Pharm Chapter 17 and 41
The nurse is teaching a client who will require long-term corticosteroid therapy how to reduce the risk of infection. What suggestions will the nurse include?
"Avoid large crowds of people in confined spaces." Explanation: With long-term therapy, the importance of avoiding exposure to infection—crowded areas, people with colds or the flu, activities associated with injury—should be stressed. If an injury or infection should occur, the client should be encouraged to seek medical care. These clients do not need to avoid work, exercise, or touching others, but they should use good hand hygiene to avoid infection from these sources.
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.
Which HbA1c result would indicate that a client's diabetes is under good control?
7% Explanation: Results vary with the laboratory method used for analysis, but in general, levels between 6.5% and 7% indicate good control of diabetes. Results of 10% or greater indicate poor blood glucose control for the last several months.
Which client demonstrates the clearest indication for treatment with prednisone?
A 70-year-old man whose rheumatoid arthritis has not responded to OTC pain relievers Explanation: There are numerous clinical indications for treatment with glucocorticoids such as prednisone. Among these are inflammatory diseases such as rheumatoid arthritis. Emphysema, hypertension, and leukemia are not health problems that are typically treated with corticosteroids.
While learning about corticosteroids in pharmacology class, a student asks the instructor what a clinical indication for the use of corticosteroids would be. What would be the instructor's best response?
A disease with an inflammatory component Explanation: Indications: Replacement therapy in adrenal cortical insufficiency, short-term management of various inflammatory and allergic disorders, hypercalcemia associated with cancer, hematological disorders, ulcerative colitis, acute exacerbations of multiple sclerosis, palliation in some leukemias, trichinosis with systemic involvement.
A 54-year-old male client is diagnosed with chronic renal failure and hyperglycemia. He asks if he can be prescribed sulfonylurea because it works well for his friend. If he were to be given sulfonylurea, this client's renal impairment may lead to what effect?
Accumulation and hypoglycemia Explanation: Sulfonylureas and their metabolites are excreted mainly by the kidneys; renal impairment may lead to accumulation and hypoglycemia. They should be used cautiously, with close monitoring of renal function, in clients with mild to moderate renal impairment and are contraindicated in severe renal impairment.
What is a strategy to minimize HPA suppression and risks of acute adrenal insufficiency?
Administering a systemic corticosteroid during high-stress situations in clients on long-term systemic therapy Explanation: Strategies to minimize HPA suppression and risks of acute adrenal insufficiency include administering a systemic corticosteroid during high-stress situations in clients who are on long-term systemic therapy (i.e., are steroid dependent).
A nurse is assigned to administer glargine to a patient at a health care facility. What precaution should the nurse take when administering glargine?
Avoid mixing glargine with other insulin. Explanation: When administering glargine to the patient, the nurse should avoid mixing it with other insulin or solutions. It will precipitate in the syringe when mixed. If glargine is mixed with another solution, it will lose glucose control, resulting in decreased effectiveness of the insulin. Glargine is administered via SC once daily at bedtime. The nurse should not shake the vial vigorously before withdrawing insulin. The vial should be gently rotated between the palms of the hands and tilted gently end-to-end immediately before withdrawing the insulin. The nurse administers insulin from vials at room temperature. Vials are stored in the refrigerator if it is to be stored for about three months for later use.
The nurse is educating a client who is beginning therapy with acarbose and tells the client to take the medication with the first bite of each main meal to help prevent what adverse effect?
Bloating and diarrhea Explanation: Clients who take acarbose should take the medication with the first bite of each main meal to prevent bloating and diarrhea.
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 female client is diagnosed with adrenal insufficiency. She presents to the emergency department with hypotension. What would the nurse expect her to be prescribed?
Corticosteroids Explanation: In adrenal insufficiency, hypotension is a common symptom in critically ill clients, and hypotension caused by adrenal insufficiency may mimic either hypovolemic or septic shock. If adrenal insufficiency is the cause of the hypotension, administration of corticosteroids can eliminate the need for vasopressor drugs to maintain adequate tissue perfusion.
The nurse is caring for a client who has been diagnosed with cerebral edema caused by trauma. Which medication should the nurse be prepared to administer?
Dexamethasone Explanation: Dexamethasone is considered the corticosteroid of choice for cerebral edema associated with brain tumors, craniotomy, or head injury because dexamethasone is thought to penetrate the blood-brain barrier more readily and achieve higher concentrations in cerebrospinal fluids and tissues.
After teaching a group of students about mineralocorticoids, the instructor determines that the teaching was successful when they state which agent as an example?
Fludrocortisone Explanation: Fludrocortisone is a mineralocorticoid. Beclomethasone is a glucocorticoid. Dexamethasone is a glucocorticoid. Flunisolide is a glucocorticoid.
A nurse has determined a client has developed a hypoglycemic reaction. Which interventions should the nurse perform if the client can adequately demonstrate swallowing and gag reflexes?
Give oral fluids or candy. Explanation: The nurse should administer oral fluids or candy to the hypoglycemic client with swallowing and gag reflexes. If the client is unconscious, the nurse should administer glucose or glucagon parenterally. The nurse should administer insulin through an insulin pump for diabetic clients who are pregnant or have had a renal transplant. Oral antidiabetic drugs are administered to clients with type 2 diabetes.
The nurse is monitoring a child who has been receiving long-term therapy with systemic corticosteroids. Which would be most important for the nurse to assess?
Growth pattern Explanation: Long-term systemic corticosteroid therapy in children can increase the child's risk for growth retardation; therefore, this would be most important to assess. Rectal bleeding can occur with corticosteroids administered via a retention enema. Epistaxis can occur with the use of intranasal corticosteroids. Cognitive development is not generally impacted by corticosteroid therapy.
The nurse is interviewing a client who was diagnosed with type 2 diabetes four months ago. The client does not record glucometer readings. 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.
The nurse is assessing a client with adrenocortical excess resulting from long-term use of corticosteroids. What is not a side effect related to this client's corticosteroid use?
Hypotension Explanation: Hypertension (rather than hypotension) is an adverse effect of corticosteroids. Long-term administration can cause Cushingoid characteristics, including muscle weakness and atrophy, obesity, and "moon face" (the presence of abnormal fat deposits in the cheeks).
After teaching a group of students about the effects of mineralocorticoids, the instructor determines that additional teaching is needed when the students identify what as an effect?
Increased calcium retention Explanation: Mineralocorticoids increase sodium reabsorption in the renal tubules, leading to sodium and water retention and increased potassium excretion. Calcium is not affected by mineralocorticoids.
You are talking to your class of nursing students about the adverse effects of corticosteroid therapy. What dietary change would you tell the students may help prevent osteoporosis related to long-term corticosteroid administration?
Increasing vitamin D intake Explanation: Osteoporosis is a potential adverse effect of corticosteroid therapy. Patients may be able to reduce the risk by increasing dietary intake of calcium, vitamin D, and protein.
When administering insulin, what would be most appropriate?
Insert the needle at a 45-degree angle for injection. Explanation: The vial should be gently rotated and vigorous shaking is to be avoided to ensure uniform suspension of the insulin. Typically the area is pinched to allow access to the loose connective tissue layer. The needle is inserted at a 45-degree angle for subcutaneous administration. Gentle pressure should be applied at the injection site.
A nurse is preparing to administer a long-acting insulin to a client. Which insulin might the nurse administer? Select all that apply. Insulin aspart Insulin lispro Insulin glargine Insulin detemir Insulin glulisine
Insulin glargine Insulin detemir Explanation: Insulin glargine and insulin detemir are long-acting insulins with a duration of 24 hours. Insulin aspart, lispro, and glulisine are rapid-acting insulins.
The health care provider orders an inhaled corticosteroid to treat exacerbations of chronic obstructive pulmonary disease (COPD) in a 69-year-old client. What advantage does an inhaled corticosteroid offer this client compared to an oral corticosteroid?
It will result in milder adverse effects. Explanation: Oral corticosteroids can improve pulmonary function and symptoms in some COPD clients, particularly in the management of acute exacerbations. Inhaled corticosteroids produce minimal adverse effects, but their effectiveness in COPD has not been clearly demonstrated.
A male client is diagnosed with Addison disease. What daily medication would the nurse expect to be administered?
Prednisone Explanation: Daily administration of corticosteroids and mineralocorticoids is required in cases of chronic adrenocortical insufficiency (Addison disease).
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.
When monitoring a client who is receiving mineralocorticoid therapy, which assessment finding would be most important for the nurse to report?
Shortness of breath Explanation: Shortness of breath may be a sign of heart failure and needs to be reported immediately. Headache and weakness are general signs and common adverse effects. The nurse would report these if the client reported they were getting worse or interfering with the client's activities of daily living. Slight pedal edema may or may not be significant.
A client with hypertension is diagnosed with type 2 diabetes. For which reason would the nurse closely monitor the client when giving glyburide with metoprolol?
Signs of hypoglycemia may be masked. Explanation: Glyburide is a second-generation sulfonylurea used to treat type 2 diabetes. Caution should be used when giving this medication with a beta blocker such as metoprolol because the signs of hypoglycemia may be masked. Taking glyburide with metoprolol will not cause an increase in blood pressure or increase blood glucose levels. These medications will not cause the development of orthostatic hypotension.
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.
A client diagnosed with type 2 diabetes several months ago has presented for a scheduled follow-up appointment. Which stated behavior most clearly indicates that the client has established effective health maintenance?
The client frequently checks blood glucose levels. Explanation: Vigilant blood glucose monitoring is imperative in the management of diabetes. This shows effective health maintenance even more clearly than exercising. Dietary modifications must be undertaken with care in people with diabetes to avoid health consequences. Explaining pathophysiology does not necessarily show effective health maintenance.
A client is prescribed a corticosteroid to reduce inflammation caused by an autoimmune disorder. Which information would the nurse include when teaching the client about this medication?
The medication is prescribed in gradually decreasing doses. Explanation: A common cause of adrenal insufficiency is prolonged use of corticosteroid hormones. When exogenous corticosteroids are used, they interfere with the feedback system and the adrenal glands begin to atrophy because the glands are no longer stimulated to produce or secrete the hormone. It takes several weeks to recover from atrophy caused by lack of stimulation. To prevent adrenal insufficiency in the client taking steroid therapy, doses will be prescribed to gradually taper the client from the hormones. This gives the adrenal glands time to recover and start producing hormones again. The medication should not be abruptly stopped. Weight gain is a common side effect of corticosteroids. The medication should be taken as prescribed and not just until the symptoms subside. Corticosteroids can cause hyperglycemia, edema, and other adverse effects.
A 65-year-old client who has been on long-term corticosteroid therapy is admitted to the hospital and will need an IV inserted. What adverse effect of corticosteroid may negatively affect this procedure?
Thinning of the skin Explanation: The client's thinning skin may make IV insertion more difficult because the skin is so much more fragile and it bruises so easily due to capillary fragility.
A nurse tells a patient to take a prescribed glucocorticoid in the morning based on the understanding that:
This time mimics the normal peak diurnal concentration levels. Explanation: Typically a glucocorticoid is taken in the morning to mimic the normal peak diurnal concentration levels and thereby minimize suppression of the hypothalamic-pituitary axis. A glucocorticoid is taken in the morning to mimic the normal peak diurnal concentration levels and thereby minimize suppression of the hypothalamic-pituitary axis. Drug absorption is not affected by time of administration. The rationale for morning administration is to mimic the normal peak diurnal concentration levels.
While learning about corticosteroids in pharmacology class, a student asks the instructor to offer an example of indications for use. What could the instructor mention?
Treatment of a disease with an inflammatory component Explanation: Because corticosteroids affect virtually every aspect of inflammatory and immune responses, they are used in the treatment of a broad spectrum of diseases with an inflammatory or immunologic component. Corticosteroids are not indicated for the treatment of diabetes mellitus, in fact, these medications can exacerbate the condition if prescribed to a client with this diagnosis. Corticosteroids can increase blood sugar levels.
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.
A nurse is caring for a 8-year-old client who has an order for predinsone. How is dosage of corticosteroids for children calculated?
according to severity of disease rather than weight Explanation: Corticosteroids are used for the same conditions in children as in adults. A concern with children is growth retardation, which can occur in the short term with small doses and administration by inhalation. Corticosteroid dosages are calculated according to severity of disease rather than weight. In addition, for both systemic and inhaled corticosteroids, each child's dose should be titrated to the lowest effective amount.
The nurse is caring for a client who is taking insulin. The nurse suspects the client is experiencing hypoglycemia when the client displays what signs?
weakness, sweating, and decreased mentation. Explanation: Symptoms of hypoglycemia include shakiness, dizziness or light-headedness, sweating, nervousness or irritability, sudden changes in behavior or mood, weakness, pale skin, and hunger. The other signs are more consistent with hyperglycemia.
A nurse is caring for a client who is receiving a corticosteroid for arthritic pain. Which statement made by the client would raise concern about medication dosage revision?
"I recently lost my health care coverage and need to look for another job." Explanation: For people receiving chronic corticosteroid therapy, dosage must be increased during periods of stress or illness. The nurse should recognize that the client has mentioned losing health care coverage and looking for a job. All the other statements are not related to stress or illness.
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.
A client prescribed alternate-day administration of corticosteroids asks the nurse why the drug isn't administered every day. How would the nurse describe the benefit of alternate-day therapy (ADT)?
"It minimizes suppression of adrenal function." Explanation: High doses of corticosteroids can suppress the hypothalamic-pituitary-adrenal, or HPA, axis, resulting in decreased production of endogenous corticosteroids. Alternate-day therapy (ADT), in which a double dose is taken every other morning, allows rest periods so that adverse effects are decreased while anti-inflammatory effects continue. ADT is used only for maintenance therapy after signs and symptoms have been controlled by more frequent dosing.
What instructions would be important to give to a 50-year-old client with type 2 diabetes who has been switched from glyburide , 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.
A 45-year-old woman has been taking a corticosteroid and calls the clinic reporting the development of acne-like lesion on her face as well as facial hair. What is the nurse's best response?
"Sadly, this is an adverse effect seen in women. It should improve when you finish the medication." Explanation: An adverse effect in women who take corticosteroids is acne and hair on the face. This side effect usually resolves after the medication is discontinued. The drug should never be stopped abruptly but weaned gradually.
While the nurse is preparing the client for discharge, the client asks why the health care provider has prescribed prednisone every other day instead of daily. What would be the nurse's best response?
"Taking it every other day minimizes adverse effects." Explanation: Alternate-day therapy, in which a double dose is taken every other day, is frequently ordered for maintenance therapy in the treatment of chronic events. This method allows rest periods so that many adverse effects are decreased while therapeutic effects continue.
The nurse is assessing a client who was administered metformin and notes hyperventilation, nausea, and somnolence. The nurse determines which nursing diagnosis should be prioritized for this client?
Altered Breathing Pattern Explanation: When taking metformin, the client is at risk for lactic acidosis manifested by unexplained hyperventilation, myalgia, malaise, GI symptoms, or unusual somnolence. Thus, a nursing diagnosis of Altered Breathing Pattern would be most likely. There are no problems with fluid balance. Acute Confusion would be appropriate if the client was experiencing hypoglycemia. Anxiety would be appropriate for a client who is newly diagnosed with diabetes and having difficulty accepting the diagnosis.
The following patients are prescribed metformin. Which patient is likely at the greatest risk of having an adverse reaction to metformin?
An alcoholic patient Explanation: Hypoglycemia is more common when metformin is administered concomitantly with other oral hypoglycemic agents, if caloric intake is deficient, or if the patient exercises strenuously. The nurse must caution patients against excessive alcohol intake while taking metformin, because alcohol use increases the risk for lactic acidosis. Also, concurrent use with chromium, garlic, gymnema, or alcohol may increase the risk for hypoglycemia. Hypoglycemia is not likely to occur more in pregnant women, patients with a predilection for sweets or candies, or patients who are allergic to seafood.
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 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.
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.
The nurse has administered glipizide and warfarin to a client. Which finding on assessment should the nurse prioritize?
Increased hypoglycemic effect Explanation: The nurse should observe for increased hypoglycemic effect in the client as the effect of the interaction of sulfonylureas (glipizide) with the anticoagulants (warfarin), chloramphenicol, clofibrate, fluconazole, histamine-2 antagonists, methyldopa, monoamine oxidase inhibitors (MAOIs), salicylates, sulfonamides, and tricyclic antidepressants. Increased risk of lactic acidosis is an effect of the interaction of metformin with glucocorticoids. Increased risk for bleeding is an effect of the interaction of oral anticoagulants with anti-infective drugs. There is a risk of acute renal failure when iodinated contrast material used for radiologic studies is administered with metformin.
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 nurse is preparing to administer insulin to the client. Which interventions 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 not be mixed with other drugs in the syringe. Some types of insulin may be combined in one syringe, but sterile water is never used.
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.
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.
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.
A client has refused a scheduled dose of metformin, stating that he/she is worried about inducing hypoglycemia because his/her blood glucose level is currently 66 mg/dL (3.66 mmol/L). The nurse should convey what teaching points to the client?
Metformin does not cause hypoglycemia. Explanation: Experts prefer to call metformin an antihyperglycemic rather than a hypoglycemic because it does not cause hypoglycemia, even in large doses, when used alone. This fact about metformin makes the other statements inaccurate.
Based on the metabolic action of glucocorticoids, a client who is on long-term glucocorticoid therapy is at risk of developing what disease?
Osteoporosis Explanation: The client who is on long-term glucocorticoid therapy is at risk for osteoporosis due to the reduction in new bone synthesis. Glucocorticoids are used to reduce swelling in the brain and spinal column and to promote bronchodilation. Cryptorchism is the failure of the testes to descend into the scrotum and is not the result of glucocorticoid therapy.
A client with hyperinsulinism has been prescribed diazoxide. After administration, which adverse reaction should the nurse prioritize?
Tachycardia Explanation: The nurse should monitor for tachycardia, congestive heart failure, sodium and fluid retention, hyperglycemia, and glycosuria as the adverse reactions in the client receiving diazoxide drug therapy. Myalgia, fatigue, and headache are the adverse reactions observed in clients undergoing pioglitazone HCl drug therapy. Flatulence is one of the adverse reactions found in clients receiving metformin drug therapy. Epigastric discomfort is one of the adverse reactions observed in clients receiving acetohexamide drugs.
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.
A nurse is providing client education to a female client who is taking fludrocortisone. The nurse will instruct the client to monitor what at home?
Weight gain Explanation: A client taking fludrocortisone should be taught to monitor weight, blood pressure, and muscle weakness. The client is not ordinarily asked to monitor her temperature at home, and it would not be possible to monitor thyroid hormone levels. The client could be asked to monitor heart rate, but it would not be a priority. The nurse should also provide follow-up and scheduling to monitor serum electrolytes.
The nurse anticipates an order for a glucocorticoid when caring for a client with what condition?
arthritis Explanation: Glucocorticoids are indicated for the short-term treatment of many inflammatory disorders, to relieve discomfort, and to give the body a chance to heal from the effects of inflammation. They block the actions of arachidonic acid, which leads to a decrease in the formation of prostaglandins and leukotrienes. Without these chemicals, the normal inflammatory reaction is blocked. Hypoglycemia would more safely be treated with glucose. Appendicitis and septicemia are infections that would contraindicate the use of glucocorticoids because of the immunosuppressant effects of the drugs.
A nurse is caring for a client with adrenocortical deficiency. The health care provider has prescribed a fludrocortisone drug to the client. Which adverse reaction should the nurse monitor for in the client?
edema Explanation: The nurse should monitor for edema, hypertension, heart failure, enlargement of the heart, increased sweating, and allergic skin rash in the client as adverse reactions to the drug. Sore throat, malaise, and nasal congestion are not adverse reactions to the fludrocortisone drug. The nurse needs to monitor for sore throat and malaise in the client receiving adrenocorticotropic hormone (ACTH). The nurse needs to monitor for nasal congestion as an adverse reaction in a client receiving vasopressin.
When reviewing the medication list of a client being seen in the clinic, the nurse notes that the client is receiving glipizide. Based on the nurse's understanding, this drug is used to treat:
hyperglycemia. Explanation: Glipizide is an antidiabetic agent with the desired action of lowering the blood glucose level. It is used to treat hyperglycemia. It would worsen, not treat, hypoglycemia, and it has no role in treating abnormal potassium levels (hypokalemia or hyperkalemia).
A client has been prescribed a corticosteroid for the treatment of chronic adrenocortical insufficiency. The nurse's instructions for administration should include taking the medication under what condition?
in the morning. Explanation: A major adverse reaction is suppression of the hypothalamic-pituitary-adrenal (HPA) axis and subsequent loss of adrenocortical function. Morning dosing is often recommended for clients with chronic adrenocortical insufficiency because the schedule simulates normal endogenous corticosteroid secretion.
The health care provider prescribes glyburide for a client who is a newly diagnosed type 2 diabetic. The nurse knows that this medication produces hypoglycemia by:
increasing insulin secretion from the pancreas. Explanation: The hypoglycemic action of glyburide results from the stimulation of pancreatic beta cells, leading to increased insulin secretion.
A client's current condition requires rapid reduction of blood sugar levels. Which type of insulin will have the most rapid onset of action?
insulin lispro Explanation: Insulin lispro has a 15-minute onset of action. NPH, 70/30, and regular insulin have longer onsets of action, a later peak, and a longer duration of action.
A visiting family member brings snacks to a client who is receiving a corticosteroid. Which food item will the nurse counsel the client to avoid while taking the medication?
licorice Explanation: Licorice increases the effects of corticosteroids, so the nurse should caution to limit intake or avoid it completely. The other food items don't interact with corticosteroids.
Rosiglitazone is being considered for the treatment of diabetes in an adult client. Before the initiation of rosiglitazone therapy, the nurse should review what laboratory work recently drawn?
liver enzymes Explanation: Rosiglitazone has been associated with hepatotoxicity and requires monitoring of liver enzymes. Liver function tests (e.g., serum aminotransferase enzymes) should be checked before starting therapy and every 2 months for 1 year, then periodically. Platelets, d-dimer, and tests of renal function are less significant to the safety and efficacy of treatment.
A nurse is providing discharge instructions to a client who will be taking fludrocortisone at home. The nurse will encourage the client to eat a diet that is:
low in sodium, high in potassium. Explanation: The client should avoid foods that are high in sodium and eat foods that are high in potassium. The client should eat foods rich in proteins because long-term fludrocortisone therapy promotes the deposition of liver glycogen and induces a negative nitrogen balance. Iron-rich food is not typically shown to have therapeutic or adverse effects of fludrocortisone; therefore, it is more important to instruct the client to avoid high-sodium foods and to eat potassium-rich ones.
A client being treated with oral prednisone is also prescribed furosemide. The nurse should prioritize assessment of what laboratory value?
potassium Explanation: The combination of corticosteroids and diuretics constitutes a risk for hypokalemia. The nurse must pay particular attention to the client's potassium levels. This combination of medications is not associated with risks involving any of the other options.
The nurse is caring for a postoperative client whose diabetes has been well controlled on acarbose. 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 nurse is preparing to administer an insulin that is clear. Which insulin would the nurse likely administer?
short-acting insulin Explanation: Short-acting or regular insulin and rapid-acting insulin such as lispro, aspart, and glulisine are clear, whereas intermediate-acting (Humulin N and Humulin L) and long-acting (Humulin U) insulins are cloudy. There is no insulin classified as ultra-short insulin.
Minimizing the effects of what process is typically the primary goal of alternate-day administration of corticosteroids?
suppression of normal adrenal function Explanation: Alternate-day therapy (ADT), in which a double dose is taken every other morning, is usually preferred for other chronic conditions. This schedule allows rest periods so that adverse effects are decreased while anti-inflammatory effects continue. Renal clearance is to be supported not minimized. While avoiding gastric upset and facilitating medication adherence are goals, they are not the primary goal of alternate-day administration.
To minimize adrenal suppression, when should the nurse encourage a client to take his or her daily dose of prescribed prednisone?
"Take your medications in the morning." Explanation: A major adverse reaction associated with corticosteroid therapy is suppression of the hypothalamic-pituitary-adrenal, or HPA, axis and subsequent loss of adrenocortical function. Scheduling of medication (morning dosing) is often recommended to prevent or minimize HPA suppression. Daily administration is required in cases of chronic adrenocortical insufficiency. The entire daily dose can be taken each morning, between 06:00 and 09:00. This schedule simulates normal endogenous corticosteroid secretion.
A client receives a dose of insulin lispro at 8 AM. The nurse would be alert for signs and symptoms of hypoglycemia at which time?
Between 8:30 AM and 9:30 AM Explanation: With insulin lispro, peak effects would occur in 30 to 90 minutes or between 8:30 AM and 9:30 AM. Regular insulin peaks in 2 to 4 hours, so the nurse would be alert for signs and symptoms of hypoglycemia at this time, which would be between 10 AM and 12 noon. With insulin detemir, peak effects would occur in 6 to 8 hours, or between 2 PM and 4 PM. With NPH insulin, peak effects would occur in 4 to 12 hours, or between 12 noon and 8 PM.
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).
A client who has been prescribed metformin is scheduled to undergo diagnostic testing with the administration of parenteral radiographic contrast media containing iodine. What fact should direct the nurse's plan of care for this client?
Metformin should be discontinued at least 48 hours before and after diagnostic tests that use contrast medias. Explanation: Metformin should be discontinued at least 48 hours before diagnostic tests are performed with contrast media and should not be resumed for at least 48 hours after the tests are done and tests indicate renal function is normal. None of the other options are required.
The nurse monitoring a client receiving insulin glulisine 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 Insulin glargine (Lantus) Hard candy Insulin detemir (Levemir)
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.
The nursing instructor is discussing short-term versus long-term corticoid steroid therapy with the nursing students. What would be the most appropriate teaching for a client on long-term corticosteroid therapy?
Taper doses when discontinuing drug Explanation: Taper doses when discontinuing from high doses or from long-term therapy to give the adrenal glands a chance to recover and produce adrenocorticoids. All answers are correct, but most important to teach the client is tapering the drug.
A female client has been taking prednisone for her asthma for 1 month. The nurse will teach her to gradually decrease her dose of prednisone to avoid:
adrenal insufficiency. Explanation: The client may develop adrenal insufficiency (Addisonian crisis), which is characterized by glucocorticoid insufficiency without mineralocorticoid insufficiency. Hypokalemia occurs as a result of hyperaldosteronism. Gastrointestinal distress and menstrual irregularities are common adverse effects of the drug, but these effects are not as serious as preventing adrenal insufficiency.
The health care provider has prescribed alternate-day therapy (ADT) for a client who is receiving a corticosteroid. When reinforcing teaching with the client, the nurse will explain that the goal of ADT is to minimize what process related to corticosteroid use?
suppression of normal adrenal function Explanation: Alternate-day therapy with corticosteroids involves taking a double dose every other morning. This schedule allows rest periods so that supression of the hypothalamic-pituitary-adrenal axis is minimized while anti-inflammatory effects continue. Renal clearance is to be supported, not minimized. While avoiding gastric upset and facilitating medication adherence are goals, they are not the primary goal of alternate-day administration.
