Ch. 32 PrepU Quiz

Altered fat metabolism

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?

Dexamethasone

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?

24-hour urine secretion of cortisol Dexamethasone suppression test Plasma levels of ACTH

The nurse is preparing a client for testing to determine if the client has Cushing syndrome. What tests are included in the screening process? Select all that apply.

The client should be strongly urged not to smoke.

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 hypothalamus secretes GHRH.

A child is born with dwarfism to normal-sized parents. The physician is explaining how growth hormone (GH) plays a central role in the increase in stature that characterizes childhood and adolescence. What is the first step in the growth hormone chain of events?

Graves disease

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

"A tumor in my brain threw off my hormone levels after I finished adolescence."

A 28-year-old male who is 6'11" tall has a diagnosis of acromegaly. The man is explaining to a curious but sympathetic coworker exactly what accounts for his extraordinary height. Which of the following explanations demonstrates a sound understanding of his health problem?

Somatotrope adenoma

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:

Poor stress management and hyperpigmentation

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?

Obesity Delayed skeletal muscle maturation Short stature

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

"The prognosis of the child depends on an improvement in behavior and catch-up growth."

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?

T4 and TSH

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?

Increased levels of ACTH

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?

Adrenocorticotropic hormone (ACTH) Growth hormone (GH) Luteinizing hormone (LH) Thyroid-stimulating hormone (TSH)

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.

Increased visceral fat

A client has been diagnosed with metabolic syndrome and growth hormone (GH) deficiency. Physical assessment of the client would identify:

Iatrogenic Cushing syndrome

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?

The client's hypothalamic--pituitary--adrenal (HPA) system will require recovery time before normal function is restored.

A client has presented to a clinic for the treatment of severe dermatitis after contact with poison ivy on a camping trip. The client has been prescribed prednisone, a corticosteroid, for the treatment of his skin condition. The client's care provider has emphasized that dosages of the drug will be gradually tapered off rather than stopped upon resolution of the symptoms. Which rationale is the most accurate for this dosing protocol?

"I will have to take my medication for the rest of my life."

A client is diagnosed with Addison's disease. What statement by the client indicates an understanding of the discharge instructions by the nurse?

Cortisol replacement therapy.

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?

A hypermetabolic state

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?

Tachycardia and rapid respiratory rate A goiter Ophthalmolopathy (exophthalmos)

A client is exhibiting signs of Graves' disease. What clinical manifestations of this disorder would the nurse document that would indicate this disease state? Select all that apply.

Growth hormone

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

Follicle stimulating hormone (FSH)

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?

Thyroid crisis

A client who has just undergone a thyroidectomy is experiencing high fever, tachycardia, and extreme restlessness. The nurse would interpret these manifestations as:

Glucocorticoids

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?

"With treatment of the hyperthyroid state, the opthalmopathy usually tends to stabilize."

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?

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

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?

Elevated thyroid-stimulating hormone (TSH) and decreased thyroxine (T4)

A client with a suspected diagnosis of primary hypothyroidism would most likely demonstrate which of the following serum laboratory values?

Coarse and dry skin and hair Intolerance to cold Decreased sweating

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.

Slow rewarming of the client to prevent vasodilation and vascular collapse

A client with severe hypothyroidism is presently experiencing hypothermia. What nursing intervention is a priority in the care of this client?

teach the client about the safe and effective use of synthetic thyroid hormones.

A client's low serum T4 level has led to a diagnosis of hypothyroidism. When planning this client's care, the nurse should:

"Your tumor in your vagina is secreting a hormone called adenocorticotropic hormone (ACTH) which is responsible for these signs/symptoms."

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?

Moderate short stature Thin build Delayed sexual maturation

A male child, age 13, is brought to the clinic for a wellness checkup who has been diagnosed with constitutional short stature. What assessment data obtained by the nurse correlates with this diagnosis? Select all that apply.

Performing a skin scrub on surgical site prior to incision with povidone-iodine solution

A newborn is found to have transient hypothyroidism after having a cesarean birth. What nursing interventions provided to the mother in preparation of the surgical procedure may have induced this newborn's condition?

The infant will have dosage levels adjusted as he grows.

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?

Hypoglycemia Hyponatremia Lactic acidosis Hypoventilation

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.

Eye health and visual acuity

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?

β-adrenergic-blocking medications to reduce sympathetic nervous stimulation

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?

Significant genital enlargement

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?

Change in level of consciousness and profound hypotension

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?

The child has fusion of the epiphyses of the long bones and increased growth hormone levels.

A very tall 8-year-old child is brought by a parent to the clinic for a follow-up visit after diagnostic testing reveals a diagnosis of gigantism. What objective assessment data gathered would the nurse recognize correlates with the child's condition?

Myxedematous coma

An overweight, 14-year-old boy feels tired all the time. He sleeps 12 to 14 hours a day and has a voracious appetite but no energy to burn off the calories. He has been diagnosed with hypothyroidism brought about by the accumulation of a nonpitting mucosus type of edema. For which life-threatening condition should his care team be prepared?

Broad, bulbous nose and a protruding lower jaw

Acromegaly is a disorder that is caused by the production of excessive GH in the adult. Because the person cannot grow taller, the soft tissues continue to grow, presenting a very distinctive appearance. What is it that is distinctive in a person with acromegaly?

GH suppression test

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?

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

After receiving change-of-shift report about the following four patients, which patient should the nurse assess first?

Starvation

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

Carpal tunnel syndrome

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?

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

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?

Mental retardation Impaired physical growth

An infant born with congenital hypothyroidism who does not receive care from any healthcare provider is likely to develop which of the following complications? Select all that apply.

The client should eat and exercise on a regular schedule.

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?

Acute adrenal insufficiency

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?

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

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?

Secondary

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?

Enlarged clitoris, fused labia, and urogenital sinus

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?

Impaired immunological and inflammatory response

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?

The client will require exogenous supplements of cortisol.

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?

Increased white cell count and audible crackles on chest auscultation.

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?

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

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

Delirium Tachycardia Very high fever

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

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.)

Muscle weakness Dehydration Altered mental status Vascular collapse

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.)

A client who has been diagnosed with Hashimoto thyroiditis

In which client would the nurse identify a primary endocrine disorder?

Drug therapy directed toward decreasing the gland's function Eradication of the gland with radioactive iodine Surgical removal of part or the entire gland

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 gland's function

Management of hyperthyroidism would include which interventions? Select all that apply.

Early activation of the hypothalamic--pituitary--gonadal axis

Parents of a 7-year-old girl are concerned about their daughter because she has begun to develop secondary sexual characteristics. What etiologic factor is most likely to underlie the child's condition?

Short stature in adults

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

Insulin Levodopa

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.

Thin extremities and muscle weakness

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?

ACTH peaks in the morning and declines throughout the day.

The health care provider is reviewing diurnal variation pattern in adrenocorticotropic (ACTH) levels. Select the typical diurnal variation pattern in adrenocorticotropic (ACTH) levels.

Breakdown of proteins and fats

The health care provider is teaching a client about the metabolic effect of cortisol. The most appropriate information to provide would be:

A shortage of hypothalamic GHRH production

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?

Cretinism

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?

Perform a heel stick to obtain a drop of blood for a T4 and TSH.

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?

Sparse axillary and pubic hair

The nurse is assessing a female client with a diagnosis of primary adrenal cortical insufficiency. The nurse anticipates the client will manifest:

Acromegaly

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?

Fludrocortisone acetate

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?

Neck vein distention Syncope when coughing Edema of the eyelids Choking

The nurse is caring for a client who has a multinodular goiter. The nurse is aware that the client may be at risk for: Select all that apply.

Anesthetics Analgesics Sedatives

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.

Propylthiouracil (PTU)

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?

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

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?

Client states, "I feel as though I am going to vomit." Client states, "I don't feel like eating anything." The client states that she feels weak

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?

Cardiovascular system

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?

Hypoglycemia and seizures

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?

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 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?

Manipulation of the thyroid gland Stress Physical or emotional trauma

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.

The client should be informed about the signs and symptoms of severe hypothyroidism and the need for early intervention.

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 medication will be given daily during the period of active growth and can be continued into adulthood.

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?

There is an increase in pharyngeal soft tissue accumulation.

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?

Heart rate 110 and bounding

The nurse is performing an assessment for a client who has hyperthyroidism that is untreated. When obtaining vital signs, what is the expected finding?

Diazepam (Valium) Phenytoin (Dilantin) Aspirin

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.

A 7-year-old female with early menarche

The nurse is reviewing the assessment data of four clients. Select the client who would be diagnosed with precocious puberty.

Hydrocortisone

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.

A 5-year-old African-American female with developing breasts and pubic hair

The nurse is working in a pediatric clinic. Which of the following children would the nurse recognize as having isosexual precocious puberty?

Chromosomal abnormalities GH deficiency Protein-calorie malnutrition Malabsorption syndromes

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.

Hashimoto thyroiditis

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

Increase in appetite

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?

Beta-adrenergic blocking agent

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?

A 32-year-old postpartum client

Which client does the nurse recognize is at the most risk for the development of subacute thyroiditis?

Cardiac structures increase in size

Which complication of acromegaly can be life threatening?

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

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

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

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

Aspirin

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

The disorder occurs when the target organ is normal, but stimulating hormones alter its function.

Which of the following best describes a secondary disorder of endocrine function?

obesity

Which of the following inhibits growth hormone (GH)?

The pituitary gland communicates with the adrenal cortex through the release of ACTH.

Which of the following statements best captures an aspect of the function of the hypothalamic-pituitary-adrenal (HPA) system?

The adrenal cortical hormones are primarily steroids and sex hormones.

Which of the following statements best captures the role of the adrenal cortex in maintaining homeostasis?

Fine-needle aspiration biopsy

Which test can the nurse prepare the client for to determine the differentiation between a benign and a malignant thyroid disease?