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A patient is hospitalized with adrenocorticoid insufficiency. Which nursing activity should you delegate to the nursing
1. Remind the patient to change positions slowly
2. Check the patient for muscle weakness
3. Teach the patient how to collect 24-hour urine
4. Plan nursing interventions to promote fluid balance


You assess a patient with Cushings disease. For which finding will you notify the physician immediately?
1. Purple striae on abdomen and thighs
2. Weight gain of 1 pound since the previous day
3. +1 dependent edema in ankles and calves
4. Crackles bilaterally in lower lobes of the lungs


The patient with pheochromocytoma had surgery to remove his adrenal glands. Which nursing intervention should you
delegate to the nursing assistant?
1. Add strategies to provide a calm and restful environment post-operatively in the careplan.
2. Warn the patient to avoid smoking and drinking caffeinated beverages.
3. Monitor the patients skin and mucous membranes for signs of adequate hydration.
4. Monitor lying and standing blood pressure every 4 hours with cuff placed on same arm.


The patient with adrenal insufficiency is to be discharged taking prednisone 10 mg orally each day. What will you be sure to
teach the patient?
1. Report excessive weight gain or swelling to the physician
2. Rapid changes of position may cause hypotension
3. A diet with foods high in potassium may be beneficial
4. Signs of hypoglycemia may occur while taking this drug


Which patients nursing care would be most appropriate for the charge nurse to assign to the LPN, under the supervision of
the RN team leader?
1. A 51-year-old patient with bilateral adrenalectomy just returned from the PACU.
2. An 83-year-old patient with type 2 diabetes and COPD
3. A 38-year-old patient with MI who is preparing for discharge
4. A 72-year-old patient admitted from long-term care with mental status changes.


You are preparing a 24-year-old patient with diabetes insipidus (DI) for discharge from the hospital. Which statement
indicates the patient needs additional teaching?
1. I will drink fluids equal to the amount of my urine output.
2. I will weigh myself every day using the same scale.
3. I will wear my medical alert bracelet at all time.
4. I will gradually wean myself off the vasopressin.


ADH hormone:
1. Is secreted in response to decreased osmolarity
2. Increases the permeability of distal tubules of the kidneys to water
3. Increases urine volume
4. Increases the permeability of distal tubules of the kidney to sodium


Which of the following is true concerning inappropriate antidiuretic hormone secretion (SIADH)?
1. ADH levels are increased, serum sodium levels are increased, urine specific gravity is increased.
2. ADH levels are increases, serum sodium levels are decreased, urine-specific gravity is increased.
3. ADH levels are decreased, serum sodium levels are decreased, urine-specific gravity is decreased.
4. ADH levels are decreased, serum sodium increased, urine-specific gravity is unchanged.


Clinical manifestations of SIADH include:

1. Serum hyponatremia
2. Serum hyerosmolality

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Urine hypoosmolality
Excess water loss

10. A patient with SIADH rings the nurses station and asks to go to the bathroom. You tell him that you will come and assist him
based on the fact that:
1. Patients with SIADH may have symptoms of hypokalemia including muscle cramping.
2. Fluid intake and output is monitored in patients with SIADH.
3. Patients with SIADH may have symptoms of hyponatremia including confusion.
4. Patients with SIADH may have symptoms of hypernatremia including confusion.
11. SIADH is suspected in which of the following patients?
1. An older patient with a recent stroke who is confused and on diuretics.
2. A patient recovering from surgery with a serum sodium level of 150 mEq/L and increased urine sodium level.
3. A pregnant woman with serum sodium level of 130 mEq/L
4. A patient with small cell carcinoma of the lung whose urine-specific gravity is 1.030 and serum sodium is 120
mEq/L. The patient is complaining of muscle cramps.
12. A patient with SIADH asks why he is on water restrictions. The appropriate response is:
1. The physician has prescribed it.
2. You are not on fluid restriction. Your sodium level is restricted.
3. Water restrictions will bring your potassium level back to normal.
4. Your body is producing too much ADH, causing you to reabsorb water. Limiting your water will help bring your
water level down and your sodium level up.
13. Which of the following hormones is deficient in the patient with diabetes insipidus?
1. testosterone
2. Estrogen
3. Insulin
4. ADH
14. The clinical symptoms of DI in which the renal tubules are not able to conserve free-water results in:
1. Bradycardia
2. Polyuria
3. Sweating
4. Polyphagia
15. Which of the following is a common cause of DI?
1. Pyelonephritis
2. Syphillis
3. Hypotension
4. Carotid stenosis
16. Which of the following vital signs would indicate DI?
1. BP 210/140, temp 97.8*
2. HR 66, temp 102*
3. RR 28, HR 40
4. BP 70/40, HR 124
17. What clinical manifestation results in the GI tract as a result of polyuria associated with DI?
1. Diarrhea
2. Constipation
3. Hemorrhage
4. Ulcerative colitis
18. The medication of choice in replacing ADH in the person with DI is:
1. Lasix

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19. What two main areas of nursing assessment are crucial in monitoring the patient with DI?
1. Cardiac rate and psychologic status
2. Airway and GI loss
3. Fluid volume and neurological status
4. Pain and pulmonary status





1. Patients with hypofunction of the adrenal glands often have hypotension and should be instructed to change positions
slowly. Once a patient has been instructed, it is appropriate for the nursing assistant to remind the patient of those
instructions. Assessing, teaching, and planning nursing care require more education and should be done by licensed nurses.
4. The presence of crackles in the patients lungs indicate excess fluid volume due to excess water and sodium reabsorption
and may be a symptom of pulmonary edema, which must be treated rapidly. Striae (stretch marks), weight gain, and
dependent edema are common findings in patients with Cushings disease. These findings should be monitored, but are not
4. Monitoring vital signs is within the educational scope of the nursing assistant. The nurse should be sure to instruct the
nursing assistant that blood pressure measurements are to be done with the cuff on the same arm. Revising the care plan and
instructing and assesses patients are beyond the scope of nursing assistants and fall within the purview of licensed nurses.
1. Rapid weight gain and edema are signs of excessive drug therapy, and the dose of the drug needs to be adjusted.
Hypertension, hyperkalemia, and hyperglycemia are common in patients with adrenal hypofunction.
2. The 83-year-old patient has no complicating factors at the moment. Providing care for stable and uncomplicated patients is
within the LPNs educational preparation and scope of practice, with the care always being provided under the supervision
and direction of the RN. The RN should assess the newly post-op patient and the new admission. The patient who is
preparing for discharge after MI may need some complex teaching.
4. The patient with permanent DI requires life-long vasopressin therapy. All of the other statements are appropriate to the
home care of this patient.
2. ADH hormone causes water reabsorption and decreases urine volume. ADH secretion is in response to increased
osmolarity and increases the permeability of distal tubules to water.
2. Inappropriate secretion of ADH causes increased permeability of the distal tubule of the kidney to water. Extracellular
water levels rise, diluting serum sodium. Small increased in BP cause sodium to be lost in the urine through pressure
natriuresis, and urine-specific gravity is elevated.
1. SIADH causes increased permeability of the distal tubule of the kidney to water. Extracellular water levels rise, diluting
serum sodium. Urine output is diminished; Serum hypoosmolality results from water retention. Small increases in BP as a
result of extracellular water expansion cause sodium to be lost in the urine through pressure natriuresis. Urine
hyperosmolality is the result.
3. Confusion is associated with serum sodium levels below 115 mEq/L. Hyponatremia is a clinical manifestation of SIADH.
Although fluid intake and output is monitored in patients with SIADH, this is not the most appropriate answer.
4. The most common malignancy associated with SIADH is small-cell lung cancer. Diagnostic evaluation includes urine
hyperosomolality and serum hyponatremia. Muscle cramps is associated with hyponatremia. Although CNS injury and
certain medications including diuretics can cause SIADH, this is not the best answer. Transient SIADH can result from
surgery, but hyponatremia is a clinical manifestation. During pregnancy, women may develop hyponatremia (as low as 130
mEq/L) because of the release of the hormone, relaxin. This is a normal change.
4. Fluid restriction is the treatment of choice SIADH because water intoxication and dilutional hyponatremia are
manifestations of SIADH. The physician has prescribed it is not an appropriate answer. Fluid, not sodium restriction, is the
treatment of choice. Potassium levels are normal is patients with SIADH.
4. ADH is deficient is patients with DI.
2. Polyuria is excess urination as a result of insufficient ADH. Tachycardia develops as a result of the loss in volume from
polyuria. Mucous membranes are dry, and the patient becomes dehydrated. The patient has polydipsia, not polyphagia.
1. Renal disease is a common cause of DI.
4. Hypotension and tachycardia indicate DI. Usually the patient becomes hypotensive as a result of the loss of fluid. The
patient is usually tachycardic, and temperature may be affected. RR may vary, depending on the acid-base balance.
2. Loss of water in polyuria results in constipation. The patient becomes dehydrated; no extra fluid is available. Hemorrhage
and ulcerative colitis do not relate to polyuria and the GI tract in the patient with DI.

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18. 4. Vasopressin is the exogenous hormone supplement of choice to replace ADH in patients with DI. Lasix further increases
urine output, thus making the situation worse. Nipride vasodilates and makes the hypotension worse because the patient is
already dealing with a fluid deficit. Mannitol is an osmotic diuretic and further increases urine output, also causing the
situation to worsen.
19. 3. Fluid volume status is directly associated with ADH, and neurologic status changes are clinically indicative of DI. The
cardiac rate is important to assess in DI, but the patients psychologic status is not crucial at this time. Airway is always an
important assessment point, but in DI the GI loss is not crucial. Pain and pulmonary status are important assessment areas;
however, when suspecting DI, these assessment points are also not crucial.

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