Unit 2

The family of a patient in the hospital with diabetes mellitus that is out of control asks the nurse to explain the clients recent weight loss while eating more than usual. How will the nurse respond?

Glucose is unused without insulin, so body fats are used for energy.

type 2 diabetes mellitus

diabetes in which either the body produces insufficient insulin or insulin resistance (a defective use of the insulin that is produced) occurs; the patient usually is not dependent on insulin for survival

term for too much growth hormone in children?

Gigantism

When trying to explain hypothyroidism to a newly diagnosed client, the nurse stresses the fact that they thyroid hormone is transported in blood by what?

Proteins

Which manifestation would a nurse expect when assessing a child with insufficient growth hormone (GH) secretion

Rank below 10% on the growth chart.

the physician suspects a client may be experiencing hypofunction of an endocrine organ. what is the appropriate test to determine organ function?

Stimulation tests

Treatment for Pheochromcytoma?

Surgical removal

A client has developed the facial apperance that is characteristic of myxedema, along with an enlarged tongue, bradycardia, voice changes. which treatment modality is most likely to benefit this client?

Synthetic preparations of T3 T4

what physiologic process best exemplifies a positive feedback mechanism?

The increase in prolactin secretion that occurs with more frequent breast-feeding

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 to rise

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

As part of maintaining homeostasis, why are hormones secreted by endocrine cells continuously inactivated?

prevent accumulation

what is a neuroendocrine hormone?

produced by and secreted from neurons and then travels through the blood to target cells

what is the test called to test a hormone?

radioimmunoassay (RIA)

Which treatment regimen will 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.

what part is the adrenal cortex

outside of the kidney

A patient present to the ER with fatigue, weakness, dehydration, and thirst. What additional symptoms would correlate with a diagnosis of type 2 diabetes mellitus?

polyuria Blurred vision candida infection

what is the function of a hormone receptor

recognize a specific hormone and translate the hormonal signal into a cellular response

What do hormones do?

regulate and integrate body functions.

Hormones are chemical messengers that provide which function in the body?

regulate body functions

exocrine glands

secrete chemical substances into ducts that lead either to other organs or out of the body

adrenal medulla

secretes epinephrine and norepinephrine

what causes diabetic neuropathy?

to much glucose and inflammation around the nerves causing decreased feeling

What happens when there is to much growth hormone in children?

weak long extremities,

What is an endocrine hormone?

when a hormone is released into the blood to travel to distant tissues

A diabetic client presents to the clinic for routine visit. Blood work reveles a HbA1C of 11%. Which response by the client may account for this abnormal lab result?

My meter broke so i have not been checking my blood glucose levels for a while

A client with severe hypoglycemia is unconscious. How shouldn't the nurse give glucose?

Orange juice orally.

What hormones does the posterior pituitary release?

Oxytocin ADH

What medication does a patient in DKA need

Insulin fluids.

diabetic mellitus

Large amounts of fruity urine

Thyroid storm

Temp 105, HTN, Tachycardia,

When caring for a patient who is being screened for osteoporosis, the nurse plans to evaluate the results of which diagnostic test?

Dual-energy xray absorptiometry (DXA)

A1C

7%

which pathophysiologic phenomenon may result in a diagnosis of cushing disease

Excess ACTH production by a pituitary tumor

Hormone that controls the parasympathetic system

acetylcholine

The nurse has just completed teaching a client, newly diagnosed with type 1 diabetes, about the treatment options. Which response by the client leads the nurse to conclude that additional teaching is needed?

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

Aldosterone

"salt-retaining hormone" which promotes water retention and then increase blood pressure

What do catecholamines do?

-Increase Heart Rate -Increase myocardial contractility -Peripheral vasoconstriction (toes and fingers; causes blood to go to organs) -This exhausts the heart

Which manifestation indicates a client is at risk for developing diabetes mellitus?

2 hour oral GTT 175

A nurse is working in a pediatric clinic. Which child would the nurse recognize as having isosexual precocious puberty?

A 5 year old back female with developing breasts and pubic hair.

Diabetic Ketoacidosis (DKA)

A form of hyperglycemia in uncontrolled diabetes in which certain acids accumulate when insulin is not available.

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 comes to a scheduled appointment in the endocrine clinic. The PCP referred the client, suspecting acromegaly. Knowing the usual testing involved, the nurse should educate the client about which lab/diagnostic procedure?

A suppression test

metabolic syndrome

A syndrome marked by the presence of usually three or more of a group of factors (as high blood pressure, abdominal obesity, high triglyceride levels, low HDL levels, and high fasting levels of blood sugar) that are linked to increased risk of cardiovascular disease and Type 2 diabetes.

The PCP is reviewing diurnal variation pattern in adrenocorticotropic (ACTH) levels. Select the typical diurnal variation pattern in adrenocorticotropic levels

ACTH peaks in the morning and declines throughout the day.

S/S of to much growth hormone as an adult:

Acromegaly, thick coarse facial features.

Cyclic adenosine monophosphate (cAMP) performs which role in the functioning of the endocrine system?

Acting as a second messenger to mediate hormone action on target cells

The nurse is assessing a client with thyrotoxicosis and the nurse is explaining how the thyroid gland is stimulated to release thyroid hormones. The nurse should describe what process?

Action of releasing hormones from hypothalamus

what is a precursor to acromegaly

An adult with excess of GH d/t an adenoma

Hormones can be synthesized by both vesicle-mediated pathways and non- vesicle mediated pathways. What hormones are synthesized by non-vesicle mediated pathways?

Androgens Estrogens

a client is to have a serum thyroxine and thyroid stimulating laboratory test performed to assess the baseline status of the hypothalamic- pituitary target cell hormones. When educating the client about the laboratory tests, when would the nurse inform him the test should be obtained?

Before 0800

the results of a 44 year old obese man's recent diagnostic workup have culminated in a new diagnosis of type 2 diabetes. Which pathophysiologic process underlies the clients new diagnosis?

Beta cell exhaustion d/t long standing insulin resistance

The pancreas is an endocrine organ that is composed of the acini and the islets of langerhans. The islets of langerhans have alpha, beta, and delta cells as well as the PP cells. Which cells secrete insulin.

Beta cells.

Diabetic ketoacidosis (DKA) is a condition that mostly occurs in type 1 diabetics. What are the definitive diagnostic criteria for DKA?

Blood glucose level greater than 250; bicarbonate less than 15 and ph less than 7.3

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

Bronchitis

what is neuroendocrine hormones?

hormone is produced and released from neurons and then travels through the blood to exert effects on target cells in the body.

Thyroid makes which hormone to regulate calcium?

Calcitonin

which complication of acromegaly can be life threatening?

Cardiac structures increase in size

A patient with type 1 diabetes has started a new exercise routine. Knowing there may be some increased risks associated with exercise, the PCP should encourage the client to do what?

Carry a snack with a rapidly absorbed form of glucose to prevent profound hypoglcemia

After having a very stressful day in pathophysiology class, the student knows that which hormone (secreted by the adrenal cortex) will help decrease the effects of stress?

Cortisol, a glucocorticoid

what is a paracrine hormone?

hormone like substance that never enters the bloodstream but acts locally

A client with type 2 diabetes experiences unexplained elevations of fasting blood glucose in the early morning hours. Which conditions can account for this?

Dawn Phenomenon

What is downregulation?

Decrease in receptor number in response to high concentration of hormone

An adult client presents to the ER after an episode of syncope. Blood pressure is low and the pulse is thready and rapid. The client frequently voids large amounts of pale, clear urine. LS are clear with inelastic skin turgor. Which endocrine disorder is the likely cause of these manifestations?

Diabetes insipidus

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 sexs are affected; although boys are not diagnosed at birth unless of enlarged genitalia. female infants often have ambiguous genitalia because of the over secretion of adrenal androgens. What are the manifestations of the ambiguous genitalia caused by congenital adrenal hyperplasia

Enlarged clitoris, Fused labia urogenital sinus

A nurse examines the lab values of a patient in heart failure. Which value indicates a compensatory hormone mechanism?

Elevated atrial natriuretic hormone

In addison disease, the majority of the adrenal cortex has been destroyed. This causes a lack of mineralocorticoids and glucocorticoids. Therapy consists of oral replacement with what drug?

Hydrocortisone.

Upon assessment the nurse finds a patient with abnormalities with emotion, pain and body temperature. Which mechanism of endocrine control will require further lab/diagnostic assessment?

Hypothalamus

Which gland acts as a signal relaying bridge between multiple body systems and the pituitary gland?

Hypothalamus

A client is diagnosed with addison 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 nurse educator is conducting a course for newly diagnosed diabetes clients. which is a statement the nurse should follow up on 1st

I've had a little sore on the sole of my foot for a few days, but I'm sure it will eventually heal.

Where does antidiuretic hormone (ADH) exert its effects to promote water reabsorption?

Kidneys

the nurse is providing education for a patient diagnosed with hypothyroidism. What info about diet should the nurse include in this info?

Maintain a low cholesterol diet.

which maternal factor contributes to an infant having macrosomia, hypoglycemia, and hyperbilirubinemia?

Maternal Diabetes

An overweight, 14 year old boy feels tired all the time. Sleeps 12-14 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 nonpitting mucosal edema. For which life-threatening condition should his care team be prepared?

Myxedema coma

A client receives steroids for several months to treat an inflammatory condition. Which action by the PCP indicates an understanding of the negative feedback mechanism when the client no longer needs the medication?

Prescribing a tapering dose of the medication over weeks

The nurse is caring for a client who received regular insulin a 7am. 4 hours later the nurse finds the client diaphoretic, cool and clammy. what is the priority right now?

give the client a concentrated carbohydrate

Several hormones, including growth hormone (GH) and thyrotropin-releasing hormone (TRH), are bound to and carried by which substance?

Proteins

Lutenizing & Follicle Stimulating Hormones and prolactin effect what

Reproduction

What do parasympathetic nerves do?

Rest and digest, salvation,

A middle-aged women has acromegaly as a result of a pituitary adenoma that was found and removed when she was a teenager. The physician is suspecting that the tumor has returned and has ordered a diagnostic work up. A glucose load is ordered. If the tumor has returned, the nurse would expect which result?

The growth hormone level will not be suppressed following glucose load.

A patient undergoing evaluation of hormone levels ask, "What regulates the hormone levels?" What is the appropriate response by the nurse?

The hypothalamic-pituitary-target cell system

A child 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 an adolescence. What is the 1st step in the growth hormone chain of events?

The hypothalamus secretes GHRH

An obese adult has recently been diagnosed with type 2 diabetes. The nurse knows that the most likely treatment plan for this client will include which topics?

Weight loss, glucose monitoring, oral antihyperglycemic medications

Pheochromocytoma

a benign tumor of the adrenal medulla that causes the gland to produce excess epinephrine

gestational diabetes

a form of diabetes mellitus that occurs during some pregnancies

what is a intracrine hormone?

a hormone that is synthesized and acts intracellularly in the same cell.

what is an autocrine hormone?

a hormone that produces a biologic effect on the same cell that produced it.

A teacher teaching a science class, mentions that both autocrine and paracrine hormonal actions occur without entering the bloodstream. a student asks, "what cells do paracrine actions affect?" the teacher will answer?

acts locally

Select the category of hormones that include norepinephrine and epinephrine

amines and amino acids

When discussing luteinizing hormone and follicle-stimulating hormone with students, the teacher will emphasize that these hormones are under the control of what?

anterior pituitary gland

A patient has developed a tumor of the posterior pituitary gland. The client is at risk for problems with secretion of what?

antidiuretic hormone oxytocin

Hyper-osmotic

higher solute concentration- very dehydrated

hyperglycemia

ataxic, starring, flailing arms about

What is a lipid soluble hormone?

can pass through the cell membrane freely and bind with intracellular receptors

Cushing's syndrome

caused by prolonged exposure to high levels of cortisol

adrenal insufficiency

condition in which the adrenal glands underproduce necessary hormones

adrenal cortex hormones

cortisol and aldosterone

what causes an adrenal crisis?

dropping off synthetic cortisol

When is cortisol released?

during stress

Graves disease S/S

exopthalamus (buldging eyes)

A 15 year old child with type 1 diabetes asks nurse about the potential to "lose sight". Which response would be the most appropriate?

explain that many people with diabetes experience some complications of retinopathy, but these are best prevented with tight control of glucose levels.

Diabetic ketoacidosis (DKA) in a client with type 1 diabetes occurs when the lack of insulin leads to the release of which physiologic product?

fatty acids

When sensors detect a change in a hormone level, the hormonal response is regulated by which mechanism that will return the level to within normal range?

feedback

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

Somegyi Phenomenon

A nurse examines the laboratory values of a client in heart failure. Which value indicates compensatory hormone mechanism?

Elevated atrial natriuretic hormone

When hormones act locally rather than being secreted into the bloodstream, their actions are termed what?

Autocrine paracrine

The nurse is assessing a female client with a diagnosis of primary adrenal cortical insufficiency. Which manifestation should the nurse anticipate?

Sparse axillary and pubic hair

which test can the nurse prepare the client for to determine the differentiation between a benign and malignant thyroid disease.

Fine needle aspiration biopsy

endocrine glands.

Glands of the endocrine system that release hormones into the bloodstream

A 62 year old man is overweight has just been diagnosed with type 2 diabetes. The nurse educator is instructing him in the ways his diabetes can be controlled. The nurse should initially prioritize which action?

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

The nurse is caring for a client with diabetes. which of these findings is cause for concern, leading the nurse to initiate client education?

Hemoglobin A1C level is 8.7%

The most common cause of thyrotoxicosis is graves disease. When assessing this client, the nurse should put which s/s on priority?

Ophthalmopathy

an infant whose mother had myxedema during the pregnancy has failed to meet standards for growth and is developmentally delayed. Which hormonal imbalance is this child exhibiting?

Hypothyroidism

A client diagnosed with metabolic syndrome and growth hormone deficiency will likely display which physical assessment finding?

Increased visceral fat

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

Insulin Resistance

A client with diabetes mellitus arrives at the hospital with a blood glucose level of 639. What assessment data would indicate type 2 diabetes mellitus rather than type 1

Negative ketones in urine

Hyperthyroidism symptoms

Nervousness, weight loss despite increased appetite, excessive sweating and heat intolerance, Soft oily skin, palpitations, frequent bowel movements, muscular weakness of the proximal type and tremor

The kidney produces 1,25- dihydroxyvitamin D. This form of vitamin D is responsible for which action in the body?

Stimulates calcium absorption from the intestine.

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 nust 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.

The nurse is taking 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

Imaging has proven useful in both the diagnosis and follow-up of endocrine disorders. Two types of imaging studies are useful when dealing with endocrine disorders: Isotopic imaging and nonisotopic imaging. What is an example of isotopic imaging?

Thyroid Scan

When hypofunction of an endocrine organ is suspected, which type of diagnostic test can be administered to measure and assess target gland response?

hormone stimulation

what is upregulation?

increase in receptor number in response to low concentration of hormone

Addison's disease

occurs when the adrenal glands do not produce enough of the hormones cortisol or aldosterone

Diabetic Insipidus

large amounts of urine that is tasteless urine-

What is myxedema coma?

life threatening condition that occurs if hypothyroidism is not treated

Normal blood glucose level

70-100

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

9

Normal calcium levels

9-11

oral glucose tolerance test

<140 mg/dL

what does hormone mean in Greek?

Arouse to activity

The release of insulin from the pancreatic beta cells can inhibit further release of insulin from the same cells.

Autocrine

What pathophysiologic phenomenon may result in a diagnosis of cushing disease

Excess ACTH production by a pituitary tumor

A 23 year old man admitted to the hospital is experiencing polyphagia, polyuria, and polydipsia. He states that the condition has come on suddenly. This client is likely to require what treatment.

Exogenous insulin injections.

Which clinical manifestations following thyroidectomy would alert the nurse that the client is going into a life threatening thyroid storm?

Exteremly agitated Telemetry showing hear rate of 184 Temperature of 104.2

A nurse on a medical unit is providing care for a 37 year old female client who has diagnosis of graves disease, which assessments should the nurse prioritize?

Eye health and visual acuity.

Hypothyroidism symptoms

Fatigue, lethargy. Modest weight gain with anorexia. Dry, coarse skin and cold intolerance. Swelling of face, hands, and legs. Constipation. Weakness, muscle cramps, arthralgias, paresthesias, impaired memory and hearing.

What hormones does the anterior pituitary release?

GH GSH/LH TSH- Thyroid ACTH-Adrenal gland Prolactin

A patient with long- term diabetes mellitus reports a "pins and needles" feeling in her feet. What interventions can help reduce this symptome

Gabapentin Lidocaine patch control blood glucose levels

A women in her 28th week of pregnancy develops gestational diabetes mellitus and has persistent elevated blood glucose when using the diet plan. What medications are appropriate?

Glyburide Insulin

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

Glycosylated hemoglobin, Hemoglobin A1C

A hospital patient 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.

A clients low serum T4 level has led to a diagnosis of hypothyroidism. When planning this clients care the nurse should?

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

What is isosexual precocious puberty?

The appearance of s/s of secondary sex characteristics before the age of 9

A young child develops type 1A diabetes. The parents ask, "They tell us this is genetic. Does that mean our other children will get diabetes? how would the nurse respond?

This auto immune disorder causes destruction of the beta cells, placing your children at high risk of developing diabetes.

A client with long standing type 2 diabetes is surprised to see high sugar readings while recovering from an emergency surgery. Which factor may have contributed to the clients inordinately elevated blood glucose levels.

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

a client with type 1 diabetes mellitus wishes to stop taking insulin injections. What option is appropriate.

Using an insulin infusion pump.

The critical care nurse has just admitted a client with diabetic ketoacidosis (DKA) whose blood glucose level is 877. The clients breath has a fruity odor and the client is confused. what is the nursing priority at this time?

giving IV fluids.

A nurse is assessing a client who is experiencing hypoglycemia caused by insulin reaction. The client is conscious and can follow directions. Which intervention is appropriate at this time?

immediately administer a rapidly absorbed form of glucose orally- if alert enough to swallow

When the nurse is performing a health history for a client who is being admitted for hyperthyroidism, what symptom does the client report that the nurse would find associated with this disorder?

increase appetite

A patient has a stroke the disrupts blood flow to the pituitary gland and develops s/s of hypopituitarism. What manifestations are unexpected findings.

increased volume of dilute urine

parathyroid hormone

increases blood calcium levels

what part is the adrenal medulla

inside of the kidney

type 1 diabetes mellitus

insulin dependent

The mother of a 2yr old newly diagnosed with type 1 diabetes asks why insulin has to be given by injection. How should the nurse respond?

insulin is destroyed by the stomach contents and has to be administered by injection

where are hormones excreted from in the body?

kidneys and liver

When educating a client about type 1 diabetes, the nurse will mention that this type is caused by which mechanism?

Autoimmune destruction of pancreatic beta cells

A client with diabetes carries insulin with him at all times. At 11:35 he obtains a blood glucose reading of 218 mg and self administers a dose of insulin in anticipation of eating lunch at noon. What type of insulin did he most likely inject?

Short Acting

A patient with severe hypothyroidism is presently experiencing hypothermia. What nursing intervention is a priority in the care of this patient?

Slow rewarming to prevent vasodilation and vascular collapse.

A patient is managing his type 2 diabetes with exercise and diet. He has a fasting blood sugar levels of 80 and a hemoglobin A1C of 5%. B ased on these findings, which of the following can the nurse assume?

The client is achieving normal glycemic control

After having a stressful day in pathophysiology class, the student knows that which hormone (secreted by the adrenal cortex) will help decrease the effects of stress?

cortisol, a glucocorticoid

While discussing the regulation of hormone levels, the teacher gives an example of hormones regulated by feedback mechanism. which is an example of this type of regulation

following a meal that is high in carbohydrates, a person's blood glucose elevates, which stimulates the release of insulin from the pancreas.