Chapter 48

The nurse is teaching a group of caregivers of children diagnosed with diabetes mellitus. The nurse is explaining insulin shock and the caregivers make the following statements. Which statement indicates the best understanding of a reason an insulin reaction might occur?

"He measures his own medication but sometimes doesn't administer the correct amount."

A 9-year-old was just diagnosed with type 1 diabetes mellitus (DM). The parents state, "We hope our child won't have to take insulin injections." How should the nurse respond?

"The pancreas doesn't produce insulin in Type 1 diabetes, so it is likely that insulin injections will be necessary."

The nurse is educating the parents of a client newly diagnosed with type 1 diabetes. Which statement by the parents indicates additional teaching is needed?

"Our child should not participate in sports or physical activity."

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?

"Please take your child straight to the emergency department."

The nurse is providing client teaching regarding the administration of desmopressin acetate for the client diagnosed with diabetes insipidus. Which statements by the client or parents indicates understanding of the teaching? Select all that apply.

-"We will want to inspect the nares of our child to be sure the medication is not irritating the tissue." -"We will need to adjust the dose based on how much our child is urinating." -"I am going to have to carry a cooler with me if I am going to be gone all day or if I go on a long hike."

The nurse is administering biosynthetic growth hormone, derived from recombinant DNA, by subcutaneous injection. The daily dosage is 0.2 to 0.3 mg/kg, given in divided doses. The child weighs 110 lb (49.9 kg). What is the safe dosage limit for this child on a daily basis? Record your answer using a whole number.

15

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

Antidiuretic hormone

A nurse is to see a child. Assessment reveals the chief complaints of urinating "a lot" and being "really thirsty." The nurse interprets these symptoms as being associated with which condition?

Diabetes insipidus

The nurse is seeing a new client in the clinic who reports polyuria and polydipsia. These conditions are indicative of which endocrine disorder?

Diabetes insipidus

A newborn is discovered to have congenital adrenogenital hyperplasia. What will the nurse most likely observe when assessing this client?

Enlarged clitoris

A 9-year-old girl has just been diagnosed with Graves disease. Which symptom should the nurse expect in this child? Select all that apply.

Exophthalmos (protruding eyes)• Moist skin• Nervousness• Increased basal metabolic rate

A child with type 1 diabetes is brought to the emergency department. The nurse suspects diabetic ketoacidosis (DKA) based on which assessment findings? Select all that apply.

Fruity breath odor Decreased level of consciousness Poor skin turgor

The nurse is assessing a child for signs of an endocrine disorder. Which statement by the parent would alert the nurse to further assess the child for an endocrine disorder?

I have all of a sudden noticed my child is always thirsty...even at night."

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

Low T4 level and high TSH level

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?

Offer the child 8 ounces of juice or soda

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

Oral calcium

Which findings should the nurse expect to assess when completing the health history of a child admitted for possible type 2 diabetes? Select all that apply.

Polydipsia Polyphagia Polyuria

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

A child has been prescribed Stimate (desmopressin) acetate for the treatment of diabetes insipidus. The client and the parents ask the nurse how this drug works. What is the correctresponse by the nurse?

Stimate (desmopressin acetate) is a synthetic antidiuretic hormone that will slow down your urine output

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

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

A 9-year-old child with Graves disease is seen at the pediatrician's office reporting sore throat and fever. The nurse notes in the history that the child is taking propylthiouracil. Which of the following would concern the nurse?

The child may have developed leukopenia.

A nurse is reinforcing the diagnosis of constitutional delay by the health provider to a 13-year-old male adolescent. Which is the best approach for this teen?

You will not need medication because your hormone levels are normal. I would be glad to discuss these findings with you."

A newborn is diagnosed with the salt-losing form of congenital adrenogenital hyperplasia. On what should the nurse focus when assessing this client?

dehydration

A 12-year-old child has hyperthyroidism. The nurse understands that the most common cause of hyperthyroidism in children is:

graves

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

growth hormone

During a visit to the clinic the adolescent client with hypothyroidism tells the nurse that she takes her Synthroid (levothyroxine) "whenever I think about it...sometimes I miss a dose, but not very often." What is the best response by the nurse?

"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."

A 10-year-old child has been diagnosed with precocious puberty. When talking with the child, what statements are appropriate? Select all that apply.

"How are you doing in school?" "Tell me about your feelings about what is happening to your body." "Developing is normal but your development is happening early." "Would talking with someone about your feelings help?"

A parent, distressed to learn that her school-aged child is diagnosed with type 2 diabetes mellitus, asks the nurse how this could happen because no one in the family has diabetes. What instruction is most accurate?

"This disorder is associated with being overweight and eating a diet high in fats and carbohydrates."

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?

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

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 woman in her first trimester of pregnancy has just been diagnosed with acquired hypothyroidism. The nurse is alarmed because this condition can lead to which pregnancy complication?

Decreased cognitive development of the fetus

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 development

An 8-year-old child is seen for moodiness and irritability. The child has begun to develop breast and pubic hair and the parents are concerned that these changes are occurring at too early an age. Which would the nurse suspect?

Precocious puberty

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

Pubic hair and hirsutism

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

A child presents to the primary care setting with enuresis, nocturia, increased hunger, weight loss, and increased thirst. What does the nurse suspect?

Type 1 diabetes mellitus

An elementary school child takes metformin three times each day. Which disorder would the school nurse expect the child to have?

Type 2 diabetes mellitus

Insulin deficiency, in association with increased levels of counter-regulatory hormones and dehydration, is the primary cause of:

diabetic ketoacidosis.