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Chapter 46

front 1

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

back 1

  • 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.

front 2

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

back 2

  • 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.

front 3

The nurse admitting a patient with acromegaly anticipates administering which medication?

  • A. Desmopressin
  • B. Corticotropin
  • C. Somatropin
  • D. Octreotide

back 3

  • D. Octreotide

Octreotide suppresses growth hormone that causes acromegaly

front 4

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.”

back 4

  • 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.

front 5

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

back 5

  • 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.

front 6

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

back 6

  • 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.

front 7

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.

back 7

  • 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.

front 8

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.”

back 8

  • 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.

front 9

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

back 9

  • 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.

front 10

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.

back 10

  • 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.

front 11

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.”

back 11

  • “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.

front 12

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.

back 12

  • 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.

front 13

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

back 13

  • Serum potassium levels for hypokalemia
  • Fludrocortisone has mineralocorticoid properties, resulting in sodium and fluid retention along with potassium excretion.

front 14

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

back 14

  • Acetaminophen
  • Acetaminophen does not cause gastric distress as do aspirin, ibuprofen, naproxen sodium, and glucocorticoids.

front 15

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.”

back 15

  • “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.

front 16

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

back 16

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.

front 17

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.

back 17

c. is given after tests prove that it is necessary.

front 18

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

back 18

d. Serum glucose

front 19

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."

back 19

d. "Using growth hormone to build muscle mass is not recommended."

front 20

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

back 20

d. Prader-Willi syndrome

front 21

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)

back 21

a. Bromocriptine mesylate (Parlodel)

front 22

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)

back 22

d. Thyrotropin (Thytropar)

front 23

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

back 23

a. Notify the provider to discuss a possible non-functioning adrenal gland.

front 24

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

back 24

a. Bruising

front 25

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)

back 25

d. Vasopressin (Pitressin)

front 26

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.

back 26

d. serum electrolytes.

front 27

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

back 27

d. Urine output and serum sodium

front 28

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

back 28

d. Myxedema

front 29

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)

back 29

b. Liothyronine (Cytomel)

front 30

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

back 30

c. Increased digoxin and decreased warfarin

front 31

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.

back 31

a. hyperglycemia.

front 32

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

back 32

d. Shellfish

front 33

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.

back 33

b. Check the patient's heart rate to assess for tachycardia.

front 34

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)

back 34

c. Propylthiouracil (PTU)

front 35

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

back 35

b. Calcitriol

front 36

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

back 36

b. Adrenocortical insufficiency

front 37

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.

back 37

c. high in protein.

front 38

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.

back 38

d. Request an order for enteric-coated aspirin.