Question 1

During the summer,many children are more physically active.What changes in the management of the child with diabetes should be taught as a result of more exercise?

Accepted Answer

Increased physical activity can lead to lower blood sugar levels, so children with diabetes may need to increase their food intake to prevent hypoglycemia.

Question 2

A nurse taking a daily weight on a child with diabetes insipidus notes the child has lost 2 pounds in 24 hours.Which is the nurse's priority action?

Accepted Answer

Losing 2 pounds in 24 hours is a significant weight loss and could be indicative of a fluid imbalance or other issue related to the child's diabetes insipidus. The nurse's priority action should be to notify the physician to determine if any interventions are necessary. Simply monitoring the child or charting the weight without taking action could lead to further complications.

Question 3

A child has been admitted to the hospital unconscious.The child has a history of insulin-dependent diabetes mellitus,and according to the child's mother,he took a normal dose of insulin this morning with breakfast.At school,the child had two pieces of birthday cake and some ice cream at a class birthday party.What is the likely reason for this child's unconscious state?

Accepted Answer

The child most likely experienced metabolic ketoacidosis due to the combination of insulin and sugar intake from the birthday cake and ice cream. This can result in high levels of ketones which can lead to unconsciousness. Insulin shock and insulin reaction are outdated terms and are now referred to as hypoglycemia. Metabolic alkalosis would not be a likely cause of the child's unconsciousness in this scenario.

Question 4

A nurse is caring for a child with growth hormone deficiency.Which assessment finding would be most characteristic of this disorder?

Accepted Answer

Decreased muscle mass is a common finding in children with growth hormone deficiency, as growth hormone plays a role in promoting muscle growth and development. The absence of abdominal fat, mature facial features, and accelerated skeletal maturation are not necessarily characteristic of this disorder.

Question 5

A nurse is planning care for a child with adrenal insufficiency (Addison's disease).Which of the following is the priority nursing diagnosis?

Accepted Answer

The priority nursing diagnosis for a child with adrenal insufficiency (Addison's disease) is risk for deficient fluid volume. This is because the child's adrenal glands are not producing enough cortisol, which can lead to decreased sodium levels and dehydration. It is important for the nurse to monitor the child's fluid balance and ensure adequate fluid intake to prevent complications such as electrolyte imbalances, hypotension, and shock. The other options may be appropriate diagnoses, but they are not the priority at this time.

Question 6

A child with growth hormone deficiency will be receiving a daily subcutaneous injection of biosynthetic growth hormone.The parents are being trained to administer the injection.Which instruction is most important for the nurse to include in parent instructions?

Accepted Answer

It is important to rotate the injection sites to prevent tissue atrophy and other complications associated with frequent injections in the same site. Avoiding alcohol before injection is not recommended as it increases the risk of infection. Using only the legs for injection sites is not necessary as other areas such as the upper arm, abdomen, and buttocks can also be used. Delaying the injection by a day if the child becomes upset is not recommended as it may disrupt the dosing schedule and affect treatment outcomes.

Question 7

The nurse is caring for a child with syndrome of inappropriate antidiuretic hormone (SIADH)disorder.Which interventions should the nurse implement for this child? Select all that apply.

Accepted Answer

SIADH involves excessive release of antidiuretic hormone, leading to water retention and dilutional hyponatremia. Therefore, fluid restriction (not encouragement) is necessary. Monitoring intake and output (B) helps assess fluid balance. Diuretics (C) may be ordered to promote water excretion. Checking urine specific gravity (D) helps evaluate urine concentration. Daily weight monitoring is important to assess fluid retention, so E is incorrect.

Question 8

The child has been diagnosed with insulin-dependent diabetes mellitus.The nurse has taught the child the difference between insulin shock and diabetic hyperglycemia.The nurse knows that the child understood the teaching when the child identifies which of the following as characteristics of diabetic hyperglycemia?

Accepted Answer

Thirst and flushed skin are characteristic of diabetic hyperglycemia, while tremors and lethargy are characteristic of insulin shock. Hunger and hypertension are not specific to either condition, and shakiness and pallor are more characteristic of insulin shock.

Question 9

A child will require lifelong cortisol replacement therapy following the removal of adrenal glands.Which is the priority instruction for the family?

Accepted Answer

Hydrocortisone, a synthetic form of cortisol, should ideally be administered early in the morning to mimic the body's natural rhythm of cortisol production. This helps in maintaining normal physiological functions and reduces the risk of side effects. Administering it every other day is not a standard practice for cortisol replacement therapy; it's mentioned here to highlight the importance of consistent morning dosing. Continuous, daily administration is typically required for life in the absence of adrenal glands.

Question 10

An adolescent girl with Graves' disease is admitted to the hospital.The nurse expects to find which clinical manifestation characteristics of Graves' disease (hyperthyroidism)present?

Accepted Answer

Hyperthyroidism, characteristic of Graves' disease, presents with symptoms such as tachycardia, fatigue, and heat intolerance due to an overactive thyroid gland. Weight gain and muscle weakness are associated with hypothyroidism while dehydration, metabolic acidosis, and hypotension are not commonly seen in Graves' disease. Hyperglycemia, ketonuria, and glucosuria are associated with diabetes mellitus.

Question 11

The nurse is administering an 0800 dose of NPH insulin to an insulin-dependent diabetic child.Based on when the insulin peaks,at which period would the child be at greatest risk for a hypoglycemic episode?

Accepted Answer

The answer of The nurse is administering an 0800 dose...

Question 12

A child with diabetes insipidus has been admitted to the Pediatric Unit.The nurse would expect the child's lab value to demonstrate:

Accepted Answer

Diabetes insipidus (DI) involves the inability to regulate fluid balance in the body due to inadequate secretion of antidiuretic hormone (ADH) by the pituitary gland. This results in excessive urine output and dehydration, leading to hypernatremia (elevated serum sodium levels). Hyperglycemia (elevated blood glucose levels) is not a characteristic finding of DI, as it is seen in diabetes mellitus. Hypercalcemia (elevated serum calcium levels) is not directly related to DI. Hypoglycemia (low blood glucose levels) is also not expected in DI.

Question 13

A child with Turner's syndrome tells the nurse she feels different from her peers.Which response should the nurse give?

Accepted Answer

The nurse should engage the child in a therapeutic conversation by asking her to talk about her feelings to better understand her concerns about her condition. This demonstrates empathy and provides an opportunity for the child to share her fears and concerns.

Question 14

You are teaching the parent of a diabetic preschool-age child about management of the disease.The parent should be told to allow the preschool child to:

Accepted Answer

Allowing the child to pick which finger to stick for glucose testing gives them a sense of control and involvement in their care, which is appropriate for their developmental level. Administering insulin injections and drawing up the insulin dose require a level of dexterity and understanding that is beyond the capabilities of most preschool-aged children. Testing blood glucose can be complex and may also be too challenging for a child of this age to do independently.

Quiz 55: The Child With Alterations in Endocrine Function