Chapter 32 disorders of endocrine control

Which disorder is a result of excess cortisol? -Cushing syndrome -Turner's syndrome -Marfan syndrome -Hashimoto disease

Cushing syndrome

A 25-year-old female client exhibits exophthalmos of both eyes. The health care provider recognizes this as a manifestation of: -Graves disease -Hashimoto thyroiditis -Myxedema -Acquired hypothyroidism

Graves disease

A client is diagnosed with Addison's disease. What statement by the client indicates an understanding of the discharge instructions by the nurse? -"Once the symptoms go away, I will be able to stop taking my medication." -"If I have surgery, it will cure me." -"I will have to take my medication for the rest of my life." - "I should be able to control my condition with diet and exercise."

-"I will have to take my medication for the rest of my life."

After receiving change-of-shift report about the following four patients, which patient should the nurse assess first? -22-year-old admitted with SIADH who has a serum sodium level of 130 mEq/L -31-year-old who has iatrogenic Cushing syndrome with a capillary blood glucose level of 204 mg/dL -53-year-old who has Addison's disease and is due for a scheduled dose of hydrocortisone (Solu-Cortef) -70-year-old returning from PACU following partial thyroidectomy who is extremely agitated, has an irregular pulse rate of 134, and an elevated temperature of 103.20 F

-70-year-old returning from PACU following partial thyroidectomy who is extremely agitated, has an irregular pulse rate of 134, and an elevated temperature of 103.20

A client is diagnosed with hyperthyroidism and is exhibiting weight loss, diarrhea, and tachycardia. What does the nurse understand that these clinical manifestations are related to? -A decrease in oxygen consumption -A decrease in the level of glucose -A hypermetabolic state -A decrease in sympathetic nervous system activity

-A hypermetabolic state

The health care provider is reviewing diurnal variation pattern in adrenocorticotropic (ACTH) levels. Select the typical diurnal variation pattern in adrenocorticotropic (ACTH) levels. -ACTH peaks in the morning and declines throughout the day. -ACTH increases in the morning and peaks again in the evening hours. -ACTH maintains a consistent level regardless of the time of day. -ACTH peaks in correspondence with food intake.

-ACTH peaks in the morning and declines throughout the day.

A client has been diagnosed with dysfunction of the anterior pituitary gland. The nurse is aware that which of the following hormones may be affected? Select all that apply. -Adrenocorticotropic hormone (ACTH) -Thyroid-stimulating hormone (TSH) -Growth hormone (GH) -Luteinizing hormone (LH) -Antidiuretic hormone (ADH) -Norepinephrine

-Adrenocorticotropic hormone (ACTH) -Thyroid-stimulating hormone (TSH) -Growth hormone (GH) -Luteinizing hormone (LH)

Which complication of acromegaly can be life threatening? -Cardiac structures increase in size -Splayed teeth result in impaired chewing -Vertebral changes result in kyphosis -Bone overgrowth causes arthralgias

-Cardiac structures increase in size

A client is diagnosed with adrenocorticotropic hormone deficiency (ACTH) and is to begin replacement therapy. Regarding which type of replacement will the nurse educate the client? -Replacement therapy with prolactin -Growth hormone replacement therapy -Replacement therapy with synthetic thyroid hormone -Cortisol replacement therapy.

-Cortisol replacement therapy.

A patient experiences an increase in thyroid hormone as a result of a thyroid tumor. Which of the following hormonal responses demonstrates the negative feedback mechanism? -Decreased thyroid-stimulating hormone (TSH) -Increased follicle-stimulating hormone -Decreased adrenocorticotropic hormone -Increased thyrotropin-releasing hormone

-Decreased thyroid-stimulating hormone (TSH)

The nurse is performing an assessment for a client who has hyperthyroidism that is untreated. When obtaining vital signs, what is the expected finding? -Blood pressure 180/110 mm Hg -Heart rate 110 and bounding -Temperature 96F -Respiratory rate 14

-Heart rate 110 and bounding

The nurse is teaching a client diagnosed with Addison disease about the importance of lifetime oral replacement therapy. Select the pharmacologic agent that would be prescribed. -Hydrocortisone -Insulin -Potassium supplements -Ketoconazole

-Hydrocortisone

When the nurse is performing a health history for a client who is being admitted for hyperthyroidism, what symptoms does the client report that the nurse would find associated with this disorder? -Constipation -Increase in appetite -Weight gain -Fatigue

-Increase in appetite

An infant born with congenital hypothyroidism who does not receive care from any health care provider is likely to develop which complications? Select all that apply. -Deformed joints and bone spurs -Impaired physical growth -Intellectual disability -Loss of fine motor control and arthritis -Down's syndrome

-Intellectual disability -Impaired physical growth

An overweight, 14-year-old boy feels tired all the time. He sleeps 12 to 14 hours a day and has a voracious appetite but no energy to burn off the calories. He has been diagnosed with hypothyroidism brought about by the accumulation of a nonpitting mucosus type of edema. For which life-threatening condition should his care team be prepared? -Thyroid storm -Phaeocytoma -The paraneoplastic secretion of endocrine hormones -Myxedematous coma

-Myxedematous coma

The nurse is caring for a client diagnosed with hyperthyroidism. Which clinical manifestations are most likely to be seen in this client? Select all that apply. -Shortness of breath -Tachycardia -Weight loss -Fine muscle tremor -Anemia -Bradycardia -Constipation -Weight gain

-Shortness of breath -Tachycardia -Weight loss -Fine muscle tremor

The nurse is educating a client with hyperthyroidism who has recovered from thyrotoxicosis (thyroid storm) and is preparing for discharge. What can the nurse inform the client that this hypermetabolic state can be caused by in order to decrease exacerbation? Select all that apply. -Stress -Physical or emotional trauma -Manipulation of the thyroid gland -Moderate physical exercise such as walking. -Eating spicy foods

-Stress -Physical or emotional trauma -Manipulation of the thyroid gland

The nurse is educating a newly diagnosed client with Hashimoto thyroiditis who is to be discharged from the acute care facility. What should the nurse be sure to include in the education to prevent complications? -The client should be informed about the signs and symptoms of severe hypothyroidism and the need for early intervention. -The client should be informed that if he observes an increase in fatigue, an extra dose of his thyroid medication should be taken. -The client should not participate in any exercise activity that could utilize more thyroid hormone. -The client should skip a dose of the thyroid supplement if he has symptoms of fever or restlessness.

-The client should be informed about the signs and symptoms of severe hypothyroidism and the need for early intervention

A newborn is screened for congenital hypothyroidism and is found to have the disorder. When educating the mother about the importance of the infant's taking thyroid hormone supplement, what should be included in the education? -The infant will have to take the medication only until he reaches puberty. -The infant will have dosage levels adjusted as he grows. -Once the dosage levels are adjusted, the infant will remain on the same amount throughout life. -The medication dosage will increase every 6 months after laboratory testing.

-The infant will have dosage levels adjusted as he grows.

A client who has just undergone a thyroidectomy is experiencing high fever, tachycardia, and extreme restlessness. The nurse would interpret these manifestations as: -Thyroid crisis -Myxedematous coma -Hypothyroidism -Addisonian crisis

-Thyroid crisis

Hyperthyroidism that is inadequately treated can cause a life-threatening condition known as a thyroid storm. What are the manifestations of a thyroid storm? (Select all that apply.) -Tachycardia -Very low fever -Delirium -Bradycardia -Very high fever

-Very high fever -Delirium -Tachycardia

The nurse is caring for a 42-year-old male client who is admitted for treatment of heart failure. He has abnormally large hands and feet and a broad face with a protruding jaw. Based on these signs and symptoms, the nurse identifies which of the following endocrine disturbances as the most likely cause for these physical changes? -Acromegaly -Hyperthyroidism -Myxedema -Cushing syndrome

Acromegaly

A client arrives in the clinic and states to the nurse, "I am tired all the time and have gained weight. My hair is so dry it is breaking." The nurse assesses that the client's face is puffy with edematous eyelids and the outer third of the eyebrows are thinning. What lab test will the nurse prepare the client for that is characteristic of this disorder? -Troponin and myoglobin levels -LDL and HDL levels -BUN and creatinine -T4 and TSH

T4 and TSH

Radioactive iodine does what to the thyroid

destroys it, leading to hypothyroidism, also used as treatment for hyperthyroidism