peds ch 26

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

do not mix this insulin with other insulins.

A 2-year-old client and the parents are at the office for a follow-up visit. The client has had excessive hormone levels in the recent blood work, and the parents question why this was not found sooner. Which response by the nurse would be most appropriate? "tt takes time to determine the level of functioning of endocrine glands." "endocrine disorders are hard to detect and you are lucky that we have found it when we did." "as endocrine functions become more stable throughout childhood, alterations become more apparent." "have there been signs and symptoms that you should have reported to the doctor?"

"as endocrine functions become more stable throughout childhood, alterations become more apparent." explanation: 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 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? "you need to remain very still for the entire test." "drink plenty of fluids because you need to have a full bladder." "limit your level of physical activity for one-half hour before the test." "you won't be able to drink any water before or during the test."

"drink plenty of fluids because you need to have a full bladder." explanation: a full bladder is needed for an ultrasound of the pelvic. The patient 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 child recently diagnosed with hypothyroidism. Which statement by a parent indicates an understanding of symptoms of this disorder? "most people with hypothyroidism have smooth, velvety skin." "when they get my son's thyroid levels normal, he won't be so tired." "my son's nervousness may be a symptom of his hypothyroidism." "heat intolerance is a caused by low thyroid levels."

"when they get my son's thyroid levels normal, he won't be so tired."

Which adolescents may have delayed puberty? Select all that apply. 14-year-old female who has not developed breasts 13-year-old male who has no changes in the appearance of his scrotum 15-year-old male who has had no changes to the size of testicles 13-year-old female who has no pubic hair 14-year-old male who has no pubic hair

14-year-old female who has not developed breasts 15-year-old male who has had no changes to the size of testicles

A group of nursing students are reviewing information about neonatal screenings. The students demonstrate understanding of the information when the students identify which system of most consistently affected by metabolic disorders? respiratory system cardiovascular system nervous system gastrointestinal system

nervous system

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? 7.0% 6.5% 7.5 % 8.5%

8.5% pg. 1038

The nurse is caring for a child recently diagnosed with hypoparathyroidism disorder. Which medication would the nurse expect to be ordered? oral potassium intravenous diuretic therapy oral calcium oral corticosteroids

oral calcium explanation: 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

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? precocious puberty syndrome of inappropriate antidiuretic hormone secretion diabetes insipidus hypopituitarism

diabetes insipidus explanation: The most common symptoms of central DI are polyuria (excessive urination) and polydipsia (excessive thirst). Children with DI typically excrete 4 to 15 L per day of urine despite the fluid intake. The onset of these symptoms is usually sudden and abrupt. Ask about repeated trips to the bathroom, nocturia, and enuresis. Other symptoms may include dehydration, fever, weight loss, increased irritability, vomiting, constipation, and, potentially, hypovolemic shock.

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 long-term blocking of beta cells oral administration of somatotropin short-term aldosterone provocation

injections of GH

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? "a weight-loss program should be implemented and maintained." "kids can usually be managed with an oral agent, meal planning, and exercise." "this will rectify itself if you follow all of the doctor's directions." "you are lucky that you did not have to learn how to give yourself a shot."

"kids can usually be managed with an oral agent, meal planning, and exercise."

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? "let me explain to you your disorder so you understand what is going on." "i know kids can be mean these days, but I am sure you will be taller soon." "would you like to talk with another child who has experienced what you are going through?" "you seem very upset. Sit down and let's talk about what is going on."

"you seem very upset. Sit down and let's talk about what is going on."

Prior to discharging an infant with congenital hypothyroidism to home with the parents, what should the nurse emphasize regarding the care that this child will need going forward? administration of vitamin C until after growth is complete administration of levothyroxine indefinitely vitamin K administration until school age an increased intake of calcium beginning immediately

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

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 thyroxine growth hormone insulin

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.

A newborn is born with hypothyroidism. If it is not recognized and treated, what complication is likely? muscle spasticity cognitive impairment blindness dehydration

cognitive impairment explanation: congenital hypothyroidism can lead to extreme cognitive challenge impairment if not treated.

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? frequent diarrhea enlarged tongue tachycardia warm, moist skin

enlarged tongue explanation: 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 diagnosed with hyperthyroidism. What finding would the nurse expect to assess? weight gain constipation facial edema heat intolerance

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.

Which results would indicate to the nurse the possibility that a neonate has congenital hypothyroidism? low T4 level and high TSH level high thyroxine (T4) level and low thyroid stimulating hormone (TSH) level normal TSH level and high T4 level normal T4 level and low TSH level

low T4 level and high TSH level

A child presents to the primary care setting with enuresis, nocturia, increased hunger, weight loss, and increased thirst. What does the nurse suspect? diabetes insipidus type 1 diabetes mellitus syndrome of inappropriate diuretic hormone hypothyroidism

type 1 diabetes mellitus pg. 1023

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 oral intake oral mucosa vital signs

urine output

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? "maybe you could do something to remind yourself to take the medication on a daily basis." "if you forget a dose you can double up the next day. We just want your thyroid level to be maintained since you don't produce enough thyroid hormone." "as long as you are missing multiple doses it should be fine. Just as long as you take the Synthroid at some point each day." "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."

"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." explanation: Synthroid (levothyroxine) is thyroid hormone replacement used to treat hypothyroidism. It is important to maintain a level thyroid hormone level by taking the medication at the same time each day (preferably 30 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

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 only temporary, right?" "so, hypothyroidism can be treated by exposing our baby to a special light, right?" "do you mean that hypothyroidism may be caused by a problem in the way the body makes thyroxine?" "are you saying that hypothyroidism is caused by a problem in the way the thyroid gland develops?"

"so, hypothyroidism can be treated by exposing our baby to a special light, right?" explanation: 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.

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 explanation is best? "a small part of your brain called the pituitary is deficient and does not make enough of a chemical called growth hormone." "your body is broken and does not produce enough a chemical called 'ADH,' which makes you really thirsty and have to go to the bathroom a lot." "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." "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."

As a nurse, you know that which condition is caused by excessive levels of circulating cortisol: cushing syndrome graves disease turner syndrome addison disease

cushing syndrome

A newborn is diagnosed with the salt-losing form of congenital adrenogenital hyperplasia. On what should the nurse focus when assessing this client? dehydration hypoglycemia bleeding tendency excessive cortisone secretion

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

The nurse is providing acute care for an 11-year-old boy with hypoparathyroidism. Which intervention is priority? administering intravenous calcium gluconate as ordered ensuring patency of the IV site to prevent tissue damage providing administration of calcium and vitamin D monitoring fluid intake and urinary calcium output

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.

Insulin deficiency, increased levels of counter regulatory hormones, and dehydration are the primary causes of: diabetic ketoacidosis. glucosuria. ketone bodies. ketonuria.

diabetic ketoacidosis. explanation: Insulin deficiency, in association with increased levels of counterregulatory 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.

A pediatric client has just been diagnosed with diabetes insipidus. What is the primary consideration for this client? polydypsia headache fluid replacement weight loss

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.

During an assessment of an adolescent child, the nurse notes that the child has a protuberant tongue, fatigued appearance, poor muscle tone and exophthalmos. What medical diagnosis would the nurse expect the child to have? cushing disease diabetes mellitus graves disease SIADH

graves disease explanation: symptoms of Graves disease include an increased rate of growth; weight loss despite an excellent appetite; hyperactivity; warm, moist skin; tachycardia; fine tremors; an enlarged thyroid gland or goiter; and ophthalmic changes including exophthalmos.

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

hypocalcemia

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? glucagon adrenocorticotropic hormone insulin glycogen

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.

Rank the different types of insulin based on their duration of action beginning with the shortest to the longest duration. lantus lispro humulin r humilin n

lispro - humulin r - humulin n - lantus explanation: 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 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 works on your pancreas to stimulate insulin production stimate (esmopressin) acetate is a synthetic antidiuretic hormone that will slow down your urine output stimate (esmopressin) acetate is a synthetic form of insulin used to lower your blood sugar stimate (esmopressin) acetate works to help your kidneys work more efficiently

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.

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 pancreas tumor of the adrenal cortex tumor of the thyroid tumor of the parathyroids

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).

The nurse measures the client's blood glucose level prior to breakfast. The measurement obtained is 130 mg/dL. The orders read to administer 2 units of Humalog insulin for a blood glucose of 100 to 150mg/dL. How soon should the nurse ensure that the client eats their breakfast after receiving their insulin? within 5 minutes within 2 hours within 60 to 90 minutes within 15 to 30 minutes

within 15 to 30 minutes