CHAPTER 61 Assessment of the Endocrine System

A patient is asked to collect a 24-hour urine specimen. What does the nurse teach the patient to do for this test? -'Place the container in the refrigerator.' -'Save the specimen that begins the collection.' -'Discard the specimen that ends the collection.' -'Add preservative to the empty collection container.'

-'Add preservative to the empty collection container.'

The nurse is assessing a premenopausal patient who reports dryness of the perineal and vaginal tissues. What does the nurse suggest to the patient? Select all that apply. -'Drink at least 1 liter of fluid daily.' -'Avoid agents that cause skin dryness.' -'Perform perineal care at least twice daily.' -'Use vaginal lubricants during sexual activity.' -'Urinate immediately after sexual intercourse.'

-'Avoid agents that cause skin dryness.' -'Perform perineal care at least twice daily.' -'Use vaginal lubricants during sexual activity.' -'Urinate immediately after sexual intercourse.'

A patient with an endocrine disorder says, 'I can't, you know, satisfy my wife anymore.' What is the nurse's best response? -'How does she feel?' -'Don't worry. That is normal.' -'Can you please tell me more?' -'Should I make an appointment with a counselor?'

-'Can you please tell me more?'

The nurse is assessing a patient with a family history of type 2 diabetes. What does the nurse instruct the patient, considering the patient's risk for this disease? Select all that apply. -'Engage in regular exercise.' -'Consume a high-carbohydrate diet.' -'Include concentrated simple sugars in the diet.' -'Maintain body weight within 10 lb of ideal weight.' -'Report failure of a wound to heal in within less than 2 weeks.'

-'Engage in regular exercise.' -'Maintain body weight within 10 lb of ideal weight.' -'Report failure of a wound to heal in within less than 2 weeks.'

The nurse is instructing a patient who will undergo a suppression test. Which statement by the patient indicates that teaching was effective? -'I will be given more hormones as a trigger.' -'I am being tested to see whether my kidneys work at all.' -'I am being tested to see whether my hormone glands are hyperactive.' -'I am being tested to see whether my hormone glands are hypoactive.'

-'I am being tested to see whether my hormone glands are hyperactive.'

The nurse is assessing a patient for endocrine dysfunction. Which comment by the patient indicates a need for further assessment? -'I don't seem to have any stressors now.' -'My weight has been stable these past few years.' -'I am worried about losing my job because of cutbacks.' -'I don't have any patience with my kids. I lose my temper faster.'

-'I don't have any patience with my kids. I lose my temper faster.'

The registered nurse is teaching a nursing student about interventions for an older patient who has decreased ovarian function. Which nursing student statements are appropriate for this patient? Select all that apply. -'I should not provide lotion to the patient.' -'I should avoid pulling and dragging the patient.' -'I should teach the patient to engage in regular exercise.' -'I should assist the patient with performing perineal care twice daily.' -'I should review the patient's diet and ensure she is consuming enough calcium.'

-'I should avoid pulling and dragging the patient.' -'I should teach the patient to engage in regular exercise.' -'I should assist the patient with performing perineal care twice daily.' -'I should review the patient's diet and ensure she is consuming enough calcium.'

The nurse is teaching a patient about the correct procedure for a 24-hour urine test for creatinine clearance. Which statement by the patient indicates a need for further teaching? -'I won't save the first urine sample.' -'I should not eat any protein when I am collecting urine for this test.' -'I should keep the urine container cool in a separate refrigerator or cooler.' -'To end the collection, I must empty my bladder, adding it to the collection.'

-'I should not eat any protein when I am collecting urine for this test.'

The nurse is teaching a patient about maintaining a proper diet to prevent an endocrine disorder. The patient states that she does not like fish. What should the nurse teach the patient? -'Eat more red meat.' -'Eat more green vegetables.' -'Use iodized salt for cooking.' -'Use salt substitute for cooking.'

-'Use iodized salt for cooking.'

While reviewing the laboratory reports of a patient, the nurse notes decreased estrogen levels in the body. What will the nurse recommend to this patient? -'Restrict fluid intake.' -'Use skin moisturizers.' -'Minimize weight-bearing activities.' -'Urinate immediately before sexual intercourse.'

-'Use skin moisturizers.'

The nurse is caring for a female patient with decreased estrogen production. Which of the following statements indicates that the patient's caregivers understand the teaching provided? -'We will dress our mother warmly.' -'We should perform transfers carefully to avoid fractures.' -'We will watch for dark urine and increase fluids as needed.' -'Skin wounds that do not heal in one to two weeks will be reported to the physician.'

-'We should perform transfers carefully to avoid fractures.'

Which urine sample is used to test for the presence of hormones and their metabolites? -24-hour urine sample -First urine sample of the day -Urine sample without preservative -Urine sample obtained 2 hours after a meal

-24-hour urine sample

Which dietary habit may ultimately cause an endocrine disorder? -Use of iodized salt in food -Intake of 70 g of protein daily -Lack of concentrated simple sugars -Absence of saltwater fish and seafood

-Absence of saltwater fish and seafood

During a physical assessment, the nurse observes that a patient has dark-colored nails and patches on the skin. Which hormonal deficiency does the nurse anticipate? -Antidiuretic hormone (ADH) -Parathyroid hormone (PTH) -Thyroid-stimulating hormone (TSH) -Adrenocorticotropic hormone (ACTH)

-Adrenocorticotropic hormone (ACTH)

What action should the nurse take when caring for an older patient with decreased antidiuretic hormone (ADH) production? -Use minimal tape on the patient's skin. -Assess the patient frequently for dehydration. -Teach the patient to engage in regular exercises. -Assist the patient to change positions every 2 hours.

-Assess the patient frequently for dehydration.

The 'fight-or-flight' response is the result of the action of a hormone. Which hormone causes this response? -Calcitonin -Catecholamines -Thyroid-stimulating hormone (TSH) -Thyrotropin-releasing hormone (TRH)

-Catecholamines

A patient is hospitalized with a possible disorder of the adrenal cortex. Which nursing activity is best for the charge nurse to delegate to an experienced nursing assistant? -Ask about risk factors for adrenocortical problems. -Teach the patient how to do a 24-hour urine collection. -Assess the patient's response to physiologic stressors. -Check the patient's blood glucose levels every 4 hours.

-Check the patient's blood glucose levels every 4 hours.

A patient has suspected alterations in antidiuretic hormone (ADH) function. Which diagnostic test does the nurse anticipate will be requested for this patient? -Chest x-ray -Renal sonography -Cranial computed tomography (CT) -Adrenocorticotropic hormone (ACTH) suppression test

-Cranial computed tomography (CT)

Which assessment data does the nurse anticipate in a patient with decreased metabolism? -Thin and dry skin -Slow wound healing -Decreased heart rate -Decreased bone density

-Decreased heart rate

What are the functions of glucocorticoid hormones? Select all that apply. -Degrade collagen -Increase lipolysis -Decrease protein catabolism -Decrease liver gluconeogenesis -Increase the number of mature neutrophils

-Degrade collagen -Increase lipolysis -Increase the number of mature neutrophils

The nurse performs an admission history on a patient who reports restlessness, tremors, and intolerance to heat. The laboratory reports reveal increased production of the highly active thyroid hormone triiodothyronine (T3). The nurse recognizes that what history finding is the likely cause of the increased conversion of thyroxine (T4) to triiodothyronine (T3)? -Current atenolol therapy -Extended exposure to cold -Excessive exposure to dyes -Current prednisolone therapy

-Extended exposure to cold

The nurse is assessing the elimination patterns of a patient for endocrine disorders. Which finding warrants further investigation? -Urine that is light-yellow in color -Frequent urination during the night -Urine that has a distinct smell of ammonia -Urine that concentrates when fluid intake is low

-Frequent urination during the night

To best determine how well a patient with diabetes mellitus is controlling blood glucose, which test does the nurse monitor? -Urine glucose level -Fasting blood glucose -Oral glucose tolerance test -Glycosylated hemoglobin (HbA 1c)

-Glycosylated hemoglobin (HbA 1c)

A patient with hyperfunction of the anterior pituitary gland undergoes a suppression test. What result does the nurse expect? -Growth hormone is released. -The growth hormone level decreases. -Adrenocorticotropic hormone is suppressed. -The adrenocorticotropic hormone level decreases.

-Growth hormone is released.

How should the nurse conduct a thyroid assessment? Select all that apply. -Have the patient swallow sips of water. -Ask the patient to sit and lower the chin. -Auscultate an enlarged thyroid for bruits. -Palpate the thyroid by standing beside the patient. -Perform a vigorous palpation for correct assessment.

-Have the patient swallow sips of water. -Ask the patient to sit and lower the chin. -Auscultate an enlarged thyroid for bruits.

What is the function of follicle-stimulating hormone (FSH)? -Helps in lipolysis -Helps in spermatogenesis -Helps in water reabsorption -Helps in testosterone secretion

-Helps in spermatogenesis

Which statement is true about hormones and their receptor sites? -Hormones need a specific receptor site to work. -Hormone stores are available for activation until needed. -Hormones need to be plasma-bound to activate the receptor site. -Hormone activity is dependent only on the function of the receptor site.

-Hormones need a specific receptor site to work.

The diagnostic report of a patient reveals low levels of vasopressin. Which nursing teaching will provide symptomatic relief to the patient? -Use iodized salt. -Increase fluid intake. -Lower salt consumption. -Decrease sugar consumption.

-Increase fluid intake.

The nurse reviews the medical record of an older adult patient and notes assessment findings of frequent urination and white, foul-smelling discharge from the vagina, lethargy, poor wound healing, and above normal body weight. The nurse anticipates what laboratory level? -Elevated blood pressure -Reduced levels of estrogen -Decreased antidiuretic hormone -Increased levels of fasting blood glucose

-Increased levels of fasting blood glucose

Which statement about thyroid hormones is correct? -Iodide in the thyroid combines with tyrosine to form T 3 and T 4. -Thyroid hormone increases the production of white blood corpuscles. -Warm temperatures affect the conversion of thyroxine (T 4) to triiodothyronine (T 3). -Dietary intake of carbohydrates and iodine is required to produce thyroid hormones.

-Iodide in the thyroid combines with tyrosine to form T 3 and T 4.

What are the functions of thyroid hormones in adults? Select all that apply. -It increases bone formation. -It controls metabolic rates of all cells. -It increases bone resorption of calcium. -It increases the production of white blood cells. -It promotes pituitary secretion of growth hormones.

-It increases bone formation. -It controls metabolic rates of all cells. -It promotes pituitary secretion of growth hormones.

What is insulin's purpose in the body? -Increases lipolysis. -Lowers blood glucose levels. -Decreases glycogen synthesis. -Decreases fatty acid synthesis.

-Lowers blood glucose levels.

What diagnostic test is used to determine the composition of thyroid nodules in a patient? -Needle biopsy -Chromatographic assay -Computed tomography (CT) scan -Glycosylated hemoglobin (HbA 1C)

-Needle biopsy

Which hormone stimulates uterine contractions and ejection of breast milk? -Oxytocin -Prolactin (PRL) -Luteinizing hormone (LH) -Follicle-stimulating hormone (FSH)

-Oxytocin

Which statement about the regulation of calcium and vitamin D in the body is correct? -Vitamin D activates the parathyroid hormone. -Parathyroid hormone increases bone resorption. -Parathyroid hormone allows calcium to be excreted by the kidneys. -Parathyroid hormone decreases when serum calcium decreases.

-Parathyroid hormone increases bone resorption.

The charge nurse on the medical-surgical unit is making patient assignments for the shift. Which patient is the most appropriate to assign to an LPN/LVN? -Patient with possible pituitary adenoma who has just arrived on the nursing unit -Patient with exophthalmos who has many questions about endocrine function -Patient with Cushing's syndrome who requires orthostatic vital signs assessments -Patient with diabetes mellitus who was admitted with a blood glucose of 45 mg/dL

-Patient with Cushing's syndrome who requires orthostatic vital signs assessments

What is the role of glucocorticoid hormones in controlling blood glucose? -Preventing hypoglycemia -Controlling insulin secretion -Preventing carbohydrate metabolism -Promoting the use of peripheral glucose

-Preventing hypoglycemia

A lactating woman states she is not producing enough milk and having difficulty releasing milk when feeding her infant. After assessing the laboratory reports, the nurse observes an imbalance in the hormonal levels. Which hormonal imbalances may be responsible for this condition? Select all that apply. -Prolactin -Oxytocin -Estrogen -Vasopressin -Luteinizing hormone (LH) -Follicle-stimulating hormone (FSH)

-Prolactin -Oxytocin

A patient experiences severe blood loss from multiple wounds, resulting in hypovolemic shock. The nurse recognizes that it is important that sodium and water be reabsorbed in the patient's body. Which specialized renal afferent arteriolar cells trigger the release of the major mineralocorticoid from the adrenal cortex to promote the reabsorption? -Renin -Androgens -Epinephrine -Norepinephrine

-Renin

The nurse is reviewing the laboratory test results for a patient admitted with a possible pituitary disorder. Which information has the mostimmediate implication for the patient's care? -Blood glucose 125 mg/dL -Serum sodium 110 mEq/L -Serum potassium 5.2 mEq/L -Blood urea nitrogen (BUN) 40 mg/dL

-Serum sodium 110 mEq/L

The nurse assesses the skin and hair of a patient for endocrine disorders. Which finding is a cause for concern? -There is no long-standing unhealed wound. -There is no significant change in the texture of the hair. -The patient has not experienced a change in shaving pattern. -Skin over the finger joints and elbows shows hyperpigmentation.

-Skin over the finger joints and elbows shows hyperpigmentation.

What common assessment finding may indicate the presence of diabetes mellitus? -Hirsutism -Slow wound healing -Thickness of fingernails -Pigmentation of mucous membranes

-Slow wound healing

What manifestations of hypothyroidism does the nurse assess for in the older patient? Select all that apply. -Slowed speech -Decreased appetite -Decreased cognition -Poor tolerance to the cold -Decreased body temperature

-Slowed speech -Decreased cognition -Poor tolerance to the cold -Decreased body temperature

What are the actions of oxytocin? Select all that apply. -Stimulates ovulation -Stimulates spermatogenesis -Promotes water reabsorption -Stimulates uterine contractions -Promotes ejection of breast milk

-Stimulates uterine contractions -Promotes ejection of breast milk

A patient is scheduled for urine analysis for endocrine testing. Which teaching will the nurse provide? -Avoid placing the specimen in ice. -Add preservative after the collection. -Save the urine specimen at the beginning of the collection. -Stop the collection of urine after the allotted 24-hour time period.

-Stop the collection of urine after the allotted 24-hour time period.

A patient reports hair loss, sudden weight gain, and intolerance to cold. Which lab test does the nurse anticipate the health care provider will order? -Estrogen levels -Blood glucose levels -Thyroid hormone levels -Antidiuretic hormone (ADH) levels

-Thyroid hormone levels

What does the nurse teach the patient to prevent thyroid-related problems? -Avoid saltwater fish in the diet. -Include at least 30 g of protein daily. -Use iodized salt when preparing food. -Include concentrated simple sugars in the diet.

-Use iodized salt when preparing food.

Which hormone does the posterior pituitary gland secrete? -Prolactin -Vasopressin -Thyroid-stimulating hormone -Corticotropin-releasing hormone

-Vasopressin

Arrange the steps in the production of thyroid hormone in the order in which they occur. 1. Hormones are stored in the follicular cells of the thyroid gland. 2. Triiodothyronine (T 4) and thyroxine (T 3) are formed. 3. Iodide combines with tyrosine. 4. Hormones bind to thyroglobulin. 5. The thyroid gland withdraws and concentrates iodide in the blood.

1. The thyroid gland withdraws and concentrates iodide in the blood. 2. Iodide combines with tyrosine. 3.Triiodothyronine (T 4) and thyroxine (T 3) are formed. 4. Hormones bind to thyroglobulin. 5.Hormones are stored in the follicular cells of the thyroid gland.

The nurse is assessing a patient who presents with excessive sweating following a motor vehicle crash. What causes this aspect of the 'fight-or-flight' response in the patient? -Action of epinephrine on beta-adrenergic receptors -Action of epinephrine on alpha-adrenergic receptors -Action of norepinephrine on beta-adrenergic receptors -Action of norepinephrine on alpha-adrenergic receptors

Action of norepinephrine on alpha-adrenergic receptors

Which gland releases catecholamines? Adrenal Thyroid Pancreas Parathyroid

Adrenal

Which endocrine gland produces growth hormone (GH)? Thyroid Hypothalamus Anterior pituitary Posterior pituitary

Anterior pituitary

The nurse should encourage fluids every 2 hours for older adult patients because of a decrease in which factor? -Glucose tolerance -General metabolism -Ovarian production of estrogen -Antidiuretic hormone (ADH) production

Antidiuretic hormone (ADH) production

Parathyroid hormone (PTH) regulates calcium and phosphorus metabolism by acting on which tissues? Select all that apply. Bones Liver Kidneys Pancreas Gastrointestinal (GI) tract

Bones Kidneys Gastrointestinal (GI) tract

What assessment finding should the nurse expect if the patient has an enlarged thyroid? Bruits Dehydration Dysrhythmias Thyroid storm

Bruits

The diagnostic report of a patient who had a fracture due to a minor fall reveals hypocalcemia. Which hormone level depletion does the nurse anticipate has contributed to the fracture? Insulin Cortisol Glucagon Calcitonin

Calcitonin

Catecholamines act on target cells in all areas of the body. Which hormone must be present for catecholamines to work? Renin Cortisol Aldosterone Angiotensin

Cortisol

A patient with reduced bone density and dry, thinner skin due to a decrease in the production of estrogen by the ovaries discusses her lifestyle with the nurse who is assessing her. Which patient actions require nursing teaching? Select all that apply. -Uses skin moisturizers -Avoids excess use of skin tapes -Drinks at least 1 L of water a day -Avoids weight-bearing exercises -Takes a daily calcium supplement

Drinks at least 1 L of water a day Avoids weight-bearing exercises

Which laboratory finding is associated with hyperaldosteronism? Elevated sodium levels Decreased urine output Elevated potassium levels Decreased blood pressure

Elevated sodium levels

Which hormone deficiency does the nurse anticipate in a patient just diagnosed with osteoporosis? Insulin Estrogen Thyroxine Vasopressin

Estrogen

Which negative feedback response is responsible for preventing hypoglycemia during sleep in nondiabetic patients? Insulin release Glucagon release Beta cells of the pancreas Alpha cells of the pancreas

Glucagon release

In type 1 diabetes, insulin injections are necessary to maintain which action between insulin and glucose? Homeostasis Insulin intolerance Negative feedback Glucose intolerance

Homeostasis

What is the function of somatostatin? -Controls release of insulin -Increases blood glucose levels -Promotes the storage of carbohydrates -Inhibits release of insulin and glucagon

Inhibits release of insulin and glucagon

Which hormone is released when blood glucose levels are elevated? Insulin Glucagon Vasopressin Testosterone

Insulin

A patient is diagnosed with thyroid-related problems. What does the nurse teach the patient to include in the diet to stimulate the production of thyroid hormones? Select all that apply. Fats Iodine Sodium Proteins Carbohydrates

Iodine Proteins

Which hormone helps control the body's sodium and potassium content? Thyroxine Glucocorticoids Catecholamines Mineralocorticoids

Mineralocorticoids

The nurse is caring for a female patient who is complaining about frequent urination at night. How does the nurse document this condition? Dysuria Nocturia Oliguria Hematuria

Nocturia

Which hormone acts on both the uterus and mammary glands to promote the stimulation of uterine contractions and ejection of breast milk? Prolactin Oxytocin Vasopressin Luteinizing hormone (LH)

Oxytocin

A patient reports numbness and tingling sensation in the feet. The diagnostic report of the patient revealed hypocalcemia. Which hormonal imbalance does the nurse anticipate? Insulin Glucagon Parathyroid hormone (PTH) Antidiuretic hormone (ADH)

Parathyroid hormone (PTH)

Which hormone stimulates the production of breast milk? Oxytocin Prolactin (PRL) Growth hormone (GH) Luteinizing hormone (LH)

Prolactin (PRL)

What symptom may indicate decreased glucose tolerance? Dry, thin skin Low bone density Slow wound healing Decreased heart rate

Slow wound healing

Which hormone inhibits the secretion of insulin from the pancreas? Gastrin Secretin Glucagon Somatostatin

Somatostatin

What action by the patient helps the nurse to palpate the thyroid gland? Raising the chin Looking upward Swallowing sips of water Turning the head to the left

Swallowing sips of water

What tissue does luteinizing hormone target? Select all that apply. Testes Bones Ovaries Thyroid Melanocytes

Testes Ovaries

The laboratory report of a patient reveal an imbalance in calcium and phosphorous levels. Which gland does the nurse suspect is functioning abnormally? Ovaries Thyroid Parathyroid Adrenal cortex

Thyroid

Which hormone promotes water reabsorption? Insulin Vasopressin Progesterone Luteinizing hormone

Vasopressin

Which pituitary hormone promotes water reabsorption? Prolactin Oxytocin Thyrotropin Vasopressin

Vasopressin

In a head-to-toe assessment of a patient, how does the nurse document areas of pigmented loss on the neck and face with increased pigmentation at the edges? Vitiligo Striae Hirsutism Exophthalmos

Vitiligo

What manifestation is common in a patient with hypofunction of the adrenal glands? Striae Vitiligo Buffalo hump Truncal obesity

Vitiligo