pharm exam 5

The nurse determines that the client needs further instruction about prescribed thyroid replacement medication if which statement is made? 1"I would expect full therapeutic effect from the medication within 3 to 5 days."2"I need to take my medication in the morning about 1 hour before eating breakfast."3"I need to make sure that I store the medication in the dark container I received it in."4"I need to check with my primary health care provider before taking any over-the-counter medications."

1

The nurse is monitoring a client receiving glipizide. The nurse knows that which finding would indicate a therapeutic outcome for this client? 1A decrease in polyuria2An increase in appetite3A glycosylated hemoglobin of 10%4A fasting blood glucose of 220 mg/dL (12.6 mmol/L)

1

The nurse is providing instructions to a client with seizures who will be taking phenytoin. Which statement, if made by the client, would indicate an understanding of the information about this medication? 1"I need to perform good oral hygiene, including flossing and brushing my teeth."2"I would try to avoid alcohol, but if I'm not able to, I can drink alcohol in moderation."3"I need to take my medication before coming to the laboratory to have a blood level drawn."4"I need to monitor for side effects and adjust my medication dose depending on how severe the side effects are."

1

The nurse is teaching a client how to mix regular insulin and NPH insulin in the same syringe. Which action, if performed by the client, indicates the need for further teaching? 1Withdraws the NPH insulin first2Withdraws the regular insulin first3Injects air into NPH insulin vial first4Injects an amount of air equal to the desired dose of insulin into each vial

1

A client is taking Humulin NPH insulin and regular insulin every morning. The nurse would provide which instructions to the client? Select all that apply. 1Hypoglycemia may be experienced before dinnertime.2The insulin dose needs to be decreased if illness occurs.3The insulin needs to be administered at room temperature.4The insulin vial needs to be shaken vigorously to break up the precipitates.5The NPH insulin needs to be drawn into the syringe first, then the regular insulin.

1 3

A client with diabetes mellitus is self-administering NPH insulin from a vial that is kept at room temperature. The client asks the nurse about the length of time an unrefrigerated vial of insulin will maintain its potency. What is the most appropriate response to the client? 1 2 weeks 2 1 month 3 2 months 4 6 months

2

The nurse in the health care clinic is reviewing the record of a client with diabetes mellitus who was just seen by the primary health care provider (PHCP). The nurse notes that the PHCP has prescribed metformin. What preexisting disorder, if noted in the client's record, would indicate a need to collaborate with the PHCP before instructing the client to take the medication? 1Foot ulcer2Emphysema3Hypertension4Hypothyroidism

2

The nurse is caring for a client after insertion of an implanted insulin pump. Which statement by the client indicates a need for further instruction? 1"I would expect to gain less weight with this pump."2"I need to make sure I still give my insulin before I eat."3"This will help me to have better control of my blood sugar."4"This pump delivers a continuous infusion of insulin throughout the day."

2

The nurse would tell the client, who is taking levothyroxine, to notify the primary health care provider (PHCP) if which problem occurs? 1Fatigue2Tremors3Cold intolerance4Excessively dry skin

2

A client received 20 units of Humulin N insulin subcutaneously at 08:00. At what time would the nurse plan to assess the client for a hypoglycemic reaction? 1 10:00 2 11:00 3 17:00 4 24:00

3

A client with diabetes mellitus calls the clinic and reports being nauseated during the night. The client asks the nurse if the morning insulin would be administered. Which is the most appropriate nursing response? 1Omit the insulin.2Administer half of the prescribed dose.3Administer the full dose as prescribed.4Wait until noon before making a decision.

3

A client with diabetes mellitus received 20 units of Humulin N insulin subcutaneously at 0800. At what time would the nurse plan to assess the client for a hypoglycemic reaction? 1 1000 2 1100 3 1700 4 2400

3

Levothyroxine is prescribed for a client diagnosed with hypothyroidism. Upon review of the client's record, the nurse notes that the client is taking warfarin. Which modification to the plan of care would the nurse review with the client's primary health care provider? 1A decreased dosage of levothyroxine2An increased dosage of levothyroxine3A decreased dosage of warfarin sodium4An increased dosage of warfarin sodium

3

The nurse is completing a health history for an insulin-dependent client who has been self-administering insulin for 40 years. The client reports experiencing periods of hypoglycemia followed by periods of hyperglycemia. What is the most likely cause for this pattern of blood glucose fluctuation? 1Eating snacks between meals2Initiating the use of the insulin pump3Injecting insulin at a site of lipodystrophy4Adjusting insulin according to blood glucose levels

3

The nurse teaches a client newly diagnosed with type 1 diabetes about storing Humulin N insulin. Which statement indicates to the nurse that the client understood the discharge teaching? 1"I would keep the insulin in the cabinet during the day only."2"I know I have to keep my insulin in the refrigerator at all times."3"I can store the open insulin bottle in the kitchen cabinet for 1 month."4"The best place for my insulin is on the windowsill, but in the cupboard is just as good."

3

The primary health care provider has prescribed regular insulin 6 units and NPH insulin 20 units subcutaneously to be administered every morning for a client diagnosed with diabetes mellitus. How would the nurse prepare to administer insulin? 1Shake the NPH insulin vial to distribute the suspension.2Administer regular insulin and NPH insulin in separate syringes.3Draw up the regular insulin first and then the NPH insulin in the same syringe.4Draw up the NPH insulin first and then the regular insulin in the same syringe.

3

Insulin lispro is prescribed for the client with diabetes mellitus, and the client is instructed to administer the insulin before meals. When would the nurse instruct the client to administer the insulin? 1 45 minutes before eating 2 60 minutes before eating 3 90 minutes before eating4Immediately before eating

4

Metformin is prescribed for a client with type 2 diabetes mellitus. The nurse would tell the client that which is the most common side or adverse effect of the medication? 1Weight gain2Hypoglycemia3Flushing and palpitations4Gastrointestinal (GI) disturbances

4

Metformin is prescribed for a client with type 2 diabetes mellitus. What is the most common side effect that the nurse would include in the client's teaching plan?1Weight gain2Hypoglycemia3Flushing and palpitations4Gastrointestinal disturbances

4

The diabetes nurse specialist conducts a teaching session to a group of nursing students regarding sulfonylureas, oral hypoglycemic medications used for type 2 diabetes mellitus. Which statement, describing the primary action of these medications, would the nurse include in the teaching session? 1"Sulfonylureas decrease insulin resistance."2"Sulfonylureas inhibit carbohydrate digestion."3"Sulfonylureas decrease glucose production by the liver."4"Sulfonylureas promote insulin secretion by the pancreas."

4

A patient with a new-onset seizure disorder receives a prescription for phenobarbital. The patient reports being concerned about the sedative side effects of this drug. Which response by the nurse is correct? a. "Phenobarbital doses for seizures are nonsedating." b. "This is a short-acting barbiturate, so sedation wears off quickly." c. "Tolerance to the sedative effects will develop in a few weeks." d. "You may actually experience paradoxical effects of euphoria."

A Phenobarbital and mephobarbital are used for seizure disorders and suppress seizures at doses that are nonsedative. Phenobarbital is a long-acting barbiturate. At therapeutic doses, sedative effects do not occur. Paradoxical drug effects are associated with benzodiazepines and in older adults and debilitated patients with barbiturates.

A patient has begun taking phenobarbital after experiencing several seizures and is currently receiving 60 mg PO twice daily. After 2 weeks of therapy, the patient has a serum drug level of 30 mcg/mL and reports feeling drowsy much of the day. What will the nurse tell this patient? a. "I will contact your provider to discuss changing your dosing to once daily to minimize the drowsiness." b. "The drug level is low and you may need a higher dose, but taking it 3 times daily will reduce the drowsiness." c. "This side effect is expected and should decrease over time. You should avoid driving in the meantime." d. "The results of your lab work show a higher than normal level of the drug and your provider will probably lower your dose."

A Phenobarbital has a long half-life and may be given once daily at bedtime to help manage its sedative effects. The serum drug level is within the normal range of 15 to 40 mcg/mL, so the dose does not need to be adjusted. Increasing the dose and the frequency is not necessary since the drug levels are therapeutic and scheduling the drug to 3 times daily will compound the sedative effects. The sedative side effects do not increase over time.

A nurse is teaching a group of nurses about Parkinson medications. The nurse is correct to state that one side effect associated with pramipexole [Mirapex] that is less likely to occur with other dopamine agonists is: a. sleep attacks. b. dizziness. c. hallucinations. d. dyskinesias.

ANS: A A few patients taking pramipexole (Mirapex) have experienced sleep attacks, or an overwhelming and irresistible sleepiness that comes on without warning. Dizziness, hallucinations, and dyskinesias are listed as side effects of pramipexole and other dopamine agonists

A nurse is discussing the use of benzodiazepines as sedative-hypnotic agents with a group of nursing students. A student asks about the actions of these drugs in the central nervous system. The nurse makes which correct statement? a. "Benzodiazepines affect the hippocampus and the cerebral cortex to cause anterograde amnesia." b. "Benzodiazepines depress neuronal functions by acting at a single site in the brain." c. "Benzodiazepines induce muscle relaxation by acting on sites outside the central nervous system." d. "Benzodiazepines promote sleep through effects on the limbic system."

ANS: A All beneficial and most adverse effects of benzodiazepines occur from depressant actions in the central nervous system (CNS); the various effects depend on the site of action. Anterograde amnesia is the result of effects in the hippocampus and the cerebral cortex. Benzodiazepines act at multiple sites in the CNS. Muscle relaxant effects are the result of actions on supraspinal motor areas in the CNS. Benzodiazepines promote sleep through effects on cortical areas and on the sleep-wakefulness "clock."

A nurse provides teaching for a patient with a newly diagnosed partial complex seizure disorder who is about to begin therapy with antiepileptic drugs (AEDs). Which statement by the patient indicates understanding of the teaching? a. "Even with an accurate diagnosis of my seizures, it may be difficult to find an effective drug." b. "I will soon know that the drugs are effective by being seizure free for several months." c. "Serious side effects may occur, and if they do, I should stop taking the medication." d. "When drug levels are maintained at therapeutic levels, I can expect to be seizure free."

ANS: A Even with an accurate diagnosis of seizures, many patients have to try more than one AED to find a drug that is effective and well tolerated. Unless patients are being treated for absence seizures, which occur frequently, monitoring of the clinical outcome is not sufficient for determining effectiveness, because patients with convulsive seizures often have long seizure-free periods. Serious side effects may occur, but withdrawing a drug precipitously can induce seizures. Not all patients have seizure control with therapeutic drug levels, because not all medications work for all patients.

A nurse is discussing partial versus generalized seizures with a group of nursing students. Which statement by a student indicates understanding of the teaching? a. "Febrile seizures are a type of generalized tonic-clonic seizure." b. "Generalized seizures are characterized by convulsive activity." c. "Partial seizures do not last as long as generalized seizures." d. "Patients having partial seizures do not lose consciousness."

ANS: A Febrile seizures typically manifest as a tonic-clonic seizure of short duration and are a type of generalized seizure. Generalized seizures may be convulsive or nonconvulsive. Partial seizures may last longer than some types of generalized seizures. Patients with complex partial seizures and secondarily generalized seizures, which are types of partial seizures, may lose consciousness.

A patient who is taking oral contraceptives begins taking valproic acid [Depakote] for seizures. After a week of therapy with valproic acid, the patient tells the nurse that she is experiencing nausea. What will the nurse do? a. Ask the patient if she is taking the valproic acid with food, because taking the drug on an empty stomach can cause gastrointestinal side effects. b. Contact the provider to request an order for a blood ammonia level, because hyperammonemia can occur with valproic acid therapy. c. Suggest that the patient perform a home pregnancy test, because valproic acid can reduce the efficacy of oral contraceptives. d. Suspect that hepatotoxicity has occurred, because this is a common adverse effect of valproic acid.

ANS: A Gastrointestinal effects, including nausea, vomiting, and indigestion, are common with valproic acid and can be minimized by taking the drug with food or using an enteric-coated product. Hyperammonemia can occur when valproic acid is combined with topiramate. Signs of pregnancy usually do not occur within a week, so this is less likely. Hepatotoxicity is a rare adverse effect.

A nurse counsels a patient who is to begin taking phenytoin [Dilantin] for epilepsy. Which statement by the patient indicates understanding of the teaching? a. "I should brush and floss my teeth regularly." b. "Once therapeutic blood levels are reached, they are easy to maintain." c. "I can consume alcohol in moderation while taking this drug." d. "Rashes are a common side effect but are not serious."

ANS: A Gingival hyperplasia occurs in about 20% of patients who take phenytoin. It can be minimized with good oral hygiene, so patients should be encouraged to brush and floss regularly. Because small fluctuations in phenytoin levels can affect response, maintaining therapeutic levels is not easy. Patients should be cautioned against consuming alcohol while taking phenytoin. Rashes can be serious and should be reported immediately

The nurse assesses a newly diagnosed patient for short-term complications of diabetes. What does this assessment include? a. Evaluation for hyperglycemia, hypoglycemia, and ketoacidosis b. Cranial nerve testing for peripheral neuropathy c. Pedal pulse palpation for arterial insufficiency d. Auscultation of the carotids for bruits associated with atherosclerosis

ANS: A High blood sugar, low blood sugar, and ketoacidosis are short-term complications of diabetes. Microvascular and macrovascular complications, such as peripheral neuropathy, are long-term complications of diabetes. Arterial insufficiency and atherosclerosis also are long-term complications of diabetes.

An adolescent patient recently attended a health fair and had a serum glucose test. The patient telephones the nurse and says, "My level was 125 mg/dL. Does that mean I have diabetes?" What is the nurse's most accurate response? a. "Unless you were fasting for longer than 8 hours, this does not necessarily mean you have diabetes." b. "At this level, you probably have diabetes. You will need an oral glucose tolerance test this week." c. "This level is conclusive evidence that you have diabetes." d. "This level is conclusive evidence that you do not have diabetes."

ANS: A If a person has not fasted for 8 hours, a blood sugar level of 125 mg/dL would be considered normal, because it is less than 200 mg/dL for a random sampling. Also, a person must have positive outcomes on two separate days to be diagnosed with diabetes. This patient does not need to have an oral glucose tolerance test, because the 125 mg/dL reading is so far below 200 mg/dL, which would require further work-up. No conclusive evidence indicates that this patient has diabetes, because the random sample value is so low, and the patient has not had two separate tests on different days. However, this also is not conclusive evidence that the patient does not have diabetes.

The child comes to the clinic for a well-child checkup. The nurse will expect the provider to: a. change the dose of levothyroxine to 6 mcg/kg/day. b. discontinue the drug if the child's physical and mental development are normal. c. increase the dose to accommodate the child's increased growth. d. stop the drug for 4 weeks and check the child's TSH level.

ANS: A In the treatment of cretinism, thyroid dosing decreases with age. For infants 6 to 12 months of age, the dose is 6 mcg/kg/day. At 1 year of age, the dose is reduced to 5 to 6 mcg/kg/day. For all children, treatment should continue for 3 years. It is incorrect to increase the dose with age. After 3 years of therapy, the patient undergoes a trial of 4 weeks without the drug, followed by assessment of the TSH and T4 levels, to determine whether the drug may be discontinued.

A nurse is discussing motor symptoms with a patient with Parkinson disease who has been taking levodopa/carbidopa [Sinemet] for 9 months and who is now having regular tics. Which statement by the patient indicates understanding of this symptom? a. "I may need to try a lower dose of Sinemet to reduce my tics." b. "My provider may order clozapine to treat these tics." c. "These tics are an indication that my dose of Sinemet is too low." d. "This means I will have to have surgery to stop the symptoms."

ANS: A Levodopa can cause movement disorders, generally within the first year of therapy. If they occur, a lower dose of levodopa may be required to alleviate them. Clozapine is an antipsychotic used to treat levodopa-induced psychoses. Movement disorders generally occur as the dose of levodopa increases. Surgery is a last option for treating movement disorders, after amantadine fails

A nurse provides teaching for a patient who is newly diagnosed with Parkinson disease. Which statement by the patient indicates understanding of the drug therapy for this disease? a. "A levodopa/carbidopa combination is used to improve motor function." b. "There are several drugs available to treat dyskinesias." c. "When 'off' times occur, I may need to increase my dose of levodopa." d. "With adequate drug therapy, the disease progression may be slowed."

ANS: A Levodopa combined with carbidopa is the initial drug of choice to treat motor symptoms. Amantadine is the only drug recommended to treat dyskinesias. Entacapone and rasagiline are used to treat abrupt loss of effect, or "off" times. Drug therapy does not slow the progression of the disease

A patient with type 1 diabetes reports mixing NPH and regular insulin to allow for 1 injection. What should the nurse tell the patient? a. This is an acceptable practice. b. These two forms of insulin are not compatible and cannot be mixed. c. Mixing these two forms of insulin may increase the overall potency of the products. d. NPH insulin should only be mixed with insulin glargine.

ANS: A NPH insulin is the only insulin suitable for mixing with short-acting insulins, such as insulin aspart [NovoLog]. These insulins are compatible and are mixed frequently for management of diabetics. The overall potency of each insulin is not increased by mixing them. Insulin glargine cannot be mixed with any other insulin for administration.

A patient has been taking levothyroxine for several years and reports that "for the past 2 weeks, the drug doesn't seem to work as well as before." What will the nurse do? a. Ask the patient when the prescription was last refilled. b. Expect the patient to have an elevated temperature and tachycardia. c. Suggest that the patient begin taking calcium supplements. d. Tell the patient to try taking the medication with food

ANS: A Not all levothyroxine preparations have the same drug bioavailability; therefore, if a patient is experiencing differing effects, the pharmacist may have switched brands. Asking a patient about a recent refill may help to explain why the drug has different effects. An elevated temperature and tachycardia would be signs of toxicity, not of a decrease in effectiveness. Calcium supplements and food would only interfere with absorption and further reduce the drug's effectiveness.

The nurse working on a high-acuity medical-surgical unit is prioritizing care for four patients who were just admitted. Which patient should the nurse assess first? a. The NPO patient with a blood glucose level of 80 mg/dL who just received 20 units of 70/30 Novolin insulin b. The patient with a pulse of 58 beats/min who is about to receive digoxin [Lanoxin] c. The patient with a blood pressure of 136/92 mm Hg who complains of having a headache d. The patient with an allergy to penicillin who is receiving an infusion of vancomycin [Vancocin]

ANS: A The NPO patient with hypoglycemia who just received 70/30 Novolin insulin takes priority, because this patient needs to consume a good source of glucose immediately or perhaps the NPO status will be discontinued for this shift. The digoxin may be withheld for the patient with a pulse of 58 beats/min, but this is not a priority action. The patient with a headache needs to be followed up, but because the blood pressure is 136/92 mm Hg, the headache is probably not caused by hypertension. The patient with an allergy to penicillin will not have a reaction to the vancomycin

A patient with Parkinson disease is taking levodopa/carbidopa [Sinemet] and reports occasional periods of loss of drug effect lasting from minutes to several hours. The nurse questions the patient further and discovers that these episodes occur at different times related to the medication administration. The nurse will contact the provider to discuss: a. administering a catechol-O-methyltransferase (COMT) inhibitor, such as entacapone. b. adding the DA-releasing agent amantadine to the regimen. c. giving a direct-acting dopamine agonist. d. shortening the dosing interval of levodopa/carbidopa.

ANS: A This patient is describing abrupt loss of effect, or the "off" phenomenon, which is treated with entacapone or another COMT inhibitor. Amantadine is used to treat dyskinesias. A direct-acting dopamine agonist is useful for gradual loss of effect, which occurs at the end of the dosing interval as the dose is wearing off. Shortening the dosing interval does not help with abrupt loss of effect

A patient shows loss of consciousness, jaw clenching, contraction and relaxation of muscle groups, and periods of cyanosis. The nurse correctly identifies this as which type of seizure? a. Tonic-clonic b. Petit mal c. Myoclonic d. Atonic

ANS: A Tonic-clonic seizures (or grand mal seizures) are considered generalized seizures and are manifested by a loss of consciousness, jaw clenching, muscle relaxation alternating with muscle contractions, and periods of cyanosis. Absence seizures (or petit mal seizures) are characterized by loss of consciousness for a brief period and usually involve eye blinking and staring into space. Myoclonic seizures consist of sudden contractions that may be limited to one limb or may involve the entire body. Atonic seizures are characterized by sudden loss of muscle tone

A nurse is teaching a patient who will begin taking methimazole [Tapazole] for Graves' disease about the medication. Which statement by the patient indicates understanding of the teaching? a. "Because of the risk for liver toxicity, I will need frequent liver function tests." b. "I should report a sore throat or fever to my provider if either occurs." c. "I will need a complete blood count every few months." d. "It is safe to get pregnant while taking this medication."

ANS: B Agranulocytosis is rare but can occur with methimazole, so patients should report signs of infection, such as a sore throat or fever. Liver toxicity is not a side effect, so liver function tests are not indicated. Because agranulocytosis often develops rapidly, periodic blood counts do not guarantee early detection. Methimazole is contraindicated in the first trimester of pregnancy.

A nurse is teaching a group of nursing students about irreversible cholinesterase inhibitors. Which statement by a student indicates understanding of the teaching? a. "Diazepam is given to reverse inhibition of cholinesterase when overdose occurs." b. "Irreversible cholinesterase inhibitors are rapidly absorbed by all routes." c. "These agents are often used to treat glaucoma." d. "Toxic doses of these agents produce an anticholinergic crisis."

ANS: B Almost all of these agents are highly lipid soluble, making them readily absorbed from all routes of administration. Diazepam is used during overdose but only to control seizures and not to reverse effects. The only clinical use for these agents is to treat glaucoma, but this use is limited. Toxic doses of these agents produce a cholinergic, not an anticholinergic, crisis.

A patient is to begin taking phenytoin [Dilantin] for seizures. The patient tells the nurse that she is taking oral contraceptives. What will the nurse tell the patient? a. She may need to increase her dose of phenytoin while taking oral contraceptives. b. She should consider a different form of birth control while taking phenytoin. c. She should remain on oral contraceptives, because phenytoin causes birth defects. d. She should stop taking oral contraceptives, because they reduce the effectiveness of phenytoin.

ANS: B Because phenytoin can reduce the effects of oral contraceptive pills (OCPs) and because avoiding pregnancy is desirable when taking phenytoin, patients should be advised to increase the dose of oral contraceptives or use an alternative method of birth control. Increasing the patient's dose of phenytoin is not necessary; OCPs do not affect phenytoin levels. Phenytoin is linked to birth defects; OCPs have decreased effectiveness in patients treated with phenytoin; and the patient should be advised to increase the OCP dose or to use an alternative form of birth control. OCPs do not alter the effects of phenytoin

A nursing student wants to know how carbidopa can be effective for treating Parkinson disease if it prevents the conversion of levodopa to dopamine. The nurse explains that carbidopa: a. can be taken with high-protein meals. b. does not cross the blood-brain barrier. c. has dopamine-like effects of its own. d. reduces abrupt loss of effect.

ANS: B Carbidopa inhibits decarboxylation of levodopa in the intestine and peripheral tissues, leading to more levodopa in the CNS. Carbidopa cannot cross the blood-brain barrier, so it does not have this action in the CNS. Carbidopa is not given with high-protein meals. Carbidopa does not have dopamine-like effects. Carbidopa does not affect abrupt loss of effect.

A nurse is caring for a patient who has been taking an antiepileptic drug for several weeks. The nurse asks the patient if the therapy is effective. The patient reports little change in seizure frequency. What will the nurse do? a. Ask the patient to complete a seizure frequency chart for the past few weeks. b. Contact the provider to request an order for serum drug levels. c. Reinforce the need to take the medications as prescribed. d. Request an order to increase the dose of the antiepileptic drug

ANS: B If medication therapy is not effective, it is important to measure serum drug levels of the medication to determine whether therapeutic levels have been reached and to help monitor patient compliance. Patients should be asked at the beginning of therapy to keep a seizure frequency chart to help deepen their involvement in therapy; asking for historical information is not helpful. Until it is determined that the patient is not complying, the nurse should not reinforce the need to take the medication. Until the drug level is known, increasing the dose is not indicated.

The nurse prepares a patient with Graves' disease for radioactive iodine (131I) therapy. Which statement made by the patient best demonstrates understanding of 131I therapy? a. "I will have to isolate myself from my family for 1 week so that I don't expose them to radiation." b. "This drug will be taken up by the thyroid gland and will destroy the cells to reduce my hyperthyroidism." c. "This drug will help reduce my cold intolerance and weight gain." d. "I will need to take this drug on a daily basis for at least 1 year."

ANS: B Iodine-131 can be used to destroy thyroid tissue in patients with hyperthyroidism; no further teaching is necessary. The patient does not need to isolate himself from others. The treatment will not reduce intolerance to cold, nor will it affect weight gain. The patient will not need the treatment daily.

A patient is admitted to the hospital and will begin taking levothyroxine [Synthroid]. The nurse learns that the patient also takes warfarin [Coumadin]. The nurse will notify the provider to discuss the dose. a. reducing; levothyroxine b. reducing; warfarin c. increasing; levothyroxine d. increasing; warfarin

ANS: B Levothyroxine accelerates the degradation of vitamin K-dependent clotting factors, which enhances the effects of warfarin. Patients taking warfarin who start taking levothyroxine may need to have their warfarin dose reduced. It is not correct to increase or decrease the levothyroxine dose or to increase the warfarin dose.

The nurse is caring for a pregnant patient recently diagnosed with hypothyroidism. The patient tells the nurse she does not want to take medications while she is pregnant. What will the nurse explain to this patient? a. Hypothyroidism is a normal effect of pregnancy and usually is of no consequence. b. Neuropsychologic deficits in the fetus can occur if the condition is not treated. c. No danger to the fetus exists until the third trimester. d. Treatment is required only if the patient is experiencing symptoms.

ANS: B Maternal hypothyroidism can result in permanent neuropsychologic deficits in the child. Hypothyroidism is not a normal effect of pregnancy and is a serious condition that can affect both mother and fetus. The greatest danger to the fetus occurs in the first trimester, because the thyroid does not fully develop until the second trimester. Early identification is essential. Symptoms often are vague. Treatment should begin as soon as possible, or mental retardation and other developmental problems may occur.

The nurse provides teaching for a patient who will begin taking rotigotine [Neupro] to treat Parkinson disease. What will the nurse include in teaching? a. "If you develop nausea and vomiting, you should stop taking the medication." b. "If you need to stop this drug, your provider will order a gradual withdrawal." c. "You will start this drug regimen with a higher than usual loading dose." d. "You will take this medication by mouth with food."

ANS: B Rotigotine is a nonergot dopamine agonist, which is given by starting with a 2-mg dose that is increased by 2 mg each week until the lowest effective dose is reached. It should not be stopped abruptly but should be decreased by 2 mg per week until tapered off. It undergoes extensive firstpass metabolism, so it is not given orally and is currently available as a transdermal patch.

A nurse caring for a patient notes that the patient has a temperature of 104°F, and a heart rate of 110 beats/min. The patient's skin is warm and moist, and the patient complains that the room is too warm. The patient appears nervous and has protuberant eyes. The nurse will contact the provider to discuss: a. cretinism. b. Graves' disease. c. myxedema. d. Plummer's disease.

ANS: B The signs and symptoms in this patient are consistent with hyperthyroidism, and because the patient's eyes are protuberant, they also are consistent with Graves' disease. Cretinism is hypothyroidism in children. Myxedema is severe hypothyroidism. Plummer's disease is a hyperthyroidism condition without exophthalmos

A patient who has been taking phenobarbital for epilepsy begins taking valproic acid [Depakote] as adjunct therapy. The nurse notes that the patient is very drowsy. What will the nurse do? a. Explain to the patient that tolerance to sedation eventually will develop. b. Notify the prescriber, and request an order to reduce the dose of phenobarbital. c. Notify the prescriber of the need to increase the dose of valproic acid. d. Request an order for liver function tests to monitor for hepatotoxicity.

ANS: B Valproic acid competes with phenobarbital for drug-metabolizing enzymes and can increase plasma levels of phenobarbital by approximately 40%. When this combination is used, the dose of phenobarbital should be reduced. Increasing the dose of valproic acid would compound the problem. Patients taking phenobarbital alone experience sedation, which diminishes as tolerance develops. Liver toxicity is a rare adverse effect of valproic acid and is marked by symptoms of nausea, vomiting, and malaise, not drowsiness

A patient newly diagnosed with diabetes expresses concern about losing her vision. Which interventions should be included in the plan of care to reduce this risk? (Select all that apply.) a. Initiation of reliable contraception to prevent pregnancy b. Ways to reduce hyperglycemic episodes c. Use of a prokinetic drug (eg, metoclopramide) d. Smoking cessation e. Emphasis on the importance of taking antihypertensive drugs consistently

ANS: B, D, E Tighter glycemic control and fewer hyperglycemic episodes have been correlated with fewer complications. Smoking cessation and strict compliance with any drugs prescribed for hypertension also help reduce the risk of complications. The use of contraception or a prokinetic drug is not related to a reduced risk of vision loss in patients with diabetes.

A nurse counsels a patient with diabetes who is starting therapy with an alpha-glucosidase inhibitor. The patient should be educated about the potential for which adverse reactions? (Select all that apply.) a. Hypoglycemia b. Flatulence c. Elevated iron levels in the blood d. Fluid retention e. Diarrhea

ANS: B, E Acarbose and miglitol frequently cause flatulence, cramps, abdominal distention, borborygmus (rumbling bowel sounds), and diarrhea. Acarbose also can cause liver damage. Neither acarbose nor miglitol causes hypoglycemia, elevated iron levels, or fluid retention.

A patient has taken levodopa [Dopar] for Parkinson disease for 2 weeks but reports no improvement in the symptoms. Which response by the nurse is correct? a. "Another agent will be needed to manage your symptoms." b. "Double the dose to see whether an effect occurs." c. "It may take several months for a response to occur." d. "The prescriber may need to change your drug regimen."

ANS: C A full therapeutic response with levodopa may take several months to develop. Until the true effect of the dose is seen, it is not necessary to change to another drug, increase the dose, or change the drug regimen

A patient with type 1 diabetes recently became pregnant. The nurse plans a blood glucose testing schedule for her. What is the recommended monitoring schedule? a. Before each meal and before bed b. In the morning for a fasting level and at 4:00 PM for the peak level c. 6 or 7 times a day d. 3 times a day, along with urine glucose testing

ANS: C A pregnant patient with type 1 diabetes must have frequent blood sugar monitoring (eg, 6 or 7 times a day) to manage both the patient and the fetus so that no teratogenic effects occur. Monitoring the blood sugar level before meals and at bedtime is not significant enough to provide the necessary glycemic control. Morning and 4:00 PM monitoring is not enough to provide glycemic control. Urine glucose testing is not sensitive enough to aid glycemic control, and monitoring 3 times a day is not enough

Insulin glargine is prescribed for a hospitalized patient who has diabetes. When will the nurse expect to administer this drug? a. Approximately 15 to 30 minutes before each meal b. In the morning and at 4:00 PM c. Once daily at bedtime d. After meals and at bedtime

ANS: C Glargine insulin is indicated for once-daily subcutaneous administration to treat adults and children with type 1 diabetes and adults with type 2 diabetes. According to the package labeling, the once-daily injection should be given at bedtime. Glargine insulin should not be given more than once a day, although some patients require BID dosing to achieve a full 24 hours of basal coverage.

A patient who has type 2 diabetes will begin taking glipizide [Glucotrol]. Which statement by the patient is concerning to the nurse? a. "I will begin by taking this once daily with breakfast." b. "It is safe to drink grapefruit juice while taking this drug." c. "I may continue to have a glass of wine with dinner." d. "I will need to check my blood sugar once daily or more."

ANS: C Glipizide is a sulfonylurea antidiabetic agent and can cause a disulfiram-like reaction when combined with alcohol. Patients should be taught to avoid alcohol while taking this medication. The initial dosing is once daily with breakfast. There is no drug interaction with grapefruit juice. Patients will need to monitor their blood glucose.

A patient with hypothyroidism begins taking PO levothyroxine [Synthroid]. The nurse assesses the patient at the beginning of the shift and notes a heart rate of 62 beats/min and a temperature of 97.2°F. The patient is lethargic and difficult to arouse. The nurse will contact the provider to request an order for which drug? a. Beta blocker b. Increased dose of PO levothyroxine c. Intravenous levothyroxine d. Methimazole [Tapazole]

ANS: C Intravenous administration of levothyroxine is used for myxedema coma. This patient is showing signs of severe hypothyroidism, or myxedema. A beta blocker is useful in patients who show signs of hyperthyroidism to minimize cardiac effects. Because the half-life of oral levothyroxine is so long, increasing the PO dose will not provide immediate relief of this patient's symptoms. Methimazole is used to treat hyperthyroidism.

A child who receives valproic acid [Depakote] begins taking lamotrigine [Lamictal] because of an increase in the number of seizures. The nurse will observe this child closely for which symptom? a. Angioedema b. Hypohidrosis c. Rash d. Psychosis

ANS: C Lamotrigine can cause life-threatening rashes, such as Stevens-Johnson syndrome and toxic epidermal necrolysis, and this risk increases with concurrent use of valproic acid. Angioedema is an adverse effect associated with pregabalin. Hypohidrosis and psychosis are associated with topiramate.

A nurse is providing teaching to a patient newly diagnosed with partial seizures who will begin taking oxcarbazepine [Trileptal]. The patient also takes furosemide [Lasix] and digoxin [Lanoxin]. Which statement by the patient indicates understanding of the teaching? a. "I may need to increase my dose of Trileptal while taking these medications." b. "I may develop a rash and itching, but these are not considered serious." c. "I should report any nausea, drowsiness, and headache to my provider." d. "I should use salt substitutes instead of real salt while taking these drugs."

ANS: C Oxcarbazepine can cause clinically significant hyponatremia in 2.5% of patients. If oxcarbazepine is combined with other drugs that reduce sodium, the patient should be monitored. Signs of hyponatremia include nausea, drowsiness, confusion, and headache, and patients should be taught to report these symptoms. Increasing the dose of oxcarbazepine is not indicated. Rashes can indicate a serious drug reaction, and providers should be notified so that the oxcarbazepine can be withdrawn. Salt substitutes would compound the problem of hyponatremia.

A patient who has begun taking levodopa/carbidopa [Sinemet] reports feeling lightheaded and dizzy, especially when standing up from a sitting position. What will the nurse recommend? a. An alpha-adrenergic antagonist medication b. Discussing amantadine with the prescriber c. Increasing salt and water intake d. Taking a drug holiday

ANS: C Postural hypotension is common early in treatment and can be reduced by increasing the intake of salt and water. An alpha-adrenergic agonist, not an antagonist, can help. Amantadine is used to treat levodopa-induced dyskinesias. Drug holidays are used when adverse effects increase with long-term use of levodopa; the drug holiday allows beneficial effects to be achieved with lower doses, which reduces the incidence of side effects.

A patient with a form of epilepsy that may have spontaneous remission has been taking an AED for a year. The patient reports being seizure free for 6 months and asks the nurse when the drug can be discontinued. What will the nurse tell the patient? a. AEDs must be taken for life to maintain remission. b. Another AED will be substituted for the current AED. c. The provider will withdraw the drug over a 6- to 12-week period. d. The patient should stop taking the AED now and restart the drug if seizures recur

ANS: C The most important rule about withdrawing AEDs is that they should be withdrawn slowly over 6 weeks to several months to reduce the risk of status epilepticus (SE). AEDs need not be taken for life if seizures no longer occur. Substituting one AED for another to withdraw AED therapy is not recommended. Stopping an AED abruptly increases the risk of SE.

A nurse obtaining an admission history on an adult patient notes that the patient has a heart rate of 62 beats/min, a blood pressure of 105/62 mm Hg, and a temperature of 96.2°F. The patient appears pale and complains of always feeling cold and tired. The nurse will contact the provider to discuss tests for which condition? a. Cretinism b. Graves' disease c. Hypothyroidism d. Plummer's disease

ANS: C This patient is showing signs of hypothyroidism: a low heart rate, low temperature, pale skin, and feeling cold and tired. In adults, thyroid deficiency is called hypothyroidism. In children, thyroid deficiency is called cretinism. Graves' disease and Plummer's disease are conditions caused by thyroid excess.

A 20-kg child has been taking valproic acid [Depakote] for 1 week to treat a seizure disorder. The child is receiving 200 mg PO twice daily. The child's parents report no improvement in seizure activity. The nurse will anticipate that the provider will order which change in this child's drug regimen? a. Adding another seizure medication to supplement the valproic acid b. Changing to phenytoin [Dilantin] since the valproic acid is not effective c. Increasing the dose of valproic acid to 300 mg PO twice daily d. Increasing the dose of valproic acid to 200 mg 3 times daily

ANS: C Valproic acid is given initially at a dose of 5 to 15 mg/kg/day, administered in two divided doses. This child is receiving 400 mg/day, which is 10 mg/kg/day. The dosage should be increased by 5 to 10 mg/kg/day each week until optimal levels are achieved up to a maximum dose of 60 mg/kg/day. At this point, adding another AED or changing to another AED is not recommended. Increasing the dose to 3 times daily is not recommended.

A patient in the emergency department is given intravenous diazepam [Valium] for seizures. When the seizures stop, the nurse notes that the patient is lethargic and confused and has a respiratory rate of 10 breaths per minute. The nurse will expect to administer which of the following? a. Flumazenil [Romazicon] b. Gastric lavage c. Respiratory support d. Toxicology testing

ANS: C When benzodiazepines are administered IV, severe effects, including profound hypotension, respiratory arrest, and cardiac arrest, can occur. Respiration should be monitored, and the airway must be managed if necessary. Flumazenil [Romazicon] is a competitive benzodiazepine receptor antagonist and is used to reverse the sedative effects but may not reverse respiratory depression. Gastric lavage would not be effective, because the benzodiazepine has been given IV. Without further indication of the ingestion of other drugs, toxicology testing is not a priority.

A patient has a free T4 level of 0.6 ng/dL and a free T3 of 220 pg/dL. The patient asks the nurse what these laboratory values mean. How will the nurse respond? a. "These laboratory values indicate that you may have Graves' disease." b. "These results suggest you may have hyperthyroidism." c. "We will need to obtain a total T4 and a total T3 to tell for sure." d. "We will need to obtain a TSH level to better evaluate your diagnosis."

ANS: D A free T4 level of less than 0.9 ng/dL and a free T3 of less than 230 pg/dL are consistent with hypothyroidism, but measurement of the thyroid-stimulating hormone (TSH) level is necessary to distinguish primary hypothyroidism from secondary hypothyroidism. Total T3 and T4 levels are not as helpful as free T3 and T4 levels. These laboratory values indicate hypothyroidism, not hyperthyroid conditions such as Graves' disease.

A nursing student wants to know why a patient who has been taking levodopa [Dopar] for years will now receive levodopa/carbidopa [Sinemet]. The nurse explains the reasons that levodopa as a single agent is no longer available. Which statement by the student indicates a need for further education? a. "Carbidopa increases the availability of levodopa in the central nervous system." b. "Carbidopa reduces the incidence of nausea and vomiting." c. "Combination products reduce peripheral cardiovascular side effects." d. "Combination products cause fewer dyskinesias and decreased psychosis."

ANS: D Adding carbidopa to levodopa does not reduce the incidence of dyskinesias or psychosis. In fact, carbidopa can increase the intensity and the speed of onset of these effects. Carbidopa inhibits decarboxylation of levodopa in the intestine and peripheral tissues, leading to more levodopa in the CNS. Carbidopa cannot cross the blood-brain barrier, so it does not have this action in the CNS. Peripheral side effects are reduced, including nausea, vomiting, and cardiovascular effects

A patient with type 1 diabetes who takes insulin reports taking propranolol for hypertension. Why is the nurse concerned? a. The beta blocker can cause insulin resistance. b. Using the two agents together increases the risk of ketoacidosis. c. Propranolol increases insulin requirements because of receptor blocking. d. The beta blocker can mask the symptoms of hypoglycemia.

ANS: D Beta blockers can delay awareness of and response to hypoglycemia by masking signs associated with stimulation of the sympathetic nervous system (eg, tachycardia, palpitations) that hypoglycemia normally causes. Furthermore, beta blockade impairs glycogenolysis, which is one means by which the body can counteract a fall in blood glucose; beta blockers, therefore, can worsen insulin-induced hypoglycemia. Propranolol does not cause insulin resistance. The incidence of DKA is not increased by concurrent use of propranolol and insulin. Insulin requirements are not increased because of receptor blocking by propranolol.

A patient who has a seizure disorder is admitted to the hospital after an increase in seizure frequency, and the prescriber orders carbamazepine [Tegretol] 100 mg twice daily to be added to the patient's medication regimen. The nurse reviewing the patient's medical history notes that the patient is already taking lamotrigine [Lamictal] 375 mg twice daily. The nurse will contact the provider to discuss which action? a. Reducing the carbamazepine dose to 50 mg twice daily b. Reducing the lamotrigine dose to 225 mg twice daily c. Increasing the carbamazepine dose to 200 mg twice daily d. Increasing the lamotrigine dose to 500 mg twice daily

ANS: D Carbamazepine induces hepatic drug-metabolizing enzymes and can increase the rate at which lamotrigine and other drugs are metabolized; therefore, patients taking any of these drugs would need an increased dose. Reducing the dose of either drug is not indicated. Increasing the dose of carbamazepine may be necessary but only after serum drug levels have been checked

Which statement is accurate about the long-term complications of diabetes? a. Long-term complications are almost always the result of hypoglycemia and ketoacidosis. b. The complication rates for patients with optimally controlled type 2 diabetes are the same as for those whose disease is not optimally controlled. c. Optimal control of type 1 diabetes produces excessive episodes of life-threatening hypoglycemia. d. Optimal control of both types of diabetes reduces the risk of eye, kidney, and nerve damage.

ANS: D In both types of diabetes, optimal control of the disease slows the development of microvascular complications. Short-term complications are more apt to result from hypoglycemia and ketoacidosis. Patients with type 2 diabetes have fewer complications if their blood sugar level is optimally controlled. Hypoglycemia does not occur more frequently in patients with optimally controlled type 1 diabetes.

An older adult patient is diagnosed with hypothyroidism. The initial free T4 level is 0.5 mg/dL, and the TSH level is 8 microunits/mL. The prescriber orders levothyroxine [Levothroid] 100 mcg/day PO. What will the nurse do? a. Administer the medication as ordered. b. Contact the provider to discuss giving the levothyroxine IV. c. Request an order to give desiccated thyroid (Armour Thyroid). d. Suggest that the provider lower the dose

ANS: D In older adult patients, initial dosing of levothyroxine should start low and be increased gradually. A typical starting dose for an elderly patient is 25 to 50 mcg/day. It is not correct to administer the medication without questioning the provider. Unless the patient has signs of myxedema, there is no need to give the medication IV. Desiccated thyroid is no longer used except in patients who have been taking it long term.

A patient has been diagnosed with Parkinson disease (PD) and begins treatment with levodopa/carbidopa [Sinemet]. After several months of therapy, the patient reports no change in symptoms. The nurse will expect the provider to: a. add a dopamine agonist. b. discuss the "on-off" phenomenon. c. increase the dose of Sinemet. d. re-evaluate the diagnosis

ANS: D Patients beginning therapy with levodopa/carbidopa (Sinemet) should expect therapeutic effects to occur after several months of treatment. Levodopa is so effective that a diagnosis of PD should be questioned if the patient fails to respond in this time frame. Adding a dopamine agonist is not indicated. The "on-off" phenomenon occurs when therapeutic effects are present. Increasing the dose of levodopa/carbidopa is not indicated.

A nurse is teaching a patient who has been diagnosed with hypothyroidism about levothyroxine [Synthroid]. Which statement by the patient indicates a need for further teaching? a. "I should not take heartburn medication without consulting my provider." b. "I should report insomnia, tremors, and an increased heart rate to my provider." c. "If I take a multivitamin with iron, I should take it 4 hours after the Synthroid." d. "If I take calcium supplements, I may need to decrease my dose of Synthroid."

ANS: D Patients taking calcium supplements should take these either 4 hours before or after taking levothyroxine, because they interfere with levothyroxine absorption. Many heartburn medications contain calcium, so patients should consult their provider before taking them. Insomnia, tremors, and tachycardia are signs of levothyroxine toxicity and should be reported. Iron also interferes with levothyroxine absorption, so dosing should be 4 hours apart

A patient arrives in the emergency department with a heart rate of 128 beats/min and a temperature of 105°F. The patient's skin feels hot and moist. The free T4 level is 4 ng/dL, the free T3 level is 685 pg/dL, and the TSH level is 0.1 microunits/mL. The nurse caring for this patient will expect to administer: a. intravenous levothyroxine. b. iodine-131 ( 131I). c. methimazole [Tapazole]. d. propylthiouracil (PTU).

ANS: D Propylthiouracil is used for patients experiencing thyroid storm, and this patient is showing signs of that condition. Levothyroxine is given IV for hypothyroidism. 131I is used in patients over age 30 who have not responded to other therapies. Methimazole is used long term to treat hyperthyroidism, but PTU is more useful for emergency treatment.

A patient with type 1 diabetes is eating breakfast at 7:30 AM. Blood sugars are on a sliding scale and are ordered before a meal and at bedtime. The patient's blood sugar level is 317 mg/dL. Which formulation of insulin should the nurse prepare to administer? a. No insulin should be administered. b. NPH c. 70/30 mix d. Lispro [Humalog]

ANS: D Regular insulin is indicated for sliding scale coverage. Insulin is definitely indicated for this high blood sugar level. NPH is used for scheduled insulin doses and is a longer-acting insulin. A 70/30 mix is also used for scheduled insulin coverage.

What is the most reliable measure for assessing diabetes control over the preceding 3-month period? a. Self-monitoring blood glucose (SMBG) graph report b. Patient's report c. Fasting blood glucose level d. Glycosylated hemoglobin level

ANS: D The glycosylated hemoglobin level tells much about what the plasma glucose concentration has been, on average, over the previous 2 to 3 months. The SMBG graph report is done by the patient and indicates each blood sugar level the patient has on a daily basis. It is not as reliable as the glycosylated hemoglobin level, because the equipment used might not be accurate and the testing may not reflect actual measurements 100% of the time. The patient's report of blood sugar levels is not considered as accurate as the glycosylated hemoglobin level for the same reason that the SMBG is not. One fasting blood glucose level indicates the patient's blood sugar level for that one time when it was obtained.

A patient who is newly diagnosed with Parkinson disease is prescribed levodopa [Dopar]. The patient asks the nurse about drugs to prevent disease progression. What will the nurse tell this patient? a. "Levodopa may prevent disease progression in higher doses and is safe to use for this purpose." b. "MAO-B inhibitors and dopamine agonists have both shown neuroprotective effects in human studies." c. "Vitamin E has been shown to delay neuron degeneration and may be used as adjunctive therapy." d. "While some drugs show promise, there are no studies that have proven a neuroprotective effect."

ANS: D To date, there is no definitive proof that any drug can protect dopaminergic neurons from progressive degeneration. Levodopa has shown neuroprotective effects, but studies have demonstrated toxic effects in the doses required for this purpose. MAO-B inhibitors have shown benefits, but only in animal studies. Vitamin E was once theorized to offer this protection, but recent studies have provided good evidence that this is not the case.

A hospitalized patient with Parkinson disease who is receiving apomorphine to treat "off" episodes develops nausea and vomiting. The nurse will discuss the use of which medication with the patient's provider? a. Levodopa [Dopar] b. Ondansetron [Zofran] c. Prochlorperazine [Compazine] d. Trimethobenzamide [Tigan]

ANS: D Trimethobenzamide can be used as an antiemetic in patients treated with apomorphine. Serotonin receptor agonists (eg, ondansetron) and dopamine receptor antagonists (eg, prochlorperazine) cannot be used, because they increase the risk of serious postural hypotension. Levodopa only increases nausea and vomiting

The nurse is teaching a patient who is newly diagnosed with myasthenia gravis about managing the disease. Which is important when teaching this patient about adverse effects of cholinesterase inhibitors? a. "There are very few serious side effects associated with your medication." b. "It is important to notify your provider if you have excessive saliva." c. "If you experience urinary urgency, you may need to increase your dose." d. "Excessive sweating is a minor side effect and will improve over time."

B Accumulation of ACh at muscarinic receptors can result in excessive salivation, bradycardia, sweating, increased gastric secretions, increased tone and motility of the GI tract, and urinary urgency. These responses may have to be suppressed with atropine. In toxic doses, accumulation of ACh may produce depolarizing neuromuscular blockade with paralysis of respiratory muscles. Patients should be taught to report any of these symptoms to their provider

A nurse is assessing a patient who becomes motionless and seems to stare at the wall and then experiences about 60 seconds of lip smacking and hand wringing. What should the nurse do? a. Ask the patient about a history of absence seizures. b. Contact the provider to report symptoms of a complex partial seizure. c. Notify the provider that the patient has had a grand mal seizure. d. Request an order for intravenous diazepam [Valium] to treat status epilepticus.

B This patient showed signs of a complex partial seizure, characterized by impaired consciousness beginning with a period of motionlessness with a fixed gaze, followed by a period of automatism. The entire episode generally lasts 45 to 90 seconds. Absence seizures are characterized by loss of consciousness for a brief period (about 10 to 30 seconds) and may involve mild, symmetric motor activity or no motor signs. A grand mal seizure is characterized by jaw clenching and rigidity followed by alternating muscle relaxation and contraction and then periods of cyanosis, all with a loss of consciousness. Status epilepticus is a seizure that persists for 30 minutes or longer

A patient newly diagnosed with Parkinson disease has been taking levodopa/carbidopa [Sinemet] for several weeks and complains of nausea and vomiting. The nurse tells the patient to discuss what with the provider? a. Taking a lower dose on an empty stomach b. Taking an increased dose along with a high-protein snack c. Taking a lower dose with a low-protein snack d. Taking dopamine in addition to levodopa/carbidopa

C Because levodopa activates the chemoreceptive trigger zone (CTZ) of the medulla, causing nausea and vomiting (N/V), the patient may need to take a lower dose temporarily until tolerance develops. A meal helps slow absorption to minimize this side effect. A high protein intake contributes to abrupt loss of effect, so meals should be low in protein. Taking a dose on an empty stomach increases absorption and also N/V. An increased dose with a high-protein snack increases N/V and also abrupt loss of effect. Dopamine increases N/V, because it activates the CTZ of the medulla

A child is diagnosed with absence seizures, and the prescriber orders ethosuximide [Zarontin]. When teaching the child's parents about dosage adjustments for this drug, the nurse will stress the importance of: a. frequent serum drug level monitoring. b. learning as much as possible about the disorder and its treatment. c. recording the number of seizures the child has each day. d. reporting dizziness and drowsiness to the provider.

C Measurements of plasma drug levels are less important than observation of seizure activity for determining effective dosages for absence seizures, because this type of seizure is characterized by as many as several hundred occurrences a day. Keeping a chart of seizure activity is the best way to monitor drug effectiveness when treating absence seizures. Frequent drug level monitoring is important when side effects occur to ensure that drug toxicity is not occurring. Learning about the disorder is an important part of adherence. Dizziness and drowsiness are common side effects that diminish with continued use.

A patient in her twenties with Graves' disease who takes methimazole [Tapazole] tells a nurse that she is trying to conceive and asks about disease management during pregnancy. What will the nurse tell her? a. Methimazole is safe to take throughout pregnancy. b. Propylthiouracil should be taken throughout her pregnancy. c. The patient should discuss changing to propylthiouracil from now until her second trimester with her provider. d. The patient should discuss therapy with iodine-131 instead of medications with her provider.

C Methimazole is not safe during the first trimester of pregnancy, because it is associated with neonatal hypothyroidism, goiter, and cretinism; however, it is safe in the second and third trimesters. Propylthiouracil is recommended for pregnant patients only in the first trimester and during lactation only if a thionamide is absolutely necessary. Iodine-131 is used in women older than 30 years who have not responded to medication therapy and is contraindicated during pregnancy.

A patient with a seizure disorder is admitted to the hospital and has a partial convulsive episode shortly after arriving on the unit. The patient has been taking phenytoin [Dilantin] 100 mg 3 times daily and oxcarbazepine [Trileptal] 300 mg twice daily for several years. The patient's phenytoin level is 8.6 mcg/mL, and the oxcarbazepine level is 22 mcg/mL. The nurse contacts the provider to report these levels and the seizure. What will the nurse expect the provider to order? a. A decreased dose of oxcarbazepine b. Extended-release phenytoin c. An increased dose of phenytoin d. Once-daily dosing of oxcarbazepine

C This patient's phenytoin level is low; the therapeutic range is 10 to 20 mcg/mL. An increase in the phenytoin dose is necessary. The oxcarbazepine level is within the normal range of 3 to 40 mcg/mL, so changing the dose is not necessary. Extended-release phenytoin is absorbed more slowly and would not increase this patient's serum phenytoin level. The dosing of oxcarbazepine does not need to be changed.

A nurse provides dietary counseling for a patient newly diagnosed with type 1 diabetes. Which instruction should be included? a. "You may eat any foods you want and cover the glucose increase with sliding scale, regular insulin." b. "Most of the calories you eat should be in the form of protein to promote fat breakdown and preserve muscle mass." c. "Your total caloric intake should not exceed 1800 calories in a 24-hour period." d. "You should use a carbohydrate counting approach to maintain glycemic control."

D Patients with diabetes should be given intensive insulin therapy education using either a carbohydrate counting or experience-based estimation approach in achieving glycemic control. A patient with diabetes cannot eat any foods desired and then cover the glucose increase with a sliding scale of regular insulin. Evidence suggests that there is not an ideal percentage of calories that should be ingested from carbohydrate, fat, or protein. Every patient with diabetes must be assessed individually to determine the number of total calories the person should have daily. The total caloric intake should be spread evenly throughout the day, with meals spaced 4 to 5 hours apart

An elderly patient who has type 2 diabetes has a history of severe hypoglycemia. The patient's spouse asks the nurse what the optimum A1c level is for the patient. Which is correct? a. Between 6.5 and 7.0 b. Below 7.0 c. Below 8.0 d. Between 7.0 and 8.5

For patients with a history of severe hypoglycemia and those with a limited life expectancy or advanced micro- and macrovascular complications, the target A1c level should be below 8.0. For most other patients with diabetes, the target is 7.0 and below