Chapter 51: Endocrine Drugs: Pituitary, Thyroid, Parathyroid, and Adrenal Disorders Nursing School Test Banks

Chapter 51: Endocrine Drugs: Pituitary, Thyroid, Parathyroid, and Adrenal Disorders
Test Bank

MULTIPLE CHOICE

1. 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 childs desired height is reached.
ANS: C
Growth hormone is given only when growth hormone deficiency is determined. It cannot be given orally. It antagonizes insulin secretion and thus can lead to the development of diabetes mellitus. It cannot be given after the epiphyses are fused.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 743
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

2. 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
ANS: D
Growth hormone antagonizes insulin secretion, so serum glucose should be monitored.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 743
TOP: NURSING PROCESS: Assessment/Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

3. 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.
ANS: D
Athletes should be advised not to take growth hormone to build muscle because of its effects on blood sugar and other side effects.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 743
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

4. 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
ANS: D
Fatalities associated with risks of taking growth hormone with Prader-Willi syndrome have been reported, so it is contraindicated in patients with this syndrome. It is not contraindicated in patients with asthma or enuresis. Dwarfism is an indication for hormone therapy.

DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: Page 743
TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

5. 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)
ANS: A
Bromocriptine is a prolactin-release inhibitor and is used to inhibit release of growth hormone from the pituitary gland if the tumor cannot be destroyed by radiation. Octreotide may be used as well, but it is expensive and is typically used as adjunct therapy to radiation. Somatrem and somatropin are used to treat growth hormone deficiency and would make acromegaly worse.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 743
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

6. 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)
ANS: D
Thyrotropin is a purified extract of thyroid-stimulating hormone and is used as a diagnostic agent to differentiate between primary and secondary hypothyroidism. Liothyronine and liotrix are thyroid replacement drugs. Methimazole is used to decrease thyroid hormone secretion.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 743
TOP: NURSING PROCESS: Planning/Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

7. 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 nurses 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.
ANS: A
Corticotropin is given to diagnose adrenal gland disorders as well as to treat adrenal gland insufficiency. When given intravenously, the serum cortisol level should increase within 30 to 60 minutes if the adrenal gland is functioning. The nurse should report adrenal gland dysfunction. The provider will determine how to treat. Since the levels should increase in 30 to 60 minutes, there is no need to repeat the test in 1 to 2 hours.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 743
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

8. 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
ANS: A
Ecchymosis is an adverse reaction to corticotropin and should be reported. Constipation and nausea are known side effects but are not serious. Myalgia is not common.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 755
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

9. 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)
ANS: D
The posterior pituitary gland secretes antidiuretic hormone (ADH) (vasopressin). When there is a deficiency of ADH, sometimes caused by head trauma, patients excrete large amounts of dilute urine. ADH replacement is necessary to prevent fluid imbalance. Calcifediol is used to treat parathyroid disorders. Corticotropin and prednisolone do not prevent diuresis.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 745
TOP: NURSING PROCESS: Planning/Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

10. 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.
ANS: D
Corticotropin can interact with piperacillin to cause hypokalemia, so serum electrolytes should be monitored. It is not necessary to change the antibiotic. Blood glucose monitoring and cardiac monitoring are not indicated.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 755
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

11. 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
ANS: D
Desmopressin is an antidiuretic hormone. The nurse should monitor intake and output as well as serum sodium levels.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 755
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

12. 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
ANS: D
Myxedema is severe hypothyroidism characterized by this womans symptoms. Cretinism is congenital hypothyroidism. Early menopause is not characterized by memory loss, facial edema, dry skin, or bradycardia. Hyperthyroidism would include tachycardia and weight loss.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 747
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pathophysiology

13. 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)
ANS: B
Liothyronine has a short half-life and rapid onset of action and is not recommended for maintenance therapy but is used as initial therapy for severe myxedema. Levothyroxine is the drug of choice for replacement therapy. Liotrix is a second-line drug. Thyroid desiccated is used for hypothyroidism to reduce goiter size.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 747
TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

14. 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
ANS: C
Thyroid preparations increase the effect of oral anticoagulants, so the warfarin dose may need to be decreased. Levothyroxine can decrease the effectiveness of digoxin, so this dose may need to be increased.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 749
TOP: NURSING PROCESS: Planning/Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

15. 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.
ANS: A
Insulin and oral antidiabetic drugs may need to be increased in patients taking levothyroxine. Patients should be taught to monitor for hyperglycemia, because of the reduced effects of these drugs.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 746
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

16. 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
ANS: D
Patients should be advised about the effects of iodine and its presence in foods such as shellfish. There is no need to avoid fava beans, purine, or grapefruit.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 750
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

17. 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 patients heart rate to assess for tachycardia.
c. Perform an assessment of hydration status.
d. Take the patients temperature to evaluate for infection.
ANS: B
The patient has signs of a thyroid crisis, which can occur with excess ingestion of thyroid hormone. The nurse should evaluate heart rate before notifying the provider. These are not symptoms of hypoglycemia. The symptoms are not indicative of infection.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 750
TOP: NURSING PROCESS: Assessment/Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

18. 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)
ANS: C
Propylthiouracil is a potent antithyroid drug used in preparation for a subtotal thyroidectomy. Liotrix and thyroid are used as thyroid replacement. Propranolol is used to treat hypertension associated with hyperthyroidism.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 748
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

19. 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
ANS: B
Calcitriol is given for management of hypocalcemia caused by parathyroid hormone deficiency. Calcitonin is used to treat hyperparathyroidism. Calcium and vitamin D are not useful in parathyroid deficiency.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 749
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

20. 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
ANS: B
Patients receiving glucocorticoids stop making their own cortisol. These drugs should be tapered slowly to allow the body to resume making this hormone. Acromegaly is associated with growth hormone hypersecretion. Hypertensive crisis and thyroid storm are associated with thyroid replacement.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 751
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

21. 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.
ANS: C
Patients receiving fludrocortisone are at risk for negative nitrogen balance and should consume a high-protein diet.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 754
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

22. 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.
ANS: D
Glucocorticoids can increase gastric distress, so an enteric-coated aspirin product is indicated. Glucocorticoids increase the risk of hypoglycemia, fluid retention, and hypertension.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 754
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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