PEDIATRIC SUCCESS ENDOCRINOLOGY PEDIATRIC REVIEW QUESTIONS CHAPTER 10

38. An 8-year-old with type I DM is complaining of a headache and dizziness and is visibly perspiring. The nurse caring for the child should do which of the following? 1. Administer glucagon intramuscularly. 2. Offer the child 8 oz of milk. 3. Administer rapid-acting insulin (lispro). 4. Offer the child 8 oz of water or calorie-free liquid.

2. Milk is best to give for mild hypo glycemia, which would present with the symptoms described.

23. Two parents bring their teen to the clinic with a tender, enlarged right breast. The nurse explains that which hormone(s) secreted by the anterior pituitary influence(s) this process? 1. Thyrotropin. 2. Gonadotropin. 3. Oxytocin. 4. Somatotropin.

2. Oxytocin is secreted by the posterior pituitary but does target the uterus and production of milk from the breasts.

57. The nurse is assigned to care for a newborn with goiter. The nurse's primary concern is which of the following? 1. Reassuring the parents that the condition is only temporary and will be treated with medication. 2. Maintaining a patent airway and preparing for emergency ventilation. 3. Preparing the infant for surgery and initiating preoperative teaching with the parents. 4. Obtaining a detailed history, particularly of medications taken during the mother's pregnancy.

2. Goiter in a newborn can cause tracheal compression, and positioning to help relieve pressure (i.e., neck hyperexten sion) is essential. Emergency precau tions for ventilation and possible tracheostomy are also instituted.

6. The school nurse notices that a 14-year-old who used to be an excellent student and very active in sports is losing weight and acting very nervous. The teen was recently checked by the primary care provider, who noted the teen had a very low level of TSH. The nurse recognizes that the teen has which condition? 1. Hashimoto thyroid disease. 2. Graves disease. 3. Hypothyroidism. 4. Juvenile autoimmune thyroiditis.

2. Graves disease is hyperthyroidism and presents with low TSH levels, weight loss, and excessive nervousness.

44. The nurse is obtaining the medical history of an 11-year-old diagnosed with hypopituitarism. An important question for the nurse to ask the parents is which of the following? 1. "Is the child receiving vasopressin intramuscularly or subcutaneously?" 2. "What time of day do you administer growth hormone?" 3. "Does your child have any concerns about being taller than the peer group?" 4. "How often is your child testing blood glucose?"

2. Growth hormone is used to treat a child with hypopituitarism.

12. A child is brought to the ED with what is presumed to be acute adrenocortical insufficiency. Which of the following should the nurse do first? 1. Insert an IV line to administer fluids and cortisol. 2. Prepare for admission to the intensive care unit. 3. Indicate the likelihood of a slow recovery. 4. Discuss the likelihood of the child's imminent death.

12. 1. Initially, in the ED, the child will be given an IV line, vital signs will be taken frequently, and seizure precau tions will be taken.

13. The nurse is working with a school-aged child with a diagnosis of Addison disease (chronic adrenocortical insufficiency). The child takes oral cortisol supplements and has to get monthly injections of desoxycorticosterone acetate injections. What teaching should be done at each visit for the injections? 1. "Keep an extra month's supply of all medications on hand at all times." 2. "Wear a MedicAlert bracelet at all times" 3. "The drug has a bitter taste." 4. "Weight gain is inevitable."

13. 1. Keeping an extra month's supply of all medications, along with a prefilled sy ringe of hydrocortisone, will enable the family to treat an impending adrenal crisis before it gets severe.

4. The nurse is working on the pediatric floor, caring for an infant who is very fussy and has a diagnosis of DI. Which parameter should the nurse monitor while the infant is on fluid restrictions? 1. Oral intake. 2. Urine output. 3. Appearance of the mucous membranes. 4. Pulse and temperature.

2. It is crucial to monitor and record urine output. The infant with DI has hypose cretion of ADH, and fluid restriction has little effect on urine formation. This in fant is at risk for dehydration and for fluid and electrolyte imbalances.

17. A school-aged child is diagnosed with bilateral pheochromocytomas. The nurse recalls that the tumor, benign in most children, arises from the adrenal medulla. Which clinical manifestations should the nurse check for in this child? 1. Hypertension, headache, and decreased gastrointestinal activity. 2. Hypoglycemia, lethargy, and increased gastrointestinal activity. 3. Bradycardia, diarrhea, and weight gain. 4. Hypotension, constipation, and anuria.

17. 1. A pheochromocytoma is a rare tumor of the adrenal glands that secretes ex cess catecholamines, which are a group of amines secreted in the body that act as neurotransmitters. Examples include epinephrine, norepinephrine, and dopamine. Hypertension, headache, and decreased gastric motility are common with pheochromocytoma.

35. A toddler is being evaluated for SIADH. The nurse should observe the child for which symptoms? Select all that apply. 1. Dehydration. 2. Fluid retention. 3. Hyponatremia. 4. Hypoglycemia. 5. Myxedema.

2. ADH assists the body in retaining flu ids and subsequently decreases serum osmolarity while the urine osmolarity rises. When serum sodium levels are decreased below 120 mEq/L, the child becomes symptomatic. 3. ADH assists the body in retaining flu ids and subsequently decreases serum osmolarity while the urine osmolarity rises. When serum sodium levels are decreased below 120 mEq/L, the child becomes symptomatic.

18. A teen comes into the clinic with complaints of having been under a lot of stress recently. The teen is being treated for Addison disease and is taking cortisol and aldosterone orally. Today, the teen shows symptoms of muscle weakness, fatigue, salt craving, and dehydration. What should the nurse discuss with the patient regarding the medications? 1. The dosage may need to be decreased in times of stress. 2. The dosage may need to be increased in times of stress. 3. The aldosterone should be stopped, and the cortisol should be increased. 4. The cortisol may need to be given IV to raise its level.

2. Because the adrenal glands are not producing enough glucocorticoids, the dosage of both the cortisol and aldos terone must be increased and some times tripled in times of stress.

55. Adolescents with diabetes have problems with low self-esteem. The nurse knows the most likely reason for this is which of the following? 1. Managing diabetes decreases independence. 2. Managing diabetes complicates perceived ability to "fit in." 3. Obesity complicates perceived ability to "fit in." 4. Hormonal changes are exacerbated by fluctuations in insulin levels.

2. Because the desire to fit in is so strong in adolescence, the need to manage one's diabetes can compromise the patient's perception of ability to do so. For example, an adolescent with type I DM has to plan meals and snacks, test blood sugar, limit choices of when and what to eat, and always be concerned with the immediate health conse quences of actions as simple as eating. The fact that these limitations can negatively affect self-esteem is an essential concept for the nurse caring for adolescents with diabetes to understand.

30. A parent with a toddler who has ambiguous genitalia asks the nurse how long before the child identifies his or her gender? Which is the best answer? 1. "A child does not know his or her gender until he or she is a teen." 2. "A child knows his or her gender by the age of 18 to 30 months." 3. "A child knows from the time of birth what his or her gender is." 4. "A child of 4 to 6 years is beginning to learn his or her gender."

2. Children 18 months to 30 months learn their gender from examining and touching their body parts and learning roles that are either male or female.

16. A baby has hypertension as a result of partial 21-hydroxylase deficiency. The parents asks the nurse to clarify why the baby is being sent home on cortisone. Which of the following is the nurse's best response about cortisone? 1. Increases the utilization of fatty acids for energy. 2. Depresses the secretion of ACTH. 3. Stimulates the adrenal glands. 4. Increases the response to inflammation.

2. Cortisone suppresses the ACTH being secreted by the pituitary. Because very little, if any, cortisol is produced by the adrenal glands, the ACTH acts to in crease cardiac activity and constrict the blood vessels, leading to hypertension.

3. A 6-year-old white girl comes with her mother for evaluation of her acne, breast buds, axillary hair, and body odor. What information should the nurse explain to them? 1. This is a typical age for girls to go into puberty. 2. Encourage the girl to dress and act appropriately for her chronological age. 3. She should be on birth control as she is fertile. 4. She may be short if her epiphyses close early.

2. Dressing and acting appropriately for her chronological age should be encour aged for the well-being of the child.

25. Which of the following hormones does the anterior pituitary secrete? Select all that apply. 1. Thyroxine. 2. Luteinizing hormone. 3. Prolactin (luteotropic hormone). 4. ACTH. 5. Epinephrine. 6. Cortisol.

2. Luteinizing hormone, prolactin, and ACTH are secreted by the anterior pituitary. 3. Luteinizing hormone, prolactin, and ACTH are secreted by the anterior pituitary. 4. Luteinizing hormone, prolactin, and ACTH are secreted by the anterior pituitary.

39. The nurse is caring for a 10-year-old post parathyroidectomy. Discharge teaching should include which of the following? 1. How to administer injectable growth hormone. 2. The importance of supplemental calcium in the diet. 3. The importance of increasing folic acid in the diet. 4. How to administer subcutaneous insulin.

2. Parathyroid is responsible for calcium reabsorption; therefore, supplemental calcium in the diet is the important point to be discussed in patient teaching.

37. A school-aged child comes in with a sore throat and fever. The child was recently diagnosed with Graves disease and is taking propylthiouracil. What concerns should the nurse have about this child? 1. The child must not be taking her medication. 2. The child may have leukopenia. 3. The child needs to start an antibiotic. 4. The child is participating in sports before she is euthyroid.

2. Propylthiouracil is used to suppress thyroid function. One of the grave complications of the medication is leukopenia.

32. The nurse is working in the well-child clinic, and a new patient is brought in for a visit. The parent brings the record along with the 21-month-old child. The records show a birth weight of 8 lb; the 6-month weight was 16 lb; the 12-month weight was 18 lb; and the 15-month weight was 19 lb. With the record showing that the toddler's weight-for age has been decreasing on the growth chart, the nurse should do what initially? 1. Omit plotting the previous weight-for-age on the new growth chart. 2. Point out the growth chart to the new HCP. 3. Consider the toddler a child with failure to thrive. 4. Weigh the child, and plot on a new growth chart.

2. The provider should be made aware of the decelerating weight for age. This pictorial information can then be re viewed with the parent.

7. A newborn develops tetany and a seizure just prior to discharge from the nursery. The newborn is diagnosed with hypocalcemia secondary to hypoparathyroidism and is started on calcium and vitamin D. Which information would be most important for the nurse to teach the parents? 1. They should observe the baby for signs of tetany and seizures. 2. They should observe for weakness, nausea, vomiting, and diarrhea, all signs of vitamin D toxicity. 3. They should administer the calcium and vitamin D daily as prescribed. 4. They should call the clinic if they have any questions about care of the newborn.

2. Vitamin D toxicity is a serious conse quence of therapy and should be the top priority in teaching.

51. The nurse is taking care of a 10-year-old patient diagnosed with Graves disease. The nurse could expect this patient to have recently had which of the following? 1. Weight gain, excessive thirst, and excessive hunger. 2. Weight loss, difficulty sleeping, and heat sensitivity. 3. Weight gain, lethargy, and goiter. 4. Weight loss, poor skin turgor, and constipation.

2. Weight loss, increased activity, and heat intolerance can be expected when the thyroid gland is hyperfunctional.

21. A 7-year-old is diagnosed with central precocious puberty. The child has to receive a monthly intramuscular injection of leuprolide acetate (Lupron). The child has great fears of pain and needles and requires considerable stress reduction techniques each time an injection is due. What could the nurse suggest that might help manage the pain? 1. Apply a eutectic mixture of local anesthetics (EMLA) of lidocaine and prilocaine to the site at least 60 minutes before the injection. 2. Have extra help on hand to help hold the child down. 3. Apply cold to the area prior to injection. 4. Identify a reward to bribe the child to behave during the injection.

21. 1. EMLA cream works well for skin and cutaneous pain. Having the child assist in putting on the EMLA patch involves the child in the pain-relieving process.

24. A toddler is admitted to the pediatric floor for hypopituitarism following removal of a craniopharyngioma. The toddler has polyuria, polydipsia, and dehydration. What area of the brain was most affected by the surgery? 1. Posterior pituitary. 2. Anterior pituitary. 3. Autonomic nervous system. 4. Sympathetic nervous system.

24. 1. The posterior pituitary is responsible for the secretion of ADH and control of the renal tubules. The symptoms are those of DI. 2

26. The adrenal cortex secretes sex hormones. Identify which hormones would result in male feminization of a young child. Select all that apply. 1. Estrogen. 2. Testosterone. 3. Progesterone. 4. Cortisol. 5. Androgens.

26. 1. Estrogen and progesterone are hor mones secreted by the adrenal cortex that in excess would cause feminization of a young male child. 3. Estrogen and progesterone are hormones secreted by the adrenal cortex that in excess would cause feminization.

28. A teen comes into the clinic with anxiety. Over the last 2 weeks, the teen has had some muscle twitching and has a positive Chvostek sign. Which explanation could the nurse provide to the parent about a Chvostek sign? 1. It is a facial muscle spasm elicited by tapping the facial nerve. 2. Muscle pain occurs when touched. 3. The sign occurs because of increased intracranial pressure. 4. The sign is a result of a vitamin D overdose.

28. 1. Chvostek sign is a facial muscle spasm elicited by tapping on the facial nerve in the region of the parotid gland, indicates heightened neuromuscular activity, and leads the nurse to suspect hypoparathyroidism.

27. A child comes into the clinic and is suspected to have Cushing syndrome. Which test(s) could be utilized to determine cortisol levels in this patient? Select all that apply. 1. Fasting blood glucose. 2. Thyroid panel (TSH, T3, T4). 3. 24-hour urine for 17-hydroxycorticoids. 4. Radiographic studies of the bones. 5. Cortisone suppression test. 6. Urine culture. 7. Complete blood count.

3. A 24-hour urine for 17-hydroxycorti coids or a cortisone suppression test is used for diagnosing overproduction of cortisol by the body. 5. A 24-hour urine for 17-hydroxycorti coids or a cortisone suppression test is used for diagnosing overproduction of cortisol by the body.

53. A student has an insulin-to-carbohydrate ratio of 1:10. The school nurse understands which of the following? 1. The student administers 10 U of regular insulin for every carbohydrate consumed. 2. The student is trying to limit carbohydrate intake to 10 g per 24 hours. 3. The student administers 1 U of regular insulin for every 10 carbohydrates consumed. 4. The student plans to eat 10 g of carbohydrate for every gram of fat or protein.

3. An insulin-to-carbohydrate ratio refers to the amount of insulin given per gram of carbohydrate. A ratio of 1:5 means 1 U for every 5 carbohydrates.

45. The nurse is caring for a patient with a diagnosis of hyperthyroidism. An important nursing intervention is which of the following? 1. Encourage an increase in physical activity. 2. Do preoperative teaching for thyroidectomy. 3. Promote opportunities for periods of rest. 4. Do dietary planning to increase caloric intake.

3. Because increased activity is character istic of hyperthyroidism, providing op portunity for rest is a recommended nursing intervention.

20. The medication for the child in the previous problem comes in a vial of 5 mg of somatropin (rDNA) and is mixed with a diluent of 5 mL. There is 5 mL of solution in each vial. What amount of the solution should the nurse draw up to give the appropriate dose each time? 1. 1 mL. 2. 0.5 mL. 3. 0.675 mL. 4. 2 mL.

3. Determine the amount of solution by setting up an equation of 5 mg/5 mL as 0.675 mg:X.

19. A 6-year-old is diagnosed with growth hormone deficiency. A prescription is written for a dose of 0.025 mg/kg of somatotropin subcutaneously three times weekly. The child weighs 27 kg (59.4 lb). What dose of medication should the nurse administer three times weekly? 1. 1 mg. 2. 0.5 mg. 3. 0.675 mg. 4. 2 mg.

3. Determine the dosage of medication by multiplying 27 kg by the medication prescribed at 0.025 mg/kg. The total dosage needed is 0.675 mg.

58. A 13-year-old is being seen for an annual physical examination. The child has lost 10 lb despite reports of excellent appetite. Appearance is normal, except for slightly protruding eyeballs, and the parents report the child has had difficulty sleeping lately. The nurse should do which of the following? 1. Prepare the family for a neurology consult. 2. Explain the need for an ophthalmology consult. 3. Discuss the plan for thyroid function tests. 4. Explain the plan for an 8-hour fasting blood glucose test.

3. Diagnostic evaluation for hyperthy roidism is based on thyroid function tests. It is expected in this case that T4 and T3 levels would be elevated, as the thyroid gland is overfunctioning.

9. The family of a young child has been told the child has DI. What information should the nurse emphasize to the family? 1. One caregiver needs to learn to give the injections of vasopressin (Pitressin). 2. Children should wear MedicAlert tags if they are over 5 years old. 3. DI is different from DM. 4. Over time, the child may grow out of the need for medication.

3. Explaining that DI is different from DM is crucial to the parents' under standing of the management of the dis ease. DI is a rare condition that affects the posterior pituitary gland, whereas DM is a more common condition that affects the pancreas.

1. At the 6-month follow-up visit for an 8-year-old who is being evaluated for short stature, the nurse again measures and plots the child's height on the growth chart. Which explanation should the nurse give the child and family? 1. "We want to make sure you were measured accurately the last two visits." 2. "We need to calculate how tall you will be when you grow to adult height." 3. "We need to see how many inches you have grown since your last visit." 4. "We need to know your height so that a dosage of medication can be calculated for you."

3. Height velocity is the most important aspect of a growth evaluation and can demonstrate deceleration in growth if it is present.

46. A 13-year-old with type II DM asks the nurse, "Why do I need to have this hemoglobin A1c test?" The nurse's response is based on which of the following? 1. To determine how balanced the child's diet has been. 2. To make sure the child is not anemic. 3. To determine how controlled the child's blood sugar has been. 4. To make sure the child's blood ketone level is normal.

3. Hemoglobin A1c, or glycosylated hemoglobin, reflects average blood glucose levels over 2 to 3 months. Frequent high blood glucose levels would result in a higher hemoglobin A 1c, suggesting that blood glucose needs to be in better control.

15. An infant is born with ambiguous genitalia. Genetic testing and an ultrasound are ordered. The infant has a large clitoris, but there is no vaginal orifice. The labia appear to be sac-like darkened tissue. No testes are located. What suggestion should the nurse offer the family? 1. Take the baby home, and wait until the gender is determined to name "it." 2. Because the parents wanted a boy, give the baby a boy's name. 3. Give the baby a neutral name that fits either a boy or a girl. 4. Call the infant "baby" until they know the gender.

3. Selecting a gender-neutral name en ables the family and child to gradually accept and adjust to the baby's medical condition and sex.

10. A nurse is working with a child who has had a bone age evaluation. Which explanation of the test should the nurse give? 1. "The bone age will give you a diagnosis of your child's short stature." 2. "If the bone age is delayed, the child will continue to grow taller." 3. "The x-ray of the bones is compared with that of the age-appropriate, standardized bone age." 4. "If the bone age is not delayed, no further treatment is needed."

3. The bone age is a method of evaluating the epiphyseal growth centers of the bone using standardized, age appropriate tables.

50. The nurse is interviewing the parent of a 9-year-old girl. The parent expresses concern because the daughter already has pubic hair and is starting to develop breasts. Which of the following statements would be most appropriate? 1. "Your daughter should get her period in approximately 6 months." 2. "Your daughter is developing early and should be evaluated for precocious puberty." 3. "Your daughter is experiencing body changes that are appropriate for her age." 4. "Your daughter will need further testing to determine the underlying cause."

3. The changes described in the question are normal for a healthy 9-year-old female.

52. A 12-year-old with type II DM presents with a fever and a 2-day history of vomiting. The nurse obtaining the history observes that the child's breath has a fruity odor and breathing that is deep and rapid. The nurse should do which of the following? 1. Offer the child 8 oz of clear non-caloric fluid. 2. Test the child's urine for ketones. 3. Prepare the child for an IV infusion. 4. Offer the child 25 g of carbohydrates.

3. This patient needs fluid and electrolyte therapy to restore tissue perfusion prior to beginning IV insulin therapy.

47. The nurse caring for a 14-year-old girl with DI understands which of the following about this disorder? 1. DI is treated on a short-term basis with hormone replacement therapy. 2. DI may cause anorexia if proper meal planning is not addressed. 3. DI is treated with vasopressin on a lifelong basis. 4. DI requires strict fluid limitation until it resolves.

3. Vasopressin is the treatment of choice. It is important for patients and parents to understand that DI is a lifelong disease.

34. A child with adrenal insufficiency is sick with the flu. The parent calls the office and wants to know what to do. What is the first thing the nurse should advise this parent? 1. Withhold all medications, and bring the child to the office. 2. Encourage the child to drink water and juices. 3. Give the child a dose of cortisol, and bring the child to the office. 4. Let the child rest; the child will be better in the morning.

3. When children with adrenal insufficiency get the flu or are ill, the situation can be life-threatening. The family should ad minister the reserve hydrocortisone in jection intramuscularly and then bring the child to the office. There is no harm in giving extra hydrocortisone.

31. The percentile of weight-for-age for an 8-kg boy who is 9 months old is ____ ?

31. 10th percentile. The child would be in the 10th percentile in comparison with other boys the same age.

33. The thyroid gland secretes two types of hormones, TH and TC. Mark TH or TC in the correct spaces below. 1. _______ This hormone regulates the metabolic rate of all cells. 2. _______ This hormone regulates body heat production. 3. _______ This hormone affects milk production during lactation and menstrual flow. 4. _______ This hormone maintains calcium metabolism. 5. _______ This hormone maintains appetite and secretion of gastrointestinal substances. 6. _______ This hormone increases gluconeogenesis and utilization of glucose.

33. 1. TH; the main physiological effect of TH is to regulate the basal metabolic rate and thereby control the process of growth and tissue differentiation. 2. TH; the main physiological effect of TH is to regulate the basal metabolic rate and thereby control the process of growth and tissue differentiation. 3. TC; the main effects that TC causes are related to maintenance of blood calcium levels by decreasing calcium concentration in the blood. 4. TC; the main effects that TC causes are related to maintenance of blood calcium levels by decreasing calcium concentration in the blood. 5. TH; the main physiological effect of TH is to regulate the basal metabolic rate and thereby control the process of growth and tissue differentiation. 6. TH; the main physiological effect of TH is to regulate the basal metabolic rate and thereby control the process of growth and tissue differentiation.

36. What should the parent of a child with DI be taught about administering desmopressin acetate nasal spray? Select all that apply. 1. The use of the flexible nasal tube. 2. Nasal congestion causes this route to be ineffective. 3. The medication should be administered every 48 hours. 4. The medication should be administered every 8 to 12 hours. 5. Overmedication results in signs of SIADH. 6. Nasal sprays do not always work as well as injections.

36. 1. Administering desmopressin acetate per nasal spray is a means of providing the necessary medication in a steady state, if it is given using the flexible nasal tube every 8 to 12 hours. This decreases nasal irritation. 2. If the child becomes ill with rhinor rhea, the nasal spray will need to be administered via the buccal mucosa or rectum or the medication changed to tablets. 4. Administering desmopressin acetate per nasal spray is a means of providing the necessary medication in a steady state, if it is given using the flexible nasal tube every 8 to 12 hours. 5. Side effects of the DDAVP are those of SIADH.

22. A child weighs 21 kg. The parent asks for the weight in pounds. Which is the correct equivalent? 1. Approximately 50 lb. 2. 42 lb. 3. 60 lb. 4. 46 lb, 3 oz.

4. 2.2 kg 1 lb. Multiplying the kilograms by 2.2 yields 46.2 lb.

5. A 12-year-old comes to the clinic with a diagnosis of Graves disease. What information should the nurse discuss with the child? 1. Suggest weight loss. 2. Encourage attending school. 3. Emphasize that the disease will go into remission. 4. Encourage the child to take responsibility for daily medications.

4. Because the child is 12 years old, en couraging responsibility for health care is important. The child still needs family involvement and ongoing supervision but should not be completely dependent on family for care.

48. A 7-year-old is tested for DI. Twenty-four hours after his fluid restriction has begun, the nurse notes that his urine continues to be clear and pale, with a low specific gravity. The most likely reason for this is which of the following? 1. Twenty-four hours is too early to evaluate effects of fluid restriction. 2. The urine should be concentrated, and it is unlikely the child has DI. 3. The child may have been sneaking fluids and needs closer observation. 4. In DI, fluid restriction does not cause urine concentration.

4. Children with DI cannot concentrate urine.

14. The nurse is instructing a family on the side effects of cortisone. What aspects of administering the medication should the nurse emphasize? 1. Weight gain and dietary management. 2. Bitterness of the taste of the medication. 3. Excitability and sleepiness resulting from the medication. 4. Taking the medication with food to decrease gastric irritation.

4. Cortisone should be taken with food to decrease gastric irritation.

49. The nurse has completed discharge teaching of the family of a 10-year-old diagnosed with DI. Which of the following statements best demonstrates the family's correct understanding of DI? 1. "My child's disease was probably brought on by a bad diet and little exercise." 2. "My father is a diabetic, and that may be why my child has it." 3. "My child will need to check blood sugar several times a day." 4. "My child will have to use the bathroom more often than other children."

4. Despite the use of vasopressin to treat the symptoms of DI, breakthrough urination is likely.

43. The nurse is caring for a child who complains of constant hunger, constant thirst, frequent urination, and recent weight loss without dieting. The nurse can expect that care for this child will include which of the following? 1. Limiting daily fluid intake. 2. Weight management consulting. 3. Strict intake and output monitoring. 4. Frequent blood glucose testing.

4. Frequent blood glucose testing is in cluded in the care of a child with type I DM. The symptoms described in the question are characteristic of a child just prior to the diagnosis of type I DM.

40. The nurse is teaching the family about caring for their 7-year-old, who has been diagnosed with type I DM. What information should the nurse provide about type I DM? 1. Best managed through diet, exercise, and oral medication. 2. Can be prevented by proper nutrition and activity. 3. Characterized mainly by insulin resistance. 4. Characterized mainly by insulin deficiency.

4. Individuals with type I DM do not pro duce insulin. If one does not produce insulin, type I DM is the diagnosis.

54. A student takes metformin (Glucophage) three times a day. The nurse expects this student has which of the following? 1. Type I DM. 2. Gastrointestinal reflux. 3. Inflammatory bowel disease. 4. Type II DM.

4. Metformin is commonly used to manage type II DM.

11. You are caring for a school-aged child with myxedematous skin changes. The HCP wants information about the child's appearance. Which descriptive terms should you use to describe your observations of the child's skin? 1. The skin is oily and scaly. 2. The skin has pale, thickened patches. 3. The eyes are sunken, and the hair is thickened. 4. The eyes are puffy, the hair is sparse, and the skin is dry.

4. Myxedema, associated with low serum thyroxine and raised thyrotropin levels, is characteristic of hypothyroid dys function and presents with swelling or puffiness of the limbs and face, sparse hair, and very dry skin. These signs may be accompanied by slowness of movements and mental dullness.

42. The nurse caring for a patient with type I DM is teaching how to self-administer insulin. The proper injection technique is which of the following? 1. Position the needle with the bevel facing downward before injection. 2. Spread the skin prior to intramuscular injection. 3. Aspirate for blood return prior to injection. 4. Elevate the subcutaneous tissue before injection.

4. Skin tissue is elevated to prevent injection into the muscle when giving a subcutaneous injection. Insulin is only given subcutaneously.

2. What key information should be explained to the family of a 3-year-old who has short stature and abnormal laboratory test results? 1. Due to the diurnal rhythm of the body, growth hormone levels are elevated following the onset of sleep. 2. Exercise can stimulate growth hormone secretion. 3. The initial screening tests need to be repeated for accuracy. 4. Growth hormone levels in children are so low that stimulation testing must be done.

4. The need for additional testing requires explanation. The abnormal IGF-1 and insulin-like growth factor binding pro tein require a definitive diagnosis when the levels are either abnormally high or low. Very young children do not secrete adequate levels of growth hormone to measure accurately and thus require challenge/stimulation testing.

29. A school-aged girl is working on a school project on glands and asks the clinic nurse to explain the function of the thymus gland. Which answer is correct? 1. It produces hormones that help with digestion. 2. It is a gland that disappears by the time a baby is born. 3. A major function is to stimulate the pituitary to act as the master gland. 4. The gland helps with immunity in fetal life and early childhood.

4. The thymus acts to provide immunity to the very young body.

41. The most appropriate nursing diagnosis for a patient with type I DM is which of the following? 1. Risk for infection related to reduced body defenses. 2. Impaired urinary elimination (enuresis). 3. Risk for injury related to medical treatment. 4. Anticipatory grieving.

41. 1. Risk for infection is a correct nursing diagnosis. Understanding DM is un derstanding the effect it has on periph eral circulation and impairment of defense mechanisms.

56. The school nurse is talking to a 14-year-old about managing type I DM. Which of the following statements indicates the student's understanding of the disease? 1. "It really does not matter what type of carbohydrate I eat as long as I take the right amount of insulin." 2. "I should probably have a snack right after gym class." 3. "I need to cut back on my carbohydrate intake and increase my lean protein intake." 4. "Losing weight will probably help me decrease my need for insulin."

56. 1. This is true. A carbohydrate is a carbo hydrate, and insulin dosing is based on blood sugar level and carbohydrates to be eaten.

59. A 12-year-old with hyperthyroidism is being treated with standard antithyroid drug therapy. A parent calls the office stating that the child has a sore throat and fever. The nurse's best response is which of the following? 1. "Bring your child to the office or emergency room immediately." 2. "Slight fever and sore throat are normal side effects of the medication." 3. "Give your child the appropriate dose of ibuprofen, and call back if symptoms worsen." 4. "Give your child at least 8 oz of clear fluids, and call back if symptoms worsen." Answer the following three questions with reference to the following figure.

59. 1. A complication of antithyroid drug therapy is leukopenia. Fever and sore throat, therefore, need to be evaluated immediately. This is an essential component of discharge teaching for patients with Graves disease.

60. Hypofunction of which endocrine gland might cause type II DM? _________________

60. F

61. Hyperfunction of which endocrine gland might cause Cushing syndrome? _______________

61. E

62. Exophthalmic goiter is caused by hyperfunction of which endocrine gland? ______________

62. C

8. A teen who was hospitalized for CRF develops symptoms of polyuria, polydipsia, and bone pain. What body mineral might be causing these symptoms? 1. Elevated calcium. 2. Low phosphorus. 3. Low vitamin D. 4. High aluminum hydroxide.

8. 1. The most common causes of secondary hyperparathyroidism are chronic renal disease and anomalies of the urinary tract. Blood studies indicate very high levels of calcium because the kidney is unable to process it.