Peds PrepU Quizzes Ch. 26, PEDS Practice: Chapter 26 Nursing Care of the Child With an Alteration in Metabolism/Endocrine Disorder, Chapter 48, PEDS: Chapter 48 Nursing Care of a Family when a child has an Endocrine or a Metabolic Disorder Prep-U

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

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

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

Pubic hair and hirsutism

The nurse is teaching the mother of a child with phenylketonuria (PKU) about diet and realizes the mother needs further instruction when she makes which of the following statements?

"Lots of fish and meat will help him." Explanation: Patients with PKU need to avoid high-protein foods including meats, fish, poultry, eggs, cheese, milk, nuts, beans, peas, and flour. The food exchange list includes vegetables, fruits, breads, cereals, fats, and miscellaneous "free foods" allowed on the diet.

The nurse is taking a history on a 10-year-old child who has a diagnosis of hypopituitarism. Which question is important for the nurse to ask the parents?

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

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

Antidiuretic hormone (ADH) Central diabetes insipidus (DI), also called neurogenic, vasopressin-sensitive, or hypothalamic DI, is a disorder of the posterior pituitary that results from deficient secretion of ADH. Nephrogenic DI is a result of the inability of the kidney to respond to ADH.

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?

Administer subcutaneous glucagon. 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.

In a child with diabetes insipidus, which characteristic would most likely be present in the child's health history?

Abrupt onset of polyuria, nocturia, and polydipsia Diabetes insipidus is characterized by deficient secretion of antidiuretic hormone leading to diuresis. Most children with this disorder experience an abrupt onset of symptoms, including polyuria, nocturia, and polydipsia. The other choices reflect symptoms of pituitary hyperfunction.

In a child with diabetes insipidus, which characteristic would most likely be present in the child's health history?

Abrupt onset of polyuria, nocturia, and polydipsia Explanation: Diabetes insipidus is characterized by deficient secretion of antidiuretic hormone leading to diuresis. Most children with this disorder experience an abrupt onset of symptoms, including polyuria, nocturia, and polydipsia. The other choices reflect symptoms of pituitary hyperfunction

Administer subcutaneous glucagon 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.

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 bloodwork and her parents question why this was not found sooner. What is the best response of the nurse?

"As endocrine functions become more stable throughout childhood, alterations become more apparent. 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 young couple seeks pregnancy counseling in the women's health clinic. They tell the nurse performing a focused health history that they are of Jewish descent and are worried about conceiving a baby with Tay-Sachs disease. No known metabolic disorders exist in the family medical history. What is the nurse's best response to this couple's concerns?

"Carrier testing is warranted for couples who have an elevated risk for Tay-Sachs disease due to their ethnic origin." Explanation: Prevention, when it is possible, is the first intervention for metabolic disorders, such as Tay-Sachs. For some diseases such as Tay-Sachs disease, mild hyperphenylalaninemia, and Gaucher disease, carrier testing (heterozygote screening) is possible. Carrier testing is warranted for people who may have elevated risk because of their ethnic or national origin. The nurse has an important role in providing genetic counseling to families who are suspected or known carriers of a metabolic disorder.

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?

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

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?

"So, hypothyroidism can be treated by exposing our baby to a special light, right?" 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 nurse is speaking to the mother of an adolescent recently diagnosed with type 1 diabetes mellitus. The mother asks the nurse how her son's basketball training will affect his blood sugar. Which is the best response by the nurse?

"When exercising, your son should add an extra snack containing 15 to 30 g of carbohydrates for each 45 to 60 minutes of exercise. When exercising, monitor insulin dose and nutritional and fluid intake, and observe for hypoglycemic reactions. Add an extra snack containing 15 to 30 g carbohydrate for each 45 to 60 minutes of exercise. Avoid exercising excessively when insulin is peaking. While monitoring of blood sugar is needed during long periods of exercise, checking it every 15 minutes is not necessary. Children are encouraged to exercise, they do not need to wait 6 months to resume exercise.

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." 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

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." 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.

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

Which adolescents may have delayed puberty? Select all that apply:

14-year-old female who has not developed breasts 15-year-old male who has had no changes to the size of testicles Explanation: Delayed puberty in the female is indicated if she has not developed breasts by the age of 13; delayed puberty in the male is indicated if he has had no testicular enlargement by the age of 14. In females, pubic hair should appear before the age of 14. In males, pubic hair should appear before the age of 15 and scrotal changes by the age of 14.

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

When collecting data on a child diagnosed with diabetes mellitus, the nurse notes that the child has had weight loss and other symptoms of the disease. The nurse would anticipate which finding in the child's fasting glucose levels?

180 mg/dL Explanation: A fasting glucose greater than or equal to 126 mg/dL or higher on two separate occasions is diagnostic for diabetes when other signs such as polyuria and weight loss, despite polyphagia, are present.

A nurse is educating the family of a small child with phenylketonuria about meal choices. Which of the following meal choices by the parents indicate to the nurse that they understand the dietary management of this disease?

A bowl of dry cereal with strawberries and apple juice Explanation: Foods low in phenylalanine include vegetables, fruits, juices, some breads, and some cereals. Steak and aspartame are high in phenylalanine and should be avoided. Hamburger may have high phenylalanine levels. Dairy products are high in phenylalanine and should be avoided. Mashed potatoes, if made from scratch, and orange juice are acceptable foods.

The nurse is providing acute care for an 11-year-old boy with hypoparathyroidism. Which intervention is priority?

Administering intravenous calcium gluconate as ordered Explanation: Administering intravenous calcium gluconate, as ordered, will restore normal calcium and phosphate levels as well as relieve severe tetany. Ensuring patency of the IV site to prevent tissue damage due to extravasation or cardiac arrhythmias is an intervention for any child with an IV, and monitoring fluid intake and urinary calcium output are secondary interventions. Providing administration of calcium and vitamin D is an intervention for nonacute symptoms.

The nurse is caring for a newborn with 21-OH enzyme deficiency congenital adrenal hyperplasia (CAH). The nurse identifies one goal of the plan of care as being the understanding of the importance of maintaining hormone supplementation. What outcome criteria demonstrates this goal has been met?

During follow-up visits the child demonstrates normal growth and development

The nurse is providing acute care for an 11-year-old boy with hypoparathyroidism. Which intervention is priority?

Administering intravenous calcium gluconate as ordered Administering intravenous calcium gluconate, as ordered, will restore normal calcium and phosphate levels as well as relieve severe tetany. Ensuring patency of the IV site to prevent tissue damage due to extravasation or cardiac arrhythmias is an intervention for any child with an IV, and monitoring fluid intake and urinary calcium output are secondary interventions. Providing administration of calcium and vitamin D is an intervention for nonacute symptoms.

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 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 complete blood cell count and erythrocyte sedimentation rate test are not used for this purpose.

The nurse is caring for a child being evaluated for diabetes insipidus. Which tests will likely be included in the diagnostic workup for this condition? Select all that apply.

CT scan skull MRI of kidney region Urinalysis Diabetes insipidus is an endocrine disorder characterized by excessive thirst, fluid intake and urinary output. Diagnostic testing will include radiographic studies such as a CT scan and MRI of the skull and kidneys. A urinalysis is performed to review urine specific gravity. Diagnostic testing for diabetes mellitus will include a hemoglobin A1C and fasting serum glucose levels

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 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 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 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.

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

Rank the different types of insulin based on their duration of action beginning with the shortest to the longest duration.

Lispro Humulin R Humulin N Lantus

A pediatric client has just been diagnosed with diabetes insipidus. What is the primary consideration for this client?

fluid replacement Explanation: Children with diabetes insipidus lose tremendous amounts of fluid, so fluid replacement is the priority consideration for this client. Excessive fluid loss can lead to seizures and death. Headache and polydipsia can be relieved with fluid replacement. Children will requirement a nutritional consultation for weight loss, but it is not the main consideration.

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

graves

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

diabetic ketoacidosis.

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

Pubic hair and hirsutism Pubic hair and hirsutism in a preschooler indicates congenital adrenal hyperplasia. Irregular heartbeat on auscultation and pain due to constipation on palpation may be signs of hyperparathyroidism. Hyperpigmentation of the skin suggests Addison disease

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 this type of insulin would most likely be used in treating this child?

Rapid-acting insulin Explanation: The introduction of rapid-acting insulin, such as lispro, has greatly changed insulin administration in children. The onset of action of rapid-acting insulin is less than 15 minutes. Rapid-acting insulin can even be used after a meal in children with unpredictable 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.

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 Explanation: Insulin for diabetic ketoacidosis is given intravenously. Only regular insulin can be administered by this route.

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

Polydipsia Polyphagia Polyuria

The nurse is interviewing the caregivers of a child admitted with a diagnosis of type 1 diabetes mellitus. The caregiver states, "She is hungry all the time and eats everything, but she is losing weight." The caregiver's statement indicates the child most likely has:

Polyphagia

The nurse is administering biosynthetic GH, derived from recombinant DNA, by subcutaneous injection. The weekly dosage is 0.2 to 0.3 mg/kg, given in divided doses daily. The child weighs 110 pounds. What is the safe dosage limit for this child on a weekly basis?

15 110 lb divided by 2.2 kg = 50 kg 50 kg X 0.2 mg = 10 mg 50 kg X 0.3 mg= 15 mg The lack of GH impairs the body's ability to metabolize protein, fat, and carbohydrates. Treatment of primary GH deficiency involves the use of supplemental GH. Treatment continues until near final height goal is achieved.

180 mg/dL A fasting glucose greater than or equal to 126 mg/dL or higher on two separate occassions diagnostic for diabetes when other signs such as polyuria and weight loss, despite polyphagia, are present.

Kate and her parents are being seen in the office after discharge from the hospital with a new diagnosis of type 2 diabetes. Which statement by the nurse is true?

"Kids can usually be managed with an oral agent, meal planning, and exercise." 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 health care. 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.

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

Antidiuretic hormone

A 10-year-old boy is upset and reports he is the shortest boy in his class. He reports he is done with school and wants to just stay at home. When reviewing the plan of care, which nursing diagnosis would be most appropriate for this concern?

Disturbed body image All of the listed nursing diagnoses may be appropriate for a child experiencing a growth hormone deficiency. The child is voicing feelings of personal devaluation. This is consistent with a lack of self-esteem making a disturbed body image the greatest concern in this scenario.

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?

Graves disease Explanation: Children who develop Graves disease experience nervousness, tremors, and increased heart rate and blood pressure cause by overstimulation of the thyroid gland. Cushing's syndrome, hypertension, and hypothryoidism are not associated with these symptoms.

A 12-year-old is being seen in the office and has hyperthyroidism; the nurse knows that the most common cause of hyperthyroidism is:

Graves disease 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 is preparing the care plan regarding medication therapy for a client with hyperpituitarism. The child is receiving Decadron (dexamethasone). What interventions should the nurse add to the care plan? Select all that apply.

Monitor client for edema Monitor client for high glucose levels Do not abruptly stop administering medication Decadron (dexamethasone) is a coritcosteroid drug. Adverse effects that the nurse must be alert to include edema, weight gain, glycosuria, signs of infection, and symptoms of peptic ulcer development. Giving the drug with food or milk helps decrease the chance of peptic ulcer disease and stomach upset. If corticosteroids are stopped abruptly, adrenal crisis can occur.

The 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 This child may have syndrome of inappropriate antidiuretic hormone (SIADH). Priority intervention for this child is to notify the physician of the neurologic findings. Remaining interventions will be to restore fluid balance with IV sodium chloride to correct hyponatremia, set up safety precautions to prevent injury due to altered level of consciousness, and monitor fluid intake, urine volume, and specific gravity.

A nurse educating a 13-year-old adolescent with diabetes mellitus about how to self-monitor and control the disease. Which of the following statements by the nurse would promote a healthy way to self-control the disease?

"Check your glucose level twice a day and the glycosylated hemoglobin every 3 months." Explanation: It is important to check glucose levels twice a day to check for high or low results. The glycosylated hemoglobin shows how well the disease is controlled over the long term. Checking it 2 to 4 times a year is sufficient. Urine glucose is not reliable for checking blood glucose levels. It is only tested in times of illness or if levels are very high. The choice of not checking glucose levels puts the patient at risk.

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

"You will not need medication because your hormone levels are normal. I would be glad to discuss these findings with you." Explanation: This diagnosis of "short stature" or constitutional delay may cause self-esteem issues with male teens. The nurse should explore the teen's feelings. Teens with a delay in puberty usually experience puberty late, so there is no need for a second opinion. Hormone therapy is not given until after age 14.

180 mg/dl

As a nurse, you know that which condition is caused by excessive levels of circulating cortisol:

Cushing syndrome Cushing syndrome 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. Graves disease is the most common form of hyperthyroidism. Turner syndrome is deletion of the entire X chromosome.

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

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

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

Oral calcium

A newborn girl is discovered to have congenital adrenal hyperplasia. When assessing her, the nurse would expect to find which physical characteristic?

Enlarged clitoris Lack of production of cortisol by the adrenal gland leads to overproduction of androgen. This leads to female infants developing an enlarged clitoris.

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

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

A 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?

"Drink plenty of fluids because you need to have a full bladder." A full bladder is needed for an ultrasound of the pelvic region. The client 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.

The nurse is speaking with the parents of a school-aged child recently diagnosed with diabetes mellitus 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." 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.

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?

"My child only took half of their 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." Explanation: No insulin or oral diabetic medications should be taken prior to the test. An oral glucose, not an IV solution, is administered. Oral glucose is ingested and in a healthy child insulin will respond and return blood glucose to normal levels; it does not test for infections. Blood samples are drawn prior to ingestion of the glucose solution and at intervals after.

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."

"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. These instructions should be reviewed with parents upon discharge. The question includes information about Graves' disease, so ibuprofen would not be the treatment. The question centers around drug therapy, not the child's fluid status.

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

"We will want to inspect the nares of our child to be sure the medication is not irritating the tissue." "We will need to adjust the dose based on how much our child is urinating." "I am going to have to carry a cooler with me if I am going to be gone all day or if I go on a long hike." Explanation: The nares should be inspected because this medication is administered via the intranasal route, and the dose is adjusted based on the client's output. The medication must be kept refrigerated so appropriate planning is necessary if the child is not going to be home. This medication is a synthetic antidiuretic hormone for the treatment of diabetes insipidus (which causes production of excessive amounts of urine), which is not related to diabetes mellitus. The medication is titrated to the amount of urine output.

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

Diabetes insipidus

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

Diabetes insipidus

A child is prescribed glargine (Lantus) insulin. What information would the nurse include when teaching the child and parents about this insulin?

Do not mix this insulin with other insulins. Explanation: Glargine (Lantus) is not to be 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.

A child is prescribed glargine (Lantus) insulin. What information would the nurse include when teaching the child and parents about this insulin?

Do not mix this insulin with other insulins. Glargine (Lantus) is not to be 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.

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?

Enlarged tongue Observation of an enlarged tongue along with an enlarged posterior fontanel and feeding difficulties are key findings for congenital hypothyroidism. The mother would report constipation rather than diarrhea. Auscultation would reveal bradycardia rather than tachycardia, and palpation would reveal cool, dry, and scaly skin.

A child is admitted to the pediatric medical unit with the diagnosis of syndrome of inappropriate antidiuretic hormone (SIADH). Based on the typical signs and symptoms of this disorder, which nursing diagnosis will the nurse identify as relating to this client?

Excess fluid volume Syndrome of inappropriate antidiuretic hormone (SIADH) occurs when 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, Excess fluid volume from edema is the highest priority.

What should be included in the teaching plan for a child with type 1 diabetes mellitus who is going home on insulin therapy?

It is absolutely normal for the growing child to require an increase in insulin; this does not mean his/her condition is getting worse. Explanation: Children show a decreased need for insulin shortly after glucose control has been established, which is referred to by some as the "honeymoon phase" and should be described to parents so that they do not get any false hope that the child does not need insulin. As children grow, they will require increased doses of insulin to maintain glucose control, and not all children need to receive two types of insulin. Insulin treatment should be based on each individual child.

Rank the different types of insulin based on their duration of action beginning with the shortest to the longest duration.

Lispro Humulin R Humulin N Lantus 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.

A child with a suspected endocrine disorder is having a fluid deprivation study performed. Which nursing interventions should be included in the plan of care? Select all that apply.

Monitor strict I & O. Assess vital signs every hour. Obtain urine specimens and serum studies as ordered. Explanation: Strict I & O must be monitored to prevent dehydration. Vital signs, especially blood pressure and pulse, should be monitored hourly to detect signs of hypotension or tachycardia. During the tests, urine is monitored for specific gravity and osmolality and serum studies are performed to monitor for sodium, antidiuretic hormone, osmolality, and hematocrit alterations as ordered. A fluid deprivation study should not be performed overnight because it can cause severe dehydration and result in central nervous system damage. The child's weight should be monitored more frequently than on admission and discharge to detect weight loss that may signify too much fluid loss.

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?

Monitoring blood glucose levels 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.

The nurse is assessing a 13-year-old boy with type 2 diabetes mellitus. What would the nurse correlate with disorder?

The parents report that their son "can't drink enough water." Explanation: Unquenchable thirst (polydipsia) is a common finding associated with diabetes mellitus, type 1 and 2. However, reports of flu-like illness and Kussmaul breathing are more commonly associated with type 1 diabetes. Blood pressure is normal with type 1 diabetes and elevated with type 2 diabetes.

A 6-year-old boy has a moon-faced, stocky appearance but with thin arms and legs. His cheeks are unusually ruddy. He is diagnosed with Cushing syndrome. What is the most likely cause of this condition in this child?

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

Type 1 diabetes mellitus

The nurse is providing education to a 10-year-old child and her parents about the CT scan that has been ordered for the following day. What information should be included in the teaching provided? Select all that apply.

You will need to lie very still during the test. This test will let us look inside at your tissues and organs. Explanation: The CT (computed tomography) test is used to look at tissue density and structures. It is able to identify the presence of tumors, cysts and other abnormalities. The test will require the client to lie still. If this is not possible, the client may require sedation. The machine does not make loud noises such as clicks and thumps. There is no need to drink large quantities of water prior to the test.

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

growth hormone

In interpreting the negative feedback system that controls endocrine function, the nurse correlates how _______ secretion is decreased as blood glucose levels decrease.

insulin 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.

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:

loss of weight. 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.

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

"He measures his own medication but we watch closely to make sure he gets the correct amount so he doesn't have an insulin reaction." Explanation: Insulin reaction (insulin shock, hypoglycemia) is caused by insulin overload, resulting in too-rapid metabolism of the body's glucose. This may be attributable to a change in the body's requirement, carelessness in diet (such as failure to eat proper amounts of food), an error in insulin measurement, or excessive exercise.

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

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

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?

"I can eat two small cookies with each meal." 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 Synthroid (levothyroxine) "whenever I think about it...sometimes I miss a dose, but not very often." What is the best response by the nurse?

"I know it's hard to remember medicines, but it is really important for you to take it before breakfast each day to control your hypothyroidism."

The physician has ordered routine hemoglobin A1C levels for a teenager with diabetes. Following teaching about the test by the nurse, the client and family demonstrate the need for further instruction with which statements? Select all that apply.

"I will be sure to not eat or drink anything the night before I get my blood drawn for the test." "I can check this level myself using a blood glucose monitor." "We will need to make sure our child gets this lab test at least every 6 months to ensure the diabetes is under control." Explanation: Hemoglobin A1C levels provides the physician or nurse practitioner with information regarding the long-term control of glucose levels so fasting is not necessary. The test indicates the level of blood glucose over a 2- to 3-month period, so it should be performed about every 3 months. Daily blood glucose monitoring can be performed by the client with the use of a finger stick and glucose meter. The physician should be informed of high stress levels as this can increase blood glucose levels.

Kate and her parents are being seen in the office after discharge from the hospital with a new diagnosis of type 2 diabetes. Which statement by the nurse is true?

"Kids can usually be managed with an oral agent, meal planning, and exercise." 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 health care. 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.

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. What should the nurse say to the boy?

"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." 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.

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

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

The nurse is taking a history on a 10-year-old child who has a diagnosis of hypopituitarism. Which question is important for the nurse to ask the parents?

"What time each day does your child take his growth hormone?" Explanation: Growth hormone is the common treatment for the child with hypopituitarism who is short, not tall, in stature. Vasopressin is the treatment for diabetes insipidus. Monitoring blood glucose is not part of the treatment for hypopituitarism.

A 12-year-old boy arrives at the emergency room experiencing nausea, vomiting, headache, and seizures. He is diagnosed with bacterial meningitis. Other findings include a decrease in urine production, hyponatremia, and water intoxication. Which pituitary gland disorder would be most associated with these symptoms?

Syndrome of inappropriate antidiuretic hormone

A nurse is educating a family about the Chvostek sign after their teen tested positive for Chvostek sign. Which statements by the caregivers shows the nurse that they understand the Chvostek sign?

"When I tap on my child's facial nerve, the reaction is a facial muscle spasm." Explanation: The Chvostek sign is a facial muscle spasm that occurs when the facial nerve is tapped. This can indicate heightened neuromuscular activity, possibly caused by hypocalcemia. Hypoparathyroidism may be suspected.

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

As a nurse, you know that which condition is caused by excessive levels of circulating cortisol:

Cushing syndrome Explanation: Cushing syndrome 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. Graves disease is the most common form of hyperthyroidism. Turner syndrome is deletion of the entire X chromosome.

Darkened pigmentation around the neck area 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.

A 4-year-old diagnosed with diabetes insipidus is being discharged. Which information below is most important to emphasize to the parents?

Diabetes insipidus is different from diabetes mellitus. Explanation: Having all caregivers trained in injections ensures that medication will be given and the need to give it to the child will be understood. All children should wear a medical alert tag upon diagnosis. For the caregiver to have a good understanding and provide good management of the child's care, the difference between diabetes insipidus and diabetes mellitus must be established. This is a rare disorder that needs to be closely managed throughout the child's life, and it is not curable.

The nurse suspects that a 4-year-old with type 1 diabetes is experiencing hypoglycemia based on what findings? Select all that apply.

Diaphoresis Slurred speech Tachycardia Explanation: Manifestations of hypoglycemia include behavioral changes, confusion, slurred speech, belligerence, diaphoresis, tremors, palpitation, and tachycardia. Blurred vision; dry, flushed skin; and fruity breath odor suggest hyperglycemia.

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?

Drowziness and fruity odor to breath Explanation: Diabetic ketoacidosis is characterized by drowsiness, decreased skin turgor, 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 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?

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.

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

Enlarged clitoris

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

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

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. 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 7-year-old child who has type 1 diabetes mellitus is at school reporting a headache and dizziness. The school nurse notices sweat on the child's face. What should the nurse do first?

Offer the child 8 ounces of juice or soda

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

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

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

Precocious puberty

The nurse is preparing a child suspected of having a thyroid disorder for a thyroid scan. What information regarding the child should the nurse alert the doctor or nuclear medicine department about?

The child is allergic to shellfish

Tumor of the adrenal cortex

Tumor of the adrenal cortex 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).

What finding would the nurse expect to assess in a child with hypothyroidism?

Weight gain Explanation: Hypothyroidism is manifested by weight gain, fatigue, cold intolerance, and dry skin. Nervousness, heat intolerance, and smooth velvety skin are associated with hyperthyroidism.

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

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

A child with a history of diabetes insipidus is admitted with polyuria, polydipsia, and mental confusion. The priority intervention for this client is to:

check vital signs. 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 client is not necessary at this time.

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. The nurse knows that the possible prognosis is:

precocious puberty. 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.

"I will be sure to not eat or drink anything the night before I get my blood drawn for the test." "I can check this level myself using a blood glucose monitor." "We will need to make sure our child gets this lab test at least every 6 months to ensure the diabetes is under control." Hemoglobin A1C levels provides the physician or nurse practitioner with information regarding the long-term control of glucose levels so fasting is not necessary. The test indicates the level of blood glucose over a 2- to 3-month period, so it should be performed about every 3 months. Daily blood glucose monitoring can be performed by the client with the use of a finger stick and glucose meter. The physician should be informed of high stress levels as this can increase blood glucose levels.

The nurse is providing client education to an adolescent newly diagnosed with type 1 diabetes mellitus. Which statement by the adolescent indicates that the nurse's teaching has been effective?

"If I take my insulin, I can eat any kind of carbohydrate I want." Explanation: Insulin doses in type 1 diabetes mellitus are based on blood glucose levels and carbohydrates to be eaten, so it is true that a carbohydrate could be any carbohydrate. Snacks should always be consumed before exercise, not afterward. A child with or without diabetes mellitus should have the same nutritional needs. Weight loss usually occurs before the diagnosis of type 1 diabetes mellitus. Clients with type 2 diabetes mellitus must manage weight loss.

The nursing is caring for a child recently admitted with an endocrine disorder. The child's mother asks the nurse what the term metabolism means. Which is the best response by the nurse?

"Metabolism refers to all physical and chemical reactions occurring in the body's cells that are necessary to sustain life."

The nursing is caring for a child recently admitted with an endocrine disorder. The child's mother asks the nurse what the term metabolism means. Which is the best response by the nurse?

"Metabolism refers to all physical and chemical reactions occurring in the body's cells that are necessary to sustain life." Metabolism refers to all physical and chemical reactions occurring in the body's cells that are necessary to sustain life.

"My child only took half of their 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." No insulin or oral diabetic medications should be taken prior to the test. An oral glucose, not an IV solution, is administered. Oral glucose is ingested and in a healthy child insulin will respond and return blood glucose to normal levels; it does not test for infections. Blood samples are drawn prior to ingestion of the glucose solution and at intervals after.

A 9-year-old girl is being evaluated for precocious puberty. What information from the child's mother is consistent with this condition? Select all that apply.

"My daughter talks about having headaches all the time." "The teachers at school say she is moody." "Sometimes at home my daughter gets aggressive with her younger siblings." "My older daughter started her period when she was only 10 years old." Central precocious puberty, the most common form, develops as a result of premature activation of the hypothalamic-pituitary-gonadal axis that results in the production of gonadotropin-releasing hormone (GnRH), which stimulates the pituitary to produce luteinizing hormone (LH) and follicle-stimulating hormone (FSH). These hormones in turn stimulate the gonads to secrete the sex hormones (estrogen or testosterone). The child develops sexual characteristics, shows increased growth and skeletal maturation, and has reproductive capability. The health history may reveal complaints of headaches, nausea, vomiting, and visual difficulties due to the circulating hormones. The psychosocial development is typical for the child's age, but the child may show emotional lability, aggressive behavior, and mood swings. There may also be a family history of early puberty. This would be evidenced in an older sibling who experienced menarche earlier than normal. Playing with dolls is normal for a 9-year-old girl.

A newborn has just been diagnosed with phenylketonuria (PKU). The physician and nurse have taught the parents about the defect. What statement by the parents demonstrates a need for further instruction?

"Nothing can be done medically to manage this condition." Explanation: Untreated PKU can result in severe damage to the central nervous system. With dietary treatment, the prognosis is good, which is what needs to be reinforced to the parents. Appropriate intervention can prevent irreparable damage. The other statements are true concerning the disease.

The nurse is caring for a child being evaluated for diabetes insipidus. Which tests will likely be included in the diagnostic workup for this condition? Select all that apply.

CT scan skull MRI of kidney region Urinalysis Explanation: Diabetes insipidus is an endocrine disorder characterized by excessive thirst, fluid intake and urinary output. Diagnostic testing will include radiographic studies such as a CT scan and MRI of the skull and kidneys. A urinalysis is performed to review urine specific gravity. Diagnostic testing for diabetes mellitus will include a hemoglobin A1C and fasting serum glucose levels.

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 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.

Antidiuretic hormone 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 newborn exhibits significant jittery movements, convulsions, and apnea. Hypoparathyroidism is suspected. What would the nurse expect to be administered?

Calcium gluconate 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 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 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.

The nurse is developing a plan of care for a 7-year-old boy with diabetes insipidus. What is the priority nursing diagnosis

Deficient fluid volume related to dehydration Explanation: The priority nursing diagnosis most likely would be deficient fluid volume related to dehydration, due to a deficiency in the secretion of antidiuretic hormone (ADH). Excess fluid would result from a disorder that leads to water retention, such as syndrome of inappropriate antidiuretic hormone (SIADH). Deficient knowledge related to fluid intake regimen is a nursing diagnosis for this child, but a secondary one. Imbalanced nutrition, more than body requirements related to excess weight would be inappropriate for this child since he probably has lost weight secondary to the fluid loss.

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?

The parents of a child with congenital adrenal hyperplasia bring the child to the emergency department for evaluation because the child has had persistent vomiting. What finding would lead the nurse to suspect that the child is experiencing an acute adrenal crisis?

Hyperkalemia Explanation: Signs and symptoms of an acute adrenal crisis include hyperkalemia, hyponatremia, tachycardia, hypotension, persistent vomiting, dehydration, and shock.

During follow-up visits the child demonstrates normal growth and deveopment 21-OH enzyme deficiency results in blocking the production of adrenal mineralocorticoids and glucocorticoids. Nursing management of the infant or child with CAH focuses on preventing and monitoring for acute adrenal crisis, helping the family to understand the disease, providing education to the child and family about the importance of maintaining hormone supplementation, and providing emotional support to the family. Improvement of symptoms, such as normal growth and development, is the best indicator that the goal of hormone replacement therapy is being carried out as ordered.

Which nursing objective is most important when working with neonates who are suspected of having congenital hypothyroidism?

Early identification 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 taking a history on a 10-year-old child who has a diagnosis of hypopituitarism. Which question is important for the nurse to ask the parents

Explanation: Growth hormone is the common treatment for the child with hypopituitarism who is short, not tall, in stature. Vasopressin is the treatment for diabetes insipidus. Monitoring blood glucose is not part of the treatment for hypopituitarism.

Tay-Sachs disease is found primarily in the Asian population.

False Explanation: Tay-Sachs disease is found primarily in the Ashkenazi Jewish population (Eastern European Jewish ancestry).

The nurse performing neonatal screenings knows that the cardiovascular system is the system most commonly affected by a metabolic disorder.

False Explanation: The nervous system is most consistently affected by metabolic disorders. The physical examination should focus on evaluating neurodevelopmental functions. Abnormalities commonly revealed include impaired states of alertness and arousal, tremors, posturing, clonic jerking, tonic spasms, or seizures.

A nurse is preparing to discharge Josephine, a neonate diagnosed with maple syrup urine disease. Which one of the following is recommended teaching for home care of Josephine?

Focus on reinforcing the need for the prescribed lifelong dietary regimen. Explanation: Family education goals should focus on reinforcing the need for the prescribed dietary regimen, the importance of follow-up appointments, and sick-day management. As the child grows, the frequency and severity of crisis events decrease, but lifelong dietary management is required. When the child is ill, protein intake should be reduced, and caloric intake should be increased from 80 to 120 kcal/kg per day to 120 to 140 kcal/kg per day by encouraging consumption of carbohydrate- and fat-containing foods (Strauss, Puffenberger and Morton, 2006).

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

Fruity breath odor Decreased level of consciousness Poor skin turgor

A child with diabetes reports that he is feeling a little shaky. Further assessment reveals that the child is coherent but with some slight tremors and sweating. A fingerstick blood glucose level is 70 mg/dL. What would the nurse do next?

Give 10 to 15 grams of a simple carbohydrate. Explanation: The child is experiencing hypoglycemia as evidenced by the assessment findings and blood glucose level. Since the child is coherent, offering the child 10 to 15 grams of a simple carbohydrate would be appropriate. Insulin is not used because the child is hypoglycemic. A complex carbohydrate snack would be used after offering the simple carbohydrate to maintain the glucose level. Intramuscular glucagons would be used if the child was not coherent.

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 the nurse suggest the mother carry out before she brings the child to see her doctor?

Give her a glass of orange juice. These are typical symptoms of hypoglycemia. Administering a form of glucose would help relieve them. Insulin cannot be absorbed when taken orally.

A 12-year-old is being seen in the office and has hyperthyroidism; the nurse knows that the most common cause of hyperthyroidism is:

Graves disease 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?

Growth hormone 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.

Growth hormone 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.

A boy is brought into the emergency room, and the preliminary diagnosis is acute adrenocortical insufficiency. Which of the interventions below should the nurse implement first?

Insert an IV line in preparation for giving IV fluids and cortisol. Explanation: In acute adrenocortical insufficiency, immediate care consists of IV fluid and cortisol to restore blood pressure, blood glucose, and sodium. The child will also need to be closely monitored for vital signs and neurologic checks. Once the child is stabilized, he or she may be admitted to an intensive care unit for close monitoring. The recovery time for this crisis is rapid; if treated properly, it is likely the child will recover within 24 hours.

A child is diagnosed with hyperthyroidism. What finding would the nurse expect to assess?

Heat intolerance 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.

A child is diagnosed with hyperthyroidism. What finding would the nurse expect to assess?

Heat intolerance 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.

The nurse caring for a female adolescent with polycystic ovary syndrom (PCOS) identifies "Disturbed body image related to signs and symptoms of the disease" as a nursing diagnosis that applies to this client. What signs and symptoms would support this nursing diagnosis?

Hirsutism Balding of hair on head Increased muscle mass Acne Hirsutism results in excessive amounts of stiff and pigmented hair on body areas where men typically grow hair, such as the face, chest and back. All of the symptoms listed except cysts would support the nursing diagnosis. The cysts themselves don't support the nursing diagnosis as they are not visible.

A nurse caring for a child with Grave's 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?

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.

In teaching the parents of an infant diagnosed with diabetes insipidus, the nurse should include which treatment?

Hormone replacement 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 adrenal hyperplasia with a child's parents, you would advise them that administration of which drug will probably be indicated?

Hydrocortisone The basic defect in congenital adrenal hyperplasia is the lack of cortisol. Administering hydrocortisone supplements this.

A 6-year-old girl visits the pediatrician with symptoms of excessive thirst, frequent voiding, weakness, lethargy, and headache. The nurse suspects diabetes insipidus. Which hormonal condition is characteristic of this disease

Hyposecretion of antidiuretic hormone 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.

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 hormonal condition is characteristic of this disease?

Hyposecretion of antidiuretic hormone 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.

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

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

A 12-year-old girl is diagnosed with hyperthyroidism. What problem would the nurse anticipate she may have in school?

Inability to submit neat handwriting assignments Children with hyperthyroidism may develop hand tremors, which leads to poor handwriting.

The student nurse is reviewing the medical record of a child with diabetes insipidus. What information found provides support for diagnosis? Select all that apply.

Increased urination Dehydration Decreased urine osmolality Explanation: Symptoms of diabetes insipidus (DI) include increased urination, hypernatremia, decreased urine osmolality, dehydration and thirst. Hyponatremia, fluid retention, weight gain and hypertension are symptoms of syndrome of inappropriate antidiuretic hormone (SIADH).

You care for a 10-year-old boy with growth hormone deficiency. Which therapy would you anticipate will be prescribed for him?

Injections of growth hormone Growth hormone deficiency occurs when the pituitary is unable to produce enough hormone for usual growth. Administering subcutaneous growth hormone supplements this

The caregivers of a child just diagnosed with diabetes express concern that they won't remember the different signs and symptoms of hyperglycemia and hypoglycemia. As a result, they are afraid they won't handle an emergency correctly. The best initial response by the nurse would be to:

Instruct them to treat the reaction as if it's hypoglycemia, which is more likely. Hypoglycemia is much more likely to occur than hyperglycemia; so if there is any doubt as to whether the child is having a hypoglycemic or hyperglycemic reaction, it should be treated as hypoglycemia. While the pump may offer continuous insulin, it does not sense blood glucose level; insulin reactions can still occur. Careful monitoring of blood glucose is still needed. While repeating signs and symptoms may be helpful, caregivers of a recently diagnosed child have lots of information to absorb and the repetition may create more anxiety. Assuming that the caregivers can read and understand them, written materials and videos may be helpful but they should not take the place of an initial teaching session with a nurse.

The nurse is teaching an 11-year-old boy and his family how to manage his diabetes. Which instruction does not focus on glucose management?

Instructing the child to rotate injection sites Instructing child to rotate injection sites to decrease scar formation is important, but does not focus on managing glucose levels. Teaching the child and family to eat a balanced diet, encouraging the child to maintain the proper injection schedule, and promoting a higher level of exercise all focus on regulating glucose control.

The nurse is teaching an 11-year-old boy and his family how to manage his diabetes. Which instruction does not focus on glucose management?

Instructing the child to rotate injection sites Explanation: Instructing child to rotate injection sites to decrease scar formation is important, but does not focus on managing glucose levels. Teaching the child and family to eat a balanced diet, encouraging the child to maintain the proper injection schedule, and promoting a higher level of exercise all focus on regulating glucose control.

In interpreting the negative feedback system that controls endocrine function, the nurse correlates how _______ secretion is decreased as blood glucose levels decrease.

Insulin 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.

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

Low T4 level and high TSH level

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

Low T4 level and high TSH level 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.

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

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.

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?

Metformin 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.

Metformin 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.

Polyphagia 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). Pica is eating nonfood substances.

Polyphagia 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). 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

Polyuria 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.

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.

Polyuria Polydipsia Polyphagia Explanation: Type 2 diabetes mellitus is characterized by a gradual onset and is most often associated with obesity and not marked weight loss. Type 1 diabetes is most often abrupt and associated with marked weight loss. Polyuria, polydipsia, and polyphagia are frequent assessment findings in both types of diabetes mellitus.

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 Insulin for diabetic ketoacidosis is given intravenously. Only regular insulin can be administered by this route.

A 2-day-old infant is diagnosed with galactosemia. Which of the following interventions should the nurse prepare the parents to do?

Remove all milk and lactose-containing foods. Explanation: Galactosemia is a rare autosomal recessive disorder that is an inborn error of carbohydrate metabolism. The enzyme galactose-1-phosphate uridyl transferase is missing, and this prevents galactose from being changed to glucose. Galactose builds up in the bloodstream, possibly causing cataracts, liver failure, and renal tube problems. Treatment consists of removing all milk lactose-containing foods, including breast milk. Soy protein is the preferred formula diet.

A child is receiving desmopressin (DDAVP) for the treatment of central diabetes insipidus. The child sneezes immediately after receiving the morning dose. Which is the best action made by the nurse?

Repeat the full dose immediately. Explanation: If a dose of desmopressin (DDAVP) is sneezed out of the child's nose immediately after giving the medication, the full dose may be repeated immediately.

The neonatal nurse is caring for children with inborn errors of metabolism. Which treatment is recommended for these conditions?

Replacing deficient enzymes through intravenous administration 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 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?

Reporting irritability or anxiety Side effects of hypothyroidism are restlessness, inability to sleep, or irritability. These should be reported to the physician. Educating how to recognize vitamin D toxicity is necessary for a child with hypoparathyroidism. Teaching parents how to maintain fluid intake regimens is important for a child with diabetes insipidus. Teaching the child and parents to administer methimazole with meals is necessary for hyperthyroidism.

The nurse is caring for a teenager recently diagnosed with Addison disease. Which findings can be anticipated by the nurse? Select all that apply.

Sodium level 128 mEq/L Potassium level 5.6 mEq/L Muscular weakness Explanation: Hyponatermia, hyperkalemia and muscle weakness are all symptoms of Addison disease. Rapid weight gain and acne are present in Cushing disorder, not Addison.

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

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

A child has been prescribed Stimate (esmopressin) 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?

Stimate (esmopressin) acetate is a synthetic antidiuretic hormone that will slow down your urine output Explanation: Stimate (esmopressin) acetate is a synthetic antidiuretic hormone that promotes reabsorption of water by action on renal tubules; it is used to control diabetes insipidus by decreasing the amount of urine produced.

Stimate (esmopressin) acetate is a synthetic antidiuretic hormone that will slow down your urine output. Stimate (esmopressin) acetate is a synthetic antidiuretic hormone that promotes reabsorption of water by action on renal tubules; it is used to control diabetes insipidus by decreasing the amount of urine produced.

A nurse is teaching a child with type 1 diabetes mellitus how to self-inject insulin. Which method should she recommend to the child for regular doses?

Subcutaneously in the outer thigh 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.

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.

The nurse is assessing a 5-year-old boy whose mother says he has been vomiting lately and has no appetite. Whst sign or symptom would the nurse identify as unique to diabetes mellitus type 1?

The child has lost weight recently. Weight loss is unique to diabetes mellitus type 1, whereas weight gain is associated with type 2. Hypertension is consistent with diabetes mellitus type 2. The sweet-smelling breath is common to both type 1 and type 2 diabetes and is a sign of ketoacidosis, a medical emergency, which is frequently how children present on initial evaluation. The rapid, deep Kussmaul breathing is common to both type 1 and type 2 diabetes and is a sign of ketoacidosis, a medical emergency, which is frequently how children present on initial evaluation.

Syndrome of inappropriate antidiuretic hormone 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 client is being treated for hyperthyroidism with propylthiouracil. The nurse suspects the client's dose of medication is inadequate when assessing which signs and/or symptoms? Select all that apply.

Tachycardia Diarrhea Fever Irritability Propylthiouraceil is an antithyroid drug which blocks synthesis of T3 and T4, and is indicated for treatment of hyperthyroidism. Signs of inadequate dose: tachycardia, diarrhea, fever, or irritability. Cold intolerance is a sign of overdosing of the medication.

The nurse working with the child diagnosed with type 2 diabetes mellitus recognizes that most often the disorder can be managed by:

Taking oral hypoglycemic agents 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

The nurse working with the child diagnosed with type 2 diabetes mellitus recognizes that most often the disorder can be managed by:

Taking oral hypoglycemic agents 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.

The child may have developed thyroid storm. Which clinical manifestations of thyroid storm should the nurse expect to find? Select all that apply.

Temperature of 103.2° F (39.6° C) Wet bed linen and report of feeling "sweaty" Apical heart rate of 172 beats per minute 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.

The child may have developed thyroid storm. Which clinical manifestations of thyroid storm should the nurse expect to find? Select all that apply.

Temperature of 103.2° F (39.6° C) Wet bed linen and report of feeling "sweaty" Apical heart rate of 172 beats per minute Signs and symptoms related to the development of thyroid storm include: fever, diaphoresis, and tachycardia. Children with thyroid storm are typically restless and irritable.

The nurse is caring for a child who is scheduled for bone scan. It is suspected that the child has a growth hormone deficiency. Which finding would support this medical diagnosis?

The bone scan would show bone age would be two or more deviations below normal. Diagnostic testing used in children with suspected GH deficiency include bone age will be two or more deviations below normal. CT or MRI scans would be used to rule out tumors or structural abnormalities, not bone scans.

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. 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.

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. 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.

The nurse is preparing a child suspected of having a thyroid disorder for a thyroid scan. What information regarding the child should the nurse alert the doctor or nuclear medicine department about?

The child is allergic to shellfish Allergies to shellfish should be reported because shellfish contains iodine; the dye used for a nuclear medicine scan is iodine based and could cause an anaphylactic reaction. The other information about the child would not need to be reported to the staff.

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

The child may have developed leukopenia.

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

The child may have developed leukopenia. 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 assessing an 8-year-old boy who is performing at the second-grade level, reports feeling tired and weak, and is only 45 inches tall. Which finding would be specific to hypothyroidism?

The child states that the exam room is cold. 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.

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

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

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

Type 2 diabetes mellitus

An infant on the pediatric floor has diabetes insipidus. Which assessment data are important for the nurse to monitor while the infant is on strict fluid precautions?

Urine output Explanation: An infant with diabetes insipidus has a decrease in antidiuretic hormone. Strict fluid precautions will not alter urine formation. This assessment is important because the infant will be at great risk for dehydration and electrolyte imbalance. It is part of a basic assessment to monitor heart rate, temperature, skin turgor, and mucous membranes. These are important but may not indicate the infant's overall health. On fluid restriction, oral intake will be specified.

When discussing care of an infant with congenital hypothyroidism, you would stress that the infant will need:

administration of levothyroxine for a lifetime. Hypothyroidism occurs because the thyroid is not producing adequate thyroxine. The child will need a supplemental source for a lifetime.

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:

congenital hypothyroidism. 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).

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

dehydration

In the salt-losing form of congenital adrenal hyperplasia, the most important observation you would make in a newborn would be for:

dehydration. With this form of the disorder, children are unable to produce aldosterone. This leads to the inability to retain sodium and fluid.

A child with a history of diabetes insipidus is admitted with polyuria, polydipsia, and mental confusion. The priority intervention for this client is to:

check vital signs. 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 client is not necessary at this time.

A child with a history of diabetes insipidus is admitted with polyuria, polydipsia, and mental confusion. The priority intervention for this client is to:

A newborn is born with hypothyroidism. A complication of this disorder if it is not recognized and treated is:

cognitive impairment Congenital hypothyroidism can lead to extreme cognitive challenge impairment if not treated.

Insulin deficiency, increased levels of counter regulatory hormones, and dehydration are the primary causes of:

diabetic ketoacidosis. 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. Glusosuria is glucose that is spilled into the urine.

The nurse is teaching a child with type 1 diabetes mellitus to administer her own insulin. The child is receiving a combination of short-acting and long-acting insulin. The nurse knows that the child has appropriately learned the technique when she:

draws up the short-acting insulin into the syringe first. 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.

A school-aged girl is diagnosed as having Cushing syndrome from long-term therapy with oral prednisone. This means that the child:

has purple striae on her abdomen. An effect of a corticosteroid is to produce striae on the abdomen. Elevated levels of corticosteroids also cause these during pregnancy.

Peds PrepU Quizzes Ch. 26, PEDS Practice: Chapter 26 Nursing Care of the Child With an Alteration in Metabolism/Endocrine Disorder, Chapter 48, PEDS: Chapter 48 Nursing Care of a Family when a child has an Endocrine or a Metabolic Disorder Prep-U

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