Assessing The Endocrine System Ch18 Verified Test Bank - Medical Surgical Nursing 7e | Test Bank by LeMone, Burke, Bauldoff by LeMone, Burke, Gerene Bauldoff. DOCX document preview.
LeMone & Burke's Medical-Surgical Nursing, 7e (Bauldoff/Gubrud/Carno)
Chapter 18 Assessing the Endocrine System
1) The nurse is assessing a patient diagnosed with hypothyroidism. Which health assessment interview question should the nurse ask this patient?
1. "Is your skin feeling rough and dry?"
2. "Is your skin smooth or flushed?"
3. "Does your skin feel clammy?"
4. "Do you have brown, shiny patches on the lower extremities?"
Page Ref: 554
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance: Techniques of Physical Assessment
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 18.2 Outline the components of the assessment of the endocrine system including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.
MNL Learning Outcome: 1. Utilize appropriate techniques to perform a health history and physical assessment of the endocrine system.
2) When measuring the blood pressure of a patient with hypoparathyroidism, the nurse notes spasms of the patient's hand. How should the nurse document this finding?
1. Trousseau sign
2. Chvostek sign
3. Turner sign
4. Cullen sign
Page Ref: 555
Cognitive Level: Applying
Client Need & Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment/Communication and Documentation
Learning Outcome: 18.2 Outline the components of the assessment of the endocrine system including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.
MNL Learning Outcome: 3. Interpret abnormal findings of the endocrine system collected during assessment.
3) A patient has a positive Trousseau sign. For which health problem should the nurse plan care for this patient?
1. Pain
2. Excessive fluid
3. Difficulty breathing
4. Reduced blood flow
Page Ref: 555
Cognitive Level: Applying
Client Need & Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 18.2 Outline the components of the assessment of the endocrine system including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.
MNL Learning Outcome: 3. Interpret abnormal findings of the endocrine system collected during assessment.
4) During an endocrine assessment, the nurse asks a patient about changes in weight. For which organ is the nurse assessing function in the patient? Select all that apply.
1. Adrenal
2. Thyroid
3. Pituitary
4. Parathyroid
5. Gonads
Page Ref: 551-552
Cognitive Level: Analyzing
Client Need & Sub: Health Promotion and Maintenance: Techniques of Physical Assessment
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 18.1 Describe the anatomy, physiology, and functions of the endocrine glands and hormones, and identify abnormal findings that may indicate impairment of the endocrine system.
MNL Learning Outcome: 1. Utilize appropriate techniques to perform a health history and physical assessment of the endocrine system.
5) The nurse is assessing a patient with a pituitary disorder. Which finding should the nurse expect to assess in this patient?
1. Enlargement of the hands and feet
2. Thin, soft hair
3. Excessive growth of facial hair
4. Purple striae over the trunk
Page Ref: 105
Cognitive Level: Analyzing
Client Need & Sub: Health Promotion and Maintenance: Techniques of Physical Assessment
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 18.2 Outline the components of the assessment of the endocrine system including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.
MNL Learning Outcome: 3. Interpret abnormal findings of the endocrine system collected during assessment.
6) A patient is demonstrating signs of exophthalmos. What additional finding should the nurse expect to assess in this patient?
1. Enlarged thyroid gland
2. Dry, thick nails
3. Dry skin
4. Decreased reflexes
Page Ref: 555
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance: Techniques of Physical Assessment
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 18.2 Outline the components of the assessment of the endocrine system including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.
MNL Learning Outcome: 3. Interpret abnormal findings of the endocrine system collected during assessment.
7) The nurse is reviewing data collected during a patient's health history. What information would indicate a disorder of the pituitary gland?
1. Dwarfism
2. Carpal spasms
3. Enlarged thyroid nodule
4. Hyperpigmentation of the skin
Page Ref: 555
Cognitive Level: Analyzing
Client Need & Sub: Health Promotion and Maintenance: Techniques of Physical Assessment
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 18.2 Outline the components of the assessment of the endocrine system including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.
MNL Learning Outcome: 3. Interpret abnormal findings of the endocrine system collected during assessment.
8) The nurse is caring for a patient with Graves disease. On which laboratory value should the nurse focus for this patient?
1. Thyroid antibodies
2. Urine-specific gravity
3. Cortisol
4. Calcium
Page Ref: 557
Cognitive Level: Analyzing
Client Need & Sub: Health Promotion and Maintenance: Techniques of Physical Assessment
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 18.2 Outline the components of the assessment of the endocrine system including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.
MNL Learning Outcome: 1. Utilize appropriate techniques to perform a health history and physical assessment of the endocrine system.
9) The nurse is conducting a physical assessment with a patient. Which assessment technique should the nurse use to assess the patient's thyroid gland?
1. Stand behind the patient and palpate the thyroid.
2. Stand in front of the patient and palpate the thyroid.
3. Place the patient supine and palpate one side of the neck at a time.
4. Have the patient flex the neck forward and palpate the thyroid.
Page Ref: 555
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance: Techniques of Physical Assessment
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 18.2 Outline the components of the assessment of the endocrine system including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.
MNL Learning Outcome: 1. Utilize appropriate techniques to perform a health history and physical assessment of the endocrine system.
10) The nurse is beginning the assessment of a patient with an endocrine disorder. What should the nurse include in this assessment? Select all that apply.
1. Height and weight
2. Skin, hair, and nails
3. Deep tendon reflexes
4. Musculoskeletal system
5. Respiratory system
Page Ref: 554-555
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance: Techniques of Physical Assessment
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 18.2 Outline the components of the assessment of the endocrine system including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.
MNL Learning Outcome: 1. Utilize appropriate techniques to perform a health history and physical assessment of the endocrine system.
11) The nurse is assessing an older patient with type 2 diabetes mellitus. What age-related endocrine change should the nurse expect in this patient?
1. Decreased sensitivity to insulin
2. More rapid insulin release
3. Intolerance of fatty foods
4. Lower and prolonged blood glucose levels
Page Ref: 561
Cognitive Level: Analyzing
Client Need & Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 18.3 Differentiate considerations for assessing the endocrine system of older adults, veterans, individuals in the LGBTQI population, and adults with sequelae of childhood/congenital conditions.
MNL Learning Outcome: 3. Interpret abnormal findings of the endocrine system collected during assessment.
12) A patient is having a 17-keosteroid test performed. What statement by the patient indicates that teaching about this test has been effective?
1. "I will store the specimen container in the refrigerator."
2. "I shouldn't eat or drink anything before this test."
3. "I know this test will be helpful in diagnosing my thyroid problem."
4. "I will arrive early to have my blood drawn."
Page Ref: 559
Cognitive Level: Analyzing
Client Need & Sub: Physiological Integrity: Reduction of Risk Potential
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Evaluation/Teaching/Learning
Learning Outcome: 18.2 Outline the components of the assessment of the endocrine system including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.
MNL Learning Outcome: 4. Recognize the purpose of and related nursing interventions for patients undergoing diagnostic tests for assessment of the endocrine system.
13) The nurse is conducting a health assessment interview with a patient. What should the nurse include when assessing the patient's endocrine system? Select all that apply.
1. Occupation
2. Use of alcohol, drugs, and tobacco
3. Lifestyle
4. Exercise and sleep patterns
5. Alterations in bowel habits
Page Ref: 554
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance: Techniques of Physical Assessment
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 18.2 Outline the components of the assessment of the endocrine system including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.
MNL Learning Outcome: 1. Utilize appropriate techniques to perform a health history and physical assessment of the endocrine system.
14) The nurse is conducting a health interview with a female patient. What should the nurse ask that focuses on the endocrine system?
1. "Is your menstrual cycle regular?"
2. "Do you have children?"
3. "Are you able to provide for your children?"
4. "How old were you when your menses first began?"
Page Ref: 554
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance: Techniques of Physical Assessment
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 18.2 Outline the components of the assessment of the endocrine system including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.
MNL Learning Outcome: 1. Utilize appropriate techniques to perform a health history and physical assessment of the endocrine system.
15) A patient is experiencing severe hypertension. Which endocrine gland should the nurse suspect is causing this patient's health problem?
1. Adrenal
2. Thyroid
3. Parathyroid
4. Gonads
Page Ref: 551
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance: Techniques of Physical Assessment
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 18.1 Describe the anatomy, physiology, and functions of the endocrine glands and hormones, and identify abnormal findings that may indicate impairment of the endocrine system.
MNL Learning Outcome: 1. Utilize appropriate techniques to perform a health history and physical assessment of the endocrine system.
16) An older adult patient reports ingesting a fat-soluble vitamin every day to boost the endocrine system. For what age-related change does the nurse recognize the patient is addressing by taking this vitamin?
1. The ability to absorb fat-soluble vitamins declines with aging.
2. Lipase production is increased and results in fat intolerance.
3. Older patients have increased resistance to insulin.
4. Indigestion increases with aging due to decreased lipase production.
Page Ref: 561
Cognitive Level: Analyzing
Client Need & Sub: Health Promotion and Maintenance: Aging Process
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 18.3 Differentiate considerations for assessing the endocrine system of older adults, veterans, individuals in the LGBTQI population, and adults with sequelae of childhood/congenital conditions.
MNL Learning Outcome: 2. Recognize normal findings of the endocrine system collected during assessment and health promotion activities to support the health of this body system.
17) The nurse is assessing an older patient for genetic influences on the endocrine system. What should the nurse ask this patient during the assessment? Select all that apply.
1. "Do you have any family members with diabetes mellitus?"
2. "Is there a pattern of obesity in your family?"
3. "Has anyone in your family been diagnosed with Hashimoto disease?"
4. "How do you cope with stress?"
5. "Have you noticed any changes in coloration of your skin?"
Page Ref: 554, 561
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance: Aging Process
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 18.3 Differentiate considerations for assessing the endocrine system of older adults, veterans, individuals in the LGBTQI population, and adults with sequelae of childhood/congenital conditions.
MNL Learning Outcome: 1. Utilize appropriate techniques to perform a health history and physical assessment of the endocrine system.
18) During a focused endocrine assessment, a patient states that a brother has fragile X syndrome. What should the nurse recall about this health problem?
1. It is an endocrine disorder having a genetic basis.
2. It is not a relevant issue since the patient is female.
3. It is a health condition separate from the endocrine system.
4. It is a blood disorder.
Page Ref: 554
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 18.2 Outline the components of the assessment of the endocrine system including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.
MNL Learning Outcome: 1. Utilize appropriate techniques to perform a health history and physical assessment of the endocrine system.
19) A patient is scheduled for surgery to remove a tumor of the anterior pituitary. Which hormone should the nurse expect to be affected by this surgery? Select all that apply.
1. Adrenocorticotropic hormone (ACTH)
2. Thyroid stimulating hormone (TSH)
3. Gonadotropin hormones
4. Prolactin
5. Oxytocin
Page Ref: 549
Cognitive Level: Analyzing
Client Need & Sub: Physiological Integrity: Reduction of Risk Potential
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 18.1 Describe the anatomy, physiology, and functions of the endocrine glands and hormones, and identify abnormal findings that may indicate impairment of the endocrine system.
MNL Learning Outcome: 1. Utilize appropriate techniques to perform a health history and physical assessment of the endocrine system.
20) While instructing a patient on pain relief, the nurse uses the example of endorphins as endocrine hormones, which act locally at the site of injury. What route of hormone transport is the nurse explaining?
1. Paracrine method
2. Direct release into the bloodstream
3. Neuroendocrine route
4. Nerve cell extension into the posterior pituitary
Page Ref: 552
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning
Learning Outcome: 18.1 Describe the anatomy, physiology, and functions of the endocrine glands and hormones, and identify abnormal findings that may indicate impairment of the endocrine system.
MNL Learning Outcome: 2. Recognize normal findings of the endocrine system collected during assessment and health promotion activities to support the health of this body system.
21) The nurse is completing an endocrine-focused health assessment interview with an older adult. What finding should the nurse suspect is related to an age-related change in the patient's thyroid function?
1. Inability to tolerate heat and cold
2. Indigestion and intolerance of fatty foods
3. Increased facial hair
4. Enlarged nose, hands, and feet
Page Ref: 561
Cognitive Level: Analyzing
Client Need & Sub: Health Promotion and Maintenance: Aging Process
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 18.3 Differentiate considerations for assessing the endocrine system of older adults, veterans, individuals in the LGBTQI population, and adults with sequelae of childhood/congenital conditions.
MNL Learning Outcome: 2. Recognize normal findings of the endocrine system collected during assessment and health promotion activities to support the health of this body system.
22) The nurse is instructing a patient with low levels of circulating thyroid hormone. Food containing which nutrient should the nurse encourage the patient to increase the consumption?
1. Iodine
2. Calcium
3. Phosphorus
4. Vitamin D
Page Ref: 550
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning
Learning Outcome: 18.1 Describe the anatomy, physiology, and functions of the endocrine glands and hormones, and identify abnormal findings that may indicate impairment of the endocrine system.
MNL Learning Outcome: 2. Recognize normal findings of the endocrine system collected during assessment and health promotion activities to support the health of this body system.
23) The nurse is conducting an interview with an adult female patient. Which question should the nurse ask that focuses on genetic factors that influence the endocrine system? Select all that apply.
1. Did you have any difficulties with your pregnancies?
2. What was the pattern and characteristics of your menstrual cycle?
3. Did you have any problems related to menopause?
4. Have you noticed any changes in your breasts?
5. Have you noticed any changes in the color of your urine or feces?
Page Ref: 554
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance: Techniques of Physical Assessment
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 18.2 Outline the components of the assessment of the endocrine system including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.
MNL Learning Outcome: 1. Utilize appropriate techniques to perform a health history and physical assessment of the endocrine system.
24) A patient is demonstrating symptoms of dehydration and excessive urination. Which hormone should the nurse suspect is causing this patient's symptoms?
1. Antidiuretic hormone (ADH)
2. Adrenocorticotropic hormone (ACTH)
3. Follicle-stimulating hormone (FSH)
4. Thyroid-stimulating hormone (TSH)
Page Ref: 550
Cognitive Level: Analyzing
Client Need & Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 18.1 Describe the anatomy, physiology, and functions of the endocrine glands and hormones, and identify abnormal findings that may indicate impairment of the endocrine system.
MNL Learning Outcome: 3. Interpret abnormal findings of the endocrine system collected during assessment.
25) The nurse suspects that a patient is experiencing a response to stress. By which route should the nurse expect hormone transport to be conducted in this stress response?
1. Neuroendocrine
2. Paracrine
3. Portal
4. Nerve cell extension
Page Ref: 552
Cognitive Level: Analyzing
Client Need & Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 18.1 Describe the anatomy, physiology, and functions of the endocrine glands and hormones, and identify abnormal findings that may indicate impairment of the endocrine system.
MNL Learning Outcome: 1. Utilize appropriate techniques to perform a health history and physical assessment of the endocrine system.
26) The nurse is assessing a patient for Trousseau sign. In which order should the nurse conduct this assessment? Place in order the steps of the process.
Choice 1. Inflate the cuff.
Choice 2. Wait 2‒5 minutes.
Choice 3. Note a point greater than systolic blood pressure.
Choice 4. Place a blood pressure cuff above the antecubital space.
Choice 5. Observe for carpal spasms in the patient's hands and fingers.
Page Ref: 555
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance: Techniques of Physical Assessment
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 18.2 Outline the components of the assessment of the endocrine system including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.
MNL Learning Outcome: 3. Interpret abnormal findings of the endocrine system collected during assessment.
27) A patient has been experiencing fatigue and prolonged symptoms of a cold that started after beginning a new job and a family member moved in. Which reaction should the nurse suspect is occurring in this patient?
1. An increase in glucocorticoid secretion
2. An increase in epinephrine secretion
3. A drop in mineralocorticoid secretion
4. A reduction in norepinephrine secretion
Page Ref: 551
Cognitive Level: Analyzing
Client Need & Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 18.1 Describe the anatomy, physiology, and functions of the endocrine glands and hormones, and identify abnormal findings that may indicate impairment of the endocrine system.
MNL Learning Outcome: 3. Interpret abnormal findings of the endocrine system collected during assessment.
28) A patient who is scheduled to have a hemoglobin A1C level drawn asks about the purpose of the test. How should the nurse respond to this patient?
1. "It's to check for pancreas functioning."
2. "It's a blood test to check for kidney functioning."
3. "It's to check for thyroid functions."
4. "It's a blood test to check for menopausal symptoms."
Page Ref: 560
Cognitive Level: Analyzing
Client Need & Sub: Physiological Integrity: Reduction of Risk Potential
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning
Learning Outcome: 18.2 Outline the components of the assessment of the endocrine system including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.
MNL Learning Outcome: 4. Recognize the purpose of and related nursing interventions for patients undergoing diagnostic tests for assessment of the endocrine system.
29) The nurse is planning to assess a patient's endocrine system. What should the nurse expect to perform on this patient?
1. Palpation of the thyroid gland
2. Palpation of the pancreas
3. Percussion of the adrenal glands
4. Palpation of the parathyroid glands
Page Ref: 554
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance: Techniques of Physical Assessment
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 18.2 Outline the components of the assessment of the endocrine system including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.
MNL Learning Outcome: 1. Utilize appropriate techniques to perform a health history and physical assessment of the endocrine system.
30) During an assessment, the nurse notes that the patient's eyes are extremely wide open and bulging. With which health problem is this finding associated?
1. Hyperthyroidism
2. Diabetes mellitus
3. Hypofunction of the adrenal glands
4. Hypofunction of the anterior pituitary gland
Page Ref: 555
Cognitive Level: Analyzing
Client Need & Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 18.2 Outline the components of the assessment of the endocrine system including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.
MNL Learning Outcome: 3. Interpret abnormal findings of the endocrine system collected during assessment.
31) The nurse is assessing a patient. What health problem should the nurse suspect is caused by abnormally high levels of growth hormone in a patient?
1. Acromegaly
2. Dwarfism
3. Hirsutism
4. Gynecomastia
Page Ref: 555
Cognitive Level: Analyzing
Client Need & Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 18.2 Outline the components of the assessment of the endocrine system including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.
MNL Learning Outcome: 3. Interpret abnormal findings of the endocrine system collected during assessment.
32) A patient is demonstrating symptoms of hypocalcemic tetany. What assessment should the nurse conduct to determine the patient's health problem?
1. Tap a finger in front of the patient's ear at the angle of the jaw.
2. Place a tuning fork over one of the patient's fingers.
3. Measure the patient's blood pressure.
4. Measure capillary blood.
Page Ref: 555
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance: Techniques of Physical Assessment
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 18.2 Outline the components of the assessment of the endocrine system including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.
MNL Learning Outcome: 3. Interpret abnormal findings of the endocrine system collected during assessment.
33) An older patient who is seen in the clinic has a palpable thyroid gland. What should the nurse realize this finding indicates?
1. Normal finding in the older patient
2. Onset of hypertension
3. Onset of diabetes mellitus
4. Explanation for a reduced urine output
Page Ref: 561
Cognitive Level: Analyzing
Client Need & Sub: Health Promotion and Maintenance: Aging Process
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 18.3 Differentiate considerations for assessing the endocrine system of older adults, veterans, individuals in the LGBTQI population, and adults with sequelae of childhood/congenital conditions.
MNL Learning Outcome: 2. Recognize normal findings of the endocrine system collected during assessment and health promotion activities to support the health of this body system.
34) A patient being treated with medication for a seizure disorder is scheduled for a serum T3 and T4 level. What results should the nurse expect for these levels?
1. Falsely reduced
2. Falsely elevated
3. Normal
4. Pending parathyroid hormone disease
Page Ref: 557-558
Cognitive Level: Analyzing
Client Need & Sub: Physiological Integrity: Reduction of Risk Potential
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 18.2 Outline the components of the assessment of the endocrine system including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.
MNL Learning Outcome: 4. Recognize the purpose of and related nursing interventions for patients undergoing diagnostic tests for assessment of the endocrine system.
35) A patient has a low cortisol level. With which health problem is this finding associated?
1. Addison disease
2. Hyperthyroidism
3. Cushing syndrome
4. Diabetes mellitus
Page Ref: 559
Cognitive Level: Analyzing
Client Need & Sub: Physiological Integrity: Reduction of Risk Potential
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 18.2 Outline the components of the assessment of the endocrine system including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.
MNL Learning Outcome: 3. Interpret abnormal findings of the endocrine system collected during assessment.
36) A patient is pleased to learn that an oral glucose tolerance test is not needed after having a fasting blood glucose level drawn. What should the nurse explain as the reason for the oral glucose tolerance test to be cancelled?
1. Consistently high fasting blood glucose levels
2. No evidence of type 1 diabetes mellitus
3. Normal renal functioning
4. Normal liver functioning
Page Ref: 560
Cognitive Level: Applying
Client Need & Sub: Physiological Integrity: Reduction of Risk Potential
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.4. Communicate effectively with all members of the healthcare team, including the patient and the patient's support network | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 18.2 Outline the components of the assessment of the endocrine system including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.
MNL Learning Outcome: 3. Interpret abnormal findings of the endocrine system collected during assessment.
37) The nurse suspects that a patient is experiencing a response caused by the hormones of the adrenal medulla. What did the nurse assess to come to this conclusion? Select all that apply.
1. Heart rate 112 beats per minute
2. Cold extremities
3. Respiratory rate 24 breaths per minute
4. Urine output 10 mL/hr
5. Blood glucose level 142 mg/dL
Page Ref: 551
Cognitive Level: Analyzing
Client Need & Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 18.1 Describe the anatomy, physiology, and functions of the endocrine glands and hormones, and identify abnormal findings that may indicate impairment of the endocrine system.
MNL Learning Outcome: 3. Interpret abnormal findings of the endocrine system collected during assessment.
38) The nurse is reviewing the function of the pancreas with a patient who is newly diagnosed with diabetes mellitus. When discussing this organ's function, on which cell type should the nurse focus? Select all that apply.
1. F cells
2. Beta cells
3. Delta cells
4. Alpha cells
5. Omega cells
Page Ref: 551
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance: Techniques of Physical Assessment
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning
Learning Outcome: 18.1 Describe the anatomy, physiology, and functions of the endocrine glands and hormones, and identify abnormal findings that may indicate impairment of the endocrine system.
MNL Learning Outcome: 3. Interpret abnormal findings of the endocrine system collected during assessment.
39) A patient is scheduled for a water deprivation test. What should the nurse instruct the patient to prepare for this test? Select all that apply.
1. Expect this test to take 16 hours to complete.
2. Abstain from smoking as directed by the healthcare provider.
3. A sedative will be provided prior to the beginning of the test.
4. Do not eat or drink anything as directed by the healthcare provider.
5. Blood and urine samples will be collected every hour during the test.
Page Ref: 556
Cognitive Level: Applying
Client Need & Sub: Physiological Integrity: Reduction of Risk Potential
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning
Learning Outcome: 18.2 Outline the components of the assessment of the endocrine system including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.
MNL Learning Outcome: 4. Recognize the purpose of and related nursing interventions for patients undergoing diagnostic tests for assessment of the endocrine system.
40) During a physical assessment the nurse suspects a patient is experiencing hypothyroidism. What skin assessment finding did the nurse use to make this assumption? Select all that apply.
1. Rough, dry skin
2. Smooth, flushed skin
3. Yellowish cast to the skin
4. Areas of hyperpigmentation
5. Purple striae over the abdomen
Page Ref: 554
Cognitive Level: Analyzing
Client Need & Sub: Health Promotion and Maintenance: Techniques of Physical Assessment
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 18.2 Outline the components of the assessment of the endocrine system including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.
MNL Learning Outcome: 3. Interpret abnormal findings of the endocrine system collected during assessment.
41) The nurse is preparing material to present during a community health fair. Which information about type 2 diabetes mellitus should the nurse include? Select all that apply.
1. Control weight.
2. Choose healthy family meals.
3. Increase amount of exercise.
4. Engage in a walking program.
5. Reduce the intake of saturated fats.
Page Ref: 562
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: VII.5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral and follow-up throughout the lifespan | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Planning/Teaching/Learning
Learning Outcome: 18.4 Summarize topics that nurses teach to promote healthy endocrine function across the lifespan.
MNL Learning Outcome: 2. Recognize normal findings of the endocrine system collected during assessment and health promotion activities to support the health of this body system.
42) A public health report was published that identified high exposure to bisphenol A (BPA) in a community. On what should the nurse focus when sharing this information during a community town hall meeting? Select all that apply.
1. Identify food containers with BPA.
2. Avoid using food containers with BPA.
3. Receive a vaccination to prevent BPA toxicity.
4. Have laboratory studies to measure BPA levels.
5. Avoid purchasing food items in containers with BPA.
Page Ref: 562
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: VII.5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral and follow-up throughout the lifespan | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Planning/Teaching/Learning
Learning Outcome: 18.4 Summarize topics that nurses teach to promote healthy endocrine function across the lifespan.
MNL Learning Outcome: 2. Recognize normal findings of the endocrine system collected during assessment and health promotion activities to support the health of this body system.
Document Information
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