1. Homeostasis in the body is maintained by what is collectively known as the
neuroendocrine system. What is the name of the nervous system that is involved?
a. Central
b. Skeletal
c. Peripheral
d. Autonomic
ANS: D The autonomic nervous system (composed of the sympathetic and
parasympathetic systems) controls involuntary functions. In combination with the
endocrine system, it maintains homeostasis. The central, skeletal, and peripheral
subdivisions of the nervous system are not part of the neuroendocrine system.
2. A child with hypopituitarism is being started on growth hormone (GH)
therapy. Nursing considerations should be based on which knowledge?
a. Therapy is most successful if it is started during adolescence.
b. Replacement therapy requires daily subcutaneous injections.
c. Hormonal supplementation will be required throughout childs lifetime.
d. Treatment is considered successful if children attain full stature by
adolescence.
ANS: B Additional support is required for children who require hormone replacement
therapy, such as preparation for daily subcutaneous injections and education for self-
management during the school-age years. Young children, obese children, and those
who are severely GH deficient have the best response to therapy. Replacement
therapy is not needed after attaining final height. The children are no longer GH
deficient. When therapy is successful, children can attain their actual or near-final
adult height at a slower rate than their peers.
,3. A child with growth hormone (GH) deficiency is receiving GH therapy. When
is the best time for the GH to be administered?
a. At bedtime
b. After meals
c. Before meals
d. After arising in morning
ANS: A Injections are best given at bedtime to more closely approximate the
physiologic release of GH. After meals, before meals, and after arising in the morning
do not parallel the physiologic release of the hormone.
4. What is a condition that can result if hypersecretion of growth hormone (GH)
occurs after epiphyseal closure?
a. Cretinism
b. Dwarfism
c. Gigantism
d. Acromegaly
ANS: D Excess GH after closure of the epiphyseal plates results in acromegaly.
Cretinism is associated with hypothyroidism. Dwarfism is the condition of being
abnormally small. Gigantism occurs when there is hypersecretion of GH before the
closure of the epiphyseal plates.
5. Peripheral precocious puberty (PPP) differs from central precocious puberty
(CPP) in which manner?
a. PPP results from a central nervous system (CNS) insult.
b. PPP occurs more frequently in girls.
c. PPP may be viewed as a variation in sexual development.
d. PPP results from hormonal stimulation of the hypothalamic
gonadotropin-releasing hormone (Gn-RH).
ANS: C PPP may be viewed as a variation in sexual development. PPP results from
hormone stimulation other than the hypothalamic Gn-RH. Isolated manifestations of
secondary sexual development occur. PPP can be missed if these changes are viewed
as variations in pubertal onset. CPP results from CNS insult, occurs more frequently
in girls, and results from hormonal stimulation of the hypothalamic Gn-RH.
,6. A child will start treatment for central precocious puberty. What synthetic
hormone will be injected?
a. Thyrotropin
b. Gonadotropins
c. Somatotropic hormone
d. Luteinizing hormone-releasing hormone
ANS: D Precocious puberty of central origin is treated with monthly subcutaneous
injections of luteinizing hormone-releasing hormone, which regulates pituitary
secretions. Thyrotropin, gonadotropins, and somatotropic hormone are not the
appropriate therapies for precocious puberty.
7. The nurse is planning care for a child recently diagnosed with diabetes
insipidus (DI). What intervention should be included?
a. Encourage the child to wear medical identification.
b. Discuss with the child and family ways to limit fluid intake.
c. Teach the child and family how to do required urine testing.
d. Reassure the child and family that this is usually not a chronic or life-
threatening illness.
ANS: DI is a potentially life-threatening disorder if the voluntary demand for fluid is
suppressed or the child does not have access to fluids. Medical alert identification
should be worn. Fluid intake is not restricted in children with DI. The child is unable
to concentrate urine and can rapidly become dehydrated. Fluid intake may be limited
during diagnosis, when the lack of intake will result in decreased urinary output and
dehydration. Urine testing is not required in DI. Changes in body weight provide
information about approximate fluid balance. This is a lifelong disorder that requires
supplemental vasopressin throughout life.
8. Intranasal administration of desmopressin acetate (DDAVP) is used to treat
which condition?
a. Hypopituitarism
b. Diabetes insipidus (DI)
c. Syndrome of inappropriate antidiuretic hormone (SIADH)
d. Acute adrenocortical insufficiency
ANS: B DDAVP is the treatment of choice for DI. It is administered intranasally
through a flexible tube. The childs response pattern is variable, with effectiveness
lasting from 6 to 24 hours.
, 9. What nursing care should be included for a child diagnosed with syndrome of
inappropriate antidiuretic hormone (SIADH)?
a. Maintain the child NPO (nothing by mouth).
b. Turn the child frequently.
c. Restrict fluids.
d. Encourage fluids.
ANS: C Increased secretion of ADH causes the kidney to reabsorb water, which
increases fluid volume and decreases serum osmolarity with a progressive reduction
in sodium concentration. The immediate management of the child is to restrict fluids
but not food. Frequently turning the child is not necessary unless the child is
unresponsive. Encouraging fluids will worsen the childs condition.
10. What is a common clinical manifestation of juvenile hypothyroidism?
a. Insomnia
b. Diarrhea
c. Dry skin
d. Rapid growth
ANS: C Dry skin, mental decline, and myxedematous skin changes are associated with
juvenile hypothyroidism. Children with hypothyroidism often have sleepiness,
constipation, and decelerated growth.
11. A goiter is an enlargement or hypertrophy of which gland?
a. Thyroid
b. Adrenal
c. Anterior pituitary
d. Posterior pituitary
ANS: A A goiter is an enlargement or hypertrophy of the thyroid gland. Goiter is not
associated with the adrenal, anterior pituitary, or posterior pituitary secretory organs.
12. Exophthalmos (protruding eyeballs) may occur in children with which
condition?
a. Hypothyroidism
b. Hyperthyroidism
c. Hypoparathyroidism
d. Hyperparathyroidism
ANS: B Exophthalmos is associated with hyperthyroidism. Hypothyroidism,
hypoparathyroidism, and hyperparathyroidism are not associated with exophthalmos.
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