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
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.

5.

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.

6.

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.

7.

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.

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.

10.

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
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.

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.

16.

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.

17.

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.

18.

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.

19.

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.

20.

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.

21.

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.

22.

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.

23.

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.

24.

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.

26.

What hormone does the posterior pituitary gland store and release?
A)
Antidiuretic hormone (ADH)
B)
Follicle-stimulating hormone (FSH)
C)
Growth hormone (GH)
D)
Thyroid stimulating hormone (TSH)
Ans:
A

Feedback:

The posterior pituitary stores two hormones produced in the hypothalamus: ADH, also known as vasopressin and oxytocin. The posterior pituitary does not store FSH, GH, or TSH.

27.

For what purposes might the nurse administer a hypothalamic hormone? (Select all that apply.)
A)
Diagnostic testing
B)
Synthesis of growth factors
C)
Prevent aging
D)
Treating some forms of cancer
E)
Adjuncts in fertility programs
Ans:
A, D, E

Feedback:

The hypothalamic hormones are not all available for pharmacological purposes. Those available are used mostly for diagnostic testing, for treating some forms of cancer, or as adjunctive therapies in fertility programs. They would not be used to prevent aging or for the synthesis of growth factor.

28.

The nurse is caring for a patient diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) which the nurse recognizes is caused by what?
A)
Excessive secretion of antidiuretic hormone (ADH)
B)
Insufficient secretion of ADH
C)
Excessive secretion of androgens
D)
Insufficient secretion of antidepressants
Ans:
A

Feedback:

SIADH occurs with excessive secretion of ADH. Insufficient secretion of ADH causes diabetes insipidus. ADH is not related to androgenic or antidepressant actions.

29.

The nurse explains the role of the posterior pituitary gland is to do what?
A)
“It synthesizes different hormones.”
B)
“It makes two hormones.”
C)
“It stores hormones.”
D)
“It controls most of the metabolic functions of the body.”
Ans:
C

Feedback:

The posterior pituitary stores two hormones produced in the hypothalamus: antidiuretic 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.

30.

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.

31.

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.

32.

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
D)
Urinary incontinence
Ans:
A

Feedback:

Older adults may be more susceptible to the imbalances associated with alterations in the endocrine system. They should be evaluated periodically during treatment for hydration and nutrition, as well as for electrolyte balance. These drugs would not be expected to impact balance, cognitive function, or to cause incontinence so these would not be the priority assessment.

33.

The mother of a child awaiting a renal transplant asks the nurse whether growth hormone could be effective for her child. What is the nurse’s best response?
A)
“Growth hormone is only used to treat short stature in children who do not produce enough growth hormone naturally.”
B)
“Growth hormone has been used successfully in children with renal failure but there is a lot to consider and you should talk to the doctor about it.”
C)
“Administration of growth hormone requires frequent injections so it would be cruel for a child with existing medical problems.”
D)
“You do not want to use growth hormone if you do not have to. What would make you even think of something like that?”
Ans:
B

Feedback:

Growth hormone therapy is used with children with renal failure but the decision carries risks as well as benefits so it is important for the mother to talk to the child’s primary physician and nephrologist to get recommendations for its safety. It is not just used in children with inadequate growth hormone secretion. It is never correct for the nurse to castigate the mother for a question so telling her it would be cruel or that she should not use it if it is not essential would destroy the patient/nurse relationship.

34.

The nurse is asked to explain how to administer somatropin (Saizen) to the mother of a 6-year-old. How would the nurse explain how this drug is administered?
A)
“It requires only a very small needle and doesn’t hurt much at all.”
B)
“There will no longer be any need to rotate sites because it uses a needleless system.”
C)
“This system will be used until your son gets older and is more tolerant of needles.”
D)
“This delivers a fine mist through the skin without needles and far less discomfort.”
Ans:
D

Feedback:

Saizen uses the cool.click delivery system, which is a neon-colored, needle-free system that delivers the drug through the skin using a fine mist. Tests have shown a bioequivalency of this method with standard injection techniques, and the young patients who must use this drug are much less resistant to the dosing. There are no needles but site of injection still require rotation to avoid skin damage. The child does not have to go back to a needle system when he gets older.