Deck 27: Caring for the Child With an Endocrinological or Metabolic Condition

Question 1

A parent with his 7-year-old son at the pediatric clinic expresses concern that the child is too short.The nurse measures the child and finds him to be 100 cm (39.3 inches)tall.Which statement by the nurse is most appropriate?

A) "Children are often 'too short' until they reach puberty."
B) "He's shorter than average, but it's not significant."
C) "Let's discuss some options for promoting growth."
D) "Your child is of average height for a 7-year-old."

Answer 1

"Let's discuss some options for promoting growth."

Question 2

A pediatric dentist refers a child to an endocrinologist because of a concern about the child having so few teeth.Which laboratory testing does the nurse anticipate ordering for the child?

A) 24-hour urinalysis for cortisol
B) Growth hormone stimulation test
C) Serum testosterone
D) Water deprivation test

Answer 2

Growth hormone stimulation test

Question 3

A child is started on recombinant growth hormone.Which teaching point does the nurse provide the parents and child?

A) Drink adequate fluids during the day.
B) Encourage increased activity.
C) Ensure proper oral hygiene.
D) Weigh daily on the same scale.

Answer 3

Ensure proper oral hygiene.

Question 4

An infant is suspected of having diabetes insipidus (DI)and is having diagnostic testing.Which action by the nurse is most important?

A) Apply a urine collection bag.
B) Facilitate DNA testing.
C) Insert an indwelling urinary catheter.
D) Start two large-bore IVs.

Question 5

The student studying endocrine disorders learns that which gland controls overall physiologic homeostasis?

A) Anterior pituitary
B) Hypothalamus
C) Parathyroid
D) Posterior pituitary

Question 6

A child is hospitalized with syndrome of inappropriate antidiuretic hormone (SIADH).Which assessment finding indicates a possible complication?

A) Crackles in lung bases
B) Decreased urine output
C) Low serum sodium level
D) Nausea and vomiting

Question 7

A nurse is preparing to administer an octreocide depot injection.Which information about this procedure does the nurse provide the parent?

A) "Octreocide stimulates growth hormone."
B) "The medication goes deep into a muscle."
C) "This shot lasts longer than a regular shot."
D) "Your child will need these shots weekly."

Question 8

A child is hospitalized with syndrome of inappropriate antidiuretic hormone (SIADH).The parent asks why the child's sodium level is so low.Which response by the nurse is the most appropriate?

A) "It's a side effect of oral desmopressin (DDAVP)."
B) "Sodium is being excreted in the large volume of urine."
C) "The water your child retains is diluting the sodium."
D) "Your child is not absorbing sodium in the intestines."

Question 9

The clinic nurse reads in a child's chart that the parent reports hyperhidrosis.Which item should the nurse take into the examination room?

A) Disposable stethoscope
B) Extra hand towels
C) Incontinence pads
D) Large blood pressure cuff

Question 10

The parent of a child with hypopituitarism asks why this condition occurs.Which response by the nurse is the most appropriate?

A) "Infection in the brain is the most common cause."
B) "It's usually a brain tumor near the pituitary gland."
C) "There are many possible causes, and often we don't know."
D) "Usually this is due to damage to the brain from trauma."

Question 11

A child has been diagnosed with diabetes insipidus (DI).The nurse is teaching the parents and child about self-care measures.Which item does the nurse explain is the priority for the child to have at all times?

A) Epinephrine injector
B) Medic-Alert bracelet
C) Medications
D) Water bottle

Question 12

A nursing student asks why the child with hypothyroidism would have high levels of thyroid-stimulating hormone (TSH).Which response by the faculty is the most appropriate?

A) "Stimulating-hormone functions are not disrupted by thyroid disorders."
B) "The pituitary gland keeps secreting TSH to try to make the thyroid function."
C) "TSH exists in an inverse relationship with the other thyroid hormones."
D) "Thyroid hormone function is very poorly understood and the reason is not clear."

Question 13

The nurse in an endocrine clinic is assessing an 8-year-old girl who has not yet started menstruating and is Tanner stage II.Which statement by the nurse to the parent is most appropriate?

A) "Bring her back when she starts menstruating."
B) "She may have a deficiency of luteinizing hormone."
C) "Your child's development is appropriate for her age."
D) "We will test her for levels of the female hormones."

Question 14

The student nurse knows that which gland produces the hormone triiodothyronine?

A) Adrenal
B) Hypothalamus
C) Parathyroid
D) Thyroid

Question 15

A nurse is teaching the parents of a child with growth hormone deficiency about medication administration.Which action charted by the nurse indicates that the goals for teaching have been met?

A) Administers growth hormone using correct intramuscular technique
B) Administers growth hormone using correct subcutaneous technique
C) Demonstrates ability to properly mix growth hormone with liquids
D) Rinses inhaler with warm water after each dose is administered

Question 16

A nurse is caring for a 45-kg (99-lb)child undergoing a water deprivation test.At a routine assessment during the test,the nurse notes the child's weight at 42 kg.Which action by the nurse takes priority?

A) Allows the child to have clear liquids, like broth
B) Documents the findings and continues to monitor
C) Increases the rate of the IV fluid infusion by 5%
D) Notifies the health-care provider immediately

Question 17

Which organ or gland is directed by the hypothalamus to release adrenocorticotropic hormone (ACTH)?

A) Anterior pituitary gland
B) Liver
C) Pancreas
D) Thyroid gland

Question 18

A parent reports that his 7-year-old child is very short compared to his peers,and his teeth came in slowly when he was younger.After searching the Internet the parent is worried about growth hormone deficiency (GHD).Which response by the nurse is the most appropriate?

A) "GHD is the only cause of the symptoms you describe."
B) "Has your child ever had his thyroid evaluated?"
C) "I will refer your child to an endocrinologist right away."
D) "What did the dentist say about his teeth being delayed?"

Question 19

A child is in the clinic for follow-up after starting recombinant growth hormone for growth hormone deficiency.After obtaining the child's height,which assessment is the priority?

A) Blood pressure
B) Bowel function
C) Respiratory effort
D) Urinary osmolality

Question 20

A mother brings her baby to the emergency department stating that the baby no longer makes tears when crying but is having multiple soaked diapers per day.Which assessment by the nurse takes priority?

A) Last bowel movement
B) Palpation of fontanels
C) Prenatal history
D) Time of last meal

Question 21

A hospitalized child is receiving calcium via a peripheral IV site.Which action by the nurse is most important?

A) Assess the IV for blood return hourly.
B) Document the infusion and child's response.
C) Facilitate the next blood draw for calcium.
D) Teach parents and child about the drug.

Question 22

A teenager has Crohn's disease and presents to the emergency department with a 3-day history of decreased appetite,lethargy,and fatigue.Today the parent reports the child is confused and "looks blue." The nurse finds the child hypotensive.Which assessment question is most helpful?

A) "Could your child be using illicit recreational drugs?"
B) "Has your child been taking steroids for Crohn's disease?"
C) "Have you taken her temperature today or yesterday?"
D) "Is anyone else in your family sick now or recently?"

Question 23

A child has been admitted with suspected pheochromocytoma.What action by the nurse takes priority?

A) Auscultate lung sounds every 4 hours during fluid therapy.
B) Facilitate stat laboratory draws when the child has episodic symptoms.
C) Perform a complete abdominal assessment including palpation.
D) Withhold water for 8 hours and collect hourly urine samples.

Question 24

A child is born with pseudohermaphroditism.After determining that the baby is a girl through genetic testing,the parents ask about her potential fertility.Which response by the nurse is the most appropriate?

A) "It is impossible to determine that until she reaches puberty."
B) "She is fertile but her uterus is abnormal so she can't carry a baby."
C) "Because her internal female organs are normal, she probably is fertile."
D) "Unfortunately, all babies born with this condition are infertile."

Question 25

A parent calls the clinic nurse to report that his child,who takes methimazole (MTZ),is running a high fever,seems agitated,and is nauseated.Which response by the nurse is the most appropriate?

A) "Bring your child to the clinic this afternoon for a checkup."
B) "Double the methimazole dose for 2 days or until the fever is gone."
C) "Give your child acetaminophen (Tylenol) every 4 hours for the fever."
D) "Take your child to the nearest emergency department right away."

Question 26

A hospitalized child has been diagnosed with hyperthyroidism and has a calcium level of 6.8 mg/dL.Which action by the nurse takes priority?

A) Administer calcium.
B) Apply telemetry.
C) Pad the side rails.
D) Start an IV.

Question 27

An adolescent has Cushing's syndrome due to long-term use of steroid therapy for another illness.When writing this child's care plan,which nursing diagnosis takes priority?

A) Activity intolerance
B) Altered body image
C) Fluid volume deficit
D) Impaired skin integrity

Question 28

A hospitalized diabetic child is sweating,nauseated,and has a headache.What action by the nurse takes priority?

A) Administer sliding-scale insulin.
B) Call laboratory for a stat blood sugar.
C) Give the child some orange juice.
D) Perform a urine ketone test.

Question 29

The nurse is helping a new diabetic child pick breakfast from the menu.Which selection would require the nurse to reinforce dietary teaching for this child?

A) Egg, bacon, whole-wheat toast
B) Cinnamon roll and juice
C) Oatmeal, almonds, artificial sweetener
D) Pancakes with sugar-free maple syrup

Question 30

The nurse gave a diabetic child an injection of Humalog insulin at 0700.At what time would it be most important to check on the child?

A) 0715
B) 0800
C) 0930
D) 1200

Question 31

A child is brought to the emergency department with severe flank pain,hematuria,and vomiting.When assessing the child's laboratory findings,which value does the nurse correlate with this condition?

A) Calcium, 6.8 mg/dL
B) Calcium, 10.2 mg/dL
C) Potassium, 3.6 mEq/L
D) Potassium, 5.2 mEq/L

Question 32

A child diagnosed with hyperaldosteronism needs a diuretic.Which diuretic does the nurse anticipate administering?

A) Bumetanide (Bumex)
B) Furosemide (Lasix)
C) Hydrocholorthiazide (Hydrodiuril)
D) Spironolactone (Aldactone)

Question 33

A nurse on an inpatient endocrine unit has received report on a group of four patients.Which patient should the nurse see first?

A) Blood glucose of 78 mg/dL, 12-year-old child
B) Had Humalog injection and is not eating
C) Needs teaching on giving insulin injections
D) NPH insulin given, waiting an hour to eat

Question 34

A child is diagnosed with congenital adrenal hyperplasia.The child's parents ask the nurse what this means.Which response by the nurse is the most appropriate?

A) "Your child is not producing ACTH."
B) "Your child is not producing androgens."
C) "Your child is not producing cortisol."
D) "Your child is not producing corticosteroid-releasing hormone."

Question 35

A child being treated for hyperthyroidism has been admitted following a seizure.Once the child has been stabilized,which action by the nurse is the most appropriate?

A) Assess the child for noncompliance.
B) Determine child's nutritional intake.
C) Refer the family to a social worker.
D) Teach the parents how to treat seizures.

Question 36

A child has hyperthyroidism and is prescribed propranlol (Inderal).The mother states "Why is she taking this? I take Inderal for my blood pressure." Which response by the nurse is the most appropriate?

A) Decreases the effects of the hyperthyroidism
B) Keeps the child's blood pressure normal
C) Prevents the development of thyroid storm
D) Because thyroid problems often cause hypertension

Question 37

Which does the nurse include on the teaching plan for the parents of a child with Addison's disease?

A) How to administer steroids subcutaneously
B) How to eliminate all stress from the child's life
C) How to give hydrocortisone (A-Hydrocort) IM
D) How to keep the child hydrated when ill

Question 38

A 5-year-old child is 3 hours postoperative after a total thyroidectomy.The nurse notes hand spasms as the blood pressure cuff is inflated,and the child reports numbness around her lips.After notifying the health-care provider,which action by the nurse takes priority?

A) Bring the crash cart to the room.
B) Call the laboratory to have blood work drawn.
C) Prepare to administer oral vitamin
D) Raise the head of the child's bed.

Question 39

A child is 4 hours postoperative after a total parathyroidectomy.Which assessment takes priority?

A) Airway
B) Dressing
C) IV site
D) Pain

Question 40

A patient has a serum sodium level of 119 mEq/L,a blood glucose level of 52 mg/dL,and a cortisol level of 1.1 mg/dL.What does the nurse add to this patient's plan of care?

A) Demonstrate proper technique to check blood glucose.
B) Encourage the child to take salt tablets with each meal.
C) Teach parents and child about desmopressin acetate (DDVAP).
D) Teach parents and child about solumedrol (Solu-Cortef).

Question 41

A nurse is teaching a new diabetic child and family about sick-day management.What information does the nurse plan to include?

A) Check blood sugars every 4 hours.
B) Hold insulin if the child is vomiting.
C) Provide plenty of rest and sleep.
D) Offer calorie-containing liquids.
E) Try to follow the usual meal plan.

Question 42

The nursing faculty member explains the functions of the anterior pituitary as regulating which processes?

A) Cognition
B) Digestion
C) Growth
D) Metabolic activity
E) Sexual development

Question 43

A 55-lb (25-kg)child in the hospital has syndrome of inappropriate antidiuretic hormone (SIADH).The nurse calculates the child's 24-hour fluid allowance at what volume? ____________________

Question 44

Which information does the nurse provide the teen with type 2 diabetes mellitus regarding exercise?

A) Aim for physical activity each day.
B) Continue to exercise when sick.
C) Exercise with caution, if at all.
D) You need strenuous activity.

Question 45

The nurse is teaching parents of an infant diagnosed with hypothyroidism.Which items are appropriate to include in the teaching plan?

A) Dissolving the levothyroxine (Synthroid) completely in formula
B) Frequent monitoring of the child's height and weight
C) Keeping a log or diary of developmental milestones the child meets
D) Monitoring the child for behavioral changes as he or she grows
E) The need for frequent laboratory testing during the child's life

Question 46

The nurse is explaining to a nursing student that which of the following affect the feedback mechanisms active in the endocrine system?

A) Activity
B) Nutrition
C) Sleep
D) Stress
E) Temperature

Question 47

A child has been diagnosed with diabetic ketoacidosis (DKA)and is in the pediatric intensive care unit.Which nursing diagnosis does the nurse direct interventions toward as the priority?

A) Fluid volume deficit
B) Ineffective breathing patterns
C) Knowledge deficit
D) Risk for infection

Question 48

Which long-term goal is most appropriate for the adolescent diabetic patient?

A) Appropriate food items chosen for meals
B) Glucose within target range 90% of the time
C) No evidence of long-term complications
D) Takes medications correctly and on time

Question 49

The nursing student knows that which glands control antidiuretic hormone (ADH)?

A) Adrenal cortex
B) Anterior pituitary
C) Hypothalamus
D) Pineal body
E) Posterior pituitary

Question 50

The student nurse caring for a child with type 1 diabetes mellitus learns which classic signs?

A) Polydactyly
B) Polydipsia
C) Polyneuritis
D) Polyphagia
E) Polyuria

Question 51

A teenager is admitted with Addison's disease.Which laboratory findings does the nurse correlate with this condition?

A) Blood glucose: 54 mg/dL
B) Potassium: 6.5 mEq/L
C) Sodium: 3.9 mEq/L
D) Urine culture: negative
E) White blood cell count: 5500/mm3

Question 52

A student nurse is caring for a child with gigantism.Which hormones does the faculty member explain are important in this condition?

A) Androgens
B) Corticosteroids
C) Growth hormone
D) Insulin-like growth factor
E) Somatostatin

Question 53

A nurse is caring for four teenagers with diabetic ketoacidosis.Which patient should the nurse see first?

A) pH: 7.22
B) Potassium: 7.2 mEq/L
C) Sodium: 128 mEq/L
D) White blood cell count: 17,250 mm3

Question 54

An adolescent with type 1 diabetes mellitus is hospitalized for the third time in 1 year with an infection.Which laboratory value would provide the nurse the most important information?

A) Albumen: 4 g/dL
B) Fasting blood sugar: 99 mg/dL
C) Hemoglobin A1C: 9.8%
D) White blood count: 15,000/mm3

Question 55

The nurse caring for children with endocrine problems recognizes which classic signs of Addison's disease?

A) Bounding, rapid pulse
B) Hyperpigmentation
C) Ketonemia
D) Low sodium levels
E) Warm intolerance

Question 56

A child is taking methimazole (MTZ).What does the nurse teach parents to report immediately?

A) Brittle hair
B) Dry skin
C) Headache
D) Jaundice
E) Pink or red urine