Chapter 62: Care of Patients with Pituitary and Adrenal Gland Problems
Ignatavicius: Medical-Surgical Nursing, 8th Edition
MULTIPLE CHOICE
1. 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
ANS: 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.
DIF: Applying/Application REF: 1267
KEY: Pituitary disorder| health screening
MSC: Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care
2. 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.
ANS: 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, and assisting the client as he or she moves from sitting to standing will
not serve as safety measures when the client is deficient in growth hormone.
DIF: Applying/Application REF: 1267
KEY: Pituitary disorder| safety
MSC: Integrated Process: Nursing Process: Implementation
NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection
Control
3. 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.”
ANS: 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.
DIF: Applying/Application REF: 1268
KEY: Pituitary disorder| medications MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral
Therapies
4. 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
ANS: 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.
DIF: Applying/Application REF: 1275
KEY: Pituitary disorder| laboratory values
MSC: Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential
5. 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.”
ANS: 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.
Ignatavicius: Medical-Surgical Nursing, 8th Edition
MULTIPLE CHOICE
1. 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
ANS: 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.
DIF: Applying/Application REF: 1267
KEY: Pituitary disorder| health screening
MSC: Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care
2. 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.
ANS: 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, and assisting the client as he or she moves from sitting to standing will
not serve as safety measures when the client is deficient in growth hormone.
DIF: Applying/Application REF: 1267
KEY: Pituitary disorder| safety
MSC: Integrated Process: Nursing Process: Implementation
NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection
Control
3. 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.”
ANS: 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.
DIF: Applying/Application REF: 1268
KEY: Pituitary disorder| medications MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral
Therapies
4. 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
ANS: 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.
DIF: Applying/Application REF: 1275
KEY: Pituitary disorder| laboratory values
MSC: Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential
5. 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.”
ANS: 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.
