Med Surg - Chapter 62 - Care of Patients with Pituitary and Adrenal Gland Problems

Which parameters are elevated in a patient with adrenal insufficiency? 1 Sodium level 2 Glucose level 3 Cortisol level 4 Potassium level

4 Potassium level A patient with adrenal insufficiency will have decreased secretion of aldosterone. Aldosterone aids urinary potassium excretion; therefore, adrenal insufficiency results in hyperkalemia. The serum sodium level is low in patients with adrenal insufficiency because of its increased excretion. Glucose levels are normal or low in a patient with adrenal insufficiency. Serum cortisol levels are low in patients with adrenal insufficiency because of hypofunction of the adrenal gland.

What is a common side effect of spironolactone therapy for hyperaldosteronism? 1 Urticaria 2 Hypokalemia 3 Constipation 4 Hypernatremia

1 Urticaria The patient receiving spironolactone therapy for hyperaldosteronism may develop urticaria or hives as a side effect. Spironolactone is a potassium sparing diuretic, and it may increase the risk for hyperkalemia. Patients should avoid potassium supplements and foods rich in potassium. Hyponatremia can occur with spironolactone therapy, and the patient may need increased dietary sodium. Diarrhea, not constipation, is another side effect of the therapy.

Which clinical manifestations would a nurse expect to find in a patient with hyperaldosteronism? Select all that apply. 1 Headache 2 Muscle weakness 3 Fatigue 4 Hypotension 5 Hyperkalemia

1 Headache 2 Muscle weakness 3 Fatigue Common clinical manifestations of excess aldosterone include headache, muscle weakness, and fatigue. The patient will develop hypertension (not hypotension) and dilutional hypokalemia (not hyperkalemia) both due to fluid retention.

The nurse has determined that a patient diagnosed with Cushing's disease is at risk for injury. What intervention is necessary? 1 Provide a low-calorie diet. 2 Instruct patient to use an electric razor. 3 Encourage patient to walk independently. 4 Avoid the use of histamine receptor blockers.

2 Instruct patient to use an electric razor. The patient should be encouraged to use an electric razor to prevent breaking the skin. A high-calorie, not a low-calorie, diet is indicated. The patient should walk with required assistive devices or assistance. Histamine receptor blockers are indicated.

What medication is used for the treatment of Cushing's disease? 1 Kayexalate 2 Metyrapone 3 Hydrocortisone 4 Phenoxybenzamine

2 Metyrapone Metyrapone is used for 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 patient is being seen by the primary care provider for thyroid-stimulating hormone (TSH) deficiency. What assessment findings are consistent with this diagnosis? Select all that apply. 1 Headache 2 Weight gain 3 Scalp alopecia 4 Slowed cognition 5 Postural hypotension

2 Weight gain 3 Scalp alopecia 4 Slowed cognition Weight gain, scalp alopecia, and slowed cognition are common findings in patients with a deficiency in TSH. Headache and postural hypotension are commonly found in patients with deficiency of ACTH, not TSH.

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? 1 "Take the drug on alternate days." 2 "Take the drug before going to bed." 3 "Take the drug with meals or a snack." 4 "Report rapid weight gain or fluid retention."

3 "Take the drug with meals or a snack." The patient should take cortisone with meals or a snack to prevent gastrointestinal irritation. Cortisone is generally administered in two divided doses; two-thirds of the dose is taken in the morning and one-third of the dose is taken between 4 and 6 in the evening. This, mimics the normal release of the hormone in the body. The patient must strictly adhere to the drug regimen every day and never skip a dose to prevent the development of acute adrenal insufficiency, a life-threatening condition. The patient who is taking hydrocortisone must report rapid weight gain or fluid retention to the health care provider because these are signs of excessive drug therapy.

A patient with acromegaly is prescribed bromocriptine mesylate therapy. What does the nurse tell the patient about this treatment? 1 "A side effect of this drug is diarrhea." 2 "Bromocriptine is given on an empty stomach." 3 "The drug must be stopped during pregnancy." 4 "You will receive a starting dose of 7.5 mg/day."

3 "The drug must be stopped during pregnancy." Bromocriptine therapy must be stopped during pregnancy to prevent adverse consequences. A patient on bromocriptine therapy does not experience diarrhea; side effects of this drug include orthostatic hypotension, gastric irritation, nausea, headaches, abdominal cramps, and constipation. The drug is given with a meal or a snack to reduce some of these side effects. Treatment starts with a low dose and is gradually increased until the desired level (usually 7.5 mg/day) is reached.

The nurse is caring for a patient with osteoporosis due to growth hormone (GH) deficiency. What is the cause of growth hormone (GH) deficiency? 1 Increased serum cholesterol levels 2 Increased production of somatomedins 3 Overgrowth of tissues of the pituitary gland 4 Failure of tissues to respond to somatomedins

4 Failure of tissues to respond to somatomedins GH stimulates the liver to produce somatomedins, which in turn enhances the growth activities in cells and tissues. GH deficiency may be a result of the failure of the tissues and cells to respond to somatomedins. Overgrowth of tissues, or hyperplasia, causes hormone oversecretion, or hyperpituitarism. An increased serum cholesterol level is a manifestation of GH deficiency. GH deficiency may be caused by failure of the liver to produce somatomedins.

What changes does the nurse note in a patient with hypercortisolism upon physical assessment? 1 Excessively dry skin 2 Muscle atrophy in the trunk 3 Absence of hair on the body 4 Presence of fat pads on the shoulders

4 Presence of fat pads on the shoulders The patient with hypercortisolism has fat pads on the neck, back, and shoulders because of fat redistribution. The patient develops extremely thin and translucent skin following increased blood vessel fragility. Excessive cortisol secretion causes acne; coats of fine hair cover the face and the body. The patient develops muscle atrophy or muscle wasting and weakness, especially in the extremities. The patient also has truncal obesity following changes in fat distribution.

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? 1 Mix drugs to be given with saline. 2 Dilute tube feedings with plain water. 3 Irrigate the tube with lukewarm water. 4 Flush the tube after each use with hypertonic saline.

1 Mix drugs to be given with saline. The patient with SIADH has fluid restrictions because fluid intake further dilutes plasma sodium levels. Drugs given via GI tube must be mixed with saline because the patient has decreased serum sodium levels. Similarly, saline must be used to dilute tube feedings, irrigate, or flush the GI tube. Hypertonic saline is used only when serum sodium levels are very low and is only administered intravenously.

Which disorder causes the adrenal cortex to secrete too much cortisol? 1 Graves disease 2 Turner syndrome 3 Cushing syndrome 4 Hashimoto disease

3 Cushing syndrome When the adrenal cortex produces too much cortisol, this can lead to Cushing syndrome. Graves disease is a result of hyperthyroidism. Turner syndrome occurs due to elevated levels of follicle-stimulating hormone. Hashimoto disease occurs due to hypersecretion of thyroid hormones.

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? 1 "My blood will be drawn over 3 days." 2 "For 24 hours, my urine will be collected." 3 "This test will show if I have high cortisol levels." 4 "I will be given doses of dexamethasone over 3 hours."

1 "My blood will be drawn over 3 days." The patient will not have blood drawn for this test. The urine will be collected over 24 hours. The test will determine if the patient has high cortisol levels. Dexamethasone suppression testing involves the administration of dexamethasone given over 3 hours.

The nurse is providing discharge instructions to a patient on spironolactone therapy. Which comment by the patient indicates a need for further teaching? 1 "I need to increase my salt intake." 2 "I should eat a banana every day." 3 "This drug will not control my heart rate." 4 "I must call the provider if I am more tired than usual."

2 "I should eat a banana every day." Spironolactone increases potassium levels, so potassium supplements and foods rich in potassium, such as bananas, should be avoided to prevent hyperkalemia. While taking spironolactone, symptoms of hyponatremia such as drowsiness and lethargy must be reported; the patient may need increased dietary sodium. Spironolactone will not have an effect on the patient's heart rate.

Which should the nurse monitor when caring for the patient receiving fludrocortisone (Florinef)? 1 Bowel function 2 Blood pressure 3 Pupillary reaction 4 Deep tendon reflexes

2 Blood pressure One major side effect of fludrocortisone (Florinef) is hypertension. Therefore, the nurse should monitor the patient's blood pressure. The nurse would assess the patient's bowel function and pupillary reaction as part of the head-to-toe assessment, not related to fludrocortisone (Florinef) therapy. Deep tendon reflexes would not need to be assessed by the nurse caring for this patient.

Which clinical findings would a nurse expect to find in a patient with Cushing syndrome? Select all that apply. 1 Acne 2 Hirsutism 3 Leukocytosis 4 Buffalo hump 5 Vaginal bleeding

1 Acne 2 Hirsutism 4 Buffalo hump The patient with Cushing syndrome produces excess amounts of cortisol. This results in acne, hirsutism (excess hair growth), and a buffalo hump due to fat redistribution. The patient will have decreased white blood cells (leukopenia), not leukocytosis. Menstrual cycles will decrease in frequency and amount of bleeding. The patient will not develop vaginal bleeding.

Which treatment modality would a nurse expect the health care provider to prescribe for a patient with hyperaldosteronism? 1 Adrenalectomy 2 Fluid restriction 3 Glucocorticoids 4 Fludrocortisone (Florinef)

1 Adrenalectomy An adrenalectomy, surgical removal of the adrenal glands, is performed for patients with hyperaldosteronism. Fluid restrictions, glucocorticoids, and fludrocortisone (Florinef) are used to treat adrenal insufficiency.

Which are key assessment findings in a patient suspected of having diabetes insipidus? Select all that apply. 1 Tachycardia 2 Hemodilution 3 Increased thirst 4 Dry mucous membranes 5 High specific urine gravity

1 Tachycardia 3 Increased thirst 4 Dry mucous membranes Tachycardia, increased thirst, and dry mucous membranes are findings typical of diabetes insipidus. The patient's blood is hemoconcentrated as a result of the significant fluid loss. The urine is diluted resulting in a low specific gravity.

A patient with a diagnosis of Cushing's disease has been hospitalized. What care is priority for this patient? 1 Treating fluid overload 2 Preventing complications 3 Monitoring for signs of infection 4 Providing support regarding body changes

1 Treating fluid overload Fluid overload is a major issue in patients diagnosed with Cushing's disease. It can lead to pulmonary edema and heart failure. Preventing complications, monitoring for infection, and providing support for a patient dealing with body changes are important but not priority.

What manifestations does the nurse expect in a patient with syndrome of inappropriate antidiuretic hormone (SIADH)? Select all that apply. 1 Water retention 2 Dependent edema 3 Full, bounding pulse 4 Decreased urine sodium level 5 Decreased sodium serum level

1 Water retention 3 Full, bounding pulse 5 Decreased sodium serum level Antidiuretic hormone continues to be released in the patient with SIADH even when plasma is hypo-osmolar. The patient experiences water retention, which results in a full, bounding pulse caused by the increased fluid volume. Water retention also causes dilutional hyponatremia or a decreased serum sodium level. In SIADH, free water (not salt) is retained and dependent edema is not present. The patient has decreased urine volume with elevated sodium levels, reflecting increased urine concentration.

Which action by the patient with hypercortisolism can prevent gastrointestinal (GI) bleeding? 1 Avoiding antacids 2 Avoiding caffeine and alcohol 3 Limiting calcium and vitamin D in the diet 4 Eliminating green leafy vegetables from the diet

2 Avoiding caffeine and alcohol The patient with hypercortisolism should avoid caffeine and alcohol, which increase the risk for GI ulcers and GI bleeding and also promote bone density loss. The patient must take, not avoid, antacids on a regular schedule because they buffer stomach acids and protect the GI mucosa. The patient must include, not limit, calcium and vitamin D to promote bone density. Green leafy vegetables are additional sources of calcium and should not be eliminated.

The nurse is educating a patient with hypercortisolism about prevention of different types of injuries. Which patient statement indicates effective understanding? 1 "I can have coffee every day." 2 "I can safely use aspirin for pain." 3 "I should eat a diet rich in calcium." 4 "I should not take antacids."

3 "I should eat a diet rich in calcium." A reduction in bone density and osteoporosis can predispose a patient with hypercortisolism to bone fractures, so the patient should eat a calcium-rich diet. The patient should avoid coffee or other caffeine products to reduce the risk for gastrointestinal (GI) ulcers, not for injury. Aspirin can increase the chances of GI bleeding in patients with hypercortisolism, so the patient should avoid aspirin or other salicylates. The patient should take antacids on a regular basis to reduce the risk for GI ulcers.

What is the rationale for administration of ranitidine to a patient who is experiencing acute adrenal insufficiency? 1 Treatment of nausea 2 Reduction of potassium 3 Prevention of gastric ulcers 4 Replacement of adrenocorticotropic hormone (ACTH)

3 Prevention of gastric ulcers Histamine blockers including ranitidine are administered to prevent ulcers in patients with acute adrenal insufficiency. The medication is not indicated for treatment of nausea. The medication will not reduce potassium. The medication will not replace adrenocorticotropic hormone.

A patient diagnosed with glucocorticoid deficiency is prescribed hydrocortisone. What teaching specific to hydrocortisone will the nurse provide? 1 "Take the medication with meals." 2 "Monitor your blood pressure regularly." 3 "If you have fever and diarrhea, call your health care provider." 4 "If you experience rapid weight gain, report this immediately."

4 "If you experience rapid weight gain, report this immediately." Hydrocortisone can be used to treat glucocorticoid deficiency, but if the patient experiences weight gain, it may be a sign of Cushing syndrome and requires dosage adjustment, so the patient should immediately report the weight gain. A patient who is prescribed cortisone is instructed to take the medication with meals to prevent gastrointestinal irritation. A patient who is prescribed fludrocortisone is instructed to monitor his or her blood pressure regularly. A patient who is prescribed prednisone is instructed to report any fever and diarrhea.

Which selection indicates the teaching regarding nutrition was effective in a patient diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH)? 1 Apple 2 Chicken breast 3 Frozen French fries 4 Canned green beans

4 Canned green beans Patients with SIADH have low sodium and need to implement foods higher in sodium. Canned green beans would have higher sodium because of preservatives. An apple, chicken breast, and frozen French fries would have low sodium content.

What does the nurse identify as a sign of infection for a patient who underwent an adrenalectomy? 1 Skin breakdown 2 Crackles and wheezes 3 Breakdown of oral mucosa 4 Increase of 1° F in body temperature

4 Increase of 1° F in body temperature An increase of 1° F in body temperature is significant for the patient who is immunosuppressed. It indicates infection unless proved otherwise. The patient's lungs are assessed every 8 hours for crackles, wheezes, or reduced breath sounds. Pulmonary hygiene must be performed for this patient every 2 to 4 hours. The patient's mouth must be inspected once every shift for lesions or mucosa breakdown. The immobile patient is at a risk for skin breakdown, so the nurse must turn the patient every hour. Crackles, wheezes, breakdown of oral mucosa, or skin breakdown are not signs of infection, but can lead to infection if adequate care is not taken.

What is the most common cause of Sheehan's syndrome? 1 Shock 2 Osteoporosis 3 Severe malnutrition 4 Postpartum hemorrhage

4 Postpartum hemorrhage Postpartum hemorrhage is the most common cause of Sheehan's syndrome. It results in pituitary infarction and ischemia, which lead to decreased hormone secretion. Shock is a cause of hypopituitarism, not Sheehan's syndrome. Osteoporosis, which causes the bones to become weak and fragile, is associated with growth hormone deficiency. Severe malnutrition, such as protein or calorie malnutrition, impairs the function of the pituitary gland.

A patient has been prescribed divided doses of prednisone. How should the patient take this drug? 1 One-third in the morning, afternoon, and night 2 One-third in the morning and two-thirds at night 3 Half in the morning and half in the late afternoon 4 Two-thirds in the morning and one-third in the late afternoon

4 Two-thirds in the morning and one-third in the late afternoon Prednisone is an oral cortisol replacement drug. The patient should take two-thirds of the drug in the morning and one-third in the late afternoon. This, mimics the normal release of cortisol. Dividing the drug in any other manner will not help the patient.

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. 1 Sodium 2 Cortisol 3 Albumin 4 Potassium 5 Liver function

1 Sodium 2 Cortisol 4 Potassium Due to cortisol and aldosterone deficiencies, the nurse would expect the health care provider to prescribe laboratory tests for sodium, cortisol, and potassium levels. Albumin level and liver function are not essential for the care of this patient.

A patient with acromegaly is prescribed bromocriptine. Which side effects of bromocriptine requires immediate medical attention? Select all that apply. 1 Diarrhea 2 Dizziness 3 Chest pain 4 Hypertension 5 Watery nasal discharge

2 Dizziness 3 Chest pain 5 Watery nasal discharge The patient must seek immediate medical attention if dizziness, chest pain, or watery nasal discharge occurs. These side effects indicate the possibility of coronary artery spasms, cardiac dysrhythmias, and leakage of cerebrospinal fluid. Dizziness can occur as a result of orthostatic hypotension. With bromocriptine, the patient's blood pressure can drop with position changes (orthostatic hypotension) and the patient can become dizzy. Therefore, the patient is hypotensive, not hypertensive. Bromocriptine causes constipation as opposed to diarrhea.

Which laboratory results indicate that fluid restrictions have been effective in treating syndrome of inappropriate antidiuretic hormone (SIADH)? 1 Decreased hematocrit 2 Increased serum sodium 3 Decreased serum osmolality 4 Increased urine specific gravity

2 Increased serum sodium Increased serum sodium due to fluid restriction indicates effective therapy. Hemoconcentration is a result of hypovolemic hyponatremia caused by SIADH and diabetes insipidus. Plasma osmolality is decreased as a result of SIADH. Urine specific gravity is decreased with diabetes insipidus and is increased with SIADH.

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? 1 "I should restrict my sodium intake in my diet." 2 "I will need to increase the amount of fluid I drink." 3 "I will need to urinate more while I am taking conivaptan." 4 "I will need to need to change positions slowly to avoid getting lightheaded."

3 "I will need to urinate more while I am taking conivaptan." Conivaptan is given to patients with SIADH to promote water excretion without causing sodium loss. Patients will need to increase, not decrease, sodium. Patients should decrease, not increase, fluid intake. Patients experience postural hypotension with diabetes insipidus, not SIADH.

Hyperfunction of which anterior pituitary hormone can cause sleep apnea? 1 Prolactin (PRL) 2 Thyrotropin (TSH) 3 Growth hormone (GH) 4 Adrenocorticotropic hormone (ACTH)

3 Growth hormone (GH) The hyperfunctioning of growth hormone can cause sleep apnea. Hyperfunctioning of prolactin can cause galactorrhea. Hyperfunctioning of thyrotropin can cause weight loss. Hyperfunctioning of adrenocorticotropic hormone can cause truncal obesity.

A nurse is helping a patient with a diagnosis of a pheochromocytoma plan an appropriate meal for dinner. Which food choice should the nurse instruct the patient to avoid? 1 Milk 2 Oatmeal 3 Wheat bread 4 Cheddar cheese

4 Cheddar cheese Foods high in tyramine such as aged cheeses and wine should be avoided, as they can cause a hypertensive crisis in a patient with a pheochromocytoma. Milk should be avoided in patients who are lactose intolerant. Oatmeal and wheat bread should be avoided in patients with celiac disease.

A patient has undergone a hypophysectomy. What postoperative intervention should the nurse perform for this patient? 1 Have the patient lie flat after surgery. 2 Monitor neurologic status every 4 hours. 3 Discard and replace the nasal drip pad at regular intervals. 4 Have the patient avoid brushing the teeth for 2 weeks after surgery.

4 Have the patient avoid brushing the teeth for 2 weeks after surgery. Following a hypophysectomy, the patient should be instructed to avoid brushing the teeth for 2 weeks after surgery until the incision sufficiently heals. Frequent mouth care with mouthwash and daily flossing provide adequate oral hygiene. The patient must use a mirror to check the gums for bleeding; reduced sensation in the mouth increases the risk for injury. The nurse monitors the patient's neurologic status every hour for the first 24 hours and then every 4 hours. The nasal drip pad is assessed for quantity and quality of drainage before it is discarded; a light yellow color at the edge of clear drainage on the dressing is indicative of cerebrospinal fluid leak. The head of the bed is elevated after surgery to prevent edema.

The assessment and clinical findings for a patient show decreased production of all hormones from the anterior pituitary. What is this condition called? 1 Panhypopituitarism 2 Pituitary hypofunction 3 Selective hypopituitarism 4 Secondary pituitary dysfunction

1 Panhypopituitarism Panhypopituitarism is an extremely rare condition in which a person has a decreased production of all of the pituitary hormones. Pituitary hypofunction is the condition in which one or more hormones of the anterior pituitary gland are under-secreted. Hormone disorders of the anterior pituitary due to problems in the hypothalamus are referred to as secondary pituitary dysfunction. Selective hypopituitarism is the condition in which there is a decrease in only one anterior pituitary hormone.

What determines the neuromuscular status of a patient who underwent endoscopic nasal hypophysectomy for hyperpituitarism? 1 Level of consciousness 2 Pupillary response to light 3 Ability to read a seven-word sentence 4 Orientation to time, place, and person

2 Pupillary response to light Pupillary response to light determines the neuromuscular status of a patient after hypophysectomy. The patient's cognition and mental status are determined by assessing the level of consciousness. The patient's cognition is also determined by the ability to read a seven-word sentence with each word not having more than three syllables. The patient's mental status is evaluated by checking orientation to time, place, and person.

A patient is taking fludrocortisone for adrenal hypofunction. The patient should report which symptom while taking this drug? 1 Anxiety 2 Nausea 3 Headache 4 Weight loss

3 Headache A side effect of fludrocortisone is hypertension. New onset of headache should be reported, and the patient's blood pressure should be monitored. Anxiety is not a side effect of fludrocortisone and is not associated with adrenal hypofunction. Nausea is associated with adrenal hypofunction; it is not a side effect of fludrocortisone. Sodium-related fluid retention and weight gain, not loss, are possible with fludrocortisone therapy.

The nurse is planning care for a patient diagnosed with acute adrenal insufficiency. Which hormone deficits will guide the nurse's interventions? Select all that apply. 1 Cortisol 2 Prolactin 3 Androgen 4 Aldosterone 5 Growth hormone

1 Cortisol 4 Aldosterone A patient with acute adrenal insufficiency will have severe deficits of cortisol and aldosterone. Prolactin deficiency is a pituitary disorder. Androgen deficiency occurs in Klinefelter syndrome. Growth hormone deficiency causes short stature.

Which musculoskeletal problem would a nurse expect to find in a patient with Cushing syndrome? 1 Striae 2 Osteoporosis 3 Osteoarthritis 4 Rheumatoid arthritis

2 Osteoporosis Excess cortisol levels deplete calcium from the bones causing weakness and osteoporosis. Striae are skin changes that happen due to weight gain. Osteoarthritis and rheumatoid arthritis are disorders of the joints less likely to be found with Cushing syndrome.

Which are considered secondary causes of adrenal insufficiency? Select all that apply. 1 Tuberculosis 2 Pituitary tumors 3 Hypophysectomy 4 Autoimmune diseases 5 Abruptly stopping corticosteroids

2 Pituitary tumors 3 Hypophysectomy 5 Abruptly stopping corticosteroids Secondary causes of adrenal insufficiency include pituitary tumors, hypophysectomy, and abruptly discontinuing corticosteroid therapy. Primary causes include tuberculosis and autoimmune diseases.

What laboratory finding is most important to monitor in a patient diagnosed with diabetes insipidus (DI)? 1 Serum sodium 2 Serum glucose 3 Serum potassium 4 Serum liver function

1 Serum sodium Serum sodium is the priority laboratory value to evaluate in patients diagnosed with DI. The inability of the kidneys to respond to ADH leads to increased sodium levels. Glucose, potassium, and liver function labs are not priority in these patients.

A patient with syndrome of inappropriate antidiuretic hormone (SIADH) is receiving IV hypertonic saline. What finding indicates fluid overload in the patient? 1 Crackles in the lungs 2 Increased urine output 3 Absence of peripheral edema 4 Absence of neurologic changes

1 Crackles in the lungs Crackles in the lungs indicate fluid overload in the patient. Pulmonary edema can occur very quickly and lead to death. The nurse must monitor vital signs and assess for subtle neurological changes, like muscle twitching, every 2 hours before seizure or coma occurs. The patient with fluid overload will exhibit peripheral edema and decreased urine output following fluid retention.

A nurse is caring for a patient admitted for acute adrenal insufficiency and places the patient on a telemetry monitor. What is the rationale for this nursing intervention? 1 Hyperkalemia 2 Hypocalcemia 3 Hyponatremia 4 Hyperphosphatemia

1 Hyperkalemia Hyperkalemia happens in acute adrenal insufficiency due to decreased cortisol and aldosterone levels. It can cause cardiac dysrhythmias, so the nurse would place the patient on a cardiac monitor. The patient may develop hypercalcemia, not hypocalcemia. Hyponatremia occurs but does not require the use of cardiac monitoring. Hyperphosphatemia is not an issue with acute adrenal insufficiency.

What finding in a patient that is 4 hours post-hypophysectomy should be reported to the health care provider immediately? 1 Increased swallowing 2 Dry mucous membranes 3 Blood-tinged nasal drainage 4 Urine specific gravity of 1.028

1 Increased swallowing Increased swallowing is a sign of CSF leakage and should be reported to the surgeon. Dry mucous membranes are a normal finding with the surgery and is related to mouth breathing. Blood-tinged nasal drainage is normal. A urine specific gravity of 1.028 is a normal finding.

What nursing intervention is a priority for a male patient diagnosed with gonadotropin deficiency who is experiencing body image disturbance? 1 Refer to a psychologist 2 Teach about testosterone therapy 3 Provide information on penile implants 4 Encourage daily exercise with weight training

2 Teach about testosterone therapy Patients with gonadotropin deficiency and body image who undergo testosterone replacement therapy often find improvement of the symptoms, body image, and self-esteem. It is important to refer the patient to a psychologist, but it is more important to begin medication therapy. Information on penile implants may be helpful, but the medication should increase penis size. Weight training is not necessary or indicated because muscle mass should improve with the initiation of testosterone therapy.

Which symptom indicates decreased adrenocorticotropic hormone (ACTH) in the body? 1 Malaise 2 Increased thirst 3 Decreased libido 4 Intolerance to cold

1 Malaise Decreased ACTH causes symptoms including a pale, sallow complexion, malaise, lethargy, and postural hypotension. Decreased bone density and libido are symptoms of deficiency of gonadotropins. Dehydration and increased thirst are symptoms of decreased antidiuretic hormone (ADH). Weight gain and intolerance to cold are symptoms of decreased thyroid-stimulating hormone (TSH).

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. 1 Provide stool softeners. 2 Infuse intravenous fluids. 3 Monitor potassium levels. 4 Avoid abdominal palpation. 5 Administer metoclopramide.

1 Provide stool softeners. 4 Avoid abdominal palpation. Straining with defecation and increased intraabdominal pressure can cause a hypertensive crisis with a pheochromocytoma. Therefore, the nurse would administer stool softeners and avoid abdominal palpation. The patient would have hypertension, so intravenous fluids would make it worse. Potassium levels should not be affected by a pheochromocytoma, which is an epinephrine- and norepinephrine-releasing tumor. Metoclopramide is an antiemetic that can precipitate a hypertensive crisis. Therefore, the nurse would not administer this medication.

A patient is prescribed an adrenocorticotropic hormone (ACTH) stimulation test for adrenal insufficiency. What cortisol response should the nurse expect in secondary insufficiency? 1 Absent 2 Normal 3 Increased 4 Decreased

3 Increased An ACTH stimulation test involves administering ACTH intravenously to the patient, and plasma cortisol levels are obtained at 30-minute and 1-hour intervals. In secondary insufficiency, cortisol response is increased. Cortisol response is either absent or decreased in primary insufficiency. Plasma cortisol is not normal in a patient with adrenal insufficiency.

While reviewing the lab reports of a patient, the nurse finds a urinary specific gravity of 1.001, osmolarity of 60mOsm/kg, and a decrease in antidiuretic hormone (ADH) levels. Which condition does the nurse anticipate in the patient? 1 Myxedema 2 Thyrotoxicosis 3 Graves disease 4 Diabetes insipidus (DI)

4 Diabetes insipidus (DI) Decreased secretion of ADH occurs in patients with DI. The ADH hypofunction may lead to inadequate urine output and result in dehydration. In patients with DI, diluted urine with a specific gravity of less than 1.005 may occur. The urinary osmolarity is also reduced and can range from 50 to 200mOsm/kg. Myxedema is the swelling of the skin tissues due to reduced thyroid hormones. Thyrotoxicosis results from elevated thyroid hormones. Graves disease is an autoimmune disorder due to Hashimoto thyroiditis.

What manifestations should the nurse expect to find in a patient with Cushing's syndrome? Select all that apply. 1 Moon face 2 Truncal obesity 3 Barrel-shaped chest 4 Loss of bone density 5 Enlarged hands and feet

1 Moon face 2 Truncal obesity 4 Loss of bone density The patient with Cushing's syndrome has increased total body fat which is redistributed, producing moon face and truncal obesity. Depletion of nitrogen and mineral loss leads to loss of bone density. The patient with acromegaly has a barrel-shaped chest and enlarged hands and feet because of an excess of growth hormone.