Chapter 47 Lewis Med Surg

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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.

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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.

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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 patient's 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.