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1

The nurse is preparing to admit a 7-year-old child with type 2 diabetes. What clinical features of type 2 diabetes should the nurse recognize? (Select all that apply.)

a.

Oral agents are effective.

b.

Insulin is usually needed.

c.

Ketoacidosis is infrequent.

d.

Diet only is often effective.

e.

Chronic complications frequently occur.

ANS:  A, C, D

The clinical features of type 2 diabetes include the following: oral agents are effective, ketoacidosis is infrequent, and diet only is often effective. Insulin is only needed in 20% to 30% of cases and chronic complications occur infrequently.

2

The clinic nurse is assessing a child with central precocious puberty. What conditions can cause central precocious puberty? (Select all that apply.)

a.

Trauma

b.

Neoplasms

c.

Radiotherapy

d.

Exogenous sex hormones

e.

Primary hypothyroidism

 

 

ANS:  A, B, C

Trauma, neoplasms, and radiotherapy can be the cause of central precocious puberty. Exogenous sex hormones and primary hypothyroidism can cause peripheral precocious puberty.

 

2

The nurse is planning to admit a 10-year-old child with syndrome of inappropriate antidiuretic hormone (SIADH). What clinical manifestations should the nurse expect to observe in this child? (Select all that apply.)

a.

Polyuria

b.

Anorexia

c.

Polydipsia

d.

Irritability

e.

Stomach cramps

ANS:  B, D, E

Clinical signs of SIADH are directly related to fluid retention and hyponatremia. When cells in the brain are exposed to too much water as opposed to sodium, swelling occurs. When serum sodium levels are diminished to 120?9?mEq/l, affected children may display anorexia, nausea, vomiting, stomach cramps, irritability, and personality changes. Polyuria and polydipsia are manifestations of diabetes insipidus.

3

What clinical manifestation 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.

 

3

What statement applies to the current focus of the dietary management of children with diabetes?

a.

Measurement of all servings of food is vital for control.

b.

Daily calculate specific amounts of carbohydrates, fats, and proteins.

c.

The number of calories for carbohydrates remains constant on a daily basis; protein and fat calories are liberal.

d.

The intake ensures day-to-day consistency in total calories, protein, carbohydrates, and moderate fat while allowing for a wide variety of foods.

ANS:  D

Essentially the nutritional needs of children with diabetes are no different from those of healthy children. Children with diabetes need no special foods or supplements. They need sufficient calories to balance daily expenditure for energy and to satisfy the requirement for growth and development.

4

A school-age child with diabetes gets 30 units of NPH insulin at 0800. According to when this insulin peaks, the child should be at greatest risk for a hypoglycemic episode between when?

a.

Lunch and dinner

b.

Breakfast and lunch

c.

0830 to his midmorning snack

d.

Bedtime and breakfast the next morning

ANS:  A

Intermediate-acting (NPH and Lente) insulins reach the blood 2 to 6 hours after injection. The insulins peak 4 to 14 hours later and stay in the blood for about 14 to 20 hours.

 

5

The nurse is caring for a child after a parathyroidectomy. What medication should the nurse have available if hypocalcemia occurs?

a.

Insulin

b.

Calcium gluconate

c.

Propylthiouracil (PTU)

d.

Cortisone (hydrocortisone)

 

 

ANS:  B

Because hypocalcemia is a potential complication after a parathyroidectomy, observing for signs of tetany, instituting seizure precautions, and having calcium gluconate available for emergency use are part of the nursing care.

5

The nurse is planning to admit an 8-year-old child with hypoparathyroidism. What clinical manifestations should the nurse expect to observe in this child? (Select all that apply.)

a.

Muscle cramps

b.

Positive Chvostek sign

c.

Emotional lability

d.

Laryngeal spasms

e.

Short attention span

ANS:  A, B, D

Clinical manifestations of hypoparathyroidism include muscle cramps, positive Chvostek sign, and laryngeal spasms. Emotional lability and short attention span are signs of Graves disease.

6

What nursing care should be included for a child diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH)?

a.

Maintain the child NPO (nothing by mouth).

b.

Turn the child frequently.

c.

Restrict fluids.

d.

Encourage fluids.

 

 

ANS:  C

Increased secretion of ADH causes the kidney to reabsorb water, which increases fluid volume and decreases serum osmolarity with a progressive reduction in sodium concentration. The immediate management of the child is to restrict fluids but not food. Frequently turning the child is not necessary unless the child is unresponsive. Encouraging fluids will worsen the child’s condition.

6

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 secretory organs.

7

What is a condition that can result if hypersecretion of growth hormone (GH) occurs after epiphyseal closure?

a.

Cretinism

b.

Dwarfism

c.

Gigantism

d.

Acromegaly

ANS:  D

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

8

Homeostasis in the body is maintained by what is collectively known as the neuroendocrine system. What is the name of the nervous system that is involved?

a.

Central

b.

Skeletal

c.

Peripheral

d.

Autonomic

ANS:  D

The autonomic nervous system (composed of the sympathetic and parasympathetic systems) controls involuntary functions. In combination with the endocrine system, it maintains homeostasis. The central, skeletal, and peripheral subdivisions of the nervous system are not part of the neuroendocrine system.

9

A 20-kg (44-lb) child in ketoacidosis is admitted to the pediatric intensive care unit. What order should the nurse not implement until clarified with the physician?

a.

Weigh on admission and daily.

b.

Replace fluid volume deficit over 48 hours.

c.

Begin intravenous line with D5 0.45% normal saline with 20 mEq of potassium chloride.

d.

Give intravenous regular insulin 2 units/kg/hr after initial rehydration bolus.

ANS:  C

The initial hydrating solution is 0.9% normal saline. Potassium is not given until the child is voiding 25 ml/hr, demonstrating adequate renal function. After initial rehydration and insulin administration, then potassium is given. Dextrose is not given until blood glucose levels are between 250 and 300 mg/dl. An accurate, current weight is essential for determination of the amount of fluid loss and as a basis for medication dosage. Replacing fluid volume deficit over 48 hours is the current recommendation in diabetic ketoacidosis in children. Cerebral edema is a risk of more rapid administration. Intravenous regular insulin 2 units/kg/hr after initial rehydration bolus is the recommended insulin administration for a child of this weight. Only regular insulin can be given intravenously, and it is given after initial fluid volume expansion.

10

The nurse is preparing to admit a 9-year-old child with syndrome of inappropriate antidiuretic hormone (SIADH). What interventions should the nurse include in the child’s care plan? (Select all that apply.)

a.

Provide a low-sodium, low-fat diet.

b.

Initiate seizure precautions.

c.

Weigh daily at the same time each day.

d.

Encourage intake of 1 l of fluid per day.

e.

Measure intake and output hourly.

ANS:  B, C, E

Nursing care of the child with SIADH includes placing the child on seizure precautions, obtaining a daily weight at the same time each day, and accurately measuring the child’s intake and output. The nurse does not need to provide a low-sodium, low-fat diet because there are no diet restrictions. The child would be on fluid precautions to avoid fluid overload, so 1 l of fluid would not be encouraged

11

Intranasal administration of desmopressin acetate (DDAVP) is used to treat which condition?

a.

Hypopituitarism

b.

Diabetes insipidus (DI)

c.

Syndrome of inappropriate antidiuretic hormone (SIADH)

d.

Acute adrenocortical insufficiency

ANS:  B

DDAVP is the treatment of choice for DI. It is administered intranasally through a flexible tube. The child’s response pattern is variable, with effectiveness lasting from 6 to 24 hours.

12

The school nurse practitioner is consulted by a fifth-grade teacher about a student who has become increasingly inattentive and hyperactive in the classroom. The nurse notes that the child’s weight has changed from the 50th percentile to the 30th percentile. The nurse is concerned about possible hyperthyroidism. What additional sign or symptom should the nurse anticipate?

a.

Skin that is cool and dry

b.

Blurred vision and loss of acuity

c.

Running and being active during recess

d.

Decreased appetite and food intake

ANS:  B

Visual disturbances such as loss of visual acuity and blurred vision are associated with hyperthyroidism. They may occur before the actual onset of other symptoms. The child’s skin is usually warm, flushed, and moist. Although the signs of hyperthyroidism include excessive motion, irritability, hyperactivity, short attention span, and emotional lability, these children are easily fatigued and require frequent rest periods. Children with hyperthyroidism have increased food intake. Even with voracious appetites, weight loss occurs.

13

A child with hypoparathyroidism is receiving vitamin D therapy. The parents should be advised to watch for which signs or symptoms of vitamin D toxicity?

a.

Headache and seizures

b.

Weakness and lassitude

c.

Anorexia and insomnia

d.

Physical restlessness, voracious appetite without weight gain

ANS:  B

Vitamin D toxicity can be a serious consequence of therapy. Parents are advised to watch for 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. Anorexia and insomnia are not characteristic of vitamin D toxicity. Physical restlessness and a voracious appetite with weight loss are manifestations of hyperthyroidism.

13

A 12-year-old girl is newly diagnosed with diabetes when she develops ketoacidosis. How should the nurse structure a successful education program?

a.

Essential information is presented initially.

b.

Teaching should take place in the child’s semiprivate room.

c.

Education is focused toward the parents because the child is too young.

d.

All information needed for self-management of diabetes is taught at once.

ANS:  A

Diagnosis of type 1 diabetes can be traumatic for the child and family. Most families are not psychologically ready for the complex teaching that is needed for self-management. Most structured diabetes education programs begin with essential or survival information followed by the complex background material when the family is better able to learn. Teaching can take place either as an outpatient or as an inpatient. The actual teaching area should be free from distractions that would interfere with learning. A semiprivate room would have many individuals entering and leaving the room, causing distraction. A 12-year-old child who is cognitively age appropriate needs to be included in the educational process. Most children older than the age of 8 years can be involved in blood glucose monitoring and insulin administration. Teaching all information needed for self-management of diabetes at once would be too overwhelming for a family in crisis.

13

The nurse is planning to admit a 14-year-old adolescent with Cushing syndrome. What clinical manifestations should the nurse expect to observe in this child? (Select all that apply.)

a.

Truncal obesity

b.

Decreased pubic hair

c.

Petechial hemorrhage

d.

Hyperpigmentation of elbows

e.

Facial plethora

f.

Headache and weakness

ANS:  A, C, E

Clinical manifestations of Cushing syndrome include truncal obesity, petechial hemorrhage, and facial plethora. Decreased pubic and axillary hair; hyperpigmentation of elbows, knees, and wrists; and headache and weakness are clinical manifestations of adrenocortical insufficiency.

14

The nurse is teaching the family of a child with type 1 diabetes about insulin. What should the nurse include in the teaching session? (Select all that apply.)

a.

Unopened vials are good for 60 days.

b.

Diabetic supplies should not be left in a hot environment.

c.

Insulin can be placed in the freezer if not used every day.

d.

After it has been opened, insulin is good for up to 28 to 30 days.

e.

Insulin bottles that have been opened should be stored at room temperature or refrigerated.

ANS:  B, D, E

Insulin bottles that have been “opened” (i.e., the stopper has been punctured) should be stored at room temperature or refrigerated for up to 28 to 30 days. After 1 month, these vials should be discarded. Unopened vials should be refrigerated and are good until the expiration date on the label. Diabetic supplies should not be left in a hot environment. Insulin need not be refrigerated but should be maintained at a temperature between 15° and 29.5° C (59° and 85° F). Freezing renders insulin inactive.

15

The nurse is assisting with a growth hormone stimulation test for a child with short stature. What should the nurse monitor closely on this child during the test?

a.

Hypotension

b.

Tachycardia

c.

Hypoglycemia

d.

Nausea and vomiting

ANS:  A

Patients receiving clonidine (Catapres) for a growth hormone stimulation test require close blood pressure monitoring for hypotension. Tachycardia, hypoglycemia, and nausea and vomiting do not occur with Catapres administered for a growth hormone stimulation test.

 

17

An adolescent diabetic is admitted to the emergency department for treatment of hyperglycemia and pneumonia. What are characteristics of diabetic hyperglycemia?

a.

Cold, clammy skin and lethargy

b.

Hunger and hypertension

c.

Thirst, being flushed, and fruity breath

d.

Disorientation and pallor

ANS:  C

The signs of hyperglycemia are thirst, being flushed, and fruity breath. The skin is not cold or clammy, and there is not hunger and hypertension. Disorientation and pallor are signs of hypoglycemia

19

What form of diabetes is characterized by destruction of pancreatic beta cells, resulting in insulin deficiency?

a.

Type 1 diabetes

b.

Type 2 diabetes

c.

Gestational diabetes

d.

Maturity-onset diabetes of the young (MODY)

ANS:  A

Type 1 diabetes is characterized by the destruction of the pancreatic beta cells, which leads to absolute insulin deficiency. Type 2 diabetes results usually from insulin resistance. The pancreatic beta cells are not destroyed in gestational diabetes. MODY is an autosomal dominant monogenetic defect in beta cell function that is characterized by impaired insulin secretion with minimum or no defects in insulin action.

 

19

The nurse is discussing with a child and family the various sites used for insulin injections. What site usually has the fastest rate of absorption?

a.

Arm

b.

Leg

c.

Buttock

d.

Abdomen

ANS:  D

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

20

The nurse is caring for a child with an anterior pituitary tumor. What hormones are secreted by the anterior pituitary? (Select all that apply.)

a.

Oxytocin

b.

Luteinizing hormone

c.

Antidiuretic hormone

d.

Thyroid-stimulating hormone

e.

Adrenocorticotrophic hormone

ANS:  B, D, E

The anterior pituitary is responsible for secreting the following hormones: growth hormone, thyroid-stimulating hormone, adrenocorticotrophic hormone, follicle-stimulating hormone, luteinizing hormone, and prolactin. The posterior pituitary secretes antidiuretic hormone and oxytocin.

21

The nurse is preparing to assist with a growth hormone provocative test for a child with short stature. The nurse recognizes that which pharmacologics should be used to provoke the release of growth hormone (GH)? (Select all that apply.)

a.

Larodopa (levodopa)

b.

Clonidine (Catapres)

c.

Propranolol (Inderal)

d.

Cortisone (hydrocortisone)

e.

Biosynthetic growth hormone

ANS:  A, B, C

GH stimulation, or provocative testing, involves the use of pharmacologics to provoke the release of GH either directly or indirectly. Provocative testing involves the use of neuromodulators such as levodopa or agents such as clonidine, arginine, insulin, propranolol, or glucagon followed by the measurement GH blood levels. Cortisone is given to replace hormone deficiencies that can occur with GH deficiency. Biosynthetic GH is used to treat GH deficiency.

23

Glucocorticoids, mineralocorticoids, and sex steroids are secreted by which gland?

a.

Thyroid gland

b.

Adrenal cortex

c.

Anterior pituitary

d.

Parathyroid glands

ANS:  B

The glucocorticoids, mineralocorticoids, and sex steroids are secreted by the adrenal cortex. The thyroid gland produces thyroid hormone and thyrocalcitonin. The anterior pituitary produces hormones such as growth hormone, thyroid-stimulating hormone, adrenocorticotropic hormone, gonadotropin, prolactin, and melanocyte-stimulating hormone. The parathyroid glands produce parathyroid hormone

24

The nurse is teaching an adolescent about giving insulin injections. The adolescent asks if the disposable needles and syringes can be used more than once. The nurse’s response should be based on which knowledge?

a.

It is unsafe.

b.

It is acceptable for up to 24 hours.

c.

It is acceptable for families with very limited resources.

d.

It is suitable for up to 3 days if stored in the refrigerator.

ANS:  D

Bacterial counts are unaffected if insulin syringes are handled in an aseptic manner and stored in the refrigerator between use. The syringes can be used up to 3 days and result in a considerable cost savings. Bacterial counts remain low for up to 72 hours with proper technique. The family’s resources are not an issue; if a practice is unsafe, the family should not be encouraged to endanger the child by reusing equipment.

25

A child is having tests done to determine parathyroid function. The clinic nurse knows that the parathyroid hormone (PTH) regulates the homeostasis of what in the serum?

a.

Sodium

b.

Calcium

c.

Potassium

d.

Magnesium

ANS:  B

The parathyroid glands secrete PTH. Along with vitamin D and calcitonin, PTH regulates the homeostasis of serum calcium concentrations.

26

The nurse is planning to admit a 14-year-old adolescent with hyperparathyroidism. What clinical manifestations should the nurse expect to observe in this patient? (Select all that apply.)

a.

Polyuria

b.

Diarrhea

c.

Hypotension

d.

Vague bone pain

e.

Paresthesia in extremities

ANS:  A, D, E

Clinical manifestations of hyperparathyroidism include polyuria, vague bone pain, and paresthesia in the extremities. Constipation, not diarrhea, and hypertension, not hypotension, are manifestations of hyperparathyroidism.