Chapter 35: Hypothalamic and Pituitary Agents
When describing desmopressin to a group of students, the instructor explains that it is a synthetic form of: oxytocin. adrenocorticotropic hormone. thyroid hormone. antidiuretic hormone.
antidiuretic hormone. Explanation: Desmopressin is a synthetic antidiuretic hormone.
A client receives desmopressin intravenously at 10:00 AM. The nurse would expect the drug to begin working at which time? 10:15 AM 10:30 AM 10:45 AM 11:00 AM
10:30 AM Explanation: Intravenous desmopressin has an onset of action of 30 minutes, or in this case, the drug would begin to work at approximately 10:30 AM.
The health care provider has prescribed growth hormone for a 12-year-old boy with growth impairment. The boy's parents should be instructed to contact the provider if they notice which signs in their son? Severe hip pain Development of a limp Severe knee pain Any of the above
Any of the above Explanation: The parents should contact the health care provider to report severe hip or knee pain or the development of a limp; any of these may indicate slipped capital femoral epiphysis.
The pediatric nurse understands that growth hormone (GH) deficiency can cause which disorder? Diabetes insipidus Somatropin deficiency syndrome (SDS) Dwarfism Acromegaly
Dwarfism Explanation: GH deficiency can cause dwarfism in children and SDS in adults.
The ICU nurse is assessing a client who has been given desmopressin for treatment of diabetes insipidus. What lab values should the nurse prioritize during assessment? Hematocrit Platelets Sodium Calcium
Sodium Explanation: The FDA has issued a black box warning stating that clients taking desmopressin can develop hyponatremia, leading to seizures. Consequently, assessment of sodium levels takes precedence over hematocrit, calcium, and platelet levels.
After teaching a group of students about growth hormone agonists and antagonists, the instructor determines that additional teaching is needed when the students identify which agent as a growth hormone antagonist? Somatropin Bromocriptine Octreotide Pegvisomant
Somatropin Explanation: Somatropin is a growth hormone agonist.
Which agent would the nurse identify as a growth hormone agonist? Bromocriptine Octreotide Somatropin Pegvisomant
Somatropin Explanation: Somatropin is considered a growth hormone agonist. Bromocriptine, octreotide, and pegvisomant are growth hormone antagonists.
The nurse is preparing to administer octreotide. The nurse expects to administer this drug by which route? Oral Subcutaneous Intramuscular Intranasal
Subcutaneous Explanation: Octreotide must be administered subcutaneously.
A client is diagnosed with diabetes insipidus. The health care provider orders desmopressin, which the nurse knows is the synthetic equivalent of what hormone? - PTH - ACTH - ADH - PTCH
ADH Explanation: Desmopressin (DDAVP, Stimate) and vasopressin (Pitressin) are synthetic equivalents of ADH. A major clinical use is the treatment of neurogenic diabetes insipidus, a disorder characterized by a deficiency of ADH and the excretion of large amounts of dilute urine.
Deficiency of which hormone causes excessive and frequent urination and excessive thirst? Prolactin deficiency ADH deficiency TSH deficiency ACTH deficiency
ADH deficiency Explanation: Antidiuretic hormone (ADH), also called vasopressin, functions to regulate water balance. When ADH is secreted, it makes renal tubules more permeable to water. This allows water in renal tubules to be reabsorbed into the plasma and so conserves body water. In the absence of ADH, little water is reabsorbed, and large amounts are lost in the urine.
A client is to undergo fertility treatment and is to receive an agent that induces ovulation because her ovaries are functioning. Which agent would this most likely be? Chorionic gonadotropin Corticotropin Cosyntropin Thyrotropin alfa
Chorionic gonadotropin Explanation: Chorionic gonadotropin would be used to induce ovulation in females with functioning ovaries. Corticotropin and cosyntropin are used to diagnose adrenal function. Thyrotropin alfa is used as adjunctive treatment for radioiodine ablation of thyroid tissue for thyroid cancer.
The nurse is aware that somatropin is not appropriate for the person who exhibits growth impairment and what other condition? - Skeletal height below the 10th percentile for age - Closure of the epiphyseal plate - Lack of lean body mass - Decreased number of red blood cells
Closure of the epiphyseal plate Explanation: Somatropin is not used in clients with growth impairment who have closure of the epiphyseal plates.
The nurse would administer what to a client in labor to improve her uterine contractions? Desmopressin Oxytocin Menotropins Chorionic gonadotropin alfa
Oxytocin Explanation: Oxytocin is a posterior pituitary hormone that is used to promote uterine contractions. Desmopressin is used to treat diabetes insipidus. Menotropins and chorionic gonadotropin alfa are fertility agents.
After administering desmopressin to a client with diabetes insipidus, which would the nurse identify as indicating drug effectiveness? Decreased reports of thirst Elevated blood glucose levels Increased urination Decreased skin turgor
Decreased reports of thirst Explanation: Thirst is associated with diabetes insipidus. A decrease in the symptom would indicate that the drug is working. Diabetes insipidus causes elevated blood glucose levels. Diabetes insipidus causes polyuria. Decreased skin turgor would suggest dehydration, which is a sign of diabetes insipidus.
Desmopressin is used to treat which endocrine disorders? Growth failure Parkinson's disease Diabetes mellitus Diabetes insipidus
Diabetes insipidus Explanation: Desmopressin is a synthetic preparation of antidiuretic hormone that is used in the treatment of diabetes insipidus, von Willebrand's disease, and hemophilia.
Lack of antidiuretic hormone (ADH) produces which disease process? Diabetes mellitus Diabetes insipidus Acromegaly Hyperthyroidism
Diabetes insipidus Explanation: Lack of ADH produces diabetes insipidus, which is characterized by large amounts of dilute urine and excessive thirst.
The nurse is caring for a client who is receiving desmopressin for treatment of neurogenic diabetes insipidus. The nurse will be alert for which symptom that will alert the client to a serious adverse effect? Decrease in urine output Diminished mental status Increasing urine specific gravity Decrease in thirst
Diminished mental status Explanation: The nurse needs to be alert for signs of hyponatremia, which include diminished mental status. Decrease in urine output, decrease in thirst, and increase in urine specific gravity are all therapeutic effects.
A patient with endometriosis has intranasal nafarelin prescribed. What is the most important instruction the nurse could give the patient? Sit upright and press a finger over one nostril to close it. Hold the spray bottle upright. Place the tip of the bottle about ½ inches into the open nostril. Do not tip the head back during administration of the drug.
Do not tip the head back during administration of the drug. Explanation: All of the steps needed to administer nafarelin intranasally are important. However, tipping the head back during administration of the medication can cause post-nasal mucosa ulceration, heartburn, and GI upset.
Which hormone is responsible for increases in the size and number of muscle cells? Growth hormone Adrenocorticotropic hormone Thyroid-stimulating hormone Corticotropin-releasing hormone
Growth hormone Explanation: Growth hormone stimulates the growth of body tissues, including growth of muscle cells. Corticotropin-releasing hormone causes the release of corticotropin (adrenocorticotropic hormone) in response to stress. Thyroid-stimulating hormone regulates the secretion of thyroid hormones.
The nurse would contact the health care provider prior to administering desmopressin to a client with a history of what condition? Allergy to bananas Heart attack Detached retina Gout
Heart attack Explanation: Desmopressin is contraindicated in clients with a history of cardiovascular disorders because a black box warning stipulates that changes in fluid volume status may result in cardiac arrest in clients with known cardiovascular disease.
A clinic nurse is following a 9-year-old boy who is taking somatropin. What will the nurse monitor periodically? Antidiuretic hormone (ADH) levels Height Dehydration Water retention
Height Explanation: Somatropin is used for the long-term treatment of pediatric clients who have growth failure due to an inadequate secretion of endogenous growth hormone; therefore, the nurse should check the client's height. If the client's growth rate does not exceed the pretreatment rate by at least 2 cm per year, nonadherence to therapy, antibody formation, malnutrition, or hypothyroidism may be considered as possible causes. Somatropin would not significantly affect antidiuretic hormone (ADH) levels, or cause dehydration or water retention.
What is the route of administration for bromocriptine? Subcutaneous Oral Intravenous Intranasal
Oral Explanation: Bromocriptine is administered orally and effectively absorbed from the gastrointestinal tract.
The anatomy and physiology instructor is discussing hormones with the pre-nursing class. Which gland would the instructor tell the students controls secretions of the pituitary gland? Hypothalamus Pineal Thyroid Adrenal cortex
Hypothalamus Explanation: The hypothalamus uses a number of hormones or factors to either stimulate or inhibit the release of hormones from the anterior pituitary. These factors are not secreted by the pineal, the thyroid, and the adrenal cortex.
Hypothalamic hormones must be given by which route to avoid destruction? Topically or vaginal suppository Injection or nasal inhalation Sublingually or nasal inhalation Injection or sublingually
Injection or nasal inhalation Explanation: Because the hormones are proteins, they must be given by injection or nasal inhalation. If taken orally, the hormones would be destroyed by the proteolytic enzymes in the GI tract.
A client is to receive nafarelin. The nurse would instruct the client in administering this drug by which route? Oral Intranasal Intramuscular Subcutaneous
Intranasal Explanation: Nafarelin is given in nasal form.
A nurse should administer vasopressin cautiously to clients with which conditions? (Select all that apply.) Sleep apnea Migraine headaches Asthma Seizure disorders Angina
Migraine headaches Asthma Seizure disorders Angina Explanation: Vasopressin (Pressyn) is used cautiously in clients with a history of seizure disorder, migraine headaches, asthma, congestive heart failure, or vascular disease (angina and myocardial infarction).
What does release of antidiuretic hormone (ADH) cause? Reabsorption of water Concentration of extracellular fluids Elevation of osmotic pressure Decreased arterial blood pressure
Reabsorption of water Explanation: ADH is released in response to increases in plasma osmolarity or decreases in blood volume. It 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.
A client being treated with desmopressin exhibits confusion and drowsiness, and reports a headache. What is the nurse's best action? Administer the next dose of desmopressin. Take the client's vital signs. Encourage increased oral fluid intake. Hold the prescribed diuretic.
Take the client's vital signs. Explanation: Excessive dosage of desmopressin is manifested as water intoxication (fluid overload). Signs and symptoms include confusion, drowsiness, and headache. The nurse should assess the vital signs of this client and notify the health care provider. Administering desmopressin, increasing fluid intake, and holding a diuretic would all lead to further water retention and fluid overload.
A client's current drug regimen includes intranasal administration of desmopressin acetate. In this client's plan of nursing care, what is the most likely desired outcome of treatment? The client's urine output will not exceed 80 mL/h. The client will gain 2 cm in height over the next 6 months. The client will ovulate at least once over the next 8 weeks. The client's vertical growth will cease in the next 4 weeks.
The client's urine output will not exceed 80 mL/h. Explanation: Desmopressin acetate is the prototype posterior pituitary hormone medication. It is used to treat diabetes insipidus. Consequently, reduced urine output is the primary goal of treatment. The drug does not influence growth (height) or ovulation.
A 13-year-old boy who is in the first percentile of height for his age has been referred for care. Which assessment finding would contraindicate the safe and effective use of somatropin to treat his growth deficiency? The boy has not yet begun puberty. The boy has low serum albumin levels. The epiphyses of the boy's long bones have closed. The sutures of the boy's skull have not yet fully closed.
The epiphyses of the boy's long bones have closed. Explanation: Somatropin is ineffective when impaired growth is present after puberty, noted when the epiphyses of the long bones have closed. The medication is prescribed before puberty begins. Low albumin is not a contraindication to the use of somatropin. The sutures of the skull close early in life.
The nurse is assessing a child who is receiving growth hormone therapy. What would the nurse identify as suggesting glucose intolerance? - Injection site pain - Fatigue - Thirst - Cold intolerance
Thirst Explanation: Signs of glucose intolerance include thirst, hunger, and voiding pattern changes. Injection site pain is an adverse effect of the therapy. Fatigue and cold intolerance suggest thyroid dysfunction.
The nurse is assessing a child who is receiving growth hormone therapy. What would the nurse identify as suggesting glucose intolerance? Injection site pain Fatigue Thirst Cold intolerance
Thirst Explanation: Signs of glucose intolerance include thirst, hunger, and voiding pattern changes. Injection site pain is an adverse effect of the therapy. Fatigue and cold intolerance suggest thyroid dysfunction.
Which diagnosis places a client at risk for developing diabetes insipidus (DI)? Traumatic head injury Type 1 diabetes mellitus Somatotropin deficiency syndrome (SDS) Parkinson's disease
Traumatic head injury Explanation: Diabetes insipidus is caused by a deficiency in the amount of posterior pituitary ADH and may result from pituitary disease or injury (e.g., head trauma, surgery, tumor). None of the other diagnoses are recognized as risks for DI.
What is the most effective method to determine a client's ability to self-administer their prescribed nasal desmopressin? Watch them administer a scheduled dose of the medication. Ask them to describe the correct method of administration. Evaluate the current level of serum antidiuretic hormone (ADH). Provide the client with both written and oral instructions on the delivery method.
Watch them administer a scheduled dose of the medication. Explanation: The nurse should watch the client administer a dose of the drug to themselves. While the other options are appropriate interventions for such a client, none can evaluate the client's ability to self-deliver the medication better than actually observing the process.
Deficiency of which hormone causes polyuria and polydipsia? melanocyte-stimulating hormone (MSH) antidiuretic hormone (ADH) thyroid-stimulating hormone (TSH) adrenocorticotropic hormone (ACTH)
antidiuretic hormone (ADH) Explanation: Antidiuretic hormone (ADH) functions to regulate water balance. When ADH is secreted, it makes renal tubules more permeable to water. This allows water in renal tubules to be reabsorbed into the plasma and so conserves body water. In the absence of ADH, little water is reabsorbed, and large amounts are lost in the urine. TSH regulates secretion of thyroid hormones, and ACTH stimulates production of corticosteroids. MSH is linked to skin pigmentation, energy metabolism, and inflammation.
Gonadotropins are classified in which pregnancy category? category X category B category C category A
category X Explanation: Gonadotropins are classified as pregnancy category X and their use is contraindicated in pregnancy. Desmopressin acetate (a pregnancy category B drug) is typically used when diabetes insipidus occurs during pregnancy; however, it still must be used cautiously then and during lactation. Glucocorticoids are classified as pregnancy category C drugs and should be used with caution during pregnancy and lactation. Pregnancy category A medications are considered safe for use in pregnancy.
Which hormone stimulates the adrenal cortex to produce and secrete adrenocortical hormones? corticotropin somatotropin vasopressin gonadotropin
corticotropin Explanation: Corticotropin is the hormone that stimulates the adrenal cortex to produce and secrete adrenocortical hormones. Somatropin is the hormone responsible for the growth of the body during childhood, especially the growth of muscles and bones. Vasopressin is the hormone responsible for the regulation of reabsorption of water by the kidneys. The gonadotropins (FSH and LH) influence the secretion of sex hormones, the development of secondary sex characteristics, and the reproductive cycle in both men and women.
Which would be used to diagnose adrenal function? Corticotropin Chorionic gonadotropin Thyrotropin alfa Menotropins
corticotropin Explanation: Cosyntropin, a synthetic form of corticotropin, is used to diagnose adrenal function. Chorionic gonadotropin would be used to induce ovulation in females with functioning ovaries. Thyrotropin alfa is used as adjunctive treatment for radioiodine ablation of thyroid tissue for thyroid cancer. Menotropins are used as a fertility drug to stimulate ovulation and spermatogenesis.
What causes the release of adrenocorticotropic hormone in response to a client's psychological and physiological stress? growth hormone release-inhibiting hormone corticotropin-releasing hormone or factor (CRH or CRF) growth hormone-releasing hormone (GHRH) thyrotropin-releasing hormone (TRH)
corticotropin-releasing hormone or factor (CRH or CRF) Explanation: Corticotropin-releasing hormone or factor (CRH or CRF) causes release of corticotropin (adrenocorticotropic hormone) in response to stress and threatening stimuli. Growth hormone release-inhibiting hormone (somatostatin) inhibits release of growth hormone. Growth hormone-releasing hormone causes the release of growth hormone in response to low blood levels of GH. Thyrotropin-releasing hormone causes the release of TSH in response to stress, such as cold.
Drugs administered to influence hypothalamic hormones typically have half-lives of: seconds. hours. minutes. days to weeks.
days to weeks. Explanation: For the most part, these drugs are absorbed slowly when given intramuscularly, subcutaneously, or in depot form. They tend to have very long half-lives of days to weeks.
A nurse is organizing the care of a child who takes somatropin. The desired outcome the nurse should prioritize in the planning of this child's care is that the client will: experience a normal progression of secondary sex characteristics. not demonstrate the signs and symptoms of water intoxication. deny feelings of anxiety. demonstrate an increase in linear growth.
demonstrate an increase in linear growth. Explanation: The primary indication for the use of somatotropin is GH deficiency leading to short stature. Anxiety, water intoxication, and lack of sex characteristics are not associated with GH deficiency and are not addressed through the therapeutic use of somatropin.
Growth hormone (GH) hypersecretion is usually caused by: adrenal tumors. pituitary tumors. thyroid tumors. parathyroid tumors.
pituitary tumors. Explanation: GH hypersecretion is usually caused by pituitary tumors and can occur at any time of life. This is often referred to as hyperpituitarism.
What effect do growth hormones (GH) have on homeostasis? Select all that apply. regulation of cell division regulation of protein synthesis programming of cell apoptosis stimulation of triglyceride synthesis sex determination during fetal development
regulation of cell division regulation of protein synthesis stimulation of triglyceride synthesis Explanation: (GH, also called somatotropin, stimulates growth of body tissues. It regulates cell division and protein synthesis required for normal growth and promotes an increase in cell size and number, including growth of muscle cells and lengthening of bone. GH enhances fat utilization by stimulating triglyceride breakdown and oxidation in fat-storing cells. GH does not influence apoptosis or sex determination.)
A critically ill client is being treated with desmopressin. When reviewing the diagnostic and laboratory findings of a client prescribed desmopressin, the nurse should prioritize what values? Select all that apply. sodium (Na) potassium (K) hemoglobin (Hgb) leukocytes (WBC) partial thromboplastin time (PTT)
sodium (Na) potassium (K) Explanation: Because of the profound changes in fluid balance that exist before and after treatment with desmopressin, it is important to assess the serum electrolytes, particularly the sodium and potassium levels. This takes precedence over coagulation factors, red blood cell indices, and white cell levels.
The control mechanisms for most metabolic functions of the body, as well as the maintenance of homeostasis, is the function of: the anterior pituitary gland. the hypothalamus and the pituitary gland. the posterior pituitary gland. hypothalamic hormones.
the hypothalamus and the pituitary gland. Explanation: The hypothalamus of the brain and the pituitary gland interact to control most metabolic functions of the body and to maintain homeostasis. The hypothalamus controls secretions of the pituitary gland. The pituitary gland, in turn, regulates secretions or functions of other body tissues, called target tissues.
The control mechanisms for most metabolic functions of the body, as well as the maintenance of homeostasis, is the function of: the anterior pituitary gland. the hypothalamus and the pituitary gland. the posterior pituitary gland. hypothalamic hormones.
the hypothalamus and the pituitary gland. Explanation: The hypothalamus of the brain and the pituitary gland interact to control most metabolic functions of the body and to maintain homeostasis. The hypothalamus controls secretions of the pituitary gland. The pituitary gland, in turn, regulates secretions or functions of other body tissues, called target tissues.
What is the regulatory function of vasopressin? growth lactation water balance corticosteroid production
water balance Explanation: Antidiuretic hormone (ADH), also called vasopressin, functions to regulate water balance. Corticotropin stimulates corticosteroid production. Oxytocin is involved in lactation. Growth hormone stimulates growth of body tissues.