Pediatric Endocrine Disorders

22. A nurse has received an order for the growth hormone somatropin to be given to a 14-year-old boy. The correct weekly dose for a 110 pound boy is: 1. 20 mg. 2. 10 mg. 3. 15 mg. 4. 25 mg.

ANS: 3 Feedback 1. The dose is too high. 2. The dose is too low. 3. 0.3 mg/kg/week is the recommendation. 15 mg per week is appropriate. 4. The dose is too high.

36. Discharge teaching for a child with Congenital Adrenal Hyperplasia includes the administration of medication for stress dosing. This should be followed when: 1. The child is going to be more active for the day. 2. The child has a high fever. 3. A dose has been missed. 4. The child has not had adequate nutrition for a day.

ANS: 2 Feedback 1. The initial dosing should be effective for an active child. 2. A high fever increases metabolism and can create a need for a higher dose of the medication. 3. Missed doses should be taken as soon as remembered. 4. An inadequate diet for one day does not change the medication dosing.

A 12-year-old patient has a diagnosis of hyperthyroidism and is hospitalized for the manifestations of a thyroid storm. Which home-care concept will the nurse include in the care of the patient during hospitalization? 1. Provide a low-stress, low-pressure environment. 2. Ensure medications are given on the home schedule. 3. Limit intake of caffeine and carbonated fluids. 4. Increase intake of foods high in calcium and vitamin K.

ANS 1 1 This is correct. A low-stress, low-pressure environment is needed after a thyroid storm both during and after hospitalization and until the child's symptoms of hyperthyroidism are decreasing. The nurse needs to integrate this home-care concept. 2 This is incorrect. Medications for hyperthyroidism should be given as prescribed by the physician, regardless of whether the patient is in the hospital or at home. 3 This is incorrect. Limiting the intake of caffeine and carbonated beverages is appropriate for the care of the patient with hypoparathyroidism. 4 This is incorrect. Increasing the intake of foods high in calcium and vitamin K is appropriate care of the patient with hypoparathyroidism.

The nurse is assessing a 4-month-old infant who has a diagnosis of hypoparathyroidism. In which manner will the nurse assess the infant for pain related to the diagnosis? 1. Tap on a facial nerve and note the response. 2. Monitor closely for signs of seizure activity. 3. Assess for hyperreflexia of the muscles. 4. Carefully monitor cardiovascular status.

ANS 1 1 This is correct. Assessment of hyperreflexia of the muscles can be performed by tapping on the facial nerve. If a spasm occurs in the facial muscles, then a positive Chvostek sign has occurred. This confirms that the child has muscle spasms, pain, cramping, and twitches. 2 This is incorrect. Seizure activity is possible with a diagnosis of hypoparathyroidism, and recognition and management is essential. However, a seizure does not indicate the presence of pain. 3 This is incorrect. Assessment for hyperreflexia of the muscles should be performed frequently while calcium levels are unstable. However, this assessment alone does not indicate the presence of pain. 4 This is incorrect. The diagnosis of hypoparathyroidism can cause prolonged QT interval confirmed by 12-lead electrocardiogram (EKG) related to low calcium levels. Cardiac telemetry may be indicated, and the nurse should carefully monitor cardiovascular status. However, this action does not indicate the presence of pain.

1. The school nurse is teaching a middle-school class about the hormones that regulate body functions. Which information provided by the nurse is accurate? 1. Hormones are chemicals secreted by endocrine glands. 2. Hormones act specifically on the glands that produce them. 3. Hormones react with negative feedback as levels decline. 4. Hormones are made from proteins, fats, and carbohydrates.

ANS 1 1 This is correct. It is true that hormones are chemicals produced by the endocrine glands and circulated in the bloodstream to another part of the body. 2 This is incorrect. Hormones do not act specifically on the glands that produce them; they activate or inhibit cells in the target organs and act as messengers to those organs. 3 This is incorrect. Positive feedback occurs when hormone levels start to decline, causing the hypothalamus to secrete hormones that stimulate the pituitary gland to release hormones that then affect the target organ. 4 This is incorrect. There are two types of hormones: protein hormones from amino acids and steroid hormones from fat. Carbohydrates are not involved in the formation of hormones.

A 13-year-old male patient is diagnosed with hypopituitarism and is prescribed to begin growth hormone replacement therapy. Which patient teaching information will best optimize the replacement therapy outcomes for the patient? 1. Clear communication about side effects of therapy and how they are managed 2. The chemical makeup and differences between the brands of somatotropin 3. How much and how quickly the patient will see the effects of the therapy 4. Psychotherapy for the family to deal with emotional problems of the condition

ANS 1 1 This is correct. Some of the side effects include headache and achiness in the joints and muscles, particularly the knees, ankles, and wrists. If side effects occur, the physician may decrease the starting dose and then increase the dose slowly until the side effects resolve. This information will best optimize the patient's outcomes. 2 This is incorrect. GH replacement therapy consists of daily subcutaneous injections of manufactured GH called somatropin. Several manufacturers have developed GH with different trade names. These derivatives of GH lack one amino acid but are otherwise identical to human GH. 3 This is incorrect. It is recommended to start children on GH therapy as early as possible to achieve the maximum growth benefit; however, the specific outcome is not predictable. 4 This is incorrect. Psychotherapy for the family to deal with emotional problems of the condition may or may not be necessary. If psychotherapy is recommended, it does not influence the physical outcomes of the hormone replacement therapy.

65. A nurse is planning care for a child with Adrenal Insufficiency (Addisons Disease). The priority nursing diagnosis is: 1. Risk for deficient fluid volume. 2. Risk for injury, secondary to hypertension. 3. Acute pain. 4. Imbalanced nutrition.

ANS: 1 Feedback 1. Adrenal insufficiency can cause a fluid deficit. The goal of care is to maintain fluid and electrolyte balance while normal levels of mineralcorticoids and corticosteroids are established. Therefore, acute pain and imbalanced nutrition are not a priority nursing diagnosis. 2. A symptom of adrenal insufficiency is hypotension, not hypertension. 3. Acute pain and imbalanced nutrition are not priority nursing diagnoses. 4. The goal of care is to maintain fluid and electrolyte balance while normal levels of mineralcorticoids and corticosteroids are established. Therefore, acute pain and imbalanced nutrition are not priority nursing diagnoses.

5. The nurse on a pediatric unit is admitting a 6-week-old infant. Symptoms include a wet daily diaper count of 10 to 12 a day, irritability, constipation, and dehydration. For which medical prescription does the nurse contact the physician? 1. Limit oral intake of water to 200 mL per shift. 2. Weigh diapers to measure 24-hour urine output. 3. Check urine-specific gravity every 8 hours. 4. Allow the mother to continue breastfeeding.

ANS 1 1 This is correct. The patient is exhibiting the symptoms of diabetes insipidus (DI). Dehydration is a critical effect of DI in children. Severe dehydration can occur very quickly in infants and smaller children, so fluids must be increased as soon as possible during exacerbation. Water deprivation testing is the only time water is restricted with this diagnosis. The nurse will contact the physician about this prescription. 2 This is incorrect. A 24-hour output will help confirm the diagnosis of DI. 3 This is incorrect. It is not unusual for the urine-specific gravity of a patient suspected of DI to be checked every 8 hours. 4 This is incorrect. The method of feeding is not an issue; however, irritability in infants can only be relieved by giving water instead of formula or breast milk.

A 19-year-old patient has a history of hyperthyroidism that is managed with medication. The patient recently moved into an apartment and is living independently. Which behavior indicates to the nurse the patient is continuing appropriate health management? Select all that apply. 1. The patient called for refills of antithyroid medications and beta-blocking agents. 2. The patient went to an urgent care facility over the weekend for a sore throat and fever. 3. The patient reports experiencing tachycardia, restlessness, and tremors for a week. 4. The patient's last laboratory results indicates a high level of T4. 5. The patient stops the medication for 1 month once a year to promote hair regrowth.

ANS 1,2 1. This is correct. Calling for refills of antithyroid medications and beta-blocking agents indicates to the nurse that the patient is managing health care appropriately and understands medication compliance. 2. This is correct. Going to an urgent care facility over the weekend for a sore throat and fever indicates the patient understands the manifestations of agranulocytosis, which can be fatal. 3. This is incorrect. Beta-blocking agents do not decrease the amount of thyroid hormone they provide comfort for the patient who is experiencing tachycardia, restlessness, and tremors. Experiencing these symptoms for a week indicates a lack of medication compliance. 4. This is incorrect. Laboratory results indicating a high level of T4 are a sign of noncompliance with antithyroid medications. 5. This is incorrect. Stopping the medication for 1 month once a year to promote hair regrowth is indicative of medication noncompliance and lack of knowledge regarding medication side effects.

The nurse is preparing a teaching plan for a patient and family. The patient is diagnosed with hyperpituitarism. Which teaching information will optimize therapy outcomes for the patient? Select all that apply. 1. Education about home administration of medications 2. Education about the disorder and treatment options 3. Explanations of long-term complications for noncompliance 4. Signs of excess bone growth and other features of gigantism 5. The impact of a tumor on or near the hypothalamus or pituitary gland

ANS 1,2,3 1. This is correct. Information about home medications such as somatostatin analogs, dopamine agonists, and GH receptor antagonist will optimize the outcomes for a patient with hyperpituitarism. 2. This is correct. Education about the disorder and treatment options will broaden the patient's and family's understanding of the condition and promote better informed decisions. 3. This is correct. The severity of long-term complications related to noncompliance is likely to optimize the outcomes for a patient with hyperpituitarism. Complications include hypertension, cardiomegaly, subsequent cardiovascular disease, diabetes mellitus, osteoarthritis, sleep apnea, and early death. 4. This is incorrect. Signs of excess bone growth and other features of gigantism are manifestations of the condition, and information is not likely to optimize the outcomes for the patient with hyperpituitarism. 5. This is incorrect. If the patient has a tumor on or near the hypothalamus or pituitary gland, the patient may have precocious puberty in conjunction with the other manifestations of hyperpituitarism. This information is not likely to optimize the outcomes for the patient.

The pediatric nurse is preparing a community education program for parents and children who have endocrine disorders. With which normal regulatory functions does the nurse begin the presentation before covering endocrine disorders? Select all that apply. 1. Growth and development 2. Sexual development 3. Energy use and storage 4. An individual's response to stress 5. Levels of glucose, fluid, and sodium in the blood

ANS 1,2,3,4,5 1. This is correct. The endocrine system regulates growth and development. 2. This is correct. The endocrine system regulates sexual development. 3. This is correct. The endocrine system regulates energy use and storage. 4. This is correct. The endocrine system regulates an individual's response to stress. 5. This is correct. The endocrine system regulates the levels of glucose, fluid, and sodium in the blood.

The nurse is providing care for a child who is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). Which laboratory result does the nurse expect with this condition? 1. Low urine-specific gravity 2. High urine and low serum osmolarity 3. High serum sodium level 4. Increase in the hematocrit level

ANS 2 1 This is incorrect. Because fluid is retained with the diagnosis of SIADH, the specific gravity of urine is expected to be high (less fluid to the ratio of solutes). 2 This is correct. With a diagnosis of SIADH, the nurse will expect to see high urine osmolarity but low serum osmolarity on laboratory tests. The kidneys are unable to conserve appropriate amounts of water, so the body retains water, leading to water intoxication, hyponatremia, and cellular edema. 3 This is incorrect. The expected laboratory finding with SIADH is a low serum sodium level. Sodium will follow water back into the cells. 4 This is incorrect. The expected laboratory finding with SIADH is a decreased hematocrit.

71. Mandatory newborn screening tests can identify children with which of the following endocrine disorders? 1. Congenital hypothyroidism 2. Hypopituitarism 3. SIADH 4. Congenital Hyperthyroidism

ANS: 1 Feedback 1. Although the newborn screening tests for many conditions, the primary endocrine disorder tested for is Congenital Hypothyroidism. The other listed disorders are not part of the newborn screening test. 2. The primary endocrine disorder tested for is Congenital Hypothyroidism. 3. SIADH occurs after birth and usually occurs in older children. 4. The primary endocrine disorder tested for is Congenital Hypothyroidism

A 10-year-old patient is diagnosed with type 2 diabetes mellitus. Which medical history finding will help the nurse identify alternative interventions for managing the patient's condition? 1. The patient's ethnicity group is African American. 2. The patient's BMI is greater than 85th percentile for age and weight. 3. The patient's mother had gestational diabetes during her pregnancy. 4. The patient's extended family exhibits a high incidence of diabetes.

ANS 2 1 This is incorrect. Certain race/ethnicity groups such as African American, Latino, Asian American, American Indians, and Pacific Islanders have a higher risk for type 2 diabetes mellitus. However, there is no alternative intervention that will diminish this risk. 2 This is correct. A BMI greater than the 85th percentile for age and weight is an indication of childhood obesity, which is a major contributor to the increasing numbers of type 2 diabetes mellitus in children. The alternative intervention the nurse will recommend is increased exercise and a decrease in sedentary lifestyle. 3 This is incorrect. Maternal history of gestational diabetes or diabetes during pregnancy puts the child at higher risk for type 2 diabetes mellitus. However, there is no alternative intervention that will diminish this risk. 4 This is incorrect. A family history of type 2 diabetes mellitus places the child at a greater risk for the condition. The nurse may or may not be able to suggest alternative interventions that will diminish this risk.

3. A 15-year-old female asks the pediatric nurse how tall she may be as an adult. The adolescent's father is 6 feet 0 inches tall; her mother is 5 feet 4 inches tall. Which calculation will the nurse use to provide a probable answer? 1. Add the parents' heights in inches together; divide by 2; add 2.5 inches. 2. Add the parents' heights in inches together; divide by 2; subtract 2.5 inches. 3. Add the parents' heights in inches together and divide the total by 4. 4. Add the parents' heights in inches together; divide by 4; add 2.5 inches.

ANS 2 1 This is incorrect. The height of both parents is 136 inches; divided by 2 = 68, plus 2.5 inches for a male. A son of these parents will be 5 feet 9 inches. 2 This is correct. The height of both parents is 136 inches; divided by 2 = 68 minus 2.5 inches for a female. The patient will be 5 feet 4.5 inches tall. 3 This is incorrect. This calculation is wrong and would predict a height of 34 inches. 4 This is incorrect. This calculation is wrong and would predict a height of 36.5 inches.

The nurse in a NICU nursery is providing care for a newborn diagnosed with congenital hypothyroidism. During hospitalization, which home-care concept will the nurse include in the newborn's care? 1. Mix thyroid replacement hormone medication in a bottle of milk. 2. Increase dietary fiber with a soy-based formula to prevent constipation. 3. Ask the breastfeeding mother to bring breastmilk to the hospital. 4. Administer hormone replacement medication using a medicine dropper.

ANS 3 1 This is incorrect. Instruct parents to administer medication via needleless syringe and not to put medication in a bottle, which may or may not be completely consumed. 2 This is incorrect. Instruct parents that formula should be milk-based and not soy-based, because soy-based formulas can break down the effects of the medication. 3 This is correct. Because the mother is breastfeeding, the nurse can use breastmilk for the administration of thyroid hormone replacement medications. The medication will be crushed and mixed with a small amount of breastmilk. 4 This is incorrect. Medications are administered to newborns and infants using a needleless syringe to assure accurate dosage.

The nurse is providing care for a 12-month-old patient who is experiencing poor weight gain. Physical assessment reveals an open anterior fontanel and open cranial sutures. To differentiate between a decrease in growth hormone and a congenital thyroid problem, which laboratory test does the nurse expect to be ordered? 1. Serum calcium 2. CBC 3. TSH 4. FSH

ANS 3 1 This is incorrect. Serum calcium will indicate parathyroid activity. 2 This is incorrect. A complete blood count (CBC) will provide information regarding blood cells, which is not affected by either condition. 3 This is correct. A laboratory test for thyroid-stimulating hormone (TSH) will indicate the functioning of the pituitary gland and the effects it has on the thyroid gland. 4 This is incorrect. Follicle-stimulating hormone (FSH) will indicate functioning of the pituitary as it affects the ovary follicles.

The nurse is planning a teaching session for a 10-year-old patient and the patient's parents. The patient is newly diagnosed with type 1 diabetes mellitus. Which is the most important topic for the nurse to cover? 1. Methods for preventing hypoglycemia during exercise 2. The purpose of setting up a dietary consult for the patient 3. All procedures involved in insulin administration 4. Instructions for blood glucose and urine ketone testing

ANS 3 1 This is incorrect. The patient and parents need to understand the actions that are necessary for preventing hypoglycemia during exercise. Teaching will include eating an extra complex carbohydrate and protein serving at least 30 minutes to 1 hour before engaging in exercise or sports. Another topic is most important. 2 This is incorrect. The patient and parents should have a dietary consult so that the patient can be placed on a diabetic diet or be taught to count carbohydrate exchanges and adjust insulin requirements based on dietary intake. This an important action, but one other is more important. 3 This is correct. Because the patient is insulin dependent, insulin management is crucial and procedures for insulin administration are vital; this is the most important topic for the nurse to present in patient and parent teaching. 4 This is incorrect. The second most important teaching for the nurse to present is the methods by which the patient and parents will monitor the patient's blood glucose levels and test for the presence of urine ketones.

2. The nurse at a pediatric clinic is assessing a 12-year-old female. The patient ask the nurse, "I am scared about what's happening to my body. How does it happen?" Which information from the nurse is most appropriate? 1. The ovaries are located on each side of the uterus. 2. The ovaries secrete hormones that regulate the menstrual cycle. 3. The ovaries play a role in the regulation of puberty and fertility. 4. The body changes will indicate the patient is a woman and not a child.

ANS 3 1 This is incorrect. The patient wants to know "how" her body is changing; providing the location of the ovaries does not answer the patient's question. 2 This is incorrect. Telling the patient a function of the hormones secreted by the ovaries does not specifically answer the patient's question of "how." 3 This is correct. The most appropriate answer to the patient's "how" is to explain how the sex glands play a role in the regulation of puberty and fertility. The nurse will use language and examples that are within the realm of the patient's understanding. 4 This is incorrect. Telling the patient that the changes she seems afraid of will indicate she is a woman and not a child is not the appropriate answer. This information may cause more doubt and fear; the patient asked specifically "how."

The nurse is providing family teaching for a child diagnosed with hypoparathyroidism. Which additional teaching will the nurse include related to alternative dietary management? Select all that apply. 1. Avoiding caffeine and limiting the intake of carbonated beverages 2. Encouraging foods high in calcium and vitamin K 3. Including dietary supplements such as magnesium and boron 4. Giving calcium and vitamin D with acidic substances 5. Providing green leafy vegetables as the primary source of calcium

ANS 3,4 1. This is incorrect. Encouraging dietary compliance, such as avoiding caffeine and limiting the intake of carbonated beverages, is not considered an alternative intervention for dietary management. 2. This is incorrect. Encouraging foods high in calcium and vitamin K is not considered an alternative intervention for dietary management. 3. This is correct. Providing dietary instruction regarding alternative dietary supplements in addition to calcium and vitamin D, such as magnesium, boron, and vitamin K, is a suggestion for an alternative intervention. 4. This is correct. Instructing parents to give calcium and vitamin D with acidic substances such as orange juice or with salads that contain lemon juice in the dressing is an alternative intervention aimed at increasing absorption. 5. This is incorrect. The patient will need calcium and vitamin D in order to maintain health; however, no preference for the source of calcium is given.

The nurse on a pediatric unit is providing care for a preschool child with syndrome of inappropriate antidiuretic hormone (SIADH). The parents brought the child to the hospital to receive IV therapy. Which statements by the parents indicate to the nurse that the child is receiving appropriate care? Select all that apply. 1. "We were getting concerned about her loving salt." 2. "Popsicles have become a favorite daytime snack." 3. "We recognized the symptoms of sodium depletion." 4. "The confusion, headache, and irritability are unusual." 5. "She loves her new little bracelet and shows it to everyone."

ANS 3,4,5 1. This is incorrect. If the parents express concern about the patient "loving salt," the nurse will remind the parents that a diet high in sodium and protein is encouraged. 2. This is incorrect. When the parents share that popsicles have become a favorite daytime snack, the nurse needs to be concerned that fluid restrictions are not being observed, because the parents do not understand hidden fluid sources. 3. This is correct. The nurse will determine the child with SIADH is getting good care when the parents recognize the signs of sodium depletion and seek IV fluid replacement. 4. This is correct. The nurse will determine the child with SIADH is getting good care when the parents pay attention to unusual behaviors and associate them with a manifestation of the child's condition. 5. This is correct. The nurse will determine the child with SIADH is getting good care when the parents have the child wear a medical alert bracelet.

The nurse in a pediatric emergency department is providing care for a 1-year-old patient with a history of congenital adrenal hyperplasia (CAH). The patient is exhibiting the manifestations of a febrile illness. Which medical intervention does the nurse expect to be prescribed? 1. Laboratory testing for elevated serum 17-OHP level 2. Cultures and testing for the cause of the febrile illness 3. A quiet, cool environment for the patient 4. Administration of corticosteroids by injection

ANS 4 1 This is incorrect. Elevated serum 17-OHP at birth, along with other presenting symptoms, is a potential for CAH. If the levels continue to be elevated after birth, CAH is expected because normal growth and development will decrease 17-OHP as the infant matures. However, this testing is not expected for this patient. 2 This is incorrect. The cause of the febrile condition is not as important at this time as recognition and treatment of a possible adrenal crisis. 3 This is incorrect. The patient is not likely to need or benefit from being placed in a quiet, cool environment. 4 This is correct. Emergency administration of corticosteroids given via injection should be taught to the parents for use when the child is in a crisis, such as febrile illness, surgery, trauma, or severe stress. The nurse expects a prescription to continue the medication. The doses will need to be doubled or tripled during the period of crisis. This is referred to as "stress dosing."

A 16-year-old adolescent has Addison's disease. The adolescent's current medication involves corticosteroid and mineralocorticoid replacement therapy. During sports practice, the adolescent collapses and loses consciousness with sudden, penetrating pain in the lower back and legs. Which action is taken by the school nurse? 1. Administer the glucagon kept for the adolescent in the clinic. 2. Place the adolescent in side-lying position in case vomiting occurs. 3. Notify the parents of the incident and request permission to transport to the hospital. 4. Give IM Solu-Cortef and call the paramedics for emergency IV infusion.

ANS 4 1 This is incorrect. Glucagon is administered to increase blood glucose for a patient with hypoglycemia. 2 This is incorrect. Placing the patient in a side-lying position in case of vomiting is not the appropriate intervention for this patient. 3 This is incorrect. In an Addisonian crisis, time is lost by calling parents for permission to have the adolescent transported for acute medical attention. 4 This is correct. The nurse will administer Solu-Cortef IM, because the patient is unconscious. Careful assessment of signs and symptoms of hypovolemic shock in the severely dehydrated patient is critical. IV fluids are needed as quickly as possible; the paramedics are notified immediately.

4. The nurse in a pediatrician's office is assessing a 9-year-old male patient who is being monitored for the possible diagnosis of hypopituitarism. Which assessment finding does the nurse recognize specifically as an indication of growth hormone deficiency? 1. High weight-to-height ratio 2. Large hands and feet for body size 3. Severe aching in knees and ankles 4. Height increase of 1.75 inches in 12 months

ANS 4 1 This is incorrect. Hypopituitarism can result in a high weight-to-height ratio; however, the finding alone can be caused by other conditions as well. 2 This is incorrect. Large hands and feet when compared to the body size is most likely associated with hyperpituitarism after closure of the epiphyseal disks. 3 This is incorrect. A side effect of growth hormone replacement therapy can be joint aches primarily in the knees, ankles, and wrists. 4 This is correct. A cardinal sign of hypopituitarism is delayed growth of less than 2 inches (3 to 4 cm) per year.

34. A common psychological issue in children with Cushings syndrome is: 1. Depression due to not looking like others. 2. Post-traumatic stress disorder related to the body. 3. Autism. 4. Difficulty maintaining eye contact and meaningful relationships.

ANS: 1 Feedback 1. A child with Cushings will have an altered appearance from his/her peers. This leads to issues of depression for many children. 2. This is not an issue because a traumatic event does not occur in order for the disease to be present. 3. Few children with Cushings have an autism diagnosis. 4. Eye contact can be maintained and relationships can be made.

73. The mother of a 6-year-old Hispanic girl comes into the clinic stating that her daughter is developing breasts, pubic hair, and has acne on her forehead. On assessment, you notice that she has Tanner Stage 2 breast and pubic hair, oily skin, and some blemishes on her forehead. You suspect, based on this assessment, that the child could be having precocious puberty. What laboratory result would you expect to see in a child with precocious puberty? 1. High LH 2. Low LH 3. High TSH 4. Low FSH

ANS: 1 Feedback 1. Children with precocious puberty have elevated hormone levels, including LH, FSH and Estradiol in females. Males will have an increase in testosterone levels. The treatment goal is to utilize GnRH Analogs to suppress hormone levels until it is a more appropriate time for the child to experience puberty. 2. LH is usually elevated. 3. TSH is not assessed. 4. FSH is usually elevated.

77. Infants are screened at birth for Congenital Hypothyroidism because of which of the following conditions that can occur if untreated? 1. Mental Retardation 2. ADHD 3. Cerebral Palsy 4. Failure to Thrive

ANS: 1 Feedback 1. Failure or delay in treatment of newborn infants with Congenital Hypothyroidism can lead to long-term cognitive effects, such as mental retardation. As a result of this, there is a national mandate that states that all infants must have newborn screening tests to rule out Congenital Hypothyroidism. 2. Failure or delay in treatment of newborn infants with Congenital Hypothyroidism can lead to long-term cognitive effects, such as mental retardation. 3. Failure or delay in treatment of newborn infants with Congenital Hypothyroidism can lead to long-term cognitive effects, such as mental retardation. 4. Failure or delay in treatment of newborn infants with Congenital Hypothyroidism can lead to long-term cognitive effects, such as mental retardation.

69. When a child with diabetes is sick, which is the most appropriate intervention to teach the patient and parents? 1. The usual dose of insulin may need to be adjusted to compensate for food intake. 2. Test blood glucose levels only if urine ketones are positive. 3. Maintain fluid intake, avoiding fluids that contain dairy products. 4. Only test for urine ketones when the blood glucose is above 300 ng/dL.

ANS: 1 Feedback 1. Illness, such as a cold, the flu, or infections can cause an elevation in blood glucose levels due to the stress on the body. As a result of elevated glucose levels, the dose of insulin will have to be adjusted to meet the demands of lowering blood glucose levels that may reach high levels until the illness subsides. The urine should be tested 2 to 3 times per day for ketones, even if the blood sugar levels are lower than 300 ng/dL. 2. Blood glucose levels should be continuously monitored when a child is sick. 3. The patient should have a high fluid intake that includes dairy products. 4. The urine should be tested 2 to 3 times per day for ketones, even if the blood sugar levels are lower than 300 ng/dL.

40. Sherry, a 15-year-old patient, has been admitted for diabetic ketoacidosis. The nurse knows each of the following statements are true except: 1. This is the most common chronic complication for DM1. 2. This is deadly if not taken care of immediately. 3. This can cause frequent hospitalizations. 4. This is caused by too much insulin being release during illness.

ANS: 1 Feedback 1. Ketoacidosis is an acute condition. 2. This can be deadly because of the rapids shifts in blood glucose levels. 3. Ketoacidosis requires close medical monitoring and insulin infusion. 4. Insulin release increases during the illness, causing further complications.

29. A child with the diagnosis of precious puberty has been given Lupron. The nurse knows that the medication should help: 1. Decrease the hormone levels to slow the puberty process. 2. Increase the process for puberty development. 3. Decrease the growth rate. 4. Increase the growth rate.

ANS: 1 Feedback 1. Lupron suppresses the release of growth hormones. 2. The medication will decrease the progression of puberty if given in the correct pediatric dosage. 3 The medication will help slow the maturation process, not linear growth. 4. The medication will help slow the maturation rate.

37. Signs of an Addisonian crisis would include all of the following except: 1. Sudden pain in the upper extremities. 2. Severe vomiting and diarrhea. 3. Dehydration. 4. High blood pressure.

ANS: 1 Feedback 1. Pain is noted in the lower extremities and lower back, not the upper extremities. 2. Vomiting and diarrhea are common symptoms in a crisis. 3. Dehydration can occur during a crisis. 4. Pain is noted in the lower extremities and lower back.

42. A nurse is teaching a newly diagnosed diabetic mellitus Type 1 patient and family about the administration of insulin. It will be important for the nurse to include: 1. Rotating the injection sites with each dose. 2. Only using 1 mL syringes for dosing. 3. Giving the amount of insulin, then checking the blood glucose levels. 4. Providing sugary snacks when the glucose level is at 120 or above.

ANS: 1 Feedback 1. Rotation of the injection sites will allow areas to heal. 2. Only a unit syringe should be used for insulin administration. 3. Blood glucose levels should be checked prior to the administration of insulin. 4. Sugary snacks should be avoided if the blood glucose level is at 120 or above.

13. A 36-month-old girl is being measured at the nurses station. The nurse knows that she should do which of the following before using the stadiometer? 1. Remove the childs shoes for an accurate height measurement 2. Allow the child to stand on his toes while being measured 3. Allow the child to have a ponytail when the height is being measured 4. All should be asked of the child.

ANS: 1 Feedback 1. Shoes should not be worn during the measurement of height. 2. The child should stand flat during the measurement of height. 3. A ponytail should not be present during the measurement of height. 4. The child should remove his shoes for an accurate height measurement.

28. A child with a sodium measurement of less than 125 mEq/L and with a diagnosis of SIADH is at risk for: 1. Seizures. 2. Diarrhea. 3. Vomiting. 4. A change in the level of consciousness.

ANS: 1 Feedback 1. The level is low and this increases the risk for seizure activity. 2. Low sodium does not place the child at risk for diarrhea. 3. Low sodium does not place the child at risk for vomiting. 4. A change in the level of consciousness is minimal. The largest risk is seizures.

30. A common test result for a child with hypothyroidism is a(n): 1. Increase in T4 levels. 2. Increase in TSH levels. 3. Normal T4 level. 4. Decreased TSH level.

ANS: 2 Feedback 1. The T4 levels tend to be low. 2. The TSH levels will be increased in a child with hypothyroidism. 3. The T4 levels tend to be low. 4. The TSH levels will be increased, not decreased.

9. An example of the medulla of the adrenal glands working properly would be: 1. A child having an increase in heart rate and dilated pupils when scared. 2. A child relaxing and watching a video. 3. A child running a race with an increased respiratory rate. 4. A child having constricted pupils and a rapid heart rate after jumping rope.

ANS: 1 Feedback 1. The medulla contains adrenaline, which controls the fight-or-flight response, which causes an increase in heart rate and dilated pupils. 2. Relaxation is not a primary concern for the adrenal medulla. 3. The race is a planned event and does not create more stress, requiring the release of the adrenaline response. 4. The pupils will dilate if the medulla requires an increase in the release of adrenaline.

5. The pineal body is being discussed with a parent. The parent demonstrates the proper understanding of the pineal bodys purpose when the parent states: 1. The pineal body helps my child sleep. 2. The pineal body can improve my childs cognitive ability as he grows. 3. The pineal body will regulate the height of my child. 4. The pineal body can affect the timing of my childs puberty.

ANS: 1 Feedback 1. The pineal body controls the release of melatonin. Melatonin helps to regulate the sleep pattern. 2. There are no influences on the cognitive ability of the child from the pineal body. 3. The pineal body does not influence growth patterns. 4. The pineal body does not influence puberty.

24. A nurse is assessing a child with a known history of untreated hyperpituitarism. The nurse would anticipate: 1. Enlarged hands and feet. 2. A small nose and forehead. 3. A report of headaches. 4. Signs of precocious puberty.

ANS: 1 Feedback 1. These are common signs of untreated hyperpituitarism. 2. There is an overgrowth of bones, so the nose and forehead may be enlarged. 3. This is usually not a reported sign of issues in hyperpituitarism. 4. This only occurs if a tumor is present.

3. A nurse is discussing the production of the somatotropic hormone. Its primary responsibility is best described as: 1. A hormone that regulates bone growth in children. 2. A hormone that increase the rate of sexual/reproductive organ development. 3. A hormone that causes fight-or-flight mechanisms. 4. A hormone that causes the body to fight infections.

ANS: 1 Feedback 1. This hormone is responsible for stopping the release of the growth hormone. 2. The somatotrophic hormone concentrates on the growth rate of children, not the sexual/reproductive hormones. 3. The fight-or-flight response is controlled by the corticotrophin hormones. 4. Immunity is not controlled by a hormone.

53. Children tend to be more active in summer. Which change in the management of the child with diabetes would the nurse teach the patient and family to help treat episodes of hypoglycemia? 1. Increase food intake prior to exercise 2. Decrease food intake prior to exercise 3. Give an additional dose of insulin prior to exercise 4. Avoid foods high in protein

ANS: 1 Feedback 1. This measure should be taken because exercise can lower blood sugar levels, so adding the extra carbohydrate and protein snack will help the blood sugar levels maintain a normal level. This means that the child is less likely to have a hypoglycemic episode. 2. Children with diabetes must have extra carbohydrate and protein servings prior to exercise. This is because exercise can lower blood sugar levels. 3. The extra dose does not stabilize the blood glucose level long term. 4. Protein snacks help keep the blood glucose level stable and within normal limits.

81. Please select the most appropriate nursing diagnosis for a 15 year old with hyperthyroidism. Select all that apply. 1. Disturbed body image related to changes in physical appearance 2. Imbalanced nutrition related to increased metabolic demands 3. Risk for decreased fluid volume related to excess salt excretion 4. Constipation related to thyroid medication side effects

ANS: 1, 2 Feedback 1. Body image according to normal growth and development is very important to an adolescent. If the adolescent with hyperthyroidism is having adverse effects, such as drastic weight loss, exopthalmus, or other complications, his/her sense of self-esteem will be altered. He/she will also have imbalanced nutrition since his/her metabolic needs exceed his/her nutritional needs. 2. Body image according to normal growth and development is very important to an adolescent. If the adolescent with hyperthyroidism is having adverse effects, such as drastic weight loss, exopthalmus, or other complications, his/her sense of self-esteem will be altered. He/she will also have imbalanced nutrition since his/her metabolic needs exceed his/her nutritional needs. 3. They do not loose salt with this disorder. Constipation is a side effect of hypothyroidism, not hyperthyroidism. 4. Diarrhea is an adverse event in children who have hyperthyroidism.

78. A child with a known diagnosis of diabetes insipididus is being discharged home. The discharge education should include: (Select all that apply.) 1. Teaching on the signs/symptoms of dehydration. 2. Teaching the parents to decrease the amount of fluid intake when the child is healthy. 3. That medications will only need to be continued for six months. 4. Obtaining an emergency alert bracelet for the child. 5. Making the school aware of the diagnosis.

ANS: 1, 4, 5 Feedback 1. The child is at high risk for dehydration, and the parents should be aware of the signs and symptoms. 2. Fluid intake should be increased to keep the hydration balanced. 3. The medication will be needed for the rest of the childs life. 4. An emergency bracelet is needed so that proper care can be provided when illness occurs away from the parents. 5. The school should be aware so that proper interventions can be made when necessary.

33. A child exhibits a positive Chvostek sign. This indicates that the child is at risk for: 1. Hyperparathyroidism. 2. Hypoparathyroidism. 3. Hypopituitarism. 4. Hyperpituitarism.

ANS: 2 Feedback 1. A child will not exhibit the positive Chvostek sign with hyperparathyroidism. 2. The lack of calcium in a child with hypoparathyroidism will exhibit tetany, which will give a positive Chvostek sign. 3. A child will not have the positive Chvostek sign with hypopituitarism. 4. A child with hyperpituitarism will not have a positive Chvostek sign.

66. A child has been admitted to the hospital while unconscious. The child has a history of insulin-dependent diabetes mellitus (IDDM), and according to the childs mother, he took a normal dose of insulin this morning with breakfast. At school, the child had two pieces of birthday cake and some ice cream at a class birthday party. What is the likely reason for this childs unconscious state? 1. Metabolic alkalosis 2. Metabolic ketoacidosis 3. Insulin shock 4. Insulin reaction

ANS: 2 Feedback 1. The child is becoming acidotic in this state. 2. Metabolic acidosis or ketoacidosis could have occurred because of the excessive intake of sugar with no additional insulin. Altered consciousness occurs as symptoms progress. 3. Insulin shock is not occurring because the child is in an acidotic state. 4. The body burns fat and protein stores for energy when no insulin is available to metabolize glucose.

74. Glycosolated hemoglobin is an acceptable method used to: 1. Diagnose diabetes mellitus. 2. Assess control of diabetes. 3. Assess oxygen saturation of the hemoglobin. 4. Determine the insulin levels in the blood.

ANS: 2 Feedback 1. A glycosolated hemoglobin is a diagnostic test that measures serum glucose levels over a 3-month period. Health-care professionals use this laboratory test to determine blood glucose control of the patient over a period of time to see if he/she is maintaining adequate control of his/her blood sugar. 2. A glycosolated hemoglobin is a diagnostic test that measures serum glucose levels over a 3-month period. Health-care professionals use this laboratory test to determine blood glucose control of the patient over a period of time to see if he/she is maintaining adequate control of his/her blood sugar. 3. This assesses glucose levels, not hemoglobin levels. 4. A glycosolated hemoglobin is a diagnostic test that measures serum glucose levels over a 3-month period. Health-care professionals use this laboratory test to determine blood glucose control of the patient over a period of time to see if he/she is maintaining adequate control of his/her blood sugar.

45. The clinic nurse is teaching on the ways to help a child with DM1 when a hypoglycemic incident occurs. The teaching should include: 1. Allowing for 6 oz of diet soda every day. 2. Providing a juice box. 3. Allowing the child to eat, then return to previous activities. 4. Providing the child a bag of Cheetos.

ANS: 2 Feedback 1. Diet soda does not contain the proper sugar level and will not be beneficial to the child. 2. Juice has the proper level of sugar to be beneficial for the child and can be absorbed into the system quickly. 3. A child should rest after eating to help decrease the metabolic demands if in a hypoglycemic state to help prevent an accident. 4. A bag of Cheetos contains carbohydrates that may help increase the glucose level, but will take longer for the body to break down for use.

63. A child with diabetes insipidus has been admitted to the pediatric unit. The nurse would expect the childs laboratory value to demonstrate: 1. Hyperglycemia. 2. Hypernatremia. 3. Hypercalcemia. 4. Hypoglycemia.

ANS: 2 Feedback 1. Glucose levels are not affected with this disorder. 2. In all forms of diabetes insipidus, serum sodium can increase to pathologic levels, so hypernatremia can occur and should be treated. 3. Hypercalcemia does not occur with this disorder. 4. Glucose levels are not affected with this disorder

21. The nurse is discussing follow-up visits with the family of a boy using growth hormone therapy. The parents demonstrate understanding of the teaching with which statement? 1. We will need to track his height every week and record it for the doctor. 2. We will need to have follow-up visits every 3 to 4 months to measure progress. 3. Our next visit will be in one year to assess growth. 4. He will need to watch his weight closely and provide the record at the next visit.

ANS: 2 Feedback 1. Height will change gradually, so measurements on a weekly basis are not recommended. 2. Measurements and visits every 3 to 4 months will allow for growth to occur and for the medical provider to assess for needed changes. 3. Growth patterns should be monitored more closely while taking a growth hormone to make changes to the medication as needed. 4. Weight gain is not an issue with hormone replacement therapy and can be monitored at the medical provider visits.

51. The nurse should recognize that when a child develops diabetic ketoacidosis, this diagnosis is which of the following? 1. An expected outcome 2. A life-threatening outcome 3. Best treated at home 4. Best treated at the practitioners office

ANS: 2 Feedback 1. It is not a normal, expected outcome. 2. Diabetic ketoacidosis is a life-threatening situation. The child should be taken to the emergency room and/or a practitioners office for intervention. 3. This cant be treated effectively at home, as there is no emergency equipment available that might be needed. 4. This cant be treated effectively at home, as there is no emergency equipment available that might be needed.

43. Kussmaul breathing will occur in children with diabetes mellitus Type 1 when: 1. The body is near death. 2. The body is attempting to correct the metabolic acidosis state. 3. The child has consumed too much sugar. 4. The body is attempting to balance the metabolic alkalosis state.

ANS: 2 Feedback 1. Kussmaul breathing may be seen near death, but the body is attempting to correct the metabolic acidosis. 2. The body is attempting to reach equilibrium and correct the metabolic acidosis, thus creating the slower breathing. 3. The body is producing too much insulin, thus not needing sugar. 4. The body is trying to balance itself from a metabolic acidosis state.

61. The nurse is caring for an adolescent who has just returned to his room after a thyroidectomy. Which of the following indicates complications and should be reported immediately to the physician? 1. Lethargy 2. Feelings of tightness in the throat, hoarseness, and stridor 3. Facial edema 4. Acute neck pain

ANS: 2 Feedback 1. Not a sign of complications from a thyroidectomy 2. It is normal for a post-operative child to have lethargy. Because the surgery involves the neck, facial edema and acute neck pain are also noted post-operatively. An emergent situation would include feelings of tightness in the throat, hoarseness, and stridor. There symptoms would indicate an inability to breath, leading to impaired gas exchange and respiratory distress. 3. The face is not associated with the surgery. 4. The pain can be a sign, but not an emergent complication.

12. A teenage girl and boy have come to the nurses office at school because of a concern of pregnancy. The nurse explains the types of tests that are used to indicate pregnancy. The teens understand that the hormone that indicates pregnancy is: 1. Relaxin. 2. Human chorionic gonadotropin. 3. Estrogen. 4. Progesterone.

ANS: 2 Feedback 1. Relaxin works on the muscles and will not indicate pregnancy. 2. Human chorionic gonadotropin is the hormone released when an embryo is developing, indicating pregnancy. 3. Estrogen is released by females to develop secondary sex characteristics. 4. Progesterone is released to maintain pregnancy.

18. A 7-year-old boy with idiopathic hypopituitarism will need growth hormone replacement and: 1. Require IV hormone infusions. 2. Require subcutaneous injections. 3. Require intramuscular injections. 4. Require oral medications.

ANS: 2 Feedback 1. Subcutaneous injections are required, not an IV. 2. Subcutaneous injections are required for treatment. 3. Subcutaneous injections are required, not IM injections. 4. Subcutaneous injections are required, not oral medications.

38. A child with a diagnosis of pheochromocytoma should have a priority assessment of: 1. Temperature. 2. Blood glucose levels. 3. Urine output. 4. Weight.

ANS: 2 Feedback 1. Temperature instability is not an issue with pheochromocytoma. 2. Blood glucose levels can change rapidly and should have careful assessment. 3. Urine output should be monitored, but it is not the priority. 4. Weight checks should be done pre- and post-op, but are not the priority.

25. An infant is diagnosed with diabetes insipidus. An electrolyte panel has returned from the laboratory. The following results indicate which condition? NA: 162 mEq/L K+: 4.0 mEq/L CL: 99 CO2: 18 Ca+: 6.4 1. Hypokalemia 2. Hypernatremia 3. Hyperkalemia 4. Hyponatremia

ANS: 2 Feedback 1. The laboratory results do not indicate hypokalemia. 2. The increase in sodium is common in a patient with diabetes insipidus because of the risks of dehydration. 3. The potassium is in a normal range for the child. 4. The sodium level is elevated.

2. The release of the luteinizing hormone causes __________ in teen girls. 1. Primary sexual organ growth 2. The release of the ovum for fertilization 3. Rapid growth 4. Pubic hair growth

ANS: 2 Feedback 1. The luteinizing hormone works during the luteal phase of ovulation and does not have an influence on primary sexual organ growth. 2. The luteinizing hormone controls the release of the ovum for fertilization. 3. The growth hormone is responsible for rapid growth. 4. Pubic hair growth occurs with the release of hormones from the hypothalamus.

26. A 4 year-old has been admitted through the ER because of a diagnosis of the syndrome of Inappropriate Antidiuretic Hormone (SIADH). The nurse will need to monitor for: 1. Rapid weight loss. 2. Laboratory tests for hyponatremia. 3. Decreased turgor. 4. An increase in urine output.

ANS: 2 Feedback 1. The nurse will see a weight gain because of fluid retention. 2. SIADH causes fluid retention, thus the sodium level rises. 3. Turgor will be increased and doughy. 4. Urine is retained, so the output will be low.

58. Glucocorticoids, mineralcorticoids, and sex steroids are secreted by the: 1. Thyroid gland. 2. Adrenal cortex. 3. Anterior pituitary gland. 4. Parathyroid gland.

ANS: 2 Feedback 1. The thyroid gland supports the bodys metabolism. 2. The adrenal cortex of the adrenal gland is where glucocorticoids, mineralcorticoids, and sex steroids are produced. 3. The adrenal cortex of the adrenal gland is where glucocorticoids, mineralcorticoids, and sex steroids are produced. 4. The parathyroid gland is responsible for calcium and phosphorous regulation.

17. A classic sign of hypopituitarism in adolescents is: 1. Rapid development of secondary sexual characteristics. 2. Delayed puberty development. 3. A rapid decrease in abdominal circumference. 4. A low-pitched voice.

ANS: 2 Feedback 1. This causes a delay in secondary sexual characteristics. 2. There is a delay in puberty. 3. Increased abdominal fat is present with this condition. 4. Voice is high pitched, not low pitched.

80. The nurse is caring for a child with Syndrome of Inappropriate Antidiuretic Hormone (SIADH). Which of the following interventions should the nurse implement for this child? Select all that apply. 1. Encourage fluid intake 2. Strict intake and output 3. Administration of ordered diuretics 4. Specific gravity of urine

ANS: 2, 3, 4 Feedback 1. Fluid intake should be restricted due to hemodilution. 2. SIADH results from excessive amounts of the serum antidiuretic hormone, causing water intoxication and hyponatremia. Intake and output should be strictly monitored. Diuretics, such as furosemide (Lasix), are administered to eliminate excess body fluid. 3. Diuretics, such as furosemide (Lasix), are administered to eliminate excess body fluid and urine-specific gravity is monitored. 4. Urine-specific gravity is monitored. Fluids are restricted to prevent further hemodilution. Weight should be measured daily in order to monitor fluid balance.

82. The nurse is teaching an 11-year-old girl and her parents how to administer growth hormone injections. The nurse knows that which of the following interventions will promote the best response to therapy? Select all that apply. 1. Give the injections in the morning before breakfast 2. Rotate injection sites each day 3. Strict adherence and minimal doses missed 4. Follow up appointments every 3 to 4 months to monitor growth progress and dose adjustment

ANS: 2, 3, 4 Feedback 1. Injections should be given before bedtime each day, as the growth hormone is secreted mostly during the night when the child is sleeping. 2. To promote the best response to therapy, the patient should always rotate injection sites daily, using the abdomen, lateral thighs, back of the arms, and the buttocks. Patients who miss minimal doses of their growth hormone have better outcomes to therapy. It is important to see the pediatric endocrinologist at least every 3 to 4 months so that response to therapy can be monitored and doses can be adjusted based on growth response and the patients weight. 3. To promote the best response to therapy, the patient should always rotate injection sites daily, using the abdomen, lateral thighs, back of the arms, and the buttocks. Patients who miss minimal doses of their growth hormone have better outcomes to therapy. It is important to see the pediatric endocrinologist at least every 3 to 4 months so that response to therapy can be monitored and doses can be adjusted based on growth response and the patients weight. 4. To promote the best response to therapy, the patient should always rotate injection sites daily, using the abdomen, lateral thighs, back of the arms, and the buttocks. Patients who miss minimal doses of their growth hormone have better outcomes to therapy. It is important to see the pediatric endocrinologist at least every 3 to 4 months so that response to therapy can be monitored and doses can be adjusted based on growth response and the patients weight.

79. You are discussing the discharge needs of a 5 year old with diabetes insipidus. The parents are concerned about the child going back to school. What are the appropriate nursing actions that the nurse can take to help decrease the parents anxiety? Select all that apply. 1. Tell the parents not to worry and recommend a family therapist. 2. Write a letter to the school nurse about the patients condition and possible accommodations that the child might need during class. 3. Provide the parents with the name of a local support group that they can attend to network with other parents of children with this condition. 4. Provide detailed education for the child and parents regarding the management of the condition, and provide them with written resources that they can refer to when needed.

ANS: 2, 3, 4 Feedback 1. This is not therapeutic and dismisses the parents concerns. Additionally, referral to a therapist is not an appropriate action unless the parents are having maladaptive coping mechanisms or ask for a therapist. 2. Working with the school nurse by providing information and recommendations is a priority, as is recommending support groups and detailed educational material that the parents can refer to when needed are the three most appropriate actions. 3. Working with the school nurse by providing information and recommendations is priority, as is recommending support groups and detailed educational material that the parents can refer to when needed are the three most appropriate actions. 4. Working with the school nurse by providing information and recommendations is priority, as is recommending support groups and detailed educational material that the parents can refer to when needed are the three most appropriate actions.

60. A goiter is an enlargement of which gland? 1. Adrenal gland 2. Anterior pituitary gland 3. Thyroid gland 4. Posterior pituitary gland

ANS: 3 Feedback 1. A goiter is an enlargement of the thyroid gland. 2. A goiter is an enlargement of the thyroid gland. 3. A goiter is an enlargement of the thyroid gland. The thyroid gland produces an oversecretion of the thyroid hormone that causes the gland to become enlarged. 4. A goiter is an enlargement of the thyroid gland.

8. A child has a history of hypoparathyroidism. While assessing the child, a nurse would expect to find: 1. A short, thick neck for a girl. 2. A malnourished child. 3. A small-statured boy. 4. A tall-statured girl.

ANS: 3 Feedback 1. The disease occurs in boys. 2. Nutrition is not an issue for growth for a child with hypoparathyroidism. 3. The disease occurs in boys. 4. The disease occurs in boys.

14. A nurse is assessing the head of an 18-month-old girl. During the assessment, the nurse should do which of the following to make sure that the child has adequate skull and brain growth? 1. Check the circumference and document the findings on the growth chart 2. Check the suture lines and posterior fontanel for alignment 3. Measure the head circumference, assess the anterior fontanel, and document the findings on the growth chart 4. Check the childs eye tracking with a pen light

ANS: 3 Feedback 1. Assessment of the anterior fontanel is also needed for an accurate assessment of brain and skull growth. 2. The anterior fontanel should be aligned at this age. Head circumference will indicate adequate nutrition. 3. Assessment of the circumference and suture lines in the anterior fontanel will indicate if suture lines have fused. 4. The tracking of the pen light only allows for a minimal assessment.

27. The nurse receives the doctors order for a child with SIADH. She should clarify which of the following orders? 1. Weight check every 24 hours 2. Diet high in protein 3. IV of Normal Saline at 120ml/hr 4. Strict intake and output documentation

ANS: 3 Feedback 1. Because of water retention, weight should be checked every 24 hours. 2. A diet high in protein is needed to provide adequate nutrition and keep the amount of sodium low. 3. A hypertonic solution of sodium chloride should be used. 4. Strict I/O will provide the information to find out if water retention is occurring.

67. A child is being seen in the clinic with a possible diagnosis of Type 2 diabetes. The mother asks what the physician uses to make the diagnosis. The nurse explains that Type 2 diabetes is suspected if the child demonstrates obesity, acanthosis nigricans, and a blood glucose level without fasting on two separate occasions above: 1. 120 2. 80 3. 200 4. 50

ANS: 3 Feedback 1. Blood glucose level is at a normal level. 2. Blood glucose level is at the normal level. 3. Blood glucose levels at or above 200 ng/dL without fasting is diagnostic of diabetes. 4. Blood glucose level is low.

20. A common blood test that should be done for a child with questionable celiac disease is: 1. TSH. 2. FSH. 3. Antigliadin antibodies. 4. ACTH.

ANS: 3 Feedback 1. Checks the function of the thyroid 2. Indicates follicle stimulation 3. Screens for celiac disease 4. Indicates hormone deficiencies

7. One of the most common causes for thyroid disease in adolescents is: 1. Graves Disease. 2. Goiter. 3. Hashimoto disease. 4. Kawasakis disease

ANS: 3 Feedback 1. Graves Disease is rare in adolescents and occurs more in adults. 2. A goiter is more common in adults. 3. The disease is the most common in adolescence. It rarely occurs in adulthood. It is a result of the thyroid malfunction. 4. Kawasakis disease is not a thyroid disorder.

19. The best time of day to give growth hormone injections for hypopituitarism is: 1. After breakfast. 2. Immediately after waking for the day. 3. At bedtime. 4. In the afternoon, before dinner.

ANS: 3 Feedback 1. Growth occurs the most at night, thus the injections should be given prior to bedtime. 2. Growth occurs the most at night, thus the injections should be given prior to bedtime 3. Children grow the most while sleeping, so giving the injections at night will help promote growth with the bodys normal system. 4. Growth occurs the most at night, thus the injections should be given prior to bedtime.

35. An infant born with ambiguous genitalia should be assessed for: 1. Hyperthyroidism. 2. Hypernatremia. 3. Adrenal hyperplasia. 4. Adrenal medulla deficiency.

ANS: 3 Feedback 1. Hyperthyroidism does not affect the formation of ambiguous genitalia. 2. Hypernatremia does not affect the formation of ambiguous genitalia. 3. Children with adrenal hyperplasia have a high risk for ambiguous genitalia because of the excessive amounts of androgen production. 4. The adrenal medulla has too much excretion, not a deficit.

55. Which of the following is considered a cardinal sign of diabetes mellitus? 1. Impaired vision 2. Seizures 3. Frequent urination 4. Nausea

ANS: 3 Feedback 1. Not a cardinal sign 2. Not a cardinal sign 3. Frequent urination (Polyuria) excessive thirst (Polydipsia) and excessive hunger (Polyphagia) are the cardinal signs of Type 1 diabetes mellitus. 4. Not a cardinal sign

56. A child with hypoparathyroidism is receiving Vitamin D therapy. The parents should be advised to watch for which of the following signs of Vitamin D toxicity? 1. Excessive thirst 2. Anorexia, insomnia, nausea, and vomiting 3. Weakness, fatigue, nausea, and vomiting 4. Headaches and seizures

ANS: 3 Feedback 1. Not a sign of Vitamin D toxicity 2. Not signs of Vitamin D toxicity 3. Signs of Vitamin D toxicity 4. Headaches and seizures are caused by the imbalance of calcium levels.

76. Exopthalmos may occur in children with which of the following conditions? 1. Hypothyroidism 2. Hyperparathyroidism 3. Hyperthyroidism 4. Hypoparathyroidism

ANS: 3 Feedback 1. Not a symptom of Hypothroidism 2. Not a symptom of Hyuperparathyroidism 3. Exopthalmos is a severe, irreversible manifestation in children who have maintained a hyperthyroid state over a long period of time with inadequate or lack of treatment. 4. Not a symptom of Hypoparathyroidism

46. Diabetes mellitus Type 2 has been increasing in children because of: 1. Environmental surroundings. 2. Autoimmune disorders. 3. Obesity. 4. Earlier use of drugs and alcohol in children.

ANS: 3 Feedback 1. Not enough evidence supports environmental surroundings being a cause for DM2 in children. 2. Autoimmune disorders can cause DM2, but they are not the primary reason for the increase. 3. Obesity has increased in children, placing a higher risk on developing DM2 at a young age. 4. The use of drugs and alcohol does not increase the risk for DM2 in children.

72. A 10-year-old boy is two days post-op, following the resection of a pituitary tumor. The nurse is providing post-operative care and notices that he is having enuresis, extreme thirst, and urinating frequently. Based on these clinical manifestations, the nurse suspects that he might be experiencing which condition? 1. Diabetes mellitus 2. Syndrome of Inappropriate Antidiuretic Hormone (SIADH) 3. Diabetes insipidus 4. Acute glomerulonephritis

ANS: 3 Feedback 1. Not seen as a complication 2. Not seen as a complication 3. Diabetes insipidus is a complication of the resection or removal of a pituitary tumor. The main symptoms of this condition are polydipsia, polyuria, and enuresis. 4. Not seen as a complication

57. Which of the following is the most common cause of secondary hyperparathyroidism? 1. Diabetes mellitus 2. Congenital heart disease 3. Anterior pituitary gland 4. Parathyroid gland

ANS: 3 Feedback 1. Rarely occurs 2. Does not frequently occur 3. The most common cause of secondary hyperparathyroidism. 4. Does not frequently occur

4. The anterior portion of the pituitary gland secretes all of the following hormones except: 1. The growth hormone. 2. Adrenocorticotrophic hormones. 3. The antidiuretic hormone. 4. The luteinizing hormone.

ANS: 3 Feedback 1. The growth hormone is secreted by the anterior portion of the pituitary gland. 2. Adrenocorticotrophic hormones are secreted in the cortex, which is in the anterior lobe. 3. The antidiuretic hormone is secreted in the posterior lobe of the pituitary gland. 4. The luteinizing hormone is controlled by the anterior portion of the pituitary gland.

11. The sex drive in males occurs in response to: 1. The development of secondary sexual characteristics. 2. Increased levels of progesterone. 3. Increase levels of testosterone. 4. Follicle cell formation.

ANS: 3 Feedback 1. The hormone produces this response and does not react to it. 2. This only occurs in females for relaxing the uterus and stimulating milk production. 3. This is an androgen that can cause the sex drive in males. 4. This only occurs in females for the release of an ovum

41. When a child with diabetes mellitus Type 1 is ill, it is important for the family to provide all of the following except: 1. Blood glucose monitoring every four hours. 2. Adjusting dosing requirements as needed. 3. Discontinuing the insulin until the child is feeling better. 4. Strongly encouraging the intake of fluids

ANS: 3 Feedback 1. The illness causes rapidly changing glucose levels and needs to be frequently monitored. 2. Insulin will need frequent adjustment during the illness. 3. Insulin continues to be important to help the body heal. 4. Fluids should be encouraged to help keep an adequate hydration status.

59. A child with a chronic adrenocortical insufficiency is receiving Hydrocortisone BID. Nursing considerations related to the administration of this medication include which of the following? 1. Take 1 hour before meals or 2 hours after meals. 2. Mix the medication with milk or formula. 3. Take the medication with food. 4. Administer the medication by injection.

ANS: 3 Feedback 1. The medication should be taken with meals. 2. Milk or formula may increase the rate of vomiting, so the medication should be taken with food. 3. The administration of hydrocortisone with food will help decrease the amount of nausea that a child could have with the dose. 4. The medication is taken orally

48. While assessing a 14 year old with a known history of diabetes mellitus Type 2, the nurse notes darker skin around the teens axilla. The nurse should: 1. Contact the doctor immediately 2. Provide a wash cloth and soap to cleanse the area. 3. Document the findings and note that acanthosis nigricans is present. 4. Ask the patient if he/she has had a recent infection.

ANS: 3 Feedback 1. This is a common condition in a teen with DM2 and does not require immediate doctor notification. 2. The area is clean. This is a discoloration in the skin. 3. Acanthosis nigricans occurs in individuals with DM2 and is a discoloration of the skin. 4. DM2 is the reasoning for the darker skin, not an infection.

64. An adolescent girl with Graves Disease is admitted to the hospital. The nurse expects to find which of the following clinical manifestations? 1. Weight gain, hirsutism, and muscle weakness 2. Dehydration, metabolic acidosis, and hypotension 3. Tachycardia, fatigue, and heat intolerance 4. Hyperglycemia, ketonuria, and glycosuria

ANS: 3 Feedback 1. Weight gain, hirsutism, and muscle weakness are signs of Cushings Syndrome. 2. Dehydration, metabolic acidosis, and hypotension are signs of Congenital Adrenal Hyperplasia. Hyperglycemia, ketonuria, and glycosuria are signs of diabetes mellitus. 3. Graves Disease occurs when thyroid hormone levels are increased, resulting in excessive levels of circulating thyroid hormones. Clinical manifestations include tachycardia, fatigue, and heat intolerance. 4. Graves Disease does not affect circulating glucose.

50. Manifestations of hypoglycemia include which of the following? 1. Lethargy 2. Confusion 3. Nausea and Vomiting 4. Shakiness and Dizziness

ANS: 4 Feedback 1. A child is least likely to be lethargic with hypoglycemia. 2. If the child has reached a state of confusion, the child is very ill and needs medical attention immediately. 3. Nausea and vomiting are usually the cause for hypoglycemia. 4. The most common side effects of children with hypoglycemia include shakiness, dizziness, headache, extreme hunger, and perspiration.

15. A child is born with ambiguous genitalia. The only way to identify if the child is male or female is to obtain an order for: 1. An ultrasound. 2. A follicle stimulating hormone test. 3. An estrogen level test. 4. A sexual chromosome test.

ANS: 4 Feedback 1. A child with ambiguous genitalia may have ovaries/uterus and testicles present. 2. The hormone test is not appropriate because children with ambiguous genitalia can have ovaries and testicles. 3. A child with ambiguous genitalia can have a release of estrogen. 4. A chromosome test is the only test that can identify the DNA makeup of a male or female when a child has ambiguous genitalia.

68. The nurse is administering an 0800 dose of NPH insulin to an insulin dependent diabetic child. Based on when the insulin peaks, the child would be at greatest risk for a hypoglycemic episode between: 1. Breakfast and lunch. 2. Bedtime and breakfast the next morning. 3. 0830 to a mid-morning snack. 4. Lunch and dinner.

ANS: 4 Feedback 1. A hypoglycemic reaction between breakfast and lunch would be associated with a short-acting insulin. 2. Between bedtime to breakfast the next morning would be associated with a long-acting insulin. 3. The 0830 to mid-morning hypoglycemia would be related to a rapid-acting insulin. 4. NPH is an intermediate-acting insulin that peaks in 6-12 hours. If administered at 0800, the risk of a hypoglycemic reaction would be at its peak between lunch and dinner.

A 12-year-old girl diagnosed with hypothyroidism has been placed on Levothyroxine. The parents demonstrate an understanding of the medication when they state: 1. The medication will be taken for three months, then we will reassess to see if she still needs the medication. 2. The medication should only be given at night. 3. The medication will require us to do daily weight checks. 4. The medication will need to be taken for the remainder of her life

ANS: 4 Feedback 1. Assessment will need to be done to make sure that the child is receiving the correct recommended dose, but the child will need the medication for the remainder of her life. 2. The medication should be given in the morning. 3. The medication does not require daily weight checks. 4. The medication will need to be taken for the remainder of the childs life because the body does not naturally regulate the hormones.

10. The purpose of exocrine release is to: 1. Restore energy while sleeping. 2. Provide a fight-or-flight response when scared. 3. Increase the release of glycogen to the muscles when running. 4. Aid in the digestion of pizza.

ANS: 4 Feedback 1. Exocrine, which sits in the pancreas, does not influence sleeping. 2. Adrenaline is not excreted in the pancreas to influence a fight-or-flight response. 3. Glycogen is formed and pushed into the cells, which breaks down, not releasing any exocrine. 4. The main purpose of exocrine is to help digest amylase, lipase, and trypsin. Pizza has a high level of lipase.

75. The nurse is teaching a newly diagnosed diabetic patient about the importance of exercise and physical activity. The nurse knows that prior to exercise or physical activity; the child should: 1. Administer an extra dose of insulin. 2. Decrease the amount of fluids prior to exercise. 3. Restrict exercise to non-contact sports. 4. Eat an extra protein and complex carbohydrate snack.

ANS: 4 Feedback 1. Extra insulin is not indicated prior to exercise or physical activity. 2. Maintaining hydration is important during sports and will help eliminate dehydration. 3. Patients with T1 DM are not limited to any type of exercise or sport unless they have a physical disability and have been advised by a physician. 4. Physical exercise in patients with Type 1 DM will decrease blood glucose levels and is a key element to include in the lifestyle of patients who have hyperglycemia. However, due to the decrease in blood glucose levels during exercise or team sports, the child must add an additional complex carbohydrate and protein snack to help the body maintain glucose levels during exercise. Maintaining hydration is important during sports and will help eliminate dehydration. Patients with T1 DM are not limited to any type of exercise or sport unless they have a physical disability and have been advised by a physician. Extra insulin is not indicated prior to exercise or physical activity.

6. Overproduction of the anterior pituitary hormones can cause all of the following except: 1. Hyperthyroidism. 2. Hypercorticosolism. 3. Precocious puberty. 4. Diabetes.

ANS: 4 Feedback 1. Hyperthyroidism occurs because of the oversecretion of thyroid stimulating hormone (TSH). 2. Hypercorticosolism occurs because of oversecretion in the anterior pituitary gland. 3. Precocious puberty occurs because of oversecretion in the anterior pituitary gland. 4. The cortex produces the hormones called glucocorticoids, which increase blood sugar, leading to a risk of diabetes.

32. Inderal has been prescribed for a 14 year old with hyperthyroidism because it helps: 1. Decrease the chance for thyroid storms. 2. Decrease the size of the goiter. 3. Treat a systolic murmur. 4. Decrease the episodes of tachycardia.

ANS: 4 Feedback 1. Inderal is a beta blocker that helps with tachycardia issues. 2. Inderal does not have an effect on a goiter because it is a medication for cardiac issues. 3. A systolic murmur will not respond to a beta blocker. 4. Inderal is a beta blocker that helps with tachycardia issues.

39. A nurse conducting an assessment of a 3-year-old with diabetes mellitus Type 1 would expect to find: 1. Polyuria. 2. Polydipsia. 3. Polyphagia. 4. All of the above.

ANS: 4 Feedback 1. Known as one of the 3 Ps of DM 1. 2. Known as one of the 3 Ps of DM 1. 3. Known as one of the 3 Ps of DM 1. 4. These are the 3Ps of DM 1.

49. A child drinks a glass of orange juice after experiencing symptoms of hypoglycemia. This rapid-releasing sugar should be followed by which of the following? 1. Protein 2. Fruit juice 3. Several glasses of water 4. Complex carbohydrates and protein

ANS: 4 Feedback 1. Once the childs blood sugar has increased, the child should immediately eat something that contains a protein. 2. Foods and beverages with simple sugars will temporarily increase the blood glucose level and are good for emergency situations. 3. Water lacks the protein and complex carbohydrates needed to help decrease the blood sugar levels. 4. Foods and beverages with simple sugars will temporarily increase blood glucose and are good for emergency situations. But once the childs blood sugar has increased, the child should immediately eat something that contains a protein and complex carbohydrate serving, such as peanut butter and crackers or cheese and wheat crackers.

70. 4-year-old Michelle has just been diagnosed with precocious puberty. The nurse is administering Lupron Depot Pediatric 7.5 mg. The recommended route of administration and frequency of dose for this medication is: 1. Intramuscular every 14 days. 2. Subcutaneously every 3 months. 3. Intramuscular every 21 days. 4. Intramuscular every 28 to 30 days.

ANS: 4 Feedback 1. Pediatric doses of Lupron Depot are administered via intramuscular injection every 28 to 30 days so that there is no break in therapy and so the patients hormone levels do not start to elevate and exacerbate symptoms of puberty. 2. The medication is to be delivered intramuscularly, not subcutaneously. 3. The dose for the medication is too soon and would not be effective. 4. Pediatric doses of Lupron Depot are administered via intramuscular injection every 28 to 30 days so that there is no break in therapy and so the patients hormone levels do not start to elevate and exacerbate symptoms of puberty. If doses are not given within this time frame, the patient may experience an increase in puberty development, as hormone levels are no longer suppressed.

62. A child with a growth hormone deficiency will be receiving daily subcutaneous injections of a biosynthetic growth hormone. The parents are being trained to administer the injections. It is important for the nurse to instruct the parents to: 1. Avoid cleaning the area with alcohol before giving the injection. 2. Use only the leg for injections. 3. Delay giving the injection by one day if the child becomes upset. 4. Rotate the injections sites daily.

ANS: 4 Feedback 1. The area should be cleansed with alcohol. 2. Lipoatrophy can occur at injection sites; therefore, the sites should be rotated between the arms, lateral thighs, abdomen, and buttocks. 3. Establishing a set time for the injection can create a routine and decrease anxiety for the child. 4. Lipoatrophy can occur at injection sites; therefore, the sites should be rotated between the arms, lateral thighs, abdomen, and buttocks. The injection should be given at the same time each day so a routine can be established. This minimizes the trauma of receiving daily injections. Delaying giving the injection will only heighten the childs anxiety.

52. The nurse is discussing the various sites used for insulin injections with a child and family. Which of the following sties usually has the fastest rate of absorption? 1. Arm 2. Leg 3. Buttock 4. Abdomen

ANS: 4 Feedback 1. The arm has a lower level of subcutaneous tissue, so the absorption rate is slower. 2. The leg has a lower level of subcutaneous tissue, so the absorption rate is slower. 3. The buttock has a lower level of subcutaneous tissue, so the absorption rate is slower and is not easily accessible for self-injections. 4. Because of a larger amount of subcutaneous tissue in the abdomen, the medication is absorbed faster.

1. An example of the bodys response to the endocrine system includes all of the following except: 1. A growth spurt for a 12-year-old boy. 2. Development of breast buds for a 10-year-old girl. 3. A teen reacting quickly, hitting another car while driving. 4. A teen answering a question on a biology test.

ANS: 4 Feedback 1. The endocrine system is responsible for growth rates in children. 2. The development of secondary sexual characteristics is controlled by the endocrine system. 3. The chemical interactions in the brain are controlled by the endocrine system. 4. The cognitive development of a teen is not controlled by the endocrine system.

47. Home management for a teen diagnosed with diabetes mellitus Type 2 would include: 1. Learning to measure foods and count carbohydrates. 2. Participating in exercise, such as riding a bike. 3. Creating a chart to indicate what foods should be eaten each day. 4. All of the above should be included in home management.

ANS: 4 Feedback 1. The measurement and counting of carbohydrates is needed to maintain an adequate balance for a teens blood glucose level. 2. Exercise will help the body burn fat and increase metabolism to decrease the need for insulin. 3. A chart will help a teen identify the correct foods to eat. 4. The measurement and counting of carbohydrates is needed to maintain an adequate balance for a teens blood glucose level. Exercise will help the body burn fat and increase metabolism to decrease the need for insulin. A chart will help a teen identify the correct foods to eat.

54. Which of the following is a characteristic of Type 1 diabetes mellitus? 1. Ketoacidosis is infrequent 2. Onset of the condition is gradual 3. Oral anti-hyperglycemic agents are an effective treatment options 4. Age at onset is usually less than 20 years old

ANS: 4 Feedback 1. The onset of Type 1 DM is very rapid and usually results in the emergent condition known as diabetic ketoacidosis. 2. This condition can be frequent, especially in children or teens who are poorly managed. 3. Oral anti-hyperglycemics are not indicated for Type 1 diabetes mellitus. 4. Diabetes mellitus Type 1 is a childhood disease and is mostly diagnosed before the age of 20. Type 2 diabetes mellitus usually occurs in middle-aged or older adults.

23. A 12-year-old girl is diagnosed with hyperpituitarism. Identify the correct primary treatment for this child. 1. A thyroidectomy 2. Chemotherapy 3. Radiation therapy to the thyroid 4. Administrating an antithyroid medication

ANS: 4 Feedback 1. The pituitary gland is the issue, not the thyroid. 2. Chemotherapy is a very aggressive treatment and not recommended as a primary treatment. 3. Radiological therapy is used for testing, not treatment. 4. The antithyroid hormone can help stop the aggressive process.

44. Diabetic ketoacidosis can occur in a known diabetic mellitus Type 1 child because: 1. Of poor compliance with the insulin regimen. 2. The insulin is out of date. 3. Puberty has begun. 4. All of the above can create a diabetic ketoacidosis state.

ANS: 4 Feedback1.Poor compliance can create a diabetic ketoacidotic state.2.Insulin should be date checked to maintain the correct potency.3.The rapid growth and metabolism during puberty can create an increased risk for diabetic ketoacidosis.4.Poor compliance can create a diabetic ketoacidotic state. Insulin should be date checked to maintain the correct potency. The rapid growth and metabolism during puberty can create an increased risk for diabetic ketoacidosis.

To ensure that an infant with congenital hypothyroidism is getting the full dose of his/her thyroid replacement medication, the nurse should instruct the parents to put the medication in the infants bottle of formula. True or False

False It is best to use a medicine dropper or medication syringe to administer the medication to an infant.2.Medications should never be mixed in a bottle, as there is no guarantee that the infant will receive the full dose if they choose not to drink all the liquid in the bottle.

82. The nurse should palpate the adrenal glands when a person has a diagnosis of pheocromocytoma during every shift to check for size. True or False

False Palpation can increase the release of catecholamine and cause a hypertensive crisis or tachyarrhythmia.

Beta blockers are frequently used in clients who have uncontrolled Graves Disease and exhibit clinical symptoms of thyroid storm. True or False

True Children with hyperthyroidism that lead to thyroid storm are often prescribed a beta blocker, along with anti-thyroid medications, to help decrease the workload on the heart. These patients tend to have extreme tachycardia and often experience arrhythmias due to the condition.