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

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?

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.

Answer 1

Take vital signs, including temperature.

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?

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.

Answer 2

Use a lift sheet to re-position the client.

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?

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."

Answer 3

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

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?

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."

Question 5

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."

Question 6

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 client's 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?

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

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.)

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

Question 9

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.

Question 10

A nurse assesses a client with anterior pituitary hyperfunction.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

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?

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 back up."

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?

A) "I will wear dark glasses to prevent sun exposure."
B) "I'll 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."

Question 13

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.

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?

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."

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?

A) Consult with the dietitian about increased dietary sodium.
B) Restrict the client's 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.

Question 16

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

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?

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."

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?

A) Pituitary hypofunction
B) Pituitary hyperfunction
C) Pituitary-induced diabetes mellitus
D) Normal pituitary response to insulin

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.)

A) Low calcium
B) Low carbohydrate
C) Low protein
D) Low calories
E) Low sodium

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?

A) Pad the siderails of the client's bed.
B) Assist the client to change positions slowly.
C) Use a lift sheet to change the client's position.
D) Keep suctioning equipment at the client's bedside.

Question 21

A nurse assesses a client with Cushing's 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

Question 22

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

Question 23

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.