MSN Exam for Acromegaly

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1) A patient suspected of having acromegaly has an elevated plasma growth hormone level. In acromegaly, the nurse would also expect the patient’s diagnostic results to include

1. hyperinsulinemia
2. a plasma glucose of less than 70
3. decreased growth hormone levels with an oral glucose challenge test
4. a serum sometomedin C (insulin-like growth-factor) of more than 300

2) During assessment of the patient with acromegaly, the nurse would expect the patient to report

1. infertility
2. dry, irritated skin
3. undesirable changes in appearance
4. an increase in height of 2 to 3 inches per year

3) The nurse is caring for a client with acromegaly. Following a transphenoidal hypophysectomy, the nurse should:

1. Monitor the client’s blood sugar
2. Suction the mouth and pharynx every hour
3. Place the client in low Trendelenburg position
4. Encourage the client to cough

4) Of the following disorders, which results from excessive secretion of somatotropin?

1. Acromegaly
2. Cretinism
3. Dwarfism
4. Adrenogenital syndrome

5) Jemma, who weighs 210 lb (95 kg) and has been diagnosed with hyperglycemia tells the nurse that her husband sleeps in another room because her snoring keeps him awake. The nurse notices that she has large hands and a hoarse voice. Which of the following would the nurse suspect as a possible cause of the client’s hyperglycemia?

1. Acromegaly
2. Type 1 diabetes mellitus
3. Hypothyroidism
4. Deficient growth hormone

6) A patient with acromegaly is treated with a transphenoidal hypophysectomy. Postoperatively, the nurse

1. ensures that any clear nasal drainage is tested for glucose
2. maintains the patient flat in bed to prevent cerebrospinal fluid leak
3. assists the patient with toothbrushing Q4H to keep the surgical area clean
4. encourages deep breathing and coughing to prevent respiratory complications

7) The nurse is planning room assignments for the day. Which client should be assigned to a private room if only one is available?

1. The client with Cushing’s disease
2. The client with diabetes
3. The client with acromegaly
4. The client with myxedema

Answers and Rationales

1. D. a serum sometomedin C (insulin-like growth-factor) of more than 300. A normal response to growth hormone secretion is stimulation of the liver to produce somatomedin C which stimulates growth of bones and soft tissue. The increased levels of somatomedin C normally inhibit growth hormone, but in acromegaly the pituitary gland secretes GH despite elevated somatomedin C levels.)
2. C. undesirable changes in appearance . The increased production of growth hormone in acromegaly causes an increase in thickness and width of bones and enlargement of soft tissues, resulting in marked changes in facial features, oily and coarse skin, and speech difficulties. Height is not increased in adults with growth hormone excess because the epiphyses of the bones are closed, and infertility is not a common finding because growth hormone is usually the only pituitary hormone involved in acromegaly.
3. A. Monitor the client’s blood sugar. Growth hormone levels generally fall rapidly after a hypophysectomy, allowing insulin levels to rise. The result is hypoglycemia.
4. A. Acromegaly . The patient with acromegaly demonstrates progressive enlargement of peripheral body parts, most commonly the face, head, hands, and feet. Cretinism occurs as a result of congenital hypothyroidism.Dwarfism is caused by insufficient secretion of growth hormone during childhood. Adrenogenital syndrome is the result of abnormal secretion of adrenocortical hormones, especially androgen.
5. A. Acromegaly . Acromegaly, which is caused by a pituitary tumor that releases excessive growth hormone, is associated with hyperglycemia, hypertension, diaphoresis, peripheral neuropathy, and joint pain. Enlarged hands and feet are related to lateral bone growth, which is seen in adults with this disorder. The accompanying soft tissue swelling causes hoarseness and often sleep apnea. Type 1 diabetes is usually seen in children, and newly diagnosed persons are usually very ill and thin. Hypothyroidism isn’t associated with hyperglycemia, nor is growth hormone deficiency.
6. A. ensures that any clear nasal drainage is tested for glucose. A transphenoidal hypophysectomy involves entry into the sella turcica through an incision in the upper lip and gingiva into the floor of the nose and the sphenoid sinuses. Postoperative clear nasal drainage with glucose content indicates CSF leakage from an open connection to the brain, putting the patient at risk for meningitis. After surgery, the patient is positioned with the head elevated to avoid pressure on the sella turcica, coughing and straining are avoided to prevent increased ICP and CSF leakage, and although mouth care is required Q4H toothbrushing should not be performed for 7-10post sx.
7. A. The client with Cushing’s disease. The client with Cushing’s disease has adrenocortical hypersecretion. This increase in the level of cortisone causes the client to be immune suppressed. In answer B, the client with diabetes poses no risk to other clients. The client in answer C has an increase in growth hormone and poses no risk to himself or others. The client in answer D has hyperthyroidism or myxedema and poses no risk to others or himself.