Question 1

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:

Accepted Answer

Gn-RH analog depot injections can be quite expensive, often ranging from $700-$1,000 per injection. It is crucial for families to be aware of these costs and to check with their insurance provider regarding coverage to avoid unexpected financial burdens.

Question 2

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?

Accepted Answer

Bone age is monitored in cases of precocious puberty to assess the impact of treatment on growth and skeletal maturation, as precocious puberty can accelerate bone age advancement, potentially leading to early cessation of growth.

Question 3

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?

Accepted Answer

Exploring with caregivers how the child and significant people in the child's life approach and interact with the child, as well as understanding the expectations placed on the child, can help identify and address the underlying issues contributing to the child's social isolation. This approach fosters a supportive environment that acknowledges the child's feelings and experiences, which is crucial for children dealing with the challenges of precocious puberty.

Question 4

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:

Accepted Answer

Diabetes insipidus often results from head trauma or cranial surgery affecting the hypothalamic-pituitary region, which disrupts the production or release of antidiuretic hormone (ADH).

Question 5

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?

Accepted Answer

Diabetes insipidus is characterized by a deficiency of antidiuretic hormone (ADH), which leads to the production of large volumes of dilute urine. This condition is distinct from diabetes mellitus, which involves insulin and blood sugar regulation.

Question 6

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:

Accepted Answer

The child's excessive thirst and drinking behavior, including drinking from unusual sources like a toilet or puddle, suggest a condition characterized by extreme thirst and frequent urination. This is more indicative of diabetes insipidus, a condition caused by a lack of antidiuretic hormone (ADH) or a resistance to it, leading to the inability to concentrate urine and resulting in excessive urine output and compensatory thirst. Type 1 and type 2 diabetes mellitus can also cause thirst and frequent urination, but the extreme behavior described is more typical of diabetes insipidus. Diabetic ketoacidosis is a serious condition that results from untreated or poorly managed diabetes mellitus, characterized by high blood sugar and ketones, and does not directly explain the extreme thirst and drinking behavior.

Question 7

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

Accepted Answer

Congenital hypothyroidism often presents with symptoms related to decreased metabolic rate and developmental delays, such as facial puffiness, swollen eyelids, enlarged tongue, low anterior hairline, flattened nasal bridge, and a dull expression. These features are indicative of the disease's impact on physical growth and development.

Question 8

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

Accepted Answer

Mandatory newborn screening programs, which typically involve taking a blood sample from newborns before they leave the hospital, are the primary method for identifying congenital hypothyroidism in infants. This allows for early detection and treatment, which is crucial for normal development.

Question 9

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?

Accepted Answer

Early treatment of congenital hypothyroidism is crucial to prevent intellectual disability and to promote normal development, including achieving a normal IQ. Delays in treatment can lead to irreversible cognitive impairments.

Question 10

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?

Accepted Answer

L-thyroxine's absorption can be affected by soy-based formulas, which can interfere with the effectiveness of the medication in treating congenital hypothyroidism.

Question 11

At what age is acquired hypothyroidism generally recognized?

Accepted Answer

Acquired hypothyroidism is generally recognized in children around the age of 24 months or later, as it develops after birth and symptoms may take time to become apparent.

Question 12

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

Accepted Answer

Hashimoto's thyroiditis, an autoimmune condition, is the most common cause of primary acquired hypothyroidism. In this condition, the immune system attacks the thyroid gland, leading to decreased production of thyroid hormones.

Question 13

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

Accepted Answer

Acquired primary hypothyroidism is more common in individuals with other autoimmune-mediated diseases such as type 1 diabetes or those with chromosomal abnormalities, reflecting the autoimmune nature of many cases of hypothyroidism.

Question 14

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

Accepted Answer

Acquired hypothyroidism in children typically presents with a decreased rate of growth, weight gain, dry skin, coarse or thinning hair, and fatigue. These symptoms reflect the slowed metabolism and other systemic effects of low thyroid hormone levels.

Question 15

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:

Accepted Answer

Acquired hypothyroidism can lead to delayed puberty and delayed tooth eruption among other symptoms, due to the lack of thyroid hormones which are crucial for growth and development.

Question 16

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

Accepted Answer

L-thyroxine is best absorbed on an empty stomach, so it should be given 30 to 60 minutes before a meal to ensure optimal absorption.

Question 17

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

Accepted Answer

Grave's disease is the most common cause of hyperthyroidism in the pediatric population. It is an autoimmune disorder where the immune system attacks the thyroid gland, causing it to produce too much thyroid hormone.

Question 18

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

Accepted Answer

Hyperthyroidism symptoms include increased metabolism leading to weight loss despite a good appetite, fine tremors due to nervous system stimulation, warm and moist skin as a result of increased sweating, tachycardia due to the increased metabolic rate, and ophthalmic changes such as exophthalmos in conditions like Graves' disease.

Question 19

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

Accepted Answer

Exophthalmos (protrusion of the eyeball) is a common symptom of hyperthyroidism, particularly in Graves' disease, which is an autoimmune disorder that affects the thyroid gland.

Question 20

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

Accepted Answer

Children with congenital adrenal hyperplasia often present with symptoms related to excess androgen production, such as premature pubic hair development, accelerated growth velocity, acne, hirsutism, and advanced bone age.

Quiz 28: Endocrine Alterations