Deck 51: The Child With an Endocrine or Metabolic Alteration

Question 1

A common clinical manifestation of juvenile hypothyroidism is

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

Answer 1

Dry skin

Question 2

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 2

Two hours after administration

Question 3

A child with GH 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

Answer 3

At bedtime

Question 4

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 5

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 6

Which sign,when exhibited by a hospitalized child,should the nurse recognize as a characteristic of diabetes insipidus?

A) Weight gain
B) Increased urine specific gravity
C) Increased urination
D) Serum sodium level of 130 mEq/L

Question 7

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 8

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 her watch can remind her to take the medication as ordered.
B) She can take the medication when she is nervous and feels she needs it.
C) She can take two pills before school and one pill at dinner, which will be easier for her to remember.
D) Her mother can be responsible for reminding her when it is time to take her medication.

Question 9

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 10

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 11

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

A) Vitamin D
B) Cortisone
C) Stool softeners
D) Calcium carbonate

Question 12

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

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

Question 13

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 14

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 15

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

Question 16

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

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

Question 17

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 18

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 of having the child foster relationships with same-age peers.
C) Assure the child's parents that there is no increased risk for sexual abuse because of her appearance.
D) Counsel parents that there is no treatment currently available for this disorder.

Question 19

A goiter is an enlargement or hypertrophy of which gland?

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

Question 20

Diabetes insipidus is a disorder of the

A) Anterior pituitary
B) Posterior pituitary
C) Adrenal cortex
D) Adrenal medulla

Question 21

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 22

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."

Question 23

Which nursing intervention is 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 D51/2NS.
D) Weigh on arrival to the unit and then every other day.
E) Maintain strict intake and output monitoring.

Question 24

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 25

Type 1 diabetes,the most common childhood endocrine disease,presents challenges to the nurse in the areas of teaching,management,and adherence.Due to recent changes in health care delivery systems,meeting the needs of a type 1 diabetic child has become even more complicated.Unless the newly diagnosed child is in diabetic ketoacidosis,the child may not be hospitalized.Is this statement true or false?

Question 26

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 27

Which children admitted to the pediatric unit would the nurse monitor closely for development of SIADH? Select all who 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

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 29

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 30

The rise in the incidence of both overweight and obese children is directly related to the increase in the number of children diagnosed with _______________.

Question 31

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.