Chapter 49 .1
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?
A patient with acromegly
A patient is suffering from numbness and a "pins and needles" sensation in the thumb, middle, and index finger, especially at night. Which condition would the nurse suspect in the patient?
Acromegaly
The nurse is preparing a patient for a water deprivation test for central diabetes insipidus in the hospital. What intervention is required for this patient?
Administer desmopressin acetate (DDAVP) subcutaneously.
A patient undergoes a physical examination and several diagnostic tests, upon which the patient is diagnosed with acromegaly. Which findings in the patient would require the nurse to prepare the patient for surgery? Select all that apply.
Appearance of pituitary tumors Increase in growth hormone (GH) concentration after oral glucose tolerance test
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.
Coma Lethargy Confusion Headache
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?
Cushing syndrome
The endocrine system involves a number of organs and glands that secrete hormones. The posterior pituitary gland is responsible for secreting antidiuretic hormone (ADH). When the posterior pituitary gland overproduces ADH, a condition called the syndrome of inappropriate antidiuretic hormone (SIADH) develops. Which characteristics best describe SIADH?
Fluid retention, serum hypoosmolality, dilutional hyponatremia, and concentrated urine with normal intravascular volume
When caring for a patient with syndrome of inappropriate antidiuretic hormone (SIADH), it is important that the nurse implement which nursing action?
Initiate seizure precautions
Which nursing intervention is most important for a patient with diabetes insipidus?
Monitoring fluid intake and output
A patient with pituitary adenoma underwent transsphenoidal hypophysectomy. What nursing actions are most effective for prevention of complications? Select all that apply.
Monitoring the pupillary response Elevating the head of the patient's bed Observing the patient for any signs of bleeding Monitoring extremity strength to detect neurologic complications
A patient diagnosed with acromegaly is to receive medication to block the hepatic production of insulin-like growth factor-1. What medication will the nurse prepare to administer to the patient?
Pegvisomant
A patient has a dysfunction of the pituitary gland. Which hormone secretion does the nurse recognize may be altered in this patient?
Prolactin
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?
Serum glucose levels
A patient has undergone surgery for acromegaly. After surgery, the patient is experiencing severe headache. What action should be taken to provide relief from the headache?
The head of the bed should be elevated to 30-degree angle.
The nurse sends the clear nasal drainage of a patient who underwent transphenoidal hypophysectomy for testing. The laboratory readings reveal glucose levels at 40 mg/dL. What does the nurse infer from this finding?
The patient is at an increased risk for meningitis.
The nurse informs a patient that has had a hypophysectomy for removal of a pituitary tumor to avoid vigorous coughing and sneezing. What explanation does the nurse give the patient for these instructions?
To prevent cerebrospinal fluid leakage
Which factors should the nurse assess in a patient who is on desmopressin acetate (DDAVP)? Select all that apply.
Weight Mental status Sodium levels
Which endocrine problem is more common in men than in women?
Ectopic adrenocorticotropic hormone production
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?
The function of cranial nerve II
Which signs and symptoms would the nurse expect to assess in a patient who is diagnosed with acromegaly? Select all that apply.
Increased shoe size Elevated blood glucose Complaint of headaches
Adrenocortical insufficiency develops secondary to inadequate secretion of which pituitary hormone?
Adrenocorticotropic hormone (ACTH)
The nurse recalls that excessive secretion of the hormone vasopressin characterizes:
Syndrome of inappropriate antidiuretic hormone secretion
A patient who had surgery for the treatment of acromegaly asked about the possibility of becoming pregnant. When responding to the patient, from what knowledge should the nurse base the rationale?
There will be a permanent loss of hormones.
What is the dosage schedule for the administration of glucocorticoids?
Two-thirds of a dose in the morning and one-third in the afternoon
The nurse assesses a patient with diabetes insipidus. The most important assessment finding is an increase in:
Urine output
The registered nurse is teaching a nursing student about the drug profile of octreotide. Which statement made by the student indicates the need for further teaching?
"Growth hormone levels are measured every four weeks."
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?
1000 mL per day fluid restriction
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.
Assessing the patient's weight Positioning the head of the bed flat Restricting fluid intake to 900 mL/day
The nurse is caring for a patient with central diabetes insipidus (DI). What does the nurse recognize is a priority focus of care?
Avoiding dehydration and fluid volume deficit
Which condition can result if hypersecretion of growth hormone (GH) occurs after epiphyseal plate closure?
Acromegaly
A patient who underwent surgery for acromegaly complains of postoperative headache and running nose. What action should the nurse take to resolve the problems within 72 hours? Select all that apply.
Check for glucose levels in nasal discharge Encourage bed rest with the head elevated
The nurse is reviewing a patient's laboratory reports that show increased levels of plasma insulin-like growth factor 1. What does this finding indicate about growth hormone levels?
Growth hormone levels are elevated
A patient with a pituitary tumor has developed excessive height, and increased hat size and shoe size. Which hormone does the nurse determine is secreting excessively?
Somatotropin
The nurse is instructing a patient regarding self-management of syndrome of inappropriate antidiuretic hormone (SIADH). The patient has gastric ulceration as a comorbid condition. Which statement by the patient needs correction?
"I should drink the electrolyte solution after meals."
Which statement by the patient who is postoperative following a transphenoidal hypophysectomy indicates a need for further education?
"It is important that I brush my teeth every day."
A patient with acromegaly has developed peripheral neuropathy and asks what is causing the discomfort. What does the nurse inform the patient about how this disorder developed?
"You have developed the condition due to hypertrophy of muscles and tissues."
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?
Acromegaly
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?
Administer hypertonic saline solution slowly.
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?
Administering indomethacin
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?
Administration of intravenous hypertonic saline solution
The nurse is caring for a patient with an alteration in the regulation of water balance and osmolarity. Which hormone will require alteration with medication?
Arginine vasopressin
Which nursing intervention is a priority for a patient recovering from removal of a pituitary gland tumor?
Assessing for signs of increased intracranial pressure (ICP)
The registered nurse is preparing to teach a group of nursing students about the pathophysiologic events associated with syndrome of inappropriate antidiuretic hormone (SIADH). Which events should the nurse include in the teaching plan? Select all that apply.
Decreased serum osmolality Increased water reabsorption Occurrence of dilutional hyponatremia
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?
Glucose level 40 mg/dL in the nasal drainage
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.
Increased thirst Increased urination
The nurse is educating family members regarding postsurgical complications for a patient who is undergoing hypophysectomy. Which complication should the nurse include in the teaching?
Infertility
The nurse is caring for a patient who underwent transsphenoidal hypophysectomy to treat acromegaly. Which is the best nursing action to prevent leakage of cerebrospinal fluid?
Instructing the patient to avoid vigorous coughing, sneezing, and straining at stool
