Module 1 - Altered Endocrine/Metabolic Function (Ch. 50, 51, 52)

Question 1

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

Answer 1

ANS: C
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.

Question 2

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 at night to urinate.”
d. “I feel a lump in my throat when I swallow.”

Answer 2

ANS: D
Difficulty in swallowing can occur with a goitre. 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.

Question 3

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

Answer 3

ANS: B
During a growth hormone stimulation test, the nurse should continually assess for hypoglycemia and hypotension. There is no indication to monitor for bradycardia or tachypnea

Question 4

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 experienced 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?”

Answer 4

ANS: D
Because thyroid function affects metabolic rate, changes in weight may indicate hyper- or hypofunction of the thyroid gland. Nocturia, visual difficulty, and changes in stress level are associated with other endocrine disorders

Question 5

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.”

Answer 5

ANS: C
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

Question 6

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 hormone
d. Parathyroid hormone

Answer 6

ANS: D
Parathyroid hormone is the major controller for blood calcium levels. Although calcitonin secretion is a counter-mechanism to parathyroid hormone, it does not play a major role in calcium balance. Catecholamine and thyroid hormone levels do not affect serum calcium level.

Question 7

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

Answer 7

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 TSH testing unless there is evidence of thyroid dysfunction. Deep palpation of the neck is not appropriate.

Question 8

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) level
d. Thyrotropin-releasing hormone (TRH) level

Answer 8

ANS: C
The most sensitive and accurate laboratory test is measurement of TSH; thus it is often recommended as a first diagnostic test for evaluation of thyroid function. A low TSH level indicates that the client’s 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

Question 9

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 nurse’s response?
a. Glucose levels 2 hours after a meal
b. Circulating, non-fasting glucose levels
c. Glucose control over the past 3 months
d. Hypoglycemic episodes in the past 90 days

Answer 9

ANS: C
Glycosylated hemoglobin testing measures glucose control over the last 3 months. Glucose testing after a meal or random testing may reveal impaired glucose tolerance and indicate prediabetes, but it is not done on clients who already have a diagnosis of diabetes. There is no test to evaluate for hypoglycemic episodes in the past.

Question 10

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 levels.

Answer 10

ANS: D
Spironolactone is a diuretic and it blocks aldosterone. Recalling that 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

Question 11

The nurse is teaching a client how to prepare for an oral glucose tolerance test (OGTT). Which of the following client response indicates that the teaching has been effective?
a. Fast 12 hours before the procedure
b. Clear fluid diet 12 hours prior to the test
c. Drink only full fluids 6 hours before the test
d. No fluid or food restrictions prior to the test

Answer 11

ANS: D
Fasting for 12 hours before the procedure demonstrates that teaching has been effective. The client is to be NPO 12 hours prior to the test. A clear fluid diet 12 hours pretest is not indicated. A full fluid diet 6 hours pretest is not indicated.

Question 12

A client is scheduled for a growth hormone stimulation test. Which of the following items should the nurse obtain in preparation for the test?
a. Basin of ice
b. Cardiac monitor
c. Vial of glargine insulin
d. Intravenous dextrose solution

Answer 12

ANS: D
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. Regular insulin is used to induce hypoglycemia (glargine is never given intravenously). The client 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.

Question 13

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

Answer 13

ANS: D
An example of the regulation of oxytocin during childbirth is an example of positive feedback. The positive feedback mechanism increases the target organ action beyond normal. The release of oxytocin is stimulated by pressure receptors in the vagina. As the fetus enters the vagina during childbirth, the pressure receptors sense increased pressure and signal the brain to release more oxytocin.

Question 14

The nurse is caring for a client who is scheduled for a 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 hours

Answer 14

ANS: A
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

Question 15

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

Answer 15

ANS: C
Part of the total calcium is bound to albumin, so hypoalbuminemia can lead to misinterpretation of calcium levels. Ionized calcium unaffected by albumin levels. The other laboratory values will not affect total calcium interpretation

Question 16

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

Answer 16

ANS: C
Tetany is associated with hypocalcemia. The other values would not be useful for this client in relation to tetany.

Question 17

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 5-kg weight gain in the last month.
c. Intake of 1 L of water an hour previously.
d. Oral corticosteroid use for rheumatoid arthritis

Answer 17

ANS: D
Corticosteroids can affect blood glucose results. The other information will be provided to the provider but will not affect the test result

Question 18

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. Administers nonmedicated eye drops to the client’s eyes.
d. Lowers the thermostat to decrease the temperature in the room

Answer 18

ANS: A
Palpation can cause the release of thyroid hormones in a client with an enlarged thyroid and should be avoided. The other actions by the new RN are appropriate when caring for a client with an enlarged thyroid

Question 19

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. 2.3 kg weight loss
c. Orthostatic hypotension
d. No change in urine osmolality

Answer 19

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.

Question 20

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 8.5 kg
d. History of ongoing headaches

Answer 20

ANS: B
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.