Aneliza De Vera

Patricia Anne Rubi

20 Board Questions

1. A patient is suspected of having a pituitary tumor causing panhypopituitarism. During
assessment of the pt, the nurse would expect to find
a. elevated blood glucose.
b. changes in secondary sex characteristics.
c. high blood pressure.
d. tachycardia and cardiac palpitations.
B
R: Changes in secondary sex characteristics are associated with decreases in FSH and
LH. Fasting hypoglycemia and hypotension occur in panhypopituitarism as a result of
decreases in ACTH and cortisol. Bradycardia is likely due to the decrease in TSH and
thyroid hormones associated with panhypopituitarism.

2. A patient seen at clinic for an upper respiratory infection reports receiving subcutaneous
somatotropin (Genotropin) when asked by the nurse about current medications. The nurse
questions the pt further about a history of
a. adrenal disease.
b. untreated acromegaly.
c. a pituitary tumor.
d. diabetes insipidus (DI).
C
R: Somatotropin is a recombinant growth hormone product used for adults with growth
hormone deficiency, such as that caused by a pituitary tumor. The med is not used in
adrenal disease or DI. The patient with untreated acromegaly will have an excess of growth
hormone.

3. During preoperative teaching for a patient scheduled for transsphenoidal
hypophysectomy for treatment of a pituitary adenoma, the nurse instructs the patient about
the need to
a. remain on bed rest for the first 48 hours after the surgery.
b. avoid brushing the teeth for at least 10 days after the surgery.
c. cough and deep-breathe every 2 hrs postoperatively.
d. be positioned flat with sandbags at the head postoperatively.
B
R: To avoid disruption of the suture line, the patient should avoid brushing the teeth for 10
days after surgery. It is not necessary to remain on bed rest after this surgery. Coughing is
discouraged because it may cause leakage of cerebrospinal fluid (CSF) from the suture line.
The head of the bed should be elevated 30 degrees to reduce pressure on the sella turcica
and decrease the risk for headaches.


4. Following a transsphenoidal resection of a pituitary tumor,
an important N assessment is
a. monitoring hourly urine output.
b. checking the dressings for serous drainage.
c. palpating for dependent pitting edema.
d. obtaining continuous pulse oximetry.
A
R: After pituitary surgery, the pt is at risk for diabetes insipidus caused by cerebral edema
and monitoring of urine output and urine specific gravity is essential. There will be no
dressing when transsphenoidal approach is used. The pt is at risk for dehydration, not
volume overload. The pt is not at high risk for problems with oxygenation, and continuous
pulse oximetry is not needed.

5. A patient with an antidiuretic hormone (ADH)-secreting small-cell cancer of the lung is
treated with demeclocycline (Declomycin) to control the symptoms of syndrome of
inappropriate secretion of antidiuretic hormone (SIADH). The nurse determines that the
demeclocycline is effective upon finding that the
a. patient's daily weight is stable.
b. urine specific gravity is increased.
c. patient's urinary output is increased.
d. peripheral edema is decreased.
C
R: Demeclocycline blocks the action of ADH on the renal tubules and increases urine
output. A stable body weight and an increase in urine specific gravity indicate that the
SIADH is not corrected. Peripheral edema does not occur with SIADH; a sudden weight
gain without edema is a common clinical manifestation of this disorder.

6. When teaching a patient with chronic SIADH about long-term management of the
disorder, the nurse determines that additional instruction is needed when the patient says,
a. "I need to shop for foods that are low in sodium and avoid adding salt to foods."
b. "I should weigh myself daily and report any sudden weight loss or gain."
c. "I need to limit my fluid intake to no more than 1 quart of liquids a day."
d. "I will eat foods high in potassium because the diuretics cause potassium loss."
A
R: Patients with SIADH are at risk for hyponatremia, and a sodium supplement may be
prescribed. The other pt statements are correct and indicate successful teaching has
occurred.

7. A patient is hospitalized with possible SIADH. The patient is confused and reports a
headache, muscle cramps, and twitching. The nurse would expect the initial laboratory
results to include a
a. serum sodium of 125 mEq/L (125 mmol/L).
b. hematocrit of 52%.
c. blood urea nitrogen (BUN) of 22 mg/dl (11.5 mmol/L).
d. serum chloride of 110 mEq/L (110 mmol/L).
A
R: When water is retained, the serum sodium level will drop below normal, causing the CMs
reported by the patient. The hematocrit will decrease because of the dilution caused by
water retention. The BUN is not helpful in diagnosis of SIADH and this BUN value is
increased. The serum chloride level will usually decrease along with the sodium level. This
chloride value is elevated.

8. A patient with symptoms of DI is admitted to the hospital for evaluation and treatment of
the condition. An appropriate nursing diagnosis for the patient is
a. insomnia related to waking at night to void.
b. risk for impaired skin integrity related to generalized edema.
c. excess fluid volume related to intake greater than output.
d. activity intolerance related to muscle cramps and weakness.
A
R: Nocturia occurs as a result of the polyuria caused by diabetes insipidus. Edema will not
be expected because dehydration is a concern with polyuria. The pt drinks large amnts of
fluid to compensate for losses experienced from diuresis. The pt's fluid and electrolyte
status remain normal as long as the patient's oral intake can keep up w fluid losses, muscle
cramps and weakness arent concerns.

9. Which information obtained when caring for a pt who has just been admitted for
evaluation of DI will be of greatest concern to the nurse?
a. The patient has a urine output of 800 ml/hr.
b. The patient's urine specific gravity is 1.003.
c. The patient had a recent head injury.
d. The patient is confused and lethargic.
D
R: Patients with diabetes insipidus compensate for fluid losses by drinking copious
amounts of fluids, but a patient who is lethargic will be unable to drink enough fluids
and will become hypovolemic. A high urine output, low urine specific gravity, and
history of a recent head injury are consistent with DI, but they do not require immediate
nursing action to avoid life-threatening complications.

10. A patient has an adrenocortical adenoma causing hyperaldosteronism and is
scheduled for laparoscopic surgery to remove the tumor. During care before surgery, the
nurse should
a. monitor blood glucose level every 4 hours.
b. provide a potassium-restricted diet.
c. monitor the blood pressure every 4 hours.
d. relieve edema by elevating the extremities.
C
R: HTN caused by Na retention is a common complication of hyperaldosteronism.
Hyperaldosteronism does not cause elevation in blood glucose. Patient will be
hypokalemic and require potassium supplementation prior to surgery. Edema does not
usually occur with hyperaldosteronism.

11. After a patient with a pituitary adenoma has had a hypophysectomy, the nurse will
plan to do discharge teaching about the need for
a. insulin use to maintain blood glucose at normal levels.
b. Na restriction to prevent fluid retention and hypertension.
c. oral corticosteroids to replace endogenous cortisol.
d. chemotherapy to prevent reoccurrence of tumor
C
R: ADH, cortisol, and thyroid hormone replacement will be needed for life after
hypophysectomy. Without the effects of ACTH and cortisol, the blood glucose and serum
sodium will be low unless cortisol is replaced. An adenoma is a benign tumor, and
chemotherapy will not be needed.

12. After receiving change-of-shift report about these pts, which patient should nurse assess
first?
a. A 22-year-old admitted with SIADH who has a serum sodium level of 130 mEq/L.
b. A 31-year-old who has iatrogenic Cushing's syndrome with a capillary blood glucose level
of 244 mg/dl.
c. A 53-year-old who has Addison's disease and is due for a scheduled dose of
hydrocortisone (Solu-Cortef).
d. A 70-year-old who recently started levothyroxine (Synthroid) to treat hypothyroidism and
has an irregular pulse of 134.
D
R: Initiation of thyroid replacement in older adults may cause angina and cardiac
dysrhythmias. The pt's high pulse rate needs rapid investigation by the nurse to assess for
and intervene with any cardiac problems. The other pts also require nursing assessment
and/or actions but are not at risk for life-threatening complications.

13. When caring for a patient with nephrogenic DI, the nurse would expect treatment to
include
a. fluid restriction
b. thiazide diuretics
c. a high-sodium diet
d. chlorpropamide (DIabinese)
B
Thiazide diuretics
(Rationale- in nephrogenic Di the kidney is unable to respond to ADH, so vasopressin or
hormone analogs are not effective. Thiazide diuretics slow the glomerular filtration rate
in the kidney and produce a decrease in urine output. Low-sodium diets are also thought
to decrease urine output. Fluids are not restricted, because the patient could become
easily dehydrated.)

14. The parents of a child whos going through testing for hypopituitarism ask the nurse
what test results they should expect. The nurses response should be based on which of
the following factors?
A . Measurement of growth hormone will occur only one time.
B. Growth hormone levels are decreased after strenuous exercise.
C. There will be increased overnight urine growth hormone concentration.
D. Growth hormone levels are elevated 45 to 90 minutes following the onset of sleep.
D.
Growth hormone levels are elevated 45 to 90 minutes following the onset of sleep. Low
growth hormone levels following the onset of sleep would indicate the need for further
evaluation. Exercise is a natural and benign stimulus for growth hormone release, and
elevated levels can be detected after 20 minutes of strenuous exercise in normal
children. Also, growth hormone levels will need to be checked frequently related to the
type of therapy instituted.

15. The nurse is assessing a client with suspected hypopituitarism. Which of the
following conditions is the chief complaint associated with this condition?
A. Insomia
B. Polyuria
C. Polydipsia
D. Short stature
D.
The chief complaint in most instances of hypopituitarism is short stature. All other
choices are complaints of the other metabolic disorders.

16. A nurse is teaching health to a class of fifth graders. Which of the following
statements related to growth should be included?
A. Theres nothing that you can do to influence your growth.
B. Intensive physical activity that begins before puberty might stunt growth.
C. All children who are short in stature also have parents who are short in stature.
D. Because this is a time of tremendous growth, being concerned about calorie intake
isnt important.
B.
Intensive physical activity (greater than 18 hours per week) that begins before puberty
may stunt growth so that the child doesnt reach full adult height. During the school-age
years, growth slows and doesnt accelerate again until adolescence. Nutrition and
environment influence a childs growth. All children who are short in stature dont
necessarily have parents who are short in stature.

17. When assessing a child with growth hormone deficiency, the nurse would expect to
observe which of the following characteristics?
A. Decreased weight with no change in height.
B. Decreased weight with increased height.
C. Increased weight with decreased height.
D. Increased weight with increased height.
C.
Height may be retarded more than weight because, with good nutrition, children with
growth hormone deficiency can become overweight or even obese. Their well-nourished
appearance is an important diagnostic clue to differentiation from other disorders such
as failure to thrive.

18. The nurse should find which of the following characteristics in her assessment of a
child with growth hormone deficiency?
A. Normal skeletal proportions
B. Abnormal skeletal proportions
C. Childs appearing older than his age
D. Longer than normal upper extremities
A.
Skeletal proportions are normal for the age, but these children appear younger than
their chronological age. However, later in life, premature aging is evident.

19. When counseling the parents of a child with growth hormone deficiency, the nurse
should encourage which of the following sports?
A. Basketball
B. Field hockey
C. Football
D. Gymnastics
D.
Children with growth hormone deficiency can be no less active than other children if
directed to size-appropriate sports, such as gymnastics, swimming, wrestling, or soccer.

20. Which of the following tests is used for a definitive diagnosis of hypopituitarism?
A. Hypersecretion of thyroid hormone
B. Increased reserves of growth hormone
C. Hyposecretion of antidiuretic hormone
D. Decreased reserves of growth hormone
D.
Definitive diagnosis is based on absent or subnormal levels of pituitary growth hormone.
Antidiuretic hormone and thyroid hormone levels arent affected.