porth essentials of pathophysiology Endocrine cont...

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

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 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."

A client with a pituitary adenoma has had a transsphenoidal removal, successfully. What statement made by the client after education by the nurse indicates the client understands pharmacological treatment?

"I will need to take my medication for about 6 to 12 months, or until my adrenal function returns."

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."

An endocrinologist is providing care for a 30-year-old male who has lived with the effects of increased levels of growth hormone (GH). Which of the following teaching points about the client's future health risks is most accurate?

"When your pituitary gland is enlarged, there's a real risk that you'll develop some sight deficiencies."

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."

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 (ACTH) which is responsible for these signs/symptoms."

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 103.20 F

The nurse is caring for several clients who are taking growth hormone replacement therapy. Which client does the nurse recognize is most at risk for side effects?

A 45-year-old obese client with an elevated serum IGF-1 concentration

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 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

The mother of 6-year-old male and female fraternal twins has brought her son to see a pediatrician because he is nearly 4 inches shorter than his sister. Which of the following phenomena would the physician most likely suspect as contributing factor to the boy's short stature?

A shortage of hypothalamic GHRH production

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.

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

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

The nurse is performing an assessment for a client with Cushing syndrome and observes a "buffalo hump" on the back, a moon face, and a protruding abdomen. What does the nurse understand contributes to the distribution of fat in these areas?

Altered fat metabolism

Which medication order should the nurse question for a client with hyperthyroidism who is experiencing signs of impending thyroid storm?

Aspirin

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

Which complication of acromegaly can be life threatening?

Cardiac structures increase in size

The nurse is caring for an adult client with growth hormone deficiency. When performing an assessment of this client, which system should the nurse be sure to assess for complications related to this disorder?

Cardiovascular system

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

A patient is admitted to the hospital in Addisonian crisis one month after a diagnosis of Addison's disease. The nurse knows which of the following clinical manifestations would support this diagnosis?

Change in level of consciousness and profound hypotension

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

Which disorder is a result of excess cortisol?

Cushing syndrome

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

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 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)

Advances in technology have made it possible to assess hypothalamic-pituitary function by newly developed imaging and radioimmunoassay methods. When baseline tests are not sufficient, what suppression test gives information about combined hypothalamic-pituitary function?

GH suppression test

A client with Graves' disease has had radioiodine treatment with worsening of ophthalmopathy. What medication does the nurse prepare to administer that the client will use for several weeks to decrease these symptoms?

Glucocorticoids

A 25-year-old female client exhibits exophthalmos of both eyes. The health care provider recognizes this as a manifestation of:

Graves disease

A client is having radiation prior to having a pituitary tumor removed. Which loss of pituitary hormone is typically the first to be lost?

Growth hormone

When the assessment of thyroid autoantibodies is performed, what is the suspected diagnosis?

Hashimoto thyroiditis

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

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 major manifestation of Cushing syndrome includes which of the following?

Hypokalemia

Following the identification of low blood levels of cortisol and low 24-hour urinary free cortisol, a 51-year-old female client has been diagnosed with a primary adrenal cortical insufficiency. Which of the following health consequences would be attributable to her low levels of cortisol?

Impaired immunological and inflammatory response

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

What is a predominant effect of a prolonged excessive growth hormone level?

Increased blood glucose levels

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

Following the identification of low levels of T3 and T4 coupled with the presence of a goiter, a 28-year-old female has been diagnosed with Hashimoto's thyroiditis. In light of this diagnosis, which of the following assessment results would constitute an unexpected finding?

Increased white cell count and audible crackles on chest auscultation.

A client with bipolar disorder has developed hypothyroidism with a goiter. When the nurse obtains a medication history, which medication taken by the client does the nurse understand may cause this disorder?

Lithium carbonate

An elderly 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

Which of the following inhibits growth hormone (GH)?

Obesity

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.

The nurse is caring for a client with hyperthyroidism and is preparing to administer the morning medications. Which medication will the nurse administer in order to block the conversion of T4 to T3 in the tissues?

Propylthiouracil (PTU)

One of the first signs that indicates an infant may have congenital hypothyroidism is:

Prolonged period of physiologic jaundice

Precocious puberty is a disorder that occurs in both boys and girls. What does precocious puberty cause in adults?

Short stature in adults

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

A 33-year-old female client who presents to the doctor's office with pronounced enlargement of her hands and facial features is diagnosed with acromegaly. The acromegaly is most likely the result of:

Somatotrope adenoma

An adolescent boy asks the nurse what increases the secretion of growth hormone (GH). The best response would be:

Starvation

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

A parent brings his child to the clinic, concerned about her short stature and asking the nurse if there is a problem with her height. What indication is the nurse aware of when performing the assessment that determines whether this child has short stature?

The child's height is well below the third percentile on several clinic visits.

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.

The nurse is providing education to a client with Addison's disease who has been treated for hyponatremia and hypoglycemia related to the disease. What should the nurse inform the client should be done to ensure control of these conditions?

The client should eat and exercise on a regular schedule.

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.

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

The infant will have dosage levels adjusted as he grows.

Following a long history of fatigue, weakness and poor appetite, a 39-year-old male has been diagnosed with hypopituitarism. Which of the following clinical findings would most likely cause his care team to suspect that the man has an additional endocrine disorder from a different source?

The man has a chronic platelet deficiency and is occasionally anemic.

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 release of ACTH.

The nurse is caring for an older adult client who is being treated for primary hypothyroidism. The medication therapy includes a "go low and go slow" regimen. What is the importance of this medication regimen for this client?

There is a risk of inducing acute coronary syndromes in the older adult client if a more rapid correction of thyroid levels is used.

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.

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

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 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

Of the following patient conditions, which patient would be at risk for experiencing a thyroid problem due to a decrease in thyroxine-binding globulin (TBG)? Select all that apply.

• 55-year-old male with cirrhosis due to alcohol abuse • 75-year-old man receiving chronic glucocorticoid therapy to treat his severe chronic obstructive pulmonary disease (COPD) • 18-year-old female anorexia nervosa patient weighing 78 pounds who has consumed no protein for the past three years.

Of the following list of nursing interventions, which would be considered priority when managing a patient with life-threatening myxedematous coma? Select all that apply.

• Administer 3% sodium IV solution to increase sodium levels. • Administer 50% dextrose to raise glucose levels. • Place on oxygen therapy to encourage deep breathing.

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)

A client has just been diagnosed with Hashimoto thyroiditis and is asking the health care provider for information about the condition. The most appropriate information to provide would be: Select all that apply.

• Autoimmune disorder • Common in females • Prone to goiter development

A woman who is exhibiting clinical manifestations of a pituitary adenoma will likely complain of: Select all that apply.

• Cessation of menses • Unusual milk secretion unrelated to pregnancy • Infertility

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

The nurse is caring for a client with primary hypothyroidism who is being monitored for the complication of myxedema coma while thyroid level therapy is started. What does the nurse understand are the three major aspects of myxedema coma?

• Elevated carbon dioxide levels and decreased oxygen saturation • Fluid and electrolyte imbalance • Hypothermia

Which interventions would be included in the plan of care for a client experiencing myxedematous coma? Select all that apply.

• Frequent monitoring of cardiac functions • Initiation of thyroid replacement therapy • Oxygen therapy to support ineffective respirations • Reversal of hypoglycemia

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

Growth hormone exerts its effects on the body in many ways. Which of these are effects of GH? (Select all that apply.)

• Increases insulin levels • Enhances fatty acid mobilization • Facilitates the rate of protein synthesis

Testing for short statue growth hormone (GH) problems can be done by pharmacologic means. Which of the following medications can be utilized to test for a rise in GH? Select all that apply.

• Insulin • Levodopa

The nurse is educating a client with hyperthyroidism who has recovered from thyrotoxicosis (thyroid storm) and is preparing for discharge. What can the nurse inform the client that this hypermetabolic state can be caused by in order to decrease exacerbation? Select all that apply.

• Manipulation of the thyroid gland • Physical or emotional trauma • Stress

Which statements are true regarding hypothyroidism? Select all that apply.

• Onset of symptoms is gradual • Weight gain • Anorexia

The nurse is receiving physician orders when admitting a client to the inpatient facility with cirrhosis of the liver. Which medications ordered 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)

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

The nurse is caring for a client who is in a severely hypothyroid state. Which medications should be avoided related to the inability to metabolize these drugs? Select all that apply.

• Sedatives • Analgesics • Anesthetics

A child has been diagnosed with classic growth hormone deficiency. The child may experience: Select all that apply.

• Short stature • Delayed skeletal muscle maturation • Obesity

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

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

The nurse is preparing a client for a test that will measure negative feedback suppression of ACTH. Which medication will the nurse administer in conjunction for this test?

Dexamethasone

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 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.

A student nurse is taking a test on the endocrine system. From the following list of clinical manifestations, she needs to select the ones she would see in hypothyroidism. Which answers should she select? Select all that apply.

• Weight gain despite loss of appetite • Coarse brittle hair • Puffy face with swollen eyelids