[Exam 4] Pediatrics: Endocrine and Genitourinary Practice Question

The most appropriate nursing diagnosis for a child with type 1 diabetes mellitus is which of the following? 1. Risk for infection related to reduced body defenses. 2. Impaired urinary elimination (enuresis). 3. Risk for injury related to medical treatment. 4. Anticipatory grieving.

1. Risk for infection related to reduced body defenses. Risk for infection is a correct nursing diagnosis. Understanding DM is understanding the effect it has on peripheral circulation and impairment of defense mechanisms.

Which finding requires immediate attention in a child with glomerulonephritis? 1. Sleeping most of the day and being very "cranky" when awake; blood pressure is 170/90. 2. Urine output is 190 mL in an 8-hour period and is the color of Coca-Cola. 3. Complaining of a severe headache and photophobia. 4. Refusing breakfast and lunch and stating he "just is not hungry."

3. Complaining of a severe headache and photophobia. A severe headache and photophobia can be signs of encephalopathy due to hypertension, and the child needs immediate attention.

When does short-acting insulin (regular, Humulin R) reach its peak? 1. No peak. 2. 8 hours. 3. 2-4 hours. 4. 30-90 minutes.

3. 2-4 hours.

When does intermediate-acting insulin (NPH, Humulin N) reach its peak? 1. No peak. 2. 6 hours. 3. 8 hours. 4. 12 hours.

3. 8 hours.

When is the best time to give furosemide (Lasix)? 1. 8:00 a.m. 2. 12 noon. 3. 6:00 p.m. 4. Bedtime.

1. 8:00 a.m. The onset of Lasix is 20 to 60 minutes. It peaks at 60 to 70 minutes, with a duration of 2 hours. By 24 hours, 50% is eliminated. Give the Lasix at 8:00 a.m. to avoid interruption of sleep with frequent urination.

When does rapid-acting insulin (lispro, Humalog) reach its peak? 1. 30-90 minutes. 2. 6 hours. 3. No peak. 4. 2-4 hours.

1. 30-90 minutes.

The parents of a child with glomerulonephritis ask how they will know their child is improving after they go home. Which are the nurse's best responses? Select all that apply. 1. "Your child's urine output will increase, and the urine will become less tea-colored." 2. "Your child will have more energy as lab tests become more normal." 3. "Your child's appetite will decrease as urine output increases." 4. "Your child's laboratory values will become more normal." 5. "Your child's weight will increase as the urine becomes less tea-colored."

1. "Your child's urine output will increase, and the urine will become less tea-colored." 5. "Your child's weight will increase as the urine becomes less tea-colored." 1. When glomerulonephritis is improving, urine output increases, and the urine becomes less tea-colored. These are signs that can be monitored at home by the child's parents. 5. The child's weight will increase as the urine resumes a more normal color, indicating lab values are returning to normal and the child is better.

The onset of short-acting insulin (regular, Humulin R) is: 1. 30 minutes to 60 minutes. 2. 1 hour. 3. 10 to 20 minutes. 4. 1 to 3 hours.

1. 30 minutes to 60 minutes.

Which child is at risk for developing glomerulonephritis? 1. A 3-year-old who had impetigo 1 week ago. 2. A 5-year-old with a history of five UTIs in the previous year. 3. A 6-year-old with new-onset type 1 diabetes. 4. A 10-year-old recovering from viral pneumonia.

1. A 3-year-old who had impetigo 1 week ago. Impetigo is a skin infection caused by the streptococcal organism that is commonly associated with glomerulonephritis.

Which causes the clinical manifestations of hydronephrosis? 1. A structural abnormality in the urinary system causes urine to back up and can cause pressure and cell death. 2. A structural abnormality causes urine to flow too freely through the urinary system, leading to fluid and electrolyte imbalances. 3. Decreased production of urine in one or both kidneys results in an electrolyte imbalance. 4. Urine with an abnormal electrolyte balance and concentration leads to increased blood pressure and subsequent increased glomerular filtration rate.

1. A structural abnormality in the urinary system causes urine to back up and can cause pressure and cell death. Hydronephrosis is due to a structural abnormality in the urinary system, causing urine to back up, leading to pressure and potential cell death.

The parents of Suzanne, a child with attention deficit hyperactivity disorder, tell the nurse they have tried everything to calm their child and nothing has worked. Which action by the nurse is most appropriate initially? 1. Actively listen to the parents' concern before planning interventions 2. Encourage the parents to discuss these issues with the mental health team 3. Provide literature regarding the disorder and its management 4. Tell the parents they are overreacting to the problem

1. Actively listen to the parents' concern before planning interventions

A 7-year-old is diagnosed with central precocious puberty. The child is to receive a monthly intramuscular (IM) injection of leuprolide acetate (Lupron). The child has great fear of pain and needles and requires considerable stress reduction techniques each time an injection is due. What could the nurse suggest that might help manage the pain? 1. Apply a eutectic mixture of local anesthetics (EMLA) of lidocaine and prilocaine to the site at least 60 minutes before the injection. 2. Have extra help on hand to help hold the child down. 3. Apply cold to the area prior to injection. 4. Identify a reward to bribe the child to behave during the injection.

1. Apply a eutectic mixture of local anesthetics (EMLA) of lidocaine and prilocaine to the site at least 60 minutes before the injection. EMLA cream works well for skin and cutaneous pain. Having the child assist in putting on the EMLA patch involves the child in the pain-relieving process.

12-year-old Caroline has recurring nephrotic syndrome. Which of the following areas of potential disturbances should be a prime consideration when planning ongoing nursing care? 1. Body image 2. Sexual maturation 3. Muscle coordination 4. Intellectual development

1. Body image

Which is a care priority for a newborn diagnosed with bladder exstrophy and a malformed pelvis? 1. Change the diaper frequently and assess for skin breakdown. 2. Keep the exposed bladder open in a warm and dry environment to avoid any heat loss. 3. Offer formula for infant growth and fluid management. 4. Cluster all care to allow the child to sleep, grow, and gain strength for the upcoming surgical repair.

1. Change the diaper frequently and assess for skin breakdown. Preventing infection from stool contamination and skin breakdown is the top priority of care.

The school nurse assesses Brook, a child newly diagnosed with attention deficit hyperactivity disorder (ADHD). Which of the following symptoms are characteristic of the disorder? Select all that apply. 1. Constant fidgeting and squirming 2. Excessive fatigue and somatic complaints 3. Difficulty paying attention to details 4. Easily distracted 5. Running away 6. Talking constantly, even when inappropriate

1. Constant fidgeting and squirming 3. Difficulty paying attention to details 4. Easily distracted 6. Talking constantly, even when inappropriate

Nurse Elena is handling a 7-year-old child who has cystitis. Which of the following would Nurse Elena expect when assessing the child? 1. Dysuria 2. Costovertebral tenderness 3. Flank pain 4. High fever

1. Dysuria

Arvic who is diagnosed with diabetes mellitus type 1 displays symptoms of hypoglycemia. Which of the following actions should the nurse instruct the parents? 1. Give the child honey (simple sugar) 2. Give the child milk (complex sugar). 3. Contact the healthcare provider before doing anything. 4. Give the child nothing by mouth.

1. Give the child honey (simple sugar)

The nurse is evaluating a female child with acute post streptococcal glomerulonephritis for signs of improvement. Which finding typically is the earliest sign of improvement? 1. Increased urine output 2. Increased appetite 3. Increased energy level 4. Decreased diarrhea

1. Increased urine output

Nurse Aries entered the room of a child with hypopituitarism and was asked by the couple about the condition of their child. Which of the following phrases if stated by the nurse best describes the condition? 1. Linear growth retardation with skeletal proportions normal for chronologic age 2. A complete normal growth pattern, but with the onset of precocious puberty 3. Normal growth for first five years, followed by progressive linear growth retardation 4. Growth retardation in which height and weight are equally affected

1. Linear growth retardation with skeletal proportions normal for chronologic age Although linear growth retardation occurs in hypopituitarism, delayed epiphyseal maturation allows for normal skeletal proportions.

Mr. Lopez has a 7-year-old son with growth hormone (GH) deficiency. He shares to the nurse the desire of his son to play ball games. However, his wife feels the child will be in danger since he is smaller than the other children. In planning anticipatory guidance for these parents, the nurse should keep in mind which of the following? 1. The child should be allowed to play because doing so can foster healthy self-esteem. 2. The risk for fractures is increased because a GH deficiency results in fragile bones. 3. Activity could aggravate insulin sensitivity, causing hyperglycemia. 4. Activity would aggravate the child's joints, already over tasked by obesity.

1. The child should be allowed to play because doing so can foster healthy self-esteem.

Which causes the symptoms in testicular torsion? 1. Twisting of the spermatic cord interrupts the blood supply. 2. Swelling of the scrotal sac leads to testicular displacement. 3. Unmanaged undescended testes cause testicular displacement. 4. Microthrombi formation in the vessels of the spermatic cord causes interruption of the blood supply

1. Twisting of the spermatic cord interrupts the blood supply. Testicular torsion is caused by an interruption of the blood supply due to twisting of the spermatic cord.

A child has been receiving prednisone for the past 3 weeks, and the parent wants to stop the medication. What is the nurse's best response? 1. "There is no problem in stopping the medication since the child's symptoms are gone." 2. "It is dangerous for steroids to be stopped suddenly." 3. "Your child may develop severe psychological symptoms when prednisone is stopped suddenly." 4. "Stopping the prednisone will require blood work."

2. "It is dangerous for steroids to be stopped suddenly." Abrupt cessation of long-term steroid therapy can cause acute adrenal insufficiency that could lead to death. Long-term steroid use can cause shrinkage of the adrenal glands, which decreases the production of the hormone.

The nurse has completed discharge teaching for the family of a 10-year-old diagnosed with diabetes insipidus (DI). Which statement best demonstrates the family's correct understanding of DI? 1. "The disease was probably brought on by a bad diet and little exercise." 2. "My child will have to use the bathroom more often than other children." 3. "Diabetes seems to run in my family, and that may be why my child has it." 4. "My child will need to check blood sugar several times a day."

2. "My child will have to use the bathroom more often than other children." Despite the use of vasopressin to treat the symptoms of DI, breakthrough urination is likely.

The community nurse visits the home of George, a child recently diagnosed with autism. The parents express feelings of shame and guilt about having somehow caused this problem. Which statement by the nurse would best help alleviate parental guilt? 1. "Autism is a rare disorder. Your other children shouldn't be affected." 2. "The specific cause of autism is unknown. However, it is known to be associated with problems in the structure of and chemicals in the brain." 3. "Sometimes a lack of prenatal care can be the cause of autism." 4. "Although autism is genetically inherited if you didn't have testing you could not have known this would happen."

2. "The specific cause of autism is unknown. However, it is known to be associated with problems in the structure of and chemicals in the brain."

The parent of a child with glomerulonephritis asks the nurse why the urine is such a funny color. Which is the nurse's best response? 1. "It is not uncommon for the urine to be discolored when children are receiving steroids and blood pressure medications." 2. "There is blood in your child's urine that causes it to be tea-colored." 3. "Your child 's urine is very concentrated, so it appears to be discolored." 4. "A ketogenic diet often causes the urine to be tea-colored."

2. "There is blood in your child's urine that causes it to be tea-colored." Blood in the child's urine causes it to be tea-colored.

The onset of long-acting insulin (glargine, Lantus) is: 1. 2-4 hours. 2. 1 hour. 3. 10 to 20 minutes. 4. 3 hours.

2. 1 hour.

Niklaus was born with hypospadias; which of the following should be avoided when a child has such condition? 1. Surgery 2. Circumcision 3. Intravenous pyelography (IVP) 4. Catheterization

2. Circumcision

What is most likely the underlying physiology of primary enuresis? 1. Psychogenic stress 2. Delayed bladder maturation 3. Urinary tract infection 4. Vesicoureteral reflux

2. Delayed bladder maturation

A toddler is being evaluated for syndrome of inappropriate antidiuretic hormone (SIADH). The nurse should observe the child for which symptoms? Select all that apply. 1. Dehydration. 2. Fluid retention. 3. Hyponatremia. 4. Hypoglycemia. 5. Myxedema.

2. Fluid retention. 3. Hyponatremia. 2. ADH assists the body in retaining fluids and subsequently decreases serum osmolarity while the urine osmolarity rises. When serum sodium levels are decreased below 120 mEq/L, the child becomes symptomatic. 3. ADH assists the body in retaining fluids and subsequently decreases serum osmolarity while the urine osmolarity rises. When serum sodium levels are decreased below 120 mEq/L, the child becomes symptomatic. The posterior pituitary is responsible for secretion of ADH. SIADH is over-secretion of ADH.

The nurse performing an admission assessment on a 2-year-old child who has been diagnosed with nephrotic syndrome notes that which most common characteristic is associated with this syndrome? 1. Hypertension. 2. Generalized edema. 3. Increased urinary output. 4. Frank, bright red blood in the urine.

2. Generalized edema.

The school nurse notices that a 14-year-old who used to be an excellent student and very active in sports is losing weight and acting very nervous. The teen was recently checked by the primary care provider (PCP), who noted the teen had a very low level of TSH. The nurse recognizes that the teen has which condition? 1. Hashimoto thyroid disease. 2. Graves disease. 3. Hypothyroidism. 4. Juvenile autoimmune thyroiditis.

2. Graves disease. Graves disease is hyperthyroidism and presents with low TSH levels, weight loss, and excessive nervousness.

When developing a plan of care for a hospitalized child, nurse Mary knows that children in which age group is most likely to view illness as a punishment for misdeeds? 1. Infancy 2. Preschool age 3. School age 4. Adolescence

2. Preschool age

The nurse in a diabetic clinic sees a 10-year-old who is a new diabetic and has had trouble maintaining blood glucose levels within normal limits. The child's parent states the child has had several daytime "accidents." The nurse knows that this is referred to as which of the following? 1. Primary enuresis. 2. Secondary enuresis. 3. Diurnal enuresis. 4. Nocturnal enuresis.

2. Secondary enuresis. Secondary enuresis refers to urinary incontinence in a child who previously had bladder control.

A school-age child comes in with a sore throat and fever. The child was recently diagnosed with Graves disease and is taking propylthiouracil. What concerns should the nurse have about this child? 1. The child must not be taking her medication. 2. The child may have leukopenia. 3. The child needs to start an antibiotic. 4. The child is not getting enough sleep.

2. The child may have leukopenia. Propylthiouracil is used to suppress thyroid function. One of the grave complications of the medication is leukopenia.

A newborn develops tetany and has a seizure prior to discharge from the nursery. The newborn is diagnosed with hypocalcemia secondary to hypoparathyroidism and is started on calcium and vitamin D. Which information would be most important for the nurse to teach the parents? 1. They should observe the baby for signs of tetany and seizures. 2. They should observe for weakness, nausea, vomiting, and diarrhea. 3. They should administer the calcium and vitamin D daily as prescribed. 4. They should call the clinic if they have any questions about care of the newborn.

2. They should observe for weakness, nausea, vomiting, and diarrhea. Vitamin D toxicity (weakness, nausea, vomiting, and diarrhea) is a serious consequence of therapy and should be the top priority in teaching.

A nurse is caring for an infant who is very fussy and has a diagnosis of diabetes insipidus (DI). Which parameters should the nurse monitor while the infant is on fluid restrictions? 1. Oral intake. 2. Urine output. 3. Appearance of the mucous membranes. 4. Change in pulse and temperature.

2. Urine output. It is crucial to monitor and record urine output. The infant with DI has hyposecretion of ADH, and fluid restriction has little effect on urine formation. This infant is at risk for dehydration and for fluid and electrolyte imbalances.

The parents of an 8-year-old come to the clinic and ask the nurse if their child should receive growth hormone to boost short stature. Which is the nurse's best response? 1. "Growth hormone only works if the child has short bones." 2. "Can your child remember to take the pills every day?" 3. "Test results are required before growth hormone can be started in children." 4. "How tall do you think your child should be?"

3. "Test results are required before growth hormone can be started in children." Growth hormone is approved for use only in children to treat a documented lack of growth hormone.

An infant is scheduled for a hypospadias and chordee repair. The parent asks the nurse, "I understand why the hypospadias repair is necessary, but do they have to fix the chordee as well?" Which is the nurse's best response? 1. "I understand your concern. Parents do not want their children to undergo extra surgery." 2. "The chordee repair is done strictly for cosmetic reasons that may affect your son as he ages." 3. "The repair is done to optimize sexual functioning when he is older." 4. "This is the best time to repair the chordee because he will be having surgery anyway."

3. "The repair is done to optimize sexual functioning when he is older." Releasing the chordee surgically is necessary for future sexual function.

A nurse is working with a child who has had a bone age evaluation. Which explanation of the test should the nurse give? 1. "The bone age will give you a diagnosis of your child ' s short stature." 2. "If the bone age is delayed, the child will continue to grow taller." 3. "The x-ray of the bones is compared with that of the age-appropriate, standardized bone age." 4. "If the bone age is not delayed, no further treatment is needed."

3. "The x-ray of the bones is compared with that of the age-appropriate, standardized bone age." The bone age is a method of evaluating the epiphyseal growth centers of the bone using standardized, age-appropriate tables.

At a follow-up visit for an 8-year-old who is being evaluated for short stature, the nurse measures and plots the child's height on the growth chart. Which explanation should the nurse give the child and family? 1. "We want to make sure you were measured accurately the last two visits." 2. "We need to calculate how tall you will be when you grow to adult height." 3. "We need to see how much you have grown since your last visit." 4. "We need to know your height so that a dosage of medication can be calculated for you."

3. "We need to see how much you have grown since your last visit." Height velocity is the most important aspect of a growth evaluation and can demonstrate deceleration in growth if it is present.

Nurse Charlotte suspects that a child, age 4, is being neglected physically. To best assess the child's nutritional status, the nurse should ask the parents which question? 1. "Has your child always been so thin?" 2. "Is your child a picky eater?" 3. "What did your child eat for breakfast?" 4. "Do you think your child eats enough?"

3. "What did your child eat for breakfast?"

Tara is an 11-year-old girl diagnosed with type 1 diabetes mellitus (DM). She asks her attending nurse why she can't take a pill rather than shots like her grandmother does. Which of the following would be the nurse's best reply? 1. "If your blood glucose levels are controlled, you can switch to using pills." 2. "The pills correct fat and protein metabolism, not carbohydrate metabolism." 3. "Your body does not make insulin, so the insulin injections help to replace it." 4. "The pills work on the adult pancreas, you can switch when you are 18."

3. "Your body does not make insulin, so the insulin injections help to replace it."

The onset of rapid-acting insulin (lispro, Humalog) is: 1. 30 minutes to 1 hour. 2. 1 to 2 hours. 3. 10 to 20 minutes. 4. 2 to 4 hours.

3. 10 to 20 minutes. Humalog insulin is rapid-acting and has an onset of 10 to 20 minutes.

Which child does not need a urinalysis to evaluate for a urinary tract infection (UTI)? 1. A 4-month-old female presenting with a 2-day history of fussiness and poor appetite; current vital signs include axillary T 100.8°F (38.2°C), HR 120 beats per minute. 2. A 4-year-old female who states, "It hurts when I pee"; she has been urinating every 30 minutes; vital signs are within normal range. 3. An 8-year-old male presenting with a finger laceration; mother states he had surgical re-implantation of his ureters 2 years ago. 4. A 12-year-old female complaining of pain to her lower right back; she denies any burning or frequency at this time; oral temperature of 101.5°F (38.6°C).

3. An 8-year-old male presenting with a finger laceration; mother states he had surgical re-implantation of his ureters 2 years ago. Although this child has had a history of urinary infections, the child is currently not displaying any signs and therefore does not need a urinalysis at this time.

The family of a young child has been told the child has diabetes insipidus (DI). What information should the nurse emphasize to the family? 1. One caregiver needs to learn to give the injections of vasopressin. 2. Children should wear MedicAlert tags if they are over 5 years old. 3. Diabetes insipidus is different from diabetes mellitus. 4. Over time, the child may grow out of the need for medication.

3. Diabetes insipidus is different from diabetes mellitus. Explaining that DI is different from DM is crucial to the parents 'understanding of the management of the disease. DI is a rare condition that affects the posterior pituitary gland, whereas DM is a more common condition that affects the pancreas.

Which of the following organisms is the most common cause of urinary tract infection (UTI) in children? 1. Klebsiella 2. Staphylococcus 3. Escherichia coli 4. Pseudomonas

3. Escherichia coli

Which combination of signs is commonly associated with glomerulonephritis? 1. Massive proteinuria, hematuria, decreased urinary output, and lethargy. 2. Mild proteinuria, increased urinary output, and lethargy. 3. Mild proteinuria, hematuria, decreased urinary output, and lethargy. 4. Massive proteinuria, decreased urinary output, and hypotension.

3. Mild proteinuria, hematuria, decreased urinary output, and lethargy. Mild-to-moderate proteinuria, hematuria, decreased urinary output, and lethargy are common fi ndings in glomerulonephritis.

A group of nurses is about to perform a procedure related to a genitourinary (GU) problem to a group of pediatric patients. Which of the following groups would find it especially extra stressful? 1. Infants 2. Toddlers 3. Preschoolers 4. School-age children

3. Preschoolers In general, preschoolers have more fears because of their fantasies, contributing to fears of the simplest procedures.

The nurse is aware that the following laboratory values support a diagnosis of pyelonephritis? 1. Myoglobinuria 2. Ketonuria 3. Pyuria 4. Low white blood cell (WBC) count

3. Pyuria Pyelonephritis is diagnosed by the presence of leukocytosis, hematuria, pyuria, and bacteriuria. A urinary specimen should be obtained for a urinalysis. On urinalysis, one should look for pyuria as it is the most common finding in patients with acute pyelonephritis.

Which assessment should be a priority to monitor in a child receiving a narcotic for pain relief? 1. Bowel sounds. 2. Blood pressure. 3. Oxygen saturation. 4. Respirations.

4. Respirations. The primary purpose of administrating an opioid analgesic is to relieve pain. The adverse effects that place the child at greatest risk are respiratory depression and decreased level of consciousness.

Dr. Jones prescribes corticosteroids for a child with nephritic syndrome. What is the primary purpose of administering corticosteroids to this child? 1. To increase blood pressure 2. To reduce inflammation 3. To decrease proteinuria 4. To prevent infection

3. To decrease proteinuria The primary purpose of administering corticosteroids to a child with nephritic syndrome is to decrease proteinuria. It helps relieve the inflammation in the kidney and promotes healing. The proteinuria usually ranges in the sub nephrotic range (less than 3.5 g/day), but it can go up to the nephrotic range. A 24-hours urinary protein assay is required if the attendant nephrotic syndrome is suspected.

Nurse Henry admits a child with suspected type 1 DM; Which of the following questions should the nurse ask the parents? 1. "Does the child complain of headache?" 2. "How much exercise does the child get?" 3. "Has the child's number and type of bowel movements changed?" 4. "Has the child experienced nocturia or bedwetting?" 5. "How much candy and sweets does your child take daily?"

4. "Has the child experienced nocturia or bedwetting?"

Which question would the nurse ask the parents of a child suspected of having glomerulonephritis? 1. "Did your child fall off a bike onto the handle bars?" 2. "Has the child had persistent nausea and vomiting?" 3. "Has the child been itching or has he had a rash in the last week?" 4. "Has the child had a sore throat or a throat infection in the last few weeks?"

4. "Has the child had a sore throat or a throat infection in the last few weeks?"

The onset of intermediate-acting insulin (NPH, Humulin N) is: 1. 10 minutes to 20 minutes. 2. 1 hour. 3. 4 to 6 hours. 4. 1 to 3 hours.

4. 1 to 3 hours.

The bladder capacity of a 3-year-old is approximately how much? 1. 1.5 fl. oz. 2. 3 fl. oz. 3. 4 fl. oz. 4. 5 fl. oz.

4. 5 fl. oz. The capacity of the bladder in fluid ounces can be estimated by adding 2 to the child's age in years.

A child newly diagnosed with diabetes mellitus has been stabilized with insulin injections daily. A nurse prepares a discharge teaching plan regarding the insulin. The teaching plan should reinforce which of the following concepts? 1. Always keep insulin vials refrigerated 2. Increase the amount of insulin before exercise 3. Ketones in the urine signify a need for less insulin 4. Systematically rotate injection sites

4. Systematically rotate injection sites

The nurse is teaching the family about caring for their 7-year-old, who has been diagnosed with type 1 diabetes mellitus. What information should the nurse provide about this condition? 1. Best managed through diet, exercise, and oral medication. 2. Can be prevented by proper nutrition and monitoring blood glucose levels. 3. Characterized mainly by insulin resistance. 4. Characterized mainly by insulin deficiency.

4. Characterized mainly by insulin deficiency. Individuals with type 1 DM do not produce insulin. If one does not produce insulin, type 1 DM is the diagnosis.

Nurse Daya, a school nurse, is meeting with the school and health treatment team about a child who has been receiving methylphenidate (Ritalin) for two (2) months. The meeting is to evaluate the results of the child's medication use. Which behavior change noted by the teacher will help determine the medication's effectiveness. 1. Decrease repetitive behaviors 2. Decreased signs of anxiety 3. Increased depressed mood 4. Increased ability to concentrate on tasks

4. Increased ability to concentrate on tasks

Justine is admitted to the pediatric unit due to the occurrence of diabetic ketoacidosis signaling a new diagnosis of diabetes. The diabetes team explores the cause of the episode and takes steps to prevent a recurrence. Diabetic ketoacidosis (DKA) results from an excessive accumulation of which of the following? 1. Sodium bicarbonate from renal compensation 2. Potassium from cell death 3. Glucose from carbohydrate metabolism 4. Ketone bodies from fat metabolism

4. Ketone bodies from fat metabolism Inability to use glucose causes lipolysis, fatty acid oxidation, and release of ketones, resulting in metabolic acidosis and coma. Ketones accumulate and cause metabolic acidosis. The body tries to compensate by hyperventilation to eliminate carbon dioxide. When the blood glucose is low or cannot be used due to a lack of insulin, ketones are the major source of energy for the brain. The brain does not have any fuel stores and has no other non-glucose-derived energy sources.

A child was brought to the emergency department with complaints of nausea, vomiting, fruity-scented breath. The resident on duty diagnosed the child with diabetes ketoacidosis. Which of the following should the nurse expect to administer? 1. Potassium chloride IV infusion. 2. Dextrose 5% IV infusion. 3. Ringer's Lactate. 4. Normal saline IV infusion.

4. Normal saline IV infusion.

An 8-year-old with type 1 diabetes mellitus is complaining of a headache and dizziness and is visibly perspiring. Which of the following should the nurse do first? 1. Administer glucagon intramuscularly. 2. Offer the child 8 oz of water or calorie-free liquid. 3. Administer rapid-acting insulin lispro (Humalog). 4. Offer the child 8 oz of milk.

4. Offer the child 8 oz of milk. Milk is best to give for mild hypoglycemia, which would present with the symptoms described.

Which medication would most likely be included in the postoperative care of a child with repair of bladder exstrophy? 1. Furosemide (Lasix). 2. Mannitol. 3. Meperidine (Demerol). 4. Oxybutynin (Ditropan).

4. Oxybutynin (Ditropan). Oxybutynin (Ditropan) is used to help control bladder spasms.

The nurse caring for a client with type 1 diabetes mellitus is teaching how to self administer insulin. Which is the proper injection technique? 1. Position the needle with the bevel facing downward before injection. 2. Spread the skin prior to intramuscular injection. 3. Aspirate for blood return prior to injection. 4. Pinch the subcutaneous tissue to elevate it before injection.

4. Pinch the subcutaneous tissue to elevate it before injection. Skin tissue is elevated to prevent injection into the muscle when giving a subcutaneous injection. Insulin is only given subcutaneously.

Stephen was diagnosed with nephrotic syndrome; which of the following signs and symptoms are characteristics of the said disorder? 1. Hypertension, edema, hematuria 2. Hypertension, edema, proteinuria 3. Gross hematuria, fever, proteinuria 4. Poor appetite, edema, proteinuria

4. Poor appetite, edema, proteinuria

A mother asks the nurse how to handle her 5-year-old child, who recently started wetting the pants after being completely toilet trained. The child just started attending nursery school 2 days a week. Which principle should guide the nurse's response? 1. The child forgets previously learned skills 2. The child experiences growth while regressing, regrouping, and then progressing 3. The parents may refer less mature behaviors 4. The child returns to a level of behavior that increases the sense of security.

4. The child returns to a level of behavior that increases the sense of security.

A 12-year-old with hyperthyroidism is being treated with standard antithyroid drug therapy. A parent calls the office stating that the child has a sore throat and fever. Which is the nurse's best response? 1. "Bring your child to the office or emergency department immediately." 2. "Slight fever and sore throat are normal side effects of the medication." 3. "Give your child the appropriate dose of ibuprofen and call back if symptoms worsen." 4. "Give your child at least 8 oz of clear fluids and call back if symptoms worsen."

1. "Bring your child to the office or emergency department immediately." A complication of antithyroid drug therapy is leukopenia. Fever and sore throat, therefore, need to be evaluated immediately. This is an essential component of discharge teaching for patients with Graves disease.

The parents of a 3-year-old are concerned that the child is having "more accidents" during the day. Which questions would be appropriate for the nurse to ask to obtain more information? Select all that apply. 1. "Has there been a stressful event in the child's life, such as the birth of a sibling?" 2. "Has anyone else in the family had problems with accidents?" 3. "Does your child seem to be drinking more than usual?" 4. "Is your child more fussy, and does your child seem to be in pain when urinating?" 5. "Is your child having difficulties at preschool?"

1. "Has there been a stressful event in the child's life, such as the birth of a sibling?" 2. "Has anyone else in the family had problems with accidents?" 3. "Does your child seem to be drinking more than usual?" 4. "Is your child more fussy, and does your child seem to be in pain when urinating?" 1. Stressors such as the birth of a sibling can lead to incontinence in a child who previously had bladder control. 2. A pattern of enuresis can often be seen in families. 3. Increased thirst and incontinence can be associated with diabetes. 4. Fussiness and incontinence can be associated with UTIs.

In growing children, growth hormone deficiency results in short stature and very slow growth rates. Short stature may result from which of the following? 1. Anterior pituitary gland hypofunction 2. Posterior pituitary gland hyperfunction 3. Parathyroid gland hyperfunction 4. Thyroid gland hyperfunction

1. Anterior pituitary gland hypofunction

The nurse caring for a 14-year-old girl with diabetes insipidus (DI) understands which of the following about this disorder? 1. DI is treated with vasopressin on a lifelong basis. 2. DI is treated on a short-term basis with hormone replacement therapy. 3. DI may cause anorexia if proper meal planning is not addressed. 4. DI requires strict fluid limitation until it resolves.

1. DI is treated with vasopressin on a lifelong basis. Vasopressin is the treatment of choice. It is important for patients and parents to understand that DI is a lifelong disease.

A teen comes into the clinic with anxiety. Over the past 2 weeks, the teen has had some muscle twitching and has a positive Chvostek sign. Which explanation could the nurse provide to the parent about a Chvostek sign? 1. It is a facial muscle spasm elicited by tapping the facial nerve. 2. Muscle pain that occurs when touched. 3. The sign occurs because of increased intracranial pressure. 4. The sign is a result of a vitamin D overdose.

1. It is a facial muscle spasm elicited by tapping the facial nerve. Chvostek sign is a facial muscle spasm elicited by tapping on the facial nerve in the region of the parotid gland, indicates heightened neuromuscular activity, and leads the nurse to suspect hypoparathyroidism.

Which of the following should be included when developing a teaching plan to prevent urinary tract infection? Select all that apply. 1. Maintaining adequate fluid intake 2. Avoiding urination before and after intercourse 3. Emptying bladder with urination 4. Wearing underwear made of synthetic material such as nylon 5. Keeping urine alkaline by avoiding acidic beverages 6. Avoiding bubble baths and tight clothing

1. Maintaining adequate fluid intake 3. Emptying bladder with urination 6. Avoiding bubble baths and tight clothing

Which should the nurse include in the discharge teaching plan for a child beginning growth hormone therapy? 1. The child is expected to grow 3 to 5 inches during the first year of treatment. 2. The parents must measure the child's weight and height weekly. 3. The child will need to continue the therapy until he or she is 21 years old. 4. There are no side effects from taking growth hormones.

1. The child is expected to grow 3 to 5 inches during the first year of treatment. The expected growth rate with growth hormone therapy is 3 to 5 inches in the first year.

The nurse is obtaining the medical history of an 11-year-old diagnosed with hypopituitarism. An important question for the nurse to ask the parents is which of the following? 1. "Is the child receiving vasopressin intramuscularly or subcutaneously?" 2. "What time of day do you administer growth hormone?" 3. "Does your child have any concerns about being taller than the peer group?" 4. "How often is your child testing blood glucose?"

2. "What time of day do you administer growth hormone?" Growth hormone is used to treat a child with hypopituitarism.

What is the duration for long-acting insulin (glargine, Lantus)? 1. 10 hours. 2. 24 hours. 3. 12-16 hours. 4. 48 hours.

2. 24 hours.

What is the duration for rapid-acting insulin (lispro, Humalog)? 1. 2-4 hours. 2. 3-5 hours. 3. 6 hours. 4. 12 hours.

2. 3-5 hours.

What is the duration for short-acting insulin (regular, Humulin R)? 1. 3-5 hours. 2. 5-8 hours. 3. 1-3 hours. 4. 2-4 hours.

2. 5-8 hours.

The 6-year-old son of Mr. and Mrs. Peters is admitted to the healthcare facility with the diagnosis of idiopathic hypopituitarism. His height is measured below the third percentile and weight at the 40th percentile. Which of the following would be the first action of his attending nurse? 1. Recommend orthodontic referral for underdeveloped jaw. 2. Collaborate with a dietician to access his caloric needs. 3. Provide for a tutor for his precocious intellectual ability. 4. Place him in a room with a 2-year-old boy.

2. Collaborate with a dietician to access his caloric needs.

A 6-year-old girl comes with her mother for evaluation of her acne, breast buds, axillary hair, and body odor. What information should the nurse explain to them? 1. This is a typical age for girls to go into puberty. 2. Encourage the girl to dress and act appropriately for her chronological age. 3. She should be on birth control because she is fertile. 4. She may be short if her epiphyses close early.

2. Encourage the girl to dress and act appropriately for her chronological age. Dressing and acting appropriately for her chronological age should be encouraged for the well-being of the child.

A child who has been diagnosed with hypothyroidism is started on levothyroxine (Synthroid). Which should be included in the nurse's teaching plan? 1. The child will have more energy the next day after starting the medication. 2. Optimal effectiveness of the medication may not occur for several weeks. 3. The medication should be taken once a day at any time. 4. The medication should be taken with milk.

2. Optimal effectiveness of the medication may not occur for several weeks. After starting therapy, peak levels of the drug may not be expected for many weeks to months. Clients need to know this to prevent them from stopping the medication because they think it is not working.

The parent brings the growth record along with the 21-month-old child to a new clinic for a well-child visit. The record shows a birth weight of 8 lb; the 6-month weight was 16 lb; the 12-month weight was 18 lb; and the 15-month weight was 19 lb. With the record showing that the toddler's weight-for-age has been decreasing, the nurse should do what initially? 1. Omit plotting the previous weight-for-age on the new growth chart. 2. Point out the growth chart to the new health-care provider (HCP). 3. Consider the toddler a child with failure to thrive. 4. Weigh the child and plot on a new growth chart.

2. Point out the growth chart to the new health-care provider (HCP). The provider should be made aware of the decelerating weight for age. This pictorial information can then be reviewed with the parent.

The nurse is caring for a newborn with hypospadias. His parents ask if circumcision is an option. Which is the nurse's best response? 1. "Circumcision is a fading practice and is now contraindicated in most children." 2. "Circumcision in children with hypospadias is recommended because it helps prevent infection." 3. "Circumcision is an option, but it cannot be done at this time." 4. "Circumcision can never be performed in a child with hypospadias."

3. "Circumcision is an option, but it cannot be done at this time." It is usually recommended that circumcision be delayed in the child with hypospadias because the foreskin may be needed for repair of the defect.

The parent of a 7-year-old voices concern over the child's continued bed-wetting at night. The parent, on going to bed, has tried getting the child up at 11:30 p.m., but the child still wakes up wet. Which is the nurse's best response about what the parent should do next? 1. "There is a medication called DDAVP that decreases the volume of the urine. The physician thinks that will work for your child." 2. "When your child wakes up wet, be very firm and indicate how displeased you are. Have your child change the sheets to see how much work is involved." 3. "Limit fluids in the evening and start a reward system in which your child can choose a reward after a certain number of dry nights." 4. "Bed-wetting alarms are readily available, and most children do very well with them."

3. "Limit fluids in the evening and start a reward system in which your child can choose a reward after a certain number of dry nights." Limiting the child's fluids in the evening will help decrease the nocturnal urge to void. Providing positive reinforcement and allowing the child to choose a reward.

The nurse is interviewing the parent of a 9-year-old girl. The parent expresses concern because the daughter already has pubic hair and is starting to develop breasts. Which statements would be most appropriate? 1. "Your daughter should get her period in approximately 6 months." 2. "Your daughter is developing early and should be evaluated for precocious puberty." 3. "Your daughter is experiencing body changes that are appropriate for her age." 4. "Your daughter will need further testing to determine the underlying cause." 5. "Your daughter will need sexual counseling now."

3. "Your daughter is experiencing body changes that are appropriate for her age." The changes described in the question are normal for a healthy 9-year-old female.

What is the duration for intermediate-acting insulin (NPH, Humulin N)? 1. 3-5 hours. 2. 8-10 hours. 3. 12-16 hours. 4. 18-24 hours.

3. 12-16 hours.

Common side effects of oxybutynin (Ditropan) are: 1. Increase in heart rate and blood pressure. 2. Sodium retention and edema. 3. Constipation and dry mouth. 4. Insomnia and hyperactivity.

3. Constipation and dry mouth. Common side effects are constipation and dry mouth as the oxybutynin (Ditropan) has an atropine-like effect.

A 13-year-old is being seen for an annual physical examination. The child has lost 10 lb despite reports of excellent appetite. Appearance is normal, except for slightly protruding eyeballs, and the parents report the child has had difficulty sleeping lately. The nurse should do which of the following? 1. Prepare the family for a neurology consult. 2. Explain the need for an ophthalmology consult. 3. Discuss the plan for thyroid function tests. 4. Explain the plan for an 8-hour fasting blood glucose test.

3. Discuss the plan for thyroid function tests. Diagnostic evaluation for hyperthyroidism is based on thyroid function tests. It is expected in this case that T4 and T3 levels would be elevated, because the thyroid gland is overfunctioning.

While Lawrence is being assessed at the clinic, Nurse Rachel observed that the child appears to be small, with an immature face and chubby body build. Her parents stated that their child's rate of growth of all body parts is somewhat slow, but her proportions and intelligence remain normal. As a knowledgeable nurse, you know that the child has a deficiency of which of the following? 1. Antidiuretic hormone (ADH) 2. Parathyroid hormone (PTH) 3. Growth hormone (GH) 4. Melanocyte-stimulating hormone (MSH)

3. Growth hormone (GH)

A 12-year-old with type 2 diabetes mellitus presents with a fever and a 2-day history of vomiting. The nurse observes that the child's breath has a fruity odor and breathing is deep and rapid. Which should the nurse do first? 1. Offer the child 8 oz of clear noncaloric fluid. 2. Test the child's urine for ketones. 3. Prepare the child for an IV infusion. 4. Offer the child 25 g of carbohydrates.

3. Prepare the child for an IV infusion. This patient needs fluid and electrolyte therapy to restore tissue perfusion prior to beginning IV insulin therapy. The patient's history of vomiting should clue the test taker to disregard choices for food or fluids by mouth, answers 1 and 4. Answer 2 might be possible, as the urine would test positive for ketones, but the deep and rapid breathing should help the test taker choose answer 3.

Which is an important nursing intervention for a child with a diagnosis of hyperthyroidism? 1. Encourage an increase in physical activity. 2. Do preoperative teaching for thyroidectomy. 3. Promote opportunities for periods of rest. 4. Do dietary planning to increase caloric intake.

3. Promote opportunities for periods of rest. Because increased activity is characteristic of hyperthyroidism, providing opportunity for rest is a recommended nursing intervention.

The nurse is caring for a 4-year-old who weighs 15 kg. At the end of a 10-hour period, the nurse notes the urine output to be 150 mL. What action does the nurse take? 1. Notifies the health-care provider because this urine output is too low. 2. Encourages the child to increase oral intake to increase urine output. 3. Records the child's urine output in the chart. 4. Administers isotonic fluid intravenously to help with rehydration.

3. Records the child's urine output in the chart. Recording the child's urine output in the chart is the appropriate action because the urine output is within the expected range of 0.5-1 mL/kg/hr, or 75-150 mL for the 10-hour period.

A 13-year-old with type 2 diabetes mellitus asks the nurse, "Why do I need to have this hemoglobin A1c test?" The nurse's response is based on which of the following? 1. To determine how balanced the child 's diet has been. 2. To make sure the child is not anemic. 3. To determine how controlled the child's blood sugar has been. 4. To make sure the child's blood ketone level is normal.

3. To determine how controlled the child's blood sugar has been. Hemoglobin A1c, or glycosylated hemoglobin, refl ects average blood glucose levels over 2 to 3 months. Frequent high blood glucose levels would result in a higher hemoglobin A1c, suggesting that blood glucose needs to be in better control.

Which of the following should the nurse include in the insulin administration instruction for the parents of a child being discharged on insulin? 1. Insert the needle and aspirate prior to injecting 2. Inject insulin into the extremity to be exercised to enhance absorption 3. The muscles in the abdomen and thigh are the easiest to use for self-administration 4. Clean the site of injection with soap and water and avoid alcohol

4. Clean the site of injection with soap and water and avoid alcohol

A 12-year-old comes to the clinic with a diagnosis of Graves disease. What information should the nurse discuss with the child? 1. Suggest weight loss. 2. Encourage attending school. 3. Emphasize that the disease will go into remission. 4. Encourage the child to take responsibility for daily medications.

4. Encourage the child to take responsibility for daily medications. Because the child is 12 years old, encouraging responsibility for health care is important. The child still needs family involvement and ongoing supervision but should not be completely dependent on family for care.

The nurse is caring for a child who complains of constant hunger, constant thirst, frequent urination, and recent weight loss without dieting. Which can the nurse expect to be included in care for this child? 1. Limiting daily fluid intake. 2. Weight management consulting. 3. Strict intake and output monitoring. 4. Frequent blood glucose testing.

4. Frequent blood glucose testing. Frequent blood glucose testing is included in the care of a child with type 1 DM. The symptoms described in the question are characteristic of a child just prior to the diagnosis of type 1 DM.

Which should the nurse teach a group of girls and parents about the importance of preventing urinary tract infections (UTIs)? 1. Avoiding constipation has no effect on the occurrence of UTIs. 2. After urinating, always wipe from back to front to prevent fecal contamination. 3. Hygiene is an important preventive measure and can be accomplished with frequent tub baths. 4. Increasing fluids will help prevent and treat UTIs.

4. Increasing fluids will help prevent and treat UTIs. Increasing fluids will help fl ush the bladder of any organisms, encourage urination, and prevent stasis of urine.

Which descriptive terms should be used to describe a school-age child with myxedematous skin/eyes/hair changes? 1. The skin is oily and scaly. 2. The skin has pale, thickened patches. 3. The skin is moist. 4. The eyes are puffy, the hair is sparse, and the skin is dry.

4. The eyes are puffy, the hair is sparse, and the skin is dry. Myxedema, associated with low serum thyroxine and raised thyrotropin levels, is characteristic of hypothyroid dysfunction and presents with swelling or puffi ness of the limbs and face, sparse hair, and very dry skin. These signs may be accompanied by slowness of movements and mental dullness.

Which is the best way to obtain a urine sample in an 8-month-old being evaluated for a urinary tract infection (UTI)? 1. Carefully cleanse the perineum from front to back and apply a self-adhesive urine collection bag to the perineum. 2. Insert an indwelling Foley catheter, obtain the sample, and wait for results. 3. Place a sterile cotton ball in the diaper and immediately obtain the sample with a syringe after the first void. 4. Using a straight catheter, obtain the sample and immediately remove the catheter without waiting for the results of the urine sample.

4. Using a straight catheter, obtain the sample and immediately remove the catheter without waiting for the results of the urine sample. An in-and-out catheterization is the best way to obtain a urine culture in a child who is not yet toilet-trained.

A 13-month-old is discharged following repair of his epispadias. Which statement made by the parents indicates they understand the discharge teaching? 1. "If a mucous plug forms in the urinary drainage tube, we will irrigate it gently to prevent a blockage." 2. "If a mucous plug forms in the urinary drainage tube, we will allow it to pass on its own because this is a sign of healing." 3. "We will make sure the dressing is loosely applied to increase the toddler's comfort." 4. "If we notice any yellow drainage, we will know that everything is healing well."

1. "If a mucous plug forms in the urinary drainage tube, we will irrigate it gently to prevent a blockage." Any mucous plugs should be removed by irrigation to prevent blockage of the urinary drainage system.

The nurse will monitor a child on high-dose prednisone for: 1. Diabetes. 2. Deep vein thrombosis. 3. Nephrotoxicity. 4. Hepatotoxicity.

1. Diabetes. One of the side effects of high-dose steroids can be diabetes mellitus. The child needs to be evaluated so that prompt treatment can be initiated. The diabetes is self-limiting and after the steroids are discontinued should no longer be present. Other side effects include mood changes, hirsutism, trunk obesity, thin extremities, gastric bleeding, poor wound healing, hypertension, immunosuppression, insomnia, and increased appetite.

A child had a urinary tract infection (UTI) 3 months ago and was treated with an oral antibiotic. A follow-up urinalysis revealed normal results. The child has had no other problems until this visit when the child was diagnosed with another UTI. Which is the most appropriate plan? 1. Obtain urinalysis and urine culture. 2. Evaluate for renal failure. 3. Admit to the pediatric unit. 4. Send home on an antibiotic.

1. Obtain urinalysis and urine culture. Urinalysis and urine culture are routinely used to diagnose UTIs. VCUG is used to determine the extent of urinary tract involvement when a renal ultrasound shows scaring or possible reflux. If the child has a UTI related to bubble baths, constipation, or wiping back to front, a VCUG would not be ordered.

The nurse is performing an assessment on a child admitted to the hospital with a probable diagnosis of nephrotic syndrome. Which assessment findings would the nurse expect to observe? Select all that apply. 1. Pallor. 2. Edema. 3. Anorexia. 4. Proteinuria. 5. Weight loss. 6. Decreased serum lipids.

1. Pallor. 2. Edema. 3. Anorexia. 4. Proteinuria.

A toddler is admitted to the pediatric fl oor for hypopituitarism following removal of a craniopharyngioma. The toddler has polyuria, polydipsia, and dehydration. Which area of the brain was most affected by the surgery? 1. Posterior pituitary. 2. Anterior pituitary. 3. Autonomic nervous system. 4. Sympathetic nervous system.

1. Posterior pituitary. The posterior pituitary is responsible for the secretion of ADH and control of the renal tubules. The symptoms are those of DI.

When does long-acting insulin (glargine, Lantus) reach its peak? 1. 1-2 hours. 2. No peak. 3. 8 hours. 4. 4-6 hours.

2. No peak.

Katie is admitted to the intensive care unit for diabetic ketoacidosis. Which of the following is of primary importance when caring for the child? 1. Giving I.V. NPH insulin in high doses 2. Evaluating the child for cardiac abnormalities 3. Limiting fluids to prevent aggravating cerebral edema 4. Monitoring and recording the child's vital signs for hypertension

2. Evaluating the child for cardiac abnormalities As the fluid volume deficit is improved, total body potassium deficiency may occur, leaving the child vulnerable to hypokalemia and, afterward, cardiac arrest. The nurse should monitor the cardiac cycle for prolonged QT interval, low T wave, and depressed ST segment, which indicate weakened heart muscle and potential irregular heartbeat.

The nurse is assigned to care for a newborn with goiter. The nurse's primary concern is which of the following? 1. Reassuring the parents that the condition is only temporary and will be treated with medication. 2. Maintaining a patent airway and preparing for emergency ventilation. 3. Preparing the infant for surgery and initiating preoperative teaching with the parents. 4. Obtaining a detailed history, particularly of medications taken during the mother's pregnancy.

2. Maintaining a patent airway and preparing for emergency ventilation. Goiter in a newborn can cause tracheal compression, and positioning to help relieve pressure (i.e., neck hyperextension) is essential. Emergency precautions for ventilation and possible tracheostomy are also instituted.

The nurse is caring for a 10-year-old post parathyroidectomy. Discharge teaching should include which of the following? 1. How to administer injectable growth hormone. 2. The importance of supplemental calcium in the diet. 3. The importance of increasing iodine in the diet. 4. How to administer subcutaneous insulin.

2. The importance of supplemental calcium in the diet. The parathyroid is responsible for calcium reabsorption; therefore, supplemental calcium in the diet is the important point to be discussed in patient teaching.

The nurse is taking care of a 10-year-old diagnosed with Graves disease. Which could the nurse expect this child to have recently had? 1. Weight gain, excessive thirst, and excessive hunger. 2. Weight loss, difficulty sleeping, and heat sensitivity. 3. Weight gain, lethargy, and goiter. 4. Weight loss, poor skin turgor, and constipation.

2. Weight loss, difficulty sleeping, and heat sensitivity. Weight loss, increased activity, and heat intolerance can be expected when the thyroid gland is hyperfunctional.

An adolescent woke up complaining of intense pain and swelling of the scrotal area and abdominal pain. He has vomited twice. Which should the nurse suggest? 1. Encourage him to drink clear liquids until the vomiting subsides; if he gets worse, bring him to the emergency room. 2. Bring him to the health-care provider 's office for evaluation. 3. Take him to the emergency department immediately. 4. Encourage him to rest; apply ice to the scrotal area and go to the emergency department if the pain does not improve.

3. Take him to the emergency department immediately. The child is having symptoms of testicular torsion, which is a surgical emergency and needs immediate attention.

What key information should be explained to the family of a 3-year-old who has short stature and abnormal laboratory test results? 1. Because of the diurnal rhythm of the body, growth hormone levels are elevated following the onset of sleep. 2. Exercise can stimulate growth hormone secretion. 3. The initial screening tests need to be repeated for accuracy. 4. Growth hormone levels in children are so low that stimulation testing must be done.

4. Growth hormone levels in children are so low that stimulation testing must be done. The need for additional testing requires explanation. The abnormal IGF-1 and insulin-like growth factor binding protein require a definitive diagnosis when the levels are either abnormally high or low. Very young children do not secrete adequate levels of growth hormone to measure accurately and thus require challenge/stimulation testing.

A 7-year-old is tested for diabetes insipidus (DI). Twenty-four hours after his fluid restriction has begun, the nurse notes that his urine continues to be clear and pale, with a low specific gravity. Which is the most likely reason for this? 1. Twenty-four hours is too early to evaluate effects of fluid restriction. 2. The urine should be concentrated, and it is unlikely the child has DI. 3. The child may have been sneaking fluids and needs closer observation. 4. In DI, fluid restriction does not cause urine concentration.

4. In DI, fluid restriction does not cause urine concentration. Children with DI cannot concentrate urine.