PrepU Activity Chapter 48

A child who has a history of adrenal gland insufficiency has had cold/flu-like symptoms and has stayed home from school. The mom calls the nurse line at the doctor's office to ask what she should do. Which nursing action should the nurse advise the mother to take first?

"Give your reserve dose of cortisol, and bring your child straight to the office." Infections and cold or flu symptoms could be life threatening to a child with adrenal insufficiency. All families should keep a reserve dose of cortisol for emergencies. The first advice should be to give this dose and see a doctor immediately. An extra dose of cortisol will not harm the child.

A 3-day-old male infant is newly diagnosed with Tay-Sachs disease. The nurse reviews information about the disease process with the parents after the doctor has met with the family. Which statement by the parents demonstrates that the nurse has reviewed the disease process with the parents effectively?

"He will have normal development for about 6 months before developmental delays develop." Tay-Sachs disease is an autosomal recessively inherited disorder in which the infant lacks hexosaminidase A (an enzyme for lipid metabolism). Therefore, lipid deposits on nerves in the brain and in ocular areas cause cognitive delays and blindness. This is progressive, and the life expectancy is 3 to 5 years. This condition is seen most often in the Ashekenazi Jewish population (central and Eastern European descent). No diet, exercise, or cure is known.

The nurse is giving medication education to the parent of a child with newly diagnosed growth hormone deficiency. Which statement made by the parent indicates that further education is needed?

"I will give the subcutaneous medication every morning." Growth hormone is given subcutaneously every night until the child's growth is complete. The child's growth plates in the bones will eventually close during puberty, and the growth hormone will no longer be effective. The other answers indicate understanding about the medication.

The nurse is teaching the mother of a child with phenylketonuria (PKU) about diet and realizes the mother needs further instruction when she makes which statement?

"Lots of fish and meat will help him." Clients with PKU need to avoid high-protein foods including meats, fish, poultry, eggs, cheese, milk, nuts, beans, peas, and flour. The food exchange list includes vegetables, fruits, breads, cereals, fats, and miscellaneous "free foods" allowed on the diet.

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." Insulin reaction (insulin shock, hypoglycemia) is caused by insulin overload, resulting in too-rapid metabolism of the body's glucose. This may be attributable to a change in the body's requirement, carelessness in diet (such as failure to eat proper amounts of food), an error in insulin measurement, or excessive exercise.

A newborn has just been diagnosed with phenylketonuria (PKU). The physician and nurse have taught the parents about the defect. What statement by the parents demonstrates a need for further instruction?

"Nothing can be done medically to manage this condition." Untreated PKU can result in severe damage to the central nervous system. With dietary treatment, the prognosis is good, which is what needs to be reinforced to the parents. Appropriate intervention can prevent irreparable damage. The other statements are true concerning the disease.

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." When providing instruction to a child, the nurse must consider the developmental age. Type 1 diabetes is a disorder that involves an absolute or relative deficiency of insulin, thus the blood glucose level remains high if an appropriate amount of insulin is not administered to the client. With type 2 diabetes, the body produces an adequate amount of insulin; however, the body is resistant to using the insulin properly to keep circulating blood glucose levels at a normal level. The rest of the statements provide incorrect information regarding the pathophysiology of type 1 diabetes.

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 pattern of heredity for many metabolic conditions is recessive. The statement that all are dominant conditions is false, because some conditions may be caused by a dominant gene. Not all metabolic conditions are evident during the neonatal period. Some manifest themselves in early childhood.

The nurse is taking a history on a 10-year-old child who has a diagnosis of hypopituitarism. Which question is important for the nurse to ask the parents?

"What time each day does your child take his growth hormone?" It is important for the nurse to know the time of day that the child takes his or her growth hormone. Growth hormone is the common treatment for the child with hypopituitarism who is short, not tall, in stature. Vasopressin is the treatment for diabetes insipidus. Monitoring blood glucose is not part of the treatment for hypopituitarism.

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 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.

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. If the child having an insulin reaction cannot take a sugar source orally, glucagon should be administered subcutaneously to bring about a prompt increase in the blood glucose level. This treatment prevents the long delay while waiting for a physician to administer IV glucose or for an ambulance to reach the child.

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 Diabetes insipidus results from a deficiency in the secretion of antidiuretic hormone (ADH). This hormone, also known as vasopressin, is produced in the hypothalamus and stored in the pituitary gland. Hypopituitarism or dwarfism involves a growth hormone deficiency. Diabetes mellitus involves a disruption in insulin secretion. Thyroxine is a thyroid hormone that if deficient leads to hypothyroidism.

A newborn exhibits significant jittery movements, convulsions, and apnea. Hypoparathyroidism is suspected. What would the nurse expect to be administered?

Calcium gluconate 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.

The nurse knows that which condition is caused by excessive levels of circulating cortisol?

Cushing syndrome 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. Reference:

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 Acanthosis nigricans (darkened, thickened pigmentation, particularly around the neck or in the axillary region) is associated with polycystic ovary syndrome. Serum levels of free testosterone typically are elevated with polycystic ovary syndrome. With polycystic ovary syndrome, body mass index indicates overweight or obesity. Short stature typically is associated with growth hormone deficiency.

A child is prescribed glargine insulin. What information would the nurse include when teaching the child and parents about this insulin?

Do not mix this insulin with other insulins. Glargine is not to be mixed with other insulins. Glargine is usually given in a single dose at bedtime. Insulin should be kept at room temperature; insulin that is administered cold may increase discomfort with the injection. Any vial of insulin that is opened should be discarded after 1 month.

A nurse is reviewing with an 8-year-old how to self-administer insulin. Which of the following is the proper injection technique for insulin injections?

Elevate the subcutaneous tissue before the injection. Insulin injections are always given subcutaneously. Elevating the skin tissue prevents injection into muscles when subcutaneous injections are given. The needle bevel should face upward. The skin is spread in intramuscular, not subcutaneous, injections. It is no longer recommended to aspirate blood for subcutaneous injections.

From which pair of metabolic disorders must the nurse instruct the parents to eliminate breast and cow's milk from the diet?

Galactosemia and phenylketonuria Both phenylketonuria and galactosemia are hereditary disorders in which the body cannot have milk. Maple syrup urine disease is an inborn error of metabolism of the branched chain amino acid. Congenital hypothyroidism is an error with the thyroid gland.

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 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.

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 group of nursing students are reviewing the components of the endocrine system. The students demonstrate understanding of the review when they identify what as the primary function of this system?

Hormonal secretion The endocrine system consists of various glands, tissues, or clusters of cells that produce and release hormones. Hormones are chemical messengers that stimulate and/or regulate the actions of other tissues, organs, or endocrine glands that have specific receptors to a hormone. Along with the nervous system, the endocrine milieu influences all physiologic effects such as growth and development, metabolic processes related to fluid and electrolyte balance and energy production, sexual maturation and reproduction, and the body's response to stress. The release patterns of the hormones vary, but the level in the body is maintained within specified limits to preserve health.

The child was recently diagnosed with type 1 diabetes. The nurse is preparing to teach the child and their parents about the insulin therapy the health care provider has prescribed. What should the nurse ensure is included in this training?

It is normal for the growing child to require an increase in insulin; this does not mean their condition is getting worse. Children show a decreased need for insulin shortly after glucose control has been established, which is referred to by some as the "honeymoon phase" and should be described to parents so that they do not get any false hope that the child does not need insulin. As children grow, they will require increased doses of insulin to maintain glucose control, and not all children need to receive two types of insulin. Insulin treatment should be based on each individual child.

The nurse is caring for a child diagnosed with low functioning parathyroid. Which is a treatment goal of a child with hypoparathyroidism?

Maintain the child's calcium level at a normal level with calcium replacement as prescribed Hypoparathyroidism will manifest as a low calcium level, so the nurse would expect the provider to provide a prescription to maintain the calcium level within normal range. Glucose is not a concern with parathyroid function. A referral would be made to a pediatric endocrinologist, not a gastrointestinal specialist. Phosphorus and calcium have an inverse proportion, so the nurse would recommend a low-phosphorus diet.

A group of students are reviewing information about oral diabetic agents. The students demonstrate understanding of these agents when they identify which agent as reducing glucose production from the liver?

Metformin Metformin, a biguanide, reduces glucose production from the liver. Glipizide, glyburide, and nateglinide all stimulate insulin secretion by increasing the response of β cells to glucose. Reference:

The nurse is assessing a 5-year-old boy who has had several convulsions. The nurse continues to assess the child and suspects that he may have hypoparathyroidism. What evidence would support this suspicion?

Observation reveals tetany. Tetany occurs in children with hypoparathyroidism due to decreased serum calcium levels. Sleepiness and lack of responsiveness would suggest hyperthyroidism. Exophthalmos is associated with hyperthyroidism. Irregular heart rate is associated with hyperthyroidism.

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 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). Pica is eating nonfood substances.

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. Abrupt onset of symptoms Marked weight loss Polyuria Polydipsia Polyphagia

Polyuria Polydipsia Polyphagia Type 2 diabetes mellitus is characterized by a gradual onset and is most often associated with obesity and not marked weight loss. Type 1 diabetes is most often abrupt and associated with marked weight loss. Polyuria, polydipsia, and polyphagia are frequent assessment findings in both types of diabetes mellitus.

A child who has type 1 diabetes mellitus is brought to the emergency department and diagnosed with diabetic ketoacidosis. What treatment would the nurse expect to administer?

Regular insulin Insulin for diabetic ketoacidosis is given intravenously. Only regular insulin can be administered by this route.

A child is receiving desmopressin (DDAVP) for the treatment of central diabetes insipidus. The child sneezes immediately after receiving the morning dose. Which is the best action made by the nurse?

Repeat the full dose immediately. If a dose of desmopressin (DDAVP) is sneezed out of the child's nose immediately after giving the medication, the full dose may be repeated immediately.

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

Subcutaneously in the outer thigh

A 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. Graves disease is defined as an overproduction of thyroid hormones. Propylthiouracil is used to suppress thyroid function. A complication of Graves disease is leukopenia. Reference:

The nurse is assessing an 8-year-old boy who is performing academically at a second-grade level. The mother reports that the boy states feeling weak and tired and has had a weight increase of 6 pounds (13.2 kg) in 3 months. Which additional data would fit with a possible diagnosis of hypothyroidism?

The child states that the exam room is cold. Cold intolerance, manifested by the fact that the child was uncomfortably cold in the exam room, is a sign of hypothyroidism. Delayed dentition, with only two of the four 6-year molars having erupted, is typical of growth hormone deficiency. Complaints of thirst may signal diabetes or diabetes insipidus. A rash can be varied disease processes but is not characteristic in hypothyroidism.

The nurse is working in the labor and delivery area with a laboring parent who is a genetic carrier for galactosemia. Following birth, which change in the plan of care occurs until it is confirmed that the neonate does not have galactosemia?

The neonate will be given a soy-based formula. Galactosemia is a rare autosomal recessive disorder that is an inborn error of carbohydrate metabolism. The enzyme galactose-1-phosphate uridyltransferase is missing, and this prevents galactose from being changed to glucose. Galactose builds up in the bloodstream, possibly causing cataracts, liver failure, and renal tube problems. Treatment consists of removing all lactose-containing foods, including breast milk. Soy protein is the preferred formula diet. Skin-to-skin contact is encouraged after birth. Glucose water may or may not be offered. Phototherapy is only initiated if and when it is needed.

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 Signs and symptoms of type 1 diabetes mellitus include polyuria, polydipsia, polyphagia, enuresis, and weight loss.

What finding would the nurse expect to assess in a child with hypothyroidism?

Weight gain Hypothyroidism is manifested by weight gain, fatigue, cold intolerance, and dry skin. Nervousness, heat intolerance, and smooth velvety skin are associated with hyperthyroidism.

An adolescent is found wandering around. The client is confused, sweaty, and pale. Which test will the nurse prepare to perform first?

blood glucose level It is important to determine a blood glucose level on the adolescent because the adolescent is exhibiting signs of hypoglycemia and needs to be treated quickly. Serum ketone testing would be indicated if the adolescent were exhibiting symptoms of hyperglycemia. A computed tomography scan or toxicology test may be needed if the adolescent's glucose level were within normal range.

A pediatric client has just been diagnosed with diabetes insipidus. What is the primary consideration for this client?

fluid replacement Children with diabetes insipidus lose tremendous amounts of fluid, so fluid replacement is the priority consideration for this client. Excessive fluid loss can lead to seizures and death. Headache and polydipsia can be relieved with fluid replacement. Children will requirement a nutritional consultation for weight loss, but it is not the main consideration.

The neonatal nurse is caring for children with inborn errors of metabolism. Which treatment is recommended for these conditions?

replacing deficient enzymes through intravenous administration Prompt treatment for metabolic disorders may include replacing deficient enzymes through intravenous administration. Other interventions are decreasing substrates preceding the enzymatic block (e.g., avoiding a particular amino acid or carbohydrate), administering a supplement of the deficient product that should have been produced, providing an enzymatic cofactor, using medications to remove accumulated substrates, undergoing liver or bone marrow transplantation to eliminate all deficient enzymes, and providing somatic gene therapy (a future option).

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." 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. Resistance to insulin is not the primary factor in type 1 DM.

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." The nurse would provide additional education if the parents state the child should not participate in sports or physical activity. The child with diabetes can, and should, be physically active to maintain proper health and facilitate efficient insulin usage by the body. Glucose levels should be checked more frequently during times of sickness, as well as assessing the urine for ketones. Consistency of intake can help prevent complications and maintain near-normal blood glucose levels. The parents and child should know how to identify foods to adequately monitor the child's nutritional intake. A dietitian with expertise in diabetes education should be consulted for referral as needed.

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

"Please take your child straight to the emergency department." A side effect of antithyroid medications is leukopenia. Signs and symptoms that include fever and sore throat need to be seen immediately. These instructions should be reviewed with parents upon discharge. The question includes information about Graves disease, so ibuprofen would not be the treatment. The question centers around drug therapy, not the child's fluid status.

A woman in her first trimester of pregnancy has just been diagnosed with acquired hypothyroidism. The nurse is alarmed because this condition can lead to which pregnancy complication?

Decreased cognitive development of the fetus If acquired hypothyroidism exists in a woman during pregnancy, her infant can be born intellectually disabled, because there was not enough iodine present for fetal growth. It is important, therefore, that girls with this syndrome be identified before they reach childbearing age.

The nurse is developing a plan of care for a 7-year-old boy with diabetes insipidus. What is the priority nursing diagnosis?

Deficient fluid volume related to dehydration The priority nursing diagnosis most likely would be deficient fluid volume related to dehydration, due to a deficiency in the secretion of antidiuretic hormone (ADH). Excess fluid would result from a disorder that leads to water retention, such as syndrome of inappropriate antidiuretic hormone (SIADH). Deficient knowledge related to fluid intake regimen is a nursing diagnosis for this child, but a secondary one. Imbalanced nutrition, more than body requirements related to excess weight would be inappropriate for this child since he probably has lost weight secondary to the fluid loss.

A 4-year-old diagnosed with diabetes insipidus is being discharged. Which information below is most important to emphasize to the parents?

Diabetes insipidus is different from diabetes mellitus. Having all caregivers trained in injections ensures that medication will be given and the need to give it to the child will be understood. All children should wear a medical alert tag upon diagnosis. For the caregiver to have a good understanding and provide good management of the child's care, the difference between diabetes insipidus and diabetes mellitus must be established. This is a rare disorder that needs to be closely managed throughout the child's life, and it is not curable.

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. The child exhibits signs and symptoms of Graves disease (hyperthyroidism). A thyroid function test would show an elevation in T4 and T3 levels caused by overfunctioning of the thyroid. Neither a neurology consult nor an eye exam would be needed. A fasting blood glucose test is used to test for Cushing syndrome and diabetes mellitus

A child is brought to the clinic experiencing symptoms of nervousness, tremors, fatigue, increased heart rate and blood pressure. Based on this assessment, the nurse would suspect a diagnosis of which condition?

Graves disease Children who develop Graves disease experience nervousness, tremors, and increased heart rate and blood pressure cause by overstimulation of the thyroid gland. Cushing syndrome, hypertension, and hypothyroidism are not associated with these symptoms. Reference:

The nurse is assessing a 13-year-old boy with type 2 diabetes mellitus. What would the nurse correlate with this disorder

The parents report that their son "can't drink enough water." Unquenchable thirst (polydipsia) is a common finding associated with diabetes mellitus, type 1 and 2. However, reports of flu-like illness and Kussmaul breathing are more commonly associated with type 1 diabetes. Blood pressure is normal with type 1 diabetes and elevated with type 2 diabetes.

An elementary school child takes metformin three times each day. Which disorder would the school nurse expect the child to have?

Type 2 diabetes mellitus Metformin is the common treatment to manage type 2 DM. Insulin, not oral medication, is the treatment of choice for type 1 DM. Metoclopramide is the treatment for GI reflux. Methylprednisolone is used to treat inflammatory bowel disease.

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 An infant with the diagnosis of diabetes insipidus has decreased secretion of antidiuretic hormone (ADH). The infant is at risk for dehydration so monitoring urinary output is the most important intervention. The child's oral intake has been ordered. Monitoring a child who is under fluid restriction includes assessing the oral mucosa; however, urine output is the most important assessment for this patient. Vital signs are part of a basic assessment.

A nurse is reviewing the diagnostic test findings of a client with a metabolic disorder. Which finding is indicative of galactosemia?

galactosuria Laboratory findings indicative of galactosemia include galactosuria, elevated blood galactose level, low glucose level, positive Benedict test of urine, deficiency of G-1-PUT in red and white blood cells and liver cells, and elevated SGPT/SGOT and bilirubin.

The nurse knows that disorders of the pituitary gland depend on the location of the physiologic abnormality. In caring for a child that has issues with the anterior pituitary, the nurse knows that this child has issues with which hormone?

growth hormone Disorders of the pituitary gland depend on the location of the physiologic abnormality. The anterior pituitary, or adenohypophysis, is made up of endocrine glandular tissue and secretes growth hormone (GH), adrenocorticotropic hormone (ACTH), TSH, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin. The posterior lobe is called the neurohypophysis because it is formed of neural tissue. It secretes antidiuretic hormone (ADH; vasopressin) and oxytocin. Usually, several target organs are affected when there is a disorder of the pituitary gland, especially the adenohypophysis.

A nurse is preparing to discharge a neonate diagnosed with maple syrup urine disease. Which nursing instruction is essential for care of the neonate in the home?

reinforcing the need for the prescribed lifelong dietary regimen Family education goals should focus on reinforcing the need for the prescribed dietary regimen, the importance of follow-up appointments, and sick-day management. This is daily information that needs to be understood. Once routine care is understood, then future care can be addressed. As the child grows, the frequency and severity of crisis events decrease, but lifelong dietary management is still required. When the child is ill, protein intake should be reduced, and caloric intake should be increased from 80 to 120 kcal/kg per day to 120 to 140 kcal/kg per day by encouraging consumption of carbohydrate- and fat-containing foods.

A young couple seeks pregnancy counseling in the women's health clinic. They tell the nurse performing a focused health history that they are of Jewish descent and are worried about conceiving a baby with Tay-Sachs disease. No known metabolic disorders exist in the family medical history. What is the nurse's best response to this couple's concerns?

"Carrier testing is warranted for couples who have an elevated risk for Tay-Sachs disease due to their ethnic origin." Prevention, when it is possible, is the first intervention for metabolic disorders, such as Tay-Sachs. For some diseases such as Tay-Sachs disease, mild hyperphenylalaninemia, and Gaucher disease, carrier testing (heterozygote screening) is possible. Carrier testing is warranted for people who may have elevated risk because of their ethnic or national origin. The nurse has an important role in providing genetic counseling to families who are suspected or known carriers of a metabolic disorder.

The nurse is preparing a teaching plan for a 10-year-old girl with hyperthyroidism. What information would the nurse include in the plan?

Explaining about the radioactive iodine procedure Explaining about the radioactive iodine procedure would be part of the teaching plan for a child with hyperthyroidism because this is a less invasive type of therapy for the disorder. Describing surgery to remove an anterior pituitary tumor would be included for a child with hyperpituitarism. Teaching a parent to give injections of growth hormone would be appropriate for a child with a growth hormone deficiency. Showing parents how to give DDAVP intranasally is appropriate for a child with diabetes insipidus.

A child with diabetes reports that he is feeling a little shaky. Further assessment reveals that the child is coherent but with some slight tremors and sweating. A fingerstick blood glucose level is 70 mg/dl. What would the nurse do next?

Give 10 to 15 grams of a simple carbohydrate. The child is experiencing hypoglycemia as evidenced by the assessment findings and blood glucose level. Since the child is coherent, offering the child 10 to 15 grams of a simple carbohydrate would be appropriate. Insulin is not used because the child is hypoglycemic. A complex carbohydrate snack would be used after offering the simple carbohydrate to maintain the glucose level. Intramuscular glucagons would be used if the child was not coherent.

An 8-year-old child is admitted to a medical-surgical unit with a diagnosis of syndrome of inappropriate antidiuretic syndrome (SIADH). The nurse will closely monitor the client's __________ , ___________ , and _________

fluid balance level of consciousness serum sodium An increase of antidiuretic hormone causes the body to hold onto fluid. The nurse should monitor fluid balance closely when caring for a child diagnosed with syndrome of inappropriate antidiuretic syndrome (SIADH).Fluid retention and shifts can cause changes in level of consciousness. The nurse should monitor the child's level of consciousness closely.The increase of antidiuretic hormone causes the body to hold onto fluid, causing dilutional hyponatremia (decreased serum sodium). The nurse should monitor the child's serum sodium level closely. Blood glucose and serum potassium are not affected in syndrome of inappropriate antidiuretic hormone (SIADH).

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

taking oral hypoglycemic agents. Oral hypoglycemic agents, such as metformin, are often effective for controlling blood glucose levels in children diagnosed with type 2 diabetes. Insulin may be used for a child with type 2 diabetes if oral hypoglycemic agents alone are not effective, but "decreasing" the daily insulin would not help treat this disorder. Lifestyle changes such as increased exercise (not conserving energy by resting during the day), and limiting large amounts of carbohydrates are important aspects of treatment for the child.

A child with a suspected endocrine disorder is having a fluid deprivation study performed. Which nursing interventions should be included in the plan of care? Select all that apply. Perform the test as an overnight study. Monitor strict I & O. Assess vital signs every hour. Monitor the child's weight on admission and before discharge. Obtain urine specimens and serum studies as ordered.

Monitor strict I & O. Assess vital signs every hour. Obtain urine specimens and serum studies as ordered. Strict I & O must be monitored to prevent dehydration. Vital signs, especially blood pressure and pulse, should be monitored hourly to detect signs of hypotension or tachycardia. During the tests, urine is monitored for specific gravity and osmolality and serum studies are performed to monitor for sodium, antidiuretic hormone, osmolality, and hematocrit alterations as ordered. A fluid deprivation study should not be performed overnight because it can cause severe dehydration and result in central nervous system damage. The child's weight should be monitored more frequently than on admission and discharge to detect weight loss that may signify too much fluid loss.

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 Cushing syndrome is caused by overproduction of the adrenal hormone cortisol; this usually results from increased ACTH production due to either a pituitary or adrenal cortex tumor. The peak age of occurrence is 6 or 7 years. The overproduction of cortisol results in increased glucose production; this causes fat to accumulate on the cheeks, chin, and trunk, causing a moon-faced, stocky appearance. Cortisol is catabolic, so protein wasting also occurs. This leads to muscle wasting, making the extremities appear thin in contrast to the trunk, and loss of calcium in bones (osteoporosis). Other effects include hyperpigmentation (the child's face is unusually red, especially the cheeks).

The nurse is teaching a child with PKU about his or her special diet during a checkup visit. It would be appropriate to teach the child that he can eat which of the following foods? Select all that apply. a hamburger a milkshake a potato a banana a scrambled egg

a potato a banana PKU (phenylketonuria) is the result of an inherited autosomal recessive trait. The enzyme phenylalanine hydroxylase is missing, and this prevents the breakdown into essential amino acids. Therefore, phenylalanine builds in the bloodstream, causing permanent damage to brain tissue. Foods high in phenylalanine include meats, eggs, and milk. Foods lows in phenylalanine include orange juice, bananas, potatoes, peas, lettuce, and spinach. Lofenalac is used in place of milk products.

A child with a history of diabetes insipidus is admitted with polyuria, polydipsia, and mental confusion. Which is the priority intervention for this child?

check vital signs Central diabetes insipidus is a disorder of the posterior pituitary. The fluid status of the child can be assessed first by assessing the vital signs. The large amounts of fluid loss can cause fluid and electrolyte imbalance that should be corrected. Urine output is important but not the priority. Encouraging fluids will not correct the problem, and weighing the client is not necessary at this time. Diabetes insipidus is managed by decreasing the protein and sodium in the diet and daily replacement of the antidiuretic hormone

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 Feedback is seen in endocrine systems that regulate concentrations of blood components such as glucose. Glucose from the ingested lactose or sucrose is absorbed in the intestine and the level of glucose in blood rises. Elevation of blood glucose concentration stimulates endocrine cells in the pancreas to release insulin. Insulin has the major effect of facilitating entry of glucose into many cells of the body; as a result, blood glucose levels fall. When the level of blood glucose falls sufficiently, the stimulus for insulin release disappears and insulin is no longer secreted. Glycogen is stored in the liver and muscles. It is released to provide energy when the blood glucose levels fall. Glucagon is also produced by the pancreas. Its job is to force the liver to release stored insulin when the body has a need for more insulin. The adrenocorticotropic hormone is produced by the anterior pituitary. Its function is to regulate cortisol. This is needed so the adrenal glands can function properly. It also helps the body respond to stress

A 12-year-old client arrives at the emergency room experiencing nausea, vomiting, headache, and seizures. The client is diagnosed with bacterial meningitis. Other findings include a decrease in urine production, hyponatremia, and water intoxication. Which pituitary gland disorder is most associated with these symptoms?

syndrome of inappropriate antidiuretic hormone (SIADH) Syndrome of inappropriate antidiuretic hormone (SIADH) is a rare condition in which there is overproduction of antidiuretic hormone by the posterior pituitary gland. This results in a decrease in urine production and water intoxication. As sodium levels fall in proportion to water, the child develops hyponatremia or a lowered sodium plasma level. It can be caused by central nervous system infections such as bacterial meningitis. As the hyponatremia grows more severe, coma or seizures occur from brain edema. Diabetes insipidus is characterized by polyuria, not decreased urine production. Hyposecretion of somatotropin (growth hormone) results in undergrowth; hypersecretion results in overgrowth.

The obstetric nurse performs a focused health history on the family of a primigravid client. The father of the fetus tells the nurse that the family comes from Ashkenazi Jewish ancestry and is very concerned about the possibility of Tay-Sachs disease. The father asks, "What is the soonest that we will know if my child has this disease." The nurse will state which time frame?

during pregnancy via amniocentesis It is important to answer the questions of the family and provide definitive answers of when health care providers can first identify if a child has Tay-Sachs disease. Tay-Sachs disease, Gaucher disease, and Niemann-Pick disease occur more frequently among individuals of Ashkenazi Jewish ancestry. Although Tay-Sachs disease occurs in 1 in 3500 to 4000 births, the carrier rate among people with Ashkenazi Jewish ancestry is 1 in 30. All of the options include when Tay-Sachs can be identified; however, the disorder can be first detected in utero via amniocentesis. By identifying the disease early, the parents do not have to worry throughout the pregnancy or can make plans, if needed, in caring for the child or terminating the pregnancy. Following birth, fetal blood can be tested for hexosaminidase. Due to the build-up of lipids in the system, the infant will begin to become developmentally delayed and even regress in meeting developmental milestones.

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 Weight loss is unique to type 1 diabetes, whereas weight gain is associated with type 2. Hypertension is consistent with type 2 diabetes. Both type 1 and type 2 diabetes cause delayed wound healing. The increase in blood glucose in diabetes causes damage to the inner lining of the arteries that cause the arteries to develop plaque and harden. These damages to the blood vessels result in a decrease in the ability of oxygen-rich blood to be transported effectively to the tissues to promote wound healing. Loose stools or repeated loose stools (diarrhea) is a common side effect of the oral medication metformin, which is prescribed for clients with type 2 diabetes. Insulin, the treatment for type 1 diabetes, has constipation as one of the side effects.