Pediatrics Ch. 28
Type 1 diabetes mellitus has just been diagnosed in a teenage boy who is actively involved in sports. What important instruction should the nurse include in the teaching plan?
Because exercise can lower the blood glucose level, blood glucose needs to be closely monitored.
An infant is born with ambiguous genitalia. Tests are being done to assist in gender assignment. The parents tell the nurse that family and friends are asking what caused the baby to be this way. What should the nurse's explanation include?
By explaining the disorder so that the parents can explain it to others
What endocrine disorder can result from prolonged steroid therapy?
Cushing syndrome
Which finding is most often observed with destruction of the pancreatic beta cells?
Decreased blood glucose levels in the body
While reviewing the laboratory reports of a pregnant patient who is at 40 weeks of gestation, the nurse finds that the patient has reduce secretion of the hormone oxytocin. What would be the consequences if treatment is delayed? Select all that apply.
Delayed labor Reduced milk ejection from the breats
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. What steps does the nurse take to evaluate the growth curve? Select all that apply.
Determine the child's absolute height. Assess the child's height velocity Determine the child's weight-to-height ratio.
A father brings his 5-year-old son to the clinic because he has recently lost a lot of weight. He reports to the nurse that the boy is always hungry, thirsty, and complaining that he has to use the bathroom. What disorder is best described by these symptoms?
Diabetes mellitus
What are the early clinical manifestations of acute adrenocortical insufficiency? Select all that apply.
Diarrhea Headache Increased irritability
What information should the nurse include when discussing a child's precocious puberty with the parents?
Dress and activities should be appropriate to the chronologic age
What are the clinical manifestations of juvenile hypothyroidism?
Dry skin, sparse hair, slowed growth
What is the most important nursing consideration related to congenital hypothyroidism?
Early identification of the disorder
The nurse is planning care for a child recently diagnosed with diabetes insipidus. Which nursing intervention should be planned?
Encourage the child to wear medical identification.
A school-age child recently diagnosed with type 1 diabetes mellitus ask the nurse if playing soccer, playing baseball, and swimming are still possible. The nurses's response should be based on what knowledge?
Exercise is not restricted unless indicated by other health conditions.
Cushing syndrome is a characteristic group of manifestations caused by excessive circulation of which hormone?
Free cortisol
An infant is born with swelling in the neck and a bluish skin color. The APGAR score of the infant is 3. The mother of the infant was on antithyroid drugs during pregnancy. What does the nurse do immediately? Select all that apply.
Give supplemental oxygen Arrange a tracheostomy set Extend the neck of the infant
A diabetic child who is treated with insulin is trembling and sweating profusely. The nurse learns that the child has skipped lunch. What should the nurse do?
Give the child 3 to 6 oz of orange juice
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 abdominal striae. What does the nurse tell the parents of the child? Select all that apply.
Give the drug on alternate days. Give the drug early in the morning.
What is the best method for assessing control of diabetes?
Glycosylated hemoblobin (hemoglobin A1c) testing
The largest percentage of childhood hyperthyroidism is caused by:
Graves disease
A neonate with a goiter has just been admitted to the newborn nursery. What is one priority nursing intervention?
Having a tracheostomy set at the bedside
Which condition does the nurse suspect in a patient with anxiety and mental depression, who has facial muscle spasms elicited by tapping the facial nerve in the region of the parotid gland and carpopedal spasm?
Hypoparathyroidism
Which condition may be suspected in a child who has dry skin, puffiness around the eyes, sparse hair, and constipation?
Hypothyroidism
The nurse should recognize that when a child develops diabetic ketoacidosis (DKA), treatment will be instituted as described in which of the following statements?
Immediate treatment is required because DKA is a life-threatening situation
During the summer, many children are more physically active. What changes in the management of the child with type 1 diabetes mellitus should be expected as a result of more exercise?
Increased food intake
The nurse is caring for a child with acute adernocortical insufficiency. Which nursing intervention must be executed first in the acute phase of adrenal crisis?
Institute precautions to prevent seizures
What is the current treatment option for children with type 1 diabetes?
Insulin and diet
An adolescent patient reports constipation, weight gain, and low mood. The patient also feels cold in warm weather. Most of the adolescents in the community have similar symptoms. What does the nurse tell the patient to include in the diet?
Iodized salt
Which statement best describes Cushing syndrome?
It is caused by excessive production of cortisol.
What are the signs and symptoms of diabetic ketoacidosis? Select all that apply.
Ketonuria Ketonemia Dehydration Acetone breath
The parents report that their child has excessive urination, thirst, hunger, irritability, fatigue, flushed skin, headache, blurred vision, and dry skin. The child is diagnosed with type 1 diabetes mellitus. Based on this diagnosis, what should the nurse include in the plan of care?
Monitor capillary blood glucose levels before meals and at bedtime
A diabetic patient is on twice-daily dosing of rapid-acting and intermediate-acting insulin. The child is admitted for dose adjustment of intermediate-acting insulin required to be administered in the evening. Which blood sugar level readings of the patient are taken into consideration?
Morning fasting blood sugar levels of the same day
The nurse is assessing a child for pituitary hyperfunction. Which assessment findings does the nurse recognize as an effect of hyperpituitarism?
Overgrowth of the long bones Malocclusion of teeth in enlarged law Thickened, deeply creased skin
While reviewing laboratory reports, the nurse finds that the posterior lobe of the patient's pituitary gland is damaged. Which hormones are likely to be imbalanced if this part of the pituitary gland is not functioning properly? Select all that apply.
Oxytocin Antidiuretic hormone
The nurse is caring for a patient with pheochromocytoma. The nurse checks the patient's blood pressure, respiratory rate, and blood glucose levels, and palpates the adrenal mass to note its measurements. Which of the actions performed by the nurse needs correction?
Palpating the mass to note its measurements in patient
On reviewing the laboratory reports of a patient, the nurse finds that the patient has a calcium level of 7.0 mg/dL due to impaired absorption of calcium. Based on these findings, which laboratory value should the nurse assess next?
Parathyroid hormone (PTH)
What are the cardinal signs of diabetes insipidus?
Polyuria and polydipsia
What does the nurse recognize as the primary clinical manifestation of diabetes insipidus?
Polyuria and polydipsia
The nurse finds that a child has excessive hair growth, a pendulous abdomen, red abdominal striae, ecchymosis, fat deposits on the upper back, and a moon-shaped face. Based on these, which laboratory value should the nurse assess first?
Potassium
Which manifestation helps the nurse to identify hyperglycemia in a child with diabetes mellitus (DM)?
Presence of acetone breath
A child is on hormone replacement therapy for panhypopituitarism. What instructions does the nurse give to the child's parents? Select all that apply.
Provide same age-appropraite responsibilities as the child's siblings. Encourage the child to wear medical identification at all times Encourage the child to participate in group activities with peers
The nurse is caring for a child hospitalized with acute adrenocortical insufficiency. The acute phase seems to be over when ascending flaccid paralysis occurs. What is the most appropriate nursing action?
Reassure the family that this condition is temporary
What manifestation of type 2 diabetes help the nurse to distinguish it from type 1 diabetes?
Relative insulin deficiency
A child admitted to the hospital for meningitis suddenly reports stomach cramps, anorexia, and vomiting. The nurse finds the child to be irritable with altered consciousness. The child's serum sodium levels are found to be 120 mEq/L. What is the most appropriate immediate next steps of the nurse?
Restrict oral fluids
A child with diabetes insipidus is prescribed vasopressin (ADH) injections. How does the nurse prepare the injection? Select all that apply.
Resuspended in the oil by holding it in warm running water for 10 to 15 minutes. Shake vigorously before use and check for small brown particles in the suspension
A 17-year-old with type 1 diabetes mellitus tells the school nurse about recently starting to drink alcohol with friends on weekends. What is the most appropriate intervention by the nurse?
Teach the adolescent about the effects of alcohol on type 1 diabetes mellitus and how to prevent problems associated with alcohol intake
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 Hg, respiration 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.
The child's response to fluid replacement The child's response to cortisol replacement
A child is undergoing hormone replacement therapy. The nurse observes that the child appears younger than the chronologic age. What does the nurse include in the child's place of care? Select all that apply.
The nurse provides education to the child for self-management. The nurse instructs the family about injection sites and techniques The nurse instructs the family on how to prepare medications
The imbalance of which hormone causes symptoms of warm, moist skin; protruding eyeballs; difficulty breathing; and heart intolerance?
Thyroid hormone
The nurse recognized that a hemoglobin A1C value of 9.0% for a toddler is:
Too high
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. What disorder is associated with these clinical symptoms?
Type 1 diabetes
Which physiologic alteration is characterized by destruction of pancreatic beta-cells that produce insulin?
Type 1 diabetes
Which statement made by the child indicates the need for further education about how to manage newly diagnosed type 1 diabetes mellitus?
"I can eat cake and candy as long as I give myself extra insulin to compensate."
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.
"Tell me about diseases in your family." "What kind of developmental issues did the child have?" "Have there been changes in the child's appetite?" "What kind of medications does the child take?"
A chronic diabetic patient has been on insulin injections for the past 3 months. The patient's blood reports show the hemoglobin A1c is 6%. What does the nurse tell the parents?
"The patient's diabetes is under control; please continue the same regimen of treatment."
Calculate the target height of a boy whose father is 175 cm tall and whose mother is 160 cm tall. Record your answer using a whole number.
174 cm
When does rapid-acting insulin (i.e., Novolog) peak?
30 to 90 minutes after injection
A child with diabetes insipidus is admitted to the hospital. What nursing interventions are important for this child? Select all that apply.
Administer intravenous fluids Monitor urine volumes regularly
Urinalysis of a patient with type 1 diabetes mellitus shows, ketones, glucose, and high concentrations of H+ ions. On examination the nurse finds that the patient's skin is dry, radial artery pulse is weak, and the level of consciousness is decreased. What measures are taken by the nurse? Select all that apply.
Administer potassium supplements. Administer insulin. Administer IV fluids.
A child with generalized tuberculosis is diagnosed with total adrenal insufficiency and is prescribed cortisol and antitubercular drugs for long-term use. What does the nurse tell the parents of the child?
Always have a prefilled syringe of hydrocortisone at home.
An infant presents with hypospadias, micropenis, and no palpable gonads. How should the nurse document these findings?
Ambiguous genitalia
The nurse suspects that the child has delayed growth. The nurse does not have serial height and weight records to assess the child's growth. What action does the nurse take?
Asks about the child's growth as compared to siblings.
The nurse is assessing a 7-year-old with precocious puberty who is taking a monthly injection of a synthetic analogue of luteinizing hormone-releasing hormone leuprolide acetate (Lupron Depot). When should treatment be discontinued?
At a chronologically appropriate time
