Chapter 46: Pituitary and Adrenal Disorders Nursing School Test Banks

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.
ANS: C
The level of growth hormone will drop in the presence of oral glucose. In a patient with acromegaly, the growth hormone level drops dramatically. The GTT is the best diagnostic tool for acromegaly.

DIF: Cognitive Level: Comprehension REF: p. 1010-1011
OBJ: 2 TOP: Acromegaly KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

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.
ANS: A
The patient should be taught to avoid sneezing, coughing, drinking through a straw, and using a stringent mouthwash that might dislodge the graft.

DIF: Cognitive Level: Comprehension REF: p. 1016 OBJ: 4
TOP: Pituitary Surgery KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

3. What causes the large flattened features of a patient with acromegaly?
a. Prolactin
b. Growth hormone
c. Thyroid-stimulating hormone
d. Adrenocorticotropic hormone
ANS: B
Excess growth hormone in an adult will cause the flat bones to grow because the adult has little capacity for heightened growth. In a child, this same excess would cause giantism.

DIF: Cognitive Level: Knowledge REF: p. 1010 OBJ: 3
TOP: Acromegaly KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

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
ANS: A
The hypovolemia from massive diuresis leads to decreased blood pressure, tachycardia, and weakness.

DIF: Cognitive Level: Knowledge REF: p. 1019 OBJ: 1
TOP: Diabetes Insipidus KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

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
ANS: B
Hydrocortisone helps regulate the excretion of potassium and sodium, the two electrolytes that control fluid distribution.

DIF: Cognitive Level: Comprehension REF: p. 1027 OBJ: 3
TOP: Addison Disease KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

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.
ANS: C
Nephrogenic DI does not respond to ADH.

DIF: Cognitive Level: Comprehension REF: p. 1019 OBJ: 3
TOP: Addison Disease KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

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 cant wear pink anymore.
d. At last! I look like I have a suntan.
ANS: A
The brown hyperpigmentation of Addison disease appears on the face and in body creases, joints, and pressure points, and it is obvious. The skin changes are not a rash nor are they red.

DIF: Cognitive Level: Comprehension REF: p. 1029-1030
OBJ: 2 TOP: Addison Disease
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

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.
ANS: A
The boy with Addison disease will not grow facial, axillary, or pubic hair. Balding and enlarged joints are not associated with Addison disease.

DIF: Cognitive Level: Comprehension REF: p. 1027 OBJ: 1
TOP: Addison Disease KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

9. What is the cardinal indication of a pheochromocytoma?
a. Significant hypertension
b. Extreme nausea
c. Abdominal pain
d. Edema in the legs
ANS: A
The patient with a pheochromocytoma exhibits dangerously high hypertension. Hypertension and its attendant symptoms are what bring the patient to the physician. The tumor is found incidentally.

DIF: Cognitive Level: Knowledge REF: p. 1033 OBJ: 4
TOP: Adrenal Tumor KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

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
ANS: B
Confusion and tachycardia are signs that the patient may be in adrenal crisis, which is a medical emergency and should be brought to the attention of the charge nurse.

DIF: Cognitive Level: Application REF: p. 1026 OBJ: 3
TOP: Adrenal Crisis KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

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.
ANS: A
Serum levels are measured to detect elevations or deficiencies of pituitary hormone levels. If plasma ACTH is low, then the pituitary is not producing enough ACTH. If the plasma ACTH is high, then the adrenal glands are unable to respond to produce corticoids.

DIF: Cognitive Level: Comprehension REF: p. 1007 OBJ: 2
TOP: Pituitary Laboratory Value KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

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
ANS: B
Hypovolemia lowers the blood pressure and may cause orthostatic hypotension.

DIF: Cognitive Level: Comprehension REF: p. 1027 OBJ: 4
TOP: Addison Disease KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

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.
ANS: A
Administering IV push Solu-Cortef will dramatically relieve the symptoms, but the therapeutic period is only approximately 5 hours; consequently, a slower IV infusion is needed to keep up the level of cortisol.

DIF: Cognitive Level: Application REF: p. 1027-1028
OBJ: 3 TOP: Adrenal Crisis
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

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.
ANS: C
The medical alert bracelet will reduce the patients risk of not receiving appropriate and timely care in an emergency situation.

DIF: Cognitive Level: Application REF: p. 1027 OBJ: 4
TOP: Addison Disease KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

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
ANS: A
Long-term corticosteroid use is a prime cause of Cushing syndrome.

DIF: Cognitive Level: Comprehension REF: p. 1030 OBJ: 3
TOP: Cushing Syndrome KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

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
ANS: C
Truncal obesity, thin extremities, and moon face are the classical signs of Cushing syndrome caused by long-term corticosteroid therapy.

DIF: Cognitive Level: Comprehension REF: p. 1031 OBJ: 1
TOP: Cushing Syndrome KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

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.
ANS: C
Patients with Cushing syndrome are especially prone to infection. Adding salt would increase fluid retention. Sun exposure and well-fitting shoes are not significant for Cushing syndrome.

DIF: Cognitive Level: Comprehension REF: p. 1032 OBJ: 3
TOP: Cushing Syndrome KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

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
ANS: D
Simmonds cachexia is a panhypopituitarism condition in which muscle wasting, small organs, very pale complexion, virtually no body hair, and subnormal body temperature are symptoms.

DIF: Cognitive Level: Comprehension REF: p. 1017 OBJ: 3
TOP: Panhypopituitarism KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

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
ANS: B
A 10-year-old boy will be excessively tall for his age. Hair is not lacking, and skin eruptions associated with giantism are observed. Most 10-year-old boys have small genitalia.

DIF: Cognitive Level: Application REF: p. 1010-1011
OBJ: 4 TOP: Hyperpituitarism
KEY: Nursing Process Step: Planning
MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

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
ANS: A
With the removal of the entire pituitary gland, the patient will have no effective ADH and will excrete large amounts of urine. The patient is usually kept in a semi-Fowler position and is medicated as needed for pain. Because of the graft, mouth care is minimal, if provided at all.

DIF: Cognitive Level: Application REF: p. 1015 OBJ: 4
TOP: Hypophysectomy KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

21. What can bring on an addisonian crisis?
a. Sudden atmospheric temperature change
b. Hyperglycemia
c. Infection
d. Change of altitude
ANS: C
Infection is one of the many stresses that can bring on an addisonian crisis.

DIF: Cognitive Level: Knowledge REF: p. 1025 OBJ: 2
TOP: Addisonian Crisis KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

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
ANS: C
Educate the patient about the responsibility for his or her own care, such as knowledge of medications, activities, and knowing when to call the physician.

DIF: Cognitive Level: Application REF: p. 1015 OBJ: 4
TOP: Discharge Planning after Hypophysectomy
KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

23. A mother of a 6-foot, 2-inch, 16-year-old girl who is being treated for hyperpituitarism says, I cant stand it that my beautiful daughter is a freak. What is the nurses 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.
ANS: C
Using a question that encourages further discussion will help the nurse understand the distress that the parent is trying to convey. Listening to the parents concerns helps them get in touch with their own feelings.

DIF: Cognitive Level: Application REF: p. 1010-1015
OBJ: 1 TOP: Gigantism KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

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.
ANS: B
To prevent complications, recognizing the importance of continuing to replace the missing hormones is essential for the patient.

DIF: Cognitive Level: Comprehension REF: p. 1018 OBJ: 4
TOP: Hypopituitarism KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

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.
ANS: D
Sandostatin will suppress growth hormone, but it will not reverse the effects of acromegaly. It is administered three times a week, and suppresses insulin secretion causing hyperglycemia.

DIF: Cognitive Level: Comprehension REF: p. 1013-1014
OBJ: 3 TOP: Growth Hormone Suppression
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

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 patients blood pressure.
d. Elevate the head of the bed to 45 degrees.
ANS: B
The headache and the nuchal rigidity are signs of meningitis.

DIF: Cognitive Level: Application REF: p. 1016 OBJ: 3
TOP: Signs of Meningitis KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

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
ANS: A, C, D, E
Retained fluid and hyponatremia cause weight gain and elevated blood pressure with an attendant headache. The hyperkalemia causes the patient to feel weak and have muscle cramps.

DIF: Cognitive Level: Comprehension REF: p. 1021 OBJ: 3
TOP: Signs of SIADH KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

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
ANS: A, B, C, E
The anterior pituitary gland controls the endocrine glands and excretes growth hormone. The signs of an adenoma of the anterior pituitary glands are amenorrhea, galactorrhea, and weight gain. The posterior pituitary controls diuresis.

DIF: Cognitive Level: Comprehension REF: p. 1010 OBJ: 3
TOP: Signs of Adenoma of Anterior Pituitary
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

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
ANS: A
A dropping blood pressure is an indication that the hypovolemia with DI has reached a significant point and will require medical implementation. All other options are the expected signs of this disorder or an indication that therapy is effective.

DIF: Cognitive Level: Comprehension REF: p. 1020 OBJ: 3
TOP: Diabetes Insipidus KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

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 _____.

ANS:
5 feet
Growth hormone is given to children with hypopituitarism until they reach a height of 5 feet.

DIF: Cognitive Level: Comprehension REF: p. 1017 OBJ: 3
TOP: Growth Hormone in a Child with Hypopituitarism
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

31. A nurse noting a peaked T wave on the electrocardiogram (ECG) of a patient with Addison disease recognizes this complex as suggestive of _____.

ANS:
hyperkalemia
Hyperkalemia will cause an elevated, peaked T wave.

DIF: Cognitive Level: Comprehension REF: p. 1026 OBJ: 3
TOP: Hyperkalemia KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

32. A nurse prepares a family for the altered appearance of the patient returning from stereotactic radiosurgery to see a(n) _____ in place.

ANS:
stereotactic frame
The stereotactic frame, which helps direct the radiation, is attached to the patients head with pins.

DIF: Cognitive Level: Comprehension REF: p. 1016 OBJ: 4
TOP: Stereotactic Radiosurgery KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

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