Chapter 48: Nursing Care of the Child with an Alteration in Metabolism/Endocrine Disorder Prep U

A 2-year-old client is at the office for a follow-up visit. The client has had excessive hormone levels in recent bloodwork and the parents question why this was not found sooner. What is the best response by the nurse? "Endocrine disorders are hard to detect and you are lucky that we have found it when we did." "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." "It takes time to determine the level of functioning of endocrine glands."

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

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? "Are you saying that hypothyroidism is caused by a problem in the way the thyroid gland develops?" "So, hypothyroidism can be treated by exposing our baby to a special light, right?" "So, hypothyroidism can be only temporary, right?" "Do you mean that hypothyroidism may be caused by a problem in the way the body makes thyroxine?"

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

The nurse is speaking with the parents of a child recently diagnosed with hypothyroidism. Which statement by a parent indicates an understanding of symptoms of this disorder? "Heat intolerance is a caused by low thyroid levels." "Most people with hypothyroidism have smooth, velvety skin." "When they get my son's thyroid levels normal, he won't be so tired." "My son's nervousness may be a symptom of his hypothyroidism."

"When they get my son's thyroid levels normal, he won't be so tired."

The nurse is administering biosynthetic growth hormone, derived from recombinant DNA, by subcutaneous injection. The daily dosage is 0.2 to 0.3 mg/kg, given in divided doses. The child weighs 110 lb (49.9 kg). What is the safe dosage limit for this child on a daily basis? Record your answer using a whole number.

15

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? 7.5 % 8.5% 7.0% 6.5%

8.5%

A newborn was diagnosed as having hypothyroidism at birth. The parent asks the nurse how the disease could be discovered this early. Which is the nurse's best answer? A newborn has a typical rash at birth that suggests the diagnosis. A simple blood test to diagnose hypothyroidism is required in most states. Hypothyroidism is usually detected at birth by the newborn's physical appearance. The newborn is already severely impaired at birth, and this suggests the diagnosis.

A simple blood test to diagnose hypothyroidism is required in most states.

Prior to discharging an infant with congenital hypothyroidism to home with the parents, what should the nurse emphasize regarding the care that this child will need going forward? Administration of levothyroxine indefinitely An increased intake of calcium beginning immediately Vitamin K administration until school age Administration of vitamin C until after growth is complete

Administration of levothyroxine indefinitely

The parents of a child who was diagnosed with diabetes insipidus ask the nurse, "How does this disorder occur?" When responding to the parents, the nurse integrates knowledge that a deficiency of which hormone is involved? Insulin Thyroxine Growth hormone Antidiuretic hormone

Antidiuretic hormone

A child with a history of diabetes insipidus is admitted with polyuria, polydipsia and mental confusion. Which action would be the priority? Checking vital signs Encouraging increased fluid intake Measuring urine output Weighing the client

Checking vital signs

The nurse knows that which condition is caused by excessive levels of circulating cortisol? Graves disease Addison disease Cushing syndrome Turner syndrome

Cushing syndrome

A newborn is diagnosed with the salt-losing form of congenital adrenogenital hyperplasia. On what should the nurse focus when assessing this client? Excessive cortisone secretion Dehydration Bleeding tendency Hypoglycemia

Dehydration

A nurse is to see a child. Assessment reveals the chief complaints of urinating "a lot" and being "really thirsty." The nurse interprets these symptoms as being associated with which condition? Diabetes insipidus Precocious puberty Hypopituitarism Syndrome of inappropriate antidiuretic hormone secretion

Diabetes insipidus

The nurse is caring for a child with central diabetes insipidus who is underweight. Which nursing intervention is appropriate for this child? Encourage high-calorie beverages. Monitor blood glucose levels. Encourage low-carbohydrate food choices. Count carbohydrates.

Encourage high-calorie beverages.

A newborn is discovered to have congenital adrenogenital hyperplasia. What will the nurse most likely observe when assessing this client? Divergent vision Small for gestational age Abnormal facial features Enlarged clitoris

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? Frequent diarrhea Tachycardia Warm, moist skin Enlarged tongue

Enlarged tongue

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? hypothyroidism Cushing syndrome Graves disease hypertension

Graves disease

Which results would indicate to the nurse the possibility that a neonate has congenital hypothyroidism? Low T4 level and high TSH level Normal TSH level and high T4 level Normal T4 level and low TSH level High thyroxine (T4) level and low thyroid stimulating hormone (TSH) level

Low T4 level and high TSH level

The nurse is caring for a child diagnosed with low functioning parathyroid. Which is a treatment goal of a child with hypoparathyroidism? Assure the parents have a plan in place for periods of low glucose levels if noted. Maintain the child's calcium level at a normal level with calcium replacement as prescribed. Provide the parents a specific dietary plan for high-phosphorus foods to be eaten. Provide the child and parent with a referral to a pediatric gastrointestinal specialist.

Maintain the child's calcium level at a normal level with calcium replacement as prescribed.

The nurse is assessing a 4-year-old girl with ambiguous genitalia. Which finding suggests congenital adrenal hyperplasia? Hyperpigmentation of the skin Pubic hair and hirsutism Pain from constipation on palpation Irregular heartbeat on auscultation

Pubic hair and hirsutism

A child has been prescribed Stimate (desmopressin) acetate for the treatment of diabetes insipidus. The client and the parents ask the nurse how this drug works. What is the correct response by the nurse?

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

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? Hyposecretion of somatotropin Hypersecretion of somatotropin Diabetes insipidus Syndrome of inappropriate antidiuretic hormone

Syndrome of inappropriate antidiuretic hormone

The nurse is preparing a child suspected of having a thyroid disorder for a thyroid scan. What information regarding the child should the nurse alert the doctor or nuclear medicine department about? The child wears a medical alert bracelet for diabetes The child is taking a vitamin supplement The child is allergic to shellfish The child has had an MRI of their leg within the past 6 weeks

The child is allergic to shellfish

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

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 pancreas Tumor of the thyroid Tumor of the adrenal cortex Tumor of the parathyroid

Tumor of the adrenal cortex

A child presents to the primary care setting with enuresis, nocturia, increased hunger, weight loss, and increased thirst. What does the nurse suspect? Diabetes insipidus Hypothyroidism Syndrome of inappropriate diuretic hormone Type 1 diabetes mellitus

Type 1 diabetes mellitus

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

Urine output

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? Color of mucous membranes Oral intake Urine output Temperature and heart rate

Urine output

The nurse measures the client's blood glucose level prior to breakfast. The measurement obtained is 130 mg/dL. The orders read to administer 2 units of Humalog insulin for a blood glucose of 100 to 150mg/dL. How soon should the nurse ensure that the client eats their breakfast after receiving their insulin? Within 15 to 30 minutes Within 60 to 90 minutes Within 5 minutes Within 2 hours

Within 15 to 30 minutes

A nurse should recognize that which laboratory result would be most consistent with a diagnosis of diabetes mellitus? proteinuria a fasting blood glucose less than 126 mg/dl glucose in the urine a fasting blood glucose greater than 126 mg/dl

a fasting blood glucose greater than 126 mg/dl

The nurse is teaching the parents of an infant newly diagnosed with congenital hypothyroidism about the etiology of the disease. What is the contributing factor? Select all that apply. symptoms are evident during the first 6 months of life cause is unknown more common in infant girls absent or nonfunctioning thyroid gland environmental factors

absent or nonfunctioning thyroid gland environmental factors more common in infant girls

A child with a history of diabetes insipidus is admitted with polyuria, polydipsia, and mental confusion. Which is the priority intervention for this child? check vital signs measure urine output encourage increased fluid intake weigh the client

check vital signs

A newborn is born with hypothyroidism. If it is not recognized and treated, what complication is likely? blindness muscle spasticity dehydration cognitive impairment

cognitive impairment

Insulin deficiency, in association with increased levels of counter-regulatory hormones and dehydration, is the primary cause of: diabetic ketoacidosis. ketonuria. glucosuria. ketone bodies.

diabetic ketoacidosis.

The nurse is teaching a child with type 1 diabetes mellitus to administer 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 the child: draws up the short-acting insulin into the syringe first. administers the insulin into a doll at a 30-degree angle. wipes off the needle with an alcohol swab. administers the insulin intramuscularly into rotating sites.

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

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? growth hormone antidiuretic hormone oxytocin vasopressin

growth hormone

An 8-year-old girl presents to the clinic for moodiness and irritability. The child has begun to develop breasts and pubic hair and the parents are concerned that the child is at too early an age for this to begin. The nurse knows that these symptoms may be indicative of what disorder? precocious puberty pseudopuberty adrenal hyperplasia neurofibromatosis

precocious puberty

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? "We will just have our child exercise and take medicine to cure this." "Her body doesn't have any insulin." "I will just feed my child healthy foods and sign her up for more sports." "Her body fights against the insulin."

"Her body doesn't have any insulin."

The nursing is caring for a child recently admitted with an endocrine disorder. The child's mother asks the nurse what the term metabolism means. Which is the best response by the nurse? "Metabolism refers to how much energy a person has to complete their daily activities." "Metabolism describes how the body uses glucose in the cells." "Metabolism refers to all physical and chemical reactions occurring in the body's cells that are necessary to sustain life." "Metabolism means how fast the body breaks down foods and uses them for energy."

"Metabolism refers to all physical and chemical reactions occurring in the body's cells that are necessary to sustain life."

The nursing is caring for a child recently admitted with an endocrine disorder. The child's mother asks the nurse what the term metabolism means. Which is the best response by the nurse? "Metabolism refers to how much energy a person has to complete their daily activities." "Metabolism refers to all physical and chemical reactions occurring in the body's cells that are necessary to sustain life." "Metabolism describes how the body uses glucose in the cells." "Metabolism means how fast the body breaks down foods and uses them for energy."

"Metabolism refers to all physical and chemical reactions occurring in the body's cells that are necessary to sustain life."

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? "Offer your child at least 8 ounces of clear fluids and call back tomorrow." "Give your child ibuprofen according to the instructions on the box." "Please take your child straight to the emergency department." "Fever and sore throat may be side effects of the medication."

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

After hospital discharge, the parent of a child newly diagnosed with type 1 diabetes mellitus telephones the nurse because the child is acting confused and very sleepy. Which emergency measure would the nurse suggest the parent carry out before bringing the child to see the health care provider? Give the child one unit of regular insulin. Give the child a glass of orange juice with one unit regular insulin in it. Give the child nothing by mouth so that a blood sugar can be drawn at the health care provider's office. Give the child a glass of orange juice.

Give the child a glass of orange juice.

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? SIADH Graves disease Cushing disease Diabetes mellitus

Graves disease

A child is diagnosed with hypoparathyroidism. Which electrolyte imbalance would the nurse most likely expect to address? Hypomagnesemia Hyperkalemia Hyponatremia Hypocalcemia

Hypocalcemia

The nurse is caring for a 10-year-old child with growth hormone (GH) deficiency. Which therapy would you anticipate will be prescribed for the child? Injections of GH Short-term aldosterone provocation Long-term blocking of beta cells Oral administration of somatotropin

Injections of GH

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? Regular insulin Lispro Detemir NPH

Regular insulin