San Jacinto College - RNSG 2201

Chapter 28: The Child with Endocrine Dysfunction

Hockenberry: Wong’s Essentials of Pediatric Nursing, 10th Edition

MULTIPLE CHOICE

1)Parents of a toddler with hypopituitarism ask the nurse, “What can we expect with this condition?” The nurse should respond with which statement?

1. 1. Growth is normal during the first 3 years of life.
   2. Weight is usually more retarded than height.
   3. Skeletal proportions are normal for age.
   4. Most of these children have subnormal intelligence.

2. A child with hypopituitarism is being started on growth hormone (GH) therapy. Nursing considerations should be based on which knowledge?
   1. Treatment is most successful if it is started during adolescence.
   2. Treatment is considered successful if children atain full stature by adulthood.
   3. Replacement therapy requires daily subcutaneous injections.
   4. Replacement therapy will be required throughout the child’s lifetime.

3. A child with growth hormone (GH) deficiency is receiving GH therapy. When is the best time for the GH to be administered?
   1. At bedtime
   2. After meals
   3. Before meals
   4. On arising in the morning

4. An adolescent is being seen in the clinic for evaluation of acromegaly. The nurse understands that which occurs with acromegaly?
   1. There is a lack of growth hormone (GH) being produced.
   2. There is excess growth hormone (GH) after closure of the epiphyseal plates.
   3. There is an excess of growth hormone (GH) before the closure of the epiphyseal plates.
   4. There is a lack of thyroid hormone being produced.

5. A child will start treatment for precocious puberty. The nurse recognizes that this will involve the injection of which synthetic medication?
   1. Thyrotropin
   2. Gonadotropins
   3. Somatotropic hormone
   4. Luteinizing hormone–releasing hormone

6. The nurse is conducting a staff in-service on childhood endocrine disorders. Diabetes insipidus is a disorder of:
   1. anterior pituitary.
   2. posterior pituitary.
   3. adrenal cortex.
   4. adrenal medulla.

7. The nurse is caring for a preschool child with suspected diabetes insipidus. Which clinical manifestation should the nurse expect to observe?
   1. Oliguria
   2. Glycosuria
   3. Nausea and vomiting
   4. Polyuria and polydipsia

8. A nasal spray of desmopressin acetate (DDAVP) is used to treat which disorder?
   1. Hypopituitarism
   2. Diabetes insipidus
   3. Acute adrenocortical insufficiency
   4. Syndrome of inappropriate antidiuretic hormone

9. The nurse is admitting a toddler with the diagnosis of juvenile hypothyroidism. Which is a common clinical manifestation of this disorder?
   1. Insomnia
   2. Diarrhea
   3. Dry skin
   4. Accelerated growth

10. A goiter is an enlargement or hypertrophy of which gland?
    1. Thyroid
    2. Adrenal
    3. Anterior pituitary
    4. Posterior pituitary

11. What condition may cause exophthalmos (protruding eyeballs) in children?
    1. Hypothyroidism

1. 2. Hyperthyroidism
   3. Hypoparathyroidism
   4. Hyperparathyroidism

12. The nurse is teaching the parents of a child who is receiving methimazole (Tapazole) for the treatment of hyperthyroidism (Graves disease). Which statement made by the parent indicates a correct understanding of the teaching?
    1. “I would expect my child to gain weight while taking this medication.”
    2. “I would expect my child to experience episodes of ear pain while taking this medication.”
    3. “If my child develops a sore throat and fever, I should contact the physician immediately.”
    4. “If my child develops the stomach flu, my child will need to be hospitalized.”

13. Which clinical manifestation may occur in the child who is receiving too much methimazole (Tapazole) for the treatment of hyperthyroidism (Graves disease)?
    1. Seizures
    2. Enlargement of all lymph glands
    3. Pancreatitis or cholecystitis
    4. Lethargy and somnolence

14. A child with hypoparathyroidism is receiving vitamin D therapy. The parents should be advised to watch for which sign of vitamin D toxicity?
    1. Headache and seizures
    2. Physical restlessness and voracious appetite without weight gain
    3. Weakness and lassitude
    4. Anorexia and insomnia

15. What secretes glucocorticoids, mineralocorticoids, and sex steroids?
    1. Thyroid gland
    2. Parathyroid glands

1. 3. Adrenal cortex
   4. Anterior pituitary

16. What is chronic adrenocortical insufficiency also called?
    1. Graves disease
    2. Addison disease
    3. Cushing syndrome
    4. Hashimoto disease

17. A neonate born with ambiguous genitalia is diagnosed with congenital adrenogenital hyperplasia. What does therapeutic management include?
    1. Administration of vitamin D
    2. Administration of cortisone
    3. Administration of stool softeners
    4. Administration of calcium carbonate

18. The parents of a neonate with adrenogenital hyperplasia tell the nurse that they are afraid to have any more children. The nurse should explain which statement about adrenogenital hyperplasia?
    1. It is not hereditary.
    2. Genetic counseling is indicated.

1. 3. It can be prevented during pregnancy.
   4. All future children will have the disorder.

19. Which is characteristic of the immune-mediated type 1 diabetes mellitus?
    1. Ketoacidosis is infrequent.
    2. Onset is gradual.
    3. Age at onset is usually younger than 20 years.
    4. Oral agents are often effective for treatment.

20. Which is considered a cardinal sign of diabetes mellitus?
    1. Nausea
    2. Seizures
    3. Impaired vision
    4. Frequent urination

21. Hyperglycemia associated with diabetic ketoacidosis is defined as a blood glucose measurement equal to or greater than         mg/dl.

a.   100

b.   120

c.   180

d.   200

22. Type 1 diabetes mellitus is suspected in an adolescent. Which clinical manifestation may be present?
    1. Moist skin
    2. Weight gain
    3. Fluid overload
    4. Poor wound healing

23. A parent asks the nurse why self-monitoring of blood glucose is being recommended for her child with diabetes. The nurse should base the explanation on which knowledge?
    1. It is a less expensive method of testing.
    2. It is not as accurate as laboratory testing.
    3. Children are better able to manage the diabetes.
    4. Parents are better able to manage the disease.

24. The parent of a child with diabetes mellitus asks the nurse when urine testing will be necessary. The nurse should explain that urine testing is necessary for which?
    1. Glucose is needed before administration of insulin.
    2. Glucose is needed four times a day.
    3. Glycosylated hemoglobin is required.

1. 4. Ketonuria is suspected.

25. The parents of a child who has just been diagnosed with type 1 diabetes ask about exercise. Which should the nurse explain about exercise in type 1 diabetes?
    1. Exercise will increase blood glucose.
    2. Exercise should be restricted.
    3. Extra snacks are needed before exercise.
    4. Extra insulin is required during exercise.

26. A child eats some sugar cubes after experiencing symptoms of hypoglycemia. What should follow this rapid-releasing sugar?
    1. Fat
    2. Fruit juice
    3. Several glasses of water
    4. Complex carbohydrate and protein

27. The nurse is caring for an 8-year-old child with type 1 diabetes. The nurse should teach the child to monitor for which manifestation of hypoglycemia?
    1. Lethargy
    2. Thirst
    3. Nausea and vomiting
    4. Shaky feeling and dizziness

28. The nurse is caring for an 11-year-old boy who has recently been diagnosed with diabetes. Which should be included in the teaching plan for daily injections?
    1. The parents do not need to learn the procedure.
    2. He is old enough to give most of his own injections.
    3. Self-injections will be possible when he is closer to adolescence.
    4. He can learn about self-injections when he is able to reach all injection sites.

29. The nurse is discussing with a child and family the various sites used for insulin injections.

Which site usually has the fastest rate of absorption?

1. 1. Arm
   2. Leg
   3. Buttock
   4. Abdomen

30. To help the adolescent deal with diabetes, the nurse must consider which characteristic of adolescence?
    1. Desire to be unique
    2. Preoccupation with the future
    3. Need to be perfect and similar to peers
    4. Need to make peers aware of the seriousness of hypoglycemic reactions

31. The nurse is implementing care for a school-age child admitted to the pediatric intensive care in diabetic ketoacidosis (DKA). Which prescribed intervention should the nurse implement first?
    1. Begin 0.9% saline solution intravenously as prescribed.
    2. Administer regular insulin intravenously as prescribed.
    3. Place child on a cardiac monitor.
    4. Place child on a pulse oximetry monitor.

32. The nurse should teach parents of a preschool child with type 1 diabetes that which can raise the blood glucose level?
    1. Exercise
    2. Steroids
    3. Decreased food intake
    4. Lantus insulin

33. A nurse is reviewing the laboratory results on a school-age child with hypoparathyroidism. Which results are consistent with this condition?
    1. Decreased serum phosphorus

1. 2. Decreased serum calcium
   3. Increased serum glucose
   4. Decreased serum cortisol level

MULTIPLE RESPONSE

1. Nursing care of a child diagnosed with a syndrome of inappropriate ADH should include which of the following? (Select all that apply.)
   1. Weigh daily
   2. Encourage fluids
   3. Turn frequently
   4. Maintain nothing by mouth (NPO)
   5. Restrict fluids

2. The nurse should expect to assess which clinical manifestations in an adolescent with Cushing syndrome? (Select all that apply.)
   1. Hyperglycemia
   2. Hyperkalemia
   3. Hypotension
   4. Cushingoid features
   5. Susceptibility to infections

3. A nurse is planning care for a school-age child with type 1 diabetes. Which insulin preparations are rapid and short acting? (Select all that apply.)
   1. Novolin N
   2. Lantus
   3. NovoLog
   4. Novolin R

4. A nurse is planning interventions for a toddler with juvenile hypothyroidism. Which interventions should the nurse plaNn UtoRSimINpGleTmB.eCnOtMfor this child? (Select all that apply.)
   1. Moisturizer for dry skin
   2. Antidiarrheal medications
   3. Medications to help with insomnia
   4. Implementation of thyroxine therapy

5. The nurse is caring for a school-age child with hyperthyroidism (Graves disease). Which clinical manifestations should the nurse monitor that may indicate a thyroid storm? (Select all that apply.)
   1. Constipation
   2. Hypotension
   3. Hyperthermia
   4. Tachycardia