EAQ CH 62- Care of Patients with Pituitary and Adrenal Gland Problems
Which laboratory results indicate that fluid restrictions have been effective in treating syndrome of inappropriate antidiuretic hormone (SIADH)? Decreased hematocrit Increased serum sodium Decreased serum osmolality Increased urine specific gravity
Increased serum sodium
What finding in a patient that is 4 hours post-hypophysectomy should be reported to the health care provider immediately? Increased swallowing Dry mucous membranes Blood-tinged nasal drainage Urine specific gravity of 1.028
Increased swallowing
Which symptom is associated with vasopressin hormone deficiency? Increased thirst Decreased bone density Decreased urinary output Increased specific gravity of the urine
Increased thirst
What manifestation does the nurse expect to find in a patient diagnosed with diabetes insipidus (DI)? Excessive hunger Reduced fluid intake Highly concentrated urine Increased urinary frequency
Increased urinary frequency
The assessment and clinical findings for a patient show decreased production of all hormones from the anterior pituitary. What is this condition called? Panhypopituitarism Pituitary hypofunction Selective hypopituitarism Secondary pituitary dysfunction
Panhypopituitarism
What finding does the nurse expect to assess in a patient with deficient growth hormone (GH)? Weight gain Intolerance to cold Decreased body hair Pathologic fractures
Pathologic fractures
A patient is admitted to the hospital with acute adrenal insufficiency. Which laboratory tests would the nurse expect the health care provider to prescribe? Select all that apply. Sodium Cortisol Albumin Potassium Liver function
Sodium Cortisol Potassium
Which laboratory value does the nurse recognize as consistent with a patient diagnosis of Addison disease? Calcium: 8 mg/dL Sodium: 128 mEq/L Potassium: 2.5 mEq/L Bicarbonates: 20mEq/L
Sodium: 128 mEq/L
A patient diagnosed with Cushing's disease has received teaching about nutrition. What food selection by the patient indicates effective teaching? Saltines Spinach Cabbage Canned soup
Spinach
A patient with iatrogenic Cushing's syndrome is a resident in a long-term care facility. Which nursing action included in the patient's care would be best to delegate to the unlicensed assistive personnel (UAP)? Assist with personal hygiene and skin care. Monitor for signs and symptoms of fluid retention. Develop a plan of care to minimize risk for infection. Instruct the patient on the reasons to avoid overeating.
Assist with personal hygiene and skin care.
What is a common side effect of spironolactone therapy for hyperaldosteronism? Urticaria Hypokalemia Constipation Hypernatremia
Urticaria
A patient presents to the emergency department with hypertension and fatigue. The patient reports weight loss and vomiting over the past several days. The nurse suspects the patient may be experiencing an Addisonian crisis. What question by the nurse is priority? 'Have you had any cravings for salt?' 'Have you been told that you have low calcium?' 'Have you recently been on steroids or pain medication?' 'Have you ever been diagnosed with excess cortisol production?'
'Have you recently been on steroids or pain medication?'
A patient who has been on long-term corticosteroid treatment calls the health care provider's office to report fatigue, nausea, and salt cravings. What question by the nurse is priority? 'Have you been using salt substitutes?' 'Have you stopped taking your corticosteroid?' 'Do you have any notable swelling in your abdomen?' 'Do you have any abnormal swelling on your upper back and shoulders?'
'Have you stopped taking your corticosteroid?'
A patient diagnosed with acromegaly is beginning bromocriptine mesylate therapy. What statement by the patient indicates a need for further teaching? 'My blood glucose should improve.' 'I am excited for my lips to be normal.' 'I should take the medicine with food.' 'I will need to change positions slowly.'
'I am excited for my lips to be normal.'
The nurse is providing discharge instructions to a patient on spironolactone therapy. Which comment by the patient indicates a need for further teaching? 'I need to increase my salt intake.' 'I should eat a banana every day.' 'This drug will not control my heart rate.' 'I must call the provider if I am more tired than usual.'
'I should eat a banana every day.'
The nurse is educating a patient with hypercortisolism about prevention of different types of injuries. Which patient statement indicates effective understanding? 'I can have coffee every day.' 'I can safely use aspirin for pain.' 'I should eat a diet rich in calcium.' 'I should not take antacids.'
'I should eat a diet rich in calcium.'
A patient diagnosed with glucocorticoid deficiency is prescribed hydrocortisone. What teaching specific to hydrocortisone will the nurse provide? 'Take the medication with meals.' 'Monitor your blood pressure regularly.' 'If you have fever and diarrhea, call your health care provider.' 'If you experience rapid weight gain, report this immediately.'
'If you experience rapid weight gain, report this immediately.'
A patient suspected of having Cushing's disease is scheduled for dexamethasone suppression testing. What statement by the patient indicates a need for further teaching? 'My blood will be drawn over 3 days.' 'For 24 hours, my urine will be collected.' 'This test will show if I have high cortisol levels.' 'I will be given doses of dexamethasone over 3 hours.'
'My blood will be drawn over 3 days.'
Which teaching will the nurse provide to a patient who has undergone nasal hypophysectomy for hyperpituitarism? 'Report any postnasal drip after surgery.' 'Brush your teeth twice every day after surgery.' 'Cough slowly at the end of a deep-breathing exercise.' 'Perform deep-breathing exercises every 15 minutes after surgery.'
'Report any postnasal drip after surgery.'
A patient has been ordered cortisone for hypofunction of the adrenal gland. What does the nurse instruct the patient about the administration of this drug? 'Take the drug on alternate days.' 'Take the drug before going to bed.' 'Take the drug with meals or a snack.' 'Report rapid weight gain or fluid retention.'
'Take the drug with meals or a snack.'
A patient with Cushing's disease begins to laugh loudly and inappropriately, causing the family in the room to be uncomfortable. What is the nurse's best response? 'Medication is available to help with this.' 'I need to check the patient's cortisol level.' 'Don't mind this. The disease is causing this.' 'The disease can sometimes affect emotional responses.'
'The disease can sometimes affect emotional responses.'
A patient with syndrome of inappropriate antidiuretic hormone (SIADH) reports a 3.3 lb (1.5 kg) increase in weight per day to the nurse. What is the amount of fluid retention in this patient? 500 mL 1000 mL 1500 mL 2000 mL
1500 mL
The nurse is caring for the following four patients. Which patient should the nurse see first? A patient diagnosed with diabetes insipidus (DI) with a serum K+ of 3.3 mEq/L A patient diagnosed with diabetes insipidus (DI) with a weight gain of 2 pounds in 24 hours A patient diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) with a serum Na of 114 mEq/L A patient diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) with an intake of 1,000 mL and an output of 900
A patient diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) with a serum Na of 114 mEq/L
The nurse is caring for the following four patients. Which patient should the nurse see first? A patient diagnosed with diabetes insipidus (DI) complaining of polyuria A patient diagnosed with diabetes insipidus (DI) with a pulse of 102 and BP of 100/62 A patient diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) with a serum Na of 132 mEq/L A patient diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) with an intake of 1,000 mL and an output of 700
A patient diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) with an intake of 1,000 mL and an output of 700
Which action by the patient with hypercortisolism can prevent gastrointestinal (GI) bleeding? Avoiding antacids Avoiding caffeine and alcohol Limiting calcium and vitamin D in the diet Eliminating green leafy vegetables from the dietThe nurse is caring for a patient who is prescribed desmopressin (DDAVP) nasal spray for diabetes insipidus. What is a potential side effect of this intranasal drug? Anuria Drowsiness Weight gain Chest tightness
Avoiding caffeine and alcohol
A patient is admitted with a diagnosis of diabetes insipidus (DI). What finding is priority to report to the health care provider? Pulse of 102 Bilateral muscle weakness Serum sodium of 147 mEq/L Intake of 1200; output of 1050
Bilateral muscle weakness
Which selection indicates the teaching regarding nutrition was effective in a patient diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH)? Apple Chicken breast Frozen French fries Canned green beans
Canned green beans
A patient diagnosed with a pheochromocytoma is admitted to the emergency department with a severe headache, flushing, and palpitations. The patient is now reporting abdominal pain. What action should the nurse take? Check blood pressure Palpate abdomen for mass Administer subcutaneous glucagon Prepare patient for magnetic resonance imaging (MRI)
Check blood pressure
Which menu selection indicates the teaching regarding nutrition was effective in a patient diagnosed with diabetes insipidus (DI)? Pizza Cold cuts Frozen French fries Canned green beans
Frozen French fries
Hyperfunction of which anterior pituitary hormone can cause sleep apnea? Prolactin (PRL) Thyrotropin (TSH) Growth hormone (GH) Adrenocorticotropic hormone (ACTH)
Growth hormone (GH)
A patient has undergone a hypophysectomy. What postoperative intervention should the nurse perform for this patient? Have the patient lie flat after surgery. Monitor neurologic status every 4 hours. Discard and replace the nasal drip pad at regular intervals. Have the patient avoid brushing the teeth for 2 weeks after surgery.
Have the patient avoid brushing the teeth for 2 weeks after surgery.
A patient is taking fludrocortisone for adrenal hypofunction. The patient should report which symptom while taking this drug? Anxiety Nausea Headache Weight loss
Headache
What clinical finding does the nurse expect in a patient with reduced aldosterone secretion? Hyperkalemia Hypervolemia Hypernatremia Hyperglycemia
Hyperkalemia
What finding does the nurse expect to see in a patient with hyperaldosteronism? Hypotension Hyperkalemia Hypernatremia Metabolic acidosis
Hypernatremia
A patient diagnosed with adrenocorticotropic hormone imbalance reports weight gain. The nurse observes moon face and truncal obesity in the patient. Which other assessment finding does the nurse anticipate? Galactorrhea Hypertension Hypoglycemia Heat intolerance
Hypertension
What does the nurse identify as a sign of infection for a patient who underwent an adrenalectomy? Skin breakdown Crackles and wheezes Breakdown of oral mucosa Increase of 1° F in body temperature
Increase of 1° F in body temperature
A patient is prescribed an adrenocorticotropic hormone (ACTH) stimulation test for adrenal insufficiency. What cortisol response should the nurse expect in secondary insufficiency? Absent Normal Increased Decreased
Increased
What is the most common electrolyte imbalance in the patient with diabetes inspidus? Increased serum sodium Decreased serum sodium Increased serum potassium Decreased serum potassium
Increased serum sodium
The nurse is caring for a patient diagnosed with nephrogenic diabetic insipidus. What is the cause of this condition? Defects in the hypothalamus or pituitary gland Tumors in or near the hypothalamus or pituitary gland Use of drugs that affect the response of kidneys to antidiuretic hormone Lack of response of the kidney tubules to the actions of antidiuretic hormone
Lack of response of the kidney tubules to the actions of antidiuretic hormone
Which symptom indicates decreased adrenocorticotropic hormone (ACTH) in the body? Malaise Increased thirst Decreased libido Intolerance to cold
Malaise
What medication is used for the treatment of Cushing's disease? Kayexalate Metyrapone Hydrocortisone Phenoxybenzamine
Metyrapone
What manifestations should the nurse expect to find in a patient with Cushing's syndrome? Select all that apply. Moon face Truncal obesity Barrel-shaped chest Loss of bone density Enlarged hands and feet
Moon face Truncal obesity Loss of bone density
A patient with a possible adrenal gland tumor is admitted for testing and treatment. Which action is most appropriate for the charge nurse to delegate to a nursing assistant? Assess skin turgor and mucous membranes for hydration status. Discuss the dietary restrictions needed for 24-hour urine testing. Plan ways to control the environment to avoid stimulating the patient. Remind the patient to avoid drinking coffee and changing position suddenly.
Remind the patient to avoid drinking coffee and changing position suddenly.
A patient with a possible adrenal gland tumor is admitted for testing and treatment. Which action is most appropriate for the charge nurse to delegate to a nursing assistant? Assess skin turgor and mucous membranes for hydration status. Discuss the dietary restrictions needed for 24-hour urine testing. Plan ways to control the environment to avoid stimulating the patient. Remind the patient to avoid drinking coffee and changing position suddenly.
Remind the patient to avoid drinking coffee and changing position suddenly.
The nurse reviews the plan of care for a patient with hyperpituitarism. The nurse should question which prescription listed on the plan? Octreotide Vasopressin Pegvisomant Bromocriptine
Vasopressin
Which hormonal hyperfunctioning can result in truncal obesity? Growth hormone (GH) Follicle-stimulating hormone (FSH) Thyroid-stimulating hormone (TSH) Adrenocorticotropic hormone (ACTH)
Adrenocorticotropic hormone (ACTH)
The nurse is teaching a patient about how to monitor therapy effectiveness for syndrome of inappropriate antidiuretic hormone (SIADH). What does the nurse tell the patient to look for? Muscle spasms Increasing heart rate Dry mucous membranes Daily weight gain of more than 2 lbs
Daily weight gain of more than 2 lbs
An adult patient has growth hormone (GH) deficiency. What risk does the nurse anticipate for this patient? Double vision Decreased height Growth retardation Decreased bone strength
Decreased bone strength
Which are key assessment findings in a patient suspected of having diabetes insipidus? Select all that apply. Tachycardia Hemodilution Increased thirst Dry mucous membranes High specific urine gravity
Tachycardia Increased thirst Dry mucous membranes
What nursing intervention is a priority for a male patient diagnosed with gonadotropin deficiency who is experiencing body image disturbance? Refer to a psychologist Teach about testosterone therapy Provide information on penile implants Encourage daily exercise with weight training
Teach about testosterone therapy
The nurse is assessing the elimination patterns of a patient. Which finding needs further evaluation to rule out the possibility of diabetes insipidus (DI)? The specific gravity of the urine is 1.005. The first morning sample of urine is pale yellow and clear. The patient reports excessive thirst and increased frequency of urination. The total urine output is slightly less than the total fluid intake in 24 hours.
The patient reports excessive thirst and increased frequency of urination.
What are the most common features of acromegaly? Acne Moon face Fine tremors Thickened lips
Thickened lips
A patient with Cushing's disease says that she has lost 5 lbs. What does the nurse do next? Forces fluids Weighs the patient Checks urine for specific gravity Auscultates the lungs for crackles
Weighs the patient
A patient diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) has received education about the diagnoses. What statement by the patient indicates an understanding of the teaching provided? 'I should restrict my sodium intake in my diet.' 'I will need to increase the amount of fluid I drink.' 'I will need to urinate more while I am taking conivaptan.' 'I will need to need to change positions slowly to avoid getting lightheaded.'
'I will need to urinate more while I am taking conivaptan.'
The nurse is providing teaching to a patient scheduled for a unilateral adrenalectomy. What statement by the patient indicates that the teaching was effective? 'I will still have one adrenal gland left.' 'The surgery cannot be done laparoscopically.' 'The surgery should improve my elevated potassium level.' 'I will need to take glucocorticoid replacement for the rest of my life.'
'I will still have one adrenal gland left.'
The nurse is caring for a patient with osteoporosis due to growth hormone (GH) deficiency. What is the cause of growth hormone (GH) deficiency? Increased serum cholesterol levels Increased production of somatomedins Overgrowth of tissues of the pituitary gland Failure of tissues to respond to somatomedins
Failure of tissues to respond to somatomedins
The nurse is caring for a patient who is prescribed desmopressin (DDAVP) nasal spray for diabetes insipidus. What is a potential side effect of this intranasal drug? Anuria Drowsiness Weight gain Chest tightness
Chest tightness
What precautions must a patient, who has had a hypophysectomy, take to prevent intracranial pressure (ICP)? Bend at the waist to pick up objects. Perform deep breathing exercises. Cover the mouth when coughing and sneezing. Consume high-fiber foods and drink plenty of fluids.
Consume high-fiber foods and drink plenty of fluids.
A patient with syndrome of inappropriate antidiuretic hormone (SIADH) is receiving IV hypertonic saline. What finding indicates fluid overload in the patient? Crackles in the lungs Increased urine output Absence of peripheral edema Absence of neurologic changes
Crackles in the lungs
Which disorder causes the adrenal cortex to secrete too much cortisol? Graves disease Turner syndrome Cushing syndrome Hashimoto disease
Cushing syndrome
Which finding does the nurse identify as contributing to the potential for infection in the patient with hypercortisolism? Increased serum sodium level Decreased lymphocyte count Increased blood glucose level Decreased serum potassium level
Decreased lymphocyte count
A patient has been admitted to the medical intensive care unit with a diagnosis of diabetes insipidus (DI) secondary to lithium overdose. Which medication is used to treat the DI? Tolvaptan Prednisone Desmopressin (DDAVP) Dopamine hydrochloride
Desmopressin (DDAVP)
A patient reports increased urinary frequency and increased thirst. The nurse observes poor skin turgidity and dry mucous membranes. Laboratory reports showed a decrease in antidiuretic hormone, and over a 24-hour period, the patient urinated 5.5 L. Which drug does the nurse anticipate will be prescribed? Octreotide Pegvisomant Desmopressin acetate Bromocriptine mesylate
Desmopressin acetate
A patient diagnosed with hyperpituitarism resulting from a prolactin-secreting tumor has been prescribed bromocriptine mesylate. As a dopamine agonist, what effect does this drug have by stimulating dopamine receptors in the brain? Increases the risk for depression Decreases the risk for cerebrovascular disease Inhibits the release of some pituitary hormones Stimulates the release of some pituitary hormones
Inhibits the release of some pituitary hormones
The nurse has determined that a patient diagnosed with Cushing's disease is at risk for injury. What intervention is necessary? Provide a low-calorie diet. Instruct patient to use an electric razor. Encourage patient to walk independently. Avoid the use of histamine receptor blockers.
Instruct patient to use an electric razor.
A patient with syndrome of inappropriate antidiuretic hormone (SIADH) is receiving gastrointestinal tube feedings. What must the nurse keep in mind when caring for this patient? Mix drugs to be given with saline. Dilute tube feedings with plain water. Irrigate the tube with lukewarm water. Flush the tube after each use with hypertonic saline.
Mix drugs to be given with saline.
Which musculoskeletal problem would a nurse expect to find in a patient with Cushing syndrome? Striae Osteoporosis Osteoarthritis Rheumatoid arthritis
Osteoporosis
These data are obtained by the RN who is assessing a patient who had a transsphenoidal hypophysectomy yesterday. What information has the most immediate implications for the patient's care? Urine specific gravity of 1.016 Dry lips and oral mucosa on examination Patient report of a headache and stiff neck Nasal drainage that tests negative for glucose
Patient report of a headache and stiff neck
Which are considered secondary causes of adrenal insufficiency? Select all that apply. Tuberculosis Pituitary tumors Hypophysectomy Autoimmune diseases Abruptly stopping corticosteroids
Pituitary tumors Hypophysectomy Abruptly stopping corticosteroids
What is the most common cause of Sheehan's syndrome? Shock Osteoporosis Severe malnutrition Postpartum hemorrhage
Postpartum hemorrhage
Which parameters are elevated in a patient with adrenal insufficiency? Sodium level Glucose level Cortisol level Potassium level
Potassium level
What changes does the nurse note in a patient with hypercortisolism upon physical assessment? Excessively dry skin Muscle atrophy in the trunk Absence of hair on the body Presence of fat pads on the shoulders
Presence of fat pads on the shoulders
What is the rationale for administration of ranitidine to a patient who is experiencing acute adrenal insufficiency? Treatment of nausea Reduction of potassium Prevention of gastric ulcers Replacement of adrenocorticotropic hormone (ACTH)
Prevention of gastric ulcers
Which condition contraindicates androgen therapy? Hypertension Prostate cancer Bronchial asthma Diabetes mellitus
Prostate cancer
What should the nurse include in the plan of care for a patient with a pheochromocytoma to prevent a hypertensive crisis? Select all that apply. Provide stool softeners. Infuse intravenous fluids. Monitor potassium levels. Avoid abdominal palpation. Administer metoclopramide.
Provide stool softeners. Avoid abdominal palpation.
A patient presents to the emergency department with acute adrenal insufficiency and the following vital signs: P 118 beats/min, R 18/min, BP 84/44 mm Hg, pulse oximetry 98%, and T 98.8° F oral. Which nursing intervention is the highest priority for this patient? Restricting sodium Providing isotonic fluids Administering furosemide Replacing potassium losses
Providing isotonic fluids
What determines the neuromuscular status of a patient who underwent endoscopic nasal hypophysectomy for hyperpituitarism? Level of consciousness Pupillary response to light Ability to read a seven-word sentence Orientation to time, place, and person
Pupillary response to light
The nurse is caring for a patient with pituitary infarction following postpartum hemorrhage. What condition does the patient have? Conn's syndrome Cushing's syndrome Sheehan's syndrome Schwartz-Bartter syndrome
Sheehan's syndrome
Which imaging assessment can identify abnormalities of the sella turcica in a patient with pituitary problems? Skull x-ray Angiogram Computed tomography (CT) Magnetic resonance imaging (MRI)
Skull x-ray
The nurse is monitoring a patient who is immobile and immunosuppressed due to hypercortisolism. Which nursing action reduces the risk for infection? Performing pulmonary hygiene every six hours Changing the patient's position every eight hours Recording the body temperature every four hours Checking for the presence of breath every twelve hours
Recording the body temperature every four hours
What skin change does the nurse expect to find in a patient with hypercortisolism? Thick skin Smooth shiny skin Hypopigmentation Reddish-purple striae
Reddish-purple striae
Which condition results from excessive secretion of vasopressin even when plasma osmolarity is low or normal? Cushing syndrome Sheehan's syndrome Schwartz-Bartter syndrome Waterhouse-Friderichsen syndrome
Schwartz-Bartter syndrome
What laboratory finding is most important to monitor in a patient diagnosed with diabetes insipidus (DI)? Serum sodium Serum glucose Serum potassium Serum liver function
Serum sodium
Weight gain, intolerance to cold, lethargy, and menstrual abnormalities are symptoms of a deficiency in which pituitary hormone? Gonadotropins Growth hormone (GH) Thyroid-stimulating hormone (TSH) Adrenocorticotropic hormone (ACTH)
Thyroid-stimulating hormone (TSH)
A patient with a diagnosis of Cushing's disease has been hospitalized. What care is priority for this patient? Treating fluid overload Preventing complications Monitoring for signs of infection Providing support regarding body changes
Treating fluid overload
A patient with a diagnosis of Cushing's disease has been hospitalized. What care is priorityfor this patient? Treating fluid overload Preventing complications Monitoring for signs of infection Providing support regarding body changes
Treating fluid overload
A patient has been prescribed divided doses of prednisone. How should the patient take this drug? One-third in the morning, afternoon, and night One-third in the morning and two-thirds at night Half in the morning and half in the late afternoon Two-thirds in the morning and one-third in the late afternoon
Two-thirds in the morning and one-third in the late afternoon
A patient is prescribed the nasal spray desmopressin for diabetes insipidus. What does the nurse teach the patient about the use of this drug? Ensure fluid intake of 4 L when taking this drug. Maintain a record of weekly weight gain or loss. Sit upright and breathe deeply when inhaling the drug. Ulceration of the mucous membranes may occur with intranasal use.
Ulceration of the mucous membranes may occur with intranasal use.
A patient with hypercortisolism is at risk for bone fractures. What does the nurse instruct the unlicensed assistive personnel (UAP) to do when caring for this patient? Use a gait belt to assist the patient when walking. Grasp the patient when assisting movement in bed. Allow the patient to use the walker without assistance. Place mats next to the bed to protect the patient from cold floors.
Use a gait belt to assist the patient when walking.
The nurse is caring for a patient with hypercortisolism. The nurse begins to feel the onset of a cold but still has 4 hours left in the shift. Which action by the nurse is correct? Refusing to care for the patient. Asking another nurse to care for the patient. Monitoring the patient for cold-like symptoms. Wearing a facemask when caring for the patient.
Wearing a facemask when caring for the patient.
Which is a sign of syndrome of inappropriate antidiuretic hormone (SIADH)? Edema Weight gain Hypernatremia Increased appetite
Weight gain
How does the drug desmopressin (DDAVP) decrease urine output in a patient with diabetes insipidus (DI)? Increases cardiac output Increases blood pressure Blocks reabsorption of sodium Works as an antidiuretic hormone (ADH) in the kidneys
Works as an antidiuretic hormone (ADH) in the kidneys