Ch. 56 assessment of endocrine system
A nurse assesses a client who is prescribed a medication that stimulates beta 1 receptors. which assessment finding would indicate that the medication is effective a. HR of 92 bpm b. resp rate of 18 c. O2 of 92% d. BP of 144/69
a. HR of 92 bpm 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 other vital signs are within normal limits and do not indicate any response to the medication.
a nurse assesses clients who have endocrine disorders. which assessment findings are paired correctly with the endocrine disorder? SATA a. excessive thyroid stimulating hormone- increased bone formation b. excessive melanocyte stimulating hormone- darkening of the skin c. excessive parathyroid hormone- synthesis and release of corticosteroids d. excessive antidiuretic hormone- increased UO e. excessive adrenocorticotropic hormone- increased bone resorption
a. excessive thyroid stimulating hormone- increased bone formation b. excessive melanocyte stimulating hormone- darkening of the skin Thyroid-stimulating hormone targets thyroid tissue and stimulates the formation of bone. Melanocyte-stimulating hormone stimulates melanocytes and promotes pigmentation or the darkening of the skin. Parathyroid hormone stimulates bone resorption. Antidiuretic hormone targets the kidney and promotes water reabsorption, causing a decrease in urinary output. Adrenocorticotropic hormone targets the adrenal cortex and stimulates the synthesis and release of corticosteroids.
a nurse cares for clients with hormone disorders. which are common key features of hormones? SATA a. hormones may travel long distances to get 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 stores in the target tissues for use later e. most hormones cause target tissues to change activities by changing gene activity
a. hormones may travel long distances to get their target tissues b. continued hormone activity requires continued production and secretion c. control of hormone activity is caused by negative feedback mechanisms 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.
a client is scheduled to have a glycosylated hgb (A1c) drawn and asks the nurse why she has to have it. How would the nurse respond? a. it measures your average blood glucose level for the past 3 months b. it determines what type of anemia you may have c. it measures the amount of liver glycogen you have d. it determines if you have some type of leukemia or other blood cancer
a. it measures your average blood glucose level for the past 3 months A1C measures the average blood glucose level to determine if the client is a diabetic or how controlled a diabetic client is.
a nurse cares for a client with a hypo functioning anterior pituitary gland. which hormones would the nurse expect to decrease as a result? SATA a. thyroid stimulating hormone b. vasopressin c. follicle stimulating hormone d. calcitonin e. growth hormone
a. thyroid stimulating hormone c. follicle stimulating hormone e. growth hormone 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.
A nurse assesses a female client who presents with hirsutism. which question would the nurse ask when assessing this client? a. how do you plan to pay for your treatments? b. how do you feel about yourself? c. what medications are you prescribed? d. what are you doing to prevent this from happening
b. how do you feel about yourself? Hirsutism, or 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 would inquire into the client's body image and self-perception. Asking about the client's financial status or current medications does not address the client's immediate problem. The client is not doing anything to herself to cause the problem, nor can the client prevent it from happening.
a nurse is caring for a patient who has excessive catecholamine release. which assessment finding would the nurse correlate with this condition? a. decreased BP b. increased pulse c. decreased RR d. increased UO
b. increased pulse Catecholamines are responsible for the fight-or-flight stress response. Activation of the sympathetic nervous system can be correlated with tachycardia. Catecholamines do not decrease blood pressure or respiratory rate, nor do they increase urine output
a nurse teaches an older woman who has a decreased production of estrogen. which statement would the nurse include in this client's teaching to decrease injury? a. drink at least 2 quarts (2L) of fluid each day b. walk around the neighborhood for daily exercise c. bathe your perineal area twice a day d. you should check your blood glucose before meals
b. walk around the neighborhood for daily exercise An older female with decreased production of estrogen is at risk for decreased bone density and fractures. The nurse would encourage the client to participate in weight-bearing exercises such as walking. Drinking fluids and performing perineal care will decrease vaginal drying but not injury. Older adults often have a decreased glucose tolerance, but this is not related to a decrease in estrogen.
the nurse is teaching the AP about hormones that are produced by the adrenal glands. which hormone has the primary responsibility of maintaining fluid volume and electrolyte composition? a. sodium b. magnesium c. aldosterone d. renin
c. aldosterone Aldosterone is a hormone secreted by the adrenal cortex that causes water and sodium absorption to maintain body fluid volume. Renin is secreted by the kidney to trigger angiotensinogen converting angiotensin I to angiotensin II to help control blood pressure. Magnesium and sodium are electrolytes and not hormones.
The nurse assesses an older client. What age-related physiologic changes would the nurse expect? a. heat intolerance b. rheumatoid arthritis c. dehydration d. increased appetite
c. dehydration As people age, the many of the endocrine glands decrease hormone production, including a decrease in antidiuretic hormone production. This change, in addition to less body fluid being present as one ages, can cause dehydration. Older adults usually have cold intolerance and a decrease in appetite. Rheumatoid arthritis is not an age-related change; osteoarthritis causes primarily by aging.
the nurse reviews the function of thyroid gland hormones. what is the primary function of calcitonin? a. sodium and potassium balance b. magnesium balance c. norepinephrine balance d. calcium and phosphorus balance
d. calcium and phosphorus balance Calcitonin is the primary body hormone that is secreted from the thyroid gland and is responsible for maintaining calcium and phosphorus balance.
The nurse assesses a client who is scheduled to have a laboratory test to determine if the client's adrenal glands are hypoactive. what type of testing would the client likely have? a. catecholamine testing b. suppression testing c. bone marrow testing d. provocative testing
d. provocative testing Provocative testing is done to determine if an endocrine gland is capable of producing its normal level of hormone(s), especially when a client is suspected of having a hypoactive endocrine gland.
when caring for an older client who has hypothyroidism, what assessment findings will the nurse except? a. lethargy b. diarrhea c. low body temp d. tachycardia e. slowed speech f. weight gain
a. lethargy c. low body temp e. slowed speech f. weight gain A client who has an underactive thyroid gland has a decreased metabolic rate, resulting in lethargy and lack of energy, weight gain, slowed speech, and decreased vital signs like a lowered body temperature. The client also typically has constipation (instead of diarrhea) due to slower peristalsis and bradycardia (instead of tachycardia).
A nurse collaborates with an AP to provide care for a client who is prescribed a 24-hour urine specimen collection. which statement would the nurse include when teaching the AP about this activity? a. note the time of the client's first void and collect urine for 24 hours d. add the preservative to the container at the end of the test c. start the collection by saving the first urine in the morning d. it is ok if one urine sample during the 24 hours is not collected
a. note the time of the client's first void and collect urine for 24 hours The collection of a 24-hour urine specimen is often delegated to AP. The nurse must ensure that the AP understands the proper process for collecting the urine. The 24-hour urine collection specimen is started after the client's first urination. The first urine specimen is discarded because there is no way to know how long it has been in the bladder, but the time of the client's first void 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. All urine samples need to be collected for the test results to be accurate.