Chapter 57: Concepts of Care for Patients With Pituitary and Adrenal Gland Problems

The nurse should monitor the client with Cushing's disease for which of the following? 1. Postprandial hypoglycemia. 2. Hypokalemia. 3. Hyponatremia. 4. Decreased urine calcium level.

2. Sodium retention is typically accompanied by potassium depletion. Hypertension, hypokalemia, edema, and heart failure may result from the hypersecretion of aldosterone. The client with Cushing's disease exhibits postprandial or persistent hyperglycemia. Clients with Cushing's disease have hypernatremia, not hyponatremia. Bone resorption of calcium increases the urine calcium level.

When teaching a client newly diagnosed with primary Addison's disease, the nurse should explain that the disease results from: 1. Insufficient secretion of growth hormone (GH). 2. Dysfunction of the hypothalamic pituitary. 3. Idiopathic atrophy of the adrenal gland. 4. Oversecretion of the adrenal medulla.

3. Primary Addison's disease refers to a problem in the gland itself that results from idiopathic atrophy of the glands. The process is believed to be autoimmune in nature. The most common causes of primary adrenocortical insuffi ciency are autoimmune destruction (70%) and tuberculosis (20%). Insufficient secretion of GH causes dwarfism or growth delay. Hyposecretion of glucocorticoids, aldosterone, and androgens occur with Addison's disease. Pituitary dysfunction can cause Addison's disease, but this is not a primary disease process. Oversecretion of the adrenal medulla causes pheochromocytoma.

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.

Which of the following indicates that the client with diabetes insipidus understands how to manage care? 1. The client will maintain normal fluid and electrolyte balance. 2. The client will select the American Diabetes Association diet correctly. 3. The client will state dietary restrictions. 4. The client will exhibit serum glucose levels within the normal range.

1. Because diabetes insipidus involves the excretion of large amounts of fluid, maintaining normal fluid and electrolyte balance is a priority for this client. Special dietary programs or restrictions are not indicated in the treatment of diabetes insipidus. Serum glucose levels are priorities in diabetes mellitus but not in diabetes insipidus.

Which of the following should the nurse include in the teaching plan of a female client with bilateral adrenalectomy? 1. Emphasizing that the client will need steroid replacement for the rest of her life. 2. Instructing the client about the importance of tapering steroid medication carefully to prevent crisis. 3. Informing the client that steroids will be required only until her body can manufacture sufficient quantities. 4. Emphasizing that the client will need to take steroids whenever her life involves physical or emotional stress.

1. Bilateral adrenalectomy requires lifelong adrenal hormone replacement therapy. If unilateral surgery is performed, most clients gradually reestablish a normal secretion pattern. The client and family will require extensive teaching and support to maintain self-care management at home. Information on dosing, adverse effects, what to do if a dose is missed, and follow-up examinations is needed in the teaching plan. Although steroids are tapered when given for an intermittent or one-time problem, they are not discontinued when given to clients who have undergone bilateral adrenalectomy because the clients will not regain the ability to manufacture steroids. Steroids must be taken on a daily basis, not just during periods of physical or emotional stress.

As the nurse assists the postoperative client out of bed, the client reports having gas pains in the abdomen. Which of the following is the most effective nursing intervention to relieve this discomfort? 1. Encourage the client to ambulate. 2. Insert a rectal tube. 3. Insert a nasogastric (NG) tube. 4. Encourage the client to drink carbonated liquids.

1. Decreased mobility is one of the most common causes of abdominal distention related to retained gas in the intestines. Peristalsis has been inhibited by general anesthesia, analgesics, and inactivity during the immediate postoperative period. Ambulation increases peristaltic activity and helps move gas. Walking can prevent the need for a rectal tube, which is a more invasive procedure. An NG tube is also a more invasive procedure and requires a physician's order. It is not a preferred treatment for gas postoperatively. Walking should prevent the need for further interventions. Carbonated liquids can increase gas formation.

The client's wife asks the nurse whether the I.V. infusion is meeting her husband's nutritional needs because he has vomited several times. The nurse's response should be based on the knowledge that 1 L of 5% dextrose in normal saline solution delivers: 1. 170 calories. 2. 250 calories. 3. 340 calories. 4. 500 calories.

1. Each liter of 5% dextrose in a normal saline solution contains 170 calories. The nurse should consult with the physician and dietitian when a client is on I.V. therapy or is on nothing-by-mouth status for an extended period because further electrolyte supplementation or alimentation therapy may be needed.

Which of the following is a priority outcome for the client with Addison's disease? 1. Maintenance of medication compliance. 2. Avoidance of normal activities with stress. 3. Adherence to a 2-g sodium diet. 4. Prevention of hypertensive episodes.

1. Medication compliance is an essential part of the self-care required to manage Addison's disease. The client must learn to adjust the glucocorticoid dose in response to the normal and unexpected stresses of daily living. The nurse should instruct the client never to stop taking the drug without consulting the health care provider to avoid an addisonian crisis. Regularity in daily habits makes adjustment easier, but the client should not be encouraged to withdraw from normal activities to avoid stress. The client does not need to restrict sodium. The client is at risk for hyponatremia. Hypotension, not hypertension, is more common with Addison's disease.

After a pituitary surgery, the nurse should assess the client for which of the following? 1. Urine specific gravity less than 1.010. 2. Urine output between 1 and 2 L/day. 3. Blood glucose level higher than 300 mg/dL. 4. Urine negative for glucose and ketones.

1. Pituitary diabetes insipidus is a potential complication after pituitary surgery because of possible interference with the production of antidiuretic hormone (ADH). One major manifestation of diabetes insipidus is polyuria because lack of ADH results in insufficient water reabsorption by the kidneys. The polyuria leads to a decreased urine specific gravity (between 1.001 and 1.010). The client may drink and excrete 5 to 40 L of fluid daily. Diabetes insipidus does not affect metabolism. A blood glucose level higher than 300 mg/dL is associated with impaired glucose metabolism or diabetes mellitus. Urine negative for sugar and ketones is normal.

Which of the following signs and symptoms are common in male clients with prolactin-secreting tumors? 1. Severe lethargy and fatigue. 2. Decreased libido and impotence. 3. Bony proliferation of the hands, jaw, and feet. 4. Deepening or coarsening of the voice.

2. Excessive prolactin secretion in men results in decreased libido and impotence; these are often the only signifi cant signs and symptoms until the tumor becomes large. Signs and symptoms of pituitary tumors result from both the presence of a space-occupying mass in the cranium and the excess secretion of hormones. Lethargy and fatigue are associated with hypothyroidism or Addisonian crisis. Bony proliferation and voice changes are associated with excessive growth hormone.

After stabilization of Addison's disease, the nurse teaches the client about stress management. The nurse should instruct the client to: 1. Remove all sources of stress from daily life. 2. Use relaxation techniques such as music. 3. Take antianxiety drugs daily. 4. Avoid discussing stressful experiences.

2. Finding alternative methods of dealing with stress, such as relaxation techniques, is a cornerstone of stress management. Removing all sources of stress from one's life is not possible. Antianxiety drugs are prescribed for temporary management during periods of major stress, and they are not an intervention in stress management classes. Avoiding discussion of stressful situations will not necessarily reduce stress.

Vasopressin (Pitressin) is administered to the client with diabetes insipidus because it: 1. Decreases blood pressure. 2. Increases tubular reabsorption of water. 3. Increases release of insulin from the pancreas. 4. Decreases glucose production within the liver.

2. The major characteristic of diabetes insipidus is decreased tubular reabsorption of water due to insuffi cient amounts of antidiuretic hormone (ADH). Vasopressin (Pitressin) is administered to the client with diabetes insipidus because it has pressor and ADH activities. Vasopressin works to increase the concentration of the urine by increasing tubular reabsorption, thus preserving up to 90% water. Vasopressin is administered to the client with diabetes insipidus because it is a synthetic ADH. The administration of vasopressin results in increased tubular reabsorption of water, and it is effective for emergency treatment or daily maintenance of mild diabetes insipidus. Vasopressin does not decrease blood pressure or affect insulin production or glucose metabolism, nor is insulin production a factor in diabetes insipidus.

A client with Addison's disease is admitted to the medical unit. The nurse diagnoses the client with Deficient fluid volume related to inadequate fluid intake and fluid loss secondary to inadequate adrenal hormone secretion. As the client's oral intake increases, which of the following fluids would be most appropriate? 1. Milk and diet soda. 2. Water and eggnog. 3. Bouillon and juice. 4. Coffee and milkshakes.

3. Electrolyte imbalances associated with Addison's disease include hypoglycemia, hyponatremia, and hyperkalemia. Salted bouillon and fruit juices provide glucose and sodium to replenish these deficits. Diet soda does not contain sugar. Water could cause further sodium dilution. Coffee's diuretic effect would aggravate the fl uid defi cit. Milk contains potassium and sodium.

Cushing's disease is manifested by the excessive secretion of corticosteroids. The hormones involved are: 1. Glucocorticoids and aldosterone. 2. Adrenocorticotropic hormone (ACTH). 3. Glucocorticoids, aldosterone, and androgens. 4. Catecholamines.

3. Excessive levels of glucocorticoids, aldosterone, and androgens secreted from the adrenal cortex result in the constellation of symptoms known as Cushing's disease. Cushing's disease can be caused by a tumor, overstimulation from the pituitary, or the use of prescription steroid drugs. Androgens are also secreted in excess. ACTH is only one hormone that is abnormal in Cushing's disease. Excessive secretion of catecholamines accompanies pheochromocytoma, a disease of the adrenal medulla.

A client undergoing bilateral adrenalectomy has postoperative orders for hydromorphone hydrochloride (Dilaudid) 2 mg to be given subcutaneously every 4 hours p.r.n. for pain. This drug is administered in relatively small doses primarily because it is: 1. Less likely to cause dependency in small doses. 2. Less irritating to subcutaneous tissues in small doses. 3. As potent as most other analgesics in larger doses. 4. Excreted before accumulating in toxic amounts in the body.

3. Hydromorphone hydrochloride (Dilaudid) is about five times more potent than morphine sulfate, from which it is prepared. Therefore, it is administered only in small doses. Hydromorphone hydrochloride can cause dependency in any dose; however, the fear of dependency developing in the postoperative period is unwarranted. The dose is determined by the client's need for pain relief. Hydromorphone hydrochloride is not irritating to subcutaneous tissues. As with opioid analgesics, excretion depends on normal liver function.

Initial treatment for cerebrospinal fluid (CSF) leak after transsphenoidal hypophysectomy would most likely involve: 1. Repacking the nose. 2. Returning the client to surgery. 3. Enforcing bed rest with the head of the bed elevated. 4. Administering high-dose corticosteroid therapy.

3. If CSF leakage is suspected or confirmed, the client is treated initially with bed rest with the head of the bed elevated to decrease pressure on the graft site. Most leaks heal spontaneously, but occasionally surgical repair of the site in the sella turcica is needed. Repacking the nose will not heal the leak at the graft site in the dura. The client will not be returned to surgery immediately because most leaks heal spontaneously. High-dose corticosteroid therapy is not effective in healing a CSF leak.

A client who is recovering from bilateral adrenalectomy has a patient-controlled analgesia (PCA) system with morphine sulfate. Which of the following actions is a priority nursing intervention for the client? 1. Observing the client at regular intervals for opioid addiction. 2. Encourage the client to reduce analgesic use and tolerate the pain. 3. Evaluating pain control at least every 2 hours. 4. Increasing the amount of morphine if the client does not administer the medication.

3. Pain control should be evaluated at least every 2 hours for the client with a PCA system. Addiction is not a common problem for the postoperative client. A client should not be encouraged to tolerate pain; in fact, other nursing actions besides PCA should be implemented to enhance the action of opioids. One of the purposes of PCA is for the client to determine frequency of administering the medication; the nurse should not interfere unless the client is not obtaining pain relief. The nurse should ensure that the client is instructed on the use of the PCA control button and that the button is always within reach.

Which of the following signs and symptoms would probably indicate that the client with Addison's disease is receiving too much glucocorticoid replacement? 1. Anorexia. 2. Dizziness. 3. Rapid weight gain. 4. Poor skin turgor.

3. Rapid weight gain, because it reflects excess fluids, is a warning sign that the client is receiving too much hormone replacement. It may be difficult to individualize the correct dosage for a client taking glucocorticoids, and the therapeutic range between underdosage and overdosage is narrow. Maintaining the client on the lowest dose that provides satisfactory clinical response is always the goal of pharmacotherapeutics. Fluid balance is an important indicator of the adequacy of hormone replacement. Anorexia is not present with glucocorticoid therapy because these drugs increase the appetite. Dizziness is not specific to the effects of glucocorticoid therapy. Poor skin turgor is a late sign of fluid volume deficit.

After a bilateral adrenalectomy for Cushing's disease, the client will receive periodic testosterone injections. The expected outcome of these injections is: 1. Balanced reproductive cycle. 2. Restored sodium and potassium balance. 3. Stimulated protein metabolism. 4. Stabilized mood swings.

3. Testosterone is an androgen hormone that is responsible for protein metabolism as well as the maintenance of secondary sexual characteristics; therefore, it is needed by both males and females. Removal of both adrenal glands necessitates the replacement of glucocorticoids and androgens. Testosterone does not balance the reproductive cycle, stabilize mood swings, or restore sodium and potassium balance.

Before undergoing transsphenoidal hypophysectomy for pituitary adenoma, the client asks the nurse how the surgeon will close the incision made in the dura. The nurse should respond based on the knowledge that: 1. Dissolvable sutures are used to close the dura. 2. Nasal packing provides pressure until normal wound healing occurs. 3. A patch is made with a piece of fascia. 4. A synthetic mesh is placed to facilitate healing.

3. The dural opening is typically repaired with a patch of muscle or fascia taken from the abdomen or thigh. The client should be prepared preoperatively for the presence of this additional incision in the abdomen or thigh. The client will need the patch of muscle or fascia to replace the dura. Disposable sutures alone will not provide an intact suture line. Nasal packing will not provide closure for the dural opening. A synthetic mesh is not the tissue of choice for surgical repair of the dura.

After surgery for bilateral adrenalectomy, the client is kept on bed rest for several days to stabilize the body's need for steroids postoperatively. Which of the following exercises will be the most effective for preparing a client for ambulation after a period of bed rest? 1. Alternately flexing and extending the knees. 2. Alternately abducting and adducting the legs. 3. Alternately stretching the Achilles tendons. 4. Alternately flexing and relaxing the quadriceps femoris muscles.

4. Alternately flexing and relaxing the quadriceps femoris muscles helps prepare the client for ambulation. This exercise helps maintain the strength in the quadriceps, which is the major muscle group used when walking. The other exercises listed do not increase a client's readiness for walking.

The nurse should tell the client to do which of the following when teaching the client about taking oral glucocorticoids? 1. "Take your medication with a full glass of water." 2. "Take your medication on an empty stomach." 3. "Take your medication at bedtime to increase absorption." 4. "Take your medication with meals or with an antacid."

4. Oral steroids can cause gastric irritation and ulcers and should be administered with meals, if possible, or otherwise with an antacid. Onlyinstructing the client to take the edication with a full glass of water will not help prevent gastric complications from steroids. Steroids should never be taken on an empty stomach. Glucocorticoids should be taken in the morning, not at bedtime.

A nurse is reviewing laboratory results for a client who has Addison's disease. Which of the following laboratory results should the nurse expect for this client? (Select all that apply.) A. Sodium 130 mEg/L B. Potassium 6.1 mEq/L C. Calcium 11.6 mg/dL D. Blood urea nitrogen (BUN) 28 mg/dL E. Fasting blood glucose 148 mg/dL

A. CORRECT: This finding is below the expected reference range. In the presence of Addison's disease, insufficient glucose can cause sodium and water excretion. Hyponatremia is an expected finding. B. CORRECT: This finding is above the expected reference range. Hyperkalemia is an expected finding for a client who has Addison's disease. C. CORRECT: This finding is above the expected reference range. Hypercalcemia is an expected finding for a client who has Addison's disease. D. CORRECT: This BUN level is above the expected reference range, which is an expected finding for a client who has Addison's disease due to dehydration. E. This finding is above the expected reference range for a fasting blood glucose level. Hypoglycemia or blood glucose in the normal range is an expected finding for a client who has Addison's disease.

A nurse is caring for a client who has diabetes insipidus. Which of the following urinalysis laboratory findings should the nurse expect? A. Presence of glucose B. Decreased specific gravity C. Presence of ketones D. Presence of red blood cells

A. Glucose in the urine is indicative of diabetes mellitus. B. CORRECT: The urine of a client who has diabetes insipidus will be diluted with a urine specific gravity of less than 1.005. C. Ketones in the urine is indicative of diabetes mellitus. D. Red blood cells in the urine is indicative of diabetes mellitus.

A nurse is planning to teach a client who is being evaluated for Addison's disease about the adrenocorticotropic hormone (ACTH) stimulation test. The nurse should base the instructions on which of the following? A. The ACTH stimulation test measures the response by the kidneys to ACTH. B. In the presence of primary adrenal insufficiency, plasma cortisol levels rise in response to administration of ACTH. C. ACTH is a hormone produced by the pituitary gland. D. The client is instructed to take a dose of ACTH by mouth the evening before the test.

A. The ACTH stimulation test measures the response by the adrenal glands to ACTH. B. In the presence of primary adrenal insufficiency, plasma cortisol levels do not rise in response to administration of ACTH. C. CORRECT: Secretion of corticotropin-releasing hormone from the hypothalamus prompts the pituitary gland to secrete ACTH. D. ACTH is administered during the testing process, and plasma cortisol levels are measured 30 min and 1 hr after the injection.

A nurse is planning care for a client who has acromegaly and is postoperative following a transsphenoidal hypophysectomy. Which of the following interventions should the nurse include in the plan? A. Maintain the client in a low-Fowler's position. B. Encourage deep breathing and coughing. C. Encourage the client to brush their teeth when awake and alert. D. Observe dressing drainage for the presence of glucose.

A. The client should be placed into a high-Fowler's position. B. Coughing should be limited in the client who is postoperative, as this increases intracranial pressure and can cause a leak of CSF C. Oral care for the client who is postoperative following transsphenoidal hypophysectomy includes oral rinses and flossing. Brushing teeth can cause a leak of CSF and is contraindicated. D. CORRECT: The nurse should monitor the drainage to the mustache dressing and observe for the presence of glucose, which would indicate the presence of CSF. Notify the provider if this occurs.

A nurse is providing medication teaching for a client who has Addison's disease and is taking hydrocortisone. Which of the following instructions should the nurse include? (Select all that apply.) A. Take the medication on an empty stomach. B. Notify the provider of any illness or stress. C. Report any manifestations of weakness or dizziness. D. Do not discontinue the medication suddenly. E. Eat a low-sodium diet.

A. The client should take hydrocortisone with food to decrease Gl distress. B. CORRECT: Physical and emotional stress increases the need for hydrocortisone. The provider can increase the dosage when stress occurs. C. CORRECT: Weakness and dizziness are indications of adrenal insufficiency. The client should report these indications to the provider. D. CORRECT: Rapid discontinuation can result in adverse effects, including acute adrenal insufficiency. If hydrocortisone is to be discontinued, the dose should be tapered. E. Addison's disease causes hyponatremia. The client might require sodium supplementation, especially if experiencing diaphoresis or vomiting.

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 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.

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.

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 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.

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.

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.

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 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.

Galactorrhea is caused by the overproduction of which hormone? 1. Prolactin. 2. Adrenocorticotropic hormone (ACTH). 3. Growth hormone (GH). 4. Thyroid-stimulating hormone (TSH).

1. Galactorrhea, or abnormal flow of breast milk, results from overproduction of prolactin. Pituitary tumors are almost always secreting tumors, and they are classified by the specific hormone secreted. Pituitary tumors can cause oversecretion of ACTH, GH, or TSH. Overproduction of ACTH results in Cushing's disease. Overproduction of GH results in gigantism. Overproduction of TSH results in hyperthyroidism.

Following transsphenoidal hypophysectomy, the nurse should assess the client for: 1. Cerebrospinal fl uid (CSF) leak. 2. Fluctuating blood glucose levels. 3. Cushing's syndrome. 4. Cardiac arrthymias.

1. A major focus of nursing care after transsphenoidal hypophysectomy is the prevention of and monitoring for a CSF leak. CSF leakage can occur if the patch or incision is disrupted. The nurse should monitor for signs of infection, including elevated temperature, increased white blood cell count, rhinorrhea, nuchal rigidity, and persistent headache. Hypoglycemia and adrenocortical insufficiency may occur. Monitoring for fluctuating blood glucose levels is not related specifically to transsphenoidal hypophysectomy. The client will be given I.V. fluids postoperatively to supply carbohydrates. Cushing's disease results from adrenocortical excess, not insufficiency. Monitoring for cardiac arrhythmias is important, but arrhythmias are not anticipated following a transsphenoidal hypophysectomy.

To provide oral hygiene for a client recovering from transsphenoidal hypophysectomy, the nurse should instruct the client to: 1. Rinse the mouth with saline solution. 2. Perform frequent toothbrushing. 3. Clean the teeth with an electric toothbrush. 4. Floss the teeth thoroughly.

1. After transsphenoidal surgery, the client must be careful not to disturb the suture line while healing occurs. Frequent oral care should be provided with rinses of saline, and the teeth may be gently cleaned with Toothettes. Frequent or vigorous toothbrushing or flossing is contraindicated because it may disturb or cause tension on the suture line.

Adrenal function is affected by the drug ketoconazole (Nizoral), an antifungal agent used to treat severe fungal infections. How is this effect manifested? 1. Ketoconazole suppresses adrenal steroid secretion. 2. Ketoconazole destroys adrenocortical cells, resulting in a "medical" adrenalectomy. 3. Ketoconazole increases adrenocorticotropic hormone (ACTH)-induced corticosteroid serum levels. 4. Ketoconazole decreases the duration of adrenal suppression when administered with corticosteroids.

1. Ketoconazole (Nizoral) suppresses adrenal steroid secretion and may cause acute hypoadrenalism. The adverse effect should reverse when the drug is discontinued. Ketoconazole does not destroy adrenal cells; mitotane (Lysodren) destroys the cells and may be used to obtain a medical adrenalectomy. Ketoconazole decreases, not increases, ACTH-induced serum corticosteroid levels. It increases the duration of adrenal suppression when given with steroids.

The client is receiving an I.V. infusion of 5% dextrose in normal saline running at 125 mL/hour. When hanging a new bag of fluid, the nurse notes swelling and hardness at the infusion site. The nurse should first: 1. Discontinue the infusion. 2. Apply a warm soak to the site. 3. Stop the flow of the solution temporarily. 4. Irrigate the needle with normal saline.

1. Signs of infiltration include slowing of the infusion and swelling, pain, hardness, pallor, and coolness of the skin at the site. If these signs occur, the I.V. line should be discontinued and restarted at another infusion site. The new anatomic site, time, and type of cannula used should be documented. The nurse may apply a warm soak to the site, but only after the I.V. line is discontinued. Parenteral administration of fluids should not be stopped intermittently. Stopping the flow does not treat the problem, nor does it address the client's need for fluid replacement. Infiltrated I.V. sites should not be irrigated; doing so will only cause more swelling and pain.

A client expresses concern about how hypophysectomy will affect his sexual function. Which of the following statements provides the most accurate information about the physiologic effects of hypophysectomy? 1. Removing the source of excess hormones should restore the client's libido, erectile function, and fertility. 2. Potency will be restored, but the client will remain infertile. 3. Fertility will be restored, but impotence and decreased libido will persist. 4. Exogenous hormones will be needed to restore erectile function after the adenoma is removed.

1. The client's sexual problems are directly related to the excessive prolactin level. Removing the source of excessive hormone secretion should allow the client to return gradually to a normal physiologic pattern. Fertility will return, and erectile function and sexual desire will return to baseline as hormone levels return to normal

The client with Addison's disease is taking glucocorticoids at home. Which of the following statements indicates that the client understands how to take the medication? 1. "Various circumstances increase the need for glucocorticoids, so I will need to adjust the dosage." 2. "My need for glucocorticoids will stabilize and I will be able to take a predetermined dose once a day." 3. "Glucocorticoids are cumulative, so I will take a dose every third day." 4. "I must take a dose every 6 hours to ensure consistent blood levels of glucocorticoids."

1. The need for glucocorticoids changes with circumstances. The basal dose is established when the client is discharged, but this dose covers only normal daily needs and does not provide for additional stressors. As the manager of the medication schedule, the client needs to know signs and symptoms of excessive and insuffi cient dosages. Glucocorticoid needs fl uctuate. Glucocorticoids are not cumulative and must be taken daily. They must never be discontinued suddenly; in the absence of endogenous production, addisonian crisis could result. Two-thirds of the daily dose should be taken at about 8 a.m. and the remainder at about 4 p.m. This schedule approximates the diurnal pattern of normal secretion, with highest levels between 4 a.m. and 6 a.m. and lowest levels in the evening.

The nurse is conducting discharge education with a client newly diagnosed with Addison's disease. Which information should be included in the client and family teaching plan? Select all that apply. 1. Addison's disease will resolve over a few weeks, requiring no further treatment. 2. Avoiding stress and maintaining a balanced lifestyle will minimize risk for exacerbations. 3. Fatigue, weakness, dizziness, and mood changes need to be reported to the physician. 4. A medical identification bracelet should be worn. 5. Family members need to be informed about the warning signals of adrenal crisis. 6. Dental work or surgery will require adjustment of daily medication.

2, 3, 4, 5, 6. Addison's disease occurs when the client does not produce enough steroids from the adrenal cortex. Lifetime steroid replacement is needed. The client should be taught lifestyle management techniques to avoid stress and maintain rest periods. A medical identifi cation bracelet should be worn and the family should be taught signs and symptoms that indicate an impending adrenal crisis, such as fatigue, weakness, dizziness, or mood changes. Dental work, infections, and surgery commonly require an adjusted dosage of steroids.

The client who has undergone a bilateral adrenalectomy is ready to return home. She tells the nurse that she is concerned about persistent body changes and the fact that her moods are still unpredictable. She says, "I thought surgery was supposed to fix all that." The nurse should tell the client that: 1. The body changes are permanent and the client will not be the same as before this condition. 2. The body and mood will gradually return to normal. 3. The physical changes are permanent, but the mood swings will disappear. 4. The physical changes are temporary, but the mood swings are permanent.

2. As the body readjusts to normal cortisol levels, mood, and physical changes will gradually return to a normal state. The body changes are not permanent, and the mood swings should level off.

The client with Cushing's disease needs to modify dietary intake to control symptoms. In addition to increasing protein, which strategy would be most appropriate? 1. Increase calories. 2. Restrict sodium. 3. Restrict potassium. 4. Reduce fat to 10%.

2. A primary dietary intervention is to restrict sodium, thereby reducing fluid retention. Increased protein catabolism results in loss of muscle mass and necessitates supplemental protein intake. The client may be asked to restrict total calories to reduce weight. The client should be encouraged to eat potassium-rich foods because serum levels are typically depleted. Although reducing fat intake as part of an overall plan to restrict calories is appropriate, fat intake of less than 20% of total calories is not recommended.

Which of the following is the priority for a client in an Addisonian crisis? 1. Controlling hypertension. 2. Preventing irreversible shock. 3. Preventing infection. 4. Relieving anxiety.

2. Addison's disease is caused by a deficiency of adrenal corticosteroids and can result in severe hypotension and shock because of uncontrolled loss of sodium in the urine and impaired mineralocorticoid function. This results in loss of extracellular fluid and dangerously low blood volume. Glucocorticoids must be administered to reverse hypotension. Preventing infection is not an appropriate goal of care in this life-threatening situation. Relieving anxiety is appropriate when the client's condition is stabilized, but the calm, competent demeanor of the emergency department staff will be initially reassuring.

Which of the following would be an expected finding in a client with an adrenal crisis (Addisonian crisis)? 1. Fluid retention. 2. Pain. 3. Peripheral edema. 4. Hunger.

2. Adrenal hormone defi ciency can cause profound physiologic changes. The client may experience severe pain (headache, abdominal pain, back pain, or pain in the extremities). Inhibited gluconeogenesis commonly produces hypoglycemia, and impaired sodium retention causes decreased, not increased, fl uid volume. Edema would not be expected. Gastrointestinal disturbances, including nausea and vomiting, are expected fi ndings in Addison's disease, not hunger.

A client has an adrenal tumor and is scheduled for a bilateral adrenalectomy. During preoperative teaching, the nurse teaches the client how to do deep breathing exercises after surgery by telling the client to: 1. "Sit in an upright position and take a deep breath." 2. "Hold your abdomen firmly with a pillow and take several deep breaths." 3. "Tighten your stomach muscles as you inhale and breathe normally." 4. "Raise your shoulders to expand your chest."

2. Effective splinting for a high incision reduces stress on the incision line, decreases pain, and increases the client's ability to deep-breathe effectively. Deep breathing should be done hourly by the client after surgery. Sitting upright ignores the need to splint the incision to prevent pain. Tightening the stomach muscles is not an effective strategy for promoting deep breathing. Raising the shoulders is not a feature of deep-breathing exercises.

Signs and symptoms of Cushing's disease include: 1. Weight loss. 2. Thin, fragile skin. 3. Hypotension. 4. Abdominal pain.

2. In Cushing's disease, excessive cortisol secretion causes rapid protein catabolism, depleting the collagen support of the skin. The skin becomes thin and fragile and susceptible to easy bruising. The typical "cushingoid" appearance of the client includes a moon face, buffalo hump, central obesity, and thin musculature. Weight gain, mood swings, and slow wound healing are other signs and symptoms of Cushing's disease. Hypertension, not hypotension, is a sign of Cushing's disease. Abdominal pain is not a symptom of Cushing's disease.

Bone resorption is a possible complication of Cushing's disease. Which of the following interventions should the nurse recommend to help the client prevent this complication? 1. Increase the amount of potassium in the diet. 2. Maintain a regular program of weight-bearing exercise. 3. Limit dietary vitamin D intake. 4. Perform isometric exercises.

2. Osteoporosis is a serious outcome of prolonged cortisol excess because calcium is resorbed out of the bone. Regular daily weight-bearing exercise (e.g., brisk walking) is an effective way to drive calcium back into the bones. The client should also be instructed to have a dietary or supplemental intake of calcium of 1,500 mg daily. Potassium levels are not relevant to the prevention of bone resorption. Vitamin D is needed to aid in the absorption of calcium. Isometric exercises condition muscle tone but do not build bones.

Because of steroid excess after bilateral adrenalectomy, the nurse should assess the client for: 1. Postoperative confusion. 2. Delayed wound healing. 3. Emboli. 4. Malnutrition.

2. Persistent cortisol excess undermines the collagen matrix of the skin, impairing wound healing. It also carries an increased risk of infection and of bleeding. The wound should be observed and documentation performed regarding the status of healing. Confusion and emboli are not expected complications after adrenalectomy. Malnutrition also is not an expected complication after adrenalectomy. Nutritional status should be regained postoperatively.

In the early postoperative period after a bilateral adrenalectomy, the client has an increased temperature. The nurse should assess the client further for signs of: 1. Dehydration. 2. Poor lung expansion. 3. Wound infection. 4. Urinary tract infection.

2. Poor lung expansion from bed rest, pain, and retained anesthesia is a common cause of slight postoperative temperature elevation. Nursing care includes turning the client and having the client cough and deep-breathe every 1 to 2 hours, or more frequently as ordered. The client will have postoperative I.V. fluid replacement ordered to prevent dehydration. Wound infections typically appear 4 to 7 days after surgery. Urinary tract infections would not be typical with this surgery.

The nurse should assess a client with Addison's disease for which of the following? 1. Weight gain. 2. Hunger. 3. Lethargy. 4. Muscle spasms.

3. Although many of the disease signs and symptoms are vague and nonspecific, most clients experience lethargy and depression as early symptoms. Other early signs and symptoms include mood changes, emotional lability, irritability, weight loss, muscle weakness, fatigue, nausea, and vomiting. Most clients experience a loss of appetite. Muscles become weak, not spastic, because of adrenocortical insufficiency.

A nurse assesses a client who potentially has hyperaldosteronism. Which serum laboratory values would the nurse associate with this disorder? (Select all that apply.) a. Sodium: 150 mEq/L (150 mmol/L) b. Sodium: 130 mEq/L (130 mmol/L) c. Potassium: 2.5 mEq/L (2.5 mmol/L) d. Potassium: 5.0 mEq/L (5.0 mmol/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 client with Cushing's disease tells the nurse that the physician said the morning serum cortisol level was within normal limits. The client asks, "How can that be? I'm not imagining all these symptoms!" The nurse's response will be based on which of the following concepts? 1. Some clients are very sensitive to the effects of cortisol and develop symptoms even with normal levels. 2. A single random blood test cannot provide reliable information about endocrine levels. 3. The excessive cortisol levels seen in Cushing's disease commonly result from loss of the normal diurnal secretion pattern. 4. Tumors tend to secrete hormones irregularly, and the hormones are generally not present in the blood.

3. Cushing's disease is commonly caused by loss of the diurnal cortisol secretion pattern. The client's random morning cortisol level may be within normal limits, but secretion continues at that level throughout the entire day. Cortisol levels should normally decrease after the morning peak. Analysis of a 24-hour urine specimen is often useful in identifying the cumulative excess. Clients will not have symptoms with normal cortisol levels. Hormones are present in the blood.

A nurse is assessing a client with Addison's disease. The nurse should review laboratory reports for which condition? 1. Hypokalemia. 2. Hypernatremia. 3. Hypoglycemia. 4. Decreased blood urea nitrogen (BUN) level.

3. Decreased hepatic gluconeogenesis and increased tissue glucose uptake cause hypoglycemia in clients with Addison's disease. Hyperkalemia and hyponatremia are characteristic of Addison's disease. There is decreased renal perfusion and excretion of waste products, which causes an elevated BUN level.

To help minimize the risk of postoperative respiratory complications after a hypophysectomy, during preoperative teaching, the nurse should instruct the client how to: 1. Use blow bottles. 2. Turn in bed. 3. Take deep breaths. 4. Cough.

3. Deep breathing is the best choice for helping prevent atelectasis. The client should be placed in the semi-Fowler's position (or as ordered) and taught deep breathing, sighing, mouth breathing, and how to avoid coughing. Blow bottles are not effective in preventing atelectasis because they do not promote sustained alveolar infl ation to maximal lung capacity. Frequent position changes help loosen lung secretions, but deep breathing is most important in preventing atelectasis. Coughing is contraindicated because it increases intracranial pressure and can cause cerebrospinal fl uid to leak from the point at which the sella turcica was entered.

Cortisone acetate (Cortone) and fludrocortisone acetate (Florinef Acetate) are prescribed as replacement therapy for a client with Addison's disease. What administration schedule should be followed for this therapy? 1. Take both drugs three times a day. 2. Take the entire dose of both drugs first thing in the morning. 3. Take all the fludrocortisone acetate and two-thirds of the cortisone acetate in the morning, and take the remaining cortisone acetate in the afternoon. 4. Take half of each drug in the morning and the remaining half of each drug at bedtime.

3. Fludrocortisone acetate (Florinef Acetate) can be administered once a day, but cortisone acetate (Cortone) administration should follow the body's natural diurnal pattern of secretion. Greater amounts of cortisol are secreted during the day to meet increased demand of the body. Typically, baseline administration of cortisone acetate is 25 mg in the morning and 12.5 mg in the afternoon. Taking it three times a day would result in an excessive dose. Taking the drug only in the morning would not meet the needs of the body later in the day and evening.

The client with Addison's disease should anticipate the need for increased glucocorticoid supplementation in which of the following situations? 1. Returning to work after a weekend. 2. Going on vacation. 3. Having oral surgery. 4. Having a routine medical checkup.

3. Illness or surgery places tremendous stress on the body, necessitating increased glucocorticoid dosage. Extreme emotional or psychological stress also necessitates dosage adjustment. Increased dosages are needed in times of stress to prevent drug-induced adrenal insufficiency. Returning to work after the weekend, going on a vacation, or having a routine checkup usually will not alter glucocorticoid dosage needs.

A client reports that she has gained weight and that her face and body are "rounder," while her legs and arms have become thinner. A tentative diagnosis of Cushing's disease is made. When examining this client, the nurse would expect to find: 1. Orthostatic hypotension. 2. Muscle hypertrophy in the extremities. 3. Bruised areas on the skin. 4. Decreased body hair.

3. Skin bruising from increased skin and blood vessel fragility is a classic sign of Cushing's disease. Hyperpigmentation and bruising are caused by the hypersecretion of glucocorticoids. Fluid retention causes hypertension, not hypotension. Muscle wasting occurs in the extremities. Hair on the head thins, while body hair increases.

A priority in the first 24 hours after a bilateral adrenalectomy is: 1. Beginning oral nutrition. 2. Promoting self-care activities. 3. Preventing adrenal crisis. 4. Ambulating in the hallway.

3. The priority in the first 24 hours after adrenalectomy is to identify and prevent adrenal crisis. Monitoring of vital signs is the most important evaluation measure. Hypotension, tachycardia, orthostatic hypotension, and arrhythmias can be indicators of pending vascular collapse and hypovolemic shock that can occur with an adrenal crisis. Beginning oral nutrition is important, but not necessarily in the first 24 hours after surgery, and it is not more important than preventing an adrenal crisis. Promoting self-care activities is not as important as preventing adrenal crisis. Ambulating in the hallway is not a priority in the first 24 hours after adrenalectomy.

The nurse is instructing a young adult with Addison's disease how to adjust the dose of glucocorticoids. The nurse should explain that the client may need an increased dosage of glucocorticoids in which of the following situations? 1. Completing the spring semester of school. 2. Gaining 4 pounds. 3. Becoming engaged. 4. Undergoing a root canal.

4. Adrenal crises can occur with physical stress, such as surgery, dental work, infection, flu, trauma, and pregnancy. In these situations, glucocorticoid and mineralocorticoid dosages are increased. Weight loss, not gain, occurs with adrenal insufficiency. Psychological stress has less effect on corticosteroid needs than physical stress.

The nurse should teach the client with Addison's disease that the adverse effect of bronze-colored skin is thought to be caused by which of the following? 1. Hypersensitivity to sun exposure. 2. Increased serum bilirubin level. 3. Adverse effects of glucocorticoid therapy. 4. Increased secretion of adrenocorticotropic hormone (ACTH).

4. Bronzing, or general deepening of skin pigmentation, is a classic sign of Addison's disease and is caused by melanocyte-stimulating hormone produced in response to increased ACTH secretion. The hyperpigmentation is typically found in the distal portion of extremities and in areas exposed to the sun. Additionally, areas that may not be exposed to sun, such as the nipples, genitalia, tongue, and knuckles, become bronze-colored. Treatment of Addison's disease usually reverses the hyperpigmentation. Bilirubin level is not related to the pathophysiology of Addison's disease. Hyperpigmentation is not related to the effects of glucocorticoid therapy.

Which of the following is the best indicator for determining whether a client with Addison's disease is receiving the correct amount of glucocorticoid replacement? 1. Skin turgor. 2. Temperature. 3. Thirst. 4. Daily weight.

4. Measuring daily weight is a reliable, objective way to monitor fluid balance. Rapid variations in weight reflect changes in fluid volume, which suggests insufficient control of the disease and the need for more glucocorticoids in the client with Addison's disease. Nurses should instruct clients taking oral steroids to weigh themselves daily and to report any unusual weight loss or gain. Skin turgor testing does supply information about fluid status, but daily weight monitoring is more reliable. Temperature is not a direct measurement of fl uid balance. Thirst is a nonspecific and very late sign of weight loss.

The nurse teaches the client to report signs and symptoms of which potential complications after hypophysectomy. 1. Acromegaly. 2. Cushing's disease. 3. Diabetes mellitus. 4. Hypopituitarism.

4. Most clients who undergo adenoma removal experience a gradual return of normal pituitary secretion and do not experience complications. However, hypopituitarism can cause growth hormone, gonadotropin, thyroid-stimulating hormone, and adrenocorticotropic hormone deficits. The client should be taught to monitor for change in mental status, energy level, muscle strength, and cognitive function. In adults, changes in sexual function, impotence, or decreased libido should be reported. Acromegaly and Cushing's disease are conditions of hypersecretion. Diabetes mellitus is related to the function of the pancreas and is not directly related to the function of the pituitary.

A client is to have a transsphenoidal hypophysectomy to remove a large, invasive pituitary tumor. The nurse should instruct the client that the surgery will be performed through an incision in the: 1. Back of the mouth. 2. Nose. 3. Sinus channel below the right eye. 4. Upper gingival mucosa in the space between the upper gums and lip.

4. With transsphenoidal hypophysectomy, the sella turcica is entered from below, through the sphenoid sinus. There is no external incision; the incision is made between the upper lip and gums.

A nurse is admitting a client who has acute adrenal insufficiency. Which of the following prescriptions should the nurse expect? (Select all that apply.) A. IV therapy with 0.45% sodium chloride B. Regular insulin C. Hydrocortisone sodium succinate D. Sodium polystyrene sulfonate E. Furosemide

A. 0.45% sodium chloride is hypotonic. Clients who have acute adrenal insufficiency are hyponatremic. Anticipate a prescription for a solution that contains 0.9% sodium chloride. B. CORRECT: Clients who have acute adrenal insufficiency are hyperkalemic. Insulin is administered to shift potassium into the cells. C. CORRECT: Hydrocortisone sodium succinate is administered as replacement therapy of both glucocorticoid and mineralocorticoid. D. CORRECT: Clients who have acute adrenal insufficiency are hyperkalemic. Sodium polystyrene sulfonate is administered because it absorbs potassium. E. CORRECT: Loop and thiazide diuretics promote potassium excretion and are administered to treat hyperkalemia.

A nurse is caring for a client who has a syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following findings should the nurse expect? (Select all that apply.) A. Decreased blood sodium B. Urine specific gravity 1.001 C. Blood osmolarity 230 mOsm/L D. Polyuria E. Increased thirst

A. CORRECT: An increase in the secretion of ADH leads to dilutional hyponatremia. B. A urine-specific gravity greater than 1.030 (concentrated urine) is caused by an increase in the secretion of ADH. C. CORRECT: A decrease in blood osmolarity is caused by an increase in the secretion of ADH leading to water retention and dilution of blood components. D. Reduced urine output is caused by the increase in the secretion of ADH. E. Increased thirst is an expected finding in a client who has diabetes insipidus.

A nurse is providing teaching to a client who has a new diagnosis of diabetes insipidus. Which of the following client statements indicates an understanding of the teaching? A. "I can drink up to 2 quarts of fluid a day." B. "I will need to use insulin to control my blood glucose levels." C. "I should expect to gain weight during this illness." D. "I might experience confusion or balance problems."

A. Excessive thirst is a manifestation of diabetes insipidus Consumption of 4 to 30 L/day can be expected. and fluid intake should not be limited. B. Elevated blood glucose levels are a manifestation of diabetes mellitus. C. Weight loss is a manifestation of diabetes insipidus. D. CORRECT: Confusion and ataxia are findings associated with DI.

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.

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.

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.