Peds test 3 Nursing Care of the Child With an Endocrine Disorder

Which nursing objective is most important when working with neonates who are suspected of having congenital hypothyroidism? a) Promoting bonding b) Encouraging fluid intake c) Early identification d) Allowing rooming in

Early identification

A newborn girl is discovered to have congenital adrenal hyperplasia. When assessing her, the nurse would expect to find which physical characteristic? a) Abnormal facial features b) Enlarged clitoris c) Divergent vision d) Small for gestational age

Enlarged clitoris

A 12-year-old is being seen in the office and has hyperthyroidism; the nurse knows that the most common cause of hyperthyroidism is: a) Addison disease b) Graves disease c) Plummer disease d) Cushing disease

Graves disease Graves disease is the most common form of hyperthyroidism.

The nurse knows that disorders of the pituitary gland depend on the location of the physiologic abnormality. Caring for a child that has issues with the anterior pituitary, the child has issues with which hormone? a) Oxytocin b) Growth hormone c) Vasopressin d) Antidiuretic hormone

Growth hormone

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? a) Intermediate-acting insulin b) Long-acting insulin c) Rapid-acting insulin d) Regular insulin

Rapid-acting insulin

A child is diagnosed with hyperthyroidism. What finding would the nurse expect to assess? a) Heat intolerance b) Facial edema c) Weight gain d) Constipation

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.

A nurse is teaching an adolescent with type 1 diabetes about the disease. Which instruction by the nurse about how to prevent hypoglycemia would be most appropriate for the adolescent? a) "Increase the insulin dosage before planned or unplanned strenuous exercise." b) "Check your blood glucose level before exercising, and eat a protein snack if the level is elevated." c) "Carry crackers or fruit to eat before or during periods of increased activity." d) "Limit participation in planned exercise activities that involve competition."

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

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

Do not mix this insulin with other insulins.

In interpreting the negative feedback system that controls endocrine function, the nurse correlates how _______ secretion is decreased as blood glucose levels decrease. a) Insulin b) Glucagon c) Adrenocorticotropic hormone d) Glycogen

Insulin

You care for a 10-year-old boy with growth hormone deficiency. Which therapy would you anticipate will be prescribed for him? a) Intramuscular injections of growth hormone b) Short-term aldosterone provocation c) Oral administration of somatotropin d) Long-term blocking of beta cells

Intramuscular injections of growth hormone

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

Low T4 level and high TSH level

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? a) Regular insulin b) Detemir c) Lispro d) NPH

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

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? a) How to maintain fluid intake regimens b) Reporting irritability or anxiety c) Administering methimazole with meals d) How to recognize vitamin D toxicity

Reporting irritability or anxiety

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? a) Subcutaneously in the outer thigh b) Intradermally in the outer arm c) Intramuscularly in the abdomen d) Intravenously in the chest

Subcutaneously in the outer thigh

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: a) administers the insulin into a doll at a 30-degree angle. b) draws up the short-acting insulin into the syringe first. c) wipes off the needle with an alcohol swab. d) administers the insulin intramuscularly into rotating sites.

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

The nurse is assessing a 16-year-old boy who has had long-term corticosteroid therapy. Which finding, along with the use of the corticosteroids, indicates Cushing disease? a) Delayed dentition b) High weight-to-height ratio c) History of rapid weight gain d) Round, child-like face

History of rapid weight gain

When discussing congenital adrenal hyperplasia with a child's parents, you would advise them that administration of which drug will probably be indicated? a) Calcium b) Hydrocortisone c) Growth hormone d) Vitamin D

Hydrocortisone The basic defect in congenital adrenal hyperplasia is the lack of cortisol.

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

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

During a well child examination which of the following comments made by the parent would indicate the possibility of a growth horme deficiency? 1. "I have to buy my child new clothes every 2-3 months." 2. "I have to buy my child larger shirts than pants; otherwise, the sleeves are too short." 3. "My child wears out his clothes before he outgrows them." 4. "I can hand down my child's clothers to his younger brother."

"My child wears out his clothes before he outgrows them."

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? a) "Your body does not produce enough a chemical called 'ADH,' which makes you really thirsty and have to go to the bathroom a lot." b) "A small part of your brain called the pituitary does not make enough of a chemical called growth hormone." c) "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." d) "Special cells in a part of your body called the pancreas cannot produce enough of a chemical called insulin, so there is too much sugar in your blood."

"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."

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 do? a) Request that someone call 911 b) Anticipate that the child will need intravenous glucose c) Dissolve a piece of candy in the child's mouth d) Administer subcutaneous glucagon

Administer subcutaneous glucagon

As a nurse, you know that which condition is caused by excessive levels of circulating cortisol: a) Cushing syndrome b) Graves disease c) Turner syndrome d) Addison disease

Cushing syndrome Explanation: Cushing syndrome is a characteristic cluster of signs and symptoms resulting from excessive levels of circulating cortisol.

A child with Addison disease has been admitted with a history of nausea and vomiting for the past three days. The client is receiving IV glucocorticoids (e.g., Solu-Medrol). Which of the following interventions would the nurse implement? a) Glucometer readings as ordered b) Intake and output measurements c) Monitoring of sodium and potassium levels d) Daily weights

Glucometer readings as ordered

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? a) Monitoring intake and output b) Monitoring blood glucose levels c) Providing a wet washcloth to suck d) Educating family about side effects

Monitoring blood glucose levels

The nurse is assessing a 4-year-old girl with ambiguous genitalia. Which finding suggests congenital adrenal hyperplasia? a) Pain from constipation on palpation b) Hyperpigmentation of the skin c) Irregular heartbeat on auscultation d) Pubic hair and hirsutism

Pubic hair and hirsutism Explanation: 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 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? a) The mother reports that the boy is always thirsty. b) The child states that the exam room is cold. c) Observation shows only two of the 6-year molars. d) The child has gained 20 pounds in the past year.

The child states that the exam room is cold.

A newborn was diagnosed as having hypothyroidism at birth. Her mother asks the nurse how the disease could be discovered this early. The nurse's best answer would be: a) a simple blood test to diagnose hypothyroidism is required in most states. b) children have a typical rash at birth that suggests the diagnosis. c) hypothyroidism is usually detected at birth by the child's physical appearance. d) her child is already severely impaired at birth, and this suggests the diagnosis.

a simple blood test to diagnose hypothyroidism is required in most states.

In the salt-losing form of congenital adrenal hyperplasia, the most important observation you would make in a newborn would be for: a) bleeding tendencies. b) excessive cortisone secretion. c) dehydration. d) hypoglycemia.

dehydration

A school-aged girl is diagnosed as having Cushing syndrome from long-term therapy with oral prednisone. This means that the child: a) appears pale and fatigued. b) has hypoglycemia. c) has purple striae on her abdomen. d) is excessively tall for her age.

has purple striae on her abdomen. Explanation: An effect of a corticosteroid is to produce striae on the abdomen.

A 7-year-old is diagnosed as having type 1 diabetes. One of the first symptoms usually noticed by parents when this illness develops is a) swelling of soft tissue. b) loss of weight. c) craving for sweets. d) severe itching.

loss of weight.

The nursing diagnosis most applicable to a child with growth hormone deficiency would be: a) risk for self-directed violence related to oversecretion of epinephrine. b) risk for situational low self-esteem related to short stature. c) ineffective tissue perfusion related to infantile blood vessels. d) impaired skin integrity related to overproduction of melanin.

risk for situational low self-esteem related to short stature.

The nurse is teaching a 9-year-old girl with diabetes mellitus type 1 and her parents about blood glucose monitoring. Which comment indicates a need for additional teaching? a) "I should check my glucose more often if I'm sick." b) "I should check my glucose before meals." c) "The normal level for her is 70 to 110 mg/dL before meals." d) "The normal level for her is 100 to 180 mg/dL before bedtime."

"The normal level for her is 70 to 110 mg/dL before meals." the proper level for a 9-year-old child with type 1 diabetes is 80 to 150 mg/dL. The normal blood glucose level for a 7-year-old child with type 1 diabetes is 90 to 180 mg/dL before meals

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? a) Warm, moist skin b) Enlarged tongue c) Tachycardia d) Frequent diarrhea

Enlarged tongue