Endocrine System Level 1 & 2

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A client has a history of hypothyroidism. Which skin condition should the nurse expect when performing a physical assessment?

Correct1 Dry 2 Moist 3 Flushed 4 Smooth Dry skin is caused by decreased function of sebaceous glands; a paucity of thyroid hormones T3 and T4, which control the basal metabolic rate, can alter the function of almost every body system. The skin will not be flushed; the client will appear pale. Moist, smooth skin occurs with hyperfunction of the thyroid and an increase in the basal metabolic rate.

During a home visit to a client, the nurse identifies tremors of the client’s hands. When discussing this assessment, the client reports being nervous, having difficulty sleeping, and feeling as if the collars of shirts are getting tight. Of the additional assessment findings, which one should the nurse report to the practitioner?

1 Increased appetite 2 Recent weight loss 3 Feelings of warmth Correct4 Fluttering in the chest Many of these problems are associated with hyperthyroidism; palpitations may indicate cardiovascular changes requiring prompt intervention. The increased metabolism associated with hyperthyroidism can lead to heart failure. Although an increased appetite becomes a compensatory mechanism for the increased metabolism associated with hyperthyroidism, it is not life threatening. Although unexplained weight loss can result from catabolism associated with hyperthyroidism, it is not life threatening. Although a feeling of warmth caused by the increased metabolism associated with hyperthyroidism is uncomfortable, it is not life threatening.

Which clinical manifestation is seen in a male client due to deficiency of gonadotropin?

Correct1 Decreased fertility 2 Increased muscle mass 3 Increased bone density 4 Decreased urine specific gravity Deficiency of gonadotropin in males results in clinical manifestation of infertility due to impotence. There is loss of muscle mass and bone density due to gonadotropin deficiency. Clients with diabetes insipidus have decreased urine specific gravity, usually less than 1.005.

While a nurse is teaching a client with diabetes about food choices, the client states, "I do not like broccoli." Which food should the nurse suggest to substitute for broccoli?

1 Peas 2 Corn Correct3 Green beans 4 Mashed potato According to exchange lists for meal planning, green beans and broccoli are equivalent vegetable substitutes. Peas are a starch and are not an equivalent vegetable substitute for broccoli. Corn is a starch and is not an equivalent vegetable substitute for broccoli. Mashed potato is a starch and is not an equivalent vegetable substitute for broccoli.

The client’s pituitary gland must be removed. Which surgery will the client undergo?

1 Mastectomy 2 Prostatectomy 3 Thyroidectomy Correct4 Hypophysectomy A hypophysectomy is the surgical removal of the pituitary gland or its tumor. A mastectomy is the surgical removal of breast tissue. A prostatectomy is the surgical removal of the prostate gland. A thyroidectomy is the surgical removal of the thyroid gland.

Which hormonal deficiency would increase the client’s risk for fractures?

Correct1 Growth hormone 2 Follicle-stimulating hormone Incorrect3 Thyroid-stimulating hormone 4 Adrenocorticotropic hormone Growth hormone deficiency causes decrease in bone density, thereby increasing the risk of fractures. Follicle-stimulating hormone deficiency causes amenorrhea, decreased libido, and infertility in women and impotence in men. Thyroid-stimulating hormone deficiency causes menstrual abnormalities and hirsutism. Adrenocorticotropic hormone deficiency causes hypoglycemia and hyponatremia.

After surgical clipping of a ruptured cerebral aneurysm, a client develops the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). What manifestations are exhibited with excessive levels of antidiuretic hormone?

1 Increased blood urea nitrogen (BUN) and hypotension 2 Hyperkalemia and poor skin turgor Correct3 Hyponatremia and decreased urine output Incorrect4 Polyuria and increased specific gravity of urine Antidiuretic hormone (ADH) causes water retention, resulting in a decreased urine output and dilution of serum electrolytes. Blood volume may increase, causing hypertension. Diluting the nitrogenous wastes in the blood decreases rather than increases the BUN. Water retention dilutes electrolytes. The client is overhydrated rather than underhydrated, so turgor is not poor. ADH acts on the nephron to cause water to be reabsorbed from the glomerular filtrate, leading to reduced urine volume. The specific gravity of urine is elevated as a result of increased concentration.

Which metabolic manifestations are likely to be observed in a client with hypothyroidism? Select all that apply.

1 Impaired memory Correct2 Intolerance to cold 3 Difficulty breathing 4 Decreased blood pressure Correct5 Decreased body temperature Cold intolerance and decreased body temperature are the metabolic manifestations observed in a client with hypothyroidism. Impaired memory is the neuromuscular manifestation of hypothyroidism. Difficulty in breathing is the pulmonary manifestation observed in the client with hypothyroidism. Decreased blood pressure is the cardiovascular manifestation observed in the client with hypothyroidism.

Which hormonal deficiency causes diabetes insipidus in a client?

1 Prolactin 2 Thyrotropin 3 Luteinizing hormone (LH) Correct4 Antidiuretic hormone (ADH) ADH deficiency causes diabetes insipidus. Decreased levels of prolactin may cause decreased amounts of milk secretion after birth. Decreased levels of thyrotropin cause hypothyroidism, weight gain, and lethargy. LH deficiency causes menstrual abnormalities, decreased libido, and breast atrophy.

A client who has had a subtotal thyroidectomy does not understand how hypothyroidism can develop when the problem was initially hyperthyroidism. On what fact should the nurse base her response?

1 Hypothyroidism is a gradual slowing of the body’s function. 2 There will be a decrease in pituitary thyroid-stimulating hormone (TSH). Correct3 There may not be enough thyroid tissue to supply adequate thyroid hormone. 4 Atrophy of tissue remaining after surgery reduces secretion of thyroid hormones. After a subtotal thyroidectomy the thyroxine output may be inadequate to maintain an appropriate metabolic rate. Hypothyroidism is a decrease in thyroid functioning, not a slowing of the entire body’s functions. In hypothyroidism the level of TSH from the pituitary usually is increased. Atrophy of the remaining thyroid tissue does not occur.

A nurse teaches a client with type 2 diabetes how to provide self-care to prevent infections of the feet. Which statement made by the client shows that teaching was effective?

1 "I should massage my feet and legs with oil or lotion." 2 "I should apply heat intermittently to my feet and legs." 3 "I should eat foods high in protein and carbohydrate kilocalories." Correct4 "I should control my blood glucose with diet, exercise, and medication." Controlling the diabetes decreases the risk of infection; this is the best prevention. Oil or lotion that is not completely absorbed may provide a warm, moist environment for bacterial growth. Coexisting neuropathy may result in injury from heat application. Protein, carbohydrates, and fats must be in an appropriate balance; high carbohydrate intake can provide too many calories.

A nurse teaches a client with type 2 diabetes how to provide self-care to prevent infections of the feet. Which statement made by the client shows that teaching was effective?

1 "I should massage my feet and legs with oil or lotion." 2 "I should apply heat intermittently to my feet and legs." 3 "I should eat foods high in protein and carbohydrate kilocalories." Correct4 "I should control my blood glucose with diet, exercise, and medication." Controlling the diabetes decreases the risk of infection; this is the best prevention. Oil or lotion that is not completely absorbed may provide a warm, moist environment for bacterial growth. Coexisting neuropathy may result in injury from heat application. Protein, carbohydrates, and fats must be in an appropriate balance; high carbohydrate intake can provide too many calories.

A client undergoes removal of a pituitary tumor through a transsphenoidal approach. What should the nurse implement postoperatively?

1 Provide oral hygiene and include brushing the teeth 2 Encourage the client to deep breathe and cough frequently Correct3 Maintain the head of the bed at a 30-degree angle continuously Incorrect4 Continue giving nothing by mouth until the nasal packing is removed Maintaining the head of the bed at a 30-degree angle continuously decreases pressure on the sella turcica and promotes venous return, thus limiting cerebral edema. Gentle oral hygiene is performed, excluding brushing of teeth, to prevent trauma to the surgical site. Although deep breathing is encouraged, initially coughing is discouraged to prevent increasing intracranial pressure. There is no need to limit oral fluids because of the presence of nasal packing.

The nurse provides a list of appropriate food choices to a client with newly diagnosed diabetes. The client reviews the list and says, "I do not like and refuse to eat asparagus, broccoli, and mushrooms." In response, the nurse teaches the client about the food exchange list. The nurse evaluates that teaching was effective when the client states, "Instead of asparagus, broccoli, and mushrooms, I will eat which foods?"

Correct1 String beans, beets, or carrots." 2 Corn, lima beans, or dried peas." 3 Baked beans, potatoes, or parsnips." 4 Corn muffins, corn chips, or pretzels." String beans, beets, and carrots are in the vegetable exchange, as are asparagus, broccoli, and mushrooms. Corn, lima beans, dried peas, baked beans, potatoes, or parsnips are starchy vegetables and are listed as bread exchanges. Corn muffins, corn chips, or pretzels are from the bread exchange list.

Which drug can cause diabetes insipidus?

1 Cabergoline 2 Metyrapone Correct3 Demeclocycline 4 Aminoglutethimide Prolonged administration of demeclocycline may cause diabetes insipidus, as this drug decreases the production of antidiuretic hormone by the kidneys. Cabergoline inhibits the release of growth hormone and prolactin by stimulating dopamine receptors in the brain. Metyrapone and aminoglutethimide decrease cortisol production.

When assessing the laboratory values of a client with type 2 diabetes, what would the nurse expect the results to reveal?

1 Ketones in the blood but not in the urine 2 Glucose in the urine but not in the blood Incorrect3 Urine and blood positive for glucose and ketones Correct4 Urine negative for ketones and positive glucose in the blood The reason for the lack of ketonuria in type 2 diabetes is unknown. One theory is that extremely high hyperglycemia and hyperosmolarity levels block the formation of ketones, stimulating lipogenesis rather than lipolysis. Ketones in the blood but not in the urine do not occur with type 2 diabetes. Glucose in the urine but not in the blood is impossible; if glycosuria is present, there must first be a level of glucose in the blood exceeding the renal threshold of 160 to 180 mg/dL (8.9 to 10 mmol/L). Urine and blood positive for glucose and ketones are expected in type 1 diabetes.

After reviewing the client’s laboratory reports, the physician concludes that the client has primary hypofunction of the adrenal gland. Which clinical manifestation is likely to be observed in that client?

Incorrect1 Edema at extremities Correct2 Uneven patches of pigment loss 3 Reddish-purple stretch marks on the abdomen 4 "Buffalo hump" between shoulders on the back Vitiligo [1] [2] is manifested by the presence of large patchy areas of pigment loss. This is mainly caused by primary hypofunction of the adrenal gland. Presence of edema at extremities indicates fluid and electrolyte imbalances mainly observed in a client with thyroid problems. Presence of reddish-purple stretch marks on the abdomen and "buffalo hump" between shoulders on the back of the neck often indicates excessive adrenocortical secretions.

Which assessment finding in a client signifies a mild form of hypocalcemia?

1 Seizures 2 Hand spasms Incorrect3 Severe muscle cramps Correct4 Numbness around the mouth A numbness or tingling sensation around the mouth or in the hands and feet indicates mild-to-moderate hypocalcemia. Seizures, hand spasms, and severe muscle cramps are associated with severe hypocalcemia.

Which hormonal deficiency causes breast atrophy in female clients?

1 Growth hormone Correct2 Luteinizing hormone 3 Thyroid-stimulating hormone Incorrect4 Adrenocorticotropic hormone A luteinizing hormone deficiency causes atrophy of the breasts. A growth hormone deficiency causes decreased bone density and pathologic fractures. A thyroid-stimulating hormone deficiency results in hirsutism, weight gain, and menstrual abnormalities. An adrenocorticotropic hormone deficiency causes postural hypotension, hypoglycemia, and anorexia.

Which hormone synthesis does the nurse state is inhibited by hypokalemia?

Correct1 Aldosterone 2 Somatostatin 3 Norepinephrine 4 Androstenedione Hypokalemia inhibits synthesis of aldosterone hormone. Somatostatin inhibits the synthesis of insulin. Norepinephrine also inhibits the synthesis of insulin. Androstenedione secretion may not be inhibited by hypokalemia.

A nurse is teaching a client with type 1 diabetes about assessing for signs and symptoms of hypoglycemia as a result of excessive insulin. What response should the nurse instruct the client to monitor in addition to nervousness and hunger?

sweating

A nurse observes that a client’s urine has a sweet fruity odor. Which information is most important to evaluate when performing a further client assessment?

1 Vital signs 2 Fluid balance Correct3 Serum glucose level 4 Dietary calorie count Sweet fruity-smelling urine is an indicator of ketoacidosis, which can result from uncontrolled diabetes. Hyperglycemia and hypoglycemia are assessed by serum glucose monitoring. Vital signs, fluid imbalance, and dietary counts have no relation to sweet fruity-smelling urine.

Which hormone does the nurse state is formed from cholesterol?

1 Insulin Correct2 Cortisol 3 Prolactin 4 Growth hormone All lipid-soluble hormones are synthesized from cholesterol. Cortisol, a lipid-soluble hormone, is secreted by the adrenal cortex. All water-soluble hormones are formed from amino acids. Insulin, prolactin, and growth hormone are water-soluble hormones. Insulin is secreted by the pancreas. Prolactin and growth hormone are also secreted by the pituitary gland.

What are the primary causes of adrenal insufficiency? Select all that apply.

Correct1 Hemorrhage Correct2 Tuberculosis 3 Pituitary tumors Incorrect4 Postpartum pituitary necrosis Correct5 Acquired immune deficiency syndrome The primary causes of adrenal insufficiency are hemorrhage, tuberculosis, and acquired immune deficiency syndrome. Pituitary tumors and postpartum pituitary necrosis are the secondary cases of adrenal insufficiency.

The laboratory report of a client reveals increased serum cholesterol levels. Which other finding indicates growth hormone deficiency in the client?

1 Scalp alopecia 2 Intolerance to cold Correct3 Pathological fractures 4 Increased urine output Growth hormone deficiency results in thinning of bones and increases the risk for pathological fractures. Thyrotropin deficiency results in scalp alopecia and intolerance to cold. Marked increase in the volume of urine output is a sign of diabetes insipidus caused by vasopressin deficiency.

What will the nurse expect diagnostic studies of a client with Cushing syndrome to indicate?

1 Moderately increased serum potassium levels 2 Increased numbers of eosinophils in the blood Correct3 High levels of 17-ketosteroids in a 24-hour urine test Incorrect4 Normal to low levels of adrenocorticotropic hormone (ACTH) High levels of 17-ketosteroids in a 24-hour urine test is a urinary metabolite of steroid hormones that are excreted in large amounts in hyperaldosteronism. With aldosterone hypersecretion, sodium is retained and potassium is excreted, resulting in hypernatremia and hypokalemia. With Cushing syndrome, the eosinophil count is decreased, not increased. ACTH levels usually are high in Cushing syndrome.

Which cells does the nurse identify as producing thyrocalcitonin hormone?

1 Islet cells 2 Adrenal cells 3 Pituitary cells Correct4 Parafollicular cells Parafollicular cells produce thyrocalcitonin hormone. This hormone helps in the regulation of serum calcium levels. Islet cells are responsible for the production of hormones such as insulin and glucagon. Adrenal cells are responsible for the production of hormones such as cortisol and aldosterone. Pituitary cells are responsible for the production of growth hormone, prolactin, and adrenocorticotropic hormone.

What assessment is the nurse’s main priority during the early postoperative period after a subtotal thyroidectomy?

1 Hemorrhage 2 Thyrotoxic crisis Correct3 Airway obstruction 4 Hypocalcemic tetany Maintaining airway patency is always the priority to permit gas exchange necessary to maintain life. Although important, hemorrhage, thyrotoxic crisis, and hypocalcemic tetany do not exceed patency of the airway in priority.

What intervention should the nurse implement when caring for a client 24 hours postthyroidectomy?

Correct1 Check the back and sides of the operative site. Incorrect2 Support the head during mild range-of-motion (ROM) exercises. 3 Encourage the client to ventilate feelings about the surgery. 4 Advise the client that regular activities can be resumed immediately. Bleeding may occur, and blood will pool in the back of the neck because the blood will flow via gravity. ROM exercises will increase pain and put tension on the suture line. Talking should be avoided in the immediate postoperative period, except to assess for a change in pitch or tone, which may indicate laryngeal nerve damage. Activity should be resumed gradually and frequent rest periods encouraged.

A client with malignant hot nodules of the thyroid gland has a thyroidectomy. What is the nurse’s priority action immediately postoperative?

Correct1 Place in semi-Fowler’s position to limit edema of the neck 2 Monitor intake and output strictly to assess for fluid overload 3 Encourage coughing and deep breathing to prevent atelectasis 4 Assess level of consciousness to determine recovery from anesthesia The inflammatory response and trauma of surgery may cause edema; elevating the head facilitates drainage, preventing compression of the trachea. Although monitoring intake and output strictly to assess for fluid overload is an important assessment for any postoperative client, it is not the priority for this client. Although deep breathing should be encouraged, coughing this early in the postoperative period is too traumatic to the operative site. Although assessing level of consciousness to determine recovery from anesthesia is important for any postoperative client, it is not the priority for this client.

A client who is taking an oral hypoglycemic daily for type 2 diabetes develops the flu and is concerned about the need for special care. What should the nurse instruct the client to do?

1 Skip the oral hypoglycemic pill, drink plenty of fluids, and stay in bed. 2 Avoid food, drink clear liquids, take a daily temperature, and stay in bed. 3 Eat as much as possible, increase fluid intake, and call the office again the next day. Correct4 Take the oral hypoglycemic pill, drink warm fluids, and perform a serum glucose test before meals and at bedtime. Physiological stress increases gluconeogenesis, requiring continued pharmacological therapy despite an inability to eat; fluids prevent dehydration, and monitoring serum glucose levels permits early intervention if necessary. Skipping the oral hypoglycemic can precipitate hyperglycemia; serum glucose levels must be monitored. Food intake should be attempted to prevent acidosis; oral hypoglycemics should be taken, and serum glucose levels should be monitored. Telling the client to eat as much as possible, increase fluid intake, and call the office again the next day are incomplete instructions; oral hypoglycemics should be taken, and serum glucose levels should be monitored. Eating as much as possible can precipitate hyperglycemia.

Which type of hormonal imbalance does the nurse infer through this image?

Correct1 Acromegaly 2 Exophthalmos 3 Addison’s disease 4 Cushing’s syndrome Acromegaly is caused by hyperpituitarism. Symptoms include thickened lips, coarse facial features, and lower-jaw protrusion. Abnormal protrusion of the eyes is seen in clients with exophthalmos. Addison’s disease, also called Addison’s insufficiency, causes skin manifestations, such as vitiligo and hyperpigmentation. A client with Cushing’s disease displays "moon face" and truncal obesity.

How does the nurse arrange the events of the positive feedback mechanism of estradiol chronologically?

orrect 1. Estradiol levels are increased during the menstrual cycle. Correct 2. Follicle-stimulating hormone (FSH) production and release is increased. Correct 3. Estradiol levels are increased due to follicle-stimulating hormone. Correct 4. Death of follicle has occurred. Correct 5. Follicle-stimulating hormone levels in serum drop. In the positive feedback mechanism of estradiol, the level of estradiol is increased during the menstrual cycle. This results in increased production and release of FSH. FSH further increases the level of estradiol until the death of the follicle. This death results in a drop of serum FSH.

Which statement regarding calcitonin is correct?

1 It is secreted by follicular cells. Correct2 Its actions are opposite to that of parathyroid hormone. Incorrect3 It decreases phosphorous levels by increasing bone resorption. 4 It works along with thyroid hormone to maintain normal calcium levels in blood. Calcitonin reduces serum calcium levels, whereas parathyroid hormone increases serum calcium levels. Therefore, the actions of calcitonin are opposite to that of parathyroid hormone. Calcitonin is secreted by parafollicular cells of the thyroid gland. Calcitonin decreases calcium and phosphorus levels by decreasing bone resorption. Calcitonin works along with parathyroid hormone to maintain calcium levels in blood.

The registered nurse instructs the new nurse in orientation regarding the physiologic processes of the endocrine system prior to client assessment. Which statement made by the new nurse indicates effective learning?

1 "The endocrine system comprises glands with narrow ducts." 2 "The endocrine system comprises salivary and lacrimal glands." Correct3 "The hormones of the endocrine system exert their action by ‘lock and key’ mechanism." 4 "The hormones secreted by endocrine system exert their action on all tissues they contact." The endocrine glands secrete hormones that exert their action on the target tissues by the "lock and key" mechanism. The hormones recognize and adhere only to specific receptor sites on the target tissue, like a correct key alone can open its specific lock. The glands of the endocrine system are ductless and secrete hormones that are carried via the blood circulation. Salivary and lacrimal glands are not endocrine but secretory glands. The hormones are carried via blood to various tissues, but they exert their action only on specific target tissues.

A client with hyperthyroidism asks the nurse about the tests that will be prescribed. Which diagnostic tests should the nurse include in a discussion with this client?

1 Thyroxine (T4) and x-ray films Correct2 Thyroid-stimulating hormone (TSH) assay and triiodothyronine (T3) 3 Thyroglobulin level and PO2 4 Protein-bound iodine and sequential multichannel autoanalyzer (SMA) A decreased TSH assay together with an elevated T3 level may indicate hyperthyroidism. X-ray results will not indicate thyroid disease, and elevation of T4 level might indicate hyperthyroidism. However, this may be a false reading because of the presence of thyroid-binding globulin (TBG) and is inadequate for diagnosis when used alone. PO2 is not specific to thyroid disease, and the thyroglobulin level is most useful to monitor for recurrence of thyroid carcinoma or response to therapy. The results with the SMA are not specific to thyroid disease; the protein-bound iodine test is not definitive because it is influenced by the intake of exogenous iodine.

What is a clinical manifestation in a client with hyposecretion of growth hormone?

Decreased bone density

A client is admitted with a head injury. The nurse identifies that the client’s urinary catheter is draining large amounts of clear, colorless urine. What does the nurse identify as the most likely cause?

1 Increased serum glucose 2 Deficient renal perfusion Correct3 Inadequate antidiuretic hormone (ADH) secretion 4 Excess amounts of intravenous (IV) fluid Deficient ADH from the posterior pituitary results in diabetes insipidus. This can be caused by head trauma; water is not conserved by the body, and excess amounts of urine are produced. Although increased serum glucose may cause polyuria, it is associated with diabetes mellitus, not diabetes insipidus. Ineffective renal perfusion will cause decreased urine production. While excess amounts of IV fluids may cause dilute urine, it is unlikely that a client with head trauma will be receiving excess fluid because of the danger of increased intracranial pressure.

Which type of drug-induced hormonal imbalance is likely to be observed in the client undergoing treatment with demeclocycline?

Which type of drug-induced hormonal imbalance is likely to be observed in the client undergoing treatment with demeclocycline? 1 Acromegaly 2 Diabetes mellitus Correct3 Diabetes insipidus 4 Cushing’s syndrome Drug-induced diabetic insipidus is usually caused by demeclocycline, which can interfere with the response of the kidneys to antidiuretic hormone. Demeclocycline does not cause endocrine disorders, such as acromegaly, diabetes mellitus, and Cushing’s syndrome.

A nurse explains to a client with diabetes that self-monitoring of blood glucose is preferred to urine glucose testing. Why is blood glucose monitoring preferred?

Correct1 Blood glucose monitoring is more accurate. 2 Blood glucose monitoring is easier to perform. 3 Blood glucose monitoring is done by the client. 4 Blood glucose monitoring is not influenced by drugs. Blood glucose testing is a more direct and accurate measure; urine testing provides an indirect measure that can be influenced by kidney function and the amount of time the urine is retained in the bladder. Whereas blood and urine testing is relatively simple, testing the blood involves additional knowledge. Both procedures can be done by the client. Whether or not it is influenced by drugs is not a factor. Although some urine tests are influenced by drugs, there are methods to test urine to bypass this effect.

Which hormone is released from the pancreas?

1 Oxytocin 2 Prolactin 3 Calcitonin Correct4 Somatostatin Somatostatin is a hormone produced by the pancreas that inhibits the release of insulin and glucagon. Oxytocin is a hormone produced by the posterior pituitary gland that acts on the uterus and mammary glands. Prolactin is a hormone produced by the anterior pituitary gland that targets the ovaries and mammary glands in women and testes in men. Calcitonin is a hormone produced by the thyroid gland that interacts with bone tissue.

Which neurologic manifestation in a client is associated with hyperthyroidism?

1 Confusion 2 Hearing loss Correct3 Tremors 4 Slowness of speech Tremors is a neurologic manifestation in a client associated with hyperthyroidism. Confusion, hearing loss, and slowness of speech are caused by hypothyroidism.

Arrange the series of reactions that occurs when plasma volume and osmolarity are disturbed.

Correct 1. Change in posture Incorrect 2. Formation of active form of angiotensin Incorrect 3. Conversion of angiotensinogen to angiotensin I Correct 4. Increased reabsorption of water and sodium Correct 5. Increased blood volume Extracellular fluid volume decreases during conditions such as posture changes and blood loss. This results in release of rennin enzyme, which converts angiotensinogen to angiotensin I. In the presence of angiotensin-converting enzyme, angiotensin I is converted to angiotensin II, which is an active form of angiotensin. Angiotensin II stimulates the adrenal secretion of aldosterone, which increases the reabsorption of water and sodium. This results in increased blood volume.

How does the nurse arrange the events that take place during the promotion of glucose transportation into the cells through cell membranes?

Correct 1. Secretion of proinsulin by beta cells Correct 2. Storage of proinsulin in the pancreas Correct 3. Transformation of proinsulin into active insulin Correct 4. Attachment of insulin to receptors Proinsulin is a prohormone that is secreted by beta cells and is stored in the beta cells of islets of Langerhans of the pancreas. Active insulin is a protein made up of 51 amino acids; it is produced when C-peptide is removed from the proinsulin. Insulin attaches to receptors present on the target tissues, such as adipose tissue or muscle, where the promotion of glucose transport into the cells through cell membranes occurs.

Which clinical manifestation is found in a client with a deficiency of adrenocorticotropic hormone?

1 Anovulation 2 Dehydration Correct3 Malaise and lethargy 4 Menstrual abnormalities Malaise is a general feeling of discomfort or illness and lethargy is a lack of energy. A client with deficiency of adrenocorticotropic hormone may experience malaise and lethargy. Adrenocorticotropic hormone deficiency is not associated with anovulation, dehydration, and menstrual abnormalities. Anovulation (ovaries do not release an oocyte during the menstrual cycle) occurs due to deficiency of gonadotropins. Dehydration is a result of deficiency of antidiuretic hormone. The deficiency of thyroid-stimulating hormone may result in menstrual abnormalities.

Which glands secrete hormones that regulate metabolism of carbohydrates, proteins, and fats? Select all that apply.

Correct1 Pancreas Correct2 Thyroid gland Correct3 Adrenal cortex 4 Adrenal medulla 5 Parathyroid gland The pancreas secretes insulin and glucagon, which affects the body’s metabolism of carbohydrates, proteins, and fats. The thyroid gland secretes thyroid hormones T3 and T4 that regulate carbohydrates, proteins, and fat metabolism. Cortisol is a glucocorticoid secreted by the adrenal cortex that affects carbohydrates, proteins, and fat metabolism. Adrenal medulla secretes catecholamines, which do not affect metabolism of carbohydrates, proteins, and fats. Hormones secreted by the parathyroid gland mainly regulate calcium and phosphorus metabolism.

A client with type 2 diabetes, who is taking an oral hypoglycemic agent, is to have a serum glucose test early in the morning. The client asks the nurse, "What do I have to do to prepare for this test?" Which statement by the nurse reflects accurate information?

Incorrect1 "Eat your usual breakfast." 2 "Have clear liquids for breakfast." 3 "Take your medication before the test." Correct4 "Do not ingest anything before the test." Fasting before the test is indicated for accurate and reliable results; food before the test will increase serum glucose levels through metabolism of the nutrients. Food should not be ingested before the test; food will increase the serum glucose level, negating accuracy of the test. Instructing the client to have clear liquids for breakfast is inappropriate; some clear fluids contain simple carbohydrates, which will increase the serum glucose level. Medications are withheld before the test because of their influence on the serum glucose level.

Which gland does the nurse state is an exocrine gland?

1 Thyroid gland Correct2 Salivary gland 3 Pituitary gland 4 Parathyroid gland Exocrine glands are glands with ducts that produce enzymes but not hormones. These glands secrete enzymes into ducts. The salivary gland secreting saliva is an example of an exocrine gland. Endocrine glands are ductless glands that produce hormones that are secreted into the blood. Thyroid, pituitary, and parathyroid glands are examples of endocrine glands.

A client, visiting the health center, reports feeling nervous, irritable, and extremely tired. The client says to the nurse, "Although I eat a lot of food, I have frequent bouts of diarrhea and am losing weight." The nurse observes a fine hand tremor, an exaggerated reaction to external stimuli, and a wide-eyed expression. What laboratory tests may be prescribed to determine the cause of these signs and symptoms?

1 Partial thromboplastin time (PTT) and prothrombin time (PT) Correct2 T3, T4, and thyroid-stimulating hormone (TSH) 3 Venereal disease research laboratory (VDRL) test and complete blood count (CBC) 4 Adrenocorticotropic hormone (ACTH), antidiuretic hormone (ADH), and corticotropin-releasing factor (CRF) T3, T4, and TSH provide a measure of thyroid hormone production; an increase is associated with the client’s signs and symptoms. PT and PTT assess blood coagulation. The VDRL test is for syphilis; the CBC assesses the hematopoietic system. ACTH stimulates the synthesis and secretion of adrenal cortical hormones. ADH increases water reabsorption by the kidney. CRF triggers the release of ACTH.

Which hormone is released from the posterior pituitary gland?

Correct1 Oxytocin 2 Prolactin Incorrect3 Growth hormone 4 Luteinizing hormone Oxytocin is released from the posterior pituitary gland, which acts on the uterus and mammary glands. Prolactin, growth hormone, and luteinizing hormone are produced by the anterior pituitary gland.

What are the most common hormones produced in excess with hyperpituitarism? Select all that apply.

Correct1 Prolactin Correct2 Growth hormone Incorrect3 Luteinizing hormone 4 Antidiuretic hormone Incorrect5 Melanocyte-stimulating hormone The most common hormones produced in excess with hyperpituitarism are prolactin and growth hormone. Excessive stimulation of luteinizing hormone and antidiuretic hormone is also associated with hyperpituitarism, but less commonly than prolactin and growth hormone. Secretion of melanocyte-stimulating hormone stimulates adrenocorticotropic hormone, which indirectly stimulates the pituitary gland, thus leading to hyperpituitarism.

A nurse is caring for a client with Addison’s disease. Upon assessment, which classic sign will the nurse find?

1 Ecchymosis 2 Hyperreflexia 3 Exophthalmos Correct4 Hyperpigmentation Hyperpigmentation, or "bronzing," is a classic sign of Addison’s disease. Ecchymosis (bruise) is the discoloration of the skin due to rupture of blood vessels beneath the skin. Hyperreflexia is a sign of hypoparathyroidism. Exophthalmos is the classic sign of hyperthyroidism.

Which hormonal deficiency reduces the growth of axillae and pubic hair in female clients?

Incorrect1 Growth hormone 2 Antidiuretic hormone 3 Thyroid-stimulating hormone Correct4 Adrenocorticotropic hormone An adrenocorticotropic hormone deficiency causes a reduced growth of axial and pubic hair in women. A growth hormone deficiency causes decreased muscle strength and decreased bone density. An antidiuretic hormone deficiency causes excessive urine output and a low urine specific gravity. A thyroid-stimulating hormone deficiency results in hirsutism and menstrual abnormalities.

Which hormone regulates blood levels of calcium?

Correct1 Parathormone 2 Luteinizing hormone Incorrect3 Thyroid stimulating hormone 4 Adrenocorticotropic hormone Parathyroid hormone (PTH), or parathormone, regulates the blood levels of calcium and phosphorus. Luteinizing hormone (LH) stimulates the production of sex hormones, promotes the growth of reproductive organs, and also stimulates reproductive processes. Thyroid stimulating hormone (TSH) stimulates the release of thyroid hormones and the growth and functioning of the thyroid gland. Adrenocorticotropic hormone (ACTH) promotes the growth of the adrenal cortex and stimulates the release of corticosteroids.

Which condition results in elevated serum adrenocorticotropic hormone (ACTH) and urine cortisol levels?

1 Diabetes insipidus 2 Adrenal Cushing’s syndrome Correct3 Pituitary Cushing’s syndrome 4 Syndrome of inappropriate antidiuretic hormone In pituitary Cushing’s syndrome, urine cortisol and serum adrenocorticotropic hormone levels are raised. Diabetes insipidus is the result of decreased levels of antidiuretic hormone and is not associated with cortisol and ACTH levels. Adrenal Cushing’s syndrome is caused by chronic steroid use, so the client will have increased urine cortisol and decreased ACTH levels. Syndrome of inappropriate antidiuretic hormone is the result of elevated levels of antidiuretic hormone and is not related with the ACTH and cortisol levels.

A nurse working in the diabetes clinic is evaluating a client’s success with managing the medical regimen. What is the best indication that a client with type 1 diabetes is successfully managing the disease?

1 Reduction in excess body weight Correct2 Stabilization of the serum glucose 3 Demonstrated knowledge of the disease 4 Adherence to the prescription for insulin A combination of diet, exercise, and medication is necessary to control the disease; the interaction of these therapies is reflected by the serum glucose level. Weight loss may occur with inadequate insulin. Acquisition of knowledge does not guarantee its application. Insulin alone is not enough to control the disease.

Which hormones are secreted by the posterior pituitary gland? Select all that apply.

Correct1 Oxytocin 2 Prolactin 3 Corticotropin Correct4 Antidiuretic hormone 5 Melanocyte-stimulating hormone Oxytocin and antidiuretic hormone (vasopressin) [1] [2] are secreted by the posterior pituitary gland. Prolactin, corticotropin, and melanocyte-stimulating hormones are secreted by the anterior pituitary gland.

Which drug would be effective for the treatment of pituitary Cushing’s syndrome?

Incorrect1 Mitotane 2 Cabergoline Correct3 Cyproheptadine 4 Bromocriptine mesylate Cyproheptadine is effective for the treatment of pituitary Cushing’s syndrome. Mitotane is prescribed for the treatment of adrenal Cushing’s syndrome. Cabergoline and bromocriptine mesylate are effective for the treatment of hyperpituitarism.

Which hormone does the nurse state has both inhibiting and releasing action?

Correct1 Prolactin 2 Somatostatin 3 Somatotropin 4 Gonadotropin Prolactin secreted by the hypothalamus has both inhibiting and releasing action. Somatostatin inhibits the secretion of growth hormone. Somatotropin and gonadotropin are releasing hormones.

A client has undergone nasal hypophysectomy surgery. During post-operative care, which finding indicates cerebrospinal leakage?

1 Dry mouth 2 Rigidity of neck muscles 3 Fall in blood pressure upon standing Correct4 A yellow edge around nasal discharge Nasal hypophysectomy is a surgical procedure performed to treat hyperpituitarism due to pituitary gland tumors. During postoperative care and follow-up, the appearance of light-yellow at the edge of otherwise clear nasal discharge in the dressing indicates leakage of cerebrospinal fluid (CSF). This is called the "halo sign" and is indicative of a CSF leak. Dry mouth after nasal hypophysectomy is normal because the client breathes through the mouth due to the nasal packing. Neck rigidity could be an indication of infection, such as meningitis following the surgery. A fall in blood pressure upon standing is called orthostatic hypotension and is a side effect of bromocriptine. Topics

Which condition is characterized by hemorrhage after a pregnant female delivers?

Correct1 Sheehan’s syndrome 2 Cushing’s syndrome 3 Addison’s syndrome 4 Schwartz-Bartter syndrome A pituitary infarction is caused by postpartum hemorrhaging; this condition is known as Sheehan’s syndrome. Cushing’s syndrome is manifested by moon face, truncal obesity, and hypertension. Addison’s disease is manifested by hyperkalemia, hypotension, and hypoglycemia. Schwartz-Bartter syndrome, also called syndrome of inappropriate antidiuretic hormone, is manifested by loss of appetite, nausea, and vomiting.

What are the cardiovascular manifestations observed in a client with adrenal insufficiency?

1 Fatigue Incorrect2 Salt craving 3 Weight loss Correct4 Hyponatremia Hyponatremia is a decrease in serum sodium levels, which is the cardiovascular manifestation of adrenal insufficiency. Fatigue is a neuromuscular manifestation observed in clients with adrenal insufficiency, while salt cravings and weight loss are the abdominal manifestations observed in clients with adrenal insufficiency.

Which catecholamine receptor is responsible for increased heart rate?

Correct1 Beta1 receptor 2 Beta2 receptor 3 Alpha1 receptor 4 Alpha2 receptor Beta1 receptors are responsible for increased heart rate. Beta2 receptors, alpha1 receptors, and alpha2 receptors are not present in the heart; therefore, they are not responsible for increasing the heart rate. Beta2 receptors are present in such organs as blood vessels, kidneys, bronchioles, and bladder. Alpha receptors are present in such organs as eyes, skin, and liver.

Which gland secretes melatonin?

Correct1 Pineal gland 2 Thyroid gland 3 Adrenal gland 4 Parathyroid gland The pineal gland secretes the hormone melatonin, which regulates the circadian rhythm and reproductive system at the onset of puberty. The thyroid gland secretes thyroid hormones. The adrenal gland secretes androgens, corticosteroids, and catecholamines. The parathyroid gland secretes the hormone calcitonin.

Which feature in the client indicates hypersecretion of adrenocorticotrophic hormone?

Correct1 Moon face 2 Lower jaw protrusion 3 Heat intolerance 4 Barrel-shaped chest Hypersecretion of adrenocorticotrophic hormone results in Cushing’s disease, which is characterized by "moon face" appearance, an abnormal distribution of fat in the face. Protrusion of the lower jaw is a feature of acromegaly, caused by excess secretion of growth hormone. Heat intolerance is seen in clients with excess secretion of thyrotropin. In acromegaly, the client presents with "barrel-shaped" chest appearance.

A nurse is providing postoperative care for a client one hour after an adrenalectomy. Maintenance steroid therapy has not begun yet. The nurse should monitor the client for which complication?

Correct1 Hypotension 2 Hyperglycemia 3 Sodium retention 4 Potassium excretion Because of instability of the vascular system and the lability of circulating adrenal hormones after an adrenalectomy, hypotension frequently occurs until the hormonal level is controlled by replacement therapy. Hyperglycemia is a sign of excessive adrenal hormones; after an adrenalectomy, adrenal hormones are not secreted. Sodium retention is a sign of hyperadrenalism; it does not occur after the adrenals are removed. Potassium excretion is a response to excessive adrenal hormones; after an adrenalectomy is performed, adrenal hormones are lowered until replacement therapy is regulated.

The primary health care provider prescribes fludrocortisone to a client with adrenal gland hypofunction. What does the nurse instruct the client about this medication?

monitor BP daily

A nurse is caring for a client with type 1 diabetes who developed ketoacidosis. Which laboratory value supports the presence of diabetic ketoacidosis?

1 Decreased serum glucose levels 2 Decreased serum calcium levels Correct3 Increased blood urea nitrogen levels 4 Increased serum bicarbonate levels With diabetic ketoacidosis blood urea nitrogen level generally is increased because of dehydration. With diabetic ketoacidosis, the serum glucose levels are generally above 300 mg/dL (16.7 mmol/L). The calcium level is unrelated to diabetic ketoacidosis. Serum bicarbonate levels are below 15 mEq/L (15 mmol/L).

A client is injured in a motor vehicle accident and is admitted to the critical care unit. Twelve hours later the client complains of increased abdominal pain in the left upper quadrant. A ruptured spleen is diagnosed, and an emergency splenectomy is scheduled. What should the nurse emphasize when preparing the client for surgery?

1 The poor prognosis associated with a splenectomy 2 The expectation that postoperative bleeding will occur 3 The high risk associated with the procedure in light of the client’s other injuries Correct4 The presence of abdominal drains for several days after the surgery Drains usually are inserted into the splenic bed to facilitate removal of fluid that may lead to abscess formation. Splenectomy has a low mortality rate (5%) except when multiple injuries are present (15% to 40%). Bleeding occurs more commonly with splenic repair than with removal. Educating the client about the risks associated with surgery is the responsibility of the primary healthcare provider. There is no need to frighten the client unnecessarily.

While assessing a postpartum client who is suspected of having a thyroid disorder, the nurse suspects that the client has autoimmune thyroiditis. Which diagnostic studies are most suitable for confirming the diagnosis?

Correct1 Radioactive iodine uptake 2 Computed tomography scan 3 Magnetic resonance imaging 4 Thyroid-stimulating hormone The postpartum client may have silent, painless thyroiditis. Radioactive iodine uptake is suppressed in silent thyroiditis, so this test would be beneficial in diagnosing the thyroiditis. A computed tomography scan is used to detect thyroid nodules. Magnetic resonance imaging is also used in evaluating thyroid nodules. A blood test for thyroid-stimulating hormone is used to evaluate thyroid function.

The nurse is caring for a client newly diagnosed with diabetes. What symptom of hypoglycemia is most common and should be taught to the client?

ncorrect1 Kussmaul respirations 2 Tachycardia Correct3 Confusion 4 Anorexia The most common symptoms of hypoglycemia are nervousness, weakness, perspiration, and confusion. Kussmaul respirations are associated with hyperglycemia or ketoacidosis. Bradycardia is associated with hypoglycemia; tachycardia is not. Anorexia is associated with hyperglycemia.

A nurse provides post-operative care to a client who has undergone a hypophysectomy. Which action should the nurse take if there is a yellowish discharge at the dressing site?

1 Change the dressing 2 Wipe the discharge off with alcohol Correct3 Inform the primary healthcare provider 4 Tighten the dressing in order to avoid leakage In order to reduce the risk of further complications, the nurse should inform the primary healthcare provider. Leakage of cerebrospinal fluid (CSF) may occur due to hypophysectomy. A yellowish discharge at the dressing site indicates the leakage of CSF. Changing the dressing, cleaning the wound with alcohol, and tightening the dressing may complicate the condition.

The nurse caring for a client with diabetic ketoacidosis (DKA) can expect to implement which intervention?

Correct1 Intravenous administration of regular insulin 2 Administer insulin glargine subcutaneously at hour of sleep 3 Maintain nothing prescribed orally (NPO) status 4 Intravenous administration of 10% dextrose A client admitted with DKA will have a blood glucose value greater than 250 and blood ketones. Intravenous (IV) administration of regular insulin is needed to rid the body of ketones and regulate blood glucose. Administration of insulin glargine is not going to reverse the ketoacidosis. The client will be allowed fluids to maintain hydration. Administration of 10% dextrose IV will increase the client’s blood glucose.

Which hormones are secreted by the client’s hypothalamus? Select all that apply.

1 Growth hormone 2 Follicle-stimulating hormone Correct3 Prolactin-inhibiting hormone Correct4 Corticotropin-releasing hormone 5 Melanocyte-stimulating hormone The hormones that are secreted by the hypothalamus include prolactin-inhibiting hormone and corticotropin-releasing hormone. Growth hormone, follicle-stimulating hormone, and melanocyte-stimulating hormone are hormones secreted by the anterior pituitary gland.

The nurse is assessing a client suspected of having hypercortisolism. Which questions should the nurse ask to help confirm the diagnosis? Select all that apply.

Incorrect1 "Did you lose any weight unintentionally?" Correct2 "Did you notice your extremities to be thin?" 3 "Did you notice any roughness of your skin?" 4 "Did you notice any skin darkening recently?" Correct5 "Did the hair on your body become thicker?" Clients with hypercortisolism may have thin extremities. Increased body hair also indicate hypercortisolism. Increased skin pigmentation (particularly in sun-exposed areas) indicates hypocortisolism. Unintentional weight loss is an indication for hyperthyroidism or diabetes mellitus. Skin may be rough (coarse) or leathery in clients with hypothyroidism or excess growth hormone levels.

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