c28endocrinedysfunction Flashcards
Parents of a toddler with hypopituitarism ask the nurse, “What can we expect with this condition?” The nurse should respond with which statement?
a. Growth is normal during the first 3 years of life.
b. Weight is usually more retarded than height.
c. Skeletal proportions are normal for age.
d. Most of these children have subnormal intelligence.
ANS: C
In children with hypopituitarism, the skeletal proportions are normal. Growth is within normal limits for the first year of life. Height is usually more delayed than weight. Intelligence is not affected by hypopituitarism.
A child with hypopituitarism is being started on growth hormone (GH) therapy. Nursing considerations should be based on which knowledge?
a. Treatment is most successful if it is started during adolescence.
b. Treatment is considered successful if children attain full stature by adulthood.
c. Replacement therapy requires daily subcutaneous injections.
d. Replacement therapy will be required throughout the child’s lifetime.
ANS: C
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. When therapy is successful, children can attain their actual or near-final adult height at a slower rate than their peers. Replacement therapy is not needed after attaining final height. They are no longer GH deficient.
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. On arising in the morning
ANS: A
Injections are best given at bedtime to more closely approximate the physiologic release of GH. After or before meals and on arising in the morning do not mimic the physiologic release of the hormone.
An adolescent is being seen in the clinic for evaluation of acromegaly. The nurse understands that which occurs with acromegaly?
a. There is a lack of growth hormone (GH) being produced.
b. There is excess growth hormone (GH) after closure of the epiphyseal plates.
c. There is an excess of growth hormone (GH) before the closure of the epiphyseal plates.
d. There is a lack of thyroid hormone being produced.
ANS: B
Excess GH after closure of the epiphyseal plates results in acromegaly. A lack of growth hormone results in delayed growth or even dwarfism. Gigantism occurs when there is hypersecretion of GH before the closure of the epiphyseal plates. Cretinism is associated with hypothyroidism.
A child will start treatment for precocious puberty. The nurse recognizes that this will involve the injection of which synthetic medication?
a. Thyrotropin
b. Gonadotropins
c. Somatotropic hormone
d. Luteinizing hormone–releasing hormone
ANS: D
Precocious puberty of central origin is treated with monthly subcutaneous injections of luteinizing hormone–releasing hormone. Thyrotropin, gonadotropins, and somatotropic hormone are not the appropriate therapies for precocious puberty.
The nurse is conducting a staff in-service on childhood endocrine disorders. Diabetes insipidus is a disorder of:
a. anterior pituitary.
b. posterior pituitary.
c. adrenal cortex.
d. adrenal medulla.
ANS: B
The principal disorder of posterior pituitary hypofunction is diabetes insipidus. The anterior pituitary produces hormones such as GH, thyroid-stimulating hormone, adrenocorticotropic hormone, gonadotropin, prolactin, and melanocyte-stimulating hormone. The adrenal cortex produces aldosterone, sex hormones, and glucocorticoids. The adrenal medulla produces catecholamines.
The nurse is caring for a preschool child with suspected diabetes insipidus. Which clinical manifestation should the nurse expect to observe?
a. Oliguria
b. Glycosuria
c. Nausea and vomiting
d. Polyuria and polydipsia
ANS: D
Excessive urination accompanied by insatiable thirst is the primary clinical manifestation of diabetes. These symptoms may be so severe that the child does little other than drink and urinate. Oliguria is decreased urine production and is not associated with diabetes insipidus. Glycosuria is associated with diabetes mellitus. Nausea and vomiting are associated with inappropriate antidiuretic hormone (ADH) secretion.
A nasal spray of desmopressin acetate (DDAVP) is used to treat which disorder?
a. Hypopituitarism
b. Diabetes insipidus
c. Acute adrenocortical insufficiency
d. Syndrome of inappropriate antidiuretic hormone
ANS: B
The drug of choice for the treatment of diabetes insipidus is DDAVP, which is a synthetic analogue of vasopressin. DDAVP is not used to treat hypopituitarism, acute adrenocortical insufficiency, or syndrome of inappropriate antidiuretic hormone.
The nurse is admitting a toddler with the diagnosis of juvenile hypothyroidism. Which is a common clinical manifestation of this disorder?
a. Insomnia
b. Diarrhea
c. Dry skin
d. Accelerated growth
ANS: C
Dry skin, mental decline, and myxedematous skin changes are associated with juvenile hypothyroidism. Children with hypothyroidism are usually sleepy. Constipation is associated with hypothyroidism. Decelerated growth is common in juvenile hypothyroidism.
A goiter is an enlargement or hypertrophy of which gland?
a. Thyroid
b. Adrenal
c. Anterior pituitary
d. Posterior pituitary
ANS: A
A goiter is an enlargement or hypertrophy of the thyroid gland. Goiter is not associated with the adrenal, anterior pituitary, or posterior pituitary organs.
What condition may cause exophthalmos (protruding eyeballs) in children?
a. Hypothyroidism
b. Hyperthyroidism
c. Hypoparathyroidism
d. Hyperparathyroidism
ANS: B
Exophthalmos is a clinical manifestation of hyperthyroidism. Hypothyroidism, hypoparathyroidism, and hyperparathyroidism are not associated with exophthalmos.
The nurse is teaching the parents of a child who is receiving methimazole (Tapazole) for the treatment of hyperthyroidism (Graves disease). Which statement made by the parent indicates a correct understanding of the teaching?
a. “I would expect my child to gain weight while taking this medication.”
b. “I would expect my child to experience episodes of ear pain while taking this medication.”
c. “If my child develops a sore throat and fever, I should contact the physician immediately.”
d. “If my child develops the stomach flu, my child will need to be hospitalized.”
ANS: C
Children being treated with Tapazole must be carefully monitored for the side effects of the medication. Parents must be alerted that sore throat and fever accompany the grave complication of leukopenia. These symptoms should be immediately reported. Weight gain, episodes of ear pain, and concern for hospitalization with the stomach flu are not concerns related to taking Tapazole.
Which clinical manifestation may occur in the child who is receiving too much methimazole (Tapazole) for the treatment of hyperthyroidism (Graves disease)?
a. Seizures
b. Enlargement of all lymph glands
c. Pancreatitis or cholecystitis
d. Lethargy and somnolence
ANS: D
Parents should be aware of the signs of hypothyroidism that can occur from overdosage of the drug. The most common manifestations are lethargy and somnolence. Seizures and pancreatitis are not associated with the administration of Tapazole. Enlargement of the salivary and cervical lymph glands occurs.
A child with hypoparathyroidism is receiving vitamin D therapy. The parents should be advised to watch for which sign of vitamin D toxicity?
a. Headache and seizures
b. Physical restlessness and voracious appetite without weight gain
c. Weakness and lassitude
d. Anorexia and insomnia
ANS: C
Vitamin D toxicity can be a serious consequence of therapy. Parents are advised to watch for signs, including 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. Physical restlessness and a voracious appetite with weight loss are manifestations of hyperthyroidism. Anorexia and insomnia are not characteristic of vitamin D toxicity.
What secretes glucocorticoids, mineralocorticoids, and sex steroids?
a. Thyroid gland
b. Parathyroid glands
c. Adrenal cortex
d. Anterior pituitary
ANS: C
These hormones are secreted by the adrenal cortex. The thyroid gland produces thyroid hormone and thyrocalcitonin. The parathyroid gland produces parathyroid hormone. The anterior pituitary produces hormones such as GH, thyroid-stimulating hormone, adrenocorticotropic hormone, gonadotropin, prolactin, and melanocyte-stimulating hormone.
What is chronic adrenocortical insufficiency also called?
a. Graves disease
b. Addison disease
c. Cushing syndrome
d. Hashimoto disease
ANS: B
Addison disease is chronic adrenocortical insufficiency. Graves and Hashimoto diseases involve the thyroid gland. Cushing syndrome is a result of excessive circulation of free cortisol.
The parents of a neonate with adrenogenital hyperplasia tell the nurse that they are afraid to have any more children. The nurse should explain which statement about adrenogenital hyperplasia?
a. It is not hereditary.
b. Genetic counseling is indicated.
c. It can be prevented during pregnancy.
d. All future children will have the disorder.
ANS: B
Some forms of adrenogenital hyperplasia are hereditary and should be referred for genetic counseling. Affected offspring should also be referred for genetic counseling. There is an autosomal recessive form of adrenogenital hyperplasia. A prenatal treatment with glucocorticoids can be offered to the mother during pregnancy to avoid the sex ambiguity, but it does not affect the presence of the disease. If it is the heritable form, for each pregnancy, a 25% risk occurs that the child will be affected.
Which is characteristic of the immune-mediated type 1 diabetes mellitus?
a. Ketoacidosis is infrequent.
b. Onset is gradual.
c. Age at onset is usually younger than 20 years.
d. Oral agents are often effective for treatment.
ANS: C
The immune-mediated type 1 diabetes mellitus typically has its onset in children or young adults. Infrequent ketoacidosis, gradual onset, and effectiveness of oral agents for treatment are more consistent with type 2 diabetes.
Which is considered a cardinal sign of diabetes mellitus?
a. Nausea
b. Seizures
c. Impaired vision
d. Frequent urination
ANS: D
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.
Hyperglycemia associated with diabetic ketoacidosis is defined as a blood glucose measurement equal to or greater than _____ mg/dl.
a. 100
b. 120
c. 180
d. 200
ANS: D
Diabetic ketoacidosis is a state of relative insulin insufficiency and may include the presence of hyperglycemia, a blood glucose level greater than or equal to 200 mg/dl. The values 100 mg/dl, 120 mg/dl, and 180 mg/dl are too low for the definition of ketoacidosis.
Type 1 diabetes mellitus is suspected in an adolescent. Which clinical manifestation may be present?
a. Moist skin
b. Weight gain
c. Fluid overload
d. Poor wound healing
ANS: D
Poor wound healing may be present in an individual with type 1 diabetes mellitus. Dry skin, weight loss, and dehydration are clinical manifestations of type 1 diabetes mellitus.
A parent asks the nurse why self-monitoring of blood glucose is being recommended for her child with diabetes. The nurse should base the explanation on which knowledge?
a. It is a less expensive method of testing.
b. It is not as accurate as laboratory testing.
c. Children are better able to manage the diabetes.
d. Parents are better able to manage the disease.
ANS: C
Blood glucose self-management has improved diabetes management and can be used successfully by children from the time of diagnosis. Insulin dosages can be adjusted based on blood glucose results. Blood glucose monitoring is more expensive but provides improved management. It is as accurate as equivalent testing done in laboratories. The ability to self-test allows the child to balance diet, exercise, and insulin. The parents are partners in the process, but the child should be taught how to manage the disease.
The parent of a child with diabetes mellitus asks the nurse when urine testing will be necessary. The nurse should explain that urine testing is necessary for which?
a. Glucose is needed before administration of insulin.
b. Glucose is needed four times a day.
c. Glycosylated hemoglobin is required.
d. Ketonuria is suspected.
ANS: D
Urine testing is still performed to detect evidence of ketonuria. Urine testing for glucose is no longer indicated because of the poor correlation between blood glucose levels and glycosuria. Glycosylated hemoglobin analysis is performed on a blood sample.
The parents of a child who has just been diagnosed with type 1 diabetes ask about exercise. Which should the nurse explain about exercise in type 1 diabetes?
a. Exercise will increase blood glucose.
b. Exercise should be restricted.
c. Extra snacks are needed before exercise.
d. Extra insulin is required during exercise.
ANS: C
Exercise lowers blood glucose levels, which can be compensated for by extra snacks. Exercise lowers blood glucose and is encouraged and not restricted, unless indicated by other health conditions. Extra insulin is contraindicated because exercise decreases blood glucose levels.
