Pharmacology Exam 4 Ch 41 & 42 PrepU Q's

When learning about type 1 diabetes, what would the student nurses learn is a distinguishing characteristic of this disease?

Exogenous insulin is required for life.

Clients with type 2 diabetes have nonfunctioning beta pancreatic cells.

False

Stress typically results in hypoglycemia.

False

Which would a nurse expect to assess in a client experiencing hyperthyroidism?

Flushed, warm skin

A nurse is caring for a client with subacute lymphocytic thyroiditis. The health care provider prescribes thyroid hormones to the client. From which sign during ongoing assessment should the nurse conclude that the client is responding to the therapy?

Increased appetite

A client prescribed levothyroxine asks the nurse to explain when the medication should be taken. Which would the nurse include in the response?

In tie morning on an empty stomach

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

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

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

"Insulin assists glucose molecules to enter the cells of muscle and fat tissues."

A client with type 2 diabetes presents at the clinic for a routine follow-up appointment. The client asks the nurse whether she can take the herbal supplement ginseng. What is the correct response by the nurse?

"It increases the risk for low blood glucose levels."

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

"It stimulates insulin production, so you need to eat soon after taking the medication."

A nurse is providing education to a client who will soon begin taking levothyroxine for the first time. Which teaching point should the nurse include in this education session?

"You'll most likely take this drug for the rest of your life."

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

-Check the health care provider's orders for the type and dosage of insulin. -Check the expiration date on the vial. -Remove all air bubbles from the syringe barrel.

Thyroid hormones are principally concerned with the increase in metabolic rate of tissues that can result in certain effects? What are some of these effects?

-Increased body temperature -Increased heart rate -Increased cardiac output

The nurse who has admited a client with diabetic ketoacidosis should look for what assessment findings that are consistent with this diagnosis? (Select all that apply.)

-Ketones in the urine -Flushed, dry skin

Which of the following is true in regard to the thyroid hormone replacement drug levothyroxine (Synthroid)? Select all that apply:

-Levothryroxine (Synthroid) has a more uniform potency than other thyroid hormone replacement drugs. -Levothryroxine (Synthroid) is relatively inexpensive.

The demonstration of what symptom would suggest that an insulin-dependent client is experiencing a hypoglycemic reaction? Select all that apply.

-weakness -diaphoresis -mental confusion -increased pulse rate

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

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

The client is scheduled to get a breakfast tray at 07:00. At what time should the client receive a prescribed dose of insulin lispro?

06:45

The client is scheduled to get a breakfast tray at 07:00. At what time should the client receive a prescribed dose of insulin lispro?

06:45 Rationale: With short-acting insulins like lispro, aspart, or glulisine, it is important to inject the medication about 15 minutes before eating.

Which HbA1c result would indicate that a client's diabetes is under good control?

7% Rationale: Results vary with the laboratory method used for analysis, but in general, levels between 6.5% and 7% indicate good control of diabetes. Results of 10% or greater indicate poor blood glucose control for the last several months.

A primary health care provider has prescribed levothyroxine to a client with hypothyroidism. Which information would the nurse include in the teaching plan to promote an optimal response to the

Administer the drug early in the morning before breakfast.

A patient has been prescribed acarbose. Which of the following interventions should the nurse perform to promote an optimal response to the medication?

Administer the drug with the first bite of the meal.

A client is prescribed methimazole for the treatment of hyperthyroidism. Which is a rare adverse effect or set of effects related to the administration of methimazole?

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

A nurse is caring for a patient suffering from a severe form of hyperthyroidism called thyrotoxicosis or thyroid storm. Which of the following should the nurse observe in the patient as a characteristic of thyroid storm?

Altered mental status

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

Assess the most recent hemoglobin A1C levels.

A nurse is assigned to administer glargine to a patient at a health care facility. What precaution should the nurse take when administering glargine?

Avoid mixing glargine with other insulin.

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

Check the expiration date on the vial. Check the health care provider's orders for the type and dosage of insulin. Remove all air bubbles from the syringe barrel.

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

Client's average blood glucose is above normal

The most common cause of subclinical hyperthyroidism is:

Excess thyroid hormone therapy.

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

Glucagon

A diabetic client is taking regular and NPH insulin to manage diabetes. What is the best evaluation tool to measure the overall client response to the insulin therapy?

Glycosylated hemoglobin (HbAlc) levels

Which is the best indicator of overall diabetic control?

Glycosylated hemoglobin levels

The nurse is preparing to administer levothyroxine to a client. Which assessment finding would cause the nurse to hold the medication?

Heart rate of 110 beats per minute

A client presents at the clinic reporting weight loss despite an increased appetite. For which condition should this client be assessed?

Hyperthyroidism

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

I'll plan to take my glyburide each night before I go to bed.

The pharmacology instructor is providing education regarding propylthiouracil to the nursing students. What would the instructor identify as the primary mode of action for this medication?

Inhibition of production of thyroid hormone

When administering insulin, what would be most appropriate?

Insert the needle at a 45-degree angle for injection.

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

Inspect the previous injection site for inflammation.

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

Insulin is needed because the beta cells of the pancreas are no longer functioning.

A client is diagnosed with liver disease. How would this affect the metabolism of the drugs used to treat the client's hypothyroidism?

It would be prolonged.

Which agent would a nurse expect to administer to a client with hypothyroidism?

Levothyroxine

An older adult has been prescribed a thyroid hormone replacement medication. The nurse should first clarify which prescription?

Levothyroxine (Synthroid) 150 mcg orally once per day

The nurse cares for a client who was admitted for multiple bone fractures resulting from a fall. The client has a comorbidity of hypothyroidism. Which diet is the most appropriate for this client?

Low calorie, high fiber

The nurse is preparing to administer insulin lispro (Humalog) to a client at 7 AM. What is the nurse's priority intervention related to this medication?

Make sure the client's breakfast is available in the next 5-10 minutes.

Which would be least appropriate when administering insulin by subcutaneous injection

Massaging the site after removing the needle

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

Massaging the site after removing the needle

A female client's diagnoses include hyperthyroidism, congestive heart failure, and type 2 diabetes mellitus. What effect will the treatment of hyperthyroidism have on her routine medications?

Metabolism will be faster than normal, and the dose will be increased.

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

Metformin

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

Metformin

A client prescribed metformin is scheduled to undergo diagnostic testing with the administration of parenteral radiographic contrast media containing iodine. What fact should direct the nurse's plan of care for this client?

Metformin should be discontinued at least 48 hours before and after diagnostic tests that use contrast medias.

A client is brought to the emergency department after taking an overdose of levothyroxine. When assessing this client, what adverse effects would the nurse expect to find?

Nervousness and tachycardia

A client who has taken an overdose of levothyroxine (Synthroid) is brought to the Emergency Department. In assessing this client, what side effect would the nurse expect to find?

Nervousness, tachycardia, tremors

A client with a history of cardiovascular disease, who is taking a thyroid hormone, reports chest pain. What is the nurse's best action?

Notify the health care provider.

A client admitted to the hospital with hyperthyroidism treated with propylthiouracil suddenly develops a skin rash. Which action would the nurse implement first?

Notify the primary health care provider.

A patient with hypothyroidism is at increased risk for respiratory depression and myxedema coma if given what category of drugs?

Opioid analgesics

Which of the following drug types is most likely to cause respiratory depression and myxedema coma in clients with thyroid disorders?

Opioid analgesics

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

Regular insulin

Thioamide antithyroid drugs treat hyperthyroidism by inhibiting the synthesis of thyroid hormone. What is the prototype of the thioamide anti-thyroid drugs?

Propylthiouracil

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

Regular (Humulin R)

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

Regular insulin

A client is admitted to the intensive care unit with diabetic ketoacidosis. The nurse knows that the client will be placed on an intravenous insulin drip. The only type of insulin that can be administered intravenously is:

Regular.

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

Subcutaneous injection

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

Subcutaneous injection

A client is receiving a thyroid hormone to treat hypothyroidism. Which would indicate to the nurse that the client needs a reduced dosage of the drug?

Tachycardia

A nurse is working with a newly diagnosed diabetic client on understanding hypoglycemia and insulin reactions. Which action would be most important for the client to understand when planning the response to an insulin reaction?

Take an oral dose of some form of glucose as soon as possible.

A nurse is caring for a patient undergoing thyroid hormone replacement therapy. What should the nurse inform this patient regarding administration of the drug?

Take the drug before breakfast.

During a general health assessment, a client indicates taking thyroid medication to increase weight loss. What statement should be the basis of the nurse's response?

Taking excessive or unnecessary thyroid medication may produce serious or life-threatening manifestations of toxicity.

An insulin-dependent diabetic male client is having trouble with hypoglycemia late in the morning. During the health history, the nurse becomes aware of the most likely cause. What would cause the late morning hypoglycemia?

The client jogs two miles in the morning before he goes to work.

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

The disease

Following an assessment by her primary care provider, a 70-year-old resident of an assisted living facility has begun taking daily oral doses of levothyroxine. Which assessment finding should prompt the nurse to withhold a scheduled dose of levothyroxine?

The resident's apical heart rate is 112 beats/minute with a regular rhythm.

The pharmacology instructor is talking about the drug propylthiouracil (PTU). What would the instructor cite as the primary mode of action for propylthiouracil (PTU)?

To inhibit production of thyroid hormone

Graves' disease is the most common cause of hyperthyroidism.

True

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

True

Thyroid hormones can be measured as protein-bound iodine.

True

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

U-10 (10 units/mL) insulin

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

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

A child has been diagnosed with congenital hypothyroidism. What term should the nurse use when providing the parents with information regarding this condition?

cretinism Rationale: Congenital hypothyroidism (cretinism) occurs when a child is born with a poorly functioning or absent thyroid gland. Cretinism is uncommon in the United States but may occur with a lack of iodine in the mother's diet. Hashimoto's thyroiditis is an autoimmune disorder characterized by inflammation of the thyroid gland. Graves' disease is an antibody-mediated autoimmune disease resulting in hyperthyroidism; most common cause of hyperthyroidism. Myxedema is hypothyroidism that occurs after early childhood, more often in women than in men.

A client diagnosed with TSH suppression has been prescribed levothyroxine sodium (T4). The nurse caring for the client should monitor for which adverse reaction to levothyroxine sodium (T4)?

diarrhea Rationale: The nurse should monitor for diarrhea, vomiting, palpitations, tachycardia, headache, nervousness, insomnia, weight loss, fatigue, sweating, and flushing as adverse reactions to levothyroxine sodium (T4). Exfoliative dermatitis, granulocytopenia, and hypoprothrombinemia are the system reactions to antithyroid drugs such as methimazole and propylthiouracil.

A client presents at the clinic with weight loss despite an increased appetite. The nurse knows this client should be assessed for:

hyperthyroidism

A client presents at the clinic with weight loss despite an increased appetite. The nurse knows this client should be assessed for:

hyperthyroidism.

The health care provider prescribes glyburide for a client who is a newly diagnosed type 2 diabetic. The nurse knows that this medication produces hypoglycemia by:

increasing insulin secretion from the pancreas.

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

insulin lispro

When describing thyroid function, the nurse would emphasize the need for intake of:

iodine.

Rosiglitazone is being considered for the treatment of diabetes in an adult male client. Before the initiation of rosiglitazone therapy, the nurse should review what laboratory work recently drawn?

liver enzymes

Based on the nurse's knowledge about thyroid hormone supplements, the nurse administers levothyroxine cautiously to a client who has recently had which condition or disorder?

myocardial infarction

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

the past 3 or 4 months

The nurse is caring for a client taking insulin. The nurse realizes the client is experiencing symptoms of hypoglycemia when the client displays:

weakness, sweating, and decreased mentation.

The nurse should teach clients who are taking thyroid hormones to take the medication:

on an empty stomach.

After teaching a group of nursing students about insulin, the instructor determines that the teaching was successful when the students identify that insulin is produced by which organ in the human body?

pancreas

A hospital client's current medication administration record specifies oral administration of propylthiouracil (PTU) every 8 hours. What sign or symptom may have originally prompted the care provider to prescribe this drug?

persistent tachycardia

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

"Regular exercise makes your body better able to use the insulin it produces."

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

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

Which hormone regulates the production and release of thyroid hormone?

Thyroid-stimulating hormone (TSH)

What is the most common cause of subclinical hyperthyroidism?

excess thyroid hormone therapy

While the nurse is talking with a client, the client informs the nurse that the client has been under treatment for weight loss management. The client indicates taking antithyroid medication to increase weight loss. Included in client education about antithyroid medication is that taking:

excessive or unnecessary antithyroid medication may produce serious or life-threatening manifestations of toxicity.

Insulin is a hormone released by the pancreatic beta cells in response to a rise in glucose levels and what else?

incretins Rationale: Insulin is the hormone produced by the pancreatic beta cells of the islets of Langerhans. The hormone is released into circulation when the levels of glucose around these cells rise. It is also released in response to incretins, peptides that are produced in the GI tract in response to food.

A nurse is preparing to administer a scheduled dose of levothyroxine to an elderly client who is being treated in the hospital for a respiratory infection. Prior to administering the drug, the nurse should perform what assessment?

measurement of blood pressure