Pediatric Nursing: Endocrine Disorders NCLEX Practice Quiz (15 Questions)

Pediatric Nursing: Endocrine Disorders NCLEX Practice Quiz (15 Questions)

Typical growth and development during infancy into childhood and adolescence entails the action of various hormones, determined by an individual child’s genetic makeup and their environment. This 15-item NCLEX style questionnaire will test your understanding regarding the endocrine disorders in Pediatric Nursing.

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― Thomas A. Edison


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1. The 6-year-old son of Mr. and Mrs. Peters is admitted to the healthcare facility with the diagnosis of idiopathic hypopituitarism. His height is measured below the third percentile and weight at the 40th percentile. Which of the following would be the first action of his attending nurse?

A. Recommend orthodontic referral for underdeveloped jaw.
B. Collaborate with a dietician to access his caloric needs.
C. Provide for a tutor for his precocious intellectual ability.
D. Place him in a room with a 2-year-old boy.

2. Katie is admitted to the intensive care unit of Nurseslabs Medical Center for diabetic ketoacidosis; which of the following is of primary importance when caring for the child?

A. Giving I.V. NPH insulin in high doses
B. Evaluating the child for cardiac abnormalities
C. Limiting fluids to prevent aggravating cerebral edema
D. Monitoring and recording the child’s vital signs for hypertension

3. Nurse Angelo is attending for a child with Cushing’s syndrome; which of the following nursing interventions would be most necessary?

A. Observing the child for signs and symptoms of metabolic acidosis
B. Handling the child carefully to prevent bruising
C. Monitoring vital signs for hypertension and tachycardia
D. Monitoring the child for signs and symptoms of hypoglycemia

4. While Andres is being assessed at the clinic, Nurse Shiela observed that the child appears to be small, with an immature face and chubby body build. Her parents stated that their child’s rate of growth of all body parts is somewhat slow, but her proportions and intelligence remain normal. As a knowledgeable nurse, you know that the child has a deficiency of which of the following?

A. Antidiuretic hormone (ADH)
B. Parathyroid hormone (PTH)
C. Growth hormone (GH)
D. Melanocyte-stimulating hormone (MSH)

5. Justine is admitted to the pediatric unit due to the occurrence of diabetic ketoacidosis signaling a new diagnosis of diabetes. The diabetes team explores the cause of the episode and take steps to prevent a recurrence. Diabetic ketoacidosis (DKA) results from an excessive accumulation of which of the following?

A. Sodium bicarbonate from renal compensation
B. Potassium from cell death
C. Glucose from carbohydrate metabolism
D. Ketone bodies from fat metabolism

6. Nurse Aries entered the room of a child with hypopituitarism and was asked by the couple about the condition of their child. Which of the following phrases if stated by the nurse best describes the condition? 

A. Linear growth retardation with skeletal proportions normal for chronologic age
B. A complete normal growth pattern, but with the onset of precocious puberty
C. Normal growth for first five years, followed by progressive linear growth retardation
D. Growth retardation in which height and weight are equally affected

7. In growing children, growth hormone deficiency results in short stature and very slow growth rates. Short stature may result from which of the following?

A. Anterior pituitary gland hypofunction
B. Posterior pituitary gland hyperfunction
C. Parathyroid gland hyperfunction
D. Thyroid gland hyperfunction

8. Tara is an 11-year-old girl diagnosed with type 1 diabetes mellitus (DM). She asks her attending nurse why she can’t take a pill rather than shots like her grandmother does. Which of the following would be the nurse’s best reply?

A. “If your blood glucose levels are controlled, you can switch to using pills.”
B. “The pills correct fat and protein metabolism, not carbohydrate metabolism.”
C. “Your body does not make insulin, so the insulin injections help to replace it.”
D. “The pills work on the adult pancreas, you can switch when you are 18.”

9. Which type of diabetes mellitus (DM) most likely results from heterogenous risk factors, making it preventable?

A. Type 1
B. Type 2
C. Type 1 and 2
D. Gestational diabetes

10. Mr. Lopez has a 7-year-old son with growth hormone (GH) deficiency. He shares to the nurse the desire of his son to play ball games. However, his wife feels the child will be in danger since he is smaller than the other children. In planning anticipatory guidance for these parents, the nurse should keep in mind which of the following?

A. The child should be allowed to play because doing so can foster healthy self-esteem.
B. The risk for fractures is increased because a GH deficiency results in fragile bones.
C. Activity could aggravate insulin sensitivity, causing hyperglycemia.
D. Activity would aggravate the child’s joints, already over tasked by obesity.

11. Arvic who is diagnosed with diabetes mellitus type 1 displays symptoms of hypoglycemia; which of the following actions should the nurse instruct the parents?

A. Give the child honey (simple sugar).
B. Give the child milk (complex sugar).
C. Contact the healthcare provider before doing anything.
D. Give the child nothing by mouth.

12. Nurse Dorothy is caring for a child with Cushing’s syndrome; which of the following should she include in the plan of care?

A. Increase fluids to prevent dehydration
B. Encourage a diet high in carbohydrates
C. Monitor weight each day and report for weight loss
D. Encourage a diet high in potassium

13. A child newly diagnosed with diabetes mellitus has been stabilized with insulin injections daily. A nurse prepares discharge teaching plan regarding the insulin. The teaching plan should reinforce which of the following concepts?

A. Always keep insulin vials refrigerated
B. Increase the amount of insulin before exercise
C. Ketones in the urine signify a need for less insulin
D. Systematically rotate injection sites

14. Which of the following should the nurse include in the insulin administration instruction for the parents of a child being discharged on insulin?

A. Insert the needle and aspirate prior to injecting
B. Inject insulin into the extremity to be exercised to enhance absorption
C. The muscles in the abdomen and thigh are the easiest to use for self administration
D. Clean the site of injection with soap and water and avoid alcohol

15. Nurse Angelo admits a child with suspected type 1 DM; which should the nurse ask the parents?

A. “Does the child complain of headache?”
B. “How much exercise does the child get?”
C. “Has the child’s number and type of bowel movements changed?”
D. “Has the child experienced nocturia or bedwetting?”
E. “How much candy and sweets does your child take daily?”

Answers and Rationale

1. Answer: B. Collaborate with a dietician to access his caloric needs.

  • B: Because the child’s weight is excessive for his height, he needs dietary assessment and a weight-loss program
  • A: An underdeveloped jaw is not usually a problem with hypopituitarism.
  • C: Providing a tutor to educate him is an appropriate action, but the rationale is incorrect. Although children with hypopituitarism generally appear intellectually precocious because of the disparity between their size and their cognitive ability, they are usually of normal intelligence.
  • D: Placing the child in a room with a toddler could contribute to poor self-esteem.

2. Answer: B. Evaluating the child for cardiac abnormalities

  • B: As the fluid volume deficit is improved, total body potassium deficiency may occur, leaving the child vulnerable to hypokalemia and, afterward, cardiac arrest. The nurse should monitor the cardiac cycle for prolonged QT interval, low T wave, and depressed ST segment, which indicate weakened heart muscle and potential irregular heartbeat.
  • A: Regular insulin is the only insulin that can be given I.V. NPH is an intermediate-acting insulin; continuous low-dose infusion of a rapid-acting insulin is preferred.
  • C: I.V. fluids should be given to correct dehydration.
  • D: Hypertension is more likely to happen secondary to dehydration.

3. Answer: B. Handling the child carefully to prevent bruising

  • B: The nurse should handle the child carefully because Cushing’s syndrome causes capillary fragility, resulting in easy bruising and calcium excretion, resulting in osteoporosis.
  • A and C: Cushing’s syndrome causes increased excretion of potassium and hydrogen ions, resulting in alkalosis and increased water and sodium retention, and hypokalemia, resulting in a sluggish and irregular heartbeat.
  • D: Cushing’s syndrome causes hyperglycemia, not hypoglycemia.

4. Answer: C. Growth hormone (GH)

  • C. GH stimulates protein anabolism, promoting bone and soft-tissue growth. A lack of GH would lead to decreased synthesis of somatomedin, resulting in decreased linear growth and decreased fat catabolism and increased glucose uptake in muscles, resulting in excessive subcutaneous fat hypoglycemia.
  • A: A deficiency in ADH results in diabetes insipidus, marked by dehydration and hypernatremia.
  • B: Deficiency of PTH causes hypocalcemia, marked by tetany, convulsions, and muscle spasms.
  • D: Deficiency of MSH causes diminished or absent skin pigmentation.

5. Answer: D. Ketone bodies from fat metabolism

  • D: Inability to use glucose causes lipolysis, fatty acid oxidation, and release of ketones, resulting in metabolic acidosis and coma.
  • A: Sodium bicarbonate administration is a treatment for DKA, not a cause.
  • B: Potassium depletion, not potassium excess, occurs in DKA
  • C: Inability to use glucose, not impaired carbohydrate metabolism, is the primary mechanism is diabetes mellitus.

6. Answer: A. Linear growth retardation with skeletal proportions normal for chronologic age

  • A: Although linear growth retardation occurs in hypopituitarism, delayed epiphyseal maturation allows for normal skeletal proportions.
  • B: The child with hypopituitarism commonly experiences delayed sexual maturation.
  • C: Normal growth may occur for the first year, followed by linear growth thereafter.
  • D: Height is affected more profoundly than weight, contributing to obesity.

7. Answer: A. Anterior pituitary gland hypofunction

  • A: Short stature usually results from diminished or deficient growth hormone, which is released from the anterior pituitary gland.
  • B: Posterior pituitary hyperfunction results in increased secretion of antidiuretic hormone or oxytocin, leading to a syndrome of inappropriate antidiuretic hormone secretion, marked by fluid retention and hyponatremia.
  • C: Parathyroid hypofunction leads to hypocalcemia
  • D: Thyroid hyperfunction causes increased secretion of thyroxine, triiodothyronine, and thyrocalcitonin, resulting in Graves’ disease, marked by accelerated linear growth and early epiphyseal closure.

8. Answer: C. “Your body does not make insulin, so the insulin injections help to replace it.”

  • C: The child has type 1 DM, indicating a lack of functioning pancreatic beta cells and an absolute insulin deficiency.
  • A: Oral antidiabetics are indicated only for those with some functioning beta cells, as in those with type 2 DM. Therefore, injections are indicated to supply insulin that is lacking in type 1 diabetes.
  • B: Oral antidiabetics do not correct metabolism.
  • D: A child with type 1 DM cannot substitute an oral antidiabetic for insulin, regardless of age.

9. Answer: B. Type 2

  • B: Type 2 DM is a complex disorder of various causes with social, behavioral, and environmental risk factors. The disorder may be prevented by encouraging lifestyle modification for children at risk.

10. Answer: A. The child should be allowed to play because doing so can foster healthy self-esteem.

  • A: Engaging in peer-group activities can aid foster a sense of belonging and a positive self-concept. T-ball is a good sport to choose because physical stature is not an important consideration in the ability to participate, unlike some other sports, such as basketball and football.
  • B: Hypopituitarism does not affect calcium and phosphorus homeostasis and demineralization of bone. So the risk for fractures is not increased.
  • C: Although rare, physical activity without adequate carbohydrate intake can cause hypoglycemia.
  • D: Moderate physical activity increases caloric use and reduces weight without undue strain on weight-bearing joints.

11. Answer: A. Give the child honey (simple sugar).

  • A: Immediate action is important. Therefore, providing little sugar temporarily corrects low serum glucose levels. A simple sugar is preferred because it is converted to glucose more quickly than a complex sugar. A child with hyperglycemia needs fluid to prevent dehydration.
  • B: Because complex sugars, such as milk, are absorbed more slowly, they do not provide an immediate response.
  • C: Contacting the healthcare provider wastes valuable time during which emergency measures could be started to raise the child’s glucose level.
  • D: Prompt action is required to prevent complications of hypoglycemia.

12. Answer: D. Encourage a diet high in potassium

  • D: The elevation of cortisol level in Cushing’s disease causes a decrease in the level of potassium, a condition called hypokalemia. At high levels, cortisol stimulates the tubules that control the absorption of electrolytes in the kidneys to excrete more potassium into the urine.

13. Answer: D. Systematically rotate injection sites

  • D: It is necessary to rotate injection sites because injecting in the same place much of the time can cause hard lumps or extra fat deposits to develop.

14. Answer: D. Clean the site of injection with soap and water and avoid alcohol

  • D: Infection risk from insulin injections is negligible (at least in normal environments – some experts feel hospital environments are riskier), and an alcohol swab is a poor way to sanitize skin in the first place. Soap and hot water are actually more effective.

15. Answer: D. “Has the child experienced nocturia or bedwetting?”

  • D: Bedwetting in children who have previously stayed dry at night is often an early sign of diabetes. Type 1 diabetes is a disease when the pancreas that produces insulin and helps get sugars (glucose) into the cells does not produce insulin.

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