Chapter 64: Assessment of the Endocrine System Nursing School Test Banks

Chapter 64: Assessment of the Endocrine System

Test Bank

MULTIPLE CHOICE

1. A client is taking a drug that blocks a hormones receptor site. What is the effect on the clients hormone response?

a.

Greater hormone metabolism

b.

Decreased hormone activity

c.

Increased hormone activity

d.

Unchanged hormone response

ANS: B

Hormones cause activity in the target tissues by binding with their specific cellular receptor sites, thereby changing the activity of the cell. When receptor sites are occupied by other substances that block hormone binding, the cells response is the same as when the level of the hormone is decreased.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 1359

TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral TherapiesExpected Actions/Outcomes) MSC: Integrated Process: Nursing Process (Evaluation)

2. How does a tropic hormone differ from other hormones?

a.

Tropic hormones are given to clients who have a hormone deficiency.

b.

Tropic hormones are exclusively involved in the production of sex hormones.

c.

Tropic hormones stimulate other endocrine glands to secrete hormones.

d.

Tropic hormones are not under negative feedback control.

ANS: C

The target tissues for tropic hormones are other endocrine glands. The effect of these agents is to stimulate another endocrine gland to secrete its hormone. The other statements are inaccurate.

DIF: Cognitive Level: Knowledge/Remembering REF: p. 1361

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)

MSC: Integrated Process: Nursing Process (Evaluation)

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

ANS: A

Aldosterone, the major mineralocorticoid, maintains extracellular fluid volume. It promotes sodium and water reabsorption and potassium excretion in the kidney tubules. A client with an aldosterone deficiency will have increased urine output. Sodium and potassium levels are normal; in aldosterone deficiency, the client would have hyponatremia and hyperkalemia. Vasoconstriction is not related.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)

MSC: Integrated Process: Nursing Process (Assessment)

4. A male client reports fluid secretion from his breasts. What does the nurse assess next in this client?

a.

Posterior pituitary hormones

b.

Adrenal medulla functioning

c.

Anterior pituitary hormones

d.

Parathyroid functioning

ANS: C

Breast fluid and milk production are induced by the presence of prolactin, secreted from the anterior pituitary gland. The other hormones do not influence this process.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)

MSC: Integrated Process: Nursing Process (Assessment)

5. 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

ANS: B

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.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)

MSC: Integrated Process: Nursing Process (Evaluation)

6. A client is admitted to the hospital with exacerbation of heart failure, which had been stable for several years. Which finding does the nurse associate with the clients current condition?

a.

Recent prescription for thyroid hormone replacement medication

b.

Recent onset of menopause

c.

Patchy areas of depigmentation on the face

d.

Absence of fish in the diet, but inclusion of the iodized form of table salt

ANS: A

Thyroid hormones regulate metabolism. Starting on thyroid replacement therapy can lead to an increase in heart rate and tissue oxygen use, which can lead to an exacerbation of heart failure if the clients heart is not able to meet these increased demands. Menopause and vitiligo (depigmentation of the skin) would not be related. Thyroid function is needed to produce thyroid hormones. The client who does not eat shellfish should use iodized table salt.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications from Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Analysis)

7. A client has abnormal calcium levels. Which hormone does the nurse anticipate testing for?

a.

Thyroxine (T4)

b.

Triiodothyronine (T3)

c.

Thyrocalcitonin (calcitonin)

d.

Propylthiouracil (PTU)

ANS: C

Parafollicular cells produce thyrocalcitonin (calcitonin [TCT]), which helps regulate serum calcium levels. The other hormones are not related directly to calcium levels.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)

MSC: Integrated Process: Nursing Process (Assessment)

8. Which is the expected clinical manifestation for a client who has excessive production of melanocyte-stimulating hormone?

a.

Hypoglycemia and hyperkalemia

b.

Irritability and insomnia

c.

Increased urine output

d.

Darkening of the skin

ANS: D

Melanocyte-stimulating hormone increases the size of melanocytes in the skin and increases the amount of pigment (melanin) that they produce. The other actions do not occur as the result of excessive melanocyte-stimulating hormone function.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 1367

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)

MSC: Integrated Process: Nursing Process (Assessment)

9. Which pulse rate finding in a client taking a drug that stimulates beta1 receptors requires immediate action by the nurse?

a.

50 beats/min

b.

95 beats/min

c.

85 beats/min

d.

100 beats/min

ANS: A

Stimulation of beta1 receptor sites in the heart has positive chronotropic and inotropic actions. The nurse expects an increase in heart rate and increased cardiac output. The client with a heart rate of 50 beats/min would be cause for concern because this would indicate that the client was not responding to the medication. The other heart rates are within normal limits but on the higher end and would be considered a therapeutic response to the medication.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral TherapiesExpected Actions/Outcomes) MSC: Integrated Process: Nursing Process (Assessment)

10. Which situation or condition is likely to result in increased production of thyroid hormones?

a.

Starvation

b.

Dehydration

c.

Adequate sleep

d.

Cold environmental temperature

ANS: D

Cold environmental temperatures stimulate the hypothalamus to secrete thyrotropin-releasing hormone, which in turn stimulates the anterior pituitary gland to secrete thyroid-stimulating hormone (TSH). TSH then stimulates the thyroid gland to secrete thyroid hormones, which, when bound to target tissues, increase the rate of metabolism to maintain body temperature near normal. The other situations would not lead to an increase in thyroid hormone production.

DIF: Cognitive Level: Knowledge/Remembering REF: p. 1363

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)

MSC: Integrated Process: Nursing Process (Assessment)

11. A client has bilateral patchy areas of skin depigmentation on the arms and the face. Which action by the nurse is best?

a.

Assess the clients mucous membranes.

b.

Draw a laboratory specimen for thyroid hormone levels.

c.

Schedule the client for fasting blood glucose.

d.

Question the client about sexual functioning.

ANS: A

Vitiligo, patchy areas of depigmentation of the skin, is associated with primary hypofunction of the adrenal glands. Other assessment findings in this condition include uneven pigmentation on the mucous membranes. The other assessments are not related to vitiligo.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Health Screening)

MSC: Integrated Process: Nursing Process (Assessment)

12. A new nurse is palpating a clients thyroid gland. Which action requires intervention from the nurses mentor?

a.

The nurse stands behind, instead of in front of, the client.

b.

The client is asked to swallow while the nurse finds the thyroid gland.

c.

The nurse palpates the right lobe with his or her left hand.

d.

The client is placed in a sitting position with the chin tucked down.

ANS: C

The client should be in a sitting position with the chin tucked down as the examiner stands behind the client. The nurse feels for the thyroid isthmus while the client swallows and turns the head to the right, and the nurse palpates the right lobe with the right hand. The technique is repeated in the opposite fashion for the left lobe.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 1368

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialSystem-Specific Assessments) MSC: Integrated Process: Nursing Process (Assessment)

13. Which client statement indicates the need for clarification regarding the instructions for collecting a 24-hour urine specimen for assessment of endocrine function?

a.

I will continue to take all my prescribed medicine during the test.

b.

I will add the preservative to the container at the beginning of the test.

c.

I will start the collection by saving the first urine of the morning.

d.

At the end of 24 hours, I will urinate and save that last specimen.

ANS: C

The 24-hour urine collection specimen is started when the client first arises and urinates. The first urine specimen is discarded because there is no way to know how long it has been in the bladder, but the time is noted. The client adds all urine voided after that first discarded specimen during the next 24 hours. When the 24-hour mark is reached, the client voids one last time and adds this specimen to the collection. The preservative, if used, must be added to the container at the beginning of the collection. Clients can continue to take all their normal medications during a timed urine collection. They should, however, avoid unnecessary medications.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialDiagnostic Tests) MSC: Integrated Process: Teaching/Learning

14. A female client with an endocrine problem has hirsutism. Which question or statement by the nurse is most appropriate?

a.

Do you have the money to pay for treatment?

b.

Im interested in knowing how you feel about yourself.

c.

Many treatment options are available for this problem.

d.

What can you do to prevent this from happening?

ANS: B

Hirsutism, 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 gently inquire into the clients body image and self-perception. Asking about the clients financial status sounds judgmental. Simply stating that treatment options are available minimizes the clients concerns. The client is not doing anything to herself to cause the problem, so the last question is inappropriate.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Psychosocial Integrity (Therapeutic Communications)

MSC: Integrated Process: Caring

15. A client asks why a 24-hour urine collection is necessary to measure excreted hormones instead of a random voided specimen. Which response by the nurse is most accurate?

a.

We are testing for a hormone secreted on a circadian rhythm.

b.

The hormone is so dilute in urine, we need a large volume.

c.

We want to see when the hormone is secreted in both large and small amounts.

d.

Youd have to be here at a specific time of the day for a random urinalysis.

ANS: A

Some hormones are secreted in a pulsatile, or circadian, cycle. When testing for these substances, a collection that occurs over 24 hours will most accurately reflect hormone secretion. The other responses are not accurate.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialDiagnostic Tests) MSC: Integrated Process: Nursing Process (Assessment)

16. An older client is being admitted to the hospital for pneumonia. The client has no other health problems. Which action by the nurse is best?

a.

Place the client on airborne precautions.

b.

Offer the client fluids every hour or two.

c.

Leave the bathroom light on at night.

d.

Palpate the clients thyroid gland on admission.

ANS: B

A normal age-related endocrine change is decreased antidiuretic hormone (ADH) production. This results in a more dilute urine output, which can lead to dehydration. If no contraindications are known, the nurse should offer (or delegate) the client something to drink at least every 2 hours. A client with a simple pneumonia would not need Airborne Precautions. The client may or may not need/want the bathroom light left on at night. Palpating the clients thyroid gland is a part of a comprehensive examination but is not specifically related to this client.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Aging Process)

MSC: Integrated Process: Nursing Process (Implementation)

17. The nurse is teaching a client about self-care after menopause. Which teaching topic is the priority?

a.

Weight-bearing exercise

b.

Skin care

c.

Intimacy needs

d.

Body image changes

ANS: A

After menopause, the ovaries produce less estrogen. This leads to decreased bone mass. The client should engage in regular weight-bearing exercise to prevent fractures. The other topics are appropriate but do not take priority over safety needs.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Alterations in Body Systems) MSC: Integrated Process: Teaching/Learning

18. The nursing assistant reports that while pouring urine into a 24-hour urine container, some urine splashed the nursing assistants hand. Which action by the nurse is best?

a.

Ask the assistant if he or she washed the hands afterward.

b.

Call the laboratory to see if the container has preservative in it.

c.

Have the assistant fill out an incident report.

d.

Send the assistant to Employee Health right away.

ANS: A

For safety, the nurse should find out if the assistant washed his or her hands. The nursing assistant should do this for two reasons. First, it is part of Standard Precautions to wash hands after client care. Second, if the container did have preservative in it, this would wash it away. The preservative may be caustic to the skin. The nurse can call the laboratory while the assistant is washing hands if needed. The nursing assistant would then need to fill out an incident or exposure report and may or may not need to go to Employee Health. The nursing assistant also needs further education on Standard Precautions, which include wearing gloves.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Safe and Effective Care Environment (Safety and Infection ControlHandling Hazardous and Infectious Materials)

MSC: Integrated Process: Teaching/Learning

MULTIPLE RESPONSE

1. 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 tissue for use later.

e.

Most hormones cause target tissues to change activities by changing gene activity.

ANS: 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 bodys 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.

DIF: Cognitive Level: Knowledge/Remembering REF: pp. 1359-1360

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)

MSC: Integrated Process: Nursing Process (Assessment)

2. A client has a hypofunctioning anterior pituitary gland. Which hormones does the nurse expect to be affected by this? (Select all that apply.)

a.

Thyroid-stimulating hormone

b.

Vasopressin

c.

Follicle-stimulating hormone

d.

Calcitonin

e.

Growth hormone

ANS: 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.

DIF: Cognitive Level: Knowledge/Remembering REF: Table 64-1, p. 1359

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)

MSC: Integrated Process: Nursing Process (Assessment)

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