Peds - Chapter 27: Endocrine Disorder
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
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? a) Tumor of the pancreas b) Tumor of the adrenal cortex c) Tumor of the parathyroids d) Tumor of the thyroid
Tumor of the adrenal cortex
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.
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: a) Polyuria b) Polydipsia c) Polyphagia d) Pica
Polyuria
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 most common mixture of insulin used with children with type 1 diabetes mellitus is a combination of an intermediate-acting insulin and a regular insulin, usually in a 2:1 ratio or 0.75 units of the intermediate-acting insulin to 0.33 units regular insulin, and given in the same syringe. a) False b) True
True
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? a) "Drink plenty of fluids because you need to have a full bladder." b) "You won't be able to drink any water before or during the test." c) "You need to remain very still for the entire test." d) "Limit your level of physical activity for one-half hour before the test."
"Drink plenty of fluids because you need to have a full bladder."
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."
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? a) "Have there been signs and symptoms that you should have reported to the doctor?" b) "Endocrine disorders are hard to detect and you are lucky that we have found it when we did." c) "It takes time to determine the level of functioning of endocrine glands." d) "As endocrine functions become more stable throughout childhood, alterations become more apparent."
"As endocrine functions become more stable throughout childhood, alterations become more apparent."
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."
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) "This will rectify itself if you follow all of the doctor's directions." b) "You are lucky that you did not have to learn how to give yourself a shot." c) "A weight-loss program should be implemented and maintained." d) "Kids can usually be managed with an oral agent, meal planning, and exercise."
"Kids can usually be managed with an oral agent, meal planning, and exercise."
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 young child has been diagnosed with a secondary growth hormone deficiency. The child weighs 58 lb (26.36 kg). The physician orders the child to receive 0.2 mg of growth hormone for each kilogram of body weight per week, divided into daily doses. How many milligrams of growth hormone would the child receive with each dose? Record your answer using three decimal places. ____________ mg/day
0.075 Explanation: The dose should be calculated using weight in kilograms. 26.3636 kg x 0.2 mg/1 kg = 0.5273 mg of growth hormone per week. 0.5273 mg/week x 1 week/7 days = 0.0753 mg/day.
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? a) 75 mg/dL b) 180 mg/dL c) 60 mg/dL d) 100 mg/dL
180 mg/dL
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.
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
Question: Rank the different types of insulin based on their duration of action beginning with the shortest to the longest duration. 1 Humulin N 2 Lantus 3 Humulin R 4 Lispro
Lispro Humulin R Humulin N Lantus
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.
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) encourage increased fluid intake. b) measure urine output. c) weigh the client. d) check vital signs.
check vital signs.
A child with a history of diabetes insipidus has been taking vasopressin. The parents bring the child to the clinic for an evaluation. During the visit, the parents mention that it seems like their son is hardly urinating. The nurse suspects syndrome of inappropriate antidiuretic hormone. What findings would the nurse expect to find to help confirm this condition? Select all that apply. a) Weight loss b) Urine specific gravity 1.033 c) Hypotension d) Serum osmolality 300 mOsm/kg e) Decreased urine osmolality f) Decreased serum sodium level
• Urine specific gravity 1.033 • Decreased serum sodium level • Serum osmolality 300 mOsm/kg (SIADH) is characterized by decreased urination, hyponatremia, serum osmolality greater than 280 mOsm/kg, urine specific gravity greater than 1.030, increased urine osmolality, fluid retention, weight gain, and hypertension.
The neonatal nurse is caring for children with inborn errors of metabolism. Which treatment is recommended for these conditions? a) Eliminating the deficient product from the child's diet b) Replacing deficient enzymes through intravenous administration c) Increasing substrates preceding the enzymatic block d) Undergoing liver or bone marrow transplant to increase deficient enzymes
Replacing deficient enzymes through intravenous administration
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.
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
In teaching the parents of an infant diagnosed with diabetes insipidus, the nurse should include which treatment? a) Antihypertensive medications b) The need for blood products c) Fluid restrictions d) Hormone replacement
Hormone replacement
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.
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? a) Hypersecretion of somatotropin b) Hyposecretion of somatotropin c) Hypersecretion of antidiuretic hormone d) Hyposecretion of antidiuretic hormone
Hyposecretion of antidiuretic hormone
A 12-year-old girl in the hospital suddenly experiences an extreme drop in blood pressure following discontinuation of prednisone. She appears gray and has no detectable pulse. Which of the following is the priority nursing intervention in this situation? a) Administration of insulin b) Administration of epinephrine c) Immediate replacement of cortisol d) Cardiopulmonary resuscitation
Immediate replacement of cortisol
A 12-year-old girl is diagnosed with hyperthyroidism. What problem would the nurse anticipate she may have in school? a) Inability to fit legs under a school desk b) Inability to submit neat handwriting assignments c) Noncomprehension of written material d) Increase in sleepiness by the end of the day
Inability to submit neat handwriting assignments Explanation: Children with hyperthyroidism may develop hand tremors, which leads to poor handwriting.
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? a) Promoting higher levels of exercise than previously maintained b) Teaching that 50% of daily calories should be carbohydrates c) Encouraging the child to maintain the proper injection schedule d) Instructing the child to rotate injection sites
Instructing the child to rotate injection sites
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
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.
In a child with diabetes insipidus, which characteristic would most likely be present in the child's health history? a) Gradual onset of personality changes, lethargy, and blurred vision b) Delayed closure of the fontanels, coarse hair, and hypoglycemia in the morning c) Vomiting early in the morning, headache, and decreased thirst d) Abrupt onset of polyuria, nocturia, and polydipsia
Abrupt onset of polyuria, nocturia, and polydipsia
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? a) "We should give her nonfat milk to drink." b) "I will be eating more breads and cereals." c) "I can have an apple or orange for snacks." d) "I can eat two small cookies with each meal."
"I can eat two small cookies with each meal."
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."
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? a) "So, hypothyroidism can be only temporary, right?" b) "Are you saying that hypothyroidism is caused by a problem in the way the thyroid gland develops?" c) "So, hypothyroidism can be treated by exposing our baby to a special light, right?" d) "Do you mean that hypothyroidism may be caused by a problem in the way the body makes thyroxine?"
"So, hypothyroidism can be treated by exposing our baby to a special light, right?"
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 caring for an obese 15-year-old girl who missed two periods and is afraid she is pregnant. Which finding indicates polycystic ovary syndrome? a) Increased respiratory rate b) Hypertrophy and weakness c) Acanthosis nigricans d) Blurred vision and headaches
Acanthosis nigricans Explanation: Observation of acanthosis nigricans in addition to the obesity and amenorrhea is a further indication of polycystic ovary syndrome. Reports of blurred vision and headaches are signs and symptoms of diabetes mellitus. Increased respiratory rate on auscultation points to diabetes insipidus. Hypertrophy and weakness on palpation is typical of hypothyroidism.
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
The nurse is providing acute care for an 11-year-old boy with hypoparathyroidism. Which intervention is priority? a) Ensuring patency of the IV site to prevent tissue damage b) Monitoring fluid intake and urinary calcium output c) Providing administration of calcium and vitamin D d) Administering intravenous calcium gluconate as ordered
Administering intravenous calcium gluconate as ordered
The nurse is caring for a 14-year-old boy with hyperpituitarism. What would be the priority treatment? a) Teaching the child and family about proper treatment b) Treating the child according to his chronological age c) Assessing the child's self-image due to the disorder d) Administering octreotide acetate as ordered
Administering octreotide acetate as ordered
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? a) Thyroxine b) Antidiuretic hormone c) Insulin d) Growth hormone
Antidiuretic hormone
A nurse is reviewing information about the various types of insulin that are used to treat diabetes mellitus type 1. Integrating knowledge about the duration of action, place these types in the order from shortest to longest duration. 1 Aspart 2 Glargine 3 Regular 4 NPH
Aspart Regular NPH Glargine
The physician has ordered a thyroid scan to confirm the diagnosis. Before the procedure the nurse should: a) Tell the client they will be asleep. b) Give the client a bolus of fluids. c) Insert a urinary catheter. d) Assess the client for allergies.
Assess the client for allergies. Uses iodine.
A 17-year-old is found after a high school football game wandering around. He is confused, sweaty, and pale. Which test is most likely to be performed first? a) CT scan b) Blood cultures c) Blood glucose level d) Arterial blood gases
Blood glucose level
A group of students are reviewing information about delayed puberty in preparation for a class discussion. The students demonstrate understanding of this condition when they describe which as occurring in girls? a) Pubic hair has not appeared by age 16. b) Menarche has not occurred by age 14. c) Breast development has not occurred by age 13. d) Growth spurt has not begun by age 12.
Breast development has not occurred by age 13.
A newborn exhibits significant jittery movements, convulsions, and apnea. Hypoparathyroidism is suspected. What would the nurse expect to be administered? a) Hydrocortisone b) Calcium gluconate c) Levothyroxine d) Desmopressin
Calcium gluconate
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 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? a) Monthly b) Bi-monthly c) Daily d) Weekly
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? a) Short stature b) Body mass index as normal c) Decreased serum levels of free testosterone d) Darkened pigmentation around the neck area
Darkened pigmentation around the neck area
A woman in her first trimester of pregnancy has just been diagnosed with acquired hypothyroidism. The nurse is alarmed because she knows that this condition can lead to which of the following pregnancy complications? a) Decreased cognitive development of the fetus b) Gestational diabetes in the mother c) Congenital heart defects in the fetus d) Spina bifida in the fetus
Decreased cognitive development of the fetus infant can be born cognitively challenged because there was not enough iodine present for fetal growth.
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
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
Tay-Sachs disease is found primarily in the Asian population. a) False b) True
False
The parathyroid glands regulate serum levels of glucose in the body. a) False b) True
False
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? a) Give her a glass of orange juice. b) Give her nothing by mouth so that a blood sugar can be drawn at the doctor's office. c) Give her a glass of orange juice with one unit regular insulin in it. d) Give her one unit of regular insulin.
Give her a glass of orange juice.
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
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.
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 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? a) Metformin b) Glyburide c) Glipizide d) Nateglinide
Metformin
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 caring for a 13-year-old girl with delayed puberty. When developing the plan of care for this child, what would be the priority? a) Monitoring for therapeutic and side effects of medication b) Involving the child in her therapy to give her a sense of control c) Helping the child discuss her feelings about her condition d) Encouraging the parents to discuss their concerns about the disorder
Monitoring for therapeutic and side effects of medication
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? a) Notifying the physician of the neurologic findings b) Monitoring urine volume and specific gravity c) Setting up safety precautions to prevent injury d) Restoring fluid balance with IV sodium
Notifying the physician of the neurologic findings
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? a) Observation reveals tetany. b) Auscultation reveals an irregular heart rate. c) The child acts sleepy and unresponsive. d) Slight exophthalmos is observed.
Observation reveals tetany.
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
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
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? a) Syndrome of inappropriate antidiuretic hormone b) Hyposecretion of somatotropin c) Diabetes insipidus d) Hypersecretion of somatotropin
Syndrome of inappropriate antidiuretic hormone
The nurse working with the child diagnosed with type 2 diabetes mellitus recognizes that most often the disorder can be managed by: a) Conserving energy with rest periods during the day b) Increasing protein in the diet, especially in the evening c) Decreasing amounts of daily insulin d) Taking oral hypoglycemic agents
Taking oral hypoglycemic agents
The nurse is caring for 1-month-old girl with thyrotoxicosis. What finding would the nurse expect to assess? a) Skin is cool, dry, and scaly to the touch. b) The child has a strong appetite but fails to thrive. c) The child is hypoactive and hypotonic. d) Observation reveals lethargy and irritability.
The child has a strong appetite but fails to thrive.
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.
The nurse is caring for a 14 y/o boy with type 1 DM. He takes NPH insulin every morning at 7:30am. Which assessment data will the nurse use to evaluate the therapeutic effectiveness of the medication? 1. presence of signs and symptoms of hypoglycemia or hyperglycemia during the morning physical assessment. 2. blood glucose level at 1630 3. appetite and food intake at lunch 4. blood glucose level before breakfast.
blood glucose level at 1630
A newborn is born with hypothyroidism. A complication of this disorder if it is not recognized and treated is: a) blindness. b) muscle spasticity. c) cognitive impairment. d) dehydration.
cognitive impairment.
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: a) secondary hypothyroidism. b) acquired hypothyroidism. c) congenital hypothyroidism. d) autoimmune thyroiditis.
congenital hypothyroidism.
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
The nurse is caring for a child with diabetes mellitus type 1. The nurse notes that the child is drowsy, has flushed cheeks and red lips, a fruity smell to the breath, and there has been an increase in the rate and depth of the child's respirations. The nurse recognizes that these symptoms indicate the child has: a) polyphagia. b) Cheyne-Stokes respirations. c) diabetic ketoacidosis. d) insulin reaction.
diabetic ketoacidosis
Insulin deficiency, increased levels of counter regulatory hormones, and dehydration are the primary causes of: a) ketonuria. b) diabetic ketoacidosis. c) glucosuria. d) ketone bodies.
diabetic ketoacidosis.
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.
When monitoring the blood glucose level of a 12 y/o child with type 2 DM, your reading is 50mg/dL. Which is the most appropriate action? 1. encourange the child to get out of bed and increase activity 2. take the child's vital signs 3. ask the child about frequent urine output 4. give the child 4oz of OJ
give the child 4oz of OJ
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.
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: a) precocious puberty. b) pseudopuberty. c) neurofibromatosis. d) adrenal hyperplasia.
precocious puberty. Explanation: 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.
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.
A young mother brings her new baby, diagnosed with congenital hypothyroidism, to the clinic so she can learn how to administer levothyroxine. The nurse should include which of the following instructions? 1. crush the medication and place it in a full bottle of formula to disguise the taste 2. administer the medication every other day 3. use an oral dispenser syringe or nipple to give the crushed medication mixed with a small amount of formula 4. tell the mother that the medication will not be needed after the age of 7
use an oral dispenser syringe or nipple to give the crushed medication mixed with a small amount of formula
Which adolescents may have delayed puberty? Select all that apply. a) 14-year-old male who has no pubic hair b) 13-year-old female who has no pubic hair c) 13-year-old male who has no changes in the appearance of his scrotum d) 14-year-old female who has not developed breasts e) 15-year-old male who has had no changes to the size of testicles
• 14-year-old female who has not developed breasts • 15-year-old male who has had no changes to the size of testicles
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. a) Obesity b) Moist skin c) Nervousness d) Exophthalmos (protruding eyes) e) Lethargy f) Increased basal metabolic rate
• Exophthalmos (protruding eyes) • Moist skin • Nervousness • Increased basal metabolic rate
The child may have developed thyroid storm. Which clinical manifestations of thyroid storm should the nurse expect to find? Select all that apply. a) Temperature of 103.2° F (39.6° C) b) Apical heart rate of 172 beats per minute c) Wet bed linen and report of feeling "sweaty" d) Report of feeling very tired and wanting to nap e) Mild-mannered and compliant demeanor
• Temperature of 103.2° F (39.6° C) • Wet bed linen and report of feeling "sweaty" • Apical heart rate of 172 beats per minute
