N4 test Pituitary and Adrenal Gland Problems

Ignatavicius & Workman: Medical-Surgical Nursing: Critical Thinking for Collaborative Care, 4th Edition
Chapter 63: Interventions for Clients with Pituitary and Adrenal Gland Problems

1. Which clinical manifestations alert you to the possibility of anterior pituitary hypofunction in a 30-year-old woman?

A. Fever, hypertension, and moon face
B. Painful menstruation, hypokalemia, and acne
C. Weight gain, hypoglycemia, and hyponatremia
D. Increased body hair, joint pain, and hypocholesterolemia

2. What clinical manifestation indicates to you that the testosterone replacement administered to an adult male with hypopituitarism is effective?

A. Virilization
B. Gynecomastia
C. Darkening of the skin
D. Increased serum potassium level

3. Your female client is receiving hormone replacement therapy with a combination of estrogen and progesterone for hypopituitarism. Which precaution should you teach this client?

A. “Use a barrier method of birth control if you are sexually active.”
B. “Report any calf pain or swelling immediately.”
C. “Report any breast tenderness immediately.”
D. “Avoid exposure to direct sunlight.”

4. Which nursing interventions should you use to prevent complications following a transsphenoidal-approach hypophysectomy?

A. Change the “mustache” dressing whenever it becomes wet or bloody.
B. Monitor urine volume and specific gravity.
C. Assist the client to cough every two hours.
D. Keep the head of the bed flat.

5. Which clinical manifestation or change indicates to you that the therapy for your client with hyperpituitarism is effective?

A. Plasma TSH and thyroid hormone levels increase.
B. Blood osmolarity decreases; blood volume increases.
C. Decreased in intensity/frequency of headache and backache.
D. Fasting blood glucose level is 132 mg/dL and blood pressure is increased.

6. The client with a brain tumor has a decreased serum sodium, decreased serum potassium, has gained 8 lbs in the past two days, and is disoriented. Which hormone imbalance do you suspect is being experienced?

A. Increased ADH synthesis and release
B. Decreased ADH synthesis and release
C. Increased ACTH synthesis and release
D. Decreased ACTH synthesis and release

7. Which manifestations make you suspect diabetes insipidus? _______ blood volume; _______ blood osmolarity.

A. decreased; decreased
B. decreased; increased
C. increased; increased
D. increased; decreased

8. Which manifestations make you suspect syndrome of inappropriate antidiuretic hormone (SIADH)? _______ blood volume; _______ blood osmolarity.

A. decreased; decreased
B. decreased; increased
C. increased; increased
D. increased; decreased

9. The client with diabetes insipidus responds to the exogenous administration of antidiuretic hormone (ADH). How should you interpret the response?

A. The disorder is probably primary diabetes insipidus.
B. The disorder is probably nephrogenic diabetes insipidus.
C. The disorder is probably drug-related diabetes insipidus.
D. A cure is possible.

10. Which statement made by the client with diabetes insipidus indicates a need for clarification regarding the management of this disorder?

A. “If I lose more than one pound in a day, I will increase my medication.”
B. “If I have a cold, I will take the medicine subcutaneously.”
C. “I will drink more on hot days or when I am exercising.”
D. “I will avoid salt and salt substitutes.”

11. Which client responses demonstrate to you that treatment for SIADH is effective? _______ urine output; _______ urine specific gravity.

A. increased; increased
B. increased; decreased
C. decreased; increased
D. decreased; decreased

12. Which action is the highest priority for you to teach the client with SIADH to monitor treatment adequacy?

A. Pulse rate/quality
B. Capillary refill
C. Abdominal girth
D. Daily weight

13. What is the priority nursing diagnosis for the client with Addison’s disease?

A. Risk for decreased cardiac output related to hyperkalemia and hypovolemia
B. Altered nutrition: less than body requirements related to anorexia
C. Body image disturbance related to skin darkening
D. Fatigue related to electrolyte imbalances

14. The client with Cushing’s disease is being treated with aminoglutethimide (Cytadren). Which clinical manifestation indicates this drug is effective?

A. Serum cortisol levels are decreased.
B. Serum sodium level is 148 mEq/L.
C. Serum potassium is 4.8 mEq/L.
D. Serum glucose level is 138 mg/dL.

15. Which precaution is the most important to teach the client who has hypercortisolism from drug therapy with prednisone for an inflammatory problem?

A. “Avoid large crowds and people who are ill.”
B. “Be sure to take your antacid to prevent peptic ulcer disease.”
C. “Take your pulse daily and report any irregularity to the physician.”
D. “Do not stop taking this medication without consulting your doctor.”

16. Which clinical manifestation in a client with Addison’s disease indicates to you that the drug therapy is effective? The:

A. client’s temperature is normal.
B. client’s heart rate is 76 and regular.
C. client’s pupils constrict equally when exposed to light.
D. client can speak a seven-word sentence without stopping for breath.

17. Which precaution is the most important to teach the client who has Addison’s disease?

A. “Weigh yourself daily at the same time of day wearing the same amount of clothing.”
B. “Avoid taking aspirin or any aspirin-containing products.”
C. “Be sure to carry candy or sugar with you at all times.”
D. “Avoid gaining any excess weight.”