NUR 2030 - 41 - Disorders of Endocrine Control of Growth and Metabolism

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

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).

Which individual displays the precursors to acromegaly?

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

A client being treated for diabetes type 2 with insulin 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 laboratory result?

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

A young child develops type 1A diabetes. The parents ask, "They tell us this is genetic. Does that mean our other children will get diabetes?" The best response by the health care provider would be:

"This autoimmune disorder causes destruction of the beta cells, placing your children at high risk of developing diabetes."

A client with small cell carcinoma lung cancer may secrete an excess of which hormone, causing an ectopic form of Cushing syndrome due to a nonpituitary tumor?

ACTH (ACTH is secreted by the adrenal gland)

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

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 cartilaginous structures in the larynx and respiratory tract become enlarged, resulting in a deepening of the voice and tendency to develop bronchitis.)

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

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

Excess ACTH caused by a pituitary tumor (Cushing disease can be caused by tumor in pituitary or adrenal cortex)

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

The family of a client in the hospital with diabetes mellitus that is out of control asks the nurse to explain the client's recent weight loss while eating more than usual. How will the nurse respond?

Glucose is unused without insulin, so body fats are used for energy.

The nurse is caring for a group of clients. Which client should the nurse prioritize as being most at risk for developing hypoglycemia? The client:

being treated for type 1 diabetes who has been having nausea and vomiting for 4 hours (Only excess of insulin for the current amount of available blood glucose can result in hypoglycemia; pt being treated for T1DB is receiving exogenous insulin)

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).

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 (10.8 mmol/l)

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 caring for a client with secondary adrenal insufficiency. What subjective assessment data obtained by the nurse would correlate with this client's condition?

-Client states, "I don't feel like eating anything." -Client states, "I feel like I am going to vomit." -The client states that she feels weak.

A client hospitalized with type 1 diabetes has been administered a scheduled dose of regular insulin. What are the primary actions of insulin? Select all that apply.

-Fat storage -Glucose uptake by muscle and adipose tissue -Protein synthesis

In an acute adrenal crisis with Addison disease, the onset of symptoms are sudden and can be precipitated by exposure to a minor illness or stress. What are the manifestations of acute adrenal crisis? Select all that apply.

-Muscle weakness -Dehydration -Altered mental status -Vascular collapse

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

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 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) (Glycosylated hemoglobin, hemoglobin A1C (HbA1C), and A1C are terms used to describe hemoglobin into which glucose has been incorporated.)

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

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 (Alcohol decreases liver gluconeogenesis, and people with diabetes need to be cautioned about its potential for causing hypoglycemia)

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 (Screening is usually done in the hospital nursery. In this test, a drop of blood is taken from the infant's heel and analyzed for 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)

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

Sensory neuropathy (people have impaired pain sensation and can be unaware of foot injuries and infection)

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 begin an exercise program

A client has developed the facial appearance that is characteristic of myxedema, along with an enlarged tongue, bradycardia, and voice changes. Which treatment modality is most likely to benefit this client?

Synthetic preparations of T3 or T4

A client is managing his type 2 diabetes with exercise and diet. He has a fasting blood sugar level (FBS) of 80 mg/dL (4.44 mmol/L) and a hemoglobin A1C of 5% (.05). Based on these findings, which of the following can the nurse assume?

The client is achieving normal glycemic control

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 (Ophthalmopathy can also be aggravated by smoking. Alcohol is not contraindicated but should be limited with any medication regimen)

A newborn is screened for congenital hypothyroidism and is found to have the disorder. When educating the mother about the importance of the infant taking thyroid hormone supplement, what should be included in the education?

The infant will have dosage levels adjusted as he grows

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