Assessment of the endocrine system Ch.56

Which hormone changes does the nurse expect when a client receives a continuous cortisol infusion for 24 hours when his or her endocrine feedback mechanisms are functioning normally? A. Lower than normal adrenocorticotropic hormone (ACTH) levels; lower than normal corticotropin-releasing hormone (CRH) levels B. Lower than normal adrenocorticotropic hormone (ACTH) levels; higher than normal corticotropin-releasing hormone (CRH) levels C. Higher than normal adrenocorticotropic hormone (ACTH) levels; lower than normal corticotropin-releasing hormone (CRH) levels D. Higher than normal adrenocorticotropic hormone (ACTH) levels; higher than normal corticotropin-releasing hormone (CRH) levels

A The release of CRH and ACTH is affected by the serum level of free cortisol acting through a negative feedback loop. The stimulus for release of CRH from the hypothalamus, which is responsible for stimulating the release of ACTH from the anterior pituitary gland, is a low blood level of cortisol. A continuous infusion of cortisol for 24 hours would be sensed by the hypothalamus as either adequate or elevated levels of cortisol, not low blood levels of cortisol. As a result, little if any CRH would be released from the hypothalamus and circulating levels would be lower than normal. With low levels of CRH, the anterior pituitary cells are not stimulated to release ACTH, this circulating levels of this hormone would also be lower than normal. Adequate or elevated blood levels of cortisol inhibit the release of CRH and ACTH.

Which serum electrolyte will the nurse need to monitor MOST closely after a client has surgery for total removal of the thyroid gland? A. Calcium B. Sodium C. Potassium D. Chloride

A The thyroid gland helps regulate serum calcium levels through the actions of thyrocalcitonin (TCT or calcitonin). Total removal of the thyroid gland disrupts this regulation. If the parathyroid glands are either damaged or removed along with the thyroid gland, parathyroid hormone production is also lost, resulting in even less regulation of serum calcium levels.

Which actions will the nurse suggest to an older client to PREVENT HARM as a result of decreased estrogen levels? Select All That Apply A. Use skin moisturizer daily. B. Drink at least 2 L of water daily. C. Increase your intake of calcium and vitamin D. D. Walk a mile a day at least four times per week. E. Be sure to urinate immediately after sexual intercourse. F. Wear socks and gloves when going outside in cool weather. G. Weigh yourself daily at the same time and wearing the same amount of clothing.

A, B, C, D, E Decreased estrogen level increase bone density loss, make skin drier and thinner, and increase the risk for cystitis. Weight-bearing activity and increasing intake of calcium and vitamin D can help slow this problem. Using skin moisturizer reduces dryness. Drinking at least 2 L of water daily and urinating immediately after intercourse help prevent cystitis. Wearing socks and gloves in cool weather does not prevent harm associated with decrease estrogen levels and neither does obtaining daily weights.

Which statements regarding endocrine function and hormones are correct? Select All That Apply A. All tissues and organs are affected by the endocrine system. B. Every hormone requires a receptor to modify the activities of its target tissue. C. Control over hormone secretion occurs through positive feedback mechanisms. D. Endocrine glands must be directly connected to their target tissues for efficient function. E. A tropic hormone from one endocrine gland has another endocrine gland as its target tissue. F. The body system that works most closely with the endocrine system to maintain homeostasis is the nervous system.

A, B, E, F The endocrine system works closely with the nervous system for physiologic regulation to maintain homeostasis. Every tissue and organ is affected by the endocrine system and each hormone recognizes its specific target tissue(s) by the presence of a membrane or intracellular receptor. The target tissue of a tropic hormone is another endocrine gland. Endocrine glands are not directly connected to their target tissues; they are ductless with hormones being secreted into the blood. Control over hormone synthesis and release occurs through negative feedback mechanisms in which a change in function occurs to stimulate the release of a hormone that will cause an action that is opposite to the change.

Which client assessment finding indicates to the nurse the need to assess further for a possible endocrine problem? A. Has taken oral contraceptives for more than 2 years B. Has lost 15lbs in the last 6 weeks without dieting C. Now needs to wear corrective lenses D. Father has prostate cancer

B An unintentional weight loss in excess of 5lbs is significant. It may indicate an increase in metabolic rate or a problem with excessive fluid loss, which could be associated with an endocrine disorder.

For which suspected client condition will the burse expect a needle biopsy of the thyroid gland to be performed in addition to imaging assessment? A. Hyperthyroidism B. Thyroid cancer C. Hypothermia D. Malnutrition

B Needle biopsy of the thyroid (and many other glands) is performed after the other types of assessment when the client is suspect to have cancer originating in that gland and surgery most likely will be needed.

Which selections will the nurse, in collaboration with a registered dietitian nutritionist, teach a client who has lower-than-normal level of thyroid hormones to increase in the diet? Select All That Apply A. Berries B. Cheese C. Protein D. Seafood E. Iodized salt F. Leafy green vegetables

B, C, D, E Production of thyroid hormones requires a diet containing adequate amounts of protein (for the amino acid tyrosine) and iodide or iodine. Goof food sources of protein include meat, fish, and dairy products. Dairy products and saltwater fish and seafood also contain iodine. Berries and leafy green vegetables contain very little protein or iodine/iodide.

Which problems does the nurse expect in an older adult as a result of age-related changes in endocrine function? Select All That Apply A. Increased basal metabolic rate (BMR) B. Decreased core body temperature C. Dehydration D. Diarrhea E. Hyperglycemia F Polyuria

B, C, E, F Th aging process generally causes a decline in the secretion of hormones from the endocrine glands, especially those of the thyroid, pancreas, and adrenal glands. Decreased thyroid hormone secretion causes a decrease in overall metabolism and basal metabolic rate. The slower metabolism results in lower core body temperatures and constipation. Decreased adrenal gland secretion limits the ability of the older adult to reabsorb water and sodium or to concentrate the urine. This condition increases the risk for dehydration. The decrease secretion of insulin from the pancreas and the decline in metabolism both results in hyperglycemia. When hyperglycemia is present, the osmolarity (osmolality) of blood increases, causing the adult to have increased thirst and to move interstitial and intracellular fluids into plasma volume, leading to polyuria.

Which hormone levels will the nurse expect to be deficient in a client who has undergone removal of the posterior pituitary gland? A. Insulin and glucagon B. Oxytocin and vasopressin C. Estrogen and testosterone D. Growth hormone and somatomedins

B. The posterior pituitary gland secretes oxytocin and vasopressin. These hormone levels would be decreased in a client who no longer had a functioning posterior pituitary gland. Growth hormone is secreted by the anterior pituitary gland as are the tropic hormones that control the secretion of estrogen and testosterone. Insulin and glucagon are secreted by islet cells in the pancreas and are unaffected by loss of posterior pituitary function.

Decreases of which hormone level does the nurse suspect may be responsible for a client's reduced catecholamine levels and decreased cardiac muscle excitability? A. Insulin B. Oxytocin C. Cortisol D. Glucagon

C Cortisol must be present for catecholamine (epinephrine, norepinephrine) action and maintaining the normal excitability of the heart muscle cells. These are not the actions of insulin, oxytocin, or glucagon.

Which precaution or action is MOST IMPORTANT for the nurse to teach the client who is to collect a 24-hour urine specimen for endocrine testing? A. Eat a normal diet during the collection period. B. Wear gloves when you urinate to prevent contamination of the specimen. C. Urinate at the end of the 24 hours and add that sample to the collection container. D. Avoid walking, running, dancing, or any vigorous exercise during the collection period.

C When a 24-hour urine specimen is started, the specimen should reflect all the urine during the specified time. The very first voiding is discarded because the urine has spent some time in the bladder and will not reflect what is happening during the actual 24 hours of the collection. The time of this discard is the beginning of the 24-hour collection period. The test requires that all urine voided after the start time be collected, including the specimen collected by emptying the bladder at the end of the 24 hours, which marks the end of the test.

What is the expected FIRST outcome of a hormone binding correctly to the receptor of its target tissue? A. Increased secretion of the hormone bound to the target tissue B. Decreased secretion of the hormone bound to the target tissue C. Increased specific function of the target tissue D. Decreased specific function of the target tissue

C. Correct binding of a hormone to its specific target tissue receptors FIRST changes the activity of the target tissue by increasing its action. Over time, the increase target tissue activity indicates a decrease need for the hormone and will result in a decrease secretion of the hormone.

Which change in appearance would the nurse expect to find in a client who has excessive production of melanocyte-stimulating hormone (MSH)? A. Acne B. Obesity C. Skin darkening D. Protruding eyes

C. MSH activates melanocytes to increase production of melanin, a pigmentation that darkens skin.

What effects on circulating levels of sodium and glucose does the nurse expect in a client who has been taking an oral cortisol preparation for 2 years because of a respiratory problems? A. Decreased sodium; decreased glucose B. Decreased sodium; increased glucose C. Increased sodium; decreased glucose D. Increased sodium; increased glucose

D Cortisol is a glucocorticoid and has some mineralocorticoid activity that increases the reabsorption of sodium from the kidney tubules, which increases the serum sodium level. Cortisol also increases liver production of glucose (gluconeogenesis) and inhibits peripheral glucose uptake by the cells. Both these actions increase blood glucose levels.

What action does the nurse AVOID TO PREVENT HARM when caring for a client with an enlarged thyroid gland who has indications of hyperthyroidism? A. Measuring blood pressure in either arm B. Urging the client to increase fluid intake C. Using excessive amounts of adhesive tape D. Touching or palpating the font of the neck

D If an enlarged thyroid gland is handled or palpated in a client with hyperthyroidism, large amounts of thyroid hormones could be released into the blood stream, leading to "thyroid storm" with exaggerated and severe symptoms of hyperthyroidism that are life-threatening. None of the other actions are likely to cause harm to a client with hyperthyroidism.

Which assessments are MOST IMPORTANT for the nurse to perform on an older adult client whose vasopressin levels are lower than normal? A. Vision and hearing B. Respiratory rate and depth C. Fasting blood glucose level D. Skin turgor and urine output

D Vasopressin is antidiuretic hormone (ADH) and promotes reabsorption of water. Lower than normal levels of ADH result in increased urine output leading to dehydration

Which client conditions will the nurse expect to stimulate the renin-angiotensin-aldosterone system (RAAS)? Select All That Apply A. Hypertension B. Hyperglycemia C. Hypokalemia D. Dehydration E. Hypoxemia F. Alkalemia

D, E Renin is produced by specialized cells of the kidney arterioles. Its release is triggered by a decrease in extracellular fluid volume from blood loss, sodium loss, or posture changes, and by hypoxemia. Renin converts renin substrate (angiotensinogen), a plasma protein, to angiotensin I. Angiotensin I is converted by an enzyme to form angiotensin II, the active form of angiotensin. In turn, angiotensin II stimulates that secretion of aldosterone. This system, although it cannot directly correct hypoxemia, causes the kidney to reabsorb sodium and water to bring the plasma volume and osmolarity back to normal and increase perfusion.

Which tissues or organs does the nurse expect will be elevated in a male client who begins to have fluid secretion from the breast? Select All That Apply A. Testes B. Posterior pituitary C. Adrenal medulla D. Hypothalamus E. Parathyroid F. Anterior pituitary

D, F Breast fluid/milk production is induced by the presence of prolactin, secreted from the anterior pituitary gland. The hypothalamus regulates secretion of prolactin through the activity of prolactin-inhibiting hormone. A problem in either the hypothalamus or the anterior pituitary gland can cause lactation in men or women (without being pregnant or giving birth).