prepU chapter 26

The nurse is caring for a child recently diagnosed with hypoparathyroidism disorder. Which medication would the nurse expect to be ordered? oral calcium oral corticosteroids intravenous diuretic therapy oral potassium

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

Question 7 of 20 The nurse is teaching glucose monitoring and insulin administration to a child with type 1 diabetes and the parents. Which comment by a parent demonstrates a need for additional teaching? "We should check our child's blood glucose levels before meals." "During exercise we should wait to check blood sugars until after our child completes the activity." "Blood glucose level, food intake, and activity need to all be considered when calculating insulin dosage." "If our child is sick we should check blood glucose levels more often." SUBMIT ANSWER Exit quiz

"During exercise we should wait to check blood sugars until after our child completes the activity." Explanation: Blood glucose monitoring needs to be performed more often during prolonged exercise. Frequent glucose monitoring before, during, and after exercise is important to recognize hypoglycemia or hyperglycemia. Frequent glucose monitoring if the child is sick is also important to recognize changes in glucose levels and prevent hypoglycemia or hyperglycemia. The parents are correct that they will check their child's glucose before meals; they should also check it before bedtime snacks. Blood glucose level should never be the only factor considered when calculating insulin dosing. Food intake and recent or expected activity/exercise must be factored in.

A nurse is educating a family about the Chvostek sign after their teen tested positive for Chvostek sign. Which statements by the caregivers shows the nurse that they understand the Chvostek sign? "When I tap on my child's facial nerve, the reaction is a facial muscle spasm." "The sign means my child is not getting enough vitamin D." "The sign occurs because my child is having increased intracranial pressure." "The sign occurs when there is muscle pain and the muscle is stimulated."

"When I tap on my child's facial nerve, the reaction is a facial muscle spasm." Explanation: The Chvostek sign is a facial muscle spasm that occurs when the facial nerve is tapped. This can indicate heightened neuromuscular activity, possibly caused by hypocalcemia. Hypoparathyroidism may be suspected.

When collecting data on a child diagnosed with diabetes mellitus, the nurse notes that the child has had weight loss and other symptoms of the disease. The nurse would anticipate which finding in the child's fasting glucose levels? 60 mg/dl 100 mg/dl 140 mg/dl 220 mg/dl

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

The parents of a child who was diagnosed with diabetes insipidus ask the nurse, "How does this disorder occur?" When responding to the parents, the nurse integrates knowledge that a deficiency of which hormone is involved? Antidiuretic hormone Growth hormone Insulin 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.

During an assessment of an adolescent child, the nurse notes that the child has a protuberant tongue, fatigued appearance, poor muscle tone, and exophthalmos. What medical diagnosis would the nurse expect the child to have? Cushing disease Graves disease diabetes syndrome of inappropriate antidiuretic hormone secretion (SIADH)

Graves disease Explanation: Symptoms of Graves disease include an increased rate of growth; weight loss despite an excellent appetite; hyperactivity; warm, moist skin; tachycardia; fine tremors; an enlarged thyroid gland or goiter; and ophthalmic changes including exophthalmos. These are not symptoms of Cushing disease, diabetes, or SIADH.

Question 11 of 20 A child is brought to the clinic experiencing symptoms of nervousness, tremors, fatigue, increased heart rate and blood pressure. Based on this assessment, the nurse would suspect a diagnosis of which condition? Cushing syndrome Graves disease hypertension hypothyroidism SUBMIT ANSWER Exit quiz

Graves disease Explanation: Children who develop Graves disease experience nervousness, tremors, and increased heart rate and blood pressure cause by overstimulation of the thyroid gland. Cushing syndrome, hypertension, and hypothyroidism are not associated with these symptoms.

A 12-year-old is being seen in the office and has hyperthyroidism; the nurse knows that the most common cause of hyperthyroidism is: Addison disease Cushing disease Graves disease Plummer 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 nurse is teaching about pharmacologic management to families with children who have diseases caused by inborn errors of metabolism. It is important for the nurse to include which information? In most cases, children can stop the treatment when they are doing better. In most cases, treatment is lifelong. In most cases, pharmacological treatment does not work. Pharmacological treatment replaces diet restrictions.

In most cases, treatment is lifelong. Explanation: Pharmacologic dosages of vitamins and medications may be given. In most cases, such treatment is lifelong as this is an inborn error and not something that will change over the lifetime of the child. Pharmacological treatments are used to supplement a deficient product, such as a hormone, or to assist in removing any accumulated substrates. They do not replace diet restrictions. They usually prove to be beneficial and are necessary for the child's survival.

Question 12 of 20 Which results would indicate to the nurse the possibility that a neonate has congenital hypothyroidism? Low T4 level and high TSH level Normal TSH level and high T4 level High thyroxine (T4) level and low thyroid stimulating hormone (TSH) level Normal T4 level and low TSH level SUBMIT ANSWER Exit quiz

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

Metformin Explanation: Metformin, a biguanide, reduces glucose production from the liver. Glipizide, glyburide, and nateglinide all stimulate insulin secretion by increasing the response of β cells to glucose.

Question 3 of 20 Which findings should the nurse expect to assess when completing the health history of a child admitted for possible type 2 diabetes? Select all that apply. Polyuria Abrupt onset of symptoms Polyphagia Polydipsia Marked weight loss SUBMIT ANSWER Exit quiz

Polyuria Polydipsia Polyphagia Type 2 diabetes mellitus is characterized by a gradual onset and is most often associated with obesity and not marked weight loss. Type 1 diabetes is most often abrupt and associated with marked weight loss. Polyuria, polydipsia, and polyphagia are frequent assessment findings in both types of diabetes mellitus

Question 8 of 20 A child who has type 1 diabetes mellitus is brought to the emergency department and diagnosed with diabetic ketoacidosis. What treatment would the nurse expect to administer? Regular insulin Detemir NPH Lispro SUBMIT ANSWER Exit quiz

Regular insulin Explanation: Insulin for diabetic ketoacidosis is given intravenously. Only regular insulin can be administered by this route.

A child with Addison disease has been admitted with a history of nausea and vomiting for the past 3 days. The client is receiving IV glucocorticoids. Which intervention will the nurse perform? Take glucometer readings as ordered. Measure intake and output. Monitor sodium and potassium levels. Weigh daily.

Take glucometer readings as ordered. Explanation: IV glucocorticoids raise the glucose levels and often require coverage with insulin. Measuring the intake and output at this time is not necessary. Sodium and potassium would be monitored when the client is receiving mineralocorticoids. Daily weights are not necessary at this time.

Question 19 of 20 A nurse is taking care of an infant with diabetes insipidus. Which assessment data are most important for the nurse to monitor while the infant has a prescription for fluid restriction? Vital signs Urine output Oral mucosa Oral intake SUBMIT ANSWER Exit quiz

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

Question 4 of 20 A child presents to the primary care setting with enuresis, nocturia, increased hunger, weight loss, and increased thirst. What does the nurse suspect? Diabetes insipidus Hypothyroidism Syndrome of inappropriate diuretic hormone Type 1 diabetes mellitus SUBMIT ANSWER Exit quiz

Type 1 diabetes mellitus Explanation: Signs and symptoms of type 1 diabetes mellitus include polyuria, polydipsia, polyphagia, enuresis, and weight loss.

Question 14 of 20 An elementary school child takes metformin three times each day. Which disorder would the school nurse expect the child to have? Gastrointestinal reflux Type 1 diabetes mellitus Inflammatory bowel disorder Type 2 diabetes mellitus SUBMIT ANSWER Exit quiz

Type 2 diabetes mellitus Explanation: Metformin is the common treatment to manage type 2 DM. Insulin, not oral medication, is the treatment of choice for type 1 DM. Metoclopramide is the treatment for GI reflux. Methylprednisolone is used to treat inflammatory bowel disease.

Question 16 of 20 A nurse should recognize that which laboratory result would be most consistent with a diagnosis of diabetes mellitus? glucose in the urine a fasting blood glucose greater than 126 mg/dl a fasting blood glucose less than 126 mg/dl proteinuria SUBMIT ANSWER Exit quiz

a fasting blood glucose greater than 126 mg/dl Explanation: A fasting blood glucose greater than 126 mg/dl is diagnostic for diabetes mellitus.

In a child with diabetes insipidus, which characteristic would most likely be present in the child's health history? delayed closure of the fontanels (fontanelles), coarse hair, and hypoglycemia in the morning gradual onset of personality changes, lethargy, and blurred vision vomiting early in the morning, headache, and decreased thirst abrupt onset of polyuria, nocturia, and polydipsia

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.

A child with a history of diabetes insipidus is admitted with polyuria, polydipsia, and mental confusion. Which action would be the priority?

checking 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. Encouraging fluids will not correct the problem and weighing the client is not necessary at this time.

A pediatric client has just been diagnosed with diabetes insipidus. What is the primary consideration for this client? fluid replacement weight loss polydipsia headache

fluid replacement Explanation: Children with diabetes insipidus lose tremendous amounts of fluid, so fluid replacement is the priority consideration for this client. Excessive fluid loss can lead to seizures and death. Headache and polydipsia can be relieved with fluid replacement. Children will requirement a nutritional consultation for weight loss, but it is not the main consideration.

Question 18 of 20 Which is the best way to control enzyme deficiencies? high-protein and low-sodium diet high-carbohydrate and low-fat diet special diet restrictions and synthetic medical foods herbs and natural foods SUBMIT ANSWER Exit quiz

special diet restrictions and synthetic medical foods Explanation: The goal of dietary restriction, the primary treatment modality for inborn errors of metabolism, is to control the substrate accumulation by reducing or eliminating carbohydrates, proteins, or both. Special diet restrictions and synthetic medical foods are the two most successful methods of controlling enzyme deficiencies.

The nurse measures the client's blood glucose level prior to breakfast. The measurement obtained is 130 mg/dl. The orders read to administer 2 units of Humalog insulin for a blood glucose of 100 to 150 mg/dl. How soon should the nurse ensure that the client eats breakfast after receiving insulin? within 5 minutes within 15 to 30 minutes within 60 to 90 minutes within 2 hours

within 15 to 30 minutes Explanation: Humalog is a rapid-acting insulin. The onset of Humalog insulin is within 15 minutes and the peak level is achieved within 30 to 90 minutes; therefore, the client should eat within 15 to 30 minutes to avoid a hypoglycemic reaction.

A nurse working in a pediatric clinic is examining a child with symptoms indicating a possible inborn error of metabolism. Which action is most important for the nurse to do at this time? Ignore the symptoms if the family does not ask about them. Counsel the family to have all siblings evaluated. Reassure the family that everything is OK, but express urgency to the health care provider. Read more about the condition and its ramifications.

Counsel the family to have all siblings evaluated. Explanation: If one child in the family has suspicious symptoms, counsel the family to have all other siblings evaluated, even if their symptoms are not exactly the same. The nurse should never ignore such a problem and should never tell a family not to worry when a problem may exist. Reading more about the problem may be helpful, but it is not a priority action at this time.

Question 10 of 20 The nurse knows that which condition is caused by excessive levels of circulating cortisol? Turner syndrome Cushing syndrome Graves disease Addison disease SUBMIT ANSWER Exit quiz

Cushing syndrome Explanation: Cushing syndrome 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. Graves disease is the most common form of hyperthyroidism. Turner syndrome is the deletion of the entire X chromosome.

Question 5 of 20 A child is prescribed glargine insulin. What information would the nurse include when teaching the child and parents about this insulin? Do not mix this insulin with other insulins. Store the insulin in the refrigerator until just before giving it. Give the dose first thing in the morning. Discard any opened vials after a week. SUBMIT ANSWER Exit quiz

Do not mix this insulin with other insulins. Explanation: Glargine is not to be 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.

Question 3 of 20 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? "My son's nervousness may be a symptom of his hypothyroidism." "Most people with hypothyroidism have smooth, velvety skin." "When they get my son's thyroid levels normal, he won't be so tired." "Heat intolerance is a caused by low thyroid levels." SUBMIT ANSWER Exit quiz

"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.

Question 13 of 20 A woman in her first trimester of pregnancy has just been diagnosed with acquired hypothyroidism. The nurse is alarmed because this condition can lead to which pregnancy complication? Spina bifida in the fetus Gestational diabetes in the mother Congenital heart defects in the fetus Decreased cognitive development of the fetus SUBMIT ANSWER Exit quiz

Decreased cognitive development of the fetus Explanation: If acquired hypothyroidism exists in a woman during pregnancy, her infant can be born intellectually disabled, 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.

A nurse is to see a child. Assessment reveals the chief complaints of urinating "a lot" and being "really thirsty." The nurse interprets these symptoms as being associated with which condition? syndrome of inappropriate antidiuretic hormone secretion hypopituitarism diabetes insipidus precocious puberty TAKE ANOTHER QUIZ

diabetes insipidus Explanation: The most common symptoms of central diabetes insipidus are polyuria (excessive urination) and polydipsia (excessive thirst). Children with diabetes insipidus typically excrete 4 to 15 L/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.

Question 17 of 20 A pediatric client has just been diagnosed with diabetes insipidus. What is the primary consideration for this client? headache fluid replacement weight loss polydipsia SUBMIT ANSWER Exit quiz

fluid replacement Explanation: Children with diabetes insipidus lose tremendous amounts of fluid, so fluid replacement is the priority consideration for this client. Excessive fluid loss can lead to seizures and death. Headache and polydipsia can be relieved with fluid replacement. Children will requirement a nutritional consultation for weight loss, but it is not the main consideration.

Question 7 of 10 A 9-year-old child with Graves disease is seen at the pediatrician's office reporting sore throat and fever. The nurse notes in the history that the child is taking propylthiouracil. Which of the following would concern the nurse? The child needs to be started on an antibiotic drug. The child may not be taking the medication. The child may have developed leukopenia. The child must be participating in sports. SUBMIT ANSWER Exit quiz

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

A 2-year-old client is at the office for a follow-up visit. The client has had excessive hormone levels in recent bloodwork and the parents question why this was not found sooner. What is the best response by the nurse? "It takes time to determine the level of functioning of endocrine glands." "Have there been signs and symptoms that you should have reported to the doctor?" "As endocrine functions become more stable throughout childhood, alterations become more apparent." "Endocrine disorders are hard to detect and you are lucky that we have found it when we did."

"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.

Question 18 of 20 The nurse is caring for a child who is suspected to have a growth hormone deficiency. Which finding after further testing supports this diagnosis? Magnetic resonance imaging shows a brain tumor. The bone age is found to be two or more deviations below normal. Physical examination finds excessive foot and finger growth for age. Computed tomography identifies a tumor on the child's kidney. SUBMIT ANSWER Exit quiz

The bone age is found to be two or more deviations below normal. Explanation: Diagnostic testing used in children with suspected growth hormone deficiency will indicate bone age to be two or more deviations below normal. The growth hormone is secreted by the pituitary gland not the kidney. Therefore, identification of a tumor on the kidney does not support growth hormone deficiency. Magnetic resonance imaging showing a brain tumor also does not support this diagnosis. Excess growth of the foot and fingers supports a diagnosis of growth hormone excess.

Question 9 of 20 Insulin deficiency, in association with increased levels of counter-regulatory hormones and dehydration, is the primary cause of: ketonuria. glucosuria. ketone bodies. diabetic ketoacidosis. SUBMIT ANSWER Exit quiz

diabetic ketoacidosis. Explanation: Insulin deficiency, in association with increased levels of counter-regulatory 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. Glucosuria is glucose that is spilled into the urine.

Question 15 of 20 The nurse is assessing a 1-month-old girl who, according to the mother, doesn't eat well. Which assessment suggests the child has congenital hypothyroidism? enlarged tongue frequent diarrhea tachycardia warm, moist skin SUBMIT ANSWER Exit quiz

enlarged tongue Explanation: Observation of an enlarged tongue along with an enlarged posterior fontanel (fontanelle) 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.

The nurse is assessing a 4-year-old girl with ambiguous genitalia. Which finding suggests congenital adrenal hyperplasia? irregular heartbeat on auscultation pubic hair and hirsutism pain from constipation on palpation hyperpigmentation of the skin

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

Question 5 of 10 A 13-year-old adolescent with hyperthyroidism who takes antithyroid medication has a sore throat and a fever. The parent calls the nurse and asks what to do. Which is the best response from the nurse? "Offer your child at least 8 ounces of clear fluids and call back tomorrow." "Fever and sore throat may be side effects of the medication." "Give your child ibuprofen according to the instructions on the box." "Please take your child straight to the emergency department." SUBMIT ANSWER Exit quiz

"Please take your child straight to the emergency department." Explanation: A side effect of antithyroid medications is leukopenia. Signs and symptoms that include fever and sore throat need to be seen immediately. These instructions should be reviewed with parents upon discharge. The question includes information about Graves disease, so ibuprofen would not be the treatment. The question centers around drug therapy, not the child's fluid status.

Question 4 of 10 After explaining the causes of hypothyroidism to the parents of a newly diagnosed infant, the nurse should recognize that further education is needed when the parents ask which question? "So, hypothyroidism can be treated by exposing our baby to a special light, right?" "Are you saying that hypothyroidism is caused by a problem in the way the thyroid gland develops?" "So, hypothyroidism can be only temporary, right?" "Do you mean that hypothyroidism may be caused by a problem in the way the body makes thyroxine?" SUBMIT ANSWER Exit quiz

"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.

A child with central diabetes insipidus is prescribed desmopressin (DDAVP) intranasally. After teaching the child and parents about this medication, the nurse determines that the teaching was successful when the parents make which statements? Select all that apply. "We will keep the drug in the cabinet above the sink." "We'll make sure our child clears out his nose before using the medication." "We should blow the liquid out of the tubing into the nose." "We should squeeze the container to get the correct dose." "We can repeat the dose if he sneezes right after he takes the medication."

"We'll make sure our child clears out his nose before using the medication." "We should blow the liquid out of the tubing into the nose." "We can repeat the dose if he sneezes right after he takes the medication."

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? Request that someone call 911. Administer subcutaneous glucagon. Anticipate that the child will need intravenous glucose. Dissolve a piece of candy in the child's mouth.

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.

Question 9 of 20 A child has been prescribed desmopressin 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? Desmopressin acetate works to help your kidneys work more efficiently. Desmopressin acetate works on your pancreas to stimulate insulin production. Desmopressin acetate is a synthetic antidiuretic hormone that will slow down your urine output. Desmopressin acetate is a synthetic form of insulin used to lower your blood sugar. SUBMIT ANSWER Exit quiz

Desmopressin acetate is a synthetic antidiuretic hormone that will slow down your urine output. Explanation: Desmopressin 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. .

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

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.

An infant on the pediatric floor has diabetes insipidus. Which assessment data are important for the nurse to monitor while the infant is on strict fluid precautions? Oral intake Urine output Color of mucous membranes Temperature and heart rate

Urine output Explanation: An infant with diabetes insipidus has a decrease in antidiuretic hormone. Strict fluid precautions will not alter urine formation. This assessment is important because the infant will be at great risk for dehydration and electrolyte imbalance. It is part of a basic assessment to monitor heart rate, temperature, skin turgor, and mucous membranes. These are important but may not indicate the infant's overall health. On fluid restriction, oral intake will be specified.

Question 9 of 10 The nurse caring for a female adolescent with polycystic ovary syndrome (PCOS) identifies "Disturbed body image related to signs and symptoms of the disease" as a nursing diagnosis that applies to this client. What signs and symptoms would support this nursing diagnosis? acne cysts on the ovaries hirsutism balding of hair on head increased muscle mass SUBMIT ANSWER Exit quiz

hirsutism balding of hair on head increased muscle mass acne Explanation: Hirsutism results in excessive amounts of stiff and pigmented hair on body areas where men typically grow hair, such as the face, chest, and back. All of the symptoms listed except cysts would support the nursing diagnosis. The cysts themselves don't support the nursing diagnosis as they are not visible.

The nurse is speaking with the parents of a school-aged child recently diagnosed with diabetes regarding the differences between hypoglycemia and hyperglycemia. Which statement by a parent indicates a need for further teaching? "If I notice changes in my son like tearfulness or irritability, his blood sugar may be high." "When my son's breath smells fruity, it almost always indicates high blood sugar." "If my son says he feels shaky, his blood sugar may be low." "Dry flushed skin may be a sign if high blood sugar."

"If I notice changes in my son like tearfulness or irritability, his blood sugar may be high." Explanation: Behavior changes such as tearfulness, irritability, confusion, and slurred speech are indications of hypoglycemia, not hyperglycemia. Tremors and diaphoresis are also indications of low blood sugar. Dry flushed skin, fatigue, weakness, nausea, vomiting, and fruity breath odor are all symptoms of hyperglycemia.

Question 7 of 10 The nurse is caring for a 5-year-old child recently diagnosed with type 1 diabetes. When discussing the care and management of the disorder with the child's parents, which statement(s) indicates understanding? Select all that apply. "When my child is ill and unable to eat, we will need to hold the insulin until the child is able to tolerate fluids." "Regular exercise will help in the regulation of my child's blood sugar levels." "If my child's blood glucose remains stable for a few months, my child can move from injections to pills." "We need to rotate insulin injection sites to prevent complications." "The insulin dosages will be directly associated to my child's carbohydrate ingestion." SUBMIT ANSWER Exit quiz

"Regular exercise will help in the regulation of my child's blood sugar levels." "We need to rotate insulin injection sites to prevent complications." "The insulin dosages will be directly associated to my child's carbohydrate ingestion." Explanation: When a child has type 1 diabetes, there is an absence of insulin to manage the metabolism of serum glucose. Regular exercise is helpful in the maintenance of stable serum glucose levels. Carbohydrate ingestion is linked to the amount of insulin that will be needed in the body. Carbohydrates break down and the body needs insulin to metabolize the resulting glucose. The rotation of insulin injection sites is important. Failing to rotate injection sites can cause a complication, lipohypertrophy. Type 1 diabetes means that the body does not have insulin, so injected insulin is needed to manage it. Oral medications are only an option for those having type 2 diabetes. When the child is ill, it is still important that the child with diabetes take the prescribed medications.

Question 1 of 10 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? "Limit participation in planned exercise activities that involve competition." "Carry crackers or fruit to eat before or during periods of increased activity." "Check your blood glucose level before exercising, and eat a protein snack if the level is elevated." "Increase the insulin dosage before planned or unplanned strenuous exercise." SUBMIT ANSWER Exit quiz

"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.

An adolescent is having an annual physical. The adolescent has a documented weight loss of 9 lb (4.08 kg). The parent states, "He eats constantly." Exam findings are normal overall, except that the child reports having trouble sleeping, and the child's eyeballs are noted to bulge slightly. Which interventions would the nurse perform based on these findings? Prepare the parent for a neurology consult. Explain why the child might need to schedule an eye exam. Discuss preparing for a thyroid function test. Explain the preparation for an 8-hour fasting blood glucose test.

Discuss preparing for a thyroid function test. Explanation: The child exhibits signs and symptoms of Graves disease (hyperthyroidism). A thyroid function test would show an elevation in T4 and T3 levels caused by overfunctioning of the thyroid. Neither a neurology consult nor an eye exam would be needed. A fasting blood glucose test is used to test for Cushing syndrome and diabetes mellitus.

The nurse is assessing an 8-year-old boy who is performing academically at a second-grade level. The mother reports that the boy states feeling weak and tired and has had a weight increase of 6 pounds (13.2 kg) in 3 months. Which additional data would fit with a possible diagnosis of hypothyroidism? The child states that the exam room is cold. Oral cavity assessment shows two of the 6-year molars. The mother reports that the boy is always thirsty. The child has a faint rash on the trunk of the body.

The child states 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. A rash can be varied disease processes but is not characteristic in hypothyroidism.

Question 4 of 20 A school-age child is seen in the family clinic. The parents ask the nurse if their child should start taking growth hormones to help the child grow because the parents are short. What is the best response by the nurse? "Growth hormones work only if the child has short bones." "Research shows that there must be a diagnosis of deficiency before growth hormones can be started at this age." "How tall would you like your child to be?" "Will your child be able to swallow oral pills every day?" SUBMIT ANSWER Exit quiz

"Research shows that there must be a diagnosis of deficiency before growth hormones can be started at this age." Explanation: The nurse should educate the parents about growth hormones before asking questions. The nurse needs to explain that a diagnosis of deficiency must be documented before growth hormones can be used. Only the long bones are affected. Growth hormone is given orally, IM, and SC.

During a visit to the clinic, the adolescent client with hypothyroidism tells the nurse that she takes her levothyroxine "whenever I think about it...sometimes I miss a dose, but not very often." What is the best response by the nurse? "I know it's hard to remember medicines, but it is really important for you to take it before breakfast each day to control your hypothyroidism." "Maybe you could do something to remind yourself to take the medication on a daily basis." "As long as you are missing multiple doses it should be fine. Just as long as you take the levothyroxine at some point each day." "If you forget a dose you can double up the next day. We just want your thyroid level to be maintained since you don't produce enough thyroid hormone.

"I know it's hard to remember medicines, but it is really important for you to take it before breakfast each day to control your hypothyroidism." Explanation: Levothyroxine is a thyroid hormone replacement used to treat hypothyroidism. It is important to maintain a consistent thyroid hormone level by taking the medication at the same time each day (preferably 30 minutes prior to breakfast for best absorption). Toxicity can occur if the dose is doubled. Suggesting the client "do something" to remember does not highlight the importance of taking it correctly.

A pediatric nurse is discharging a 1-month-old infant. The infant was diagnosed with congenital hypothyroidism on this admission and will be treated with levothyroxine. The nurse knows it is important to teach the parent about medication administration. Which process will the nurse include in the teaching? Give the crushed medication in a syringe mixed with a small amount of formula. Crush the medication and put it in the full bottle of formula so it tastes better. Administer the medication every other day. Explain that this treatment is administered until the child is 3 years of age.

Give the crushed medication in a syringe mixed with a small amount of formula. Explanation: The medication should be mixed in a small amount of food to make sure the infant receives the whole dose. It should not be placed in a whole bottle because the infant may not drink the entire bottle. This medication is prescribed for daily use, and hypothyroidism is a lifelong condition.

Question 7 of 20 The nurse is assessing a 5-year-old child whose parent reports the child has been vomiting lately, has no appetite, and has had an extreme thirst. Laboratory work for diabetes is being completed. Which symptom would differentiate between type 1 diabetes from type 2 diabetes? blood pressure of 142/92 mm Hg loose stools recent weight loss slow healing wounds SUBMIT ANSWER Exit quiz

recent weight loss Explanation: Weight loss is unique to type 1 diabetes, whereas weight gain is associated with type 2. Hypertension is consistent with type 2 diabetes. Both type 1 and type 2 diabetes cause delayed wound healing. The increase in blood glucose in diabetes causes damage to the inner lining of the arteries that cause the arteries to develop plaque and harden. These damages to the blood vessels result in a decrease in the ability of oxygen-rich blood to be transported effectively to the tissues to promote wound healing. Loose stools or repeated loose stools (diarrhea) is a common side effect of the oral medication metformin, which is prescribed for clients with type 2 diabetes. Insulin, the treatment for type 1 diabetes, has constipation as one of the side effects.

Question 7 of 20 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? Body mass index as normal Darkened pigmentation around the neck area Short stature Decreased serum levels of free testosterone SUBMIT ANSWER Exit quiz

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.

Question 13 of 20 A child has been diagnosed with the syndrome of inappropriate antidiuretic hormone (SIADH) and has been admitted to the hospital. Which nursing intervention is most important for this child? Correct nausea and vomiting. Monitor sodium levels. Monitor intake and output. Monitor the child's weight daily. SUBMIT ANSWER Exit quiz

Monitor sodium levels. Explanation: The syndrome of inappropriate antidiuretic hormone (SIADH) occurs when ADH (vasopressin) is secreted in the presence of a low osmolality because the feedback mechanism that regulates ADH does not work. ADH continues to be released, causing water retention and decreased serum sodium. To correct the problem the child should be placed on fluid restriction and IV sodium chloride should be administered to correct hyponatremia. If the sodium levels drop, neurological signs develop (headache, altered mental status, behavior changes, seizures, and even coma). The child would need to be weighed daily and any gastrointestinal symptoms need to be corrected. Intake and output, especially the output, are important to monitor.

Question 6 of 10 The nurse is caring for a newborn with 21-OH enzyme deficiency congenital adrenal hyperplasia (CAH). The nurse identifies one goal of the plan of care as being the understanding of the importance of maintaining hormone supplementation. Which outcome criteron demonstrates this goal has been met? During follow-up visits the child demonstrates normal growth and development. The parents ask appropriate questions about the planned treatment goals. The parents fill the prescription for hormone replacement therapy prior to discharge. Prior to discharge the parents state that they understand the medication regimen. SUBMIT ANSWER Exit quiz

During follow-up visits the child demonstrates normal growth and development. Explanation: 21-OH enzyme deficiency results in blocking the production of adrenal mineralocorticoids and glucocorticoids. Nursing management of the infant or child with CAH focuses on preventing and monitoring for acute adrenal crisis, helping the family to understand the disease, providing education to the child and family about the importance of maintaining hormone supplementation, and providing emotional support to the family. Improvement of symptoms, such as normal growth and development, is the best indicator that the goal of hormone replacement therapy is being carried out as ordered.

Question 2 of 20 A newborn is discovered to have congenital adrenogenital hyperplasia. What will the nurse most likely observe when assessing this client? Divergent vision Abnormal facial features Enlarged clitoris Small for gestational age SUBMIT ANSWER Exit quiz

Enlarged clitoris Explanation: Congenital adrenal hyperplasia is a syndrome that is inherited as an autosomal recessive trait, which causes the adrenal glands to not be able to synthesize cortisol. Because the adrenal gland is unable to produce cortisol, the level of adrenocorticotropic hormone (ACTH) secreted by the pituitary in an attempt to stimulate the gland to increase function is increased. Although the adrenals enlarge under the effect of ACTH, they still cannot produce cortisol but rather overproduce androgen. Excessive androgen production during intrauterine life masculinizes the genital organs in a female fetus so that the clitoris is so enlarged it appears to be a penis. This disorder does not cause divergent vision. The child will not be born small for gestational age. This disorder does not cause abnormal facial features.

Question 5 of 20 The nurse is assessing a child diagnosed with Cushing syndrome. Which statement by the parents demonstrates a need for further teaching? "We need to pay close attention to any wounds our child gets to monitor for adequate healing." "My child's round, full face appearance is reversible with appropriate treatment." "This disorder is most likely due to an infection my child had recently." "My child may experience excessive weight gain." SUBMIT ANSWER Exit quiz

"This disorder is most likely due to an infection my child had recently." Explanation: A round, full face (moon face), rapid weight gain, and poor wound healing are all seen in Cushing syndrome. Cushingoid appearance is reversible with appropriate treatment. The most common cause of Cushing syndrome is long-term corticosteroid therapy or a pituitary adenoma, not an infection.

Question 8 of 10 A school-age child is diagnosed as having Cushing syndrome from long-term therapy with oral prednisone. What assessment finding is consistent with this child's diagnosis and treatment? There are purple striae on the abdomen. The child is excessively tall for chronologic age. The child is demonstrating signs of hypoglycemia. Child appears pale and fatigued. SUBMIT ANSWER Exit quiz

There are purple striae on the abdomen. Explanation: Cushing syndrome is caused by overproduction of the adrenal hormone cortisol. The overproduction of cortisol results in hyperpigmentation, which occurs from the melanin-stimulating properties of ACTH. Purple striae resulting from collagen deficit appear on the child's abdomen. The child will not be pale or fatigued. The child will not be excessively tall. The child will not be demonstrating signs of hypoglycemia.

Question 4 of 20 A 6-year-old boy has a moon-face, stocky appearance but with thin arms and legs. His cheeks are unusually ruddy. He is diagnosed with Cushing syndrome. What is the most likely cause of this condition in this child? Tumor of the parathyroid Tumor of the adrenal cortex Tumor of the thyroid Tumor of the pancreas SUBMIT ANSWER

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). Other effects include hyperpigmentation (the child's face is unusually red, especially the cheeks).

Question 6 of 20 The nurse is teaching a group of caregivers of children diagnosed with diabetes. The nurse is explaining insulin shock and the caregivers make the following statements. Which statement indicates the best understanding of a reason an insulin reaction might occur? "My child measures their own medication but sometimes doesn't administer the correct amount." "On the weekends we encourage our child to participate in lots of sports activities and stay busy so they don't have an insulin reaction." "My child monitors their glucose levels to keep them from going too high." "If my child eats as much as their older brother eats they could have an insulin reaction." SUBMIT ANSWER Exit quiz

"My child measures their own medication but sometimes doesn't administer the correct amount." Explanation: Insulin reaction (insulin shock, hypoglycemia) is caused by insulin overload, resulting in too-rapid metabolism of the body's glucose. This may be attributable to a change in the body's requirement, carelessness in diet (such as failure to eat proper amounts of food), an error in insulin measurement, or excessive exercise.

The nurse is caring for a 10-year-old child with growth hormone (GH) deficiency. Which therapy would you anticipate will be prescribed for the child? Short-term aldosterone provocation Injections of GH Oral administration of somatotropin Long-term blocking of beta cells

Injections of GH Explanation: Growth hormone (GH) deficiency occurs when the anterior pituitary is unable to produce enough hormone for usual growth. Somatotropin is the name of the growth hormone administered. Administering subcutaneous GH to the child helps correct this deficiency. The GH dosage is 0.2 to 0.3 mg/kg given daily. It is not administered orally. Aldosterone causes sodium to be retained and a provocation would be the administration of diuretics to reduce the sodium. Beta cells are found in the heart muscles, smooth muscles, airways, and arteries. They are also found in the pancreas to secrete insulin. None of these cell actions are related to the anterior pituitary.

Question 19 of 20 A nurse is reviewing with an 8-year-old how to self-administer insulin. Which of the following is the proper injection technique for insulin injections? Place the needle with the bevel facing down before the injection. Aspirate the syringe for blood return before the injection. Spread the skin before the injection. Elevate the subcutaneous tissue before the injection. SUBMIT ANSWER Exit quiz

Elevate the subcutaneous tissue before the injection. Insulin injections are always given subcutaneously. Elevating the skin tissue prevents injection into muscles when subcutaneous injections are given. The needle bevel should face upward. The skin is spread in intramuscular, not subcutaneous, injections. It is no longer recommended to aspirate blood for subcutaneous injections

A newborn is diagnosed with the salt-losing form of congenital adrenogenital hyperplasia. On what should the nurse focus when assessing this client? Dehydration Hypoglycemia Bleeding tendency Excessive cortisone secretion

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

Question 17 of 20 The nurse caring for a child who has issues with the anterior pituitary and expects the child to have issues with which hormone? antidiuretic hormone oxytocin growth hormone vasopressin SUBMIT ANSWER Exit quiz

growth hormone Explanation: Disorders of the pituitary gland depend on the location of the physiologic abnormality. The anterior pituitary, or adenohypophysis, is made up of endocrine glandular tissue and secretes growth hormone (GH), adrenocorticotropic hormone (ACTH), thyroid-stimulating hormone (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 adenohypophysis.

Question 16 of 20 The nurse is interpreting the negative feedback system that controls endocrine function. What secretion will the nurse correlate as decreasing while blood glucose levels decrease? glucagon adrenocorticotropic hormone insulin glycogen SUBMIT ANSWER Exit quiz

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. Glycogen is stored in the liver and muscles. It is released to provide energy when the blood glucose levels fall. Glucagon is also produced by the pancreas. Its job is to force the liver to release stored insulin when the body has a need for more insulin. The adrenocorticotropic hormone is produced by the anterior pituitary. Its function is to regulate cortisol. This is needed so the adrenal glands can function properly. It also helps the body respond to stress.

An 8-year-old girl presents to the clinic for moodiness and irritability. The child has begun to develop breasts and pubic hair and the parents are concerned that the child is at too early an age for this to begin. The nurse knows that these symptoms may be indicative of what disorder? precocious puberty pseudopuberty adrenal hyperplasia neurofibromatosis

precocious puberty Explanation: Precocious puberty occurs when the child's sexual characteristics begin to develop before the normal age of puberty. 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. The behavior may change to that of a typical adolescent. Girls may have episodes of moodiness and irritability, whereas boys may become more aggressive. Pseudopuberty occurs when there is only partial development after testosterone is secreted. It occurs in males. Adrenal hyperplasia is an inherited disorder and it affects the production of androgen. Neurofibromatosis is a genetic disorder of the nervous system where tumors grow on the nerves.

Question 20 of 20 A 12-year-old client arrives at the emergency room experiencing nausea, vomiting, headache, and seizures. The client is diagnosed with bacterial meningitis. Other findings include a decrease in urine production, hyponatremia, and water intoxication. Which pituitary gland disorder is most associated with these symptoms? diabetes insipidus (DI) hyposecretion of somatotropin syndrome of inappropriate antidiuretic hormone (SIADH) hypersecretion of growth hormone SUBMIT ANSWER Exit quiz

syndrome of inappropriate antidiuretic hormone (SIADH) 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 (growth hormone) results in undergrowth; hypersecretion results in overgrowth.