EXAM 3 Endocrine

For endocrine system assessment, ask patient about

The use of hormone replacements, previous hospitalizations, surgery, chemotherapy, and radiation therapy (especially head and neck)

Endocrine diagnostic studies: Laboratory tests usually involve

1: Blood and urine testing 2: May include direct measurement of the hormone level 3: or involve an indirect measure of gland function by evaluating blood or urine components affected by the hormones (e.g., electrolytes, glucose)

When inspecting the Thyroid gland

1: Observe in the normal position (preferably with side lighting) 2: Observe in slight extension 3: Observe as the patient swallow a sip of water 4: Palpate the thyroid for its: size, shape, symmetry, and tenderness, as well as for any nodules 5: Assess the size, shape, symmetry, and general proportion of hand and feet Only an experienced clinician should palpate an enlarged thyroid gland.

acromegaly

A rare condition resulting from excess secretion of growth hormone (GH), most often results of a Pituitary adenoma

Aldosterone

Adrenal gland hormone: Potent mineralocorticoid that maintains extracellular fluid volume.

Cortisol

Adrenal gland hormone: helps regulate blood glucose concentration, inhibit inflammatory action, and support the stress response

growth hormone (GH)

Affects protein, lipid, and carbohydrate metabolism, it has effects on all body tissues

While assessing the health of a female client, the nurse suspects endocrine dysfunction. Which findings support the nurse's suspicion? Select all that apply. One, some, or all responses may be correct. 1. Diminished pubic hair 2. Yellow-colored urine 3. Pulse of 74 beats per minute 4. Protrusion of eyeballs 5. Blood pressure 178/80 mm Hg

Answer: 1. Diminished of pubic hair 4. Protrusion of eyeballs 5. Blood pressure 178/80 mm Hg Diminished axillary and pubic hair, protruding eyeballs, and elevated blood pressure are signs of endocrine dysfunction. Yellow urine is a normal finding. The normal pulse rate ranges from 60 to 100 beats per minute.

The nurse teaches the client about endocrine functioning of part of the image labeled A. Which information from the client indicates successful learning? 1. Promotes growth 2. Promotes stress response 3. Increases serum calcium levels 4. Increases intestinal calcium absorption

Answer: 1. Promotes growth Part A is the pituitary gland. Growth hormone secreted by the pituitary gland promotes protein anabolism (growth and tissue repair). The adrenal medulla releases epinephrine and norepinephrine during the stress response. Secreted by the parathyroid gland, parathormone increases serum calcium levels and also increases the intestinal absorption of calcium.

An older adult who has an endocrine disorder is scheduled for a diagnostic study with contrast medium. The nurse identifies that it is essential for which laboratory test to be performed before the procedure? 1. Urine pH 2. Serume Creatinine 3. Serum Albumin 4. Creatinine clearance

Answer: 2. Serum Creatinine If a contrast medium is used in older adults with an elevated serum creatinine, it may cause renal failure. Thus the nurse would assess the client's renal function before the diagnostic by checking the serum creatinine to assess for renal failure. Urinary pH may not help the nurse assess the client's risk of renal failure. A serum albumin test is performed if symptoms of liver disease or other liver problems are present; it is not routinely done before contrast medium tests. Creatinine clearance helps assess the glomerular filtration rate.

To ensure a quality specimen and an accurate test result, which instruction would the nurse give a client who is scheduled to undergo urine endocrine testing? 1. Start urine collection when the bladder is full 2. Store the urine collection in a cooler with ice 3. Store the urine collection in a home refrigerator 4. Save the urine specimen that begins the collection

Answer: 2. Store the urine collection in a cooler with ice The urine specimen that is collected for endocrine testing should be stored in a cooler with ice to prevent bacterial growth in the specimen. The nurse should instruct the client to start the urine collection after emptying the bladder. The client should be instructed not to store the urine specimen in a home refrigerator with other food and drinks because it could lead to cross-contamination. The client should be instructed to refrain from saving the urine specimen that begins the collection because the timing for urine collection starts from after the initial voiding specimen.

Which lab finding will alert the nurse that aldosterone will be released in a client who has a history with an endocrine disorder? 1. Hypokalemia 2. Hypoglycemia 3. Hyponatremia 4. Hypochloremia

Answer: 3. Hyponatremia Hyponatremia stimulates the secretion of aldosterone. Hypoglycemia inhibits the secretion of insulin. Hyperkalemia, not hypokalemia, stimulates the secretion of aldosterone. Hypochloremia is associated with increased levels of antidiuretic hormone.

Which order do the events of heat production through the endocrine system occur? 1. Release of Thyroxine from the thyroid gland 2. Stimulation of the Anterior pituitary gland 3. Hypothalamus secretes the thyrotropin-releasing hormone 4. Increase metabolic rate, stimulation of glycolysis, and vasoconstriction 5. Release epinephrine from activated adrenal gland 6. Release of thyroid-stimulating hormone

Answer: 3. Hypothalamus secretes the thyrotropin-releasing hormone 2. Stimulation of the Anterior pituitary gland 6. Release of thyroid-stimulating hormone (TSH) 1. Release of Thyroxine from the thyroid gland 5. Release epinephrine from activated adrenal gland 4. Increase metabolic rate, stimulation of glycolysis, and vasoconstriction When a drop in the body temperature occurs, the hypothalamus receives the information from thermoreceptors in the body. Then the hypothalamus secretes thyrotropin-releasing hormone, which in turn stimulates the anterior pituitary gland to release thyroid-stimulating hormone (TSH). This TSH in turn triggers the thyroid gland to release thyroxine. The thyroxine activates the adrenal medulla to release epinephrine. This epinephrine increases the metabolic rate, stimulates the process of glycolysis, and causes vasoconstriction, thus increasing heat production in the body.

After surgery for cancer of the pancreas, the client's nutrition and fluid regimen are influenced by the remaining amount of functioning pancreatic tissue. The nurse considers both the exocrine and the endocrine functions of the pancreas and expects that, postoperatively, the client's dietary regimen will be focused on the management of which substances? 1. Alcohol and Caffeine 2. Fluids and Electrolytes 3. Vitamins and Minerals 4. Fats and Carbohydrates

Answer: 4. Fats and Carbohydrates The formation of lipase necessary for the digestion of fats is an exocrine function; the endocrine function is to secrete insulin, a hormone essential in carbohydrate metabolism. Although it is necessary to avoid alcohol, this is not related to pancreatic exocrine functions; caffeine is unrelated to pancreatic function. Fluid and electrolyte problems are unrelated to exocrine or endocrine pancreatic functioning. Deficiencies of vitamins and minerals may occur because of inadequate intake, but these deficiencies are not specifically related to exocrine or endocrine pancreatic functioning.

The nurse reviews a client's medical record, specifically the client's skull radiograph results. An abnormality in the endocrine gland situated in a depression of the sphenoid bone is noted on the report. The nurse recalls that which hormone release is most probably affected? 1. Glucagon 2. Cortisol 3. Aldosterone 4. Corticotropin

Answer: 4. corticotropin The pituitary gland is the endocrine gland that is situated in a bony depression of the sphenoid bone. Corticotropin or adrenocorticotropic hormones are secreted by the anterior pituitary and could be affected by an abnormality in the pituitary. Glucagon is a hormone that is secreted by the pancreas. Cortisol and aldosterone are hormones secreted by the adrenal cortex. There is less likelihood that the release of glucagon, cortisol, or aldosterone might be affected by a suspected abnormality in the pituitary gland.

A patient has a total serum calcium level of 3 mg/dL (1.5 mEq/L). If this finding reflects hypoparathyroidism, the nurse would expect further diagnostic testing to reveal a. decreased serum PTH. b. increased serum ACTH. c. increased serum glucose. d. decreased serum cortisol levels.

Answer: a. decreased serum PTH. Normal serum calcium level are 8.6-10.2 mg/dL. In hypoparathyroidism, the serum calcium level is low with a decreased serum parathyroid hormone (PTH) level.

When obtaining subjective data from a patient during assessment of the endocrine system, the nurse asks specifically about a. energy level. b. intake of vitamin C. c. employment history. d. frequency of sexual intercourse.

Answer: a. energy level. The nurse should ask about energy levels and compare them with the patient's past energy level. Fatigue and hyperactivity are two common problems associated with endocrine problems.

Abnormal findings during an endocrine assessment include (select all that apply) a. excess facial hair on a woman. b. blood pressure of 100/70 mm Hg. c. soft, formed stool every other day. d. 3-lb weight gain over last 6 months. e. hyperpigmented coloration in lower legs.

Answer: a. excess facial hair on a woman. e. hyperpigmented coloration in lower legs. Hirsutism (i.e., excess facial hair on women) may occur with Cushing Syndrome or Prolactinoma, a pituitary tumor. Hyperpigmentation (i.e., darkening of skin, particularly in skinfolds and creases) may indicate Addison's diseases, which is associated with increased secretion of melanocyte-stimulating hormone, or Acanthosis nigricans.

A patient has a serum sodium level of 152 mEq/L (152 mmol/L). The normal hormonal response to this situation is a. release of ADH. b. release of ACTH. c. secretion of aldosterone. d. secretion of corticotropin-releasing hormone.

Answer: a. release of ADH. The most important stimulus of an antidiuretic hormone (ADH) secretion is plasma osmolality, which is a measure of solute concentration in circulating blood. Plasma osmolality increases when there is a decrease in extracellular fluid or an increase in solute concentration. The increased plasma osmolality activates osmoreceptors, which are extremely sensitive, specialized neurons in the hypothalamus. These activated osmoreceptors stimulate ADH release. With ADH release, the renal tubules reabsorb water, which causes urine to be more concentrated.

Endocrine disorders often go unrecognized in the older adult because a. symptoms are often attributed to aging. b. older adults rarely have identifiable symptoms. c. endocrine disorders are relatively rare in the older adult. d. older adults usually have subclinical endocrine disorders that minimize symptoms.

Answer: a. symptoms are often attributed to aging. Assessment of effects of aging on the endocrine system is hard because the subtle changes of aging often mimic manifestations of endocrine disorders.

A characteristic common to all hormones is that they a. circulate in the blood bound to plasma proteins. b. influence cellular activity of specific target tissues. c. accelerate the metabolic processes of all body cells. d. enter a cell and change the cell's metabolism or gene expression.

Answer: b. influence cellular activity of specific target tissues. A hormone is a chemical substance synthesized and secreted by a specific organ or tissue. Most hormone have common characteristics, including (1) secretion in small amounts at variable but predictable rates, (2) circulation through the blood, and (3) binding to specific cell receptors in the cell membrane or within the cell

A patient is receiving radiation therapy for cancer of the kidney. The nurse monitors the patient for signs and symptoms of damage to the a. pancreas. b. thyroid gland. c. adrenal glands. d. posterior pituitary gland.

Answer: c. adrenal glands. The adrenal glands are small, paired, highly vascularized glands found on the upper part of each kidney. Radiation therapy of the kidney may damage the adrenal glands

An appropriate technique to use during physical assessment of the thyroid gland is a. asking the patient to hyperextend the neck during palpation. b. percussing the neck for dullness to define the size of the thyroid. c. having the patient swallow water during inspection and palpation of the gland. d. using deep palpation to determine the extent of a visibly enlarged thyroid gland.

Answer: c. having the patient swallow water during inspection and palpation of the gland. Water should always be available for the patient to swallow as part of the inspection and palpation of the thyroid gland

A nurse educator instructs a new nurse during orientation about the physiological processes of the endocrine system. Which statement made by the new nurse indicates effective learning? 1. The endocrine system comprises glands with narrow ducts 2. The endocrine system comprises salivary and lacrimal glands 3. The hormones of the endocrine system exert their action by "lock and key" mechanism 4. The hormones secreted by the endocrine system exert their action on all tissues they contact.

Answer: 3. The hormones of the endocrine system exert their action by "lock and key" mechanism The endocrine glands secrete hormones that exert their action on the target tissues by the "lock and key" mechanism. The hormones recognize and adhere only to specific receptor sites on the target tissue, like a correct key alone can open its specific lock. The glands of the endocrine system are ductless and secrete hormones that are carried via the blood circulation. Salivary and lacrimal glands are not endocrine but secretory glands. The hormones are carried via blood to various tissues, but they exert their action only on specific target tissues.

All cells in the body are believed to have intracellular receptors for a. insulin. b. glucagon. c. growth hormone. d. thyroid hormone.

Answer: d. thyroid hormone. There are two types of receptors: those that are within the cell (e.g., steroid, thyroid hormone receptors) and those are on the cell membrane (e.g., water-soluble hormone receptors). Thyroid hormone receptors are found inside the cell. Because these hormones are lipid soluble, they pass through the target cell membrane by passive diffusion and bind to receptor sites found in the cytoplasm or nucleus of the target cell.

Effects of normal aging on Endocrine system

Decreased hormone Production and Secretion Altered hormone Metabolism and Biologic activity Decreased responsiveness of target tissues to hormones Changes in the circadian rhythms Subtle changes of aging often mimic manifestations of endocrine disorders Endocrine disorders can mimic subtle changes of aging

Endocrine dysfunction may result from

Deficient or excess hormone secretion, transport abnormalities, an inability of the target tissue to respond to a hormone, or inappropriate stimulation of the target-tissue receptor

Endocrine system assessment focuses on and includes

Detecting manifestations associated with the specific gland Includes: History of growth and development Weight distribution and changes Comparisons of these factors with normal findings Disorders can cause changes in mental and emotional status Note: color and texture of the skin, hair and nails Palpate: skin for texture and presence of moisture Inspect: hair distribution and pattern of the genitalia

Anterior Pituitary diagnostic studies: Laboratory studies used to assess pituitary function include

GH, Prolactin, FSH, LH, TSH, and ACTH level

Catecholamines Epinephrine Norepinephrine Dopamine

Hormone secreted by the Adrenal Medulla

Positive Feedback

Increasing hormone levels cause another gland to release a hormone that then stimulates further release of the first hormone

Oxytocin (OT)

Kidneys hormone: stimulates ejection of milk into the mammary ducts and contraction of uterine growth muscle

Circadian or sleep-related secretion

Notation of sample time on the laboratory slip and sample is important

parathyroid hormone (PTH)

PTH: regulates the blood level of calcium Parathyroid glands are four small, oval structures usually arranged in pairs behind each thyroid lobe.

Insulin

Pancreas hormone: Anabolic hormone: principal regulator of the metabolism and storage of ingested carbohydrates, fats, and proteins.

Glucagon

Pancreas hormone: Catabolic hormone: that increases blood glucose by stimulating glycogenolysis, gluconeogenesis, and ketogenesis

Melatonin

Pineal gland hormone: helps regulate circadian rhythm and reproduction

The specificity of hormone-targeting cell interaction is determined by

Receptors: in a "Lock-and-key type of mechanism

antidiuretic hormone (ADH)

Regulates fluid volume by stimulating reabsorption of water in the kidneys

luteinizing hormone (LH)

Stimulates ovulation in women and secretion of sex hormones in both men and women

Follicle-stimulating hormone (FSH)

Stimulates secretion of estrogen along with the development of ova in women and sperm in men.

Thyroid diagnostic studies: Test to assess abnormal thyroid function include

TSH (most common), Total T4, free T4, and Total T3

Hormones exert their effects on

Target tissue

Thyroxine (T4) and Triiodothyronine (T3)

Thyroid gland hormone: T4 and T3 affect metabolic rate, carbohydrate and lipid metabolism, growth development, and nervous system activities. Iodine is required for the synthesis of thyroid hormones

Calcitonin

Thyroid gland hormone: made by C cells (parafollicular cells) of the thyroid gland in response to high circulating calcium levels

Hormones release by Anterior Pituitary are called

Tropic hormones: they regulate the secretion of hormones by other glands

Hypothalamus and Pituitary gland integrate

communication between nervous and endocrine system, forming a Neuroendocrine system

Negative Feedback

gland responds by increasing or decreasing the secretion of a hormone based on feedback from various factors

Adrenocorticotropic hormone (ACTH)

stimulates the adrenal cortex to secrete corticosteroids

Thyroid-stimulating hormone (TSH)

stimulates the thyroid gland to secrete thyroid hormones