PREP U Chapter 32: 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?
Increase in appetite
A client's low serum T4 level has led to a diagnosis of hypothyroidism. When planning this client's care, the nurse should:
teach the client about the safe and effective use of synthetic thyroid hormones.
A client is diagnosed with Addison's disease. What statement by the client indicates an understanding of the discharge instructions by the nurse?
"I will have to take my medication for the rest of my life."
In which client would the nurse identify a primary endocrine disorder?
A client who has been diagnosed with Hashimoto thyroiditis
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 103.2 F
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)
The nurse is caring for an adult client with growth hormone deficiency. When performing an assessment of this client, which system should the nurse be sure to assess for complications related to this disorder?
Cardiovascular system
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 with a suspected diagnosis of primary hypothyroidism would most likely demonstrate which of the following serum laboratory values?
Elevated thyroid-stimulating hormone (TSH) and decreased thyroxine (T4)
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
When the assessment of thyroid autoantibodies is performed, what is the suspected diagnosis?
Hashimoto thyroiditis
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
In Addison disease, the majority of the adrenal cortex has been destroyed. This causes a lack of mineralocorticoids and glucocorticoids. Therapy consists of oral replacement with what drug?
Hydrocortisone
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
Which statements are true regarding hypothyroidism? Select all that apply.
Onset of symptoms is gradual Weight gain Anorexia
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
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 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 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 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?
Altered fat metabolism
Which disorder is a result of excess cortisol?
Cushing syndrome
Parents of a 7-year-old girl are concerned about their daughter because she has begun to develop secondary sexual characteristics. What etiologic factor is most likely to underlie the child's condition?
Early activation of the hypothalamic--pituitary--gonadal axis
A client with Graves' disease has had radioiodine treatment with worsening of ophthalmopathy. What medication does the nurse prepare to administer that the client will use for several weeks to decrease these symptoms?
Glucocorticoids
A client has been taking long-term glucocorticoid therapy for the treatment of asthma. What condition is the nurse aware that this client may develop in relation to this pharmacological therapy?
Iatrogenic Cushing syndrome
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 hypothalamus secretes GHRH
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."
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."
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
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
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
The nurse is assessing a client who underwent a thyroidectomy earlier in the day. Assessment reveals a heart rate of 133 beats per minute, oral temperature of 38.5°C, and the client is uncharacteristically agitated and disoriented. After informing the primary care provider, which action by the nurse is the priority?
Closely monitor the client's cardiac status.
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
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
Management of hyperthyroidism would include which interventions? Select all that apply.
Eradication of the gland with radioactive iodine Surgical removal of part or the entire gland Drug therapy directed toward decreasing the gland's function
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
A 25-year-old female client exhibits exophthalmos of both eyes. The health care provider recognizes this as a manifestation of:
Graves disease
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?
Increased levels of ACTH
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
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 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
The nurse is educating a newly diagnosed client with Hashimoto thyroiditis who is to be discharged from the acute care facility. What should the nurse be sure to include in the education to prevent complications?
The client should be informed about the signs and symptoms of severe hypothyroidism and the need for early intervention.
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.
Diagnostic testing has revealed that a client has pituitary hypofunction, resulting in deficient production of ACTH. The nurse should recognize what implication of this finding?
The client will require exogenous supplements of cortisol.
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.
Which of the following statements best captures an aspect of the function of the hypothalamic-pituitary-adrenal (HPA) system?
The pituitary gland communicates with the adrenal cortex through the release of ACTH.
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