Chapter 41 CC4Pt Pituitary Disorders PDF

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Chapter 41: Coordinating Care for Patients with Pituitary Disorders MULTIPLE CHOICE 1. In assessing a patient diagnosed with hypopituitarism, the nurse correlates the function of which additional structure to determine the root cause of this disorder? 1. Cerebellum 2. Cerebrum 3. Hypothalamus 4. Medulla ANS: 3 Chapter number and title: 41, Coordinating Care for Patients with Pituitary Disorders Chapter learning objective: 1. Describing the epidemiology of pituitary disorders Chapter page reference: 919 Heading: Hypopituitarism/Epidemiology Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity/Physiological Adaptation Cognitive Level: Comprehension [Understanding] Concept: Metabolism Difficulty: Easy Feedback 1 2

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The function of the cerebellum is on coordination, not endocrine activity. The major role of the cerebrum is related to higher cognitive functions, not endocrine functions. The cause of anterior pituitary dysfunction is often secondary to damage to the hypothalamus. The parathyroid glands have a major role in calcium regulation and have no role in the function of the pituitary gland.

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2. A patient is demonstrating signs of hypopituitarism. The nurse monitors results from which diagnostic test for this disorder? 1. Magnetic resonance imaging (MRI) 2. Lumbar puncture 3. Cerebral angiogram 4. Carotid Doppler studies ANS: 1 Chapter number and title: 41, Coordinating Care for Patients with Pituitary Disorders Chapter learning objective: 3. Describing the diagnostic results used to confirm the diagnosis of pituitary disorders Chapter page reference: 919-920 Heading: Hypopituitarism/Medical Management/Diagnosis Integrated Processes: Nursing Process: Planning Client Need: Physiological Integrity/Reduction of Risk Potential Cognitive Level: Comprehension Concept: Assessment

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If a tumor of the brain or pituitary is suspected, an MRI or computed tomography (CT) scan of the head is part of the diagnostic evaluation. A lumbar puncture is indicated for patients with suspected infectious processes in the cerebrospinal fluid. A cerebral angiogram is used to evaluate disorders impacting cerebrovascular circulation such as cerebral aneurysms or arteriovenous malformations. Carotid Doppler studies are used to examine for narrowing, blockage, or plague formation in the carotid arteries.

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3. The nurse is reviewing medications prescribed for a patient with hypopituitarism. Which medications are indicated for the treatment of this disorder? 1. Diuretics 2. Antibiotics 3. Antihypertensives 4. Electrolyte supplements ANS: 4 Chapter number and title: 41, Coordinating Care for Patients with Pituitary Disorders Chapter learning objective: 4. Discussing the medical management of: Hypopituitarism Chapter page reference: 920 Heading: Hypopituitarism/Medical Management/Medications Integrated Processes: Nursing Process: Planning Client Need: Physiological Integrity/Pharmacological and Parenteral Therapies Cognitive Level: Comprehension Concept: Medication Difficulty: Easy Feedback 1 2 3

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Diuretics are not routinely prescribed for a patient with hypopituitarism. Antibiotics are not required to treat hypopituitarism. Antihypertensives are not routinely prescribed for a patient with hypopituitarism. Supportive therapies such as electrolyte replacement are the key to managing the patient with hypopituitarism.

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4. The nurse provides teaching to a patient who is newly diagnosed with hypopituitarism. Which patient statement indicates that teaching was effective in relationship to medication management? 1. “I will take my medication each evening.” 2. “I will take my medication each morning.” 3. “I will take my medication only as needed.” 4. “I will take my medication every other day.”

ANS: 2 Chapter number and title: 41, Coordinating Care for Patients with Pituitary Disorders Chapter learning objective: 4. Discussing the medical management of hypopituitarism. Chapter page reference: 921 Heading: Hypopituitarism/Nursing Interventions/Teaching Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Application [Applying] Concept: Medication Difficulty: Moderate Feedback 1

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This statement indicates the need for additional teaching because hormone supplements are taken in the morning, not the evening, to mimic the normal release of these hormones. This statement indicates a correct understanding of the information presented. Patients diagnosed with hypopituitarism are taught to take hormone supplements in the morning to mimic the normal release of these hormones. This statement indicates the need for additional teaching because hormone supplements are taken each day (not as needed) in the morning to mimic the normal release of these hormones. This statement indicates the need for additional teaching because hormone supplements are taken in the morning, not every other day.

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5. The nurse incorporates which information into the patient teaching for a patient with hypopituitarism? 1. “Avoid extremes in temperature.” 2. “Minimize your exposure to people with infections.” 3. “Increase foods containing high amounts of calcium.” 4. “Increase rest periods throughout the day.” ANS: 3 Chapter number and title: 41, Coordinating Care for Patients with Pituitary Disorders Chapter learning objective: 6. Designing a plan of care that includes pharmacological, dietary, and lifestyle considerations for patients with pituitary disorders Chapter page reference: 921 Heading: Hypopituitarism/Nursing Interventions/Actions Integrated Processes: Teaching and Learning Client Need: Physiological Integrity/Basic Care and Comfort Cognitive Level: Application [Applying] Concept: Metabolism Difficulty: Moderate Feedback 1 2 3

The patient with hypopituitarism does not need to avoid extremes in temperature. The patient with hypopituitarism is not at risk for infections. The nurse should instruct the patient on ways to increase calcium intake because

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this helps to treat osteoporosis secondary to decreased growth hormone. The patient with hypopituitarism is not fatigued and will not need additional rest periods throughout the day.

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6. A patient with hypopituitarism is experiencing muscle weakness. Which referral should the nurse make to help this patient? 1. Home care 2. Physical therapy 3. Recreational therapy 4. Occupational therapy ANS: 2 Chapter number and title: 41, Coordinating Care for Patients with Pituitary Disorders Chapter learning objective: 7. Coordinating the interprofessional plan of care for the patient undergoing treatment for pituitary disorders Chapter page reference: 921 Heading: Hypopituitarism/Nursing Interventions/Actions Integrated Processes: Communication and Documentation Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Comprehension [Understanding] Concept: Collaboration Difficulty: Easy Feedback 1 2

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The patient does not have a need for skilled nursing care. Physical therapy would be helpful to maximize this patient’s mobility. Osteoporosis increases the risk for falls, and the physical therapist can provide input into safe transfers from bed to chair and measures to decrease the incidence of falls. There is no evidence that the patient is psychosocially stressed or in need of assistance with coping. Occupational therapy would be helpful for activities of daily living. There is no evidence that the patient needs this type of support.

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7. The nurses assesses for which clinical manifestations in the patient being evaluated for hyperpituitarism? 1. Hair loss 2. Headaches 3. Hypoglycemia 4. Muscle cramps ANS: 2 Chapter number and title: 41, Coordinating Care for Patients with Pituitary Disorders Chapter learning objective: 1. Describing the epidemiology of pituitary disorders Chapter page reference: 921-922

Heading: Hyperpituitarism/Clinical Manifestations/Table 41.3 – Clinical Manifestations Associated with Hyperpituitarism Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity/Physiological Adaptation Cognitive Level: Analysis [Analyzing] Concept: Assessment Difficulty: Moderate Feedback 1 2

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Hair loss may develop in patients with hypothyroidism. Hyperpituitarism is usually related to a hypersecreting tumor. The patient presentation is consistent with clinical manifestations associated to the oversecreted hormone, and the tumor itself may lead to headaches. Hyperpituitarism may result in increased glucocorticoid secretion, leading to hyperglycemia, not hypoglycemia. Muscle cramps are not a manifestation of hyperpituitarism but may occur in patients with hypocalcemia secondary to hypoparathyroidism.

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8. Which clinical manifestation does the nurse associate with abnormal secretion of growth hormone in the patient with hyperpituitarism? 1. Elevated blood pressure 2. Increased serum glucose levels 3. Menstrual irregularities 4. Weight loss ANS: 3 Chapter number and title: 41, Coordinating Care for Patients with Pituitary Disorders Chapter learning objective: 2. Correlating clinical manifestations to pathophysiology processes of hyperpituitarism? Chapter page reference: 921-922 Heading: Hyperpituitarism/Clinical Manifestations/Table 41.3 – Clinical Manifestations Associated with Hyperpituitarism Integrated Processes: Nursing Process: Analysis Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Application [Applying] Concept: Assessment Difficulty: Moderate Feedback 1

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Hypertension occurs as a result of the increases in mineralocorticoids, not growth hormone. Hyperglycemia occurs as a result of the increases in glucocorticoids, not growth hormone. Menstrual irregularities are caused by increases in growth hormone that accompanies a diagnosis of hyperpituitarism. Increased levels of the thyroid stimulating hormone, not growth hormone, cause issues with weight loss.

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9. A male patient presents to the clinic with complaints of changes in his facial features and enlarged, painful hands. The nurse correlates these clinical manifestations with a disorder of which hormone? 1. Testosterone 2. Growth hormone 3. Thyroid-stimulating hormone 4. Adrenocorticotropic hormone (ACTH) ANS: 2 Chapter number and title: 41, Coordinating Care for Patients with Pituitary Disorders Chapter learning objective: 2. Correlating clinical manifestations to pathophysiological processes of: Hyperpituitarism Chapter page reference: 921-922 Heading: Hyperpituitarism/Clinical Manifestations/Table 41.3 – Clinical Manifestations Associated with Hyperpituitarism Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity/Physiological Adaptation Cognitive Level: Analysis [Analyzing] Concept: Metabolism Difficulty: Moderate Feedback 1 2

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Testosterone is not a hormone controlled by the pituitary gland, and its release does not cause enlargement of hands and feet in an adult. Increased levels of growth hormone in an adult can cause course facial features and alter the bone structure of the hands and feet. Manifestations of increased thyroid-stimulating hormone include weight loss and exophthalmos. Elevated levels of adrenocorticotropic hormone (ACTH) cause hyperglycemia, hypertension, hypernatremia, and hypokalemia.

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10. What is the rationale for frequent mouth care in a patient after undergoing a transsphenoidal hypophysectomy for removal of a pituitary tumor? 1. Dry mucous membranes secondary to increased vasopressin (Pitressin) levels 2. Maintenance of nothing by mouth status 3. Mouth breathing because of nasal packing 4. Stomatitis caused by the hormone imbalance ANS: 3 Chapter number and title: 41, Coordinating Care for Patients with Pituitary Disorders Chapter learning objective: 5. Developing a comprehensive plan of nursing care for patients with pituitary disorders Chapter page reference: 924 Heading: Hyperpituitarism/Nursing Interventions/Actions Integrated Processes: Nursing Process: Analysis

Client Need: Physiological Integrity/Basic Care and Comfort Cognitive Level: Application [Applying] Concept: Comfort Difficulty: Moderate Feedback 1 2 3 4

Increased Pitressin levels lead to fluid overload, not decreased fluid volume status. The patient most likely is no longer on nothing by mouth status. Because of the surgical procedure and postoperative packing, the patient breathes primarily through the mouth, increasing the chance of dry mouth. Hormone imbalances do not cause stomatitis.

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11. The nurse provides discharge instruction to a patient who had a transsphenoidal hypophysectomy. Which patient statement indicates a need for additional teaching? 1. “My neck will probably be stiff and sore for several days.” 2. “I will call my provider if I am thirstier than normal.” 3. “I should use a soft toothbrush to avoid irritating my incision.” 4. “I won’t bend at the waist until I see the provider at my follow-up appointment.” ANS: 1 Chapter number and title: 41, Coordinating Care for Patients with Pituitary Disorders Chapter learning objective: 4. Discussing the medical management of hyperpituitarism. Chapter page reference: 924-925 Heading: Assessments Hyperpituitarism/Nursing Interventions for a Patient after Transsphenoidal Hypophysectomy/Teaching Integrated Processes: Teaching and Learning Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Analysis [Analyzing] Concept: Metabolism Difficulty: Moderate Feedback 1

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This patient statement indicates the need for additional teaching from the nurse. The surgical approach increases the patient’s risk of meningitis; therefore, elevated temperature, nuchal rigidity (stiff neck), and photophobia should be reported immediately to the healthcare provider for further investigation. This patient statement indicates a correct understanding of the information presented. This patient is at risk for developing diabetes insipidus; therefore, instruct the patient to notify the healthcare provider for increased urine output and excessive thirst. This patient statement indicates a correct understanding of the information presented. Use of a soft toothbrush after this surgical procedure decreases the potential to damage the incision line. This patient statement indicates a correct understanding of the information presented. The patient is taught to avoid activities (coughing, sneezing, and bending at the waist) after this surgical procedure as they can put strain on the surgical site.

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12. A patient is being discharged after surgery for hyperpituitarism. The nurse incorporates which information to reduce the risk of postoperative complications? 1. Restrict fluids. 2. Avoid strain on the suture line. 3. Maintain bedrest for several days. 4. Expect clear nasal drainage to occur. ANS: 2 Chapter number and title: 41, Coordinating Care for Patients with Pituitary Disorders Chapter learning objective: 6. Designing a plan of care that includes pharmacological, dietary, and lifestyle considerations for patients with pituitary disorders Chapter page reference: 924-925 Heading: Hyperpituitarism/Nursing Interventions/Actions Integrated Processes: Teaching and Learning Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Nursing Roles Difficulty: Moderate Feedback 1

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Restricting fluids is not indicated in this patient. Fluid intake is based on urine output and thirst. Strain on the suture line may lead to separation at the surgical site, allowing microorganisms to enter the central nervous system and potentially leading to meningitis. There is no indication for bedrest for several days. The patient is encouraged to advance activity as tolerated. Clear nasal drainage could indicate a cerebrospinal fluid leak that should be reported to the healthcare provider because this increases the patient’s risk of developing meningitis postoperatively.

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13. The nurse recognizes that the patient with dysfunction of the posterior pituitary gland is at risk for which disorder? 1. Acromegaly 2. Osteoporosis 3. Diabetes insipidus 4. Type 1 diabetes mellitus ANS: 3 Chapter number and title: 41, Coordinating Care for Patients with Pituitary Disorders Chapter learning objective: 1. Describing the epidemiology of pituitary disorders: Diabetes Insipidus Chapter page reference: 926 Heading: Diabetes Insipidus/Epidemiology Integrated Processes: Nursing Process: Planning

Client Need: Physiological Integrity/Reduction of Risk Potential Cognitive Level: Comprehension [Understanding] Concept: Metabolism Difficulty: Easy Feedback 1 2 3 4

Acromegaly is caused by oversecretion of growth hormone. Osteoporosis is an adverse effect of hypopituitarism. Central diabetes insipidus is caused by a decreased secretion of antidiuretic hormone (ADH) from the posterior pituitary gland. Type 1 diabetes mellitus is caused by a malfunction of the cells within the pancreas.

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14. The nurse correlates the action of which medication to the treatment of diabetes insipidus (DI)? 1. Pitocin 2. Synthroid 3. Vitamin D 4. Desmopressin (DDAVP) ANS: 4 Chapter number and title: 41, Coordinating Care for Patients with Pituitary Disorders Chapter learning objective: 4. Discussing the medical management of: Diabetes insipidus Chapter page reference: 926 Heading: Diabetes Insipidus/Medical Management/Fluid Management and Medications Integrated Processes: Nursing Process: Analysis Client Need: Physiological Integrity/Pharmacological and Parenteral Therapies Cognitive Level: Comprehension [Understanding] Concept: Medication Difficulty: Moderate Feedback 1 2 3 4

Pitocin is used to induce or enhance labor in pregnancy. Synthroid is a replacement for hypothyroidism. Vitamin D is appropriate for a patient with osteoporosis caused by low growth hormone levels. Desmopressin (DDAVP), a synthetic analog of antidiuretic hormone (ADH), is the drug of choice in patients with DI.

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15. The nurse prioritizes which nursing diagnosis to guide care for the patient diagnosed with diabetes insipidus? 1. Fluid Volume Deficit 2. Alteration in Comfort 3. Body Image Disturbance 4. Sensory Perceptual Alteration

ANS: 1 Chapter number and title: 41, Coordinating Care for Patients with Pituitary Disorders Chapter learning objective: 5. Developing a comprehensive plan of nursing care for patients with pituitary disorders Chapter page reference: 927 Heading: Diabetes Insipidus/Nursing Management/Nursing Diagnoses Integrated Processes: Nursing Process: Analysis Client Need: Physiological Integrity/Reduction of Risk Potential Cognitive Level: Analysis Concept: Nursing Roles Difficulty: Difficult Feedback 1 2

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Diabetes insipidus, caused by a lack of antidiuretic hormone, results in excretion of large volumes of dilute urine. The patient might be uncomfortable because of dehydration, but this is n...