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.

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.

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.

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.

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.

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.