Ch 48: Nursing Care of a Family when a Child has an Endocrine or a Metabolic Disorder

c) Cushing syndrome Pg. 1357 Cushing syndrome is a characteristic cluster of signs and symptoms resulting from excessive levels of circulating cortisol. Addison disease is caused by autoimmune destruction of the adrenal cortex, which results in dysfunction of steroidogenesis. Graves disease is the most common form of hyperthyroidism. Turner syndrome is the deletion of the entire X chromosome.

20. The nurse knows that which condition is caused by excessive levels of circulating cortisol? a) Graves disease b) Addison disease c) Cushing syndrome d) Turner syndrome

b) Hyperkalemia Pg. 1357 Signs and symptoms of an acute adrenal crisis include hyperkalemia, hyponatremia, tachycardia, hypotension, persistent vomiting, dehydration, and shock.

5. The parents of a child with congenital adrenal hyperplasia bring the child to the emergency department for evaluation because the child has had persistent vomiting. What finding would lead the nurse to suspect that the child is experiencing an acute adrenal crisis? a) Hypertension b) Hyperkalemia c) Bradycardia d) Hypernatremia

c) Blood glucose level Pg. 1365-1366 It is important to determine a blood glucose level on the adolescent because the adolescent is exhibiting signs of hypoglycemia and needs to be treated quickly. Serum ketone testing would be indicated if the adolescent were exhibiting symptoms of hyperglycemia. A CT scan or toxicology test may be needed if the adolescent's glucose level were within normal range.

19. An adolescent is found wandering around. The client is confused, sweaty, and pale. Which test will the nurse prepare to perform first? a) Serum ketone testing b) Blood toxicology c) Blood glucose level d) Computed tomography (CT) scan

b) Graves disease Pg. 1354-1355 Hyperthyroidism occurs less often in children than hypothyroidism. Graves disease, the most common cause of hyperthyroidism in children, occurs in 1 in 5,000 children between 11 and 15 years of age. Hyperthyroidism occurs more often in females, and the peak incidence occurs during adolescence.

25. A 12-year-old is being seen in the office and has hyperthyroidism; the nurse knows that the most common cause of hyperthyroidism is: a) Cushing disease b) Graves disease c) Plummer disease d) Addison disease

c) Diabetic ketoacidosis Pg. 1366 Insulin deficiency, in association with increased levels of counter-regulatory hormones (glucagon, growth hormone, cortisol, catecholamines) and dehydration, is the primary cause of diabetic ketoacidosis (DKA), a life-threatening form of metabolic acidosis that is a frequent complication of diabetes. Liver converts triglycerides (lipolysis) to fatty acids, which in turn change to ketone bodies. The accumulation and excretion of ketone bodies by the kidneys is called ketonuria. Glucosuria is glucose that is spilled into the urine.

4. Insulin deficiency, in association with increased levels of counter-regulatory hormones and dehydration, is the primary cause of: a) Ketone bodies b) Ketonuria c) Diabetic ketoacidosis d) Glucosuria

d) Heat intolerance Pg. 1355 Hyperthyroidism is manifested by heat intolerance, nervousness or anxiety, diarrhea, weight loss, and smooth velvety skin. Constipation, weight gain, and facial edema are associated with hypothyroidism.

26. A child is diagnosed with hyperthyroidism. What finding would the nurse expect to assess? a) Constipation b) Weight gain c) Facial edema d) Heat intolerance

b) Growth hormone Pg. 1351 Disorders of the pituitary gland depend on the location of the physiologic abnormality. The anterior pituitary, or adenohypophysis, is made up of endocrine glandular tissue and secretes growth hormone (GH), adrenocorticotropic hormone (ACTH), TSH, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin. The posterior lobe is called the neurohypophysis because it is formed of neural tissue. It secretes antidiuretic hormone (ADH; vasopressin) and oxytocin. Usually, several target organs are affected when there is a disorder of the pituitary gland, especially the adenohypophysis.

7. The nurse knows that disorders of the pituitary gland depend on the location of the physiologic abnormality. In caring for a child that has issues with the anterior pituitary, the nurse knows that this child has issues with which hormone? a) Vasopressin b) Growth hormone c) Antidiuretic hormone d) Oxytocin

a) "Our child should not participate in sports or physical activity" Pg. 1347 The nurse would provide additional education if the parents state the child should not participate in sports or physical activity. The child with diabetes can, and should, be physically active to maintain proper health and facilitate efficient insulin usage by the body. Glucose levels should be checked more frequently during times of sickness, as well as assessing the urine for ketones. Consistency of intake can help prevent complications and maintain near-normal blood glucose levels. The parents and child should know how to identify foods to adequately monitor the child's nutritional intake. A dietitian with expertise in diabetes education should be consulted for referral as needed.

8. The nurse is educating the parents of a client newly diagnosed with type 1 diabetes. Which statement by the parents indicates additional teaching is needed? a) "Our child should not participate in sports or physical activity" b) "Our child should eat three meals and mid afternoon and bedtime snacks each day" c) "When our child is sick, we may need to check glucose levels more frequently" d) "We and our child need to learn to identify carbohydrate, protein, and fat foods"

a) "Special cells in a part of your body called the pancreas cannot make a chemical called insulin, which helps control the sugar level in your blood" Pg. 1358-1359 When providing instruction to a child, the nurse must consider the developmental age. Type 1 diabetes is a disorder that involves an absolute or relative deficiency of insulin, thus the blood glucose level remains high if an appropriate amount of insulin is not administered to the client. With type 2 diabetes, the body produces an adequate amount of insulin; however, the body is resistant to using the insulin properly to keep circulating blood glucose levels at a normal level. The rest of the statements provide incorrect information regarding the pathophysiology of type 1 diabetes.

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

d) Regular insulin Pg. 1360-1366 Insulin for diabetic ketoacidosis is given intravenously. Only regular insulin can be administered by this route.

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

b) Do not mix this insulin with other insulins Pg. 1361 Glargine is not to be mixed with other insulins. Glargine is usually given in a single dose at bedtime. Insulin should be kept at room temperature; insulin that is administered cold may increase discomfort with the injection. Any vial of insulin that is opened should be discarded after 1 month.

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

b) Darkened pigmentation around the neck area Pg. 1368-1369 Acanthosis nigricans (darkened, thickened pigmentation, particularly around the neck or in the axillary region) is associated with polycystic ovary syndrome. Serum levels of free testosterone typically are elevated with polycystic ovary syndrome. With polycystic ovary syndrome, body mass index indicates overweight or obesity. Short stature typically is associated with growth hormone deficiency.

33. A 15-year-old girl is brought to the clinic by her mother because the girl has been experiencing irregular and sporadic menstrual periods and excessive body hair growth. Polycystic ovary syndrome is suspected. Which additional assessment finding would help to support this suspicion? a) Decreased serum levels of free testosterone b) Darkened pigmentation around the neck area c) Body mass index as normal d) Short stature

b) Urine output Pg. 1352 An infant with diabetes insipidus has a decrease in antidiuretic hormone. Strict fluid precautions will not alter urine formation. This assessment is important because the infant will be at great risk for dehydration and electrolyte imbalance. It is part of a basic assessment to monitor heart rate, temperature, skin turgor, and mucous membranes. These are important but may not indicate the infant's overall health. On fluid restriction, oral intake will be specified.

6. An infant on the pediatric floor has diabetes insipidus. Which assessment data are important for the nurse to monitor while the infant is on strict fluid precautions? a) Oral intake b) Urine output c) Color of mucous membranes d) Temperature and heart rate

a) It is difficult to keep the child awake Pg. 1353 During the health history, the parents may state that it is difficult to keep the child awake. Physical examination would reveal that the child is below weight and height, that his skin is pale and mottled, and that he is lethargic and irritable.

17. The nurse is obtaining a health history from parents whose 4-month-old boy has congenital hypothyroidism. What would the nurse most likely assess? a) It is difficult to keep the child awake b) The skin is pink and healthy looking c) The child has above-normal growth for his age d) The child is active and playful

b) Insert an IV line in preparation for giving IV fluids and cortisol Pg. 1356 In acute adrenocortical insufficiency, immediate care consists of IV fluid and cortisol to restore blood pressure, blood glucose, and sodium. The child will also need to be closely monitored for vital signs and neurologic checks. Once the child is stabilized, he or she may be admitted to an intensive care unit for close monitoring. The recovery time for this crisis is rapid; if treated properly, it is likely the child will recover within 24 hours. The monitoring of heart rhythms or oxygen status is not the initial focus for this disease.

3. A school-aged child is brought into the emergency room, and the preliminary diagnosis is acute adrenocortical insufficiency. Which of the interventions below should the nurse implement first? a) Prepare the child for admission to the pediatric intensive care unit b) Insert an IV line in preparation for giving IV fluids and cortisol c) Arrange for a bedside electrocardiogram to be performed d) Administer oxygen via a nonrebreather mask

a) "What time each day does your child take his growth hormone?" Pg. 1350 It is important for the nurse to know the time of day that the child takes his or her growth hormone. Growth hormone is the common treatment for the child with hypopituitarism who is short, not tall, in stature. Vasopressin is the treatment for diabetes insipidus. Monitoring blood glucose is not part of the treatment for hypopituitarism.1359

11. The nurse is taking a history on a 10-year-old child who has a diagnosis of hypopituitarism. Which question is important for the nurse to ask the parents? a) "What time each day does your child take his growth hormone?" b) "How often do you test your child's blood glucose?" c) "Is your child taking vasopressin IM or SC?" d) "Does your child get upset about being taller than friends?"

c) "Lots of fish and meat will help him" Pg. 1370 Clients with PKU need to avoid high-protein foods including meats, fish, poultry, eggs, cheese, milk, nuts, beans, peas, and flour. The food exchange list includes vegetables, fruits, breads, cereals, fats, and miscellaneous "free foods" allowed on the diet.

32. The nurse is teaching the mother of a child with phenylketonuria (PKU) about diet and realizes the mother needs further instruction when she makes which statement? a) "'Free foods' are allowed" b) "Most fruits are good" c) "Lots of fish and meat will help him" d) "Some vegetables are good"

a) Polyphagia c) Polyuria e) Polydipsia Pg. 1368-1369 Type 2 diabetes mellitus is characterized by a gradual onset and is most often associated with obesity and not marked weight loss. Type 1 diabetes is most often abrupt and associated with marked weight loss. Polyuria, polydipsia, and polyphagia are frequent assessment findings in both types of diabetes mellitus.

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

d) Graves disease Pg. 1355 Children who develop Graves disease experience nervousness, tremors, and increased heart rate and blood pressure cause by overstimulation of the thyroid gland. Cushing syndrome, hypertension, and hypothyroidism are not associated with these symptoms.

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

b) It is absolutely normal for the growing child to require an increase in insulin; this does not mean his/her condition is getting worse Pg. 1363 Children show a decreased need for insulin shortly after glucose control has been established, which is referred to by some as the "honeymoon phase" and should be described to parents so that they do not get any false hope that the child does not need insulin. As children grow, they will require increased doses of insulin to maintain glucose control, and not all children need to receive two types of insulin. Insulin treatment should be based on each individual child.

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

b) Antidiuretic hormone (ADH) Pg. 1349-1352 Central diabetes insipidus (DI) is a disorder of the posterior pituitary that results from deficient secretion of ADH. ADH is responsible for the concentration of urine in the renal tubules. Without ADH there is a massive amount of water loss and an increase in serum sodium. Nephrogenic DI occurs as a genetic problem or from end-stage renal disease. It is the result of the inability of the kidney to respond to ADH and not from a pituitary gland problem. LH is produced from the anterior pituitary. In females, it stimulates ovulation and the development of the corpus luteum. TSH is secreted by the thyroid gland. ACTH is secreted by the anterior pituitary.

37. Diabetes insipidus is a disorder of the posterior pituitary that results in deficient secretion of which hormone? a) Luteinizing hormone (LH) b) Antidiuretic hormone (ADH) c) Adrenocorticotropic hormone (ACTH) d) Thyroid stimulating hormone (TSH)

c) Insulin Pg. 1358-1359 Feedback is seen in endocrine systems that regulate concentrations of blood components such as glucose. Glucose from the ingested lactose or sucrose is absorbed in the intestine and the level of glucose in blood rises. Elevation of blood glucose concentration stimulates endocrine cells in the pancreas to release insulin. Insulin has the major effect of facilitating entry of glucose into many cells of the body; as a result, blood glucose levels fall. When the level of blood glucose falls sufficiently, the stimulus for insulin release disappears and insulin is no longer secreted. Glycogen is stored in the liver and muscles. It is released to provide energy when the blood glucose levels fall. Glucagon is also produced by the pancreas. Its job is to force the liver to release stored insulin when the body has a need for more insulin. The adrenocorticotropic hormone is produced by the anterior pituitary. Its function is to regulate cortisol. This is needed so the adrenal glands can function properly. It also helps the body respond to stress.

10. The nurse is interpreting the negative feedback system that controls endocrine function. What secretion will the nurse correlate as decreasing while blood glucose levels decrease? a) Glucagon b) Adrenocorticotropic hormone c) Insulin d) Glycogen

b) "Her body doesn't have any insulin" Pg. 1359 Type 1 diabetes mellitus (DM) is a disorder in which the child's body has a deficiency of insulin; children with type 1 DM cannot produce insulin. Type 2 DM is controlled through diet, medicine, and exercise. Type 2 DM can be prevented through diet and exercise, but type 1 DM cannot. Resistance to insulin is not the primary factor in type 1 DM.

12. A nurse who is caring for a 7-year-old is providing client education to the child and caregiver. Which response by the caregiver demonstrates to the nurse that the caregiver understands the diagnosis of type 1 diabetes mellitus? a) "I will just feed my child healthy foods and sign her up for more sports" b) "Her body doesn't have any insulin" c) "Her body fights against the insulin" d) "We will just have our child exercise and take medicine to cure this"

b) "When I tap on my child's facial nerve, the reaction is a facial muscle spasm" Pg. 1369 The Chvostek sign is a facial muscle spasm that occurs when the facial nerve is tapped. This can indicate heightened neuromuscular activity, possibly caused by hypocalcemia. Hypoparathyroidism may be suspected.

13. A nurse is educating a family about the Chvostek sign after their teen tested positive for Chvostek sign. Which statements by the caregivers shows the nurse that they understand the Chvostek sign? a) "The sign means my child is not getting enough vitamin D" b) "When I tap on my child's facial nerve, the reaction is a facial muscle spasm" c) "The sign occurs because my child is having increased intracranial pressure" d) "The sign occurs when there is muscle pain and the muscle is stimulated"

c) Urine output Pg. 1352 An infant with the diagnosis of diabetes insipidus has decreased secretion of antidiuretic hormone (ADH). The infant is at risk for dehydration so monitoring urinary output is the most important intervention. The child's oral intake has been ordered. Monitoring a child who is under fluid restriction includes assessing the oral mucosa; however, urine output is the most important assessment for this patient. Vital signs are part of a basic assessment.

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

c) Elevate the subcutaneous tissue before the injection Pg. 1361-1362 Insulin injections are always given subcutaneously. Elevating the skin tissue prevents injection into muscles when subcutaneous injections are given. The needle bevel should face upward. The skin is spread in intramuscular, not subcutaneous, injections. It is no longer recommended to aspirate blood for subcutaneous injections.

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

c) It is a genetic disease that affects lipid metabolism Pg. 1372 The nurse must identify that an absence of hexosaminidase indicates the genetic disease Tay-Sachs. All of the options provide accurate information about Tay-Sachs disease. At this time, the nurse is correct to answer the client's question honestly with basic information such as what it is and why it is a problem. The health care provider, who the client is there to see, will provide the necessary details in a private setting. Tay-Sachs disease is caused by an autosomal-recessive gene that has a deficiency in hexosaminidase A. Almost all children who have this disease are of Ashkenazi Jewish ancestry. There is no cure for the disease.

18. A nurse is working in a clinic where high-risk pregnancies are prevalent. The nurse is assisting with diagnostic screening for pregnant clients and fetuses. A client comes to the clinic newly diagnosed with an absence of hexosaminidase. The client is upset and does not know how this will affect the fetus. Prior to the appointment with the health care provider, which information is best for the nurse to explain? a) It is an autosomal-recessive inherited disease b) It is a disease that has no cure c) It is a genetic disease that affects lipid metabolism d) It is a disease that occurs in the Ashkenazi Jewish population

c) Taking oral hypoglycemic agents Pg. 1369 Oral hypoglycemic agents, such as metformin, are often effective for controlling blood glucose levels in children diagnosed with type 2 diabetes. Insulin may be used for a child with type 2 diabetes if oral hypoglycemic agents alone are not effective, but "decreasing" the daily insulin would not help treat this disorder. Lifestyle changes such as increased exercise (not conserving energy by resting during the day), and limiting large amounts of carbohydrates are important aspects of treatment for the child.

2. The nurse working with the child diagnosed with type 2 diabetes recognizes the disorder can be managed by: a) Conserving energy with rest periods during the day b) Increasing carbohydrates in the diet, especially in the evening c) Taking oral hypoglycemic agents d) Decreasing amounts of daily insulin

a) Galactosemia and phenylketonuria Pg. 1370-1371 Both phenylketonuria and galactosemia are hereditary disorders in which the body cannot have milk. Maple syrup urine disease is an inborn error of metabolism of the branched chain amino acid. Congenital hypothyroidism is an error with the thyroid gland.

21. From which pair of metabolic disorders must the nurse instruct the parents to eliminate breast and cow's milk from the diet? a) Galactosemia and phenylketonuria b) Maple syrup urine disease and galactosemia c) Congenital hypothyroidism and phenylketonuria d) Turner syndrome and maple syrup urine disease

d) Tumor of the adrenal cortex Pg. 1357-1358 Cushing syndrome is caused by overproduction of the adrenal hormone cortisol; this usually results from increased ACTH production due to either a pituitary or adrenal cortex tumor. The peak age of occurrence is 6 or 7 years. The overproduction of cortisol results in increased glucose production; this causes fat to accumulate on the cheeks, chin, and trunk, causing a moon-faced, stocky appearance. Cortisol is catabolic, so protein wasting also occurs. This leads to muscle wasting, making the extremities appear thin in contrast to the trunk, and loss of calcium in bones (osteoporosis). Other effects include hyperpigmentation (the child's face is unusually red, especially the cheeks).

23. A 6-year-old boy has a moon-face, stocky appearance but with thin arms and legs. His cheeks are unusually ruddy. He is diagnosed with Cushing syndrome. What is the most likely cause of this condition in this child? a) Tumor of the thyroid b) Tumor of the parathyroid c) Tumor of the pancreas d) Tumor of the adrenal cortex

d) The parents report that their son "can't drink enough water" Pg. 1359 Unquenchable thirst (polydipsia) is a common finding associated with diabetes mellitus, type 1 and 2. However, reports of flu-like illness and Kussmaul breathing are more commonly associated with type 1 diabetes. Blood pressure is normal with type 1 diabetes and elevated with type 2 diabetes.

24. The nurse is assessing a 13-year-old boy with type 2 diabetes mellitus. What would the nurse correlate with this disorder? a) Auscultation reveals Kussmaul breathing b) The parents report that their child had "a cold or flu" recently c) Blood pressure is decreased when checking vital signs d) The parents report that their son "can't drink enough water"

b) Drowsiness and fruity odor to breath Pg. 1366 Diabetic ketoacidosis is characterized by drowsiness, decreased skin turgor, acetone breath with a fruity smell, and Kussmaul breathing (abnormal increase in the depth and rate of the respiratory movements). Nausea and vomiting may occur. If untreated, the child lapses into coma and exhibits dehydration, electrolyte imbalance, rapid pulse, and subnormal temperature and blood pressure.

28. The nurse is caring for a child admitted to the emergency center in diabetic ketoacidosis. Which clinical manifestations would the nurse most likely note in this child? a) Pale and moist skin b) Drowsiness and fruity odor to breath c) Slow pulse and elevated blood pressure d) Hyperactive and restless behavior

a) The child may have developed leukopenia Pg. 1355 Graves disease is defined as an overproduction of thyroid hormones. Propylthiouracil is used to suppress thyroid function. A complication of Graves disease is leukopenia.

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

c) Give 10 to 15 grams of a simple carbohydrate Pg. 1365 The child is experiencing hypoglycemia as evidenced by the assessment findings and blood glucose level. Since the child is coherent, offering the child 10 to 15 grams of a simple carbohydrate would be appropriate. Insulin is not used because the child is hypoglycemic. A complex carbohydrate snack would be used after offering the simple carbohydrate to maintain the glucose level. Intramuscular glucagons would be used if the child was not coherent.

30. A child with diabetes reports that he is feeling a little shaky. Further assessment reveals that the child is coherent but with some slight tremors and sweating. A fingerstick blood glucose level is 70 mg/dl. What would the nurse do next? a) Offer a complex carbohydrate snack b) Administer glucagon intramuscularly c) Give 10 to 15 grams of a simple carbohydrate d) Administer a sliding-scale dose of insulin

a) Growth hormone Pg. 1351 Disorders of the pituitary gland depend on the location of the physiologic abnormality. The anterior pituitary, or adenohypophysis, is made up of endocrine glandular tissue and secretes growth hormone (GH), adrenocorticotropic hormone (ACTH), TSH, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin. The posterior lobe is called the neurohypophysis because it is formed of neural tissue. It secretes antidiuretic hormone (ADH; vasopressin) and oxytocin. Usually, several target organs are affected when there is a disorder of the pituitary gland, especially the adenohypophysis.

31. The nurse knows that disorders of the pituitary gland depend on the location of the physiologic abnormality. In caring for a child that has issues with the anterior pituitary, the nurse knows that this child has issues with which hormone? a) Growth hormone b) Oxytocin c) Vasopressin d) Antidiuretic hormone

b) Syndrome of inappropriate antidiuretic hormone Pg. 1353 Syndrome of inappropriate antidiuretic hormone (SIADH) is a rare condition in which there is overproduction of antidiuretic hormone by the posterior pituitary gland. This results in a decrease in urine production and water intoxication. As sodium levels fall in proportion to water, the child develops hyponatremia or a lowered sodium plasma level. It can be caused by central nervous system infections such as bacterial meningitis. As the hyponatremia grows more severe, coma or seizures occur from brain edema. Diabetes insipidus is characterized by polyuria, not decreased urine production. Hyposecretion of somatotropin, or growth hormone, results in undergrowth; hypersecretion results in overgrowth.

34. 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? a) Hyposecretion of somatotropin b) Syndrome of inappropriate antidiuretic hormone c) Hypersecretion of somatotropin d) Diabetes insipidus

a) Decreased cognitive development of the fetus Pg. 1354 If acquired hypothyroidism exists in a woman during pregnancy, her infant can be born intellectually disabled, because there was not enough iodine present for fetal growth. It is important, therefore, that girls with this syndrome be identified before they reach childbearing age.

35. A woman in her first trimester of pregnancy has just been diagnosed with acquired hypothyroidism. The nurse is alarmed because this condition can lead to which pregnancy complication? a) Decreased cognitive development of the fetus b) Gestational diabetes in the mother c) Congenital heart defects in the fetus d) Spina bifida in the fetus

c) Fluid replacement Pg. 1352 Children with diabetes insipidus lose tremendous amounts of fluid, so fluid replacement is the priority consideration for this client. Excessive fluid loss can lead to seizures and death. Headache and polydipsia can be relieved with fluid replacement. Children will requirement a nutritional consultation for weight loss, but it is not the main consideration.

38. A pediatric client has just been diagnosed with diabetes insipidus. What is the primary consideration for this client? a) Headache b) Polydipsia c) Fluid replacement d) Weight loss

c) "Carrier testing is warranted for couples who have an elevated risk for Tay-Sachs disease due to their ethnic origin" Pg. 1372 Prevention, when it is possible, is the first intervention for metabolic disorders, such as Tay-Sachs. For some diseases such as Tay-Sachs disease, mild hyperphenylalaninemia, and Gaucher disease, carrier testing (heterozygote screening) is possible. Carrier testing is warranted for people who may have elevated risk because of their ethnic or national origin. The nurse has an important role in providing genetic counseling to families who are suspected or known carriers of a metabolic disorder.

39. A young couple seeks pregnancy counseling in the women's health clinic. They tell the nurse performing a focused health history that they are of Jewish descent and are worried about conceiving a baby with Tay-Sachs disease. No known metabolic disorders exist in the family medical history. What is the nurse's best response to this couple's concerns? a) "Neonatal screening is available to diagnose Tay-Sachs in an otherwise asymptomatic neonate in as little as two weeks" b) "Early diagnosis of the disease can be made in utero and a decision can be made at that time to maintain or terminate the pregnancy" c) "Carrier testing is warranted for couples who have an elevated risk for Tay-Sachs disease due to their ethnic origin" d) "Since neither of you have a metabolic disorder, you should not be concerned about conceiving a baby with Tay-Sachs"

b) Deficient fluid volume related to dehydration Pg. 1352 The priority nursing diagnosis most likely would be deficient fluid volume related to dehydration, due to a deficiency in the secretion of antidiuretic hormone (ADH). Excess fluid would result from a disorder that leads to water retention, such as syndrome of inappropriate antidiuretic hormone (SIADH). Deficient knowledge related to fluid intake regimen is a nursing diagnosis for this child, but a secondary one. Imbalanced nutrition, more than body requirements related to excess weight would be inappropriate for this child since he probably has lost weight secondary to the fluid loss.

40. The nurse is developing a plan of care for a 7-year-old boy with diabetes insipidus. What is the priority nursing diagnosis? a) Excess fluid volume related to edema b) Deficient fluid volume related to dehydration c) Deficient knowledge related to fluid intake regimen d) Imbalanced nutrition, more than body requirements related to excess weight