Chapter 48: Nursing Care of the Child With an Alteration in Metabolism/Endocrine Disorder

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?

"As endocrine functions become more stable throughout childhood, alterations become more apparent."

A nurse is teaching an adolescent with type 1 diabetes about the disease. Which instruction by the nurse about how to prevent hypoglycemia would be most appropriate for the adolescent?

"Carry crackers or fruit to eat before or during periods of increased activity."

During a visit to the clinic the adolescent client with hypothyroidism tells the nurse that she takes her Synthroid (levothyroxine) "whenever I think about it...sometimes I miss a dose, but not very often." What is the best response by the nurse?

"I know it's hard to remember medicines, but it is really important for you to take it before breakfast each day to control your hypothyroidism."

A 13-year-old adolescent with hyperthyroidism who takes antithyroid medication has a sore throat and a fever. The parent calls the nurse and asks what to do. Which is the best response from the nurse?

"Please take your child straight to the emergency department."

After explaining the causes of hypothyroidism to the parents of a newly diagnosed infant, the nurse should recognize that further education is needed when the parents ask which question?

"So, hypothyroidism can be treated by exposing our baby to a special light, right?"

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?

"What time each day does your child take his growth hormone?"

A nurse in the school office is seeing a 7-year-old child with type 1 diabetes after gym class. The child is jittery and appears sweaty. Which intervention would the nurse advise the child to do?

"You will need to drink this 6-ounce bottle of orange juice."

A nurse is reinforcing the diagnosis of constitutional delay by the health provider to a 13-year-old male adolescent. Which is the best approach for this teen?

"You will not need medication because your hormone levels are normal. I would be glad to discuss these findings with you."

The nurse caring for a female adolescent with polycystic ovary syndrom (PCOS) identifies "Disturbed body image related to signs and symptoms of the disease" as a nursing diagnosis that applies to this client. What signs and symptoms would support this nursing diagnosis?

- Balding of hair on head - Hirsutism - Acne - Increased muscle mass

Diabetes insipidus is a disorder of the posterior pituitary that results in deficient secretion of which hormone?

Antidiuretic hormone (ADH)

The nurse is seeing a new client in the clinic who reports polyuria and polydipsia. These conditions are indicative of which endocrine disorder?

Diabetes insipidus

The nurse is teaching a child with type 1 diabetes mellitus to administer her own insulin. The child is receiving a combination of short-acting and long-acting insulin. The nurse knows that the child has appropriately learned the technique when she:

Draws up the short-acting insulin into the syringe first.

A newborn girl is discovered to have congenital adrenal hyperplasia. When assessing her, the nurse would expect to find which physical characteristic?

Enlarged clitoris

The nurse is assessing a 1-month-old girl who, according to the mother, doesn't eat well. Which assessment suggests the child has congenital hypothyroidism?

Enlarged tongue

The nurse working on a pediatric floor understands the importance of diagnosing inborn errors of metabolism early. A child with a suspected problem must have testing done of the blood urea nitrogen (BUN) and creatinine. Which is the purpose of these two tests?

Evaluate renal function

A 12-year-old child has hyperthyroidism. The nurse understands that the most common cause of hyperthyroidism in children is:

Graves disease.

A pediatric nurse is discharging a 1-month-old infant. The infant was diagnosed with congenital hypothyroidism on this admission and will be treated with levothyroxine. The nurse knows it is important to teach the parent about medication administration. Which process will the nurse include in the teaching?

Give the crushed medication in a syringe mixed with a small amount of formula.

A 12-year-old is being seen in the office and has hyperthyroidism; the nurse knows that the most common cause of hyperthyroidism is:

Graves disease

During an assessment of an adolescent child, the nurse notes that the child has a protuberant tongue, fatigued appearance, poor muscle tone and exophthalmos. What medical diagnosis would the nurse expect the child to have?

Graves disease

A child is diagnosed with hyperthyroidism. What finding would the nurse expect to assess?

Heat intolerance

In interpreting the negative feedback system that controls endocrine function, the nurse correlates how _______ secretion is decreased as blood glucose levels decrease.

Insulin

Which results would indicate to the nurse the possibility that a neonate has congenital hypothyroidism?

Low T4 level and high TSH level

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?

Stimate (esmopressin) acetate is a synthetic antidiuretic hormone that will slow down your urine output

The nurse is caring for a child recently diagnosed with hypoparathyroidism disorder. Which medication would the nurse expect to be ordered?

Oral calcium

The nurse is caring for a school-aged child newly diagnosed with type 1 diabetes mellitus. Which nursing action supports the 2020 National Health Goals to reduce the long-term complications from this disease process?

Schedule the child and parents to attend diabetes education classes.

A nurse is teaching a child with type 1 diabetes mellitus how to self-inject insulin. Which method should she recommend to the child for regular doses?

Subcutaneously in the outer thigh

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

The nurse working with the child diagnosed with type 2 diabetes mellitus recognizes that most often the disorder can be managed by:

Taking oral hypoglycemic agents

A 9-year-old child with Graves' disease is seen at the pediatrician's office with a complaint of sore throat and fever. The nurse notes in the history that the child is taking propylthiouracil. Which of the following would concern the nurse?

The child may have developed leukopenia.

A 6-year-old boy has a moon-faced, stocky appearance but with thin arms and legs. His cheeks are unusually ruddy. He is diagnosed with Cushing syndrome. What is the most likely cause of this condition in this child?

Tumor of the adrenal cortex

An elementary school child takes metformin (Glucophage) three times each day. Which of the following disorders would the school nurse expect the child to have?

Type 2 DM

A nurse should recognize that which laboratory result would be most consistent with a diagnosis of diabetes mellitus?

a fasting blood glucose greater than 126 mg/dL

When discussing care of an infant with congenital hypothyroidism, you would stress that the infant will need:

administration of levothyroxine for a lifetime.

A newborn is born with hypothyroidism. A complication of this disorder if it is not recognized and treated is:

cognitive impairment.

In the salt-losing form of congenital adrenal hyperplasia, the most important observation you would make in a newborn would be for:

dehydration.

A school-aged girl is diagnosed as having Cushing syndrome from long-term therapy with oral prednisone. This means that the child:

has purple striae on her abdomen.

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?

Urine output

A 10-year-old boy has been diagnosed with type 1 diabetes mellitus. He is curious about what the cause of his disease is and asks the nurse to explain it to him. What explanation is best?

"Special cells in a part of your body called the pancreas can't make a chemical called insulin, which helps control the sugar level in your blood."

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?

"When I tap on my child's facial nerve, the reaction is a facial muscle spasm."

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.

- Polyuria - Polydipsia - Polyphagia

A nurse is making a home visit to a 12-year-old child with type 1 diabetes and is reviewing insulin administration. The nurse determines that the teaching was successful when the child performs which actions? Select all that apply.

- Draw up the short-acting insulin before the intermediate-acting insulin - Stores the insulin vial at room temperature - Gives the injection at a 45-degree angle