Deck 28: Endocrine Alterations

Question 1

At what point is hormonal control over most body systems complete?

A) birth
B) 72 hours after birth
C) 1 month
D) 12 to 18 months of age

Answer 1

12 to 18 months of age

Question 2

Which of the following endocrine glands stores vasopressin (antidiuretic hormone)?

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

Answer 2

posterior pituitary

Question 3

Which of the following systems or mechanisms regulates the secretion of aldosterone?

A) renin-angiotensin system
B) negative feedback system involving adrenocorticotropic hormone (ACTH)
C) immune system
D) baroreceptors in the circulatory system

Answer 3

renin-angiotensin system

Question 4

The nurse working with parents of school-aged children will talk about growth hormone with the parents and stress that this hormone is secreted mainly at which of the following times?

A) during exposure to sunlight or fluorescent light
B) when the child is most active and jarring the long bones
C) primarily after the onset of sleep
D) the short period after intake of food high in calories

Question 5

Which of the following is most commonly the cause of growth hormone deficiency?

A) injury
B) destruction of the anterior pituitary gland
C) infection or irradiation
D) idiopathic condition

Question 6

Which of the following tests are conducted to confirm a diagnosis of growth hormone deficiency?

A) dexamethasone suppression test
B) Chvostek's sign
C) Trousseau's sign
D) pituitary function testing

Question 7

Which of the following side effects are seen as potential complications to growth hormone therapy given at physiologic replacement doses?

A) slipped femoral epiphysis, pseudotumor cerebri, edema, and sodium retention
B) immunodeficiency with increased susceptibility to infections
C) unexplained development of an autoimmune disease such as Addison's disease
D) circulatory disorders such as cardiac arrhythmias, valve disease, or stroke

Question 8

Which of the following will the nurse working in a clinic do to maintain the child's self-esteem and a good body image when preparing the child, who has been diagnosed with growth hormone deficiency, for a physical exam?

A) Remove the mirrors from the examining room and surrounding area.
B) Discreetly provide a step stool beside the examining table.
C) Use a growth chart that is in a language not understood by the child.
D) Measure the child's height with the child lying down on the table.

Question 9

The school nurse is talking with the teacher of a child who has growth hormone deficiency. As an advocate for the child, the school nurse will most need to talk with the teacher about which of the following needs of the child?

A) to be placed at least one grade lower
B) to be given extra-light homework assignments
C) to be spoken to in an age-appropriate manner
D) to be praised more often to build self-esteem

Question 10

The nurse is working with a child who has growth hormone deficiency and who will most likely have a diagnosis of delayed growth and development related to inadequate growth hormone secretion. Which of the following nursing diagnoses is the most likely additional diagnosis for this child?

A) disturbed body image related to short stature
B) at risk for injury related to inability to protect self
C) imbalanced nutrition more than body requirements related to eating with peers
D) impaired parenting related to lack of understanding of child's needs

Question 11

Parents of a child with growth hormone deficiency ask the nurse about the cost of growth hormone, saying that they have heard it is expensive and they have little income. Which of the following is the nurse's best response?

A) "The cost is small compared to the benefits your child will receive, so you need to do this for your child."
B) "Growth hormone can cost $30,000 per year or more; however, let's check what your insurance and special drug company programs will cover."
C) "Don't worry about the cost as there will somehow be a way to pay for it."
D) "Why don't you ask your church to help you look for a way to deal with the cost of treatment for your child's delayed growth and development?"

Question 12

A child with growth hormone deficiency asks the nurse how many hormone shots he will have to take. The nurse will respond with which of the following answers?

A) "All you need is one injection, and then the problem will be fixed."
B) "This is a series of three injections, which will jump-start your production of growth hormone."
C) "There will be injections for about a year, and then you will be tall enough."
D) "These injections to help you grow can continue for many years."

Question 13

Which of the following best describes precocious puberty in a Caucasian girl and an African-American girl?

A) breast development before 7 years of age for Caucasian girls and before 6 years for African-American girls
B) starting menses at age 9 for Caucasian girls and at age 8 for African-American girls
C) dating before age 12 for both Caucasian and African-American girls
D) wearing makeup and dressing in a sexually provocative way for both girls

Question 14

Which of the following is most frequently the cause of precocious puberty in females?

A) idiopathic
B) central nervous system lesions
C) trauma
D) pituitary malfunction

Question 15

When assessing a child with true precocious puberty, the nurse will most likely find which of the following signs or symptoms in addition to evidence of secondary sexual characteristics?

A) sexual provocativeness, active sexual involvement, and lack of involvement with caregivers
B) normal or elevated levels of gonadotropin-releasing Gn-RH), luteinizing hormone (LH), follicle-stimulating hormone (FSH), and estrogen or testosterone being produced
C) low self-esteem, fear related to being more sexually developed than peers
D) acne, adult body odor, greater height than peers, reproductive capability, and emotional lability

Question 16

Which of the following statements best describes the difference between precocious pseudopuberty and true precocious puberty?

A) In precocious pseudopuberty, the maturational changes are not real and are only in the imagination of the child or parents.
B) In precocious pseudopuberty, there is an initial activation of reproductive-related hormones, but it is a false start and soon deactivates.
C) In precocious pseudopuberty, there is early pseudo menses not connected with ovulation, whereas in true precocious puberty menses is associated with ovulation.
D) In precocious pseudopuberty, there is breast or sexual hair growth but no activation of the hypothalamic-pituitary-gonadal axis.

Question 17

You are the nurse taking a health history on a young girl with symptoms of precocious puberty. You would most want to ask the girl and her family to do which of the following things?

A) to make a log of all the foods the girl eats during a week and to answer if alcohol is available in the household
B) to show you the beauty products used by the young girl and to determine if birth control pills are available in the household
C) to share with you what they know about birth control and the prevention of pregnancy
D) to share with you what they know about precocious puberty

Question 18

Which of the following should be included in the physical examination of a young boy who has symptoms and signs of precocious puberty?

A) examination of the testes and penis
B) electrocardiogram (EKG) and cardiac enzymes
C) a computed axial tomography (CAT) scan, magnetic resonance imaging (MRI) scan, or skull film
D) an examination for gynecomastia

Question 19

The nurse assessing a child with precocious puberty will do a careful measurement of upper and lower body ratio. This ratio is best described as a comparison of which of the following measurements?

A) the distance from the top of the head to the top of the pelvic bone and from the top of the pelvic bone to the bottom of the feet
B) the width of the chest at the widest point and the pelvis at the widest point
C) a comparison of the distance from the top of the head to the top of the synthesis pubis and from the synthesis pubis to the bottom of the feet
D) a diagonal measurement from the distal end of the collarbone to the opposite pelvic bone midpoint and from that pelvic bone to the bottom of the opposite foot

Question 20

A child who has been diagnosed with precocious puberty is treated with a gonadotropin-releasing Gn-RH) analog. The nurse will do some teaching with the family and will explain that the initial repose to this analog will be:

A) stimulation of gonadotropin release
B) suppression of gonadotropin release
C) no change in gonadotropin suppression or release
D) total shutdown of gonadotropin release

Question 21

When the nurse works with a child who is to receive the gonadotropin-releasing (Gn-RH) analog depot, the nurse most needs to prepare the family for:

A) the amount of pain and bruising associated with the injection
B) the average cost of $700-$1,000 per injection and the importance of checking insurance for any requirements relating to coverage
C) the reaction of extended family members, friends, and others and how this will affect the child's self-esteem and body image
D) the serious side effects of the Gn-RH analog depot

Question 22

After a child begins treatment for precocious puberty, the child's growth will be monitored every 3 to 4 months. The areas monitored and evaluated will most likely include serum hormone levels and which one of the following areas?

A) bone age
B) mammography
C) cardiac enzymes
D) blood sugar

Question 23

The nurse is working with the parents of a child who has precocious puberty and who has been socially isolating. Which of the following interventions would be most helpful to reduce this isolating behavior?

A) Explain to the child that he needs to interact with others and not isolate himself.
B) Set up a series of rewards and consequences for isolating from others.
C) Explore with caregivers how the child and significant people such as teachers approach the child and what expectations are placed on the child.
D) Prepare a calendar of prescheduled public outings, and take the child on these outings.

Question 24

In looking at the history of a child with a diagnosis of diabetes insipidus, the nurse will most often find that the condition occurs as a result of:

A) uncontrolled diabetes mellitus
B) a genetic defect in the synthesis of antidiuretic hormone (ADH)
C) infections affecting the spinal cord or brain, such as encephalitis or meningitis
D) head trauma or cranial surgery to remove tumors of the hypothalamic-pituitary region

Question 25

A caregiver has just learned that his child has diabetes insipidus and asks the nurse: "Just what is diabetes insipidus?" Which of the following is the nurse's best answer?

A) "This disease involves a shortage of a hormone called antidiuretic hormone (ADH) that normally concentrates urine, and a shortage results in excretion of large amounts of dilute urine."
B) "It is a form of diabetes mellitus, and although it shares some features, it is somewhat different from type 1 and type 2."
C) "It is the only type of diabetes that does not involve the pancreas and insulin deficiency."
D) "There is a malfunction of the thirst mechanism in the brain, and the child drinks copious amounts of water without ever being satisfied and is in danger of water intoxication."

Question 26

The nurse discovers on talking with the parents of a child that the child is waking at night to drink. Once when denied water, the child drank out of the toilet and another time the child drank from a puddle. The nurse most suspects and further assesses this child for:

A) type 1 diabetes mellitus
B) type 2 diabetes mellitus
C) diabetes insipidus
D) diabetic ketoacidosis

Question 27

The nurse assessing the newborn will most often note which of the following signs in a child with congenital hypothyroidism?

A) recessed jaw, delayed eruption of teeth, and difficulty swallowing at times
B) low-set ears, wide-set eyes, a particularly wide face, and occasionally polydactylism
C) exophthalmia, rapid pulse, elevated blood pressure, diarrhea, jitteriness, and difficulty sleeping at night
D) facial puffiness, swollen eyelids, enlarged tongue, low anterior hairline, flattened nasal bridge, and dull expression

Question 28

The majority of newborns with congenital hypothyroidism are identified in which of the following manners?

A) in the pediatrician's office during a physical exam by the pediatrician
B) mandatory newborn screening using blood obtained from the infants
C) in the nursery or obstetrical unit by a nurse observing the infant
D) the mother noticing something is wrong with the newborn baby

Question 29

The nurse working with the parents of a child with congenital hypothyroidism will encourage the parents to agree to treatment of the hypothyroidism as soon as possible for which of the following reasons?

A) A delay in treatment is associated with lower mean IQ.
B) The parents may change their mind if allowed to wait for the decision.
C) The problem is more difficult to correct as the child gets older.
D) The cost will be more the longer the parents wait to begin treatment.

Question 30

An infant has been diagnosed as having congenital hypothyroidism. L-thyroxine is ordered for the infant. The infant is being bottle-fed. Why will the nurse who is working with this child and family instruct the caregivers to avoid formulas that are soy-based and provide the family with a list of soy-based formulas?

A) L-thyroxine's absorption is affected by formulas that are soy based.
B) Children who are on L-thyroxine and soy-based formulas often have allergic reactions.
C) The L-thyroxine interferes with the absorption of calcium in the soy formula.
D) Infants on soy formula and L-thyroxine will tend to vomit the formula.

Question 31

At what age is acquired hypothyroidism generally recognized?

A) 6 months
B) 12 months
C) 18 months
D) 24 months

Question 32

Which of the following conditions most often causes primary acquired hypothyroidism?

A) childhood communicable diseases such as chickenpox or mumps
B) an unusual reaction to immunizations for childhood communicable diseases
C) autoimmune chronic lymphocytic thyroiditis called Hashimoto's thyroiditis
D) infections, particularly beta-hemolytic streptococcus infections

Question 33

Acquired primary hypothyroidism occurs more often in which of the following groups or with which of the following conditions?

A) males
B) other autoimmune-mediated diseases such as type 1 diabetes or chromosomal abnormalities
C) pituitary or hypothalamic dysfunction
D) American Indians

Question 34

In assessing a child with acquired hypothyroidism, the nurse will most often find which of the following signs or symptoms?

A) decreased rate of growth, weight gain, dry skin, coarse or thinning hair, and fatigue
B) headaches, dizziness, shakiness, disturbed vision, confusion, and frequent hunger
C) rapid respiratory rate, tachycardia, weakness, and unusual odor to breath
D) skin rash, loss of taste, mild leukopenia, and abnormal pigmentation of hair

Question 35

A student tells the school nurse that she is concerned about her delayed puberty and a delay in tooth eruption. The nurse will suspect and further assess for:

A) acquired hypothyroidism
B) hyperthyroidism
C) Addison's disease
D) Cushing's disease

Question 36

The nurse instructing caregivers about the administration of L-thyroxine will tell the caregivers to do which of the following?

A) Mix the medicine with a citrus juice before administration.
B) Give the medicine with the meal itself.
C) Give the medicine 30 to 60 minutes prior to a meal.
D) Give the medicine with only a few sips of water.

Question 37

Which of the following is the most common cause of hyperthyroidism in the pediatric population?

A) Grave's disease
B) cancer
C) infection
D) Addison's disease

Question 38

The nurse assessing a child with hyperthyroidism will most likely find which of the following symptoms?

A) constipation, bradycardia, slowed respirations, lack of energy, and complaint of tiredness
B) disorientation, confusion, extreme hunger, agitation, pallor, headaches, and blurred vision
C) weight loss despite excellent appetite, fine tremors, warm and moist skin, tachycardia, and ophthalmic changes
D) cardiac arrhythmias, low potassium and high sodium levels, and polyuria

Question 39

A teenaged girl has noticeable exophthalmia of the right eyeball and proptosis of the left eye. The nurse will suspect and further assess for:

A) hypothyroidism
B) congenital adrenal hyperplasia
C) growth hormone deficiency
D) hyperthyroidism

Question 40

Children in the toddler or preschool years who have congenital adrenal hyperplasia will have which of the following symptoms or signs?

A) depression, loss of energy, and bruising easily
B) enlarged adrenal glands, hypertension, profuse amounts of dilute urine, and edema of extremities
C) premature pubic hair development, accelerated growth velocity, acne, hirsutism, and advanced bone age
D) excretion of abnormally large amount of urine, and excessive thirst

Question 41

If not diagnosed at birth, a newborn with 21-hydroxylase (21-OH) deficiency and salt wasting will develop which of the following problems by days 10 to 14 of life?

A) seizures
B) coma
C) thyroid storm
D) adrenal crisis

Question 42

The recent dramatic increase in the incidence of type 2 diabetes has occurred mainly in which of the following groups? Select all that apply.

A) overweight children
B) culturally diverse populations
C) males over age 25
D) females over age 25