Patho Chapter 32
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
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
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
In Addison disease, the majority of the adrenal cortex has been destroyed. This causes a lack of mineralocorticoids and glucocorticoids. Therapy consists of oral replacement with what drug?
hydrocortisone
What is a predominant effect of a prolonged excessive growth hormone level?
increased blood glucose levels
A major manifestation of Cushing syndrome includes which of the following?
Hypokalemia
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
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
Which client does the nurse recognize is at the most risk for the development of subacute thyroiditis?
A 32 year old postpartum client
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 hypermetalolic state
The nurse is preforming 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
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
When the assessment of thyroid autoantibodies is performed, what is the suspected diagnosis?
hashimoto thyroiditis
In an acute adrenal crisis, the onset of symptoms is sudden and, in the case of Addison disease, 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 parents of a child who is diagnosed with short stature ask what may have caused the abnormality. The best response are: Select all that apply.
-chromosomal abnormalities -GH deficiency -protein-calorie malnutrition -malabsorption syndromes
Growth hormone exerts its effects on the body in many ways. Which of these are effects of GH? (Select all that apply.)
-enhances fatty acid mobilization -increases insulin levels -facilitates the rate of protein synthesis
Management of hyperthyroidism would include which interventions? Select all that apply.
-eradication of the gland with radioactive iodine -surgical removal of part or the entire gland -drug therapy directed toward decreasing the glands function
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 just undergone a diagnostic cardiac angiogram. As part of their ordered labs, the physician has ordered a thyroid panel. The physiological principle behind ordering this lab tests includes which of the following correlations? Hyperthyroidism can cause: Select all that apply.
-rise in oxygen consumption -increase in cardiac output
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
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 103.2 F
The nurse is working in a pediatric clinic. Which of the following children would the nurse recognize as having isosexual precocious puberty?
A 5 year old African American female with developing breasts and pubic hair
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
A lung cancer client with small cell carcinoma may secrete an excess of which hormone causing an ectopic form of Cushing syndrome due to a nonpituitary tumor?
ACTH
A nurse on a medical unit is providing care for a 37-year-old female patient who has a diagnosis of Graves' disease. Which of the following treatments would the nurse most likely anticipate providing for the client?
B-adrenergic-blocking medications to reduce sympathetic nervous stimulation
The health care provider is teaching a client about the metabolic effect of cortisol. The most appropriate information to provide would be
Breakdown down of proteins and fats
Which complication of acromegaly can be life threatening?
Cardiac structures increase in size
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 disorder is a result of excess cortisol?
Cushing syndrome
Which test can the nurse prepare the client for to determine the differentiation between a benign and malignant thyroid disease?
Fine-needle aspiration biopsy
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 25-year-old female client exhibits exophthalmos of both eyes. The health care provider recognizes this as a manifestation of:
Myxedema
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
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 caring for a child with congenital adrenal hyperplasia and has depletion of sodium levels. What pharmacological therapy does the nurse anticipate administering to this child?
fludrocortisone acetate
A newborn is screened for congenital hypothyroidism and is found to have the disorder. When educating the mother about the importance of the infants taking thyroid hormone supplement, what should be included in the education?
The infant will have dosage levels adjusted as he grows
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
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 who has just undergone a thyroidectomy is experiencing high fever, tachycardia, and extreme restlessness. The nurse would interpret these manifestations as
Thyroid crisis
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 (ACTCH) which is responsible for these signs/symptoms
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
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
A client with a suspected diagnosis of primary hypothyroidism would most likely demonstrate which of the following serum laboratory values?
decreased thyroid-stimulating hormone (TSH) related to poor thyroid function
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 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 of the following inhibits growth hormone (GH)?
obesity
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 hyperpigmentation
One of the first signs that indicates an infant may have congenital hypothyroidism is:
prolonged period of physiologic jaundice
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
Which of the following statements best captures the role of the adrenal cortex in maintaining homeostasis?
the adrenal cortical hormones are primarily steroids and sex hormones
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 rlease of ACTH
The nurse is performing 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 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