NUR 243 Prep U Ch 26 Nursing Care of the Child With an Alteration in Metabolism/Endocrine Disorder
After explaining the causes of hypothyroidism to the parents of a newly diagnosed infant, the nurse should recognize that further education is needed when the parents ask which question?
"So, hypothyroidism can be treated by exposing our baby to a special light, right?"
A nurse is teaching an adolescent with type 1 diabetes about the disease. Which instruction by the nurse about how to prevent hypoglycemia would be most appropriate for the adolescent?
"Carry crackers or fruit to eat before or during periods of increased activity."
The nurse is teaching glucose monitoring and insulin administration to a child with type 1 diabetes and the parents. Which comment by a parent demonstrates a need for additional teaching?
"During exercise we should wait to check blood sugars until after our child completes the activity."
A pediatric client has just been diagnosed with diabetes insipidus. What is the primary consideration for this client?
fluid replacement
During a visit to the clinic, the adolescent client with hypothyroidism tells the nurse that she takes her levothyroxine "whenever I think about it...sometimes I miss a dose, but not very often." What is the best response by the nurse?
"I know it's hard to remember medicines, but it is really important for you to take it before breakfast each day to control your hypothyroidism." Explanation: Levothyroxine is a thyroid hormone replacement used to treat hypothyroidism. It is important to maintain a consistent thyroid hormone level by taking the medication at the same time each day (preferably 30 minutes prior to breakfast for best absorption). Toxicity can occur if the dose is doubled.
A nurse is reinforcing the diagnosis of constitutional delay by the health provider to a 13-year-old male adolescent. Which is the best approach for this teen?
"You will not need medication because your hormone levels are normal. I would be glad to discuss these findings with you."
The nurse is teaching the parents of an infant newly diagnosed with congenital hypothyroidism about the etiology of the disease. Which information would the nurse likely include? Select all that apply.
-Due to an absent or nonfunctioning thyroid gland -Role of environmental factors -More common in infant girls
Which findings should the nurse expect to assess when completing the health history of a child admitted for possible type 2 diabetes? Select all that apply.
-Polyuria -Polydipsia -Polyphagia
Diabetes insipidus is a disorder of the posterior pituitary that results in deficient secretion of which hormone?
ADH
The school nurse notes that a child diagnosed with diabetes mellitus is experiencing an insulin reaction and is unable to eat or drink. Which action would be the most appropriate for the school nurse to take?
Administer subcutaneous glucagon.
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 Explanation: The treatment for hypothyroidism is oral administration of synthetic thyroid hormone or sodium levothyroxine. A small dose is given at first, and then the dose is gradually increased to therapeutic levels. The child needs to continue taking the synthetic thyroid hormone indefinitely to supplement that which the thyroid does not make.
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?
Antidiuretic hormone
The nurse working with the child diagnosed with type 2 diabetes recognizes the disorder can be managed by:
taking oral hypoglycemic agents
A pediatric client has just been diagnosed with diabetes. What would the nurse do first?
Check blood glucose levels. Explanation: The nurse must check the insulin level before it can be administered. Once a need is established, then insulin administration becomes the priority intervention. Stress management, glucose checks, and nutritional consultation can all be implemented once therapy with insulin begins
The nurse is examining a child with hypoparathyroidism. The nurse would expect to assess which signs and symptoms? Select all that apply.
Chvostek sign Trousseau sign
A 15-year-old girl is brought to the clinic by her mother because the girl has been experiencing irregular and sporadic menstrual periods and excessive body hair growth. Polycystic ovary syndrome is suspected. Which additional assessment finding would help to support this suspicion?
Darkened pigmentation around the neck area
The nurse working on a pediatric floor understands the importance of diagnosing inborn errors of metabolism early. A child with a suspected problem must have blood urea nitrogen (BUN) and creatinine testing done. Which is the purpose of these two tests?
Evaluate renal function
A nurse caring for a child with Graves disease is administering propylthiouracil (PTU). The child has been on this drug for a few weeks and now has sudden symptoms of a sore throat. What is the priority intervention for the nurse?
Hold the dose and call the health care provider.
The nurse is interviewing the caregivers of a child admitted with a diagnosis of type 1 diabetes mellitus. The caregiver states, "She is hungry all the time and eats everything, but she is losing weight." The caregiver's statement indicates the child most likely has:
Polyphagia Explanation: Symptoms of type 1 diabetes mellitus include polyphagia (increased hunger and food consumption), polyuria (dramatic increase in urinary output, probably with enuresis) and polydipsia (increased thirst).
A 12-year-old boy arrives at the emergency room experiencing nausea, vomiting, headache, and seizures. He is diagnosed with bacterial meningitis. Other findings include a decrease in urine production, hyponatremia, and water intoxication. Which pituitary gland disorder would be most associated with these symptoms?
Syndrome of inappropriate antidiuretic hormone
A school-age child is diagnosed as having Cushing syndrome from long-term therapy with oral prednisone. What assessment finding is consistent with this child's diagnosis and treatment?
There are purple striae on the abdomen
The nurse is preparing teaching materials for a family whose child is prescribed somatropin for a growth hormone deficiency. What should the nurse instruct the parents about the administration of this medication?
This medication must be given by injection.
A 6-year-old boy has a moon-face, stocky appearance but with thin arms and legs. His cheeks are unusually ruddy. He is diagnosed with Cushing syndrome. What is the most likely cause of this condition in this child?
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?
Type 1 diabetes mellitus
When would the nurse screen newborns for inborn errors of metabolism?
before discharge and preferably between 24 and 72 hours of birth
After teaching a group of students about endocrine disorders, the instructor determines that the teaching was successful when the students identify insulin deficiency, increased levels of counterregulatory hormones, and dehydration as the primary cause of which condition?
diabetic ketoacidosis Explanation: Insulin deficiency, in association with increased levels of counterregulatory hormones (glucagon, growth hormone, cortisol, catecholamines) and dehydration, is the primary cause of diabetic ketoacidosis, a life-threatening form of metabolic acidosis that is a frequent complication of diabetes. -The liver converts triglycerides (lipolysis) to fatty acids, which in turn change to ketone bodies. -The accumulation and excretion of ketone bodies by the kidneys is called ketonuria. -Glucosuria is glucose that is spilled into the urine
A child is diagnosed with hyperthyroidism. What finding would the nurse expect to assess?
heat intolerance. -Hyperthyroidism is manifested by heat intolerance, nervousness or anxiety, diarrhea, weight loss, and smooth velvety skin. -Constipation, weight gain, and facial edema are associated with hypothyroidism
A nurse is taking care of an infant with diabetes insipidus. Which assessment data are most important for the nurse to monitor while the infant has a prescription for fluid restriction?
urine output
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?
"Her body doesn't have any insulin." Explanation: Type 1 diabetes mellitus (DM) is a disorder in which the child's body has a deficiency of insulin; children with type 1 DM cannot produce insulin. Type 2 DM is controlled through diet, medicine, and exercise. Type 2 DM can be prevented through diet and exercise, but type 1 DM cannot.
The nurse is caring for a child recently diagnosed with growth hormone deficiency. After providing education regarding this disorder, which statement by the parent demonstrates a need for further teaching?
"If growth hormone therapy is used, it will continue for the rest of my child's life."
A child and her parents are being seen in the office after discharge from the hospital with a new diagnosis of type 2 diabetes. Which statement by the nurse is true?
"Kids can usually be managed with an oral agent, meal planning, and exercise."
The nurse is teaching a group of caregivers of children diagnosed with diabetes. The nurse is explaining insulin shock and the caregivers make the following statements. Which statement indicates the best understanding of a reason an insulin reaction might occur?
"My child measures their own medication but sometimes doesn't administer the correct amount."
The nurse is educating the parents of a client newly diagnosed with type 1 diabetes. Which statement by the parents indicates additional teaching is needed?
"Our child should not participate in sports or physical activity."
A 10-year-old child has been diagnosed with type 1 diabetes. The child is curious about the cause of the disease and asks the nurse to explain it. Which explanation will the nurse provide?
"Special cells in a part of your body called the pancreas cannot make a chemical called insulin, which helps control the sugar level in your blood."
The nurse is teaching parents about the pattern of heredity of metabolic conditions. The nurse realizes that further teaching is needed when the parent makes which statement?
"The pattern of heredity for all metabolic conditions is dominant."
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?
"When they get my son's thyroid levels normal, he won't be so tired."
The nurse is preparing to administer the child's ordered lispro (Humalog) insulin at 0800. When will the child's blood glucose level begin to decline?
0815
A nurse is reviewing the blood sugar test results of a child diagnosed with type 1 diabetes: Before meal: 84 mg/dL (4.66 mmol/l) 1 hour after meal: 160 mg/dL (8.88 mmol/l) 2 hours after meal: 180 mg/dL (9.99 mmol/l) Middle of the night: 92 mg/dL (5.11 mmol/l) Which result would lead the nurse to notify the health care provider?
2 hours after meal
When collecting data on a child diagnosed with diabetes mellitus, the nurse notes that the child has had weight loss and other symptoms of the disease. The nurse would anticipate which finding in the child's fasting glucose levels?
220 mg/dl Explanation: A fasting blood sugar result of 200 mg/dL or more almost certainly is diagnostic for diabetes when other signs, such as polyuria and weight loss despite polyphagia, are present.
A newborn exhibits significant jittery movements, convulsions, and apnea. Hypoparathyroidism is suspected. What would the nurse expect to be administered?
Calcium gluconate Explanation: Intravenous calcium gluconate is used to treat acute or severe tetany. -Hydrocortisone is used to treat congenital adrenal hyperplasia and Addison disease. -Desmopressin is used to control diabetes insipidus. -Levothyroxine is a thyroid hormone replacement used to treat hypothyroidism
A child has been prescribed 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?
Desmopressin acetate is a synthetic antidiuretic hormone that will slow down your urine output. Explanation: Desmopressin acetate is a synthetic antidiuretic hormone that promotes reabsorption of water by action on renal tubules; it is used to control diabetes insipidus by decreasing the amount of urine produced
The nurse is seeing a new client in the clinic who reports polyuria and polydipsia. These conditions are indicative of which endocrine disorder?
Diabetes insipidus (DI)
An adolescent is having an annual physical. The adolescent has a documented weight loss of 9 lb (4.08 kg). The parent states, "He eats constantly." Exam findings are normal overall, except that the child reports having trouble sleeping, and the child's eyeballs are noted to bulge slightly. Which interventions would the nurse perform based on these findings?
Discuss preparing for a thyroid function test
A newborn is discovered to have congenital adrenogenital hyperplasia. What will the nurse most likely observe when assessing this client?
Enlarged clitoris
A pediatric nurse is discharging a 1-month-old infant. The infant was diagnosed with congenital hypothyroidism on this admission and will be treated with levothyroxine. The nurse knows it is important to teach the parent about medication administration. Which process will the nurse include in the teaching?
Give the crushed medication in a syringe mixed with a small amount of formula. Explanation: The medication should be mixed in a small amount of food to make sure the infant receives the whole dose.
A 12-year-old is being seen in the office and has hyperthyroidism; the nurse knows that the most common cause of hyperthyroidism is:
Graves disease Explanation: Hyperthyroidism occurs less often in children than hypothyroidism. Graves disease, the most common cause of hyperthyroidism in children, occurs in 1 in 5,000 children between 11 and 15 years of age. Hyperthyroidism occurs more often in females, and the peak incidence occurs during adolescence
The caregivers of a child just diagnosed with diabetes express concern that they won't remember the different signs and symptoms of hyperglycemia and hypoglycemia. As a result, they are afraid they won't handle an emergency correctly. What is the best initial response by the nurse to help ensure the child's safety?
Instruct them to treat the reaction as if it's hypoglycemia, which is more likely.
Rank the different types of insulin based on their duration of action beginning with the shortest to the longest duration.
Lispro Humulin R Humulin N Lantus
Which results would indicate to the nurse the possibility that a neonate has congenital hypothyroidism
Low T4 level and high TSH level Explanation: Screening results that show a low T4 level and a high TSH level indicate congenital hypothyroidism and the need for further tests to determine the cause of the disease.
The nurse is caring for a 4-year-old boy during a growth hormone stimulation test. Which task is priority in the care of this child?
Monitoring blood glucose levels
A 7-year-old child who has type 1 diabetes mellitus is at school reporting a headache and dizziness. The school nurse notices sweat on the child's face. What should the nurse do first?
Offer the child 8 ounces of juice or soda Explanation: These are symptoms of hypoglycemia. Glucagon is given only for severe hypoglycemia. Juice or soda is the best choice to get the child an immediate source of carbohydrates.
A nurse is teaching a child with type 1 diabetes mellitus how to self-inject insulin. Which method should she recommend to the child for regular doses?
Subcutaneously in the outer thigh Explanation: Insulin is always injected SC except in emergencies, when half the required dose may be given IV. SC tissue injection sites used most frequently in children include those of the upper outer arms and the outer aspects of the thighs. The abdominal SC tissue injection sites commonly used in adults can be adequate sites but most children dislike this site as abdominal skin is tender
The nurse is caring for a child who is scheduled for bone scan. It is suspected that the child has a growth hormone deficiency. Which finding would support this medical diagnosis?
The bone scan would show bone age to be two or more deviations below normal
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.
A nurse should recognize that which laboratory result would be most consistent with a diagnosis of diabetes mellitus?
a fasting blood glucose greater than 126 mg/dl
In a child with diabetes insipidus, which characteristic would most likely be present in the child's health history?
abrupt onset of polyuria, nocturia, and polydipsia Explanation: Diabetes insipidus is characterized by deficient secretion of antidiuretic hormone leading to diuresis. Most children with this disorder experience an abrupt onset of symptoms, including polyuria, nocturia, and polydipsia.
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
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. Explanation: Drawing up the short-acting insulin first prevents mixing a long-acting form into the vial of short-acting insulin. This maintains the short-acting insulin for an emergency. Insulin is given subcutaneously not intramuscularly. A SQ injection is administered at a 90-degree angle if the person can grasp 2 in (5 cm) of skin. If only 1 in (2.5 cm) of skin can be grasped, then the injection should be given at a 45 degree angle
A child is diagnosed with hypoparathyroidism. Which electrolyte imbalance would the nurse most likely expect to address?
hypocalcemia
The nurse is interpreting the negative feedback system that controls endocrine function. What secretion will the nurse correlate as decreasing while blood glucose levels decrease?
insulin
The nurse is caring for a child recently diagnosed with hypoparathyroidism disorder. Which medication would the nurse expect to be ordered?
oral calcium
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
The nurse is assessing a 4-year-old girl with ambiguous genitalia. Which finding suggests congenital adrenal hyperplasia?
pubic hair and hirsutism Explanation: Pubic hair and hirsutism in a preschooler indicate congenital adrenal hyperplasia. -Irregular heartbeat on auscultation and pain due to constipation on palpation may be signs of hyperparathyroidism. -Hyperpigmentation of the skin suggests Addison disease.
The nurse is assessing a 5-year-old child whose parent reports the child has been vomiting lately, has no appetite, and has had an extreme thirst. Laboratory work for diabetes is being completed. Which symptom would differentiate between type 1 diabetes from type 2 diabetes?
recent weight loss
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 150 mg/dl. How soon should the nurse ensure that the client eats breakfast after receiving insulin?
within 15 to 30 minutes Explanation: Humalog is a rapid-acting insulin. The onset of Humalog insulin is within 15 minutes and the peak level is achieved within 30 to 90 minutes; therefore, the client should eat within 15 to 30 minutes to avoid a hypoglycemic reaction
A nurse is teaching the parents of a child with phenylketonuria about appropriate nutrition. The nurse determines that the teaching was successful when the parents state which food(s) as appropriate for their child to have? Select all that apply.
-potatoes -apples -spinach
The primary health care provider has ordered a thyroid scan to confirm the diagnosis of hyperthyroidism. Which would the nurse do before the scan?
Assess the client for allergies.
The nurse is caring for a newborn with 21-OH enzyme deficiency congenital adrenal hyperplasia (CAH). The nurse identifies one goal of the plan of care as being the understanding of the importance of maintaining hormone supplementation. Which outcome criteron demonstrates this goal has been met?
During follow-up visits the child demonstrates normal growth and development.
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.
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?
8.5%
The nurse knows that which condition is caused by excessive levels of circulating cortisol?
Cushing syndrome Explanation: -Cushing syndrome is a characteristic cluster of signs and symptoms resulting from excessive levels of circulating cortisol. -Addison disease is caused by autoimmune destruction of the adrenal cortex, which results in dysfunction of steroidogenesis. -Graves disease is the most common form of hyperthyroidism. -Turner syndrome is the deletion of the entire X chromosome.
