Endocrine Ch 31 PrepU (DONE)
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 bestresponse by the nurse?
"Research shows that there must be a diagnosis of deficiency before growth hormones can be started at this age." (Explanation: 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.)
The nurse is caring for a 5-year-old child recently diagnosed with type 1 diabetes. The mother confides to the nurse that she is afraid that this stress will harm her already shaky marriage. How can the nurse best address the mother's concerns?
"This is a stressful time; let's talk about some ways to address this." Explanation: The nurse should acknowledge that the time surrounding diagnosis is when stress has a greater chance of being higher. She must also determine what measures will facilitate and support successful coping and psychological health. Telling the mother to put her marital problems aside, telling her to get counseling, or having her remind her husband that tension can affect her daughter is not helpful.
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?
"When I tap on my child's facial nerve, the reaction is a facial muscle spasm." (Explanation: 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.)
The nurse is caring for a 7-year-old girl diagnosed with precocious puberty. The child is tearful when talking with the nurse about the signs and symptoms of the disorder. She states, "I don't look like my friends." When preparing the care plan for this child, which nursing diagnosis has the highest priority?
Disturbed body image Explanation: In precocious puberty, the child develops sexual characteristics before the usual age of pubertal onset. Disturbed body image would be the highest priority nursing diagnosis based on the child being tearful and the statement about not looking like her friends. Deficient knowledge about the disorder or treatment may apply, but is not the priority in this situation.
The nurse is preparing a teaching plan for a 10-year-old girl with hyperthyroidism. What information would the nurse include in the plan?
Explaining about the radioactive iodine procedure
A 12-year-old child is diagnosed with hyperthyroidism. What problem would the nurse anticipate the child may have in school?
Inability to submit neat handwriting assignments
Which results would indicate to the nurse the possibility that a neonate has congenital hypothyroidism?
Low T4 level and high TSH level
A child is diagnosed with hyperthyroidism. Which agent would the nurse expect the physician to prescribe?
Methimazole
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?
Monitoring blood glucose levels. Monitoring blood glucose levels during this study is the priority task along with observing for signs of hypoglycemia since insulin is given during the test to stimulate release of growth hormone.
A 7-year-old child who has type 1 diabetes mellitus is at school reporting a headache and dizziness. The school nurse notices sweat on the child's face. What should the nurse do first?
Offer the child 8 ounces of juice or soda (Explanation: These are symptoms of hypoglycemia. Glucagon is given only for severe hypoglycemia. Juice or soda is the best choice to get the child an immediate source of carbohydrates. Insulin or water would be given for hyperglycemia.)
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?
There are purple striae on the abdomen.
A child presents to the primary care setting with enuresis, nocturia, increased hunger, weight loss, and increased thirst. What does the nurse suspect?
Type 1 diabetes mellitus
A nurse is taking care of an infant with diabetes insipidus. Which assessment data are mostimportant for the nurse to monitor while the infant has a prescription for fluid restriction?
Urine output Explanation: 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.
What finding would the nurse expect to assess in a child with hypothyroidism?
Weight gain Explanation: Hypothyroidism is manifested by weight gain, fatigue, cold intolerance, and dry skin. Nervousness, heat intolerance, and smooth velvety skin are associated with hyperthyroidism.
A nurse should recognize that which laboratory result would be most consistent with a diagnosis of diabetes mellitus?
a fasting blood glucose greater than 126 mg/dl Explanation: A fasting blood glucose greater than 126 mg/dl is diagnostic for diabetes mellitus.
In a child with diabetes insipidus, which characteristic would most likely be present in the child's health history?
brupt onset of polyuria, nocturia, and polydipsia Explanation: Diabetes insipidus is characterized by deficient secretion of antidiuretic hormone leading to diuresis. Most children with this disorder experience an abrupt onset of symptoms, including polyuria, nocturia, and polydipsia. The other choices reflect symptoms of pituitary hyperfunction.
A child with a history of diabetes insipidus is admitted with polyuria, polydipsia, and mental confusion. Which is the priority intervention for this child?
check vital signs
Which nursing objective is most important when working with neonates who are suspected of having congenital hypothyroidism?
early identification Explanation: The most important nursing objective is early identification of the disorder. Nurses caring for neonates must be certain that screening is performed, especially in neonates who are preterm, discharged early, or born at home. Promoting bonding, allowing rooming-in, and encouraging fluid intake are all important but are less important than early identification.
A child with growth hormone deficiency is receiving growth hormone. What result would the nurse interpret as indicating effectiveness of this therapy?
height increase of 4 inches (Explanation: Effectiveness of growth hormone therapy is indicated by at least a 3- to 5-inch increase in linear growth in the first year of treatment. Rapid weight gain and headaches are adverse reactions of this therapy. The drug is stopped when the epiphyseal growth plates close.)
The nurse is caring for a 12-year-old girl with hypothyroidism. Which information should be part of the nurse's teaching plan for the child and family?
reporting irritability or anxiety
The nursing diagnosis most applicable to a child with growth hormone deficiency would be:
risk for situational low self-esteem related to short stature. ( Explanation: Children who are short in stature can develop low self-esteem from their altered appearance.)
Chvostek Sign
spasm of the facial muscles produced by sharply tapping over the facial nerve in front of the parotid gland and anterior to the ear; suggestive of latent tetany in patients with hypocalcemia
A nurse is taking care of an infant with diabetes insipidus. Which assessment data are mostimportant for the nurse to monitor while the infant has a prescription for fluid restriction?
urine output
The nurse is teaching a 12-year-old girl with type 2 diabetes mellitus and her parents about dietary measures to control her glucose levels. Which comment by the child indicates a need for additional teaching?
"I can eat two small cookies with each meal." Explanation: Cookies, cakes, candy, potato chips, and crackers are high in sugars and fats and should be eaten in moderation as special treats; they would not be included with each meal. An apple or orange makes a good snack. Nonfat milk is a better option than whole milk. Long-acting carbohydrates should be the largest category of foods eaten.
A 7-year-old child is being followed closely for "short stature." Approximately 6 months after the child's last doctor's visit, the nurse re-measures the height and weight of the child and plots it on the growth chart. The parents ask why their child has to be measured again. Which response should the nurse give?
"I need to see if your child has grown taller since your last visit." Explanation: The finding of growth in height is the most important part of the assessment. A halt in growth or gradual lack of growth may indicate a disorder or a possible tumor. Measuring may differ by office and nurse, and one could not predict this. The adult height can be calculated by using the parents' measurements, and this can be done anytime. Medication for growth replacement is weight-based.
A child and her parents are being seen in the office after discharge from the hospital with a new diagnosis of type 2 diabetes. Which statement by the nurse is true?
"Kids can usually be managed with an oral agent, meal planning, and exercise." Explanation: Treating type 2 diabetes in children may require insulin at the outset if the child is acidotic and acutely ill. More commonly, the child can be managed initially with oral agents, meal planning, and increased activity. Telling the child that she is lucky she did not have to learn how to give a shot might scare her, so it will inhibit her from seeking future health care. The condition will not rectify itself if all orders are followed. A weight-loss program might need to be implemented but that is not always the case.
The nurse is talking with a parent of an adolescent who is newly diagnosed with type 2 diabetes and asks, "How could this happen? No one in our family has diabetes." What response would be appropriate?
"This is caused by insulin resistance from previous pancreatic injury or generalized infection."
The nurse has told the 14-year-old adolescent with diabetes that the doctor would like to have a hemoglobin A1C test performed. Which comment by the client indicates that she understands what this test is for?
"This will tell my doctor what my average blood glucose level has been over the last 2 to 3 months." ( Explanation: Hemoglobin A1C (HgbA1C) provides the physician or nurse practitioner with information regarding the long-term control of glucose levels, as it provides an average of what the blood glucose levels are over a 2 to 3 month period. No fasting is required. Desired levels for children and adolescents 13 to 19 years are less than 7.5%.)
The nurse is taking a history on a 10-year-old child who has a diagnosis of hypopituitarism. Which question is important for the nurse to ask the parents?
"What time each day does your child take his growth hormone?"
The nurse is taking a history on a 10-year-old child who has a diagnosis of hypopituitarism. Which question is important for the nurse to ask the parents?
"What time each day does your child take his growth hormone?" Explanation: 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 nurse is reinforcing the diagnosis of constitutional delay by the health provider to a 13-year-old male adolescent. Which is the best approach for this teen?
"You will not need medication because your hormone levels are normal. I would be glad to discuss these findings with you." Explanation: This diagnosis of "short stature" or constitutional delay may cause self-esteem issues with male teens. The nurse should explore the teen's feelings. Teens with a delay in puberty usually experience puberty late, so there is no need for a second opinion. Hormone therapy is not given until after age 14.
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 levothyroxine indefinitely Explanation: The treatment for hypothyroidism is oral administration of synthetic thyroid hormone or sodium levothyroxine. A small dose is given at first, and then the dose is gradually increased to therapeutic levels. The child needs to continue taking the synthetic thyroid hormone indefinitely to supplement that which the thyroid does not make. Vitamin K is not needed. Supplemental vitamin D, and not calcium, may be given to prevent the development of rickets when rapid bone growth begins. Supplemental vitamin C is not indicated for this disorder.
Diabetes insipidus is a disorder of the posterior pituitary that results in deficient secretion of which hormone?
Antidiuretic hormone (ADH) (Explanation: Central diabetes insipidus (DI) is a disorder of the posterior pituitary that results from deficient secretion of ADH. ADH is responsible for the concentration of urine in the renal tubules. Without ADH there is a massive amount of water loss and an increase in serum sodium. Nephrogenic DI occurs as a genetic problem or from end-stage renal disease. It is the result of the inability of the kidney to respond to ADH and not from a pituitary gland problem. LH is produced from the anterior pituitary. In females, it stimulates ovulation and the development of the corpus luteum. TSH is secreted by the thyroid gland. ACTH is secreted by the anterior pituitary.)
The primary health care provider has ordered a thyroid scan to confirm the diagnosis of hyperthyroidism. Which would the nurse do before the scan?
Assess the client for allergies. ( Explanation: A thyroid scan uses a radionucleotide dye so a client should be assessed for allergies to iodine and shellfish to prevent a possible allergic reaction. The client will not be asleep. There is no need to give the child a bolus of fluid or insert a urinary catheter.)
A 6-year-old child is being evaluated for growth hormone dysfunction. Which tests will be employed in the diagnostic workup? Select all that apply.
CT scan MRI pituitary function test
A 6-year-old child is being evaluated for growth hormone dysfunction. Which tests will be employed in the diagnostic workup? Select all that apply.
CT scan MRI pituitary function test Explanation: The child will undergo laboratory tests to rule out chronic illnesses such as renal failure or liver and thyroid dysfunction. Laboratory and diagnostic tests used in children with suspected GH deficiency include CT and MRI to assess for structural abnormalities. A pituitary function test will be used to confirm a diagnosis of growth hormone dysfunction. A complete blood count and erythrocyte sedimentation rate test are not used for this purpose.
A newborn exhibits significant jittery movements, convulsions, and apnea. Hypoparathyroidism is suspected. What would the nurse expect to be administered?
Calcium gluconate
A pediatric client has just been diagnosed with diabetes. What would the nurse do first?
Check blood glucose levels. ( Explanation: 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.)
The nurse knows that which condition is caused by excessive levels of circulating cortisol?
Cushing syndrome (Explanation: 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.)
Kussmaul respirations
Deep, rapid breathing; usually the result of an accumulation of certain acids when insulin is not available in the body. (usually associated with diabetic acidosis and renal failure)
The nurse is seeing a new client in the clinic who reports polyuria and polydipsia. These conditions are indicative of which endocrine disorder?
Diabetes insipidus (DI) 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.
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?
Discuss preparing for a thyroid function test. Explanation: 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 newborn is discovered to have congenital adrenogenital hyperplasia. What will the nurse most likely observe when assessing this client?
Enlarged clitoris (Explanation: Congenital adrenal hyperplasia is a syndrome that is inherited as an autosomal recessive trait, which causes the adrenal glands to not be able to synthesize cortisol. Because the adrenal gland is unable to produce cortisol, the level of adrenocorticotropic hormone (ACTH) secreted by the pituitary in an attempt to stimulate the gland to increase function is increased. Although the adrenals enlarge under the effect of ACTH, they still cannot produce cortisol but rather overproduce androgen. Excessive androgen production during intrauterine life masculinizes the genital organs in a female fetus so that the clitoris is so enlarged it appears to be a penis. This disorder does not cause divergent vision. The child will not be born small for gestational age. This disorder does not cause abnormal facial features.)
A 12-year-old is being seen in the office and has hyperthyroidism; the nurse knows that the most common cause of hyperthyroidism is:
Graves disease Explanation: Hyperthyroidism occurs less often in children than hypothyroidism. Graves disease, the most common cause of hyperthyroidism in children, occurs in 1 in 5,000 children between 11 and 15 years of age. Hyperthyroidism occurs more often in females, and the peak incidence occurs during adolescence.
When discussing congenital adrenal hyperplasia with a child's parents, the nurse would advise them that administration of which drug is anticipated?
Hydrocortisone Congenital adrenal hyperplasia is an autosomal inherited disease. The adrenal glands produce an insufficient supply of the enzymes required for the synthesis of cortisol and aldosterone. Hydrocortisone is a corticosteroid that is used to replace the supply of cortisol
The nurse working triage in the urgent care center notices a diabetic child may be having metabolic acidosis. Which of the following assessment data would be most indicative of this disorder?
Kussmaul respiration and drowsiness ( Explanation: Kussmaul respiration and drowsiness are signs of metabolic acidosis. Irritability and tachycardia are signs of respiratory acidosis. Dizziness and numbness are signs of respiratory alkalosis. Muscle tetany and tachycardia are signs of metabolic alkalosis.)
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 Explanation: Growth hormone (GH) deficiency occurs when the anterior pituitary is unable to produce enough hormone for usual growth. Somatotropin is the name of the growth hormone administered. Administering subcutaneous GH to the child helps correct this deficiency. The GH dosage is 0.2 to 0.3 mg/kg given daily. It is not administered orally. Aldosterone causes sodium to be retained and a provocation would be the administration of diuretics to reduce the sodium. Beta cells are found in the heart muscles, smooth muscles, airways, and arteries. They are also found in the pancreas to secrete insulin. None of these cell actions are related to the anterior pituitary.
The nurse is obtaining a health history from parents whose 4-month-old boy has congenital hypothyroidism. What would the nurse most likely assess?
It is difficult to keep the child awake. Explanation: During the health history, the parents may state that it is difficult to keep the child awake. Physical examination would reveal that the child is below weight and height, that his skin is pale and mottled, and that he is lethargic and irritable.
Which results would indicate to the nurse the possibility that a neonate has congenital hypothyroidism?
Low T4 level and high TSH level (Explanation: Screening results that show a low T4 level and a high TSH level indicate congenital hypothyroidism and the need for further tests to determine the cause of the disease.)
Which results would indicate to the nurse the possibility that a neonate has congenital hypothyroidism?
Low T4 level and high TSH level Explanation: Screening results that show a low T4 level and a high TSH level indicate congenital hypothyroidism and the need for further tests to determine the cause of the disease.
The nurse is caring for a child diagnosed with low functioning parathyroid. Which is a treatment goal of a child with hypoparathyroidism?
Maintain the child's calcium level at a normal level with calcium replacement as prescribed. Explanation: 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 nurse is teaching the parents of an infant with congenital adrenal hyperplasia about the signs and symptoms of adrenal crisis. The nurse determines that the teaching was successful when the parents correctly identify what sign of adrenal crisis?
Persistent vomiting
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.
Polyuria Polydipsia Polyphagia (Explanation: 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.)
An infant on the pediatric floor has diabetes insipidus. Which assessment data are important for the nurse to monitor while the infant is on strict fluid precautions?
Urine output Explanation: An infant with diabetes insipidus has a decrease in antidiuretic hormone. Strict fluid precautions will not alter urine formation. This assessment is important because the infant will be at great risk for dehydration and electrolyte imbalance. It is part of a basic assessment to monitor heart rate, temperature, skin turgor, and mucous membranes. These are important but may not indicate the infant's overall health. On fluid restriction, oral intake will be specified.
What finding would the nurse expect to assess in a child with hypothyroidism?
Weight gain ( Explanation: Hypothyroidism is manifested by weight gain, fatigue, cold intolerance, and dry skin. Nervousness, heat intolerance, and smooth velvety skin are associated with hyperthyroidism.)
In a child with diabetes insipidus, which characteristic would most likely be present in the child's health history?
abrupt onset of polyuria, nocturia, and polydipsia (Explanation: Diabetes insipidus is characterized by deficient secretion of antidiuretic hormone leading to diuresis. Most children with this disorder experience an abrupt onset of symptoms, including polyuria, nocturia, and polydipsia. The other choices reflect symptoms of pituitary hyperfunction.)
The nurse is assessing a child diagnosed with Cushing syndrome. Which signs and symptoms would the nurse likely note? Select all that apply.
acne abdominal striae excessive hair growth
The nurse is assessing a child diagnosed with Cushing syndrome. Which signs and symptoms would the nurse likely note? Select all that apply.
acne abdominal striae excessive hair growth Explanation: Signs and symptoms of Cushing syndrome include excessive hair growth, moon face with ruddy cheeks, dorsocervical fat pad, truncal obesity, abdominal striae, easy bruising, and poor wound healing.
Polydipsia
condition of excessive thirst
The nurse is caring for a child who has developed thyroid storm. What intervention(s) will the nurse initiate? Select all that apply.
cooling blanket continuous cardiac monitoring decrease stimulation, such as turning off lights and television
The nurse is preparing a teaching plan for the family and their 6-year-old child who has just been diagnosed with diabetes. What would the nurse identify as the initial goal for the teaching plan?
developing management and decision-making skills
A newborn girl is discovered to have congenital adrenal hyperplasia. When assessing her, the nurse would expect to find which physical characteristic?
enlarged clitoris Explanation: Lack of production of cortisol by the adrenal gland leads to overproduction of androgen. This leads to female infants developing an enlarged clitoris.
The nurse knows that disorders of the pituitary gland depend on the location of the physiologic abnormality. In caring for a child that has issues with the anterior pituitary, the nurse knows that this child has issues with which hormone?
growth hormone Explanation: Disorders of the pituitary gland depend on the location of the physiologic abnormality. The anterior pituitary, or adenohypophysis, is made up of endocrine glandular tissue and secretes growth hormone (GH), adrenocorticotropic hormone (ACTH), TSH, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin. The posterior lobe is called the neurohypophysis because it is formed of neural tissue. It secretes antidiuretic hormone (ADH; vasopressin) and oxytocin. Usually, several target organs are affected when there is a disorder of the pituitary gland, especially the adenohypophysis.
Shortly after delivery, a newborn is diagnosed with hypocalcemia. What manifestation will the nurse assess in this client?
jitteriness
Metabolic acidosis is
low pH, low HCO3
Which hormones are secreted by the adrenal medulla? Select all that apply.
norepinephrine epinephrine
Which hormones are secreted by the adrenal medulla? Select all that apply.
norepinephrine epinephrine Explanation: The adrenal medulla secretes epinephrine and norepinephrine; the adrenal cortex secretes aldosterone and cortisol. The pancreas secretes insulin.
The nurse knows that which condition is caused by excessive levels of circulating cortisol?
Cushing syndrome Explanation: 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 newborn is diagnosed with the salt-losing form of congenital adrenogenital hyperplasia. On what should the nurse focus when assessing this client?
Dehydration Explanation: 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 reviewing with an 8-year-old how to self-administer insulin. Which of the following is the proper injection technique for insulin injections?
Elevate the subcutaneous tissue before the injection. Explanation: Insulin injections are always given subcutaneously. Elevating the skin tissue prevents injection into muscles when subcutaneous injections are given. The needle bevel should face upward. The skin is spread in intramuscular, not subcutaneous, injections. It is no longer recommended to aspirate blood for subcutaneous injections.
The nurse is assessing an 8-year-old boy who is performing academically at a second-grade level. The mother reports that the boy states feeling weak and tired and has had a weight increase of 6 pounds (13.2 kg) in 3 months. Which additional data would fit with a possible diagnosis of hypothyroidism?
The child states that the exam room is cold.
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 The loss of electrolytes would be reflected in vital signs
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?
diabetes insipidus (Explanation: The most common symptoms of central diabetes insipidus are polyuria (excessive urination) and polydipsia (excessive thirst). Children with diabetes insipidus typically excrete 4 to 15 L/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.)
Insulin deficiency, in association with increased levels of counter-regulatory hormones and dehydration, is the primary cause of:
diabetic ketoacidosis. (Explanation: Insulin deficiency, in association with increased levels of counter-regulatory 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. Glucosuria is glucose that is spilled into the urine.)
A 6-week-old infant has been diagnosed with congenital hypothyroidism. Once the level of medication has been determined, in order to maintain the proper dosing of thyroid hormone, the nurse instructs the parents to have the baby's levels tested how often during the first year?
every 1 to 3 months
The nurse is caring for a 12-year-old girl with a chronic endocrine condition that has resulted in weight gain, facial hair, and acne. During a routine examination, the girl confides that she doesn't participate in any extracurricular activities or have any social life because she is so unattractive. She feels it is pointless to get involved with anything or anyone because she is always going to be "fat and ugly." When responding to the girl, which of the following would be the priority?
exploring the girl's perception of her body image and health status Explanation: Obtaining information about how the child perceives herself provides a baseline from which to develop a teaching plan to address the child's inaccurate beliefs and then develop strategies to highlight good feelings. Assisting the girl with methods to enhance physical appearance is helpful after the nurse addresses the child's perceptions. Referral to a counselor might be appropriate after exploring the child's feelings.
The nurse is assessing a 9-year-old girl with a history of tuberculosis at age 6 years. She has been losing weight and has no appetite. The nurse suspects Addison disease based on which assessment findings?
hyperpigmentation and hypotension
A child is diagnosed with hypoparathyroidism. Which electrolyte imbalance would the nurse mostlikely expect to address?
hypocalcemia (Explanation: Hypoparathyroidism results in low production of PTH, which in turn leads to hypocalcemia and hyperphosphatemia. )
An 8-year-old girl presents to the clinic for moodiness and irritability. The child has begun to develop breasts and pubic hair and the parents are concerned that the child is at too early an age for this to begin. The nurse knows that these symptoms may be indicative of what disorder?
precocious puberty ( Explanation: Precocious puberty occurs when the child's sexual characteristics begin to develop before the normal age of puberty. 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. The behavior may change to that of a typical adolescent. Girls may have episodes of moodiness and irritability, whereas boys may become more aggressive. Pseudopuberty occurs when there is only partial development after testosterone is secreted. It occurs in males. Adrenal hyperplasia is an inherited disorder and it affects the production of androgen. Neurofibromatosis is a genetic disorder of the nervous system where tumors grow on the nerves.)
A 15-year-old girl has had type 1 diabetes since she was 2 years old. She recently began dialysis and is also struggling with exhaustion. She has been hospitalized with an infection and confides to the nurse that she feels hopeless due to her failing health. How should the nurse respond?
"What do you think would help you feel better or improve your situation?"
The nurse is developing a plan of care for a 7-year-old boy with diabetes insipidus. What is the priority nursing diagnosis?
Deficient fluid volume related to dehydration Explanation: The priority nursing diagnosis most likely would be deficient fluid volume related to dehydration, due to a deficiency in the secretion of antidiuretic hormone (ADH). Excess fluid would result from a disorder that leads to water retention, such as syndrome of inappropriate antidiuretic hormone (SIADH). Deficient knowledge related to fluid intake regimen is a nursing diagnosis for this child, but a secondary one. Imbalanced nutrition, more than body requirements related to excess weight would be inappropriate for this child since he probably has lost weight secondary to the fluid loss.
The nurse is caring for a 12-year-old girl with a chronic endocrine condition that has resulted in weight gain, facial hair, and acne. During a routine examination, the girl confides that she doesn't participate in any extracurricular activities or have any social life because she is so unattractive. She feels it is pointless to get involved with anything or anyone because she is always going to be "fat and ugly." Which of the following actions should the nurse take first?
Explore the girl's perception of her body image and health status. Explanation: Knowing the child's perceptions enables teaching to address inaccurate beliefs and develop strategies to highlight good feelings. Assisting the girl with methods to enhance physical appearance is helpful after the nurse addresses the child's perceptions. Referral to a counselor might be appropriate after exploring the child's feelings.
The nurse is seeing a new client in the clinic who reports polyuria and polydipsia. These conditions are indicative of which endocrine disorder?
Diabetes insipidus (DI) ( 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.)
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?
Metformin ( Explanation: Metformin, a biguanide, reduces glucose production from the liver. Glipizide, glyburide, and nateglinide all stimulate insulin secretion by increasing the response of β cells to glucose.)
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?
"Carry crackers or fruit to eat before or during periods of increased activity." Explanation: 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.
Insulin deficiency, in association with increased levels of counter-regulatory hormones and dehydration, is the primary cause of:
diabetic ketoacidosis. Explanation: Insulin deficiency, in association with increased levels of counter-regulatory 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. Glucosuria is glucose that is spilled into the urine.
A newborn girl is discovered to have congenital adrenal hyperplasia. When assessing her, the nurse would expect to find which physical characteristic?
enlarged clitoris ( Explanation: Lack of production of cortisol by the adrenal gland leads to overproduction of androgen. This leads to female infants developing an enlarged clitoris.)
The nurse is caring for a child recently diagnosed with hypoparathyroidism disorder. Which medication would the nurse expect to be ordered?
oral calcium Explanation: 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.
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 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.
The nurse is administering biosynthetic growth hormone, derived from recombinant DNA, by subcutaneous injection. The daily dosage is 0.2 to 0.3 mg/kg, given in divided doses. The child weighs 110 lb (49.9 kg). What is the safe dosage limit for this child on a daily basis? Record your answer using a whole number.
15 Explanation: Use the child's weight in kilograms: 49.9 Minimum: 49.9 kg × 0.2 mg/kg = 9.98 mg, round to 10 mgMaximum: 49.9 kg × 0.3 mg/kg = 14.97 mg, round to 15 mg The safe limit is determined by using the maximum dosage. The lack of growth hormone impairs the body's ability to metabolize protein, fat, and carbohydrates. Treatment of primary growth hormone deficiency involves the use of supplemental growth hormone. Treatment continues until near-final height goal is achieved.
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 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.
The school nurse observes an 8th grader at school who suddenly is losing weight, is not participating in gym, and is in poor academic standing. The nurse takes a history and notes that the child seems very nervous. The nurse notifies the parent, who explains that the child has just been seen by the family health care provider and tested low for thyroid-stimulating hormone (TSH). For which condition will the nurse devise a plan of care?
Graves disease
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. ( Explanation: 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.)
An elementary school child takes metformin three times each day. Which disorder would the school nurse expect the child to have?
Type 2 diabetes mellitus (Explanation: Metformin is the common treatment to manage type 2 DM. Insulin, not oral medication, is the treatment of choice for type 1 DM. Metoclopramide is the treatment for GI reflux. Methylprednisolone is used to treat inflammatory bowel disease.)
A nurse is taking care of an infant with diabetes insipidus. Which assessment data are mostimportant for the nurse to monitor while the infant has a prescription for fluid restriction?
Urine output (Explanation: 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.)
When discussing care of an infant with congenital hypothyroidism, you would stress that the infant will need:
administration of levothyroxine for a lifetime. Explanation: Hypothyroidism occurs because the thyroid is not producing adequate thyroxine. The child will need a supplemental source for a lifetime.
An 8-year-old child is seen for moodiness and irritability. The child has begun to develop breast and pubic hair and the parents are concerned that these changes are occurring at too early an age. Which would the nurse suspect?
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.
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.
Polyuria Polydipsia Polyphagia Explanation: 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.
An 8-year-old child is seen for moodiness and irritability. The child has begun to develop breast and pubic hair and the parents are concerned that these changes are occurring at too early an age. Which would the nurse suspect?
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 nurse is teaching glucose monitoring and insulin administration to a child with type 1 diabetes and the parents. Which comment by a parent demonstrates a need for additional teaching?
"During exercise we should wait to check blood sugars until after our child completes the activity." Explanation: Blood glucose monitoring needs to be performed more often during prolonged exercise. Frequent glucose monitoring before, during, and after exercise is important to recognize hypoglycemia or hyperglycemia. Frequent glucose monitoring if the child is sick is also important to recognize changes in glucose levels and prevent hypoglycemia or hyperglycemia. The parents are correct that they will check their child's glucose before meals; they should also check it before bedtime snacks. Blood glucose level should never be the only factor considered when calculating insulin dosing. Food intake and recent or expected activity/exercise must be factored in.
A 12-year-old is being seen in the office and has hyperthyroidism; the nurse knows that the most common cause of hyperthyroidism is:
Graves disease ( Explanation: Hyperthyroidism occurs less often in children than hypothyroidism. Graves disease, the most common cause of hyperthyroidism in children, occurs in 1 in 5,000 children between 11 and 15 years of age. Hyperthyroidism occurs more often in females, and the peak incidence occurs during adolescence.)
The nurse is caring for an 8-year-old girl with an endocrine disorder involving the posterior pituitary gland. What care would the nurse expect to implement?
Teaching the parents how to administer the desmopressin acetate ( Explanation: The nurse would teach the parents how to administer desmopressin acetate, which treats diabetes insipidus, a disorder related to the posterior pituitary gland. Instructing parents to report adverse reactions to growth hormone is an intervention for growth hormone deficiency. Informing the parents that treatment stops at the normal time of puberty is a teaching intervention for precocious puberty. Educating the parents to report signs of an acute adrenal crisis is an intervention for congenital adrenal hyperplasia. All three of these other disorders are related to the anterior pituitary.)
A child with growth hormone deficiency is receiving growth hormone. What result would the nurse interpret as indicating effectiveness of this therapy?
height increase of 4 inches Explanation: Effectiveness of growth hormone therapy is indicated by at least a 3- to 5-inch increase in linear growth in the first year of treatment. Rapid weight gain and headaches are adverse reactions of this therapy. The drug is stopped when the epiphyseal growth plates close.
The nurse is assessing a 5-year-old child whose parent reports the child has been vomiting lately, has no appetite, and has had an extreme thirst. Laboratory work for diabetes is being completed. Which symptom would differentiate between type 1 diabetes from type 2 diabetes?
recent weight loss (Explanation: Weight loss is unique to type 1 diabetes, whereas weight gain is associated with type 2. Hypertension is consistent with type 2 diabetes. Both type 1 and type 2 diabetes cause delayed wound healing. The increase in blood glucose in diabetes causes damage to the inner lining of the arteries that cause the arteries to develop plaque and harden. These damages to the blood vessels result in a decrease in the ability of oxygen-rich blood to be transported effectively to the tissues to promote wound healing. Loose stools or repeated loose stools (diarrhea) is a common side effect of the oral medication metformin, which is prescribed for clients with type 2 diabetes. Insulin, the treatment for type 1 diabetes, has constipation as one of the side effects.)
A child and her parents are being seen in the office after discharge from the hospital with a new diagnosis of type 2 diabetes. Which statement by the nurse is true?
"Kids can usually be managed with an oral agent, meal planning, and exercise." (Explanation: Treating type 2 diabetes in children may require insulin at the outset if the child is acidotic and acutely ill. More commonly, the child can be managed initially with oral agents, meal planning, and increased activity. Telling the child that she is lucky she did not have to learn how to give a shot might scare her, so it will inhibit her from seeking future health care. The condition will not rectify itself if all orders are followed. A weight-loss program might need to be implemented but that is not always the case.)
A1C test
A test for checking the sugar on red blood cells to get an average glucose level in your bloodstream over several months.
After hospital discharge, the parent of a child newly diagnosed with type 1 diabetes mellitus telephones the nurse because the child is acting confused and very sleepy. Which emergency measure would the nurse suggest the parent carry out before bringing the child to see the health care provider?
Give the child a glass of orange juice. (Explanation: The child is experiencing symptoms of hypoglycemia. Administering a form of glucose would help relieve them. This can be glucose tablets or a rapidly absorbable carbohydrate such as orange juice. This should be followed by a snack of complex carbohydrates and protein within 30 to 60 minutes. Insulin cannot be absorbed when taken orally and administering insulin would make the hypoglycemia worse. Withholding treatment waiting to get to the health care provider's office may cause the hypoglycemia to worsen and be a risk to the child's life. Children with diabetes and their parents need to be taught to recognize and treat the symptoms of hypoglycemia.)
A 7-year-old child who has type 1 diabetes mellitus is at school reporting a headache and dizziness. The school nurse notices sweat on the child's face. What should the nurse do first?
Offer the child 8 ounces of juice or soda Explanation: These are symptoms of hypoglycemia. Glucagon is given only for severe hypoglycemia. Juice or soda is the best choice to get the child an immediate source of carbohydrates. Insulin or water would be given for hyperglycemia.
The nurse is caring for 1-month-old girl with thyrotoxicosis. What finding would the nurse expect to assess?
The child has a strong appetite but fails to thrive.
The nurse is caring for a child who has developed thyroid storm. What intervention(s) will the nurse initiate? Select all that apply.
cooling blanket continuous cardiac monitoring decrease stimulation, such as turning off lights and television Explanation: Signs and symptoms related to the development of thyroid storm include fever, diaphoresis, and tachycardia. Children with thyroid storm are typically restless and irritable. Interventions include a cooling blanket, continuous cardiac monitoring and decreasing stimulation. Caloric intake may need to be increased and dosages of L-thyroxine sodium may need to be held or decreased.
The nurse is developing a plan of care for a 7-year-old boy with diabetes insipidus. What is the priority nursing diagnosis?
Deficient fluid volume related to dehydration ( Explanation: The priority nursing diagnosis most likely would be deficient fluid volume related to dehydration, due to a deficiency in the secretion of antidiuretic hormone (ADH). Excess fluid would result from a disorder that leads to water retention, such as syndrome of inappropriate antidiuretic hormone (SIADH). Deficient knowledge related to fluid intake regimen is a nursing diagnosis for this child, but a secondary one. Imbalanced nutrition, more than body requirements related to excess weight would be inappropriate for this child since he probably has lost weight secondary to the fluid loss.)
A 10-year-old child has been diagnosed with type 1 diabetes. The child is curious about the cause of the disease and asks the nurse to explain it. Which explanation will the nurse provide?
"Special cells in a part of your body called the pancreas cannot make a chemical called insulin, which helps control the sugar level in your blood." Explanation: When providing instruction to a child, the nurse must consider the developmental age. Type 1 diabetes is a disorder that involves an absolute or relative deficiency of insulin, thus the blood glucose level remains high if an appropriate amount of insulin is not administered to the client. With type 2 diabetes, the body produces an adequate amount of insulin; however, the body is resistant to using the insulin properly to keep circulating blood glucose levels at a normal level. The rest of the statements provide incorrect information regarding the pathophysiology of type 1 diabetes.
A nurse is reinforcing the diagnosis of constitutional delay by the health provider to a 13-year-old male adolescent. Which is the best approach for this teen?
"You will not need medication because your hormone levels are normal. I would be glad to discuss these findings with you." ( Explanation: This diagnosis of "short stature" or constitutional delay may cause self-esteem issues with male teens. The nurse should explore the teen's feelings. Teens with a delay in puberty usually experience puberty late, so there is no need for a second opinion. Hormone therapy is not given until after age 14.)
A child and parents are being seen in the office after discharge from the hospital. The child was newly diagnosed with type 2 diabetes. When talking with the child and parents, which statement by the nurse would be most appropriate?
"Young people can usually be managed with an oral agent, meal planning, and exercise." (Explanation: Treating type 2 diabetes in children may require insulin at the outset if the child is acidotic and acutely ill. More commonly, the child can be managed initially with oral agents, meal planning, and increasing activity. Telling the child that she is lucky she did not have to learn how to give a shot might scare her, so it will inhibit her from seeking future health care. Additionally, insulin may be used if good control is not achieved. The condition will not rectify itself if all orders are followed. A weight-loss program might need to be implemented but that is not always the case.)
The nurse is taking a history on a 10-year-old child who has a diagnosis of hypopituitarism. Which question is important for the nurse to ask the parents?
"What time each day does your child take his growth hormone?" ( Explanation: 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 child is undergoing diagnostic testing for an endocrine dysfunction. The results indicate excessive levels of circulating cortisol. The nurse interprets this finding as indicating which of the following?
Cushing syndrome Explanation: 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 deletion of the entire X chromosome.
A child is undergoing diagnostic testing for an endocrine dysfunction. The results indicate excessive levels of circulating cortisol. The nurse interprets this finding as indicating which of the following?
Cushing syndrome ( Explanation: 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 deletion of the entire X chromosome.)
The nurse is caring for a 12-year-old girl with a chronic endocrine condition that has resulted in weight gain, facial hair, and acne. During a routine examination, the girl confides that she doesn't participate in any extracurricular activities or have any social life because she is so unattractive. She feels it is pointless to get involved with anything or anyone because she is always going to be "fat and ugly." Which of the following actions should the nurse take first?
Explore the girl's perception of her body image and health status. ( Explanation: Knowing the child's perceptions enables teaching to address inaccurate beliefs and develop strategies to highlight good feelings. Assisting the girl with methods to enhance physical appearance is helpful after the nurse addresses the child's perceptions. Referral to a counselor might be appropriate after exploring the child's feelings.)
A child has been diagnosed with the syndrome of inappropriate antidiuretic hormone (SIADH) and has been admitted to the hospital. Which nursing intervention is most important for this child?
Monitor sodium levels. Explanation: The syndrome of inappropriate antidiuretic hormone (SIADH) occurs when ADH (vasopressin) is secreted in the presence of a low osmolality because the feedback mechanism that regulates ADH does not work. ADH continues to be released, causing water retention and decreased serum sodium. To correct the problem the child should be placed on fluid restriction and IV sodium chloride should be administered to correct hyponatremia. If the sodium levels drop, neurological signs develop (headache, altered mental status, behavior changes, seizures, and even coma). The child would need to be weighed daily and any gastrointestinal symptoms need to be corrected. Intake and output, especially the output, are important to monitor.
