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