N305 Chapter 32 PrepU
Following the identification of low blood levels of cortisol and low 24-hour urinary free cortisol, a 51-year-old female client has been diagnosed with a primary adrenal cortical insufficiency. Which of the following health consequences would be attributable to her low levels of cortisol?
Impaired immunological and inflammatory response Explanation: Cortisol plays a central role in the normal functioning of the immune response and inflammation. Exophthalmos is associated with Graves' disease and secondary sex characteristics are a function of adrenal androgens. Potassium and sodium are regulated by mineralocorticoids. Page 785
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?
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
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
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 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 Explanation: 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. Page 782
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?
In which client would the nurse identify a primary endocrine disorder?
A client who has been diagnosed with Hashimoto thyroiditis
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:
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?
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 test can the nurse prepare the client for to determine the differentiation between a benign and a malignant thyroid disease? You Selected:
Fine-needle aspiration biopsy
A 25-year-old female client exhibits exophthalmos of both eyes. The health care provider recognizes this as a manifestation of:
Graves disease Explanation: 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. Page 781
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?
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?
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)
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?
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 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." Explanation: 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. Page 772
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." Explanation: 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. Page 782
A female patient presented to her primary care physician with classic signs/symptoms of Cushing syndrome. Upon testing, it was discovered that the patient had vaginal small cell carcinoma. How can the healthcare providers explain her Cushing syndrome signs/symptoms to this patient?
"Your tumor in your vagina is secreting a hormone called adenocorticotropic hormone (ACTH) which is responsible for these signs/symptoms."
When educating a client with possible glucocorticoid dysfunction, the nurse will explain that the CRH controls the release of ACTH. The best time to perform the blood test to measure peak ACTH levels would be
06:00 to 08:00 AM
After receiving change-of-shift report about the following four patients, which patient should the nurse assess first?
70-year-old returning from PACU following partial thyroidectomy who is extremely agitated, has an irregular pulse rate of 134, and an elevated temperature of 103.20 F
The nurse is 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.
24-hour urine secretion of cortisol Dexamethasone suppression test Plasma levels of ACTH
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?
Which client does the nurse recognize is at the most risk for the development of subacute thyroiditis?
A 32-year-old postpartum client
Which client does the nurse recognize is at the most risk for the development of subacute thyroiditis?
A 32-year-old postpartum client Explanation: The transient hyperthyroid state is caused by leakage of preformed thyroid hormone from damaged cells of the gland. Subacute thyroiditis, which can occur in postpartum (postpartum thyroiditis) can also result in hypothyroidism. Page 780
The nurse is working in a pediatric clinic. Which of the following children would the nurse recognize as having isosexual precocious puberty?
A 5-year-old African-American female with developing breasts and pubic hair
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 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 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. Explanation: ACTH levels have diurnal variation in which they reach their peak in the early morning (around 6 to 8 AM) and decline as the day progresses related to rhythmic activity of the CNS. The diurnal pattern is reversed in people who work during the night and sleep during the day. The rhythm also may be changed by physical and psychological stresses, endogenous depression, and liver disease or other conditions that affect cortisol metabolism. Page 784
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
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?
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 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 Explanation: The major manifestations of Cushing syndrome represent an exaggeration of the many actions of cortisol. Altered fat metabolism causes a peculiar deposition of fat characterized by a protruding abdomen, subclaviclar fat pads or "buffalo hump" on the back, and a round, plethoric "moon face." Page 789
Starvation
An adolescent boy asks the nurse what increases the secretion of growth hormone (GH). The best response would be:
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?
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 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 Explanation: 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. Page 782
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 Explanation: The best-known metabolic effect of cortisol and other glucocorticoids is their ability to stimulate gluconeogenesis (glucose production) by the liver. Metabolic effects of cortisol involve the metabolism of proteins, carbohydrates, and fats. Behavior and emotion regulation is a psychological effect of cortisol. The other two options are immunologic and inflammatory effects of cortisol. Page 784
Which complication of acromegaly can be life threatening
Cardiac structures increase in size
Which complication of acromegaly can be life threatening?
Cardiac structures increase in size Explanation: 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. Page 774
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
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?
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
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
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 Explanation: Congenital hypothyroidism is a common cause of preventable intellectual disability. 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. Page 780
Which disorder is a result of excess cortisol?
Cushing syndrome
Which disorder is a result of excess cortisol?
Cushing syndrome Explanation: The term Cushing syndrome refers to the manifestations of hypercortisolism from any cause. Turner's and Marfan syndromes are chromosomal disorders that affect height while Hashimoto disease is a thyroid disorder. Page 788
A 25-year-old female client exhibits exophthalmos of both eyes. The health care provider recognizes this as a manifestation of:
Graves disease
The nurse is preparing a client for a test that will measure negative feedback suppression of ACTH. Which medication will the nurse administer in conjunction for this test?
Dexamethasone
The 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?
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
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 Explanation: 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. Page 786
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
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
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) Explanation: ACTH controls the release of cortisol from the adrenal gland. TSH controls the secretion of thyroid hormone from the thyroid gland. LH regulates sex hormones. FSH regulates fertility. Page 768
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?
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 Explanation: Some physicians prescribe glucocorticoids for several weeks surrounding the radioiodine treatment if the person had signs of ophthalhmopathy. Page 783
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.)
When the assessment of thyroid autoantibodies is performed, what is the suspected diagnosis?
Hashimoto thyroiditis Explanation: 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. Page 778
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
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.)
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 Explanation: In the neonate, GH deficiency can lead to hypoglycemia and seizures. If ACTH deficiency also is present, the hypoglycemia often is more severe. Page 772
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 Explanation: 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. Page 781
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
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
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.
Which statements are true regarding hypothyroidism? Select all that apply.
Onset of symptoms is gradual Weight gain Anorexia
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 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. Explanation: Screening is usually done in the hospital nursery. In this test, a drop of blood is taken from the infant's heel and analyzed for T4 and TSH. Page 780
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
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
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 Explanation: A low tolerance for stress and unstable electrolyte levels are associated with Addison disease and its consequent elevated levels of ACTH. High blood pressure, hypokalemia, a buffalo hump, and moon face are all characteristic of the elevated steroid levels that denote Cushing syndrome. Page 788
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?
Poor stress management and hyperpigmentation Explanation: Hyperpigmentation and a low tolerance for stress are associated with Addison's disease and its consequent elevated levels of ACTH. High blood pressure, hypokalemia, and buffalo hump and moon face are all characteristic of the elevated steroid levels that denote Cushing syndrome. Page 788
Short stature in adults
Precocious puberty is a disorder that occurs in both boys and girls. What does precocious puberty cause in adults?
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
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 Explanation: 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. Page 786
A child has been diagnosed with classic growth hormone deficiency. The child may experience: Select all that apply.
Short stature Delayed skeletal muscle maturation Obesity
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 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 Explanation: 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. Page 775
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
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
Stress Physical or emotional trauma Manipulation of the thyroid gland
A young adult woman has presented with an unusual deposit of fat on her upper back and a rounded appearance to her face. She acknowledges increasing weakness over the past several months and has developed "stretch marks" over the past year. The nurse should anticipate what treatment?
Surgical removal of the client's pituitary tumour
Hyperthyroidism that is inadequately treated can cause a life-threatening condition known as a thyroid storm. What are the manifestations of a thyroid storm? (Select all that apply.)
Tachycardia Delirium Very high fever
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. Explanation: Hypothyroidism is treated by replacement therapy with synthetic preparations of T3 or T4. Graves disease is associated with hyperthyroidism, not hypothyroidism. Surgery is not a usual treatment modality. Page 781
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.
Which of the following statements best captures the role of the adrenal cortex in maintaining homeostasis?
The adrenal cortical hormones are primarily steroids and sex hormones.
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?
The child has fusion of the epiphyses of the long bones and increased growth hormone levels.
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. Explanation: Short stature is a condition in which the attained height is well below the third percentile, or linear growth is below normal for age and sex. Diagnosis of short stature is not made on a single measurement, but is based on sequential height measurements and on velocity of growth and parental height. Page 771
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.
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.
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?
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. Explanation: Like other pituitary functions, hypothalamic stimulation precedes hormone release. In the case of GH, stimulation is the result of GHRH by the hypothalamus. GH is then released by the pituitary gland, stimulating the liver to release IGFs, which ultimately causes the epiphyseal plates of long bones to grow. Page 771
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.
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?
The nurse is caring for an older adult client who is being treated for primary hypothyroidism. The medication therapy includes a "go low and go slow" regimen. What is the importance of this medication regimen for this client?
There is a risk of inducing acute coronary syndromes in the older adult client if a more rapid correction of thyroid levels is used.
The nurse is performing a health history from a client with acromegaly. The client informs the nurse that he is waking up several times a night and has been told he has sleep apnea. What does the nurse inform the client is the rationale for this syndrome?
There is an increase in pharyngeal soft tissue accumulation
The hallmark manifestations of Cushing syndrome are a moon face, a "buffalo hump" between the shoulder blades, and a protruding abdomen. What other manifestations of Cushing syndrome occur?
Thin extremities and muscle weakness
A client who has just undergone a thyroidectomy is experiencing high fever, tachycardia, and extreme restlessness. The nurse would interpret these manifestations as
Thyroid crisis
A client who has just undergone a thyroidectomy is experiencing high fever, tachycardia, and extreme restlessness. The nurse would interpret these manifestations as:
Thyroid crisis
Hashimoto thyroiditis
When the assessment of thyroid autoantibodies is performed, what is the suspected diagnosis?
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?
obesity
Which of the following inhibits growth hormone (GH)?
Of the following list of nursing interventions, which would be considered priority when managing a patient with life-threatening myxedematous coma? Select all that apply.
• Administer 3% sodium IV solution to increase sodium levels. • Administer 50% dextrose to raise glucose levels. • Place on oxygen therapy to encourage deep breathing.
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?
A lung cancer client with small cell carcinoma may secrete an excess of which hormone causing an ectopic form of Cushing syndrome due to a nonpituitary tumor?
ACTH
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
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?
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. Explanation: 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. Page 770
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
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
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 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. Explanation: Because people with Addison's disease are likely to have episodes of hyponatremia and hypoglycemia, they need to have a regular schedule for meals and exercise. It is not necessary to limit carbohydrate and fat intake or salt related to this disorder. Page 788
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 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?
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?
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.
• 24-hour urine secretion of cortisol • Dexamethasone suppression test • Plasma levels of ACTH
Of the following patient conditions, which patient would be at risk for experiencing a thyroid problem due to a decrease in thyroxine-binding globulin (TBG)? Select all that apply.
• 55-year-old male with cirrhosis due to alcohol abuse • 75-year-old man receiving chronic glucocorticoid therapy to treat his severe chronic obstructive pulmonary disease (COPD) • 18-year-old female anorexia nervosa patient weighing 78 pounds who has consumed no protein for the past three years.
Which of the following clients are at risk for developing hypothyroidism? Select all that apply.
• 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 bipolar client prescribed lithium carbonate
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
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." Explanation: Addison's disease, like type I diabetes, is a chronic metabolic disorder that requires lifetime hormone replacement therapy. The daily regulation of the chronic phase of Addison disease is usually accomplished with oral replacement therapy, with higher doses being given during periods of stress. Page 788
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?
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?
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." Explanation: Hyperfunction is usually associated with excessive hormone production. This can result from excessive stimulation and hyperplasia of the endocrine gland or from a hormone-producing tumor. A clinical example of this phenomenon is evidenced by the case of a woman with vaginal small cell carcinoma who also presented with Cushing syndrome. After testing, it was determined that the tumor was secreting ACTH. In this situation, the cause was not related to a pituitary problem. There is a connection between Cushing syndrome and the carcinoma. The thyroid gland is not responsible for Cushing syndrome. Page 788
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.
-24-hour urine secretion of cortisol -Dexamethasone suppression test -Plasma levels of ACTH Explanation: The determination of 24-hour excretion of cortisol in urine provides a reliable and practical index of cortisol secretions. One of the prominent features of Cushing syndrome is loss of the diurnal pattern of cortisol secretion. The overnight 1 mg dexamethasone suppression test is also used as a screening tool for Cushing syndrome. Other tests include measurement of plasma levels of ACTH. Page 789
Increased visceral fat
A client has been diagnosed with metabolic syndrome and growth hormone (GH) deficiency. Physical assessment of the client would identify:
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.
-Stress -Physical or emotional trauma -Manipulation of the thyroid gland Explanation: Thyroid storm is often precipitated by stress, such as an infection, by physical or emotional trauma, or by manipulation of a hyperactive thyroid gland during thyroidectomy. Page 783
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:
he nurse is caring for several clients who are taking growth hormone replacement therapy. Which client does the nurse recognize is most at risk for side effects?
A 45-year-old obese client with an elevated serum IGF-1 concentration
The nurse is 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 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
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?
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?
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?
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 Explanation: Chronic suppression causes atrophy of the adrenal gland, and the abrupt withdrawal of drugs can cause acute adrenal insufficiency. The other answers are incorrect. Page 786
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)
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.
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?
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?
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 one year for the same problem. What condition does the nurse understand results from this client's enlarged cartilaginous structures?
Bronchitis
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 Explanation: The cartilaginous structures in the larynx and respiratory tract become enlarged, resulting in a deepening of the voice and tendency to develop bronchitis. Page 774
Which complication of acromegaly can be life threatening?
Cardiac structures increase in size
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
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 Explanation: The most common side effects of GH treatment in adults with hypopituitarism are peripheral edema, arthralgias, myalgias, carpal tunnel syndrome, paresthesias, and decreased glucose tolerance. Page 773
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
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 Explanation: Isosexual or central precocious puberty involves early activation of the hypothalamic--pituitary--gonadal axis, resulting in the development of appropriate sexual characteristics and fertility. It is not caused by trauma such as sexual abuse and it does not involve thyroid function. Precocious puberty is not noted to be a genetic trait. Page 775
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 Explanation: The ophthalmopathy 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 (due to the exophthalmos). Eye assessment is consequently a priority over assessment of skin integrity, cognition, or musculoskeletal status. Page 782
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?
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?
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
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 Explanation: 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. Page 781
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?
Iatrogenic Cushing syndrome
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 Explanation: 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. Page 787
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? You Selected:
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?
Increased white cell count and audible crackles on chest auscultation. Explanation: An increased white cell count and the presence of adventitious fluid in the lungs are not classic findings associated with hypothyroidism. Myxedema, weight gain, lethargy, and dry skin and nails are commonly associated with low levels of thyroid hormones. Page 780
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 Explanation: Myxedema implies the presence of a nonpitting mucous type of edema caused by an accumulation of a hydrophilic mucopolysaccharide substance in the connective tissues throughout the body. The hypothyroid state may be mild, with only a few signs and symptoms, or it may progress to a life-threatening condition called myxedematous coma. Phaeocytoma is a tumour of the adrenal gland, Thyroid storm is related to hyperthyroidism and paraneoplastic syndrome is a separate condition. Page 781
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
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
One of the first signs that indicates an infant may have congenital hypothyroidism is:
Prolonged period of physiologic jaundice
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
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 Explanation: 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. Page 781
A parent brings his child to the clinic, concerned about her short stature and asking the nurse if there is a problem with her height. What indication is the nurse aware of when performing the assessment that determines whether this child has short stature?
The child's height is well below the third percentile on several clinic visits.
The nurse is educating a newly diagnosed client with Hashimoto thyroiditis who is to be discharged from the acute care facility. What should the nurse be sure to include in the education to prevent complications?
The client should be informed about the signs and symptoms of severe hypothyroidism and the need for early intervention. Explanation: 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. Page 780
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:
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
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.
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. Explanation: 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 intellectual disability in infants detected by screening programs is essentially nonexistent. Page 780
The nurse is educating a parent of a child with short stature caused by growth hormone (GH) deficiency about the administration of GH. What should the nurse include when educating the parents about administration?
The medication will be given daily during the period of active growth and can be continued into adulthood.
A 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?
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.
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.
Which of the following statements best captures an aspect of the function of the hypothalamic-pituitary-adrenal (HPA) system?
The pituitary gland communicates with the adrenal cortex through the release of ACTH.
The 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 Explanation: The major manifestations of Cushing syndrome represent an exaggeration of the many actions of cortisol (see Table 32-2). Altered fat metabolism causes a peculiar deposition of fat characterized by a protruding abdomen, subclavicular fat pads or "buffalo hump" on the back, and a round, plethoric "moon face." There is muscle weakness, and the extremities are thin because of protein breakdown and muscle wasting. The other answers are incorrect. Page 788-790
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 Explanation: 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. Page 781
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?
A client has been diagnosed with dysfunction of the anterior pituitary gland. The nurse is aware that which of the following hormones may be affected? Select all that apply.
• Adrenocorticotropic hormone (ACTH) • Thyroid-stimulating hormone (TSH) • Growth hormone (GH) • Luteinizing hormone (LH)
A client has just been diagnosed with Hashimoto thyroiditis and is asking the health care provider for information about the condition. The most appropriate information to provide would be: Select all that apply.
• Autoimmune disorder • Common in females • Prone to goiter development
A woman who is exhibiting clinical manifestations of a pituitary adenoma will likely complain of: Select all that apply.
• Cessation of menses • Unusual milk secretion unrelated to pregnancy • Infertility
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
Loss of pituitary function can result in deficiencies/loss of which of the following hormones' secretions? Select all that apply.
• Growth hormone • Luteinizing hormone • Follicle stimulating hormone • Prolactin
The nurse is caring for a client diagnosed with hyperthyroidism. Which of the following signs and symptoms are most likely to be seen in this client? Select all that apply.
• Hypertension • Diarrhea • Weight loss • Tremor
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
Which statements are true regarding hypothyroidism? Select all that apply.
• Onset of symptoms is gradual • Weight gain • Anorexia
The nurse is receiving physician orders when admitting a client to the inpatient facility with cirrhosis of the liver. Which medications ordered by the physician should the nurse question since they may affect the binding of thyroid hormone to normal concentrations of binding proteins? Select all that apply.
• Phenytoin (Dilantin) • Aspirin • Diazepam (Valium)
A client has just undergone a diagnostic cardiac angiogram. As part of their ordered labs, the physician has ordered a thyroid panel. The physiological principle behind ordering this lab tests includes which of the following correlations? Hyperthyroidism can cause: Select all that apply.
• Rise in oxygen consumption • Increase in cardiac output
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.
-Intolerance to cold -Decreased sweating -Coarse and dry skin and hair Explanation: The client with hypothyroidism experiences an intolerance to cold, decreased sweating, and coarse and dry skin and hair, related to the decrease in metabolic rate from the deficient thyroid secretion. Page 778
Hyperthyroidism that is inadequately treated can cause a life-threatening condition known as a thyroid storm. What are the manifestations of a thyroid storm? (Select all that apply.)
-Tachycardia -Delirium -Very high fever Explanation: Thyroid storm is manifested by a very high fever, extreme cardiovascular effects (i.e., tachycardia, congestive failure, and angina), and severe CNS effects (i.e., agitation, restlessness, and delirium). The mortality rate is high. Very low fever and bradycardia are not manifestations of a thyroid storm. Page 783
Which statements are true regarding hypothyroidism? Select all that apply.
-Weight gain -Anorexia -Onset of symptoms is gradual Explanation: 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. Gastrointestinal motility is decreased, producing constipation, flatulence, and abdominal distention. Page 780
The nurse is caring for a client diagnosed with hyperthyroidism. Which of the following signs and symptoms are most likely to be seen in this client? Select all that apply.
-Weight loss -Hypertension -Tremor -Diarrhea Explanation: The signs and symptoms of hyperthyroidism relate to the increased metabolic rate associated with this condition. Hypertension, diarrhea, weight loss, and tremor are all signs and symptoms of hyperthyroidism, while the other choices reflect signs and symptoms of hypothyroidism. Page 781
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?
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.
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?
"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?
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?
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
A client is diagnosed with hyperthyroidism and is exhibiting weight loss, diarrhea, and tachycardia. What does the nurse understand that these clinical manifestations are related to?
A hypermetabolic state
A client is diagnosed with hyperthyroidism and is exhibiting weight loss, diarrhea, and tachycardia. What does the nurse understand that these clinical manifestations are related to?
A hypermetabolic state Explanation: 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. Page 781
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.
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 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 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 Explanation: 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. Page 772
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?
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 Explanation: 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. Page 773
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?
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 Explanation: Evidence shows that cardiovascular mortality increases in GH-deficient adults. A higher prevalence of atherosclerotic plaques and endothelial dysfunction has been reported in both childhood and adult GH deficiency. The GH deficiency syndrome is associated with a cluster of cardiovascular risk factors, including central adiposity, insulin resistance, and dyslipidemia. Page 773
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 Explanation: Acute adrenal crisis is a life-threatening situation. Exposure to even a minor illness or stress can cause a client with Addison's disease to develop nausea, vomiting, muscular weakness, hypotension, dehydration, and vascular collapse (which causes a change in LOC). Hemorrhage (low BP) can be caused by septicemia, adrenal trauma, anticoagulant therapy, adrenal vein thrombosis, or adrenal metastases. A hyperactive reflex may indicate disease of the pyramidal tract above the level of the reflex arc being tested. Generalized hyperactivity of DTRs may be caused by hyperthyroidism. Any tear or hole in the membrane that surrounds the brain and spinal cord (dura) can allow the fluid that surrounds those organs to leak. This fluid is called the cerebrospinal fluid (CSF). When it leaks out, the pressure around the brain and spinal cord drops. Causes of leakage through the dura include certain head, brain, or spinal surgeries; head injury; placement of tubes for epidural anesthesia or pain medications; or lumbar puncture. Irregular heart rates (arrhythmias) may be caused by many different factors, including coronary artery disease, electrolyte imbalances in the blood (such as sodium or potassium), changes in the heart muscle, or injury from a heart attack. Page 788
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 Explanation: 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. Page 778
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 Explanation: 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. Page 788
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?
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?
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. Explanation: 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. Page 783
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?
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 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?
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 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?
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?
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. Explanation: The pathogenesis of sleep apnea syndrome is obstructive in the majority of people due to increased pharyngeal soft tissue accumulation. Page 774
A client is suspected to have increased growth hormone levels. When performing a health history, what assessment data would be important for the nurse to report to the physician? Select all that apply.
• The client has fainted due to low blood glucose levels on several occasions. • The client has been experiencing a great deal of emotional stress due to family issues. • The client is on a weight loss diet and is exercising excessively.
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
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
Hyperthyroidism that is inadequately treated can cause a life-threatening condition known as a thyroid storm. What are the manifestations of a thyroid storm? (Select all that apply.)
• Tachycardia • Delirium • Very high fever
Which of the following 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 • Telemetry showing heart rate of 184 • Extremely agitated
