Care of Patients With Pituitary and Adrenal Gland Problems

What manifestations does the nurse expect to find in a patient with gonadotropin deficiency? Anorexia Amenorrhea Breast atrophy Pale, sallow complexion Decreased axillary hair

Amenorrhea Breast atrophy Decreased axillary hair Rationale The patient with gonadotropin deficiency has a loss or change of secondary sex characteristics. The patient may report amenorrhea or the absence of menstrual periods, breast atrophy, and decreased axillary and pubic hair. The patient with adrenocorticotropic hormone deficiency has anorexia and a pale, sallow complexion. p. 1267

Which manifestations would the nurse anticipate finding in a female patient diagnosed with deficient gonadotropins? Anovulation Menorrhagia Breast atrophy Decreased libido High estrogen levels

Anovulation Breast atrophy Decreased libido Rationale Anovulation, breast atrophy, and decreased libido are common findings in patients diagnosed with deficient gonadotropins. Amenorrhea, not menorrhagia, would be found in patients with deficient gonadotropins. Estrogen levels would be low, not high.

What lab findings are consistent with a patient diagnosed with hyper aldosteronism? Arterial pH 7.48 Serum sodium 148 mEq/L Serum calcium 8.0 mg/dL Serum glucose 358 mg/dL Serum potassium 5.3 mEq/L

Arterial pH 7.48 Serum sodium 148 mEq/L Rationale Patients diagnosed with hyperaldosteronism usually are alkalotic and have hypernatremia. Calcium and glucose are not usually affected with this diagnosis. Potassium is usually low, not high.

What nursing interventions should be implemented for a patient diagnosed with diabetes insipidus (DI)? Check urine for ketones Assess mucous membranes Implement seizure precautions Monitor blood glucose every hour Perform strict intake and output assessments

Assess mucous membranes Perform strict intake and output assessments Rationale Assessing the mucous membranes is important in evaluating dehydration. Strict intake and output is important to determine improvement or worsening of the DI. Seizure precautions are common with decreased serum sodium, not DI. Checking urine for ketones and assessing blood glucose are not indicated in patients with DI.

A patient diagnosed with a pheochromocytoma is admitted to the emergency department with a severe headache, flushing, and palpitations. The patient is now reporting abdominal pain. What action should the nurse take? Check blood pressure Palpate abdomen for mass Administer subcutaneous glucagon Prepare patient for magnetic resonance imaging (MRI)

Check blood pressure Rationale The patient has signs of a hypertensive attack. The nurse should assess the patient's blood pressure. Palpating the abdomen is contraindicated in patients with pheochromocytoma because it may worsen the attack. Glucagon is not indicated and can worsen the attack. A patient having an attack will not be sent for an MRI while the attack is occurring.

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

Failure of tissues to respond to somatomedins Rationale 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. p. 1267

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

Have the patient avoid brushing the teeth for 2 weeks after surgery Rationale 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. p. 1271

What findings are consistent with a diagnosis of hyperaldosteronism? Headache Dehydration Muscle weakness Profuse diaphoresis Intermittent hypertension

Headache Dehydration Muscle weakness Rationale Headache, dehydration, and muscle weakness are common findings in patients diagnosed with hyperaldosteronism. Profuse diaphoresis and intermittent hypertension are not consistent with this diagnosis.

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

Increased serum sodium Rationale 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.

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

Increased swallowing Rationale 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 are related to mouth breathing. Blood-tinged nasal drainage is normal. A urine specific gravity of 1.028 is a normal finding.

A patient has undergone a transsphenoidal hypophysectomy. Which intervention does the nurse implement to avoid increasing intracranial pressure (ICP) in the patient? <p>A patient has undergone a transsphenoidal hypophysectomy. Which intervention does the nurse implement to avoid increasing intracranial pressure (ICP) in the patient?</p> Encourages the patient to cough and deep-breathe. Instructs the patient not to strain during a bowel movement. Instructs the patient to blow the nose for postnasal drip. Places the patient in the Trendelenburg position.

Instructs the patient not to strain during a bowel movement. Straining during a bowel movement increases ICP and must be avoided. Laxatives may be given and fluid intake encouraged to help with this. Although deep-breathing is encouraged, the patient must avoid coughing early after surgery because this increases pressure in the incision area and may lead to a cerebrospinal fluid (CSF) leak. If the patient has postnasal drip, he or she must inform the nurse and not blow the nose; postnasal drip may indicate leakage of CSF. The head of the bed must be elevated after surgery. p. 1284

What nursing interventions are appropriate for a patient diagnosed with adrenal hypofunction? . Monitor BUN levels Monitor hematocrit levels Administer steroid therapy Place patient on salt restrictions Administer a potassium replacement

Monitor BUN levels Monitor hematocrit levels Administer steroid therapy

After receiving a change-of-shift report about these four patients, which patient does the nurse attend to first? Patient with acute adrenal insufficiency who has a blood glucose of 36 mg/dL Patient with diabetes insipidus who has a dose of desmopressin (DDAVP) due Patient with hyperaldosteronism who has a serum potassium of 3.4 mEq/L Patient with pituitary adenoma who is reporting a severe headache

Patient with acute adrenal insufficiency who has a blood glucose of 36 mg/dL Rationale A glucose level of 36 mg/dL is considered an emergency; this patient must be assessed and treated immediately. Although it is important to maintain medications on schedule, the patient requiring a dose of desmopressin is not the first patient who needs to be seen. A serum potassium of 3.4 mEq/L in the patient with hyperaldosteronism may be considered normal (or slightly hypokalemic), based on specific hospital levels. The patient reporting a severe headache needs to be evaluated as soon as possible after the patient with acute adrenal insufficiency. As an initial measure, the RN could delegate obtaining vital signs to unlicensed assistive personnel (UAP). p.1274

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

Presence of fat pads on the shoulders Rationale 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 at the extremities. The patient also has truncal obesity following changes in fat distribution.

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

Prevention of gastric ulcers Rationale 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.

The nurse is caring for a patient with hypercortisolism. The nurse begins to feel the onset of a cold but still has 4 hours left in the shift. What does the nurse do? Asks another nurse to care for the patient. Monitors the patient for coldlike symptoms. Refuses to care for the patient. Wears a facemask when caring for the patient.

Rationale A patient with hypercortisolism will be immune-suppressed. Anyone with a suspected upper respiratory infection who must enter the patient's room must wear a mask to prevent the spread of infection. Although asking another nurse to care for the patient might be an option in some facilities, it is not generally realistic or practical. The nurse, not the patient, feels the onset of the cold, so monitoring the patient for coldlike symptoms is part of good patient care for a patient with hypercortisolism. Refusing to care for the patient after starting care would be considered abandonment.

The nurse is caring for a patient who is diagnosed with adrenal insufficiency. The patient has the following lab results: potassium 5.9 mEq/dL, sodium 128 mEq/dL, and calcium 8.0 mg/dL. The patient reports palpitations. What action by the nurse is priority?

Rationale Patients with hyperkalemia may experience dysrhythmias. The patient's cardiac rhythm must be assessed and monitored because the patient is reporting they have palpitations, which is indicative of a dysrhythmia. An increase in IV fluids may be needed, yet it is not the first priority in this situation. Weighing the patient daily is important in assessing fluid balance in a patient with adrenal insufficiency, yet it is not a priority intervention when the patient reports palpitations. Assessing the potassium intake is also not a priority. p. 1275

A patient presents to the emergency department with acute adrenal insufficiency and the following vital signs: P 118 beats/min, R 18/min, BP 84/44 mm Hg, pulse oximetry 98%, and T 98.8° F oral. Which nursing intervention is the highest priority for this patient? Administering furosemide Providing isotonic fluids Replacing potassium losses Restricting sodium

Rationale Providing isotonic fluid is the priority intervention because this patient's vital signs indicate volume loss that may be caused by nausea and vomiting and may accompany acute adrenal insufficiency. Isotonic fluids will be needed to administer IV medications such as hydrocortisone. Furosemide is a loop diuretic, which this patient does not need. Potassium is normally increased in acute adrenal insufficiency, but potassium may have been lost if the patient has had diarrhea; laboratory work will have to be obtained. Any restrictions, including sodium, should not be started without obtaining laboratory values to establish the patient's baseline.

The nurse is assigned the following four patients. Which patient should the nurse see first? A patient diagnosed with pheochromocytoma with a headache rated 10/10 A patient diagnosed with Addison's disease who has an order for cortisol due A patient diagnosed with Cushing's disease who has a sodium level of 147 mEq/dL A patient diagnosed with Conn's syndrome who is scheduled for surgery and has a potassium level of 4.0 mEq/L

Rationale The patient with pheochromocytoma with a headache rated 10/10 is likely experiencing an attack. The patient should be assessed, and the blood pressure should be evaluated for hypertension. The patient with Addison's disease can have medication administered after caring for the patient with pheochromocytoma. The patient with Cushing's disease has a slightly elevated sodium but is not critical. The patient with Conn's syndrome has a normal potassium level and is not priority.

Which condition results from excessive secretion of vasopressin even when plasma osmolarity is low or normal? Cushing syndrome Sheehan's syndrome Schwartz-Bartter syndrome Waterhouse-Friderichsen syndrome

Schwartz-Bartter syndrome Rationale Schwartz-Bartter syndrome is also known as the syndrome of inappropriate antidiuretic hormone secretion. In this condition, excess vasopressin or antidiuretic hormone is secreted even when plasma osmolarity is low or normal. Cushing's syndrome is characterized by the increased secretion of cortisol from the adrenal cortex, which results in widespread problems. Sheehan's syndrome is described as pituitary ischemia or infarction caused by postpartum hemorrhage resulting in decreased secretion of hormones. Waterhouse-Friderichsen syndrome is caused by adrenal gland failure resulting from severe gram-negative sepsis. p. 1272

What are the most common features of acromegaly? Moon face Thickened lips Fine tremors Acne

Thickened lips Rationale Overproduction of GH in adults results in acromegaly. The onset may be gradual with slow progression and may be noticed as thickened lips, coarse facial features, increasing head size and lower jaw protrusion. Moon face is related to Cushing's disease. Fine tremors are associated with excessive thyroid stimulating hormone and acne is associated with hyperproduction of adrenocorticotropic hormone (ACTH).

A patient with hypercortisolism is at risk for bone fractures. What does the nurse instruct the unlicensed assistive personnel (UAP) to do when caring for this patient? Use a gait belt to assist the patient when walking. Grasp the patient when assisting movement in bed. Allow the patient to use the walker without assistance. Place mats next to the bed to protect the patient from cold floors.

Use a gait belt to assist the patient when walking. Rationale The patient with hypercortisolism has low bone density and is at risk of bone fractures so a gait belt should be used to assist the patient when walking. The UAP must use lift sheets to help the patient to move in bed, and not grasp and lift the patient. This helps reduce the shear on the skin and prevents any risk of injury to the patient. The UAP must remind the patient to call for help when ambulating; the patient must not be allowed to use the walker or cane and move without assistance. The UAP must ensure that the room is free of objects that can cause the patient to trip and fall. p. 1280

The patient is being seen by the primary care provider for thyroid-stimulating hormone (TSH) deficiency. What assessment findings are consistent with this diagnosis? Headache Weight gain Scalp alopecia Slowed cognition Postural hypotension

Weight gain Scalp alopecia 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 diagnosed with acromegaly is beginning bromocriptine mesylate therapy. What statement by the patient indicates a need for further teaching? "My blood glucose should improve." "I am excited for my lips to be normal." "I should take the medicine with food." "I will need to change positions slowly."

"I am excited for my lips to be normal." Rationale The facial features and musculoskeletal issues resulting from acromegaly are not reversible. The patient's lips and facial features will not change after medication is started. The patient should have an improvement in their blood glucose once therapy is initiated. The medication should be taken with food. Patients should change positions slowly because orthostatic hypotension is a side effect of the medication.

A patient diagnosed with diabetes insipidus (DI) has received education about his diagnoses. What statement by the patient indicates an understanding of the teaching? "I will need to decrease the amount of fluid I drink." "I should increase my sodium intake to avoid seizures." "It is important to take my conivaptan at the same time every day." "I will need to change positions slowly to avoid getting lightheaded."

"I will need to change positions slowly to avoid getting lightheaded." Rationale DI can lead to orthostatic hypotension. Patients should be taught to change positions slowly. Patients with DI need increased, not decreased, fluid intake. The patient will have hypernatremia and should not increase sodium intake; instead, it should be restricted. Conivaptan is indicated in patients with SIADH, not DI, to promote water excretion.

A patient diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) has received education about his diagnoses. What statement by the patient indicates an understanding of the teaching provided? "I should restrict my sodium intake in my diet." "I will need to increase the amount of fluid I drink." "I will need to urinate more while I am taking conivaptan." "I will need to need to change positions slowly to avoid getting lightheaded."

"I will need to urinate more while I am taking conivaptan." Rationale 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.

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

"My blood will be drawn over 3 days." Rationale 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.