E4: Endocrine
ANS: B Decreased urine osmolality is a sign of diabetes insipidus.
Decreased urine osmolality is a sign of which disorder? a. Hyperglycemia b. Diabetes insipidus c. Thyroid crisis d. Syndrome of inappropriate secretion of antidiuretic hormone
ANS: C Any patient who has head trauma or resection of a pituitary tumor has an increased risk of developing diabetes insipidus.
Patients who have sustained head trauma or have undergone resection of a pituitary tumor have an increased risk of developing which disorder? a. Type 1 diabetes b. Thyrotoxicosis c. Diabetes insipidus d. Myxedema coma
ANS: C This excessive intake of water reduces the serum osmolality to a more normal level and prevents dehydration. In the person with a decreased level of consciousness, the polyuria leads to severe hypernatremia, dehydration, decreased cerebral perfusion, seizures, loss of consciousness, and death.
The nurse understands that the onset of seizures in the patient with diabetes insipidus (DI) is indicative of which situation? a. Increased potassium levels b. Hyperosmolality c. Severe dehydration d. Toxic ammonia levels
ANS: B The adrenal cortex secretes cortisol. It regulates fluid homeostasis by means of aldosterone, and it secretes androgens.
What hormone does the adrenal cortex secrete to maintain homeostasis? a. Androgens b. Aldosterone c. Adrenocorticotrophic hormone (ACTH) d. Corticosteroid
ANS: C The patient with the syndrome of inappropriate antidiuretic hormone (SIADH) has an excess of ADH secreted into the bloodstream, more than the amount needed to maintain normal blood volume and serum osmolality. Excessive water is resorbed at the kidney tubule, leading to dilutional hyponatremia. Symptoms of severe hyponatremia include an inability to concentrate, mental confusion, apprehension, seizures, a decreased level of consciousness, coma, and death.
Which nursing intervention should be initiated on all patients with the syndrome of inappropriate antidiuretic hormone (SIADH)? a. Placing the patient on an air mattress b. Forcing fluids c. Initiating seizure precautions d. Applying soft restraints
ANS: A Patients with central diabetes insipidus (DI) who are unable to synthesize antidiuretic hormone (ADH) require replacement ADH (vasopressin) or an ADH analog. The most commonly prescribed drug is the synthetic analog of ADH, desmopressin (DDAVP). DDAVP can be given intravenously, subcutaneously, or as a nasal spray. A typical DDAVP dose is 1 to 2 mcg intravenously or subcutaneously every 12 hours.
The nurse is caring for a patient with a head injury who has developed diabetes insipidus (DI). What medication would the nurse expect to be prescribed for the patient? a. Vasopressin b. Insulin c. Glucagon d. Propylthiouracil
ANS: A The hypothalamus gland is known as the "master gland" because of the influence it has over all areas of body functioning. The hypothalamus controls pituitary gland action and response by secreting substances called release-inhibiting factors.
Which anatomic structure has influence over all areas of body functioning? a. Hypothalamus b. Pancreas c. Thyroid d. Pituitary
ANS: D In cases of severe central diabetes insipidus (DI)d the urine osmolality shows a significant increase (becomes more concentrated). Test results in which urine osmolality remains unchanged indicate nephrogenic DI.
A patient is admitted with hypernatremia secondary to diabetes insipidus (DI). The practitioner suspects the patient has neurogenic DI. Which finding would confirm that diagnosis? a. A slight increase in urine osmolality b. A decrease in urine output c. A decrease in serum osmolality d. No change in urine osmolality
ANS: C Values for serum osmolality in the bloodstream range from 275 to 295 mOsm/kg H2O. Increased serum osmolality stimulates the release of antidiuretic hormone, which in turn reduces the amount of water lost through the kidney.
A patient is admitted with hypernatremia secondary to neurogenic diabetes insipidus. The nurse notes that the patient's serum osmolality is 350 mOsm/kg. What does this finding indicate? a. The patient is overhydrated. b. The patient's serum osmolality is normal. c. The patient is dehydrated. d. The patient is hypothyroid.
ANS: D Antidiuretic hormone has two functions: (1) By means of the V1 receptors, it constricts smooth muscles within the arterial wall, and (2) through V2 receptors, it regulates fluid balance by altering the permeability of the kidney tubule to water.
A patient has been admitted after a craniotomy. The patient starts to exhibit changes in the level of antidiuretic hormone (ADH). The nurse knows that ADH works primarily affects which organ? a. Liver b. Pancreas c. Stomach d. Kidneys
ANS: C The clinical diagnosis is made by the dramatic increase in dilute urine output in the absence of diuretics, a fluid challenge, or hyperglycemia. Characteristics of DI are intense thirst and the passage of excessively large quantities of very dilute urine.
A patient has been admitted after surgery for removal of a brain tumor. The nurse suspects the patient may be developing diabetes insipidus (DI). Which findings would confirm the nurse's suspicion? a. Hyperglycemia and hyperosmolarity b. Hyperglycemia and peripheral edema c. Intense thirst and passage of excessively large quantities of dilute urine d. Peripheral edema and pulmonary crackles
ANS: B Antidiuretic hormone (ADH) also contributes to control of the sodium level in the extracellular fluid by control of plasma osmolality. The sodium ion concentration in the plasma largely determines plasma osmolality. Osmoreceptors, located in the hypothalamus, are sensitive to changes in the circulating plasma osmolality. Because ADH causes the patient to retain free water, the patient will have a dilutional hyponatremia.
A patient has been admitted with a brain tumor. The patient starts to exhibit signs of an increase in antidiuretic hormone (ADH). When large amounts of ADH are released, the nurse should anticipate what change in the patient's sodium levels? a. Increase b. Decrease c. Rapid increase than decrease d. Depends on potassium level
ANS: B Serum sodium levels must be evaluated at least every 4 hours during the acute phase of sodium replacement. The serum sodium should not be raised more than 10 mEq/L in 24 hours.
A patient has been diagnosed with syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The nurse is administering hypertonic saline. The nurse knows that the serum sodium should not be raised more than how many milliequivalents per day? a. 5 mEq/day b. 10 mEq/day c. 20 mEq/day d. 25 mEq/day
ANS: A Reduction in fluid intake is one component of the treatment plan for syndrome of inappropriate secretion of antidiuretic hormone (SIADH).
A patient has been diagnosed with syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The nurse would expect the first line treatment to include which intervention? a. Fluid restriction b. Hypotonic intravenous fluid administration c. Administration of D5W d. Administration of vasopressin
ANS: A, B, D, F Signs and symptoms of Cushing syndrome include hypertension, thin skin that bruises easily, and poor wound healing.
A patient is admitted with Cushing syndrome. Which findings would the nurse expect to note as confirming this diagnosis? (Select all that apply, one, some, or all.) a. Hirsutism b. Rounded face c. Hypotension d. Decreased libido e. Scleroderma f. Fatigue and weakness
ANS: C Psychogenic diabetes insipidus (DI) is a rare form of the disease that occurs with compulsive drinking of more than 5 L of water a day. Long-standing psychogenic DI closely mimics nephrogenic DI because the kidney tubules become less responsive to antidiuretic hormone as a result of prolonged conditioning to hypotonic urine.
A patient is admitted with a long history of mental illness. The patient's spouse states the patient has been drinking up to 10 gallons of water each day for the past 2 days and refuses to eat. The patient is severely dehydrated and soaked with urine. The nurse suspects the patient has which problem? a. Central diabetes insipidus (DI) b. Nephrogenic DI c. Dipsogenic DI d. Iatrogenic DI
ANS: B Antidiuretic hormone has been identified as the single most important hormone responsible for regulating fluid balance within the body.
A patient is admitted with a traumatic head injury. The patient starts to exhibit signs of a decrease in antidiuretic hormone (ADH). What is the function of ADH? a. Control blood pressure b. Regulate fluid balance c. Normalize potassium levels d. Maintain homeostasis
ANS: B A low sodium level is associated with a low serum osmolality (hypoosmolar state). When sodium levels rise, plasma osmolality increases (hyperosmolar state). Antidiuretic hormone is then released to stimulate water resorption at the nephron to maintain sodium balance. This process decreases water loss from the body and subsequently concentrates and reduces urine volume. Fluid conserved in this manner is returned to the circulating plasma, where it dilutes the concentration (osmolality) of
A patient is admitted with a traumatic head injury. The patient starts to exhibit signs of a decrease in antidiuretic hormone (ADH). Which symptom would alert the nurse to this problem? a. Rapidly escalating hypertension b. Massive diuresis c. Pulmonary edema d. Hyperkalemia
ANS: C An Addisonian crisis is a life-threatening condition in which the adrenal gland is almost nonfunctional, usually because of destruction of adrenal tissue. The patient presents acutely with critical hypotension, an elevated serum potassium level (hyperkalemia), a low serum sodium level (hyponatremia), and hypoglycemia.
A patient is admitted with critical hypotension, hyperkalemia, hyponatremia, and hypoglycemia. The nurse knows that these symptoms are highly suggestive of which disorder? a. Myxedema b. Diabetes insipidus c. Addisonian crisis d. Cushing syndrome
ANS: D The antidiuretic hormone test is used to differentiate between neurogenic diabetes insipidus (DI) (central) and nephrogenic (kidney) DI. In severe central DI, in which the pituitary is affected, the urine osmolality shows a significant increase (becomes more concentrated), which indicates that the cell receptor sites on the kidney tubules are responsive to vasopressin. Test results in which urine osmolality remains unchanged indicate nephrogenic DI, suggesting kidney dysfunction because t
A patient is admitted with hypernatremia secondary to diabetes insipidus (DI). Which test would help the practitioner differentiate between central and nephrogenic DI? a. Water deprivation test b. Serum osmolality c. Serum antidiuretic hormone level d. Antidiuretic hormone (ADH) test
ANS: B To prepare the patient for the test, all drugs that may alter the release of antidiuretic hormone (ADH) are withheld for a minimum of 8 hours. Common medications that affect ADH levels include morphine sulfate, lithium carbonate, chlorothiazide, carbamazepine, oxytocin, nicotine, alcohol, and selective serotonin reuptake inhibitors.
A patient is admitted with hyponatremia. The practitioner suspects the patient may have syndrome of inappropriate secretion of antidiuretic hormone (SIADH) and orders a serum ADH level for the next morning. Which medications must be stopped or withheld at least 8 hours prior to the test? a. Insulin and furosemide b. Morphine and carbamazepine c. Digoxin and potassium d. Heparin and lopressor
ANS: D Cortisol is released in response to physiologic stress caused by infection, trauma, and the fasting state.
A patient is admitted with multiple trauma. Which hormone would the nurse expect to be increased in response to physiologic stress? a. Mineralocorticoid b. Corticosteroid c. Glucocorticoid d. Cortisol
ANS: B The patient with syndrome of inappropriate secretion of antidiuretic hormone (SIADH) has an excess of ADH secreted into the bloodstream, more than the amount needed to maintain normal blood volume and serum osmolality. Excessive water is resorbed at the kidney tubule, leading to dilutional hyponatremia.
A patient is admitted with syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The nurse understands that the hyponatremia associated with this disorder is the result of which mechanism? a. Increased cortisol release b. Excessive water reabsorption c. Excessive sodium excretion d. Decreased glucagon release
ANS: A With hemorrhage the serum osmolality increases, which stimulates the release of antidiuretic hormone.
A patient is brought to the hospital with a major stab wound. After excessive blood loss, the nurse should anticipate what change in the patient's serum osmolality? a. Increase b. Decrease c. Rapid decrease than increase d. Equal to his or her sodium level
ANS: A In central diabetes insipidus (DI), there is an inability to secrete an adequate amount of antidiuretic hormone (arginine vasopressin) in response to an osmotic or nonosmotic stimuli, resulting in inappropriately dilute urine. Hypernatremia is usually associated with serum hyperosmolality.
A patient is presenting with signs of diabetes insipidus (DI). Which findings would confirm this diagnosis? a. Hyperosmolality and hypernatremia b. Hyperosmolality and hyponatremia c. Hypoosmolality and hypernatremia d. Hypoosmolality and hyponatremia
ANS: C Insulin is a potent anabolic hormone that produces hypoglycemia and augments the transport of potassium into the cells. With potassium driven into the cells, serum potassium may decrease, resulting in hypokalemia.
A patient is receiving insulin due to the development of steroid-induced hyperglycemia. In addition to lowering blood glucose levels, what other physiologic effect may occur when insulin is administered? a. Breakdown of proteins b. Hypercalcemia c. Hypokalemia d. Cellular dehydration
ANS: A Symptoms identical to those of primary Cushing syndrome occur in patients with the secondary form who chronically take pharmacologic doses of glucocorticoids, for example, transplant recipients who take steroids to prevent solid organ rejection, patients with chronic obstructive pulmonary disease, or those with chronic inflammatory conditions. Cortisol and aldosterone are hormones released by the adrenal gland.
A patient was admitted with asthma who has been on steroids for a long time. The nurse knows that this patient is at risk of developing secondary Cushing syndrome. What would be the cause of this condition? a. Pharmacologic glucocorticoids b. Pharmacologic mineralocorticoids c. Cortisol d. Aldosterone
ANS: C A decreased urine output, hyponatremia, hypoosmolality, and high urine specific gravity are classic signs of syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Oat cell carcinoma is a precipitating factor for SIADH.
A patient with bronchogenic oat cell carcinoma has a drop in urine output. The laboratory reports a serum sodium level of 120 mEq/L, a serum osmolality level of 220 mOsm/kg, and urine specific gravity of 1.035. The nurse suspects the patient may be developing what problem? a. Diabetes ketoacidosis (DKA) b. Diabetes insipidus (DI) c. Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) d. Hyperaldosteronism
ANS: D Serum antidiuretic hormone (ADH) levels are compared with the blood and urine osmolality to differentiate syndrome of inappropriate antidiuretic hormone (SIADH) from central diabetes insipidus (DI). Increased ADH levels in the bloodstream compared with a low serum osmolality and elevated urine osmolality confirms the diagnosis of SIADH. Reduced levels of serum ADH in a patient with high serum osmolality, hypernatremia, and reduced urine concentration signal central DI.
The nurse is caring for a patient with a traumatic brain injury. The nurse suspects the patient is developing diabetes insipidus. Which test or procedure would confirm this diagnosis? a. Skull radiographs b. Serum glucose level c. Water deprivation test d. Antidiuretic hormone (ADH) stimulation test
ANS: C,D Emesis, hemorrhage, and pain stimulate the release of antidiuretic hormone (ADH). Cold and opioids inhibit the release of ADH. Infection does not directly affect the release of ADH.
The nurse is caring for a patient with diabetes insipidus, which is the result of a decrease in antidiuretic hormone (ADH). Which statements regarding the stimulation or inhibition of ADH are accurate? (Select all that apply, one, some, or all.) a. Infection stimulates the release of ADH. b. Cold stimulates the release of ADH. c. Emesis stimulates the release of ADH. d. Opioids inhibit the release of ADH. e. Hemorrhage inhibits the release of ADH. f. Pain inhibits the release of ADH.
ANS: D Secretion of antidiuretic hormone (SIADH) occurs when there are increased levels of ADH in the blood compared with a low serum osmolality.
The nurse is caring for a patient with the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Which findings would confirm this diagnosis? a. Decreased ADH level and hyperkalemia b. Decreased ADH level and hypernatremia c. Increased ADH level and serum ketones d. Increased ADH level and low serum osmolality
ANS: A Patient and family education about syndrome of inappropriate secretion of antidiuretic hormone (SIADH), its effect on water balance, and the reasons for fluid restrictions using the teach back method should include how to measure intake and output.
The nurse is developing a discharge education plan for a patient with syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Which topic should be included in the plan? a. Measuring intake and output b. Encouraging fluids c. A low-sodium diet d. Hypothermia management
ANS: B Patients with the syndrome of inappropriate antidiuretic hormone (SIADH) have an excess of antidiuretic hormone secreted into the bloodstream, more than the amount needed to maintain normal blood volume and serum osmolality. Excessive water is resorbed at the kidney tubule, leading to dilutional hyponatremia.
Which pathophysiologic mechanism occurs in the syndrome of inappropriate antidiuretic hormone (SIADH)? a. Massive diuresis, leading to hemoconcentration b. Dilutional hyponatremia, reducing sodium concentration to critically low levels c. Hypokalemia from massive diuresis d. Serum osmolality greater than 350 mOsm/kg
