Ricci Chapter 48 PrepU

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? a. "When I tap on my child's facial nerve, the reaction is a facial muscle spasm." b. "The sign means my child is not getting enough vitamin D." c. "The sign occurs because my child is having increased intracranial pressure." d. "The sign occurs when there is muscle pain and the muscle is stimulated."

a. "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.

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

a. 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 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. daily b. weekly c. bi-monthly d. monthly

a. 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.

A child with growth hormone deficiency is prescribed growth hormone (GH) by subcutaneous injection. When teaching the child's parents about this drug, the nurse would instruct the parents to administer the drug at which frequency? a. daily, 6 to 7 days a week b. every 3 days c. weekly d. monthly

a. daily, 6 to 7 days a week Explanation: The parent or the child administers GH by subcutaneous injection usually 6 to 7 days per week (usually daily). It is generally given at bedtime to attempt to mimic the body's natural production and release during sleep.

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? a. recent weight loss b. blood pressure of 142/92 mm Hg c. slow healing wounds d. loose stools

a. 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.

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? a. hypertension b. Graves disease c. Cushing syndrome d. hypothyroidism

b. 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.

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? a. Cushing disease b. Graves disease c. diabetes d. syndrome of inappropriate antidiuretic hormone secretion (SIADH)

b. 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.

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? a. The child may not be taking the medication. b. The child may have developed leukopenia. c. The child needs to be started on an antibiotic drug. d. The child must be participating in sports.

b. 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 10-year-old child is newly diagnosed with type 1 diabetes. The child's hemoglobin A1C level is being monitored. The nurse determines that additional intervention is needed with the child based on which result? a. 8.5% b. 6.5% c. 7.5 % d. 7.0%

a. 8.5% Explanation: The goal for hemoglobin A1C in children between the ages of 6 and 12 years is less than 8%. Therefore, a result of 8.5% would indicate that additional intervention is needed to achieve the recommended goal.

The nurse is caring for a 12-year-old girl with hypothyroidism. Which information should be part of the nurse's teaching plan for the child and family? a. how to recognize vitamin D toxicity b. how to maintain fluid intake regimens c. administering methimazole with meals d. reporting irritability or anxiety

d. reporting irritability or anxiety Explanation: Side effects of hypothyroidism are restlessness, inability to sleep, or irritability. These 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.

The primary health care provider has ordered a thyroid scan to confirm the diagnosis of hyperthyroidism. Which would the nurse do before the scan? a. Assess the client for allergies. b. Give the client a bolus of fluids c. Tell the client he or she will be asleep. d. Insert a urinary catheter.

a. Assess the client for allergies. Explanation: A thyroid scan uses a radionucleotide dye so a client should be assessed for allergies to iodine and shellfish to prevent a possible allergic reaction. The client will not be asleep. There is no need to give the child a bolus of fluid or insert a urinary catheter.

A newborn exhibits significant jittery movements, convulsions, and apnea. Hypoparathyroidism is suspected. What would the nurse expect to be administered? a. Calcium gluconate b. Hydrocortisone c. Desmopressin d. Levothyroxine

a. 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 administering biosynthetic growth hormone, derived from recombinant DNA, by subcutaneous injection. The daily dosage is 0.2 to 0.3 mg/kg, given in divided doses. The child weighs 110 lb (49.9 kg). What is the safe dosage limit for this child on a daily basis? Record your answer using a whole number.

15 Explanation: Use the child's weight in kilograms: 49.9 Minimum: 49.9 kg × 0.2 mg/kg = 9.98 mg, round to 10 mgMaximum: 49.9 kg × 0.3 mg/kg = 14.97 mg, round to 15 mg The safe limit is determined by using the maximum dosage. The lack of growth hormone impairs the body's ability to metabolize protein, fat, and carbohydrates. Treatment of primary growth hormone deficiency involves the use of supplemental growth hormone. Treatment continues until near-final height goal is achieved.

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. "Drink plenty of fluids because you need to have a full bladder." b. "You need to remain very still for the entire test." c. "You won't be able to drink any water before or during the test." d. "Limit your level of physical activity for one-half hour before the test."

a. "Drink plenty of fluids because you need to have a full bladder." Explanation: A full bladder is needed for an ultrasound of the pelvic region. The client 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 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? a. "During exercise we should wait to check blood sugars until after our child completes the activity." b. "If our child is sick we should check blood glucose levels more often." c. "We should check our child's blood glucose levels before meals." d. "Blood glucose level, food intake, and activity need to all be considered when calculating insulin dosage."

a. "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.

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? a. "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." b. "Maybe you could do something to remind yourself to take the medication on a daily basis." c. "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." d. "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."

a. "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.

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? a. "If I notice changes in my son like tearfulness or irritability, his blood sugar may be high." b. "When my son's breath smells fruity, it almost always indicates high blood sugar." c. "If my son says he feels shaky, his blood sugar may be low." d. "Dry flushed skin may be a sign if high blood sugar."

a. "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.

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. Antidiuretic hormone b. Growth hormone c. Insulin d. Thyroxine

a. 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.

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. Darkened pigmentation around the neck area b. Decreased serum levels of free testosterone c. Body mass index as normal d. Short stature

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

a. 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.

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

a. 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.

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? a. During follow-up visits the child demonstrates normal growth and development. b. Prior to discharge the parents state that they understand the medication regimen. c. The parents fill the prescription for hormone replacement therapy prior to discharge. d. The parents ask appropriate questions about the planned treatment goals.

a. 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.

A child is diagnosed with diabetes insipidus (DI) and will start on the medication desmopressin. Which instruction(s) would the nurse include in teaching the parent about administering this drug? Select all that apply. a. Keep the drug refrigerated. b. The drug must be administered every 24 hours. c. Clear the nostrils before administering the drug. d. If the child sneezes, repeat the dose administration. e. Monitor the urine specific gravity while the child is taking the drug.

a. Keep the drug refrigerated. c. Clear the nostrils before administering the drug. d. If the child sneezes, repeat the dose administration. e. Monitor the urine specific gravity while the child is taking the drug. Explanation: Diabetes insipidus is a disorder of the posterior pituitary gland. It reduces the amount of ADH (vasopressin). ADH concentrates urine. As a result of this decrease, the kidneys lose massive amounts of water and retain sodium. The treatment is to replace the lost vasopressin. This is done with the drug desmopressin. Typically the drug is administered in a nasal spray or drop. The drug is a long-acting vasopressin analog. It must be administered every 8 to 12 hours, not every 24 hours. The dosage is dependent on the child's age, the amount of urine output, and the urine specific gravity. The specific gravity must be measured in the home. The drug needs to remain refrigerated. The nostrils need to be cleared prior to administration. If the mucus is present, it will interfere with absorption. If the child sneezes, the dose should be repeated.

The nurse is caring for a child diagnosed with low functioning parathyroid. Which is a treatment goal of a child with hypoparathyroidism? a. Maintain the child's calcium level at a normal level with calcium replacement as prescribed. b. Assure the parents have a plan in place for periods of low glucose levels if noted. c. Provide the child and parent with a referral to a pediatric gastrointestinal specialist. d. Provide the parents a specific dietary plan for high-phosphorus foods to be eaten.

a. Maintain the child's calcium level at a normal level with calcium replacement as prescribed. Explanation: Hypoparathyroidism will manifest as a low calcium level, so the nurse would expect the provider to provide a prescription to maintain the calcium level within normal range. Glucose is not a concern with parathyroid function. A referral would be made to a pediatric endocrinologist, not a gastrointestinal specialist. Phosphorus and calcium have an inverse proportion, so the nurse would recommend a low-phosphorus diet.

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? a. Monitor sodium levels. b. Monitor the child's weight daily. c. Monitor intake and output. d. Correct nausea and vomiting.

a. 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.

The nurse is assessing a 7-year-old girl with a headache, irritability, and vomiting. Her health history reveals she has had meningitis. Which intervention is priority? a. Notifying the physician of the neurologic findings. b. Setting up safety precautions to prevent injury. c. Monitoring urine volume and specific gravity. d. Restoring fluid balance with IV sodium.

a. 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 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? a. Regular insulin b. Lispro c. NPH d. Detemir

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

The nurse is planning care for a school-age child diagnosed with growth hormone deficiency. Which diagnosis should the nurse select to help the child with this health problem? a. Risk for situational low self-esteem related to short stature b. Ineffective tissue perfusion related to infantile blood vessels c. Impaired skin integrity related to overproduction of melanin d. Risk for self-directed violence related to oversecretion of epinephrine

a. Risk for situational low self-esteem related to short stature Explanation: Children with short stature tend to report feeling of lower quality of life largely related to discrimination. The nurse may need to remind parents to assign duties and responsibilities to children that match their chronologic age, not their physical size, to promote children's feelings of maturity and self-esteem. A child that differs in any way from peers may be bullied. The nurse should alert the parents to this possibility and assess for this at well-child visits to help protect the child's quality of life. Tissue perfusion is not affected by this disorder. This disorder does not cause altered skin integrity. There is no overproduction of epinephrine with this disorder.

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? a. Take glucometer readings as ordered. b. Measure intake and output. c. Monitor sodium and potassium levels. d. Weigh daily.

a. Take glucometer readings as ordered. Explanation: IV glucocorticoids raise 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.

The nurse is caring for 1-month-old girl with thyrotoxicosis. What finding would the nurse expect to assess? a. The child has a strong appetite but fails to thrive. b. Observation reveals lethargy and irritability. c. Skin is cool, dry, and scaly to the touch. d. The child is hypoactive and hypotonic.

a. 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.

The nurse is preparing a child suspected of having a thyroid disorder for a thyroid scan. What information regarding the child should the nurse alert the doctor or nuclear medicine department about? a. The child is allergic to shellfish. b. The child is taking a vitamin supplement. c. The child has had an MRI of their leg within the past 6 weeks. d. The child wears a medical alert bracelet for diabetes.

a. The child is allergic to shellfish. Explanation: Allergies to shellfish should be reported because shellfish contains iodine; the dye used for a nuclear medicine scan is iodine based and could cause an anaphylactic reaction. The other information about the child would not need to be reported to the staff.

The nurse is preparing teaching materials for a family whose child is prescribed somatropin for a growth hormone deficiency. What should the nurse instruct the parents about the administration of this medication? a. This medication must be given by injection. b. This medication must be given in the morning before school. c. Hip or knee pain is an expected adverse effect of this medication. d. This medication does not interact with any other types of medication.

a. This medication must be given by injection. Explanation: Somatropin is administered by injection. It is best given at the hour of sleep because that is when growth hormone is released. Hip or knee pain could indicate a slipped capital epiphysis and should be reported to the health care provider. The nurse should urge the parents to inform all health care providers that the child is receiving this medication to avoid medication interactions.

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? a. Tumor of the adrenal cortex b. Tumor of the thyroid c. Tumor of the pancreas d. Tumor of the parathyroid

a. 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).

Which nursing objective is most important when working with neonates who are suspected of having congenital hypothyroidism? a. early identification b. promoting bonding c. allowing rooming in d. encouraging fluid intake

a. 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.

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

a. 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.

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? a. precocious puberty b. pseudopuberty c. adrenal hyperplasia d. neurofibromatosis

a. 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.

The nurse working with the child diagnosed with type 2 diabetes recognizes the disorder can be managed by: a. taking oral hypoglycemic agents. b. increasing carbohydrates in the diet, especially in the evening. c. conserving energy with rest periods during the day. d. decreasing amounts of daily insulin.

a. taking oral hypoglycemic agents. Explanation: Oral hypoglycemic agents, such as metformin, are often effective for controlling blood glucose levels in children diagnosed with type 2 diabetes. Insulin may be used for a child with type 2 diabetes if oral hypoglycemic agents alone are not effective, but "decreasing" the daily insulin would not help treat this disorder. Lifestyle changes such as increased exercise (not conserving energy by resting during the day), and limiting large amounts of carbohydrates are important aspects of treatment for the child.

The nurse is educating the parents of a client newly diagnosed with type 1 diabetes. Which statement by the parents indicates additional teaching is needed? a. "When our child is sick, we may need to check glucose levels more frequently." b. "Our child should eat three meals and midafternoon and bedtime snacks each day." c. "We and our child need to learn to identify carbohydrate, protein, and fat foods." d. "Our child should not participate in sports or physical activity."

b. "Our child should not participate in sports or physical activity." Explanation: The nurse would provide additional education if the parents state the child should not participate in sports or physical activity. The child with diabetes can, and should, be physically active to maintain proper health and facilitate efficient insulin usage by the body. Glucose levels should be checked more frequently during times of sickness, as well as assessing the urine for ketones. Consistency of intake can help prevent complications and maintain near-normal blood glucose levels. The parents and child should know how to identify foods to adequately monitor the child's nutritional intake. A dietitian with expertise in diabetes education should be consulted for referral as needed.

The nurse is taking a history on a 10-year-old child who has a diagnosis of hypopituitarism. Which question is important for the nurse to ask the parents? a. "Is your child taking vasopressin IM or SC?" b. "What time each day does your child take his growth hormone?" c. "Does your child get upset about being taller than friends?" d. "How often do you test your child's blood glucose?"

b. "What time each day does your child take his growth hormone?" Explanation: It is important for the nurse to know the time of day that the child takes his or her growth hormone. Growth hormone is the common treatment for the child with hypopituitarism who is short, not tall, in stature. Vasopressin is the treatment for diabetes insipidus. Monitoring blood glucose is not part of the treatment for hypopituitarism.

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

b. 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.

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? a. Ignore the symptoms if the family does not ask about them. b. Counsel the family to have all siblings evaluated. c. Reassure the family that everything is OK, but express urgency to the health care provider. d. Read more about the condition and its ramifications.

b. 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.

The nurse working on a pediatric floor understands the importance of diagnosing inborn errors of metabolism early. A child with a suspected problem must have blood urea nitrogen (BUN) and creatinine testing done. Which is the purpose of these two tests? a. Detect changes in amino acid patterns. b. Evaluate renal function. c. Evaluate liver function. d. Evaluate metabolism.

b. Evaluate renal function. Explanation: Tests of BUN and creatinine evaluate renal function. These tests are done to rule out chronic renal failure and to monitor the effects of treatments on the renal system. Tests of ammonia and lactic acid evaluate metabolism. Tests of plasma amino acids detect changes in amino acid pattern, while a liver function panel would help evaluate hepatic function.

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? a. Child appears pale and fatigued. b. There are purple striae on the abdomen. c. The child is excessively tall for chronologic age. d. The child is demonstrating signs of hypoglycemia.

b. 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.

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? a. Oral intake b. Urine output c. Color of mucous membranes d. Temperature and heart rate

b. 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.

A child with a history of diabetes insipidus is admitted with polyuria, polydipsia, and mental confusion. Which is the priority intervention for this child? a. measure urine output b. check vital signs c. encourage increased fluid intake d. weigh the client

b. check vital signs Explanation: Central diabetes insipidus is a disorder of the posterior pituitary. The fluid status of the child can be assessed first by assessing the vital signs. The large amounts of fluid loss can cause fluid and electrolyte imbalance that should be corrected. 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. Diabetes insipidus is managed by decreasing the protein and sodium in the diet and daily replacement of the antidiuretic hormone.

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? a. frequent diarrhea b. enlarged tongue c. tachycardia d. warm, moist skin

b. 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.

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? a. "It takes time to determine the level of functioning of endocrine glands." b. "Have there been signs and symptoms that you should have reported to the doctor?" c. "As endocrine functions become more stable throughout childhood, alterations become more apparent." d. "Endocrine disorders are hard to detect and you are lucky that we have found it when we did."

c. "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 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? a. "Growth hormones work only if the child has short bones." b. "Will your child be able to swallow oral pills every day?" c. "Research shows that there must be a diagnosis of deficiency before growth hormones can be started at this age." d. "How tall would you like your child to be?"

c. "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.

A newborn was diagnosed as having hypothyroidism at birth. The parent asks the nurse how the disease could be discovered this early. Which is the nurse's best answer? a. Hypothyroidism is usually detected at birth by the newborn's physical appearance. b. A newborn has a typical rash at birth that suggests the diagnosis. c. A simple blood test to diagnose hypothyroidism is required in most states. d. The newborn is already severely impaired at birth, and this suggests the diagnosis.

c. A simple blood test to diagnose hypothyroidism is required in most states. Explanation: With hypothyroidism there is insufficient production of the thyroid hormones required to meet the body's metabolic as well as growth and developmental needs. Without these hormones, cognitive impairment occurs. Hypothyroidism is diagnosed by a newborn screening procedure. This screening procedure is required by most states. With early diagnosis the condition can be treated by replacing the missing hormones. The later the diagnosis is made, the more irreversible cognitive impairment becomes. At birth, a newborn with hypothyroidism will be a poor feeder. Other symptoms, such as lethargy and hypotonicity, become evident after the first month of life. There are no other outward manifestations, such as rashes or appearances, that can be seen. These are not part of the condition.

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? a. Desmopressin acetate works on your pancreas to stimulate insulin production. b. Desmopressin acetate is a synthetic form of insulin used to lower your blood sugar. c. Desmopressin acetate is a synthetic antidiuretic hormone that will slow down your urine output. d. Desmopressin acetate works to help your kidneys work more efficiently.

c. 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 12-year-old is being seen in the office and has hyperthyroidism; the nurse knows that the most common cause of hyperthyroidism is: a. Addison disease b. Cushing disease c. Graves disease d. Plummer disease

c. 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.

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: a. Polyuria b. Pica c. Polyphagia d. Polydipsia

c. 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). Pica is eating nonfood substances.

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. a. Abrupt onset of symptoms b. Marked weight loss c. Polyuria d. Polydipsia e. Polyphagia

c. Polyuria d. Polydipsia e. Polyphagia Explanation: 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.

A child presents to the primary care setting with enuresis, nocturia, increased hunger, weight loss, and increased thirst. What does the nurse suspect? a. Syndrome of inappropriate diuretic hormone b. Diabetes insipidus c. Type 1 diabetes mellitus d. Hypothyroidism

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

A child with growth hormone deficiency is receiving growth hormone. What result would the nurse interpret as indicating effectiveness of this therapy? a. rapid weight gain b. reports of headaches c. height increase of 4 inches d. growth plate closure

c. height increase of 4 inches Explanation: Effectiveness of growth hormone therapy is indicated by at least a 3- to 5-inch (7.5- to 10-cm) increase in linear growth in the first year of treatment. Rapid weight gain and headaches are adverse reactions of this therapy. The drug is stopped when the epiphyseal growth plates close.

A nurse who is caring for a 7-year-old is providing client education to the child and caregiver. Which response by the caregiver demonstrates to the nurse that the caregiver understands the diagnosis of type 1 diabetes mellitus? a. "We will just have our child exercise and take medicine to cure this." b. "I will just feed my child healthy foods and sign her up for more sports." c. "Her body fights against the insulin." d. "Her body doesn't have any insulin."

d. "Her body doesn't have any insulin." Explanation: Type 1 diabetes mellitus (DM) is a disorder in which the child's body has a deficiency of insulin; children with type 1 DM cannot produce insulin. Type 2 DM is controlled through diet, medicine, and exercise. Type 2 DM can be prevented through diet and exercise, but type 1 DM cannot. Resistance to insulin is not the primary factor in type 1 DM.

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. "So, hypothyroidism can be only temporary, right?" b. "Are you saying that hypothyroidism is caused by a problem in the way the thyroid gland develops?" c. "Do you mean that hypothyroidism may be caused by a problem in the way the body makes thyroxine?" d. "So, hypothyroidism can be treated by exposing our baby to a special light, right?"

d. "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.

An elementary school child takes metformin three times each day. Which disorder would the school nurse expect the child to have? a. Type 1 diabetes mellitus b. Gastrointestinal reflux c. Inflammatory bowel disorder d. Type 2 diabetes mellitus

d. 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.

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? a. Vital signs b. Oral intake c. Oral mucosa d. Urine output

d. 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.

A newborn is born with hypothyroidism. If it is not recognized and treated, what complication is likely? a. blindness b. muscle spasticity c. dehydration d. cognitive impairment

d. cognitive impairment Explanation: A newborn with congenital hypothyroidism is lethargic, hypotonic and irritable. Delayed growth is seen as well as decreased mental responsiveness. The newborn has an enlarged tongue and poor sucking ability. Without treatment with the thyroid hormone, the newborn will develop a cognitive impairment and failure to thrive. Blindness, muscle spasticity and dehydration are not symptoms or complications of the disease.

A child is admitted to the pediatric medical unit with the diagnosis of syndrome of inappropriate antidiuretic hormone (SIADH). The child experiences the typical signs and symptoms of this disorder. Which concern will the nurse include in care planning? a. delayed growth and development risk b. altered nutrition risk c. noncompliance because of difficulty coping d. excess fluid volume risk

d. excess fluid volume risk Explanation: Syndrome of inappropriate antidiuretic hormone (SIADH) occurs when antidiuretic hormone (ADH; vasopressin) is secreted in the presence of low serum osmolality because the feedback mechanism that regulates ADH does not function properly. ADH continues to be released, and this leads to water retention, decreased serum sodium due to hemodilution, and extracellular fluid volume expansion; thus, the priority concern for care planning is the risk for excess fluid volume from edema.

The nurse knows that disorders of the pituitary gland depend on the location of the physiologic abnormality. In caring for a child that has issues with the anterior pituitary, the nurse knows that this child has issues with which hormone? a. vasopressin b. antidiuretic hormone c. oxytocin d. growth hormone

d. 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), 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.

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

The nurse is preparing a child suspected of having a thyroid disorder for a thyroid scan. What information regarding the child should the nurse alert the doctor or nuclear medicine department about? - The child is allergic to shellfish. - The child is taking a vitamin supplement. - The child has had an MRI of their leg within the past 6 weeks. - The child wears a medical alert bracelet for diabetes.

The child is allergic to shellfish.

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 may not be taking the medication. - The child may have developed leukopenia. - The child needs to be started on an antibiotic drug. - The child must be participating in sports.

The child may have developed leukopenia.

An elementary school child takes metformin three times each day. Which disorder would the school nurse expect the child to have? - Type 1 diabetes mellitus - Gastrointestinal reflux - Inflammatory bowel disorder - Type 2 diabetes mellitus

Type 2 diabetes mellitus

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 - Oral intake - Oral mucosa - Urine output

Urine output

A newborn is born with hypothyroidism. If it is not recognized and treated, what complication is likely? - blindness - muscle spasticity - dehydration - cognitive impairment

cognitive impairment

Which nursing objective is most important when working with neonates who are suspected of having congenital hypothyroidism? - early identification - promoting bonding - allowing rooming in - encouraging fluid intake

early identification

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? - frequent diarrhea - enlarged tongue - tachycardia - warm, moist skin

enlarged tongue

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."

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? - "During exercise we should wait to check blood sugars until after our child completes the activity." - "If our child is sick we should check blood glucose levels more often." - "We should check our child's blood glucose levels before meals." - "Blood glucose level, food intake, and activity need to all be considered when calculating insulin dosage."

"During exercise we should wait to check blood sugars until after our child completes the activity."

A nurse who is caring for a 7-year-old is providing client education to the child and caregiver. Which response by the caregiver demonstrates to the nurse that the caregiver understands the diagnosis of type 1 diabetes mellitus? - "We will just have our child exercise and take medicine to cure this." - "I will just feed my child healthy foods and sign her up for more sports." - "Her body fights against the insulin." - "Her body doesn't have any insulin."

"Her body doesn't have any insulin."

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."

The nurse is educating the parents of a client newly diagnosed with type 1 diabetes. Which statement by the parents indicates additional teaching is needed? - "When our child is sick, we may need to check glucose levels more frequently." - "Our child should eat three meals and midafternoon and bedtime snacks each day." - "We and our child need to learn to identify carbohydrate, protein, and fat foods." - "Our child should not participate in sports or physical activity."

"Our child should not participate in sports or physical activity."

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." - "Will your child be able to swallow oral pills every day?" - "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?"

"Research shows that there must be a diagnosis of deficiency before growth hormones can be started at this age."

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 only temporary, right?" - "Are you saying that hypothyroidism is caused by a problem in the way the thyroid gland develops?" - "Do you mean that hypothyroidism may be caused by a problem in the way the body makes thyroxine?" - "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?"

The nurse is taking a history on a 10-year-old child who has a diagnosis of hypopituitarism. Which question is important for the nurse to ask the parents? - "Is your child taking vasopressin IM or SC?" - "What time each day does your child take his growth hormone?" - "Does your child get upset about being taller than friends?" - "How often do you test your child's blood glucose?"

"What time each day does your child take his growth hormone?"

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. - Abrupt onset of symptoms - Marked weight loss - Polyuria - Polydipsia - Polyphagia

- Polyuria - Polydipsia - Polyphagia

A 10-year-old child is newly diagnosed with type 1 diabetes. The child's hemoglobin A1C level is being monitored. The nurse determines that additional intervention is needed with the child based on which result? - 8.5% - 6.5% - 7.5 % - 7.0%

8.5%

A newborn was diagnosed as having hypothyroidism at birth. The parent asks the nurse how the disease could be discovered this early. Which is the nurse's best answer? - Hypothyroidism is usually detected at birth by the newborn's physical appearance. - A newborn has a typical rash at birth that suggests the diagnosis. - A simple blood test to diagnose hypothyroidism is required in most states. - The newborn is already severely impaired at birth, and this suggests the diagnosis.

A simple blood test to diagnose hypothyroidism is required in most states.

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.

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

The primary health care provider has ordered a thyroid scan to confirm the diagnosis of hyperthyroidism. Which would the nurse do before the scan? - Assess the client for allergies. - Give the client a bolus of fluids - Tell the client he or she will be asleep. - Insert a urinary catheter.

Assess the client for allergies.

A newborn exhibits significant jittery movements, convulsions, and apnea. Hypoparathyroidism is suspected. What would the nurse expect to be administered? - Calcium gluconate - Hydrocortisone - Desmopressin - Levothyroxine

Calcium gluconate

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 - Decreased serum levels of free testosterone - Body mass index as normal - Short stature

Darkened pigmentation around the neck area

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

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 on your pancreas to stimulate insulin production. - Desmopressin acetate is a synthetic form of insulin used to lower your blood sugar. - Desmopressin acetate is a synthetic antidiuretic hormone that will slow down your urine output. - Desmopressin acetate works to help your kidneys work more efficiently.

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

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. - Give the dose first thing in the morning. - Store the insulin in the refrigerator until just before giving it. - Discard any opened vials after a week.

Do not mix this insulin with other insulins.

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. - Prior to discharge the parents state that they understand the medication regimen. - The parents fill the prescription for hormone replacement therapy prior to discharge. - The parents ask appropriate questions about the planned treatment goals.

During follow-up visits the child demonstrates normal growth and development.

A 12-year-old child has hyperthyroidism. The nurse understands that the most common cause of hyperthyroidism in children is: - Addison disease. - Cushing syndrome. - Graves disease. - Plummer disease.

Graves disease

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

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

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: - Polyuria - Pica - Polyphagia - Polydipsia

Polyphagia

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 - Lispro - NPH - Detemir

Regular insulin

The nurse is planning care for a school-age child diagnosed with growth hormone deficiency. Which diagnosis should the nurse select to help the child with this health problem? - Risk for situational low self-esteem related to short stature - Ineffective tissue perfusion related to infantile blood vessels - Impaired skin integrity related to overproduction of melanin - Risk for self-directed violence related to oversecretion of epinephrine

Risk for situational low self-esteem related to short stature

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.

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. - Observation reveals lethargy and irritability. - Skin is cool, dry, and scaly to the touch. - The child is hypoactive and hypotonic.

The child has a strong appetite but fails to thrive.

A child is admitted to the pediatric medical unit with the diagnosis of syndrome of inappropriate antidiuretic hormone (SIADH). The child experiences the typical signs and symptoms of this disorder. Which concern will the nurse include in care planning? - delayed growth and development risk - altered nutrition risk - noncompliance because of difficulty coping - excess fluid volume risk

excess fluid volume risk

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? - Child appears pale and fatigued. - There are purple striae on the abdomen. - The child is excessively tall for chronologic age. - The child is demonstrating signs of hypoglycemia.

There are purple striae on the abdomen.

The nurse is preparing teaching materials for a family whose child is prescribed somatropin for a growth hormone deficiency. What should the nurse instruct the parents about the administration of this medication? - This medication must be given by injection. - This medication must be given in the morning before school. - Hip or knee pain is an expected adverse effect of this medication. - This medication does not interact with any other types of medication.

This medication must be given by injection.

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 adrenal cortex - Tumor of the thyroid - Tumor of the pancreas - Tumor of the parathyroid

Tumor of the adrenal cortex

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

Type 1 diabetes mellitus

The nurse knows that disorders of the pituitary gland depend on the location of the physiologic abnormality. In caring for a child that has issues with the anterior pituitary, the nurse knows that this child has issues with which hormone? - vasopressin - antidiuretic hormone - oxytocin - growth hormone

growth hormone

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

heat intolerance

A child with growth hormone deficiency is receiving growth hormone. What result would the nurse interpret as indicating effectiveness of this therapy? - rapid weight gain - reports of headaches - height increase of 4 inches - growth plate closure

height increase of 4 inches

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

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

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? - recent weight loss - blood pressure of 142/92 mm Hg - slow healing wounds - loose stools

recent weight loss

The nurse working with the child diagnosed with type 2 diabetes recognizes the disorder can be managed by: - taking oral hypoglycemic agents. - increasing carbohydrates in the diet, especially in the evening. - conserving energy with rest periods during the day. - decreasing amounts of daily insulin.

taking oral hypoglycemic agents.

The nurse is caring for a child diagnosed with low functioning parathyroid. Which is a treatment goal of a child with hypoparathyroidism? - Maintain the child's calcium level at a normal level with calcium replacement as prescribed. - Assure the parents have a plan in place for periods of low glucose levels if noted. - Provide the child and parent with a referral to a pediatric gastrointestinal specialist. - Provide the parents a specific dietary plan for high-phosphorus foods to be eaten.

Maintain the child's calcium level at a normal level with calcium replacement as prescribed.

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? - Monitor sodium levels. - Monitor the child's weight daily. - Monitor intake and output. - Correct nausea and vomiting.

Monitor sodium levels.