NUR 6665 FINAL EXAM SCRIPT 2026 FULL
SOLUTIONS AND CORRECT ANSWERS
GRADED A+
⩥ pediatric endocrine: lack of homeostatic control. Answer: - vulnerable
to fluid and electrolyte imbalance
- affects glucose and amino acid metabolism
⩥ pediatric endocrine: immature feedback loop between ACTH and
adrenal cortex. Answer: less tolerance for stress and increased risk for
acute insufficiency with cardiovascular collapse
⩥ testing for endocrine function. Answer: - family history
- child health: previous hx and presenting symptoms
- endocrine testing: water deprivation test (diabetes insipidus),
glucose/ketones (DM), cortisol (acute adrenal insufficiency)
- MRI for tumor
⩥ Neurogenic (central) diabetes insipidus. Answer: Posterior pituitary
hypofunction →under secretion of ADH → body cannot balance fluid
levels as they are lost in urine.
,⩥ Neurogenic (central) diabetes insipidus s/sx. Answer: Cardinal:
Polyuria/polydipsia (early) →dehydration/ electrolyte imbalance, with
irritability in infants.
This condition is entirely unrelated to diabetes mellitus confusion arises
from the polydipsia and polyuria (common to both)
⩥ Neurogenic (central) diabetes insipidus lab values. Answer:
Hypernatremia (Na > 145 mEq/L) (water lost > salt loss) and high serum
osmolality are 2 key tests
⩥ Neurogenic (central) diabetes insipidus diagnostic and medical
management. Answer: + Water deprivation test (water restrictions do not
decrease urine output)
Long term hormone replacement using DDVAP (route oral, intranasal, or
parental) BID
Fluid replacement may be needed to correct dehydration
⩥ Neurogenic (central) diabetes insipidus priority nursing dx. Answer:
Fluid volume deficit/electrolyte imbalance
provide fluids, monitor weight, I/O, s/sx of dehydration, labs, and teach
about disease.
⩥ Neurogenic (central) diabetes insipidus quality outcomes. Answer:
Early recognition of signs and symptoms of DI
,Differentiation of DI from other causes of polyuria and polydipsia (i.e.,
diabetes mellitus)
Effective hormone replacement
⩥ DI vs SIADH. Answer: DI: high and dry
SIADH: soaked inside
⩥ Syndrome of Inappropriate Antidiuretic Hormone (SIADH). Answer:
Posterior pituitary →Over production/secretion of antidiuretic hormone
→ kidney reabsorbs more water increases circulating volume.
⩥ SIADH s/sx. Answer: Low urine output (retention of free water),
anorexia, vomiting, irritability, progressive signs of stupor and seizures
(most are signs due to cerebral edema associate with Na < 120 mEq/L)
⩥ SIADH lab values. Answer: Hyponatremia ( < 135 mEq/L) (dilution
effect) and low serum osmolality are two key tests. BUN is normal to
low
⩥ SIADH diagnostic and medical management. Answer: Fluid
Restriction immediately
May require oral sodium replacement or hypertonic saline infusion (w/
severe hyponatremia)
Consider diuretics
, Seizure precautions
⩥ SIADH Priority Nursing Diagnosis. Answer: Fluid volume
excess/electrolyte imbalance
monitor weight, I/O, s/sx of hypervolemia, neuro status, labs, and teach
about disease.
⩥ SIADH quality outcomes. Answer: Early recognition of signs and
symptoms of SIADH
Fluid overload prevented
Seizures prevented
⩥ Cushing's syndrome. Answer: Excessive circulating free cortisol in
peds r/t repeated/prolonged steroid therapy
⩥ Cushing's syndrome clinical manifestations. Answer: Hypertension
from Na+ & water retention)
Infection risk due to ¯ antibodies/halt of immune activities
⩥ Cushing's syndrome lab values. Answer: ↑ cortisol, ↑ ACTH (due to
overproduction/loss of negative feedback loop), hyperglycemia (↑
gluconeogenesis), hypokalemia (d/t high cortisol), & metabolic alkalosis
(caused by loss of K+ and H+ ions)
SOLUTIONS AND CORRECT ANSWERS
GRADED A+
⩥ pediatric endocrine: lack of homeostatic control. Answer: - vulnerable
to fluid and electrolyte imbalance
- affects glucose and amino acid metabolism
⩥ pediatric endocrine: immature feedback loop between ACTH and
adrenal cortex. Answer: less tolerance for stress and increased risk for
acute insufficiency with cardiovascular collapse
⩥ testing for endocrine function. Answer: - family history
- child health: previous hx and presenting symptoms
- endocrine testing: water deprivation test (diabetes insipidus),
glucose/ketones (DM), cortisol (acute adrenal insufficiency)
- MRI for tumor
⩥ Neurogenic (central) diabetes insipidus. Answer: Posterior pituitary
hypofunction →under secretion of ADH → body cannot balance fluid
levels as they are lost in urine.
,⩥ Neurogenic (central) diabetes insipidus s/sx. Answer: Cardinal:
Polyuria/polydipsia (early) →dehydration/ electrolyte imbalance, with
irritability in infants.
This condition is entirely unrelated to diabetes mellitus confusion arises
from the polydipsia and polyuria (common to both)
⩥ Neurogenic (central) diabetes insipidus lab values. Answer:
Hypernatremia (Na > 145 mEq/L) (water lost > salt loss) and high serum
osmolality are 2 key tests
⩥ Neurogenic (central) diabetes insipidus diagnostic and medical
management. Answer: + Water deprivation test (water restrictions do not
decrease urine output)
Long term hormone replacement using DDVAP (route oral, intranasal, or
parental) BID
Fluid replacement may be needed to correct dehydration
⩥ Neurogenic (central) diabetes insipidus priority nursing dx. Answer:
Fluid volume deficit/electrolyte imbalance
provide fluids, monitor weight, I/O, s/sx of dehydration, labs, and teach
about disease.
⩥ Neurogenic (central) diabetes insipidus quality outcomes. Answer:
Early recognition of signs and symptoms of DI
,Differentiation of DI from other causes of polyuria and polydipsia (i.e.,
diabetes mellitus)
Effective hormone replacement
⩥ DI vs SIADH. Answer: DI: high and dry
SIADH: soaked inside
⩥ Syndrome of Inappropriate Antidiuretic Hormone (SIADH). Answer:
Posterior pituitary →Over production/secretion of antidiuretic hormone
→ kidney reabsorbs more water increases circulating volume.
⩥ SIADH s/sx. Answer: Low urine output (retention of free water),
anorexia, vomiting, irritability, progressive signs of stupor and seizures
(most are signs due to cerebral edema associate with Na < 120 mEq/L)
⩥ SIADH lab values. Answer: Hyponatremia ( < 135 mEq/L) (dilution
effect) and low serum osmolality are two key tests. BUN is normal to
low
⩥ SIADH diagnostic and medical management. Answer: Fluid
Restriction immediately
May require oral sodium replacement or hypertonic saline infusion (w/
severe hyponatremia)
Consider diuretics
, Seizure precautions
⩥ SIADH Priority Nursing Diagnosis. Answer: Fluid volume
excess/electrolyte imbalance
monitor weight, I/O, s/sx of hypervolemia, neuro status, labs, and teach
about disease.
⩥ SIADH quality outcomes. Answer: Early recognition of signs and
symptoms of SIADH
Fluid overload prevented
Seizures prevented
⩥ Cushing's syndrome. Answer: Excessive circulating free cortisol in
peds r/t repeated/prolonged steroid therapy
⩥ Cushing's syndrome clinical manifestations. Answer: Hypertension
from Na+ & water retention)
Infection risk due to ¯ antibodies/halt of immune activities
⩥ Cushing's syndrome lab values. Answer: ↑ cortisol, ↑ ACTH (due to
overproduction/loss of negative feedback loop), hyperglycemia (↑
gluconeogenesis), hypokalemia (d/t high cortisol), & metabolic alkalosis
(caused by loss of K+ and H+ ions)
