Nokea
Congenital adrenal hyperplasia (CAH) is suspected in a newborn because of ambiguous genitalia. The parents are appropriately upset and concerned about their childs gender. In teaching the parents about CAH, what should the nurse explain?
- A. Reconstructive surgery as a female is preferred.
- B. Sexual assignment should wait until genetic sex is determined.
- C. Prenatal masculinization will strongly influence the childs development.
- D. The child should be raised as a boy because of the presence of a penis and scrotum.
Correct Answer: B
Rationale: Sexual assignment in CAH should align with genetic sex, determined before deciding on surgery or rearing. Female genetic sex with hormone therapy can reverse virilization, while male genetic sex may require supplementation. Prenatal masculinization doesn?t dictate development, and genital appearance alone doesn?t determine gender.
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A child with hypoparathyroidism is receiving vitamin D therapy. The parents should be advised to watch for which signs or symptoms of vitamin D toxicity?
- A. Headache and seizures
- B. Weakness and lassitude
- C. Anorexia and insomnia
- D. Physical restlessness, voracious appetite without weight gain
Correct Answer: B
Rationale: Vitamin D toxicity can cause weakness, lassitude, nausea, vomiting, and renal issues like polyuria. Headaches occur but seizures do not, anorexia and insomnia are not typical, and restlessness with appetite changes suggests hyperthyroidism, not toxicity.
What blood glucose measurement is most likely associated with diabetic ketoacidosis?
- A. 185 mg/dl
- B. 220 mg/dl
- C. 280 mg/dl
- D. 330 mg/dl
Correct Answer: D
Rationale: Diabetic ketoacidosis (DKA) typically involves blood glucose levels ?330 mg/dl, reflecting severe insulin deficiency. Levels of 185, 220, and 280 mg/dl are hyperglycemic but below the threshold commonly associated with DKA.
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
Correct Answer: D
Rationale: Acromegaly results from excess GH after epiphyseal closure, causing bone and tissue overgrowth. Cretinism is linked to hypothyroidism, dwarfism to GH deficiency, and gigantism to GH excess before closure.
The school nurse practitioner is consulted by a fifth-grade teacher about a student who has become increasingly inattentive and hyperactive in the classroom. The nurse notes that the childs weight has changed from the 50th percentile to the 30th percentile. The nurse is concerned about possible hyperthyroidism. What additional sign or symptom should the nurse anticipate?
- A. Skin that is cool and dry
- B. Blurred vision and loss of acuity
- C. Running and being active during recess
- D. Decreased appetite and food intake
Correct Answer: B
Rationale: Blurred vision and loss of acuity are early signs of hyperthyroidism, alongside hyperactivity and weight loss. Skin is typically warm and moist, activity during recess is expected, and appetite increases despite weight loss in hyperthyroidism.
What clinical manifestation occurs with hypoglycemia?
- A. Lethargy
- B. Confusion
- C. Nausea and vomiting
- D. Weakness and dizziness
- E. All of the above
Correct Answer: D
Rationale: Hypoglycemia manifests as weakness, dizziness, difficulty concentrating, sweating, and pallor due to low glucose affecting the brain and body. Lethargy, confusion, and nausea are more typical of hyperglycemia, not hypoglycemia.