Chapter 26: Nursing Care of the Child With an Alteration in Metabolism/Endocrine Disorder

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The physician has ordered routine hemoglobin A1C levels for a teenager with diabetes. Following teaching about the test by the nurse, the client and family demonstrate the need for further instruction with which statements? Select all that apply. "I will be sure to not eat or drink anything the night before I get my blood drawn for the test." "This test will help us monitor if our child is following the prescribed diet and treatment regimen." "I can check this level myself using a blood glucose monitor." "We will need to make sure our child gets this lab test at least every 6 months to ensure the diabetes is under control." "If I am under a lot of stress I should let my doctor know during my visit in case my hemoglobin A1C levels are elevated."

"I will be sure to not eat or drink anything the night before I get my blood drawn for the test." "I can check this level myself using a blood glucose monitor." "We will need to make sure our child gets this lab test at least every 6 months to ensure the diabetes is under control." Explanation: Hemoglobin A1C levels provide the physician or nurse practitioner with information regarding the long-term control of glucose levels, so fasting is not necessary. The test indicates the level of blood glucose over a 2- to 3-month period, so it should be performed about every 3 months. Daily blood glucose monitoring can be performed by the client with the use of a fingerstick and glucose meter. The physician should be informed of high stress levels as this can increase blood glucose levels.

The school-age child is scheduled for a 2-hour plasma glucose test. The nurse has given verbal and written instructions to the parent regarding the test. Which comments by the parent indicate that instructions for the test were not followed? Select all that apply. "My child only took half of the normal insulin dose this morning." "When will the IV be started that administers the sugar solution?" "You will be drawing blood at different times for testing, correct?" "This test will show how well my child's blood glucose levels return to normal after the sugar solution is given." "This test helps in diagnosing infections that may cause my child's blood sugar to be abnormal."

"My child only took half of the normal insulin dose this morning." "When will the IV be started that administers the sugar solution?" "This test helps in diagnosing infections that may cause my child's blood sugar to be abnormal." Explanation: No insulin or oral diabetic medications should be taken prior to the test. An oral glucose, not an IV solution, is administered. Oral glucose is ingested and in a healthy child insulin will respond and return blood glucose to normal levels; it does not test for infections. Blood samples are drawn prior to ingestion of the glucose solution and at intervals after.

The nurse is providing client education regarding the administration of desmopressin acetate for the client diagnosed with diabetes insipidus. Which statements by the client or parents indicate understanding of the teaching? Select all that apply. "It is important that I keep a close watch on my blood glucose levels to determine if the medication is working." "We will want to inspect the nares of our child to be sure the medication is not irritating the tissue." "This medication will make me urinate more, so I need to plan for that when I am at school." "We will need to adjust the dose based on how much our child is urinating." "I am going to have to carry a cooler with me if I am going to be gone all day or if I go on a long hike."

"We will want to inspect the nares of our child to be sure the medication is not irritating the tissue." "We will need to adjust the dose based on how much our child is urinating." "I am going to have to carry a cooler with me if I am going to be gone all day or if I go on a long hike." Explanation: The nares should be inspected because this medication is administered via the intranasal route, and the dose is adjusted based on the client's output. The medication must be kept refrigerated so appropriate planning is necessary if the child is not going to be home. This medication is a synthetic antidiuretic hormone for the treatment of diabetes insipidus (which causes production of excessive amounts of urine), which is not related to diabetes mellitus. The medication is titrated to the amount of urine output.

The nurse is administering biosynthetic growth hormone, derived from recombinant DNA, by subcutaneous injection. The daily dosage is 0.2 to 0.3 mg/kg, given in divided doses. The child weighs 110 lb (49.9 kg). What is the safe dosage limit for this child on a daily basis? Record your answer using a whole number.

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

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

The nurse is examining a child with hypoparathyroidism. The nurse would expect to assess which signs and symptoms? Select all that apply. capillary refill polyphagia Chvostek sign Babinski sign Trousseau sign

Chvostek sign Trousseau sign Explanation: A child with hypoparathyroidism would have a positive Chvostek or Trousseau sign, both of which indicate hypocalcemia. To test for the Chvostek sign, tap sharply over the facial nerve below the temple and anteriorly to the ear. The sign is positive when the mouth twitches (contraction of the lateral facial muscles). To check for the Trousseau sign, apply a blood pressure cuff to the child's upper arm. Inflate the cuff until the blood supply is occluded. If doing so causes carpal spasm (the fingers contract and the child is unable to open the hand), the Trousseau sign is positive. Capillary refill helps to evaluate tissue oxygenation. Polyphagia refers to excessive eating or hunger. Babinski refers to the Babinski reflex, which suggests neurologic dysfunction.

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? "Limit participation in planned exercise activities that involve competition." "Carry crackers or fruit to eat before or during periods of increased activity." "Increase the insulin dosage before planned or unplanned strenuous exercise." "Check your blood glucose level before exercising, and eat a protein snack if the level is elevated."

Correct response: "Carry crackers or fruit to eat before or during periods of increased activity." Explanation: Hypoglycemia can usually be prevented if an adolescent with diabetes eats more food before or during exercise. Because exercise with adolescents isn't commonly planned, carrying additional carbohydrate foods is a good preventive measure.

A 15-year-old adolescent is scheduled for a pelvic ultrasound to evaluate for a possible ovarian cyst. Which instruction by the nurse would be most appropriate? "Drink plenty of fluids because you need to have a full bladder." "You need to remain very still for the entire test." "You won't be able to drink any water before or during the test." "Limit your level of physical activity for one-half hour before the test."

Correct response: "Drink plenty of fluids because you need to have a full bladder." Explanation: A full bladder is needed for an ultrasound of the pelvic region. The client needs to remain still for a computed tomography or magnetic resonance imaging scan, not an ultrasound. Water is withheld during a water deprivation test used to detect diabetes insipidus. Limiting stress and physical activity for 30 minutes before the test is required for the growth hormone stimulation test.

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." "If our child is sick we should check blood glucose levels more often." "We should check our child's blood glucose levels before meals." "Blood glucose level, food intake, and activity need to all be considered when calculating insulin dosage."

Correct response: "During exercise we should wait to check blood sugars until after our child completes the activity." Explanation: Blood glucose monitoring needs to be performed more often during prolonged exercise. Frequent glucose monitoring before, during, and after exercise is important to recognize hypoglycemia or hyperglycemia. Frequent glucose monitoring if the child is sick is also important to recognize changes in glucose levels and prevent hypoglycemia or hyperglycemia. The parents are correct that they will check their child's glucose before meals; they should also check it before bedtime snacks. Blood glucose level should never be the only factor considered when calculating insulin dosing. Food intake and recent or expected activity/exercise must be factored in.

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? "We will just have our child exercise and take medicine to cure this." "I will just feed my child healthy foods and sign her up for more sports." "Her body fights against the insulin." "Her body doesn't have any insulin."

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

The nurse is teaching a 12-year-old girl with type 2 diabetes mellitus and her parents about dietary measures to control her glucose levels. Which comment by the child indicates a need for additional teaching? "I can eat two small cookies with each meal." "I can have an apple or orange for snacks." "I can have nonfat milk to drink." "I will be eating more breads and cereals."

Correct response: "I can eat two small cookies with each meal." Explanation: Cookies, cakes, candy, potato chips, and crackers are high in sugars and fats and should be eaten in moderation as special treats; they would not be included with each meal. An apple or orange makes a good snack. Nonfat milk is a better option than whole milk. Long-acting carbohydrates should be the largest category of foods eaten.

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." "Maybe you could do something to remind yourself to take the medication on a daily basis." "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."

Correct response: "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.

The nurse is speaking with the parents of a school-aged child recently diagnosed with diabetes regarding the differences between hypoglycemia and hyperglycemia. Which statement by a parent indicates a need for further teaching? "If I notice changes in my son like tearfulness or irritability, his blood sugar may be high." "When my son's breath smells fruity, it almost always indicates high blood sugar." "If my son says he feels shaky, his blood sugar may be low." "Dry flushed skin may be a sign if high blood sugar."

Correct response: "If I notice changes in my son like tearfulness or irritability, his blood sugar may be high." Explanation: Behavior changes such as tearfulness, irritability, confusion, and slurred speech are indications of hypoglycemia, not hyperglycemia. Tremors and diaphoresis are also indications of low blood sugar. Dry flushed skin, fatigue, weakness, nausea, vomiting, and fruity breath odor are all symptoms of hyperglycemia.

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? "This early diagnosis and treatment will lead to a better prognosis that my child will reach normal adult height." "My child will follow up with an endocrinologist every 3 to 6 months to monitor growth." "It is important I treat my child according to the child's age not based on the child's size." "If growth hormone therapy is used, it will continue for the rest of my child's life."

Correct response: "If growth hormone therapy is used, it will continue for the rest of my child's life." Explanation: The goal of growth promotion in a child with growth hormone deficiency is for the child to demonstrate an improved growth rate, as evidenced by at least 3 to 5 in (7.5 to 12.5 cm) in linear growth in the first year of treatment without complications. With early diagnosis and treatment, the child has a better prognosis for reaching a normal adult height. The child will need to visit the pediatric endocrinologist every 3 to 6 months to monitor for growth, for potential adverse effects, and for compliance with therapy. The child with growth hormone deficiency often has younger-looking features and is shorter than his or her peers. Treating and communicating with the child in an age-appropriate manner even though he or she may appear younger is important. Treatment stops when the epiphyseal growth plates fuse; therefore, it will not continue throughout the child's lifetime.

The nurse is teaching the parents of a 3-year-old girl with diabetes insipidus how to administer desmopressin acetate (DDAVP). Which comment indicates further need for teaching? "If she sneezes the medicine out of her nose, I wait until the next dose." "First I suction her nostrils, if necessary, to help the drug be absorbed." "I check the specific gravity of her urine to see if the drug is working." "Once the tube is filled, I hold it closed until I insert it into her nostril.

Correct response: "If she sneezes the medicine out of her nose, I wait until the next dose." Explanation: The nurse must remind the parents that the medicine should be readministered immediately if the child sneezes. Proper intranasal administration of DDAVP starts with clearing the nostril. The effectiveness of the drug is monitored by checking the specific gravity of the child's urine. Proper administration involves inserting the measured tubing into the bottle, filling it to the proper dosage, holding the tube closed until it is inserted into the child's nostril, then blowing the fluid out of the tube.

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? "You are lucky that you did not have to learn how to give yourself a shot." "Kids can usually be managed with an oral agent, meal planning, and exercise." "This will rectify itself if you follow all of the doctor's directions." "A weight-loss program should be implemented and maintained."

Correct response: "Kids can usually be managed with an oral agent, meal planning, and exercise." Explanation: Treating type 2 diabetes in children may require insulin at the outset if the child is acidotic and acutely ill. More commonly, the child can be managed initially with oral agents, meal planning, and increased activity. Telling the child that she is lucky she did not have to learn how to give a shot might scare her, so it will inhibit her from seeking future health care. The condition will not rectify itself if all orders are followed. A weight-loss program might need to be implemented but that is not always the case.

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? "If my child eats as much as their older brother eats they could have an insulin reaction." "My child measures their own medication but sometimes doesn't administer the correct amount." "My child monitors their glucose levels to keep them from going too high." "On the weekends we encourage our child to participate in lots of sports activities and stay busy so they don't have an insulin reaction."

Correct response: "My child measures their own medication but sometimes doesn't administer the correct amount." Explanation: 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 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? "I would be worried about your short stature too and get a second opinion." "You will not need medication because your hormone levels are normal. I would be glad to discuss these findings with you." "If you think you want testosterone shots, then I will get them scheduled for you." "It really doesn't matter how tall your dad is. The physician just looks at your height to make this diagnosis."

Correct response: "You will not need medication because your hormone levels are normal. I would be glad to discuss these findings with you." Explanation: This diagnosis of "short stature" or constitutional delay may cause self-esteem issues with male teens. The nurse should explore the teen's feelings. Teens with a delay in puberty usually experience puberty late, so there is no need for a second opinion. Hormone therapy is not given until after age 14.

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? "When our child is sick, we may need to check glucose levels more frequently." "Our child should eat three meals and midafternoon and bedtime snacks each day." "We and our child need to learn to identify carbohydrate, protein, and fat foods." "Our child should not participate in sports or physical activity."

Correct response: "Our child should not participate in sports or physical activity." Explanation: 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." "Fever and sore throat may be side effects of the medication." "Give your child ibuprofen according to the instructions on the box." "Offer your child at least 8 ounces of clear fluids and call back tomorrow."

Correct response: "Please take your child straight to the emergency department." Explanation: 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.

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 only temporary, right?" "Are you saying that hypothyroidism is caused by a problem in the way the thyroid gland develops?" "Do you mean that hypothyroidism may be caused by a problem in the way the body makes thyroxine?" "So, hypothyroidism can be treated by exposing our baby to a special light, right?"

Correct response: "So, hypothyroidism can be treated by exposing our baby to a special light, right?" Explanation: Congenital hypothyroidism can be permanent or transient and may result from a defective thyroid gland or an enzymatic defect in thyroxine synthesis. Only the last question, which refers to phototherapy for physiologic jaundice, indicates that the parents need more information.

The adolescent with diabetes reports ketones in the urine when testing at home. The adolescent states to the nurse, "I forget what that means, but I do not think it is good." What is the best response from the nurse? "This can be a sign that your diabetes is not well controlled. What have your fingerstick blood glucose levels been?" "It depends. If you are trying to lose weight you might be spilling ketones into your urine." "Yes, you are correct that this is not good. We do not like to see ketones in the urine." "Ketones can be an early sign that you are going into diabetic ketoacidosis. This is very dangerous."

Correct response: "This can be a sign that your diabetes is not well controlled. What have your fingerstick blood glucose levels been?" Explanation: Ketones are a product of fat metabolism. In the client with diabetes this often means that the blood glucose level is not well controlled and the body is breaking down fats for energy use. Correlating ketones in the urine with fingerstick levels is helpful in determining the control of the diabetes. Telling the client that this is "not good" or "this is very dangerous" would not be the best responses.

The nurse is assessing a child diagnosed with Cushing syndrome. Which statement by the parents demonstrates a need for further teaching? "We need to pay close attention to any wounds our child gets to monitor for adequate healing." "My child may experience excessive weight gain." "This disorder is most likely due to an infection my child had recently." "My child's round, full face appearance is reversible with appropriate treatment."

Correct response: "This disorder is most likely due to an infection my child had recently." Explanation: A round, full face (moon face), rapid weight gain, and poor wound healing are all seen in Cushing syndrome. Cushingoid appearance is reversible with appropriate treatment. The most common cause of Cushing syndrome is long-term corticosteroid therapy or a pituitary adenoma, not an infection.

The nurse is talking with a parent of an adolescent who is newly diagnosed with type 2 diabetes and asks, "How could this happen? No one in our family has diabetes." What response would be appropriate? "This is caused by the pancreas not making enough insulin." "This disorder usually occurs when inadequate calories are ingested on a regular basis." "Because this disorder is genetic, someone in the family will eventually develop the illness." "This is caused by insulin resistance from previous pancreatic injury or generalized infection."

Correct response: "This is caused by insulin resistance from previous pancreatic injury or generalized infection." Explanation: Type 2 diabetes is now seen in overweight adolescents as well as those who eat a diet high in fats and carbohydrates and do not exercise regularly. Pancreatic malfunction is not a cause of type 2 diabetes. This disorder is not linked to inadequate ingestion of daily calories. This disorder may have a genetic link, but environmental factors such as obesity, diet, and exercise can influence its development. Type 2 diabetes is a result of insulin resistance in the metabolism of glucose to maintain normal blood glucose levels, but it is not associated with infection or a previous pancreatic injury.

The nurse has told the 14-year-old adolescent with diabetes that the doctor would like to have a hemoglobin A1C test performed. Which comment by the client indicates that she understands what this test is for? "That is the test that I take after I have fasted for at least 8 hours." "The normal level for my hemoglobin A1C is between 60 to 100 mg/dl." "I monitor my own blood glucose every day at home. I don't see why the doctor would want this done." "This will tell my doctor what my average blood glucose level has been over the last 2 to 3 months."

Correct response: "This will tell my doctor what my average blood glucose level has been over the last 2 to 3 months." Explanation: Hemoglobin A1C (HgbA1C) provides the physician or nurse practitioner with information regarding the long-term control of glucose levels, as it provides an average of what the blood glucose levels are over a 2 to 3 month period. No fasting is required. Desired levels for children and adolescents 13 to 19 years are less than 7.5%.

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 0845 0900 0930

Correct response: 0815 Explanation: The onset of rapid acting insulins like lispro (Humalog) is within 15 minutes. The onset of short-acting insulin is 30 to 60 minutes. The onset of intermediate-acting insulin is 1-3 hours, and long-acting insulin's onset is 1-2 hours.

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? 60 mg/dl 100 mg/dl 140 mg/dl 220 mg/dl

Correct response: 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 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% 6.5% 7.5 % 7.0%

Correct response: 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 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? Request that someone call 911. Administer subcutaneous glucagon. Anticipate that the child will need intravenous glucose. Dissolve a piece of candy in the child's mouth.

Correct response: Administer subcutaneous glucagon. Explanation: 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 nurse is providing acute care for an 11-year-old boy with hypoparathyroidism. Which intervention is priority? Providing administration of calcium and vitamin D. Ensuring patency of the IV site to prevent tissue damage. Monitoring fluid intake and urinary calcium output. Administering intravenous calcium gluconate as ordered.

Correct response: Administering intravenous calcium gluconate as ordered. Explanation: Administering intravenous calcium gluconate, as ordered, will restore normal calcium and phosphate levels as well as relieve severe tetany. Ensuring patency of the IV site to prevent tissue damage due to extravasation or cardiac arrhythmias is an intervention for any child with an IV, and monitoring fluid intake and urinary calcium output are secondary interventions. Providing administration of calcium and vitamin D is an intervention for nonacute symptoms.

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? Vitamin K administration until school age Administration of levothyroxine indefinitely An increased intake of calcium beginning immediately Administration of vitamin C until after growth is complete

Correct response: 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. Vitamin K is not needed. Supplemental vitamin D, and not calcium, may be given to prevent the development of rickets when rapid bone growth begins. Supplemental vitamin C is not indicated for this disorder.

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 Growth hormone Insulin Thyroxine

Correct response: 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.

Diabetes insipidus is a disorder of the posterior pituitary that results in deficient secretion of which hormone? Adrenocorticotropic hormone (ACTH) Thyroid stimulating hormone (TSH) Luteinizing hormone (LH) Antidiuretic hormone (ADH)

Correct response: Antidiuretic hormone (ADH) Explanation: Central diabetes insipidus (DI) is a disorder of the posterior pituitary that results from deficient secretion of ADH. ADH is responsible for the concentration of urine in the renal tubules. Without ADH there is a massive amount of water loss and an increase in serum sodium. Nephrogenic DI occurs as a genetic problem or from end-stage renal disease. It is the result of the inability of the kidney to respond to ADH and not from a pituitary gland problem. LH is produced from the anterior pituitary. In females, it stimulates ovulation and the development of the corpus luteum. TSH is secreted by the thyroid gland. ACTH is secreted by the anterior pituitary.

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. Give the client a bolus of fluids Tell the client he or she will be asleep. Insert a urinary catheter.

Correct response: Assess the client for allergies. Explanation: A thyroid scan uses a radionucleotide dye so a client should be assessed for allergies to iodine and shellfish to prevent a possible allergic reaction. The client will not be asleep. There is no need to give the child a bolus of fluid or insert a urinary catheter.

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

Correct response: 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 nurse working in a pediatric clinic is examining a child with symptoms indicating a possible inborn error of metabolism. Which action is most important for the nurse to do at this time? Ignore the symptoms if the family does not ask about them. Counsel the family to have all siblings evaluated. Reassure the family that everything is OK, but express urgency to the health care provider. Read more about the condition and its ramifications.

Correct response: Counsel the family to have all siblings evaluated. Explanation: If one child in the family has suspicious symptoms, counsel the family to have all other siblings evaluated, even if their symptoms are not exactly the same. The nurse should never ignore such a problem and should never tell a family not to worry when a problem may exist. Reading more about the problem may be helpful, but it is not a priority action at this time.

The nurse knows that which condition is caused by excessive levels of circulating cortisol? Addison disease Graves disease Turner syndrome Cushing syndrome

Correct response: 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.

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 cause anorexia if appropriate meals are not planned. DI can be managed with vasopressin given as lifelong treatment. DI requires strict fluid restrictions until it resolves.

Correct response: 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.

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 Decreased serum levels of free testosterone Body mass index as normal Short stature

Correct response: Darkened pigmentation around the neck area Explanation: 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 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 Gestational diabetes in the mother Congenital heart defects in the fetus Spina bifida in the fetus

Correct response: Decreased cognitive development of the fetus Explanation: 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.

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 works on your pancreas to stimulate insulin production. Desmopressin acetate is a synthetic form of insulin used to lower your blood sugar. Desmopressin acetate is a synthetic antidiuretic hormone that will slow down your urine output. Desmopressin acetate works to help your kidneys work more efficiently.

Correct response: 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.

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? Prepare the parent for a neurology consult. Explain why the child might need to schedule an eye exam. Discuss preparing for a thyroid function test. Explain the preparation for an 8-hour fasting blood glucose test.

Correct response: Discuss preparing for a thyroid function test. Explanation: 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.

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. Prior to discharge the parents state that they understand the medication regimen. The parents fill the prescription for hormone replacement therapy prior to discharge. The parents ask appropriate questions about the planned treatment goals.

Correct response: During follow-up visits the child demonstrates normal growth and development. Explanation: 21-OH enzyme deficiency results in blocking the production of adrenal mineralocorticoids and glucocorticoids. Nursing management of the infant or child with CAH focuses on preventing and monitoring for acute adrenal crisis, helping the family to understand the disease, providing education to the child and family about the importance of maintaining hormone supplementation, and providing emotional support to the family. Improvement of symptoms, such as normal growth and development, is the best indicator that the goal of hormone replacement therapy is being carried out as ordered.

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? Place the needle with the bevel facing down before the injection. Spread the skin before the injection. Aspirate the syringe for blood return before the injection. Elevate the subcutaneous tissue before the injection.

Correct response: Elevate the subcutaneous tissue before the injection. Explanation: 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.

After hospital discharge, the parent of a child newly diagnosed with type 1 diabetes mellitus telephones the nurse because the child is acting confused and very sleepy. Which emergency measure would the nurse suggest the parent carry out before bringing the child to see the health care provider? Give the child one unit of regular insulin. Give the child a glass of orange juice. Give the child nothing by mouth so that a blood sugar can be drawn at the health care provider's office. Give the child a glass of orange juice with one unit regular insulin in it.

Correct response: Give the child a glass of orange juice. Explanation: The child is experiencing symptoms of hypoglycemia. Administering a form of glucose would help relieve them. This can be glucose tablets or a rapidly absorbable carbohydrate such as orange juice. This should be followed by a snack of complex carbohydrates and protein within 30 to 60 minutes. Insulin cannot be absorbed when taken orally and administering insulin would make the hypoglycemia worse. Withholding treatment waiting to get to the health care provider's office may cause the hypoglycemia to worsen and be a risk to the child's life. Children with diabetes and their parents need to be taught to recognize and treat the symptoms of hypoglycemia.

The school nurse observes an 8th grader at school who suddenly is losing weight, is not participating in gym, and is in poor academic standing. The nurse takes a history and notes that the child seems very nervous. The nurse notifies the parent, who explains that the child has just been seen by the family health care provider and tested low for thyroid-stimulating hormone (TSH). For which condition will the nurse devise a plan of care? Hashimoto thyroid disease Graves disease Hypothyroidism Diabetes mellitus

Correct response: Graves disease Explanation: Graves disease is hyperthyroidism and would result in a low TSH level, noted weight loss, and nervous behavior. Hashimoto thyroid disease is a hypothyroid disease, which would result in a high TSH level. Hypothyroidism would also show a high TSH level. Diabetes mellitus involves the pancreas.

During an assessment of an adolescent child, the nurse notes that the child has a protuberant tongue, fatigued appearance, poor muscle tone, and exophthalmos. What medical diagnosis would the nurse expect the child to have? Cushing disease Graves disease diabetes syndrome of inappropriate antidiuretic hormone secretion (SIADH)

Correct response: Graves disease Explanation: Symptoms of Graves disease include an increased rate of growth; weight loss despite an excellent appetite; hyperactivity; warm, moist skin; tachycardia; fine tremors; an enlarged thyroid gland or goiter; and ophthalmic changes including exophthalmos. These are not symptoms of Cushing disease, diabetes, or SIADH.

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? hypertension Graves disease Cushing syndrome hypothyroidism

Correct response: Graves disease Explanation: 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.

A 12-year-old is being seen in the office and has hyperthyroidism; the nurse knows that the most common cause of hyperthyroidism is: Addison disease Cushing disease Graves disease Plummer disease

Correct response: 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.

A 12-year-old child has hyperthyroidism. The nurse understands that the most common cause of hyperthyroidism in children is: Addison disease. Cushing syndrome. Graves disease. Plummer disease.

Correct response: Graves disease. Explanation: Hyperthyroidism occurs less often in children than hypothyroidism. Graves disease is the most common cause of hyperthyroidism in children. Hyperthyroidism occurs more often in females, and the peak incidence occurs during adolescence. Addison disease refers to chronic adrenocortical insufficiency. Cushing syndrome results from excessive levels of circulating cortisol. Plummer disease is a less common cause of hyperthyroidism.

When discussing congenital adrenal hyperplasia with a child's parents, the nurse would advise them that administration of which drug is anticipated? Calcium Vitamin D Hydrocortisone Growth hormone

Correct response: Hydrocortisone Explanation: Congenital adrenal hyperplasia is an autosomal inherited disease. The adrenal glands produce an insufficient supply of the enzymes required for the synthesis of cortisol and aldosterone. Hydrocortisone is a corticosteroid that is used to replace the supply of cortisol. It would be administered throughout the life of the child. The other drugs are not necessary to treat this disorder.

A 12-year-old child is diagnosed with hyperthyroidism. What problem would the nurse anticipate the child may have in school? Inability to submit neat handwriting assignments Increase in sleepiness by the end of the day Noncomprehension of written material Inability to fit legs under a school desk

Correct response: Inability to submit neat handwriting assignments Explanation: Children with hyperthyroidism are seen in the health care provider's office with the first reports being sleep problems, poor school performance, and distractibility. These children are easily frustrated, get overheated, and fatigued during physical education classes. The disease causes muscle weakness and the child can develop fine tremors, which leads to poor handwriting. The child tends to have an increased rate of growth but the growth is not abnormal so he or she should not have a problem placing the legs under the desk. The child is tired throughout the entire day, not just at the end of the day. The disease does not cause problems with cognitive delays so the child should not have problems with comprehension.

The nurse is caring for a 10-year-old child with growth hormone (GH) deficiency. Which therapy would you anticipate will be prescribed for the child? Short-term aldosterone provocation Injections of GH Oral administration of somatotropin Long-term blocking of beta cells

Correct response: Injections of GH Explanation: Growth hormone (GH) deficiency occurs when the anterior pituitary is unable to produce enough hormone for usual growth. Somatotropin is the name of the growth hormone administered. Administering subcutaneous GH to the child helps correct this deficiency. The GH dosage is 0.2 to 0.3 mg/kg given daily. It is not administered orally. Aldosterone causes sodium to be retained and a provocation would be the administration of diuretics to reduce the sodium. Beta cells are found in the heart muscles, smooth muscles, airways, and arteries. They are also found in the pancreas to secrete insulin. None of these cell actions are related to the anterior pituitary.

The nurse is teaching an 11-year-old boy and his family how to manage his diabetes. Which instruction does not focus on glucose management? Teaching that 50% of daily calories should be carbohydrates. Instructing the child to rotate injection sites. Encouraging the child to maintain the proper injection schedule. Promoting higher levels of exercise than previously maintained.

Correct response: Instructing the child to rotate injection sites. Explanation: Instructing the child to rotate injection sites to decrease scar formation is important, but does not focus on managing glucose levels. Teaching the child and family to eat a balanced diet, encouraging the child to maintain the proper injection schedule, and promoting a higher level of exercise all focus on regulating glucose control.

Rank the different types of insulin based on their duration of action beginning with the shortest to the longest duration. Click an option, hold and drag it to the desired position, or click an option to highlight it and move it up or down in the order using the arrows to the left. 1 Lispro 2 Humulin R 3 Humulin N 4 Lantus

Correct response: Lispro Humulin R Humulin N Lantus Explanation: Lispro is a rapid-acting insulin. Humulin R is a short-acting insulin. Humulin N is an intermediate-acting insulin. Lantus is a long-acting insulin.

Which results would indicate to the nurse the possibility that a neonate has congenital hypothyroidism? High thyroxine (T4) level and low thyroid stimulating hormone (TSH) level Low T4 level and high TSH level Normal TSH level and high T4 level Normal T4 level and low TSH level

Correct response: 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? Providing a wet washcloth to suck. Educating family about side effects. Monitoring blood glucose levels. Monitoring intake and output.

Correct response: Monitoring blood glucose levels. Explanation: Monitoring blood glucose levels during this study is the priority task along with observing for signs of hypoglycemia since insulin is given during the test to stimulate release of growth hormone. Providing a wet washcloth would be more appropriate for a child who is on therapeutic fluid restriction, such as with syndrome of inappropriate antidiuretic hormone. Monitoring intake and output would not be necessary for this test but would be appropriate for a child with diabetes insipidus. While it is important to educate the family about this test, it is not the priority task.

The nurse is assessing a 7-year-old girl with a headache, irritability, and vomiting. Her health history reveals she has had meningitis. Which intervention is priority? Notifying the physician of the neurologic findings. Setting up safety precautions to prevent injury. Monitoring urine volume and specific gravity. Restoring fluid balance with IV sodium.

Correct response: Notifying the physician of the neurologic findings. Explanation: This child may have syndrome of inappropriate antidiuretic hormone (SIADH). Priority intervention for this child is to notify the physician of the neurologic findings. Remaining interventions will be to restore fluid balance with IV sodium chloride to correct hyponatremia, set up safety precautions to prevent injury due to altered level of consciousness, and monitor fluid intake, urine volume, and specific gravity.

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. The child acts sleepy and unresponsive. Slight exophthalmos is observed. Auscultation reveals an irregular heart rate.

Correct response: Observation reveals tetany. Explanation: 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 caring for an 11-year-old child who has type 2 diabetes mellitus. The child has been vomiting for 48 hours and the breath has a fruity odor. The nurse notes that respirations are deep and rapid with a temperature of 102°F (38.9°C). Which intervention would be most appropriate? Give the child 8 ounces of clear liquid. Test the child's urine to detect the presence of ketones. Prepare for IV insertion. Give the child 25 g of carbohydrates.

Correct response: Prepare for IV insertion. Explanation: The child needs nursing interventions rapidly to change his or her diabetic status. This child should be given an IV with fluids and electrolytes to improve and restore tissue perfusion. Fruity breath and deep and rapid respirations are signs of ketoacidosis (hyperglycemia), which occurs before oral rehydration. The urine may show ketones, but checking the urine is not the priority in this risky situation.

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 Lispro NPH Detemir

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

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

Correct response: 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.

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. Oral cavity assessment shows two of the 6-year molars. The mother reports that the boy is always thirsty. The child has a faint rash on the trunk of the body.

Correct response: The child states that the exam room is cold. Explanation: 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.

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? Child appears pale and fatigued. There are purple striae on the abdomen. The child is excessively tall for chronologic age. The child is demonstrating signs of hypoglycemia.

Correct response: There are purple striae on the abdomen. Explanation: Cushing syndrome is caused by overproduction of the adrenal hormone cortisol. The overproduction of cortisol results in hyperpigmentation, which occurs from the melanin-stimulating properties of ACTH. Purple striae resulting from collagen deficit appear on the child's abdomen. The child will not be pale or fatigued. The child will not be excessively tall. The child will not be demonstrating signs of hypoglycemia.

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. This medication must be given in the morning before school. Hip or knee pain is an expected adverse effect of this medication. This medication does not interact with any other types of medication.

Correct response: This medication must be given by injection. Explanation: Somatropin is administered by injection. It is best given at the hour of sleep because that is when growth hormone is released. Hip or knee pain could indicate a slipped capital epiphysis and should be reported to the health care provider. The nurse should urge the parents to inform all health care providers that the child is receiving this medication to avoid medication interactions.

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 Tumor of the thyroid Tumor of the pancreas Tumor of the parathyroid

Correct response: 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 child presents to the primary care setting with enuresis, nocturia, increased hunger, weight loss, and increased thirst. What does the nurse suspect? Syndrome of inappropriate diuretic hormone Diabetes insipidus Type 1 diabetes mellitus Hypothyroidism

Correct response: Type 1 diabetes mellitus Explanation: Signs and symptoms of type 1 diabetes mellitus include polyuria, polydipsia, polyphagia, enuresis, and weight loss.

An elementary school child takes metformin three times each day. Which disorder would the school nurse expect the child to have? Type 1 diabetes mellitus Gastrointestinal reflux Inflammatory bowel disorder Type 2 diabetes mellitus

Correct response: Type 2 diabetes mellitus Explanation: 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.

An infant on the pediatric floor has diabetes insipidus. Which assessment data are important for the nurse to monitor while the infant is on strict fluid precautions? Oral intake Urine output Color of mucous membranes Temperature and heart rate

Correct response: Urine output Explanation: An infant with diabetes insipidus has a decrease in antidiuretic hormone. Strict fluid precautions will not alter urine formation. This assessment is important because the infant will be at great risk for dehydration and electrolyte imbalance. It is part of a basic assessment to monitor heart rate, temperature, skin turgor, and mucous membranes. These are important but may not indicate the infant's overall health. On fluid restriction, oral intake will be specified.

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 intake Oral mucosa Urine output

Correct response: 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 less than 126 mg/dl a fasting blood glucose greater than 126 mg/dl glucose in the urine

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

In teaching the parents of an infant diagnosed with diabetes insipidus, the nurse should include which treatment? the need for blood products antihypertensive medications hormone replacement fluid restrictions

Correct response: hormone replacement Explanation: The usual treatment for diabetes insipidus is hormone replacement with vasopressin or desmopressin acetate (DDAVP). Blood products shouldn't be needed. No problem with hypertension is associated with this condition, and fluids shouldn't be restricted.

In a child with diabetes insipidus, which characteristic would most likely be present in the child's health history? delayed closure of the fontanels (fontanelles), coarse hair, and hypoglycemia in the morning gradual onset of personality changes, lethargy, and blurred vision vomiting early in the morning, headache, and decreased thirst abrupt onset of polyuria, nocturia, and polydipsia

Correct response: 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. The other choices reflect symptoms of pituitary hyperfunction.

When would the nurse screen newborns for inborn errors of metabolism? before discharge and preferably within 12 hours of birth before discharge and preferably between 12 and 24 hours of birth before discharge and preferably between 24 and 72 hours of birth anytime after the first 7 days of life

Correct response: before discharge and preferably between 24 and 72 hours of birth Explanation: Newborn screenings are performed to detect illnesses that could be fatal or cause severe cognitive delays if not detected and treated early. All newborns complete newborn screening before discharge from the newborn nursery, preferably between 24 and 48 hours after birth. If the testing is done before 24 hours of age then it needs to be repeated at 14 days of life. In many states, newborn screening is mandated again at 14 days of life.

A child with a history of diabetes insipidus is admitted with polyuria, polydipsia, and mental confusion. Which is the priority intervention for this child? measure urine output check vital signs encourage increased fluid intake weigh the client

Correct response: check vital signs Explanation: 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.

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 measuring urine output encouraging increased fluid intake weighing the client

Correct response: checking vital signs Explanation: The large amount of fluid loss can cause fluid and electrolyte imbalance that should be corrected. The loss of electrolytes would be reflected in vital signs. Urine output is important. Encouraging fluids will not correct the problem and weighing the client is not necessary at this time.

A child with a primary growth hormone deficiency is to receive biosynthetic growth hormone. The nurse would explain to the child and parents that this hormone would be given at which frequency? daily weekly bi-monthly monthly

Correct response: daily Explanation: Biosynthetic growth hormone, derived from recombinant DNA, is given by subcutaneous injection. The weekly dosage is 0.2 to 0.3 mg/kg, divided into equal doses given daily for best growth.

A child with growth hormone deficiency is prescribed growth hormone (GH) by subcutaneous injection. When teaching the child's parents about this drug, the nurse would instruct the parents to administer the drug at which frequency? daily, 6 to 7 days a week every 3 days weekly monthly

Correct response: daily, 6 to 7 days a week Explanation: The parent or the child administers GH by subcutaneous injection usually 6 to 7 days per week (usually daily). It is generally given at bedtime to attempt to mimic the body's natural production and release during sleep.

The nurse is assessing a 1-month-old girl who, according to the mother, doesn't eat well. Which assessment suggests the child has congenital hypothyroidism? frequent diarrhea enlarged tongue tachycardia warm, moist skin

Correct response: enlarged tongue Explanation: Observation of an enlarged tongue along with an enlarged posterior fontanel (fontanelle) and feeding difficulties are key findings for congenital hypothyroidism. The mother would report constipation rather than diarrhea. Auscultation would reveal bradycardia rather than tachycardia, and palpation would reveal cool, dry, and scaly skin.

A pediatric client has just been diagnosed with diabetes insipidus. What is the primary consideration for this client? fluid replacement weight loss polydipsia headache

Correct response: fluid replacement Explanation: 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 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? vasopressin antidiuretic hormone oxytocin growth hormone

Correct response: 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), 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.

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

Correct response: 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.

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? glucagon adrenocorticotropic hormone insulin glycogen

Correct response: insulin Explanation: 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.

The nurse is caring for a child recently diagnosed with hypoparathyroidism disorder. Which medication would the nurse expect to be ordered? oral calcium oral corticosteroids intravenous diuretic therapy oral potassium

Correct response: oral calcium Explanation: Medical management of hypoparathyroidism includes intravenous calcium gluconate for acute or severe tetany, then intramuscular or oral calcium as prescribed. IV diuretics are used in the treatment of hyperparathyroidism. Oral corticosteroids and oral potassium are not used in the treatment of hypoparathyroidism.

The nurse is assessing a 4-year-old girl with ambiguous genitalia. Which finding suggests congenital adrenal hyperplasia? irregular heartbeat on auscultation pubic hair and hirsutism pain from constipation on palpation hyperpigmentation of the skin

Correct response: 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 blood pressure of 142/92 mm Hg slow healing wounds loose stools

Correct response: recent weight loss Explanation: 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.

The nurse is caring for a 12-year-old girl with hypothyroidism. Which information should be part of the nurse's teaching plan for the child and family? how to recognize vitamin D toxicity how to maintain fluid intake regimens administering methimazole with meals reporting irritability or anxiety

Correct response: reporting irritability or anxiety Explanation: Side effects of hypothyroidism are restlessness, inability to sleep, or irritability. These should be reported to the physician. Educating how to recognize vitamin D toxicity is necessary for a child with hypoparathyroidism. Teaching parents how to maintain fluid intake regimens is important for a child with diabetes insipidus. Teaching the child and parents to administer methimazole with meals is necessary for hyperthyroidism.

Which is the best way to control enzyme deficiencies? herbs and natural foods special diet restrictions and synthetic medical foods high-carbohydrate and low-fat diet high-protein and low-sodium diet

Correct response: special diet restrictions and synthetic medical foods Explanation: The goal of dietary restriction, the primary treatment modality for inborn errors of metabolism, is to control the substrate accumulation by reducing or eliminating carbohydrates, proteins, or both. Special diet restrictions and synthetic medical foods are the two most successful methods of controlling enzyme deficiencies.

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) diabetes insipidus (DI) hyposecretion of somatotropin hypersecretion of growth hormone

Correct response: syndrome of inappropriate antidiuretic hormone (SIADH) Explanation: 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 nurse working with the child diagnosed with type 2 diabetes recognizes the disorder can be managed by: taking oral hypoglycemic agents. increasing carbohydrates in the diet, especially in the evening. conserving energy with rest periods during the day. decreasing amounts of daily insulin.

Correct response: taking oral hypoglycemic agents. Explanation: 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.

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 5 minutes within 15 to 30 minutes within 60 to 90 minutes within 2 hours

Correct response: 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.

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 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.

The nurse is assessing a child diagnosed with Cushing syndrome. Which signs and symptoms would the nurse likely note? Select all that apply. acne abdominal striae excessive hair growth thin face sunken abdomen

acne abdominal striae excessive hair growth Explanation: Signs and symptoms of Cushing syndrome include excessive hair growth, moon face with ruddy cheeks, dorsocervical fat pad, truncal obesity, abdominal striae, easy bruising, and poor wound healing.

The nurse is caring for a child who has developed thyroid storm. What intervention(s) will the nurse initiate? Select all that apply. cooling blanket continuous cardiac monitoring increase dosage of L-thyroxine sodium decrease stimulation, such as turning off lights and television decrease caloric intake by 10% to 15%

cooling blanket continuous cardiac monitoring decrease stimulation, such as turning off lights and television Explanation: Signs and symptoms related to the development of thyroid storm include fever, diaphoresis, and tachycardia. Children with thyroid storm are typically restless and irritable. Interventions include a cooling blanket, continuous cardiac monitoring and decreasing stimulation. Caloric intake may need to be increased and dosages of L-thyroxine sodium may need to be held or decreased.

The nurse works to accomplish the best results for children with inborn errors of metabolism and their families. Which approaches to the problem should the nurse take? Select all that apply. prevention early diagnosis tertiary care prompt treatment

prevention early diagnosis prompt treatment Explanation: The management of children and families affected by inborn errors of metabolism is approached by the health care team in three ways: prevention, early diagnosis, and prompt treatment. If there is a familial history, the parents should be screened for problems before conception or shortly after conception. With an early diagnosis there can be early treatment. Early treatment prevents many long term complications. Tertiary care is involved when a diagnosis has already been made and rehabilitation is needed.

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 ______,________,________ Laboratory Values: blood glucose serum potassium serum sodium level of consciousness fluid balance

serum sodium level of consciousness fluid balance Explanation: 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).

A child with a history of diabetes insipidus has been taking vasopressin. The parents bring the child to the clinic for an evaluation. During the visit, the parents mention that it seems like their son is hardly urinating. The nurse suspects syndrome of inappropriate antidiuretic hormone. What findings would the nurse expect to find to help confirm this condition? Select all that apply. urine specific gravity 1.033 decreased serum sodium level serum osmolality 260 mOsm/kg (260 mmol/kg) decreased urine osmolality weight loss hypotension

urine specific gravity 1.033 decreased serum sodium level serum osmolality 260 mOsm/kg (260 mmol/kg) Explanation: Syndrome of inappropriate antidiuretic hormone (SIADH) is characterized by decreased urination, hyponatremia, serum osmolality less than 280 mOsm/kg (280 mmol/kg), urine specific gravity greater than 1.030, increased urine osmolality, fluid retention, weight gain, and hypertension.

Chapter 26: Nursing Care of the Child With an Alteration in Metabolism/Endocrine Disorder

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