PEDS Practice: Chapter 26 Nursing Care of the Child With an Alteration in Metabolism/Endocrine Disorder

The nurse is teaching a 12-year-old girl with diabetes mellitus type 2 and her parents about dietary measures to control her glucose levels. Which comment by the child indicates a need for additional teaching?

"I can eat two small cookies with each meal." Cookies, cakes, candy, potato chips, and crackers are high in sugars and fats and should be eaten in moderation as special treats; they would not be included with each meal. An apple or orange makes a good snack. Nonfat milk is a better option than whole milk. Long-acting carbohydrates should be the largest category of foods eaten

The nurse is speaking with the parents of a school-aged child recently diagnosed with diabetes mellitus regarding the differences between hypoglycemia and hyperglycemia. Which statement by a parent indicates a need for further teaching?

"If I notice changes in my son like tearfulness or irritability, his blood sugar may be high." Behavior changes such as tearfulness, irritability, confusion and slurred speech are indications of hypoglycemia, not hyperglycemia. Tremors and diaphoresis are also indications of low blood sugar. Dry flushed skin, fatigue, weakness, nausea, vomiting and fruity breath odor are all symptoms of hyperglycemia.

A 10-year-old boy has been diagnosed with type 1 diabetes mellitus. He is curious about what the cause of his disease is and asks the nurse to explain it to him. What should the nurse say to the boy?

"Special cells in a part of your body called the pancreas can't make a chemical called insulin, which helps control the sugar level in your blood." Type 1 diabetes is a disorder that involves an absolute or relative deficiency of insulin, in contrast to type 2 where insulin production is only reduced. Insulin is produced by beta islet cells in the pancreas. Diabetes insipidus is caused by the pituitary gland not producing enough ADH and is characterized by extreme thirstiness and polyuria. Insufficient growth hormone is also related to dysfunction of the pituitary gland.

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." Tiredness, fatigue, constipation, cold intolerance and weight gain are all symptoms of hypothyroidism. Nervousness, anxiety, heat intolerance, weight loss and smooth velvety skin are all symptoms of hyperthyroidism

The nurse is preparing to administer the child's ordered lispro (Humalog) insulin at 0800. When will the child's blood glucose level begin to decline?

0815 The onset of rapid acting insulins like lispro (Humalog) is within 15 minutes. Short-acting insulin's onset is 30 to 60 minutes. Intermediate-acting insulin's onset is 1-3 hours, and long-acting insulin's onset is 1-2 hours.

The nurse is administering biosynthetic GH, derived from recombinant DNA, by subcutaneous injection. The weekly dosage is 0.2 to 0.3 mg/kg, given in divided doses daily. The child weighs 110 pounds. What is the safe dosage limit for this child on a weekly basis?

15 110 lb divided by 2.2 kg = 50 kg 50 kg X 0.2 mg = 10 mg 50 kg X 0.3 mg= 15 mg The lack of GH impairs the body's ability to metabolize protein, fat, and carbohydrates. Treatment of primary GH deficiency involves the use of supplemental GH. Treatment continues until near final height goal is achieved.

The parents of a child who was diagnosed with diabetes insipidus ask the nurse, "How does this disorder occur?" When responding to the parents, the nurse integrates knowledge that a deficiency of which hormone is involved?

Antidiuretic hormone Diabetes insipidus results from a deficiency in the secretion of antidiuretic hormone (ADH). This hormone, also known as vasopressin, is produced in the hypothalamus and stored in the pituitary gland. Hypopituitarism or dwarfism involves a growth hormone deficiency. Diabetes mellitus involves a disruption in insulin secretion. Thyroxine is a thyroid hormone that if deficient leads to hypothyroidism.

Diabetes insipidus is a disorder of the posterior pituitary that results in deficient secretion of which hormone?

Antidiuretic hormone (ADH) Central diabetes insipidus (DI), also called neurogenic, vasopressin-sensitive, or hypothalamic DI, is a disorder of the posterior pituitary that results from deficient secretion of ADH. Nephrogenic DI is a result of the inability of the kidney to respond to ADH.

Rank the different types of insulin based on their duration of action beginning with the shortest to the longest duration.

Lispro Humulin R Humulin N Lantus Lispro is a rapid-acting insulin. Humulin R is a short-acting insulin. Humulin N is an intermediate-acting insulin. Lantus is a long-acting insulin.

As a nurse, you know that which condition is caused by excessive levels of circulating cortisol:

Cushing syndrome Cushing syndrome is a characteristic cluster of signs and symptoms resulting from excessive levels of circulating cortisol. Addison disease is caused by autoimmune destruction of the adrenal cortex, which results in dysfunction of steroidogenesis. Graves disease is the most common form of hyperthyroidism. Turner syndrome is deletion of the entire X chromosome.

A child with a primary growth hormone deficiency is to receive biosynthetic growth hormone. The nurse would explain to the child and parents that this hormone would be given at which frequency?

Daily Biosynthetic growth hormone, derived from recombinant DNA, is given by subcutaneous injection. The weekly dosage is 0.2 to 0.3 mg/kg, divided into equal doses given daily for best growth.

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 Acanthosis nigricans (darkened, thickened pigmentation, particularly around the neck or in the axillary region) is associated with polycystic ovary syndrome. Serum levels of free testosterone typically are elevated with polycystic ovary syndrome. With polycystic ovary syndrome, body mass index indicates overweight or obesity. Short stature typically is associated with growth hormone deficiency.

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

Early identification The most important nursing objective is early identification of the disorder. Nurses caring for neonates must be certain that screening is performed, especially in neonates who are preterm, discharged early, or born at home. Promoting bonding, allowing rooming in, and encouraging fluid intake are all important but are less important than early identification.

A newborn girl is discovered to have congenital adrenal hyperplasia. When assessing her, the nurse would expect to find which physical characteristic?

Enlarged clitoris Lack of production of cortisol by the adrenal gland leads to overproduction of androgen. This leads to female infants developing an enlarged clitoris.

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

Growth hormone Disorders of the pituitary gland depend on the location of the physiologic abnormality. The anterior pituitary, or adrenohypophysis, is made up of endocrine glandular tissue and secretes growth hormone (GH), adrenocorticotropic hormone (ACTH), TSH, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin. The posterior lobe is called the neurohypophysis because it is formed of neural tissue. It secretes antidiuretic hormone (ADH; vasopressin) and oxytocin. Usually, several target organs are affected when there is a disorder of the pituitary gland, especially the adrenohypophysis.

In teaching the parents of an infant diagnosed with diabetes insipidus, the nurse should include which treatment?

Hormone replacement The usual treatment for diabetes insipidus is hormone replacement with vasopressin or desmopressin acetate (DDAVP). Blood products shouldn't be needed. No problem with hypertension is associated with this condition, and fluids shouldn't be restricted.

A 12-year-old girl is diagnosed with hyperthyroidism. What problem would the nurse anticipate she may have in school?

Inability to submit neat handwriting assignments Children with hyperthyroidism may develop hand tremors, which leads to poor handwriting.

You care for a 10-year-old boy with growth hormone deficiency. Which therapy would you anticipate will be prescribed for him?

Injections of growth hormone Growth hormone deficiency occurs when the pituitary is unable to produce enough hormone for usual growth. Administering subcutaneous growth hormone supplements this

The nurse is teaching an 11-year-old boy and his family how to manage his diabetes. Which instruction does not focus on glucose management?

Instructing the child to rotate injection sites Instructing child to rotate injection sites to decrease scar formation is important, but does not focus on managing glucose levels. Teaching the child and family to eat a balanced diet, encouraging the child to maintain the proper injection schedule, and promoting a higher level of exercise all focus on regulating glucose control.

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

Low T4 level and high TSH level Screening results that show a low T4 level and a high TSH level indicate congenital hypothyroidism and the need for further tests to determine the cause of the disease.

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 Metformin, a biguanide, reduces glucose production from the liver. Glipizide stimulates insulin secretion by increasing the response of β cells to glucose. Glyburide stimulates insulin secretion by increasing the response of β cells to glucose. Nateglinide stimulates insulin secretion by increasing the response of β cells to glucose.

The nurse is assessing a 5-year-old boy who has had several convulsions. The nurse continues to assess the child and suspects that he may have hypoparathyroidism. What evidence would support this suspicion?

Observation reveals tetany. Tetany occurs in children with hypoparathyroidism due to decreased serum calcium levels. Sleepiness and lack of responsiveness would suggest hyperthyroidism. Exophthalmos is associated with hyperthyroidism. Irregular heart rate is associated with hyperthyroidism.

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

Oral calcium Medical management for hypoparathyroidism includes intravenous calcium gluconate for acute or severe tetany, then intramuscular or oral calcium as prescribed. IV diuretics is used in treatment of hyperparathyroidism. Oral corticosteroids and oral potassium are not used in the treatment of hypoparathyroidism

The nurse is assessing a 4-year-old girl with ambiguous genitalia. Which finding suggests congenital adrenal hyperplasia?

Pubic hair and hirsutism Pubic hair and hirsutism in a preschooler indicates congenital adrenal hyperplasia. Irregular heartbeat on auscultation and pain due to constipation on palpation may be signs of hyperparathyroidism. Hyperpigmentation of the skin suggests Addison disease

The child may have developed thyroid storm. Which clinical manifestations of thyroid storm should the nurse expect to find? Select all that apply.

Temperature of 103.2° F (39.6° C) Wet bed linen and report of feeling "sweaty" Apical heart rate of 172 beats per minute Signs and symptoms related to the development of thyroid storm include: fever, diaphoresis, and tachycardia. Children with thyroid storm are typically restless and irritable.

The nurse is preparing a child suspected of having a thyroid disorder for a thyroid scan. What information regarding the child should the nurse alert the doctor or nuclear medicine department about?

The child is allergic to shellfish Allergies to shellfish should be reported because shellfish contains iodine; the dye used for a nuclear medicine scan is iodine based and could cause an anaphylactic reaction. The other information about the child would not need to be reported to the staff.

When discussing care of an infant with congenital hypothyroidism, you would stress that the infant will need:

administration of levothyroxine for a lifetime. Hypothyroidism occurs because the thyroid is not producing adequate thyroxine. The child will need a supplemental source for a lifetime.

In the salt-losing form of congenital adrenal hyperplasia, the most important observation you would make in a newborn would be for:

dehydration. With this form of the disorder, children are unable to produce aldosterone. This leads to the inability to retain sodium and fluid.

Insulin deficiency, increased levels of counter regulatory hormones, and dehydration are the primary causes of:

diabetic ketoacidosis. Insulin deficiency, in association with increased levels of counter regulatory hormones (glucagon, growth hormone, cortisol, catecholamines) and dehydration, is the primary cause of diabetic ketoacidosis (DKA), a life-threatening form of metabolic acidosis that is a frequent complication of diabetes. Liver converts triglycerides (lipolysis) to fatty acids, which in turn change to ketone bodies. The accumulation and excretion of ketone bodies by the kidneys is called ketonuria. Glusosuria is glucose that is spilled into the urine.

A school-aged girl is diagnosed as having Cushing syndrome from long-term therapy with oral prednisone. This means that the child:

has purple striae on her abdomen. An effect of a corticosteroid is to produce striae on the abdomen. Elevated levels of corticosteroids also cause these during pregnancy.

The nurse is teaching a child with type 1 diabetes mellitus to administer her own 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 she:

draws up the short-acting insulin into the syringe first. Drawing up the short-acting insulin first prevents mixing a long-acting form into the vial of short-acting insulin. This maintains the short-acting insulin for an emergency. Insulin is given subcutaneously.

A 7-year-old is diagnosed as having type 1 diabetes. One of the first symptoms usually noticed by parents when this illness develops is:

loss of weight. Lack of insulin reduces the ability of body cells to use glucose; this leads to starvation of cells and loss of weight as an early symptom.

Eve, 2 years old, and her parents are at the office for a follow-up visit. She has had excessive hormone levels in her recent bloodwork and her parents question why this was not found sooner. What is the best response of the nurse?

"As endocrine functions become more stable throughout childhood, alterations become more apparent. The endocrine glands are all present at birth; however, endocrine functions are immature. As these functions mature and become stabilized during the childhood years, alterations in endocrine function become more apparent. Thus, endocrine disorders may arise at any time during childhood development.

A newborn is born with hypothyroidism. A complication of this disorder if it is not recognized and treated is:

cognitive impairment Congenital hypothyroidism can lead to extreme cognitive challenge impairment if not treated.

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." Hypoglycemia can usually be prevented if an adolescent with diabetes eats more food before or during exercise. Because exercise with adolescents isn't commonly planned, carrying additional carbohydrate foods is a good preventive measure.

Kate and her parents are being seen in the office after discharge from the hospital with a new diagnosis of type 2 diabetes. Which statement by the nurse is true?

"Kids can usually be managed with an oral agent, meal planning, and exercise." Treating type 2 diabetes in children may require insulin at the outset if the child is acidotic and acutely ill. More commonly, the child can be managed initially with oral agents, meal planning, and increasing activity. Telling the child that she is lucky she did not have to learn how to give a shot might scare her so it will inhibit her from seeking future health care. The condition will not rectify itself if all orders are followed. A weight-loss program might need to be implemented but that is not always the case.

In a child with diabetes insipidus, which characteristic would most likely be present in the child's health history?

Abrupt onset of polyuria, nocturia, and polydipsia Diabetes insipidus is characterized by deficient secretion of antidiuretic hormone leading to diuresis. Most children with this disorder experience an abrupt onset of symptoms, including polyuria, nocturia, and polydipsia. The other choices reflect symptoms of pituitary hyperfunction.

The school nurse notes that a child diagnosed with diabetes mellitus is experiencing an insulin reaction and is unable to eat or drink. Which action would be the most appropriate for the school nurse to do?

Administer subcutaneous glucagon If the child having an insulin reaction cannot take a sugar source orally, glucagon should be administered subcutaneously to bring about a prompt increase in the blood glucose level. This treatment prevents the long delay while waiting for a physician to administer IV glucose or for an ambulance to reach the child.

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

Do not mix this insulin with other insulins. Glargine (Lantus) is not to be mixed with other insulins. Glargine is usually given in a single dose at bedtime. Insulin should be kept at room temperature; insulin that is administered cold may increase discomfort with the injection. Any vial of insulin that is opened should be discarded after 1 month.

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 Observation of an enlarged tongue along with an enlarged posterior fontanel and feeding difficulties are key findings for congenital hypothyroidism. The mother would report constipation rather than diarrhea. Auscultation would reveal bradycardia rather than tachycardia, and palpation would reveal cool, dry, and scaly skin.

The nurse caring for a female adolescent with polycystic ovary syndrom (PCOS) identifies "Disturbed body image related to signs and symptoms of the disease" as a nursing diagnosis that applies to this client. What signs and symptoms would support this nursing diagnosis?

Hirsutism Balding of hair on head Increased muscle mass Acne Hirsutism results in excessive amounts of stiff and pigmented hair on body areas where men typically grow hair, such as the face, chest and back. All of the symptoms listed except cysts would support the nursing diagnosis. The cysts themselves don't support the nursing diagnosis as they are not visible.

The nurse is caring for a 4-year-old boy during a growth hormone stimulation test. Which task is priority in the care of this child?

Monitoring blood glucose levels Monitoring blood glucose levels during this study is the priority task along with observing for signs of hypoglycemia since insulin is given during the test to stimulate release of growth hormone. Providing a wet washcloth would be more appropriate for a child who is on therapeutic fluid restriction, such as with syndrome of inappropriate antidiuretic hormone. Monitoring intake and output would not be necessary for this test but would be appropriate for a child with diabetes insipidus. While it is important to educate the family about this test, it is not the priority task.

The nurse is caring for a 12-year-old girl with hypothyroidism. Which information should be part of the nurse's teaching plan for the child and family?

Reporting irritability or anxiety Side effects of hypothyroidism are restlessness, inability to sleep, or irritability. These should be reported to the physician. Educating how to recognize vitamin D toxicity is necessary for a child with hypoparathyroidism. Teaching parents how to maintain fluid intake regimens is important for a child with diabetes insipidus. Teaching the child and parents to administer methimazole with meals is necessary for hyperthyroidism.

A client is being treated for hyperthyroidism with propylthiouracil. The nurse suspects the client's dose of medication is inadequate when assessing which signs and/or symptoms? Select all that apply.

Tachycardia Diarrhea Fever Irritability Propylthiouraceil is an antithyroid drug which blocks synthesis of T3 and T4, and is indicated for treatment of hyperthyroidism. Signs of inadequate dose: tachycardia, diarrhea, fever, or irritability. Cold intolerance is a sign of overdosing of the medication.

The nurse is caring for 1-month-old girl with thyrotoxicosis. What finding would the nurse expect to assess?

The child has a strong appetite but fails to thrive. Infants with thyrotoxicosis may display hyperphagia but fail to gain weight. A combination of lethargy and irritability suggests congenital hypothyroidism. Cool, dry skin that is scaly to the touch suggests congenital hypothyroidism. Hypoactivity and hypotonicity are findings that suggest congenital hypothyroidism.

A child with a history of diabetes insipidus is admitted with polyuria, polydipsia, and mental confusion. The priority intervention for this client is to:

check vital signs. The large amount of fluid loss can cause fluid and electrolyte imbalance that should be corrected; the loss of electrolytes would be reflected in vital signs. Urine output is important but not the priority. Encouraging fluids will not correct the problem and weighing the client is not necessary at this time.

A 15-year-old adolescent is scheduled for a pelvic ultrasound to evaluate for a possible ovarian cyst. Which instruction by the nurse would be most appropriate?

"Drink plenty of fluids because you need to have a full bladder." A full bladder is needed for an ultrasound of the pelvic region. The client needs to remain still for a computed tomography or magnetic resonance imaging scan, not an ultrasound. Water is withheld during a water deprivation test used to detect diabetes insipidus. Limiting stress and physical activity for 30 minutes before the test is required for the growth hormone stimulation test.

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

Administering intravenous calcium gluconate as ordered Administering intravenous calcium gluconate, as ordered, will restore normal calcium and phosphate levels as well as relieve severe tetany. Ensuring patency of the IV site to prevent tissue damage due to extravasation or cardiac arrhythmias is an intervention for any child with an IV, and monitoring fluid intake and urinary calcium output are secondary interventions. Providing administration of calcium and vitamin D is an intervention for nonacute symptoms.

A 6-year-old child is being evaluated for growth hormone dysfunction. Which tests will be employed in the diagnostic workup? Select all that apply.

CT scan MRI Pituitary function test The child will undergo laboratory tests to rule out chronic illnesses such as renal failure or liver and thyroid dysfunction. Laboratory and diagnostic tests used in children with suspected GH deficiency include CT and MRI to assess for structural abnormalities. A pituitary function test will be used to confirm a diagnosis of growth hormone dysfunction. A complete blood cell count and erythrocyte sedimentation rate test are not used for this purpose.

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 Hyperthyroidism occurs less often in children than hypothyroidism. Graves' disease, the most common cause of hyperthyroidism in children, occurs in 1 in 5,000 children between 11 and 15 years of age. Hyperthyroidism occurs more often in females, and the peak incidence occurs during adolescence.

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

Heat intolerance Hyperthyroidism is manifested by heat intolerance, nervousness or anxiety, diarrhea, weight loss and smooth, velvety skin. Constipation, weight gain, and facial edema are associated with hypothyroidism.

The nurse is interviewing the caregivers of a child admitted with a diagnosis of type 1 diabetes mellitus. The caregiver states, "She is hungry all the time and eats everything, but she is losing weight." The caregiver's statement indicates the child most likely has:

Polyphagia Symptoms of type 1 diabetes mellitus include polyphagia (increased hunger and food consumption), polyuria (dramatic increase in urinary output, probably with enuresis), and polydipsia (increased thirst). Pica is eating nonfood substances.

The nurse is interviewing the caregivers of a child admitted with a diagnosis of type 1 diabetes mellitus. The caregiver states, "The teacher tells us that our child has to use the restroom many more times a day than other students do." The caregiver's statement indicates the child most likely has

Polyuria Symptoms of type 1 diabetes mellitus include polyuria (dramatic increase in urinary output, probably with enuresis), polydipsia (increased thirst), and polyphagia (increased hunger and food consumption). Pica is eating nonfood substances.

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 Insulin for diabetic ketoacidosis is given intravenously. Only regular insulin can be administered by this route.

The nurse is assessing an 8-year-old boy who is performing at the second-grade level, reports feeling tired and weak, and is only 45 inches tall. Which finding would be specific to hypothyroidism?

The child states that the exam room is cold. Cold intolerance, manifested by the fact that the child was uncomfortably cold in the exam room, is a sign of hypothyroidism. Delayed dentition, with only two of the four 6-year molars having erupted, is typical of growth hormone deficiency. Complaints of thirst may signal diabetes or diabetes insipidus. The dramatic weight gain could be due to hypothyroidism, Cushing syndrome, or syndrome of inappropriate antidiuretic hormone.

Reva is an 8-year-old who is being seen today in the clinic for moodiness and irritability. She has begun to develop breasts and pubic hair and her parents are concerned that she is at too early an age for this to begin. The nurse knows that the possible prognosis is:

precocious puberty. The prognosis for a child with precocious puberty depends on the age at diagnosis and immediate treatment. Appropriate treatment can halt, and sometimes even reverse, sexual development and can stop the rapid growth that results in severe short adult stature caused by premature closure of the epiphysis. Treatment for precocious puberty allows the child to achieve the maximum growth potential possible. Mental development in children with precocious puberty is normal, and developmental milestones are not affected; however, the behavior may change to that of a typical adolescent. Girls may have episodes of moodiness and irritability, whereas boys may become more aggressive.

When collecting data on a child diagnosed with diabetes mellitus, the nurse notes that the child has had weight loss and other symptoms of the disease. The nurse would anticipate which finding in the child's fasting glucose levels?

180 mg/dL A fasting glucose greater than or equal to 126 mg/dL or higher on two separate occassions diagnostic for diabetes when other signs such as polyuria and weight loss, despite polyphagia, are present.

The nurse working with the child diagnosed with type 2 diabetes mellitus recognizes that most often the disorder can be managed by:

Taking oral hypoglycemic agents If the child presents with diabetic ketoacidosis, initial treatment is insulin administration, but then oral hypoglycemic agents such as metformin are often effective for controlling blood glucose levels. Lifestyle changes such as weight loss and increased exercise are important aspects of treatment for the child

The nurse is caring for a child who is scheduled for bone scan. It is suspected that the child has a growth hormone deficiency. Which finding would support this medical diagnosis?

The bone scan would show bone age would be two or more deviations below normal. Diagnostic testing used in children with suspected GH deficiency include bone age will be two or more deviations below normal. CT or MRI scans would be used to rule out tumors or structural abnormalities, not bone scans.

The nurse is caring for a child being evaluated for diabetes insipidus. Which tests will likely be included in the diagnostic workup for this condition? Select all that apply.

CT scan skull MRI of kidney region Urinalysis Diabetes insipidus is an endocrine disorder characterized by excessive thirst, fluid intake and urinary output. Diagnostic testing will include radiographic studies such as a CT scan and MRI of the skull and kidneys. A urinalysis is performed to review urine specific gravity. Diagnostic testing for diabetes mellitus will include a hemoglobin A1C and fasting serum glucose levels

The nurse is caring for a newborn with 21-OH enzyme deficiency congenital adrenal hyperplasia (CAH). The nurse identifies one goal of the plan of care as being the understanding of the importance of maintaining hormone supplementation. What outcome criteria demonstrates this goal has been met?

During follow-up visits the child demonstrates normal growth and deveopment 21-OH enzyme deficiency results in blocking the production of adrenal mineralocorticoids and glucocorticoids. Nursing management of the infant or child with CAH focuses on preventing and monitoring for acute adrenal crisis, helping the family to understand the disease, providing education to the child and family about the importance of maintaining hormone supplementation, and providing emotional support to the family. Improvement of symptoms, such as normal growth and development, is the best indicator that the goal of hormone replacement therapy is being carried out as ordered.

A 10-year-old boy is upset and reports he is the shortest boy in his class. He reports he is done with school and wants to just stay at home. When reviewing the plan of care, which nursing diagnosis would be most appropriate for this concern?

Disturbed body image All of the listed nursing diagnoses may be appropriate for a child experiencing a growth hormone deficiency. The child is voicing feelings of personal devaluation. This is consistent with a lack of self-esteem making a disturbed body image the greatest concern in this scenario.

The nurse is assessing a 7-year-old girl with a headache, irritability, and vomiting. Her health history reveals she has had meningitis. Which intervention is priority?

Notifying the physician of the neurologic findings This child may have syndrome of inappropriate antidiuretic hormone (SIADH). Priority intervention for this child is to notify the physician of the neurologic findings. Remaining interventions will be to restore fluid balance with IV sodium chloride to correct hyponatremia, set up safety precautions to prevent injury due to altered level of consciousness, and monitor fluid intake, urine volume, and specific gravity.

The nurse is assessing a 5-year-old boy whose mother says he has been vomiting lately and has no appetite. Whst sign or symptom would the nurse identify as unique to diabetes mellitus type 1?

The child has lost weight recently. Weight loss is unique to diabetes mellitus type 1, whereas weight gain is associated with type 2. Hypertension is consistent with diabetes mellitus type 2. The sweet-smelling breath is common to both type 1 and type 2 diabetes and is a sign of ketoacidosis, a medical emergency, which is frequently how children present on initial evaluation. The rapid, deep Kussmaul breathing is common to both type 1 and type 2 diabetes and is a sign of ketoacidosis, a medical emergency, which is frequently how children present on initial evaluation.

After hospital discharge, the mother of a child newly diagnosed with type 1 diabetes mellitus telephones you because her daughter is acting confused and very sleepy. Which emergency measure would the nurse suggest the mother carry out before she brings the child to see her doctor?

Give her a glass of orange juice. These are typical symptoms of hypoglycemia. Administering a form of glucose would help relieve them. Insulin cannot be absorbed when taken orally.

The nurse is preparing the care plan regarding medication therapy for a client with hyperpituitarism. The child is receiving Decadron (dexamethasone). What interventions should the nurse add to the care plan? Select all that apply.

Monitor client for edema Monitor client for high glucose levels Do not abruptly stop administering medication Decadron (dexamethasone) is a coritcosteroid drug. Adverse effects that the nurse must be alert to include edema, weight gain, glycosuria, signs of infection, and symptoms of peptic ulcer development. Giving the drug with food or milk helps decrease the chance of peptic ulcer disease and stomach upset. If corticosteroids are stopped abruptly, adrenal crisis can occur.

In interpreting the negative feedback system that controls endocrine function, the nurse correlates how _______ secretion is decreased as blood glucose levels decrease.

insulin Feedback is seen in endocrine systems that regulate concentrations of blood components such as glucose. Glucose from the ingested lactose or sucrose is absorbed in the intestine and the level of glucose in blood rises. Elevation of blood glucose concentration stimulates endocrine cells in the pancreas to release insulin. Insulin has the major effect of facilitating entry of glucose into many cells of the body; as a result, blood glucose levels fall. When the level of blood glucose falls sufficiently, the stimulus for insulin release disappears and insulin is no longer secreted.

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?" Congenital hypothyroidism can be permanent or transient and may result from a defective thyroid gland or an enzymatic defect in thyroxine synthesis. Only the last question, which refers to phototherapy for physiologic jaundice, indicates that the parents need more information.

When discussing congenital adrenal hyperplasia with a child's parents, you would advise them that administration of which drug will probably be indicated?

Hydrocortisone The basic defect in congenital adrenal hyperplasia is the lack of cortisol. Administering hydrocortisone supplements this.

A child is admitted to the pediatric medical unit with the diagnosis of syndrome of inappropriate antidiuretic hormone (SIADH). Based on the typical signs and symptoms of this disorder, which nursing diagnosis will the nurse identify as relating to this client?

Excess fluid volume Syndrome of inappropriate antidiuretic hormone (SIADH) occurs when ADH (vasopressin) is secreted in the presence of low serum osmolality because the feedback mechanism that regulates ADH does not function properly. ADH continues to be released, and this leads to water retention, decreased serum sodium due to hemodilution, and extracellular fluid volume expansion; thus, Excess fluid volume from edema is the highest priority.

The caregivers of a child just diagnosed with diabetes express concern that they won't remember the different signs and symptoms of hyperglycemia and hypoglycemia. As a result, they are afraid they won't handle an emergency correctly. The best initial response by the nurse would be to:

Instruct them to treat the reaction as if it's hypoglycemia, which is more likely. Hypoglycemia is much more likely to occur than hyperglycemia; so if there is any doubt as to whether the child is having a hypoglycemic or hyperglycemic reaction, it should be treated as hypoglycemia. While the pump may offer continuous insulin, it does not sense blood glucose level; insulin reactions can still occur. Careful monitoring of blood glucose is still needed. While repeating signs and symptoms may be helpful, caregivers of a recently diagnosed child have lots of information to absorb and the repetition may create more anxiety. Assuming that the caregivers can read and understand them, written materials and videos may be helpful but they should not take the place of an initial teaching session with a nurse.

The physician has ordered routine hemoglobin A1C levels for a teenager with diabetes. Following teaching about the test by the nurse, the client and family demonstrate the need for further instruction with which statements? Select all that apply.

"I will be sure to not eat or drink anything the night before I get my blood drawn for the test." "I can check this level myself using a blood glucose monitor." "We will need to make sure our child gets this lab test at least every 6 months to ensure the diabetes is under control." Hemoglobin A1C levels provides the physician or nurse practitioner with information regarding the long-term control of glucose levels so fasting is not necessary. The test indicates the level of blood glucose over a 2- to 3-month period, so it should be performed about every 3 months. Daily blood glucose monitoring can be performed by the client with the use of a finger stick and glucose meter. The physician should be informed of high stress levels as this can increase blood glucose levels.

The school age child is scheduled for a 2-hour plasma glucose test. The nurse has given verbal and written instructions to the parent regarding the test. Which comments by the parent indicate that instructions for the test were not followed?

"My child only took half of their normal insulin dose this morning." "When will the IV be started that administers the sugar solution?" "This test helps in diagnosing infections that may cause my child's blood sugar to be abnormal." No insulin or oral diabetic medications should be taken prior to the test. An oral glucose, not an IV solution, is administered. Oral glucose is ingested and in a healthy child insulin will respond and return blood glucose to normal levels; it does not test for infections. Blood samples are drawn prior to ingestion of the glucose solution and at intervals after.

A 6-year-old girl visits the pediatrician with complaints of excessive thirst, frequent voiding, weakness, lethargy, and headache. The nurse suspects diabetes insipidus. Which hormonal condition is characteristic of this disease?

Hyposecretion of antidiuretic hormone Diabetes insipidus is a disease in which there is decreased release of antidiuretic hormone (ADH) by the pituitary gland. The child with diabetes insipidus experiences excessive thirst (polydipsia) that is relieved only by drinking large amounts of water; there is accompanying polyuria. Symptoms include irritability, weakness, lethargy, fever, headache, and seizures. Overproduction of antidiuretic hormone by the posterior pituitary gland results in a decrease in urine production and water intoxication and features weight gain, concentrated urine (increased specific gravity), nausea, and vomiting. As the hyponatremia grows more severe, coma or seizures occur from brain edema. Hyposecretion of somatotropin, or growth hormone, results in undergrowth; hypersecretion results in overgrowth.

The nursing is caring for a child recently admitted with an endocrine disorder. The child's mother asks the nurse what the term metabolism means. Which is the best response by the nurse?

"Metabolism refers to all physical and chemical reactions occurring in the body's cells that are necessary to sustain life." Metabolism refers to all physical and chemical reactions occurring in the body's cells that are necessary to sustain life.

A child has been prescribed Stimate (esmopressin) 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?

Stimate (esmopressin) acetate is a synthetic antidiuretic hormone that will slow down your urine output. Stimate (esmopressin) acetate is a synthetic antidiuretic hormone that promotes reabsorption of water by action on renal tubules; it is used to control diabetes insipidus by decreasing the amount of urine produced.

A 9-year-old girl is being evaluated for precocious puberty. What information from the child's mother is consistent with this condition? Select all that apply.

"My daughter talks about having headaches all the time." "The teachers at school say she is moody." "Sometimes at home my daughter gets aggressive with her younger siblings." "My older daughter started her period when she was only 10 years old." Central precocious puberty, the most common form, develops as a result of premature activation of the hypothalamic-pituitary-gonadal axis that results in the production of gonadotropin-releasing hormone (GnRH), which stimulates the pituitary to produce luteinizing hormone (LH) and follicle-stimulating hormone (FSH). These hormones in turn stimulate the gonads to secrete the sex hormones (estrogen or testosterone). The child develops sexual characteristics, shows increased growth and skeletal maturation, and has reproductive capability. The health history may reveal complaints of headaches, nausea, vomiting, and visual difficulties due to the circulating hormones. The psychosocial development is typical for the child's age, but the child may show emotional lability, aggressive behavior, and mood swings. There may also be a family history of early puberty. This would be evidenced in an older sibling who experienced menarche earlier than normal. Playing with dolls is normal for a 9-year-old girl.

The nurse is speaking to the mother of an adolescent recently diagnosed with type 1 diabetes mellitus. The mother asks the nurse how her son's basketball training will affect his blood sugar. Which is the best response by the nurse?

"When exercising, your son should add an extra snack containing 15 to 30 g of carbohydrates for each 45 to 60 minutes of exercise. When exercising, monitor insulin dose and nutritional and fluid intake, and observe for hypoglycemic reactions. Add an extra snack containing 15 to 30 g carbohydrate for each 45 to 60 minutes of exercise. Avoid exercising excessively when insulin is peaking. While monitoring of blood sugar is needed during long periods of exercise, checking it every 15 minutes is not necessary. Children are encouraged to exercise, they do not need to wait 6 months to resume exercise.

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 Syndrome of inappropriate antidiuretic hormone (SIADH) is a rare condition in which there is overproduction of antidiuretic hormone by the posterior pituitary gland. This results in a decrease in urine production and water intoxication. As sodium levels fall in proportion to water, the child develops hyponatremia or a lowered sodium plasma level. It can be caused by central nervous system infections such as bacterial meningitis. As the hyponatremia grows more severe, coma or seizures occur from brain edema. Diabetes insipidus is characterized by polyuria, not decreased urine production. Hyposecretion of somatotropin, or growth hormone, results in undergrowth; hypersecretion results in overgrowth.

A 6-year-old boy has a moon-faced, 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 Cushing syndrome is caused by overproduction of the adrenal hormone cortisol; this usually results from increased ACTH production due to either a pituitary or adrenal cortex tumor. The peak age of occurrence is 6 or 7 years. The overproduction of cortisol results in increased glucose production; this causes fat to accumulate on the cheeks, chin, and trunk, causing a moon-faced, stocky appearance. Cortisol is catabolic, so protein wasting also occurs. This leads to muscle wasting, making the extremities appear thin in contrast to the trunk, and loss of calcium in bones (osteoporosis). Yet other effects are hyperpigmentation (the child's face to be unusually red, especially the cheeks).