Chapter 61 - Assessment of the Endocrine System

The nurse should encourage fluids every 2 hours for older adult clients because of a decrease in which factor? A.Antidiuretic hormone (ADH) production B.General metabolism C.Glucose tolerance D.Ovarian production of estrogen

A A decrease in ADH production causes urine to be more dilute, so urine might not concentrate when fluid intake is low. The older adult is at greater risk for dehydration as a result of urine loss. A decrease in general metabolism causes decreased tolerance to cold, decreased appetite, and decreased heart rate and blood pressure; it is not related to fluid intake or hydration. A decrease in glucose tolerance does not affect fluid intake or hydration. A decrease in estrogen production causes a decrease in bone density and is not related to fluid intake and hydration.

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

A Suppression tests are used when hormone levels are high or in the upper range of normal. Failure of suppression of hormone production during testing indicates hyperfunction. A stimulation test assesses whether hormone glands are hypoactive. The adrenal glands are endocrine glands that are located on the kidneys; a suppression test does not measure kidney function. Hormones are given as a trigger in a stimulation test.

Which gland releases catecholamines? A.Adrenal B.Pancreas C.Parathyroid D.Thyroid

A The adrenal medulla releases catecholamines in response to stimulation of the sympathetic nervous system. The principal hormones of the pancreas are insulin, glucagon, and somatostatin. Parathyroid hormone is the principal hormone of the parathyroid gland. Triiodothyronine (T3), thyroxine (T4), and calcitonin are the principal hormones of the thyroid.

17. The nurse is teaching a client about self-care after menopause. Which teaching topic is the priority? a.Weight-bearing exercise b.Skin care c.Intimacy needs d.Body image changes

ANS: A After menopause, the ovaries produce less estrogen. This leads to decreased bone mass. The client should engage in regular weight-bearing exercise to prevent fractures. The other topics are appropriate but do not take priority over safety needs.

3. A client has a deficiency of aldosterone. Which assessment finding does the nurse correlate with this condition? a.Increased urine output b.Vasoconstriction c.Blood glucose, 98 mg/dL d.Serum sodium, 144 mEq/L

ANS: A Aldosterone, the major mineralocorticoid, maintains extracellular fluid volume. It promotes sodium and water reabsorption and potassium excretion in the kidney tubules. A client with an aldosterone deficiency will have increased urine output. Sodium and potassium levels are normal; in aldosterone deficiency, the client would have hyponatremia and hyperkalemia. Vasoconstriction is not related.

6. A client is admitted to the hospital with exacerbation of heart failure, which had been stable for several years. Which finding does the nurse associate with the client's current condition? a.Recent prescription for thyroid hormone replacement medication b.Recent onset of menopause c.Patchy areas of depigmentation on the face d.Absence of fish in the diet, but inclusion of the iodized form of table salt

ANS: A Thyroid hormones regulate metabolism. Starting on thyroid replacement therapy can lead to an increase in heart rate and tissue oxygen use, which can lead to an exacerbation of heart failure if the client's heart is not able to meet these increased demands. Menopause and vitiligo (depigmentation of the skin) would not be related. Thyroid function is needed to produce thyroid hormones. The client who does not eat shellfish should use iodized table salt.

11. A client has bilateral patchy areas of skin depigmentation on the arms and the face. Which action by the nurse is best? a.Assess the client's mucous membranes. b.Draw a laboratory specimen for thyroid hormone levels. c.Schedule the client for fasting blood glucose. d.Question the client about sexual functioning.

ANS: A Vitiligo, patchy areas of depigmentation of the skin, is associated with primary hypofunction of the adrenal glands. Other assessment findings in this condition include uneven pigmentation on the mucous membranes. The other assessments are not related to vitiligo.

1. Which are common key features of hormones? (Select all that apply.) a.Hormones may travel long distances to get to their target tissues. b.Continued hormone activity requires continued production and secretion. c.Control of hormone activity is caused by negative feedback mechanisms. d.Most hormones are stored in the target tissue for use later. e.Most hormones cause target tissues to change activities by changing gene activity.

ANS: A, B, C Hormones are secreted by endocrine glands and travel through the body to reach their target tissues. Hormone activity can increase or decrease according to the body's needs, and continued hormone activity requires continued production and secretion. Control is maintained via negative feedback. Hormones are not stored for later use, and they do not alter genetic activity.

2. A client has a hypofunctioning anterior pituitary gland. Which hormones does the nurse expect to be affected by this? (Select all that apply.) a.Thyroid-stimulating hormone b.Vasopressin c.Follicle-stimulating hormone d.Calcitonin e.Growth hormone

ANS: A, C, E Thyroid-stimulating hormone, follicle-stimulating hormone, and growth hormone all are secreted by the anterior pituitary gland. Vasopressin is secreted from the posterior pituitary gland. Calcitonin is secreted from the thyroid gland.

16. An older client is being admitted to the hospital for pneumonia. The client has no other health problems. Which action by the nurse is best? a.Place the client on airborne precautions. b.Offer the client fluids every hour or two. c.Leave the bathroom light on at night. d.Palpate the client's thyroid gland on admission.

ANS: B A normal age-related endocrine change is decreased antidiuretic hormone (ADH) production. This results in a more dilute urine output, which can lead to dehydration. If no contraindications are known, the nurse should offer (or delegate) the client something to drink at least every 2 hours. A client with a simple pneumonia would not need Airborne Precautions. The client may or may not need/want the bathroom light left on at night. Palpating the client's thyroid gland is a part of a comprehensive examination but is not specifically related to this client.

14. A female client with an endocrine problem has hirsutism. Which question or statement by the nurse is most appropriate? a."Do you have the money to pay for treatment?" b."I'm interested in knowing how you feel about yourself." c."Many treatment options are available for this problem." d."What can you do to prevent this from happening?"

ANS: B Hirsutism, excessive hair growth on the face and body, can result from endocrine disorders. This may cause a disruption in body image, especially for female clients. The nurse should gently inquire into the client's body image and self-perception. Asking about the client's financial status sounds judgmental. Simply stating that treatment options are available minimizes the client's concerns. The client is not doing anything to herself to cause the problem, so the last question is inappropriate.

A client is taking a drug that blocks a hormone's receptor site. What is the effect on the client's hormone response? a.Greater hormone metabolism b.Decreased hormone activity c.Increased hormone activity d.Unchanged hormone response

ANS: B Hormones cause activity in the target tissues by binding with their specific cellular receptor sites, thereby changing the activity of the cell. When receptor sites are occupied by other substances that block hormone binding, the cell's response is the same as when the level of the hormone is decreased.

4. A male client reports fluid secretion from his breasts. What does the nurse assess next in this client? a.Posterior pituitary hormones b.Adrenal medulla functioning c.Anterior pituitary hormones d.Parathyroid functioning

ANS: C Breast fluid and milk production are induced by the presence of prolactin, secreted from the anterior pituitary gland. The other hormones do not influence this process.

7. A client has abnormal calcium levels. Which hormone does the nurse anticipate testing for? a.Thyroxine (T4) b.Triiodothyronine (T3) c.Thyrocalcitonin (calcitonin) d.Propylthiouracil (PTU)

ANS: C Parafollicular cells produce thyrocalcitonin (calcitonin [TCT]), which helps regulate serum calcium levels. The other hormones are not related directly to calcium levels.

13. Which client statement indicates the need for clarification regarding the instructions for collecting a 24-hour urine specimen for assessment of endocrine function? a."I will continue to take all my prescribed medicine during the test." b."I will add the preservative to the container at the beginning of the test." c."I will start the collection by saving the first urine of the morning." d."At the end of 24 hours, I will urinate and save that last specimen."

ANS: C The 24-hour urine collection specimen is started when the client first arises and urinates. The first urine specimen is discarded because there is no way to know how long it has been in the bladder, but the time is noted. The client adds all urine voided after that first discarded specimen during the next 24 hours. When the 24-hour mark is reached, the client voids one last time and adds this specimen to the collection. The preservative, if used, must be added to the container at the beginning of the collection. Clients can continue to take all their normal medications during a timed urine collection. They should, however, avoid unnecessary medications.

10. Which situation or condition is likely to result in increased production of thyroid hormones? a.Starvation b.Dehydration c.Adequate sleep d.Cold environmental temperature

ANS: D Cold environmental temperatures stimulate the hypothalamus to secrete thyrotropin-releasing hormone, which in turn stimulates the anterior pituitary gland to secrete thyroid-stimulating hormone (TSH). TSH then stimulates the thyroid gland to secrete thyroid hormones, which, when bound to target tissues, increase the rate of metabolism to maintain body temperature near normal. The other situations would not lead to an increase in thyroid hormone production.

8. Which is the expected clinical manifestation for a client who has excessive production of melanocyte-stimulating hormone? a.Hypoglycemia and hyperkalemia b.Irritability and insomnia c.Increased urine output d.Darkening of the skin

ANS: D Melanocyte-stimulating hormone increases the size of melanocytes in the skin and increases the amount of pigment (melanin) that they produce. The other actions do not occur as the result of excessive melanocyte-stimulating hormone function.

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

B Eating protein does not interfere with collection or testing of the urine sample. Because the specimen must be kept cool, it can be placed in an inexpensive cooler with ice; the client should not keep the specimen container with food or beverages. The timing of the 24-hour collection begins after the initial void. To end a 24-hour urine specimen, emptying the bladder and adding it to the collection is the proper procedure.

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

B In general, each receptor site type is specific for only one hormone. Hormone receptor actions work in a "lock and key" manner, in that only the correct hormone (key) can bind to and activate the receptor site (lock). Hormones travel through the blood to all body areas, but exert their actions only on target tissues. Not all hormones are plasma-bound; for example, thyroid hormones are plasma protein-bound, whereas posterior pituitary hormones are transported by axons. Only certain cells manufacture specific hormones and store the hormones in vesicles.

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

C ADH is a hormone of the posterior pituitary. Brain abscess, tumor, or subarachnoid hemorrhage could cause alterations in ADH levels. These can be seen on a CT scan of the brain. ACTH triggers the release of cortisol from the adrenal cortex and is not related to ADH. A chest x-ray would not show a pituitary tumor or brain abscess. Even though ADH acts on distal convoluted tubules in the kidneys, a renal sonogram would diagnose the cause of syndrome of inappropriate antidiuretic hormone.

Which negative feedback response is responsible for preventing hypoglycemia during sleep in nondiabetic clients? A.Alpha cells of the pancreas B.Beta cells of the pancreas C.Glucagon release D.Insulin release

C Glucagon is the hormone that binds to receptors on liver cells. This causes the liver cells to convert glycogen to glucose, which keeps blood sugar levels normal during sleep. Alpha cells are responsible for synthesizing and secreting the hormone glucagon. Beta cells are responsible for synthesizing and secreting the hormone insulin. Insulin is the hormone responsible for lowering blood glucose. Insulin improves glucose uptake by the cell.

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

D The normal range for serum sodium is 135 to 145 mEq/L; a result of 110 mEq/L is considered hyponatremia and is extremely dangerous. The client is at risk for increased intracranial pressure, seizures, and death. The RN must act rapidly because this situation requires immediate intervention. The normal range for fasting blood glucose is 60 to 110 mg/dL; 125 mg/dL is high, but is not considered dangerous. The normal range for BUN is 7 to 20 mg/dL; 40 mg/dL is high. An elevated BUN can be an indication of kidney failure, dehydration, fever, increased protein intake, and shock, so the client should have a creatinine drawn for a more complete picture of kidney function. The normal range for serum potassium is 3.5 to 5.2 mEq/L; 5.2 mEq/L is high normal.

12. A new nurse is palpating a client's thyroid gland. Which action requires intervention from the nurse's mentor? a.The nurse stands behind, instead of in front of, the client. b.The client is asked to swallow while the nurse finds the thyroid gland. c.The nurse palpates the right lobe with his or her left hand. d.The client is placed in a sitting position with the chin tucked down.

ANS: C The client should be in a sitting position with the chin tucked down as the examiner stands behind the client. The nurse feels for the thyroid isthmus while the client swallows and turns the head to the right, and the nurse palpates the right lobe with the right hand. The technique is repeated in the opposite fashion for the left lobe.

2. How does a tropic hormone differ from other hormones? a.Tropic hormones are given to clients who have a hormone deficiency. b.Tropic hormones are exclusively involved in the production of sex hormones. c.Tropic hormones stimulate other endocrine glands to secrete hormones. d.Tropic hormones are not under negative feedback control.

ANS: C The target tissues for tropic hormones are other endocrine glands. The effect of these agents is to stimulate another endocrine gland to secrete its hormone. The other statements are inaccurate.

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

A An LPN/LVN will be familiar with Cushing's syndrome and the method for assessment of orthostatic vital signs. The client with a blood glucose of 45 mg/dL, the client with questions about endocrine function, and the client with a possible pituitary adenoma all have complex needs that require the experience and scope of practice of an RN.

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

A Asking the client to explain his concerns in an open-ended question allows the nurse to explore his feelings more thoroughly. Telling a client that something is "normal" is dismissive; this is new to the client and is a concern for him. The focus of the nurse's response needs to be on the client, not on the wife initially. Referring the client to a counselor is not an appropriate first step; this dismisses the client's concerns and does not allow him to express his frustrations at the moment.

The nurse is teaching a client about maintaining a proper diet to prevent an endocrine disorder. Which food does the nurse suggest after the client indicates a dislike of fish? A.Iodized salt for cooking B.More red meat C.More green vegetables D.Salt substitute for cooking

A Dietary deficiencies in iodide-containing foods may be a cause of an endocrine disorder. For clients who do not eat saltwater fish on a regular basis, teach them to use iodized salt in food preparation. The client should eat a well-balanced diet that includes less animal fat. Eating vegetables contributes to a proper diet; however, this does not prevent an endocrine disorder. Using a salt substitute does not prevent an endocrine disorder; in addition, salt substitutes may contain high levels of potassium, which may lead to electrolyte imbalances.

15. A client asks why a 24-hour urine collection is necessary to measure excreted hormones instead of a random voided specimen. Which response by the nurse is most accurate? a."We are testing for a hormone secreted on a circadian rhythm." b."The hormone is so dilute in urine, we need a large volume." c."We want to see when the hormone is secreted in both large and small amounts." d."You'd have to be here at a specific time of the day for a random urinalysis."

ANS: A Some hormones are secreted in a pulsatile, or circadian, cycle. When testing for these substances, a collection that occurs over 24 hours will most accurately reflect hormone secretion. The other responses are not accurate.

5. A client has a condition of excessive catecholamine release. Which assessment finding does the nurse correlate with this condition? a.Decreased blood pressure b.Increased pulse c.Decreased respiratory rate d.No change in vital signs

ANS: B Catecholamines are responsible for the "fight-or-flight" stress response. Activation of the sympathetic nervous system can be correlated with tachycardia. The other options are not correlated with excessive catecholamine release.

A client is hospitalized for pituitary function testing. Which nursing action included in the client's plan of care will be most appropriate for the RN to delegate to the LPN/LVN? A.Assess the client for clinical manifestations of hypopituitarism. B.Inject regular insulin for the growth hormone stimulation test. C.Palpate the thyroid gland for size and firmness. D.Teach the client about the adrenocorticotropic hormone stimulation test.

B Injection of insulin is within the LPN/LVN scope of practice. Client assessment for clinical manifestations of hypopituitarism, palpating the thyroid gland, and client education are complex skills requiring training and expertise, and are best performed by an RN.

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

B Insulin injections maintain homeostasis, or normal balance, between insulin and glucose in the client with type 1 diabetes. Type 1 diabetes is a lack of insulin production, not glucose intolerance, and requires frequent doses of insulin. Negative feedback does not occur in type 1 diabetes because of lack of insulin.

A client 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? A.Ask about risk factors for adrenocortical problems. B.Assess the client's response to physiologic stressors. C.Check the client's blood glucose levels every 4 hours. D.Teach the client how to do a 24-hour urine collection.

C Blood glucose monitoring is within the nursing assistant's scope of practice if the nursing assistant has received education and evaluation in the skill. Assessing risk factors for adrenocortical problems is not part of a nursing assistant's education. Assessing the client's response to physiologic stressors requires the more complex skill set of licensed nursing staff. Teaching the proper method for a 24-hour urine collection is a multi-step process; this task should not be delegated.

18. The nursing assistant reports that while pouring urine into a 24-hour urine container, some urine splashed the nursing assistant's hand. Which action by the nurse is best? a.Ask the assistant if he or she washed the hands afterward. b.Call the laboratory to see if the container has preservative in it. c.Have the assistant fill out an incident report. d.Send the assistant to Employee Health right away.

ANS: A For safety, the nurse should find out if the assistant washed his or her hands. The nursing assistant should do this for two reasons. First, it is part of Standard Precautions to wash hands after client care. Second, if the container did have preservative in it, this would wash it away. The preservative may be caustic to the skin. The nurse can call the laboratory while the assistant is washing hands if needed. The nursing assistant would then need to fill out an incident or exposure report and may or may not need to go to Employee Health. The nursing assistant also needs further education on Standard Precautions, which include wearing gloves.

9. Which pulse rate finding in a client taking a drug that stimulates beta1 receptors requires immediate action by the nurse? a.50 beats/min b.95 beats/min c.85 beats/min d.100 beats/min

ANS: A Stimulation of beta1 receptor sites in the heart has positive chronotropic and inotropic actions. The nurse expects an increase in heart rate and increased cardiac output. The client with a heart rate of 50 beats/min would be cause for concern because this would indicate that the client was not responding to the medication. The other heart rates are within normal limits but on the higher end and would be considered a therapeutic response to the medication.

To best determine how well a client with diabetes mellitus is controlling blood glucose, which test does the nurse monitor? A.Fasting blood glucose B.Glycosylated hemoglobin (HbA1c) C.Oral glucose tolerance test D.Urine glucose level

B Glycosylated hemoglobin indicates the average blood glucose over several months and is the best indicator of overall blood glucose control. Fasting blood glucose can be used to monitor glucose control, but it is not the best method (although this may be the method that clients are most familiar with). Oral glucose testing and urine glucose levels look at one period of time and are not the best methods to look at overall effectiveness of treatment.

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

B Many endocrine problems can change a client's behavior, personality, and psychological responses; the client stating that he or she has become short-tempered warrants further assessment. Worrying about losing a job is a normal concern but does not give any indication of a need for further assessment. The nurse will need to assess the client's claim that he or she has no stressors at present because the client's response does not provide enough information to make this determination; however, the client's statement about losing patience is the priority. Weight gain or loss may or may not be an indication of an endocrine disorder.