patho chapter 41 disorders of endocrine system

When providing nutrition education to the client with diabetes, the nurse should include which statement regarding fat intake?

"If you have diabetes, avoiding saturated fats is important." Explanation: Because diabetes is a risk factor for cardiovascular, cerebrovascular, and peripheral vascular disease, it is recommended that less than 7% of daily calories should be obtained from saturated fat and that dietary cholesterol be limited to 200 mg or less, and intake of trans fats minimized. Page 1082

Which clients with diabetes mellitus would the nurse anticipate to having persistent elevation of blood glucose levels? Select all that apply.

A client with high anxiety A client with COPD taking steroids A client with a newly diagnosed leg fracture Explanation: High anxiety would increase the secretion of catecholamines such as epinephrine. A fracture is a stressor that raises growth hormone levels. Steroids are glucocorticoids used to treat inflammatory conditions such as COPD and autoimmune disorders. Growth hormone, glucocorticoids, and epinephrine raise blood glucose levels. pg 1078

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

Addison disease Explanation: Although the etiology differs, the adrenal cortical insufficiency resulting from the abrupt cessation of glucocorticoids is nearly identical to Addison disease in terms of physiologic effects. Cushing syndrome refers to the manifestations of hypercortisolism. Graves disease is a state of hyperthyroidism, goiter, and ophthalmopathy. Cushing disease is caused by glucocorticoid hormone excess. p 1067

The nurse and nursing student are caring for a client undergoing a severe stressor with release of epinephrine into the bloodstream. The nurse teaches the student that epinephrine will cause which effect on blood glucose levels?

Blood glucose will elevate. Explanation: Epinephrine, a catecholamine, helps to maintain blood glucose levels during periods of stress. Epinephrine causes glycogenolysis in the liver, thus causing large quantities of glucose to be released into the blood. Page 1072

A client with acromegaly comes to the clinic and informs the nurse that she is having a productive cough and a low grade fever. This is the client's fourth visit in 1 year for the same problem. What condition does the nurse understand results from this client's enlarged cartilaginous structures?

Bronchitis Explanation: The cartilaginous structures in the larynx and respiratory tract become enlarged, resulting in a deepening of the voice and tendency to develop bronchitis. pg 1053

A client with diabetes has been injured. The nurse will be educating the client that healing of the injury may be delayed due to which diabetic complications? Select all that apply.

Chronic neuropathies Vascular impairment Explanation: Suboptimal response to injury and infection in a person with diabetes is caused by chronic complications, including vascular disease and neuropathies, poorly controlled hyperglycemia, and altered immune cell and neutrophil function. Sensory loss decreases awareness of minor trauma and infection, and vascular disease impairs circulation of blood with substances needed for effective healing. The Somogyi effect is an acute complication of diabetes, causing hypoglycemia. Ketoacidosis is an acute complication of hyperglycemia when liver ketone production exceeds cell use. Page 1081

A client with long-term diabetes mellitus reports a "pins and needles" feeling in the feet. What interventions can help reduce this symptom? Select all that apply.

Control blood glucose Gabapentin Lidocaine patch Explanation: People with peripheral neuropathies may develop altered perception of pain, vibration, and temperature in the distal extremities. The primary intervention for neuropathy is controlling the blood glucose levels. Additional interventions for diabetic neuropathic pain include antidepressants, anticonvulsants, and topical anesthetics. Alternative therapies include acupuncture and capsaicin (hot pepper) cream. If the client has reduced sensation in the feet, walking could lead to injuries due to lack of awareness. Better activity choices would be those that place less stress on the feet, such as swimming or cycling. A diuretic will not improve neuropathy. p 1073

A client tells his health care provider that his body is changing. It used to be normal for his blood glucose to be higher during the latter part of the morning. However, now his fasting blood glucose level is elevated in the early AM (07:00). The health care provider recognizes the client may be experiencing:

Dawn phenomenon Explanation: A change in the normal circadian rhythm for glucose tolerance, which usually is higher during the later part of the morning, is altered in people with diabetes, with abnormal nighttime growth hormone secretion as a possible factor. The dawn phenomenon is characterized by increased levels of fasting blood glucose or insulin requirements, or both, between 5 AM and 9 AM without preceding hypoglycemia. The Somogyi effect describes a cycle of insulin-induced posthypoglycemic episodes. The cycle begins when the increase in blood glucose and insulin resistance is treated with larger insulin doses. The insulin-induced hypoglycemia produces a compensatory increase in blood levels of catecholamines, glucagon, cortisol, and growth hormone, leading to increased blood glucose with some insulin resistance. pg 1081

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. pg 1054

A client tells the health care provider that he has been very compliant over the last 2 months in the management of his diabetes. The best diagnostic indicator that would support the client's response would be:

Glycosylated hemoglobin, hemoglobin A1C (HbA1C) Explanation: Glycosylated hemoglobin, hemoglobin A1C (HbA1C), and A1C are terms used to describe hemoglobin into which glucose has been incorporated. Glycosylation is essentially irreversible, and the level of A1C present in the blood provides an index of blood glucose levels over the previous 6 to 12 weeks. In uncontrolled diabetes or diabetes with hyperglycemia, there is an increase in the level of A1C. The other options would not reflect the 2-month period. p. 1075.

Loss of pituitary function can result in deficiencies (or loss) of secretions of which hormones? Select all that apply.

Growth hormone Luteinizing hormone Follicle stimulating hormone Prolactin Explanation: Anterior pituitary hormone loss is usually gradual, especially with progressive loss of pituitary reserve due to tumors or previous pituitary radiation therapy (which may take 10 to 20 years to produce hypopituitarism). The loss of pituitary function tends to follow a classic course beginning with the loss of GH, LH, and FSH secretion followed by deficiencies in TSH, then ACTH, and finally prolactin. Corticotropin-releasing hormone is secreted from the hypothalamus during stressful times. Page 104term-109

A nurse is assessing an older adult woman diagnosed with chronic hypothyroidism who has developed myxedema coma. The nurse will likely assess which lab and clinical manifestations in this client? Select all that apply.

Hypoventilation Hyponatremia Hypoglycemia Lactic acidosis Explanation: Myxedema coma is a life-threatening, end-stage expression of hypothyroidism. It is characterized by coma, hypothermia, cardiovascular collapse, hypoventilation, and severe metabolic disorders, including hyponatremia, hypoglycemia, and lactic acidosis. pg 1060

Which metabolic abnormality can lead to the development of type 2 diabetes?

Insulin resistance Explanation: The metabolic abnormalities that lead to type 2 diabetes include (1) peripheral insulin resistance, (2) deranged secretion of insulin by the pancreatic beta cells, and (3) increased glucose production by the liver. Obese people have increased resistance to the action of insulin and impaired suppression of glucose production by the liver, resulting in both hyperglycemia and hyperinsulinemia. Lifestyle and overeating seem to be the triggering events (rather than metabolic abnormalities). Acute pancreatitis is a reversible impairment of alpha and beta cell function, with hypoinsulinemia as a complication. Page 1077

Which treatment regimen is most likely to result in stable blood glucose levels for a client with a diagnosis of type 1 diabetes?

Monitor blood glucose levels throughout the day and administer exogenous insulin replacement as needed Explanation: Because of the loss of insulin response, all people with immune-mediated type 1 diabetes require exogenous insulin replacement to reverse the catabolic state, control blood glucose levels, and prevent ketosis. Page 1075

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

Myxedema 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 myxedema coma. Pheochromocytoma is a tumor of the adrenal gland. Thyroid storm is related to hyperthyroidism. Paraneoplastic syndrome is a separate condition. pg 1060

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. pg 1058-1059

Select the most common symptoms of diabetes. Select all that apply.

Polydipsia Polyuria Polyphagia Explanation: The most commonly identified signs and symptoms of diabetes are often referred to as the three polys: (1) polyuria (i.e., excessive urination), (2) polydipsia (i.e., excessive thirst), and (3) polyphagia (i.e., excessive hunger). Polyhydramnios is a medical condition describing an excess of amniotic fluid in the amniotic sac. Polycythemia is a condition of increased red blood cells. Page 1078

A hospital client with a diagnosis of type 1 diabetes has been administered a scheduled dose of regular insulin. Which effect will result from the action of insulin?

Promotion of glucose uptake by target cells Explanation: The actions of insulin are threefold: (1) it promotes glucose uptake by target cells and provides for glucose storage as glycogen; (2) it prevents fat and glycogen breakdown; and (3) it inhibits gluconeogenesis and increases protein synthesis. Glucagon, not insulin, promotes glycogenolysis. pg 1075

A hospital client with a diagnosis of type 1 diabetes has been administered a scheduled dose of regular insulin. Which effect will result from the action of insulin?

Promotion of glucose uptake by target cells Explanation: The actions of insulin are threefold: (1) it promotes glucose uptake by target cells and provides for glucose storage as glycogen; (2) it prevents fat and glycogen breakdown; and (3) it inhibits gluconeogenesis and increases protein synthesis. Glucagon, not insulin, promotes glycogenolysis. p. 1075.

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 the 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. pg 1054

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 pterm-0hysician 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 1054

Research has identified a cycle of insulin-induced posthypoglycemic episodes. What is this phenomenon called?

Somogyi effect Explanation: The Somogyi effect describes a cycle of insulin-induced posthypoglycemic episodes. In 1924, Joslin and associates noticed that hypoglycemia was associated with alternate episodes of hyperglycemia. pg 1081

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. pg 1062