Chapter 52: Assessment: Endocrine System
A young adult patient who is being seen in the clinic has excessive secretion of the anterior pituitary hormones. Which laboratory test result would the nurse expect? a. Increased urinary cortisol b. Decreased serum thyroxine c. Elevated serum aldosterone d. Low urinary catecholamines
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. The anterior pituitary does not control aldosterone and catecholamine levels.
A patient is admitted with tetany. Which laboratory value would the nurse plan to 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.
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. The patient reports intense thirst. b. The patient has a 5-lb (2.3-kg) weight loss. c. The patient feels dizzy when sitting on the bed. d. The patient's urine osmolality does not increase
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.
During the physical examination, the nurse cannot feel the patient's thyroid gland. Which action would 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.
B) The thyroid is usually nonpalpable. The nurse would simply document the finding. Deep palpation of the neck is not appropriate; do not press too hard or massage an enlarged thyroid gland as this can cause a sudden release of thyroid hormone into an already overloaded system. 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.
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 mg/dL
B) 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 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 pounds d. Patient reports 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 patient who is scheduled for an oral glucose tolerance test would the nurse consider in interpreting the test results? 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 not affect the glucose test results.
A patient seen in the emergency department for severe headache and acute confusion has a serum sodium level of 118 mEq/L. The nurse would 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 the cause of the patient's hyponatremia
A nurse is caring for a patient with a goiter and possible hyperthyroidism. Which action by the nurse has the potential for patient harm? a. The nurse checks the blood pressure in both arms. b. The nurse palpates the neck to assess thyroid size. c. The nurse orders saline eye drops to lubricate the patient's bulging eyes. d. The nurse lowers the thermostat to decrease the temperature in the room.
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 nurse are appropriate when caring for a patient with an enlarged thyroid.
Which additional information would the nurse 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
B) Part of the total calcium is bound to albumin, so hypoalbuminemia can lead to misinterpretation of total calcium levels, while ionized calcium levels are unchanged by inconsistent serum albumin levels. The other laboratory values will not affect total calcium interpretation
Which instruction would the nurse give to a patient who is scheduled to complete a 24-hour urine collection for 17-ketosteroids? 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 the 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.
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
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. The other information also will be useful but is not as important in developing an individualized plan for the necessary lifestyle changes.
Which information will a patient's glycosylated hemoglobin (A1C) result 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
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 laboratory value would 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
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.
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."
C) An enlarged thyroid gland can cause problems swallowing or a change in neck size. Nocturia is associated with diseases such as diabetes, diabetes insipidus, or chronic kidney disease. Breast tenderness would occur with excessive gonadal hormone levels. Thirst is a sign of disease such as diabetes.
A patient is taking a drug that blocks the action of aldosterone. Which additional effect of the medication would the nurse monitor? 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 from the nurse during a patient interview would 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?"
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 patient is scheduled in the outpatient clinic for blood cortisol testing. Which instruction would 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.
In preparation for which test would the nurse teach the patient to minimize physical and emotional stress? a. A water deprivation test b. A test 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. Stress does not impact the other tests
An 18-yr-old male patient with small stature is scheduled for a growth hormone stimulation test. Which item would the nurse obtain in preparation for the test? 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. The patient does not need 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.
A patient admitted with pneumonia has a total serum calcium level of 13.3 mg/dL. Which serum level would the nurse anticipate will be tested next? a. Calcitonin b. Catecholamine c. Thyroid hormone d. Parathyroid hormone
D) Parathyroid hormone (PTH) is the major controller of blood calcium levels. Although calcitonin secretion is a counter mechanism to PTH, it does not play a major role in calcium balance. Catecholamine and thyroid hormone levels do not affect serum calcium level.
