ENDOCRINE Flashcards
Chapter 48 (153 cards)
1
Q
What is the primary function of the endocrine system?
a) Digest food
b) Regulate body growth
c) Control body temperature
d) Fight infections
A
b) Regulate body growth
The primary function of the endocrine system is to regulate the body’s growth and development through the secretion of hormones. While food digestion, temperature control, and infection response are important body functions, they are not the main role of the endocrine system.
2
Q
What is the result of inadequate secretion of growth hormone in children?
a) Hypoglycemia
b) Gigantism
c) Dwarfism
d) Hyperthyroidism
A
c) Dwarfism
Explanation: Inadequate secretion of growth hormone in children results in dwarfism, characterized by stunted growth and shorter stature. Gigantism occurs when there is excess growth hormone, not a deficiency. Hypoglycemia is related to insulin issues, and hyperthyroidism is related to thyroid hormones.
3
Q
What hormone is primarily responsible for promoting bone and cartilage growth?
a) Insulin
b) Thyroxine
c) Growth hormone
d) Cortisol
A
c) Growth hormone
Growth hormone, secreted by the pituitary gland, directly promotes the growth of bones and cartilage, especially in childhood. Insulin regulates glucose metabolism, thyroxine affects metabolism, and cortisol is a stress hormone, none of which primarily promote bone/cartilage growth.
4
Q
Which of the following is a common complication of growth hormone therapy?
a) Hyperglycemia
b) Hypotension
c) Peripheral edema
d) Intracranial hypertension
A
d) Intracranial hypertension
Explanation: Intracranial hypertension, or increased pressure within the skull, is a known complication of growth hormone therapy. It can cause headaches and visual disturbances. While hyperglycemia and peripheral edema can be seen with various treatments, they are not as directly related to growth hormone therapy.
5
Q
What is the most common endocrine disorder seen in children, often leading to excessive thirst and urination? a) Hyperthyroidism
b) Type 1 Diabetes
c) Addison’s disease
d) Cushing’s syndrome
A
b) Type 1 Diabetes
Explanation: Type 1 diabetes is the most common endocrine disorder in children, leading to hyperglycemia, excessive thirst (polydipsia), and frequent urination (polyuria). Hyperthyroidism can cause increased thirst, but it is not as common as type 1 diabetes in children. Addison’s disease and Cushing’s syndrome are rarer conditions.
6
Q
What is the term used for excessive fluid loss due to urination in diabetic patients?
a) Hypovolemia
b) Polydipsia
c) Polyuria
d) Polyphagia
A
c) Polyuria
Explanation: Polyuria refers to excessive urination, which is a hallmark symptom of diabetes. Hypovolemia refers to low blood volume, polydipsia is excessive thirst, and polyphagia refers to excessive hunger, all of which may occur with diabetes but are not specifically linked to urination.
7
Q
A deficiency of which hormone in children leads to poor growth and delayed puberty?
a) Thyroxine
b) Parathyroid hormone
c) Growth hormone
d) Cortisol
A
c) Growth hormone
Explanation: Growth hormone is responsible for stimulating growth in children. A deficiency leads to poor growth and delayed puberty. Thyroxine regulates metabolism, parathyroid hormone regulates calcium, and cortisol is involved in stress response, none of which are directly related to growth stimulation.
8
Q
What test is used to screen for metabolic and endocrine disorders in newborns?
a) Blood culture
b) Urinalysis
c) Blood spot test
d) CT scan
A
c) Blood spot test
Explanation: The blood spot test (heel prick test) is used to screen for metabolic and endocrine disorders, such as hypothyroidism and phenylketonuria, in newborns. A blood culture is for infections, urinalysis is used for kidney issues, and a CT scan is typically used for imaging, not screening for metabolic disorders.
9
Q
Which hormone is responsible for regulating the body’s metabolism?
a) Insulin
b) Cortisol
c) Thyroxine
d) Growth hormone
A
c) Thyroxine
Explanation: Thyroxine, produced by the thyroid gland, regulates metabolism by controlling the rate of energy production in cells. Insulin regulates blood sugar levels, cortisol is a stress hormone, and growth hormone is important for growth but not metabolism regulation.
10
Q
What term refers to the condition where the thyroid gland produces excessive thyroid hormones?
a) Hypothyroidism
b) Hyperthyroidism
c) Goiter
d) Myxedema
A
b) Hyperthyroidism
Explanation: Hyperthyroidism occurs when the thyroid gland produces too much thyroid hormone, leading to an increased metabolic rate. Hypothyroidism is the opposite, where the thyroid produces too little. Goiter refers to an enlarged thyroid gland, and myxedema is a severe form of hypothyroidism.
11
Q
What is a common sign of hyperglycemia in children?
a) Increased appetite
b) Decreased thirst
c) Vomiting and dehydration
d) Excessive sweating
A
c) Vomiting and dehydration
Explanation: Hyperglycemia in children, especially in undiagnosed or poorly managed diabetes, often leads to dehydration and vomiting as the body tries to rid itself of excess glucose. Increased appetite (polyphagia) can also occur, but vomiting and dehydration are more directly linked to hyperglycemia.
12
Q
What condition is characterized by an underproduction of antidiuretic hormone (ADH)?
a) Diabetes insipidus
b) Cushing’s syndrome
c) Hypothyroidism
d) Addison’s disease
A
a) Diabetes insipidus
Explanation: Diabetes insipidus is caused by a deficiency of ADH, which leads to excessive urination and thirst. Cushing’s syndrome involves excessive cortisol production, hypothyroidism involves low thyroid hormone, and Addison’s disease involves adrenal insufficiency, none of which are directly related to ADH deficiency.
13
Q
What is the treatment for growth hormone deficiency in children?
a) Insulin therapy
b) Recombinant growth hormone
c) Radiation therapy
d) Thyroid hormone replacement
A
b) Recombinant growth hormone
Explanation: Recombinant growth hormone is used to treat growth hormone deficiency in children, helping them grow at a normal rate. Insulin therapy is for diabetes, radiation therapy is for cancer, and thyroid hormone replacement is for hypothyroidism, none of which address growth hormone deficiency.
14
Q
What term describes a state of excessive fluid intake in diabetes mellitus patients?
a) Polyuria
b) Polydipsia
c) Polyphagia
d) Hyperglycemia
A
b) Polydipsia
Polydipsia refers to excessive thirst, which is common in diabetes as a result of high blood sugar. Polyuria refers to excessive urination, polyphagia refers to excessive hunger, and hyperglycemia refers to high blood sugar levels.
15
Q
Which of the following is a common nursing diagnosis related to endocrine disorders like diabetes?
a) Imbalanced nutrition
b) Impaired skin integrity
c) Risk for infection
d) Deficient fluid volume
A
d) Deficient fluid volume
Explanation: Deficient fluid volume is a common nursing diagnosis for patients with endocrine disorders like diabetes, due to the excessive fluid loss from polyuria. While imbalanced nutrition and impaired skin integrity can be concerns in diabetes, deficient fluid volume is more directly linked.
16
Q
What is the name of the hormone secreted by the pancreas that regulates blood sugar levels?
a) Adrenaline
b) Insulin
c) Thyroxine
d) Cortisol
A
b) Insulin
Explanation: Insulin, produced by the pancreas, regulates blood sugar levels by allowing glucose to enter cells. Adrenaline is involved in the fight-or-flight response, thyroxine regulates metabolism, and cortisol is a stress hormone.
17
Q
Which endocrine disorder can result in a child growing excessively tall due to overproduction of growth hormone before puberty?
a) Hypothyroidism
b) Acromegaly
c) Gigantism
d) Cretinism
A
c) Gigantism
Explanation: Gigantism occurs when there is an overproduction of growth hormone before puberty, leading to excessive growth in children. Acromegaly is a similar condition but occurs after puberty. Hypothyroidism and cretinism are unrelated to growth hormone overproduction.
18
Q
What is the medical term for the condition of low thyroid hormone production?
a) Hyperthyroidism
b) Hypothyroidism
c) Goiter
d) Graves’ disease
A
b) Hypothyroidism
Explanation: Hypothyroidism is characterized by low thyroid hormone production, leading to symptoms like weight gain and fatigue. Hyperthyroidism is the opposite, goiter refers to an enlarged thyroid, and Graves’ disease is an autoimmune disorder causing hyperthyroidism.
19
Q
What hormone is associated with the fight or flight response and is released from the adrenal glands?
a) Growth hormone
b) Insulin
c) Epinephrine
d) Cortisol
A
c) Epinephrine
Epinephrine (adrenaline) is released from the adrenal glands during the fight-or-flight response to prepare the body for immediate physical action. Growth hormone affects growth, insulin regulates blood sugar, and cortisol helps the body respond to stress, but none are directly related to the fight-or-flight response.
20
Q
In which endocrine disorder would a nurse expect to find symptoms of fatigue, weight gain, and cold intolerance?
a) Cushing’s syndrome
b) Hyperthyroidism
c) Hypothyroidism
d) Addison’s disease
A
c) Hypothyroidism
Explanation: Hypothyroidism is characterized by low thyroid hormone production, leading to symptoms like fatigue, weight gain, and sensitivity to cold. Cushing’s syndrome and hyperthyroidism have opposite effects on metabolism, and Addison’s disease primarily affects adrenal function.
21
Q
A nurse is caring for an adolescent female diagnosed with hyperthyroidism. Which of the following clinical manifestations should the nurse expect?
A. Weight gain, cold intolerance, and bradycardia
B. Weight loss, heat intolerance, and tachycardia
C. Puffy face, constipation, and fatigue
D. Dry skin, hoarseness, and slowed speech
A
Correct Answer: B. Weight loss, heat intolerance, and tachycardia
Rationale:
These are classic symptoms of hyperthyroidism due to excessive thyroid hormone activity:
Weight loss occurs despite increased appetite.
Heat intolerance is common due to increased metabolism.
Tachycardia results from increased sympathetic activity.
Why others are incorrect:
A describes hypothyroidism, not hyperthyroidism.
C and D also reflect hypothyroid symptoms such as facial puffiness, constipation, and slowed body functions.
22
Q
Which of the following are appropriate nursing interventions for a child with diabetes insipidus (DI)?
A. Administer desmopressin acetate (DDAVP) as ordered
B. Encourage unrestricted fluid intake
C. Monitor intake and output accurately
D. Observe for signs of dehydration
E. Restrict sodium in the diet
A
Correct Answers: A, C, D, E
Rationale:
A: DDAVP is the medication of choice for central DI; it mimics ADH.
C: Close monitoring of I&O is crucial to detect imbalances.
D: Children with DI are at risk for dehydration due to excessive urination.
E: Sodium restriction helps prevent further dehydration and hypernatremia.
Why B is incorrect:
B: Fluids should be given as ordered, not unrestricted. Overhydration may not correct the problem and may cause complications like water intoxication if DDAVP is already being used.
23
Q
A 14-year-old girl presents with fatigue, weight gain, constipation, and sensitivity to cold. Lab tests reveal low T3 and T4, and elevated TSH. She is diagnosed with hypothyroidism.
What medication does the nurse expect to be prescribed?
A. Methimazole
B. Levothyroxine
C. Desmopressin
D. Prednisone
A
Correct Answer: B. Levothyroxine
Rationale:
Levothyroxine is a synthetic thyroid hormone (T4) used to replace the low levels seen in hypothyroidism.
Dosage is individualized and monitored via TSH levels.
Why others are incorrect:
A (Methimazole) is for hyperthyroidism, not hypothyroidism.
C (Desmopressin) is for diabetes insipidus.
D (Prednisone) is a corticosteroid used for adrenal insufficiency or inflammation—not for thyroid hormone replacement.
24
Q
In managing a patient with Syndrome of Inappropriate Antidiuretic Hormone (SIADH), which nursing intervention is a priority?
A. Encourage fluid intake of at least 3 liters/day
B. Administer vasopressin to maintain hydration
C. Monitor serum sodium levels frequently
D. Provide a high-protein diet
A
Correct Answer: C. Monitor serum sodium levels frequently
Rationale:
SIADH causes water retention and hyponatremia due to excessive ADH.
Monitoring sodium is critical to prevent complications like seizures or cerebral edema.
Why others are incorrect:
A: Fluid intake should be restricted, not encouraged.
B: Vasopressin worsens SIADH as it’s an ADH analog.
D: Protein intake is not the priority; fluid balance and sodium monitoring are.
25
Which hormone is deficient in a child with diabetes insipidus, and what is the expected effect on urine output?
A. Insulin; decreased urine output
B. Antidiuretic hormone (ADH); increased urine output
C. Cortisol; concentrated urine
D. Thyroxine; normal urine output
Correct Answer: B. Antidiuretic hormone (ADH); increased urine output
Rationale:
Diabetes insipidus involves a deficiency of ADH, resulting in excessive dilute urine (polyuria).
The kidneys cannot concentrate urine without ADH.
Why others are incorrect:
A: Insulin deficiency causes hyperglycemia, not polyuria due to ADH loss.
C: Cortisol affects metabolism, not urine concentration directly.
D: Thyroxine deficiency affects metabolic rate, not urine output.
26
The word “hormone” is derived from the Greek word hormaein. What does this term mean?
a. To regulate
b. To secrete
c. To set in motion
d. To coordinate
A: c. To set in motion
Explanation:
The text directly defines “hormone” as coming from the Greek hormaein, meaning “to set in motion.” While the other options describe functions related to hormones, the specific derivation mentioned is “to set in motion.”
27
Which hormone is responsible for increasing bone and cartilage growth by enhancing calcium absorption?
A. Antidiuretic hormone (ADH)
B. Thyrotropin (TSH)
C. Somatotropin (GH)
D. Corticotropin (ACTH)
Answer:
C. Somatotropin (GH)
Rationale:
Somatotropin (Growth Hormone) acts on all body cells to stimulate growth and calcium absorption. TSH stimulates the thyroid, ACTH stimulates the adrenal glands, and ADH regulates fluid balance via kidneys.
28
A nurse is assessing a 3-year-old child who presents with short stature, a high-pitched voice, delayed dentition, and crowded teeth. The nurse suspects growth hormone deficiency. What additional assessment would be most important to rule out a tumor?
A. Family history of short stature
B. Headache and increased head circumference
C. Recent immunization history
D. Delay in language development
Answer:
B. Headache and increased head circumference
Rationale:
Sudden halted growth, headache, and increased head size are red flags for increased intracranial pressure, suggesting a possible pituitary tumor. Family history can help but does not rule out organic causes. Immunizations and language delay are unrelated to GH deficiency diagnosis.
29
Which of the following may indicate an endocrine disorder in children? (Select all that apply)
A. Scaling or dry skin
B. Protrusion of eyeballs
C. Low-pitched, husky voice
D. Frequent urination
E. Early onset of pubic hair
Answer:
A, B, D, E
Rationale:
A: Dry or scaling skin can indicate thyroid issues.
B: Exophthalmos is a classic sign of hyperthyroidism.
D: Polyuria may signal diabetes mellitus or insipidus.
E: Early pubertal changes may signal precocious puberty.
C is incorrect as GH-deficient children often have high-pitched voices.
30
A child with an endocrine disorder is noted to have extreme thirst and excessive urination. Which condition might these symptoms indicate?
a. Diabetes insipidus or type 1 diabetes mellitus
b. Hyperthyroidism
c. Hypothyroidism
d. Cushing syndrome
a. Diabetes insipidus or type 1 diabetes mellitus
Explanation:
The text notes that “extreme thirst or appetite may occur with an endocrine disorder such as diabetes insipidus or type 1 diabetes mellitus,” and that frequent voiding may be due to polyuria from these conditions. Hyperthyroidism and Cushing syndrome have different clinical manifestations, while hypothyroidism typically presents with fatigue and weight gain.
31
Which finding on physical examination may indicate a pituitary disorder in a child?
a. Height and weight below the 3rd percentile or above the 90th percentile
b. Excessive hair growth on the face
c. Soft, elastic skin
d. Inability to produce tears
a. Height and weight below the 3rd percentile or above the 90th percentile
Explanation:
According to the text, endocrine disorders can alter growth, and pituitary dysfunction may be reflected as unusually short or tall stature. Option (b) may be noted in disorders like Cushing syndrome but is not specific for the pituitary. Options (c) and (d) are not mentioned.
32
Which is an appropriate short-term nursing diagnosis for a child with growth hormone deficiency?
A. Ineffective breathing pattern related to thyroid enlargement
B. Risk for imbalanced nutrition: more than body requirements
C. Disturbed body image related to abnormal height
D. Impaired gas exchange related to exophthalmos
Answer:
C. Disturbed body image related to abnormal height
Rationale:
Short stature often affects self-image. A and D are unrelated to GH deficiency, and B applies more to T2D or thyroid issues.
33
Which nursing diagnosis is appropriate for a child with diabetes mellitus exhibiting constant fluid loss?
a. Deficient fluid volume
b. Risk for infection
c. Impaired gas exchange
d. Disturbed body image
a. Deficient fluid volume
Explanation:
The text lists “deficient fluid volume related to constant excessive loss of fluid through urination” as an example of a nursing diagnosis for endocrine disorders. This directly corresponds with the symptoms of diabetes mellitus. Options (b), (c), and (d) relate to other aspects of patient care but not directly to fluid imbalance.
34
What is the rationale behind educating parents and children about the signs, causes, and symptoms of endocrine disorders?
a. It minimizes the need for long-term care.
b. It supports their participation in a long-term plan of care.
c. It reduces the incidence of the disease immediately.
d. It eliminates the need for periodic evaluations.
b. It supports their participation in a long-term plan of care.
Explanation:
The text emphasizes that understanding the causes and symptoms enables parents and children to actively participate in long-term care plans. Options (a), (c), and (d) are not supported by the text; endocrine disorders are long term and require ongoing management and evaluation.
35
A child is prescribed somatropin. Which of the following nursing instructions is most important?
A. Take the medication by mouth after meals.
B. Monitor for signs of dehydration.
C. Observe for limping or hip pain.
D. Administer with prednisone to improve effects.
Answer:
C. Observe for limping or hip pain
Rationale:
Somatropin may cause slipped capital femoral epiphysis; hip pain or limping should be immediately reported. It is administered by injection (not oral), and prednisone may reduce its effect, not enhance it.
36
Which of the following is one of the recommended outcomes for children with endocrine/metabolic disorders?
a. The child should show no memory of taking medications.
b. The child's recorded medication log should indicate adherence to the prescribed regimen.
c. The child’s weight should remain unchanged throughout growth.
d. The child should achieve normal height regardless of their condition.
b. The child's recorded medication log should indicate adherence to the prescribed regimen.
The text lists as a desired outcome “the child brings to clinic a written record showing that she took her medication as recommended.” This outcome demonstrates adherence. The other options either contradict the chronic nature of these disorders or set unrealistic benchmarks.
37
Which hormone is secreted by the neurohypophysis and what is its target organ?
a. ACTH; Adrenal glands
b. Somatotropin; Bone and cartilage
c. ADH; Kidneys
d. TSH; Thyroid gland
c. ADH; Kidneys
Explanation:
The text states that antidiuretic hormone (ADH) is secreted by the neurohypophysis and its target organ is the kidney, where it regulates fluid volume by decreasing urine output. ACTH, somatotropin, and TSH are secreted by the adenohypophysis and have different targets and functions.
38
Which action would best promote medication compliance in a school-aged child newly diagnosed with GH deficiency?
A. Use candy rewards for every injection
B. Emphasize the severity of stunted growth
C. Help parents set up reminders on phones
D. Involve school nurse to administer meds daily
Answer:
C. Help parents set up reminders on phones
Rationale:
Routine and structured reminders help with long-term compliance. Bribes (A) are discouraged. Fear-based education (B) may cause anxiety. School nurse involvement (D) may help but is secondary to empowering the family.
39
What effect does increased secretion of thyroid hormone have on a child’s behavior according to the text?
a. The child will lie down after school to rest quietly.
b. The child may be unable to sit quietly due to hyperactivity.
c. The child will have an enhanced ability to concentrate.
d. The child will show no change in activity levels.
b. The child may be unable to sit quietly due to hyperactivity.
Explanation:
The text mentions that a child with increased thyroid hormone production “may be unable to sit quietly at all” due to a hyperactive state. The other options do not correctly reflect the described behavior of hyperthyroidism.
40
In the assessment of a child with suspected endocrine disorders, which of the following physical findings might indicate hypothyroidism?
a. Exophthalmos
b. Cool to touch skin and brittle hair
c. Tachycardia
d. Increased muscle tone
b. Cool to touch skin and brittle hair
Explanation:
The text lists “skin: cool to touch” and “hair: brittle” as signs associated with hypothyroidism. Exophthalmos and tachycardia are related to hyperthyroidism, and increased muscle tone is not mentioned.
41
A nurse assessing a child with suspected pituitary dysfunction finds the child’s growth has slowed markedly over the past few years with an infantile facial appearance. Which hormonal deficiency is most likely present?
a. Insulin deficiency
b. Cortisol deficiency
c. Growth hormone (GH) deficiency
d. TSH deficiency
c. Growth hormone (GH) deficiency
Explanation:
The text describes that children with GH deficiency “are not able to grow to full size” and may display infantile facial features, such as a recessed mandible and delayed dentition. The other hormone deficiencies do not directly account for poor growth and the specific physical features mentioned.
42
Which diagnostic modality is used to establish bone age in a child suspected of having growth hormone deficiency?
a. MRI of the brain
b. CT scan of the sella turcica
c. Wrist X-ray
d. Ultrasound of long bones
c. Wrist X-ray
Explanation:
The text notes that “bone age is established by a wrist X-ray,” which reveals delayed epiphyseal closure when GH deficiency is present. MRI, CT, or ultrasound are used for different diagnostic purposes such as identifying pituitary tumors.
43
What is the primary therapeutic management for growth hormone deficiency in children?
a. Daily administration of oral glucose
b. Administration of recombinant human growth hormone (rhGH)
c. High-calorie nutritional supplements
d. Long-term antibiotic therapy
b. Administration of recombinant human growth hormone (rhGH)
Explanation:
The text indicates that GH deficiency is managed by the “administration of intramuscular (IM) recombinant human growth hormone (rhGH)” given daily at bedtime. This is the appropriate treatment, whereas the other options do not address the underlying hormone deficiency.
44
When administering rhGH therapy, which adverse effect must parents be alerted to as an early sign of complications?
a. Increased muscle tone
b. Slipped capital epiphysis manifested as knee or hip pain
c. Excessive thirst and urination
d. Chronic diarrhea
b. Slipped capital epiphysis manifested as knee or hip pain
Explanation:
The text clearly states that parents should be alert for “limping or knee or hip pain,” as these symptoms may indicate a slipped capital epiphysis—a known complication associated with rhGH supplementation. The other symptoms are not described as adverse effects of rhGH in the text.
45
In the context of endocrine disorder management in children, why is periodic evaluation essential?
a. To determine if the child is eventually cured.
b. Because growth and changing activity levels necessitate changes in medication dosages and care plans.
c. To decide when to stop all medications.
d. To monitor the child’s academic performance exclusively.
b. Because growth and changing activity levels necessitate changes in medication dosages and care plans.
Explanation:
The text emphasizes that “children with disorders of endocrine or metabolic function need periodic evaluations throughout childhood” due to growth and changes in activities; this ensures medication dosages are adjusted and care plans remain effective. The other options do not correctly reflect the need for ongoing management.
46
Which of the following is a correct nursing implication related to administering rhGH?
a. X-rays of the wrist should be performed only after therapy is completed.
b. Parents should be informed that rhGH may interact with glucocorticoid therapies such as prednisone.
c. The medication should be withheld if the child shows any sign of growth.
d. No additional monitoring is necessary once the first dose is given.
b. Parents should be informed that rhGH may interact with glucocorticoid therapies such as prednisone.
Explanation:
The text mentions that rhGH may interact with glucocorticoid therapy (e.g., prednisone), decreasing its effectiveness, so parents must inform all health care providers about this therapy. X-rays are to be done before therapy begins, and continued monitoring is essential, making the other options incorrect.
47
Which of the following factors should be included in a comprehensive assessment for a child with suspected growth hormone deficiency?
a. Family history of tall stature only
b. Child’s prenatal and birth history for intrauterine growth restriction
c. Assessment of the child’s academic performance
d. Exclusive focus on the child’s current height
b. Child’s prenatal and birth history for intrauterine growth restriction
Explanation:
The text instructs that assessment should include the child’s prenatal and birth history (for evidence of intrauterine growth restriction), family history (traits of short stature or familial late development), nutritional history, and both physical and psychosocial aspects. Options (a), (c), and (d) are either too narrow or not directly related to the endocrine assessment.
48
How are endocrine and metabolic disorders in children typically first detected according to the text?
a. Through a genetic test at birth
b. During routine health care visits by assessing height and weight percentiles
c. With a CT scan of the pituitary
d. By observing changes in hair texture alone
b. During routine health care visits by assessing height and weight percentiles
Explanation:
The text states that if not identified at birth, these disorders are usually detected when the child’s height and weight are measured at a health care visit and are found to be atypical for the child’s age. The other choices are either too specific or not mentioned as primary detection methods.
49
What is the primary function of Antidiuretic Hormone (ADH)?
a. Stimulates the production of cortisol
b. Increases water reabsorption in the kidneys
c. Promotes the release of insulin
d. Regulates blood sugar levels
b. Increases water reabsorption in the kidneys
Explanation:
ADH, secreted by the posterior pituitary, primarily functions to regulate water balance in the body. It promotes water reabsorption by the kidneys, reducing urine output and helping maintain fluid balance. The other options are related to different hormones with distinct functions.
50
Which of the following is commonly used to diagnose a deficiency of Antidiuretic Hormone (ADH)?
a. ACTH stimulation test
b. Water deprivation test
c. Growth hormone stimulation test
d. Serum prolactin test
b. Water deprivation test
A water deprivation test is used to diagnose conditions like diabetes insipidus, which is caused by a deficiency in ADH. This test helps determine if the kidneys can concentrate urine properly in the absence of water intake. The other tests assess different conditions unrelated to ADH deficiency.
51
What hormone is responsible for stimulating cortisol production from the adrenal glands?
a. Thyroid-stimulating hormone (TSH)
b. Growth hormone (GH)
c. Adrenocorticotropic hormone (ACTH)
d. Luteinizing hormone (LH)
c. Adrenocorticotropic hormone (ACTH)
Explanation:
ACTH, secreted by the anterior pituitary gland, stimulates the adrenal glands to produce cortisol, a hormone critical for managing stress and regulating metabolism. TSH affects the thyroid, GH stimulates growth, and LH is involved in reproduction.
52
What diagnostic test is used to assess adrenal gland function in response to ACTH?
a. Thyroid function test
b. ACTH stimulation test
c. Serum insulin test
d. Serum cortisol test
b. ACTH stimulation test
Explanation:
The ACTH stimulation test is specifically designed to assess how the adrenal glands respond to ACTH by measuring the cortisol level after synthetic ACTH is administered. This helps in diagnosing conditions like adrenal insufficiency.
53
What hormone stimulates the thyroid gland to produce T3 and T4?
a. Adrenocorticotropic hormone (ACTH)
b. Luteinizing hormone (LH)
c. Thyroid-stimulating hormone (TSH)
d. Prolactin (PRL)
c. Thyroid-stimulating hormone (TSH)
Explanation:
TSH, secreted by the anterior pituitary gland, stimulates the thyroid gland to produce T3 and T4 hormones, which regulate metabolism and growth. The other hormones affect different glands and functions.
53
What is an elevated TSH level an indicator of?
a. Hyperthyroidism
b. Hypothyroidism
c. Adrenal insufficiency
d. Pituitary gland tumor
b. Hypothyroidism
Explanation:
An elevated TSH level typically indicates hypothyroidism, where the thyroid is not producing enough thyroid hormones. In response, the pituitary releases more TSH to stimulate the thyroid. Hyperthyroidism is characterized by low TSH levels due to excessive thyroid hormone production.
54
Q: Which diagnostic test is most commonly used to assess thyroid function?
a. ACTH stimulation test
b. Serum TSH test
c. FSH blood test
d. Urine cortisol test
b. Serum TSH test
Explanation:
The serum TSH test is the most commonly used test to evaluate thyroid function. It measures the level of TSH in the blood, which can indicate whether the thyroid is overactive or underactive. Other tests assess different functions.
55
Which test is used to diagnose growth hormone deficiency?
a. ACTH stimulation test
b. Growth hormone stimulation test
c. Serum prolactin test
d. FSH blood test
b. Growth hormone stimulation test
Explanation:
The growth hormone stimulation test measures the body's response to stimuli (such as insulin or arginine) to assess if the pituitary is producing enough growth hormone. The other tests assess different conditions unrelated to GH production.
56
What hormone helps regulate the female menstrual cycle by triggering ovulation?
a. Prolactin (PRL)
b. Luteinizing hormone (LH)
c. Thyroid-stimulating hormone (TSH)
d. Growth hormone (GH)
b. Luteinizing hormone (LH)
Explanation:
LH, secreted by the anterior pituitary gland, triggers ovulation and supports the production of estrogen and progesterone in females, crucial for regulating the menstrual cycle. Prolactin influences milk production, TSH affects the thyroid, and GH is involved in growth.
57
Which diagnostic test can be used to monitor LH levels?
a. Serum prolactin test
b. Serum LH test
c. FSH blood test
d. TSH test
b. Serum LH test
Explanation:
A serum LH test measures the level of luteinizing hormone in the blood, helping evaluate ovulatory function and fertility in women. FSH and TSH tests are related to other aspects of reproductive health, and the prolactin test is focused on milk production.
58
What hormone is responsible for milk production in females?
a. Prolactin (PRL)
b. Growth hormone (GH)
c. Estrogen
d. Oxytocin
a. Prolactin (PRL)
Explanation:
Prolactin, produced by the anterior pituitary, is responsible for stimulating milk production after childbirth. While estrogen and oxytocin are involved in lactation, prolactin is the key hormone that directly stimulates milk production.
59
Which hormone is involved in the regulation of metabolism and is produced by the thyroid gland?
a. Prolactin
b. Cortisol
c. Thyroid hormones (T3 and T4)
d. Adrenocorticotropic hormone (ACTH)
c. Thyroid hormones (T3 and T4)
Explanation:
The thyroid hormones, T3 (triiodothyronine) and T4 (thyroxine), are produced by the thyroid gland and are essential for regulating metabolism, growth, and development. They influence the body’s energy use, heart rate, and body temperature. Prolactin is involved in milk production, cortisol is a stress hormone, and ACTH stimulates cortisol release.
60
What test is used to assess the thyroid’s ability to produce T3 and T4?
a. Serum TSH test
b. Serum cortisol test
c. ACTH stimulation test
d. Water deprivation test
a. Serum TSH test
Explanation:
The serum TSH test measures the level of thyroid-stimulating hormone (TSH) in the blood. High levels of TSH indicate hypothyroidism (low thyroid function), while low levels suggest hyperthyroidism (overactive thyroid). This test is a key diagnostic tool for thyroid function. The other tests assess different hormonal systems.
61
What hormone is involved in the stress response and is produced by the adrenal glands?
a. Estrogen
b. Progesterone
c. Cortisol
d. Thyroxine
c. Cortisol
Explanation:
Cortisol, produced by the adrenal glands, is a key hormone in the body's response to stress. It helps regulate metabolism, blood sugar levels, and inflammation. Estrogen and progesterone are involved in reproductive processes, while thyroxine is related to thyroid function.
62
Which test is used to assess the function of the adrenal glands in response to stress?
a. ACTH stimulation test
b. Serum cortisol test
c. Growth hormone stimulation test
d. Prolactin test
b. Serum cortisol test
Explanation:
A serum cortisol test measures cortisol levels in the blood. It is used to assess adrenal gland function, particularly in response to stress or to diagnose adrenal insufficiency. The ACTH stimulation test assesses the adrenal glands’ ability to respond to ACTH, but the cortisol test is the most direct indicator of adrenal function.
63
Which hormone helps regulate the immune response and inflammation?
a. Cortisol
b. Insulin
c. Progesterone
d. Oxytocin
a. Cortisol
Explanation:
Cortisol is a glucocorticoid hormone that regulates the immune response and reduces inflammation. It also plays a role in metabolism. Insulin regulates blood sugar levels, progesterone is involved in the reproductive system, and oxytocin is related to childbirth and lactation.
64
Which diagnostic test is commonly used to assess insulin secretion and glucose metabolism?
a. Glucose tolerance test
b. Serum cortisol test
c. TSH test
d. ACTH stimulation test
a. Glucose tolerance test
Explanation:
The glucose tolerance test (GTT) is used to assess how well the body processes glucose and to diagnose conditions like diabetes mellitus. The serum cortisol test is for adrenal function, the TSH test assesses thyroid function, and the ACTH stimulation test evaluates the adrenal glands.
65
Which hormone is primarily responsible for regulating blood sugar levels?
a. Insulin
b. Estrogen
c. Thyroxine
d. Prolactin
a. Insulin
Explanation:
Insulin, produced by the pancreas, is the primary hormone responsible for regulating blood sugar levels by promoting the uptake of glucose into cells. Estrogen affects reproductive health, thyroxine regulates metabolism, and prolactin is involved in milk production.
66
What diagnostic test is used to assess insulin production and blood sugar regulation?
a. Serum insulin test
b. Serum cortisol test
c. TSH test
d. ACTH stimulation test
a. Serum insulin test
Explanation:
A serum insulin test measures the level of insulin in the blood. It is used to assess insulin production and diagnose conditions like diabetes. The other tests evaluate different hormones, not insulin.
67
Which hormone stimulates milk ejection during breastfeeding?
a. Prolactin
b. Oxytocin
c. Estrogen
d. Luteinizing hormone (LH)
b. Oxytocin
Explanation:
Oxytocin, produced by the posterior pituitary, stimulates the milk ejection reflex during breastfeeding. Prolactin stimulates milk production, estrogen influences reproductive functions, and LH triggers ovulation.
68
What is the function of prolactin in the body?
a. Stimulates milk production
b. Regulates metabolism
c. Stimulates ovulation
d. Promotes stress response
a. Stimulates milk production
Explanation:
Prolactin, secreted by the anterior pituitary, plays a key role in stimulating milk production after childbirth. The other hormones have distinct roles: cortisol regulates stress, estrogen and progesterone influence the reproductive system, and LH is involved in ovulation.
69
Which test is used to monitor prolactin levels?
a. Serum prolactin test
b. Serum insulin test
c. ACTH stimulation test
d. Growth hormone stimulation test
a. Serum prolactin test
Explanation:
The serum prolactin test measures the level of prolactin in the blood, which helps monitor milk production and diagnose conditions like prolactinomas or hypothyroidism. The other tests assess different hormone systems.
70
What hormone is responsible for regulating the menstrual cycle and supporting pregnancy?
a. Progesterone
b. Estrogen
c. Growth hormone
d. Testosterone
a. Progesterone
Explanation:
Progesterone plays a crucial role in regulating the menstrual cycle and preparing the uterus for pregnancy. It helps maintain the uterine lining during the luteal phase and early pregnancy. Estrogen is also involved in the reproductive system, but progesterone is the primary hormone for pregnancy support.
71
Which test is used to assess ovarian function and evaluate estrogen levels?
a. Serum estrogen test
b. TSH test
c. ACTH stimulation test
d. Serum insulin test
a. Serum estrogen test
Explanation:
The serum estrogen test measures estrogen levels in the blood, which is important for evaluating ovarian function and assessing conditions like menopause or ovarian disorders. The other tests measure hormones related to different systems.
72
What is the most likely physical feature of a child with growth hormone excess before epiphyseal closure?
A. Disproportionate short limbs
B. Proportional overgrowth of long bones
C. Thin body and delayed height
D. Decreased head circumference
B. Proportional overgrowth of long bones
In children, excess GH before growth plate closure leads to gigantism, which causes proportional growth of bones, muscles, and organs, resulting in very tall stature. Unlike some disorders, their growth is proportionate, not deformed.
73
Which of the following is a distinguishing feature of acromegaly in adults?
A. Dwarfism with weak bones
B. Short stature with thick limbs
C. Enlarged jaw and thickened facial features
D. Reduced facial hair and thin skin
C. Enlarged jaw and thickened facial features
Explanation:
In acromegaly (GH excess after bone growth has stopped), bones can’t grow longer, but soft tissues and bones of the face, hands, and feet thicken. This includes a larger jaw, broad nose, and deep facial creases.
74
What diagnostic test is most useful to confirm growth hormone excess?
A. Complete blood count
B. Serum growth hormone levels
C. Liver function test
D. Urinalysis
B. Serum growth hormone levels
Explanation:
Serum GH levels are directly measured to confirm excess. High levels, especially when they don’t decrease with glucose tolerance testing, are strong indicators of GH hypersecretion.
75
Which of the following symptoms might suggest increased intracranial pressure in a child with a GH-secreting pituitary tumor?
A. Delayed tooth eruption
B. Mild fatigue
C. Headache and visual disturbances
D. Increased appetite and growth
C. Headache and visual disturbances
Explanation:
A pituitary tumor can cause increased pressure inside the skull (ICP), leading to headaches, nausea, and visual problems due to compression of nearby structures like the optic nerve.
76
What best differentiates gigantism from acromegaly?
A. Presence of pituitary tumor
B. Occurrence before or after epiphyseal closure
C. Degree of weight gain
D. Enlargement of the heart
B. Occurrence before or after epiphyseal closure
Explanation:
Gigantism occurs before the bone growth plates (epiphyses) close, leading to extreme height. Acromegaly occurs after closure, leading to widening of bones and soft tissue overgrowth, especially in the face, hands, and feet.
77
Which of the following is a classic facial change seen in acromegaly?
A. Narrow nose and small lips
B. Underdeveloped jaw and cheeks
C. Overgrowth of tongue, jaw, and sinuses
D. Pale skin and sunken eyes
C. Overgrowth of tongue, jaw, and sinuses
Explanation:
Acromegaly causes enlargement of facial soft tissues and bones, especially the tongue, jaw, lips, and sinuses, giving the face a coarse, exaggerated appearance.
78
What dental issue is commonly seen in acromegaly due to jaw enlargement?
A. Early tooth eruption
B. Loss of primary teeth
C. Separation and malocclusion of teeth
D. Bleeding gums
C. Separation and malocclusion of teeth
Explanation:
The enlarged jaw in acromegaly causes teeth to spread apart and misalign (malocclusion), since the bones grow but the teeth don’t increase in size to match.
79
Which of the following confirms a diagnosis of growth hormone excess?
A. Increased blood pressure
B. Elevated serum growth hormone levels
C. Low blood sugar levels
D. Increased calcium in the blood
B. Elevated serum growth hormone levels
Explanation:
Growth hormone (GH) levels are directly measured. Persistent elevated GH, especially after glucose loading (which should suppress it), confirms hypersecretion of GH.
80
What is the most definitive treatment for a GH-secreting pituitary tumor?
A. Oral medication
B. Physical therapy
C. Surgical removal of the tumor
D. High-protein diet
C. Surgical removal of the tumor
Explanation:
The first-line treatment is to remove the pituitary tumor, often via hypophysectomy (surgery). This addresses the root cause of GH excess.
81
Which therapy may follow surgery to destroy any remaining pituitary tissue?
A. Antibiotics
B. Radiologic therapy or radioactive implants
C. Chemotherapy
D. Stem cell injection
B. Radiologic therapy or radioactive implants
Explanation:
If the tumor isn't fully removed or recurs, radiation therapy (external or implant-based) is used to destroy remaining pituitary tissue and lower GH production.
82
Why is hormone replacement needed after hypophysectomy?
A. GH levels become too high after surgery
B. The body produces too much insulin
C. The pituitary can no longer regulate other hormones
D. To stimulate faster wound healing
C. The pituitary can no longer regulate other hormones
Explanation:
The pituitary gland controls many other glands. Removing it may lead to hormone deficiencies, so replacements (e.g., thyroid hormone, cortisone, sex hormones) are needed.
83
What is a key nursing role for children with suspected growth hormone excess?
A. Restrict physical activity
B. Delay diagnostic testing
C. Early identification and referral
D. Avoid discussing their height
C. Early identification and referral
Explanation:
Early detection of excessive growth helps prevent complications. Nurses should track growth patterns and refer children for evaluation if signs are abnormal.
84
What surgical procedure is used to treat a pituitary tumor causing GH excess?
A. Thyroidectomy
B. Hypophysectomy
C. Craniotomy
D. Laparotomy
B. Hypophysectomy
Explanation:
A hypophysectomy is the removal of the pituitary gland or tumor, done to stop excess hormone production.
85
What is the term for radiation placed directly into the pituitary area to treat GH excess?
A. Chemotherapy
B. External beam therapy
C. Radioactive implant
D. Ultrasound therapy
C. Radioactive implant
Explanation:
Radioactive implants deliver focused radiation to destroy abnormal pituitary cells, used when surgery isn't possible or complete.
86
Which hormone therapy is given after pituitary surgery to replace lost hormone function?
A. Parathyroid hormone
B. Estrogen only
C. Cortisone, thyroid extract, and sex hormones
D. Growth hormone
C. Cortisone, thyroid extract, and sex hormones
Explanation:
After surgery, patients often need replacement of hormones that were normally regulated by the pituitary.
87
What is the term for the appearance of sexual development before age 8 in girls and 9 in boys?
A. Delayed puberty
B. Hypogonadism
C. Precocious puberty
D. Menarche
C. Precocious puberty
Explanation:
Precocious puberty is defined as early onset of secondary sexual characteristics—before 8 in girls and before 9 in boys.
88
Which sex is more commonly affected by precocious puberty?
A. Boys
B. Girls
C. Equal in both
D. Depends on family history
B. Girls
Explanation:
Girls are more frequently affected by precocious puberty, although boys are more likely to have an identifiable cause like CNS lesions.
89
Which factor is associated with earlier pubertal development in girls?
A. High calcium levels
B. Increased physical activity
C. Higher body fat percentage at age 5
D. Low vitamin D intake
C. Higher body fat percentage at age 5
Explanation:
Girls with a higher percentage of body fat at a young age are more likely to experience earlier onset of puberty, likely due to hormonal changes.
90
In boys, precocious puberty is most commonly associated with which of the following?
A. Pituitary tumor only
B. CNS insult or structural injury
C. Poor nutrition
D. Emotional stress
B. CNS insult or structural injury
Explanation:
In boys, precocious puberty often has an identifiable cause, with CNS injury or abnormality being a common factor.
91
What term describes precocious puberty caused by early activation of the hypothalamic-pituitary-gonadal axis?
A. False precocious puberty
B. Secondary sexual disorder
C. True or complete precocious puberty
D. Adrenal puberty
C. True or complete precocious puberty
Explanation:
True precocious puberty is caused by premature activation of the hypothalamic-pituitary-gonadal axis, leading to early gonadal development and secondary sex characteristics.
92
What distinguishes precocious pseudopuberty from true precocious puberty?
A. It causes delayed puberty
B. It results from early gonadotropin secretion
C. It does not involve early gonadotropin secretion
D. It is only seen in males
C. It does not involve early gonadotropin secretion
Explanation:
Precocious pseudopuberty happens due to early overproduction of sex hormones but without gonadotropin involvement, unlike true precocious puberty.
93
Which of the following is a potential cause of precocious pseudopuberty?
A. Early activation of the hypothalamic-pituitary-gonadal axis
B. Emotional stress
C. Tumor of the ovary or testis
D. Growth hormone deficiency
C. Tumor of the ovary or testis
Explanation:
A sex hormone-secreting tumor of the ovary or testis can trigger early secondary sex characteristics without activating the normal gonadotropin pathway.
94
What rare adrenal condition can cause precocious pseudopuberty?
A. Addison’s disease
B. Estrogen- or testosterone-secreting adrenal tumor
C. Cortisol deficiency
D. Hyperthyroidism
B. Estrogen- or testosterone-secreting adrenal tumor
Explanation:
A rare adrenal tumor that secretes estrogen or testosterone can lead to early development of secondary sex characteristics.
95
Which enzyme contributes to pseudopuberty by converting androgens to estrogens?
A. Insulin
B. Amylase
C. Aromatase
D. Renin
C. Aromatase
Explanation:
Aromatase is the enzyme responsible for aromatization, converting androgens into estrogens, which can stimulate early development in pseudopuberty.
96
What external source of hormones may trigger precocious pseudopuberty in girls?
A. Inhalers
B. Multivitamins
C. Oral contraceptive pills
D. Antibiotics
C. Oral contraceptive pills
Explanation:
Ingestion of estrogen-containing medications like oral contraceptive pills can mimic puberty in girls, leading to signs such as breast development or menarche.
97
Which type of precocious puberty is dependent on gonadotropin-releasing hormone (GnRH)?
A. Peripheral Precocious Puberty
B. Central Precocious Puberty
C. Incomplete Puberty
D. Adrenal Pseudopuberty
B. Central Precocious Puberty
Explanation:
Central Precocious Puberty is GnRH-dependent and involves early activation of the hypothalamic-pituitary-gonadal axis, leading to elevated gonadotropins.
98
What characterizes Peripheral Precocious Puberty (GnRH-independent)?
A. Low sex hormone levels
B. Gonadotropin overproduction
C. Elevated sex steroids from gonads or adrenals
D. Delayed skeletal maturation
. Elevated sex steroids from gonads or adrenals
Explanation:
Peripheral (GnRH-independent) precocious puberty results from the early secretion of sex hormones (like estrogen or testosterone) from the gonads or adrenal glands, not from gonadotropins.
99
Which clinical sign is more commonly seen in girls with precocious puberty but without full body hair development?
A. Obvious muscle gain
B. Menstrual bleeding
C. Deep voice
D. Increased chest hair
B. Menstrual bleeding
Explanation:
Girls may have early menstrual bleeding due to estrogen effects, but often with little pubic or axillary hair, since adrenal androgens are not yet significantly elevated.
100
What is the usual method to confirm a diagnosis of precocious puberty?
A. Ultrasound of the ovaries or testes
B. X-ray of long bones
C. Serum analysis of estrogen or androgens at adult levels
D. Blood sugar level test
C. Serum analysis of estrogen or androgens at adult levels
Explanation:
Diagnosis of precocious puberty is confirmed by finding estrogen or androgen levels that are in the adult range, even though the child is still young.
101
What physical sign would you most expect in boys with precocious puberty?
A. Voice hoarseness
B. Excessive body hair
C. Obvious genital growth
D. Growth plate closure
C. Obvious genital growth
Explanation:
Boys with precocious puberty typically show enlargement of the testes and penis as one of the first noticeable signs.
102
What is the purpose of administering Luteinizing Hormone-Releasing Hormone (LHRH) such as Lupron in precocious puberty?
A. To increase estrogen levels
B. To regulate pituitary secretions and pause early puberty
C. To stimulate bone growth
D. To induce menstruation
B. To regulate pituitary secretions and pause early puberty
Explanation:
LHRH analogs like Lupron help suppress premature pituitary activity, halting the progression of early puberty until a more appropriate age.
103
When should treatment for precocious puberty typically be discontinued?
A. At age 8
B. Once secondary sexual characteristics disappear
C. When puberty is chronologically appropriate
D. After 1 year of treatment
C. When puberty is chronologically appropriate
Explanation:
Treatment is usually stopped when the child reaches the proper age for puberty, allowing normal pubertal changes to continue naturally.
104
What is the mechanism of aromatase inhibitors in treating precocious puberty?
A. Stimulate gonadotropin secretion
B. Block estrogen effects by inhibiting aromatase enzyme
C. Increase testosterone production
D. Directly shrink the gonads
B. Block estrogen effects by inhibiting aromatase enzyme
Explanation:
Aromatase inhibitors block the enzyme aromatase, which converts androgens to estrogens, thereby reducing estrogen effects in early puberty.
105
Why should a child with precocious puberty dress and engage in activities appropriate to their chronological age?
A. To help them look younger
B. To hide their physical changes
C. To support psychological and emotional development
D. Because they are not allowed to participate in advanced activities
C. To support psychological and emotional development
Explanation:
Maintaining age-appropriate activities and dress helps ensure the child is treated and supported according to their true developmental level, preventing emotional stress or identity confusion.
106
What should nurses emphasize to parents about children with precocious puberty?
A. Their fertility will be delayed
B. They are permanently delayed in physical growth
C. They are infertile
D. They are fertile despite early development
D. They are fertile despite early development
Explanation:
Even though puberty occurs early, the child is fertile, and parents need to understand this for appropriate education and supervision.
107
What hormone is deficient in Diabetes Insipidus (DI)?
A. Insulin
B. Aldosterone
C. Antidiuretic hormone (ADH)
D. Cortisol
C. Antidiuretic hormone (ADH)
Explanation:
Diabetes Insipidus results from hyposecretion of ADH (vasopressin), leading to excessive urination and loss of water.
108
Diabetes Insipidus is a disorder primarily affecting which part of the pituitary gland?
A. Anterior pituitary
B. Intermediate pituitary
C. Posterior pituitary
D. Entire pituitary gland
C. Posterior pituitary
Explanation:
ADH is produced by the hypothalamus and released by the posterior pituitary. DI is caused by posterior pituitary hypofunction, affecting water balance.
109
What is the most common characteristic symptom of Diabetes Insipidus?
A. Hypertension
B. Uncontrolled diuresis
C. Hypoglycemia
D. Edema
B. Uncontrolled diuresis
Explanation:
The hallmark of DI is uncontrolled diuresis—excessive urination due to the lack of ADH, which normally promotes water reabsorption in the kidneys.
110
Which of the following is a secondary cause of Diabetes Insipidus?
A. Hyperthyroidism
B. Hypocalcemia
C. Head trauma or surgery affecting the pituitary
D. Diabetes mellitus
C. Head trauma or surgery affecting the pituitary
Explanation:
Trauma or surgical injury to the pituitary can disrupt ADH release and lead to secondary DI.
111
What is the rare type of Diabetes Insipidus where kidneys do not respond to ADH despite adequate production?
A. Neurogenic DI
B. Central DI
C. Nephrogenic DI
D. Primary DI
C. Nephrogenic DI
Explanation:
In Nephrogenic DI, the kidneys are unresponsive to ADH, despite normal pituitary function—this is a renal cause of DI.
112
Which of the following infections may lead to secondary Diabetes Insipidus?
A. Pneumonia and sinusitis
B. Tuberculosis and gastritis
C. Encephalitis and meningitis
D. Bronchitis and conjunctivitis
C. Encephalitis and meningitis
Explanation:
Central nervous system (CNS) infections like encephalitis and meningitis can damage the hypothalamus or pituitary, resulting in impaired ADH production.
113
What vascular condition is considered a secondary cause of Diabetes Insipidus?
A. Stroke
B. Deep vein thrombosis
C. Aneurysm
D. Varicose veins
C. Aneurysm
Explanation:
An aneurysm near the hypothalamic-pituitary area can disrupt ADH secretion, making it a vascular secondary cause of DI.
114
What are the cardinal signs of Diabetes Insipidus?
A. Polyphagia and polyuria
B. Polyuria and polydipsia
C. Hypoglycemia and polyuria
D. Polydipsia and hyperthermia
B. Polyuria and polydipsia
Explanation:
The cardinal signs of Diabetes Insipidus are polyuria (excessive urination) and polydipsia (excessive thirst), caused by the body’s inability to retain water.
115
In older children with Diabetes Insipidus, what compensatory behavior accompanies urination?
A. Insatiable hunger
B. Insatiable thirst
C. Excessive sleep
D. Hyperactivity
B. Insatiable thirst
Explanation:
In older children, insatiable thirst often accompanies urination, leading to excessive drinking (polydipsia) to compensate for fluid loss due to polyuria.
116
What is the first sign of Diabetes Insipidus in infants?
A. Poor weight gain
B. Irritability
C. Excessive sleep
D. Constant hunger
B. Irritability
Explanation:
In infants, irritability is often the first sign of Diabetes Insipidus. This is relieved by water (not milk), as the infant is unable to retain fluid properly due to the lack of ADH.
117
What serious complication can occur in infants with Diabetes Insipidus if not managed properly?
A. Hypercalcemia
B. Dehydration and electrolyte imbalance
C. Hypoglycemia
D. Bradycardia
B. Dehydration and electrolyte imbalance
Explanation:
Infants with Diabetes Insipidus are prone to dehydration, electrolyte imbalances, and even circulatory collapse if hydration is not maintained.
118
Why is it important to encourage sufficient liquid intake in children with Diabetes Insipidus?
A. To prevent constipation
B. To prevent dehydration and electrolyte imbalance
C. To promote digestion
D. To prevent hyperglycemia
B. To prevent dehydration and electrolyte imbalance
Explanation:
Adequate fluid intake is essential for children with Diabetes Insipidus to prevent dehydration, electrolyte imbalances, and other severe complications like circulatory collapse.
119
What is often the first sign of Diabetes Insipidus in older children?
A. Polyphagia
B. Enuresis
C. Hyperactivity
D. Weight loss
B. Enuresis
Explanation:
The first sign of Diabetes Insipidus in older children is often enuresis (bedwetting), which occurs as a result of polyuria (excessive urination).
120
Which type of Diabetes Insipidus is characterized by a lack of ADH synthesis or release?
A. Nephrogenic Diabetes Insipidus
B. Central Diabetes Insipidus
C. Dipsogenic Diabetes Insipidus
D. Gestational Diabetes Insipidus
B. Central Diabetes Insipidus
Explanation:
Central Diabetes Insipidus is caused by the lack of ADH synthesis or release from the pituitary gland, leading to increased urine output.
121
In Nephrogenic Diabetes Insipidus, what is the issue with ADH?
A. There is no ADH production.
B. ADH is produced but the kidneys do not respond to it.
C. ADH is excessively secreted.
D. ADH is blocked by external factors.
B. ADH is produced but the kidneys do not respond to it.
Explanation:
In Nephrogenic Diabetes Insipidus, ADH is produced normally, but the kidneys do not respond to it properly, resulting in increased urine output.
122
What is the main defect in Dipsogenic Diabetes Insipidus?
A. Excessive water intake due to thirst mechanism dysfunction
B. Lack of ADH secretion
C. Kidney resistance to ADH
D. Hormonal imbalance in the pituitary gland
A. Excessive water intake due to thirst mechanism dysfunction
Explanation:
Dipsogenic Diabetes Insipidus occurs due to a defect in the thirst mechanism, leading to excessive water intake and resulting in increased urine output.
123
Which type of Diabetes Insipidus occurs due to excessive Vasopressinase activity secreted by the placenta?
A. Central Diabetes Insipidus
B. Nephrogenic Diabetes Insipidus
C. Dipsogenic Diabetes Insipidus
D. Gestational Diabetes Insipidus
D. Gestational Diabetes Insipidus
Explanation:
Gestational Diabetes Insipidus occurs due to the excessive activity of Vasopressinase (secreted by the placenta), which inactivates ADH, resulting in increased urine output.
124
What is a key diagnostic test for Diabetes Insipidus?
A. Urine culture
B. Fluid restriction and observation of urine volume and concentration
C. Blood glucose level check
D. MRI of the brain
B. Fluid restriction and observation of urine volume and concentration
Explanation:
In the diagnostic evaluation of Diabetes Insipidus, fluid restriction is used to observe changes in urine volume and concentration. If there’s little to no change in urine formation, it suggests DI, as fluid restriction typically causes weight loss from dehydration but does not affect urine formation in DI.
125
What test is administered if the fluid restriction test is positive for Diabetes Insipidus?
A. Aqueous Vasopressin (Pitressin) injection
B. Oral glucose tolerance test
C. Urine osmolality test
D. MRI of the pituitary gland
A. Aqueous Vasopressin (Pitressin) injection
Explanation:
If the fluid restriction test for Diabetes Insipidus is positive, an injected test dose of Aqueous Vasopressin (Pitressin) is given. If this alleviates polyuria and polydipsia, it confirms the diagnosis. If there’s no response, it indicates Nephrogenic Diabetes Insipidus.
126
What is the drug of choice for hormone replacement therapy in Diabetes Insipidus?
A. Insulin
B. Desmopressin Acetate (DDAVP)
C. Vasopressin
D. Lisinopril
B. Desmopressin Acetate (DDAVP)
Explanation:
The drug of choice for hormone replacement therapy in Diabetes Insipidus is Desmopressin Acetate (DDAVP). It can be given orally or in nasal form and helps replace the missing vasopressin.
127
What is the advantage of injectable Desmopressin (DDAVP)?
A. It can be taken daily
B. It lasts 48-72 hours, allowing a full night of sleep
C. It has no side effects
D. It works faster than oral DDAVP
B. It lasts 48-72 hours, allowing a full night of sleep
Explanation:
The injectable form of Desmopressin (DDAVP) lasts 48-72 hours, which allows children to get a full night of sleep. However, it requires frequent injections and proper preparation, which may be a disadvantage compared to oral forms.
128
What is a disadvantage of the injectable form of Desmopressin (DDAVP) in the treatment of Diabetes Insipidus?
A. It causes more side effects than other forms
B. It requires frequent injections and proper preparation
C. It does not control symptoms effectively
D. It is less effective than the nasal form
B. It requires frequent injections and proper preparation
Explanation:
Although the injectable DDAVP has the benefit of a longer duration (48–72 hours), its main disadvantage is the need for frequent injections and careful preparation, making it less convenient, especially for children.
129
How is nasal Desmopressin (DDAVP) administered for Diabetes Insipidus treatment?
A. Through an inhaler
B. Via a syringe directly into the nostrils
C. Using a flexible tube
D. As a nasal patch
C. Using a flexible tube
Explanation:
Nasal DDAVP is administered using a flexible tube to ensure proper delivery into the nasal cavity and adequate symptom control.
130
What is a major concern when using nasal DDAVP in children?
A. It causes severe nasal irritation
B. It may lead to drug resistance
C. Children may experience water intoxication due to overdose
D. It increases glucose levels
C. Children may experience water intoxication due to overdose
Explanation:
Overdose of nasal DDAVP can cause water intoxication, which presents with symptoms similar to Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH). Therefore, children must be carefully observed.
131
What is the initial nursing objective in caring for a child with Diabetes Insipidus?
A. Prepare the child for surgery
B. Begin IV fluid replacement
C. Identify the disorder
D. Schedule monthly checkups
C. Identify the disorder
Explanation:
Early identification of the disorder is essential so that appropriate treatment and education can begin promptly.
132
What should be emphasized when educating parents about treatment for Diabetes Insipidus?
A. It is only needed during illness
B. It is required only during the night
C. It is a short-term treatment
D. It is a lifelong treatment
D. It is a lifelong treatment
Explanation:
Parents must understand that managing DI usually involves lifelong hormone replacement therapy, so they need full guidance and support.
133
Why should school personnel be informed about a child’s condition of Diabetes Insipidus?
A. To give the child extra homework time
B. To monitor blood sugar
C. To allow unrestricted access to water and the bathroom
D. To prevent participation in sports
C. To allow unrestricted access to water and the bathroom
Explanation:
Children with DI need frequent access to fluids and bathroom use due to excessive urination and thirst. School staff should be made aware to accommodate this.
134
What is the treatment of choice for Diabetes Insipidus if a tumor is present?
A. Desmopressin therapy
B. Radiation therapy
C. Surgery
D. Fluid restriction
C. Surgery
Explanation:
If the cause of Diabetes Insipidus is a tumor, surgical removal of the tumor is the treatment of choice to address the underlying cause directly. Medical therapy may still be needed afterward depending on the outcome.
135
Which statement best describes the administration and effect of nasal Desmopressin (DDAVP) in Diabetes Insipidus?
A. It is injected subcutaneously and lasts 8 hours
B. It is taken orally and works uniformly in all patients
C. It is administered via a flexible tube and lasts 8–20 hours
D. It is only used in emergency cases for rapid effect
C. It is administered via a flexible tube and lasts 8–20 hours
Explanation:
Nasal DDAVP is commonly administered through a flexible tube into the nose and its response varies, typically lasting 8 to 20 hours. It's effective in controlling symptoms but requires monitoring due to the variable response.
136
Which electrolyte imbalance is most commonly seen in SIADH?
A. Hypernatremia
B. Hypokalemia
C. Hyponatremia
D. Hypercalcemia
C. Hyponatremia
Explanation: Because excess water is retained, sodium gets diluted in the blood, leading to hyponatremia, which is a key finding in SIADH.
136
What is the primary effect of SIADH on the body?
A. Excessive urination
B. Water retention and low sodium levels
C. High blood glucose levels
D. Increased potassium excretion
B. Water retention and low sodium levels
Explanation: In SIADH, too much ADH causes the body to retain water, which dilutes the blood and leads to hyponatremia (low sodium).
137
Which of the following is a common cause of SIADH?
A. Diabetes Mellitus
B. Brain tumor
C. Hypothyroidism
D. Pancreatitis
B. Brain tumor
Explanation: SIADH can be triggered by CNS disorders like brain tumors, infections (like meningitis), or trauma, which affect the hypothalamus or pituitary.
138
A child with SIADH is most at risk for which complication?
A. Dehydration
B. Seizures
C. Hyperglycemia
D. Renal failure
B. Seizures
Explanation: The low sodium levels (hyponatremia) from SIADH can cause neurological symptoms like headache, confusion, and seizures.
139
What is the role of ADH in the body?
A. Stimulate insulin release
B. Increase sodium reabsorption
C. Promote water reabsorption in kidneys
D. Trigger appetite regulation
C. Promote water reabsorption in kidneys
Explanation: ADH (antidiuretic hormone) helps the kidneys reabsorb water, concentrating the urine and maintaining water balance.
140
What is the first-line restriction in the management of SIADH?
A. Sodium-rich diet
B. High-protein diet
C. Fluid restriction
D. Increased potassium intake
C. Fluid restriction
Explanation: In SIADH, the body retains too much water. Restricting fluids helps prevent further dilution of sodium and correct hyponatremia.
141
What medication may be given to block the action of ADH in SIADH?
A. Desmopressin
B. Vasopressin
C. Demeclocycline
D. Insulin
C. Demeclocycline
Explanation: Demeclocycline inhibits the action of ADH at the kidney tubules, promoting diuresis and correcting water retention in SIADH.
142
Which of the following is a priority nursing assessment for a child with SIADH?
A. Blood glucose monitoring
B. Capillary refill
C. Neurological status and sodium levels
D. Wound healing
C. Neurological status and sodium levels
Explanation: Because hyponatremia can cause neurological changes such as confusion or seizures, monitoring neuro status and sodium levels is essential.
143
What is a potential complication of rapid correction of hyponatremia in SIADH?
A. Cerebral edema
B. Central pontine myelinolysis
C. Diabetes insipidus
D. Renal failure
B. Central pontine myelinolysis
Explanation: Rapid correction of sodium can lead to central pontine myelinolysis, a serious neurological condition. Sodium correction must be done slowly and carefully.
144
What nursing instruction is MOST important for the family of a child diagnosed with SIADH?
A. Encourage free water intake
B. Monitor weight daily
C. Allow unlimited physical activity
D. Avoid all dairy products
B. Monitor weight daily
Explanation: Daily weight is a key indicator of fluid retention, and a sudden increase may signal worsening SIADH.
145
Which of the following symptoms is most indicative of hyponatremia in SIADH?
A. Weight loss and dry skin
B. Polyuria and polydipsia
C. Weight gain and concentrated urine
D. Bradycardia and hypertension
C. Weight gain and concentrated urine
Explanation: In SIADH, water retention causes weight gain and urine becomes concentrated due to reduced output, even though the person is retaining water. This dilution lowers serum sodium levels (hyponatremia).
146
A child with SIADH suddenly becomes confused and combative. What is the nurse’s first priority?
A. Document the behavior
B. Offer electrolyte-rich fluids
C. Assess serum sodium and neurological status
D. Call a psychiatrist for evaluation
C. Assess serum sodium and neurological status
Explanation: Acute confusion and combativeness in SIADH may indicate severe hyponatremia, which can progress to seizures or coma. Immediate assessment of sodium levels and neuro status is critical.
147
What is the confirmatory diagnostic test for SIADH?
A. Chest X-ray
B. Blood and urine analysis for sodium and osmolality
C. CT scan of the abdomen
D. Electrocardiogram (ECG)
B. Blood and urine analysis for sodium and osmolality
Explanation: SIADH is diagnosed through blood and urine tests that measure serum sodium, urine sodium, and osmolality to detect imbalances and concentration abnormalities.
148
What is a key treatment strategy for managing fluid retention in SIADH?
A. High sodium diet
B. Potassium supplementation
C. Fluid restriction to 30–75% of normal intake
D. Unlimited oral fluids
C. Fluid restriction to 30–75% of normal intake
Explanation: To manage SIADH, fluid restriction helps reduce water overload and correct hyponatremia. The restriction level depends on the severity of the condition.
149
Which medication is used to block the action of ADH in patients with SIADH?
A. Vasopressin
B. Desmopressin
C. Demeclocycline
D. Hydrocortisone
C. Demeclocycline
Explanation: Demeclocycline inhibits ADH at the renal tubules, reducing water reabsorption and helping correct fluid overload and hyponatremia in SIADH.
150
What is the purpose of administering IV sodium supplementation in a child with SIADH?
A. To increase ADH secretion
B. To correct hyperkalemia
C. To raise dangerously low sodium levels
D. To improve urine output
C. To raise dangerously low sodium levels
Explanation: In severe hyponatremia, IV sodium (usually hypertonic saline) is used cautiously to restore sodium balance and prevent complications like seizures or coma.
151
