Pathophysiology chapter 32
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
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."
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
Which client does the nurse recognize is at the most risk for the development of subacute thyroiditis?
A 32-year-old postpartum client
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
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
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
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 health care provider is reviewing diurnal variation pattern in adrenocorticotropic (ACTH) levels. Select the typical diurnal variation pattern in adrenocorticotropic (ACTH) levels.
ACTH peaks in the morning and declines throughout the day.
The nurse is caring for a 42-year-old male client who is admitted for treatment of heart failure. He has abnormally large hands and feet and a broad face with a protruding jaw. Based on these signs and symptoms, the nurse identifies which of the following endocrine disturbances as the most likely cause for these physical changes?
Acromegaly
At times, it is necessary to give medications that suppress the adrenal glands on a long-term basis. When the suppression of the adrenals becomes chronic, the adrenal glands atrophy. What does the abrupt withdrawal of these suppressive drugs cause?
Acute adrenal insufficiency
Which classification of medication does the nurse prepare to administer to the client with hyperthyroidism that will block the effects of the hyperthyroid state on sympathetic nervous system function?
Beta-adrenergic blocking agent
Which complication of acromegaly can be life threatening?
Cardiac structures increase in size
An adult client with growth-hormone deficiency related to hypopituitarism has been taking replacement therapy for several months. The client informs the nurse that she is having pain in the hand and wrist almost constantly. What does the nurse understand is a common side effect of this therapy that seems to have affected this client?
Carpal tunnel syndrome
A 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 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)
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 teaching a client diagnosed with Addison disease about the importance of lifetime oral replacement therapy. Select the pharmacologic agent that would be prescribed.
Hydrocortisone
When the nurse is performing a health history for a client who is being admitted for hyperthyroidism, what symptoms does the client report that the nurse would find associated with this disorder?
Increase in appetite
A 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
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
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.
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
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 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
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.
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 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
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.
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 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.
Following a long history of fatigue, weakness and poor appetite, a 39-year-old male has been diagnosed with hypopituitarism. Which of the following clinical findings would most likely cause his care team to suspect that the man has an additional endocrine disorder from a different source?
The man has a chronic platelet deficiency and is occasionally anemic.
The nurse is 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
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.
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
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
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
A child has been removed from a home in which she has experienced severe neglect and emotional abuse, and has been placed in foster care. The child has psychosocial dwarfism and the foster parents ask the nurse what this means for the future of the child. What is the best response by the nurse?
"The prognosis of the child depends on an improvement in behavior and catch-up growth."
A client with Graves' disease has opthalmopathy and asks the nurse if the eyes will stay like this forever. What is the best response by the nurse?
"With treatment of the hyperthyroid state, the opthalmopathy usually tends to stabilize."
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 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
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 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
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
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
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
One of the first signs that indicates an infant may have congenital hypothyroidism is:
Prolonged period of physiologic jaundice
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
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.
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
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
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
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
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.
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
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
Which disorder is a result of excess cortisol?
Cushing syndrome
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
