Chapter 49: Endocrine Problems: disorders of the pituitary gland

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." 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.

Which clinical manifestations would the nurse document that correlate with the development of diabetes mellitus in a patient with a history of acromegaly? 1 Increased thirst 2 Dysrhythmias 3 Constipation 4 Increased urination 5 Tingling sensation of the hands

1. increased thrist 4. increased urination since growth hormone (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)

Which clinical manifestations of severe serum sodium level decline would the nurse assess in a patient who has cerebral edema associated with syndrome of inappropriate antidiuretic hormone (SIADH)? select all that apply 1 Coma 2 Lethargy 3 Confusion 4 Headache 5 Tachycardia 6 Hypovolemic shock

1. coma 2. lethargy 3. confusion 4. headache

Which pathophysiologic events occur with syndrome of inappropriate antidiuretic hormone secretion (SIADH)? 1. Decreased serum osmolality 2. Occurrence of hypernatremia 3. Increased water reabsorption 4. Decreased water reabsorption 5. Occurrence of dilutional hyponatremia

1. decreased serum osmolality 3. increased water reabsorption 5. occurrence of dilutional hyponatremia 1 & 3 occur in cases of SIADH due to increased water reabsorption in the renal tubules and impairment in water excretion caused by the inability to suppress the secretions of antidiuretic hormone (ADH).

A patient is suspected of having acromegaly. When gathering a health history, what questions would be important for the nurse to ask? Select all that apply. 1.Do you snore? 2.Do you crave salty foods? 3.Have you experienced a recent weight loss? 4.Have you noticed an increase in your shoe size? 5.Have you experienced unusual thirst or excessive urination? 6.Have you experienced numbness or tingling in your fingers or hands?

1. do you snore? 4. have you noticed an increase in shoe size? 5. have you experienced unusual thirst and excessive urination? 6. have you experienced numbness or tingling in your fingers or hands?

Which interventions does the nurse use when caring for a patient recovering from a transsphenoidal hypophysectomy? 1. Elevate the head of the bed 30 degrees 2. Monitor for and report clear nasal drainage 3. Encourage hourly coughing and deep breathing 4. Perform routine pin cares according to agency policy 5. Monitor for and report increased urinary output

1. elevate the head of the bed 30 degrees (Decreases pressure on the sell turcica in the brain/decreasing risk of headache) 2. monitor for and report clear nasal drainage (clear drainage may represent a clerebral spinal fluid leak) 5. monitor for and report increased urinary output

Which effect does an increased level of plasma insulin-like growth factor-1 have on 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.

1. 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

which actions would the nurse take when caring for a patient status post a transsphenoidal hypophysectomy? 1. Monitoring the pupillary response 2. Elevating the head of the patient's bed 3. Observing the patient for any signs of bleeding 4 Advising the patient to brush his or her teeth twice daily 5. Monitoring extremity strength to detect neurologic complications

1. monitoring the pupillary response (helps rule out any visual changes) 2. elevating the head of the patients bed (alleviates pressure on the sella turcica and decreases headaches) 3. observing the patient for any signs of bleeding (utmost importance, hemorrhage) 5. monitoring extremity strength to detect neurologic complications (rule out postoperative neurologic complications (ataxia))

which medication would the nurse plan on teaching a patient about who is admitted to the hospital for treatment of euvolemia-hyponatremia? 1.Tolvaptan 2.Octreotide 3.Carbamazepine 4.Demeclocycline

1. tolvaptan a vasopressin receptor antagonist used to treat euvolemia-hyponatremia.

Which side effects would the nurse assess in a patient who is on desmopressin acetate (DDAVP)? 1. Weight 2.Skin turgor 3.Mental status 4.Sodium levels 5.Mucus membranes

1. weight gain 3. altered mental status 4. fluctuating sodium levels DDAVP is a synthetic analog of the natural pituitary hormone, arginine vasopressin, an antidiuretic hormone (ADH) that affects renal water conservation.

The patient with small cell lung cancer experiences a sudden 5-pound weight gain without edema and a decreased urinary output. Serum sodium is 128 mEq/L. Which treatment would the nurse plan to teach the patient about? Low-sodium diet Head of bed elevated 30 degrees 1000 mL per day fluid restriction Administration of desmopressin acetate nasal spray

1000 mL per day fluid restriction the patient is exhibiting signs of syndrome of inapprorpiate antidiuretic hormone secretion (SIADH). Small cell lung cancer is one of the most common causes of SIADH. In patients with SIADH, there is an excess of antidiuretic hormone (ADH); this causes excess water reabsorption by the kidneys, resulting in increased vascular volume. the decreased excretion of water by the kidneys/resulting increased intravascular volume leads to wt gain without edema, decreased urinary output with an increase in urine specific gravity, decreased plasma osmolarity and dilutional hyponatremia. if the patients serum sodium is above 125 mEq/L, a fluid restriction may be all that is needed

Which condition can result if hypersecretion of growth hormone (GH) occurs after epiphyseal plate closure? 1 Dwarfism 2 Acromegaly 3 Gigantism 4 Cretinism

2. Acromegaly excess GH after closure of the epiphyseal plates results in acromegaly.

Which signs and symptoms would the nurse expect to assess in a patient who is diagnosed with acromegaly? 1. Fragile skin 2. Increased shoe size 3. Elevated blood glucose 4. Complaint of headaches 5. Increased height and weight

2. increased shoe size 3. elevated blood glucose 4. complaint of headaches acromegaly is a disorder in which there is increased secretion of growth hormones. Enlargement of the feet and hands occurs as a result of overgrowth of bones and tissue. GH antagonizes the action of insulin, and therefore blood glucose is elevated. Headaches also are common if the increased secretion of GH is caused by a pituitary adenoma, which increases pressues on the optic nerve. The skin becomes thick and leathery.

A patient with diabetes insipidus has an IV of dextrose 5% in water (D5W) infusing. Which parameter would the nurse monitor for the management of osmotic diuresis? 1 Blood pressure 2 Serum glucose levels 3 Fluid and electrolytes 4 Specific gravity of the urine

2. serum glucose levels if IV glucose solutions are administered, then the serum glucoses levels of the patient should be monitorored because hyperglycemia and glcosuria can occur, which can lead to osmotic diuresis and increase in fluid volume deficit.

Which assessment finding would be increased in a patient with diabetes insipidus? 1. Temperature 2. Urine output 3. Serum glucose 4. BP

2. urine output Diabetes insipidus is a disorder of the posterior pituitary gland that results in a deficiency of antidiuretic hormone, which in turn causes the kidneys to be unable to reabsorb water. This deficiency leads to increased urine output as a primary clinical manifestation of the disorder. Without treatment, an affeced individual can become severely dehydrated and experience hypovolemic shock.

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

3. Check for glucose levels in nasal discharge 4. 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. Test-Taking Tip: Make certain that the answer you select is reasonable and obtainable under ordinary circumstances and that the action can be carried out in the given situation. Text Reference - pp. 1158-1159

Which hormone is secreting excessively if a patient with a pituitary tumor has developed excessive height and increased hat size and shoe size? 1 Cortisol 2 Thyroxine 3 Growth hormone (GH) 4 Triiodothyronine

3. Growth hormone (GH) excessive secretion of GH results in overgrowth of soft tissues and bones resulting in acromegaly.

Which focus of care is priority when caring for a patient with central diabetes insipidus (DI)? 1. Pacing activities and minimizing fatigue 2. Educating the patient regarding the hormone replacement desmopressin acetate (DDAVP) 3. Avoiding dehydration and fluid volume deficit 4. Teaching the patient about the disease process

3. avoiding dehydration and fluid volume deficit

A patient who is diagnosed with syndrome of inappropriate antidiuretic hormone secretion (SIADH) has a serum sodium level of 114 mEq/L and presents with seizures. Which intervention would be the most appropriate for this patient? 1 Fluid restriction of 1000 mL/day 2 Administration of vasopressin receptor antagonists 3 Administration of loop diuretics such as furosemide 4 Administration of IV hypertonic saline solution

4 administration of IV hypertonic saline solution in case of severe hyponatremia (sodium levels below 120 mEd/L), especially in the presence of neurologic manifestations such as seizures, SLOW administration of IV hypertonic (3% or 5%) solution is recommended to help to improve sodium levels.

Which disorder is characterized by excessive secretion of the hormone vasopressin? 1 Thyrotoxicosis 2 Diabetes insipidus 3 Hyperosmolar hyperglycemic nonketotic syndrome 4 Syndrome of inappropriate antidiuretic hormone secretion

4. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) another name for antidiuretic hormone (ADH) is vasopressin. Syndrome of inappropriate antidiuretic hormone secretion is characterized by excessive release of ADH from the posterior pituitary gland, resulting in the inability of the kidneys to dilute urine. The patient retains water and experiences increased extracellular fluid volume and hyponatremia. This disorder can cause cardiopulmonary overload and neurologic problems as a result of water intoxication..

Which disorder is characterized by fat pads on the back of the neck, an increased abdominal girth, a "buffalo hump." and a "moon" face? 1 Acromegaly 2 Conn's disease 3 Graves' disease 4 Cushing syndrome 4 Cushing syndrome

4. cushing syndrome caused by excessive secretion of adrenocorticotropic hormone. Weight gain is the most common feature. It results from the accumlation of adipose tissue in the trunk (centripetal obesity), face (moon face), and cervical areas (buffalo hump).

For which complication would a 35-year-woman who had a hypophysectomy and who developed a deficiency of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) be at risk? 1 Slowed speech 2 Impaired memory 3 Increase in weight 4 Decreased fertility rate

4. decreased fertility rate when a hypophysectomy is performed on the pituitary gland, it may result in damage to the pituitary gland, which affects the release of FSH and LH associated with reproduction and development of eggs in women. Therefore decreased fertility rate is a side effect of the surgery.

Which clinical manifestation would be most prominent in the assessment of a patient with suspected Cushing syndrome? 1 Hypotension with periods of dizziness 2 "Bulking up" of skeletal muscle 3 Hypoglycemia with intense hunger 4 Weight gain, including truncal obesity

4. weight gain, including truncal obesity. the most prominent clinical manifestation in Cushing 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 syndrome's results from an overproduction of adrenocorticosterioids or large doses of steroid medication.

Which symptom would the nurse assess in a patient with acromegaly? 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, fett, 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.

which statement by the patient who is status post a transsphenoidal hypophysectomy indicates a need for further education? "It is important that I brush my teeth every day." "I should refrain from vigorous coughing and sneezing" "I should notify the nurse if I develop a severe headache." "I may need to take a stool softener so that I do not strain with having a bowel movement."

It is important that I brush my teeth every day tooth burshing should be avoided for 10 days to protect the suture line.

The nurse is reviewing the results of four diagnostic tests for diabetes insipidus (DI). Which patient's results indicate nephrogenic DI? A - Urine Volume decreases to 50 ml/HR B - Urine Osmolality of 260 mOsm/kg C - Urine Osmolality of 600 mOsm/kg D - Responds to ADH analog by concentration volume

Patient B patients with nephrogenic diabetes insipidus will not be able to increase urine osmolality to greater than 300 mOsm/kg as shown with Patient B

which cause is associated with central diabetes insipidus? a. The presence of a brain tumor b. Renal damage from long-standing hypertension c. Drug therapy with lithium for bipolar disorder d. Structural lesion in the thirst center

a. the presence of a brain tumor which occurs due to the interference with antidiuretic hormone synthesis, transport, or release.

The nurse would implement which nursing action when caring for a patient with syndrome of inappropriate antidiuretic hormone (SIADH)? a. Initiate seizure precautions. b. Elevate the patient to a semi-Fowler's position. c. Increase fluid intake to at least 1500 mL/24 hours. d. Infuse prescribed hypotonic IV solution, such as 0.45% saline.

a. initiate seizure preacautions SIADH is a disorder in which there is abnormally high production of antidiuretic hormone (ADH). Dilutional hyponatremia is characteristic of SIADH and can cause seizures, nausea and vomiting, muscle cramps, and decreased neurologic function.

Which intervention is required for a patient having a water deprivation test for central diabetes insipidus in the hospital? Deprive the patient of water for six hours. Administer IV hypotonic saline or dextrose 5% in water. Administer desmopressin acetate (DDAVP) subcutaneously. Provide the patient with a diluted solution of sodium.

administer desmopressin acetate (DDAVP) subcutaneously the patient is given DDAVP subcutaneously or nasally. The patient is deprived of water for 8-12 hours before administration of DDAVP.

The nurse is caring for a patient diagnosed with nephrogenic diabetes insipidus not responding to primary treatment. Which intervention would be useful in increasing the renal response to antidiuretic hormone? 1. Administering indomethacin 2. Providing hormonal therapy 3. Administering thiazide diuretics 4. Limiting sodium intake to 3 g/day

administering indomethacin a nonsteroidal antinnflammatory drug that helps to increase the renal response to antidiuretic hormone.

which nursing intervention would be included in the plan of care for a patient who underwent a transsphenoidal hypophysectomy? a. Place the patient in a supine position at all times. b. Monitor pupillary response and speech patterns. c. Perform mouth care every 12 hours. d. Test any clear nasal drainage for potassium.

b. monitor pupillary response and speech patterns the nurse should monitor the pupillary response, speech patterns, and extremity strength to detect neurologic complications. The nurse should ensure the head of bed is elevated at all times to a 30-degree angle to avoid pressure on the sella turcica and to decrease headaches, a frequent postoperative problem. The nurse must perform mouth care for the patient every four hours to keep the surgical area clean and free of debris

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

b. monitoring fluid intake and output polyuria and polydipsia are the major clinical manifestations of diabetes insipidus. Therefore strict monitoring of fluid intake and output is a priority nursing intervention.

Which medication blocks the hepatic production of insulin-like growth factor-1 in a patient with acromegaly? a. Lanreotide b. Cabergoline c. Pegvisomant d. Bromocriptine

c. pegvisomant

which nursing intervention is a priority for a patient recovering from hypophysectomy? a. Maintaining patent IV access b. Monitoring the patient for increased temperature c. Offering the bedpan or urinal at least every two to three hours d. Assessing for signs of increased intracranial pressure (ICP)

d. assessing for signs of increased intracranial pressure (ICP) because removal of a pituitary tumor (a hypophysectomy) involves entering the cranium, increased ICP is always a risk, especially in the immediate postoperative period. With this knowledge, assessment for increased ICP is a priority for the nurse.

Which characteristic is seen in syndrome of inappropriate antidiuretic hormone secretion (SIADH)? a. Polyuria b. Serum hyperosmolality c. Dilutional hypernatremia d. Fluid retention

d. fluid retention the posterior pituitary gland secretes an excess of antidiuretic hormone (ADH), which ultimately increases fluid retention and causes decreased serum osmolality.

Which nursing action would prevent the leakage of cerebrospinal fluid (CSF) after a transsphenoidal hypophysectomy? a. Having the patient lie down in the supine position b. Ensuring oral hygiene in the patient by regular brushing c. Informing the health care provider about nasal drainage d. Instructing the patient to avoid vigorous coughing, sneezing, and straining at stool

d. instructing the patient to avoid vigorous coughing, sneezing, and straining at stool 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.

A nurse has just received a report from the emergency department on a patient admitted with a closed head injury after falling down a flight of stairs. The nurse is reviewing the patient's lab results: sodium level of 128 mEq/L, serum osmolality of 271 mOsm/kg, and urine specific gravity of 1.030. This data is indicative of which condition? a. Diabetes insipidus b. Cushing syndrome c. Primary hyperparathyroidism d. Syndrome of inappropriate antidiuretic hormone (SIADH)

d. syndromve of inappropriate antidiuretic hormone secretion (SIADH) the characteristics of SIADH include a decreased serum sodiuem level, serum osmolality less than 280 mOsm/kg, and an increased urine specific gravity above 1.025

About which treatment would the nurse plan to teach a patient who is newly diagnosed with central diabetes insipidus (DI)? Indomethacin Thiazide diuretics Desmopressin acetate (DDAVP) Fluid restrictions

desmopressin acetate (DDAVP) an analog of antidiuretic hormone, is the hormone replacement choice for central diabetes insipidus

A patient status post a hypophysectomy had drainage on the moustache dressing. which complication is this patient at risk for if the glucose level of the drainage is 50 mg/dL? Diabetes Meningitis Hypoglycemia Visual deterioration

meningitis A hypophysectomy is usually performed through the sphenoid sinuses, and the health care provider packs the sphenoid sinus with gauze. When a specimen is tested for a cerebrospinal fluid (CSF) leak, a glucose level greater than 30 mg/dL indicates a CSF leak from an open connection with the brain. If this happens, then the patient has an increased risk for meningitis.

Which discharge instructions regarding desmopressin acetate would be given to a patient with diabetes insipidus? "You may experience weight loss resulting from increased diuresis." "Report a sudden increase in thirst your health care provider." "You should know the symptoms of hypernatremia because it is a side effect of this drug." "Report any decrease in urinary elimination to your health care provider."

report a sudden increase in thirst to your health care provider. desmopressin acetate is used to treat diabetes insipidus by replacing the antidiuretic hormone that the patient is lacking. Patients should be taught to report any sudden increase in thrist because this may indicate that they need to increase the dosage of the drug

Which rationale would the nurse give a patient who had a hypophysectomy to avoid vigorous coughing and sneezing? 1. To avoid seizures 2. To avoid headache 3. To prevent cerebrospinal fluid leakage 4. To monitor pupillary and speech responses

to prevent cerebrospinal fluid leakage

A patient has a serum sodium level of 134 mEq/L, an osmolality less than 280 mOsm/kg, and the urine specific gravity is greater than 1.025. which medication is most beneficial for this patient? Tolvaptan Propranolol Methimazole Desmopressin

tolvaptan levels indicate dilutional hyponatremia. Tolvaptan is an antihyponatremic drug used to treat dilutional hyponatremia by increasing the sodium concentration in the body.