endocrine disorders exam 2
the nurse and 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 the blood glucose levels. A: blood glucose will elevate B: hypoglycemia will occur. C: an unusable form of glucose will be released. D: gluconeogenesis will occur
A: blood glucose will elevate 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.
a 23 yr old man admitted to the hospital. he is experiencing polyphagia, polyuria, and polydipsia. he states that the condition has come on very suddenly. this client is likely to require what treatment? A: exogenous insulin injections B: Sulfonylureas C: Biguanides D: Meglitinides
A: exogenous insulin injections Type 1 diabetes is the best diagnosis as the client has no other symptoms and the disease presented so rapidly. Insulin will likely be necessary and oral anti hyperglycemics will not be sufficient. Meglitinides treat type 2 diabetes
a client who has just undergone a thyroidectomy is experiencing high fever, tachycardia, and extreme restlessness. the nurse would interpret these findings as manifestations of which complications. A: thyroid storm B: myxedema coma C: hypothyroidism D: addisonian crisis
A: thyroid storm he symptoms this client is experiencing are related to thyroid storm and must be treated immediately to prevent death.Myxedema coma is related to hypothyroidism but typically does not occur after a thyroidectomy. Addisonian crisis is related to hypoadrenalism.
the nurse is caring for a client who is in a severe hypothyroid state. which medication should be avoided related to the inability to metabolize these drugs. Select all that apply. A: calcium channel blockers B: sedatives C: analgesics D: non-steroidal anti-inflammatories E: anesthetics
B,C,E The severely hypothyroid person is unable to metabolize sedatives, analgesics, and anesthetic drugs, and buildup of these agents may precipitate coma.
abnormal stimulation of the thyroid gland by TSH-receptor antibodies is implicated in cases of A: cushing syndrome B: graves diseSe C: addison disease D: cusing disease
B: graves diseSe Graves disease is an autoimmune disorder characterized by abnormal stimulation of the thyroid gland by thyroid-stimulating antibodies (TSH-receptor antibodies) that act through the normal TSH receptors
a client with hyperthyroidism arrives in the ED with a fever of 104 F (40C), tachycardia, chest pain, and crackles in bilateral lung bases, what treatment options does the nurse anticipate being prescribed in order to remove the thyroid hormone? Select all that apply A: Levothyroxine B:plasmapheresis C:dialysis D: hemoperfusion E: aspirin
B:plasmapheresis C:dialysis D: hemoperfusion The client is exhibiting signs of excess thyroid hormone, or thyroid storm. Thyroid hormones can be removed by plasmapheresis, dialysis, or hemoperfusion absorption. Aspirin increases the level of free thyroid hormone and should not be used during thyroid storm. Levothyroxine will increase the level of thyroid hormone
a client with type 2 diabetes experiences unexplained elevations of fasting blood glucose in the early morning hours. which condition can account for this effect? A: Autonomic Neuropathy B: Diabetic ketoacidosis C: Dawn phenomenon D: Inadequate bedtime insulin
C: Dawn phenomenon The dawn phenomenon involves increased levels of fasting blood glucose or insulin requirement during the early morning hours. It is not preceded by hypoglycemia. Circadian release of growth hormone and cortisol may be contributing factors.The other answer selections are not characterized by increased early morning levels of blood glucose
a client is diagnose with addison disease. which statement by the client indicates an understanding of the discarge instructions by the nurse. A: once the symptoms go away, I can stop taking my medication B: If i have surgery, it will cure me C: i will have to take medication for the rest of my life D: I should be able to control my condition with diet and exercise.
C: i will have to take medication for the rest of my life Addison 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
the OB nurse is caring for a client who has been treated for gestational diabetes. when teaching the client about the causes of gestation diabetes, the nurse should include which risk factor in the teaching. A: women who has a a child under 5lbs B: first birth occurring During the teenage years C: women with a family history of diabetes. D: first pregnancy
C: women with a family history of diabetes. Gestational diabetes occurs most commonly in black, Hispanic/Latino and Native American/First Nation women. It most frequently affects women with a family history of diabetes; a history of stillbirth or spontaneous abortion; women who previously gave birth to a newborn with fetal anomaly or had a previous large-for-gestational-age infant; those who are obese; those of advanced maternal age; or those who have had five or more pregnancies
the nurse is caring for a client diagnosed with hyperthyroidism. which clinical manifestations are most likely to be seen in this client A: shortness of breath B: tachycardia C: weight loss D: fine muscle tremor E: weight gain
A, B, C, D The signs and symptoms of hyperthyroidism relate to the increased metabolic rate associated with this condition.Tachycardia, shortness of breath, weight loss, and fine muscle tremor are all signs and symptoms of hyperthyroidism, while the other choices reflect signs and symptoms of hypothyroidism
hyperthyroidism that is inadequately treated can cause a life threatening condition known as thyroid storm. What are the manifestations of a thyroid storm? select all that apply A: tachycardia B: very low fever C: delirium D: bradycardia E: very high fever
A, C, E Thyroid storm is manifested by a very high fever, extreme cardiovascular effects (e.g., tachycardia, congestive failure, andantino), and severe CNS effects (e.g., agitation, restlessness, and delirium). The mortality rate is high. Very low fever and bradycardia are not manifestations of a thyroid storm
The mother of a 2-year-old newly diagnosed with type 1 diabetes asks why insulin has to be given by injection. The best response by the nurse is: A: "Insulin is destroyed by the stomach contents and has to be administered by injection. B: Insulin needs to go directly into the vein to work best. C: "Your child is not old enough to swallow the pills needed to treat her diabetes." D:"When your child gets old enough, you will not have to administer injections
A: "Insulin is destroyed by the stomach contents and has to be administered by injection. Insulin is destroyed by the gastrointestinal tract and needs to be administered via injection or inhalation. Type 1 diabetics not treated with oral medications at this time. Insulin is administered subcutaneously rather than in the vein.The statement about the mother not having to give injections once the child is older does not address the mother's concerns.
the nurse is reviewing assessment data and determines which client is at highest risk for developing T2DM A: 45 yr old obese female with a sedentary lifestyles B: 10 yrl old make whose grandma has Type 2 C: 40 yr old male who has liver disease due to hepatitis D: 60 yrld old female with a history of gestational diabetes
A: 45 yr old obese female with a sedentary lifestyles The person most at risk for developing type 2 diabetes is the 45-year-old obese female with a sedentary lifestyle. Other risk factors include family history, over age 40, and history of gestational diabetes. The 60-year-old would have developed it before age 60, if there were additional risk factors. Diabetes and metabolic syndrome are due to pancreatic problems, not liver problems.
the nurse is teaching a client with diabetes about the signs and symptoms of hypoglycemia. the client asks, "why will i get headache, disturbed behavior, coma, and seizures if it's my pancreas thats impair." A: The brain relies on blood glucose as its main energy source B: insulin produces a rebound hyperglycemia C: hepatic glycogenolysis D: hypoglycemia causes ketone breakdown
A: The brain relies on blood glucose as its main energy source Because the brain relies on blood glucose as its main energy source, hypoglycemia produces behaviors related to altered cerebral function. Headache, difficulty in problem solving, disturbed or altered behavior, coma, and seizures may occur. Hyperglycemia causes ketone breakdown. Hepatic glycogenolysis is stimulated by epinephrine, resulting in the raising of the level of blood glucose. However, that process is generally initiated by the fight-or-flight response, as opposed to the physiologic drop in blood glucose levels that stimulates glucagon secretion. Somogyi phenomenon is also known as rebound hyperglycemia. The Somogyi phenomenon describes a rebound high blood glucose level in response to low blood glucose
the nurse is assessing a male client and finds abnormally large hands and feet, a bulbous nose, and a broad face with a protruding jaw, based on these findings, which endocrine abnormality is most likely the cause for these physical changes A: acromegaly B: hyperthyroidism C: myxedema D: cushing syndrome
A: acromegaly 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.
which individual displays the precursor to acromegaly A: an adult with an excess of growth homorne due to an adenoma B: a girl who has been diagnosed with precocious puberty C: An adult who has a diagnosis of Cushing syndrome D: A client who has recently developed primay adrenal carcinoma
A: an adult with an excess of growth homorne due to an adenoma When growth hormone (GH) excess occurs in adulthood or after the epiphyses of the long bones have fused, it causes a condition called acromegaly, which represents an exaggerated growth of the ends of the extremities
the nurse and 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 level. A: blood glucose will elevate B: hypoglycemia form of glucose will be released C: an unusable form of glucose will be released D: gluceneogenesis will occur
A: blood glucose will elevate 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.
which maternal factor contributes to an infant having macrosomia, hypoglycemia, and hyperbilirubinemia A: maternal diabetes B: maternal nutrition C: fetal gene disorder D: fetal chromosome disorder
A: maternal diabetes A mother with diabetes is more likely to have a large body size (macrosomia), especially if the diabetes is uncontrolled.Other fetal abnormalities include hypoglycemia, hypocalcemia, polycythemia, and hyperbilirubinemia. The other factors contribute primarily to the infant being small for gestational age (SGA). The other disorders do not necessarily lead to a high birth weight
a clients low serum T4 level has left to a diagnosis of destruction of the beta cells, placing your children at high risk of developing diabetes." A: teach the client about the safe and effective use of synthetic thyroid hormones B: teach the client about the signs and symptoms of graves disease C: ensure the client knows that the physical may propose surgery educate the client about the need to report any weigh changes promptly D: educate the client about the need to report ay weight changes promptly
A: teach the client about the safe and effective use of synthetic thyroid hormones 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.
the nurse is caring for a client with primary hypothyroidism who is being monitor for the complication of myxedema coma while thyroid-level therapy is started. what does the nurse understand are the 3 major aspects of myxedema coma? select 3 A:Elevated carbon dioxide levels of decreases oxygen saturation B: fluid and electrolyte imbalance C: Hypothermia D: congestive heart failure
A:Elevated carbon dioxide levels of decreases oxygen saturation B: fluid and electrolyte imbalance C: Hypothermia The pathophysiology of myxedema coma involves three major aspects: (1) carbon dioxide retention and hypoxia, (2) fluid and electrolyte imbalance, and (3) hypothermia
A client is managing his type 2 diabetes with exercise and diet. He has a fasting blood sugar level FBS of 80 mg/dL 4.44 mmol/L and a hemoglobin A1C of 5% (.05. Based on these findings, which of the following can the nurse assume? A:the client is achieving normal glycemic control. B: the client needs to modify his diet related to the low readings C: the client is a risk for developing hyperglycemia D: the client is at risk for an insulin reaction
A:the client is achieving normal glycemic control. the reading for the FBS is appropriate (<100 mg/dL [5.55 mmol/L] is normal) and the hemoglobin A1C level (<6.5) shows good control of glucose levels over a 6- to 12-week period. This client should continue his current exercise and diet routine, which is working well for him.
a client has been taking long term glucocorticoid therapy for the treatment of asthma. The nurse is aware that this client may develop which condition in relation to this pharmacologic therapy A: Addison disease B: Iatrogenic cushing disease C: ectopic cushing syndrome D: pituitary cushing syndrome
B: Iatrogenic cushing disease three important forms of Cushing syndrome result from excess glucocorticoid production by the body. One is a pituitary form, which results from excessive production of ACTH by a tumor of the pituitary gland. This form of the disease was the one originally described by Cushing. The second form is the adrenal form, caused by a benign or malignant adrenal tumor.The third form is ectopic, caused by a non pituitary ACTH-secreting tumor. Cushing syndrome can also result from long-term therapy with one of the potent pharmacologic preparations of the glucocorticoids called iatrogenic
abnormal stimulation of the thyroid gland by TSH recepetion antibodies is implicated in cases of: A: cushing syndrome B: graves disease C: addison disease D: cushing disease
B: graves disease Graves disease is an autoimmune disorder characterized by abnormal stimulation of the thyroid gland by thyroid-stimulating antibodies (TSH-receptor antibodies) that act through the normal TSH receptors.
when the nurse is performing a health history for a client who is being admitted for hyperthyroidsm, what symptom does the client report that the nurse would find associated with the disorder A: constipation B: increase in appetite C: fatigue D: weight gain
B: increase in appetite 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 within creased thyroid hormone levels. At the same time, weight loss occurs because of the increased use of calories
a hospital client with a diagnosis of T1DM has been administered a schedule dose of regular insulin. which effect will result from the action of insulin A: promotion of fat breakdown B: protien of glucose uptake by target cells C: promotion of gluconeogenesis D: intitiation of glycogenolysis
B: protein of glucose uptake by target cells 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.
the nurse is providing education for a client diagnosed with hypothyroidism. what information about diet should the nurse be sure to include in this information A: due to increased metabolism, the client will need to increase the caloric intake B: the client should maintain a low cholesterol in her diet C: the client should increase the sodium content in her diet D: the client should maintain a high protein diet.
B: the client should maintain a low cholesterol in her diet blood levels of cholesterol are decreased in hyperthyroidism and increased in hypothyroidism. The client may be placed on an anti hyperlipidemic medication in addition to decreasing the cholesterol heavy foods in the diet.
impaired and delayed healing in a person with diabetes is caused by long term complications that include A: ketotacidosis B: somogyi effect C: fluid imbalance D: chronic neuropathies
D: chronic neuropathies Suboptimal response to infection in a person with diabetes is caused by the presence of chronic complications, such as vascular disease and neuropathies, poorly controlled hyperglycemia, and altered immune cell and neutrophil function.Sensory deficits may cause a person with diabetes to ignore minor trauma and infection, and vascular disease may impair circulation and delivery of blood cells and other substances needed to produce an adequate inflammatory response and effect healing. Somogyi effect is an acute complication of diabetes, causing hypoglycemia. Ketoacidosis is an acute complication of hyperglycemia when liver ketone production exceeds cell use.
the family of a client in the hospital with DM that is out of control asks the nurse to explain the client's recent weight loss while eating more than usual. how will the nurse respond? A: surplus glucose is stored as glycogen in the liver B: fatty acids enter the glycotic pathway to release energy C: glucose is unused without insulin, so body fats are used for energy D: lack of insulin raises circulating blood glucose levels.
C: glucose is unused without insulin, so body afts are used for energy Most of these options are true statements, but they do not answer the question asked by the family. Normally, nutrients are metabolized in a number of ways. Glucose is transported into cells by insulin and then is broken down to carbon dioxide and water. When there is surplus glucose present, it is metabolized and stored as glycogen in the liver and skeletal muscles. Further surplus is converted by the liver to fatty acids and stored as triglycerides. When triglycerides are metabolized, the glycerol molecule enters the glycolytic pathway to release energy. Excess proteins are also converted to fatty acids for storage. Insulin is needed to transport glucose into cells, prevent fat breakdown, and inhibit gluconeogenesis. When diabetes is out of control there is lack of insulin. Weight loss occurs as the cells break down fats to use fatty acids for energy
a client with severe hypothyroidism is presently experiencing hypothermia. what nursing intervention is a priority in the care of the client " A: active rewarming of the client to increase body temp rapidly B: placing the client on a hyperthermia blanket and using heated saline in order to induce vasodilation C: slow remaining of the client to prevent vasodilation and vascular collapse D: keeping the client in a hypothermic state in order to prevent renal failure
C: slow remaining of the client to prevent vasodilation and vascular collapse 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.
a young child develops Type 1A diabetes. the parents ask, "they tell us this is genetic. does that can our other children will get diabetes?" the best response could be A: Probably not. Since genetically your other children have a different cellular makeup, they just might not become diabetic." B:"If you put all your children on a low-carbohydrate diet, maybe they won't get diabetes." C: "We don't know what causes diabetes, so we will just have to wait and see. D: "This autoimmune disorder causes destruction of the beta cells, placing your children at high risk of developing diabetes."
D: "This autoimmune disorder causes destruction of the beta cells, placing your children at high risk of developing diabetes." Type 1 diabetes is subdivided into two types: type 1A, immune-mediated diabetes, and type 1B, idiopathic diabetes. Type1A diabetes is characterized by autoimmune destruction of beta cells. The other choices are not absolutely correct. The fact that type 1 diabetes is thought to result from an interaction between genetic and environmental factors led to research into methods directed at prevention and early control of the disease. These methods include the identification of genetically susceptible persons and early intervention in newly diagnosed persons with type 1 diabetes
when educating a client about T1DM, the nurse will mention that this type is caused by which mechanism? A: genetic predisposition B: Overuse of steroids, making pancreatic cells resistant tp glucose C: idiopathic, abnormally large pancreatic cells D: autoimmune destruction of pancreatic beta cells
D: autoimmune destruction of pancreatic beta cells Type 1 diabetes involves autoimmune destruction of beta cells. The pathophysiology of type 2 diabetes has both genetic and acquired factors
a client with T1DM has started a new exercise routine. Knowing there may be some increased risks associated with exercise, the health care provider should encourage the client to: A: watch for rapid weight loss B: monitor for respiratory disorders. C: be careful that he or she is not experiencing rebound hyperglycemia D: carry a snack with a rapidly absorbed form of glucose to prevent profound hypoglycemia
D: carry a snack with a rapidly absorbed form of glucose to prevent profound hypoglycemia People with diabetes are usually aware that delayed hypoglycemia can occur after exercise. Although muscle uptake of glucose increases significantly, the ability to maintain blood glucose levels is hampered by failure to suppress the absorption of injected insulin and activate the counter regulatory mechanisms that maintain blood glucose (to cause a hyperglycemia response). Even after exercise ceases, insulin's lowering effect on blood glucose levels continues, resulting in profound symptomatic hypoglycemia. Treatment of hypoglycemia involves administration of a rapidly absorbed form of glucose. Rapid weight loss accompanies the polyuria and dehydration of hyperglycemia rather than hypoglycemia.Respiratory disorders are associated with preexisting pulmonary or vascular problems exacerbated by the period of exercise
when educating a client about glargine, the nurse should explain that this medication. A: has a rapid onset and peaks in about 5 minutes after injection, so the client will need to ear food immediately after injection B: will have a peak effect within 30 minutes, and thus it can be taken after a meal. C: is a combination with short acting and intermediate acting insulin so it is safe to take anytime throughout the day. D: has a prolonged absorption rate and provides a relatively constant concentration for 12 - 24 hours.
D: has a prolonged absorption rate and provides a relatively constant concentration for 12 - 24 hours. Glargine is long-acting insulin that has a slow, prolonged absorption rate and provides a relatively constant concentration over 12-24 hours. Rapid acting insulin has a rapid onset and peaks in about 5 minutes after injection. Short acting insulin will have a peak effect within 30 minutes, and thus it can be taken after a meal. Intermediate-acting insulin is a combination with short acting insulin so it is safe to take anytime throughout the day
the nurse is providing discharge instructions for a client with graves diseases who has opthalmopathy. What should the nurse be sure to include in the instructions to decrease execration of this clinical manifestations. A: the client should be informed that he should not be in contact with other people during the acute phase B: the client should be informed that of he beings tp feel symptoms getting worse, he should take an extra dose of medication C:the client should be strong encouraged not to drink any alcohol D: the client should be strongly urged not to smoke
D: the client should be strongly urged not to smoke 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
