NU3 TEST 3 -PRACTICE QUESTIONS

Which of the following would indicate to the nurse that a client is experiencing an endocrine disorder that is affecting the neurological system? (Select all that apply.) 1. Tremors 2. Memory loss 3. Jitteriness 4. Nervousness 5. Loss of sensation in the feet 6. Nerve pain

1, 2, 3, 4, 5 Common neurological findings with an endocrine disorder include tremors, memory loss, jitteriness, nervousness, and decreased sensation in the hands and feet. Nerve pain is not associated with an endocrine disorder affecting the neurological system.

A client is diagnosed with primary adrenal insufficiency. The nurse realizes that this disorder affects which of the following glands 1. Adrenal cortex 2. Adrenal medulla 3. Thyroid 4. Pituitary

1. Adrenal cortex Mineralocorticoids, glucocorticoids, and androgens are produced in the adrenal cortex. The principal mineralocorticoid is aldosterone. The adrenal medulla secretes the catecholamines. The thyroid and pituitary do not secrete aldosterone.

The nurse is assessing a client diagnosed with hyperaldosteronism. Which of the following would take the least priority during this period? 1. Assessment of breath sounds 2. Cardiac monitoring 3. Assistance with activities of daily living (ADLs) 4. Review of electrolyte levels

3. Assistance with activities of daily living (ADLs) The first priority for the nurse is to monitor cardiac and respiratory status. Cardiac status can be impaired because of changes in potassium levels, and fluid balance can be impaired because of sodium, affecting the respiratory status. After the client is stabilized, the nurse can assist the client with activities of daily living.

A client is diagnosed with a low serum calcium level. The nurse realizes that which hormone is released when serum calcium levels are low? 1. Calcitonin 2. Cortisol 3. Parathyroid hormone 4. Thyroxine

3. Parathyroid hormone Parathyroid hormone is secreted when serum calcium levels are low. Calcitonin is released when serum calcium levels are high. Cortisol and thyroxine are not related to calcium

.The nurse realizes that an adequate amount of which vitamin must be present for parathyroid hormone to be fully effective? 1. Vitamin A 2. Vitamin C 3. Vitamin D 4. Vitamin E

3. Vitamin D Adequate vitamin D is necessary for absorption of calcium into the bloodstream. Vitamins A, C, and E do not have a role in calcium regulation.

The nurse, instructing a client regarding hormones, would include which of the following in these instructions? 1. Hormones are nonspecific. 2. Hormone release triggers a rapid response. 3. Hormones do not influence other hormones. 4. The nervous system and hormones work together to maintain homeostasis.

4. The nervous system and hormones work together to maintain homeostasis

A nurse cares for a client with a hypofunctioning anterior pituitary gland. Which hormones should the nurse expect to be affected by this condition? (Select all that apply.) a. Thyroid-stimulating hormone b. Vasopressin c. Follicle-stimulating hormone d. Calcitonin e. Growth hormone

A, C, E Thyroid-stimulating hormone, follicle-stimulating hormone, and growth hormone all are secreted by the anterior pituitary gland. Vasopressin is secreted from the posterior pituitary gland. Calcitonin is secreted from the thyroid gland.

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 nurse evaluates the following laboratory results for a client who has hypoparathyroidism: Calcium 7.2 mg/dL Sodium 144 mEq/L Magnesium 1.2 mEq/L Potassium 5.7 mEq/L Based on these results, which medications should the nurse anticipate administering? (Select all that apply.) a. Oral potassium chloride b. Intravenous calcium chloride c. 3% normal saline IV solution d. 50% magnesium sulfate e. Oral calcitriol (Rocaltrol)

B, D The client has hypocalcemia (treated with calcium chloride) and hypomagnesemia (treated with magnesium sulfate). The potassium level is high, so replacement is not needed. The client's sodium level is normal, so hypertonic IV solution is not needed. No information about a vitamin D deficiency is evident, so calcitriol is not needed.

A nurse is caring for a client who has diabetes insidious. For which of the following findings should the nurse monitor?

Polyuria Diabetes insipidus is characterized by increased thirst (polydipsia) and increased urination (polyuria). The client who has diabetes insipidus will excrete large quantities of urine with a very low specific gravity.

A nurse assesses a client diagnosed with adrenal hypofunction. Which client statement should the nurse correlate with this diagnosis? a. "I have a terrible craving for potato chips." b. "I cannot seem to drink enough water." c. "I no longer have an appetite for anything." d. "I get hungry even after eating a meal

a. "I have a terrible craving for potato chips." The nurse correlates a client's salt craving with adrenal hypofunction. Excessive thirst is related to diabetes insipidus or diabetes mellitus. Clients who have hypothyroidism often have a decrease in appetite. Excessive hunger is associated with diabetes mellitus.

10. What are two effects of hypokalemia on the endocrine system? a. Decreased insulin and aldosterone release b. Decreased glucagon and increased cortisol release c. Decreased release of ANP and increased ADH release d. Decreased release of parathyroid hormone and increased calcitonin release

a. Decreased insulin and aldosterone release Hypokalemia inhibits aldosterone release as well as insulin release. Hypokalemia does not directly effect the other options.

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. History of renal insufficiency 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 patients diagnosis of a pituitary tumor.

12. In a patient with an elevated serum cortisol, what should the nurse expect other laboratory findings to reveal? a. Hypokalemia b. Hyponatremia c. Hypoglycemia d. Decreased serum triglycerides

a. Hypokalemia Although cortisol is a glucocorticoid, it has action on mineralocorticoid receptors, which causes sodium retention and potassium excretion from the kidney, resulting in hypokalemia. Because water is reabsorbed with the sodium, serum sodium remains normal. In its effect on glucose and fat metabolism, cortisol causes an elevation in blood glucose as well as increases in free fatty acids and triglycerides.

3. A client has a deficiency of aldosterone. Which assessment finding does the nurse correlate with this condition? a. Increased urine output b. Vasoconstriction c. Blood glucose, 98 mg/dL d. Serum sodium, 144 mEq/L

a. Increased urine output

A nurse cares for a client with a deficiency of aldosterone. Which assessment finding should the nurse correlate with this deficiency? a. Increased urine output b. Vasoconstriction c. Blood glucose of 98 mg/dL d. Serum sodium of 144 mEq/L

a. Increased urine output

The nurse is caring for a patient admitted with diabetes insipidus (DI). Which information is most important to report to the health care provider? a. The patient is confused and lethargic. b. The patient reports a recent head injury. c. The patient has a urine output of 400 mL/hr. d. The patients urine specific gravity is 1.003.

a. The patient is confused and lethargic The patients confusion and lethargy may indicate hypernatremia and should be addressed quickly. In addition, patients with DI compensate for fluid losses by drinking copious amounts of fluids, but a patient who is lethargic will be unable to drink enough fluids and will become hypovolemic. A high urine output, low urine specific gravity, and history of a recent head injury are consistent with diabetes insipidus, but they do not require immediate nursing action to avoid life-threatening complications

1. 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 urinary cortisol. 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.

A 56-year-old female patient has an adrenocortical adenoma, causing hyperaldosteronism. The nurse providing care should a. monitor the blood pressure every 4 hours. b. elevate the patients legs to relieve edema. c. monitor blood glucose level every 4 hours. d. order the patient a potassium-restricted diet.

a. monitor the blood pressure every 4 hours. Hypertension caused by sodium retention is a common complication of hyperaldosteronism. Hyperaldosteronism does not cause an elevation in blood glucose. The patient will be hypokalemic and require potassium supplementation before surgery. Edema does not usually occur with hyperaldosteronism.

A nurse assesses a female client who presents with hirsutism. Which question should the nurse ask when assessing this client? a. "How do you plan to pay for your treatments? b. "How do you feel about yourself?" c. "What medications are you prescribed?" d. "What are you doing to prevent this from happening?"

b. "How do you feel about yourself?" Hirsutism, or excessive hair growth on the face and body, can result from endocrine disorders. This may cause a disruption in body image, especially for female clients. The nurse should inquire into the client's body image and self-perception. Asking about the client's financial status or current medications does not address the client's immediate problem. The client is not doing anything to herself to cause the problem, nor can the client prevent it from happening.

A nurse teaches an older adult with a decreased production of estrogen. Which statement should the nurse include in this client's teaching to decrease injury? a. "Drink at least 2 liters of fluids each day." b. "Walk around the neighborhood for daily exercise." c. "Bathe your perineal area twice a day." d. "You should check your blood glucose before meals."

b. "Walk around the neighborhood for daily exercise." An older adult client with decreased production of estrogen is at risk for decreased bone density and fractures. The nurse should encourage the client to participate in weight-bearing exercises such as walking. Drinking fluids and performing perineal care will decrease vaginal drying but not decrease injury. Older adults often have a decreased glucose tolerance, but this is not related to a decrease in estrogen.

A nurse assesses clients for potential endocrine disorders. Which client is at greatest risk for hyperparathyroidism? a. A 29-year-old female with pregnancy-induced hypertension b. A 41-year-old male receiving dialysis for end-stage kidney disease c. A 66-year-old female with moderate heart failure d. A 72-year-old male who is prescribed home oxygen therapy

b. A 41-year-old male receiving dialysis for end-stage kidney disease Clients who have chronic kidney disease do not completely activate vitamin D and poorly absorb calcium from the GI tract. They are chronically hypocalcemic, and this triggers overstimulation of the parathyroid glands. Pregnancy-induced hypertension, moderate heart failure, and home oxygen therapy do not place a client at higher risk for hyperparathyroidism.

7. What is released in the normal response to increased serum osmolality? a. Aldosterone from the adrenal cortex, which stimulates sodium excretion by the kidney b. ADH from the posterior pituitary gland, which stimulates the kidney to reabsorb water c. Mineralocorticoids from the adrenal gland, which stimulate the kidney to excrete potassium d. Calcitonin from the thyroid gland, which increases bone resorption and decreases serum calcium levels

b. ADH from the posterior pituitary gland, which stimulates the kidney to reabsorb water ADH release is controlled by the osmolality of the blood. As the osmolality rises, ADH is released from the posterior pituitary gland and acts on the kidney to cause reabsorption of water from the kidney tubule, resulting in more dilute blood and more concentrated urine. Aldosterone, the major mineralocorticoid, causes sodium reabsorption from the kidney and potassium excretion. Calcium levels are not a factor in serum osmolality.

3. 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. Antidiuretic hormone level 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 patients hyponatremia.

A nurse cares for a client who is prescribed a drug that blocks a hormone's receptor site. Which therapeutic effect should the nurse expect? a. Greater hormone metabolism b. Decreased hormone activity c. Increased hormone activity d. Unchanged hormone response

b. Decreased hormone activity

A 45-year-old male patient with suspected acromegaly is seen at the clinic. To assist in making the diagnosis, which question should the nurse ask? a. Have you had a recent head injury? b. Do you have to wear larger shoes now? c. Is there a family history of acromegaly? d. Are you experiencing tremors or anxiety?

b. Do you have to wear larger shoes now? Acromegaly causes an enlargement of the hands and feet. Head injury and family history are not risk factors for acromegaly. Tremors and anxiety are not clinical manifestations of acromegaly.

A 63-year-old patient with primary hyperparathyroidism has a serum phosphorus level of 1.7 mg/dL (0.55 mmol/L) and calcium of 14 mg/dL (3.5 mmol/L). Which nursing action should be included in the plan of care? a. Restrict the patient to bed rest. b. Encourage 4000 mL of fluids daily. c. Institute routine seizure precautions. d. Assess for positive Chvosteks sign.

b. Encourage 4000 mL of fluids daily. The patient with hypercalcemia is at risk for kidney stones, which may be prevented by a high fluid intake. Seizure precautions and monitoring for Chvosteks or Trousseaus sign are appropriate for hypocalcemic patients. The patient should engage in weight-bearing exercise to decrease calcium loss from bone.

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b. FPG for all individuals at age 45 and then every 3 years

A client has a condition of excessive catecholamine release. Which assessment finding does the nurse correlate with this condition? a. Decreased blood pressure b. Increased pulse c. Decreased respiratory rate d. No change in vital signs

b. Increased pulse Catecholamines are responsible for the fight-or-flight stress response. Activation of the sympathetic nervous system can be correlated with tachycardia. The other options are not correlated with excessive catecholamine release.

The cardiac telemetry unit charge nurse receives status reports from other nursing units about four patients who need cardiac monitoring. Which patient should be transferred to the cardiac unit first? a. Patient with Hashimotos thyroiditis and a heart rate of 102 b. Patient with tetany who has a new order for IV calcium chloride c. Patient with Cushing syndrome and a blood glucose of 140 mg/dL d. Patient with Addisons disease who takes hydrocortisone twice daily

b. Patient with tetany who has a new order for IV calcium chloride Emergency treatment of tetany requires IV administration of calcium; ECG monitoring will be required because cardiac arrest may occur if high calcium levels result from too-rapid administration. The information about the other patients indicates that they are more stable than the patient with tetany.

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 patients urine osmolality does not increase. d. The patient feels dizzy when sitting on the edge of the bed.

b. The patient has a 5-lb (2.3 kg) weight loss. 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.

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. The patient takes oral corticosteroids for rheumatoid arthritis Corticosteroids can affect blood glucose results. The other information will be provided to the health care

A nurse plans care for a client with hyperparathyroidism. Which intervention should the nurse include in this client's plan of care? a. Ask the client to ambulate in the hallway twice a day. b. Use a lift sheet to assist the client with position changes. c. Provide the client with a soft-bristled toothbrush for oral care. d. Instruct the unlicensed assistive personnel to strain the client's urine for stones.

b. Use a lift sheet to assist the client with position changes. Hyperparathyroidism causes increased resorption of calcium from the bones, increasing the risk for pathologic fractures. Using a lift sheet when moving or positioning the client, instead of pulling on the client, reduces the risk of bone injury. Hyperparathyroidism can cause kidney stones, but not every client will need to have urine strained. The priority is preventing injury. Ambulating in the hall and using a soft toothbrush are not specific interventions for this client.

Which question will the nurse in the endocrine clinic ask to help determine a patients risk factors for goiter? a. How much milk do you drink? b. What medications are you taking? c. Are your immunizations up to date? d. Have you had any recent neck injuries?

b. What medications are you taking? Medications that contain thyroid-inhibiting substances can cause goiter. Milk intake, neck injury, and immunization history are not risk factors for goiter.

18. To ensure accurate results of a fasting blood glucose analysis, the nurse instructs the patient to fast for at least how long? a. 2 hours b. 4 hours c. 8 hours d. 12 hours

c. 8 hours To ensure that the level is a fasting level, a minimum of 8 hours should be allowed. Water may be taken, however, and does not affect the glucose level. Many medications may also influence results, which will have to be evaluated.

A nurse evaluates laboratory results for a male client who reports fluid secretion from his breasts. Which hormone value should the nurse assess first? a. Posterior pituitary hormones b. Adrenal medulla hormones c. Anterior pituitary hormones d. Parathyroid hormone

c. Anterior pituitary hormone Breast fluid and milk production are induced by the presence of prolactin, secreted from the anterior pituitary gland. The other hormones would not cause fluid secretion from the client's breast.

A nurse cares for a client with excessive production of thyrocalcitonin (calcitonin). For which electrolyte imbalance should the nurse assess? a. Potassium b. Sodium c. Calcium d. Magnesium

c. Calcium

27. The nurse assesses the technique of the patient with diabetes for self-monitoring of blood glucose (SMBG) 3 months after initial instruction. Which error in the performance of SMBG noted by the nurse requires intervention? a. Doing the SMBG before and after exercising b. Puncturing the finger on the side of the finger pad c. Cleaning the puncture site with alcohol before the puncture d. Holding the hand down for a few minutes before the puncture

c. Cleaning the puncture site with alcohol before the puncture Cleaning the puncture site with alcohol is not necessary and may interfere with test results and lead to drying and splitting of the fingertips. Washing the hands with warm water is adequate cleaning and promotes blood flow to the fingers. Blood flow is also increased by holding the hand down. Punctures on the side of the finger pad are less painful. Self-monitored blood glucose (SMBG) should be performed before and after exercise.

When a patient in the outpatient clinic has an order for blood cortisol testing, which instruction will the nurse provide for the patient? 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. Come to the laboratory to have the blood drawn early in the morning. 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

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. Have you had a recent unplanned weight gain or loss?

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

Which information obtained by the nurse in the endocrine clinic about a patient who has been taking prednisone (Deltasone) 40 mg daily for 3 weeks is most important to report to the health care provider? a. Patients blood pressure is 148/94 mm Hg. b. Patient has bilateral 2+ pitting ankle edema. c. Patient stopped taking the medication 2 days ago. d. Patient has not been taking the prescribed vitamin D.

c. Patient stopped taking the medication 2 days ago Sudden cessation of corticosteroids after taking the medication for a week or more can lead to adrenal insufficiency, with problems such as severe hypotension and hypoglycemia. The patient will need immediate evaluation by the health care provider to prevent and/or treat adrenal insufficiency. The other information will also be reported, but does not require rapid treatment.

A 29-year-old woman with systemic lupus erythematosus has been prescribed 2 weeks of high-dose prednisone therapy. Which information about the prednisone is most important for the nurse to include? a. Weigh yourself daily to monitor for weight gain caused by increased appetite. b. A weight-bearing exercise program will help minimize the risk for osteoporosis. c. The prednisone dose should be decreased gradually rather than stopped suddenly. d. Call the health care provider if you experience mood alterations with the prednisone.

c. The prednisone dose should be decreased gradually rather than stopped suddenly. Acute adrenal insufficiency may occur if exogenous corticosteroids are suddenly stopped. Mood alterations and weight gain are possible adverse effects of corticosteroid use, but these are not life-threatening effects. Osteoporosis occurs when patients take corticosteroids for longer periods.

During assessment of the patient with acromegaly, what should the nurse expect the patient to report? a. Infertility b. Dry, irritated skin c. Undesirable changes in appearance d. An increase in height of 2 to 3 inches a year

c. Undesirable changes in appearance

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. elevated serum potassium. 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.

An expected nursing diagnosis for a 30-year-old patient admitted to the hospital with symptoms of diabetes insipidus is a. excess fluid volume related to intake greater than output. b. impaired gas exchange related to fluid retention in lungs. c. sleep pattern disturbance related to frequent waking to void. d. risk for impaired skin integrity related to generalized edema.

c. sleep pattern disturbance related to frequent waking to void. Nocturia occurs as a result of the polyuria caused by diabetes insipidus. Edema, excess fluid volume, and fluid retention are not expected.

14. Common nonspecific manifestations that may alert the nurse to endocrine dysfunction include a. goiter and alopecia. b. exophthalmos and tremors. c. weight loss, fatigue, and depression. d. polyuria, polydipsia, and polyphagia

c. weight loss, fatigue, and depression. Assessment of the endocrine system is often difficult because hormones affect every body tissue and system, causing great diversity in the signs and symptoms of endocrine dysfunction. Weight loss, fatigue, and depression are signs that may occur with many different endocrine problems or other diseases. Goiter, exophthalmos, and the three "polys" are findings of specific endocrine glands' dysfunction.

A patient suspected of having acromegaly has an elevated plasma growth hormone (GH) level. In acromegaly, what would the nurse also expect the patient's diagnostic results to indicate? a. Hyperinsulinemia b. Plasma glucose of <70 mg/dL (3.9 mmol/L) c. Decreased GH levels with an oral glucose challenge test d. Elevated levels of plasma insulin-like growth factor-1 (IGF-1)

d. Elevated levels of plasma insulin-like growth factor-1 (IGF-1)

2. 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. I feel a lump in my throat when I swallow. 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.

8. What accurately demonstrates that hormones of one gland influence the function of hormones of another gland? a. Increased insulin levels inhibit the secretion of glucagon. b. Increased cortisol levels stimulate the secretion of insulin. c. Increased testosterone levels inhibit the release of estrogen. d. Increased atrial natriuretic peptide (ANP) levels inhibit the secretion of aldosterone.

d. Increased atrial natriuretic peptide (ANP) levels inhibit the secretion of aldosterone.

Which finding by the nurse when assessing a patient with a large pituitary adenoma is most important to report to the health care provider? a. Changes in visual field b. Milk leaking from breasts c. Blood glucose 150 mg/dL d. Nausea and projectile vomiting

d. Nausea and projectile vomiting Nausea and projectile vomiting may indicate increased intracranial pressure, which will require rapid actions for diagnosis and treatment. Changes in the visual field, elevated blood glucose, and galactorrhea are common with pituitary adenoma, but these do not require rapid action to prevent life-threatening complications.

11. The nurse determines that a patient with a 2-hour OGTT of 152 mg/dL has a. diabetes. b. elevated A1C. c. impaired fasting glucose. d. impaired glucose tolerance

d. impaired glucose tolerance Impaired glucose tolerance exists when a 2-hour OGTT level is higher than normal but lower than the level diagnostic for diabetes (i.e., >200 mg/dL). Impaired fasting glucose exists when fasting glucose levels are greater than the normal of 100 mg/dL but less than the 126 mg/dL diagnostic of diabetes. Both abnormal values indicate prediabetes.

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 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.

A patient 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 a. calcitonin levels. b. catecholamine levels. c. thyroid hormone levels. d. parathyroid hormone levels.

d. parathyroid hormone levels. Parathyroid hormone is the major controller for 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.

The nurse is interviewing a patient who has a possible thyroid disorder. Which question will provide the most useful information? a. What methods do you use to help cope with stress? b. Have you experienced any blurring or double vision? c. Do you have to get up at night to empty your bladder? d.Have you had any recent unplanned weight gain or loss?

d.Have you had any recent unplanned weight gain or loss? Because thyroid function affects metabolic rate, changes in weight may indicate hyper- or hypofunction of the thyroid gland. Nocturia, visual difficulty, and changes in stress level are associated with other endocrine disorders.

The nurse is planning care for a client diagnosed with hypercalcemia caused by hyperparathyroidism. Which of the following should the nurse add as interventions to this clients care plan? (Select all that apply.) 1. Administer high volume intravenous fluids as prescribed. 2. Monitor arterial blood gases. 3. Calculate sodium chloride intake to achieve 400 mEq each day. 4. Provide low rates of intravenous fluids. 5. Provide thyroid replacement medication orally. 6. Monitor body temperature.

1, 3, Management of fluid and electrolytes is the priority for a client diagnosed with hypercalcemia caused by hyperparathyroidism. The client needs intensive hydration with intravenous normal saline. The nurse also needs to ensure that the client receives greater than 400 mEq of sodium chloride each day. The other answer choices are interventions appropriate for a client diagnosed with myxedema.

A client is diagnosed with benign cysts on the cortex of the adrenal glands. Which of the following hormones will be affected with this health problem? 1. Aldosterone and cortisol 2. Calcitonin and parathyroid hormone 3. Epinephrine and norepinephrine 4. Prolactin and luteinizing hormone

1. Aldosterone and cortisol Aldosterone and cortisol are released by the adrenal cortex. The adrenal medulla releases epinephrine and norepinephrine. Calcitonin and parathyroid hormone are released by the thyroid and parathyroid, respectively. Prolactin and luteinizing hormone are anterior pituitary hormones.

A client tells the nurse that he is so thirsty that he has already consumed four pitchers of water. The clients urine output is 3500 mL in an 8-hour period. The client is recovering from surgery on the pituitary gland. What endocrine disorder is the client most likely experiencing? 1. Diabetes insipidus 2. Diabetes mellitus 3. Myxedema 4. Syndrome of inappropriate antidiuretic hormone secretion

1. Diabetes insipidus Diabetes insipidus and diabetes mellitus both cause increased urine output, but diabetes insipidus is related to a problem with antidiuretic hormone; diabetes mellitus is a problem with glucose. Myxedema is caused by a thyroid hormone imbalance. Syndrome of inappropriate antidiuretic hormone secretion causes fluid retention.

A client has a central nervous system disorder. The nurse realizes that the client may be experiencing alterations in hormones regulated by which of the following organs? 1. Hypothalamus 2. Pineal gland 3. Pituitary gland 4. Thyroid

1. Hypothalamus The hypothalamus is considered the major regulating organ of the body because it is the connection between the nervous system and the endocrine system. The other organs take direction from the hypothalamus through the central nervous system

A client has been instructed regarding a prolactin level to be drawn the next day. Which of the following statements indicate that the client will need further instruction? 1. I will be on time, in the afternoon. 2. I will be relaxed. 3. I will make sure not to take my antihistamine. 4. I will practice another method of birth control rather than the pill.

1. I will be on time, in the afternoon. Certain medications (e.g., antihistamines and oral contraceptives) and fear can increase the prolactin level. The prolactin level is drawn in the morning.

An adult client is complaining of vision changes and difficulty speaking because the tongue is larger. The client also states that his shoes no longer fit. Based on these symptoms, the client is most likely to be diagnosed with: 1. acromegaly. 2. cretinism. 3. gigantism. 4. Graves disease.

1. acromegaly.

Blood work of a female client shows an increase in the production of estradiol. The nurse realizes that this hormone is controlled by: 1. positive feedback. 2. negative feedback. 3. nervous feedback. 4. reverse feedback.

1. positive feedback. Even though most of the hormones in the endocrine system are under a negative feedback mechanism, estradiol is not one of those hormones. Estradiol is controlled by a positive feedback mechanism in that when it increases, there will be in an increase in the production of follicle-stimulating hormone by the anterior pituitary.

A client is experiencing a disorder to the anterior pituitary gland. The nurse realizes that all of the following hormones will be affected by this disorder EXCEPT: 1.adrenocorticotropic hormone. 2.antidiuretic hormone. 3.melanocyte-stimulating hormone. 4.luteinizing hormone.

2. antidiuretic hormone. Antidiuretic hormone is stored by the posterior pituitary. The other choices are under the regulation of the anterior pituitary gland and would be affected by a disorder in this area

A nurse assesses clients who have endocrine disorders. Which assessment findings are paired correctly with the endocrine disorder? (Select all that apply.) a. Excessive thyroid-stimulating hormone - Increased bone formation b. Excessive melanocyte-stimulating hormone - Darkening of the skin c. Excessive parathyroid hormone - Synthesis and release of corticosteroids d. Excessive antidiuretic hormone - Increased urinary output e. Excessive adrenocorticotropic hormone - Increased bone resorption

A, B Thyroid-stimulating hormone targets thyroid tissue and stimulates the formation of bone. Melanocyte-stimulating hormone stimulates melanocytes and promotes pigmentation or the darkening of the skin. Parathyroid hormone stimulates bone resorption. Antidiuretic hormone targets the kidney and promotes water reabsorption, causing a decrease in urinary output. Adrenocorticotropic hormone targets the adrenal cortex and stimulates the synthesis and release of

A nurse cares for clients with hormone disorders. Which are common key features of hormones? (Select all that apply.) a. Hormones may travel long distances to get to their target tissues. b. Continued hormone activity requires continued production and secretion. c. Control of hormone activity is caused by negative feedback mechanisms. d. Most hormones are stored in the target tissues for use later. e. Most hormones cause target tissues to change activities by changing gene activity.

A, B, C Hormones are secreted by endocrine glands and travel through the body to reach their target tissues. Hormone activity can increase or decrease according to the body's needs, and continued hormone activity requires continued production and secretion. Control is maintained via negative feedback. Hormones are not stored for later use, and they do not alter genetic activity

16. Which abnormal assessment findings are related to thyroid dysfunction (select all that apply)? a. Tetanic muscle spasms with hypofunction b. Heat intolerance caused by hyperfunction c. Exophthalmos associated with excessive secretion d. Hyperpigmentation associated with hypofunction e. A goiter with either hyperfunction or hypofunction f. Increase in hand and foot size associated with excessive secretion

b, c, e Heat intolerance, exophthalmos, and a goiter are all related to thyroid dysfunction. Tetanic muscle spasms are related to hypofunction of the parathyroid. Hyperpigmentation is related to hypofunction of the adrenal gland. Increased hand and foot size is related to excess growth hormone secretion.

38. What disorders and diseases are related to macrovascular complications of diabetes (select all that apply)? a. Chronic kidney disease b. Coronary artery disease c. Microaneurysms and destruction of retinal vessels d. Ulceration and amputation of the lower extremities e. Capillary and arteriole membrane thickening specific to diabetes

b, d Macrovascular disease causes coronary artery disease and ulceration and results in amputation of the lower extremities. However, neuropathy may also contribute to not feeling ulcerations. The remaining options are related to microvascular complications of diabetes.

39. The patient with diabetes has been diagnosed with autonomic neuropathy. What problems should the nurse expect to find in this patient (select all that apply)? a. Painless foot ulcers b. Erectile dysfunction c. Burning foot pain at night d. Loss of fine motor control e. Vomiting undigested food f. Painless myocardial infarction

b, e, f Autonomic neuropathy affects most body systems. Manifestations of autonomic neuropathy include erectile dysfunction in men and decreased libido, gastroparesis (nausea, vomiting, gastroesophageal reflux and feeling full), painless myocardial infarction, postural hypotension, and resting tachycardia. The remaining options would occur with sensory neuropathy.

A patient who had radical neck surgery to remove a malignant tumor developed hypoparathyroidism. The nurse should plan to teach the patient about a. bisphosphonates to reduce bone demineralization. b. calcium supplements to normalize serum calcium levels c. increasing fluid intake to decrease risk for nephrolithiasis. d. including whole grains in the diet to prevent constipation.

b. calcium supplements to normalize serum calcium levels Oral calcium supplements are used to maintain the serum calcium in normal range and prevent the complications of hypocalcemia. Whole grain foods decrease calcium absorption and will not be recommended. Bisphosphonates will lower serum calcium levels further by preventing calcium from being reabsorbed from bone. Kidney stones are not a complication of hypoparathyroidism and low calcium levels

The nurse is assessing a 41-year-old African American male patient diagnosed with a pituitary tumor causing panhypopituitarism. Assessment findings consistent with panhypopituitarism include a. high blood pressure. b. decreased facial hair. c. elevated blood glucose. d. tachycardia and cardiac palpitations.

b. decreased facial hair. Changes in male secondary sex characteristics such as decreased facial hair, testicular atrophy, diminished spermatogenesis, loss of libido, impotence, and decreased muscle mass are associated with decreases in follicle stimulating hormone (FSH) and luteinizing hormone (LH). Fasting hypoglycemia and hypotension occur in panhypopituitarism as a result of decreases in adrenocorticotropic hormone (ACTH) and cortisol. Bradycardia is likely due to the decrease in thyroid stimulating hormone (TSH) and thyroid hormones associated with panhypopituitarism.

During a physical examination, the nurse finds that a patients thyroid gland cannot be palpated. The most appropriate action by the nurse is to a. palpate the patients 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. document that the thyroid was nonpalpable. 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 TSH testing unless there is evidence of thyroid dysfunction. Deep palpation of the neck is not appropriate.