Meg-Surg Week 9 Ch. 62, Care of Patients with Pituitary and Adrenal Gland Problems

The nurse is reviewing the laboratory reports of a patient with hypercortisolism. Which finding should the nurse report immediately to the primary health care provider?

A serum sodium level increase from 138 mEq/L to 154 mEq/L

What precautions must a patient, who has had a hypophysectomy, take to prevent intracranial pressure (ICP)?

Consume high-fiber foods and drink plenty of fluids.

After receiving a change-of-shift report about four patients, which patient does the nurse attend to first?

Patient with acute adrenal insufficiency who had a blood glucose of 36 mg/dL

Which teaching will the nurse provide to a patient who has undergone nasal hypophysectomy for hyperpituitarism?

"Report any postnasal drip after surgery."

Which imaging assessment can identify abnormalities of the sella turcica in a patient with pituitary problems?

Skull x-ray

How does the drug desmopressin (DDAVP) decrease urine output in a patient with diabetes insipidus (DI)?

Works as an antidiuretic hormone (ADH) in the kidneys

Which manifestations would the nurse anticipate finding in a female patient diagnosed with deficient gonadotropins? Select all that apply.

Anovulation Breast atrophy Decreased libido

A patient with iatrogenic Cushing's syndrome is a resident in a long-term care facility. Which nursing action included in the patient's care would be best to delegate to the unlicensed assistive personnel (UAP)?

Assist with personal hygiene and skin care

What foods should be avoided by a patient diagnosed with pheochromocytoma? Select all that apply.

Bacon Cheddar cheese

A patient is admitted with a diagnosis of diabetes insipidus (DI). What finding is priority to report to the health care provider?

Bilateral muscle weakness

Which should the nurse monitor when caring for the patient receiving fludrocortisone (Florinef)?

Blood pressure

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

The nurse is planning care for a patient diagnosed with acute adrenal insufficiency. Which hormone deficits will guide the nurse's interventions? Select all that apply.

Cortisol Aldosterone

A patient with syndrome of inappropriate antidiuretic hormone (SIADH) is receiving IV hypertonic saline. What finding indicates fluid overload in the patient?

Crackles in the lungs

A patient has been admitted to the medical intensive care unit with a diagnosis of diabetes insipidus (DI) secondary to lithium overdose. Which medication is used to treat the DI?

Desmopressin (DDAVP)

A patient reports increased urinary frequency and increased thirst. The nurse observes poor skin turgidity and dry mucous membranes. Laboratory reports showed a decrease in antidiuretic hormone, and over a 24-hour period, the patient urinated 5.5 L. Which drug does the nurse anticipate will be prescribed?

Desmopressin acetate

A patient has been diagnosed with hyperaldosteronism. What laboratory finding is used to confirm this diagnosis?

Elevated blood pH

What laboratory findings are consistent with a diagnosis of Cushing's disease? Select all that apply.

Elevated serum cortisol Increased serum sodium Decreased serum potassium

The nurse is caring for a patient with osteoporosis due to growth hormone (GH) deficiency. What is the cause of growth hormone (GH) deficiency?

Failure of tissues to respond to somatomedins

Which menu selection indicates the teaching regarding nutrition was effective in a patient diagnosed with diabetes insipidus (DI)?

Frozen french fries

What does the nurse identify as a sign of infection for a patient who underwent an adrenalectomy?

Increase of 1 F in body tem

A patient is prescribed an adrenocorticotropic hormone (ACTH) stimulation test for adrenal insufficiency. What cortisol response should the nurse expect in secondary insufficiency?

Increased

The nurse has determined that a patient diagnosed with Cushing's disease is at risk for injury. What intervention is necessary?

Instruct patient to use an electric razor.

What manifestations should the nurse expect to find in a patient with Cushing's syndrome? Select all that apply.

Moon face Truncal obesity Loss of bone density

Which musculoskeletal problem would a nurse expect to find in a patient with Cushing syndrome?

Osteroporosis

The assessment and clinical findings for a patient show decreased production of all hormones from the anterior pituitary. What is this condition called?

Panhypopituitarism

What is the most common cause of Sheehan's syndrome?

Postpartum hemorrhage

Which parameters are elevated in a patient with adrenal insufficiency?

Potasssiu

What determines the neuromuscular status of a patient who underwent endoscopic nasal hypophysectomy for hyperpituitarism?

Pupillary response to light

What are the most common features of acromegaly?

T

Which are key assessment findings in a patient suspected of having diabetes insipidus? Select all that apply.

Tachycardia Increased thrist Dry mucous membranes

A patient with a diagnosis of Cushing's disease has been hospitalized. What care is priority for this patient?

Treating fluid overload

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.

Which clinical findings would a nurse expect to find in a patient with Cushing syndrome? Select all that apply.

Acne Hirsutism Buffalo hump

A patient with syndrome of inappropriate antidiuretic hormone (SIADH) reports a 3.3 lb (1.5 kg) increase in weight per day to the nurse. What is the amount of fluid retention in this patient?

1500 mL

The nurse is assigned the following four patients. Which patient should the nurse see first?

A patient diagnosed with pheochromocytoma with headache rated 10/10

The nurse is caring for the following four patients. Which patient should the nurse see first?

A patient diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) with a serum Na of 114 mEq/L

The nurse is caring for the following four patients. Which patient should the nurse see first?

A patient diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) with an intake of 1,000 mL and an output of 700

Which treatment modality would a nurse expect the health care provider to prescribe for a patient with hyperaldosteronism?

Adrenalectomy

A patient with adrenal insufficiency is placed on a low-potassium diet. What dietary selections by the patient indicate that nutritional teaching has been effective? Select all that apply.

Apples Cabbage

Which selection indicates the teaching regarding nutrition was effective in a patient diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH)?

Canned green beans

The nurse is caring for a patient with pituitary infarction following postpartum hemorrhage. What condition does the patient have?

Sheehan's syndrome

An adult patient has growth hormone (GH) deficiency. What risk does the nurse anticipate for this patient?

Decreased bone strength

What laboratory finding is most important to monitor in a patient diagnosed with diabetes insipidus (DI)?

Serum sodium

Which laboratory value does the nurse recognize as consistent with a patient diagnosis of Addison disease?

Sodiu

The nurse is assessing the elimination patterns of a patient. Which finding needs further evaluation to rule out the possibility of diabetes insipidus (DI)?

The patient reports excessive thirst and increased frequency of urination.

A patient with Cushing's disease begins to laugh loudly and inappropriately, causing the family in the room to be uncomfortable. What is the nurse's best response?

"The disease can sometimes affect emotional responses."

A nurse is caring for a patient admitted for acute adrenal insufficiency and places the patient on a telemetry monitor. What is the rationale for this nursing intervention?

Hyperkalemia

What clinical finding does the nurse expect in a patient with reduced aldosterone secretion?

Hyperkalemia

What finding does the nurse expect to see in a patient with hyperaldosteronism?

Hypernatremia

The nurse is monitoring a patient who is immobile and immunosuppressed due to hypercortisolism. Which nursing action reduces the risk for infection?

Recording the body temperature every four hours

What skin change does the nurse expect to find in a patient with hypercortisolism?

Reddish-purple striae

What is a common side effect of spironolactone therapy for hyperaldosteronism?

Urticaria

A patient presents to the emergency department with hypertension and fatigue. The patient reports weight loss and vomiting over the past several days. The nurse suspects the patient may be experiencing an Addisonian crisis. What question by the nurse is priority?

"Have you recently been on steroids or pain medication?"

A patient who has been on long-term corticosteroid treatment calls the health care provider's office to report fatigue, nausea, and salt cravings. What question by the nurse is priority?

"Have you stopped taking your corticosteroid?"

A patient diagnosed with acromegaly is beginning bromocriptine mesylate therapy. What statement by the patient indicates a need for further teaching?

"I am excited for my lips to be normal."

The nurse is providing discharge instructions to a patient on spironolactone therapy. Which comment by the patient indicates a need for further teaching?

"I should eat a banana every day."

The nurse is educating a patient with hypercortisolism about prevention of different types of injuries. Which patient statement indicates effective understanding?

"I should eat a diet rich in calcium."

A patient diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) has received education about the diagnoses. What statement by the patient indicates an understanding of the teaching provided?

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

A patient diagnosed with glucocorticoid deficiency is prescribed hydrocortisone. What teaching specific to hydrocortisone will the nurse provide?

"If you experience rapid weight gain, report this immediately."

Which manifestations would the nurse anticipate finding in a patient diagnosed with Cushing's disease? Select all that apply.

Acne Moon face Hyperglycemia Elevated cortisol level

Hyperfunction of which anterior pituitary hormone can cause sleep apnea?

Growth hormone (GH)

What are primary causes of adrenal insufficiency? Select all that apply.

Tuberculosis Hemorrhage Autoimmune disease

Which laboratory results indicate that fluid restrictions have been effective in treating syndrome of inappropriate antidiuretic hormone (SIADH)?

Increased serum sodium

What finding does the nurse expect to assess in a patient with deficient growth hormone (GH)?

Pathologic fractures

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. Which action by the nurse is correct?

Wearing a facemask when caring for the patient.

Which is a sign of syndrome of inappropriate antidiuretic hormone (SIADH)?

Weight gain

What changes does the nurse note in a patient with hypercortisolism upon physical assessment?

Presence of fat pads on the shoulders

The nurse is precepting a nursing student who is caring for a patient who is on 10 mg prednisone orally for adrenal insufficiency. Which patient instruction provided by the nursing student will be helpful in adjusting the dosage?

"Report if you find any abrupt decrease in your body weight."

Which action by the patient with hypercortisolism can prevent gastrointestinal (GI) bleeding?

Avoiding caffeine and alcohol

Upon review of a patient's laboratory report, the nurse suspects Cushing syndrome. In addition to increased cortisol levels, which other finding may be present?

Serum sodium level of 155mmol/L

The laboratory reports of a patient indicated the serum cortisol levels as 4 mcg/dL. Which patient condition should the nurse anticipate?

Addison Disease

A patient taking exogenous glucocorticoids is to be discharged from the hospital. What should the nurse teach the patient and the caregiver? Select all that apply.

Adhere to the drug regimen. Use proper hygiene and avoid crowds Make a point to receive an influenza vaccination.

A patient with syndrome of inappropriate antidiuretic hormone (SIADH) is admitted with a serum sodium level of 105 mEq/L. Which request by the health care provider does the nurse address first?

Administer infusion of 150 mL of 3% NaCl over 3 hours

A patient is admitted with a diagnosis of syndrome of inappropriate antidiuretic hormone (SIADH). What finding is priority to report to the health care provider?

Serum sodium of 115 mEq/L

The nurse reviews the plan of care for a patient with hyperpituitarism. The nurse should question which prescription listed on the plan?

Vasopressin

A nurse is helping a patient with a diagnosis of a pheochromocytoma plan an appropriate meal for dinner. Which food choice should the nurse instruct the patient to avoid?

Cheddar cheese

The nurse is caring for a patient who is prescribed desmopressin (DDAVP) nasal spray for diabetes insipidus. What is a potential side effect of this intranasal drug?

Chest tightness

A patient diagnosed with adrenocorticotropic hormone imbalance reports weight gain. The nurse observes moon face and truncal obesity in the patient. Which other assessment finding does the nurse anticipate?

Hypertension

Which manifestations would the nurse anticipate finding in a patient diagnosed with Addison's disease? Select all that apply.

Vitiligo Hyperkalemia Hyperpigmentation

The nurse is teaching a patient about how to monitor therapy effectiveness for syndrome of inappropriate antidiuretic hormone (SIADH). What does the nurse tell the patient to look for?

Daily weight gain of more than 2 lbs

Which finding does the nurse identify as contributing to the potential for infection in the patient with hypercortisolism?

Decreased lymphocyte count

What findings indicate the possibility of syndrome of inappropriate antidiuretic hormone (SIADH)? Select all that apply.

Full and bounding pulse Elevated urine sodium levels Decreased serum sodium level

A patient has undergone a hypophysectomy. What postoperative intervention should the nurse perform for this patient?

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

A patient is taking fludrocortisone for adrenal hypofunction. The patient should report which symptom while taking this drug?

Headache

What findings are consistent with a diagnosis of hyperaldosteronism? Select all that apply.

Headache Dehydration Muscle weakness

Which clinical manifestations would a nurse expect to find in a patient with hyperaldosteronism? Select all that apply.

Headache Muscle weakness Fatigue

What finding in a patient that is 4 hours post-hypophysectomy should be reported to the health care provider immediately?

Increased swallowing

What manifestation does the nurse expect to find in a patient diagnosed with diabetes insipidus (DI)?

Increased urinary frequency

The nurse is caring for a patient diagnosed with nephrogenic diabetic insipidus. What is the cause of this condition?

Lack of response of the kidney tubules to the actions of antidiuretic hormone

Which symptom indicates decreased adrenocorticotropic hormone (ACTH) in the body?

Malaise

A patient with syndrome of inappropriate antidiuretic hormone (SIADH) is receiving gastrointestinal tube feedings. What must the nurse keep in mind when caring for this patient?

Mix drugs to be given with saline.

What nursing interventions are appropriate for a patient diagnosed with adrenal hypofunction? Select all that apply.

Monitor BUN levels Monitor hematocrit levels Administer steroid therapy

Which are considered secondary causes of adrenal insufficiency? Select all that apply.

Pituitary tumors Hypophysectomy Abruptly stopping corticosteroids

What is the rationale for administration of ranitidine to a patient who is experiencing acute adrenal insufficiency?

Prevention of gastric ulcers

Which condition contraindicates androgen therapy?

Prostate cancer

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?

Providing isotonic fluids

A patient with a possible adrenal gland tumor is admitted for testing and treatment. Which action is most appropriate for the charge nurse to delegate to a nursing assistant?

Remind the patient to avoid drinking coffee and changing position suddenly.

A patient diagnosed with Cushing's disease has received teaching about nutrition. What food selection by the patient indicates effective teaching?

S

Which condition results from excessive secretion of vasopressin even when plasma osmolarity is low or normal?

Schwartz-Bartter syndrome

A patient is admitted to the hospital with acute adrenal insufficiency. Which laboratory tests would the nurse expect the health care provider to prescribe? Select all that apply.

Sodium Cortisol Potassium

Which medication is contraindicated for a patient diagnosed with acute adrenal insufficiency and hyperkalemia?

Spironolactone

What teaching should be provided for a patient diagnosed with Addison's disease who is going to be taking a cortisol replacement? Select all that apply.

Take it twice a day Monitor weight daily Take the medication with food

What nursing intervention is a priority for a male patient diagnosed with gonadotropin deficiency who is experiencing body image disturbance?

Teach about testosterone therapy

Weight gain, intolerance to cold, lethargy, and menstrual abnormalities are symptoms of a deficiency in which pituitary hormone?

Thyroid-stimulating hormone (TSH)

A patient diagnosed with hyperpituitarism resulting from a prolactin-secreting tumor has been prescribed bromocriptine mesylate. As a dopamine agonist, what effect does this drug have by stimulating dopamine receptors in the brain?

Inhibits the release of some pituitary hormones

A patient has undergone a transsphenoidal hypophysectomy. Which intervention should the nurse implement to avoid increasing intracranial pressure (ICP) in the patient?

Instruct the patient not to strain during a bowel movement.

What medication is used for the treatment of Cushing's disease?

Metyrapone

A patient has been prescribed divided doses of prednisone. How should the patient take this drug?

Two-thirds in the morning and one-third in the late afternoon

A patient is prescribed the nasal spray desmopressin for diabetes insipidus. What does the nurse teach the patient about the use of this drug?

Ulceration of the mucous membranes may occur with intranasal use.

A patient presents to the emergency department with a history of adrenal insufficiency. The following laboratory values are obtained: Na 130 mEq/L, K 5.6 mEq/L, and glucose 72 mg/dL. Which is the first intervention that the nurse should anticipate?

Administer insulin and dextrose in normal saline to shift potassium into cells