Chapter 44: Management of Clients with Adrenal and Pituitary Disorders Nursing School Test Banks

Black & Hawks: Medical-Surgical Nursing, 8th Edition

Test Bank

Chapter 44: Management of Clients with Adrenal and Pituitary Disorders

MULTIPLE CHOICE

1. The nurse recognizes that the manifestations of Addisons disease are primarily related to the pathophysiology of

a.

adrenal insufficiency.

b.

increased intracranial pressure.

c.

renal disease.

d.

thyroid hyperfunction.

ANS: A

Commonly known as Addisons disease, primary adrenal insufficiency results from idiopathic atrophy or destruction of the adrenal glands by an autoimmune process or another disease. The other three options are not involved in Addisons disease.

DIF: Knowledge/Remembering REF: p. 1040 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

2. In a client with addisonian crisis, assessment would indicate that the drug Kayexalate is not effective when the nurses assesses the clinical manifestation of

a.

decreasing blood pressure.

b.

low back pain.

c.

pedal edema.

d.

rapid or erratic pulse.

ANS: D

Sodium polystyrene sulfonate (Kayexalate) is given to reduce hyperkalemia. If Kayexalate is not effective, hyperkalemia results and can cause cardiac dysrhythmias.

DIF: Analysis/Analyzing REF: p. 1041 OBJ: Assessment

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Pharmacological Agents/Actions

3. A client has Cushings syndrome secondary to needing large doses of glucocorticoids to control asthma. Today the client calls the clinic complaining of not feeling very well, but has no other complaints. The nurse should advise this client to

a.

come in for an examination and lab work.

b.

cut the steroid dose in half for the next week.

c.

make an appointment for next week.

d.

rest and drink plenty of fluids.

ANS: A

Clients with Cushings syndrome have altered immunity that leads them to be vulnerable to infection with few manifestations. This client needs to be seen this day. All the other options would make the clients condition worse: cutting steroids could lead to addisonian crisis; waiting until next week to be seen or self-treating with fluids and rest could cause the client to become acutely ill.

DIF: Analysis/Analyzing REF: p. 1045 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

4. The nurse formulating a discharge plan for a client with Addisons disease should place the highest emphasis on

a.

compliance with replacement therapy.

b.

prevention of the complication of hypertension.

c.

teaching the client how to cope with a chronic disease.

d.

weight control and the importance of good nutrition.

ANS: A

The nurse should provide the client and significant others with written instructions for self-administration of steroids. This information should include the importance of taking medications daily, without fail, exactly as prescribed. Teaching the client measures to increase coping are also important, but do not take the priority that option a does.

DIF: Application/Applying REF: p. 1043 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care

5. A client has Addisons disease. The nurse should teach the client to carry an injection kit at all times with the medication

a.

adrenaline.

b.

Benadryl.

c.

epinephrine.

d.

hydrocortisone.

ANS: D

The nurse should instruct the client to wear an emergency identification bracelet and carry an emergency kit for hydrocortisone injection in case of an adrenal crisis.

DIF: Application/Applying REF: p. 1043 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care

6. The nurse would assess that the individual most at risk for adrenal insufficiency is the

a.

asthmatic client taking hydrocortisone once a week who has emergency surgery.

b.

athlete who stops daily doses of steroids after taking them for 2 years.

c.

COPD client using an aerosol bronchodilator daily who becomes pregnant.

d.

hypertensive client taking a diuretic who contracts a febrile illness.

ANS: B

Sudden cessation of steroids after a more than every-other-day schedule could greatly increase the risk for development of adrenal insufficiency.

DIF: Comprehension/Understanding REF: p. 1040 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

7. Health promotion activities a school nurse could teach the student athletes that will help them avoid endocrine problems in the future include

a.

avoiding alcohol.

b.

getting plenty of rest.

c.

not smoking.

d.

not using steroids.

ANS: D

Educating clients to avoid using exogenous steroids unless prescribed is an important health promotion activity to avoid iatrogenic Cushings syndrome.

DIF: Application/Applying REF: p. 1040 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Lifestyle Choices

8. During assessment of a 45-year-old man with the medical diagnosis of Cushings syndrome, the nurse would note the most consistent finding of

a.

male pattern baldness.

b.

peripheral edema.

c.

hypertension.

d.

jaundice.

ANS: C

Aldosterone affects tubular reabsorption of sodium and water and excretion of potassium and hydrogen ions in the renal tubular epithelial cells. This leads to the development of hypernatremia, hypervolemia, hypokalemia, and metabolic alkalosis. With the hypovolemia and hypernatremia, blood pressure increases, often to very high levels, and renin production is suppressed.

DIF: Comprehension/Understanding REF: p. 1045 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

9. For a client with a pheochromocytoma, the most critical assessment by the nurse is

a.

abdominal girth.

b.

blood pressure.

c.

daily weight.

d.

pulse quality.

ANS: B

Hypertension is the principal manifestation of pheochromocytoma and can be persistent, fluctuating, intermittent, or paroxysmal in nature. Because of the excessive epinephrine and norepinephrine they secrete, pheochromocytomas can produce severe manifestations and even death. The other three options are not seen in pheochromocytoma.

DIF: Comprehension/Understanding REF: p. 1052 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

10. In making the care plan for a client with Cushings disease, the nurse would choose which diagnosis as a priority?

a.

Activity Intolerance

b.

Pain, Chronic

c.

Risk for Fluid Volume Deficit

d.

Risk for Injury

ANS: D

The client should be protected against falls and accidents. Clients with Cushings syndrome have osteoporosis and tend to develop fractures with even minor trauma.

DIF: Application/Applying REF: p. 1048 OBJ: Diagnosis

MSC: Safe, Effective Care Environment Safety and Infection Control-Injury Prevention

11. A client with hyperpituitarism tells the nurse that he thinks he looks different now than he did 5 years ago. The nurses most appropriate response to this remark considers that the client is

a.

experiencing a sensory disturbance and needs reorientation.

b.

having visual disturbances and may need a ophthalmologist consult.

c.

making bizarre comments because of increased intracranial pressure and needs a neurosurgical consult.

d.

referring to physical changes from acromegaly and needs emotional support.

ANS: D

In the adult with acromegaly (increased growth hormone after epiphyseal closure), bones increase in thickness, and there is increase in soft tissue growth. Clients with hyperpituitarism do need careful assessment of neurologic status and an ophthalmologic exam before surgery.

DIF: Comprehension/Understanding REF: pp. 1054, 1056

OBJ: Intervention

MSC: Psychological Integrity Coping and Adaptation-Unexpected Body Image Changes

12. When formulating the teaching plan for a client with hyperpituitarism being prepared for transsphenoidal hypophysectomy, the nurse would give priority to

a.

alerting the client to the need for constant monitoring after surgery.

b.

instructing the client to avoid activities such as coughing and sneezing.

c.

reviewing the clinical manifestations of infection.

d.

teaching coughing and deep-breathing techniques.

ANS: B

A priority nursing diagnosis for this preoperative client is Risk for Injury. Prevention of elevated intracranial pressure is accomplished by avoiding activities that raise intracranial pressure, similar to the care of a client undergoing craniotomy.

DIF: Analysis/Analyzing REF: p. 1056 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

13. Twelve hours after surgery for pheochromocytoma, the nurse should assess a postoperative client for manifestations of abdominal hematoma, including

a.

absent bowel sounds.

b.

blurred vision.

c.

elevated blood pressure.

d.

increased urine output.

ANS: A

For the first day or two the client should be monitored closely for complications of the operation, including adrenal insufficiency, hypotension, hemorrhage, and shock. If the client is bleeding internally, an abdominal hematoma can develop, resulting in paralytic ileus. Manifestations of paralytic ileus include abdominal pain, distention, severe nausea, vomiting, and diminished or absent bowel sounds.

DIF: Application/Applying REF: pp. 1053-1054

OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

14. The nurse assessing a client with hypopituitarism would note the finding most consistent with this disorder as

a.

a pendulous abdomen.

b.

frequent nasal drainage.

c.

mottled skin.

d.

short stature.

ANS: D

Specific disorders resulting from pituitary hyposecretion include short stature, sexual and reproductive disorders, hypothyroidism, secondary adrenocortical insufficiency, and prolactin deficiency.

DIF: Comprehension/Understanding REF: p. 1058 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

15. For a client who has undergone transsphenoidal hypophysectomy, the aspect of usual postoperative care that the nurse would modify is

a.

administration of oxygen.

b.

leg exercises.

c.

nutrition.

d.

oral care.

ANS: D

The client who has undergone a transsphenoidal hypophysectomy requires frequent oral hygiene using a gauze sponge, and the lips should be lubricated with petroleum jelly. The client should not brush the teeth for 2 weeks after surgery.

DIF: Application/Applying REF: p. 1057 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

16. The nurse explains the pathophysiology of diabetes insipidus as arising from a deficiency in

a.

antidiuretic hormone (ADH).

b.

follicle-stimulating hormone (FSH).

c.

growth hormone (GH).

d.

oxytocin.

ANS: A

Diabetes insipidus results from a deficiency in ADH and leads to an inability to conserve water.

DIF: Comprehension/Understanding REF: p. 1057 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

17. The nurse monitoring hourly urine output in a client following transsphenoidal hypophysectomy would immediately report

a.

100 ml of urine in 1 hour.

b.

150 ml of urine in 1 hour.

c.

175 ml of urine in 1 hour.

d.

225 ml of urine in 1 hour.

ANS: D

The nurse should maintain strict documentation of intake and output in this postoperative client and notify the physician if urine output is greater than 200 ml/hour with urine specific gravity below 1.005.

DIF: Application/Applying REF: p. 1057 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

18. Before surgery, a client diagnosed with pheochromocytoma would be instructed to avoid

a.

a diet high in vitamins and minerals.

b.

coffee, tea, and cola.

c.

long rest periods.

d.

sedative medications.

ANS: B

Important preoperative nursing interventions for the client with pheochromocytoma include promoting rest and relief from stress; administering prescribed sedatives; providing a diet high in vitamins, minerals, and calories; prohibiting caffeine-containing beverages (e.g., coffee, tea, cola); and monitoring vital signs.

DIF: Comprehension/Understanding REF: p. 1053 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

MULTIPLE RESPONSE

1. Critical actions the nurse takes specifically when caring for the client with Cushings syndrome who had an adrenalectomy include (Select all that apply)

a.

ambulate the client as soon as the client is able.

b.

begin discharge planning on admission for the operation.

c.

use strict aseptic technique when changing dressings.

d.

strongly encourage client to cough and deep breathe.

ANS: A, B

The client receiving steroid replacement is at high risk for infection because of lowered resistance to stress and a compromised immune system. Protecting this client from infection is vital. Discharge planning begins on admission for all clients. Most postoperative clients benefit from ambulation as soon as they are able.

DIF: Analysis/Analyzing REF: p. 1048 OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Medical and Surgical Asepsis

2. In reviewing laboratory data for a client with Cushings syndrome, the nurse might expect to see the laboratory abnormalities of (Select all that apply)

a.

hypercalcemia.

b.

hyperglycemia.

c.

hyperproteinemia.

d.

hypoglycemia.

e.

hypokalemia.

f.

hyponatremia.

ANS: B, E

The exaggerated physiologic action of glucocorticoids appears as persistent hyperglycemia (steroid diabetes) and potassium depletion, leading to hypokalemia.

DIF: Comprehension/Understanding REF: pp. 1044-1045

OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

Elsevier items and derived items 2009 by Saunders, an imprint of Elsevier Inc.

Some material was previously published.

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