Ricci ch 48

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? "My son's nervousness may be a symptom of his hypothyroidism." "Most people with hypothyroidism have smooth, velvety skin." "Heat intolerance is a caused by low thyroid levels." "When they get my son's thyroid levels normal, he won't be so tired."

"When they get my son's thyroid levels normal, he won't be so tired." Explanation: Tiredness, fatigue, constipation, cold intolerance and weight gain are all symptoms of hypothyroidism. Nervousness, anxiety, heat intolerance, weight loss and smooth velvety skin are all symptoms of hyperthyroidism.

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% 7.0% 6.5% 7.5 %

8.5% Explanation: The goal for hemoglobin A1C in children between the ages of 6 and 12 years is less than 8%. Therefore, a result of 8.5% would indicate that additional intervention is needed to achieve the recommended goal.

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

Antidiuretic hormone Explanation: 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 nurse on the pediatric floor is taking care of a 12-year-old child with diabetes insipidus (DI). Which fact would the nurse understand about this disease? DI can be managed by short-term treatment with hormone replacement medications. DI can be managed with vasopressin given as lifelong treatment. DI requires strict fluid restrictions until it resolves. DI can cause anorexia if appropriate meals are not planned.

DI can be managed with vasopressin given as lifelong treatment. Explanation: Vasopressin is the drug of choice for this lifelong disease. In DI, antidiuretic hormone is undersecreted. Use of vasopressin is long-term, not short-term, treatment. Diabetes mellitus, not diabetes insipidus, is the disorder that requires diet management. DI involves excessive urination, so fluid replacement, not fluid restriction, is needed.

The nurse is seeing a new client in the clinic who reports polyuria and polydipsia. These conditions are indicative of which endocrine disorder? Precocious puberty Syndrome of inappropriate antidiuretic hormone (SIADH) secretion Hypopituitarism Diabetes insipidus (DI)

Diabetes insipidus (DI) Explanation: The most common symptoms of central DI are polyuria (excessive urination) and polydipsia (excessive thirst). Children with DI typically excrete 4 to 15 L per day of urine despite the fluid intake. The onset of these symptoms is usually sudden and abrupt. Ask about repeated trips to the bathroom, nocturia, and enuresis. Other symptoms may include dehydration, fever, weight loss, increased irritability, vomiting, constipation, and, potentially, hypovolemic shock.

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. Polydipsia Polyphagia Polyuria Abrupt onset of symptoms Marked weight loss

Polyuria Polydipsia Polyphagia Explanation: 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 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 needs to be started on an antibiotic drug. The child must be participating in sports. The child may have developed leukopenia. The child may not be taking the medication.

The child may have developed leukopenia. Explanation: Graves disease is defined as an overproduction of thyroid hormones. Propylthiouracil is used to suppress thyroid function. A complication of Graves disease is leukopenia.

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

Tumor of the adrenal cortex Explanation: 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).

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? Vital signs Oral mucosa Oral intake Urine output

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

a fasting blood glucose greater than 126 mg/dl Explanation: A fasting blood glucose greater than 126 mg/dl is diagnostic for diabetes mellitus.

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

cognitive impairment Explanation: A newborn with congenital hypothyroidism is lethargic, hypotonic and irritable. Delayed growth is seen as well as decreased mental responsiveness. The newborn has an enlarged tongue and poor sucking ability. Without treatment with the thyroid hormone, the newborn will develop a cognitive impairment and failure to thrive. Blindness, muscle spasticity and dehydration are not symptoms or complications of the disease.

The nurse caring for a child who has issues with the anterior pituitary gland would expect the child to have issues with which hormone? growth hormone antidiuretic hormone vasopressin oxytocin

growth hormone Explanation: 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), thyroid-stimulating hormone (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 child with growth hormone deficiency is receiving growth hormone. What result would the nurse interpret as indicating effectiveness of this therapy? reports of headaches rapid weight gain growth plate closure height increase of 4 inches

height increase of 4 inches Explanation: Effectiveness of growth hormone therapy is indicated by at least a 3- to 5-inch increase in linear growth in the first year of treatment. Rapid weight gain and headaches are adverse reactions of this therapy. The drug is stopped when the epiphyseal growth plates close.

A child is diagnosed with hypoparathyroidism. Which electrolyte imbalance would the nurse most likely expect to address? hyponatremia hypocalcemia hypomagnesemia hyperkalemia

hypocalcemia Explanation: Hypoparathyroidism results in low production of PTH, which in turn leads to hypocalcemia and hyperphosphatemia.

An 8-year-old child is admitted to a medical-surgical unit with a diagnosis of syndrome of inappropriate antidiuretic syndrome (SIADH). Drag words from the choices below to fill in each blank in the following sentence. The nurse will closely monitor the client's , , and . blood glucose potassium sodium level of consciousness fluid balance

sodium fluid balance level of consciousness 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).

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." "As long as you are missing multiple doses it should be fine. Just as long as you take the levothyroxine at some point each day." "If you forget a dose you can double up the next day. We just want your thyroid level to be maintained since you don't produce enough thyroid hormone." "Maybe you could do something to remind yourself to take the medication on a daily basis."

"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. Suggesting the client "do something" to remember does not highlight the importance of taking it correctly.

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

A simple blood test to diagnose hypothyroidism is required in most states. Explanation: With hypothyroidism there is insufficient production of the thyroid hormones required to meet the body's metabolic as well as growth and developmental needs. Without these hormones, cognitive impairment occurs. Hypothyroidism is diagnosed by a newborn screening procedure. This screening procedure is required by most states. With early diagnosis the condition can be treated by replacing the missing hormones. The later the diagnosis is made, the more irreversible cognitive impairment becomes. At birth, a newborn with hypothyroidism will be a poor feeder. Other symptoms, such as lethargy and hypotonicity, become evident after the first month of life. There are no other outward manifestations, such as rashes or appearances, that can be seen. These are not part of the condition.

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

diabetic ketoacidosis. Explanation: Insulin deficiency, in association with increased levels of counter-regulatory hormones (glucagon, growth hormone, cortisol, catecholamines) and dehydration, is the primary cause of diabetic ketoacidosis (DKA), a life-threatening form of metabolic acidosis that is a frequent complication of diabetes. 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.

Which nursing objective is most important when working with neonates who are suspected of having congenital hypothyroidism? allowing rooming in promoting bonding encouraging fluid intake early identification

early identification Explanation: The most important nursing objective is early identification of the disorder. Nurses caring for neonates must be certain that screening is performed, especially in neonates who are preterm, discharged early, or born at home. Promoting bonding, allowing rooming-in, and encouraging fluid intake are all important but are less important than early identification.