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."

Accepted Answer

This child's height is well below the 5th percentile for age,so he could have hypopituitarism leading to growth hormone deficiency.The nurse should acknowledge the fact and begin discussions about the condition gently and objectively.The other answers are not appropriate.

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

Accepted Answer

Growth hormone stimulation testing is often done with insulin or arginine.If the substance used does not stimulate an appropriate amount of growth hormone release,the diagnosis can be made.Measurements of cortisol are done to test adrenal gland function.Testosterone tests are done for sex hormone testing.The water deprivation test is done for diabetes insipidus.

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.

Accepted Answer

Proper oral hygiene and regular visits to the dentist are important because growth hormone treatments make the child's teeth softer and more prone to cavities.The other options do not address a specific issue related to this treatment.

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.

Accepted Answer

Infants are tested for DI with desmopressin (DDAVP)instead of a water deprivation test.After administering the medication,urine osmolality is tested at baseline and every 30 minutes for the next 2 hours.The nurse must collect the urine.An indwelling catheter is needed to obtain samples so frequently.A urine collection bag collects the urine but the infant may not void every 30 minutes.If no increase is seen in the osmolality,the infant may have hereditary nephrogenic DI,which can be confirmed by subsequent DNA testing.Because the child is not deprived of water,there is no need for an IV.

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

Accepted Answer

Although all endocrine glands have a role in homeostasis,the job of the hypothalamus is to communicate the messages of the central autonomic nervous system to the organs/glands of the endocrine system,thus maintaining homeostasis throughout the body.

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

Accepted Answer

Because of fluid retention,heart failure is a potential complication and would manifest with lung congestion.The nurse would hear rales or crackles in the child's lungs.The other assessment findings are expected in the child with SIADH.

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."

Accepted Answer

A depot injection is one in which the medication effect lasts a longer time,such as 2 or 3 months.Octreocide suppresses growth hormone.Depot injections can be either subcutaneous or intramuscular.Because the medication lasts for months,the child does not need weekly injections.

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."

Accepted Answer

Hyponatremia is most often caused by dilution.In this case,the excess fluid the child is retaining is the cause.DDVAP is used to treat diabetes insipidus,not SIADH.In SIADH,urine volume is low.Absorption of sodium is not the issue.

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

Accepted Answer

Hyperhidrosis is excessive sweating.The nurse might want to offer the child some extra washcloths or hand towels.The other items are not related.

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."

Accepted Answer

The cause of hypopituitarism is often unknown,but there are many possibilities.CNS tumor is the most common,accounting for 47%.Trauma accounts for about 3% of the cases of this condition.Infection is an uncommon cause (1%).

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

Accepted Answer

A Medic-Alert bracelet,medications,and a water bottle are all important for the child with DI to have with him or her.However,preventing dehydration takes priority,so the most important item is the water bottle or other ready access to water.

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."

Accepted Answer

Because the levels of thyroid hormone are low,the anterior pituitary gland keeps secreting more and more TSH to try to force the thyroid into producing its hormones.This also clues the provider that the problem is in the thyroid gland itself,not in the brain regulating system.The other answers are not accurate.

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."

Accepted Answer

Precocious puberty in a female is suspected when any secondary sex characteristics begin to develop before the age of 9 years.A child who is assessed at Tanner stage II has some breast development,pubic hair development,or both.

Question 14

The student nurse knows that which gland produces the hormone triiodothyronine?
A) Adrenal
B) Hypothalamus
C) Parathyroid
D) Thyroid

Accepted Answer

Triiodothyronine (T₃)is produced by the parathyroid gland.

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

Accepted Answer

Growth hormone is administered via subcutaneous injections.It is not given orally,intramuscularly,or by inhalation.

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

Accepted Answer

During a water deprivation test,the child's weight is not allowed to decrease by more than 2-5%.This child's weight has dropped by more than 5%,so the health-care provider must be notified immediately and the test stopped.Broth contains high levels of sodium,which is already high in the dehydrated child.The child's IV fluid rate may need to be increased,but not without the provider's order.Documenting the findings is important,but does not take priority over notifying the provider.

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

Accepted Answer

The anterior pituitary gland releases ACTH in response to the hypothalamus.

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?"

Accepted Answer

Although those manifestations do sound like GHD,they could also be indicative of hypothyroidism.The nurse asks if the child's thyroid function has ever been checked.The nurse cannot refer to an endocrinologist without a provider order.Asking about the dentist's opinion may be important,but it is not as specific for the problem as asking about thyroid function testing.

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

Accepted Answer

One of the side effects of human growth hormone administration is hypertension.The nurse should assess the child's blood pressure.Bowel function,respiratory effort,and urine osmolality are not affected.

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

Accepted Answer

This child has manifestations of dehydration,and with the frequent soaked diapers,may have diabetes insipidus.Assessments of circulation take priority.The nurse assesses the other factors,but they can wait until more important assessments have been completed.

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

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

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

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

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

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

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?

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

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

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 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?

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?

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

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 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?

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

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 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 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?