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A client is suspected of having acromegaly. What definitive diagnostic testing is the most reliable method of confirming acromegaly?
- A. A serum glucose level
- B. Glucose tolerance test in combination with a GH measurement
- C. Growth hormone levels
- D. Bone radiographs
Correct Answer: B
Rationale: A glucose tolerance test in combination with a GH measurement is the most reliable method of confirming acromegaly. Ingestion of a bolus of glucose should lower GH levels, but GH levels remain elevated in persons with acromegaly. Increased blood levels of IGF-1 can also indicate acromegaly in nonpregnant women, they typically have IGF-1 levels two to three times higher than normal in pregnant women. A serum glucose level is not an indicator of acromegaly. Growth hormone levels and bone radiographs may support the diagnosis but are not reliable indicators.
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The nurse is administering a medication to a client with hyperthyroidism to block the production of thyroid hormone. The client is not a candidate for surgical intervention at this time. What medication should the nurse administer to the client?
- A. Levothyroxine
- B. Spironolactone
- C. Propylthiouracil
- D. Propranolol
Correct Answer: C
Rationale: Antithyroid drugs, such as propylthiouracil and methimazole, are given to block the production of thyroid hormone preoperatively or for long-term treatment for clients who are not candidates for surgery or radiation treatment. Levothyroxine would increase the level of thyroid and be contraindicated in this client. Spironolactone is a diuretic and does not have the action of blocking production of thyroid hormone, and neither does propranolol, which is a beta-blocker.
The instructor is teaching a group of students about Simmonds disease. The instructor determines that additional instruction is necessary when the students identify which hormone as being involved?
- A. Growth hormone
- B. Luteinizing hormone
- C. Adrenocorticotropic hormone
- D. Oxytocin
Correct Answer: D
Rationale: Oxytocin is a hormone of the posterior pituitary gland and would not be involved. Simmonds disease affects all hormones of the anterior pituitary: GH (bones and muscles), adrenocorticotropic hormone (ACTH, adrenals), thyroid-stimulating hormone (TSH, thyroid), follicle-stimulating hormone (FSH, ovaries and testes), luteinizing hormone (LH, ovaries), interstitial cell-stimulating hormone (ICSH (LH), testes), and prolactin (breasts).
A client with diabetes insipidus is extremely dehydrated and is unable to take oral fluids. Fluid therapy is prescribed. Which intervention would be most important for the client?
- A. Measuring the urine output every 30 minutes
- B. Monitoring the rate of IV infusions
- C. Measuring the fluid intake
- D. Weighing the client daily
Correct Answer: A
Rationale: The nurse must measure the urine output every 30 minutes when administering prescribed fluid and drug therapy when the client is acutely ill or extremely dehydrated, fails to take oral fluids, or is beginning to receive medical treatment. Doing so ensures adequate kidney function. Although monitoring the rate of IV infusions, measuring fluid intake, and weighing the client daily are important, measuring the urine output every 30 minutes is the priority.
A client is receiving a test to determine adrenal function. What medication does the nurse administer as a screening test?
- A. Cosyntropin
- B. Sodium bicarbonate
- C. Fludrocortisone
- D. Glucagon
Correct Answer: A
Rationale: A dose of synthetic ACTH, cosyntropin, is administered intramuscularly as a screening test for adrenal function. The other medications are not screening medications to determine adrenal function.
An adult client has been diagnosed with a rare disorder, Simmonds disease (panhypopituitarism), and placed on hormone replacements. What is important for the nurse to educate the client about regarding the medication?
- A. The medication must be taken as ordered until surgery is scheduled to remove the tumor.
- B. Thyroid medication will be administered for the duration of the client's life.
- C. Adhere to the medication schedule and never omit a dose.
- D. The client must take growth hormone for the duration of his life.
Correct Answer: C
Rationale: Teaching the client to adhere to the medication schedule and never to omit a dose is important. The client will have destruction of the pituitary gland so removal will be unnecessary. More than just thyroid medication will be taken. Growth hormone is only administered to children, not adult clients.