Peds PrepU: Chapter 27 Nursing Care of the Child with an Endocrine Disorder
A 12-year-old is being seen in the office and has hyperthyroidism; the nurse knows that the most common cause of hyperthyroidism is which of the following: a) Plummer disease b) Addison disease c) Graves disease d) Cushing disease
Graves disease Explanation: Hyperthyroidism occurs less often in children than hypothyroidism. Graves' disease, the most common cause of hyperthyroidism in children, occurs in 1 in 5,000 children between 11 and 15 years of age. Hyperthyroidism occurs more often in females, and the peak incidence occurs during adolescence
A 12-year-old girl is diagnosed with hyperthyroidism. What problem do you anticipate she may have in school? a) Noncomprehension of written material b) Increase in sleepiness by the end of the day c) Inability to fit legs under a school desk d) Inability to submit neat handwriting assignments
Inability to submit neat handwriting assignments Explanation: Children with hyperthyroidism may develop hand tremors, which leads to poor handwriting.
The nurse is assessing an 8-year-old boy who is performing at the second-grade level, complains of feeling tired and weak, and is only 45 inches tall. Which of the following findings would be specific to hypothyroidism? a) The child has gained 20 pounds in the past year. b) The child complains that the exam room is cold. c) The mother reports that the boy is always thirsty. d) Observation shows only two of the 6-year molars.
The child complains that the exam room is cold. Explanation: Cold intolerance, manifested by the fact that the child was uncomfortably cold in the exam room, is a sign of hypothyroidism. Delayed dentition, with only two of the four 6-year molars having erupted, is typical of growth hormone deficiency. Complaints of thirst may signal diabetes or diabetes insipidus. The dramatic weight gain could be due to hypothyroidism, Cushing syndrome, or syndrome of inappropriate antidiuretic hormone.
The nurse is teaching the parents of a 3-year-old girl with diabetes insipidus how to administer desmopressin acetate (DDAVP). Which comment indicates further need for teaching? a) "If she sneezes the medicine out of her nose, I wait until the next dose." b) "Once the tube is filled, I hold it closed until I insert it into her nostril." c) "I check the specific gravity of her urine to see if the drug is working." d) "First I suction her nostrils, if necessary, to help the drug be absorbed."
"If she sneezes the medicine out of her nose, I wait until the next dose." Explanation: The nurse must remind the parents that the medicine should be readministered immediately if the child sneezes. Proper intranasal administration of DDAVP starts with clearing the nostril. The effectiveness of the drug is monitored by checking the specific gravity of the child's urine. Proper administration involves inserting the measured tubing into the bottle, filling it to the proper dosage, holding the tube closed until it is inserted into the child's nostril, then blowing the fluid out of the tube.
In interpreting the negative feedback system that controls endocrine function, the nurse correlates how _______ secretion is decreased as blood glucose levels decrease. a) Adrenocorticotropic hormone b) Glucagon c) Glycogen d) Insulin
Insulin Explanation: Feedback is seen in endocrine systems that regulate concentrations of blood components such as glucose. Glucose from the ingested lactose or sucrose is absorbed in the intestine and the level of glucose in blood rises. Elevation of blood glucose concentration stimulates endocrine cells in the pancreas to release insulin. Insulin has the major effect of facilitating entry of glucose into many cells of the body; as a result, blood glucose levels fall. When the level of blood glucose falls sufficiently, the stimulus for insulin release disappears and insulin is no longer secreted.
The nurse is assessing a 5-year-old boy who has had several convulsions. The nurse continues to assess the child and suspects that he may have hypoparathyroidism. Which of the following would support this suspicion? a) Auscultation reveals an irregular heart rate. b) Observation reveals tetany. c) Slight exophthalmos is observed. d) The child acts sleepy and unresponsive.
Observation reveals tetany. Explanation: Tetany occurs in children with hypoparathyroidism due to decreased serum calcium levels. Sleepiness and lack of responsiveness would suggest hyperthyroidism Exophthalmos is associated with hyperthyroidism Irregular heart rate is associated with hyperthyroidism.
A child with a history of diabetes insipidus is admitted with polyuria, polydipsia, and mental confusion. The priority intervention for this client is: a) Measure urine output b) Weigh the client c) Check vital signs d) Encourage increased fluid intake
Check vital signs Explanation: The large amount of fluid loss can cause fluid and electrolyte imbalance that should be corrected; the loss of electrolytes would be reflected in vital signs. Urine output is important but not the priority. Encouraging fluids will not correct the problem and weighing the patient is not necessary at this time
A child is diagnosed with hyperthyroidism. Which of the following would the nurse expect to assess? a) Heat intolerance b) Constipation c) Facial edema d) Weight gain
Heat intolerance Explanation: Hyperthyroidism is manifested by heat intolerance, nervousness or anxiety, diarrhea, weight loss and smooth, velvety skin. Constipation, weight gain, and facial edema are associated with hypothyroidism.
A newborn is born with hypothyroidism. A complication of this disorder if it is not recognized and treated is a) dehydration. b) cognitive impairment. c) muscle spasticity. d) blindness.
cognitive impairment. Explanation: Congenital hypothyroidism can lead to extreme cognitive challenge impairment if not treated.
Eve, 2 years old, and her parents are at the office for a follow-up visit. She has had excessive hormone levels in her recent blood work and her parents question why this was not found sooner. What is the best response of the nurse?v a) "It takes time to determine the level of functioning of endocrine glands." b) "Endocrine disorders are hard to detect and you are lucky that we have found it when we did." c) "Have there been signs and symptoms that you should have reported to the doctor?" d) "As endocrine functions become more stable throughout childhood, alterations become more apparent."
"As endocrine functions become more stable throughout childhood, alterations become more apparent." Explanation: The endocrine glands are all present at birth; however, endocrine functions are immature. As these functions mature and become stabilized during the childhood years, alterations in endocrine function become more apparent. Thus, endocrine disorders may arise at any time during childhood development.
A 10-year-old boy has been diagnosed with type 1 diabetes mellitus. He is curious about what the cause of his disease is and asks the nurse to explain it to him. Which of the following should the nurse say to the boy? a) "A small part of your brain called the pituitary does not make enough of a chemical called growth hormone." b) "Special cells in a part of your body called the pancreas can't make a chemical called insulin, which helps control the sugar level in your blood." c) "Special cells in a part of your body called the pancreas cannot produce enough of a chemical called insulin, so there is too much sugar in your blood." d) "Your body does not produce enough a chemical called 'ADH,' which makes you really thirsty and have to go to the bathroom a lot."
"Special cells in a part of your body called the pancreas can't make a chemical called insulin, which helps control the sugar level in your blood." Explanation: Type 1 diabetes is a disorder that involves an absolute or relative deficiency of insulin in contrast to type 2 where insulin production is only reduced. Insulin is produced by beta islet cells in the pancreas. Diabetes insipidus is caused by the pituitary gland not producing enough ADH and is characterized by extreme thirstiness and polyuria. Insufficient growth hormone is also related to dysfunction of the pituitary gland.
The school nurse notes that a child diagnosed with diabetes mellitus is experiencing an insulin reaction and is unable to eat or drink. Which of the following actions would be the most appropriate for the school nurse to do? a) Dissolve a piece of candy in the child's mouth b) Administer subcutaneous glucagon c) Anticipate that the child will need intravenous glucose d) Request that someone call 911
Administer subcutaneous glucagon Explanation: If the child having an insulin reaction cannot take a sugar source orally, glucagon should be administered subcutaneously to bring about a prompt increase in the blood glucose level. This treatment prevents the long delay while waiting for a physician to administer IV glucose or for an ambulance to reach the child.
The nurse is providing acute care for an 11-year-old boy with hypoparathyroidism. Which of the following is the priority intervention? a) Providing administration of calcium and vitamin D b) Ensuring patency of the IV site to prevent tissue damage c) Administering intravenous calcium gluconate as ordered d) Monitoring fluid intake and urinary calcium output
Administering intravenous calcium gluconate as ordered Explanation: Administering intravenous calcium gluconate, as ordered, will restore normal calcium and phosphate levels as well as relieve severe tetany. Ensuring patency of the IV site to prevent tissue damage due to extravasation or cardiac arrhythmias is an intervention for any child with an IV, and monitoring fluid intake and urinary calcium output are secondary interventions. Providing administration of calcium and vitamin D is an intervention for nonacute symptoms
A 17-year-old is found after a high school football game wandering around. He is confused, sweaty, and pale. Which of the following tests is most likely to be performed first? a) CT scan b) Arterial blood gases c) Blood glucose level d) Blood cultures
Blood glucose level Explanation: It is important to draw a blood glucose level on the child because he is exhibiting signs of hypoglycemia and he needs to be treated as soon as possible. Once the patient is stabilized, a complete health history will need to be taken to determine the extent of his illness.
The nurse is assessing a 4-year-old girl with ambiguous genitalia. Which of the following findings would be consistent with congenital adrenal hyperplasia? a) Irregular heartbeat on auscultation b) Hyperpigmentation of the skin c) Pubic hair and hirsutism d) Pain from constipation on palpation
C Explanation: Observing pubic hair and hirsutism in a preschooler indicates congenital adrenal hyperplasia. Auscultation revealing an irregular heartbeat and palpation eliciting pain due to constipation may be signs of hyperparathyroidism. Observing hyperpigmentation of the skin would suggest Addison's disease.
You are going in to see a new patient in the clinic and the chief complaints for the patient are polyuria and polydipsia. You know that these are indicative of which endocrine disorder? a) Hypopituitarism b) Precocious puberty c) Diabetes insipidus d) Syndrome of inappropriate antidiuretic hormone secretion
Diabetes insipidus Correct Explanation: The most common symptoms of central DI are polyuria (excessive urination) and polydipsia (excessive thirst). Children with DI typically excrete 4 to 15 L per day of urine despite the fluid intake. The onset of these symptoms is usually sudden and abrupt. Ask about repeated trips to the bathroom, nocturia, and enuresis. Other symptoms may include dehydration, fever, weight loss, increased irritability, vomiting, constipation, and, potentially, hypovolemic shock.
The nurse knows that disorders of the pituitary gland depend on the location of the physiologic abnormality. Caring for a child that has issues with the anterior pituitary, the child has issues with which hormone? a) Oxytocin b) Antidiuretic hormone c) Vasopressin d) Growth hormone
Growth hormone Explanation: Disorders of the pituitary gland depend on the location of the physiologic abnormality. The anterior pituitary, or adrenohypophysis, is made up of endocrine glandular tissue and secretes growth hormone (GH), adrenocorticotropic hormone (ACTH), TSH, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin. The posterior lobe is called the neurohypophysis because it is formed of neural tissue. It secretes antidiuretic hormone (ADH; vasopressin) and oxytocin. Usually, several target organs are affected when there is a disorder of the pituitary gland, especially the adrenohypophysis.
A 6-year-old girl visits the pediatrician with complaints of excessive thirst, frequent voiding, weakness, lethargy, and headache. The nurse suspects diabetes insipidus. Which of the following hormonal conditions is characteristic of this disease? a) Hypersecretion of antidiuretic hormone b) Hyposecretion of somatotropin c) Hyposecretion of antidiuretic hormone d) Hypersecretion of somatotropin
Hyposecretion of antidiuretic hormone Explanation: Diabetes insipidus is a disease in which there is decreased release of antidiuretic hormone (ADH) by the pituitary gland. The child with diabetes insipidus experiences excessive thirst (polydipsia) that is relieved only by drinking large amounts of water; there is accompanying polyuria. Symptoms include irritability, weakness, lethargy, fever, headache, and seizures. Overproduction of antidiuretic hormone by the posterior pituitary gland results in a decrease in urine production and water intoxication and features weight gain, concentrated urine (increased specific gravity), nausea, and vomiting. As the hyponatremia grows more severe, coma or seizures occur from brain edema. Hyposecretion of somatotropin, or growth hormone, results in undergrowth; hypersecretion results in overgrowth.
The nurse is assessing a 7-year-old girl who complains of headache, is irritable, and vomiting. Her health history reveals she has had meningitis. Which of the following is the priority intervention? a) Setting up safety precautions to prevent injury b) Restoring fluid balance with IV sodium c) Notifying the physician of the neurologic findings d) Monitoring urine volume and specific gravity
Notifying the physician of the neurologic findings Explanation: This child may have syndrome of inappropriate antidiuretic hormone (SIADH). Priority intervention for this child is to notify the physician of the neurologic findings. Remaining interventions will be to restore fluid balance with IV sodium chloride to correct hyponatremia, set up safety precautions to prevent injury due to altered level of consciousness, and monitor fluid intake, urine volume, and specific gravity.
A nurse is teaching a child with type 1 diabetes mellitus how to self-inject insulin. Which of the following methods should she recommend to the child for regular doses? a) Subcutaneously in the outer thigh b) Intradermally in the outer arm c) Intramuscularly in the abdomen d) Intravenously in the chest
Subcutaneously in the outer thigh Explanation: Insulin is always injected SC except in emergencies, when half the required dose may be given IV. SC tissue injection sites used most frequently in children include those of the upper outer arms and the outer aspects of the thighs. The abdominal SC tissue injection sites commonly used in adults can be adequate sites but most children dislike this site as abdominal skin is tender.
The nurse working with the child diagnosed with Type 2 Diabetes Mellitus recognizes that most often the disorder can be managed by which of the following? a) Increasing protein in the diet, especially in the evening b) Conserving energy with rest periods during the day c) Decreasing amounts of daily insulin d) Taking oral hypoglycemic agents
Taking oral hypoglycemic agents Explanation: If the child presents with diabetic ketoacidosis, initial treatment is insulin administration, but then oral hypoglycemic agents such as metformin are often effective for controlling blood glucose levels. Lifestyle changes such as weight loss and increased exercise are important aspects of treatment for the child.
A newborn was diagnosed as having hypothyroidism at birth. Her mother asks you how the disease could be discovered this early. Your best answer would be a) children have a typical rash at birth that suggests the diagnosis. b) her child is already severely impaired at birth, and this suggests the diagnosis. c) a simple blood test to diagnose hypothyroidism is required in most states. d) hypothyroidism is usually detected at birth by the child's physical appearance.
a simple blood test to diagnose hypothyroidism is required in most states. Explanation: Hypothyroidism is diagnosed by a screening procedure a few days after birth.
A 9-year-old girl has just been diagnosed with Graves' disease. Which of the following symptoms should the nurse expect in this child? (Select all that apply.) a) Increased basal metabolic rate b) Moist skin c) Obesity d) Lethargy e) Nervousness f) Exophthalmos (protruding eyes)
• Increased basal metabolic rate • Nervousness • Moist skin • Exophthalmos (protruding eyes) Explanation: In Graves disease, children gradually experience nervousness, tremors, loss of muscle strength, and easy fatigue. Their basal metabolic rate, blood pressure, and pulse all increase. Their skin feels moist and they perspire freely. An exophthalmos-producing pituitary substance causes the prominent-appearing eyes that accompany hyperthyroidism in some children. Obesity and lethargy are symptoms of hypothyroidism, not of Graves' disease (hyperthyroidism)
A 12-year-old boy arrives at the emergency room experiencing nausea, vomiting, headache, and seizures. He is diagnosed with bacterial meningitis. Other findings include a decrease in urine production, hyponatremia, and water intoxication. Which pituitary gland disorder would be most associated with these symptoms? a) Hypersecretion of somatotropin b) Syndrome of inappropriate antidiuretic hormone c) Hyposecretion of somatotropin d) Diabetes insipidus
Syndrome of inappropriate antidiuretic hormone Explanation: Syndrome of inappropriate antidiuretic hormone (SIADH) is a rare condition in which there is overproduction of antidiuretic hormone by the posterior pituitary gland. This results in a decrease in urine production and water intoxication. As sodium levels fall in proportion to water, the child develops hyponatremia or a lowered sodium plasma level. It can be caused by central nervous system infections such as bacterial meningitis. As the hyponatremia grows more severe, coma or seizures occur from brain edema. Diabetes insipidus is characterized by polyuria, not decreased urine production. Hyposecretion of somatotropin, or growth hormone, results in undergrowth; hypersecretion results in overgrowth.
Kate and her parents are being seen in the office after discharge from the hospital with a new diagnosis of type 2 diabetes. Which of the following statements by the nurse is true? a) "Kids can usually be managed with an oral agent, meal planning, and exercise." b) "This will rectify itself if you follow all of the doctor's directions." c) "You are lucky that you did not have to learn how to give yourself a shot." d) "A weight-loss program should be implemented and maintained."
"Kids can usually be managed with an oral agent, meal planning, and exercise." Explanation: Treating type 2 diabetes in children may require insulin at the outset if the child is acidotic and acutely ill. More commonly, the child can be managed initially with oral agents, meal planning, and increasing activity. Telling the child that she is lucky, she did not have to learn how to give a shot might scare her so it will inhibit her from seeking future healthcare. The condition will not rectify itself if all orders are followed. A weight-loss program might need to be implemented but that is not always the case.
After explaining the causes of hypothyroidism to the parents of a newly diagnosed infant, the nurse should recognize that further education is needed when the parents ask which question? a) "Do you mean that hypothyroidism may be caused by a problem in the way the body makes thyroxine?" b) "Are you saying that hypothyroidism is caused by a problem in the way the thyroid gland develops?" c) "So, hypothyroidism can be only temporary, right?" d) "So, hypothyroidism can be treated by exposing our baby to a special light, right?"
"So, hypothyroidism can be treated by exposing our baby to a special light, right?" Explanation: Congenital hypothyroidism can be permanent or transient and may result from a defective thyroid gland or an enzymatic defect in thyroxine synthesis. Only the last question, which refers to phototherapy for physiologic jaundice, indicates that the parents need more information
The parents of a child who was diagnosed with diabetes insipidus ask the nurse, "How does this disorder occur?" When responding to the parents, the nurse integrates knowledge that a deficiency of which hormone is involved? a) Insulin b) Antidiuretic hormone c) Growth hormone d) Thyroxine
Antidiuretic hormone Explanation: Diabetes insipidus results from a deficiency in the secretion of antidiuretic hormone (ADH). This hormone, also known as vasopressin, is produced in the hypothalamus and stored in the pituitary gland. Hypopituitarism or dwarfism involves a growth hormone deficiency. Diabetes mellitus involves a disruption in insulin secretion. Thyroxine is a thyroid hormone that if deficient leads to hypothyroidism
Diabetes insipidus is a disorder of the posterior pituitary that results in deficient secretion of which hormone? a) Luteinizing hormone (LH) b) Antidiuretic hormone (ADH) c) Thyroid stimulating hormone (TSH) d) Adrenocorticotropic hormone (ACTH)
Antidiuretic hormone (ADH) Explanation: Central diabetes insipidus (DI), also called neurogenic, vasopressin-sensitive, or hypothalamic DI, is a disorder of the posterior pituitary that results from deficient secretion of ADH. Nephrogenic DI is a result of the inability of the kidney to respond to ADH.
As a nurse, you know that which of the following is caused by excessive levels of circulating cortisol: a) Graves disease b) Turner syndrome c) Cushing syndrome d) Addison disease
Cushing syndrome Explanation: CS is a characteristic cluster of signs and symptoms resulting from excessive levels of circulating cortisol. Addison disease is caused by autoimmune destruction of the adrenal cortex, which results in dysfunction of steroidogenesis. Grave disease is the most common form of hyperthyroidism. Turner syndrome is deletion of the entire X chromosome.
A 15-year-old girl is brought to the clinic by her mother because the girl has been experiencing irregular and sporadic menstrual periods and excessive body hair growth. Polycystic ovary syndrome is suspected. Which additional assessment finding would help to support this suspicion? a) Short stature b) Darkened pigmentation around the neck area c) Decreased serum levels of free testosterone d) Body mass index as normal
Darkened pigmentation around the neck area Explanation: Acanthosis nigricans (darkened, thickened pigmentation, particularly around the neck or in the axillary region) is associated with polycystic ovary syndrome. Serum levels of free testosterone typically are elevated with polycystic ovary syndrome. With polycystic ovary syndrome, body mass index indicates overweight or obesity. Short stature typically is associated with growth hormone deficiency.
A woman in her first trimester of pregnancy has just been diagnosed with acquired hypothyroidism. The nurse is alarmed because she knows that this condition can lead to which of the following pregnancy complications? a) Gestational diabetes in the mother b) Spina bifida in the fetus c) Congenital heart defects in the fetus d) Decreased cognitive development of the fetus
Decreased cognitive development of the fetus Explanation: If acquired hypothyroidism exists in a woman during pregnancy, her infant can be born cognitively challenged because there was not enough iodine present for fetal growth. It is important, therefore, that girls with this syndrome be identified before they reach childbearing age.
Which nursing objective is most important when working with neonates who are suspected of having congenital hypothyroidism? a) Allowing rooming in b) Encouraging fluid intake c) Promoting bonding d) Early identification
Early identification Explanation: The most important nursing objective is early identification of the disorder. Nurses caring for neonates must be certain that screening is performed, especially in neonates who are preterm, discharged early, or born at home. Promoting bonding, allowing rooming in, and encouraging fluid intake are all important but are less important than early identification.
A newborn girl is discovered to have congenital adrenogenital hyperplasia. When assessing her, you would expect to find which physical characteristic? a) Small for gestational age b) Divergent vision c) Abnormal facial features d) Enlarged clitoris
Enlarged clitoris Explanation: Lack of production of cortisol by the adrenal gland leads to overproduction of androgen. This leads to female infants developing an enlarged clitoris.
Tay-Sachs disease is found primarily in the Asian population. a) False b) True
False Explanation: Tay-Sachs disease is found primarily in the Ashkenazi Jewish population (Eastern European Jewish ancestry)
The nurse is assessing a 16-year-old boy who has had long-term corticosteroid therapy. Which of the following findings, along with the use of the corticosteroids, would indicate Cushing disease? a) Observing delayed dentition b) History of rapid weight gain c) Observing high weight to height ratio d) Observing a round, child-like face
History of rapid weight gain Explanation: A history of rapid weight gain and long-term corticosteroid therapy suggests this child may have Cushing disease, which could be confirmed using an adrenal suppression test. A round, child-like face is common to both Cushing and growth hormone deficiency. Observing high weight to height ratio and delayed dentition are findings with growth hormone deficiency.
A group of students are reviewing information about oral diabetic agents. The students demonstrate understanding of these agents when they identify which agent as reducing glucose production from the liver? a) Metformin b) Glipizide c) Glyburide d) Nateglinide
Metformin Explanation: Metformin, a biguanide reduces glucose production from the liver. Glipizide stimulates insulin secretion by increasing the response of β cells to glucose. Glyburide stimulates insulin secretion by increasing the response of β cells to glucose. Nateglinide stimulates insulin secretion by increasing the response of β cells to glucose.
The nurse is interviewing the caregivers of a child admitted with a diagnosis of Type 1 Diabetes Mellitus. The caregiver states, "She is hungry all the time and eats everything, but she is losing weight." The caregiver's statement indicates the child most likely has which of the following? a) Pica b) Polyphagia c) Polydipsia d) Polyuria
Polyphagia Explanation: Symptoms of Type 1 Diabetes Mellitus include polyphagia (increased hunger and food consumption), polyuria (dramatic increase in urinary output, probably with enuresis), and polydipsia (increased thirst), and. Pica is eating nonfood substances.
The most common mixture of insulin used with children with type 1 diabetes mellitus is a combination of an intermediate-acting insulin and a regular insulin, usually in a 2:1 ratio or 0.75 units of the intermediate-acting insulin to 0.33 units regular insulin, and given in the same syringe. a) False b) True
True
A 6-year-old boy has a moon-faced, stocky appearance but with thin arms and legs. His cheeks are unusually ruddy. He is diagnosed with Cushing syndrome. The nurse knows that which of the following is the most likely cause of this condition in this child? a) Tumor of the pancreas b) Tumor of the parathyroids c) Tumor of the adrenal cortex d) Tumor of the thyroid
Tumor of the adrenal cortex Explanation: Cushing syndrome is caused by overproduction of the adrenal hormone cortisol; this usually results from increased ACTH production due to either a pituitary or adrenal cortex tumor. The peak age of occurrence is 6 or 7 years. The overproduction of cortisol results in increased glucose production; this causes fat to accumulate on the cheeks, chin, and trunk, causing a moon-faced, stocky appearance. Cortisol is catabolic, so protein wasting also occurs. This leads to muscle wasting, making the extremities appear thin in contrast to the trunk, and loss of calcium in bones (osteoporosis). Yet other effects are hyperpigmentation (the child's face to be unusually red, especially the cheeks).
In the salt-losing form of congenital adrenal hyperplasia, the most important observation you would make in a newborn would be for a) excessive cortisone secretion. b) hypoglycemia. c) dehydration. d) bleeding tendencies.
c dehydration. Explanation: With this form of the disorder, children are unable to produce aldosterone. This leads to the inability to retain sodium and fluid.
You teach a child with type 1 diabetes mellitus to administer her own insulin. She is receiving a combination of short-acting and long-acting insulin. You know that she has appropriately learned the technique when she a) administers the insulin into a doll at a 30-degree angle. b) administers the insulin intramuscularly into rotating sites. c) wipes off the needle with an alcohol swab. d) draws up the short-acting insulin into the syringe first.
draws up the short-acting insulin into the syringe first. Explanation: Drawing up the short-acting insulin first prevents mixing a long-acting form into the vial of short-acting insulin. This maintains the short-acting insulin for an emergency. Insulin is given subcutaneously
A 7-year-old is diagnosed as having type 1 diabetes. One of the first symptoms usually noticed by parents when this illness develops is a) swelling of soft tissue. b) loss of weight. c) craving for sweets. d) severe itching
loss of weight. Explanation: Lack of insulin reduces the ability of body cells to use glucose; this leads to starvation of cells and loss of weight as an early symptom
The nursing diagnosis most applicable to a child with growth hormone deficiency would be a) risk for situational low self-esteem related to short stature. b) risk for self-directed violence related to oversecretion of epinephrine. c) impaired skin integrity related to overproduction of melanin. d) ineffective tissue perfusion related to infantile blood vessels.
risk for situational low self-esteem related to short stature. Explanation: Children who are short in stature can develop low self-esteem from their altered appearance
When collecting data on a child diagnosed with diabetes mellitus, the nurse notes that the child has had weight loss and other symptoms of the disease. The nurse would anticipate which of the following findings in the child's fasting glucose levels? a) 60 mg/dL b) 180 mg/dL c) 240 mg/dL d) 120 mg/dL
240 mg/dL Explanation: If the blood glucose level is elevated or ketonuria is present, a fasting blood sugar (FBS) is performed. An FBS result of 200 mg/dL or higher almost certainly is diagnostic for diabetes when other signs such as polyuria and weight loss, despite polyphagia, are present.
The physician has ordered a thyroid scan to confirm the diagnosis. Before the procedure the nurse should: a) Assess the client for allergies. b) Give the client a bolus of fluids. c) Insert a urinary catheter. d) Tell the client they will be asleep
Assess the client for allergies. Explanation: A thyroid scan uses dye, so a client should be assessed for allergies to iodine and shellfish to prevent a possible reaction. The client will not be asleep, have a catheter, or receive a bolus of fluids.
A child is prescribed glargine (Lantus) insulin. Which of the following would the nurse include when teaching the child and parents about this insulin? a) "Give the dose first thing in the morning." b) Discard any opened vials after a week. c) Store the insulin in the refrigerator until just before giving it. d) "Do not mix this insulin with other insulins."
"Do not mix this insulin with other insulins." Explanation: Glargine (Lantus) is not mixed with other insulins. Glargine is usually given in a single dose at bedtime. Insulin should be kept at room temperature; insulin that is administered cold may increase discomfort with the injection. Any vial of insulin that is opened should be discarded after 1 month
A newborn exhibits significant jittery movements, convulsions, and apnea. Hypoparathyroidism is suspected. Which of the following would the nurse expect to be administered? a) Desmopressin b) Levothyroxine c) Hydrocortisone d) Calcium gluconate
Calcium gluconate Explanation: Intravenous calcium gluconate is used to treat acute or severe tetany. Hydrocortisone is used to treat congenital adrenal hyperplasia and Addison disease. Desmopressin is used to control diabetes insipidus. Levothyroxine is a thyroid hormone replacement used to treat hypothyroidism.
A child with a primary growth hormone deficiency is to receive biosynthetic growth hormone. The nurse would explain to the child and parents that this hormone would be given at which frequency? a) Weekly b) Monthly c) Daily d) Bi-monthly
Daily Explanation: Biosynthetic growth hormone, derived from recombinant DNA, is given by subcutaneous injection. The weekly dosage is 0.2 to 0.3 mg/kg, divided into equal doses given daily for best growth.
The nurse is caring for a child with diabetes mellitus type 1. The nurse notes that the child is drowsy, has flushed cheeks and red lips, a fruity smell to the breath, and there has been an increase in the rate and depth of the child's respirations. The nurse recognizes that these symptoms indicate the child has which of the following? a) Diabetic ketoacidosis b) Insulin reaction c) Polyphagia d) Cheyne stokes respiration
Diabetic ketoacidosis Explanation: Diabetic ketoacidosis is characterized by drowsiness, dry skin, flushed cheeks and cherry-red lips, acetone breath with a fruity smell, and Kussmaul breathing (abnormal increase in the depth and rate of the respiratory movements).
A child is prescribed glargine (Lantus) insulin. Which of the following would the nurse include when teaching the child and parents about this insulin? a) "Do not mix this insulin with other insulins." b) Discard any opened vials after a week. c) Store the insulin in the refrigerator until just before giving it. d) "Give the dose first thing in the morning."
"Do not mix this insulin with other insulins." Explanation: Glargine (Lantus) is not mixed with other insulins. Glargine is usually given in a single dose at bedtime. Insulin should be kept at room temperature; insulin that is administered cold may increase discomfort with the injection. Any vial of insulin that is opened should be discarded after 1 month.
The nurse is caring for a 14-year-old boy with hyperpituitarism. Which of the following would be the priority? a) Assessing the child's self-image due to the disorder b) Teaching the child and family about proper treatment c) Administering octreotide acetate as ordered d) Treating the child according to his chronological age
Administering octreotide acetate as ordered Explanation: Administering octreotide acetate as ordered is the priority intervention and treatment for acromegaly. Assessing the child's self-image is appropriate but would not be the priority Treating the child according to his chronological age would be appropriate but not the priority. Teaching the child and family about proper treatment is appropriate and important but not the immediate priority.
Hypothyroidism results from deficient production of thyroid hormone or a defect in the thyroid hormone receptor activity. Hypothyroidism caused during embryonic development of the gland is called: a) Congenital hypothyroidism b) Acquired hypothyroidism c) Secondary hypothyroidism d) Autoimmune thyroiditis
a Congenital hypothyroidism Explanation: Congenital hypothyroidism is most commonly caused by defective embryonic development of the gland. Acquired hypothyroidism usually refers to thyroid deficiency that becomes evident after a period of apparently normal thyroid function. The most common cause of acquired hypothyroidism in iodine-sufficient regions of the world is lymphocytic thyroiditis (also called Hashimoto's or autoimmune thyroiditis).
In a child with diabetes insipidus, which characteristic would most likely be present in the child's health history? a) delayed closure of the fontanels, coarse hair, and hypoglycemia in the morning b) gradual onse of personality changes, lethargy and blurred vision c) vomiting early in the morning, headache, and decreased thirst d) abrupt onset of polyuria, nocturia, and polydipsia
D Abrupt onset of polyuria, nocturia, and polydipsia Explanation: Diabetes insipidus is characterized by deficient secretion of antidiuretic hormone leading to diuresis. Most children with this disorder experience an abrupt onset of symptoms, including polyuria, nocturia, and polydipsia. The other choices reflect symptoms of pituitary hyperfunction.
After hospital discharge, the mother of a child newly diagnosed with type 1 diabetes mellitus telephones you because her daughter is acting confused and very sleepy. Which emergency measure would you suggest the mother carry out before she brings the child to see her doctor? a) Give her a glass of orange juice with one unit regular insulin in it. b) Give her nothing by mouth so that a blood sugar can be drawn at the doctor's office. c) Give her a glass of orange juice. d) Give her one unit of regular insulin.
Give her a glass of orange juice. Explanation: These are typical symptoms of hypoglycemia. Administering a form of glucose would help relieve them. Insulin cannot be absorbed when taken orally.
In teaching the parents of an infant diagnosed with diabetes insipidus, the nurse should include which treatment? a) Hormone replacement b) Antihypertensive medications c) Fluid restrictions d) The need for blood products
Hormone replacement Explanation: The usual treatment for diabetes insipidus is hormone replacement with vasopressin or desmopressin acetate (DDAVP). Blood products shouldn't be needed. No problem with hypertension is associated with this condition, and fluids shouldn't be restricted.
When discussing congenital adrenogenital hyperplasia with a child's parents, you would advise them that administration of which of the following drugs will probably be indicated? a) Growth hormone b) Vitamin D c) Calcium d) Hydrocortisone
Hydrocortisone Explanation: The basic defect in congenital adrenogenital hyperplasia is the lack of cortisol. Administering hydrocortisone supplements this
The nurse is teaching an 11-year-old boy and his family how to manage his diabetes. Which of the following does not focus on glucose management? a) Instructing the child to rotate injection sites to decrease scar formation b) Promoting higher levels of exercise than previously maintained c) Teaching that 50% of daily calories should be carbohydrates d) Encouraging the child to maintain the proper injection schedule
Instructing the child to rotate injection sites to decrease scar formation Explanation: Instructing child to rotate injection sites to decrease scar formation is important, but does not focus on managing glucose levels. Teaching the child and family to eat a balanced diet, encouraging the child to maintain the proper injection schedule, and promoting a higher level of exercise all focus on regulating glucose control.
The nurse is caring for a 12-year-old girl with hypothyroidism. Which of the following will be part of the nurse's teaching plan for the child and family? a) Instructing to report irritability or anxiety b) Educating how to recognize vitamin D toxicity c) Teaching to administer methimazole with meals d) Teaching how to maintain fluid intake regimens
Instructing to report irritability or anxiety Explanation: Side effects of hypothyroidism are restlessness, inability to sleep, or irritability and should be reported to the physician. Educating how to recognize vitamin D toxicity is necessary for a child with hypoparathyroidism. Teaching parents how to maintain fluid intake regimens is important for a child with diabetes insipidus. Teaching the child and parents to administer methimazole with meals is necessary for hyperthyroidism.
Question: Rank the different types of insulin based on their duration of action beginning with the shortest to the longest duration.
Lispro Humulin R Humulin N Lantus Explanation: Lispro is a rapid-acting insulin. Humulin R is a short-acting insulin. Humulin N is an intermediate-acting insulin. Lantus is a long-acting insulin.
The nurse is assessing a 1-month-old girl who, according to the mother, doesn't eat well. Which of the following assessments would suggest the child has congenital hypothyroidism? a) Observation of an enlarged tongue b) Auscultation reveals tachycardia c) Mother reports frequent diarrhea d) Palpation reveals warm, moist skin
Observation of an enlarged tongue Explanation: Observation of an enlarged tongue along with an enlarged posterior fontanel and feeding difficulties are key findings for congenital hypothyroidism. The mother would report constipation rather than diarrhea. Auscultation would reveal bradycardia rather than tachycardia, and palpation would reveal cool, dry, and scaly skin
A school-aged girl is diagnosed as having Cushing's syndrome from long-term therapy with oral prednisone. This means that the child a) has purple striae on her abdomen. b) appears pale and fatigued. c) has hypoglycemia. d) is excessively tall for her age.
has purple striae on her abdomen. Explanation: An effect of a corticosteroid is to produce striae on the abdomen. Elevated levels of corticosteroids also cause these during pregnancy.
A nurse is teaching an adolescent with type 1 diabetes about the disease. Which instruction by the nurse about how to prevent hypoglycemia would be most appropriate for the adolescent? a) "Increase the insulin dosage before planned or unplanned strenuous exercise." b) "Carry crackers or fruit to eat before or during periods of increased activity." c) "Limit participation in planned exercise activities that involve competition." d) "Check your blood glucose level before exercising, and eat a protein snack if the level is elevated."
"Carry crackers or fruit to eat before or during periods of increased activity." Explanation: Hypoglycemia can usually be prevented if an adolescent with diabetes eats more food before or during exercise. Because exercise with adolescents isn't commonly planned, carrying additional carbohydrate foods is a good preventive measure.
Reva is an 8-year-old who is being seen today in the clinic for moodiness and irritability. She has begun to develop breasts and pubic hair and her parents are concerned that she is at too early an age for this to begin. As a nurse you know that the possible prognosis for her is: a) Pseudopuberty b) Adrenal hyperplasia c) Precocious puberty d) Neurofibromatosis
Precocious puberty Explanation: The prognosis for a child with precocious puberty depends on the age at diagnosis and immediate treatment. Appropriate treatment can halt, and sometimes even reverse, sexual development and can stop the rapid growth that results in severe short adult stature caused by premature closure of the epiphysis. Treatment for precocious puberty allows the child to achieve the maximum growth potential possible. Mental development in children with precocious puberty is normal, and developmental milestones are not affected; however, the behavior may change to that of a typical adolescent. Girls may have episodes of moodiness and irritability, whereas boys may become more aggressive.
A child who has type 1 diabetes mellitus is brought to the emergency department and diagnosed with diabetic ketoacidosis. Which of the following would the nurse expect to administer? a) Detemir b) NPH c) Regular insulin d) Lispro
Regular insulin Explanation: Insulin for diabetic ketoacidosis is given intravenously. Only regular insulin can be administered by this route
The nurse is teaching a 12-year-old girl with diabetes mellitus type 2 and her parents about dietary measures to control her glucose levels. Which comment by the child indicates a need for additional teaching? a) "I can eat two small cookies with each meal." b) "We should give her nonfat milk to drink." c) "I will be eating more breads and cereals." d) "I can have an apple or orange for snacks."
"I can eat two small cookies with each meal." Explanation: Cookies, cakes, candy, potato chips, and crackers are high in sugars and fats and should be eaten in moderation as special treats; they would not be included with each meal. An apple or orange makes a good snack. Nonfat milk is a better option than whole milk. Long-acting carbohydrates should be the largest category of foods eaten.
The parents of a child who was diagnosed with diabetes insipidus ask the nurse, "How does this disorder occur?" When responding to the parents, the nurse integrates knowledge that a deficiency of which hormone is involved? a) Thyroxine b) Antidiuretic hormone c) Insulin d) Growth hormone
Antidiuretic hormone Explanation: Diabetes insipidus results from a deficiency in the secretion of antidiuretic hormone (ADH). This hormone, also known as vasopressin, is produced in the hypothalamus and stored in the pituitary gland. Hypopituitarism or dwarfism involves a growth hormone deficiency. Diabetes mellitus involves a disruption in insulin secretion. Thyroxine is a thyroid hormone that if deficient leads to hypothyroidism
The parathyroid glands regulate serum levels of glucose in the body. a) True b) False
False Explanation: The four parathyroid glands, located posterior and adjacent to the thyroid gland, regulate serum levels of calcium in the body by controlling the rate of bone metabolism
You care for a 10-year-old boy with growth hormone deficiency. Which therapy would you anticipate will be prescribed for him? a) Intramuscular injections of growth hormone b) Oral administration of somatotropin c) Short-term aldosterone provocation d) Long-term blocking of beta cells
Intramuscular injections of growth hormone Explanation: Growth hormone deficiency occurs when the pituitary is unable to produce enough hormone for usual growth. Administering IM growth hormone supplements this.
The nurse is caring for a 10-year-old girl with hyperparathyroidism. Which of the following would be a primary nursing diagnosis for this child? a) Deficient knowledge related to treatment of the disease b) Deficient fluid volume related to electrolyte imbalance c) Imbalanced nutrition: more than body requirements d) Disturbed body image related to hormone dysfunction
Deficient fluid volume related to electrolyte imbalance Explanation: The primary nursing diagnosis would be deficient fluid volume related to electrolyte imbalance. It is important to increase the child's hydration to minimize renal calculi formation. Disturbed body image related to hormone dysfunction is a diagnosis for growth hormone deficiency. Imbalanced nutrition: more than body requirements would be important for a child with diabetes mellitus. Deficient knowledge related to treatment of the disease is appropriate for hyperparathyroidism, but it is not a priority diagnosis.
Which results would indicate to the nurse the possibility that a neonate has congenital hypothyroidism? a) Low T4 level and high TSH level b) Normal T4 level and low TSH level c) High thyroxine (T4) level and low thyroid stimulating hormone (TSH) level d) Normal TSH level and high T4 level
Low T4 level and high TSH level Explanation: Screening results that show a low T4 level and a high TSH level indicate congenital hypothyroidism and the need for further tests to determine the cause of the disease.
A child with a history of diabetes insipidus has been taking vasopressin. The parents bring the child to the clinic for an evaluation. During the visit, the parents mention that it seems like their son is hardly urinating. The nurse suspects syndrome of inappropriate antidiuretic hormone. Which of the following would the nurse expect to find to help confirm this condition? Select all that apply. a) Decreased urine osmolality b) Weight loss c) Serum osmolality 300 mOsm/kg d) Hypotension e) Decreased serum sodium level f) Urine specific gravity 1.033
• Urine specific gravity 1.033 • Decreased serum sodium level • Serum osmolality 300 mOsm/kg Explanation: Syndrome of inappropriate antidiuretic hormone (SIADH) is characterized by decreased urination, hyponatremia, serum osmolality greater than 280 mOsm/kg, urine specific gravity greater than 1.030, increased urine osmolality, fluid retention, weight gain, and hypertension.
The nurse is caring for a child admitted to the emergency center in diabetic ketoacidosis. Which of the following clinical manifestations would the nurse most likely note in this child? a) Drowsiness and fruity odor to breath b) Hyperactive and restless behavior c) Slow pulse and elevated blood pressure d) Pale and moist skin
A Explanation: Diabetic ketoacidosis is characterized by drowsiness, dry skin, flushed cheeks and cherry-red lips, acetone breath with a fruity smell, and Kussmaul breathing (abnormal increase in the depth and rate of the respiratory movements). Nausea and vomiting may occur. If untreated, the child lapses into coma and exhibits dehydration, electrolyte imbalance, rapid pulse, and subnormal temperature and blood pressure.
Insulin deficiency, increased levels of counterregulatory hormones, and dehydration are the primary cause of which of the following: a) Diabetic ketoacidosis b) Ketonuria c) Ketone bodies d) Glucosuria
Diabetic ketoacidosis Explanation: Insulin deficiency, in association with increased levels of counterregulatory hormones (glucagon, growth hormone, cortisol, catecholamines) and dehydration, is the primary cause of diabetic ketoacidosis (DKA), a life-threatening form of metabolic acidosis that is a frequent complication of diabetes. Liver converts triglycerides (lipolysis) to fatty acids, which in turn change to ketone bodies. The accumulation and excretion of ketone bodies by the kidneys is called ketonuria. Glusosuria is glucose that is spilled into the urine.
The child may have developed thyroid storm. Which of the following are clinical manifestations of thyroid storm? Select all that apply. a) The child's linen is wet and the child complains of feeling "sweaty" b) The child's temperature is 103.2°F (39.6°C) c) The child's apical heart rate is 172 beats per minute d) The child states he feels very tired and wants to take a nap e) The child has been mild-mannered and compliant
• The child's linen is wet and the child complains of feeling "sweaty" • The child's temperature is 103.2°F (39.6°C) • The child's apical heart rate is 172 beats per minute Explanation: The following are signs and symptoms related to the development of thyroid storm: fever, diaphoresis, and tachycardia. Children who are patients are also typically restless and irritable.
The child has developed hypothyroidism and has been prescribed sodium L-thyroxine. The starting dose is 12 mg/kg of body weight each day. The child weighs 72 pounds. Calculate the child's dose in micrograms and round to the nearest whole number.
393 Explanation: The child weighs 72 pounds and 2.2 pounds = 1 kg. 72 pounds x 1 kg/2.2 pounds = 32.727 kg. 32.727 kg x 12 mcg/1 kg = 392.727 mcg Rounded to the nearest whole number = 393 mcg
A 15-year-old adolescent is scheduled for a pelvic ultrasound to evaluate for a possible ovarian cyst. Which instruction by the nurse would be most appropriate? a) "You need to remain very still for the entire test." b) "Drink plenty of fluids because you need to have a full bladder." c) "Limit your level of physical activity for one-half hour before the test." d) "You won't be able to drink any water before or during the test."
"Drink plenty of fluids because you need to have a full bladder." Explanation: A full bladder is needed for an ultrasound of the pelvic. The patient needs to remain still for a computed tomography or magnetic resonance imaging scan, not an ultrasound. Water is withheld during a water deprivation test used to detect diabetes insipidus. Limiting stress and physical activity for 30 minutes before the test is required for the growth hormone stimulation test.
The nurse is caring for an obese 15-year-old girl who missed two periods and is afraid she is pregnant. Which of the following findings would indicate polycystic ovary syndrome? a) Observation of acanthosis nigricans b) Complains of blurred vision and headaches c) Palpation reveals hypertrophy and weakness d) Auscultation reveals increased respiratory rate
Observation of acanthosis nigricans Explanation: Observation of acanthosis nigricans in addition to the obesity and amenorrhea is a further indication of polycystic ovary syndrome. Complaint of blurred vision and headaches are signs and symptoms of diabetes mellitus. Auscultation revealing an increased respiratory rate points to diabetes insipidus. Palpation revealing hypertrophy and weakness is typical of hypothyroidism.
The nurse is caring for a 3-year-old diagnosed with diabetes mellitus. The child's eating patterns are unpredictable. One day the child will eat almost nothing, the next day the child eats everything on her tray. The nurse recognizes that which of the following types of insulin would most likely be used in treating this child? a) Rapid-acting insulin b) Long-acting insulin c) Intermediate-acting insulin d) Regular insulin
Rapid-acting insulin Explanation: The introduction of rapid-acting insulin, such as lispro or humalog, has greatly changed insulin administration in children. The onset of action of rapid-acting insulin is less than 15 mi nutes. Rapid-acting insulin can even be used after a meal in children with un predic table eating habits. Regular, intermediate, and long-acting insulin all have a longer onset, peak, and duration than rapid acting insulin, and are more difficult to regulate in the child with unpredictable eating patterns
The nurse is caring for a 4-year-old boy during a growth hormone stimulation test. Which of the following is a priority task for the care of this child? a) Monitoring intake and output b) Educating family about side effects c) Providing a wet washcloth to suck on d) Monitoring blood glucose levels
Monitoring blood glucose levels Explanation: Monitoring blood glucose levels during this study is the priority task along with observing for signs of hypoglycemia since insulin is given during the test to stimulate release of growth hormone. Providing a wet washcloth would be more appropriate for a child who is on therapeutic fluid restriction, such as with syndrome of inappropriate antidiuretic hormone. Monitoring intake and output would not be necessary for this test but would be appropriate for a child with diabetes insipidus. While it is important to educate the family about this test, it is not the priority task.
The neonatal nurse caring for children with inborn errors of metabolism explains to the student nurse that prompt treatment is an essential intervention to successful management of the diseases. Which of the following is a recommended treatment for these conditions? a) Undergoing liver or bone marrow transplant to increase deficient enzymes b) Replacing deficient enzymes through intravenous administration c) Eliminating the deficient product from the child's diet d) Increasing substrates preceding the enzymatic block
Replacing deficient enzymes through intravenous administration Explanation: Prompt treatment for metabolic disorders may include replacing deficient enzymes through intravenous administration. Other interventions are decreasing substrates preceding the enzymatic block (e.g., avoiding a particular amino acid or carbohydrate), administering a supplement of the deficient product that should have been produced, providing an enzymatic cofactor, using medications to remove accumulated substrates, undergoing liver or bone marrow transplantation to eliminate all deficient enzymes, and providing somatic gene therapy (a future option)
