Chapter 41: Disorders of Endocrine Control of Growth and Metabolism - MLQ
Promotion of glucose uptake by target cells
A hospital client 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?
Prolonged period of physiologic jaundice
Which sign of congenital hypothyroidism in a neonate is one of the first signs the nurse would pick up on?
Maternal diabetes
Which maternal factor contributes to an infant having macrosomia, hypoglycemia, and hyperbilirubinemia? You Selected:
Insulin resistance
Which metabolic abnormality can lead to the development of type 2 diabetes?
Explain that many people with diabetes experience some complications like retinopathy, but these are best prevented with tight control of glucose levels.
A 15-year-old child with type 1 diabetes asks nurse about the potential to "lose sight." Which response would be the most appropriate?
Helping the client make meaningful changes to his diet and activity level.
A 62-year-old man who 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?
"The prognosis of the child depends on an improvement in behavior and catch-up growth."
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 hypothalamus secretes GHRH.
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?
Thyroid storm
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 complication?
"With treatment of the hyperthyroid state, the opthalmopathy usually tends to stabilize."
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?
Elevated thyroid-stimulating hormone (TSH) and decreased thyroxine (T4)
A client with a suspected diagnosis of primary hypothyroidism would most likely demonstrate which serum laboratory value?
Bronchitis
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 1 year for the same problem. What condition does the nurse understand results from this client's enlarged cartilaginous structures?
Short acting
A client with diabetes carries insulin with him at all times. At 11:35, he obtains a blood glucose reading of 218 mg/dL (12.1 mmol/L) and self-administers a dose of insulin in anticipation of eating lunch at noon. What type of insulin did he most likely inject?
carry a snack with a rapidly absorbed form of glucose to prevent profound hypoglycemia.
A client with type 1 diabetes 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:
teach the client about the safe and effective use of synthetic thyroid hormones.
A client's low serum T4 level has led to a diagnosis of hypothyroidism. When planning this client's care, the nurse should:
"My meter broke so I have not been checking my blood glucose levels for a while."
A diabetic client presents to a clinic for routine visit. Blood work reveals a HbA1C of 11.0% (high). Which response by the client may account for this abnormal lab result?
"This autoimmune disorder causes destruction of the beta cells, placing your children at high risk of developing diabetes."
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?" The best response by the health care provider would be:
Myxedema coma
An overweight, 14-year-old boy feels tired all the time. He sleeps 12 to 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 a nonpitting mucosus type of edema. For which life-threatening condition should his care team be prepared?
A 7-year-old female with early menarche
Which pediatric assessment finding would the nurse recognize as an example of precocious puberty?
The client will require exogenous supplements of cortisol
Diagnostic testing has revealed that a client has pituitary hypofunction, resulting in deficient production of ACTH. The nurse should recognize which implication of this finding?
Hyperglycemia
During periods of fasting and starvation, the glucocorticoid and other corticosteroid hormones are critical for survival because of their stimulation of gluconeogenesis by the liver. When the glucocorticoid hormones remain elevated for extended periods of time, what can occur?
Very high fever Delirium Tachycardia
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.
ACTH
One of the earliest signs of Cushing syndrome is the loss of variable diurnal secretion of cortisol-releasing hormone (CRH) and:
Somogyi effect
Research has identified a cycle of insulin-induced posthypoglycemic episodes. What is this phenomenon called?
-polydipsia -polyuria -polyphagia
Select the most common symptoms of diabetes. Select all that apply.
Administration of intravenous fluids
The critical care nurse has just admitted a client with diabetic ketoacidosis (DKA) whose blood glucose level is 877 mg/dL (48.67 mmol/L). The client's breath has a fruity odor and the client is confused. Which of these does the nurse set as the priority at this time?
Glucose is unused without insulin, so body fats are used for energy.
The family of a client in the hospital with diabetes mellitus 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?
ACTH peaks in the morning and declines throughout the day.
The health care provider is reviewing diurnal variation pattern in adrenocorticotropic (ACTH) levels. Select the typical diurnal variation pattern in adrenocorticotropic (ACTH) levels.
Blood glucose will elevate.
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?
Cerebral edema -The treatment of HHS requires judicious medical observation and care as water moves back into brain cells, posing a threat of cerebral edema. The other signs and symptoms are manifestations of HHS.
The nurse caring for a client with HHS (hyperosmolar hyperglycemic state) should perform which priority assessment on this client?
Acromegaly
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?
Hemoglobin A1C level is 8.7%
The nurse is caring for a client with diabetes. Which of these findings is cause for concern, leading the nurse to initiate client education?
Hypothermia Elevated carbon dioxide levels and decreased oxygen saturation Fluid and electrolyte imbalance
The nurse is caring for a client with primary hypothyroidism who is being monitored for the complication of myxedema coma while thyroid-level therapy is started. What does the nurse understand are the three major aspects of myxedema coma? Select three that apply.
The medication will be given daily during the period of active growth and can be continued into adulthood.
The nurse is discussing the administration of GH with a parent of a child who has short stature caused by growth hormone (GH) deficiency. What should the nurse include when educating the parents about administration?
Heart rate 110 and bounding
The nurse is performing an assessment for a client who has hyperthyroidism that is untreated. When obtaining vital signs, what is the expected finding?
Dexamethasone
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?
The client should be strongly urged not to smoke.
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?
Random blood glucose 195 mg/dL (10.82 mmol/L)
The nurse screening for diabetes mellitus at a health fair obtains these results. Which client should be referred to a primary health care provider for further evaluation?
2 hour oral GTT 175 mg/dL (9.7 mmol/L)
Which manifestation indicates a client is at risk for developing diabetes mellitus?
Woman with a family history of diabetes
The obstetrical nurse is caring for a client who has been treated for gestational diabetes. When teaching the client about the causes of gestational diabetes, the nurse should include which risk factor in the teaching?
Persons whose mothers have diabetes Individuals of Native American/First Nation descent Clients with fasting blood glucose of 113 mg/dL (6.27 mmol/L)
When conducting a community education class on diabetes, which individual does the nurse explain is at risk for type 2 diabetes? Select all that apply.
"If you have diabetes, avoiding saturated fats is important."
When providing nutrition education to the client with diabetes, the nurse should include which statement regarding fat intake?
Has a high blood pressure that is consistently in the range of 140/90 mm Hg or greater
Which assessment finding of a client constitutes a criterion for a diagnosis of metabolic syndrome?
Cardiac structures increase in size
Which complication of acromegaly can be life threatening?
-low serum bicarbonate -Ketonuria -Blood glucose > 250 mg/dL (13.88 mmol/L
Which finding in a client would support a diagnosis of diabetic ketoacidosis (DKA)? Select all that apply.
An adult with an excess of growth hormone due to an adenoma
Which individual displays the precursors to acromegaly?
Monitor blood glucose levels throughout the day and administer exogenous insulin replacement as needed
Which treatment regimen is most likely to result in stable blood glucose levels for a client with a diagnosis of type 1 diabetes?
