PEDs Chapt 27 Nursing Care of the Child with an Endocrine Disorder
A child who has type 1 diabetes mellitus is brought to the emergency department and diagnosed with diabetic ketoacidosis. Which of the following would the nurse expect to administer? a) NPH b) Regular insulin c) Detemir d) Lispro
Regular insulin Correct Explanation: Insulin for diabetic ketoacidosis is given intravenously. Only regular insulin can be administered by this route.
After hospital discharge, the mother of a child newly diagnosed with type 1 diabetes mellitus telephones you because her daughter is acting confused and very sleepy. Which emergency measure would you suggest the mother carry out before she brings the child to see her doctor? a) Give her a glass of orange juice. b) Give her a glass of orange juice with one unit regular insulin in it. c) Give her one unit of regular insulin. d) Give her nothing by mouth so that a blood sugar can be drawn at the doctor's office.
Give her a glass of orange juice. Correct Explanation: These are typical symptoms of hypoglycemia. Administering a form of glucose would help relieve them. Insulin cannot be absorbed when taken orally.
A child with Addison disease has been admitted with a history of nausea and vomiting for the past three days. The client is receiving IV glucocorticoids (e.g., Solu-Medrol). Which of the following interventions would the nurse implement? a) Daily weights b) Monitoring of sodium and potassium levels c) Glucometer readings as ordered d) Intake and output measurements
Glucometer readings as ordered Explanation: IV glucocorticoids raise the 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 mineral corticoids. Daily weights are not necessary at this time.
A 12-year-old is being seen in the office and has hyperthyroidism; the nurse knows that the most common cause of hyperthyroidism is which of the following: a) Plummer disease b) Cushing disease c) Addison disease d) Graves disease
Graves disease Correct Explanation: Hyperthyroidism occurs less often in children than hypothyroidism. Graves' disease, the most common cause of hyperthyroidism in children, occurs in 1 in 5,000 children between 11 and 15 years of age. Hyperthyroidism occurs more often in females, and the peak incidence occurs during adolescence.
The nurse knows that disorders of the pituitary gland depend on the location of the physiologic abnormality. Caring for a child that has issues with the anterior pituitary, the child has issues with which hormone? a) Oxytocin b) Antidiuretic hormone c) Vasopressin d) Growth hormone
Growth hormone Correct Explanation: Disorders of the pituitary gland depend on the location of the physiologic abnormality. The anterior pituitary, or adrenohypophysis, 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 posterior lobe is called the neurohypophysis because it is formed of neural tissue. It secretes antidiuretic hormone (ADH; vasopressin) and oxytocin. Usually, several target organs are affected when there is a disorder of the pituitary gland, especially the adrenohypophysis
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 which of the following? a) Pica b) Polyphagia c) Polydipsia d) Polyuria
Polyphagia Correct Explanation: Symptoms of Type 1 Diabetes Mellitus include polyphagia (increased hunger and food consumption), polyuria (dramatic increase in urinary output, probably with enuresis), and polydipsia (increased thirst), and. Pica is eating nonfood substances.
The nurse is interviewing the caregivers of a child admitted with a diagnosis of Type 1 Diabetes Mellitus. The caregiver states, "The teacher tells us that our child has to use the restroom many more times a day than other students do." The caregiver's statement indicates the child most likely has which of the following? a) Polyphagia b) Polydipsia c) Pica d) Polyuria
Polyuria Correct Explanation: Symptoms of Type 1 Diabetes Mellitus include polyuria (dramatic increase in urinary output, probably with enuresis), polydipsia (increased thirst), and polyphagia (increased hunger and food consumption). Pica is eating nonfood substances.
Reva is an 8-year-old who is being seen today in the clinic for moodiness and irritability. She has begun to develop breasts and pubic hair and her parents are concerned that she is at too early an age for this to begin. As a nurse you know that the possible prognosis for her is: a) Pseudopuberty b) Adrenal hyperplasia c) Precocious puberty d) Neurofibromatosis
Precocious puberty Correct Explanation: The prognosis for a child with precocious puberty depends on the age at diagnosis and immediate treatment. 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. Mental development in children with precocious puberty is normal, and developmental milestones are not affected; however, the behavior may change to that of a typical adolescent. Girls may have episodes of moodiness and irritability, whereas boys may become more aggressive.
The young child has been diagnosed with a secondary growth hormone deficiency. The child weighs 58 pounds. The physician orders the child to receive 0.2 mg of growth hormone for each kilogram of body weight per week, divided into daily doses. How many milligrams of growth hormone would the child receive with each dose? Round to the thousandths place.
0.075 Explanation: The child weighs 58 pounds and 2.2 pounds = 1 kg. 58 pounds x 1 kg/2.2 pounds = 26.3636 kg of body weight. 26.3636 x 0.2 mg/1 kg = 0.5273 mg of growth hormone per week. 0.5273 mg/week x 1 week/7 days = 0.0753 mg/day.
Tay-Sachs disease is found primarily in the Asian population. a) True b) False
False Correct Explanation: Tay-Sachs disease is found primarily in the Ashkenazi Jewish population (Eastern European Jewish ancestry).
The most common mixture of insulin used with children with type 1 diabetes mellitus is a combination of an intermediate-acting insulin and a regular insulin, usually in a 2:1 ratio or 0.75 units of the intermediate-acting insulin to 0.33 units regular insulin, and given in the same syringe. a) False b) True
True
A newborn was diagnosed as having hypothyroidism at birth. Her mother asks you how the disease could be discovered this early. Your best answer would be a) her child is already severely impaired at birth, and this suggests the diagnosis. b) hypothyroidism is usually detected at birth by the child's physical appearance. c) children have a typical rash at birth that suggests the diagnosis. d) a simple blood test to diagnose hypothyroidism is required in most states.
a simple blood test to diagnose hypothyroidism is required in most states. Explanation: Hypothyroidism is diagnosed by a screening procedure a few days after birth.
The nursing diagnosis most applicable to a child with growth hormone deficiency would be a) risk for self-directed violence related to oversecretion of epinephrine. b) risk for situational low self-esteem related to short stature. c) ineffective tissue perfusion related to infantile blood vessels. d) impaired skin integrity related to overproduction of melanin.
risk for situational low self-esteem related to short stature. Correct Explanation: Children who are short in stature can develop low self-esteem from their altered appearance.
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. Which of the following would the nurse expect to find to help confirm this condition? Select all that apply. a) Decreased urine osmolality b) Decreased serum sodium level c) Hypotension d) Weight loss e) Serum osmolality 300 mOsm/kg f) Urine specific gravity 1.033
• Urine specific gravity 1.033 • Decreased serum sodium level • Serum osmolality 300 mOsm/kg Explanation: Syndrome of inappropriate antidiuretic hormone (SIADH) is characterized by decreased urination, hyponatremia, serum osmolality greater than 280 mOsm/kg, urine specific gravity greater than 1.030, increased urine osmolality, fluid retention, weight gain, and hypertension.
A child is prescribed glargine (Lantus) insulin. Which of the following would the nurse include when teaching the child and parents about this insulin? a) "Give the dose first thing in the morning." b) "Do not mix this insulin with other insulins." c) Discard any opened vials after a week. d) Store the insulin in the refrigerator until just before giving it.
"Do not mix this insulin with other insulins." Correct Explanation: Glargine (Lantus) is not mixed with other insulins. Glargine is usually given in a single dose at bedtime. Insulin should be kept at room temperature; insulin that is administered cold may increase discomfort with the injection. Any vial of insulin that is opened should be discarded after 1 month.
Kate and her parents are being seen in the office after discharge from the hospital with a new diagnosis of type 2 diabetes. Which of the following statements by the nurse is true? a) "This will rectify itself if you follow all of the doctor's directions." b) "Kids can usually be managed with an oral agent, meal planning, and exercise." c) "A weight-loss program should be implemented and maintained." d) "You are lucky that you did not have to learn how to give yourself a shot."
"Kids can usually be managed with an oral agent, meal planning, and exercise." Correct Explanation: Treating type 2 diabetes in children may require insulin at the outset if the child is acidotic and acutely ill. More commonly, the child can be managed initially with oral agents, meal planning, and increasing activity. Telling the child that she is lucky, she did not have to learn how to give a shot might scare her so it will inhibit her from seeking future healthcare. The condition will not rectify itself if all orders are followed. A weight-loss program might need to be implemented but that is not always the case.
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 of the following findings in the child's fasting glucose levels? a) 180 mg/dL b) 120 mg/dL c) 60 mg/dL d) 240 mg/dL
240 mg/dL Correct Explanation: If the blood glucose level is elevated or ketonuria is present, a fasting blood sugar (FBS) is performed. An FBS result of 200 mg/dL or higher almost certainly is diagnostic for diabetes when other signs such as polyuria and weight loss, despite polyphagia, are present.
The school nurse notes that a child diagnosed with diabetes mellitus is experiencing an insulin reaction and is unable to eat or drink. Which of the following actions would be the most appropriate for the school nurse to do? a) Request that someone call 911 b) Administer subcutaneous glucagon c) Dissolve a piece of candy in the child's mouth d) Anticipate that the child will need intravenous glucose
Administer subcutaneous glucagon Correct Explanation: If the child having an insulin reaction cannot take a sugar source orally, glucagon should be administered subcutaneously to bring about a prompt increase in the blood glucose level. This treatment prevents the long delay while waiting for a physician to administer IV glucose or for an ambulance to reach the child.
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? a) Insulin b) Antidiuretic hormone c) Growth hormone d) 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. Hypopituitarism or dwarfism involves a growth hormone deficiency. Diabetes mellitus involves a disruption in insulin secretion. Thyroxine is a thyroid hormone that if deficient leads to hypothyroidism.
A nurse is reviewing information about the various types of insulin that are used to treat diabetes mellitus type 1. Integrating knowledge about the duration of action, place the types below in the order from shortest to longest duration. Glargine NPH Aspart Regular
Aspart Regular NPH Glargine Explanation: Aspart has a duration of action of 3 to 5 hours; regular insulin has a duration of 5 to 8 hours; NPH has a duration of 10 to 16 hours; and glargine has a duration of 12 to 24 hours.
The physician has ordered a thyroid scan to confirm the diagnosis. Before the procedure the nurse should: a) Give the client a bolus of fluids. b) Tell the client they will be asleep. c) Assess the client for allergies. d) Insert a urinary catheter.
Assess the client for allergies. Correct Explanation: A thyroid scan uses dye, so a client should be assessed for allergies to iodine and shellfish to prevent a possible reaction. The client will not be asleep, have a catheter, or receive a bolus of fluids.
A group of students are reviewing information about delayed puberty in preparation for a class discussion. The students demonstrate understanding of this condition when they describe which of the following as occurring in girls? a) Growth spurt has not begun by age 12. b) Breast development has not occurred by age 13. c) Pubic hair has not appeared by age 16. d) Menarche has not occurred by age 14.
Breast development has not occurred by age 13. Explanation: Delayed puberty is a condition of delayed secondary sexual development. In girls, it exists if the breasts have not developed by age 13, pubic hair has not appeared by age 14 or menarche has not occurred by age 16. Growth spurt is not a criterion for the disorders.
As a nurse, you know that which of the following is caused by excessive levels of circulating cortisol: a) Cushing syndrome b) Graves disease c) Addison disease d) Turner syndrome
Cushing syndrome Correct Explanation: CS is a characteristic cluster of signs and symptoms resulting from excessive levels of circulating cortisol. Addison disease is caused by autoimmune destruction of the adrenal cortex, which results in dysfunction of steroidogenesis. Grave disease is the most common form of hyperthyroidism. Turner syndrome is deletion of the entire X chromosome.
A woman in her first trimester of pregnancy has just been diagnosed with acquired hypothyroidism. The nurse is alarmed because she knows that this condition can lead to which of the following pregnancy complications? a) Gestational diabetes in the mother b) Spina bifida in the fetus c) Decreased cognitive development of the fetus d) Congenital heart defects in the fetus
Decreased cognitive development of the fetus Correct Explanation: If acquired hypothyroidism exists in a woman during pregnancy, her infant can be born cognitively challenged 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 newborn girl is discovered to have congenital adrenogenital hyperplasia. When assessing her, you would expect to find which physical characteristic? a) Abnormal facial features b) Small for gestational age c) Divergent vision d) Enlarged clitoris
Enlarged clitoris Correct Explanation: Lack of production of cortisol by the adrenal gland leads to overproduction of androgen. This leads to female infants developing an enlarged clitoris.
The parathyroid glands regulate serum levels of glucose in the body. a) False b) True
False Correct Explanation: The four parathyroid glands, located posterior and adjacent to the thyroid gland, regulate serum levels of calcium in the body by controlling the rate of bone metabolism.
A child is diagnosed with hyperthyroidism. Which of the following would the nurse expect to assess? a) Weight gain b) Facial edema c) Constipation d) Heat intolerance
Heat intolerance Correct Explanation: 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.
In teaching the parents of an infant diagnosed with diabetes insipidus, the nurse should include which treatment? a) Antihypertensive medications b) Fluid restrictions c) The need for blood products d) Hormone replacement
Hormone replacement Correct Explanation: The usual treatment for diabetes insipidus is hormone replacement with vasopressin or desmopressin acetate (DDAVP). Blood products shouldn't be needed. No problem with hypertension is associated with this condition, and fluids shouldn't be restricted.
When discussing congenital adrenogenital hyperplasia with a child's parents, you would advise them that administration of which of the following drugs will probably be indicated? a) Calcium b) Hydrocortisone c) Vitamin D d) Growth hormone
Hydrocortisone Correct Explanation: The basic defect in congenital adrenogenital hyperplasia is the lack of cortisol. Administering hydrocortisone supplements this.
A 6-year-old girl visits the pediatrician with complaints of excessive thirst, frequent voiding, weakness, lethargy, and headache. The nurse suspects diabetes insipidus. Which of the following hormonal conditions is characteristic of this disease? a) Hypersecretion of somatotropin b) Hyposecretion of somatotropin c) Hyposecretion of antidiuretic hormone d) Hypersecretion of antidiuretic hormone
Hyposecretion of antidiuretic hormone Correct Explanation: Diabetes insipidus is a disease in which there is decreased release of antidiuretic hormone (ADH) by the pituitary gland. The child with diabetes insipidus experiences excessive thirst (polydipsia) that is relieved only by drinking large amounts of water; there is accompanying polyuria. Symptoms include irritability, weakness, lethargy, fever, headache, and seizures. Overproduction of antidiuretic hormone by the posterior pituitary gland results in a decrease in urine production and water intoxication and features weight gain, concentrated urine (increased specific gravity), nausea, and vomiting. As the hyponatremia grows more severe, coma or seizures occur from brain edema. Hyposecretion of somatotropin, or growth hormone, results in undergrowth; hypersecretion results in overgrowth.
Which results would indicate to the nurse the possibility that a neonate has congenital hypothyroidism? a) Low T4 level and high TSH level b) Normal TSH level and high T4 level c) Normal T4 level and low TSH level d) High thyroxine (T4) level and low thyroid stimulating hormone (TSH) level
Low T4 level and high TSH level Correct 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.
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) Glyburide b) Metformin c) Glipizide d) Nateglinide
Metformin Correct Explanation: Metformin, a biguanide reduces glucose production from the liver. Glipizide stimulates insulin secretion by increasing the response of β cells to glucose. Glyburide stimulates insulin secretion by increasing the response of β cells to glucose. Nateglinide stimulates insulin secretion by increasing the response of β cells to glucose.
The nurse is caring for a 13-year-old girl with delayed puberty. When developing the plan of care for this child, which of the following would be the priority? a) Encouraging the parents to discuss their concerns about the disorder b) Helping the child discuss her feelings about her condition c) Involving the child in her therapy to give her a sense of control d) Monitoring for therapeutic and side effects of medication
Monitoring for therapeutic and side effects of medication Explanation: The child will be receiving hormone supplementation; therefore, monitoring for therapeutic results and possible side effects of medications is key. The physiological effects of the medications take priority over the psychosocial needs of the family or the child. Encouraging the parents to discuss their concerns about the disorder, involving the child in her therapy to give her a sense of control, and helping the child discuss her feelings about her condition would also be included in the plan of care but they would be addressed later on.
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. Which of the following would support this suspicion? a) Observation reveals tetany. b) Slight exophthalmos is observed. c) Auscultation reveals an irregular heart rate. d) The child acts sleepy and unresponsive.
Observation reveals tetany. Explanation: 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 nurse is teaching a child with type 1 diabetes mellitus how to self-inject insulin. Which of the following methods should she recommend to the child for regular doses? a) Subcutaneously in the outer thigh b) Intradermally in the outer arm c) Intramuscularly in the abdomen d) Intravenously in the chest
Subcutaneously in the outer thigh Correct Explanation: Insulin is always injected SC except in emergencies, when half the required dose may be given IV. SC tissue injection sites used most frequently in children include those of the upper outer arms and the outer aspects of the thighs. The abdominal SC tissue injection sites commonly used in adults can be adequate sites but most children dislike this site as abdominal skin is tender.
A newborn is born with hypothyroidism. A complication of this disorder if it is not recognized and treated is a) cognitive impairment. b) blindness. c) dehydration. d) muscle spasticity.
cognitive impairment. Correct Explanation: Congenital hypothyroidism can lead to extreme cognitive challenge impairment if not treated.
In the salt-losing form of congenital adrenogenital hyperplasia, the most important observation you would make in a newborn would be for a) excessive cortisone secretion. b) dehydration. c) bleeding tendencies. d) hypoglycemia.
dehydration. Correct Explanation: With this form of the disorder, children are unable to produce aldosterone. This leads to the inability to retain sodium and fluid.
A school-aged girl is diagnosed as having Cushing's syndrome from long-term therapy with oral prednisone. This means that the child a) appears pale and fatigued. b) has hypoglycemia. c) has purple striae on her abdomen. d) is excessively tall for her age.
has purple striae on her abdomen. Correct Explanation: An effect of a corticosteroid is to produce striae on the abdomen. Elevated levels of corticosteroids also cause these during pregnancy.
A 7-year-old is diagnosed as having type 1 diabetes. One of the first symptoms usually noticed by parents when this illness develops is a) craving for sweets. b) loss of weight. c) severe itching. d) swelling of soft tissue.
loss of weight. Correct Explanation: Lack of insulin reduces the ability of body cells to use glucose; this leads to starvation of cells and loss of weight as an early symptom.
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? a) Monthly b) Weekly c) Bi-monthly d) Daily
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.
A 10-year-old boy has been diagnosed with type 1 diabetes mellitus. He is curious about what the cause of his disease is and asks the nurse to explain it to him. Which of the following should the nurse say to the boy? a) "Special cells in a part of your body called the pancreas can't make a chemical called insulin, which helps control the sugar level in your blood." b) "Special cells in a part of your body called the pancreas cannot produce enough of a chemical called insulin, so there is too much sugar in your blood." c) "Your body does not produce enough a chemical called 'ADH,' which makes you really thirsty and have to go to the bathroom a lot." d) "A small part of your brain called the pituitary does not make enough of a chemical called growth hormone."
"Special cells in a part of your body called the pancreas can't make a chemical called insulin, which helps control the sugar level in your blood." Explanation: Type 1 diabetes is a disorder that involves an absolute or relative deficiency of insulin in contrast to type 2 where insulin production is only reduced. Insulin is produced by beta islet cells in the pancreas. Diabetes insipidus is caused by the pituitary gland not producing enough ADH and is characterized by extreme thirstiness and polyuria. Insufficient growth hormone is also related to dysfunction of the pituitary gland.
The nurse is caring for a 14-year-old boy with hyperpituitarism. Which of the following would be the priority? a) Assessing the child's self-image due to the disorder b) Teaching the child and family about proper treatment c) Administering octreotide acetate as ordered d) Treating the child according to his chronological age
Administering octreotide acetate as ordered Explanation: Administering octreotide acetate as ordered is the priority intervention and treatment for acromegaly. Assessing the child's self-image is appropriate but would not be the priority Treating the child according to his chronological age would be appropriate but not the priority. Teaching the child and family about proper treatment is appropriate and important but not the immediate priority.
You care for a 10-year-old boy with growth hormone deficiency. Which therapy would you anticipate will be prescribed for him? a) Oral administration of somatotropin b) Short-term aldosterone provocation c) Intramuscular injections of growth hormone d) Long-term blocking of beta cells
Intramuscular injections of growth hormone Correct Explanation: Growth hormone deficiency occurs when the pituitary is unable to produce enough hormone for usual growth. Administering IM growth hormone supplements this.
The nurse is assessing an 8-year-old boy who is performing at the second-grade level, complains of feeling tired and weak, and is only 45 inches tall. Which of the following findings would be specific to hypothyroidism? a) The child complains that the exam room is cold. b) The mother reports that the boy is always thirsty. c) The child has gained 20 pounds in the past year. d) Observation shows only two of the 6-year molars.
The child complains that the exam room is cold. Correct 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. The dramatic weight gain could be due to hypothyroidism, Cushing syndrome, or syndrome of inappropriate antidiuretic hormone.
The nurse is caring for 1-month-old girl with thyrotoxicosis. Which of the following would the nurse expect to assess? a) The child is hypoactive and hypotonic. b) Skin is cool, dry, and scaly to the touch. c) Observation reveals lethargy and irritability. d) The child has a strong appetite but fails to thrive.
The child has a strong appetite but fails to thrive. Explanation: Infants with thyrotoxicosis may display hyperphagia but fail to gain weight. A combination of lethargy and irritability suggests congenital hypothyroidism. Cool, dry skin that is scaly to the touch suggests congenital hypothyroidism. Hypoactivity and hypotonicity are findings that suggest congenital hypothyroidism.
When discussing care of an infant with congenital hypothyroidism, you would stress that the infant will need a) administration of levothyroxine for a lifetime. b) administration of vitamin C until after growth is complete. c) vitamin K administration until school age. d) an increased intake of calcium beginning in infancy.
administration of levothyroxine for a lifetime. Correct Explanation: Hypothyroidism occurs because the thyroid is not producing adequate thyroxine. The child will need a supplemental source for a lifetime.
You teach a child with type 1 diabetes mellitus to administer her own insulin. She is receiving a combination of short-acting and long-acting insulin. You know that she has appropriately learned the technique when she a) wipes off the needle with an alcohol swab. b) administers the insulin intramuscularly into rotating sites. c) administers the insulin into a doll at a 30-degree angle. d) draws up the short-acting insulin into the syringe first.
draws up the short-acting insulin into the syringe first. Correct Explanation: 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.
Eve, 2 years old, and her parents are at the office for a follow-up visit. She has had excessive hormone levels in her recent blood work and her parents question why this was not found sooner. What is the best response of the nurse? a) "Have there been signs and symptoms that you should have reported to the doctor?" b) "As endocrine functions become more stable throughout childhood, alterations become more apparent." c) "Endocrine disorders are hard to detect and you are lucky that we have found it when we did." d) "It takes time to determine the level of functioning of endocrine glands."
"As endocrine functions become more stable throughout childhood, alterations become more apparent." Correct Explanation: 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 newborn exhibits significant jittery movements, convulsions, and apnea. Hypoparathyroidism is suspected. Which of the following would the nurse expect to be administered? a) Hydrocortisone b) Desmopressin c) Levothyroxine d) Calcium gluconate
Calcium gluconate Correct Explanation: Intravenous calcium gluconate is used to treat acute or severe tetany. Hydrocortisone is used to treat congenital adrenal hyperplasia and Addison disease. Desmopressin is used to control diabetes insipidus. Levothyroxine is a thyroid hormone replacement used to treat hypothyroidism.
A child with a history of diabetes insipidus is admitted with polyuria, polydipsia, and mental confusion. The priority intervention for this client is: a) Check vital signs b) Encourage increased fluid intake c) Measure urine output d) Weigh the client
Check vital signs Correct Explanation: The large amount of fluid loss can cause fluid and electrolyte imbalance that should be corrected; the loss of electrolytes would be reflected in vital signs. Urine output is important but not the priority. Encouraging fluids will not correct the problem and weighing the patient is not necessary at this time.
Hypothyroidism results from deficient production of thyroid hormone or a defect in the thyroid hormone receptor activity. Hypothyroidism caused during embryonic development of the gland is called: a) Autoimmune thyroiditis b) Congenital hypothyroidism c) Secondary hypothyroidism d) Acquired hypothyroidism
Congenital hypothyroidism Correct Explanation: Congenital hypothyroidism is most commonly caused by defective embryonic development of the gland. Acquired hypothyroidism usually refers to thyroid deficiency that becomes evident after a period of apparently normal thyroid function. The most common cause of acquired hypothyroidism in iodine-sufficient regions of the world is lymphocytic thyroiditis (also called Hashimoto's or autoimmune thyroiditis).
The nurse is caring for a child with diabetes mellitus type 1. The nurse notes that the child is drowsy, has flushed cheeks and red lips, a fruity smell to the breath, and there has been an increase in the rate and depth of the child's respirations. The nurse recognizes that these symptoms indicate the child has which of the following? a) Diabetic ketoacidosis b) Polyphagia c) Insulin reaction d) Cheyne stokes respiration
Diabetic ketoacidosis Correct Explanation: Diabetic ketoacidosis is characterized by drowsiness, dry skin, flushed cheeks and cherry-red lips, acetone breath with a fruity smell, and Kussmaul breathing (abnormal increase in the depth and rate of the respiratory movements).
Rank the different types of insulin based on their duration of action beginning with the shortest to the longest duration. Humulin R Lispro Humulin N Lantus
Lispro Humulin R Humulin N Lantus Correct Explanation: Lispro is a rapid-acting insulin. Humulin R is a short-acting insulin. Humulin N is an intermediate-acting insulin. Lantus is a long-acting insulin.
The nurse is caring for a child admitted to the emergency center in diabetic ketoacidosis. Which of the following clinical manifestations would the nurse most likely note in this child? a) Hyperactive and restless behavior b) Slow pulse and elevated blood pressure c) Red lips and fruity odor to breath d) Pale and moist skin
Red lips and fruity odor to breath Correct Explanation: Diabetic ketoacidosis is characterized by drowsiness, dry skin, flushed cheeks and cherry-red lips, acetone breath with a fruity smell, and Kussmaul breathing (abnormal increase in the depth and rate of the respiratory movements). Nausea and vomiting may occur. If untreated, the child lapses into coma and exhibits dehydration, electrolyte imbalance, rapid pulse, and subnormal temperature and blood pressure.
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? a) Hypersecretion of somatotropin b) Syndrome of inappropriate antidiuretic hormone c) Diabetes insipidus d) Hyposecretion of somatotropin
Syndrome of inappropriate antidiuretic hormone 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, or growth hormone, results in undergrowth; hypersecretion results in overgrowth.
A 15-year-old adolescent is scheduled for a pelvic ultrasound to evaluate for a possible ovarian cyst. Which instruction by the nurse would be most appropriate? a) "You need to remain very still for the entire test." b) "Limit your level of physical activity for one-half hour before the test." c) "You won't be able to drink any water before or during the test." d) "Drink plenty of fluids because you need to have a full bladder."
"Drink plenty of fluids because you need to have a full bladder." Explanation: A full bladder is needed for an ultrasound of the pelvic. The patient needs to remain still for a computed tomography or magnetic resonance imaging scan, not an ultrasound. Water is withheld during a water deprivation test used to detect diabetes insipidus. Limiting stress and physical activity for 30 minutes before the test is required for the growth hormone stimulation test.
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? a) "Increase the insulin dosage before planned or unplanned strenuous exercise." b) "Limit participation in planned exercise activities that involve competition." c) "Carry crackers or fruit to eat before or during periods of increased activity." d) "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." Correct Explanation: Hypoglycemia can usually be prevented if an adolescent with diabetes eats more food before or during exercise. Because exercise with adolescents isn't commonly planned, carrying additional carbohydrate foods is a good preventive measure.
You are going in to see a new patient in the clinic and the chief complaints for the patient are polyuria and polydipsia. You know that these are indicative of which endocrine disorder? a) Hypopituitarism b) Precocious puberty c) Diabetes insipidus d) Syndrome of inappropriate antidiuretic hormone secretion
Diabetes insipidus Correct Explanation: The most common symptoms of central DI are polyuria (excessive urination) and polydipsia (excessive thirst). Children with DI typically excrete 4 to 15 L per day of urine despite the fluid intake. The onset of these symptoms is usually sudden and abrupt. Ask about repeated trips to the bathroom, nocturia, and enuresis. Other symptoms may include dehydration, fever, weight loss, increased irritability, vomiting, constipation, and, potentially, hypovolemic shock.
In interpreting the negative feedback system that controls endocrine function, the nurse correlates how _______ secretion is decreased as blood glucose levels decrease. a) Glucagon b) Insulin c) Adrenocorticotropic hormone d) Glycogen
Insulin Correct Explanation: Feedback is seen in endocrine systems that regulate concentrations of blood components such as glucose. Glucose from the ingested lactose or sucrose is absorbed in the intestine and the level of glucose in blood rises. Elevation of blood glucose concentration stimulates endocrine cells in the pancreas to release insulin. Insulin has the major effect of facilitating entry of glucose into many cells of the body; as a result, blood glucose levels fall. When the level of blood glucose falls sufficiently, the stimulus for insulin release disappears and insulin is no longer secreted.
The nurse is teaching a 12-year-old girl with diabetes mellitus type 2 and her parents about dietary measures to control her glucose levels. Which comment by the child indicates a need for additional teaching? a) "I can eat two small cookies with each meal." b) "I can have an apple or orange for snacks." c) "We should give her nonfat milk to drink." d) "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.
After explaining the causes of hypothyroidism to the parents of a newly diagnosed infant, the nurse should recognize that further education is needed when the parents ask which question? a) "So, hypothyroidism can be treated by exposing our baby to a special light, right?" b) "Are you saying that hypothyroidism is caused by a problem in the way the thyroid gland develops?" c) "So, hypothyroidism can be only temporary, right?" d) "Do you mean that hypothyroidism may be caused by a problem in the way the body makes thyroxine?"
"So, hypothyroidism can be treated by exposing our baby to a special light, right?" Explanation: Congenital hypothyroidism can be permanent or transient and may result from a defective thyroid gland or an enzymatic defect in thyroxine synthesis. Only the last question, which refers to phototherapy for physiologic jaundice, indicates that the parents need more information.
The school nurse notes that a child diagnosed with diabetes mellitus is experiencing an insulin reaction and is unable to eat or drink. Which of the following actions would be the most appropriate for the school nurse to do? a) Request that someone call 911 b) Dissolve a piece of candy in the child's mouth c) Anticipate that the child will need intravenous glucose d) Administer subcutaneous glucagon
Administer subcutaneous glucagon Correct Explanation: If the child having an insulin reaction cannot take a sugar source orally, glucagon should be administered subcutaneously to bring about a prompt increase in the blood glucose level. This treatment prevents the long delay while waiting for a physician to administer IV glucose or for an ambulance to reach the child.
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? a) Body mass index as normal b) Darkened pigmentation around the neck area c) Short stature d) Decreased serum levels of free testosterone
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.
Which nursing objective is most important when working with neonates who are suspected of having congenital hypothyroidism? a) Promoting bonding b) Early identification c) Encouraging fluid intake d) Allowing rooming in
Early identification Correct 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 neonatal nurse caring for children with inborn errors of metabolism explains to the student nurse that prompt treatment is an essential intervention to successful management of the diseases. Which of the following is a recommended treatment for these conditions? a) Undergoing liver or bone marrow transplant to increase deficient enzymes b) Replacing deficient enzymes through intravenous administration c) Eliminating the deficient product from the child's diet d) Increasing substrates preceding the enzymatic block
Replacing deficient enzymes through intravenous administration Correct Explanation: Prompt treatment for metabolic disorders may include replacing deficient enzymes through intravenous administration. Other interventions are decreasing substrates preceding the enzymatic block (e.g., avoiding a particular amino acid or carbohydrate), administering a supplement of the deficient product that should have been produced, providing an enzymatic cofactor, using medications to remove accumulated substrates, undergoing liver or bone marrow transplantation to eliminate all deficient enzymes, and providing somatic gene therapy (a future option).
The nurse working with the child diagnosed with Type 2 Diabetes Mellitus recognizes that most often the disorder can be managed by which of the following? a) Increasing protein in the diet, especially in the evening b) Decreasing amounts of daily insulin c) Conserving energy with rest periods during the day d) Taking oral hypoglycemic agents
Taking oral hypoglycemic agents Correct Explanation: If the child presents with diabetic ketoacidosis, initial treatment is insulin administration, but then oral hypoglycemic agents such as metformin are often effective for controlling blood glucose levels. Lifestyle changes such as weight loss and increased exercise are important aspects of treatment for the child.
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. The nurse knows that which of the following is the most likely cause of this condition in this child? a) Tumor of the parathyroids b) Tumor of the adrenal cortex c) Tumor of the pancreas d) Tumor of the thyroid
Tumor of the adrenal cortex Explanation: Cushing syndrome is caused by overproduction of the adrenal hormone cortisol; this usually results from increased ACTH production due to either a pituitary or adrenal cortex tumor. The peak age of occurrence is 6 or 7 years. The overproduction of cortisol results in increased glucose production; this causes fat to accumulate on the cheeks, chin, and trunk, causing a moon-faced, stocky appearance. Cortisol is catabolic, so protein wasting also occurs. This leads to muscle wasting, making the extremities appear thin in contrast to the trunk, and loss of calcium in bones (osteoporosis). Yet other effects are hyperpigmentation (the child's face to be unusually red, especially the cheeks).
A 17-year-old is found after a high school football game wandering around. He is confused, sweaty, and pale. Which of the following tests is most likely to be performed first? a) Arterial blood gases b) Blood glucose level c) Blood cultures d) CT scan
Blood glucose level Correct Explanation: It is important to draw a blood glucose level on the child because he is exhibiting signs of hypoglycemia and he needs to be treated as soon as possible. Once the patient is stabilized, a complete health history will need to be taken to determine the extent of his illness.
Insulin deficiency, increased levels of counterregulatory hormones, and dehydration are the primary cause of which of the following: a) Ketone bodies b) Ketonuria c) Glucosuria d) Diabetic ketoacidosis
Diabetic ketoacidosis Correct Explanation: Insulin deficiency, in association with increased levels of counterregulatory 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. Glusosuria is glucose that is spilled into the urine.
The nurse is caring for a 3-year-old diagnosed with diabetes mellitus. The child's eating patterns are unpredictable. One day the child will eat almost nothing, the next day the child eats everything on her tray. The nurse recognizes that which of the following types of insulin would most likely be used in treating this child? a) Regular insulin b) Rapid-acting insulin c) Intermediate-acting insulin d) Long-acting insulin
Rapid-acting insulin Explanation: The introduction of rapid-acting insulin, such as lispro or humalog, has greatly changed insulin administration in children. The onset of action of rapid-acting insulin is less than 15 mi nutes. Rapid-acting insulin can even be used after a meal in children with un predic table eating habits. Regular, intermediate, and long-acting insulin all have a longer onset, peak, and duration than rapid acting insulin, and are more difficult to regulate in the child with unpredictable eating patterns.
