Flashcards in LA#3 (Endocrine) Chapters 50, 51, 52 in Med Surg Deck (115)
When evaluating the laboratory findings of a patient with increased secretion of the anterior pituitary hormones, what would the nurse expect to find?
a. Increased urinary free cortisol
b. Decreased serum thyroxine (T4) levels
c. Low urinary excretion of catecholamines
d. Increased serum aldosterone levels
Increased secretion of adrenocorticotropic hormone by the anterior pituitary gland will lead to an increase in serum and urinary cortisol levels.
When obtaining the health history, which of the following statements by a patient indicates that the nurse should assess further for a possible problem with the thyroid gland?
a. “I have noticed difficulty in swallowing.”
b. “I get up several times at night to urinate.”
c. “I have noticed my breasts are tender lately.”
d. “I drink about 6 L of water a day.”
Difficulty swallowing can occur with a goitre.
What is the most common type of feedback system in the regulation of hormones?
The most common type of feedback system is negative feedback, in which the gland responds by increasing or decreasing the secretion of a hormone on the basis of feedback from various factors (e.g., insulin).
During a patient assessment, which of the following is a question the nurse can ask that addresses thyroid function?
a. “Do you have to get up at night to urinate?”
b. “Have you experienced any blurring or double vision?”
c. “Do you experience fatigue even if you have slept a long time?”
d. “Can you describe the amount of stress you have at home and work?”
Fatigue may be a sign of hypothyroidism.
The physician has ordered a serum cortisol level to rule out adrenal dysfunction in a patient who is a night security guard who works from 2300 hours to 0700 hours and normally sleeps from 0800 hours to 1600 hours. To ensure the most reliable test results, when does the nurse arrange the blood specimen to be drawn?
a. At 0300 hours
b. At 2300 hours
c. In the early morning
d. In the late afternoon
Cortisol levels are usually drawn in the morning, when levels are highest. In a patient who sleeps during the day, the highest level would be soon after awakening in the late afternoon.
A patient has a total serum calcium level of 3.3 mmol/L (13.3 mg/dL; 6.7 mEq/L). The nurse understands that this level of calcium normally does which of the following?
a. Indicates hypothyroidism
b. Stimulates the secretion of calcitonin
c. Occurs when the parathyroid gland is surgically removed
d. Can be caused by oversecretion of calcitonin from the thyroid gland
Calcitonin is secreted by the C cells of the thyroid gland in response to elevated blood calcium levels.
Which action taken by a nursing student when caring for a patient with thyroiditis and a goitre requires that the supervising nurse intervene immediately?
a. The student nurse checks the blood pressure on both arms.
b. The student nurse lowers the thermostat to decrease the temperature in the room.
c. The student nurse palpates the neck to check thyroid size.
d. The student nurse orders nonmedicated eyedrops to lubricate the patient’s eyes.
Palpation can cause the release of thyroid hormones in a patient with an enlarged thyroid and should be avoided.
During a physical examination, the nurse finds that a patient’s thyroid gland cannot be palpated. What does the nurse interpret this finding as?
a. A normal finding
b. Evidence of an atrophied thyroid gland
c. Insignificant in a patient with elevated triiodothyronine (T3) and T4 levels
d. Abnormal, and confirmation of the finding by another experienced health care provider is necessary
The thyroid is frequently nonpalpable. The nurse should simply document the finding.
Which hormone is an example of positive feedback in the regulation of hormonal secretion?
c. Thyroid-stimulating hormone (TSH)
d. Thyroid-releasing hormone
An example of a positive-feedback hormone is oxytocin during the birth process. Insulin is an example of a negative-feedback hormone. Thyroid hormones are an example of complex feedback.
When working with a patient who has diabetes mellitus, the nurse uses the results of testing for glycosylated hemoglobin to evaluate which of the following?
a. Glucose levels 2 hours after a meal
b. Glucose control over the past 3 months
c. Circulating, nonfasting glucose levels
d. Episodes of hypoglycemia in the past 2 months
Glycosylated hemoglobin testing measures glucose control over the last 3 months.
Which of the following is an age-related change affecting the endocrine system?
a. Increase in TSH secretion
b. Decreased parathyroid secretion
c. Increased glucose intolerance
d. Decreased secretion of norepinephrine
A normal age-related change in assessment findings of the endocrine system is an increased glucose intolerance leading to a decreased sensitivity to insulin.
A patient is scheduled for a growth hormone (GH) stimulation test. In preparation for the test, which of the following will the nurse obtain?
a. Vial of 50% dextrose solution
b. Vial of glargine insulin
c. Cardiac monitor
d. Basin of ice
Hypoglycemia is induced during the GH stimulation test, and the nurse should be ready to administer 50% dextrose immediately.
To confirm the diagnosis of reactive hypoglycemia in a patient experiencing symptoms of the disorder, the nurse would expect the patient to be scheduled for which of the following tests?
a. Fasting blood glucose test
b. 2-hour glucose tolerance test
c. 5-hour glucose tolerance test
d. 24-hour urine test for glucose and ketones
Patients with reactive hypoglycemia have adrenergic symptoms and glucose levels less than 3.3 mmol/L with a 5-hour glucose tolerance test.
Which of the following factors stimulates the secretion of insulin?
a. Decreased glucose levels
b. Increased somatostatin levels
c. Decreased amino acid levels
d. Increased vagal stimulation
Increased vagal stimulation is a factor that will stimulate the secretion of insulin. All of the others inhibit the secretion of insulin.
When the nurse is describing the effects of insulin on the body to a patient newly diagnosed with diabetes mellitus, which of the following is the best explanation?
a. “Insulin promotes the breakdown of fatty tissue into triglycerides, which can be used for energy.”
b. “When proteins are taken into the body, insulin promotes their breakdown and conversion to fats.”
c. “Insulin stimulates the conversion of stored sugars into blood glucose and the conversion of proteins into glucose.”
d. “When carbohydrates, fats, and proteins are eaten, insulin promotes cellular transport and storage of all these nutrients.”
Insulin is an anabolic hormone that assists with the transport of nutrients into cells and their synthesis into glycogen, triglycerides, and proteins.
Use of nursing interventions to decrease the patient’s physical and emotional stress is most important when the patient is undergoing which of the following tests?
a. A water deprivation test
b. Testing for serum T3 and T4 levels
c. A 24-hour urine test for free cortisol
d. A radioactive iodine uptake test
Physical and emotional stress can affect the results for the free cortisol test. The other tests are not impacted by stress.
A patient is scheduled for a 24-hour urine collection for 17-ketosteroids. The nurse will plan to do which of the following?
a. Insert a retention catheter.
b. Keep the specimen on ice.
c. Have the patient void and save that specimen to start the collection.
d. Encourage the patient to drink 2 to 3 L of fluid during the 24 hours.
The specimen must be kept on ice or refrigerated until the collection is finished.
When caring for a patient having a water deprivation test, which assessment obtained by the nurse will be of greatest concern?
a. The patient complains of intense thirst.
b. The patient has experienced a 2.5-kg weight loss.
c. The patient feels dizzy when sitting up on the edge of the bed.
d. The patient’s urine osmolality does not change after antidiuretic hormone is given.
A drop in the weight of more than 2 kg indicates severe dehydration, and the test should be discontinued.
Which of the following is a common characteristic of most hormones?
a. Secretion at unpredictable rates
b. Circulation through the blood
c. Binding to receptors only on the cell membrane
d. Binding only to receptors within the cell
Most hormones have three common characteristics: secretion in small amounts at variable but predictable rates, circulation through the blood, and binding to specific receptors in the cell membrane or within the cell.
A patient seeks care at the clinic because of increasing speech difficulties and hoarseness, telling the nurse his tongue has gotten so big that he can hardly talk. The physician suspects acromegaly. During the nursing history, which of the following should the nurse specifically ask the patient whether he has experienced?
a. A recent head injury
b. An increase in shoe size
c. A family history of endocrine problems
d. Symptoms of hypoglycemia, such as hunger and nervousness
Acromegaly causes an enlargement of the hands and feet.
During preoperative teaching for a patient scheduled for transsphenoidal hypophysectomy for treatment of a pituitary adenoma, what should the nurse instruct the patient that she will have to do?
a. Take replacement growth hormone for the rest of her life
b. Not brush her teeth for at least 10 days after the surgery
c. Be expected to cough and breathe deeply every 2 hours postoperatively
d. Be positioned flat in bed with sandbags at her head to prevent head movement
To avoid disruption of the suture line, the patient should avoid brushing the teeth for 10 days after surgery.
Following a transsphenoidal resection of a pituitary tumour, the nurse suspects that the patient has developed diabetes insipidus on finding which of the following data?
a. A urine specific gravity of 1.001
b. A consistent rise in blood pressure
c. Fluid retention with dependent edema
d. A serum sodium of 130 mmol/L
After pituitary surgery, the patient is at risk for diabetes insipidus caused by cerebral edema, and monitoring of urinary output and urine specific gravity is essential.
A patient is suspected of having a pituitary tumour causing panhypopituitarism. During assessment of the patient, the nurse would expect to find which of the following changes?
a. Elevated plasma glucose levels and dyslipidemia
b. Changes in secondary sex characteristics and loss of libido
c. Hypertension resulting from increased water reabsorption in the kidney
d. Evidence of hypofunction of the adrenal, thyroid, and parathyroid glands
Changes in secondary sex characteristics are associated with decreases in follicle-stimulating hormone and luteinizing hormone. Fasting hypoglycemia and hypotension occur in panhypopituitarism as a result of decreases in adrenocorticotropic hormone and cortisol.
Which of the following effects on the cardiovascular system would a patient with a hypofunction of the parathyroid gland most likely exhibit?
b. Increased cardiac output
c. Decreased contractility of heart muscle
A patient with a hypofunction of their parathyroid gland would most likely exhibit a decrease in the contractibility of their heart muscle.
A patient with an antidiuretic hormone (ADH)–secreting small cell cancer of the lung is treated to control the symptoms of syndrome of inappropriate ADH (SIADH). The nurse determines that treatment is effective on finding which of the following data?
a. The patient’s weight is stable.
b. The urine specific gravity is increased.
c. The patient’s urinary output is increased.
d. The patient’s edema is reduced.
Treatment is aimed at blocking the action of ADH on the renal tubules, causing an increase in urinary output.
When teaching a patient with chronic SIADH about long-term management of the disorder, the nurse determines that additional instruction is needed when the patient gives which of the following responses?
a. “I need to maintain a sodium-restricted diet at home.”
b. “I should weigh myself daily and report a sudden loss or gain.”
c. “I need to limit my fluid intake to no more than 950 mL of liquids a day.”
d. “I will eat foods high in potassium because the diuretics cause potassium loss.”
Patients with SIADH are at risk for hyponatremia, and a sodium supplement may be prescribed; therefore, more teaching would be required to the patient who indicated that he or she would have to maintain a sodium-restricted diet.
A 73-year-old woman is hospitalized with possible SIADH. She is confused and reports a headache, muscle cramps, and twitching. Initially, which of the following laboratory results would the nurse expect to find?
a. Hematocrit of 0.52 (52%)
b. Blood urea nitrogen of 7.9 mmol/L (22 mg/dL)
c. Serum sodium of 124 mmol/L
d. Serum chloride of 111 mmol/L
When water is retained, the serum sodium level will drop below normal, causing the clinical manifestations reported by the patient.
A patient with symptoms of diabetes insipidus is admitted to the hospital for evaluation and treatment of the condition. What is an appropriate nursing diagnosis that the nurse would document for the patient based on an understanding of this condition?
a. Disturbed sleep pattern related to nocturia
b. Risk for impaired skin integrity related to edema
c. Excess fluid volume related to intake greater than output
d. Activity intolerance related to muscle cramps and weakness
Nocturia occurs as a result of the polyuria caused by diabetes insipidus, which leads to a disturbed sleep pattern.
Which information obtained when caring for a patient who has just been admitted for evaluation of diabetes insipidus will be of greatest concern to the nurse?
a. Has a urinary output of 800 mL/hour
b. Has a urine specific gravity of 1.003
c. Had a recent head injury
d. Is confused and lethargic
Patients with diabetes insipidus 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.