Question 1

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

Accepted Answer

Nuchal rigidity is a major manifestation of meningitis,a potential postoperative complication associated with this surgery.Meningitis is an infection; usually the client will also have a fever and tachycardia.Range-of-motion exercises are inappropriate because meningitis is a possibility.Documentation should be done after all assessments are completed and should not be the only action.Although pain medication may be a palliative measure,it is not the most appropriate initial action.

Question 2

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

Accepted Answer

In adults,growth hormone is necessary to maintain bone density and strength.Adults with growth hormone deficiency have thin,fragile bones.Avoiding IM medications,using protective isolation,and assisting the client as he or she moves from sitting to standing will not serve as safety measures when the client is deficient in growth hormone.

Question 3

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

Accepted Answer

Steroid dosage adjustment may be needed if the client works outdoors and might be difficult,especially in hot weather,when the client is sweating a great deal more than normal.Clients take prednisone orally,have no need for a salt restriction,and usually start the regimen with two tablets in the morning and one at night.

Question 4

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

Accepted Answer

Although removal of the tissue that is oversecreting hormones can relieve many symptoms of hyperpituitarism,skeletal changes and organ enlargement are not reversible.It will be appropriate for the client to drink as needed postoperatively and avoid bending over.The client can be reassured that the incision will not be visible.

Question 5

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

Accepted Answer

Spironolactone is a potassium-sparing diuretic used to control potassium levels.Its use can lead to hyperkalemia.Although the goal is to increase the client's potassium,unknowingly adding potassium can cause complications.Some salt substitutes are composed of potassium chloride and should be avoided by clients on spironolactone therapy.Depending on the client,he or she may benefit from a low-sodium diet before surgery,but this may not be necessary.Avoiding sunlight and Tylenol is not necessary.

Question 6

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

Accepted Answer

Excess cortisol reduces the number of circulating lymphocytes,inhibits maturation of macrophages,reduces antibody synthesis,and inhibits production of cytokines and inflammatory chemicals.As a result,these clients are at greater risk of infection and may not have the expected inflammatory manifestations when an infection is present.The nurse needs to take precautions to decrease the client's risk.It is not necessary to keep the client in isolation.The client does not need a daily chest x-ray.

Question 7

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

Accepted Answer

Gonadotropin and growth hormone are anterior pituitary hormones.Head trauma is a common cause of anterior pituitary hypofunction.The other factors do not increase the risk of this condition.

Question 8

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

Accepted Answer

Aldosterone increases reabsorption of sodium and excretion of potassium.Hyperaldosteronism causes hypernatremia,hypokalemia,and metabolic alkalosis.Hyponatremia,hyperkalemia,and acidosis are manifestations of adrenal insufficiency.

Question 9

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

Accepted Answer

A light yellow drainage or a halo effect on the dressing is indicative of a cerebrospinal fluid leak.The client should have the head of the bed elevated after surgery.Although deep breathing is important postoperatively,coughing should be avoided to prevent cerebrospinal fluid leakage.Although application of petroleum jelly to the lips will help with dryness,this instruction is not as important as reporting the yellowish drainage.

Question 10

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

Accepted Answer

Anterior pituitary hyperfunction typically will cause protrusion of the lower jaw,deepening of the voice,enlarged hands and feet,kyphosis,barrel-shaped chest,and excessive sweating.

Question 11

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

Accepted Answer

One of the most common causes of adrenal insufficiency,a life-threatening problem,is the sudden cessation of long-term,high-dose corticosteroid therapy.This therapy suppresses the hypothalamic-pituitary-adrenal axis and must be withdrawn gradually to allow for pituitary production of adrenocorticotropic hormone and adrenal production of cortisol.Decreasing hormone therapy slowly ensures self-production of hormone,not hormone effectiveness.Building the client's immune system and rebound inflammation are not concerns related to stopping high-dose corticosteroids.

Question 12

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

Accepted Answer

After this surgery,the client must take care to avoid activities that can increase intracranial pressure.The client should avoid bending from the waist and should not bear down,cough,or lie flat.With this approach,there is no incision to clean and dress.Protection from sun exposure is not necessary after this procedure.

Question 13

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

Accepted Answer

All actions are appropriate for the client with adrenal crisis.However,therapy is given intravenously,so the priority is to establish IV access.Solu-Cortef is the drug of choice.Blood glucose is monitored hourly and treatment is provided as needed.Insulin and dextrose are used to treat any hyperkalemia.

Question 14

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

Accepted Answer

Testosterone therapy is initiated with high-dose testosterone derivatives and is continued until virilization is achieved.The dose is then decreased,but therapy continues throughout life.Therapy will continue throughout life; therefore,it will not be discontinued when blood levels are normal,at the age of 50 years,or when sperm counts are high.

Question 15

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

Accepted Answer

With SIADH,clients often have dilutional hyponatremia.The client needs a fluid restriction,sometimes to as little as 500 to 600 mL/24 hr.Adding sodium to the client's diet will not help if he or she is retaining fluid and diluting the sodium.The client is not at increased risk for fracture,so gentle handling is not an issue.The client should be on intake and output; however,this will monitor only the client's intake,so it is not the best answer.Reducing intake will help increase the client's sodium.

Question 16

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

Accepted Answer

Pituitary tumors,anorexia nervosa,hypertension,and shock are all conditions that can cause hypopituitarism.Diplopia is a manifestation of hypopituitarism,and weight gain is a manifestation of Cushing's disease and syndrome of inappropriate antidiuretic hormone.They are not risk factors for hypopituitarism.

Question 17

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?

Accepted Answer

Hypercortisolism can cause the client to show neurotic or psychotic behavior.The client needs to know that these behavior changes do not reflect a true psychiatric disorder and will resolve when therapy results in lower and steadier blood cortisol levels.The client needs to understand this effect and does not need a psychiatrist,support groups,or restricted visitors at this time.

Question 18

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

Accepted Answer

Some tests for pituitary function involve administering agents that are known to stimulate the secretion of specific pituitary hormones and then measuring the response.Such tests are termed stimulation tests.The stimulation test for GH or ACTH assessment involves injecting the client with regular insulin (0.05 to 1 unit/kg of body weight)and checking circulating levels of GH and ACTH.The presence of insulin in clients with normal pituitary function causes increased release of GH and ACTH.

Question 19

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

Accepted Answer

The client with Cushing's disease has weight gain,muscle loss,hyperglycemia,and sodium retention.Dietary modifications need to include reduction of carbohydrates and total calories to prevent or reduce the degree of hyperglycemia.Sodium retention causes water retention and hypertension.Clients are encouraged to restrict their sodium intake moderately.Clients often have bone density loss and need more calcium.Increased protein intake will help decrease muscle loss.

Question 20

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

Accepted Answer

Cushing's syndrome or disease greatly increases the serum levels of cortisol,which contributes to excessive bone demineralization and increases the risk for pathologic bone fracture.Padding the siderails and assisting the client to change position may be effective,but these measures will not protect him or her as much as using a lift sheet.The client should not require suctioning.

Quiz 62: Care of Patients with Pituitary and Adrenal Gland Problems