Question 1

In making the care plan for a client with Cushing's 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

Accepted Answer

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

Question 2

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.

Accepted Answer

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.

Question 3

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.

Accepted Answer

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

Question 4

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.

Accepted Answer

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.

Question 5

A client has Addison's 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.

Accepted Answer

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.

Question 6

In reviewing laboratory data for a client with Cushing's 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.

Accepted Answer

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

Question 7

Critical actions the nurse takes specifically when caring for the client with Cushing's 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.

Accepted Answer

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.

Question 8

During assessment of a 45-year-old man with the medical diagnosis of Cushing's syndrome, the nurse would note the most consistent finding of
A) male pattern baldness.
B) peripheral edema.
C) hypertension.
D) jaundice.

Accepted Answer

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.

Question 9

A client has Cushing's 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.

Accepted Answer

Clients with Cushing's 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 client's 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.

Question 10

The nurse recognizes that the manifestations of Addison's disease are primarily related to the pathophysiology of
A) adrenal insufficiency.
B) increased intracranial pressure.
C) renal disease.
D) thyroid hyperfunction.

Accepted Answer

Commonly known as Addison's 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 Addison's disease.

Question 11

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.

Accepted Answer

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

Question 12

The nurse formulating a discharge plan for a client with Addison's 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.

Accepted Answer

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.

Question 13

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.

Accepted Answer

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

Question 14

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.

Accepted Answer

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

Question 15

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.

Accepted Answer

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.

Question 16

A client with hyperpituitarism tells the nurse that he thinks he looks different now than he did 5 years ago. The nurse's 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.

Accepted Answer

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.

Question 17

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.

Accepted Answer

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.

Question 18

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.

Accepted Answer

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.

Question 19

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.

Accepted Answer

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

Question 20

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.

Accepted Answer

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.

Quiz 44: Management of Clients with Adrenal and Pituitary Disorders

In making the care plan for a client with Cushing's disease, the nurse would choose which diagnosis as a priority?

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

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

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

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

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

Critical actions the nurse takes specifically when caring for the client with Cushing's syndrome who had an adrenalectomy include (Select all that apply)

During assessment of a 45-year-old man with the medical diagnosis of Cushing's syndrome, the nurse would note the most consistent finding of

A client has Cushing's 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

The nurse recognizes that the manifestations of Addison's disease are primarily related to the pathophysiology of

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

The nurse formulating a discharge plan for a client with Addison's disease should place the highest emphasis on

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

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

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

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

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

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

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

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