CH. 26. Nursing Care of the Child with an Alteration in Metabolism/Endocrine Disorder

A nurse who is caring for a 7-year-old is providing client education to the child and caregiver. Which response by the caregiver demonstrates to the nurse that the caregiver understands the diagnosis of type 1 diabetes mellitus? A. "We will just have our child exercise and take medicine to cure this." B. "I will just feed my child healthy foods and sign her up for more sports." C. "Her body fights against the insulin." D. "Her body doesn't have any insulin."

"D. Her body doesn't have any insulin. (Type 1 diabetes mellitus (DM) is a disorder in which the child's body has a deficiency of insulin; children with type 1 DM cannot produce insulin. Type 2 DM is controlled through diet, medicine, and exercise. Type 2 DM can be prevented through diet and exercise, but type 1 DM cannot. Resistance to insulin is not the primary factor in type 1 DM.)

Which nursing objective is most important when working with neonates who are suspected of having congenital hypothyroidism? A. early identification B. promoting bonding C. allowing rooming in D. encouraging fluid intake

A. early identification. Every infant should have a newborn screening before discharge from hospital or 2-4 days after birth. Radioimmunoassay measures levels of T4, which accurately reflect a child's thyroid status. Low T4 and elevated TSH confirm diagnosis.

Which results would indicate to the nurse the possibility that a neonate has congenital hypothyroidism? A. High thyroxine (T4) level and low thyroid stimulating hormone (TSH) level B. Low T4 level and high TSH level C. Normal TSH level and high T4 level D. Normal T4 level and low TSH level

B. Low T4 level and high TSH level

A school-age child is seen in the family clinic. The parents ask the nurse if their child should start taking growth hormones to help the child grow because the parents are short. What is the best response by the nurse? A. "Growth hormones work only if the child has short bones." B. "Will your child be able to swallow oral pills every day?" C. "Research shows that there must be a diagnosis of deficiency before growth hormones can be started at this age." D. "How tall would you like your child to be?"

C. Research shows that there must be a diagnosis of deficiency before growth hormones can be started at this age.

(T/F): glucose is used by the cells of the body for energy production and is produced when the body breaks down fats

False

(T/F): hyperpituitarism may produce excessive growth of 7 to 8 feet in height

T

(T/F): fats can be used by the body for energy when glucose is not available

True

glycosuria occurs when the amount of glucose in the blood __________ the renal threshold

exceeds

During a visit to the clinic, the adolescent client with hypothyroidism tells the nurse that she takes her levothyroxine "whenever I think about it...sometimes I miss a dose, but not very often." What is the best response by the nurse? A. "I know it's hard to remember medicines, but it is really important for you to take it before breakfast each day to control your hypothyroidism." B. "Maybe you could do something to remind yourself to take the medication on a daily basis." C. "As long as you are missing multiple doses it should be fine. Just as long as you take the levothyroxine at some point each day." D. "If you forget a dose you can double up the next day. We just want your thyroid level to be maintained since you don't produce enough thyroid hormone."

A. (Medication will be needed throughout the child's life. Explain that missed doses may lead to developmental delays and poor growth.)

An adolescent is having an annual physical. The adolescent has a documented weight loss of 9 lb (4.08 kg). The parent states, "He eats constantly." Exam findings are normal overall, except that the child reports having trouble sleeping, and the child's eyeballs are noted to bulge slightly. Which interventions would the nurse perform based on these findings? A. Prepare the parent for a neurology consult. B. Explain why the child might need to schedule an eye exam. C. Discuss preparing for a thyroid function test. D. Explain the preparation for an 8-hour fasting blood glucose test.

C. Discuss preparing for a thyroid function test. Symptoms of hyperthyroidism: hyperactivity, heat intolerance, emotional lability and insomnia. Increased rate of growth; weight loss despite an excellent appetite; warm, moist skin; tachycardia; fine tremors; an enlarged thyroid or goiter; and ophthalmic changes(exophthalmos, less pronounced in children)

A 13-year-old adolescent with hyperthyroidism who takes antithyroid medication has a sore throat and a fever. The parent calls the nurse and asks what to do. Which is the best response from the nurse? A. "Please take your child straight to the emergency department." B. "Fever and sore throat may be side effects of the medication." C. "Give your child ibuprofen according to the instructions on the box." D. "Offer your child at least 8 ounces of clear fluids and call back tomorrow."

A (A side effect of antithyroid medications is leukopenia. Signs and symptoms that include fever and sore throat need to be seen immediately. These instructions should be reviewed with parents upon discharge. The question includes information about Graves disease, so ibuprofen would not be the treatment. The question centers around drug therapy, not the child's fluid status.)

The nurse is caring for a 14-year-old boy with type 1 DM. He takes NPH insulin every morning at 7:30 AM. Which assessment data will the nurse use to evaluate the therapeutic effectiveness of the medication? A. Presence of signs and symptoms of hypoglycemia or hyperglycemia during the morning physical assessment B. Blood glucose level at 1630 C. Appetite and food intake at lunch D. Blood glucose level before breakfast

B Blood glucose level at 1630 (NPH is a long-acting insulin used to lower blood glucose levels. Its peak action is at 2to4 hours with a duration of 10to16 hours. Blood glucose monitoring provides evaluation of the therapeutic effectiveness.)

A 12-year-old child has hyperthyroidism. The nurse understands that the most common cause of hyperthyroidism in children is: A. Addison disease. B. Cushing syndrome. C. Graves disease. D. Plummer disease.

C. Graves disease Hyperthyroidism is a result of hyperfunction of the thyroid gland. Graves disease is an autoimmune disorder that causes excessive amounts of thyroid hormone to be released in response to human thyroid stimulator immunoglobulin(TSI). 4x more common in girls. Cushing syndrome is hyperfunction of the adrenal gland while Addison's is adrenal insufficiency.

The nurse is assessing an 8-year-old boy who is performing academically at a second-grade level. The mother reports that the boy states feeling weak and tired and has had a weight increase of 6 pounds (13.2 kg) in 3 months. Which additional data would fit with a possible diagnosis of hypothyroidism? A. The child states that the exam room is cold. B. Oral cavity assessment shows two of the 6-year molars. C. The mother reports that the boy is always thirsty. D. The child has a faint rash on the trunk of the body.

A (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. A rash can be varied disease processes but is not characteristic in hypothyroidism.)

The nurse is assessing a 5-year-old child whose parent reports the child has been vomiting lately, has no appetite, and has had an extreme thirst. Laboratory work for diabetes is being completed. Which symptom would differentiate between type 1 diabetes from type 2 diabetes? A. recent weight loss B. blood pressure of 142/92 mm Hg C. slow healing wounds D. loose stools

A (Weight loss is unique to type 1 diabetes, whereas weight gain is associated with type 2. Hypertension is consistent with type 2 diabetes. Both type 1 and type 2 diabetes cause delayed wound healing. The increase in blood glucose in diabetes causes damage to the inner lining of the arteries that cause the arteries to develop plaque and harden. These damages to the blood vessels result in a decrease in the ability of oxygen-rich blood to be transported effectively to the tissues to promote wound healing. Loose stools or repeated loose stools (diarrhea) is a common side effect of the oral medication metformin, which is prescribed for clients with type 2 diabetes. Insulin, the treatment for type 1 diabetes, has constipation as one of the side effects.)

A child is diagnosed with hyperthyroidism. What finding would the nurse expect to assess? A. Heat intolerance B. Constipation C. Weight gain D. Facial edema

A. 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.)

A nurse is reviewing with an 8-year-old how to self-administer insulin. Which of the following is the proper injection technique for insulin injections? A. Place the needle with the bevel facing down before the injection. B. Spread the skin before the injection. C. Aspirate the syringe for blood return before the injection. D. Elevate the subcutaneous tissue before the injection.

D. Elevate the subcutaneous tissue before the injection. With a subcutaneous injection you want to pinch the skin to ensure administration into the fat. No need to aspirate for blood return as it is not an intramuscular injection.

When monitoring the blood glucose level of a 12-year-old child with type 2 DM, your reading is 50 mg/dL. Which is the most appropriate action? A. Encourage the child to get out of bed and increase activity. B. Take the child's vital signs. C. Ask the child about frequent urine output. D. Give the child 4 oz of orange juice.

D. Give the child 4 oz of orange juice (The child's glucose level is too low. Orange juice will provide quick sugar to raise the child's blood glucose level. Increased exercise would be contraindicated since it would lower blood glucose even further.)

The nurse is teaching a child with type 1 diabetes mellitus to administer insulin. The child is receiving a combination of short-acting and long-acting insulin. The nurse knows that the child has appropriately learned the technique when the child: A. administers the insulin into a doll at a 30-degree angle. B. draws up the short-acting insulin into the syringe first. C. wipes off the needle with an alcohol swab. D. administers the insulin intramuscularly into rotating sites.

B. 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 not intramuscularly. A SQ injection is administered at a 90-degree angle if the person can grasp 2 in (5 cm) of skin. If only 1 in (2.5 cm) of skin can be grasped, then the injection should be given at a 45 degree angle. The needle is sterile. It should not be wiped with an alcohol swab. Only the top of the insulin vial should be wiped with an alcohol swab.)

A 7-year-old child who has type 1 diabetes mellitus is at school reporting a headache and dizziness. The school nurse notices sweat on the child's face. What should the nurse do first? A. Give glucagon IM B. Offer the child 8 ounces of juice or soda C. Give rapid-acting insulin D. Offer the child 8 ounces of water

B. Offer the child 8 ounces of juice or soda.

The nurse is taking a history on a 10-year-old child who has a diagnosis of hypopituitarism. Which question is important for the nurse to ask the parents? A. "Is your child taking vasopressin IM or SC?" B. "What time each day does your child take his growth hormone?" C. "Does your child get upset about being taller than friends?" D. "How often do you test your child's blood glucose?"

B. What time each day does your child take his growth hormone?

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? A. frequent diarrhea B. enlarged tongue C. tachycardia D. warm, moist skin

B. enlarged tongue Congenital hypothyroidism physical characteristics: lethargic baby, hypotonia, hypo-activity, and a dull expression. Irritability, delayed mental responsiveness, delayed growth. Persistent open posterior fontanelle, coarse facies with short neck and limbs, peri-orbital puffiness, enlarged tongue, and poor sucking responsiveness. Skin may appear pale with mottling, yellow from prolonged jaundice, cool, dry, and scaly to the tough with sparse hair development on the older child.

A newborn was diagnosed as having hypothyroidism at birth. The parent asks the nurse how the disease could be discovered this early. Which is the nurse's best answer? A. Hypothyroidism is usually detected at birth by the newborn's physical appearance. B. A newborn has a typical rash at birth that suggests the diagnosis. C. A simple blood test to diagnose hypothyroidism is required in most states. D. The newborn is already severely impaired at birth, and this suggests the diagnosis.

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

During a well-child examination which of the following comments made by the parent would indicate the possibility of a growth hormone deficiency? A. "I have to buy my child new clothes every 2 to 3 months" B. "I have to buy my child much larger shirts than pants but then the sleeves are too long." C. "My child wears out his clothes before he outgrows them." D. "I can hand down my child's clothes to his younger brother."

C. My child wears out his clothes before he outgrows them

A child presents to the primary care setting with enuresis, nocturia, increased hunger, weight loss, and increased thirst. What does the nurse suspect? A. Syndrome of inappropriate diuretic hormone B. Diabetes insipidus C. Type 1 diabetes mellitus D. Hypothyroidism

C. Type 1 diabetes mellitus SIADH manifests as decreased urine output, decreased weight gain, GI symptoms such as anorexia, nausea and vomiting. Diabetes insipidus is characterized by excessive thirst and excessive urination that is not affected by decreased fluid intake; weight loss or increased hunger are not factors. Hypothyroidism involves insufficient production of the thyroid hormones which does not relate to the characteristics in the question.

The nurse is teaching glucose monitoring and insulin administration to a child with type 1 diabetes and the parents. Which comment by a parent demonstrates a need for additional teaching? A. "During exercise we should wait to check blood sugars until after our child completes the activity." B. "If our child is sick we should check blood glucose levels more often." C. "We should check our child's blood glucose levels before meals." D. "Blood glucose level, food intake, and activity need to all be considered when calculating insulin dosage."

A. During exercise we should wait to check blood sugars until after our child completes the activity. Exercise can lead to both hyperglycemia or hypoglycemia; therefore, frequent glucose monitoring before, during, and after exercise is important.

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? A. Metformin B. Glipizide C. Glyburide D. Nateglinide

A. Metformin Metformin(from the biguanide group which reduces glucose production from the liver) is an oral diabetic medication and is an effective initial therapy unless significant liver or kidney impairment is present.

A young mother brings her new baby, diagnosed with congenital hypothyroidism, to the clinic so she can learn how to administer levothyroxine. The nurse should include which of the following instructions? A. Crush the medication and place it in a full bottle of formula to disguise the taste. B. Administer the medication every other day. C. Use an oral dispenser syringe or nipple to give the crushed medication mixed with a small amount of formula. D. Tell the mother that the medication will not be needed after the age of 7.

C (Hypothyroidism is a lifelong condition and requires daily medication indefinitely. It is important for the infant to ingest the complete amount of the medication each day, so it should be mixed with only a small amount of formula; giving the medication in a full bottle may not ensure the complete administration of the medication if the child does not drink the full bottle.)

A nurse should recognize that which laboratory result would be most consistent with a diagnosis of diabetes mellitus? A. proteinuria B. a fasting blood glucose less than 126 mg/dl C. a fasting blood glucose greater than 126 mg/dl D. glucose in the urine

C. A fasting blood glucose greater than 126 mg/dl. Diagnosis of diabetes mellitus: > fasting glucose level greater than or equal to 126mg/dl. > 2-hr plasma glucose level greater than or equal to 200mg/dl > random glucose level greater than or equal to 200mg/dl

A 2-year-old client and the parents are at the office for a follow-up visit. The client has had excessive hormone levels in the recent blood work, and the parents question why this was not found sooner. Which response by the nurse would be most appropriate? A. "It takes time to determine the level of functioning of endocrine glands." B. "Have there been signs and symptoms that you should have reported to the doctor?" C. "As endocrine functions become more stable throughout childhood, alterations become more apparent." D. "Endocrine disorders are hard to detect and you are lucky that we have found it when we did."

C. 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.)

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

D. Growth hormone. The anterior pituitary releases growth, thyroid-stimulating, adrenocorticotropic, follicle-stimulating, luteinizing, melanocyte-producing hormones, and prolactin. Vasopressin is synthesized by the hypothalamus, while antidiuretic hormone and oxytocin is released by the posterior pituitary gland.