Patho Quiz 8
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. Precocious puberty is now defined as the appearance of secondary sexual development before the age of 7 years in white girls and 6 years in black girls. In boys of both races, the lower age limit remains 9 years. However, it is recognized that puberty can develop earlier in boys with obesity.
A client exhibiting problems with her thyroid has been scheduled for a radioactive scan. From the following list of clients, which would the nurse question as to whether this would be a safe procedure for this client?
A young female client who has been trying to get pregnant. Radioactive iodine therapy is contraindicated in pregnant women because it crosses the placenta and can adversely affect the fetal thyroid gland. The other clients would have no contraindication to the substance.
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. Enlargement of the small bones of the hands and feet and of the membranous bones of the face and skull results in a pronounced enlargement of the hands and feet, a broad and bulbous nose, a protruding jaw, and a slanting forehead. Bone overgrowth often leads to arthralgias and degenerative arthritis of the spine, hips, and knees. Virtually every organ of the body is increased in size. Enlargement of the heart and accelerated atherosclerosis may lead to an early death. Hyperthyroidism results from excess thyroid hormone. Myxedema and Cushing syndrome are the result of adrenal abnormalities and do not cause these bone changes.
A student asks the faculty member, "I just do not get how a hormone can be produced within a neuron and then travel via the blood to affect target cells. Can you give me a couple of examples of this phenomenon?" Which faculty response(s) answers this student's question? Select all that apply.
Antidiuretic hormone Epinephrine Neuroendocrine actions are when a hormone produced within a neuron then travels through circulation to exert effects on target cells. Vasopressin (antidiuretic hormone) and epinephrine are examples of hormonal substances with neuroendocrine effects. Sex steroids is a paracrine action. Paracrine action or signaling is a form of cell-to-cell communication in which a cell produces a signal to induce changes in nearby cells, altering the behavior of those cells. Insulin is an autocrine hormone. Autocrine action is a mode of hormone action to which hormones bind to receptors on the cell and affects the cell that produces it, like when growth factors that stimulate cell division. Paracrine describes hormone action where hormones are released from cells and bind to receptor on nearby cells and affects their function. The anterior pituitary gland secretes LH which stimulates secretion of testosterone development of interstitial tissue of testes. There is no neuroendocrine action involved in the secretion of testosterone.
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. The goals in treating DKA are to improve circulatory volume and tissue perfusion, decrease blood glucose, and correct the acidosis and electrolyte imbalances. These objectives usually are accomplished through the administration of insulin and intravenous fluid and electrolyte replacement solutions. An initial loading dose of short-acting (i.e., regular) or rapid-acting insulin often is given intravenously, followed by continuous low-dose, short-acting insulin infusion. Frequent laboratory tests are used to monitor blood glucose. The fluids need to be replaced, not withheld. Too rapid a drop in blood glucose may cause hypoglycemia, which can occur with a large dose of regular insulin. The client may require bicarbonate, but glucose levels are lowered with insulin in this emergency situation, not by oral medication.
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. Epinephrine, a catecholamine, helps to maintain blood glucose levels during periods of stress. Epinephrine causes glycogenolysis in the liver, thus causing large quantities of glucose to be released into the blood.
Which clinical manifestations would the nurse identify as indications of increased blood glucose levels? Select all that apply.
Blurred vision Thirst Fatigue Skin infections Polyuria, polyphagia, and polydipsia are three classic signs of diabetes. Hypotension and fatigue are signs of hypovolemia that may accompany increased blood glucose levels. Skin infections occur frequently in type 2 diabetes. Blurred vision results from exposure of the lens and retina to hyperosmotic fluids.
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 The client with hypothyroidism experiences an intolerance to cold, decreased sweating, and coarse and dry skin and hair, related to the decrease in metabolic rate from the deficient thyroid secretion.
A nurse is teaching a client about the difference between saturated and unsaturated fats. The nurse should inform the client that the best source for unsaturated fats is:
Corn oil Saturated fats usually are from animal sources and remain solid at room temperature. With the exception of coconut and palm oils (which are saturated), unsaturated fats are found in plant oils and usually are liquid at room temperature.
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 change in the normal circadian rhythm for glucose tolerance, which usually is higher during the later part of the morning, is altered in people with diabetes, with abnormal nighttime growth hormone secretion as a possible factor. The dawn phenomenon is characterized by increased levels of fasting blood glucose or insulin requirements, or both, between 5 AM and 9 AM without preceding hypoglycemia. The Somogyi effect describes a cycle of insulin-induced posthypoglycemic episodes. The cycle begins when the increase in blood glucose and insulin resistance is treated with larger insulin doses. The insulin-induced hypoglycemia produces a compensatory increase in blood levels of catecholamines, glucagon, cortisol, and growth hormone, leading to increased blood glucose with some insulin resistance.
A client experiences an increase in thyroid hormone as a result of a thyroid tumor. Which hormonal response demonstrates the negative feedback mechanism?
Decreased thyroid-stimulating hormone (TSH). Negative feedback occurs when secretion of one hormone causes a reduction in the secretion of the hormone that stimulates production of the first hormone. In this case, TSH, which is manufactured by the anterior pituitary gland, would normally stimulate release of thyroid hormones, but with the increase of those hormones by the secreting tumor, enough thyroid hormones flood the system that there should be a reduction in TSH levels.
A nurse examines the laboratory values of a client in heart failure. Which value indicates a compensatory hormone mechanism?
Elevated atrial natriuretic hormone. In heart failure, the client experiences fluid backlog in the heart as venous blood continues to return, but cardiac output is reduced. This stretches the atria, which secrete atrial natriuretic hormone (or peptide) to stimulate vasodilation and increased renal excretion of sodium and water. This reduces the volume and the strain in the heart.
When caring for a client with anemia and a decrease in red blood cells (RBCs), the nurse recognizes which of these hormones will stimulate the bone marrow to produce additional RBCs?
Erythropoietin. Erythropoietin is made in the kidney and stimulates erythropoiesis, production of RBCs in the bone marrow.
A client is diagnosed with type 2 diabetes mellitus and begins to follow a nutritional plan at home. What result at the follow-up visit indicates a successful outcome?
Glycosylated hemoglobin 5.2% (0.52) The goals of the nutritional plan for type 2 diabetes mellitus include normal glucose levels, normal lipid levels, weight loss to ideal body weight (or at least 5% to 10% of total body weight) and regulating blood pressure. High-density cholesterol should be above 60 mg/dL (1.55 mmol/L).
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. Glycosylation is essentially irreversible, and the level of A1C present in the blood provides an index of blood glucose levels over the previous 6 to 12 weeks. In uncontrolled diabetes or diabetes with hyperglycemia, there is an increase in the level of A1C. The other options would not reflect the 2-month period.
Routine physical examination reveals a client has a new diagnosis of upper body obesity with central fat distribution. This diagnosis places the client at greater risk for developing which disease process?
Heart disease Upper body obesity, more than other types of obesity, carries a high cardiometabolic risk. Obese people tend to develop joint problems and arthritis, but there is no direct association with osteoporosis. Chronic anemia is associated with malnutrition and starvation. Primary renal disease is unrelated to excessive weight.
The nurse is teaching a client with diabetes about medications that will increase the blood glucose level. Which information would be most important for the nurse to provide? Select all that apply.
Loop diuretics Oral contraceptives Total parenteral nutrition Antipsychotics Several diuretics—thiazide and loop diuretics—can elevate blood glucose. Other drugs and therapies known to cause hyperglycemia include diazoxide, glucocorticoids, oral contraceptives, antipsychotic agents, and total parenteral nutrition. Insulin would cause a decrease in blood glucose. Vitamins will not alter the levels
The nurse screening for diabetes mellitus at a health fair does not have enough supplies for all of the clients attending. Which client should be given screening priority?
Male age 45, BMI 37 Screening should be conducted on clients age 45 and older. Priority is also given to clients who are obese, have a first-degree relative with diabetes, are members of a high-risk group (black, Latino, or Native American/First Nation), have had five or more pregnancies, delivered a child born large-for-gestational age, or have been diagnosed with gestational diabetes. Other conditions that place clients at risk for diabetes mellitus are hypertension, hyperlipidemia, or impaired glucose tolerance in previous testing.
A client admitted to the hospital with elevated blood glucose is diagnosed with type 2 diabetes mellitus. What characteristics commonly differentiate type 2 diabetes mellitus from type 1 diabetes mellitus? Select all that apply.
Onset after age 35 Overweight Diabetes mellitus (DM) type 1 commonly occurs before age 20 with abrupt onset of polyuria, polyphagia, and polydipsia, and is the result of autoimmune destruction of beta cells, which causes the necessity of exogenous insulin to regulate blood sugar. Glycosylated hemoglobin, also called hemoglobin A1C, will be elevated in uncontrolled diabetes mellitus of any type. Diabetes mellitus type 2 generally occurs after age 35 to clients who are overweight. The symptoms develop over a longer period of time. Often clients who lose weight or implement diet changes do not need insulin to control blood glucose because the beta cells are not destroyed.
A nursing instructor is teaching a group of students about the action of hormones. The instructor determined that teaching was effective when the students recognize the local action of hormones as:
Paracrine. When hormones act locally on cells other than those that produced the hormone, the action is called paracrine. Hormones can also exert an autocrine action on the cells in which they were produced. Pancreatic and hormonal are not actions.
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.
Select the most common symptoms of diabetes. Select all that apply.
Polydipsia Polyuria Polyphagia The most commonly identified signs and symptoms of diabetes are often referred to as the three polys: (1) polyuria (i.e., excessive urination), (2) polydipsia (i.e., excessive thirst), and (3) polyphagia (i.e., excessive hunger). Polyhydramnios is a medical condition describing an excess of amniotic fluid in the amniotic sac. Polycythemia is a condition of increased red blood cells.
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. If hypothermia is present, active rewarming of the body is contraindicated because it may induce vasodilation and vascular collapse. Prevention is preferable to treatment and entails special attention to high risk populations, such as women with a history of Hashimoto thyroiditis.
A nurse has just completed client education on how hormones are normally regulated by feedback mechanisms. The client asks, "What, if anything, can alter the regulation of anterior pituitary hormones?" Which response by the nurse would be considered an appropriate reply? Select all that apply.
Stress Temperature Nutritional status The release of anterior pituitary hormones comes from the hypothalamus, which is the coordinating center of the brain for endocrine, behavioral, and autonomic nervous system function. It is at the level of the hypothalamus that emotion (like stress), pain, and body temperature are communicated to the endocrine system. Genetics, weight, and age will not influence response.
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. Diagnosis of hypothyroidism is based on history, physical examination, and laboratory tests. A low serum T4 and elevated TSH levels are characteristic of primary hypothyroidism.
When a client asks why some body fat is good, the nurse responds based on what fact?
The body stores energy in adipose tissue. More than 90% of body energy is stored in adipose tissues of the body. The other options do not represent factual data about fat or adipose tissue.
A client is suspected to have increased growth hormone levels. When performing a health history, what assessment data would be important for the nurse to report to the physician? Select all that apply.
The client has fainted due to low blood glucose levels on several occasions. The client has been experiencing a great deal of emotional stress due to family issues. The client is on a weight-loss diet and is exercising excessively. GH secretion is stimulated by hypoglycemia, fasting, starvation, increased blood levels of amino acids, and stress conditions such as trauma, excitement, emotional stress, and heavy exercise. GH is inhibited by increased glucose levels, free fatty acid release, cortisol, and obesity.
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. Prevention is preferable to treatment and entails special attention to high-risk populations, such as women with a history of Hashimoto thyroiditis. These persons should be informed about the signs and symptoms of severe hypothyroidism and the need for early medical treatment.
The nurse administers a glucocorticoid medication to a client with pneumonia. Which of these does the nurse teach the client is the purpose of the medication?
To decrease airway inflammation. Glucocorticoids affect metabolism of all nutrients and have anti-inflammatory effects, which can assist with airway inflammation.
The nurse explains to a client in labor who has demonstrated ineffective contractions impeding progression of labor that the health care provider has added oxytocin infusion to the orders. What does the nurse teach the client is the purpose of oxytocin?
To stimulate contraction of the uterus. The role of oxytocin is to stimulate contraction of the pregnant uterus and milk ejection from breasts after childbirth. An infusion of oxytocin will promote effective contractions.
When discussing adolescent health with a group of high school teachers, the school nurse reports the student population is becoming increasingly obese. Therefore, faculty were taught about manifestations of which high-risk disease process they should be looking for?
Type 2 diabetes mellitus Childhood obesity is directly related to the increased incidence of type 2 diabetes. Until recently, type 2 diabetes rarely developed in children. JIA, attention deficit disorder, and resistant bacterial infections are unrelated to excessive fat storage (obesity).
The nurse is assessing the body mass index (BMI) of an adult who is considered to be underweight. Which BMI result correlates with underweight status?
less than 18.5A BMI less than 18.5 is classified as being underweight. A BMI between 25 and 29.9 is considered overweight. A BMI greater than 30.0 is diagnosed as obesity and is further divided into classes I (BMI 30.0 to 34.9), II (BMI 35.0 to 39.9), and III or extreme obesity (BMI >40). Body weight reflects both lean body mass and adipose tissue and cannot be used as a method for describing body composition or the percentage of fat tissue present.
A middle-aged female client has been diagnosed with a thyroid condition. The nurse educates the client about the prescription and needed follow-up lab work, which will help regulate the dosage. The client asks, "Why do I not return to the clinic for weeks, since I am starting the medication tomorrow morning?" The nurse bases the answer on the knowledge that thyroid hormones:
may take days for the full effect to occur, based on the mechanism of action. Hormones produce their effects through interaction with high-affinity receptors, which in turn are linked to one or more effector systems within the cell. These mechanisms involve many of the cell's metabolic activities, ranging from ion transport at the cell surface to stimulation of nuclear transcription of complex molecules. The rate at which hormones react depends on their mechanism of action. Thyroid hormone, which controls cell metabolism and synthesis of intracellular signaling molecules, requires days for its full effect to occur. None of the other distractors are accurate reasons to have the client return to the clinic weeks after starting the medication.