Chapter 62. Pituitary and Adrenal Gland Problems

The nurse is planning to administer medications to a client with diabetes insipidus (DI) who has dry lips and mucous membranes and poor skin turgor. Which intervention will the nurse provide first? Encourage oral fluid intake B. Offer lip balm C. Perform a 24-hour urine test D. Withhold desmopressin acetate (DDAVP)

A. ANS: A

After receiving change-of-shift report about these four clients, which client does the nurse attend to first? A. Client with acute adrenal insufficiency who has a blood glucose of 36 mg/dL (2.0 mmol/L) B. Client with diabetes insipidus who has a dose of desmopressin (DDAVP) due C.Client with hyperaldosteronism who has a serum potassium of 3.4 mEq/L (3.4 mmol/L) D. Client with pituitary adenoma who is reporting a severe headache

ANS: A

A nurse prepares to discharge a client who has a wound and is prescribed home health care. Which information should the nurse include in the hand-off report to the home health nurse? a. Recent wound assessment, including size and appearance b. Insurance information for billing and coding purposes c. Complete health history and physical assessment findings d. Resources available to the client for wound care supplies

ANS: A The hospital nurse should provide details about the wound, including size and appearance and any special wound needs, in a hand-off report to the home health nurse. Insurance information is important to the home health agency and manager, but this is not appropriate during this hand-off report. The nurse should report focused assessment findings instead of a complete health history and physical assessment. The home health nurse should work with the client to identify community resources.

25. A client is brought to the emergency department via rescue squad in acute adrenal crisis. Which action by the nurse is the priority? a. Start an IV line if the client does not already have one. b. Administer hydrocortisone sodium succinate (Solu-Cortef). c. Instruct the nursing assistant to check the client's blood glucose. d. Administer 20 units of insulin and 20 mg of dextrose in normal saline.

ANS: A All actions are appropriate for the client with adrenal crisis. However, therapy is given IV, so the priority is to establish IV access. Solu-Cortef is the drug of choice. Blood glucose is monitored hourly and treatment is provided as needed. Insulin and dextrose are used to treat any hyperkalemia.

5. When performing personal care on a middle-aged woman, the nurse observes that the client has very little pubic and axillary hair. Which is the nurse's best action? a. Ask the client if she has less pubic hair now than 5 years ago. b. Ask the client the date of her last menstrual period. c. Examine the client's scalp hair for texture and thickness. d. Draw blood for hormonal immune assays.

ANS: A Although pubic hair thickness varies from person to person, loss of pubic hair is associated with gonadotropin deficiency. The nurse needs to determine whether this manifestation is normal for this client. A middle-aged woman may be postmenopausal, which would not give the nurse helpful information. Examining the client's scalp also would not yield helpful information. Diagnostic studies should not be undertaken without further assessment.

The nurse working in the rheumatology clinic is seeing clients with rheumatoid arthritis (RA). What assessment would be most important for the client whose chart contains the diagnosis of Sjögren's syndrome? a. Abdominal assessment b. Oxygen saturation c. Renal function studies d. Visual acuity

ANS: A Chronic steroid use is seen in clients with SLE and can lead to osteonecrosis (bone necrosis). The nurse should determine if the client has been taking a steroid. Physical therapy may be beneficial, but there is not enough information about the client yet. Measuring range of motion is best done by the physical therapist. Notifying the provider immediately is not warr

A nurse has educated a client on an epinephrine auto-injector (EpiPen). What statement by the client indicates additional instruction is needed? a. "I don't need to go to the hospital after using it." b. "I must carry two EpiPens with me at all times." c. "I will write the expiration date on my calendar." d. "This can be injected right through my clothes."

ANS: A Clients should be instructed to call 911 and go to the hospital for monitoring after using the EpiPen. The other statements show good understanding of this treatment.

21. The client has chronic hypercortisolism. Which intervention is the highest priority for the nurse? a. Wash the hands when entering the room. b. Keep the client in protective isolation. c. Observe the client for increased white blood cell counts. d. Assess the daily chest x-ray.

ANS: A Excess cortisol reduces the number of circulating lymphocytes, inhibits maturation of macrophages, reduces antibody synthesis, and inhibits production of cytokines and inflammatory chemicals. As a result, these clients are at greater risk of infection and may not have the expected inflammatory manifestations when an infection is present. The nurse needs to take precautions to decrease the client's risk. It is not necessary to keep the client in isolation. The client does not need a daily chest x-ray.

26. A female client has a decrease in all pituitary hormones. Which assessment question by the nurse elicits the best information? a. "Do you have any biological children?" b. "Do you have a decreased sex drive?" c. "Have you noticed increased facial hair?" d. "Are you more intolerant of heat?"

ANS: A Hypofunction of all anterior pituitary hormones is often caused by postpartum hemorrhage of the anterior pituitary gland. This usually occurs immediately after delivery but may be delayed for several years. Asking the client if she has children of her own would let the nurse know of this possibility. The other questions are assessments for specific hormone dysfunction.

The nurse is teaching a client with gout dietary strategies to prevent exacerbations or other problems. Which statement by the nurse is most appropriate? a. "Drink 1 to 2 liters of water each day." b. "Have 10 to 12 ounces of juice a day." c. "Liver is a good source of iron." d. "Never eat hard cheeses or sardines."

ANS: A Kidney stones are common in clients with gout, so drinking plenty of water will help prevent this from occurring. Citrus juice is high in ash, which can help prevent the formation of stones, but the value of this recommendation is not clear. Clients with gout should not eat organ meats or fish with bones, such as sardines.

A client in the orthopedic clinic has a self-reported history of osteoarthritis. The client reports a low-grade fever that started when the weather changed and several joints started "acting up," especially both hips and knees. What action by the nurse is best? a. Assess the client for the presence of subcutaneous nodules or Baker's cysts. b. Inspect the client's feet and hands for podagra and tophi on fingers and toes. c. Prepare to teach the client about an acetaminophen (Tylenol) regimen. d. Reassure the client that the problems will fade as the weather changes again.

ANS: A Osteoarthritis is not a systemic disease, nor does it present bilaterally. These are manifestations of rheumatoid arthritis. The nurse should assess for other manifestations of this disorder, including subcutaneous nodules and Baker's cysts. Podagra and tophi are seen in gout. Acetaminophen is not used for rheumatoid arthritis. Telling the client that the symptoms will fade with weather changes is not accurate.

20. The new nurse is assessing a client with suspected pheochromocytoma. Which action by the nurse requires the precepting nurse to intervene? a. Auscultating, palpating, and percussing the client's abdomen b. Taking the client's blood pressure for reports of chest pain c. Assessing the client's diet for red wine and aged cheeses d. Limiting visitors while the client is sleeping

ANS: A Pheochromocytomas are found on the adrenal glands or in the abdomen. Palpation of a pheochromocytoma can cause intense release of catecholamines and can precipitate a hypertensive crisis. The experienced nurse should intervene if the new nurse attempts this. The other actions would be appropriate.

19. A client with hyperaldosteronism is being treated with spironolactone (Aldactone) before surgery. Which precautions does the nurse teach this client? a. "Read the label before using salt substitutes." b. "Do not add salt to your food when you eat." c. "Avoid exposure to sunlight." d. "Take Tylenol instead of aspirin for pain."

ANS: A Spironolactone is a potassium-sparing diuretic used to control potassium levels. Its use can lead to hyperkalemia. Although the goal is to increase the client's potassium, unknowingly adding potassium can cause complications. Some salt substitutes are composed of potassium chloride and should be avoided by clients on spironolactone therapy. Depending on the client, he or she may benefit from a low-sodium diet before surgery, but this may not be necessary. Avoiding sunlight and Tylenol is not necessary.

A client has rheumatoid arthritis (RA) and the visiting nurse is conducting a home assessment. What options can the nurse suggest for the client to maintain independence in activities of daily living (ADLs)? (Select all that apply.) a. Grab bars to reach high items b. Long-handled bath scrub brush c. Soft rocker-recliner chair d. Toothbrush with built-up handle e. Wheelchair cushion for comfort .

ANS: A, B, D Grab bars, long-handled bath brushes, and toothbrushes with built-up handles all provide modifications for daily activities, making it easier for the client with RA to complete ADLs independently. The rocker-recliner and wheelchair cushion are comfort measures but do not help increase independence

A nurse is teaching a female client with rheumatoid arthritis (RA) about taking methotrexate (MTX) (Rheumatrex) for disease control. What information does the nurse include? (Select all that apply.) a. "Avoid acetaminophen in over-the-counter medications." b. "It may take several weeks to become effective on pain." c. "Pregnancy and breast-feeding are not affected by MTX." d. "Stay away from large crowds and people who are ill." e. "You may find that folic acid, a B vitamin, reduces side effects." .

ANS: A, B, D, E MTX is a disease-modifying antirheumatic drug and is used as a first-line drug for RA. MTX can cause liver toxicity, so the client should be advised to avoid medications that contain acetaminophen. It may take 4 to 6 weeks for effectiveness. MTX can cause immunosuppression, so avoiding sick people and crowds is important. Folic acid helps reduce side effects for some people. Pregnancy and breast-feeding are contraindicated while on this drug

2. Which conditions may cause hypopituitarism? (Select all that apply.) a. Benign pituitary tumors b. Diplopia c. Anorexia nervosa d. Hypotension e. Shock f. Weight gain

ANS: A, C, D, E

. A nurse assesses clients with potential endocrine disorders. Which clients are at high risk for hypopituitarism? (Select all that apply.) a. A 20-year-old female with benign pituitary tumors b. A 32-year-old male with diplopia c. A 41-year-old female with anorexia nervosa d. A 55-year-old male with hypertension e. A 60-year-old female who is experiencing shock f. A 68-year-old male who has gained weight recently

ANS: A, C, D, E Pituitary tumors, anorexia nervosa, hypertension, and shock are all conditions that can cause hypopituitarism. Diplopia is a manifestation of hypopituitarism, and weight gain is a manifestation of Cushings disease and syndrome of inappropriate antidiuretic hormone. They are not risk factors for hypopituitarism.

1. Which physical characteristics are indicative of anterior pituitary hyperfunction? (Select all that apply.) a. Protrusion of the lower jaw b. High-pitched voice c. Enlarged hands and feet d. Kyphosis e. Barrel-shaped chest f. Excessive sweating

ANS: A, C, D, E, F Anterior pituitary hyperfunction typically will cause protrusion of the lower jaw, deepening of the voice, enlarged hands and feet, kyphosis, barrel-shaped chest, and excessive sweating.

Which serum laboratory values alert the nurse to the possibility of hyperaldosteronism? (Select all that apply.) a. Sodium, 150 mEq/L b. Sodium, 130 mEq/L c. Potassium, 2.5 mEq/L d. Potassium, 5.0 mEq/L e. pH, 7.28 f. pH, 7.50

ANS: A, C, E Aldosterone increases reabsorption of sodium and excretion of potassium. Hyperaldosteronism causes hypernatremia, hypokalemia, and metabolic alkalosis. The other values are not indicative of hyperaldosteronism.

A nurse assesses a client with Cushings disease. Which assessment findings should the nurse correlate with this disorder? (Select all that apply.) a. Moon face b. Weight loss c. Hypotension d. Petechiae e. Muscle atrophy

ANS: A, D, E Clinical manifestations of Cushings disease include moon face, weight gain, hypertension, petechiae, and muscle atrophy.

A nurse cares for a client who is prescribed vasopressin (DDAVP) for diabetes insipidus. Which assessment findings indicate a therapeutic response to this therapy? (Select all that apply.) a. Urine output is increased. b. Urine output is decreased. c. Specific gravity is increased. d. Specific gravity is decreased. e. Urine osmolality is increased. f. Urine osmolality is decreased.

ANS: A, D, F Diabetes insipidus causes urine output to be greatly increased, with a low urine osmolality, as evidenced by a low specific gravity. Effective treatment results in decreased urine output that is more concentrated, as evidenced by an increased specific gravity

A client had a total knee replacement earlier in the day and has a continuous femoral nerve blockade (CFNB). When entering the room to assess the client, the nurse notes that the television volume is quite loud. The client explains that it is hard to hear with "all the ringing in my ears." What action by the nurse takes priority? a. Perform a neurovascular assessment on the operative extremity. b. Call another nurse to notify the anesthesiologist immediately. c. Take a full set of vital signs and discontinue the CFNB. d. Pad the siderails and instituting other seizure precautions.

ANS: B

A client has undergone a transsphenoidal hypophysectomy. Which intervention does the nurse implement to avoid increasing intracranial pressure (ICP) in the client? A. Encourage the client to cough and deep-breathe. B. Instruct the client not to strain during a bowel movement. C. Instruct the client to blow the nose if there is any postnasal drip. D. Place the client in the Trendelenburg position.

ANS: B

The nurse is working with a client who has severe rheumatoid arthritis in her hands. The client states that she is frustrated at mealtime because it is difficult for her to manage cups and silverware. What is the nurse's best response? a. "I'll have the nursing assistants set up your meal trays while you are in the hospital." b. "Let's see if the occupational therapist can provide you with some utensils that are easier for you to use." c. "I'll arrange for a home nursing assistant to help you with your meals after you are discharged from the hospital." d. "Let's see if the physical therapist can suggest some muscle strengthening exercises for you."

ANS: B

The nurse is caring for clients on the medical-surgical unit. What action by the nurse will help prevent a client from having a type II hypersensitivity reaction? a. Administering steroids for severe serum sickness b. Correctly identifying the client prior to a blood transfusion c. Keeping the client free of the offending agent d. Providing a latex-free environment for the client

ANS: B A classic example of a type II hypersensitivity reaction is a blood transfusion reaction. These can be prevented by correctly identifying the client and cross-checking the unit of blood to be administered. Serum sickness is a type III reaction. Avoidance therapy is the cornerstone of treatment for a type IV hypersensitivity. Latex allergies are a type I hypersensitivity.

A client with Sjögren's syndrome reports dry skin, eyes, mouth, and vagina. What nonpharmacologic comfort measure does the nurse suggest? a. Frequent eyedrops b. Home humidifier c. Strong moisturizer d. Tear duct plugs

ANS: B A humidifier will help relieve many of the client's Sjögren's syndrome symptoms. Eyedrops and tear duct plugs only affect the eyes, and moisturizer will only help the skin.

10. A client is going home after an endoscopic transnasal hypophysectomy. Which statement by the client indicates an adequate understanding of discharge instructions? a. "I will wear dark glasses whenever I am outdoors." b. "I will keep food on upper shelves so I do not have to bend over." c. "I will wash the incision line every day with peroxide and redress it immediately." d. "I will remember to cough and deep breathe every 2 hours while I am awake."

ANS: B After this surgery, the client must take care to avoid activities that can increase intracranial pressure. The client should avoid bending from the waist and should not bear down, cough, or lie flat. With this approach, there is no incision to clean and dress.

A nurse works in the rheumatology clinic and sees clients with rheumatoid arthritis (RA). Which client should the nurse see first? a. Client who reports jaw pain when eating b. Client with a red, hot, swollen right wrist c. Client who has a puffy-looking area behind the knee d. Client with a worse joint deformity since the last visit

ANS: B All of the options are possible manifestations of RA. However, the presence of one joint that is much redder, hotter, or more swollen that the other joints may indicate infection. The nurse needs to see this client first.

A client having severe allergy symptoms has received several doses of IV antihistamines. What action by the nurse is most important? a. Assess the client's bedside glucose reading. b. Instruct the client not to get up without help. c. Monitor the client frequently for tachycardia. d. Record the client's intake, output, and weight.

ANS: B Antihistamines can cause drowsiness, so for the client's safety, he or she should be instructed to call for assistance prior to trying to get up. Hyperglycemia and tachycardia are side effects of sympathomimetics. Fluid and sodium retention are side effects of corticosteroids.

22. A female client is beginning treatment with bromocriptine (Parlodel). The nurse has initiated teaching sessions about potential side effects. Which is the most important point of instruction? a. "Take and record your temperature daily." b. "Be sure to eat 20 to 30 grams of fiber daily." c. "Plan to take the medication on an empty stomach." d. "I will need to teach you how to give the injection."

ANS: B Constipation is an expected side effect of treatment with bromocriptine, so the client should be taught ways to prevent and/or manage it. Eating plenty of fiber and drinking fluids is a good plan. Taking the client's temperature daily is not necessary. The medication, which is given orally, should be taken with food to reduce side effects.

An adult client has been diagnosed with a deficiency of gonadotropin and growth hormone. Which fact reported in the client's history could have contributed to this problem? a. Mother with adult-onset diabetes mellitus b. Experienced head trauma 5 years ago c. Severe allergy to shellfish and iodine d. Has used oral contraceptives for 5 years

ANS: B Gonadotropin and growth hormone are anterior pituitary hormones. Head trauma is a common cause of anterior pituitary hypofunction. The other factors do not increase the risk of this condition.

17. The client with adrenal hyperfunction screams at her husband, bursts into tears, and throws her water pitcher against the wall. She then tells the nurse, "I feel like I am going crazy." Which is the nurse's best response? a. "I will ask your doctor to order a psychiatric consult for you." b. "You feel this way because of your hormone levels." c. "Can I bring you information about support groups?" d. "I will close the door to your room and restrict visitors."

ANS: B Hypercortisolism can cause the client to show neurotic or psychotic behavior. The client needs to know that these behavior changes do not reflect a true psychiatric disorder and will resolve when therapy results in lower and steadier blood cortisol levels. The client needs to understand this effect and does not need a psychiatrist, support groups, or restricted visitors at this time.

A client who has been taking high-dose corticosteroid therapy for 1 month to treat a severe inflammatory condition, which has now resolved, asks the nurse why she needs to continue taking corticosteroids. Which is the nurse's best response? a. "It is possible for the inflammation to recur if you stop the drugs." b. "Once you start corticosteroids, you have to be weaned off them." c. "You must decrease the dose slowly so your hormones will begin to work again." d. "The drug suppresses your immune system, which needs to be built back up."

ANS: B One of the most common causes of adrenal insufficiency, a life-threatening problem, is the sudden cessation of long-term, high-dose corticosteroid therapy. This therapy suppresses the hypothalamic-pituitary-adrenal axis and must be withdrawn gradually to allow for pituitary production of adrenocorticotropic hormone (ACTH) and adrenal production of cortisol.

24. A client has cortisol deficiency and is being treated with prednisone (Deltasone). Which instruction by the nurse is most appropriate? a. "You will need to learn how to rotate the injection sites." b. "If you work outside when it's hot, you may need another drug." c. "Be sure to stay on your salt restriction even though it's difficult." d. "Take one tablet in the morning and two tablets at night to start."

ANS: B Steroid dosage adjustment may be needed and might be difficult, especially in hot weather, when the client is sweating a great deal more than normal. Clients take prednisone orally, have no need for a salt restriction, and usually start the regimen with two tablets in the morning and one at night.

A nurse teaches a client with a cortisol deficiency who is prescribed prednisone (Deltasone). Which statement should the nurse include in this clients instructions? a. You will need to learn how to rotate the injection sites. b. If you work outside in the heat, you may need another drug. c. You need to follow a diet with strict sodium restrictions. d. Take one tablet in the morning and two tablets at night.

ANS: B Steroid dosage adjustment may be needed if the client works outdoors and might be difficult, especially in hot weather, when the client is sweating a great deal more than normal. Clients take prednisone orally, have no need for a salt restriction, and usually start the regimen with two tablets in the morning and one at night.

4. The male client with hypopituitarism asks the nurse how long he will have to take testosterone hormone replacement therapy. Which is the nurse's best answer? a. "When your blood levels of testosterone are normal, the therapy is no longer needed." b. "When your beard thickens and your voice deepens, the dose is decreased, but treatment will continue forever." c. "When your sperm count is high enough to demonstrate fertility, you will no longer need this therapy." d. "When you start to have undesirable side effects, the dose is decreased to the lowest possible level, and treatment is continued until you are 50 years old."

ANS: B Testosterone therapy is initiated with high-dose testosterone derivatives and is continued until virilization is achieved. The dose is then decreased, but therapy continues throughout life.

13. Which dietary alterations does the nurse make for a client with Cushing's disease? a. High carbohydrate, low potassium b. Low carbohydrate, low sodium c. Low protein, low calcium d. High carbohydrate, low potassium

ANS: B The client with Cushing's disease has weight gain, muscle loss, hyperglycemia, and sodium retention. Dietary modifications need to include reduction of total calories and carbohydrates to prevent or reduce the degree of hyperglycemia. Sodium retention causes water retention and hypertension. Clients are encouraged to restrict their sodium intake moderately. Clients often have bone density loss and need more calcium.

11. A client with suspected syndrome of inappropriate antidiuretic hormone (SIADH) has a serum sodium of 114 mEq/L. Which action by the nurse is best? a. Consult with the registered dietitian about increased dietary sodium. b. Restrict the client's fluid intake to 900 mL/24 hr. c. Handle the client gently by using turn sheets for repositioning. d. Instruct the nursing assistants to measure intake and output.

ANS: B With SIADH, clients often have dilutional hyponatremia. The client needs a fluid restriction, sometimes to as little as 500 to 600 mL/24 hr. The client should be on intake and output (I&O); however, this will monitor only the client's intake, so it is not the best answer. Reducing intake will help increase the client's sodium. Adding sodium to the client's diet will not help if he or she is retaining fluid and diluting the sodium. The client is not at increased risk for fracture, so gentle handling is not an issue.

The nursing student studying rheumatoid arthritis (RA) learns which facts about the disease? (Select all that apply.) a. It affects single joints only. b. Antibodies lead to inflammation. c. It consists of an autoimmune process. d. Morning stiffness is rare. e. Permanent damage is inevitable.

ANS: B, C RA is a chronic autoimmune systemic inflammatory disorder leading to arthritis-type symptoms in the joints and other symptoms that can be seen outside the joints. Antibodies are created that lead to inflammation. Clients often report morning stiffness. Permanent damage can be avoided with aggressive, early treatment.

he nurse working in the rheumatology clinic assesses clients with rheumatoid arthritis (RA) for late manifestations. Which signs/symptoms are considered late manifestations of RA? (Select all that apply.) a. Anorexia b. Felty's syndrome c. Joint deformity d. Low-grade fever e. Weight loss

ANS: B, C, E Late manifestations of RA include Felty's syndrome, joint deformity, weight loss, organ involvement, osteoporosis, extreme fatigue, and anemia, among others. Anorexia and low-grade fever are both seen early in the course of the disease.

4. A nurse teaches a client with Cushings disease. Which dietary requirements should the nurse include in this clients teaching? (Select all that apply.) a. Low calcium b. Low carbohydrate c. Low protein d. Low calories e. Low sodium

ANS: B, D, E The client with Cushings disease has weight gain, muscle loss, hyperglycemia, and sodium retention. Dietary modifications need to include reduction of carbohydrates and total calories to prevent or reduce the degree of hyperglycemia. Sodium retention causes water retention and hypertension. Clients are encouraged to restrict their sodium intake moderately. Clients often have bone density loss and need more calcium. Increased protein intake will help decrease muscle loss.

After a total knee replacement, a client is on the postoperative nursing unit with a continuous femoral nerve blockade. On assessment, the nurse notes the client's pulses are 2+/4+ bilaterally; the skin is pale pink, warm, and dry; and the client is unable to dorsiflex or plantarflex the affected foot. What action does the nurse perform next? a. Document the findings and monitor as prescribed. b. Increase the frequency of monitoring the client. c. Notify the surgeon or anesthesia provider immediately. d. Palpate the client's bladder or perform a bladder scan.

ANS: C

The nurse provides discharge teaching for a client to prevent a new attack of gout. Which statement by the client indicates that additional teaching is required? a. "I will keep a food and symptom diary for a few weeks." b. "If I get a headache, I will take Tylenol instead of aspirin." c. "I hate to start limiting my fluid intake so much!" d. "Citrus juices and milk may keep me from having kidney stones."

ANS: C

. A nurse cares for a client who is prescribed vancomycin (Vancocin) 500 mg IV every 6 hours for a methicillin-resistant Staphylococcus aureus (MRSA) infection. Which action should the nurse take? a. Administer it over 30 minutes using an IV pump. b. Give the client diphenhydramine (Benadryl) before the drug. c. Assess the IV site at least every 2 hours for thrombophlebitis. d. Ensure that the client has increased oral intake during therapy.

ANS: C Vancomycin is very irritating to the veins and can easily cause thrombophlebitis. This drug is given over at least 60 minutes; although it can cause histamine release (leading to "red man syndrome"), it is not customary to administer diphenhydramine before starting the infusion. Increasing oral intake is not specific to vancomycin therapy.

A client has a hormone deficiency. Which deficiency is the highest priority? a. Growth hormone b. Luteinizing hormone c. Thyroid-stimulating hormone d. Follicle-stimulating hormone

ANS: C A deficiency of thyroid-stimulating hormone (TSH) is the most life-threatening deficiency of the hormones listed in this question. TSH is needed to ensure proper synthesis and secretion of the thyroid hormones, whose functions are essential for life.

23. The nurse is caring for a client who has undergone a hypophysectomy. Which is the nurse's priority postoperative intervention? a. Keep the head of the bed flat and the client supine. b. Instruct the client to cough, turn, and deep breathe hourly. c. Report clear or yellow drainage from the nose or incision site. d. Apply petroleum jelly to the client's lips to avoid mouth dryness.

ANS: C A light yellow drainage or a halo effect on the dressing is indicative of a cerebrospinal leak. The client should have the head of the bed elevated after surgery. Although deep breathing is important postoperatively, coughing should be avoided to prevent cerebrospinal leakage. Although application of petroleum jelly to the lips will help with mouth dryness, this instruction is not as important as reporting the yellowish drainage.

8. A client just diagnosed with acromegaly is scheduled for a hypophysectomy. Which statement made by the client indicates a need for clarification regarding this treatment? a. "I will drink whenever I feel thirsty after surgery." b. "I'm glad no visible incision will result from this surgery." c. "I hope I can go back to wearing size 8 shoes instead of size 12." d. "I will wear slip-on shoes after surgery so I don't have to bend over."

ANS: C Although removal of the tissue that is oversecreting hormones can relieve many symptoms of hyperpituitarism, skeletal changes and organ enlargement are not reversible. It will be appropriate for the client to drink as needed postoperatively and avoid bending over, reassured that the incision will not be visible.

7. A client has documented acromegaly. During a physical assessment before surgery for a knee replacement, the nurse discovers that she has a moderately enlarged liver. Which is the nurse's best action? a. Counsel the client on the health risks of alcoholism. b. Assess for jaundice of the skin and eyes. c. Document the finding and monitor the client. d. Draw blood for liver function studies.

ANS: C Clients with acromegaly or gigantism commonly have organomegaly of the heart and liver. Other than documenting the finding and monitoring the client, these actions would be inappropriate because the finding is commonly associated with acromegaly.

12. Which safety measure is most important for the nurse to institute for a client who has Cushing's disease? a. Pad the siderails of the client's bed. b. Assist the client to change positions slowly. c. Use a lift sheet to change the client's position. d. Keep suctioning equipment at the client's bedside.

ANS: C Cushing's syndrome or disease greatly increases the serum levels of cortisol, which contributes to excessive bone demineralization and increases the risk for pathologic bone fracture. The client should not require suctioning. Padding the siderails and assisting the client to change position may be effective, but these measures will not protect him or her as much as using a lift sheet.

15. A client has received vasopressin (DDAVP) for diabetes insipidus. Which assessment finding indicates a therapeutic response to this therapy? a. Urine output is increased; specific gravity is increased. b. Urine output is increased; specific gravity is decreased. c. Urine output is decreased; specific gravity is increased. d. Urine output is decreased; specific gravity is decreased.

ANS: C Diabetes insipidus causes urine output to be greatly increased, with a low urine osmolarity, as evidenced by a low specific gravity. Effective treatment results in decreased urine output that is more concentrated, as evidenced by an increased specific gravity.

. A client has newly diagnosed systemic lupus erythematosus (SLE). What instruction by the nurse is most important? a. "Be sure you get enough sleep at night." b. "Eat plenty of high-protein, high-iron foods." c. "Notify your provider at once if you get a fever." d. "Weigh yourself every day on the same scale."

ANS: C Fever is the classic sign of a lupus flare and should be reported immediately. Rest and nutrition are important but do not take priority over teaching the client what to do if he or she develops an elevated temperature. Daily weights may or may not be important depending on renal involvement.

3. Which safety measure does the nurse use for the adult client who has growth hormone deficiency? a. Avoid intramuscular medications. b. Place the client in protective isolation. c. Use a lift sheet to reposition the client. d. Assist the client to change positions slowly.

ANS: C In adults, growth hormone is necessary to maintain bone density and strength. Adults with growth hormone deficiency have thin, fragile bones. Avoiding IM medications, using protective isolation, and assisting the client as he or she moves from sitting to standing will not serve as safety measures when the client is deficient in growth hormone.

9. A client who had a trans-sphenoidal hypophysectomy 2 days ago now has nuchal rigidity. Which is the nurse's priority action? a. Have the client do active range-of-motion exercises for the neck. b. Document the finding and monitor the client. c. Take the client's temperature and other vital signs. d. Assess using a pain scale and administer pain medication.

ANS: C Nuchal rigidity is a major manifestation of meningitis, a potential postoperative complication associated with this surgery. Meningitis is an infection; usually the client will also have a fever and tachycardia. Range-of-motion exercises are inappropriate because meningitis is a possibility. Although pain medication may be a palliative measure, it is not the most appropriate initial action. Documentation should be done after all assessments are completed and should not be the only action.

A client has rheumatoid arthritis that especially affects the hands. The client wants to finish quilting a baby blanket before the birth of her grandchild. What response by the nurse is best? a. "Let's ask the provider about increasing your pain pills." b. "Hold ice bags against your hands before quilting." c. "Try a paraffin wax dip 20 minutes before you quilt." d. "You need to stop quilting before it destroys your fingers."

ANS: C Paraffin wax dips are beneficial for decreasing pain in arthritic hands and lead to increased mobility. The nurse can suggest this comfort measure. Increasing pain pills will not help with movement. Ice has limited use unless the client has a "hot" or exacerbated joint. The client wants to finish her project, so the nurse should not negate its importance by telling the client it is destroying her joints.

18. A client on medication after a bilateral adrenalectomy calls the clinic asking to be seen for "stomach flu" with nausea and vomiting. Which response by the nurse is best? a. "I will call in a prescription for an antiemetic medication for you." b. "Try to drink extra fluids until you can come in for an appointment." c. "You need to go to the nearest emergency department today." d. "Double the dose of your medication today and tomorrow."

ANS: C The client with bilateral adrenalectomy is on lifelong cortisol replacement therapy. The client cannot skip any doses of his or her medication. If the client has nausea and vomiting for longer than 24 hours and cannot give himself or herself an injection of hydrocortisone, the client must go to the nearest emergency department to get it. The other answers are inappropriate.

A client is suspected to have rheumatoid arthritis. Which manifestations does the nurse assess this client carefully for? a. Crepitus when the client moves the shoulders b. Numbness and tingling in the client's fingers c. Client has cool feet, with weak pedal pulses d. Low-grade fever, fatigue, anorexia with weight loss

ANS: D

. A nurse is caring for a client who has a pressure ulcer on the right ankle. Which action should the nurse take first? a. Draw blood for albumin, prealbumin, and total protein. b. Prepare for and assist with obtaining a wound culture. c. Place the client in bed and instruct the client to elevate the foot. d. Assess the right leg for pulses, skin color, and temperature.

ANS: D A client with an ulcer on the foot should be assessed for interruption in arterial flow to the area. This begins with the assessment of pulses and color and temperature of the skin. The nurse can also assess for pulses noninvasively with a Doppler flowmeter if unable to palpate with his or her fingers. Tests to determine nutritional status and risk assessment would be completed after the initial assessment is done. Wound cultures are done after it has been determined that drainage, odor, and other risks for infection are present. Elevation of the foot would impair the ability of arterial blood to flow to the area.

A client is in the preoperative holding area prior to surgery. The nurse notes that the client has allergies to avocados and strawberries. What action by the nurse is best? a. Assess that the client has been NPO as directed. b. Communicate this information with dietary staff. c. Document the information in the client's chart. d. Ensure the information is relayed to the surgical team.

ANS: D A client with allergies to avocados, strawberries, bananas, or nuts has a higher risk of latex allergy. The nurse should ensure that the surgical staff is aware of this so they can provide a latex-free environment. Ensuring the client's NPO status is important for a client having surgery but is not directly related to the risk of latex allergy. Dietary allergies will be communicated when a diet order is placed. Documentation should be thorough but does not take priority.

A nurse is discharging a client to a short-term rehabilitation center after a joint replacement. Which action by the nurse is most important? a. Administering pain medication before transport b. Answering any last-minute questions by the client c. Ensuring the family has directions to the facility d. Providing a verbal hand-off report to the facility

ANS: D As required by The Joint Commission and other accrediting agencies, a hand-off report must be given to the new provider to prevent error. The other options are valid responses but do not take priority.

16. A client with hypercortisolism has an irregular pulse. Which is the nurse's priority intervention? a. Documenting the finding and reassessing in 1 hour b. Assessing blood pressure in both arms c. Administering atropine sulfate d. Assessing the telemetry reading

ANS: D Hypercortisolism causes potassium imbalances, which can lead to fatal dysrhythmias. With an irregular pulse, the nurse should assess the client's cardiac rhythm. The finding should be documented, but the nurse cannot wait an hour to take further action. Assessing bilateral blood pressures will not provide useful information. No indications for atropine are known.

A client who has had systemic lupus erythematosus (SLE) for many years is in the clinic reporting hip pain with ambulation. Which action by the nurse is best? a. Assess medication records for steroid use. b. Facilitate a consultation with physical therapy. c. Measure the range of motion in both hips. d. Notify the health care provider immediately. anted.

ANS: D Sjögren's syndrome is seen in clients with RA and manifests with dryness of the eyes, mouth, and vagina in females. Visual disturbances can occur. The other assessments are not related to RA and Sjögren's syndrome.

6. A client thought to have a problem with the pituitary gland is given a stimulation test using insulin. A short time later, blood analysis reveals elevated levels of growth hormone (GH) and adrenocorticotropic hormone (ACTH). Which is the nurse's interpretation of this finding? a. Pituitary hypofunction b. Pituitary hyperfunction c. Pituitary-induced diabetes mellitus d. A normal pituitary response to insulin

ANS: D Some tests for pituitary function involve administering agents that are known to stimulate the secretion of specific pituitary hormones and then measuring the response. Such tests are termed stimulation tests. For example, the presence of insulin in those with normal pituitary function causes increased release of GH and ACTH. The stimulation test for GH or ACTH assessment involves injecting the client with regular insulin (0.05 to 1 U/kg of body weight) and checking circulating levels of GH and ACTH.