Nokea
A client with acromegaly is admitted to the hospital with complaints of partial blindness that began suddenly. What does the nurse suspect is occurring with this client?
- A. Glaucoma
- B. Corneal abrasions
- C. Retinal detachment
- D. Pressure on the optic nerve
Correct Answer: D
Rationale: Partial blindness may result from pressure on the optic nerve. Glaucoma does not occur suddenly, and the client did not report injury to suspect corneal abrasions or retinal detachment.
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The nurse is instructing a client about the use of pegvisomant for the treatment of acromegaly. How will the nurse instruct to take this medication?
- A. Injected subcutaneously once a day
- B. Injected intramuscularly once a month
- C. Administer via an implanted port once a month
- D. Injected intramuscularly one every 6 months
Correct Answer: A
Rationale: Pegvisomant, a GH receptor antagonist, is the newest and most effective drug for treating acromegaly. Injected subcutaneously once a day, it normalizes the IGF-I level in 93% to 97% of cases by blocking the GH stimulation of IGF-I produced by the liver.
A client with Addison disease is being discharged from the hospital and is being instructed about the dietary regimen. What type of diet should the nurse provide written and verbal instructions about?
- A. Low-carbohydrate, low-protein diet
- B. Low-fat, high-protein diet
- C. Low-protein, high-carbohydrate diet
- D. High-protein, moderate-carbohydrate diet
Correct Answer: D
Rationale: A high-protein, moderate-carbohydrate diet that is low in refined carbohydrates is recommended to reduce the risk of hypoglycemia from excess insulin secretion. The risk of hypoglycemia is also lessened by consuming frequent meals and snacks, especially a substantial bedtime snack. The other dietary regimens are not effective in the management of Addison disease.
A client sustained a head injury when falling from a ladder. While in the hospital, the client begins voiding large amounts of clear urine and reports being very thirsty. The client states feeling weak and having experienced an 8 pound weight loss since admission. What condition does the nurse expect the client to be tested for?
- A. Diabetes insipidus (DI)
- B. Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
- C. Pituitary tumor
- D. Hypothyroidism
Correct Answer: A
Rationale: With diabetes insipidus, urine output may be as high as 20 L/24 hours. Urine is dilute, with a specific gravity of 1.002 or less. Limiting fluid intake does not control urine excretion. Thirst is excessive and constant. Activities are limited by the frequent need to drink and void. Weakness, dehydration, and weight loss develop. SIADH will have the opposite clinical manifestations. The client's symptoms are related to the trauma and not to a pituitary tumor. The thyroid gland does not cause these symptoms.
The nurse is teaching a client about the dietary restrictions related to a diagnosis of hyperparathyroidism. What foods should the nurse encourage the client to avoid?
- A. Bananas
- B. Chicken livers
- C. Hamburger
- D. Milk
Correct Answer: D
Rationale: Clients with hyperparathyroidism should use a low-calcium diet (fewer dairy products) and drink at least 3 to 4 L of fluid daily to dilute the urine and prevent renal stones from forming. It is especially important that the client drink fluids before going to bed and periodically throughout the night to avoid concentrated urine. Bananas, chicken livers, and hamburgers do not require avoidance. Milk is the highest in calcium content.
The instructor is teaching a group of students about Simmonds disease. The instructor determines that additional instruction is necessary when the students identify which hormone as being involved?
- A. Growth hormone
- B. Luteinizing hormone
- C. Adrenocorticotropic hormone
- D. Oxytocin
Correct Answer: D
Rationale: Oxytocin is a hormone of the posterior pituitary gland and would not be involved. Simmonds disease affects all hormones of the anterior pituitary: GH (bones and muscles), adrenocorticotropic hormone (ACTH, adrenals), thyroid-stimulating hormone (TSH, thyroid), follicle-stimulating hormone (FSH, ovaries and testes), luteinizing hormone (LH, ovaries), interstitial cell-stimulating hormone (ICSH (LH), testes), and prolactin (breasts).