Pituitary Disorders: Acromegaly and SIADH/DI Practice Questions
20 free Pituitary Disorders: Acromegaly and SIADH/DI practice questions for the NCLEX Exam. Tap an option to answer — you get instant feedback, the correct answer, and a detailed explanation for every question.
Which condition is most likely in a patient with a pituitary adenoma presenting with enlarged hands and feet, coarse facial features, and new-onset sleep apnea?
- A SIADH
- B Diabetes insipidus
- C Acromegaly
- D Hypopituitarism
Correct answer: Acromegaly
Acromegaly is characterized by excess growth hormone post-epiphyseal closure, leading to enlargement of extremities, coarse facial features, and complications such as sleep apnea.
Which laboratory test is most useful in the initial evaluation of suspected acromegaly?
- A Random serum growth hormone level
- B Insulin-like growth factor 1 (IGF-1) level
- C Urine osmolality measurement
- D Serum sodium concentration
Correct answer: Insulin-like growth factor 1 (IGF-1) level
IGF-1 is more reliable than random GH because GH is secreted in pulses; elevated IGF-1 supports acromegaly.
What disorder should the nurse suspect in a post-operative patient after pituitary surgery who begins passing very large volumes of very dilute urine and has extreme thirst?
- A SIADH
- B Diabetes insipidus
- C Cushing’s disease
- D Acromegaly
Correct answer: Diabetes insipidus
Following pituitary surgery, damage to the posterior pituitary may cause ADH deficiency leading to central diabetes insipidus, manifested by polyuria and polydipsia.
In the case of SIADH, what does the nurse expect in terms of findings?
- A SIADH
- B Diabetes insipidus
- C Cushing’s disease
- D Acromegaly
Correct answer: Diabetes insipidus
After pituitary surgery, damage to the posterior pituitary can cause ADH deficiency leading to central diabetes insipidus, with large volumes of dilute urine and intense thirst. SIADH would cause water retention; Cushing's and acromegaly do not cause polyuria.
Which pre-operative nursing assessment is most important for a patient with acromegaly scheduled for transsphenoidal surgery?
- A Hypernatremia with high urine output
- B Hyponatremia with low urine output
- C Hypokalemia with marked dehydration
- D High urine osmolality with hypernatremia
Correct answer: Hyponatremia with low urine output
Acromegaly often leads to enlarged soft tissues and sleep apnea; airway assessment is critical before anesthesia and surgery.
What is a teaching point for a patient diagnosed with SIADH?
- A Increase fluid intake to 4–5 litres each day
- B Restrict fluids and watch for hyponatremia
- C Urinate every hour regardless of thirst
- D Stop all medications unless ADH is prescribed
Correct answer: Restrict fluids and watch for hyponatremia
In SIADH, fluid restriction is standard nursing management to prevent worsening hyponatremia; monitoring for confusion or seizures is important.
In diabetes insipidus, what specific urinalysis finding does the nurse expect?
- A Urine osmolality greater than 800 mOsm/kg
- B Very low urine osmolality with high volume
- C Urine specific gravity above 1.030
- D High urine sodium concentration on testing
Correct answer: Very low urine osmolality with high volume
In DI the kidneys cannot concentrate urine due to ADH deficiency or resistance; thus very dilute urine (low osmolarity) with high volume is typical.
Joint pain and numbness in hands in a patient with acromegaly are recognized as:
- A These symptoms are unrelated to the disease
- B Carpal tunnel syndrome and acromegalic arthropathy
- C Symptoms caused only by age-related arthritis
- D Manifestations of underlying adrenal insufficiency
Correct answer: Carpal tunnel syndrome and acromegalic arthropathy
Acromegaly often causes arthropathy and carpal tunnel syndrome due to tissue overgrowth and compression.
What possible complication should the nurse recognize in the first 48 hours after removal of a GH-secreting pituitary adenoma when the patient has a rapid drop in GH and IGF-1?
- A Fluid retention with peripheral edema
- B Negative fluid balance with increased urine output
- C Hypernatremia with worsening hypertension
- D Severe and isolated hypoglycemia
Correct answer: Negative fluid balance with increased urine output
After acromegaly surgery, removal of GH excess leads to a sudden negative fluid balance; rapid diuresis may occur as fluid retention from GH resolves.
What is a hallmark physical sign of acromegaly?
- A Moon face with a dorsal buffalo hump
- B Macroglossia, widened teeth spacing, large extremities
- C Dry thin skin with marked cold intolerance
- D Decreased bone growth resulting in dwarfism
Correct answer: Macroglossia, widened teeth spacing, large extremities
Acromegaly is noted for enlargement of hands/feet, macroglossia, and characteristic facial changes due to GH excess.
In SIADH, what neurological complication related to its main electrolyte disturbance does the nurse monitor for?
- A Seizures from hyponatremia
- B Hemiplegia due to hypernatremia
- C Peripheral neuropathy from hyperkalemia
- D Visual loss from hypercalcemia
Correct answer: Seizures from hyponatremia
Hyponatremia in SIADH can lead to cerebral edema and seizures, making neurologic monitoring important.
Which therapy is first-line for central diabetes insipidus?
- A Strict fluid restriction on its own
- B Administration of desmopressin (DDAVP)
- C A high-salt dietary regimen
- D Thiazide diuretics used alone
Correct answer: Administration of desmopressin (DDAVP)
Desmopressin (synthetic ADH) is the standard treatment for central DI to replace the deficient ADH and reduce urine volume.
What lab result would most strongly support the diagnosis of acromegaly in a patient cared for by a nurse?
- A A low serum IGF-1 level
- B High IGF-1 with no GH suppression on glucose load
- C Low GH together with a high IGF-1
- D An elevated serum ADH level
Correct answer: High IGF-1 with no GH suppression on glucose load
Elevated IGF-1 and GH failure to suppress with glucose load are diagnostic of acromegaly because GH normally suppresses with glucose.
Which disorder should the nurse consider if a patient with pituitary surgery develops sudden hyponatremia on day 5 post-op?
- A Diabetes insipidus alone
- B SIADH following pituitary surgery
- C Addison’s disease (adrenal crisis)
- D Acromegaly recurrence
Correct answer: SIADH following pituitary surgery
SIADH can occur after pituitary surgery due to transient ADH excess, resulting in hyponatremia; this is a known complication in pituitary patients.
When educating a patient with acromegaly about the condition, what does the nurse emphasize?
- A It is always benign and spares other organs
- B It raises cardiovascular, diabetes and colon polyp risk
- C It is purely a cosmetic concern only
- D Once GH is removed, no follow-up is needed
Correct answer: It raises cardiovascular, diabetes and colon polyp risk
Acromegaly increases risks of cardiovascular disease, insulin resistance/diabetes, and colon polyps; thus long-term follow-up is needed.
In SIADH, what does the nurse anticipate in terms of the patient’s urine sodium?
- A Low (less than 20 mEq/L) on testing
- B High (over 40 mEq/L) despite hyponatremia
- C Zero because the kidneys conserve sodium
- D Not relevant to making the diagnosis
Correct answer: High (over 40 mEq/L) despite hyponatremia
In SIADH, inappropriate ADH causes water retention and excretion of sodium in urine; urine sodium is typically elevated.
What is the key risk if untreated in a patient with DI admitted with extreme thirst and large urine volume?
- A Hypervolemia with worsening hypertension
- B Dehydration with hypernatremia
- C Profound symptomatic hypoglycemia
- D Life-threatening hyperkalemia
Correct answer: Dehydration with hypernatremia
In DI inadequate ADH leads to inability to retain water, large urine losses, thirst, dehydration, and hypernatremia if water intake cannot keep up.
If a patient’s urine output is 300 mL/hour and serum sodium rises to 150 mEq/L on post-op day 2 after transsphenoidal surgery for a pituitary adenoma, what does the nurse suspect?
- A Early postoperative SIADH
- B Postoperative diabetes insipidus
- C Acute adrenal crisis
- D Underlying chronic kidney disease
Correct answer: Postoperative diabetes insipidus
High urine output and rising sodium post pituitary surgery suggest DI due to ADH deficiency rather than SIADH, which causes low urine output and low sodium.
What is especially important for a patient with acromegaly receiving a somatostatin analog (octreotide), in terms of nursing assessments?
- A Monitoring solely for episodes of hypoglycemia
- B Assessing for gallstones and checking glucose
- C Encouraging a high-carbohydrate diet only
- D No special monitoring is required at all
Correct answer: Assessing for gallstones and checking glucose
Somatostatin analogs can impair gallbladder motility causing gallstones and may impact glucose metabolism; hence monitoring is important.
When educating a patient with SIADH who is on fluid restriction, what advice does the nurse give the patient?
- A Drink freely whenever thirsty with no limits
- B Track intake/output, weigh daily, and watch for hyponatremia
- C Only check serum sodium about once a month
- D Increase water intake whenever the urine looks dark
Correct answer: Track intake/output, weigh daily, and watch for hyponatremia
In SIADH fluid restriction is key; monitoring intake/output, weight, and early signs of hyponatremia is essential for safe management.