Chapter 26: book questions
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.
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.
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.)
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."
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.)
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."
B. Offer the child 8 ounces of juice or soda.
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
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 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. 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 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
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.
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.
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 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.
A. (Medication will be needed throughout the child's life. Explain that missed doses may lead to developmental delays and poor growth.)
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."
C. My child wears out his clothes before he outgrows them
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."
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.)
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
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.)
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. 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.)
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.
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.
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."
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.)
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.
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 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
