Chapter 32: Disorders of Endocrine Control of Growth and Metabolism-Patho

Which complication of acromegaly can be life threatening? a) Splayed teeth result in impaired chewing b) Bone overgrowth causes arthralgias c) Cardiac structures increase in size d) Vertebral changes result in kyphosis

Cardiac structures increase in size While all the complications can exist, it is the enlargement of the heart and accelerated atherosclerosis that may lead to an early death. The teeth become splayed, causing a disturbed bite and difficulty in chewing. Vertebral changes often lead to kyphosis, or hunchback. 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.

A client with a suspected diagnosis of primary hypothyroidism would most likely demonstrate which of the following serum laboratory values? a) Decreased thyroid-stimulating hormone (TSH) related to poor thyroid function b) Decreased thyroid-stimulating hormone (TSH) and thyroxine (T4), and low T3 c) Elevated thyroid-stimulating hormone (TSH) and decreased thyroxine (T4) d) Elevated thyroid-stimulating hormone (TSH), thyroxine (T4), and T3

Elevated thyroid-stimulating hormone (TSH) and decreased thyroxine (T4) A low serum T4 and elevated TSH levels are characteristic of primary hypothyroidism. Elevated TSH, T4, and T3 may indicate hyperthyroidism. Decreased levels may be due to suppression by medication.

A 25-year-old female client exhibits exophthalmos of both eyes. The health care provider recognizes this as a manifestation of: a) Myxedema b) Acquired hypothyroidism c) Graves disease d) Hashimoto thyroiditis

Graves disease Graves disease is a state of hyperthyroidism in which opthalmopathies, such as exophthalmos, typically occur. The other conditions are states of hypothyroidism and are not associated with this abnormality.

When the assessment of thyroid autoantibodies is performed, what is the suspected diagnosis? a) Congenital hypothyroidism b) Hashimoto thyroiditis c) Thyroid tumor d) Goiter

Hashimoto thyroiditis The assessment of thyroid autoantibodies (e.g., antithyroid peroxidase antibodies in Hashimoto thyroiditis) is important in the diagnostic workup and consequent follow-up of thyroid clients.

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? a) Increase in appetite b) Constipation c) Weight gain d) Fatigue

Increase in appetite Thyroid hormone enhances gastrointestinal function, causing an increase in motility and production of GI secretions that often results in diarrhea. An increase in appetite and food intake accompanies the higher metabolic rate that occurs with increased thyroid hormone levels. At the same time, weight loss occurs because of the increased use of calories.

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? a) Phenytoin (Dilantin) b) Levothyroxine (Synthroid) c) Sertraline (Zoloft) d) Lithium carbonate

Lithium carbonate Certain goitrogenic agents, such as lithium carbonate (used in the treatment of manic-depressive states) and the antithyroid drugs propylthiouracil and methimazole, in continuous dosage can block hormone synthesis and produce hypothyroidism with goiter.

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? a) Rhinitis b) Tuberculosis c) Influenza d) Bronchitis

Bronchitis The cartilaginous structures in the larynx and respiratory tract become enlarged, resulting in a deepening of the voice and tendency to develop bronchitis.

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? a) Increased levels of ACTH b) Increase in sedimentation rate c) Elevated WBC count d) Positive C-reactive protein

Increased levels of ACTH Hyperpigmentation results from elevated levels of ACTH. The skin looks bronzed or suntanned in exposed and unexposed areas, and the normal creases and pressure points tend to become especially dark. The gums and oral mucous membranes may become bluish-black. The amino acid sequence of ACTH is strikingly similar to that of melanocyte stimulating hormone; hyperpigmentation occurs in greater than 90 percent of persons with Addison's disease and is helpful in distinguishing the primary and secondary forms of adrenal insufficiency.

Which of the following inhibits growth hormone (GH)? a) Starvation b) Obesity c) Hypoglycemia d) Heavy exercise

Obesity GH is inhibited by increased glucose levels, free fatty acid release, cortisol, and obesity. It is stimulated by hypoglycemia, fasting starvation, increased blood levels of amino acids, and stress conditions such as trauma, excitement, emotional stress, and heavy exercise.

A client has a disorder that causes him to have a deficiency of all of the anterior pituitary hormones. What condition will the nurse education the client about for replacement therapy? a) Laron-type dwarfism b) Congenital GH deficiency c) Psychosocial dwarfism d) Panhypopituitarism

Panhypopituitarism The term panhypopituitarism refers to conditions that cause a deficiency of all of the anterior pituitary hormones. Laron-type dwarfism is when GH levels are normal or elevated, but there is a hereditary defect in IGF production that can be treated directly with IGF-1 replacement. Psychosocial dwarfism involves a functional hypopituitarism and is seen in some emotionally deprived children. Congenital GH deficiency is associated with decreased birth length, followed by a decrease in growth rate that can be identified by careful measurement during the first year and that becomes obvious by 1 to 2 years of age.

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? a) Multiple dental caries b) Enlarged head circumference c) Significant genital enlargement d) The child is 20 pounds over his target weight for height

Significant genital enlargement Diagnosis of precocious puberty is based on physical findings of early thelarche, adrenarche, and menarche. The most common sign in boys is early genital enlargement. Radiologic findings may indicate advanced bone age. People with precocious puberty are unusually tall for their age as children but short as adults because of the early closure of the epiphyses.

A client who has just undergone a thyroidectomy is experiencing high fever, tachycardia, and extreme restlessness. The nurse would interpret these manifestations as: a) Hypothyroidism b) Thyroid crisis c) Addisonian crisis d) Myxedematous coma

Thyroid crisis The symptoms this client is experiencing are related to thyroid crisis or storm and must be treated immediately to prevent death. Myxedematous coma is related to hypothyroidism but typically does not occur after a thyroidectomy. Addisonian crisis is related to hypoadrenalism.

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) A decrease in the level of glucose b) A decrease in oxygen consumption c) A decrease in sympathetic nervous system activity d) A hypermetabolic state

A hypermetabolic state Many of the manifestations of hyperthyroidism are related to the increase in oxygen consumption and use of metabolic fuels associated with the hypermetabolic state, as well as to the increase in sympathetic nervous system activity that occurs.

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? a) Acute adrenal insufficiency b) Acute adrenal hyperplasia c) Acute adrenal hypoplasia d) Acute adrenal cortical hyperplasia

Acute adrenal insufficiency Chronic suppression causes atrophy of the adrenal gland, and the abrupt withdrawal of drugs can cause acute adrenal insufficiency. The other answers are incorrect.

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. a) Growth hormone (GH) b) Antidiuretic hormone (ADH) c) Luteinizing hormone (LH) d) Norepinephrine e) Adrenocorticotropic hormone (ACTH) f) Thyroid-stimulating hormone (TSH)

• Adrenocorticotropic hormone (ACTH) • Thyroid-stimulating hormone (TSH) • Growth hormone (GH) • Luteinizing hormone (LH) The anterior lobe of the pituitary gland produces adrenocorticotropic hormone (ACTH), thyroid-stimulating hormone (TSH), growth hormone (GH), the gonadotropic hormones (follicle-stimulating hormone [FSH] and luteinizing hormone [LH]), and prolactin. ADH is produced in the posterior pituitary, and norepinephrine is produced in the adrenal medulla.

Loss of pituitary function can result in deficiencies/loss of which of the following hormones' secretions? Select all that apply. a) Growth hormone b) Luteinizing hormone c) Prolactin d) Corticotropin-releasing hormone e) Follicle stimulating hormone

• Growth hormone • Luteinizing hormone • Follicle stimulating hormone • Prolactin Anterior pituitary hormone loss is usually gradual, especially with progressive loss of pituitary reserve due to tumors or previous pituitary radiation therapy (which may take 10 to 20 years to produce hypopituitarism). The loss of pituitary function tends to follow a classic course beginning with the loss of GH, LH, and FSH secretion followed by deficiencies in TSH, then ACTH, and finally prolactin.

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? a) Dehydration from diarrhea b) Accelerated growth c) Cretinism d) Irritability and restlessness

Cretinism Congenital hypothyroidism is a common cause of preventable mental retardation. It affects approximately 1 in 4000 infants. The manifestations of untreated congenital hypothyroidism are referred to as cretinism. The term does not apply to the normally developing infant in whom replacement thyroid hormones therapy was instituted shortly after birth.

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: a) 04:00 to 6:00 PM b) 09:00 to 11:00 PM c) 06:00 to 08:00 AM d) 10:00 to 12:00 AM

06:00 to 08:00 AM Levels of cortisol increase as ACTH levels rise and decrease as ACTH levels fall. There is considerable diurnal variation in ACTH levels, which reach their peak in the early morning (around 6 to 8 AM) and decline as the day progresses.

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? a) "The protrusion of the eyes will get worse before they get better." b) "With treatment of the hyperthyroid state, the opthalmopathy usually tends to stabilize." c) "Once we treat your Graves' disease, your eyes will go back to their normal state." d) "Your eyes will be like this but there are things we can do to reduce visual loss."

"With treatment of the hyperthyroid state, the opthalmopathy usually tends to stabilize." The ophlalmopathy of Graves' disease can cause severe eye problems, including tethering of the extraocular muscles resulting in diplopia; involvement of the optic nerve, with some visual loss; and corneal ulceration because the lids do not close over the protruding eyeball. The opthalmopathy usually tends to stabilize after treatment of the hyperthyroidism.

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? a) Enlarged clitoris, fused labia, and urogenital sinus b) Small clitoris, open labia, and urogenital sinus c) Small clitoris, fused labia, and urogenital sinus d) Enlarged clitoris, open labia, and urogenital sinus

Enlarged clitoris, fused labia, and urogenital sinus In female infants, an increase in androgens is responsible for creating the virilization syndrome of ambiguous genitalia with an enlarged clitoris, fused labia, and urogenital sinus. The other answers are incorrect

Which test can the nurse prepare the client for to determine the differentiation between a benign and a malignant thyroid disease? a) Ultrasonography b) Fine-needle aspiration biopsy c) MRI d) CT scan

Fine-needle aspiration biopsy Ultrasonography can be used to differentiate cystic from solid thyroid lesions, and CT and MRI scans are used to demonstrate tracheal compression or impingement on other neighboring structures. Fine-needle aspiration biopsy of a thyroid nodule has proved to be the best method for differentiation of benign from malignant thyroid disease. (less)

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? a) Somatic b) Tertiary c) Secondary d) Primary

Secondary In secondary disorders of endocrine function, the target gland is essentially normal, but defective levels of stimulating hormones or releasing factors from the pituitary system alter its function.

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? a) Administration of somatostatin analogs to inhibit GH production b) Administration of levothyroxine to supplement thyroid function c) Calcium channel blocking medications to reduce heart rate and cardiac risks d) β-adrenergic-blocking medications to reduce sympathetic nervous stimulation

β-adrenergic-blocking medications to reduce sympathetic nervous stimulation The hyperthyroidism that constitutes Graves' disease can often be mitigated by the administration of β-adrenergic-blocking medications. Levothyroxine would be used to address hypothyroidism and calcium channel blockers are not an identified treatment modality for Graves' disease. Somatostatin analogs are used to treat GH excess

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? a) "I will have to take medication for the rest of my life." b) "They gave me all of the medication I needed in the hospital." c) "Since I have had surgery, there is nothing else I will need to take." d) "I will need to take my medication for about 6 to 12 months, or until my adrenal function returns."

"I will need to take my medication for about 6 to 12 months, or until my adrenal function returns." Transsphenoidal removal of a pituitary adenoma or a hemihypophysectomy is the preferred method of treatment for Cushing disease. This allows removal of only the tumor rather than the entire pituitary gland. After successful removal, the person must receive cortisol replacement therapy for 6 to 12 months or until 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? a) "This situation will not improve at all and is not reversible." b) "The child must receive injections of growth hormone for the duration of her life." c) "The prognosis of the child depends on an improvement in behavior and catch-up growth." d) "The child will have a thin build and delayed skeletal and sexual maturation."

"The prognosis of the child depends on an improvement in behavior and catch-up growth." Psychosocial dwarfism involves a functional hypopituitarism and is seen in some emotionally deprived children. These children usually present with poor growth, potbelly, and poor eating and drinking habits. Typically, there is a history of disturbed family relationships in which the child has been severely neglected or disciplined. Often, the neglect is confined to one child in the family. GH function usually returns to normal after the child is removed from the constraining environment. The prognosis is dependent on improvement in behavior and catch-up growth.

The nurse is working in a pediatric clinic. Which of the following children would the nurse recognize as having isosexual precocious puberty? a) A 5-year-old African-American female with developing breasts and pubic hair b) A 14-year old Caucasian female who has not yet developed secondary sex characteristics c) A 10-year-old African-American female who has begun menstruating d) A 9-year-old Caucasian female who has small breast buds

A 5-year-old African-American 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 African-American 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.

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) Genetic short stature b) Lack of IGF receptors in epiphyseal long bones c) A shortage of hypothalamic GHRH production d) Excess insulin production resulting in chronically low blood glucose levels

A shortage of hypothalamic GHRH production Inadequate levels of hypothalamic GHRH will result in adequate production but inadequate release of GH by the pituitary. Genetic short stature is less likely given the disparity between his height and his twin's, and a shortage of IGF receptors is not a noted pathology. While poorly controlled diabetes can contribute to short stature, excess insulin production is not a likely factor.

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? a) ACTH b) DHEA c) GH d) TSH

ACTH The third form (of Cushing syndrome) is ectopic Cushing syndrome, caused by a nonpituitary ACTH-secreting tumor. Certain extra pituitary malignant tumors such as small cell carcinoma of the lung may secrete ACTH or, rarely, CRH and produce Cushing syndrome. The adrenal sex hormone dehydroepiandrosterone (DHEA) contributes to the pubertal growth of body hair, particularly pubic and axillary hair in women. Thyroid-stimulating hormone (TSH) levels are used to differentiate between primary and secondary thyroid disorders. Although secretion of growth hormone (GH) has diurnal variations over a 24-hour period, with nocturnal sleep bursts occurring 1 to 4 hours after onset of sleep, it is unrelated to ACTH and/or CRH secretion.

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? a) Hyperthyroidism b) Myxedema c) Acromegaly d) Cushing syndrome

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.

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) Beta-adrenergic blocking agent b) Angiotensin receptor blocking agent c) Calcium channel blocking agent d) Angiotensin converting enzyme inhibitor

Beta-adrenergic blocking agent The beta-adrenergic blocking drugs (propranolol, metoprolol, atenolol, and nadolol are preferred) are administered to block the effects of the hyperthyroid state on sympathetic nervous system function. They are given in conjunction with antithyroid drugs such as propylthiouracil and methimazole.

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? a) Small hands and feet compared to length of arms and legs b) Slanting forehead and a receding lower jaw c) Broad, bulbous nose and a protruding lower jaw d) Protruding lower jaw and forehead

Broad, bulbous nose and a protruding lower jaw When the production of excessive GH occurs after the epiphyses of the long bones have closed, as in the adult, the person cannot grow taller, but the soft tissues continue to grow. 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 lower jaw, and a slanting forehead. The other answers are incorrect.

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) Replacement therapy with synthetic thyroid hormone b) Replacement therapy with prolactin c) Cortisol replacement therapy. d) Growth hormone replacement therapy

Cortisol replacement therapy. Cortisol replacement is started when ACTH deficiency is present; thyroid replacement when TSH deficiency is detected; and sex hormone replacement when LH and FSH are deficient. GH replacement is indicated for pediatric GH deficiency, and is increasingly being used to treat GH deficiency in adults.

A 25-year-old female client exhibits exophthalmos (abnormal protrusion of the eyeballs) or eyeball of both eyes. The health care provider recognizes this as a manifestation of: a) Graves disease b) Myxedema c) Hashimoto thyroiditis d) Acquired hypothyroidism

Graves disease Graves disease is a state of hyperthyroidism in which opthalmopathies, such as exophthalmos, typically occur. The other conditions are states of hypothyroidism and are not associated with this abnormality.

The nurse is performing an assessment for a client who has hyperthyroidism that is untreated. When obtaining vital signs, what is the expected finding? a) Blood pressure 180/110 mm Hg b) Heart rate 110 and bounding c) Respiratory rate 14 d) Temperature 96oF

Heart rate 110 and bounding Cardiovascular and respiratory functions are strongly affected by thyroid function. With an increase in metabolism, there is a rise in oxygen consumption and production of metabolic end products, with an accompanying increase in vasodilation. Blood volume, cardiac output, and ventilation are all increased. Heart rate and cardiac contractility are enhanced as a means of maintaining the needed cardiac output. Blood pressure is likely to change little because the increase in vasodilation tends to offset the increase in cardiac output.

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) Hydrocortisone b) Potassium supplements c) Insulin d) Ketoconazole

Hydrocortisone Hydrocortisone is usually the drug of choice in treating Addison disease. In mild cases, hydrocortisone alone may be adequate. Ketoconazole causes excessive breakdown of glucocorticoids and can also result in adrenal insufficiency. Clients with Addison disease usually have elevated potassium levels, and insulin is not the treatment for Addison disease.

A client with severe hypothyroidism is presently experiencing hypothermia. What nursing intervention is a priority in the care of this client? a) Keeping the client in a hypothermic state in order to prevent renal failure b) Active rewarming of the client to increase body temperature rapidly c) Slow rewarming of the client to prevent vasodilation and vascular collapse d) Placing the client on a hyperthermia blanket and using heated saline in order to induce vasodilation

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 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? a) The client has increased cortisol levels, truncal obesity, and altered fat distribution. b) The child has excess levels of growth hormones and the epiphyses of the long bones are not fused. c) The child has an increase in the TSH level and has a goiter. d) The child has fusion of the epiphyses of the long bones and increased growth hormone levels.

The child has fusion of the epiphyses of the long bones and increased growth hormone levels. Growth hormone excess occurring before puberty and the fusion of the epiphyses of the long bones results in gigantism. Excessive secretion of GH by somatotrope adenomas causes gigantism in the prepubertal child. It occurs when the epiphyses are not fused and high levels of IGF-1 stimulate excessive skeletal growth. When GH excess occurs in adulthood or after the epiphyses of the long bones have fused, the condition is referred to as acromegaly.

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? a) The client should be informed that if he observes an increase in fatigue, an extra dose of his thyroid medication should be taken. b) The client should skip a dose of the thyroid supplement if he has symptoms of fever or restlessness. c) The client should be informed about the signs and symptoms of severe hypothyroidism and the need for early intervention. d) The client should not participate in any exercise activity that could utilize more thyroid hormone.

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 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? a) The client should be strongly encouraged not to drink any alcohol. b) The client should be strongly urged not to smoke. c) The client should be informed that he should not be in contact with other people during the acute phase. d) The client should be informed that if he begins to feel symptoms getting worse, he should take an extra dose of their medication.

The client should be strongly urged not to smoke. Ophthalmopathy can also be aggravated by smoking, which should be strongly discouraged. It is not necessary for the client to avoid contact with others. Alcohol is not contraindicated but should be limited when taking any medication regimen. The client should not adjust the doses of medications without first consulting the physician.

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? a) The infant will have to take the medication only until he reaches puberty. b) Once the dosage levels are adjusted, the infant will remain on the same amount throughout life. c) The medication dosage will increase every 6 months after laboratory testing. d) The infant will have dosage levels adjusted as he grows.

The infant will have dosage levels adjusted as he grows. Congenital hypothyroidism is treated by hormone replacement. Evidence indicates that it is important to normalize T4 levels as rapidly as possible because a delay is accompanied by poorer psychomotor and mental development. Dosage levels are adjusted as the child grows. When early and adequate treatment regimens are followed, the risk of mental retardation in infants detected by screening programs is essentially nonexistent.

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. a) Loss of fine motor control and arthritis b) Deformed joints and bone spurs c) Impaired physical growth d) Down's syndrome e) Mental retardation

• Impaired physical growth • Mental retardation Thyroid hormone is essential for normal growth and brain development, almost half of which occurs during the first 6 months of life. If untreated, congenital hypothyroidism causes mental retardation and impairs physical growth. Down's syndrome is a congenital birth defect and not caused by hypothyroidism.

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. a) Coarse brittle hair b) Heat intolerance c) Puffy face with swollen eyelids d) Weight gain despite loss of appetite e) Nervousness with fine muscle tremors

• Weight gain despite loss of appetite • Coarse brittle hair • Puffy face with swollen eyelids The hypometabolic state associated with hypothyroidism is characterized by a gradual onset of weakness and fatigue, a tendency to gain weight despite a loss of appetite, and cold intolerance. As the condition progresses, the skin becomes dry and rough and the hair becomes coarse and brittle. Reduced conversion of carotene to vitamin A and increased blood levels of carotene may give the skin a yellowish color. The face becomes puffy with edematous eyelids, and there is thinning of the outer third of the eyebrows. Nervousness with fine muscle tremors and heat intolerance are signs of hyperthyroidism.