Chapter 51: Nursing Management:
Endocrine Problems Lewis et al.:
Medical-Surgical Nursing in Canada, 3rd
Edition
1. A patient seeks care at the clinic because of increasing speech difficulties and
hoarseness, telling the nurse his tongue has gotten so big that he can hardly talk. The
physician suspects acromegaly. During the nursing history, which of the following should the
nurse specifically ask the patient whether he has experienced?
a. A recent head injury
b. An increase in shoe size
c. A family history of endocrine problems
d. Symptoms of hypoglycemia, such as hunger and nervousness - correct answer-ANS: B
Acromegaly causes an enlargement of the hands and feet.
PTS: 1 DIF: Cognitive Level: Comprehension REF: page 1394
OBJ: 1 TOP: Nursing Process: Assessment MSC: CRNE: CH-1
2. During preoperative teaching for a patient scheduled for transsphenoidal hypophysectomy
for treatment of a pituitary adenoma, what should the nurse instruct the patient that she will
have to do?
a. Take replacement growth hormone for the rest of her life
b. Not brush her teeth for at least 10 days after the surgery
c. Be expected to cough and breathe deeply every 2 hours postoperatively
d. Be positioned flat in bed with sandbags at her head to prevent head movement - correct
answer-ANS: B
To avoid disruption of the suture line, the patient should avoid brushing the teeth for 10 days
after surgery.
PTS: 1 DIF: Cognitive Level: Application REF: page 1396
OBJ: 1 TOP: Nursing Process: Implementation MSC: CRNE: CH-31
3. Following a transsphenoidal resection of a pituitary tumour, the nurse suspects that the
patient has developed diabetes insipidus on finding which of the following data?
a. A urine specific gravity of 1.001
b. A consistent rise in blood pressure
c. Fluid retention with dependent edema
d. A serum sodium of 130 mmol/L - correct answer-ANS: A
After pituitary surgery, the patient is at risk for diabetes insipidus caused by cerebral edema,
and monitoring of urinary output and urine specific gravity is essential.
PTS: 1 DIF: Cognitive Level: Comprehension REF: page 1396
OBJ: 1 TOP: Nursing Process: Assessment MSC: CRNE: CH-8
, 4. A patient is suspected of having a pituitary tumour causing panhypopituitarism. During
assessment of the patient, the nurse would expect to find which of the following changes?
a. Elevated plasma glucose levels and dyslipidemia
b. Changes in secondary sex characteristics and loss of libido
c. Hypertension resulting from increased water reabsorption in the kidney
d. Evidence of hypofunction of the adrenal, thyroid, and parathyroid glands - correct
answer-ANS: B
Changes in secondary sex characteristics are associated with decreases in
follicle-stimulating hormone and luteinizing hormone. Fasting hypoglycemia and hypotension
occur in panhypopituitarism as a result of decreases in adrenocorticotropic hormone and
cortisol.
PTS: 1 DIF: Cognitive Level: Application REF: page 1397
OBJ: 1 TOP: Nursing Process: Assessment MSC: CRNE: CH-8
5. Which of the following effects on the cardiovascular system would a patient with a
hypofunction of the parathyroid gland most likely exhibit?
a. Hypertension
b. Increased cardiac output
c. Decreased contractility of heart muscle
d. Dysrhythmias - correct answer-ANS: C
A patient with a hypofunction of their parathyroid gland would most likely exhibit a decrease
in the contractibility of their heart muscle.
PTS: 1 DIF: Cognitive Level: Comprehension REF: page 1397
OBJ: 4 TOP: Nursing Process: Assessment MSC: CRNE: CH-8
6. A patient with an antidiuretic hormone (ADH)-secreting small cell cancer of the lung is
treated to control the symptoms of syndrome of inappropriate ADH (SIADH). The nurse
determines that treatment is effective on finding which of the following data?
a. The patient's weight is stable.
b. The urine specific gravity is increased.
c. The patient's urinary output is increased.
d. The patient's edema is reduced. - correct answer-ANS: C
Treatment is aimed at blocking the action of ADH on the renal tubules, causing an increase
in urinary output.
PTS: 1 DIF: Cognitive Level: Application REF: page 1398
OBJ: 2 TOP: Nursing Process: Evaluation MSC: CRNE: CH-48
7. When teaching a patient with chronic SIADH about long-term management of the
disorder, the nurse determines that additional instruction is needed when the patient gives
which of the following responses?
a. "I need to maintain a sodium-restricted diet at home."
b. "I should weigh myself daily and report a sudden loss or gain."
c. "I need to limit my fluid intake to no more than 950 mL of liquids a day."
Endocrine Problems Lewis et al.:
Medical-Surgical Nursing in Canada, 3rd
Edition
1. A patient seeks care at the clinic because of increasing speech difficulties and
hoarseness, telling the nurse his tongue has gotten so big that he can hardly talk. The
physician suspects acromegaly. During the nursing history, which of the following should the
nurse specifically ask the patient whether he has experienced?
a. A recent head injury
b. An increase in shoe size
c. A family history of endocrine problems
d. Symptoms of hypoglycemia, such as hunger and nervousness - correct answer-ANS: B
Acromegaly causes an enlargement of the hands and feet.
PTS: 1 DIF: Cognitive Level: Comprehension REF: page 1394
OBJ: 1 TOP: Nursing Process: Assessment MSC: CRNE: CH-1
2. During preoperative teaching for a patient scheduled for transsphenoidal hypophysectomy
for treatment of a pituitary adenoma, what should the nurse instruct the patient that she will
have to do?
a. Take replacement growth hormone for the rest of her life
b. Not brush her teeth for at least 10 days after the surgery
c. Be expected to cough and breathe deeply every 2 hours postoperatively
d. Be positioned flat in bed with sandbags at her head to prevent head movement - correct
answer-ANS: B
To avoid disruption of the suture line, the patient should avoid brushing the teeth for 10 days
after surgery.
PTS: 1 DIF: Cognitive Level: Application REF: page 1396
OBJ: 1 TOP: Nursing Process: Implementation MSC: CRNE: CH-31
3. Following a transsphenoidal resection of a pituitary tumour, the nurse suspects that the
patient has developed diabetes insipidus on finding which of the following data?
a. A urine specific gravity of 1.001
b. A consistent rise in blood pressure
c. Fluid retention with dependent edema
d. A serum sodium of 130 mmol/L - correct answer-ANS: A
After pituitary surgery, the patient is at risk for diabetes insipidus caused by cerebral edema,
and monitoring of urinary output and urine specific gravity is essential.
PTS: 1 DIF: Cognitive Level: Comprehension REF: page 1396
OBJ: 1 TOP: Nursing Process: Assessment MSC: CRNE: CH-8
, 4. A patient is suspected of having a pituitary tumour causing panhypopituitarism. During
assessment of the patient, the nurse would expect to find which of the following changes?
a. Elevated plasma glucose levels and dyslipidemia
b. Changes in secondary sex characteristics and loss of libido
c. Hypertension resulting from increased water reabsorption in the kidney
d. Evidence of hypofunction of the adrenal, thyroid, and parathyroid glands - correct
answer-ANS: B
Changes in secondary sex characteristics are associated with decreases in
follicle-stimulating hormone and luteinizing hormone. Fasting hypoglycemia and hypotension
occur in panhypopituitarism as a result of decreases in adrenocorticotropic hormone and
cortisol.
PTS: 1 DIF: Cognitive Level: Application REF: page 1397
OBJ: 1 TOP: Nursing Process: Assessment MSC: CRNE: CH-8
5. Which of the following effects on the cardiovascular system would a patient with a
hypofunction of the parathyroid gland most likely exhibit?
a. Hypertension
b. Increased cardiac output
c. Decreased contractility of heart muscle
d. Dysrhythmias - correct answer-ANS: C
A patient with a hypofunction of their parathyroid gland would most likely exhibit a decrease
in the contractibility of their heart muscle.
PTS: 1 DIF: Cognitive Level: Comprehension REF: page 1397
OBJ: 4 TOP: Nursing Process: Assessment MSC: CRNE: CH-8
6. A patient with an antidiuretic hormone (ADH)-secreting small cell cancer of the lung is
treated to control the symptoms of syndrome of inappropriate ADH (SIADH). The nurse
determines that treatment is effective on finding which of the following data?
a. The patient's weight is stable.
b. The urine specific gravity is increased.
c. The patient's urinary output is increased.
d. The patient's edema is reduced. - correct answer-ANS: C
Treatment is aimed at blocking the action of ADH on the renal tubules, causing an increase
in urinary output.
PTS: 1 DIF: Cognitive Level: Application REF: page 1398
OBJ: 2 TOP: Nursing Process: Evaluation MSC: CRNE: CH-48
7. When teaching a patient with chronic SIADH about long-term management of the
disorder, the nurse determines that additional instruction is needed when the patient gives
which of the following responses?
a. "I need to maintain a sodium-restricted diet at home."
b. "I should weigh myself daily and report a sudden loss or gain."
c. "I need to limit my fluid intake to no more than 950 mL of liquids a day."
