NURSING 6005 CHAPTER 59: DRUGS RELATED TO HYPOTHALAMIC AND PITUITARY FUNCTION

NURSING 6005 CHAPTER 59: DRUGS RELATED TO HYPOTHALAMIC AND PITUITARY FUNCTION Test Bank MULTIPLE CHOICE 1. 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? a. Behavior problems b. Low muscle tone c. Mental impairment d. Sleep apnea ANS: D 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. DIF: Cognitive Level: Application REF: Growth Hormone | Therapeutic Uses | Pediatric Short Stature Associated with Prader-Willi Syndrome TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 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? a. “Intramuscular dosing is more effective than subcutaneous dosing.” b. “I will have increased muscle mass and strength as well as increased height.” c. “I will need to monitor my blood pressure frequently while taking this drug.” d. “I will need to take insulin while using this, because it causes hyperglycemia.” ANS: C 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 pre-existing diabetes. DIF: Cognitive Level: Application REF: Growth Hormone | Therapeutic Uses | Adult-Onset Growth Hormone Deficiency | Adverse Effects and Interactions | Hyperglycemia | Administration TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 3. 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: a. antibiotics. b. reducing the dose of mecasermin. c. discontinuing the mecasermin. d. tonsillectomy. ANS: D 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. DIF: Cognitive Level: Application REF: Mecasermin (Insulin-Like Growth Factor-1) TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 4. 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? a. Administer the drug as ordered. b. Discard the drug and prepare another dose. c. Notify the prescriber. d. Shake the drug to dissipate the particles. ANS: B 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. DIF: Cognitive Level: Application REF: Summary of Major Nursing Implications | Somatropin (Human Growth Hormone) | Administration TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 5. 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? a. Diabetes insipidus b. Diabetes mellitus c. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) d. Water intoxication ANS: A 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. DIF: Cognitive Level: Application REF: Antidiuretic Hormone (Vasopressin) | Pathophysiology: Hypothalamic Diabetes Insipidus TOP: Nursing Process: Diagnosis MSC: NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation