endocrine assess 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?
Test Bank - Lewis’s Medical Surgical Nursing (11th Edition by Harding) 590
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.
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.
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.
A 44-year-old patient is admitted with tetany. Which laboratory value should the nurse monitor?
a. Total protein
b. Blood glucose
c. Ionized calcium
d. Serum phosphate
ANS: C
Tetany is associated with hypocalcemia. The other values would not be useful for this patient.
- Which information about a 30-year-old patient who is scheduled for an oral glucose tolerance test should
be reported to the health care provider before starting the test?
a. The patient reports having occasional orthostatic dizziness.
b. The patient takes oral corticosteroids for rheumatoid arthritis.
c. The patient has had a 10-pound weight gain in the last month.
d. The patient drank several glasses of water an hour previously.
ANS: B
Corticosteroids can affect blood glucose results. The other information will be provided to the health care provider but will not affect the test results.
Which action by a new registered nurse (RN) caring for a patient with a goiter and possible
hyperthyroidism indicates that the charge nurse needs to do more teaching?
a. The RN checks the blood pressure on both arms.
b. The RN palpates the neck thoroughly to check thyroid size.
c. The RN lowers the thermostat to decrease the temperature in the room.
d. The RN orders nonmedicated eye drops to lubricate the patients bulging eyes.
ANS: B
Palpation can cause the release of thyroid hormones in a patient with an enlarged thyroid and should be
avoided. The other actions by the new RN are appropriate when caring for a patient with an enlarged thyroid.
The nurse is caring for a 45-year-old male patient during a water deprivation test. Which finding is most
important for the nurse to communicate to the health care provider?
a. The patient complains of intense thirst.
b. The patient has a 5-lb (2.3 kg) weight loss.
c. The patients urine osmolality does not increase.
d. The patient feels dizzy when sitting on the edge of the bed.
ANS: B
A drop in the weight of more than 2 kg indicates severe dehydration, and the test should be discontinued. The
other assessment data are not unusual with this test.
A 35-year-old female patient with a possible pituitary adenoma is scheduled for a computed tomography (CT) scan with contrast media. Which patient information is most important for the nurse to communicate to the health care provider before the test?
a. Bilateral poor peripheral vision
b. Allergies to iodine and shellfish
c. Recent weight loss of 20 pounds
d. Complaint of ongoing headaches
ANS: B
Because the usual contrast media is iodine-based, the health care provider will need to know about the allergy
before the CT scan. The other findings are common with any mass in the brain such as a pituitary adenoma.
The nurse is caring for a 63-year-old with a possible pituitary tumor who is scheduled for a computed tomography (CT) scan with contrast. Which information about the patient is most important to discuss with the health care provider before the test?
a. History of renal insufficiency
b. Complains of chronic headache
c. Recent bilateral visual field loss
d. Blood glucose level of 134 mg/dL
ANS: A
Because contrast media may cause acute kidney injury in patients with poor renal function, the health care
provider will need to prescribe therapies such as IV fluids to prevent this complication. The other findings are
consistent with the patients diagnosis of a pituitary tumor.
Which statements will the nurse include when teaching a patient who is scheduled for oral glucose tolerance
testing in the outpatient clinic (select all that apply)?
a. You will need to avoid smoking before the test.
b. Exercise should be avoided until the testing is complete.
c. Several blood samples will be obtained during the testing.
d. You should follow a low-calorie diet the day before the test.
e. The test requires that you fast for at least 8 hours before testing
ANS: A, C, E
Smoking may affect the results of oral glucose tolerance tests. Blood samples are obtained at baseline and at
30, 60, and 120 minutes. Accuracy requires that the patient be fasting before the test. The patient should
consume at least 1500 calories/day for 3 days before the test. The patient should be ambulatory and active for
accurate test results.
A 48-year-old male patient screened for diabetes at a clinic has a fasting plasma glucose level of 120 mg/dL
(6.7 mmol/L). The nurse will plan to teach the patient about
a. self-monitoring of blood glucose.
b. using low doses of regular insulin.
c. lifestyle changes to lower blood glucose.
d. effects of oral hypoglycemic medications.
ANS: C
The patients impaired fasting glucose indicates prediabetes, and the patient should be counseled about lifestyle
changes to prevent the development of type 2 diabetes. The patient with prediabetes does not require insulin or
oral hypoglycemics for glucose control and does not need to self-monitor blood glucose.
A 28-year-old male patient with type 1 diabetes reports how he manages his exercise and glucose control. Which behavior indicates that the nurse should implement additional teaching?
a. The patient always carries hard candies when engaging in exercise.
b. The patient goes for a vigorous walk when his glucose is 200 mg/dL.
c. The patient has a peanut butter sandwich before going for a bicycle ride.
d. The patient increases daily exercise when ketones are present in the urine.
ANS: D
When the patient is ketotic, exercise may result in an increase in blood glucose level. Type 1 diabetic patients
should be taught to avoid exercise when ketosis is present. The other statements are correct.
The nurse is assessing a 22-year-old patient experiencing the onset of symptoms of type 1 diabetes. Which
question is most appropriate for the nurse to ask?
a. Are you anorexic?
b. Is your urine dark colored?
c. Have you lost weight lately?
d. Do you crave sugary drinks?
ANS: C
Weight loss occurs because the body is no longer able to absorb glucose and starts to break down protein and
fat for energy. The patient is thirsty but does not necessarily crave sugar-containing fluids. Increased appetite
is a classic symptom of type 1 diabetes. With the classic symptom of polyuria, urine will be very dilute.
A patient with type 2 diabetes is scheduled for a follow-up visit in the clinic several months from now. Which test will the nurse schedule to evaluate the effectiveness of treatment for the patient?
a. Urine dipstick for glucose
b. Oral glucose tolerance test
c. Fasting blood glucose level
d. Glycosylated hemoglobin level
ANS: D
The glycosylated hemoglobin (A1C or HbA1C) test shows the overall control of glucose over 90 to 120 days. A
fasting blood level indicates only the glucose level at one time. Urine glucose testing is not an accurate
reflection of blood glucose level and does not reflect the glucose over a prolonged time. Oral glucose tolerance
testing is done to diagnose diabetes, but is not used for monitoring glucose control once diabetes has been
diagnosed.
