Ch 28 Endocrine
Type 1 diabetes mellitus has just been diagnosed in a teenage boy who is actively involved in sports. What important instruction should the nurse include in the teaching plan? 1 Because exercise can lower the blood glucose level, blood glucose needs to be closely monitored. 2 Because exercise can increase the blood glucose level, blood glucose needs to be closely monitored. 3 Because exercise can increase the blood glucose level, additional insulin should be taken before physical activity. 4 Because exercise can lower the blood glucose level, additional insulin should be taken before physical activity.
1 Because exercise can lower, not increase, the blood glucose level, blood glucose needs to be closely monitored. Additional insulin should not be administered before physical activity, because both insulin and physical activity lower blood glucose.
An infant is born with ambiguous genitalia. Tests are being performed to enable sex assignment. The parents tell the nurse that family and friends are asking what caused the baby to be this way. What is this nurse's best response? 1 By explaining the disorder so the parents can explain it to others 2 By helping the parents understand that no one knows how this occurs 3 By encouraging the parents not to worry while the tests are being done 4 By suggesting that the parents avoid family and friends until the sex is assigned
1 Explaining the disorder to the parents so that they can explain it to others is the most therapeutic approach while the parents await the sex assignment of their child. Ambiguous genitalia are caused by decreased enzyme activity required for adrenocortical production of cortisol. Avoidance of family and friends is impractical and would isolate the family from their support system while they await test results. The parents will be concerned; telling them not to worry without giving them specific alternative actions will not be effective.
An adolescent patient reports constipation, weight gain, and low mood. The patient also feels cold in warm weather. Most of the adolescents in the community have similar symptoms. What does the nurse tell the patient to include in the diet? 1 Iodized salt 2 Iron-fortified milk 3 Essential fatty acids 4 Essential amino acids
1 The clinical findings of the patient indicate hypothyroidism, which occurs due to the deficiency of thyroid hormones. The fact that many adolescents in the community have similar symptoms indicates that hypothyroidism is endemic in the area. This usually occurs due to iodine deficiency in the diet. Iodine is required for the formation of thyroid hormones. Therefore the nurse should advise the patient to include iodized salt in the diet. Iron-fortified milk should be advised for patients with iron-deficiency anemia. Though essential fatty acids and essential amino acids are required for the body, they are not helpful in patients with hypothyroidism.
The nurse suspects that the child has delayed growth. The nurse does not have serial height and weight records to assess the child's growth. What action does the nurse take? 1 Asks about the child's growth as compared to siblings. 2 Asks the parents about the child's allergy status. 3 Asks about the child's height and weight at birth. 4 Asks about the child's weight as compared to the siblings.
1 The nurse asks about the child's growth compared to the siblings in order to evaluate the growth delay in the child. The child's allergy status will help to identify the medication risks, not the child's height. Asking about the child's height and weight at birth will not help to identify the current growth delay, because the delay may be caused due to chronic illness after birth. Asking about the weight will not help to assess the child's growth pattern, because the child's weight may differ from that of the siblings due to other factors such as diet.
Which physiologic alteration is characterized by destruction of pancreatic beta-cells that produce insulin? 1 Type 1 diabetes 2 Type 2 diabetes 3 Gestational diabetes 4 Impaired glucose tolerance
1 Type 1 diabetes is characterized by destruction of the insulin-producing pancreatic beta cells. Type 2 diabetes is a result of insulin resistance. The insulin-producing pancreatic beta-cells are destroyed in type 1 diabetes and are not associated with impaired glucose tolerance. Gestational diabetes occurs during pregnancy and is not associated with the destruction of pancreatic beta-cells.
The nurse is planning care for a child with recently diagnosed diabetes insipidus. Which nursing intervention should be planned? 1 Encouraging the child to wear medical identification 2 Discussing with the child and family ways to limit fluid intake 3 Teaching the child and family how to do required urine testing 4 Reassuring the child and family that diabetes insipidus is usually not a chronic or life-threatening illness
1 (I put 3) Because of the unstable nature of the child's fluid and electrolyte balance, encouraging the child to wear a medical alert bracelet or carrying a medical identification card is an extremely important intervention. With diabetes insipidus the child should have unrestricted access to fluids because the child will characteristically have polyuria as a result of hyposecretion of antidiuretic hormone. No urine testing is required with diabetes insipidus. This disorder should not be confused with diabetes mellitus. Diabetes insipidus is both lifelong and life-threatening. Medication must be taken and the effects monitored closely.
The imbalance of which hormone causes symptoms of warm, moist skin; protruding eyeballs; difficulty breathing; and heat intolerance? 1 Insulin 2 Thyroid hormone 3 Parathyroid hormone 4 Antidiuretic hormone
2 Alteration of thyroid hormone levels leads to dyspnea; warm, moist skin; protruding eyeballs; and heat intolerance. Alteration of insulin hormone causes polydipsia, polyuria, overeating, weight loss, fatigue, and irritability. Alteration of parathyroid hormone causes confusion, anorexia, muscle pain, and fatigue. Alteration of antidiuretic hormone causes polyuria and polydipsia.
What are the clinical manifestations of juvenile hypothyroidism? 1 Sleepiness, dry skin, diarrhea 2 Dry skin, sparse hair, slowed growth 3 Diarrhea, dry skin, decelerated growth 4 Constipation, dry skin, enlarged thyroid
2 Clinical manifestations of juvenile hypothyroidism include dry skin, sparse hair, decelerated growth, constipation, puffiness around the eyes, sleepiness, and mental decline. Diarrhea and enlarged thyroid are not associated with juvenile hypothyroidism.
Which statement best describes Cushing syndrome? 1 Treatment involves replacement of cortisol. 2 It is caused by excessive production of cortisol. 3 The major clinical features are exophthalmia and pigment changes. 4 Diagnosis is suspected with findings of hypotension, hyperkalemia, and polyuria.
2 Cushing syndrome is a description of the clinical manifestations caused by too much circulating cortisol. Exophthalmia and pigmentary changes are manifestations of hyperthyroidism, not Cushing syndrome. The treatment for Cushing syndrome involves the reduction of circulating cortisol. If the cause is a pituitary tumor, surgery is indicated. Hypertension and hypokalemia—not hypotension, hyperkalemia, or polyuria—are expected findings with Cushing syndrome.
The largest percentage of childhood hyperthyroidism is caused by: 1 Poor diet 2 Graves disease 3 Hashimoto disease 4 Hypoparathyroidism
2 Graves disease accounts for the largest percentage of childhood hyperthyroidism. Poor diet does not account for the largest percentage of hyperthyroidism in childhood; neither does Hashimoto disease or hypoparathyroidism.
Which condition may be suspected in a child who has dry skin, puffiness around the eyes, sparse hair, and constipation? 1 Goiter 2 Hypothyroidism 3 Hyperparathyroidism 4 Type 1 diabetes mellitus
2 In this case, the child is suspected of having hypothyroidism. Thyroid hormone regulates the metabolic rate of all cells and the processes of cell growth and tissue differentiation. Hypothyroidism is a condition that occurs due to hyposecretion of thyroid hormone and is characterized by myxedematous skin changes like dry skin, puffiness around eyes, sparse hair, constipation, and sleepiness. A goiter is a condition that occurs due to a lack of iodine in the diet and is characterized by enlargement of the thyroid gland. Hyperparathyroidism happens because of elevated parathyroid hormone (PTH) levels, which increase blood calcium levels. This results in osteoporosis and kidney stones. Type 1 diabetes mellitus is a juvenile-onset inherited disorder characterized by polydipsia, polyuria, overeating, weight loss, and fatigue.
The parents of a child who is on growth hormone replacement therapy are not satisfied with the outcome of the treatment, because the child's height is not increasing. The child is still shorter than school peers. What is the most appropriate action of the nurse? 1 Increase the dose of growth hormone to the child. 2 Reassure the parents and set realistic expectations. 3 Change the route of administration of growth hormone. 4 Advise the parents to feed the child a high-protein diet.
2 It is important for a nurse to educate the parents about the expected outcomes of growth hormone replacement therapy. The nurse should inform them that these children are likely to attain their eventual adult height slowly when compared to their peers. Therefore parents should set realistic expectations. Increasing the dose is not required at this stage and should not be done without consulting the primary health care provider. Changing the route of administration is of no use, because the therapeutic effect remains the same. Giving a high-protein diet to the child will not result in increased growth rate.
What information should the nurse include when discussing a child's precocious puberty with the parents? 1 The child is not yet fertile. 2 Sexual interest is usually advanced. 3 Dress and activities should be appropriate to the chronologic age. 4 The appearance of secondary sex characteristics does not proceed in the usual order.
3 Because of the child's early sexual maturation, both the family and child require extensive teaching. Included in this teaching is the information that the child should be engaged in activities according to his or her chronologic age. Functioning sperm or ova may be produced, making the child fertile. Heterosexual interest is usually appropriate to the chronologic age. Development of the secondary sex characteristics proceeds in the usual order in precocious puberty.
The mother of a child with type 1 diabetes mellitus asks why her child cannot avoid all those "shots" and instead take pills as an uncle does. What is the most appropriate response by the nurse? 1 "The pills only work with an adult pancreas." 2 "The drugs affect fat and protein metabolism, not sugar." 3 "Your child needs to have insulin replaced, and the oral hypoglycemics only add to an existing supply of insulin." 4 "Perhaps when your child is older the pancreas will produce its own insulin, and then your child can take oral hypoglycemics."
3 In type 1 diabetes, the beta-cells have been destroyed. It is necessary to supply the insulin no longer produced by these cells. The oral medications have different modes of action that supplement insulin production by the pancreas, decreasing insulin resistance or affecting liver production of glucose. They are not insulin substitutes and are primarily used in type 2 diabetes mellitus. Oral hypoglycemics can supplement insulin production by the pancreas, decrease insulin resistance, or affect the liver production of glucose. In type 1 diabetes, without a pancreatic beta-cell transplant, it is unlikely that insulin would be produced.
The nurse is assessing a 7-year-old girl with precocious puberty who is taking a monthly injection of a synthetic analogue of luteinizing hormone-releasing hormone leuprolide acetate (Lupron Depot). When should treatment be discontinued? 1 When growth slows 2 When breast development occurs 3 At a chronologically appropriate time 4 When the targeted adult height is obtained
3 Treatment with leuprolide acetate (Lupron Depot) should be discontinued at a chronologically appropriate time, allowing pubertal changes to resume. Treatment should not be discontinued when growth slows unless the medication is thought to be interfering with predicted adult height. Treatment should not be discontinued when breast development occurs, because more pubertal changes need to occur. Treatment should be discontinued at a chronologically appropriate time, not when the adult targeted height is obtained.
An infant presents with hypospadias, micropenis, and no palpable gonads. How should the nurse document these findings? 1 Atrophy 2 Cushing syndrome 3 Ambiguous genitalia 4 Adrenal insufficiency
3 (I guessed 4) The condition of ambiguous genitalia is marked by hypospadias, micropenis, and no palpable gonads. Cushing syndrome is an endocrine disorder that involves excessive circulating free cortisol. Atrophy and adrenal insufficiency are not associated with hypospadias, micropenis, or gonads that are not palpable.
What endocrine disorder can result from prolonged steroid therapy? 1 Goiter 2 Addison disease 3 Diabetes mellitus 4 Cushing syndrome
4 Cushing syndrome can occur from prolonged steroid therapy. Goiter, Addison disease, and diabetes mellitus are not associated with prolonged steroid therapy.
A school-age child recently diagnosed with type 1 diabetes mellitus asks the nurse if playing soccer, playing baseball, and swimming are still possible. The nurse's response should be based on what knowledge? 1 Exercise is contraindicated in the type 1 diabetic child 2 The level of activity depends on the type of insulin required 3 Soccer and baseball are too strenuous, but swimming is acceptable 4 Exercise is not restricted unless indicated by other health conditions
4 Exercise is encouraged for children with type 1 diabetes because it lowers blood glucose levels. Insulin and meal requirements require careful monitoring to ensure the child has sufficient energy for exercise. Exercise is highly encouraged. The decrease in blood glucose can be accommodated by having snacks available. Sports are encouraged, with insulin and food adjusted for the exercise. The child needs to be cautioned to monitor responses to the exercise. The level of activity does not depend on the type of insulin used. Long-acting and short-acting insulin may both be used to provide coverage for the training and sporting events.
What is the best method for assessing control of diabetes? 1 Urine testing 2 Patient logbooks 3 Self-monitoring of blood glucose 4 Glycosylated hemoglobin (hemoglobin A1c) testing
4 Glycosylated hemoglobin (hemoglobin A1c) is the best parameter for assessing control of diabetes. Urine testing for glucose is no longer used because there is poor correlation between simultaneous glycosuria and blood glucose concentrations. Patient logbooks and self-monitoring with the use of blood glucose monitors are helpful in assessing diabetes control, but hemoglobin A1c is the best method.
A chronic diabetic patient has been on insulin injections for the past 3 months. The patient's blood reports show the hemoglobin A1c is 6%. What does the nurse tell the parents? 1 "The patient's diabetes is cured; therefore, you need not take insulin henceforth." 2 "The patient has high blood glucose, so you need to visit the endocrinologist." 3 "The patient has anemia due to deficiency of iron, so the patient needs iron-rich food." 4 "The patient's diabetes is under control; please continue the same regimen of treatment."
4 Hemoglobin A1c of 7% or less indicates that the blood glucose is well controlled by the current regimen of treatment. Therefore the patient should be told to continue with the same treatment. Hemoglobin A1c levels usually indicate the effectiveness of the treatment over a period of 2 to 3 months. However, a normal report of Hemoglobin A1c does not indicate that the diabetes is cured. Hemoglobin A1c levels are normal in the patient; therefore consultation from an endocrinologist may not be needed. Hemoglobin A1c levels do not mean reduction of hemoglobin levels and do not call for supplementation with iron-rich food.
A 17-year-old with type 1 diabetes mellitus tells the school nurse about recently starting to drink alcohol with friends on weekends. What is the most appropriate intervention by the nurse? 1 Tell the adolescent not to drink alcohol 2 Ask the adolescent about the reasons for drinking alcohol 3 Recommend counseling so the adolescent understands the serious consequences of alcohol consumption 4 Teach the adolescent about the effects of alcohol on type 1 diabetes mellitus and how to prevent problems associated with alcohol intake
4 The nurse is taking a proactive approach. The adolescent is provided with information to facilitate the management of the illness. Telling someone not to drink will not help should the person choose to continue drinking. Asking the adolescent the reason for the drinking will provide information to the nurse but will not address the information that the adolescent needs to have about managing the disease. Counseling can be included in the teaching plan.
The parents report that their child has excessive urination, thirst, hunger, irritability, fatigue, flushed skin, headache, blurred vision, and dry skin. The child is diagnosed with type 1 diabetes mellitus. Based on this diagnosis, what should the nurse include in the plan of care? 1 Assess the feet for open sores. 2 Obtain a urine dipstick for bacteria. 3 Administer corticosteroids to decrease inflammation. 4 Monitor capillary blood glucose levels before meals and at bedtime.
4 Type 1 diabetes mellitus is a carbohydrate-metabolism disorder characterized by polyuria, polydipsia, overeating, weight loss, fatigue, and irritability. The patient with type 1 diabetes mellitus will have hyperglycemia due to an inability of the pancreas to secrete insulin. Therefore the nurse should monitor the capillary blood glucose levels before meals and at bedtime. It is important to assess the feet of diabetic patients for open sores, but this is a long-term complication of uncontrolled diabetes mellitus. Obtaining a urine dipstick for bacteria will help diagnose a urinary tract infection and is not related to diabetes management. Corticosteroids will increase blood glucose levels and should not be administered unless absolutely necessary.
