Chapter 41: Disorders of Endocrine Control of Growth and Metabolism
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
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."
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
Which individual displays the precursors to acromegaly?
An adult with an excess of growth hormone due to an adenoma
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
A male client is being evaluated for metabolic syndrome. Which are diagnostic criteria for this syndrome? Select all that apply.
Client's body mass index (BMI) is 31. Client's high-density lipoprotein (HDL) cholesterol is 25. Client's blood pressure (BP) is 150/90 mm Hg.
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.
The nurse is teaching a client diagnosed with Addison disease about the importance of lifetime oral replacement therapy. Which pharmacologic agent would be the drug of choice and included in this teaching plan?
Hydrocortisone
A nurse is assessing a client who is experiencing hypoglycemia caused by an insulin reaction. The client is conscious and can follow directions. Which intervention is most appropriate at this time?
Immediately administer a rapidly absorbed form of glucose (preferably via oral route if the client is alert enough to swallow).
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
The diagnosis of type 1 diabetes would be confirmed by which principle?
Insulin is not available for use by the body.
Which factor contributes to an infant developing macrosomia (large body size)?
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
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 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)
A client presents to the emergency room with fatigue, weakness, dehydration, and thirst. What additional symptoms would correlate with a diagnosis of type 1 diabetes mellitus? Select all that apply.
Recent weight loss Polyuria Blurred vision
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
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 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.
A client with type 1 diabetes mellitus wishes to stop taking insulin injections. What option is appropriate?
Using an insulin infusion pump
The nurse has just completed teaching a client, newly diagnosed with type 1 diabetes, about the treatment options. Which response by the client leads the nurse to conclude that additional teaching is needed?
"So I can stop my insulin if I start an exercise program."
A client is diagnosed with Addison 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."
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 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."
When educating a client with possible glucocorticoid dysfunction, the nurse will explain that the CRH controls the release of ACTH. The best time to perform the blood test to measure peak ACTH levels would be:
06:00 to 08:00 AM
Which manifestation indicates a client is at risk for developing diabetes mellitus?
2 hour oral GTT 175 mg/dL (9.7 mmol/L)
Which clients with diabetes mellitus would the nurse anticipate to have persistent elevation of blood glucose levels? Select all that apply.
A client with high anxiety A client with COPD taking steroids A client with a newly diagnosed leg fracture
A nurse is evaluating clients for the risk of developing type 2 diabetes. Which client has the highest risk for developing this metabolic disorder?
A middle aged obese adult with a sedentary lifestyle
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
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
Which criterion about insulin would prompt a diagnosis of type 1 diabetes?
Complete failure of insulin secretion
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
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 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
Which maternal factor contributes to an infant having macrosomia, hypoglycemia, and hyperbilirubinemia?
Maternal diabetes
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
The nurse screening for diabetes mellitus at a health fair obtains these results. Which client should be referred to a primary health care provider for further evaluation?
Random blood glucose 195 mg/dL (10.82 mmol/L)
An adolescent boy asks the nurse what increases the secretion of growth hormone (GH). Which response by the nurse is best?
Starvation
The nurse is discussing the administration of GH with a parent of a child who has short stature caused by growth hormone (GH) deficiency. 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 pathophysiologic phenomeon may result in a diagnosis of Cushing disease?
Excess ACTH production by a pituitary tumor
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
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."
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
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
The nurse knows that the client with which complication of diabetes has the greatest risk for the development of foot ulcers?
Sensory neuropathy
Which complication of acromegaly can be life threatening?
Cardiac structures increase in size
A client with long-term diabetes mellitus reports a "pins and needles" feeling in the feet. What interventions can help reduce this symptom? Select all that apply.
Control blood glucose Gabapentin Lidocaine patch
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 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 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
Which clinical manifestations following thyroidectomy would alert the nurse that the client is going into a life-threatening thyroid storm? Select all that apply.
Temperature of 104.2°F (40.1°C) Telemetry showing heart rate of 184 Extremely agitated
The obstetrical nurse is caring for a client who has been treated for gestational diabetes. When teaching the client about the causes of gestational diabetes, the nurse should include which risk factor in the teaching?
Woman with a family history of diabetes
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).