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Chapter 35- Hypothalamic and Pituitary Agents
1.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. 2.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. 3.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.
4.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
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. 8.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. 9.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. 11.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. 13.What is the purpose of releasing hormones secreted by the hypothalamus? A) Stimulating or inhibiting release of hormones from the pituitary
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. 14.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. 15.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
- 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. 25.A 4-year-old is tested and found to have deficient growth hormone (GH). What does this condition cause? A) Gigantism B) Acromegaly C) Syndrome of inappropriate antidiuretic hormone (SIADH) D) Dwarfism Ans: D Feedback: GH deficiency in children results in short stature (dwarfism). Excess production of GH results in gigantism and acromegaly. SIADH is caused by excessive production of antidiuretic hormone.
- What hormone does the posterior pituitary gland store and release?
hormone (ADH, also known as vasopressin) and oxytocin. The posterior pituitary is anatomically an extension of the hypothalamus and is composed mainly of nerve fibers. Although it does not manufacture any hormones itself, it stores and releases hormones synthesized in the hypothalamus. The hypothalamus of the brain and the pituitary gland interact together to control most metabolic functions of the body and to maintain homeostasis.
- The nurse is caring for a patient receiving tolvaptan and digoxin. What drug–drug interaction will the nurse assess for when reviewing this patient's laboratory results? A) Elevated serum sodium levels B) Reduced digoxin levels C) Elevated serum potassium levels D) Tolvaptan toxicity Ans: C Feedback: Tolvaptan should be used with care with digoxin, which could cause hyperkalemia, so the nurse must carefully monitor serum potassium levels. The combination of drugs would not cause reduced digoxin levels or tolvaptan toxicity. The indication for administering tolvaptan would be to treat hyponatremia, so an elevation in serum sodium levels to normal range would be an indication the drug was working but would not be a result of a drug-drug interaction.
- The nurse is caring for a patient who has been receiving long-term growth hormone treatment to stimulate growth. What diagnostic testing would the nurse expect to see ordered as a standard part of the treatment plan? (Select all that apply.) A) Blood sugar level B) Serum electrolytes C) X-ray of the long-bones D) Nasal examination E) Bone density studies Ans: A, B, C Feedback: Periodic radiography of the long bones, as well as monitoring of blood sugar levels and electrolytes, should be a standard part of the treatment plan for children who receive any of the hypothalamic or pituitary agents. There would be no indication for nasal assessment because growth hormone is not administered nasally. Bone density would not be impacted by these drugs.
- What is the nurse's priority assessment when administering hypothalamic or pituitary agents to older adults? A) Hydration and nutrition B) Balance and fall risk
C) Cognitive function
