PrepU Ch. 49: Disorders of Endocrine Control of Growth and Metabolism
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? Constipation Increase in appetite Weight gain Fatigue
Increase in appetite
A client is diagnosed with Addison's disease. What statement by the client indicates an understanding of the discharge instructions by the nurse? "Once the symptoms go away, I will be able to stop taking my medication." "If I have surgery, it will cure me." "I will have to take my medication for the rest of my life." "I should be able to control my condition with diet and exercise."
"I will have to take my medication for the rest of my life."
Which test can the nurse prepare the client for to determine the differentiation between a benign and a malignant thyroid disease? Ultrasonography CT scan MRI Fine-needle aspiration biopsy
Fine-needle aspiration biopsy
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? Fludrocortisone acetate Dexamethasone Growth hormone ACTH
Fludrocortisone acetate
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." "This situation will not improve at all and is not reversible." "The child must receive injections of growth hormone for the duration of her life." "The child will have a thin build and delayed skeletal and sexual maturation."
"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? "Once we treat your Graves' disease, your eyes will go back to their normal state." "With treatment of the hyperthyroid state, the opthalmopathy usually tends to stabilize." "The protrusion of the eyes will get worse before they get better." "Your eyes will be like this but there are things we can do to reduce visual loss."
"With treatment of the hyperthyroid state, the opthalmopathy usually tends to stabilize."
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 10:00 to 12:00 AM 04:00 to 6:00 PM 09:00 to 11:00 PM
06:00 to 08:00 AM
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. ACTH increases in the morning and peaks again in the evening hours. ACTH maintains a consistent level regardless of the time of day. ACTH peaks in correspondence with food intake.
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 Hyperthyroidism Myxedema Cushing syndrome
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? Decrease in carbohydrate metabolism Decrease in cortisol secretion Weight gain Altered fat metabolism
Altered fat metabolism
A client with Hashimoto thyroiditis has developed a goiter. Which medication that the client is taking for the treatment of ventricular dysrhythmias should the nurse suspect may be contributing to the development of the goiter? Amiodarone (Cordarone) Procainamide (Pronestyl) Lidocaine hydrochloride Sotalol (Betapace)
Amiodarone (Cordarone)
Which of the following residents of a long-term facility is exhibiting clinical manifestations of hypothyroidism? An 80-year-old woman who has uncharacteristically lost her appetite of late and often complains of feeling cold A 90-year-old woman with a history of atrial fibrillation whose arrhythmia has recently become more severe An 88-year-old man with a history of Alzheimer disease who has become increasingly agitated and is wandering around the facility more frequently A 91-year-old man with a chronic venous ulcer and a sacral ulcer who has developed sepsis
An 80-year-old woman who has uncharacteristically lost her appetite of late and often complains of feeling cold
Which of the following individuals displays the precursors to acromegaly? An adult with an excess of growth hormone due to an adenoma A girl who has been diagnosed with precocious puberty An adult who has a diagnosis of Cushing syndrome A client who has recently developed primary adrenal carcinoma
An adult with an excess of growth hormone due to an adenoma
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 the nurse inform him the test should be obtained? Before 0800 After 0900 Prior to midnight At noon
Before 0800
Which complication of acromegaly can be life threatening? Cardiac structures increase in size Splayed teeth result in impaired chewing Vertebral changes result in kyphosis Bone overgrowth causes arthralgias
Cardiac structures increase in size
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? Replacement therapy with prolactin Growth hormone replacement therapy Replacement therapy with synthetic thyroid hormone Cortisol replacement therapy
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? Irritability and restlessness Accelerated growth Dehydration from diarrhea Cretinism
Cretinism
Growth hormone exerts its effects on the body in many ways. Which of these are effects of GH? (Select all that apply.) Enhances fatty acid mobilization Increases insulin levels Facilitates the rate of protein synthesis Decreases ACTH production Decreases use of fatty acids for fuel
Enhances fatty acid mobilization Increases insulin levels Facilitates the rate of protein synthesis
Which of the following pathophysiologic phenomena may result in a diagnosis of Cushing disease? Hypopituitarism Excess ACTH production by a pituitary tumor Autoimmune destruction of the adrenal cortex Malfunction of the HPA system
Excess ACTH production by a pituitary tumor
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 Cognition and judgment Signs and symptoms of decreased bone density Skin integrity and distribution of adipose tissue
Eye health and visual acuity
Abnormal stimulation of the thyroid gland by TSH-receptor antibodies is implicated in cases of which of the following? Cushing syndrome Graves' disease Addison's disease Cushing disease
Graves' disease
The nurse is performing an assessment for a client who has hyperthyroidism that is untreated. When obtaining vital signs, what is the expected finding? Blood pressure 180/110 mm Hg Heart rate 110 and bounding Temperature 96oF Respiratory rate 14
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 Insulin Potassium supplements Ketoconazole
Hydrocortisone
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? Elevated WBC count Increased levels of ACTH Increase in sedimentation rate Positive C-reactive protein
Increased levels of ACTH
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? Aspirin Levothyroxine (Synthroid) Sotalol (Naldol) Propylthiouracil (PTU)
Propylthiouracil (PTU)
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 Multiple dental caries The child is 20 pounds over his target weight for height Enlarged head circumference
Significant genital enlargement
A client with severe hypothyroidism is presently experiencing hypothermia. What nursing intervention is a priority in the care of this client? Active rewarming of the client to increase body temperature rapidly Placing the client on a hyperthermia blanket and using heated saline in order to induce vasodilation Slow rewarming of the client to prevent vasodilation and vascular collapse Keeping the client in a hypothermic state in order to prevent renal failure
Slow rewarming of the client to prevent vasodilation and vascular collapse
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 low fever Delirium Bradycardia Very high fever
Tachycardia Delirium Very high fever
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 informed that he should not be in contact with other people during the acute phase. The client should be informed that if he begins to feel symptoms getting worse, he should take an extra dose of their medication. The client should be strongly encouraged not to drink any alcohol. The client should be strongly urged not to smoke.
The client should be strongly urged not to smoke.
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? Due to increased metabolism, the client will need to increase the caloric intake. The client should maintain a low cholesterol diet. The client should increase the sodium content in her diet. The client should maintain a high protein diet.
The client should maintain a low cholesterol diet.
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 disorder occurs in the target gland responsible for producing the hormone. The disorder occurs from hypothalamic dysfunction resulting in understimulation of the target organ. The disorder occurs when the target organ becomes dysfunctional.
The disorder occurs when the target organ is normal, but stimulating hormones alter its function.
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 liver is stimulated. The hypothalamus secretes GHRH. GH is released and circulates unbound in the plasma. Epiphyseal growth plates of long bones are influenced.
The hypothalamus secretes GHRH.
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 Muscle wasting and thickened extremities Muscle weakness and thickened extremities Thin extremities and increased strength
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 Myxedematous coma Hypothyroidism Addisonian crisis
Thyroid crisis
Which clinical manifestations lead the health care worker to suspect the client is at the end-stage expression of hypothyroidism? A client: Select all that apply. Who takes analgesics for chronic pain that goes into a coma Brought to the emergency department with hypothermia who presents with low serum sodium levels In the emergency department presenting with tachycardia and palpitations Whose family took him to the health care provider complaining of shortness of breath and heat intolerance Who has abnormal retraction of eyelids and infrequent blinking
Who takes analgesics for chronic pain that goes into a coma Brought to the emergency department with hypothermia who presents with low serum sodium levels