Chapter 47: Endocrine Dysfunction NCLEX

A goiter is an enlargement or hypertrophy of which gland? a. Thyroid b. Adrenal c. Anterior pituitary d. Posterior pituitary

A (A goiter is an enlargement or hypertrophy of the thyroid gland. Goiter is not associated with the adrenals or the anterior and posterior pituitaries.)

The nurse is implementing care for a school-age child admitted to the pediatric intensive care in diabetic ketoacidosis (DKA). Which prescribed intervention should the nurse implement first? a. Begin 0.9% saline solution intravenously as prescribed. b. Administer regular insulin intravenously as prescribed. c. Place child on a cardiac monitor. d. Place child on a pulse oximetry monitor.

A (All patients with DKA experience dehydration (10% of total body weight in severe ketoacidosis) because of the osmotic diuresis, accompanied by depletion of electrolytes (sodium, potassium, chloride, phosphate, and magnesium). The initial hydrating solution is 0.9% saline solution. Insulin therapy should be started after the initial rehydration bolus because serum glucose levels fall rapidly after volume expansion. The child should be placed on the cardiac and pulse oximetry monitors after the rehydrating solution has been initiated.)

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. Increased food intake B. Decreased food intake C. Increased risk of hyperglycemia D. Decreased risk of insulin shock

A (Food intake should be increased in the summer when the child is more active. Races and other competitions may require more food than other practice times. The child will require increased food on days of increased activity. The increased activity lowers blood glucose levels. Blood sugars must be monitored closely to avoid the administration of too much insulin during a time of reduced need.)

A child with growth hormone (GH) deficiency is receiving GH therapy. The best time for the GH to be administered is: a. At bedtime. b. After meals. c. Before meals. d. On arising in the morning.

A (Injections are best given at bedtime to more closely approximate the physiologic release of GH. Before or after meals and on arising in the morning are times that do not mimic the physiologic release of the hormone.)

The nurse should expect to assess which clinical manifestations in an adolescent with Cushing's syndrome (Select all that apply)? a. Hyperglycemia b. Hyperkalemia c. Hypotension d. Cushingoid features e. Susceptibility to infections

A, D, E (In Cushing's syndrome, physiologic disturbances seen are cushingoid features, hyperglycemia, susceptibility to infection, hypertension, and hypokalemia.)

The nurse is teaching an adolescent, newly diagnosed with type I diabetes, ways to minimize discomfort with insulin injections. Which interventions are helpful in minimizing injection discomfort? (Select all that apply.) A. Do not reuse needles B. Inject insulin when it is cold C. Flex or tense the muscle during injection D. Remove all bubbles from the syringe before injection E. Do not move the direction of the needle-syringe during insertion or withdrawal

A, D, E (The reuse of needles leads to more discomfort on injection from decreased sharpness of the needle and being 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 muscles during injections causes more discomfort.)

Nursing care of a child diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) should include (Select all that apply): a. Weigh daily. b. Encourage fluids. c. Turn frequently. d. Maintain nothing by mouth. e. Restrict fluids.

A, E (Increased secretion of ADH causes the kidney to resorb water, which increases fluid volume and decreases serum osmolarity with a progressive reduction in sodium concentration. The immediate management of the child is to restrict fluids. The child should also be weighed at the same time each day. Encouraging fluids, turning frequently, and maintaining nothing by mouth are not associated with SIADH.)

What should a nurse advise the parents of a child with type 1 diabetes mellitus who is not eating as a result of a minor illness? a. Give the child half his regular morning dose of insulin. b. Substitute simple carbohydrates or calorie-containing liquids for solid foods. c. Give the child plenty of unsweetened, clear liquids to prevent dehydration. d. Take the child directly to the emergency department.

B (A sick-day diet of simple carbohydrates or calorie-containing liquids will maintain normal serum glucose levels and decrease the risk of hypoglycemia. The child should receive his regular dose of insulin even if he does not have an appetite. If the child is not eating as usual, he needs calories to prevent hypoglycemia. During periods of minor illness, the child with type 1 diabetes mellitus can be managed safely at home.)

Chronic adrenocortical insufficiency is also referred to as: a. Graves' disease. b. Addison's disease. c. Cushing's syndrome. d. Hashimoto's disease.

B (Addison's disease is chronic adrenocortical insufficiency. Graves' and Hashimoto's diseases involve the thyroid gland. Cushing's syndrome is a result of excessive circulation of free cortisol.)

What is the most appropriate intervention for the parents of a 6-year-old girl with precocious puberty? a. Advise the parents to consider birth control for their daughter. b. Explain the importance of having the child foster relationships with same-age peers. c. Assure the child's parents that there is no increased risk for sexual abuse because of her appearance. d. Counsel parents that there is no treatment currently available for this disorder.

B (Despite the child's appearance, the child needs to be treated according to her chronologic age and to interact with children in the same age-group. An expected outcome is that the child will adjust socially by exhibiting age-appropriate behaviors and social interactions. Advising the parents of a 6-year-old to put their daughter on birth control is not appropriate and will not reverse the effects of precocious puberty. Parents need to be aware that there is an increased risk of sexual abuse for a child with precocious puberty. Treatment for precocious puberty is the administration of gonadotropin-releasing hormone blocker, which slows or reverses the development of secondary sexual characteristics and slows rapid growth and bone aging.)

An adolescent is being seen in the clinic for evaluation of acromegaly. The nurse understands that which occurs with acromegaly? a. There is a lack of growth hormone (GH) being produced. b. There is excess GH after closure of the epiphyseal plates. c. There is an excess of GH before the closure of the epiphyseal plates. d. There is a lack of thyroid hormone being produced.

B (Excess GH after closure of the epiphyseal plates results in acromegaly. A lack of growth hormone results in delayed growth or even dwarfism. Gigantism occurs when there is hypersecretion of GH before the closure of the epiphyseal plates. Cretinism is associated with hypothyroidism.)

Exophthalmos (protruding eyeballs) may occur in children with: a. Hypothyroidism. b. Hyperthyroidism. c. Hypoparathyroidism. d. Hyperparathyroidism.

B (Exophthalmos is a clinical manifestation of hyperthyroidism. Hypothyroidism, hypoparathyroidism, and hyperparathyroidism are not associated with exophthalmos.)

The nurse is caring for an 11-year-old boy who has recently been diagnosed with diabetes. What should be included in the teaching plan for daily injections? a. The parents do not need to learn the procedure. b. He is old enough to give most of his own injections. c. Self-injections will be possible when he is closer to adolescence. d. He can learn about self-injections when he is able to reach all injection sites.

B (School-age children are able to give their own injections. Parents should participate in learning and giving the insulin injections. He is already old enough to administer his own insulin. The child is able to use thighs, abdomen, part of the hip, and arm. Assistance can be obtained if other sites are used.)

Which laboratory finding confirms that a child with type 1 diabetes is experiencing diabetic ketoacidosis? a. No urinary ketones b. Low arterial pH c. Elevated serum carbon dioxide d. Elevated serum phosphorus

B (Severe insulin deficiency produces metabolic acidosis, which is indicated by a low arterial pH. Urinary ketones, often in large amounts, are present when a child is in diabetic ketoacidosis. Serum carbon dioxide is decreased in diabetic ketoacidosis. Serum phosphorus is decreased in diabetic ketoacidosis.)

A nurse is reviewing the laboratory results on a school-age child with hypoparathyroidism. Which results are consistent with this condition? a. Decreased serum phosphorus b. Decreased serum calcium c. Increased serum glucose d. Decreased serum cortisol

B (The diagnosis of hypoparathyroidism is made on the basis of clinical manifestations associated with decreased serum calcium and increased serum phosphorus. Decreased serum phosphorus would be seen in hyperparathyroidism, elevated glucose in diabetes, and decreased serum cortisol in adrenocortical insufficiency (Addison's disease).)

A neonate born with ambiguous genitalia is diagnosed with congenital adrenogenital hyperplasia. Therapeutic management includes administration of: a. Vitamin D. b. Cortisone c. Stool softeners. d. Calcium carbonate.

B (The most common biochemical defect with congenital adrenal hyperplasia is partial or complete 21-hydroxylase deficiency. With complete deficiency, insufficient amounts of aldosterone and cortisol are produced, so circulatory collapse occurs without immediate replacement. Vitamin D, stool softeners, and calcium carbonate have no role in the therapy of adrenogenital hyperplasia.)

Diabetes insipidus is a disorder of the: a. Anterior pituitary. b. Posterior pituitary. c. Adrenal cortex. d. Adrenal medulla.

B (The principal disorder of posterior pituitary hypofunction is diabetes insipidus. The anterior pituitary produces hormones such as growth hormone, thyroid-stimulating hormone, adrenocorticotropic hormone, gonadotropin, prolactin, and melanocyte-stimulating hormone. The adrenal cortex produces aldosterone, sex hormones, and glucocorticoids. The adrenal medulla produces catecholamines.)

The nurse should recognize that, when a child develops diabetic ketoacidosis, it is: A. an expected outcome. B. a life-threatening situation. C. best treated at home. D. best treated at the practitioner's office/clinic.

B (This is a medical emergency needing prompt assessment and intervention, usually in an intensive care environment. Diabetic ketoacidosis is the state of complete insulin deficiency. It is a medical emergency that must be diagnosed and treated. The child is usually admitted to an intensive care unit for assessment, insulin administration, and fluid and electrolyte replacement. This is a medical emergency needing prompt assessment and intervention, usually in an intensive care environment. This is a medical emergency needing prompt assessment and intervention, usually in an intensive care environment.)

Which children admitted to the pediatric unit would the nurse monitor closely for development of syndrome of inappropriate antidiuretic hormone (SIADH) (Select all that apply)? a. A newly diagnosed preschooler with type 1 diabetes b. A school-age child returning from surgery for removal of a brain tumor c. An infant with suspected meningitis d. An adolescent with blunt abdominal trauma following a car accident e. A school-age child with head trauma

B, C, E (Childhood SIADH usually is caused by disorders affecting the central nervous system, such as infections (meningitis), head trauma, and brain tumors. Type 1 diabetes and blunt abdominal trauma are not likely to cause SIADH.)

A child is diagnosed with hypothyroidism. The nurse should expect to assess which symptoms associated with hypothyroidism (Select all that apply)? a. Weight loss b. Fatigue c. Diarrhea d. Dry, thick skin e. Cold intolerance

B, D, E (A child with hypothyroidism will display fatigue; dry, thick skin; and cold intolerance. Weight loss and diarrhea are signs of hyperthyroidism.)

The nurse is discharging a 10-year-old patient admitted to the hospital in diabetic ketoacidosis. The child has been newly diagnosed with type 1 diabetes mellitus (DM) on this admission. The nurse should teach the child and parents which signs of type 1? (Select all that apply.) A. weight gain B. nocturia C. irritability D. cool, clammy skin E. blurred vision

B, D, E (Clinical manifestations of type 1 diabetes mellitus include: Polyphagia, Polyuria, Polydipsia, Weight loss, Enuresis or nocturia, Irritability; "not himself" or "herself", Shortened attention span, Lowered frustration tolerance, Dry skin, Blurred vision, Poor wound healing, Fatigue, Flushed skin, Headache, Frequent infections, Hyperglycemia, Elevated blood glucose levels, Glucosuria, Diabetic ketosis, Ketones and glucose in urine, Dehydration in some cases, Diabetic ketoacidosis, Dehydration, Electrolyte imbalance, Acidosis, Deep, rapid breathing (Kussmaul respirations))

A child with hypopituitarism is being started on growth hormone (GH) therapy. Nursing considerations should be based on which of the following? a. Treatment is most successful if it is started during adolescence. b. Treatment is considered successful if children attain full stature by adulthood. c. Replacement therapy requires daily subcutaneous injections. d. Replacement therapy will be required throughout the child's lifetime.

C (Additional support is required for children who require hormone replacement therapy, such as preparation for daily subcutaneous injections and education for self-management during the school-age years. Young children, obese children, and those who are severely GH deficient have the best response to therapy. When therapy is successful, children can attain their actual or near-final adult height at a slower rate than their peers. Replacement therapy is not needed after attaining final height. They are no longer GH deficient.)

A 17-year-old boy with diabetes mellitus tells the school nurse that he has recently started drinking alcohol with his friends on weekends. The nurse should: A. Tell him not to do this. B. Ask him why he is drinking alcohol. C. Teach him about the effects of alcohol on diabetes and how to prevent problems associated with alcohol intake. D. Recommend counseling so he understands the serious consequences of alcohol consumption.

C (Admonishing him will not help the adolescent if he chooses to continue drinking. Asking him why will provide information to the nurse but will not address the information that the adolescent needs to have about managing his disease. The nurse is taking a proactive approach. The adolescent is provided with information to facilitate the management of his illness. A recommendation for counseling can be included in the teaching plan.)

To help the adolescent deal with diabetes, the nurse must consider which characteristic of adolescence? a. Desire to be unique b. Preoccupation with the future c. Need to be perfect and similar to peers d. Need to make peers aware of the seriousness of hypoglycemic reactions

C (Adolescence is a time when the individual wants to be perfect and similar to peers. Having diabetes makes adolescents different from their peers. Adolescents do not wish to be unique; they desire to fit in with the peer group and are usually not future oriented. Forcing peer awareness of the seriousness of hypoglycemic reactions would further alienate the adolescent with diabetes. The peer group would focus on the differences.)

A child eats some sugar cubes after experiencing symptoms of hypoglycemia. This rapid-releasing sugar should be followed by: a. Saturated and unsaturated fat. b. Fruit juice. c. Several glasses of water. d. Complex carbohydrate and protein.

D (Symptoms of hypoglycemia are treated with a rapid-releasing sugar source followed by a complex carbohydrate and protein. Saturated and unsaturated fat, fruit juice, and several glasses of water do not provide the child with complex carbohydrate and protein necessary to stabilize the blood sugar.)

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 knowing that: a. It is a less expensive method of testing. b. It is not as accurate as laboratory testing. c. Children are better able to manage the diabetes. d. The parents are better able to manage the disease.

C (Blood glucose self-management has improved diabetes management and can be used successfully by children from the time of diagnosis. Insulin dosages can be adjusted based on blood sugar results. Blood glucose monitoring is more expensive but provides improved management. It is as accurate as equivalent testing done in laboratories. The ability to self-test allows the child to balance diet, exercise, and insulin. The parents are partners in the process, but the child should be taught how to manage the disease.)

The nurse is teaching the parents of a child who is receiving propylthiouracil for the treatment of hyperthyroidism (Graves' disease). Which statement made by the parent indicates a correct understanding of the teaching? a. "I would expect my child to gain weight while taking this medication." b. "I would expect my child to experience episodes of ear pain while taking this medication." c. "If my child develops a sore throat and fever, I should contact the physician immediately." d. "If my child develops the stomach flu, my child will need to be hospitalized."

C (Children being treated with propylthiouracil must be carefully monitored for the side effects of the drug. Parents must be alerted that sore throat and fever accompany the grave complication of leukopenia. These symptoms should be immediately reported. Weight gain, episodes of ear pain, and stomach flu are not usually associated with leukopenia.)

The nurse is admitting a toddler with the diagnosis of juvenile hypothyroidism. Which is a common clinical manifestation of this disorder? a. Insomnia b. Diarrhea c. Dry skin d. Accelerated growth

C (Dry skin, mental decline, and myxedematous skin changes are associated with juvenile hypothyroidism. Children with hypothyroidism are usually sleepy. Constipation is associated with hypothyroidism. Decelerated growth is common in juvenile hypothyroidism.)

A school-age child recently diagnosed with type 1 diabetes mellitus asks the nurse if he can still play soccer, baseball, and swim. The nurse's response should be based on knowledge that: A. exercise is contraindicated. B. soccer and baseball are too strenuous, but swimming is acceptable. C. exercise is not restricted unless indicated by other health conditions. D. the level of activity depends on the type of insulin required.

C (Exercise is highly encouraged. The decrease in blood glucose can be accommodated by having snacks available. Sports are encouraged to help regulate the insulin, and food should be adjusted according to the amount of exercise. The child needs to be cautioned to monitor responses to the exercises. Exercise is encouraged for children with diabetes because it lowers blood glucose levels. Insulin and meal requirements require careful monitoring to ensure that the child has sufficient energy for exercise. The level of activity does not depend on the type of insulin used. Long- and short-acting insulin both may be used to compensate for the effects of training and sporting events.)

The parents of a child who has just been diagnosed with type 1 diabetes ask about exercise. The nurse should explain that: a. Exercise will increase blood glucose. b. Exercise should be restricted. c. Extra snacks are needed before exercise. d. Extra insulin is required during exercise.

C (Exercise lowers blood glucose levels, which can be compensated for by extra snacks. Exercise is encouraged and not restricted unless indicated by other health conditions. Extra insulin is contraindicated because exercise decreases blood glucose levels.)

Which statement best describes hypopituitarism? a. Growth is normal during the first 3 years of life. b. Weight is usually more retarded than height. c. Skeletal proportions are normal for age. d. Most of these children have subnormal intelligence.

C (In children with hypopituitarism, the skeletal proportions are normal. Growth is within normal limits for the first year of life. Height is usually more delayed than weight. Intelligence is not affected by hypopituitarism.)

What is the priority nursing goal for a 14-year-old with Graves' disease? a. Relieving constipation b. Allowing the adolescent to make decisions about whether or not to take medication c. Verbalizing the importance of adherence to the medication regimen d. Developing alternative educational goals

C (In order to adhere to the medication schedule, children need to understand that the medication must be taken two or three times per day. The adolescent with Graves' disease is not likely to be constipated. Adherence to the medication schedule is important to ensure optimal health and wellness. Medications should not be skipped and dose regimens should not be tapered by the child without consultation with the child's medical provider. The management of Graves' disease does not interfere with school attendance and does not require alternative educational plans.)

At what age is sexual development in boys and girls considered to be precocious? a. Boys, 11 years; girls, 9 years b. Boys, 12 years; girls, 10 years c. Boys, 9 years; girls, 8 years d. Boys, 10 years; girls, 9.5 years

C (Manifestations of sexual development before age 9 in boys and age 8 in girls are considered precocious and should be investigated. Boys older than 9 years of age and girls older than 8 years of age fall within the expected range of pubertal onset.)

What is characteristic of the immune-mediated type 1 diabetes mellitus? a. Ketoacidosis is infrequent. b. Onset is gradual. c. Age at onset is usually younger than 18 years. d. Oral agents are often effective for treatment.

C (The immune-mediated type 1 diabetes mellitus typically has its onset in children or young adults. Peak incidence is between the ages of 10 and 15 years. Infrequent ketoacidosis, gradual onset, and treatment with oral agents are more consistent with type 2 diabetes.)

The nurse is discussing various sites used for insulin injections with a child and her family. Which site usually has the fastest rate of absorption? a. Arm b. Leg c. Buttock d. Abdomen

D (The abdomen has the fastest rate of absorption but the shortest duration. The arm has a fast rate of absorption but short duration. The leg has a slow rate of absorption but a long duration. The buttock has the slowest rate of absorption and the longest duration.)

The mother of a child with type 1 diabetes mellitus asks why her child cannot avoid all those "shots" and take pills as an uncle does. The nurse's BEST reply is: A. "The pills work with an adult pancreas only." B. "The drugs affect fat and protein metabolism, not sugar." C. "Your child needs insulin replaced, and the oral hypoglycemics only add to an existing supply of insulin." D. "Perhaps when your child is older the pancreas will produce its own insulin, and then your child can take oral hypoglycemics."

C (The oral medications have different modes of action, which supplement insulin production by the pancreas, decreasing insulin resistance or affecting liver production of glucose. They are not insulin substitutes. The oral medications have different modes of action, which supplement insulin production by the pancreas, decreasing insulin resistance or affecting liver production of glucose. They are not insulin substitutes. In type 1 diabetes, the b-cells have been destroyed. It is necessary to supply the insulin that they no longer produce. In type 1 diabetes, the b-cells are destroyed. Without a pancreas b-cell transplant, it is unlikely that insulin would be produced.)

Glucocorticoids, mineralocorticoids, and sex steroids are secreted by the: a. Thyroid gland. b. Parathyroid glands. c. Adrenal cortex. d. Anterior pituitary.

C (These hormones are secreted by the adrenal cortex. The thyroid gland produces thyroid hormone and thyrocalcitonin. The parathyroid glands produce parathyroid hormone. The anterior pituitary produces hormones such as growth hormone, thyroid-stimulating hormone, adrenocorticotropic hormone, gonadotropin, prolactin, and melanocyte-stimulating hormone.)

A child with hypoparathyroidism is receiving vitamin D therapy. The parents should be advised to watch for which sign of vitamin D toxicity? a. Headache and seizures b. Physical restlessness and voracious appetite without weight gain c. Weakness and lassitude d. Anorexia and insomnia

C (Vitamin D toxicity can be a serious consequence of therapy. Parents are advised to watch for signs including weakness, fatigue, lassitude, headache, nausea, vomiting, and diarrhea. Renal impairment is manifested through polyuria, polydipsia, and nocturia. Headaches may be a sign of vitamin D toxicity, but seizures are not. Physical restlessness and a voracious appetite with weight loss are manifestations of hyperthyroidism. Anorexia and insomnia are not characteristic of vitamin D toxicity.)

A nurse is planning care for a school-age child with type 1 diabetes. Which insulin preparations are rapid and short acting (Select all that apply)? a. Novolin N b. Lantus c. NovoLog d. Novolin R

C, D (Rapid-acting insulin (e.g., NovoLog) reaches the blood within 15 minutes after injection. The insulin peaks 30 to 90 minutes later and may last as long as 5 hours. Short-acting (regular) insulin (e.g., Novolin R) usually reaches the blood within 30 minutes after injection. The insulin peaks 2 to 4 hours later and stays in the blood for about 4 to 8 hours. Intermediate-acting insulins (e.g., Novolin N) reach the blood 2 to 6 hours after injection. The insulins peak 4 to 14 hours later and stay in the blood for about 14 to 20 hours. Long-acting insulin (e.g., Lantus) takes 6 to 14 hours to start working. It has no peak or a very small peak 10 to 16 hours after injection. The insulin stays in the blood between 20 and 24 hours.)

The nurse is caring for a school-age child with hyperthyroidism (Graves' disease). Which clinical manifestations should the nurse monitor that may indicate a thyroid storm (Select all that apply)? a. Constipation b. Hypotension c. Hyperthermia d. Tachycardia e. Vomiting

C, D, E (A child with a thyroid storm will have severe irritability and restlessness, vomiting, diarrhea, hyperthermia, hypertension, severe tachycardia, and prostration.)

The nurse is caring for a child with suspected diabetes insipidus. Which clinical manifestation would she or he expect to observe? a. Oliguria b. Glycosuria c. Nausea and vomiting d. Polyuria and polydipsia

D (Excessive urination accompanied by insatiable thirst is the primary clinical manifestation of diabetes. These symptoms may be so severe that the child does little other than drink and urinate. Oliguria is decreased urine production and is not associated with diabetes insipidus. Glycosuria is associated with diabetes mellitus. Nausea and vomiting are associated with inappropriate antidiuretic hormone secretion.)

Which symptom is considered a cardinal sign of diabetes mellitus? a. Nausea b. Seizures c. Impaired vision d. Frequent urination

D (Hallmarks of diabetes mellitus are glycosuria, polyuria, and polydipsia. Nausea and seizures are not clinical manifestations of diabetes mellitus. Impaired vision is a long-term complication of the disease.)

Which clinical manifestation may occur in the child who is receiving too much methimazole (Tapazole) for the treatment of hyperthyroidism (Graves' disease)? a. Seizures b. Enlargement of all lymph glands c. Pancreatitis or cholecystitis d. Lethargy and somnolence

D (Parents should be aware of the signs of hypothyroidism that can occur from overdosage of the drug. The most common manifestations are lethargy and somnolence. Seizures and pancreatitis are not associated with the administration of Tapazole. Enlargement of the salivary and cervical lymph glands occurs.)

Type 1 diabetes mellitus is suspected in an adolescent. Which clinical manifestation may be present? a. Moist skin b. Weight gain c. Fluid overload d. Poor wound healing

D (Poor wound healing is often an early sign of type 1 diabetes mellitus. Dry skin, weight loss, and dehydration are clinical manifestations of type 1 diabetes mellitus.)

A child will start treatment for precocious puberty. This involves injections of synthetic: a. Thyrotropin. b. Gonadotropins. c. Somatotropic hormone. d. Luteinizing hormone-releasing hormone.

D (Precocious puberty of central origin is treated with monthly subcutaneous injections of luteinizing hormone-releasing hormone. Thyrotropin, gonadotropin, and somatotropic hormone are not appropriate therapies for precocious puberty.)

Manifestations of hypoglycemia include: a. Lethargy. b. Thirst. c. Nausea and vomiting. d. Shaky feeling and dizziness.

D (Some of the clinical manifestations of hypoglycemia include shaky feelings; dizziness; difficulty concentrating, speaking, focusing, and coordinating; sweating; and pallor. Lethargy, thirst, and nausea and vomiting are manifestations of hyperglycemia.)

The parent of a child with diabetes mellitus asks the nurse when urine testing will be necessary. The nurse should explain that urine testing is necessary for which? a. Glucose is needed before administration of insulin. b. Glucose is needed four times a day. c. Glycosylated hemoglobin is required. d. Ketonuria is suspected.

D (Urine testing is still performed to detect evidence of ketonuria. Urine testing for glucose is no longer indicated because of the poor correlation between blood glucose levels and glycosuria. Glycosylated hemoglobin analysis is performed on a blood sample.)