NSG 132 Exam #2 Endocrine review-Questions with
Correct Answers/ Verified/ Latest Update
What hormones are secreted by the Anterior Pituitary? - ✔✔TSH (Thyroid Stimulating
Hormone), ACTH (Adrenocorticotropic Hormone), FSH (follicle Stimulating Hormone), LH
(Lutenizing Hormone), and GH (Growth Hormone).
What hormones are stored in the Posterior Pituitary? - ✔✔ADH (Antidiurectic Hormone),
Oxytocin.
What is Acromegaly? - ✔✔Rare condition resulting from excess secretion of growth
hormone (GH).
What are the clinical manifestations of Acromegaly? - ✔✔Enlargement of the hands and
feet, thickening and enlargement of face and head body and soft tissue, deepening of the
voice, enlargement of the tongue, visual changes, thick leathery skin, sleep apnea, signs of
diabetes mellitus, cardiomegaly, and hypertension.
What diagnostic studies are done for Acromegaly? - ✔✔H & P, evaluation of plasma insulin
like growth factor (IGF-1), IGF binding proteins (IGFBP-3), and GH response to an oral
glucose challenge. MRI and CT scan.
How is an Oral Glucose Tolerance Test performed? - ✔✔GH secretion is inhibited by
glucose. Two baseline GH levels are obtained before ingestion of 75 - 100 g of oral glucose,
and additional GH measurements are made at 30, 60, 90 and 120 minutes following oral
glucose load. Normally GH concentrations fall during an OGTT. In acromegaly, GH levels do
not fall below 3 ng/mL2.
What is Nursing Management following a Hypophysectomy with a Acromegaly patient? -
✔✔Avoidance of virgorous coughing, sneezing and straining at stool to prevent CSF leakage
from where sella turcica was entered. Head of bed elevated 30 degrees at all times.
Neurological status and monitor. Mild analgesia is used for headache. Teeth brushing is
avoided for ten days.
,What is treatment for Acromegaly? - ✔✔Goal is to return GH levels to normal through
surgery, radioation, and drug therapy. Prognosis is dependent on age of onset, when
treatment was initiated and tumor size.
What are the surgical options for Acromegaly? - ✔✔Hypophysectomy - removal of the
entire pituitary gland.
What does a patient need after a Hypophysectomy or pituitary damage? - ✔✔ADH, cortisol
and thyroid replacement for life.
When is radiation therapy used for Acromegaly? - ✔✔When surgery has failed to complete
remission, and those considered high risk for surgery. Used in combination of drugs and can
also reduce the size of the tumor before surgery.
When is the drug therapy for Acromegay used? - ✔✔Used in patients who have inadequate
response to or cannot be treated with radiation therapy.
What is drug therapy for Acromegaly? - ✔✔Octrotide (Sandostatin) - a somatostatin analog
that reduces GH levels to within normal range in many patients. Given subcutaneously three
times a week. Long acting analogs are available, injections given every 2 - 4 weeks.
What is Syndrome of Inappropriate Antidiuretic Hormone (SIADH)? - ✔✔Results from
abnormal production or sustained secretionof ADH.
What is the most common cause of SIADH? - ✔✔Lung cancer.
What can cause SIADH besides lung cancer? - ✔✔Head injury or head trauma.
What are the clinical manifestations of SIADH? - ✔✔Hypoosmolality, hyponatremia, muscle
cramps, weakness, increased vascular volume -> hypertension, edema, low U/O,
seizure/coma/death.
,What diagnostic procedures are positive for SIADH? - ✔✔Serum osmolality less than 275,
increased urine osmolality, all normal serum electrolyte levels except serum sodium.
What is Nursing Management for SIADH? - ✔✔Assess VS. Monitor I & O. Monitor
cardiovascular and pulmonary status. Seizure precautions. Lowest bed position possible.
Good oral hygiene. Skin care - monitor breakdowns and edema. Safety.
What is Treatment for SIADH? - ✔✔Directed at underlying cause with a goal to restore
normal fluid volume and osmolality. Fluid restriction, and self management.
What is Diabetes Insipidus (DI)? - ✔✔Associated with deficiency of production or secretion
of ADH or decreased renal response to ADH. May be transient or life-long.
What are the Clinical Manifestations of DI? - ✔✔Polydipsia, polyuria, decreased urine
osmolality, hypernatremia, increased serum osmolality, fatigue, constipation, poor skin
turgor, hypotension, tachycardia.
What happens if oral fluid intake cannot keep up with urinary losses? - ✔✔Severe fluid
volume deficit results as manifested by weight loss, constipation, poor skin turgor,
hypotension and shock. Increased urinary output and plasma osmolality can cause severe
fluid and electrolyte balance.
What Diagnostic Tests are done for DI? - ✔✔Water Restriction/Deprivation Test.
How is a Water Restriction/Deprivation Test done? - ✔✔Basline weight, pulse, urine/plasma
osmolalities, urine specific gravity and BP. Instruct pt to with-hold all fluids for 8 - 16 hours
before testing. Reassure testing will be stopped if fluid volume deficit symptoms become
severe. Observe the patient throughout the test because of craving to drink. During the test
assess patients BP, weight and urine osmolality. Test continues until urine osmolality
stabilizes, or body weight declines 3%. Vasopressin is given, and urinary osmolality is
measured 1 hour later.
What indicates positive DI with a Water Restriction/Deprivation Test? - ✔✔Urine osmolality
after vasopressin exceeding 9%.
, What is Nursing Management for DI? - ✔✔Early detection, maintenance of adequate
hydration and patient teaching for long term management.
What is collaborative care for DI? - ✔✔Hypotonic IV fluids, desmopression (ADH), low
sodium diet, thiazide diuretics, monitor U/O, daily weights and I & O.
What is treatment for DI? - ✔✔Treating the primary cause central to management.
Therapeutic goal is maintenance of fluid and electrolyte balance.
What is Goiter? - ✔✔an enlarged thyroid gland.
What happens in the formation of a Goiter? - ✔✔Thyroid cells are stimulated to grow,
which may result in an overactive thyroid (hyperthyroidism) or underactive one
(hypothyroidism).
What diagnostic data is measure to determine Thyroid Function? - ✔✔TSH and T4 levels.
What surgical procedure is used for Goiters? - ✔✔Surgical removal of large goiters may be
performed.
What is Thyrotoxicosis? - ✔✔Physiologic effects or clinical syndrome of hypermetabolsim
that results from excess circulating levels of T4, T3 or both.
What is Graves Disease? - ✔✔An autoimmune disease of unknow etiology marked by
diffused thyroid enlargement and excessive hormone secretion. 75% of hyperthyroidism
cases.
What are the clinical manifestations of Hyperthyroidism? - ✔✔Related to the effect of
excess thyroid hormone. Increases metabolism and increases tissue sensitivity to
stimulation by the SNS. Goiter, opthalamopathy - exophtalamos, weight loss, intolerance to
heat, tachycardia, insomnia tremors, hypertension.
