Ch 47: Assessment of Endocrine System

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

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.

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.

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.

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.

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.

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.

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.

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.

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.