Chapter 40: Assessment of Endocrine Function

The nurse notes that a patient's aldosterone level is elevated. Which structure is responsible for controlling this hormone? 1) Thyroid 2) Hypothalamus 3) Adrenal cortex 4) Adrenal medulla

3 Aldosterone is the primary mineralocorticoid secreted from the adrenal cortex.

The nurse is conducting a physical assessment of a patient's endocrine system. What should the nurse include with auscultation? 1) Lung sounds 2) Bowel sounds 3) Carotid arteries 4) Abdominal aorta

3 Because of the increased vascularity associated with hyperthyroidism, the nurse also listens over the carotid arteries for carotid bruits.

A patient with an endocrine disorder is being considered for diagnostic tests. What test should the nurse expect to be prescribed for this patient? 1) CT scan 2) Urinalysis 3) Sedimentation rate 4) Hemoglobin and hematocrit

1 Computed tomography (CT) is used to confirm abnormalities of the endocrine glands.

The nurse is preparing to complete a physical assessment on a patient's endocrine system. Which gland should the nurse prepare to palpate? 1) Testes 2) Ovaries 3) Pancreas 4) Parathyroid

1 The nurse uses palpation to assess the testes and evaluate for size, symmetry, shape, and any nodules or changes in texture.

A patient is being evaluated for elevated levels of antidiuretic hormone (ADH). What findings would cause ADH to be secreted? Select all that apply. 1) Dehydration 2) Decreased heart rate 3) Decreased blood pressure 4) Increased serum osmolarity 5) Elevated blood glucose level

134 Antidiuretic hormone is secreted in response to dehydration, decreased BP, and increased serum osmolarity

A patient's cortisol level is elevated. How will this elevation affect the patient? Select all that apply. 1) Alteration in fat metabolism 2) Enhance secretion of sodium 3) Alteration in protein metabolism 4) Alteration in carbohydrate metabolism 5) Suppression of the immune response

1345 Glucocorticoids cause reabsorption of sodium.

The nurse is planning to assess a patient's endocrine system. What should be included in this assessment? 1) Lung sounds 2) Body weight 3) Bowel sounds 4) Peripheral pulses

2 Because the endocrine system affects homeostasis and metabolic activity, the nurse must assess changes in body weight.

A 60-year-old patient asks why endocrine testing is being done. Which is the best response for the nurse to make? 1) "Endocrine organs atrophy with aging." 2) "Endocrine function can change through the lifespan." 3) "Endocrine function remains the same through the lifespan." 4) "Endocrine testing identifies which hormone replacement therapy you will need."

2 Changes in endocrine function are associated with aging, and early detection and treatment can minimize long-term consequences.

The nurse notes that an older patient is wearing a sweater and scarf on a warm summer day. What should this observation indicate to the nurse? 1) The patient's target organs are diseased. 2) The patient's metabolism is slowing down. 3) The patient needs hormone replacement therapy. 4) The patient's endocrine organs are malfunctioning.

2 Decreased metabolism is associated with susceptibility to cold intolerance.

An older patient's fluid balance record shows a significant increase in urine output over the last few weeks with no other reported clinical symptoms. For which potential health problem should the nurse plan care for this patient? 1) Diabetes 2) Dehydration 3) Hyponatremia 4) Urinary tract infection

2 Decreased synthesis of antidiuretic hormone in the older adult is associated with increased urine frequency and dilute urine, leading to an increased risk of dehydration.

The nurse is preparing a teaching tool that focuses on the endocrine system. How should the nurse explain the negative feedback system? 1) Hormone secretion increases when circulating levels drop. 2) Hormone secretion increases when target organs send signals. 3) Hormone secretion increases when circulating levels increase. 4) Hormone secretion increases when the target tissue does not recognize the level.

2 Increasing hormone secretion when the target organ send signals does not describe a negative feedback system.

The nurse is preparing a teaching tool on the major hormones of the body for a community program. Which gland should the nurse identify as controlling calcium levels in the body? 1) Thyroid 2) Parathyroid 3) Hypothalamus 4) Posterior pituitary

2 Thyrocalcitonin (calcitonin) has a role in the regulation of calcium, along with parathyroid hormone (PTH; parathormone secreted from the parathyroid glands).

A patient's vitamin D level is below normal. Which endocrine gland will need additional investigation? 1) Thyroid 2) Parathyroid 3) Hypothalamus 4) Anterior pituitary

2 Vitamin D levels are decreased in hypoparathyroidism. The parathyroid glands need further examination.

A patient is experiencing dysfunction of the hypothalamus. Which hormones will be affected by this dysfunction? Select all that apply. 1) Follicle-stimulating hormone (FSH) 2) Thyrotropin-releasing hormone (TRH) 3) Corticotropin-releasing hormone (CRH) 4) Gonadotropin-releasing hormone (Gn-RH) 5) Growth hormone-releasing hormone (GHRH)

2345 FSH is controlled by the anterior pituitary gland.

A patient is diagnosed with insufficient growth hormone. What effects will this have on the patient? Select all that apply. 1) Change in hair color 2) Alteration in bone density 3) Sluggish protein synthesis 4) Increased use of fatty acids 5) Increase in circulating blood glucose

2345 Melanocyte-stimulating hormone from the anterior pituitary gland affects skin and hair color. Growth hormone is necessary for maintaining bone density. Growth hormone facilitates protein synthesis. Growth hormone increases the use of fatty acids. Growth hormone affects blood glucose levels by decreasing the use of glucose for energy.

An older patient with several chronic diseases asks why some of the health problems are being caused by hormone imbalances. What explanation should the nurse provide to this patient? 1) "The hormone imbalance caused the chronic disease." 2) "The chronic diseases exposed the underlying hormone imbalance." 3) "Other health problems can affect the normal production and response of hormones." 4) "The treatment for the chronic diseases adversely affected the organs and hormone production."

3 Chronic disease may affect hormone production and tissue response.

A patient has not eaten for 18 hours because of diagnostic testing. Which pancreatic hormone is maintaining this patient's blood glucose level? 1) Insulin 2) Cortisol 3) Glucagon 4) Epinephrine

3 In response to low blood glucose levels, the hormone glucagon is released from the pancreatic alpha cells. Glucagon stimulates production and release of glucose from glycogen stores in the liver leading to increased blood glucose levels.

The nurse notes that a patient has a tumor on the thyroid gland. Where should the nurse expect to palpate this tumor? 1) Anteriorly below the chin 2) At the level of the clavicle 3) Below the cricoid cartilage 4) Slightly above the angle of Louis

3 Located in the anterior neck, the thyroid gland lies directly below the cricoid cartilage.

An adolescent is experiencing delayed puberty. Which gland function should be evaluated? 1) Pancreas 2) Adrenal cortex 3) Anterior pituitary 4) Posterior pituitary

3 Sexual development and function are controlled by hormones secreted from the ovaries and testes. Both glands are controlled by tropic hormones released from the anterior pituitary gland.

A patient is diagnosed with a disorder of the hypothalamus. To which other gland is this structure attached? 1) Thyroid 2) Thalamus 3) Pituitary gland 4) Adrenal glands

3 The hypothalamus is connected to the pituitary gland by the infundibulum.

The nurse is preparing to palpate a patient's thyroid gland. Which technique should be used for this assessment? 1) Palpate the left lobe with the patient's head turned to the right 2) Palpate the right lobe with the patient's head turned to the left 3) Stand behind the patient and place fingers on both sides of the neck 4) Stand in front of the patient and palpate the lobes when the patient swallows

3 The thyroid gland may be best palpated by standing behind the patient. The thumbs of both hands are placed on the back of the neck, and the fingers are curved to the front of the neck on either side of the trachea.

The nurse suspects that a patient's beta 2 receptors are being stimulated. What did the nurse assess to make this clinical determination? Select all that apply. 1) Diaphoresis 2) Dilated pupils 3) Warm dry skin 4) Urinary incontinence 5) Elevated blood pressure

345 Alpha receptors affect sweating and pupil dilation

The nurse suspects that an older patient's new diagnosis of hypothyroidism is caused by downregulation. How should the nurse explain this to the patient? 1) "The organ making the hormones is degenerating." 2) "The strength of the hormones being synthesized is weaker." 3) "The body becomes confused about the purpose of the hormones. 4) "There are fewer receptors on the surface of target tissues."

4 Some of the endocrine changes associated with age are secondary to hypoactive function of endocrine glands secondary to downregulation or a decreased number of receptors on the surface of the target tissue.

A patient is having a test to suppress cortisol levels. Which response suggests that additional testing of the adrenal cortex would be required? 1) Increase in urine output 2) Increase in cortisol level 3) Decrease in cortisol level 4) No change in cortisol level

4 Suppression tests are indicated when there are excess levels of circulating hormone. When levels of circulating hormone do not decrease with suppression testing, hyperfunction of the gland is indicated.

Upon inspection the nurse notes that a patient's face is puffy. Which endocrine gland should the nurse assess for function? 1) Thyroid 2) Pancreas 3) Parathyroid 4) Adrenal cortex

4 With elevated levels of cortisol, the nurse may note puffiness of the face. Cortisol is the main glucocorticoid controlled by the adrenal cortex.

The nurse correlates which findings to age-related changes of the endocrine system in a 55-year-old female? (Select all that apply.) A. Breast enlargement B. Decreased libido C. Increased sweating D. Vaginal dryness E. Insomnia

Answer: B, D, and E Rationale: Changes in release of reproductive hormones may lead to problems with sexual functioning, including erectile dysfunction in men and decreased libido in women. Bone density decrease, thinning and drying of the skin, and perineal and vaginal dryness are all associated with advancing age. Decreased metabolism is associated with decreased appetite, susceptibility to cold intolerance, changes in the quality of sleep, and decreased resting pulse rate and blood pressure.

Which thyroid hormone value does the nurse correlate to primary hyperthyroidism? A. Elevated TRH B. Elevated TSH C. Elevated T3 D. Elevated thyrocalcitonin

Answer: C Rationale: Because primary hyperthyroidism is an excess secretion of thyroid hormones, both T3 and T4 levels are elevated. In primary hyperthyroidism, both TRH and TSH are decreased due to elevated thyroid hormones. Thyrocalcitonin secretion is based upon serum calcium levels.

A patient is undergoing a stimulation test to assess adrenal function. After the administration of cortisol, which laboratory result indicates normal function? A. Decreased blood glucose B. Decreased serum sodium C. Decreased serum potassium D. Decreased serum calcium

Answer: C Rationale: Cortisol leads to increased reabsorption of sodium and excretion of potassium. Cortisol also leads to increased serum glucose. Calcium is primarily controlled by parathormone (PTH) from the parathyroid gland.

The nurse assesses for which of the following in the patient with hypersecretion of parathyroid hormone (PTH)? A. Increased serum sodium B. Increased serum glucose C. Increased serum calcium D. Increased serum potassium

Answer: C Rationale: Parathyroid hormone increases serum calcium by increasing bone resorption, reabsorption of calcium in the kidneys, and activation of vitamin D which increases intestinal reabsorption of calcium.

The nurse correlates an increase in the secretion of which hormone as a result of the release of TRH? A. Triiodothyronine (T3) B. Thyroxine C. Thyroid stimulating hormone (TSH) D. Thyrocalcitonin

Answer: C Rationale: Thyroid stimulating hormone (TSH) is released from the anterior pituitary gland in response to secretion of thyroid releasing hormone (TRH) from the hypothalamus. Triiodothyronine (T3), Thyroxine, and Thyrocalcitonin are released from the thyroid glands.

The nurse correlates an increase in the secretion of cortisol to an increase in the release of which of the following hormones? A. Growth hormone B. Epinephrine C. Corticotropin-releasing hormone D. Adrenocorticotropic hormone

Answer: D Rationale: Adrenocorticotropic hormone (ACTH) increases secretion of glucocorticoids and mineralocorticoids, and cortisol is the primary glucocorticoid. Growth hormone is controlled by secretion of growth hormone-releasing hormone (GHRH) and growth hormone-inhibiting hormone (somato- statin; GHIH) from the anterior pituitary gland. Epinephrine is released from the adrenal medulla. Corticotropin-releasing hormone secretion from the hypothalamus increases release of ACTH from the anterior pituitary gland.

In a patient with a secondary disorder of the thyroid gland, the nurse assesses for changes in function in which structure? A. Thyroid gland B. Hypothalamus C. Posterior pituitary gland D. Anterior pituitary gland

Answer: D Rationale: Primary endocrine disorders involve the endocrine gland (thyroid glands in this example). Secondary disorders result from malfunction of the anterior pituitary gland, and tertiary disorders result from malfunction of the hypothalamus. The posterior pituitary gland secretes antidiuretic hormone (vasopressin) and oxytocin.

In order to better locate the isthmus of the thyroid gland in preparation for palpation, the nurse asks the patient to perform which action? A. "Say 'ah.'" B. "Touch your chin to your chest." C. "Look at the ceiling." D. "Swallow a sip of water."

Answer: D Rationale: The nurse uses palpation to assess the thyroid glands. The thyroid gland may be best palpated by standing behind the patient. The thumbs of both hands are placed on the back of the neck, and the fingers are curved to the front of the neck on either side of the trachea. The patient is asked to swallow, and the nurse locates the isthmus by feeling it rise when the patient swallows.

The nurse recognizes that the negative feedback system causes which change secondary to increased T3 and T4? A. Increased TRH B. Decreased TSH C. Increased parathormone D. Decreased thyrocalcitonin

Answer: B Rationale: With elevated circulating levels of thyroid hormones (T3 and T4), the hypothalamus decreases the secretion of thyroid releasing hormone (TRH) and the anterior pituitary gland decreases secretion of thyroid stimulating hormone (TSH). Parathormone is secreted by the parathyroid gland when serum calcium levels are low. Thyrocalcitonin secretion from the thyroid gland increases or decreases based upon serum calcium levels.

The nurse correlates which effects to the stimulation of alpha receptors? (Select all that apply.) A. Increased heart rate B. Vasoconstriction C. Bronchiole relaxation D. Pupil dilation E. Increased gastrointestinal motility

Answer: B and D Rationale: Alpha receptors lead to vasoconstriction, pupil dilation, increased sphincter tome, increased sweating, and increased gluconeogenesis. Stimulation of Beta1 increases heart rate, and stimulation of Beta2 leads to bronchial dilation. Gastric motility is influenced by beta receptors.

Which hormones are released from the posterior pituitary gland? (Select all that apply). A. Aldosterone B. Antidiuretic hormone C. Follicle-stimulating hormone D. Luteinizing hormone E. Oxytocin

Answer: B and E Rationale: Antidiuretic hormone and oxytocin are released from the posterior pituitary gland. Aldosterone is secreted from the adrenal cortex. The anterior pituitary gland secretes two gonadotropins (hormones that stimulate the gonads), follicle-stimulating hormone (FSH) and luteinizing hormone (LH) that have major roles in female and male reproductive functions.

Which statement by a patient diagnosed with a primary thyroid disorder indicates the need for further teaching? A. "Having a brain tumor is so scary." B. "My thyroid gland is not working." C. "Now I understand why the nurse keeps measuring my neck." D. "My energy level may be affected by this disorder."

Answer: A Rationale: A primary disorder of thyroid function is caused by a malfunction of the thyroid glands. Secondary thyroid disorders are related to malfunction of the anterior pituitary gland, and tertiary disorders are related to hypothalamic malfunction. Patients with brain tumors may have tumor growth in the hypothalamus (tertiary) or pituitary gland (secondary).

Increased secretion of ADH results in which action? A. Decreased urine output B. Increased urine output C. Decreased serum potassium D. Increased serum potassium

Answer: A Rationale: Secretion of antidiuretic hormone (ADH) results in decreased urinary output. A lack of ADH leads to an increase in urinary output. Mineralocorticoids and glucocorticoids lead to excretion of potassium in the kidneys, so an increase in either hormone may lead to hypokalemia.

In assessing a patient with an alteration in thyroid function, the nurse must understand that TRH release is from which structure? A. Hypothalamus B. Anterior pituitary gland C. Posterior pituitary gland D. Thyroid gland

Answer: A Rationale: Thyroid function is controlled through the coordinated activities of the hypothalamusthat secretes TRH what in turn acts on the anterior pituitary.

In caring for a patient with elevated secretion of triiodothyronine and thyroxine, the nurse assesses for which findings? (Select all that apply.) A. Increased heart rate B. Increased gastric motility C. Increased cholesterol D. Increased urine output E. Increased respiratory rate

Answer: A, B, and E Rationale: Actions of thyroid hormones (triiodothyronine and thyroxine) lead to increased heart rate, increased gastric motility, increased respiratory rate, as well as overall increase in metabolic activity. These hormones also decrease production of cholesterol and phospholipids. Urinary output is more related to release of antidiuretic hormone.

Which clinical manifestation observed in Ms. Johnson does the nurse correlate to elevated levels of thyroid hormone? A. Lethargy B. Insomnia C. Dry skin D. Constipation

Answer: B Rationale: Ms. Johnson has an acceleration of metabolism which can lead to hyperexcitability and insomnia. Lethargy, dry skin, and constipation are associated with hypothyroidism secondary to decreased metabolic rate.

Case Study

The nurse practitioner begins a work-up for thyroid dysfunction for Greta Johnson. On the basis of her clinical presentation, hyperthyroidism is suspected. The laboratory results reveal increased levels of T3 and T4 with decreased levels of TSH. A tentative diagnosis of primary hyperthyroidism is made, and Greta is referred for further evaluation and treatment.