Chapter 27: The Child with an Endocrine or Metabolic Alteration My Nursing Test Banks

Chapter 27: The Child with an Endocrine or Metabolic Alteration

Test Bank

MULTIPLE CHOICE

1. A nurse is describing the endocrine system to a nursing student. Which statement best describes the negative feedback system of the pituitary gland?

a.

The pituitary gland produces five hormones that are interdependent.

b.

Target organs stimulate the hypothalamus, which in turn produces hormones.

c.

The anterior pituitary stimulates the production of posterior pituitary hormones.

d.

The pituitary gland secretes hormones that stimulate target organs to produce specific hormones. As hormonal secretions of the target organs increase, the pituitary gland decreases the secretion of the stimulating hormone.

ANS: D

The pituitary stimulates target organs to produce specific hormones. When enough hormone is produced, the target organ signals the pituitary to stop secretion of the stimulating hormone. There are six hormones secreted by the anterior pituitary; they are not interdependent. The anterior pituitary gland stimulates target organs to produce specific hormones and does not control production of posterior pituitary hormones.

DIF: Cognitive Level: Application REF: p. 700|p. 703

OBJ: Nursing Process Step: Assessment MSC: Physiological Integrity

2. Which is the priority outcome of mandatory newborn screening for hypothyroidism?

a.

Appropriate community referral for affected families

b.

Parental education about raising a special needs child

c.

Early identification of the disorder

d.

Facilitation of parentchild bonding

ANS: C

Early identification of hypothyroidism is basic to the prevention of mental retardation in the child. Community referral is appropriate after a diagnosis is made. With early identification and treatment with thyroid hormone replacement, mental retardation is prevented. Facilitation of parentchild bonding is a consideration for all newborn infants.

DIF: Cognitive Level: Comprehension REF: p. 707

OBJ: Nursing Process Step: Evaluation MSC: Health Promotion and Maintenance

3. What is a nursing goal for a 12-year-old child with Graves disease?

a.

Relief of constipation

b.

Allowing the adolescent to make decisions about taking her medication

c.

Verbal demonstration of an understanding about the medication regimen

d.

Development of alternative educational goals

ANS: C

To adhere to the medication schedule, children need to understand that the medication must be taken two or three times per day. The adolescent with Graves disease is not constipated. Making decisions about her medication is not appropriate for a 12-year-old child. The management of Graves disease does not interfere with school attendance and does not require alternative educational plans.

DIF: Cognitive Level: Analysis REF: p. 710

OBJ: Nursing Process Step: Planning MSC: Health Promotion and Maintenance

4. Which symptom should be reported to the healthcare provider when a child is taking propylthiouracil?

a.

Nausea and vomiting

b.

Fever and sore throat

c.

Increased appetite and diarrhea

d.

Weight gain and mood swings

ANS: B

Propylthiouracil or methimazole is the treatment of choice for childhood hyperthyroidism. Fever and sore throat are clinical manifestations of neutropenia, a side effect of propylthiouracil. Nausea and vomiting are not common side effects of propylthiouracil. Increased appetite and diarrhea are clinical manifestations of Graves disease. Weight gain and mood swings are not considered side effects of propylthiouracil.

DIF: Cognitive Level: Comprehension REF: p. 710

OBJ: Nursing Process Step: Implementation

MSC: Health Promotion and Maintenance

5. What information provided by the nurse would be helpful to a 15-year-old adolescent taking propylthiouracil three times a day?

a.

Pill dispensers and alarms on her watch can remind her to take the medication as ordered.

b.

She can take the medication when she is nervous and feels she needs it.

c.

She can take two pills before school and one pill at dinner, which will be easier for her to remember.

d.

Her mother can be responsible for reminding her when it is time to take her medication.

ANS: A

Propylthiouracil is an antithyroid medication that should be taken three times a day. Reminders will facilitate taking medication as ordered. This medication needs to be taken regularly, not on an as-needed basis. The dosage cannot be combined to reduce the frequency of administration. Because of the adolescents school schedule and activities, she, rather than her mother, needs to be responsible for her medication.

DIF: Cognitive Level: Application REF: p. 710

OBJ: Nursing Process Step: Evaluation MSC: Health Promotion and Maintenance

6. A nurse is assessing a child with diabetes insipidus. Which sign should the nurse expect to note?

a.

Weight gain

b.

Increased urine specific gravity

c.

Increased urination

d.

Serum sodium level of 130 mEq/L

ANS: C

The deficiency of antidiuretic hormone associated with diabetes insipidus causes the body to excrete large volumes of dilute urine. Weight gain results from retention of water when there is an excessive production of antidiuretic hormone; in diabetes insipidus there is a decreased production of antidiuretic hormone. Concentrated urine is a sign of the syndrome of inappropriate antidiuretic hormone (SIADH), in which there is an excessive production of antidiuretic hormone. A deficiency of antidiuretic hormone, as with diabetes insipidus, results in an increased serum sodium concentration (greater than 145 mEq/L).

DIF: Cognitive Level: Comprehension REF: p. 711

OBJ: Nursing Process Step: Assessment MSC: Physiological Integrity

7. What should the nurse include in the teaching plan for parents of a child with diabetes insipidus who is receiving DDAVP intranasally?

a.

Increase the dosage of DDAVP as the urine specific gravity (SG) increases.

b.

Give DDAVP only if the urine output decreases.

c.

Child should have free access to water and toilet facilities at school.

d.

Cleanse the skin before administering the transdermal patch.

ANS: C

The childs teachers should be aware of the diagnosis and the child should have free access to water and toilet facilities at school. DDAVP needs to be given as ordered by the physician. If the parents are monitoring urine SG at home, they would not increase the medication dose for increased SG; the physician may order an increased dosage for very dilute urine with decreased SG. DDAVP needs to be given continuously as ordered by the physician. DDAVP is typically given intranasally or by subcutaneous injection. For nocturnal enuresis, it may be given orally.

DIF: Cognitive Level: Application REF: p. 713

OBJ: Nursing Process Step: Planning MSC: Health Promotion and Maintenance

8. A nurse is explaining growth hormone deficiency to parents of a child admitted to rule out this problem. Which metabolic alteration should the nurse explain to the parent that is related to growth hormone deficiency?

a.

Hypocalcemia

b.

Hypoglycemia

c.

Diabetes insipidus

d.

Hyperglycemia

ANS: B

Growth hormone helps maintain blood sugar at normal levels. Symptoms of hypocalcemia are associated with hypoparathyroidism. Diabetes insipidus is a disorder of the posterior pituitary. Growth hormone is produced by the anterior pituitary. Hyperglycemia results from an insufficiency of insulin, which is produced by the beta cells in the islets of Langerhans in the pancreas.

DIF: Cognitive Level: Application REF: p. 716

OBJ: Nursing Process Step: Implementation MSC: Physiological Integrity

9. Which is the most appropriate intervention for the parents of a 6-year-old child with precocious puberty?

a.

Advise the parents to consider birth control for their daughter.

b.

Explain the importance of having the child foster relationships with same-age peers.

c.

Assure the childs parents that there is no increased risk for sexual abuse because of her appearance.

d.

Counsel parents that there is no treatment currently available for this disorder.

ANS: B

Despite the childs appearance, the child needs to be treated according to her chronological age and to interact with children in the same age group. An expected outcome is that the child will adjust socially by exhibiting age-appropriate behaviors and social interactions. Advising the parents of a 6-year-old to put their daughter on birth control is not appropriate. Parents need to be aware that there is an increased risk of sexual abuse for a child with precocious puberty. Treatment for precocious puberty is the administration of gonadotropin-releasing hormone blocker, which slows or reverses the development of secondary sexual characteristics and slows rapid growth and bone aging.

DIF: Cognitive Level: Application REF: pp. 715-716

OBJ: Nursing Process Step: Implementation

MSC: Health Promotion and Maintenance

10. A neonate is displaying tremors, twitching, and irritability. This is suggestive of:

a.

hypocalcemia.

b.

hypothyroidism.

c.

hypoglycemia.

d.

phenylketonuria (PKU).

ANS: A

When hypocalcemia is present, neonates may display twitching, tremors, irritability, jitteriness, electrocardiographic changes, and, rarely, seizures. An infant with hypothyroidism may exhibit skin mottling, a large fontanel, a large tongue, hypotonia, slow reflexes, a distended abdomen, prolonged jaundice, lethargy, constipation, feeding problems, and coldness to touch. Hypoglycemia causes the neonate to exhibit jitteriness, poor feeding, lethargy, seizures, and respiratory alterations including apnea, hypotonia, high-pitched cry, bradycardia, cyanosis, and temperature instability. Infants with PKU may initially have digestive problems with vomiting, and they may have a musty or mousy odor to the urine, infantile eczema, hypertonia, and hyperactive behavior.

DIF: Cognitive Level: Knowledge REF: p. 703

OBJ: Nursing Process Step: Assessment MSC: Physiological Integrity

11. What is the best time for the nurse to assess the peak effectiveness of subcutaneously administered Regular insulin?

a.

Two hours after administration

b.

Four hours after administration

c.

Immediately after administration

d.

Thirty minutes after administration

ANS: A

The peak action for Regular (short-acting) insulin is 2 to 3 hours after subcutaneous administration. The duration of Regular (short-acting) insulin is only 3 to 6 hours. Peak action occurs 2 to 3 hours after the insulin is administered. Subcutaneously administered Regular (short-acting) insulin has an onset of action of 30 to 60 minutes after injection. The effectiveness of subcutaneously administered, short-acting insulin cannot be assessed immediately after administration. Thirty minutes corresponds to the onset of action for Regular (short-acting) insulin.

DIF: Cognitive Level: Application REF: p. 721

OBJ: Nursing Process Step: Evaluation MSC: Physiological Integrity

12. Which statement made by a 14-year-old adolescent who is newly diagnosed with insulin-dependent diabetes mellitus (IDDM) indicates a need for further teaching?

a.

I should eat meals and snack at the same time every day.

b.

Exercise will decrease my insulin requirements.

c.

It is okay to drink chocolate milk with meals.

d.

I need to check my sugars before meals and at bedtime.

ANS: C

Chocolate milk is high in carbohydrates. Carbohydrates raise blood glucose levels. A beverage low in carbohydrates is a better choice. Meals and snacks should be eaten at regular times. Exercise decreases insulin requirements. Checking serum glucose before breakfast and dinner is appropriate.

DIF: Cognitive Level: Application REF: p. 722

OBJ: Nursing Process Step: Evaluation MSC: Health Promotion and Maintenance

13. What is the primary concern for a 7-year-old child with insulin-dependent diabetes mellitus (IDDM) who asks his mother not to tell anyone at school that he has diabetes?

a.

The childs safety

b.

The privacy of the child

c.

Development of a sense of industry

d.

Peer group acceptance

ANS: A

Safety is the primary issue. School personnel need to be aware of the signs and symptoms of hypoglycemia and hyperglycemia and the appropriate interventions. Privacy is not a life-threatening concern. The treatment of IDDM should not interfere with the school-age childs development of a sense of industry. Peer group acceptance and body image are issues for the early adolescent with IDDM. This is not of greater priority than the childs safety.

DIF: Cognitive Level: Analysis REF: p. 723

OBJ: Nursing Process Step: Evaluation MSC: Health Promotion and Maintenance

14. Which is the best nursing action when a child with insulin-dependent diabetes mellitus is sweating, trembling, and pale?

a.

Offer the child a glass of water.

b.

Give the child 5 units of Regular insulin subcutaneously.

c.

Give the child a glass of orange juice.

d.

Give the child glucagon subcutaneously.

ANS: C

Four ounces of orange juice is an appropriate treatment for the conscious child who is exhibiting signs of hypoglycemia. A glass of water is not indicated in this situation. An easily digested carbohydrate is indicated when a child exhibits symptoms of hypoglycemia. Insulin would lower blood glucose and is contraindicated for a child with hypoglycemia. Subcutaneous injection of glucagon is used to treat hypoglycemia when the child is unconscious.

DIF: Cognitive Level: Application REF: p. 719

OBJ: Nursing Process Step: Implementation MSC: Physiological Integrity

15. Which sign is the nurse most likely to assess in a child with hypoglycemia?

a.

Urine positive for ketones and serum glucose greater than 300 mg/dL

b.

Normal sensorium and serum glucose greater than 160 mg/dL

c.

Irritability and serum glucose less than 70 mg/dL

d.

Increased urination and serum glucose less than 120 mg/dL

ANS: C

Irritability and serum glucose less than 70 mg/dL are neuroglycopenic manifestations of hypoglycemia. Serum glucose greater than 300 mg/dL and urine positive for ketones are indicative of diabetic ketoacidosis. Normal sensorium and serum glucose greater than 160 mg/dL are associated with hyperglycemia. Increased urination is an indicator of hyperglycemia. A serum glucose level less than 120 mg/dL is within normal limits.

DIF: Cognitive Level: Application REF: p. 719

OBJ: Nursing Process Step: Assessment MSC: Physiological Integrity

16. When would a child diagnosed with insulin-dependent diabetes mellitus most likely demonstrate a decreased need for insulin?

a.

During the honeymoon phase

b.

During adolescence

c.

During growth spurts

d.

During minor illnesses

ANS: A

During the honeymoon phase, which may last from a few weeks to a year or longer, the child is likely to need less insulin. During adolescence, physical growth and hormonal changes contribute to an increase in insulin requirements. Insulin requirements are typically increased during growth spurts. Stress either from illness or from events in the environment can cause hyperglycemia. Insulin requirements are increased during periods of minor illness.

DIF: Cognitive Level: Application REF: pp. 718-719

OBJ: Nursing Process Step: Evaluation MSC: Physiological Integrity

17. What should a nurse suggest to the parent of a child with insulin-dependent diabetes mellitus (IDDM) who is not eating as a result of a minor illness?

a.

Give the child half his regular morning dose of insulin.

b.

Substitute calorie-containing liquids for solid food to maintain normal serum glucose levels.

c.

Give the child plenty of unsweetened, clear liquids to prevent dehydration.

d.

Take the child directly to the emergency department.

ANS: B

Calorie-containing liquids will maintain normal serum glucose levels and decrease the risk of hypoglycemia. The child should receive his regular dose of insulin even if he does not have an appetite. If the child is not eating as usual, he needs calories to prevent hypoglycemia. During periods of minor illness, the child with IDDM can be managed safely at home.

DIF: Cognitive Level: Analysis REF: p. 727

OBJ: Nursing Process Step: Implementation

MSC: Health Promotion and Maintenance

18. Which is the nurses best response to the parents of a 10-year-old child newly diagnosed with insulin-dependent diabetes mellitus (IDDM) who are concerned about the childs continued participation in soccer?

a.

Consider the swim team as an alternative to soccer.

b.

Encourage intellectual activity rather than participation in sports.

c.

It is okay to play sports such as soccer when the weather is moderate.

d.

Give the child an extra 15 to 30 grams of carbohydrate snack before soccer practice.

ANS: D

Exercise lowers blood glucose levels. A snack with 15 to 30 grams of carbohydrates before exercise will decrease the risk of hypoglycemia. Soccer is an appropriate sport for a child with IDDM as long as the child prevents hypoglycemia by eating a snack. Participation in sports is not contraindicated for a child with IDDM. The child with IDDM may participate in sports activities regardless of climate.

DIF: Cognitive Level: Application REF: p. 722

OBJ: Nursing Process Step: Planning MSC: Health Promotion and Maintenance

19. Which comment made by a 12-year-old child with insulin-dependent diabetes mellitus (IDDM) indicates a knowledge deficit?

a.

I rotate my insulin injection sites every time I give myself an injection.

b.

I keep records of my glucose levels and insulin sites and amounts.

c.

Ill be glad when I can take a pill for my diabetes like my uncle does.

d.

I keep Lifesavers in my school bag in case I have a low-sugar reaction.

ANS: C

Children with IDDM will require life-long insulin therapy. Rotating injection sites is appropriate because insulin absorption varies at different sites. Keeping records of serum glucose and insulin sites and amounts is appropriate. Prompt treatment of hypoglycemia reduces the possibility of a severe reaction. Keeping hard candy on hand is an appropriate action.

DIF: Cognitive Level: Analysis REF: p. 721

OBJ: Nursing Process Step: Evaluation MSC: Health Promotion and Maintenance

20. Which laboratory findings would confirm that a child with insulin-dependent diabetes mellitus (IDDM) is experiencing diabetic ketoacidosis?

a.

No urinary ketones

b.

Low arterial pH

c.

Elevated serum carbon dioxide

d.

Elevated serum phosphorus

ANS: B

Severe insulin deficiency produces metabolic acidosis, which is indicated by a low arterial pH. Urinary ketones, often in large amounts, are present when a child is in diabetic ketoacidosis. Serum carbon dioxide is decreased in diabetic ketoacidosis. Serum phosphorus is decreased in diabetic ketoacidosis.

DIF: Cognitive Level: Analysis REF: p. 728

OBJ: Nursing Process Step: Assessment MSC: Physiological Integrity

MULTIPLE RESPONSE

1. A child is diagnosed with hypothyroidism. The nurse should expect to assess which symptoms associated with hypothyroidism? Select all that apply.

a.

Weight loss

b.

Fatigue

c.

Diarrhea

d.

Dry, thick skin

e.

Cold intolerance

ANS: B, D, E

A child with hypothyroidism will display fatigue, dry, thick skin, and cold intolerance. Weight loss and diarrhea are signs of hyperthyroidism.

DIF: Cognitive Level: Analysis REF: p. 722

OBJ: Nursing Process Step: Assessment MSC: Physiological Integrity

OTHER

1. A nurse is preparing to administer 10 units of Regular insulin and 5 units of Lente insulin. Place in order the steps the nurse should follow to administer the total dosage of 15 units of insulin. Place the initial step first and end with the final step. Use the following format for your answers: A, B, C, D

a. Inject 5 units of air into the Lente insulin vial.

b. Draw up the 5 units of Lente insulin.

c. Inject 10 units of air into the Regular insulin vial.

d. Cleanse the insulin vials with alcohol wipes.

e. Draw up the 10 units of Regular insulin.

ANS:

D, A, C, E, B

Cleanse the insulin vials with alcohol wipes initially. When mixing two different types of insulin, inject the appropriate amount of air into both vials and then withdraw the short-acting (clear) insulin first. So the steps should be to cleanse the insulin vials, inject air into the Lente, inject air into the Regular insulin vial, then draw the Regular (clear) insulin, and lastly draw the Lente (cloudy) insulin.

DIF: Cognitive Level: Application REF: p. 710

OBJ: Nursing Process Step: Implementation MSC: Physiological Integrity

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