Anterior Pituitary
The anterior pituitary secretes this many hormones.
What is six?
The posterior pituitary secretes this many hormones.
What is two?
During the assessment of the patient with acromegaly, the nurse would expect the patient to report:
a. infertility
b. dry, irritated skin
c. undesirable changes in appearance
d. an increase in height of 2-3 inches per year
What is c: undesirable changes in appearance?
(Rationale- the increased production of growth hormone in acromegaly causes an increase in thickness and width of bones and enlargement of soft tissues, resulting in marked changes in facial features, oily and coarse skin, and speech difficulties. Height is not increased in adults with growth hormone excess because the epiphyses of the bones are closed, and infertility is not a common finding because growth hormone is usually the only pituitary hormone involved in acromegaly.)
Diabetes insipidus is caused by a deficiency of this hormone.
What is ADH?
SIADH is caused by the excessive release of this hormone.
What is ADH?
This hormone stimulates protein synthesis and growth of muscle and bone.
What is the growth hormone?
If a patient's posterior pituitary is removed, which hormone would the nurse expect to decrease?
a. PRF
b. ADH
c. ACTH
d. Growth Hormone (GH)
What is b. ADH?
After teaching a client with acromegaly who is scheduled for a hypophysectomy, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching?
a. I will no longer need to limit my fluid intake after surgery.
b. I am glad no visible incision will result from this surgery.
c. I hope I can go back to wearing size 8 shoes instead of size 12.
d. I will wear slip-on shoes after surgery to limit bending over.
What is c.?
Although removal of the tissue that is oversecreting hormones can relieve many symptoms of hyperpituitarism, skeletal changes and organ enlargement are not reversible. It will be appropriate for the client to drink as needed postoperatively and avoid bending over. The client can be reassured that the incision will not be visible.
In a patient with diabetes insipidus, administration of aqueous vasopressin during a water deprivation test will result in a:
a. decrease in body weight
b. increase in urinary output
c. decrease in blood pressure
d. increase in urine osmolality
What is d.?
d. increase in urine osmolality
(rationale- a patient with DI has a deficiency of ADH with excessive loss of water from the kidney, hypovolemia, hypernatreamia, and dilute urine with a low specific gravity. When vasopressin is administered, the symptoms are reversed, with water retention, decreased urinary output that increases urine osmolality, and an increase in blood pressure.)
A patient with SIADH is treated with water restriction and administration of IV fluids. The nurses evaluates that treatment has been effective when the patient experiences
a. increased urine output, decreased serum sodium, and increased urine specific gravity
b. increased urine output, increased serum sodium, and decreased urine specific gravity
c. decreased urine output, increased serum sodium, and decreased urine specific gravity
d. decreased urine output, decreased serum sodium, and increased urine specific gravity
What is b.?
b. increased urine output, increased serum sodium, and decreased urine specific gravity
(rationale- the patient with SIADH has water retention with hyponatremia, decreased urine output and concentrated urine with high specific gravity. improvement in the patient's condition reflected by increased urine output, normalization of serum sodium, and more water in the urine, decreasing the specific gravity.)
Which of the following hormones is produced in the anterior pituitary?
a. dopamine
b. somatostatin
c. thyroid stimulating hormone (TSH)
d. gonadotropin releasing hormone (GnRH)
What is c. TSH?
This hormone is responsible for increasing resorption of water in the kidneys.
What is antidiuretic hormone or vasopressin?
A patient with acromegaly is treated with a transphenoidal hypophysectomy. Postoperatively, the nurse:
a. ensures that any clear nasal drainage is tested for glucose
b. maintains the patient flat in bed to prevent cerebrospinal fluid leak
c. assists the patient with toothbrushing Q4H to keep the surgical area clean
d. encourages deep breathing and coughing to prevent respiratory complications
What is a. ensures that any clear nasal drainage is tested for glucose
(Rationale- a transphenoidal hypophysectomy involves entry into the sella turcica through an incision in the upper lip and gingiva into the floor of the nose and the sphenoid sinuses. Postoperative clear nasal drainage with glucose content indicates CSF leakage from an open connection to the brain, putting the patient at risk for meningitis. After surgery, the patient is positioned with the head elevated to avoid pressure on the sella turcica, coughing and straining are avoided to prevent increased ICP and CSF leakage, and although mouth care is required Q4H toothbrushing should not be performed for 7-10post sx.)
Which of the following signs and symptoms is NOT expected with diabetes insipidus?
a. polyuria
b. polydipsia
c. polyphagia
d. extreme thirst
What is c. Polyphagia?
During care of a patient with syndrome of inappropriate ADH (SIADH), the nurse should
a. monitor neurologic status Q2H or more often if needed
b. keep the head of the bed elevated to prevent ADH release
c. teach the patient receiving treatment with diuretics to restrict sodium intake
d. notify the physician if the patient's blood pressure decreases more than 20mmHg from baseline
What is a. monitor neurologic status Q2H or more often as needed?
Rationale- the patient with SIADH has marked dilution hyponatremia and should be monitored for decreased neurologic function and convulsions every 2 hours. ADH release is reduced by keeping the head of the bed flat to increase left atrial filling pressure, and sodium intake is supplemented because of hyponatremia and sodium loss caused by diuretics. A reduction in blood pressure indicates a reduction in total fluid volume and is an expected outcome of treatment.)
Infertility and sexual dysfunction may be manifestations of an alteration in these hormones from the anterior pituitary.
What are gonadotropins (FSH & LH)?
ADH release from the posterior pituitary is stimulated by which process?
A. Low blood pressure sensed by baroreceptors in the kidneys.
B. High plasma osmolarity sensed by osmoreceptors in the hypothalamus.
C. Low osmolality sensed by osmoreceptors in the kidneys.
D. High concentration of potassium sensed by chemoreceptors in the carotid body.
What is b. ?
High plasma osmolarity sensed by osmoreceptors in the hypothalamus.
The nurse is caring for a client with acromegaly. Following transphenoidal hypophysectomy, the nurse should:
a. place the client in low Trendelenburg position
b. encourage the client cough
c. monitor the client's blood sugar
d. suction the mouth and pharynx every hour
What is c. monitor the blood sugar?
The nurse is assisting with the care of a client who has diabetes insipidus. The nurse should monitor the client for which of the following manifestations?
a. hypotension
b. polyphagia
c. hyperglycemia
d. bradycardia
What is a. hypotension?
The client who has diabetes insipidus produces excessive urine resulting in hypovolemia and hypotension. The nurse should monitor the client for hypotension and dehydration.
A nurse cares for a client who possibly has syndrome of inappropriate antidiuretic hormone (SIADH). The client's serum sodium level is 114 mEq/L. Which action should the nurse take first?
a. Consult with the dietitian about increased dietary sodium.
b. Restrict the client's fluid intake to 600 mL/day.
c. Handle the client gently by using turn sheets for re-positioning.
d. Instruct unlicensed assistive personnel to measure intake and output.
What is b.?
With SIADH, clients often have dilutional hyponatremia. The client needs a fluid restriction, sometimes to as little as 500 to 600 mL/24 hr. Adding sodium to the client's diet will not help if she is retaining fluid and diluting the sodium. The client is not at increased risk for fracture, so gentle handling is not an issue. The client should be on intake and output; however, this will monitor only the client's intake, so it is not the best answer. Reducing intake will help increase the client's sodium.
A nurse assesses clients for potential endocrine dysfunction. Which client is at greatest risk for a deficiency of gonadotropin and growth hormone?
a. A 36-year-old female who has used oral contraceptives for 5 years
b. A 42-year-old male who experienced head trauma 3 years ago
c. A 55-year-old female with a severe allergy to shellfish and iodine
d. A 64-year-old male with adult-onset diabetes mellitus
What is b.?
B ~ Gonadotropin and growth hormone are anterior pituitary hormones. Head trauma is a common cause of anterior pituitary hypofunction. The other factors do not increase the risk of this condition.
A patient is admitted to the intensive care unit with a closed head injury sustained in a motorcycle accident. The injury has caused severe damage to the posterior pituitary. Which of the following complications should the nurse anticipate?
A. Dilutional hyponatremia
B. Dehydration from polyuria
C. Cardiac arrest from hyperkalemia
D. Metabolic acidosis
What is b.?
B. Dehydration from polyuria
A patient suspected of having acromegaly has an elevated plasma growth hormone level. In acromegaly, the nurse would also expect the patient's diagnostic results to include:
a. Hyperinsulinemia
b. Decreased growth hormone levels with an oral glucose challenge test
c. A plasma glucose of less than 70
d. A serum sometomedin C (insulin like growth factor) of more than 300
What is d.?
Insulin like growth factor increased levels normally inhibit the growth hormone but in acromegaly the pituitary gland secretes GH despite the elevated levels
A client is receiving desmopressin acetate for diabetes insipidus. Which actions should the nurse take when caring for this client? Select all that apply.
a. monitor intake and output
b. monitor neurologic and cardiovascular status
c. Stop the medication as soon as the patient feels better
d. Monitor serum electrolytes
e. Monitor for hypotension
What is a, b, d, and e.?
A patient with SIADH is undergoing IV treatment of a hypertonic IV solution of 3% saline and IV Lasix. Which of the following nursing findings requires intervention?
A. Sodium level of 136.
B. Patient reports urinating more frequently.
C. Potassium level of 5.0.
D. Assessment finding of crackles throughout the lung fields.
What is d.?
Assessment finding of crackles throughout the lung fields. Remember that when administering a hypertonic solution you have to do this very slowly and watch for volume overload. Hypertonic solutions pull fluid from the cell (which is already water intoxicated) and place it back into the vascular system...therefore, crackles in the lungs are a sign there is too much fluid in the body and the heart can not compensate so the fluid is backing up into the lungs. This would require intervention.