Medical-Surgical Nursing Chapter 50 Endocrine Problems
A patient is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) after a head injury. What condition does the nurse suspect that correlates with this disorder? 1 Decreased antidiuretic hormone (ADH) 2 Excessive urine output 3 Increased serum osmolality 4 Increased intravascular volume
4 The syndrome of inappropriate antidiuretic hormone (SIADH) is characterized by inappropriate secretion of ADH, which disrupts the fluid and electrolyte balance. Increased intravascular volume is one of the characteristic features of SIADH. Decreased ADH, excessive urine output, and increased serum osmolality are the features of diabetes insipidus. Text Reference - p. 1193
A patient is diagnosed with central diabetes insipidus and states not knowing how the illness was acquired. What does the nurse recognize as a possible cause of this disorder? 1 The presence of a brain tumor 2 Renal damage from long-standing hypertension 3 Drug therapy with lithium for bipolar disorder 4 Structural lesion in the thirst center
1 Brain tumor is one possible cause for central diabetes insipidus, which occurs due to the interference with antidiuretic hormone synthesis, transport, or release. In cases of renal damage and drug therapy with lithium, there would be an inadequate renal response to antidiuretic hormone despite the presence of adequate antidiuretic hormone, which leads to nephrogenic diabetes insipidus. A structural lesion in the thirst center may cause primary diabetes insipidus, which can be a result of excessive water intake. Text Reference - p. 1194
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
1 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. Spleenomegaly is enlargement of the spleen. Dactylomegaly is enlargement of the toes and fingers. Text Reference - p. 1190
The nurse is caring for a patient diagnosed with nephrogenic diabetes insipidus not responding to primary treatment. Which intervention does the nurse expect to 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
1 Indomethacin is a nonsteroidal antiinflammatory drug that helps increase the renal response to antidiuretic hormone. Patients with nephrogenic diabetes insipidus are not responsive to hormonal therapy. Hormonal therapy would not aid in increasing the renal response to antidiuretic hormone. Thiazide diuretics and limiting sodium intake are the primary treatments for nephrogenic diabetes insipidus; the patient has not responded to these treatments. Text Reference - p. 1195
The nurse is caring for a patient who is diagnosed with the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention would promote a reduction in the release of antidiuretic hormone (ADH)? 1 Positioning the head of the bed flat 2 Encouraging the patient to ambulate 3 Changing the patient position frequently 4 Instructing the patient to perform range-of-motion exercises
1 Once SIADH is diagnosed, the treatment is directed at the underlying causes. Positioning the head of the patient's bed flat enhances venous return to the heart and increases the left arterial filling pressure, thereby reducing the release of antidiuretic hormone (ADH). Ambulation is necessary to improve circulation the mobility of joints. Ambulation is not involved in promoting a reduction of ADH. Turning and positioning the patient frequently, and encouraging range-of-motion exercises maintain skin integrity and joint mobility, especially in bed-ridden patients; these interventions do not promote a reduction of ADH. Text Reference - p. 1194
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
1 Prolactin is secreted by the pituitary gland. Thyroxine hormone is secreted by the thyroid gland. The kidney secretes erythropoietin. Parathormone is secreted by parathyroid gland. Text Reference - p. 1192
The nurse is caring for a patient who has cerebral edema associated with syndrome of inappropriate antidiuretic hormone (SIADH). What clinical manifestation of severe serum sodium level decline does the nurse assess? Select all that apply. 1 Coma 2 Lethargy 3 Confusion 4 Headache 5 Tachycardia 6 Hypovolemic shock
1, 2, 3, 4 If the plasma osmolality and serum sodium levels continue to decline below 120 mmol/L, cerebral edema may occur, leading to the manifestations such as coma, lethargy, confusion, and headache. Tachycardia and hypovolemic shock are the complications of diabetes insipidus. Text Reference - p. 1193
A patient with pituitary adenoma underwent transsphenoidal hypophysectomy. What nursing actions are most effective for prevention of complications? Select all that apply. 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, 2, 3, 5 Monitoring the papillary response helps rule out any visual changes after transsphenoidal hypophysectomy. Observing the patient for signs of bleeding is of the utmost importance as hemorrhage can cause complications. The strength of the extremities is monitored to rule out postoperative neurologic complications, such as ataxia. Elevating the head of the patient's bed to a 30-degree angle alleviates pressure on the sella turcica and decreases headaches, which are a frequent postoperative problem. Avoiding tooth brushing for at least 10 days helps protect the suture line. Text Reference - p. 1191
Which factors should the nurse assess in a patient who is on desmopressin acetate (DDAVP)? Select all that apply. 1 Weight 2 Skin turgor 3 Mental status 4 Sodium levels 5 Mucus membranes
1, 3, 4 Desmopressin acetate is a synthetic analogue of natural pituitary hormone, 8-arginine vasopressin (ADH), an antidiuretic hormone that affects renal water conservation. Assessing the weight of the patient when the patient is using desmopressin acetate is important, because weight gain is a side effect of desmopressin acetate. The use of desmopressin acetate may also alter the mental status of the patient, causing hallucinations and depression. Desmporessin acetate may cause fluctuations in sodium levels. Therefore, regular assessment of sodium levels of the patient is necessary. Reduced skin turgor and dried mucous membranes are the signs of severe dehydration, which are not side effects of desmopressin acetate. Text Reference - p. 1195
The registered nurse is preparing to teach a group of nursing students about the pathophysiologic events associated with syndrome of inappropriate antidiuretic hormone (SIADH). Which events should the nurse include in the teaching plan? Select all that apply. 1 Decreased serum osmolality 2 Occurrence of hypernatremia 3 Increased water reabsorption 4 Decreased water reabsorption 5 Occurrence of dilutional hyponatremia
1, 3, 5 Dilutional hyponatremia occurs 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 low serum osmolality will suppress the release of ADH, resulting in decreased water reabsorption and more concentrated plasma. Text Reference - p. 1193
The nurse is caring for a patient with syndrome of inappropriate antidiuretic hormone secretion in the acute care setting. What nursing interventions are important for this patient? Select all that apply. 1 Restrict fluid intake to no more than 1000 mL/day. 2 Elevate the head of the bed to an angle of 30 degrees. 3 Avoid frequent repositioning of the patient. 4 Implement seizure precautions and set the bed alarm. 5 Provide the patient with ice chips to decrease thirst.
1, 4, 5 In the acute care setting the patient's total fluid intake is restricted to no more than 1000 mL/day, including that taken with medications. The nurse should implement seizure precautions and set the bed alarm to protect the patient from injury, because of the potential for an alteration in mental status. The nurse should provide the patient with frequent oral care and ice chips to decrease discomfort related to thirst from the fluid restrictions. The head of the bed should be flat or elevated no more than 10 degrees to enhance venous return to the heart and increase left atrial filling pressure, thereby reducing the release of antidiuretic hormone. Frequent turning, positioning, and range-of-motion exercises are important to maintain skin integrity and joint mobility. Text Reference - p. 1193
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? 1 The bed should be placed parallel to the floor. 2 The head of the bed should be elevated to 30-degree angle. 3 The glucose level of the patient should be maintained. 4 The patient should be told to avoid coughing and sneezing
2 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. Text Reference - p. 1191
Which condition can result if hypersecretion of growth hormone (GH) occurs after epiphyseal plate closure? 1 Dwarfism 2 Acromegaly 3 Gigantism 4 Cretinism
2 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. Text Reference - p. 1190
The nurse is administering intravenous glucose solution to a patient who is suffering from diabetes insipidus. What parameters 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 If intravenous glucose solutions are administered, the serum glucose levels of the patient should be monitored, because hyperglycemia and glycosuria can occur, which can lead to osmotic dieresis and an increase in fluid volume deficit. Monitoring blood pressure is not specifically required for managing osmotic dieresis, but is essential and may be required hourly in patients who are acutely ill. Monitoring fluid and electrolyte levels is required to check the intake and output of fluids and is useful for adjusting fluid levels during fluid replacement, not for the management of osmotic diureses. Specific gravity of urine is not related to osmotic dieresis. Text Reference - p. 1195
The nurse is reviewing the results of four diagnostic tests for diabetes insipidus (DI). Which patient's results indicate nephrogenic DI? 1. Patient A 2. Patient B 3. Patient C 4. Patient D
2 Patients with nephrogenic diabetes insipidus will not be able to increase urine osmolality to greater than 300 mOsm/kg. Patients with central diabetes insipidus show a significant decrease in urine volume below 200 mL/hr and a dramatic increase in the urine osmolality from 100 to 600 mOsm/kg. When an antidiuretic hormone analog such as desmopressin is administered, if the patient has central diabetes, the kidneys respond by forming concentrated urine. Text Reference - p. 1195
Which nursing intervention is most important for a patient with diabetes insipidus? 1 Providing dietary education 2 Monitoring fluid intake and output 3 Assessing for constipation every day 4 Obtaining a finger-stick blood glucose level
2 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. Text Reference - p. 1194
A patient reports to the nurse having visual problems, and is found to have a compressed optic chiasm. Which condition could be the reason for this complication? 1 Acromegaly 2 Prolactinomas 3 Diabetes insipidus 4 Panhypopituitarism
2 Prolactinomas are among the most common type of pituitary adenomas; compression of the chiasm nerve is a complication of this condition and can cause visual problems with signs of increased intracranial pressure, including headache, nausea, and vomiting. Patients with acromegaly, diabetes insipidus, and panhypopituitarism are not associated with the complication of a compressed optic chiasm. Test-Taking Tip: Be certain to answer every question. You must arrive at one correct or one "best" answer. If you must, "guess" between two alternatives or eliminate the two or three answers you know are wrong first. Text Reference - p. 1192
The nurse is caring for a patient who underwent a transsphenoidal hypophysectomy. What is the most important nursing intervention for this patient? 1 Place the patient in a supine position at all times. 2 Monitor pupillary response and speech patterns. 3 Perform mouth care every 12 hours. 4 Test any clear nasal drainage for potassium.
2 The nurse should monitor the pupillary response, speech patterns, and extremity strength to detect neurologic complications. The nurse should ensure the head of the bed is elevated at all times to a 30-degree angle to avoid pressure on the sellaturcica 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. The nurse must notify the surgeon and send any clear nasal fluid to the laboratory to test for glucose. Test-Taking Tip: Do not read information into questions, and avoid speculating. Reading into questions creates errors in judgment. Text Reference - p. 1191
Which signs and symptoms would the nurse expect to assess in a patient who is diagnosed with acromegaly? Select all that apply. 1 Fragile skin 2 Increased shoe size 3 Elevated blood glucose 4 Complaint of headaches 5 Increased height and weight
2, 3, 4 Acromegaly is a disorder in which there is increased secretion of growth hormone (GH). 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 pressure on the optic nerve. The skin becomes thick and leathery. The patient's weight may increase, but there is no change in height because acromegaly occurs after epiphyseal closure. Text Reference - p. 1190
A patient has developed diabetes insipidus. Arrange the events in the order they occur in this patient. 1. Increase in serum osmolality 2. Decrease in antidiuretic hormone 3. Decrease in water reabsorption 4. Decrease in intravascular fluid volume
2, 3, 4, 1 Diabetes insipidus is caused by abnormalities in antidiuretic hormone levels. In patients with diabetes insipidus, the levels of antidiuretic hormone is reduced; this leads to decreased reabsorption of water, increasing the urine output, which reduces the intravascular fluid volume and elevates the osmolality in the blood. Text Reference - p. 1194
The nurse is instructing a patient regarding self-management of syndrome of inappropriate antidiuretic hormone (SIADH). The patient has gastric ulceration as a comorbid condition. Which statement by the patient needs correction? 1 "I should take demeclocycline as prescribed." 2 "I should chew sugarless gum and ice chips." 3 "I should drink the electrolyte solution after meals." 4 "I should dilute the electrolyte solution before administration."
3 Electrolyte solutions should be taken during meals, because it dilutes the solution by allowing it to mix with the food, which prevents irritation and damage to the gastrointestinal tract. Administration of demeclocycline blocks the effect of antidiuretic hormone on the renal tubules, resulting in more dilute urine. Chewing sugarless gum and ice chips decreases thirst. Diluting the electrolyte solution before administration prevents gastrointestinal damage. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. Text Reference - p. 1194
A patient with a pituitary tumor has developed excessive height, and increased hat size and shoe size. Which hormone does the nurse determine is secreting excessively? 1 Cortisol 2 Thyroxine 3 Somatotropin 4 Triidothyronine
3 Somatotropin is also called growth hormone (GH). Excessive secretion of GH results in overgrowth of soft tissues and bones resulting in acromegaly. Cortisol produces a number of physiologic effects, such as increasing blood glucose levels, potentiating the action of catecholamines on blood vessels, and inhibiting the inflammatory response. Thyroxine acts as a precursor to triiodothyronine, which regulates metabolic rate of all cells and processes of cell growth and tissue differentiation. Excessive secretion of cortisol, thyroxine, and triiodothyronine do not result in acromegaly. Text Reference - p. 1190
The nurse is caring for a patient with an alteration in the regulation of water balance and osmolarity. Which hormone will require alteration with medication? 1 Oxytocin 2 Growth hormone 3 Arginine vasopressin 4 Adrenocorticotropic hormone
3 The hormones secreted by the posterior pituitary gland are antidiuretic hormone and oxytocin. They are produced in the hypothalamus and transported and stored in the posterior pituitary gland. Antidiuretic hormone (ADH) is also referred to as arginine vasopressin, which plays a major role in the regulation of water balance and osmolarity. Oxytocin, growth hormone, and adrenocorticotropic hormone are secreted by the anterior pituitary gland, and are not involved in the regulation of water balance and osmolarity. Text Reference - p. 1193
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)
3 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. Text Reference - p. 1195
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? 1 To avoid seizures 2 To avoid headache 3 To prevent cerebrospinal fluid leakage 4 To monitor pupillary and speech responses
3 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. Text Reference - p. 1191
The registered nurse is preparing to teach a group of nursing students about the pathophysiologic events associated with syndrome of inappropriate antidiuretic hormone (SIADH). Which events should the nurse include in the teaching plan? Select all that apply. 1 Decreased serum osmolality 2 Occurrence of hypernatremia 3 Increased water reabsorption 4 Decreased water reabsorption 5 Occurrence of dilutional hyponatremia
3, 5 Dilutional hyponatremia occurs 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 low serum osmolality will suppress the release of ADH, resulting in decreased water reabsorption and more concentrated plasma. Text Reference - p. 1193
The nurse is caring for a patient with syndrome of inappropriate antidiuretic hormone (SIADH) who has muscle twitching, vomiting, severe abdominal cramps, and begins to have seizures. The nurse assesses a serum sodium level of 116 mEq/L. What is the priority nursing action for this patient? 1 Administer lorazepam IV slowly. 2 Administer carbamazepine by mouth. 3 Administer furosemide 40 mg IV push. 4 Administer hypertonic saline solution slowly.
4 A patient with a serum sodium level of 116 mEq/L is severely hyponatremic and needs replacement with a hypertonic saline solution (at least 3 to 5 percent) slowly to correct the neurologic effects of the severe hyponatremia. Lorazepam and carbamazepine are used for seizures but would not be indicated in this case since the only way the seizures will cease are with correction of the hyponatremia. Lasix should not be given to a patient with a serum sodium level under 125 mEq/L, because it will cause further loss of sodium. Text Reference - p. 1194
The syndrome of inappropriate antidiuretic hormone (SIADH) is characterized by inappropriate secretion of ADH, which disrupts the fluid and electrolyte balance. Increased intravascular volume is one of the characteristic features of SIADH. Decreased ADH, excessive urine output, and increased serum osmolality are the features of diabetes insipidus. Text Reference - p. 1193
4 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. Text Reference - p. 1190
Which endocrine problem is more common in men than in women? 1 Graves' disease 2 Thyroid nodules 3 Hyperaldosteronism 4 Ectopic adrenocorticotropic hormone production
4 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 as women as men. Text Reference - p. 1190
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? 1 Having the patient lie down in the supine position 2 Ensuring oral hygiene in the patient by regular brushing 3 Informing the primary health care provider about nasal drainage 4 Instructing the patient to avoid vigorous coughing, sneezing, and straining at stool
4 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.
