Question 1

Congenital adrenal hyperplasia (CAH) is suspected in a newborn because of ambiguous genitalia. The parents are appropriately upset and concerned about their child's gender. In teaching the parents about CAH, what should the nurse explain?
A) Reconstructive surgery as a female is preferred.
B) Sexual assignment should wait until genetic sex is determined.
C) Prenatal masculinization will strongly influence the child's development.
D) The child should be raised as a boy because of the presence of a penis and scrotum.

Accepted Answer

It is preferable to raise the child according to genetic sex. With hormone replacement and surgical intervention if needed, genetically female children achieve satisfactory results in reversing virilism and achieving normal puberty and ability to conceive. Reconstructive surgery as a female is only preferred for infants who are genetically female. Infants who are genetically male should be given hormonal supplementation. Sex assignment and rearing depend on psychosocial influences, not on genetic sex hormone influences during fetal life. It is not advised to raise the child as a boy because of the presence of a penis and scrotum unless the child is genetically male. If a genetic female, the child will be sterile and may never be able to function satisfactorily in a heterosexual relationship.

Question 2

Exophthalmos (protruding eyeballs) may occur in children with which condition?
A) Hypothyroidism
B) Hyperthyroidism
C) Hypoparathyroidism
D) Hyperparathyroidism

Accepted Answer

Exophthalmos is associated with hyperthyroidism. Hypothyroidism, hypoparathyroidism, and hyperparathyroidism are not associated with exophthalmos.

Question 3

What is a condition that can result if hypersecretion of growth hormone (GH) occurs after epiphyseal closure?
A) Cretinism
B) Dwarfism
C) Gigantism
D) Acromegaly

Accepted Answer

Excess GH after closure of the epiphyseal plates results in acromegaly. Cretinism is associated with hypothyroidism. Dwarfism is the condition of being abnormally small. Gigantism occurs when there is hypersecretion of GH before the closure of the epiphyseal plates.

Question 4

A goiter is an enlargement or hypertrophy of which gland?
A) Thyroid
B) Adrenal
C) Anterior pituitary
D) Posterior pituitary

Accepted Answer

A goiter is an enlargement or hypertrophy of the thyroid gland. Goiter is not associated with the adrenal, anterior pituitary, or posterior pituitary secretory organs.

Question 5

A child is receiving propylthiouracil for the treatment of hyperthyroidism (Graves disease). The parents and child should be taught to recognize and report which sign or symptom immediately?
A) Fatigue
B) Weight loss
C) Fever, sore throat
D) Upper respiratory tract infection

Accepted Answer

Children being treated with propylthiouracil must be carefully monitored for the side effects of the drug. Parents must be alerted that sore throat and fever accompany the grave complication of leukopenia. These symptoms should be immediately reported. Fatigue and weight loss are manifestations of hyperthyroidism. Their presence may indicate that the drug is not effective but does not require immediate evaluation. Upper respiratory tract infections are most likely viral in origin and not a sign of leukopenia.

Question 6

Glucocorticoids, mineralocorticoids, and sex steroids are secreted by which gland?
A) Thyroid gland
B) Adrenal cortex
C) Anterior pituitary
D) Parathyroid glands

Accepted Answer

The glucocorticoids, mineralocorticoids, and sex steroids are secreted by the adrenal cortex. The thyroid gland produces thyroid hormone and thyrocalcitonin. The anterior pituitary produces hormones such as growth hormone, thyroid-stimulating hormone, adrenocorticotropic hormone, gonadotropin, prolactin, and melanocyte-stimulating hormone. The parathyroid glands produce parathyroid hormone.

Question 7

What clinical manifestation is considered a cardinal sign of diabetes mellitus?
A) Nausea
B) Seizures
C) Impaired vision
D) Frequent urination

Accepted Answer

Hallmarks of diabetes mellitus are glycosuria, polyuria, and polydipsia. Nausea and seizures are not clinical manifestations of diabetes mellitus. Impaired vision is a long-term complication of the disease.

Question 8

Intranasal administration of desmopressin acetate (DDAVP) is used to treat which condition?
A) Hypopituitarism
B) Diabetes insipidus (DI)
C) Syndrome of inappropriate antidiuretic hormone (SIADH)
D) Acute adrenocortical insufficiency

Accepted Answer

DDAVP is the treatment of choice for DI. It is administered intranasally through a flexible tube. The child's response pattern is variable, with effectiveness lasting from 6 to 24 hours.

Question 9

Peripheral precocious puberty (PPP) differs from central precocious puberty (CPP) in which manner?
A) PPP results from a central nervous system (CNS) insult.
B) PPP occurs more frequently in girls.
C) PPP may be viewed as a variation in sexual development.
D) PPP results from hormonal stimulation of the hypothalamic gonadotropin-releasing hormone (Gn-RH).

Accepted Answer

PPP may be viewed as a variation in sexual development. PPP results from hormone stimulation other than the hypothalamic Gn-RH. Isolated manifestations of secondary sexual development occur. PPP can be missed if these changes are viewed as variations in pubertal onset. CPP results from CNS insult, occurs more frequently in girls, and results from hormonal stimulation of the hypothalamic Gn-RH.

Question 10

What is a common clinical manifestation of juvenile hypothyroidism?
A) Insomnia
B) Diarrhea
C) Dry skin
D) Rapid growth

Accepted Answer

Dry skin, mental decline, and myxedematous skin changes are associated with juvenile hypothyroidism. Children with hypothyroidism often have sleepiness, constipation, and decelerated growth.

Question 11

A child will start treatment for central precocious puberty. What synthetic hormone will be injected?
A) Thyrotropin
B) Gonadotropins
C) Somatotropic hormone
D) Luteinizing hormone-releasing hormone

Accepted Answer

Precocious puberty of central origin is treated with monthly subcutaneous injections of luteinizing hormone-releasing hormone, which regulates pituitary secretions. Thyrotropin, gonadotropins, and somatotropic hormone are not the appropriate therapies for precocious puberty.

Question 12

A child with hypoparathyroidism is receiving vitamin D therapy. The parents should be advised to watch for which signs or symptoms of vitamin D toxicity?
A) Headache and seizures
B) Weakness and lassitude
C) Anorexia and insomnia
D) Physical restlessness, voracious appetite without weight gain

Accepted Answer

Vitamin D toxicity can be a serious consequence of therapy. Parents are advised to watch for weakness, fatigue, lassitude, headache, nausea, vomiting, and diarrhea. Renal impairment is manifested through polyuria, polydipsia, and nocturia. Headaches may be a sign of vitamin D toxicity, but seizures are not. Anorexia and insomnia are not characteristic of vitamin D toxicity. Physical restlessness and a voracious appetite with weight loss are manifestations of hyperthyroidism.

Question 13

What form of diabetes is characterized by destruction of pancreatic beta cells, resulting in insulin deficiency?
A) Type 1 diabetes
B) Type 2 diabetes
C) Gestational diabetes
D) Maturity-onset diabetes of the young (MODY)

Accepted Answer

Type 1 diabetes is characterized by the destruction of the pancreatic beta cells, which leads to absolute insulin deficiency. Type 2 diabetes results usually from insulin resistance. The pancreatic beta cells are not destroyed in gestational diabetes. MODY is an autosomal dominant monogenetic defect in beta cell function that is characterized by impaired insulin secretion with minimum or no defects in insulin action.

Question 14

A child with growth hormone (GH) deficiency is receiving GH therapy. When is the best time for the GH to be administered?
A) At bedtime
B) After meals
C) Before meals
D) After arising in morning

Accepted Answer

Injections are best given at bedtime to more closely approximate the physiologic release of GH. After meals, before meals, and after arising in the morning do not parallel the physiologic release of the hormone.

Question 15

A child with hypopituitarism is being started on growth hormone (GH) therapy. Nursing considerations should be based on which knowledge?
A) Therapy is most successful if it is started during adolescence.
B) Replacement therapy requires daily subcutaneous injections.
C) Hormonal supplementation will be required throughout child's lifetime.
D) Treatment is considered successful if children attain full stature by adolescence.

Accepted Answer

Additional support is required for children who require hormone replacement therapy, such as preparation for daily subcutaneous injections and education for self-management during the school-age years. Young children, obese children, and those who are severely GH deficient have the best response to therapy. Replacement therapy is not needed after attaining final height. The children are no longer GH deficient. When therapy is successful, children can attain their actual or near-final adult height at a slower rate than their peers.

Question 16

What nursing care should be included for a child diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH)?
A) Maintain the child NPO (nothing by mouth).
B) Turn the child frequently.
C) Restrict fluids.
D) Encourage fluids.

Accepted Answer

Increased secretion of ADH causes the kidney to reabsorb water, which increases fluid volume and decreases serum osmolarity with a progressive reduction in sodium concentration. The immediate management of the child is to restrict fluids but not food. Frequently turning the child is not necessary unless the child is unresponsive. Encouraging fluids will worsen the child's condition.

Question 17

Homeostasis in the body is maintained by what is collectively known as the neuroendocrine system. What is the name of the nervous system that is involved?
A) Central
B) Skeletal
C) Peripheral
D) Autonomic

Accepted Answer

The autonomic nervous system (composed of the sympathetic and parasympathetic systems) controls involuntary functions. In combination with the endocrine system, it maintains homeostasis. The central, skeletal, and peripheral subdivisions of the nervous system are not part of the neuroendocrine system.

Question 18

What statement is characteristic of type 1 diabetes mellitus?
A) Onset is usually gradual.
B) Ketoacidosis is infrequent.
C) Peak age incidence is 10 to 15 years.
D) Oral agents are available for treatment.

Accepted Answer

Type 1 diabetes mellitus typically usually has its onset before the age of 20 years, with a peak incidence between ages 10 and 15 years. Type 1 has an abrupt onset, in contrast to type 2, which has a more gradual appearance. Ketoacidosis occurs when insulin is unavailable and the body uses sources other than glucose for cellular metabolism. Ketoacidosis is more common in type 1 diabetes than in type 2. At this time, oral agents are available only for type 2 diabetes.

Question 19

The nurse is planning care for a child recently diagnosed with diabetes insipidus (DI). What intervention should be included?
A) Encourage the child to wear medical identification.
B) Discuss with the child and family ways to limit fluid intake.
C) Teach the child and family how to do required urine testing.
D) Reassure the child and family that this is usually not a chronic or life-threatening illness.

Accepted Answer

DI is a potentially life-threatening disorder if the voluntary demand for fluid is suppressed or the child does not have access to fluids. Medical alert identification should be worn. Fluid intake is not restricted in children with DI. The child is unable to concentrate urine and can rapidly become dehydrated. Fluid intake may be limited during diagnosis, when the lack of intake will result in decreased urinary output and dehydration. Urine testing is not required in DI. Changes in body weight provide information about approximate fluid balance. This is a lifelong disorder that requires supplemental vasopressin throughout life.

Question 20

The school nurse practitioner is consulted by a fifth-grade teacher about a student who has become increasingly inattentive and hyperactive in the classroom. The nurse notes that the child's weight has changed from the 50th percentile to the 30th percentile. The nurse is concerned about possible hyperthyroidism. What additional sign or symptom should the nurse anticipate?
A) Skin that is cool and dry
B) Blurred vision and loss of acuity
C) Running and being active during recess
D) Decreased appetite and food intake

Accepted Answer

Visual disturbances such as loss of visual acuity and blurred vision are associated with hyperthyroidism. They may occur before the actual onset of other symptoms. The child's skin is usually warm, flushed, and moist. Although the signs of hyperthyroidism include excessive motion, irritability, hyperactivity, short attention span, and emotional lability, these children are easily fatigued and require frequent rest periods. Children with hyperthyroidism have increased food intake. Even with voracious appetites, weight loss occurs.

Quiz 33: The Child with Endocrine Dysfunction

Congenital adrenal hyperplasia (CAH) is suspected in a newborn because of ambiguous genitalia. The parents are appropriately upset and concerned about their child's gender. In teaching the parents about CAH, what should the nurse explain?

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

What is a condition that can result if hypersecretion of growth hormone (GH) occurs after epiphyseal closure?

A goiter is an enlargement or hypertrophy of which gland?

A child is receiving propylthiouracil for the treatment of hyperthyroidism (Graves disease) . The parents and child should be taught to recognize and report which sign or symptom immediately?

Glucocorticoids, mineralocorticoids, and sex steroids are secreted by which gland?

What clinical manifestation is considered a cardinal sign of diabetes mellitus?

Intranasal administration of desmopressin acetate (DDAVP) is used to treat which condition?

Peripheral precocious puberty (PPP) differs from central precocious puberty (CPP) in which manner?

What is a common clinical manifestation of juvenile hypothyroidism?

A child will start treatment for central precocious puberty. What synthetic hormone will be injected?

A child with hypoparathyroidism is receiving vitamin D therapy. The parents should be advised to watch for which signs or symptoms of vitamin D toxicity?

What form of diabetes is characterized by destruction of pancreatic beta cells, resulting in insulin deficiency?

A child with growth hormone (GH) deficiency is receiving GH therapy. When is the best time for the GH to be administered?

A child with hypopituitarism is being started on growth hormone (GH) therapy. Nursing considerations should be based on which knowledge?

What nursing care should be included for a child diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) ?

Homeostasis in the body is maintained by what is collectively known as the neuroendocrine system. What is the name of the nervous system that is involved?

What statement is characteristic of type 1 diabetes mellitus?

The nurse is planning care for a child recently diagnosed with diabetes insipidus (DI) . What intervention should be included?