Exam 4: Pituitary Disorders (NCLEX)
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 - Answer 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 nurse plans care for a client with a growth hormone deficiency. Which action should
the nurse include in this client's plan of care?
a. Avoid intramuscular medications.
b. Place the client in protective isolation.
c. Use a lift sheet to re-position the client.
d. Assist the client to dangle before rising. - Answer C
In adults, growth hormone is necessary to maintain bone density and strength. Adults
with growth hormone deficiency have thin, fragile bones. Avoiding IM medications, using
protective isolation & assisting the client as she moves from sitting to standing will not
serve as safety measures when the client is deficient in growth hormone.
A nurse cares for a male client with hypopituitarism who is prescribed testosterone
hormone replacement therapy. The client asks, "How long will I need to take this
medication?" How should the nurse respond?
a. When your blood levels of testosterone are normal, the therapy is no longer needed.
b. When your beard thickens and your voice deepens, the dose is decreased, but
treatment will continue forever.
c. When your sperm count is high enough to demonstrate fertility, you will no longer
need this therapy.
d. With age, testosterone levels naturally decrease, so the medication can be stopped
when you are 50 years old. - Answer B
Testosterone therapy is initiated with high-dose testosterone derivatives and is
continued until virilization is achieved. The dose is then decreased, but therapy
continues throughout life. Therapy will continue throughout life; therefore, it will not be
discontinued when blood levels are normal, at the age of 50 years, or when sperm
counts are high.
A nurse cares for a client after a pituitary gland stimulation test using insulin. The client's
post-stimulation laboratory results indicate elevated levels of growth hormone (GH) and
adrenocorticotropic hormone (ACTH). How should the nurse interpret these results?
,a. Pituitary hypofunction
b. Pituitary hyperfunction
c. Pituitary-induced diabetes mellitus
d. Normal pituitary response to insulin - Answer D
Some tests for pituitary function involve administering agents that are known to
stimulate the secretion of specific pituitary hormones and then measuring the response.
Such tests are termed stimulation tests. The stimulation test for GH or ACTH
assessment involves injecting the client with regular insulin (0.05 to 1 unit/kg of body
weight) and checking circulating levels of GH and ACTH. The presence of insulin in
clients with normal pituitary function causes increased release of GH and ACTH.
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. - Answer 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.
A nurse assesses a client who is recovering from a transsphenoidal hypophysectomy.
The nurse notes nuchal rigidity. Which action should the nurse take first?
a. Encourage range-of-motion exercises.
b. Document the finding and monitor the client.
c. Take vital signs, including temperature.
d. Assess pain and administer pain medication. - Answer C
Nuchal rigidity is a major manifestation of meningitis, a potential postoperative
complication associated with this surgery. Meningitis is an infection; usually the client
will also have a fever and tachycardia. Range-of-motion exercises are inappropriate
because meningitis is a possibility. Documentation should be done after all
assessments are completed and should not be the only action. Although pain
medication may be a palliative measure, it is not the most appropriate initial action.
After teaching a client who is recovering from an endoscopic trans-nasal
hypophysectomy, the nurse assesses the client's understanding. Which statement
made by the client indicates a correct understanding of the teaching?
a. I will wear dark glasses to prevent sun exposure.
b. I'll keep food on upper shelves so I do not have to bend over.
c. I must wash the incision with peroxide and redress it daily.
, d. I shall cough and deep breathe every 2 hours while I am awake. - Answer B
After this surgery, the client must take care to avoid activities that can increase
intracranial pressure. The client should avoid bending from the waist and should not
bear down, cough, or lie flat. With this approach, there is no incision to clean and dress.
Protection from sun exposure is not necessary after this procedure.
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. - Answer 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 cares for a client who is recovering from a hypophysectomy. Which action
should the nurse take first?
a. Keep the head of the bed flat and the client supine.
b. Instruct the client to cough, turn, and deep breathe.
c. Report clear or light yellow drainage from the nose.
d. Apply petroleum jelly to lips to avoid dryness. - Answer C
A light yellow drainage or a halo effect on the dressing is indicative of a cerebrospinal
fluid leak. The client should have the head of the bed elevated after surgery. Although
deep breathing is important postoperatively, coughing should be avoided to prevent
cerebrospinal fluid leakage. Although application of petroleum jelly to the lips will help
with dryness, this instruction is not as important as reporting the yellowish drainage.
A nurse assesses a client with anterior pituitary hyperfunction. Which clinical
manifestations should the nurse expect? (SATA)
a. Protrusion of the lower jaw
b. High-pitched voice
c. Enlarged hands and feet
d. Kyphosis
e. Barrel-shaped chest
f. Excessive sweating - Answer ACDEF
Anterior pituitary hyperfunction typically will cause protrusion of the lower jaw,
deepening of the voice, enlarged hands and feet, kyphosis, barrel-shaped chest, and
excessive sweating.
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 - Answer 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 nurse plans care for a client with a growth hormone deficiency. Which action should
the nurse include in this client's plan of care?
a. Avoid intramuscular medications.
b. Place the client in protective isolation.
c. Use a lift sheet to re-position the client.
d. Assist the client to dangle before rising. - Answer C
In adults, growth hormone is necessary to maintain bone density and strength. Adults
with growth hormone deficiency have thin, fragile bones. Avoiding IM medications, using
protective isolation & assisting the client as she moves from sitting to standing will not
serve as safety measures when the client is deficient in growth hormone.
A nurse cares for a male client with hypopituitarism who is prescribed testosterone
hormone replacement therapy. The client asks, "How long will I need to take this
medication?" How should the nurse respond?
a. When your blood levels of testosterone are normal, the therapy is no longer needed.
b. When your beard thickens and your voice deepens, the dose is decreased, but
treatment will continue forever.
c. When your sperm count is high enough to demonstrate fertility, you will no longer
need this therapy.
d. With age, testosterone levels naturally decrease, so the medication can be stopped
when you are 50 years old. - Answer B
Testosterone therapy is initiated with high-dose testosterone derivatives and is
continued until virilization is achieved. The dose is then decreased, but therapy
continues throughout life. Therapy will continue throughout life; therefore, it will not be
discontinued when blood levels are normal, at the age of 50 years, or when sperm
counts are high.
A nurse cares for a client after a pituitary gland stimulation test using insulin. The client's
post-stimulation laboratory results indicate elevated levels of growth hormone (GH) and
adrenocorticotropic hormone (ACTH). How should the nurse interpret these results?
,a. Pituitary hypofunction
b. Pituitary hyperfunction
c. Pituitary-induced diabetes mellitus
d. Normal pituitary response to insulin - Answer D
Some tests for pituitary function involve administering agents that are known to
stimulate the secretion of specific pituitary hormones and then measuring the response.
Such tests are termed stimulation tests. The stimulation test for GH or ACTH
assessment involves injecting the client with regular insulin (0.05 to 1 unit/kg of body
weight) and checking circulating levels of GH and ACTH. The presence of insulin in
clients with normal pituitary function causes increased release of GH and ACTH.
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. - Answer 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.
A nurse assesses a client who is recovering from a transsphenoidal hypophysectomy.
The nurse notes nuchal rigidity. Which action should the nurse take first?
a. Encourage range-of-motion exercises.
b. Document the finding and monitor the client.
c. Take vital signs, including temperature.
d. Assess pain and administer pain medication. - Answer C
Nuchal rigidity is a major manifestation of meningitis, a potential postoperative
complication associated with this surgery. Meningitis is an infection; usually the client
will also have a fever and tachycardia. Range-of-motion exercises are inappropriate
because meningitis is a possibility. Documentation should be done after all
assessments are completed and should not be the only action. Although pain
medication may be a palliative measure, it is not the most appropriate initial action.
After teaching a client who is recovering from an endoscopic trans-nasal
hypophysectomy, the nurse assesses the client's understanding. Which statement
made by the client indicates a correct understanding of the teaching?
a. I will wear dark glasses to prevent sun exposure.
b. I'll keep food on upper shelves so I do not have to bend over.
c. I must wash the incision with peroxide and redress it daily.
, d. I shall cough and deep breathe every 2 hours while I am awake. - Answer B
After this surgery, the client must take care to avoid activities that can increase
intracranial pressure. The client should avoid bending from the waist and should not
bear down, cough, or lie flat. With this approach, there is no incision to clean and dress.
Protection from sun exposure is not necessary after this procedure.
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. - Answer 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 cares for a client who is recovering from a hypophysectomy. Which action
should the nurse take first?
a. Keep the head of the bed flat and the client supine.
b. Instruct the client to cough, turn, and deep breathe.
c. Report clear or light yellow drainage from the nose.
d. Apply petroleum jelly to lips to avoid dryness. - Answer C
A light yellow drainage or a halo effect on the dressing is indicative of a cerebrospinal
fluid leak. The client should have the head of the bed elevated after surgery. Although
deep breathing is important postoperatively, coughing should be avoided to prevent
cerebrospinal fluid leakage. Although application of petroleum jelly to the lips will help
with dryness, this instruction is not as important as reporting the yellowish drainage.
A nurse assesses a client with anterior pituitary hyperfunction. Which clinical
manifestations should the nurse expect? (SATA)
a. Protrusion of the lower jaw
b. High-pitched voice
c. Enlarged hands and feet
d. Kyphosis
e. Barrel-shaped chest
f. Excessive sweating - Answer ACDEF
Anterior pituitary hyperfunction typically will cause protrusion of the lower jaw,
deepening of the voice, enlarged hands and feet, kyphosis, barrel-shaped chest, and
excessive sweating.
