43 Pituitary and Adrenocortical Hormones

24. The client develops acne. What should the nurse instruct the client with acne? A) Use water-based cosmetics or creams. B) Do not receive live virus vaccines. C) Avoid the use of alcohol while taking the drug. D) Avoid exposure to infections. drug.

Ans: A Feedback: The nurse should instruct the client with acne to keep the affected areas clean and use over-the-counter acne drugs and water-based cosmetics or creams. The nurse need not instruct the client to stop receiving live virus vaccines, avoid using alcohol, or avoid exposure to infections. When the client is undergoing long-term or high-dose glucocorticoid therapy, the nurse should inform the client to avoid receiving live virus vaccines and avoid exposure to infections if possible in the teaching plan for the client and family. If the client is undergoing vasopressin therapy, the nurse needs to instruct the client to avoid the use of alcohol while taking the

18. A nurse is caring for a client with nocturnal enuresis. A physician has prescribed desmopressin acetate to the client. The nurse would assess the client for which of the following as a possible adverse reaction? A) Nasal congestion B) Breast tenderness C) Fluid retention D) Gynecomastia

Ans: A Feedback: The nurse should monitor for nasal congestion, abdominal cramps, headache, and nausea in the client as the adverse reactions to desmopressin acetate. When the client is administered gonadotropin, the nurse needs to monitor for fluid retention and gynecomastia as the adverse reactions to the drug. When choriogonadotropin alfa is administered to the client, the nurse should monitor for breast tenderness, ovarian overstimulation, and vasomotor flushes as the adverse reactions to the drug.

23. A client is receiving corticosteroids at a health care facility. The client is also receiving digoxin as treatment for heart failure. The nurse understands that which of the following is a possibility due to the interaction of these two drugs? A) Increased risk for toxicity B) Decreased muscle function C) Increased risk of hyperkalemia D) Decreased serum corticosteroid levels

Ans: A Feedback: The nurse should observe for an increased risk for digoxin toxicity when corticosteroids are given with digoxin. Decreased muscle function, hyperkalemia, and decreased serum corticosteroid levels are not associated with the interaction.

26. A client has been prescribed glucocorticoids for the treatment of congenital adrenal hyperplasia. Which of the following assessments should the nurse perform for the client? A) Take and record vital signs every 4 to 8 hours. B) Test the serum electrolyte levels. C) Auscultate the abdomen and record the findings. D) Observe for signs of blanching of the skin.

Ans: A Feedback: When glucocorticoids are administered to the client, the nurse should take and record vital signs every 4 to 8 hours. The nurse need not perform assessments related to serum electrolyte levels, abdominal auscultation, or skin blanching. These are appropriate for a client receiving vasopressin therapy.

7. Which of the following should be included in the nurse's preadministration assessment of a client receiving desmopressin (DDAVP) for relief of abdominal distention? Select all that apply. A)Abdominal girth B)Weight C)Pulse D)Respiratory rate E)Blood glucose

Ans: A, C, D Feedback: Blood pressure, pulse, respiratory rate, and abdominal girth should be included in the nurse's preadministration assessment of a client receiving desmopressin (DDAVP) for relief of abdominal distention.

9. A nurse completing discharge counseling should advise a client taking vasopressin (Pressyn) to notify the physician if which of the following occur? Select all that apply. A) Changes in urine output B) Abdominal cramps C) Skin blanching D) Diarrhea E) Cough

Ans: A,B,C Feedback: A nurse completing discharge counseling should advise a client taking vasopressin (Pressyn) to notify the physician if any of the following occur: a significant increase or decrease in urine output, abdominal cramps, skin blanching, nausea, confusion, headache, drowsiness, or signs of inflammation or infection at the injection sites.

27. A nurse is assessing a client who is receiving desmopressin therapy and suspects that the client is experiencing water intoxication. Which of the following would support the nurse's suspicions? Select all that apply. A) Drowsiness B) Headache C) Confusion D) Abdominal pain E) Diarrhea

Ans: A,B,C Feedback: Symptoms of water intoxication include drowsiness, listlessness, confusion, and headache (which may precede convulsions and coma). Abdominal pain and diarrhea are not associated with water intoxication.

28. A client receiving gonadotropin therapy comes to the clinic for follow-up. Which of the following would the nurse immediately report to the primary health care provider? Select all that apply. A) Ascites B) Abdominal distention C) Abdominal pain D) Weight gain E) Irritability

Ans: A,B,C Feedback: The client is at risk for ovarian enlargement manifested by abdominal distention, pain, and ascites (with serious cases). The nurse would immediately notify the primary health care provider and the drug would be discontinued at the first sign of ovarian stimulation or enlargement. Weight gain and irritability would not need to be reported immediately.

12. Which of the following should be included in the nurse's preadministration assessment of a client about to receive somatropin (Nutropin)? Select all that apply. A) Height B) Weight C) Blood pressure D) Pulse E) Respiratory rate

Ans: A,B,C,D,E Feedback: Blood pressure, pulse, respiratory rate, temperature, height, and weight should be included in the nurse's preadministration assessment of a client about to receive somatropin (Nutropin).

1. A nursing instructor is preparing for a class discussion on pituitary gland hormones. Which of the following hormones would the instructor include as being secreted by the anterior pituitary gland? Select all that apply. A) Growth hormone B) Adrenocorticotropic hormone C) Vasopressin D) Prolactin E) Oxytocin

Ans: A,B,D Feedback: Prolactin, adrenocorticotropic hormone, growth hormone, luteinizing hormone, follicle- stimulating hormone, and thyroid-stimulating hormone are secreted by the anterior pituitary gland. Vasopressin and oxytocin are secreted by the posterior pituitary gland.

15. The nurse should educate a client receiving adrenocorticotropic hormone (ACTH) to report which of the following to the health care provider? Select all that apply. A) Malaise B) Sores that don't heal C) Otic irritation D) Fever E) Diarrhea

Ans: A,B,D Feedback: The nurse instructs a client receiving adrenocorticotropic hormone (ACTH) to report any of the following adverse reactions to the physician: sore throat, cough, fever, malaise, sores that don't heal, or redness or irritation of the eyes.

14. Which of the following should be included in the nurse's preadministration assessment of a client about to receive adrenocorticotropic hormone (ACTH)? Select all that apply. A) Lung auscultation B) Mental status assessment C) Height D) Pulse E) Skin integrity assessment

Ans: A,B,D,E Feedback: Blood pressure, pulse, respiratory rate, temperature, weight, skin integrity assessment, mental status assessment, and lung auscultation should be included in the nurse's preadministration assessment of a client about to receive ACTH.

8. A nurse is educating a client and his family about vasopressin (DDAVP) for the treatment of diabetes insipidus. In addition to administration instructions, which of the following should the nurse discuss with the client and family? Select all that apply. A) Wearing a medical alert bracelet B) Monitoring the daily intake of fluids C) Avoiding sun exposure while using the drug D) Carrying extra doses with the client at all times E) Carrying liquids with the client at all times

Ans: A,B,D,E Feedback: In addition to administration instructions, the nurse should include the following: wear a medical alert bracelet, monitor the daily intake and output of fluids, avoid the use of alcohol, and carry extra doses and liquids with the client at all times.

13. A client is receiving treatment with adrenocorticotropic hormone. The nurse would instruct the client to avoid receiving which vaccine? Select all that apply. A) Zostavax (shingles) B) Meruvax (rubella) C) Td (tetanus and diphtheria) D) Fluzone (influenza) E) Attenuvax (measles)

Ans: A,B,E Feedback: Clients taking ACTH should avoid any vaccination with live virus including Zostavax, Meruvax, and Attenuvax.

17. Which of the following adrenocortical hormone drugs influence or regulate functions such as the immune response; glucose, fat, and protein metabolism; and the anti- inflammatory response? Select all that apply. A) Betamethasone (Celestone) B) Fludrocortisone (Florinef) C) Budesonide (Entocort EC) D) Hydrocortisone (Cortef) E) Dexamethasone (Decadron)

Ans: A,C,D,E Feedback: Glucocorticoids, like betamethasone (Celestone), budesonide (Entocort EC), hydrocortisone (Cortef), and dexamethasone (Decadron), influence or regulate functions such as the immune response; glucose, fat, and protein metabolism; and the anti- inflammatory response.

5. A nurse is caring for a client receiving desmopressin (DDAVP). The nurse would assess the client for which of the following adverse reactions? Select all that apply. A) Tremor B) Hypotension C) Diaphoresis D) Dehydration E) Nausea

Ans: A,C,E Feedback: A nurse should monitor a client taking desmopressin (DDAVP) for the following adverse reactions: tremor, diaphoresis, vertigo, nasal congestion, nausea, vomiting, abdominal cramps, and water intoxication.

22. A client with diabetes insipidus has been prescribed vasopressin. The client's ambulatory status is limited. Which of the following would be most important for this client? A) Measuring the amount of fluid loss every 24 hours B) Refilling the water container at frequent intervals C) Giving four glasses of water immediately after the client takes the drug D) Examining the client's abdomen every 15 to 30 minutes

Ans: B Feedback: Clients with diabetes insipidus are continually thirsty, and in this case, the client also has limited ambulatory activities. Therefore, the nurse should be careful to refill the water container at frequent intervals to ensure the availability of enough drinking water at hand for the client. The nurse need not be careful to measure the amount of fluid loss every 24 hours, give four glasses of water immediately after the client takes the drug, or examine the client's abdomen every 15 to 30 minutes. The nurse instructs the client to measure the amount of urine excreted at each voiding and then total the amount for each 24-hour period. The nurse should instruct the client to drink one or two glasses of water immediately before taking the drug. The nurse need not auscultate the abdomen every 15 to 30 minutes in a client with diabetes insipidus. The nurse auscultates the abdomen every 15 to 30 minutes in a client with abdominal distention.

11. The nurse should discontinue therapy and notify the physician if which of the following adverse reactions occurs in a client taking gonadotropin (Menopur)? A) Abdominal pain B) Visual disturbances C) Auditory disturbances D) Ascites

Ans: B Feedback: If the patient complains of visual disturbances, the drug therapy is discontinued and the primary health care provider notified. An examination by an ophthalmologist is usually indicated. Abdominal pain and ascites are adverse reactions that may or may not require discontinuation of the drug. Auditory disturbances are not associated with this drug.

16. A nurse suspects that a client taking short-term high-dose methylprednisolone (Medrol) is developing Cushing's syndrome based on assessment of which of the following? Select all that apply. A) Weight loss B) Moon face C) Buffalo hump D) Dry skin E) Hypotension

Ans: B, C Feedback: A nurse should monitor a client taking short-term high-dose methylprednisolone (Medrol) for signs and symptoms of Cushing's syndrome, which include buffalo hump, moon face, oily skin, acne, osteoporosis, purple striae on the abdomen and hips, altered skin pigmentation, and weight gain.

3. Which of the following hormones are secreted by the adrenal gland? Select all that apply. A) Growth hormone B) Mineralocorticoids C) Glucocorticoids D) Prolactin E) Oxytocin

Ans: B, C Feedback: Glucocorticoids and mineralocorticoids are secreted by the adrenal gland. Growth hormone, prolactin, and oxytocin are secreted by the pituitary gland.

4. A nurse is preparing to teach a client about vasopressin. Which of the following would the nurse integrate into the teaching? Select all that apply. A) Vasopressin is secreted by the adrenal gland. B) Vasopressin is secreted when body fluids must be conserved. C) Vasopressin exhibits its greatest activity in the bladder. D) Vasopressin regulates the reabsorption of water from the kidney. E) Vasopressin is used to treat diabetes mellitus.

Ans: B, D Feedback: The following is true of the hormone vasopressin: it is secreted by the posterior pituitary gland, is secreted when body fluids must be conserved, exhibits its greatest activity on the renal tubular epithelium, regulates the reabsorption of water from the kidney, and is used to treat diabetes insipidus.

6. A nurse would administer vasopressin (Pressyn) cautiously to a client with which of the following? Select all that apply. A) Sleep apnea B) Migraine headaches C) Asthma D) Seizure disorders E) Angina

Ans: B,C,D,E Feedback: 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).

10. Which of the following drugs might a nurse administer to a female client with fertility problems to help increase her chances of becoming pregnant? Select all that apply. A) Vasopressin (Pressyn) B) Clomiphene (Clomid) C) Octreotide (Sandostatin) D) Cetrorelix (Cetrotide) E) Gonadotropin (Menopur)

Ans: B,D,E Feedback: A nurse might administer clomiphene (Clomid), cetrorelix (Cetrotide), or gonadotropin (Menopur) to a female client with fertility problems to help increase her chances of becoming pregnant.

19. A physician has prescribed vasopressin to the client for regulating the reabsorption of water by the kidneys. Which of the following assessments should the nurse perform after the administration of vasopressin? A) Observe for and report any evidence of edema, such as dyspnea. B) Measure and record the client's abdominal girth every hour. C) Observe the client for blanching of the skin, abdominal cramps, and nausea. D) Weigh the client every day to obtain a baseline weight.

Ans: C Feedback: After vasopressin is administered to the client, the nurse should observe the client every 10 to 15 minutes for signs of an excessive dosage, which include blanching of the skin, abdominal cramps, and nausea. After corticotropin is administered to the client, the nurse needs to observe for and report any evidence of edema, such as weight gain, rales, increased pulse or dyspnea, or swollen extremities. If the client is receiving vasopressin for abdominal distention, the nurse needs to auscultate the abdomen every 15 to 30 minutes and measure abdominal girth hourly. The nurse needs to weigh the client to obtain a baseline weight for future comparison before administering vasopressin to the client.

25. A physician has ordered a client to receive growth hormone subcutaneously. Which of the following tests would the nurse anticipate as required at different intervals during the treatment? A) Carbohydrate tolerance B) Serum electrolyte levels C) Glucose tolerance D) pH level of the blood

Ans: C Feedback: Periodic testing of growth hormone levels, glucose tolerance, and thyroid functioning are required during growth hormone treatment for the client. The pH level of blood and carbohydrate tolerance testing are not required. Testing serum electrolyte levels is needed when a client is undergoing vasopressin therapy.

20. A nurse is reviewing the medical history report of a client who is to receive gonadotropins. In which of the following conditions would the use of gonadotropins be contraindicated? A) Sensitivity to benzyl alcohol B) Epiphyseal closure C) Adrenal dysfunction D) Epilepsy

Ans: C Feedback: While reviewing the medical history of the client, the nurse should identify that gonadotropins are contraindicated in clients with adrenal dysfunction, high gonadotropin levels, thyroid dysfunction, liver disease, abnormal bleeding, ovarian cysts, sex-hormone-dependent tumors, or organic intracranial lesions (pituitary tumors). Gonadotropins should be used cautiously in clients with epilepsy. Somatropin growth hormones are contraindicated in clients with sensitivity to benzyl alcohol, epiphyseal closure, and underlying cranial lesions.

2. A group of nursing students demonstrate understanding of a class discussion on pituitary hormones when they identify which of the following hormones as secreted by the posterior pituitary gland? Select all that apply. A) Growth hormone B) Adrenocorticotropic hormone C) Vasopressin D) Prolactin E) Oxytocin

Ans: C, E Feedback: Vasopressin and oxytocin are secreted by the posterior pituitary gland. Growth hormone, adrenocorticotropic hormone, and prolactin are secreted by the posterior pituitary gland.

29. A client is receiving corticosteroid therapy. Which nursing diagnosis would the nurse be least likely to identify for this client? A) Risk for Infection B) Disturbed Body Image C) Risk for Injury D) Deficient Fluid Volume

Ans: D Feedback: A client who is receiving corticosteroid therapy would be least likely to have a nursing diagnosis of Deficient Fluid Volume. Rather, Excess Fluid Volume would be more appropriate. Risk for Infection related to immunosuppression, Disturbed Body Image related to cushingoid effects, and Risk for Injury related to muscle atrophy and osteoporosis would be appropriate.

30. After teaching a group of nursing students about corticosteroids, the instructor determines that the teaching was successful when the students identify which of the following as a mineralocorticoid? A) Hydrocortisone B) Betamethasone C) Triamcinolone D) Fludrocortisone

Ans: D Feedback: Fludrocortisone is a mineralocorticoid. Hydrocortisone, betamethasone, and triamcinolone are glucocorticoids.

21. A nurse is caring for a client who has been undergoing glucocorticoid therapy at a health care facility and is getting discharged. Which of the following instructions should the nurse include in the teaching plan for the client and family? A) Report any symptoms of sore throat or fever immediately. B) Notify the PHCP if glucose appears in the urine. C) Measure the amount of fluids taken each day. D) Take the oral drug with meals or snacks.

Ans: D Feedback: The nurse should instruct the client to take the oral drug with meals or snacks to decrease the gastrointestinal effects and upsets in the teaching plan for the client and family. Reporting any symptoms of sore throat or fever immediately and notifying the primary health care provider if glucose appears in the urine should be included in the teaching plan for a client undergoing adrenocorticotropic hormone (ACTH) therapy. The nurse should instruct the client to measure the amount of fluids taken each day in the teaching plan for the client receiving vasopressin.