Pathophysiology Chapter 49 PrepU Questions
A client is diagnosed with Addison's 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." (p. 1298)
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." (p. 1282)
Which complication of acromegaly can be life threatening?
Cardiac structures increase in size (p. 1284)
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 (p. 1279)
Which of the following pathophysiologic phenomena may result in a diagnosis of Cushing disease?
Excess ACTH production by a pituitary tumor (p. 1299)
Which test can the nurse prepare the client for to determine the differentiation between a benign and a malignant thyroid disease?
Fine-needle aspiration biopsy (p. 1288)
Abnormal stimulation of the thyroid gland by TSH-receptor antibodies is implicated in cases of which of the following?
Graves' disease (p. 1292)
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 (p. 1288)
The nurse is caring for an infant in the neonatal intensive care unit who has growth hormone deficiency. What critical issues should the nurse carefully monitor for in this infant?
Hypoglycemia and seizures (p. 1262)
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 (p. 1288)
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 (p. 1298)
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. (p. 1291)
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 (p. 1291)
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." (p. 1292)
A client has been diagnosed with dysfunction of the anterior pituitary gland. The nurse is aware that which of the following hormones may be affected? Select all that apply.
- Adrenocorticotropic hormone (ACTH) - Thyroid-stimulating hormone (TSH) - Growth hormone (GH) - Luteinizing hormone (LH) (p. 1278 and 1293)
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 (p. 1298-99)
The nurse is caring for a client with cirrhosis of the liver. Which medications prescribed by the physician should the nurse question since they may affect the binding of thyroid hormone to normal concentrations of binding proteins? Select all that apply.
- Phenytoin (Dilantin) - Aspirin - Diazepam (Valium) (p. 1287)
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 - Very high fever - Delirium (p. 1293)
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. (p. 1295)
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 (p. 1283)
Which of the following individuals displays the precursors to acromegaly?
An adult with an excess of growth hormone due to an adenoma (p. 1283)
A client is to have a serum thyroxine and thyroid stimulating laboratory test performed to assess the baseline status of the hypothalamic-pituitary target cell hormones. When educating the client about the laboratory tests, when would the the nurse inform him the test should be obtained?
Before 0800 (p. 1278)
Which classification of medication does the nurse prepare to administer to the client with hyperthyroidism that will block the effects of the hyperthyroid state on sympathetic nervous system function?
Beta-adrenergic blocking agent (p. 1292)
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 (p. 1284)
Which effect of thyroid hormone deficit alters the function of all major organs in the body?
Decreases metabolism (p. 1290-91)
The nurse is assessing a client who underwent a thyroidectomy earlier in the day. Assessment reveals a heart rate of 133 beats per minute, oral temperature of 38.5°C, and the client is uncharacteristically agitated and disoriented. After informing the primary care provider, which action by the nurse is the priority?
Closely monitor the client's cardia status (p. 1293)
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?
Crentinism (p. 1289)
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 (p. 1392)
A client is seeking treatment for infertility. What decrease in hormone secretion from the anterior lobe of the pituitary gland that regulates fertility would the nurse recognize may cause this issue?
Follicle stimulating hormone (FSH) (p. 1278)
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 (p. 1298)
The most common cause of thyrotoxicosis is Graves disease. When assessing this client, the nurse should put priority on which of the following signs/symptoms?
Opthalmopathy (p. 1292)
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 (p. 1285)
A client with severe hypothyroidism is presently experiencing hypothermia. What nursing intervention is a priority in the care of this client?
Slow warming of the client to prevent vasodilation and vascular collapse (p. 1291)
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 (p. 1292)
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 (p. 1287)
Diagnostic testing has revealed that a client has pituitary hypofunction, resulting in deficient production of ACTH. The nurse should recognize what implication of this finding?
The client will require exogenous supplements of cortisol (p. 1279)
Which of the following best describes a secondary disorder of endocrine function?
The disorder occurs when the target organ is normal, but stimulating hormones alter its function. (p. 1278)
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. (p. 1284)
The hallmark manifestations of Cushing syndrome are a moon face, a "buffalo hump" between the shoulder blades, and a protruding abdomen. What other manifestations of Cushing syndrome occur?
Thin extremities and muscle weakness (p. 1299-1300)
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 (p. 1293)