Chapter 029

Hockenberry, et al.
: Wong's Essential of Pediatric Nursing, 8

th
Edition
Chapter 29: The Child With Endocrine Dysfunction
MU!"PE #H$"#E
1. Which of the following statements best describes hypopituitarism
1. !rowth is normal during the first " years of life.
2. Weight is usually more retarded than height.
". #$eletal proportions are normal for age.
%. &ost of these children ha'e subnormal intelligence.
()#: "
". *n children with hypopituitarism+ the s$eletal proportions are normal.
1. !rowth is within normal limits for the first year of life.
2. ,eight is usually more delayed than weight.
%. *ntelligence is not affected by hypopituitarism.
D*-: Cogniti'e .e'el: Comprehension T/0: *ntegrated 0rocess: )ursing 0rocess:
(ssessment
&#C: (rea of Client )eeds: 0hysiological *ntegrity: 1eduction of 1is$ 0otential
2. ( child with hypopituitarism is being started on growth hormone therapy. )ursing
considerations should be based on $nowledge of which of the following
1. Treatment is most successful if it is started during adolescence.
2. Treatment is considered successful if children attain full stature by adulthood.
". 1eplacement therapy re2uires daily subcutaneous in3ections.
%. 1eplacement therapy will be re2uired throughout child4s lifetime.
()#: "
". (dditional support is re2uired for children who re2uire hormone replacement therapy+ such
as preparation for daily subcutaneous in3ections and education for self5management during
the school5age years.
1. 6oung children+ obese children+ and those who are se'erely growth hormone deficient ha'e
the best response to therapy.
2. When therapy is successful+ children can attain their actual or near5final adult height at a
slower rate than their peers.
%. 1eplacement therapy is not needed after attaining final height. They are no longer growth
hormone deficient.
D*-: Cogniti'e .e'el: (nalysis T/0: *ntegrated 0rocess: )ursing 0rocess:
0lanning
&#C: (rea of Client )eeds: 0hysiological *ntegrity: 0harmacologic and 0arenteral Therapy
&osby items and deri'ed items 7 2889+ 288:+ 2881 by &osby *nc.
Test ;an$
". ( child with growth hormone <!,= deficiency is recei'ing !, therapy. When is the best
time for the !, to be administered
1. (t bedtime
2. (fter meals
". ;efore meals
%. (rising in the (&
()#: 1
1. *n3ections are best gi'en at bedtime to more closely appro>imate the physiologic release of
!,.
2+ "+ and %. These times do not mimic the physiologic release of the hormone.
D*-: Cogniti'e .e'el: (pplication T/0: *ntegrated 0rocess: )ursing 0rocess:
*mplementation
%. Which of the following is a condition that can result if hypersecretion of !, occurs after
epiphyseal closure
1. Dwarfism
2. (cromegaly
". !igantism
%. Cretinism
()#: 2
2. E>cess !, after closure of the epiphyseal plates results in acromegaly.
1. Dwarfism is the condition of being abnormally small.
". !igantism occurs when there is hypersecretion of !, before the closure of the epiphyseal
plates.
%. Cretinism is associated with hypothyroidism.
(ssessment
:. (t what age is se>ual de'elopment in boys and girls considered to be precocious
1. ;oys+ 11 years? girls+ 9 years
2. ;oys+ 12 years? girls+ 18 years
". ;oys+ 9 years? girls+ 9 years
%. ;oys+ 18 years? girls+ 9 1@2 years
()#: "
". &anifestations of se>ual de'elopment before age 9 in boys and age 9 in girls is considered
precocious and should be in'estigated.
1+ 2+ and %. These ages fall within the e>pected range of pubertal onset.
2
Test ;an$
0roblem *dentification
A. ( child will start treatment for precocious puberty. This in'ol'es in3ections of synthetic:
1. Thyrotropin.
2. !onadotropins.
". #omatotropic hormone.
%. .uteiniBing hormoneCreleasing hormone.
()#: %
%. 0recocious puberty of central origin is treated with monthly subcutaneous in3ections of
luteiniBing hormoneCreleasing hormone.
1+ 2+ and ". These are not the appropriate therapies for precocious puberty.
*mplementation
D. Diabetes insipidus is a disorder of which of the following
1. (nterior pituitary
2. 0osterior pituitary
". (drenal corte>
%. (drenal medulla
()#: 2
2. The principal disorder of posterior pituitary hypofunction is diabetes insipidus.
1. The anterior pituitary produces hormones such as growth hormone+ thyroid5stimulating
hormone+ adrenocorticotropic hormone+ gonadotropin+ prolactin+ and melanocyte5stimulating
hormone.
". The adrenal corte> produces aldosterone+ se> hormones+ and glucocorticoids.
%. The adrenal medulla produces catecholamines.
(ssessment
&#C: (rea of Client )eeds: 0hysiological *ntegrity: 0hysiological (daptation
9. Which of the following is the primary clinical manifestation of diabetes insipidus
1. /liguria
2. !lycosuria
". )ausea+ 'omiting
%. 0olyuria+ polydipsia
()#: %
"
Test ;an$
%. E>cessi'e urination accompanied by insatiable thirst is the primary clinical manifestations of
diabetes. These symptoms may be so se'ere that the child does little other than drin$ and
urinate.
1. /liguria is decreased urine production and is not associated with diabetes insipidus.
2. !lycosuria is associated with diabetes mellitus.
". )ausea and 'omiting are associated with inappropriate antidiuretic hormone <(D,=
secretion.
(ssessment
9. ( nasal spray of desmopressin acetate <DD(E0= is used to treat:
1. ,ypopituitarism.
2. Diabetes insipidus.
". (cute adrenocortical insufficiency.
%. #yndrome of inappropriate (D,.
()#: 2
2. The drug of choice for the treatment of diabetes insipidus is DD(E0+ which is a synthetic
analog of 'asopressin.
1+ "+ and %. (D, is not affected in these disorders.
*mplementation
18. )ursing care of a child diagnosed with syndrome of inappropriate (D, should include
which of the following
1. Encourage fluids.
2. Turn fre2uently.
". &aintain nothing by mouth <)0/=.
%. 1estrict fluids.
()#: %
%. *ncreased secretion of (D, causes the $idney to reabsorb water which increases fluid
'olume and decreases serum osmolarity with a progressi'e reduction in sodium
concentration. The immediate management of the child is to restrict fluids.
1. This will further worsen the child4s condition.
2. This is not an appropriate inter'ention unless the child is unresponsi'e.
". -luids+ but not food+ should be restricted.
0lanning
%
Test ;an$
11. Which of the following is a common clinical manifestation of 3u'enile hypothyroidism
1. *nsomnia
2. Diarrhea
". Dry s$in
%. (ccelerated growth
()#: "
". Dry s$in+ mental decline and my>edematous s$in changes are associated with 3u'enile
hypothyroidism.
2. Constipation is associated with hypothyroidism.
1. Children with hypothyroidism are usually sleepy.
%. Decelerated growth is common in 3u'enile hypothyroidism.
(ssessment
12. ( goiter is an enlargement or hypertrophy of which gland
1. Thyroid
2. (drenal
". (nterior pituitary
%. 0osterior pituitary
()#: 1
1. ( goiter is an enlargement or hypertrophy of the thyroid gland.
2+ "+ and %. !oiter is not associated with these secretory organs.
1". ( 1"5year5old girl is brought to the clinic with the complaint of Femotional lability and
restlessness.G /ther symptoms include: gradual weight loss despite a good appetite? warm+
moist s$in? heat intolerance? and unusually fine hair. These manifestations are most
suggesti'e of which of the following
1. ,ypothyroidism
2. ,yperthyroidism
". ,ypoparathyroidism
%. ,yperparathyroidism
()#: 2
2. This adolescent is demonstrating the clinical manifestations of hyperthyroidism or !ra'es4
disease.
1. ,ypothyroidism is associated with dry s$in+ mental decline+ decelerated growth+ sleepiness+
constipation+ and my>edematous s$in changes.
" and %. The parathyroid glands are in'ol'ed in calcium metabolism.
:
Test ;an$
(ssessment
1%. E>ophthalmos <protruding eyeballs= may occur in children with which of the following
conditions
1. ,ypothyroidism
2. ,yperthyroidism
". ,ypoparathyroidism
%. ,yperparathyroidism
()#: 2
2. E>ophthalmos is a clinical manifestation of hyperthyroidism.
1+ "+ and %. These disorders are not associated with e>ophthalmos.
(ssessment
1:. ( child is recei'ing propylthiouracil for the treatment of hyperthyroidism <!ra'es4 disease=.
The parents and child should be taught to recogniBe and report which of the following
symptoms immediately
1. (nore>ia
2. Ear pain
". -e'er+ sore throat
%. Hpper respiratory infection
()#: "
". Children being treated with propylthiouracil must be carefully monitored for the side effects
of the drug. 0arents must be alerted that sore throat and fe'er accompany the gra'e
complication of leu$openia. These symptoms should be immediately reported.
1+ 2+ %. These are not usually associated with leu$openia.
D*-: Cogniti'e .e'el: Comprehension T/0: *ntegrated 0rocess: Teaching@.earning
1A. Which of the following clinical manifestations may occur in the child who is recei'ing too
much propylthiouracil for the treatment of hyperthyroidism <!ra'es4 disease=
1. #eiBures
2. Enlargement of all lymph glands
". 0ancreatitis or cholecystitis
%. .ethargy and somnolence
()#: %
%. 0arents should be aware of the signs of hypothyroidism that can occur from o'erdosage of
the drug. The most common manifestations are lethargy and somnolence.
A
Test ;an$
1 and ". #eiBures and pancreatitis are not associated with the administration of propylthiouracil.
2. Enlargement of the sali'ary and cer'ical lymph glands occurs.
*mplementation
1D. ( child with hypoparathyroidism is recei'ing 'itamin D therapy. The parents should be
ad'ised to watch for which of the following signs of 'itamin D to>icity
1. ,eadache+ seiBures
2. 0hysical restlessness+ 'oracious appetite without weight gain.
". Wea$ness and lassitude
%. (nore>ia and insomnia
()#: "
". Eitamin D to>icity can be a serious conse2uence of therapy. 0arents are ad'ised to watch for
signs including wea$ness+ fatigue+ lassitude+ headache+ nausea+ 'omiting+ and diarrhea. 1enal
impairment is manifested through polyuria+ polydipsia+ and nocturia.
1. ,eadaches may be a sign of 'itamin D to>icity+ but seiBures are not.
2. 0hysical restlessness and a 'oracious appetite with weight loss are manifestations of
hyperthyroidism.
%. (nore>ia and insomnia are not characteristic of 'itamin D to>icity.
D*-: Cogniti'e .e'el: (pplication T/0: *ntegrated 0rocess: Teaching@.earning
19. !lucocorticoids+ mineralocorticoids+ and se> steroids are secreted by the:
1. Thyroid gland.
2. 0arathyroid glands.
". (drenal corte>.
%. (nterior pituitary.
()#: "
". These hormones are secreted by the adrenal corte>.
1. The thyroid gland produces thyroid hormone and thyrocalcitonin.
2. The parathyroid gland produces parathyroid hormone.
%. The anterior pituitary produces hormones such as growth hormone+ thyroid5stimulating
hormone+ adrenocorticotropic hormone+ gonadotropin+ prolactin+ and melanocyte5stimulating
hormone.
(ssessment
19. Chronic adrenocortical insufficiency also is referred to as:
1. !ra'es4 disease.
D
Test ;an$
2. (ddison disease.
". Cushing syndrome.
%. ,ashimoto disease.
()#: 2
2. (ddison disease is chronic adrenocortical insufficiency.
1 and %. !ra'es4 and ,ashimoto diseases in'ol'e the thyroid gland.
". Cushing syndrome is a result of e>cessi'e circulation of free cortisol.
28. ( neonate+ born with ambiguous genitalia+ is diagnosed with congenital adrenogenital
hyperplasia. Therapeutic management will include administration of:
1. Eitamin D.
2. Cortisone.
". #tool softeners.
%. Calcium carbonate.
()#: 2
2. Cortisone is administered to suppress the abnormally high secretions of adrenocorticotropic
hormone <(CT,=+ which in turn inhibits the secretion of adrenocorticosteroid+ which stems
the progressi'e 'iriliBation.
1+ "+ and %. These medications ha'e no role in the therapy of adrenogenital hyperplasia.
*mplementation
21. The parents of a neonate with adrenogenital hyperplasia tell the nurse that they will be afraid
to ha'e any more children. The nurse should e>plain that:
1. *t is not hereditary.
2. !enetic counseling is indicated.
". *t can be pre'ented during pregnancy.
%. (ll future children will ha'e the disorder.
()#: 2
2. #ome forms of adrenogenital hyperplasia are hereditary and should be referred for genetic
counseling. (ffected offspring should also be referred for genetic counseling.
1. There is an autosomal recessi'e form of adrenogenital hyperplasia.
". ( prenatal treatment with glucocorticoids can be offered to the mother during pregnancy to
a'oid the se> ambiguity+ but it does not affect the presence of the disease.
%. *f it is the heritable form+ for each pregnancy+ a 2:I ris$ occurs that the child will be
affected.
9
Test ;an$
D*-: Cogniti'e .e'el: (nalysis T/0: *ntegrated 0rocess: Teaching@.earning
22. Which of the following is characteristic of the immune5mediated type 1 diabetes mellitus
1. Jetoacidosis is infre2uent.
2. /nset is gradual.
". (ge at onset is usually younger than 28 years.
%. /ral agents are often effecti'e for treatment.
()#: "
". The immune5mediated type 1 diabetes mellitus typically has its onset in children or young
adults.
1+ 2+ and %. These manifestations are more consistent with type 2 diabetes.
2". Which of the following is considered a cardinal sign of diabetes mellitus
1. )ausea
2. #eiBures
". *mpaired 'ision
%. -re2uent urination
()#: %
%. ,allmar$s of diabetes mellitus are glycosuria+ polyuria+ and polydipsia.
1 and 2. )ausea and seiBures are not clinical manifestations of diabetes mellitus.
". *mpaired 'ision is a long5term complication of the disease.
D*-: Cogniti'e .e'el: Comprehension
T/0: *ntegrated 0rocess: )ursing 0rocess: 0roblem *dentification
2%. ,yperglycemia associated with diabetic $etoacidosis is defined as a blood glucose
measurement e2ual to or greater than:
1. 19: mg@d..
2. 228 mg@d..
". 298 mg@d..
%. ""8 mg@d..
()#: %
%. Diabetic $etoacidosis is a state of relati'e insulin insufficiency and may include the presence
of hyperglycemia+ blood glucose le'el greater than or e2ual to ""8 mg@d..
9
Test ;an$
1+ 2+ and ". These 'alues are too low for the definition of $etoacidosis.
2:. Type 1 diabetes mellitus is suspected in an adolescent. Which of the following clinical
manifestations may be present
1. &oist s$in
2. Weight gain
". -luid o'erload
%. 0oor wound healing
()#: %
%. 0oor wound healing may be present in an indi'idual with type 1 diabetes mellitus.
1+ 2+ and ". Dry s$in+ weight loss+ and dehydration are clinical manifestations of type 1 diabetes
mellitus.
2A. The parent of a child as$s the nurse why self5monitoring of blood glucose is being
recommended for her child with diabetes. The nurse should base the e>planation on which of
the following
1. *t is a less e>pensi'e method of testing.
2. *t is not as accurate as laboratory testing.
". Children are better able to manage the diabetes.
%. The parents are able to manage the disease better.
()#: "
". ;lood glucose self5management has impro'ed diabetes management and can be used
successfully by children from the time of diagnosis. *nsulin dosages can be ad3usted based on
blood sugar results.
1. ;lood glucose monitoring is more e>pensi'e but pro'ides impro'ed management.
2. *t is as accurate as e2ui'alent testing done in laboratories.
%. The ability to self5test allows the child to balance diet+ e>ercise+ and insulin. The parents are
partners in the process+ but the child should be taught how to manage the disease.
2D. The parent of a child with diabetes mellitus as$s the nurse when urine testing will be
necessary. The nurse should e>plain that urine testing for:
1. !lucose is needed before administration of insulin.
2. !lucose is needed % times a day.
18
Test ;an$
". Hrine is needed to test for glycosylated hemoglobin.
%. Hrine will be tested when $etonuria is suspected.
()#: %
%. Hrine testing is still performed to detect e'idence of $etonuria.
1 and 2. Hrine testing for glucose is no longer indicated because of the poor correlation between
blood glucose le'els and glycosuria.
". !lycosylated hemoglobin analysis is performed on a blood sample.
D*-: Cogniti'e .e'el: Comprehension T/0: *ntegrated 0rocess: Teaching@.earning
29. The parents of a child who has 3ust been diagnosed with type 1 diabetes as$ about e>ercise.
The nurse should e>plain that:
1. E>ercise will increase blood sugar.
2. E>ercise should be restricted.
". E>tra snac$s are needed before e>ercise.
%. E>tra insulin is re2uired during e>ercise.
()#: "
". E>ercise lowers blood glucose le'els+ which can be compensated for by e>tra snac$s.
1. E>ercise lowers blood sugar.
2. E>ercise is encouraged and not restricted+ unless indicated by other health conditions.
%. E>tra insulin is contraindicated because e>ercise decreases blood glucose le'els.
D*-: Cogniti'e .e'el: (pplication T/0: *ntegrated 0rocess: Teaching@.earning
29. ( child eats some sugar cubes after e>periencing symptoms of hypoglycemia. This rapid5
releasing sugar should be followed by which of the following
1. -at
2. -ruit 3uice
". #e'eral glasses of water
%. Comple> carbohydrate and protein
()#: %
%. #ymptoms of hypoglycemia are treated with a rapid5releasing sugar source followed by a
comple> carbohydrate and protein.
1+ 2+ and ". These food choices do not pro'ide the child with comple> carbohydrate and protein
necessary to stabiliBe the blood sugar.
0lanning
11
Test ;an$
"8. &anifestations of hypoglycemia include which of the following
1. .ethargy
2. Thirst
". )ausea and 'omiting
%. #ha$y feeling and diBBiness
()#: %
%. #ome of the clinical manifestations of hypoglycemia include sha$y feelings+ diBBiness+ as
well as difficulty concentrating+ spea$ing+ focusing+ coordinating+ sweating+ and pallor.
1+ 2+ and ". These are manifestations of hyperglycemia.
(ssessment
"1. (n 115year5old boy has recently been diagnosed with diabetes. The nurse4s teaching plan for
daily in3ections should be based on which of the following
1. The parents do not need to learn the procedure.
2. ,e is old enough to gi'e most of his own in3ections.
". #elf5in3ections will be possible when he is closer to adolescence.
%. ,e can learn about self5in3ections when he is able to reach all in3ection sites.
()#: 2
2. #chool5age children are able to gi'e their own in3ections.
1. 0arents should participate in learning and gi'ing the insulin in3ections.
". ,e is already old enough to administer his own insulin.
%. The child is able to use thighs+ abdomen+ part of the hip+ and arm. (ssistance can be obtained
if other sites are used.
D*-: Cogniti'e .e'el: (pplication
T/0: *ntegrated 0rocess: Teaching@.earning &#C: (rea of Client )eeds:
0hysiological *ntegrity: 0harmacologic and 0arenteral Therapy
"2. The nurse is discussing with a child and family the 'arious sites used for insulin in3ections.
Which of the following sites usually has the fastest rate of absorption
1. (rm
2. .eg
". ;uttoc$
%. (bdomen
()#: %
%. The abdomen has the fastest rate of absorption but the shortest duration.
1. The arm has a fast rate of absorption but short duration.
2. The leg has a slow rate of absorption but a long duration.
". The buttoc$ has the slowest rate of absorption and the longest duration.
12
Test ;an$
*mplementation
"". To help the adolescent deal with diabetes+ the nurse must consider which of the following
characteristics of adolescence
1. Desire to be uni2ue
2. 0reoccupation with the future
". )eed to be perfect and similar to peers
%. &a$ing peers aware of the seriousness of hypoglycemic reactions.
()#: "
". (dolescence is a time when the indi'idual has a need to be perfect and similar to peers.
,a'ing diabetes ma$es adolescents different from their peers.
1. (dolescents do not wish to be uni2ue? they desire to fit in with the peer group.
2. This age group is usually not future oriented.
% This would further alienate the adolescent with diabetes. The peer group would focus on the
differences.
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Hockenberry, et al.

: Wong's Essential of Pediatric Nursing, 8

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