PEDs Chapter 48: Endocrine
A school-age child is seen in the family clinic. The parents ask the nurse if their child should start taking growth hormones to help the child grow because the parents are short. What is the best response by the nurse? "How tall would you like your child to be?" "Research shows that there must be a diagnosis of deficiency before growth hormones can be started at this age." "Growth hormones work only if the child has short bones." "Will your child be able to swallow oral pills every day?"
"Research shows that there must be a diagnosis of deficiency before growth hormones can be started at this age." Explanation: The nurse should educate the parents about growth hormones before asking questions. The nurse needs to explain that a diagnosis of deficiency must be documented before growth hormones can be used. Only the long bones are affected. Growth hormone is given orally, IM, and SC.
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? Explain the preparation for an 8-hour fasting blood glucose test. Discuss preparing for a thyroid function test. Explain why the child might need to schedule an eye exam. Prepare the parent for a neurology consult.
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 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. Continue medication to relieve the signs of Graves disease. Hold the dose and call the health care provider. Offer throat lozenges to soothe the throat.
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. The medication dose may need to be adjusted. Lozenges will not help this side effect. It is not appropriate to imply that a child may be making up symptoms to avoid school.
A group of nursing students are reviewing the components of the endocrine system. The students demonstrate understanding of the review when they identify what as the primary function of this system? Cellular metabolism Hormonal secretion Regulation of water balance Growth stimulation
Hormonal secretion Explanation: The endocrine system consists of various glands, tissues, or clusters of cells that produce and release hormones. Hormones are chemical messengers that stimulate and/or regulate the actions of other tissues, organs, or endocrine glands that have specific receptors to a hormone. Along with the nervous system, the endocrine milieu influences all physiologic effects such as growth and development, metabolic processes related to fluid and electrolyte balance and energy production, sexual maturation and reproduction, and the body's response to stress. The release patterns of the hormones vary, but the level in the body is maintained within specified limits to preserve health.
The nurse is obtaining a health history from parents whose 4-month-old boy has congenital hypothyroidism. What would the nurse most likely assess? The skin is pink and healthy looking. The child is active and playful. The child has above-normal growth for his age. It is difficult to keep the child awake.
It is difficult to keep the child awake. Explanation: During the health history, the parents may state that it is difficult to keep the child awake. Physical examination would reveal that the child is below weight and height, that his skin is pale and mottled, and that he is lethargic and irritable.
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: Pica Polydipsia Polyphagia Polyuria
Polyuria 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.
The nurse is caring for a child who is suspected to have a growth hormone deficiency. Which finding after further testing supports this diagnosis? Magnetic resonance imaging shows a brain tumor. The bone age is found to be two or more deviations below normal. Computed tomography identifies a tumor on the child's kidney. Physical examination finds excessive foot and finger growth for age.
The bone age is found to be two or more deviations below normal. Explanation: Diagnostic testing used in children with suspected growth hormone deficiency will indicate bone age to be two or more deviations below normal. The growth hormone is secreted by the pituitary gland not the kidney. Therefore, identification of a tumor on the kidney does not support growth hormone deficiency. Magnetic resonance imaging showing a brain tumor also does not support this diagnosis. Excess growth of the foot and fingers supports a diagnosis of growth hormone excess.
Which nursing objective is most important when working with neonates who are suspected of having congenital hypothyroidism? promoting bonding allowing rooming in early identification 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 child for signs of an endocrine disorder. Which statement by the parent would alert the nurse to further assess the child for an endocrine disorder? "My child tells me that his knees hurt at night, especially after running around all day." "My child's skin is red after a bath or shower." "My child says he has trouble seeing the print in the chapter books the teacher sends home." "I have all of a sudden noticed my child is always thirsty...even at night."
"I have all of a sudden noticed my child is always thirsty...even at night." Explanation: Polydipsia (extreme thirst) is a sign of diabetes mellitus, an endocrine disorder. The other statements by the parent would indicate musculoskeletal, vision, or integumentary disorders. The nurse would further assess for polyuria, weight loss and polyphagia.
The nurse is caring for a 7-year-old girl diagnosed with precocious puberty. The child is tearful when talking with the nurse about the signs and symptoms of the disorder. She states, "I don't look like my friends." When preparing the care plan for this child, which nursing diagnosis has the highest priority? Deficient knowledge Imbalanced nutrition Interrupted family process Disturbed body image
Disturbed body image Explanation: In precocious puberty, the child develops sexual characteristics before the usual age of pubertal onset. Disturbed body image would be the highest priority nursing diagnosis based on the child being tearful and the statement about not looking like her friends. Deficient knowledge about the disorder or treatment may apply, but is not the priority in this situation.
A newborn is discovered to have congenital adrenogenital hyperplasia. What will the nurse most likely observe when assessing this client? Enlarged clitoris Abnormal facial features Small for gestational age Divergent vision
Enlarged clitoris Explanation: Congenital adrenal hyperplasia is a syndrome that is inherited as an autosomal recessive trait, which causes the adrenal glands to not be able to synthesize cortisol. Because the adrenal gland is unable to produce cortisol, the level of adrenocorticotropic hormone (ACTH) secreted by the pituitary in an attempt to stimulate the gland to increase function is increased. Although the adrenals enlarge under the effect of ACTH, they still cannot produce cortisol but rather overproduce androgen. Excessive androgen production during intrauterine life masculinizes the genital organs in a female fetus so that the clitoris is so enlarged it appears to be a penis. This disorder does not cause divergent vision. The child will not be born small for gestational age. This disorder does not cause abnormal facial features.
