Unit3: Ch 35- Hypothalamic and Pituitary Agents (Karch 7th Ed) Flashcards
A patient suspected of having Cushing’s disease comes to the clinic. What drug might the nurse
administer to test for adrenal function and responsiveness?
A) Corticotropin
B) Menotropins
C) Thyrotropin alfa
D) Chorionic gonadotropin
Ans: A
Feedback:
Corticotropin (ACTH) and cosyntropin are used for diagnostic purposes to test adrenal function and
responsiveness. Menotropin is a purified preparation of gonadotropins and is used as a fertility drug.
Thyrotropin alfa is used as adjunctive treatment for radioiodine ablation of thyroid tissue remnants in
patients who have undergone a near-total to total thyroidectomy for well-differentiated thyroid cancer
and who do not have evidence of metastatic thyroid cancer. Chorionic gonadotropin acts like
luteinizing hormone and stimulates the production of testosterone and progesterone.
A nurse is working at a fertility clinic. Today she is administering ganirelix acetate (Antagon) to a
woman participating in a fertility research program. By what route is this drug administered?
A) Orally
B) Subcutaneously
C) Intramuscularly
D) IV
Ans: B
Feedback:
Ganirelix acetate (Antagon) is administered subcutaneously and cannot be administered orally,
intramuscularly, or intravenously.
A patient is taking leuprolide (Lupron) to treat prostatic cancer. The nurse caring for this patient is careful to monitor for what? A) Diarrhea B) Urinary retention C) Peripheral edema D) Increased appetite
Ans: C
Feedback:
Peripheral edema is an identified adverse effect of leuprolide therapy. Constipation not diarrhea;
urinary frequency not urinary retention; and anorexia not increased appetite are also identified adverse
effects.
After administering somatropin (Saizen) to an 11-year-old patient with growth failure, what outcome
would indicate that the drug should be stopped?
A) Early sexual development
B) Thyroid overactivity
C) Closure of the epiphyses in long bones
D) Gynecomastia
Ans: C
Feedback:
Closure of the epiphyses is a sign that the drug should be stopped. Early sexual development, thyroid
overactivity, and gynecomastia would not be associated with this drug.
The nurse administers desmopressin (DDAVP) to the patient to treat diabetes insipidus. What
assessment finding would indicate to the nurse that the desmopressin is producing a therapeutic effect?
A) Decreased urine output
B) Decreased water reabsorption
C) Increased plasma osmolarity
D) Decreased blood volume
Ans: A
Feedback:
Desmopressin produces its antidiuretic activity in the kidneys, causing the cortical and medullary parts
of the collecting duct to become permeable to water, thereby increasing water reabsorption and
decreasing urine formation. These activities reduce plasma osmolarity and increase blood volume.
A patient with diabetes insipidus is taking desmopressin (DDAVP). He or she is complaining of
drowsiness, lightheadedness, and headache. What does the nurse suspect that he is experiencing?
A) An allergic reaction
B) Dehydration
C) Depression
D) Water intoxication
Ans: D
Feedback:
The adverse effects associated with the use of desmopressin include water intoxication (drowsiness,
light-headedness, headache, coma, convulsions) related to the shift to water retention and resulting
electrolyte imbalance. An allergic reaction, dehydration, or depression would not be associated with
these symptoms and desmopressin.
What drug would the nurse expect to administer to an AIDS patient with cachexia? A) Bromocriptine (Parlodel) B) Somatropin (Saizen) C) Desmopressin (DDAVP) D) Leuprolide (Lupron)
Ans: B
Feedback:
Indications for somatropin therapy include cachexia, long-term treatment of children with growth
failure associated with various deficiencies, girls with Turner’s syndrome, AIDS-related wasting,
growth hormone deficiency in adults, and treatment of growth failure in children of small gestational
age who do not achieve catch-up growth by 2 years of age. Bromocriptine mesylate is indicated for the
treatment of Parkinson’s disease, hyperprolactinemia associated with pituitary adenomas, female
infertility associated with hyperprolactinemia, and acromegaly; and short-term treatment of amenorrhea
or galactorrhea. Desmopressin is indicated for the treatment of neurogenic diabetes insipidus and
hemophilia A. Leuprolide is used as an antineoplastic agent for treatment of specific cancers.
What symptoms will the nurse instruct the patient taking octreotide (Sandostatin) to report to the health care provider? A) Abdominal pain B) Alteration in consciousness C) Changes in vision D) Muscle cramps
Ans: A
Feedback:
Octreotide and lanreotide have commonly been associated with the development of acute cholecystitis,
cholestatic jaundice, biliary tract obstruction, and pancreatitis, which would present with abdominal
pain, so patients should be taught to report this symptom. The drug is not associated with alteration in
consciousness, changes in vision, or muscle cramps.
The nurse has been caring for a child who has been receiving growth hormone therapy for several
years. When the child returns for evaluation following a sudden growth spurt, what nursing diagnosis
will the nurse add to the plan of care?
A) Disturbed body image
B) Deficient knowledge regarding drug therapy
C) Imbalanced nutrition: Less than body requirements related to metabolic changes
D) Risk for disproportionate growth
Ans: C
Feedback:
A child who is taking growth hormone may experience sudden growth, which will require increased
nutritional intake, so it is important to include nutritional needs in the plan of care. More than likely an increase in caloric intake and nutrients will be necessary. Most children who are small for their age see
growth as a positive thing and not a disturbed body image. After taking the drug for several years, the
patient should have received adequate teaching from the nurse ot make deficient knowledge unlikely.
The child should not be at risk for, but have a diagnosis of, disproportionate growth as the reason for
taking the medication.
The nurse receives an order to administer leuprolide 5 mcg/kg subcutaneously to a child with
precocious puberty. The child weighs 30 kg. What is the correct dosage for this child?
A) 150 mcg
B) 6 mcg
C) 68 mcg
D) 330 mcg
Ans: A
Feedback:
Multiply the child’s weight times the mg/kg: 30 × 5 = 150 mcg/dose.
The nurse is caring for a patient with infertility related to hyperprolactinemia. What drug would the
nurse recognize was ordered to treat this problem?
A) Bromocriptine mesylate
B) Somatropin
C) Leuprolide
D) Desmopressin
Ans: A
Feedback:
Bromocriptine mesylate is indicated for the treatment of female infertility associated with
hyperprolactinemia. Somatropin is indicated for the treatment of growth failure, Turner s syndrome,
AIDS wasting and cachexia, and growth hormone deficiency in adults. Leuprolide is used as
antineoplastic agent for treatment of specific cancers and for treatment of endometriosis and precocious
puberty that results from hypothalamic activity. Desmopressin is used for the treatment of neurogenic
diabetes insipidus, von Willebrand’s disease, hemophilia; and is currently being studied for the
treatment of chronic autonomic failure.
12. A child weighing 14.5 kg has von Willebrand’s disease. How much desmopressin (DDAVP) should be administered? A) 4.4 mcg B) 9.6 mcg C) 10.3 mcg D) 21.1 mcg
Ans: A
Feedback:
The normal dosage of desmopressin used to treat von Willebrand’s disease is 0.3 mcg/kg. Multiply this
dosage times the child’s weight: 14.5 kg × 0.3 g = 4.4 g.
- What is the purpose of releasing hormones secreted by the hypothalamus?
A) Stimulating or inhibiting release of hormones from the pituitary
B) Stimulating organs within the body to secrete hormones
C) Allowing the secretion of hormones from the hypothalamus
D) Stimulating other glands to release hormones
Ans: A
Feedback:
The hypothalamus uses various hormones or factors to either stimulate or inhibit the release of
hormones from the anterior pituitary. These do not stimulate other organs, the hypothalamus, or other
glands to release hormones.
- A 48-year-old patient with acromegaly is not a candidate for other therapy. What medication,
administered subcutaneously, would the nurse caring for the patient expect the physician to order?
A) Gonadorelin hydrochloride (Factrel)
B) Octreotide (Sandostatin)
C) Nafarelin (Synarel)
D) Gonadorelin acetate (Lutrepulse)
Ans: B
Feedback:
Octreotide (Sandostatin) is a treatment for acromegaly in adults who are not candidates for, or cannot
tolerate, other therapy. Gonadorelin hydrochloride, nafarelin, and gonadorelin acetate are not indicated
for treating acromegaly
A patient is brought to the emergency department after a motor vehicle accident. The patient is
hemorrhaging, indicating that which hormone is being secreted to restore blood volume?
A) Growth hormone (GH)
B) Follicle-stimulating hormone (FSH)
C) Antidiuretic hormone (ADH)
D) Adrenocorticotropic hormone (ACTH)
Ans: C
Feedback:
ADH possesses antidiuretic, hemostatic, and vasopressor properties. During hemorrhage, GH, FSH and
ACTH are not involved in blood volume restoration.
The nurse administers somatropin to a child with impaired growth due to a deficiency of endogenous
growth hormone during what period of growth and development?
A) Before the start of elementary school
B) Any time before age 18
C) Before the child reaches 5 feet in height
D) Before epiphyses close
Ans: D
Feedback:
Somatropin is contraindicated in the presence of closed epiphyses so the drug can be given at any time before closure of the epiphyses. Age and height are not an indication impacting when the drug is given
so long as the epiphyses remain open
The nurse would teach a patient receiving octreotide for acromegaly of the importance of baseline and
periodic what?
A) Ultrasound evaluation of the gallbladder
B) Magnetic resonance imaging (MRI) of the brain
C) Serum glucose levels
D) Complete blood counts
Ans: A
Feedback:
Arrange for baseline and periodic ultrasound evaluation of the gallbladder for patients receiving
octreotide because common adverse effects of the drug are acute cholecystitis, cholestatic jaundice,
biliary tract obstruction, and pancreatitis. A patient taking octreotide does not need baseline and
periodic MRIs of the brain, serum glucose levels, or complete blood counts.
The nurse is caring for a patient with neurogenic diabetes insipidus and administers what drug to treat the condition? A) Dexamethasone (Decadron) B) Desmopressin (DDAVP, Stimate) C) Methylprednisolone (Solu-Medrol) D) Physostigmine (Antilirium)
Ans: B
Feedback:
Synthetic preparations of antidiuretic hormone (ADH), which are purer and have fewer adverse effects,
are used to treat diabetes insipidus. Only one ADH preparation is currently available, desmopressin.
Dexamethasone, methylprednisolone, and physostigmine would not be indicated for treatment of this
disorder.
The nurse transcribes an order for menotropin (Pergonal), which will be administered to have what
effect?
A) Promote development of secondary sex characteristics
B) Induce ovulation
C) Promote bone growth
D) Treat diabetes insipidus
Ans: B
Feedback:
Menotropin (Pergonal) is used as fertility drug to stimulate ovulation and spermatogenesis. Pergonal is
not used to promote the development of secondary sex hormones, to promote bone growth, or to treat
diabetes insipidus.
The nurse administers desmopressin to treat a patient with diabetes insipidus. Assessment of what
laboratory studies would indicate the drug is working?
A) Increased serum sodium levels
B) Increased red blood cell count
C) Decreased urine specific gravity
D) Reduced urine glucose levels
Ans: A
Feedback:
Patients with diabetes insipidus (DI) produce large amounts of dilute urine with a decrease in serum
sodium levels. Administering desmopressin would reduce urine output and allow sodium levels to rise.
Urine specific gravity would increase as the urine production slows and urine becomes more
concentrated. There is no impact on red blood cell production with diabetes insipidus or its treatment.
The urine of a patient with DI does not contain glucose.
The nurse would administer desmopressin (DDAVP) cautiously, with careful monitoring, to the patient
with what co-morbidity? (Select all that apply.)
A) Hyponatremia
B) Asthma
C) Severe renal dysfunction
D) Gastrointestinal (GI) disease
E) Epilepsy
Ans: A, B, E
Feedback:
Caution should be used with any known vascular disease because of its effects on vascular smooth
muscle, epilepsy, asthma, and with hyponatremia, which could be exacerbated by the effects of the
drug. The drug is contraindicated and should not be used in patients with severe renal dysfunction. GI
disease is not a caution or contraindication.
The nurse is caring for a 25-year-old female patient who is receiving chorionic gonadotropin alfa. What
would be an appropriate nursing diagnosis for this patient?
A) Anxiety related to injection of medication
B) Acute pain related to need for injections
C) Imbalanced nutrition: More than body requirements
D) Evaluate effectiveness of the teaching plan
Ans: B
Feedback:
Nursing diagnoses related to drug therapy might include acute pain related to need for injections. Not
all patients are anxious at the thought of an injection so more information would be needed. The patient
is more likely to have reduced nutritional intake because of gastrointestinal (GI) adverse effects.
Evaluating the effectiveness of the teaching plan is not a nursing diagnosis.
When providing patient teaching to the family of a 12-year-old child receiving Somatropin, the nurse
stresses the need to notify prescriber if what manifestation occurs?
A) Severe hip or knee pain
B) Development of a bruise
C) Severe hypertension
D) Tachycardia
Ans: A
Feedback:
The adverse effects that most often occur when using a growth hormone (GH) include the development
of antibodies to GH and subsequent signs of inflammation and autoimmune-type reactions, such as
swelling and joint pain, and the endocrine reactions of hypothyroidism and insulin resistance. It would
not be necessary to notify the physician for development of a bruise. The health care provider should
always be notified if a patient develops severe hypertension or tachycardia but this would not be related
to administration of somatropin so it would not be included in drug teaching.
What medication would the nurse expect the physician to prescribe as palliative treatment for advanced prostate cancer? A) Histrelin (Vantas) B) Ganirelix (Antagon) C) Nafarelin (Synarel) D) Somatropin (Nutropin)
Ans: A
Feedback:
Histrelin (Vantas) is used to provide palliative treatment for advanced prostate cancer. Nafarelin
(Synarel) is used for treatment of endometriosis and precocious puberty; Ganirelix (Antagon) is used
for inhibition of premature luteinizing hormone surge in women undergoing controlled ovarian
stimulation as part of a fertility program; Somatropin (Nutropin) is used for treatment of children with
growth failure due to lack of growth hormone or to chronic renal failure.
