Disorders of the Pituitary AQ
The nurse is obtaining a history and physical on a patient with acromegaly who reports visual changes. What should the nurse assess in this patient? Multiple choice question The function of cranial nerve II The function of cranial nerve III The function of cranial nerve IV The function of cranial nerve VI
The function of cranial nerve II In acromegaly, pituitary adenoma creates pressure on the optic nerve (cranial nerve II), causing visual changes. Cranial nerves III, IV, VI and are responsible for eye movements and eye muscle movements; pressure on these nerves does not cause visual changes in patients with acromegaly.
A young adult female patient with normal body weight has excessive hair growth on her face. Other symptoms include bitemporal hemianopsia, infrequent menstruation, and infertility. What type of endocrine disorder is suspected in the patient? Multiple choice question Acromegaly Prolactinomas Graves' disease Cushing syndrome
Prolactinomas Prolactinomas are a common type of pituitary adenomas that are associated with hirsutism, partial blindness, infrequent menstruation, and inability to conceive in females. Visual changes may occur with acromegaly, but symptoms such as infertility and hirsutism are not commonly seen. Graves' disease mostly manifests as exophthalmia and menstrual changes in females. In Cushing syndrome, weight gain, central obesity, and hypocalcemia are seen along with hirsutism and infertility.
The nurse is assessing a female patient that has developed fat pads on the back of the neck, an increased abdominal girth, facial hair growth, and a "moon" face. What disorder does this assessment data indicate? Multiple choice question Acromegaly Conn's disease Graves' disease Cushing syndrome
Cushing syndrome Cushing syndrome is caused by excessive secretion of adrenocorticotropic hormone. Acromegaly occurs due to excess secretion of growth hormone. Conn's disease occurs due to increased secretion of aldosterone hormone. Graves' disease occurs due to the excess secretion of thyroid hormone.
A patient has recently undergone transsphenoidal hypophysectomy and reports a severe supraorbital headache. The nurse maintains the patient's head in an elevated position and requests the patient stay on bed rest for four days. Which finding in the laboratory report is the reason for this nursing action? Multiple choice question Glucose level 15 mg/dL in the urine sample Glucose level 70 mg/dL in the blood sample Glucose level 40 mg/dL in the nasal drainage Glucose level 60 mg/dL in the cerebrospinal fluid
Glucose level 40 mg/dL in the nasal drainage A glucose level greater than 30 mg/dL in the nasal drainage indicates cerebrospinal leakage from an open connection to the brain. Supraorbital headache in a patient who has undergone transsphenoidal hypophysectomy is caused by cerebrospinal fluid (CSF) leakage into the sinuses. It can be resolved by placing the patient's head in an elevated position and asking him or her to take bed rest for 72 hours. Glucose levels in urine and blood are measured to know the diabetic condition of the patient; they do not indicate CSF leakage. Glucose levels in the cerebrospinal fluid (CSF) are used to monitor infections, tumors, and inflammation in the central nervous system, not postoperative leakage of CSF.
A patient is undergoing transsphenoidal hypophysectomy. The nurse is aware that the procedure involves surgical resection of what gland? Multiple choice question Thyroid Adrenal Pituitary Parathyroid
Pituitary Transsphenoidal hypophysectomy is the surgical removal of the pituitary gland. The surgical approach to the pituitary gland is made through an incision through the upper gum and nare into the base of the skull. Transsphenoidal hypophysectomy does not involve removal of the thyroid, adrenal, or parathyroid gland.
The nurse recalls that excessive secretion of the hormone vasopressin characterizes: Multiple choice question Thyrotoxicosis Diabetes insipidus Hyperosmolar hyperglycemic nonketotic syndrome Syndrome of inappropriate antidiuretic hormone secretion
Syndrome of inappropriate antidiuretic hormone secretion Another term for antidiuretic hormone (ADH) is vasopressin. Syndrome of inappropriate antidiuretic hormone secretion is characterized by excessive release of ADH from the posterior pituitary gland, resulting in the inability of the kidneys to dilute urine. The patient retains water and experiences increased extracellular fluid volume and hyponatremia. The disorder can cause cardiopulmonary overload and neurological problems as a result of water intoxication. Thyrotoxicosis, also known as thyroid storm or thyroid crisis, results from an abrupt increase in T3 and T4 thyroid hormones. Diabetes insipidus results from a decrease in ADH. Hyperosmolar hyperglycemic nonketotic syndrome results from hyperglycemia in type 2 non-insulin-dependent diabetes mellitus.
The nurse is educating patients about having a screening colonoscopy every three to four years, because they are at risk for developing colon polyps and colorectal cancer. What patient is at greatest risk for this complication? Multiple choice question A patient with acromegaly A patient with prolactinomas A patient with hypopituitarism A patient with pituitary infarctions
A patient with acromegaly Patients with acromegaly are at higher risk for colon polyps and colorectal cancer, and should have a screening colonoscopy performed every three to four years. Prolactinomas are the most common type of pituitary adenomas; these types of adenomas do not require colonoscopy. Hypopituitarism is a rare disorder that involves a decrease in one or more pituitary hormones; it does not require a screening colonoscopy. Pituitary infarctions are also called Sheehan syndrome; it involves the death of areas of tissue in the pituitary gland. This condition does not require a screening colonoscopy, because it is not associated with a risk of colon polyps and colorectal cancer.
The patient with small cell lung cancer experiences a sudden 5-pound weight gain without edema and a decreased urinary output. Serum sodium is 128 mEq/L. Which strategy does the nurse anticipate will be prescribed for the patient? Multiple choice question Low-sodium diet Elevate head of bed 30 degrees 1000 mL per day fluid restriction Administration of desmopressin acetate nasal spray
The patient is exhibiting signs of syndrome of inappropriate antidiuretic hormone (SIADH). Small cell lung cancer is one of the most common causes of SIADH. In the patient with SIADH, there is an excess of antidiuretic hormone (ADH); this causes excess water reabsorption by the kidneys, with a resulting increase in vascular volume. The decreased excretion of water by the kidneys and resulting increase in intravascular volume leads to weight gain without edema, decreased urinary output with an increase in urine-specific gravity, decreased plasma osmolarity, and dilutional hyponatremia. If the patient's serum sodium is above 125 mEq/L, a fluid restriction may be all that is needed to promote a rise in serum sodium to normal. Lower serum sodium requires more aggressive treatment. Because the patient is hyponatremic, a liberal salt diet is encouraged. The head of the bed should not be raised any higher than 10 degrees. Keeping the head of the bed low increases venous return to the heart; this increases left ventricular filling pressure, which triggers a message to the brain to decrease ADH release. Desmopressin acetate is a pharmacologic form of ADH, and it is used to treat diabetes insipidus, which is a condition of too little ADH secretion.
Which statement by the patient who is postoperative following a transphenoidal hypophysectomy indicates a need for further education? Multiple choice question "It is important that I brush my teeth every day." "I should refrain from vigorous coughing and sneezing" "I should notify the nurse if I develop a severe headache." "I may need to take a stool softener so that I do not strain with having a bowel movement."
"It is important that I brush my teeth every day." Tooth brushing should be avoided for 10 days to protect the suture line. Vigorous coughing and sneezing should be avoided to prevent cerebrospinal leakage. A severe headache may indicate cerebrospinal leakage into the sinuses. Straining with bowel movements may cause cerebrospinal leakage.
A patient is instructed to ingest 75 g of glucose orally as a part of an oral glucose tolerance test. In addition, growth hormone measurements are taken consecutively at 30, 60, 90, and 120 minutes. Glucose levels and growth hormone levels are found to be constant during the test. What does the nurse infer from these findings? Multiple choice question Acromegaly Hepatomegaly Splenomegaly Dactylomegaly
Acromegaly In addition to the patient history and physical examination, the oral glucose tolerance test is a specific test for acromegaly. As growth hormone secretion is normally inhibited by glucose, measurement of glucose nonsuppresibility is required. Growth hormone concentration normally falls during the oral glucose tolerance test, but in patients with acromegaly, the growth hormone levels do not fall. Hepatomegaly is enlargement of the liver. Splenomegaly is enlargement of the spleen. Dactylomegaly is enlargement of the toes and fingers.
A patient who is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) has the serum sodium levels below 120 mEq/L and presents with neurologic manifestations such as seizures. What would be the most appropriate nursing intervention? Multiple choice question Fluid restriction of 1000 mL/day Administration of vasopressin receptor antagonists Administration of loop diuretics such as furosemide Administration of intravenous hypertonic saline solution
Administration of intravenous hypertonic saline solution In the case of severe hyponatremia, especially in the presence of neurological manifestations such as seizures, slow administration of intravenous hypertonic (3% or 5%) solution is recommended to help improve sodium levels. Fluid restriction alone may not correct the sodium levels when hyponatremia is severe. Vasopressin receptors are the drug of choice to treat euvolemia-hyponatremia in hospitalized patients, but are not appropriate when serum sodium levels are very low. Loop diuretics such as furosemide may be used to promote diuresis, but only if the serum sodium levels are at least 125 mEq/L.
Adrenocortical insufficiency develops secondary to inadequate secretion of which pituitary hormone? Multiple choice question Antidiuretic hormone (ADH) Follicle-stimulating hormone (FSH) Thyroid-stimulating hormone (TSH) Adrenocorticotropic hormone (ACTH)
Adrenocorticotropic hormone (ACTH) Adrenocortical insufficiency occurs as a result of an inadequate amount of serum cortisol, which occurs as a result of undersecretion of ACTH by the anterior pituitary. ADH and FSH are both secreted by the posterior pituitary, not the anterior pituitary. TSH is secreted by the anterior pituitary, but it acts on the thyroid gland to secrete thyroid hormones.
The nurse is caring for a patient who has cerebral edema associated with syndrome of inappropriate antidiuretic hormone (SIADH). What clinical manifestation of severe serum sodium level decline does the nurse assess? Select all that apply. Multiple selection question Coma Lethargy Confusion Headache Tachycardia Hypovolemic shock
Coma Lethargy Confusion Headache If the plasma osmolality and serum sodium levels continue to decline below 120 mmol/L, cerebral edema may occur, leading to the manifestations such as coma, lethargy, confusion, and headache. Tachycardia and hypovolemic shock are the complications of diabetes insipidus.
A 70-year-old man was admitted to an inpatient unit for a closed head injury after falling down a flight of stairs. The patient has been calling for the nurse every half hour requesting more water to drink and to use the urinal. The unlicensed assistive person (UAP) recorded urine output every hour for the past five hours as 500, 400, 600, 250, and 300 mL. Along with the urine output, the urinalysis revealed a specific gravity of 1.000 on each specimen. Because the patient had a head injury, the primary healthcare provider determines that the patient has central diabetes insipidus (DI). What does the nurse expect the primary healthcare provider will order for the patient? Multiple choice question Indomethacin Thiazide diuretics Desmopressin acetate (DDAVP) Fluid restrictions, oral and intravenous
Desmopressin acetate (DDAVP) DDAVP, an analog of antidiuretic hormone, is the hormone replacement choice for central DI. Thiazide diuretics are used with nephrogenic DI, because it does not respond to hormone therapy. Indomethacin is given for nephrogenic DI after a low-sodium diet and when thiazide drugs are not effective. Fluid is not restricted; a patient with DI will need fluid replacement therapy due to severe dehydration.
Which interventions does the nurse use when caring for a patient recovering from a transsphenoidal hypophysectomy? Select all that apply. Multiple selection question Elevate the head of the bed 30 degrees Monitor for and report clear nasal drainage Encourage hourly coughing and deep breathing Perform routine pin cares according to agency policy Monitor for and report increased urinary output
Elevate the head of the bed 30 degrees Monitor for and report clear nasal drainage Monitor for and report increased urinary output Elevating the head of the bed 30 degrees decreases pressure on the sella turcica in the brain and decreases the patient's risk of headache. Clear nasal drainage may represent a cerebral spinal fluid leak. The primary health care provider should be notified and a sample of the drainage should be sent to the laboratory for analysis. The patient with cerebral spinal fluid leak is at risk for meningitis. Any insult to the posterior lobe of the pituitary gland puts the patient at risk for diabetes insipidus (DI). Transsphenoidal hypophysectomy induced pituitary insult may result in diabetes insipidus, either because of direct manipulation of the gland during surgery or as a result of postoperative edema. When diabetes insipidus occurs, there is a decrease in antidiuretic hormone (ADH), leading to a significant increase in urinary output. The increase in pressure created by vigorous coughing, sneezing, and straining to have a bowel movement can lead to cerebral spinal fluid leak in the patient recovering from transsphenoidal hypophysectomy. Deep breathing exercises are encouraged, but the patient should avoid coughing. Stereotactic radiosurgery may be a treatment option for some patients. Stereotactic radiosurgery is a form of radiation therapy that requires application of a stereotactic head frame to the patient's scalp. Patients with a stereotactic head frame require pin cares. Transphenoidal hypophysectomy is a surgical procedure that is accomplished via an endonasal (through the nose) approach or, less commonly, sublabially (under the lip at the upper gum line). Transsphenoidal hypophysectomy does not require attachment of a head frame and there are no pin cares.
A patient is suspected of having acromegaly. Which symptom should the nurse assess for in this patient? Multiple choice question Fatigue Loss of smell Increase in shoe size Decreased peripheral vision
Increase in shoe size Acromegaly is a rare condition characterized by overproduction of growth hormone. Excess secretion of growth hormone results in overgrowth of soft tissues and bones in the hands, feet, and face. Evaluation of physical changes such as increase in shoe size is important, because they are gradual and slow; hence the patient may not identify them. Identification of these symptoms helps in treatment, with which bone growth can be stopped and tissue hypertrophy can be reversed. Fatigue is a symptom associated with excess production of thyroid-stimulating hormone. Loss of smell and decreased peripheral vision are associated with hypopituitarism.
A patient is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) after a head injury. What condition does the nurse suspect that correlates with this disorder? Multiple choice question Decreased antidiuretic hormone (ADH) Excessive urine output Increased serum osmolality Increased intravascular volume
Increased intravascular volume The syndrome of inappropriate antidiuretic hormone (SIADH) is characterized by inappropriate secretion of ADH, which disrupts the fluid and electrolyte balance. Increased intravascular volume is one of the characteristic features of SIADH. Decreased ADH, excessive urine output, and increased serum osmolality are the features of diabetes insipidus.
The nurse is educating family members about postsurgical complications for a patient who is undergoing hypophysectomy. Which complication should the nurse include in the teaching? Multiple choice question Seizures Infertility Cerebral edema Transient diabetes mellitus
Infertility Hypophysectomy may result in permanent loss or deficiencies of follicle-stimulating hormone, luteinizing hormone, and thyroid hormones resulting in decreased fertility or infertility. Seizures and cerebral edema are possible complications for patients undergoing stereotactic radio surgery, not hypophysectomy. Transient diabetes insipidus, not diabetes mellitus, may occur following hypophysectomy.
The nurse is caring for a patient who underwent a transsphenoidal hypophysectomy. What is the most important nursing intervention for this patient? Multiple choice question Place the patient in a supine position at all times. Monitor pupillary response and speech patterns. Perform mouth care every 12 hours. Test any clear nasal drainage for potassium.
Monitor pupillary response and speech patterns. The nurse should monitor the pupillary response, speech patterns, and extremity strength to detect neurologic complications. The nurse should ensure the head of the bed is elevated at all times to a 30-degree angle to avoid pressure on the sella turcica and to decrease headaches, a frequent postoperative problem. The nurse must perform mouth care for the patient every four hours to keep the surgical area clean and free of debris. The nurse must notify the surgeon and send any clear nasal fluid to the laboratory to test for glucose.
The nurse is caring for a patient who is diagnosed with the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention would promote a reduction in the release of antidiuretic hormone (ADH)? Multiple choice question Positioning the head of the bed flat Encouraging the patient to ambulate Changing the patient position frequently Instructing the patient to perform range-of-motion exercises
Positioning the head of the bed flat Once SIADH is diagnosed, the treatment is directed at the underlying causes. Positioning the head of the patient's bed flat enhances venous return to the heart and increases the left arterial filling pressure, thereby reducing the release of antidiuretic hormone (ADH). Ambulation is necessary to improve circulation the mobility of joints. Ambulation is not involved in promoting a reduction of ADH. Turning and positioning the patient frequently, and encouraging range-of-motion exercises maintain skin integrity and joint mobility, especially in bed-ridden patients; these interventions do not promote a reduction of ADH.
The nurse is administering intravenous glucose solution to a patient who is suffering from diabetes insipidus. What parameters would the nurse monitor for the management of osmotic diuresis? Multiple choice question Blood pressure Serum glucose levels Fluid and electrolytes Specific gravity of the urine
Serum glucose levels If intravenous glucose solutions are administered, the serum glucose levels of the patient should be monitored, because hyperglycemia and glycosuria can occur, which can lead to osmotic dieresis and an increase in fluid volume deficit. Monitoring blood pressure is not specifically required for managing osmotic dieresis, but is essential and may be required hourly in patients who are acutely ill. Monitoring fluid and electrolyte levels is required to check the intake and output of fluids and is useful for adjusting fluid levels during fluid replacement, not for the management of osmotic diureses. Specific gravity of urine is not related to osmotic dieresis.
A nurse has just received a report from the emergency department on a patient admitted with a closed head injury after falling down a flight of stairs. The nurse is reviewing the lab results in the patient's electronic record and discovers a sodium level of 128 mEq/L, serum osmolality of 271 mOsm/kg, and a urine specific gravity of 1.030. After reviewing these results, about which disorder is the nurse most concerned? Multiple choice question Diabetes insipidus Cushing syndrome Primary hyperparathyroidism Syndrome of inappropriate antidiuretic hormone (SIADH)
Syndrome of inappropriate antidiuretic hormone (SIADH) The characteristics of SIADH include a decreased serum sodium level, serum osmolality less than 280 mOsm/kg, and an increased urine specific gravity above 1.025. Diabetes insipidus is marked by decreased production of antidiuretic hormone with increased urine output and increased plasma osmolality. Cushing syndrome occurs when levels of cortisol are too high. Primary hyperparathyroidism is a result of an increased production of parathyroid hormone and affects calcium and phosphate levels.
The nurse is providing discharge instructions to a patient with diabetes insipidus. Which instructions regarding desmopressin acetate would be most appropriate? Multiple choice question The patient can expect to experience weight loss resulting from increased diuresis. The patient should alternate nostrils during administration to prevent nasal irritation. The patient should monitor for symptoms of hypernatremia as a side effect of this drug. The patient should report any decrease in urinary elimination to the health care provider.
The patient should alternate nostrils during administration to prevent nasal irritation. Desmopressin acetate is used to treat diabetes insipidus by replacing the antidiuretic hormone that the patient is lacking. Inhaled desmopressin acetate can cause nasal irritation, headache, nausea, and other signs of hyponatremia. Diuresis will be decreased and is expected, and hypernatremia should not occur.
A patient has a serum sodium level of 134 mEq/L, an osmolality less than 280 mOsm/kg, and the urine specific gravity is greater than 1.025. Which medication is most beneficial for this patient? Multiple choice question Tolvaptan Propranolol Methimazole Desmopressin
Tolvaptan A serum sodium level of 134 mEq/L, an osmolality less than 280 mOsm/kg, and a urine specific gravity greater than 1.025 indicate dilutional hyponatremia. Tolvaptan is an antihyponatremic drug used to treat dilutional hyponatremia by increasing the sodium concentration in the body. Propranolol is a beta blocker that is used to treat pheochromocytoma. Methimazole is used to treat a goiter. Desmopressin is used to treat diabetes insipidus.
The nurse assesses a patient with diabetes insipidus. The most important assessment finding is an increase in: Multiple choice question Temperature Urine output Serum glucose Blood pressure
Urine output Diabetes insipidus is a disorder of the posterior pituitary gland that results in a deficiency of antidiuretic hormone, which in turn causes the kidneys to be unable to reabsorb water. This deficiency leads to increased urine output as a primary clinical manifestation of the disorder. Without treatment, an affected individual can become severely dehydrated and experience hypovolemic shock. As diabetes insipidus progresses, the individual may experience hypotension; however, temperature and serum glucose level are usually not affected.
While assessing a patient with suspected Cushing's syndrome, of what most prominent clinical manifestation is the nurse aware? Multiple choice question Dehydration and hypotension "Bulking up" of skeletal muscle Hypoglycemia with intense hunger Weight gain, including truncal obesity
Weight gain, including truncal obesity The most prominent clinical manifestation in Cushing's syndrome is weight gain leading to truncal obesity, with a characteristic rounded "moon face" and fat deposits in the neck and upper back, also known as a "buffalo hump." Cushing's syndrome's results from an overproduction of adrenocorticosteroids or large doses of steroid medication. Dehydration and hypotension, bulking of skeletal muscle, and hypoglycemia with intense hunger are not directly associated with Cushing's syndrome.
The nurse is caring for a patient with syndrome of inappropriate antidiuretic hormone (SIADH) who has muscle twitching, vomiting, severe abdominal cramps, and begins to have seizures. The nurse assesses a serum sodium level of 116 mEq/L. What is the priority nursing action for this patient? Multiple choice question Administer lorazepam IV slowly. Administer carbamazepine by mouth. Administer furosemide 40 mg IV push. Administer hypertonic saline solution slowly.
Administer hypertonic saline solution slowly. A patient with a serum sodium level of 116 mEq/L is severely hyponatremic and needs replacement with a hypertonic saline solution (at least 3 to 5 percent) slowly to correct the neurologic effects of the severe hyponatremia. Lorazepam and carbamazepine are used for seizures but would not be indicated in this case since the only way the seizures will cease are with correction of the hyponatremia. Lasix should not be given to a patient with a serum sodium level under 125 mEq/L, because it will cause further loss of sodium.
The nurse is caring for a patient diagnosed with nephrogenic diabetes insipidus not responding to primary treatment. Which intervention does the nurse expect to be useful in increasing the renal response to antidiuretic hormone? Multiple choice question Administering indomethacin Providing hormonal therapy Administering thiazide diuretics Limiting sodium intake to 3 g/day
Administering indomethacin Indomethacin is a nonsteroidal antiinflammatory drug that helps increase the renal response to antidiuretic hormone. Patients with nephrogenic diabetes insipidus are not responsive to hormonal therapy. Hormonal therapy would not aid in increasing the renal response to antidiuretic hormone. Thiazide diuretics and limiting sodium intake are the primary treatments for nephrogenic diabetes insipidus; the patient has not responded to these treatments.
A patient has been diagnosed with acromegaly and is suspected of having developed diabetes mellitus as a result of the increased growth hormone (GH). What clinical manifestations does the nurse document that correlate with the development of diabetes mellitus? Select all that apply. Multiple selection question Increased thirst Dysrhythmias Constipation Increased urination Tingling sensation of the hands
Increased thirst Increased urination Since GH antagonizes the action of insulin leading to hyperglycemia, glucose intolerance and manifestations of diabetes mellitus might occur including polydipsia (increased thirst) and polyuria (increased urine output). Dysrhythmias, constipation, and tingling sensation of the hands are not clinical manifestations of diabetes mellitus.
A patient with pituitary adenoma underwent transsphenoidal hypophysectomy. What nursing actions are most effective for prevention of complications? Select all that apply. Multiple selection question Monitoring the pupillary response Elevating the head of the patient's bed Observing the patient for any signs of bleeding Advising the patient to brush his or her teeth twice daily Monitoring extremity strength to detect neurologic complications
Monitoring the pupillary response Elevating the head of the patient's bed Observing the patient for any signs of bleeding Advising the patient to brush his or her teeth twice daily Monitoring extremity strength to detect neurologic complications Monitoring the papillary response helps rule out any visual changes after transsphenoidal hypophysectomy. Observing the patient for signs of bleeding is of the utmost importance as hemorrhage can cause complications. The strength of the extremities is monitored to rule out postoperative neurologic complications, such as ataxia. Elevating the head of the patient's bed to a 30-degree angle alleviates pressure on the sella turcica and decreases headaches, which are a frequent postoperative problem. Avoiding tooth brushing for at least 10 days helps protect the suture line.
A patient diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) has a serum sodium level of 130mEq/L and complains of a severe backache. What are the most appropriate nursing interventions? Select all that apply. Multiple selection question Assessing the patient's weight Positioning the head of the bed flat Restricting fluid intake to 900 mL/day Administering opioid analgesics for the management of pain Administering intravenous hypertonic solution for the management of sodium levels
Assessing the patient's weight Positioning the head of the bed flat Restricting fluid intake to 900 mL/day Assessing the patient's weight after the initiation of fluid restriction would give the nurse information about gradual weight reduction, because fluid restriction results in the weight reduction and a progressive rise in serum sodium concentration, osmolality, and symptomatic improvement. Positioning the head of the patient's bed flat enhances venous return to the heart and increases left atrial filling pressure, thereby reducing the release of antidiuretic hormone. When the patient's serum sodium levels are at or above 125 mEq/L, fluid intake should be restricted to 800 to 1000mL/day to prevent severe symptoms. Opioid drugs are contraindicated in patients with SIADH, because they stimulate the release antidiuretic hormone (ADH). Administration of intravenous hypertonic solution is not required when the symptoms are mild.
The nurse is reviewing the results of four diagnostic tests for diabetes insipidus (DI). Which patient's results indicate nephrogenic DI? A - Urine Volume decreases to 50 ml/HR B - Urine Osmolality of 260 mOsm/kg C - Urine Osmolality of 600 mOsm/kg D - Responds to ADH analog by concentration volume
B - Urine Osmolality of 260 mOsm/kg Patients with nephrogenic diabetes insipidus will not be able to increase urine osmolality to greater than 300 mOsm/kg. Patients with central diabetes insipidus show a significant decrease in urine volume below 200 mL/hr and a dramatic increase in the urine osmolality from 100 to 600 mOsm/kg. When an antidiuretic hormone analog such as desmopressin is administered, if the patient has central diabetes, the kidneys respond by forming concentrated urine.
A nurse on an inpatient unit is caring for a patient who underwent a hypophysectomy. While performing the adult ongoing assessment at the beginning of the shift, the nurse notices the moustache dressing is saturated with clear drainage. After notifying the primary healthcare provider, the nurse sends a specimen to the laboratory to assess for a cerebrospinal fluid (CSF) leak. The glucose level is 50 mg/dL. Considering this result, for which complication is the patient most at risk? Multiple choice question Diabetes Meningitis Hypoglycemia Visual deterioration
Meningitis A hypophysectomy is usually performed through the sphenoid sinuses, and the physician packs the sphenoid sinus with gauze. When a specimen is tested for a CSF leak, a glucose level greater than 30 mg/dL indicates a CSF leak from an open connection with the brain. If this happens, the patient has an increased risk of meningitis. Diabetes is not a complication of a CSF leak from hypophysectomy. Hypoglycemia is not a complication of a CSF leak from hypophysectomy. Visual deterioration after hypophysectomy would be evidenced by changes in extraocular movements, peripheral vision changes, and changes in visual acuity.
A patient reports to the nurse having visual problems, and is found to have a compressed optic chiasm. Which condition could be the reason for this complication? Multiple choice question Acromegaly Prolactinomas Diabetes insipidus Panhypopituitarism
Prolactinomas Prolactinomas are among the most common type of pituitary adenomas; compression of the chiasm nerve is a complication of this condition and can cause visual problems with signs of increased intracranial pressure, including headache, nausea, and vomiting. Patients with acromegaly, diabetes insipidus, and panhypopituitarism are not associated with the complication of a compressed optic chiasm.
