Question 1

A patient with acromegaly asks the nurse about treatments for this condition. What will the nurse tell the patient?

Accepted Answer

Drugs for acromegaly are generally reserved for patients who do not respond to other therapies or for whom these therapies are not viable options. Drug therapy requires daily subQ injections and is expensive. Drug therapy is indefinite, not short term.

Question 2

A nurse is providing teaching for a nondiabetic adult who develops growth hormone deficiency and who will begin treatment with somatropin [Humatrope]. Which statement by the patient indicates understanding of the teaching?

Accepted Answer

Growth hormone in adults causes an increase in systolic blood pressure, so patients should be taught to monitor blood pressure while taking the drug. Subcutaneous dosing is as effective as IM dosing and is preferred, because it is less painful. Although muscle mass will increase, strength and height will not. Growth hormone is diabetogenic but causes significant problems in patients with preexisting diabetes.

Question 3

A child with Prader-Willi syndrome (PWS) has short stature, and the provider is considering treatment with growth hormone. Which aspect of this child's history should the nurse report to the provider?

Accepted Answer

Growth hormone must be avoided in patients with PWS who are severely obese, who have a history of upper airway obstruction or sleep apnea, or who have severe respiratory impairment because of a risk of sudden death associated with these disorders. Behavior problems, low muscle tone, and mental impairment are commonly associated with PWS and are not contraindications to treatment with growth hormone.

Question 4

Which are indications for discontinuing growth hormone (GH) therapy in children with documented growth hormone deficiency?

Accepted Answer

Treatment with GH for a child with a documented GH deficiency may continue until a satisfactory adult height has been achieved, if a child does not show a response to the hormone, or until epiphyseal closure begins. Treatment does not continue for life, and GH should not be administered during or after closure of the epiphyses. Treatment does not depend on growth hormone levels; these are measured to ensure therapeutic dosing.

Question 5

The nurse is caring for a patient receiving desmopressin [Stimate]. The nurse is performing a physical assessment and notes that the patient is drowsy and listless and complains of a recent onset of headache. Which finding would be most consistent with these symptoms?

Accepted Answer

Water intoxication is manifested by drowsiness, listlessness, and headache. The patient's signs and symptoms are not consistent with hypernatremia or hyperglycemia, and there is no indication of hypertension.

Question 6

A patient with antidiuretic hormone deficiency is receiving desmopressin (DDAVP). The nurse will teach this patient to:

Accepted Answer

Patients taking desmopressin should be taught to reduce fluid intake to avoid fluid overload, because this drug prevents continued fluid loss. Desmopressin metabolism is not affected by grapefruit juice. Increasing the sodium intake would only cause increased fluid retention. Desmopressin is a weak pressor agent and does not adversely affect hemodynamics, so monitoring blood pressure is not necessary.

Question 7

A 7-year-old child who is otherwise healthy is receiving mecasermin [Increlex] replacement therapy to treat severe primary deficiency of insulin-like growth factor-1 (IGF-1). The child develops tonsillar hypertrophy. The nurse anticipates that the provider will recommend:

Accepted Answer

Mecasermin can cause hypertrophy of the tonsils, which can be managed by tonsillectomy if needed. Antibiotics are not indicated, because the tonsil enlargement is not caused by infection. Neither reducing the dose of mecasermin nor discontinuing the drug is indicated.

Question 8

A nurse is preparing to administer a dose of growth hormone and reconstitutes the medication. After adding the diluent, the nurse notices that the preparation is cloudy. What will the nurse do?

Accepted Answer

The medication should not be injected if the preparation is cloudy or contains particulate matter. The drug should be discarded and another dose drawn up and administered. There is no need to notify the prescriber. The preparation should never be shaken.

Question 9

A male patient reports decreased libido and the nurse notes galactorrhea during a physical assessment. The nurse will report these findings to the provider and will anticipate an order for which medication?

Accepted Answer

The patient is showing signs of prolactin hypersecretion. Cabergoline is a dopamine agonist and is used to inhibit prolactin release. Conivaptan is used to treat hypernatremia. Dopamine is not given. Prolactin would make the condition worse.

Question 10

A patient is hospitalized with head trauma after a motor vehicle accident. The nurse caring for the patient notes a marked increase in the output of pale, dilute urine. The nurse suspects which condition?

Accepted Answer

Deficiency of antidiuretic hormone (ADH) produces hypothalamic diabetes insipidus, in which large volumes of dilute urine are produced. Head trauma can cause the hypothalamus to stop producing ADH. Diabetes mellitus is an endocrine disorder of the pancreas that causes the production of large volumes of nondilute urine. SIADH is a condition in which too much ADH is produced, causing oliguria. Water intoxication occurs with SIADH.

Question 11

A clinic patient who has cirrhosis of the liver develops hypervolemic hypernatremia. Which medication will the nurse expect the provider to order?

Accepted Answer

Tolvaptan is an oral vasopressin antagonist indicated for reducing hypernatremia in patients with euvolemic or hypervolemic hypernatremia. Conivaptan has the same indications, but it is administered IV for hospitalized patients. Desmopressin and vasopressin are antidiuretic hormone replacement medications that will make the condition worse.

Question 12

What are the effects of prolactin secretion in males?

Accepted Answer

Prolactin can cause decreased libido, delayed puberty, and galactorrhea in males, but it does not cause breast development or infertility.

Question 13

A nurse teaches a nursing student about the differences between desmopressin (DDAVP) and vasopressin [Pitressin]. Which statement by the student indicates a need for further teaching?

Accepted Answer

Desmopressin has a long duration of action, which is the reason it is preferred for the treatment of diabetes insipidus. It can be administered intranasally, so it is easier to administer than vasopressin. Vasopressin has hemodynamic effects that can be beneficial during cardiac resuscitation but that also can cause serious adverse cardiovascular effects.

Quiz 59: Drugs Related to Hypothalamic and Pituitary Function