peds endocrine
A nurse is presenting information to a group of clients about nutrition habits that prevent type 2 diabetes mellitus. Which of the following should the nurse include in the information? Select all that apply. A. Eat less meat and processed foods. B. Decreased intake of saturated fat. C. Increase daily fiber intake. D. Limit saturated fat intake to 15% of daily caloric intake. E. Include omega-3 fatty acid in the diet
A, B, C, E Healthy nutrition should include decreasing consumption of meats and processed foods, which can prevent diabetes and hyperlipidemia. Healthy nutrition should include lowering LDL by decreasing intake of saturated fats. Healthy nutrition should include increasing dietary fiber to control weight gain and decrease the risk of diabetes and hyperlipidemia. Healthy nutrition should include omega-3 fatty acid for secondary prevention of diabetes and heart disease.
A nurse is reviewing the laboratory findings of a client who has Cushing's disease. Which of the following findings are expected for this client? Select all that apply. A. Sodium 150 mEq/L B. Potassium 3.3 mEq/L C. Calcium 8.0 mg/dL D. Lymphocyte count 35% E. Fasting glucose 145 mg/dL
A, B, C, E Hypernatremia is an expected finding for clients with Cushing's disease. Hypokalemia is an expected finding for client to have Cushing's disease Hypocalcemia is an expected finding for clients at cushions disease. Clients with Cushing's disease have an elevated fasting BG because glucose metabolism is affected.
A nurse is reviewing serum laboratory results for a client who has Addison's disease. Which of the following findings are typical for a client who has his condition? Select all that apply. A. Sodium 130 mEq/L B. Potassium 6.1 mEq/L C. Calcium 11.6 mg/dL D. Magnesium 2.5 mg/dL E. Glucose 65 mg/dL
A, B, C, E In the presence of Addison's disease, insufficient glucose can cause sodium and water excretion. Therefore, Hyponatremia, hyperkalemia, hypercalcemia, and hypoglycemia are expected findings for Addison's disease
The nurse is planning care for a client who has Cushing's disease. In planning care, the nurse should recognize that the clients with Cushing's disease are increased risk for which of the following? Select all that apply. A. Infection B. Gastric ulcer C. Renal calculi D. Bone fractures E. Dysphagia
A, B, D Suppression of the immune system places a client at risk for infection; overproduction of gastric acid places the client at risk for gastric ulcers; clients who have Cushing's disease are at risk for bone fractures because decreased calcium absorption leads to osteoporosis.
A nurse is caring for client who has syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following findings should the nurse expect? (Select all that apply) A. decreased serum sodium B. Urine specific gravity 1.001 C. Serum osmolarity 230 mOsm/L D. Polyuria E. Increased thirst
A, C
A nurse is reviewing the health record of the client Who has hyperglycemic hyperosmolar syndrome (HHS). Which of the following data confirms the diagnosis? Select all that apply. A. Evidence of recent myocardial infarction B. BUN 35 mg/dL C. Takes a calcium channel blocker D. Age of 77 years E. No insulin production
A,B,C,D
A nurse is caring for a kid who has short stature. Which of the following diagnostic tests should be completed to confirm GH deficiency? a. CT scan of the head b. Bone age scan C. GH stimulation test d. Serum IGF-1 e. DNA testing
A,B,C,D *CT done to determine whether there is a structural component to the short stature * Bone scan done to determine the development of the bones
A nurse is providing discharge teaching to a client who experienced DKA. Which of the following should the nurse include in the teaching? Select all that apply. A. Drink 3 L of fluid daily B. Monitor blood glucose every 4 hrs when ill C. Administer insulin as prescribed when ill D. Notify provider when BG is 200 mg/dL E. Report ketones in the urine after 24 hours of illness
A,B,C,E
A nurse is teaching the parent of a kid who has GH deficiency. Which of the following are complications of untreated GH deficiency? a. delayed sexual development b. premature aging c. advanced bone age d. short stature e. increased epiphyseal closure
A,B,D
A nurse is reviewing sick day management with a parent of a child who has type 1 diabetes mellitus. Which of the following should the nurse include in the teaching? (Select all that apply.) A. Monitor blood glucose levels every 3 hr. B. Discontinue taking insulin until feeling better. C. Drink 8 oz of fruit juice every hour. D. Test urine for ketones. E. Call the health care provider if blood glucose is greater than 240 mg/dL.
A,D,E
A nurse at the beginning of the shift is assessing a client who has Cushing's disease. Which of the following is a priority assessment? A. Daily weights B. Fatigue C. Fragile skin D. Joint pain
A. The greatest risk to a client with Cushing's disease is fluid retention, which can lead to hypertension and heart failure.
A nurse is reviewing the laboratory findings of the client has suspected hyperthyroidism. An elevation of which of the following supports this diagnosis? A. T3 B. VMA C. ACTH D. HB A1C
A. T3
A nurse is assessing a child for short stature. Which of the following findings would indicate a GH deficiency? A. proportional ht & wt B. ht proportionally greater than wt. C. wt proportionally greater then ht. D. BMI greater than ht/wt ratio
A. proportional ht & wt
In growing children, growth hormone deficiency results in short stature and very slow growth rates. Short stature may result from which of the following? A. Anterior pituitary gland hypofunction B. Posterior pituitary gland hyperfunction C. Parathyroid gland hyperfunction D. Thyroid gland hyperfunction
Answer: A. Anterior pituitary gland hypofunction A: Short stature usually results from diminished or deficient growth hormone, which is released from the anterior pituitary gland. B: Posterior pituitary hyperfunction results in increased secretion of antidiuretic hormone or oxytocin, leading to a syndrome of inappropriate antidiuretic hormone secretion, marked by fluid retention and hyponatremia. C: Parathyroid hypofunction leads to hypocalcemia D: Thyroid hyperfunction causes increased secretion of thyroxine, triiodothyronine, and thyrocalcitonin, resulting in Graves' disease, marked by accelerated linear growth and early epiphyseal closure.
Arvic who is diagnosed with diabetes mellitus type 1 displays symptoms of hypoglycemia; which of the following actions should the nurse instruct the parents? A. Give the child honey (simple sugar). B. Give the child milk (complex sugar). C. Contact the healthcare provider before doing anything. D. Give the child nothing by mouth.
Answer: A. Give the child honey (simple sugar). A: Immediate action is important. Therefore, providing little sugar temporarily corrects low serum glucose levels. A simple sugar is preferred because it is converted to glucose more quickly than a complex sugar. A child with hyperglycemia needs fluid to prevent dehydration. B: Because complex sugars, such as milk, are absorbed more slowly, they do not provide an immediate response. C: Contacting the healthcare provider wastes valuable time during which emergency measures could be started to raise the child's glucose level. D: Prompt action is required to prevent complications of hypoglycemia.
Nurse Aries entered the room of a child with hypopituitarism and was asked by the couple about the condition of their child. Which of the following phrases if stated by the nurse best describes the condition? A. Linear growth retardation with skeletal proportions normal for chronologic age B. A complete normal growth pattern, but with the onset of precocious puberty C. Normal growth for first five years, followed by progressive linear growth retardation D. Growth retardation in which height and weight are equally affected
Answer: A. Linear growth retardation with skeletal proportions normal for chronologic age A: Although linear growth retardation occurs in hypopituitarism, delayed epiphyseal maturation allows for normal skeletal proportions. B: The child with hypopituitarism commonly experiences delayed sexual maturation. C: Normal growth may occur for the first year, followed by linear growth thereafter. D: Height is affected more profoundly than weight, contributing to obesity.
Nurse Angelo admits a child with suspected type 1 DM; which should the nurse ask the parents? A. "Does the child complain of headache?" B. "How much exercise does the child get?" C. "Has the child's number and type of bowel movements changed?" D. "Has the child experienced nocturia or bedwetting?" E. "How much candy and sweets does your child take daily?"
Answer: D. "Has the child experienced nocturia or bedwetting?" D: Bedwetting in children who have previously stayed dry at night is often an early sign of diabetes. Type 1 diabetes is a disease when the pancreas that produces insulin and helps get sugars (glucose) into the cells does not produce insulin.
Mr. Lopez has a 7-year-old son with growth hormone (GH) deficiency. He shares to the nurse the desire of his son to play ball games. However, his wife feels the child will be in danger since he is smaller than the other children. In planning anticipatory guidance for these parents, the nurse should keep in mind which of the following? A. The child should be allowed to play because doing so can foster healthy self-esteem. B. The risk for fractures is increased because a GH deficiency results in fragile bones. C. Activity could aggravate insulin sensitivity, causing hyperglycemia. D. Activity would aggravate the child's joints, already over tasked by obesity.
Answer: A. The child should be allowed to play because doing so can foster healthy self-esteem. A: Engaging in peer-group activities can aid foster a sense of belonging and a positive self-concept. T-ball is a good sport to choose because physical stature is not an important consideration in the ability to participate, unlike some other sports, such as basketball and football. B: Hypopituitarism does not affect calcium and phosphorus homeostasis and demineralization of bone. So the risk for fractures is not increased. C: Although rare, physical activity without adequate carbohydrate intake can cause hypoglycemia. D: Moderate physical activity increases caloric use and reduces weight without undue strain on weight-bearing joints.
Katie is admitted to the intensive care unit of Nurseslabs Medical Center for diabetic ketoacidosis; which of the following is of primary importance when caring for the child? A. Giving I.V. NPH insulin in high doses B. Evaluating the child for cardiac abnormalities C. Limiting fluids to prevent aggravating cerebral edema D. Monitoring and recording the child's vital signs for hypertension
Answer: B B: As the fluid volume deficit is improved, total body potassium deficiency may occur, leaving the child vulnerable to hypokalemia and, afterward, cardiac arrest. The nurse should monitor the cardiac cycle for prolonged QT interval, low T wave, and depressed ST segment, which indicate weakened heart muscle and potential irregular heartbeat. A: Regular insulin is the only insulin that can be given I.V. NPH is an intermediate-acting insulin; continuous low-dose infusion of a rapid-acting insulin is preferred. C: I.V. fluids should be given to correct dehydration. D: Hypertension is more likely to happen secondary to dehydration.
Nurse Angelo is attending for a child with Cushing's syndrome; which of the following nursing interventions would be most necessary? A. Observing the child for signs and symptoms of metabolic acidosis B. Handling the child carefully to prevent bruising C. Monitoring vital signs for hypertension and tachycardia D. Monitoring the child for signs and symptoms of hypoglycemia
Answer: B B: The nurse should handle the child carefully because Cushing's syndrome causes capillary fragility, resulting in easy bruising and calcium excretion, resulting in osteoporosis. A and C: Cushing's syndrome causes increased excretion of potassium and hydrogen ions, resulting in alkalosis and increased water and sodium retention, and hypokalemia, resulting in a sluggish and irregular heartbeat. D: Cushing's syndrome causes hyperglycemia, not hypoglycemia.
The 6-year-old son of Mr. and Mrs. Peters is admitted to the healthcare facility with the diagnosis of idiopathic hypopituitarism. His height is measured below the third percentile and weight at the 40th percentile. Which of the following would be the first action of his attending nurse? A. Recommend orthodontic referral for underdeveloped jaw. B. Collaborate with a dietician to access his caloric needs. C. Provide for a tutor for his precocious intellectual ability. D. Place him in a room with a 2-year-old boy.
Answer: B. B: Because the child's weight is excessive for his height, he needs dietary assessment and a weight-loss program A: An underdeveloped jaw is not usually a problem with hypopituitarism. C: Providing a tutor to educate him is an appropriate action, but the rationale is incorrect. Although children with hypopituitarism generally appear intellectually precocious because of the disparity between their size and their cognitive ability, they are usually of normal intelligence. D: Placing the child in a room with a toddler could contribute to poor self-esteem.
Which type of diabetes mellitus (DM) most likely results from heterogenous risk factors, making it preventable? A. Type 1 B. Type 2 C. Type 1 and 2 D. Gestational diabetes
Answer: B. Type 2 B: Type 2 DM is a complex disorder of various causes with social, behavioral, and environmental risk factors. The disorder may be prevented by encouraging lifestyle modification for children at risk.
While Andres is being assessed at the clinic, Nurse Shiela observed that the child appears to be small, with an immature face and chubby body build. Her parents stated that their child's rate of growth of all body parts is somewhat slow, but her proportions and intelligence remain normal. As a knowledgeable nurse, you know that the child has a deficiency of which of the following? A. Antidiuretic hormone (ADH) B. Parathyroid hormone (PTH) C. Growth hormone (GH) D. Melanocyte-stimulating hormone (MSH)
Answer: C C. GH stimulates protein anabolism, promoting bone and soft-tissue growth. A lack of GH would lead to decreased synthesis of somatomedin, resulting in decreased linear growth and decreased fat catabolism and increased glucose uptake in muscles, resulting in excessive subcutaneous fat hypoglycemia. A: A deficiency in ADH results in diabetes insipidus, marked by dehydration and hypernatremia. B: Deficiency of PTH causes hypocalcemia, marked by tetany, convulsions, and muscle spasms. D: Deficiency of MSH causes diminished or absent skin pigmentation.
Tara is an 11-year-old girl diagnosed with type 1 diabetes mellitus (DM). She asks her attending nurse why she can't take a pill rather than shots like her grandmother does. Which of the following would be the nurse's best reply? A. "If your blood glucose levels are controlled, you can switch to using pills." B. "The pills correct fat and protein metabolism, not carbohydrate metabolism." C. "Your body does not make insulin, so the insulin injections help to replace it." D. "The pills work on the adult pancreas, you can switch when you are 18."
Answer: C. "Your body does not make insulin, so the insulin injections help to replace it." C: The child has type 1 DM, indicating a lack of functioning pancreatic beta cells and an absolute insulin deficiency. A: Oral antidiabetics are indicated only for those with some functioning beta cells, as in those with type 2 DM. Therefore, injections are indicated to supply insulin that is lacking in type 1 diabetes. B: Oral antidiabetics do not correct metabolism. D: A child with type 1 DM cannot substitute an oral antidiabetic for insulin, regardless of age.
Which of the following should the nurse include in the insulin administration instruction for the parents of a child being discharged on insulin? A. Insert the needle and aspirate prior to injecting B. Inject insulin into the extremity to be exercised to enhance absorption C. The muscles in the abdomen and thigh are the easiest to use for self administration D. Clean the site of injection with soap and water and
Answer: D. Clean the site of injection with soap and water and avoid alcohol D: Infection risk from insulin injections is negligible (at least in normal environments - some experts feel hospital environments are riskier), and an alcohol swab is a poor way to sanitize skin in the first place. Soap and hot water are actually more effective.
Nurse Dorothy is caring for a child with Cushing's syndrome; which of the following should she include in the plan of care? A. Increase fluids to prevent dehydration B. Encourage a diet high in carbohydrates C. Monitor weight each day and report for weight loss D. Encourage a diet high in potassium
Answer: D. Encourage a diet high in potassium D: The elevation of cortisol level in Cushing's disease causes a decrease in the level of potassium, a condition called hypokalemia. At high levels, cortisol stimulates the tubules that control the absorption of electrolytes in the kidneys to excrete more potassium into the urine.
Justine is admitted to the pediatric unit due to the occurrence of diabetic ketoacidosis signaling a new diagnosis of diabetes. The diabetes team explores the cause of the episode and take steps to prevent a recurrence. Diabetic ketoacidosis (DKA) results from an excessive accumulation of which of the following? A. Sodium bicarbonate from renal compensation B. Potassium from cell death C. Glucose from carbohydrate metabolism D. Ketone bodies from fat metabolism
Answer: D. Ketone bodies from fat metabolism D: Inability to use glucose causes lipolysis, fatty acid oxidation, and release of ketones, resulting in metabolic acidosis and coma. A: Sodium bicarbonate administration is a treatment for DKA, not a cause. B: Potassium depletion, not potassium excess, occurs in DKA C: Inability to use glucose, not impaired carbohydrate metabolism, is the primary mechanism is diabetes mellitus.
A child newly diagnosed with diabetes mellitus has been stabilized with insulin injections daily. A nurse prepares discharge teaching plan regarding the insulin. The teaching plan should reinforce which of the following concepts? A. Always keep insulin vials refrigerated B. Increase the amount of insulin before exercise C. Ketones in the urine signify a need for less insulin D. Systematically rotate injection sites
Answer: D. Systematically rotate injection sites D: It is necessary to rotate injection sites because injecting in the same place much of the time can cause hard lumps or extra fat deposits to develop.
A nurse is caring for a client who has Addison's disease and is taking hydrocortisone (Cortef). Which of the following medication instructions is appropriate for the nurse to include? Select all that apply. A. Take the medication on an empty stomach. B. Notify the provider of any illness or stress. C. Report any symptoms of weakness or dizziness. D. Do not discontinue the medication suddenly. E. Eat a low sodium diet.
B, C, D Physical and emotional stress increase the need for cortisone. Therefore, the provider may increase dosage when stress occurs. Weakness and dizziness or indications of adrenal insufficiency, and the client should report the indications to the provider. Rapid discontinuation can result in adverse effects, including acute adrenal insufficiency. If hydrocortisone is to be discontinued, the dosage should be tapered.
A nurse is admitting a client who has acute adrenal insufficiency to the intensive care unit. Which of the following prescriptions should the nurse anticipate? Select all that apply. A. IV therapy with 0.45% sodium chloride B. Regular insulin C. Hydrocortisone sodium succinate (Solu-Cortef) D. Sodium polyestyrene sulfonate (Kayexalate) E. Furosemide (Lasix)
B, C, D, E Clients who have acute adrenal sufficiency are hyperkalemic, therefore need the following medications.
The nurse is reinforcing teaching with a client who has been prescribed levothyroxine (Synthroid) to treat hypothyroidism. Which of the following should the nurse include in the teaching? Select all that apply. A. Weight gain is expected while taking this medication. B. Medication should not be discontinued without the advice of the provider. C. Follow up serum TSH levels should be obtained. D. Take the medication on an empty stomach. E. Use fiber laxatives for constipation.
B,C,D
A nurse is assessing a client who has DKA and ketones in the urine. Which of the following are expected findings? Select all that apply. A. Weight gain B. Fruity odor or breath C. Abdominal pain D. Kussmaul respirations E. Metabolic acidosis
B,C,D,E
A nurse is collecting an admission history from a female client who has hypothyroidism. Which of the following findings are expected with this condition? Select all that apply. A. Diarrhea B. Menorrhagia C. Dry skin D. Increased libido E. Hoarseness
B,C,E
A nurse is reviewing the clinical manifestations of hyperthyroidism with the client. Which of the following findings should the nurse include? Select all that apply. A. Dry skin B. Heat intolerance C. Constipation D. Palpitations E. Weight loss F. Bradycardia
B,D,E
A nurse is caring for a client who has Diabetes Insipidus. Which of the following urinalysis laboratory findings should the nurse anticipate? A. Absence of glucose B. Decreased specific gravity C. Presence of ketones D. Presence of RBCs
B. Decreased specific gravity
A client asks the nurse why the provider bases his medication regimen on his HbA1C instead of his log of morning fasting blood glucose results. Which of the following is an appropriate response by the nurse? A. HB A1C measures how well insulin is regulating your blood glucose between meals. B. HB A1 C indicates how well your blood glucose has been regulated over the past three months. C. A test of HB A1C is the first test to determine if an individual has diabetes. D. A test of HB A1C determines if the dosage of insulin needs to be adjusted.
B. HB A1 C indicates how well your blood glucose has been regulated over the past three months.
The nurse is reviewing laboratory reports of a client who has HHS. Which of the following is an expected finding? A. Serum pH 7.2 B. Serum osmolarity 350 mOsm/L C. Serum potassium 3.8 mg/dL D. Serum creatinine 0.8 mg/dL
B. Serum osmolarity 350 mOsm/L
A nurse is teaching an adolescent who has diabetes about clinical manifestations of hypoglycemia. Which of the following should be included int he teaching? (Select all that apply.) A. Increased urination B. Hunger C. Signs of dehydration D. Irritability E. Sweating and pallor F. Kussmaul respirations
B. Hunger D. Irritability E. Sweating and pallor
The nurse is teaching care to client who has DM. Which of the following information should the nurse include in the teaching? Select all that apply. A. Remove calluses using over-the-counter remedies B. Apply lotion between toes C. Perform nail care after bathing D. Trim toenails straight across E. Wear closed-toe shoes
C, D, E perform nail care after bathing, when toenails are softer and easier to trim Trim toenails straight across to prevent injury to soft tissues of the toes. Wear closed-toe shoes to prevent injury to soft tissue the toes and feet.
The nurse is assessing a client who has SIADH. Which of the following findings indicate the client is experiencing a complication? A. Decreased central venous pressure (CVP) B. Increased urine output C. Distended neck veins D. Extreme thirst
C. Distended neck veins are a manifestation of fluid overload, which can lead to pulmonary edema and heart failure. Decreased CVP is indicative of shock. Increased urine output is indicative of DI. Extreme thirst is indicative of DI.
A nurse in a providers office is reviewing the laboratory findings of the client who's being evaluated for primary hypothyroidism. Which of the following laboratory findings is expected for a client who has hypothyroidism? A. Serum T4 10 mcg/dL B. Serum T3 200 ng/dL C. Hematocrit 34% D. Serum cholesterol 100 mg/dL
C. Hematocrit of 34% indicates anemia, which is an expected result for a client who has hypothyroidism.
The nurse is planning to teach a client who is being evaluated for Addison's disease about the adrenocorticotropic hormone (ACTH) stimulation test. The nurse should base her instructions to the client on which of the following? A. The ACTH stimulation test measures the response by the kidneys to ACTH. B. In the presence of primary adrenal insufficiency, plasma cortisol levels rise in response to administration of ACTH. C. ACTH is a hormone produced by the pituitary gland. D. The client is instructed to take a dose of ACTH by mouth the evening before the test.
C. Secretion of corticotropin releasing hormone from the hypothalamus pituitary gland to secrete ACTH. The ACTH stimulation test measures the response by the adrenal glands, not the kidneys, to ACTH.
A nurse is teaching a child who has type 1 diabetes mellitus about self care. Which of the following statements by the child indicates understanding of the teaching? A. "I should skip breakfast when I am not hungry." B. "I should increase my insulin with exercise." C. "I should drink a glass of milk when I am feeling irritable." D. "I should draw up the NPH insulin into the syringe before the regular insulin."
C. "I should drink a glass of milk when I am feeling irritable."
A nurse is caring for a child who has type 1 diabetes. Which of the following is a clinical manifestation of diabetic ketoacidosis? (Select all that apply.) A. Blood glucose 58 mg/dL B. Weight gain C. Dehydration D. Mental confusion E. Fruity breath
C. Dehydration D. Mental confusion E. Fruity breath
A nurse is preparing to administer IV fluids to client who has DKA. Which of the following is an appropriate nursing action? A. Administering IV infusion of regular insulin at 0.3 units per kilogram per hour B. Administer and IV infusion of 0.45% sodium chloride C. Rapidly administering IV infusion of 0.9% sodium chloride D. Add glucose to the IV infusion when serum glucose is 350 mg/dL
C. Rapidly administering IV infusion of 0.9% sodium chloride
A nurse is teaching an adolescent who has diabetes about foot care. Which of the following shud the nurse include in the teaching? A. "You should inject the needle at a 30-degree angle." B. "You should combine your glargine and regular insulin in the same syringe" C. "You should aspirate for blood before injecting the insulin." D. "You should give 4 or 5 injections in one area before switching sites"
D. "You should give 4 or 5 injections in one area before switching sites"
A nurse is providing teaching to a client who has a new diagnosis of diabetes insipidus. Which of the following statements indicates understanding of teaching? A.) "I can drink up to 2 quarts of fluid a day" B.) "I will need to use insulin to control my glucose levels" C.) "I should expect to gain weight during this illness" D.) "Muscle weakness is a symptom"
D.) "Muscle weakness is a symptom"
A parent of a school ages kid with GH deficiency asks the nurse how long his son will need to take injections for his growth delay. Which of the following is an appropriate response? a. until age 12 for boys and age 10 for girls b. until the kid reaches 5th percentile c. until there is evidence of epiphyseal closure d. their entire life
c. until there is evidence of epiphyseal closure