Which patient should the nurse expect to be most likely to be treated with somatropin?
- A. A 7-year-old diagnosed with growth hormone deficiency
- B. A 10-year-old of short stature who has severe asthma
- C. An 8-year-old with Prader-Willi syndrome Incorrect
- D. A 17-year-old who is 5 feet tall
- A. A 7-year-old diagnosed with growth hormone deficiency
- For this medication to be used, the patient has to be diagnosed with a growth hormone deficiency, and the epiphyses must not be fused, so the child needs to be young. Severe respiratory conditions, Prader-Willi syndrome, and age of 17 years are contraindications to this medication.
What assessment finding indicates to the nurse that vasopressin has been effective?
- A. Increased serum albumin levels
- B. Increased urine specific gravity
- C. Decreased adrenocorticotropic hormone levels
- D. Relief of pain
- B. Increased urine specific gravity
- Vasopressin causes decreased water excretion in the renal tubule, thus increasing urine specific gravity. It is used to treat diabetes insipidus, which presents with a low urine specific gravity. This medication does not affect serum albumin, decrease adrenocorticotropic hormone levels, or decrease pain.
The nurse admitting a patient with acromegaly anticipates administering which medication?
- A. Desmopressin
- B. Corticotropin
- C. Somatropin
- D. Octreotide
- D. Octreotide
Octreotide suppresses growth hormone that causes acromegaly
Which patient statement demonstrates understanding of the nurse’s teaching for levothyroxine?
- A. “I will take this medication first thing in the morning.”
- B. “I will double my dose if I gain more than 1 pound/day.”
- C. “It is best to take the medication with food to prevent gastrointestinal upset.”
- D. “I can expect to see relief of my symptoms within 1 week.”
- A. “I will take this medication first thing in the morning.”
- Levothyroxine increases basal metabolism and thus wakefulness. It should be taken first thing in the morning. The patient should not increase the dose. The medication is absorbed best on an empty stomach. Depending on the symptoms, some symptoms may take weeks to improve.
What nursing diagnosis is a priority for a patient receiving desmopressin (DDAVP)?
- A. Risk for injury
- B. Alteration in comfort
- C. Fluid volume excess
- D. Knowledge deficit
- C. Fluid volume excess
Desmopressin (DDAVP) is a form of antidiuretic hormone, which increases sodium and water retention, leading to an alteration in fluid volume. Although the other nursing diagnoses may be appropriate, they are not a priority using Maslow hierarchy of needs.
The nurse is caring for a patient who has just started taking levothyroxine. What assessment finding is a priority for the nurse to address?
- A. Heart rate 55 beats/min
- B. Intolerance to cold
- C. Weight gain of 3 pounds in the last week
- D. Irritability
- D. Irritability Correct
- Irritability is a symptom of hyperthyroidism. This could be a sign that the medication dose is too high. A lowered heart rate, weight gain, and intolerance to cold could be symptoms of hypothyroidism and are expected in this patient, who just began medication therapy.
The nurse is caring for a patient who is taking levothyroxine and warfarin. Which intervention is a priority for the nurse?
- A. Monitor the patient for cardiac dysrhythmias.
- B. Monitor the patient for increased risk of bleeding.
- C. Weigh patient daily for excessive weight loss.
- D. Assess peripheral pulses and Homans sign daily.
- B. Monitor the patient for increased risk of bleeding.
- Levothyroxine can compete with protein-binding sites of warfarin (Coumadin), allowing more warfarin to be unbound or free, thus increasing the effects of warfarin and the risk of bleeding. This combination does not place the patient at an increased risk of dysrhythmias, weight loss, or deep vein thrombosis.
A patient receiving propylthiouracil (PTU) asks the nurse how this medication will help relieve symptoms. Which statement is the nurse’s bestresponse?
- A. “PTU inactivates any circulating thyroid hormone, thus decreasing signs and symptoms of hyperthyroidism.”
- B. “This medication inhibits the formation of new thyroid hormone, thus gradually returning your metabolism to normal.”
- C. “PTU helps the thyroid gland use iodine and synthesize hormones better.”
- D. “This medication stimulates the pituitary gland to secrete thyroid-stimulating hormone, which inhibits the production of hormones by the thyroid gland.”
- B. “This medication inhibits the formation of new thyroid hormone, thus gradually returning your metabolism to normal.”
- Propylthiouracil (PTU) is an antithyroid medication used to treat hyperthyroidism. It works by inhibiting the synthesis of new thyroid hormone. It does not inactivate hormone already present.
The patient is taking an antithyroid medication. Which foods should the nurse teach the patient to avoid eating?
- Chicken salad sandwich with mayonnaise, vegetable soup, milk
- Ham and cheese omelet, rye toast with butter, orange juice
- Hamburger on sesame roll, salad with French dressing, milk Incorrect
- Shrimp cocktail, boiled lobster, spinach salad without dressing, water Correct
- Shrimp cocktail, boiled lobster, spinach salad without dressing, water
- Seafood contains high amounts of iodine. The other choices do not. The nurse instructs a patient taking an antithyroid medication to avoid foods high in iodine.
What should the nurse include in the plan of care for the patient beginning prednisone therapy?
- Administer the medication early evening to coincide with the natural secretion pattern of the adrenal cortex.
- Plan to keep a strict, unchanging schedule to prevent adverse reactions.
- Take the medication with food to diminish the risk of gastric irritation.
- Take the medication only every other day to decrease the risk of adrenal hyperplasia.
- Take the medication with food to diminish the risk of gastric irritation.
- Glucocorticoids can cause gastric distress and should be administered with food. The normal circadian secretion of the adrenal cortex is early morning to wake the person up, not early evening. These medications should be tapered off slowly to prevent adrenal crisis. The patient takes the medication daily.
A patient asks the nurse to explain the action of glucocorticoids. Which statement is the nurse’s best response?
- “Glucocorticoids influence carbohydrate, lipid, and protein metabolism.”
- “Glucocorticoids are produced in decreased amounts during times of stress.”
- “Glucocorticoids decrease serum sodium and glucose levels.”
- “Glucocorticoids stimulate defense mechanisms to produce immunity.”
- “Glucocorticoids influence carbohydrate, lipid, and protein metabolism.”
- Glucocorticoids play a major role in carbohydrate, lipid, and protein metabolism within the body. They are produced in increasing amounts during stress. They increase sodium and glucose levels and suppress the immune system.
The nurse is caring for several patients who will be receiving glucocorticoid therapy. Which patient should be assessed first based on clinical diagnosis?
- Uncontrolled diabetes mellitus
- Chronic rheumatoid arthritis
- Recovering from septic shock
- Exacerbation of asthma controlled using oxygen therapy.
- Uncontrolled diabetes mellitus Correct
- A common side effect of steroid therapy is hyperglycemia. The patient with uncontrolled diabetes mellitus could suffer a severe hyperglycemic episode. The other clinical diagnoses presented do not required immediate action.
When assessing for potential side effects of fludrocortisone, what is a priority for the nurse to monitor?
- Serum sodium levels for potential hyponatremia
- Serum calcium levels for hypercalcemia
- Serum potassium levels for hypokalemia
- Intake and output for potential fluid volume deficit
- Serum potassium levels for hypokalemia
- Fludrocortisone has mineralocorticoid properties, resulting in sodium and fluid retention along with potassium excretion.
A nurse is providing discharge teaching for a patient receiving glucocorticoids. Which medication should the nurse expect to be included for pain management?
- Aspirin
- Acetaminophen
- Ibuprofen
- Naproxen sodium
- Acetaminophen
- Acetaminophen does not cause gastric distress as do aspirin, ibuprofen, naproxen sodium, and glucocorticoids.
The patient is receiving corticotropin for ACTH deficiency. Which statement by the patient indicates a need for additional teaching?
- “I can administer the drug subcutaneously.”
- “When my symptoms are resolved, I can discontinue the drug.”
- “I need to eat foods high in potassium.”
- “The drug may suppress symptoms of infection.”
- “When my symptoms are resolved, I can discontinue the drug.”
- The patient should not discontinue the drug abruptly; the dose of the drug must be tapered over several days. Hypokalemia is possible, so eating foods high in potassium is correct. The drug can be administered subcutaneously.
After administering corticotropin, what assessments are priorities for the nurse? (Select all that apply.)
- Acid and alkaline phosphatase levels
- C-reactive protein levels
- Changes in vision
- Glucose levels
- Intake and output
- Serum sodium levels
Changes in vision, Glucose levels, Intake and output, Serum sodium levels
Corticotropin can cause cataracts and glaucoma, so the nurse needs to monitor for changes in vision. Corticotropin stimulates the release of adrenal hormones, which can lead to sodium and fluid retention as well as hyperglycemia. Corticotropin can cause sodium and fluid retention, so that intake and output should be monitored. Serum sodium levels should be monitored, as sodium retention can be a result of corticotropin administration. C-reactive protein, acid and alkaline phosphatase levels are not indicated for monitoring.
The parents of an 11-year-old boy ask about growth hormone therapy
for their child who is shorter than his 10-year-old sister. The nurse
will tell the parents that growth hormone
a. does not affect
other hormones when given.
b. is available as an oral tablet to
be taken once daily.
c. is given after tests prove that it is
necessary.
d. may be given until the child's desired height is reached.
c. is given after tests prove that it is necessary.
The nurse is caring for a patient who is receiving growth hormone.
Which assessment will the nurse monitor daily?
a. Complete blood
count
b. Height and weight
c. Renal function
d. Serum glucose
d. Serum glucose
The parents of a 16-year-old boy who plays football want their child
to receive growth hormone to improve muscle strength. What will the
nurse tell the parents?
a. "Growth hormone may be used to
improve strength in young athletes."
b. "If the
epiphyses are not fused, growth hormone may be an
option."
c. "Small doses of growth hormone may be used
indefinitely for this purpose."
d. "Using growth
hormone to build muscle mass is not recommended."
d. "Using growth hormone to build muscle mass is not recommended."
Which would be a contraindication for hormone therapy with somatropin
(Genotropin) in a school-age child?
a. Asthma
b.
Dwarfism
c. Enuresis
d. Prader-Willi syndrome
d. Prader-Willi syndrome
A child exhibits acromegaly caused by a tumor that cannot be
destroyed with radiation. Which medication will most likely be used to
treat this child?
a. Bromocriptine mesylate (Parlodel)
b.
Octreotide acetate (Sandostatin)
c. Somatrem (Protropin)
d.
Somatropin (Genotropin)
a. Bromocriptine mesylate (Parlodel)
The nurse is caring for a patient who has hypothyroidism. To assist
in differentiating between primary and secondary hypothyroidism, the
nurse will expect the provider to order which drug?
a.
Liothyronine sodium (Cytomel)
b. Liotrix (Thyrolar)
c.
Methimazole (Tapazole)
d. Thyrotropin (Thytropar)
d. Thyrotropin (Thytropar)
The nurse administers intravenous corticotropin (Acthar) to a
patient. A serum cortisol level drawn 60 minutes later shows no change
in serum cortisol levels from prior to the dose. What is the nurse's
first action?
a. Notify the provider to discuss a possible
non-functioning adrenal gland.
b. Recognize the need for an
increased dose to treat pituitary insufficiency.
c. Request an
order for a second dose of corticotropin to treat cortisone
deficiency.
d. Request an order to repeat the serum cortisol
level in 1 to 2 hours
a. Notify the provider to discuss a possible non-functioning adrenal gland.
The nurse provides teaching for a patient receiving corticotropin.
The nurse will instruct the patient to contact the provider if which
condition occurs?
a. Bruising
b. Constipation
c.
Myalgia
d. Nausea
a. Bruising
The nurse is caring for a patient who has experienced head trauma in
a motor vehicle accident. The patient is having excessive output of
dilute urine. The nurse will notify the provider and will anticipate
administering which medication?
a. Calcifediol (Calderol)
b.
Corticotropin (Acthar)
c. Prednisolone (AK-Pred)
d.
Vasopressin (Pitressin)
d. Vasopressin (Pitressin)
The nurse is preparing to administer piperacillin to a patient to
treat an infection caused by pseudomonas. The nurse learns that the
patient receives corticotropin to treat multiple sclerosis. The nurse
will request an order for
a. a different antibiotic.
b.
blood glucose monitoring.
c. cardiac monitoring.
d. serum electrolytes.
d. serum electrolytes.
The nurse is caring for a patient who is receiving desmopressin
acetate (DDAVP). Which assessments are important while caring for this
patient?
a. Blood pressure and serum potassium
b. Heart rate
and serum calcium
c. Lung sounds and serum magnesium
d.
Urine output and serum sodium
d. Urine output and serum sodium
A 35-year-old woman reports lethargy, difficulty remembering things,
facial edema, dry skin, and cessation of menses. The nurse notes a
heart rate of 60 beats per minute and a weight increase of 5 pounds
from a previous visit. The nurse will notify the provider of which
possible condition?
a. Cretinism
b. Early menopause
c.
Hyperthyroidism
d. Myxedema
d. Myxedema
A patient is admitted to the hospital to treat hypothyroidism. For
rapid improvement in symptoms, the nurse will expect to administer
which medication?
a. Levothyroxine sodium (Synthroid)
b.
Liothyronine (Cytomel)
c. Liotrix (Thyrolar)
d. Thyroid
desiccated (Armour Thyroid)
b. Liothyronine (Cytomel)
A patient who takes warfarin (Coumadin) and digoxin (Lanoxin)
develops hypothyroidism and will begin taking levothyroxine
(Synthroid). The nurse anticipates which potential adjustments in
dosing for this patient?
a. Decreased digoxin and decreased
warfarin
b. Decreased digoxin and increased warfarin
c.
Increased digoxin and decreased warfarin
d. Increased digoxin and
increased warfarin
c. Increased digoxin and decreased warfarin
A patient who takes the oral antidiabetic agent metformin
(Glucophage) will begin taking levothyroxine (Synthroid). The nurse
will teach this patient to monitor for
a. hyperglycemia.
b.
hypoglycemia.
c. hyperkalemia.
d. hypokalemia.
a. hyperglycemia.
A patient who has hyperthyroidism will begin treatment with an
antithyroid medication. The patient asks the nurse about dietary
requirements. The nurse will counsel the patient to avoid which
food(s)?
a. Fava beans
b. Foods high in purine
c.
Grapefruit
d. Shellfish
d. Shellfish
The nurse is caring for a patient who is being treated for
hypothyroidism. The patient reports insomnia, nervousness, and
flushing of the skin. Before notifying the provider, the nurse will
perform which action?
a. Assess serum glucose to evaluate
possible hypoglycemia.
b. Check the patient's heart rate to
assess for tachycardia.
c. Perform an assessment of hydration
status.
d. Take the patient's temperature to evaluate for infection.
b. Check the patient's heart rate to assess for tachycardia.
A patient with Graves disease exhibits tachycardia, heat intolerance,
and exophthalmos. Prior to surgery, which drug is used to alter
thyroid hormone levels?
a. Liotrix (Thyrolar)
b. Propranolol
(Inderal)
c. Propylthiouracil (PTU)
d. Thyroid (Thyrotab)
c. Propylthiouracil (PTU)
A patient has hypocalcemia caused by parathyroid hormone deficiency.
Which medication will the nurse anticipate giving to this
patient?
a. Calcitonin
b. Calcitriol
c. Calcium
d.
Vitamin D
b. Calcitriol
A patient is receiving a glucocorticoid medication to treat an
inflammatory condition, and the provider has ordered a slow taper in
order to discontinue this medication. The nurse explains to the
patient that this is done to prevent which condition?
a.
Acromegaly
b. Adrenocortical insufficiency
c. Hypertensive
crisis
d. Thyroid storm
b. Adrenocortical insufficiency
A patient is taking prednisolone and fludrocortisone (Florinef). When
teaching this patient about dietary intake, the nurse will instruct
the patient to consume a diet
a. high in carbohydrates.
b.
high in fat.
c. high in protein.
d. low in potassium.
c. high in protein.
A patient who takes high-dose aspirin to treat arthritis will need to
take prednisone to treat an acute flare of symptoms. What action will
the nurse perform?
a. Observe the patient for
hypoglycemia.
b. Monitor closely for increased urine
output.
c. Observe the patient for hypotension.
d. Request
an order for enteric-coated aspirin.
d. Request an order for enteric-coated aspirin.