Chapter 32: Disorders of Endocrine Control of Growth and Metabolism
A client is diagnosed with Addison's disease. What statement by the client indicates an understanding of the discharge instructions by the nurse?
"I will have to take my medication for the rest of my life."
Which statements are true regarding hypothyroidism? Select all that apply.
Onset of symptoms is gradual Weight gain Anorexia
The nurse is reviewing the assessment data of four clients. Select the client who would be diagnosed with precocious puberty
A 7-year-old female with early menarche
The nurse is preparing a client for testing to determine if the client has Cushing syndrome. What tests are included in the screening process? Select all that apply.
24-hour urine secretion of cortisol Dexamethasone suppression test Plasma levels of ACTH
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 hypermetabolic state
After receiving change-of-shift report about the following four patients, which patient should the nurse assess first?
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
Which client does the nurse recognize is at the most risk for the development of subacute thyroiditis?
A 32-year-old postpartum client
he nurse is caring for several clients who are taking growth hormone replacement therapy. Which client does the nurse recognize is most at risk for side effects?
A 45-year-old obese client with an elevated serum IGF-1 concentration
In which client would the nurse identify a primary endocrine disorder?
A client who has been diagnosed with Hashimoto thyroiditis
A client is exhibiting signs of Graves' disease. What clinical manifestations of this disorder would the nurse document that would indicate this disease state? Select all that apply.
A goiter Ophthalmolopathy (exophthalmos) Tachycardia and rapid respiratory rate
The mother of 6-year-old male and female fraternal twins has brought her son to see a pediatrician because he is nearly 4 inches shorter than his sister. Which of the following phenomena would the physician most likely suspect as contributing factor to the boy's short stature?
A shortage of hypothalamic GHRH production
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
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)
The nurse is performing an assessment for a client with Cushing syndrome and observes a "buffalo hump" on the back, a moon face, and a protruding abdomen. What does the nurse understand contributes to the distribution of fat in these areas?
Altered fat metabolism
Which complication of acromegaly can be life threatening
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?
Cortisol replacement therapy
The newborn-nursery nurse is obtaining a blood sample to determine if a newborn has congenital hypothyroidism. What long-term complication is the nurse aware can occur if this test is not performed and the infant has congenital hypothyroidism
Cretinism
The nurse is preparing a client for a test that will measure negative feedback suppression of ACTH. Which medication will the nurse administer in conjunction for this test?
Dexamethasone
A nurse on a medical unit is providing care for a 37-year-old female client who has a diagnosis of Graves' disease. Which assessments should the nurse prioritize
Eye health and visual acuity
A nurse on a medical unit is providing care for a 37-year-old female client who has a diagnosis of Graves' disease. Which assessments should the nurse prioritize?
Eye health and visual acuity
Which test can the nurse prepare the client for to determine the differentiation between a benign and a malignant thyroid disease? You Selected:
Fine-needle aspiration biopsy
Advances in technology have made it possible to assess hypothalamic-pituitary function by newly developed imaging and radioimmunoassay methods. When baseline tests are not sufficient, what suppression test gives information about combined hypothalamic-pituitary function?
GH suppression test
A 25-year-old female client exhibits exophthalmos of both eyes. The health care provider recognizes this as a manifestation of:
Graves disease
A client comes to the clinic with fatigue and muscle weakness. The client also states she has been having diarrhea. The nurse observes the skin of the client has a bronze tone and when asked, the client says she has not had any sun exposure. The mucous membranes of the gums are bluish-black. When reviewing laboratory results from this client, what does the nurse anticipate seeing?
Increased levels of ACTH
The nurse is performing an assessment for a client who has hyperthyroidism that is untreated. When obtaining vital signs, what is the expected finding?
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
A nurse is assessing an elderly woman diagnosed with chronic hypothyroidism who has developed myxedematous coma. The nurse is aware that the client may manifest: Select all that apply.
Hypoventilation Hyponatremia Hypoglycemia Lactic acidosis
A client has been taking long-term glucocorticoid therapy for the treatment of asthma. What condition is the nurse aware that this client may develop in relation to this pharmacological therapy?
Iatrogenic Cushing syndrome
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?
Increase in appetite
Following the identification of low levels of T3 and T4 coupled with the presence of a goiter, a 28-year-old female has been diagnosed with Hashimoto's thyroiditis. In light of this diagnosis, which of the following assessment results would constitute an unexpected finding? You Selected:
Increased white cell count and audible crackles on chest auscultation.
Testing for short statue growth hormone (GH) problems can be done by pharmacologic means. Which of the following medications can be utilized to test for a rise in GH? Select all that apply.
Insulin Levodopa
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?
Myxedematous coma
The newborn-nursery nurse is preparing to perform a required neonatal screening for congenital hypothyroidism. What should the nurse do to obtain the necessary sample?
Perform a heel stick to obtain a drop of blood for a T4 and TSH
A 51-year-old woman has been diagnosed with Cushing syndrome after a diagnostic work-up that reveals cortisol hypersecretion. Which assessment findings would be inconsistent with her diagnosis?
Poor stress management and electrolyte imbalances
Following destruction of the pituitary gland, ACTH stimulation stops. Without ACTH to stimulate the adrenal glands, the adrenals' production of cortisol drops. This is an example of which type of endocrine disorder?
Secondary
A child has been diagnosed with classic growth hormone deficiency. The child may experience: Select all that apply.
Short stature Delayed skeletal muscle maturation Obesity
A parent arrives in the endocrinology clinic with her 8-year-old son, concerned about his rapid development and tall stature. What significant assessment finding does the nurse recognize is important to report to the physician related to the development of precocious puberty?
Significant genital enlargement
A client with severe hypothyroidism is presently experiencing hypothermia. What nursing intervention is a priority in the care of this client?
Slow rewarming of the client to prevent vasodilation and vascular collapse
A 33-year-old female client who presents to the doctor's office with pronounced enlargement of her hands and facial features is diagnosed with acromegaly. The acromegaly is most likely the result of:
Somatotrope adenoma
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
A young adult woman has presented with an unusual deposit of fat on her upper back and a rounded appearance to her face. She acknowledges increasing weakness over the past several months and has developed "stretch marks" over the past year. The nurse should anticipate what treatment?
Surgical removal of the client's pituitary tumour
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?
T4 and TSH
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 Delirium Very high fever
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 nurse is providing discharge instructions for a client with Graves' disease who has ophthalmopathy. What should the nurse be sure to include in the instructions to decrease exacerbation of this clinical manifestation?
The client should be strongly urged not to smoke
A client has presented to a clinic for the treatment of severe dermatitis after contact with poison ivy on a camping trip. The client has been prescribed prednisone, a corticosteroid, for the treatment of his skin condition. The client's care provider has emphasized that dosages of the drug will be gradually tapered off rather than stopped upon resolution of the symptoms. Which rationale is the most accurate for this dosing protocol?
The client's hypothalamic--pituitary--adrenal (HPA) system will require recovery time before normal function is restored
The nurse is educating a parent of a child with short stature caused by growth hormone (GH) deficiency about the administration of GH. What should the nurse include when educating the parents about administration?
The medication will be given daily during the period of active growth and can be continued into adulthood.
Which of the following statements best captures an aspect of the function of the hypothalamic-pituitary-adrenal (HPA) system?
The pituitary gland communicates with the adrenal cortex through the release of ACTH.
The nurse is caring for an older adult client who is being treated for primary hypothyroidism. The medication therapy includes a "go low and go slow" regimen. What is the importance of this medication regimen for this client?
There is a risk of inducing acute coronary syndromes in the older adult client if a more rapid correction of thyroid levels is used.
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
