Pharm Test #4 Sample questions/rationale

What is the mechanism of action for cosyntropin (Cortrosyn)?

-stimulates release of cortisol from adrenal cortex -has anti inflammatory effects

Desmopressin

treat bedwetting Nocturnal enuresis; Hemophilia A; type 1 von Willebrand disease

Type 2 Diabetes

2Dm usually arises because of insulin resistance, in which the body fails to use insulin properly, combined with relative (rather than absolute) insulin deficiency. Relative lack of insulin or resistance to the action of insulin. Insulin is sufficient to to stabilize fat and protein metabolism but not carbohydrate metabolism.

In what time frame should patient's expect full therapeutic response from levothyroxine?

3-4 weeks. (It takes about a month (four half lives) for plasma levels of levothyroxine to reach therapeutic levels.)

The nurse is providing discharge teaching for a client newly diagnosed with type 2 diabetes mellitus who has been prescribed metformin. Which client statement indicates the need for further teaching? 1. "It is okay if I skip meals once in a while." 2. "I need to let my doctor know if I get unusually tired." 3. "I need to constantly watch for signs of low blood sugar." 4. "I will be sure to not drink alcohol excessively while on this medication."

3. "I need to constantly watch for signs of low blood sugar."

The nurse is providing discharge teaching for a client newly diagnosed with type 2 diabetes mellitus who has been prescribed metformin. Which client statement indicates the need for further teaching? 1. "It is okay if I skip meals once in a while." 2. "I need to let my doctor know if I get unusually tired." 3. "I need to constantly watch for signs of low blood sugar." 4. "I will be sure to not drink alcohol excessively while on this medication."

3. "I need to constantly watch for signs of low blood sugar." Rationale: metformin is well suited for patients who skip meals because there it does not stimulate the release of insulin and therefore poses little risk for hypoglycemia.

Sulfonylurea glipizide (Glucotrol)

A second-generation sulfonylurea drug. Oral hypoglycemic drug. Pregnacy category C It has a very rapid onset & short duration of action, with no active metabolites. The rapid onset of action allows it to function much like the body normally does in response to meals when greater levels of insulin are required rapidly to deal with the increased glucose in the blood. In pt with type 2 DM, it rapidly stimulates the pancreas to release insulin & increases insulin sensitivtity. Facilitates the transport of excess glucose from the blood into the cells of the muscles, liver, & adipose tissues. It works best if given 30 minutes before meals, usually before breakfast.

The nurse is administering insulin lispro (Humalog) and will keep in mind that this insulin will start to have an effect within which time frame? A. 15 min B. 1 to 2 hours C. 80 minutes D. 3 to 5 hours

A. 15 min

A 75 year old woman with type 2 diabetes has recently been placed on glipizide (Glucotrol). She asks the nurse when the best time would be to take this medication. What is the nurses best response? A. Take this medication in the morning, 30 minutes before breakfast B. Take this medication in the evening with a snack C. This medication needs to be taken after the midday meal D. It does not matter what time of day you take this medication

A. Take this medication in the morning, 30 minutes before breakfast

A patient who is taking a thyroid replacement medication tells the nurse that she is starting to experience cold intolerance, depression, constipation, and dry skin. What potential cause does the nurse A.inadequate doses of the medication. B.possible overdose of the medication. C.worsening of the underlying disease. drug interactions with another medication

A.inadequate doses of the medication.

The nurse notes in a patient's medication history that the patient has been taking desmopressin (DDAVP). Based on this finding, the nurse interprets that the patient has which disorder? A. Diabetes mellitus B. Diabetes insipidus C. Adrenocortical insufficiency D. Carcinoid tumor

Diabetes insipidus

A patients medication order indicates that he is to receive a dose of cosyntropin (Cortrosyn). The nurse is aware that this drug is used to diagnose which condition? Adrenocortical insufficiency Diabetes Insipidus Myasthenia gravis Pituitary dwarfism

Adrenocortical insufficiency

A prescription reads levothyroxine, 150 mcg orally daily. The medical label reads levothyroxine 0.1mg/tablet. The nurse administers how many tablets to the patient?

Answer: 1.5 tablets. (Convert 150 mcg to mg. Therefore, 150 mcg equals 0.15mg. 0.15mg/0.1mg x 1 tablet = 1.5 tablets)

acarbose (Precose), an alpha-glucosidase inhibitor

Are to be taken at the first bite of every meal

During a teaching session for a patient on antithyroid drugs, the nurse will discuss which dietary instructions? A. Using iodized salt when cooking B. Avoiding food containing iodine C. Restricting fluid intake to 250mm mL/day D. Increasing intake of sodium and potassium containing foods

Avoiding foods containing iodine

A 19 year old student was diagnosed with hypothyroidism and has started thyroid replacement therapy with levothyroxine (Synthroid). After 1 week, she called the clinic to report that she does not feel better. Which response from the nurse is correct? A. it will probably require surgery for a cure to happen B. The full therapeutic effect may not occur for several weeks C. It is possible that you did not take your medication as instructed? D. Lets review your diet; it may be causing absorption problems

B. The full therapeutic effect may not occur for several weeks

A patient will be receiving somatropin. The nurse expects that the patient has which disorder? A.Adrenocortical insufficiency B.Hypopituitary dwarfism C.Esophageal varices D.Septic shock

B.Hypopituitary dwarfism

A nurse is preparing to administer levothyroxine. What findings would require further assessment? A. Calcium level of 9.5 B. Heart Rate of 110 beats per minute C. Potassium level of 3.5 mEq/dL D. Blood pressure of 104/70

B: Tachycardia is an adverse effect of levothyroxine and could indicate a thyroid crisis.

What teaching would a nurse provide to a patient taking Fosamax (Alendronate) for osteoporosis prevention?

Bisphosphonates (e.g., alendronate) are to be taken exactly as prescribed; that is, the drug is taken at least 30 minutes before the first morning beverage, food, or other medication and with at least 6 to 8 oz of water. Emphasize the importance of remaining upright for at least 30 minutes after taking the medication to prevent esophageal and GI adverse effects. Esophageal irritation, dysphagia, severe heartburn, and retrosternal pain must be reported to the prescriber immediately to help prevent severe reactions

Corticosterid therapy may induce hyperglycemia, particularily in prediabetic and diabetic patients. All patients must be monitored for the development of: Complete blood count Partial thromboplastin time Liver function panel Blood Glucose levels

Blood Glucose levels

After the 0700 report, the day shift nurse notices that a patient has a 0730 dose of insulin due and goes to the automated dispensing machine to retrieve the insulin. The nurse sees that the night shift nurse had removed the 0730 dose of insulin, but the medication administration record has not been signed by the nurse. The patient is confused and says she "thinks" the night nurse gave her the insulin. The patient's blood glucose level is 142 mg/dL. What will the day shift nurse do? A.Give the insulin because it was not signed off. B.Hold the insulin because the patient thinks she received it, and it is recorded in the machine. C.Ask the charge nurse to call the night nurse at home to clarify whether the insulin was given. D.Report this to the nursing supervisor.

C. Ask the charge nurse to call the night nurse at home to clarify whether the insulin was given.

estrogen drugs are contraindicated in what type of patient?

Known drug allergy, any estrogen-dependent cancer, undiagnosed abnormal vaginal bleeding, pregnancy, and active thromboembolic disorder or history of such disorder

When monitoring a patient's response to oral antidiabetic drugs, the nurse knows that which laboratory result would indicate a therapeutic response? A. Random blood glucose of 180 mg/dL B. Blood glucose level of 50 after meals C. Fasting blood glucose level of 92 mg/dL D. Evening blood glucose level below 80 mg/dL

C. Fasting blood glucose level of 92 mg/dL

A woman in labor is on an oxytocin infusion. The nurse notes that her contractions are close to 100 seconds apart and are lasting 1.25 seconds. The mother's blood pressure has increased to 130/98 mm Hg, and the fetal heart rate decreases during the contractions. The woman states, "Wow, this medicine is sure hurrying things along!" What is the nurse's priority action? A.Continue to monitor the labor, which is progressing nicely. B.Offer comfort measures during the contractions. C.Stop the infusion, administer oxygen, have her lie on her left side, and notify the physician immediately. D.Take the patient to the delivery area because delivery is imminent

C. Stop the infusion, administer oxygen, have her lie on her left side, and notify the physician immediately.

A woman in labor is on an oxytocin infusion. The nurse notes that her contractions are close to 100 seconds apart and are lasting 1.25 seconds. The mother's blood pressure has increased to 130/98 mm Hg, and the fetal heart rate decreases during the contractions. The woman states, "Wow, this medicine is sure hurrying things along!" What is the nurse's priority action? A.Continue to monitor the labor, which is progressing nicely. B.Offer comfort measures during the contractions. C.Stop the infusion, administer oxygen, have her lie on her left side, and notify the physician immediately. D.Take the patient to the delivery area because delivery is imminent.

C. Stop the infusion, administer oxygen, have her lie on her left side, and notify the physician immediately.

The patient was taking metformin before this hospitalization. To facilitate better glucose control, the patient has been switched to insulin therapy while hospitalized. The patient asks the nurse why it is so important to time meals with the insulin injection and to give him an example of a long-acting insulin. 2. Which drug will the nurse tell the patient is a long-acting insulin? A.Insulin glulisine (Apidra) B.Insulin isophane suspension (NPH) C.Insulin detemir (Levemir) D.Regular insulin (Humulin R)

C.Insulin detemir (Levemir)

A male patient who has a history of type 2 DM is admitted to the medical unit with a diagnosis of pneumonia. The patient has many questions regarding his care and asks the nurse why everyone keeps telling him about HbA1C. 1. What can the nurse inform the patient about the use of HbA1C in diabetes mellitus? A.Helps to identify which type of DM the patient has B.Will identify if he has an infection C.Will aid in monitoring patient compliance with treatment regimen for several months previously D.Represents current fasting blood glucose level

C.Will aid in monitoring patient compliance with treatment regimen for several months previously

When teaching about hypoglycemia, the nurse will make sure the patient is aware of the early signs of hypoglycemia, including which of these? A. Hypothermia and seizures B. Nausea and diarrhea C. Confusion and sweating D. Fruity, acetone odor to breathe

Confusion and sweating

The nurse is reviewing the medical record of a hospitalized client scheduled later that day for a computerized tomography (CT) scan with an intravenous contrast dye. On review of the record the nurse notes that the client has diabetes mellitus and is taking metformin. The nurse prepares to take what actions?

Contact the radiology department to inform them that the client is taking metformin and for rescheduling the scan. ▪ Check with the primary health care provider about the time for withholding the metformin after the scan is completed. ▪ Encourage fluid intake after the scan is completed. ▪ Check the serum creatinine level before resuming the metformin.

The nurse has just administered the morning dose of a patient's lispro (Humalog) insulin. Just after the injection, the dietary department calls to inform the patient care unit that breakfast trays will be 45 minutes late. What will the nurse do next? A.Inform the patient of the delay. B.Check the patient's blood glucose levels. C.Call the dietary department to send a tray immediately. D. Give the patient food, such as cereal and skim milk, and juice.

D. Give the patient food, such as cereal and skim milk, and juice.

A patient has been taking levothyroxine (Synhroid) for more than one decade for primary hypothyroidism. Today she calls because she has a cousin who can get her the same medication in a generic form from a pharmaceutical supply company. Which is the nurses best advice? A. This would be a great way to save money B. Theres no difference in brnads of this medication C. This should never be done, once you start with a certain brand you must stay with it. D. Its better not to switch unless we talk to your Doctor.

D. Its better not to switch unless we talk to your Doctor.

When assessing a patient taking testosterone, which laboratory value is most important for the nurse to review? A. Hemoglobin A1C B. Triglycerides C. Potassium D. Lactate dehydrogenase (LDH)

D. Lactate dehydrogenase (LDH) Assess the patient for liver disease because formation of blood-filled cavities may occur. This condition, also called peliosis, is associated with long-term therapy and may be life threatening. Perform liver function studies (e.g., LDH, CPK, and bilirubin levels) as ordered to monitor for the possible adverse effect of abnormal liver function and jaundice.

A 60-year-old woman is taking a bisphosphonate. She calls the clinic and tells the nurse that her stomach has been bothering her and wants to know what she should do. Which instruction is most appropriate for the nurse to provide? A.Take the medication with milk. B.Take the medication with breakfast. C.Remain upright in a sitting position for at least 10 minutes after taking the medication. D.Stop the medication and come in for an evaluation.

D. Stop the medication and come in for an evaluation. Bisphosphonates (e.g., alendronate) are to be taken exactly as prescribed; that is, the drug is taken at least 30 minutes before the first morning beverage, food, or other medication and with at least 6 to 8 oz of water. Emphasize the importance of remaining upright for at least 30 minutes after taking the medication to prevent esophageal and GI adverse effects. Esophageal irritation, dysphagia, severe heartburn, and retrosternal pain must be reported to the prescriber immediately to help prevent severe reactions. Sherptah PP

A 60-year-old woman is taking a bisphosphonate. She calls the clinic and tells the nurse that her stomach has been bothering her and wants to know what she should do. Which instruction is most appropriate for the nurse to provide? A.Take the medication with milk. B.Take the medication with breakfast. C.Remain upright in a sitting position for at least 10 minutes after taking the medication. D. Stop the medication and come in for a an evaluation

D. Stop the medication and come in for an evaluation. Rationale: Biphospates should be take exactly as prescribed, 30 min before the first food or beverage of the day, remaining in an upright position to avoid esophageal and GI adverse effects. Irritation, dysphagia, severe heartburn adn retrosternal pain should be reported to prescriber right away.

A patient with type 1 DM is admitted to the medical unit with an acute exacerbation of chronic obstructive pulmonary disease. He is placed on IV piggyback antibiotics, nebulizer treatments with albuterol, and an IV corticosteroid, and he is also taking a proton pump inhibitor for gastroesophageal reflux disease. He takes a dose of glargine insulin every evening. This evening the nurse notes that his blood glucose level is 170 mg/dL. The next morning, his fasting glucose level is 202 mg/dL. What is the most likely cause of his elevated glucose levels? A.The albuterol B.The antibiotics C.The proton pump inhibitor D. The corticosteroid

D. The corticosteroid

The nurse is teaching a group of patients about self administration of insulin. What content is important to include? A. Patients need to use the injection site that is the most accessible B. If 2 different insulins are ordered, they need to be given separately C. When mixing insulins, the cloudy (s/a NPH) insulin is drawn first D. When mixing insulins, the clear (s/a Regular) is drawn first

D. When mixing insulins, the clear (s/a Regular) is drawn first

Which information will the nurse include when teaching a patient about thyroid replacement therapy? A."Take the medication before bed." B."You will experience beneficial effects of the drug after 1 week of treatment." C."Stop taking the drug if you experience insomnia." D."Take the medication on an empty stomach."

D."Take the medication on an empty stomach."

The patient is being discharged home with insulin aspart (NovoLog) and insulin isophane suspension (NPH). 3. Which information does the nurse include when providing discharge teaching to the patient? A.Store the insulins in the refrigerator. B.Shake the insulins for 1 full minute before use. C.Administer the injection at a 30-degree angle to your skin. D.Draw up the insulin aspart (NovoLog) first and then draw up the insulin isophane suspension (NPH) into the same syringe.

D.Draw up the insulin aspart (NovoLog) first and then draw up the insulin isophane suspension (NPH) into the same syringe.

Which would be the best menu choice for a patient who is taking an antithyroid medication? A.A seafood platter B.Sushi C.Tofu burger D.Pasta with marinara sauce

D.Pasta with marinara sauce (Patient should avoid foods high in iodine such as soy tofu and seafood)

A patient with diabetes is prescribed levothyroxine for hypothyroidism. Which action should the nurse anticipate the health care provider to do? A. No change to current diabetic treatments B. A decrease in the patient's insulin dose C. A change from insulin to an oral diabetic drug D. An increase in the patients insulin dose

D: An increase in the patient's insulin dose. (Levothyroxine is know to cause a decrease in the effectiveness of insulin. Patient's often require higher doses of insulin.)

Glucocorticoid therapy is contraindicated in what disorder?

Drug Allergy Diabetes Mellitus, PUD, Cataracts, glaucoma, mental health

What are the early signs of hypoglycemia

Early symptoms of hypoglycemia include the central nervous system manifestations of confusion, irritability, tremor and sweating. (Later symptoms include hypothermia and seizures.

Which is the most appropriate timing regarding the nurses administration of a rapid action insulin to a hospitalized patient?

Give it 15 minutes before the patient begins a meal.

What lab test indicates therapeutic response in oral antidiabetic drugs

HbA1c is a reflection of how well blood glucose levels have been controlled over the last 90 days. Consistent poor glycemic control in a client with diabetes mellitus is usually the cause of an increase in HbA1c value.

What laboratory test to evaluate the patient's adherence to the antidiabetic therapy over the past few months?

HbA1c, Hemoglobin A1C

The nurse is preparing to administer somatropin (Humatrope) and will monitor the patient for which adverse effect? Select all that apply (Pharm book page 480) ⬜ Increase blood pressure ⬜Headache ⬜Flu like syndrome ⬜ Nausea ⬜Hyperglycemia ⬜ Fever

Headache Flu like syndrome Hyperglycemia

The nurse monitoring a patient for a therapeutic response to oral diabetic drugs will look for which of these? A. Fewer episodes of DKA B. Weight loss of 5 lbs C. Hemoglobin A1C levels of less than 7% D. Glucose levels of 150 mg/dL

Hemoglobin A1C levels of less than 7%

A patient is asking about the use of saw palmetto for prostate health. The nurse tells him that drugs that interact with saw palmetto include which of these? Select all that apply: 🔲 Acetaminophen 🔲Nitrates 🔲 Hormones 🔲NSAIDS 🔲Antihypertensive drugs

Hormones, NSAIDS Rationale: Nitrates and Hypertension medications when used together can have a SERIOUS ADVERSE EFFECT of severe hypotension.

What combination of adverse effects should a nurse monitor for when administering IV insulin to a client with diabetic ketoacidosis?

Hypoglycemia and Hypokalemia Monitor for increased intracranial pressure Rationale: Blood glucose needs to be monitored in clients receiving IV insulin because of the risk of hypoglycemia and hypokalemia. Hypogylcemia might occur if too much insulin is administered. Hypokalemia might occur because IV insulin forces potassium into cells, thereby lowering the plasma level of potassium. Calcium and sodium levels are NOT affected by IV insulin administration.

A patient tells the nurse that he takes saw palmetto because he thinks his prostate gland is enlarged. The patient informs the nurse of the medications he takes on a regular basis. Which medication will be of most concern to the nurse? ⬜ Calcium with Vitamin D ⬜ Acetaminophen ⬜ St. John's Wort ⬜ Ibuprofen

Ibuprofen Rationale: the nurse should be most concerned about concurrent use with NSAID, ibuprofen, because of the potential for drug interactions.

The nurse is providing discharge instructions to a client with diabetes mellitus. The clients glycosated hemoglobin (HbA1c) level is 10%. The nurse would make which statement? A. Increase the amount of vegetables and water intake in your diet regimen B. Change the time of day you exercise because it may cause hypoglycemia C. Continue with the same diet and exercise program you are currently using D. Start a high level intensity exercise regimen and decrease carbohydrate intake

Increase the amount of vegetables and water intake in your diet regimen

An 8 year old child has been diagnosed with true pituitary dwarfism and is being treated with somatropin. In follow up visits, the nurse will monitor for which expected outcome? Increased growth Decreased urinary output Increased muscle strength Increased height when the child reaches puberty

Increased growth

Florinef

Indication: Addisons disease Adverse Effects: sodium and water retention, HTN, edema Monitor: vital signs, ICP, Muscle pain/weakness

What medication is administered for pre-term labor?

Indomethacin

Match the drug used in labor with its therapeutic use: Indomethacin Hydroxyprogesterone Caproate Dinoprostone Oxytocin

Indomethacin-suppression of labor Hydroxyprogesterone Caproate-prevention of labor Dinoprostone-cervical ripening Oxytocin-labor induction

The nurse is assessing a professional weightlifter who has been banned from practicing weight lifting because of drug doping. The patients report reveal excessive concentration of nandrolone in the blood. Which risk would the nurse interpret from these findings? Select all that apply: ☐ Anemia ⛘Infertility ☐ Muscle Atrophy ⛘ Cardiovascular Disorder ☐ Malabsorption syndrome

Infertility and Cardiovascular Rationale: Nandrolone is an anabolic steroid often abused by athletes for its muscle building properties. These drugs are known to imhibit sperm production and increase cholesterol levels. Thus sterility and CV disorders are the consequences associated with improper use of anabolic steroids.

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: Insomnia Weight loss Bradycardia Constipation Mild Heat Intolerance

Insomnia Weigh loss Mild Heat Intolerance

The pharmacy has called a patient to notify her that the current brand of thyroid replacement hormone is on back order. The patient calls the clinic to ask what to do. Which is the best response by the nurse? (Pharm book) ⬜Go ahead and take the other brand that the pharmacy has available ⬜ You can stop the medication until your current brand is available ⬜ You can split the thyroid pills you have left so they will last longer ⬜Let me ask your prescriber what needs to be done; we will need to watch how you do if you switch brands.

Let me ask your prescriber what needs to be done; we will need to watch how you do if you switch brands.

When reviewing the medication profile of a patient with a new order for desmopressin (DDAVP) Aspirin Digoxin Lithium Penicillin

Lithium

secondary amenorrhea - what drug's are used for this diagnosis?

Medroxyprogesterone (Provera, Depo Provera) is used to treat uterine bleeding, secondary amenorrhea, endometrial cancer, renal cancer and is also used as a contraceptive

Which hormonal contraceptive has the longest elimination half life?

Medroxyprogesterone (Provera, Depo-Provera) has the longest elimination half life of 50 days.

The nurse is reviewing the medical record of a hospitalized client scheduled later that day for a computerized tomography (CT) scan with an intravenous contrast dye. On review of the record the nurse notes that the client has diabetes mellitus and is taking metformin. The nurse prepares to take the following actions: ▪ Contact the radiology department to inform them that the client is taking metformin and for rescheduling the scan. ▪ Check with the primary health care provider about the time for withholding the metformin after the scan is completed. ▪ Encourage fluid intake after the scan is completed. ▪ Check the serum creatinine level before resuming the metformin. Saunders pg 632 Why?

Metformin needs to be withheld temporarily before and for 48 hours after having any radiological study that involves the administration of intravenous contrast dye because of the risk of contrast induced nephropathy and lactic acidosis.

How does Indomethacin work as a tocolytic?

NSAID that blocks cyclooxygenase and decreases level of prostaglandin

The nurse provides instructions to a client who is taking Levothyroxine. The nurse would tell the client to take the medication in which way? ☐ With food ☐ At lunchtime ☐ On an empty stomach ☐ At bedtime with a snack.

On an empty stomach

Levothyroxine (Synthroid) has been prescribed for a patient with hypothyroidism. The nurse reviews the patient's current medications for potential interactions. Which of these drugs or drug classes interact with levothyroxine? (Select all that apply.) a. Phenytoin (Dilantin) b. Estrogens c. Beta blockers d. Warfarin (Coumadin) e. Penicillins f. Iron supplements

Phenytoin Estrogen Warfarin Iron Supplement

Levothyroxine (Synthroid) has been prescribed for a patient with hypothyroidism. The nurse reviews the patient's current medications for potential interactions. Which of these drugs or drug classes interact with levothyroxine? Select all that apply: A. Phenyoin (Dilantin) B. Estogens C. Beta Blockers D. Warfarin (Coumadin) E. Penicillins F. Iron Supplements

Phenytoin Estrogens Warfarin (Coumadin) Iron Supplements

What are some nursing considerations when administering Indomethacin for pre term labor?

Potential adverse effects: Indigestion/vaginal bleeding Contraindications: Coag disorders, chronic hypertension, heart failure, impaired liver function, CVD disease Nursing Interventions: Should not be used more than 2-3 days at a time. Should not be used in women who are more than 32 weeks preganant because of the risk of ductus arteriosus. Should be avoided in those with a history of ulcers, bleeding disorders, kidney, liver disease. Monitor: Amniotic fluid levels and fetal heart

A woman visits a health center requesting oral contraceptives. Which laboratory test is most important for the nurse to assess before the patient begins oral contraceptive therapy? Complete blood count Serum potassium level Vaginal cultures Pregnancy test

Pregnancy test

What is the mechanism of action of metformin?

Reduces hepatic glucose production and enhances action of insulin The goal of therapy with metformin is to promote homeostasis by stabilizing glucose production and utilization. Metformin acts by decreasing glucose, triglyceride, and cholesterol production in the liver, decreasing glucose absorption in the gut, and increasing targeted cells insulin sensitivity.

A patient who has been on somatropin (Humatrope) has been hospitalized for an acute asthma exacerbation and is receiving intravenous doses of glucocorticoids. The nurse recognized that which effect may occur if these drugs are given together? A. reduction of growth effects B. Hyperkalemia C. Increased urine output D. Diarrhea

Reduction of growth effects

A client is admitted to the unit with DKA (Diabetic ketoacidosis) which insulin would the nurse expect to administer intravenously?

Regular

What is the only insulin that can be given intravenously?

Regular Regular insulin can be given via intravenous bolus, intravenous infusion or IM along with the common route, SQ. These routes, especially the intravenous infusion route, are often used in cases of DKA or coma associated with uncontrolled diabetes type 1.

saw palmetto

Saw palmetto comes from a tree that is also known as the American dwarf palm. The therapeutically active part of the tree is its ripe fruit. It is believed to inhibit dihydrotestosterone and 5-alpha reductase. A prostatic specific antigen test and digital rectal exam should be performed before initiation of treatment for BPH.

What is the drug of choice to treat growth hormone deficiency?

Somatropin (A.Hypopituitary dwarfism)

Januvia can cause significant hypoglycemia when used in combination of what other glucose lowering medication?

Sulfonylurea

When educating a patient the use of oral contraceptives, the nurse provides what explanation for the pills having different colors each week?

The different color pills are because of different amounts of hormones in each week. Rationale: Oral contraceptive pills can be monophasic, biphasic or triphasic. If the pills are different colors, they likely have different amounts of hormones and are likely the triphasic type of contraceptive.

What outcome would a nurse expect for a patient who has AIDS and is receiving megestrol acetate (Megace)? A. the patient will verbalize pain relief B. The patients temperature will return to normal C. The patient will verbalize an increase in appetite D. The patient will demonstrate an elevation in the T-lymphocyte count

The patient will verbalize an increase in appetite. Rationale: Megace is a synthtic progestin that may be used as an antineoplastic for endometrial carcinoma or as a palliative in advance endometrial breast cancer. A side effect of this drug is increased appetite. Therefore, it is sometimes given to patients with AIDS to stimulate their appetites.

A patient has been taking levothyroxine for 6 months. After this month lab work, the nurse practioner tells the nurse that the patient is "euthyroid". What does that term mean?

The patient's thyroid hormone levels are within normal range.

A 16 year old boy is taking somatropin comes into the office because he had an asthma attack during a race at school. Because of this new development, the nurse expects which intervention to occur next? He will need to stop participating in school physical education classes The somatropin must be discontinued immediately The somatropin dosage may be adjusted His growth will be documented and monitored for changes

The somatropin dosage may be adjusted

biguanide metformin (Glucophage) - is used in the diagnosis of metabolic syndrome, why?

This drug benefits patients with type 2 DM who are obese and/or hyperlipidemic because it decreases weight, blood pressure, and plasma lipid levels. (sherpath) (Metabolic syndrome! DM-Obesity-Hyperlipidemic) Metformin beneficially impacts several aspects of metabolic syndrome including dysglycemia, obesity, and liver dysfunction, thus making it widely used frontline treatment for early stage type 2 diabetes which is associated with these disorders. Metformin is recommended by the ADA as the initial oral diabetes drug for treatment of newly diagnosed type 2 diabetes. Because it might also cause moderate weight loss, it is particularly useful for the many patients with T2D who are overweight or obese

A 48-year-old man asks the nurse practitioner for a prescription for sildenafil (Viagra). He is currently taking transdermal nitroglycerin, hydrochlorothiazide, and potassium supplements for cardiac problems, as well as a multivitamin with iron. Which medication would be a cause for concern if taken with the sildenafil? A. Transdermal nitroglycerin B. Hydrochlorothiazide C. Potassium D. Multivitamin with iron

Transdermal nitroglycerin

What action enhances the effectiveness of levothyroxine for the patient with hypothyroidism?

Using levothyroxine at a consistent time each day

What should be included in the discharge instructions for a patient taking levothyroxine?

You will need to have lab work done periodically. (The nurse would advise the patient that TSH and T4 levels will need to be checked for therapeutic response)

What would the nurse teach the client about medroxyprogesterone acetate as a method of contraception?

You would need to come back every 12 weeks to receive another injection of the contraceptive. You will receive the shot within the first five days on menstruation, but if you get is later another form of contraception should be used to help prevent pregnancy. This type of contraception does not protect against STD's. This shot can also increase the appetite causing women to gain weight.

type 1 diabetes mellitus

a lack of insulin production or by the production of defective insulin, which results in acute hyperglycemia (total lack of insulin) Characterized by the destruction of the pancreatic beta cells, which produce insulin, this results in absolute insulin deficiency. If insulin is not given, fats are metabolized for energy resulting in ketonemia (acidosis)

A patient wants to try an oral soy product to relieve perimenopausal symptoms. The nurse will assess the patient's medication history for which potential drug interaction? a. Thyroid replacement therapy b. Oral anticoagulant therapy c. Nonsteroidal anti-inflammatory drugs d. Beta blockers

a. Thyroid replacement therapy Rationale: Orally administered soy may interfere with thyroid hormone absorption, so concurrent use must be avoided. The other options are incorrect.

A patient is taking Metformin for new onset type 2 diabetes. When reviewing potential adverse effects, the nurse will include information about: (Select all that apply)(pharm book pg 512) ⬛ Abdominal bloating ⬛ Nausea ⬛ Diarrhea ⬜ Headache ⬜ Weight gain ⬛ Metallic taste

abdominal bloating nausea diarrhea metallic taste

What is the indication for cosyntropin (Cortrosyn) use?

adrenocortical insufficiency

After starting treatment for type 2 diabetes mellitus 6 months earlier, a patient is in the office for a follow-up examination. The nurse will monitor which laboratory test to evaluate the patient's adherence to the antidiabetic therapy over the past few months? a. Hemoglobin levels b. Hemoglobin A1C level c. Fingerstick fasting blood glucose level d. Serum insulin levels

b. Hemoglobin A1C level

A patient is receiving oxytocin (Pitocin) to induce labor. During administration of this medication, the nurse will also implement which action? a. Giving magnesium sulfate along with the oxytocin b. Administering the medication in an intravenous (IV) bolus c. Administering the medication with an IV infusion pump d. Monitoring fetal heart rate and maternal vital signs every 6 hours

c. Administering the medication with an IV infusion pump

A patient is suspected of having adrenocortical insufficiency. The nurse expects to administer which drug to aid in the diagnosis of this condition? a. octreotide (Sandostatin) b. vasopressin (Pitressin) c. somatropin (Humatrope) d. cosyntropin (Cortrosyn)

d. cosyntropin (Cortrosyn)

intravenous corticosteroids - effects on patients taking who are diabetic?

may increase serum glucose levels, possibly requiring adjustments in dosages of antidiabetic drugs. Because of interactions related to metabolizing enzymes, they may also raise blood levels of the immunosuppressants cyclosporine and tacrolimus.

What are some adverse effects of cosyntropin (Cortrosyn)?

promotes renal retention of sodium, which can result in: -edema -hypertension

The nurse monitoring a patient for a therapeutic response to oral diabetic drugs will look for which of these? ☐ Fewer episodes of DKA ☐ Weight loss of 5 lbs ☐ Hemoglobin A1C levels of less than 7% ☐ Glucose levels of 150 mg/dL

▉ Hemoglobin A1C levels of less than 7%

The nurse would tell the client who is taking levothyroxine to notify the primary health care provider if which problem occurs? ☐Fatigue ☐Tremors ☐ Cold Intolerance ☐ Excessively dry skin

⛘ Tremors Rationale: Excessive doses of levothyroxine can produce s/sx of HYPERTHYROIDISM. 1-3-4 are all signs of hypothyroidism)

Which patients would a nurse determine CANNOT safely receive oxytocin for labor induction? ⬜A patient who has an active herpes infection ⬜A patient whose cervix is covering the placenta ⬜A patient with a fetus in the transverse position ⬜A patient whose fetus is too large for delivery ⬜A patient who is getting ready to deliver her 3rd baby

⬛ A patient who has an active herpes infection ⬛ A patient whose cervix is covering the placenta ⬛ A patient with a fetus in the transverse position ⬛ A patient whose fetus is too large for delivery

A patient is suspected of having adrenocortical insufficiency. The nurse expects to administer which drug to aid in the diagnosis of this condition? ⬜ octreotide (Sandostatin) ⬜ vasopressin (Pitressin) ⬜Somatropin (Humatrope) ⬜ (Cortrosyn)

⬛ Cosyntropin (Cortrosyn)

A patient tells the nurse that he takes saw palmetto because he thinks his prostate gland is enlarged. The patient informs the nurse of the medications he takes on a regular basis. Which medication will be of most concern to the nurse? ⬜ Calcium with Vitamin D ⬜ Acetaminophen ⬜ St. John's Wort ⬜Ibuprofen

⬛ Ibuprofen

Which factors would be takin into consideration as a nurse administers oxytocin as part of labor and delivery? Select all that apply: ⬜oxytocin may be to induce labor and to control postpartum bleeding ⬜ Cervical ripening must occur after the initiation of oxytocin to avoid maternal and fetal injury ⬜ Intravenous oxytocin is dosed in mcg/min and should be carefully monitored by the nurse ⬜ The dosage of oxytocin is typically increased every 5-10 minutes unil the desired contraction pattern occurs ⬜Patient receiving intravenous fluids with prolonged oxytocin administration may develop water intoxication

⬛ oxytocin may be to induce labor and to control postpartum bleeding ⬛ Patient receiving intravenous fluids with prolonged oxytocin administration may develop water intoxication

The nurse is preparing to administer insulin intravenously. Which statement about the administration of intravenous insulin is true? ⬜Insulin is never given intravenously ⬜ Only Regular insulin can be administered intravenously ⬜ Insulin aspart or insulin lispro can be administered intravenously ⬜ Any form of insulin can be administered intravenously

⬜ Only Regular insulin can be administered intravenously