Lewis 4th ed: Ch 50 Endocrine System Flashcards
The nurse is evaluating the laboratory results for a client who has increased secretion of the anterior pituitary hormones. Which of the following findings should the nurse anticipate when reviewing the laboratory findings?
a. Decreased serum thyroxine levels
b. Elevated serum aldosterone levels
c. An increase in urinary free cortisol
d. Low urinary excretion of catecholamines.
c. An increase in urinary free cortisol
Increased secretion of adrenocorticotropic hormone by the anterior pituitary gland will lead to an increase in serum and urinary cortisol levels. An increase rather than 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.
The nurse is obtaining the health history from a client. Which of the following statements by the client indicates 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 a time to urinate”
d. I feel a lump in my throat when i swallow”
d. I feel a lump in my throat when i swallow”
The nurse is caring for a client who is preparing for a growth hormone stimulation test. Which of the following adverse effects should the nurse monitor for during the test?
a. bradycardia
b. hypotension
c. hyperglycemia
d. tachypnea
b. hypotension
The nurse is interviewing a client who has a possible thyroid disorder. Which of the following questions will provide the most useful information?
a. “what methods do you use to help cope with stress?”
b. “have you experiencing any blurring or double vision?”
c. “do you have to get up at night to empty your bladder?”
d. “have you had any recent unplanned weight gain or loss?”
d. “have you had any recent unplanned weight gain or loss?”
The nurse is caring for a client in the outpatient clinic who has a prescription for blood cortisol testing. Which of the following instructions should the nurse provide for the client?
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”
c. “Come to the laboratory to have the blood drawn early in the morning”
Cortisol levels are usually drawn in the morning when levels are highest. The other instructions would be given to clients who were having other endocrine testing.
A client has a total serum calcium level of 3.3 mmol/L. Which of the following laboratory results should the nurse assess next?
a. Calcitonin
b. Catecholamine
c. Thyroid hoemone
d. Parathyroid hormone
d. Parathyroid hormone
Is the major controller for blood calcium levels.
a total serum calcium level of 3.3 mmol/L is high (normal range: 2.1–2.6 mmol/L), meaning the patient has hypercalcemia. The next step is to check parathyroid hormone (PTH) levels because PTH is the primary regulator of blood calcium.
Why Assess Parathyroid Hormone (PTH)?
• If PTH is high → The hypercalcemia is likely due to primary hyperparathyroidism (e.g., parathyroid adenoma or hyperplasia).
• If PTH is low → The hypercalcemia is likely from a non-parathyroid cause, such as:
• Malignancy (cancers like multiple myeloma or lung cancer producing PTH-related peptide).
• Excess vitamin D or calcium supplementation.
• Chronic kidney disease or granulomatous diseases (e.g., sarcoidosis).
During a physical examination, the nurse finds that a client’s thyroid gland cannot be palpated. Which of the following is the best action for the nurse to take?
a. Palpate the client’s neck more deeply
b. Document that the thyroid was nonpalpable
c. Notify the health care provider immediately
d. Teach the client about thyroid hormone testing.
b. Document that the thyroid was nonpalpable
The thyroid is frequently nonpalpable.
The nurse is caring for a client who has clinical manifestations of hypothyroidism. Which of the following laboratory tests is most accurate to evaluate thyroid function?
a. Thyroxine (T4) level
b. Triiodothyronine (T3) level
c. Thyroid-stimulating hormone (TSH).
d. Thyrotropin-releasing hormone (TRH) level.
c. Thyroid-stimulating hormone (TSH).
A client who has diabetes mellitus asks the nurse what the glycosylated hemoglobin (HbA1C) test measures. WHich of the following explanations should be the basis of the nurses response?
a. Glucose levels 2 hours after a meal
b. Circulating, nonfasting glucose levels
c. Glucose control over the past 3 months
d. Hypoglycemic episodes in the past 90 days.
c. Glucose control over the past 3 months
The nurse is caring for a client who is taking spironolactone. Which of the following parameters should the nurse monitor?
a. Decreased urinary output
b. Evidence of fluid overload
c. Increased serum sodium levels
d. Elevated serum potassium
d. Elevated serum potassium
Spironolactone is a diuretic that blocks aldosterone. Aldosterone increases the excretion of potassium,… therefore a medication that blocks aldosterone will tend to cause hyperkalemia.
The nurse is teaching a client how to prepare for an oral glucose tolerance test (OGTT). Which of the following client responses indicates that the teaching has been effective?
a. Fast 12 hours before the procedure
b. Clear fluid diet 12 hours propr to before the test
c. Drink only full fluids 6 hours before the test
d. No fluid or food restriction prior to the test.
d. No fluid or food restriction prior to the test.
(Correct answer is D, according to test bank but the rationale states: Fasting for 12 hours before the procedure demonstrates that teaching has been effective.) Patient needs to be NPO 12 hours prior to the test.
A client is scheduled for growth hormone stimulation test. Which of the following items should the nurse obtain in preparation for the test?
a. Basin of rice
b. Cardiac monitor
c. Vial of glargine insulin
d. Intravenous dextrose solution
d. Intravenous dextrose solution
Hypoglycemia is induced during the growth hormone stimulation test, and the nurse should be prepared to administer glucose IV immediately or have a sweet snack available for the client immediately following the test.
The regulation of oxytocin during childbirth is an example of which of the following mechanisms?
a. Physiological rhythm
b. Secondary input
c. Loop regulation
d. Positive feedback
d. Positive feedback
The nurse is caring for a client who is scheduled for 24-hour urine collection for 17-ketosteroids. Which of the following actions should the nurse implement?
a. Keep the specimen on ice
b. Insert a retention catheter
c. Have the client void and save that specimen to start the collection
d. Encourage the client to drink 2-3 L of fluid during the 24-hour collection.
a. Keep the specimen on ice
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.
When reviewing the laboratory results for a client’s total calcium level, which of the following information should the nurse consider?
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.
c. The serum albumin level is low.
Part of the total calcium is bound to albumin, so hypoalbuminemia can lead to misinterpretation of calcium levels. Ionized calcium unaffected by album levels. The other laboratory values will not affect total calcium interpretation.
The nurse is caring for a client who was admitted with tetany. Which of the following laboratory values should the nurse monitor?
a. Total protein
b. Blood glucose
c. Ionized calcium
d. Serum phosphate
c. Ionized calcium
Tetany is associated with hypocalcemia. The other values would not be useful for this client in relation to tetany.
Which of the following information about a client who is scheduled for an oral glucose tolerance test should be reported to the health care provider before starting the test?
a. Occasional orthostatic dizziness
b. A 5kg weight gain in the last month
c. Intake of 1 L of water an hour previously
d. Oral corticosteroid use of rheumatoid arthritis
d. Oral corticosteroid use of rheumatoid arthritis
Corticosteroids can affect blood glucose results. The other information will be provided to the provider but will not affect the test results.
The student nurse is caring for a client with goitre and possible hyperthyroidism. Which of the following actions by the student nurse should cause the nursing instructor to intervene?
a. Palpates the neck to check thyroid size
b. Checks the blood pressure on both arms
c. Administered non medicated eye drops to the client’s eyes
d. Lowers the thermostat to decrease the temperature in the room.
a. Palpates the neck to check thyroid size
Palpation can cause the release of thyroid hormones in a client with an enlarged thyroid and should be avoided. The other actions are appropriate.
The nurse is caring for a client who is undergoing a water deprivation test. Which of the following findings is most important for the nurse to communicate to the health care provider?
a. Intense thirst
b. 2.3kg of weight loss
c. Orthostatic hypotension
d. No change in urine osmolality
b. 2.3kg of weight loss
A drop in the weight of more than 2kg indicates severe dehydration, and the test should be discontinued.
A client with a possible pituitary adenoma is scheduled for a computed tomography (CT) scan with contrast media. Which of the following client 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 8.5kg.
d. Hx of ongoing headaches.
b. Allergies to iodine and shellfish
Since the usual contrast medica 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.
