Chapter 31: The Child with Endocrine Dysfunction

A child with growth hormone (GH) deficiency is receiving GH therapy. When is the best time for the GH to be administered?

a. At bedtime

The nurse is planning care for a child recently diagnosed with diabetes insipidus (DI). What intervention should be included?

a. Encourage the child to wear medical identification.

A 12-year-old girl is newly diagnosed with diabetes when she develops ketoacidosis. How should the nurse structure a successful education program?

a. Essential information is presented initially.

The nurse is caring for an adolescent with anorexia nervosa. What pituitary dysfunction should the nurse assess for in the adolescent?

a. Hypopituitarism

The nurse is assisting with a growth hormone stimulation test for a child with short stature. What should the nurse monitor closely on this child during the test?

a. Hypotension

The thyroid-stimulating hormone (TSH) increases secretion in response to which hormone?

a. Low levels of circulating thyroid hormone

A school-age child with diabetes gets 30 units of NPH insulin at 0800. According to when this insulin peaks, the child should be at greatest risk for a hypoglycemic episode between when?

a. Lunch and dinner

A goiter is an enlargement or hypertrophy of which gland?

a. Thyroid

What form of diabetes is characterized by destruction of pancreatic beta cells, resulting in insulin deficiency?

a. Type 1 diabetes

During the summer many children are more physically active. What changes in the management of the child with diabetes should be expected as a result of more exercise?

a. increase food intake

Chronic adrenocortical insufficiency is also referred to as:

b. Addison disease.

A preadolescent has maintained good glycemic control of his type 1 diabetes through the school year. During summer vacation, he has had repeated episodes of hypoglycemia. What additional teaching is needed?

b. Additional snacks are needed to compensate for increased activity.

Glucocorticoids, mineralocorticoids, and sex steroids are secreted by which gland?

b. Adrenal cortex

The school nurse practitioner is consulted by a fifth-grade teacher about a student who has become increasingly inattentive and hyperactive in the classroom. The nurse notes that the child's weight has changed from the 50th percentile to the 30th percentile. The nurse is concerned about possible hyperthyroidism. What additional sign or symptom should the nurse anticipate?

b. Blurred vision and loss of acuity

A child is having tests done to determine parathyroid function. The clinic nurse knows that the parathyroid hormone (PTH) regulates the homeostasis of what in the serum?

b. Calcium

The nurse is caring for a child after a parathyroidectomy. What medication should the nurse have available if hypocalcemia occurs?

b. Calcium gluconate

Intranasal administration of desmopressin acetate (DDAVP) is used to treat which condition?

b. Diabetes insipidus (DI)

The nurse is teaching the parent of a preschool child how to administer the child's insulin injection. The child will be receiving 2 units of regular insulin and 12 units of NPH insulin every morning. What should the parent be taught?

b. Draw the regular insulin first and then the NPH into the same syringe.

The nurse is caring for an 11-year-old boy who has recently been diagnosed with diabetes. Which of the following should be included in the teaching plan for daily injections?

b. He is old enough to give most of his own injections.

What is a condition that can result if hypersecretion of growth hormone (GH) occurs after epiphyseal closure?

d. Acromegaly

Homeostasis in the body is maintained by what is collectively known as the neuroendocrine system. What is the name of the nervous system that is involved?

d. Autonomic

A child eats some sugar cubes after experiencing symptoms of hypoglycemia. This rapid-releasing sugar should be followed by which of the following?

d. Complex carbohydrate and protein

The nurse is taking care of a child who had a thyroidectomy. The nurse recognizes what as a positive Chvostek sign?

d. Facial muscle spasm elicited by tapping the facial nerve in the region of the parotid gland

What clinical manifestation is considered a cardinal sign of diabetes mellitus?

d. Frequent urination

The clinic nurse is assessing a child with hypopituitarism. Hypopituitarism can lead to which disorder?

d. Growth hormone deficiency

The nurse is preparing to administer a prescribed dose of desmopressin acetate (DDAVP) intramuscularly (IM) to a child with diabetes insipidus. What action should the nurse take before drawing the medication into a syringe?

d. Hold the medication under warm water for 10 to 15 minutes and then shake vigorously.

The nurse is teaching an adolescent about giving insulin injections. The adolescent asks if the disposable needles and syringes can be used more than once. The nurse's response should be based on which knowledge?

d. It is suitable for up to 3 days if stored in the refrigerator.

A child will start treatment for central precocious puberty. What synthetic hormone will be injected?

d. Luteinizing hormone-releasing hormone

A child eats some sugar cubes after experiencing symptoms of hypoglycemia. This rapid-releasing sugar should be followed by which dietary intervention?

d. Milk and peanut butter on bread

The nurse is caring for a child with suspected diabetes insipidus. Which of the following clinical manifestations would the nurse expect to observe?

d. Polyuria and polydipsia

Type 1 diabetes mellitus is suspected in an adolescent. Which of the following clinical manifestations may be present?

d. Poor wound healing

Prolonged steroid therapy has caused a child to have Cushing syndrome. To lessen the cushingoid effects, the steroid should be administered at which time?

d. QOD in the AM

Manifestations of hypoglycemia include which of the following?

d. Shaky feeling and dizziness

What statement applies to the current focus of the dietary management of children with diabetes?

d. The intake ensures day-to-day consistency in total calories, protein, carbohydrates, and moderate fat while allowing for a wide variety of foods.

What clinical manifestation occurs with hypoglycemia?

d. Weakness and dizziness

A 20-kg (44-lb) child in ketoacidosis is admitted to the pediatric intensive care unit. What order should the nurse not implement until clarified with the physician?

c. Begin intravenous line with D5 0.45% normal saline with 20 mEq of potassium chloride.

At what age is sexual development in boys and girls considered to be precocious?

c. Boys, 9 years; girls, 8 years

A parent asks the nurse why self-monitoring of blood glucose is being recommended for her child with diabetes. The nurse should base the explanation on which of the following?

c. Children are better able to manage the diabetes.

Exophthalmos (protruding eyeballs) may occur in children with which condition?

b. Hyperthyroidism

A child with hypopituitarism is being started on growth hormone (GH) therapy. Nursing considerations should be based on which knowledge?

b. Replacement therapy requires daily subcutaneous injections.

Congenital adrenal hyperplasia (CAH) is suspected in a newborn because of ambiguous genitalia. The parents are appropriately upset and concerned about their child's gender. In teaching the parents about CAH, what should the nurse explain?

b. Sexual assignment should wait until genetic sex is determined.

A child with hypoparathyroidism is receiving vitamin D therapy. The parents should be advised to watch for which signs or symptoms of vitamin D toxicity?

b. Weakness and lassitude

A neonate born with ambiguous genitalia is diagnosed with congenital adrenogenital hyperplasia. Therapeutic management includes administration of:

b. cortisone.

The parents of a neonate with adrenogenital hyperplasia tell the nurse that they will be afraid to have any more children. The nurse should explain that:

b. genetic counseling is indicated.

The parents of a child who has just been diagnosed with type 1 diabetes ask about exercise. What effect does exercise have on a type 1 diabetic?

c. Additional snacks are needed before exercise.

Which of the following is characteristic of the immune-mediated type 1 diabetes mellitus?

c. Age at onset is usually younger than 20 years.

What is a common clinical manifestation of juvenile hypothyroidism?

c. Dry skin

A child is receiving propylthiouracil for the treatment of hyperthyroidism (Graves disease). The parents and child should be taught to recognize and report which sign or symptom immediately?

c. Fever, sore throat

To help an adolescent deal with diabetes, the nurse needs to consider which characteristic of adolescence?

c. Need to be perfect and similar to peers

Peripheral precocious puberty (PPP) differs from central precocious puberty (CPP) in which manner?

c. PPP may be viewed as a variation in sexual development.

What statement is characteristic of type 1 diabetes mellitus?

c. Peak age incidence is 10 to 15 years.

What nursing care should be included for a child diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH)?

c. Restrict fluids.

Which of the following statements best describes hypopituitarism?

c. Skeletal proportions are normal for age.

An adolescent diabetic is admitted to the emergency department for treatment of hyperglycemia and pneumonia. What are characteristics of diabetic hyperglycemia?

c. Thirst, being flushed, and fruity breath

The parents of a child who has just been diagnosed with type 1 diabetes ask about exercise. The nurse should explain that:

c. extra snacks are needed before exercise.

What blood glucose measurement is most likely associated with diabetic ketoacidosis?

d. 330 mg/dl

The nurse is discussing with a child and family the various sites used for insulin injections. What site usually has the fastest rate of absorption?

d. Abdomen

The parent of a child with diabetes mellitus asks the nurse when urine testing will be necessary. The nurse should explain that urine testing for:

d. ketonuria should be done when it is suspected.