Nokea
The nurse is instructing a client about the use of pegvisomant for the treatment of acromegaly. How will the nurse instruct to take this medication?
- A. Injected subcutaneously once a day
- B. Injected intramuscularly once a month
- C. Administer via an implanted port once a month
- D. Injected intramuscularly one every 6 months
Correct Answer: A
Rationale: Pegvisomant, a GH receptor antagonist, is the newest and most effective drug for treating acromegaly. Injected subcutaneously once a day, it normalizes the IGF-I level in 93% to 97% of cases by blocking the GH stimulation of IGF-I produced by the liver.
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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.
The nurse is reviewing a client's history which reveals that the client has had an oversecretion of growth hormone (GH) that occurred before puberty. The nurse interprets this as resulting in which condition?
- A. Gigantism
- B. Dwarfism
- C. Acromegaly
- D. Simmonds disease
Correct Answer: A
Rationale: When oversecretion of GH occurs before puberty, gigantism results. Dwarfism occurs when secretion of GH is insufficient during childhood. Oversecretion of GH during adulthood results in acromegaly. An absence of pituitary hormonal activity causes Simmonds disease.
A client has been diagnosed with myxedema from long-standing hypothyroidism. What clinical manifestation(s) of this disorder does the nurse recognize is progressing to myxedema coma? Select all that apply.
- A. Hypothermia
- B. Hypertension
- C. Hypotension
- D. Hypoventilation
- E. Hyperventilation
Correct Answer: A,C,D
Rationale: Severe hypothyroidism is called myxedema. Advanced, untreated myxedema can progress to myxedema coma. Signs of this life-threatening event are hypothermia, hypotension, and hypoventilation. Hypertension and hyperventilation indicate increased metabolic responses, which are the opposite of what the client would be experiencing.
The nurse is teaching a client who is to receive lypressin nasal spray as treatment for neurogenic diabetes insipidus about administration. Which client statement indicates the need for additional teaching?
- A. I'll inhale fully after spraying the drug.'
- B. If my nose gets irritated, I'll call my physician.'
- C. I should hold the spray container upright.'
- D. While sitting up, I'll place the nozzle in my nostril.'
Correct Answer: A
Rationale: When administering lypressin nasal spray, the client should not inhale the drug. Calling the physician if he or she experiences nasal irritation, holding the container upright, and placing the nozzle in the nostril while sitting up are appropriate.
The nurse is providing education to a client who will be having a hypophysectomy. What should the nurse be sure to include to prevent complications?
- A. Perform exercises involving bending at the hips
- B. Avoid sneezing and coughing
- C. Blow nose to clear the cold when packing is removed.
- D. Drink all liquids through a straw.
Correct Answer: B
Rationale: The nurse should instruct the client to avoid sneezing and coughing postoperatively. If the client has nasal packing, the nurse monitors drainage from the nose and postnasal drainage for the presence of cerebrospinal fluid. The nurse should remind the client to avoid drinking from a straw, sneezing, coughing, blowing the nose, and bending over to prevent dislodging the graft that seals the operative area between the cranium and nose.