PrepU CH. 32
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 50% dextrose to raise glucose levels. Place on oxygen therapy to encourage deep breathing. Administer 3% sodium IV solution to increase sodium levels.
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)
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.)
Delirium Very high fever Tachycardia
The nurse is caring for an infant in the neonatal intensive care unit who has growth hormone deficiency. What critical issues should the nurse carefully monitor for in this infant?
Hypoglycemia and seizures
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.
Impaired physical growth Mental retardation
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
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?
Performing a skin scrub on surgical site prior to incision with povidone-iodine solution
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
Which client does the nurse recognize is at the most risk for the development of subacute thyroiditis?
A 32-year-old postpartum client
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.
A goiter Ophthalmolopathy (exophthalmos) Tachycardia and rapid respiratory rate
Which classification of medication does the nurse prepare to administer to the client with hyperthyroidism that will block the effects of the hyperthyroid state on sympathetic nervous system function?
Beta-adrenergic blocking agent
Which complication of acromegaly can be life threatening?
Cardiac structures increase in size
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.
Choking • Edema of the eyelids • Syncope when coughing • Neck vein distention
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.
Chromosomal abnormalities GH deficiency Protein-calorie malnutrition Malabsorption syndromes
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
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?
Early activation of the hypothalamic--pituitary--gonadal axis
When the assessment of thyroid autoantibodies is performed, what is the suspected diagnosis?
Hashimoto thyroiditis
In Addison disease, the majority of the adrenal cortex has been destroyed. This causes a lack of mineralocorticoids and glucocorticoids. Therapy consists of oral replacement with what drug?
Hydrocortisone
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 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 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
The nurse is assessing a female client with a diagnosis of primary adrenal cortical insufficiency. The nurse anticipates the client will manifest:
Sparse axillary and pubic hair
An adolescent boy asks the nurse what increases the secretion of growth hormone (GH). The best response would be:
Starvation
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?
The hypothalamus secretes GHRH.
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.
Thin build Delayed sexual maturation Moderate short stature
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
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
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
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 statements are true regarding hypothyroidism? Select all that apply.
Onset of symptoms is gradual Weight gain Anorexia
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 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.
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.
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.
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 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 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 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."
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."
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
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 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
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 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
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
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
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
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
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
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 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
A client has been diagnosed with metabolic syndrome and growth hormone (GH) deficiency. Physical assessment of the client would identify:
Increased visceral fat
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
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?
Myxedematous coma
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?
Panhypopituitarism
A 51-year-old woman has been diagnosed with Cushing syndrome after a diagnostic work-up that reveals cortisol hypersecretion. Which assessment findings would be inconsistent with her diagnosis?
Poor stress management and electrolyte imbalances
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)
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
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 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
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
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.
Diagnostic testing has revealed that a client has pituitary hypofunction, resulting in deficient production of ACTH. The nurse should recognize what implication of this finding?
The client will require exogenous supplements of cortisol.
An 11-year-old boy has poorly controlled type 1 diabetes. In addition to assessing for complications of hyperglycemia, the nurse should assess for:
growth retardation
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?
The client's hypothalamic--pituitary--adrenal (HPA) system will require recovery time before normal function is restored.
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.
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.
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.
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.
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.
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?
β-adrenergic-blocking medications to reduce sympathetic nervous stimulation
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
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
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.)
• Muscle weakness • Dehydration • Altered mental status • Vascular collapse
