Chapter 46: Pituitary and Adrenal Disorders
Linton: Introduction to Medical–Surgical Nursing, 6th Edition
MULTIPLE CHOICE
1. A patient believed to have acromegaly asks the purpose of the diagnostic glucose tolerance
test (GTT). What is the most accurate response by the nurse?
a.
“The doctor wants to know if you have either diabetes or acromegaly.”
b.
“The growth hormone will cause the glucose to be used up very quickly during the
test.”
c.
“It measures the growth hormone in the presence of oral glucose levels at specified
times.”
d.
“It tells whether your thyroid reacts to the high levels of sugar taken during this
test.”
2. What should preoperative teaching for a patient scheduled for a transsphenoidal
hypophysectomy include that the patient should do postoperatively?
a.
Avoid sneezing.
b.
Drink through a straw.
c.
Cough forcefully.
d.
Wash mouth out with peroxide.
3. What causes the large flattened features of a patient with acromegaly?
a.
Prolactin
b.
Growth hormone
c.
Thyroid-stimulating hormone
d.
Adrenocorticotropic hormone
4. What are the classic symptoms of diabetes insipidus (DI)?
a.
Diuresis, tachycardia, and weakness
b.
Dizziness, hypertension, and excitability
c.
Stress incontinence, vomiting, and edema
d.
Bradycardia, insomnia, and muscle cramps
5. A patient with Addison disease asks why she must take hydrocortisone. What should the nurse
relay that the action of hydrocortisone is with Addison disease?
a.
Increases cardiac output
b.
Regulates the excretion of potassium and sodium
c.
Decreases the level of cortisol
d.
Lowers the blood sugar level
6. A patient states that he is confused because the physician told him that his diabetes insipidus
(DI) is nephrogenic. What should the nurse state when describing the difference between
nephrogenic DI and neurogenic DI?
a.
Nephrogenic DI will eventually resolve without medication.
b.
Nephrogenic DI requires the nasal spray lypressin.
c.
Nephrogenic DI does not respond to ADH.
d.
Nephrogenic DI will require dialysis.
7. Which statement by a woman with Addison disease would indicate a disturbance in body
image?
a.
“Will I look like a zebra for the rest of my life?”
b.
“I have found makeup to cover my rash.”
c.
“With this red face, I sure can’t wear pink anymore.”
d.
“At last! I look like I have a suntan.”
8. A 14-year-old adolescent male patient has been diagnosed with Addison disease. Which effect
of Addison disease should this patient be aware of?
a.
He will not develop pubic hair.
b.
He will grow a heavy beard.
c.
He will become bald at an early age.
d.
He will have enlarged joints.
9. What is the cardinal indication of a pheochromocytoma?
a.
Significant hypertension
b.
Extreme nausea
c.
Abdominal pain
d.
Edema in the legs
10. A nurse is caring for a patient diagnosed with Addison disease. Which signs and symptoms
should lead the nurse to suspect an adrenal crisis?
a.
Hypertension and abdominal pain
b.
Confusion and tachycardia
c.
Bradycardia and nausea
d.
Widening pulse pressure and shortness of breath
11. A patient inquires about the purpose of the laboratory test to measure the serum level of
adrenocorticotropic hormone (ACTH). What should a nurse respond that the laboratory test
will determine?
a.
The pituitary gland is sending the correct message to the adrenal glands.
b.
The thyroid gland is not stimulating the production of ACTH.
c.
The adrenal glands are not responding to produce cortisol.
d.
Androgen metabolites are low or borderline.
12. A nurse includes in the discharge plan for a patient with Addison disease, “Risk for injury.”
What should measures to deal with this include?
a.
Arranging for uncluttered floor space
b.
Rising slowly from a lying position
c.
Keeping the room well lit
d.
Providing instructions in the use of a walker
13. A family member of a patient who is in adrenal crisis asks why the IV cortisone is continued
after the initial IV push of Solu-Cortef, which seemed to stop the symptoms. What is the best
explanation by the nurse?
a.
Solu-Cortef has a very brief therapeutic period and needs a maintenance IV
infusion to keep up the level.
b.
IV infusions guarantee that Solu-Cortef will be absorbed.
c.
Long-term IV infusions maintain adequate urine output.
d.
IV cortisone supports peripheral perfusion and elevates the blood pressure.
14. What should a nurse include when planning education to a patient with Addison disease?
a.
Discontinue hormonal replacement therapy if the patient becomes nauseated or has
diarrhea.
b.
Decrease medication if the patient is under stress or is being treated for an
infection.
c.
Wear a medical alert tag and carry emergency dexamethasone.
d.
Begin a vigorous exercise program to overcome weakness and muscle wasting.
15. A patient with long-term asthma develops Cushing syndrome. What is the cause of this
condition?
a.
Taking corticosteroids for many years
b.
Abruptly withdrawing cortisone therapy
c.
Lacking ACTH, related to the pituitary gland
d.
Poorly functioning adrenal glands
16. Which findings are expected when assessing a patient with Cushing syndrome?
a.
Edema of the trunk, extremities, and face
b.
Wasting of the abdomen with thick, calloused skin
c.
Excess adipose tissue in the trunk, slender extremities, and moon face
d.
High levels of potassium and low levels of sodium, weakness, and wasting
17. Which statement by a patient diagnosed with Cushing syndrome leads a nurse to conclude that
teaching has been effective?
a.
“I know I should add salt to everything I eat.”
b.
“I make a point to avoid excessive exposure to sun.”
c.
“I avoid being exposed to anyone with an infection.”
d.
“I am careful to wear well–fitting shoes.”
18. A nurse is assessing a patient with Simmonds cachexia. What symptom should the nurse
anticipate the patient will exhibit?
a.
High body temperature
b.
Ruddy complexion
c.
Silky body hair
d.
Muscle wasting
19. A nurse making a care plan for a 10-year-old boy with hyperpituitarism identifies a disturbed
self-image. What should the nurse relate this nursing diagnosis to?
a.
Lack of facial hair
b.
Excessive height
c.
Small genitalia
d.
Skin eruptions on the face
20. What should a nurse include when caring for a patient after a hypophysectomy, during which
the entire pituitary was removed?
a.
Maintaining strict intake and output fluids
b.
Keeping the patient flat in bed for the first 24 hours
c.
Withholding analgesics to assess the level of consciousness
d.
Providing mouth care with thorough cleansing of the oral cavity
21. What can bring on an addisonian crisis?
a.
Sudden atmospheric temperature change
b.
Hyperglycemia
c.
Infection
d.
Change of altitude
22. What should discharge planning for a patient who underwent a hypophysectomy focus on?
a.
Finding a support group
b.
Nutritional maintenance
c.
Education on self-care
d.
Self-image improvement
23. A mother of a 6-foot, 2-inch, 16-year-old girl who is being treated for hyperpituitarism says,
“I can’t stand it that my beautiful daughter is a freak.” What is the nurse’s best response?
a.
“Gigantism is treatable.”
b.
“Her height could help her be a basketball star or a model.”
c.
“What is it about her height that makes her a freak?”
d.
“All parents feel responsible when their children have problems.”
24. A patient with hypopituitarism must take medications for the rest of his or her life. What
should the patient teaching plan include?
a.
“Constipation must be prevented because straining increases intracranial pressure.”
b.
“You must become familiar with the signs and symptoms of inadequate or
excessive hormone replacement.”
c.
“It is not necessary to wear a medical alert bracelet or necklace.”
d.
“Your self-image is important. Take positive steps to improve your appearance.”
25. A patient is receiving the medication octreotide (Sandostatin) as a treatment for acromegaly.
What should the nurse explain regarding this medication?
a.
It reverses the effects of acromegaly.
b.
It should be given on a daily basis by injection.
c.
It increases insulin secretion causing hypoglycemia.
d.
It suppresses the growth hormone.
26. Two days after a hypophysectomy a patient complains of a headache and nuchal rigidity.
What action should the nurse take based on these assessments?
a.
Medicate with the prescribed analgesic.
b.
Report suspected meningitis to the head nurse.
c.
Closely monitor the patient’s blood pressure.
d.
Elevate the head of the bed to 45 degrees.
MULTIPLE RESPONSE
27. What symptoms should a nurse expect a patient with the diagnosis of SIADH to report during
an intake interview? (Select all that apply.)
a.
Headache
b.
Hypotension
c.
Weight gain
d.
Muscle cramps
e.
Weakness
28. An 18-year-old girl is diagnosed with adenoma of the anterior pituitary gland. What classic
signs of this diagnosis should the nurse assess? (Select all that apply.)
a.
Cessation of menses
b.
Milk production
c.
Changing facial features
d.
Excessive urine output
e.
Weight gain
29. A nurse is caring for a patient with diabetes insipidus (DI). Which signs should the nurse
report that indicate a change in condition? (Select all that apply.)
a.
Dropping blood pressure
b.
Light clear urine
c.
Moist mucous membranes
d.
Excessive thirst
e.
Large urine output
COMPLETION
30. A nurse explains that growth hormone will be given to the child with hypopituitarism on a
scheduled basis until the child reaches the height of _____.
31. A nurse noting a peaked T wave on the electrocardiogram (ECG) of a patient with Addison
disease recognizes this complex as suggestive of _____.
32. A nurse prepares a family for the altered appearance of the patient returning from stereotactic
radiosurgery to see a(n) _____ in place.