test 4--Diabetes Insipidus, SIADH, Pituitary-Old and new book

The nurse explains the pathophysiology of diabetes insipidus as arising from a deficiency in A. antidiuretic hormone ADH B. follicle-stimulating hormone FSH C. growth hormone D. oxytocin

A Diabetes insipidus results from a deficiency in ADH and leads to an inability to conserve water.

Twelve hours after surgery for pheochromocytoma, the nurse should assess a postoperative client for manifestations of abdominal hematoma, including A. absent bowel sounds B. blurred vision C. elevated Blood pressure D. increased urine output

A For the first day or two the client should be monitored closely for complications of the operation, including adrenal insufficiency, hypotension, hemorrhage, and shock. If the client is bleeding internally, an abdominal hematoma can develop, resulting in paralytic ileus. Manifestations of paralytic ileus include abdominal pain, distention, severe nausea, vomiting, and diminished or absent bowel sounds.

A patient with a diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH) is being cared for on the critical care unit. The priority nursing diagnosis for a patient with this condition is what? A. risk for peripheral neurovascular dysfunction B. excess fluid volume C. hypothermia D. ineffective airway clearance

B The priority nursing diagnosis for a patient with SIADH is excess fluid volume, as the patient retains fluids and develops a sodium deficiency. Restricting fluid intake is a typical intervention for managing this syndrome. Temperature imbalances are not associated with SIADH. The patient is not at risk for neurovascular dysfunction or a compromised airway.

When formulating the teaching plan for a client with hyperpituitarism being prepared for transsphenoidal hypophysectomy, the nurse would give priority to A. alerting the client to the need for constant monitoring after surgery B. instructing the client to avoid activities such as coughing and sneezing C. reviewing the clinical manifestations of infection D. teaching coughing and deep-breathing techniques

B A priority nursing diagnosis for this preoperative client is Risk for Injury. Prevention of elevated intracranial pressure is accomplished by avoiding activities that raise intracranial pressure, similar to the care of a client undergoing craniotomy.

For a client with a pheochromocytoma, the most critical assessment by the nurse is A. abdominal girth B. blood pressure C. daily weight D. pulse quality

B Hypertension is the principal manifestation of pheochromocytoma and can be persistent, fluctuating, intermittent, or paroxysmal in nature. Because of the excessive epinephrine and norepinephrine they secrete, pheochromocytomas can produce severe manifestations and even death. The other three options are not seen in pheochromocytoma.

Before surgery, a client diagnosed with pheochromocytoma would be instructed to avoid A. a diet high in vitamins and minerals B. coffee, tea, and cola C. long rest periods D. sedative medications

B Important preoperative nursing interventions for the client with pheochromocytoma include promoting rest and relief from stress; administering prescribed sedatives; providing a diet high in vitamins, minerals, and calories; prohibiting caffeine-containing beverages (e.g., coffee, tea, cola); and monitoring vital signs.

The physician has ordered a fluid deprivation test for a patient suspected of having diabetes insipidus. During the test, the nurse should prioritize what assessments? A. temperature and oxygen saturation B. heart rate and BP C. breath sounds and bowel sounds D. Color, warmth, movement, and sensation of extremities

B The fluid deprivation test is carried out by withholding fluids for 8 to 12 hours or until 3% to 5% of the body weight is lost. The patient's condition needs to be monitored frequently during the test, and the test is terminated if tachycardia, excessive weight loss, or hypotension develops. Consequently, BP and heart rate monitoring are priorities over the other listed assessments.

A nurse caring for a patient with diabetes insipidus is reviewing laboratory results. What is an expected urinalysis finding? A. glucose in the urine B. albumin in the urine C. highly dilute urine D. leukocytes in the urine

C Patients with diabetes insipidus produce an enormous daily output of very dilute, water-like urine with a specific gravity of 1.001 to 1.005. The urine contains no abnormal substances such as glucose or albumin. Leukocytes in the urine are not related to the condition of diabetes insipidus, but would indicate a urinary tract infection, if present in the urine.

A client with hyperpituitarism tells the nurse that he thinks he looks different now than he did 5 years ago. The nurse's most appropriate response to this remark considers that the client is A. experiencing a sensory disturbance and needs reorientation B. having visual disturbances and may need an opthalmologist consult C. making bizzare comments b/c of increased intracranial pressure and needs a neurosurgical consult D. referring to physical changes from acromegaly and needs emotional support

D In the adult with acromegaly (increased growth hormone after epiphyseal closure), bones increase in thickness, and there is increase in soft tissue growth. Clients with hyperpituitarism do need careful assessment of neurologic status and an ophthalmologic exam before surgery.

The nurse assessing a client with hypopituitarism would note the finding most consistent with this disorder as A. pendulous abdomen B. frequent nasal drainage C. mottled skin D. short stature

D Specific disorders resulting from pituitary hyposecretion include short stature, sexual and reproductive disorders, hypothyroidism, secondary adrenocortical insufficiency, and prolactin deficiency.

For a client who has undergone transsphenoidal hypophysectomy, the aspect of usual postoperative care that the nurse would modify is A. administration of oxygen B. leg exercises C. nutrition D. oral care

D The client who has undergone a transsphenoidal hypophysectomy requires frequent oral hygiene using a gauze sponge, and the lips should be lubricated with petroleum jelly. The client should not brush the teeth for 2 weeks after surgery.

The nurse monitoring hourly urine output in a client following transsphenoidal hypophysectomy would immediately report A. 100 ml of urine in 1 hour B. 150 ml of urine in 1 hour C. 175 ml of urine in 1 hour D. 225 ml of urine in 1 hour

D The nurse should maintain strict documentation of intake and output in this postoperative client and notify the physician if urine output is greater than 200 ml/hour with urine specific gravity below 1.005.