PHARM - Endocrine

The client with Cushing's syndrome had bilateral adrenalectomies and is now on corticosteroid therapy. The client also has a history of seizures. The nurse giving discharge instructions concerning corticosteroid therapy realizes there is a need for further teaching when the client makes which statement?

"I know my doctor can now decrease my dosage of phenytoin." Rationale: Corticosteroid therapy should never be stopped abruptly but tapered off. It should be taken in the morning with food. A Medic Alert bracelet needs to be worn because of the many medication interactions. This therapy will decrease the effect of phenytoin, so the dosage will likely be increased.

Which instruction should the nurse reinforce to the client with diabetes mellitus receiving acarbose? Select all that apply.

"Take the medication with each meal." "Side effects include abdominal bloating and flatus." "Take some form of glucose if hypoglycemia occurs." "Report symptoms such as shortness of breath or tiredness." Rationale: The mechanism of action of acarbose is a delay in absorption of dietary carbohydrates, thereby reducing the rise in blood glucose after a meal. To accomplish this, the medication must be taken with each meal. Because of its bacterial fermentation of unabsorbed carbohydrates in the colon, side effects such as borborygmus, cramps, abdominal distention, and flatulence can occur. The medication also can affect absorption of iron, leading to symptoms (shortness of breath, tiredness) of anemia.

Glimepiride is prescribed for a client with diabetes mellitus. The nurse reinforces instructions for the client and tells the client to avoid which while taking this medication?

Alcohol Rationale: When alcohol is combined with glimepiride, a disulfiram-like reaction may occur. This syndrome includes flushing, palpitations, and nausea. Alcohol can also potentiate the hypoglycemic effects of the medication. Clients need to be instructed to avoid alcohol consumption while taking this medication.

Prednisone is prescribed for a client with diabetes mellitus who is taking NPH insulin daily. Which prescription should the nurse anticipate during therapy with the prednisone?

An increased amount of daily NPH insulin Rationale: Glucocorticoids can elevate blood glucose levels. Diabetic clients may need their dosage of insulin or oral hypoglycemic medications increased during glucocorticoid therapy.

The nurse is reinforcing instructions to a client regarding the administration of lypressin. The nurse instructs the client that the medication will be taken by which routes?

Intranasal Rationale: Lypressin is administered by the intranasal route. It is used for diabetes insipidus. The usual adult dosage is 1 or 2 sprays into each nostril 4 times daily.

Lispro insulin is prescribed for a child with type 1 diabetes mellitus. The nurse is reinforcing a teaching session with the child and mother about the onset, peak, and duration times of the insulin. The nurse provides which information about this type of insulin?

Onset of 15 to 30 minutes from injection time, peak of 2 to 4 hours later, and duration time of 4 to 8 hours Rationale: Lispro insulin has an onset of action of 15 to 30 minutes from injection time, peak action of 2 to 4 hours later, and a duration time of 4 to 8 hours.

The nurse is reinforcing instructions to a client regarding intranasal desmopressin acetate. The nurse should tell the client that the medication has which side effect?

Runny nose Rationale: Desmopressin administered by the intranasal route can cause a runny or stuffy nose. Headache, vulval pain, and flushed skin are side effects if the medication is administered by the intravenous (IV) route.

A client is seen in the clinic for complaints of thirst, frequent urination, and headaches. Following diagnostic studies, diabetes insipidus is diagnosed. Desmopressin acetate is prescribed for the client. What would the nurse explain to the client as the purpose of the medication?

To increase water reabsorption Rationale: Desmopressin acetate is an antidiuretic hormone used in the treatment of diabetes insipidus. It promotes renal conservation of water by acting on the collecting ducts of the kidney to increase their permeability to water, which results in increased water reabsorption.

Somatrem is administered to a client with pituitary dwarfism. Which is the expected therapeutic effect of this medication?

To stimulate linear growth Rationale: Somatrem is a growth stimulator used in the long-term treatment of growth failure resulting from growth hormone deficiency. It stimulates linear growth and increases the number and size of muscle cells and red cell mass. It affects carbohydrate metabolism by antagonizing the action of insulin, increasing mobilization of fats, and increasing cellular protein synthesis.

rednisone 10 mg orally daily has been prescribed for a client. The nurse provides instructions to the client regarding the medication. Which statement by the client indicates that further teaching is needed?

"I can take acetylsalicylic acid (aspirin) or my antihistamine if I need it." Rationale: Aspirin and other over-the-counter medications should not be used unless the client consults with the primary health care provider. The client is instructed to take the medication every day at the same time. A slight weight gain with improved appetite is expected, but after the dosage is stabilized, an increase in weight of 5 pounds or more weekly should be reported to the primary health care provider. Caffeine-containing foods and fluids must be avoided because they may contribute to steroid-ulcer development.

The home care nurse visits a client at home who has been prescribed prednisone 5 mg orally daily. The nurse reinforces teaching for the client about the medication. Which statement made by the client indicates a need for further teaching?

"I can take aspirin or my antihistamine if I need it." Rationale: Aspirin and other over-the-counter medications should not be taken unless the client consults with the PHCP. The client needs to take the medication at the same time every day and should be instructed not to stop. A slight weight gain as a result of an improved appetite is expected, but after the dosage is stabilized, a weight gain of 5 lb or more weekly should be reported to the PHCP. Caffeine-containing foods and fluids need to be avoided because they may contribute to steroid-ulcer development.

The nurse realizes that the client taking metformin needs further teaching when the client makes which statement?

"I should treat hypoglycemic episodes due to metformin with glucose tablets only." Rationale: Metformin may be used alone or with other medications, including insulin, to treat type 2 diabetes. Metformin is in a class of drugs called biguanides. Metformin helps control the amount of glucose in your blood. It decreases the amount of glucose absorbed from food and the amount of glucose made by the liver. Metformin also increases the body's response to insulin, a natural substance that controls the amount of glucose in the blood. Gastrointestinal side effects such as flatulence and diarrhea can occur from this medication. Lactic acidosis can occur from the interaction of contrast dye and metformin; therefore, as prescribed, metformin is withheld for 48 hours after certain diagnostic tests that use dye.

The nurse is reinforcing instructions to the client about insulin glargine. The nurse determines that the client understands the action of the medication if the client makes which statement?

"I will give myself this medication subcutaneously once each night before bed." Rationale: Insulin glargine is a modified human insulin with a prolonged duration of action (at least 24 hours). The medication is indicated for once-daily subcutaneous administration to treat adults and children with type 1 diabetes mellitus and adults with type 2 diabetes mellitus. The daily injection should be administered at bedtime. Regular insulin is the only insulin that can be added to an insulin pump. Regardless of the type of insulin the client uses, the blood glucose should be monitored at least daily if not more often.

Which statement indicates that a client with Addison's disease knows how to safely manage a medication regimen that consists of daily doses of glucocorticoids?

"I will need to call my doctor for an increase in medication dose when I'm experiencing a lot of stress." Rationale: The client with Addison's disease will require lifelong replacement of adrenal hormones. The medications must be taken daily, and an alternate route of administration must be used if the client cannot take oral medications for any reason such as nausea and vomiting. Additional doses of glucocorticoids will be needed during times of acute stress. The nurse must emphasize to the client that the primary health care provider must be called to obtain a dosage increase when experiencing stressful situations. Abrupt withdrawal of this medication can result in Addisonian crisis. Although side effects are not severe at lower doses, side effects may be experienced with glucocorticoid administration. It is very unsafe to stop taking the medication without first consulting the primary health care provider.

The nurse reinforces instructions to a client with myxedema about the dosage, method of administration, and side effects of levothyroxine sodium. Which statement by the client indicates an understanding of the nurse's instructions?

"I will report any episodes of palpitations, chest pain, or dyspnea." Rationale: A major concern when initiating thyroid hormone replacement therapy is that the dosage may be too high, which can lead to cardiovascular problems. As a result, clients need to be aware of the early signs and symptoms of toxicity and that they must report these immediately to their primary health care provider. Diarrhea, insomnia, and excessive sweating are signs and symptoms of hyperthyroidism, and although they can occur with thyroid replacement therapy, they are not expected and should be reported. Tremors and nervousness are also signs of toxicity that need to be reported. Clients should never take it on themselves to adjust hormone dosage. Levothyroxine sodium is not administered topically.

Cortisone acetate is prescribed for a client with adrenal insufficiency, and the nurse reinforces instructions to the client regarding the medication. Which statement by the client would indicate a need for further teaching?

"I will stop the medication when I feel better." Rationale: Glucocorticoids should not be abruptly discontinued to prevent acute adrenal insufficiency. They can cause sodium and water retention and the loss of potassium, and clients should be instructed to limit sodium intake and consume potassium-rich foods. These medications can increase the risk of infection, and the client should avoid contact with persons who are ill.

Lispro insulin is prescribed three times a day, with the amount based on blood glucose levels. The nurse determines that the client understands teaching regarding lispro insulin if which statement is made?

"I will take the lispro 10 to 15 minutes before I eat breakfast, lunch, and dinner." Rationale: Lispro is a rapid-acting insulin analog with an onset of action of 15 minutes. The client should administer the dose 0 to 15 minutes before eating a meal. Because the insulin peaks in ¾ to 1½ hours, it would not be beneficial to wait for 1 hour after the meal to administer it. In addition, if the lispro is given 1 hour before the meal, the medication will begin to peak before the client's meal is eaten, possibly resulting in hypoglycemia. Lispro administration should not be spread out evenly throughout the 24-hour day.

An adult client with hypothyroidism is admitted to the hospital. When reviewing the client's health record, the nurse notes that the client is taking a maintenance dose of levothyroxine. The nurse is also reviewing instructions concerning taking levothyroxine with the client. There is a need for further teaching when the client makes which statement?

"I will take the pill with milk to keep from upsetting my stomach." Rationale: Levothyroxine should be taken on an empty stomach because many medications and foods, especially those rich in iron, fiber, calcium, or soy interfere with absorption. It should be taken at the same time each day; morning is usually recommended. If it is not effective, the pulse will increase. Do not to switch brands unless approved by prescriber.

Thyroid replacement therapy is prescribed for a client diagnosed with hypothyroidism. The client asks the nurse when the medication will no longer be needed. Which response by the nurse would be accurate?

"The medication will need to be continued for life." Rationale: For most hypothyroid clients, replacement therapy must be continued for life. Treatment provides symptomatic relief but does not produce a cure. The client should be told that although therapy will improve symptoms, these improvements do not constitute a reason to interrupt or discontinue the medication.

A client is taking Humulin NPH insulin daily every morning. The nurse reinforces instructions to the client and should tell the client that which is the most likely time for a hypoglycemic reaction to occur?

6 to 14 hours after administration Rationale: Humulin NPH is an intermediate-acting insulin. The onset of action is 1 to 2 hours, it peaks in 6 to 14 hours, and its duration of action is 16 to 24 hours. Hypoglycemic reactions most likely occur during peak time.

A client received 20 units of NPH insulin subcutaneously at 8:00 am. The nurse should check the client for a potential hypoglycemic reaction at which time?

5:00 pm Rationale: NPH insulin is intermediate-acting insulin. Its onset of action is 60 to 120 minutes, it peaks in 6 to 14 hours, and its duration of action is 16 to 24 hours. Hypoglycemic reactions most likely occur during peak time.

The client plans to give his lispro insulin injection at 0800 right before eating breakfast. The nurse knows that the client understood the education provided when the client states which time presents the greatest risk for hypoglycemia?

0930 Rationale: Rapid-acting insulin such as lispro peaks in 30 to 90 minutes after subcutaneous administration. Peak times of insulin correlates with the highest incidence of hypoglycemia. Option 0815 correlates with the onset of action, and options 1045 and 1200 correlate with the duration of action.

A client received a dose of regular insulin this morning at 7:00 am. At which time should the nurse likely anticipate the potential for a hypoglycemic reaction to occur?

10:00 am Rationale:Regular insulin is a rapid-acting insulin with a peak action of 2 to 4 hours after injection. During the peak action of insulin is when hypoglycemic reactions are most likely to occur. This makes 10:00 am correct.

A client has self-administered his first injection of regular insulin at 7:30 am, before breakfast. This client should be instructed to closely monitor for signs of hypoglycemia at which time?

11:00 am Rationale: The peak time for regular insulin is 2 to 4 hours after injection; 11:00 am is the option that best fits within the time frame, and 7:30 am is likely too early for a reaction to occur. The other options indicate times that do not correlate to the insulin peak time for regular insulin.

A client informs the nurse that she has been taking acarbose as prescribed. The nurse determines that a therapeutic effect of the medication has occurred if which laboratory value is noted?

2-hour postprandial serum glucose of 120 mg/dL Rationale: Acarbose is an oral antidiabetic medication used as an adjunct to diet to lower blood glucose in clients with type 2 diabetes mellitus whose hyperglycemia cannot be managed by diet alone. All of the laboratory values presented in the options are within a normal value. Lipase level monitors pancreatic activity. Sodium is an electrolyte. The BUN measures renal function. A 2-hour postprandial serum glucose of 120 mg/dL would identify a therapeutic effect of the medication.

The nurse is asked to prefill syringes containing NPH and regular insulin for a diabetic client who lives at home alone and has difficulty with seeing and accurately preparing dosages. Considering the stability of insulin, which number of prefilled syringes should the nurse prepare for the client?

A 7-day supply Rationale: Mixtures of insulin in prefilled syringes should be stored in a refrigerator where they will be stable for at least 1 week. The syringe should be stored vertically with the needle pointing up to avoid clogging the needle. Before administration, the syringe should be agitated gently to resuspend the insulin.

Potassium iodide is prescribed for a client. The nurse reinforces instructions to the client that the primary health care provider should be notified if the client experiences which symptom? Select all that apply.

A burning in the mouth A brassy taste in the mouth Soreness of the gums and teeth Rationale: The client should be informed about symptoms of iodism that can occur with the administration of potassium iodide solution. These symptoms include a brassy taste, burning sensation in the mouth, and soreness of gums and teeth. The client should be instructed to withhold the medication and notify the primary health care provider if these signs occur. Gastric upset and a bitter taste may occur, but do not indicate iodism. The solution can be taken with milk or juice to minimize these effects.

The nurse is monitoring a client receiving glipizide. Which outcome indicates an ineffective response from the medication?

A glycosylated hemoglobin level of 12% Rationale: Glipizide is an oral hypoglycemic agent administered to decrease the serum glucose level and the signs and symptoms of hyperglycemia. Therefore, a decrease in both polyuria and polyphagia would indicate a therapeutic response. Laboratory values are also used to monitor a client's response to treatment. A fasting blood glucose level of 100 mg/dL (5.7 mmol/L) is within normal limits. However, glycosylated hemoglobin of 12% indicates poor glycemic control.

A client with myasthenia gravis verbalizes complaints of feeling much weaker than normal. The primary health care provider plans to implement a diagnostic test to determine if the client is experiencing a myasthenic crisis and administers edrophonium. Which data would indicate that the client is experiencing a myasthenic crisis?

A temporary improvement in the condition Rationale: Edrophonium is administered to determine whether the client is reacting to an overdose of a medication (cholinergic crisis) or to an increasing severity of the disease (myasthenic crisis). When the edrophonium injection is given and the condition improves temporarily, the client is in myasthenic crisis. This is known as a positive test. Increasing weakness would occur in cholinergic crisis.

A client has been prescribed acarbose for treatment of diabetes mellitus. Client teaching regarding this medication should include which instructions? Select all that apply.

Abdominal cramping is common. Side effects include excessive flatulence. The medication should be taken with each meal. Rationale: Acarbose (an alpha-glucosidase inhibitor) inhibits digestion and absorption of carbohydrates, and thereby reduces the postprandial rise in blood glucose. To be effective, the medication must be taken with each meal; a full glass of water alone is not enough sustenance. The major adverse effects of acarbose are gastrointestinal disturbances including flatulence, cramps, and abdominal distention. Fatty stools are seen in the client with cystic fibrosis; this is not a side effect of acarbose. Dizziness is an adverse effect and may be a sign of hypoglycemia and is not an expected side effect of acarbose.

When discussing the rationale for levothyroxine with a client with hypothyroidism, the nurse should emphasize that the client can anticipate which primary expected outcome?

Achieving normal thyroid hormone levels Rationale: Laboratory determination of the serum thyroid-stimulating hormone level (TSH) is an important means of evaluation of therapy with levothyroxine. Effective therapy will cause the elevated TSH levels to decrease. These levels will begin their decline within hours of the onset of therapy and will continue to drop as plasma levels of thyroid hormone build up. If an adequate dosage is established, TSH levels will remain suppressed for the duration of the therapy. Although energy levels are expected to increase, the primary expected outcome is measured by thyroid hormone levels.

A client with diabetes mellitus calls the clinic and tells the nurse that she has been nauseated during the night. The client asks the nurse if the morning insulin should be administered. Which is the appropriate nursing response?

Administer the full dose as prescribed. Rationale: When a diabetic client becomes ill, control is more difficult. Insulin is not omitted, and the client is encouraged to consume liquid carbohydrates if unable to eat regular meals. The client is instructed to notify the primary health care provider if vomiting or diarrhea occurs, or if the illness progresses past 2 days.

A hospitalized client with severe seborrheic dermatitis is receiving treatments of topical glucocorticoid applications followed by the application of an occlusive dressing. The nurse monitors the client for which systemic effect that can occur as a result of this treatment?

Adrenal suppression ationale: Topical glucocorticoids can be absorbed in sufficient amounts to produce systemic toxicity. Primary concerns are growth retardation (in children) and adrenal suppression in all age groups. Systemic toxicity is more likely under extreme conditions such as with prolonged therapy in which extensive surfaces are treated with high doses of high-potency agents in conjunction with occlusive dressings.

A client receiving desmopressin begins to complain of a headache. The nurse notes that the client is listless and falls asleep easily. The nurse interprets that the client is most likely experiencing which reaction?

Adverse medication effects Rationale: Desmopressin is used in the management of diabetes insipidus. Thus the action of the medication is to cause water retention. Adverse effects of desmopressin then could include water intoxication or hyponatremia. Early signs include drowsiness, listlessness, and headache. Decreased urination, rapid weight gain, confusion, seizures, and coma also may occur as a result of overhydration.

A client is suspected of having myasthenia gravis, and the primary health care provider administers edrophonium to determine the diagnosis. After administration of this medication, which sign/symptom would indicate the presence of myasthenia gravis?

An increase in muscle strength Rationale: Edrophonium is a short-acting acetylcholinesterase inhibitor used as a diagnostic agent. When a client with suspected myasthenia gravis is given the medication intravenously, an increase in muscle strength would be seen in 1 to 3 minutes. If no response occurs, another dose is given over the next 2 minutes, and muscle strength is again tested. If no increase in muscle strength occurs with this higher dose, the muscle weakness is not caused by myasthenia gravis. Clients receiving injections of this medication commonly demonstrate a drop of blood pressure, feel faint and dizzy, and are flushed.

Prednisone is prescribed for a client with diabetes mellitus who is taking Humulin neutral protamine Hagedorn (NPH) insulin daily. Which prescription change does the nurse anticipate during therapy with the prednisone?

An increased amount of daily Humulin NPH insulin Rationale: Glucocorticoids can elevate blood glucose levels. Clients with diabetes mellitus may need their dosages of insulin or oral hypoglycemic medications increased during glucocorticoid therapy.

A client with an exacerbation of chronic obstructive pulmonary disease (COPD) has been on oral glucocorticoids and is being weaned to triamcinolone by inhalation. The nurse determines that the client understands the potential adverse effects to watch for during this medication change when the client states to monitor for which?

Anorexia, nausea, weakness, and fatigue Rationale: The client being changed from oral to inhalation glucocorticoids could experience signs of adrenal insufficiency. The nurse teaches the client to report anorexia, nausea, weakness, and fatigue. Other objective signs that can be detected include hypotension and hypoglycemia.

The nurse is monitoring a client receiving levothyroxine sodium for hypothyroidism. Which findings indicate the presence of a side effect associated with this medication? Select all that apply.

Bradycardia Weight loss Mild heat intolerance Rationale: Insomnia, weight loss, and mild heat intolerance are side effects of levothyroxine sodium. Bradycardia and constipation are not side effects associated with this medication, but rather are associated with hypothyroidism, which is the disorder that this medication is prescribed to treat.

The nurse is collecting data from a client seen in the health care clinic for the first time. When the nurse asks the client about current prescribed medications, the client tells the nurse that metformin is taken daily. Based on this finding, the nurse elicits data from the client regarding the presence of which condition?

Diabetes mellitus Rationale: Metformin is an antidiabetic medication used for clients with type 2 diabetes mellitus, and the medication reduces the blood glucose. It is used as an adjunct to diet and exercise. It is not used to treat respiratory conditions.

The nurse is caring for a client with Paget's disease who has an elevated serum calcium level of 12.3 mEq/L. The nurse should expect the primary health care provider to prescribe which? Select all that apply.

Calcitonin Furosemide Assist to ambulate PRN Rationale: The normal serum calcium level is 4.5 to 5.5 mEq/L or 9 to 11 mg/dL. Calcitonin, a thyroid hormone, decreases the plasma calcium level by increasing the incorporation of calcium into the bones thus keeping it out of the serum. In hypercalcemia, large doses of vitamin D should be avoided. Encourage high fluid intake (3000 to 4000 mL/day). Furosemide (Lasix) may be given to promote the excretion of calcium in the urine. Determine the patient's ability to perform self-care safely and provide help as needed.

A client is admitted with chest pain related to atrial fibrillation. Based on her blood glucose reading, metformin is prescribed for the client. As the nurse reviews the client's chart and prescriptions, which finding would require the nurse to verify the metformin prescription? Refer to chart.

Creatinine result Rationale: Metformin is contraindicated with a creatinine level greater than 1.4 mg/dL. Although the blood pressure is elevated, the client is on a beta blocker. The hemoglobin A1c is elevated as is the blood glucose level suggesting the need for an antidiabetic medication. Migraine headaches do not affect the kidneys.

A client who has sustained an eye injury has been prescribed corticosteroid eye drops. The nurse should most carefully monitor for side effects of this medication if the client has which health problem listed on the medical record?

Diabetes mellitus Rationale: The client with diabetes mellitus is especially at risk for side effects when taking this medication, which is a corticosteroid. The client may experience elevations in blood glucose, which should be monitored routinely. The other options are incorrect and unrelated to the use of corticosteroids.

A client is diagnosed with hypothyroidism, and levothyroxine is prescribed. The nurse notes that the client is presently taking warfarin sodium and anticipates that the primary health care provider will alter which medication dosage?

Decrease the dosage of warfarin sodium. Rationale: Levothyroxine accelerates the degradation of vitamin K-dependent clotting factors. As a result, effects of warfarin sodium are enhanced. If thyroid hormone replacement therapy is instituted in a client who has been taking warfarin sodium, the dosage of warfarin sodium should be reduced.

A licensed practical nurse (LPN) is assisting in the care of a client who is receiving oxytocin to induce labor. The LPN plans to notify the registered nurse immediately if which signs and symptoms are noted? Select all that apply.

Decreased blood pressure, increased pulse Contractions greater than 1 minute in duration Rationale: Induction of labor is the initiation of labor through mechanical or pharmacological means. Oxytocin is a synthetic hormone that stimulates uterine contractions and is a medication commonly used to induce labor. Oxytocin will increase contraction frequency, intensity, and duration; however, the primary health care provider needs to be notified of durations greater than 1 minute. Blood pressure and pulse need to be monitored for signs of hemorrhage. Early decelerations of the fetal heart rate are a reassuring sign and do not indicate fetal distress.

The nurse is collecting data from a client receiving pioglitazone 30 mg orally daily. Which finding indicates that the client is experiencing the expected result of the action of this medication?

Decreased fasting blood glucose and reduced hemoglobin A1c (HbA1c) Rationale: Pioglitazone is similar to other thiazolidinediones, also known as glitazones. Like rosiglitazone, pioglitazone activates peroxisome proliferator-activated receptor PPAR-gamma, and thereby reduces insulin resistance. In clients with type 2 diabetes, monotherapy with pioglitazone can decrease fasting blood glucose by 30 to 56 mg/dL, and can lower HbA1c by about 0.9%.

Desmopressin acetate is prescribed for the treatment of diabetes insipidus. The nurse monitors the client after medication administration for which therapeutic response?

Decreased urinary output Rationale: Desmopressin promotes renal conservation of water. The hormone carries out this action by acting on the collecting ducts of the kidney to increase their permeability to water, which results in increased water reabsorption. The therapeutic effect of this medication would be manifested by a decreased urine output.

The home care nurse is visiting a client who was recently diagnosed with type 2 diabetes mellitus. The client, prescribed repaglinide and metformin, asks the nurse to explain these medications. The nurse should reinforce which instructions to the client? Select all that apply.

Diarrhea can occur secondary to metformin. The repaglinide is not taken if a meal is skipped. The repaglinide is taken 30 minutes before eating. Candy or another simple sugar is carried and used to treat mild hypoglycemia episodes. Rationale: Repaglinide is a rapid-acting oral hypoglycemic agent that stimulates pancreatic insulin secretion that should be taken before meals and that should be withheld if the client does not eat. Hypoglycemia is a side effect of repaglinide, and the client should always be prepared by carrying a simple sugar with her or him at all times. Metformin is an oral hypoglycemic given in combination with repaglinide and works by decreasing hepatic glucose production. A common side effect of metformin is diarrhea. Muscle pain may occur as an adverse effect from metformin, but it also might signify a more serious condition that warrants PHCP notification, not the use of acetaminophen.

The nurse is preparing to administer an injection of regular insulin. The vial of the regular insulin has been refrigerated. On inspection of the vial, the nurse finds that the medication is frozen. Which action should the nurse take?

Discard the insulin and obtain another vial. Rationale: Insulin preparations are stable at room temperature for up to 1 month without significant loss of activity. Insulin should not be frozen. If the insulin is frozen, it should be discarded, and the nurse should obtain another vial.

A glucocorticoid is prescribed for a client with adrenal insufficiency, and the nurse reinforces medication instructions to the client. The nurse determines that the client needs further teaching if the client states which action is necessary?

Discontinue the medication when symptoms subside. Rationale: Glucocorticoids should not be discontinued abruptly to prevent acute adrenal insufficiency. Because glucocorticoids cause sodium and water to be retained while causing loss of potassium, the client should limit sodium intake and increase potassium intake. These medications can increase the risk of infection, and the client should avoid contact with persons who are ill. Eating breakfast each day is a general health-promoting behavior.

The nurse is monitoring a client receiving desmopressin acetate for adverse effects to the medication. Which sign/symptom indicates the presence of an adverse effect?

Drowsiness Rationale: Water intoxication (overhydration) or hyponatremia is an adverse effect of desmopressin. Early signs include drowsiness, listlessness, and headache. Decreased urination, rapid weight gain, confusion, seizures, and coma also may occur in overhydration.

A daily dose of prednisone is prescribed for a client. The nurse reinforces instructions to the client regarding administration of the medication and instructs the client to take this medication at which time?

Early morning Rationale: Corticosteroids (glucocorticoids) should be administered before 9:00 am. Administration at this time helps minimize adrenal insufficiency and mimics the burst of glucocorticoids released naturally by the adrenal glands each morning.

Fludrocortisone is prescribed for a client with Addison's disease. The primary health care provider needs to be notified if the client experiences which conditions? Select all that apply.

Edema Chest pain Muscle cramps Rationale: The client with Addison's disease being treated with fludrocortisone needs to notify the primary health care provider of muscle cramps, weight gain, edema, nausea, infection, trauma, stress, or chest pain.

A client diagnosed with hypothyroidism is taking levothyroxine. The client returns to the clinic 1 week after beginning the medication and tells the nurse that the medication has not helped. The appropriate nursing response to the client is based on which information?

Full therapeutic effect may take 1 to 3 weeks. Rationale: Levothyroxine is used in the treatment of hypothyroidism. Although therapy with levothyroxine may begin with small doses that are gradually increased, the appropriate response is to inform the client that full therapeutic effect may take 1 to 3 weeks.

Metformin is prescribed for a client with type 2 diabetes mellitus. Which should the nurse tell the client is a common side effect of the medication?

Gastrointestinal (GI) disturbances Rationale: The most common side effect of metformin is GI disturbances, including decreased appetite, nausea, and diarrhea. These generally subside over time. This medication does not cause weight gain; in fact, clients lose an average of 7 to 8 pounds because the medication causes decreased appetite. Hypoglycemia may be an adverse effect.

The nurse performs an admission assessment on a client who visits a health care clinic for the first time. The client tells the nurse that propylthiouracil is taken daily. The nurse continues to collect data from the client, suspecting that the client has a history of which disorder?

Graves' disease Rationale: Propylthiouracil inhibits thyroid hormone synthesis and is used to treat hyperthyroidism, or Graves' disease. Myxedema indicates hypothyroidism. Cushing's syndrome and Addison's disease are disorders related to adrenal function.

A client has a fasting blood glucose of 268 mg/dL at 7:30 am. The sliding scale prescriptions are blood glucose 151 to 200 mg/dL, administer 3 units Humalog insulin; 201 to 250, administer 6 units Humalog insulin; 251 to 300 mg/dL, administer 9 units Humalog insulin; over 300 mg/dL contact the primary health care provider. Therefore, at 7:30 am, how many units of Humalog should be administered?

Humalog 9 units Rationale: A sliding insulin scale may be prescribed to provide adequate insulin coverage and is based on the client's blood glucose level. The client has a fasting blood glucose of 268 mg/dL. Therefore, the client would receive Humalog 9 units. The remaining options are incorrect because they do not follow the primary health care provider's prescription.

A client newly diagnosed with diabetes mellitus is instructed by the primary health care provider to obtain glucagon hydrochloride for emergency home use. The client asks the nurse about the purpose of the medication. The nurse tells the client that the purpose of the medication is to treat which aspect of diabetes?

Hypoglycemia from insulin overdose Rationale: Glucagon is used to treat hypoglycemia resulting from insulin overdose. The family of the client is instructed in how to administer the medication. In an unconscious client, arousal usually occurs within 20 minutes of injection. Once consciousness has been produced, oral carbohydrates should be given. Lipoatrophy and lipohypertrophy result from insulin injections.

Levothyroxine sodium is prescribed for a client with hypothyroidism. When should the nurse encourage the client to take the medication?

In the morning Rationale: Synthetic levothyroxine sodium increases basal metabolic rate and is used to treat hypothyroidism. It is administered in the morning (on an empty stomach) to prevent insomnia. The remaining options are incorrect because they do not represent the optimum time to take the medication.

The nurse is teaching a client, newly diagnosed with diabetes mellitus, to mix 24 units NPH and 12 units regular insulin in the same syringe. Which instructions should the nurse give to the client to take after wiping the vials with an alcohol wipe?

Inject 24 units of air into the NPH insulin vial. Rationale: After wiping the vials with an alcohol wipe, the nurse would inject 24 units of air into the NPH insulin vial, then 12 units of air into the regular insulin vial. Air should be injected into the vials before drawing the correct dose.

The nurse needs to mix Regular insulin (clear) and NPH insulin (cloudy) in the same syringe. Arrange the actions in the order that they should be performed. All options must be used.

Inject air into the NPH insulin vial. Inject air into the regular insulin vial. Draw up the regular insulin into the syringe. Draw up the NPH insulin into the syringe. Rationale: When insulin is mixed, the faster-acting insulin should be drawn up first to prevent contamination of the faster-acting insulin vial with the longer-acting insulin. Air is injected first (cloudy vial, then clear vial), then insulin is drawn up (clear first, cloudy last).

A client diagnosed with diabetes insipidus is beginning medication therapy with lypressin. The nurse realizes the client understands instructions if the client comments the medicine will be taken in which manner?

Intranasally to promote water reabsorption Rationale: Lypressin is antidiuretic hormone administered by the intranasal route. The usual adult dosage is 1 or 2 sprays into each nostril 4 times daily. It acts on the collecting ducts of the kidneys to increase water reabsorption by increasing their permeability to water.

An oral hypoglycemic medication, a sulfonylurea, is prescribed for a client with type 2 diabetes mellitus. The nurse is reviewing the medical record and needs to contact the primary health care provider if there is a history of which condition?

Liver disease Rationale: Sulfonylureas are contraindicated in liver disease. Alpha-glucosidase inhibitors should not be given if there is inflammatory bowel disease. Biguanides are contraindicated in acidosis. Thiazolidinediones should not be given if there is congestive heart failure.

Potassium iodide is prescribed for a client. The client calls the nurse at the clinic and complains of a brassy taste and burning sensations in the mouth. How should the nurse respond?

Notify the primary health care provider. Rationale: Chronic ingestion of iodide can produce iodism. The client needs to be instructed about the symptoms of iodism, which include a brassy taste, burning sensations in the mouth, soreness of gums and teeth, frontal headache, coryza, salivation, and skin eruptions. The client needs to be instructed to notify the primary health care provider if these symptoms occur.

Insulin glargine is prescribed for a client with diabetes mellitus. The nurse tells the client that which is the best time to take the insulin?

Once daily at the same time each day Rationale: Insulin glargine is a long-acting recombinant DNA human insulin used to treat type 1 and type 2 diabetes mellitus. It has 24-hour duration of action and is administered once a day at the same time each day.

The nurse preparing a client for surgery reviews the client's medication record. The client is to receive nothing by mouth (NPO) after midnight. Which medication noted on the client's record should the nurse question?

Prednisone Rationale: Prednisone is a corticosteroid that can cause adrenal atrophy, which reduces the body's ability to withstand stress. Before and during surgery, dosages may be temporarily increased. Cyclobenzaprine is a skeletal muscle relaxant. Alendronate is a bone-resorption inhibitor. Allopurinol is an antigout medication

A client with diabetes mellitus visits a healthcare clinic. The client's diabetes mellitus previously had been well controlled with glyburide daily, but recently the fasting blood glucose level has been 180 mg/dL to 200 mg/dL (10.2 mmol/L to 11.4 mmol/L). Which medication, added to the client's regimen, may have contributed to the hyperglycemia?

Prednisone Rationale: Prednisone may decrease the effect of oral hypoglycemics, insulin, diuretics, and potassium supplements. Option 1, a ß-blocker and option 3, a monoamine oxidase inhibitor, have their own intrinsic hypoglycemic activity. Option 4 decreases urinary excretion of sulfonylurea agents, causing increased levels of the oral agents, which can lead to hypoglycemia.

The nurse assists with creating a plan of care for a client with hyperparathyroidism receiving calcitonin-human. Which outcome has the highest priority regarding this medication?

Reaching normal serum calcium levels Rationale: Hypercalcemia can occur in clients with hyperparathyroidism, and calcitonin is used to lower plasma calcium levels. The highest-priority outcome in this client situation would be a reduction in serum calcium level. Although absence of side effects and verbalization of appropriate medication knowledge are expected outcomes, they are not the highest priority for administering this medication.

The homecare nurse visits a client recently diagnosed with diabetes mellitus who is taking Humulin NPH insulin daily. The client asks the nurse how to store the unopened vials of insulin. The nurse should provide which information?

Refrigerate the insulin. Rationale: Insulin in unopened vials should be stored under refrigeration until needed. Vials should not be frozen because freezing affects the chemical composition of the insulin. When stored unopened under refrigeration, insulin can be used up to the expiration date on the vial. Freezing insulin, storing insulin in a dark, dry place and keeping the insulin at room temperature are all incorrect actions.

The nurse is assisting in reinforcing a teaching plan for a client given a prescription for pioglitazone. The nurse plans to reinforce instructions to the client about which information related to this medication?

Signs of hypoglycemia Rationale: Pioglitazone is an antidiabetic medication used for clients with type 2 diabetes mellitus, and the medication reduces the blood glucose. It is used as monotherapy or in combination with a sulfonylurea, metformin, or insulin as an adjunct to diet and exercise. It should be taken 15 to 30 minutes before a meal. A prescribed diet is an essential component of treatment in a diabetic client, but the client is not told to increase calorie intake unless this is specifically prescribed by the primary health care provider. The client is instructed in the signs of hypoglycemia because this effect can occur with the use of antidiabetic medications. The client is also instructed regarding the interventions necessary if hypoglycemia occurs. Anemia is not associated with the use of this medication.

A client diagnosed with hyperthyroidism will be taking propylthiouracil. The nurse reinforces medication instructions and determines that the client understands the information if the client states that it is most important to report which symptoms to the primary health care provider?

Sore throat Rationale: An adverse effect of propylthiouracil is agranulocytosis. The client should be alert for this effect by noting the presence of fever or sore throat, which should be reported immediately. Muscle aches, weight loss, and excitability are neither side effects nor adverse effects of this medication.

A client is scheduled for subtotal thyroidectomy. Potassium iodide is prescribed. The nurse understands that which outcome is the therapeutic effect of this medication?

Suppress thyroid hormone production. Rationale: Potassium iodide solution is administered to hyperthyroid individuals in preparation for thyroidectomy to suppress thyroid function. Initial effects develop within 24 hours; peak effects develop in 10 to 15 days.

A client is newly diagnosed with hypothyroidism. Levothyroxine is prescribed. The nurse should reinforce to the client which instructions about the medication?

Take on an empty stomach. Rationale: Levothyroxine should be taken on an empty stomach to enhance absorption. The client also is instructed to take the medication in the morning before breakfast.

The nurse reinforces instructions to a client who is taking levothyroxine. Which instruction should the nurse give the client?

Take the medication on an empty stomach. Rationale: Oral doses of levothyroxine should be taken on an empty stomach to enhance absorption. Dosing should be done in the morning before breakfast. Therefore, the remaining options are incorrect times of administration.

A client with a partial right adrenalectomy is placed on corticosteroid replacement therapy. Which data would indicate that the client is experiencing an adverse effect related to the pharmacological treatment?

Tarry stools Rationale: Glucocorticoids increase gastric secretion, and this can result in peptic ulcers and gastrointestinal bleeding. A sign of gastrointestinal bleeding is the presence of tarry (black) stools. Corticosteroids increase the blood glucose. Hypotension and a dry mouth are not side effects of corticosteroid therapy.

A client who exhibits fatigue, lack of energy, constipation, and depression is diagnosed with hypothyroidism. The primary health care provider prescribes levothyroxine. To increase the likelihood of medication compliance in the early course of treatment, the nurse plans to reinforce which information?

The full therapeutic effect may take 1 to 3 weeks. Rationale: The full therapeutic effect of this medication may not be seen for 1 to 3 weeks. Clients should be aware of this so that they do not discontinue the medication on their own due to lack of perceived effect. Diarrhea and weight gain are not side effects of this medication.

The nurse reinforces medication instructions to a client who is taking levothyroxine. The nurse instructs the client to notify the primary health care provider (PHCP) if which sign/symptom occurs?

Tremors Rationale: Excessive doses of levothyroxine can produce signs and symptoms of hyperthyroidism. These include tachycardia, chest pain, tremors, nervousness, insomnia, hyperthermia, heat intolerance, and sweating. The client should be instructed to notify the PHCP if these occur. The remaining options are signs of hypothyroidism.

The nurse is reinforcing teaching for a client regarding how to mix regular insulin and NPH insulin in the same syringe. Which action performed by the client indicates the need for further teaching?

Withdraws the NPH insulin first Rationale: When preparing a mixture of regular insulin with another insulin preparation, the regular insulin is drawn into the syringe first. This sequence will avoid contaminating the vial of regular insulin with insulin of another type. Options 2, 3, and 4 identify the correct actions for preparing NPH and regular insulin.

A client who will undergo thyroidectomy at a later date has been started on medication therapy with potassium iodide As the licensed practical nurse (LPN) prepares to administer a scheduled dose, the client states that there is a burning sensation and a brassy taste in the mouth. Which action should the LPN take?

Withhold the medication and notify the RN. Rationale: Long-term ingestion of potassium iodide can produce iodism. Symptoms include a brassy taste, burning sensations in the mouth, soreness of gums and teeth, frontal headache, nasal congestion, salivation, and skin lesions. If these occur, the nurse should withhold the medication and notify the RN, who will then contact the primary health care provider.