Deck 51: The Child with an Endocrine or Metabolic Alteration

Question 1

New parents ask the nurse,"Why is it necessary for our baby to have the newborn blood test?" The nurse explains that the priority outcome of mandatory newborn screening for inborn errors of metabolism is

A) appropriate community referral for affected infants.
B) parental education about raising a special needs child.
C) early identification of serious genetically transmitted metabolic diseases.
D) early identification of electrolyte imbalances.

Answer 1

early identification of serious genetically transmitted metabolic diseases.

Question 2

A neonate is displaying mottled skin,has a large fontanel and tongue,is lethargic,and is having difficulty feeding.The nurse recognizes that this is most suggestive of which disorder?

A) Hypocalcemia
B) Hypothyroidism
C) Hypoglycemia
D) Phenylketonuria (PKU)

Answer 2

Hypothyroidism

Question 3

What is the best time for the nurse to assess the peak effectiveness of subcutaneously administered regular insulin?

A) Two hours after administration
B) Four hours after administration
C) Immediately after administration
D) Thirty minutes after administration

Answer 3

Two hours after administration

Question 4

At what age is sexual development in boys and girls considered to be precocious?

A) Boys, 11 years; girls, 9 years
B) Boys, 12 years; girls, 10 years
C) Boys, 9 years; girls, 8 years
D) Boys, 10 years; girls, 9 1/2 years

Question 5

What is the most appropriate intervention for the parents of a 6-year-old child with precocious puberty?

A) Advise the parents to consider birth control for their daughter.
B) Explain the importance the child having relationships with same-age peers.
C) Reassure parents that there are no long-term consequences.
D) Counsel parents that there is no treatment currently available for this disorder.

Question 6

A common clinical manifestation of congenital hypothyroidism is

A) insomnia.
B) diarrhea.
C) hoarse cry.
D) jitteriness.

Question 7

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

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

Question 8

What is the priority nursing goal for a 14-year-old with Graves' disease?

A) Relieving constipation
B) Allowing the adolescent to make decisions about whether or not to take medication
C) Verbalizing the importance of adherence to the medication regimen
D) Developing alternative educational goals

Question 9

A neonate born with ambiguous genitalia is diagnosed with congenital adrenal hyperplasia.Therapeutic management includes administration of

A) vitamin D.
B) cortisone acetate.
C) stool softeners.
D) calcium carbonate.

Question 10

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

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

Question 11

What is the best nursing action when a child with type 1 diabetes mellitus is sweating,trembling,and pale?

A) Offer the child a glass of water.
B) Give the child 5 units of regular insulin subcutaneously.
C) Give the child a glass of orange juice.
D) Give the child glucagon subcutaneously.

Question 12

What should the nurse include in the teaching plan for parents of a child with diabetes insipidus who is receiving DDAVP?

A) Increase the dosage of DDAVP as the urine specific gravity (SG) increases.
B) Give DDAVP only if urine output decreases.
C) The child should have free access to water and toilet facilities at school.
D) Cleanse skin before administering the transdermal patch.

Question 13

A nurse is explaining growth hormone deficiency to parents of a child admitted to rule out this problem.Which metabolic alteration that is related to growth hormone deficiency should the nurse explain to the parent?

A) Hypocalcemia
B) Hypoglycemia
C) Diabetes insipidus
D) Hyperglycemia

Question 14

Diabetes insipidus is a disorder of the

A) anterior pituitary.
B) posterior pituitary.
C) adrenal cortex.
D) adrenal medulla.

Question 15

What is the primary concern for a 7-year-old child with type 1 diabetes mellitus who asks his mother not to tell anyone at school that he has diabetes?

A) The child's safety
B) The privacy of the child
C) Development of a sense of industry
D) Peer group acceptance

Question 16

Type 1 diabetes mellitus is suspected in an adolescent.Which clinical manifestation may be present?

A) Moist skin
B) Weight gain
C) Fluid overload
D) Blurred vision

Question 17

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 the knowledge that

A) it is a less expensive method of testing.
B) it is not as accurate as laboratory testing.
C) children are better able to manage the diabetes.
D) the parents are better able to manage the disease.

Question 18

A child is hospitalized after a serious motor vehicle crash and has developed increased urination.What action by the nurse takes priority?

A) Weigh the child daily.
B) Monitor the child's intake and output.
C) Assess the daily serum sodium level.
D) Restrict dietary sodium intake.

Question 19

What information provided by the nurse would be helpful to a 15-year-old adolescent taking methimazole three times a day?

A) Pill dispensers and alarms on a watch can be effective reminders to take the medication.
B) She can take the medication when she is feels symptomatic.
C) She can take two pills before school and one pill at dinner, which is easier to remember.
D) The mother can be responsible for reminding her to take her medication.

Question 20

A goiter is an enlargement or hypertrophy of which gland?

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

Question 21

When would a child diagnosed with type 1 diabetes mellitus most likely demonstrate a decreased need for insulin?

A) During the "honeymoon" phase
B) During adolescence
C) During growth spurts
D) During minor illnesses

Question 22

Which sign is the nurse most likely to assess in a child with hypoglycemia?

A) Urine positive for ketones and serum glucose greater than 300 mg/dL
B) Normal sensorium and serum glucose greater than 160 mg/dL
C) Irritability and serum glucose less than 60 mg/dL
D) Increased urination and serum glucose less than 120 mg/dL

Question 23

An infant has just been diagnosed with Tay-Sachs disease.What action by the nurse is most appropriate?

A) Refer the family to a support group.
B) Educate the family on bone marrow transplant.
C) Teach the family how to promote growth and development.
D) Obtain informed consent for laser eye surgery.

Question 24

A child is diagnosed with hypothyroidism.The nurse should expect to assess which symptoms associated with hypothyroidism? (Select all that apply.)

A) Weight loss
B) Fatigue
C) Diarrhea
D) Dry, thick skin
E) Cold intolerance

Question 25

Which nursing interventions are appropriate for a child with type 1 diabetes who is experiencing deficient fluid volume related to abnormal fluid losses through diuresis and emesis? (Select all that apply.)

A) Initiate IV access.
B) Begin IV fluid replacement with normal saline.
C) Begin IV fluid replacement with D5 1/2NS.
D) Weigh on arrival to the unit and then every other day.
E) Maintain strict intake and output monitoring.

Question 26

What should a nurse advise the parents of a child with type 1 diabetes mellitus who is not eating as a result of a minor illness?

A) Give the child half his regular morning dose of insulin.
B) Substitute simple carbohydrates or calorie-containing liquids for solid foods.
C) Give the child plenty of unsweetened, clear liquids to prevent dehydration.
D) Take the child directly to the emergency department.

Question 27

Which children admitted to the pediatric unit would the nurse monitor closely for development of SIADH? (Select all that apply.)

A) A newly diagnosed preschooler with type 1 diabetes
B) A school-age child returning from surgery for removal of a brain tumor
C) An infant with suspected meningitis
D) An adolescent with blunt abdominal trauma following a car accident
E) A school-age child with head trauma

Question 28

A nurse is caring for a child undergoing an ACTH stimulation test.After administering the Cortrosyn according to policy,what action by the nurse takes priority?

A) Obtain a set of vital signs.
B) Monitor the urine output.
C) Facilitate a lab draw in 30 minutes.
D) Keep the child NPO.

Question 29

Which laboratory finding confirms that a child with type 1 diabetes is experiencing diabetic ketoacidosis?

A) No urinary ketones
B) Low arterial pH
C) Elevated serum carbon dioxide
D) Elevated serum phosphorus

Question 30

Which comment by a 12-year-old child with type 1 diabetes indicates deficient knowledge?

A) "I rotate my insulin injection sites every time I give myself an injection."
B) "I keep records of my glucose levels and insulin sites and amounts."
C) "I'll be glad when I can take a pill for my diabetes like my uncle does."
D) "I keep Lifesavers in my school bag in case I have a low-sugar reaction."

Question 31

Which is the nurse's best response to the parents of a 10-year-old child newly diagnosed with type 1 diabetes mellitus who are concerned about the child's continued participation in soccer?

A) "Consider the swim team as an alternative to soccer."
B) "Encourage intellectual activity rather than participation in sports."
C) "It is okay to play sports such as soccer unless the weather is too hot."
D) "Give the child an extra 15 to 30 g of carbohydrate snack before soccer practice."