Medical-Surgical Nursing Assessment and Management of Clinical Problems 9e Chapter 48

Chapter 48: Nursing Assessment: Endocrine System
Test Bank
MULTIPLE CHOICE
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.
ANS: A
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.
DIF: Cognitive Level: Understand (comprehension) REF: 1149

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
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.
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.
DIF: Cognitive Level: Apply (application) REF: 1144

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
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 patients
hyponatremia.
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
4. 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?
ANS: C
Because thyroid function affects metabolic rate, changes in weight may indicate hyperfunction
or hypofunction of the thyroid gland. Nocturia, visual difficulty, and changes in stress level
are associated with other endocrine disorders.

5. A 29-year-old patient in the outpatient clinic will be scheduled for blood cortisol testing.
Which instruction will the nurse provide?
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.
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.

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
6. 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
ANS: D
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.
DIF: Cognitive Level: Apply (application) REF: 1136 | 1149

7. During the physical examination of a 36-year-old female, the nurse finds that the 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.
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 thyroid-stimulating hormone (TSH) testing unless there is evidence of thyroid
dysfunction. Deep palpation of the neck is not appropriate.

8. Which laboratory value should the nurse review to determine whether a patients
hypothyroidism is caused by a problem with the anterior pituitary gland or with the thyroid
gland?
a. Thyroxine (T4) level
b. Triiodothyronine (T3) level
c. Thyroid-stimulating hormone (TSH) level
d. Thyrotropin-releasing hormone (TRH) level
ANS: C
A low TSH level indicates that the patients 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.

9. The nurse reviews a patients glycosylated hemoglobin (Hb A1C) results to evaluate
a. fasting preprandial glucose levels.
b. glucose levels 2 hours after a meal.
c. glucose control over the past 90 days.
d. hypoglycemic episodes in the past 3 months.
ANS: C
Glycosylated hemoglobin testing measures glucose control over the last 3 months. Glucose
testing before/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.
DIF: Cognitive Level: Understand (comprehension) REF: 1150

TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity
10. 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.
ANS: C
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.

TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity
11. A 40-year-old male patient has been newly diagnosed with type 2 diabetes mellitus. Which
information about the patient will be most useful to the nurse who is helping the patient
develop strategies for successful adaptation to this disease?
a. Ideal weight
b. Value system
c. Activity level
d. Visual changes
ANS: B
When dealing with a patient with a chronic condition such as diabetes, identification of the
patients 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.
DIF: Cognitive Level: Apply (application) REF: 1143-1144

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity
12. An 18-year-old male patient with a small stature is scheduled for a growth hormone
stimulation test. In preparation for the test, the nurse will obtain
a. ice in a basin.
b. glargine insulin.
c. a cardiac monitor.
d. 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 IV). 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.

13. The nurse will teach a patient to plan to minimize physical and emotional stress while the
patient is undergoing
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 (I-131) uptake test.
ANS: C
Physical and emotional stress can affect the results of the free cortisol test. The other tests are
not impacted by stress.
14. A nurse will teach a patient who is scheduled to complete a 24-hour urine collection for 17-
ketosteroids to
a. insert and maintain a retention catheter.
b. keep the specimen refrigerated or on ice.
c. drink at least 3 L of fluid during the 24 hours.
d. void and save that specimen to start the collection.
ANS: B
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.

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
15. Which additional information will the nurse need to consider when reviewing the laboratory
results for a patients total calcium level?
a. The blood glucose is elevated.
b. The phosphate level is normal.
c. The serum albumin level is low.
d. 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.

16. 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
ANS: C
Tetany is associated with hypocalcemia. The other values would not be useful for this patient.

17. 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.
ANS: B
Corticosteroids can affect blood glucose results. The other information will be provided to the
health care provider but will not affect the test results.

OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
18. Which action by a new registered nurse (RN) caring for a patient with a goiter and possible
hyperthyroidism indicates that the charge nurse needs to do more teaching?
a. The RN checks the blood pressure on both arms.
b. The RN palpates the neck thoroughly to check thyroid size.
c. The RN lowers the thermostat to decrease the temperature in the room.
d. The RN orders nonmedicated eye drops to lubricate the patients bulging eyes.
ANS: B
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.

OBJ: Special Questions: Delegation TOP: Nursing Process: Evaluation
MSC: NCLEX: Safe and Effective Care Environment
19. 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.
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.

20. A 35-year-old female 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?
a. Bilateral poor peripheral vision
b. Allergies to iodine and shellfish
c. Recent weight loss of 20 pounds
d. Complaint of ongoing headaches
ANS: B
Because 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.

21. 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
ANS: A
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.

MULTIPLE RESPONSE
1. 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.
ANS: 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.


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Chapter 48: Nursing Assessment: Endocrine System

DIF: Cognitive Level: Understand (comprehension) REF: 1149

DIF: Cognitive Level: Apply (application) REF: 1144

DIF: Cognitive Level: Apply (application) REF: 1143

DIF: Cognitive Level: Apply (application) REF: 1149

DIF: Cognitive Level: Apply (application) REF: 1136 | 1149

DIF: Cognitive Level: Apply (application) REF: 1145

DIF: Cognitive Level: Apply (application) REF: 1151

DIF: Cognitive Level: Understand (comprehension) REF: 1150

DIF: Cognitive Level: Apply (application) REF: 1140

DIF: Cognitive Level: Apply (application) REF: 1143-1144

DIF: Cognitive Level: Apply (application) REF: 1147

DIF: Cognitive Level: Apply (application) REF: 1150

DIF: Cognitive Level: Apply (application) REF: 1149

DIF: Cognitive Level: Apply (application) REF: 1146

DIF: Cognitive Level: Apply (application) REF: 1142

DIF: Cognitive Level: Apply (application) REF: 1144

DIF: Cognitive Level: Apply (application) REF: 1148

DIF: Cognitive Level: Apply (application) REF: 1148

DIF: Cognitive Level: Apply (application) REF: 1148

DIF: Cognitive Level: Apply (application) REF: 1150

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