Chapter 62: Care of Patients with Pituitary and Adrenal Gland Problems

Which are physical findings of Cushing's syndrome? Select all that apply.

"Moon-faced" appearance, Truncal obesity, Thin easily damaged skin, and Extremity muscle wasting

In caring for a patient with hyperpituitarism, which symptoms does the nurse expect the patient to report? Select all that apply. 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

A patient with a hypophysectomy can postoperatively experience transient diabetes insipidus. Which manifestation alerts the nurse to this problem? A) Output much greater than intake. B) Change in mental status indicating confusion. C) Laboratory results indicating hypoatremia. D) Nonpitting edema.

A) Output much greater than intake.

The nurse expects to perform which diagnostic test for pheochromocytoma?

24 hour urine collection for vanillymandelic acid V M A. or 24 hour urine collection for fractionated metanephrine and catecholamine levels

Which type of I V fluid does the nurse use to treat a patient with S I A D H when the serum sodium level is very low?

3% normal saline

A patient is prescribed bromocriptine mesylate (Parlodel). Which information does the nurse teach the patient? Select all that apply A) Get up slowly from a lying position. B) Take medication on an empty stomach. C) Take daily for purposes of raising growth hormone (GH) levels to reduce symptom of acromegaly. D) Begin therapy with maintenance level dose. E) Report watery nasal discharge to the health care provider immediately.

A) Get up slowly from a lying position E) report watery nasal discharge to the health care provider immediately.

Which patient's history puts her at risks for developing S I A D H?

58 year old with metastatic lung or breast cancer.

Following a hypophysectomy, the patient requires instruction on hormone replacement for which hormones? Select all that apply. A) Cortisol B) Thyroid C) Gonadal D) Vasopressin E) PRL

A) Cortisol B) Thyroid C) Gonadal D) Vasopressin

A patient with Prolactin (PRL) secreting tumor is likely to be treated with which medication? A) Dopamine agonists B) Vasopressin C) Steroids D) Growth hormone

A) Dopamine agonists

Which statements abut the etiology of hypopituitarism are correct? Select all that apply. A) Dysfunction can result from radiation treatment to the head or brain. B) Dysfunction can result from infection or a brain tubor. C) Infraction following systemic shock can result in hypopituitarism. D) Severe malnutrition and body fat depletion can depress pituitary gland function. E) There is always and underlying 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, and D) severe malnutrition and body fat depletion can depress pituitary gland function.

When analyzing lab values, the nurse expects to fins which value as a direct result of overproduction of growth hormone (GH)? A) Hyperglycemia B) Hyperphosphatemia C) Hypocalcemia D) Hypercalcemia

A) Hyperglycemia

A malfunctioning anterior pituitary gland result in which disorder? Select all that apply. A) Pituitary hypofunction B) Pituitary hyperfunction C) Diabetes insipidus (DI) D) Hypothyroidism E) Osteoporosis

A) Pituitary hypofunction B) pituitary hyper function D) hypothyroidism E) osteoporosis

A deficiency of which anterior pituitary hormone is considered life threatening? Select all that apply. A) Growth Hormone B) Melanocyte-stimulating hormone C) Prolactin D) Thyroid-stimulating hormone E) Adrenocorticotropic hormone

D) Thyroid stimulating hormone (TSH) E) Adrenocorticotropic hormone (ACTH)

An A C T H stimulation test is the most definitive test for which disorder?

Adrenal insufficiency

Which drug decreases cortisol production?

Aminoglutethimide (Cytadren)

After a hypophysectomy, home care monitoring by the nurse includes assessing which factors? Select all that apply. A) hypoglycemia B) bowel habits C) possible leakage of cerebrospinal fluid (CSF) D) 24-hour intake of fluids and urine output E) 24-hour diet recall F) activity level

B) Bowel habits C) possible leakage of cerebrospinal fluid (CSF) D) 24 hour intake of fluids and urine output E) 24 hour diet recall, and activity level.

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

B) Drainage of cerebral spinal fluid C S F from the patient's nose.

Postoperative care for a patient who has had a transsphenoidal hypophysectomy includes which intervention? A) Encouraging coughing and deep-breathing to decrease pulmonary complications. B) Testing nasal drainage for glucose to determine weather it contains cerebrospinal fluid. C) Keeping the bed flath to decrease central cerebrospinal fluid leakage. D) Assisting the patient with brushing the teeth to reduce risk of infection.

B) Testing nasal drainage for glucose to determine whether it contains cerebral spinal fluid cerebrospinal fluid.

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

B)Thickened lips

A malfunctioning posterior pituitary glands can result in which disorder? Select all that apply. A) Hypothyroidism B) Altered Sexual Function C) Diabetes insipidus (DI) D) Growth retardation E) Syndrome of inappropriate antidiuretic hormone (SIADH)

C) Diabetes insipidus D I D) Syndrome of inappropriate antidiuretic hormone (SIADH)

A patient requires 100 g of oral glucose for suppression testing and growth hormone G H levels are measured serially for 120 minutes. The results are abnormal. The nurse would assess for the signs and symptoms of which endocrine disorder? A) Adrenal insufficiency B) DI C) Hyperpituitarism D) Hypothyroidism

C) Hyperpituitarism

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

C) Prolactin inhibiting secretion of gonadotropins

Which medications are used to treat Diabetes Insipidus D I?

Chlorpropamide (Diabinese) or Desmopressin acetate (DDAVP)

The nurse is caring for a patient with Diabetes Insipidus D I. What is the priority goal of collaborative care?

Correct the water metabolism problem

When diagnosed with Cushing's syndrome, the manifestations are most likely related to an excess production of which hormone?

Cortisol from the adrenal cortex

***Interferes with A C T H production

Cypropheptadine (Periactin)

Patients diagnosed with an anterior pituitary tumor can have symptoms such as acromeglay or giantism. These symptoms are result of overproduction of which hormone? A) ACTH B) Prolactin C) Gonadotropins D) Growth Hormone

D) Growth hormone

Problems in the hypothalamus that change the function of the anterior pituitary glands result in which condition? A) Adenohypophysis B) Panhypopituitarism C) Primary Pituitary dysfunction D) Secondary pituitary dysfunction

D) Secondary pituitary dysfunction

A patient is recovering from a transphenoidal hypophysectomy. What post operative nursing intervention apply to this patient? Select all that apply. A) Encouraging the patient to perform deep breathing exercises. B) Vigorous coughing and deep-breathing exercises. C) Instructing on the use of soft-bristled toothbrush for busing the teeth. D) Strict monitoring of fluid balance. E) Hourly neurological checks for the first 24 hours. F) Instructing the patient to alert the nurse regarding post nasal drip.

D) Strict monitoring of fluid balance. E) Hourly neurological checks for the first 24 hours. F) Instructing the patient to alert the nurse regarding post nasal drip.

A female patient has been prescribed hormone replacement therapy. What does the nurse instruct the patient to do regarding this type of therapy? A) Report any recurrence of symptoms, such as decreased libido, between injections. B) Monitor blood pressure at least weekly for potential hypotension. C) Treat leg pain, especially in the calves, with gentle muscle stretching. D) Take measures to reduce risk for hypertension and thrombosis.

D) Take measures to reduce risk for hypertension and thrombosis.

Which statement about hormone replacement therapy for hypopituitarism is correct? A) Once manifestations of hypofunction are corrected, treatment is no longer needed. B) The most effective route of androgen replacementis the oral route. C) Testosterone replacement therapy is contraindicated in men with prostate cancer. D) Clomiphene citrate (Clomid) is used to suppress ovulation in women.

D) Testosterone replacement therapy is contraindicated in men with prostate cancer.

** *Which statement about the etiology and incidence of S I A D H is correct?

Democlocycline may be used to treat S I A D H.

What is the disorder that results from a deficiency of vasopressin from the posterior pituitary gland called?

Diabetes insipidus

The action of antidiuretic hormone A D H influences normal kidney function by stimulating which mechanism?

Distal nephron tubules and collecting ducts to reabsorb water.

The nurse is teaching a patient being discharged after a bilateral adrenalectomy. What medication information does the nurse emphasize in the teaching plan?

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

A patient uses desmopressin acetate metered dose spray as replacement hormone for AntiDiuretic Hormone A D H. Which is an indication for another dose? Select all that apply.

Excessive urination and specific gravity of 1.003

Which statement about a patient with hyperaldosteronism after a successful unilateral adrenalectomy is correct?

Glucocorticoid replacement therapy is temporary.

***Which are hormones produced and secreted by the anterior pituitary gland? Select all that apply.

Growth hormone (GH; somatropin), Prolactin (PRL), Thyrotropin (Thyroid stimulating hormone TSH), and Gonadotropins (follicle stimulating hormone FSH and luteinizing hormone LH).

What is the most common cause of endogenous hypercortisolism, or Cushing's syndrome?

Hyperplasia of the adrenal cortex

***When assessing a patient with Cushing's syndrome, what does the nurse expect to find?

Hypertension

Which statement about hyperaldosteronism is correct?

Hypokalemia and hypertension are the main issues.

Which interventions are necessary for a patient with acute adrenal insufficiency, Addisonian crisis? Select all that apply.

I V infusion of normal saline, Hourly glucose monitoring, and Insulin administration

***Which are causes for decreased production of adrenalcortical steroids? Select all that apply.

Inadequate secretion of A C T H, dysfunction of hypothalamic-pituitary control mechanism, adrenal gland dysfunction, cancer, and AIDS.

Which lab finding does the nurse expect to find with Cushing's syndrome? Select all that apply.

Increased serum glucose, increased serum sodium, and decreased serum calcium

In S I A D H as a result of water retention from excess A D H, which lab value does the nurse expect to find? Select all that apply.

Increased urine osmolarity/increased sodium in the urine, increased specific gravity/concentrated urine, and decreased serum osmolarity.

Which intervention applies to a patient with pheochromocytoma?

Instruct not to smoke or drink coffee or change positions suddently

Which statement about pheochromocytoma is correct?

It is a catecholamine producing tumor.

Which statement about diabetes insipidus D I are accurate? Select all that apply.

It is caused by antidiuretic hormone deficiency, urine output of greater than 4 L/24 hours is the first diagnostic indication, and water loss increases plasma osmolarity.

The nurse determines that the administration of hydrocortisone for Addisonian crisis is effective when which assessment is made?

Lethargy improving; patient alert and oriented.

Which drug is an adrenal cytotoxic agent used for inoperable adrenal tumors

Mitotane (Lysodren)

A patient in the E R is diagnosed with possible pheochromocytoma. What is the priority nursing intervention?

Monitor blood pressure for severe hypertension.

What does the nurse instruct patients with permanent Diabetes Insipidus D I to do? Select all that apply.

Monitor for recurrence of polydipsia, excessive thirst, and polyuria, excessive urination, monitor and record weight daily, and wear a medical alert bracelet.

Which intervention is contraindicated of a patient with pheohromocytoma?

Palpating the abdomen.

Which patient is at risk for developing a secondary adrenal insufficiency?

Patient who suddenly stops taking high dose steroid therapy.

The nurse would instruct a patient who is taking hydrocortisone to report which symptoms to the doctor for possible dose adjustment? Select all that apply.

Rapid weight gain, Round face, and Fluid retention

Which nursing intervention is a preventative measure for adrenalcortical insufficiency?

Reducing high dose glucocorticoid doses gradually

Which nursing intervention is the priority for a patient with S I A D H?

Restrict fluid intake.

A patient in the E R who reports lethargy, muscle weakness, nausea, vomiting, and weight loss over the past weeks is diagnosed with Addisonian crisis, an acute adrenal insufficiency. Which drugs does the nurse expect to administer to this patient?

Solu-Cortef IV along with IM injections of hydrocortisone

Which diuretic is ordered by the doctor to treat hyperaldosteronism?

Spironolactone (Aldactone)

A patient is scheduled for bilateral adrenalectomy. Before surgery, steroids are to be given. Which is the reasoning behind the administration of this drug?

To compensate for sudden lack of adrenal hormones following surgery.

The nurse determines a priority patient problems of altered self-concept in a female patient with Cushing's syndrome who expresses concern about the changes in her general appearance. What is the expected outcome for this patient?

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

Which medications are used in S I A D H to promote water excretion without causing sodium loss? Select all that apply.

Tolvaptan (Samsca) and Conivaptan (Vaprisol)

The effect of increased A D H in the blood results in which effect on the kidney?

Tubular reabsorption of water increases.

Which statement about the pathophysiology of S I A D H is correct?

Water retention results in dilution hyponatremia and expanded extracellular fluid (ECF) volume.