ch 41. Coordinating Care for Patients With Pituitary Disorders

A patient is suspected of having a disorder of the posterior pituitary gland. For which additional health problem should the nurse anticipate planning care for this patient? 1) Acromegaly 2) Osteoporosis 3) Diabetes insipidus 4) Type 1 diabetes mellitus

3 1 Acromegaly is caused by over-secretion of growth hormone. 2 Osteoporosis is an adverse effect of hypopituitarism. 3 Central diabetes insipidus is caused by a decreased secretion of antidiuretic hormone (ADH) from the posterior pituitary gland. 4 Type 1 diabetes mellitus is caused by a malfunction of the cells within the pancreas.

A patient with a history of syndrome of inappropriate antidiuretic hormone (SIADH) reports a low urine output for several days. What should the nurse respond to this patient? 1) "Drink more fluids." 2) "Avoid eating salty foods." 3) "Go to the emergency room now." 4) "Take an over-the-counter NSAID."

3 1 Drinking fluids will exacerbate the low sodium level and make the condition worse. 2 The patient most likely has a low sodium level. Restricting salt would make the condition worse. 3 The patient needs medical attention immediately. 4 NSAIDs can cause SIADH. This could make the condition worse.

____ 21. The nurse is preparing medications for a patient with syndrome of inappropriate antidiuretic hormone (SIADH). Which medication would most likely be prescribed for this patient? 1) Ampicillin 2) Tetracycline 3) Vancomycin 4) Demeclocycline

4 1 Ampicillin is not used to treat SIADH. 2 Tetracycline is not used to treat SIADH. 3 Vancomycin is not used to treat SIADH. 4 Demeclocycline (Declomycin), a tetracycline derivative, may also be used because it increases water excretion by the kidneys.

A patient is being treated for diabetes insipidus (DI). Which medication should the nurse prepare to administer? 1) Calcium 2) Synthroid 3) Vitamin D 4) Desmopressin (DDAVP)

4 1 Calcium supplements would be required for a patient with hypopituitarism. 2 Synthroid is a replacement for hypothyroidism. 3 Vitamin D would be appropriate for a patient with osteoporosis caused by low growth hormone levels. 4 Desmopressin (DDAVP), a synthetic analog of ADH, is the drug of choice in patients with DI.

The nurse is reviewing orders written for a patient with hypopituitarism. What should the nurse expect to be prescribed for this patient? 1) Diuretics 2) Antibiotics 3) Antihypertensives 4) Electrolyte supplements

4 1 Diuretics are not routinely prescribed for a patient with hypopituitarism. 2 Antibiotics are not required to treat hypopituitarism. 3 Antihypertensives are not routinely prescribed for a patient with hypopituitarism. 4 Supportive therapies such as electrolyte replacement are the key to managing the patient with hypopituitarism.

A patient with diabetes insipidus (DI) is experiencing extreme dehydration. What should be used to guide intravenous fluid replacement therapy for this patient? 1) Skin turgor 2) Urine output total 3) Hemoglobin level 4) Serum sodium level

4 1 Skin turgor would not be used to guide intravenous fluid replacement therapy. 2 The urine output total would not be used to guide intravenous fluid replacement therapy. 3 Hemoglobin level is not used to guide intravenous fluid replacement therapy. 4 The solution ordered is based upon serum sodium level.

A patient is demonstrating signs of low pituitary gland function. Which diagnostic test should the nurse expect to be prescribed for this patient? 1) MRI 2) Lumbar puncture 3) Cerebral angiogram 4) Carotid Doppler studies

1 1 If a tumor of the brain or pituitary is suspected, a head MRI may be completed. 2 A lumbar puncture is not indicated for a disorder of the pituitary gland. 3 A cerebral angiogram is not indicated for a disorder of the pituitary gland. 4 Carotid Doppler studies are not indicated for a disorder of the pituitary gland.

The nurse is reviewing orders written for a patient with syndrome of inappropriate antidiuretic hormone (SIADH). Which order should the nurse clarify? 1) No added salt diet 2) Fluid restriction 1L/day 3) IV fluids 0.9% normal saline 125 mL/hr 4) Furosemide (Lasix) 20 mg by mouth every day

1 1 Medical management is primarily focused on treating the hyponatremia. The nurse should question a no added salt diet. 2 The patient is placed on a fluid restriction, usually less than 1000 mL/day. 3 IV administration of a saline solution would be expected. 4 Diuretics may be administered to increase urine output.

A patient with syndrome of inappropriate antidiuretic hormone (SIADH) is experiencing a headache and confusion. Which laboratory test would best explain the reason for this patient's symptoms? 1) Sodium 2) Calcium 3) Potassium 4) Hematocrit

1 1 The clinical presentation of the patient with SIADH is primarily related to the resultant hyponatremia. The neurological signs associated with the hyponatremia are related to osmotic fluid shifts in the brain that lead to cerebral edema and increased intracranial pressure. 2 The manifestations of SIADH are not caused by a calcium imbalance. 3 The manifestations of SIADH are not caused by a potassium imbalance. 4 The manifestations of SIADH are not caused by a change in hematocrit level.

The nurse is preparing to assess a patient with diabetes insipidus (DI). Which manifestations should the nurse expect? Select all that apply. 1) Fatigue 2) Extreme thirst 3) Extreme hunger 4) Large amounts of urine output 5) Waking up to urinate during the night

1245 1. Fatigue is a sign of fluid volume deficit. 2. Polydipsia or extreme thirst is a primary clinical manifestation of DI. 3. Extreme hunger is a manifestation of diabetes mellitus. 4. Polyuria is a primary clinical manifestation of DI. 5. Nocturia or waking up during the night to void is a primary clinical manifestation of DI.

A patient's thyroid-stimulating hormone (TSH) is below normal. What should the nurse expect to assess in this patient? Select all that apply. 1) Weight gain 2) Thinning hair 3) Decreased bone density 4) Decreased muscle strength 5) Complaints of decreased libido

125 1. Manifestations of low TSH levels include weight gain. 2. Manifestations of low TSH levels include thinning hair. 3. Manifestations of low growth hormone include decreased bone density. 4. Manifestations of low growth hormone include decreased muscle strength. 5. Manifestations of low TSH levels include decreased libido.

The nurse is planning care for a patient with hypopituitarism. What interventions would be a priority for this patient? Select all that apply. 1) Fertility 2) Skin care 3) Vital signs 4) Bone density 5) Fluid balance

134 1. Changes in fertility can occur in hypopituitarism. 2. Skin care is not an identified issue in hypopituitarism. 3. Vital signs can be altered in hypopituitarism. 4. Bone density can decrease in hypopituitarism. 5. Fluid balance is not an identified issue in hypopituitarism.

Laboratory results have been posted for a male patient experiencing manifestations of diabetes insipidus (DI). Which results would confirm the diagnosis? Select all that apply. 1) Hematocrit 52% 2) White blood cells 8000 3) Serum sodium 150 mEq/L 4) Urine specific gravity 1.002 5) Serum potassium 5.5 mEq/L

134 1. Hematocrit is increased in DI. 2. White blood cells are not measured specifically for DI. 3. Serum sodium is elevated in DI. 4. Urine specific gravity is decreased in DI. 5. Serum potassium is not measured specifically for DI.

The nurse notes that patient with diabetes insipidus (DI) has a loss of free water. Which nursing diagnosis should the nurse use to guide care for this patient? 1) Fluid Volume Deficit 2) Alteration in Comfort 3) Body Image Disturbance 4) Sensory Perceptual Alteration

1 1 The diagnosis Fluid Volume Deficit related to loss of free water secondary to lack of ADH would be appropriate for this patient. 2 The patient might be uncomfortable because of dehydration; however, this is not an ideal nursing diagnosis for this patient. 3 Body image disturbance would be appropriate for the patient with hyperpituitarism. 4 Sensory perception alteration would address vision changes and not fluid balance.

The nurse is reviewing discharge instructions with a patient being treated for diabetes insipidus (DI). What should the nurse direct the patient to do regarding changes in body weight? 1) Restrict fluids for a day 2) Notify the health-care provider 3) Increase the intake of salty foods 4) Take an extra dose of medication

2 1 It is beyond the nurse's scope of practice to prescribe therapy for weight changes. 2 Weight is directly associated with water loss or gain, and changes of more than 2 lb per day should be reported to the health-care provider. 3 Salty foods would cause more water weight gain. 4 It is beyond the nurse's scope of practice to alter the prescribed medication dose for the patient.

A patient is being discharged after surgery for hyperpituitarism. What should the nurse emphasize to reduce the risk of postoperative infection? 1) Restrict fluids 2) Avoid straining the suture line 3) Maintain bedrest for several days 4) Expect clear nasal drainage to occur

2 1 Restricting fluids would not reduce the risk of postoperative infection. 2 Strain on the suture line could introduce microorganisms into the surgical site and enter the central nervous system. Cerebrospinal fluid leak could lead to meningitis. 3 The client does not need to be on bedrest for several days. 4 Clear nasal drainage could indicate a cerebrospinal fluid leak that should be reported since this increases the patient's risk of developing meningitis postoperatively.

A patient is concerned because facial features are changing and the hands are becoming larger and painful. Which hormone should the nurse suspect is causing this patient's manifestations? 1) Testosterone 2) Growth hormone 3) Thyroid-stimulating hormone 4) Adrenocorticotropic hormone (ACTH)

2 1 Testosterone is not a hormone controlled by the pituitary gland. 2 Increased levels of growth hormone in an adult can cause course facial features and alter the bone structure of the hands and feet. 3 Manifestations of increased thyroid-stimulating hormone include weight loss and exophthalmos. 4 Elevated levels of adrenocorticotropic hormone (ACTH) cause hyperglycemia, hypertension, hypernatremia, and hypokalemia.

A patient with hypopituitarism is experiencing muscle weakness. Which referral should the nurse make to help this patient? 1) Home care 2) Physical therapy 3) Recreational therapy 4) Occupational therapy

2 1 The patient does not have a need for skilled nursing care. 2 Physical therapy would be helpful to maximize this patient's mobility. Osteoporosis increases the risk for falls, and the physical therapist can provide input into safe transfers from bed to chair and measures to decrease the incidence of falls. 3 There is no evidence that the patient is psychosocially stressed or in need of assistance with coping. 4 Occupational therapy would be helpful for activities of daily living. There is no evidence that the patient needs this type of support.

A patient is being evaluated for possible hyperpituitarism. Which manifestation most likely caused this patient to seek medical treatment? 1) Hair loss 2) Headaches 3) Sore throat 4) Muscle cramps

2 1 The patient most likely would not seek medical treatment for hair loss. 2 Hyperpituitarism is usually related to a hypersecreting tumor. The patient presentation is consistent with clinical manifestations associated to the over-secreted hormone, and the tumor itself may lead to headaches. 3 A sore throat is a common symptom of the common cold and other upper respiratory disorders. Medical treatment is not often sought for a sore throat. 4 Muscle cramps are not a manifestation of hyperpituitarism.

The patient is preparing discharge teaching for a patient recovering from surgery to treat hyperpituitarism. Which interdisciplinary team member should be consulted to ensure medication teaching is appropriate? 1) Surgeon 2) Pharmacist 3) Charge nurse 4) Endocrinologist

2 1 The surgeon would be consulted regarding the surgical procedure. 2 Because of the complexity of the disease process and possible side effects of medications (that may decrease secretion of other anterior pituitary hormones), the patient and family need to understand the specific changes to be reported to the health-care provider. Collaborate with the pharmacist for mediation teaching. 3 The charge nurse would not have the specific information required about the medications. 4 The endocrinologist would be consulted regarding the hormone imbalance and the effects.

A patient has a serum sodium level of 126 mEq/L. What action should the nurse take to ensure for this patient's safety? 1) Apply wrist restraints 2) Implement seizure precautions 3) Prepare for nasogastric tube insertion 4) Plan for intermittent urinary catheterization

2 1 There is no indication that wrist restraints are needed for this patient. 2 If the serum sodium level goes below 125 mEq/L, the patient is at risk of seizures. 3 The patient does not need a nasogastric tube. 4 Intermittent urinary catheterization is not indicated for this patient.

The nurse is preparing discharge teaching for a patient recovering from a transsphenoidal hypophysectomy for a pituitary tumor. What should the nurse emphasize in this teaching? Select all that apply. 1) No lifting 2) Avoid coughing 3) Do not bend over 4) Sneeze with an open mouth 5) Avoid driving for several weeks

23 1. No lifting is not identified as important to teach this patient. 2. The patient should be instructed to avoid activities that increase pressure at the incision site such as coughing. 3. The patient should be instructed to avoid activities that increase pressure at the incision site such as bending over. 4. The patient should be instructed to avoid all sneezing. 5. There is no evidence that driving is restricted after this surgery.

A patient is being evaluated for hyperpituitarism. Which laboratory studies should the nurse expect to be prescribed for this patient? Select all that apply. 1) Calcium level 2) Growth hormone 3) Cortrosyn stimulation test 4) Follicle-stimulating hormone level (FSH) 5) Thyroid-stimulating hormone level (TSH)

2345 1. Calcium level would be appropriate if a parathyroid gland disorder is suspected. 2. Hormonal studies conducted to assess for hyperpituitarism include growth hormone provocative tests. 3. Hormonal studies conducted to assess for hyperpituitarism include the ACTH (Cortrosyn) stimulation test. 4. Hormonal studies conducted to assess for hyperpituitarism include measurements of FSH. 5. Hormonal studies conducted to assess for hyperpituitarism include measurements of TSH.

The nurse is reviewing laboratory values for a female patient who has had minimal urine output over the last shift. Which finding suggests that this patient may be experiencing syndrome of inappropriate antidiuretic hormone (SIADH)? 1) Hematocrit 40% 2) Serum sodium 136 mEq/L 3) Urine specific gravity 1.035 4) Serum potassium 3.9 mEq/L

3 1 The hematocrit level is within normal limits for a female. 2 The serum sodium level is within normal limits. 3 The urine specific gravity is elevated, which is seen in patients with SIADH. In patients with SIADH, due to excessive ADH secretion, they present with scant urine output and elevated urine specific gravity. 4 The serum potassium level is within normal limits even though this electrolyte is not used in the diagnosis of SIADH.

A patient is recovering from surgery to remove a pituitary tumor. Why should the nurse schedule frequent mouth care for this patient? 1) Medications dry mucous membranes 2) Maintenance of nothing by mouth status 3) Mouth breathing because of nasal packing 4) Stomatitis caused by the hormone imbalance

3 1 The patient is not on any medications that dry the mucous membranes. 2 The patient most likely is no longer on nothing by mouth status. 3 Because of the surgical procedure and postoperative packing, the patient breathes primarily through the mouth, increasing the chance of dry mouth. 4 Hormone imbalances do not cause stomatitis.

The bone density report for a patient with hypopituitarism shows areas of thinning and demineralization. What teaching should the nurse prepare for this patient? 1) Importance of avoiding extremes in temperature 2) Need to reduce exposure to people with infections 3) Food sources containing high amounts of calcium 4) Strategies to increase rest periods throughout the day

3 1 The patient with hypopituitarism does not need to avoid extremes in temperature. 2 The patient with hypopituitarism is not at risk for infections. 3 The nurse should instruct the patient on ways to increase calcium intake since this helps to treat osteoporosis secondary to decreased growth hormone. 4 The patient with hypopituitarism is not fatigued and will not need additional rest periods throughout the day.

A patient with osteoarthritis develops the syndrome of inappropriate antidiuretic hormone (SIADH). What information in the patient's history should the nurse identify as being the best reason for the development of this disorder? 1) Male gender 2) Age 70 years 3) Use of NSAIDs 4) African American

3 1 There are no specific relationships between the development of SIADH and sex. 2 There are no specific relationships between the development of SIADH and age. 3 Causes of SIADH vary and include side effects of medications such as non-steroidal anti-inflammatory drugs (NSAIDs). 4 There are no specific relationships between the development of SIADH and race.

A patient is diagnosed with hypopituitarism. Which additional body structure will most like be examined to determine the root cause of this disorder? 1) Thyroid 2) Cerebrum 3) Hypothalamus 4) Parathyroid glands

3 Hypopituitarism is not caused by dysfunction of the thyroid gland. Hypopituitarism is not caused by dysfunction of the cerebrum. The etiology of anterior pituitary dysfunction is often secondary to damage to the hypothalamus. Hypopituitarism is not caused by dysfunction of the parathyroid glands.