Endocrine System Part 1 Questions

A nurse should consider which diagnostic test a priority to obtain before a patient receives iodine-131? A. White blood cell (WBC) count B. Electrocardiogram (ECG) C. Beta human chorionic gonadotropin (hCG) test D. Creatinine level

Beta human chorionic gonadotropin (hCG) test Rationale: Any female patient of reproductive age requires a negative result on a beta hCG (pregnancy hormone) test before iodine-131 (131I) can be administered. 131I is a radioactive isotope used to treat hyperthyroidism and is contraindicated in pregnancy and lactation. A WBC count, ECG, and creatinine level are not indicated before treatment with iodine-131.

A patient in cardiac arrest receives vasopressin [Pitressin] during cardiopulmonary resuscitation (CPR). An increase in which finding would indicate a desired effect of the medication? A. Respiratory rate B. Blood pH C. Blood pressure D. Body temperature

Blood pressure Rationale: Vasopressin is a potent vasoconstrictor. Benefits derive from increased blood flow to the heart and brain during CPR. The blood pH, body temperature, and respiratory rate are not affected by vasopressin.

A patient who has Cushing's syndrome is taking ketoconazole [Nizoral] as an adjunct treatment to brain radiation. A nurse should expect the patient to have which of these therapeutic responses? A. Increased resistance to infection B. Enhanced radiation effect to the brain C. Suppressed cortisol synthesis D. Increased ACTH production

Enhanced radiation effect to the brain Rationale: Ketoconazole is an antifungal drug that inhibits glucocorticoid synthesis very effectively. It is used as an adjunct to radiation or surgery in patients with Cushing's syndrome. Increased ACTH production and resistance to infection and suppressed cortisol synthesis are not actions of ketoconazole.

A pediatric patient has gigantism caused by excess growth hormone (GH). Which finding would indicate to the nurse that the patient has developed an additional complication related to this condition? A. Blood glucose below 70 mg/dL B. Elevation of liver function test results Incorrect C. Atrophy of sweat glands D. Enlarged heart on chest x-ray

Enlarged heart on chest x-ray Rationale: Gigantism caused by GH excess can cause children not only to grow very tall but also to develop complications such as headache, profuse sweating, cardiomegaly (enlarged heart), and diabetes. Because of its effect on carbohydrate metabolism, excess GH may cause an elevated blood glucose level, not hypoglycemia.

The nurse is planning care for a patient with signs of acute adrenal insufficiency. What is the priority nursing diagnosis? A. Altered comfort B. Altered nutrition C. Fluid volume deficit D. Activity intolerance

Fluid volume deficit Rationale: Acute adrenal insufficiency (adrenal crisis) is characterized by hypotension, dehydration, weakness, lethargy, and gastrointestinal (GI) symptoms of nausea and vomiting. Rapid replacement of fluid, salt, and glucocorticoids is essential to prevent shock and death. Comfort, nutrition, and activity are important to address once fluid balance has been restored.

A nurse is caring for a patient with decreased triiodothyronine (T3) and thyroxine (T4) and elevated thyroid-stimulating hormone (TSH) levels. The nurse knows the patient is likely suffering from what? A. Thyrotoxicosis B. Hypothyroidism C. Hyperthyroidism D. Graves' disease

Hypothyroidism Rationale: The anterior pituitary increases the production of TSH when thyroid hormone levels of T3 and T4 are reduced, reflecting primary hypothyroidism. Thyrotoxicosis, hyperthyroidism, and Graves' disease are medical conditions indicative of excessive thyroid activity.

Which statements about hydrocortisone are correct? (Select all that apply.) A. It is a synthetic steroid identical to cortisol. B. It is a preferred drug for adrenocortical insufficiency. C. It has glucocorticoid and mineralocorticoid actions. D. It is given IV for chronic replacement therapy. E. It should not be given during times of stress.

It is a synthetic steroid identical to cortisol. It is a preferred drug for adrenocortical insufficiency. It has glucocorticoid and mineralocorticoid actions. Rationale: Hydrocortisone is a synthetic steroid with a structure identical to that of cortisol. Hydrocortisone is a preferred drug for all forms of adrenocortical insufficiency. Oral hydrocortisone is ideal for chronic replacement therapy. Parenteral administration is used for acute adrenal insufficiency and to supplement oral doses at times of stress. Despite being classified as a glucocorticoid, hydrocortisone also has mineralocorticoid actions.

An adult patient who has GH deficiency is receiving somatropin [Nutropin]. An increase in which finding would indicate to the nurse that the patient is improving? A. Height (by 3 inches) B. Lean body mass C. Physical strength D. Joint range of motion

Lean body mass Rationale: Nutropin is a form of GH. In adults with GH deficiency, replacement therapy does not cause long bone growth or an increase in height, because the epiphyses are already closed. It does increase lean body mass and reduces adipose tissue. Although it increases muscle mass, Nutropin does not increase strength.

When assessing a patient who has Cushing's syndrome, a nurse associates which clinical manifestations with this disorder? (Select all that apply.) A. Osteoporosis Correct B. Moon face Correct C. Glycosuria Correct D. Ketonuria E. Mood swings

Osteoporosis Moon face Glycosuria Mood swings Rationale: Cushing's syndrome results from excess secretion of adrenocorticotropic hormone (ACTH), and these effects result in manifestations such as redistribution of fat to the face and belly, excess blood sugar, mood changes, and calcium loss from bone.

The patient reports that she had to switch pharmacies to save money. She noticed that her "thyroid pill" looks different. The nurse anticipates that the healthcare provider will order what? A. Thyroid stimulating hormone (TSH) B. Electrocardiogram (ECG) C. Beta human chorionic gonadotropin (hCG) test D. Creatinine level

Thyroid stimulating hormone (TSH) Rationale: If a switch is made (from one branded product to another, from a branded product to a generic product, or from one generic product to another), retest serum TSH in 6 weeks, and adjust the levothyroxine dosage as indicated.

Which manifestation would the nurse most clearly associate with a tumor of the hypothalamus? A. Mood swings B. Unstable body temperature C. Irregular respirations D. Increased heart rate

Unstable body temperature Rationale: One function of the hypothalamus is the regulation of body temperature, and a tumor that compresses the hypothalamus would impair this function. Regulation of mood swings, respiratory rate, and heart rate are not functions of the hypothalamus.

A patient who has diabetes insipidus is receiving desmopressin [DDAVP]. Which laboratory test should a nurse obtain to evaluate the effectiveness of the medication? A. Urine ketones B. Blood urea nitrogen (BUN) C. Creatinine D. Urine specific gravity

Urine specific gravity Rationale: Diabetes insipidus is characterized by a decrease in the urine specific gravity because of the excretion of large volumes of dilute urine. Desmopressin acts to prevent fluid loss through the renal tubules and increases the urine specific gravity. Urine ketones are present in type 1 diabetes mellitus.

A patient has been given instructions about levothyroxine [Synthroid]. Which statement by the patient indicates understanding of these instructions? A. "I'll take this medication in the morning so as not to interfere with sleep." B. "I'll plan to double my dose if I gain more than 1 pound per day." C. "It is best to take the medication with food so I don't have any nausea." D. "I'll be glad when I don't have to take this medication in a few months."

"I'll take this medication in the morning so as not to interfere with sleep." Levothyroxine is used to treat hypothyroidism by increasing the basal metabolism and thus wakefulness. It is administered as a once-daily dose and is a lifelong therapy. It is best taken on an empty stomach to enhance absorption.

A patient with Graves' disease is treated with iodine-131 therapy. Which statement by the patient would indicate understanding of the treatment's effects? A. "I'll have to isolate myself from my family so I don't expose them to radiation." B. "I'm looking forward to feeling better immediately after this treatment." C. "I'll tell my doctor if I have fatigue, hair loss, or cold intolerance." D."I'll need to take this drug on a daily basis for at least 1 year."

"I'll tell my doctor if I have fatigue, hair loss, or cold intolerance." Rationale: Iodine-131 usually is given as a single treatment to produce remission of Graves' disease. Fatigue, hair loss, and cold intolerance are signs of hypothyroidism, which is a complication of the treatment.

A patient is receiving desmopressin [DDAVP] for the treatment of diabetes insipidus. Which instruction is the priority for a nurse to give the patient? A. "Reduce your water intake to prevent water intoxication." B. "Rotate the nostril you use daily to prevent irritation." C. "Weigh yourself several times each week." D. "You'll quickly see the results of a lower urine amount."

"Reduce your water intake to prevent water intoxication." Rationale: Failure to reduce the fluid intake while using desmopressin results in water intoxication, leading to seizures and coma. DDAVP is administered intranasally; therefore, rotating the nostril used is important to prevent irritation. Monitoring weekly weights for volume status and understanding that a rapid treatment response occurs also are important. However, they are not as important as reducing the fluid intake to prevent water intoxication.

The nurse is teaching the patient about oral steroid therapy. Which statement by the patient indicates a need for further teaching? A. "I can take my full dose in the morning." B. "I can break up my dose and take some in the afternoon if I get tired." C. "I understand that I shouldn't experience many adverse effects." D. "When I am traveling for work I will take lower doses."

"When I am traveling for work I will take lower doses." Rationale: To mimic normal cortisol secretion, patients can take the entire daily dose in the morning, immediately after waking. If this schedule results in afternoon or evening fatigue, patients may split the dosage, taking two-thirds in the morning and one-third around 4:00 PM. Stress, such as travel for work, may require an increase in medication.

The patient states that when he takes hydrocortisone 24 mg in the morning, he is very tired by mid-afternoon. Which statement by the nurse is correct? A. "You can take 12 mg in the morning and 12 mg at night." B. "You can take 24 mg at night instead." C. "You can take 16 mg in the morning and 8 mg in the afternoon." D. "This is an adverse effect and you should stop taking the medication."

"You can take 16 mg in the morning and 8 mg in the afternoon." Rationale: To mimic normal cortisol secretion, patients can take the entire daily dose in the morning, immediately after waking. If this schedule results in afternoon or evening fatigue, patients may split the dosage, taking two-thirds in the morning and one-third around 4:00 PM. Patients should not stop taking their medication unless advised by their healthcare provider.

Which statement is the most important for a nurse to make to a patient who is taking methimazole? A. "You need to notify your doctor if you have a sore throat and fever." B. "Another medication can be given if you experience any nausea." C. "You may experience some muscle soreness with this medicine." Incorrect D. "Headache and dizziness may occur but not very frequently."

"You need to notify your doctor if you have a sore throat and fever." Rationale: Agranulocytosis (the absence of granulocytes to fight infection) is the most serious toxicity associated with methimazole. Sore throat and fever may be the earliest signs. Nausea, muscle soreness, and headache and dizziness are other adverse effects of methimazole that are not as serious as agranulocytosis.

The healthcare provider orders 150 mcg of levothyroxine [Synthroid] PO every morning. The medication available is levothyroxine [Synthroid] 75-mcg tablets. How many tablets will the nurse administer? A. 0.5 B. 1 C. 2 D. 4

2 The ordered dose is 150 mcg. The available tablets are 75 mcg. 75 multiplied by 2 equals 150. Therefore, 2 tablets is the correct dose.

Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) are products of which structure? A. Hypothalamus B. Anterior pituitary gland C. Posterior pituitary gland D. Ovaries

Anterior pituitary gland Rationale: FSH and LH are secreted by the anterior pituitary gland. They both act on the ovaries to promote either follicular growth and development or ovulation and the development of the corpus luteum. They act in a negative feedback loop with the anterior pituitary gland and hypothalamus to affect the ovaries.

A nurse is developing a plan of care for a patient who has Addison's disease and is taking hydrocortisone [Cortef]. Which of these outcomes should receive priority in the plan? A. At times of stress, the patient increases the glucocorticoid dose. B. The patient wears a Medic Alert bracelet at all times. C. The patient carries an injectable form and an oral form of glucocorticoid. D. The patient divides the daily dose, taking two-thirds of it in the morning and one-third in the afternoon.

At times of stress, the patient increases the glucocorticoid dose. Rationale: Patients with adrenal insufficiency require lifelong replacement doses of glucocorticoids. Failure to increase the dosage at times of stress and illness can be life-threatening. Wearing a Medic Alert bracelet, carrying injectable and oral forms of glucocorticoid, and dividing the daily glucocorticoid dose are important for a patient taking hydrocortisone, but they are not priorities over understanding the need to increase the dose during stress.

A nurse administers dexamethasone [Decadron], 1 mg, at 11:00 PM to a patient who has suspected adrenal dysfunction. The nurse obtains blood for which of these laboratory tests at 8:00 AM the next morning? A. Potassium B. Cortisol C. Glucose D. Sodium

Cortisol Rationale: The overnight dexamethasone suppression test is used to diagnose Cushing's syndrome. Normally, dexamethasone acts to suppress the release of ACTH, thereby suppressing the release of cortisol. In a patient with Cushing's disease, no cortisol suppression occurs. Potassium, glucose, and sodium are not used as measures of adrenal function.

Which finding in a patient taking levothyroxine [Synthroid] and warfarin [Coumadin] would require follow-up by a nurse? A. Cardiac dysrhythmias B. Excessive bruising C.Weight loss of 5 kg D. Shortness of breath

Excessive bruising Rationale: Levothyroxine intensifies the effect of warfarin, an anticoagulant that increases the patient's risk for bleeding. The warfarin dose may need to be reduced.

Which nursing diagnosis should be the priority for a patient who is receiving desmopressin [DDAVP]? A. Activity intolerance B. Alteration in comfort C. Fluid volume imbalance D. Deficient knowledge

Fluid volume imbalance Rationale: Desmopressin is a form of antidiuretic hormone that increases sodium and water retention, leading to an alteration in fluid volume. Monitoring of urine volumes and body weights is essential to prevent complications. Alteration in comfort, deficient knowledge of the condition, and activity intolerance are important nursing problems; however, they are not priorities according to the Maslow hierarchy of needs.

Which statements about levothyroxine [Synthroid] are correct? (Select all that apply.) A.Levothyroxine should be taken with food. B. Levothyroxine can be given by IV but is usually taken orally. C. Levothyroxine brands should not be changed if possible. D. Levothyroxine should be taken at night to avoid adverse effects. E. Levothyroxine can affect the metabolism of other medications.

Levothyroxine can be given by IV but is usually taken orally. Levothyroxine brands should not be changed if possible. Levothyroxine can affect the metabolism of other medications. Rationale: Levothyroxine is almost always administered by mouth. Oral doses should be taken once daily on an empty stomach (to enhance absorption). Dosing is usually done in the morning, at least 30 to 60 minutes before breakfast. Maintain patients on the same brand-name levothyroxine product. Intravenous administration is used for myxedema coma and for patients who cannot take levothyroxine orally. Levothyroxine affects the metabolism of other medications, including warfarin.

A patient is taking fludrocortisone [Florinef]. A nurse should recognize that the patient is at risk for developing an electrolyte imbalance if the patient reports which symptom? A. Syncope B. Weight loss C. Muscle weakness D. Numbness and tingling

Muscle weakness Rationale: Muscle weakness is a sign of hypokalemia, which can occur because fludrocortisone has mineralocorticoid properties, resulting in sodium and fluid retention and potassium excretion. Syncope and weight loss do not occur because of salt and water retention. Numbness and tingling may be associated with another problem but are not related to fludrocortisone.

Which outcome should a nurse establish for a patient who has acromegaly and is receiving octreotide [Sandostatin]? A. Normal urine volume B. Softening of facial features C. Increase in long-bone growth D. Stimulation of the milk reflex

Softening of facial features Rationale: Octreotide suppresses GH, which is excessive in acromegaly. This results in coarse facial features, splayed teeth, and large hands and feet. Treatment with octreotide reduces the continued development of these effects. The epiphyses have closed in adults, so height is not affected. Urine volume is affected by antidiuretic hormone. Prolactin stimulates the milk reflex.

Which manifestations should a nurse investigate first when monitoring a patient who is taking levothyroxine [Synthroid]? A. Tachycardia B. Tremors C. Insomnia D. Irritability

Tachycardia Rationale: High doses of levothyroxine may cause thyrotoxicosis, a condition of profound excessive thyroid activity. *Tachycardia* is the priority assessment, because it can lead to severe cardiac dysfunction. Tremors, insomnia, and irritability are other symptoms of thyrotoxicosis and should be assessed after tachycardia.