she has heard about both virological testing and HIV antibody testing but isn't sure which is appropriate. Which is the best response by the nurse? "Virological testing is the only form of HIV testing available." "The infant does not yet have AIDS, so virological testing is not needed." "The infant is too immature to produce antibodies so your child does not need virological testing." "Maternal antibodies are present in infant blood, so your child should receive virological testing rather than antibody testing."

"Maternal antibodies are present in infant blood, so your child should receive virological testing rather than antibody testing." Antibody testing is not accurate because maternal anti-HIV IgG crosses the placenta. Antibody testing cannot distinguish maternal from infant antibodies.

The patient with Type 2 DM receives metformin (Glucophage). What statements would the nurse include when educating the patient about the drug? Select all that apply. "If your BUN level is 20 mg/dL, the metformin will be held." "You can take metformin three times daily without regard to food." "Given that you are taking metformin twice daily, you do not need to follow a diabetic meal plan." "If you have forgotten to take your metformin, you can take 2 doses at the next scheduled time." "Metformin does not cause the body to make more insulin. As such, it rarely causes low blood glucose when used alone." "Side effects like diarrhea, nausea, and upset stomach are mild but common, and should go away after your body gets used to the medications."

"Metformin does not cause the body to make more insulin. As such, it rarely causes low blood glucose when used alone." Since Metformin does not cause the body to make more insulin, it rarely causes low blood glucose (hypoglycemia) when used alone. Hypoglycemia may occur when Glucophage is taken in combination with insulin or other diabetes pills such as repaglinide (Prandin®), nateglinide (Starlix®) or sulfonylureas. "Side effects like diarrhea, nausea, and upset stomach are mild but common, and should go away after your body gets used to the medications." Minor side effects from metformin (including mild diarrhea, nausea, or upset stomach) usually go away after the body gets used to taking the medicine for several weeks.

A pre-school child newly diagnosed with Type 1 DM and parent meet with the nurse. Which statement best explains why play therapy can be effective in dealing with diabetes mellitus when meeting with the patient? "Play therapy with other children helps the child act out frustration." "Play therapy is appropriate for this age for normal development." "Play therapy with dolls and diabetes equipment helps the child express concerns regarding injections and finger sticks." "Play therapy with age-appropriate toys can distract the child from thinking about the need for insulin and special diet."

"Play therapy with dolls and diabetes equipment helps the child express concerns regarding injections and finger sticks." Play therapy can help the child express concerns about insulin injections and being different from the other children and can help the child deal effectively with diabetes mellitus.

The nurse is meeting with an early school-age patient and parent to discuss management of the patient's Type 1 DM. The nurse understands that further teaching is needed when the parent makes which statement about the child's ability to participate in care? "My school-age child is involved in after-school sports. I need to be sure to pack an extra snack to prevent hypoglycemia." "A school nurse can help with testing blood sugars and draw up the appropriate dose of insulin. My child is not yet able to give herself injections." "Since my child is at school most of the day, she and I developed a diabetic management plan and presented it to her home room teacher." "My school-age child is not able to take part in diabetic management tasks yet. I check my child's blood glucose before and after school and give insulin as needed at those times."

"My school-age child is not able to take part in diabetic management tasks yet. I check my child's blood glucose before and after school and give insulin as needed at those times." The school child is able to participate in care. A school nurse or health aide should be identified to supervise before-lunch blood glucose monitoring and assist with insulin. This way the child does not feel singled out as needing special care. Since the parent does not understand this, further teaching is necessary.

The diabetes educator is meeting with a group of parents to discuss diabetes mellitus management. Many parents have questions about the role of the child. Together the diabetes educator and parents discuss ways to improve adherence with medication administration. The diabetes educator evaluates that learning has occurred when one parent makes which statements? "I can have my toddler take part in insulin administration by having them push the plunger on the insulin syringe". "My seventeen-year-old is focused on sports. She understands the need to independently manage her blood sugars to be able to be with her team for every game". "My school-age child is reluctant to take part in after-school activities. Having her bring pre-filled insulin syringes to activities and do the injections as scheduled may encourage her to participate". "My fourteen-year-old daughter is so influenced by her peers. If I get her best friend to talk to her about diabetes and insulin control, I know that she will adhere to the plan of checking blood sugars".

"My seventeen-year-old is focused on sports. She understands the need to independently manage her blood sugars to be able to be with her team for every game". The older adolescent is influenced by current needs, like being with friends, taking part in sports, etc. The older adolescent is able to recognize consequences of behaviors and choices and take charge of decisions.

During an exercise class for patients with type 2 diabetes, the nurse instructs the patients and parents on recommended daily activity. The nurse notes the need to reinforce teaching when a parent makes which statement? "My son spends hours outside drawing and then plays his video games in his room for no more than 40 minutes." "My child likes to play basketball outside with her friends for at least an hour after school. That only leaves her with about 30 minutes of TV time after dinner." "I like to take long walks with my son to the park down the street. We do this every day; it's great! It takes us over an hour, but we have a great time! He doesn't even miss the TV!" "Our daughter is on the school's swimming team. She practices daily from 3-6 p.m. About an hour before bed, we let her wind down with some cartoons or reading."

"My son spends hours outside drawing and then plays his video games in his room for no more than 40 minutes." Light physical activity is not enough activity for prevention and management of Type 2 diabetes mellitus. Recommended is at least 60 minutes of moderate to vigorous physical activity daily and less than 2 hours per day of "screen time" sedentary activities. This is not an appropriate activity level.

A parent of a child undergoing a water deprivation test asks the nurse what to expect. Which statement would be included in the discussion of the test? "Normal findings include decreased output and increased urine concentration." "This child has access to water throughout the testing process and weight gain is expected." "Normal findings include increased urine specific gravity and increased serum osmolality." "The child will experience drowsiness with the water deprivation, and this will resolve after the test is completed."

"Normal findings include decreased output and increased urine concentration." Normal findings of a healthy child include a decrease in urine output following water deprivation and an increase in the concentration of the urine.

The nurse is caring for a young child with juvenile idiopathic arthritis (JIA). The child's parents express concern with the possibility of the child developing impaired mobility and ask the nurse if the child might benefit from physical therapy. Which nursing education is appropriate for the family? "Physical therapy can be used to maintain functional mobility." "Physical therapy is often too painful for the child to be effective." "Nonpharmacological therapy is not considered effective for children with JIA." "Physical therapy is only indicated for children with JIA who have contractures or impaired mobility."

"Physical therapy can be used to maintain functional mobility." Physical therapy is indicated for children with JIA to maintain functional mobility and allow affected children to keep up with their peers.

A patient with central Diabetes Insipidus is treated with DDAVP. Which instructions should the nurse provide? Select all that apply. "DDAVP is given in three equal doses daily". "Restrict water intake." "This can be administered via nasal spray". "There are no risks of seizures with this medication". "The effect should be observed by 2 hours after administration".

"Restrict water intake." The patient should avoid excessive fluid intake while on DDAVP, as this could lead to hyponatremia, potentially resulting in seizures. "This can be administered via nasal spray". DDAVP may be administered intranasally or orally. The dosing is different, but both routes of administration result in the same effect. "The effect should be observed by 2 hours after administration". Decreased urine output is observed 1-2 hours after administration.

An adolescent patient asks the nurse how human immunodeficiency virus (HIV) is transmitted. Which responses from the nurse are appropriate? Select all that apply. "Sharing needles is a source of HIV infection." "Unprotected sex puts you at a high risk for acquiring HIV." "Donating blood or blood products carries a risk of HIV infection." "HIV can be transmitted through unsanitary public restrooms." "Patients who care for relatives with HIV may contract HIV themselves."

"Sharing needles is a source of HIV infection." Needle or syringe sharing is a high-risk behavior for HIV infection. This is an appropriate statement from the nurse. "Unprotected sex puts you at a high risk for acquiring HIV." Unprotected sexual activity is a high-risk behavior for HIV infection. This statement from the nurse is appropriate.

The nurse is assessing a 5-year-old patient with juvenile idiopathic arthritis (JIA). Which statement by the parent should prompt the nurse to alert the health care provider immediately? "She has trouble sleeping some nights due to discomfort." "She is very irritable in the morning when she wakes up." "She doesn't like to walk and frequently asks to be carried." "She's been feeling hot and flushed every night around the same time."

"She's been feeling hot and flushed every night around the same time." Temperature elevation, especially in the late afternoon or evening, may indicate a flare of systemic JIA and should be reported to the health care provider immediately.

A young female patient is noted to be overweight and early onset of puberty is present. The patient's mother asks, "Why this is happening?" Which response should the nurse provide? "In girls, CNS abnormalities are a frequent cause of precocious puberty." "Your rapid height increase stimulated the hormones that bring about puberty." "This early onset of puberty before age 9, called precocious puberty, is normal in some children." "Sometimes, early onset of puberty does not have a specific reason. However, it may be related to excess weight."

"Sometimes, early onset of puberty does not have a specific reason. However, it may be related to excess weight." In girls, precocious puberty is idiopathic in 90% of cases. Factors that may contribute to precocious puberty in girls include obesity.

A parent calls the nurse line, reporting that the child with diabetes is nauseated and vomiting. What is the priority statement the nurse will include in the instructions to the parent? "Hold the regular dose of insulin." "Allow the child to decide what to eat." "Test the blood glucose level frequently." "Encourage active engagement in activities."

"Test the blood glucose level frequently." The nurse will tell parent to test blood glucose level every 3-4 hours or more often if hypoglycemic or hyperglycemic. Testing blood glucose will help parent monitor child's illness and let them know what actions to take.

Which statements accurately describe the interaction between the endocrine system and the autonomic nervous system (ANS)? Select all that apply. "The thyroid gland bridges their function." "A negative feedback loop exists between the two systems." "The hypothalamus helps to integrate the function of the two systems." "The endocrine system and ANS work together to maintain homeostasis." "The endocrine system and ANS regulate coordinated movements and flexibility."

"The hypothalamus helps to integrate the function of the two systems." The hypothalamus, stimulated by the ANS, releases hormonal factors to the pituitary gland, which controls the release of hormones from other glands in the endocrine system. "The endocrine system and ANS work together to maintain homeostasis." The endocrine system and ANS work together to regulate body functions, including growth, metabolism, and reproduction. One stimulates the other; both are necessary at any given time to maintain homeostasis in the body.

Which statement is accurate regarding the pediatric endocrine system? "The pediatric endocrine system is immature at birth." "Birth complications can lead to hormonal abnormalities." "Endocrine abnormalities only become apparent with age." "Disorders of the endocrine system quickly correct themselves."

"The pediatric endocrine system is immature at birth." Hormonal control over the body is immature until 12 to 18 months of age. As such, infants may manifest imbalances in the concentration of glucose, though normoglycemia may be present at this age.

A child is diagnosed with precocious puberty and the nurse is reinforcing treatment plans with the family. Which statement by the parent indicates an understanding of the primary goal of treatment of the child? "The primary goal is to help my child and me understand the need for daily medication." "The primary goal is to stop my child's early sexual development without altering growth in any other ways." "The primary goal is to assist my child in engaging in age-appropriate social interactions at school." "The primary goal is to assist my child in expressing feelings about early sexual development and verbalizing acceptance."

"The primary goal is to stop my child's early sexual development without altering growth in any other ways." The primary goal of treatment of the child with precocious puberty is to preserve final adult height followed by stopping or reversing the development of secondary sexual characteristics.

When providing education to the parents of a toddler with Type 1 DM, the nurse should include which statement related to hypoglycemia? "The toddler is at great risk for severe hypoglycemia; be sure that you have a predetermined meal plan for every day and stick to it." "The toddler has varied intake from day to day. Better to allow for more food choices and work toward carbohydrate consistency." "The toddler can be fussy with respect to food. Minimize the battle by allowing the toddler to be in charge of selecting what to eat for each meal." "Toddlers are "spur of the moment" patients. Being flexible with checking blood glucose levels and giving insulin will limit the potential of on-going battles with care."

"The toddler has varied intake from day to day. Better to allow for more food choices and work toward carbohydrate consistency." A diet strategy that stresses carbohydrate consistency rather than specific food groups offers more flexibility to encourage adequate intake on the part of the toddler. Achieving consistency in dietary intake can be difficult in the toddler. Inconsistent intake, particularly of carbohydrates, contributes to blood glucose level variability.

A nurse is admitting a pediatric patient with an endocrine disorder. The admission orders include recording height, weight, and Tanner stage. Which statement by the nurse indicates an understanding of normal growth and development in relation to hormonal influence? "Growth spurts are related to chronological age." "Weight increases are proportional to height increases." "Variations in onset, timing, and pace of pubertal changes are normal." "The average pubertal changes occur before the age of 8 years in girls or age 9 in years in boys."

"Variations in onset, timing, and pace of pubertal changes are normal." Variations in the onset, timing, and pace of pubertal changes are normal; routine evaluation measures progression through puberty, but not necessarily progress toward specific data points.

The nurse is caring for a child with seasonal allergic rhinitis. Which statement from the child's parents would indicate the need for further education regarding allergic rhinitis? "We have her play inside most of the time." "We have closed the cat door so the cat stays inside." "We give her oral antihistamine only during spring time." "We make sure to wash her hair after she's been outside."

"We have her play inside most of the time." Having the child play inside is a not the most effective way to manage allergic rhinitis. Therefore, this statement would indicate a need for further teaching.

The adolescent patient and parent have completed diabetic education. Which statements by the parent would indicate an understanding of the goals of insulin therapy for diabetic management? Select all that apply. "Insulin replenishes the insulin-producing cells, the beta cells." "Insulin decreases insulin resistance and improves insulin sensitivity." "We will schedule the insulin to correspond to the child's usual meal times." "Insulin is used to balance blood glucose, independent of food intake and physical activity." "Insulin replaces the insulin the child is no longer able to make in an acceptable physiologic pattern."

"We will schedule the insulin to correspond to the child's usual meal times." This schedule, to correspond to the child's usual meal times, is in place to minimize the possibility of hypoglycemia. This is a correct goal of insulin therapy. "Insulin replaces the insulin the child is no longer able to make in an acceptable physiologic pattern." The goal of insulin therapy is to replace the insulin the child is no longer able to make in an acceptable physiologic pattern. The beta cells in the pancreas no longer produce/secrete insulin. This is a correct goal of insulin therapy.

The nurse is caring for a patient with juvenile idiopathic arthritis (JIA). While discussing long-term care with the patient's family, which statement by the family indicates the need for further education regarding management of JIA? "She just got a new painting kit for her birthday." "We're discouraging her from playing outside so she doesn't get hurt." "I've started offering a heating pad between doses of pain medicine." "We keep a special calendar on the wall so she can mark it every time she takes her medicine."

"We're discouraging her from playing outside so she doesn't get hurt." Activity that helps maintain normal muscle and joint integrity should be encouraged, though it may need to be modified in children with JIA. The child should not be discouraged from active play due to a perceived risk of injury. Therefore, this statement would indicate a need for further education about management of JIA.

A nurse is caring for a child with recurrent painful joint inflammation. Which statement from the family indicates an appropriate understanding of caring for the child with juvenile idiopathic arthritis (JIA)? "We ensure he has many naps throughout the day whenever he starts to feel tired." "We're having him take the flu shot instead of the mist." "We think his medication might be causing him to have a short attention span." "He gets annoyed by the range-of-motion exercises, so we stopped after a couple of weeks."

"We're having him take the flu shot instead of the mist." Since some medications used to treat JIA can cause immunosuppression, children with JIA should be given the inactivated injectable flu vaccination.

The antepartum nurse is caring for a woman who is positive for human immunodeficiency virus (HIV) and six weeks pregnant. During the visit, the patient expresses concern about her child potentially contracting HIV. Which response from the nurse is appropriate? "What kind of concerns are you having?" "Have you missed a dose of your medications?" "If you take your antiretroviral medications as ordered, your baby will not have HIV." "Right now we should focus on your pregnancy. It is too early to tell if your baby has HIV."

"What kind of concerns are you having?" This response acknowledges the patient's concerns and allows the patient to discuss them further; therefore it is an appropriate response.

The nurse is providing nutrition education to a patient newly diagnosed with Type 1 Diabetes Mellitus. The patient states, "I should have a glass of orange juice with a teaspoon of sugar if I feel lightheaded, cool, and clammy mid-morning." Which statement is the best response by the nurse? "No, 4 oz. of 100% orange juice will not have an immediate effect." "Yes, 4 oz. of 100% orange juice will quickly help to treat hypoglycemia." "Yes, 4 oz. of 100% orange juice is needed for long-term maintenance of blood glucose." "No, 4 oz. of 100% orange juice has too much sugar, a snack of cottage cheese and 7 whole grain crackers is a better option."

"Yes, 4 oz. of 100% orange juice will quickly help to treat hypoglycemia." The choice of 4 oz. of 100% orange juice is a good option when blood glucose falls during day. Hypoglycemia can be treated immediately with 15 g of easily digested (simple) carbohydrates. In 15 minutes, if symptoms are not relieved or blood glucose is 80 mg/dL or lower, repeat treatment.

The nurse is caring for a neonate who has just been diagnosed with human immunodeficiency virus (HIV) and will be discharged and continuing antiretroviral therapy at home. Before discharge, which statement by the nurse is appropriate teaching for the infant's family? Select all that apply. "You should keep track of how many wet diapers the infant has." "Be sure to wear gloves when handling any spit-up or vomit." "Remember to double-bag garbage cans containing dirty diapers." "If the infant has a low-grade fever, you should call the provider immediately." "There is a risk of transmission if you come into contact with the infant's saliva."

"You should keep track of how many wet diapers the infant has." Keeping track of wet diapers helps the family monitor for signs of dehydration, which can indicate infection. Therefore this teaching is appropriate for the family. "Be sure to wear gloves when handling any spit-up or vomit." Standard precautions should be taught to the family because they will be handling infected fluids and blood-borne pathogens. Therefore this teaching is appropriate for the family. "If the infant has a low-grade fever, you should call the provider immediately." The infant's immune response is immature and affected by HIV, so symptoms of infection are subdued. Therefore this teaching is appropriate for the family.

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? "The pills only work with an adult pancreas." "The drugs affect fat and protein metabolism, not sugar." "Your child needs to have insulin replaced, and the oral hypoglycemics only add to an existing supply of insulin." "Perhaps when your child is older the pancreas will produce its own insulin, and then your child can take oral hypoglycemics."

"Your child needs to have insulin replaced, and the oral hypoglycemics only add to an existing supply of insulin" In type 1 diabetes, the beta-cells have been destroyed. It is necessary to supply the insulin no longer produced by these cells. The oral medications have different modes of action that supplement insulin production by the pancreas, decreasing insulin resistance or affecting liver production of glucose. They are not insulin substitutes and are primarily used in type 2 diabetes mellitus. Oral hypoglycemics can supplement insulin production by the pancreas, decrease insulin resistance, or affect the liver production of glucose. In type 1 diabetes, without a pancreatic beta-cell transplant, it is unlikely that insulin would be produced.

A patient has type 1 diabetes mellitus and receives insulin. The patient asks the nurse why she cannot take pills instead. What is the best explanation by the nurse? "You will be able to use pills during what we call the honeymoon phase." "Your pancreas is unable to secrete an adequate amount of insulin." "You can take pills, but they are better to reserve for sick days when your blood glucose is variable." "You lost the ability to make insulin because of autoimmune destruction of the insulin-producing cells, the alpha cells."

"Your pancreas is unable to secrete an adequate amount of insulin." The child with Type 1 diabetes mellitus is unable to produce and secrete adequate amount of insulin. Beta cells in pancreas have been destroyed by inflammation. Medications like Metform, a biguanide, do not increase level of insulin in body, but increase sensitivity of muscle to insulin.

Which patient is at highest risk to develop Type 2 Diabetes Mellitus? 10-year-old Caucasian child whose father has Type 1 diabetes mellitus 5'10" 200 lb 18-year-old male taking atenolol daily, who walks 2 miles a day Overweight 16-year-old African American woman taking diphenhydramine daily 1-year-old Asian American female whose parents have Type 2 diabetes mellitus, taking one atorvastatin daily

1-year-old Asian American female whose parents have Type 2 diabetes mellitus, taking one atorvastatin daily This individual has three risk factors: family history (2) of diabetes, race, on antilipid medication (indicating a cardiac condition).

A newborn patient presents with ambiguous genitalia and is diagnosed with CAH. The nurse anticipates which enzymatic deficiency present in the newborn? Select all that apply. ACTH 11-deoxycortisol 21-hydroxylase 3-beta-hydroxysteroid dehydrogenase

21-hydroxylase 21-hydroxylase deficiency is the most common enzymatic defect in patients with CAH.

The nurse receives a shift report in the pediatric unit. Which patient would the nurse expect to be tested for human immunodeficiency virus (HIV)? A 7-month-old patient with toxoplasmosis A 3-year-old patient with bacterial meningitis A 16-year-old patient with chronic anemia and a history of multiple blood transfusions A 9-year-old patient with trisomy 21 (Down syndrome) who has recurrent otitis media

A 3-year-old patient with bacterial meningitis Bacterial meningitis may be a manifestation of HIV infection in children. This patient will likely receive HIV testing.

Which scenario would raise concern about the possibility of human immunodeficiency virus (HIV) infection in a pediatric patient? A child with a history of headaches and arthralgia presents with symptoms of a grand mal seizure. A child with a history of repeated urinary tract infections presents with vancomycin-resistant enterococci in the urine. A child with a history of repeated tonsil infection presents with loss of hearing. A child with a history of repeated episodes of otitis media now presents with pneumonia caused by Pneumocystis jiroveci.

A child with a history of repeated episodes of otitis media now presents with pneumonia caused by Pneumocystis jiroveci. Pneumocystis jiroveci pneumonia is an opportunistic infection seen almost exclusively in patients with HIV infection and the resultant immunodeficiency. This infection would raise serious concern about possible HIV infection.

Which patient would require immediate administration of epinephrine? A patient who reports a bright red rash after hiking outdoors A patient receiving penicillin infusion who reports tingling of the lips and tongue A patient who comes into the clinic after horseback riding and reports itchy eyes and runny nose A patient receiving cephalosporin treatment who develops raised red welts on the shoulders and chest

A patient receiving penicillin infusion who reports tingling of the lips and tongue A patient reporting tingling of the lips and tongue requires immediate administration of epinephrine. This patient's symptoms are characteristic of anaphylaxis.

The nurse is caring for a young patient who is being treated for Growth hormone (GH) deficiency. The child asks "When will I grow tall like my daddy?" What patient goal is a priority for the nurse to address? Acceptance of body image Patient acceptance of current stature Teaching the family the appropriate injection schedule Patient adherence to treatment so that a normal height can be obtained

Acceptance of body image The nurse should ensure that the child develops an acceptance of body image, as evidenced by the patient's verbalization of acceptance of the ultimate height. Because the young patient's statement indicates a failure to understand the likelihood of having a short stature, this goal is a priority for the nurse.

A diabetic patient arrives at the ER with tachycardia, diaphoresis, and unresponsive to voice. Which intervention is the priority action? Administer 50% dextrose IV per protocol Administer oxygen 2 L per nasal cannula Administer prescribed insulin subcutaneous (SQ) Administer naloxone hydrochloride (narcan) per protocol

Administer 50% dextrose IV per protocol Given symptoms, patient needs IV glucose.

An adolescent develops hives and swollen lips after a bee sting. What is the priority nursing intervention for this patient? Administer epinephrine as prescribed. Administer corticosteroids as prescribed. Administer diphenhydramine as prescribed. Carefully observe the patient for worsening of symptoms.

Administer epinephrine as prescribed. The adolescent appears to be experiencing anaphylaxis. Administration of injectable epinephrine via an EpiPen or other delivery system is the most important intervention.

A child comes into the school nurse office with slurred speech, itching of the head and shoulders, and swollen lips. Which action should the nurse take first? Call 911. Have the child lie down. Administer the child's EpiPen injection. Administer the child's prescribed diphenhydramine.

Administer the child's EpiPen injection. This child is showing signs of anaphylaxis, which should be treated immediately. The nurse should administer epinephrine first because it may be only a matter of minutes before shock occurs.

A nurse is caring for the parents of a child with allergic rhinitis. The parents state that since the child takes the prescribed antihistamines before bed, and since both the antihistamines and the child's mouth breathing cause dryness, they have placed a humidifier in the child's room at night. This demonstrates the need for further education on which aspect of managing allergic rhinitis? Air quality control Medication side effects Adequate patient hygiene Recognizing signs and symptoms of allergic rhinitis

Air quality control Use of a humidifier may encourage mold growth and cause the spread of allergens inside the child's room. The parents' statements indicate the need for further education regarding air quality control.

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

Ambiguous genitalia The condition of ambiguous genitalia is marked by hypospadias, micropenis, and no palpable gonads. Cushing syndrome is an endocrine disorder that involves excessive circulating free cortisol. Atrophy and adrenal insufficiency are not associated with hypospadias, micropenis, or palpable gonads.

Which of the following answers accurately describes an allergy? A deficit in one or several aspects of immune function An immune-mediated attack on the body's own systems An excessive and inappropriate immune response to a harmless antigen An effect of some medications or disease states that inhibits one or many aspects of the immune system

An excessive and inappropriate immune response to a harmless antigen An allergy is an excessive and inappropriate immune response to a harmless antigen (an allergen).

A patient is brought to the clinic and is diagnosed with glomerulonephritis. Which statement describes the interaction of molecules involved in this allergic reaction? IgE attaches to mast cell and basophil causing release of histamine. Antigen binds with antibodies and the structure then deposits into tissues. Antigen stimulates IgE, which then activates complement, eventually leading to cell damage. Sensitized T-cells come in contact with antigen on re-exposure causing tissue damage from cytokine release.

Antigen binds with antibodies and the structure then deposits into tissues. While local inflammation can be caused by a topical allergic reaction, this patient's symptoms are not characteristic of a topical allergic reaction. This state reflects what happens in a patient with glomerulonephritis, which is a type III allergic reaction.

A patient is brought into the emergency department with anaphylaxis due to an insect sting on the arm. After establishing a patent airway and administering epinephrine, which action should the nurse perform first? Start an IV line. Administer the prescribed corticosteroids. Administer the prescribed antihistamines. Apply a tourniquet to the affected extremity.

Apply a tourniquet to the affected extremity. In order to contain the allergen, the nurse should apply a tourniquet to the affected extremity proximal to the site of the sting. This is the action the nurse should perform first after establishing a patent airway and administering epinephrine.

The nurse is caring for a child with human immunodeficiency virus (HIV) who has just been transferred from the emergency department with suspected pneumonia. Which action should the nurse perform first? Initiate contact precautions Assess the child's respirations Administer oxygen via face mask Collect a sputum sample to test for Pneumocystis pneumonia

Assess the child's respirations Assessment of a child with HIV should be focused on respiratory status, hydration status, skin and mucous membranes, and pain level. Assessing respirations is the first action the nurse should take.

A patient is admitted to the hospital with a diagnosis of DI. What should the nurse include in the care plan for weight management of this patient? Restrict physical activity. Monitor the patient's weight gain. Assess the patient for weight loss. Observe for changes in the patient's nutritional intake.

Assess the patient for weight loss. DI is a disorder where the kidneys pass an abnormally large volume of urine. Weight loss is a reflection of that fluid loss.

The patient is managed with NPH and regular insulin before breakfast, lunch, and dinner. When is the patient most likely to experience a hypoglycemic reaction? Never Mid-day Before lunch Before breakfast

Before lunch Regular insulin peaks in 2-3 hours with duration of 8-10 hours. NPH insulin has onset of 2-4 hours. If too much a.m. insulin or not enough breakfast food is given, most likely time for a hypoglycemic episode is before lunch-regular insulin is at peak and NPH insulin has its onset, breakfast food has been metabolized.

A 15-year-old patient is diagnosed with juvenile idiopathic arthritis (JIA). The nurse should know that which methods are used to treat JIA? Select all that apply. Biologic drug therapy Systemic corticosteroids Assisted mobility therapy Joint replacement therapy Oral nonsteroidal anti-inflammatory drug (NSAID) therapy

Biologic drug therapy Biologic drug therapy is an important aspect of JIA management in terms of limiting joint inflammation. Systemic corticosteroids The inflammatory response associated with JIA can be managed with systemic corticosteroids. These drugs should therefore be familiar to the nurse in planning care for a patient with JIA. Oral nonsteroidal anti-inflammatory drug (NSAID) therapy Oral nonsteroidal anti-inflammatory drug (NSAID) therapy is a key aspect of JIA management in terms of limiting pain and maintaining mobility.

The nurse is caring for a patient with systemic lupus erythematosus (SLE) who reports numbness and pallor of the fingertips after being outdoors in the cold climate. While the patient's hands are warmed, which assessment finding should prompt the nurse to alert the health care provider immediately? Blistering of the skin Redness of the fingertips Patient report of tingling under the skin Patient report of stinging pain in the fingertips

Blistering of the skin Blistering of the skin upon rewarming is not characteristic of Raynaud phenomena but may be a sign of frostbite. This finding should prompt the nurse to notify the health care provider immediately.

The nurse correctly understands that which action is a possible mode of human immunodeficiency virus (HIV) transmission? Select all that apply. Kissing Breastfeeding During pregnancy Close physical contact Passage through the birth canal

Breastfeeding HIV may be transmitted during breastfeeding. This is considered one type of mother-to-child or perinatal transmission of HIV. During pregnancy HIV may be transmitted from mother to infant during pregnancy. This is considered one type of mother-to-child or perinatal transmission of HIV. Passage through the birth canal HIV is transmitted via blood or reproductive fluids. HIV may be transmitted during delivery. This is considered one type of mother-to-child or perinatal transmission of HIV.

The nurse is educating parents on preventative measures to take for their child who has a severe bee allergy. During the instruction it is important for the nurse to include which advice on the biphasic reaction associated with use of the EpiPen? Place ice on the sting and area of injection, and provide plenty of oral fluids. Administer a low dose of an antiinflammatory medication to help reduce any pain experienced by the child. Ensure the child receives plenty of rest immediately after the injection. Bring the child to the emergency department because there may be another reaction. Administer a double dose of antihistamine to the child and provide plenty of oral fluids.

Bring the child to the emergency department because there may be another reaction. The biphasic reaction can occur in instances of anaphylaxis. This means even after being treated with epinephrine, a second reaction can occur with the same level of severity. A visit to the emergency department should be advised after an EpiPen injection.

A patient with type 2 diabetes mellitus complains of nausea, vomiting, diaphoresis and headache. Which of the following nursing actions should the nurse perform first? Check the patient's blood glucose level. Instruct the patient to take a Glucophage tablet. Instruct the patient to take 6 units of regular insulin. Provide the patient with 8 oz of orange juice with 1 tsp sugar.

Check the patient's blood glucose level. Checking the patient's blood glucose level will provide objective data of the patient's status. From this data, interventions can be implemented.

Match the signs and symptoms with the associated disorder. Congenital Hypothyroidism Acquired Hypothyroidism Hyperthyroidism

Congenital Hypothyroidism Slow feeding Acquired Hypothyroidism Pale and puffy face Hyperthyroidism Tremors, hyperactive

A patient is given cosyntropin to evaluate for endocrine dysfunction. Which would be an expected finding after administering cosyntropin to a patient in good overall health? Cortisol increase Cortisol decrease Adrenocorticotropic hormone (ACTH) increase Adrenocorticotropic hormone (ACTH) decrease

Cortisol increase Cortisol would be expected to increase with the administration of cosyntropin. Cosyntropin is a form of ACTH that acts to increase cortisol in a healthy patient and has either no effect or a reduced effect in a patient with endocrine dysfunction.

A child presents to the clinic with swelling of the lips and tongue, severe flushing, and pruritus. Which medication should the nurse administer first? Cetirizine Prednisone Epinephrine Diphenhydramine

Epinephrine Epinephrine is the first-line medication used to treat anaphylaxis.

The nurse understands that teaching has been effective when a patient makes which statement about Diabetes Insipidus (DI) and Syndrome of Inappropriate Antidiuretic Hormone (SIADH)? Seizures are likely in DI, but not SIADH. DI can lead to weight loss, whereas SIADH can lead to weight gain. DI is caused by excessive hormone production, whereas SIADH is caused by a hormone deficiency. DI can be treated by increasing water intake, whereas SIADH can be treated by restricting water intake.

DI can lead to weight loss, whereas SIADH can lead to weight gain. DI leads to excessive urine output and dehydration and may result in weight loss due to water loss. SIADH is characterized by fluid retention and may lead to weight gain and edema.

A patient is admitted to the hospital with DI. What should the nurse consider or assess when making a plan of care for this patient? Select all that apply. Polyphagia Weight gain Daily urine output of 3L Headache, dizziness, fatigue Child's ability to regulate thirst

Daily urine output of 3L Daily urine output of 3L suggests increased urinary output. This is a finding which will need to be considered by the nurse in the care plan DI. Child's ability to regulate thirst The nurse will need to plan care for a patient with polydipsia or who is experiencing excessive thirst and excessive fluid volume intake.

The nurse is caring for a patient with SIADH. Which clinical manifestation should alert the nurse that the patient is experiencing complications? Polyuria Weight loss Muscle tension Decreased level of consciousness

Decreased level of consciousness SIADH causes hyponatremia. Low sodium can impact the patient's neurological status and increase their risk for seizure activity.

The nurse is caring for an infant with human immunodeficiency virus (HIV). Which management goals are appropriate for the patient's care plan? Select all that apply. Curing the infection Decreasing the viral load Preserving immune function Preventing medication resistance Facilitating normal growth and development

Decreasing the viral load The goals of management are directed toward rapidly decreasing the viral load to reduce the effects of the virus on the immune system. Preserving immune function The goals of management include preserving immune function to maintain the patient's ability to fight infection. Preventing medication resistance The goals of management include preventing drug resistance to preserve effectiveness of treatment. Facilitating normal growth and development The goals of management include facilitating normal growth and development to prevent developmental stagnation or disorders secondary to HIV infection.

The nurse speaks to a new mom about PKU. Which complication will be a priority in the plan of care for this patient? Itchy, fluid-filled blisters Deficient fluid volume Risk for an allergic response Accelerated growth and development

Deficient fluid volume Deficient fluid volume would be included in the plan of care. The child with PAH deficiency has digestive problems associated with vomiting.

What should be the priority nursing intervention for a diabetic child with fever and deep, rapid breathing who is admitted to an intensive care facility for management? Administer antibiotics to the child. Administer continuous intravenous insulin. Determine the blood glucose level of the child. Obtain a sample for arterial partial pressure of oxygen.

Determine the blood glucose level of the child Deep, rapid breathing in a diabetic child may reflect hyperventilation due to metabolic acidosis or diabetic ketoacidosis. Rapid assessment of the child is a priority nursing intervention. The blood glucose level must be determined at the bedside. Antibiotics are administered to the febrile child only after obtaining appropriate specimens for culture. Continuous intravenous insulin is administered after the initial rehydration; it should not be administered until blood glucose and urine ketone levels are obtained. A blood sample needs to be obtained for determining arterial partial pressure of oxygen as part of the rapid assessment of the child; however, the sample is obtained after determining the blood glucose level at the bedside.

A pediatric patient presents to the urgent care clinic after the parent suspects the child is experiencing an allergy to a prescribed antibiotic. Which assessment finding would be most concerning to the nurse? Flushing of the face Increased heart rate Complaints of feeling warm Difficulty speaking and catching his breath

Difficulty speaking and catching his breath Difficulty speaking and catching one's breath can indicate laryngospasm in the patient experiencing a type I reaction. The patient is at risk for airway compromise. This is the most concerning finding.

Which is a priority nursing action to include in the treatment plan of a 5-year-old patient with Growth hormone (GH) deficiency? Advise the parent to measure their child's height and keep a growth chart with all measurements. Discuss the importance of hormone therapy and demonstrate the injection technique to the parent; request a return demonstration. Reassure the child and parents that adherence to the injections should improve present height. Provide instructions about meeting with the endocrinologist three or four times a year.

Discuss the importance of hormone therapy and demonstrate the injection technique to the parent; request a return demonstration. Having the parents understand the importance of hormone therapy will be a priority. It is appropriate to demonstrate the injection technique to the parents and request a return demonstration. This also applies to the child if age-appropriate.

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? Do not reuse needles. Inject insulin when it is cold. Flex or tense the muscle during injection. Remove all bubbles from the syringe before the injection. Do not move the direction of the needle-syringe during insertion or withdrawal.

Do not reuse needles. Remove all bubbles from the syringe before the injection. Do not move the direction of the needle-syringe during insertion or withdrawal. The reuse of needles leads to more discomfort on injection because the needles become dull and this also poses an infection-control problem. Removing bubbles from the syringe will minimize discomfort. Keeping the direction of the syringe constant during the insertion and withdrawal minimizes discomfort. Insulin should be injected at room temperature to minimize discomfort. Flexing or tensing the muscle during injection causes more discomfort.

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

Dry skin, sparse hair, slowed growth Clinical manifestations of juvenile hypothyroidism include dry skin, sparse hair, decelerated growth, constipation, puffiness around the eyes, sleepiness, and mental decline. Diarrhea and enlarged thyroid are not associated with juvenile hypothyroidism.

A child with type 1 diabetes mellitus who is taking insulin is seen in the school's clinic. The nurse develops a teaching plan for the child regarding food and exercise because the child has told the nurse that she will begin basketball practice. Which instruction should the nurse provide to the child? Withhold insulin on the day of basketball practice. Eat lunch 2 hours earlier on the day of basketball practice. Joining the basketball team should be delayed for 1 more year. Eat an extra snack of carbohydrates before the basketball practice starts.

Eat an extra snack of carbohydrates before the basketball practice starts. Because exercise lowers blood glucose levels, the child must be taught how to prevent hypoglycemia. The extra snack before practice will avert the hypoglycemia.

The nurse is planning the care for a patient admitted with precocious puberty. Which actions should the nurse include in the patient's plan of care? Select all that apply. Educate the family on the medical treatment plan. Encourage the child to accept and cope with the physical changes. Encourage the child to take part in activities appropriate for the physical development stage. Provide the parents and child an outlet for expressing feelings about the child's early development. Help the child adjust socially and emotionally to changes associated with treatment.

Educate the family on the medical treatment plan. The primary treatment goal of precocious puberty is to preserve final adult height followed by stopping or reversing the development of secondary sexual characteristics. This involves correct use of medication. Provide the parents and child an outlet for expressing feelings about the child's early development. Providing an outlet for expression is part of the plan of care, and so the nurse will need to provide psychosocial support for the parents and the child. Help the child adjust socially and emotionally to changes associated with treatment. As the child adjusts to the changes associated with medical treatment, the nurse will be there to provide emotional support for the child

The nurse is preparing to discuss long-term care of a child with advanced human immunodeficiency virus (HIV) disease. The patient's mother is also HIV positive and concerned about her child's future. Which topics should the nurse anticipate discussing with the mother? Select all that apply. Education Quality of life Continuing care End-of-life decisions Guardianship/placement

Education Although children with HIV infection are protected from educational discrimination by federal law, parents of children who are HIV positive often have questions. Therefore the nurse should anticipate discussing future education with the patient's mother. Quality of life Quality of life is an important topic to discuss when planning future care of a child who is HIV positive, especially if the child's disease is advanced. The nurse should anticipate discussing quality of life with the patient's mother. Continuing care Continuing care is frequently discussed when planning long-term care for a child with HIV, especially if the child's HIV disease is advanced. The nurse should anticipate discussing continuing care with the patient's mother. Guardianship/placement Planning for a child with HIV often includes discussion of potential standby guardianship, kinship care, or foster and adoptive placement because of the multigenerational nature of the disease. The nurse should anticipate discussing guardianship with the patient's mother because both the patient and the mother are HIV positive.

An infant with confirmed human immunodeficiency virus (HIV) has a decreasing CD4+ percentage with ongoing monitoring. Based on the lab results, which physical finding is most appropriate for the nurse to assess for? Constipation Decreased reflexes Elevated temperature Deteriorated muscle tone

Elevated temperature Elevated temperature is a nonspecific sign of infection that is often associated with a decreasing CD4+ percentage.

A 5-year-old child exhibits itchy, watery eyes and nose, and sneezing. Which nursing care action is performed first to support a diagnosis of allergic rhinitis? View patient chest x-ray. Order a complete blood count. Perform skin prick/puncture test. Examine patient and family history.

Examine patient and family history. A thorough personal and family history usually elicits a description that suggests an allergic rather than infectious pattern and should be the first step in assessment.

Which statement best describes the thyroid levels in hypothyroidism and hyperthyroidism? Expect an elevated T4 level with suppressed TSH with hypothyroidism and a suppressed T4 level with elevated TSH with hyperthyroidism. Expect a suppressed T4 level with elevated TSH with hypothyroidism and an elevated T4 level with suppressed TSH with hyperthyroidism. Expect an elevated T4 level with suppressed TSH with hypothyroidism and an elevated T4 level with suppressed TSH with hyperthyroidism. Expect a suppressed T4 level with elevated TSH with hypothyroidism and a suppressed T4 level with suppressed TSH with hyperthyroidism.

Expect a suppressed T4 level with elevated TSH with hypothyroidism and an elevated T4 level with suppressed TSH with hyperthyroidism. A low T4 level with TSH elevation is indicative of congenital hypothyroidism. With a low T4, the pituitary gland produces more TSH. Elevated serum T4 and T3 levels with suppressed TSH levels and signs and symptoms of hyperthyroidism are suggestive of Graves disease. The pituitary gland secretes less TSH to compensate for excess T3 and T4 hormones in the blood.

A child presents with red-raised skin lesions and is diagnosed with contact dermatitis. What is the most likely cause of this allergic reaction? An insect sting Ingestion of nuts Inhalation of pollen Exposure to poison ivy

Exposure to poison ivy Contact dermatitis is a localized, cutaneous manifestation of an allergy that is often caused in children by contact with poison ivy. Therefore, it is likely that this patient's reaction was caused by exposure to poison ivy.

Which potential complication should be included in the plan of care for a female patient with hyperthyroidism? Select all that apply. Injury from falls I Nutrient Deficiencies Fluid volume deficit Disturbed body image Risk for decreased cardiac output

Fluid volume deficit The patient with hyperthyroidism may have diarrhea given the overstimulation of gastrointestinal system. Fluid volume deficit related to abnormal fluid loss due to diarrhea can be a finding in patients with hyperthyroidism. Risk for decreased cardiac output The patient with hyperthyroid is in a hyper-metabolic state, leading to tachycardia and high blood pressure.

A diabetic child who is treated with insulin is trembling and sweating profusely. The nurse learns that the child has skipped lunch. What is the nurse's best action? Administer a glucagon injection. Give the child 3 to 6 oz of orange juice. Give the child insulin injection immediately. Ignore the symptoms because it is a normal finding.

Give the child 3-6 oz of orange juice The symptoms of the patient indicate adrenergic symptoms of hypoglycemia. Therefore the nurse should give the child a simple, high-carbohydrate drink such as 3 to 6 oz of orange juice, which should be followed by a starch-protein snack. Administering a glucagon injection is reserved for hypoglycemic patients who are unconscious, unresponsive, or having seizures. An insulin injection should not be given to this patient, because the symptoms are being caused by low blood sugar. Ignoring the symptoms can lead to further deterioration in the patient's condition and may eventually lead to death.

A patient with clear rhinorrhea and itchy eyes and ears reports more frequent symptoms after outdoor play. What is the first step in alleviating the patient's symptoms? Dry the child's shoes. Keep low humidity in the house. Have the child bathe after coming inside. Wash the child's sheets and blankets in hot water.

Have the child bathe after coming inside. If the child bathes and washes his or her hair after coming inside, it can remove pollen and dander and reduce further exposure to the allergen.

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

Having a tracheostomy set at the bedside The goiter puts the infant at risk for respiratory failure. Preparations are made for emergency ventilation, including having a tracheostomy set at the bedside. Placing the neonate in a side-lying position is not indicated. Hyperextension of the child's neck may facilitate breathing. There is no indication for suctioning in a neonate with goiter. No dressing is indicated in a neonate who has a goiter.

A nurse is reviewing the treatment plan for a patient with DI and notes the patient is receiving vasopressin (DDAVP). Which signs or symptoms exhibited by the patient warrant the nurse's immediate action? Decreased urine output Headache and irritability Increase in appetite Serum sodium level of 136 mEq/L

Headache and irritability The child's neurologic status is closely monitored every 2 to 4 hours to record the level of consciousness and observing for headache, irritability, or seizures. Chronic use of vasopressin for DI can lead to excessive ADH, triggering SIADH. The patient is at risk for the development of decreased LOC and seizures.

The nurse would expect a patient with hypothyroidism to report which health concern? Polyuria and polydipsia Excess energy and difficulty sleeping Height and weight at the 5th percentile Profuse sweating, flushing, tachycardia

Height and weight at the 5th percentile Height, weight, and head circumference <50th percentile are indicative of delayed growth and development. The child with hypothyroidism may display this characteristic due to inadequate levels of TSH.

Which finding may lead to a suspicion of Growth hormone (GH) deficiency? Increased blood glucose level Growth hormone levels less of 15 ng/mL Height in the 3rd percentile over two years Diminished body fat with increased muscle mass

Height in the 3rd percentile over two years GH deficiency results from inadequate production or secretion of GH, causing poor growth and short stature. Any child growing less than 5 cm per year should be referred to an endocrinologist for further evaluation.

A child presents with swelling of the lips and tongue, severe flushing, and pruritus. Which chemical mediator is likely responsible for these symptoms? Histamine Epinephrine Corticosteroid Diphenhydramine

Histamine The child is displaying signs and symptoms of anaphylaxis. Histamine release by mast cells is the cause of many of the signs and symptoms of anaphylaxis.

A child infected with human immunodeficiency virus (HIV) will primarily exhibit deficiencies in which aspects of immune function? Select all that apply. Phagocytosis Complement Inflammation Humoral immunity Cell-mediated immunity

Humoral immunity Humoral immunity, which depends primarily on immunoglobulins, becomes nonfunctional with HIV infection. A child with HIV will exhibit primary deficiency in humoral immunity. Cell-mediated immunity Cell-mediated immunity, which depends highly on helper T-cells, is most affected by HIV infection. A child with HIV will exhibit primary deficiency in cell-mediated immunity.

Match the gland to the normal development to which it is attributed. Increased skeletal and muscular growth, voice changes Involved in the basal metabolic rate Involved in the process of ovulation Stimulates reabsorption of water from kidney tubules

Increased skeletal and muscular growth, voice changes Testes Involved in the basal metabolic rate Thyroid Involved in the process of ovulation Anterior pituitary lobe Stimulates reabsorption of water from kidney tubules Posterior pituitary lobe

The diabetes educator is meeting with school nurses to discuss ways to increase diabetes management in the schools, allowing for students with diabetes to take part in everyday activities, before, during, and after school. The school nurses provide scenarios of their involvement with diabetes management. Which statement indicates a safe nursing action on the part of the school nurse? I had a 15-year-old diabetic child come to my office last week. She was not able to have breakfast that morning but denied symptoms of hypoglycemia, such as tachycardia or sweating. I assisted her with the a.m. dose of regular insulin. I had a 14-year-old diabetic child come to my office yesterday after school. Her coach asked that she see me because of irritability, pallor, and clammy skin. The child reported that after running 1 mile as warm-up, these symptoms developed. We tested her blood glucose. I had a 12-year-old diabetic child last week come to my office complaining of increased thirst and fatigue. I noticed deep, rapid respirations and a fruity odor to her breath. The child has a management plan that includes self-blood glucose monitoring. She obtained a reading of 104 mg/dL, so I let her go back to class. I had a 16-year-old diabetic child come to my office yesterday morning, asking about managing her diabetes when going out with friends. She wants to be a cheerleader and has to keep her weight down. She told me that skipping her evening dose of insulin would help her achieve that goal. That seemed reasonable, as then the intake would not be metabolized.

I had a 14-year-old diabetic child come to my office yesterday after school. Her coach asked that she see me because of irritability, pallor, and clammy skin. The child reported that after running 1 mile as warm-up, these symptoms developed. We tested her blood glucose. Check the child's blood glucose when the child has symptoms of hypoglycemia after running a mile, midafternoon. This is a safe nursing action as it will give information that can determine what to do next.

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

Immediate treatment is required because DKA is a life-threatening situation DKA is the complete state of insulin deficiency. It is a medical emergency that must be diagnosed and treated immediately. The child is usually admitted to an intensive care unit for assessment, intravenous insulin administration, and fluid and electrolyte replacement. DKA is a medical emergency needing prompt assessment and intervention, usually in an intensive care environment. It is not an expected outcome of type 1 diabetes mellitus. DKA is a medical emergency that requires hospitalization, usually in an intensive care unit.

Which statement correctly indicates the underlying cause of hyponatremia in SIADH? Inadequate urine output Insensitively to vasopressin Insufficient intake of sodium in the diet Altered ADH secretion caused by low serum osmolality

Inadequate urine output Inadequate urine output (retention of water but not solute) leads to the hyponatremia in SIADH.

What changes in the management of the child with type 1 diabetes mellitus should be expected as a result of more exercise? Increased food intake Decreased food intake Decreased risk of insulin shock Increased risk of hyperglycemia

Increased food intake Food intake should be increased when the child is more active. During races and other competitions, more food may be required than during practice to maintain a balance between glucose and exogenously administered insulin. The child will require increased food on days of increased activity. The increased activity lowers the blood glucose level. Blood sugar must be monitored closely to avoid administration of too much insulin during a time of reduced need.

A patient with Type 1 diabetes mellitus is admitted to the emergency department in DKA. Which action should the nurse take first? Correct the hypokalemia Determine cause of the ketoacidosis Administer regular insulin intravenously Initiate fluid replacement with 0.9% saline

Initiate fluid replacement with 0.9% saline The nurse will initiate fluid replacement with 0.9% saline IV to restore intravascular volume to raise blood pressure and ensure glomerular perfusion. This is priority.

What is the most effective treatment option for children with type 1 diabetes? Diet only Oral agents Insulin and diet Diet and oral agents

Insulin and diet Insulin and dietary changes are the current treatment for children with type 1 diabetes. Dietary changes alone are not effective in treating type 1 diabetes. Oral agents are effective against type 2 diabetes, not type 1. Diet and oral agents are used to treat type 2 diabetes, not type 1 diabetes.

How is the delivery of insulin through an insulin infusion pump different from delivery of insulin through subcutaneous injections? Insulin infusion pump delivers insulin into the thigh muscles. Insulin infusion pump causes less skin infections than injections. Insulin infusion pump delivers fixed amounts of insulin continuously. Insulin infusion pump is less expensive than giving multiple injections.

Insulin infusion pump delivers fixed amounts of insulin continuously An insulin infusion pump delivers fixed amounts of insulin continuously, similar to the release of insulin from the islet cells of the pancreas. Both the infusion pump and the injections deliver insulin into the subcutaneous tissue of either the abdomen or the thigh and not into the muscles. Because the infusion pump stays in place, skin infections are common. Delivery of insulin through infusion pumps is more expensive than delivery of insulin through injections.

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

It is caused by excessive production of cortisol Cushing syndrome is a description of the clinical manifestations caused by too much circulating cortisol. Exophthalmia and pigmentary changes are manifestations of hyperthyroidism, not Cushing syndrome. The treatment for Cushing syndrome involves the reduction of circulating cortisol. If the cause is a pituitary tumor, surgery is indicated. Hypertension and hypokalemia—not hypotension, hyperkalemia, or polyuria—are expected findings with Cushing syndrome.

Which cutaneous manifestation of systemic lupus erythematosus (SLE) is shown in the image? Photo of an adolescent's face with a malar rash, presenting as an inflamed, red bumps arranged in a butterfly shape over the cheeks and bridge of the nose. Malar rash Discoid rash Photosensitivity Raynaud phenomenon

Malar rash The image displays the classic malar (butterfly) rash seen in SLE.

Match the clinical manifestation that corresponds to the stage of human immunodeficiency virus (HIV). Mild HIV Moderate HIV Severe HIV

Mild HIV Dermatitis Moderate HIV Hepatitis Severe HIV Encephalopathy

The nurse is caring for an adolescent patient with systemic lupus erythematosus (SLE) who is receiving antihypertensive therapy and has been eating a low-salt diet. Which assessment finding should prompt the nurse to alert the health care provider immediately? Blood pressure of 98/60 Bilateral edema of both wrists Mild confusion during conversation Bright red rash on the shoulders following sun exposure

Mild confusion during conversation Confusion is a symptom of hyponatremia, which can result from a low-salt diet. Hyponatremia can be life-threatening if it progresses. This finding should prompt the nurse to notify the health care provider immediately.

A patient is admitted with a diagnosis of DKA. What signs and symptoms would the nurse expect to find in the patient? Select all that apply. Slow heart rate Mild disorientation Cool and clammy skin Constantly feeling tired Rapid, shallow respirations

Mild disorientation Altered consciousness in the form of mild disorientation or confusion can occur with DKA. Constantly feeling tired Lethargy, constantly feeling tired, is a common symptom in patients with DKA due to cells not receiving adequate fuel source to produce energy.

The provider writes orders for a patient with Type 1 DM admitted with DKA. Which order should the nurse question? Fluid replacement, 0.9% sodium chloride, initial bolus. Monitor blood glucose every 3-4 hours during IV insulin infusion. Monitor for bradycardia, muscle weakness, hyperreflexia, and cardiac irregularities. Humulin insulin IV, continuous, 6 U/h until blood glucose level drops to less than 180 mg/dL.

Monitor blood glucose every 3-4 hours during IV insulin infusion. It is protocol to monitor blood glucose every hour during IV insulin infusion; therefore, this order should be questioned.

The provider writes orders for a patient with Type 1 DM admitted with elevated blood glucose levels. Which order should the nurse question? Humulin insulin IV, continuous, 6 U/h until the blood glucose level drops to less than 180 mg/dL. Fluid replacement, 0.9% sodium chloride, initial bolus. Monitor blood glucose every 3-4 hours during IV insulin infusion. Monitor for bradycardia, muscle weakness, hyperreflexia, cardiac irregularities.

Monitor blood glucose every 3-4 hours during IV insulin infusion. It is protocol to monitor blood glucose every hour during IV insulin infusion; therefore, this order should be questioned.

A young patient newly diagnosed with diabetes is admitted with a BP of 85/58 mm Hg, pulse of 120 bpm, respirations 42, blood glucose level of 450 mg/dL, pH of 7.07 and bicarbonate level of 13 mEq/L. The patient is lethargic and slow to respond to touch. Which conditions will the nurse need to monitor? Select all that apply. Monitor blood pH Check level of consciousness Monitor level of potassium Maintain Fluid intake and output Monitor for bradycardia

Monitor blood pH Ketosis will put the child into an acidotic state and therefore the nurse will need to monitor the child's pH. Check level of consciousness Since the patient is lethargic, the patient's level of consciousness will need to monitored. Monitor level of potassium The potassium levels in the patient will need to be addressed since the patient is developing DKA. Maintain Fluid intake and output This patient is developing DKA and will need to have fluid intakes and output monitored.

The nurse is caring for an infant born to a mother with human immunodeficiency virus (HIV). The infant had a negative HIV RNA assay at 2 weeks and 2 months of age. When would HIV infection be finally ruled out? Negative virological test result at 4 months. Negative antibody test result at 4 months. Negative antibody test result at 18 months. No further testing is required; negative HIV status is confirmed.

Negative virological test result at 4 months. A negative virological assay result at 4 months combined with earlier testing would confirm negative HIV status.

What kind of activity restrictions should be placed on the child with recently diagnosed type 1 diabetes? Daily exercise is contraindicated. The child may not participate in sports. Swimming is acceptable, but soccer is too strenuous. No activities are restricted unless they are contraindicated because of other health conditions.

No activities are restricted unless they are contraindicated because of other health conditions Exercise is encouraged for children with diabetes because it reduces blood glucose. Insulin and meal requirements require careful monitoring to ensure that the child has sufficient energy for exercise. Participating in sports can be a healthy part of life for a child with type 1 diabetes. Exercise is not contraindicated in children with type 1 diabetes. Swimming is acceptable and so is soccer.

A 19-year-old with Type 1 DM is taking 30 units of NPH insulin each morning and 15 units at night. Because of persistent morning glycosuria with some ketonuria, the evening dose is increased to 20 units. This worsens the morning glycosuria, and now moderate ketones are noted in urine. The patient complains of sweats and headaches at night. The next step in management is: Switch from NPH to regular insulin Decrease morning dose of insulin Increase morning dose of insulin Obtain blood glucose levels at 2 a.m.

Obtain blood glucose levels at 2 a.m. A glucose reading in middle of night will disclose hypoglycemia because of insulin therapy and lead one to consider Somogi phenomenon. Episodic hypoglycemia at night is followed by rebound hyperglycemia. This condition, Somogi phenomenon, develops in response to excessive insulin administration.

The nurse is caring for a 3-year-old girl with prolonged swelling and stiffness in her arm. The nurse should know that these symptoms are indicative of which type of juvenile idiopathic arthritis (JIA)? Systemic JIA Polyarticular JIA Oligoarticular JIA Juvenile rheumatoid arthritis

Oligoarticular JIA The patient's age, sex, and joint involvement are indicative of oligoarticular JIA.

A child is using regular insulin according to blood glucose monitoring results. At 2 pm, the child has a blood glucose of 185 mg/dl, for which the patient received 8 units of regular insulin. The nurse should expect the dose's onset and peak to be at which times? Onset 2:15 pm and peak 4:00-5:00 pm Onset 2:15 pm and peak 2:30-3:30 pm Onset 2:30-3:00 pm and peak 4:00-5:00 pm Onset 2:30-3:00 pm and peak 10:00-11:00 pm

Onset 2:30-3:00 pm and peak 4:00-5:00 pm Onset of regular insulin is 30-60 minutes and peak action is 2-3 hours after injection.

Which tissues make up the endocrine system? Select all that apply. Ovary Prostate Thyroid gland Sebaceous gland Montgomery's gland Anterior pituitary gland

Ovary The ovary is one of the major endocrine glands. It produces oocytes (eggs) for fertilization and produces the reproductive hormones, estrogen and progesterone. Thyroid gland The thyroid gland is one of the major endocrine glands. It regulates metabolism and produces triiodothyronine (T3) and thyroxine (T4). Anterior pituitary gland The anterior pituitary gland is one of the major endocrine glands. It regulates several physiological processes, including stress, growth, reproduction, and lactation.

A child with a lengthy history of juvenile idiopathic arthritis (JIA) is being managed with naproxen. Which assessment finding alerts the nurse to a possible adverse reaction? Persistent abdominal pain Bilateral pain to both ankles Crackles auscultated bilaterally Tender bruising to the left shoulder

Persistent abdominal pain Gastric irritation and bleeding are common side effects of long-term NSIAD therapy. Children who rely on NSAIDs for pain control and joint mobility should be monitored closely.

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

Polyuria and polydipsia Polyuria and polydipsia are the cardinal signs of diabetes insipidus (DI). Vascular anomalies can be a secondary cause of DI but are not cardinal signs of DI. Hypotension and dehydration are not the cardinal signs of DI. Dehydration and diminished urine output may occur with DI but are not the cardinal signs of DI.

Which manifestation helps the nurse to identify hyperglycemia in a child with diabetes mellitus (DM)? Presence of paleness or pallor Shallow normal respirations Presence of acetone breath Excessive sweating

Presence of acetone breath Fruity, acetone breath is easily identified in the child with hyperglycemia. In the absence of insulin, glucose is unavailable for cellular metabolism. Consequently, fats break down into fatty acids, and glycerol in the fat cells is converted by the liver to ketone bodies. Any excess is eliminated in the urine (ketonuria) or the lungs (acetone breath). The skin appears flushed and shows signs of dehydration. The respiratory system tries to eliminate the excess carbon dioxide by increased depth and rate of breathing, which is known as Kussmaul respirations. Hypoglycemia causes sweating, paleness, and pallor. Respirations are shallow and normal in hypoglycemia.

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? Increase the dose of growth hormone to the child. Reassure the parents and set realistic expectations. Change the route of administration of growth hormone. Advise the parents to feed the child with high protein diet.

Reassure the parents and set realistic expectations It is important for a nurse to educate the parents about the expected outcomes of growth hormone replacement therapy. The nurse should inform them that these children are likely to attain their eventual adult height slowly when compared to their peers. Therefore parents should set realistic expectations. Increasing the dose is not required at this stage and should not be done without consulting the primary health care provider. Changing the route of administration is of no use, because the therapeutic effect remains the same. Giving a high protein diet to the child will not result in increased growth rate.

The blood glucose of a patient newly diagnosed with Type 1 diabetes mellitus has a blood glucose level of 310 mg/dL. Which type of insulin would the nurse expect to be ordered at this time? NPH Regular Lantus NPH + regular

Regular Regular insulin is short-acting insulin. Onset is 30-60 min. This is correct insulin choice for blood glucose level of 310 mg/dL.

While a nurse is discussing dietary considerations with the parent of an infant with PKU, the parent verbalizes, "At least I'll be able to give my baby regular formula." Which is the best response by the nurse? Regular formula will not provide adequate vitamins and minerals for the infant. Regular formula is high in calories and will be too much for the infant. Regular formula will not provide the needed calories for the infant. Regular formula is not safe; it contains nutrients that the infant cannot use for energy.

Regular formula is not safe; it contains nutrients that the infant cannot use for energy. The safety concern with regular formula is that it provides nutrients the infant cannot metabolize. Patients must have a low-protein formula due to the possible poor CNS outcomes.

A patient with DKA is given normal saline and intravenous regular insulin. The nurse checks blood glucose level hourly. Which other assessment data is the best indicator of clinical improvement? Pulse 130. Temperature in normal range Patient eats a full meal and respiratory rate is normal Improved level of consciousness and increasing urine output Respiration rate of 12 to 15 and normal BP in the standing position

Respiration rate of 12 to 15 and normal BP in the standing position Respirations in normal range are indicative of normal bicarbonate level. Normal BP indicates adequate circulating fluid volume (resolution of diuresis). This is an indicator of clinical improvement.

Serum sodium concentration below 120 mmol/l, urinary specific gravity of 1.030 Serum sodium concentration below 135 mmol/l, irritability, lethargy, confusion, agitation Extreme thirst; 3 L urine output/24 hr; urinary specific gravity of 1.005 Matching

SIADH Hyponatremia Diabetes Insipidus

Systemic lupus erythematosus (SLE) is typically diagnosed many years after the onset. Which describes why this is often the case? Most children are immunized against SLE SLE has varied, nonspecific manifestations Few health care providers are aware of SLE Few patients with SLE seek medical attention

SLE has varied, nonspecific manifestations Malaise, arthralgia, and recurrent fever of unknown etiology frequently are among the early manifestations of SLE, and these manifestations can be easily confused with signs of other childhood illnesses.

Which is a common clinical manifestation of hypopituitarism that occurs due to deficiency of growth hormone (GH) or a deficiency of thyroid stimulating hormone (TSH)? Short stature Delayed dentition Increased insulin sensitivity Delayed epiphyseal closure

Short stature Short stature may be seen due to deficiency of GH as well as due to TSH deficiency. However, a patient with GH deficiency has short stature with proportional height and weight, whereas a patient with TSH deficiency has a short stature with infantile proportions. Delayed dentition is a feature of TSH deficiency. Increased insulin sensitivity and delayed epiphyseal closure occur due to GH deficiency, not TSH deficiency.

The parents of a 10-year-old patient with human immunodeficiency virus (HIV) are discussing disclosing the diagnosis to their child. Which subjects should the nurse anticipate discussing with the parents regarding disclosure? Select all that apply. Social stigma Emotional impact Potential for transmission Changes to school environment Patient participation in medication regimen

Social stigma HIV comes with a unique social stigma that the patient's parents should be prepared to discuss with the patient if they decide to disclose the diagnosis. The nurse should anticipate discussing this topic with the parents. Emotional impact Disclosure of any long-term illness can have a significant emotional impact, and the parents should be prepared for this possibility before disclosing the child's diagnosis. The nurse should anticipate discussing this topic with the parents. Patient participation in medication regimen The patient should be encouraged to be an active participant in the medication regimen, and disclosure may help the patient better understand the reasons for taking the medicine. The nurse should anticipate discussing this topic with the parents.

The nurse is caring for a 12-year-old patient who is positive for human immunodeficiency virus (HIV). When discussing long-term care with the patient's family, which topic has greater significance to someone with HIV compared with patients with other long-term illnesses? Social stigma Medication regimen adherence Need for long-term medications Importance of continued follow-up

Social stigma Unlike many other long-term illnesses, an HIV diagnosis carries a social stigma. Discussion of this stigma is uniquely important for the family of a patient who is HIV positive.

A child has a family history of allergies. He has lately been having trouble concentrating and has grown increasingly drowsy. Which suggestion can the nurse make to help alleviate this child's symptoms? Take allergy medications at night before bed. Keep an EpiPen close by for fast administration. Wash hair in the morning before going outside. Limit the child's play time so they can go to bed earlier.

Take allergy medications at night before bed. Allergic rhinitis can impair concentration and antihistamines can cause drowsiness. To solve this problem, the antihistamines for allergic rhinitis should be taken before bed.

A patient presents with malaise, a fever, and joint pain. If a systemic lupus erythematosus (SLE) diagnosis is being considered, which additional assessments should the nurse perform? Select all that apply. Take patient blood pressure Assess for enlarged thyroid gland Ensure that urine is collected for a urinalysis Palpate the abdomen and listen to bowel sounds Ask the patient simple questions and note patient response

Take patient blood pressure Cardiovascular manifestations, such as hypertension, pericarditis, and blood dyscrasias, are often seen in children with SLE. Taking the patient's blood pressure is an assessment the nurse can perform to help identify SLE. Ensure that urine is collected for a urinalysis Urinary manifestations, such as proteinuria, hematuria, and nephritis, are often seen in children with SLE. Collecting a urine sample for a urinalysis to be performed is an assessment the nurse can perform to help identify SLE. Ask the patient simple questions and note patient response Neurologic manifestations, such as headaches, mood disorders, cognitive disorders, and seizure disorders, are often seen in children with SLE. Asking the patient simple questions relevant to their expected developmental age can help gauge basic cognitive function and may help identify SLE.

A child is being worked up for a pituitary tumor. Why would a computed tomography (CT) scan or a magnetic resonance imaging (MRI) be ordered instead of a hormone stimulation test for this patient's initial work-up? The CT scan or the MRI can evaluate growth hormone (GH) production. The CT scan or the MRI can determine bone maturation. The CT scan or the MRI can evaluate for central precocious puberty. The CT scan or the MRI can determine the presence of an abnormal brain growth.

The CT scan or the MRI can determine the presence of an abnormal brain growth. CT scans or MRIs are used to determine the presence of an abnormal growth affecting the hypothalamus, pituitary, or target glands. Therefore, a CT or MRI would be ordered instead of a hormone stimulation test for the initial work-up.

Which condition is a manifestation related to a cytotoxic reaction? Hives caused by a medication allergy Dermatitis after contact with poison ivy Serum sickness after antibody administration Transfusion reaction due to incompatible blood type

Transfusion reaction due to incompatible blood type A transfusion reaction after receiving incompatible blood is an example of a cytotoxic reaction.

The nurse manager is developing an educational session for parents on the symptoms of congenital adrenal hyperplasia. A parent questions why their child has developed a deeper voice and early appearance of pubic hair. Which information should the nurse manager include in the session regarding these manifestations? The body is producing too much aldosterone, resulting in symptoms of early puberty. The body has low levels of cortisol, resulting in these symptoms. The body is unable to retain enough sodium, resulting in these symptoms. The body's metabolism is hyperactive, leading to faster growth and development and these symptoms.

The body has low levels of cortisol, resulting in these symptoms. Salt-wasting CAH also causes low levels of cortisol and high levels of androgens, resulting in symptoms of virilization.

Which statement describes the contraindication of Western blot assay for diagnosing human immunodeficiency virus (HIV) in infants younger than 18 months? The infant's antibody levels are too low for the Western Blot assay to detect before 18 months. The Western blot assay requires a larger blood sample than is safe to obtain from an infant younger than 18 months. The infant's antibody levels may be artificially elevated by maternal antibodies for the first 18 months. The antibodies detected by the Western blot assay do not develop in the HIV-infected infant for the first 18 months.

The infant's antibody levels may be artificially elevated by maternal antibodies for the first 18 months. Maternal antibodies that cross the placenta may artificially increase the infant's antibody levels and cause a false-positive result.

Why is ongoing quantification of CD4+ lymphocytes and viral burden important in the treatment of the child who is positive for human immunodeficiency virus (HIV)? Select all that apply. The measurements help to determine prognosis. The measurements help to determine quality of life. The measurements help to guide treatment decisions. The measurements help to determine the infected child's immune status. The measurements help to determine immunization schedules.

The measurements help to determine prognosis. The HIV RNA copy numbers work in tandem with the CD4+ percentage to provide independent information about prognosis. The measurements help to guide treatment decisions. The HIV RNA copy numbers work in tandem with the CD4+ percentage to guide treatment decisions. The measurements help to determine the infected child's immune status. The HIV RNA copy numbers work in tandem with the CD4+ percentage to determine immune status and function.

The nurse is caring for a child who is positive for human immunodeficiency virus (HIV) and will be starting school in a few months. What education is appropriate for the patient's family? The nurse should inform the parent that the child's HIV status may appear in school records because of public health concerns. The nurse should discuss ways in which the child's HIV status may prevent him or her from participating in some extracurricular programs. The nurse should educate the parent about potential disruptions in the child's school routine as a result of medication administration. The nurse should include information about federal laws that prevent the child from being discriminated against on the basis of HIV status in school.

The nurse should include information about federal laws that prevent the child from being discriminated against on the basis of HIV status in school. Children who have HIV are protected by the federal Individuals with Disabilities Education Act and may not be discriminated against in school. The nurse should inform the parents of these protections in order to provide reassurance and address any concerns they may have regarding enrolling their child in school.

The nurse is caring for a newborn with perinatally acquired human immunodeficiency virus (HIV). The infant is free of symptoms, and laboratory reports indicate normal immune function. What antiretroviral medication orders should the nurse anticipate finding in the patient's chart? No antiretroviral therapy Two nucleoside analog reverse-transcriptase inhibitors (NTRIs) plus efavirenz One nucleoside analog reverse-transcriptase inhibitor (NTRI) plus lopinavir or ritonavir. Two nucleoside analog reverse-transcriptase inhibitors (NTRIs) plus lopinavir or ritonavir.

Two nucleoside analog reverse-transcriptase inhibitors (NTRIs) plus lopinavir or ritonavir. Two NTRIs plus lopinavir or ritonavir is the preferred drug combination for neonates born at 42 weeks gestation and from age 14 days to younger than 3 years. Because of a more rapid disease progression in children than in adults and the fact that laboratory studies are less precise in predicting disease progression, children are treated aggressively for HIV infection regardless of virological status.

Which physiologic alteration is characterized by destruction of pancreatic beta-cells that produce insulin? Type 1 diabetes Type 2 diabetes Gestational diabetes Impaired glucose tolerance

Type 1 diabetes Type 1 diabetes is characterized by destruction of the insulin-producing pancreatic beta cells. Type 2 diabetes is a result of insulin resistance. The insulin-producing pancreatic beta-cells are destroyed in type 1 diabetes and are not associated with impaired glucose tolerance. Gestational diabetes occurs during pregnancy and is not associated with the destruction of pancreatic beta-cells.

How is type 2 diabetes mellitus (DM) different from type 1 DM in children? Type 2 DM has an abrupt onset. Type 2 DM occurs primarily in Caucasians. Type 2 DM is a chronic disorder of metabolism. Type 2 DM is frequently associated with a family history.

Type 2 DM is frequently associated with a family history Type 2 DM typically occurs in children who have a family history of diabetes. Type 1 DM is only sometimes associated with a family history. Onset of type 2 DM is gradual, whereas that of type 1 DM is abrupt. Type 1 DM occurs primarily in Caucasians. The incidence of type 2 DM is higher for Native American, African-American, and Hispanic children. Both type 1 and type 2 DM are chronic metabolic disorders.

When caring for a child with human immunodeficiency virus (HIV), a nurse determines that the child is not adhering to the medication schedule. Which actions should the nurse take to improve medication adherence? Select all that apply. Use adherence aids Discuss dosing schedule challenges Provide supportive encouragement Suggest a self-reporting medication log Report noncompliance to social services

Use adherence aids Use of adherence aids (e.g., pillboxes, alarm watches, or stickers) improves patient adherence and helps improve therapeutic management. Discuss dosing schedule challenges Discuss the medication dosing schedule with the family to determine whether the current dosing schedule conflicts with school and after-school activities. To the extent possible, the health care team will adjust dosing to accommodate the child's school schedule. Provide supportive encouragement Providing supportive encouragement helps foster a positive therapeutic relationship and encourages the patient's and family's independence regarding treatment, which helps to improve adherence. Suggest a self-reporting medication log A self-reporting medication log is a strategy that helps the parent or child keep accurate records of medication administration. This is an effective intervention for encouraging patient and family independence and confidence when adhering to treatment.

The risk/benefit ratio should be considered before recommending which routine childhood vaccines to children who are infected with human immunodeficiency virus (HIV)? Varicella Influenza Hepatitis B Human papillomavirus

Varicella Because live-virus vaccines like the varicella vaccine can be dangerous to immunocompromised children by triggering an immune response, the risks may outweigh the benefits. Therefore special consideration is required before administration.

Which is the most appropriate diagnostic screening test and time for an infant born to a high risk mother whose human immunodeficiency virus (HIV) serologic status is unknown? Virological assay at birth Virological assay at 1 month HIV antibody assay at birth HIV antibody assay at 1 month

Virological assay at birth Health care providers should consider performing virological assay immediately after birth for any infant known to be at risk for exposure to HIV.