Chapter 44: Drug Therapy to Regulate Calcium and Bone Metabolism, Chapter 43: Drug Therapy for Pituitary and Hypothalamic Dysfunction, Chapter 42: Drug Therapy for Hyperthyroidism and Hypothyroidism, chapter 41 drug therapy for diabetes mellitus, Pha…

A nurse is providing client education to a 13-year-old girl who was just diagnosed with type 1 diabetes mellitus. Which statement by the client will alert the nurse that special instructions regarding insulin are necessary?

"I am on the middle school track team." Explanation: Because the client is on the track team, she will have increased exercise at various times that will require increased insulin and special instructions related to hypoglycemia that may come hours after she has ceased exercising. Walking two blocks every day and walking up stairs would not be considered increased physical exercise and would not be a factor. Wanting to have her mother administer the insulin is not uncommon for this age client, and the nurse would normally instruct both the mother and the daughter in the administration of the drug.

A young man has been diagnosed with type 2 diabetes and has been prescribed glyburide. Which statement suggests that the nurse should perform further health education?

"I'll plan to take my glyburide each night before I go to bed." Explanation: Glyburide is normally taken in the morning, before breakfast. No drug cures diabetes; the goal of therapy is the maintenance of safe blood glucose levels. The client should check before taking other drugs and should indeed be aware of the risk of hypoglycemia.

The nurse is discussing diabetes with a group of individuals who are at risk for the disease. Which statement by a participant indicates an understanding of the role of insulin in the disease?

"Insulin assists glucose molecules to enter the cells of muscle and fat tissues." Explanation: Insulin appears to activate a process that helps glucose molecules enter the cells of striated muscle and adipose tissue. It also stimulates the synthesis of glycogen by the liver, promotes protein synthesis, and helps the body store fat by preventing its breakdown for energy.

What instructions would be important to give to a 50-year-old client with type 2 diabetes who has been switched from glyburide (DiaBeta), a sulfonylurea, to repaglinide, a meglitinide?

"It stimulates insulin production, so you need to eat soon after taking the medication." Explanation: Glyburide's onset of action is 2 to 4 hours, and its duration is 24 hours. Repaglinide's onset of action is within 30 minutes, peak is 1 hour, and duration is approximately 3 to 4 hours. Repaglinide is taken 15 to 30 minutes before each meal because it stimulates the pancreas to secrete insulin to correspond to the food intake. If there is no food intake, the person is at risk of hypoglycemia. Glyburide, a sulfonylurea, also stimulates pancreatic cells, but not until 2 to 4 hours after it is taken. Repaglinide is not less potent, it is not more potent, and the two medications are not virtually the same.

A 59-year-old man with type 2 diabetes is prescribed metformin. When the client returns to the clinic, he reports that he has lost 8 pounds in a month. How should the nurse respond?

"Please continue taking the medication and monitoring your weight. This is an expected outcome of this drug therapy." Explanation: The nurse should advise the client to continue therapy as prescribed because weight loss is a beneficial adverse effect for type 2 diabetics. The client need not seek a decrease in dosage or change in medication, nor would discontinuation of the drug be warranted.

What statement would be appropriately included in the teaching concerning type 2 diabetes?

"Regular exercise makes your body better able to use the insulin it produces." Explanation: People who need less than 0.5 units/kg/d may produce some endogenous insulin, or their tissues may be more responsive to insulin because of exercise and good physical conditioning. Exercise is an extremely strong hypoglycemic agent. Diabetics need to check their blood sugar level regardless of whether they are or are not prescribed insulin. The need for insulin injections is determined by the function of the pancreas and its ability to produce sufficient quantities of insulin. It is not correct to assume diet is the only factor in this process. Alcohol should be avoided, and the dosage of oral antidiabetic medication should not be altered without guidance from a health care provider.

What instructions should the nurse give to a client with type 2 diabetes who has been switched from glyburide (DiaBeta) to repaglinide?

"Repaglinide rapidly stimulates insulin production, so you need to eat soon after taking the medication." Explanation: Glyburide is a second-generation sulfonylurea that stimulates insulin release from the beta cells in the pancreas with a 2- to 4-hour onset of action. Repaglinide has an onset of action within 30 minutes with peak effect in 1 hour, and duration of action is approximately 3 to 4 hours. Because repaglinide has a much faster onset of action, it is important the client eats within 15 to 30 minutes after taking the drug to avoid hypoglycemia. Repaglinide is not less potent, it is not more potent, and the two medications are not virtually the same.

during a teaching session on the care of the client with diabetes, the nurse should make which statement to explain the difference in insulin?

"insulins have different onsets and duration of actions"

Levothyroxine (Synthroid) 88 mcg is prescribed for a client. How many mg of Synthroid will the nurse administer? Do NOT round the answer.

0.088 1 mg = 1000 mcg. 88 mcg = 0.088 mg

The nurse transcribes an order for chlorpropamide (Diabinese). What is an appropriate dosage range for this medication?

100 to 250 mg per day Explanation: The appropriate dosage range for oral chlorpropamide is 100 to 250 mg/d. Tolbutamide is 0.25 to 3 g/d. Glimepiride is 1 to 4 mg/d. Glipizide is taken 5 mg PO daily.

the nurse knows that the lunch trays are usually distributed at approximately 12:15. the nurse should plan to administer the clients prescribed 4 units of regular insulin at what time

11:45

Methimazole (Tapazole) 30 mg /day orally divided in 3 doses is prescribed for a client diagnosed with Graves' disease. The pharmacy has 5 mg tablets available. How many tablets should the nurse administer with each dose?

2 30 mg/day divided in 3 doses = 10 mg/dose; 10 mg / 5 mg tablets = 2 tablets per dose

A preschool age child who weighs 33 lb (15 kg) is prescribed to receive 4 mg/kg of intravenous calcium chloride every 6 hours. How many milligrams of the medication will the client receive in one day? Record the answer as a whole number.

240 To calculate a single dose of calcium chloride, multiply the client's weight in kg by 4 mg/kg: 15 kg × 4 mg/kg = 60 mg. Then, because 1 dose every 6 hours means that 4 doses will be given in a single day, multiply the individual dose by 4: 60 mg/dose × 4 doses = 240 mg.

A client who began treatment for type 2 diabetes 8 months ago is now meeting with a diabetic nurse for a scheduled follow-up. How can the nurse best assess the client's glycemic control since beginning treatment?

Assess the most recent hemoglobin A1C levels. Explanation: Health care providers also look at the glycosylated hemoglobin (hemoglobin A1C) levels to assess the effectiveness of treatment. Because glucose stays attached to hemoglobin for the life of the red blood cell, which is about 120 days, the hemoglobin A1C level reflects the average blood glucose level over the past 3 months. Reviewing blood glucose readings, measuring the client's random blood glucose, and dialoguing with the client are all therapeutic strategies, but hemoglobin A1C is most accurate.

A female client is a newly diagnosed diabetic. She is a stay-at-home mother and responsible for meal planning and management of the home. What will the home care nurse teach this client? (Select all that apply.)

Assist the client in making menus that will meet the needs of both the client and the family. Watch the client draw up and administer her insulin. Reinforce instructions on dealing with hypoglycemia. Explanation: The home care nurse would assist the client and family to know how to plan meals that meet the needs of the client and the family. The nurse would also want to assure that the client knows how to administer insulin correctly and would need to make sure that the client understands how to deal with hypoglycemia.

A nurse is caring for a 48-year-old woman who has been hospitalized after injecting the wrong type of insulin. Which sign of hypoglycemia will the nurse be careful to observe for?

Blurred vision Explanation: Blurred or double vision (diplopia), fatigue, trembling, irritability, headache, nausea, numbness, muscle weakness, hunger, tachycardia, sweating, and nervousness are signs of a hypoglycemic reaction. Fruity breath can be an indication of ketoacidosis, and flushing of the face is a sign of hyperglycemia. Dry skin is unrelated to hypoglycemia.

A nurse should take what steps prior to administering insulin glargine (Lantus) to a client? Select all that apply.

Check the expiration date on the vial. Check the health care provider's orders for the type and dosage of insulin. Remove all air bubbles from the syringe barrel. Explanation: Prior to administering insulin glargine (Lantus) to a client, the nurse must complete the following pre-administration steps: carefully check the provider's order for the type and dosage of insulin, check the expiration date on the vial, gently rotate the vial between the palms of the hands, and gently tilt end-to-end before withdrawing the insulin, remove all air bubbles from the syringe barrel, and never mix or dilute insulin glargine (Lantus) with any other insulin or solution because the insulin will not be effective.

A female client visits the health care provider's office after routine labs are drawn. The nurse notes that her A1C is 9. How does the nurse interpret this finding?

Client's average blood glucose is above normal. Explanation: The American Diabetes Association (ADA) suggests a target A1C of less than 7%. A1C should be measured every 3 to 6 months. An A1C of 9 indicates that the client's average blood glucose is consistently above normal.

A client with a recent diagnosis of type 2 diabetes has begun taking metformin. This drug will help the client achieve adequate blood sugar control through which mechanisms? (Select all that apply)

Decreasing glucose production by the liver Improving insulin sensitivity Decreasing glucose absorption in the GI tract Explanation: Metformin decreases hepatic glucose production, decreases intestinal absorption of glucose, and improves insulin sensitivity by increasing peripheral glucose uptake and use in skeletal muscle and adipose tissue through increased transport of glucose across the cell membrane. It does not promote urinary excretion of glucose or bind it to adipose tissue.

A client who is a newly diagnosed diabetic is prescribed glyburide. The nurse caring for this client identifies which occurrence is a classic symptom of hyperglycemia?

Excessive urination Explanation: The classic symptoms of hyperglycemia include excessive urination (polyuria) and excessive thirst (polydipsia) caused by the osmotic pull of glucose. Grand mal seizures and hemiparesis are symptoms of nonketotic hyperglycemia, while tachycardia is a symptom of diabetic ketoacidosis.

Clients with type 2 diabetes have nonfunctioning beta pancreatic cells.

False Explanation: Type 2 diabetes reflects an inability to produce enough insulin as needed or a change in insulin receptor sensitivity.

A nurse is caring for a patient who has developed a hypoglycemic reaction. Which intervention should the nurse perform if swallowing and gag reflexes are present in the patient?

Give oral fluids or candy. Explanation: The nurse should administer oral fluids or candy to the hypoglycemic patient with swallowing and gag reflexes. If the patient is unconscious the nurse should administer glucose or glucagon parenterally. The nurse should administer insulin through an insulin pump to special categories of diabetic patients, such as pregnant women with diabetes and renal transplantation. Oral antidiabetic drugs are administered to patients with type 2 diabetes.

A man is brought to the emergency department. He is nonresponsive, and his blood glucose level is 32 mg/dL. Which would the nurse expect to be ordered?

Glucagon Explanation: The client is significantly hypoglycemic and needs emergency treatment. Glucagon would be the agent of choice to raise the client's glucose level because it can be given intravenously and has an onset of approximately 1 minute. Diazoxide can be used to elevate blood glucose levels, but it must be given orally. Lispro and regular insulin would be used to treat hyperglycemia.

Which would a nurse identify as an example of a sulfonylurea?

Glyburide Explanation: Glyburide is an example of a sulfonylurea. Metformin is classified as a biguanide. Acarbose and miglitol are alpha-glucosidase inhibitors.

Which is the best indicator of overall diabetic control?

Glycosylated hemoglobin levels Explanation: The glycosylated hemoglobin indicates glucose bound to hemoglobin in red blood cells (RBCs) when RBCs are exposed to hyperglycemia. The binding is irreversible and lasts for the lifespan of RBCs (approximately 120 days). The test reflects the average blood sugar level during the previous 2 to 3 months. The goal is usually less than 7% (blood level 0.07). The range for people without diabetes is approximately 4% to 6% (blood level 0.04 to 0.06). Reference:

The nurse is interviewing a client who was diagnosed with type 2 diabetes four months ago. The client does not records glucometer readings but reports no concerns. What laboratory test does the nurse anticipate the health care provider will order for this client?

HbA1c Explanation: The nurse anticipates that the glycosylated hemoglobin (HbA1c) will be ordered for this client because it provides an average of the client's blood glucose level for the last three- to four-month period. It will also tell how well controlled the client's blood glucose is. A stat urine for glucose and an FBG in the AM will only indicate the client's current blood glucose level, not how well it is being controlled. An insulin level will not give the information needed to understand the client's control of blood glucose.

a client newly diagnosed with type 2 has attented educational sessions to provide insight into the diagnosis. which of the client statements should promt the nurse to provide further teaching

I'm disappointed, but I take some solace in the fact that I wont ever have to have insulin injections

Which of the following are risk factors for type 2 diabetes that a nurse should recognize in a client? Select all that apply:

Impaired glucose tolerance Obesity History of gestational diabetes Explanation: A nurse should be able to identify all the risk factors for type 2 diabetes in a client. These include: obesity, older age, family history of diabetes, history of gestational diabetes, impaired glucose tolerance, minimal or no physical activity, and race/ethnicity (African Americans, Hispanic/Latino Americans, Native Americans, and some Asian Americans).

When describing the effects of incretins on blood glucose control to a group of students, which would an instructor include?

Increases insulin release Explanation: Incretins increase insulin release, decrease glucagon release, slow GI emptying, and stimulate the satiety center. Growth hormone increases protein building.

A nurse at a health care facility is assigned to administer insulin to the patient. Which intervention should the nurse perform before administering each insulin dose?

Inspect the previous injection site for inflammation. Explanation: The nurse should check the previous injection site before administering each insulin dose. The injection sites should be rotated to prevent lipodystrophy. Prefilled syringes should not be kept horizontally; they should be kept in a vertical or oblique position to avoid plugging the needle. The nurse checks for symptoms of myalgia or malaise when administration of metformin leads to lactic acidosis. Insulin should be kept at room temperature for administration. Insulin is refrigerated if it needs to be stored for up to three months for later use.

A client newly diagnosed with type 1 diabetes asks the nurse why the client cannot just take a pill. The nurse would incorporate what knowledge when responding to this client?

Insulin is needed because the beta cells of the pancreas are no longer functioning. Explanation: Insulin is needed in type 1 diabetes because the beta cells of the pancreas are no longer functioning. With type 2 diabetes, insulin is produced, but perhaps not enough to maintain glucose control or the insulin receptors are not sensitive enough to insulin.

A nurse is presenting an educational event at a local senior citizens' club about diabetes. What would the nurse tell the attendees at the event about diabetes?

It is a complicated disorder that alters the metabolism of glucose. Explanation: Diabetes is a complicated disorder that alters the metabolism of glucose, fats, and proteins affecting many end organs and causing numerous clinical complications. It is part of the metabolic syndrome, a collection of conditions that predispose to cardiovascular disease.

Lactic acidosis can occur in clients receiving metformin (Glucophage), especially those with renal impairment, which of the following are symptoms of lactic acidosis for which a nurse should monitor a client taking metformin (Glucophage)? Select all that apply:

Malaise Tachypnea Abdominal pain Muscular pain Explanation: Symptoms of lactic acidosis include malaise, abdominal pain, tachypnea, shortness of breath, and muscular pain.

Which would be least appropriate when administering insulin by subcutaneous injection?

Massaging the site after removing the needle Explanation: Gentle pressure should be applied to the injection after the needle is withdrawn. Massaging could contribute to erratic or unpredictable absorption.

The nurse is caring for a client with polycystic ovary syndrome. What antidiabetic drug would the nurse anticipate will be ordered?

Metformin Explanation: Metformin and pioglitazone have proven effective in increasing insulin sensitivity and decreasing androgen and luteinizing hormone levels to break the cycle and allow ovulation to occur if pregnancy is desired. A fertility drug is often used with the antidiabetic agent. Other options are not appropriate because they are not indicated for treating polycystic ovary syndrome.

After teaching a class about the various drugs used to control blood glucose, the instructor determines that the teaching was successful when the class identifies what as a biguanide?

Metformin Explanation: Metformin is classified as a biguanide. Miglitol is an alpha-glucosidase inhibitor. Tolbutamide is a first generation sulfonylurea. Glipizide is a second generation sulfonylurea.

What antidiabetic agent is approved for the nurse to administer to children 10 years old and older with type 2 diabetes?

Metformin Explanation: Metformin is the only oral antidiabetic drug approved for children. It has established dosage for children 10 years of age and older. With the increasing number of children being diagnosed with type 2 diabetes, the use of other agents in children is being tested. Because metformin is the only drug approved for use with children, pioglitazone, repaglinide, and luraglutide would not be appropriate.

A nurse is caring for a patient with diabetes mellitus who is receiving an oral antidiabetic drug. Which of following ongoing assessments should the nurse perform when caring for this patient?

Observe the patient for hypoglycemic episodes. Explanation: As the ongoing assessment activity, the nurse should observe the patient for hypoglycemic episodes. Documenting family medical history and assessing the patient's skin for ulcers, cuts, and sores on the body is a pre-administration assessment activity performed by the nurse. Lipodystrophy occurs if the sites of insulin injection are not rotated.

The nurse monitoring a client receiving insulin glulisine (Apidra) notices the client has become confused, diaphoretic, and nauseated. The nurse checks the client's blood glucose and it is 60 mg/dL (3.33 mmol/L). Which can a nurse give to treat a client with a hypoglycemic episode? (Select all that apply.)

Orange or other fruit juice Glucose tablets Hard candy Explanation: Methods of terminating a hypoglycemic reaction include the administration of one or more of the following: orange or other fruit juice, hard candy or honey, glucose tablets, glucagon, or glucose 10 percent or 50 percent IV.

A student asks the nursing instructor what insulin has the quickest therapeutic effect once administered. What would be the best response?

Regular (Humulin R) Explanation: Regular insulin has the quickest onset of 30-60 minutes. PZI and ultralente have an onset of 4-8 hours. NPH has an onset of 60-90 minutes.

The nurse is caring for a postoperative client whose diabetes has been well controlled on acarbose (Precose). The client is not allowed to take anything orally following complications of abdominal surgery and is receiving high-glucose total parenteral nutrition via a central IV line. What medication can the nurse administer intravenously to control the client's blood glucose level?

Regular insulin Explanation: Only regular insulin can be administered IV. No other insulins or oral antidiabetic medications can be given IV.

A client is admitted to the Emergency Department in diabetic ketoacidosis (DKA) with a blood glucose level of 33 mmol/L. The provider orders an initial dose of 25 U insulin IV. Which type of insulin will be administered?

Regular insulin Explanation: Regular insulin is a short-acting insulin that manages the hyperglycemia and hyperkalemia of DKA (diabetic ketoacidosis), which is a life-threatening complication that occurs with severe insulin deficiency. Humulin N, Humulin L, and NPH are intermediate-acting insulins.

A nurse is preparing an in-service presentation for a group of staff members on diabetes. Which would the nurse include as the primary delivery system for insulin?

Subcutaneous injection Explanation: Although other delivery systems are available for insulin administration such as the jet injector, insulin pen, and external pump, subcutaneous injection remains the primary delivery system.

After teaching a group of students about the various methods for the delivery of insulin, the instructor determines that the teaching was successful when the students identify which method as most commonly used for administration?

Subcutaneous injection Explanation: Subcutaneous injection currently is the most common method for administering insulin.

The nurse is conducting a class for newly diagnosed adult diabetic patients. What would the nurse educate the patients about?

The disease Explanation: While it would be important to teach the patients about nutrition, the preservation of intact skin and self-care, adults need extensive education about the disease as well as the drug therapy. Warning signs and symptoms should be stressed repeatedly as the adult learns to juggle insulin needs with exercise, stressors, other drug effects, and diet.

A 35-year-old client has begun the administration of glyburide for treatment of diabetes mellitus type 2. The nurse caring for this client provides education regarding this medication. Which statement would NOT be an appropriate instruction for this client?

The medication should have a fixed dose which cannot be manipulated. Explanation: Manipulating the dosing of glyburide can often reduce the unpleasant reactions. The primary adverse effect associated with glyburide (and the other sulfonylureas) is hypoglycemia. Concomitant alcohol use increases the rate of glyburide metabolism and may cause a disulfiram-like reaction. Administer glyburide before breakfast or the first main meal of the day in order to stimulate insulin production. It is important to caution clients to avoid taking OTC medications and herbal or dietary supplements without first consulting the prescriber.

Regular insulin may be administered intravenously or intramuscularly in an emergency situation.

True Explanation: Regular insulin is given IM or IV in emergency situations.

In what condition is human insulin not recommended for diabetic clients?

Type 2 diabetes controlled by diet Explanation: Insulin is recommended for treatment of type 2 diabetes mellitus in clients whose diabetes cannot be controlled by diet or other agents. If the diabetes can be controlled by diet, the pancreas is still functioning and releasing insulin. Type 2 diabetes is characterized by hyperglycemia and insulin resistance. The hyperglycemia results from increased production of glucose by the liver and decreased uptake of glucose in liver, muscle, and fat cells. Insulin resistance means that higher-than-usual concentrations of insulin are required. Thus, insulin is present, but unable to work effectively at the cellular level. Diet control requires a reduction of ingested calories, which lowers the serum glucose levels. Human insulin can be used in gestational diabetes, type 2 diabetics controlled on oral antidiabetic agents with systemic infection, or type 1 diabetics of many years.

A 2-month-old male child is diagnosed with diabetes. His parents are having difficulty measuring 2 units of insulin in the U-100 syringe. What would the nurse expect the health care provider to order?

U-10 (10 units/mL) insulin Explanation: Administration of insulin for infants and toddlers who weigh less than 10 kg or require less than 5 units of insulin per day can be difficult because small doses are hard to measure in a U-100 syringe. Use of diluted insulin allows more accurate administration. The most common dilution strength is U-10 (10 units/mL), and a diluent is available from insulin manufacturers for this purpose. Vials of diluted insulin should be clearly labeled and should be discarded after 1 month.

Alendronate (Fosamax) is prescribed for a patient. Which statement made by the patient will indicate to the nurse that further instruction is needed? a. "I can go back to bed as soon as I take this drug." b. "I must wait at least 30 minutes after taking this drug before eating or drinking anything." c. "I will take this drug with a full glass of water." d. "I will immediately report any upper abdominal pain or heartburn."

a. "I can go back to bed as soon as I take this drug." The patient must remain upright (sitting or standing) for at least 30 minutes after taking alendronate with a full glass of water. Nothing should be taken by mouth for at least 30 minutes. Upper abdominal pain or heartburn may indicate that alendronate is causing esophageal irritation or damage.

A child with von Willebrand's disease requires an intravenous injection of 0.3 mcg/kg of desmopressin in 50 mL of sterile saline. The child weighs 15 kg. How much desmopressin should be administered? a. 4.5 mcg b. 0.02 mcg c. 50 mcg d. 45 mcg

a. 4.5 mcg 15 kg × 0.3 mcg/kg = 4.5 mcg.

The nurse educates a client newly diagnosed with hypothyroidism that replacement therapy usually continues until the client is euthyroid for how long? a. 6 to 12 months b. 18 to 24 months c. 3 to 6 months d. 8 to 12 months

a. 6 to 12 months Thyroid replacement therapy in the client with hypothyroidism is lifelong; no clear cut guidelines exist regarding duration of antithyroid drug therapy because of exacerbations and remissions. Replacement therapy usually continues until the client has been euthyroid for 6 to 12 months.

Somatropin would be prescribed for which of these patients? a. A 5-year-old with short stature and Turner syndrome b. A 5-year-old with short stature and history of open heart surgery in the past month c. A 7-year-old with short stature and recently involved in an ATV rollover d. A 12-year-old with short stature and closure of the growth plates

a. A 5-year-old with short stature and Turner syndrome Somatropin is used as long-term replacement therapy for children who have a growth failure secondary to inadequate endogenous GH secretion and those with short stature caused by Turner syndrome. Somatropin stimulates linear growth in such patients, resulting in an increase in skeletal growth. Therefore, it is given for short stature only when the epiphyses are not closed. Somatropin is not indicated for patients with acute critical illness due to complications following open heart or abdominal surgery, multiple accidental trauma, or acute respiratory failure because of an increased risk of mortality with these conditions.

A 43-year-old male client takes prednisone 7.5 mg daily to treat his temporal arteritis. His dose varies from 7.5 to 10 mg based on symptoms and laboratory test analysis. His disease process has been managed successfully with this drug regimen for 7 years. To prevent osteoporosis, what would his health care provider order? (Select all that apply.) a. A calcium supplement b. Testosterone c. A bisphosphonate drug d. Regular weight-bearing exercise e. A soy supplement

a. A calcium supplement c. A bisphosphonate drug d. Regular weight-bearing exercise Preventive measures are necessary for clients on chronic corticosteroid therapy (e.g., prednisone 7.5 mg daily; equivalent amounts of other systemic drugs; high doses of inhaled drugs). For both men and women, most of the guidelines for prevention of osteoporosis apply (e.g., calcium supplements, regular exercise, a bisphosphonate drug). In addition, low doses and nonsystemic routes help prevent osteoporosis and other adverse effects. For men, corticosteroids decrease testosterone levels by approximately one half, and replacement therapy may be needed.

A client has a blood calcium level of 4.6 mg/dL and is experiencing twitching of the facial muscles and tingling of the lips, fingers and toes. What is the priority action by the nurse? a. Administer calcium gluconate IV as prescribed. b. Request a prescription for ibandronate IV. c. Give calcitonin IV as prescribed d. Administer prednisone PO as prescribed.

a. Administer calcium gluconate IV as prescribed. The client's critically low calcium level is causing neuromuscular irritability as evidenced by the tetany and reports of tingling in the fingers, toes, and lips. The client needs calcium supplementation with an IV preparation that will work rapidly to elevate the calcium levels. Therefore, the nurse would administer prescribed calcium gluconate. Ibandronate is a biphosphate used for the treatment of osteoporosis; it would not be effective for emergency treatment of low calcium levels. Calcitonin and prednisone are indicated for treatment of hypercalcemia.

The nurse is reviewing the client's medication history. The client is to receive ibandronate. Which supplements would the nurse identify as possibly interfering with the drug's absorption? (Select all that apply.) a. Antacids b. Iron c. Calcium d. Multiple vitamins e. Aspirin

a. Antacids b. Iron c. Calcium d. Multiple vitamins Antacids decrease the absorption of oral bisphosphonates, such as ibandronate. Iron decreases the absorption of oral bisphosphonates, such as ibandronate. Calcium decreases the absorption of oral bisphosphonates, such as ibandronate. Multiple vitamins decrease the absorption of oral bisphosphonates, such as ibandronate. Aspirin increases the GI distress associated with bisphosphonates, but does not affect absorption.

Damage to which lobe of the pituitary gland would result in problems related to the function of stimulating hormones? a. Anterior b. Posterior c. Intermediate d. Lateral

a. Anterior The pituitary is made up of three lobes: Anterior, posterior, and intermediate. The anterior lobe produces stimulating hormones in response to hypothalamic stimulation.

A nurse's assessment of a client has revealed signs and symptoms of Paget's disease. Which of the following is one of the signs the nurse may have observed? a. Bone deformity b. Nearsightedness c. Shuffling gait d. Decreased pain response

a. Bone deformity Paget's disease is an inflammatory skeletal disease that affects older people. Its etiology is unknown. It is characterized by a high rate of bone turnover and results in bone deformity and pain.

Which of the following are examples of vitamin D preparations for oral intake? Choose all that apply. a. Calcitriol (Rocaltrol, Calcijex) b. Cholecalciferol (Delta-D) c. Paricalcitol (Zemplar) d. Calcium acetate (PhosLo) e. Calcium carbonate (Os-Cal, Tums)

a. Calcitriol (Rocaltrol, Calcijex) b. Cholecalciferol (Delta-D) c. Paricalcitol (Zemplar) Calcium acetate (PhosLo) and calcium carbonate (Os-Cal, Tums) are both examples of calcium supplements. All the others are examples of vitamin D preparations.

A client is taking prednisone 10 mg per day. Which laboratory study does the nurse identify as directly correlated with the use of this medication? a. Calcium level of 6.2 mg b. Potassium level of 4.2 mEq/L c. Phosphorus level of 3.5 mg/dL d. Sodium level of 145 mEq/L

a. Calcium level of 6.2 mg Normal serum calcium is 8.5 to 10.5 mg/dL. A low calcium level directly corresponds to the chronic use of corticosteroids; steroids decrease the absorption of calcium and place the client at risk for the development of osteoporosis. Potassium, sodium, and phosphorus levels are within normal range.

The nurse is preparing to administer methimazole to an 11-year-old client newly diagnosed with hyperthyroidism. What are the potential risks for the use of methimazole in children? (Select all that apply.) a. Cancer caused by radioactive iodine b. Chromosome damage c. Chronic hypertension d. Chronic hypotension e. Chronic hypothyroidism

a. Cancer caused by radioactive iodine b. Chromosome damage e. Chronic hypothyroidism For hyperthyroidism, PTU or methimazole is used. Potential risks for adverse effects are similar to those in adults. Radioactive iodine may cause cancer and chromosome damage in children; therefore, this agent should be used only for hyperthyroidism that cannot be controlled by other antithyroid drugs or surgery. It also may lead to the development of hypothyroidism

Calcium participates in many metabolic processes, including the regulation of which of the following? Choose all that apply. a. Cell membrane permeability and function b. Nerve-cell excitability and transmission of impulses c. Contraction of cardiac, skeletal, and smooth muscle d. Essential component of deoxyribonucleic acid e. Combines with fatty acids to form phospholipids

a. Cell membrane permeability and function b. Nerve-cell excitability and transmission of impulses c. Contraction of cardiac, skeletal, and smooth muscle Calcium participates in many metabolic processes, including the regulation of cell membrane permeability and function; nerve-cell excitability and transmission of impulses (e.g., required for release of neurotransmitters at synapses); and contraction of cardiac, skeletal, and smooth muscle. Phosphorus is an essential component of DNA and also forms phospholipids.

A client is to undergo fertility treatment and is to receive an agent that induces ovulation because her ovaries are functioning. Which agent would this most likely be? a. Chorionic gonadotropin b. Corticotropin c. Cosyntropin d. Thyrotropin alfa

a. Chorionic gonadotropin Chorionic gonadotropin would be used to induce ovulation in females with functioning ovaries. Corticotropin and cosyntropin are used to diagnose adrenal function. Thyrotropin alfa is used as adjunctive treatment for radioiodine ablation of thyroid tissue for thyroid cancer.

A child is receiving growth hormone therapy. The nurse suspects possible thyroid dysfunction based on which assessment? a. Cold intolerance b. Thirst c. Hunger d. Increased urination

a. Cold intolerance Intolerance to cold is associated with thyroid dysfunction. Thirst is associated with glucose intolerance. Hunger would reflect glucose intolerance. Increased urination would reflect glucose intolerance.

The primary function of the thyroid gland includes: a. Control of cellular metabolic activity b. Facilitation of milk ejection c. Reabsorption of water d. Reduction of plasma level of calcium

a. Control of cellular metabolic activity The primary function of the thyroid hormone is to control cellular metabolic activity. Oxytocin facilitates milk ejection during lactation and increases the force of uterine contraction during labor and delivery. Antidiuretic hormone (ADH) release results in reabsorption of water into the bloodstream rather than excretion by the kidneys. Calcitonin reduces the plasma level of calcium by increasing its deposition in bone.

Which would be used to diagnose adrenal function? a. Corticotropin b. Chorionic gonadotropin c. Thyrotropin alfa d. Menotropins

a. Corticotropin Cosyntropin, a synthetic form of corticotropin, is used to diagnose adrenal function. Chorionic gonadotropin would be used to induce ovulation in females with functioning ovaries. Thyrotropin alfa is used as adjunctive treatment for radioiodine ablation of thyroid tissue for thyroid cancer. Menotropins are used as a fertility drug to stimulate ovulation and spermatogenesis.

The treatment protocol for a client with hyperthyroidism includes antithyroid medication and propranolol. The purpose of propranolol is to do which of the following? a. Decrease tachycardia b. Promote weight loss c. Decrease the risk of infection d. Relieve coughing

a. Decrease tachycardia Propranolol is an adrenergic blocking agent. It is prescribed as adjunctive treatment for several weeks during antithyroid treatment, until the therapeutic effects of the antithyroid drug are obtained. Propranolol decreases tachycardia and palpitations, but it does not decrease the risk of infection or relieve coughing. People with hyperthyroidism tend to have difficulty with keeping weight on, a medication to enhance this effect would not be prescribed as part of the client's treatment.

The nurse is caring for a client with severe hypothyroidism and knows to contact the health care provider if which symptoms of myxedema coma occur? (Select all that apply.) a. Decreased level of consciousness b. Fever c. Decreased respirations d. High blood glucose level e. Decreased blood pressure

a. Decreased level of consciousness c. Decreased respirations e. Decreased blood pressure Symptoms of myxedema coma include coma, hypothermia, cardiovascular collapse, hypoventilation, hypoglycemia, and lactic acidosis.

After administering desmopressin to a client with diabetes insipidus, which would the nurse identify as indicating drug effectiveness? a. Decreased reports of thirst b. Elevated blood glucose levels c. Increased urination d.Decreased skin turgor

a. Decreased reports of thirst Thirst is associated with diabetes insipidus. A decrease in the symptom would indicate that the drug is working. Diabetes insipidus causes elevated blood glucose levels. Diabetes insipidus causes polyuria. Decreased skin turgor would suggest dehydration, which is a sign of diabetes insipidus.

A client diagnosed with diabetes insipidus is taking vasopressin (Desmopressin). What outcome would indicate to the nurse that the desmopressin is producing a therapeutic effect? a. Decreased urine output b. Decreased water reabsorption c. Increased plasma osmolarity d. Decreased blood volume

a. Decreased urine output Vasopressin causes the cortical and medullary parts of the collecting duct to become permeable to water, increasing water reabsorption and decreasing urine output. This process produces decreased plasma osmolarity and increases blood volume.

Which is released in response to decreased oxygenated blood flowing through the kidneys? a. Erythropoietin b. Glucagon c. Calcitonin d. Aldosterone

a. Erythropoietin Erythropoietin is released in response to a decrease in oxygenated blood flowing through the kidneys. Glucagon is released based on blood glucose levels. Calcitonin is released in response to serum calcium levels. Aldosterone is released in response to ACTH and to high potassium levels.

Which of the following should be included in the nurse's pre-administration assessment of a client about to receive somatropin ? Select all that apply: a. Height b. Weight c. Blood pressure d. Pulse e. Respiratory rate

a. Height b. Weight c. Blood pressure d. Pulse e. Respiratory rate Blood pressure, pulse, respiratory rate, temperature, height and weight should be included in the nurse's pre-administration assessment of a client about to receive somatropin (Nutropin).

The anatomy and physiology instructor is discussing hormones with the pre-nursing class. Which gland would the instructor tell the students controls secretions of the pituitary gland? a. Hypothalamus b. Pineal c. Thyroid d. Adrenal cortex

a. Hypothalamus The hypothalamus uses a number of hormones or factors to either stimulate or inhibit the release of hormones from the anterior pituitary. These factors are not secreted by the pineal, the thyroid, and the adrenal cortex.

The nurse is caring for a 77-year-old client and understands that calcium deficiency commonly occurs in the elderly because of what factors? (Select all that apply.) a. Impaired absorption of calcium from the intestine b. Excessive exposure to ultraviolet rays c. Lack of exposure to sunlight d. Impaired liver or kidney metabolism of vitamin D e. Excessive intake of sodium

a. Impaired absorption of calcium from the intestine c. Lack of exposure to sunlight d. Impaired liver or kidney metabolism of vitamin D Calcium deficiency commonly occurs in the elderly because of long-term dietary deficiencies of calcium and vitamin D, impaired absorption of calcium from the intestine, lack of exposure to sunlight, and impaired liver or kidney metabolism of vitamin D to its active form. It is not connected to sodium intake.

A nurse is caring for a client with subacute lymphocytic thyroiditis. The health care provider prescribes thyroid hormones to the client. From which sign during ongoing assessment should the nurse conclude that the client is responding to the therapy? a. Increased appetite b. Swollen neck c. Excessive sweating d. Flushing

a. Increased appetite The nurse should observe for signs of therapeutic responses, which include increased appetite, weight loss, mild diuresis, an increased pulse rate, and decreased puffiness of the face, hands, and feet. The nurse need not observe swollen neck, excessive sweating, or heat intolerance as signs of responding to therapy. Swollen neck, sore throat, and cough may occur after two to three days of administering radioactive iodine. Sweating and flushing are the adverse reactions to thyroid hormones.

Thyroid hormones are principally concerned with the increase in metabolic rate of tissues that can result in certain effects. What are some of these effects? Select all that apply. a. Increased heart rate b. Decreased respiratory rate c. Increased body temperature d. Increased cardiac output e. Decreased oxygen consumption

a. Increased heart rate c. Increased body temperature d. Increased cardiac output Thyroid hormones are principally concerned with the increase in metabolic rate of tissues, which results in increased heart and respiratory rate, body temperature, cardiac output, oxygen consumption, and the metabolism of fats, proteins, and carbohydrates.

A client is experiencing an increase in blood glucose levels. The nurse understands that which hormone would be important in lowering the client's blood glucose level? a. Insulin b. Parathormone c. Melatonin d. Calcitonin

a. Insulin Insulin is a hormone released by the beta islet cells that lowers the level of blood glucose when it rises above normal limits. Parathormone increases the level of calcium in the blood when a decrease in serum calcium levels occurs. Melatonin aids in regulating sleep cycles and mood. Calcitonin is a thyroid hormone that inhibits the release of calcium from the bone into the extracellular fluid.

What qualifies the hypothalamus to be called the master gland? a. It regulates the nervous and endocrine responses to stimuli. b. It stimulates the pituitary gland to control the endocrine system. c. It combines the nervous and endocrine system to work together. d. It produces all of the releasing hormones in the body.

a. It regulates the nervous and endocrine responses to stimuli. The hypothalamus gland is called the master gland of the neuroendocrine system because it regulates both nervous and endocrine responses to internal and external stimuli. There is more to the hypothalamus than just its stimulation of the pituitary gland or its production of releasing hormones that leads it to be considered the master gland. The neuroendocrine system combines the nervous and endocrine systems to work closely together to maintain regulatory control and homeostasis in the body.

The nurse is caring for a client with a possible calcium deficiency and reads the client's history to see if the client has experienced which common reasons for calcium deficiency? (Select all that apply.) a. Long-term dietary deficiencies of calcium and vitamin D b. Impaired absorption of calcium from the intestine c. Lack of exposure to sunlight d. Overexposure to ultraviolet rays e. Chronic use of ampicillin

a. Long-term dietary deficiencies of calcium and vitamin D b. Impaired absorption of calcium from the intestine c. Lack of exposure to sunlight Calcium deficiency commonly occurs because of long-term dietary deficiencies of calcium and vitamin D, impaired absorption of calcium from the intestine, lack of exposure to sunlight, and impaired liver or kidney metabolism of vitamin D to its active form. It is not associated with chronic use of ampicillin.

The nurse cares for a client who was admitted for multiple bone fractures resulting from a fall. The client has a comorbidity of hypothyroidism. Which diet is the most appropriate for this client? a. Low calorie, high fiber b. Low calorie, low fiber c. High calorie, low fiber d. High calorie, high fiber

a. Low calorie, high fiber Hypothyroidism slows the metabolism and decreases gastrointestinal secretions and motility. Hypothyroid clients, therefore, should be encouraged to eat a low-calorie, high-fiber diets to combat weight gain and constipation.

Which would the nurse expect to assess in a patient who is to start therapy with bisphosphonates? a. Muscle weakness b. Hyperactive reflexes c. Tetany d. Paresthesias

a. Muscle weakness Muscle weakness is a sign of hypercalcemia for which bisphosphonate, an antihypercalcemic agent, would be used. Hyperactive reflexes suggest hypocalcemia for which an antihypocalcemic agent would be used. Tetany suggests hypocalcemia for which an antihypocalcemic agent would be used. Paresthesias suggest hypocalcemia for which an antihypocalcemic agent would be used.

The nurse is caring for a client who is seeking care for a chronic condition. The nurse is aware that the FDA has issued a black box warning regarding the use of thyroid hormones for the treatment of what condition? a. Obesity b. Hypotension c. Diabetes mellitus type 1 d. GERD

a. Obesity The FDA has issued a black box warning regarding the use of thyroid hormones for the treatment of obesity or for weight loss, either alone or with other therapeutic agents. Significant and serious complications may develop in euthyroid people taking thyroid hormones.

Which of the following drug types is most likely to cause respiratory depression and myxedema coma in clients with thyroid disorders? a. Opioid analgesics b. Inderal c. Calcium channel blockers d. Methimazole

a. Opioid analgesics Clients with hypothyroidism are especially likely to experience respiratory depression and myxedema coma with opioid analgesics and other sedating drugs. These drugs should be avoided when possible.

After reviewing the hormonal secretion of the pituitary gland, the students demonstrate understanding when they identify which hormone as being released by the posterior lobe? a. Oxytocin b. Endorphins c. Thyrotropin d. Growth hormone

a. Oxytocin Oxytocin is released by the posterior pituitary gland. Endorphins are released by the intermediate lobe of the pituitary gland. Thyrotropin or thyroid releasing hormone is released from the anterior pituitary gland. Growth hormone is released by the anterior pituitary gland.

Which hormone is important for milk production in a lactating woman? a. Prolactin b. Oxytocin c. Luteinizing hormone d. Estrogen

a. Prolactin Prolactin is responsible for milk production in lactating women. Oxytocin is responsible for uterine contraction and the let down reflex. Luteinizing hormone is important in regulating the secretion of estrogen and progesterone in the menstrual cycle and in regulating the secretion of testosterone in males. Estrogen is responsible for the development of secondary sex characteristics in the female.

A patient will be treated for postmenopausal osteoporosis. The nurse knows that which drug for osteoporosis is an estrogen-receptor modulator? a. Raloxifene (Evista) b. Alendronate (Fosamax) c. Calcitonin-salmon (Miacalcin) d. Denosumab (Prolia)

a. Raloxifene (Evista) Raloxifene interacts with specific estrogen receptors. In bone it has agonist activity, which inhibits bone resorption. In the breasts and uterus, it is an estrogen-receptor blocker. Alendronate is a bisphosphonate binding directly to bone. Calcitonin-salmon and denosumab decrease bone resorption via actions that do not involve estrogen receptors.

Which event would mark the beginning of diurnal rhythm? a. Secretion of corticotropin releasing factor b. Peaking of adrenocortical response c. Falling levels of melanocyte stimulating hormone d. Release of follicle stimulating hormone

a. Secretion of corticotropin releasing factor Secretion of corticotropin releasing factor is the beginning event of diurnal rhythm. This event occurs usually early in the morning of the diurnal rhythm. Melanocyte stimulating hormone does not play a role in diurnal rhythm. Follicle stimulating hormone plays a role in the menstrual cycle.

A female client presents to the emergency department with symptoms and laboratory values indicative of hypercalcemia. What IV solutions would the health care provider order to treat the hypercalcemia? a. Sodium chloride (0.9%) b. D5 1/2 normal saline c. D5 1/4 normal saline d. Lactated Ringer's solution

a. Sodium chloride (0.9%) Sodium chloride (0.9%) injection (normal saline) is an IV solution that contains water, sodium, and chloride. It is included here because it is the treatment of choice for hypercalcemia and is usually effective. The sodium contained in the solution inhibits the reabsorption of calcium in renal tubules and thereby increases urinary excretion of calcium.

After teaching a group of students about growth hormone agonists and antagonists, the instructor determines that additional teaching is needed when the students identify which agent as a growth hormone antagonist? a. Somatropin b. Bromocriptine c. Octreotide d. Pegvisomant

a. Somatropin Somatropin is a growth hormone agonist.

A patient is to receive pegvisomant. The nurse would expect to administer this agent by which route? a. Subcutaneous b. Oral c. Intramuscular d. Intravenous

a. Subcutaneous Pegvisomant is administered by subcutaneous injection.

A patient is receiving teriparatide. The nurse would expect to administer this drug by which route? a. Subcutaneous b. Oral c. Intramuscular d. Intravenous

a. Subcutaneous Teriparatide is administered by subcutaneous injection.

A client is receiving a thyroid hormone to treat hypothyroidism. Which would indicate to the nurse that the client needs a reduced dosage of the drug? a. Tachycardia b. Slowed reflexes c. Pale dry skin d. Intolerance to cold

a. Tachycardia Tachycardia suggests hyperthyroidism due to excessive thyroid hormone; this would require a reduction in dosage. The other responses suggest hypothyroidism and drug ineffectiveness.

Which information about medication administration and meals should the nurse include in teaching a client prescribed calcium orally? a. Take with or after meals. b. Take 2 hours before a meal. c. Take early in the morning. d. Take as recommended by the pharmacist.

a. Take with or after meals. Oral preparations of calcium can be administered with or after meals to increase absorption. If used with an antacid, administer the calcium after a meal. The client does not need to take calcium 2 hours before a meal or early in the morning. The nurse should provide the administration recommendations while teaching about the need for the medication.

What is the body's physiological response when blood levels of calcium are excessive? a. The parathyroid glands stop making parathyroid hormone. b. The thyroid stops making parathyroid hormone. c. The parathyroid stops absorbing calcium. d. The parathyroid begins absorbing calcium.

a. The parathyroid glands stop making parathyroid hormone. When blood calcium levels increase above a certain point, calcium-sensing receptors in the parathyroid gland are activated to decrease hormone production. The thyroid gland does not produce parathyroid hormone. Calcium is absorbed in the intestines, not in the parathyroid gland.

Which of the following are appropriate goals to set with your patient who is suffering from an alteration in calcium levels? Choose all that apply. a. The patient will achieve and maintain normal serum levels of calcium. b. The patient will comply with instructions for safe drug use. c. The patient will decrease dietary intake of calcium-containing foods to prevent or treat osteoporosis. d. The patient will be monitored closely for therapeutic and adverse effects of drugs used to treat hypercalcemia.

a. The patient will achieve and maintain normal serum levels of calcium. b. The patient will comply with instructions for safe drug use. d. The patient will be monitored closely for therapeutic and adverse effects of drugs used to treat hypercalcemia. All are correct except the patient will want to increase dietary intake of calcium-containing foods to prevent and treat osteoporosis.

A female client is diagnosed with a pituitary hormone deficiency. She reports that her drug dosages are modified frequently. The nurse explains that the dosage of all pituitary hormones must be individualized. The nurse knows that what factor determines the dosage? a. The responsiveness of affected tissues, which varies b. The age of the client c. The weight of the client d. The responsiveness of affected tissues, which is static

a. The responsiveness of affected tissues, which varies Dosage of all pituitary hormones must be individualized because the responsiveness of affected tissues varies.

What is the duration of action of water-soluble, protein-derived hormones compared to that of lipid-soluble steroid and thyroid hormones? a. The water-soluble hormones have a shorter duration of action. b. The water-soluble hormones have a longer duration of action. c. The water-soluble hormones have the same duration of action. d. No comparison can be made regarding the duration of action.

a. The water-soluble hormones have a shorter duration of action. The lipid-soluble steroid and thyroid hormones have a longer duration of action than water-soluble, protein-derived hormones, because the former are bound to plasma proteins.

Which hormones are controlled by a negative feedback mechanism? (Select all that apply.) a. Thyroid hormone b, Follicle stimulating hormone c. Adrenocorticotropic hormone d. Prolactin e. Growth hormone

a. Thyroid hormone b, Follicle stimulating hormone c. Adrenocorticotropic hormone Thyroid hormone is controlled by the negative feedback system. Follicle stimulating hormone is controlled by the negative feedback system. Adrenocorticotropic hormone is controlled by the negative feedback system. Prolactin is not controlled by the negative feedback system. Growth hormone is not controlled by the negative feedback system.

A home health registered nurse has a client who cannot afford medications. The health care provider has ordered a calcium supplement for the client. What would the nurse recommend for the client? a. Tums (5 per day) b. Alendronate (Fosamax) c. Ibandronate (Boniva) d. Risedronate (Actonel)

a. Tums (5 per day) If taking a calcium supplement, calcium carbonate 500 milligrams twice daily is often recommended. This can be obtained through the inexpensive over-the-counter antacid Tums, which contains 200 milligrams of calcium per tablet.

Which of the following drugs is most commonly used in the treatment of bleeding esophageal varices? a. Vasopressin b. Pitocin c. Thyrogen d. Somavert

a. Vasopressin Pitocin functions in childbirth and lactation. Somavert is a GH receptor antagonist used in the treatment of acromegaly in adults who are unable to tolerate or are resistant to other management strategies. Thyrogen is a synthetic formulation of TSH used as a diagnostic adjunct for serum thyroglobulin (Tg) testing in individuals with well-differentiated thyroid cancer. Vasopressin is used as a vasoconstrictor for bleeding varices.

Which statement best summarizes the negative feedback loop of the hormones that regulate calcium and bone metabolism? a. When serum calcium levels are decreased, hormonal mechanisms increase them. b. When serum calcium levels are increased, hormonal mechanisms increase them. c. When hormonal levels are decreased, serum calcium levels are secreted. d. When hormonal levels are increased, serum calcium levels are inhibited.

a. When serum calcium levels are decreased, hormonal mechanisms increase them. Three hormones regulate calcium and bone metabolism: parathyroid hormone, calcitonin, and vitamin D. They all act to maintain normal serum levels of calcium. When serum calcium levels are decreased, hormonal mechanisms raise them. When the serum calcium levels are increased, hormonal mechanisms lower them. Overall, the hormones alter absorption of the dietary calcium from the gastrointestinal tract, movement of calcium from bone to serum, and excretion of calcium through the kidneys.

When is calcitonin released by the body? a. When serum calcium levels rise b. When serum calcium levels fall c. When PTH secretion mobilizes calcium d. When PTH secretion immobilizes calcium

a. When serum calcium levels rise The release of calcitonin is not controlled by the hypothalamic-pituitary axis, but is regulated locally at the cellular level. Calcitonin is released when serum calcium levels rise.

A client is diagnosed with Graves disease. Propylthiouracil (PTU) is prescribed. After 8 weeks of therapy, the client reports a fever and sore throat. The nurse is concerned that this symptoms may be early signs of: a. agranulocytosis. b. altered renal function. c. hepatotoxicity. d. hyperthyroidism.

a. agranulocytosis. Agranulocytosis is a serious but rare complication of PTU therapy. Agranulocytosis is characterized by an extreme reduction of white blood cells (neutropenia) and usually occurs in the first few months of PTU therapy. Altered renal function, hepatotoxicity, and hyperthyroidism are not identified adverse effects of PTU.

Bisphosphonates are drugs that bind to bone and inhibit calcium resorption from bone. These drugs are used to treat hypercalcemia. Which of the following are bisphosphonates? Choose all that apply. a. alendronate (Fosamax) b. ibandronate (Boniva) c. risedronate (Actonel) d. raloxifene (Evista) e. teriparatide (Forteo)

a. alendronate (Fosamax) b. ibandronate (Boniva) c. risedronate (Actonel) Fosamax, Boniva, and Actonel are all examples of bisphosphonates. Raloxifene is a selective estrogen receptor modulator; teriparatide is a parathyroid hormone.

Which of the following clinical manifestations are indicative of hypercalcemia? Choose all that apply. a. calcium serum level > 10.5 mg/dL b. coma c. lethargy d. convulsions e. tetany

a. calcium serum level > 10.5 mg/dL b. coma c. lethargy Severe hypercalcemia may produce lethargy, syncope, disorientation, hallucinations, coma, and death. Clinical manifestations of hypocalcemia are characterized by increased neuromuscular irritability, which may progress to tetany. Tetany is characterized by numbness and tingling of the lips, fingers, and toes; twitching of facial muscles; spasms of skeletal muscle; carpopedal spasm; laryngospasm; and convulsions.

During physical examination of a client with a suspected endocrine disorder, the nurse assesses the body structures. The nurse gathers this data based on the understanding that it is an important aid in: a. detecting evidence of hormone hypersecretion. b. detecting information about possible tumor growth. c. determining the presence or absence of testosterone levels. d. determining the size of the organs and location.

a. detecting evidence of hormone hypersecretion. The evaluation of body structures helps the nurse detect evidence of hypersecretion or hyposecretion of hormones. This helps in the assessment of findings that are unique to specific endocrine glands. Radiographs of the chest or abdomen are taken to detect tumors. Radiographs also determine the size of the organ and its location. Antidiuretic hormone (ADH) levels determine the presence or absence of ADH and testosterone levels.

The nurse knows that raloxifene achieves a therapeutic effect by altering the function of what hormone? a. estrogen b. thyroid-stimulating hormone (TSH) c. prolactin d. insulin

a. estrogen Raloxifene is a selective estrogen receptor modulator that is used to prevent or treat postmenopausal osteoporosis. It acts like estrogen in some body tissues and prevents the action of estrogen in other body tissues. It has estrogenic effects in bone tissue, thereby decreasing bone breakdown and increasing bone mass density. The drug is unrelated to TSH, prolactin, or insulin.

A client is receiving prednisone. When reviewing electrolyte level results, which would the nurse identify as an adverse reaction related to drug therapy? Select all that apply. a. hypokalemia b. hypernatremia c. hypocalcemia d. hyperkalemia e. hyponatremia

a. hypokalemia b. hypernatremia c. hypocalcemia Electrolyte disturbances associated with glucocorticoids such as prednisone include sodium retention (hypernatremia), potassium loss (hypokalemia), and hypocalcemia. The major cause of hyperkalemia is kidney dysfunction. Common causes of hyponatremia include diuretic use, diarrhea, heart failure, liver disease, renal disease, and the syndrome of inappropriate ADH secretion (SIADH).

Hypothalamic hormones must be given by what route to avoid destruction? Select all that apply. a. injection b. topically c. vaginally d. sublingually e. nasal inhalation

a. injection e. nasal inhalation Because the hormones are proteins, they must be given by injection or nasal inhalation (nafarelin). If taken orally, the hormones would be destroyed by the proteolytic enzymes in the gastrointestinal (GI) tract.

What hormones does the pancreas produce and release that help moderate the body's varying blood glucose levels? Select all that apply. a. insulin b. antidiuretic hormone (ADH) c. glucagon d. somatostatin e. amylase

a. insulin c. glucagon d. somatostatin The pancreas produces and releases insulin, glucagon, and somatostatin from different cells in response to varying blood glucose levels. ADH does not respond to blood glucose levels but controls sodium and potassium levels. Amylase is an enzyme released by the pancreas.

When describing thyroid function, the nurse would emphasize the need for intake of: a. iodine. b. calcium. c. sodium. d. vitamin B6.

a. iodine. Iodine intake is necessary for the production of thyroid hormones.

A nurse is teaching a client about a prescribed thyroid supplement and describes a drug that is relatively inexpensive, requires once-a-day dosing, and has a more uniform potency than do other thyroid hormone replacement drugs. Which drug is the nurse describing? a. levothyroxine b. propylthiouracil c. methimazole d. liotrix

a. levothyroxine Levothyroxine is the drug of choice for hypothyroidism because it is relatively inexpensive, requires once-a-day dosing, and has a more uniform potency than do other thyroid hormone replacement drugs. Propylthiouracil and methimazole are used to treat hyperthyroidism and are given in 8-hour intervals. Liotrix is used to treat hypothyroidism, given once a day, however, it is more expensive and does not have a more uniform potency.

In addition to calcium, what electrolyte affects parathyroid hormone (PTH) secretion? a. magnesium b. sodium c. potassium d. zinc

a. magnesium Another electrolyte—magnesium—also affects PTH secretion by mobilizing calcium and inhibiting the release of PTH when concentrations rise above or fall below normal. Sodium, potassium, and zinc do not affect PTH function.

A nurse is preparing to administer a scheduled dose of levothyroxine to an older adult client who is being treated in the hospital for a respiratory infection. Prior to administering the drug, the nurse should perform what assessment? a. measurement of blood pressure b. assessment of pupillary response c. chest auscultation for rales d. temperature measurement

a. measurement of blood pressure In older adults receiving levothyroxine, regular monitoring of blood pressure and pulse is essential. Temperature, pupillary response, and chest auscultation are not necessary before safe administration of this medication.

Based on the nurse's knowledge about thyroid hormone supplements, the nurse administers levothyroxine cautiously to a client who has recently had which condition or disorder? a. myocardial infarction b. cataract surgery c. seizure d. hypoglycemic episode

a. myocardial infarction A nurse should be cautious not to administer levothyroxine to a client who has recently had a myocardial infarction. Drug interactions with oral antidiabetics and insulin with hormone supplements can cause hyperglycemia. Seizure and cataract surgery are not contraindicated with the use of levothyroxine.

What drug type is most likely to cause respiratory depression and myxedema coma in clients with thyroid disorders? a. opioid analgesics b. thioamide antithyroids c. beta-adrenergic blockers d. calcium channel blockers

a. opioid analgesics Clients with hypothyroidism are especially likely to experience respiratory depression and myxedema coma with opioid analgesics and other sedating drugs. These drugs should be avoided when possible. None of the other options present with this contraindication.

What organ provides the control over the amount of calcium in the blood? a. parathyroid glands b. thyroid gland c. pituitary d. kidneys

a. parathyroid glands Parathyroid chief cells are cells in the parathyroid glands that produce parathyroid hormone. The end result of increased secretion by the chief cells of a parathyroid gland is an increase in the serum level of calcium. Parathyroid chief cells constitute one of the few cell types of the body that regulate intracellular calcium levels as a consequence of extracellular (or serum) changes in calcium concentration. The thyroid controls how quickly the body burns energy and makes proteins, and how sensitive the body should be to other hormones. The pituitary releases ACTH (adrenocorticotropic hormone), which in turn tells the adrenal cortex to release cortisol and aldosterone into the blood. The kidneys are complicated organs that have numerous biological roles. Their primary role is to maintain the homeostatic balance of bodily fluids by filtering and secreting metabolites (such as urea) and minerals from the blood and excreting them, along with water, as urine.

A hospital client's current medication administration record specifies oral administration of propylthiouracil (PTU) every 8 hours. What sign or symptom may have originally prompted the care provider to prescribe this drug? a. persistent tachycardia b. orthostatic hypotension c. visual disturbances d. tinnitus

a. persistent tachycardia Propylthiouracil (PTU) is used for the treatment of hyperthyroidism; one of the characteristic symptoms of this disease is tachycardia. Tinnitus, visual disturbances, and hypotension are not associated with hyperthyroidism.

Serum calcium levels are directly related to what blood components? a. protein b. potassium c. glucose d. sodium

a. protein Circulating calcium is in the free, ionized form (Ca2+) or bound to blood proteins such as serum albumin. Low serum albumin decreases the total serum level of calcium by decreasing the amount of calcium that is bound to protein. Serum calcium levels are not dependent on sodium, potassium, or glucose levels.

What effect do growth hormones (GH) have on homeostasis? Select all that apply. a. regulation of cell division b. regulation of protein synthesis c. programming of cell apoptosis d. stimulation of triglyceride synthesis e. sex determination during fetal development

a. regulation of cell division b. regulation of protein synthesis d. stimulation of triglyceride synthesis GH, also called somatotropin, stimulates growth of body tissues. It regulates cell division and protein synthesis required for normal growth and promotes an increase in cell size and number, including growth of muscle cells and lengthening of bone. GH enhances fat utilization by stimulating triglyceride breakdown and oxidation in fat-storing cells. GH does not influence apoptosis or sex determination.

A critically ill client is being treated with desmopressin. When reviewing the diagnostic and laboratory findings of a client prescribed desmopressin, the nurse should prioritize what values? Select all that apply. a. sodium (Na) b. potassium (K) c. hemoglobin (Hgb) d. leukocytes (WBC) e. partial thromboplastin time (PTT)

a. sodium (Na) b. potassium (K) Because of the profound changes in fluid balance that exist before and after treatment with desmopressin, it is important to assess the serum electrolytes, particularly the sodium and potassium levels. This takes precedence over coagulation factors, red blood cell indices, and white cell levels.

Which hormones are responsible for the growth of the body during childhood, especially the growth of muscles and bones? a. somatotropin b. vasopressin c. gonadotropin d. adrenocorticotropic hormone (ACTH)

a. somatotropin Somatropin is the hormone responsible for the growth of the body during childhood, especially the growth of muscles and bones. Vasopressin is the hormone responsible for the regulation of reabsorption of water by the kidneys. The gonadotropins (FSH and LH) influence the secretion of sex hormones, the development of secondary sex characteristics, and the reproductive cycle in both men and women. ACTH stimulates the adrenal cortex to secrete the corticosteroids in response to biologic stress.

Alendronate (Fosamax) is prescribed for a 67-year-old postmenopausal woman. In order to help prevent gastrointestinal distress, the nurse will advise the patient to: a. stand or sit upright for at least 30 minutes after taking alendronate. b. avoid drinking water with the drug. c. lift weights in the gym at least five times a week. d. take calcium and vitamin D supplements.

a. stand or sit upright for at least 30 minutes after taking alendronate. To decrease gastrointestinal distress, the patient should stand or sit upright for at least 30 minutes after taking the drug. Drinking at least 6 to 8 oz of water with the drug helps maximize the therapeutic effect of the drug. The patient should also take calcium and vitamin D supplements along with lifting weights to improve the success of therapy, but these interventions would not directly serve to decrease gastrointestinal distress.

What is the main purpose of the hormones secreted by the hypothalamus? a. stimulating or inhibiting release of hormones from the pituitary b. stimulating organs within the body to secrete hormones c. allowing the secretion of hormones from the hypothalamus d. stimulating other glands to release hormones

a. stimulating or inhibiting release of hormones from the pituitary The hypothalamus uses various hormones or factors to either stimulate or inhibit the release of hormones from the anterior pituitary. These do not stimulate other organs, the hypothalamus, or other glands to release hormones.

Diabetes insipidus is treated with replacement of which hormones? a. vasopressin b. gonadotropin c. somatropin d. adrenocorticotropic hormone (ACTH)

a. vasopressin Diabetes insipidus is treated with replacement of vasopressin. Gonadotropins are used to induce ovulation and pregnancy in anovulatory women (women whose bodies fail to produce an ovum or fail to ovulate). Of recombinant DNA origin, somatropin is identical to human GH and produces skeletal growth in children. This drug is administered to children who have not grown because of a deficiency of pituitary GH; it must be used before closure of the child's bone epiphyses. Bone epiphyses are the ends of bones. ACTH is produced by the anterior pituitary and stimulates the adrenal cortex to secrete the corticosteroids in response to biologic stress.

A group of nursing students are reviewing information about hormones secreted by the posterior pituitary gland. The students demonstrate understanding when they identify which hormone? a. vasopressin b. gonadotropin c. growth hormone d. adrenocorticotropic hormone (ACTH)

a. vasopressin Vasopressin is a hormone secreted by the posterior pituitary gland. Gonadotropin, growth hormones, and adrenocorticotropic hormones are secreted by the anterior pituitary gland.

Which hormones are responsible for the regulation of reabsorption of water by the kidneys? a. vasopressin b. gonadotropin c. somatotropin d. adrenocorticotropic hormone (ACTH)

a. vasopressin Vasopressin is the hormone responsible for the regulation of reabsorption of water by the kidneys. The gonadotropins (FSH and LH) influence the secretion of sex hormones, the development of secondary sex characteristics, and the reproductive cycle in both men and women. GH, also called somatotropic hormone, is secreted by the anterior pituitary. This hormone regulates the growth of the individual until approximately early adulthood or the time when the person no longer gains height. ACTH stimulates the adrenal cortex to secrete the corticosteroids in response to biologic stress.

a client will be using an insulin pump to deliver a consistent amount of insulin to meet the clients needs. where should the nurse insert the pump for the maximum amount of absorption

abdomen

the nurse is caring for a client who has been prescribed glyburide. which factor if identified in the client history, would cause the nurse to inform the health care provider of a contraindication to use?

allergy to sulfonamides

a older adult client has been prescribed metformin for the treatment of type 2 for several years. which change in the client lab values may demonstrate a need to discontinue the med?

an increase in serum lactate

The nurse educates a client recently diagnosed with hypothyroidism about using the prescribed levothyroxine. The client has a history of diabetes. Which client statement establishes the need for further clarification? a. "I will take the drug thirty minutes before breakfast the same time each day." b. "It does not matter which brand of the drug I take, they are all the same." c. "The levothyroxine can increase my glucose, so I need to report hyperglycemia." d. "Thyroid replacement is lifelong; dosage changes must come from my provider."

b. "It does not matter which brand of the drug I take, they are all the same." The nurse needs to clarify with further teaching the client's statement that it does not matter what brand of levothyroxine is taken. The client needs to keep taking the same brand because switching brands can lead to changes in the hormone level and affect the treatment. The other statements made by the client support an adequate understanding of various teaching points. Taking the drug before breakfast allows the medication to dissolve and be absorbed on an empty stomach. Taking the medication at the same time of day helps to maintain a steady state of the drug. Thyroid replacement may cause symptoms of diabetes to increase, so monitoring for hyperglycemia is warranted since the client has a history of diabetes. Thyroid replacement in this case is lifelong, and the client should not intentionally change a dose by increasing, decreasing, or skipping a dose.

Deficiency of which hormone causes excessive and frequent urination and excessive thirst? a. Prolactin deficiency b. ADH deficiency c. TSH deficiency d. ACTH deficiency

b. ADH deficiency Antidiuretic hormone (ADH), also called vasopressin, functions to regulate water balance. When ADH is secreted, it makes renal tubules more permeable to water. This allows water in renal tubules to be reabsorbed into the plasma and so conserves body water. In the absence of ADH, little water is reabsorbed, and large amounts are lost in the urine.

The nurse is caring for a child who needs replacement of the parathyroid hormone. A student nurse asks the nurse what the most common cause of hypoparathyroidism is. What would be the best correct response? a. Radiation injury b. Accidental removal of glands c. Destruction by iodine d. Accidental resection of thyroid

b. Accidental removal of glands The absence of PTH results in a low calcium level (hypocalcemia) and a relatively rare condition called hypoparathyroidism. This is most likely to occur with the accidental removal of the parathyroid glands during thyroid surgery.

A health care provider has prescribed thyroid drugs to a client with euthyroid goiter. Which should the nurse include in the nursing diagnosis checklist? a. Disturbed thought processes related to adverse drug reactions b. Anxiety related to symptoms, adverse reactions, and treatment regimen c. Risk for infection related to adverse drug reactions d. Risk for impaired skin integrity related to adverse reactions

b. Anxiety related to symptoms, adverse reactions, and treatment regimen The nurse should include anxiety related to symptoms, adverse reactions, and treatment regimen in the nursing diagnosis checklist on administering thyroid drugs to the client with euthyroid goiter. In the nursing diagnosis checklist for this client, the nurse need not include disturbed thought processes related to adverse drug reactions, risk for infection, or risk for impaired skin integrity related to adverse drug reactions. Risk for infection related to adverse drug reactions and risk for impaired skin integrity related to adverse reactions must be included in the nursing diagnosis checklist of a patient who is administered antithyroid drugs. The nursing diagnosis checklist of a client receiving ACTH must include disturbed thought processes related to adverse drug reactions.

The health care provider has ordered oral calcium for a client. The nurse understands that this medication is used to treat or manage which conditions? (Select all that apply.) a. Poor digestion b. Bone loss c. Fractures d. Chronic nonemergent hypercalcemia e. Heartburn

b. Bone loss c. Fractures e. Heartburn Calcium is used to decrease stomach acid and reduce heartburn. It also is used in the treatment of chronic nonemergent hypocalcemia. It decreases bone loss and assists in reducing fractures in women.

The nurse should review which lab result before advising a client about taking the first dose of ibandronate (Boniva)? a. Potassium b. Calcium c. Glucose d. Magnesium

b. Calcium When bisphosphonates are administered, serum calcium levels are monitored before, during, and after therapy.

A client who is taking tetracycline has been prescribed a calcium supplement. What guidance should the nurse include in medication teaching? a. Calcium enhances the effectiveness of tetracycline. b. Calcium should be taken at least 2 hours before or after taking tetracycline. c. Calcium presents no considerations associated with tetracycline therapy. c. Calcium and tetracycline should be taken 4 to 6 hours after meals to prevent toxicity.

b. Calcium should be taken at least 2 hours before or after taking tetracycline. Oral calcium preparations decrease the effects of oral tetracycline drugs by combining with the antibiotic and preventing its absorption. The two medications should be taken at least 2 hours apart.

The pharmacology instructor is discussing hormones with the nursing students. What hormone, important in the digestive process, is secreted by the gastrointestinal mucosa? a. Liothyronine b. Cholecystokinin c. Tetraiodothyronine d. Prolactin

b. Cholecystokinin Gastrointestinal mucosa produces hormones that are important in the digestive process (i.e., gastrin, enterogastrone, secretin, and cholecystokinin).

The nurse is caring for a client who would like to increase her phosphorus intake. The nurse instructs the client to increase the amount of what foods that are high in phosphorus? a. Apples b. Dairy products c. Tomatoes d. Potatoes

b. Dairy products Dairy products are high in phosphorus.

The most common cause of subclinical hyperthyroidism is: a. Untreated osteoporosis. b. Excess thyroid hormone therapy. c. Previous neck radiation. d. Taking central nervous system depressants.

b. Excess thyroid hormone therapy. Clients should be monitored closely for hypothyroidism while taking antithyroid drugs, which usually develops within a year after receiving treatment for hyperthyroidism. The most common cause of subclinical hyperthyroidism is excess thyroid hormone therapy.

During a general health assessment, a client indicates taking thyroid medication to increase weight loss. What should the nurse teach the client about this use of the medication? a. Thyroid medication will increase weight loss, but the client needs to take a calcium supplement as well. b. Excessive or unnecessary antithyroid medication may produce serious or life-threatening manifestations of toxicity. c. Thyroid medication will increase weight loss, but the client will need to take supplementary iodine. d. Studies have shown that thyroid medication will not contribute to weight loss.

b. Excessive or unnecessary antithyroid medication may produce serious or life-threatening manifestations of toxicity. The FDA has issued a black box warning regarding the use of thyroid hormones for the treatment of obesity or weight loss, either alone or with other therapeutic agents. Significant and serious complications may develop with normal thyroid function.

A nurse should recognize that a client taking antithyroid medication may be developing thyrotoxicosis if the client exhibits which of the following symptoms? a. Sore throat b. Extreme tachycardia c. Excessive fatigue d. Easy bruising

b. Extreme tachycardia Signs of thyrotoxicosis (increased hyperthyroidism) include high fever, extreme tachycardia, and altered mental status. A sore throat would alert the nurse to possible agranulocytosis. Fatigue is a sign of hypothyroidism. Bruising is a sign of increased bleeding tendency, not hyperthyroidism.

The nurse would contact the health care provider prior to administering desmopressin to a client with a history of what condition? a. Allergy to bananas b. Heart attack c. Detached retina d. Gout

b. Heart attack Desmopressin is contraindicated in clients with a history of cardiovascular disorders because a black box warning stipulates that changes in fluid volume status may result in cardiac arrest in clients with known cardiovascular disease.

Teriparatide (Forteo) is a recombinant DNA version of parathyroid hormone (PTH). How is this drug different than others that are used in the treatment of osteoporosis? Choose all that apply. a. Slows bone loss b. Increases bone formation c. Does not accumulate in bone or other tissues d. Does not require dose adjustment with renal or hepatic impairment e. Increases serum levels of calcium and calcitriol

b. Increases bone formation c. Does not accumulate in bone or other tissues d. Does not require dose adjustment with renal or hepatic impairment e. Increases serum levels of calcium and calcitriol Other drugs for osteoporosis slow bone loss, whereas teriparatide increases bone formation by increasing the number of bone-building cells (osteoblasts). Teriparatide also increases serum levels of calcium and calcitriol. It is not expected to accumulate in bone or other tissues, to interact significantly with other drugs, or to require dosage adjustment with renal or hepatic impairment.

The nursing students in pharmacology class are learning about menotropin. What would they learn this drug is used to treat? a. Promote development of secondary sex characteristics b. Induce ovulation c. Promote bone growth d. Treat diabetes insipidus

b. Induce ovulation Menotropin is used as fertility drug to stimulate ovulation and spermatogenesis. is not used to promote the development of secondary sex hormones, promote bone growth, or treat diabetes insipidus.

The pharmacology instructor is providing education regarding propylthiouracil to the nursing students. What would the instructor identify as the primary mode of action for this medication? a. Destruction of part of the thyroid gland b. Inhibition of production of thyroid hormone c. Suppression of the anterior pituitary gland's hormonal secretions d. Sedation of the central nervous system and suppression of cardiac function

b. Inhibition of production of thyroid hormone Propylthiouracil acts by inhibiting production of thyroid hormones and peripheral conversion of thyroxine (T4) to the more active triiodothyronine (T3).

Hypothalamic hormones must be given by which route to avoid destruction? a. Topically or vaginal suppository b. Injection or nasal inhalation c. Sublingually or nasal inhalation d. Injection or sublingually

b. Injection or nasal inhalation Because the hormones are proteins, they must be given by injection or nasal inhalation. If taken orally, the hormones would be destroyed by the proteolytic enzymes in the GI tract.

A client is to receive nafarelin. The nurse would instruct the client in administering this drug by which route? a. Oral b. Intranasal c. Intramuscular d. Subcutaneous

b. Intranasal Nafarelin is given in nasal form.

A client diagnosed with hyperthyroidism is unsure about the need for the prescribed propranolol, stating, "I looked this up online and it's for high blood pressure, not thyroid problems." What statement concerning beta-adrenergic blockers should the nurse use as a basis for the response? a. It will inhibit the release of hormones from the anterior pituitary gland. b. It will block stimulation of the sympathetic nervous system. c. It stimulates the parasympathetic nervous system. d. It limits the action potential involved in cardiac conduction.

b. It will block stimulation of the sympathetic nervous system. When given to clients with hyperthyroidism, propranolol blocks beta-adrenergic receptors in various organs and thereby controls symptoms of hyperthyroidism resulting from excessive stimulation of the sympathetic nervous system. None of the other options provide accurate information concerning the appropriate use of propranolol in the management of hyperthyroidism.

A nurse is performing patient education for a woman who has just been prescribed a bisphosphonate. Which diagnostic and history findings would have prompted the woman's care provider to prescribe a bisphosphonate? a. Height in the lowest quartile of the population and a history of joint pain b. Low bone density and a family history of osteoporosis c. Reports of cold intolerance, recurrent constipation, and evidence of diverticular disease d. Labile moods and short-term memory deficits

b. Low bone density and a family history of osteoporosis Bisphosphonate drugs are recommended for long-term management of hypercalcemia to increase bone resorption of calcium, in treating and preventing osteoporosis in postmenopausal women, and in managing Paget disease. Low bone density and a family history of osteoporosis would consequently indicate a potential benefit. Impaired growth, cold intolerance, and cognitive deficits are not indications for the use of bisphosphonates.

A patient asks the nurse to explain the physiological actions of phosphorous. The nurse knows which of these statements regarding phosphorous is correct? a. Most phosphorous is free in the circulatory system. b. Milk is the best source of phosphorous. c. Vitamin D is essential for phosphorous absorption. d. Phosphorous deficiency is a common disorder.

b. Milk is the best source of phosphorous. Most phosphorous is bound to calcium in bones and teeth. Milk contains equal amounts of phosphorous and calcium, which promotes absorption of phosphorous. Vitamin D enhances but is not essential for phosphorous absorption. Phosphorous is found in many foods, especially dairy products, meats, eggs, and nuts; thus, deficiency is rare.

The pharmacology instructor is discussing the endocrine system with a class of pre-nursing students. What would the instructor tell the students is considered to be a hormone? a. Acetylcholine b. Norepinephrine c. Nucleic acid d. Serotonin

b. Norepinephrine A hormone is secreted directly into the blood stream and travels from the site of production to react with specific receptor sites to cause an action. Norepinephrine, which is a neurotransmitter, is a hormone when it is produced in the adrenal medulla, secreted into circulation, and travels to norepinephrine receptor sites to cause an effect. Acetylcholine and serotonin are neurotransmitters, but are not hormones. Nucleic acid is used to build DNA and RNA.

A nurse is reviewing the laboratory values of a client being treated for a diagnosis of hypocalcemia. The current serum calcium level is 8.1 mg/dL. What intervention does the nurse expect the prescriber to order? a. Redraw the serum level of calcium. b. Order an additional calcium supplement. c. Prescribe potassium chloride infusion. d. The prescriber will not order any intervention.

b. Order an additional calcium supplement. Normal serum calcium levels are in the range of 8.5 to 10.5 mg/dL. The nurse would anticipate that the level is below the therapeutic range and the prescriber should order another calcium supplement. Once the hypocalcemia is stabilized, finding the underlying cause of recurrence is priority. Measurement of serum magnesium levels should also be completed to correct the hypocalcemia. The potassium chloride infusion is not associated with calcium.

The nurse is discussing the use of corticosteroids with a group of nursing students and tells that students that both men and women who take corticosteroids are at risk for what side effect? a. Infertility b. Osteoporosis c. Hypertension d. Paget's disease

b. Osteoporosis Both men and women who take corticosteroids are at risk for osteoporosis.

The nurse is preparing to administer octreotide. The nurse expects to administer this drug by which route? a. Oral b. Subcutaneous c. Intramuscular d. Intranasal

b. Subcutaneous Octreotide must be administered subcutaneously.

A client is to receive teriparatide. The nurse would instruct the client in: a. Oral administration b. Subcutaneous injection c. Intranasal spray administration d. Transdermal application

b. Subcutaneous injection Teriparatide is administered subcutaneously.

Following an assessment by her primary care provider, a 70-year-old resident of an assisted living facility has begun taking daily oral doses of levothyroxine. Which assessment finding should prompt the nurse to withhold a scheduled dose of levothyroxine? a. The resident has not eaten breakfast because of a recent loss of appetite. b. The resident's apical heart rate is 112 beats/minute with a regular rhythm. c. The resident had a fall during the night while transferring from her bed to her bathroom. d. The resident received her annual influenza vaccination the previous day.

b. The resident's apical heart rate is 112 beats/minute with a regular rhythm. If the pulse rate is greater than 100 bpm, it is necessary to withhold a levothyroxine dose in an older adult. Anorexia, recent vaccination, and recent falls do not necessary indicate a need to withhold this medication.

Which hormone regulates the production and release of thyroid hormone? a. Thyrotropin-releasing hormone (TRH) b. Thyroid-stimulating hormone (TSH) c. Tetraiodothyronine d. Triiodothyronine

b. Thyroid-stimulating hormone (TSH) The anterior pituitary hormone called thyroid-stimulating hormone (TSH) regulates thyroid hormone production and release. The secretion of TSH is regulated by thyrotropin-releasing hormone (TRH), a hypothalamic regulating factor. Tetraiodothyronine and triiodothyronine are thyroid hormones produced by the thyroid gland using iodine that is found in the diet.

Knowing that thyroid hormones are principally concerned with the increase in metabolic rate of tissues, which symptoms would a nurse observe in a client with uncontrolled hypothyroidism? (Select all that apply.) a. Elevated body temperature b. Weight gain c. Bradycardia d. Hypertension e. Sleepiness

b. Weight gain c. Bradycardia e. Sleepiness The signs and symptoms of hypothyroidism include: decreased metabolism, cold intolerance, low body temperature, weight gain, bradycardia, hypotension, lethargy, sleepiness, pale, cool, dry skin, face appears puffy, coarse hair, thick, hard nails, heavy menses, fertility problems, and low sperm count.

Knowing that thyroid hormones are principally concerned with the increase in metabolic rate of tissues, which symptom would a nurse observe in a client with uncontrolled hyperthyroidism? (Select all that apply.) a. Low body temperature b. Weight loss c. Tachycardia d. Hypotension e. Sleepiness

b. Weight loss c. Tachycardia The signs and symptoms of hyperthyroidism include increased metabolism, heat intolerance, elevated body temperature, weight loss, tachycardia, hypertension, nervousness, anxiety, insomnia, exophthalmos, flushed (warm, moist, red) skin, thinning hair, goiter, and irregular or scant menses.

The nurse is providing education to a client who has been newly diagnosed with osteoporosis. How should the nurse describe the role of the parathyroid on the development of the disorder? a. When there is too much parathyroid hormone, the bones retain calcium at a rate that is too high, resulting in bones that have too little calcium. b. When there is too much parathyroid hormone, the bones release their calcium into the blood at a rate that is too high, resulting in bones which have too little calcium. c. When there is too much parathyroid hormone, the thyroid releases calcium into the blood at a rate that is too high, resulting in bones that have too little calcium. d. When there is too much thyroid hormone, the parathyroid releases calcium into the blood at a rate that is too high, resulting in bones that have too little calcium.

b. When there is too much parathyroid hormone, the bones release their calcium into the blood at a rate that is too high, resulting in bones which have too little calcium. Osteoporosis associated with hyperparathyroidism is caused by the high parathyroid hormone that is secreted by the overactive parathyroid gland(s). This excess parathyroid hormone acts directly on the bones to remove calcium from the bones.

The nurse is providing education to a client who is taking calcium for the treatment of osteopenia. What is the rationale for the nurse suggesting that the client limit whole grains in the diet? a. Whole grains contain insufficient amounts of needed calcium. b. Whole grains are known to interfere with calcium absorption. c. Whole grains interact with calcium and increase serum phosphate levels. d. Whole grains increase the client's risks of adverse effects when taking calcium supplements.

b. Whole grains are known to interfere with calcium absorption. Clients should be taught to avoid whole grain cereals in the meal before taking calcium because they interfere with calcium absorption. The restriction is not related to serum phosphate levels, adverse effects, or the nutritional content of the grain products.

Which hormone is released in the presence of low blood volume? a. growth hormone (GH) b. antidiuretic hormone (ADH) c. adrenocorticotropic hormone (ACTH) d. thyroid-stimulating hormone (TSH)

b. antidiuretic hormone (ADH) Secretion of ADH (vasopressin) occurs when body fluids become concentrated (high amounts of electrolytes in proportion to the amount of water) and when blood volume is low. None of the other hormones are secreted in cases of low blood volume.

Increases in what specific physiologic effects are expected outcomes of thyroid hormone therapy? Select all that apply. a. pituitary secretion of TSH b. carbohydrate metabolism c. cellular metabolism d. oxygen consumption e. cardiac output

b. carbohydrate metabolism c. cellular metabolism d. oxygen consumption e. cardiac output Some specific physiologic effects of thyroid hormones include increased rate of cellular metabolism and oxygen consumption, with a resultant increase in heat production; increased heart rate, force of contraction, and cardiac output; increased carbohydrate metabolism; increased fat metabolism, including increased lipolytic effects of other hormones and metabolism of cholesterol to bile acids; and inhibition of pituitary secretion of thyroid-stimulating hormone (TSH).

The nurse is reviewing the medication history of a client who reports taking a calcium supplement. What medication, if taken with calcium, presents the risk of drug toxicity? a. fluoroquinolones b. digoxin c. atenolol d. phenytoin

b. digoxin Calcium preparations and digoxin have similar effects on the myocardium. Therefore, if calcium is given to a client taking digoxin, the risks of digitalis toxicity and cardiac dysrhythmias are increased. This combination must be used very cautiously. Calcium decreases the effects of multiple drugs—including phenytoin, atenolol, and fluoroquinolones—so calcium should be taken separately.

A nurse is caring for a 70-year-old client who is taking desmopressin (DDAVP). The client has a history of cardiovascular disease. The nurse will prioritize the assessment of: a. weight. b. electrolyte levels. c. dehydration. d. body temperature.

b. electrolyte levels. Desmopressin should be used with caution in clients with conditions associated with fluid and electrolyte imbalance, such as cystic fibrosis or renal or cardiovascular diseases, because these clients are especially prone to hyponatremia. When administered to either pediatric or geriatric individuals, fluid intake should be adjusted downward to limit the risk of hyponatremia and water intoxication. The drug has no effect on the weight or the temperature of the client. There is no risk for dehydration.

The nurse is caring for a pediatric client with a new onset of hypercalcemia. What condition would be most likely to cause this altered serum calcium level? a. radiation injury b. malignancy c. liver failure d. hypothyroidism

b. malignancy Hypercalcemia is relatively rare in children, although it may be seen with certain malignancies. It would not result from a radiation injury, which would be more likely to affect the thyroid gland, and it would not be caused by liver failure or hypothyroidism.

The nurse is caring for a client who is prescribed raloxifene to treat postmenopausal osteoporosis. The nurse will question the health care provider about this medication when noticing what information in the medical record? a. history of total hip replacement b. treatment for coronary heart disease c. medicated for type 2 diabetes d. treatment for a small bowel obstruction 3 months ago

b. treatment for coronary heart disease Raloxifene is a selective estrogen receptor modulator that is used to prevent or treat postmenopausal osteoporosis. It acts like estrogen in some body tissues and prevents the action of estrogen in other tissues. Raloxifene increases the risk of deep vein thrombosis or pulmonary emboli, and the risk of death due to stroke may be increased in clients with coronary heart disease. Because of these risks, the nurse should question providing the medication to the client with coronary heart disease. Raloxifene is not contraindicated for a history of joint replacements, treatment for type 2 diabetes, or a previous small bowel obstruction.

a hospital client diganosed with type 1 is prescribed regular insulin on a sliding scale. based on the clients blood glucose reading. the nurse administerd 8 units of insulin at 7:45. the nurse should consequently check the clients blood glucose level at what time to monitor peak effecitveness of the med?

between 9:45 and 10:45

A female client with a six-month-old infant has been prescribed propylthiouracil (PTU). What is the most important question the nurse should ask this client? a. "Have you ever taken thyroid replacement medications in the past?" b. "Did your baby have hyperthyroidism in utero?" c. "Are you breastfeeding your child?" d. "How long have you had thyroid related symptoms?"

c. "Are you breastfeeding your child?" Mothers taking PTU should not breastfeed their children (pregnancy category D). For the safety of the infant, the nurse should ask the client if she's breastfeeding. Taking thyroid medications in the past does not have an immediate impact on safety for the client or infant. Using PTU during pregnancy can cause hypothyroidism in the fetus. The time frame in which the client has had thyroid-related symptoms does not have an immediate effect on safety of the client or infant.

A nurse is discussing nutrition with a group of older adults at a community senior center. The nurse informs the group that the recommended daily calcium intake is: a. 1500-2000 mg b. 750-1250 mg c. 1000-1500 mg d. 2000-2500 mg

c. 1000-1500 mg For most adults, the calcium requirement is 1000 mg daily. For postmenopausal women do not take replacement estrogens, it is 1500 mg daily.

A client is diagnosed with diabetes insipidus. The health care provider orders desmopressin, which the nurse knows is the synthetic equivalent of what hormone? a. PTH b. ACTH c. ADH d. PTCH

c. ADH Desmopressin (DDAVP, Stimate) and vasopressin (Pitressin) are synthetic equivalents of ADH. A major clinical use is the treatment of neurogenic diabetes insipidus, a disorder characterized by a deficiency of ADH and the excretion of large amounts of dilute urine.

A client is diagnosed with both hypothyroidism and adrenal insufficiency. If the adrenal insufficiency is not treated first, what may occur with the administration of thyroid hormone? a. Hypertensive crisis b. Acute congestive heart failure c. Acute adrenocortical insufficiency d. Life-threatening arrhythmias

c. Acute adrenocortical insufficiency When hypothyroidism and adrenal insufficiency coexist, the adrenal insufficiency should be treated with a corticosteroid drug before starting thyroid replacement. Thyroid hormones increase tissue metabolism and tissue demands for adrenocortical hormones. If adrenal insufficiency is not treated first, administration of thyroid hormone may cause acute adrenocortical insufficiency, a life-threatening condition.

A primary health care provider has prescribed levothyroxine to a client with hypothyroidism. Which information would the nurse include in the teaching plan to promote an optimal response to the drug therapy? a. Bring your recorded pulse rates to the primary health care provider. b. Offer suggestions about the dosage schedule. c. Administer the drug early in the morning before breakfast. d. Apply soothing creams or lubricants to prevent rashes.

c. Administer the drug early in the morning before breakfast. The nurse should instruct the client to administer the drug early in the morning before breakfast to promote an optimal response to the drug therapy since an empty stomach increases the absorption of the oral preparation. When methimazole and propylthiouracil are administered to the client, the nurse should recommend that the client record the pulse rates and bring the record to the primary health care provider. If the client expresses a concern about the dosage schedule, the nurse can offer suggestions to the client about the dosage schedule. If the client experiences a rash while taking methimazole or propylthiouracil, the nurse needs to inform the client to apply soothing creams or lubricants.

The nurse elicits a positive Chvostek sign when tapping on the facial nerve. What action by the nurse is a priority after this assessment is complete? a. Assess the client's level of thyroid hormone. b. Assess the client's sodium level for hyponatremia. c. Assess the client's calcium level for hypocalcemia. d. Assess the client's potassium level for hypokalemia.

c. Assess the client's calcium level for hypocalcemia. Hypocalcemia is indicated by a positive Chvostek sign and the nurse should assess the calcium level for the deficit and prepare to administer calcium. Low levels of potassium, thyroid hormone, and sodium do not elicit the response of tetany.

A nurse is caring for a patient with hypothyroidism. The nurse would know that the effects of hypothyroidism include: a. Nervousness and restlessness b. Fever c. Decreased cardiac output d. Increased blood pressure

c. Decreased cardiac output Decreased cardiac output is an effect of hypothyroidism. Low-grade fever, nervousness and restlessness, and increased systolic blood pressure are among the effects of hyperthyroidism.

The client with hypothyroidism takes levothyroxine daily and has triiodothyronine (T3), thyroxine (T4), and thyroid-stimulating hormone (TSH) levels drawn in the laboratory to check appropriateness of prescribed dosage. What results would the nurse analyze as indicating the need for a higher dosage of medication? a. Elevated TSH, elevated T3, and reduced T4 levels b. Reduced TSH, elevated T3 and T4 levels c. Elevated TSH, reduced T3 and T4 levels d. Reduced TSH, T3, and T4 levels

c. Elevated TSH, reduced T3 and T4 levels TSH levels would be elevated to stimulate increased thyroid hormone secretion, whereas T4 and T3 will be low, which indicates the need for a higher dosage of medication. If TSH level is low, it would indicate a reduction in dosage would be needed, particularly if T3 and T4 levels are elevated.

Which would a nurse expect to assess in a client experiencing hyperthyroidism? a. Slow and deep tendon reflexes b. Bradycardia c. Flushed, warm skin d. Intolerance to cold

c. Flushed, warm skin Clients with hyperthyroidism typically exhibit flushed, warm skin; hyperactive deep tendon reflexes; tachycardia; and intolerance to heat.

The release of FSH and LH are stimulated by what hormone? a. Thyrotropin-releasing hormone b. Prolactin-releasing factor c. Gonadotropin-releasing factor d. Melanocyte-stimulating hormone

c. Gonadotropin-releasing factor Factors that stimulate the release of hormones are growth hormone-releasing hormone (GHRH), thyrotropin-releasing hormone (TRH), gonadotropin-releasing hormone (GnRH), corticotropin-releasing hormone (CRH), and prolactin-releasing hormone (PRH).

The nurse is preparing to administer levothyroxine to a client. Which assessment finding would cause the nurse to hold the medication? a. Respiratory rate of 16 b. Temperature of 99.3°F c. Heart rate of 110 beats per minute d. Blood pressure of 107/64

c. Heart rate of 110 beats per minute Levothyroxine should be held if the client's heart rate is over 100 beats per minute.

What is the best position for the client after the administration of a bisphosphonate medication? a. Supine b. Prone c. High Fowler's d. Lateral recumbent

c. High Fowler's The client should be instructed to remain upright (avoid lying down - supine, prone, or lateral recumbent) for at least 30 minutes after taking bisphosphonate drugs. Therefore, the best position is high Fowler's.

Predisposing factors for myxedema coma include all of the following EXCEPT: a. Exposure to cold. b. Respiratory disease. c. History of Lupus. d. Taking central nervous system depressants.

c. History of Lupus. Myxedema coma is severe, life-threatening hypothyroidism characterized by coma, hypothermia, cardiovascular collapse, hypoventilation, and severe metabolic disorders such as hyponatremia, hypoglycemia, and lactic acidosis. Predisposing factors include exposure to cold, infection, trauma, respiratory disease, and administration of central nervous system depressants.

A 45-year-old client is receiving somatropin for treatment of a growth hormone deficiency. The nurse educates the client that regular laboratory tests will be needed to monitor the client for which adverse effect? a. Leukocytosis b. Renal dysfunction c. Hyperglycemia d. Hyponatremia

c. Hyperglycemia Middle-aged and older adults who use GH for treatment of a growth hormone deficiency are at high risk for the development of hyperglycemia.

A patient is diagnosed with hypocalcemia. The nurse knows that which statement regarding hypocalcemia is correct? a. Hypocalcemia is a calcium blood level of 10.5 mg/dL. b. Hypocalcemia is characterized by a decrease in muscle tone. c. Hypocalcemia can be accompanied by hyperphosphatemia. d. Hypocalcemia often occurs with breast cancer and multiple myeloma.

c. Hypocalcemia can be accompanied by hyperphosphatemia. Normal blood levels of calcium are 8.5 to 10.5 mg/dL. Calcium blood levels below 8.5 mg/dL are hypocalcemia. This imbalance is characterized by increased muscle tone that can progress to tetany. Phosphorus levels are increased when calcium levels fall; thus, hypocalcemia is often accompanied by hyperphosphatemia. Several malignancies, including breast cancer and multiple myeloma, enhance decalcification of bone, leading to hypercalcemia.

Several nursing students are reviewing information about osteoporosis in preparation for a class discussion. The students demonstrate a need for additional review when they state that which of the following is a risk factor? a. Excess caffeine intake b. Prolonged corticosteroid use c. Hypothyroidism d. Sedentary lifestyle

c. Hypothyroidism Among the many risk factors for osteoporosis are sedentary lifestyle, excessive intake of caffeine or alcohol, chronic use of certain medications (e.g., corticosteroids), hyperthyroidism, advanced age, white or Asian race, and family history of the disease.

A client is diagnosed with liver disease. How would this affect the metabolism of the drugs used to treat the client's hypothyroidism? a. It would be unaffected. b. It would be rapid. c. It would be prolonged. d. It would be short-lived.

c. It would be prolonged. Drug metabolism in the liver is delayed in clients with hypothyroidism and liver disease, so most drugs given to these clients have a prolonged effect.

Prevention of osteoporosis includes which of the following measures? a. Placing items within reach of the client. b. Installing grab bars in the bathroom to prevent falls. c. Maintaining adequate calcium and vitamin D intake. d. Using a professional alert system in the home in case a fall occurs when the client is alone.

c. Maintaining adequate calcium and vitamin D intake. Measures that can reduce the risk of developing osteoporosis include maintaining adequate dietary intake of calcium and vitamin D. The other options describe measures that can reduce the risk of injury related to the disease.

A client is prescribed ibandronate. The nurse instructs the client to take the drug at which frequency? a. Once a week b. Once every 2 weeks c. Once a month d. Once every 3 months

c. Once a month Ibandronate is taken once a month on the same day each month.

A patient with hypothyroidism is at increased risk for respiratory depression and myxedema coma if given what category of drugs? a. Antibiotics b. Corticosteroids c. Opioid analgesics d. Nonsteroidal anti-inflammatory drugs

c. Opioid analgesics Most drugs given to patients with hypothyroidism have a prolonged effect, because drug metabolism in the liver is delayed and the glomerular filtration rate of the kidneys is decreased. People with hypothyroidism are especially likely to experience respiratory depression and myxedema coma with opioid analgesics and other sedating drugs. These drugs should be avoided when possible.

Which hormone would be responsible for the letdown reflex in lactating women? a. Prolactin b. Follicle-stimulating hormone c. Oxytocin d. Luteinizing hormone

c. Oxytocin Oxytocin stimulates uterine smooth muscle contraction in late pregnancy and also causes the milk release or letdown reflex in lactating women. Prolactin is the hormone responsible for milk production. Follicle-stimulating hormone and luteinizing hormone are responsible for the initial events of the menstrual cycle.

An instructor is preparing a teaching plan for a class on the various pituitary hormones. Which hormone would the instructor include as being released by the posterior pituitary gland? a. Somatotropin b. Prolactin c. Oxytocin d. Adrenocorticotropic hormone

c. Oxytocin The posterior pituitary gland releases oxytocin and antidiuretic hormone. Somatotropin, prolactin, and adrenocorticotropic hormone are released by the anterior pituitary gland.

A 25-year-old female client is diagnosed with hypothyroidism. She is admitted to the hospital for acute gallbladder disease and subsequent surgical intervention. When planning postoperative opioid pain management, the nurse must take into account the fact that the client is at greater risk for what condition, secondary to the client's hypothyroidism diagnosis? a. Hypotension b. Hypertension c. Respiratory depression d. Atrial fibrillation

c. Respiratory depression People with hypothyroidism are especially likely to experience respiratory depression and myxedema coma with opioid analgesics and other sedating drugs.

The nurse is caring for a client who has a possible thyroid disorder and is aware that what medication will be used in diagnostic testing? a. PTU b. Levothyroxine c. Sodium iodide-131 d. Propranolol

c. Sodium iodide-131 Sodium iodide-131 is used in the diagnosis of thyroid disease and also in the treatment of hyperthyroidism.

A client is prescribed levothyroxine. The nurse understands that this drug contains: a. T3. b. iodine. c. T4. d. vitamin D.

c. T4. Levothyroxine is a synthetic salt of T4; desiccated thyroid contains both T3 and T4. Liothyronine contains T3. Iodine is an antithyroid agent. Calcitriol is a form of vitamin D.

The client, prescribed posterior pituitary hormone therapy, demonstrates the technique used to deliver the medication nasally. Which action requires immediate review of the technique by the nurse? a. Sits upright in a chair b. Inserts tip of bottle into nostril 1/2 inch c. The head is tilted back d. Presses finger against one nostril to occlude it

c. The head is tilted back Instruct the patient to sit upright and press a finger over one nostril to close it. Then, with the spray bottle held upright, have the patient place the tip of the bottle about 1.5 cm (1/2 in.) into the open nostril. A firm squeeze should deliver the drug to the desired mucosal area for absorption. Caution the patient not to use excessive force and not to tip the head back because these actions could result in ineffective administration.

The nurse is assessing a child who is receiving growth hormone therapy. What would the nurse identify as suggesting glucose intolerance? a. Injection site pain b. Fatigue c. Thirst d. Cold intolerance

c. Thirst Signs of glucose intolerance include thirst, hunger, and voiding pattern changes. Injection site pain is an adverse effect of the therapy. Fatigue and cold intolerance suggest thyroid dysfunction.

Which of the following hypothalamic hormones causes the release of TSH in response to stress, such as exposure to cold? a. Growth hormone-releasing hormone (GHRH) b. Gonadotropin-releasing hormone (GnRH) c. Thyrotropin-releasing hormone (TRH) d. Prolactin-inhibitory factor (PIF)

c. Thyrotropin-releasing hormone (TRH) In response to stress, the hypothalamus releases TRH, which stimulates the pituitary to produce TSH (thyrotropin).

Your client, an 18-year-old bodybuilder, indicates that he is considering using growth hormones to increase his muscle mass. When discussing this, you would advise him about all of the following EXCEPT: a. Possible adverse effects include acromegaly and diabetes. b. Possible adverse effects include hypertension and increased risk of cardiovascular disease. c. Using growth hormone in moderate amounts can make the heart function more efficiently. d. Using growth hormones is potentially dangerous because the long-term effects are unknown.

c. Using growth hormone in moderate amounts can make the heart function more efficiently. Inappropriate use of GH is an increasing concern. Young athletes may use the drug for bodybuilding and to enhance athletic performance. If so, they are likely to use relatively high doses. In addition, the highest levels of physiologic hormone are secreted during adolescence. The combination of high pharmacologic and high physiologic amounts increases the risks of health problems from excessive hormone. Also, there is little evidence that hormone use increases muscle mass or strength beyond that achieved with exercise alone.

Which statement reflects the relationship between calcium and phosphate? a. There is no relationship with calcium and phosphate. b. When there is an increase in calcium, the phosphate is elevated. c. When there is an increase in calcium, the phosphate is decreased. d. When there is a decrease in calcium, the phosphate is decreased.

c. When there is an increase in calcium, the phosphate is decreased. An inverse relationship exists between calcium and phosphate. When serum calcium levels increase, serum phosphate levels decrease. When the serum calcium level decreases, serum phosphate levels increase. Calcium and phosphorus are learned together as they are closely related. These mineral nutrients occur in the same food, and absorbed together.

The process in which hormone secretion is stimulated when hormones are needed and inhibited when they are not needed is known as: a. cyclic patterns. b. a positive feedback system. c. a negative feedback system. d. releasing and inhibitory factors.

c. a negative feedback system. A negative feedback system is one in which hormone secretion is stimulated when hormones are needed and inhibited when they are not needed. The hypothalamic-pituitary-thyroid axis also functions by a negative feedback mechanism.

After administering somatropin to an 11-year-old client with growth failure, what outcome would indicate that the drug should be stopped? a. early sexual development b. thyroid over activity c. closure of the epiphyses in long bones d. gynecomastia

c. closure of the epiphyses in long bones Closure of the epiphyses is a sign that the drug should be stopped. Early sexual development, thyroid overactivity, and gynecomastia would not be associated with this drug.

The hypothalamus is the gland that helps regulate the CNS and ANS and the endocrine system. By regulating these systems, the hypothalamus works to maintain the: a. negative feedback system. b. diurnal rhythm. c. homeostasis. d. prolactin-inhibiting factor (PIF).

c. homeostasis. The hypothalamus works to help maintain homeostasis or a balance between the endocrine system and the CNS and ANS. The negative feedback system is how the homeostasis is maintained. When the hypothalamus senses a need for a certain hormone, it secretes a releasing factor directly into an area such as the anterior pituitary. This causes the area to produce a hormone. When the hypothalamus senses a rising level of the hormone, it stops secreting the releasing factor, which decreases the hormone production. When this occurs, the hypothalamus senses the falling hormone level and the releasing factor is secreted again. This process is how the hormone level is maintained. Diurnal rhythm refers to the release of hormones at various times of the day. PIF produced by the hypothalamus acts as a regulator to shut off production of hormones when levels become too high.

What is a common cause of primary hypothyroidism? Select all that apply. a. insufficient release of thyrotropin-releasing hormone (TRH) b. dysfunctional anterior pituitary secretion c. hyperthyroidism medication therapy d. Hashimoto's thyroiditis e. radiation to the neck

c. hyperthyroidism medication therapy d. Hashimoto's thyroiditis e. radiation to the neck Common causes of primary hypothyroidism include chronic (Hashimoto's) thyroiditis, an autoimmune disorder characterized by inflammation of the thyroid gland, and treatment of hyperthyroidism with antithyroid drugs, radiation therapy, or surgery. Secondary hypothyroidism occurs when there is decreased TSH from the anterior pituitary gland or decreased thyrotropin-releasing hormone (TRH) secreted from the hypothalamus, which disrupts the negative feedback mechanism.

A client diagnosed with excessive parathyroid production is prone to develop: a. Alzheimer's disease. b. hypertension. c. osteopenia. d. heart disease.

c. osteopenia. Most of the symptoms of parathyroid disease are "neurological" in origin. The most common symptoms are fatigue and tiredness. Other very common symptoms are lack of energy, memory problems, depression, problems with concentration, and problems sleeping. However, these symptoms are improved after intervention. Thus, although it may contribute to an existing diagnosis of Alzheimer's, it is not the cause. Hypertension is not commonly associated with this disorder. Excess parathyroid hormone acts directly on the bones to remove calcium from the bones. The calcium levels may cause abnormalities in heart function, but they do not cause heart disease.

When learning about thyroid hormones in pharmacology, the nursing students learn that when the thyroid gland is stimulated by thyroid-stimulating hormone (thyrotropin or TSH) from the anterior pituitary gland, thyroid hormones are: a. stored in the thyroid gland. b. stored in the parathyroid glands. c. released into the bloodstream. d. released into the lymphatic system.

c. released into the bloodstream. Thyroid hormones are released into the circulation when the thyroid gland is stimulated by thyroid-stimulating hormone (thyrotropin or TSH) from the anterior pituitary gland.

The nurse is caring for a client who takes alendronate. What laboratory result best demonstrates successful treatment? a. serum iodine 515 nmol/L (65.3 µg/L) b. free thyroxine 22 pmol/L (1.7 ng/dL) c. serum calcium 2.45 mmol/L (9.8 mg/dL) d. thyrotropin 3.1 mIU/L (3.1 mIU/L)

c. serum calcium 2.45 mmol/L (9.8 mg/dL) Alendronate and risedronate are commonly used drugs for osteoporosis and calcium lowering. All of the listed components are within their respective reference ranges, but calcium levels are the focus of this client's treatment.

The nurse is preparing a teaching tool on the action of calcium preparations. The nurse will identify that calcium is absorbed through which body area? a. mouth b. stomach c. small intestine d. large intestine

c. small intestine The absorption of calcium occurs in the small intestines. Approximately one third of the amount of calcium consumed is actually absorbed. Calcium is not absorbed through the mouth, the stomach, or the large intestines.

What is the regulatory function of vasopressin? a. growth b. lactation c. water balance d. corticosteroid production

c. water balance Antidiuretic hormone (ADH), also called vasopressin, functions to regulate water balance. Corticotropin stimulates corticosteroid production. Oxytocin is involved in lactation. Growth hormone stimulates growth of body tissues.

Some hormones are secreted in cyclic patterns. How long is the time pattern related to secretion of estrogen and progesterone? a. 24 hours b. 5 weeks c. 7 days d. 28 days

d. 28 days Estrogen and progesterone secretion is related to the menstrual cycle, which is typically 28 days long.

A client is prescribed methimazole for the treatment of hyperthyroidism. Which is a rare adverse effect or set of effects related to the administration of methimazole? a. Joint swelling with fever b. Immune-mediated hyperthyroidism c. Arthralgia d. Agranulocytosis

d. Agranulocytosis The rare but fatal adverse effects of methimazole are agranulocytosis, which affects only 0.2% to 0.5% of all people taking antithyroid medication; aplastic anemia; liver damage; and vasculitis. On the other hand, arthralgia, joint swelling, itching, rash, fever, hives, headaches, nausea, and vomiting are common, minor adverse effects of the drug. However, methimazole is used to treat immune-mediated hyperthyroidism of Graves disease, and it is not an adverse effect of the drug.

A nurse is caring for a client suffering from a severe form of hyperthyroidism called thyrotoxicosis or thyroid storm. What would the nurse observe for in the client as a characteristic of thyroid storm? a. Memory impairment b. Cold intolerance c. Constipation d. Altered mental status

d. Altered mental status A severe form of hyperthyroidism called thyrotoxicosis or thyroid storm is characterized by high fever, extreme tachycardia, and altered mental status (e.g., coma). The nurse need not observe memory impairment, cold intolerance, or constipation as characteristics of thyroid storm. Memory impairment, cold intolerance, and constipation are the manifestations of myxedema, which is a severe hypothyroidism.

When the release of a hormone is not influenced by the HPA, what is their release in response to? a. Indirect local stimulation b. Direct delayed stimulation c. Indirect delayed stimulation d. Direct local stimulation

d. Direct local stimulation Some hormones are not influenced by the HPA and are released in response to direct, local stimulation.

A female client presents to the health care provider's office for a routine physical examination. The nurse assesses her current over-the-counter drug history and discovers that she takes vitamin D 600 international units daily. The nurse recognizes that the client is at risk for what condition? a. Paget's disease b. Hypocalcemia c. Hypocalciuria d. Hypercalcemia

d. Hypercalcemia Clients diagnosed with osteoporosis require adequate calcium and vitamin D (at least the recommended dietary allowance), whether obtained from the diet or from supplements. Calcium 600 mg and vitamin D 200 international units once or twice daily are often recommended for postmenopausal women with osteoporosis, and pharmacologic doses of vitamin D are sometimes used to treat clients with serious osteoporosis. If such doses are used, caution should be exercised, because excessive amounts of vitamin D can cause (?)

A client presents at the clinic reporting weight loss despite an increased appetite. For which condition should this client be assessed? a. Chronic thyroiditis b. Hyperglycemia c. Hypothyroidism d. Hyperthyroidism

d. Hyperthyroidism Hyperthyroidism is manifested by increased appetite and metabolism. Without treatment, it may be difficult for hyperthyroid individuals to consume enough calories to prevent weight loss. Hypothyroidism, which may be caused by thyroiditis, causes decreased appetite and metabolism, and hypothyroid patients frequently experience weight gain.

The nurse knows that phosphates should be given only when hypercalcemia is accompanied by hypophosphatemia. Hypophosphatemia is assumed when the serum phosphorus is less than what level? a. Less than 5 mg/dL b. Less than 10 mg/dL c. Less than 4 mg/dL d. Less than 3 mg/dL

d. Less than 3 mg/dL Phosphates should be given only when hypercalcemia is accompanied by hypophosphatemia (serum phosphorus less than 3 mg/dL) and renal function is normal, to minimize the risk of soft tissue calcification.

A female client's diagnoses include hyperthyroidism, congestive heart failure, and type 2 diabetes mellitus. What effect will the treatment of hyperthyroidism have on her routine medications? a. Metabolism will be slower than normal, and the dose will be increased. b. Metabolism will be slower than normal, and the dose will be decreased. c. Metabolism will be faster than normal, and the dose will be decreased. d. Metabolism will be faster than normal, and the dose will be increased.

d. Metabolism will be faster than normal, and the dose will be increased. Treatment of hyperthyroidism changes the rate of body metabolism, including the rate of metabolism of many drugs. In the hyperthyroid state, drug metabolism may be very rapid, and higher doses of most drugs may be necessary to achieve therapeutic results. When the client becomes euthyroid, the rate of drug metabolism is decreased. Consequently, doses of all medications should be evaluated and probably reduced to avoid severe adverse effects.

After teaching a group of students about bisphosphonates, the students demonstrate understanding of the information when they identify which drug as an example? a. Teriparatide b. Calcitonin-salmon c. Dihydrotachysterol d. Pamidronate

d. Pamidronate Pamidronate is an example of a bisphosphonate. Teriparatide and dihydrotachysterol are antihypocalcemic agents. Calcitonin-salmon is a calcitonin used to treat hypercalcemia.

Growth hormones cause all of the following EXCEPT: a. Stimulation and growth of body tissues. b. Regulation of cell division and protein synthesis. c. Promotion of an increase in cell size and number. d. Suppression of triglyceride synthesis.

d. Suppression of triglyceride synthesis. GH, also called somatotropin, stimulates growth of body tissues. It regulates cell division and protein synthesis required for normal growth and promotes an increase in cell size and number, including growth of muscle cells and lengthening of bone. These effects occur mainly via altered metabolism of carbohydrate, protein, and fat by direct and indirect effects. GH is often considered an insulin antagonist because it suppresses the abilities of insulin to stimulate uptake of glucose in peripheral tissues and enhance glucose synthesis in the liver.

A client diagnosed with hypothyroidism is to start thyroid hormone replacement therapy. Which lab value should the nurse review to assist the health care provider in determining the dosage? a. Platelets b. Glucose c. CBC d. TSH

d. TSH Lab work to determine thyroid hormone dosages includes TSH (thyroid-stimulating hormone), T3 and T4 levels, and possibly thyroid antibodies.

During a general health assessment, a client indicates taking thyroid medication to increase weight loss. What statement should be the basis of the nurse's response? a. While taking thyroid medication, the client needs to take a calcium supplement as well. b. While taking thyroid medication, the client needs to take additional dietary supplements of iodine as well. c. Taking thyroid medication will not contribute to weight loss but only result in a redistribution of fat deposits. d. Taking excessive or unnecessary thyroid medication may produce serious or life-threatening manifestations of toxicity.

d. Taking excessive or unnecessary thyroid medication may produce serious or life-threatening manifestations of toxicity. The FDA has issued a black box warning regarding the use of thyroid hormones for the treatment of obesity or weight loss, either alone or with other therapeutic agents. Significant and serious complications may develop in euthyroid clients talking thyroid hormones.

The nurse is caring for four clients. Which client is at the highest risk for osteoporosis? a. The client receiving diuretic therapy b. The client with a diagnosis of renal hypertension c. The client with frequent falls d. The female client aged 76

d. The female client aged 76 Postmenopausal women are at high risk for osteoporosis.

A patient is receiving calcitonin by IM injection. The nurse would expect the drug's effects to last how long? a. less than 1 hour b. approximately 2 hours c. approximately 3 to 4 hours d. approximately 6 to 8 hours

d. approximately 6 to 8 hours Calcitonin by IM injection decreases serum calcium levels in approximately 2 hours; its effects last approximately 6 to 8 hours.

A patient with osteoporosis has bones that become progressively porous, brittle, and especially prone to fracture. This increased susceptibility to fracture manifests most commonly as: a. spiral fracture of the tibia. b. dislocation of the shoulder. c. boxer's fracture. d. compression fracture of the vertebrae.

d. compression fracture of the vertebrae. Although all bones in the affected patient are more prone to fracture, common fracture sites are the vertebrae of the lower dorsal and lumbar spines, wrists, and hips.

A nurse is organizing the care of a child who takes somatropin. The desired outcome the nurse should prioritize in the planning of this child's care is that the client will: a. experience a normal progression of secondary sex characteristics. b. not demonstrate the signs and symptoms of water intoxication. c. deny feelings of anxiety. d. demonstrate an increase in linear growth.

d. demonstrate an increase in linear growth. The primary indication for the use of somatotropin is GH deficiency leading to short stature. Anxiety, water intoxication, and lack of sex characteristics are not associated with GH deficiency and are not addressed through the therapeutic use of somatropin.

A 65-year-old client was involved in a motor vehicle accident and sustained a closed head injury. He is diagnosed with diabetes insipidus and is prescribed vasopressin for the management of this condition. Which condition would pose a risk for this client as a vasopressin recipient? a. gender would be a risk factor b. if the client has abused alcohol in the past c. has a history of chronic obstructive pulmonary disease d. has a history of left ventricular enlargement

d. has a history of left ventricular enlargement Vasopressin should be used with caution in patients with coronary artery insufficiency or those who are hypertensive. Vasopressin is used cautiously in patients with a history of seizures, migraine headaches, asthma, heart failure (HF), or vascular disease (because the substance may precipitate angina or myocardial infarction) and in those with perioperative polyuria.

What organs function to control most of the body's metabolic functions and maintain homeostasis? Select all that apply. a. gonads b. thyroid c. adrenal gland d. hypothalamus e. pituitary gland

d. hypothalamus e. pituitary gland The hypothalamus of the brain and the pituitary gland interact to control most metabolic functions of the body and to maintain homeostasis. The hypothalamus controls secretions of the pituitary gland. The pituitary gland, in turn, regulates secretions or functions of other body tissues, called target tissues. The functions of the other glands are more limited in scope.

A client exhibits severe tachycardia, fever, dehydration, and heart failure. The nurse recognizes that these signs are consistent with what thyroid-associated health condition? a. subclinical hyperthyroidism b. Hashimoto's disease c. myxedema d. thyroid storm

d. thyroid storm Thyroid storm is a crisis or life-threatening condition characterized by an exaggeration of the usual physiologic response seen in hyperthyroidism. Whereas hyperthyroidism can cause symptoms such as sweating, feeling hot, palpitations, and weight loss, the symptoms of thyroid storm are more severe, resulting in complications such as fever, rapid heart rate, nausea/vomiting, diarrhea, irregular heartbeat, weakness, heart failure, confusion/disorientation, and coma. Myxedema and Hashimoto's disease are forms of hypothyroidism, so they would not manifest similarly.

an 8 month old infant admitted with a new diagnnosis of diabetes is to receive 1 unit of regular insulin. how will that 1 unit be administered

dilution strength of U-10

a client newly diagnosed with diabetes reports "constant,insatiable thirst" when providing teaching to the clinet, how should the nurse explain the symptoms?

excess glucose pulled more water through your kidneys and the increased urination caused thirt

the nurse is providing education to the parents of a child who has been newly diagnosed with type 1. what distinguishing characteristic of the disorder does the nurse include in the teaching

exogenous insulin is required for life

the nurse is providing education to a client who has been prescribed thearpy with an antidiabetic medication. during teaching, the nurse will caution the clinet against heavy intake of which herb?

garlic

the nurse is preparing to administer 20 units of NPH insulin to a client. before administering the med, the nurse should implement which interventions?

have a colleague confirm the dosage

The nurse is caring for a client who is taking glyburide as treatment for type 2 diabetes mellitus. The health care provider has added a corticosteroid to this client's medication regimen for treatment of a severe allergic reaction. The nurse knows that this drug combination may cause what adverse effect on this client?

hyperglycemia Explanation: Corticosteroids increase insulin needs, so the client may develop hyperglycemia.

After reviewing information about different insulin preparations, a nursing student demonstrates understanding of the information when the student identifies which medication as an example of a long-acting insulin?

insulin glargine Explanation: Insulin glargine is an example of a long-acting insulin. Insulin lispro and insulin aspart are rapid-acting insulin. Isophane insulin suspension is an intermediate-acting insulin.

A nurse is preparing to administer a rapid-acting insulin. Which medication would the nurse most likely administer?

insulin lispro Explanation: Insulin lispro is an example of a rapid-acting insulin. Insulin glargine and insulin detemir are long-acting insulin. Isophane insulin suspension is an intermediate-acting insulin.

a client has been prescribe acarbose. what is the advantage of acarbose over alternative drugs

it delays the digestion of complex carbohydrates

a client diagnosed with type 2 is prescribed pramlintide. how will this drug assist in controlling the client blood sugar?

it slows gastric emptying

what is teh expected action of sitagliptin on type 2?

it slows the rate of inactivation of the incretin hormones

a client who regularly takes metformin has developed a severe infection. hwo will the infection change the established diabetic regimen?

metformin is contraindicated in the presence of infections

When considering the management of diabetic ketoacidosis (DKA), what type of insulin can be administered intravenously?

regular Explanation: Regular insulin (insulin injection) has a rapid onset of action and can be given intravenously. Therefore, it is the insulin of choice during acute situations, such as DKA, severe infection or other illness, and surgical procedures. All the other options are administered subcutaneously.

the nurse is preparing to administer insulin intravenously to a client with a blood glucose level of over 600mg/dL (33.33 mmol?l). what type of insulin will the nurse MOST likely give

regular insulin

the nurse is educating a client regarding the use of pramlintide acetate for the treatment of diabetes type 1. what statement made by the client indicates that further education is required

since I amon this new med, I dont have to take my insulin any longer

a 4 year old child with type 1 becomes angry and then lethargic. what should the nurse educate the parents regarding the behavioral changes

the child may be experiencing a hypoglycemic response

a client has not had anything to eat or drink within the past 12 hours and has a fasting blood glucose level of 125 mg/dL. what does the nurse interpret these findings to indicate?

the client has an impaired fasting blood glucose level

which condition must be met in order for glyburide treatment to be effective?

the client must have functioning pancreatic beta cells

the parent of a child with diabetes asks the nurse why a quick-acting sugar given by mouth is better in the regulation of insulin than the use of intravenous glucose for a low blood sugar. which statement by the nurse represents the MOST appropriate response to the questions?

the ingestion of food allows the digestive tract to stimulate vagal activity and the release of incretins

a client eats a large meal of pasta. when does the nurse inform the client the insulin levels will rise?

the insulin levels will rise to a peak in a matter of minutes then decrease to baseline in 2 to 3 hours

A client with diabetes is undergoing testing for glycosylated hemoglobin. The nurse instructs the client that this test measures average blood glucose over what time period?

the past 3 or 4 months Explanation: Glycosylated hemoglobin measures glucose control over the past 3 to 4 months. When blood glucose levels are high, glucose molecules attach to hemoglobin in the red blood cell. The longer the hyperglycemia lasts, the more glucose binds to the red blood cell and the higher the glycosylated hemoglobin. This binding lasts for the life of the red blood cell (about 4 months) so the other time frames would not be accurate.