Chapter 48: Nursing Care of the Child With an Alteration in Metabolism/Endocrine Disorder

A nurse should recognize that which laboratory result would be most consistent with a diagnosis of diabetes mellitus?

a fasting blood glucose greater than 126 mg/dl Rationale: A fasting blood glucose greater than 126 mg/dl is diagnostic for diabetes mellitus.

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

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.

15 Rationale: Use the child's weight in kilograms: 49.9 Minimum: 49.9 kg × 0.2 mg/kg = 9.98 mg, round to 10 mgMaximum: 49.9 kg × 0.3 mg/kg = 14.97 mg, round to 15 mg The safe limit is determined by using the maximum dosage. The lack of growth hormone impairs the body's ability to metabolize protein, fat, and carbohydrates. Treatment of primary growth hormone deficiency involves the use of supplemental growth hormone. Treatment continues until near-final height goal is achieved.

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?

220 mg/dl Rationale: A fasting blood sugar result of 200 mg/dL or more almost certainly is diagnostic for diabetes when other signs, such as polyuria and weight loss despite polyphagia, are present.

A 10-year-old child is newly diagnosed with type 1 diabetes. The child's hemoglobin A1C level is being monitored. The nurse determines that additional intervention is needed with the child based on which result?

8.5% Rationale: The goal for hemoglobin A1C in children between the ages of 6 and 12 years is less than 8%. Therefore, a result of 8.5% would indicate that additional intervention is needed to achieve the recommended goal.

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

Administering intravenous calcium gluconate as ordered. Rationale: 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 newborn is diagnosed with the salt-losing form of congenital adrenogenital hyperplasia. On what should the nurse focus when assessing this client?

Dehydration Rationale: If there is a complete blockage of cortisol formation, aldosterone production will also be deficient. Without adequate aldosterone, salt is not retained by the body, so fluid is not retained. Almost immediately after birth, affected infants begin to have vomiting, diarrhea, anorexia, loss of weight, and extreme dehydration. If these symptoms remain untreated, the extreme loss of salt and fluid can lead to collapse and death as early as 48 to 72 hours after birth. The salt-losing form must be detected before an infant reaches an irreversible point of salt depletion. This disorder does not cause hypoglycemia, excessive bleeding, or excessive cortisone secretion.

A nurse caring for a child with Graves disease is administering propylthiouracil (PTU). The child has been on this drug for a few weeks and now has sudden symptoms of a sore throat. What is the priority intervention for the nurse?

Hold the dose and call the health care provider. Rationale: 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.

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 Rationale: 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 nurse is taking care of an infant with diabetes insipidus. Which assessment data are most important for the nurse to monitor while the infant has a prescription for fluid restriction?

Urine output Rationale: An infant with the diagnosis of diabetes insipidus has decreased secretion of antidiuretic hormone (ADH). The infant is at risk for dehydration so monitoring urinary output is the most important intervention. The child's oral intake has been ordered. Monitoring a child who is under fluid restriction includes assessing the oral mucosa; however, urine output is the most important assessment for this patient. Vital signs are part of a basic assessment.

A child with a history of diabetes insipidus is admitted with polyuria, polydipsia, and mental confusion. Which action would be the priority?

checking vital signs Rationale: 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. Encouraging fluids will not correct the problem and weighing the client is not necessary at this time.

The nurse is interpreting the negative feedback system that controls endocrine function. What secretion will the nurse correlate as decreasing while blood glucose levels decrease?

insulin Rationale: 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. Glycogen is stored in the liver and muscles. It is released to provide energy when the blood glucose levels fall. Glucagon is also produced by the pancreas. Its job is to force the liver to release stored insulin when the body has a need for more insulin. The adrenocorticotropic hormone is produced by the anterior pituitary. Its function is to regulate cortisol. This is needed so the adrenal glands can function properly. It also helps the body respond to stress.

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.

1. tachycardia 2. diarrhea 3. fever 4. irritability Rationale: Propylthiouracil 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 is speaking with the parents of a school-aged child recently diagnosed with diabetes 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." Rationale: 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 nurse is examining a child with hypoparathyroidism. The nurse would expect to assess which signs and symptoms? Select all that apply.

1. Chvostek Sign 2. Trousseau Sign Rationale: A child with hypoparathyroidism would have a positive Chvostek or Trousseau sign, both of which indicate hypocalcemia. To test for the Chvostek sign, tap sharply over the facial nerve below the temple and anteriorly to the ear. The sign is positive when the mouth twitches (contraction of the lateral facial muscles). To check for the Trousseau sign, apply a blood pressure cuff to the child's upper arm. Inflate the cuff until the blood supply is occluded. If doing so causes carpal spasm (the fingers contract and the child is unable to open the hand), the Trousseau sign is positive. Capillary refill helps to evaluate tissue oxygenation. Polyphagia refers to excessive eating or hunger. Babinski refers to the Babinski reflex, which suggests neurologic dysfunction.

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

Calcium gluconate Rationale: 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.

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

Antidiuretic hormone (ADH) Rationale: Central diabetes insipidus (DI) is a disorder of the posterior pituitary that results from deficient secretion of ADH. ADH is responsible for the concentration of urine in the renal tubules. Without ADH there is a massive amount of water loss and an increase in serum sodium. Nephrogenic DI occurs as a genetic problem or from end-stage renal disease. It is the result of the inability of the kidney to respond to ADH and not from a pituitary gland problem. LH is produced from the anterior pituitary. In females, it stimulates ovulation and the development of the corpus luteum. TSH is secreted by the thyroid gland. ACTH is secreted by the anterior pituitary.

The nurse is reviewing the laboratory work for a new client who is 6 weeks' pregnant. Based on the above results, what is the nurse's conclusion?

Client is anemic and at risk for gestational diabetes Rationale: The client's hemoglobin and hematocrit are low, indicating anemia. The hemoglobin A1C is in the range that indicates a high risk for developing gestational diabetes. All the remaining laboratory results are within expected ranges. There is no evidence of urinary tract infection (white blood cells and urine leukocytes are within normal limits), or pulmonary embolism. An HbA1C level of 6.0% is not diagnostic of diabetes.

The nurse knows that which condition is caused by excessive levels of circulating cortisol?

Cushing syndrome Rationale: 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 the deletion of the entire X chromosome.

A woman in her first trimester of pregnancy has just been diagnosed with acquired hypothyroidism. The nurse is alarmed because this condition can lead to which pregnancy complication?

Decreased cognitive development of the fetus Rationale: 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.

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

A child is diagnosed with hypoparathyroidism. Which electrolyte imbalance would the nurse most likely expect to address?

hypocalcemia Rationale: Hypoparathyroidism results in low production of PTH, which in turn leads to hypocalcemia and hyperphosphatemia.

The nurse is teaching glucose monitoring and insulin administration to a child with type 1 diabetes and the parents. Which comment by a parent demonstrates a need for additional teaching?

"During exercise we should wait to check blood sugars until after our child completes the activity." Rationale: Blood glucose monitoring needs to be performed more often during prolonged exercise. Frequent glucose monitoring before, during, and after exercise is important to recognize hypoglycemia or hyperglycemia. Frequent glucose monitoring if the child is sick is also important to recognize changes in glucose levels and prevent hypoglycemia or hyperglycemia. The parents are correct that they will check their child's glucose before meals; they should also check it before bedtime snacks. Blood glucose level should never be the only factor considered when calculating insulin dosing. Food intake and recent or expected activity/exercise must be factored in.

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." Rationale: 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 has told the 14-year-old adolescent with diabetes that the doctor would like to have a hemoglobin A1C test performed. Which comment by the client indicates that she understands what this test is for?

"This will tell my doctor what my average blood glucose level has been over the last 2 to 3 months." Rationale: Hemoglobin A1C (HgbA1C) provides the physician or nurse practitioner with information regarding the long-term control of glucose levels, as it provides an average of what the blood glucose levels are over a 2 to 3 month period. No fasting is required. Desired levels for children and adolescents 13 to 19 years are less than 7.5%.

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?" Rationale: It is important for the nurse to know the time of day that the child takes his or her growth hormone. 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.

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.

1. Polyuria 2. Polydipsia 3. Polyphagia Rationale: 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 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 Rationale: 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.

The nurse is caring for a 7-year-old girl diagnosed with precocious puberty. The child is tearful when talking with the nurse about the signs and symptoms of the disorder. She states, "I don't look like my friends." When preparing the care plan for this child, which nursing diagnosis has the highest priority?

Disturbed Body Image Rationale: In precocious puberty, the child develops sexual characteristics before the usual age of pubertal onset. Disturbed body image would be the highest priority nursing diagnosis based on the child being tearful and the statement about not looking like her friends. Deficient knowledge about the disorder or treatment may apply, but is not the priority in this situation.

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

Enlarged clitoris Rationale: Congenital adrenal hyperplasia is a syndrome that is inherited as an autosomal recessive trait, which causes the adrenal glands to not be able to synthesize cortisol. Because the adrenal gland is unable to produce cortisol, the level of adrenocorticotropic hormone (ACTH) secreted by the pituitary in an attempt to stimulate the gland to increase function is increased. Although the adrenals enlarge under the effect of ACTH, they still cannot produce cortisol but rather overproduce androgen. Excessive androgen production during intrauterine life masculinizes the genital organs in a female fetus so that the clitoris is so enlarged it appears to be a penis. This disorder does not cause divergent vision. The child will not be born small for gestational age. This disorder does not cause abnormal facial features.

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 Rationale: 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.

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

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

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 Rationale: 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 working with the child diagnosed with type 2 diabetes recognizes the disorder can be managed by:

taking oral hypoglycemic agents. Rationale: Oral hypoglycemic agents, such as metformin, are often effective for controlling blood glucose levels in children diagnosed with type 2 diabetes. Insulin may be used for a child with type 2 diabetes if oral hypoglycemic agents alone are not effective, but "decreasing" the daily insulin would not help treat this disorder. Lifestyle changes such as increased exercise (not conserving energy by resting during the day), and limiting large amounts of carbohydrates are important aspects of treatment for the child.

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." Rationale: 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.

A newborn is born with hypothyroidism. If it is not recognized and treated, what complication is likely?

cognitive impairment Rationale: A newborn with congenital hypothyroidism is lethargic, hypotonic and irritable. Delayed growth is seen as well as decreased mental responsiveness. The newborn has an enlarged tongue and poor sucking ability. Without treatment with the thyroid hormone, the newborn will develop a cognitive impairment and failure to thrive. Blindness, muscle spasticity and dehydration are not symptoms or complications of the disease.

A child with growth hormone deficiency is prescribed growth hormone (GH) by subcutaneous injection. When teaching the child's parents about this drug, the nurse would instruct the parents to administer the drug at which frequency?

daily, 6 to 7 days a week Rationale: The parent or the child administers GH by subcutaneous injection usually 6 to 7 days per week (usually daily). It is generally given at bedtime to attempt to mimic the body's natural production and release during sleep.

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?

history of rapid weight gain Rationale: A history of rapid weight gain and long-term corticosteroid therapy suggests this child may have Cushing disease, which could be confirmed using an adrenal suppression test. A round, moon-shaped face is common to both Cushing disease and growth hormone deficiency. A high weight-to-height ratio and delayed dentition are findings with growth hormone deficiency.

A nurse on the pediatric floor is taking care of a 12-year-old child with diabetes insipidus (DI). Which fact would the nurse understand about this disease?

DI can be managed with vasopressin given as lifelong treatment. Rationale: Vasopressin is the drug of choice for this lifelong disease. In DI, antidiuretic hormone is undersecreted. Use of vasopressin is long-term, not short-term, treatment. Diabetes mellitus, not diabetes insipidus, is the disorder that requires diet management. DI involves excessive urination, so fluid replacement, not fluid restriction, is needed.

A 4-year-old child is undergoing a radioimmunoassay of T4 and T3 to determine whether the thyroid is functioning properly. Which factor could abnormally elevate the child's iodine level and thus invalidate the test?

Recent consumption of large amounts of cough medicine Rationale: Radioimmunoassay of T4 and T3 is a specific blood study to determine how much protein-bound iodine (PBI) is present in serum. Ask if a child has recently taken large amounts of cough medicine containing iodide before the study or the PBI level may be abnormally elevated. The small amount of iodine ingested from iodized salt does not affect PBI levels. Children who have low circulating albumin levels can have abnormally low PBI levels, because iodine is carried bound to protein. Phenytoin, a common anticonvulsant medication prescribed for children with recurrent seizures, may displace thyroxine from binding globulin and further contribute to low PBI levels.

A 6-year-old boy has a moon-face, 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 Rationale: 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). Other effects include hyperpigmentation (the child's face is unusually red, especially the cheeks).

During a visit to the clinic, the adolescent client with hypothyroidism tells the nurse that she takes her 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." Rationale: Levothyroxine is a thyroid hormone replacement used to treat hypothyroidism. It is important to maintain a consistent thyroid hormone level by taking the medication at the same time each day (preferably 30 minutes prior to breakfast for best absorption). Toxicity can occur if the dose is doubled. Suggesting the client "do something" to remember does not highlight the importance of taking it correctly.

A child 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." Rationale: 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 increased 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 client is upset and tells the school nurse. "I am the shortest one in my class. I am done with school and just want to stay home." Which response by the nurse is most appropriate?

"You seem very upset. Sit down and let's talk about what is going on." Rationale: The child is voicing feelings of personal devaluation. This is consistent with a lack of self-esteem and the nurse needs to first acknowledge and then talk to the client about the feelings. Explaining the disorder to the client does not help with the client's feelings. Stating "I am sure you will be taller soon" may not be true and the nurse should not make such statements as these will lead to a lack of trust. The nurse would first explore the client's feelings and thoughts at this time. It may be appropriate for the client to speak with someone with the same experiences to gain insight and understanding of coping methods based on what the client is feeling.

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. Rationale: 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.

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 Rationale: Observation of an enlarged tongue along with an enlarged posterior fontanel (fontanelle) 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.

The nurse is interpreting the negative feedback system that controls endocrine function. What secretion will the nurse correlate as decreasing while blood glucose levels decrease?

insulin Rationale: 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. Glycogen is stored in the liver and muscles. It is released to provide energy when the blood glucose levels fall. Glucagon is also produced by the pancreas. Its job is to force the liver to release stored insulin when the body has a need for more insulin. The adrenocorticotropic hormone is produced by the anterior pituitary. Its function is to regulate cortisol. This is needed so the adrenal glands can function properly. It also helps the body respond to stress.

The nurse is caring for a 10-year-old child with growth hormone (GH) deficiency. Which therapy would you anticipate will be prescribed for the child?

Injections of GH Rationale: Growth hormone (GH) deficiency occurs when the anterior pituitary is unable to produce enough hormone for usual growth. Somatotropin is the name of the growth hormone administered. Administering subcutaneous GH to the child helps correct this deficiency. The GH dosage is 0.2 to 0.3 mg/kg given daily. It is not administered orally. Aldosterone causes sodium to be retained and a provocation would be the administration of diuretics to reduce the sodium. Beta cells are found in the heart muscles, smooth muscles, airways, and arteries. They are also found in the pancreas to secrete insulin. None of these cell actions are related to the anterior pituitary.