Chapter 45 My Nursing Test Banks

Osborn, Medical-Surgical Nursing, 2e
Chapter 45

Question 1

Type: MCMA

A patient has had surgery to remove a tumor of the anterior pituitary. The nurse plans to assess for dysfunction associated with decreased levels of which hormones?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Adrenocorticotropic hormone (ACTH)

2. Thyroid-stimulating hormone (TSH)

3. Gonadotropic hormones

4. Antidiuretic hormone

5. Somatostatin

Correct Answer: 1,2,3,5

Rationale 1: The anterior pituitary produces adrenocorticotropic hormone.

Rationale 2: The anterior pituitary produces thyroid-stimulating hormone.

Rationale 3: Gonadotropin-releasing hormone is released by the hypothalamus and stimulates the anterior pituitary to secrete the gonadotropic hormones, follicle-stimulating hormone and luteinizing hormone. If the anterior pituitary is damaged, this secretion cannot occur.

Rationale 4: Antidiuretic hormone is secreted by the posterior pituitary.

Rationale 5: Somatostatin inhibits growth hormone and thyroid-stimulating hormone release from the anterior pituitary. If the anterior pituitary is damaged, this release cannot take place.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 45-1

Question 2

Type: MCSA

A patient with hormone imbalance is demonstrating symptoms of dehydration and excessive urination. The nurse realizes that which hormone is most directly associated with these symptoms?

1. Antidiuretic hormone (ADH)

2. Adrenocorticotropic hormone (ACTH)

3. Follicle stimulating hormone (FSH)

4. Thyroid-stimulating hormone (TSH)

Correct Answer: 1

Rationale 1: Antidiuretic hormone decreases urine production by causing the renal tubules to reabsorb water from the urine and return it to the circulating blood. This patient is demonstrating excessive urination, which might indicate an alteration in this hormone.

Rationale 2: ACTH stimulates the production and release of adrenocortical hormones such as glucocorticoids, mineralocorticoids, and androgens. The effects of these hormones on water balance are not as direct as those of another hormone.

Rationale 3: FSH stimulates estrogen secretion and follicle maturation in females and spermatogenesis in males. It does not have a direct relationship to the patients symptoms.

Rationale 4: Thyroid-stimulating hormone stimulates thyroid function. Alteration in this hormone does not have as direct a relationship to the patients symptoms as another hormone does.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 45-2

Question 3

Type: MCSA

During an assessment, the nurse notes that the patients eyes are extremely wide open and bulging. The nurse would conduct additional assessment for which endocrine disorder?

1. Hyperthyroidism

2. Diabetes mellitus

3. Hypofunction of the adrenal glands

4. Hypofunction of the anterior pituitary gland

Correct Answer: 1

Rationale 1: Exophthalmos is protrusion of the eyeball(s). This finding is associated with Graves disease, which is a form of hyperthyroidism.

Rationale 2: This change in the eyeballs is not associated with diabetes mellitus.

Rationale 3: Decreased secretion from the adrenal glands does not result in changes in the structure of the eyeball.

Rationale 4: Protrusion of the eyeballs is not associated with inadequate pituitary function.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 45-4

Question 4

Type: MCSA

The nurse understands that an alteration in growth hormone can lead to changes in an individuals physical stature. Which finding would cause the nurse to assess for high levels of growth hormone?

1. Acromegaly

2. Dwarfism

3. Hirsutism

4. Gynecomastia

Correct Answer: 1

Rationale 1: Acromegaly is a change in facial features caused by excessive growth hormone.

Rationale 2: Extremely short stature may indicate dwarfism, which is caused by insufficient growth hormone.

Rationale 3: Hirsutism, or abnormal hair growth, is associated with adrenal hormone excess.

Rationale 4: Gynecomastia, or development of breast tissue in men, is frequently associated with androgen therapy.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 45-4

Question 5

Type: MCMA

The nurse performing an assessment of a patients endocrine system expects to address the structure and function of which glands?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Lacrimal glands

2. Gonads

3. Salivary glands

4. Hypothalamus

5. Thyroid gland

Correct Answer: 2,4,5

Rationale 1: Lacrimal glands are exocrine glands (excrete their fluids via a duct to an environment external to themselves).

Rationale 2: An assessment of the endocrine system (in which hormones are secreted into the bloodstream) would include the gonad glands.

Rationale 3: Salivary glands are exocrine glands (excrete their fluids via a duct to an environment external to themselves).

Rationale 4: An assessment of the endocrine system (in which hormones are secreted into the bloodstream) would include the hypothalamus.

Rationale 5: An assessment of the endocrine system (in which hormones are secreted into the bloodstream) would include the thyroid.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 45-1

Question 6

Type: MCMA

The nurse is preparing to discuss the importance of neuroendrocrine regulation with a group of nurses who work in the endocrine clinic. The nurse will explain that this type of regulation facilitates which essential abilities?


Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Ability to think critically

2. Ability to reason

3. Ability to reproduce

4. Ability to adapt to external changes

5. Ability to grow physically

Correct Answer: 3,4,5

Rationale 1: Critical thinking is a cognitive function that is not regulated by neuroendrocrine collaboration.

Rationale 2: Reasoning is a cognitive function that is not regulated by neuroendrocrine collaboration.

Rationale 3: The functioning of the endocrine system is intimately connected to that of the nervous system. This connection is referred to as neuroendrocrine regulation. The systems work synergistically to regulate overall physiological functioning, including reproduction.

Rationale 4: The functioning of the endocrine system is intimately connected to that of the nervous system. This connection is referred to as neuroendrocrine regulation. The systems work synergistically to regulate overall physiological functioning, including adaptability to changes in the external environment.

Rationale 5: The functioning of the endocrine system is intimately connected to that of the nervous system. This connection is referred to as neuroendrocrine regulation. The systems work synergistically to regulate overall physiological functioning, including growth and development.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 45-3

Question 7

Type: MCSA

Which example would help the nurse explain hormone regulation directed by circadian rhythm?

1. The regulation of the female menstrual cycle

2. The release of cortisol to peak in the early morning

3. The stimulation of insulin production by an increased level of glucose

4. The increased production of luteinizing hormone (LH) during the menstrual cycle

Correct Answer: 2

Rationale 1: Infradian rhythms are those that last for more than 24 hours, such as the female menstrual cycle.

Rationale 2: An example of circadian rhythms regulation is the release of cortisol, whose peaks and troughs vary during a 24-hour period.

Rationale 3: The increased production of insulin as stimulated by the brains perception of increased serum glucose is an example of the neural regulatory process.

Rationale 4: The release of luteinizing hormone in response to higher estrogen levels is an example of positive feedback.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 45-3

Question 8

Type: MCSA

An older adult female has been given instructions concerning an endocrine assessment the nurse will be conducting. Which statement by the patient would indicate that further instruction is necessary?

1. Because I am already past menopause, there will be no need for a breast exam in this assessment.

2. The nurse will look at my skin, nails, and hair.

3. Ill be sure to let the nurse know that diabetes runs in my family.

4. The nurse will palpate my throat in the front.

Correct Answer: 1

Rationale 1: The breast tissue of all patients, male and female, should be examined as part of the endocrine assessment.

Rationale 2: The endocrine assessment does include inspection of the skin, nails, and hair

Rationale 3: Diabetes mellitus is an endocrine disorder that appears to have some degree of family connection, so the patient is correct in providing this information.

Rationale 4: Palpation of the thyroid gland is part of the endocrine assessment.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 45-4

Question 9

Type: MCSA

The nurse is conducting a health history interview with a female patient. To best assess the patients endocrine system, the nurse asks which question?

1. Is there a history of cancer in your family?

2. Is your menstrual cycle regular, every 28 days?

3. Have you ever experienced difficulty breathing?

4. Do you have problems with indigestion?

Correct Answer: 2

Rationale 1: History of cancer is not the most important assessment question.

Rationale 2: The patient who has an irregular menstrual cycle might be experiencing an endocrine disorder such as increased androgen production or decreased estrogen levels.

Rationale 3: Difficulty breathing is not directly related to endocrine assessment.

Rationale 4: Indigestion is not directly related to endocrine assessment.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 45-4

Question 10

Type: MCSA

When caring for a patient diagnosed with Graves disease, the nurse recognizes the importance of regular monitoring of which laboratory results?

1. Calcium level

2. Cortisol level

3. Thyroxine (T4)

4. Urine-specific gravity

Correct Answer: 3

Rationale 1: The parathyroid gland regulates calcium level and is not associated with Graves disease.

Rationale 2: The adrenal gland produces cortisol and is not associated with Graves disease.

Rationale 3: Graves disease is influenced by the secretions of the thyroid gland. Thyroxine (T4) is the hormone secreted by the thyroid gland.

Rationale 4: Urine-specific gravity would be measured to provide information about the posterior pituitary, which is not associated with Graves disease.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 45-5

Question 11

Type: MCMA

A patient is hospitalized following trauma to the neck that affected the thyroid gland. The nurse would monitor for changes in which hormone levels?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Androgens

2. Calcitonin

3. Triiodothyronine

4. Thyroxine

5. Thyomamine

Correct Answer: 2,3,4

Rationale 1: Androgens are male sex steroid hormones produced by the adrenal glands.

Rationale 2: Calcitonin is secreted by the thyroid. The primary function of calcitonin is to inhibit bone resorption.

Rationale 3: Triiodothyronine or T3 is secreted by the thyroid gland.

Rationale 4: Thyroxine or T4 is secreted by the thyroid gland.

Rationale 5: Thyomamine is not a hormone.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 45-2

Question 12

Type: MCSA

Following thyroid surgery, a patient develops hypercalcemia. The nurse would suspect which etiology?

1. Damage to the part of the thyroid that produces T3 hormone

2. Stimulation of the area of the thyroid that produces antidiuretic hormone

3. Damage to parathyroid tissues

4. Decrease in the amount of available thyroid-stimulating hormone

Correct Answer: 3

Rationale 1: Deficiency of T3 hormone would not change the calcium level.

Rationale 2: Antidiuretic hormone is produced by the posterior pituitary.

Rationale 3: The parathyroid glands are embedded in thyroid tissue and can be inadvertently damaged during thyroid surgery. Parathyroid hormone functions to maintain calcium balance.

Rationale 4: Thyroid-stimulating hormone is produced in the anterior pituitary.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 45-2

Question 13

Type: MCSA

A patient is diagnosed with a disorder of autocrine regulation. Which explanation of this condition would the nurse provide to the patient and family?

1. The cells that produce some of your bodys hormones are not recognizing that sufficient hormone is present.

2. Your blood is not circulating hormones well enough to get them to the places they need to be in your body.

3. Some of your hormones are not able to travel to their neighboring cells to do their work.

4. Your nervous system is not working with your endocrine system correctly.

Correct Answer: 1

Rationale 1: Autocrine regulation occurs when hormones communicate with the cells producing them to indicate levels are sufficient.

Rationale 2: Blood-borne communication occurs when hormones travel through the circulation to target organs.

Rationale 3: Paracrine communication occurs when hormones diffuse through interstitial fluids and act on cellular receptors in neighboring cells.

Rationale 4: Hormonal communication integration with the nervous system occurs in neuroendocrine communication.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 45-3

Question 14

Type: MCMA

A patient reports to the clinic with complaints of nervousness, weight changes, and a general feeling of ill health. History reveals that the patient recently took a demanding new job that requires frequent air travel across the country. The nurse recognizes which risk factors for endocrine disturbance?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Probable exposure to unfamiliar infection pathogens

2. Psychological stress from the new job

3. Physiological stress of travel

4. Disruption of circadian rhythms

5. Ingestion of unfamiliar foods and beverages

Correct Answer: 2,3,4

Rationale 1: While this patient may have contracted an infection, this is not a likely cause of an endocrine disorder.

Rationale 2: Psychological stress can disrupt levels of hormones such as cortisol.

Rationale 3: Physiological stressors from frequent travel include dehydration and immobility. Physiological stress can disrupt hormonal levels.

Rationale 4: Frequent time zone changes may cause sleep disruption, which can result in hormonal imbalance.

Rationale 5: The patient may be eating and drinking things that are not familiar, but this is not likely to cause endocrine disruption.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 45-3

Question 15

Type: MCSA

A patient has not eaten in 12 hours, and the blood sugar is low. The patients endocrine system has suppressed the production of insulin. Which form of endocrine communication does this condition represent?

1. Positive feedback

2. Unregulated response

3. Free steroidal influence

4. Negative feedback

Correct Answer: 4

Rationale 1: Positive feedback is a linear relationship in which the original stimulus is promoted. If this were a positive feedback situation, insulin production would increase.

Rationale 2: The blood sugar-insulin production system is closely regulated.

Rationale 3: Free steroidal influence is not a means of blood sugar control.

Rationale 4: Negative feedback represents a reciprocal relationship between a stimulus and a hormone. In this instance, the low blood sugar influences the body to reduce the amount of insulin produced.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 45-3

Question 16

Type: MCMA

The nurse is preparing to conduct physical assessment of a patients endocrine system. The nurse will include palpation of which glands in this assessment?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Adrenal

2. Pancreas

3. Thyroid

4. Pituitary

5. Ovaries

Correct Answer: 3,5

Rationale 1: The adrenal glands are located on the top of the superior pole of the kidney and cannot be palpated.

Rationale 2: The pancreas is a deep abdominal organ and cannot be easily palpated.

Rationale 3: The thyroid is often visible and can easily be palpated during assessment.

Rationale 4: The pituitary gland is deep in the brain and cannot be palpated.

Rationale 5: The ovaries are accessible for direct palpation.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 45-4

Question 17

Type: MCMA

The nurse is collecting patient history information as part of the initial clinic visit. Which patient statements would the nurse note as indicating a possible endocrine disorder?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. I am tired all the time, but I have trouble sleeping at night.

2. I have gained 20 pounds since I retired.

3. I havent found very many gray hairs yet.

4. My appetite has not been very good recently.

5. I have burning when I urinate.

Correct Answer: 1,2,4

Rationale 1: Changes in sleep pattern and activity tolerance are core symptoms of several endocrine disorders.

Rationale 2: Weight change is a core symptom of several endocrine disorders.

Rationale 3: Graying of the hair is an expected effect of aging and does not indicate an endocrine disorder.

Rationale 4: Appetite change is a core symptom of many endocrine disorders.

Rationale 5: Burning with urination may indicate infection but is not usually associated with an endocrine disorder.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 45-4

Question 18

Type: MCMA

A patient with several adult-onset endocrine disorders is concerned that his children may develop similar problems as they grow older. Which information should the nurse provide?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Endocrine disorders are not known to be genetically transmitted.

2. The tendency toward development of some endocrine disorders seems to cluster in families.

3. It is too late to worry about that now, so we just need to be certain your children are well taken care of as adults.

4. The current thinking is that it takes both a genetic tendency and environmental influences to cause some endocrine disorders.

5. Some of these disorders seem to be autoimmune in nature, so genetics is not a factor.

Correct Answer: 2,4

Rationale 1: Thyroid disease and diabetes are two examples of endocrine disorders that may have genetic links.

Rationale 2: Epidemiology reveals that some endocrine disorders seem to occur more frequently in some families than in others.

Rationale 3: Telling the patient that it is too late to worry is not therapeutic.

Rationale 4: Current research indicates that environmental influences on a patient with genetic tendency toward some endocrine disorders may result in expression of the disease.

Rationale 5: Type 1 diabetes and autoimmune thyroid disease are two disorders that may have both genetic and environmental causative factors. Genetic predisposition may exist.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 45-4

Question 19

Type: MCSA

A patient presents to the emergency department with reports of suddenly feeling exhausted. The patient reports loss of appetite, inability to sleep, and weight gain of 5 pounds over the last week. Which finding would the nurse evaluate as being least suggestive of an endocrine disorder?

1. Weight gain

2. Inability to sleep.

3. Sudden exhaustion

4. Loss of appetite

Correct Answer: 3

Rationale 1: Endocrine disorders can result in weight loss or gain.

Rationale 2: Endocrine disorders can result in sleep disturbances.

Rationale 3: The sudden onset of symptomology is not common with endocrine disorders.

Rationale 4: Endocrine disorders can cause appetite changes.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 45-4

Question 20

Type: MCSA

During an endocrine assessment, the nurse asks specific questions about the patients employment. What rationale would the nurse provide for this line of questioning?

1. Occupational exposure to some toxic chemicals may be implicated in the development of endocrine disorders.

2. People in occupations that require sitting for long periods are at higher risk for endocrine disorders.

3. People who are exposed to environmental tobacco smoke are at high risk for development of thyroid disorders.

4. People working in occupations requiring lifting are at higher risk for development of adrenal disorders.

Correct Answer: 1

Rationale 1: Some toxic chemicals may be implicated in the development of endocrine disorders.

Rationale 2: There is no evidence that sitting for long periods is implicated in the development of endocrine disorders.

Rationale 3: There is no indication that exposure to environmental tobacco smoke increases the risk for thyroid disorders.

Rationale 4: There is no indication that lifting is associated with adrenal disorders.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 45-4

Question 21

Type: MCSA

A 70-year-old woman comes to the emergency department with a history of confusion and increasing depression over the last week. Auscultation of the heart and lungs reveals fine crackles and an S3 heart sound. Among other possible etiologies, the nurse considers which endocrine disorder?

1. Hypothyroidism

2. Graves disease

3. Diabetes mellitus

4. Deficiency of luteinizing hormone

Correct Answer: 1

Rationale 1: Older adults with hypothyroidism are more likely to present with heart failure symptoms and cognitive impairment than are younger patients.

Rationale 2: Graves disease is a form of hyperthyroidism, which would more likely present with cardiac dysrhythmia.

Rationale 3: Diabetes mellitus would be unlikely to present initially with depression and fluid volume overload.

Rationale 4: Luteinizing hormone stimulates ovulation, estrogen, and progesterone secretion in females. It is not likely to be a factor in a 70-year-old woman.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 45-4

Question 22

Type: MCSA

The nurse is conducting an endocrine assessment on a patient with cognitive impairment. Which nursing action is indicated?

1. Defer palpation of the thyroid.

2. Perform the palpation from in front of the patient.

3. Use standard palpation technique from behind the patient.

4. Have the caretaker hold the patients head still during the exam.

Correct Answer: 2

Rationale 1: Thyroid palpation is an integral part of endocrine assessment and should not be deferred.

Rationale 2: The patient is likely to be calmer if the nurse is in sight.

Rationale 3: If the patient has cognitive impairment, approaching from behind and placing hands on the neck may cause anxiety.

Rationale 4: The combination of having a strangers hands on the neck and being held by the caretaker may cause extreme anxiety in this patient.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 45-4

Question 23

Type: MCSA

During an endocrine assessment, the nurse notes that the patients heart rate is sustained at 160 beats per minute. The patient reports nervousness but has no loss of consciousness or reduced mentation. What nursing intervention is priority?

1. Ask how long the patients heart has been beating so fast.

2. Note the findings in the patients medical record.

3. Notify the health care provider immediately.

4. Have the patient ambulate around the room and reassess.

Correct Answer: 3

Rationale 1: While onset of symptomology is always important, this is not the priority nursing intervention.

Rationale 2: Documentation is important but is not the priority nursing intervention.

Rationale 3: This heart rate is dangerous and the patient may decompensate rapidly. Pharmacologic intervention is probably indicated until more definitive treatment can be given.

Rationale 4: The patients heart rate will not decrease with the added physiologic stress of walking.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 45-4

Question 24

Type: MCSA

A patient is diagnosed with secondary hypothyroidism. The nurse would expect which laboratory test result?

1. Low triiodothyronine level

2. Low thyroid-stimulating hormone (TSH) level

3. Low thyroxine level

4. Low thyrotropin-releasing hormone level

Correct Answer: 2

Rationale 1: Low triiodothyronine results in primary hypothyroidism.

Rationale 2: Low TSH from the anterior pituitary gland results in secondary hypothyroidism.

Rationale 3: A low thyroxine level results in primary hypothyroidism.

Rationale 4: A low thyrotopin-releasing hormone level results in tertiary hypothyroidism.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 45-5

Question 25

Type: MCSA

A patient is scheduled for an ACTH stimulation test as part of endocrine evaluation. What information should the nurse provide as preparation for this test?

1. At least two blood samples will be drawn.

2. Wear comfortable clothing and supportive shoes for this exam.

3. You will be asked to swallow some medication during X-ray examination.

4. You should not drive for at least 12 hours after this exam.

Correct Answer: 1

Rationale 1: A baseline blood sample will be drawn and at least one additional blood sample after the ACTH is administered.

Rationale 2: Clothing is not a factor in the completion of this test.

Rationale 3: ACTH stimulation testing does not include radiological exams.

Rationale 4: There is no indication that driving should be avoided for 12 hours.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 45-5

Question 26

Type: MCMA

A patient with assessment findings suggesting acromegaly is scheduled for a growth hormone suppression test. The nurse would prepare the patient for this test with which information?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Several blood samples will be drawn for this test.

2. You will be asked to drink a solution of glucose.

3. You will be asked to assume several positions as X-rays are taken.

4. Contrast media that includes iodine will be administered intravenously.

5. Your urine will be collected for 24 hours.

Correct Answer: 1,2

Rationale 1: A baseline sample will be drawn as well as several post-test samples.

Rationale 2: Hyperglycemia suppresses growth hormone. Ingestion of 75 to 100 grams of glucose is part of the testing.

Rationale 3: Radiology is not a part of this test.

Rationale 4: Contrast media is not required for this test.

Rationale 5: Urine collection is not part of this test.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 45-5

Question 27

Type: MCSA

A patient is scheduled for a thyroid scan. The nurse should specifically ask the patient about possible allergy to which substance?

1. Penicillin

2. Iodine

3. Citrus fruit

4. Sulfa drugs

Correct Answer: 2

Rationale 1: Penicillin allergy is not a factor in a thyroid scan.

Rationale 2: The patient having a thyroid scan will be asked to swallow an iodine-containing substance. The nurse should specifically ask about iodine or shellfish allergy.

Rationale 3: Allergy to citrus fruit is not a factor in a thyroid scan.

Rationale 4: Allergy to sulfa drugs is not a factor in a thyroid scan.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 45-5

Question 28

Type: MCMA

Which information should the nurse provide for a patient scheduled for an MRI procedure as part of endocrine assessment?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. You will need to take out your earrings when you get in the MRI suite.

2. I will remove your transdermal medication patch before you go to the MRI suite.

3. Be certain to report any permanent cosmetic or other tattoos to the MRI technologist before you enter the MRI suite.

4. I will help you remove your dentures before you go to the MRI suite.

5. We will tape over the top of your wedding ring so that you can wear it during the procedure.

Correct Answer: 2,3,4

Rationale 1: The MRI magnet is always on, so all metal must be removed prior to entering the suite.

Rationale 2: Some transdermal medication patches include metal components that may react adversely during MRI.

Rationale 3: Some permanent cosmetics or other tattoos may react adversely with MRI technology.

Rationale 4: Dentures often have metal components that will react adversely in the MRI environment.

Rationale 5: Metal rings should be removed before entering the MRI environment.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 45-5

Question 29

Type: MCMA

The patient is scheduled for an MRI using gadolinium contract medium. The nurse would teach the patient that which mild reactions are considered common and can be expected?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Headache

2. Nausea

3. Dizziness

4. Swelling of the lips

5. Dyspnea

Correct Answer: 1,2,3

Rationale 1: Headache is a minor adverse reaction of this contrast medium.

Rationale 2: Transient nausea may occur when the contrast medium is injected.

Rationale 3: Dizziness may occur but is transient.

Rationale 4: Swelling of the lips is a severe adverse reaction and occurs rarely.

Rationale 5: Dyspnea is a severe adverse reaction and occurs rarely.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 45-5

Question 30

Type: MCSA

A patient is scheduled for MRI with gadolinium contrast. The nurse should review the medical record for which essential baseline test?

1. Kidney function

2. Chest X-ray

3. CBC with differential

4. Presence of pedal pulses

Correct Answer: 1

Rationale 1: Gadolinium is cleared through the renal system. People with reduced kidney function should not be exposed to this contrast medium.

Rationale 2: There is no indication that a chest X-ray is essential.

Rationale 3: CBC with differential is often drawn as part of admission lab but has no particular importance to the use of gadolinium.

Rationale 4: Checking for the presence of pedal pulses has no particular significance to the use of gadolinium.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 45-5

 

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