CHAPTER 28: ENDOCRINE ALTERATIONS My Nursing Test Banks

CHAPTER 28: ENDOCRINE ALTERATIONS

MULTIPLE CHOICE

1.At what point is hormonal control over most body systems complete?

a.

birth

c.

1 month

b.

72 hours after birth

d.

12 to 18 months of age

ANS: D

Feedback

A

Incorrect. Hormonal control of many body systems is not complete at birth.

B

Incorrect. Hormonal control of many body systems is not complete at 72 hours after birth.

C

Incorrect. Hormonal control of many body systems is not complete at 1 month of age.

D

Correct. Hormonal control of many body functions is lacking until 12 to 18 months of age.

PTS: 1 REF: p. 984 Endocrine Alterations OBJ: Cognitive Level: Knowledge

2.Which of the following endocrine glands stores vasopressin (antidiuretic hormone)?

a.

adrenal medulla

c.

posterior pituitary

b.

adrenal cortex

d.

anterior pituitary

ANS: C

Feedback

A

Incorrect. The adrenal medulla is an endocrine gland but is involved in the production of epinephrine and norepinephrine.

B

Incorrect. The adrenal cortex is an endocrine gland but is involved in the production of glucocorticoids, androgens and mineralocorticoids.

C

Correct. The posterior pituitary gland produces oxytocin and stores the hormone arginine vasopressin or antidiuretic hormone (ADH), which is produced by the hypothalamus.

D

Incorrect. The anterior pituitary is an endocrine gland but is involved in the production of growth hormones, luteinizing hormone, follicle-stimulating hormone, ACTH, TSH and prolactin hormone.

PTS:1REF:p. 985 Anatomy and Physiology

OBJ: Cognitive Level: Comprehension

3.Which of the following systems or mechanisms regulates the secretion of aldosterone?

a.

renin-angiotensin system

b.

negative feedback system involving adrenocorticotropic hormone (ACTH)

c.

immune system

d.

baroreceptors in the circulatory system

ANS: A

Feedback

A

Correct. Aldosterone is the most important mineralocorticoid, causing sodium retention and potassium excretion. Its secretion is regulated by the renin-angiotensin system.

B

Incorrect. The negative feedback system involving adrenocorticotropic hormone (ACTH) does not regulate the secretion of aldosterone.

C

Incorrect. The immune system does not regulate the secretion of aldosterone.

D

Incorrect. The baroreceptors in the circulatory system do not regulate the secretion of aldosterone.

PTS:1REF:p. 986 Anatomy and Physiology

OBJ: Cognitive Level: Comprehension

4.The nurse working with parents of school-aged children will talk about growth hormone with the parents and stress that this hormone is secreted mainly at which of the following times?

a.

during exposure to sunlight or fluorescent light

b.

when the child is most active and jarring the long bones

c.

primarily after the onset of sleep

d.

the short period after intake of food high in calories

ANS: C

Feedback

A

Incorrect. Talking about growth hormone with parents, the nurse will not stress that this hormone is secreted mainly during exposure to sunlight or fluorescent light.

B

Incorrect. Talking about growth hormone with parents, the nurse will not stress that this hormone is secreted mainly when the child is most active and jarring the long bones.

C

Correct. Growth hormone plays a primary role in postnatal growth. It is released in a pulsatile (pulsating) fashion throughout the day; however, most is secreted after the onset of sleep.

D

Incorrect. Talking about growth hormone with parents, the nurse will not stress that this hormone is secreted mainly during the short period after intake of food high in calories.

PTS:1REF:p. 986 Anatomy and Physiology

OBJ: Cognitive Level: Application

5.Which of the following is most commonly the cause of growth hormone deficiency?

a.

injury

b.

destruction of the anterior pituitary gland

c.

infection or irradiation

d.

idiopathic condition

ANS: D

Feedback

A

Incorrect. Injury is not the most common cause of growth hormone deficiency.

B

Incorrect. The destruction of the anterior pituitary gland is not the most common cause of growth hormone deficiency.

C

Incorrect. Neither infection nor irradiation are the most common cause of growth hormone deficiency.

D

Correct. In 75% of the children diagnosed with growth hormone deficiency (GHD), no cause for the dysfunction is found (idiopathic).

PTS:1REF:p. 986 Anatomy and Physiology

OBJ: Cognitive Level: Comprehension

6.Which of the following tests are conducted to confirm a diagnosis of growth hormone deficiency?

a.

dexamethasone suppression test

c.

Trousseaus sign

b.

Chvosteks sign

d.

pituitary function testing

ANS: D

Feedback

A

Incorrect. The dexamethasone suppression test is not conducted to confirm a diagnosis of growth hormone deficiency.

B

Incorrect. Chvosteks sign is never used to confirm a diagnosis of growth hormone deficiency.

C

Incorrect. Trousseaus sign is never used to confirm a diagnosis of growth hormone deficiency.

D

Correct. Pituitary function testing is necessary to confirm a diagnosis of growth hormone deficiency.

PTS:1REF:p. 987 Disorders of the Anterior Pituitary

OBJ: Cognitive Level: Comprehension

7.Which of the following side effects are seen as potential complications to growth hormone therapy given at physiologic replacement doses?

a.

slipped femoral epiphysis, pseudotumor cerebri, edema, and sodium retention

b.

immunodeficiency with increased susceptibility to infections

c.

unexplained development of an autoimmune disease such as Addisons disease

d.

circulatory disorders such as cardiac arrhythmias, valve disease, or stroke

ANS: A

Feedback

A

Correct. There are potential complications to growth hormone therapy. At physiological replacement doses, side effects can include slipped femoral epiphysis, pseudotumor cerebri, edema, and sodium retention.

B

Incorrect. Immunodeficiency with increased susceptibility to infections is not among the potential complications to growth hormone therapy.

C

Incorrect. The unexplained development of an autoimmune disease such as Addisons disease is not among the potential complications to growth hormone therapy.

D

Incorrect. Circulatory disorders such as cardiac arrhythmias, valve disease, or stroke are not among the potential complications to growth hormone therapy.

PTS:1REF:p. 987 Disorders of the Anterior Pituitary

OBJ: Cognitive Level: Comprehension

8.Which of the following will the nurse working in a clinic do to maintain the childs self-esteem and a good body image when preparing the child, who has been diagnosed with growth hormone deficiency, for a physical exam?

a.

Remove the mirrors from the examining room and surrounding area.

b.

Discreetly provide a step stool beside the examining table.

c.

Use a growth chart that is in a language not understood by the child.

d.

Measure the childs height with the child lying down on the table.

ANS: B

Feedback

A

Incorrect. The nurse working in a clinic with a child diagnosed with growth hormone deficiency will not remove the mirrors from the examining room and surrounding area.

B

Correct. The nurse working in a clinic with a child diagnosed with growth hormone deficiency will discreetly provide a step stool beside the examining table in order to maintain the childs self-esteem and a good body image.

C

Incorrect. The nurse working in a clinic with a child diagnosed with growth hormone deficiency will not use a growth chart that is in a language not understood by the child.

D

Incorrect. The nurse working in a clinic with a child diagnosed with growth hormone deficiency will not measure the childs height with the child lying down on the table as this may further damage the childs self-esteem and a good body image.

PTS:1REF:p. 988 Disorders of the Anterior Pituitary

OBJ: Cognitive Level: Application

9.The school nurse is talking with the teacher of a child who has growth hormone deficiency. As an advocate for the child, the school nurse will most need to talk with the teacher about which of the following needs of the child?

a.

to be placed at least one grade lower

b.

to be given extra-light homework assignments

c.

to be spoken to in an age-appropriate manner

d.

to be praised more often to build self-esteem

ANS: C

Feedback

A

Incorrect. Talking with the teacher of a child who has growth hormone deficiency, the school nurse will not most need to talk with the teacher about placing the child at least one grade lower.

B

Incorrect. Talking with the teacher of a child who has growth hormone deficiency, the school nurse will not most need to talk with the teacher about lightening up the homework assignments.

C

Correct. Talking with the teacher of a child who has growth hormone deficiency, the school nurse will most need to talk with the teacher about speaking to the child in an age-appropriate manner.

D

Incorrect. Talking with the teacher of a child who has growth hormone deficiency, the school nurse will not most need to talk with the teacher about continuous praise.

PTS:1REF:p. 988 Disorders of the Anterior Pituitary

OBJ: Cognitive Level: Application

10.The nurse is working with a child who has growth hormone deficiency and who will most likely have a diagnosis of delayed growth and development related to inadequate growth hormone secretion. Which of the following nursing diagnoses is the most likely additional diagnosis for this child?

a.

disturbed body image related to short stature

b.

at risk for injury related to inability to protect self

c.

imbalanced nutrition more than body requirements related to eating with peers

d.

impaired parenting related to lack of understanding of childs needs

ANS: A

Feedback

A

Correct. Among the diagnoses typical for a child who has growth hormone deficiency, the nurse will identify delayed growth and development, disturbed body image related to short stature, and deficient knowledge on the part of caregivers about treatment.

B

Incorrect. The nurse is not most likely to identify a diagnosis typical for a child who has growth hormone deficiency a risk for injury related to inability to protect self.

C

Incorrect. The nurse is not most likely to identify a diagnosis typical for a child who has growth hormone deficiency imbalanced nutrition more than body requirements related to eating with peers.

D

Incorrect. The nurse is not most likely to identify a diagnosis typical for a child who has growth hormone deficiency impaired parenting.

PTS:1REF:p. 988 Disorders of the Anterior Pituitary

OBJ: Cognitive Level: Application

11.Parents of a child with growth hormone deficiency ask the nurse about the cost of growth hormone, saying that they have heard it is expensive and they have little income. Which of the following is the nurses best response?

a.

The cost is small compared to the benefits your child will receive, so you need to do this for your child.

b.

Growth hormone can cost $30,000 per year or more; however, lets check what your insurance and special drug company programs will cover.

c.

Dont worry about the cost as there will somehow be a way to pay for it.

d.

Why dont you ask your church to help you look for a way to deal with the cost of treatment for your childs delayed growth and development?

ANS: B

Feedback

A

Incorrect. Asked about the cost of growth hormone treatments, the nurses best response to the parents is not that the cost is well forth it and you need to do this.

B

Correct. Caregivers need to be prepared for the financial implications of growth hormone therapy, which costs $ 25,000 to $ 30,000 per year to treat the average 30 kg child with GHD.

C

Incorrect. Asked about the cost of growth hormone treatments, the nurses best response to the parents is not that there is no need to worry.

D

Incorrect. Asked about the cost of growth hormone treatments, the nurses best response to the parents is not that they should look into charity first, there are many other options to explore.

PTS:1REF:p. 988 Disorders of the Anterior Pituitary

OBJ: Cognitive Level: Application

12.A child with growth hormone deficiency asks the nurse how many hormone shots he will have to take. The nurse will respond with which of the following answers?

a.

All you need is one injection, and then the problem will be fixed.

b.

This is a series of three injections, which will jump-start your production of growth hormone.

c.

There will be injections for about a year, and then you will be tall enough.

d.

These injections to help you grow can continue for many years.

ANS: D

Feedback

A

Incorrect. Responding to a child with growth hormone deficiency asking how many shots he will have to take, the nurses best response is not one injection, and then the problem will be fixed.

B

Incorrect. Responding to a child with growth hormone deficiency asking how many shots he will have to take, the nurses best response is not a series of three injections, which will jump-start your production of growth hormone.

C

Incorrect. Responding to a child with growth hormone deficiency asking how many shots he will have to take, the nurses best response is not injections for about a year, and then you will be tall enough.

D

Correct. Growth hormone treatment can continue for many years.

PTS:1REF:p. 988 Disorders of the Anterior Pituitary

OBJ: Cognitive Level: Application

13.Which of the following best describes precocious puberty in a Caucasian girl and an African-American girl?

a.

breast development before 7 years of age for Caucasian girls and before 6 years for African-American girls

b.

starting menses at age 9 for Caucasian girls and at age 8 for African-American girls

c.

dating before age 12 for both Caucasian and African-American girls

d.

wearing makeup and dressing in a sexually provocative way for both girls

ANS: A

Feedback

A

Correct. Precocious puberty in a Caucasian girl and an African-American girl is best described by breast development before 7 years of age for Caucasian girls and before 6 years for African-American girls.

B

Incorrect. Precocious puberty in a Caucasian girl and an African-American girl is not best described by the age they start their menses.

C

Incorrect. Precocious puberty in a Caucasian girl and an African-American girl is not best described by the age they start dating.

D

Incorrect. Precocious puberty in a Caucasian girl and an African-American girl is not best described by wearing makeup and dressing in a sexually provocative way for both girls.

PTS:1REF:p. 989 Disorders of the Anterior Pituitary

OBJ: Cognitive Level: Comprehension

14.Which of the following is most frequently the cause of precocious puberty in females?

a.

idiopathic

c.

trauma

b.

central nervous system lesions

d.

pituitary malfunction

ANS: A

Feedback

A

Correct. The cause of precocious puberty is most frequently idiopathic in girls. In contrast, in boys, the cause is most likely related to abnormalities in the central nervous system such as lesions.

B

Incorrect. The cause of precocious puberty in females is not most frequently central nervous system lesions (although true among males).

C

Incorrect. The cause of precocious puberty in females is not most frequently a result of trauma.

D

Incorrect. The cause of precocious puberty in females is not most frequently a pituitary malfunction.

PTS:1REF:p. 989 Disorders of the Anterior Pituitary

OBJ: Cognitive Level: Comprehension

15.When assessing a child with true precocious puberty, the nurse will most likely find which of the following signs or symptoms in addition to evidence of secondary sexual characteristics?

a.

sexual provocativeness, active sexual involvement, and lack of involvement with caregivers

b.

normal or elevated levels of gonadotropin-releasing Gn-RH), luteinizing hormone (LH), follicle-stimulating hormone (FSH), and estrogen or testosterone being produced

c.

low self-esteem, fear related to being more sexually developed than peers

d.

acne, adult body odor, greater height than peers, reproductive capability, and emotional lability

ANS: D

Feedback

A

Incorrect. The nurse will not most likely find that a child with true precocious puberty will express sexual provocativeness, active sexual involvement, and lack of involvement with caregivers.

B

Incorrect. The nurse will not most likely find that a child with true precocious puberty will display normal or elevated levels of gonadotropin-releasing Gn-RH), luteinizing hormone (LH), follicle-stimulating hormone (FSH), and estrogen or testosterone.

C

Incorrect. The nurse will not most likely find that a child with true precocious puberty will exhibit low self-esteem, fear related to being more sexually developed than peers.

D

Correct. The child with precocious puberty will have an accelerated growth rate, an advanced bone age, evidence of secondary sexual characteristics, acne, an adult body odor, and sometimes behavioral changes. Psychosocial development is typically age-appropriate. Emotional lability, aggressive behavior, and mood swings may occur.

PTS:1REF:p. 989 Disorders of the Anterior Pituitary

OBJ: Cognitive Level: Application

16.Which of the following statements best describes the difference between precocious pseudopuberty and true precocious puberty?

a.

In precocious pseudopuberty, the maturational changes are not real and are only in the imagination of the child or parents.

b.

In precocious pseudopuberty, there is an initial activation of reproductive-related hormones, but it is a false start and soon deactivates.

c.

In precocious pseudopuberty, there is early pseudo menses not connected with ovulation, whereas in true precocious puberty menses is associated with ovulation.

d.

In precocious pseudopuberty, there is breast or sexual hair growth but no activation of the hypothalamic-pituitary-gonadal axis.

ANS: D

Feedback

A

Incorrect. The statement, the maturational changes are not real and are only in the imagination of the child or parents does not best describe the difference between precocious pseudopuberty and true precocious puberty.

B

Incorrect. The statement, there is an initial activation of reproductive-related hormones, but it is a false start and soon deactivates does not best describe the difference between precocious pseudopuberty and true precocious puberty.

C

Incorrect. The statement, there is early pseudo menses not connected with ovulation, whereas in true precocious puberty menses is associated with ovulation does not best describe the difference between precocious pseudopuberty and true precocious puberty.

D

Correct. True or central precocious puberty can be distinguished from precocious pseudopuberty. True precocious puberty results from premature activation of the hypothalamic-pituitary-gonadal axis, with GnRH, LH, FSH, and estrogen or testosterone produced. Precocious pseudopuberty occurs when there is evidence of secondary sexual characteristics (breast or sexual hair growth) but not activation of the axis (normal levels of GnRH, LH, and FSH).

PTS:1REF:p. 989 Disorders of the Anterior Pituitary

OBJ: Cognitive Level: Application

17.You are the nurse taking a health history on a young girl with symptoms of precocious puberty. You would most want to ask the girl and her family to do which of the following things?

a.

to make a log of all the foods the girl eats during a week and to answer if alcohol is available in the household

b.

to show you the beauty products used by the young girl and to determine if birth control pills are available in the household

c.

to share with you what they know about birth control and the prevention of pregnancy

d.

to share with you what they know about precocious puberty

ANS: B

Feedback

A

Incorrect. Taking a health history on a young girl with symptoms of precocious puberty, you would not most want to ask the girl and her family to make a log of all the foods the girl eats during a week and to answer if alcohol is available in the household.

B

Correct. Many over-the-counter beauty products contain estrogen. If birth control pills are available in the house, verify that the child has not had access to them, possibly ingesting the pills to be just like mommy. This exposure to exogenous hormones could promote the development of symptoms of precocious puberty.

C

Incorrect. Taking a health history on a young girl with symptoms of precocious puberty, you would not most want to ask the girl and her family to share with you what they know about birth control and the prevention of pregnancy.

D

Incorrect. Taking a health history on a young girl with symptoms of precocious puberty, you would not most want to ask the girl and her family to share with you what they know about precocious puberty.

PTS:1REF:p. 989 Disorders of the Anterior Pituitary

OBJ: Cognitive Level: Application

18.Which of the following should be included in the physical examination of a young boy who has symptoms and signs of precocious puberty?

a.

examination of the testes and penis

b.

electrocardiogram (EKG) and cardiac enzymes

c.

a computed axial tomography (CAT) scan, magnetic resonance imaging (MRI) scan, or skull film

d.

an examination for gynecomastia

ANS: C

Feedback

A

Incorrect. As young males exhibiting symptoms and signs of precocious puberty very often have abnormalities in the central nervous system, it is not especially critical to perform an examination of the testes and penis.

B

Incorrect. As young males exhibiting symptoms and signs of precocious puberty very often have abnormalities in the central nervous system, it is not especially critical to perform an electrocardiogram (EKG) and test the cardiac enzymes.

C

Correct. As young males exhibiting symptoms and signs of precocious puberty very often have abnormalities in the central nervous system, it is especially critical to perform a computed axial tomography (CAT) scan, magnetic resonance imaging (MRI) scan, or skull film to look for lesions.

D

Incorrect. As young males exhibiting symptoms and signs of precocious puberty very often have abnormalities in the central nervous system, it is not especially critical to perform an examination for gynecomastia (abnormal enlargement of breasts in males).

PTS:1REF:p. 990 Disorders of the Anterior Pituitary

OBJ: Cognitive Level: Comprehension

19.The nurse assessing a child with precocious puberty will do a careful measurement of upper and lower body ratio. This ratio is best described as a comparison of which of the following measurements?

a.

the distance from the top of the head to the top of the pelvic bone and from the top of the pelvic bone to the bottom of the feet

b.

the width of the chest at the widest point and the pelvis at the widest point

c.

a comparison of the distance from the top of the head to the top of the synthesis pubis and from the synthesis pubis to the bottom of the feet

d.

a diagonal measurement from the distal end of the collarbone to the opposite pelvic bone midpoint and from that pelvic bone to the bottom of the opposite foot

ANS: C

Feedback

A

Incorrect. The upper/lower body ratio is not best calculated from the top of the head to the top of the pelvic bone, but from the top of the head to the top of the synthesis pubis.

B

Incorrect. The upper/lower body ratio is not best calculated from the width of the chest at the widest point and the pelvis at the widest point.

C

Correct. The upper/lower body ratio is calculated from a measurement from the top of the head to the top of the synthesis pubis and from the synthesis pubic to the bottom of the feet.

D

Incorrect. The upper/lower body ratio is not best calculated from any kind of diagonal measurements of whatever description.

PTS:1REF:p. 990 Disorders of the Anterior Pituitary

OBJ: Cognitive Level: Application

20.A child who has been diagnosed with precocious puberty is treated with a gonadotropin-releasing Gn-RH) analog. The nurse will do some teaching with the family and will explain that the initial repose to this analog will be:

a.

stimulation of gonadotropin release

b.

suppression of gonadotropin release

c.

no change in gonadotropin suppression or release

d.

total shutdown of gonadotropin release

ANS: A

Feedback

A

Correct. Precocious puberty is treated with a GnRH analog, usually given as a depot injection every 3-4 weeks. When initially given, it will stimulate gonadotropin release. Over time, it suppresses gonadotropin release, resulting in a decreased growth rate.

B

Incorrect. Teaching the family and child about treatment with a gonadotropin-releasing Gn-RH) analog, the nurse will not explain that the initial response will be the suppression of gonadotropin release.

C

Incorrect. Teaching the family and child about treatment with a gonadotropin-releasing Gn-RH) analog, the nurse will not explain that the initial response will be no change in gonadotropin suppression or release.

D

Incorrect. Teaching the family and child about treatment with a gonadotropin-releasing Gn-RH) analog, the nurse will not explain that the initial response will be a total shutdown of gonadotropin release.

PTS:1REF:p. 990 Disorders of the Anterior Pituitary

OBJ: Cognitive Level: Application

21.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:

a.

the amount of pain and bruising associated with the injection

b.

the average cost of $700-$1,000 per injection and the importance of checking insurance for any requirements relating to coverage

c.

the reaction of extended family members, friends, and others and how this will affect the childs self-esteem and body image

d.

the serious side effects of the Gn-RH analog depot

ANS: B

Feedback

A

Incorrect. Working with a child who is to receive the gonadotropin-releasing (Gn-RH) analog depot, the nurse does not most need to prepare the family for the amount of pain and bruising associated with the injection.

B

Correct. The childs family will need to be prepared for the financial aspect of the treatment. The GnRH analog depot cost averages $ 700-1,000 per injection. Third-party payers, with appropriate documentation, will frequently cover the cost of the therapy after the childs deductible has been met.

C

Incorrect. Working with a child who is to receive the gonadotropin-releasing (Gn-RH) analog depot, the nurse does not most need to prepare the family for the reaction of extended family members, friends, and others and how this will affect the childs self-esteem and body image.

D

Incorrect. Working with a child who is to receive the gonadotropin-releasing (Gn-RH) analog depot, the nurse does not most need to prepare the family for the serious side effects of the Gn-RH analog depot.

PTS:1REF:p. 990 Disorders of the Anterior Pituitary

OBJ: Cognitive Level: Application

22.After a child begins treatment for precocious puberty, the childs 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?

a.

bone age

c.

cardiac enzymes

b.

mammography

d.

blood sugar

ANS: A

Feedback

A

Correct. The childs growth is monitored regularly after initial treatment (every 3-4 months) and plotted accurately on a standardized growth chart. Bone age and serum hormone levels are monitored to evaluate the response to treatment.

B

Incorrect. Bone age and serum hormone levels are monitored to evaluate the response to treatment, not mammography.

C

Incorrect. Bone age and serum hormone levels are monitored to evaluate the response to treatment, not cardiac enzymes.

D

Incorrect. Bone age and serum hormone levels are monitored to evaluate the response to treatment, not blood sugar.

PTS:1REF:p. 993 Disorders of the Thyroid Gland

OBJ: Cognitive Level: Comprehension

23.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?

a.

Explain to the child that he needs to interact with others and not isolate himself.

b.

Set up a series of rewards and consequences for isolating from others.

c.

Explore with caregivers how the child and significant people such as teachers approach the child and what expectations are placed on the child.

d.

Prepare a calendar of prescheduled public outings, and take the child on these outings.

ANS: C

Feedback

A

Incorrect. Explaining to the child that he needs to interact with others and not isolate himself would be the least helpful intervention.

B

Incorrect. Setting up a series of rewards and consequences for isolating from others would not be the most helpful intervention.

C

Correct. Expectations of caregivers and others (teachers) are often based on the physical appearance of the child. A child who has precocious puberty will appear more mature than their age, and can generate inappropriate expectations that can increase the social isolation of the child.

D

Incorrect. Preparing a calendar of prescheduled public outings, and taking the child on these outings would not be the most helpful intervention.

PTS:1REF:p. 990 Disorders of the Anterior Pituitary

OBJ: Cognitive Level: Application

24.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:

a.

uncontrolled diabetes mellitus

b.

a genetic defect in the synthesis of antidiuretic hormone (ADH)

c.

infections affecting the spinal cord or brain, such as encephalitis or meningitis

d.

head trauma or cranial surgery to remove tumors of the hypothalamic-pituitary region

ANS: D

Feedback

A

Incorrect. The nurse will not most often find that diabetes insipidus occurs as a result of uncontrolled diabetes mellitus.

B

Incorrect. The nurse will not most often find that diabetes insipidus occurs as a result of a genetic defect in the synthesis of antidiuretic hormone (ADH).

C

Incorrect. The nurse will not most often find that diabetes insipidus occurs as a result of infections affecting the spinal cord or brain, such as encephalitis or meningitis.

D

Correct. Diabetes insipidus or neurogenic DI is a disorder of water regulation. DI is most often seen in children as a complication following head trauma or cranial surgery to remove tumors of the hypothalamic-pituitary regions. DI that develops after surgery may be transient or permanent.

PTS:1REF:p. 990 Disorders of the Anterior Pituitary

OBJ: Cognitive Level: Comprehension

25.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 nurses best answer?

a.

This disease involves a shortage of a hormone called antidiuretic hormone (ADH) that normally concentrates urine, and a shortage results in excretion of large amounts of dilute urine.

b.

It is a form of diabetes mellitus, and although it shares some features, it is somewhat different from type 1 and type 2.

c.

It is the only type of diabetes that does not involve the pancreas and insulin deficiency.

d.

There is a malfunction of the thirst mechanism in the brain, and the child drinks copious amounts of water without ever being satisfied and is in danger of water intoxication.

ANS: A

Feedback

A

Correct. Diabetes insipidus is best described as a disease involving a shortage of a hormone called antidiuretic hormone (ADH) that normally concentrates urine, and this shortage results in excretion of large amounts of dilute urine.

B

Incorrect. Answering a caregivers question about how best to describe diabetes insipidus, the nurses best answer is not: It is a form of diabetes mellitus, and although it shares some features, it is somewhat different from type 1 and type 2.

C

Incorrect. Answering a caregivers question about how best to describe diabetes insipidus, the nurses best answer is not: It is the only type of diabetes that does not involve the pancreas and insulin deficiency.

D

Incorrect. Answering a caregivers question about how best to describe diabetes insipidus, the nurses best answer is not that there is a malfunction of the thirst mechanism in the brain, causing the child to drink huge amounts of water risking water intoxication.

PTS:1REF:p. 990 Disorders of the Anterior Pituitary

OBJ: Cognitive Level: Application

26.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:

a.

type 1 diabetes mellitus

c.

diabetes insipidus

b.

type 2 diabetes mellitus

d.

diabetic ketoacidosis

ANS: C

Feedback

A

Incorrect. Learning that a child is waking at night to drink, and when denied water has then taken water out of the toilet or a puddle, the nurse will not most suspect type 1 diabetes mellitus.

B

Incorrect. Learning that a child is waking at night to drink, and when denied water has then taken water out of the toilet or a puddle, the nurse will not most suspect type 2 diabetes mellitus.

C

Correct. A common symptom of diabetes insipidus is the child who is much more satisfied with water in copious amounts than other liquids. The child will awaken at night to drink. Young children who have been denied fluids have been known to drink from a toilet or a puddle on the ground.

D

Incorrect. Learning that a child is waking at night to drink, and when denied water has then taken water out of the toilet or a puddle, the nurse will not most suspect diabetic ketoacidosis.

PTS:1REF:p. 991 Disorders of the Posterior Pituitary

OBJ: Cognitive Level: Application

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

a.

recessed jaw, delayed eruption of teeth, and difficulty swallowing at times

b.

low-set ears, wide-set eyes, a particularly wide face, and occasionally polydactylism

c.

exophthalmia, rapid pulse, elevated blood pressure, diarrhea, jitteriness, and difficulty sleeping at night

d.

facial puffiness, swollen eyelids, enlarged tongue, low anterior hairline, flattened nasal bridge, and dull expression

ANS: D

Feedback

A

Incorrect. Clinical manifestations of congenital hypothyroidism do not include recessed jaw or delayed eruption of teeth, but may include feeding difficulties.

B

Incorrect. Clinical manifestations of congenital hypothyroidism do not include low-set ears, wide-set eyes, a particularly wide face, and occasionally polydactylism.

C

Incorrect. Clinical manifestations of congenital hypothyroidism do not include exophthalmia, rapid pulse, elevated blood pressure, diarrhea, jitteriness, and difficulty sleeping at night.

D

Correct. Congenital hypothyroidism, a disorder present at birth, is a reduced rate of metabolism caused by a low concentration of circulating thyroid hormones. Clinical manifestations may include pallor, hypothermia, enlarged tongue, hypotonia, hypoactivity, feeding difficulties, delayed mental responsiveness or dull expression, cool, dry, scaly skin and swollen eyelids.

PTS:1REF:p. 992 Disorders of the Posterior Pituitary

OBJ: Cognitive Level: Comprehension

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

a.

in the pediatricians office during a physical exam by the pediatrician

b.

mandatory newborn screening using blood obtained from the infants

c.

in the nursery or obstetrical unit by a nurse observing the infant

d.

the mother noticing something is wrong with the newborn baby

ANS: B

Feedback

A

Incorrect. The majority of newborns with congenital hypothyroidism are not identified in the pediatricians office during a physical exam by the pediatrician.

B

Correct. Mandatory newborn screening identifies the majority of newborns with congenital hypothyroidism and allows early treatment, thereby reducing the incidence of mental retardation.

C

Incorrect. The majority of newborns with congenital hypothyroidism are identified by mandatory newborn screening which may occur in the nursery or obstetrical unit by a nurse observing the infant, but always at birth and not because a nurse observed the infant.

D

Incorrect. The majority of newborns with congenital hypothyroidism are not identified by the mother noticing something is wrong with the newborn baby.

PTS:1REF:p. 992 Disorders of the Posterior Pituitary

OBJ: Cognitive Level: Comprehension

29.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?

a.

A delay in treatment is associated with lower mean IQ.

b.

The parents may change their mind if allowed to wait for the decision.

c.

The problem is more difficult to correct as the child gets older.

d.

The cost will be more the longer the parents wait to begin treatment.

ANS: A

Feedback

A

Correct. Thyroid hormone is vital to the growing, developing central nervous system. A delay in treatment is associated with lower mean intelligence quotients (IQ).

B

Incorrect. The nurse will not encourage the parents to agree to treatment of hypothyroidism as soon as possible to avoid any change of mind on their part.

C

Incorrect. The nurse will not encourage the parents to agree to treatment of hypothyroidism as soon as possible because the problem is more difficult to correct as the child gets older, instead the brain damage is permanent and irreversible.

D

Incorrect. The nurse will not encourage the parents to agree to treatment of hypothyroidism as soon as possible to avoid larger bills.

PTS:1REF:p. 992 Disorders of the Posterior Pituitary

OBJ: Cognitive Level: Application

30.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?

a.

L-thyroxines absorption is affected by formulas that are soy based.

b.

Children who are on L-thyroxine and soy-based formulas often have allergic reactions.

c.

The L-thyroxine interferes with the absorption of calcium in the soy formula.

d.

Infants on soy formula and L-thyroxine will tend to vomit the formula.

ANS: A

Feedback

A

Correct. L-thyroxines absorption is affected by formulas that are soy based; therefore, caregivers should avoid using Alsoy (Nestle), Gerber Soy, Isomil (Mead Johnson), Nursoy (Wyeth-Ayerst), ProSobee (Mead Johnson), and Soyalac (Loma Linda), and any other soy-based formula.

B

Incorrect. L-thyroxines absorption is affected by formulas that are soy based, this is not an issue of allergies.

C

Incorrect. L-thyroxines absorption is affected by formulas that are soy based, it has nothing to do with the absorption of calcium in the soy formula.

D

Incorrect. L-thyroxines absorption is affected by formulas that are soy based, this is not an issue of vomiting.

PTS:1REF:p. 993 Disorders of the Thyroid Gland

OBJ: Cognitive Level: Application

31.At what age is acquired hypothyroidism generally recognized?

a.

6 months

c.

18 months

b.

12 months

d.

24 months

ANS: D

Feedback

A

Incorrect. Acquired hypothyroidism is generally recognized after the age of 2 years, not 6 months.

B

Incorrect. Acquired hypothyroidism is generally recognized after the age of 2 years, not 12 months.

C

Incorrect. Acquired hypothyroidism is generally recognized after the age of 2 years, not 18 months.

D

Correct. Acquired hypothyroidism, recognized after the age of 2 years, is a condition in which there are inadequate thyroid hormones.

PTS:1REF:p. 993 Disorders of the Thyroid Gland

OBJ: Cognitive Level: Knowledge

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

a.

childhood communicable diseases such as chickenpox or mumps

b.

an unusual reaction to immunizations for childhood communicable diseases

c.

autoimmune chronic lymphocytic thyroiditis called Hashimotos thyroiditis

d.

infections, particularly beta-hemolytic streptococcus infections

ANS: C

Feedback

A

Incorrect. Primary acquired hypothyroidism is not caused by childhood communicable diseases such as chickenpox or mumps.

B

Incorrect. Primary acquired hypothyroidism is not caused by an unusual reaction to immunizations for childhood communicable diseases.

C

Correct. Primary acquired hypothyroidism is the most common form and is usually caused by autoimmune chronic lymphocytic thyroiditis called Hashimotos thyroiditis. This condition occurs during childhood and adolescence and more frequently in girls.

D

Incorrect. Primary acquired hypothyroidism is not caused by infections, particularly beta-hemolytic streptococcus infections.

PTS:1REF:p. 994 Disorders of the Thyroid Gland

OBJ: Cognitive Level: Comprehension

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

a.

males

b.

other autoimmune-mediated diseases such as type 1 diabetes or chromosomal abnormalities

c.

pituitary or hypothalamic dysfunction

d.

American Indians

ANS: B

Feedback

A

Incorrect. Acquired primary hypothyroidism occurs in greater frequency among females.

B

Correct. Acquired primary hypothyroidism occurs in greater frequency with other autoimmune-mediated diseases like type 1 diabetes or chromosomal abnormalities such as Down syndrome.

C

Incorrect. Secondary or tertiary hypothyroidism is associated with pituitary or hypothalamic dysfunction.

D

Incorrect. Acquired primary hypothyroidism is not especially related to American Indians.

PTS:1REF:p. 994 Disorders of the Thyroid Gland

OBJ: Cognitive Level: Comprehension

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

a.

decreased rate of growth, weight gain, dry skin, coarse or thinning hair, and fatigue

b.

headaches, dizziness, shakiness, disturbed vision, confusion, and frequent hunger

c.

rapid respiratory rate, tachycardia, weakness, and unusual odor to breath

d.

skin rash, loss of taste, mild leukopenia, and abnormal pigmentation of hair

ANS: A

Feedback

A

Correct. Clinical manifestations of acquired hypothyroidism include decreased rate of growth, weight gain, constipation, dry skin, thinning or coarse hair, fatigue, cold intolerance, edema of face, eyes and hands, delayed deep tendon reflexes and delayed puberty and tooth eruption.

B

Incorrect. Clinical manifestations of acquired hypothyroidism do not include headaches, dizziness, shakiness, disturbed vision, confusion, and frequent hunger.

C

Incorrect. Clinical manifestations of acquired hypothyroidism do not include rapid respiratory rate, tachycardia, weakness, and unusual odor to breath.

D

Incorrect. Clinical manifestations of acquired hypothyroidism do not include skin rash, loss of taste, mild leukopenia, and abnormal pigmentation of hair.

PTS:1REF:p. 994 Disorders of the Thyroid Gland

OBJ: Cognitive Level: Application

35.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:

a.

acquired hypothyroidism

c.

Addisons disease

b.

hyperthyroidism

d.

Cushings disease

ANS: A

Feedback

A

Correct. 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 acquired hypothyroidism.

B

Incorrect. Hearing a student is concerned about her delayed puberty and a delay in tooth eruption, the nurse will not suspect and further assess for hyperthyroidism.

C

Incorrect. Hearing a student is concerned about her delayed puberty and a delay in tooth eruption, the nurse will not suspect and further assess for Addisons disease.

D

Incorrect. Hearing a student is concerned about her delayed puberty and a delay in tooth eruption, the nurse will not suspect and further assess for Cushings disease.

PTS:1REF:p. 994 Disorders of the Thyroid Gland

OBJ: Cognitive Level: Application

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

a.

Mix the medicine with a citrus juice before administration.

b.

Give the medicine with the meal itself.

c.

Give the medicine 30 to 60 minutes prior to a meal.

d.

Give the medicine with only a few sips of water.

ANS: C

Feedback

A

Incorrect. Instructing caregivers about the administration of L-thyroxine, the nurse will not tell the caregivers to mix the medicine with a citrus juice before administration.

B

Incorrect. Instructing caregivers about the administration of L-thyroxine, the nurse will not tell the caregivers to give the medicine with the meal itself.

C

Correct. Instructing caregivers about the administration of L-thyroxine, the nurse will tell the caregivers the importance of daily medication given 30-60 minutes prior to a meal to optimize its absorption.

D

Incorrect. Instructing caregivers about the administration of L-thyroxine, the nurse will not tell the caregivers to give the medicine with only a few sips of water.

PTS:1REF:p. 994 Disorders of the Thyroid Gland

OBJ: Cognitive Level: Application

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

a.

Graves disease

c.

infection

b.

cancer

d.

Addisons disease

ANS: A

Feedback

A

Correct. The most common cause of hyperthyroidism in the pediatric population is Graves disease, which is five times more common in girls than in boys.

B

Incorrect. The most common cause of hyperthyroidism in the pediatric population is not cancer.

C

Incorrect. The most common cause of hyperthyroidism in the pediatric population is not infection.

D

Incorrect. The most common cause of hyperthyroidism in the pediatric population is not Addisons disease.

PTS:1REF:p. 994 Disorders of the Thyroid Gland

OBJ: Cognitive Level: Comprehension

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

a.

constipation, bradycardia, slowed respirations, lack of energy, and complaint of tiredness

b.

disorientation, confusion, extreme hunger, agitation, pallor, headaches, and blurred vision

c.

weight loss despite excellent appetite, fine tremors, warm and moist skin, tachycardia, and ophthalmic changes

d.

cardiac arrhythmias, low potassium and high sodium levels, and polyuria

ANS: C

Feedback

A

Incorrect. Clinical manifestations of hyperthyroidism does not include constipation, bradycardia, slowed respirations, lack of energy, and complaint of tiredness.

B

Incorrect. Clinical manifestations of hyperthyroidism does not include disorientation, confusion, extreme hunger, agitation, pallor, headaches, and blurred vision.

C

Correct. Clinical manifestations of hyperthyroidism includes increased rate of growth, weight loss despite excellent appetite, warm and moist skin, tachycardia, ophthalmic changes, heat intolerance, emotional lability, insomnia, and fine tremors.

D

Incorrect. Clinical manifestations of hyperthyroidism does not include cardiac arrhythmias, low potassium and high sodium levels, and polyuria.

PTS:1REF:p. 997 Disorders of the Thyroid Gland

OBJ: Cognitive Level: Knowledge

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

a.

hypothyroidism

c.

growth hormone deficiency

b.

congenital adrenal hyperplasia

d.

hyperthyroidism

ANS: D

Feedback

A

Incorrect. Ophthalmic changes are not associated with hypothyroidism.

B

Incorrect. Ophthalmic changes are not associated with congenital adrenal hyperplasia.

C

Incorrect. Ophthalmic changes are not associated with growth hormone deficiency.

D

Correct. Ophthalmic changes with hyperthyroidism include exophthalmos (bulging of the eyeballs), proptosis (downward displacement of the eyeball), lid lag, lid retraction, staring expression, periorbital edema (swelling around the eyeball), and diplopia (double vision).

PTS:1REF:p. 997 Disorders of the Thyroid Gland

OBJ: Cognitive Level: Application

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

a.

depression, loss of energy, and bruising easily

b.

enlarged adrenal glands, hypertension, profuse amounts of dilute urine, and edema of extremities

c.

premature pubic hair development, accelerated growth velocity, acne, hirsutism, and advanced bone age

d.

excretion of abnormally large amount of urine, and excessive thirst

ANS: C

Feedback

A

Incorrect. Children in the toddler or preschool years who have congenital adrenal hyperplasia will not have symptoms of depression, loss of energy, and bruising easily.

B

Incorrect. Children in the toddler or preschool years who have congenital adrenal hyperplasia will not have symptoms of enlarged adrenal glands, hypertension, profuse amounts of dilute urine, and edema of extremities.

C

Correct. Children in the toddler or preschool years who have congenital adrenal hyperplasia will have symptoms of premature pubic hair development, accelerated growth velocity, acne, hirsutism, and advanced bone age.

D

Incorrect. Children in the toddler or preschool years who have congenital adrenal hyperplasia will not have symptoms of excessive thirst and the excretion of an abnormally large amount of urine.

PTS:1REF:p. 999 Disorders of the Thyroid Gland

OBJ: Cognitive Level: Comprehension

41.If not diagnosed at birth, a newborn with 21-hydroxylase (21-OH) deficiency and salt wasting will develop which of the following problems by days 10 to 14 of life?

a.

seizures

c.

thyroid storm

b.

coma

d.

adrenal crisis

ANS: D

Feedback

A

Incorrect. If not diagnosed at birth, a newborn with 21-hydroxylase (21-OH) deficiency and salt wasting will have lower sodium level, higher potassium level and a lower volume of blood circulation, not subject to seizures.

B

Incorrect. If not diagnosed at birth, a newborn with 21-hydroxylase (21-OH) deficiency and salt wasting will have lower sodium level, higher potassium level and a lower volume of blood circulation, with coma as a potential; but, greater risks possible.

C

Incorrect. If not diagnosed at birth, a newborn with 21-hydroxylase (21-OH) deficiency and salt wasting will develop a life-threatening hyponatremia, hyperkalemia, and hypovolemia by day 10-14 of life. This is not known as a thyroid storm.

D

Correct. If not diagnosed at birth, a newborn with 21-hydroxylase (21-OH) deficiency and salt wasting will develop a life-threatening hyponatremia, hyperkalemia, and hypovolemia by day 10-14 of life. This is known as adrenal crisis.

PTS:1REF:p. 999 Disorders of the Thyroid Gland

OBJ: Cognitive Level: Comprehension

MULTIPLE RESPONSE

1.The recent dramatic increase in the incidence of type 2 diabetes has occurred mainly in which of the following groups? Select all that apply.

a.

overweight children

c.

males over age 25

b.

culturally diverse populations

d.

females over age 25

ANS: A, B

Feedback

Correct

The incidence of type 2 diabetes has increased dramatically in children who are overweight.

The incidence of type 2 diabetes has increased dramatically in children who are overweight and in culturally diverse populations.

Incorrect

Type 2 diabetes is increasing in individuals under the age of 25, rather than in males and females over age 25.

Type 2 diabetes is increasing in individuals under the age of 25, rather than in males and females over age 25.

PTS:1REF:p. 1001 Disorders of the Adrenal Gland

OBJ: Cognitive Level: Comprehension

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