Chapter 48: Nursing Assessment: Endocrine System Flashcards
- A 22-year-old patient is being seen in the clinic with increased secretion of the anterior pituitary hormones. The nurse would expect the laboratory results to show
a.
increased urinary cortisol.
b.
decreased serum thyroxine.
c.
elevated serum aldosterone levels.
d.
low urinary catecholamines excretion.
ANS: A
Increased secretion of adrenocorticotropic hormone (ACTH) by the anterior pituitary gland will lead to an increase in serum and urinary cortisol levels. An increase, rather than a decrease, in thyroxine level would be expected with increased secretion of thyroid stimulating hormone (TSH) by the anterior pituitary. Aldosterone and catecholamine levels are not controlled by the anterior pituitary.
- Which statement by a 50-year-old female patient indicates to the nurse that further assessment of thyroid function may be necessary?
a.
I notice my breasts are tender lately.
b.
I am so thirsty that I drink all day long.
c.
I get up several times at night to urinate.
d.
I feel a lump in my throat when I swallow.
ANS: D
Difficulty in swallowing can occur with a goiter. Nocturia is associated with diseases such as diabetes mellitus, diabetes insipidus, or chronic kidney disease. Breast tenderness would occur with excessive gonadal hormone levels. Thirst is a sign of disease such as diabetes.
- A 30-year-old patient seen in the emergency department for severe headache and acute confusion is found to have a serum sodium level of 118 mEq/L. The nurse will anticipate the need for which diagnostic test?
a.
Urinary 17-ketosteroids
b.
Antidiuretic hormone level
c.
Growth hormone stimulation test
d.
Adrenocorticotropic hormone level
ANS: B
Elevated levels of antidiuretic hormone will cause water retention and decrease serum sodium levels. The other tests would not be helpful in determining possible causes of the patients hyponatremia
- Which question will provide the most useful information to a nurse who is interviewing a patient about a possible thyroid disorder?
a.
What methods do you use to help cope with stress?
b.
Have you experienced any blurring or double vision?
c.
Have you had a recent unplanned weight gain or loss?
d.
Do you have to get up at night to empty your bladder?
ANS: C
Because thyroid function affects metabolic rate, changes in weight may indicate hyperfunction or hypofunction of the thyroid gland. Nocturia, visual difficulty, and changes in stress level are associated with other endocrine disorders.
- A 29-year-old patient in the outpatient clinic will be scheduled for blood cortisol testing. Which instruction will the nurse provide?
a.
Avoid adding any salt to your foods for 24 hours before the test.
b.
You will need to lie down for 30 minutes before the blood is drawn.
c.
Come to the laboratory to have the blood drawn early in the morning.
d.
Do not have anything to eat or drink before the blood test is obtained.
ANS: C
Cortisol levels are usually drawn in the morning, when levels are highest. The other instructions would be given to patients who were having other endocrine testing.
- A 61-year-old female patient admitted with pneumonia has a total serum calcium level of 13.3 mg/dL (3.3 mmol/L). The nurse will anticipate the need to teach the patient about testing for _____ levels.
a.
calcitonin
b.
catecholamine
c.
thyroid hormone
d.
parathyroid hormone
ANS: D
Parathyroid hormone is the major controller of blood calcium levels. Although calcitonin secretion is a countermechanism to parathyroid hormone, it does not play a major role in calcium balance. Catecholamine and thyroid hormone levels do not affect serum calcium level.
- During the physical examination of a 36-year-old female, the nurse finds that the patients thyroid gland cannot be palpated. The most appropriate action by the nurse is to
a.
palpate the patients neck more deeply.
b.
document that the thyroid was nonpalpable.
c.
notify the health care provider immediately.
d.
teach the patient about thyroid hormone testing.
ANS: B
The thyroid is frequently nonpalpable. The nurse should simply document the finding. There is no need to notify the health care provider immediately about a normal finding. There is no indication for thyroid-stimulating hormone (TSH) testing unless there is evidence of thyroid dysfunction. Deep palpation of the neck is not appropriate.
- Which laboratory value should the nurse review to determine whether a patients hypothyroidism is caused by a problem with the anterior pituitary gland or with the thyroid gland?
a.
Thyroxine (T4) level
b.
Triiodothyronine (T3) level
c.
Thyroid-stimulating hormone (TSH) level
d.
Thyrotropin-releasing hormone (TRH) level
ANS: C
A low TSH level indicates that the patients hypothyroidism is caused by decreased anterior pituitary secretion of TSH. Low T3 and T4 levels are not diagnostic of the primary cause of the hypothyroidism. TRH levels indicate the function of the hypothalamus.
- The nurse reviews a patients glycosylated hemoglobin (Hb A1C) results to evaluate
a.
fasting preprandial glucose levels.
b.
glucose levels 2 hours after a meal.
c.
glucose control over the past 90 days.
d.
hypoglycemic episodes in the past 3 months.
ANS: C
Glycosylated hemoglobin testing measures glucose control over the last 3 months. Glucose testing before/after a meal or random testing may reveal impaired glucose tolerance and indicate prediabetes, but it is not done on patients who already have a diagnosis of diabetes. There is no test to evaluate for hypoglycemic episodes in the past.
- A 60-year-old patient is taking spironolactone (Aldactone), a drug that blocks the action of aldosterone on the kidney, for hypertension. The nurse will monitor for
a.
increased serum sodium.
b.
decreased urinary output.
c.
elevated serum potassium.
d.
evidence of fluid overload.
ANS: C
Because aldosterone increases the excretion of potassium, a medication that blocks aldosterone will tend to cause hyperkalemia. Aldosterone also promotes the reabsorption of sodium and water in the renal tubules, so spironolactone will tend to cause increased urine output, a decreased or normal serum sodium level, and signs of dehydration.
- A 40-year-old male patient has been newly diagnosed with type 2 diabetes mellitus. Which information about the patient will be most useful to the nurse who is helping the patient develop strategies for successful adaptation to this disease?
a.
Ideal weight
b.
Value system
c.
Activity level
d.
Visual changes
ANS: B
When dealing with a patient with a chronic condition such as diabetes, identification of the patients values and beliefs can assist the health care team in choosing strategies for successful lifestyle change. The other information also will be useful, but is not as important in developing an individualized plan for the necessary lifestyle changes.
- An 18-year-old male patient with a small stature is scheduled for a growth hormone stimulation test. In preparation for the test, the nurse will obtain
a.
ice in a basin.
b.
glargine insulin.
c.
a cardiac monitor.
d.
50% dextrose solution.
ANS: D
Hypoglycemia is induced during the growth hormone stimulation test, and the nurse should be ready to administer 50% dextrose immediately. Regular insulin is used to induce hypoglycemia (glargine is never given IV). The patient does not require cardiac monitoring during the test. Although blood samples for some tests must be kept on ice, this is not true for the growth hormone stimulation test.
- The nurse will teach a patient to plan to minimize physical and emotional stress while the patient is undergoing
a.
a water deprivation test.
b.
testing for serum T3 and T4 levels.
c.
a 24-hour urine test for free cortisol.
d.
a radioactive iodine (I-131) uptake test.
ANS: C
Physical and emotional stress can affect the results of the free cortisol test. The other tests are not impacted by stress.
- A nurse will teach a patient who is scheduled to complete a 24-hour urine collection for 17-ketosteroids to
a.
insert and maintain a retention catheter.
b.
keep the specimen refrigerated or on ice.
c.
drink at least 3 L of fluid during the 24 hours.
d.
void and save that specimen to start the collection.
ANS: B
The specimen must be kept on ice or refrigerated until the collection is finished. Voided or catheterized specimens are acceptable for the test. The initial voided specimen is discarded. There is no fluid intake requirement for the 24-hour collection.
- Which additional information will the nurse need to consider when reviewing the laboratory results for a patients total calcium level?
a.
The blood glucose is elevated.
b.
The phosphate level is normal.
c.
The serum albumin level is low.
d.
The magnesium level is normal.
ANS: C
Part of the total calcium is bound to albumin so hypoalbuminemia can lead to misinterpretation of calcium levels. The other laboratory values will not affect total calcium interpretation.
