Chapter 47: Assessment- 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 at least 8 hours before testing."

ANS: A, C, E Smoking may affect the results of oral glucose tolerance tests, blood samples are obtained at baseline and at 30, 60, and 120 minutes, and accuracy requires that the patient be fasting before the test.

The nurse is caring for a patient during a water deprivation test. Which finding is most important for the nurse to communicate to the health care provider? a. patient reports intense thirst b. patient has a 2.3 kg weight loss c. patient feels dizzy when sitting on the bed d. patient's urine osmolality does not increase

ANS: B A drop in the weight of more than 2 kg indicates severe dehydration and the test should be discontinued.

The nurse is caring for a patient 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. report of chronic headache b. history of renal insufficiency c. recent bilateral visual field loss d. blood glucose level of 134

ANS: B Because contrast media may cause acute kidney injury in patients with poor renal function, the health care provider will need to prescribed therapies such as IV fluids to prevent this complication.

A patient with a possible pituitary adenoma is scheduled for a 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 pounds d. patient reports ongoing headaches

ANS: B Because the usual contrast is iodine-based, the health care provider will need to know about the allergy before the CT scan.

Which information about a patient who is scheduled for an oral glucose tolerance test should the nurse consider in interpreting the test results? a. patient reports having occasional orthostatic dizziness b. patient takes oral corticosteroids for rheumatoid arthritis c. patient has has a 10lb weight gain in the last month d. patient drank several glasses of water an hour previously

ANS: B Corticosteroids can affect blood glucose results.

A patient seen in the emergency department for severe headache and acute confusion has a serum sodium level of 118. The nurse should anticipate the need for which diagnostic test? a. urinary 17-ketosteriods b. antidiuretic hormone level c. growth hormone stimulation test d. adrenocorticotropic hormone level

ANS: B Elevated levels of antidiuretic hormone will cause water retention and decrease serum sodium levels.

A 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. RN checks the BP in both arms b. RN palpates the neck to assess thyroid size c. RN orders saline eyedrops to lubricate the patient's bulging eyes d. RN lowers the thermostat to decrease the temperature in the room

ANS: B Palpation can cause the release of thyroid hormones in a patient with an enlarged thyroid and should be avoided.

Which laboratory value should the nurse review to determine whether a patient's hypothyroidism is caused by a problem with the anterior pituitary gland? a. thyroxine (T4) level b. triiodothyronine (T3) level c. thyroid-stimulating hormone (TSH) level d. thyrotropin-releasing hormone (TRH) level

ANS: C A low TSH level indicated that the patient's hypothyroidism is caused by decreased anterior pituitary secretion of TSH.

A patient is taking spironolactone, a drug that blocks the action of aldosterone on the kidney, for hypertension. What additional effect of the medication should the nurse monitor? a. increased serum sodium b. decreased urinary output c. elevated serum potassium d. evidence of fluid overload

ANS: C Because aldosterone increases the excretion of potassium, a medication that blocks aldosterone will tend to cause hyperkalemia.

Which additional information should the nurse 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

ANS: B Part of the total calcium is bound to albumin, so hypoalbuminemia can lead to misinterpretation of calcium levels.

What should the nurse teach a patient who is scheduled to complete a 24-hour urine collection for 17-ketosteroids? a. to insert and maintain a retention catheter b. to keep the specimen refrigerated or on ice c. to drink at least 3L of fluid during the 24 hours d. to avoid and save the specimen to start the collection

ANS: B The specimen must be kept on ice or refrigerated until the collection is finished.

During the physical examination, the nurse cannot feel the patient's thyroid gland. What action should the nurse take? 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

ANS: B The thyroid is usually nonpalpable, the nurse should simply document the finding.

A young adult patient who is being seen in the clinic has excessive secretion of the anterior pituitary hormones. Which laboratory test results should the nurse expect? a. increased urinary cortisol b. decreased serum thyroxine c. elevated serum aldosterone d. low urinary catecholamines

ANS: A Increased secretion of adrenocorticotropic hormone by the anterior pituitary gland will lead to an increase in serum and urinary cortisol levels.

A patient has been newly diagnosed with type 2 diabetes. 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

ANS: B 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.

A patient is scheduled in the outpatient clinic for blood cortisol testing. Which instruction should 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."

ANS: C Cortisol levels are usually drawn in the morning.

Which question from the nurse during a patient interview will provide focused information about 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?"

ANS: C Because thyroid function affects metabolic rate, changed in weight may indicate hyperfunction or hypofunction of the thyroid gland.

Which statement made by a 50 yr old female patient indicates to the nurse that further assessment of thyroid function may be needed? a. "I am so thirsty that I drink all day long." b. "I get up several times at night to urinate." c. "I feel a lump in my throat when I swallow." d. "I notice my breasts are always tender lately."

ANS: C Difficulty in swallowing can occur with a goiter.

What information will a review of a patient's glycosylated hemoglobin (A1C) results provide to the nurse? 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

ANS: C Glycosylated hemoglobin testing measures glucose control over the last 3 months.

In preparation for which test should the nurse teach the patient to minimize physical and emotional stress? a. water deprivation test b. test for serum T3 and T4 levels c. 24-hour urine test for free cortisol d. radioactive iodine uptake test

ANS: C Physical and emotional stress can affect the results of the free cortisol test.

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

ANS: C Tetany is associated with hypocalcemia.

An 18 yr old male patient with small stature is scheduled for a growth hormone stimulation test. What should the nurse obtain in preparation for the test? a. ice in a basin b. glargine insulin c. cardiac monitor d. 50% dextrose solution

ANS: D Hypoglycemia is induced during the growth hormone stimulation test, and the nurse should be ready to administer 50% dextrose immediately.

A patient admitted with pneumonia has a total serum calcium level of 13.3. What should the nurse anticipate will be tested next? a. calcitonin b. catecholamine c. thyroid hormone d. parathyroid hormone

ANS: D Parathyroid hormone (PTH) is the major controller of blood calcium levels.