Quiz 7: Adrenal & Pituitary

62. Which are causes of secondary adrenal insufficiency? SATA A. Tuberculosis B. Pituitary Tumors C. Adrenalectomy D. Hypophysectomy E. Metastatic Cancer F. High-dose pituitary radiation

B. Pituitary Tumors D. Hypophysectomy F. High-dose pituitary radiation

8. The nurse is performing an assessment of an adult patient with new onset acromegaly. What does the nurse expect to find? A. Extremely long arms and legs B. Thickened lips C. Changes in menses with infertility D. Rough, extremely dry skin

B. Thickened lips

30. Which statement about the pathophysiology of SIADH is correct? A. ADH secretion is inhibited in the presence of low plasma osmolality. B. Water retention results in dilutional hyponatrmia and expanded extracellular fluid (ECF) volume. C. The glomerulus is unable to increase its filtration rate to reduce the excess plasma volume. D. Renin and aldosterone are released and help decrease the loss of urinary sodium.

B. Water retention results in dilutional hyponatrmia and expanded extracellular fluid (ECF) volume.

50. Which drug decreases cortisol production? A. Mitotane B. Aminoglutethimide C. Cyproheptadine D. Hydrocortisone

B. Aminoglutethimide

365. Fludrocortisone (Florinef) is prescribed for a client with adrenal insufficiency. Which reponses to the medication should the nurse teach the client to report? SATA 1. Edema 2. Rapid weight gain 3. Fatigue in the afternoon 4. Unpredictable changes in mood 5. Increased frequency of urination

1. Edema 2. Rapid weight gain

352. What should the nurse do when collecting a 24-hour urine specimen? 1. Check to verify if a preservative is needed. 2. Weigh the client before starting the collection. 3. Discard the last voided specimen of the 24-hour specimen. 4. Assess the client's intake and output for the previous 24-hours.

1. Check to verify if a preservative is needed.

348. A nurse is assessing a female client with Cushing syndrome. Which clinical findings can the nurse expect to identify? SATA 1. Hirsutism 2. Menorrhagia 3. Buffalo hump 4. dependent edema 5. Migraine headaches

1. Hirsutism 3. Buffalo hump

355. A nurse is caring for a client who had an adrenalectomy. For what clinical response should the nurse monitor while steroid therapy is being regulated? 1. Hypotension 2. Hyperglycemia 3. Sodium retention 4. Potassium excretion

1. Hypotension

349. Which clinical indicators can the nurse expect when assessing a client with Cushing syndrome? SATA 1. Liability of mood 2. Slow wound healing 3. A decrease in the growth of hair 4. Ectomorphism with a moon face 5. An increased resistance to bruising

1. Liability of mood 2. Slow wound healing

343. Which information from the client's history does the nurse identify as a risk factor for developing osteoporosis? 1. Receives long-term steroid therapy 2. Has a history of hypopatathyroidism 3. Engages in strenuous physical activity 4. Consumes high doses of the hormone estrogen

1. Receives long-term steroid therapy

351. A client is diagnosed with Cushing syndrome. Which clinical manifestation does the nurse expect to increase in a client with Cushing syndrome? 1. Urine output 2. Glucose level 3. Serum potassium 4. Immune response

2. Glucose level

347. A nurse is caring for a client with a diagnosis of Cushing syndrome. What is the most common cause of Cushing syndrome that the nurse should consider before assessing this client for physiological responses? 1. Pituitary hypoplasia. 2. Hyperplasia of the adrenal cortex. 3. Deprivation of adrenocortical hormones. 4. Insufficient adrenocorticotropic hormone production

2. Hyperplasia of the adrenal cortex.

350. A nurse is caring for a male client with a diagnosis of Cushing syndrome. Which clinical manifestations does the nurse expect to identify? SATA 1. Polyuria 2. Obese trunk 3. Hypotension 4. Sleep disturbance. 5. Thin arms and legs

2. Obese trunk 4. Sleep disturbance. 5. Thin arms and legs

362. Which is an important intervention that the nurse should include in the plan of care that is specific for a client with Addison disease? 1. Encouraging the client to exercise 2. Protecting the client from exertion 3. Restricting the client's fluid intake 4. Monitoring the client for hypokalemia

2. Protecting the client from exertion

340. After surgical clipping of a cerebral aneurysm, the client develops the syndrome of inappropriate secretion of antidiuretic hormone. For which manifestations of excessive levels of antidiuretic hormone (ADH) should the nurse assess the client? SATA 1. Polyuria 2. Weight gain 3. Hypotension 4. Hyponatremia 5. Decreased specific gravity

2. Weight gain 4. Hyponatremia

341. A client who has acromegaly and insulin-dependent diabetes undergoes a hypophysectomy. the nurse identifies that further teaching about the hypophysectomy is necessary when the client state, "I know I will: 1. be sterile for the rest of my life." 2. require larger doses of insulin than I did preoperatively." 3. have to take cortisone or a similar drug for the rest of my life." 4. have to take thyroxine or a similar medication of the rest of my life."

2. require larger doses of insulin than I did preoperatively."

356. A client who has just had an adrenalectomy is told about a death in the family and becomes very upset. What concern about the client requires the nurse to notify the health care provider? 1. Analgesia and mild sedation will be required to ensure rest. 2. Steroid replacement medication therapy will have to be reduced. 3. The is a decreased ability to handle stress despite steroid therapy. 4. Feelings of exhaustion and lethargy may result from the emotional stress.

3. The is a decreased ability to handle stress despite steroid therapy.

344. A nurse is caring for two clients newly diagnosed with diabetes. One client has type 1 diabetes and the other client has type 2 diabetes. The nurse determines that the main difference between newly diagnosed type 1 and type 2 diabetes is that in type 1 diabetes: 1. onset of the disease is slow 2. excessive weight is a contributing factor. 3. complications are not present at the time of diagnosis 4. treatment involves diet, exercise and oral medications.

3. complications are not present at the time of diagnosis

358. A health care provider orders a low-sodium, high-potassium diet for a client with Cushing syndrome. Which explanation should the nurse provide as to why the client needs to follow this diet? 1. "The use of salt probably contributed to the disease." 2. "Excess weight will be gained if sodium is not limited." 3. " The loss of excess sodium and potassium in the urine requires less renal stimulation." 4. "Excessive aldosterone and cortisone cause retention of sodium and loss of potassium."

4. "Excessive aldosterone and cortisone cause retention of sodium and loss of potassium."

353. A client is scheduled for bilateral adrenalectomy. Before surgery, steroids are administered to the client. What does the nurse determine is the reason for the steroids? 1. Foster accumulation of glycogen in the liver 2. Increase the inflammatory action to promote scar formation 3. Facilitate urinary excretion of salt and water following surgery. 4. Compensate for sudden lack of these hormones

4. Compensate for sudden lack of these hormones

359. A nurse is caring for a client with the clinical manifestation of hypotension associated with a diagnosis of Addison disease. Which hormone is impaired in its production as a result of this disease? 1. Estrogens 2. Androgens 3. Glucocorticoids 4. Mineralcorticoids

4. Mineralcorticoids

10. In caring for a patient with hyperpituitarism, which symptoms does the nurse expect the patient to report? SATA A. Joint pain B. Visual disturbances C. Changes in menstruation D. Increased libido E. Headache F. Fatigue

A. Joint pain B. Visual disturbances C. Changes in menstruation E. Headache F. Fatigue

40. Which intervention applies to a patient with pheochromocyoma? A. Assist to sit in a chair for blood pressure monitoring. B. Instruct not to smoke, drink coffee, or change positions suddenly. C. Encourage to maintain an active exercise schedule including activity such as running. D. Encourage one glass of red wine nightly to promote rest.

B. Instruct not to smoke, drink coffee, or change positions suddenly.

20. While caring for a postoperative patient following a transsphenoidal hypophysectomy, the nurse observes nasal drainage that is clear with yellow color at the edge. This "halo sign" is indicative of which condition? A. Worsening neurologic status of the patient B. Drainage of CSF from the patient's nose C. Onset of postoperative infection D. An expected finding following this surgery.

B. Drainage of CSF from the patient's nose

2. A malfunctioning posterior pituitary gland can result in which disorders? SATA A. Hypothyroidism B. Altered Sexual Function C. Diabetes Insipidus D. Growth retardation E. Syndrome of inappropriate antidiuretic hormone (SIADH) F. Virilization

C. Diabetes insipidus E. Syndrome of inappropriate antidiuretic hormone (SIADH)

42. Which diuretic is ordered by the health care provider to treat hyperaldosteronism> A. Furosemide B. Ethacrynic Acid C. Bumetanide D. Spironolactone

D. Spironolactone

361. A client is admitted to a medical unit with a diagnosis of Addison disease. The client is emaciated and reports muscular weakness and fatigue. Which disturbed body process does the nurse determine is the root cause of the client's clinical manifestations? 1. Fluid balance 2. Electrolyte levels 3. Protein anabolism 4. Masculinizing hormones

3. Protein anabolism

44. When diagnosed with Cushing's syndrome, the patient's manifestations are most likely related to an excess production of which hormone? A. Insulin from the pancreas B. ADH from posterior pituitary gland C. PRL from anterior pituitary gland D. Cortisol from the adrenal cortex

D. Cortisol from the adrenal cortex

337. A nurse is assessing a client with a diagnosis of diabetes insipidus. For which signs indicative of diabetes insipidus should the nurse assess the client? SATA 1. Excessive thirst 2. Increased blood glucose 3. Dry mucous membranes 4. Increased blood pressure 5. Decreased serum osmolarity 6. Decreased urine specific gravity

1. Excessive thirst 3. Dry mucous membranes 6. Decreased urine specific gravity 1. As excessive fluid is lost through urination, dehydration triggers the thirst response. 2. Diabetes insipidus is not a disorder of glucose metabolism; blood glucose levels are not affected. Diabetes mellitus affects cglucose metabolism 3. As excessive fluid is lost through urination, dehydration occurs, resulting in dry mucous membranes and poor skin turgot. 4. Loss of fluid may decrease the blood pressure because fluid is lost from the intravascular compartment. 5. As fluid is lost from the intravascular compartment, serum osmolarity increases, not decreases. 6. Because water is not being reabsorbed urine is dilute, resulting in a low specific gravity (less than 1.005)

360. A nurse is monitoring for clinical manifestations of infection in a client with a diagnosis of Addison disease. Which body mechanism related to infectious processes does the nurse conclude is impaired as a result of this disease? 1. Stress response 2. Electrolyte balance 3. Metabolic processes 4. Respiratory function

1. Stress response

345. A client is scheduled for an adrenalectomy. Which nursing intervention should the nurse anticipate will be ordered for this client? 1. administer IV steroids. 2. Provide a high-protein diet. 3. Collect a 24-hour urine specimen. 4. Withhold all medications for 48 hours.

1. administer IV steroids.

354. A nurse is caring for a client who is scheduled for a bilateral adrenalectomy. Which medication should the nurse expect to be prescribed for this client on the day of surgery and in the immediate postoperative period? 1. Methimazole (Tapazole) 2. Pituitary Extract (Pituitrin) 3. Regular insulin (Novolin R) 4. Hydrocortisone succinate (Solu-Cortef)

4. Hydrocortisone succinate (Solu-Cortef)

357. A client with a tentative diagnosis of Cushing syndrome has an increased cortisol level. For what response should the nurse assess this client? 1. Hypovolemia 2. Hyperkalemia 3. Hypoglycemia 4. Hypernatremia

4. Hypernatremia

342. A nurse is caring for a client who had a hypophysectomy. For which complication specific to this surgery should the nurse assess the client for early clinical manifestations? 1. Urinary retention 2. Respiratory distress 3. Bleeding at the suture line 4. Increased intracranial pressure

4. Increased intracranial pressure

339. After a head injury a client develops a deficiency of antidiuretic hormone (ADH). What should the nurse consider about the response to secretion of ADH before assessing this client? 1. Serum osmolarity increases 2. Urine concentration decreases 3. Glomerular filtration dcreases 4. Tubular reabsorption of water increases

4. Tubular reabsorption of water increases

18. After a hypophysectomy, focused assessment and monitoring by the nurse include which factors? SATA A. Cognition and mental status B. Maintaining bedrest with bedside commode C. Possible leakage of cerebrospinal fluid (CSF) D. 24-hour intake of fluids and urine output E. 24-hour diet recall F. Headaches or visual disturbances

A. Cognition and mental status C. Possible leakage of cerebrospinal fluid (CSF) D. 24-hour intake of fluids and urine output F. Headaches or visual disturbances

28. Which medication is used to treat diabetes insipidus (DI)? A. Desmopressin Acetate B. Lithium C. Vasopressin D. Demeclocycline

A. Desmopressin Acetate

12. Which statements about the etiology of hypopituitarism are correct? SATA A. Dysfunction can result from radiation treatment to the head or brain. B. Dysfunction can result from infection or a brain tumor. C. Infarction following systemic shock can result in hypopituitarism. D. Severe malnutrition and body fat depletion can depress pituitary glad function. E. There is always an underlying cause of hypopituitarism. F. Pituitary tumors are the most common cause of hypopituitarism.

A. Dysfunction can result from radiation treatment to the head or brain. B. Dysfunction can result from infection or a brain tumor. C. Infarction following systemic shock can result in hypopituitarism. D. Severe malnutrition and body fat depletion can depress pituitary glad function.

16. A patient is recovering from a transsphenoidal hypophysectomy. What postoperative nursing interventions apply to this patient? SATA A. Encouraging the patient to perform deep-breathing exercises B. Vigorous coughing and deep-breathing exercises. C. Instructing on the use of a soft-bristled toothbrush for brushing the teeth. D. Strict monitoring of fluid balance E. Hourly neurologic checks for first 24 hours F. Instructing the patient to alert the nurse regarding postnasal drip

A. Encouraging the patient to perform deep-breathing exercises D. Strict monitoring of fluid balance E. Hourly neurologic checks for first 24 hours F. Instructing the patient to alert the nurse regarding postnasal drip

26. A hospitalized patient is prescribed desmoprssin acetate metered dose spray as a replacement hormone for vasopressin (ADH) which is an indication for another dose? SATA A. Excessive urination B. Specific gravity of 1.003 C. Dark, concentrated urine D. Edema in the legs E. Decreased urination F. Shortness of breath

A. Excessive urination B. Specific gravity of 1.003

6. A 30-year-old female patient is prescribed bromocriptine. Which information does the nurse teach the patient? SATA A. Get up slowly from a lying position. B. Take medication on an empty stomach. C. Take daily for purposes of raising GH levels to reduce symptoms of acromegaly. D. Begin therapy with a maintenance level dose. E. Report watery nasal discharge to the health care provider immediately. F. If pregnancy occurs the drug is stopped immediately.

A. Get up slowly from a lying position. E. Report watery nasal discharge to the health care provider immediately. F. If pregnancy occurs the drug is stopped immediately.

56. Which interventions are necessary for a patient with acute adrenal insufficiency (addisonian crisis)? SATA A. IV infusion of normal saline B. IV infusion of 3% saline C. Hourly glucose monitoring D. Insulin administration E. IV potassium therapy F. Administer IV hydrocortisone sodium

A. IV infusion of normal saline C. Hourly glucose monitoring D. Insulin administration F. Administer IV hydrocortisone sodium

32. In SIADH, as result of water retention from excess ADH, which laboratory values does the nurse expect to find? SATA A. Increased sodium in urine B. Elevated serum sodium level C. Increased urine specific gravity D. Decreased serum osmolarity E. Decreased urine specific gravity F. Decreased serum sodium level

A. Increased sodium in urine C. Increased urine specific gravity D. Decreased serum osmolarity F. Decreased serum sodium level

24. Which statements about diabetes insipidus (DI) are accurate? SATA A. It is caused by ADH deficiency. B. It is characterized by a decrease in urination. C. Urine output of greater than 4 L/24 hours is the first diagnostic indication. D. The water loss increases plasma osmolarity E. Nephrogenic DI can be caused by lithium (Eskalith). F. Increased thirst is a mechanism of the body to attempt maintaining fluid balance.

A. It is caused by ADH deficiency. C. Urine output of greater than 4 L/24 hours is the first diagnostic indication. D. The water loss increases plasma osmolarity F. Increased thirst is a mechanism of the body to attempt maintaining fluid balance.

60. The nurse should instruct a patient who is taking hydrocortisone to report which symptoms to the health care provider for possible dosage adjustment? SATA A. Rapid weight gain B. Changes in blood pressure C. Fluid Retention D. Gastrointestinal irritation E. Urinary incontinence F. Round face

A. Rapid weight gain C. Fluid Retention F. Round face

48. The female patient with Cushing's syndrome expresses concern about the changes in her general appearance. What is the expected outcome for this patient? A. To verbalize an understanding that that treatment will reverse many of the problems B. To ventilate about the frustration of these lifelong physical changes. C. To verbalize ways to cope with the changes such as joining a support group or changing style of dress D. To achieve a personal desired level of sexual functioning

A. To verbalize an understanding that that treatment will reverse many of the problems

64. Which patient care tasks could the nurse delegate to the unlicensed assistive personnel (UAP) in the care of a patient with acute adrenal insufficiency that is immobile? SATA A. Turn the patient every 1-2 hours B. Apply skin lubricants. C. Assess lung sounds every 2-4 hours D. Provide mouth care every 2 hours while awake. E. Record accurate intake and output F. Teach the patient to cough and deep breathe.

A. Turn the patient every 1-2 hours B. Apply skin lubricants. D. Provide mouth care every 2 hours while awake. E. Record accurate intake and output

54. Which patient is at risk for developing secondary adrenal insufficiency? A. patient who suddenly stops taking high-dose steroid therapy B. Patient who tapers the dosages of steroid therapy C. Patient deficient in ADH D. Patient with an adrenal tumor causing excessive secretion of ACTH

A. patient who suddenly stops taking high-dose steroid therapy

14. A female patient has been prescribed hormone replacement therapy. What does the nurse instruct the patient to do regarding this therapy? SATA A. Report any recurrence of symptoms, such as decreased libido, between injections. B. Avoid smoking because of the increased risk for cardiovascular complications. C. Treat leg pain, especially in the calves, with gentle muscle stretching. D. Take measures to reduce risk for hypertension and thrombosis. E. Monitor blood pressure at least weekly for potential hypotension. F. Regular follow-up visits with the health care provider are essential.

B. Avoid smoking because of the increased risk for cardiovascular complications. D. Take measures to reduce risk for hypertension and thrombosis. F. Regular follow-up visits with the health care provider are essential.

38. A patient in the emergency department is diagnosed with possible pheochromocytoma. What is priority nursing intervention for this patient? A. Monitor the patient's intake and output and urine specific gravity. B. Monitor blood pressure for severe hypertension C. Monitor blood pressure for severe hypotension D. Administer medication to increase cardiac output.

B. Monitor blood pressure for severe hypertension

34. Which type of IV fluid does the nurse use to treat a patient with SIADH when the serum sodium level is very low? A. D5 1/2 normal saline B. D5W C. 3% normal saline D. normal saline

C. 3% normal saline

22. The action of antidiuretic hormone (ADH) influences normal kidney funtion by stimulation which mechanism? A. Glomerulus to control the filtration rate B. Proximal nephron tubules to reabsorb water C. Distal Nephron Tubules and collecting ducts to reabsorb water D. Constriction of glomerular capillaries to prevent loss of protein in urine.

C. Distal Nephron Tubules and collecting ducts to reabsorb water

4. The assessment findings of a male patient with an anterior pituitary tumor include reports of changes in secondary sex characteristics, such as episodes of impotence and decreased libido. The nurse explains to the patient that these findings are a result of overproduction of which hormone? A. Gonadotropins inhibiting prolactin (PRL) B. Thyroid hormone inhibiting prolactin (PRL) C. Prolactin (PRL) inhibiting secretion of gonadotropins D. Steroids inhibiting production of sex hormones

C. Prolactin (PRL) inhibiting secretion of gonadotropins

346. A nurse is caring for a newly admitted client with a diagnosis of Cushing syndrome. Why should the nurse monitor this client for clinical indicators of diabetes mellitus? 1. Cortical hormones stimulate rapid weight loss. 2. Tissue catabolism results in a negative nitrogen balance. 3. Glucocorticoids accelerate the process of gluconeogenesis. 4. Excessive adrenocorticotropic hormone secretion damage pancreatic tissue.

3. Glucocorticoids accelerate the process of gluconeogenesis.

338. A client is admitted with a head injury. The nurse identifies that the client's urinary retention catheter is draining large amounts of clear, colorless urine. What does the nurse identify as the most likely cause? 1. Increased serum glucose 2. Deficient renal perfusion 3. Inadequate ADH secretion 4.Excess amounts of IV fluid

3. Inadequate ADH secretion

363. A health care provider writes orders addressing the needs of a client with Addison disease. Which outcome does the nurse conclude is the main focus of treatment for the client? 1. Decrease in eosinophils 2. Increase in lymphoid tissue 3. Restoration of electrolyte balance 4. Improvement of carbohydrate metabolism

3. Restoration of electrolyte balance

364. A nurse is caring for a client with Addison disease. Which information should the nurse include in a teaching plan as a means of encouraging this client to modify dietary intake? 1. Increased amounts of potassium are needed to replace renal losses. 2. Increased protein is needed to heal the adrenal tissue and thus cure the disease. 3. Supplemental vitamins are needed to supply energy and assist in regaining the lost weight. 4. Extra salt is needed to replace the amount being lost due to lack of sufficient aldosterone to conserve sodium.

4. Extra salt is needed to replace the amount being lost due to lack of sufficient aldosterone to conserve sodium.

46. Which are physical findings of Cushing's Disease? SATA A. "Moon-faced" appearance. B. Decreased amount of body hair C. Truncal obesity D. Coarse facial features E. Thin, easily damaged skin F. Extremity muscle wasting

A. "Moon-faced" appearance. C. Truncal obesity E. Thin, easily damaged skin F. Extremity muscle wasting

66. The patient with hypercortisolism asks the nurse why she is prescribed the drug ranitidine. What is the nurse's best response? A. This drug inhibits the gastric proton pump an prevents the formation of hydrochloric acid in your stomach. B. Gastrointestinal bleeding is common complication in patients with hypercortisolism. C. Ranitidine blocks the H2-receptor site to decrease formation of hydrochloric acid and prevent GI bleeding. D. This drug buffers stomach acids and protects the gastrointestinal mucosa.

C. Ranitidine blocks the H2-receptor site to decrease formation of hydrochloric acid and prevent GI bleeding.

52. The nurse is teaching a patient being discharged after bilateral adrenalectomy. Wat medication information does the nurse emphasize in the teaching plan? A. The dosage of steroid replacement drugs will be consistent throughout the patient's lifetime. B. The steroid drugs should be taken in the evening so as not to interfere with sleep. C. The patient should take the drugs on an empty stomach. D. The patient should learn how to give himself an intramuscular injection of hydrocortisone.

D. The patient should learn how to give himself an intramuscular injection of hydrocortisone.