Chapter 41: Disorders of Endocrine Control of Growth and Metabolism

A client diagnosed with type 2 diabetes has been instructed about managing his condition with diet. Which statements by the client indicate a need for additional education? Select all that apply. "I must avoid all candies and cookies, but can eat unlimited amounts of pasta and breads." "I can drink 8 to 10 glasses of water daily without concern for calories." "I need to limit the amount of foods that I eat that contain trans fats." "I need to avoid adding salt to my foods." "I need to carefully limit my protein consumption."

"I must avoid all candies and cookies, but can eat unlimited amounts of pasta and breads." "I need to carefully limit my protein consumption." The client needs more education regarding all carbohydrate sources. Protein consumption should remain normal for optimal nutrition. All the other statements are correctly stated and demonstrate good understanding of dietary needs for type 2 diabetes.

A client with a new diagnosis of type 2 diabetes mellitus states, "I am really worried that I might need to take injections. Is there something I can do to avoid that?" What is the best response by the nurse? "If you exercise weekly, you won't need injections." "You could regulate your diet, exercise regularly, and lose weight." "Diabetes management is complicated; you can't avoid injections." "A support group could help you cope with stress and learn helpful tips."

"You could regulate your diet, exercise regularly, and lose weight." Diabetes management is based on dietary regulation, exercise, and medications. Many clients with type 2 diabetes mellitus can avoid injections if they exercise regularly, follow dietary guidelines, and manage their weight.

The nurse is reviewing assessment data and determines which client is at highest risk for developing type 2 diabetes? A 45-year-old obese female with a sedentary lifestyle A 10-year-old male whose grandmother has type 2 diabetes A 40-year-old male who has liver disease due to hepatitis A 60-year-old female with a history of gestational diabetes

A 45-year-old obese female with a sedentary lifestyle 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 working in a pediatric clinic. Which child would the nurse recognize as having isosexual precocious puberty? A 9-year-old white female who has small breast buds A 5-year-old black female with developing breasts and pubic hair A 14-year old white female who has not yet developed secondary sex characteristics A 10-year-old black female who has begun menstruating

A 5-year-old black female with developing breasts and pubic hair Precocious puberty is now defined as the appearance of secondary sexual development before the age of 7 years in white girls and 6 years in black girls. In boys of both races, the lower age limit remains 9 years. However, it is recognized that puberty can develop earlier in boys with obesity.

Which pediatric assessment finding would the nurse recognize as an example of precocious puberty? A 7-year-old female with early menarche A 12-year-old male with advanced growth A 13-year-old female with menarche and a recent growth spurt A 16-year-old male with genital enlargement and pubic hair growth

A 7-year-old female with early menarche The 7-year-old needs to be evaluated. Precocious puberty is defined as the appearance of secondary sexual development before the age of 8 years in girls. There is a shift toward a "new normal" of earlier ages of puberty, with black girls entering puberty earlier than white girls and children who are obese entering puberty at earlier ages than children of normal body weight for age. In boys of both races, the lower age limit remains 9 years; however, it is recognized that puberty can develop earlier in boys with obesity. The assessment findings of the 12-, 13-, and 16-year-olds are not of concern because they are normal findings.

One of the earliest signs of Cushing syndrome is the loss of variable diurnal secretion of cortisol-releasing hormone (CRH) and: GH TSH DHEA ACTH

ACTH One of the earliest signs of Cushing syndrome, a disorder of cortisol excess, is the loss of diurnal variation in CRH and adrenocorticotropin hormone (ACTH) secretion, with corticotropin-releasing hormone (CRH) controlling the release of ACTH. The adrenal sex hormone dehydroepiandrosterone (DHEA) contributes to the pubertal growth of body hair, particularly pubic and axillary hair in women. Thyroid-stimulating hormone (TSH) levels are used to differentiate between primary and secondary thyroid disorders. Although secretion of growth hormone (GH) has diurnal variations over a 24-hour period, with nocturnal sleep bursts occurring 1 to 4 hours after onset of sleep, it is unrelated to ACTH and/or CRH secretion.

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? Acromegaly Hyperthyroidism Myxedema Cushing syndrome

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 resident 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 dysrhythmia 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 Loss of appetite and cold intolerance are characteristic symptoms of hypothyroidism. Dysrhythmias, agitation, and infections are not typically associated with hypofunction of the thyroid gland.

Which individual 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 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.

When educating a client about type 1 diabetes, the nurse will mention that this type is caused by which mechanism? Genetic predisposition Overuse of steroids, making pancreatic cells resistant to glucose Idiopathic, abnormally large pancreatic cells Autoimmune destruction of pancreatic beta cells

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.

What is the most common cause of hypothyroidism? Goiter Myxedema Thyroidectomy Autoimmune thyroiditis

Autoimmune thyroiditis The most common cause of hypothyroidism is Hashimoto thyroiditis, an autoimmune disorder in which the thyroid gland may be totally destroyed by an immunologic process. It is the major cause of goiter and hypothyroidism in children and adults. Myxedema is associated with severe hypothyroidism and is characterized by a non-pitting mucus-type edema caused by the accumulation of hydrophobic extracellular matrix substances in the connective tissues of a number of body tissues. Although the myxedema is most obvious in the face and other superficial parts, it also affects many of the body organs and is responsible for many of the manifestations of the hypothyroid state. Thyroidectomy, a rather uncommon surgical procedure, causes primary hypothyroidism. Goiter, an increase in the size of the thyroid gland, is a result (rather than a cause) of hypothyroid, euthyroid, or hyperthyroid states.

A client with a new diagnosis of diabetes mellitus receives education about the diabetic diet plan. Which menu selection indicates the client understood the instruction? Cheeseburger, french fries, milk shake Green salad without dressing, an apple, and tea Baked chicken breast, cole slaw, and milk Oatmeal, bagel with jam, orange juice

Baked chicken breast, cole slaw, and milk Diet is a cornerstone of diabetes control. Meals and snacks should be eaten at regular intervals. Initial recommendations are for carbohydrates to make up between 45 percent and 60 percent, fats to be between 20 and 35 percent, and for protein to comprise about 10 to 20 percent of each meal. The cheeseburger meal contains too large an amount of fat. The salad and oatmeal menus are too high in carbohydrates without sufficient fat and protein.

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. Hypoglycemia will occur. An unusable form of glucose will be released. Gluconeogenesis will be suppressed.

Blood glucose will elevate. Epinephrine, a catecholamine, helps to maintain blood glucose levels during periods of stress. Epinephrine accelerates glycogenolysis and gluconeogenesis leading to increased endogenous blood glucose production, elevating blood glucose levels. Epinephrine also suppresses insulin release but does not alter the form of glucose to an unusable form. Epinephrine release reduces the risk for hypoglycemia.

A male client is being evaluated for metabolic syndrome. Which are diagnostic criteria for this syndrome? Select all that apply. Client's body mass index (BMI) is 31. Client's high-density lipoprotein (HDL) cholesterol is 25. Client's resting heart rate is 90 to 95 beats per minute. Client's blood pressure (BP) is 150/90 mm Hg. Client does less than 30 minutes of strenuous physical activity each week.

Client's body mass index (BMI) is 31. Client's high-density lipoprotein (HDL) cholesterol is 25. Client's blood pressure (BP) is 150/90 mm Hg. Diagnostic criteria for metabolic syndrome include BP of greater than 130/85 mm Hg, low HDL, and obesity (BMI greater than 30 constitutes obesity). Sedentary lifestyle and high resting heart rate are associated with other health problems, including diabetes, but these are not diagnostic criteria for metabolic syndrome.

Select the most appropriate intervention for the nurse to teach a client diagnosed with distal symmetric neuropathy related to diabetes. Inspect the feet for blisters daily Rotate insulin injection sites once a week Wear comfortable, open-toed shoes Decrease daily walking activity

Inspect the feet for blisters daily A client with neuropathy is at risk for damage to his or her feet, such as blisters or ulcers, as the clients are unable to feel this damage. Clients need to inspect their feet daily, wear foot coverings (such as closed-toe shoes) to prevent injuries, and continue the exercise patterns to promote improved circulation.

Which factor contributes to an infant developing macrosomia (large body size)? Maternal diabetes Maternal nutrition Fetal gene disorder Fetal chromosome disorder

Maternal diabetes A mother with diabetes during pregnancy is more likely to have a larger fetus, especially if the diabetes is uncontrolled. The other factors may cause the infant to be small for gestational age (SGA).

Which treatment regimen is most likely to result in stable blood glucose levels for a client with a diagnosis of type 1 diabetes? Perform a daily moderate exercise routine prior to insulin administration Wait until after eating the first meal of the day before checking blood glucose and then calculate insulin dose Monitor blood glucose levels throughout the day and administer exogenous insulin replacement as needed Initially try to control blood glucose levels with diet and exercise routines along with weight reduction

Monitor blood glucose levels throughout the day and administer exogenous insulin replacement as needed 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.

What are the hallmark signs of diabetes mellitus? Polyuria, polydipsia, and pheochromocytoma Polyuria, polyphagia, and polycythemia Polyuria, polydipsia, and polyphagia Polycythemia, polydipsia, and pheochromocytoma

Polyuria, polydipsia, and polyphagia The most commonly identified signs and symptoms of diabetes are 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). Pheochromocytoma and polycythemia are not hallmark signs of diabetes mellitus.

A woman in her 28th week of pregnancy tests positive for gestational diabetes mellitus and begins to follow a nutritional plan at home. What result at the follow-up visit indicates a successful outcome? Glycosylated hemoglobin 7.2% (.07) Gained 5 lb in one week 1% ketones present in urine Random blood glucose 85 mg/dL (4.72 mmol/L)

Random blood glucose 85 mg/dL (4.72 mmol/L) The goals of the nutritional plan for gestational diabetes mellitus (GDM) include normal glucose levels, no ketosis, proper weight gain for the pregnancy, and adequate nutrition for fetal health.

A child has been diagnosed with classic growth hormone deficiency. Which physical findings may occur in this child? Select all that apply. Short stature Delayed skeletal muscle maturation Obesity Below normal intelligence Early puberty Mature facial features

Short stature Delayed skeletal muscle maturation Obesity Children with classic GH deficiency have normal intelligence, short stature, obesity with immature facial features, and some delay in skeletal maturation. Puberty often is delayed, and males with the disorder have microphallus (abnormally small penis), especially if the condition is accompanied by gonadotropin-releasing hormone (GnRH) deficiency.

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? Troponin and myoglobin levels LDL and HDL levels BUN and creatinine T4 and TSH

T4 and TSH Diagnosis of hypothyroidism is based on history, physical examination, and laboratory tests. A low serum T4 and elevated TSH levels are characteristic of primary hypothyroidism.

Which pregnant woman likely faces the greatest risk of developing gestational diabetes? A client who: was diagnosed with placenta previa early in her pregnancy. is gravida five (in her fifth pregnancy). has BP of 130/85 mm Hg and pulse rate of 90 beats/minute. is morbidly obese (defined as greater than 100 pounds over ideal weight).

is morbidly obese (defined as greater than 100 pounds over ideal weight). Obesity is among the risk factors for gestational diabetes mellitus (GDM). Obstetric complications, multiple pregnancies, high triglycerides, and hypertension are not specific risk factors for GDM.