Chapter 47: Endocrine System Introduction

MULTIPLE CHOICE

1. A patient is receiving the medication octreotide (Sandostatin) as a treatment for acromegaly.

What should the nurse explain regarding this medication?
a. It reverses the effects of acromegaly.
b. It should be given on a daily basis by injection.
c. It increases insulin secretion causing hypoglycemia.
d. It suppresses the growth hormone.
ANS: D
Sandostatin will suppress growth hormone, but it will not reverse the effects of acromegaly. It
is administered three times a week and suppresses insulin secretion causing hyperglycemia.

DIF: Cognitive Level: Comprehension REF: p. 922 OBJ: 3

TOP: Growth Hormone Suppression KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

2. Which instruction should a nurse provide when a patient starts taking a saturated solution of
potassium iodide (SSKI)?
a. Sip medication through a straw to prevent tooth staining.
b. Double the dose if a dose is missed.
c. Expect excessive salivation.
d. Take before meals.
ANS: A
SSKI can discolor teeth if not sipped through a straw; no iodide drug should be doubled;
excessive salivation is a sign of toxicity; and the medication should be taken after meals.

DIF: Cognitive Level: Comprehension REF: p. 925 OBJ: 4

TOP: SSKI KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

3. Which significant need should be included in instructions to a patient scheduled for a thyroid
scan (123I)?
a. Provide a special container to collect urine for the next 24 hours.
b. Wear a protective apron to shield him or her from radiation for the next 24 hours.
c. Request that visitors keep a distance of at least 6 feet away for the next 24 hours.
d. Do not consume iodine for one week before the test..
ANS: D
The patient should not consume iodine for one week before the test. Iodine is in radiographic
dyes, some oral contraceptives, weight control drugs, multivitamins, all thyroid drugs, and
some food, especially seafood.

DIF: Cognitive Level: Application REF: p. 916 OBJ: 2

TOP: Thyroid Diagnostic Tests KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control
4. A patient asks about his laboratory test, which showed a high level of thyroid-stimulating
hormone (TSH) and a low level of T4. What is the most accurate explanation?
a. “It means that you have an inconsistency in your thyroid tests, and you will need
more testing.”
b. “I am sorry. You will have to ask your physician about your laboratory results. We
are not allowed to discuss them.”
c. “The TSH is sending a message to your thyroid gland to increase production, but
your thyroid isn’t producing enough hormone.”
d. “That means that you will have to go on hormone therapy for the rest of your life.”
ANS: C
The test determines whether the problem is in the pituitary gland or in the thyroid gland. In
this patient, the high level of TSH is coming from the pituitary gland as it should, but the
thyroid gland is not responding with adequate hormone production.

DIF: Cognitive Level: Comprehension REF: p. 917|p. 922

OBJ: 2 TOP: Thyroid Laboratory Tests
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

5. A patient has been given an antithyroid drug called methimazole. What appropriate nursing
implementations should be included?
a. Using special radioactive precautions for her urine for the first 24 hours
b. Monitoring her vital signs and withholding the medications if her pulse is greater
than 100 beats/min
c. Teaching her to watch for and report any signs and symptoms of hypothyroidism
or infections
d. Keeping her on a low-calorie, low-protein diet
ANS: C
The drug targets the thyroid gland to slow its function, so signs and symptoms of
hypothyroidism or infections need to be reported. Thionamides may cause suppression of
neutrophils leading to a lowered resistance.

DIF: Cognitive Level: Application REF: p. 924 OBJ: 3 | 4

TOP: Antithyroid Medications KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

6. An older patient with hypothyroidism asks why her daily dose of thyroid hormone, which she
has taken for 15 years, has been reduced. What is nurse’s best rationale when explaining what
the decreased dose is related to?
a. Improved efficacy of the thyroid preparation
b. Age-related reduction in metabolic rate
c. Drug-related hypertrophy of the thyroid
d. Changes in your diet and activity level
ANS: B
Older patients have slower drug metabolism; consequently, the drug stays in their systems. All
patients receiving hormone replacement need to be periodically evaluated.

DIF: Cognitive Level: Comprehension REF: p. 924 OBJ: 3

TOP: Age-Related Changes in Therapy KEY: Nursing Process Step: Implementation
 MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

MULTIPLE RESPONSE

1. A nurse makes a list of symptoms that a patient who is taking methimazole (Tapazole), a
thionamide drug, should report. What should this list include? (Select all that apply.)
a. Becoming pregnant
b. Jaundice
c. Blood in the stool
d. Rash
e. Urine retention
ANS: A, B, C, D
Urine retention is not a side effect of methimazole (Tapazole).

DIF: Cognitive Level: Knowledge REF: p. 924 OBJ: 4

TOP: Patient Education for Thionamides KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

2. What are the common age-related changes in the endocrine system? (Select all that apply.)
a. Diminished response to antidiuretic hormone (ADH).
b. Decline in growth hormone (GH) production.
c. Reduction in protein synthesis.
d. Decreased risk for hypothyroidism.
e. Decline in cortisol secretion.
ANS: A, B, C, E
Endocrine function usually remains adequate in healthy older adults, but small changes are
important when an illness alters homeostasis. Age-related endocrine changes include dimished
response to ADH; decline in GH production, which leads to a reduction in protein synthesis;
and a decline in cortisol secretion. Although not normal, hypothyroidism is more common in
older adults, especially in women.

DIF: Cognitive Level: Comprehension REF: p. 919 OBJ: 1

TOP: Hypothyroidism KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease