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

A group of students are reviewing information about oral diabetic agents. The students demonstrate understanding of these agents when they identify which agent as reducing glucose production from the liver?

Metformin

A 2-year-old client and the parents are at the office for a follow-up visit. The client has had excessive hormone levels in the recent blood work, and the parents question why this was not found sooner. Which response by the nurse would be most appropriate?

"As endocrine functions become more stable throughout childhood, alterations become more apparent."

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?

"Carry crackers or fruit to eat before or during periods of increased activity."

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."

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?

Enlarged tongue

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 treated by exposing our baby to a special light, right?"

The nurse is assessing a child diagnosed with Cushing disease. Which statement by the parents demonstrates a need for further teaching?

"This disorder is most likely due to an infection my child had recently."

The nurse is speaking with the parents of a child recently diagnosed with hypothyroidism. Which statement by a parent indicates an understanding of symptoms of this disorder?

"When they get my son's thyroid levels normal, he won't be so tired."

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.

15

The nurse is providing acute care for an 11-year-old boy with hypoparathyroidism. Which intervention is priority?

Administering intravenous calcium gluconate as ordered

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?

Administration of levothyroxine indefinitely

The nurse knows that which condition is caused by excessive levels of circulating cortisol?

Cushing syndrome

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

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 is a synthetic antidiuretic hormone that will slow down your urine output.

A 9-year-old girl has just been diagnosed with Graves disease. Which symptom should the nurse expect in this child? Select all that apply.

Exophthalmos (protruding eyes) Moist skin Nervousness Increased basal metabolic rate

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

Graves disease

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?

Graves disease

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

Hypocalcemia

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?

Injections of GH

Which results would indicate to the nurse the possibility that a neonate has congenital hypothyroidism?

Low T4 level and high TSH level

A 7-year-old child who has type 1 diabetes mellitus is at school reporting a headache and dizziness. The school nurse notices sweat on the child's face. What should the nurse do first?

Offer the child 8 ounces of juice or soda

The nurse is caring for a child recently diagnosed with hypoparathyroidism disorder. Which medication would the nurse expect to be ordered?

Oral calcium

A 12-year-old boy arrives at the emergency room experiencing nausea, vomiting, headache, and seizures. He is diagnosed with bacterial meningitis. Other findings include a decrease in urine production, hyponatremia, and water intoxication. Which pituitary gland disorder would be most associated with these symptoms?

Syndrome of inappropriate antidiuretic hormone

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 have developed leukopenia.

A nurse should recognize that which laboratory result would be most consistent with a diagnosis of diabetes mellitus?

a fasting blood glucose greater than 126 mg/dL

A newborn was diagnosed as having hypothyroidism at birth. The parent asks the nurse how the disease could be discovered this early. Which is the nurse's best answer?

a simple blood test to diagnose hypothyroidism is required in most states.

Which nursing objective is most important when working with neonates who are suspected of having congenital hypothyroidism?

early identification

A pediatric client has just been diagnosed with diabetes insipidus. What is the primary consideration for this client?

fluid replacement

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?

insulin

A 4-year-old diagnosed with diabetes insipidus is being discharged. Which information below is most important to emphasize to the parents?

Diabetes insipidus is different from diabetes mellitus.

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?

Discuss preparing for a thyroid function test.

A child is prescribed glargine insulin. What information would the nurse include when teaching the child and parents about this insulin?

Do not mix this insulin with other insulins.

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?

Elevate the subcutaneous tissue before the injection.

The nurse knows that disorders of the pituitary gland depend on the location of the physiologic abnormality. Caring for a child who has issues with the anterior pituitary, the nurse would expect the child to have issues with which hormone?

Growth hormone

A child is diagnosed with hyperthyroidism. What finding would the nurse expect to assess?

Heat intolerance

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?

Urine output

A child is diagnosed with diabetes insipidus (DI) and will start on the medication desmopressin. Which instruction(s) would the nurse include in teaching the parent about administering this drug? Select all that apply.

Keep the drug refrigerated. Clear the nostrils before administering the drug. If the child sneezes, repeat the dose administration. Monitor the urine specific gravity while the child is taking the drug.

An 8-year-old child is seen for moodiness and irritability. The child has begun to develop breast and pubic hair and the parents are concerned that these changes are occurring at too early an age. Which would the nurse suspect?

precocious puberty

The nurse is teaching a child with type 1 diabetes mellitus to administer insulin. The child is receiving a combination of short-acting and long-acting insulin. The nurse knows that the child has appropriately learned the technique when the child:

draws up the short-acting insulin into the syringe first.

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

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

A child presents to the primary care setting with enuresis, nocturia, increased hunger, weight loss, and increased thirst. What does the nurse suspect?

Type 1 diabetes mellitus

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?

Urine output

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

The nurse is teaching a group of caregivers of children diagnosed with diabetes mellitus. 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?

"My child measures their own medication but sometimes doesn't administer the correct amount."