Patho: chapter 41
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."
Which individual displays the precursors to acromegaly?
An adult with an excess of growth hormone due to an adenoma
Which metabolic abnormality can lead to the development of type 2 diabetes?
insulin resistance
For what complication does the nurse assess an infant when the mother has uncontrolled gestational diabetes mellitus (GDM)?
macrosomnia
An older adult woman is brought to the emergency department by her family. They relate to the nurse that the client has had mental status changes and cannot remember her grandchildren's names. They go on to say that she is intolerant of cold and is lethargic. On physical examination, the nurse notes that the client has a husky voice, her face is puffy around the eyes, and her tongue appears to be enlarged. What diagnosis would the nurse suspect?
myxedema
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."
Which pathophysiologic phenomenon may result in a diagnosis of Cushing disease?
Excess ACTH production by a pituitary tumor
What are the hallmark signs of diabetes mellitus?
Polyuria, polydipsia, and polyphagia
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 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 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 ophthalmopathy 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 ophthalmopathy usually tends to stabilize."
A client with a new diagnosis of type 2 diabetes mellitus states, "I am really worried that I might need to take injections. Is there something I can do to avoid that?" What is the best response by the nurse?
"You could regulate your diet, exercise regularly, and lose weight."
Which manifestation indicates a client is at risk for developing diabetes mellitus?
2 hour oral GTT 175 mg/dL (9.7 mmol/L)
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
Which effect of thyroid hormone deficit alters the function of all major organs in the body?
Decreases metabolism
A hospital client with a diagnosis of type 1 diabetes has been administered a scheduled dose of regular insulin. Which effect will result from the action of insulin?
Promotion of glucose uptake by target cells
Impaired and delayed healing in a person with diabetes is caused by long-term complications that include:
Chronic neuropathies
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 as though I am going to vomit." The client states that she feels weak.
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
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 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 caring for a child with congenital adrenal hyperplasia and has depletion of sodium levels. What pharmacologic therapy does the nurse anticipate administering to this child?
Fludrocortisone acetate
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)
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
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 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
A nurse is assessing an older adult woman diagnosed with chronic hypothyroidism who has developed myxedema coma. The nurse will likely assess which lab and clinical manifestations in this client? Select all that apply.
Hypoventilation Hyponatremia Hypoglycemia Lactic acidosis
Select the most appropriate intervention for the nurse to teach a client diagnosed with distal symmetric neuropathy related to diabetes.
Inspect the feet for blisters daily
Which fetal abnormalities are associated with gestational diabetes mellitus?
Macrosomia and hypocalcemia
Research has identified a cycle of insulin-induced posthypoglycemic episodes. What is this phenomenon called?
Somogyi effect
Which factor contributes to an infant developing macrosomia (large body size)?
Maternal diabetes
Which maternal factor contributes to an infant having macrosomia, hypoglycemia, and hyperbilirubinemia?
Maternal diabetes
Which treatment regimen is most likely to result in stable blood glucose levels for a client with a diagnosis of type 1 diabetes?
Monitor blood glucose levels throughout the day and administer exogenous insulin replacement as needed
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 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
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 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 is managing diabetes with exercise and diet. The health care provider reviews the client's most recent laboratory results: fasting blood glucose level at 80 mg/dL (4.44 mmol/L) and a hemoglobin A1C of 5% (0.05). Select the response that best identifies the client.
The client is achieving normal glycemic control.
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 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.
A client with type 2 diabetes mellitus currently taking a sulfonylurea has recently begun taking the alpha-glucosidase inhibitor acarbose. What is the most important instruction the nurse should provide?
Use glucose tablets or gel if you have hypoglycemia.
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 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
Select the most common symptoms of diabetes. Select all that apply.
Polydipsia Polyuria Polyphagia
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.
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.
An 8-year-old child has been diagnosed with gigantism. Which criteria would the nurse correlate with the diagnosis of gigantism?
There is increased growth hormone levels and the epiphyses of the long bones are not fused.
A client diagnosed with metabolic syndrome and growth hormone (GH) deficiency will likely display which physical assessment finding?
increased visceral fat
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 resident of a long-term facility is exhibiting clinical manifestations of hypothyroidism?
An 80-year-old woman who has uncharacteristically lost her appetite of late and often complains of feeling cold
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
Abnormal stimulation of the thyroid gland by TSH-receptor antibodies is implicated in cases of:
Graves disease
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 Delirium Very high fever
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 nurse is teaching a client who has been diagnosed with Addison disease and is prescribed to take hydrocortisone daily. Which clinical finding is expected with this condition if left untreated?
hyponatremia
The nurse knows that the client with which complication of diabetes has the greatest risk for the development of foot ulcers?
sensory neuropathy
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 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
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 nurse suspects diabetic ketoacidosis (DKA) in a client with type 1 diabetes. Which finding(s) best support that the client may be experiencing DKA?
increased respiratory rate and decreased blood pressure
A client with severe hypoglycemia is unconscious. Which method of providing glucose should not be used for this client?
orange juice orally
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)
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
