Chapter 48: Nursing Care of the Child With an Alteration in Metabolism/Endocrine Disorder
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? "It takes time to determine the level of functioning of endocrine glands." "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." "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." 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.
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? 0930 0815 0845 0900
0815 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.
A newborn exhibits significant jittery movements, convulsions, and apnea. Hypoparathyroidism is suspected. What would the nurse expect to be administered? Levothyroxine Hydrocortisone Desmopressin Calcium gluconate
Calcium gluconate 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.
The nurse knows that which condition is caused by excessive levels of circulating cortisol? Graves disease Turner syndrome Cushing syndrome Addison disease
Cushing syndrome 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 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 Short stature Body mass index as normal Decreased serum levels of free testosterone
Darkened pigmentation around the neck area 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 working on a pediatric floor understands the importance of diagnosing inborn errors of metabolism early. A child with a suspected problem must have blood urea nitrogen (BUN) and creatinine testing done. Which is the purpose of these two tests? Evaluate liver function. Detect changes in amino acid patterns. Evaluate renal function. Evaluate metabolism.
Evaluate renal function. Tests of BUN and creatinine evaluate renal function. These tests are done to rule out chronic renal failure and to monitor the effects of treatments on the renal system. Tests of ammonia and lactic acid evaluate metabolism. Tests of plasma amino acids detect changes in amino acid pattern, while a liver function panel would help evaluate hepatic function.
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. Exophthalmos (protruding eyes) Increased basal metabolic rate Moist skin Nervousness Lethargy Obesity
Exophthalmos (protruding eyes) Moist skin Nervousness Increased basal metabolic rate In Graves disease, children gradually experience nervousness, tremors, loss of muscle strength, and easy fatigue. Their basal metabolic rate, blood pressure, and pulse all increase. Their skin feels moist and they perspire freely. An exophthalmos-producing pituitary substance causes the prominent-appearing eyes that accompany hyperthyroidism in some children. Obesity and lethargy are symptoms of hypothyroidism, not of Graves disease (hyperthyroidism).
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? Regular insulin NPH Lispro Detemir
Regular insulin Insulin for diabetic ketoacidosis is given intravenously. Only regular insulin can be administered by this route.
A child with Addison disease has been admitted with a history of nausea and vomiting for the past 3 days. The client is receiving IV glucocorticoids. Which intervention would the nurse implement? Weigh daily. Measure intake and output. Take glucometer readings as ordered. Monitor sodium and potassium levels.
Take glucometer readings as ordered. IV glucocorticoids raise the glucose levels and often require coverage with insulin. Measuring the intake and output at this time is not necessary. Sodium and potassium would be monitored when the client is receiving mineralocorticoids. Daily weights are not necessary at this time.
The nurse is caring for a child who is scheduled for bone scan. It is suspected that the child has a growth hormone deficiency. Which finding would support this medical diagnosis? The bone scan would show bone age to be two or more deviations below normal. The bone scan would show a tumor on the child's kidney. The bone scan would show a brain tumor. The bone scan would show bone age to be three or more deviations above normal.
The bone scan would show bone age to be two or more deviations below normal. Diagnostic testing used in children with suspected GH deficiency would indicate bone age to be two or more deviations below normal. CT or MRI scans, not bone scans, would be used to rule out tumors or structural abnormalities.
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. The child wears a medical alert bracelet for diabetes. The child has had an MRI of their leg within the past 6 weeks. The child is taking a vitamin supplement.
The child is allergic to shellfish. 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.
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 not be taking the medication. The child may have developed leukopenia. The child needs to be started on an antibiotic drug. The child must be participating in sports.
The child may have developed leukopenia. Graves disease is defined as an overproduction of thyroid hormones. Propylthiouracil is used to suppress thyroid function. A complication of Graves disease is leukopenia.
A child presents to the primary care setting with enuresis, nocturia, increased hunger, weight loss, and increased thirst. What does the nurse suspect? Syndrome of inappropriate diuretic hormone Hypothyroidism Diabetes insipidus Type 1 diabetes mellitus
Type 1 diabetes mellitus Signs and symptoms of type 1 diabetes mellitus include polyuria, polydipsia, polyphagia, enuresis, and weight loss.
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 encouraging increased fluid intake weighing the client measuring urine output
checking vital signs 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.
A newborn is born with hypothyroidism. If it is not recognized and treated, what complication is likely? muscle spasticity blindness cognitive impairment dehydration
cognitive impairment 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.
After teaching a group of students about endocrine disorders, the instructor determines that the teaching was successful when the students identify insulin deficiency, increased levels of counterregulatory hormones, and dehydration as the primary cause of which condition? diabetic ketoacidosis ketonuria ketone bodies glucosuria
diabetic ketoacidosis Insulin deficiency, in association with increased levels of counterregulatory hormones (glucagon, growth hormone, cortisol, catecholamines) and dehydration, is the primary cause of diabetic ketoacidosis, a life-threatening form of metabolic acidosis that is a frequent complication of diabetes. The 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. Glucosuria is glucose that is spilled into the urine.
In teaching the parents of an infant diagnosed with diabetes insipidus, the nurse should include which treatment? hormone replacement the need for blood products fluid restrictions antihypertensive medications
hormone replacement The usual treatment for diabetes insipidus is hormone replacement with vasopressin or desmopressin acetate (DDAVP). Blood products shouldn't be needed. No problem with hypertension is associated with this condition, and fluids shouldn't be restricted.
A 7-year-old child is diagnosed as having type 1 diabetes. What is one of the first symptoms usually noticed by parents when this illness develops? loss of weight swelling of soft tissue severe itching craving for sweets
loss of weight The classic signs of type 1 diabetes are polydipsia, polyuria, and polyphagia. With polyphagia, the child has an increased appetite and increased hunger, and the child eats all the time but is losing weight. This occurs because the lack of energy sugar supplies causes the muscle tissues and the fat stores to shrink. The lack of insulin also reduces the ability of the body's cells to use glucose. This leads to starvation of the cells. Loss of weight is an early symptom parents see first. They tend to equate the increased appetite as normal with growing, but become concerned when the child starts losing weight even though the child is eating. Itching and swelling are not signs of diabetes. A craving for sweets is normal for a child, especially one who is growing rapidly.
The nurse is caring for a child recently diagnosed with hypoparathyroidism disorder. Which medication would the nurse expect to be ordered? intravenous diuretic therapy oral potassium oral calcium oral corticosteroids
oral calcium 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.
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." A full bladder is needed for an ultrasound of the pelvic region. The client 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.
A nurse is educating a family about the Chvostek sign after their teen tested positive for Chvostek sign. Which statements by the caregivers shows the nurse that they understand the Chvostek sign? "The sign means my child is not getting enough vitamin D." "When I tap on my child's facial nerve, the reaction is a facial muscle spasm." "The sign occurs when there is muscle pain and the muscle is stimulated." "The sign occurs because my child is having increased intracranial pressure."
"When I tap on my child's facial nerve, the reaction is a facial muscle spasm." The Chvostek sign is a facial muscle spasm that occurs when the facial nerve is tapped. This can indicate heightened neuromuscular activity, possibly caused by hypocalcemia. Hypoparathyroidism may be suspected.
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 Vital signs Oral intake Oral mucosa
Urine output 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 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." "Fever and sore throat may be side effects of the medication." "Offer your child at least 8 ounces of clear fluids and call back tomorrow." "Give your child ibuprofen according to the instructions on the box."
"Please take your child straight to the emergency department." 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.
A child has been prescribed desmopressin 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? Desmopressin acetate is a synthetic antidiuretic hormone that will slow down your urine output. Desmopressin acetate works on your pancreas to stimulate insulin production. Desmopressin acetate works to help your kidneys work more efficiently. Desmopressin acetate is a synthetic form of insulin used to lower your blood sugar.
Desmopressin acetate is a synthetic antidiuretic hormone that will slow down your urine output. Desmopressin 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 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 hypertension hypothyroidism Cushing syndrome
Graves disease 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.
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." "Heat intolerance is a caused by low thyroid levels." "My son's nervousness may be a symptom of his hypothyroidism." "When they get my son's thyroid levels normal, he won't be so tired."
"When they get my son's thyroid levels normal, he won't be so tired." 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.
The nurse is caring for a newborn with 21-OH enzyme deficiency congenital adrenal hyperplasia (CAH). The nurse identifies one goal of the plan of care as being the understanding of the importance of maintaining hormone supplementation. Which outcome criteiron demonstrates this goal has been met? Prior to discharge the parents state that they understand the medication regimen. The parents ask appropriate questions about the planned treatment goals. The parents fill the prescription for hormone replacement therapy prior to discharge. During follow-up visits the child demonstrates normal growth and development.
During follow-up visits the child demonstrates normal growth and development. 21-OH enzyme deficiency results in blocking the production of adrenal mineralocorticoids and glucocorticoids. Nursing management of the infant or child with CAH focuses on preventing and monitoring for acute adrenal crisis, helping the family to understand the disease, providing education to the child and family about the importance of maintaining hormone supplementation, and providing emotional support to the family. Improvement of symptoms, such as normal growth and development, is the best indicator that the goal of hormone replacement therapy is being carried out as ordered.
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. Continue medication to relieve the signs of Graves disease. Offer throat lozenges to soothe the throat. Ask the child if there is a reason he or she does not want to go back to school.
Hold the dose and call the health care provider. 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 health care provider has prescribed a thyroid scan to confirm a diagnosis. What intervention should the nurse perform before the examination? Tell the client he or she will be asleep. Give the client a bolus of fluids. Assess the client for allergies. Insert a urinary catheter.
Assess the client for allergies. A thyroid scan visualizes nodes through the use of a contrast medium and fluoroscopy. The child cannot be administered the contrast medium if allergic to shellfish or iodine. It can cause a reaction. The reaction could be mild with just a rash or could even be severe, causing seizures or anaphylaxis. The nurse should assess the allergy status of the child before the procedure. The nurse should educate the child and the family about the procedure and what to expect. The child will not be asleep, have a catheter, or receive a bolus of fluids.
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? "I know kids can be mean these days, but I am sure you will be taller soon." "Let me explain to you your disorder so you understand what is going on." "You seem very upset. Sit down and let's talk about what is going on." "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." 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.
An adolescent is having an annual physical. The adolescent has a documented weight loss of 9 lb (4.08 kg). The parent states, "He eats constantly." Exam findings are normal overall, except that the child reports having trouble sleeping, and the child's eyeballs are noted to bulge slightly. Which interventions would the nurse perform based on these findings? Explain the preparation for an 8-hour fasting blood glucose test. Explain why the child might need to schedule an eye exam. Discuss preparing for a thyroid function test. Prepare the parent for a neurology consult.
Discuss preparing for a thyroid function test. The child exhibits signs and symptoms of Graves disease (hyperthyroidism). A thyroid function test would show an elevation in T4 and T3 levels caused by overfunctioning of the thyroid. Neither a neurology consult nor an eye exam would be needed. A fasting blood glucose test is used to test for Cushing syndrome and diabetes mellitus.
A nurse is making a home visit to a 12-year-old child with type 1 diabetes and is reviewing insulin administration. The nurse determines that the teaching was successful when the child performs which actions? Select all that apply. Draws up the short-acting insulin before the intermediate-acting insulin. Gives the injection at a 45-degree angle. Stores the insulin vial at room temperature. Aspirates for a blood return before injecting the medication. Shakes the bottle of intermediate-acting insulin to make sure is it uniform.
Draws up the short-acting insulin before the intermediate-acting insulin. Gives the injection at a 45-degree angle. Stores the insulin vial at room temperature. The child demonstrates appropriate technique by drawing up the short-acting insulin before the intermediate-acting insulin, stores the insulin at room temperature, and gives the injection at a 45-degree angle. The child should gently roll the bottle of insulin to ensure a uniform mixture and inject the insulin without aspirating.
The nurse is caring for a child diagnosed with low functioning parathyroid. Which is a treatment goal of a child with hypoparathyroidism? Provide the parents a specific dietary plan for high-phosphorus foods to be eaten. Provide the child and parent with a referral to a pediatric gastrointestinal specialist. Assure the parents have a plan in place for periods of low glucose levels if noted. Maintain the child's calcium level at a normal level with calcium replacement as prescribed.
Maintain the child's calcium level at a normal level with calcium replacement as prescribed. Hypoparathyroidism will manifest as a low calcium level, so the nurse would expect the provider to provide a prescription to maintain the calcium level within normal range. Glucose is not a concern with parathyroid function. A referral would be made to a pediatric endocrinologist, not a gastrointestinal specialist. Phosphorus and calcium have an inverse proportion, so the nurse would recommend a low-phosphorus diet.
A newborn girl is discovered to have congenital adrenal hyperplasia. When assessing her, the nurse would expect to find which physical characteristic? abnormal facial features divergent vision small for gestational age enlarged clitoris
enlarged clitoris Lack of production of cortisol by the adrenal gland leads to overproduction of androgen. This leads to female infants developing an enlarged clitoris.
After teaching the parents of a child with central precocious puberty about medication therapy, which statement by the parents indicates successful teaching? "Our child will start puberty again when the medication stops." "Our child needs to use the nasal spray once every day." "This medicine will reverse the symptoms and onset of puberty." "Once therapy is done, our child will need surgery."
"Our child will start puberty again when the medication stops." Treatment for central precocious puberty involves administering a gonadotropin-releasing hormone (GnRH) analog. When it is stopped, puberty resumes according to the appropriate developmental stages. This analog can be given by depot injection every 3 to 4 weeks, a daily subcutaneous injection, or an intranasal spray two or three times per day. With GnRH analog treatment, secondary sexual development stabilizes or regresses. Surgery is indicated only if there is a tumor. The goal of the medication is to delay the progression of puberty and not to reverse it.
A 16-year-old adolescent is at the office for a checkup. The parent states, "My child keeps forgetting to take insulin. What can we do to make sure my child takes it?" Which is the best response by the nurse? "You can offer your child prizes for taking the medication." "You can make sure that you are the only one who understands and is able to administer the medication." "You can set a medication time that allows your child to have a normal routine that does not interrupt school or sleep." "You can remind your child that the medication is in the cabinet, and that the child should take it when needed."
"You can set a medication time that allows your child to have a normal routine that does not interrupt school or sleep." Guidelines for successful long-term medication administration include making a dosing schedule/calendar that promotes a normal lifestyle. Avoid bribing kids; this is too hard to maintain. Involve the child in the purpose and administration of medication as early as possible to ensure interest, independence, and cooperation.
A newborn was diagnosed as having hypothyroidism at birth. The parent asks the nurse how the disease could be discovered this early. Which is the nurse's best answer? A newborn has a typical rash at birth that suggests the diagnosis. The newborn is already severely impaired at birth, and this suggests the diagnosis. Hypothyroidism is usually detected at birth by the newborn's physical appearance. A simple blood test to diagnose hypothyroidism is required in most states.
A simple blood test to diagnose hypothyroidism is required in most states. With hypothyroidism there is insufficient production of the thyroid hormones required to meet the body's metabolic as well as growth and developmental needs. Without these hormones, cognitive impairment occurs. Hypothyroidism is diagnosed by a newborn screening procedure. This screening procedure is required by most states. With early diagnosis the condition can be treated by replacing the missing hormones. The later the diagnosis is made, the more irreversible cognitive impairment becomes. At birth, a newborn with hypothyroidism will be a poor feeder. Other symptoms, such as lethargy and hypotonicity, become evident after the first month of life. There are no other outward manifestations, such as rashes or appearances, that can be seen. These are not part of the condition.
A school-age child is diagnosed as having Cushing syndrome from long-term therapy with oral prednisone. What assessment finding is consistent with this child's diagnosis and treatment? The child is demonstrating signs of hypoglycemia. The child is excessively tall for chronologic age. Child appears pale and fatigued. There are purple striae on the abdomen.
There are purple striae on the abdomen. Cushing syndrome is caused by overproduction of the adrenal hormone cortisol. The overproduction of cortisol results in hyperpigmentation, which occurs from the melanin-stimulating properties of ACTH. Purple striae resulting from collagen deficit appear on the child's abdomen. The child will not be pale or fatigued. The child will not be excessively tall. The child will not be demonstrating signs of hypoglycemia.
The nurse is teaching a child with type 1 diabetes mellitus to administer 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 the child: administers the insulin into a doll at a 30-degree angle. draws up the short-acting insulin into the syringe first. administers the insulin intramuscularly into rotating sites. wipes off the needle with an alcohol swab.
draws up the short-acting insulin into the syringe first. Drawing up the short-acting insulin first prevents mixing a long-acting form into the vial of short-acting insulin. This maintains the short-acting insulin for an emergency. Insulin is given subcutaneously not intramuscularly. A SQ injection is administered at a 90-degree angle if the person can grasp 2 in (5 cm) of skin. If only 1 in (2.5 cm) of skin can be grasped, then the injection should be given at a 45 degree angle. The needle is sterile. It should not be wiped with an alcohol swab. Only the top of the insulin vial should be wiped with an alcohol swab.
The nurse is assessing a 4-year-old girl with ambiguous genitalia. Which finding suggests congenital adrenal hyperplasia? pubic hair and hirsutism pain from constipation on palpation hyperpigmentation of the skin irregular heartbeat on auscultation
pubic hair and hirsutism Pubic hair and hirsutism in a preschooler indicate 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.
A school-age child is seen in the family clinic. The parents ask the nurse if their child should start taking growth hormones to help the child grow because the parents are short. What is the best response by the nurse? "Will your child be able to swallow oral pills every day?" "Research shows that there must be a diagnosis of deficiency before growth hormones can be started at this age." "Growth hormones work only if the child has short bones." "How tall would you like your child to be?"
"Research shows that there must be a diagnosis of deficiency before growth hormones can be started at this age." The nurse should educate the parents about growth hormones before asking questions. The nurse needs to explain that a diagnosis of deficiency must be documented before growth hormones can be used. Only the long bones are affected. Growth hormone is given orally, IM, and SC.
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. Polydipsia Polyphagia Abrupt onset of symptoms Polyuria Marked weight loss
Polyuria Polydipsia Polyphagia 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 newborn is diagnosed with the salt-losing form of congenital adrenogenital hyperplasia. On what should the nurse focus when assessing this client? Dehydration Excessive cortisone secretion Bleeding tendency Hypoglycemia
Dehydration 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 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? "Increase the insulin dosage before planned or unplanned strenuous exercise." "Check your blood glucose level before exercising, and eat a protein snack if the level is elevated." "Limit participation in planned exercise activities that involve competition." "Carry crackers or fruit to eat before or during periods of increased activity."
"Carry crackers or fruit to eat before or during periods of increased activity." Hypoglycemia can usually be prevented if an adolescent with diabetes eats more food before or during exercise. Because exercise with adolescents isn't commonly planned, carrying additional carbohydrate foods is a good preventive measure.
A 9-year-old girl is being evaluated for precocious puberty. What information from the child's mother is consistent with this condition? Select all that apply. "The teachers at school say she is moody." "Sometimes at home my daughter gets aggressive with her younger siblings." "My older daughter started her period when she was only 10 years old." "My daughter talks about having headaches all the time." "My child likes to play with dolls."
"The teachers at school say she is moody." "Sometimes at home my daughter gets aggressive with her younger siblings." "My older daughter started her period when she was only 10 years old." "My daughter talks about having headaches all the time." Central precocious puberty, the most common form, develops as a result of premature activation of the hypothalamic-pituitary-gonadal axis that results in the production of gonadotropin-releasing hormone (GnRH), which stimulates the pituitary to produce luteinizing hormone (LH) and follicle-stimulating hormone (FSH). These hormones in turn stimulate the gonads to secrete the sex hormones (estrogen or testosterone). The child develops sexual characteristics, shows increased growth and skeletal maturation, and has reproductive capability. The health history may reveal complaints of headaches, nausea, vomiting, and visual difficulties due to the circulating hormones. The psychosocial development is typical for the child's age, but the child may show emotional lability, aggressive behavior, and mood swings. There may also be a family history of early puberty. This would be evidenced in an older sibling who experienced menarche earlier than normal. Playing with dolls is normal for a 9-year-old girl.
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? "Does your child get upset about being taller than friends?" "What time each day does your child take his growth hormone?" "How often do you test your child's blood glucose?" "Is your child taking vasopressin IM or SC?"
"What time each day does your child take his growth hormone?" 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.
A pediatric client has just been diagnosed with diabetes. What would the nurse do first? Educate the client on stress management. Administer insulin. Check blood glucose levels. Regulate nutrition.
Check blood glucose levels. The nurse must check the insulin level before it can be administered. Once a need is established, then insulin administration becomes the priority intervention. Stress management, glucose checks, and nutritional consultation can all be implemented once therapy with insulin begins.
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 Tumor of the parathyroid Tumor of the pancreas Tumor of the thyroid
Tumor of the adrenal cortex 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).
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? glycogen adrenocorticotropic hormone glucagon insulin
insulin 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.
