Chapter 48: Metabolism/Endocrine Disorders Flashcards
- The nurse is obtaining a health history from parents whose 4-month-old boy
has congenital hypothyroidism. What would the nurse most likely assess?
A) The child has above-normal growth for his age.
B) The child is active and playful.
C) The skin is pink and healthy looking.
D) It is difficult to keep the child awake.
Ans: D
Rationale: The parents may state, during the health history, that it is difficult to keep the child awake. Physical examination would reveal that the child is below the normal weight and height for his age, that his skin is pale and mottled, and that he is lethargic and irritable.
- The nurse is caring for an 8-year-old girl with hyperpituitarism. What ordered treatment will the nurse expect to perform?
A) Give desmopressin acetate intranasally
B) Inject octreotide acetate
C) Give 1 mg/kg/day of methimazole
D) Administer glipizide orally
Ans: B
Rationale: The nurse would give the child a subcutaneous injection of octreotide acetate every 12 hours as directed. Desmopressin is a synthetic antidiuretic hormone used to
treat diabetes insipidus. Methimazole is an antithyroid drug used to treat hyperthyroidism. Glipizide is a hypoglycemic drug that assists insulin production in children with diabetes mellitus type 2.
- The nurse is developing a plan of care for a 7-year-old boy with diabetes insipidus. What is the priority nursing diagnosis?
A) Deficient fluid volume related to dehydration
B) Excess fluid volume related to edema
C) Deficient knowledge related to fluid intake regimen
D) Imbalanced nutrition, more than body requirements related to excess
weight
Ans: A
Rationale: The priority nursing diagnosis most likely would be deficient fluid volume related to dehydration, due to a deficiency in the secretion of antidiuretic hormone (ADH). Excess fluid would result from a disorder that leads to water retention, such as syndrome of inappropriate antidiuretic hormone (SIADH). Deficient knowledge related to fluid intake regimen is a nursing diagnosis for this child, but a secondary
one. Imbalanced nutrition, more than body requirements related to excess weight would be inappropriate for this child since he probably has lost weight secondary to the fluid loss.
- The nurse is assessing a 9-year-old girl with a history of tuberculosis at age 6 years. She has been losing weight and has no appetite. The nurse suspects Addison disease based on which assessment findings?
A) Arrested height and increased weight
B) Thin, fragile skin and multiple bruises
C) Hyperpigmentation and hypotension
D) Blurred vision and enuresis
Ans: C
Rationale: Hyperpigmentation and hypotension would point to Addison disease. Arrested height and increased weight are typical of acquired hypothyroidism; this girl has
lost weight. Thin, fragile skin and multiple bruises are indicative of Cushing syndrome. Blurred vision, headaches, and enuresis would be complaints of a child with diabetes mellitus.
- The nurse is caring for a 13-year-old girl with delayed puberty. Based on the nurse’s knowledge of this condition, the nurse would include which nursing diagnosis in the child’s plan of care?
A) Disabled family coping related to the child’s disorder
B) Imbalanced nutrition, less than body requirements related to the child’s short stature
C) Noncompliance related to the need for lifelong hormone therapy
D) Deficient knowledge related to the administration of estradiol
Ans: D
Rationale: Deficient knowledge related to the administration of estradiol is an appropriate nursing diagnosis for this child. There are oral, transdermal, topical, injectable, and
vaginal preparations available. Disabled family coping due to the child’s disorder and noncompliance due to long-term therapy are not likely diagnoses because of the simplicity and brevity of the treatment for this disorder. Imbalanced nutrition evidenced by short stature would be appropriate for a child with growth hormone deficiency.
- The nurse is preparing a teaching plan for the family and their 6-year-old son who has just been diagnosed with diabetes mellitus. What would the nurse identify
as the initial goal for the teaching plan?
A) Developing management and decision-making skills
B) Educating the parents about diabetes mellitus type 1
C) Developing a nutritionally sound, 30-day meal plan
D) Promoting independence with self-administration of insulin
Ans: A
Rationale: Developing basic management and decision-making skills related to the diabetes is the initial goal of the teaching plan for this child and family. The nurse would have
provided a basic description of the disorder after it was diagnosed. Development of a detailed monthly meal plan would come later, perhaps after consulting with a nutritionist. It is too soon to expect the boy to administer his own insulin.
- The nurse is caring for an 8-year-old girl with an endocrine disorder involving the posterior pituitary gland. What care would the nurse expect to implement?
A) Instructing the parents to report adverse reactions to the growth hormone treatment
B) Teaching the parents how to administer desmopressin acetate
C) Informing the parents that treatment stops when puberty begins
D) Educating the parents to report signs of acute adrenal crisis
Ans: B
Rationale: The nurse would teach the parents how to administer desmopressin acetate, which treats diabetes insipidus, a disorder related to the posterior pituitary gland. Instructing parents to report adverse reactions to growth hormone is an intervention for growth hormone deficiency. Informing the parents that treatment stops at the normal time of puberty is a teaching intervention for precocious
puberty. Educating the parents to report signs of an acute adrenal crisis is an intervention for congenital adrenal hyperplasia. All three of these other disorders are related to the anterior pituitary.
- The nurse is assessing a 13-year-old boy with type 2 diabetes mellitus. What would the nurse correlate with disorder?
A) The parents report that their child had “a cold or flu” recently.
B) Blood pressure is decreased when checking vital signs.
C) The parents report that their son “can’t drink enough water.”
D) Auscultation reveals Kussmaul breathing.
Ans: C
Rationale: Unquenchable thirst (polydipsia) is a common finding associated with diabetes mellitus, type 1 and 2. However, reports of flu-like illness and Kussmaul breathing
are more commonly associated with type 1 diabetes. Blood pressure is normal with type 1 diabetes and elevated with type 2 diabetes.
- The nurse is preparing a teaching plan for a 10-year-old girl with hyperthyroidism. What information would the nurse include in the plan?
A) Describing surgery to remove an anterior pituitary tumor
B) Teaching her parents to give injections of growth hormone
C) Explaining about the radioactive iodine procedure
D) Showing her parents how to give DDAVP intranasally
Ans: C
Rationale: Explaining about the radioactive iodine procedure would be part of the teaching plan for a child with hyperthyroidism because this is a less invasive type of therapy for the disorder. Describing surgery to remove an anterior pituitary tumor would be included for a child with hyperpituitarism. Teaching a parent to give injections of
growth hormone would be appropriate for a child with a growth hormone deficiency. Showing parents how to give DDAVP intranasally is appropriate for a child with diabetes insipidus.
- What finding would the nurse expect to assess in a child with hypothyroidism?
A) Nervousness
B) Heat intolerance
C) Smooth velvety skin
D) Weight gain
Ans: D
Rationale: Hypothyroidism is manifested by weight gain, fatigue, cold intolerance, and dry skin. Nervousness, heat intolerance, and smooth velvety skin are associated with
hyperthyroidism.
- The parents of a child with congenital adrenal hyperplasia bring the child to the emergency department for evaluation because the child has had persistent
vomiting. What finding would lead the nurse to suspect that the child is experiencing an acute adrenal crisis?
A) Hypernatremia
B) Bradycardia
C) Hypertension
D) Hyperkalemia
Ans: D
Rationale: Signs and symptoms of an acute adrenal crisis include hyperkalemia, hyponatremia, tachycardia, hypotension, persistent vomiting, dehydration, and
shock.
- A child with diabetes reports that he is feeling a little shaky. Further assessment reveals that the child is coherent but with some slight tremors and sweating. A fingerstick blood glucose level is 70 mg/dL. What would the nurse do
next?
A) Administer a sliding-scale dose of insulin.
B) Give 10 to 15 g of a simple carbohydrate.
C) Offer a complex carbohydrate snack.
D) Administer glucagon intramuscularly.
Ans: B
Rationale: The child is experiencing hypoglycemia as evidenced by the assessment findings and blood glucose level. Since the child is coherent, offering the child 10 to 15 g of a simple carbohydrate would be appropriate. Insulin is not used because the child is hypoglycemic. A complex carbohydrate snack would be used after offering the
simple carbohydrate to maintain the glucose level. Intramuscular glucagon would be used if the child was not coherent.
- A child with growth hormone deficiency is receiving growth hormone. Whatresult would the nurse interpret as indicating effectiveness of this therapy?
A) Rapid weight gain
B) Complaints of headaches
C) Height increase of 4 in
D) Growth plate closure
Ans: C
Rationale: Effectiveness of growth hormone therapy is indicated by at least a 3- to 5-in increase in linear growth in the first year of treatment. Rapid weight gain and headaches are adverse reactions of this therapy. The drug is stopped when the epiphyseal growth plates close.
- After teaching the parents of a daughter with central precocious puberty about medication therapy, which statement by the parents indicates successful teaching?
A) “She needs to use the nasal spray once every day.”
B) “She will start puberty again when the medication stops.”
C) “This medication will slow down the changes but not reverse them.”
D) “Once therapy is done, she’ll need surgery.
Ans: B
Rationale: Treatment for central precocious puberty involves administering a gonadotropin- releasing hormone (GnRH) analog. When it is stopped, puberty resumes according to the appropriate developmental stages. This analog can be given by depot injection every 3 to 4 weeks, a daily subcutaneous injection, or an intranasal spray two or three times per day. With GnRH analog treatment, secondary sexual development stabilizes or regresses. Surgery is indicated only if there is a tumor.
- A group of nursing students are reviewing information about the endocrine
system in infants and children. The students demonstrate understanding of the information when they state:
A) Endocrine glands begin developing in the third trimester of gestation.
B) B) At birth, the endocrine glands are completely functional.
C) Infants have difficulty balancing glucose and electrolytes.
D) A child’s endocrine system has little effect on growth and
development.
Ans: C
Rationale: Typically, most endocrine glands begin to develop during the first trimester of gestation, but their development is incomplete at birth. Thus, complete hormonal control is lacking during the early years of life, and the infant can not appropriately balance fluid concentration, electrolytes, amino acids, glucose, and trace substances.
