FINAL EXAM PEDI 2023/ PrepU CH26
A 6-year-old child is being evaluated for growth hormone dysfunction. Which tests will be employed in the diagnostic workup? Select all that apply.
CT scan MRI pituitary function test Explanation: The child will undergo laboratory tests to rule out chronic illnesses such as renal failure or liver and thyroid dysfunction. Laboratory and diagnostic tests used in children with suspected GH deficiency include CT and MRI to assess for structural abnormalities. A pituitary function test will be used to confirm a diagnosis of growth hormone dysfunction.
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.
The nurse is caring for a child who has developed thyroid storm. What intervention(s) will the nurse initiate? Select all that apply. cooling blanket continuous cardiac monitoring increase dosage of L-thyroxine sodium decrease stimulation, such as turning off lights and television decrease caloric intake by 10% to 15%
cooling blanket continuous cardiac monitoring decrease stimulation, such as turning off lights and television Explanation: Signs and symptoms related to the development of thyroid storm include fever, diaphoresis, and tachycardia. Children with thyroid storm are typically restless and irritable. Interventions include a cooling blanket, continuous cardiac monitoring and decreasing stimulation. Caloric intake may need to be increased and dosages of L-thyroxine sodium may need to be held or decreased.
the child has a protuberant tongue, fatigued appearance, poor muscle tone, and exophthalmos. What medical diagnosis would the nurse expect the child to have? Cushing disease Graves disease diabetes syndrome of inappropriate antidiuretic hormone secretion (SIADH)
Graves disease
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.
The nurse is caring for 1-month-old girl with thyrotoxicosis. What finding would the nurse expect to assess? The child has a strong appetite but fails to thrive. Observation reveals lethargy and irritability. Skin is cool, dry, and scaly to the touch. The child is hypoactive and hypotonic.
The child has a strong appetite but fails to thrive. Explanation: Infants with thyrotoxicosis may display hyperphagia but fail to gain weight
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." Explanation: Treatment stops when the epiphyseal growth plates fuse; therefore, it will not continue throughout the child's lifetime.
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." Explanation: Tiredness, fatigue, constipation, cold intolerance and weight gain are all symptoms of hypothyroidism. Nervousness, anxiety, heat intolerance, weight loss and smooth velvety skin are all symptoms of hyperthyroidism.
Prior to discharging an infant with congenital hypothyroidism to home with the parents, what should the nurse emphasize regarding the care that this child will need going forward? Vitamin K administration until school age Administration of levothyroxine indefinitely An increased intake of calcium beginning immediately Administration of vitamin C until after growth is complete
Administration of levothyroxine indefinitely Explanation: The treatment for hypothyroidism is oral administration of synthetic thyroid hormone or sodium levothyroxine. A small dose is given at first, and then the dose is gradually increased to therapeutic levels. The child needs to continue taking the synthetic thyroid hormone indefinitely to supplement that which the thyroid does not make.
A new mother is concerned about the need to provide medication to a newborn every day for an indefinite period of time. What should the nurse encourage the mother to do to help ensure medication compliance? Select all that apply. Check the expiration dates on all medications. Plan times for medications that fit in with the daily routine. Build medication administration into the general home routine. Make medication administration pleasant such as including it during mealtimes. Schedule prescription refills at least 1 day before the current amount is used up.
Check the expiration dates on all medications. Plan times for medications that fit in with the daily routine. Build medication administration into the general home routine.
x 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
A pediatric nurse is discharging a 1-month-old infant. The infant was diagnosed with congenital hypothyroidism on this admission and will be treated with levothyroxine. The nurse knows it is important to teach the parent about medication administration. Which process will the nurse include in the teaching? Give the crushed medication in a syringe mixed with a small amount of formula. Crush the medication and put it in the full bottle of formula so it tastes better. Administer the medication every other day. Explain that this treatment is administered until the child is 3 years of age.
Give the crushed medication in a syringe mixed with a small amount of formula.
A nurse caring for a child with Graves disease is administering propylthiouracil (PTU). The child has been on this drug for a few weeks and now has sudden symptoms of a sore throat. What is the priority intervention for the nurse? Ask the child if there is a reason he or she does not want to go back to school. Hold the dose and call the health care provider. Offer throat lozenges to soothe the throat. Continue medication to relieve the signs of Graves disease.
Hold the dose and call the health care provider. Explanation: The severe sore throat could be a sign of leukopenia, which is a side effect of PTU. The medication should be held and the health care provider called.
A 12-year-old child is diagnosed with hyperthyroidism. What problem would the nurse anticipate the child may have in school? Inability to submit neat handwriting assignments Increase in sleepiness by the end of the day Noncomprehension of written material Inability to fit legs under a school desk
Inability to submit neat handwriting assignments Explanation: Children with hyperthyroidism are seen in the health care provider's office with the first reports being sleep problems, poor school performance, and distractibility
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
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 elevate
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
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.
A child is admitted to the pediatric medical unit with the diagnosis of syndrome of inappropriate antidiuretic hormone (SIADH). The child experiences the typical signs and symptoms of this disorder. Which concern will the nurse include in care planning? delayed growth and development risk altered nutrition risk noncompliance because of difficulty coping excess fluid volume risk
excess fluid volume risk Explanation: Syndrome of inappropriate antidiuretic hormone (SIADH) occurs when antidiuretic hormone (ADH; vasopressin) is secreted in the presence of low serum osmolality because the feedback mechanism that regulates ADH does not function properly. ADH continues to be released, and this leads to water retention, decreased serum sodium due to hemodilution, and extracellular fluid volume expansion; thus, the priority concern for care planning is the risk for excess fluid volume from edema.
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 ___________________________
fluid balance, serum sodium, LOC
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? vasopressin antidiuretic hormone oxytocin growth hormone
growth hormone Explanation: Disorders of the pituitary gland depend on the location of the physiologic abnormality. The anterior pituitary, or adenohypophysis, is made up of endocrine glandular tissue and secretes growth hormone (GH), adrenocorticotropic hormone (ACTH), TSH, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin.
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
A 2-month-old infant is diagnosed with hypothyroidism. When educating the parents, the nurse explains which as signs suggesting hypothyroidism? Select all that apply. "Your infant's high-pitched cry is a sign." "Your infant had a long period of jaundice from birth." "Your infant's motor activity has been decreased." "Your infant has had ongoing constipation." "Your infant was unusually long in length at birth." TAKE ANOTHER QUIZ
"Your infant had a long period of jaundice from birth." "Your infant's motor activity has been decreased." "Your infant has had ongoing constipation." Explanation: Hypothyroidism in an infant is marked by hypotonicity or poor/decreased muscle activity, prolonged jaundice at birth, and constipation due to a slow metabolic rate.
The nurse is caring for a 10-year-old child with growth hormone (GH) deficiency. Which therapy would you anticipate will be prescribed for the child? Short-term aldosterone provocation Injections of GH Oral administration of somatotropin Long-term blocking of beta cells
Injections of GH Explanation: Growth hormone (GH) deficiency occurs when the anterior pituitary is unable to produce enough hormone for usual growth. Somatotropin is the name of the growth hormone administered. Administering subcutaneous GH to the child helps correct this deficiency. The GH dosage is 0.2 to 0.3 mg/kg given daily. It is not administered orally.
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*****
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.
The nurse is assessing a 16-year-old girl who is in the office because she has not started menstruating. Which endocrine gland is most often affected by age-related changes? parathyroid adrenal thyroid anterior pituitary
thyroid Explanation: Many menstrual problems may be symptoms of undiagnosed thyroid conditions. Girls who have either very early or very late menstruation should be evaluated for a potential thyroid problem, as thyroid problems can frequently be a cause of early or delayed puberty and menstruation. Hyperthyroidism in a teenage girl can delay the onset of puberty and onset of menstruation into the mid-teens, in some cases after the age of 15.
A child with a history of diabetes insipidus has been taking vasopressin. The parents bring the child to the clinic for an evaluation. During the visit, the parents mention that it seems like their son is hardly urinating. The nurse suspects syndrome of inappropriate antidiuretic hormone. What findings would the nurse expect to find to help confirm this condition? Select all that apply urine specific gravity 1.033 decreased serum sodium level serum osmolality 260 mOsm/kg (260 mmol/kg) decreased urine osmolality weight loss hypotension
urine specific gravity 1.033 decreased serum sodium level serum osmolality 260 mOsm/kg (260 mmol/kg) Explanation: Syndrome of inappropriate antidiuretic hormone (SIADH) is characterized by decreased urination, hyponatremia, serum osmolality less than 280 mOsm/kg (280 mmol/kg), urine specific gravity greater than 1.030, increased urine osmolality, fluid retention, weight gain, and hypertension.
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
A 14-year-old client has just been diagnosed with Graves disease. Which symptom(s) is likely to be noted in the assessment? Select all that apply. exophthalmos moist skin nervousness increased basal metabolic rate obesity lethargy
exophthalmos moist skin nervousness increased basal metabolic rate Explanation: In Graves disease, the client gradually experiences nervousness, tremors, loss of muscle strength, and easy fatigue. Their basal metabolic rate, blood pressure, and pulse all increase. Their skin feels moist and they perspire freely. An exophthalmos-producing pituitary substance causes the prominent-appearing eyes that accompany hyperthyroidism in some clients
