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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."

During a visit to the clinic, the adolescent client with hypothyroidism tells the nurse that she takes her 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 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."

The nurse is teaching a group of caregivers of children diagnosed with diabetes. 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?

"My child measures their own medication but sometimes doesn't administer the correct amount."

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."

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?"

The nurse is taking a history on a 10-year-old child who has a diagnosis of hypopituitarism. Which question is important for the nurse to ask the parents?

"What time each day does your child take his growth hormone?"

The nurse is 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

A 10-year-old client is upset and tells the school nurse. "I am the shortest one in my class. I am done with school and just want to stay home." Which response by the nurse is most appropriate?

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

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

Cushing syndrome

After hospital discharge, the mother of a child newly diagnosed with type 1 diabetes mellitus telephones you because her daughter is acting confused and very sleepy. Which emergency measure would the nurse suggest the mother carry out before she brings the child to see her doctor?

Give her a glass of orange juice.

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.

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

Low T4 level and high TSH level

A group of students are reviewing information about oral diabetic agents. The students demonstrate understanding of these agents when they identify which agent as reducing glucose production from the liver?

Metformin

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 which of the following?

Polyuria Explanation: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.

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 Marked weight loss Abrupt onset of symptoms Polyphagia

Polyuria Polydipsia Polyphagia

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

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

The 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 Allergies to shellfish should be reported because shellfish contains iodine; the dye used for a nuclear medicine scan is iodine based and could cause an anaphylactic reaction. The other information about the child would not need to be reported to the staff.

A 9-year-old child with Graves disease is seen at the pediatrician's office reporting sore throat and fever. The nurse notes in the history that the child is taking propylthiouracil. Which of the following would concern the nurse?

The child may have developed leukopenia. Explanation:Graves disease is defined as an overproduction of thyroid hormones. Propylthiouracil is used to suppress thyroid function. A complication of Graves disease is leukopenia

A child presents to the primary care setting with enuresis, nocturia, increased hunger, weight loss, and increased thirst. What does the nurse suspect?

Type 1 diabetes mellitus

An elementary school child takes metformin (Glucophage) three times each day. Which of the following disorders would the school nurse expect the child to have?

Type 2 diabetes mellitus

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 Explanation:An infant with the diagnosis of diabetes insipidus has decreased secretion of antidiuretic hormone (ADH). The infant is at risk for dehydration so monitoring urinary output is the most important intervention. The child's oral intake has been ordered. Monitoring a child who is under fluid restriction includes assessing the oral mucosa; however, urine output is the most important assessment for this patient. Vital signs are part of a basic assessment.

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

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.

The nurse is assessing a 5-year-old child whose parent reports the child has been vomiting lately, has no appetite, and has had an extreme thirst. Laboratory work for diabetes is being completed. Which symptom would differentiate between type 1 diabetes from type 2 diabetes?

recent weight loss

The nurse is teaching parents about the pattern of heredity of metabolic conditions. The nurse realizes that further teaching is needed when the parent makes which statement?

"The pattern of heredity for ALL metabolic conditions is dominant."

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

A fasting blood sugar result of 200 mg/dL or more almost certainly is diagnostic for diabetes when other signs, such as polyuria and weight loss despite polyphagia, are present.

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

Hypocalcemia Explanation:Hypoparathyroidism results in low production of PTH which in turn leads to hypocalcemia and hyperphosphatemia.

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

Inability to submit neat handwriting assignments

Which nursing objective is most important when working with neonates who are suspected of having congenital hypothyroidism? early identification promoting bonding allowing rooming in encouraging fluid intake

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 nursing instructor teaching students about the pattern of heredity of metabolic conditions realizes that further teaching is needed when a student makes which of the following statements?

"The pattern of heredity for all metabolic conditions is dominant."

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%Explanation:The goal for hemoglobin A1C in children between the ages of 6 and 12 years is less than 8%. Therefore, a result of 8.5% would indicate that additional intervention is needed to achieve the recommended goal.

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

A new mother is concerned about the need to provide medication to a newborn every day for an indefinite period of time. What should the nurse encourage the mother to do to help ensure medication compliance? Select all that apply.

Check the expiration dates on all medications. Plan times for medications that fit in with the daily routine. Build medication administration into the general home routine.

The nurse is teaching glucose monitoring and insulin administration to a child with type 1 diabetes mellitus and the parents. Which comment by a parent demonstrates a need for additional teaching?

During exercise we should wait to check blood sugars until after our child completes the activity

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

Oral calcium Explanation:Medical management for hypoparathyroidism includes intravenous calcium gluconate for acute or severe tetany, then intramuscular or oral calcium as prescribed. IV diuretics is used in treatment of hyperparathyroidism. Oral corticosteroids and oral potassium are not used in the treatment of hypoparathyroidism.

A newborn was diagnosed as having hypothyroidism at birth. Her mother asks the nurse how the disease could be discovered this early. The nurse's best answer would be:

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

The nurse is assessing a child diagnosed with Cushing syndrome. Which statement by the parents demonstrates a need for further teaching?

"This disorder is most likely due to an infection my child had recently."

A newborn exhibits significant jittery movements, convulsions, and apnea. Hypoparathyroidism is suspected. What would the nurse expect to be administered?

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 13-year-old adolescent is seen in the office and appears very anxious. For the past 2 weeks, the adolsecent has had some muscle twitching; upon examination, the client is found to have a positive Chvostek's sign. Which would be an appropriate explanation of Chvostek's sign?"

Chvostek's sign is a facial muscle spasm demonstrated by tapping the facial nerve.

A child is undergoing diagnostic testing for an endocrine dysfunction. The results indicate excessive levels of circulating cortisol. The nurse interprets this finding as indicating which of the following?

Cushing syndrome

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

Dehydration Explanation:If there is a complete blockage of cortisol formation, aldosterone production will also be deficient. Without adequate aldosterone, salt is not retained by the body, so fluid is not retained. Almost immediately after birth, affected infants begin to have vomiting, diarrhea, anorexia, loss of weight, and extreme dehydration. If these symptoms remain untreated, the extreme loss of salt and fluid can lead to collapse and death as early as 48 to 72 hours after birth. The salt-losing form must be detected before an infant reaches an irreversible point of salt depletion. This disorder does not cause hypoglycemia, excessive bleeding, or excessive cortisone secretion.

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

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

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

The nurse is caring for an 11-year-old child who has type 2 diabetes mellitus. The child has been vomiting for 48 hours and the breath has a fruity odor. The nurse notes that respirations are deep and rapid with a temperature of 102°F (38.9°C). Which intervention would be most appropriate?

Prepare for IV insertion Rationale: The child needs nursing interventions rapidly to change his or her diabetic status. This child should be given an IV with fluids and electrolytes to improve and restore tissue perfusion. Fruity breath and deep and rapid respirations are signs of ketoacidosis (hyperglycemia), which occurs before oral rehydration. The urine may show ketones, but checking the urine is not the priority in this risky situation. Analyze Chapter 48

The nurse is planning care for a school-age child diagnosed with growth hormone deficiency. Which diagnosis should the nurse select to help the child with this health problem?

Risk for situational low self-esteem related to short stature Explanation:Children with short stature tend to report feeling of lower quality of life largely related to discrimination. The nurse may need to remind parents to assign duties and responsibilities to children that match their chronologic age, not their physical size, in order to promote children's feelings of maturity and self-esteem. A child that differs in any way from peers may be the victim of bullying. The nurse should alert the parent to this possibility and assess for this at well-child visits to help protect the child's quality of life. Tissue perfusion is not affected by this disorder. This disorder does not cause impaired skin integrity. There is no overproduction of epinephrine with this disorder.

A child with a history of diabetes insipidus has been taking vasopressin. The parents bring the child to the clinic for an evaluation. During the visit, the parents mention that it seems like their son is hardly urinating. The nurse suspects syndrome of inappropriate antidiuretic hormone. What findings would the nurse expect to find to help confirm this condition? Select all that apply.

Urine specific gravity 1.033 Decreased serum sodium level Serum osmolality 260 mOsm/kg

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. a. Monitor client for weight loss. b. Monitor client for edema. c. Do not abruptly stop administering medication. d. Give medication on an empty stomach. e. Monitor client for high glucose levels.

b. Monitor client for edema c. Do not abruptly stop administering medication e. Monitor client for high glucose levels 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.