Chapter 47: Endocrine System Practice Questions

indications of prednisone (glucocorticoids)

- inflammatory conditions such as asthma, copd, rheumatic disorders, hives, allergic reactions and inflammatory bowel disorders. it does so by decreasing immune activity, and consequently, inflammation in the body. -organ transplant

what hormones does the anterior pituitary gland release

-adrenocorticotropic hormone (ACTH) -thyroid stimulating hormone (TSH) -prolactin (PRL) -growth hormone (GH)

diabetes assessment type 2

-adult onset or non insulin dependent diabetes usually seen in those 35 or older but can occur at any age -insulin resistance (the pancreas continues to produce insulin; however insufficient for the body needs or is poorly used by the tissue. -obesity major risk especially abdominal and visceral adipose tissue. other risk include lack of exercise increasing age, and family history.

contrindications of Oxytocin (Pitocin)

-fetal lung immaturity -cervix not ripened -active genital herpes infections

Indications of Glucagon

-hypoglycemic emergency

diabetes assessment type 1

-juvenile onset or insulin dependent diabetes. it is more common in young people but can occur at any age. -absent of insulin production (insulin injections are need to substan life) -ketosis prone (diabetic ketoacidosis a medical emergency resultling from a shortage of insulin in which the body switches to burning fatty acids and producing acidic ketone bodies.

Oxytocin (Pitocin) indications

-labor induction -control postpartum hemorrhage

sigh and symptoms syndrome of inappropriate antidiurectic hormone (SIADH)

-osmolality decrease below normal often less than 280 mOsm/kg -coma/seizure -extracellual blood volume is diluted with free water causes hyponatremia such as muscle cramps, weakness, fatigue, confusion, and changes in LOC. -diagnose only if serum sodium levels are below normal <135 mEq/L. -cramps and tremors -euvolemia (normal overall fluid volume status due to excessive free water reabsorption despite hyponatremia due to excessive secretion into the urine. -change in LOC

consideration of Glucagon

-reconstitute powder with sterile diluent provided by the manufactured priot to use -consume oral carbohydrates to replace glycogen stores in the liver.

complications of diabetes

-retinopathy - nephropathy - neuropathy - Peripheral Vascular disease

considerations of Oxytocin (Pitocin)

-use lowest dose - must given by IV or IM

side effect of Oxytocin (Pitocin)

-uterine rupture -water intoxication

what are the direct hormones of the posterior pituitary

-vasopressin is secreted in response to increase blood osmolarity and result in greater retention of water as well as constriction of blood vessels raising BP. -oxytocin is mammalian hormone that plays a role in sexual reproduction during and after childbirth. it coordinates of uterine smooth muscle during second and third stages of labor. it also cause mammary glands to contract and release milk in response to stimulation of the nipples during breastfeeding.

calcium (Ca2+) lab value

8.5-10.5 mg/dL

The nurse is caring for a 63-year-old with a possible pituitary tumor who is scheduled for a computed tomography (CT) scan with contrast. Which information about the patient is most 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

A - Because contrast media may cause acute kidney injury in patients with poor renal function, the health care provider will need to prescribe therapies such as IV fluids to prevent this complication. The other findings are consistent with the patient's diagnosis of a pituitary tumor.

A 22-year-old patient is being seen in the clinic with increased secretion of the anterior pituitary hormones. The nurse would expect the laboratory results to show A. Increased urinary cortisol. B. Decreased serum thyroxine. C. Elevated serum aldosterone levels. D. Low urinary catecholamines excretion.

A - Increased secretion of adrenocorticotropic hormone (ACTH) by the anterior pituitary gland will lead to an increase in serum and urinary cortisol levels. An increase, rather than a decrease, in thyroxine level would be expected with increased secretion of thyroid stimulating hormone (TSH) by the anterior pituitary. Aldosterone and catecholamine levels are not controlled by the anterior pituitary.

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."

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. Accuracy requires that the patient be fasting before the test. The patient should consume at least 1500 calories/day for 3 days before the test. The patient should be ambulatory and active for accurate test results.

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.

ANS: B Palpation can cause the release of thyroid hormones in a patient with an enlarged thyroid and should be avoided. The other actions by the new RN are appropriate when caring for a patient with an enlarged thyroid.

The nurse is caring for a 45-year-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.

B - A drop in the weight of more than 2 kg indicates severe dehydration, and the test should be discontinued. The other assessment data are not unusual with this test.

A 35-year-old female patient with a possible pituitary adenoma is scheduled for a computed tomography (CT) scan with contrast media. Which patient information is most 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. Complaint of ongoing headaches

B - Because the usual contrast media is iodine-based, the health care provider will need to know about the allergy before the CT scan. The other findings are common with any mass in the brain such as a pituitary adenoma.

Which information about a 30-year-old 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-pound weight gain in the last month. D. The patient drank several glasses of water an hour previously.

B - Corticosteroids can affect blood glucose results. The other information will be provided to the health care provider but will not affect the test results.

A 30-year-old patient seen in the emergency department for severe headache and acute confusion is found to have 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

B - Elevated levels of antidiuretic hormone will cause water retention and decrease serum sodium levels. The other tests would not be helpful in determining possible causes of the patient's hyponatremia.

Corticosteroids can affect blood glucose results. The other information will be provided to the health care provider but will not affect the test results. A. The RN checks the blood pressure on both arms. B. The RN palpates the neck thoroughly to check thyroid size. C. The RN lowers the thermostat to decrease the temperature in the room. D. The RN orders nonmedicated eye drops to lubricate the patient's bulging eyes.

B - Palpation can cause the release of thyroid hormones in a patient with an enlarged thyroid and should be avoided. The other actions by the new RN are appropriate when caring for a patient with an enlarged thyroid.

A 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.

B - The specimen must be kept on ice or refrigerated until the collection is finished. Voided or catheterized specimens are acceptable for the test. The initial voided specimen is discarded. There is no fluid intake requirement for the 24-hour collection.

During the physical examination of a 36-year-old female, the nurse finds that the patient's thyroid gland cannot be palpated. 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.

B - The thyroid is frequently nonpalpable. The nurse should simply document the finding. There is no need to notify the health care provider immediately about a normal finding. There is no indication for thyroid-stimulating hormone (TSH) testing unless there is evidence of thyroid dysfunction. Deep palpation of the neck is not appropriate.

A 40-year-old male 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

B - When dealing with a patient with a chronic condition such as diabetes, identification of the patient's values and beliefs can assist the health care team in choosing strategies for successful lifestyle change. The other information also will be useful, but is not as important in developing an individualized plan for the necessary lifestyle changes.

The nurse will teach a patient to plan 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 - Physical and emotional stress can affect the results of the free cortisol test. The other tests are not impacted by stress.

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

C - A low TSH level indicates that the patient's hypothyroidism is caused by decreased anterior pituitary secretion of TSH. Low T3 and T4 levels are not diagnostic of the primary cause of the hypothyroidism. TRH levels indicate the function of the hypothalamus.

A 60-year-old 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 - Because aldosterone increases the excretion of potassium, a medication that blocks aldosterone will tend to cause hyperkalemia. Aldosterone also promotes the reabsorption of sodium and water in the renal tubules, so spironolactone will tend to cause increased urine output, a decreased or normal serum sodium level, and signs of dehydration.

Which question will provide the most useful information to a nurse who is interviewing a patient 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?"

C - Because thyroid function affects metabolic rate, changes in weight may indicate hyperfunction or hypofunction of the thyroid gland. Nocturia, visual difficulty, and changes in stress level are associated with other endocrine disorders.

A 29-year-old patient in the outpatient clinic will be scheduled 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."

C - Cortisol levels are usually drawn in the morning, when levels are highest. The other instructions would be given to patients who were having other endocrine testing.

The nurse reviews a patient's glycosylated hemoglobin (Hb 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.

C - Glycosylated hemoglobin testing measures glucose control over the last 3 months. Glucose testing before/after a meal or random testing may reveal impaired glucose tolerance and indicate prediabetes, but it is not done on patients who already have a diagnosis of diabetes. There is no test to evaluate for hypoglycemic episodes in the past.

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 is elevated. B. The phosphate level is normal. C. The serum albumin level is low. D. The magnesium level is normal.

C - Part of the total calcium is bound to albumin so hypoalbuminemia can lead to misinterpretation of calcium levels. The other laboratory values will not affect total calcium interpretation.

A 44-year-old patient is admitted with tetany. Which laboratory value should the nurse monitor? A. Total protein B. Blood glucose C. Ionized calcium D. Serum phosphate

C - Tetany is associated with hypocalcemia. The other values would not be useful for this patient.

A 61-year-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 B. Catecholamine C. Thyroid hormone D. Parathyroid hormone

D - Parathyroid hormone is the major controller of blood calcium levels. Although calcitonin secretion is a countermechanism to parathyroid hormone, it does not play a major role in calcium balance. Catecholamine and thyroid hormone levels do not affect serum calcium level.

Which statement by a 50-year-old female patient indicates to the nurse that further assessment of thyroid function may be necessary? A. "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."

D - Difficulty in swallowing can occur with a goiter. Nocturia is associated with diseases such as diabetes mellitus, diabetes insipidus, or chronic kidney disease. Breast tenderness would occur with excessive gonadal hormone levels. Thirst is a sign of disease such as diabetes.

An 18-year-old male patient with a 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 - Hypoglycemia is induced during the growth hormone stimulation test, and the nurse should be ready to administer 50% dextrose immediately. Regular insulin is used to induce hypoglycemia (glargine is never given IV). The patient does not require cardiac monitoring during the test. Although blood samples for some tests must be kept on ice, this is not true for the growth hormone stimulation test.

prednisone (glucocorticoids) MOA

binds to glucorticoid receptors. it up-regulate anti-inflammatory proteins decreasing immune activity. additionally, they regulate the metabolism of glucose.

calcitonin is a result of

bone building the uptake of excess calcium in the blood.

Glucagon MOA

made by alpha cellsof the pancreas. glucagon increases the amount of circulating glucose readily available for use. glycogen is form of glucose stored in the liver that converts to glucose when necessary. glucagon promotes glycogneolysis or the hepatic conversion of stored glycogen into glucose to be released into the bloodstream. this drug inhibits glycolysis or the conversion of glucose to stored glycogen. glycagon increase the biosyntheisis of readliy available glucose.

Side effects of glucagon

nausea and vomiting

when does gestational diabetes happen

develops during pregnacy. glucose intolerance is a classic sign the body does not produce adequate amounts of insulin to deal with the increase blood sugars that occurs during prenancy. blood sugars may remain high and treatment revolves around the goal of keeping blood sugar level with the required limits for the duration of the pregnancy.

posteior pituitary

endocrine gland primarily composed of the nerve terminals of axons extending from the hypothalamus.

Thyroid gland

is a large endocrine gland that is in the neck. it releases T3 and T4 hormone which help the body regulate metabolism.

Hypothalamus

locate in the brain and links the nervous and endocring system to each other. it release a variety of neurohormones that either stimulate or inhibit secretion of the pituitary hormones and also uses electrical signaling to affect the posterior pituitary. it innervates the anterior pituitary through CRF, GHRH, PIF and TRH. all of these hormones stimulate further hormone relase the anterior pituitary.

Oral Glucose Tolerance Test (OGTT)

performed to confirm a diagnosis of diabetes mellitus and to aid in diagnosing hypoglycemia. before test a blood sample is taken to assess baseline typically fasting. normal values less than 100 mg/dL. blood sample are taken 30 min. after glucose ingestion and again at 60 min.normal values at the 30 and 60 min. is below 200 mg/dL. at a 120 min. the last glucose sample are drawn after baseline. normal are 140 which indicates impaired tolerance with values greater than 200mg/ml are mark for diabetes mellitus.

Glucagon

polypeptide hormone that causes hepatic conversion of stored glycogen into readily avaiable glucose. the med is indicated for hypoglycemia cause by insulin overdose and not related to starvation.

prednisone (glucocorticoids)

synthetic glucocorticoids med. used to treat inflammatory disease and to prevent organ tranplant rejection.

Oxytocin (Pitocin)

synthetic hormone produced in the hypothalamus that is stored and released in the posterior pituitary gland.

Oxytocin (Pitocin) MOA

this med. both begins and increases the strength of uterine contractions by stimulating receptors on the uterine muscle wall. in addition it also stimulates milk ejection from nipple.

what hormone regulates metabolic rate and affect the growth and funciton rate of other cells and system in the body.

thyroid-stimulating hormone produces T3 (triiodothyronine) and T4 (thyroxine)