(64) Which hormone levels should the nurse expect to change in response to a client receiving a continuous cortisol infusion over a 24-hour period when the endocrine negative feedback mechanism is functioning properly?
A. Higher-than-normal serum cortisol levels; lower-than-normal serum ACTH levels
Rationale: The infusing cortisol increases the serum cortisol levels. These increased levels suppress the release of corticotropic releasing hormone (CRH) from the hypothalamus, which inhibits secretion of adrenocorticotropic hormone (ACTH) from the anterior pituitary. Thus serum cortisol levels are higher than normal and serum ACTH levels are lower than normal.
(64) The nurse is reviewing these laboratory test results for a client admitted with a possible pituitary disorder. Which information has the most immediate implication for the client's care?
A. Serum sodium 110 mEq/L
Incorrect: The normal range for fasting blood glucose is 60 to 110mg/dL. A blood glucose of 125 mg/dL is high but is not considered dangerous.
Incorrect: The normal range for blood urea nitrogen (BUN) is 7 to 20 mg/dL, so a result of 40 mg/dL is high. An elevated BUN can be an indication of kidney failure, dehydration, fever, increased protein intake, and shock. This client should have a creatinine drawn for a more complete picture of kidney function.
Incorrect: The normal range for serum potassium is 3.5 to 5.2 mEq/L. This result is high normal.
Correct: The normal range for serum sodium is 135 to 145 mEq/L. A result of 110 mEq/L is considered hyponatremia and is extremely dangerous. This client is at risk for increased intracranial pressure, seizures, and death. The RN must act rapidly because this client requires immediate intervention.
(64) The nurse is teaching the client about maintaining a proper diet to prevent an endocrine disorder. Which food does the nurse suggest after the client indicates a dislike of fish?
B. Iodized salt for cooking
Correct: Dietary deficiencies in iodide-containing foods may be a cause of an endocrine disorder. For clients who do not eat saltwater fish on a regular basis, teach them to use iodized salt in food preparation.
Incorrect: The client should eat a well-balanced diet that includes less animal fat.
Incorrect: Eating vegetables contributes to a proper diet; however, this does not prevent an endocrine disorder.
Incorrect: Using a salt substitute does not prevent an endocrine disorder. Salt substitutes may contain high levels of potassium, which may lead to electrolyte imbalances.
(64) The client with an endocrine disorder says, "I can't, you know, satisfy my wife anymore." What is the nurse's best response?
A. "Can you please tell me more?"
Correct: Asking the client to explain his concerns in an open-ended question allows the nurse to explore his feelings more thoroughly.
Incorrect: The focus of the nurse's response needs to be on the client, not on the wife initially.
(64) Which negative feedback response is responsible for preventing hypoglycemia during sleep in nondiabetic clients?
D. Glucagon release
Incorrect: Alpha cells are responsible for synthesizing and secreting the hormone glucagon, but this is NOT A RESPONSE.
Correct: Glucagon is the hormone that binds to receptors on liver cells. This causes the liver cells to convert glycogen to glucose, which keeps blood sugar levels normal during sleep.
(64) In type 1 diabetes, insulin injections are necessary to maintain which action between insulin and glucose?
(64) The nurse should encourage fluids every 2 hours for older adult clients because of a decrease in which factor?
D. Antidiuretic hormone (ADH) production
Correct: A decrease in ADH production causes urine to be more dilute, so urine might not concentrate when fluid intake is low. The older adult is at greater risk for dehydration as a result of urine loss.
Incorrect: A decrease in general metabolism causes decreased tolerance to cold, decreased appetite, and decreased heart rate and blood pressure. It is not related to fluid intake or hydration.
(64) The client has suspected alterations in antidiuretic hormone (ADH) function. Which diagnostic test does the nurse anticipate will be requested for this client?
B. Cranial computed tomography (CT)
Correct: ADH is a hormone of the posterior pituitary. Brain abscess, tumor, or subarachnoid hemorrhage could cause alterations in ADH levels. These could be seen on a CT scan of the brain.
Incorrect: Even though ADH acts on distal convoluted tubules in the kidneys, a renal sonogram would NOT diagnose the cause of inappropriate ADH.