Honan-Chapter 29: Nursing Assessment: Endocrine Function
A nursing student asks the instructor why the pituitary gland is called the "master gland." What is the best response by the instructor? A. "It regulates the function of other endocrine glands." B. "It is the gland that is responsible for regulating the hypothalamus." C. "The gland does not have any other function other than to cause secretion of the growth hormones." D. "It regulates metabolism."
A. "It regulates the function of other endocrine glands." RATIONALE The pituitary gland is called the master gland because it regulates the function of other endocrine glands. The term is somewhat misleading, however, because the hypothalamus influences the pituitary gland. The gland has many other hormones that it secretes.
Which of the following hormones controls secretion of adrenal androgens? A. ACTH B. TSH C. Parathormone D. Calcitonin
A. ACTH RATIONALE ACTH controls the secretion of adrenal androgens. When secreted in normal amounts, the adrenal androgens appear to have little effect, but when secreted in excess, as in certain inborn enzyme deficiencies, masculinization may result. The secretion of T3 and T4 by the thyroid gland is controlled by TSH. Parathormone regulates calcium and phosphorous metabolism. Calcitonin reduces the plasma level of calcium by increasing its deposition in bone.
The primary function of the thyroid gland includes which of the following? A. Control of cellular metabolic activity B. Facilitation of milk ejection C. Reabsorption of water D. Reduction of plasma level of calcium
A. Control of cellular metabolic activity RATIONALE The primary function of the thyroid hormone is to control cellular metabolic activity. Oxytocin facilitates milk ejection during lactation and increases the force of uterine contraction during labor and delivery. Antidiuretic hormone (ADH) release results in reabsorption of water into the bloodstream rather than excretion by the kidneys. Calcitonin reduces the plasma level of calcium by increasing its deposition in bone.
Which disorder is characterized by a group of symptoms produced by an excess of free circulating cortisol from the adrenal cortex? A. Cushing syndrome B. Addison disease C. Graves disease D. Hashimoto disease
A. Cushing syndrome RATIONALE The client with Cushing syndrome demonstrates truncal obesity, moon face, acne, abdominal striae, and hypertension. Regardless of the cause, the normal feedback mechanisms that control the function of the adrenal cortex become ineffective, and the usual diurnal pattern of cortisol is lost. The signs and symptoms of Cushing syndrome are primarily a result of the oversecretion of glucocorticoids and androgens, although mineralocorticoid secretion also may be affected.
During physical examination of a client with a suspected endocrine disorder, the nurse assesses the body structures. The nurse gathers this data based on the understanding that it is an important aid in which of the following? A. Detecting evidence of hormone hypersecretion. B. Detecting information about possible tumor growth. C. Determining the presence or absence of testosterone levels. D. Determining the size of the organs and location.
A. Detecting evidence of hormone hypersecretion. RATIONALE The evaluation of body structures helps the nurse detect evidence of hypersecretion or hyposecretion of hormones. This helps in the assessment of findings that are unique to specific endocrine glands. Radiographs of the chest or abdomen are taken to detect tumors. Radiographs also determine the size of the organ and its location. Antidiuretic hormone (ADH) levels determine the presence or absence of ADH and testosterone levels.
An adult patient is experiencing a temporary decrease in serum levels of T3and T4. What physiological response is this state likely to result in? A. Increased release of TSH B. Increased resorption of T3 and T4 in the renal tubules C. Release of sequestered T3 and T4 by the spleen D. Compensatory release of T5 by the parathyroid
A. Increased release of TSH RATIONALE If the thyroid hormone concentration in the blood decreases, the release of TSH increases, which causes increased output of T3 and T4. Low levels of thyroid hormone are not resolved by the action of the kidneys. Thyroid hormone is not sequestered in the spleen, and T5 does not exist.
A client is suspected to have a pituitary tumor due to signs of diabetes insipidus. What initial test does the nurse help to prepare the client for? A. Magnetic resonance imaging (MRI) B. Radioactive iodine uptake test C. Radioimmunoassay D. A nuclear scan
A. Magnetic resonance imaging (MRI) RATIONALE A computed tomography (CT) or magnetic resonance imaging (MRI) scan is performed to detect a suspected pituitary tumor or to identify calcifications or tumors of the parathyroid glands. A radioactive iodine uptake test would be useful for a thyroid tumor. Radioimmunoassay determines the concentration of a substance in plasma.
A client has a decreased level of thyroid hormone being excreted. What will the feedback loop do to maintain the level of thyroid hormone required to maintain homeostatic stability? A. Stimulate more hormones using the negative feedback system B .Stimulate more hormones using the positive feedback system C. Produce a new hormone to try and regulate the thyroid function D. The feedback loop will be unable to perform in response to low levels of thyroid hormone.
A. Stimulate more hormones using the negative feedback system RATIONALE Feedback can be either negative or positive. Most hormones are secreted in response to negative feedback; a decrease in levels stimulates the releasing gland.
Parathyroid hormone (PTH) has which effects on the kidney? A. Stimulation of calcium reabsorption and phosphate excretion B. Stimulation of phosphate reabsorption and calcium excretion C. Increased absorption of vitamin D and excretion of vitamin E D. Increased absorption of vitamin E and excretion of vitamin D
A. Stimulation of calcium reabsorption and phosphate excretion RATIONALE PTH stimulates the kidneys to reabsorb calcium and excrete phosphate and converts vitamin D to its active form, 1,25-dihydroxyvitamin D. PTH doesn't have a role in the metabolism of vitamin E.
A client is being screened for a thyroid disorder. The nurse would anticipate that the client would most likely undergo which test? A. TSH B. T4 C. T3 D. needle aspiration
A. TSH RATIONALE Serum TSH is the best screening test for thyroid disorders and helps differentiate between disorders of the thyroid gland itself and disorders of the pituitary and hypothalamus. High levels of serum TSH will indicate normal function or hypothyroidism, whereas low values indicate hyperthyroidism. This is an example of the negative feedback system. If the thyroid hormones (T3 and T4) are not secreted by the thyroid, TSH is increased to help stimulate the thyroid to produce these hormones. If T3 and T4 are excreted in large amounts, as occurs in hyperthyroidism, TSH is decreased. Also TSH is used to monitor thyroid replacement regimen. Needle aspiration biopsy can be done to evaluate thyroid cell structure.
The nurse is assisting with the preparation of a patient who will undergo a radioactive iodine uptake (RAIU) test. The nurse should understand that this patient is being assessed for dysfunction of the: A. Thyroid gland B. Adrenal cortex C. Adrenal medulla D. Anterior pituitary
A. Thyroid gland RATIONALE The rate of iodine uptake by thyroid gland increases in hyperthyroidism and decreases in hypothyroidism. It is unaffected by changes in the structure or function of the pituitary or adrenal glands.
The nursing educator is teaching a group of new graduates about Cushing's disease. What symptom would the educator identify as being characteristic of Cushing's disease? (Select all that apply) A. Truncal obesity B. Hypertension C. Muscle weakness D. "Moon" face
A. Truncal obesity B. Hypertension D. "Moon" face RATIONALE Patients with Cushing's syndrome demonstrate truncal obesity, "moon" face, acne, abdominal striae, and hypertension.
A nurse is performing an examination and notes that the client exhibits signs of exophthalmos. What has the nurse observed? A. abnormal bulging or protrusion of the eyes B. excessive hair growth C. enlarged thyroid gland D. changes in pigmentation
A. abnormal bulging or protrusion of the eyes RATIONALE When there is an increase in the volume of the tissue behind the eyes, the eyes will appear to bulge out of the face. Exophthalmos is a bulging of the eye anteriorly out of the orbit.
A nurse is reviewing the laboratory order for a client suspected of having an endocrine disorder. The lab slip includes obtaining cortisol levels. What is being tested? A. adrenal function B. thyroid function C. thymus function D. parathyroid function
A. adrenal function RATIONALE The adrenal cortex manufactures and secretes glucocorticoids, such as cortisol, which affect body metabolism, suppress inflammation, and help the body withstand stress.
A nurse is developing a teaching plan for a client diagnosed with hyperparathyroidism that explains this condition. When describing the underlying problem, the nurse would most likely include a discussion about which mineral? A. calcium B. sodium C. potassium D. magnesium
A. calcium RATIONALE Hyperparathyroidism is characterized by having excess parathormone (PTH), leading to a markedly increased level of serum calcium that can present as a potentially life-threatening situation. Sodium, potassium and magnesium are not involved. Reference:
Which diagnostic test is done to determine suspected pituitary tumor? A. computed tomography scan B. measurement of blood hormone levels C. radioimmunoassay D. radiographs of the abdomen
A. computed tomography scan RATIONALE A computed tomography or magnetic resonance imaging scan is done to detect a suspected pituitary tumor. Radiographs of the chest or abdomen are taken to detect tumors. Radiographs also determine the size of the organ and their location. Measuring blood hormone levels helps determine the functioning of endocrine glands. A radioimmunoassay determines the concentration of a substance in plasma.
A nurse explains the role of the ovaries. Which hormones would be included in that discussion? A. estrogen and progesterone B. estrogen and progestin C. testosterone and progesterone D. estrogen and testosterone
A. estrogen and progesterone RATIONALE The ovaries produce estrogen and progesterone. Progestin is a synthetic compound. Testosterone is involved with the development and maintenance of male secondary sex characteristics, such as facial hair and a deep voice.
A nurse is teaching a client with an endocrine disorder how the nervous system and endocrine system are linked. Which structure would the nurse identify as the link between the two systems. A. hypothalamus B. brain C. medulla oblongata D. pancreas
A. hypothalamus RATIONALE The hypothalamus is the link between the nervous system and the endocrine system. The hypothalamus controls the pituitary gland, which secretes hormones to influence the target glands through the action of the secreting hormones. The brain and medulla oblongata are part of the nervous system. The pancreas is an endocrine organ.
Although not designated as endocrine glands, several organs within the body secrete hormones as part of their normal function. Which organ secretes hormones involved in increasing blood pressure and volume and maturation of red blood cells? A. kidneys B. cardiac atria C. brain D. liver
A. kidneys RATIONALE The kidneys release renin, a hormone that initiates the production of angiotensin and aldosterone to increase blood pressure and blood volume. The kidneys also secrete erythropoietin, a substance that promotes the maturation of red blood cells.
Which diagnostic test is done to determine a suspected pituitary tumor? A. Radiography of the abdomen B. Computed tomography C. Measuring blood hormone levels D. Radioimmunoassay
B. Computed tomography RATIONALE CT or magnetic resonance imaging is used to diagnose the presence and extent of pituitary tumors.
A client with a history of hyperparathyroidism comes to the emergency department complaining of extreme muscle weakness, vomiting, and bone pain. The client is diagnosed with hypercalcemic crisis. When providing care, the nurse would most likely administer which intervention if ordered? Select all that apply. A. large volumes of IV fluids B. diuretics C. phosphate therapy D. calcium gluconate E. propylthiouracil
A. large volumes of IV fluids B. diuretics C. phosphate therapy RATIONALE Acute hypercalcemic crisis can occur with extreme elevation of serum calcium levels. Serum calcium levels of greater than 15 mg/dL (3.7 mmol/L) result in neurologic, cardiovascular, and renal symptoms that can be life-threatening. Treatment involves rehydration with large volumes of IV fluids to keep urine output above 100 mL/hr (normal saline expands volume and inhibits calcium resorption); diuretic agents (to promote renal excretion of excess calcium); and phosphate therapy (to correct hypophosphatemia and decrease serum calcium levels by promoting calcium deposition in bone and reducing the GI absorption of calcium). Calcium gluconate would be given if hypoparathyroidism was involved. Propylthiouracil is used to treat hyperthyroidism.
A client is undergoing diagnostics for an alteration in thyroid function. What physiologic function is affected by altered thyroid function? A. metabolic rate B. growth C. fluid/electrolyte balance D. sleep/wake cycles
A. metabolic rate RATIONALE The thyroid concentrates iodine from food and uses it to synthesize thyroxine (T4) and triiodothyronine (T3). These two hormones regulate the body's metabolic rate.
A nurse assesses a female client and suspects that the client may be experiencing an excess in adrenocortical hormones. Which assessment finding would support the nurse's suspicion? Select all that apply. A. moon face B. facial hair C. buffalo hump D. truncal obesity E. exophthalmos
A. moon face B. facial hair C. buffalo hump D. truncal obesity
A nurse is assessing a client with Cushing's syndrome. Which observation should the nurse report to the physician immediately? A. Pitting edema of the legs B. An irregular apical pulse C. Dry mucous membranes D. Frequent urination
B. An irregular apical pulse RATIONALE Because Cushing's syndrome causes aldosterone overproduction, which increases urinary potassium loss, the disorder may lead to hypokalemia. Therefore, the nurse should immediately report signs and symptoms of hypokalemia, such as an irregular apical pulse, to the physician. Edema is an expected finding because aldosterone overproduction causes sodium and fluid retention. Dry mucous membranes and frequent urination signal dehydration, which isn't associated with Cushing's syndrome.
A patient with a diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH) is being cared for on a medical unit, and the nurse is writing an individualized care plan. The priority nursing diagnosis for a patient with this condition is what? A. Deficient fluid volume B. Excessive fluid volume C. Hypothermia D. Hyperthermia
B. Excessive fluid volume RATIONALE The priority nursing diagnosis for a patient with SIADH is excessive fluid volume, as the patient retains fluids and develops a sodium deficiency. Restricting fluid intake is a typical intervention for managing this syndrome. Temperature imbalances are not associated with SIADH, so hyperthermia and hypothermia are not priority nursing diagnoses.
A patient with a diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH) is being cared for on a medical unit, and the nurse is writing an individualized care plan. The priority nursing diagnosis for a patient with this condition is what? A. Deficient fluid volume B. Excessive fluid volume C. Hypothermia D. Hyperthermia
B. Excessive fluid volume RATIONALE The priority nursing diagnosis for a patient with SIADH is excessive fluid volume, as the patient retains fluids and develops a sodium deficiency. Restricting fluid intake is a typical intervention for managing this syndrome. Temperature imbalances are not associated with SIADH, so hyperthermia and hypothermia are not priority nursing diagnoses.
The nurse is caring for a client with diabetes who developed hypoglycemia. What can the nurse administer to the client to raise the blood sugar level? A. Insulin B. Glucagon C. Cortisone D. Estrogen
B. Glucagon RATIONALE Glucagon, a hormone released by alpha islet cells, raises blood sugar levels by stimulating glycogenolysis, the breakdown of glycogen into glucose, in the liver. Insulin is released to lower the blood sugar levels. Cortisone and estrogen are not released from the pancreas.
A client complains of nervousness and palpitations. Upon assessing the patient's heart rate, the nurse notes a heart rate of 120 bpm. Which of the following endocrine disorders is associated with palpitations and increased heart rate? A. Hypothyroidism B. Hyperthyroidism C. SIADH D. Hypoparathyroidism
B. Hyperthyroidism RATIONALE Hyperthyroidism increases the heart rate and palpitations. Thyroid hormone increases the cardiac contractility, cardiac output, and heart rate.
A nurse is providing care to a client who is experiencing low blood glucose levels. The nurse understands that the body attempts to raise the level by secreting which hormone? A. insulin B. glucagon C. somatostatin D. aldosterone
B. glucagon RATIONALE The beta cells of the pancreas secrete insulin, which facilitates glucose transport into body cells, thus lowering the blood glucose levels when they are above normal. When blood glucose levels are low, alpha cells of the pancreas secrete the hormone glucagon. It promotes gluconeogenesis to raise the blood glucose level. Because its action is opposite to insulin, it may be termed a counter-regulatory hormone. The delta cells of the pancreas secrete somatostatin, which reduces the rate at which food is absorbed from the GI tract. Aldosterone is secreted by the adrenal cortex and is responsible for regulating sodium balance.
A nurse is assigned to care for a patient with increased parathormone secretion. Which of the following serum levels should the nurse monitor for this patient? A. Glucose B. Sodium C. Calcium D. Potassium
C. Calcium RATIONALE Increased secretion of parathormone results in bone resorption. Calcium is released into the blood, increasing serum levels.
An elderly woman complaining of weight gain, depression, and lethargy is diagnosed with hypothyroidism, and thyroid replacement is prescribed. During initiation of thyroid replacement therapy for the patient, the priority assessment for the nurse is to evaluate which of the following? A. Mental status B. Nutritional status C. Cardiovascular function D. Bowel function
C. Cardiovascular function RATIONALE Hypothyroidism is associated with coronary-related diseases such as elevated serum cholesterol, atherosclerosis, and coronary artery disease (CAD). When thyroid hormone is administered, the myocardial oxygen demand increases without increasing the myocardial oxygen supply; therefore, patients should be monitored for cardiac complications such as chest pain and congestive heart failure. Patients may also be treated for angina or arrhythmias due to the release of catecholamine's that may be activated during thyroid replacement therapy.
A nurse is performing a physical examination on client suspected of having an endocrine disorder. Which assessment finding might be indicative of a problem with the thyroid gland? A. Sudden weight loss without dieting B. Dilated pupils C. Cold intolerance D. Diarrhea
C. Cold intolerance RATIONALE The thyroid releases hormones that regulate the body's metabolic rate. A client with a malfunctioning thyroid gland may experience weight gain, constipation, cold intolerance, and slowing of body functions. Dilation of the pupils would more likely be related to the adrenal medulla secreting epinephrine and norepinephrine.
A client is having chronic pain from arthritis. What type of hormone is released in response to the stress of this pain that suppresses inflammation and helps the body withstand stress? A. Testosterone B. Mineralocorticoids C. Glucocorticoids D. Estrogen
C. Glucocorticoids RATIONALE Glucocorticoids, such as cortisol, affect body metabolism, suppress inflammation, and help the body withstand stress. Mineralocorticoids, primarily aldosterone, maintain water and electrolyte balances. The androgenic hormones convert to testosterone and estrogens.
The nurse is teaching a patient about nutrition and knows that the body needs specific nutrients in order to function normally. What element is essential to thyroid function? A. Potassium B. Selenium C. Iodine D. Chlorine
C. Iodine RATIONALE Iodine is essential to the thyroid gland for synthesis of its hormones.
The nursing educator is teaching a group of new graduates about Addison's disease. What symptom would the educator identify as being characteristic of Addison's disease? A. Truncal obesity B. Hypertension C. Muscle weakness D. "Moon" face
C. Muscle weakness RATIONALE Patients with Addison's disease demonstrate muscular weakness, anorexia, gastrointestinal symptoms, fatigue, emaciation, dark pigmentation of the skin, and hypotension.
While assessing a client with Cushing syndrome, the nurse should expect high blood glucose reading due to increased secretion of which of the following? A. The thyroid gland B. The parathyroid glands C. The adrenal glands D. The pituitary gland
C. The adrenal glands RATIONALE In Cushing's syndrome, increased secretion of glucocorticoid hormones from the adrenal glands causes increased levels of blood glucose.
A client is scheduled for a diagnostic test to measure blood hormone levels. The nurse expects that this test will determine which of the following? A. The concentration of a substance in plasma B. Details about the size of the organ and its location C. The functioning of endocrine glands D. The client's blood sugar level
C. The functioning of endocrine glands RATIONALE Measuring blood hormone levels helps determine the functioning of endocrine glands. A radioimmunoassay determines the concentration of a substance in plasma. The measurement of blood hormone levels will not reveal a client's blood sugar level. Radiographs of the chest or abdomen determine the size of the organ and its location.
The nurse is assessing a client for acromegaly at the clinic. Besides asking about changes in shoe size and facial features, the nurse should also inquire about changes in which of the following? A. Hearing B. Bowel habits C. Vision D. Taste of foods
C. Vision RATIONALE Oversecretion of the growth hormone from the anterior pituitary results in acromegaly. The pituitary gland may be enlarged and causing a pressure on the optic nerve in the brain, thus changes in vision may occur.
A patient with pheochromocytoma has been admitted for an adrenalectomy tomorrow. The patient is to start IV medication this evening to prevent adrenal insufficiency. What medication is the patient most likely to require? A. Antibiotics B. Antihypertensives C. Parenteral nutrition D. Corticosteroids
D. Corticosteroids RATIONALE The adrenal cortex produces corticosteroids. As a result, corticosteroids would be administered to prevent adrenal insufficiency. Antibiotics, antihypertensives, and parenteral nutrition do not prevent adrenal insufficiency.
A client is being seen in the clinic to receive the results of the lab work to determine thyroid levels. The nurse observes the client's eyes appear to be bulging, and there is swelling around the eyes. What does the nurse know that the correct documentation of this finding is? A. Retinal detachment B. Periorbital swelling C. Bulging eyes D. Exophthalmos
D. Exophthalmos RATIONALE Exophthalmos is an abnormal bulging or protrusion of the eyes and periorbital swelling. These findings are not consistent with retinal detachment.
A 47-year-old woman presents to her primary care provider complaining of bone pain. Routine laboratory studies reveal a high serum calcium of 12.0 mg/dL and increased PTH levels. Which of the following is the most likely diagnosis? A. Graves disease B. Cushing disease C. Addison disease D. Hyperparathyroidism
D. Hyperparathyroidism RATIONALE Hyperparathyroidism is characterized by having excess parathormone (PTH), leading to a markedly increased level of serum calcium
A nurse explains to a client with thyroid disease that the thyroid gland normally produces: A. iodine and TSH B. TRH and TSH. C. TSH, T3, and calcitonin. D. T3, T4, and calcitonin.
D. T3, T4, and calcitonin. RATIONALE The thyroid gland normally produces thyroid hormone (T3 and T4) and calcitonin. The pituitary gland produces TSH to regulate the thyroid gland. The hypothalamus gland produces TRH to regulate the pituitary gland.
A nurse explains to a client with thyroid disease that the thyroid gland normally produces: A. iodine and thyroid-stimulating hormone (TSH). B. thyrotropin-releasing hormone (TRH) and TSH. C. TSH, triiodothyronine (T3), and calcitonin. D. T3, thyroxine (T4), and calcitonin.
D. T3, thyroxine (T4), and calcitonin. RATIONALE The thyroid gland normally produces thyroid hormone (T3 and T4) and calcitonin. The pituitary gland produces TSH to regulate the thyroid gland. The hypothalamus gland produces TRH to regulate the pituitary gland.
A client who is frightened of needles has been told that he will have to have an intravenous (IV) line inserted. The client's blood pressure and pulse rate increase, and the nurse observes the pupils dilating. What does the nurse recognize has occurred with this client? A. The client is developing an infection. B. The client is having a response to dehydration. C. The client is in a hypertensive crisis. D. The client is showing the fight-or-flight response.
D. The client is showing the fight-or-flight response. RATIONALE The adrenal medulla secretes epinephrine and norepinephrine. These two hormones are released in response to stress or threat to life. They facilitate what is referred to as the physiologic stress response, also known as the fight-or-flight response. Many organs respond to the release of epinephrine and norepinephrine. Responses include increased blood pressure and pulse rate, dilation of the pupils, constriction of blood vessels, bronchodilation, and decreased peristalsis. The client does not demonstrate the signs of infection, dehydration, or hypertensive crisis.
During a follow-up visit to the physician, a client with hyperparathyroidism asks the nurse to explain the physiology of the parathyroid glands. The nurse states that these glands produce parathyroid hormone (PTH). PTH maintains the balance between calcium and: A. sodium. B. potassium. C. magnesium. D. phosphorus.
D. phosphorus. RATIONALE PTH increases the serum calcium level and decreases the serum phosphate level. PTH doesn't affect sodium, potassium, or magnesium regulation.