MCA-2 Adaptive Quiz #1 Disorders of the Pituitary

Which is a sign of syndrome inappropriate antidiuretic hormone (SIADH)? Decreased ADH Excessive urine output Increased serum osmolality Increased intravascular volume

Increased serum osmolality Increased intravascular volume Rationale SIADH is characterized by an increase in antidiuretic hormone (ADH) levels in the body. As a result, the patient will have an increased intravascular volume. Decreased ADH, excessive urine output, and increased serum osmolality are features of diabetes insipidus. pp. 1159-1160

Which nursing intervention is most important for a patient with diabetes insipidus? Providing dietary education Monitoring fluid intake and output Assessing for constipation every day Obtaining a finger-stick blood glucose level

Monitoring fluid intake and output Rationale Polyuria and polydipsia are the major clinical manifestations of diabetes insipidus. Therefore, strict monitoring of fluid intake and output is a priority nursing intervention. Diet education and finger-stick blood glucose measurements are not high-priority interventions for diabetes insipidus. Constipation can be a secondary problem, as a result of dehydration. pp. 1161-1162

A patient has a dysfunction of the pituitary gland. Which hormone secretion does the nurse recognize may be altered in this patient? Prolactin Thyroxine Erythropoietin Parathormone

Prolactin Rationale Prolactin is secreted by the pituitary gland. Thyroxine hormone is secreted by the thyroid gland. The kidney secretes erythropoietin. Parathormone is secreted by the parathyroid gland. pp. 1157-1158

A patient has undergone surgery for acromegaly. After surgery, the patient is experiencing severe headache. What action should be taken to provide relief from the headache? The bed should be placed parallel to the floor. The head of the bed should be elevated to 30-degree angle. The glucose level of the patient should be maintained. The patient should be told to avoid coughing and sneezing.

The head of the bed should be elevated to 30-degree angle. Rationale Elevating the head of the bed to a 30-degree angle alleviates pressure on the sella turcica and thereby relieves the headache. Placing the bed parallel to the floor does not alleviate pressure on the sella turcica. Glucose levels are used to check cerebrospinal fluid leakage. Vigorous coughing and sneezing should be avoided to prevent cerebrospinal fluid leakage. Test-Taking Tip: Do not worry if you select the same numbered answer repeatedly, because there usually is no pattern to the answers pp. 1158-1159

A patient diagnosed with acromegaly has developed speech difficulties and asks what is causing the problem. Which response by the nurse is accurate? "You have developed the condition from numbness of the vocal cords." "You have developed the condition due to overgrowth of the tongue." "You have developed the condition from an overgrowth of soft tissue in the neck." "You have developed the condition related to upper airway narrowing."

"You have developed the condition due to overgrowth of the tongue." Rationale Acromegaly most often occurs because of a benign growth hormone (GH)-secreting pituitary adenoma. The excess GH results in an overgrowth of soft tissues and bones in the hands, feet, and face. Overgrowth of the tongue leads to dental and speech difficulties. The voice may deepen due to overgrowth of the vocal cords, but there is not a change in sensation. Soft tissue of the neck may overgrow, leading to difficulties with skin conditions such as acne. Upper airway narrowing can predispose the person with acromegaly to sleep apnea, not speech difficulties. pp. 1156-1157

Which condition can result if hypersecretion of growth hormone (GH) occurs after epiphyseal plate closure? Dwarfism Acromegaly Gigantism Cretinism

Acromegaly Rationale Excess GH after closure of the epiphyseal plates results in acromegaly. When there is excess GH before the epiphyseal plates close, then gigantism can result. Dwarfism is associated with a deficiency, not an excess of GH and cretinism can result as an effect of congenital hypothyroidism. pp. 1156-1157

A patient is instructed to ingest 75 g of glucose orally as a part of an oral glucose tolerance test. In addition, growth hormone measurements are taken consecutively at 30, 60, 90, and 120 minutes. Glucose levels and growth hormone levels are found to be constant during the test. What does the nurse infer from these findings? Acromegaly Hepatomegaly Splenomegaly Dactylomegaly

Acromegaly Rationale In addition to the patient history and physical examination, the oral glucose tolerance test is a specific test for acromegaly. As growth hormone secretion is normally inhibited by glucose, measurement of glucose nonsuppresibility is required. Growth hormone concentration normally falls during the oral glucose tolerance test, but in patients with acromegaly, the growth hormone levels do not fall. Hepatomegaly is enlargement of the liver. Splenomegaly is enlargement of the spleen. Dactylomegaly is enlargement of the toes and fingers. pp. 1156-1157

Adrenocortical insufficiency develops secondary to inadequate secretion of which pituitary hormone? Antidiuretic hormone (ADH) Follicle-stimulating hormone (FSH) Thyroid-stimulating hormone (TSH) Adrenocorticotropic hormone (ACTH)

Adrenocorticotropic hormone (ACTH) Rationale Adrenocortical insufficiency occurs as a result of an inadequate amount of serum cortisol, which occurs as a result of undersecretion of ACTH by the anterior pituitary. ADH and FSH are both secreted by the posterior pituitary, not the anterior pituitary. TSH is secreted by the anterior pituitary, but it acts on the thyroid gland to secrete thyroid hormones. p. 1178

The nurse is caring for a patient with central diabetes insipidus (DI). What does the nurse recognize is a priority focus of care? Pacing activities and minimizing fatigue Preventing treatment-related hypoglycemia Avoiding dehydration and fluid volume deficit Decreasing renal responsiveness to antidiuretic hormone (ADH)

Avoiding dehydration and fluid volume deficit Rationale The patient with diabetes insipidus may experience massive diuresis of up to 20 L per day. Severe dehydration and hypovolemic shock may occur if the patient does not consume or receive sufficient fluids to address the urinary losses. The patient may experience nocturia-related weakness and fatigue, but this is of lower priority than preventing dehydration and fluid volume deficit. Diabetes insipidus is a condition of too little ADH. Glucose-lowering agents are not used to treat diabetes insipidus. Whereas diabetes insipidus and diabetes mellitus both result in polydipsia and polyphagia, the mechanism driving these symptoms is entirely different between the two disorders, and treatment is not the same. Diabetes insipidus is a disorder of too little antidiuretic hormone. Decreasing renal responsiveness to a hormone that is already insufficiently present would be deleterious. pp. 1162-1163

A patient who underwent surgery for acromegaly complains of postoperative headache and running nose. What action should the nurse take to resolve the problems within 72 hours? Select all that apply. Prepare the patient for spinal tap Monitor the vital parameters regularly Check for glucose levels in nasal discharge Encourage bed rest with the head elevated Check for growth hormone (GH) levels in the blood

Check for glucose levels in nasal discharge Encourage bed rest with the head elevated Rationale Postoperative headache and running nose may be caused by cerebrospinal fluid (CSF) leak from an open connection to the brain. CSF leak is confirmed when higher glucose levels (30 mg/dL) are observed in nasal discharge. A CSF leak resolves within 72 hours when treated with head elevation and bed rest. Spinal taps should be done to reduce pressure to below normal levels if the leaks are persistent even after 72 hours. Vital parameters should be monitored regularly to assess the patient's progress; however, it does not directly help resolve the CSF leak. GH levels in the blood are not related to CSF leakage. pp. 1158-1159

The nurse is assessing a female patient that has developed fat pads on the back of the neck, an increased abdominal girth, facial hair growth, and a "moon" face. What disorder does this assessment data indicate? Acromegaly Conn's disease Graves' disease Cushing syndrome

Cushing syndrome Rationale Cushing syndrome is caused by excessive secretion of adrenocorticotropic hormone. Acromegaly occurs due to excess secretion of growth hormone. Conn's disease occurs due to increased secretion of aldosterone hormone. Graves' disease occurs due to the excess secretion of thyroid hormone. p. 1174

Which endocrine problem is more common in men than in women? Graves' disease Thyroid nodules Hyperaldosteronism Ectopic adrenocorticotropic hormone production

Ectopic adrenocorticotropic hormone production Rationale Ectopic adrenocorticotropic hormone production is more common in men. Graves' disease affects four to eight times more women than men. Thyroid nodules affect up to four times more women than men. Hyperaldosteronism affects two times as many women as men. p. 1163

The endocrine system involves a number of organs and glands that secrete hormones. The posterior pituitary gland is responsible for secreting antidiuretic hormone (ADH). When the posterior pituitary gland overproduces ADH, a condition called the syndrome of inappropriate antidiuretic hormone (SIADH) develops. Which characteristics best describe SIADH? Polyuria, serum hypoosmolality, dilutional hyponatremia, and concentrated urine with normal intravascular volume Polyuria, serum hyperosmolality, dilutional hyponatremia, and concentrated urine with normal intravascular volume Fluid retention, serum hyperosmolality, dilutional hypernatremia, and concentrated urine with normal intravascular volume Fluid retention, serum hypoosmolality, dilutional hyponatremia, and concentrated urine with normal intravascular volume

Fluid retention, serum hypoosmolality, dilutional hyponatremia, and concentrated urine with normal intravascular volume Rationale The posterior pituitary gland secretes an excess of ADH, which ultimately increases fluid retention and causes decreased serum osmolality. The glomerular filtration rate increases, and sodium levels decline, causing dilutional hyponatremia. SIADH is characterized by fluid retention, serum hypoosmolality, dilutional hyponatremia, and concentrated urine with normal intravascular volume. A patient with SIADH experiences low urine output, not polyuria, and serum hypoosmolality due to fluid retention, not serum hyperosmolality. A patient with SIADH does not experience dilutional hypernatremia, because the sodium levels are low due to the expanding fluid volume. p. 1160

The nurse is reviewing a patient's laboratory reports that show increased levels of plasma insulin-like growth factor 1. What does this finding indicate about growth hormone levels? Growth hormone levels are elevated. Growth hormone levels are decreased. Growth hormone production has stopped. Growth hormone levels are unchanged.

Growth hormone levels are elevated. Rationale In acromegaly, the level of insulin-like growth factor 1 is tested to evaluate growth hormone levels. Increases in insulin-like growth hormone indicate increased levels of growth hormone. Insulin-like growth factor 1 is proportional to the growth hormone; therefore, increased levels do not indicate that growth hormone production has stopped or is unchanged. pp. 1156-1157

A patient is suspected of having acromegaly. Which symptom should the nurse assess for in this patient? Fatigue Loss of smell Increase in shoe size Decreased peripheral vision

Increase in shoe size Rationale Acromegaly is a rare condition characterized by overproduction of growth hormone. Excess secretion of growth hormone results in overgrowth of soft tissues and bones in the hands, feet, and face. Evaluation of physical changes such as increase in shoe size is important, because they are gradual and slow; hence the patient may not identify them. Identification of these symptoms helps in treatment, with which bone growth can be stopped and tissue hypertrophy can be reversed. Fatigue is a symptom associated with excess production of thyroid-stimulating hormone. Loss of smell and decreased peripheral vision are associated with hypopituitarism. pp. 1156-1157

A patient has been diagnosed with acromegaly and is suspected of having developed diabetes mellitus as a result of the increased growth hormone (GH). What clinical manifestations does the nurse document that correlate with the development of diabetes mellitus? Select all that apply. Increased thirst Dysrhythmias Constipation Increased urination Tingling sensation of the hands

Increased thirst Increased urination Rationale Since GH antagonizes the action of insulin leading to hyperglycemia, glucose intolerance and manifestations of diabetes mellitus might occur including polydipsia (increased thirst) and polyuria (increased urine output). Dysrhythmias, constipation, and tingling sensation of the hands are not clinical manifestations of diabetes mellitus. p. 1157

The nurse is educating family members about postsurgical complications for a patient who is undergoing hypophysectomy. Which complication should the nurse include in the teaching? Seizures Infertility Cerebral edema Transient diabetes mellitus

Infertility Rationale Hypophysectomy may result in permanent loss or deficiencies of follicle-stimulating hormone, luteinizing hormone, and thyroid hormones resulting in decreased fertility or infertility. Seizures and cerebral edema are possible complications for patients undergoing stereotactic radio surgery, not hypophysectomy. Transient diabetes insipidus, not diabetes mellitus, may occur following hypophysectomy. pp. 1158-1159

The nurse is caring for a patient who underwent transsphenoidal hypophysectomy to treat acromegaly. Which is the best nursing action to prevent leakage of cerebrospinal fluid? Having the patient lie down in the supine position Ensuring oral hygiene in the patient by regular brushing Informing the primary health care provider about nasal drainage Instructing the patient to avoid vigorous coughing, sneezing, and straining at stool

Instructing the patient to avoid vigorous coughing, sneezing, and straining at stool Rationale Vigorous coughing, sneezing, and straining at stool may result in cerebrospinal fluid (CSF) leakage after transsphenoidal hypophysectomy. The patient should lie in an elevated position, with the head of the bed at a 30-degree angle, as opposed to lying in the supine position. Tooth brushing should be avoided for a minimum of 10 days to protect the suture line. Reporting clear nasal discharge to the surgeon is important, because elevated glucose levels in the discharge indicate CSF leakage; however, this intervention does not prevent the leakage of CSF. pp. 1158-1159

The nurse is obtaining a history and physical on a patient with acromegaly who reports visual changes. What should the nurse assess in this patient? The function of cranial nerve II The function of cranial nerve III The function of cranial nerve IV The function of cranial nerve VI

The function of cranial nerve II Rationale In acromegaly, pituitary adenoma creates pressure on the optic nerve (cranial nerve II), causing visual changes. Cranial nerves III, IV, VI and are responsible for eye movements and eye muscle movements; pressure on these nerves does not cause visual changes in patients with acromegaly. p. 1157

A patient who had surgery for the treatment of acromegaly asked about the possibility of becoming pregnant. When responding to the patient, from what knowledge should the nurse base the rationale? There will be a decrease in thyroid hormone. There will be a permanent loss of hormones. There is a loss of antidiuretic hormone (ADH). There will be increased levels of corticosteroids.

There will be a permanent loss of hormones. Rationale Surgery for acromegaly may result in permanent loss or deficiencies in follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which leads to decreased fertility. Hypothyroidism occurs when a patient is deficient in thyroid-stimulating hormone (TSH) and is generally observed in radiation therapy. Loss of antidiuretic hormone is seen in patients with transient diabetes insipidus. Cushing syndrome results from increased levels of corticosteroids. pp. 1156-1157

The nurse informs a patient that has had a hypophysectomy for removal of a pituitary tumor to avoid vigorous coughing and sneezing. What explanation does the nurse give the patient for these instructions? To avoid seizures To avoid headache To prevent cerebrospinal fluid leakage To monitor pupillary and speech responses

To prevent cerebrospinal fluid leakage Rationale Vigorous coughing and sneezing causes leakage of the cerebrospinal fluid, which increases the risk of developing meningitis. Seizures are changes in the brain's electrical activity; they are not triggered by vigorous coughing and sneezing. Postoperative headache can be avoided by raising the head of the patient's bed to a 30-degree angle. Pupillary and speech responses are monitored to detect neurologic complications. pp. 1158-1159

While assessing a patient with suspected Cushing's syndrome, of what most prominent clinical manifestation is the nurse aware? Dehydration and hypotension "Bulking up" of skeletal muscle Hypoglycemia with intense hunger Weight gain, including truncal obesity

Weight gain, including truncal obesity Rationale The most prominent clinical manifestation in Cushing's syndrome is weight gain leading to truncal obesity, with a characteristic rounded "moon face" and fat deposits in the neck and upper back, also known as a "buffalo hump." Cushing's syndrome's results from an overproduction of adrenocorticosteroids or large doses of steroid medication. Dehydration and hypotension, bulking of skeletal muscle, and hypoglycemia with intense hunger are not directly associated with Cushing's syndrome. p. 1175