Patho PrepU Chapter 41 Thyroid and Diabetes

Which clients are at risk for developing hypothyroidism? Select all that apply. A client who is prescribed amiodarone for frequent dysrhythmias A client who has bulging eyeballs being treated with beta-adrenergic blockers (beta-blockers) A client who has precancerous thyroid lesions who underwent ablation with radiation A female experiencing an autoimmune disorder called thyroiditis A client with bipolar disorder prescribed lithium carbonate

A client who is prescribed amiodarone for frequent dysrhythmias A client who has precancerous thyroid lesions who underwent ablation with radiation A female experiencing an autoimmune disorder called thyroiditis A client with bipolar disorder prescribed lithium carbonate

The nurse is teaching a client diagnosed with Addison disease about the importance of lifetime oral replacement therapy. Which pharmacologic agent would be the drug of choice and included in this teaching plan? Hydrocortisone Insulin Potassium supplements Ketoconazole

Hydrocortisone

Which individual displays the precursors to acromegaly? An adult with an excess of growth hormone due to an adenoma A girl who has been diagnosed with precocious puberty An adult who has a diagnosis of Cushing syndrome A client who has recently developed primary adrenal carcinoma

An adult with an excess of growth hormone due to an adenoma

When providing nutrition education to the client with diabetes, the nurse should include which statement regarding fat intake? "People with diabetes should not consume fats." "If you have diabetes, avoiding saturated fats is important." "When diabetes is present, 40% of calories may be from fat." "Individuals with type 2 diabetes may consume more fat calories than those with type 1 diabetes."

"If you have diabetes, avoiding saturated fats is important."

A diabetic client presents to a clinic for routine visit. Blood work reveals a HbA1C of 11.0% (high). Which response by the client may account for this abnormal lab result? "I've had more periods of hypoglycemia than usual over the past few months." "I've been doing great. I haven't needed much insulin coverage before meals." "To tell you the truth, my blood glucose levels have been pretty normal for me." "My meter broke so I have not been checking my blood glucose levels for a while."

"My meter broke so I have not been checking my blood glucose levels for a while."

The nurse has just completed teaching a client, newly diagnosed with type 1 diabetes, about the treatment options. Which response by the client leads the nurse to conclude that additional teaching is needed? "So I can stop my insulin if I start an exercise program." "If I work on losing some weight, that might help prevent complications later." "An exercise plan will be helpful for prevention of long-term complications." "If I forget my insulin in the morning, I should take it as soon as I can to prevent hyperglycemia."

"So I can stop my insulin if I start an exercise program."

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." "This situation will not improve at all and is not reversible." "The child must receive injections of growth hormone for the duration of her life." "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."

A client with Graves disease has ophthalmopathy and asks the nurse if the eyes will stay like this forever. What is the best response by the nurse? "Once we treat your Graves disease, your eyes will go back to their normal state." "With treatment of the hyperthyroid state, the ophthalmopathy usually tends to stabilize." "The protrusion of the eyes will get worse before they get better." "Your eyes will be like this but there are things we can do to reduce visual loss."

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

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 10:00 AM to noon 04:00 to 6:00 PM 09:00 to 11:00 PM

06:00 to 08:00 AM

The nurse educates a client newly diagnosed with diabetes regarding diet and energy requirements. The nurse knows that 1 gram of fat will provide _____ kcal of energy.

9

The nurse is working in a pediatric clinic. Which child would the nurse recognize as having isosexual precocious puberty? A 9-year-old white female who has small breast buds A 5-year-old black female with developing breasts and pubic hair A 14-year old white female who has not yet developed secondary sex characteristics A 10-year-old black female who has begun menstruating

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

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. ACTH increases in the morning and peaks again in the evening hours. ACTH maintains a consistent level regardless of the time of day. ACTH peaks in correspondence with food intake.

ACTH peaks in the morning and declines throughout the day.

The signs and symptoms of abrupt cessation of pharmacologic glucocorticoids closely resemble those of which disease process? Addison disease Cushing disease Cushing syndrome Graves disease

Addison disease

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? Decrease in carbohydrate metabolism Decrease in cortisol secretion Weight gain Altered fat metabolism

Altered fat metabolism

When educating a client about type 1 diabetes, the nurse will mention that this type is caused by which mechanism? Genetic predisposition Overuse of steroids, making pancreatic cells resistant to glucose Idiopathic, abnormally large pancreatic cells Autoimmune destruction of pancreatic beta cells

Autoimmune destruction of pancreatic beta cells

What is the most common cause of hypothyroidism? Goiter Myxedema Thyroidectomy Autoimmune thyroiditis

Autoimmune thyroiditis

The results of a 44-year-old obese man's recent diagnostic workup have culminated in a new diagnosis of type 2 diabetes. Which pathophysiologic process underlies the client's new diagnosis? Beta cell exhaustion due to long-standing insulin resistance Destruction of beta cells that is not attributable to autoimmunity T-lymphocyte-mediated hypersensitivity reactions Actions of insulin autoantibodies (IAAs) and islet cell autoantibodies (ICAs)

Beta cell exhaustion due to long-standing insulin resistance

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? Angiotensin receptor blocking agent Angiotensin-converting enzyme (ACE) inhibitor Calcium channel blocking agent Beta-adrenergic blocking agent (beta-blocker)

Beta-adrenergic blocking agent (beta-blocker)

The health care provider is teaching a client about the metabolic effect of cortisol. The most appropriate information to provide would be: Breakdown of proteins and fats Regulation of behavior and emotion Suppression of the immune response to invasive pathogens Regulation of anti-inflammatory reactions

Breakdown of proteins and fats

An adult with acromegaly presents with a very distinctive appearance. What is the distinctive feature in a person with acromegaly? Small hands and feet compared to length of arms and legs Broad, bulbous nose and a protruding lower jaw Slanting forehead and a receding lower jaw Protruding lower jaw and forehead

Broad, bulbous nose and a protruding lower jaw

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 1 year for the same problem. What condition does the nurse understand results from this client's enlarged cartilaginous structures? Bronchitis Rhinitis Tuberculosis Influenza

Bronchitis

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? Respiratory system Renal system Cardiovascular system Neurologic system

Cardiovascular system

A client with diabetes mellitus has sudden onset of slurred speech, incoordination, and cool, clammy skin. What will the nurse do first? Administer glucose Check blood glucose Notify the physician Provide cheese and crackers

Check blood glucose

______ syndrome is the diagnosis that is most commonly associated with glucocorticoid excess.

Cushing

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? Physiologic effects of sexual abuse Early activation of the hypothalamic-pituitary-gonadal axis Premature pituitary development resulting from a thyroid disorder Genetic predisposition

Early activation of the hypothalamic-pituitary-gonadal axis

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 Cognition and judgment Signs and symptoms of decreased bone density Skin integrity and distribution of adipose tissue

Eye health and visual acuity

An overactive thyroid gland contributes to a lowered matabolism TRUE or FALSE

FALSE

The adrenal cortex produces the hormones primarily responsible for regulation of physical growth and development. TRUE or FALSE

FALSE

Type 1A diabetes is now considered an autoimmune disorder. What factors are considered necessary for type 1A diabetes to occur? Genetic predisposition, environmental triggering event, and a T-lymphocyte-mediated hypersensitivity reaction against some beta-cell antigen Genetic predisposition, physiologic triggering event, allergic reaction to pancreatic alpha cells Diabetogenic gene from both parents, physiologic triggering event, and an allergic reaction to pancreatic delta cells Diabetogenic gene from both parents, environmental triggering event, and a B-lymphocyte reaction to alpha cell antigens

Genetic predisposition, environmental triggering event, and a T-lymphocyte-mediated hypersensitivity reaction against some beta-cell antigen

The nurse is caring for a client who received regular insulin at 7 am. Four hours later the nurse finds the client diaphoretic, cool, and clammy. Which of these interventions is the priority? Bathe the client with tepid water. Give the client a concentrated carbohydrate. Repeat the dose of insulin. Place the client in the supine position.

Give the client a concentrated carbohydrate.

Abnormal stimulation of the thyroid gland by TSH-receptor antibodies is implicated in cases of: Cushing syndrome Graves disease Addison disease Cushing disease

Graves disease

_____ hormone has multiple rolls, including anti-insulin effects and effect on the length of linear bones and rates of cell division

Growth

A 62-year-old man who is overweight has just been diagnosed with type 2 diabetes. The nurse educator is instructing him in the ways his diabetes can be controlled. The nurse should initially prioritize which action? Assisting the client with the appropriate choice of oral antihyperglycemics. Educating the client about the risks and management of hypoglycemia. Helping the client make meaningful changes to his diet and activity level. Teaching the client about the action and safe administration of insulin.

Helping the client make meaningful changes to his diet and activity level.

A man is brought into the emergency department by paramedics who state that the client passed out on the street. The man smells of alcohol, and when roused says he has not eaten since yesterday. He is wearing a medic alert bracelet that says he is a diabetic. What would the nurse suspect as a diagnosis? Hypoglycemia Hyperglycemia Hyponatremia Hypernatremia

Hypoglycemia

The production and release of hormones by the pituitary glandrequires stimulation by the _____.

Hypothalamus

A client diagnosed with metabolic syndrome and growth hormone (GH) deficiency will likely display which physical assessment finding? Increased visceral fat Enhanced insulin uptake Increase in lean body mass Increased bone mineral density

Increased visceral fat

The diagnosis of type 1 diabetes would be confirmed by which principle? Insulin is not available for use by the body. Insulin is present in large amounts for use by the body. Small amounts of insulin are produced daily. Insulin is produced but unavailable for use in the body.

Insulin is not available for use by the body.

Which treatment regimen is most likely to result in stable blood glucose levels for a client with a diagnosis of type 1 diabetes? Perform a daily moderate exercise routine prior to insulin administration Wait until after eating the first meal of the day before checking blood glucose and then calculate insulin dose Monitor blood glucose levels throughout the day and administer exogenous insulin replacement as needed Initially try to control blood glucose levels with diet and exercise routines along with weight reduction

Monitor blood glucose levels throughout the day and administer exogenous insulin replacement as needed

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 mucosal edema. For which life-threatening condition should his care team be prepared? Thyroid storm Pheochromocytoma The paraneoplastic secretion of endocrine hormones Myxedema coma

Myxedema coma

Select the most common symptoms of diabetes. Select all that apply. Polydipsia Polyuria Polyphagia Polyhydramnios Polycythemia

Polydipsia Polyuria Polyphagia

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? Obtain a blood sample from a scalp vein. Obtain a serum blood sample for T3 and T4. Perform a heel stick to obtain a drop of blood for a T4 and TSH. Place a urinary bag over the genitals to collect a urine specimen for T3 and TSH.

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

A client is diagnosed with diabetic ketoacidosis (DKA) in the emergency department. Which clinical manifestations will the client likely exhibit? Polyuria, polydipsia, vomiting, and fatigue Weakness, severe dehydration, and hemiparesis. Headache, difficulty with problem solving and disturbed behavior, and seizures Ankle edema, headache, stomach bloating, and high blood pressure

Polyuria, polydipsia, vomiting, and fatigue

Research has identified a cycle of insulin-induced posthypoglycemic episodes. What is this phenomenon called? Dawn phenomenon Joslin phenomenon Somogyi effect Sunset effect

Somogyi effect

A client with diabetes carries insulin with him at all times. At 11:35, he obtains a blood glucose reading of 218 mg/dL (12.1 mmol/L) and self-administers a dose of insulin in anticipation of eating lunch at noon. What type of insulin did he most likely inject? Intermediate acting Long acting Short acting Premixed

Short acting

A client has developed the facial appearance that is characteristic of myxedema, along with an enlarged tongue, bradycardia, and voice changes. Which treatment modality is most likely to benefit this client? Synthetic preparations of T3 or T4 beta-adrenergic blocking drugs (beta-blockers) Corticosteroid replacement therapy Oral or parenteral cortisol replacement

Synthetic preparations of T3 or T4

Adrenal insufficiency or Addison's Disease requires hormone replacement therapy TRUE or FALSE

TRUE

Hypofunction of the pituitary gland is associated with short stature TRUE or FALSE

TRUE

Primary defects in endocrine function originate in the target gland responsible for producing the hormone, TRUE or FALSE

TRUE

Which clinical manifestations following thyroidectomy would alert the nurse that the client is going into a life-threatening thyroid storm? Select all that apply. Temperature of 104.2°F (40.1°C) Telemetry showing heart rate of 184 Unable to close eyelids completely together Extremely agitated Bruising on knees and feet

Temperature of 104.2°F (40.1°C) Telemetry showing heart rate of 184 Extremely agitated

The nurse is teaching a client with diabetes about the signs and symptoms of hypoglycemia. The client asks, "Why will I get headache, disturbed behavior, coma, and seizures if it's my pancreas that's impaired?" Which response is the best explanation? The brain relies on blood glucose as its main energy source. Insulin produces a rebound hyperglycemia. Hepatic glycogenolysis Hypoglycemia causes ketone breakdown.

The brain relies on blood glucose as its main energy source.

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 linear growth is above normal for age and sex. The child's height is well below the 3rd percentile on several clinic visits. The child's height is below the 50th percentile for height by the time she is 3 years old. The child has had no growth in height for 3 consecutive visits to the clinic.

The child's height is well below the 3rd percentile on several clinic visits.

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

The client should be strongly urged not to smoke.

A client with long-standing type 2 diabetes is surprised to see high blood sugar readings while recovering from an emergency surgery. Which factor may have contributed to the client's inordinately elevated blood glucose levels? The tissue trauma of surgery resulted in gluconeogenesis. Illness inhibited the release and uptake of glucagon. The stress of the event caused the release of adrenal cortical hormones. Sleep disruption in the hospital precipitated the dawn effect.

The stress of the event caused the release of adrenal cortical hormones.

_____ hormone is central to the maintenance of the body metabolism and growth and development in children

Thyroid

The nurse caring for a client diagnosed with hyperglycemic hyperosmolar state (HHS) knows that the client's elevated serum osmolality has pulled water out of the brain cells based on which assessment findings? Select all that apply. Weakness one side of the body Body shakes rapidly and uncontrollably for a short period of time Increase in urine output in proportion to the increase in blood glucose Unable to respond verbally to questions Uncontrollable "pill rolling" of the fingers

Weakness one side of the body Body shakes rapidly and uncontrollably for a short period of time Increase in urine output in proportion to the increase in blood glucose Unable to respond verbally to questions

A ____ is a visible increase in the size of the thyroid gland and can be caused by either hyperthyroidism or hypothyroidism

goiter

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. teach the client about the signs and symptoms of Graves disease. ensure the client knows that the physician may propose surgery. educate the client about the need to report any weight changes promptly.

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

Which clinical manifestations lead the health care worker to suspect the client is at the end-stage expression of hypothyroidism? A client: Select all that apply. who takes analgesics for chronic pain and goes into a coma. brought to the emergency department with hypothermia who presents with low serum sodium levels. in the emergency department presenting with tachycardia and palpitations. whose family took him to the health care provider complaining of shortness of breath and heat intolerance. who has abnormal retraction of eyelids and infrequent blinking.

who takes analgesics for chronic pain and goes into a coma. brought to the emergency department with hypothermia who presents with low serum sodium levels