Care Management 2 Ch. 57

Which action taken by the nurse is most likely to reduce skin complications in a client who has hypercortisolism? A. Using roller gauze to anchor an IV B. Massaging the client's feet and calves C. Applying pressure after IM injections D. Applying dressings to areas with striae

A The client's skin is thin and easily injured. Once injured, the skin is slow to heal. When tape is needed, its use directly on the skin is minimized. Using roller gauze in place of tape helps to protect the client's skin. Massaging calves can promote embolization of a clot and is not recommended for any client. Applying pressure after IM injections can help reduce bleeding but does not prevent skin injury. Striae do not require dressings and their application can increase skin injury.

What is the nurse's best response when a client who is about to have a unilateral adrenalectomy for an adenoma that is causing hypercortisolism asks if she will have to continue the severe sodium restriction after surgery? A. "No, once the tumor has been removed and your cortisol levels have normalized, you will not retain excess sodium anymore." B. "No, after surgery you will have to take oral cortisol, which can easily be controlled so that your sodium levels do not rise." C. Yes, the fact that you are retaining sodium and have high blood pressure is related to your age and lifestyle, not the tumor." D. "Yes, sodium is very bad for people and everyone needs to eliminate sodium completely from their diets for the rest of their lives."

A A tumor secreting excessive amounts of cortisol is this client's reason for needing to severely restrict her sodium. Once the tumor is removed, she will not have hypercortisolism but may have to take oral cortisol until the remaining adrenal gland begins to secrete sufficient cortisol. She will no longer experience severe sodium retention.

Which precaution is most important for the nurse to teach to prevent harm in a client prescribed oral corticosteroids for hormone replacement therapy after a bilateral adrenalectomy? A. "Do not stop taking this drug without consulting your primary health care provider." B. "Avoid crowds and people who are ill." C. "Be sure to take this drug with food." D. "Reduce your salt intake."

A All of the choices are precautions that the nurse will teach the client taking an oral corticosteroid chronically. However, the most critical precaution is to not stop taking this drug because chronic corticosteroid use causes atrophy of the adrenal glands. With adrenal gland atrophy, the client no longer makes his or her own normal levels of corticosteroids, which are essential for life. Long-term steroid use is never suddenly stopped.

Which assessment finding is most important for the nurse to report in a client with diabetes insipidus (DI)? A. Poor skin turgor B. Respirations of 26 beats/min C. Blood pressure of 130/80 mm Hg D. Potassium level of 4.8 mEq/L (mmol/L)

A Clients with DI are at great risk for dehydration. Poor skin turgor is an indication of dehydration. Respiratory rate is slightly elevated, but is not a cause for concern. The blood pressure is at the upper limits of normal, but also is not a cause for concern. The potassium level is within normal limits.

What is the nurse's best response to a male client with a prolactinoma tumor of the anterior pituitary gland when he asks why he has not been able to achieve an erection? A. "The high levels of prolactin suppress release of your normal sex hormones." B. "You are probably embarrassed by the fact that fluid is coming from your nipples." C. "Don't worry. This problem is temporary and will most likely resolve after treatment." D. "Most men who are told they have a brain tumor experience psychological impotence."

A High levels of prolactin secreted by a prolactinoma suppress the release of gonadotropins. With reduced levels of gonadotropins, circulating levels of testosterone are too low to support normal sexual functioning. Although anxiety and embarrassment can lead to impotence, this does not really answer the client's question. Being told not to worry dismisses the client's valid concerns.

Which action will the nurse instruct assistive personnel (AP) to avoid when caring for a client with diabetes insipidus (DI) to prevent harm? A. Restricting fluids B. Taking blood pressures C. Urging the client to cough D. Allowing the client to sit with knees bent

A Restricting fluids in a client with DI greatly increases the risk for life-threatening dehydration. Clients are encouraged to take in as much fluid as they feel is necessary to satisfy thirst and prevent dehydration. Taking blood pressures, coughing, and sitting with the knees bent are not specifically harmful to the client with DI.

Which serum laboratory value in a client receiving conivaptin therapy for syndrome of inappropriate antidiuretic hormone (SIADH) will the nurse report immediately to the primary health care provider to prevent harm? A. Sodium 148 mEq/L (mmol/L) B. Potassium 3.2 mEq/L (mmol/L) C. Glucose 204 mg/mL (11.4 mmol/L) D. Arterial pH of 7.42

A The therapeutic effect of the vaptans, including conivaptan, is to induce water loss without an accompanying loss of sodium to bring the serum sodium level back to normal. A serum sodium level of 148 mEq/L (mmol/L) represents hypernatremia, which could have serious consequences and requires immediate action. The potassium is a little low but does not require immediate action. The pH is normal and the glucose level is high but not dangerously so.

Which changes in laboratory values will the nurse expect in a client who has untreated syndrome of inappropriate antidiuretic hormone (SIADH)? Select all that apply. A. Increased urine sodium B. Serum potassium 2.9 mEq/mL (mmol/L) C. Urine specific gravity 1.053 D. Serum osmolarity 250 mOsm/L E. Increased hematocrit F. Serum sodium 119 mEq/mL (mmol/L)

A, B, C, F In SIADH, the kidney tubules reabsorb water and return it to the vascular volume leading to hypervolemia and dilution of all blood components. Urine output decreases and urine concentration increases, especially with sodium.

Which postoperative actions are appropriate for the nurse to take when caring for a client who is recovering from a transsphenoidal hypophysectomy? Select all that apply. A. Monitoring fluid and electrolyte balance closely B. Instructing the client how to perform incision care C. Performing neurologic checks hourly for first 24 hours D. Urging the client to cough vigorously every 2 hours while awake E. Encouraging the client to perform hourly deep-breathing exercises F. Instructing the client to use a soft-bristled toothbrush for oral hygiene

A, C, E A hypophysectomy removes all pituitary tissue and results in deficiency of all pituitary hormones, including antidiuretic hormone, which can lead to profound disturbances of fluid and electrolyte balance. Although limited in scope, a hypophysectomy can cause brain swelling that leads to neurologic problems. This requires the performance of neurologic checks hourly for the first 24 hours. The client needs to avoid activity that could increase intracranial pressure, such as coughing, but still needs to prevent postoperative atelectasis by performing deep-breathing exercises hourly. With a transsphenoidal approach, the incision can be injured from inside the oral cavity. Thus, using any type of toothbrush is avoided until healing is complete.

Which physical assessment findings will the nurse expect in a client with long-term Cushing disease? Select all that apply. A. "Moon-face" B. Body hair loss C. Truncal obesity D. Prominent lower jaw E. Thin, easily damaged skin F. Extremity muscle wasting

A, C, E, F Common physical changes in a client who has had Cushing disease for more than a few months include fat redistribution that results in a moon-face and truncal obesity. The skin becomes thinner and more fragile. Skeletal muscles decrease in size and strength, especially in the extremities. Body hair is increased, not decreased and the jaw does not change thickness or position.

Which assessment findings will the nurse expect to see in a 30-year-old client who has just been diagnosed with acromegaly? Select all that apply. A. Thickened lips B. Near-sightedness C. Hyperglycemia D. Hyponatremia E. Extremely long arms and legs F. Protruding lower jaw

A, C, F With acromegaly, the adult client has an over production of growth hormone (GH) that results in gradual enlargement of soft tissues and growth of desmoid bone, resulting in irreversible enlargement of the face, hands, feet, and protrusion of the lower jaw. Skeletal bones thicken but do not grow longer, and organs such as the liver and heart enlarge. The client also experiences breakdown of joint cartilage; and hypertrophy of ligaments, vocal cords, lips, and eustachian tubes are common. Hyperglycemia is common. Visual changes and electrolyte disturbances are not associated with acromegaly.

A nurse assesses a client with Cushings disease. Which assessment findings should the nurse correlate with this disorder? (Select all that apply.)a. Moon face b. Weight loss c. Hypotension d. Petechiae e. Muscle atrophy

ANS: A, D, E Clinical manifestations of Cushings disease include moon face, weight gain, hypertension, petechiae, and muscle atrophy.a. Moon face b. Weight loss c. Hypotension d. Petechiae e. Muscle atrophy

An emergency nurse cares for a client who is experiencing an acute adrenal crisis. Which action should the nurse take first? a. Obtain intravenous access. b. Administer hydrocortisone succinate (Solu-Cortef). c. Assess blood glucose. d. Administer insulin and dextrose.

ANS: A All actions are appropriate for the client with adrenal crisis. However, therapy is given intravenously, so the priority is to establish IV access. Solu-Cortef is the drug of choice. Blood glucose is monitored hourly and treatment is provided as needed. Insulin and dextrose are used to treat any hyperkalemia.

A nurse cares for a client with chronic hypercortisolism. Which action should the nurse take? a. Wash hands when entering the room. b. Keep the client in airborne isolation. c. Observe the client for signs of infection. d. Assess the clients daily chest x-ray.

ANS: A Excess cortisol reduces the number of circulating lymphocytes, inhibits maturation of macrophages, reduces antibody synthesis, and inhibits production of cytokines and inflammatory chemicals. As a result, these clientsare at greater risk of infection and may not have the expected inflammatory manifestations when an infection is present. The nurse needs to take precautions to decrease the clients risk. It is not necessary to keep the client in isolation. The client does not need a daily chest x-ray.

A client with hyperaldosteronism is being treated with spironolactone (Aldactone) before surgery. Which precautions does the nurse teach this client? a. Read the label before using salt substitutes. b. Do not add salt to your food when you eat. c. Avoid exposure to sunlight. d. Take Tylenol instead of aspirin for pain.

ANS: A Spironolactone is a potassium-sparing diuretic used to control potassium levels. Its use can lead to hyperkalemia. Although the goal is to increase the clients potassium, unknowingly adding potassium can cause complications. Some salt substitutes are composed of potassium chloride and should be avoided by clients on spironolactone therapy. Depending on the client, he or she may benefit from a low-sodium diet before surgery, but this may not be necessary. Avoiding sunlight and Tylenol is not necessary.

The nurse is caring for a client who has acromegaly. What physical change would the nurse expect to observe? a. Large hands and face b. Thin, dry skin c. Short height d. Truncal obesity

ANS: A The client who has acromegaly has an excess of growth hormone as an adult and therefore has a large musculoskeletal structure that is readily observed.

A nurse is reviewing care for a client who has syndrome of inappropriate antidiuretic hormone (SIADH) with assistive personnel. What statement by the AP indicates understanding of this client's care? a. "I will weigh the client carefully before breakfast and compare with yesterday's weight." b. "I will encourage plenty of fluids to promote urination and prevent dehydration." c. "I will teach the client not to select high-sodium or salty foods on the menu." d. "I will assess the client's mucous membranes and skin for signs of dehydration."

ANS: A The client with SIADH usually has a fluid restriction, not an increase in fluids. It is the role of the RN rather than AP to perform assessments and provide health teaching. The AP needs to weigh the client daily and report a significant weight changes.

A nurse assesses clients with potential endocrine disorders. Which clients are at high risk for adrenal insufficiency? (Select all that apply.) a. A 22-year-old female with metastatic cancer b. A 43-year-old male with tuberculosis c. A 51-year-old female with asthma d. A 65-year-old male with gram-negative sepsis e. A 70-year-old female with hypertension

ANS: A, B, D Metastatic cancer, tuberculosis, and gram-negative sepsis are primary causes of adrenal insufficiency. Active tuberculosis is a contributing factor for syndrome of inappropriate antidiuretic hormone. Hypertension is a key manifestation of Cushings disease. These are not risk factors for adrenal insufficiency.

A client is admitted with a possible diagnosis of diabetes insipidus (DI). What assessment findings would the nurse expect? (Select all that apply.) a. Hypotension b. Increased urinary output c. Concentrated urine d. Decreased thirst e. Poor skin turgor f. Bradycardia

ANS: A, B, E The client who has DI has excessive urination and dehydration. Clients who are dehydrated have decreased blood pressure, increased pulse (tachycardia), and poor skin turgor. The urine is dilute with a low specific gravity.

A nurse assesses clients with potential endocrine disorders. Which clients are at high risk for hypopituitarism? (Select all that apply.) a. A 20-year-old female with benign pituitary tumors b. A 32-year-old male with diplopia c. A 41-year-old female with anorexia nervosa d. A 55-year-old male with hypertension e. A 60-year-old female who is experiencing shock f. A 68-year-old male who has gained weight recently

ANS: A, C, D, E Pituitary tumors, anorexia nervosa, hypertension, and shock are all conditions that can cause hypopituitarism. Diplopia is a manifestation of hypopituitarism, and weight gain is a manifestation of Cushings disease and syndrome of inappropriate antidiuretic hormone. They are not risk factors for hypopituitarism.

A nurse assesses a client with anterior pituitary hyperfunction. Which clinical manifestations should the nurse expect? (Select all that apply.) a. Protrusion of the lower jaw b. High-pitched voice c. Enlarged hands and feet d. Kyphosis e. Barrel-shaped chest f. Excessive sweating

ANS: A, C, D, E, F Anterior pituitary hyperfunction typically will cause protrusion of the lower jaw, deepening of the voice, enlarged hands and feet, kyphosis, barrel-shaped chest, and excessive sweating.

ANS: A, B, E The client who has DI has excessive urination and dehydration. Clients who are dehydrated have decreased blood pressure, increased pulse (tachycardia), and poor skin turgor. The urine is dilute with a low specific gravity.f. pH 7.50

ANS: A, C, E Aldosterone increases reabsorption of sodium and excretion of potassium. Hyperaldosteronism causes hypernatremia, hypokalemia, and metabolic alkalosis. Hyponatremia, hyperkalemia, and acidosis are manifestations of adrenal insufficiency.

A nurse assesses a client who potentially has hyperaldosteronism. Which serum laboratory values should the nurse associate with this disorder? (Select all that apply.) a. Sodium: 150 mEq/L b. Sodium: 130 mEq/L c. Potassium: 2.5 mEq/L d. Potassium: 5.0 mEq/L e. pH: 7.28 f. pH: 7.50

ANS: A, C, E Aldosterone increases reabsorption of sodium and excretion of potassium. Hyperaldosteronism causes hypernatremia, hypokalemia, and metabolic alkalosis. Hyponatremia, hyperkalemia, and acidosis are manifestations of adrenal insufficiency.

A nurse assesses a client with Cushing disease. Which assessment findings would the nurse expect? (Select all that apply.) a. Moon face b. Weight loss c. Hypotension d. Petechiae e. Muscle atrophy

ANS: A, D, E Clinical manifestations of Cushing disease include moon face, weight gain, hypertension, petechiae, and muscle atrophy.

A nurse cares for a client who is prescribed vasopressin (DDAVP) for diabetes insipidus. Which assessment findings indicate a therapeutic response to this therapy? (Select all that apply.) a. Urine output is increased. b. Urine output is decreased. c. Specific gravity is increased. d. Specific gravity is decreased. e. Urine osmolality is increased. f. Urine osmolality is decreased.

ANS: A, D, F Diabetes insipidus causes urine output to be greatly increased, with a low urine osmolality, as evidenced by a low specific gravity. Effective treatment results in decreased urine output that is more concentrated, as evidenced by an increased specific gravity.

After teaching a client who is recovering from an endoscopic transsphenoidal hypophysectomy, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the teaching? a. "I will wear dark glasses to prevent sun exposure." b. "I'll keep food on upper shelves so I do not have to bend over." c. "I must wash the incision with saline and redress it daily." d. "I should cough and deep breathe every 2 hours while I am awake."

ANS: B After this surgery, the client must take care to avoid activities that can increase intracranial pressure. The client should avoid bending from the waist and should not bear down, cough, or lie flat. With this approach, there is no incision to clean and dress. Protection from sun exposure is not necessary after this procedure.

After teaching a client who is recovering from an endoscopic trans-nasal hypophysectomy, the nurse assesses the clients understanding. Which statement made by the client indicates a correct understanding of the teaching? a. I will wear dark glasses to prevent sun exposure. b. Ill keep food on upper shelves so I do not have to bend over.c. I must wash the incision with peroxide and redress it daily. d. I shall cough and deep breathe every 2 hours while I am awake.

ANS: B After this surgery, the client must take care to avoid activities that can increase intracranial pressure. The client should avoid bending from the waist and should not bear down, cough, or lie flat. With this approach, there is no incision to clean and dress. Protection from sun exposure is not necessary after this procedure.

A nurse assesses clients for potential endocrine dysfunction. Which client is at greatest risk for a deficiency of gonadotropin and growth hormone? a. A 36-year-old female who has used oral contraceptives for 5 years b. A 42-year-old male who experienced head trauma 3 years ago c. A 55-year-old female with a severe allergy to shellfish and iodine d. A 64-year-old male with adult-onset diabetes mellitus

ANS: B Gonadotropin and growth hormone are anterior pituitary hormones. Head trauma is a common cause of anterior pituitary hypofunction. The other factors do not increase the risk of this condition.

A nurse assesses clients for potential endocrine dysfunction. Which client is at greatest risk for a deficiency of gonadotropin and growth hormone? a. A 36-year-old female who has used oral contraceptives for 5 years b. A 42-year-old male who experienced head trauma 3 years ago c. A 55-year-old female with a severe allergy to shellfish and iodine d. A 64-year-old male with adult-onset diabetes mellitus

ANS: B Gonadotropin and growth hormone are anterior pituitary hormones. Head trauma is a common cause of anterior pituitary hypofunction. The other factors do not increase the risk of this condition.

A nurse cares for a client with adrenal hyperfunction. The client screams at her husband, bursts into tears, and throws her water pitcher against the wall. She then tells the nurse, "I feel like I am going crazy." How would the nurse respond? a. "I will ask your doctor to order a mental health consult for you." b. "You feel this way because of your hormone levels." c. "Can I bring you information about support groups?" d. "I will close the door to your room and restrict visitors."

ANS: B Hypercortisolism can cause the client to have neurotic or psychotic behaviors. The client needs to know that these behavior changes do not reflect a true mental or behavioral health disorder and will resolve when therapy results in lower and steadier blood cortisol levels. The client needs to understand this effect and does not need a psychiatrist, support groups, or restricted visitors at this time.

A nurse cares for a client with adrenal hyperfunction. The client screams at her husband, bursts into tears, and throws her water pitcher against the wall. She then tells the nurse, I feel like I am going crazy. How should the nurse respond? a. I will ask your doctor to order a psychiatric consult for you. b. You feel this way because of your hormone levels. c. Can I bring you information about support groups? d. I will close the door to your room and restrict visitors.

ANS: B Hypercortisolism can cause the client to show neurotic or psychotic behavior. The client needs to know that these behavior changes do not reflect a true psychiatric disorder and will resolve when therapy results in lower and steadier blood cortisol levels. The client needs to understand this effect and does not need a psychiatrist, support groups, or restricted visitors at this time.

A nurse is caring for a client who was prescribed high-dose corticosteroid therapy for 1 month to treat a severe inflammatory condition. The clients symptoms have now resolved and the client asks, When can I stop taking these medications? How should the nurse respond? a. It is possible for the inflammation to recur if you stop the medication. b. Once you start corticosteroids, you have to be weaned off them. c. You must decrease the dose slowly so your hormones will work again. d. The drug suppresses your immune system, which must be built back up.

ANS: B One of the most common causes of adrenal insufficiency, a life-threatening problem, is the sudden cessation of long-term, high-dose corticosteroid therapy. This therapy suppresses the hypothalamic-pituitary-adrenal axis and must be withdrawn gradually to allow for pituitary production of adrenocorticotropic hormone and adrenal production of cortisol. Decreasing hormone therapy slowly ensures self-production of hormone, not hormone effectiveness. Building the clients immune system and rebound inflammation are not concerns related to stopping high-dose corticosteroids.

A nurse teaches a client with a cortisol deficiency who is prescribed prednisone (Deltasone). Which statement should the nurse include in this clients instructions? a. You will need to learn how to rotate the injection sites. b. If you work outside in the heat, you may need another drug. c. You need to follow a diet with strict sodium restrictions. d. Take one tablet in the morning and two tablets at night.

ANS: B Steroid dosage adjustment may be needed if the client works outdoors and might be difficult, especially in hot weather, when the client is sweating a great deal more than normal. Clients take prednisone orally, have no need for a salt restriction, and usually start the regimen with two tablets in the morning and one at night.

3. A nurse cares for a male client with hypopituitarism who is prescribed testosterone hormone replacement therapy. The client asks, How long will I need to take this medication? How should the nurse respond? a. When your blood levels of testosterone are normal, the therapy is no longer needed. b. When your beard thickens and your voice deepens, the dose is decreased, but treatment will continue forever. c. When your sperm count is high enough to demonstrate fertility, you will no longer need this therapy. d. With age, testosterone levels naturally decrease, so the medication can be stopped when you are 50 years old.

ANS: B Testosterone therapy is initiated with high-dose testosterone derivatives and is continued until virilization is achieved. The dose is then decreased, but therapy continues throughout life. Therapy will continue throughout life; therefore, it will not be discontinued when blood levels are normal, at the age of 50 years, or when sperm counts are high.

A nurse cares for a client who possibly has syndrome of inappropriate antidiuretic hormone (SIADH). The client's serum sodium level is 114 mEq/L (114 mmol/L). What nursing action would be appropriate? a. Consult with the dietitian about increased dietary sodium. b. Restrict the client's fluid intake to 600 mL/day. c. Handle the client gently by using turn sheets for repositioning. d. Instruct assistive personnel to measure intake and output.

ANS: B With SIADH, clients often have dilutional hyponatremia. The client needs a fluid restriction, sometimes to as little as 500 to 600 mL/24 hr. Adding sodium to the client's diet will not help if he or she is retaining fluid and diluting the sodium. The client is not at increased risk for fracture, so gentle handling is not an issue. The client would be on intake and output; however, this will monitor only the client's intake, so it is not the best answer. Reducing fluid intake will help increase the client's sodium.

A nurse cares for a client who possibly has syndrome of inappropriate antidiuretic hormone (SIADH). The clients serum sodium level is 114 mEq/L. Which action should the nurse take first? a. Consult with the dietitian about increased dietary sodium. b. Restrict the clients fluid intake to 600 mL/day. c. Handle the client gently by using turn sheets for re-positioning. d. Instruct unlicensed assistive personnel to measure intake and output.

ANS: B With SIADH, clients often have dilutional hyponatremia. The client needs a fluid restriction, sometimes to as little as 500 to 600 mL/24 hr. Adding sodium to the clients diet will not help if he or she is retaining fluid and diluting the sodium. The client is not at increased risk for fracture, so gentle handling is not an issue. The client should be on intake and output; however, this will monitor only the clients intake, so it is not the best answer. Reducing intake will help increase the clients sodium.

A nurse teaches a client with Cushing disease. Which dietary requirements would the nurse include in this client's health teaching? (Select all that apply.) a. Low calcium b. Low carbohydrate c. Low protein d. Low calories e. Low sodium

ANS: B, D, E The client with Cushing disease has weight gain, muscle loss, hyperglycemia, and sodium retention. Dietary modifications need to include reduction of carbohydrates and total calories to prevent or reduce the degree of hyperglycemia. Sodium retention causes water retention and hypertension. Clients are encouraged to restrict their sodium intake moderately. Clients often have bone density loss and need more calcium. Increased protein intake will help decrease muscle loss.

A nurse teaches a client with Cushings disease. Which dietary requirements should the nurse include in this clients teaching? (Select all that apply.) a. Low calcium b. Low carbohydrate c. Low protein d. Low calories e. Low sodium

ANS: B, D, E The client with Cushings disease has weight gain, muscle loss, hyperglycemia, and sodium retention. Dietary modifications need to include reduction of carbohydrates and total calories to prevent or reduce the degree of hyperglycemia. Sodium retention causes water retention and hypertension. Clients are encouraged to restrict their sodium intake moderately. Clients often have bone density loss and need more calcium. Increased protein intake will help decrease muscle loss.

The nurse is preparing to give tolvaptan for a client who has syndrome of inappropriate antidiuretic hormone (SIADH). For which potentially life-threatening adverse effect would the nurse monitor? a. Increased intracranial pressure b. Myocardial infarction c. Rapid-onset hypernatremia d. Bowel perforation

ANS: C Tolvaptan has a black box warning that rapid increases in serum sodium levels have been associated with central nervous system demyelination that can lead to serious complications and death.

A nurse cares for a client who is recovering from a hypophysectomy. Which action should the nurse take first? a. Keep the head of the bed flat and the client supine. b. Instruct the client to cough, turn, and deep breathe. c. Report clear or light yellow drainage from the nose. d. Apply petroleum jelly to lips to avoid dryness.

ANS: C A light yellow drainage or a halo effect on the dressing is indicative of a cerebrospinal fluid leak. The client should have the head of the bed elevated after surgery. Although deep breathing is important postoperatively, coughing should be avoided to prevent cerebrospinal fluid leakage. Although application of petroleum jelly to the lips will help with dryness, this instruction is not as important as reporting the yellowish drainage.

After teaching a client with acromegaly who is scheduled for an open transsphenoidal hypophysectomy, the nurse assesses the client's understanding. Which statement made by the client indicates a need for further teaching? a. "I will no longer need to limit my fluid intake after surgery." b. "I am glad no visible incision will result from this surgery." c. "I hope I can go back to wearing size 8 shoes instead of size 12." d. "I will wear slip-on shoes after surgery to limit bending over."

ANS: C Although removal of the tissue that is oversecreting hormones can relieve many symptoms of hyperpituitarism, skeletal changes and organ enlargement are not reversible. It will be appropriate for the client to drink as needed postoperatively and avoid bending over. The client can be reassured that the incision will not be visible.

After teaching a client with acromegaly who is scheduled for a hypophysectomy, the nurse assesses the clients understanding. Which statement made by the client indicates a need for additional teaching? a. I will no longer need to limit my fluid intake after surgery. b. I am glad no visible incision will result from this surgery. c. I hope I can go back to wearing size 8 shoes instead of size 12. d. I will wear slip-on shoes after surgery to limit bending over.

ANS: C Although removal of the tissue that is oversecreting hormones can relieve many symptoms of hyperpituitarism, skeletal changes and organ enlargement are not reversible. It will be appropriate for the client to drink as needed postoperatively and avoid bending over. The client can be reassured that the incision will not be visible.

A nurse plans care for a client with Cushings disease. Which action should the nurse include in this clients plan of care to prevent injury? a. Pad the siderails of the clients bed. b. Assist the client to change positions slowly. c. Use a lift sheet to change the clients position. d. Keep suctioning equipment at the clients bedside.

ANS: C Cushings syndrome or disease greatly increases the serum levels of cortisol, which contributes to excessive bone demineralization and increases the risk for pathologic bone fracture. Padding the siderails and assisting the client to change position may be effective, but these measures will not protect him or her as much as using a lift sheet. The client should not require suctioning.

A nurse plans care for a client with a growth hormone deficiency. Which action would the nurse include in this client's plan of care? a. Avoid intramuscular medications. b. Place the client in protective isolation. c. Use a lift sheet to reposition the patient. d. Assist the client to dangle before rising.

ANS: C In adults, growth hormone is necessary to maintain bone density and strength. Adults with growth hormone deficiency have thin, fragile bones. Avoiding IM medications, using protective isolation, and assisting the client as he or she moves from sitting to standing will not serve as safety measures when the client is deficient in growth hormone.

A nurse plans care for a client with a growth hormone deficiency. Which action should the nurse include in this clients plan of care? a. Avoid intramuscular medications. b. Place the client in protective isolation. c. Use a lift sheet to re-position the client. d. Assist the client to dangle before rising.

ANS: C In adults, growth hormone is necessary to maintain bone density and strength. Adults with growth hormone deficiency have thin, fragile bones. Avoiding IM medications, using protective isolation, and assisting the client as he or she moves from sitting to standing will not serve as safety measures when the client is deficient in growth hormone.

A nurse assesses a client who is recovering from a transsphenoidal hypophysectomy. The nurse notes nuchal rigidity. Which action should the nurse take first? a. Encourage range-of-motion exercises. b. Document the finding and monitor the client. c. Take vital signs, including temperature. d. Assess pain and administer pain medication.

ANS: C Nuchal rigidity is a major manifestation of meningitis, a potential postoperative complication associated with this surgery. Meningitis is an infection; usually the client will also have a fever and tachycardia. Range-of- motion exercises are inappropriate because meningitis is a possibility. Documentation should be done after all assessments are completed and should not be the only action. Although pain medication may be a palliative measure, it is not the most appropriate initial action.

The nurse is caring for a client who is diagnosed with diabetes insipidus (DI). For what common complication will the nurse monitor? a. Hypertension b. Bradycardia c. Dehydration d. Pulmonary embolus

ANS: C The client who has DI has fluid loss through excessive urination. Decreased fluid volume, or dehydration, is manifested by tachycardia, hypotension, and possibly elevated temperature. Pulmonary embolism (PE) could possible as a clot in the lower extremity (caused by dehydration) could fragment and travel to the lungs.

The nurse is caring for a client with acromegaly who is starting bromocriptine. What health teaching by the nurse about drug therapy will the nurse include? a. "Take this drug on an empty stomach first thing in the morning." b. "You will be starting on a high dose of the drug to ensure it will work." c. "You might experience an increase in blood pressure in about a week." d. "Seek medical attention immediately if you have chest pain and dizziness."

ANS: D Bromocriptine should be started on a low dose and taken with food. The drug can cause decreased blood pressure, including orthostatic hypotension. Serious effects such as cardiac dysrhythmias, coronary artery spasms, and cerebrospinal leak can occur Therefore, the nurse teaches the client should seek medical attention if he or she experiences chest pain, dizziness, and watery nasal discharge.

A nurse cares for a client after a pituitary gland stimulation test using insulin. The clients post-stimulation laboratory results indicate elevated levels of growth hormone (GH) and adrenocorticotropic hormone (ACTH).How should the nurse interpret these results? a. Pituitary hypofunction b. Pituitary hyperfunction c. Pituitary-induced diabetes mellitus d. Normal pituitary response to insulin

ANS: D Some tests for pituitary function involve administering agents that are known to stimulate the secretion of specific pituitary hormones and then measuring the response. Such tests are termed stimulation tests. The stimulation test for GH or ACTH assessment involves injecting the client with regular insulin (0.05 to 1 unit/kg of body weight) and checking circulating levels of GH and ACTH. The presence of insulin in clients with normal pituitary function causes increased release of GH and ACTH.

The nurse is caring for a client with adrenal insufficiency. What priority physical assessment would the nurse perform? a. Respiratory assessment b. Skin assessment c. Neurologic assessment d. Cardiac assessment

ANS: D The client who has adrenal insufficiency has hyperkalemia that can cause cardiac dysrhythmias. Therefore, the nurse would monitor the client's cardiovascular status through frequent assessments.

A client is being treated for diabetes insipidus (DI) with synthetic vasopressin (desmopressin). What is the priority health teaching that the nurse provides regarding drug therapy? a. The need to check the client's urinary specific gravity. b. The need to take blood pressure at least twice a day. c. The need to monitor blood glucose every day. d. The need to weigh every day and report weight gain.

ANS: D The client with DI who takes lifelong hormone replacement will need to report significant weight gain to monitor for water toxicity. Water toxicity causes headache, vomiting, and acute confusion.

Which action will the nurse instruct assistive personnel to perform to prevent harm for a client who has adrenal insufficiency? A. Padding the side rails of the client's bed B. Assisting the client to change positions slowly C. Using a lift sheet when repositioning the client D. Placing suctioning equipment at the client's bedside

B Adrenocortical insufficiency causes severe orthostatic (postural) hypotension, greatly increasing the client's risk for falls. Assisting the client to change positions slowly can help reduce the degree of blood pressure drop during position changes and reduce the risk for falls. The client has no need for padded side rails and does not have an increased risk for fractures. Although the client who has adrenal insufficiency may have a lower-than-normal serum sodium level, this level does not drop to the level that the client is at risk for seizure activity.

What is the nurse's best response when a client who must continue to take a corticosteroid asks why an H2 histamine blocker has been prescribed? A. "The drug therapy increases the development of allergies." B. "Corticosteroids are associated with an increased risk for gastric ulcers." C. "When taken together, the H2 histamine blocker improves the absorption of the corticosteroid." D. "The H2 histamine blocker counteracts the increased appetite stimulated by the corticosteroid."

B Corticosteroids increase the risk for gastric ulcer formation by stimulating increased production of stomach acids and thinning the stomach lining. H2 histamine blockers reduce this risk by inhibiting the release of gastric acids. This drug category is not used for allergy prevention and does not suppress appetite. Combination therapy does not increase absorption of the corticosteroid.

Why is a deficiency in the production of the anterior pituitary hormone adrenocorticotropin hormone (ACTH) life threatening? A. Reduces sexual maturation leading to untreatable sterility B. Inhibits adrenal production of cortisol, which is necessary for life C. Reduces excretion of extracellular fluid leading to fluid overload and heart failure D. Lack of reabsorption of sodium and potassium leads to serious fluid and electrolyte imbalances

B Deficiencies of adrenocorticotropic hormone (ACTH) or thyroid-stimulating hormone (TSH) are the most life threatening because they cause a decrease in the secretion of vital hormones from the adrenal and thyroid glands. Cortisol from the adrenal cortex is necessary for life by regulating the body's response to stress; carbohydrate, protein, and fat metabolism; emotional stability; immune function; sodium and water balance; and influencing other important body processes. For example, it must be present for epinephrine and norepinephrine action and maintaining the normal excitability of the heart muscle cells.

Which urine characteristics indicate to the nurse that a client being managed for diabetes insipidus requires another dose of desmopressin? A. Urine output volume increased; urine specific gravity increased B. Urine output volume increased; urine specific gravity decreased C. Urine output volume decreased; urine specific gravity increased D. Urine output volume decreased; urine specific gravity decreased

B Diabetes insipidus (DI) occurs with reduced or absent secretion of vasopressin (ADH). As a result, water is excessively excreted, causing a decrease in blood volume and an increase in urine volume. Blood is concentrated indicating dehydration and urine is very dilute, as measured by specific gravity, which is very low. When drug therapy with synthetic vasopressin (desmopressin) is effective, the client increases water reabsorption so that urine output volume decreases at the same time that urine concentration increases, seen as an increased urine specific gravity. When urine volume increases and urine concentration decreases, another drug dose is needed to prevent hypovolemia and dehydration.

Which change in laboratory values indicates to the nurse that the fluid restriction ordered for a client with syndrome of inappropriate antidiuretic hormone (SIADH) is having the desired effect? A. Decreased hematocrit B. Increased serum sodium C. Decreased serum osmolarity D. Increased urine specific gravity

B Increased serum sodium due to fluid restriction indicates effective therapy. Restricting fluid would result in increasing hematocrit levels as the fluid volume excess resolves. Plasma osmolality is decreased as a result of SIADH, so treatment would result in this level rising to near normal. Urine specific gravity is increased with SIADH and would decrease to near normal with treatment.

A client who has been receiving bromocriptine therapy for 1 month to manage hyperpituitarism now has all of the following symptoms or changes. Which ones will the nurse report to the primary health care provider immediately to prevent harm? Select all that apply. A. Nausea B. Possible pregnancy C. Headaches D. Irregular heart beat E. Taste changes F. Watery nasal discharge

B, D, F Bromocriptine can cause serious cardiac dysrhythmias, coronary artery spasms, and cerebrospinal fluid leakage. It is also contraindicated during pregnancy. Constipation, increased sleepiness, headaches, and nausea are possible side effects of the drug and their degree of discomfort to the client should always be considered; however, their presence does not constitute harm or require immediate attention. Change in taste sensation may or may not be related to bromocriptine therapy and is not considered a problem requiring further investigation.

Which diuretic will the nurse expect to be prescribed by the primary health care provider to manage a client who has hyperaldosteronism? A. Mannitol B. Furosemide C. Spironolactone D. Ethacrynic acid

C Aldosterone enhances the reabsorption of water and sodium, along with excretion of potassium. Clients with hyperaldosteronism have fluid overload, hyponatremia, and hypokalemia. Correction of these imbalances requires a diuretic, such as spironolactone, that increases sodium and water excretion and conserves potassium. Mannitol is an osmotic diuretic that promotes only water excretion. Furosemide and ethacrynic acid promote sodium and potassium loss along with water loss.

Which change in a client's condition indicates to the nurse that corticosteroid therapy for the client in acute adrenal crisis is effective? A. Urine output is increased. B. Pitting edema has resolved. C. Client is alert and oriented. D. Blood glucose level is 60 mg/dL (3.3 mmol/L)

C Clients with acute adrenal insufficiency are hypotensive and dehydrated with hypoglycemia, hyponatremia, and hyperkalemia. Their level of consciousness is altered to the point of lethargy and confusion. Edema is not present and urine output can be excessive. A major indication of drug therapy effectiveness is a return to an alert and oriented level of consciousness.

Which hormone deficiency does the nurse associate with a client who has diabetes insipidus? A. Insulin B. Aldosterone C. Antidiuretic hormone D. Adrenocorticotropic hormone

C DI is caused by either the decreased production of antidiuretic hormone or the inability of the kidney tubules to respond to its presence. Deficiencies of insulin, aldosterone, and adrenocorticotropic hormone are not a cause of DI.

Which additional assessment is a priority for the nurse to perform on a client who develops a fever of 102°F (38.9°C) the day after a transsphenoidal hypophysectomy? A. Listening to breath sounds B. Checking pupillary responses C. Checking neck range of motion D. Asking about pain and burning on urination

C Nuchal rigidity is a major indication of meningitis, a potential postoperative complication associated with this surgery. Meningitis is an infection and usually the client will also have a fever. Although a fever could indicate a respiratory or urinary tract infection and these must be ruled out, meningitis is more serious. Checking pupillary responses is not as critical as determining the presence or absence of nuchal rigidity and would not be performed first.

Which client will the nurse recognize as being at increased risk for development of syndrome of inappropriate antidiuretic hormone (SIADH)? A. 27-year-old on high-dose steroids B. 47-year-old with acute renal failure C. 58-year-old with small cell lung cancer D. 60-year-old who had a myocardial infarction last year

C SIADH is more common among clients who have any type of continuing respiratory problem, especially lung cancer being managed with chemotherapy. None of the other health problems listed increase the risk for SIADH.

Which side effect will the nurse teach a male client receiving androgen therapy to expect? A. Increased testicular size B. Loss of body hair C. Gynecomastia D. Weight gain

C Side effects of androgen therapy include male breast development (gynecomastia), acne, baldness, and prostate enlargement. Although penile size increases with androgen therapy, testicular size usually decreases as a result of elevated blood androgen levels suppressing the release of gonadotropins from the hypothalamus because of negative feedback.

Which client will the nurse recognize as having a high risk for developing secondary adrenal insufficiency? A. 25-year-old using oral contraceptives B. 35-year-old with diabetes insipidus C. 45-year-old who suddenly stops taking high-dose corticosteroid therapy D. 55-year-old with an adrenal tumor causing excessive secretion of cortisol

C The most common cause of secondary adrenal insufficiency is discontinuing higher dose corticosteroid therapy without an appropriate tapering down period to allow atrophied adrenal tissues to restart secretion of endogenous corticosteroids. None of the other conditions trigger adrenal insufficiency.

For which complications will the nurse assess, when planning prevention strategies with other interprofessional team members for client with hypercortisolism? A. Anorexia, constipation, hypotension B. Kidney stones, weight loss, cataracts C. Skin breakdown, infection, GI ulceration D. Diabetes insipidus, bradycardia, arthritis

C Under the influence of excessive amounts of cortisol, skin becomes thinner, prone to striations, and has decreased cell division. Although the white blood cell count may be high, the activity of the leukocytes (especially lymphocytes) is decreased and the client is immunosuppressed. The cortisol increases the risk for GI ulceration in many ways, including stimulating increased secretion of hydrochloric acid and thinning the protective mucus layer in the stomach.

Which action is most appropriate for the nurse to take in the preoperative holding area when a client who is scheduled to have an adrenalectomy for hypercortisolism is prescribed to receive cortisol by intravenous infusion? A. Requesting a "time-out" to determine whether this is a valid prescription B. Asking the client whether he or she usually takes prednisone C. Holding the dose because the client has a high cortisol level D. Administering the drug as prescribed

D Although the client has hypercortisolism, removal of the adrenal gland will stop the secretion of this important hormone that is essential for life. Further, the stress of surgery also increases the client's need for this hormone. Supplying the hormone throughout surgery prevents the complication (or at least reduces the risk) for acute adrenal crisis.

Which action will the nurse take to prevent harm related to syndrome of inappropriate antidiuretic hormone (SIADH) when a client with the disorder is receiving feedings through a nasogatric (NG) tube? A. Turning off NG suction for an hour after feedings B. Using tape sparingly when anchoring the NG tube C. Removing the tube as soon as bowel sounds are present D. Using normal saline instead of water as the irrigation fluid

D Preventing harm for a client with syndrome of inappropriate antidiuretic hormone (SIADH) involves avoiding care that could further dilute the electrolyte concentrations. By using normal saline for NG irrigations instead of water, the risk for further dilution is reduced. The other actions relate to general NG issues.

Which statement made by a female client receiving hormone replacement therapy with estrogen and progesterone for anterior pituitary hypofunction indicates to the nurse correct understanding of the drug therapy? A. "I will switch to vaping instead of smoking cigarettes." B. "Reducing my use of hot showers and baths may help my dry skin." C. "If my breast sizes increase, I will report it to my primary health care provider." D. "I will report any leg pain or swelling immediately to my primary health care provider."

D The use of exogenous estrogen and progesterone increases the risk for thrombus and emboli formation. This risk is even greater for women who use nicotine in any form (even vaping). Persistent leg pain and swelling without trauma are an indication of deep vein thrombosis in the extremity. Breast size increases are an expected side effect of this hormone replacement therapy. Exogenous estrogen and progesterone therapy are more likely to promote adequate skin oil production rather than dry skin.

Which disorders will the nurse expect that a client with an abnormally functioning posterior pituitary gland could possibly have? Select all that apply. A. Hypothyroidism B. Bone density loss C. Growth retardation D. Diabetes insipidus (DI) E. Excessive virilization F. Syndrome of inappropriate antidiuretic hormone (SIADH)

D, F The major hormone secreted on a daily basis by a normally functioning posterior pituitary gland is antidiuretic hormone (ADH, vasopressin). (Oxytocin secretion has less effects on day-to-day homeostasis.) Undersecretion of ADH results in DI. Oversecretion of ADH results in SIADH.