Chapter 41: Disorders of Endocrine Control

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

Which disorder is a result of excess cortisol?

Cushing syndrome

A client tells his health care provider that his body is changing. It used to be normal for his blood glucose to be higher during the latter part of the morning. However, now his fasting blood glucose level is elevated in the early AM (07:00). The health care provider recognizes the client may be experiencing:

Dawn phenomenon

A client with type 2 diabetes experiences unexplained elevations of fasting blood glucose in the early morning hours. Which conditions can account for this effect?

Dawn phenomenon

Which effect of thyroid hormone deficit alters the function of all major organs in the body?

Decreases metabolism

Which metabolic abnormalities can cause type 2 diabetes? Select all that apply.

Deranged secretion of insulin Insulin resistance Increased glucose production by the liver

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

A client is diagnosed with diabetic ketoacidosis (DKA) in the emergency department. Which clinical manifestations will the client likely exhibit?

Polyuria, polydipsia, voming, and fatigue

The nurse is caring for a client with hyperthyroidism and is preparing to administer the morning medications. Which medication will the nurse administer in order to block the conversion of T4 to T3 in the tissues?

Propylthiouracil

A woman in her 28th week of pregnancy tests positive for gestational diabetes mellitus and begins to follow a nutritional plan at home. What result at the follow-up visit indicates a successful outcome?

Random blood glucose 85 mg/dL (4.72 mmol/L)

The nurse is caring for a client with diabetes who has developed gastroparesis. Which symptom does the nurse expect the client to report?

Vomiting after eating

The nurse caring for a client diagnosed with hyperglycemic hyperosmolar state (HHS) knows that the client's elevated serum osmolality has pulled water out of the brain cells based on which assessment findings? Select all that apply.

Weakness one side of the body Body shakes rapidly and uncontrollably for a short period of time Increase in urine output in proportion to the increase in blood glucose Unable to respond verbally to questions

An obese adult has recently been diagnosed with type 2 diabetes. The nurse knows that the most likely treatment plan for this client will include which topics?

Weight loss, glucose monitoring, and oral antihyperglycemic medications

A nurse educator is conducting a course for newly diagnosed diabetes clients. Which statement by a participant should the nurse follow up first?

"I've had a little sore on the sole of my foot for a few days, but I'm sure it will eventually heal."

When providing nutrition education to the client with diabetes, the nurse should include which statement regarding fat intake?

"If you have diabetes, avoiding saturated fats is important."

The mother of a 2-year-old newly diagnosed with type 1 diabetes asks why insulin has to be given by injection. The best response by the nurse is:

"Insulin is destroyed by the stomach contents and has to be administered by injection."

A diabetic client presents to a clinic for routine visit. Blood work reveals a HbA1C of 11.0% (high). Which response by the client may account for this abnormal lab result?

"My meter broke so I have not been checking my blood glucose levels for a while."

A client's primary care provider has ordered an oral glucose tolerance test (OGTT) as a screening measure for diabetes. Which instruction should the client be given?

"The lab tech will give you a sugar solution and then measure your blood sugar levels at specified intervals."

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."

Following an oral glucose tolerance, a 36-year-old mother of 4 has been diagnosed with gestational diabetes mellitus (GDM), a problem that was not present in any of her previous pregnancies. What should her primary care provider tell her about this new health problem?

"Your baby could become too large or have low blood sugars if we're not vigilant about controlling your sugars."

Which manifestation indicates a client is at risk for developing diabetes mellitus?

2 hour oral GTT 175 mg/dL (9.7 mmol/L)

The nurse is working in a pediatric clinic. Which child would the nurse recognize as having isosexual precocious puberty?

A 5-year-old black female with developing breasts and pubic hair

Which pediatric assessment finding would the nurse recognize as an example of precocious puberty?

A 7-year-old female with early menarche

Which client would be considered to be exhibiting manifestations of "prediabetes"?

A middle-aged overweight adult with a fasting plasma glucose level of 122 with follow-up OGTT of 189 mg/dL (10.49 mmol/L).

The nurse is assessing a male client and finds abnormally large hands and feet, a bulbous nose, and a broad face with a protruding jaw. Based on these findings, which endocrine abnormality is most likely the 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 signs and symptoms of abrupt cessation of pharmacologic glucocorticoids closely resemble those of which disease process?

Addison disease

A 48-year-old male client diagnosed with type 2 diabetes presents with the following:• Blood glucose level of 46 mg/dL (2.55 mmol/L)• Very lethargic• Has cool, clammy skin.Select the most appropriate intervention.

Administer injectable glucagon

The critical care nurse has just admitted a client with diabetic ketoacidosis (DKA) whose blood glucose level is 877 mg/dL (48.67 mmol/L). The client's breath has a fruity odor and the client is confused. Which of these does the nurse set as the priority at this time?

Administration of intravenous fluids

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 individual displays the precursors to acromegaly?

An adult with an excess of growth hormone due to an adenoma

A 33-year-old client has been admitted to the hospital for the treatment of Graves disease. Which assessment should the client's care team prioritize?

Assessment of the client's vision and oculomotor function

When educating a client about type 1 diabetes, the nurse will mention that this type is caused by which mechanism?

Autoimmune destruction of pancreatic beta cells

What is the most common cause of hypothyroidism?

Autoimmune thyroiditis

A client is to have a serum thyroxine and thyroid stimulating laboratory test performed to assess the baseline status of the hypothalamic-pituitary target cell hormones. When educating the client about the laboratory tests, when would the the nurse inform him the test should be obtained?

Before 0800

The results of a 44-year-old obese man's recent diagnostic workup have culminated in a new diagnosis of type 2 diabetes. Which pathophysiologic process underlies the client's new diagnosis?

Beta cell exhaustion due to long-standing insulin resistance

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 (beta-blocker)

Diabetic ketoacidosis (DKA) is a condition that mostly occurs in type 1 diabetics. What are the definitive diagnostic criteria for DKA?

Blood glucose level greater than 250 mg/dL (13.88 mmol/L); bicarbonate less than 15 mEq/L (15 mmol/L) and pH less than 7.3

The nurse is assisting with the birth of a full-term neonate. The nurse monitors for which neonatal assessment that will require treatment?

Blood glucose of 30 mg/dL (1.67 mmol/L) at 3 hours of life

The nurse and nursing student are caring for a client undergoing a severe stressor with release of epinephrine into the bloodstream. The nurse teaches the student that epinephrine will cause which effect on blood glucose levels?

Blood glucose will elevate.

When caring for the client with diabetic ketoacidosis, the nurse recognizes that fatty acids and ketones may be used for energy by most organs. Which organ does the nurse recognize is reliant on glucose as the major energy source?

Brain

An adult with acromegaly presents with a very distinctive appearance. What is the distinctive feature in a person with acromegaly?

Broad, bulbous nose and a protruding lower jaw

A client with diabetes mellitus has sudden onset of slurred speech, incoordination, and cool, clammy skin. What will the nurse do first?

Check blood glucose

The nurse suspects that a girl is experiencing precocious puberty based on which physical findings? Select all that apply.

Early breast development Beginning of augmented adrenal androgen production Beginning of menstrual function

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? Select three that apply.

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

Which pathophysiologic phenomeon may result in a diagnosis of Cushing disease?

Excess ACTH production by a pituitary tumor

A 23-year-old man is admitted to the hospital. He is experiencing polyphagia, polyuria, and polydipsia. He states that the condition has come on very suddenly. This client is likely to require what treatment?

Exogenous insulin injections

A 15-year-old child with type 1 diabetes asks nurse about the potential to "lose sight." Which response would be the most appropriate?

Explain that many people with diabetes experience some complications like retinopathy, but these are best prevented with tight control of glucose levels.

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

Diabetic ketoacidosis (DKA) in a client with type 1 diabetes occurs when the lack of insulin leads to the release of which physiologic product?

Fatty acids

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

Fine-needle aspiration biopsy

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)

A young adult has been experiencing some extreme fatigue, changes in vision, and unexpected weight loss, leading the health care provider to suspect hyperglycemia. Which clinical manifestations correlate with a diagnosis of diabetes? Select all that apply.

Frequent thirst Excess urination Ravenous hunger

Type 1A diabetes is now considered an autoimmune disorder. What factors are considered necessary for type 1A diabetes to occur?

Genetic predisposition, environmental triggering event, and a T-lymphocyte-mediated hypersensitivity reaction against some beta-cell antigen

A client with diabetes will be undergoing an evaluation of the fluctuation of blood glucose over the previous 120-day span. Which test will this client undergo?

Glycosylated hemoglobin

A client tells the health care provider that he has been very compliant over the last 2 months in the management of his diabetes. The best diagnostic indicator that would support the client's response would be:

Glycosylated hemoglobin, hemoglobin A1C (HbA1C)

Abnormal stimulation of the thyroid gland by TSH-receptor antibodies is implicated in cases of:

Graves disease

Which characteristics in a pregnant woman increase the risk of gestational diabetes mellitus? Select all that apply.

Gravida 5 BMI 35 Sister with type 2 diabetes mellitus

Which assessment finding of a client constitutes a criterion for a diagnosis of metabolic syndrome?

Has a high blood pressure that is consistently in the range of 140/90 mm Hg or greater

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

Hashimoto thyroiditis

A 62-year-old man who is overweight has just been diagnosed with type 2 diabetes. The nurse educator is instructing him in the ways his diabetes can be controlled. The nurse should initially prioritize which action?

Helping the client make meaningful changes to his diet and activity level.

The nurse is caring for a client with diabetes. Which of these findings is cause for concern, leading the nurse to initiate client education?

Hemoglobin A1C level is 8.7%.

During periods of fasting and starvation, the glucocorticoid and other corticosteroid hormones are critical for survival because of their stimulation of gluconeogenesis by the liver. When the glucocorticoid hormones remain elevated for extended periods of time, what can occur?

Hyperglycemia

A 30-year-old male who manages his type 1 diabetes with glyburide presents at the emergency room reporting headache, confusion, and tachycardia. He has come from a party at which he drank two beers to celebrate running his first half-marathon. Which of the following is likely to be the cause of his complaints?

Hypoglycemia

A 30-year-old man who manages his type 1 diabetes with glyburide presents at the emergency room reporting headache, confusion, and tachycardia. He has come from a party at which he drank two beers to celebrate running his first half marathon. Which phenomenon is likely to be the cause of his symptoms?

Hypoglycemia

A man is brought into the emergency department by paramedics who state that the client passed out on the street. The man smells of alcohol, and when roused says he has not eaten since yesterday. He is wearing a medic alert bracelet that says he is a diabetic. What would the nurse suspect as a diagnosis?

Hypoglycemia

An extremely lethargic client arrives by ambulance at the emergency department. His blood glucose level is 32 mg/dL (1.78 mmol/L). The nurse will anticipate that this client will be diagnosed with:

Hypoglycemia

While trying to explain the physiology behind type 2 diabetes to a group of nursing students, the instructor will mention which accurate information?

In skeletal muscle, insulin resistance prompts decreased uptake of glucose. Following meals (postprandial), glucose levels are higher due to diminished efficiency of glucose clearance.

When the nurse is performing a health history for a client who is being admitted for hyperthyroidism, what symptom does the client report that the nurse would find associated with this disorder?

Increase in appetite

Which interventions are important for the nurse to teach a client diagnosed with distal symmetric neuropathy caused by diabetes? Select all that apply.

Inspect the feet daily for blisters. Wear well-fitted shoes.

The diagnosis of type 1 diabetes would be confirmed by which principle?

Insulin is not available for use by the body.

Which metabolic abnormality can lead to the development of type 2 diabetes?

Insulin resistance

Diabetics are at higher risk than are the majority of the population for injury to organ systems in the body. Which organs are most at risk?

Kidneys and eyes

A client with diabetic retinopathy develops a retinal bleed and asks the nurse, "How can I prevent this from happening again?" What response provides the most effective information?

Maintain healthy blood pressure and blood sugar levels.

Which maternal factor contributes to an infant having macrosomia, hypoglycemia, and hyperbilirubinemia?

Maternal diabetes

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?

Myxedema coma

In which situation would an increase of glucagon be expected?

NPO before surgery

A client with diabetes mellitus arrives at the hospital with a blood glucose level of 639 mg/dL (35.46). What assessment data would indicate type 2 diabetes mellitus rather than type 1?

Negative ketones in urine

The most common cause of thyrotoxicosis is Graves disease. When assessing this client, the nurse should put priority on which sign/symptom?

Ophthalmopathy

A client with severe hypoglycemia is unconscious. Which method of providing glucose should be avoided?

Orange juice orally

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

The nurse knows that the client with which complication of diabetes has the greatest risk for the development of foot ulcers?

Sensory neuropathy

Primary adrenal insufficiency is manifested by:

Serum sodium level of 120 mEq/L (120 mmol/L) (low) and blood glucose level of 48 mg/dL (2.66 mmol/L) (low)

A client with diabetes carries insulin with him at all times. At 11:35, he obtains a blood glucose reading of 218 mg/dL (12.1 mmol/L) and self-administers a dose of insulin in anticipation of eating lunch at noon. What type of insulin did he most likely inject?

Short acting

Precocious puberty is a disorder that occurs in both boys and girls. Which condition may occur in adults due to precocious puberty?

Short stature in adults

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 client with diabetes mellitus is reporting burning pain of the feet and some numbness. These symptoms are likely due to which cause?

Somatic neuropathy

Research has identified a cycle of insulin-induced posthypoglycemic episodes. What is this phenomenon called?

Somogyi effect

A parent brings his child to the clinic, concerned about her short stature and asking the nurse if there is a problem with her height. What indication is the nurse aware of when performing the assessment that determines whether this child has short stature?

The child's height is well below the 3rd percentile on several clinic visits.

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.

The nurse is providing education to a client with Addison disease who has been treated for hyponatremia and hypoglycemia related to the disease. The nurse inform the client that which action should be taken to ensure control of these conditions?

The client should eat and exercise on a regular schedule.

The nurse is providing education for a client diagnosed with hypothyroidism. What information about diet should the nurse be sure to include in this information?

The client should maintain a low cholesterol diet.

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

The client will require exogenous supplements of cortisol.

A client with type 1 diabetes has started a new exercise routine. Knowing there may be some increased risks associated with exercise, the health care provider should encourage the client to:

carry a snack with a rapidly absorbed form of glucose to prevent profound hypoglycemia.

When educating a client about glargine, the nurse should explain that this medication:

has a prolonged absorption rate and provides a relatively constant concentration for 12-24 hours.

Which pregnant woman likely faces the greatest risk of developing gestational diabetes? A client who:

is morbidly obese (defined as greater than 100 pounds over ideal weight).

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.

A client with a history of diabetes presents to the emergency department following several days of polyuria and polydipsia with nausea/vomiting. On admission, the client labs show a blood glucose level of 480 mg/dL (26.64 mmol/L) and bicarbonate level of 7.8 mEq/L (7.8 mmol/L). The nurse suspects the client has diabetic ketoacidosis (DKA). The priority intervention should include:

Begin a loading dose of IV regular insulin followed by a continuous insulin infusion.

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 1 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

The parents of a child who is diagnosed with short stature ask what may have caused the abnormality. Which response by the nurse is most accurate? Select all that apply.

Chromosomal abnormalities GH deficiency Protein-calorie malnutrition Malabsorption syndromes

Impaired and delayed healing in a person with diabetes is caused by long-term complications that include:

Chronic neuropathies

A client with diabetes has been injured. The nurse will be educating the client that healing of the injury may be delayed due to which diabetic complications? Select all that apply.

Chronic neuropathies Vascular impairment

Peripheral neuropathies occur in people with diabetes mellitus. With the loss of sensation in the lower extremities, diabetics become predisposed to what impairment?

Clawing of toes and denervation of the small muscles of the foot

A client with hypothyroidism has not taken medication for several months, informing the nurse that she lost her insurance and is unable to afford the medication. When assessing the client's temperature tolerance and skin, what does the nurse anticipate finding? Select all that apply.

Coarse and dry skin and hair Intolerance to cold Decreased sweating

Which criterion about insulin would prompt a diagnosis of type 1 diabetes?

Complete failure of insulin secretion

Which individual is experiencing the effects of a primary endocrine disorder?

Person who has low calcium levels because of the loss of the parathyroid gland

Secondary diabetes occurs because of disorders that produce hyperglycemia by stimulating the hepatic production of glucose or decrease the cellular use of glucose. Which disorders can be causes of secondary diabetes?

Pheochromocytoma and Cushing syndrome

A client who has been taking 80 mg of prednisone, a glucocorticoid, each day has been warned by his primary care provider to carefully follow a plan for the gradual reduction of the dose rather than stopping the drug suddenly. What is the rationale for this directive?

Stopping the drug suddenly may cause acute adrenal insufficiency.

The nurse is teaching a client with diabetes about the signs and symptoms of hypoglycemia. The client asks, "Why will I get headache, disturbed behavior, coma, and seizures if it's my pancreas that's impaired?" Which response is the best explanation?

The brain relies on blood glucose as its main energy source.

A client with long-standing type 2 diabetes is surprised to see high blood sugar readings while recovering from an emergency surgery. Which factor may have contributed to the client's inordinately elevated blood glucose levels?

The stress of the event caused the release of adrenal cortical hormones.

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.

The nurse is taking a health history from a client with acromegaly. The client informs the nurse that he is waking up several times a night and has been told he has sleep apnea. What does the nurse inform the client is the rationale for this syndrome?

There is an increase in pharyngeal soft tissue accumulation.

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