Ward: Ch 27: Caring for the Child With an Endocrinological or Metabolic Condition

A 55-lb (25-kg) child in the hospital has syndrome of inappropriate antidiuretic hormone (SIADH). The nurse calculates the child's 24-hour fluid allowance at what volume?

1,077 mL The child with SAIDH is put on a fluid restriction that typically consists of two-thirds of his or her daily fluid maintenance levels. For the 25-kg child, normal daily fluid maintenance is 1,608 mL. Two-thirds of this volume is 1,061 mL

A child is 4 hours postoperative after a total parathyroidectomy. Which assessment takes priority? A. Airway B. Dressing C. IV site D. Pain

A All assessments listed are important for this child; however, airway is always the priority assessment.

A child is hospitalized with syndrome of inappropriate antidiuretic hormone (SIADH). Which assessment finding indicates a possible complication? A. Crackles in lung bases B. Decreased urine output C. Low serum sodium level D. Nausea and vomiting

A Because of fluid retention, heart failure is a potential complication and would manifest with lung congestion. The nurse would hear rales or crackles in the child's lungs. The other assessment findings are expected in the child with SIADH.

A child has been diagnosed with diabetic ketoacidosis (DKA) and is in the pediatric intensive care unit. Which nursing diagnosis does the nurse direct interventions toward as the priority? A. Fluid volume deficit B. Ineffective breathing patterns C. Knowledge deficit D. Risk for infection

A Because the child with DKA can be severely dehydrated, priority interventions are directed toward the goal of rehydration. Breathing patterns for the child in DKA may consist of Kussmaul respirations, which are actually the body's way of trying to compensate for the acidosis. As the glucose decreases, this will self-correct. Knowledge deficit can be addressed when the child's condition is stable. Risk for infection is always a potential diagnosis, and the nurse ensures proper technique to prevent this from occurring. But because the dehydration is so severe, this takes priority.

A hospitalized child is receiving calcium via a peripheral IV site. Which action by the nurse is most important? A. Assess the IV for blood return hourly. B. Document the infusion and child's response. C. Facilitate the next blood draw for calcium. D. Teach parents and child about the drug.

A Intravenous calcium infusions can cause extravasation if they infiltrate, so the nurse ensures the IV line is patent by checking the site and blood return frequently. The other actions are important as well, but for patient safety, monitoring the IV is the priority.

A child is in the clinic for follow-up after starting recombinant growth hormone for growth hormone deficiency. After obtaining the child's height, which assessment is the priority? A. Blood pressure B. Bowel function C. Respiratory effort D. Urinary osmolality

A One of the side effects of human growth hormone administration is hypertension. The nurse should assess the child's blood pressure. Bowel function, respiratory effort, and urine osmolality are not affected.

A child has hyperthyroidism and is prescribed propranlol (Inderal). The mother states "Why is she taking this? I take Inderal for my blood pressure." Which response by the nurse is the most appropriate? A. Decreases the effects of the hyperthyroidism B. Keeps the child's blood pressure normal C. Prevents the development of thyroid storm D. Because thyroid problems often cause hypertension

A Propranolol is used to decrease the effects of the child's hyperthyroidism. It is not used for blood pressure control or to prevent thyroid storm.

Which information does the nurse provide the teen with type 2 diabetes mellitus regarding exercise? A. Aim for physical activity each day. B. Continue to exercise when sick. C. Exercise with caution, if at all. D. You need strenuous activity.

A The American Diabetes Association has a goal of 30-60 minutes of physical activity a day. When ill, the diabetic should rest. Strenuous activity is not required.

Which organ or gland is directed by the hypothalamus to release adrenocorticotropic hormone (ACTH)? A. Anterior pituitary gland B. Liver C. Pancreas D. Thyroid gland

A The anterior pituitary gland releases ACTH in response to the hypothalamus.

A 5-year-old child is 3 hours postoperative after a total thyroidectomy. The nurse notes hand spasms as the blood pressure cuff is inflated, and the child reports numbness around her lips. After notifying the health-care provider, which action by the nurse takes priority? A. Bring the crash cart to the room. B. Call the laboratory to have blood work drawn. C. Prepare to administer oral vitamin D. D. Raise the head of the child's bed.

A This child is demonstrating manifestations of critical hypocalcemia, a known complication of thyroid surgery. The nurse ensures emergency equipment is available, as the child may progress to laryngospasm and be unable to breathe. Alternatively, the nurse stays with the patient while a coworker brings the crash cart. Blood work will be done but is not the priority. In a child with a potential airway problem developing, oral meds and nutrition are not given. Raising the head of the bed may help with comfort, but it is not the priority.

A child being treated for hyperthyroidism has been admitted following a seizure. Once the child has been stabilized, which action by the nurse is the most appropriate? A. Assess the child for noncompliance. B. Determine child's nutritional intake. C. Refer the family to a social worker. D. Teach the parents how to treat seizures.

A Untreated hyperthyroidism leads to low calcium, high phosphate, and low magnesium levels. Seizures can occur due to these imbalances. The nurse should assess the child and family for noncompliance. The other actions may be appropriate, but this is the priority to prevent further problems from occurring.

A teenager is admitted with Addison's disease. Which laboratory findings does the nurse correlate with this condition? (Select all that apply.) A. Blood glucose: 54 mg/dL B. Potassium: 6.5 mEq/L C. Sodium: 3.9 mEq/L D. Urine culture: negative E. White blood cell count: 5500/mm3

A, B In Addison's disease, the lack of adrenal hormones can cause decreased blood glucose, due to increased sensitivity to insulin, and elevated potassium levels. The other findings are not related.

A nurse is teaching a new diabetic child and family about sick-day management. What information does the nurse plan to include? (Select all that apply.) A. Check blood sugars every 4 hours. B. Hold insulin if the child is vomiting. C. Provide plenty of rest and sleep. D. Offer calorie-containing liquids. E. Try to follow the usual meal plan.

A, C, D, E Sick-day rules are important to prevent diabetic ketoacidosis (DKA). The child should take the normal dose of medication (the liver continues to produce glucose even when not eating) while trying to follow the meal plan. If solids are not tolerated, then offer liquids that contain calories. Check blood sugars every 4 hours while the child is ill, and check ketones with each instance of voiding. Be sure to notify the physician for any concerns.

A hospitalized child has been diagnosed with hyperthyroidism and has a calcium level of 6.8 mg/dL. Which action by the nurse takes priority? A. Administer calcium. B. Apply telemetry. C. Pad the side rails. D. Start an IV.

B All actions are appropriate for this child. However, hypocalcemia can cause fatal cardiac dysrhythmias, and the child needs to be placed on telemetry monitoring so the nurse can assess and intervene immediately if this occurs.

The student studying endocrine disorders learns that which gland controls overall physiologic homeostasis? A. Anterior pituitary B. Hypothalamus C. Parathyroid D. Posterior pituitary

B Although all endocrine glands have a role in homeostasis, the job of the hypothalamus is to communicate the messages of the central autonomic nervous system to the organs/glands of the endocrine system, thus maintaining homeostasis throughout the body.

The nurse is helping a new diabetic child pick breakfast from the menu. Which selection would require the nurse to reinforce dietary teaching for this child? A. Egg, bacon, whole-wheat toast B. Cinnamon roll and juice C. Oatmeal, almonds, artificial sweetener D. Pancakes with sugar-free maple syrup

B Although no food is off limits, the child with diabetes does need to learn the typical diet plan: 40-50% carbohydrates (complex is better than simple), 20-30% fats, and 15-20% protein. The first meal is appropriate. The oatmeal is a carbohydrate, but the nuts give some protein and some fat. The pancakes with sugar-free syrup are alright if the child adds a protein. The cinnamon roll and juice are all simple carbohydrates, and this selection shows the child needs further instruction.

A parent reports that his 7-year-old child is very short compared to his peers, and his teeth came in slowly when he was younger. After searching the Internet the parent is worried about growth hormone deficiency (GHD). Which response by the nurse is the most appropriate? A. "GHD is the only cause of the symptoms you describe." B. "Has your child ever had his thyroid evaluated?" C. "I will refer your child to an endocrinologist right away." D. "What did the dentist say about his teeth being delayed?"

B Although those manifestations do sound like GHD, they could also be indicative of hypothyroidism. The nurse asks if the child's thyroid function has ever been checked. The nurse cannot refer to an endocrinologist without a provider order. Asking about the dentist's opinion may be important, but it is not as specific for the problem as asking about thyroid function testing.

A nursing student asks why the child with hypothyroidism would have high levels of thyroid-stimulating hormone (TSH). Which response by the faculty is the most appropriate? A. "Stimulating-hormone functions are not disrupted by thyroid disorders." B. "The pituitary gland keeps secreting TSH to try to make the thyroid function." C. "TSH exists in an inverse relationship with the other thyroid hormones." D. "Thyroid hormone function is very poorly understood and the reason is not clear."

B Because the levels of thyroid hormone are low, the anterior pituitary gland keeps secreting more and more TSH to try to force the thyroid into producing its hormones. This also clues the provider that the problem is in the thyroid gland itself, not in the brain regulating system. The other answers are not accurate.

A nurse is teaching the parents of a child with growth hormone deficiency about medication administration. Which action charted by the nurse indicates that the goals for teaching have been met? A. Administers growth hormone using correct intramuscular technique B. Administers growth hormone using correct subcutaneous technique C. Demonstrates ability to properly mix growth hormone with liquids D. Rinses inhaler with warm water after each dose is administered

B Growth hormone is administered via subcutaneous injections. It is not given orally, intramuscularly, or by inhalation.

A pediatric dentist refers a child to an endocrinologist because of a concern about the child having so few teeth. Which laboratory testing does the nurse anticipate ordering for the child? A. 24-hour urinalysis for cortisol B. Growth hormone stimulation test C. Serum testosterone D. Water deprivation test

B Growth hormone stimulation testing is often done with insulin or arginine. If the substance used does not stimulate an appropriate amount of growth hormone release, the diagnosis can be made. Measurements of cortisol are done to test adrenal gland function. Testosterone tests are done for sex hormone testing. The water deprivation test is done for diabetes insipidus.

A nurse on an inpatient endocrine unit has received report on a group of four patients. Which patient should the nurse see first? A. Blood glucose of 78 mg/dL, 12-year-old child B. Had Humalog injection and is not eating C. Needs teaching on giving insulin injections D. NPH insulin given, waiting an hour to eat

B Humalog is a rapid-acting insulin, and a meal must be eaten within about 15 minutes of the injection, so the nurse needs to assess this patient first. The 12-year-old's blood sugar is normal, and if it gets lower the child is old enough to recognize hypoglycemia and call the nurse. NPH has an onset of action of 2-4 hours, so waiting an hour to eat will not cause a problem. The child who needs teaching will need an extended amount of time, so the nurse ensures all the other patients are stable prior to beginning the teaching session.

A child is brought to the emergency department with severe flank pain, hematuria, and vomiting. When assessing the child's laboratory findings, which value does the nurse correlate with this condition? A. Calcium, 6.8 mg/dL B. Calcium, 10.2 mg/dL C. Potassium, 3.6 mEq/L D. Potassium, 5.2 mEq/L

B Hypercalcemia can lead to kidney stones, which this child is manifesting. The other laboratory values are not related.

The clinic nurse reads in a child's chart that the parent reports hyperhidrosis. Which item should the nurse take into the examination room? A. Disposable stethoscope B. Extra hand towels C. Incontinence pads D. Large blood pressure cuff

B Hyperhidrosis is excessive sweating. The nurse might want to offer the child some extra washcloths or hand towels. The other items are not related.

A teenager has Crohn's disease and presents to the emergency department with a 3-day history of decreased appetite, lethargy, and fatigue. Today the parent reports the child is confused and "looks blue." The nurse finds the child hypotensive. Which assessment question is most helpful? A. "Could your child be using illicit recreational drugs?" B. "Has your child been taking steroids for Crohn's disease?" C. "Have you taken her temperature today or yesterday?" D. "Is anyone else in your family sick now or recently?"

B Steroids are often used to treat Crohn's disease and other autoimmune disorders. Because the child is manifesting signs of Addisonian crisis, the nurse should inquire about the use of steroids. Also, because the patient is a teenager, noncompliance is always a possibility. Abrupt discontinuation of steroids can precipitate an Addisonian crisis. The other assessment questions may yield valuable information but are not directly related to this child's history and presentation.

An adolescent has Cushing's syndrome due to long-term use of steroid therapy for another illness. When writing this child's care plan, which nursing diagnosis takes priority? A. Activity intolerance B. Altered body image C. Fluid volume deficit D. Impaired skin integrity

B The child with Cushing's syndrome has a typical appearance consisting of a pendulous abdomen, round "moon" face, facial flushing, a buffalo hump, thin fragile skin, and striae. This would lead the teen to have an altered body image, as he or she would want to look like his or her peers. The other nursing diagnoses may or may not apply to individual children.

The nurse gave a diabetic child an injection of Humalog insulin at 0700. At what time would it be most important to check on the child? A. 0715 B. 0800 C. 0930 D. 1200

B The peak action of humalog insulin is in 55 minutes, so the most appropriate time to check on the child is at 0800.

A mother brings her baby to the emergency department stating that the baby no longer makes tears when crying but is having multiple soaked diapers per day. Which assessment by the nurse takes priority? A. Last bowel movement B. Palpation of fontanels C. Prenatal history D. Time of last meal

B This child has manifestations of dehydration, and with the frequent soaked diapers, may have diabetes insipidus. Assessments of circulation take priority. The nurse assesses the other factors, but they can wait until more important assessments have been completed.

A nurse is caring for four teenagers with diabetic ketoacidosis. Which patient should the nurse see first? A. pH: 7.22 B. Potassium: 7.2 mEq/L C. Sodium: 128 mEq/L D. White blood cell count: 17,250 mm3

B This potassium is critically high and can lead to fatal dysrhythmias. The nurse should see this patient first. All of the other children have abnormal laboratory values too, but this takes priority.

A child has been admitted with suspected pheochromocytoma. What action by the nurse takes priority? A. Auscultate lung sounds every 4 hours during fluid therapy. B. Facilitate stat laboratory draws when the child has episodic symptoms. C. Perform a complete abdominal assessment including palpation. D. Withhold water for 8 hours and collect hourly urine samples.

B When the child has episodic symptoms of pheochromocytoma, it is important to have stat labs drawn to measure catecholamine levels, which will be transiently high. The other actions are not warranted.

The nurse caring for children with endocrine problems recognizes which classic signs of Addison's disease? (Select all that apply.) A. Bounding, rapid pulse B. Hyperpigmentation C. Ketonemia D. Low sodium levels E. Warm intolerance

B, C, D There are many signs and symptoms of Addison's disease, including hyperpigmentation, ketonemia, and hyponatremia. The patient's pulse is probably rapid but thready due to dehydration. The patient will complain of cold intolerance.

The nurse is teaching parents of an infant diagnosed with hypothyroidism. Which items are appropriate to include in the teaching plan? (Select all that apply.) A. Dissolving the levothyroxine (Synthroid) completely in formula B. Frequent monitoring of the child's height and weight C. Keeping a log or diary of developmental milestones the child meets D. Monitoring the child for behavioral changes as he or she grows E. The need for frequent laboratory testing during the child's life

B, C, D, E The parents of an infant diagnosed with hypothyroidism need to maintain logs of the child's height, weight, and developmental milestones to help ensure his or her growth and development stays within normal ranges. The child will need frequent blood tests, and the parents can also monitor for behavioral changes that might indicate a need to increase the medication as the child grows. For an infant, the medication is crushed and dissolved in a small amount of liquid and administered via a syringe. It is not added to a bottle of formula.

The nurse is explaining to a nursing student that which of the following affect the feedback mechanisms active in the endocrine system? (Select all that apply.) A. Activity B. Nutrition C. Sleep D. Stress E. Temperature

B, D, E Feedback regulation can be affected by stress, temperature, and nutritional status.

The student nurse caring for a child with type 1 diabetes mellitus learns which classic signs? (Select all that apply.) A. Polydactyly B. Polydipsia C. Polyneuritis D. Polyphagia E. Polyuria

B, D, E The classic signs of diabetes type 1 are polyuria (frequent urination), polyphagia (extreme hunger), and polydipsia (extreme thirst). Polydactyly is having more than five fingers or toes. Polyneuropathy is having an abnormal condition affecting multiple nerves.

A nurse is preparing to administer an octreocide depot injection. Which information about this procedure does the nurse provide the parent? A. "Octreocide stimulates growth hormone." B. "The medication goes deep into a muscle." C. "This shot lasts longer than a regular shot." D. "Your child will need these shots weekly."

C A depot injection is one in which the medication effect lasts a longer time, such as 2 or 3 months. Octreocide suppresses growth hormone. Depot injections can be either subcutaneous or intramuscular. Because the medication lasts for months, the child does not need weekly injections.

An adolescent with type 1 diabetes mellitus is hospitalized for the third time in 1 year with an infection. Which laboratory value would provide the nurse the most important information? A. Albumen: 4 g/dL B. Fasting blood sugar: 99 mg/dL C. Hemoglobin A1C: 9.8% D. White blood count: 15,000/mm3

C A diabetic adolescent with many infections should be assessed for noncompliance. The hemoglobin A1C is the average blood glucose over the last 3 months and will be helpful to determine how the teen's blood glucose has been controlled over time, thus giving information about compliance. The albumen is normal. The fasting blood sugar is normal and, while in the hospital, is not surprising. The WBC is high, indicating infection.

Which does the nurse include on the teaching plan for the parents of a child with Addison's disease? A. How to administer steroids subcutaneously B. How to eliminate all stress from the child's life C. How to give hydrocortisone (A-Hydrocort) IM D. How to keep the child hydrated when ill

C An important safety measure the nurse teaches the parents of this child is how to administer hydrocortisone intramuscularly in case the child is vomiting. It is not given subcutaneously. The parents will not be able to eliminate all stress from the child's life. Keeping the child hydrated when ill is important, but is not specific for this disease process.

A child is born with pseudohermaphroditism. After determining that the baby is a girl through genetic testing, the parents ask about her potential fertility. Which response by the nurse is the most appropriate? A. "It is impossible to determine that until she reaches puberty." B. "She is fertile but her uterus is abnormal so she can't carry a baby." C. "Because her internal female organs are normal, she probably is fertile." D. "Unfortunately, all babies born with this condition are infertile."

C Females born with pseudohermaphroditism have normal internal reproductive organs, so the chances are good that she will be fertile. Waiting until puberty will not reveal anything new.

A child is hospitalized with syndrome of inappropriate antidiuretic hormone (SIADH). The parent asks why the child's sodium level is so low. Which response by the nurse is the most appropriate? A. "It's a side effect of oral desmopressin (DDAVP)." B. "Sodium is being excreted in the large volume of urine." C. "The water your child retains is diluting the sodium." D. "Your child is not absorbing sodium in the intestines."

C Hyponatremia is most often caused by dilution. In this case, the excess fluid the child is retaining is the cause. DDVAP is used to treat diabetes insipidus, not SIADH. In SIADH, urine volume is low. Absorption of sodium is not the issue.

A child is diagnosed with congenital adrenal hyperplasia. The child's parents ask the nurse what this means. Which response by the nurse is the most appropriate? A. "Your child is not producing ACTH." B. "Your child is not producing androgens." C. "Your child is not producing cortisol." D. "Your child is not producing corticosteroid-releasing hormone."

C In this syndrome, the adrenal glands do not produce cortisol. The other hormones listed are produced in higher-than-normal amounts.

An infant is suspected of having diabetes insipidus (DI) and is having diagnostic testing. Which action by the nurse is most important? A. Apply a urine collection bag. B. Facilitate DNA testing. C. Insert an indwelling urinary catheter. D. Start two large-bore IVs.

C Infants are tested for DI with desmopressin (DDAVP) instead of a water deprivation test. After administering the medication, urine osmolality is tested at baseline and every 30 minutes for the next 2 hours. The nurse must collect the urine. An indwelling catheter is needed to obtain samples so frequently. A urine collection bag collects the urine but the infant may not void every 30 minutes. If no increase is seen in the osmolality, the infant may have hereditary nephrogenic DI, which can be confirmed by subsequent DNA testing. Because the child is not deprived of water, there is no need for an IV.

A child is started on recombinant growth hormone. Which teaching point does the nurse provide the parents and child? A. Drink adequate fluids during the day. B. Encourage increased activity. C. Ensure proper oral hygiene. D. Weigh daily on the same scale.

C Proper oral hygiene and regular visits to the dentist are important because growth hormone treatments make the child's teeth softer and more prone to cavities. The other options do not address a specific issue related to this treatment.

The parent of a child with hypopituitarism asks why this condition occurs. Which response by the nurse is the most appropriate? A. "Infection in the brain is the most common cause." B. "It's usually a brain tumor near the pituitary gland." C. "There are many possible causes, and often we don't know." D. "Usually this is due to damage to the brain from trauma."

C The cause of hypopituitarism is often unknown, but there are many possibilities. CNS tumor is the most common, accounting for 47%. Trauma accounts for about 3% of the cases of this condition. Infection is an uncommon cause (1%).

Which long-term goal is most appropriate for the adolescent diabetic patient? A. Appropriate food items chosen for meals B. Glucose within target range 90% of the time C. No evidence of long-term complications D. Takes medications correctly and on time

C The most appropriate long-term goal is that the teen is free from complications, some of which can be devastating. Choosing appropriate foods, blood glucose readings, and taking medications are good goals too, but are too specific for an overall long-term goal.

A hospitalized diabetic child is sweating, nauseated, and has a headache. What action by the nurse takes priority? A. Administer sliding-scale insulin. B. Call laboratory for a stat blood sugar. C. Give the child some orange juice. D. Perform a urine ketone test.

C This child is exhibiting signs of hypoglycemia. The nurse should first treat the child instead of waiting for the laboratory to come draw blood. If the nurse has bedside glucose monitoring available, check the glucose first, then treat, but do not wait the several minutes it will take for phlebotomy. Because the child has low blood sugar, do not give insulin. Do not delay by trying to get a urine sample; also, ketones are present in hyperglycemia.

A parent with his 7-year-old son at the pediatric clinic expresses concern that the child is too short. The nurse measures the child and finds him to be 100 cm (39.3 inches) tall. Which statement by the nurse is most appropriate? A. "Children are often 'too short' until they reach puberty." B. "He's shorter than average, but it's not significant." C. "Let's discuss some options for promoting growth." D. "Your child is of average height for a 7-year-old."

C This child's height is well below the 5th percentile for age, so he could have hypopituitarism leading to growth hormone deficiency. The nurse should acknowledge the fact and begin discussions about the condition gently and objectively. The other answers are not appropriate.

The student nurse knows that which gland produces the hormone triiodothyronine? A. Adrenal B. Hypothalamus C. Parathyroid D. Thyroid

C Triiodothyronine (T3) is produced by the parathyroid gland.

The nursing student knows that which glands control antidiuretic hormone (ADH)? (Select all that apply.) A. Adrenal cortex B. Anterior pituitary C. Hypothalamus D. Pineal body E. Posterior pituitary

C, D ADH is secreted by the hypothalamus and stored (and subsequently released) by the posterior pituitary glands.

The nursing faculty member explains the functions of the anterior pituitary as regulating which processes? (Select all that apply.) A. Cognition B. Digestion C. Growth D. Metabolic activity E. Sexual development

C, D, E The anterior pituitary produces hormones that influence and regulate growth, metabolic activity, and sexual development.

A student nurse is caring for a child with gigantism. Which hormones does the faculty member explain are important in this condition? (Select all that apply.) A. Androgens B. Corticosteroids C. Growth hormone D. Insulin-like growth factor E. Somatostatin

C, D, E The nurse must understand the interplay of three hormones important in gigantism: growth hormone, insulin-like growth factor, and somatostatin.

A child has been diagnosed with diabetes insipidus (DI). The nurse is teaching the parents and child about self-care measures. Which item does the nurse explain is the priority for the child to have at all times? A. Epinephrine injector B. Medic-Alert bracelet C. Medications D. Water bottle

D A Medic-Alert bracelet, medications, and a water bottle are all important for the child with DI to have with him or her. However, preventing dehydration takes priority, so the most important item is the water bottle or other ready access to water.

A child diagnosed with hyperaldosteronism needs a diuretic. Which diuretic does the nurse anticipate administering? A. Bumetanide (Bumex) B. Furosemide (Lasix) C. Hydrocholorthiazide (Hydrodiuril) D. Spironolactone (Aldactone)

D Aldactone is a potassium-sparing diuretic, which is important because children with hyperaldosteronism have low potassium levels. The other three diuretics are potassium wasting.

A nurse is caring for a 45-kg (99-lb) child undergoing a water deprivation test. At a routine assessment during the test, the nurse notes the child's weight at 42 kg. Which action by the nurse takes priority? A. Allows the child to have clear liquids, like broth B. Documents the findings and continues to monitor C. Increases the rate of the IV fluid infusion by 5% D. Notifies the health-care provider immediately

D During a water deprivation test, the child's weight is not allowed to decrease by more than 2-5%. This child's weight has dropped by more than 5%, so the health-care provider must be notified immediately and the test stopped. Broth contains high levels of sodium, which is already high in the dehydrated child. The child's IV fluid rate may need to be increased, but not without the provider's order. Documenting the findings is important, but does not take priority over notifying the provider.

A parent calls the clinic nurse to report that his child, who takes methimazole (MTZ), is running a high fever, seems agitated, and is nauseated. Which response by the nurse is the most appropriate? A. "Bring your child to the clinic this afternoon for a checkup." B. "Double the methimazole dose for 2 days or until the fever is gone." C. "Give your child acetaminophen (Tylenol) every 4 hours for the fever." D. "Take your child to the nearest emergency department right away."

D Methimazole is used to treat hyperthyroidism. With fever, nausea and vomiting, and agitation, the child is demonstrating manifestations of thyroid storm, which is a medical emergency. The parent should take the child to the emergency department.

The nurse in an endocrine clinic is assessing an 8-year-old girl who has not yet started menstruating and is Tanner stage II. Which statement by the nurse to the parent is most appropriate? A. "Bring her back when she starts menstruating." B. "She may have a deficiency of luteinizing hormone." C. "Your child's development is appropriate for her age." D. "We will test her for levels of the female hormones."

D Precocious puberty in a female is suspected when any secondary sex characteristics begin to develop before the age of 9 years. A child who is assessed at Tanner stage II has some breast development, pubic hair development, or both.

A patient has a serum sodium level of 119 mEq/L, a blood glucose level of 52 mg/dL, and a cortisol level of 1.1 mg/dL. What does the nurse add to this patient's plan of care? A. Demonstrate proper technique to check blood glucose. B. Encourage the child to take salt tablets with each meal. C. Teach parents and child about desmopressin acetate (DDVAP). D. Teach parents and child about solumedrol (Solu-Cortef).

D These laboratory values are indicative of Addison's disease. The drug used to treat this disorder is solumedrol. DDVAP is used for diabetes insipidus. Blood sugar and sodium levels should normalize during treatment.

A child is taking methimazole (MTZ). What does the nurse teach parents to report immediately? (Select all that apply.) A. Brittle hair B. Dry skin C. Headache D. Jaundice E. Pink or red urine

D, E Methimazole has some side effects that can be serious. Jaundice can signal hepatic failure and pink/red urine can be a manifestation of glomerulonephritis, and so both should be reported without delay. The other manifestations are not due to side effects of this drug.