Nursing Assessment: Endocrine System

1. The nurse is interviewing a patient who has a possible thyroid disorder. Which question will provide the most useful information?

“What methods do you use to help cope with stress?”

“Have you experienced any blurring or double vision?”

“Do you have to get up at night to empty your bladder?”

“Have you had any recent unplanned weight gain or loss?”

ANS: D
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.

Explanation

ANS: D
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.

2. When the nurse is obtaining the health history, which statement by a patient indicates further assessment of thyroid function may be necessary?

“I notice my breasts are tender lately.”

“I am so thirsty that I drink all day long.”

“I get up several times at night to urinate.”

“I feel a lump in my throat when I swallow.”

ANS: D
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.

Explanation

ANS: D
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.

3. When a patient has clinical manifestations of hypothyroidism, which laboratory value should the nurse review to determine whether the hypothyroidism is caused by a problem with the anterior pituitary gland or with the thyroid gland?

Thyroxine (T4) level

Triiodothyronine (T3) level

Thyroid-stimulating hormone (TSH) level

Thyrotropin-releasing hormone (TRH) level

ANS: C
A low TSH level indicates that the patient’s hypothyroidism is caused by decreased anterior pituitary secretion of TSH. Low T3 and T4 levels are not diagnostic of the primary cause of the hypothyroidism. TRH levels indicate the function of the hypothalamus.

Explanation

ANS: C
A low TSH level indicates that the patient’s hypothyroidism is caused by decreased anterior pituitary secretion of TSH. Low T3 and T4 levels are not diagnostic of the primary cause of the hypothyroidism. TRH levels indicate the function of the hypothalamus.

4. A patient with a possible pituitary adenoma is scheduled for a computed tomography (CT) scan with contrast media. Which patient information is most important for the nurse to communicate to the health care provider before the test?

Bilateral poor peripheral vision

Allergies to iodine and shellfish

Recent weight loss of 20 pounds

Complaints of ongoing headaches

ANS: B
Since the usual contrast media is iodine-based, the health care provider will need to know about the allergy before the CT scan. The other findings are common with any mass in the brain such as a pituitary adenoma.

Explanation

ANS: B
Since the usual contrast media is iodine-based, the health care provider will need to know about the allergy before the CT scan. The other findings are common with any mass in the brain such as a pituitary adenoma.

5. When the nurse is caring for a patient who was admitted with tetany, which laboratory value should be monitored?

Total protein

Blood glucose

Ionized calcium

Serum phosphate

ANS: C
Tetany is associated with hypocalcemia. The other values would not be useful for this patient.

Explanation

ANS: C
Tetany is associated with hypocalcemia. The other values would not be useful for this patient.

6. When working with a patient who has diabetes mellitus, the nurse reviews the results of testing for glycosylated hemoglobin (HbA1C) to evaluate for

Glucose levels 2 hours after a meal.

Circulating, nonfasting glucose levels.

Glucose control over the past 3 months.

Hypoglycemic episodes in the past 90 days.

ANS: C
Glycosylated hemoglobin testing measures glucose control over the last 3 months. Glucose testing after a meal or random testing may reveal impaired glucose tolerance and indicate prediabetes, but it is not done on patients who already have a diagnosis of diabetes. There is no test to evaluate for hypoglycemic episodes in the past.

Explanation

ANS: C
Glycosylated hemoglobin testing measures glucose control over the last 3 months. Glucose testing after a meal or random testing may reveal impaired glucose tolerance and indicate prediabetes, but it is not done on patients who already have a diagnosis of diabetes. There is no test to evaluate for hypoglycemic episodes in the past.

7. A patient is admitted with a serum sodium level of 118 mEq/L. The nurse will anticipate the need for which diagnostic test?

Urinary 17-ketosteroids

Antidiuretic hormone level

Growth hormone stimulation test

Adrenocorticotropic hormone level

ANS: B
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 patient’s hyponatremia.

Explanation

ANS: B
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 patient’s hyponatremia.

8. During a physical examination, the nurse finds that a patient's thyroid gland cannot be palpated. The most appropriate action by the nurse is to

Palpate the patient’s neck more deeply.

Document that the thyroid was nonpalpable.

Notify the health care provider immediately.

Teach the patient about thyroid hormone testing.

ANS: B
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.

Explanation

ANS: B
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.

9. After the nurse manager at the endocrine clinic has completed the orientation of a new RN, which action by the new RN who is caring for a patient with a goiter and possible hyperthyroidism indicates the charge nurse needs to do more teaching?

The RN palpates the neck to check thyroid size.

The RN checks the blood pressure on both arms.

The RN orders nonmedicated eye drops to lubricate the patient’s eyes.

The RN lowers the thermostat to decrease the temperature in the room.

ANS: A
Palpation can cause the release of thyroid hormones in a patient with an enlarged thyroid and should be avoided. The other actions by the new RN are appropriate when caring for a patient with an enlarged thyroid.

Explanation

ANS: A
Palpation can cause the release of thyroid hormones in a patient with an enlarged thyroid and should be avoided. The other actions by the new RN are appropriate when caring for a patient with an enlarged thyroid.

10. Which information about a patient who is scheduled for an oral glucose tolerance test should be reported to the health care provider before starting the test?

The patient reports having occasional orthostatic dizziness.

The patient has had a 10-pound weight gain in the last month.

The patient drank several glasses of water an hour previously.

The patient takes oral corticosteroids for rheumatoid arthritis.

ANS: D
Corticosteroids can affect blood glucose results. The other information will be provided to the provider, but will not affect the test results.

Explanation

ANS: D
Corticosteroids can affect blood glucose results. The other information will be provided to the provider, but will not affect the test results.

11. 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

Calcitonin levels.

Catecholamine levels.

Thyroid hormone levels.

Parathyroid hormone levels.

ANS: D
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.

Explanation

ANS: D
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.

12. When a patient in the outpatient clinic has an order for blood cortisol testing, which instruction will the nurse provide for the patient?

“Avoid adding any salt to your foods for 24 hours before the test.”

“You will need to lie down for 30 minutes before the blood is drawn.”

“Come to the laboratory to have the blood drawn early in the morning.”

“Do not have anything to eat or drink before the blood test is obtained.”

ANS: C
Cortisol levels are usually drawn in the morning, when levels are highest. The other instructions would be given to patients who were having other endocrine testing.

Explanation

ANS: C
Cortisol levels are usually drawn in the morning, when levels are highest. The other instructions would be given to patients who were having other endocrine testing.

13. The nurse will plan patient care that will decrease the patient's physical and emotional stress when the patient is undergoing

A water deprivation test.

Testing for serum T3 and T4 levels.

A 24-hour urine test for free cortisol..

A radioactive iodine (I-131) uptake test

ANS: C
Physical and emotional stress can affect the results for the free cortisol test. The other tests are not impacted by stress.

Explanation

ANS: C
Physical and emotional stress can affect the results for the free cortisol test. The other tests are not impacted by stress.

14. A patient is scheduled for a 24-hour urine collection for 17-ketosteroids. The nurse will need to

Keep the specimen on ice.

Insert a retention catheter.

Have the patient void and save that specimen to start the collection.

Encourage the patient to drink 2 to 3 L of fluid during the 24 hours.

ANS: A
The specimen must be kept on ice or refrigerated until the collection is finished. Voided or catheterized specimens are acceptable for the test. The initial voided specimen is discarded. There is no fluid intake requirement for the 24-hour collection.

Explanation

ANS: A
The specimen must be kept on ice or refrigerated until the collection is finished. Voided or catheterized specimens are acceptable for the test. The initial voided specimen is discarded. There is no fluid intake requirement for the 24-hour collection.

15. When a patient is taking spironolactone (Aldactone), a drug that blocks the action of aldosterone on the kidney, the nurse will monitor for

Decreased urinary output.

Evidence of fluid overload.

Increased serum sodium levels.

Elevated serum potassium levels.

ANS: D
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.

Explanation

ANS: D
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.

16. A patient is scheduled for a growth hormone stimulation test. In preparation for the test, the nurse will obtain a

Basin of ice.

Cardiac monitor.

Vial of glargine insulin..

Vial of 50% dextrose solution

ANS: D
Hypoglycemia is induced during the growth hormone stimulation test, and the nurse should be ready to administer 50% dextrose immediately. Regular insulin is used to induce hypoglycemia (glargine is never given intravenously). The patient does not require cardiac monitoring during the test. Although blood samples for some tests must be kept on ice, this is not true for the growth hormone stimulation test.

Explanation

ANS: D
Hypoglycemia is induced during the growth hormone stimulation test, and the nurse should be ready to administer 50% dextrose immediately. Regular insulin is used to induce hypoglycemia (glargine is never given intravenously). The patient does not require cardiac monitoring during the test. Although blood samples for some tests must be kept on ice, this is not true for the growth hormone stimulation test.

17. When caring for a patient having a water deprivation test, which finding is most important for the nurse to communicate to the health care provider?

The patient complains of intense thirst.

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

The patient feels dizzy when sitting up on the edge of the bed.

The patient’s urine osmolality does not change after antidiuretic hormone (ADH) is given.

ANS: B
A drop in the weight of more than 2 kg indicates severe dehydration, and the test should be discontinued. The other assessment data are not unusual with this test.

Explanation

ANS: B
A drop in the weight of more than 2 kg indicates severe dehydration, and the test should be discontinued. The other assessment data are not unusual with this test.

18. When evaluating the laboratory results for a patient with increased secretion of the anterior pituitary hormones, the nurse would expect to find

Decreased serum thyroxine levels.

Elevated serum aldosterone levels.

An increase in urinary free cortisol.

Low urinary excretion of catecholamines.

ANS: C
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.

Explanation

ANS: C
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.

19. When reviewing the laboratory results for a patient's total calcium level, which information will the nurse need to consider?

The blood glucose is elevated.

The phosphate level is normal.

The serum albumin level is low.

The magnesium level is normal.

ANS: C
Part of the total calcium is bound to albumin so hypoalbuminemia can lead to misinterpretation of calcium levels. The other laboratory values will not affect total calcium interpretation.

Explanation

ANS: C
Part of the total calcium is bound to albumin so hypoalbuminemia can lead to misinterpretation of calcium levels. The other laboratory values will not affect total calcium interpretation.

20. Which information about a patient with newly diagnosed diabetes mellitus will be most useful to the nurse in developing strategies for successful adaptation to this disease?

Ideal weight

Value system

Activity level

Visual changes

ANS: B
When dealing with a patient with a chronic condition such as diabetes, identification of the patient’s values and beliefs can assist the health care team in choosing strategies for successful lifestyle change. The other information also will be useful, but is not as important in developing an individualized plan for the necessary lifestyle changes.

Explanation

ANS: B
When dealing with a patient with a chronic condition such as diabetes, identification of the patient’s values and beliefs can assist the health care team in choosing strategies for successful lifestyle change. The other information also will be useful, but is not as important in developing an individualized plan for the necessary lifestyle changes.