Med-Surg Neuro/Endo
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? 1 The function of cranial nerve II 2 The function of cranial nerve III 3 The function of cranial nerve IV 4 The function of cranial nerve VI
The function of cranial nerve II 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.
Which condition can result if hypersecretion of growth hormone (GH) occurs after epiphyseal plate closure? 1 Dwarfism 2 Acromegaly 3 Gigantism 4 Cretinism
Acromegaly 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.
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? 1 Acromegaly 2 Hepatomegaly 3 Splenomegaly 4 Dactylomegaly
Acromegaly 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.
The nurse is caring for a patient with central diabetes insipidus (DI). What does the nurse recognize is a priority focus of care? 1 Pacing activities and minimizing fatigue 2 Preventing treatment-related hypoglycemia 3 Avoiding dehydration and fluid volume deficit 4 Decreasing renal responsiveness to antidiuretic hormone (ADH)
Avoiding dehydration and fluid volume deficit 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.
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. 1 Prepare the patient for spinal tap 2 Monitor the vital parameters regularly 3 Check for glucose levels in nasal discharge 4 Encourage bed rest with the head elevated 5 Check for growth hormone (GH) levels in the blood
Check for glucose levels in nasal discharge Encourage bed rest with the head elevated 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.
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? 1 Acromegaly 2 Conn's disease 3 Graves' disease 4 Cushing syndrome
Cushing syndrome 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.
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? 1 Polyuria, serum hypoosmolality, dilutional hyponatremia, and concentrated urine with normal intravascular volume 2 Polyuria, serum hyperosmolality, dilutional hyponatremia, and concentrated urine with normal intravascular volume 3 Fluid retention, serum hyperosmolality, dilutional hypernatremia, and concentrated urine with normal intravascular volume 4 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. 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.
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? 1 Growth hormone levels are elevated. 2 Growth hormone levels are decreased. 3 Growth hormone production has stopped. 4 Growth hormone levels are unchanged.
Growth hormone levels are elevated 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.
A patient is suspected of having acromegaly. Which symptom should the nurse assess for in this patient? 1 Fatigue 2 Loss of smell 3 Increase in shoe size 4 Decreased peripheral vision
Increase in shoe size 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.
Which is a sign of syndrome inappropriate antidiuretic hormone (SIADH)? 1 Decreased ADH 2 Excessive urine output 3 Increased serum osmolality 4 Increased intravascular volume
Increased intravascular volume 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.
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. 1 Increased thirst 2 Dysrhythmias 3 Constipation 4 Increased urination 5 Tingling sensation of the hands
Increased thirst Increased urination 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.
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? 1 Seizures 2 Infertility 3 Cerebral edema 4 Transient diabetes mellitus
Infertility 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.
A patient has a dysfunction of the pituitary gland. Which hormone secretion does the nurse recognize may be altered in this patient? 1 Prolactin 2 Thyroxine 3 Erythropoietin 4 Parathormone
Prolactin 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.
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? 1 There will be a decrease in thyroid hormone. 2 There will be a permanent loss of hormones. 3 There is a loss of antidiuretic hormone (ADH). 4 There will be increased levels of corticosteroids
There will be a permanent loss of hormones.
A patient diagnosed with acromegaly has developed speech difficulties and asks what is causing the problem. Which response by the nurse is accurate? 1 "You have developed the condition from numbness of the vocal cords." 2 "You have developed the condition due to overgrowth of the tongue." 3 "You have developed the condition from an overgrowth of soft tissue in the neck." 4 "You have developed the condition related to upper airway narrowing."
You have developed the condition from an overgrowth of the tongue 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.