Chapter 43: Drug Therapy for Pituitary and Hypothalamic Dysfunction
Some hormones are secreted in cyclic patterns. How long is the time pattern related to secretion of estrogen and progesterone? 5 weeks 24 hours 28 days 7 days
28 days Explanation: Estrogen and progesterone secretion is related to the menstrual cycle, which is typically 28 days long
Damage to which lobe of the pituitary gland would result in problems related to the function of stimulating hormones? Posterior Intermediate Lateral Anterior
Anterior Explanation: The pituitary is made up of three lobes: Anterior, posterior, and intermediate. The anterior lobe produces stimulating hormones in response to hypothalamic stimulation
What would the nurse expect to assess if a client was receiving too much methimazole? · Flushed warm skin · Decreased appetite · Tachycardia · Nervousness
Decreased appetite Explanation: Decreased appetite is associated with hypothyroidism, suggesting that the client is receiving too much methimazole, an antithyroid drug. Nervousness would indicate hyperthyroidism suggesting that the client is not receiving enough methimazole, an antithyroid drug. Flushed warm skin would indicate hyperthyroidism, suggesting that the client is not receiving enough methimazole, an antithyroid drug. Tachycardia would indicate hyperthyroidism, suggesting that the client is not receiving enough methimazole, an antithyroid drug.
Which is released in response to decreased oxygenated blood flowing through the kidneys? Erythropoietin Glucagon Calcitonin Aldosterone
Erythropoietin Explanation: Erythropoietin is released in response to a decrease in oxygenated blood flowing through the kidneys. Glucagon is released based on blood glucose levels. Calcitonin is released in response to serum calcium levels. Aldosterone is released in response to ACTH and to high potassium levels
A nurse is caring for a client with subacute lymphocytic thyroiditis. The health care provider prescribes thyroid hormones to the client. From which sign during ongoing assessment should the nurse conclude that the client is responding to the therapy? · Flushing · Excessive sweating · Increased appetite · Swollen neck
Increased appetite Explanation: The nurse should observe for signs of therapeutic responses, which include increased appetite, weight loss, mild diuresis, an increased pulse rate, and decreased puffiness of the face, hands, and feet. The nurse need not observe swollen neck, excessive sweating, or heat intolerance as signs of responding to therapy. Swollen neck, sore throat, and cough may occur after two to three days of administering radioactive iodine. Sweating and flushing are the adverse reactions to thyroid hormones.
A 34-year-old teacher is being seen at the primary care group. The client is undergoing diagnostics for an alteration in thyroid function. What physiologic function is affected by the altered thyroid function? Growth Metabolic rate Fluid, electrolyte balance Sleeping, wake cycles
Metabolic rate Explanation: The thyroid concentrates iodine from food and uses it to synthesize thyroxine (T) and triiodothyronine (T). These two hormones regulate the body's metabolic rate.
A 34-year-old teacher is being seen at the primary care group. The client is undergoing diagnostics for an alteration in thyroid function. What physiologic function is affected by the altered thyroid function? • Growth • Metabolic rate • Sleeping, wake cycles • Fluid, electrolyte balance
Metabolic rate Explanation: The thyroid concentrates iodine from food and uses it to synthesize thyroxine (T) and triiodothyronine (T). These two hormones regulate the body's metabolic rate.
A patient is experiencing a prolonged labor and her contractions are ineffective. Which agent would the nurse expect to be ordered? • Desmopressin • Chorionic gonadotropin alfa • Abarelix • Oxytocin
Oxytocin Explanation: Oxytocin is a posterior pituitary hormone that is used to promote uterine contractions. Abarelix is used to treat advanced prostate cancer. Desmopressin is used to treat diabetes insipidus. Chorionic gonadotropin alfa is a fertility agents.
After reviewing the hormonal secretion of the pituitary gland, the students demonstrate understanding when they identify which hormone as being released by the posterior lobe? • Oxytocin • Endorphins • Growth hormone • Thyrotropin
Oxytocin Explanation: Oxytocin is released by the posterior pituitary gland. Endorphins are released by the intermediate lobe of the pituitary gland. Thyrotropin or thyroid releasing hormone is released from the anterior pituitary gland. Growth hormone is released by the anterior pituitary gland.
An instructor is preparing a teaching plan for a class on the various pituitary hormones. Which hormone would the instructor include as being released by the posterior pituitary gland? Oxytocin Prolactin Adrenocorticotropic hormone Somatotropin
Oxytocin Explanation: The posterior pituitary gland releases oxytocin and antidiuretic hormone. Somatotropin, prolactin, and adrenocorticotropic hormone are released by the anterior pituitary gland
Which of the following hypothalamic hormones causes the release of TSH in response to stress, such as exposure to cold? Thyrotropin-releasing hormone (TRH) Growth hormone-releasing hormone (GHRH) Prolactin-inhibitory factor (PIF) Gonadotropin-releasing hormone (GnRH)
Thyrotropin-releasing hormone (TRH) Explanation: In response to stress, the hypothalamus releases TRH, which stimulates the pituitary to produce TSH (thyrotropin)
The nurse educates a client recently diagnosed with hypothyroidism about using the prescribed levothyroxine. The client has a history of diabetes. Which client statement establishes the need for further clarification? · "It does not matter which brand of the drug I take, they are all the same." · "The levothyroxine can increase my glucose, so I need to report hyperglycemia." · "Thyroid replacement is lifelong; dosage changes must come from my provider." · "I will take the drug thirty minutes before breakfast the same time each day."
"It does not matter which brand of the drug I take, they are all the same." Explanation: The nurse needs to clarify with further teaching the client's statement that it does not matter what brand of levothyroxine is taken. The client needs to keep taking the same brand because switching brands can lead to changes in the hormone level and affect the treatment. The other statements made by the client support an adequate understanding of various teaching points. Taking the drug before breakfast allows the medication to dissolve and be absorbed on an empty stomach. Taking the medication at the same time of day helps to maintain a steady state of the drug. Thyroid replacement may cause symptoms of diabetes to increase, so monitoring for hyperglycemia is warranted since the client has a history of diabetes. Thyroid replacement in this case is lifelong, and the client should not intentionally change a dose by increasing, decreasing, or skipping a dose.
Older adult clients are at increased risk for adverse cardiovascular reactions when taking thyroid drugs; therefore, increases in dosage, if needed, are made in smaller increments during a period of how many weeks? · 8 weeks · 6 weeks · 4 weeks · 1 week
8 weeks Explanation: Older adult clients are at increased risk for adverse cardiovascular reactions when taking thyroid drugs; therefore, increases in dosage, if needed, are made in smaller increments during a period of 8 weeks. Due to the gradual increase the increment of 1 to 6 weeks is not enough time to increase slowly.
A nurse is caring for a client suffering from a severe form of hyperthyroidism called thyrotoxicosis or thyroid storm. What would the nurse observe for in the client as a characteristic of thyroid storm? · Cold intolerance · Constipation · Altered mental status · Memory impairment
Altered mental status Explanation: A severe form of hyperthyroidism called thyrotoxicosis or thyroid storm is characterized by high fever, extreme tachycardia, and altered mental status (e.g., coma). The nurse need not observe memory impairment, cold intolerance, or constipation as characteristics of thyroid storm. Memory impairment, cold intolerance, and constipation are the manifestations of myxedema, which is a severe hypothyroidism.
The adrenal cortex influences glucose levels through the production of which hormone? Renin Secretin Calcitonin Cortisol
Cortisol Explanation: The adrenal cortex produces cortisol which increases glucose levels. None of the remaining options are produced by the adrenal cortex nor do they affect glucose levels
Which would be used to diagnose adrenal function? Chorionic gonadotropin Menotropins Thyrotropin alfa Corticotropin
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.
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 Decreased skin turgor Increased urination
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
A patient with hypothyroidism is at increased risk for respiratory depression and myxedema coma if given what category of drugs? · Opioid analgesics · Nonsteroidal anti-inflammatory drugs · Corticosteroids · Antibiotics
Opioid analgesics Explanation: Most drugs given to patients with hypothyroidism have a prolonged effect, because drug metabolism in the liver is delayed and the glomerular filtration rate of the kidneys is decreased. People with hypothyroidism are especially likely to experience respiratory depression and myxedema coma with opioid analgesics and other sedating drugs. These drugs should be avoided when possible.
The most common cause of subclinical hyperthyroidism is: · Excess thyroid hormone therapy. · Previous neck radiation. · Untreated osteoporosis. · Taking central nervous system depressants.
Excess thyroid hormone therapy. Explanation: Clients should be monitored closely for hypothyroidism while taking antithyroid drugs, which usually develops within a year after receiving treatment for hyperthyroidism. The most common cause of subclinical hyperthyroidism is excess thyroid hormone therapy.
The release of FSH and LH are stimulated by what hormone? Melanocyte-stimulating hormone Gonadotropin-releasing factor Prolactin-releasing factor Thyrotropin-releasing hormone
Gonadotropin-releasing factor Explanation: Factors that stimulate the release of hormones are growth hormone-releasing hormone (GHRH), thyrotropin-releasing hormone (TRH), gonadotropin-releasing hormone (GnRH), corticotropin-releasing hormone (CRH), and prolactin-releasing hormone (PRH)
The nurse would contact the health care provider prior to administering desmopressin to a client with a history of what condition? Allergy to bananas Detached retina Gout Heart attack
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
A client presents at the clinic reporting weight loss despite an increased appetite. For which condition should this client be assessed? · Chronic thyroiditis · Hyperthyroidism · Hypothyroidism · Hyperglycemia
Hyperthyroidism Explanation: Hyperthyroidism is manifested by increased appetite and metabolism. Without treatment, it may be difficult for hyperthyroid individuals to consume enough calories to prevent weight loss. Hypothyroidism, which may be caused by thyroiditis, causes decreased appetite and metabolism, and hypothyroid patients frequently experience weight gain.
These are events in the hypothalamic-pituitary axis. Place the events in the proper sequence. Hypothalamus secretion of releasing factor Anterior pituitary release of stimulating hormone Hormone secretion by the endocrine gland Rising level of the hormone Cessation of releasing hormone secretion
Hypothalamus secretion of releasing factor Anterior pituitary release of stimulating hormone Hormone secretion by the endocrine gland Rising level of the hormone Cessation of releasing hormone secretion Explanation: The initiating event in the HPA axis is the hypothalamic secretion of releasing factors, which leads to the anterior pituitary secreting the stimulating hormone, which in turn leads to the secretion of the hormone by the gland. Rising levels of the hormone cause the hypothalamus to cease secretion of the releasing hormone
The pharmacology instructor is providing education regarding propylthiouracil to the nursing students. What would the instructor identify as the primary mode of action for this medication? · Inhibition of production of thyroid hormone · Destruction of part of the thyroid gland · Sedation of the central nervous system and suppression of cardiac function · Suppression of the anterior pituitary gland's hormonal secretions
Inhibition of production of thyroid hormone Explanation: Propylthiouracil acts by inhibiting production of thyroid hormones and peripheral conversion of thyroxine (T4) to the more active triiodothyronine (T3).
Hypothalamic hormones must be given by which route to avoid destruction? Injection or nasal inhalation Topically or vaginal suppository 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 diagnosed with liver disease. How would this affect the metabolism of the drugs used to treat the client's hypothyroidism? · It would be unaffected. · It would be rapid. · It would be short-lived. · It would be prolonged.
It would be prolonged. Explanation: Drug metabolism in the liver is delayed in clients with hypothyroidism and liver disease, so most drugs given to these clients have a prolonged effect.
Which agent would a nurse expect to administer to a client with hypothyroidism? · Levothyroxine · Propylthiouracil · Calcitriol · Methimazole
Levothyroxine Explanation: Levothyroxine would be used to treat a deficiency of thyroid hormone or hypothyroidism. Methimazole and propylthiouracil are antithyroid agents used to treat hyperthyroidism. Calcitriol is an antihypocalcemic agent used to treat hypoparathyroidism.
A client is brought to the emergency department after taking an overdose of levothyroxine. When assessing this client, what adverse effects would the nurse expect to find? · Slow speech and mental dullness · Nervousness and tachycardia · Drowsiness and bradycardia · Skin rash and itching
Nervousness and tachycardia Explanation: Excessive doses of levothyroxine, a thyroid drug, can cause the same signs and symptoms that occur with hyperthyroidism. These include nervousness and tachycardia.
A client admitted to the hospital with hyperthyroidism treated with propylthiouracil suddenly develops a skin rash. Which action would the nurse implement first? · Record weight and report weight gain or loss. · Notify the primary health care provider. · Provide soothing cream to affected areas. · Avoid using soap to cleanse affected areas.
Notify the primary health care provider. Explanation: Whenever a client develops a skin rash after taking propylthiouracil, the nurse must notify the primary health care provider immediately because it may be an adverse reaction. The other measures are important to protect the skin integrity: avoid soap and apply soothing cream to affected areas. Recording the weight and reporting weight gain or loss are also important.
The nursing class is studying family nursing. What hormone would the instructor tell the students plays a part in milk production? Oxytocin Thyrotropin Prolactin Melanocyte
Prolactin Explanation: Factors that stimulate the release of hormones are growth hormone-releasing hormone (GHRH), thyrotropin-releasing hormone (TRH), gonadotropin-releasing hormone (GnRH), corticotropin-releasing hormone (CRH), and prolactin-releasing hormone (PRH). Factors that inhibit the release of hormones are somatostatin, (growth hormone inhibiting factor) and prolactin-inhibiting factor (PIF)
Growth hormones cause all of the following EXCEPT: Promotion of an increase in cell size and number. Suppression of triglyceride synthesis. Regulation of cell division and protein synthesis. Stimulation and growth of body tissues.
Suppression 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. These effects occur mainly via altered metabolism of carbohydrate, protein, and fat by direct and indirect effects. GH is often considered an insulin antagonist because it suppresses the abilities of insulin to stimulate uptake of glucose in peripheral tissues and enhance glucose synthesis in the liver
A nurse is caring for a patient undergoing thyroid hormone replacement therapy. What should the nurse inform this patient regarding administration of the drug? · Take the drug before bedtime. · Take the drug before breakfast. · Take the drug just before dinner. · Take the drug after lunch.
Take the drug before breakfast. Explanation: The nurse should inform the patient undergoing thyroid hormone replacement therapy to take the drug in the morning, preferably before breakfast. The nurse should not ask the patient to take the drug before bedtime, just before dinner, or after lunch as that is not generally recommended by the health care provider.
A teenage male client has not developed facial hair, a deeper voice, or other secondary sex characteristics. What hormone would the nurse expect would be checked for this client? Melatonin Progesterone Testosterone Estrogen
Testosterone Explanation: The testes are the major source of the hormone testosterone, which is involved with the development and maintenance of male secondary sex characteristics, such as facial hair and a deep voice
A female client is diagnosed with a pituitary hormone deficiency. She reports that her drug dosages are modified frequently. The nurse explains that the dosage of all pituitary hormones must be individualized. The nurse knows that what factor determines the dosage? The weight of the client The age of the client The responsiveness of affected tissues, which varies The responsiveness of affected tissues, which is static
The responsiveness of affected tissues, which varies Explanation: Dosage of all pituitary hormones must be individualized because the responsiveness of affected tissues varies
What is the duration of action of water-soluble, protein-derived hormones compared to that of lipid-soluble steroid and thyroid hormones? The water-soluble hormones have the same duration of action. The water-soluble hormones have a longer duration of action. The water-soluble hormones have a shorter duration of action. No comparison can be made regarding the duration of action.
The water-soluble hormones have a shorter duration of action. Explanation: The lipid-soluble steroid and thyroid hormones have a longer duration of action than water-soluble, protein-derived hormones, because the former are bound to plasma proteins.
The process in which hormone secretion is stimulated when hormones are needed and inhibited when they are not needed is known as: cyclic patterns. a positive feedback system. a negative feedback system. releasing and inhibitory factors
a negative feedback system. Explanation: A negative feedback system is one in which hormone secretion is stimulated when hormones are needed and inhibited when they are not needed. The hypothalamic-pituitary-thyroid axis also functions by a negative feedback mechanism.
Which diagnosis places a client at risk for developing diabetes insipidus (DI)? Parkinson's disease Type 1 diabetes mellitus Somatotropin deficiency syndrome (SDS) Traumatic head injury
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
Which hormone is released in the presence of low blood volume? growth hormone (GH) adrenocorticotropic hormone (ACTH) thyroid-stimulating hormone (TSH) antidiuretic hormone (ADH)
antidiuretic hormone (ADH) Explanation: Secretion of ADH (vasopressin) occurs when body fluids become concentrated (high amounts of electrolytes in proportion to the amount of water) and when blood volume is low. None of the other hormones are secreted in cases of low blood volume
Which hormone is released in the presence of low blood volume? • adrenocorticotropic hormone (ACTH) • thyroid-stimulating hormone (TSH) • antidiuretic hormone (ADH) • growth hormone (GH
antidiuretic hormone (ADH) Explanation: Secretion of ADH (vasopressin) occurs when body fluids become concentrated (high amounts of electrolytes in proportion to the amount of water) and when blood volume is low. None of the other hormones are secreted in cases of low blood volume.
The nurse is caring for a client 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. blood sugar level x-ray of the long-bones liver enzyme levels serum electrolytes computed tomography of the head
blood sugar level x-ray of the long-bones serum electrolytes Explanation: 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. Growth hormone would not be expected to impact liver function. There would be no obvious indication for a CT head, which is usually used to visualize the brain
After administering somatropin to an 11-year-old client with growth failure, what outcome would indicate that the drug should be stopped? early sexual development closure of the epiphyses in long bones gynecomastia thyroid over activity
closure of the epiphyses in long bones Explanation: 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
A client has been admitted to the intensive care unit with myxedema coma. What predisposing factor is considered when diagnosing myxedema coma? · congenital heart disease · core body temperature of 94°F (34°C) · central nervous system (CNS) stimulant abuse · serum sodium level of 112 mEq/L (112 mmol/L)
core body temperature of 94°F (34°C) Explanation: Hypothermia happens when core body temperature drops below 95°F (35°C). Predisposing factors for myxedema coma include exposure to cold, infection, trauma, respiratory disease, and administration of central nervous system depressants. Myxedema coma is severe, life-threatening hypothyroidism characterized by coma, hypothermia, cardiovascular collapse, hypoventilation, and severe metabolic disorders such as hyponatremia, hypoglycemia, and lactic acidosis.
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: demonstrate an increase in linear growth. not demonstrate the signs and symptoms of water intoxication. experience a normal progression of secondary sex characteristics. deny feelings of anxiety.
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
What is the most common cause of subclinical hyperthyroidism? · history of neck radiation · central nervous system depressant therapy · excess thyroid hormone therapy · untreated osteoporosis
excess thyroid hormone therapy Explanation: The most common cause of subclinical hyperthyroidism is excess thyroid hormone therapy. Clients should be monitored closely for hypothyroidism while taking antithyroid drugs, which usually develops within a year after receiving treatment for hyperthyroidism. Common causes of primary hypothyroidism include treatment of hyperthyroidism with radiation therapy or surgery. Predisposing factors for myxedema coma include administration of central nervous system depressants. Untreated osteoporosis is not relevant to subclinical hyperthyroidism
The community health nurse is preparing to administer a prescribed dose of levothyroxine to a client. What is the nurse's priority assessment? · level of consciousness · heart rate and rhythm · blood glucose · respiratory rate and rhythm
heart rate and rhythm Explanation: The effects of hypothyroidism and thyroid medications are varied, due to the broad effects of thyroid hormones. However, cardiac function is among the most frequent and serious. For this reason, cardiac assessment is a priority. Hypothyroidism may cause drowsiness or decreased LOC, but this poses a lower risk to safety than cardiac issues. Blood glucose is less commonly affected and respiratory function is only affected as a consequence of cardiac dysfunction, as in cases of heart failure.
With regard to the functioning of the thyroid gland, which is an essential element for the manufacturing of thyroxine and triiodothyronine? · iodine · potassium · hydrogen · sodium
iodine Explanation: Iodine is the essential element for the manufacturing of thyroxine and triiodothyronine. Sodium plays a key role in muscle contraction, nerve conduction, and water balance in the body. Hydrogen in the body is mostly found attached to oxygen to form water, and acts as a proton or positive ion in chemical reactions. Potassium is crucial to heart function and plays a key role in skeletal and smooth muscle contraction.
Based on the nurse's knowledge about thyroid hormone supplements, the nurse administers levothyroxine cautiously to a client who has recently had which condition or disorder? · seizure · hypoglycemic episode · cataract surgery · myocardial infarction
myocardial infarction Explanation: A nurse should be cautious not to administer levothyroxine to a client who has recently had a myocardial infarction. Drug interactions with oral antidiabetics and insulin with hormone supplements can cause hyperglycemia. Seizure and cataract surgery are not contraindicated with the use of levothyroxine.
The nurse should teach clients who are taking thyroid hormones to take the medication: · in divided doses in the morning and evening. · in the evening after dinner. · on an empty stomach. · at bedtime.
on an empty stomach. Explanation: Thyroid hormones are administered once per day, early in the morning and preferably before breakfast. An empty stomach increases the absorption of the drug.
A hospital client's current medication administration record specifies oral administration of propylthiouracil (PTU) every 8 hours. What sign or symptom may have originally prompted the care provider to prescribe this drug? · tinnitus · persistent tachycardia · visual disturbances · orthostatic hypotension
persistent tachycardia Explanation: Propylthiouracil (PTU) is used for the treatment of hyperthyroidism; one of the characteristic symptoms of this disease is tachycardia. Tinnitus, visual disturbances, and hypotension are not associated with hyperthyroidism.
The anterior pituitary gland produces seven hormones. Which act directly on their target tissues? Select all that apply. prolactin follicle-stimulating hormone (FSH) growth hormone (GH) thyroid-stimulating hormone (TSH) adrenocorticotropic hormone (ACTH)
prolactin growth hormone (GH) The anterior pituitary gland produces seven hormones. Two of these, GH and prolactin, act directly on their target tissues; the other five act indirectly by stimulating target tissues to produce other hormones
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. partial thromboplastin time (PTT) sodium (Na) leukocytes (WBC) potassium (K) hemoglobin (Hgb)
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.
Which needs to be used in a child prior to the closure of the bone epiphyses in order to exert its effects? luteinizing hormone somatropin folic stimulating hormone prolactin
somatropin Explanation: Somatropin needs to be used in a child prior to the closure of the bone epiphyses in order to exert its effects. Follicle-stimulating hormone is used to stimulate follicles to release more eggs to be used in fertilization protocols in vitro. Luteinizing hormones are used in boys to treat prepubertal cryptorchidism (failure of the testes to descend into the scrotum) and in men to treat selected cases of hypogonadotropic hypogonadism. Prolactin stimulates the production of breast milk in the postpartum client
The control mechanisms for most metabolic functions of the body, as well as the maintenance of homeostasis, is the function of: • hypothalamic hormones. • the hypothalamus and the pituitary gland. • the anterior pituitary gland. • the posterior pituitary gland.
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.
A child weighing 14.5 kg has von Willebrand's disease. The patient requires an intravenous injection of 0.3 g/kg of desmopressin (DDAVP) in 10 mL of sterile saline. How much DDAVP should be administered? • 4.4 g • 10.3 g • 21.1 g • 9.6 g
• 4.4 g Explanation: 14.5 kg X 0.3 g = 4.4 g. Therefore Options B, C, and D are incorrect.
A clinic nurse is following a 9-year-old boy who is taking somatropin. What will the nurse monitor periodically? • Antidiuretic hormone (ADH) levels • Water retention • Height • Dehydration
• 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 most likely goal for oxytocin therapy? • Slow the progression of labor. • Induce uterine contractions. • Stop preterm labor. • Promote lactation.
• Induce uterine contractions. Explanation: Oxytocin is a synthetic drug that exerts the same physiologic effects as the posterior pituitary hormone. Thus, it promotes uterine contractility and is used clinically to induce labor and in the postpartum period to control bleeding.
An instructor is preparing a teaching plan for a class on the various pituitary hormones. Which hormone would the instructor include as being released by the posterior pituitary gland? • Adrenocorticotropic hormone • Oxytocin • Prolactin • Somatotropin
• Oxytocin Explanation: The posterior pituitary gland releases oxytocin and antidiuretic hormone. Somatotropin, prolactin, and adrenocorticotropic hormone are released by the anterior pituitary gland.
An instructor is preparing a teaching plan for a class on the various pituitary hormones. Which hormone would the instructor include as being released by the posterior pituitary gland? • Prolactin • Adrenocorticotropic hormone • Somatotropin • Oxytocin
• Oxytocin Explanation: The posterior pituitary gland releases oxytocin and antidiuretic hormone. Somatotropin, prolactin, and adrenocorticotropic hormone are released by the anterior pituitary gland.
What does release of antidiuretic hormone (ADH) cause? • Decreased arterial blood pressure • Elevation of osmotic pressure • Reabsorption of water • Concentration of extracellular fluids
• 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.
The nurse is assessing a child who is receiving growth hormone therapy. What would the nurse identify as suggesting glucose intolerance? • Thirst • Fatigue • Cold intolerance • Injection site pain
• 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 hormone is released in the presence of low blood volume? • adrenocorticotropic hormone (ACTH) • thyroid-stimulating hormone (TSH) • antidiuretic hormone (ADH) • growth hormone (GH)
• antidiuretic hormone (ADH) Explanation: Secretion of ADH (vasopressin) occurs when body fluids become concentrated (high amounts of electrolytes in proportion to the amount of water) and when blood volume is low. None of the other hormones are secreted in cases of low blood volume.
The anterior pituitary gland produces seven hormones. Which act directly on their target tissues? Select all that apply. • prolactin • follicle-stimulating hormone (FSH) • thyroid-stimulating hormone (TSH) • adrenocorticotropic hormone (ACTH) • growth hormone (GH)
• growth hormone (GH) Explanation: The anterior pituitary gland produces seven hormones. Two of these, GH and prolactin, act directly on their target tissues; the other five act indirectly by stimulating target tissues to produce other hormones.
What hormones does the pancreas produce and release that help moderate the body's varying blood glucose levels? Select all that apply. • antidiuretic hormone (ADH) • insulin • amylase • somatostatin • glucagon
• insulin • glucagon • somatostatin Explanation: The pancreas produces and releases insulin, glucagon, and somatostatin from different cells in response to varying blood glucose levels. ADH does not respond to blood glucose levels but controls sodium and potassium levels. Amylase is an enzyme released by the pancreas.