Chapter 51: Endocrine dysfunction

Question 1

1. Which statement best describes hypopituitarism?
   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 the age.
   d. Most of these children have subnormal intelligence.

Answer 1

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.

Question 2

2. Which is a condition that can result if there is hypersecretion of growth hormone (GH) after epiphyseal closure? a. Dwarfism
   b. Acromegaly c. Gigantism d. Cretinism

Answer 2

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

Question 3

3. At what age is sexual development in boys and girls considered to be precocious?
   a. Boys, 11 years; girls, 9 years
   b. Boys, 12 years; girls, 10 years
   c. Boys, 9 years; girls, 8 years
   d. Boys, 10 years; girls, 9.5 years

Answer 3

ANS: C
Manifestations of sexual development before age 9 in boys and 8 in girls are considered precocious and should be investigated. However, recent research indicates that puberty is beginning early in girls and it is suggested that precocious puberty may be evident as young as 6 or 7 years of age. Boys older than 9 years of age and girls older than 8 years of age fall within the expected range of pubertal onset.

Question 4

4. A child is starting treatment for precocious puberty. This involves injections of which synthetic substance?
   a. Thyrotropin
   b. Gonadotropins
   c. Somatotropic hormone
   d. Luteinizing hormone–releasing hormone

Answer 4

ANS: D
Precocious puberty of central origin is treated with monthly subcutaneous injections of luteinizing hormone–releasing hormone. Thyrotropin, gonadotropin, and somatotropic hormone are not appropriate therapies for precocious puberty.

Question 5

5. Diabetes insipidus is a disorder of which of structure?
   a. Anterior pituitary
   b. Posterior pituitary
   c. Adrenal cortex
   d. Adrenal medulla

Answer 5

ANS: B
The principal disorder of posterior pituitary hypofunction is diabetes insipidus. The anterior pituitary produces growth hormones, thyroid-stimulating hormones, adrenocorticotropic hormones, gonadotropin, prolactin, and melanocyte-stimulating hormone. The adrenal cortex produces aldosterone, sex hormones, and glucocorticoids. The adrenal medulla produces catecholamines.

Question 6

6. Which clinical manifestation would the nurse expect to observe when caring for a child with suspected diabetes insipidus?
   a. Oliguria
   b. Glycosuria
   c. Nausea and vomiting
   d. Polyuria and polydipsia

Answer 6

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 secretion.

Question 7

7. Which would the nurse expect when completing an assessment on a child with juvenile hypothyroidism?
   a. Insomnia
   b. Diarrhea
   c. Dry skin
   d. Accelerated growth

Answer 7

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 and decelerated growth is common.

Question 8

8. A goitre is an enlargement, or hypertrophy, of which gland?
   a. Thyroid gland
   b. Adrenal gland
   c. Anterior pituitary gland
   d. Posterior pituitary gland

Answer 8

ANS: A
A goitre is an enlargement, or hypertrophy, of the thyroid gland. Goitre is not associated with the adrenals or the anterior and posterior pituitaries.

Question 9

9. Which may cause exophthalmos? a. Hypothyroidism
   b. Hyperthyroidism
   c. Hypoparathyroidism
   d. Hyperparathyroidism

Answer 9

ANS: B
Exophthalmos is manifested as protruding eyeballs and is a clinical manifestation of hyperthyroidism. Hypothyroidism, hypoparathyroidism, and hyperparathyroidism are not associated with exophthalmos.

Question 10

10. The nurse is teaching the parents of a child who is receiving propylthiouracil for the treatment of Graves’ disease. Which statement indicates the parents’ correct understanding of the teaching?
    a. “I expect my child to gain weight while taking this medication.”
    b. “I 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, he will need to be hospitalized.”

Answer 10

ANS: C
Children being treated with propylthiouracil must be carefully monitored for the adverse effects of the drug. Parents must be alerted that sore throat and fever accompany the grave complication of leukopenia, so these symptoms should be immediately reported. Weight gain, episodes of ear pain, and stomach flu are not usually associated with leukopenia.

Question 12

11. 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

Answer 12

ANS: C
Vitamin D toxicity can be a serious consequence of vitamin D 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.

Question 13

12. Which secretes glucocorticoids, mineralocorticoids, and sex steroids?
    a. Thyroid gland
    b. Parathyroid glands
    c. Adrenal cortex
    d. Anterior pituitary

Answer 13

ANS: C
These hormones are secreted by the adrenal cortex. The thyroid gland produces thyroid hormone and thyrocalcitonin. The parathyroid glands produce parathyroid hormones. The anterior pituitary produces growth hormone, thyroid-stimulating hormone, adrenocorticotropic hormone, gonadotropin, prolactin, and melanocyte-stimulating hormone.

Question 14

13. What is another name for chronic adrenocortical insufficiency?
    a. Graves’ disease
    b. Addison’s disease
    c. Cushing’s syndrome
    d. Hashimoto’s disease

Answer 14

ANS: B
Addison’s disease is chronic adrenocortical insufficiency. Graves’ and Hashimoto’s diseases involve the thyroid gland. Cushing’s syndrome is a result of excessive circulation of free cortisol.

Question 15

14. Therapeutic management for a newborn with congenital adrenogenital hyperplasia includes which medication?
    a. Vitamin D
    b. Cortisone
    c. Stool softeners
    d. Calcium carbonate

Answer 15

ANS: B
The most common biochemical defect with congenital adrenal hyperplasia is partial or complete 21-hydroxylase deficiency. With complete deficiency, insufficient amounts of aldosterone and cortisol are produced, so circulatory collapse occurs without immediate replacement. Vitamin D, stool softeners, and calcium carbonate have no role in the treatment of adrenogenital hyperplasia.

Question 16

5. Which is true of immune-mediated type 1 diabetes mellitus?
   a. Ketoacidosis is infrequent.
   b. Onset is gradual.
   c. It occurs most often in children and adolescents.
   d. Oral agents are often effective for treatment.

Answer 16

ANS: C
The onset of immune-mediated type 1 diabetes mellitus typically occurs in children or young adults. Peak incidence is between the ages of 10 and 15 years. Infrequent ketoacidosis, gradual onset, and treatment with oral agents are more consistent with type 2 diabetes.

Question 17

16. What is a cardinal sign of diabetes mellitus?
    a. Nausea
    b. Seizures
    c. Impaired vision
    d. Frequent urination

Answer 17

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.
DIF: Cognitive Leve

Question 18

18. A parent asks the nurse why self-monitoring of blood glucose is being recommended for her child with diabetes. What knowledge should form the basis of the nurse’s explanation?
    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. The parents are better able to manage the disease.

Answer 18

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 on the basis of blood sugar 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.

Question 19

19. What should the nurse explain about exercise to the parents of a child who has just been diagnosed with 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.

Answer 19

ANS: C
Exercise lowers blood glucose levels, which can be compensated for by extra snacks. Exercise is encouraged and not restricted, unless indicated by other health conditions. Extra insulin is contraindicated because exercise decreases blood glucose levels.

Question 20

20. A child eats some sugar cubes after experiencing symptoms of hypoglycemia. What type of food or beverage should follow this rapid-releasing sugar?
    a. Saturated and unsaturated fat
    b. Fruit juice
    c. Several glasses of water
    d. Complex carbohydrate and protein

Answer 20

ANS: D
Symptoms of hypoglycemia are treated with a rapid-releasing sugar source followed by a complex carbohydrate and protein. Saturated and unsaturated fat, fruit juice, and several glasses of water do not provide the child with the complex carbohydrates and protein necessary to stabilize the blood sugar.

Question 21

21. Which would the nurse expect when assessing a child with hypoglycemia?
    a. Lethargy
    b. Thirst
    c. Nausea and vomiting
    d. Shaky feeling and dizziness

Answer 21

ANS: D
Some of the clinical manifestations of hypoglycemia include shaky feelings; dizziness; difficulty concentrating, speaking, focusing, and coordinating; sweating; and pallor. Lethargy, thirst, nausea, and vomiting are manifestations of hyperglycemia.

Question 22

22. The nurse is caring for an 11-year-old boy who has recently been diagnosed with diabetes. What should be included in the teaching plan for daily injections?
    a. The parents do not need to learn the procedure.
    b. He is old enough to give most of his own injections.
    c. Self-injections will be possible when he is closer to adolescence.
    d. He can learn about self-injections when he is able to reach all injection sites.

Answer 22

ANS: B
School-age children are able to give their own injections, but parents should still participate in learning and giving the insulin injections. He is already old enough to administer his own insulin. The child is able to use thighs, abdomen, part of the hip, and arm. He can obtain assistance if he needs to use other sites.

Question 23

23. The nurse is discussing with a child and family the various sites used for insulin injections. Which site usually has the fastest rate of absorption?
    a. Arm
    b. Leg
    c. Buttock d. Abdomen

Answer 23

ANS: D
The abdomen has the fastest rate of absorption but the shortest duration. The arm has a fast rate of absorption but short duration. The leg has a slow rate of absorption but a long duration. Finally, the buttock has the slowest rate of absorption and the longest duration.

Question 24

24. Which should be included when providing nursing care for a child diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH)?
    a. Weigh the child daily.
    b. Encourage fluids.
    c. Turn the child frequently.
    d. Maintain nothing by mouth.

Answer 24

ANS: A
Increased secretion of ADH causes the kidneys to resorb water, which increases fluid volume and decreases serum osmolarity, resulting in a progressive reduction in sodium concentration. The immediate management for the child is to restrict fluids. The child should also be weighed at the same time each day. Encouraging fluids, turning frequently, and maintaining nothing by mouth are not associated with SIADH.

Question 25

1. Which are clinical manifestations of chronic adrenocortical insufficiency? Select all that apply. Express answer in small letters followed by a comma and a space—e.g., a, b, c.
   a. Insomnia
   b. Palmar creases
   c. Weight gain
   d. Hypertension
   e. Syncope attacks
   f. Hypoglycemia

Answer 25

ANS: B, E, F
Clinical manifestations of chronic adrenocortical insufficiency include palmar creases, syncope or fainting attacks, and hypoglycemia. Manifestations include increased sleeping, not insomnia. Weight loss, anorexia, and dehydration are manifestations, not weight gain, as well as hypotension.

Question 26

2. Which would the nurse expect to find when assessing a child with hypoglycemia? Select all that apply. Express answer in small letters followed by a comma and a space—e.g., a, b, c.
   a. Glucose level of 10.7 mmol/L
   b. Tachycardia
   c. Trace of ketones in the urine
   d. Blurred vision
   e. Diplopia
   f. Flushed skin

Answer 26

ANS: B, C, E
Clinical manifestations of hypoglycemia include tachycardia, a trace of ketones in the urine, and diplopia. A glucose level of 10.7 mmol/L, blurred vision, and flushed skin are manifestations of hyperglycemia.