Chapter 42: Assessment of the Endocrine and Metabolic Systems Nursing School Test Banks

Black & Hawks: Medical-Surgical Nursing, 8th Edition

Test Bank

Chapter 42: Assessment of the Endocrine and Metabolic Systems

MULTIPLE CHOICE

1. To obtain the most helpful information from a client about risk factors related to hepatitis, the nurse would ask

a.

Do you eat foods that are high in fat?

b.

Do you exercise regularly?

c.

Have you ever had body piercing or a tattoo?

d.

How many bowel movements do you have weekly?

ANS: C

Blood tests, transfusions of blood products, dental procedures, ear or other body piercing, tattooing, and any intravenous injection with a potentially contaminated needle are important to assess, because these breaks in the skin may be the route of entry for hepatitis virus (type B or C) or other pathogens.

DIF: Application/Applying REF: p. 1011 OBJ: Assessment

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-High Risk Behaviors

2. In obtaining a medication history from a client who reports taking all the following medications, the nurse would know that the medication considered hepatotoxic is

a.

acetaminophen.

b.

digoxin.

c.

ferrous sulfate.

d.

insulin.

ANS: A

The nurse should ask specifically about medications the client currently is taking or has taken previously, including over-the-counter (OTC) drugs. Many drugs and chemicals are potentially hepatotoxic, such as alcohol, gold compounds, mercury, phosphorus, anabolic steroids, acetaminophen, isoniazid, halothane, sulfonamide, arsenic, thiazide diuretics, zidovudine (azidothymidine or AZT), and anticancer drugs such as methotrexate.

DIF: Knowledge/Remembering REF: p. 1011 OBJ: Assessment

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Adverse Effects/Contraindications

3. A client is having a physical examination and tells the nurse about a painful area in the right upper quadrant of the abdomen. Based on this information, the nurse would

a.

avoid any manipulation or contact with the painful area.

b.

examine the painful area at the end of the assessment.

c.

examine the right upper quadrant area first.

d.

notify the physician to complete the examination.

ANS: B

Before the examination, the nurse should ask the client to point to any painful area and should examine that section last so that any abdominal guarding will not confuse the examination of other areas.

DIF: Application/Applying REF: p. 1014 OBJ: Assessment

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Techniques of Physical Assessment

4. The nurse performing an assessment of a 69-year-old man with a long history of complex medical problems would be aware that a systemic manifestation suggestive of hepatic dysfunction is

a.

gynecomastia.

b.

hematuria.

c.

melena.

d.

oily skin.

ANS: A

The nurse should inspect for gynecomastia (breast enlargement) in men, which can develop because of decreased metabolism of estrogen when the liver is dysfunctional.

DIF: Application/Applying REF: p. 1013 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

5. As an indication that the safety needs of a client scheduled for an angiography are being addressed, the nurse would ask

a.

Are you allergic to any seafood?

b.

Have you gained or lost weight in the last 2 months?

c.

What is your age and marital status?

d.

When was the date of your last tetanus booster?

ANS: A

Radiologic studies with iodinated contrast media permit visualization of tubes and vessels. Before any of these procedures are performed, the nurse questions the client about known hypersensitivity to iodine. Fish are very high in iodine content, especially shellfish.

DIF: Analysis/Analyzing REF: p. 1015 OBJ: Assessment

MSC: Safe, Effective Care Environment Safety and Infection Control-Client Safety

6. Explaining a paracentesis to an anxious client, the nurse states that the purpose is to

a.

collect fluid accumulations from the pleura.

b.

evaluate secretions of the gallbladder.

c.

extract fluid sequestered in the pancreas.

d.

remove excess fluid from the peritoneum.

ANS: D

Paracentesis (peritoneal tap) is used to extract fluid accumulation in the peritoneum (ascites); relieve intra-abdominal tension, which can impair the clients respiratory status; or obtain fluid for culture.

DIF: Comprehension/Understanding REF: p. 1016 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications of Diagnostic Tests/Treatments/Procedures

7. A client is having a physical examination and the nurse notes that the clients hands and feet are large compared to the rest of the body. The nurse should suspect

a.

acromegaly.

b.

congenital disorders.

c.

diabetes.

d.

muscle deformity.

ANS: A

Acromegaly may present with abnormally enlarged hands, feet, or head.

DIF: Analysis/Analyzing REF: p. 1008 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

8. A nurse is performing a physical examination on an elderly client. The nurse notes the abdomen is rounded and sagging. The most appropriate action by the nurse would be to

a.

ask the client about exercise routines.

b.

discuss the clients bowel habits.

c.

inquire about any abdominal pain.

d.

record this as a normal finding.

ANS: D

Options a, b, and c are all part of a physical examination. But in the older client, a rounded and saggy abdomen is a normal finding and should not prompt the nurse to inquire further about it.

DIF: Application/Applying REF: p. 1014 OBJ: Assessment

MSC: Health Promotion and Maintenance Growth and Development Through the Lifespan-Age Related Differences

9. The nurse preparing a client for a T3 and T4 radioimmunoassay would recognize that the medication with the potential to influence test results, making readings unreliable, is

a.

aspirin.

b.

digitalis.

c.

gentamicin.

d.

heparin.

ANS: D

Hypothyroidism, strenuous exercise, heparin, and lithium decrease serum T4 level.

DIF: Knowledge/Remembering REF: p. 1016 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-Laboratory Values

10. A client is complaining of abdominal pain described as dull, aching, and cramping. The nurse would record this pain as

a.

parietal.

b.

referred.

c.

spasmodic.

d.

visceral.

ANS: D

Visceral pain is described as the above plus burning or colicky. Parietal pain is more severe and steady. Referred pain is pain that travels from the original site. Spasmodic is not one of the three correct terms used to describe abdominal pain.

DIF: Application/Applying REF: p. 1007 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-System Specific Assessments

11. In preparing a client for urine collection in the evaluation of urinary ketosteroids, the nurse would

a.

place an indwelling catheter.

b.

place a preservative in the collection bottle.

c.

measure hourly urine outputs.

d.

use a new collection bag.

ANS: B

A preservative is required for the collection bottle, and if the client has an indwelling catheter, the urinary drainage bag is emptied frequently and the urine is refrigerated.

DIF: Application/Applying Diagnostic Testing REF: p. 1017

OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Laboratory Values

12. A client being assessed for adrenal medulla function through the use of a urinalysis involves measuring

a.

catecholamines and metabolites.

b.

diurnal excretion of glucose.

c.

calcitonin and parathyroid hormone.

d.

growth hormone and ADH.

ANS: A

The function of the adrenal medulla can be assessed through urine levels of catecholamines and their metabolites (e.g., vanillylmandelic acid, or VMA). A 24-hour urine specimen is collected and assayed. Glucose is not excreted in a diurnal pattern. Calcitonin and parathyroid hormones are not measured through a UA. Growth hormone and ADH are secreted by the pituitary gland.

DIF: Comprehension/Understanding REF: p. 1017 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Laboratory Values

13. A client presents with complaints of fatigue and the nurse notes dry, brittle hair. The nurse would anticipate which of the following laboratory tests?

a.

Bilirubin, AST, ALT

b.

Serum cortisol and ACTH

c.

Serum glucose, hemoglobin A1c

d.

Tests of thyroid function

ANS: D

Clients presenting with dry, brittle hair might indicate a thyroid disorder.

DIF: Comprehension/Understanding REF: p. 1008 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-Laboratory Values

MULTIPLE RESPONSE

1. The nurse assessing a client knows that endocrine disorders can present with which of the following manifestations? (Select all that apply.)

a.

Dark or tea-colored urine

b.

Decreased libido

c.

Impotence or infertility

d.

Irregular menstrual cycle

e.

Muscle wasting and atrophy

ANS: B, C, D

Other manifestations of endocrine disorders include loss or premature development of secondary sex characteristics. Visual changes such as bulging eyes may occur from hyperthyroidism.

DIF: Knowledge/Remembering REF: p. 1008 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-System Specific Assessments

2. Important aspects of the social history the nurse should include when examining a client are (Select all that apply)

a.

alcohol intake.

b.

food preferences.

c.

sexual activities.

d.

use of items contaminated with body fluids.

e.

use of recreational drugs.

ANS: A, C, D, E

The clients social history can give important information as to risks for diseases. All the above options except b are included in a social history.

DIF: Application/Applying REF: p. 1011 OBJ: Assessment

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-High Risk Behaviors

Elsevier items and derived items 2009 by Saunders, an imprint of Elsevier Inc.

Some material was previously published.

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