Pharmacology: Chapter 35: Hypothalamic and Pituitary Agents
How should the nurse best explain the role of the posterior pituitary gland? a."It synthesizes different hormones." b."It makes two different hormones." c."It stores hormones that are produced in your brain." d."It controls many of the metabolic functions of the body."
"It stores hormones that are produced in your brain." 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.
The nurse receives an order to administer leuprolide 5 mcg/kg subcutaneously to a child with precocious puberty. The child weighs 66 lbs. What is the correct dosage for this child? Provide your answer using numbers only - no units.
150 Feedback: To begin, convert the child's weight to kilograms by dividing by 2.2: 66 ÷ 2.2 = 30. Multiply the child's weight in kilograms times the mg/kg: 30 × 5 = 150 mcg/dose.
A child weighing 14.5 kg has von Willebrand's disease and has been prescribed desmopressin 0.3 mcg/kg IV. How much desmopressin should the nurse administer? a.4.4 mcg b.9.6 mcg c.10.3 mcg d.21.1 mcg
4.4 mcg 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.
The nurse administers desmopressin to treat a client with diabetes insipidus. What change in the client's 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.
The nurse is caring for a 25-year-old female client who is receiving chorionic gonadotropin alpha. What would be the most appropriate nursing diagnosis for this client? a.Risk for imbalanced fluid volume related to diuresis b.Acute pain related to administration of injections c.Imbalanced nutrition: more than body requirements related to increased appetite d.Risk for disproportionate growth related to adverse effects
Acute pain related to administration of injections 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.
The nurse is caring for a client receiving octreotide for the treatment of acromegaly. The nurse should emphasize the need for what form of baseline and periodic testing? 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.
The nurse is caring for a client with infertility related to hyperprolactinemia. What drug would best 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, Turners 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.
The nurse administers desmopressin to the client 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.
When providing health education to a client taking octreotide, the nurse should warn the client about the possibility of what potential adverse effect? a.Abdominal pain b.Alteration in consciousness c.Changes in vision d.Tinnitus
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.
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 and adherence to treatment d.Bowel function
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.
What is the main purpose of the 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.
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.
The nurse would administer desmopressin cautiously, with close monitoring, to the client with what comorbidities? 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.
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.
The parent of a child awaiting a renal transplant asks the nurse whether growth hormone could be effective for the 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 very painful for a child with existing medical problems." d."You do not want to use growth hormone if you do not have to, because there are serious adverse effects that go along with it?"
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.
A client is brought to the emergency department after a motor vehicle accident. The client 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.
After administering somatropin to an 11-year-old client 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.
A client is taking leuprolide to treat prostatic cancer. The nurse caring for this client should monitor most closely 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.
he nurse is asked to explain how to administer somatropin to the parent 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.
The nurse is working with a child who has impaired growth due to a deficiency of endogenous growth hormone. What change in the client's health status would contraindicate the safe and effective use of somatropin? a.The client has begun playing organized sports b.The client is developing increased amounts of abdominal fat c.The client has reached 5 feet in height d.The client's epiphyses have begun to close
Ans: D Feedback: Somatropin is contraindicated in the presence of closed epiphyses; it can be given at any time before closure of the epiphyses. Height does not impact when the drug can be given, so long as the epiphyses remain open. Similarly, participation in sports and increased adipose tissue do not mean that somatropin cannot be given safely.
The nurse is caring for a client who receives monthly injections of goserelin. What assessment should the nurse perform when monitoring the client for therapeutic effects? a.Assess the character and severity of the client's cancer pain b.Assess the client's height and plot it against age-based percentiles c.Monitor the client's quantity and distribution of body fat d.Monitor the client's level of consciousness and orientation
Assess the character and severity of the client's cancer pain
A 9-year-old female client has been prescribed nafarelin 1,600 mcg nasal spray daily. What assessment should the nurse prioritize when following up this client's treatment? a.Assessing for signs and symptoms of excess fluid volume b.Assessing the client's cognition and orientation c.Assessing the client's height and body mass index d.Assessing for the development of secondary sex characteristics
Assessing for the development of secondary sex characteristics
The nurse is caring for a client with neurogenic diabetes insipidus and administers what drug to treat the condition? a.Dexamethasone b.Desmopressin c.Methylprednisolone d.Physostigmine
Desmopressin (DDAVP, Stimate) 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.
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
Dwarfism 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.
What medication would the nurse expect the provider to prescribe as palliative treatment for advanced prostate cancer? a.Histrelin b.Ganirelix c.Nafarelin d.Somatropin
Histrelin (Vantas) 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.
A 48-year-old client with acromegaly is not a candidate for other therapy. What medication, administered subcutaneously, would the nurse caring for the client expect the physician to order? a.Gonadorelin hydrochloride b.Octreotide c.Nafarelin d.Gonadorelin acetate
Octreotide (Sandostatin) 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.
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 should the nurse most likely add to the plan of care? a.Disturbed body image related to change in height b.Deficient knowledge regarding drug therapy c.Risk for imbalanced nutrition: less than body requirements related to metabolic changes d.Decreased cardiac output related to increased metabolic needs
Risk for imbalanced nutrition: less than body requirements related to metabolic changes 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.
The nurse is caring for a client receiving tolvaptan and digoxin. When assessing for drug-drug interactions, the nurse should prioritize what laboratory result? a.Creatinine level b.Digoxin level c.Serum potassium level d.Hematocrit
Serum potassium level 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.
When providing client 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.Upper respiratory infection lasting more than 6 days c.Nosebleeds d.Dry skin accompanied by pruritus
Severe hip or knee pain 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.
What drug would the nurse expect to administer to a client with acquired immunodeficiency syndrome who has developed cachexia? a.Bromocriptine b.Somatropin c.Desmopressin d.Leuprolide
Somatropin (Saizen) 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.
The nurse has administered a subcutaneous injection of 250 mcg chorionic gonadotropin alpha. What outcome best indicates therapeutic effects? a.The client's urine output decreases and becomes more concentrated b.The client become pregnant c.The client's height increases d.The client's sexual development ceases
The client become pregnant
A nurse has administered 250 mcg ganirelix acetate subcutaneously to a client. What result indicates successful treatment? a.The client's cancer pain is relieved b.The client becomes pregnant c.The client's breast cancer goes into remission d.The client experiences relief from perimenopausal symptoms
The client becomes pregnant
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. a.Blood sugar level b.Serum electrolytes c.X-ray of the long bones d.Liver enzyme levels e.Computed tomography of the head
a.Blood sugar level b.Serum electrolytes c.X-ray of the long bones 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.
The nurse is caring for a trauma client who presents with total body edema and scant urine output. The nurse should recognize the effects of what endocrine disruption? a.Excessive secretion of antidiuretic hormone b.Insufficient secretion of antidiuretic hormone c.Excessive secretion of androgens d.Acute growth hormone deficiency
excessive secretion of antidiuretic hormone Explanation: This client's presentation is suggestive of syndrome of inappropriate antidiuretic hormone. SIADH occurs with excessive secretion of ADH. Insufficient secretion of ADH causes diabetes insipidus, which is the opposite problem. ADH is not related to androgenic actions or a decrease in growth hormone levels.
A client with diabetes insipidus has been administered desmopressin and is now reporting drowsiness, light-headedness, and headache. What intervention will best address this client's symptoms? a.Temporary bed rest b.STAT administration of epinephrine c.Administration of a loop diuretic d.Reduction in the client's dose of desmopressin
reduction in the client's dose of desmopressin Explanation: 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. These symptoms warrant a reduction in dose. The use of diuretics would not resolve the client's symptoms. Epinephrine would resolve anaphylaxis, not water intoxication. Best rest would have no therapeutic effect beyond ensuring physical safety.