Chapter 31, The Child with Endocrine Dysfun

The nurse is planning care for a child with recently diagnosed diabetes insipidus. Which nursing intervention is included? 1 Encouraging the child to wear medical identification 2 Discussing with the child and family ways to limit fluid intake 3 Teaching the child and family how to do required urine testing 4 Reassuring the child and family that diabetes insipidus is not a chronic or life-threatening illness

1 Because of the unstable nature of the child's fluid and electrolyte balance, encouraging the child to wear a medical alert bracelet or carrying a medical identification card is an extremely important intervention. With diabetes insipidus the child should have unrestricted access to fluids because the child will characteristically have polyuria as a result of hyposecretion of antidiuretic hormone. No urine testing is required with diabetes insipidus. This disorder should not be confused with diabetes mellitus. Diabetes insipidus is both lifelong and life threatening. Medication must be taken and the effects monitored closely. p. 1179

Which condition is common in a child with Turner syndrome and in one with growth hormone (GH) deficiency? 1 Growth failure 2 Normal bone age 3 Chromosomal abnormalities 4 An increase in weight/height ratio

1 Children with Turner syndrome and children with GH deficiency have growth failure. Whereas the child with Turner syndrome has near normal bone age, the child with GH deficiency has delayed epiphyseal maturation. Turner syndrome, not GH deficiency, is due to chromosomal abnormalities. In GH deficiency, there is an increased weight/height ratio. Such an increase is not seen in Turner syndrome.

Cushing syndrome is a characteristic group of manifestations caused by excessive circulation of which hormone? 1 Free cortisol 2 Thyroid hormone 3 Androgen hormones 4 Adrenocorticotropic hormone (ACTH)

1 Cushing syndrome is characterized by a group of manifestations caused by excessive circulating free cortisol, not excessive circulating thyroid hormone, excessive circulating ACTH, or excessive circulating androgen hormones.

Which changes in the management of the child with type 1 diabetes mellitus are expected as a result of more exercise? 1 Increased food intake 2 Decreased food intake 3 Decreased risk of insulin shock 4 Increased risk of hyperglycemia

1 Food intake should be increased when the child is more active. During races and other competitions, more food may be required than during practice to maintain a balance between glucose and exogenously administered insulin. The child will require increased food on days of increased activity. The increased activity lowers the blood glucose level. Blood sugar must be monitored closely to avoid administration of too much insulin during a time of reduced need.

A nurse is caring for a 15-year-old girl who is experiencing polyuria, polydipsia, and polyphagia. The girl is underweight and reports being extremely fatigued over the past 3 days. The nurse anticipates testing will confirm which diagnosis? 1 Type 1 diabetes 2 Type 2 diabetes 3 Pheochromocytoma 4 Congenital adrenal hyperplasia

1 Polyuria, polydipsia, and polyphagia in an underweight girl under the age of 20 are suggestive of type 1 diabetes. Type 2 diabetes progresses gradually, and polyuria, polydipsia, and polyphagia are not observed as often. Pheochromocytoma is a rare tumor characterized by the secretion of catecholamines. Congenital adrenal hyperplasia is characterized by the secretion of excessive amounts of cortisol precursors and androgens.

Which is the most effective treatment option for children with type 1 diabetes? 1 Diet only 2 Oral agents 3 Insulin and diet 4 Diet and oral agents

3 Insulin and dietary changes are the current treatment for children with type 1 diabetes. Dietary changes alone are not effective in treating type 1 diabetes. Oral agents are effective against type 2 diabetes, not type 1. Diet and oral agents are used to treat type 2 diabetes, not type 1 diabetes.

Which is a common clinical manifestation of hypopituitarism that occurs due to deficiency of growth hormone (GH) or a deficiency of thyroid-stimulating hormone (TSH)? 1 Short stature 2 Delayed dentition 3 Increased insulin sensitivity 4 Delayed epiphyseal closure

1 Short stature may be seen due to deficiency of GH as well as due to TSH deficiency. However, a patient with GH deficiency has short stature with proportional height and weight, whereas a patient with TSH deficiency has a short stature with infantile proportions. Delayed dentition is a feature of TSH deficiency. Increased insulin sensitivity and delayed epiphyseal closure occur due to GH deficiency, not TSH deficiency.

Which statement does the nurse include in teaching for the parents of a child with diabetes regarding insulin injections? 1 "Pinch the skin when injecting insulin." 2 "Keep the needle at 30 degrees to the skin." 3 "Inject insulin into the same area each time." 4 "Inject insulin either into the abdomen or the thigh."

1 The nurse should teach that pinching will tent the skin and allow easy access of the needle to the subcutaneous tissue. The injection needle should be at 90 degrees to the skin. Insulin absorption is slowed by fat pads that develop in overused injection areas. Therefore the parents and child should be taught to work out a rotation pattern to inject into various areas of the body and enhance absorption. Insulin can be injected into any area where there is adipose tissue over muscle. The usual injection sites for insulin injections are the arms, thighs, hips, and abdomen.

What is the difference between type 1 and type 2 diabetes mellitus (DM)? 1 Twin concordance is less in type 1 DM than in type 2 DM. 2 Most diabetic people have type 1 DM rather than type 2 DM. 3 Insulin therapy is required in more cases of type 2 DM than in type 1 DM. 4 Islet-cell antibodies are found more often in type 2 DM than in type 1 DM.

1 Twin concordance is 25% to 50% in type 1 DM and 90% to 100% in type 2 DM. Among the diabetic population, 5% to 8% of those affected have type 1 DM and 85% to 90% have type 2 DM. Insulin therapy is always required for type 1 DM. About 20% to 30% of the type 2 DM patients require insulin therapy. Islet-cell antibodies are found in 80% to 85% of type 1 DM patients and in less than 5% of type 2 DM.

Which physiologic alteration is characterized by destruction of pancreatic beta cells that produce insulin? 1 Type 1 diabetes 2 Type 2 diabetes 3 Gestational diabetes 4 Impaired glucose tolerance

1 Type 1 diabetes is characterized by destruction of the insulin-producing pancreatic beta cells. Type 2 diabetes is a result of insulin resistance. The insulin-producing pancreatic beta cells are destroyed in type 1 diabetes and are not associated with impaired glucose tolerance. Gestational diabetes occurs during pregnancy and is not associated with the destruction of pancreatic beta cells.

The nurse is assessing a child with delayed growth. Which questions does the nurse include in the assessment while interviewing the parents? Select all that apply. 1 "Tell me about diseases in your family." 2 "What kind of medications does the child take?" 3 "Have there been changes in the child's appetite?" 4 "What kind of developmental issues did the child have?" 5 "What behavioral therapies is the child undergoing now?"

1,2,3,4 The nurse asks about diseases in the family to assess any hereditary causes for delayed growth. The nurse also asks about any developmental issues in the past to evaluate if they are linked to growth delay. Asking about medications will help to assess the child's health status. Asking about the child's appetite may help to identify if nutritional inadequacy has led to delayed growth. Behavioral therapies do not have an impact on the child's growth.

Which are the signs and symptoms of diabetic ketoacidosis? Select all that apply. 1 Ketonuria 2 Ketonemia 3 Dehydration 4 Acetone breath 5 Shallow, slow breathing

1,2,3,4 Signs and symptoms of diabetic ketoacidosis include ketonuria, ketonemia, dehydration, and acetone breath. Kussmaul respirations (rapid and deep, not slow and shallow) are usually present.

Parents have brought their child in to the clinic for a well-child visit. They express some concern that the child seems to have short stature. The nurse needs to determine if the cause is familial short stature or constitutional growth delay. Which steps does the nurse take to evaluate the growth curve? Select all that apply. 1 Assess the child's height velocity. 2 Determine the child's absolute height. 3 Determine the child's motor development. 4 Determine the child's weight-to-height ratio. 5 Determine the child's cognitive development

1,2,4 The nurse determines the absolute height and the weight of the child and compares it with the standard growth charts so that abnormal growth patterns can be assessed. Deceleration of height velocity helps to identify any pathologic condition for abnormal growth. The weight-to-height ratio is assessed to find the cause of the growth delay in the child with short stature. Cognitive development of the child is assessed in cases of cognitive impairment. Motor development is assessed when a condition like hyperthyroidism is suspected.

A child with meningococcemia reports headache, abdominal pain, nausea, and diarrhea. On examination the nurse finds that the child's pulse is weak and rapid, blood pressure is 80/50 mm of Hg, respirations are shallow, and skin is cold and clammy. The primary health care provider has instituted appropriate treatment. What does the nurse monitor in this child? Select all that apply. 1 The child's response to fluid replacement 2 The child's response to insulin replacement 3 The child's response to cortisol replacement 4 The child's response to sodium replacement 5 The child's response to thyroxine replacement

1,3 The signs and symptoms of the child indicate adrenal crisis, which is generally seen in patients with meningococcemia. Its treatment includes immediate fluid and cortisol replacement. Therefore the nurse should monitor for the child's response to the treatment. Too rapid administration of fluids can result in cardiac failure, and overdose of cortisol can lead to hypotension. Insulin replacement is done in case of diabetes mellitus. Sodium replacement is usually required for patients with hyponatremia, such as in cases of syndrome of inappropriate antidiuretic hormone secretion (SIADH), whereas thyroxine replacement is required for patients with hypothyroidism.

A neonate with a goiter has just been admitted to the newborn nursery. Which is the priority nursing intervention? 1 Positioning the neonate on the left side 2 Having a tracheostomy set at the bedside 3 Suctioning the child at least every 5 to 10 minutes 4 Explaining to the parents how to place the dressing on the goiter

2 The goiter puts the infant at risk for respiratory failure. Preparations are made for emergency ventilation, including having a tracheostomy set at the bedside. Placing the neonate in a side-lying position is not indicated. Hyperextension of the child's neck may facilitate breathing. There is no indication for suctioning in a neonate with goiter. No dressing is indicated in a neonate who has a goiter.

A child is on hormone replacement therapy for panhypopituitarism. What instructions does the nurse give to the child's parents? Select all that apply. 1 Provide same age-appropriate responsibilities as the child's siblings. 2 Provide responsibilities that would be appropriate for a younger child. 3 Encourage the child to wear medical identification at all times. 4 Encourage the child to participate in group activities with peers. 5 Keep the child away from other children, because they will bully the child.

1,3,4 The growth rate of children undergoing hormone replacement therapy is slower than that of their peers. They may appear younger than their age, and others may behave with them in childish ways. Therefore parents should give them the same age-appropriate responsibilities as their siblings. It is also important for a nurse to advise that these children should wear medical identification at all times. They should also be encouraged to participate in group activities with their peers as they approach adolescence. It helps them to lead a normal life. Giving responsibilities that are not appropriate to the child's age may hinder the development of the child. Keeping the child away from other children may lead to isolation and hamper appropriate growth and development.

Which clinical manifestations in children help to distinguish between hypoglycemia and hyperglycemia? Select all that apply. 1 A child with hypoglycemia has sweating. 2 A child with hypoglycemia has nausea and vomiting. 3 A child with hyperglycemia has exaggerated reflexes. 4 A child with hyperglycemia has deep, rapid breathing. 5 A child with hyperglycemia has tachycardia and palpitations.

1,4 In a child with hypoglycemia, sweating reflects increased adrenergic nervous system activity plus increased secretion of catecholamines. Deep and rapid respirations, or Kussmaul breathing, is a sign of diabetic ketoacidosis, which indicates that the child is hyperglycemic. Nausea and vomiting are common in a child with hyperglycemia. Children with hyperglycemia show diminished reflexes on neurologic evaluation. Children with hypoglycemia have tachycardia and palpitations.

The nurse is teaching an adolescent with newly diagnosed type I diabetes ways to minimize discomfort with insulin injections. Which recommendations are helpful in minimizing injection discomfort? Select all that apply. 1 Do not reuse needles. 2 Inject insulin when it is cold. 3 Flex or tense the muscle during injection. 4 Remove all bubbles from the syringe before the injection. 5 Do not move the direction of the needle-syringe during insertion or withdrawal.

1,4,5 The reuse of needles leads to more discomfort on injection because the needles become dull, and this also poses an infection-control problem. Removing bubbles from the syringe will minimize discomfort. Keeping the direction of the syringe constant during the insertion and withdrawal minimizes discomfort. Insulin should be injected at room temperature to minimize discomfort. Flexing or tensing the muscle during injection causes more discomfort.

Which are the clinical manifestations of juvenile hypothyroidism? 1 Sleepiness, dry skin, diarrhea 2 Dry skin, sparse hair, slowed growth 3 Diarrhea, dry skin, decelerated growth 4 Constipation, dry skin, enlarged thyroid

2 Clinical manifestations of juvenile hypothyroidism include dry skin, sparse hair, decelerated growth, constipation, puffiness around the eyes, sleepiness, and mental decline. Diarrhea and enlarged thyroid are not associated with juvenile hypothyroidism.

An infant is born with ambiguous genitalia. Tests are being performed to enable sex assignment. The parents tell the nurse that family and friends are asking what caused the baby to be this way. Which is the nurse's best response? 1 Explain the disorder so the parents can explain it to others 2 Help the parents understand that no one knows how this occurs 3 Encourage the parents not to worry while the tests are being done 4 Suggest that the parents avoid family and friends until the sex is assigned

2 Explaining the disorder to the parents so that they can explain it to others is the most therapeutic approach while the parents await the sex assignment of their child. Ambiguous genitalia are caused by decreased enzyme activity required for adrenocortical production of cortisol. Avoidance of family and friends is impractical and would isolate the family from their support system while they await test results. The parents will be concerned; telling them not to worry without giving them specific alternative actions will not be effective.

Which manifestation helps the nurse to identify hyperglycemia in a child with diabetes mellitus (DM)? 1 Excessive sweating 2 Presence of acetone breath 3 Shallow normal respirations 4 Presence of paleness or pallor

2 Fruity, acetone breath is easily identified in the child with hyperglycemia. In the absence of insulin, glucose is unavailable for cellular metabolism. Consequently, fats break down into fatty acids, and glycerol in the fat cells is converted by the liver to ketone bodies. Any excess is eliminated in the urine (ketonuria) or the lungs (acetone breath). The skin appears flushed and shows signs of dehydration. The respiratory system tries to eliminate the excess carbon dioxide by increased depth and rate of breathing, which is known as Kussmaul respirations. Hypoglycemia causes sweating, paleness, and pallor. Respirations are shallow and normal in hypoglycemia.

The parents of a child who is receiving growth hormone replacement therapy are not satisfied with the outcome of the treatment, because the child's height is not increasing. The child is still shorter than school peers. Which is the most appropriate action of the nurse? 1 Increase the dose of growth hormone to the child. 2 Reassure the parents and set realistic expectations. 3 Change the route of administration of growth hormone. 4 Advise the parents to feed the child with high protein diet.

2 It is important for a nurse to educate the parents about the expected outcomes of growth hormone replacement therapy. The nurse should inform them that these children are likely to attain their eventual adult height slowly when compared to their peers. Therefore parents should set realistic expectations. Increasing the dose is not required at this stage and should not be done without consulting the primary health care provider. Changing the route of administration is of no use, because the therapeutic effect remains the same. Giving a high protein diet to the child will not result in increased growth rate.

Which are the cardinal signs of diabetes insipidus? 1 Vascular anomalies 2 Polyuria and polydipsia 3 Hypotension and dehydration 4 Dehydration and diminished urine output

2 Polyuria and polydipsia are the cardinal signs of diabetes insipidus (DI). Vascular anomalies can be a secondary cause of DI but are not cardinal signs of DI. Hypotension and dehydration are not the cardinal signs of DI. Dehydration and diminished urine output may occur with DI but are not the cardinal signs of DI.

How is the parasympathetic nervous system different from the sympathetic nervous system? 1 Parasympathetic nervous system secretes neurotransmitting substances. 2 Parasympathetic nervous system primarily regulates the digestive system. 3 Parasympathetic nervous system maintains homeostasis during times of stress. 4 Parasympathetic nervous system controls the nonvoluntary functions of the body.

2 Unlike the sympathetic nervous system, the parasympathetic nervous system primarily regulates the digestive system of the body. Both the parasympathetic and the sympathetic nervous systems secrete neurotransmitting substances. The sympathetic, not the parasympathetic, nervous system maintains homeostasis during times of stress. Both systems control nonvoluntary functions of the body.

A child with generalized tuberculosis is diagnosed with total adrenal insufficiency and is prescribed cortisol and antitubercular drugs for long-term use. Which statement does the nurse include in parent teaching? 1 "Give antibiotics regularly to avoid adrenal crisis." 2 "Always have a prefilled syringe of hydrocortisone at home." 3 "Give a high-fat and high-protein diet to prevent malnutrition." 4 "Do not give cortisol injection when the child vomits the food and the tablet."

2 The most probable reason for the child's adrenal insufficiency is tuberculosis. A child with adrenal insufficiency is put on long-term treatment with cortisol. It is important for a nurse to advise the parents that sudden termination of cortisol therapy can lead to adrenal crisis. Therefore they should always have an extra supply of prefilled syringes of hydrocortisone at home. Antibiotics cannot prevent adrenal crisis, because they are only effective against infectious agents. The child is at risk of obesity, so a high-fat diet should be avoided. The child can be at risk of adrenal crisis due to vomiting of tablets, and in such cases, cortisol injections should be given.

The nurse is assessing a child for pituitary hyperfunction. Which assessment findings does the nurse recognize as an effect of hyperpituitarism? Select all that apply. 1 Absence of sexual maturation 2 Overgrowth of the long bones 3 Thickened, deeply creased skin 4 Delayed dentition and tooth loss

2,3,5 Excess growth hormone (GH) in the child with hyperpituitarism results in proportional overgrowth of the long bones. If oversecretion of GH occurs after epiphyseal closure, growth is in the transverse direction. Manifestations include separation and malocclusion of the teeth in the enlarged jaw and thickened, deeply creased skin. Deficient secretion of pituitary gonadotropin-releasing hormones causes gonadotropin deficiency, with absence or regression of secondary sex characteristics. Thyroid-stimulating hormone deficiency hypopituitarism leads to delayed dentition and loss of teeth. Teeth may be overcrowded and malpositioned in an underdeveloped jaw.

What are the similarities between cortisol and aldosterone? Select all that apply. 1 Both are mineralocorticoids. 2 Both promote sodium retention. 3 Both promote potassium retention. 4 Both are produced by the adrenal cortex. 5 Both are regulated by the renin-angiotensin system.

2,4 Both cortisol and aldosterone promote sodium retention in the renal tubules. Both hormones are produced by the adrenal cortex. Aldosterone is a mineralocorticoid, whereas cortisol is a glucocorticoid. Both hormones promote potassium excretion, not potassium retention. Aldosterone production is regulated by the renin-angiotensin system of the kidney, whereas cortisol production is regulated by a feedback mechanism that involves the hypothalamus and the pituitary gland.

How is the delivery of insulin through an insulin infusion pump different from delivery of insulin through subcutaneous injections? 1 Insulin infusion pump delivers insulin into the thigh muscles. 2 Insulin infusion pump causes less skin infections than injections. 3 Insulin infusion pump delivers fixed amounts of insulin continuously. 4 Insulin infusion pump is less expensive than giving multiple injections.

3 An insulin infusion pump delivers fixed amounts of insulin continuously, similar to the release of insulin from the islet cells of the pancreas. Both the infusion pump and the injections deliver insulin into the subcutaneous tissue of either the abdomen or the thigh and not into the muscles. Because the infusion pump stays in place, skin infections are common. Delivery of insulin through infusion pumps is more expensive than delivery of insulin through injections.

The child has been diagnosed with diabetic ketoacidosis (DKA). The nurse plans care based on which understanding of diabetic ketoacidosis? 1 DKA is best treated at home 2 DKA is best treated at a practitioner's office or clinic 3 Immediate treatment is required because DKA is a life-threatening situation 4 No treatment is required, because DKA is an expected outcome of type 1 diabetes mellitus

3 DKA is the complete state of insulin deficiency. It is a medical emergency that must be diagnosed and treated immediately. The child is usually admitted to an intensive care unit for assessment, intravenous insulin administration, and fluid and electrolyte replacement. DKA is a medical emergency needing prompt assessment and intervention, usually in an intensive care environment. It is not an expected outcome of type 1 diabetes mellitus. DKA is a medical emergency that requires hospitalization, usually in an intensive care unit. p. 1198

Which is the nurse's best action when caring for a child with diabetes who has a diminished food intake due to typhoid? 1 Restrict the child's fluid intake. 2 Omit insulin therapy during the illness. 3 Monitor blood glucose of the child every 3 hours. 4 Notify the primary health care provider if the child vomits more than three times.

3 Illness alters diabetes management, and it is important to restore euglycemia during illness. Therefore blood glucose should be monitored every 3 hours. Encouraging adequate fluid intake is the most important intervention during an illness. It prevents dehydration and flushes out ketones. Insulin is not omitted during an illness; however, the dose may be adjusted as required. The health care provider must be notified if the child vomits more than once.

Which is a common clinical manifestation of adrenocortical insufficiency that occurs due to deficiency of glucocorticoids and mineralocorticoids? 1 Fewer pubic and axillary hairs 2 Hyperkalemia and hyponatremia 3 Irritability, apathy, and negativism 4 Hyperpigmentation in knees and elbows

3 In a child with adrenocortical insufficiency, irritability, apathy, and negativism are psychologic symptoms that occur due to deficiency of glucocorticoids as well as due to deficiency of mineralocorticoids. Decreased pubic and axillary hair occur due to androgen deficiency in older children and adults with adrenocortical insufficiency. Hyperkalemia and hyponatremia occur due to mineralocorticoid deficiency but not due to glucocorticoid deficiency. Hyperpigmented knees and elbows occur due to increased adrenocorticotropic hormone and β-lipoprotein.

How is Hashimoto disease different from Graves disease (GD)? 1 Hashimoto disease has a peak incidence during the first 3 years of life. 2 Hashimoto disease is the most common cause of hyperthyroidism in children. 3 Hashimoto disease is characterized by an increase in thyroid-stimulating hormone (TSH). 4 Hashimoto disease is adequately treated with surgical ablation of the thyroid tumor.

3 Patients with Hashimoto disease, or lymphocytic thyroiditis, have an increase in TSH, though other thyroid function tests may be normal. Though Hashimoto disease can occur during the first 3 years of life, its peak incidence occurs during adolescence. GD is the most common cause of hyperthyroidism in children; Hashimoto disease is the most common thyroid disease in children, but it causes hypothyroidism, not hyperthyroidism. Surgery is contraindicated in Hashimoto disease. Surgical ablation of the thyroid tumor may be considered in GD.

An infant presents with hypospadias, micropenis, and no palpable gonads. Which term does the nurse use to document these findings? 1 Atrophy 2 Cushing syndrome 3 Ambiguous genitalia 4 Adrenal insufficiency

3 The condition of ambiguous genitalia is marked by hypospadias, micropenis, and no palpable gonads. Cushing syndrome is an endocrine disorder that involves excessive circulating free cortisol. Atrophy and adrenal insufficiency are not associated with hypospadias, micropenis, or palpable gonads.

What levels of thyroid hormone (TH) and thyroid-stimulating hormone (TSH) characterize primary congenital hypothyroidism? 1 Low level of circulating TH, low level of TSH at birth 2 Low level of circulating TH, normal level of TSH at birth 3 Low level of circulating TH, elevated level of TSH at birth 4 High level of circulating TH, elevated level of TSH at birth

3 The thyroid hormones run on a negative feedback loop. Therefore low levels of circulating thyroid hormone (TH) and elevated levels of thyroid-stimulating hormone (TSH) at birth are characteristic of primary congenital hypothyroidism. Primary congenital hypothyroidism is not associated with low levels of both TH and TSH, low TH with normal TSH, or high levels of both TH and TSH.

How is the function of the neurohypophysis different from that of the adenohypophysis? 1 The neurohypophysis secretes growth hormone. 2 The neurohypophysis secretes luteinizing hormone. 3 The neurohypophysis secretes antidiuretic hormone. 4 The neurohypophysis secretes follicle-stimulating hormone

3 The neurohypophysis is the posterior lobe of the pituitary gland, whereas the adenohypophysis is the anterior lobe of the pituitary gland. The neurohypophysis secretes antidiuretic hormone. Growth hormone, luteinizing hormone, and follicle-stimulating hormone are secreted by the adenohypophysis, not the neurohypophysis.

Which manifestation of type 2 diabetes helps the nurse to distinguish it from type 1 diabetes? 1 Rapid, deep breathing 2 Absence of serum insulin 3 Relative insulin deficiency 4 Excessive thirst and hunger

3 Type 2 diabetes usually arises because of insulin resistance, in which the body fails to use insulin properly, combined with relative insulin deficiency. Type 1 diabetes leads to excessive hunger, thirst, and urination. Type 1 diabetes is characterized by destruction of the pancreatic beta cells, which produce insulin; this usually leads to absolute insulin deficiency. In the type I diabetic with hyperglycemia, the respiratory system attempts to eliminate the excess carbon dioxide by increased depth and rate known as Kussmaul respirations.

What is the difference between epinephrine and norepinephrine? 1 Epinephrine elevates blood pressure and norepinephrine reduces blood pressure. 2 Norepinephrine increases cardiac output and epinephrine decreases cardiac output. 3 Norepinephrine affects only the beta receptors and epinephrine affects both alpha and beta receptors. 4 Epinephrine can affect both alpha and beta receptors and norepinephrine affects only the alpha receptors.

4 Epinephrine can affect both alpha and beta receptors, whereas norepinephrine affects only the alpha receptors. Epinephrine causes only weak constriction of the blood vessels of muscles in comparison to norepinephrine; therefore it is norepinephrine, not epinephrine, that elevates the blood pressure. Epinephrine has a greater effect on cardiac activity than norepinephrine; epinephrine, rather than norepinephrine, increases the cardiac output. Norepinephrine affects only the alpha receptors, rather than the beta receptors.

What kind of activity restrictions are placed on the child with recently diagnosed type 1 diabetes? 1 Daily exercise is contraindicated. 2 The child may not participate in sports. 3 Swimming is acceptable, but soccer is too strenuous. 4 No activities are restricted unless they are contraindicated because of other health conditions.

4 Exercise is encouraged for children with diabetes because it reduces blood glucose. Insulin and meal requirements require careful monitoring to ensure that the child has sufficient energy for exercise. Participating in sports can be a healthy part of life for a child with type 1 diabetes. Exercise is not contraindicated in children with type 1 diabetes. Swimming is acceptable and so is soccer.

Which is the best method for assessing control of diabetes? 1 Urine testing 2 Patient logbooks 3 Self-monitoring of blood glucose 4 Glycosylated hemoglobin (hemoglobin A1c) testing

4 Glycosylated hemoglobin (hemoglobin A1c) is the best parameter for assessing control of diabetes. Urine testing for glucose is no longer used because there is poor correlation between simultaneous glycosuria and blood glucose concentrations. Patient logbooks and self-monitoring with the use of blood glucose monitors are helpful in assessing diabetes control, but hemoglobin A1c is the best method.

Which diagnostic finding helps distinguish nephrogenic diabetes insipidus (DI) from central DI? 1 Rise in urine osmolality after fluid deprivation 2 Loss of the body weight after fluid deprivation 3 Rise in urine osmolality after injection of vasopressin 4 Unresponsiveness to administration of exogenous vasopressin

4 Nephrogenic DI is caused by unresponsiveness of the renal tubules to the hormone vasopressin. Therefore there is no change in the urine on administering exogenous vasopressin. Though normally fluid deprivation causes a decrease in volume and increase in osmolality of the urine, such a change is not seen with fluid deprivation in DI. However, loss of body weight may occur due to dehydration. Central DI occurs due to inadequate production of the hormone vasopressin. An injection of vasopressin will therefore cause a rise in the urine osmolality if there is central DI. However, such a change will not be seen in the case of nephrogenic DI.

The student nurse is caring for a patient with pheochromocytoma. Which action, if performed by the student nurse, would prompt the charge nurse to intervene immediately? 1 Checking the blood pressure of the patient 2 Checking the respiratory rate of the patient 3 Measuring the blood glucose levels in patient 4 Palpating the mass to note its measurements in patient

4 Pheochromocytoma is a tumor usually arising from the chromaffin cells of the adrenal medulla and is characterized by increased catecholamine secretions. This can lead to hypertension, hyperglycemia, tachypnea, tachycardia, headache, polydipsia, and polyuria. The nurse should know that the adrenal mass should never be palpated, because this can lead to an increased secretion of catecholamines, which can in turn result in severe hypertension and tachyarrhythmias. The nurse should regularly monitor the patient's blood pressure, respiratory rate, and blood glucose levels.

When does rapid-acting insulin peak? 1 2 hours after injection 2 5 hours after injection 3 15 to 30 minutes after injection 4 30 to 90 minutes after injection

4 Rapid-acting insulin peaks 30 to 90 minutes after injection, not 2 hours, 5 hours, or 15 to 30 minutes after injection.

Which is the most appropriate test to diagnose Cushing syndrome in a child? 1 Serum potassium level 2 Histamine stimulation test 3 Fasting blood glucose level 4 Dexamethasone suppression test

4 The dexamethasone suppression test provides a definitive diagnosis of Cushing syndrome. Administration of exogenous dexamethasone (cortisone) normally suppresses the production of adrenocorticotrophic hormone (ACTH). This decreases the production of cortisol from the adrenals. However, in Cushing syndrome, the cortisol level remains elevated. Serum potassium level indicates hypokalemia in Cushing syndrome; however, hypokalemia may also be seen in other conditions, such as catecholamine-secreting tumors of the adrenal medulla and diabetic ketoacidosis, and is not the definitive test to diagnose Cushing syndrome. A histamine stimulation test is a definitive test for pheochromocytoma. Although a fasting blood glucose level may be elevated in Cushing syndrome, it is not a definitive diagnostic test for Cushing syndrome.

How is type 2 diabetes mellitus (DM) different from type 1 DM in children? 1 Type 2 DM has an abrupt onset. 2 Type 2 DM occurs primarily in white people. 3 Type 2 DM is a chronic disorder of metabolism. 4 Type 2 DM is frequently associated with a family history.

4 Type 2 DM typically occurs in children who have a family history of diabetes. Type 1 DM is only sometimes associated with a family history. Onset of type 2 DM is gradual, whereas that of type 1 DM is abrupt. Type 1 DM occurs primarily in white people. The incidence of type 2 DM is higher for Native American, African American, and Hispanic children. Both type 1 and type 2 DM are chronic metabolic disorders.

A child with diabetes insipidus is admitted to the hospital. Which nursing interventions are most important for this child? Select all that apply. 1 Monitor temperature. 2 Check airway and breathing. 3 Monitor blood glucose levels. 4 Administer intravenous fluids. 5 Monitor urine volumes regularly

4,5 In diabetes insipidus there is a deficiency of vasopressin, which is characterized by polydipsia and polyuria. A nurse should be aware that dehydration can occur in children who are not able to drink fluids voluntarily. Therefore in these cases the nurse should administer intravenous fluids and monitor urine volumes regularly. Although dehydration can cause hyperthermia (and temperature is monitored in all hospitalized patients), this is not a priority intervention. Checking airway and breathing are less important, because diabetes insipidus does not hamper respiration and circulation. Blood glucose levels should be monitored in cases of diabetes mellitus.

The parents of a child who is on a long-term steroid therapy are worried about the child's appearance. The child has gained a lot of weight and has excessive hair growth. The nurse finds that the child has moon face, pendulous abdomen, and red abdominal striae. The nurse reports the findings to the provider and prepares to provide which education to the parents? Select all that apply. 1 Reduce the drug dose. 2 Give the drug in the evening. 3 Give the drug daily without fail. 4 Give the drug on alternate days. 5 Give the drug early in the morning.

4,5 The signs and symptoms of the child indicate cushingoid syndrome due to long-term steroid therapy. It is important for a nurse to inform the parents that this condition is reversible. The effects of steroid therapy can be reduced by giving the drug on an alternate-day basis and early in the morning. An alternate-day schedule gives the anterior pituitary gland an opportunity to maintain a normal hypothalamus-pituitary-adrenal axis, and giving it early in the morning helps maintain a normal diurnal pattern of cortisol. It should not be given in the evening, because the levels of cortisol are low in the evening, and additional supply can result in pronounced effects. The drug should not be given daily, because it can cause overdose. Reducing the drug dosage can reduce the therapeutic effects. The drug should not be stopped abruptly, because this can lead to adrenal insufficiency.

Calculate the estimated target height of a 10-year-old daughter if the heights of the father and mother are 177 cm and 160 cm, respectively. Record your answer as a whole number. _________ cm

The formula for calculating estimated target height of a female child is (father's height [in cm] plus mother's height [in cm] - 13) divided by 2. Therefore the daughter's estimated target height is [(177 + 160 - 13)/2] = 162 cm.