Peds Q's: GI & Endocrine

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

A

A 17-year-old adolescent is found wandering around. The adolescent is confused, sweaty, and pale. Which test would the nurse expect to be performed first? Blood glucose level CT scan Arterial blood gases Blood cultures

A

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

A

A 9-year-old girl has justNbUeeRnSdIiaNgGno-sTedEwSiTthBGArNavKe.'sCdOisMease. Which symptom should the nurse expect in this child? Select all that apply. A Exophthalmos (protruding eyes) B Moist skin C Nervousness D Increased basal metabolic rate E Obesity F Lethargy

ABCD

A 19-year-old client with hypothyroidism asks the nurse if she will need to take thyroid medication if she becomes pregnant. The nurse integrates understanding of which of the following when responding to the client? A Regulation of thyroid medication is more difficult because the thyroid gland increases in size during pregnancy B There is no need to take a thyroid medication because the fetus's thyroid produces thyroid stimulating hormone C It is more difficult to maintain thyroid regulation during pregnancy due to the slowing of metabolism D Fetal growth is arrested if the thyroid medications are continued during pregnancy.

A

A child with Addison's disease has been admitted with a history of nausea and vomiting for the past 3 days. The client is receiving IV glucocorticoids. Which intervention would the nurse implement? Take glucometer readings as ordered Measure intake and output Monitor sodium and potassium levels Weigh daily

A

A group of nursing students are reviewing information about neonatal screenings. The students demonstrate understanding of the information when the students identify which system of most consistently affected by metabolic disorders? Nervous system Cardiovascular system Gastrointestinal system D. Respiratory system

A

A parent calls the health care provider's office and tells the nurse that the 2-year-old child has had diarrhea off and on for the past few days. The parent asks if he or she should be concerned about this. What is the best response by the nurse? "Tell me more about what your child is experiencing." "As long as your child is active, there is nothing to worry about." "You should take your child to the emergency department." "Bring your child to our office this afternoon and we will check the child."

A

Diabetes insipidus a disorder of the posterior pituitary resulting in deficient secretion of which hormone? Antidiuretic hormone Adrenocorticotropic hormone Thyroid stimulating hormone Luteinizing hormone

A

A child has been admitted to the acute care facility for the management of dehydration. The nurse is preparing to administer intravenous fluid replacement to the child. Which fluids are suitable for use? Select all that apply. A Lactated Ringer B Normal saline C 5% dextrose in water D 0.45% saline E 10% dextrose in water

A B

The nurse is caring for a teenager recently diagnosed with Addison disease. Which findings can be anticipated by the nurse? Select all that apply. A Sodium level 128 mEq/L B Potassium level 5.6 mEq/L C Muscular weakness D Rapid weight gain E Facial acne

A B C

The young child has been diagnosed with hepatitis B. Which of the following statements by the child's mother indicates that further education is required? A "We went swimming in a local lake 2 months ago and I just knew she drank some of the lake water." B "Could I have this virus in my body, too?" C "The virus is the reason her skin looks a little yellowish." D "The only way you can get this virus is from intravenous drug use." E "Her fever and rash are probably related to this virus."

A D

13. The nurse is caring for a child with a gastrointestinal disorder and measuring intake and output. The nurse observes that the child is demonstrating symptoms of adequate hydration when she/he has which of the following? Select all that apply. A Fontanelles with normal tension B Adequate skin turgor C Oral intake D Pink and moist mucous membranes E Loose stools

ABD

A child aged 3 months has been spitting up regularly since birth and is somewhat underweight. The nurse suggests which interventions to the parents? Select all that apply. A Thicken feedings with rice cereal. B Feed smaller amounts more frequently. C Feed the infant in the supine position. D Burp well when feeding.

ABD

A child is diagnosed with short bowel syndrome. What would the nurse expect to be included in the child's plan of care? Select all that apply. A Antibiotics B Vitamin supplements C Total parenteral nutrition D Laxatives E Immunosuppressants

ABC

The adolescent has been diagnosed with gastroesophageal reflux disease (GERD). Which statements by the teen indicates that adequate learning has occurred? Select all that apply. A "This famotidine may make me tired." B "The omeprazole could give me a headache." C "It sounds like the physician is reluctant to give me a prokinetic because of the side effects." D "I will probably need a laxative because of the omeprazole." E "I should try to lie down right after I eat."

ABC

The nurse caring for a young adolescent with Crohn's disease. After teaching the adolescent and her family about this condition, the nurse determines that the teaching was successful when they identify which of the following as a possible complication? Select all that apply. A Stricture B Fistula C Intra-abdominal abscess formation D Gallstones E Pancreatitis

ABC

The nurse is caring for a newborn with a cleft palate. Which findings in the maternal medical record are considered to be contributing factors? Select all that apply. A Maternal tobacco use. B Moderate maternal alcohol use prior to pregnancy. C Maternal age less than 18 years. D Anticonvulsant therapy used to manage a seizure disorder. E Reports of marijuana use in early pregnancy.

AD

A 2-year-old child is admitted to the hospital with a fever, vomiting, and diarrhea. The nurse has completed an assessment and is creating a plan of care. What important consideration is necessary to the child's plan of care? Fluid loss is slower in a child than an adult. Children require more fluid intake than adults to maintain fluid balance. The presence of fever will lessen the child's fluid loss. Insensible water loss will not affect the child's outcome.

B

A 2-year-old child is hospitalized with a diagnosis of severe dehydration. The child has had several episodes of watery diarrhea and has vomited three times since admission. The child has a temperature of 104°F (40°C). The parents are worried that the child has not eaten anything or urinated since the day before. What should be the priority focus of the child's care? Febrile state Fluid status Parental education Urine output

B

A nurse suspects that a child is experiencing isotonic dehydration based on which assessment findings? Select all that apply. A Extreme thirst B Cool skin temperature C Irritability D Normal serum sodium level E Clammy skin

BCD

The nurse is reviewing the history of an adolescent with peptic ulcer disease. Which client activity would the nurse identify as an associated contributing factor? Select all that apply. A Use of acetaminophen B Ingestion of diet colas C High coffee intake D Cigarette smoking E High-fat diet

BCD

A nurse is developing a teaching plan for an adolescent diagnosed with gastroesophageal reflux disease. Which would the nurse include? Select all that apply. A "Try sitting upright for an hour after eating." B "You need to avoid acidic foods like oranges and grapefruits." C "Eating smaller portions might be helpful." D "You'll need to take your prescribed medications for about 6 to 8 weeks." E "Try sleeping with your upper body elevated on a foam wedge."

BCE

The nurse is caring for a pediatric client newly diagnosed with Crohn's disease. When reviewing the client's subjective and objective data, which is consistent with the diagnostic criteria? Select all that apply. A Severe bloody diarrhea B Significant weight loss C Perianal lesions D Lesions limited to the colon and rectum E Cobblestone appearance of intestinal surface

BCE

A 2-year-old client and the parents are at the office for a follow-up visit. The client has had excessive hormone levels in the recent blood work, and the parents question why this was not found sooner. Which response by the nurse would be most appropriate? "It takes time to determine the level of functioning of endocrine glands." "Have there been signs and symptoms that you should have reported to the doctor?" "As endocrine functions become more stable throughout childhood, alterations become more apparent." "Endocrine disorders are hard to detect and you are lucky that we have found it when we did."

C

A child has been prescribed Stimate (esmopressin) acetate for the treatment of diabetes insipidus. The client and the parents ask the nurse how this drug works. What is the correct response by the nurse? A Stimate (esmopressin) acetate works on your pancreas to stimulate insulin production B Stimate (esmopressin) acetate is a synthetic form of insulin used to lower your blood sugar C Stimate (esmopressin) acetate is a synthetic antidiuretic hormone that will slow down your urine output D Stimate (esmopressin) acetate works to help your kidneys work more efficiently

C

A community health nurse is doing a home assessment of a family with a 2-year-old child. During the assessment, the nurse identifies a potential safety hazard. Which finding should the nurse discuss with the family? Covered electrical outlets Window blinds with turn handles Can of peanuts on the table Tub full of toys in the corner

C

The nurse assesses a toddler who is hospitalized with a diagnosis of dehydration with vomiting and diarrhea for 3 days. Which assessment finding requires immediate intervention by the nurse? Urine output of 1 ml/kg/hr Weight loss of 8 oz (2.3 kg) over 7 days Lethargy Temperature of 102°F (38.9°C)

C

What should be included in the teaching plan for a child with type 1 diabetes mellitus who is going home on insulin therapy? A Children show an increased need for insulin during the first months after glucosecontrol is established. B Once glucose control is established, there will never be a need for an increase in the amount of insulin administered. C It is absolutely normal for the growing child to require an increase in insulin; this does not mean his/her condition is getting worse. B All children should be on at least two types of insulin to establish glucose control.

C

The nurse is examining a child with hypoparathyroidism. The nurse would expect to assess which signs and symptoms? Select all that apply. A Capillary refill B Polyphagia C. Chvostek D Babinski E Trousseau

C E

A child is admitted to the pediatric medical unit with the diagnosis of syndrome of inappropriate antidiuretic hormone (SIADH). Based on the typical signs and symptoms of this disorder, which nursing diagnosis will the nurse identify as relating to this client? Delayed growth and development Imbalanced nutrition: More than body requirements Noncompliance Excess fluid volume

D

The nurse knows that disorders of the pituitary gland depend on the location of the physiologic abnormality. Caring for a child who has issues with the anterior pituitary, the nurse would expect the child to have issues with which hormone? Vasopressin Antidiuretic hormone Oxytocin Growth hormone

D

The nurse is preparing an 18-month-old for discharge following treatment for dehydration secondary to diarrhea. What instruction would the nurse most likely include in the discharge teaching? "Encourage a bland diet." "Implement clear liquids." "Provide plenty of 100% fruit juice." "Offer flavored gelatin if hungry."

a

The nurse is conducting a physical examination of a child with suspected Crohn disease. Which finding would be the most suspicious of Crohn disease? Normal growth patterns Perianal skin tags or fissures Increased hunger Abdominal tenderness

B

When describing the negative feedback system that controls endocrine function, the nurse explains that a decreased secretion of which correlates with a decrease in blood glucose levels? Insulin Glucagon Adrenocorticotropic hormone Glycogen

A

During the assessment of a preschooler, the nurse notes that the child has abnormal dryness and thickening of the conjunctiva and dry and scaly skin. Which vitamin deficiency does the nurse suspect this child is experiencing? Vitamin A Vitamin B Vitamin D Vitamin E

A

The nurse is caring for a child who is scheduled for bone scan. It is suspected that the child has a growth hormone deficiency. Which finding would support this medical diagnosis? A The bone scan would show bone age would be two or more deviations below normal. B The bone scan would show a brain tumor. C The bone scan would show bone age would be three or more deviations above normal. D The bone scan would a tumor on the child's kidney.

A

The nurse is preparing teaching materials for a family whose child is prescribed somatropin for a growth hormone deficiency. What should the nurse instruct the parents about the administration of this medication? This medication must be given by injection. This medication must be given in the morning before school. Hip or knee pain is an expected adverse effect of this medication. This medication does not interact with any other types of medication.

A

Which type of diet should be included in the plan of care for a child diagnosed with Addison disease? High-protein, low-carbohydrate, high-sodium diet High-protein, high-carbohydrate, low-sodium diet Low-calorie, low-carbohydrate, low-sodium diet Low-calorie, low-cholesterol, low-saturated fat diet

A

The nurse is speaking with the parents of a school-aged child recently diagnosed with diabetes mellitus regarding the differences between hypoglycemia and hyperglycemia. Which statement by a parent indicates a need for further teaching? A "If I notice changes in my son like tearfulness or irritability, his blood sugar may be high." B "When my son's breath smells fruity, it almost always indicates high blood sugar." C "If my son says he feels shaky, his blood sugar may be low." D "Dry flushed skin may be a sign if high blood sugar."

A

The nurse is performing discharge teaching for a 16-year-old diagnosed with peptic ulcer disease. Which statements by the parents and client demonstrate learning has occurred? A "I will need to make sure to take all of the antibiotic prescribed." B "It's important to take my histamine agonist medication at the appropriate time." C "My proton pump inhibitor should be taken when I feel discomfort." D "The prednisone that I take for my rheumatoid arthritis may be a cause of mypeptic ulcer disease." E. "My mom having peptic ulcer disease has nothing to do with my having it."

ABD

While observing the parents of a neonate with pyloric stenosis feeding the baby, the nurse notes that the parents are becoming frustrated. The nurse identifies a nursing diagnosis of risk for impaired parenting related to frustration and difficulty feeding neonate. Which would be appropriate for the nurse to include in the plan of care? Select all that apply. A Encouraging rooming in with the neonate B Helping them understand their stress level contributes to the neonate's vomiting C Assisting the parents in holding and feeding their neonate D Pointing out positive aspects about their neonate E Informing the parents that the condition will require them to adjust their lifestyles

ACD

A nurse is providing care for a 2-year-old child diagnosed with severe dehydration due to vomiting and diarrhea over 3 days. The child has not had an episode of vomiting for 6 hours but has had two episodes of diarrhea in the past 3 hours. The nurse has received the above admission prescriptions. Which prescription should the nurse implement first? Obtain the stool culture. Start the intravenous bolus. Draw the complete blood count, basic metabolic panel, and glucose. Administer ondansetron 3.5 mg IV.

B

A nurse is teaching the parents of a 26-month-old toddler about toddler safety. A parent asks about the best way to keep the toddler safe in the car. The toddler weighs 28 lb. (12.7 kg). Which is the nurse's best response? "The best place for your toddler to ride is in the back seat of the car." "Your toddler should ride in a rear-facing seat that is appropriate for the child's height and weight." "A front-facing car seat is appropriate for your toddler." "A booster seat strapped to the back seat is appropriate for your toddler."

B

A nurse manages the interdisciplinary care for an infant born with an omphalocele. What is an accurate description of the care for an omphalocele? A At birth, protect the exposed bowel by gently manipulating it back into the abdominal cavity. B Obtain IV access to give fluid resuscitation and correct any electrolyte abnormalities. C Administer corticosteroids as prescribed—either oral prednisone or prednisolone or as IV methylprednisolone. D Insert an NG tube to decompress the stomach and to prevent gastric distention.

B

A parent calls the health care provider's office concerned about the 2-year-old child who has had one episode of vomiting and three episodes of diarrhea. The parent asks the nurse what to do for the child. The nurse tells the parent to begin oral rehydration therapy. What instruction should the nurse include for the parent? "You can rehydrate your child by offering sips of chicken broth." "Over-the-counter solutions such as Pedialyte can be used to rehydrate your child." "Water and/or milk are the best fluids to rehydrate your child." "Give your child as much water and fruit juice as tolerated."

B

A school-aged girl with Crohn's disease will receive total parenteral nutrition (TPN) for the next 6 weeks. Which would best help her accept the treatment plan? Help her ambulate with the bottles. Provide some time to talk to her several times a day. Help her give the bottles nicknames and personalities. Explain that TPN substitutes for normal food.

B

The nurse is caring for a 2-month-old with a cleft palate. The child will undergo corrective surgery at age 3 months. The mother would like to continue breastfeeding the baby after surgery and wonders if it is possible. How should the nurse respond? A "There is a good chance that you will be able to breastfeed almost immediately." B "Breastfeeding is likely to be possible, but check with the surgeon." C "After the suture line heals, breastfeeding can resume." D. "We will have to wait and see what happens after the surgery."

B

A child is admitted to the hospital with a diagnosis of dehydration. The family is originally from the Middle East and practices the Islamic faith. While conducting the admission assessment, the nurse notices that whenever questions are asked, only the father answers. What action should the nurse take? Explain to the father that the mother needs to be involved in the assessment as well. Ask the mother if she would feel more comfortable with an interpreter present. Realize that the father is very controlling and the mother is intimidated by him. Continue to direct questions to both parents with the understanding that in this culture, the father makes healthcare decisions.

D

A nurse has provided care to several 2-year-old toddlers in the pediatric clinic. In reviewing the children's growth and development, which toddler should the nurse refer for evaluation? Has a temper tantrum in the waiting room Prefers reaching for things with left hand Carries several blocks to the exam room Consistently walks on the tiptoes

D

A nurse is providing care to a child hospitalized with a diagnosis of moderate dehydration and has written the above admission note. The nurse takes a repeat set of vital signs 2 hours later: blood pressure 86/45 mm Hg; pulse 130 beats/min; temperature 103°F (39.4°C); respiratory rate 38 breaths/min; pulse oximetry 94% on room air. The child is sleeping in the parent's arms. What is the best action for the nurse take? Continue to monitor the child. Increase the IV infusion rate. Ask the parent if the child has voided yet. Notify the health care provider of the vital signs.

D

A parent has brought the 2-year-old child to the emergency department. The child exhibits the following clinical manifestations: very lethargic, moaning, and barely opens the eyes when called by name. The parent states that the child vomited dinner and had two episodes of vomiting and diarrhea the night before. The nurse suspects the child is dehydrated and performs an assessment. Which finding is most indicative of dehydration? Temperature of 102.5°F (39.1°C) Capillary refill less than 3 seconds Lethargy Sticky mucous membranes

D