Lewis 47: Assessment of the Endocrine System
d
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 c. thyroid hormone b. catecholamine d. parathyroid hormone
d
A patient has a visible mass in the anterior neck. What intervention is performed when assessing the patient? a. Palpate using the anterior approach. b. Palpate using the posterior approach. c. Feel the neck when patient sips water. d. Auscultate the lateral lobes with a stethoscope.
b
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
c
A patient has been ordered to undergo a diagnostic procedure to determine the severity of thyroid dysfunction. For what test should the nurse prepare the patient? a. X-ray b. Computed tomography (CT) scan c. Radioactive iodine uptake (RAIU) d. Magnetic resonance imaging (MRI)
a
A patient has sought care because of a loss of 25 lb over the past six months during which the patient states that he or she has made no significant dietary changes. For what potential problem should the nurse assess the patient? a. Thyroid disorders b. Diabetes insipidus c. Pituitary dysfunction d. Parathyroid dysfunction
c
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
d
A patient is receiving an insulin tolerance test. Which is an appropriate nursing action for a patient who may develop hypoglycemia during the test? a. Give the patient fruit juices. b. Keep the patient in a well-ventilated room. c. Keep the oral hypoglycemic drugs ready near the bedside of the patient. d. Keep 50% dextrose intravenous solution ready near the bedside of the patient.
bde
A patient is referred for a non-contrast magnetic resonance imaging (MRI) scan for radiologic evaluation of the pituitary gland. Which pre-procedure teaching would the nurse provide to the patient? Select all that apply. a. Inform the patient that a 6-hour fast is required. b. Explain that the test is noninvasive. c. Assess serum BUN and creatinine. d. Assure the patient that the test is painless. e. Inform the patient of the need to lie still during the procedure.
c
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.
c
A patient presents at the outpatient unit for a cortisol (total) blood test. Which intervention should the nurse perform? a. Keep the sample on ice. b. Use a plastic heparinized tube. c. Mark the time of blood draw on the slip. d. Instruct the patient to restrict food, fluid, or medication before test.
b
A patient reports excessive thirst, increased urine output, and weight loss. Upon reviewing the laboratory reports of the patient, the nurse finds increased blood glucose levels. The nurse suspects that the patient has which condition? a. Acromegaly b. Diabetes mellitus c. Addison's disease d. Cushing syndrome
b
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
c
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."
b
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 lb d. Complaint of ongoing headaches
c
A patient's laboratory reports indicate an abnormal decrease in blood Ca+ levels. Which hormone is likely to be released? a. Calcitonin (CT) b. Thyroxine (T4) c. Parathormone (PTH) d. Triiodothyronine (T3)
c
A patient's recent medical history is indicative of diabetes insipidus. The nurse would perform patient teaching related to which diagnostic test? a. Thyroid scan b. Fasting glucose test c. Water deprivation test d. Oral glucose tolerance
c
A patient's serum potassium level is 3 mEq/L and serum sodium level is 145 mEq/L. Which hormone synthesis does the nurse understand is inhibited by these conditions? a. Oxytocin b. Thyroxine c. Aldosterone d. Progesterone
b
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.
a
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.
a
An adult patient is experiencing menopause-related symptoms. Which hormone decline results in an increased risk of atherosclerosis and osteoporosis? a. Estrogen b. Epinephrine c. Progesterone d. Norepinephrine
d
An older adult patient is scheduled to have a computed tomography (CT) scan with intravenous contrast. What assessment data should the nurse report immediately to the primary health care provider prior to the test? a. Sodium level of 138 mEq/L b. Total bilirubin of 0.3 mg/dL c. Serum potassium of 3.8 mEq/L d. Creatinine clearance of 185 mL/min
c
An older adult patient is seen in the endocrine clinic. Upon assessment, the nurse is able to palpate the thyroid gland. What does this finding indicate? a. The onset of hypertension. b. The onset of diabetes mellitus. c. This is a normal finding in the elderly. d. An explanation for reduced urine output.
b
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.
a
The health care provider was unable to save a patient's parathyroid gland during a radical thyroidectomy. The nurse should consequently pay particular attention to which laboratory value? a. Calcium levels b. Potassium levels c. Blood glucose levels d. Sodium and chloride levels
a
The nurse assesses the laboratory results for a female patient and finds there are increased levels of follicle-stimulating hormone (FSH). What condition does the nurse suspect this patient is experiencing? a. Pregnancy b. Hypothyroidism c. Hyperthyroidism d. Polycystic ovarian syndrome
bce
The nurse is caring for a patient with hypercortisolism. Which assessment findings does the nurse anticipate documenting? Select all that apply. a. Weight gain b. Truncal obesity c. Thin extremities d. Increased appetite e. Purple abdominal striae
d
The nurse is educating a patient about an ultrasound of the thyroid gland to observe for any nodules. What should the nurse teach the patient? a. Instruct the patient to fast. b. Inform the patient that sedation may be required. c. Inform the patient that the test will last approximately 30 minutes. d. Inform the patient that a gel and transducer will be used over the neck.
c
The nurse is performing an assessment for a patient who has been admitted to the acute care facility. A "bronze" skin tone is observed during the assessment. What condition does the nurse recognize that this patient may have? a. Goiter b. Acromegaly c. Addison's disease d. Cushing syndrome
d
The nurse is performing an assessment for a patient with hypoparathyroidism. Which assessment finding does the nurse document that correlates with this condition? a. Cold intolerance b. Hypertension c. Frequent defecation d. Decreased skin pigmentation
abe
The nurse is preparing a patient to undergo a computed tomography (CT) scan using an intravenous (IV) contrast medium for evaluating the size of a tumor in the pituitary gland. Which information would the nurse provide to the patient? Select all that apply. a. "You may need both oral and intravenous contrast.'' b. "You must lie still during the procedure.'' c. "The process is painless and noninvasive.'' d. "I will not inform you about the procedure.'' e. "I will test your renal function before the procedure.''
c
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.
b
The nurse reviews the laboratory results of a patient and recalls that the normal range of thyroglobulin in females is what? a. 0.5-53 ng/mL b. 0.5-43 ng/mL c. 0.62-2.79 nmol/L d. 1.08-3.14 nmol/L
c
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.
c
The nurse working in an endocrine clinic knows that Chvostek's sign is a diagnostic tool that is used to assess for which electrolyte disturbance? a. Hypokalemia b. Hyperkalemia c. Hypocalcemia d. Hypercalcemia
d
The nurse working in an endocrine clinic knows that Trousseau's sign is an important diagnostic tool. Which statement best describes how to conduct the test for Trousseau's sign? a. Depress the skin over the sternum for one minute b. Observe for circumoral twitches following speaking c. Tap two fingers anterior to the front of the patient's ear d. Inflate a blood pressure cuff above the antecubital space
a
When assessing a patient with hypothyroidism, which finding does the nurse anticipate? a. Goiter b. Dry eyes c. Cyanosis d. Dehydration
b
Which additional information will the nurse need to consider when reviewing the laboratory results for a patient's total calcium level? a. The blood glucose b. The serum albumin c. The phosphate level d. The magnesium level
a
Which assessment parameter is of highest priority when caring for a patient undergoing a water deprivation test? a. Patient weight b. Serum glucose c. Arterial blood gases d. Patient temperature
b
Which hormone deficiency would the nurse expect find in the diagnostic report of a female client with abnormal breast development? a. Insulin b. Estrogen c. Testosterone d. Corticosteroids
b
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.
a
Which phase of the menstrual cycle or postmenopausal phase is predominant in a woman with follicle-stimulating hormone (FSH) level that is 1.09 to 9.2 mU/mL? a. Luteal phase b. Follicular phase c. Ovulatory phase d. Postmenopausal
c
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
b
Which phase of the menstrual cycle or postmenopausal phase is predominant in a woman with follicle-stimulating hormone (FSH) level that is 1.37 to 9.9 mU/mL? a. Luteal phase b. Follicular phase c. Ovulatory phase d. Postmenopausal
d
Which phase of the menstrual cycle or postmenopausal phase is predominant in a woman with follicle-stimulating hormone (FSH) level that is 19.3 to 100.6 mU/mL? a. Luteal phase b. Follicular phase c. Ovulatory phase d. Postmenopausal
c
Which phase of the menstrual cycle or postmenopausal phase is predominant in a woman with follicle-stimulating hormone (FSH) level that is 6.17 to 17.2 mU/mL? a. Luteal phase b. Follicular phase c. Ovulatory phase d. Postmenopausal
c
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?"
d
Which statement by a 50-yr-old female patient indicates to the nurse that further assessment of thyroid function may be necessary? ba. "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."
b
A patient complains about symptoms that include unexplained weight gain, a puffy face, dry skin, and heavy, irregular menstrual periods. Which abnormal assessment would help guide the patient's treatment? a. Abnormal insulin levels b. Abnormal thyroxine levels c. Abnormal calcitonin levels d. Abnormal melatonin levels
d
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.
d
The nurse is assessing a patient diagnosed with Addison's disease. What would the nurse expect to find in this patient? a. Patchy areas of light skin b. Warm, smooth, moist skin c. Purplish red marks on the abdomen d. Darkened skin on the knuckles, elbows, and palmar creases
b
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.
a
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
b
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.
a
The patient has been feeling tired lately and has gained weight and reports thickened, dry skin, and increased cold sensitivity even though it is now summer. Which endocrine diagnostic test should be done first ? a. Free thyroxine (FT4) b. Serum growth hormone (GH) c. Follicle stimulating hormone (FSH) d. Magnetic resonance imaging (MRI) of the head
ace
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."
