Chapter 49.1 Disorders of the Pituitary EAQ

The nurse recalls that excessive secretion of the hormone vasopressin characterizes:

Syndrome of inappropriate antidiuretic hormone secretion

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)? 1.Positioning the head of the bed flat 2.Encouraging the patient to ambulate 3.Changing the patient position frequently 4.Instructing the patient to perform range-of-motion exercises

1. Positioning the HOB 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. Text Reference - pp. 1159-1160

A patient is suspected of having acromegaly. When gathering a health history, what questions would be important for the nurse to ask? Select all that apply. 1.Do you snore? 2.Do you crave salty foods? 3.Have you experienced a recent weight loss? 4.Have you noticed an increase in your shoe size? 5.Have you experienced unusual thirst or excessive urination? 6.Have you experienced numbness or tingling in your fingers or hands?

1.Do you snore? 4.Have you noticed an increase in your shoe size? 5.Have you experienced unusual thirst or excessive urination? 6.Have you experienced numbness or tingling in your fingers or hands? The patient with acromegaly experiences excess secretion of growth hormone from the anterior pituitary. Growth hormone excess results in enlargement and thickening of bones and soft tissues. Sleep apnea can occur because of narrowing of the airway caused by enlargement of the soft tissues of the upper airway. Increased snoring is suggestive of sleep apnea. Bones and tissues of the face, feet, and hands are particularly susceptible to the effects of excess growth hormone. Patients may notice that their rings no longer fit and that their shoe size is increasing. Because growth hormone antagonizes insulin, patients with acromegaly often experience hyperglycemia. Hyperglycemia causes an osmotic diuresis, resulting in increased thirst and excessive urination. As soft tissues and bony structures enlarge, patients may experience nerve impingement syndromes. Numbness or tingling of the fingers or hands may be caused by carpal tunnel syndrome. There is no association between acromegaly and a craving for salty foods. Acromegaly occurs when there is excess secretion of growth hormone after the epiphyses of the long bones have closed. Although the patient will not gain additional height, thickening of the bones leads to an increase, rather than a decrease, in body weight

The nurse is caring for a patient who underwent a transsphenoidal hypophysectomy. What is the most important nursing intervention for this patient? 1.Place the patient in a supine position at all times. 2.Monitor pupillary response and speech patterns. 3.Perform mouth care every 12 hours. 4.Test any clear nasal drainage for potassium.

2.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. Text Reference - pp. 1158-1159

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? 1 Diabetes insipidus 2 Cushing syndrome 3 Primary hyperparathyroidism 4 Syndrome of inappropriate antidiuretic hormone (SIADH)

4 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.

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? 1.Decreased antidiuretic hormone (ADH) 2.Excessive urine output 3.Increased serum osmolality 4.Increased intravascular volume

4. 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. Text Reference - p. 1160

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? 1. Polyuria, serum hypoosmolality, dilutional hyponatremia, and concentrated urine with normal intravascular volume 2. Polyuria, serum hyperosmolality, dilutional hyponatremia, and concentrated urine with normal intravascular volume 3. Fluid retention, serum hyperosmolality, dilutional hypernatremia, and concentrated urine with normal intravascular volume 4. Fluid retention, serum hypoosmolality, dilutional hyponatremia, and concentrated urine with normal intravascular volume

4. Fluid retention, serum hypoosmolality, dilutional hyponatremia, and concentrated urine with normal intravascular volume The posterior pituitary gland secretes an excess of ADH, which ultimately increases fluid retention and causes decreased serum osmolality. The glomerular filtration rate increases, and sodium levels decline, causing dilutional hyponatremia. SIADH is characterized by fluid retention, serum hypoosmolality, dilutional hyponatremia, and concentrated urine with normal intravascular volume. A patient with SIADH experiences low urine output, not polyuria, and serum hypoosmolality due to fluid retention, not serum hyperosmolality. A patient with SIADH does not experience dilutional hypernatremia, because the sodium levels are low due to the expanding fluid volume. Text Reference - p. 1160

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? 1.Fluid restriction of 1000 mL/day 2.Administration of vasopressin receptor antagonists 3.Administration of loop diuretics such as furosemide 4. 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. Text Reference - pp. 1160-1161

The nurse is caring for a patient with central diabetes insipidus (DI). What does the nurse recognize is a priority focus of care? 1.Pacing activities and minimizing fatigue 2.Preventing treatment-related hypoglycemia 3.Avoiding dehydration and fluid volume deficit 4.Decreasing renal responsiveness to antidiuretic hormone (ADH

Avoiding dehydration and fluid volume deficit The patient with diabetes insipidus may experience massive diuresis of up to 20 L per day. Severe dehydration and hypovolemic shock may occur if the patient does not consume or receive sufficient fluids to address the urinary losses. The patient may experience nocturia-related weakness and fatigue, but this is of lower priority than preventing dehydration and fluid volume deficit. Diabetes insipidus is a condition of too little ADH. Glucose-lowering agents are not used to treat diabetes insipidus. Whereas diabetes insipidus and diabetes mellitus both result in polydipsia and polyphagia, the mechanism driving these symptoms is entirely different between the two disorders, and treatment is not the same. Diabetes insipidus is a disorder of too little antidiuretic hormone. Decreasing renal responsiveness to a hormone that is already insufficiently present would be deleterious.

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. 1.Prepare the patient for spinal tap 2.Monitor the vital parameters regularly 3.Check for glucose levels in nasal discharge 4.Encourage bed rest with the head elevated 5.Check for growth hormone (GH) levels in the blood

Check for glucose levels in nasal discharge Encourage bed rest with the head elevated Postoperative headache and running nose may be caused by cerebrospinal fluid (CSF) leak from an open connection to the brain. CSF leak is confirmed when higher glucose levels (30 mg/dL) are observed in nasal discharge. A CSF leak resolves within 72 hours when treated with head elevation and bed rest. Spinal taps should be done to reduce pressure to below normal levels if the leaks are persistent even after 72 hours. Vital parameters should be monitored regularly to assess the patient's progress; however, it does not directly help resolve the CSF leak. GH levels in the blood are not related to CSF leakage. Test-Taking Tip: Make certain that the answer you select is reasonable and obtainable under ordinary circumstances and that the action can be carried out in the given situation. Text Reference - pp. 1158-1159

A patient with pituitary adenoma underwent transsphenoidal hypophysectomy. What nursing actions are most effective for prevention of complications? Select all that apply. 1 Monitoring the pupillary response 2 Elevating the head of the patient's bed 3 Observing the patient for any signs of bleeding 4 Advising the patient to brush his or her teeth twice daily 5 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 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 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? 1. There will be a decrease in thyroid hormone. 2. There will be a permanent loss of hormones. 3. There is a loss of antidiuretic hormone (ADH). 4. There will be increased levels of corticosteroids.

There will be a permanent loss of hormones. Surgery for acromegaly may result in permanent loss or deficiencies in follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which leads to decreased fertility. Hypothyroidism occurs when a patient is deficient in thyroid-stimulating hormone (TSH) and is generally observed in radiation therapy. Loss of antidiuretic hormone is seen in patients with transient diabetes insipidus. Cushing syndrome results from increased levels of corticosteroids. Text Reference - pp. 1156-1157

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? 1 Acromegaly 2 Hypopituitarism 3 Hyperthyroidism 4 Diabetes insipidus

Acromegaly In acromegaly, carpal tunnel syndrome may exist, which is characterized by feelings of numbness and discomfort in the thumb and fingers. Hypopituitarism leads to visual changes, loss of smell, and nausea and vomiting. Hyperthyroidism can be easily diagnosed by palpating the thyroid gland. Diabetes insipidus is mostly manifested by excessive thirst caused by frequent urination.

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 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? 1. Glucose level 15 mg/dL in the urine sample 2 Glucose level 70 mg/dL in the blood sample 3 Glucose level 40 mg/dL in the nasal drainage 4 Glucose level 60 mg/dL in the cerebrospinal fluid

Glucose level 40 mg/dL in the nasal drainage

A patient is admitted to the hospital for treatment of euvolemia-hyponatremia. What medication does the nurse anticipate administering to this patient? 1.Tolvaptan 2.Octreotide 3.Carbamazepine 4.Demeclocycline

Tolvaptan Tolvaptan is a vasopressin receptor antagonist used to treat euvolemia-hyponatremia. Octreotide is used for the treatment of growth hormone-producing tumors, pituitary tumors, diarrhea, and flushing episodes. Carbamazepine would not be the drug of choice in treating euvolemia-hyponatremia; rather, it helps alleviate the thirst associated with central diabetes insipidus. Demeclocycline is used to treat patients in whom fluid restriction is ineffective.

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: 1.Temperature 2.Urine output 3.Serum glucose 4.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.

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

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

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 patient with systemic lupus erythematosus has been diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). What should the nurse expect to include in this patient's plan of care? Select all that apply. 1 Obtain weekly weights 2 Limit fluids to 1000 mL per day 3 Monitor for signs of hypernatremia 4 Minimize turning and range of motion 5 Keep the head of the bed at 10 degrees or less elevation

2 Limit fluids to 1000 mL per day 5 Keep the head of the bed at 10 degrees or less elevation The care for the patient with SIADH will include limiting fluids to 1000 mL per day or less to decrease weight, increase osmolality, and improve symptoms. The head of the bed should be kept elevated at 10 degrees or less to enhance venous return to the heart and increase left atrial filling pressure, thereby reducing the release of ADH. The weights should be done daily along with intake and output. Signs of hyponatremia should be monitored and frequent turning, positioning, and range of motion exercises are important to maintain skin integrity and joint mobility.

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."

Which nursing intervention is a priority for a patient recovering from removal of a pituitary gland tumor? 1 Maintaining patent IV access 2 Monitoring the patient for increased temperature 3 Offering the bedpan or urinal at least every two to three hours 4 Assessing for signs of increased intracranial pressure (ICP)

Assessing for signs of increased intracranial pressure (ICP) Because removal of a pituitary tumor involves entering the cranium, increased ICP is always a risk, especially in the immediate postoperative period. With this knowledge, assessment for increased ICP is a priority for the nurse. Maintaining patent IV access, monitoring the patient for increased temperature, and offering the bedpan frequently are all appropriate but secondary to assessing the patient for increased ICP.

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 nurse is educating family members regarding postsurgical complications for a patient who is undergoing hypophysectomy. Which complication should the nurse include in the teaching? 1. Seizures 2. Infertility 3. Cerebral edema 4. 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.

Which factors should the nurse assess in a patient who is on desmopressin acetate (DDAVP)? Select all that apply. 1.Weight 2.Skin turgor 3.Mental status 4.Sodium levels 5.Mucus membranes

Weight Mental status Sodium levels Desmopressin acetate is a synthetic analogue of natural pituitary hormone, 8-arginine vasopressin (ADH), an antidiuretic hormone that affects renal water conservation. Assessing the weight of the patient when the patient is using desmopressin acetate is important, because weight gain is a side effect of desmopressin acetate. The use of desmopressin acetate may also alter the mental status of the patient, causing hallucinations and depression. Desmopressin acetate may cause fluctuations in sodium levels. Therefore, regular assessment of sodium levels of the patient is necessary. Reduced skin turgor and dried mucous membranes are the signs of severe dehydration, which are not side effects of desmopressin acetate.

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? 1. "Octreotide is the primary drug for treating acromegaly." 2. "Growth hormone levels are measured every four weeks." 3. "Octreotide is administered subcutaneously three times a week." 4. "Growth hormone levels are initially measured every two weeks."

"Growth hormone levels are measured every four weeks." Growth hormone levels are initially measured every two weeks, not every four weeks, to guide drug dosing. Octreotide is administered three times a week. It is the primary drug used in the treatment of acromegaly; it is a somatostatin analog that reduces the growth hormone levels to normal levels in many patients. Growth hormone levels are initially measured every two weeks and then every six months, so that the dose may be adjusted based on the alterations in the growth hormone levels. Text Reference - pp. 1156-1157

A patient is diagnosed with central diabetes insipidus and states not knowing how the illness was acquired. What does the nurse recognize as a possible cause of this disorder? 1 The presence of a brain tumor 2 Renal damage from long-standing hypertension 3 Drug therapy with lithium for bipolar disorder 4 Structural lesion in the thirst center

1 The presence of a brain tumor Brain tumor is one possible cause for central diabetes insipidus, which occurs due to the interference with antidiuretic hormone synthesis, transport, or release. In cases of renal damage and drug therapy with lithium, there would be an inadequate renal response to antidiuretic hormone despite the presence of adequate antidiuretic hormone, which leads to nephrogenic diabetes insipidus. A structural lesion in the thirst center may cause primary diabetes insipidus, which can be a result of excessive water intake.

A patient is undergoing transsphenoidal hypophysectomy. The nurse is aware that the procedure involves surgical resection of what gland? 1.Thyroid 2.Adrenal 3.Pituitary 4.Parathyroid

3. 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. Text Reference - pp. 1175-1176

A 35-year-woman who has undergone hypophysectomy develops deficiency of follicle-stimulating hormone and luteinizing hormone. What consequence of this complication should the nurse monitor in the patient? 1 Slowed speech 2 Impaired memory 3 Increase in weight 4 Decreased fertility rate

4 Decreased fertility rate When a hypophysectomy is performed on the pituitary gland, it may result in damage to the pituitary gland, which affects the release of follicle-stimulating hormone and luteinizing hormone associated with reproduction and development of eggs in women. So, decreased fertility rate is a side effect of the surgery. Memory impairment, increased weight gain, slowed speech are manifestations of hypothyroidism. Text Reference - pp. 1158-1159

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 developed diabetes insipidus. Arrange the events in the order they occur in this patient. 1.Decrease in antidiuretic hormone 4.Decrease in water reabsorption 3. Decrease in intravascular fluid volume 2. Increase in serum osmolality

Diabetes insipidus is caused by abnormalities in antidiuretic hormone levels. In patients with diabetes insipidus, the level of antidiuretic hormone is reduced; this leads to decreased reabsorption of water, increasing the urine output, which reduces the intravascular fluid volume and elevates the osmolality in the blood.

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? 1. Having the patient lie down in the supine position 2. Ensuring oral hygiene in the patient by regular brushing 3. Informing the primary health care provider about nasal drainage 4. Instructing the patient to avoid vigorous coughing, sneezing, and straining at stool

Instructing the patient to avoid vigorous coughing, sneezing, and straining at stool Vigorous coughing, sneezing, and straining at stool may result in cerebrospinal fluid (CSF) leakage after transsphenoidal hypophysectomy. The patient should lie in an elevated position, with the head of the bed at a 30-degree angle, as opposed to lying in the supine position. Tooth brushing should be avoided for a minimum of 10 days to protect the suture line. Reporting clear nasal discharge to the surgeon is important, because elevated glucose levels in the discharge indicate CSF leakage; however, this intervention does not prevent the leakage of CSF. Text Reference - pp. 1158-1159

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? 1.Diabetes 2.Meningitis 3.Hypoglycemia 4.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.

Which nursing intervention is most important for a patient with diabetes insipidus? 1. Providing dietary education 2. Monitoring fluid intake and output 3. Assessing for constipation every day 4. Obtaining a finger-stick blood glucose level

Monitoring fluid intake and output Polyuria and polydipsia are the major clinical manifestations of diabetes insipidus. Therefore, strict monitoring of fluid intake and output is a priority nursing intervention. Diet education and finger-stick blood glucose measurements are not high-priority interventions for diabetes insipidus. Constipation can be a secondary problem, as a result of dehydration. Text Reference - pp. 1161-1162

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? 1. Cortisol 2. Thyroxine 3. Somatotropin 4 Triiodothyronine

Somatotropin Somatotropin is also called growth hormone (GH). Excessive secretion of GH results in overgrowth of soft tissues and bones resulting in acromegaly. Cortisol produces a number of physiologic effects, such as increasing blood glucose levels, potentiating the action of catecholamines on blood vessels, and inhibiting the inflammatory response. Thyroxine acts as a precursor to triiodothyronine, which regulates metabolic rate of all cells and processes of cell growth and tissue differentiation. Excessive secretion of cortisol, thyroxine, and triiodothyronine do not result in acromegaly.

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? 1.The function of cranial nerve II 2.The function of cranial nerve III 3.The function of cranial nerve IV 4.The function of cranial nerve V

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.

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? 1. The patient is at an increased risk for stroke. 2.The patient is at an increased risk for meningitis. 3.The patient is at an increased risk for encephalitis. 4.The patient is at an increased risk for subdural hematoma

The patient is at an increased risk for meningitis. A glucose level greater than 30mg/dL in a patient's nasal discharge after transphenoidal hypophysectomy indicates that the patient has cerebrospinal fluid leakage. Patients with cerebrospinal fluid leakage are at an increased risk of acquiring meningitis. Stroke is not related to the leakage of cerebrospinal fluid. Encephalitis, an inflammation in the brain, is caused by infection or an allergic reaction; CSF leakage is not a risk factor of encephalitis. Subdural hematoma is the collection of blood under the dura matter; it is not related to CSF leakage. Text Reference - pp. 1158-1159

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? 1.Tolvaptan 2.Propranolol 3.Methimazole 4.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 receives primary care provider orders for a patient with syndrome of inappropriate antidiuretic hormone (SIADH). Which medication order should the nurse question? 1.Vinblastine 2.Cabergoline 3.Bromocriptine 4. Lysine vasopressin

1. Chemotherapeutic agents such as vinblastine are contraindicated for SIADH, because these drugs induce the release of antidiuretic hormone (ADH). Cabergoline and bromocriptine do not induce the release of ADH, so these drugs are not contraindicated in patients with SIADH. Lysine vasopressin does not induce the release of ADH; therefore, it is not contraindicated in patients with SIADH.

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? 1. Administer lorazepam IV slowly. 2 Administer carbamazepine by mouth. 3 Administer furosemide 40 mg IV push. 4 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 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.

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

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

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 condition can result if hypersecretion of growth hormone (GH) occurs after epiphyseal plate closure?

Acromegaly

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? 1.A patient with acromegaly 2A patient with prolactinomas 3A patient with hypopituitarism 4A patient with pituitary infarctions

A patient with acromegly 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. Text Reference - pp. 1156-1157

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 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? 1.Acromegaly 2.Prolactinomas 3.Graves' disease 4.Cushing syndrome

2. 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 providing discharge instructions to a patient with diabetes insipidus. Which instructions regarding desmopressin acetate would be most appropriate? 1. The patient can expect to experience weight loss resulting from increased diuresis. 2. The patient should alternate nostrils during administration to prevent nasal irritation. 3. The patient should monitor for symptoms of hypernatremia as a side effect of this drug. 4. The patient should report any decrease in urinary elimination to the health care provider

2. 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.

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? 1. "I should take demeclocycline as prescribed." 2. "I should chew sugarless gum and ice chips." 3. "I should drink the electrolyte solution after meals." 4. "I should dilute the electrolyte solution before administration."

"I should drink the electrolyte solution after meals." Electrolyte solutions should be taken during meals, because it dilutes the solution by allowing it to mix with the food, which prevents irritation and damage to the gastrointestinal tract. Administration of demeclocycline blocks the effect of antidiuretic hormone on the renal tubules, resulting in more dilute urine. Chewing sugarless gum and ice chips decreases thirst. Diluting the electrolyte solution before administration prevents gastrointestinal damage.

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? 1.Low-sodium diet 2.Elevate head of bed 30 degrees 3.1000 mL per day fluid restriction 4.Administration of desmopressin acetate nasal spray

1000 mL per day fluid restriction 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.

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. 1. Dry skin 2. Atrophy of vocal chords 3. Appearance of pituitary tumors 4. Decreased pressure on optic nerves 5. Increase in growth hormone (GH) concentration after oral glucose tolerance test

3. Appearance of pituitary tumors 5. Increase in growth hormone (GH) concentration after oral glucose tolerance test Magnetic resonance imaging (MRI) and computed tomography (CT) are used to detect pituitary tumors. An oral glucose tolerance test (OGTT) is a specific test for acromegaly. Growth hormone secretion is normally inhibited by glucose. Normally, growth hormone (GH) concentration falls during an oral glucose tolerance test. However, GH levels do not fall, and sometimes even rise in patients with acromegaly. The presence of pituitary tumors and increased levels of GH indicate the need for surgery because these conditions are best cured by surgical therapy. Dry skin is not a symptom of acromegaly. Hypertrophy, not atrophy, of the vocal chords is a symptom of acromegaly. Pituitary adenoma increases rather than decreases pressure on the optic nerve resulting in visual changes in patients with acromegaly. Text Reference - pp. 1156-1157

Which is a sign of syndrome inappropriate antidiuretic hormone (SIADH)? 1.Decreased ADH 2.Excessive urine output 3.Increased serum osmolality 4.Increased intravascular volume

4.Increased intravascular volume SIADH is characterized by an increase in antidiuretic hormone (ADH) levels in the body. As a result, the patient will have an increased intravascular volume. Decreased ADH, excessive urine output, and increased serum osmolality are features of diabetes insipidus. Text Reference - pp. 1159-1160

Adrenocortical insufficiency develops secondary to inadequate secretion of which pituitary hormone? 1 Antidiuretic hormone (ADH) 2 Follicle-stimulating hormone (FSH) 3 Thyroid-stimulating hormone (TSH) 4 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.

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

A patient has a dysfunction of the pituitary gland. Which hormone secretion does the nurse recognize may be altered in this patient? 1. Prolactin 2. Thyroxine 3. Erythropoietin 4. Parathormone

Prolactin Prolactin is secreted by the pituitary gland. Thyroxine hormone is secreted by the thyroid gland. The kidney secretes erythropoietin. Parathormone is secreted by the parathyroid gland. Text Reference - pp. 1157-1158

Which endocrine problem is more common in men than in women? 1.Graves' disease 2.Thyroid nodules 3.Hyperaldosteronism 4.Ectopic adrenocorticotropic hormone production

Ectopic adrenocorticotropic hormone production Ectopic adrenocorticotropic hormone production is more common in men. Graves' disease affects four to eight times more women than men. Thyroid nodules affect up to four times more women than men. Hyperaldosteronism affects two times as many women as men. Text Reference - p. 1163

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 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? 1. Acromegaly 2. Prolactinomas 3. Diabetes insipidus 4. 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. Text Reference - pp. 1156, 1157

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? 1 Blood pressure 2 Serum glucose levels 3 Fluid and electrolytes 4 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.

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 interventions does the nurse use when caring for a patient recovering from a transsphenoidal hypophysectomy? Select all that apply. 1.Elevate the head of the bed 30 degrees 2.Monitor for and report clear nasal drainage 3.Encourage hourly coughing and deep breathing 4.Perform routine pin cares according to agency policy 5. Monitor for and report increased urinary output

1. Elevate the head of the bed 30 degrees 2. Monitor for and report clear nasal drainage 5. 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 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? 1.Acromegaly 2.Hepatomegaly 3.Splenomegaly 4.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. Text Reference - pp. 1156-1157

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? 1.Lanreotide 2.Cabergoline 3.Pegvisomant 4.Bromocriptine

Pegvisomant Pegvisomant is a growth hormone antagonist, which reduces the effect of growth hormone in the body by blocking the hepatic production of insulin-like growth factor-1. Lanreotide is a long-acting somatostatin analog, which is administered intramuscularly every four weeks in the treatment of acromegaly. Cabergoline may be administered alone or along with somatostatin analogs; it acts by reducing the secretions of growth hormone from the tumor. Bromocriptine is a dopamine antagonist that helps reduce the secretion of growth hormone from the tumor. Text Reference - p. 1157

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? 1. To avoid seizures 2. To avoid headache 3. To prevent cerebrospinal fluid leakage 4. To monitor pupillary and speech responses

To prevent cerebrospinal fluid leakage Vigorous coughing and sneezing causes leakage of the cerebrospinal fluid, which increases the risk of developing meningitis. Seizures are changes in the brain's electrical activity; they are not triggered by vigorous coughing and sneezing. Postoperative headache can be avoided by raising the head of the patient's bed to a 30-degree angle. Pupillary and speech responses are monitored to detect neurologic complications. Text Reference - pp. 1158-1159