Question 1

A child weighing 18.2 kg with a history of diabetes insipidus has been admitted to the hospital. Which of the physician's orders would the nurse question?
A)Stat electrolytes
B)Urine specific gravity with each void
C)DDAVP (desmopressin) PO
D)Restrict oral fluids to 500 mL every 24 hours.

Accepted Answer

Restricting oral fluids to 500 mL every 24 hours would be inappropriate for a child with diabetes insipidus as this condition causes excessive thirst and urination. The child would require adequate fluids to prevent dehydration.

Question 2

The child was diagnosed with phenylketonuria shortly after birth and has been treated by the endocrine clinic for the last four years. The mother has missed the last three appointments. When the child keeps the next appointment, the mother assures the nurse that the child has followed the dietary restrictions. Which finding would make the nurse question this statement?
A)The child's body has a musty odor.
B)This child is a blue-eyed blond.
C)The child appears sleepy and uninterested in the surroundings.
D)The child has a sunburn over his entire body.

Accepted Answer

A musty odor is a classic symptom of untreated phenylketonuria, indicating that the child has not been following dietary restrictions. The other options are not directly related to the child's condition.

Question 3

The nurse is giving discharge instructions to the parents of a child whose adrenal glands have been removed due to a tumor. The nurse knows that the mother needs more instructions when the mother states:
A)"I will call the doctor if my child has restlessness and confusion."
B)"If my child has any gastric irritation, I will give him antacids."
C)"If my child has vomiting and diarrhea, I will hold his hydrocortisone."
D)"I will give my child his hydrocortisone in the morning."

Accepted Answer

The adrenal glands produce cortisol, a hormone that is essential for regulating metabolism, immune response, and stress response. After adrenal gland removal, a child would need lifelong replacement of cortisol, typically in the form of hydrocortisone. Holding hydrocortisone during times of vomiting and diarrhea is incorrect because these conditions increase the body's need for cortisol due to stress, and not providing it could lead to an adrenal crisis, which is a life-threatening condition.

Question 4

An adolescent female with untreated Graves' disease is admitted to the hospital. The nurse expects to find which signs and symptoms in this client?
A)Hyperglycemia, ketonuria, and glucosuria
B)Weight gain, hirsutism, and muscle weakness
C)Tachycardia, fatigue, and heat intolerance
D)Dehydration, metabolic acidosis, and hypertension

Accepted Answer

Graves' disease is a type of hyperthyroidism where the thyroid gland produces an excess of thyroid hormones. Common signs and symptoms include tachycardia (rapid heart rate), fatigue, and heat intolerance. Hyperglycemia, ketonuria, and glucosuria may be seen in diabetes mellitus. Weight gain, hirsutism, and muscle weakness are associated with Cushing's syndrome. Dehydration, metabolic acidosis, and hypertension are not typical signs and symptoms of Graves' disease.

Question 5

A hospitalized child has been diagnosed with SIADH (syndrome of inappropriate antidiuretic hormone), a complication of his meningitis. What would the nurse expect to see on this child's lab results?
A)Hyponatremia
B)Hypocalcemia
C)Hyperglycemia
D)Hypernatremia

Accepted Answer

SIADH causes the body to retain water, leading to decreased sodium levels (hyponatremia).

Question 6

The nurse is providing information to a teenager newly diagnosed with diabetes and his parents. The nurse teaches them that the signs of diabetic ketoacidosis (DKA) include:
A)Change in mental status.
B)Tachycardia.
C)Fruity breath odor.
D)Rapid, shallow respirations.
E)Abdominal pain.

Accepted Answer

Diabetic ketoacidosis (DKA) is characterized by a change in mental status, fruity breath odor due to acetone, and abdominal pain. Rapid, shallow respirations are not typical; instead, Kussmaul respirations, which are deep and labored, are observed. Tachycardia can occur but is not a primary sign of DKA.

Question 7

A 12-year-old has been selected to be a cheerleader for her middle school. This child has been recently diagnosed with type 1 diabetes. In teaching this child's mother about care for her child, the nurse wants the mother to understand that with increased physical activity, the child will need:
A)Decreased food intake.
B)Increased doses of insulin.
C)Increased food intake.
D)Decreased doses of insulin.

Accepted Answer

With increased physical activity, the child's body will require more glucose for energy, which can lead to hypoglycemia if not properly managed. Therefore, the child will need to increase her food intake to ensure that her blood sugar levels remain stable. This does not necessarily mean that the child will need increased doses of insulin. The insulin regimen should be individualized based on the child's blood sugar levels and carbohydrate intake.

Question 8

When the newborn female is born with ambiguous genitalia, the follow-up investigation discovers adrenogenital syndrome (also called congenital adrenal hyperplasia). The parents question why the baby's genitalia looks more male than female. The nurse would explain that:
A)The disorder caused the infant to be a hermaphrodite with both male and female sex organs.
B)The changes in the genitalia are due to increased androgens secondary to deficient cortisol.
C)The excessive cortisol caused the enlargement of the female tissue, creating a male appearance.
D)The child has only one sex chromosome resulting in an XO configuration.

Accepted Answer

Adrenogenital syndrome (also called congenital adrenal hyperplasia) is a genetic disorder that affects the adrenal glands, resulting in increased production of androgens (male hormones). In affected newborn females, the excess androgens can cause ambiguous genitalia or even masculine appearing genitalia. This occurs because the female tissue is unable to develop normally in the presence of excess androgens. The infant does not have both male and female sex organs (hermaphroditism) nor is there an issue with the number of sex chromosomes.

Question 9

The home health nurse is visiting a three-month-old who has been diagnosed with congenital hypothyroidism and is taking daily thyroxine. The baby is on soy formula and is at the 50^th percentile for height and weight. It is important that the mother understands that: A)Parents may stop the thyroxine as long as the baby remains in the 50^th percentile for height and weight. B)Soy-based formula can interfere with the absorption of thyroxine. C)Dairy-based formula is contraindicated when an infant is taking thyroxine. D)As long as the baby is growing along the same growth curve, no interventions are necessary.

Accepted Answer

Soy-based formula can interfere with the absorption of thyroxine. It is important for the mother to understand this so that she can discuss with the healthcare provider about a possible change in formula or adjusting the dose of thyroxine. It is also important to continue monitoring the baby's growth and development and follow-up regularly with the healthcare provider. Stopping thyroxine without medical supervision can have serious consequences on the baby's health.

Question 10

The nurse is caring for a hospitalized three-year-old admitted with a history of syndrome of inappropriate antidiuretic hormone (SIADH). He has just received his breakfast tray. Which food should the nurse remove from his tray?
A)Oatmeal
B)Yogurt
C)Biscuit
D)Cantaloupe

Accepted Answer

Cantaloupe should be removed because it has a high water content. In SIADH, there is an excessive release of antidiuretic hormone leading to water retention and hyponatremia. Foods high in water content can exacerbate these conditions.

Question 11

The nurse is teaching a teenage client newly diagnosed with type 1diabetes about complications of the disease. The nurse explains that clients with type 1 diabetes can avoid lipoatrophy by:
A)Rotating injection sites.
B)Checking blood sugars at mealtime and bedtime.
C)Using a sliding scale for additional coverage.
D)Administration of insulin via insulin pump.

Accepted Answer

Lipoatrophy is a condition where fat tissue under the skin shrinks or is lost, resulting in visible dents or depressions. This can occur at injection sites if the same site is used repeatedly. Rotating injection sites can help to prevent lipoatrophy. Checking blood sugars, using a sliding scale, and administering insulin via insulin pump are all important in managing diabetes, but do not specifically prevent lipoatrophy.

Question 12

A five-year-old with a history of being treated for hypopituitarism comes to the physician with complaints of right hip and leg pain. The nurse understands that this symptom might be related to which medication that is used to treat hypopituitarism?
A)Daily growth hormone
B)Insulin before meals and bedtime
C)DDAVP (desmopressin acetate) at HS
D)Cortisone injections

Accepted Answer

Growth hormone therapy can increase the risk of hip and leg pain in children because it can cause a condition called avascular necrosis, which is the death of bone tissue due to a lack of blood supply. This can lead to pain and stiffness in the surrounding joints, particularly the hip. Insulin, DDAVP, and cortisone injections are not typically associated with hip and leg pain.

Question 13

The nurse is teaching the caregiver of a child who is newly diagnosed with type 1 diabetes mellitus how to minimize pain with insulin injections. Which interventions to minimize pain will the nurse include in the teaching?
A)Do not reuse needles.
B)Remove all bubbles from the syringe before injecting.
C)Have the child flex the muscle during injection.
D)Inject insulin when it is cold.
E)Do not change the direction of the needle during insertion or withdrawal.

Accepted Answer

Reusing needles can cause blunting, increasing pain with injection. Bubbles in the syringe can cause discomfort and irritation at the injection site. Changing the direction of the needle during insertion or withdrawal can also cause pain and bruising at the injection site. Injecting insulin when it is cold can cause pain and irritation as well. Having the child flex the muscle during injection is not a recommended intervention to minimize pain with insulin injections.

Question 14

Mandatory testing in the newborn nursery determines that the infant has hypothyroidism. When discussing the treatment with the new mother, the mother states that she doesn't believe in taking medications. The nurse would explain that failure to treat the infant with the appropriate medication will result in:
A)Heart disease.
B)Mental retardation.
C)Renal failure.
D)Thyroid storm.

Accepted Answer

Untreated congenital hypothyroidism can lead to mental retardation and developmental delays. It is important for the newborn to receive the appropriate medication to prevent these potential long-term effects.

Question 15

A teenager has arrived in the emergency department (ED) with confusion. The physician suspects diabetic ketoacidosis (DKA). A stat serum glucose is done, and the result is 76l5 mg/dL. The nurse expects that this teen has which symptoms?
A)Tachycardia, dehydration, and abdominal pain
B)Sweating, photophobia, and tremors
C)Dry mucous membranes, blurred vision, and weakness
D)Dry skin, shallow rapid breathing, and dehydration

Accepted Answer

The answer of A teenager has arrived in the emergency...

Question 16

During the hospital stay in the newborn nursery, the infant is tested for galactosemia. When the test is positive, the parents are educated about treatment for galactosemia. The infant will be placed on what type of infant feeding?
A)Goat's milk formula
B)Breast milk
C)Cow's milk-based formula
D)Meat-based formula such as Nutramigen

Accepted Answer

Infants with galactosemia cannot metabolize galactose, which is present in breast milk and cow's milk-based formulas. Nutramigen is a hypoallergenic formula that does not contain lactose or galactose, making it suitable for infants with galactosemia.

Question 17

A three-year-old child was born with congenital adrenal insufficiency and is being treated with oral hydrocortisone. When the child develops pneumonia and is admitted to the hospital, the nurse would expect the dose of hydrocortisone to be:
A)Stopped.
B)Reduced by 50%.
C)Continued as previously prescribed.
D)Increased.

Accepted Answer

During times of stress, such as illness or surgery, patients with adrenal insufficiency require an increased dose of glucocorticoids (such as hydrocortisone) to prevent an adrenal crisis. Therefore, the dose of hydrocortisone should be increased in this scenario to prevent further complications.

Question 18

Based on physical findings, including a webbed neck and low hairline, the newborn female infant is suspected of having Turner's syndrome. The baby is in the newborn nursery while preparations are made for further evaluation including karyotyping. The nurse will want to monitor this baby for common associated conditions including:
A)Club foot (talipes equinovarus).
B)Congenital heart anomalies.
C)Hyperbilirubinemia due to liver abnormalities.
D)Diaphragmatic hernia.

Accepted Answer

Congenital heart anomalies are a common associated condition with Turner's syndrome. Club foot, hyperbilirubinemia due to liver abnormalities, and diaphragmatic hernia are not typically associated with Turner's syndrome.

Question 19

The nurse is caring for a child just admitted with diabetic ketoacidosis (DKA). Which of the physician's orders should the nurse question?
A)Neurological checks hourly
B)Insert urinary catheter and measure output hourly.
C)NPH insulin IV at 0.1 units/kg per hour
D)Stat serum electrolytes

Accepted Answer

NPH insulin is not typically given intravenously and can cause hypoglycemia if given by this route. The nurse should question this order and clarify with the physician the appropriate route and dose of insulin for the child with DKA.

Question 20

The school nurse has noticed an increase in the number of children in the school being diagnosed with type 2 diabetes. Which changes could the nurse implement at school to help reduce students' risk for developing type 2 diabetes?
A)Increase the amount of daily physical activity.
B)Meet with all parents and explain the risk that is associated with obesity.
C)Test each child's urine monthly.
D)Teach the parents to avoid administering aspirin to their children.
E)Work with the cafeteria to decrease the amount of fat in the foods served.

Accepted Answer

The answer of The school nurse has noticed an increase...

Quiz 54: The Child With Alterations in Endocrine Function

A child weighing 18.2 kg with a history of diabetes insipidus has been admitted to the hospital. Which of the physician's orders would the nurse question?

The nurse is giving discharge instructions to the parents of a child whose adrenal glands have been removed due to a tumor. The nurse knows that the mother needs more instructions when the mother states:

An adolescent female with untreated Graves' disease is admitted to the hospital. The nurse expects to find which signs and symptoms in this client?

A hospitalized child has been diagnosed with SIADH (syndrome of inappropriate antidiuretic hormone) , a complication of his meningitis. What would the nurse expect to see on this child's lab results?

The nurse is providing information to a teenager newly diagnosed with diabetes and his parents. The nurse teaches them that the signs of diabetic ketoacidosis (DKA) include:

A 12-year-old has been selected to be a cheerleader for her middle school. This child has been recently diagnosed with type 1 diabetes. In teaching this child's mother about care for her child, the nurse wants the mother to understand that with increased physical activity, the child will need:

When the newborn female is born with ambiguous genitalia, the follow-up investigation discovers adrenogenital syndrome (also called congenital adrenal hyperplasia) . The parents question why the baby's genitalia looks more male than female. The nurse would explain that:

The home health nurse is visiting a three-month-old who has been diagnosed with congenital hypothyroidism and is taking daily thyroxine. The baby is on soy formula and is at the 50^th percentile for height and weight. It is important that the mother understands that:

The nurse is caring for a hospitalized three-year-old admitted with a history of syndrome of inappropriate antidiuretic hormone (SIADH) . He has just received his breakfast tray. Which food should the nurse remove from his tray?

The nurse is teaching a teenage client newly diagnosed with type 1diabetes about complications of the disease. The nurse explains that clients with type 1 diabetes can avoid lipoatrophy by:

A five-year-old with a history of being treated for hypopituitarism comes to the physician with complaints of right hip and leg pain. The nurse understands that this symptom might be related to which medication that is used to treat hypopituitarism?

The nurse is teaching the caregiver of a child who is newly diagnosed with type 1 diabetes mellitus how to minimize pain with insulin injections. Which interventions to minimize pain will the nurse include in the teaching?

A teenager has arrived in the emergency department (ED) with confusion. The physician suspects diabetic ketoacidosis (DKA) . A stat serum glucose is done, and the result is 76l5 mg/dL. The nurse expects that this teen has which symptoms?

During the hospital stay in the newborn nursery, the infant is tested for galactosemia. When the test is positive, the parents are educated about treatment for galactosemia. The infant will be placed on what type of infant feeding?

A three-year-old child was born with congenital adrenal insufficiency and is being treated with oral hydrocortisone. When the child develops pneumonia and is admitted to the hospital, the nurse would expect the dose of hydrocortisone to be:

The nurse is caring for a child just admitted with diabetic ketoacidosis (DKA) . Which of the physician's orders should the nurse question?

The school nurse has noticed an increase in the number of children in the school being diagnosed with type 2 diabetes. Which changes could the nurse implement at school to help reduce students' risk for developing type 2 diabetes?