Chapter 51
New parents ask the nurse, “Why is it necessary for our baby to have the newborn blood test?” The nurse explains that the priority outcome of mandatory newborn screening for inborn errors of metabolism is
Appropriate community referral for affected infants
Parental education about raising a special needs child
Early identification of serious genetically transmitted metabolic diseases
Early identification of electrolyte imbalances
What is the priority nursing goal for a 14-year-old with Graves’ disease?
Relieving constipation
Allowing the adolescent to make decisions about whether or not to take medication
Verbalizing the importance of adherence to the medication regimen
Developing alternative educational goals
What information provided by the nurse would be helpful to a 15-year-old adolescent taking methimazole three times a day?
Pill dispensers and alarms on her watch can remind her to take the medication as ordered.
She can take the medication when she is nervous and feels she needs it.
She can take two pills before school and one pill at dinner, which will be easier for her to remember.
Her mother can be responsible for reminding her when it is time to take her medication.
Diabetes insipidus is a disorder of the
Anterior pituitary
Posterior pituitary
Adrenal cortex
Adrenal medulla
Which sign, when exhibited by a hospitalized child, should the nurse recognize as a characteristic of diabetes insipidus?
Weight gain
Increased urine specific gravity
Increased urination
Serum sodium level of 130 mEq/L
What should the nurse include in the teaching plan for parents of a child with diabetes insipidus who is receiving DDAVP?
Increase the dosage of DDAVP as the urine specific gravity (SG) increases.
Give DDAVP only if urine output decreases.
The child should have free access to water and toilet facilities at school.
Cleanse skin before administering the transdermal patch.
A child with GH deficiency is receiving GH therapy. What is the best time for the GH to be administered?
At bedtime
After meals
Before meals
On arising in the morning
A nurse is explaining growth hormone deficiency to parents of a child admitted to rule out this problem. Which metabolic alteration that is related to growth hormone deficiency should the nurse explain to the parent?
Hypocalcemia
Hypoglycemia
Diabetes insipidus.
Hyperglycemia
At what age is sexual development in boys and girls considered to be precocious?
Boys, 11 years; girls, 9 years
Boys, 12 years; girls, 10 years
Boys, 9 years; girls, 8 years
Boys, 10 years; girls, 9 1/2 years
What is the most appropriate intervention for the parents of a 6-year-old child with precocious puberty?
Advise the parents to consider birth control for their daughter
Explain the importance of having the child foster relationships with same-age peers.
Assure the child’s parents that there is no increased risk for sexual abuse because of her appearance.
Counsel parents that there is no treatment currently available for this disorder.
A neonate is displaying mottled skin, has a large fontanel and tongue, is lethargic, and is having difficulty feeding. The nurse recognizes that this is most suggestive of
Hypocalcemia
Hypothyroidism
Hypoglycemia
Phenylketonuria (PKU
A common clinical manifestation of juvenile hypothyroidism is
Insomnia
Diarrhea
Dry skin
Accelerated growth
A goiter is an enlargement or hypertrophy of which gland?
Thyroid
Adrenal
Anterior pituitary
Posterior pituitary
Exophthalmos (protruding eyeballs) may occur in children with which condition?
Hypothyroidism
Hyperthyroidism
Hypoparathyroidism
Hyperparathyroidism
A neonate born with ambiguous genitalia is diagnosed with congenital adrenogenital hyperplasia. Therapeutic management includes administration of
Vitamin D
Cortisone
Stool softeners
Calcium carbonate
Type 1 diabetes mellitus is suspected in an adolescent. Which clinical manifestation may be present?
Moist skin
Weight gain
Fluid overload
Blurred vision
A parent asks the nurse why self-monitoring of blood glucose is being recommended for her child with diabetes. The nurse should base the explanation on the knowledge that
It is a less expensive method of testing.
It is not as accurate as laboratory testing.
Children are better able to manage the diabetes.
The parents are better able to manage the disease.
What is the best time for the nurse to assess the peak effectiveness of subcutaneously administered Regular insulin?
Two hours after administration
Four hours after administration
Immediately after administration
Thirty minutes after administration
What is the primary concern for a 7-year-old child with type 1 diabetes mellitus who asks his mother not to tell anyone at school that he has diabetes?
The child’s safety
The privacy of the child
Development of a sense of industry
Peer group acceptance
What is the best nursing action when a child with type 1 diabetes mellitus is sweating, trembling, and pale?
Offer the child a glass of water.
Give the child 5 units of regular insulin subcutaneously.
Give the child a glass of orange juice.
Give the child glucagon subcutaneously.
Which sign is the nurse most likely to assess in a child with hypoglycemia?
Urine positive for ketones and serum glucose greater than 300 mg/dL
Normal sensorium and serum glucose greater than 160 mg/dL
Irritability and serum glucose less than 60 mg/dL
Increased urination and serum glucose less than 120 mg/dL
When would a child diagnosed with type 1 diabetes mellitus most likely demonstrate a decreased need for insulin?
During the “honeymoon” phase
During adolescence
During growth spurts
During minor illnesses
What should a nurse advise the parents of a child with type 1 diabetes mellitus who is not eating as a result of a minor illness?
Give the child half his regular morning dose of insulin.
Substitute simple carbohydrates or calorie-containing liquids for solid foods.
Give the child plenty of unsweetened, clear liquids to prevent dehydration.
Take the child directly to the emergency department.
Which is the nurse’s best response to the parents of a 10-year-old child newly diagnosed with type 1 diabetes mellitus who are concerned about the child’s continued participation in soccer?
�Consider the swim team as an alternative to soccer.”
�Encourage intellectual activity rather than participation in sports.”
�It is okay to play sports such as soccer unless the weather is too hot.”
�Give the child an extra 15 to 30 g of carbohydrate snack before soccer practice.”
Which comment by a 12-year-old child with type 1 diabetes indicates deficient knowledge?
�I rotate my insulin injection sites every time I give myself an injection.”
�I keep records of my glucose levels and insulin sites and amounts.”
�I’ll be glad when I can take a pill for my diabetes like my uncle does.”
�I keep Lifesavers in my school bag in case I have a low-sugar reaction.”
Which laboratory finding confirms that a child with type 1 diabetes is experiencing diabetic ketoacidosis?
No urinary ketones
Low arterial pH
Elevated serum carbon dioxide
Elevated serum phosphorus
Which nursing intervention is appropriate for a child with type 1 diabetes who is experiencing deficient fluid volume related to abnormal fluid losses through diuresis and emesis? Select all that apply.
Initiate IV access
Begin IV fluid replacement with normal saline.
Begin IV fluid replacement with D51/2NS.
Weigh on arrival to the unit and then every other day.
Maintain strict intake and output monitoring.
Which children admitted to the pediatric unit would the nurse monitor closely for development of SIADH? Select all who apply.
A newly diagnosed preschooler with type 1 diabetes
A school-age child returning from surgery for removal of a brain tumor
An infant with suspected meningitis
An adolescent with blunt abdominal trauma following a car accident
A school-age child with head trauma
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