Chapter 30: Pituitary Drugs

When teaching a patient regarding desmopressin (DDAVP), the nurse will inform the patient to monitor for which potential side effects? Select all that apply. 1 Headache 2 Weight gain 3 Nasal irritation 4 Hyperglycemia 5 Hypotension

1,2,3 Desmopressin works to decrease urine output; thus the patient would retain fluid and gain weight. Headache may also occur as a sequela of fluid retention. Because it is administered intranasally, it can be irritating; thus nostrils should be rotated. Desmopressin does not affect serum glucose levels.

Cosyntropin (Cortrosyn)

11. Cosyntropin (Cortrosyn) is used for the diagnosis of adrenocortical insufficiency, not for treatment. Once a diagnosis is made, the actual drug treatment gener- ally involves replacement hormonal therapy using drug forms of the deficient corticosteroid hormones. (Lilley, 122012)

The nurse would question an order for somatrem (Protropin) in a patient with which condition? 1dwarfism 2Acromegaly 3Growth failure 4Hypopituitarism

2 Somatrem is a synthetic form of growth hormone. Acromegaly is caused by excessive growth hormone, and thus this drug would be contraindicated.

Which is a priority nursing diagnosis for a patient receiving desmopressin (DDAVP)? 1Risk for injury 2Acute pain 3Excess fluid volume 4Deficient knowledge regarding medication

3 Desmopressin is a form of antidiuretic hormone, which increases sodium and water retention, leading to an alteration in fluid volume. Although the other nursing diagnoses may be appropriate, they are not a priority using Maslow's hierarchy of needs.

After administering somatropin (Serostim), the nurse would assess for adverse effects by monitoring which parameters? 1Serum potassium levels 2Mental status 3Respiratory rate 4Serum glucose levels

4 Hyperglycemia and hypoglycemia are potential adverse effects of somatropin therapy.

The nurse admitting a patient with acromegaly anticipates administering which medication? 1desmopressin (DDAVP) 2corticotropin (Acthar) 3somatropin (Nutropin) 4octreotide (Sandostatin)

4 Octreotide suppresses growth hormone, the culprit of acromegaly.

6 Which drugs have an action similar to that of the naturally occurring hormone ADH? (Select all that apply.) a cosyntropin (Cortrosyn) b desmopressin (DDAVP) c somatropin (Humatrope) d vasopressin (Pitressin) e octreotide (Sandostatin)

B,D

2 A patient is suspected of having adrenocortical insufficiency. The nurse expects to administer which drug to aid in the diagnosis of this condition? a octreotide (Sandostatin) b vasopressin (Pitressin) c somatropin (Humatrope) d cosyntropin (Cortrosyn)

D

3 The nurse is reviewing the medication list for a patient who will be starting therapy with somatropin. Which type of drug would raise a concern that needs to be addressed before the patient starts the somatropin? a Nonsteroidal antiinflammatory drug for arthritis b Antidepressant drug c Penicillin d Glucocorticoid

D

5 When monitoring for the therapeutic effects of intranasal desmopressin (DDAVP) in a patient who has diabetes insipidus, which assessment finding will the nurse look for as an indication that the medication therapy is successful? a Increased insulin levels b Decreased diarrhea c Improved nasal patency d Decreased thirst

D

5. The nurse will instruct a patient taking desmopressin acetate as a nasal spray for the treatment of diabetes insipidus to perform which action to obtain maxi- mum benefit from the drug? a. Clear the nasal passages before spraying the medication. b. Blow his nose after taking the medication. c. Take an over-the-counter preparation to control mucus if nasal congestion occurs. d. Press on the pump once to prime it before delivering the dose.

a

7. When assessing a patient who is receiving octreotide (Sandostatin) therapy, the nurse will closely monitor which assessment finding? a. Blood glucose levels b. Pulse c. Weight d. Serum potassium levels (Lilley, 122012)

a

4. Which nursing diagnosis is most appropriate for a patient who is receiving a pituitary drug? a. Constipation b. Disturbed body image c. Impaired physical mobility d. Impaired skin integrity

b

3. A nurse is administering octreotide (Sandostatin) to a patient who has a metastatic carcinoid tumor. The patient asks about the purpose of this drug. What is the nurse's best response? a. "This drug helps to reduce the size of your tumor." b. "This drug works to prevent the spread of your tumor." c. "This drug helps to control the flushing and di- arrhea that you are experiencing." d. "This drug reduces the nausea and vomiting you are having from the chemotherapy." (Lilley, 122012)

c

2. When administering vasopressin, which is the priority vital sign for the nurse to monitor? a. Temperature b. Pulse c. Respirations d.Blood pressure (Lilley, 122012)

d

The nurse is providing care to a patient following a non-accidental traumatic brain injury. The patient has developed diabetes insipidus due to the injury. What medication is most often used in the management of diabetes insipidus? 1desmopressin (DDAVP) 2corticotrophin (Acthar) 3octreotide (Sandostatin) 4somatropin (Humatrope)

1 Vasopressin (Pitressin) and desmopressin (DDAVP) are used to prevent or control polydipsia (excessive thirst), polyuria, and dehydration in patients with diabetes insipidus caused by a deficiency of endogenous antidiuretic hormone.

What would the nurse assess when monitoring for the therapeutic effectiveness of vasopressin? 1Fluid balance 2Patient's pain scale 3Serum albumin levels 4Adrenocorticotropic hormone (ACTH) levels

1 Vasopressin causes decreased water excretion in the renal tubule, thus decreasing urine output. It is used to treat diabetes insipidus, which presents with polyuria and dehydration.

6. During vasopressin therapy, which is the priority nursing action? a. Check blood glucose levels regularly. b. Monitor the electrocardiogram for changes. c. Monitor the IV site for signs of infiltration. d. Watch for hyperthermia.

c

1 A patient is experiencing severe diarrhea, flushing, and life-threatening hypotension associated with carcinoid crisis. The nurse will prepare to administer which drug? a octreotide (Sandostatin) b vasopressin (Pitressin) c somatropin (Humatrope) d cosyntropin (Cortrosyn)

A

7. A patient's medication order indicates that he is to receive a dose of cosyntropin (Cortrosyn). The nurse is aware that this drug is used to diagnose which condition? a. Adrenocortical insufficiency b. Diabetes insipidus c. Myasthenia gravis d. Pituitary dwarfism

ANS: A Cosyntropin is used for the diagnosis of adrenocortical insufficiency. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 495 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

5. An 8-year-old child has been diagnosed with true pituitary dwarfism and is being treated with somatropin. In follow-up visits, the nurse will monitor for which expected outcome? a. Increased growth b. Decreased urinary output c. Increased muscle strength d. Increased height when the child reaches puberty

ANS: A In patients for whom somatropin is indicated, increased growth is expected. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 499 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

1. The nurse notes in a patient's medication history that the patient has been taking desmopressin (DDAVP). Based on this finding, the nurse interprets that the patient has which disorder? a. Diabetes mellitus b. Diabetes insipidus c. Adrenocortical insufficiency d. Carcinoid tumor

ANS: B Desmopressin is used to prevent or control polydipsia (excessive thirst), polyuria, and dehydration in patients with diabetes insipidus. The symptoms are caused by a deficiency of endogenous antidiuretic hormone. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 496 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

6. When reviewing the medication profile of a patient with a new order for desmopressin (DDAVP), the nurse notes that a drug interaction will occur if which drug is taken with desmopressin? a. aspirin b. digoxin c. lithium d. penicillin

ANS: C Lithium may cause a decreased therapeutic effect of desmopressin. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 496 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

2. A 16-year-old boy who is taking somatropin comes into the office because he had an asthma attack during a race at school. Because of this new development, the nurse expects which intervention to occur next? a. He will need to stop participating in school physical education classes. b. The somatropin must be discontinued immediately. c. The somatropin dosage may be adjusted. d. His growth will be documented and monitored for changes.

ANS: C Somatropin is to be used with caution in acute or chronic illnesses, such as migraine headaches, epilepsy, and asthma. It will not have to be immediately discontinued but will require close monitoring. The patient's growth will be measured and documented throughout therapy with somatropin. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 496 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

1. A patient is about to receive a dose of octreotide (Sandostatin). The nurse will assess for which contraindications or cautions? (Select all that apply.) a. Carcinoid crisis b. Diarrhea c. Type 1 diabetes mellitus d. Gallbladder disease e. Chronic renal failure f. Esophageal varices

ANS: C, D, E Octreotide is used with caution in patients with diabetes (type 1 or 2), gallbladder impairment, or renal impairment. Carcinoid crisis, which may be associated with severe diarrhea and flushing, is an indication for octreotide; esophageal varices are also an indication. DIF: COGNITIVE LEVEL: Applying (Application) REF: pp. 496-197 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

3. When a patient is receiving vasopressin (Pitressin), the nurse will monitor for which therapeutic response? a. Improved appetite b. Increased serum albumin levels c. Increased serum potassium levels d. Decreased urinary output

ANS: D Decreased severe thirst and decreased urinary output are the therapeutic responses expected with vasopressin. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 497 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

4. A pituitary drug is prescribed for a patient with a hormone deficiency, and the nurse provides instructions about the medication. Which statement by the patient indicates a need for further instruction? a. "I will not stop the drug unless my doctor tells me to stop it." b. "I will call my doctor if I have a fever or sore throat." c. "I will have to stop drinking my nightly glass of wine." d. "I am looking forward to a cure for my condition with this hormone replacement."

ANS: D The medication does not lead to a cure but does help to alleviate the symptoms of the disease for which it is being given. The patient needs to avoid alcohol while taking any of the pituitary drugs. Instruct the patient not to discontinue this drug abruptly because of possible negative consequences to the patient and the levels of pituitary hormones. Any fever, sore throat, joint pain, or muscular pain needs to be reported to the prescriber immediately. DIF: COGNITIVE LEVEL: Analyzing (Analysis) REF: pp. 498-499 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

4 A patient who is about to be given octreotide is also taking a diuretic, IV heparin, ciprofloxacin (Cipro), and an opioid as needed for pain. The nurse will monitor for what possible interaction? a Hypokalemia due to an interaction with the diuretic b Decreased anticoagulation due to an interaction with the heparin c Prolongation of the QT interval due to an interaction with ciprofloxacin d Increased sedation if the opioid is given

C