ex3 PED chapter 26

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? "Limit participation in planned exercise activities that involve competition." "Carry crackers or fruit to eat before or during periods of increased activity." "Increase the insulin dosage before planned or unplanned strenuous exercise." "Check your blood glucose level before exercising, and eat a protein snack if the level is elevated."

"Carry crackers or fruit to eat before or during periods of increased activity."

The nurse is teaching a 12-year-old girl with type 2 diabetes mellitus 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." "I can have an apple or orange for snacks." "I can have nonfat milk to drink." "I will be eating more breads and cereals."

"I can eat two small cookies with each meal."

The nurse is caring for a child recently diagnosed with growth hormone deficiency. After providing education regarding this disorder, which statement by the parent demonstrates a need for further teaching? "This early diagnosis and treatment will lead to a better prognosis that my child will reach normal adult height." "My child will follow up with an endocrinologist every 3 to 6 months to monitor growth." "It is important I treat my child according to the child's age not based on the child's size." "If growth hormone therapy is used, it will continue for the rest of my child's life."

"If growth hormone therapy is used, it will continue for the rest of my child's life."

The nurse is teaching a group of caregivers of children diagnosed with diabetes. 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? "If my child eats as much as their older brother eats they could have an insulin reaction." "My child measures their own medication but sometimes doesn't administer the correct amount." "My child monitors their glucose levels to keep them from going too high." "On the weekends we encourage our child to participate in lots of sports activities and stay busy so they don't have an insulin reaction."

"My child measures their own medication but sometimes doesn't administer the correct amount."

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." "Fever and sore throat may be side effects of the medication." "Give your child ibuprofen according to the instructions on the box." "Offer your child at least 8 ounces of clear fluids and call back tomorrow."

"Please take your child straight to the emergency department." Explanation: A side effect of antithyroid medications is leukopenia. Signs and symptoms that include fever and sore throat need to be seen immediately.

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." "My son's nervousness may be a symptom of his hypothyroidism." "Heat intolerance is a caused by low thyroid levels." "Most people with hypothyroidism have smooth, velvety skin."

"When they get my son's thyroid levels normal, he won't be so tired."

The nurse is providing acute care for an 11-year-old boy with hypoparathyroidism. Which intervention is priority? Providing administration of calcium and vitamin D. Ensuring patency of the IV site to prevent tissue damage. Monitoring fluid intake and urinary calcium output. Administering intravenous calcium gluconate as ordered.

Administering intravenous calcium gluconate as ordered.

A mother brings her 4-day-old infant to the clinic with vomiting and poor feeding. The newborn was healthy at birth. The nurse should suspect: Sturge-Weber syndrome An inborn error of metabolism Trisomy 18 Turner syndrome

An inborn error of metabolism

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 Growth hormone Insulin Thyroxine

Antidiuretic hormone Explanation: 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.

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 Gestational diabetes in the mother Congenital heart defects in the fetus Spina bifida in the fetus

Decreased cognitive development of the fetus Explanation: If acquired hypothyroidism exists in a woman during pregnancy, her infant can be born intellectually disabled, because there was not enough iodine present for fetal growth. It is important, therefore, that girls with this syndrome be identified before they reach childbearing age.

A child has been prescribed desmopressin 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? Desmopressin acetate works on your pancreas to stimulate insulin production. Desmopressin acetate is a synthetic form of insulin used to lower your blood sugar. Desmopressin acetate is a synthetic antidiuretic hormone that will slow down your urine output. Desmopressin acetate works to help your kidneys work more efficiently.

Desmopressin acetate is a synthetic antidiuretic hormone that will slow down your urine output.

The nurse is caring for a child admitted to the emergency center in diabetic ketoacidosis. Which clinical manifestations would the nurse most likely note in this child? Pale and moist skin Drowsiness and fruity odor to breath Hyperactive and restless behavior Slow pulse and elevated blood pressure

Drowsiness and fruity odor to breath

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? Place the needle with the bevel facing down before the injection. Spread the skin before the injection. Aspirate the syringe for blood return before the injection. Elevate the subcutaneous tissue before the injection.

Elevate the subcutaneous tissue before the injection. Explanation: Insulin injections are always given subcutaneously. Elevating the skin tissue prevents injection into muscles when subcutaneous injections are given. The needle bevel should face upward. The skin is spread in intramuscular, not subcutaneous, injections. It is no longer recommended to aspirate blood for subcutaneous injections.

After hospital discharge, the parent of a child newly diagnosed with type 1 diabetes mellitus telephones the nurse because the child is acting confused and very sleepy. Which emergency measure would the nurse suggest the parent carry out before bringing the child to see the health care provider? Give the child one unit of regular insulin. Give the child a glass of orange juice. Give the child nothing by mouth so that a blood sugar can be drawn at the health care provider's office. Give the child a glass of orange juice with one unit regular insulin in it.

Give the child a glass of orange juice.

A child is brought to the clinic experiencing symptoms of nervousness, tremors, fatigue, increased heart rate and blood pressure. Based on this assessment, the nurse would suspect a diagnosis of which condition? hypertension Graves disease Cushing syndrome hypothyroidism

Graves disease

The school nurse observes an 8th grader at school who suddenly is losing weight, is not participating in gym, and is in poor academic standing. The nurse takes a history and notes that the child seems very nervous. The nurse notifies the parent, who explains that the child has just been seen by the family health care provider and tested low for thyroid-stimulating hormone (TSH). For which condition will the nurse devise a plan of care? Hashimoto thyroid disease Graves disease Hypothyroidism Diabetes mellitus

Graves disease

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

Low T4 level and high TSH level Explanation: 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.

he 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. Setting up safety precautions to prevent injury. Monitoring urine volume and specific gravity. Restoring fluid balance with IV sodium.

Notifying the physician of the neurologic findings.

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. Abrupt onset of symptoms Marked weight loss Polyuria Polydipsia Polyphagia

Polyuria Polydipsia Polyphagia

A 4-year-old child is undergoing a radioimmunoassay of T4 and T3 to determine whether the thyroid is functioning properly. Which factor could abnormally elevate the child's iodine level and thus invalidate the test? Recent consumption of large amounts of cough medicine Recent consumption of table salt Low circulating albumin levels Taking phenytoin

Recent consumption of large amounts of cough medicine Explanation: Radioimmunoassay of T4 and T3 is a specific blood study to determine how much protein-bound iodine (PBI) is present in serum. Ask if a child has recently taken large amounts of cough medicine containing iodide before the study or the PBI level may be abnormally elevated.

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 Lispro NPH Detemir

Regular insulin

A child with Addison disease has been admitted with a history of nausea and vomiting for the past 3 days. The client is receiving IV glucocorticoids. Which intervention will the nurse perform? Take glucometer readings as ordered. Measure intake and output. Monitor sodium and potassium levels. Weigh daily.

Take glucometer readings as ordered. Explanation: IV glucocorticoids raise glucose levels and often require coverage with insulin. Measuring the intake and output at this time is not necessary. Sodium and potassium would be monitored when the client is receiving mineralocorticoids. Daily weights are not necessary at this time. Reference:

The nurse is caring for a child who is suspected to have a growth hormone deficiency. Which finding after further testing supports this diagnosis? The bone age is found to be two or more deviations below normal. Magnetic resonance imaging shows a brain tumor. Physical examination finds excessive foot and finger growth for age. Computed tomography identifies a tumor on the child's kidney.

The bone age is found to be two or more deviations below normal.

A school-age child is diagnosed as having Cushing syndrome from long-term therapy with oral prednisone. What assessment finding is consistent with this child's diagnosis and treatment? Child appears pale and fatigued. There are purple striae on the abdomen. The child is excessively tall for chronologic age. The child is demonstrating signs of hypoglycemia.

There are purple striae on the abdomen. Cushing syndrome is caused by overproduction of the adrenal hormone cortisol. The overproduction of cortisol results in hyperpigmentation, which occurs from the melanin-stimulating properties of ACTH. Purple striae resulting from collagen deficit appear on the child's abdomen. The child will not be pale or fatigued. The child will not be excessively tall. The child will not be demonstrating signs of hypoglycemia

The nurse is preparing teaching materials for a family whose child is prescribed somatropin for a growth hormone deficiency. What should the nurse instruct the parents about the administration of this medication? This medication must be given by injection. This medication must be given in the morning before school. Hip or knee pain is an expected adverse effect of this medication. This medication does not interact with any other types of medication.

This medication must be given by injection. Explanation: Somatropin is administered by injection. It is best given at the hour of sleep because that is when growth hormone is released. Hip or knee pain could indicate a slipped capital epiphysis and should be reported to the health care provider. The nurse should urge the parents to inform all health care providers that the child is receiving this medication to avoid medication interactions.

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

Type 1 diabetes mellitus Explanation: Signs and symptoms of type 1 diabetes mellitus include polyuria, polydipsia, polyphagia, enuresis, and weight loss.

A child with growth hormone (GH) deficiency is receiving GH therapy. The best time for the GH to be administered is: a. At bedtime. c. Before meals. b. After meals. d. On arising in the morning.

a. At bedtime.

A neonate born with ambiguous genitalia is diagnosed with congenital adrenogenital hyperplasia. Therapeutic management includes administration of: a. Vitamin D. c. Stool softeners. b. Cortisone. d. Calcium carbonate.

b. Cortisone. The most common biochemical defect with congenital adrenal hyperplasia is partial or complete 21- hydroxylase deficiency. With complete deficiency, insufficient amounts of aldosterone and cortisol are produced, so circulatory collapse occurs without immediate replacement. Vitamin D, stool softeners, and calcium carbonate have no role in the therapy of adrenogenital hyperplasia.

The nurse is discussing various sites used for insulin injections with a child and her family. Which site usually has the fastest rate of absorption? a. Arm c. Buttock b. Leg d. Abdomen

d. Abdomen

A child eats some sugar cubes after experiencing symptoms of hypoglycemia. This rapid-releasing sugar should be followed by: a. Saturated and unsaturated fat. c. Several glasses of water. b. Fruit juice. d. Complex carbohydrate and protein.

d. Complex carbohydrate and protein.

A child with growth hormone deficiency is prescribed growth hormone (GH) by subcutaneous injection. When teaching the child's parents about this drug, the nurse would instruct the parents to administer the drug at which frequency? daily, 6 to 7 days a week every 3 days weekly monthly

daily, 6 to 7 days a week

Insulin deficiency, in association with increased levels of counter-regulatory hormones and dehydration, is the primary cause of: diabetic ketoacidosis. ketone bodies. ketonuria. glucosuria.

diabetic ketoacidosis. Explanation: 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. Glucosuria is glucose that is spilled into the urine.

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

early identification Explanation: 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.

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? frequent diarrhea enlarged tongue tachycardia warm, moist skin

enlarged tongue

A 9-year-old male is coming into the office to be seen for possible precocious puberty. The nurse would expect that the lab will perform which test? cortisol level hCG test IGF-1 test FSH test

hCG test Explanation: Laboratory testing may include different blood tests, depending on the sex of the client. In boys, the healthcare prescriber may order a serum human chorionic gonadotropin (hCG) test, which if elevated could indicate an hCG-secreting tumor. In girls, an elevated cortisol or ACTH level with no signs of Cushing syndrome (CS) could be caused by glucocorticoid resistance, evidenced by signs of precocious puberty. IGF-1 levels are assessed for growth hormone deficiency, not precocious puberty. FSH is measured to assess delayed puberty.

In teaching the parents of an infant diagnosed with diabetes insipidus, the nurse should include which treatment? the need for blood products antihypertensive medications hormone replacement fluid restrictions

hormone replacement

An 8-year-old girl presents to the clinic for moodiness and irritability. The child has begun to develop breasts and pubic hair and the parents are concerned that the child is at too early an age for this to begin. The nurse knows that these symptoms may be indicative of what disorder? precocious puberty pseudopuberty adrenal hyperplasia neurofibromatosis

precocious puberty Explanation: Precocious puberty occurs when the child's sexual characteristics begin to develop before the normal age of puberty. 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

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 take? Request that someone call 911. Administer subcutaneous glucagon. Anticipate that the child will need intravenous glucose. Dissolve a piece of candy in the child's mouth.

Administer subcutaneous glucagon.

A child is prescribed glargine insulin. What information would the nurse include when teaching the child and parents about this insulin? Do not mix this insulin with other insulins. Give the dose first thing in the morning. Store the insulin in the refrigerator until just before giving it. Discard any opened vials after a week.

Do not mix this insulin with other insulins.

A child with a history of diabetes insipidus is admitted with polyuria, polydipsia, and mental confusion. Which is the priority intervention for this child? measure urine output check vital signs encourage increased fluid intake weigh the client

check vital signs

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 weekly bi-monthly monthly

daily Explanation: 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.

An 8-year-old child is admitted to a medical-surgical unit with a diagnosis of syndrome of inappropriate antidiuretic syndrome (SIADH). Drag words from the choices below to fill in each blank in the following sentence. The nurse will closely monitor the client's ..............., ................, and ..................

serum sodium, level of consciousness, fluid balance

The nurse is teaching a 12-year-old girl with type 2 diabetes mellitus 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." "I can have an apple or orange for snacks." "I can have nonfat milk to drink." "I will be eating more breads and cereals."

"I can eat two small cookies with each meal." Explanation: 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.

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? "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." "Maybe you could do something to remind yourself to take the medication on a daily basis." "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." "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."

"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."

The nurse is teaching the parents of a 3-year-old girl with diabetes insipidus how to administer desmopressin acetate (DDAVP). Which comment indicates further need for teaching? "If she sneezes the medicine out of her nose, I wait until the next dose." "First I suction her nostrils, if necessary, to help the drug be absorbed." "I check the specific gravity of her urine to see if the drug is working." "Once the tube is filled, I hold it closed until I insert it into her nostril."

"If she sneezes the medicine out of her nose, I wait until the next dose."

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? Select all that apply. "My child only took half of the normal insulin dose this morning." "When will the IV be started that administers the sugar solution?" "You will be drawing blood at different times for testing, correct?" "This test will show how well my child's blood glucose levels return to normal after the sugar solution is given." "This test helps in diagnosing infections that may cause my child's blood sugar to be abnormal."

"My child only took half of the 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."

36. Nursing care of a child diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) should include (Select all that apply): a. Weigh daily. b. Encourage fluids. c. Turn frequently. d. Maintain nothing by mouth. e. Restrict fluids.

ANS: A, E Increased secretion of ADH causes the kidney to resorb water, which increases fluid volume and decreases serum osmolarity with a progressive reduction in sodium concentration. The immediate management of the child is to restrict fluids. The child should also be weighed at the same time each day. Encouraging fluids, turning frequently, and maintaining nothing by mouth are not associated with SIADH.

What is the most appropriate intervention for the parents of a 6-year-old girl with precocious puberty? a. Advise the parents to consider birth control for their daughter. b. Explain the importance of having the child foster relationships with same-age peers. c. Assure the childs parents that there is no increased risk for sexual abuse because of her appearance. d. Counsel parents that there is no treatment currently available for this disorder.

ANS: B Despite the childs appearance, the child needs to be treated according to her chronologic age and to interact with children in the same age-group. An expected outcome is that the child will adjust socially by exhibiting age-appropriate behaviors and social interactions. Advising the parents of a 6-year-old to put their daughter on birth control is not appropriate and will not reverse the effects of precocious puberty. Parents need to be aware that there is an increased risk of sexual abuse for a child with precocious puberty. Treatment for precocious puberty is the administration of gonadotropin-releasing hormone blocker, which slows or reverses the development of secondary sexual characteristics and slows rapid growth and bone aging.

An adolescent is being seen in the clinic for evaluation of acromegaly. The nurse understands that which occurs with acromegaly? a. There is a lack of growth hormone (GH) being produced. b. There is excess GH after closure of the epiphyseal plates. c. There is an excess of GH before the closure of the epiphyseal plates. d. There is a lack of thyroid hormone being produced.

ANS: B Excess GH after closure of the epiphyseal plates results in acromegaly. A lack of growth hormone results in delayed growth or even dwarfism. Gigantism occurs when there is hypersecretion of GH before the closure of the epiphyseal plates. Cretinism is associated with hypothyroidism.

A child with hypopituitarism is being started on growth hormone (GH) therapy. Nursing considerations should be based on which of the following? a. Treatment is most successful if it is started during adolescence. b. Treatment is considered successful if children attain full stature by adulthood. c. Replacement therapy requires daily subcutaneous injections. d. Replacement therapy will be required throughout the childs lifetime.

ANS: C Additional support is required for children who require hormone replacement therapy, such as preparation for daily subcutaneous injections and education for self-management during the school-age years. Young children, obese children, and those who are severely GH deficient have the best response to therapy. When therapy is successful, children can attain their actual or near-final adult height at a slower rate than their peers.

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. The child acts sleepy and unresponsive. Slight exophthalmos is observed. Auscultation reveals an irregular heart rate.

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.

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 not be taking the medication. The child may have developed leukopenia. The child needs to be started on an antibiotic drug. The child must be participating in sports.

The child may have developed leukopenia. Explanation: Graves disease is defined as an overproduction of thyroid hormones. Propylthiouracil is used to suppress thyroid function. A complication of Graves disease is leukopenia.

A nurse is taking care of an infant with diabetes insipidus. Which assessment data are most important for the nurse to monitor while the infant has a prescription for fluid restriction? Vital signs Oral intake Oral mucosa Urine output

Urine output

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? recent weight loss blood pressure of 142/92 mm Hg slow healing wounds loose stools

recent weight loss

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? how to recognize vitamin D toxicity how to maintain fluid intake regimens administering methimazole with meals reporting irritability or anxiety

reporting irritability or anxiety

The nurse is caring for a school-age child with hyperthyroidism (Graves disease). Which clinical manifestations should the nurse monitor that may indicate a thyroid storm (Select all that apply)? a. Constipation b. Hypotension c. Hyperthermia d. Tachycardia e. Vomiting

c. Hyperthermia d. Tachycardia e. Vomiting

The nurse is teaching parents about the pattern of heredity of metabolic conditions. The nurse realizes that further teaching is needed when the parent makes which statement? "The pattern of heredity for many metabolic conditions is recessive." "The pattern of heredity for some metabolic conditions is dominant." "The pattern of heredity for all metabolic conditions is dominant." "Not all metabolic conditions are clinically evident during the neonatal period."

"The pattern of heredity for all metabolic conditions is dominant." Explanation: The pattern of heredity for many metabolic conditions is recessive. The statement that all are dominant conditions is false, because some conditions may be caused by a dominant gene

Diabetes insipidus is a disorder of the: a. Anterior pituitary. c. Adrenal cortex. b. Posterior pituitary. d. Adrenal medulla.

ANS: B The principal disorder of posterior pituitary hypofunction is diabetes insipidus. The anterior pituitary produces hormones such as growth hormone, thyroid-stimulating hormone, adrenocorticotropic hormone, gonadotropin, prolactin, and melanocyte-stimulating hormone. The adrenal cortex produces aldosterone, sex hormones, and glucocorticoids. The adrenal medulla produces catecholamines.

Which clinical manifestation may occur in the child who is receiving too much methimazole (Tapazole) for the treatment of hyperthyroidism (Graves disease)? a. Seizures c. Pancreatitis or cholecystitis b. Enlargement of all lymph glands d. Lethargy and somnolence

ANS: D Parents should be aware of the signs of hypothyroidism that can occur from overdosage of the drug. The most common manifestations are lethargy and somnolence. Seizures and pancreatitis are not associated with the administration of Tapazole. Enlargement of the salivary and cervical lymph glands occurs.

The nurse has told the 14-year-old adolescent with diabetes that the doctor would like to have a hemoglobin A1C test performed. Which comment by the client indicates that she understands what this test is for? "That is the test that I take after I have fasted for at least 8 hours." "The normal level for my hemoglobin A1C is between 60 to 100 mg/dl." "I monitor my own blood glucose every day at home. I don't see why the doctor would want this done." "This will tell my doctor what my average blood glucose level has been over the last 2 to 3 months."

"This will tell my doctor what my average blood glucose level has been over the last 2 to 3 months."

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 0845 0900 0930

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

A nurse is planning care for a school-age child with type 1 diabetes. Which insulin preparations are rapid and short acting (Select all that apply)? a. Novolin N b. Lantus c. NovoLog d. Novolin R

ANS: C, D

A pediatric client has just been diagnosed with diabetes insipidus. What is the primary consideration for this client? fluid replacement weight loss polydipsia headache

fluid replacement

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? The child states that the exam room is cold. Oral cavity assessment shows two of the 6-year molars. The mother reports that the boy is always thirsty. The child has a faint rash on the trunk of the body.

The child states that the exam room is cold. Explanation: 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 working on a pediatric floor understands the importance of diagnosing inborn errors of metabolism early. A child with a suspected problem must have blood urea nitrogen (BUN) and creatinine testing done. Which is the purpose of these two tests? Detect changes in amino acid patterns. Evaluate renal function. Evaluate liver function. Evaluate metabolism.

Evaluate renal function. Explanation: Tests of BUN and creatinine evaluate renal function. These tests are done to rule out chronic renal failure and to monitor the effects of treatments on the renal system. Tests of ammonia and lactic acid evaluate metabolism. Tests of plasma amino acids detect changes in amino acid pattern, while a liver function panel would help evaluate hepatic function.

An elementary school child takes metformin three times each day. Which disorder would the school nurse expect the child to have? Type 1 diabetes mellitus Gastrointestinal reflux Inflammatory bowel disorder Type 2 diabetes mellitus

Type 2 diabetes mellitus

The nurse is speaking with the parents of a school-aged child recently diagnosed with diabetes 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." "When my son's breath smells fruity, it almost always indicates high blood sugar." "If my son says he feels shaky, his blood sugar may be low." "Dry flushed skin may be a sign if high blood sugar."

"If I notice changes in my son like tearfulness or irritability, his blood sugar may be high." Explanation: 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 nurse working in a pediatric clinic is examining a child with symptoms indicating a possible inborn error of metabolism. Which action is most important for the nurse to do at this time? Ignore the symptoms if the family does not ask about them. Counsel the family to have all siblings evaluated. Reassure the family that everything is OK, but express urgency to the health care provider. Read more about the condition and its ramifications.

Counsel the family to have all siblings evaluated. If one child in the family has suspicious symptoms, counsel the family to have all other siblings evaluated, even if their symptoms are not exactly the same. The nurse should never ignore such a problem and should never tell a family not to worry when a problem may exist. Reading more about the problem may be helpful, but it is not a priority action at this time.

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? "During exercise we should wait to check blood sugars until after our child completes the activity." "If our child is sick we should check blood glucose levels more often." "We should check our child's blood glucose levels before meals." "Blood glucose level, food intake, and activity need to all be considered when calculating insulin dosage."

"During exercise we should wait to check blood sugars until after our child completes the activity." Explanation: Blood glucose monitoring needs to be performed more often during prolonged exercise. Frequent glucose monitoring before, during, and after exercise is important to recognize hypoglycemia or hyperglycemia. Frequent glucose monitoring if the child is sick is also important to recognize changes in glucose levels and prevent hypoglycemia or hyperglycemia.

The nurse is examining a child with hypoparathyroidism. The nurse would expect to assess which signs and symptoms? Select all that apply. capillary refill polyphagia Chvostek sign Babinski sign Trousseau sign

Chvostek sign Trousseau sign A child with hypoparathyroidism would have a positive Chvostek or Trousseau sign, both of which indicate hypocalcemia. To test for the Chvostek sign, tap sharply over the facial nerve below the temple and anteriorly to the ear. The sign is positive when the mouth twitches (contraction of the lateral facial muscles). To check for the Trousseau sign, apply a blood pressure cuff to the child's upper arm. Inflate the cuff until the blood supply is occluded. If doing so causes carpal spasm (the fingers contract and the child is unable to open the hand), the Trousseau sign is positive. Capillary refill helps to evaluate tissue oxygenation. Polyphagia refers to excessive eating or hunger. Babinski refers to the Babinski reflex, which suggests neurologic dysfunction.

A nurse is making a home visit to a 12-year-old child with type 1 diabetes and is reviewing insulin administration. The nurse determines that the teaching was successful when the child performs which actions? Select all that apply. Draws up the short-acting insulin before the intermediate-acting insulin. Stores the insulin vial at room temperature. Gives the injection at a 45-degree angle. Shakes the bottle of intermediate-acting insulin to make sure is it uniform. Aspirates for a blood return before injecting the medication.

Draws up the short-acting insulin before the intermediate-acting insulin. Stores the insulin vial at room temperature. Gives the injection at a 45-degree angle.

The nurse is caring for a child recently diagnosed with hypoparathyroidism disorder. Which medication would the nurse expect to be ordered? oral calcium oral corticosteroids intravenous diuretic therapy oral potassium

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

The nurse is talking with a parent of an adolescent who is newly diagnosed with type 2 diabetes and asks, "How could this happen? No one in our family has diabetes." What response would be appropriate? "This is caused by the pancreas not making enough insulin." "This disorder usually occurs when inadequate calories are ingested on a regular basis." "Because this disorder is genetic, someone in the family will eventually develop the illness." "This is caused by insulin resistance from previous pancreatic injury or generalized infection."

"This disorder usually occurs when inadequate calories are ingested on a regular basis." Explanation: Type 2 diabetes is now seen in overweight adolescents as well as those who eat a diet high in fats and carbohydrates and do not exercise regularly. Pancreatic malfunction is not a cause of type 2 diabetes. This disorder is not linked to inadequate ingestion of daily calories. This disorder may have a genetic link, but environmental factors such as obesity, diet, and exercise can influence its development. Type 2 diabetes is a result of insulin resistance in the metabolism of glucose to maintain normal blood glucose levels, but it is not associated with infection or a previous pancreatic injury.

The nurse measures the client's blood glucose level prior to breakfast. The measurement obtained is 130 mg/dl. The orders read to administer 2 units of Humalog insulin for a blood glucose of 100 to 150 mg/dl. How soon should the nurse ensure that the client eats breakfast after receiving insulin? within 5 minutes within 15 to 30 minutes within 60 to 90 minutes within 2 hours

within 15 to 30 minutes

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? Providing a wet washcloth to suck. Educating family about side effects. Monitoring blood glucose levels. Monitoring intake and output.

Monitoring blood glucose levels. Explanation: 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.

A 6-week-old infant has been diagnosed with congenital hypothyroidism. Once the level of medication has been determined, in order to maintain the proper dosing of thyroid hormone, the nurse instructs the parents to have the baby's levels tested how often during the first year? every 1 to 3 days every 1 to 3 weeks every 1 to 3 months every 3 to 6 months

every 1 to 3 months Explanation: Thyroid levels are measured at recommended intervals, such as every 2 weeks until the target range is reached on a stabilized dose of medication, then every 1 to 3 months until the child is 1 year old, every 2 to 3 months until the child is 3 years old, and becoming less frequent as the child gets older.

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 Decreased serum levels of free testosterone Body mass index as normal Short stature

Darkened pigmentation around the neck area Explanation: 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.

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? Prepare the parent for a neurology consult. Explain why the child might need to schedule an eye exam. Discuss preparing for a thyroid function test. Explain the preparation for an 8-hour fasting blood glucose test.

Discuss preparing for a thyroid function test. Explanation: The child exhibits signs and symptoms of Graves disease (hyperthyroidism). A thyroid function test would show an elevation in T4 and T3 levels caused by overfunctioning of the thyroid. Neither a neurology consult nor an eye exam would be needed. A fasting blood glucose test is used to test for Cushing syndrome and diabetes mellitus.

A child has been diagnosed with the syndrome of inappropriate antidiuretic hormone (SIADH) and has been admitted to the hospital. Which nursing intervention is most important for this child? Monitor sodium levels. Monitor the child's weight daily. Monitor intake and output. Correct nausea and vomiting.

Monitor sodium levels. Explanation: The syndrome of inappropriate antidiuretic hormone (SIADH) occurs when ADH (vasopressin) is secreted in the presence of a low osmolality because the feedback mechanism that regulates ADH does not work. ADH continues to be released, causing water retention and decreased serum sodium. To correct the problem the child should be placed on fluid restriction and IV sodium chloride should be administered to correct hyponatremia. If the sodium levels drop, neurological signs develop (headache, altered mental status, behavior changes, seizures, and even coma). The child would need to be weighed daily and any gastrointestinal symptoms need to be corrected. Intake and output, especially the output, are important to monitor.

The nurse is caring for an 11-year-old child who has type 2 diabetes mellitus. The child has been vomiting for 48 hours and the breath has a fruity odor. The nurse notes that respirations are deep and rapid with a temperature of 102°F (38.9°C). Which intervention would be most appropriate? Give the child 8 ounces of clear liquid. Test the child's urine to detect the presence of ketones. Prepare for IV insertion. Give the child 25 g of carbohydrates.

Prepare for IV insertion. Explanation: The child needs nursing interventions rapidly to change his or her diabetic status. This child should be given an IV with fluids and electrolytes to improve and restore tissue perfusion. Fruity breath and deep and rapid respirations are signs of ketoacidosis (hyperglycemia), which occurs before oral rehydration. The urine may show ketones, but checking the urine is not the priority in this risky situation.

At what age is sexual development in boys and girls considered to be precocious? a. Boys, 11 years; girls, 9 years c. Boys, 9 years; girls, 8 years b. Boys, 12 years; girls, 10 years d. Boys, 10 years; girls, 9.5 years

c. Boys, 9 years; girls, 8 years Manifestations of sexual development before age 9 in boys and age 8 in girls are considered precocious and should be investigated. Boys older than 9 years of age and girls older than 8 years of age fall within the expected range of pubertal onset.

A 12-year-old client arrives at the emergency room experiencing nausea, vomiting, headache, and seizures. The client is diagnosed with bacterial meningitis. Other findings include a decrease in urine production, hyponatremia, and water intoxication. Which pituitary gland disorder is most associated with these symptoms? syndrome of inappropriate antidiuretic hormone (SIADH) diabetes insipidus (DI) hyposecretion of somatotropin hypersecretion of growth hormone

syndrome of inappropriate antidiuretic hormone (SIADH) Explanation: 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 (growth hormone) results in undergrowth; hypersecretion results in overgrowth.