Endocrine

Which client is most at risk for developing Cushing's Disease? A. A patient with a tumor on the pituitary gland and is excreting too much ACTH. B. A client presenting with pneumonia C. A client revering from an Adrenalectomy D. A patient taking glucocorticoids for several weeks now.

ANSWER IS D: Cushing Disease occurs when your body has too much of the hormone cortisol over time. This can result from taking oral corticosteroid medication. Or your body might produce too much cortisol. But as with excessive production of cortisol in your body, taking too much corticosteroid medications can, over time, lead to Cushing's syndrome.

1. Which of the following symptoms would NOT be expected in a patient diagnosed with Addison's disease? a. Truncal obesity b. Hyperpigmentation c. Hypotension d. Muscle weakness

Correct Answer: A Rationale: Truncal obesity is a symptom of Cushing's disease, not Addison's disease. B, C, and D are all expected symptoms of Addison's disease.

1. The Nurse is developing a teaching plan for a male client diagnosed with Diabetes Insipidus. The Nurse should include information about which hormone lacking in clients with DI? a. Luteinizing Hormone (LH) b. Anti-diuretic Hormone (ADH) c. Follicle- Stimulating Hormone (FSH) d. Thyroid-Stimulating Hormone (TSH)

Correct Answer: B. Anti- diuretic Hormone is lacking for the client with diabetes insipidus. The client should be educated on the manifestations to indicate this is occurring.

The nurse is admitting a client diagnosed with Addison's Diease (adrenal cortex insuffciency). Which clinical manifestations should the nurse expect to see? Seclect all that apply. A. Mood face B. Hypotension C. Fever D. Anorexia E. Bronze pigmentation

Rationale: The correct answers are B,D, and E. Expected assessment data for a patient with Addison's Disease areL hypotension, anorexia, bronze pigmentation, hypoglycemia, changes in body hair, GI disturbances, general weakness, and weight loss. PermalinkReply ◀︎ Diabetes Insipidus Cushing's ▶︎ ◀︎ Endocrine Scenario 5

1. Which clinical manifestations relate to Addison's Disease? (Select all that apply) a. hyperglycemia b. weight gain c. hypotension d. extreme fatigue e. hyperpigmentation (darkening of skin)

ANSWER: C, D, E. One diagnosed with Addison's Disease will commonly present with, HYPOglycemia, weight loss, hypotension, extreme fatigue and hyperpigmentation.

A patient diagnosed with diabetes insipidus is being started on Diabinese. What teaching would you prioritize when talking with this patient? a. Restrict intake of caffeine while taking this medication b. Signs and symptoms of hypoglycemia c. Take Diabinese before bedtime d. If you miss a dose it is ok to double up on your next dose

Answer B. It is most important to teach this patient signs and symptoms of hypoglycemia due to the mechanism of action of the medication. There is no need to restrict caffeine while taking this medication, it should be taken first thing in the morning with breakfast and if they miss a dose it is okay to take if it is not at the same time as the next scheduled doe. Do NOT double dose if a dose is missed.

A nurse is teaching a group of students the signs and symptoms of Cushing's disease, which statement by the student would require further teaching? A. The most common cause of Cushing's disease is a pituitary adenoma. B. The patient could present with truncal obesity and muscle atrophy of the extremities. C. The patient could develop hyponatremia. D. Women are more likely to develop Cushing's than men.

Answer C A pituitary adenoma is the most common cause of Cushing's Disease. An adenoma is a tumor that could be pressing on the pituitary gland causing it to excrete excess cortisol. Truncal obesity and muscle atrophy are both signs of Cushing's as well as moon face, buffalo hump, thinning skin, striae and bruising. A patient with Cushing's may develop hypernatremia, not hyponatremia. Women are the most likely of the two to develop Cushing's.

1. A patient is starting on cortisol replacement therapy. Which statement indicates the patient needs further teaching? a. I will take my medication in divided doses b. I will weigh myself daily and keep a record c. If I have side effects I should stop taking my medication d. I will take my medication with a meal or snack

Answer C (Page 1260 chart 62-11 in Iggy 9th Edition) A. Medication should be taken in divided doses, a dose in the morning and the second dose 4-6 PM. B. The patient should closely monitor their weight. The patient should call their HCP if they gain 3 lbs. over one week or 1-2 lbs. in 24 hours. C. Patients taking corticosteroid therapy should not stop taking it abruptly. The drug should be tapered gradually under the care of the HCP. D. Medication should be taken with a meal or snack.

1. What statement made by the client who has diabetes insipidus indicates to the nurse that more teaching is needed? a. My diabetes makes me dehydrated so I should drink the same amount as my urine output. b. Approximately 60% of clients who have diabetes mellitus type 2 are obese. c. I should check my glucose before meals if I am a diabetic. d. I don't need to check my weight daily when taking a DI drug.

Answer D. weight is a good indicator of fluid status and so should be checked every day especially if on desmopressin replacement therapy.

1. Your patient comes into the ED with increased BP, barrel chest, and they are thinking that it is possible that they have Cushing's disease. Overuse of which drug would you expect to see in the patient's medication list? a. Prednisone b. Tylenol c. Phenytoin d. Ibuprofen

Answer is: A. Prednisone The patient with Cushing's disease is expected to have overused prednisone because prednisone affects the adrenal gland. A. Prednisone is the right answer because it affects the adrenal gland causing Cushing's disease. B. Tylenol if overused affects the liver. C. Phenytoin is used to prevent seizures in the brain and doesn't affect the adrenal gland. D. Ibuprofen if overused will affect your kidneys. Medical-Surgical Nursing 9th edition, Chapter 62

1. A patient is admitted to the medical surgical unit with Addison's disease what is the priority assessment for the nurse? a. Apical heart rate b. Urine output c. Activity level d. Abdominal pain

Answer with rational: A: Apical heart rate. Potassium is normally increased with a patient who have Addison's. Hyperkalemia can cause dysrhythmias with an irregular heart rate and result in cardiac arrest, assessing cardiac function is a nursing priority. Due to decrease water and sodium retention the patient may begin to experience hypovolemia. The first manifestation of hypovolemia is an increased heart rate. pg 1255

The patient with SIADH been brought to the ER after experiencing a seizure at home. The patient reports decreased urine output, weight gain, and muscle weakness. Which lab does the nurse prioritize? A. Potassium 4.6 mEq/L B. Sodium 118 mEq/L C. Sp. Gravity 1.030 D. Serum blood osmolarity 270 mOsm/kg

Answer: B: Sodium 118 mEq/L. When the sodium is below 120 mEq/L it is a critical level. Severe hyponatremia can cause seizure activity due to osmotic fluid shifts. Hypertonic solution should be started and monitored closely.

1. Which statement by the patient indicates a need for further education relating to post op care from the removal of a pituitary adenoma? a. I will be sure to perform good oral care as I should not brush my teeth for a short time after surgery b. I could lose my sense of smell for up to a year after my surgery c. I should be sure to bend at the knees and not at the waist d. I need to avoid blowing my nose for a short time after surgery

Answer: 2 Patient may lose their sense of smell for up to a couple months, not 1 year.

1. A client with Addison's Disease is experiencing an adrenal crisis, which of the following nursing interventions would be a priority? Select ALL THAT APPLY. a. Monitor for hypocalcemia b. Monitor for hypoglycemia c. Monitor for fluid volume deficit d. Monitor for hyponatremia

Answer: 2. 3. 4. Adrenal crisis causes hypoglycemia due to the low levels of corticosteroids, especially cortisol. Patients are at risk for a volume deficit due to severe vomiting and diarrhea. In adrenal crisis, it is difficult to excrete water, the blood becomes diluted causing hyponatremia. Patients in adrenal crisis experience hypercalcemia, NOT hypocalcemia, calcium being pushed out of the cells and less excretion by the kidneys.

1. The student nurse is providing patient education to the client recently diagnosed with Cushing's disease/syndrome. Which statement, if made by the client, indicates the need for further instruction? a. "I really need to eat a low-calorie diet with all of this weight I seem to be carrying around my middle." b. "I will weigh myself every morning before breakfast and report any weight gain of more than 3 a week or 1 to 2 pounds in a day." c. "Since I am on an oral cortisol replacement, I should notify my health care provider if I have vomiting or severe diarrhea and cannot take my medication for 24 to 36 hours." d. "I should be really careful and wear shoes or slippers with soles when I am indoors and avoid crowded places if I do not feel well."

Answer: A A: Instruct the client that a high-calorie diet that includes increased amounts of calcium and vitamin D is needed. Milk, cheese, yogurt, and green leafy and root vegetables will add calcium to promote bone density. With Cushing's disease/syndrome, bone density is decreased and osteoporosis is common. Advise the client to avoid alcohol and caffeine, which increase the risk for GI ulcers and reduce bone density. Avoid foods that are high in sodium such as processed meats and deli products. Refer to pages 1257 and 1259 in 9th edition of textbook. B. Clients with Cushing's disease/syndrome are at increased risk for fluid volume excess due to fluid and electrolyte imbalances. Teach the client to use the same scale and same type of clothing and do weight checks at the same time every day. Refer to page 1260 in 9th edition of textbook. C. Teach the client to never skip a dose of medication. If the client has persistent vomiting or severe diarrhea and cannot take his/her oral cortisol replacement medication for 24 to 36 hours, the client should contact his/her primary HCP. The client may need an injection to take the place of the client's usual oral cortisol replacement medication. Refer to chart 62-11 in 9th edition of textbook. D. The client with Cushing's disease/syndrome is at increased risk for injury/infection. Excess cortisol results in reduced immunity. Excess cortisol reduces the number of circulating lymphocytes, inhibits macrophage activity, reduces antibody synthesis, and inhibits production of inflammatory chemicals. Therefore, the client may not exhibit a fever, purulent exudate, or redness in an affected area when an infection is present. Refer to page 1257 in 9th edition

1. Norma Gene is a 67-year-old woman and has recently been diagnosed with Hyperpituitarism. What statement made by the patient indicates that teaching was successful? a. "Once skeletal changes have happened it is impossible to reverse them." b. "This disease only affects bone tissue." c. "A hypophysectomy is rarely the treatment for my condition." d. " A bone biopsy is how you came to the conclusion that I had hyperpituitarism."

Answer: A Medical-Surgical Nursing 9th edition, pg 1247-1249 A. Skeletal changes are irreversible.B. This disease affects organs such as the liver, heart and lungs. C. A hypophysectomy is the most common treatment for hyperpituitarism. D. An MRI is the best imaging assessment for diagnosing hyperpituitarism.

1. Which statement about Addison's Disease made by a student nurse needs to be corrected? a. Addison's Disease is manifested by over secretion of aldosterone b. Potassium levels will increase c. Sodium levels will decrease d. Cortisol and aldosterone deficiencies are corrected by hormone replacement therapies

Answer: A Rationale: Addison's disease is the insufficiency of aldosterone and cortisol. The reduced secretions cause fluid and electrolyte imbalances where sodium and water excretion is increase and potassium excretion is decrease causing the patient to have hyperkalemia.

1. What medication is used to treat diabetes insipidus (DI)? a. Desmopressin acetate b. Lithium c. Vasopressin d. Demeclocycline

Answer: A) Desmopressin Acetate: is the most preferred drug. A synthetic form of vasopressin given orally, as a sublingual "melt", or intranasally in a metered spray (pg. 1251).

1. Your patient has just returned from a hypophysectomy for hyperpituitarism. What should your focus assessment include? Select all that apply a. Assess cardiovascular status b. Assess cognition and mental status c. Assess neuromuscular status d. Assess kidney function e. Assess condition of operative site

Answer: A, B, C, D, E Rational The patient just underwent surgery in the brain. Complications of a hypophysectomy include transient diabetes insipidus, cerebrospinal fluid leakage, infection, and increased intracranial pressure. Teaching after hypophysectomy is very important as well and should include the following: teaching the patient to report any increased postnasal drip or increased swallowing. Keep the head of the bed elevated after surgery. Assess nasal drainage for quantity, quality, and the presence of glucose. Avoid coughing or sneezing. Encourage deep breathing.

A patient is admitted to the Emergency Department for diabetes insipidus. Which nursing interventions would be appropriate for this patient? Select all that apply A. Administer desmopressin as ordered B. Daily weight C. Monitor urine specific gravity D. Fluid restriction of 2000mL/ day E. Measure I & O

Answer: A, B, C, E Rationale: The preferred drug for therapy is desmopressin acetate given orally or sublingual which is used to treat diabetes insipidus. Drugs used to treat DI can induce water retention and cause fluid overload. Monitoring urine specific gravity is important to ensure patient is hydrated, dehydration can lead to death if severe enough. With DI we do not want to restrict fluid intake, we allow them to drink to maintain their hydration status. Monitoring intake and output consistently is an indicator of how poor or good their hydration status is and if further intervention is needed.

1. What signs and symptoms would indicate to the nurse that her patient's pituitary adenoma was increasing in size? (Select all that apply) a. Double vision b. Cardiac dysrhythmias c. Headache d. Confusion e. Increased blood pressure

Answer: A, C, D, E Rationale: Signs and symptoms of a growing adenoma include visual disturbances (double vision), headache, neurological changes (confusion), and increased intracranial pressure (increased blood pressure). Although dysrhythmias can result from enlargement of the heart leading to heart failure in hyperpituitarism, they are not a sign of increased tumor growth.

A patient is admitted with a diagnosis of Diabetes Insipidus. Which assessments would the nurse expect to find? Select all that apply. A. Blood pressure 88/52. B. Patient has decreased urine output. C. Patient is confused and irritable. D. Patient has dry mucus membranes. E. Heart rate of 56 bpm.

Answer: A, C, and D. Rationale: Most symptoms of Diabetes Insipidus are related to dehydration. (Chart 62-5 Iggy). Cardiovascular symptoms are hypotension, tachycardia, weak peripheral pulses, and hemoconcentration. Kidney/Urinary symptoms are increased urinary output, dilute, specific gravity. Skin symptoms are poor skin turgor and dry mucus membranes. Neurologic symptoms are decreased cognition, ataxia, increased thirst, and irritability. PermalinkReply ◀︎ Cushing's Disease SIADH ▶︎ ◀︎ Endocrine Scenario 5

A client presents to the ED with profound weakness and dehydration. Assessment notes: Na 130, K 5.9, BUN 35, pH 7.30/HCO3 18/paCO2 50, Blood glucose 50, BP 90/55. What orders would the nurse expect? (SATA) A. Start rapid infusion of D5W in normal saline B. Administer Spironolactone daily C. Monitor blood glucose before meals D. Monitor strict I&O E. Administer initial steroid dose as an IV bolus

Answer: A, D, E Adrenal crisis is characterized by decreasing sodium, increasing potassium, hypotension, metabolic acidosis, profound fatigue, and dehydration. Primary emergency care of this client focuses on hormone replacement, hyperkalemia and hypoglycemia management. Rapid infusion of D5W in normal saline boosts volume depletion and supports hypoglycemia. Spironolactone is a potassium sparing diuretic and is not appropriate to use. Blood glucose should be monitored hourly. Adequate output is an indicator of decreasing dehydration and increasing potassium output. Steroid bolus is used to correct the hormone deficiency.

1. A 46-year-old patient is admitted with tumor of the pituitary gland. He is scheduled for a Hypophysectomy at noon. The consent has been signed and the nurse is teaching the patient on what to expect after surgery. You will know more teaching is need when the patient makes this comment. Select all that apply: a. I will get to go home a few hours after surgery. b. I will have a mustache dressing for nasal drainage along with nasal packing. c. I should not brush my teeth, but I can floss. d. I should perform cough and deep breathing exercises after surgery. e. If I feel a sneeze coming on, I should bend forward to help with the sneeze.

Answer: A, D, E Rational: Page 1249. A. Monitor the patient's neuro status hourly for the first 24 hours and then every 4 hours after. B. Preop care: Nasal packing is present for 2-3 days after surgery, it will be necessary to breathe through your mouth, and a "Mustache" dressing (drip pad) will be placed under the nose. C. Instruct patient not to brush teeth, cough, sneeze, blow nose, or bend forward after surgery as this will increase the ICP and delay healing. Patient should avoid bending at the waist as this also increases ICP. D. Encourage patient to perform deep breathing exercises but coughing is not recommended as it will increase ICP. E. Coughing, sneezing, blowing of the nose, and leaning forward at the waist are all discouraged as these things will all increase inter-cranial pressure.

Which of the following would you expect to see in a patient with Cushing's disease? Select all that apply a.Hyperglycemia b.Bronzed pigmentation of the skin c.Urine output of 4-30L/day d.Moon face e.Hypertension

Answer: A,D,E Hyperglycemia, moon face, and hypertension are all symptoms seen in someone with Cushing's disease. Bronzed pigmentation is seen in Addison's disease and high urine output is seen in diabetes insipidus.

1. A nurse is reviewing discharge teaching with a client who has Cushing's syndrome. Which statement by the client indicates that the instructions related to dietary management were understood? a. "I can eat foods that contain potassium." b. "I will need to limit the amount of protein in my diet." c. "I am fortunate that I can eat all the salty foods I enjoy." d. "I am fortunate that I do not need to follow any special diet."

Answer: A. A diet that is low in calories, carbohydrates, and sodium but ample in protein and potassium content is encouraged for a client with Cushing's syndrome. Such a diet promotes weight loss, the reduction of edema and hypertension, the control of hypokalemia, and the rebuilding of wasted tissue.

1. When caring for a patient with Addison's disease what symptom would you NOT see? a. Hypocalcemia b. Hypotension c. Hyperkalemia d. Hyponatremia

Answer: A. Hypocalcemia. Hypocalcemia is seen in Cushing's disease. Addison's has cardiovascular symptoms of Hypercalcemia, Hyperkalemia, Hypotension and Hyponatremia. Page 1254, Chart 62-7

Which of the following is most appropriate for a client with Addison's disease? a. Risk for infection b. Excessive fluid volume c. Urinary retention d. Hypothermia

Answer: A. Risk for infection. Addison's disease decreases the production of all adrenal hormones, compromising the body's normal stress response and increasing the risk of infection. Other appropriate nursing diagnoses for a client with Addison's disease include Deficient fluid volume and Hyperthermia. Urinary retention isn't appropriate because Addison's disease causes polyuria.

1. The nurse is teaching a client to ensure certain things are completed on a daily basis to ensure control of Diabetes Insipidus (DI). Which statement indicates further teaching is necessary? a. If I gain more than 2.2 pounds in one day and experience symptoms of water toxicity, I will take another dose of my medication. b. I will monitor my intake an output daily. c. I will take my DI drugs for the rest of my life. d. I will ensure my medical alert bracelet is in place at all times.

Answer: A.) If I gain more than 2.2 pounds in one day and experience symptoms of water toxicity, I will take another dose of my medication. Reasoning: If the patient has a weight gain of 2.2 pounds in one day and experience symptoms of water toxicity (persistent headache, acute confusion, N/V), they should call 911 or go to the nearest ER, NOT take another dose of medication (page 1251.)

1. The student nurse is caring for a patient diagnosed with Diabetes Insipidus. Which of the following statements made by the student indicates the need for further teaching? a. Persistent headache, weight gain of 2.2 lbs. in a day, acute confusion, nausea, and vomiting are indications of water toxicity." b. "This patient needs to be placed on a fluid restriction." c. "It is important to accurately measure this patient's intake and output." d. "Desmopressin acetate is the preferred drug to treat Diabetes Insipidus."

Answer: B Medical-Surgical Nursing 9th edition, pg. 1250, 1251 Rationale: A. This statement is correct; these symptoms are all indications of water toxicity. Instruct the patient or family that the patient must go to the emergency room or call 911 if they are experiencing these symptoms. B. Patients with Diabetes Insipidus are at risk for fluid volume deficit, and should not be placed on a fluid restriction. Urge the patient to drink fluids in an amount equal to urine output. If the patient is not able to increase their oral fluid intake, they may develop shock from fluid loss. C. This statement is correct; monitoring intake and output, checking urine specific gravity, and assessing daily weight all help detect dehydration early on. D. This statement is correct; desmopressin acetate is a synthetic form of vasopressin to help control symptoms associated with DI.

When treating a patient with Diabetes Insipidus, a patient needs another dose of desmopressin acetate when experiencing the following symptoms (select all that apply): A) Weight gain of 2.2 lbs overnight B) Polyuria C) Polydipsia D) Persistent headache

Answer: B and C Rationale: Desmopressin acetate is a synthetic form of vasopressin (ADH). A weight gain of 2.2 lbs. overnight and persistent HA would signal fluid overload. Therefore, the dose might be too high. Excessive thirst (polydipsia) and polyuria would indicate another dose of ADH is needed.

1. The nurse is assessing a patient recently diagnosed with Diabetes Insipidus which of the following nursing assessments would the nurse expect to see (Select all that apply)? a. High levels of ADH b. Hypernatremia c. Polyuria d. Fluid retention e. Dehydration

Answer: B, C, E. Since the patient with DI is unable to retain water from insufficiency of ADH they will have excessive urination (polyuria), hypernatremia and dehydration are from excessive fluid loss. Fluid retention and high levels of ADH are seen in SIADH because of the excessive production of ADH.

1. Which of the following statements, if made by a patient with Cushing's Disease, would require intervention by the nurse? (Select all that apply) a. I'm going to dinner with my best friend this weekend" b. "It's easier for me to fix quick meals like canned soup or frozen pizza" c. "My parents want me to fly to Las Vegas with them to see Celine Dion" d. "I get my flu shot every year at the health department" e. "I'm thinking about taking up rollerblading so I can get more fresh air"

Answer: B, C, E. There is no concern for the patient going to dinner with a friend as long as the patient uses good basic hygiene to avoid illness. It is good for the patient to maintain healthy relationships. The patient should not eat a diet high in processed food because they are high in sodium, which can cause water retention. The patient should avoid large crowds such as at an airport or concert venue. The patient should get a flu shot every year. The patient should not roller blade because they have a high risk of breaking a bone or tearing their skin, which can lead to infection, if they fall.

After teaching a client with acromegaly who is scheduled for a hypophysectomy, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching? a. I will no longer need to limit my fluid intake after surgery. b. I am 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 to limit bending over.

Answer: 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. The client can be reassured that the incision will not be visible.

1. A client is diagnosed with SIADH and the doctor has prescribed Tolvaptan. What outcome would indicate to the nurse that a therapeutic response to the drug? a. Patients serum sodium level went from 120 mEq/L to 115 mEq/L b. Patients lung sounds have crackles present in bilateral lower lobes. c. Patients serum sodium level went from 115 mEq/L to 121 mEq/L in 24hrs. d. Patients urine output decrease from 30mL/hr to 20mL/hr

Answer: C (On page 1252 in IGGY 9th edition) A. Tolvaptan causes hypernatremia, this shows worsening hyponatremia. This is not a therapeutic response to the medication. B. Crackles in the bilateral lower lobes indicates pulmonary edema. This is a side effect of SIADH. C. Tolvaptan has to be infused slowly because it has to be closely monitored for hypernatremia. An increase of 12 mEq/L in 24 hours can cause CNS demyelination that can cause serious complications or death. An increase of 6 mEq/L in 24 hours indicates a therapeutic response to the medication. D. Tolvaptan is a vasopressin receptor antagonist. It promotes water excretion without causing hyponatremia. A decrease in urine output indicates the medication is ineffective.

1. The nurse is assessing client with Cushing's syndrome. What would the nurse expect to find? a. Thick, coarse skin b. Hypotension c. Deposits of adipose tissue in the trunk and dorsocervical area d. Weight gain in arms and legs

Answer: C Because of the changes in fat distribution, adipose accumulates in the truck, face, and dorsocervical (buffalo hump) HTN is caused by fluid retention. Skin becomes thin and bruises easily, due to loss of collagen. Muscle wasting causes muscle atrophy and thin extremities.

1. The nurse is caring for a patient diagnosed with Diabetes Insipidus. The nurse knows that the ADH deficiency is caused by which gland? a. Adrenal gland b. Hypothalamus c. Posterior pituitary d. Thyroid

Answer: C Posterior pituitary gland stores and releases the antidiuretic hormone (vasopressin)

1. A patient is diagnosed with Addison's Disease and is now preparing for discharge. Which statement made by the patient indicates teaching is successful? a. My body was making too much aldosterone. b. I need to take my medications only when I have symptoms of crisis. c. My body wasn't making enough cortisol. d. Addison's disease causes weight gain.

Answer: C Rationale: Cortisol levels are low with Addison's Disease as the adrenal glands cannot produce as much. All of the adrenal hormones may be deficient depending on the cause. The main hormones that are important are aldosterone and cortisol.

You're caring for a patient on the Med-Surg floor who has gained 20 pounds over the last year. He states he's tired all the time, even though his appetite is really good. You walk into his room after the morning report and he presents with these signs and symptoms, which clinical manifestation is a priority for the nurse to address first to the health care provider? A. Striae on the abdomen, thighs, and upper arms. B. An enlarged trunk and hirsutism. C. Bounding pulses and reduced urine output. D. Temperature of 100.7 degrees F.

Answer: C. Rationale: Cushing's disease occurs due to excess secretion of cortisol from the adrenal cortex, which can cause fluid and electrolyte imbalances. Sodium and water are retained, leading to hypervolemia and edema formation. Bounding pulses and reduced urine output are signs and symptoms of pulmonary edema which can quickly lead to death and the HCP needs to be notified. Other signs and symptoms of pulmonary edema are increased neck vein distension, lung crackles, and increasing peripheral edema. It's important to monitor fluid overload every 2 hours in Cushing's disease. Striae on the abdomen, thighs, and upper arms, an enlarged trunk and hirsutism, and a temperature of 100.7 degrees F are all expected in Cushing's disease and are not considered to be a priority over bounding pulses and reduced urine output.

1. The patient is 4 hours post hypophysectomy. The CNA is talking to the nurse about the interaction with the patient. When would the nurse need to intervene in the conversation? a. The patient is mouth breathing quite a bit and I have had to do mouth care three times already." b. "The patient was telling me that she needs to keep this thing packed in her nose for a few days." c. "The patient was leaning forward a couple of times to grab her booklet and phone cord that fell on the ground." d. "The patient has been sitting with the head of her bed up at 45 degrees since returning from surgery."

Answer: C. Leaning forward (bending at the waist), coughing, blowing nose, sneezing, or straining can all cause increased intercranial pressure which can cause pressure on the incision area and may lead to CSF leakage. Pg. 1249

1. The graduate nurse is educating the patient on SIADH what statement would the experienced nurse need to intervene? a. Monitor sodium levels when using Lasix. b. Tolvaptan can affect CNS demyelination, could lead to death, and increased risk for liver failure. c. Tolvaptan and Conivaptan are given only in the hospital setting. d. It is a good idea to consume lots of fluids at least 3-4L daily. e. Measure I&O and daily weights to determine the need for fluid restriction.

Answer: D Rationale- The patient will most likely be on a fluid restriction. Page:1273

1. A patient is hospitalized for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). The nurse understands the symptoms of SIADH include which of the following? a. Hypernatremia b. Thready pulse c. Rapid weight loss d. Hyponatremia

Answer: D SIADH is a condition in which ADH is secreted to excess, even when plasma osmolarity is low or normal. This causes water to be retained, resulting in dilutional hyponatremia. pg. 1251

1. Which assessment finding by the nurse would indicate a complication for the patient with Cushing's Disease? a. urine output of 35mLs/hr for the last two hours b. truncal obesity c. bruising on the upper arms d. pink frothy sputum

Answer: D The patient with Cushing's disease can develop pulmonary edema very quickly and needs to be frequently assessed for this complication. Pink frothy sputum indicates the patient is experiencing pulmonary edema.

1. A Primary Health care provider calls in the following medications for a SIADH patient with the following labs, Serum osmolarity of 200 mOsm/L, Potassium 4.5 mEq/L, Sodium 110, and +2 pitting edema. Which order will you question? a. hypertonic saline (3% sodium chloride) titrated very cautiously b. mix drugs with saline to go into GI tube. c. tolvaptan (samsca) d. Furosemide

Answer: D, Hyper tonic saline is used when serum sodium is very low, but it needs to be used cautiously to not contribute to fluid overload. For a patient with a GI tube you would mix the drugs with saline, not water, this would help with the sodium loss and not to add to fluid overload. Tolvaptan (samsca) is a vasopressin receptor agonist and is used in the treatment of SIADH. Furosemide you would question because the patient's sodium level is very low and diuretics will deplete the sodium further. You would only use a diuretic if the patient had near stable sodium and they were in heart failure.

1. What teaching would the nurse include in preoperative care for a patient with hyperpituitarism that is about to undergo a hypophysectomy? Select all that apply. a. Nasal packing will be present for 2 to 3 days after surgery and that patient will need to breathe through the mouth. b. A "mustache" dressing will be placed under the nose. c. The patient will have to lay completely flat for 6 hours after surgery. d. Avoid activities like sneezing, coughing, blowing their nose, and bending over that can increase ICP. e. The patient must remain NPO for 36 hours before surgery.

Answer: The correct responses are A, B, and D. The patient will have nasal packing and a "mustache" dressing after surgery to collect any nasal drainage. The patient should avoid any activities that increase ICP/pressure in the incision area as this might lead to a CSF leak.

1. What are possible complications of a hypophysectomy? (select all that apply) a. Diabetes Insipidus b. Meningitis c. CSF leak. d. Muscle pain and weakness

Answers are A, B, C Rationale: Diabetes insipidus is a complication due to pituitary gland has been removed so no signal for vasopressin(ADH) to reabsorb the water within the body therefore we just keep voiding, meningitis(infection), and CSF leak is a complication noted from fluid coming from the nasal cavity. It will test high in glucose.

A client has been taking prednisone for COPD for several years. Which observations may be related to the prednisone? (Select all that apply) A. Blood pressure 143/83 B. Blood sugar 330 C. Hemoglobin 8.2 D. Potassium 3.6 E. Temperature 101.2

Answers: B, E Rationale: Patients with long term-steroid use are at increased risk of sepsis/infection and hyperglycemia.

1. Which of the following clinical manifestations would someone with Hyperpituitarism present with? Select all that apply. a. Sexual Dysfunction b. Decreased lip size c. Hyperglycemia d. Enlarged hands and feet e. Small nose and jaw

Correct Answers are A, C, and D. Thickened lips and increased nose and jaw sizes are symptoms of an increase in Growth Hormone excess, not decreased lip size or nose/jaw size. Hyperglycemia and enlarged hands and feet as well as sexual dysfunction are symptoms of anterior pituitary hyperfunction.

What medication is used for the treatment of Cushing's disease? A- Kayexalate B- Metyrapone C- Hydrocortisone D- Phenoxybenzamine

Rationale- Metyrapone is used for the treatment of Cushing's disease. Kayexalate and phenoxybenzamine are not indicated for Cushing's disease. Hydrocortisone is contraindicated in patients with Cushing's disease.

The nurse is caring for a client who has been diagnosed with SIADH. Which electrolyte imbalance would the nurse monitor for with this diagnosis? A. Hyponatremia B. Hypernatremia C. Hyperkalemia D. Hypokalemia

The correct answer is A. Syndrome of inappropriate antidiuretic hormone (SIADH) is a condition in which the body produces too much anti-diuretic hormone which causes the client to retain fluids, causing decreased sodium levels.

A student nurse is putting together a care plan for a patient with Cushing's. Which interventions should be a priority in preventing injury? SATA A. Check and turn the patient every two hours B. Maintain a low calcium and VD diet C. Use a soft bristled toothbrush D. Use a lift sheet when moving the pt up in bed E. Place adhesive tape over gauze on old venipuncture sites.

The correct answers are A, C, and D. Turning pts every 2hrs prevents skin breakdown. Using a soft bristled toothbrush prevents injury to the mouth, and using a lift sheet prevents injury and puts less pressure on the bones.

1. What lab value is the nurse most concerned about in a client with Cushing's Disease? a. Na+ 146 b. K+ 5.4 c. K+ 3.1 d. Na+ 132

answer: C A client with Cushing's has lowered potassium due to excessive cortisol levels and the excretion of potassium. Low potassium could lead to cardiac dysrhythmias.

You are developing a plan of care for a patient with SIADH. Which of the following is a priority intervention for the nurse to implement for this patient? A. Daily weights B. Strict I&Os C. Administer loop diuretic D. Maintain fluid restriction of 500-1000 mls per day

ANSWER: D. Rationale: Pg 1252 in Iggy: Medical interventions for SIADH focus on restricting fluid intake. Fluid restriction is essential because fluid intake further dilutes plasma sodium levels. In some cases fluid intake may be kept as low as 500-1000 ml/24 hours.

1. While completing an assessment on your patient, which of the following symptoms are indicative of SAIDH? (Select All That Apply) a. Low Sodium b. Low ADH, Low water in body c. Weight gain d. Low urine output, oliguria e. High urine output, polyuria

(Correct Answers: A, C, D)

What are complications associated with a hypophysectomy? Select all that apply. a) Re-active patellar and bicep reflexes b) Clear nasal drainage with glucose c) Continued severe heardaches d) Orthostatic hypotension e) Ease of bowel movement

Answer B,C,D Reactive patellar and bicep reflexes is an expected outcome. Clear nasal drainage with glucose indicates leakage of CSF. Severe headaches should subside not continue. Orthostatic hypotension is a complication. Ease of bowel movement is not a complication constipation and straining can cause increased ICP.

1. You are caring for a patient who is diagnosed with diabetes insipidus. Which order by the provider would you question? a. Keep patient NPO for 8 hours b. Administer Desmopressin Acetate c. Measure strict input and output d. Obtain a daily weight

ANSWER- A *Rationale* A patient with this condition loses a lot of water in the body. Therefore, fluids should not be withheld for more than 4 hours or dehydration can occur.

A patient presents to the Emergency Department with an exacerbation of Cushings Disease. What findings can the nurse expect when performing an assessment? Select all that apply. a. Hypertension b. Hypotension c. Petechiae d. A thin trunk and enlarged extremities e. A round face

ANSWER: A, C and E Rationale: Retention of sodium and water causes an excess of fluid volume and edema. The heart has to pump harder in order to compensate for the increased fluid volume, increasing the blood pressure. The blood vessels become more fragile which results in increased bruising, wounds that won't heal, reddish-purple striae (stretch marks) and petechiae. Cushing's disease can cause changes in fat distribution, resulting in fat pads on the neck, back, and shoulders (buffalo hump), and enlarged trunk with thin extremities, and a round face (moon face).

1. You know teaching is successful when the patient living with Addison's disease states: a. I can eat anything I want now b. Being overly tired is normal and I don't need to worry about it c. I should contact my doctor if a loved one dies. d. I should contact my doctor if I start sweating profusely.

ANSWER: C Rationale: major stress (i.e. death of a loved one) or injury can cause an Addisonian crisis.

A patient presents with moon face, buffalo hump, and hypertension. The patient reports using glucocorticoids regularly. Which lab values would the nurse expect to see? (SATA) a. Decreased sodium b.Elevated glucose c. decreased calcium d. Increased Cortisol e. Elevated Sodium

Ans: B, C, D, E. All except A are correct. In cushings Sodium and water are reabsorbed and retained, blood glucose is high because insulin receptors are less sensitive, and high cortisol is the hallmark of cushings.

When caring for a patient with diabetes insipidus, the nurse expects to administer: A. vasopressin (Pitressin Synthetic). B. furosemide (Lasix) c. Regular Insulin D. Dextrose 10%

Answer A Because diabetes insipidus results from decreased antidiuretic hormone (vasopressin) production, the nurse should expect to administer synthetic vasopressin for hormone replacement therapy. Lasix would cause the patient to lose more fluid. Insulin and Dextrose wouldn't help the patient since their blood sugars are not effected.

1. When teaching a patient with chronic SIADH about long-term management of the disorder, the nurse determines that additional instruction is needed when the patient makes which statement? a. "I need to shop for foods that are low in sodium and avoid adding salt to foods." b. "I should weigh myself daily and report any sudden weight loss or gain." c. "I need to limit my fluid intake to no more than 1 quart of liquids a day." d. "I will eat foods high in potassium because the diuretics cause potassium loss."

Answer A: Rationale: Pts with SIADH are at risk for hyponatremia, and a sodium supplement may be prescribed. The other pt. statements are correct and indicate successful teaching has occurred.

1. A client is recently diagnosed with diabetes insipidus and has just been started on Desmopressin. The nurse knows the client has correct understanding of the medication when he states? a. I will be sure to drink more than 3 Liters of water a day while taking this drug. b. I will call my Doctor if I notice weight gain and concentrated urine. c. I should weigh myself once a week. d. I should call my Doctor if I am experiencing any acute confusion.

Answer B (On page 1379 of Iggy 7th edition) A. When clients are taking this drug they should not drink more than 3L of water a day. B. This is correct because weight gain could be a sign of fluid retention and adjustments to the drug may be needed. C. Clients taking Desmopressin should weigh themselves daily at the same time, on the same scale, with the same clothes. D: If a patient develops a persistent headache or acute confusion. He/she should call 911 or go the Emergency department immediately, not call their Doctor. HA and confusion are signs of water toxicity and a seizure activity could occur.

1. The nurse is caring for a patient diagnosed with Hyperpituitarism is recovering from a transphenoidal hypophysectomy. Upon entering the patient's room, which finding would cause the nurse to intervene immediately? a. The patient states they feel cold b. The patient states they feel fatigued c. The patient is bending over at the waist to put on socks d. The patient complains of being thirsty.

Answer C. Patients with hyperpituitarism should bend from the knees. Bending over at the waist could increase ICP.

1. A patient was recently experienced a fall with head a head injury and is now diagnosed with diabetes Insipidus. What type of symptoms could the patient be experiencing? (Select all that apply) a. Hyponatremia b. Polyuria c. Increased thirst d. Dehydration e. Hypotension

Answer: B, C, D, E Diabetes insipidus is a disorder of the posterior pituitary gland where water loss occurs due to ADH deficiency or kidney issues where the kidneys cannot respond to ADH. Injuries to the head can cause a deficiency in ADH. With decreased ADH the body gets rid of large amounts of water resulting in hypernatremia, dehydration, increased thirst, polyuria, and potentially hypovolemic shock.

1. Which result best indicates a patient has a positive result from a suppression test when diagnosing hyperpituitarism? a. Growth hormone level of 4 ng/mL b. Adrenocorticotropic hormone level of 30 pg/mL c. Growth hormone level of 7 ng/mL d. Prolactin level of 32 ng/mL

Answer: C - GH levels that do not fall below 5 ng/mL indicate a positive (abnormal) result

A patient was recently diagnosed with Addison's Disease. Which of the following symptoms is most likely to be exhibited by a patient with this disease? a. Hirsutism b. Purple striae. c. Bronze pigmentation d. Hypertension

Answer: C. Patients with Addison's Disease are likely to have a bronze pigmentation to their skin. Answers A, B, and D are all symptoms of a patient with Cushing's Syndrome.

1. Which of the following is a cause of Primary Neurogenic Diabetes Insipidus? a. Defect in the pituitary gland b. Head Trauma c. Infectious Processes d. Brain Surgery

Correct Answer: A Rationale (page 1250 in Iggy) A: Primary neurogenic diabetes insipidus is caused by a defect in the hypothalamus or pituitary gland., resulting in a lack of ADH production or release. B: Secondary neurogenic diabetes insipidus is not caused by a direct problem with the posterior pituitary but is a result of tumors in or near the hypothalamus or pituitary gland, head trauma, infectious processes, brain surgery, or metastatic tumors. C: Secondary neurogenic diabetes insipidus is not caused by a direct problem with the posterior pituitary but is a result of tumors in or near the hypothalamus or pituitary gland, head trauma, infectious processes, brain surgery, or metastatic tumors. D: Secondary neurogenic diabetes insipidus is not caused by a direct problem with the posterior pituitary but is a result of tumors in or near the hypothalamus or pituitary gland, head trauma, infectious processes, brain surgery, or metastatic tumors.

1. Which of the following signs and symptoms is NOT expected with Diabetes Insipidus? a. Polyuria b. Polyphagia c. Fatigue d. Polydipsia

Correct answer is B. Polyphagia is not a symptom of Diabetes insipidus. This is a symptom of diabetes mellitus due to the glucose being unable to enter the cell causing a lack of energy and increased hunger. DI is caused by a hormone abnormality not by a lack of glucose within the cells.

The nurse is planning the care of a client diagnosed with Addison's Disease. Which intervention should be included? A. Administer steroid medications B. Place the client on a fluid restriction C. Provide frequent stimulation D. Consult physical therapy for gait training

Correct answer: A Rationale: Clients diagnosed with Addison's disease have adrenal gland hypofunction. The hormones normally produced by the gland must be replaced. Steroids and androgens are produced by the adrenal glands.

The nurse is caring for a patient suspected of having diabetes insipidius. Which assessments made by the nurse would be most concerning? (SATA) A. Polyuria B. High sodium C. Weight gain D. Low ADH E. Water intoxication

Correct answers: ABD Polyuria, Low ADH, and high sodium are all symptoms of Diabetes Insipidus and should be documented. Weight gain and water intoxication are symptoms of SIADH

The RN overhears a Graduate Nurse providing education to a patient who will be having nasal hypophysectomy. The RN intervenes when she hears the Graduate Nurse say the following: a. After the surgery please be sure you only breathe through your nose, to allow for healing of nasal passages. b. You will not be able to bend forward after surgery. c. You should not blow your nose after surgery. d. You will need to do your best to not sneeze or cough after surgery.

Rationale: A. After nasal hypophysectomy, the patient will only be able to breathe through the mouth, due to the dressing placed under the nose. All other instructions given by the Graduate Nurse are correct. The other activities listed contribute to increased ICP and delay healing for the patient.

1. A patient with Cushing's disease is being discharged home, which response by the patient indicates that further teaching is needed? a. I will call the doctor with any signs of an infection. b. I will weigh myself each week to monitor for weight gain. c. I will need to check food labels for the sodium content. d. I will need to use a soft toothbrush and an electric shaver.

Rationale: B.) A patient with Cushing's disease is at high risk for fluid overload. Monitoring the patient's weight daily with the same time, same scale, and same type of clothes will help get an accurate weight of the patient each day to monitor for any weight increase or decrease.

1. The nurse is performing an assessment on a client diagnosed with diabetes insipidus. What finding would indicate to the nurse that the client's condition is improving? a. A urine specific gravity >1.005 b. Increased urination and excessive thirst c. A weight gain of more than 2.2lbs overnight d. Acute confusion, nausea and vomiting

Rationale: correct answer is A. a patient with DI will have dilute, low specific gravity less than 1.005. Answer B is incorrect because increased urination and excessive thirst are key symptoms in a patient with onset DI. Answer C is incorrect because drugs for DI can cause fluid retention, and a weight gain of 2.2lbs or more is a medical emergency. Answer D is incorrect because those symptoms indicate water toxicity, a medical emergency.

1. A 65-year-old male patient with Addison's disease is admitted to your unit. What assessment finding is most concerning to the nurse? a. Fatigue b. Joint pain and muscle weakness c. BUN 23 d. Potassium 6.5 mEq/L

Rationale: the correct answer is D. The patient suffering from Addison's disease is expected to exhibit fatigue, joint pain and muscle weakness. Although that might lead to a potential problem, it is an expected abnormal. BUN 23 is slightly elevated, however it can be higher in older adults and is not the priority right now. Hyperkalemia is caused by the adrenal hormone output insufficiency. Because hyperkalemia can cause dysrhythmias with an irregular heart rate and result in cardiac arrest, assessing cardiac function is a nursing priority.

1. The nurse is caring for a patient with severe diabetes insipidus. The physician writes the following orders. Which order does the nurse question? a. Continuous telemetry monitoring b. Measure intake and output q2 c. Fluid restriction 500-1000 mL per 24 hours d. Weigh patient each morning

correct answer: C Rational: SIADH patients require fluid restriction of 500-1000mL, DI patients need their fluids replaced. Telemetry to monitor for early signs of hypovolemic shock (tachycardia), I&Os to determine fluid balance and effectiveness of treatment, daily weights to measure treatment effectiveness/monitor for fluid overload (+2.2lb/1kg = 1L fluid)