Which drug class can blunt the growth-promoting effect of somatropin when the two are taken together?
Glucocorticoids
✓
Beta blockers
Loop diuretics
Antihistamines
Correct Answer
Glucocorticoids
Glucocorticoids oppose the growth-promoting action of growth hormone, so a child who needs both may need dose adjustments and close monitoring of growth. Beta blockers do not counteract somatropin's effect on growth. Loop diuretics have no recognized effect on growth hormone action. Antihistamines do not interfere with somatropin either.
Category: Growth Hormone Replacement
Question 2
A child with type 1 diabetes is starting somatropin. What should the nurse anticipate?
Insulin needs may fall as blood glucose drops
Insulin needs may increase as blood glucose rises
✓
Somatropin may replace the need for insulin
Blood glucose control will not be affected
Correct Answer
Insulin needs may increase as blood glucose rises
Growth hormone opposes the action of insulin and raises blood glucose, so glucose is monitored closely and insulin doses may need to go up. Insulin needs falling describes the opposite effect. Somatropin cannot replace insulin in type 1 diabetes. Saying glucose control will not be affected ignores a labeled interaction.
Category: Growth Hormone Replacement
Question 3
A child receiving somatropin develops a limp and complains of knee pain. What should the nurse do?
Reassure the family that these are growing pains
Give an anti-inflammatory and continue as usual
Report it promptly so the hip can be evaluated
✓
Hold the next dose and then resume without telling anyone
Correct Answer
Report it promptly so the hip can be evaluated
A new limp or hip or knee pain during growth hormone therapy can signal a slipped capital femoral epiphysis, which needs prompt evaluation of the hip. Calling it growing pains could delay treatment of a serious problem. Giving an anti-inflammatory and continuing as usual also delays evaluation. Holding a dose without reporting the finding leaves the cause unassessed.
Category: Growth Hormone Replacement
Question 4
Why should a patient rotate somatropin injection sites?
To speed absorption of the drug
To lower the risk of hypoglycemia
To keep bone from growing at one site
To prevent loss of fat tissue under the skin
✓
Correct Answer
To prevent loss of fat tissue under the skin
Repeated injections in one spot can cause lipoatrophy, a loss of fat tissue under the skin, so sites such as the thigh, abdomen and buttock are rotated. Rotation is not done to speed absorption. It does not change the risk of hypoglycemia; somatropin tends to raise blood glucose. Injecting at one site does not cause local bone growth.
Category: Growth Hormone Replacement
Question 5
During long-term octreotide therapy, the nurse should monitor for which adverse effect?
Gallstones
✓
Kidney stones
Hearing loss
Gum overgrowth
Correct Answer
Gallstones
Somatostatin analogs reduce gallbladder contraction and bile flow, so gallstones and other gallbladder problems can develop; patients report right upper abdominal pain. Kidney stones are not a typical effect of octreotide. Hearing loss is linked to drugs such as aminoglycosides and loop diuretics. Gum overgrowth is linked to phenytoin.
Category: Growth Hormone Suppressants
Question 6
Which cardiac adverse effect can octreotide cause?
Hypertensive crisis
Bradycardia
✓
Pericarditis
Heart valve fibrosis
Correct Answer
Bradycardia
Octreotide can slow the heart rate and cause conduction problems, so the pulse is monitored and the drug is used carefully with beta blockers and other drugs that slow the heart. A hypertensive crisis is not a typical effect. Pericarditis is not linked to octreotide. Heart valve fibrosis is associated with some ergot-derived dopamine agonists, not with octreotide.
Category: Growth Hormone Suppressants
Question 7
The response to pegvisomant in acromegaly is judged mainly by which serum level?
Growth hormone
Prolactin
Insulin-like growth factor 1
✓
Cortisol
Correct Answer
Insulin-like growth factor 1
Pegvisomant blocks growth hormone receptors, so the level of insulin-like growth factor 1, which those receptors normally trigger, is used to adjust therapy; liver tests are also monitored. Serum growth hormone is not useful because it stays high or rises while the receptors are blocked. Prolactin is the hormone tracked when treating a prolactin-secreting tumor. Cortisol is not affected by pegvisomant.
Category: Growth Hormone Suppressants
Question 8
Bromocriptine treats a prolactin-secreting pituitary tumor by which action?
Blocking dopamine receptors, which raises prolactin release
Blocking growth hormone receptors in body tissues
Mimicking the action of antidiuretic hormone
Stimulating dopamine receptors, which suppresses prolactin release
✓
Correct Answer
Stimulating dopamine receptors, which suppresses prolactin release
Dopamine normally inhibits prolactin release, so the dopamine agonist bromocriptine lowers prolactin and can shrink prolactin-secreting tumors. Blocking dopamine receptors would raise prolactin, as some antipsychotics do. Blocking growth hormone receptors describes pegvisomant. Mimicking antidiuretic hormone describes desmopressin.
Category: Growth Hormone Suppressants
Question 9
To reduce nausea from bromocriptine, what should the nurse teach?
Take it with food
✓
Take it on an empty stomach
Take it with grapefruit juice
Take it with an antacid
Correct Answer
Take it with food
Nausea is one of the most common adverse effects of bromocriptine, and taking each dose with food lessens it, as the labeling directs. Taking it on an empty stomach makes nausea more likely. Grapefruit juice can raise levels of some drugs and is not a remedy for nausea. An antacid is not the recommended way to manage this effect.
Category: Growth Hormone Suppressants
Question 10
Octreotide relieves severe diarrhea and flushing caused by which tumors?
Pheochromocytomas
Carcinoid tumors
✓
Prolactin-secreting adenomas
Thyroid adenomas
Correct Answer
Carcinoid tumors
Carcinoid tumors release serotonin and other substances that cause flushing and diarrhea, and octreotide suppresses this hormone release. Pheochromocytomas release catecholamines and are treated with adrenergic blockers and surgery. Prolactin-secreting adenomas are treated with dopamine agonists. Thyroid adenomas are not treated with somatostatin analogs.
Category: Growth Hormone Suppressants
Question 11
Before minor surgery, a patient with mild hemophilia A receives desmopressin. How does the drug help?
It supplies vitamin K
It breaks down fibrin clots
It raises factor VIII levels
✓
It lowers blood pressure
Correct Answer
It raises factor VIII levels
Desmopressin releases stored factor VIII and von Willebrand factor into the blood, which improves clotting in mild hemophilia A and some types of von Willebrand disease. Supplying vitamin K describes phytonadione. Breaking down fibrin clots describes thrombolytics, which would worsen bleeding. Lowering blood pressure is not how desmopressin helps clotting.
Category: ADH Drugs
Question 12
A patient taking demeclocycline for SIADH should receive which teaching?
Take each dose with a glass of milk
Avoid foods that contain tyramine
Check the pulse before each dose
Limit sun exposure and use sun protection
✓
Correct Answer
Limit sun exposure and use sun protection
Demeclocycline is a tetracycline and can cause photosensitivity, an exaggerated sunburn reaction, so patients limit direct sunlight, use protection and report skin redness. Taking each dose with a glass of milk is wrong, because dairy products interfere with the absorption of tetracyclines. Avoiding foods that contain tyramine is teaching for MAO inhibitors. Checking the pulse before each dose is done for drugs such as digoxin, not demeclocycline.
Category: ADH Antagonists
Question 13
A patient taking desmopressin develops headache, confusion and drowsiness. What should the nurse suspect?
Hyponatremia from water retention
✓
Hypernatremia from dehydration
Hypoglycemia from the drug
Hyperkalemia from kidney injury
Correct Answer
Hyponatremia from water retention
Desmopressin makes the kidneys retain water, and too much retained water dilutes the blood sodium, producing the headache, confusion and drowsiness of water intoxication; the nurse holds the dose and notifies the provider. Hypernatremia from dehydration is the problem of untreated diabetes insipidus. Hypoglycemia is not a known effect of desmopressin. Hyperkalemia is not caused by this drug.
Category: ADH Drugs
Question 14
A child takes desmopressin tablets at bedtime for nighttime bed-wetting. Which teaching is correct?
Drink extra fluids at bedtime
Limit fluids in the evening around the dose
✓
Take it with a large glass of water
Take a diuretic with the dose
Correct Answer
Limit fluids in the evening around the dose
Because desmopressin keeps water in the body, fluid intake is limited in the evening around the dose to prevent water intoxication and hyponatremia. Drinking extra fluids at bedtime raises that risk. Taking the tablet with a large glass of water adds unneeded fluid. A diuretic is not given with desmopressin and would work against it.
Category: ADH Drugs
Question 15
Why must tolvaptan be started, or restarted, in a hospital?
It can only be given by IV infusion
It often causes a hypertensive crisis
Serum sodium must be watched so it does not rise too fast
✓
It requires dialysis during the first doses
Correct Answer
Serum sodium must be watched so it does not rise too fast
Tolvaptan carries a boxed warning: correcting hyponatremia too quickly can cause osmotic demyelination, with problems such as trouble speaking and swallowing, seizures, coma and death, so sodium is checked closely in the hospital. Tolvaptan is an oral tablet, not an IV infusion. It does not commonly cause a hypertensive crisis. Dialysis is not part of starting this drug.
Category: ADH Antagonists
Question 16
Which beverage should a patient taking tolvaptan avoid?
Milk
Apple juice
Green tea
Grapefruit juice
✓
Correct Answer
Grapefruit juice
Tolvaptan is broken down by the CYP3A enzyme, and grapefruit juice inhibits that enzyme, which can raise tolvaptan levels and the risk of overly rapid sodium correction. Milk is not known to interact with tolvaptan. Apple juice is not a labeled interaction. Green tea is not a labeled interaction either.
Category: ADH Antagonists
Question 17
Fludrocortisone must be used with great caution in a patient who also has which condition?
Heart failure
✓
Allergic rhinitis
Osteoarthritis
Migraine headaches
Correct Answer
Heart failure
Fludrocortisone is a mineralocorticoid that makes the kidneys retain sodium and water, which expands fluid volume and can worsen fluid overload in heart failure; weight gain, edema and crackles are reported to the provider. Allergic rhinitis is not worsened by its salt-retaining effect. Osteoarthritis is not a recognized concern with this drug. Migraine headaches are not a listed caution either.
Category: Adrenal Insufficiency
Question 18
A patient in adrenal crisis has severe hypotension and confusion. Which drug does the nurse expect to give IV?
Fludrocortisone
Hydrocortisone
✓
Spironolactone
Levothyroxine
Correct Answer
Hydrocortisone
Adrenal crisis is treated with IV hydrocortisone along with IV fluids, because it quickly replaces cortisol and, at high doses, also provides mineralocorticoid effect. Fludrocortisone is an oral mineralocorticoid used for long-term replacement, not emergency treatment. Spironolactone blocks aldosterone and would worsen the crisis. Levothyroxine replaces thyroid hormone, not cortisol.
Category: Adrenal Insufficiency
Question 19
Long-term high-dose prednisone therapy can produce which group of findings?
Weight loss, low blood pressure and darkened skin
Bulging eyes, heat intolerance and tremor
Round face, fat pad between the shoulders and thin skin
✓
Enlarged hands, jaw growth and coarse features
Correct Answer
Round face, fat pad between the shoulders and thin skin
Prolonged glucocorticoid excess causes iatrogenic Cushing syndrome, with a moon face, a buffalo hump, thin fragile skin and central weight gain. Weight loss, low blood pressure and darkened skin suggest adrenal insufficiency. Bulging eyes, heat intolerance and tremor suggest hyperthyroidism. Enlarged hands, jaw growth and coarse features suggest acromegaly.
Category: Glucocorticoid Therapy
Question 20
Why is a once-daily systemic glucocorticoid usually taken in the morning?
It doubles absorption on an empty stomach
It prevents high blood glucose overnight
It reduces the risk of oral thrush
It matches the body's natural morning cortisol peak
✓
Correct Answer
It matches the body's natural morning cortisol peak
Cortisol secretion is normally highest in the early morning, so a morning dose imitates that rhythm, causes less suppression of the body's own production and is less likely to cause insomnia. Morning dosing does not double absorption, and oral glucocorticoids are usually taken with food. It does not prevent high blood glucose. Oral thrush is a concern with inhaled corticosteroids and is not affected by the time of day.
Category: Glucocorticoid Therapy