Exam #4-Pediatric Endocrine Disorders

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A newborn girl is discovered to have congenital adrenal hyperplasia. When assessing her, the nurse would expect to find which physical characteristic?

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.

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

Graves disease

A 10-year-old child has been diagnosed with precocious puberty. When talking with the child, what statements are appropriate? Select all that apply.

"How are you doing in school?" "Developing is normal but your development is happening early." "Would talking with someone about your feelings help?" "Tell me about your feelings about what is happening to your body."

"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.

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." 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 nurse is teaching an adolescent with type 1 diabetes about the disease. Which instruction by the nurse about how to prevent hypoglycemia would be most appropriate for the adolescent? a) "Increase the insulin dosage before planned or unplanned strenuous exercise." b) "Carry crackers or fruit to eat before or during periods of increased activity." c) "Limit participation in planned exercise activities that involve competition." d) "Check your blood glucose level before exercising, and eat a protein snack if the level is elevated."

"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.

"I can eat two small cookies with each meal." 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

The nurse is teaching a 12-year-old girl with diabetes mellitus type 2 and her parents about dietary measures to control her glucose levels. Which comment by the child indicates a need for additional teaching? a) "I can eat two small cookies with each meal." b) "We should give her nonfat milk to drink." c) "I will be eating more breads and cereals." d) "I can have an apple or orange for snacks."

"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.

During a visit to the clinic the adolescent client with hypothyroidism tells the nurse that she takes her Synthroid (levothyroxine) "whenever I think about it...sometimes I miss a dose, but not very often." What is the best response by the nurse?

"I know it's hard to remember medicines, but it is really important for you to take it before breakfast each day to control your hypothyroidism."

The nurse is teaching the parents of a 3-year-old girl with diabetes insipidus how to administer desmopressin acetate (DDAVP). Which comment indicates further need for teaching? a) "If she sneezes the medicine out of her nose, I wait until the next dose." b) "Once the tube is filled, I hold it closed until I insert it into her nostril." c) "I check the specific gravity of her urine to see if the drug is working." d) "First I suction her nostrils, if necessary, to help the drug be absorbed."

"If she sneezes the medicine out of her nose, I wait until the next dose." Explanation: The nurse must remind the parents that the medicine should be readministered immediately if the child sneezes. Proper intranasal administration of DDAVP starts with clearing the nostril. The effectiveness of the drug is monitored by checking the specific gravity of the child's urine. Proper administration involves inserting the measured tubing into the bottle, filling it to the proper dosage, holding the tube closed until it is inserted into the child's nostril, then blowing the fluid out of the tube.

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

Antidiuretic hormone (ADH)

The school age child is scheduled for a 2-hour plasma glucose test. The nurse has given verbal and written instructions to the parent regarding the test. Which comments by the parent indicate that instructions for the test were not followed?

"My child only took half of their normal insulin dose this morning." "When will the IV be started that administers the sugar solution?" "This test helps in diagnosing infections that may cause my child's blood sugar to be abnormal."

The nurse is educating the parents of a client newly diagnosed with type 1 diabetes. Which statement by the parents indicates additional teaching is needed?

"Our child should not participate in sports or physical activity."

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."

After explaining the causes of hypothyroidism to the parents of a newly diagnosed infant, the nurse should recognize that further education is needed when the parents ask which question? a) "Do you mean that hypothyroidism may be caused by a problem in the way the body makes thyroxine?" b) "Are you saying that hypothyroidism is caused by a problem in the way the thyroid gland develops?" c) "So, hypothyroidism can be only temporary, right?" d) "So, hypothyroidism can be treated by exposing our baby to a special light, right?"

"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 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?"

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."

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."

The nurse is preparing to administer the child's ordered lispro (Humalog) insulin at 0800. When will the child's blood glucose level begin to decline?

0815 The onset of rapid acting insulins like lispro (Humalog) is within 15 minutes. Short-acting insulin's onset is 30 to 60 minutes. Intermediate-acting insulin's onset is 1-3 hours, and long-acting insulin's onset is 1-2 hours.

The nurse is administering biosynthetic GH, derived from recombinant DNA, by subcutaneous injection. The weekly dosage is 0.2 to 0.3 mg/kg, given in divided doses daily. The child weighs 110 pounds. What is the safe dosage limit for this child on a weekly basis?

15 110 lb divided by 2.2 kg = 50 kg 50 kg X 0.2 mg = 10 mg 50 kg X 0.3 mg= 15 mg The lack of GH impairs the body's ability to metabolize protein, fat, and carbohydrates. Treatment of primary GH deficiency involves the use of supplemental GH. Treatment continues until near final height goal is achieved.

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

8.5%

The nurse is caring for a child admitted to the emergency center in diabetic ketoacidosis. Which of the following clinical manifestations would the nurse most likely note in this child? a) Drowsiness and fruity odor to breath b) Hyperactive and restless behavior c) Slow pulse and elevated blood pressure d) Pale and moist skin

A Explanation: Diabetic ketoacidosis is characterized by drowsiness, dry skin, flushed cheeks and cherry-red lips, acetone breath with a fruity smell, and Kussmaul breathing (abnormal increase in the depth and rate of the respiratory movements). Nausea and vomiting may occur. If untreated, the child lapses into coma and exhibits dehydration, electrolyte imbalance, rapid pulse, and subnormal temperature and blood pressure.

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 simple blood test to diagnose hypothyroidism is required in most states.

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

Administering intravenous calcium gluconate as ordered Administering intravenous calcium gluconate, as ordered, will restore normal calcium and phosphate levels as well as relieve severe tetany. Ensuring patency of the IV site to prevent tissue damage due to extravasation or cardiac arrhythmias is an intervention for any child with an IV, and monitoring fluid intake and urinary calcium output are secondary interventions. Providing administration of calcium and vitamin D is an intervention for nonacute symptoms.

The nurse is providing acute care for an 11-year-old boy with hypoparathyroidism. Which of the following is the priority intervention? a) Providing administration of calcium and vitamin D b) Ensuring patency of the IV site to prevent tissue damage c) Administering intravenous calcium gluconate as ordered d) Monitoring fluid intake and urinary calcium output

Administering intravenous calcium gluconate as ordered Explanation: Administering intravenous calcium gluconate, as ordered, will restore normal calcium and phosphate levels as well as relieve severe tetany. Ensuring patency of the IV site to prevent tissue damage due to extravasation or cardiac arrhythmias is an intervention for any child with an IV, and monitoring fluid intake and urinary calcium output are secondary interventions. Providing administration of calcium and vitamin D is an intervention for nonacute symptoms

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

Antidiuretic hormone

Diabetes insipidus is a disorder of the posterior pituitary that results in deficient secretion of which hormone? a) Luteinizing hormone (LH) b) Antidiuretic hormone (ADH) c) Thyroid stimulating hormone (TSH) d) Adrenocorticotropic hormone (ACTH)

Antidiuretic hormone (ADH) Explanation: Central diabetes insipidus (DI), also called neurogenic, vasopressin-sensitive, or hypothalamic DI, is a disorder of the posterior pituitary that results from deficient secretion of ADH. Nephrogenic DI is a result of the inability of the kidney to respond to ADH.

The health care provider has prescribed a thyroid scan to confirm a diagnosis. What intervention should the nurse perform before the examination?

Assess the client for allergies.

The physician has ordered a thyroid scan to confirm the diagnosis. Before the procedure the nurse should:

Assess the client for allergies. A thyroid scan uses dye, so a client should be assessed for allergies to iodine and shellfish to prevent a possible reaction. The client will not be asleep, have a catheter, or receive a bolus of fluids

The physician has ordered a thyroid scan to confirm the diagnosis. Before the procedure the nurse should: a) Assess the client for allergies. b) Give the client a bolus of fluids. c) Insert a urinary catheter. d) Tell the client they will be asleep

Assess the client for allergies. Explanation: A thyroid scan uses dye, so a client should be assessed for allergies to iodine and shellfish to prevent a possible reaction. The client will not be asleep, have a catheter, or receive a bolus of fluids.

A 17-year-old adolescent is found wandering around. The adolescent is confused, sweaty, and pale. Which test would the nurse expect to be performed first?

Blood glucose level

A 17-year-old is found after a high school football game wandering around. He is confused, sweaty, and pale. Which of the following tests is most likely to be performed first? a) CT scan b) Arterial blood gases c) Blood glucose level d) Blood cultures

Blood glucose level Explanation: It is important to draw a blood glucose level on the child because he is exhibiting signs of hypoglycemia and he needs to be treated as soon as possible. Once the patient is stabilized, a complete health history will need to be taken to determine the extent of his illness.

A child is prescribed glargine insulin. What information would the nurse include when teaching the child and parents about this insulin?

Do not mix this insulin with other insulins.

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 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 cell count and erythrocyte sedimentation rate test are not used for this purpose.

A pediatric client has just been diagnosed with diabetes mellitus. What would the nurse do first?

Check blood glucose levels.

As a nurse, you know that which condition is caused by excessive levels of circulating cortisol:

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 deletion of the entire X chromosome.

As a nurse, you know that which of the following is caused by excessive levels of circulating cortisol: a) Graves disease b) Turner syndrome c) Cushing syndrome d) Addison disease

Cushing syndrome Explanation: CS 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. Grave disease is the most common form of hyperthyroidism. Turner syndrome is deletion of the entire X chromosome.

The major role of the endocrine system is to: A. produce enzymes. B. regulate insulin. C. absorb nutrients. D. secrete hormones.

D. secrete hormones.

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

Daily, 6 to 7 days a week

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.

A newborn is diagnosed with the salt-losing form of congenital adrenogenital hyperplasia. On what should the nurse focus when assessing this client?

Dehydration

In the salt-losing form of congenital adrenal hyperplasia, the most important observation you would make in a newborn would be for:

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

You are going in to see a new patient in the clinic and the chief complaints for the patient are polyuria and polydipsia. You know that these are indicative of which endocrine disorder? a) Hypopituitarism b) Precocious puberty c) Diabetes insipidus d) Syndrome of inappropriate antidiuretic hormone secretion

Diabetes insipidus Correct 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.

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

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.

A child is prescribed glargine (Lantus) insulin. What information would the nurse include when teaching the child and parents about this insulin?

Do not mix this insulin with other insulins. Glargine (Lantus) is not to be mixed with other insulins. Glargine is usually given in a single dose at bedtime. Insulin should be kept at room temperature; insulin that is administered cold may increase discomfort with the injection. Any vial of insulin that is opened should be discarded after 1 month

A newborn girl is discovered to have congenital adrenogenital hyperplasia. When assessing her, you would expect to find which physical characteristic? a) Small for gestational age b) Divergent vision c) Abnormal facial features d) Enlarged clitoris

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 assessing a 1-month-old girl who, according to the mother, doesn't eat well. Which assessment suggests the child has congenital hypothyroidism?

Enlarged tongue

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 testing done of the blood urea nitrogen (BUN) and creatinine. Which is the purpose of these two tests?

Evaluate renal function

A child is admitted to the pediatric medical unit with the diagnosis of syndrome of inappropriate antidiuretic hormone (SIADH). Based on the typical signs and symptoms of this disorder, which nursing diagnosis will the nurse identify as relating to this client?

Excess fluid volume

Tay-Sachs disease is found primarily in the Asian population. a) False b) True

False Explanation: Tay-Sachs disease is found primarily in the Ashkenazi Jewish population (Eastern European Jewish ancestry)

A 12-year-old is being seen in the office and has hyperthyroidism; the nurse knows that the most common cause of hyperthyroidism is which of the following: a) Plummer disease b) Addison disease c) Graves disease d) Cushing disease

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

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 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.

A 12-year-old child has hyperthyroidism. The nurse understands that the most common cause of hyperthyroidism in children is

Graves disease.

A child is diagnosed with hyperthyroidism. What finding would the nurse expect to assess?

Heat intolerance

A child is diagnosed with hyperthyroidism. Which of the following would the nurse expect to assess? a) Heat intolerance b) Constipation c) Facial edema d) Weight gain

Heat intolerance Explanation: Hyperthyroidism is manifested by heat intolerance, nervousness or anxiety, diarrhea, weight loss and smooth, velvety skin. Constipation, weight gain, and facial edema are associated with hypothyroidism.

The nurse is assessing a 16-year-old boy who has had long-term corticosteroid therapy. Which finding, along with the use of the corticosteroids, indicates Cushing disease?

History of rapid weight gain

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.

A 12-year-old girl is diagnosed with hyperthyroidism. What problem would the nurse anticipate she may have in school?

Inability to submit neat handwriting assignments Children with hyperthyroidism may develop hand tremors, which leads to poor handwriting.

A 12-year-old girl is diagnosed with hyperthyroidism. What problem do you anticipate she may have in school? a) Noncomprehension of written material b) Increase in sleepiness by the end of the day c) Inability to fit legs under a school desk d) Inability to submit neat handwriting assignments

Inability to submit neat handwriting assignments Explanation: Children with hyperthyroidism may develop hand tremors, which leads to poor handwriting.

The caregivers of a child just diagnosed with diabetes express concern that they won't remember the different signs and symptoms of hyperglycemia and hypoglycemia. As a result, they are afraid they won't handle an emergency correctly. The best initial response by the nurse would be to:

Instruct them to treat the reaction as if it's hypoglycemia, which is more likely. Hypoglycemia is much more likely to occur than hyperglycemia; so if there is any doubt as to whether the child is having a hypoglycemic or hyperglycemic reaction, it should be treated as hypoglycemia. While the pump may offer continuous insulin, it does not sense blood glucose level; insulin reactions can still occur. Careful monitoring of blood glucose is still needed. While repeating signs and symptoms may be helpful, caregivers of a recently diagnosed child have lots of information to absorb and the repetition may create more anxiety. Assuming that the caregivers can read and understand them, written materials and videos may be helpful but they should not take the place of an initial teaching session with a nurse.

In interpreting the negative feedback system that controls endocrine function, the nurse correlates how _______ secretion is decreased as blood glucose levels decrease. a) Adrenocorticotropic hormone b) Glucagon c) Glycogen d) Insulin

Insulin Explanation: Feedback is seen in endocrine systems that regulate concentrations of blood components such as glucose. Glucose from the ingested lactose or sucrose is absorbed in the intestine and the level of glucose in blood rises. Elevation of blood glucose concentration stimulates endocrine cells in the pancreas to release insulin. Insulin has the major effect of facilitating entry of glucose into many cells of the body; as a result, blood glucose levels fall. When the level of blood glucose falls sufficiently, the stimulus for insulin release disappears and insulin is no longer secreted.

Question: Rank the different types of insulin based on their duration of action beginning with the shortest to the longest duration.

Lispro Humulin R Humulin N Lantus Explanation: Lispro is a rapid-acting insulin. Humulin R is a short-acting insulin. Humulin N is an intermediate-acting insulin. Lantus is a long-acting insulin.

A group of students are reviewing information about oral diabetic agents. The students demonstrate understanding of these agents when they identify which agent as reducing glucose production from the liver? a) Metformin b) Glipizide c) Glyburide d) Nateglinide

Metformin Explanation: Metformin, a biguanide reduces glucose production from the liver. Glipizide stimulates insulin secretion by increasing the response of β cells to glucose. Glyburide stimulates insulin secretion by increasing the response of β cells to glucose. Nateglinide stimulates insulin secretion by increasing the response of β cells to glucose.

The nurse is preparing the care plan regarding medication therapy for a client with hyperpituitarism. The child is receiving Decadron (dexamethasone). What interventions should the nurse add to the care plan? Select all that apply.

Monitor client for edema Monitor client for high glucose levels Do not abruptly stop administering medication Decadron (dexamethasone) is a coritcosteroid drug. Adverse effects that the nurse must be alert to include edema, weight gain, glycosuria, signs of infection, and symptoms of peptic ulcer development. Giving the drug with food or milk helps decrease the chance of peptic ulcer disease and stomach upset. If corticosteroids are stopped abruptly, adrenal crisis can occur.

The nurse is interviewing the caregivers of a child admitted with a diagnosis of type 1 diabetes mellitus. The caregiver states, "She is hungry all the time and eats everything, but she is losing weight." The caregiver's statement indicates the child most likely has

Polyphagia

The nurse is assessing a 7-year-old girl with a headache, irritability, and vomiting. Her health history reveals she has had meningitis. Which intervention is priority?

Notifying the physician of the neurologic findings This child may have syndrome of inappropriate antidiuretic hormone (SIADH). Priority intervention for this child is to notify the physician of the neurologic findings. Remaining interventions will be to restore fluid balance with IV sodium chloride to correct hyponatremia, set up safety precautions to prevent injury due to altered level of consciousness, and monitor fluid intake, urine volume, and specific gravity.

The nurse is caring for an obese 15-year-old girl who missed two periods and is afraid she is pregnant. Which of the following findings would indicate polycystic ovary syndrome? a) Observation of acanthosis nigricans b) Complains of blurred vision and headaches c) Palpation reveals hypertrophy and weakness d) Auscultation reveals increased respiratory rate

Observation of acanthosis nigricans Explanation: Observation of acanthosis nigricans in addition to the obesity and amenorrhea is a further indication of polycystic ovary syndrome. Complaint of blurred vision and headaches are signs and symptoms of diabetes mellitus. Auscultation revealing an increased respiratory rate points to diabetes insipidus. Palpation revealing hypertrophy and weakness is typical of hypothyroidism.

The nurse is assessing a 5-year-old boy who has had several convulsions. The nurse continues to assess the child and suspects that he may have hypoparathyroidism. Which of the following would support this suspicion? a) Auscultation reveals an irregular heart rate. b) Observation reveals tetany. c) Slight exophthalmos is observed. d) The child acts sleepy and unresponsive.

Observation reveals tetany. Explanation: Tetany occurs in children with hypoparathyroidism due to decreased serum calcium levels. Sleepiness and lack of responsiveness would suggest hyperthyroidism Exophthalmos is associated with hyperthyroidism Irregular heart rate is associated with hyperthyroidism.

The nurse is interviewing the caregivers of a child admitted with a diagnosis of Type 1 Diabetes Mellitus. The caregiver states, "She is hungry all the time and eats everything, but she is losing weight." The caregiver's statement indicates the child most likely has which of the following? a) Pica b) Polyphagia c) Polydipsia d) Polyuria

Polyphagia Explanation: Symptoms of Type 1 Diabetes Mellitus include polyphagia (increased hunger and food consumption), polyuria (dramatic increase in urinary output, probably with enuresis), and polydipsia (increased thirst), and. Pica is eating nonfood substances.

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

The neonatal nurse caring for children with inborn errors of metabolism explains to the student nurse that prompt treatment is an essential intervention to successful management of the diseases. Which of the following is a recommended treatment for these conditions? a) Undergoing liver or bone marrow transplant to increase deficient enzymes b) Replacing deficient enzymes through intravenous administration c) Eliminating the deficient product from the child's diet d) Increasing substrates preceding the enzymatic block

Replacing deficient enzymes through intravenous administration Explanation: Prompt treatment for metabolic disorders may include replacing deficient enzymes through intravenous administration. Other interventions are decreasing substrates preceding the enzymatic block (e.g., avoiding a particular amino acid or carbohydrate), administering a supplement of the deficient product that should have been produced, providing an enzymatic cofactor, using medications to remove accumulated substrates, undergoing liver or bone marrow transplantation to eliminate all deficient enzymes, and providing somatic gene therapy (a future option)

A nurse is teaching a child with type 1 diabetes mellitus how to self-inject insulin. Which of the following methods should she recommend to the child for regular doses? a) Subcutaneously in the outer thigh b) Intradermally in the outer arm c) Intramuscularly in the abdomen d) Intravenously in the chest

Subcutaneously in the outer thigh Explanation: Insulin is always injected SC except in emergencies, when half the required dose may be given IV. SC tissue injection sites used most frequently in children include those of the upper outer arms and the outer aspects of the thighs. The abdominal SC tissue injection sites commonly used in adults can be adequate sites but most children dislike this site as abdominal skin is tender.

The nurse working with the child diagnosed with Type 2 Diabetes Mellitus recognizes that most often the disorder can be managed by which of the following? a) Increasing protein in the diet, especially in the evening b) Conserving energy with rest periods during the day c) Decreasing amounts of daily insulin d) Taking oral hypoglycemic agents

Taking oral hypoglycemic agents Explanation: If the child presents with diabetic ketoacidosis, initial treatment is insulin administration, but then oral hypoglycemic agents such as metformin are often effective for controlling blood glucose levels. Lifestyle changes such as weight loss and increased exercise are important aspects of treatment for the child.

The nurse is assessing a 5-year-old boy whose mother says he has been vomiting lately and has no appetite. Whst sign or symptom would the nurse identify as unique to diabetes mellitus type 1?

The child has lost weight recently. Weight loss is unique to diabetes mellitus type 1, whereas weight gain is associated with type 2. Hypertension is consistent with diabetes mellitus type 2. The sweet-smelling breath is common to both type 1 and type 2 diabetes and is a sign of ketoacidosis, a medical emergency, which is frequently how children present on initial evaluation. The rapid, deep Kussmaul breathing is common to both type 1 and type 2 diabetes and is a sign of ketoacidosis, a medical emergency, which is frequently how children present on initial evaluation.

The most common mixture of insulin used with children with type 1 diabetes mellitus is a combination of an intermediate-acting insulin and a regular insulin, usually in a 2:1 ratio or 0.75 units of the intermediate-acting insulin to 0.33 units regular insulin, and given in the same syringe. a) False b) True

True

A 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

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

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

Within 15 to 30 minutes Humalog is a rapid-acting insulin. The onset of Humalog insulin is within 15 minutes and the peak level is achieved within 30 to 90 minutes; therefore, the client should eat within 15 to 30 minutes to avoid a hypoglycemic reaction

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

In the salt-losing form of congenital adrenal hyperplasia, the most important observation you would make in a newborn would be for a) excessive cortisone secretion. b) hypoglycemia. c) dehydration. d) bleeding tendencies.

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

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

cognitive impairment

A newborn is born with hypothyroidism. A complication of this disorder if it is not recognized and treated is a) dehydration. b) cognitive impairment. c) muscle spasticity. d) blindness.

cognitive impairment. Explanation: Congenital hypothyroidism can lead to extreme cognitive challenge impairment if not treated.

Insulin deficiency, in association with increased levels of counter-regulatory hormones and dehydration, is the primary cause of

diabetic ketoacidosis.

Insulin deficiency, in association with increased levels of counter-regulatory hormones and dehydration, is the primary cause of:

diabetic ketoacidosis.

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

A school-aged girl is diagnosed as having Cushing syndrome from long-term therapy with oral prednisone. This means that the child:

has purple striae on her abdomen. An effect of a corticosteroid is to produce striae on the abdomen. Elevated levels of corticosteroids also cause these during pregnancy.

A school-aged girl is diagnosed as having Cushing's syndrome from long-term therapy with oral prednisone. This means that the child a) has purple striae on her abdomen. b) appears pale and fatigued. c) has hypoglycemia. d) is excessively tall for her age.

has purple striae on her abdomen. Explanation: An effect of a corticosteroid is to produce striae on the abdomen. Elevated levels of corticosteroids also cause these during pregnancy.

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

insulin

A 7-year-old is diagnosed as having type 1 diabetes. One of the first symptoms usually noticed by parents when this illness develops is a) swelling of soft tissue. b) loss of weight. c) craving for sweets. d) severe itching

loss of weight. Explanation: Lack of insulin reduces the ability of body cells to use glucose; this leads to starvation of cells and loss of weight as an early symptom

The nursing diagnosis most applicable to a child with growth hormone deficiency would be a) risk for situational low self-esteem related to short stature. b) risk for self-directed violence related to oversecretion of epinephrine. c) impaired skin integrity related to overproduction of melanin. d) ineffective tissue perfusion related to infantile blood vessels.

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

The nurse working with the child diagnosed with type 2 diabetes mellitus recognizes the disorder can be managed by:

taking oral hypoglycemic agents.

A 6-year-old child is being evaluated for growth hormone dysfunction. Which tests will be employed in the diagnostic workup?

• CT scan • MRI • Pituitary function test 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 child with a history of diabetes insipidus has been taking vasopressin. The parents bring the child to the clinic for an evaluation. During the visit, the parents mention that it seems like their son is hardly urinating. The nurse suspects syndrome of inappropriate antidiuretic hormone. Which of the following would the nurse expect to find to help confirm this condition? Select all that apply. a) Decreased urine osmolality b) Weight loss c) Serum osmolality 300 mOsm/kg d) Hypotension e) Decreased serum sodium level f) Urine specific gravity 1.033

• Urine specific gravity 1.033 • Decreased serum sodium level • Serum osmolality 300 mOsm/kg Explanation: Syndrome of inappropriate antidiuretic hormone (SIADH) is characterized by decreased urination, hyponatremia, serum osmolality greater than 280 mOsm/kg, urine specific gravity greater than 1.030, increased urine osmolality, fluid retention, weight gain, and hypertension.

The 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.

A child with a history of diabetes insipidus is admitted with polyuria, polydipsia, and mental confusion. The priority intervention for this client is to:

check 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 but not the priority. Encouraging fluids will not correct the problem and weighing the client is not necessary at this time.

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

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?"

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?

"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 child is prescribed glargine (Lantus) insulin. Which of the following would the nurse include when teaching the child and parents about this insulin? a) "Give the dose first thing in the morning." b) Discard any opened vials after a week. c) Store the insulin in the refrigerator until just before giving it. d) "Do not mix this insulin with other insulins."

"Do not mix this insulin with other insulins." Explanation: Glargine (Lantus) is not mixed with other insulins. Glargine is usually given in a single dose at bedtime. Insulin should be kept at room temperature; insulin that is administered cold may increase discomfort with the injection. Any vial of insulin that is opened should be discarded after 1 month

A child is prescribed glargine (Lantus) insulin. Which of the following would the nurse include when teaching the child and parents about this insulin? a) "Do not mix this insulin with other insulins." b) Discard any opened vials after a week. c) Store the insulin in the refrigerator until just before giving it. d) "Give the dose first thing in the morning."

A 15-year-old adolescent is scheduled for a pelvic ultrasound to evaluate for a possible ovarian cyst. Which instruction by the nurse would be most appropriate? a) "You need to remain very still for the entire test." b) "Drink plenty of fluids because you need to have a full bladder." c) "Limit your level of physical activity for one-half hour before the test." d) "You won't be able to drink any water before or during the test."

"Drink plenty of fluids because you need to have a full bladder." Explanation: A full bladder is needed for an ultrasound of the pelvic. The patient needs to remain still for a computed tomography or magnetic resonance imaging scan, not an ultrasound. Water is withheld during a water deprivation test used to detect diabetes insipidus. Limiting stress and physical activity for 30 minutes before the test is required for the growth hormone stimulation test.

The nurse is teaching a group of caregivers of children diagnosed with diabetes mellitus. The nurse is explaining insulin shock and the caregivers make the following statements. Which statement indicates the best understanding of a reason an insulin reaction might occur?

"He measures his own medication but sometimes doesn't administer the correct amount."

The nurse is speaking with the parents of a school-aged child recently diagnosed with diabetes mellitus regarding the differences between hypoglycemia and hyperglycemia. Which statement by a parent indicates a need for further teaching?

"If I notice changes in my son like tearfulness or irritability, his blood sugar may be high." Behavior changes such as tearfulness, irritability, confusion and slurred speech are indications of hypoglycemia, not hyperglycemia. Tremors and diaphoresis are also indications of low blood sugar. Dry flushed skin, fatigue, weakness, nausea, vomiting and fruity breath odor are all symptoms of hyperglycemia

The nursing is caring for a child recently admitted with an endocrine disorder. The child's mother asks the nurse what the term metabolism means. Which is the best response by the nurse?

"Metabolism refers to all physical and chemical reactions occurring in the body's cells that are necessary to sustain life."

When collecting data on a child diagnosed with diabetes mellitus, the nurse notes that the child has had weight loss and other symptoms of the disease. The nurse would anticipate which finding in the child's fasting glucose levels?

180 mg/dL A fasting glucose greater than or equal to 126 mg/dL or higher on two separate occassions diagnostic for diabetes when other signs such as polyuria and weight loss, despite polyphagia, are present.

The child has developed hypothyroidism and has been prescribed sodium L-thyroxine. The starting dose is 12 mg/kg of body weight each day. The child weighs 72 pounds. Calculate the child's dose in micrograms and round to the nearest whole number.

393 Explanation: The child weighs 72 pounds and 2.2 pounds = 1 kg. 72 pounds x 1 kg/2.2 pounds = 32.727 kg. 32.727 kg x 12 mcg/1 kg = 392.727 mcg Rounded to the nearest whole number = 393 mcg

Antidiuretic hormone Explanation: Diabetes insipidus results from a deficiency in the secretion of antidiuretic hormone (ADH). This hormone, also known as vasopressin, is produced in the hypothalamus and stored in the pituitary gland. Hypopituitarism or dwarfism involves a growth hormone deficiency. Diabetes mellitus involves a disruption in insulin secretion. Thyroxine is a thyroid hormone that if deficient leads to hypothyroidism

A newborn exhibits significant jittery movements, convulsions, and apnea. Hypoparathyroidism is suspected. Which of the following would the nurse expect to be administered? a) Desmopressin b) Levothyroxine c) Hydrocortisone d) Calcium gluconate

Calcium gluconate Explanation: 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.

A newborn is born with hypothyroidism. A complication of this disorder if it is not recognized and treated is:

Cognitive impairment. Congenital hypothyroidism can lead to extreme cognitive challenge impairment if not treated.

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

Cushing syndrome

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

Enlarged clitoris

A child with a primary growth hormone deficiency is to receive biosynthetic growth hormone. The nurse would explain to the child and parents that this hormone would be given at which frequency?

Daily Biosynthetic growth hormone, derived from recombinant DNA, is given by subcutaneous injection. The weekly dosage is 0.2 to 0.3 mg/kg, divided into equal doses given daily for best growth.

The nurse is caring for a child with diabetes mellitus type 1. The nurse notes that the child is drowsy, has flushed cheeks and red lips, a fruity smell to the breath, and there has been an increase in the rate and depth of the child's respirations. The nurse recognizes that these symptoms indicate the child has which of the following? a) Diabetic ketoacidosis b) Insulin reaction c) Polyphagia d) Cheyne stokes respiration

Diabetic ketoacidosis Explanation: Diabetic ketoacidosis is characterized by drowsiness, dry skin, flushed cheeks and cherry-red lips, acetone breath with a fruity smell, and Kussmaul breathing (abnormal increase in the depth and rate of the respiratory movements).

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

Draw up the short-acting insulin before the intermediate-acting insulin Stores the insulin vial at room temperature Gives the injection at a 45-degree angle

Which nursing objective is most important when working with neonates who are suspected of having congenital hypothyroidism? a) Allowing rooming in b) Encouraging fluid intake c) Promoting bonding d) Early identification

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.

The parathyroid glands regulate serum levels of glucose in the body. a) True b) False

False Explanation: The four parathyroid glands, located posterior and adjacent to the thyroid gland, regulate serum levels of calcium in the body by controlling the rate of bone metabolism

Give her a glass of orange juice. These are typical symptoms of hypoglycemia. Administering a form of glucose would help relieve them. Insulin cannot be absorbed when taken orally.

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

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

Hypocalcemia

You care for a 10-year-old boy with growth hormone deficiency. Which therapy would you anticipate will be prescribed for him?

Injections of growth hormone Growth hormone deficiency occurs when the pituitary is unable to produce enough hormone for usual growth. Administering subcutaneous growth hormone supplements this

The caregivers of a child just diagnosed with diabetes express concern that they won't remember the different signs and symptoms of hyperglycemia and hypoglycemia. As a result, they are afraid they won't handle an emergency correctly. What is the best initial response by the nurse to help ensure the child's safety?

Instruct them to treat the reaction as if it's hypoglycemia, which is more likely.

You care for a 10-year-old boy with growth hormone deficiency. Which therapy would you anticipate will be prescribed for him? a) Intramuscular injections of growth hormone b) Oral administration of somatotropin c) Short-term aldosterone provocation d) Long-term blocking of beta cells

Intramuscular injections of growth hormone Explanation: Growth hormone deficiency occurs when the pituitary is unable to produce enough hormone for usual growth. Administering IM growth hormone supplements this.

Which results would indicate to the nurse the possibility that a neonate has congenital hypothyroidism?

Low T4 level and high TSH level

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

Oral calcium

The nurse is assessing a 7-year-old girl who complains of headache, is irritable, and vomiting. Her health history reveals she has had meningitis. Which of the following is the priority intervention? a) Setting up safety precautions to prevent injury b) Restoring fluid balance with IV sodium c) Notifying the physician of the neurologic findings d) Monitoring urine volume and specific gravity

Notifying the physician of the neurologic findings Explanation: This child may have syndrome of inappropriate antidiuretic hormone (SIADH). Priority intervention for this child is to notify the physician of the neurologic findings. Remaining interventions will be to restore fluid balance with IV sodium chloride to correct hyponatremia, set up safety precautions to prevent injury due to altered level of consciousness, and monitor fluid intake, urine volume, and specific gravity.

Polyphagia Symptoms of type 1 diabetes mellitus include polyphagia (increased hunger and food consumption), polyuria (dramatic increase in urinary output, probably with enuresis), and polydipsia (increased thirst). Pica is eating nonfood substances.

The nurse is interviewing the caregivers of a child admitted with a diagnosis of type 1 diabetes mellitus. The caregiver states, "The teacher tells us that our child has to use the restroom many more times a day than other students do." The caregiver's statement indicates the child most likely has

Polyuria Symptoms of type 1 diabetes mellitus include polyuria (dramatic increase in urinary output, probably with enuresis), polydipsia (increased thirst), and polyphagia (increased hunger and food consumption). Pica is eating nonfood substances.

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

A child who has type 1 diabetes mellitus is brought to the emergency department and diagnosed with diabetic ketoacidosis. Which of the following would the nurse expect to administer? a) Detemir b) NPH c) Regular insulin d) Lispro

Regular insulin Explanation: Insulin for diabetic ketoacidosis is given intravenously. Only regular insulin can be administered by this route

A child has been prescribed Stimate (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?

Stimate (desmopressin acetate) is a synthetic antidiuretic hormone that will slow down your urine output

A child has been prescribed Stimate (esmopressin) acetate for the treatment of diabetes insipidus. The client and the parents ask the nurse how this drug works. What is the correct response by the nurse?

Stimate (esmopressin) acetate is a synthetic antidiuretic hormone that will slow down your urine output Stimate (esmopressin) acetate is a synthetic antidiuretic hormone that promotes reabsorption of water by action on renal tubules; it is used to control diabetes insipidus by decreasing the amount of urine produced

A 12-year-old boy arrives at the emergency room experiencing nausea, vomiting, headache, and seizures. He is diagnosed with bacterial meningitis. Other findings include a decrease in urine production, hyponatremia, and water intoxication. Which pituitary gland disorder would be most associated with these symptoms? a) Hypersecretion of somatotropin b) Syndrome of inappropriate antidiuretic hormone c) Hyposecretion of somatotropin d) Diabetes insipidus

Syndrome of inappropriate antidiuretic hormone Explanation: Syndrome of inappropriate antidiuretic hormone (SIADH) is a rare condition in which there is overproduction of antidiuretic hormone by the posterior pituitary gland. This results in a decrease in urine production and water intoxication. As sodium levels fall in proportion to water, the child develops hyponatremia or a lowered sodium plasma level. It can be caused by central nervous system infections such as bacterial meningitis. As the hyponatremia grows more severe, coma or seizures occur from brain edema. Diabetes insipidus is characterized by polyuria, not decreased urine production. Hyposecretion of somatotropin, or growth hormone, results in undergrowth; hypersecretion results in overgrowth.

A client is being treated for hyperthyroidism with propylthiouracil. The nurse suspects the client's dose of medication is inadequate when assessing which signs and/or symptoms? Select all that apply.

Tachycardia Diarrhea Fever Irritability Propylthiouraceil is an antithyroid drug which blocks synthesis of T3 and T4, and is indicated for treatment of hyperthyroidism. Signs of inadequate dose: tachycardia, diarrhea, fever, or irritability. Cold intolerance is a sign of overdosing of the medication.

A 6-year-old boy has a moon-faced, stocky appearance but with thin arms and legs. His cheeks are unusually ruddy. He is diagnosed with Cushing syndrome. What is the most likely cause of this condition in this child?

Tumor of the 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). Yet other effects are hyperpigmentation (the child's face to be unusually red, especially the cheeks).

A 6-year-old boy has a moon-faced, stocky appearance but with thin arms and legs. His cheeks are unusually ruddy. He is diagnosed with Cushing syndrome. The nurse knows that which of the following is the most likely cause of this condition in this child? a) Tumor of the pancreas b) Tumor of the parathyroids c) Tumor of the adrenal cortex d) Tumor of the thyroid

Tumor of the adrenal cortex Explanation: Cushing syndrome is caused by overproduction of the adrenal hormone cortisol; this usually results from increased ACTH production due to either a pituitary or adrenal cortex tumor. The peak age of occurrence is 6 or 7 years. The overproduction of cortisol results in increased glucose production; this causes fat to accumulate on the cheeks, chin, and trunk, causing a moon-faced, stocky appearance. Cortisol is catabolic, so protein wasting also occurs. This leads to muscle wasting, making the extremities appear thin in contrast to the trunk, and loss of calcium in bones (osteoporosis). Yet other effects are hyperpigmentation (the child's face to be unusually red, especially the cheeks).

Hypothyroidism results from deficient production of thyroid hormone or a defect in the thyroid hormone receptor activity. Hypothyroidism caused during embryonic development of the gland is called: a) Congenital hypothyroidism b) Acquired hypothyroidism c) Secondary hypothyroidism d) Autoimmune thyroiditis

a Congenital hypothyroidism Explanation: Congenital hypothyroidism is most commonly caused by defective embryonic development of the gland. Acquired hypothyroidism usually refers to thyroid deficiency that becomes evident after a period of apparently normal thyroid function. The most common cause of acquired hypothyroidism in iodine-sufficient regions of the world is lymphocytic thyroiditis (also called Hashimoto's or autoimmune thyroiditis).

A newborn was diagnosed as having hypothyroidism at birth. Her mother asks you how the disease could be discovered this early. Your best answer would be a) children have a typical rash at birth that suggests the diagnosis. b) her child is already severely impaired at birth, and this suggests the diagnosis. c) a simple blood test to diagnose hypothyroidism is required in most states. d) hypothyroidism is usually detected at birth by the child's physical appearance.

a simple blood test to diagnose hypothyroidism is required in most states. Explanation: Hypothyroidism is diagnosed by a screening procedure a few days after birth.

You teach a child with type 1 diabetes mellitus to administer her own insulin. She is receiving a combination of short-acting and long-acting insulin. You know that she has appropriately learned the technique when she a) administers the insulin into a doll at a 30-degree angle. b) administers the insulin intramuscularly into rotating sites. c) wipes off the needle with an alcohol swab. d) draws up the short-acting insulin into the syringe first.

draws up the short-acting insulin into the syringe first. Explanation: 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

The child may have developed thyroid storm. Which of the following are clinical manifestations of thyroid storm? Select all that apply. a) The child's linen is wet and the child complains of feeling "sweaty" b) The child's temperature is 103.2°F (39.6°C) c) The child's apical heart rate is 172 beats per minute d) The child states he feels very tired and wants to take a nap e) The child has been mild-mannered and compliant

• The child's linen is wet and the child complains of feeling "sweaty" • The child's temperature is 103.2°F (39.6°C) • The child's apical heart rate is 172 beats per minute Explanation: The following are signs and symptoms related to the development of thyroid storm: fever, diaphoresis, and tachycardia. Children who are patients are also typically restless and irritable.

A child with a history of diabetes insipidus is admitted with polyuria, polydipsia, and mental confusion. The priority intervention for this client is: a) Measure urine output b) Weigh the client c) Check vital signs d) Encourage increased fluid intake

Check vital signs Explanation: 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 but not the priority. Encouraging fluids will not correct the problem and weighing the patient is not necessary at this time

Which nursing objective is most important when working with neonates who are suspected of having congenital hypothyroidism?

Early identification 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 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.

The nurse is assessing a 4-year-old girl with ambiguous genitalia. Which finding suggests congenital adrenal hyperplasia?

Pubic hair and hirsutism Pubic hair and hirsutism in a preschooler indicates congenital adrenal hyperplasia. Irregular heartbeat on auscultation and pain due to constipation on palpation may be signs of hyperparathyroidism. Hyperpigmentation of the skin suggests Addison disease

A child with a primary growth hormone deficiency is to receive biosynthetic growth hormone. The nurse would explain to the child and parents that this hormone would be given at which frequency? a) Weekly b) Monthly c) Daily d) Bi-monthly

Daily Explanation: Biosynthetic growth hormone, derived from recombinant DNA, is given by subcutaneous injection. The weekly dosage is 0.2 to 0.3 mg/kg, divided into equal doses given daily for best growth.

A 15-year-old girl is brought to the clinic by her mother because the girl has been experiencing irregular and sporadic menstrual periods and excessive body hair growth. Polycystic ovary syndrome is suspected. Which additional assessment finding would help to support this suspicion? a) Short stature b) Darkened pigmentation around the neck area c) Decreased serum levels of free testosterone d) Body mass index as normal

Darkened pigmentation around the neck area Explanation: 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.

Which results would indicate to the nurse the possibility that a neonate has congenital hypothyroidism? a) Low T4 level and high TSH level b) Normal T4 level and low TSH level c) High thyroxine (T4) level and low thyroid stimulating hormone (TSH) level d) Normal TSH level and high T4 level

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 4-year-old boy during a growth hormone stimulation test. Which of the following is a priority task for the care of this child? a) Monitoring intake and output b) Educating family about side effects c) Providing a wet washcloth to suck on d) Monitoring blood glucose levels

Monitoring blood glucose levels Explanation: 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. Providing a wet washcloth would be more appropriate for a child who is on therapeutic fluid restriction, such as with syndrome of inappropriate antidiuretic hormone. Monitoring intake and output would not be necessary for this test but would be appropriate for a child with diabetes insipidus. While it is important to educate the family about this test, it is not the priority task.

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."

Kate and her parents are being seen in the office after discharge from the hospital with a new diagnosis of type 2 diabetes. Which of the following statements by the nurse is true? a) "Kids can usually be managed with an oral agent, meal planning, and exercise." b) "This will rectify itself if you follow all of the doctor's directions." c) "You are lucky that you did not have to learn how to give yourself a shot." d) "A weight-loss program should be implemented and maintained."

"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 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 healthcare. 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.

Kate and her parents are being seen in the office after discharge from the hospital with a new diagnosis of type 2 diabetes. Which statement by the nurse is true?

"Kids can usually be managed with an oral agent, meal planning, and exercise." 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. 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 has told the 14-year-old diabetic that the doctor would like them to have their 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." Hemoglobin A1C (HbA1C) 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 is less than 7.5%.

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?

"Research shows that there must be a diagnosis of deficiency before growth hormones can be started at this age."

The nurse is providing client teaching regarding the administration of desmopressin acetate for the client diagnosed with diabetes insipidus. Which statements by the client or parents indicates understanding of the teaching? Select all that apply.

"We will want to inspect the nares of our child to be sure the medication is not irritating the tissue." "We will need to adjust the dose based on how much our child is urinating." "I am going to have to carry a cooler with me if I am going to be gone all day or if I go on a long hike."

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."

240 mg/dL Explanation: If the blood glucose level is elevated or ketonuria is present, a fasting blood sugar (FBS) is performed. An FBS result of 200 mg/dL or higher almost certainly is diagnostic for diabetes when other signs such as polyuria and weight loss, despite polyphagia, are present.

The school nurse notes that a child diagnosed with diabetes mellitus is experiencing an insulin reaction and is unable to eat or drink. Which action would be the most appropriate for the school nurse to do?

Administer subcutaneous glucagon If the child having an insulin reaction cannot take a sugar source orally, glucagon should be administered subcutaneously to bring about a prompt increase in the blood glucose level. This treatment prevents the long delay while waiting for a physician to administer IV glucose or for an ambulance to reach the child

Insulin deficiency, increased levels of counter regulatory hormones, and dehydration are the primary causes of:

Diabetic ketoacidosis. 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. Glusosuria is glucose that is spilled into the urine

After hospital discharge, the mother of a child newly diagnosed with type 1 diabetes mellitus telephones you because her daughter is acting confused and very sleepy. Which emergency measure would you suggest the mother carry out before she brings the child to see her doctor? a) Give her a glass of orange juice with one unit regular insulin in it. b) Give her nothing by mouth so that a blood sugar can be drawn at the doctor's office. c) Give her a glass of orange juice. d) Give her one unit of regular insulin.

Give her a glass of orange juice. Explanation: These are typical symptoms of hypoglycemia. Administering a form of glucose would help relieve them. Insulin cannot be absorbed when taken orally.

A pediatric nurse is discharging a 1-month-old infant. The infant was diagnosed with congenital hypothyroidism on this admission and will be treated with levothyroxine. The nurse knows it is important to teach the parent about medication administration. Which process will the nurse include in the teaching?

Give the crushed medication in a syringe mixed with a small amount of formula.

The nurse knows that disorders of the pituitary gland depend on the location of the physiologic abnormality. Caring for a child that has issues with the anterior pituitary, the child has issues with which hormone?

Growth hormone Disorders of the pituitary gland depend on the location of the physiologic abnormality. The anterior pituitary, or adrenohypophysis, 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 adrenohypophysis.

The nurse is assessing a 16-year-old boy who has had long-term corticosteroid therapy. Which of the following findings, along with the use of the corticosteroids, would indicate Cushing disease? a) Observing delayed dentition b) History of rapid weight gain c) Observing high weight to height ratio d) Observing a round, child-like face

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

The nurse is teaching an 11-year-old boy and his family how to manage his diabetes. Which of the following does not focus on glucose management? a) Instructing the child to rotate injection sites to decrease scar formation b) Promoting higher levels of exercise than previously maintained c) Teaching that 50% of daily calories should be carbohydrates d) Encouraging the child to maintain the proper injection schedule

Instructing the child to rotate injection sites to decrease scar formation Explanation: Instructing child to rotate injection sites to decrease scar formation is important, but does not focus on managing glucose levels. Teaching the child and family to eat a balanced diet, encouraging the child to maintain the proper injection schedule, and promoting a higher level of exercise all focus on regulating glucose control.

Rank the different types of insulin based on their duration of action beginning with the shortest to the longest duration.

Lispro Humulin R Humulin N Lantus Lispro is a rapid-acting insulin. Humulin R is a short-acting insulin. Humulin N is an intermediate-acting insulin. Lantus is a long-acting insulin.

A 7-year-old is diagnosed as having type 1 diabetes. One of the first symptoms usually noticed by parents when this illness develops is:

Loss of weight. Lack of insulin reduces the ability of body cells to use glucose; this leads to starvation of cells and loss of weight as an early symptom.

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. Providing a wet washcloth would be more appropriate for a child who is on therapeutic fluid restriction, such as with syndrome of inappropriate antidiuretic hormone. Monitoring intake and output would not be necessary for this test but would be appropriate for a child with diabetes insipidus. While it is important to educate the family about this test, it is not the priority task.

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

Reva is an 8-year-old who is being seen today in the clinic for moodiness and irritability. She has begun to develop breasts and pubic hair and her parents are concerned that she is at too early an age for this to begin. The nurse knows that the possible prognosis is:

Precocious puberty. 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

A nurse is teaching a child with type 1 diabetes mellitus how to self-inject insulin. Which method should she recommend to the child for regular doses?

Subcutaneously in the outer thigh Insulin is always injected SC except in emergencies, when half the required dose may be given IV. SC tissue injection sites used most frequently in children include those of the upper outer arms and the outer aspects of the thighs. The abdominal SC tissue injection sites commonly used in adults can be adequate sites but most children dislike this site as abdominal skin is tender.

A nurse formulates the following nursing diagnosis for a child: "Risk for disproportionate growth and development related to metabolite accumulation affecting body system development." Which would be most appropriate for the nurse to include in the child's plan of care to address this diagnosis?

Teach parents to effectively and consistently discipline the child for inappropriate behaviors of social acting out

The child may have developed thyroid storm. Which clinical manifestations of thyroid storm should the nurse expect to find? Select all that apply.

Temperature of 103.2° F (39.6° C) Wet bed linen and report of feeling "sweaty" Apical heart rate of 172 beats per minute Signs and symptoms related to the development of thyroid storm include: fever, diaphoresis, and tachycardia. Children with thyroid storm are typically restless and irritable.

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? A. The child is allergic to shellfish B. The child has had an MRI of their leg within the past 6 weeks C. The child is taking a vitamin supplement D. The child wears a medical alert bracelet for diabetes

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.

The nurse is assessing an 8-year-old boy who is performing at the second-grade level, reports feeling tired and weak, and is only 45 inches tall. Which finding would be specific to hypothyroidism?

The child states that the exam room is cold. Cold intolerance, manifested by the fact that the child was uncomfortably cold in the exam room, is a sign of hypothyroidism. Delayed dentition, with only two of the four 6-year molars having erupted, is typical of growth hormone deficiency. Complaints of thirst may signal diabetes or diabetes insipidus. The dramatic weight gain could be due to hypothyroidism, Cushing syndrome, or syndrome of inappropriate antidiuretic hormone.

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

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

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.

"My daughter talks about having headaches all the time." "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." 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.

"When exercising, your son should add an extra snack containing 15 to 30 g of carbohydrates for each 45 to 60 minutes of exercise. When exercising, monitor insulin dose and nutritional and fluid intake, and observe for hypoglycemic reactions. Add an extra snack containing 15 to 30 g carbohydrate for each 45 to 60 minutes of exercise. Avoid exercising excessively when insulin is peaking. While monitoring of blood sugar is needed during long periods of exercise, checking it every 15 minutes is not necessary. Children are encouraged to exercise, they do not need to wait 6 months to resume exercise.

When discussing care of an infant with congenital hypothyroidism, you would stress that the infant will need:

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

The nurse knows that disorders of the pituitary gland depend on the location of the physiologic abnormality. Caring for a child who has issues with the anterior pituitary, the nurse would expect the child to have issues with which hormone?

Growth hormone

In teaching the parents of an infant diagnosed with diabetes insipidus, the nurse should include which treatment? a) Hormone replacement b) Antihypertensive medications c) Fluid restrictions d) The need for blood products

Hormone replacement Explanation: 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.

In teaching the parents of an infant diagnosed with diabetes insipidus, the nurse should include which treatment?

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.

When discussing congenital adrenogenital hyperplasia with a child's parents, you would advise them that administration of which of the following drugs will probably be indicated? a) Growth hormone b) Vitamin D c) Calcium d) Hydrocortisone

Hydrocortisone Explanation: The basic defect in congenital adrenogenital hyperplasia is the lack of cortisol. Administering hydrocortisone supplements this

In interpreting the negative feedback system that controls endocrine function, the nurse correlates how _______ secretion is decreased as blood glucose levels decrease.

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.

The nurse is assessing a 1-month-old girl who, according to the mother, doesn't eat well. Which of the following assessments would suggest the child has congenital hypothyroidism? a) Observation of an enlarged tongue b) Auscultation reveals tachycardia c) Mother reports frequent diarrhea d) Palpation reveals warm, moist skin

Observation of an enlarged tongue Explanation: Observation of an enlarged tongue along with an enlarged posterior fontanel and feeding difficulties are key findings for congenital hypothyroidism. The mother would report constipation rather than diarrhea. Auscultation would reveal bradycardia rather than tachycardia, and palpation would reveal cool, dry, and scaly skin

A child 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 Insulin for diabetic ketoacidosis is given intravenously. Only regular insulin can be administered by this route.

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. Infants with thyrotoxicosis may display hyperphagia but fail to gain weight. A combination of lethargy and irritability suggests congenital hypothyroidism. Cool, dry skin that is scaly to the touch suggests congenital hypothyroidism. Hypoactivity and hypotonicity are findings that suggest congenital hypothyroidism.

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 nurse is speaking with the parents of a child recently diagnosed with hypothyroidism. Which statement by a parent indicates an understanding of symptoms of this disorder?

"When they get my son's thyroid levels normal, he won't be so tired." 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 seeing a new client in the clinic who reports polyuria and polydipsia. These conditions are indicative of which endocrine disorder?

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

The physician has ordered routine hemoglobin A1C levels for a teenager with diabetes. Following teaching about the test by the nurse, the client and family demonstrate the need for further instruction with which statements? Select all that apply.

"I will be sure to not eat or drink anything the night before I get my blood drawn for the test." "I can check this level myself using a blood glucose monitor." "We will need to make sure our child gets this lab test at least every 6 months to ensure the diabetes is under control." Hemoglobin A1C levels provides the physician or nurse practitioner with information regarding the long-term control of glucose levels so fasting is not necessary. The test indicates the level of blood glucose over a 2- to 3-month period, so it should be performed about every 3 months. Daily blood glucose monitoring can be performed by the client with the use of a finger stick and glucose meter. The physician should be informed of high stress levels as this can increase blood glucose levels.

A woman in her first trimester of pregnancy has just been diagnosed with acquired hypothyroidism. The nurse is alarmed because she knows that this condition can lead to which of the following pregnancy complications? a) Gestational diabetes in the mother b) Spina bifida in the fetus c) Congenital heart defects in the fetus d) Decreased cognitive development of the fetus

Decreased cognitive development of the fetus Explanation: If acquired hypothyroidism exists in a woman during pregnancy, her infant can be born cognitively challenged because there was not enough iodine present for fetal growth. It is important, therefore, that girls with this syndrome be identified before they reach childbearing age.

A 10-year-old boy is upset and reports he is the shortest boy in his class. He reports he is done with school and wants to just stay at home. When reviewing the plan of care, which nursing diagnosis would be most appropriate for this concern?

Disturbed body image All of the listed nursing diagnoses may be appropriate for a child experiencing a growth hormone deficiency. The child is voicing feelings of personal devaluation. This is consistent with a lack of self-esteem making a disturbed body image the greatest concern in this scenario

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. What outcome criteria demonstrates this goal has been met?

During follow-up visits the child demonstrates normal growth and deveopment 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.

Growth hormone Explanation: Disorders of the pituitary gland depend on the location of the physiologic abnormality. The anterior pituitary, or adrenohypophysis, 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 adrenohypophysis.

The nurse is teaching an 11-year-old boy and his family how to manage his diabetes. Which instruction does not focus on glucose management?

Instructing the child to rotate injection sites Instructing child to rotate injection sites to decrease scar formation is important, but does not focus on managing glucose levels. Teaching the child and family to eat a balanced diet, encouraging the child to maintain the proper injection schedule, and promoting a higher level of exercise all focus on regulating glucose control.

The nurse is assessing a 5-year-old boy who has had several convulsions. The nurse continues to assess the child and suspects that he may have hypoparathyroidism. What evidence would support this suspicion?

Observation reveals tetany. Tetany occurs in children with hypoparathyroidism due to decreased serum calcium levels. Sleepiness and lack of responsiveness would suggest hyperthyroidism. Exophthalmos is associated with hyperthyroidism. Irregular heart rate is associated with hyperthyroidism.

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.

Syndrome of inappropriate antidiuretic hormone

The nurse working with the child diagnosed with type 2 diabetes mellitus recognizes that most often the disorder can be managed by:

Taking oral hypoglycemic agents If the child presents with diabetic ketoacidosis, initial treatment is insulin administration, but then oral hypoglycemic agents such as metformin are often effective for controlling blood glucose levels. Lifestyle changes such as weight loss and increased exercise are important aspects of treatment for the child

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 would be two or more deviations below normal. Diagnostic testing used in children with suspected GH deficiency include bone age will be two or more deviations below normal. CT or MRI scans would be used to rule out tumors or structural abnormalities, not bone scans.

In a child with diabetes insipidus, which characteristic would most likely be present in the child's health history? a) delayed closure of the fontanels, coarse hair, and hypoglycemia in the morning b) gradual onse of personality changes, lethargy and blurred vision c) vomiting early in the morning, headache, and decreased thirst d) abrupt onset of polyuria, nocturia, and polydipsia

D 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.

A 10-year-old boy has been diagnosed with type 1 diabetes mellitus. He is curious about what the cause of his disease is and asks the nurse to explain it to him. Which of the following should the nurse say to the boy? a) "A small part of your brain called the pituitary does not make enough of a chemical called growth hormone." b) "Special cells in a part of your body called the pancreas can't make a chemical called insulin, which helps control the sugar level in your blood." c) "Special cells in a part of your body called the pancreas cannot produce enough of a chemical called insulin, so there is too much sugar in your blood." d) "Your body does not produce enough a chemical called 'ADH,' which makes you really thirsty and have to go to the bathroom a lot."

"Special cells in a part of your body called the pancreas can't make a chemical called insulin, which helps control the sugar level in your blood." Explanation: Type 1 diabetes is a disorder that involves an absolute or relative deficiency of insulin in contrast to type 2 where insulin production is only reduced. Insulin is produced by beta islet cells in the pancreas. Diabetes insipidus is caused by the pituitary gland not producing enough ADH and is characterized by extreme thirstiness and polyuria. Insufficient growth hormone is also related to dysfunction of the pituitary gland.

The nurse is teaching a child with type 1 diabetes mellitus to administer her own insulin. The child is receiving a combination of short-acting and long-acting insulin. The nurse knows that the child has appropriately learned the technique when she:

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

The nurse is caring for a 12-year-old girl with hypothyroidism. Which of the following will be part of the nurse's teaching plan for the child and family? a) Instructing to report irritability or anxiety b) Educating how to recognize vitamin D toxicity c) Teaching to administer methimazole with meals d) Teaching how to maintain fluid intake regimens

Instructing to report irritability or anxiety Explanation: Side effects of hypothyroidism are restlessness, inability to sleep, or irritability and should be reported to the physician. Educating how to recognize vitamin D toxicity is necessary for a child with hypoparathyroidism. Teaching parents how to maintain fluid intake regimens is important for a child with diabetes insipidus. Teaching the child and parents to administer methimazole with meals is necessary for hyperthyroidism.

The nurse is assessing an 8-year-old boy who is performing at the second-grade level, complains of feeling tired and weak, and is only 45 inches tall. Which of the following findings would be specific to hypothyroidism? a) The child has gained 20 pounds in the past year. b) The child complains that the exam room is cold. c) The mother reports that the boy is always thirsty. d) Observation shows only two of the 6-year molars.

The child complains that the exam room is cold. Explanation: Cold intolerance, manifested by the fact that the child was uncomfortably cold in the exam room, is a sign of hypothyroidism. Delayed dentition, with only two of the four 6-year molars having erupted, is typical of growth hormone deficiency. Complaints of thirst may signal diabetes or diabetes insipidus. The dramatic weight gain could be due to hypothyroidism, Cushing syndrome, or syndrome of inappropriate antidiuretic hormone.

A 9-year-old girl has just been diagnosed with Graves' disease. Which of the following symptoms should the nurse expect in this child? (Select all that apply.) a) Increased basal metabolic rate b) Moist skin c) Obesity d) Lethargy e) Nervousness f) Exophthalmos (protruding eyes)

• Increased basal metabolic rate • Nervousness • Moist skin • Exophthalmos (protruding eyes) Explanation: 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)

The nurse is speaking to the mother of an adolescent recently diagnosed with type 1 diabetes mellitus. The mother asks the nurse how her son's basketball training will affect his blood sugar. Which is the best response by the nurse? A. "Your son will need to check his blood sugar prior to his training. If it's over 300 then he will be fine to exercise." B. "Exercising will increase your son's blood sugar. He will need to check his blood sugar every 15 minutes during his training." C. "Your son will need to make sure his blood sugar is under control for at least 6 months prior to resuming his training." D. "When exercising, your son should add an extra snack containing 15 to 30 g of carbohydrates for each 45 to 60 minutes of exercise."

The school nurse notes that a child diagnosed with diabetes mellitus is experiencing an insulin reaction and is unable to eat or drink. Which of the following actions would be the most appropriate for the school nurse to do? a) Dissolve a piece of candy in the child's mouth b) Administer subcutaneous glucagon c) Anticipate that the child will need intravenous glucose d) Request that someone call 911

Administer subcutaneous glucagon Explanation: If the child having an insulin reaction cannot take a sugar source orally, glucagon should be administered subcutaneously to bring about a prompt increase in the blood glucose level. This treatment prevents the long delay while waiting for a physician to administer IV glucose or for an ambulance to reach the child.

The nurse is assessing a 4-year-old girl with ambiguous genitalia. Which of the following findings would be consistent with congenital adrenal hyperplasia? a) Irregular heartbeat on auscultation b) Hyperpigmentation of the skin c) Pubic hair and hirsutism d) Pain from constipation on palpation

C Explanation: Observing pubic hair and hirsutism in a preschooler indicates congenital adrenal hyperplasia. Auscultation revealing an irregular heartbeat and palpation eliciting pain due to constipation may be signs of hyperparathyroidism. Observing hyperpigmentation of the skin would suggest Addison's disease.

The nurse is caring for a child being evaluated for diabetes insipidus. Which tests will likely be included in the diagnostic workup for this condition? Select all that apply.

CT scan skull MRI of kidney region Urinalysis Diabetes insipidus is an endocrine disorder characterized by excessive thirst, fluid intake and urinary output. Diagnostic testing will include radiographic studies such as a CT scan and MRI of the skull and kidneys. A urinalysis is performed to review urine specific gravity. Diagnostic testing for diabetes mellitus will include a hemoglobin A1C and fasting serum glucose levels

The nurse is caring for a 10-year-old girl with hyperparathyroidism. Which of the following would be a primary nursing diagnosis for this child? a) Deficient knowledge related to treatment of the disease b) Deficient fluid volume related to electrolyte imbalance c) Imbalanced nutrition: more than body requirements d) Disturbed body image related to hormone dysfunction

Deficient fluid volume related to electrolyte imbalance Explanation: The primary nursing diagnosis would be deficient fluid volume related to electrolyte imbalance. It is important to increase the child's hydration to minimize renal calculi formation. Disturbed body image related to hormone dysfunction is a diagnosis for growth hormone deficiency. Imbalanced nutrition: more than body requirements would be important for a child with diabetes mellitus. Deficient knowledge related to treatment of the disease is appropriate for hyperparathyroidism, but it is not a priority diagnosis.

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 Side effects of hypothyroidism are restlessness, inability to sleep, or irritability. These should be reported to the physician. Educating how to recognize vitamin D toxicity is necessary for a child with hypoparathyroidism. Teaching parents how to maintain fluid intake regimens is important for a child with diabetes insipidus. Teaching the child and parents to administer methimazole with meals is necessary for hyperthyroidism.

Eve, 2 years old, and her parents are at the office for a follow-up visit. She has had excessive hormone levels in her recent blood work and her parents question why this was not found sooner. What is the best response of the nurse?v a) "It takes time to determine the level of functioning of endocrine glands." b) "Endocrine disorders are hard to detect and you are lucky that we have found it when we did." c) "Have there been signs and symptoms that you should have reported to the doctor?" d) "As endocrine functions become more stable throughout childhood, alterations become more apparent."

"As endocrine functions become more stable throughout childhood, alterations become more apparent." Explanation: The endocrine glands are all present at birth; however, endocrine functions are immature. As these functions mature and become stabilized during the childhood years, alterations in endocrine function become more apparent. Thus, endocrine disorders may arise at any time during childhood development.

A 10-year-old boy has been diagnosed with type 1 diabetes mellitus. He is curious about what the cause of his disease is and asks the nurse to explain it to him. What should the nurse say to the boy?

"Special cells in a part of your body called the pancreas can't make a chemical called insulin, which helps control the sugar level in your blood." Type 1 diabetes is a disorder that involves an absolute or relative deficiency of insulin, in contrast to type 2 where insulin production is only reduced. Insulin is produced by beta islet cells in the pancreas. Diabetes insipidus is caused by the pituitary gland not producing enough ADH and is characterized by extreme thirstiness and polyuria. Insufficient growth hormone is also related to dysfunction of the pituitary gland

The nurse is caring for a 14-year-old boy with hyperpituitarism. Which of the following would be the priority? a) Assessing the child's self-image due to the disorder b) Teaching the child and family about proper treatment c) Administering octreotide acetate as ordered d) Treating the child according to his chronological age

Administering octreotide acetate as ordered Explanation: Administering octreotide acetate as ordered is the priority intervention and treatment for acromegaly. Assessing the child's self-image is appropriate but would not be the priority Treating the child according to his chronological age would be appropriate but not the priority. Teaching the child and family about proper treatment is appropriate and important but not the immediate priority.

Insulin deficiency, increased levels of counterregulatory hormones, and dehydration are the primary cause of which of the following: a) Diabetic ketoacidosis b) Ketonuria c) Ketone bodies d) Glucosuria

Diabetic ketoacidosis Explanation: Insulin deficiency, in association with increased levels of counterregulatory hormones (glucagon, growth hormone, cortisol, catecholamines) and dehydration, is the primary cause of diabetic ketoacidosis (DKA), a life-threatening form of metabolic acidosis that is a frequent complication of diabetes. Liver converts triglycerides (lipolysis) to fatty acids, which in turn change to ketone bodies. The accumulation and excretion of ketone bodies by the kidneys is called ketonuria. Glusosuria is glucose that is spilled into the urine.

The nurse caring for a female adolescent with polycystic ovary syndrom (PCOS) identifies "Disturbed body image related to signs and symptoms of the disease" as a nursing diagnosis that applies to this client. What signs and symptoms would support this nursing diagnosis?

Hirsutism Balding of hair on head Increased muscle mass Acne Hirsutism results in excessive amounts of stiff and pigmented hair on body areas where men typically grow hair, such as the face, chest and back. All of the symptoms listed except cysts would support the nursing diagnosis. The cysts themselves don't support the nursing diagnosis as they are not visible.

Hyposecretion of antidiuretic hormone Diabetes insipidus is a disease in which there is decreased release of antidiuretic hormone (ADH) by the pituitary gland. The child with diabetes insipidus experiences excessive thirst (polydipsia) that is relieved only by drinking large amounts of water; there is accompanying polyuria. Symptoms include irritability, weakness, lethargy, fever, headache, and seizures. Overproduction of antidiuretic hormone by the posterior pituitary gland results in a decrease in urine production and water intoxication and features weight gain, concentrated urine (increased specific gravity), nausea, and vomiting. As the hyponatremia grows more severe, coma or seizures occur from brain edema. Hyposecretion of somatotropin, or growth hormone, results in undergrowth; hypersecretion results in overgrowth.

A 6-year-old girl visits the pediatrician with complaints of excessive thirst, frequent voiding, weakness, lethargy, and headache. The nurse suspects diabetes insipidus. Which of the following hormonal conditions is characteristic of this disease? a) Hypersecretion of antidiuretic hormone b) Hyposecretion of somatotropin c) Hyposecretion of antidiuretic hormone d) Hypersecretion of somatotropin

Hyposecretion of antidiuretic hormone Explanation: Diabetes insipidus is a disease in which there is decreased release of antidiuretic hormone (ADH) by the pituitary gland. The child with diabetes insipidus experiences excessive thirst (polydipsia) that is relieved only by drinking large amounts of water; there is accompanying polyuria. Symptoms include irritability, weakness, lethargy, fever, headache, and seizures. Overproduction of antidiuretic hormone by the posterior pituitary gland results in a decrease in urine production and water intoxication and features weight gain, concentrated urine (increased specific gravity), nausea, and vomiting. As the hyponatremia grows more severe, coma or seizures occur from brain edema. Hyposecretion of somatotropin, or growth hormone, results in undergrowth; hypersecretion results in overgrowth.

Metformin

The nurse is caring for a 3-year-old diagnosed with diabetes mellitus. The child's eating patterns are unpredictable. One day the child will eat almost nothing, the next day the child eats everything on her tray. The nurse recognizes that which of the following types of insulin would most likely be used in treating this child? a) Rapid-acting insulin b) Long-acting insulin c) Intermediate-acting insulin d) Regular insulin

Rapid-acting insulin Explanation: The introduction of rapid-acting insulin, such as lispro or humalog, has greatly changed insulin administration in children. The onset of action of rapid-acting insulin is less than 15 mi nutes. Rapid-acting insulin can even be used after a meal in children with un predic table eating habits. Regular, intermediate, and long-acting insulin all have a longer onset, peak, and duration than rapid acting insulin, and are more difficult to regulate in the child with unpredictable eating patterns

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

draws up the short-acting insulin into the syringe first.

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