NUR 397 Chapter 62: Care of Patients Pituitary Adrenal Glad Problems (Hormonal Regulation)

A patient with syndrome of inappropriate antidiuretic hormone (SIADH) is receiving IV hypertonic saline. What finding indicates fluid overload in the patient? 1.) Crackles in the lungs 2.) Increased urine output 3.) Absence of peripheral edema 4.) Absence of neurologic changes

1 Crackles in the lungs indicate fluid overload in the patient. Pulmonary edema can occur very quickly and lead to death. The nurse must monitor vital signs and assess for subtle neurological changes, like muscle twitching, every 2 hours before seizure or coma occurs. The patient with fluid overload will exhibit peripheral edema and decreased urine output following fluid retention.

Which symptom indicates decreased adrenocorticotropic hormone (ACTH) in the body? 1.) Malaise 2.) Increased thirst 3.) Decreased libido 4.) Intolerance to cold

1 Decreased ACTH causes symptoms including a pale, sallow complexion, malaise, lethargy, and postural hypotension. Decreased bone density and libido are symptoms of deficiency of gonadotropins. Dehydration and increased thirst are symptoms of decreased antidiuretic hormone (ADH). Weight gain and intolerance to cold are symptoms of decreased thyroid-stimulating hormone (TSH).

What finding in a patient that is 4 hours post-hypophysectomy should be reported to the health care provider immediately? 1.) Increased swallowing 2.) Dry mucous membranes 3.) Blood-tinged nasal drainage 4.) Urine specific gravity of 1.028

1 Increased swallowing is a sign of CSF leakage and should be reported to the surgeon. Dry mucous membranes are a normal finding with the surgery and is related to mouth breathing. Blood-tinged nasal drainage is normal. A urine specific gravity of 1.028 is a normal finding.Test-Taking Tip: If the question asks for an immediate action or response, all of the answers may be correct, so base your selection on identified priorities for action.

The assessment and clinical findings for a patient show decreased production of all hormones from the anterior pituitary. What is this condition called? 1.) Panhypopituitarism 2.) Pituitary hypofunction 3.) Selective hypopituitarism 4.) Secondary pituitary dysfunction

1 Panhypopituitarism is an extremely rare condition in which a person has a decreased production of all of the pituitary hormones. Pituitary hypofunction is the condition in which one or more hormones of the anterior pituitary gland are under-secreted. Hormone disorders of the anterior pituitary due to problems in the hypothalamus are referred to as secondary pituitary dysfunction. Selective hypopituitarism is the condition in which there is a decrease in only one anterior pituitary hormone.

Which imaging assessment can identify abnormalities of the sella turcica in a patient with pituitary problems? 1.) Skull x-ray 2.) Angiogram 3.) Computed tomography (CT) 4.) Magnetic resonance imaging (MRI)

1 Pituitary problems may cause changes in the sellaturcica, the bony nest where the pituitary gland rests. These changes can be identified in skull x-rays. An angiogram helps to rule out the presence of an aneurysm or other vascular problems in the area. CT and MRI are used to assess bone or soft tissue lesions.

Which are key assessment findings in a patient suspected of having diabetes insipidus? Select all that apply. 1.) Tachycardia 2.) Hemodilution 3.) Increased thirst 4.) Dry mucous membranes 5.) High specific urine gravity

1,3,4 Tachycardia, increased thirst, and dry mucous membranes are findings typical of diabetes insipidus. The patient's blood is hemoconcentrated as a result of the significant fluid loss. The urine is diluted resulting in a low specific gravity.Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer.

A patient is admitted with a diagnosis of diabetes insipidus (DI). What finding is priority to report to the health care provider? 1.) Pulse of 102 2.) Bilateral muscle weakness 3.) Serum sodium of 147 mEq/L 4.) Intake of 1200; output of 1050

2 Bilateral muscle weakness is a sign of significant hypernatremia and should be reported to the health care provider immediately. An expected finding in patients with DI is an increased pulse; a pulse rate of 102 is not emergent or priority. The serum sodium is elevated but is not a critical value and not priority. An intake exceeding the output is a positive sign in DI, indicating that the treatment is likely working.

Which laboratory results indicate that fluid restrictions have been effective in treating syndrome of inappropriate antidiuretic hormone (SIADH)? 1.) Decreased hematocrit 2.) Increased serum sodium 3.) Decreased serum osmolality 4.) Increased urine specific gravity

2 Increased serum sodium due to fluid restriction indicates effective therapy. Hemoconcentration is a result of hypovolemic hyponatremia caused by SIADH and diabetes insipidus. Plasma osmolality is decreased as a result of SIADH. Urine specific gravity is decreased with diabetes insipidus and is increased with SIADH.Test-Taking Tip: Identifying content and what is being asked about that content is critical to your choosing the correct response. Be alert for words in the stem of the item that are the same or similar in nature to those in one or two of the options. Example: If the item relates to and identifies stroke rehabilitation as its focus and only one of the options contains the word stroke in relation to rehabilitation, you are safe in identifying this choice as the correct response.

A patient diagnosed with adrenocorticotropic hormone imbalance reports weight gain. The nurse observes moon face and truncal obesity in the patient. Which other assessment finding does the nurse anticipate? 1.) Galactorrhea 2.) Hypertension 3.) Hypoglycemia 4.) Heat intolerance

2 Presence of moon face and truncal obesity are signs of Cushing disease, which is associated with excess secretion of cortisol from the adrenal cortex. Hypertension is another symptom of Cushing disease. Galactorrhea is associated with increased prolactin levels, not cortisol levels. Hyperglycemia, not hypoglycemia, is a symptom of Cushing disease. Heat intolerance is associated with increased thyrotropin levels.

These data are obtained by the RN who is assessing a patient who had a transsphenoidal hypophysectomy yesterday. What information has the most immediate implications for the patient's care? 1.) Urine specific gravity of 1.016 2.) Dry lips and oral mucosa on examination 3.) Patient report of a headache and stiff neck 4.) Nasal drainage that tests negative for glucose

3 Headache and stiff neck (nuchal rigidity) are symptoms of meningitis that have immediate implications for the patient's care. Dry lips and mouth are not unusual after surgery. Frequent oral rinses and the use of dental floss should be encouraged because the patient cannot brush the teeth. Any nasal drainage should test negative for glucose; nasal drainage that tests positive for glucose indicates the presence of a cerebrospinal fluid (CSF) leak. A urine specific gravity of 1.016 is within normal limits.Test-Taking Tip: Once you have decided on an answer, look at the stem again. Does your choice answer the question that was asked? If the question stem asks "why," be sure the response you have chosen is a reason. If the question stem is singular, then be sure the option is singular, and the same for plural stems and plural responses. Many times, checking to make sure that the choice makes sense in relation to the stem will reveal the correct answer.

Hyperfunction of which anterior pituitary hormone can cause sleep apnea? 1.) Prolactin (PRL) 2.) Thyrotropin (TSH) 3.) Growth hormone (GH) 4.) Adrenocorticotropic hormone (ACTH)

3 The hyperfunctioning of growth hormone can cause sleep apnea. Hyperfunctioning of prolactin can cause galactorrhea. Hyperfunctioning of thyrotropin can cause weight loss. Hyperfunctioning of adrenocorticotropic hormone can cause truncal obesity.

An adult patient has growth hormone (GH) deficiency. What risk does the nurse anticipate for this patient? 1.) Double vision 2.) Decreased height 3.) Growth retardation 4.) Decreased bone strength

4 Deficiency of GH in an adult leads to decreased bone strength following an increased rate of destructive activity of the bone. This increases the risk for fracture in the patient. A decrease in GH in children leads to growth retardation resulting in short stature or decreased height. Diplopia, or double vision, is a neurological manifestation of hypopituitarism as a result of tumor growth.

A patient is prescribed the nasal spray desmopressin for diabetes insipidus. What does the nurse teach the patient about the use of this drug? 1.) Ensure fluid intake of 4 L when taking this drug. 2.) Maintain a record of weekly weight gain or loss. 3.) Sit upright and breathe deeply when inhaling the drug. 4.) Ulceration of the mucous membranes may occur with intranasal use.

4 Ulceration of the mucous membranes, allergy, a sensation of chest tightness, and lung inhalation of the spray may occur with use of the intranasal preparations. The patient must note changes in daily weight and report to the health care provider if there is an increase of 2 lb or more in 24 hours; a rapid increase in weight is an indicator of fluid retention. The patient must sit upright and hold the breath when using the nasal spray to help the absorption of the drug by the mucosa rather than going down into the throat. The patient must not consume more than 3 L of fluid when taking this drug because it causes fluid retention.

What laboratory finding is most important to monitor in a patient diagnosed with diabetes insipidus (DI)? 1.) Serum sodium 2.) Serum glucose 3.) Serum potassium 4.) Serum liver function

1 Serum sodium is the priority laboratory value to evaluate in patients diagnosed with DI. The inability of the kidneys to respond to ADH leads to increased sodium levels. Glucose, potassium, and liver function labs are not priority in these patients.

Which teaching will the nurse provide to a patient who has undergone nasal hypophysectomy for hyperpituitarism? 1.) "Report any postnasal drip after surgery." 2.) "Brush your teeth twice every day after surgery." 3.) "Cough slowly at the end of a deep-breathing exercise." 4.) "Perform deep-breathing exercises every 15 minutes after surgery."

1 The occurrence of postnasal drip or increased swallowing after surgery might indicate a leakage of cerebrospinal fluid into the nasal cavity, so the patient should be instructed to report it. The patient should be instructed not to brush his or her teeth as it can disturb the operation site. Instead, the patient can use oral mouth rinses. Coughing can increase intracranial pressure and should be avoided after surgery. The patient should be instructed to perform deep-breathing exercises every hour after surgery; every 15 minutes is more frequent than necessary.

A patient with syndrome of inappropriate antidiuretic hormone (SIADH) is receiving gastrointestinal tube feedings. What must the nurse keep in mind when caring for this patient? 1.) Mix drugs to be given with saline. 2.) Dilute tube feedings with plain water. 3.) Irrigate the tube with lukewarm water. 4.) Flush the tube after each use with hypertonic saline.

1 The patient with SIADH has fluid restrictions because fluid intake further dilutes plasma sodium levels. Drugs given via GI tube must be mixed with saline because the patient has decreased serum sodium levels. Similarly, saline must be used to dilute tube feedings, irrigate, or flush the GI tube. Hypertonic saline is used only when serum sodium levels are very low and is only administered intravenously.

What nursing intervention is a priority for a male patient diagnosed with gonadotropin deficiency who is experiencing body image disturbance? 1.) Refer to a psychologist 2.) Teach about testosterone therapy 3.) Provide information on penile implants 4.) Encourage daily exercise with weight training

2 Patients with gonadotropin deficiency and body image who undergo testosterone replacement therapy often find improvement of the symptoms, body image, and self-esteem. It is important to refer the patient to a psychologist, but it is more important to begin medication therapy. Information on penile implants may be helpful, but the medication should increase penis size. Weight training is not necessary or indicated because muscle mass should improve with the initiation of testosterone therapy.

A patient diagnosed with acromegaly is beginning bromocriptine mesylate therapy. What statement by the patient indicates a need for further teaching? 1.) "My blood glucose should improve." 2.) "I am excited for my lips to be normal." 3.) "I should take the medicine with food." 4.) "I will need to change positions slowly."

2 The facial features and musculoskeletal issues resulting from acromegaly are not reversible. The patient's lips and facial features will not change after medication is started. The patient should have an improvement in their blood glucose once therapy is initiated. The medication should be taken with food. Patients should change positions slowly because orthostatic hypotension is a side effect of the medication.Test-Taking Tip: The most reliable way to ensure that you select the correct response to a multiple-choice question is to recall it. Depend on your learning and memory to furnish the answer to the question. To do this, read the stem, and then stop! Do not look at the response options yet. Try to recall what you know and, based on this, what you would give as the answer. After you have taken a few seconds to do this, then look at all of the choices and select the one that most nearly matches the answer you recalled. It is important that you consider all the choices and not just choose the first option that seems to fit the answer you recall. Remember the distractors. The second choice may look okay, but the fourth choice may be worded in a way that makes it a slightly better choice. If you do not weigh all the choices, you are not maximizing your chances of correctly answering each question.

Which menu selection indicates the teaching regarding nutrition was effective in a patient diagnosed with diabetes insipidus (DI)? 1.) Pizza 2.) Cold cuts 3.) Frozen French fries 4.) Canned green beans

3 Patients diagnosed with DI have to reduce sodium intake. Frozen French fries are low in sodium and indicated for this patient. Pizza, cold cuts, and canned green beans all have high sodium content.Test-Taking Tip: Read the question carefully before looking at the answers: (1) determine what the question is really asking; look for key words; (2) read each answer thoroughly and see if it completely covers the material asked by the question; (3) narrow the choices by immediately eliminating answers you know are incorrect.

A patient has undergone a hypophysectomy. What postoperative intervention should the nurse perform for this patient? 1.) Have the patient lie flat after surgery. 2.) Monitor neurologic status every 4 hours. 3.) Discard and replace the nasal drip pad at regular intervals. 4.) Have the patient avoid brushing the teeth for 2 weeks after surgery.

4 Following a hypophysectomy, the patient should be instructed to avoid brushing the teeth for 2 weeks after surgery until the incision sufficiently heals. Frequent mouth care with mouthwash and daily flossing provide adequate oral hygiene. The patient must use a mirror to check the gums for bleeding; reduced sensation in the mouth increases the risk for injury. The nurse monitors the patient's neurologic status every hour for the first 24 hours and then every 4 hours. The nasal drip pad is assessed for quantity and quality of drainage before it is discarded; a light yellow color at the edge of clear drainage on the dressing is indicative of cerebrospinal fluid leak. The head of the bed is elevated after surgery to prevent edema.

Which hormonal hyperfunctioning can result in truncal obesity? 1.) Growth hormone (GH) 2.) Follicle-stimulating hormone (FSH) 3.) Thyroid-stimulating hormone (TSH) 4.) Adrenocorticotropic hormone (ACTH)

4 In a condition called Cushing disease, there is an increase in ATCH, which manifests in truncal obesity and the patient's face resembling a moon shape. An increase in levels of GH manifests in a patient with a barrel-shaped chest and sleep apnea. There can be hypogonadism or hypergonadism when there is an increase in levels of FSH. An increase in levels of TSH or thyrotropin manifests as weight loss, heat intolerance, fine tremors, etc.Test-Taking Tip: Sometimes the reading of a question in the middle or toward the end of an exam may trigger your mind with the answer or provide an important clue to an earlier question.

What are the most common features of acromegaly? 1.) Acne 2.) Moon face 3.) Fine tremors 4.) Thickened lips

4 Overproduction of GH in adults, results in acromegaly. The onset may be gradual with slow progression and may be noticed as thickened lips, coarse facial features, increasing head size and lower jaw protrusion. Moon face is related to Cushing's disease. Fine tremors are associated with excessive thyroid stimulating hormone and acne is associated with hyperproduction of adrenocorticotropic hormone (ACTH).

The nurse is caring for a patient who is prescribed desmopressin (DDAVP) nasal spray for diabetes insipidus. What is a potential side effect of this intranasal drug? 1.) Anuria 2.) Drowsiness 3.) Weight gain 4.) Chest tightness

4 The patient may have a sensation of chest tightness as a side effect of desmopressin. Other side effects include ulceration of mucous membranes, allergy, or lung inhalation of the spray. Anuria, drowsiness, and weight gain are signs of water intoxication in patients taking vasopressin, an exogenous form of antidiuretic hormone.

The nurse is teaching a patient about how to monitor therapy effectiveness for syndrome of inappropriate antidiuretic hormone (SIADH). What does the nurse tell the patient to look for? 1.) Muscle spasms 2.) Increasing heart rate 3.) Dry mucous membranes 4.) Daily weight gain of more than 2 lbs

4 The patient must monitor daily weights because this assesses the degree of fluid restriction needed. A weight gain of 2 lbs or more daily or a gradual increase over several days is cause for concern. Dry mucous membranes are a sign of dehydration and an indication that therapy is not effective. An increased heart rate indicates increased fluid retention or dehydration and hypovolemia, and either condition is an indication that therapy is not effective. Muscle spasms are associated with hyponatremia and are an indication of a change in the patient's neurologic status. Untreated hyponatremia can lead to seizures and coma.Test-Taking Tip: Read the question carefully before looking at the answers: (1) determine what the question is really asking; look for key words; (2) read each answer thoroughly and see if it completely covers the material asked by the question; (3) narrow the choices by immediately eliminating answers you know are incorrect.