Deck 33: The Child with Endocrine Dysfunction

Question 1

Congenital adrenal hyperplasia (CAH) is suspected in a newborn because of ambiguous genitalia. The parents are appropriately upset and concerned about their child's gender. In teaching the parents about CAH, what should the nurse explain?

A) Reconstructive surgery as a female is preferred.
B) Sexual assignment should wait until genetic sex is determined.
C) Prenatal masculinization will strongly influence the child's development.
D) The child should be raised as a boy because of the presence of a penis and scrotum.

Answer 1

Sexual assignment should wait until genetic sex is determined.

Question 2

Exophthalmos (protruding eyeballs) may occur in children with which condition?

A) Hypothyroidism
B) Hyperthyroidism
C) Hypoparathyroidism
D) Hyperparathyroidism

Answer 2

Hyperthyroidism

Question 3

What is a condition that can result if hypersecretion of growth hormone (GH) occurs after epiphyseal closure?

A) Cretinism
B) Dwarfism
C) Gigantism
D) Acromegaly

Answer 3

Acromegaly

Question 4

A goiter is an enlargement or hypertrophy of which gland?

A) Thyroid
B) Adrenal
C) Anterior pituitary
D) Posterior pituitary

Question 5

A child is receiving propylthiouracil for the treatment of hyperthyroidism (Graves disease). The parents and child should be taught to recognize and report which sign or symptom immediately?

A) Fatigue
B) Weight loss
C) Fever, sore throat
D) Upper respiratory tract infection

Question 6

Glucocorticoids, mineralocorticoids, and sex steroids are secreted by which gland?

A) Thyroid gland
B) Adrenal cortex
C) Anterior pituitary
D) Parathyroid glands

Question 7

What clinical manifestation is considered a cardinal sign of diabetes mellitus?

A) Nausea
B) Seizures
C) Impaired vision
D) Frequent urination

Question 8

Intranasal administration of desmopressin acetate (DDAVP) is used to treat which condition?

A) Hypopituitarism
B) Diabetes insipidus (DI)
C) Syndrome of inappropriate antidiuretic hormone (SIADH)
D) Acute adrenocortical insufficiency

Question 9

Peripheral precocious puberty (PPP) differs from central precocious puberty (CPP) in which manner?

A) PPP results from a central nervous system (CNS) insult.
B) PPP occurs more frequently in girls.
C) PPP may be viewed as a variation in sexual development.
D) PPP results from hormonal stimulation of the hypothalamic gonadotropin-releasing hormone (Gn-RH).

Question 10

What is a common clinical manifestation of juvenile hypothyroidism?

A) Insomnia
B) Diarrhea
C) Dry skin
D) Rapid growth

Question 11

A child will start treatment for central precocious puberty. What synthetic hormone will be injected?

A) Thyrotropin
B) Gonadotropins
C) Somatotropic hormone
D) Luteinizing hormone-releasing hormone

Question 12

A child with hypoparathyroidism is receiving vitamin D therapy. The parents should be advised to watch for which signs or symptoms of vitamin D toxicity?

A) Headache and seizures
B) Weakness and lassitude
C) Anorexia and insomnia
D) Physical restlessness, voracious appetite without weight gain

Question 13

What form of diabetes is characterized by destruction of pancreatic beta cells, resulting in insulin deficiency?

A) Type 1 diabetes
B) Type 2 diabetes
C) Gestational diabetes
D) Maturity-onset diabetes of the young (MODY)

Question 14

A child with growth hormone (GH) deficiency is receiving GH therapy. When is the best time for the GH to be administered?

A) At bedtime
B) After meals
C) Before meals
D) After arising in morning

Question 15

A child with hypopituitarism is being started on growth hormone (GH) therapy. Nursing considerations should be based on which knowledge?

A) Therapy is most successful if it is started during adolescence.
B) Replacement therapy requires daily subcutaneous injections.
C) Hormonal supplementation will be required throughout child's lifetime.
D) Treatment is considered successful if children attain full stature by adolescence.

Question 16

What nursing care should be included for a child diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH)?

A) Maintain the child NPO (nothing by mouth).
B) Turn the child frequently.
C) Restrict fluids.
D) Encourage fluids.

Question 17

Homeostasis in the body is maintained by what is collectively known as the neuroendocrine system. What is the name of the nervous system that is involved?

A) Central
B) Skeletal
C) Peripheral
D) Autonomic

Question 18

What statement is characteristic of type 1 diabetes mellitus?

A) Onset is usually gradual.
B) Ketoacidosis is infrequent.
C) Peak age incidence is 10 to 15 years.
D) Oral agents are available for treatment.

Question 19

The nurse is planning care for a child recently diagnosed with diabetes insipidus (DI). What intervention should be included?

A) Encourage the child to wear medical identification.
B) Discuss with the child and family ways to limit fluid intake.
C) Teach the child and family how to do required urine testing.
D) Reassure the child and family that this is usually not a chronic or life-threatening illness.

Question 20

The school nurse practitioner is consulted by a fifth-grade teacher about a student who has become increasingly inattentive and hyperactive in the classroom. The nurse notes that the child's weight has changed from the 50th percentile to the 30th percentile. The nurse is concerned about possible hyperthyroidism. What additional sign or symptom should the nurse anticipate?

A) Skin that is cool and dry
B) Blurred vision and loss of acuity
C) Running and being active during recess
D) Decreased appetite and food intake

Question 21

What blood glucose measurement is most likely associated with diabetic ketoacidosis?

A) 185 mg/dl
B) 220 mg/dl
C) 280 mg/dl
D) 330 mg/dl

Question 22

The nurse is teaching the parent of a preschool child how to administer the child's insulin injection. The child will be receiving 2 units of regular insulin and 12 units of NPH insulin every morning. What should the parent be taught?

A) Draw the insulin in separate syringes.
B) Draw the regular insulin first and then the NPH into the same syringe.
C) Draw the NPH insulin first and then the regular into the same syringe.
D) Check blood sugar first, and if below 120, hold the regular insulin and give the NPH.

Question 23

A child eats some sugar cubes after experiencing symptoms of hypoglycemia. This rapid-releasing sugar should be followed by which dietary intervention?

A) Sports drink and fruit
B) Glucose tabs and protein
C) Glass of water and crackers
D) Milk and peanut butter on bread

Question 24

The nurse is discussing with a child and family the various sites used for insulin injections. What site usually has the fastest rate of absorption?

A) Arm
B) Leg
C) Buttock
D) Abdomen

Question 25

An adolescent diabetic is admitted to the emergency department for treatment of hyperglycemia and pneumonia. What are characteristics of diabetic hyperglycemia?

A) Cold, clammy skin and lethargy
B) Hunger and hypertension
C) Thirst, being flushed, and fruity breath
D) Disorientation and pallor

Question 26

To help an adolescent deal with diabetes, the nurse needs to consider which characteristic of adolescence?

A) Desire to be unique
B) Preoccupation with the future
C) Need to be perfect and similar to peers
D) Awareness of peers that diabetes is a severe disease

Question 27

A preadolescent has maintained good glycemic control of his type 1 diabetes through the school year. During summer vacation, he has had repeated episodes of hypoglycemia. What additional teaching is needed?

A) Carbohydrates in the diet need to be replaced with protein.
B) Additional snacks are needed to compensate for increased activity.
C) The child needs to decrease his activity level to minimize episodes of hypoglycemia.
D) Insulin dosage should be increased to compensate for a change in activity level.

Question 28

The parents of a child who has just been diagnosed with type 1 diabetes ask about exercise. What effect does exercise have on a type 1 diabetic?

A) Exercise increases blood glucose.
B) Extra insulin is required during exercise.
C) Additional snacks are needed before exercise.
D) Excessive physical activity should be restricted.

Question 29

The thyroid-stimulating hormone (TSH) increases secretion in response to which hormone?

A) Low levels of circulating thyroid hormone
B) High levels of circulating thyroid hormone
C) Low levels of circulating adrenocorticotropic hormone
D) High levels of circulating adrenocorticotropic hormone

Question 30

What statement applies to the current focus of the dietary management of children with diabetes?

A) Measurement of all servings of food is vital for control.
B) Daily calculate specific amounts of carbohydrates, fats, and proteins.
C) The number of calories for carbohydrates remains constant on a daily basis; protein and fat calories are liberal.
D) The intake ensures day-to-day consistency in total calories, protein, carbohydrates, and moderate fat while allowing for a wide variety of foods.

Question 31

During the summer many children are more physically active. What changes in the management of the child with diabetes should be expected as a result of more exercise?

A) ­food intake
B) ¯food intake
C) ­risk of hyperglycemia
D) ¯risk of insulin reaction

Question 32

Prolonged steroid therapy has caused a child to have Cushing syndrome. To lessen the cushingoid effects, the steroid should be administered at which time?

A) In the PM
B) After lunch
C) QD in the AM
D) QOD in the AM

Question 33

The nurse is assisting with a growth hormone stimulation test for a child with short stature. What should the nurse monitor closely on this child during the test?

A) Hypotension
B) Tachycardia
C) Hypoglycemia
D) Nausea and vomiting

Question 34

The clinic nurse is assessing a child with hypopituitarism. Hypopituitarism can lead to which disorder?

A) Gigantism
B) Hyperthyroidism
C) Cushing syndrome
D) Growth hormone deficiency

Question 35

A 12-year-old girl is newly diagnosed with diabetes when she develops ketoacidosis. How should the nurse structure a successful education program?

A) Essential information is presented initially.
B) Teaching should take place in the child's semiprivate room.
C) Education is focused toward the parents because the child is too young.
D) All information needed for self-management of diabetes is taught at once.

Question 36

What clinical manifestation occurs with hypoglycemia?

A) Lethargy
B) Confusion
C) Nausea and vomiting
D) Weakness and dizziness

Question 37

A school-age child with diabetes gets 30 units of NPH insulin at 0800. According to when this insulin peaks, the child should be at greatest risk for a hypoglycemic episode between when?

A) Lunch and dinner
B) Breakfast and lunch
C) 0830 to his midmorning snack
D) Bedtime and breakfast the next morning

Question 38

A 20-kg (44-lb) child in ketoacidosis is admitted to the pediatric intensive care unit. What order should the nurse not implement until clarified with the physician?

A) Weigh on admission and daily.
B) Replace fluid volume deficit over 48 hours.
C) Begin intravenous line with D5 0.45% normal saline with 20 mEq of potassium chloride.
D) Give intravenous regular insulin 2 units/kg/hr after initial rehydration bolus.

Question 39

The nurse is teaching an adolescent about giving insulin injections. The adolescent asks if the disposable needles and syringes can be used more than once. The nurse's response should be based on which knowledge?

A) It is unsafe.
B) It is acceptable for up to 24 hours.
C) It is acceptable for families with very limited resources.
D) It is suitable for up to 3 days if stored in the refrigerator.

Question 40

The nurse is caring for an adolescent with anorexia nervosa. What pituitary dysfunction should the nurse assess for in the adolescent?

A) Hypopituitarism
B) Pituitary hyperfunction
C) Hyperplasia of the pituitary cells
D) Overproduction of the anterior pituitary hormones

Question 41

The health care provider has prescribed desmopressin acetate (DDAVP) 0.05mg/kg/day PO divided twice daily for a child with diabetes insipidus. The child weighs 110 lb. The nurse is preparing to administer the 0900 dose. Calculate the dose the nurse should administer in milligrams. Record your answer in a whole number.
_________

Question 42

The nurse is planning to admit a 12-year-old with Graves disease (GD). What clinical manifestations should the nurse expect to observe in this child? (Select all that apply.)

A) Insomnia
B) Irritability
C) Tonic rigidity
D) Hyperactivity
E) Muscle cramps

Question 43

A child is having tests done to determine parathyroid function. The clinic nurse knows that the parathyroid hormone (PTH) regulates the homeostasis of what in the serum?

A) Sodium
B) Calcium
C) Potassium
D) Magnesium

Question 44

What are characteristics of diabetic ketoacidosis? (Select all that apply.)

A) Pallor
B) Acidosis
C) Bradypnea
D) Dehydration
E) Electrolyte imbalance

Question 45

The nurse is preparing to assist with a growth hormone provocative test for a child with short stature. The nurse recognizes that which pharmacologics should be used to provoke the release of growth hormone (GH)? (Select all that apply.)

A) Larodopa (levodopa)
B) Clonidine (Catapres)
C) Propranolol (Inderal)
D) Cortisone (hydrocortisone)
E) Biosynthetic growth hormone

Question 46

The nurse is planning to admit a 14-year-old adolescent with Cushing syndrome. What clinical manifestations should the nurse expect to observe in this child? (Select all that apply.)

A) Truncal obesity
B) Decreased pubic hair
C) Petechial hemorrhage
D) Hyperpigmentation of elbows
E) Facial plethora
F) Headache and weakness

Question 47

The nurse is taking care of a child who had a thyroidectomy. The nurse recognizes what as a positive Chvostek sign?

A) Paresthesia occurring in feet and toes
B) Frequent sharp flexion of wrist and ankle joints
C) Carpal spasm elicited by pressure applied to the nerves of the upper arm
D) Facial muscle spasm elicited by tapping the facial nerve in the region of the parotid gland

Question 48

The nurse is preparing a community outreach program for adolescents about the characteristic differences between type 1 and type 2 diabetes mellitus (DM). What concepts should the nurse include? (Select all that apply.)

A) Type 1 DM has an abrupt onset.
B) Type 1 DM is often controlled with oral glucose agents.
C) Type 1 DM occurs primarily in whites.
D) Type 2 DM always requires insulin therapy.
E) Type 2 DM frequently has a familial history.
F) Type 2 DM occurs in people who are overweight.

Question 49

The nurse is preparing to admit a 9-year-old child with syndrome of inappropriate antidiuretic hormone (SIADH). What interventions should the nurse include in the child's care plan? (Select all that apply.)

A) Provide a low-sodium, low-fat diet.
B) Initiate seizure precautions.
C) Weigh daily at the same time each day.
D) Encourage intake of 1 l of fluid per day.
E) Measure intake and output hourly.

Question 50

The nurse is caring for a child with an anterior pituitary tumor. What hormones are secreted by the anterior pituitary? (Select all that apply.)

A) Oxytocin
B) Luteinizing hormone
C) Antidiuretic hormone
D) Thyroid-stimulating hormone
E) Adrenocorticotrophic hormone

Question 51

The nurse is planning to admit a 14-year-old adolescent with hyperparathyroidism. What clinical manifestations should the nurse expect to observe in this patient? (Select all that apply.)

A) Polyuria
B) Diarrhea
C) Hypotension
D) Vague bone pain
E) Paresthesia in extremities

Question 52

The health care provider has prescribed leuprolide acetate (Lupron Depot) 0.2 mg/kg IM every 4 weeks for a child with precocious puberty. The child weighs 55 lb. The nurse is preparing to administer the dose. Calculate the dose the nurse should administer in milligrams. Record your answer below in a whole number.
_________

Question 53

The nurse is preparing to admit a 7-year-old child with type 2 diabetes. What clinical features of type 2 diabetes should the nurse recognize? (Select all that apply.)

A) Oral agents are effective.
B) Insulin is usually needed.
C) Ketoacidosis is infrequent.
D) Diet only is often effective.
E) Chronic complications frequently occur.

Question 54

The clinic nurse is assessing a child with central precocious puberty. What conditions can cause central precocious puberty? (Select all that apply.)

A) Trauma
B) Neoplasms
C) Radiotherapy
D) Exogenous sex hormones
E) Primary hypothyroidism

Question 55

The health care provider has prescribed levothyroxine (Synthroid) 4 mcg/kg/day PO for a child with hypothyroidism. The child weighs 77 lb. The nurse is preparing to administer the daily dose. Calculate the dose the nurse should administer in micrograms. Record your answer below in a whole number.
________

Question 56

The nurse is teaching the family of a child with type 1 diabetes about insulin. What should the nurse include in the teaching session? (Select all that apply.)

A) Unopened vials are good for 60 days.
B) Diabetic supplies should not be left in a hot environment.
C) Insulin can be placed in the freezer if not used every day.
D) After it has been opened, insulin is good for up to 28 to 30 days.
E) Insulin bottles that have been opened should be stored at room temperature or refrigerated.

Question 57

The nurse is caring for a child after a parathyroidectomy. What medication should the nurse have available if hypocalcemia occurs?

A) Insulin
B) Calcium gluconate
C) Propylthiouracil (PTU)
D) Cortisone (hydrocortisone)

Question 58

The nurse is preparing to administer a prescribed dose of desmopressin acetate (DDAVP) intramuscularly (IM) to a child with diabetes insipidus. What action should the nurse take before drawing the medication into a syringe?

A) Mix the medication with sterile water.
B) Mix the medication with sterile normal saline.
C) Have another nurse double-check the medication dose.
D) Hold the medication under warm water for 10 to 15 minutes and then shake vigorously.

Question 59

The nurse is planning to admit a 10-year-old child with syndrome of inappropriate antidiuretic hormone (SIADH). What clinical manifestations should the nurse expect to observe in this child? (Select all that apply.)

A) Polyuria
B) Anorexia
C) Polydipsia
D) Irritability
E) Stomach cramps

Question 60

The nurse is planning to admit an 8-year-old child with hypoparathyroidism. What clinical manifestations should the nurse expect to observe in this child? (Select all that apply.)

A) Muscle cramps
B) Positive Chvostek sign
C) Emotional lability
D) Laryngeal spasms
E) Short attention span

Question 61

The health care provider has prescribed propylthiouracil (PTU) 7 mg/kg/day PO divided every 12 hours for a child with Graves disease. The child weighs 66 lb. The nurse is preparing to administer the 0800 dose. Calculate the dose the nurse should administer in milligrams. Record your answer below in a whole number.
_________

Question 62

A health care provider prescribes hydrocortisone (Solu-Cortef) 200 mg IV STAT for a child with acute adrenocortical insufficiency. The medication label states Solu-Cortef 100 mg/2 ml. The nurse prepares to administer one dose. How many milliliters will the nurse prepare to administer one dose? Fill in the blank. Record your answer below in a whole number.
________________