Ch 47: Assessment of Endocrine System

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. b. The negative feedback system is failing to stimulate the anterior pituitary gland. c. The patient has an underactive thyroid gland that is not receiving TSH stimulation. d. A tumor on the anterior pituitary gland that is causing increased production of TSH.

a. Endocrine disorders related to hormone secretion from glands that are stimulated by tropic hormones can be caused by a malsecretion of the tropic hormone or of the target gland. If the problem is in the target gland, it is known as a primary endocrine disorder; a problem with tropic hormone secretion is known as a secondary endocrine disorder. Serum levels of tropic hormones can illustrate the status of the negative feedback system in relation to target organ hormone levels. Normally, if a target organ produces low amounts of hormone, tropic hormones will be increased; if a target organ is overproducing hormones, tropic hormones will be low or undetectable.

Match each hormone with the primary factor that stimulates its secretion and the primary factor that inhibits its secretion (factors may be used more than once). Hormone a. TSH or thyrotropin b. Corticotropin-releasing hormone c. ADH d. Follicle-stimulating hormone (FSH) e. Calcitonin f. Aldosterone g. Glucagon h. Parathyroid hormone (PTH) i. Insulin

a.3,2 b.1,4 c.13,14 d.6,5 e.9,10 f.11,12 g.8, 7 h. 10, 9 i. 7, 8

Which statement about the adrenal medulla hormones is accurate? a. Overproduction of androgens may cause masculinization in women. b. Both the adrenal medulla and the thyroid gland have a negative feedback system to the hypothalamus. c. Cortisol levels would be altered in a person who normally works a night shift from 11:00 PM to 7:00 AM and sleeps from 8:00 AM to 3:00 PM. d. Catecholamines are considered hormones when they are secreted by the adrenal medulla and neurotransmitters when they are secreted by nerve cells.

d. The catecholamines, epinephrine and norepinephrine, are hormones from the adrenal medulla. Androgens and cortisol are from the adrenal cortex. The thyroid and adrenal cortex are controlled by negative feedback, but the adrenal medulla's hormone production is controlled by the central nervous system.

A young adult patient who is being seen in the clinic has excessive secretion of the anterior pituitary hormones. Which laboratory test result should the nurse expect? a. Increased urinary cortisol b. Decreased serum thyroxine c. Elevated serum aldosterone d. Low urinary catecholamines

ANS: A Increased secretion of adrenocorticotropic hormone (ACTH) by the anterior pituitary gland will lead to an increase in serum and urinary cortisol levels. An increase, rather than a decrease, in thyroxine level would be expected with increased secretion of thyroid-stimulating hormone (TSH) by the anterior pituitary. The anterior pituitary does not control aldosterone and catecholamine levels.

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." b. "Exercise should be avoided until the testing is complete." c. "Several blood samples will be obtained during the testing." d. "You should follow a low-calorie diet the day before the test." e. "The test requires that you fast for at least 8 hours before testing."

ANS: A, C, E 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/day for 3 days before the test. The patient should be ambulatory and active for accurate test results

The nurse is caring for a patient during a water deprivation test. Which finding is most important for the nurse to communicate to the health care provider? a. The patient reports intense thirst. b. The patient has a 5-lb (2.3-kg) weight loss. c. The patient feels dizzy when sitting on the bed. d. The patient's urine osmolality does not increase.

ANS: B A drop in the weight of more than 2 kg indicates severe dehydration, and the test should be discontinued. The other assessment data are not unusual with this test.

Which information about a patient who is scheduled for an oral glucose tolerance test should the nurse consider in interpreting the test results? a. The patient reports having occasional orthostatic dizziness. b. The patient takes oral corticosteroids for rheumatoid arthritis. c. The patient has had a 10 pound weight gain in the last month. d. The patient drank several glasses of water an hour previously.

ANS: B Corticosteroids can affect blood glucose results. The other information will not affect the test results

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? a. The RN checks the blood pressure in both arms. b. The RN palpates the neck to assess thyroid size. c. The RN orders saline eyedrops to lubricate the patient's bulging eyes. d. The RN lowers the thermostat to decrease the temperature in the room.

ANS: B Palpation can cause the release of thyroid hormones in a patient with an enlarged thyroid and should be avoided. The other actions by the new RN are appropriate when caring for a patient with an enlarged thyroid.

During the physical examination, the nurse cannot feel the patient's thyroid gland. What action should the nurse take? a. Palpate the patient's neck more deeply. b. Document that the thyroid was nonpalpable. c. Notify the health care provider immediately d. Teach the patient about thyroid hormone testing

ANS: B The thyroid is usually nonpalpable. The nurse should simply document the finding. There is no need to notify the health care provider immediately about a normal finding. There is no indication for thyroid-stimulating hormone (TSH) testing unless there is evidence of thyroid dysfunction. Deep palpation of the neck is not appropriate

Which additional information should the nurse consider when reviewing the laboratory results for a patient's total calcium level? a. The blood glucose b. The serum albumin c. The phosphate level d. The magnesium level

ANS: B Part of the total calcium is bound to albumin, so hypoalbuminemia can lead to misinterpretation of calcium levels. The other laboratory values will not affect total calcium interpretation

The nurse is caring for a patient 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. Report of chronic headache b. History of renal insufficiency c. Recent bilateral visual field loss d. Blood glucose level of 134 mg/dL

ANS: B 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 IV fluids to prevent this complication. The other findings are consistent with the patient's diagnosis of a pituitary tumor

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? a. Bilateral poor peripheral vision b. Allergies to iodine and shellfish c. Recent weight loss of 20 pounds d. Patient reports ongoing headaches

ANS: B Because the usual contrast media is iodine-based, the health care provider will need to know about the allergy before the CT scan. The other findings are common with any mass in the brain such as a pituitary adenoma

A patient seen in the emergency department for severe headache and acute confusion has a serum sodium level of 118 mEq/L. The nurse should anticipate the need for which diagnostic test? a. Urinary 17-ketosteroids b. Antidiuretic hormone level c. Growth hormone stimulation test d. Adrenocorticotropic hormone level

ANS: B Elevated levels of antidiuretic hormone will cause water retention and decrease serum sodium levels. The other tests would not be helpful in determining the cause of the patient's hyponatremia.

What should the nurse teach a patient who is scheduled to complete a 24-hour urine collection for 17-ketosteroids? a. To insert and maintain a retention catheter b. To keep the specimen refrigerated or on ice c. To drink at least 3 L of fluid during the 24 hours d. To void and save the specimen to start the collection

ANS: B 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 has been newly diagnosed with type 2 diabetes. 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? a. Ideal weight b. Value system c. Activity level d. Visual changes

ANS: B 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. The other information also will be useful but is not as important in developing an individualized plan for the necessary lifestyle changes.

Which question from the nurse during a patient interview will provide focused information about a possible thyroid disorder? a. "What methods do you use to help cope with stress?" b. "Have you experienced any blurring or double vision?" c. "Have you had a recent unplanned weight gain or loss?" d. "Do you have to get up at night to empty your bladder?"

ANS: C 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 patient is scheduled in the outpatient clinic for blood cortisol testing. Which instruction should the nurse provide? a. "Avoid adding any salt to your foods for 24 hours before the test." b. "You will need to lie down for 30 minutes before the blood is drawn." c. "Come to the laboratory to have the blood drawn early in the morning." d. "Do not have anything to eat or drink before the blood test is obtained."

ANS: C Cortisol levels are usually drawn in the morning, when levels are highest. The other instructions would be given to patients who were having other endocrine testing

What information will a review of a patient's glycosylated hemoglobin (A1C) results provide to the nurse? a. Fasting preprandial glucose levels b. Glucose levels 2 hours after a meal c. Glucose control over the past 90 days d. Hypoglycemic episodes in the past 3 months

ANS: C Glycosylated hemoglobin testing measures glucose control over the last 3 months. Glucose testing before/after a meal or random testing may reveal impaired glucose tolerance and indicate prediabetes, but it is not done on patients who already have a diagnosis of diabetes. There is no test to evaluate for hypoglycemic episodes in the past.

Which laboratory value should the nurse review to determine whether a patient's hypothyroidism is caused by a problem with the anterior pituitary gland? a. Thyroxine (T4) level b. Triiodothyronine (T3) level c. Thyroid-stimulating hormone (TSH) level d. Thyrotropin-releasing hormone (TRH) level

ANS: C A low TSH level indicates that the patient's hypothyroidism is caused by decreased anterior pituitary secretion of TSH. Low T3and T4 levels are not diagnostic of the primary cause of the hypothyroidism. TRH levels indicate the function of the hypothalamus

A patient is taking spironolactone (Aldactone), a drug that blocks the action of aldosterone on the kidney, for hypertension. What additional effect of the medication should the nurse monitor? a. Increased serum sodium b. Decreased urinary output c. Elevated serum potassium d. Evidence of fluid overload

ANS: C Because aldosterone increases the excretion of potassium, a medication that blocks aldosterone will tend to cause hyperkalemia. Aldosterone also promotes the reabsorption of sodium and water in the renal tubules, so spironolactone will tend to cause increased urine output, a decreased or normal serum sodium level, and signs of dehydration.

Which statement made by a 50-yr-old female patient indicates to the nurse that further assessment of thyroid function may be needed? a. "I am so thirsty that I drink all day long." b. "I get up several times at night to urinate." c. "I feel a lump in my throat when I swallow." d. "I notice my breasts are always tender lately."

ANS: C Difficulty in swallowing can occur with a goiter. Nocturia is associated with diseases such as diabetes, diabetes insipidus, or chronic kidney disease. Breast tenderness would occur with excessive gonadal hormone levels. Thirst is a sign of disease such as diabetes.

A patient is admitted with tetany. Which laboratory value should the nurse plan to monitor? a. Total protein b. Blood glucose c. Ionized calcium d. Serum phosphate

ANS: C Tetany is associated with hypocalcemia. The other values would not be useful for this patient.

An 18-yr-old male patient with small stature is scheduled for a growth hormone stimulation test. What should the nurse obtain in preparation for the test? a. Ice in a basin b. Glargine insulin c. A cardiac monitor d. 50% dextrose solution

ANS: D Hypoglycemia is induced during the growth hormone stimulation test, and the nurse should be ready to administer 50% dextrose immediately. Regular insulin is used to induce hypoglycemia. The patient does not need cardiac monitoring during the test. Although blood samples for some tests must be kept on ice, this is not true for the growth hormone stimulation test.

A patient admitted with pneumonia has a total serum calcium level of 13.3 mg/dL. What should the nurse anticipate will be tested next? a. Calcitonin b. Catecholamine c. Thyroid hormone d. Parathyroid hormone

ANS: D Parathyroid hormone (PTH) is the major controller of blood calcium levels. Although calcitonin secretion is a counter mechanism to PTH, it does not play a major role in calcium balance. Catecholamine and thyroid hormone levels do not affect serum calcium level.

In preparation for which test should the nurse teach the patient to minimize physical and emotional stress? a. A water deprivation test b. A test for serum T3 and T4 levels c. A 24-hour urine test for free cortisol d. A radioactive iodine (I-131) uptake test

ANS:C Physical and emotional stress can affect the results of the free cortisol test. Stress does not impact the other tests.

Which hormones are secreted by the anterior pituitary gland (select all that apply)? a. Prolactin b. Melatonin c. Somatostatin d. Parathyroid hormone e. Growth hormone (GH) f. Gonadotropic hormones g. Antidiuretic hormone (ADH) h. Melanocyte-stimulating hormone i. Thyroid-stimulating hormone (TSH) j. Adrenocorticotropic hormone (ACTH)

a, e, f, i, j. The anterior pituitary gland secretes prolactin, growth hormone (GH), gonadotropic hormones, thyroid- stimulating hormone (TSH), and adrenocorticotropic hormone (ACTH). The pineal gland secretes melatonin. The delta cells of the islets of Langerhans secrete somatostatin. The parathyroid secretes parathormone. The posterior pituitary secretes antidiuretic hormone (ADH). The intermediate lobe produces melanocyte-stimulating hormone.

In a patient with an elevated serum cortisol, what should the nurse expect other laboratory findings to reveal? a. Hypokalemia b. Hyponatremia c. Hypoglycemia d. Decreased serum triglycerides

a. Although cortisol is a glucocorticoid, it has action on mineralocorticoid receptors, which causes sodium retention and potassium excretion from the kidney, resulting in hypokalemia. Because water is reabsorbed with the sodium, serum sodium remains normal. In its effect on glucose and fat metabolism,cortisol causes an elevation in blood glucose as well as increases in free fatty acids and triglycerides.

What are two effects of hypokalemia on the endocrine system? a. Decreased insulin and aldosterone release b. Decreased glucagon and increased cortisol release c. Decreased release of ANP and increased ADH release d. Decreased release of parathyroid hormone and increased calcitonin release

a. Hypokalemia inhibits aldosterone release as well as insulin release. Hypokalemia does not directly effect the other options.

Which abnormal assessment findings are related to thyroid dysfunction (select all that apply)? a. Tetanic muscle spasms with hypofunction b. Heat intolerance caused by hyperfunction c. Exophthalmos associated with excessive secretion d. Hyperpigmentation associated with hypofunction e. A goiter with either hyperfunction or hypofunction f. Increase in hand and foot size associated with excessive secretion

b, c, e. Heat intolerance, exophthalmos, and a goiter are all related to thyroid dysfunction. Tetanic muscle spasms are related to hypofunction of the parathyroid. Hyperpigmentation is related to hypofunction of the adrenal gland. Increased hand and foot size is related to excess growth hormone secretion.

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)? a. Thyroglobulin b. Luteinizing hormone (LH) c. Parathyroid hormone (PTH) d. Follicle-stimulating hormone (FSH) e. Magnetic resonance imaging (MRI) of the head f. Adrenal corticotropic hormone (ACTH) suppression

b, d, e. Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) are used to distinguish gonad problems from pituitary insufficiency. LH and FSH are low in pituitary insufficiency and high in gonadal failure. The MRI would be used to identify tumors involving the pituitary gland or hypothalamus. Thyroglobulin is a tumor marker for thyroid cancer. Parathyroid hormone (PTH), along with calcium and phosphorus levels, are checked for parathyroid function. The ACTH suppression test assesses adrenal function, especially with hyperactivity.

What is released in the normal response to increased serum osmolality? a. Aldosterone from the adrenal cortex, which stimulates sodium excretion by the kidney b. ADH from the posterior pituitary gland, which stimulates the kidney to reabsorb water c. Mineralocorticoids from the adrenal gland, which stimulate the kidney to excrete potassium d. Calcitonin from the thyroid gland, which increases bone resorption and decreases serum calcium levels

b. ADH release is controlled by the osmolality of the blood. As the osmolality rises, ADH is released from the posterior pituitary gland and acts on the kidney to cause reabsorption of water from the kidney tubule, resulting in more dilute blood and more concentrated urine. Aldosterone, the major mineralocorticoid, causes sodium reabsorption from the kidney and potassium excretion. Calcium levels are not a factor in serum osmolality.

Common nonspecific manifestations that may alert the nurse to endocrine dysfunction include a. goiter and alopecia. b. exophthalmos and tremors. c. weight loss, fatigue, and depression. d. polyuria, polydipsia, and polyphagia.

c. Assessment of the endocrine system is often difficult because hormones affect every body tissue and system, causing great diversity in the signs and symptoms of endocrine dysfunction. Weight loss, fatigue, and depression are signs that may occur with many different endocrine problems or other diseases. Goiter, exophthalmos, and the three "polys" are findings of specific endocrine glands' dysfunction.

Which endocrine gland secretes cortisol in a diurnal pattern? a. Ovaries b. Thyroid c. Adrenal cortex d. Adrenal medulla

c. Cortisol is secreted by the adrenal cortex in a diurnal pattern, creating circadian rhythm. Ovaries secrete estrogen and progesterone to maintain a woman's secondary sex characteristic function. The thyroid secretes thyroxine (T4) and triiodothyronine (T3) in response to TSH, and calcitonin in response to high serum calcium levels. The adrenal medulla secretes epinephrine and norepinephrine in response to stress.

What is a potential adverse effect of palpation of an enlarged thyroid gland? a. Carotid artery obstruction b. Damage to the cricoid cartilage c. Release of excessive thyroid hormone into circulation d. Hoarseness from pressure on the recurrent laryngeal nerve

c. In the patient with enlarged thyroid, palpation can cause the release of thyroid hormone into circulation, increasing the patient's symptoms and potentially causing a thyroid storm. Examination should be deferred to a more experienced clinician if possible. If the thyroid is palpated correctly, the carotid arteries are not compressed. Pressure should not be so great as to damage the cricoid cartilage or laryngeal nerve.

What accurately demonstrates that hormones of one gland influence the function of hormones of another gland? a. Increased insulin levels inhibit the secretion of glucagon. b. Increased cortisol levels stimulate the secretion of insulin. c. Increased testosterone levels inhibit the release of estrogen. d. Increased atrial natriuretic peptide (ANP) levels inhibit the secretion of aldosterone.

d. Atrial natriuretic peptide (ANP) is secreted in response to high blood volume and high serum sodium levels and has an inhibiting effect on ADH and the renin-angiotensin- aldosterone system, the effects of which would make the blood volume even higher. The relationship between cortisol and insulin is indirect; cortisol raises blood glucose levels, and insulin secretion is stimulated by high glucose levels. Glucagon secretion inhibits insulin secretion, but insulin does not inhibit glucagon. Testosterone and estrogen have no reciprocal action, and both are secreted by the body in response to tropic hormones.

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? a. Hair loss and moon face b. Decreased weight and hirsutism c. Decreased muscle mass and thick skin d. Elevated blood pressure and blood glucose

d. The elevated cortisol of Cushing syndrome manifests in elevated blood pressure and blood glucose. Also seen are moon face, hirsutism, decreased muscle mass from protein wasting, increased weight, and fragile skin with striae across the abdomen.

How do hormones respond following the ingestion of a high-protein, carbohydrate-free meal? a. Both insulin and glucagon are inhibited because blood glucose levels are unchanged. b. Insulin is inhibited by low glucose levels, and glucagon is released to promote gluconeogenesis. c. Insulin is released to facilitate the breakdown of amino acids into glucose, and glucagon is inhibited. d. Glucagon is released to promote gluconeogenesis, and insulin is released to facilitate movement of amino acids into muscle cells.

d. Usually insulin and glucagon function in a reciprocal manner, except after a high-protein, carbohydrate-free meal, in which both hormones are secreted. Glucagon increases gluconeogenesis and insulin facilitates transport of amino acids across muscle membranes for protein synthesis.

The patient with type 1 diabetes mellitus is in the clinic to check his long-term glycemic control. Which test should be used? a. Water deprivation test b. Fasting blood glucose test c. Oral glucose tolerance test d. Glycosylated hemoglobin (A1C)

d. Glycosylated hemoglobin (A1C) is used to assess blood glucose control during the previous 3 months. Water deprivation (ADH stimulation) is used to differentiate causes of diabetes insipidus. Fasting blood glucose will measure only the current blood glucose result. The oral glucose tolerance test is used to diagnose diabetes when abnormal fasting blood glucose levels do not clearly indicate diabetes.

Identify the glands in the following illustration. a. b. c. d. e. f. g. h. i.

a. Pineal b. parathyroids c. testes (male) d. ovaries (female) e. pancreatic islets of Langerhans f. adrenals g. thyroid h. pituitary i. hypothalamus

What manifestations of endocrine problems in the older adult are commonly attributed to the aging process? a. Tremors and paresthesias b. Fatigue and mental impairment c. Hyperpigmentation and oily skin d. Fluid retention and hypertension

b. Many symptoms of hypothyroidism, such as fatigue, mental impairment, dry skin, and constipation that would be apparent in younger persons are attributed to general aging in the older adult; as a result, hypothyroidism goes unrecognized as a treatable condition.

From where is the hormone glucagon secreted? a. F cells of the islets of Langerhans b. β-cells of the islets of Langerhans c. α-cells of the islets of Langerhans d. Delta cells of the islets of Langerhans

c. The α-cells in the islets of Langerhans in the pancreas produce and secrete the hormone glucagon. The F cells secrete pancreatic polypeptide. The β-cells produce and secrete insulin and amylin. The delta cells produce and secrete somatostatin.

o ensure accurate results of a fasting blood glucose analysis, the nurse instructs the patient to fast for at least how long? a. 2 hours b. 4 hours c. 8 hours d. 12 hours

c. To ensure that the level is a fasting level, a minimum of 8 hours should be allowed. Water may be taken, however, and does not affect the glucose level. Many medications may also influence results, which will have to be evaluated.