ATI: Chapter 76 - Endocrine Diagnostic Procedures Flashcards
Disorders of the endocrine system relate to either the excess or deficiency of a hormone or to a defect in a receptor site for a ______.
hormone.
Lab tests for evaluating endocrine function vary according to the organ or system under _______.
analysis
Many of these tests are blood, urine, or saliva tests that determine an excess or lack of a particular ________ in the body.
hormone
Some of these test stimulate a ______ in the body that will facilitate diagnosis of a particular disorder.
reaction
Stimulation testing involves stimulating the target gland to determine if the gland is capable of ______ hormone production.
normal
________ testing involves giving medications or substances to evaluate the body’s ability to suppress excessive hormone production.
Suppression
The ______ pituitary gland secretes the hormone vasopressin (ADH).
posterior
ADH increases permeability of the renal distal tubules, causing the kidneys to reabsorb, causing the kidney to _______.
reabsorb water.
A deficiency for ________ causes diabetes insipidus, which is the excretion of a large quantity of dilute urine.
ADH
Excessive secretion of ADH causes the _____________,
SIADH (syndrome of inappropriate antidiuretic hormone
With _____________ , the kidneys retain water, urine becomes concentrated, urinary output decreases , and extracellular fluid volume increases.
SIADH
Diagnostic tests for the posterior pituitary gland include the _______ test, ADH, serum and urine electrolytes and osmolality, and ________.
water deprivation test
urine specific gravity
The water deprivation test measures the _______ ability to concentrate urine in light of an increased plasma osmolality and a low plasma vaspopressin level. It requires a controlled setting with careful observation of the client for complications of ______.
kidneys’
dehydration
The water deprivation test helps identify causes and types of ________.
diabetes insipidus (DI)
_______ DI is caused by the failure of the kidneys to respond to ADH for a variety of reasons, such as hypokalemia and hypocalcemia.
Nephrogenic
______ DI is caused when there is a heady injury, tumor, irradiation of the pituitary gland, or serious infection.
Central (neurogenic)
_______ DI is caused by lithium, demeclocycline.
Medication-induced
The water deprivation test requires that the client have a baseline _______ level within the expected reference range and a urine osmolality less than _______.
sodium
300 mOsm/kg H20
The expected reference range for osmolality is ____ to ______.
285 to 295
Osmolality increases with ______ and decreases with overhydration, so it provides important information about fluid and electrolyte balance.
dehydration
Contraindications for this test include renal insufficiency, uncontrolled diabetes mellitus, hypovolemia, and _______ or _______ hormone defiency.
adrenal or thyroid
Tests to identify SIADH
ADH
serum and urine electrolytes and osmolality
urine specific gravity tests
Prior to a water deprivation test withhold fluids for a specific number of hours, or until the client loses a specific amount of _______.
body weight
The osmolality must be greater than ______ before administering the ADH hormone for the water deprivation test.
288 mOsm/kg
Monitor closely to identify and intervene for severe _______ prior to a water deprivation test.
dehydration
Before a water deprivation test establish a _____.
IV access
During the water deprivation test place the client in a _______ position for 20 minutes. The client may sit or stand during urination and weight determination.
recumbent
During the water deprivation test ask the client to empty his bladder. Record the amount, and send the specimen to the lab for immediate processing to determine _______.
osmolaity
During the water deprivation test weight the client to the nearest _____ of a kilogram (0.1 kg). Record the weight. Measure and record bp and pulse.
tenth
During the water deprivation test initiate complete ________. Have the client maintain a semi-recumbent position except to urinate.
fluid restriction
While in the semi recumbent position during the water deprivation test, repeat the three steps: weight and measure urine osmolality hourly until a specific number of _______ (tow or three) show a urine osmolity increase of less than ______. Obtain serum osmolity and record any findings. Administer a dose of _______ or desmopressin at a predetermined point during the test and obtain urine osmoality again after ___ to _____ minutes.
hourly
30 mOsM/kg H20
30 to 60 minutes
For an ADH test the client should fast and avoid stress for _____ hr prior to the test.
12 hours
Some medications (including acetaminophen, antidepressants, diuretics, opioids, phenytoin) can interfere with the _____ test.
ADH
When doing an ADH test collect a blood sample and transport it to the lab within _____.
10 minutes
For ______ testing there is no pre- or postprocedure care necessary.
electrolytes
The lab analyzes samples of ____ for electrolyte components.
blood
For a urine electrolytes and osmolality there are no _______ or ______ procedures.
pre or post
For a urine electrolyte and osmolality test the lab analyzes the ____ for electrolyte components.
urine
The lab usually performs a _________ test but nurses can use a calibrated hydrometer or a _______ to perform it on a clinical unit.
urine specific
temperature compensated refractometer
During a water deprivation test, clients who have _____ DI have up to a 9% decrease in urine osmolality during the test due to the kidney’s inability to concentrate urine.
nephrogenic DI
During a water deprivation test, client who have ______ DI have a rise in osmolality of more than 9% following administration of vasopressin.
central (neurogenic)
During a water deprivation test clients who have __________ have an osmolality less than 9% and take longer to become dehydrated during the test than are cleints who have central DI.
medication-induced DI
In an ADH test and increase in ADH indicates _______.
SIADH
The expected reference range of ADH is _____ to _____ pg/mL
1 to 5
The electrolyte test will show ____ sodium levels with SIADH.
low
The electrolyte test will show _____ osmolality and ______ urine osmolality indicating SIADH.
decreased osmolality
increased urine osmolality
Expected reference range for sodium
136 to 145
Expected reference range for potassium
3.5 to 5
Expected reference range for chloride
98 to 106
Expected reference range for Magnesium
1.3 to 2.1
_____ urine sodium content is expected with SIADH.
high
_____ urine osmolality indicates SIADH.
increased
Expected reference range for urine sodium
40 to 220 mEq/24 hr in a 24 hour collection or
greater than 20 mEq/L in a random urine collection
Expected reference range for urine potassium
25 to 100 mEq/L/24hr , depending on potassium intake
Expected reference range for urine chloride
110 to 250 mEq/24 hr
Expected reference range for urine osmolality
50 to 1,200 mOsm/kg H20, depending on fluid intake
A ______ in urine output and an _____ in urine specific gravity occur as a result of excess production of ADH.
decrease in urine output
increase in urine specific gravity
Expected reference range for urine specific gravity:
1.010 to 1.025
With a water deprivation test ______ is a complication that can occur due to a decrease in vascular volume.
dehydration
With a water deprivation test monitor closely for early indications of dehydration, including postural hypotension, tachycardia, and ______. Discontinue the test if the client loses more than ______ (or a specific amount) of body weight.
dizziness
2 kg
A hyperfunctioning ________ and an excess production of cortisol characterize Cushing’s disease and Cushing’s syndrome (hypercortisolism).
adrenal cortex
Hypofunctioning of the adrenal cortex and a consequent lack of adequate amounts of serum cortisol characterize _______.
Addison’s disease.
Diagnostic tests for the adrenal cortex include the dexamethasone suppression test, plasma and salivary cortisol, 24 hr urine for cortisol, ________, and ACTH stimulation tests.
adrenocorticotropic hormone (ACTH)
A ______ and an MRI identify atrophy of the adrenal glands causing hypofunction.
CT scan
A ______ test determines whether dexamethasone, a synthetic steroid similar to cortisol, has an effect on cortisol levels.
dexamethasone
Typically for a dexamethasone suppression test, the client takes a dose of dexamethasone by mouth and a ______ the next morning determines whether cortisol is present.
blood samples
A low dose of dexamethasone screens a client for ______ disease.
Cushing’s disease
High doses of dexamthasone help determines the ________ of Cushing’s disease.
cause
The client should stop taking some medications (_______, ________, _______) and try to reduce stress prior to and during testing, as these can affect the test results with a dexamethasone suppression test.
diurectics, antiboitics, oral contraceptives
With a plasma cortisol, the provider will determine the best time for testing, usually with blood sampling at _____ and againg at _____.
8 am
4 pm
When collecting salivary cortisol it usually occurs at ______.
midnight
A salivary ________ inside the client’s cheek, directly over the salivary gland, collects the sample.
cushion pad
The lab measures urine cortisol in a ______ urine collection.
24 hours
Physical exercise and _______ elevate cortisol levels.
emotional stress
The client _______ his bladder and then collects all urine he excretes during the next 24 hr period for a urinary cortisol test.
empties
The client keeps the urine for a urinary cortisol test in a container with _______ in it and keeps it on ice or in a refrigeration.
boric acid
Some medications, such as ______, interfere with the urinary cortisol test results, so the client should stop taking them, with the provider’s approval, for several days prior to urine collection.
diurectics
______ is most accurate with morning blood samples.
ACTH
Administer cosyntropin IV, and obtain specimens for plasma cortisol levels at _____ and ____ for an ACTH stimulation test.
30 minutes and 1 hour
With the dexamethasone suppression test, the pituitary gland produces ____ amounts of ACTH, the adrenal glands release _______ amounts of cortisol.
decreased
decreased
When clients who have Cushing’s disease receive dexamethsone during teh dexamethasone suppression test, there is ______ in the production of ACTH and cortisol.
no decrease
Higher levels of ________ indicate hypercortisolism (Cushing’s disease).
plasma cortisol
______ levels of plasma cortisol can indicate hypocortisolism (Addison’s disease).
Low
Cortisol varies according to the ______.
time of day
Cortisol has a _____ pattern, higher levels are present in the early morning, and the lowest levels occur around midnight, or 3 to 5 hours after onset of sleep.
diurnal (daily)
High levels of salivary cortisol indicate _______.
hypercortisolism
Salivary cortisol is at is lowest point around ______ and at its highest point between ______ and _____.
midnight
7 - 9 am
______ levels of urinary cortisol can indicate hypercortisolism (Cushing’s disease).
Higher
_____ levels of urinary cortisol can indicate hypocortisolism (Addison’s disease).
low
Urinary coritsol expected reference range is less than _______ in a 24 hr urine collection
100 mcg/day
_____ increases with Addison’s disease and either increases or decreases with Cushing’s disease (depending on the cause of the syndrome).
ACTH
An ______ in cortisol after administration of ACTH is expected with a ACTH stimulation test.
increase
If cortisol does not increase after administration of cosyntropin (an ACTH like medication) with an ACTH stimulation test, the test is positive for _______ or hypocortisolism.
Addison’s disease
The ACTH stimulation test determines the functioning of the ______ in relation to stimulating the secretion of adrenal hormones of cortisol.
pituitary gland
A 24 hour test or a _____ test is an option with IV infusions of cosyntropin over several hours.
3 day
Disorders of teh adrenal medulla, such as a tumor, can cause hypersecretion of ________, resulting in stimulation of a sympathetic response, such as tachycardia, hypertension, and diaphoresis. These tests determine whetere teh cause of a client’s unrelieved hypertension is a _______.
catecholamines
pheochromocytoma
Diagnostic tests for the adrenal medulla include plasma free metanephrine testing and the ________ test.
clonidine suppression
Plasma free metanephrine test is used in the identification of ________. The lab tests blood samples for both metanephrine and _________.
pheochromocytoma
normetanephrine
Clonidine suppression test identifies pheochromocytoma and the lab measures plasma catecholamines levels prior to and _____ after administration of clonidine.
3 hours
During the preprocedure for a metanephrine test the client should not have ______, alcohol, and several medications that could interfere with the test results.
caffeine
During the preprocedure for a metanephrine test you should review the client’s medications, including ________, with the provider.
acetaminophen
Before the preprocedure for a metanephrine test the client should stop taking acetaminophen for ______ hours prior to the test.
48 hours
For a metanephrine test the client should avoid ________ and increased stress prior to the test because it can interfere with the results.
physical exercise
Before the preprocedure for a metanephrine test assess the client’s _____. Having the client lie down and rest for 30 minutes prior to the test can reduce _____.
stress level.
stress
Before the preprocedure for a metanephrine test notify the provider about any _______ factors before obtaining a blood sample for the test.
interfering
Instruct the client before the plasma free metanephrine test instruct the client to maintain a _____ of activity and instruct the client about alcohol and caffeine restrictions.
moderate
Before and during the clonidine suppression test monitor for ______.
hypotension
After a clonidine procedure inform the client that _______ can occur after the test. Continue monitoring bp for at least _____ following the procedure.
fatigue
1 hour
With a plasma-free metanephrine test elevation of both metanephrine and normatanephrine above the expected reference range indicates a _____.
pheochromocytoma.
With a plasma free metanephrine test if only metaneprhine or normatenephrine are elevated, a pheochromocytoma is _____.
probable
with clonidine suppression test a client does not have a pheochromocytoma, clonidine suppresses catecholamine release and ______ the level of catecholamines (_______ bp)
decreases
decrease
If the client has a pheochromocytoma, the conidine has _______.
no effect (no decreased bp)
Hypovolemia is a contraindication for a ______ test due to the risk for severe hypotension.
clonidine suppression test
Insulin deficiency
type 1 diabetes mellitus
insulin resistance
type 2 diabetes mellitus
Both types of diabetes can alter carbohydrate metabolism, resulting in _______.
hyperglycemia
Diagnostic tests to evaluate carbohydrate metabolism include _____ (blood glucose, oral glucose tolerance testing, and glycosylated hemoglobin (HbA1c).
fasting - no caloric intake for 8 hr
Prior to a fasting blood glucose, the client should postpone taking ______ medications until after the blood sampling.
antidiabetes
Instruct the client to consume a balanced diet for _____ prior to the test and fast for 10 to 12 hours prior to the oral glucose test.
3 days
The technician will obtain a blood specimen for a fasting blood glucose level at the _____ of the test.
start
The client then consumes a specific amount of _______ for an oral glucose tolerance test after getting a blood sample.
glucose
The technician obtains blood samples at ____, ____, ____, ____ and sometimes 4 hour intervals after the client consumes glucose. Assess clients for _______ throughout the procedure.
30 min, 1 hr, 2 hr, 3 hr
hypoglycemia
With a glycosylated hemoglobin (HbA1C) test there is no pre and post procedure care necessary. THe test requires no fasting, just obtaining a random ______.
blood sample
Fasting blood glucose greater than _____ on two different occasions can indicate diabetes mellitus.
126 mg/dL
Prior to a fasting blood glucose test you can not have food or fluids other than ______ for 8 hrs.
water
Adults and children older than 2 years should have a fasting blood glucose of ______. These numbers will be slightly increased for adults older than 50.
70 to 110 mg/dL
With an oral glucose test, a blood glucose less than ____ mg/dL at 2 hours following glucose ingestion can indicate diabetes. The test may be repeated on another day to check results.
200
The oral glucose tolerance test determines the ability to ______ a standard amount of glucose.
metabolize
An expected reference range 1 hr after ingesting glucose is a glucose less than ______.
200 mg/dL
An expected reference range 2 hr after ingesting glucose is a glucose less than _____ mg/dL.
140
An expected reference range 3 or 4 hr after ingesting glucose is ____ to _____ mg/dL
70 to 115 mg/dL
HbAac is the best indicator of an ____ blood glucose level for the past ______ days.
average
120
Glycosylated hemoglobin (HbA1c) assists in evaluating treatment ______ and adherence to the diet plan, medication regimen, and exercise schedule.
effectiveness
HbA1c at _____ or less indicates no diabetes mellitus.
5.7%
HbA1c less than _____% indicates good diabetic control.
7%
HbA1c between ___ and ____ indicates fair diabetes control.
8% to 9%
HbA1c at _____ or greater indicates poor diabetes control.
9%
Hyperthyroidism and hypothyroidism are disorder in which there are inappropriate amounts of the thyroid hormones triiodothyronine (T3) and _______ (T4) circulating. These inappropriate amounts can cause an increase or decrease in metabolic rate that affects all body systems.
thyroxine
The ________ gland secretes thyroid stimulating hormone (TSH).
anterior pituitary
________ of TSH can lead to secondary hypothyroidism.
hyposecretion
________ of TSH can cause secondary hyperthyroidism.
hypersecretion
Diagnostic tests to evaluate the function of the thyroid and anterior pituitary glans include
Triiodothyronine T3 Thyroxine T4 TSH thyrotropin-releasing hormone TSH stimulation test radioactive iodine uptake
______ and CT scans determine the size, shape and presence of nodules and masses on the thyroid and anterior pituitary gland.
ultrasounds
TSH results help monitor ________ therapy and differentiate types of thyroid disorders.
thyroid replacement
A _______ is a noninvasive gamma probe over the thyroid measures the amount of 123I the gland absorbed.
thyroid scan
A thyroid scan evaluates size, shape, _____, and ability of the thyroid gland to function following an oral dose of 123I.
position
To test T3 and T4 there is not pre or post testing considerations, only a _____.
blood sample
To test TSH there is no pre or postprocedure care necessary. The lab requires a blood sample. TSH stimulates the release of ______ by the anterior pituitary gland.
thyroid
TRH requires giving a bolus of thyrotropin-releasing hormone, and then assessing serum concentrations of ________.
TSH at intervals.
With a thyroid scan the client receives an oral radioactive dose of 123I, and a ______ measures the amount the thyroid absorbed.
scintillation counter
Pregnancy and recent exposure to ______-containing dye are contraindications to a thyroid scan.
iodine
Explain to the client that 123I has a very ______, thus radiation precautions are not necessary for this test.
short half life
Low levels of T3 indicate _____.
hypothyroidism
High levels of T4 indicate _______.
hyperthyroidism
A high level of _____ is a better indicator hyperthyroidism than is _____.
T3
T4
Expected reference range of T3 is ____ to _____ ng/dL
70 to 205 ng/dL
Expected reference range of T4 is _____ to _____ mcg/dL
4.0 to 12.0
TSh can increase or decrease, depending on the _______.
cause
An increased value of TSH indicates primary _________ due to thyroid dysfunction or thyroiditis.
hypothyroidism
A decreased value of TSH indicated ________ (Graves disease) or secondary hypothyroidism (due to pituitary or hypothalamus dysfunction)
primary hypothyroidism
The expected reference range of _______ is relative to baseline.
TRH
The TSH should ______ the baseline value shortly after administration of thyrotropin-releasing hormone.
double
If the TSH increase ____ or more above baseline, this finding indicates hypothyroidism.
twofold
Clients who have hyperthyrodiism absorb ______ amounts of 123I (greater than 35%), determined by the thyroid scan.
high
A client asks the nurse why the provider bases his medication regimen on his HbA1C instead of his log of morning fasting blood glucose results. Which of the following is an appropriate response by the nurse?
A. HB A1C measures how well insulin is regulating your blood glucose between meals.
B. HB A1 C indicates how well your blood glucose has been regulated over the past three months.
C. A test of HB A1C is the first test to determine if an individual has diabetes.
D. A test of HB A1C determines if the dosage of insulin needs to be adjusted.
B.
HB A1C measures the client’s BC control over the past 2 to 4 months.
The nurse is reviewing the health record of a client who has syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following laboratory findings should the nurse anticipate? Select all that apply.
A. Low serum sodium B. High serum potassium C. Decreased urine osmolality D. High urine sodium E. Increased urine specific gravity
A, D, E
SIADH results in water retention, causing a low serum sodium level.
SIADH results in water retention, causing a high urine sodium level.
SIADH results in water retention, causing an increase in urine specific gravity.
A nurse is caring for a client who has a primary adrenal insufficiency. Which of the following findings should the nurse anticipate after an IV injection of ACTH 1.0 mg?
A. Decrease in serum plasma cortisol
B. Elevated fasting blood glucose
C. Decrease in serum sodium
D. Increase in urinary output
A.
A decrease in serum plasma cortisol is indicative of primary adrenal insufficiency due to inadequate production of aldosterone and cortisol.
A nurse is assessing a client during a water deprivation test. For which of the following complications should the nurse monitor the client?
A. Bradycardia
B. Orthostatic hypotension
C. Neck and Vein distention
D> Crackles in the lungs
B. Orthostatic hypotension - as a result of dehydration during the test
_____ is a complication the nurse should monitor for during a water deprivation test due to dehyrdration.
Tachycardia
