chap 57 concepts of care for pt's w pituitary and adrenal gland probs practice ?'s

For which symptoms will the nurse instruct the family and client who is being treated for diabetes insipidus (DI) to call 911 or go to the nearest emergency department? (Select all that apply.) A. Decreased urine output B. Hypotension C. Weigh gain of more than 2.2 lb (1 kg) in 24 hours D. Persistent headache E. Hyperglycemia F. Acute confusion

A. Decreased urine output C. Weigh gain of more than 2.2 lb (1 kg) in 24 hours D. Persistent headache F. Acute confusion

What is the nurse's best action when noticing that the phlebotomist, who plans to draw blood from the client with severe hypercortisolism, displays symptoms of a cold? A. Ensuring the phlebotomist wears a facemask while in the client's room B. Asking the phlebotomist to delay the blood draw C. Monitoring the client closely for cold-like symptoms D. Placing a facemask on the client

A. Ensuring the phlebotomist wears a facemask while in the client's room

Which change in serum electrolyte values in the past 12 hours for a client with syndrome of inappropriate antidiuretic hormone (SIADH) being treated with tolvaptan will the nurse report immediately to the health care provider? A. Serum sodium increases from 122 mEq/L to 140 mEq/L. B. Serum potassium decreases from 4.2 mEq/L to 3.8 mEq/L. C. Serum chloride decreases from 109 mEq/L to 99 mEq/L. D. Serum calcium increases from 9.5 mg/dL to 10.2 mg/dL.

A. Serum sodium increases from 122 mEq/L to 140 mEq/L.

Which assessment finding in a client with diagnosis of diabetes insipidus (DI) indicates to the nurse that desmopressin therapy is effective? A. Urine output of 30 to 50 mL/hr B. Blood glucose level of 110 mg/dL (6.1 mmol/L) C. Respiratory rate of 20 breaths/min D. Potassium level of 3.9 mEq/L (mmol/L)

A. Urine output of 30 to 50 mL/hr

Which statement made by the client who is going home after a transsphenoidal hypophysectomy indicates to the nurse correct understanding of actions to prevent complications from this treatment? A. "While I am awake, I will be sure to cough and deep breathe at least every 2 hours." B. "I will keep the cat food bowl on my counter so that I do not have to bend over." C. "Whenever I am out-of-doors in the sunshine, I will wear dark glasses." D. "If the dressing gets wet, I will wash the incision line and redress it immediately."

B. "I will keep the cat food bowl on my counter so that I do not have to bend over."

What is the nurse's best response when a client, who has been taking high-dose corticosteroid therapy for a month for a problem that has now resolved, asks you why she needs to continue taking the corticosteroid? A. "Corticosteroids are a type of hormone, and once you have been started on a replacement hormone, you must continue the hormone replacement therapy for the rest of your life." B. "The drug suppressed your own adrenal gland secretion of corticosteroids. Slowly decreasing the dose over time allows your adrenal glands to start adequate secretion again." C. "It is possible for your health problem to recur when corticosteroid therapy is halted suddenly." D. "The drug suppressed your immune system while you were taking it. Slowly decreasing the dose over time prevents your immune system from starting up too quickly and causing allergic reactions."

B. "The drug suppressed your own adrenal gland secretion of corticosteroids. Slowly decreasing the dose over time allows your adrenal glands to start adequate secretion again."

What is the nurse's best response when a client with Cushing syndrome screams at her husband, bursts into tears, throws her water pitcher against the wall, and then says "I feel like I am going crazy"? A. "You must learn to control your behavior. Because you are disturbing others, I am going to keep the door to your room closed and restrict your visitors." B. "You feel this way because of your high hormone levels. Your health care provider can prescribe an antianxiety drug for you." C. "I will tell your primary health care provider order a psychiatric consult for you." D. "You are probably feeling this way because you are frightened about having a chronic disease. Would you like some information about a support group?"

B. "You feel this way because of your high hormone levels. Your health care provider can prescribe an antianxiety drug for you."

Clients who have deficiencies of which hormones will the nurse assess for increased risk of life-threatening consequences? A. Prolactin and prolactin inhibiting hormone (PIH) B. Adrenocorticotrophicn hormone (ACTH) and thyroid-stimulating hormone (TSH) C. Growth hormone (GH) and melanocyte-stimulating hormone (MSH) D. Follicle-stimulating hormone (FSH) and luteinizing hormone (LH)

B. Adrenocorticotrophicn hormone (ACTH) and thyroid-stimulating hormone (TSH)

Which assessment finding in a client with hyperaldosteronism indicates to the nurse that the condition is becoming more severe? A. Urine output for the past 24 hours has increased. B. Client reports numbness and tingling around the mouth. C. Temperature is now elevated. D. pH is now 7.43.

B. Client reports numbness and tingling around the mouth.

In collaboration with the registered dietitian nutritionist, which dietary alterations will the nurse instruct a client with Cushing disease to make? A. High carbohydrate, low potassium, and fluid restriction B. Low carbohydrate, high calorie, and low sodium C. Low protein, high carbohydrate, and low calcium D. High protein, high carbohydrate, and low potassium

B. Low carbohydrate, high calorie, and low sodium

A 30-year-old male client having an annual health physical reports that all of the following changes have developed during the past year. Which ones alert the nurse to possible pituitary hyperfunction? Select all that apply. A. 15 lb weight gain B. Decreased libido C. Four sinus infections D. Frequent constipation E. Increased foot callus formation F. Occasional dripping of clear fluid from both breasts G. Severely sprained ankle from a volley ball injury

A. 15 lb weight gain F. Occasional dripping of clear fluid from both breasts

Which electrolyte laboratory values indicate to the nurse monitoring a client with adrenal insufficiency undergoing IV therapy with hydrocotisone that the client is responding positively to this drug therapy? A. Serum sodium 147 mEq/L (mmol/L); serum potassium 7.1 mEq/L (mmol/L) B. Serum sodium 137 mEq/L (mmol/L); serum potassium 4.9 mEq/L (mmol/L) C. Serum sodium 127 mEq/L (mmol/L); serum potassium 2.8 mEq/L (mmol/L) D. Serum sodium 119 mEq/L ((mmol/L); serum potassium 6.2 mEq/L (mmol/L)

B. Serum sodium 137 mEq/L (mmol/L); serum potassium 4.9 mEq/L (mmol/L)

Which of the following are the priority precautions the nurse will teach the client who remains at continuing risk for adrenal hypofunction and is taking hormone replacement therapy to prevent harm related to the disorder? Select all that apply. A. Avoid crowds and people who are ill B. Check your heart rate for irregular or skipped beats twice daily C. Do not choose low sodium versions of prepared foods D. Get up slowly from sitting or lying positions E. Keep a source of glucose, such as candy, with you at all times F. Never skip your hormone replacement drugs

A. Avoid crowds and people who are ill B. Check your heart rate for irregular or skipped beats twice daily C. Do not choose low sodium versions of prepared foods D. Get up slowly from sitting or lying positions E. Keep a source of glucose, such as candy, with you at all times F. Never skip your hormone replacement drugs

Which action immediately after a hypophysectomy will the nurse instruct a client to avoid to prevent harm? (Select all that apply.) A. Bending at the waist B. Talking C. Deep breathing D. Coughing E. Wearing makeup F. Using dental floss

A. Bending at the waist D. Coughing

For which change reported by a client taking bromocriptine therapy to manage hyperpituitarism will the nurse notify the primary health care provider immediately to prevent harm? A. Chest pain B. Constipation C. Headache D. Increased sleepiness

A. Chest pain

Which precaution is most important for the nurse to teach a female client to prevent harm while undergoing drug therapy with estrogen and progesterone for hypopituitarism? A. "Use a barrier method of contraception to prevent an unplanned pregnancy." B. "Wear a hat with a brim and use sunscreen when outdoors." C. "Do not smoke or use nicotine in any form." D. "Avoid drinking caffeinated beverages."

C. "Do not smoke or use nicotine in any form."

Which client symptom appearing after a head injury suffered in a car crash is most relevant for the nurse to consider the possibility of diabetes insipidus (DI)? A. New-onset hypertension. B. The client reports extreme salt craving. C. No change in urine output with minimal fluid intake. D. The client's headache is gradually increasing in intensity.

C. No change in urine output with minimal fluid intake.

Which urine characteristics indicate to the nurse that the client being managed for diabetes insipidus is responding appropriately to interventions? A. Urine output volume increased; urine specific gravity increased B. Urine output volume increased; urine specific gravity decreased C. Urine output volume decreased; urine specific gravity increased D. Urine output volume decreased; urine specific gravity decreased

C. Urine output volume decreased; urine specific gravity increased

A nurse caring for a client with Cushing's syndrome who must remain on continued corticosteroid therapy for another health problem will use which of the following actions to prevent harm? A. Urging the client to salt his or her food. B. Testing voided urine for the present of glucose. C. Using non-adhesive methods to secure an IV access. D. Ensuring that the prescribed corticosteroid drug is given on an empty stomach

C. Using non-adhesive methods to secure an IV access.

Which question asked by a 48-year-old client with sleep apnea whose blood glucose level is elevated suggests to the nurse the possibility of a growth hormone excess? A. "Do you think if I lost weight my sleep apnea would improve?" B. "Why do I feel thirsty all the time?" C. "How can I make my skin less itchy?" D. "Does everyone's feet get bigger during menopause?"

D. "Does everyone's feet get bigger during menopause?"

Which question is most relevant to ask a male client suspected to have a gonadotropin deficiency? A. "Are you experiencing any pain during sexual intercourse?" B. "Do you work with or have hobbies that involve exposure to chemicals?" C. "Have you gained or lost any weight recently?" D. "How often do you need to shave your face?"

D. "How often do you need to shave your face?"

A client preparing for surgery to remove a cortisol-secreting tumor from the adrenal gland asks the nurse whether the physical changes from the excessive cortisol will go away as a result of the surgery so she can look like herself again. What is the nurse's best response? A. "The surgery is to remove the tumor, not reconstructive surgery." B. "You will notice a great difference in your appearance starting within a week after surgery." C. "All the changes will resolve but may take a year or longer to completely disappear." D. "The fatty changes and and acne will resolve with time but the stretch marks only fade."

D. "The fatty changes and and acne will resolve with time but the stretch marks only fade."

The nurse has just received report on a group of clients. Which client is the nurse's first priority? A. A 42 year old with diabetes insipidus who has a dose of desmopressin due. B. A 35 year old with hyperaldosteronism who has a serum potassium of 3.0 mEq/L (3.0 mmol/L). C. A 50 year old with pituitary adenoma who is reporting a severe headache. D. A 28 year old with acute adrenal insufficiency who has a blood glucose of 36 mg/dL (2.0 mmol/L).

D. A 28 year old with acute adrenal insufficiency who has a blood glucose of 36 mg/dL (2.0 mmol/L).

For which assessment finding in a client who had a transsphenoidal hypophysectomy yesterday will the nurse notify the primary health care provider immediately? A. Dry lips and oral mucosa on examination. B. Nasal drainage that tests negative for glucose. C. Urine specific gravity of 1.016 D. Client report of a headache and stiff neck

D. Client report of a headache and stiff neck

Which primary health care provider order will the nurse perform first for a client with syndrome of inappropriate antidiuretic hormone (SIADH) who has a serum sodium level of 105 mEq/L (105 mmol/L)? A. Administering an infusion of 150 mL hypertonic saline over the next 3 hours B. Drawing blood for hemoglobin and hematocrit levels C. Measuring serial weights at the same daily with the client wearing the same amount of clothing D. Inserting an indwelling catheter and monitoring urine output

D. Inserting an indwelling catheter and monitoring urine output

Which client report of changes in appearance indicates to the nurse that a client's adrenal insufficiency is related to direct malfunction of the adrenal glands? A. 5-lb weight loss B. Dry, cracked lips C. Thinning pubic hair D. Skin darkening

D. Skin darkening

Which assessment has the highest priority for the nurse to perform for a client with syndrome of inappropriate antidiuretic hormone (SIADH) receiving tolvaptan therapy for 24 hours? A. Evaluating serum sodium levels B. Evaluating serum potassium levels C. Examining the skin and sclera for jaundice D. Examining the IV site for indications of phlebitis

A. Evaluating serum sodium levels