Chapter 47 - Assessment of Endocrine System

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."* *Rationale* 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 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* b. Complains of chronic headache c. Recent bilateral visual field loss d. Blood glucose level of 134 mg/dL *Rationale* 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 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* b. decreased serum thyroxine c. elevated serum aldosterone levels d. low urinary catecholamines excretion *Rationale* 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. Aldosterone and catecholamine levels are not controlled by the anterior pituitary.

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

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. *Rationale* 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.

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...

a. ice in a basin b. glargine insulin c. a cardiac monitor *d. 50% dextrose solution* *Rationale* 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 (glargine is never given IV). The patient does not require 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 will be scheduled in the outpatient clinic for blood cortisol testing. Which instruction will 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." *Rationale* 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.

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

a. insert and maintain a retention catheter. *b. keep the specimen refrigerated or on ice.* c. drink at least 3 L of fluid during the 24 hours. d. void and save that specimen to start the collection. *Rationale* 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.

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...

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. *Rationale* The thyroid is frequently 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.

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 *Rationale* Tetany is associated with hypocalcemia. The other values would not be useful for this patient.

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

a. "I notice my breasts are tender lately." b. "I am so thirsty that I drink all day long." c. "I get up several times at night to urinate." *d. "I feel a lump in my throat when I swallow."* *Rationale* Difficulty in swallowing can occur with a goiter. Nocturia is associated with diseases such as diabetes mellitus, diabetes insipidus, or chronic kidney disease. Breast tenderness would occur with excessive gonadal hormone levels. Thirst is a sign of disease such as diabetes.

Which question from a 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?" *Rationale* 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 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 eye drops to lubricate the patient's bulging eyes. d. The RN lowers the thermostat to decrease the temperature in the room. *Rationale* 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.

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?

a. The patient complains of intense thirst. *b. The patient has a 5-lb (2.3-kg) weight loss.* c. The patient's urine osmolality does not increase. d. The patient feels dizzy when sitting on the edge of the bed. *Rationale* 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 be reported to the health care provider before starting the test?

a. The patient reports having occasional orthostatic dizziness. *b. The patient takes oral corticosteroids for rheumatoid arthritis.* c. The patient has had a 10-lb weight gain in the last month. d. The patient drank several glasses of water an hour previously. *Rationale* Corticosteroids can affect blood glucose results. The other information will be provided to the health care provider but will not affect the test results.

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?

a. Thyroxine (T4) level b. Triiodothyronine (T3) level *c. Thyroid-stimulating hormone (TSH) level* d. Thyrotropin-releasing hormone (TRH) level *Rationale* 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 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?

a. Urinary 17-ketosteroids *b. Antidiuretic hormone level* c. Growth hormone stimulation test d. Adrenocorticotropic hormone level *Rationale* Elevated levels of antidiuretic hormone will cause water retention and decrease serum sodium levels. The other tests would not be helpful in determining possible causes of the patient's hyponatremia.

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

a. a water deprivation test. b. testing for serum T3 and T4 levels. *c. a 24-hour urine test for free cortisol.* d. a radioactive iodine (I-131) uptake test. *Rationale* Physical and emotional stress can affect the results of the free cortisol test. The other tests are not impacted by stress.

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 lbs d. complaint of ongoing headaches *Rationale* 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.

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

a. blood glucose *b. serum albumin* c. phosphate level d. magnesium level *Rationale* 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.

A 61-yr-old female patient admitted with pneumonia has a total serum calcium level of 13.3 mg/dL (3.3 mmol/L). The nurse will anticipate the need to teach the patient about testing for _____ levels.

a. calcitonin b. catecholamine c. thyroid hormone *d. parathyroid hormone* *Rationale* Parathyroid hormone (PTH) is the major controller of blood calcium levels. Although calcitonin secretion is a countermechanism to PTH, it does not play a major role in calcium balance. Catecholamine and thyroid hormone levels do not affect serum calcium level.

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?

a. ideal weight *b. value system* c. activity level d. visual changes *Rationale* 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.

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

a. increased serum sodium b. decreased urinary output *c. elevated serum potassium* d. evidence of fluid overload *Rationale* 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.