Endocrine Function
Lydia Kranston, a three-year-old female, is being seen by a physician in the endocrinology group where you practice nursing. She has a significant height deficit and is being seen for diagnostic purposes. What could be the cause of her disorder? a) Pituitary disorder b) Adrenal disorder c) Thyroid disorder d) Parathyroid disorder
A) Pituitary disorder Pituitary disorders usually result from excessive or deficient production and secretion of a specific hormone. Dwarfism occurs when secretion of GH is insufficient during childhood.
Before discharge, what should a nurse instruct a client with Addison's disease to do when exposed to periods of stress? a) Perform capillary blood glucose monitoring four times daily. b) Drink 8 oz of fluids. c) Administer hydrocortisone I.M. d) Continue to take his usual dose of hydrocortisone.
C) Administer hydrocortisone I.M Clients with Addison's disease and their family members should know how to administer I.M. hydrocortisone during periods of stress. Although it's important for the client to keep well hydrated during stress, the critical component in this situation is to know how and when to use I.M. hydrocortisone. Capillary blood glucose monitoring isn't indicated in this situation because the client doesn't have diabetes mellitus. Hydrocortisone replacement doesn't cause insulin resistance.
Which of the following diagnostic tests are done to determine suspected pituitary tumor? Choose the correct option. a) Radiographs of the abdomen b) A radioimmunoassay c) Measuring blood hormone levels d) A computed tomography scan
D) A computed tomography scan 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. However, measuring blood hormone levels helps determine the functioning of endocrine glands. A radioimmunoassay determines the concentration of a substance in plasma.
A hospitalized client is found to be comatose and hypoglycemic with a blood sugar of 50 mg/dL. Which of the following would the nurse do first? a) Infuse 1000 mL D5W over a 12-hour period. b) Encourage the client to drink orange juice with added sugar. c) Check the client's urine for the presence of sugar and acetone. d) Administer 50% glucose intravenously.
D) Administer 50% glucose intravenously The unconscious, hypoglycemic client needs immediate treatment with IV glucose. If the client does not respond quickly and the blood glucose level continues to be low, glucagon, a hormone that stimulates the liver to release glycogen, or 20 to 50 mL of 50% glucose is prescribed for IV administration. A dose of 1,000 mL D5W over a 12-hour period indicates a lower strength of glucose and a slow administration rate. Checking the client's urine for the presence of sugar and acetone is incorrect because a blood sample is easier to collect and the blood test is more specific and reliable. An unconscious client cannot be given a drink. In such a case glucose gel may be applied in the buccal cavity of the mouth
For a client with hyperthyroidism, treatment is most likely to include: a) a thyroid hormone antagonist. b) thyroid extract. c) emollient lotions. d) a synthetic thyroid hormone.
A) A thyroid hormone antagonist Thyroid hormone antagonists, which block thyroid hormone synthesis, combat increased production of thyroid hormone. Treatment of hyperthyroidism also may include radioiodine therapy, which destroys some thyroid gland cells, and surgery to remove part of the thyroid gland; both treatments decrease thyroid hormone production. Thyroid extract, synthetic thyroid hormone, and emollient lotions are used to treat hypothyroidism.
The surgeon was unable to save a patient's parathyroid gland during a radical thyroidectomy. The nurse should consequently pay particular attention to which of the following components of the patient's laboratory values? A) Calcium levels B) Potassium levels C) Blood glucose levels D) Sodium and chloride levels
A) Calcium levels The parathyroid gland plays a key role in maintaining calcium levels. Potassium, sodium, glucose, and chloride are not directly influenced by the loss of the parathyroid gland.
The sounds of sirens announce the arrival of the latest trauma to address the trauma center where you practice nursing. Your heart is pounding, your mouth is dry. What gland is responsible for your physiologic response? a) Pineal gland b) Thyroid gland c) Adrenal glands d) Parathyroid gland
C) Adrenal glands The adrenal medulla secretes epinephrine and norepinephrine. These two hormones are released in response to stress or threat to life. They facilitate what has been referred to as the fight-or-flight response.
After undergoing a thyroidectomy, a client develops hypocalcemia and tetany. Which electrolyte should the nurse anticipate administering? a) Sodium phosphorus b) Sodium bicarbonate c) Calcium gluconate d) Potassium chloride
C) Calcium gluconate Immediate treatment for a client who develops hypocalcemia and tetany after thyroidectomy is calcium gluconate. Potassium chloride and sodium bicarbonate aren't indicated. Sodium phosphorus wouldn't be given because phosphorus levels are already elevated.
The nurse would monitor for which of the following adverse changes in the patient's laboratory values as a result of being treated with dexamethasone (Decadron)? A) Sodium 130 mEq/L B) Calcium 8.2 mg/dl C) Potassium 4.9 mEq/L D) Blood glucose 162 mg/dl
D) Blood glucose 162 mg/dl Hyperglycemia or increased blood glucose level is an adverse effect of corticosteroid therapy.
A nurse is assessing a client with possible Cushing's syndrome. In a client with Cushing's syndrome, the nurse expects to find: a) weight gain in arms and legs. b) thick, coarse skin. c) hypotension. d) deposits of adipose tissue in the trunk and dorsocervical area.
D) Deposits of adipose tissue in the trunk and dorsocervical area Because of changes in fat distribution, adipose tissue accumulates in the trunk, face (moon face), and dorsocervical areas (buffalo hump). Hypertension is caused by fluid retention. Skin becomes thin and bruises easily because of a loss of collagen. Muscle wasting causes muscle atrophy and thin extremities.
A client is receiving long-term treatment with high-dose corticosteroids. Which of the following would the nurse expect the client to exhibit? a) Weight loss b) Pale thick skin c) Hypotension d) Moon face
D) Moon face Clients who are receiving long-term high-dose corticosteroid therapy often develop a cushingoid appearance, manifested by facial fullness and the characteristic moon face. They also may exhibit weight gain, peripheral edema, and hypertension due to sodium and water retention. The skin is usually thin, and ruddy.
A patient's recent medical history is indicative of diabetes insipidus. The nurse would perform patient education related to which of the following diagnostic tests? A) Thyroid scan B) Fasting glucose test C) Oral glucose tolerance D) Water deprivation test
D) Water deprivation test A water deprivation test is used to diagnose the polyuria that accompanies diabetes insipidus. Glucose tests and thyroid tests are not directly related to the diagnosis of diabetes insipidus.
A client has a disorder of the pancreas. The nurse recognizes that which of the following hormones may be affected as a result? Select all that apply. a) Somatostatin b) Glucagon c) Aldosterone d) Insulin e) Epinephrine
Somatostatin, Glucagon, Insulin The pancreas lies below the stomach, with the head of the gland close to the duodenum. It is both an exocrine and an endocrine gland. The exocrine portion secretes digestive enzymes that the common bile duct carries to the small intestine. The hormone-secreting cells of the pancreas, called the islets of Langerhans, release insulin, glucagon, somatostatin, and pancreatic polypeptide. Insulin lowers the level of blood glucose when it rises beyond normal limits. Glucagon raises blood sugar levels by stimulating glycogenolysis, the breakdown of glycogen into glucose, in the liver. Somatostatin helps maintain a relatively constant level of blood sugar by inhibiting the release of insulin and glucagons.
Wallace Guterman, a 36-year-old construction manager, is being seen by a physician in the primary care group where you practice nursing. He presents with a huge lower jaw, bulging forehead, large hands and feet and frequent headaches. What could be causing his symptoms? a) Hyperpituitarism b) Panhyperpituitarism c) Hypopituitarism d) Panhypopituitarism
A) Hyperpituitarism Acromegaly is a condition in which GH is oversecreted after the epiphyses of the long bones have sealed. A client with acromegaly has coarse features, a huge lower jaw, thick lips, a thickened tongue, a bulging forehead, a bulbous nose, and large hands and feet. When the overgrowth is from a tumor, headaches caused by pressure on the sella turcica are common.
A patient has sought care because of a loss of 25 lb over the past 6 months, during which the patient claims to have made no significant dietary changes. The nurse should assess the patient for potential A) Thyroid disorders. B) Diabetes insipidus. C) Pituitary dysfunction. D) Parathyroid dysfunction.
A) Thyroid disorders Hyperthyroidism is associated with weight loss. Alterations in pituitary function, such as diabetes insipidus, and parathyroid dysfunction are not commonly associated with this phenomenon.
Which of the following hormones would the nurse identify as being secreted by the thyroid gland? a) Thyroxine b) Parathormone c) Somatotropin d) Thymosin
A) Thyroxine The thyroid gland secretes thyroxine (T4 or tetraiodothyronine), triiodothyronine (T3), and calcitonin. Parathormone is secreted by the parathyroid glands. Thymosin is secreted by the thymus gland. Somatotropin is secreted by the anterior pituitary gland.
A patient is noted to be anemic. Which hormone will affect the development of red blood cells in this patient? a) Epinephrine b) Erythropoietin c) Secretin d) Insulin
B) Erythropoietin The kidneys produce erythropoietin, a hormone that stimulates the bone marrow to produce red blood cells. Insulin is a pancreatic hormone that decreases blood sugar. The gastrointestinal mucosa produces the hormone of secretin. Epinephrine is a hormone that causes vasoconstriction to elevate blood sugar.
After teaching a class about the endocrine system, the instructor determines that the students need additional instruction when they identify which of the following as an endocrine gland? a) Pancreas b) Kidneys c) Testes d) Adrenal gland
B) Kidneys Although the kidneys secrete renin and erythropoietin, they are typically not considered endocrine glands. The pancreas, adrenal glands, and testes are considered endocrine glands.
Which of the following assessment parameters is of highest priority when caring for a patient undergoing a water deprivation test? A) Serum glucose B) Patient weight C) Arterial blood gases D) Patient temperature
B) Patient weight A patient is at risk for severe dehydration during a water deprivation test. The test should be discontinued and the patient rehydrated if the patient's weight drops more than 2 kg at any time. The other assessment parameters do not assess fluid balance.
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) magnesium. b) phosphorus. c) sodium. d) potassium.
B) Phosphorus PTH increases the serum calcium level and decreases the serum phosphate level. PTH doesn't affect sodium, potassium, or magnesium regulation.
While assessing a client with hypoparathyroidism, the nurse taps the client's facial nerve and observes twitching of the mouth and tightening of the jaw. The nurse would document this finding as which of the following? a) Positive Trousseau's sign b) Positive Chvostek's sign c) Tetany d) Hyperactive deep tendon reflex
B) Positive Chvostek's sign If a nurse taps the client's facial nerve (which lies under the tissue in front of the ear), the client's mouth twitches and the jaw tightens. The response is identified as a positive Chvostek's sign. The nurse may elicit a positive Trousseau's sign by placing a BP cuff on the upper arm, inflating it between the systolic and diastolic BP, and waiting 3 minutes. The nurse observes the client for spasm of the hand (carpopedal spasm), which is evidenced by the hand flexing inward. Deep tendon reflexes include the biceps, brachioradialis, triceps, and patellar reflexes. Tetany would be manifested by reports of numbness and tingling in the fingers or toes or around the lips, voluntary movement that may be followed by an involuntary, jerking spasm, and muscle cramping. Tonic (continuous contraction) flexion of an arm or a finger may occur.
The nurse is providing discharge instructions to a patient with diabetes insipidus. Which of the following instructions regarding desmopressin acetate (DDAVP) would be most appropriate? A) The patient can expect to experience weight loss resulting from increased diuresis. B) The patient should alternate nostrils during administration to prevent nasal irritation. C) The patient should monitor for symptoms of hypernatremia as a side effect of this drug. D) The patient should report any decrease in urinary elimination to the health care provider.
B) The patient should alternate nostrils during administration to prevent nasal irritation DDAVP is used to treat diabetes insipidus by replacing the antidiuretic hormone that the patient is lacking. DDAVP can cause nasal irritation, headache, nausea, and other signs of hyponatremia.
When caring for a client with diabetes insipidus, the nurse expects to administer: a) furosemide (Lasix). b) vasopressin (Pitressin). c) 10% dextrose. d) regular insulin.
B) Vasopressin (Pitressin) Because diabetes insipidus results from decreased antidiuretic hormone (vasopressin) production, the nurse should expect to administer synthetic vasopressin for hormone replacement therapy. Furosemide, a diuretic, is contraindicated because a client with diabetes insipidus experiences polyuria. Insulin and dextrose are used to treat diabetes mellitus and its complications, not diabetes insipidus.
What skin findings should a nurse pay particular attention to in a client with a history of endocrine problems? a) Rashes b) Skin breaks that heal quickly c) Excessive hair growth or loss d) Susceptibility to sunburn
C) Excessive hair growth or loss While assessing skin findings related to the endocrine system, the nurse inspects the skin for excessive oiliness or dryness, excessive or absent areas of pigmentation, excessive hair growth or loss, and skin breaks that heal poorly.
Which of the following would the nurse expect to find in a client with severe hyperthyroidism? a) Tetany b) Buffalo hump c) Exophthalmos d) Striae
C) Exophthalmos Exophthalmos that results from enlarged muscle and fatty tissue surrounding the rear and sides of the eyeball is seen in clients with severe hyperthyroidism. Tetany is the symptom of acute and sudden hypoparathyroidism. Buffalo hump and striae are the symptoms of Cushing's syndrome.
The nurse is educating a couple who has had difficulty with conception. The client asks about the hormone, which is responsible for the production of eggs. The nurse answers that this hormone is called: a) melanocyte-stimulating hormone b) luteinizing hormone (LH) c) follicle-stimulating hormone (FSH) d) interstitial cell-stimulating hormone (ICSH)
C) Follicle-stimulating hormone (FSH) FSH stimulates the growth and secretion of ovarian follicles in women and the production of sperm in men. LH is not responsible for stimulating the growth and secretion of ovarian follicles in women and the production of sperm in men. In women, LH stimulates ovulation and the formulation of the corpus luteum. In men, LH is called ICSH and it influences the secretion of testosterone and other sex hormones from specialized areas in the testes. Melanocyte-stimulating hormone influences skin pigmentation, and is not responsible for stimulating the growth and secretion of ovarian follicles in women and the production of sperm in men.
The nurse is caring for a patient admitted with suspected hyperparathyroidism. Because of the potential effects of this disease on electrolyte balance, the nurse should assess this patient for which of the following manifestations? A) Neurologic irritability B) Declining urine output C) Lethargy and weakness D) Hyperactive bowel sounds
C) Lethargy and weakness Hyperparathyroidism can cause hypercalcemia. Signs of hypercalcemia include polyuria, constipation, nausea and vomiting, lethargy, and muscle weakness.
The surgeon was unable to spare a patient's parathyroid gland during a thyroidectomy. Which of the following assessments should the nurse prioritize when providing postoperative care for this patient? A) Assessing the patient's white blood cell levels and assessing for infection B) Monitoring the patient's hemoglobin, hematocrit, and red blood cell levels C) Monitoring the patient's serum calcium levels and assessing for signs of hypocalcemia D) Monitoring the patient's level of consciousness and assessing for acute delirium or agitation
C) Monitoring the patient's serum calcium levels and assessing for signs of hypocalcemia Loss of the parathyroid gland is associated with hypocalcemia. Infection and anemia are not associated with loss of the parathyroid gland, whereas cognitive changes are less pronounced than the signs and symptoms of hypocalcemia.
Which of the following is a nursing priority in the care of a patient with a diagnosis of hypothyroidism? A) Providing a dark, low-stimulation environment B) Closely monitoring the patient's intake and output C) Patient teaching related to levothyroxine (Synthroid) D) Patient teaching related to radioactive iodine therapy
C) Patient teaching related to levothyroxine (Synthroid) A euthyroid state is most often achieved in patients with hypothyroidism by the administration of levothyroxine (Synthroid). It is not necessary to carefully monitor intake and output, and low stimulation and radioactive iodine therapy are indicated in the treatment of hyperthyroidism.
A patient has been taking oral prednisone for the past several weeks after having a severe reaction to poison ivy. The nurse has explained the procedure for gradual reduction rather than sudden cessation of the drug. What is the rationale for this approach to drug administration? A) Prevention of hypothyroidism B) Prevention of diabetes insipidus C) Prevention of adrenal insufficiency D) Prevention of cardiovascular complications
C) Prevention of adrenal insufficiency Sudden cessation of corticosteroid therapy can precipitate life-threatening adrenal insufficiency. Diabetes insipidus, hypothyroidism, and cardiovascular complications are not common consequences of stopping corticosteroid therapy suddenly.
A client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate? a) Infusing I.V. fluids rapidly as ordered b) Administering glucose-containing I.V. fluids as ordered c) Restricting fluids d) Encouraging increased oral intake
C) Restricting fluids To reduce water retention in a client with the SIADH, the nurse should restrict fluids. Administering fluids by any route would further increase the client's already heightened fluid load.
When instructing a patient regarding a urine study for free cortisol, it is most important for the nurse to tell the patient to A) Save the first voided urine in the am. B) Maintain a high-sodium diet 3 days before collection. C) Try to avoid stressful situations during the collection period. D) Complete at least 30 minutes of strenuous exercise before collecting the urine sample.
C) Try to avoid stressful situations during the collection period A urine study for free cortisol requires a 24-hour urine collection. The patient should be instructed to avoid stressful situations and excessive physical exercise that could unduly increase cortisol levels. The patient should also maintain a low-sodium diet before and during the urine collection period.
