Chapter 47: Assessment: Endocrine System (Lewis)

Which information about a patient who is scheduled for an oral glucose tolerance test should be reported to the health care provider before starting the test?

B) The patient takes oral corticosteroids for rheumatoid arthritis. (Corticosteroids can affect blood glucose results. The other information will be provided to the health care provider but will not affect the test results.)

During the nurse's physical examination of a young adult, the patient's thyroid gland cannot be felt. The most appropriate action by the nurse is to

B) document that the thyroid was nonpalpable. (The thyroid is frequently nonpalpable. The nurse should simply document the finding.)

A patient will be scheduled in the outpatient clinic for blood cortisol testing. Which instruction will the nurse provide?

C) "Come to the laboratory to have the blood drawn early in the morning." (Cortisol levels are usually drawn in the morning, when levels are highest.)

Which question from a nurse during a patient interview will provide focused information about a possible thyroid disorder?

C) "Have you had a recent unplanned weight gain or loss?" (Because thyroid function affects metabolic rate, changes in weight may indicate hyperfunction or hypofunction of the thyroid gland. Nocturia, visual difficulty, and changes in stress level are associated with other endocrine disorders.)

A 61-yr-old female patient admitted with pneumonia has a total serum calcium level of 13.3 mg/dL. The nurse will anticipate the need to teach the patient about testing for _____ levels.

D) parathyroid hormone (Parathyroid hormone [PTH] is the major controller of blood calcium levels. It increases serum calcium levels)

What are two effects of hypokalemia on the endocrine system?

a. Decreased insulin and aldosterone release

In a patient with an elevated serum cortisol, what should the nurse expect other laboratory findings to reveal?

a. Hypokalemia (Hyperglycemia=hypokalemia high cortisol=hyperglycemia hypoglycemia=hyperkalemia)

Which hormones are secreted by the anterior pituitary gland (select all that apply)?

a. Prolactin e. Growth hormone (GH) f. Gonadotropic hormones i. Thyroid-stimulating hormone (TSH) j. Adrenocorticotropic hormone (ACTH)

What is released in the normal response to increased serum osmolality?

b. ADH from the posterior pituitary gland, which stimulates the kidney to reabsorb water

To ensure accurate results of a fasting blood glucose analysis, the nurse instructs the patient to fast for at least how long?

c. 8 hours

Which endocrine gland secretes cortisol in a diurnal pattern?

c. Adrenal cortex

Which laboratory value should the nurse review to determine whether a patient's hypothyroidism is caused by a problem with the anterior pituitary gland or with the thyroid gland?

c. Thyroid-stimulating hormone (TSH) level (A low TSH level indicates that the patient's hypothyroidism is caused by decreased anterior pituitary secretion of TSH.)

The nurse will plan to teach a patient to minimize physical and emotional stress while the patient is undergoing

c. a 24-hour urine test for free cortisol. (Physical and emotional stress can affect the results of the free cortisol test. The other tests are not impacted by stress.)

Which statement by a 50-yr-old female patient indicates to the nurse that further assessment of thyroid function may be necessary?

d. "I feel a lump in my throat when I swallow." (Difficulty in swallowing can occur with a goiter.)

An 18-yr-old male patient with small stature is scheduled for a growth hormone stimulation test. In preparation for the test, the nurse will obtain

d. 50% dextrose solution (Hypoglycemia is induced during the growth hormone stimulation test, and the nurse should be ready to administer 50% dextrose immediately.)

Which statement about the adrenal medulla hormones is accurate?

d. Catecholamines are considered hormones when they are secreted by the adrenal medulla and neurotransmitters when they are secreted by nerve cells.

The female patient is admitted with a new diagnosis of Cushing syndrome with elevated serum and urine cortisol levels. Which assessment findings should the nurse expect to see in this patient?

d. Elevated blood pressure and blood glucose

How do hormones respond following the ingestion of a high-protein, carbohydrate-free meal?

d. Glucagon is released to promote gluconeogenesis, and insulin is released to facilitate movement of amino acids into muscle cells.

A patient has a low serum T3 level. The HCP orders measurement of the TSH level. If the TSH level is elevated, what does this indicate?

a. The cause of the low T3 level is most likely primary hypothyroidism.

A young adult patient is being seen in the clinic with increased secretion of the anterior pituitary hormones. The nurse would expect the laboratory test results to show

a. increased urinary cortisol. (The hormone [ACTH] by the anterior pituitary gland will lead to an increase in serum and urinary cortisol levels.)

A patient has been newly diagnosed with type 2 diabetes mellitus. Which information about the patient will be most useful to the nurse who is helping the patient develop strategies for successful adaptation to this disease?

b. Value system (When dealing with a patient with a chronic condition such as diabetes, identification of the patient's values and beliefs can assist the interprofessional team in choosing strategies for successful lifestyle change.)

A patient with a possible pituitary adenoma is scheduled for a computed tomography (CT) scan with contrast media. Which patient information is important for the nurse to communicate to the health care provider before the test?

b. Allergies to iodine and shellfish (Because the usual contrast media is iodine-based, the health care provider will need to know about the allergy before the CT scan.)

A patient seen in the emergency department for severe headache and acute confusion has a serum sodium level of 118 mEq/L. The nurse will anticipate the need for which diagnostic test?

b. Antidiuretic hormone level (excess fluid retention + diluted hyponatremia-SIADH) (Elevated levels of antidiuretic hormone will cause water retention and decrease serum sodium levels.)

The nurse will teach a patient who is scheduled to complete a 24-hour urine collection for 17-ketosteroids to

b. keep the specimen refrigerated or on ice (The specimen must be kept on ice or refrigerated until the collection is finished. Voided or catheterized specimens are acceptable for the test. The initial voided specimen is discarded. There is no fluid intake requirement for the 24-hour collection.)

A patient is admitted with tetany. Which laboratory value should the nurse plan to monitor?

c. Ionized calcium (Tetany is associated with hypocalcemia.)

What is a potential adverse effect of palpation of an enlarged thyroid gland?

c. Release of excessive thyroid hormone into circulation

A patient is taking spironolactone (Aldactone), a drug that blocks the action of aldosterone on the kidney, for hypertension. The nurse will monitor for

c. elevated serum potassium. (Because aldosterone increases the excretion of potassium, a medication that blocks aldosterone will tend to cause hyperkalemia.)

The nurse reviews a patient's glycosylated hemoglobin (A1C) results to evaluate

c. glucose control over the past 90 days. (Glycosylated hemoglobin testing measures glucose control over the last 3 months.)

Common nonspecific manifestations that may alert the nurse to endocrine dysfunction include

c. weight loss, fatigue, and depression.

From where is the hormone glucagon secreted?

c. α-cells of the islets of Langerhans

The patient with type 1 diabetes mellitus is in the clinic to check his long-term glycemic control. Which test should be used?

d. Glycosylated hemoglobin (A1C)

What accurately demonstrates that hormones of one gland influence the function of hormones of another gland?

d. Increased atrial natriuretic peptide (ANP) levels inhibit the secretion of aldosterone.

Which statements will the nurse include when teaching a patient who is scheduled for oral glucose tolerance testing in the outpatient clinic (select all that apply)?

a. "You will need to avoid smoking before the test." c. "Several blood samples will be obtained during the testing." e. "The test requires that you fast for at least 8 hours before testing." (Smoking may affect the results of oral glucose tolerance tests. Blood samples are obtained at baseline and at 30, 60, and 120 minutes. Accuracy requires that the patient be fasting before the test. The patient should consume at least 1500 calories per day for 3 days before the test. The patient should be ambulatory and active for accurate test results.)

Which abnormal assessment findings are related to thyroid dysfunction (select all that apply)?

b. Heat intolerance caused by hyperfunction c. Exophthalmos associated with excessive secretion e. A goiter with either hyperfunction or hypofunction

The nurse is caring for a 63-yr-old with a possible pituitary tumor who is scheduled for a computed tomography scan with contrast. Which information about the patient is important to discuss with the health care provider before the test?

a. History of renal insufficiency (Because contrast media may cause acute kidney injury in patients with poor renal function, the health care provider will need to prescribe therapies such as I.V fluids to prevent this complication.)

Which additional information will the nurse need to consider when reviewing the laboratory results for a patient's total calcium level?

b. The serum albumin (Part of the total calcium is bound to albumin, so hypoalbuminemia can lead to misinterpretation of calcium levels.)

What manifestations of endocrine problems in the older adult are commonly attributed to the aging process?

b. Fatigue and mental impairment

Patient-Centered Care: A 30-yr-old female patient was brought to the emergency department (ED) after a seizure at work. During the assessment she mentions hair loss and menstrual irregularities. What diagnostic tests would be helpful to determine if endocrine problems are a cause of her problem (select all that apply)?

b. Luteinizing hormone (LH) d. Follicle-stimulating hormone (FSH) e. Magnetic resonance imaging (MRI) of the head

A registered nurse (RN) is caring for a patient with a goiter and possible hyperthyroidism. Which action by the RN indicates that the charge nurse needs to provide the RN with additional teaching?

b. The RN palpates the neck to assess thyroid size. (Palpation can cause the RELEASE of thyroid hormones in a patient with an enlarged thyroid and should be avoided.)

The nurse is caring for a 45-yr-old male patient during a water deprivation test. Which finding is most important for the nurse to communicate to the health care provider?

b. The patient has a 5-lb (2.3-kg) weight loss. (A drop in the weight of more than 2 kg indicates dehydration, and the test should be discontinued.)