Chapter 51 The Child with an Endocrine or Metabolic Alteration

Chapter 51  The Child with an Endocrine or Metabolic Alteration

Complete Chapter Questions And Answers
 

Sample Questions

MULTIPLE CHOICE

1. 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
a. appropriate community referral for affected infants.
b. parental education about raising a special needs child.
c. early identification of serious genetically transmitted metabolic diseases.
d. early identification of electrolyte imbalances.

ANS: C
Mandatory genetic screening allows early identification of genetically transmitted metabolic
disorders. These disorders can be managed best with early diagnosis and in some cases, early
treatment prevents serious physical and cognitive delays. Community referral is appropriate
after a diagnosis is made. Parental education will be important, but that is not the goal of
screening. Although electrolyte imbalances could occur with some of the inborn errors of
metabolism, this is not the priority outcome, nor would the newborn screen detect electrolyte
imbalances.

PTS: 1 DIF: Cognitive Level: Application/Applying
REF: p. 1248 OBJ: Nursing Process: Planning
MSC: Client Needs: Physiologic Integrity

2. What is the priority nursing goal for a 14-year-old with Graves’ disease?

a. Relieving constipation
b. Allowing the adolescent to make decisions about whether or not to take medication
c. Verbalizing the importance of adherence to the medication regimen
d. Developing alternative educational goals

ANS: C
A priority goal is for the adolescent to verbalize the need to remain adherent to the medication
regime. The adolescent with Graves’ disease is not constipated. Adherence to the medication
schedule is important to ensure optimal health and wellness. Medications should not be
skipped, and dose regimens should not be tapered by the child without consultation with the
child’s medical provider. The management of Graves’ disease does not interfere with school
attendance and does not require alternative educational plans.

PTS: 1 DIF: Cognitive Level: Comprehension/Understanding
REF: p. 1252 OBJ: Nursing Process: Planning
MSC: Client Needs: Physiologic Integrity

3. What information provided by the nurse would be helpful to a 15-year-old adolescent taking

methimazole three times a day?
a. Pill dispensers and alarms on a watch can be effective reminders to take the

medication.
b. She can take the medication when she is feels symptomatic.
c. She can take two pills before school and one pill at dinner, which is easier to

remember.
d. The mother can be responsible for reminding her to take her medication.

ANS: A
Methimazole is an antithyroid medication that should be taken three times a day. Reminders
will facilitate taking medication as ordered. This medication needs to be taken regularly, not
on an as-needed basis. The dosage cannot be combined to reduce the frequency of
administration. An adolescent is old enough and mature enough to be responsible for taking
medications.

PTS: 1 DIF: Cognitive Level: Comprehension/Understanding
REF: p. 1253 OBJ: Integrated Process: Teaching-Learning
MSC: Client Needs: Physiologic Integrity

4. Diabetes insipidus is a disorder of the

a. anterior pituitary.
b. posterior pituitary.
c. adrenal cortex.
d. adrenal medulla.

ANS: B
The principal disorder of posterior pituitary hypofunction is diabetes insipidus. ADH is
produced in the hypothalamus and stored in the posterior pituitary gland. When ADH is not
released appropriately by the posterior pituitary gland, DI occurs. The anterior pituitary
produces hormones such as growth hormone, thyroid-stimulating hormone,
adrenocorticotropic hormone, gonadotropin, prolactin, and melanocyte-stimulating hormone.
The adrenal cortex produces aldosterone, sex hormones, and glucocorticoids. The adrenal
medulla produces catecholamines.

PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: p. 1243 | p. 1253 OBJ: Nursing Process: Assessment
MSC: Client Needs: Physiologic Integrity

5. A child is hospitalized after a serious motor vehicle crash and has developed increased

urination. What action by the nurse takes priority?
a. Weigh the child daily.
b. Monitor the child’s intake and output.
c. Assess the daily serum sodium level.
d. Restrict dietary sodium intake.

ANS: C
This child might have diabetes insipidus; being in a car crash has the potential for a head
injury. That coupled with frequent urination leads the nurse to suspect DI. A high serum
sodium and low urine specific gravity are hallmarks of this condition. The priority action for
the nurse is to review the child’s most recent serum sodium. Daily weights and I&O are also
important for many children but is not as specific for this condition as assessing the sodium
level. The child may or may not need a sodium restriction, but assessment comes first.

PTS: 1 DIF: Cognitive Level: Analysis/Analyzing
REF: p. 1254 | Nursing Quality Alert Box
OBJ: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment