Unit 4 (not completed)
What is diabetes insipidus
Insufficient production of ADH (acts on the kidneys to restore water & control amount of urine excreted) *lifelong condition* so teaching parents & patients how to deal with DI is an ongoing process throughout their life [uncontrolled diuresis]
What are S/S of Cushing's syndrome
*Physical appearance changes slowly* ‒Weight gain, pendulous abdomen, moon face, temporal fat, red cheeks, ecchymoses, buffalo hump, pink/purple stretch marks on abd/thighs/arms ‒Fatigue, muscle wasting, weakness of extremities, depression, anxiety, irritability, growth delay, hyperglycemia --> diabetes, HTN, arteriosclerosis susceptibility to infection, & hypokalemia
How is hyperparathyroidism diagnosed
*High calcium Low Phosphorus* labs show elevated calcium & decreased phosphorus X-ray Bone densitometry
A nurse is reviewing the health history and laboratory results of a school-aged child admitted to the pediatric unit with acute nonlymphoid leukemia (acute myeloid leukemia). What clinical findings does the nurse expect? *Select all that apply* 1 Oliguria 2 Listlessness 3 Few stem cells 4 Difficulty swallowing 5 Bone marrow depression
2 Listlessness 5 Bone marrow depression
What is normal TSH range for age 2-20 weeks & 20 weeks-18 years
2-20 weeks TSH: 1.7-9.1 20 weeks-18 years TSH: 0.7-64
What is hypoparathyroidism
Deficient PTH
How is hypoparathyroidism diagnosed
Based on S/S *High Phosphorus Low calcium & magnesium* labs show decreased calcium & magnesium, and increased phosphorus PTH levels are low
How is Cushing's syndrome diagnosed
Based on S/S & serum cortisol levels Electrolytes & blood glucose drawn Bone scan for osteoporosis MRI of pituitary gland CT of adrenal glands
How is hyperthyroidism diagnosed
Based on increased levels of T4 & T3, with suppressed TSH levels, thyroid antibodies, thyroid u/s *High T3 T4 Low TSH*
What are S/S of hypoparathyroidism
Hypocalcemia, vomiting, poor tooth development, headaches, confusion, seizures, muscle spasms, hyperreflexia, Chvostek sign, Trousseau sign, laryngeal spasm, convulsions
What are S/S of adrenal insufficiency
May experience hypoglycemia in times of stress like surgery/febrile illness Weakness, fatigue, dizziness, rapid pulse, dark skin, black freckles, bluish/black nipple, scrotum/vaginal discoloration, weight loss, dehydration, loss of appetite, intense salt cravings, N/V, cold intolerance
What is hyperthyroidism
Most common cause is Graves disease Seen more often in girls. Peak incidence is 12-14 years of age (may be present at birth) Family association
How is hypothyroidism diagnosed
Thyroid lab tests (T3/T4, TSH, anti-thyroid antibodies) Thyroid u/s Bone age x-ray Partial or complete thyroidectomy for cancer Thyrotoxicosis Lithium medication use, or following radiation
What is hyperparathyroidism
Excess PTH Primary from adenoma of the parathyroid gland or Secondary from chronic renal disease or congenital anomalies
What is pituitary hyperfunction
With too much hormone especially before the growth plates close can cause the child to be 8ft or taller. If it occurs after the closure it leads to acromegaly
How is syndrome of inappropriate antidiuretic hormone secretion (SIADH) diagnosed
Early detection is essential Labs will show: -low sodium, low blood osmolality, low BUN, low hematocrit -elevated urine osmolality, elevated urine spec grav
How is adrenal insufficiency diagnosed
Labs: low sodium & blood sugar, high potassium Low blood pressure & low cortisol levels in morning (when they should be highest)
How is hypoparathyroidism treated
Vitamin D therapy (observe for S/S of vitamin d toxicity [weakness, n/v/d]) IV/Oral calcium Blood monitoring seizure precautions until calcium levels normal telemetry until electrolytes balanced
Which are sources of lead the nurse should assess for when providing care to a toddler-age client who is admitted with lead poisoning? *Select all that apply* 1 Water 2 Pottery 3 Stained glass 4 Collectable toys 5 Vinyl miniblinds
1 Water 2 Pottery 4 Collectable toys 5 Vinyl miniblinds
When providing health teaching to a group of adolescent with type 1 diabetes mellitus , a nurse instructs them that a hypoglycemia reaction may occur because of? 1 Too much glucose in the body 2 Eating too much junk food 3 Exercising strenuously 4 Not enough insulin in the body
3 Exercising strenuously
A client undergoes removal of a pituitary tumor through a transsphenoidal approach. What should the nurse implement postoperatively? 1 Provide oral hygiene and include brushing the teeth 2 Encourage the client to deep breathe and cough frequently 3 Maintain the head of the bed at a 30-degree angle continuously 4 Continue giving nothing by mouth until the nasal packing is removed
3 Maintain the head of the bed at a 30-degree angle continuously
Which medications will prevent binding of human immunodeficiency virus (HIV) to a client's cells? *Select all that apply* 1 Rilpivirine 2 Maraviroc 3 Saquinavir 4 Raltegravir 5 Enfuvirtide
2 Maraviroc 5 Enfuvirtide
A platelet transfusion is to be administered to a child with acute lymphocytic leukemia. What will the nurse do first? 1 Administer the platelets rapidly through the intravenous (IV) line 2 Set the IV pump to run for 8 hours 3 Flush the IV line with a dextrose solution 4 Check the vital signs every 2 hours during the transfusion
1 Administer the platelets rapidly through the intravenous (IV) line
What are S/S of hypopituitarism
-Child may start grow normally the first yr. then slow. -Short stature but proportional height/weight to start, then weight will continue to increase while height stays the same, creating a disproportion in growth -Below 3rd% for height, should trigger attention for more assessment -Delayed epiphyseal closure, slow bone age proportional to height, premature aging common in later life -Increased insulin sensitivity. -'Baby face' for longer. HA & vision changes may occur r/t tumor.
How is hypopituitarism diagnosed
-Start with good history of child's growth pattern &family history of growth & size. -Then do a hand-wrist x-ray to see what bone age is, through this they can estimate how tall child will grow to be. -Will check labs to see if hormone levels are low, may do this several times to see if its consistent. -Then perform advanced labs & may use insulin-like growth factor 1 test & repeat test several times 15 min apart to see the response to the stimuli. From this, they can diagnose a true hormone deficiency
How is hypopituitarism treated
-Surgical removal or radiation of tumor, if present -Replacement of the hormone, which is successful in 80% of children, via SQ injection *so education is important.* Can be in form of a pill for thyroid, cortisone, testosterone or estrogen (not GH) -Response varies based on age, length of treatment, frequency of doses, dosage, weight, & GH receptor amount *Given at night* -Family support, expense, increased doctor visits, ed. on shots
A 4-year-old child with newly diagnosed leukemia is admitted for chemotherapy. While assisting with morning care the nurse observes bloody expectorant after the child has brushed the teeth. How will the nurse respond to this occurrence? 1 By securing a smaller toothbrush for the child to use 2 By documenting and reporting the incident 3 By telling the child to be more careful when brushing the teeth 4 By rinsing the child's mouth with half-strength hydrogen peroxide
2 By documenting and reporting the incident
During a scheduled exam, a child's Hb1Ac level is 9%. The child has had type 1 diabetes for 1 year. Which of the following actions should the nurse take? 1 Assess signs of infection and child's intake for the past 24 hours 2 Explore the child's general dietary pattern for the past 3 months 3 Review the parent's understanding of diabetic foot care 4 Immediately administer child's rapid-acting insulin dose
2 Explore the child's general dietary pattern for the past 3 months
A teenager with a diagnosis of osteosarcoma is to have the affected leg amputated. What should the nurse do to promote psychologic adjustment and early function immediately after surgery? 1 Allow the client to change the first dressing. 2 Help the client adjust to the temporary prosthesis. 3 Assign the client to a room with another adolescent. 4 Have the client meet with a member of a cancer survivor organization.
2 Help the client adjust to the temporary prosthesis.
A nurse is caring for a child with type 1 diabetes who has been taking insulin for 3 months. Which of the following diagnostic studies will the provider most likely order to determine how well the child's diabetes is being managed? 1 Moring fasting blood glucose 2 two hr oral glucose tolerance test 3 Hb1Ac 4 Diary of the child's daily blood glucoses
3 Hb1Ac
When providing health teaching to a group of adolescents with diabetes mellitus, a nurse teaches them to observe for S/S of hypoglycemia. Which of the following should adolescents be aware of to detect hypoglycemia? *Select all that apply* 1 Frequent urination 2 Increase energy level 3 Nausea 4 Nervousness and irritability 5 Sweating and pallor 6 Deep, rapid, and labored respiration
3 Nausea 4 Nervousness and irritability 5 Sweating and pallor
A primary healthcare provider recommends that an adolescent with the diagnosis of osteogenic sarcoma have the affected leg amputated and then be treated with chemotherapy. The parents are concerned about what to tell their child and ask the nurse for advice. What should the nurse suggest they discuss? 1 Causes of cancer and details about the treatment 2 Chemotherapy and the possibility of an amputation 3 The amputation and information about chemotherapy 4 Treatment choices and that it is too soon for a final decision
3 The amputation and information about chemotherapy
Iron deficiency anemia is characterized by what? A. Small, pale RBC's & decrease in bone marrow erythropoiesis B. Large, pale RBC's & dangerous increase in bone marrow erythropoiesis C. Platelet count decrease & spontaneous bleeding D. Platelet count increase & blood in mucous membranes
A. Small, pale RBC's & decrease in bone marrow erythropoiesis
How is hyperthyroidism treated
Antithyroid drugs (propylthiouracil/PTU & methimazole) Subtotal thyroidectomy Ablation w/ radioiodine (isolation) Goal of therapy is to retard rate of hormone secretion screenings, diet, ed., supportive
Which type of lymphoma occurs in the peripheral lymph nodes and spreads to tissues throughout the body? A. Hodgkin's lymphoma B. Non-Hodgkin's lymphoma
B. Non-Hodgkin's lymphoma
What is syndrome of inappropriate antidiuretic hormone secretion (SIADH)
Excessive ADH production causes kidneys to be unable to conserve appropriate amount of water, so filtered water is reabsorbed from kidneys back into central circulation causing water intoxification, hyponatremia, & cellular edema.
A young child is admitted to the pediatric unit with a diagnosis of Wilm's tumor. Considering the unique needs of a child with this diagnosis, what statement should be on a sign placed by the nurse at the child's bedside? 1 Keep NPO. 2 No IV medications. 3 Record intake and output. 4 Do not palpate the abdomen.
4 Do not palpate the abdomen.
A 13-year-old child with type 1 diabetes is receiving 15 units of regular insulin and 20 units of NPH insulin at 7:00 AM each day. At what time does the nurse anticipate a hypoglycemic reaction from the NPH insulin to occur? 1 Before noon 2 In the afternoon 3 Within 30 minutes 4 During the evening
2 In the afternoon
A 5-year-old client has recently been diagnosed with type 1 diabetes. A glucose tolerance test is prescribed. The prescription reads, "Administer glucose 1g/kg." The client weighs 60 pounds. How much glucose should the nurse administer in g ? Round to whole number.
27 g
How is pituitary hyperfunction treated
Surgical treatment to remove the tumor Irradiation & radioactive implants Hormone replacement therapy post op in some cases Early identifying of children w/ excessive growth rates Early treatment for improved outcomes Emotional support Body image concerns
The laboratory report of a client reveals the presence of 350 cells/mm3 (350 cells/uL) of CD4+ T-cell count. According to the Centers for Disease Control and Prevention (CDC), which stage of human immunodeficiency virus (HIV) disease is present in the client? 1 Stage 1 2 Stage 2 3 Stage 3 4 Stage 4
2 Stage 2
What is normal range of T3 & T4
T3: 100-200 T4: 2.0-2.7
Which group of clients should the nurse anticipate to have the highest incidence of non-Hodgkin lymphomas? 1 Children 2 Older adults 3 Young adults 4 Middle-aged persons
2 Older adults
Which drug would be effective for the treatment of pituitary Cushing's syndrome? 1 Mitotane 2 Cabergoline 3 Cyproheptadine 4 Bromocriptine mesylate
3 Cyproheptadine
When teaching a child newly diagnosed with type 1 diabetes , a nurse should place the highest priority on information regarding 1 Weight loss measures 2 Self-monitoring of blood glucose 3 Need to reduce physical activity 4 Elimination of sugar from the diet
2 Self-monitoring of blood glucose
Metformin 2 g by mouth is prescribed for a client with type 2 diabetes. Each tablet contains 500 mg. How many tablets should the nurse administer? Record your answer using a whole number.
4 tabs
Which task can be safely delegated by a registered nurse (RN) to unlicensed nursing personnel (UNP) for a client with thrombocytopenia? 1 Shaving the client 2 Positioning the client 3 Maintaining oral hygiene 4 Giving intravenous platelet infusions
2 Positioning the client
A parent of a 9 year old child with GH deficiency asks the nurse how long his son will need to take injections for this growth problem. Which of the following responses by the nurse is most appropriate? 1 "injections are usually continued until age 10 for girls & 12 for boys 2 "Injections need to continue until child reaches 5th% on growth chart" 3 "Injections should continue until bone maturation is complete, usually between 14 & 16" 4 "The injections will need to be administered throughout the child's entire life
3 "Injections should continue until bone maturation is complete, usually between 14 & 16"
A 6-year-old boy is undergoing chemotherapy to treat a neuroblastoma, stage IV, and had his first chemotherapy session last week. He arrives with his mother for this week's session. How should the nurse greet the child? 1 "It's time for your next dose." 2 "There are only three more sessions." 3 "Did you get sick to your stomach last time?" 4 "How did you feel after your last treatment?"
4 "How did you feel after your last treatment?"
The nurse is caring for a client who is diagnosed with hyperpituitarism due to a prolactin-secreting tumor. Which clinical manifestation can help confirm the diagnosis? 1 Hypertrophy of skin 2 Enlargement of liver 3 Hypertrophy of the heart 4 Absence of menstruation
4 Absence of menstruation
Diabetes insipidus (DI) is insufficient production of what hormone? A. ADH B. GHD C. HCG D. FSH
A. ADH
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 < 240 mg/dL.
A. Monitor blood glucose levels every 3 hr. D. Test urine for ketones. E. Call health care provider if blood glucose < 240 mg/dL.
At what age does Grave's disease occur most frequently? A. 6 to 12 months B. 2 to 5 years C. 12 to 14 years D. 17 to 18 years
C. 12 to 14 years
A nurse is reviewing the laboratory reports of four clients. Which client's laboratory report indicates acquired immunodeficiency syndrome (AIDS)? Pt. 1 CD4 T-cell count 750 cells/mm3; HIV Positive Pt. 2 CD4 T-cell count 550 cells/mm3; HIV Positive Pt. 3 CD4 T-cell count 175 cells/mm3; HIV Positive Pt. 4 CD4 T-cell count 450 cells/mm3; HIV Positive
Client 3: CD4 T-cell count 175 cells/mm3; HIV Positive (<200)
What are S/S of pituitary hyperfunction
Delay in fontanel closure due to enlarged head C. Fast vertical growth w/ rapid & increased muscle development Weight is generally in proportion to height Pain in joints & muscles, muscle weakness Acromegaly
How is Cushing's syndrome treated
Depends on cause (if due to steroid use, gradual d/c will treat it) Ed: cause of cortisol over production, surgery, & radiation Emotional Support & education is key Endocrinology referral
How is pituitary hyperfunction diagnosed
History Physical assessment Assessing growth charts for excessive growth spurts (or consistent charts over 95%) Labs: GH (IGF-1) to test for elevated GH Bone age Xray MRI: rule out tumor on hypothalamus & pituitary gland
What is Cushing's syndrome
Metabolic disorder caused by an over-production of cortisol by the adrenal glands (commonly results from cortisol-producing tumors, adrenal hyperplasia, benign adrenal tumors, chronic/prolonged steroid use) *Excessive cortisol* circulating don't d/c steroid abruptly, may adrenal crisis
What is hypothyroidism
One of the most common endocrine probles Main purpose of thyroid is to increase BMR Hypothyroidism occurs due to underactive thyroid gland, balance of T3, T4, TSH Cause can be congenital or acquired Can lead to mental retardation or other cognitive disabilities (incomplete brain growth if left untreated)
What are S/S of hyperthyroidism
*Hyperthyroidism, Goiter, & Exopthalmos* physical restlessness, fatigue, tachycardia, hypertension, increased perspiration, increased appetite, weight loss, difficulty sleeping, tremor, heat intolerance, fine hair, systolic murmurs, absence of menses, mood changes irritability
Which nursing interventions are appropriate while caring for a preschooler exposed to lead poisoning? *Select all that apply* 1 Administering the local anesthetic procaine 2 Educating parents to use hot water for cooking 3 Preventing further exposure of the child to lead 4 Identifying the sources of lead in the environment 5 Administering chelating agents into a small muscle mass
1 Administering the local anesthetic procaine 3 Preventing further exposure of the child to lead 4 Identifying the sources of lead in the environment
A client is admitted with thrombocytopenia. Which specific nursing actions are appropriate to include in the plan of care for this client? *Select all that apply* 1 Avoid intramuscular injections 2 Institute neutropenic precautions 3 Monitor the white blood cell count 4 Administer prescribed anticoagulants 5 Examine the skin for ecchymotic areas
1 Avoid intramuscular injections 5 Examine the skin for ecchymotic areas
A nurse is assessing a client with Cushing syndrome. Which signs should the nurse expect the client to exhibit? *Select all that apply* 1 Hirsutism (excessive hair growth) 2 Round face 3 Pitting edema 4 Buffalo hump 5 Hypoglycemia
1 Hirsutism (excessive hair growth) 2 Round face 4 Buffalo hump
The school nurse is assessing a 10-year-old boy with hemophilia who has fallen while playing in the schoolyard. At which site does the nurse expect to find internal bleeding? 1 Joints 2 Abdomen 3 Cerebrum 4 Epiphyses
1 Joints
A client with a primary brain tumor has developed syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The nurse will expect to see which clinical findings upon assessment? *Select all that apply* 1 Nausea and vomiting 2 Hyperthermia 3 Bradycardia 4 Increased weight 5 Decreased serum sodium 6 Decreased level of consciousness
1 Nausea and vomiting 4 Increased weight 5 Decreased serum sodium 6 Decreased level of consciousness
A 2-year-old boy with hemophilia A is to start receiving prophylactic intravenous infusions of the recombinant form of factor VIII three times a week. The nurse will instruct the parents to administer the factor at what time on the designated days? 1 At bedtime 2 After lunch 3 Before dinner 4 Upon awakening
4 Upon awakening
A 9-year-old child with type 1 diabetes is prone to having hypoglycemic episodes in the morning. Which intervention would be included in the school nurse's plan of care for this child? 1 Limiting fluid intake during school hours 2 Asking the child each day what was eaten for breakfast 3 Considering the presence of diabetes but treating the child the same as the other children 4 Checking several times a day for injuries because of participation in the physical education program
2 Asking the child each day what was eaten for breakfast
A client is diagnosed with acute lymphoid leukemia and is receiving chemotherapy. The nurse should monitor what thrombocytopenic side effects of chemotherapy? *Select all that apply* 1 Nausea 2 Melena 3 Purpura 4 Diarrhea 5 Hematuria
2 Melena 3 Purpura 5 Hematuria
The primary healthcare provider suspects pituitary gland dysfunction in a female client. Which diagnostic test would the primary healthcare provider suggest to the client? 1 Estradiol test 2 Prolactin test 3 Sims-Huhner test 4 Papanicolaou (Pap) test
2 Prolactin test
A 4-year-old child diagnosed with sickle cell anemia is at a high risk of acquiring pneumococcal diseases even after receiving one or two doses of the pneumococcal conjugate vaccine (PCV). Based on the immunization protocol, what dose of PCV should the nurse administer? 1 Administer four more doses of PCV 2 Administer three more doses of PCV 3 Administer two more doses of PCV 4 Administer one more dose of PCV
3 Administer two more doses of PCV
A nurse is assessing the status of a school-aged child with leukemia who is receiving vincristine/oncovin. What laboratory test result alerts the nurse that fluid intake should be increased? 1 Urine pH of 6 2 Urine specific gravity of 1.020 3 Blood uric acid level of 7.5 mg/dL 4 Blood urea nitrogen level of 15 mg/dL
3 Blood uric acid level of 7.5 mg/dL
The laboratory reports of a client reveal selective hypopituitarism related to growth hormone (GH). What other findings does the nurse anticipate in the client? *Select all that apply* 1 Decreased body hair 2 Decreased serum cortisol 3 Decreased muscle strength 4 Increased serum cholesterol 5 Decreased tolerance to cold
3 Decreased muscle strength 4 Increased serum cholesterol
What medication does a nurse expect to administer to control bleeding in a child with hemophilia A? 1 Albumin 2 Fresh frozen plasma 3 Factor VIII concentrate 4 Factors II, VII, IX, X complex
3 Factor VIII concentrate
A nursing instructor asks a nursing student to outline the steps that a nurse should follow while examining a 4-year-old sick child. Which statement made by the student indicates inadequate learning? 1 "I should give the child time to play around." 2 "I should start the exam by checking the child's fingers & hands." 3 "I should gather all info r/t child's sickness from parents." 4 "I should make judgments when a parent shares details of child's illness."
4 "I should make judgments when a parent shares details of child's illness."
During which of the following periods of growth and development should a nurse anticipate behavioral problems from a child with untreated GH deficiency? 1 Infant 2 Preschooler 3 School-age child 4 Adolescent
4 Adolescent
How is adrenal insufficiency treated
Frequent lab assessments Administer corticosteroids 2-3x/day IV or IM if in Addisonian crisis (ed. parents on this) IV fluids Strict I/O to avoid dehydration Ed. importance of med compliance at home w/ corticosteroid use Addisonian crisis: life threatening event that requires immediate medical attention (IV or IM corticosteroids - Solu-Cortef) for symptoms of sudden, penetrating pain of lower back & legs, severe vomiting & dia, dehydration, low BP, & loss of consciousness that can lead to death quickly if left untreated
How is hypothyroidism treated
Hormone replacement (ed on importance of consistency) Close observation of growing pattern Assess activity level, appetite, hair loss/thinning, constipation, cold intolerance Assess for family Hx of auto-immune thyroid problems (especially in female family members) Synthroid/Levothyroxine (S/E: irritability, tachycardia, dyspnea, sweating, fever) Monitor for S/E of med's & efficacy of therapy Assess activity level, feedings, BM's, thyroid levels *Early identification helps prevent g/d delays*
What are S/S of hyperparathyroidism
Hypercalcemia N/V, renal issues, bone and joint pain, osteoporosis, muscle weakness, abd pain, constipation, lack of appetite, excessive thirst/urination, depression, anxiety, memory loss, fatigue
How is diabetes insipidus treated
IV fluid replacements & hormone replacement using vasopressin through IM or Sub Q injection or a nasal spray *intranasal med's: blow nose before med admin, if they have a cold or congestion use other route* -Never deprive DI patient of oral fluids -Strict monitoring of I/O, daily weights, labs (electrolytes, osmolality), urine spec grav, osmolality, vitals -Educate on long-term needs for med's (Vasopressin) & S/S of fluid/electrolyte imbalance
A child with type 1 diabetes mellitus is taking twice-daily insulin injections consisting of a combination of lispro (Humalog) and NPH insulin. The child eats breakfast at 8:00 am daily. At what time should the child inject morning insulin? Provide rationale.
Inject between 7:45 and 7:50. It will begin to act within 10-15 minute
What are S/S of hypothyroidism
Mild delays in reading, composition, & math, if caught in time, those kids can catch up by the sixth grade. Hypotonia, lethargy, open fontanel/sutures, umbilical hernia, jaundice, pallor, enlarged, tongue, hoarse cry, constipation, dry skin, respiratory difficulties, poor weight gain, generalized edema, goiter, abd distention, increased birth weight Adolescence may have problems w/ memories or attention
How is hyperparathyroidism treated
Remove tumor or treat underlying cause (parathyroidectomy) Assess for kidney stones, edema, infection, hematoma at site, IV hydration, electrolyte monitoring
Place the following steps used to treat hypoglycemia detected by low blood glucose level in the correct order. -Recheck blood glucose in 15 min -Treat with 15 g carbohydrates -If still low, give 15 g more of carbohydrates -Stop activity and sit down -Recheck blood glucose in 15 min
Stop activity and sit down Treat with 15 g carbohydrates Recheck blood glucose in 15 min If still low, give 15 g more of carbohydrates Recheck blood glucose in 15 min
What is hypopituitarism
There is not enough of the hormones. Gonadotropic deficiency affects 2nd sex characteristics. GH deficiency slows growth of the child. TSH deficiency can lead to hypothyroidism & affects metabolism. Corticotropin deficiency results in adrenal gland problems. (is caused by a tumor most of the time)
What are S/S of diabetes insipidus
*Polyuria & Polydipsia* Thirsty throughout the night for water Constipation, fever, dehydration, hypernatremia Dilute urine, vomiting, dehydration (child at severe risk for dehydration, electrolyte imbalance, hyperthermia, azotemia, & circulatory collapse)
The nurse is assessing a client who has syndrome of inappropriate antidiuretic hormone (SIADH). Which finding in the client is consistent with the diagnosis? 1 Preservation of salt 2 Retention of water 3 Decrease of vasopressin 4 Presence of pedal edema
2 Retention of water
A school-aged child with newly diagnosed acute lymphocytic leukemia (ALL) is to undergo induction therapy with prednisone, vincristine, and asparaginase. After several days the child becomes constipated. What does the nurse suspect as the cause? 1 Diet, which lacks bulk 2 Inactivity, which results from illness 3 Vincristine, which decreases peristalsis 4 Prednisone, which causes gastric irritability
3 Vincristine, which decreases peristalsis
A parent of a 13-year-old adolescent with recently diagnosed Hodgkin disease tells a nurse, "I don't want my child to know about the diagnosis." How should the nurse respond? 1 "It's best for your child to know the diagnosis." 2 "Did you know that the cure rate for Hodgkin disease is high?" 3 "Would you like someone with Hodgkin disease to talk with you?" 4 "Let's talk about how you're feeling about your child's diagnosis."
4 "Let's talk about how you're feeling about your child's diagnosis."
A toddler is scheduled to receive methotrexate for treatment of leukemia. The mother asks the nurse whether the child should be started on vitamin supplements because the child seems so weak. How will the nurse respond? 1 "That's a fine suggestion, & I'll ask for a prescription." 2 "Vitamin supplements won't help him feel any better right now." 3 "He'll benefit from a vitamin supplement & will be getting it soon." 4 "Supplements that contain folic acid interfere with the effectiveness of chemotherapy."
4 "Supplements that contain folic acid interfere with the effectiveness of chemotherapy."
A nurse is caring for a client with diabetes insipidus. Which clinical manifestation should a nurse expect the client to exhibit? 1 Increased blood glucose 2 Decreased serum sodium 3 Increased specific gravity 4 Decreased urine osmolarity
4 Decreased urine osmolarity
An 18-year-old adolescent who was diagnosed with new-onset type 1 diabetes mellitus has stress and reports not having a menstrual cycle for a long time. Which condition is the adolescent experiencing? 1 Amenorrhea 2 Primary amenorrhea 3 Female athlete triad 4 Hypogonadotropic amenorrhea
4 Hypogonadotropic amenorrhea
At 7:00 AM a nurse learns that an adolescent with diabetes had a 6:30 AM fasting blood glucose level of 180 mg/dL (10.0 mmol/L). What is the priority nursing action at this time? 1 Encouraging the adolescent to start exercising 2 Asking the adolescent to obtain an immediate glucometer reading 3 Informing the adolescent that a complex carbohydrate such as cheese should be eaten 4 Telling the adolescent that the prescribed dose of rapid-acting insulin should be administered
4 Telling the adolescent that the prescribed dose of rapid-acting insulin should be administered
What is adrenal insufficiency
Addison's Disease Insufficient cortisol and aldosterone from the adrenal glands
What are S/S of syndrome of inappropriate antidiuretic hormone secretion (SIADH)
Anorexia, Nausea, Abd cramps, Irritability, Personality changes, Neuro changes (stupor & seizure may occur) fluid retention & hypotonicity, vomiting, combativeness, hallucinations, confusion, fluid overload (increased BP, NVD, lung crackles, weight gain, visible edema, decreased urine output, high spec grav, low Na)
How is syndrome of inappropriate antidiuretic hormone secretion (SIADH) treated
Fluid restriction: 75% restricted at first, then 50% after 6 hr if improvements seen Secondary treatment depends on cause of SIADH IV hypertonic NaCl solution to treat hyponatremia & neurological conditions Corticosteroids if adrenal insufficiency strict I/O, daily weights seizure precautions (low Na increases seizure risk) neuro examinations assess for signs of fluid overload diet (high in Na & protein)
How is diabetes insipidus diagnosed
Measure 24-hour urine Labs: elevated Na, lower spec grav (< 1.005) & urine osmolality Water deprivation test: restrict fluid & see what urine production does (normally if you decreased fluid intake, output would decrease & become concentrated) in DI it will not change, only cause further dehydration & weight loss)
