Ch 22: Endocrine Clinical Assessment and Diagnostic Procedures jk
The nurse is managing a patient with hyperglycemia. Which findings would the nurse expect to note to support this diagnosis? (Select all that apply.) a.Anorexia b.Abdominal pain c.Bradycardia d.Fluid overload e.Change in level of consciousness f.Kussmaul respirations
a.Anorexia b.Abdominal pain e.Change in level of consciousness f.Kussmaul respirations More than likely the patient with hyperglycemia will be fluid volume depleted and tachycardic.
A nurse is teaching a patient with diabetes mellitus. The patient asks the nurse what is an acceptable HbA1c level for him. What should the nurse tell the patient? a."An acceptable level is less than 5.4%." b."An acceptable level is less than 6.5%." c."An acceptable level is determined by your practitioner." d."It is dependent on your age."
b."An acceptable level is less than 6.5%." A normal HbA1c value is less than 5.4%, with an acceptable target level for patients with diabetes below 6.5%.
The nurse is caring for a patient with a traumatic brain injury. Yesterday the patient weighed 62 kg and today the patient weighs 60 kg. How much fluid loss does this change in weight reflect? a.1 L b.2 L c.4 L d.10 L
b.2 L Daily weight changes coincide with fluid retention and fluid loss. 1 L of fluid lost or retained is equal to approximately 2.2 lb, or 1 kg, of weight gained or lost. This patient lost 2 kg of weight which is equivalent to 2 L of fluid.
A patient has been admitted with a brain mass. The practitioner suspects it might be a pituitary tumor and orders a computed tomography (CT) scan. What area of brain should be scanned to confirm this diagnosis? a.Frontal lobe b.Base of the skull c.Temporal lobe d.Anterior fossa
b.Base of the skull CT of the base of the skull identifies pituitary tumors, blood clots, cysts, nodules, or other soft tissue masses
The nurse is caring for a patient with a traumatic brain injury. The nurse suspects the patient is developing diabetes insipidus. Which test or procedures would confirm this diagnosis? a.Skull radiographs b.Serum glucose level c.Water deprivation test d.Antidiuretic hormone (ADH) stimulation test
d.Antidiuretic hormone (ADH) stimulation test Serum antidiuretic hormone ADH levels are compared with the blood and urine osmolality to differentiate syndrome of inappropriate antidiuretic hormone (SIADH) from central diabetes insipidus (DI). Increased ADH levels in the bloodstream compared with a low serum osmolality and elevated urine osmolality confirm the diagnosis of SIADH. Reduced levels of serum ADH in a patient with high serum osmolality, hypernatremia, and reduced urine concentration signal central DI.
A patient is admitted with diabetic ketoacidosis. The nurse requests the practitioner to order a glycosylated hemoglobin (HbA1c). What information does this test provide to the health care team? a.It is an indicator of the patient's average blood glucose level over the previous 3 to 4 months. b.It compares blood glucose levels with serum hemoglobin over the previous 3 to 4 weeks. c.It is an indicator of the patient's highest blood ketone level over the past month. d.It associates the serum and urine glucose levels and is an indicator of kidney involvement.
a.It is an indicator of the patient's average blood glucose level over the previous 3 to 4 months. The glycated hemoglobin test (also known as the glycosylated hemoglobin, or HbA1c or A1c), provides information about the average amount of glucose that has been present in the patient's bloodstream over the previous 3 to 4 months. During the 120-day life span of red blood cells (erythrocytes), the hemoglobin within each cell binds to the available blood glucose through a process known as glycosylation.
The nurse is caring for a patient who has been newly diagnosed with type 1 diabetes. The nurse observes that the patient is extremely dehydrated. To make this assessment, what did the nurse evaluate? a.Skin turgor b.Nail bed color c.Capillary refill d.Skin temperature
a.Skin turgor A hydration assessment includes observations of skin integrity, skin turgor, and buccal membrane moisture. Moist, shiny buccal membranes indicate satisfactory fluid balance. Skin turgor that is resilient and returns to its original position in less than 3 seconds after being pinched or lifted indicates adequate skin elasticity. Skin over the forehead, clavicle, and sternum is the most reliable for testing tissue turgor because it is less affected by aging and thus more easily assessed for changes related to fluid balance.
A patient is admitted in thyrotoxicosis. Which laboratory tests would the nurse expect to be ordered for this patient? (Select all that apply.) a.Total serum triiodothyronine (TT3) b.Total serum thyroxine (TT4) c.Free urine thyroid-stimulating hormone d.Total urine thyroxine e.Thyroglobulin (Tg) f.Free thyroxine (T4)
a.Total serum triiodothyronine (TT3) b.Total serum thyroxine (TT4) e.Thyroglobulin (Tg) f.Free thyroxine (T4) Thyroid tests include total serum thyroxine, free thyroxine, total serum triiodothyronine, free triiodothyronine, thyroid-stimulating hormone (thyrotropin), and thyroglobulin.
A patient has been admitted who is suspected of having thyrotoxicosis. Which laboratory findings would confirm this diagnosis? a.Very low thyroid-stimulating hormone (TSH) b.Decreased T3 uptake ratio c.Increased serum osmolality d.Decreased urine osmolality
a.Very low thyroid-stimulating hormone (TSH) Hyperthyroidism (thyrotoxicosis) is indicated by very low thyroid-stimulating hormone level, high serum T4, and an increased T3:T4 ratio.
A patient has been admitted with uncontrolled atrial fibrillation and muscle wasting. The practitioner suspects the patient may have a thyroid disorder. The nurse auscultates a bruit over the thyroid. What does this finding indicate? a.Normal function b.Enlargement of the thyroid c.Hypoplasia of the thyroid d.Tumor of the thyroid
b.Enlargement of the thyroid Auscultation of the thyroid is accomplished by use of the bell portion of the stethoscope to identify a bruit or blowing noise from the circulation through the thyroid gland. The presence of a bruit indicates enlargement of the thyroid as evidenced by increased blood flow through the glandular tissue.
A patient is admitted with severe hyperglycemia due new-onset type 1 diabetes mellitus. The nurse notes a sweet-smelling odor on the patient's exhaled breath. What causes this phenomenon? a.Metabolic alkalosis b.Ketoacidosis c.Glycosylation d.Dehydration
b.Ketoacidosis Ketoacidosis results in the patient's breathing becomes deep and rapid (Kussmaul respirations) and the patient's breath having a fruity odor. Metabolic alkalosis and dehydration do not cause this phenomenon. Glycosylation is when the hemoglobin within each cell binds to the available blood glucose.
A patient is admitted with hyponatremia. The practitioner suspects the patient may have syndrome of inappropriate secretion of antidiuretic hormone (SIADH) and orders a serum ADH level for the next morning. Which medications must be stopped or withheld at least 8 hours prior to the test? a.Insulin and furosemide b.Morphine and carbamazepine c.Digoxin and potassium d.Heparin and lopressor
b.Morphine and carbamazepine To prepare the patient for the test, all drugs that may alter the release of antidiuretic hormone (ADH) are withheld for a minimum of 8 hours. Common medications that affect ADH levels include morphine sulfate, lithium carbonate, chlorothiazide, carbamazepine, oxytocin, nicotine, alcohol, and selective serotonin reuptake inhibitors.
A patient has been admitted with abdominal pain. The patient's fasting blood glucose is 120 mg/dL. Which statement regarding this finding is accurate? a.This is a normal finding in critically patients. b.This finding is indicative of prediabetes. c.This finding is indicative of diabetes. d.This finding is indicative of diabetic ketoacidosis.
b.This finding is indicative of prediabetes. A normal fasting glucose (FPG) level is between 70 and 100 mg/dL. An FPG level between 100 and 125 mg/dL identifies a person who is prediabetic. An FPG level greater than 126 mg/dL is diagnostic of diabetes. In nonurgent settings, the test is repeated on another day to make sure the result is accurate.
The nurse is caring for a patient who has been newly diagnosed with type 1 diabetes. Which laboratory results would the nurse note confirming this diagnosis? a.Glycated Hemoglobin A1c of 3% b.Absence of ketones in the urine c.Presence of ketones in the blood d.Fasting glucose of 105 mg/dL
c.Presence of ketones in the blood Ketone bodies are a by-product of rapid fat breakdown. Ketone blood levels rise in acute illness, fasting, and with sustained elevation of blood glucose in type 1 diabetes in the absence of insulin. The patient would also have ketones in the urine, a hemoglobin A1c greater than 6%, and a fasting glucose greater than 125 mg/dL
A patient is admitted with hypernatremia secondary to neurogenic diabetes insipidus. The patient's serum osmolality is 350 mOsm/kg. What does this finding indicate? a.The patient is overhydrated. b.The patient's serum osmolality is normal. c.The patient is dehydrated. d.The patient is hypothyroid.
c.The patient is dehydrated. Values for serum osmolality in the bloodstream range from 275 to 295 mOsm/kg H2O. Increased serum osmolality stimulates the release of antidiuretic hormone, which in turn reduces the amount of water lost through the kidney.
A patient is admitted with hypernatremia secondary to diabetes insipidus (DI). Which test would help the practitioner differentiate between central and nephrogenic DI? a.Water deprivation test b.Serum osmolality c.Thyroid-stimulating hormone test d.Antidiuretic hormone (ADH) test
d.Antidiuretic hormone (ADH) test The antidiuretic hormone test is used to differentiate between neurogenic diabetes insipidus (DI) (central) and nephrogenic (kidney) DI. In severe central DI, in which the pituitary is affected, the urine osmolality shows a significant increase (becomes more concentrated), which indicates that the cell receptor sites on the kidney tubules are responsive to vasopressin. Test results in which urine osmolality remains unchanged indicate nephrogenic DI, suggesting kidney dysfunction because the kidneys are no longer responsive to ADH.
A patient is reporting a headache, fatigue, abdominal pain, and blurred vision. The nurse knows that these signs may indicate the patient has what problem? a.Hypothyroidism b.Pituitary tumor c.Cushing syndrome d.Hyperglycemia
d.Hyperglycemia Because severe hyperglycemia affects a variety of body systems, all systems are assessed. The patient may complain of blurred vision, headache, weakness, fatigue, drowsiness, anorexia, nausea, and abdominal pain.
A patient is admitted with severe hyperglycemia due to new-onset type 1 diabetes mellitus. Which signs and symptoms obtained as part of the patient's history might indicate the presence of hyperglycemia? a.Recent episodes of tachycardia and missed heart beat b.Decreased urine output accompanied by peripheral edema c.Periods of hyperactivity with weight gain d.Increased thirst and increased urinary output
d.Increased thirst and increased urinary output The patient or family member may relay information about recent, unexplained changes in weight, thirst, hunger, and urination patterns
A patient is admitted with hypernatremia secondary to diabetes insipidus (DI). The practitioner suspects the patient has nephrogenic DI. Which finding would confirm this diagnosis? a.A slight increase in urine osmolality b.A decrease in urine output c.A decrease in serum osmolality d.No change in urine osmolality
d.No change in urine osmolality In cases of severe central DI, the urine osmolality shows a significant increase (becomes more concentrated). Test results in which urine osmolality remains unchanged indicate nephrogenic DI
A patient has been admitted who is suspected of having thyrotoxicosis. Which sign or symptom would support this diagnosis? a.Moist, shiny buccal membranes b.Presence of a headache with fatigue and weakness c.Lack of visibility of the thyroid gland in the anterior neck d.Presence of a bruit upon auscultation of the thyroid
d.Presence of a bruit upon auscultation of the thyroid Auscultation of the thyroid is accomplished by use of the bell portion of the stethoscope to identify a bruit or blowing noise from the circulation through the thyroid gland. The presence of a bruit indicates enlargement of the thyroid, as evidenced by increased blood flow through the glandular tissue.