NUR 304 Chapter 54 Concepts of Care for Patients with Pituitary and Adrenal Gland Conditions

A nurse assesses clients for potential endocrine dysfunction. Which client is at greatest risk for a deficiency of gonadotropin and growth hormone?

a. A 36-year-old female who has used oral contraceptives for 5 years

b. A 42-year-old male who experienced head trauma 3 years ago

c. A 55-year-old female with a severe allergy to shellfish and iodine

d. A 64-year-old male with adult-onset diabetes mellitus

b

A nurse plans care for a client with a growth hormone deficiency. Which action should the nurse include in this clients plan of care?

a. Avoid intramuscular medications.

b. Place the client in protective isolation.

c. Use a lift sheet to re-position the client.

d. Assist the client to dangle before rising.

c

A nurse cares for a male client with hypo pituitarism who is prescribed testosterone hormone replacement therapy. The client asks, How long will I need to take this medication? How should the nurse respond?

a. When your blood levels of testosterone are normal, the therapy is no longer needed.

b. When your beard thickens and your voice deepens, the dose is decreased, but treatment

will continue forever.

c. When your sperm count is high enough to demonstrate fertility, you will no longer need this therapy.

d. With age, testosterone levels naturally decrease, so the medication can be stopped when you are 50 years old.

b

A nurse cares for a client after a pituitary gland stimulation test using insulin. The clients post- stimulation laboratory results indicate elevated levels of growth hormone (GH) and adreno corticotropic hormone(ACTH). How should the nurse interpret these results?

a. Pituitary hypo function

b. Pituitary hyper function

c. Pituitary-induced diabetes mellitus

d. Normal pituitary response to insulin

d

After teaching a client with acromegaly who is scheduled for a hypo physectomy, the nurse assesses the clients understanding. Which statement made by the client indicates a need for additional teaching?

a. I will no longer need to limit my fluid intake after surgery.

b. I am glad no visible incision will result from this surgery.

c. I hope I can go back to wearing size 8 shoes instead of size 12.

d. I will wear slip-on shoes after surgery to limit bending over.

c

A nurse assesses a client who is recovering from a trans sphenoidal hypophysectomy. The nurse notes nuchal rigidity. Which action should the nurse take first?

a. Encourage range-of-motion exercises.

b. Document the finding and monitor the client.

c. Take vital signs, including temperature.

d. Assess pain and administer pain medication.

c

After teaching a client who is recovering from an endoscopic trans-nasal hypo physectomy, the nurse assesses the clients understanding. Which statement made by the client indicates a correct understanding of the teaching?

a. I will wear dark glasses to prevent sun exposure.

b. Ill keep food on upper shelves so I do not have to bend over.

c. I must wash the incision with peroxide and redress it daily.

d. I shall cough and deep breathe every 2 hours while I am awake.

b

A nurse cares for a client who possibly has syndrome of inappropriate anti diuretic hormone (SIADH). The clients serum sodium level is 114 mEq/L. Which action should the nurse take first?

a. Consult with the dietitian about increased dietary sodium.

b. Restrict the clients fluid intake to 600 mL/day.

c. Handle the client gently by using turn sheets for re-positioning.

d. Instruct unlicensed assistive personnel to measure intake and output.

b

A nurse plans care for a client with Cushings disease. Which action should the nurse include in this clients plan of care to prevent injury?

a. Pad the siderails of the clients bed.

b. Assist the client to change positions slowly.

c. Use a lift sheet to change the clients position.

d. Keep suctioning equipment at the clients bedside.

c

A nurse is caring for a client who was prescribed high-dose corticosteroid therapy for 1 month to treat a severe inflammatory condition. The clients symptoms have now resolved and the client asks, When can I stop taking these medications? How should the nurse respond?

a. It is possible for the inflammation to recur if you stop the medication.

b. Once you start corticosteroids, you have to be weaned off them.

c. You must decrease the dose slowly so your hormones will work again.

d. The drug suppresses your immune system, which must be built backup.

b

A nurse cares for a client with adrenal hyperfunction. The client screams at her husband, bursts into tears, and throws her water pitcher against the wall. She then tells the nurse, I feel like I am going crazy. How should the nurse respond?

a. I will ask your doctor to order a psychiatric consult for you.

b. You feel this way because of your hormone levels.

c. Can I bring you information about support groups?

d. I will close the door to your room and restrict visitors.

b

A client with hyperaldosteronism is being treated with spironolactone (Aldactone) before surgery. Which precautions does the nurse teach this client?

a. Read the label before using salt substitutes.

b. Do not add salt to your food when you eat.

c. Avoid exposure to sunlight.

d. Take Tylenol instead of aspirin for pain.

a

A nurse cares for a client with chronic hypercortisolism. Which action should the nurse take?

a. Wash hands when entering the room.

b. Keep the client in airborne isolation.

c. Observe the client for signs of infection.

d. Assess the clients daily chest x-ray.

a

A nurse cares for a client who is recovering from a hypophysectomy. Which action should the nurse take first?

a. Keep the head of the bed flat and the client supine.

b. Instruct the client to cough, turn, and deep breathe.

c. Report clear or light yellow drainage from the nose.

d. Apply petroleum jelly to lips to avoid dryness.

c

A nurse teaches a client with a cortisol deficiency who is prescribed prednisone (Deltasone). Which statement should the nurse include in this clients instructions?

a. You will need to learn how to rotate the injection sites.

b. If you work outside in the heat, you may need another drug.

c. You need to follow a diet with strict sodium restrictions.

d. Take one tablet in the morning and two tablets at night.

b

An emergency nurse cares for a client who is experiencing an acute adrenal crisis. Which action should the nurse take first?

a. Obtain intravenous access.

b. Administer hydrocortisone succinate (Solu-Cortef).

c. Assess blood glucose.

d. Administer insulin and dextrose.

a

A nurse assesses a client with anterior pituitary hyper function. Which clinical manifestations should the nurse expect? (Select all that apply.)

a. Protrusion of the lower jaw

b. High-pitched voice

c. Enlarged hands and feet

d. Kyphosis

e. Barrel-shaped chest

f. Excessive sweating

a,c,d,e,f

A nurse assesses clients with potential endocrine disorders. Which clients are at high risk for hypopituitarism? (Select all that apply.)

a. A 20-year-old female with benign pituitary tumors

b. A 32-year-old male with diplopia

c. A 41-year-old female with anorexia nervosa

d. A 55-year-old male with hypertension

e. A 60-year-old female who is experiencing shock

f. A 68-year-old male who has gained weight recently

a,c,d,e

A nurse assesses a client who potentially has hyper aldosteronism. Which serum laboratory values should the nurse associate with this disorder? (Select all that apply.)

a. Sodium: 150 mEq/L

b. Sodium: 130 mEq/L

c. Potassium: 2.5 mEq/L

d. Potassium: 5.0 mEq/L

e. pH: 7.28

f. pH: 7.50

a,c,e

A nurse teaches a client with Cushings disease. Which dietary requirements should the nurse include in this clients teaching? (Select all that apply.)

a. Low calcium

b. Low carbohydrate

c. Low protein

d. Low calories

e. Low sodium

b,d,e

A nurse cares for a client who is prescribed vasopressin (DDAVP) for diabetes insipidus. Which assessment findings indicate a therapeutic response to this therapy? (Select all that apply.)

a. Urine output is increased.

b. Urine output is decreased.

c. Specific gravity is increased.

d. Specific gravity is decreased.

e. Urine osmolality is increased.

f. Urine osmolality is decreased.

a,d,f

A nurse assesses clients with potential endocrine disorders. Which clients are at high risk for adrenal insufficiency? (Select all that apply.)

a. A 22-year-old female with metastatic cancer

b. A 43-year-old male with tuberculosis

c. A 51-year-old female with asthma

d. A 65-year-old male with gram-negative sepsis

e. A 70-year-old female with hypertension

a,b,d

A nurse assesses a client with Cushings disease. Which assessment findings should the nurse correlate with this disorder? (Select all that apply.)

a. Moon face

b. Weight loss

c. Hypotension

d. Petechiae

e. Muscle atrophy

a,d,e

A 30-year-old male client having an annual health physical reports that all of the following changes have developed during the past year. Which ones alert the nurse to possible pituitary hyperfunction? Select all that apply.

A. 15-lb weight gain

B. Decreased libido

C. Four sinus infections

D. Frequent constipation

E. Increased foot callus formation

F. Occasional dripping of clear fluid from both breasts

G. Severely sprained ankle from a volleyball injury

a,b,f

Which urine characteristics indicate to the nurse that the client being managed for diabetes insipidus is responding appropriately to interventions?

A. Urine output volume increased; urine specific gravity increased

B. Urine output volume increased; urine specific gravity decreased

C. Urine output volume decreased; urine specific gravity increased

D. Urine output volume decreased; urine specific gravity decreased

c

Which electrolyte laboratory values indicate to the nurse monitoring a client with adrenal insufficiency undergoing IV therapy with hydrocortisone that the client is responding positively to this drug therapy?

A. Serum sodium 147 mEq/L (mmol/L); serum potassium 7.1 mEq/L (mmol/L)

B. Serum sodium 137 mEq/L (mmol/L); serum potassium 4.9 mEq/L (mmol/L)

C. Serum sodium 127 mEq/L (mmol/L); serum potassium 2.8 mEq/L (mmol/L)

D. Serum sodium 119 mEq/L (mmol/L); serum potassium 6.2 mEq/L (mmol/L)

b

A nurse caring for a client with Cushing syndrome who must remain on continued glucocorticoid therapy for another health problem will use which of the following actions to prevent harm?

A. Urging the client to salt his or her food

B. Testing voided urine for the present of glucose

C. Using nonadhesive methods to secure an IV access

D. Ensuring the prescribed glucocorticoid drug is given on an empty stomach

c

Which precaution is most important for the nurse to teach a female client to prevent harm while undergoing drug therapy with estrogen and progesterone for hypopituitarism?

A. "Use a barrier method of contraception to prevent an unplanned pregnancy."

B. "Wear a hat with a brim and use sunscreen when outdoors."

C. "Do not smoke or use nicotine in any form."

D. "Avoid drinking caffeinated beverages."

c

Which assessment has the highest priority for the nurse to perform for a client with syndrome of inappropriate antidiuretic hormone (SIADH) receiving tolvaptan therapy for 24 hours?

A. Evaluating serum sodium levels

B. Evaluating serum potassium levels

C. Examining the skin and sclera for jaundice

D. Examining the IV site for indications of phlebitis

a

Which of the following are the priority precautions the nurse will teach the client who remains at continuing risk for adrenal hypofunction and is taking hormone replacement therapy to prevent harm related to the disorder? Select all that apply.

A. "Avoid crowds and people who are ill."

B. "Check your heart rate for irregular or skipped beats twice daily."

C. "Do not choose low-sodium versions of prepared foods."

D. "Get up slowly from sitting or lying positions."

E. "Keep a source of glucose, such as candy, with you at all times."

F. "Never skip your hormone replacement drugs."

a,b,c,d,e,f

A client preparing for surgery to remove a cortisol-secreting tumor from the adrenal gland asks the nurse whether the physical changes from the excessive cortisol will go away as a result of the surgery so she can look like herself again. What is the nurse's best response?

A. "The surgery is to remove the tumor, not reconstructive surgery."

B. "You will notice a great difference in your appearance starting within a week after surgery."

C. "All the changes will resolve but may take a year or longer to completely disappear."

D. "The fay changes and acne will resolve with time but the stretch marks only fade."

d

The nurse is caring or a female client receiving hormone replacement therapy with estrogen and progesterone for anterior pituitary hypofunction. Which client statement indicates to the nurse an understanding of drug therapy?

A. "I will switch to vaping instead of smoking cigarettes."

B. "Reducing my use of hot showers and baths may help my dry skin?"

C. "If my breast size increases, I will need to have a mammogram done soon."

D. "I will report any leg pain or swelling immediately to my primary health care provider."

d

Which change in a clients condition indicates to the nurse that corticosteroid therapy for acute adrenal insufficiency is effective?

А.Urine output is increased.

B. Client reports not being hungry.

C. Client is alert and oriented.

D. Blood glucose level is 60 mg/dl (3.3 mmol/L.).

c

The nurse is caring for a client with syndrome of inappropriate antidiuretic hormone secretion (SIADH) who is on fluid restriction. Which change in laboratory values indicates to the nurse that this intervention is having the desired effect?

A. Decreased hematocrit

B. Increased serum sodium

C. Decreased serum osmolarity

D. Increased urine specific gravity

b