NUR334 PrepU: Chapter 32: Disorders of Endocrine Control of Growth and Metabolism

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.

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 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."

A child has been removed from a home in which she has experienced severe neglect and emotional abuse, and has been placed in foster care. The child has psychosocial dwarfism and the foster parents ask the nurse what this means for the future of the child. What is the best response by the nurse?

"The prognosis of the child depends on an improvement in behavior and catch-up growth."

A client with Graves' disease has opthalmopathy and asks the nurse if the eyes will stay like this forever. What is the best response by the nurse?

"With treatment of the hyperthyroid state, the opthalmopathy usually tends to stabilize."

A female patient presented to her primary care physician with classic signs/symptoms of Cushing syndrome. Upon testing, it was discovered that the patient had vaginal small cell carcinoma. How can the healthcare providers explain her Cushing syndrome signs/symptoms to this patient?

"Your tumor in your vagina is secreting a hormone called adenocorticotropic hormone (ACTH) which is responsible for these signs/symptoms."

The nurse is caring for a client with primary hypothyroidism who is being monitored for the complication of myxedema coma while thyroid level therapy is started. What does the nurse understand are the three major aspects of myxedema coma?

-Hypothermia. -Fluid and electrolyte imbalance. -Elevated carbon dioxide levels and decreased oxygen saturation.

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 high fever. -Delirium.

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.

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 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.

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.

At times, it is necessary to give medications that suppress the adrenal glands on a long-term basis. When the suppression of the adrenals becomes chronic, the adrenal glands atrophy. What does the abrupt withdrawal of these suppressive drugs cause?

Acute adrenal insufficiency.

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 classification of medication does the nurse prepare to administer to the client with hyperthyroidism that will block the effects of the hyperthyroid state on sympathetic nervous system function?

Beta-adrenergic blocking agent.

A client with acromegaly comes to the clinic and informs the nurse that she is having a productive cough and a low grade fever. This is the client's fourth visit in one year for the same problem. What condition does the nurse understand results from this client's enlarged cartilaginous structures?

Bronchitis.

The nurse is caring for an adult client with growth hormone deficiency. When performing an assessment of this client, which system should the nurse be sure to assess for complications related to this disorder?

Cardiovascular system.

An adult client with growth-hormone deficiency related to hypopituitarism has been taking replacement therapy for several months. The client informs the nurse that she is having pain in the hand and wrist almost constantly. What does the nurse understand is a common side effect of this therapy that seems to have affected this client?

Carpal tunnel syndrome.

A patient is admitted to the hospital in Addisonian crisis one month after a diagnosis of Addison's disease. The nurse knows which of the following clinical manifestations would support this diagnosis?

Change in level of consciousness and profound hypotension.

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.

Which test can the nurse prepare the client for to determine the differentiation between a benign and a malignant thyroid disease?

Fine-needle aspiration biopsy.

A client is having radiation prior to having a pituitary tumor removed. Which loss of pituitary hormone is typically the first to be lost?

Growth hormone.

When the assessment of thyroid autoantibodies is performed, what is the suspected diagnosis?

Hashimoto thyroiditis.

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.

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 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 young adult woman is reporting an unusual deposit of fat on her upper back, a rounded appearance to her face, increasing weakness, and development of "stretch marks." The nurse should anticipate what treatment given these manifestations?

Surgical removal of the client's pituitary tumor.

A client's low serum T4 level has led to a diagnosis of hypothyroidism. When planning this client's care, the nurse should:

Teach the client about the safe and effective use of synthetic thyroid hormones.

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 education to a client with Addison's disease who has been treated for hyponatremia and hypoglycemia related to the disease. What should the nurse inform the client should be done to ensure control of these conditions?

The client should eat and exercise on a regular schedule.

Diagnostic testing has revealed that a client has pituitary hypofunction, resulting in deficient production of ACTH. The nurse should recognize what implication of this finding?

The client will require exogenous supplements of cortisol.

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 dosage levels adjusted as he grows.

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 patient should be strongly urged not to smoke.

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 (adrenocorticotropic hormone).

The hallmark manifestations of Cushing syndrome are a moon face, a "buffalo hump" between the shoulder blades, and a protruding abdomen. What other manifestations of Cushing syndrome occur?

Thin extremities and muscle weakness.

Parents of a 7-year-old girl are concerned about their daughter because she has begun to develop secondary sexual characteristics. What etiologic factor is most likely to underlie the child's condition?

Early activation of the hypothalamic--pituitary--gonadal axis.

Congenital adrenal hyperplasia is a congenital disorder in which a deficiency exists in any of the enzymes necessary for the synthesis of cortisol. Infants of both sexes are affected, although boys are not diagnosed at birth unless of enlarged genitalia. Female infants often have ambiguous genitalia because of the oversecretion of adrenal androgens. What are the manifestations of the ambiguous genitalia caused by congenital adrenal hyperplasia?

Enlarged clitoris, fused labia, and urogenital sinus.

A client is seeking treatment for infertility. What decrease in hormone secretion from the anterior lobe of the pituitary gland that regulates fertility would the nurse recognize may cause this issue?

Follicle stimulating hormone (FSH).

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.

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 (adrenocorticotropic hormone).

A newborn is found to have transient hypothyroidism following a cesarean birth. Which nursing intervention could have induced the transient hypothyroidism as the staff prepared the mother for the surgical procedure?

Performing a skin scrub with povidone-iodine solution on delivery site.

A 51 year-old woman has been diagnosed with Cushing syndrome after a diagnostic workup that reveals cortisol hypersecretion. The nurse knows which of the following assessment findings would be inconsistent with her diagnosis?

Poor stress management and hyper pigmentation.