Peds PrepU Quizzes Ch. 26
The nurse is caring for a child being evaluated for diabetes insipidus. Which tests will likely be included in the diagnostic workup for this condition? Select all that apply.
CT scan skull MRI of kidney region Urinalysis Explanation: Diabetes insipidus is an endocrine disorder characterized by excessive thirst, fluid intake and urinary output. Diagnostic testing will include radiographic studies such as a CT scan and MRI of the skull and kidneys. A urinalysis is performed to review urine specific gravity. Diagnostic testing for diabetes mellitus will include a hemoglobin A1C and fasting serum glucose levels.
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?
Darkened pigmentation around the neck area Explanation: Acanthosis nigricans (darkened, thickened pigmentation, particularly around the neck or in the axillary region) is associated with polycystic ovary syndrome. Serum levels of free testosterone typically are elevated with polycystic ovary syndrome. With polycystic ovary syndrome, body mass index indicates overweight or obesity. Short stature typically is associated with growth hormone deficiency.
Which results would indicate to the nurse the possibility that a neonate has congenital hypothyroidism?
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.
Which adolescents may have delayed puberty? Select all that apply:
14-year-old female who has not developed breasts 15-year-old male who has had no changes to the size of testicles Explanation: Delayed puberty in the female is indicated if she has not developed breasts by the age of 13; delayed puberty in the male is indicated if he has had no testicular enlargement by the age of 14. In females, pubic hair should appear before the age of 14. In males, pubic hair should appear before the age of 15 and scrotal changes by the age of 14.
The nursing is caring for a child recently admitted with an endocrine disorder. The child's mother asks the nurse what the term metabolism means. Which is the best response by the nurse?
"Metabolism refers to all physical and chemical reactions occurring in the body's cells that are necessary to sustain life."
The nurse is speaking with the parents of a child recently diagnosed with hypothyroidism. Which statement by a parent indicates an understanding of symptoms of this disorder?
"When they get my son's thyroid levels normal, he won't be so tired." Explanation: Tiredness, fatigue, constipation, cold intolerance and weight gain are all symptoms of hypothyroidism. Nervousness, anxiety, heat intolerance, weight loss and smooth velvety skin are all symptoms of hyperthyroidism.
In a child with diabetes insipidus, which characteristic would most likely be present in the child's health history?
Abrupt onset of polyuria, nocturia, and polydipsia 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
The school nurse notes that a child diagnosed with diabetes mellitus is experiencing an insulin reaction and is unable to eat or drink. Which action would be the most appropriate for the school nurse to take?
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 intervention is priority?
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.
The nurse is caring for a child admitted to the emergency center in diabetic ketoacidosis. Which clinical manifestations would the nurse most likely note in this child?
Drowziness and fruity odor to breath Explanation: Diabetic ketoacidosis is characterized by drowsiness, decreased skin turgor, 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.
The student nurse is reviewing the medical record of a child with diabetes insipidus. What information found provides support for diagnosis? Select all that apply.
Increased urination Dehydration Decreased urine osmolality Explanation: Symptoms of diabetes insipidus (DI) include increased urination, hypernatremia, decreased urine osmolality, dehydration and thirst. Hyponatremia, fluid retention, weight gain and hypertension are symptoms of syndrome of inappropriate antidiuretic hormone (SIADH).
The nurse is teaching an 11-year-old boy and his family how to manage his diabetes. Which instruction does not focus on glucose management?
Instructing the child to rotate injection sites Explanation: Instructing child to rotate injection sites to decrease scar formation is important, but does not focus on managing glucose levels. Teaching the child and family to eat a balanced diet, encouraging the child to maintain the proper injection schedule, and promoting a higher level of exercise all focus on regulating glucose control.
Rank the different types of insulin based on their duration of action beginning with the shortest to the longest duration.
Lispro Humulin R Humulin N Lantus
A child has been prescribed Stimate (esmopressin) acetate for the treatment of diabetes insipidus. The client and the parents ask the nurse how this drug works. What is the correct response by the nurse?
Stimate (esmopressin) acetate is a synthetic antidiuretic hormone that will slow down your urine output Explanation: Stimate (esmopressin) acetate is a synthetic antidiuretic hormone that promotes reabsorption of water by action on renal tubules; it is used to control diabetes insipidus by decreasing the amount of urine produced.
The nurse is caring for a teenager recently diagnosed with Addison disease. Which findings can be anticipated by the nurse? Select all that apply.
Sodium level 128 mEq/L Potassium level 5.6 mEq/L Muscular weakness Explanation: Hyponatermia, hyperkalemia and muscle weakness are all symptoms of Addison disease. Rapid weight gain and acne are present in Cushing disorder, not Addison.
The nurse working with the child diagnosed with type 2 diabetes mellitus recognizes that most often the disorder can be managed by:
Taking oral hypoglycemic agents Explanation: If the child presents with diabetic ketoacidosis, initial treatment is insulin administration, but then oral hypoglycemic agents such as metformin are often effective for controlling blood glucose levels. Lifestyle changes such as weight loss and increased exercise are important aspects of treatment for the child.
The child may have developed thyroid storm. Which clinical manifestations of thyroid storm should the nurse expect to find? Select all that apply.
Temperature of 103.2° F (39.6° C) Wet bed linen and report of feeling "sweaty" Apical heart rate of 172 beats per minute Explanation: Signs and symptoms related to the development of thyroid storm include: fever, diaphoresis, and tachycardia. Children with thyroid storm are typically restless and irritable.
The nurse is caring for 1-month-old girl with thyrotoxicosis. What finding would the nurse expect to assess?
The child has a strong appetite but fails to thrive. Explanation: Infants with thyrotoxicosis may display hyperphagia but fail to gain weight. A combination of lethargy and irritability suggests congenital hypothyroidism. Cool, dry skin that is scaly to the touch suggests congenital hypothyroidism. Hypoactivity and hypotonicity are findings that suggest congenital hypothyroidism.
A child with a history of diabetes insipidus is admitted with polyuria, polydipsia, and mental confusion. The priority intervention for this client is to:
check vital signs. 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 client is not necessary at this time.
The nurse is providing education to a 10-year-old child and her parents about the CT scan that has been ordered for the following day. What information should be included in the teaching provided? Select all that apply.
You will need to lie very still during the test. This test will let us look inside at your tissues and organs. Explanation: The CT (computed tomography) test is used to look at tissue density and structures. It is able to identify the presence of tumors, cysts and other abnormalities. The test will require the client to lie still. If this is not possible, the client may require sedation. The machine does not make loud noises such as clicks and thumps. There is no need to drink large quantities of water prior to the test.
The school age child is scheduled for a 2-hour plasma glucose test. The nurse has given verbal and written instructions to the parent regarding the test. Which comments by the parent indicate that instructions for the test were not followed?
"My child only took half of their normal insulin dose this morning." "When will the IV be started that administers the sugar solution?" "This test helps in diagnosing infections that may cause my child's blood sugar to be abnormal." Explanation: No insulin or oral diabetic medications should be taken prior to the test. An oral glucose, not an IV solution, is administered. Oral glucose is ingested and in a healthy child insulin will respond and return blood glucose to normal levels; it does not test for infections. Blood samples are drawn prior to ingestion of the glucose solution and at intervals after.
A newborn exhibits significant jittery movements, convulsions, and apnea. Hypoparathyroidism is suspected. What would the nurse expect to be administered?
Calcium gluconate Explanation: Intravenous calcium gluconate is used to treat acute or severe tetany. Hydrocortisone is used to treat congenital adrenal hyperplasia and Addison disease. Desmopressin is used to control diabetes insipidus. Levothyroxine is a thyroid hormone replacement used to treat hypothyroidism.
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 this type of insulin would most likely be used in treating this child?
Rapid-acting insulin Explanation: The introduction of rapid-acting insulin, such as lispro, has greatly changed insulin administration in children. The onset of action of rapid-acting insulin is less than 15 minutes. Rapid-acting insulin can even be used after a meal in children with unpredictable 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 physician has ordered routine hemoglobin A1C levels for a teenager with diabetes. Following teaching about the test by the nurse, the client and family demonstrate the need for further instruction with which statements? Select all that apply.
"I will be sure to not eat or drink anything the night before I get my blood drawn for the test." "I can check this level myself using a blood glucose monitor." "We will need to make sure our child gets this lab test at least every 6 months to ensure the diabetes is under control." Explanation: Hemoglobin A1C levels provides the physician or nurse practitioner with information regarding the long-term control of glucose levels so fasting is not necessary. The test indicates the level of blood glucose over a 2- to 3-month period, so it should be performed about every 3 months. Daily blood glucose monitoring can be performed by the client with the use of a finger stick and glucose meter. The physician should be informed of high stress levels as this can increase blood glucose levels.
The nurse is providing client teaching regarding the administration of desmopressin acetate for the client diagnosed with diabetes insipidus. Which statements by the client or parents indicates understanding of the teaching? Select all that apply.
"We will want to inspect the nares of our child to be sure the medication is not irritating the tissue." "We will need to adjust the dose based on how much our child is urinating." "I am going to have to carry a cooler with me if I am going to be gone all day or if I go on a long hike." Explanation: The nares should be inspected because this medication is administered via the intranasal route, and the dose is adjusted based on the client's output. The medication must be kept refrigerated so appropriate planning is necessary if the child is not going to be home. This medication is a synthetic antidiuretic hormone for the treatment of diabetes insipidus (which causes production of excessive amounts of urine), which is not related to diabetes mellitus. The medication is titrated to the amount of urine output.
