Endocrine Study Questions
A nurse is caring for a client in acute addisonian crisis. Which test result does the nurse expect to see? A) Serum potassium level of 6.8 mEq/L B) Blood urea nitrogen (BUN) level of 2.3 mg/dl C) Serum sodium level of 156 mEq/L D) Serum glucose level of 236 mg/dl
Correct Answer: A A serum potassium level of 6.8 mEq/L indicates hyperkalemia, which can occur in adrenal insufficiency as a result of reduced aldosterone secretion. A BUN level of 2.3 mg/dl is lower than normal. A client in addisonian crisis is likely to have an increased BUN level because the glomerular filtration rate is reduced. A serum sodium level of 156 mEq/L indicates hypernatremia. Hyponatremia is more likely in this client because of reduced aldosterone secretion. A serum glucose level of 236 mg/dl indicates hyperglycemia. This client is likely to have hypoglycemia caused by reduced cortisol secretion, which impairs glyconeogenesis.
A nurse is assessing a client with Cushing's syndrome. Which observation should the nurse report to the physician immediately? A) Pitting edema of the legs B) An irregular apical pulse C) Dry mucous membranes D) Frequent urination
Correct Answer: An irregular apical pulse Because Cushing's syndrome causes aldosterone overproduction, which increases urinary potassium loss, the disorder may lead to hypokalemia. Therefore, the nurse should immediately report signs and symptoms of hypokalemia, such as an irregular apical pulse, to the physician. Edema is an expected finding because aldosterone overproduction causes sodium and fluid retention. Dry mucous membranes and frequent urination signal dehydration, which isn't associated with Cushing's syndrome.
After a thyroidectomy, the client develops a carpopedal spasm while the nurse is taking a BP reading on the left arm. Which action by the nurse is appropriate? A) Administer a sedative as ordered. B) Administer IV calcium gluconate as ordered. C) Start administering oxygen at 2 L/min via a cannula. D) Administer an oral calcium supplement as ordered.
Correct Answer: B When hypocalcemia and tetany occur after a thyroidectomy, the immediate treatment is administration of IV calcium gluconate. If this does not immediately decrease neuromuscular irritability and seizure activity, sedative agents such as pentobarbital may be administered.
The nurse is providing discharge teaching to a patient prescribed corticosteroid therapy. Which statement by the patient would most concern the nurse? A) "I will avoid fried foods and foods high in fat." B) "I will be staying with my son who has pneumonia." C) "I will weigh myself daily." D) "I will take walks every day to increase stength."
Correct Answer: B as a result of corticosteroid therapy, the patient will have an increased risk for infection and should avoid coming into contact with any kind of microorganisms.
Which of the following should the nurse include when teaching a patient about glucocorticoid therapy? A) Avoid use of antiulcer medications when taking glucocorticoids. B) Do not abruptly stop taking the drug. C) When used long term, alternate-day dosing of glucocorticoids will help minimize thyroid suppression. D) Take the medication on an empty stomach.
Correct Answer: B) Do not abruptly stop With oral and all other forms of glucocorticoids that are given short or long term, abrupt withdrawal must be avoided. Abrupt withdrawal of adrenal drugs (e.g., prednisone, methylprednisolone) may lead to a sudden decrease in, or no production of, endogenous glucocorticoids, resulting in adrenal insufficiency.
For which client does the nurse question the prescription of androgen replacement therapy? A) 35-year-old man who has had a vasectomy B) 48-year old man who takes prednisone for severe asthma C) 62-year-old man who has a history of prostate cancer D) 70-year-old man who has hypertension and type 2 diabetes
Correct Answer: C Prostate cancer tends to increase its growth rate in the presence of any type of androgen. Thus, the man who has a history of prostate cancer should avoid exogenous androgen because it could enhance the growth if the previously treated cancer returns. None of the other conditions are contraindicated for androgen replacement therapy.
A nurse assessing a patient with SIADH would expect to find laboratory values of which of the following? a. Serum Na of 150 mEq/L and high osmolality b. Serum K of 5 mEq/L and low urine osmolality c. Serum Na of 120 mEq/L and high urine osmolality d. Serum K of 3 mEq/L and low osmolality
Correct Answer: C SIADH occurs when excessive antidiuretic hormone (ADH) is released, even when the plasma (serum) osmolality is normal. The excess ADH increases the permeability of the renal tubules, causing reaborption of water into the circulation. As a result of extracellular fluid expansion, serum osmolality decreases. Also, sodium levels decline, leading to hyponatremia.
The nurse auscultates a bruit over the thyroid glands. What does the nurse understand is the significance of this finding? A) The patient may have hypothyroidism. B) The patient may have thyroiditis. C) The patient may have hyperthyroidism. D) The patient may have Cushing disease.
Correct Answer: The pt may have hyperthyroidism If palpation discloses an enlarged thyroid gland, both lobes are auscultated using the diaphragm of the stethoscope. Auscultation identifies the localized audible vibration of a bruit. This is indicative of increased blood flow through the thyroid gland associated with hyperthyroidism and necessitates referral to a physician.
A patient is admitted to the unit with a diagnosis of SIADH. For which electrolyte abnormality will you be sure to monitor? a. Hypokalemia b. Hyperkalemia c. Hyponatremia d. hypernatremia
Correct Answer: c. hyponatremia SIADH causes a relative sodium deficit due to excessive retention of water
During physical examination of a client with a suspected endocrine disorder, the nurse assesses the body structures. The nurse gathers this data based on the understanding that it is an important aid in which of the following? A) Detecting evidence of hormone hyper-secretion B) Detecting information about possible tumor growth C) Determining the presence or absence of testosterone levels D) Determining the size of the organs and location
Correct Answer: determining evidence of hormone hyper-secretion The evaluation of body structures helps the nurse detect evidence of hypersecretion or hyposecretion of hormones. This helps in the assessment of findings that are unique to specific endocrine glands. Radiographs of the chest or abdomen are taken to detect tumors. Radiographs also determine the size of the organ and its location.
When teaching a client with Cushing's syndrome about dietary changes, the nurse should instruct the client to increase intake of: A) fresh fruits B) dairy products C) processed meats D) cereals and grains
Correct Answer: fresh fruits Cushing's syndrome causes sodium retention, which increases urinary potassium loss. Therefore, the nurse should advise the client to increase intake of potassium-rich foods, such as fresh fruit. The client should restrict consumption of dairy products, processed meats, cereals, and grains because they contain significant amounts of sodium.
The nurse is assessing the laboratory data of a patient diagnosed with Cushing's syndrome. The nurse would expect to note which lab values prior to initiation of drug therapy? (Select all that apply) a. Elevated plasma cortisol level b. Decreased blood glucose level c. Increased white blood cell count d. Increased sodium level e. Increased potassium level
Correct Answers: A, C, D
The nurse should teach a patient taking an oral corticosteroid to take the medication at what time? A) 12 noon B) 8:00 am C) 5:00 pm D) 8:00 pm
Correct answer: B) 8:00 am Oral corticosteroids should be taken in the morning to minimize adrenal suppression.
A 35-year-old female client who complains of weight gain, facial hair, absent menstruation, frequent bruising, and acne is diagnosed with Cushing's syndrome. Cushing's syndrome is most likely caused by: A) an ectopic corticotropin-secreting tumor. B) adrenal carcinoma. C) a corticotropin-secreting pituitary adenoma. D) an inborn error of metabolism.
Corect Answer: A corticotropin-secreting pituitary adenoma A corticotropin-secreting pituitary adenoma is the most common cause of Cushing's syndrome in women ages 20 to 40. Ectopic corticotropin-secreting tumors are more common in older men and are commonly associated with weight loss. Adrenal carcinoma isn't usually accompanied by hirsutism. A female with an inborn error of metabolism wouldn't be menstruating.
A nurse is caring for a client with Cushing's syndrome. Which interventions would the nurse include in the client's plan of care? Select all that apply. A) Report systolic BP greater than 139 mm Hg or diastolic BP greater than 89 mm Hg. B) Examine extremities for pitting edema. C) Provide a high sodium diet. D) Administer prescribed diuretics. E) Monitor weight.
Correct Answer(s): A, B, D, E Fluid retention is manifested by swelling in dependent areas, pitting when pressure is applied to the skin over a bone by tight-fitting shoes or rings, the appearance of lines in the skin from stockings and seams in the shoes or areas where they lace. Hypertension is defined as a consistently elevated BP above 139/89 mm Hg. One factor that contributes to hypertension is excess circulatory volume. Diuretics promote the excretion of sodium and water. The client's weight needs to be monitored for fluid balance. The client needs to limit sodium to reduce the potential for fluid retention.
1. A patient with Addison disease is taking corticosteroid replacement therapy. The nurse should instruct the patient about which of the following side effects of corticosteroids? (Select all that apply) a. Hyperkalemia b. Skeletal muscle weakness c. Mood changes d. Hypocalcemia e. Increased susceptibility to infection f. Hypotension
Correct Answer(s): B, C, D, E
A patient with Addison disease is hospitalized for an acute crisis. During the crisis, which of the following nursing diagnosis is a priority? a. Deficient fluid volume b. Activity intolerance c. Anxiety d. Risk for injury
Correct Answer: A
A patient taking corticosteroids for exacerbation of Crohn's disease comes to the clinic and informs the nurse that he wants to stop taking them because of the increase in acne and moon face. What can the nurse educate the patient regarding these symptoms? A) The symptoms are permanent side effects of the corticosteroid therapy. B) The moon face and acne will resolve when the medication is tapered off. C) Those symptoms are not related to the corticosteroid therapy. D) The dose of the medication must be too high and should be lowered.
Correct Answer: B Cushing syndrome is commonly caused by the use of corticosteroid medications and is infrequently the result of excessive corticosteroid production secondary to hyperplasia of the adrenal cortex. The patient develops a "moon-faced" appearance and may experience increased oiliness of the skin and acne. If Cushing syndrome is a result of the administration of corticosteroids, an attempt is made to reduce or taper the medication to the minimum dosage needed to treat the underlying disease process
A nurse is completing an assessment of a client with suspected acromegaly. To assist in making the diagnosis, which question should the nurse ask? A) "Have you had a recent head injury?" B) "Has your shoe size increased recently?" C) "Do you experience skin breakouts?" D) "Is there any family history of acromegaly?"
Correct Answer: B Excessive skeletal growth occurs only in the feet, the hands, the superciliary ridge, the molar eminences, the nose, and the chin, giving rise to the clinical condition of acromegaly.
The nurse is completing discharge teaching with a client with hyperthyroidism who has been treated with radioactive iodine at an outpatient clinic. The nurse instructs the client to A) discontinue all antithyroid medications. B) monitor for symptoms of hypothyroidism. C) watch for symptoms of hyperthyroidism to disappear within 1 week. D) continue radioactive precautions with all body secretions.
Correct Answer: B Symptoms of hyperthyroidism may be followed later by those of hypothyroidism and myxedema. Hypothyroidism also commonly occurs in clients with previous hyperthyroidism who have been treated with radioiodine or antithyroid medications or thyroidectomy (surgical removal of all or part of the thyroid gland).
A nurse is planning care for a client in acute addisonian crisis. Which nursing diagnosis should receive the highest priority? A) Risk for infection B) Decreased cardiac output C) Impaired physical mobility D) Imbalanced nutrition: Less than body requirements
Correct Answer: Decreased cardiac output An acute addisonian crisis is a life-threatening event, caused by deficiencies of cortisol and aldosterone. Glucocorticoid insufficiency causes a decrease in cardiac output and vascular tone, leading to hypovolemia. The client becomes tachycardic and hypotensive and may develop shock and circulatory collapse.
A nurse manager overhears a nurse delegating tasks to an unlicensed assistive personnel (UAP) for a patient diagnosed with Cushing's disease. Which task would cause the nurse manager to intervene? a. Taking the patient their food tray. b. Ambulating the patient to the bathroom. c. Encouraging fluid intake. d. Getting the patient's vital signs.
Correct Answer: Encouraging fluid intake Patient education is no t within the scope of practice of a UAP. The other options are all within the UAP's scope of practice and would be appropriate for the RN to delegate.
When instructing a client diagnosed with hyperparathyroidism about diet, the nurse should stress the importance of: A) restricting fluids. B) restricting sodium. C) encouraging fluids. D) restricting potassium.
Correct Answer: Encouraging fluids The nurse should encourage fluid intake to prevent renal calculi formation. Sodium should be encouraged to replace losses in urine. Restricting potassium isn't necessary in hyperparathyroidism.
A group of students is reviewing material about endocrine system function. The students demonstrate understanding of the information when they identify which of the following as secreted by the adrenal medulla? A) Glucocorticoids B) Mineralocorticoids C) Glucagon D) Epinephrine
Correct Answer: Epinephrine The adrenal medulla secretes epinephrine and norepinephrine. The adrenal cortex manufactures and secretes glucocorticoids, mineralocorticoids, and small amounts of androgenic sex hormones. Glucagon is released by the pancreas.
A patient is diagnosed with Addison's disease, a condition that results in insufficient production of cortisol. Which of the following is the most important function of cortisol that the nurse needs to consider when caring for a patient with Addison's disease? A) Helps the body adjust to stress B) Maintains blood pressure C) Slows the body's response to inflammation D) Regulates metabolism
Correct Answer: Helps the body adjust to stress. Cortisol, a glucocorticoid, affects almost every organ in the body, helping it respond to a variety of stressors. Its most important function is helping the body adjust to stress.
A number of pharmacologic agents are used to treat hyperthyroidism. Which of the following drugs is one of the most commonly prescribed and acts by blocking synthesis of the thyroid hormones? A) Propranolol B) Dexamethasone C) Potassium Iodide D) Methimazole
Correct Answer: Methimazole Propylthiouracil (PTU) and methimazole are commonly used. They both act by blocking the synthesis of hormones. The other choices suppress the release of the thyroid hormones, except for propranolol which is a beta-adrenergic blocking agent.
A client with Addison's disease comes to the clinic for a follow-up visit. When assessing this client, the nurse should stay alert for signs and symptoms of: A) calcium and phosphorus abnormalities. B) chloride and magnesium abnormalities. C) sodium and chloride abnormalities. D) sodium and potassium abnormalities.
Correct Answer: Na+ and K abdnormalities In Addison's disease, a form of adrenocortical hypofunction, aldosterone secretion is reduced. Aldosterone promotes sodium conservation and potassium excretion. Therefore, aldosterone deficiency increases sodium excretion, predisposing the client to hyponatremia, and inhibits potassium excretion, predisposing the client to hyperkalemia.
The nurse is administering a medication to a client with hyperthyroidism to block the production of thyroid hormone. The client is not a candidate for surgical intervention at this time. What medication should the nurse administer to the client? A) Levothyroxine B) Spironolactone C) Propylthiouracil D) Propranolol
Correct Answer: Propylthiouracil Antithyroid drugs, such as propylthiouracil and methimazole are given to block the production of thyroid hormone preoperatively or for long-term treatment for clients who are not candidates for surgery or radiation treatment. Levothyroxine would increase the level of thyroid and be contraindicated in this client. Spironolactone is a diuretic and does not have the action of blocking production of thyroid hormone and neither does propranolol, which is a beta-blocker.
Which nursing intervention is most appropriate for a patient admitted with SIADH? a. Infusing normal saline as ordered b. Encouraging increased oral intake c. Restrict fluids d. Reposition every 2 hours
Correct Answer: Restrict fluids SIADH causes fluid retention related to hyponatremia caused by reabsorbtion of water in the kidneys, the nurse should restrict fluids to 500-1,000 mL/day to decrease total water weight.
A client has been experiencing a decrease in serum calcium. After diagnostics, the physician believes the calcium level fluctuation is due to altered parathyroid function. What is the role of parathormone? A) increase serum calcium level B) inhibit release of calcium into extracellular fluid C) decrease serum calcium level D) promote urinary secretion of calcium
Correct Answer: increase serum calcium level The parathyroid glands secrete parathormone, which increases the level of calcium in the blood when there is a decrease in the serum level.
A nurse is caring for a client with diabetes insipidus. The nurse should anticipate administering: A) insulin. B) furosemide. C) potassium chloride. D) vasopressin.
Correct Answer: vasopressin Vasopressin is given subcutaneously to manage diabetes insipidus. Insulin is used to manage diabetes mellitus. Furosemide causes diuresis. Potassium chloride is given for hypokalemia.
The student nurse is creating a care plan for the patient with Cushing's disease. Which priority problems should be the focus of the care plan? (Select all that apply.) A) Fatigue B) Fluid overload C) Sleep deprivation D) Potential for infection E) Predisposition to injury
Correct Answers: B, D, E Although everything listed is a manifestation or potential problem of Cushing's Syndrome, priority problems that the nurse should focus on are fluid overload due to excess fluid retention (as result of hyponatremia), potential for infection (result of altered protein metabolism and inflammatory response), and risk for injury related to weakness and loss of muscle mass caused by hypokalemia.
When administering aminoglutethimide to a patient, it is most important for the nurse to monitor which of the following? A) Serum electrolytes. B) Cardiac enzymes. C) Liver enzymes. D) Arterial blood gases.
Correct answer: Liver enzymes Aminoglutethimide therapy may cause hepatotoxicity, so it is important to monitor liver enzymes.
Which information is important to teach a patient who is taking corticosteroids? (Select all that apply.) a. Do not suddenly stop taking the medication. b. Avoid exposure to crowds. c. Wound healing may be delayed. d. Avoid operating heavy equipment for 6 hours. e. Take before going to bed.
Correct answers: A, B, C coriticosteroids should not be stopped abruptly; tapering the drug gives the adrenal glands time to return to their normal patterns of secretion; avoiding crowds is essential due to an increased risk for infection during drug therapy; corticosteroids are known to affect all three phases of wound healing (inflammatory, proliferative, and remodeling)
A patient is diagnosed with over-activity of the adrenal medulla. What epinephrine value does the nurse recognize is a positive diagnostic indicator for over-activity of the adrenal medulla?
Correct response: 450 pg/mL Normal plasma values of epinephrine are 100 pg/mL (590 pmol/L); normal values of norepinephrine are generally less than 100 to 550 pg/mL (590 to 3,240 pmol/L). Values of epinephrine greater than 400 pg/mL (2,180 pmol/L) or norepinephrine values greater than 2,000 pg/mL (11,800 pmol/L) are considered diagnostic of pheochromocytoma (associated with overactivity of the adrenal medulla). Values that fall between normal levels and those diagnostic of pheochromocytoma indicate the need for further testing.