Chapter 53: The Child with Alterations in Endocrine Function

A 5-year-old child with a history of hypopituitarism presents with complaints of right hip and leg pain. Which prescribed medication for the diagnosis should the nurse identify as the cause for the current symptoms? 1. Daily growth hormone 2. Insulin before meals and bedtime 3. DDAVP (desmopressin) at bedtime 4. Cortisone injections

Answer: 1 Explanation: 1. Growth hormone injections and hypopituitarism have been associated with slipped capital femoral epiphysis, which manifests with complaints of hip or knee pain. 2. Insulin is not used to treat hypopituitarism. 3. DDAVP reduces urinary output. It does not cause slipped capital femoral epiphysis. 4. Cortisone is not used for hypopituitarism

Which action related to insulin administration should the nurse include in the teaching plan for an adolescent client who has been newly diagnosed with diabetes mellitus to avoid the development of lipoatrophy? 1. Rotating injection sites 2. Checking blood sugars at mealtime and bedtime 3. Using a sliding scale for additional coverage 4. Administration of insulin via insulin pump

Answer: 1 Explanation: 1. Lipoatrophy is caused by using the same insulin injection site. 2. Checking blood sugars does not influence lipoatrophy. 3. A sliding scale does not influence lipoatrophy. 4. Insulin administration via pump does not influence lipoatrophy.

A hospitalized child has been diagnosed with SIADH (syndrome of inappropriate antidiuretic hormone), a complication of his meningitis. Which laboratory data should the nurse anticipate for this child? 1. Hyponatremia 2. Hypocalcemia 3. Hyperglycemia 4. Hypernatremia

Answer: 1 Explanation: 1. SIADH is associated with increased permeability in distal renal tubes, leading to water intoxication and low sodium. 2. Hypocalcemia is not seen with SIADH. 3. Hyperglycemia is not related to SIADH. 4. Hypernatremia is seen with diabetes insipidus, not SIADH.

Which assessment finding would cause the nurse to question whether a preschool-age boy, diagnosed with phenylketonuria shortly after birth, is following the prescribed dietary restrictions? 1. The child's body has a musty odor. 2. This child is a blue-eyed blond. 3. The child appears sleepy and uninterested in the surroundings. 4. The child has a sunburn over his entire body.

Answer: 1 Explanation: 1. The odor is caused by the excretion of phenylketone by-products through the skin and would indicate noncompliance with the dietary restrictions. 2. While this is a characteristic of most children with PKU, it is not related to dietary intake or restrictions. 3. This is not a symptom of untreated phenylketonuria. 4. Photophobia is not associated with PKU. The child with untreated PKU has an eczematous rash.

Which pediatric client diagnoses would cause the nurse to include information related to short stature? Select all that apply. 1. Hypothyroidism 2. Turner syndrome 3. Chronic renal failure 4. Cushing syndrome 5. Diabetes mellitus

Answer: 1, 2, 3, 4 Explanation: 1. Hypothyroidism is a pediatric client diagnosis that would cause the nurse to include information related to short stature. 2. Turner syndrome is a pediatric client diagnosis that would cause the nurse to include information related to short stature. 3. Chronic renal failure is a pediatric client diagnosis that would cause the nurse to include information related to short stature. 4. Cushing syndrome is a pediatric client diagnosis that would cause the nurse to include information related to short stature. 5. Diabetes mellitus is not a pediatric client diagnosis that would cause the nurse to include information related to short stature.

Which diagnostic tests should the nurse include in the plan of care for a pediatric client who is at risk for short stature? Select all that apply. 1. Thyroid function studies 2. Adrenocorticotropic hormone (ACTH) and cortisol levels 3. Complete blood count 4. Blood culture 5. Urine creatinine

Answer: 1, 2, 3, 5 Explanation: 1. Thyroid function tests are often included in the plan of care for a pediatric client at risk for short stature. 2. ACTH and cortisol levels are often included in the plan of care for a pediatric client at risk for short stature. 3. A complete blood count often included in the plan of care for a pediatric client at risk for short stature. 4. A blood culture is not included in the plan of care for a pediatric client at risk for short stature. 5. A urine creatinine is often included in the plan of care for a pediatric client at risk for short stature.

Which changes should the school nurse implement to decrease the risk for the development of type 2 diabetes mellitus for a population who is identified as being at risk? Select all that apply. 1. Increase the amount of daily physical activity. 2. Meet with all parents and explain the risk that is associated with obesity. 3. Test each child's urine monthly. 4. Teach the parents to avoid administering aspirin to their children. 5. Work with the cafeteria to decrease the amount of fat in the foods served.

Answer: 1, 2, 5 Explanation: 1. Increased physical activity will decrease a child's risk of developing type 2 diabetes. 2. Obese children have an increased risk of type 2 diabetes. Working with the parents, the nurse can reduce the obesity in the school. 3. Testing urine will not decrease the risk of developing type 2 diabetes, although it may lead to earlier diagnosis of the disease. 4. Aspirin administration is not related to type 2 diabetes. 5. A diet high in fat is associated with type 2 diabetes.

The nurse is teaching the caregiver of a child who is newly diagnosed with type 1 diabetes mellitus how to minimize pain with insulin injections. Which interventions should the nurse include in the teaching session? Select all that apply. 1. Do not reuse needles. 2. Remove all bubbles from the syringe before injecting. 3. Have the child flex the muscle during injection. 4. Inject insulin when it is cold. 5. Do not change the direction of the needle during insertion or withdrawal.

Answer: 1, 2, 5 Explanation: 1. Reusing needles leads to more pain on injection. 2. Removing bubbles from the syringe minimizes pain. 3. Flexing or tensing muscles during injection causes more discomfort. 4. Insulin should be injected when it is at room temperature to minimize pain. 5. Keeping the direction of the syringe constant will minimize pain.

Which functions of the adrenal androgens should the nurse include in a teaching session for a pediatric client diagnosed with alterations in adrenal function? Select all that apply. 1. Stimulates bone development 2. Increases sodium ion reabsorption 3. Stimulates secondary sexual characteristics 4. Increases potassium excretion by the kidneys 5. Activates the sympathetic nervous system

Answer: 1, 3 Explanation: 1. This is a function of androgens. 2. This is a function of aldosterone, not androgens. 3. This is a function of androgens. 4. This is a function of aldosterone, not androgens. 5. This is a function of epinephrine, not aldosterone.

The nurse is providing information to an adolescent newly diagnosed with diabetes. Which clinical manifestations of diabetic ketoacidosis (DKA) should the nurse include in the teaching session? Select all that apply. 1. Change in mental status 2. Tachycardia 3. Fruity breath odor 4. Rapid, shallow respirations 5. Abdominal pain

Answer: 1, 3, 5 Explanation: 1. A change in mental state can be associated with DKA. 2. Tachycardia is not a typical symptom of DKA. 3. A fruity breath odor is common when the client is in a state of ketoacidosis. 4. Respirations are rapid, but deep (Kussmaul breathing) in DKA. 5. Abdominal pain is commonly seen with DKA.

The nurse is providing care to a newborn who is suspected of having Turner syndrome. Which should the nurse assess the newborn for based on the current diagnosis? 1. Club foot (talipes equinovarus) 2. Congenital heart anomalies 3. Hyperbilirubinemia due to liver abnormalities 4. Diaphragmatic hernia

Answer: 2 Explanation: 1. Club foot is not associated with Turner syndrome. 2. Congenital heart anomalies, including coarctation of the aorta, frequently are associated with Turner syndrome. 3. The newborn with Turner syndrome has the normal risk for hyperbilirubinemia. 4. Diaphragmatic hernias are not associated with Turner syndrome.

Which sequela should the nurse include in the teaching session for a parent who does not believe in medication for the treatment of the newborn's hypothyroidism? 1. Heart disease 2. Mental retardation 3. Renal failure 4. Thyroid storm

Answer: 2 Explanation: 1. If the hypothyroidism is left untreated, the child will experience bradycardia but will not develop heart disease. 2. Untreated hypothyroidism will lead to mental retardation. 3. Untreated hypothyroidism does not lead to renal failure. 4. Thyroid storm is a complication of hyperthyroidism, not hypothyroidism.

The home health nurse is visiting a 3-month-old infant who is diagnosed with congenital hypothyroidism and is prescribed daily levothyroxine. Which should the nurse include in the infant's continued plan of care? 1. Stopping the medication as long as the child continues to grow 2. Preventing hypothermia with appropriate clothing 3. Changing formula because it is contraindicated with prescribed medication 4. Monitoring growth and development without any other prescribed interventions

Answer: 2 Explanation: 1. The medication must be continued for life. 2. The parents should be cautioned to dress the child appropriately to prevent hypothermia. 3. The infant formula is not contraindicated with the prescribed medication. 4. The child will continue to need monitoring and intervention even if growth and development are not affected.

The nurse is providing care to a newborn female who is born with ambiguous genitalia. The follow-up investigation discovers adrenogenital syndrome (also called congenital adrenal hyperplasia [CAH]). The parents question why the baby's genitalia looks more male than female. Which response by the nurse is accurate? 1. "The disorder caused your baby to be a hermaphrodite with both male and female sex organs." 2. "The changes in the genitalia are due to increased androgens secondary to deficient cortisol." 3. "The excessive cortisol caused the enlargement of the female tissue, creating a male appearance." 4. "Your baby has only one sex chromosome resulting in an XO configuration.

Answer: 2 Explanation: 1. This statement is incorrect. The child's internal organs will be ovaries only. 2. Deficient cortisol causes the amount of adrenocorticotropic hormone (ACTH) to be high, overstimulating the adrenal production of androgens, which causes the pseudomasculinization. 3. The cortisol level is decreased, not increased. 4. XO sex chromosomes describe Turner syndrome, not CAH.

Which functions of the adrenal hormone aldosterone should the nurse include in a teaching session for a pediatric client diagnosed with alterations in adrenal function? Select all that apply. 1. Stimulates bone development 2. Increases sodium ion reabsorption 3. Stimulates secondary sexual characteristics 4. Increases potassium excretion by the kidneys 5. Activates the sympathetic nervous system

Answer: 2, 4 Explanation: 1. This is a function of androgens, not aldosterone. 2. This is a function of aldosterone. 3. This is a function of androgens, not aldosterone. 4. This is a function of aldosterone. 5. This is a function of epinephrine, not aldosterone.

Which teaching point should the nurse include when providing education to an adolescent client, who participates in soccer, regarding the plan of care for diabetes mellitus? 1. Decreased food intake 2. Increased doses of insulin 3. Increased food intake 4. Decreased doses of insulin

Answer: 3 Explanation: 1. Decreased food intake would increase the chance of hypoglycemia. 2. Increased dose of insulin would cause hypoglycemia. Exercise causes insulin to be used more efficiently by the body, so an increase in insulin would not be needed. 3. An increase in physical activity requires an increase in caloric intake to prevent hypoglycemia. 4. A decreased dose of insulin would not allow the sugar to enter the cells where it is needed during exercise.

The nurse is caring for a child just admitted with diabetic ketoacidosis (DKA). Which healthcare provider prescription should the nurse question? 1. Neurologic checks hourly 2. Insert urinary catheter and measure output hourly 3. NPH insulin IV at 0.1 unit/kg per hour 4. Stat serum electrolytes

Answer: 3 Explanation: 1. Hourly neurologic checks are an appropriate order. 2. Urinary catheter and hourly outputs are appropriate. 3. NPH insulin is never administered IV. A short-acting insulin needs to be ordered. 4. Stat electrolytes are an appropriate order.

Which clinical manifestations should the nurse anticipate when providing care to an adolescent client who presents with untreated Graves disease? 1. Hyperglycemia, ketonuria, and glucosuria 2. Weight gain, hirsutism, and muscle weakness 3. Tachycardia, fatigue, and heat intolerance 4. Dehydration, metabolic acidosis, and hypertension

Answer: 3 Explanation: 1. Hyperglycemia, ketonuria, and glucosuria are signs of diabetes. 2. Weight gain, hirsutism, and muscle weakness are seen in clients with Cushing disease. 3. Clinical manifestations of Graves disease are tachycardia, fatigue, and heat intolerance, seen with hyperthyroidism. 4. Dehydration, metabolic acidosis, and hypertension are signs of congenital adrenal hyperplasia.

The nurse is giving discharge instructions to the parents of a child whose adrenal glands have been removed due to a tumor. Which parental statement indicates the need for further education? 1. "I will call the doctor if my child has restlessness and confusion." 2. "If my child has any gastric irritation, I will give him antacids." 3. "If my child has vomiting and diarrhea, I will hold his hydrocortisone." 4. "I will give my child his hydrocortisone in the morning."

Answer: 3 Explanation: 1. Restlessness and confusion can be signs of adrenal insufficiency, and the healthcare provider would need to know these symptoms. No further instruction is needed. 2. Hydrocortisone can cause gastric irritation, and antacids are given between meals. No further instruction is needed. 3. If the child is ill and cannot take hydrocortisone by mouth, the child would need to have an injection. Failure to give hydrocortisone could lead to severe illness and cardiovascular collapse. The mother needs additional instruction. 4. The child should have hydrocortisone in the morning, which mimics the normal diurnal pattern of cortisol secretion. No further instruction is needed.

An adolescent presents in the emergency department (ED) with confusion. The healthcare provider suspects diabetic ketoacidosis (DKA). A stat serum glucose is done, and the result is 7l5 mg/dL. Which clinical manifestations does the nurse anticipate upon assessment for this client? 1. Tachycardia, dehydration, and abdominal pain 2. Sweating, photophobia, and tremors 3. Dry mucous membranes, blurred vision, and weakness 4. Dry skin, shallow rapid breathing, and dehydration

Answer: 3 Explanation: 1. Tachycardia is seen in hypoglycemia. 2. Sweating, photophobia, and tremors are indicative of hypoglycemia. 3. Dry mucous membranes, blurred vision, and weakness are seen with hyperglycemia. 4. Dry skin and dehydration are signs of hyperglycemia, but shallow breathing is a sign of hypoglycemia.

Which assessment data for a pediatric client supports the diagnosis of familial or idiopathic central diabetes insipidus (DI)? Select all that apply. 1. Polyuria 2. Polydipsia 3. Nocturia 4. Enuresis 5. Constipation

Answer: 3, 4, 5 Explanation: 1. Polyuria is not a clinical manifestation associated with familial or idiopathic central DI. 2. Polydipsia is not a clinical manifestation associated with familial or idiopathic central DI. 3. Nocturia is a clinical manifestation associated with familial or idiopathic central DI. 4. Enuresis a clinical manifestation associated with familial or idiopathic central DI. 5. Constipation a clinical manifestation associated with familial or idiopathic central DI.

Which food should the nurse remove from the food tray for a toddler-age client who is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH)? 1. Oatmeal 2. Yogurt 3. Biscuit 4. Watermelon

Answer: 4 Explanation: 1. A child with SIADH may have carbohydrates and fiber, such as in oatmeal. 2. A child with SIADH may have dairy products, such as yogurt. 3. A child with SIADH may have carbohydrates, such as in a biscuit. 4. A child with SIADH is on a fluid restriction. Watermelon contains significant fluid volume, so it would not be a good food for this child to consume.

Which type of nutrition should the nurse include when planning care for a newborn who is diagnosed with galactosemia? 1. Goat's milk formula 2. Breast milk 3. Cow's milk-based formula 4. Lactose-free formula

Answer: 4 Explanation: 1. Goat's milk formula contains galactose and is excluded from the newborn's diet. 2. Breast milk contains galactose and is excluded from the newborn's diet. 3. Cow's milk-based formula contains galactose and is excluded from the newborn's diet. 4. A lactose-free formula is the type of nutrition the nurse should include in the teaching plan for this newborn.

Which prescription regarding an oral hydrocortisone for a toddler-age client diagnosed with congenital adrenal insufficiency should the nurse anticipate when the client is admitted to the hospital with pneumonia? 1. It will be discontinued. 2. It will be reduced. 3. It will be continued as previously prescribed. 4. It will be increased.

Answer: 4 Explanation: 1. Hydrocortisone is the glucocorticoid that helps the body deal with stress. It would be inappropriate to stop the medication. 2. The drug dosage would not be decreased. 3. During periods of stress, the child will need additional corticosteroids. 4. During periods of stress including illness and surgery, the dose of steroids needs to be increased.

A child weighing 18.2 kg with a history of diabetes insipidus (DI) has been admitted to the hospital. Which healthcare provider prescription should the nurse question? 1. Stat electrolytes 2. Urine specific gravity with each void 3. DDAVP (desmopressin) PO 4. Restrict oral fluids to 500 mL every 24 hours

Answer: 4 Explanation: 1. Stat electrolytes would be an appropriate order to check for hypernatremia. 2. Urine specific gravity is checked because it is often low. 3. DDAVP is the drug of choice for a child with DI. 4. Fluid replacement, not fluid restriction, is necessary for child with DI.