Pharmacology Test #2

A patient with Graves' disease is treated with iodine-131 (Iodope) therapy. Which statement by the patient would indicate understanding of the treatment's effects?

"I'll tell my doctor if I have fatigue, hair loss, or cold intolerance."

What does the nurse identify as a possible adverse effect of long-term glucocorticoid therapy? (Select all that apply.)

1. Adrenal insufficiency 2. Osteoporosis 3. Cataracts

A nurse caring for a patient who has diabetic ketoacidosis recognizes which characteristics in the patient? (Select all that apply.)

1. Altered fat metabolism leading to ketones 2. Sudden onset, triggered by acute illness 3. Plasma osmolality of 300 to 320 mOsm/L

Prednisone dosage

5-60 mg/day PO in single daily dose or divided q6-12hr

A patient is receiving glucocorticoids for the treatment of rheumatoid arthritis. The patient complains of having a headache. Which ordered medication should the nurse administer?

Acetaminophen (Tylenol)

A nurse is developing a plan of care for a patient who has Addison's disease and is taking hydrocortisone (Cortef). Which of these outcomes should receive priority in the plan?

At times of stress, the patient increases the glucocorticoid dose.

Before administering metformin (Glucophage), the nurse should notify the prescriber about which laboratory value?

Creatinine (Cr) level of 2.1 mg/dL

When administering prednisone to a patient, the nurse will do what?

Ensure that meals are at bedside so that administration with food reduces gastric irritation

A diabetic patient taking glucocorticoids is at risk of devoloping what?

Hyperglycemia

Which substance serves as the stimulus for macrophage activation in delayed-type hypersensitivity (DTH) reactions?

Interferon gamma

Adult dosage of hydrocotisone

Oral, Intramuscular or Intravenous: 15 to 240 mg/day.

The nurse should question an order for glucocorticoids in the treatment of a patient with what?

Systemic fungal infection

Glycated hemoglobin (HbA1c)

is a measure of plasma glucose levels on average over the previous 2- to 3-month period. The target value is 7% or lower.

glipizide (Glucotrol)

is a sulfonylurea oral hypoglycemic medication that acts to promote insulin release from the pancreas. Beta-adrenergic blockers can mask early signs of sympathetic system responses to hypoglycemia; the most important of these is tachycardia,

Which instruction should the nurse provide when teaching a patient to mix regular insulin and NPH insulin in the same syringe?

"Draw up the clear regular insulin first, followed by the cloudy NPH insulin."

When assessing a patient for adverse effects of cyclosporine (Sandimmune), it is most important for the nurse to review which laboratory findings? (Select all that apply.)

1. Creatinine level 2. Bilirubin level 3. White blood cell (WBC) count

Which blood cells produced in the bone marrow participate in providing both cellular-mediated and humoral immunity? (Select all that apply.)

1. Granulocytes 2. lymphocytes 3. B lymphocytes

What does the nurse identify as possible complications of glucocorticoid therapy? (Select all that apply.)

1. Impaired carbohydrate and glucose tolerance 2. Predisposition to gastrointestinal ulceration

A nurse monitors a patient who takes azathioprine (Imuran) for which adverse effects? (Select all that apply.)

1. Leukopenia 2. Thrombocytopenia 3. Alopecia

When assessing a patient who has Cushing's syndrome, a nurse associates which clinical manifestations with this disorder? (Select all that apply.)

1. Osteoporosis 2. Moon face 3. Glycosuria

When the immune system fails to provide immunity by discerning self from nonself, which autoimmune condition can develop? (Select all that apply.)

1. Ulcerative colitis 2. Graves' disease 3. Psoriasis

The nurse would question the order for steroids in a patient with what other disorder? (select all that apply)

1. glaucoma 2. Osteoporosis 3. fungal infection 4. Congestive heart failure 5. Diabetes/hyperglycemia 6. Peptic ulcer disease

IgM

1st class of antibody produced in response to an antigen. Fixes complement and thereby promotes target-cell lysis

diabetic ketoacidosis

Alterations in fat metabolism lead to the production of ketones and ketoacids. Increased ketoacid levels lead to a fall in arterial blood pH below 7.35. Altered glucose metabolism leads to hyperglycemia, water loss, and an elevated plasma osmolality (285 to 295 mOsm/L).

Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) are products of which structure?

Anterior pituitary gland

The nurse identifies which immune system cells as responsible for the production of antibodies required for humoral immunity?

B lymphocytes

Which medication does the nurse identify as a monoclonal antibody used to inhibit allograft rejection in transplant recipients?

Basiliximab (Simulect)

Basiliximab (Simulect)

Basiliximab is a monoclonal antibody that blocks the activation of T cells. It is used in the prophylaxis of organ rejection in the first 6 months after renal transplantation.

Which cells release histamine in response to an allergen?

Basophils

A nurse should consider which diagnostic test a priority to obtain before a patient receives iodine-131 (Iodotope)?

Beta human chorionic gonadotropin (hCG) test

A patient is scheduled to start taking insulin glargine (Lantus). On the care plan, a nurse should include which of these outcomes related to the therapeutic effects of the medication?

Blood glucose control for 24 hours

A patient in cardiac arrest receives vasopressin (Pitressin) during cardiopulmonary resuscitation (CPR). An increase in which finding would indicate a desired effect of the medication?

Blood pressure

When evaluating the laboratory results of a patient with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), the nurse identifies a deficiency of what as the most reliable indicator of the status of the patient's immune system?

CD4+ T lymphocytes

What is the major complication of Diabetic Ketoacidosis

Cerbral edema. ideal treatment of cerebral edema in DKA is intravenous mannitol and hypertonic saline (3%)

A patient who took NPH insulin at 0800 reports feeling weak and tremulous at 1700. Which action should the nurse take?

Check the patient's capillary blood sugar.

Antibodies help promote phagocytosis of bacteria by opsonization, which is described as what?

Coating with antibodies

A nurse administers dexamethasone (Decadron), 1 mg, at 11:00 PM to a patient who has suspected adrenal dysfunction. The nurse obtains blood for which of these laboratory tests at 8:00 AM the next morning?

Cortisol

A patient who has Cushing's syndrome is taking ketoconazole (Nizoral) as an adjunct treatment to brain radiation. A nurse should expect the patient to have which of these therapeutic responses?

Enhanced radiation effect to the brain

A pediatric patient has gigantism caused by excess growth hormone (GH). Which finding would indicate to the nurse that the patient has developed an additional complication related to this condition?

Enlarged heart on chest x-ray

Which finding in a patient taking levothyroxine (Synthroid) and warfarin (Coumadin) would require follow-up by a nurse?

Excessive bruising

IgA

First line defense against microbes entering through mucous membranes. Transferred to infants via breast milk

The nurse is planning care for a patient with signs of acute adrenal insufficiency. What is the priority nursing diagnosis?

Fluid volume deficit

Which nursing diagnosis should be the priority for a patient who is receiving desmopressin (DDAVP)?

Fluid volume imbalance

Glucophage (metformin)

Get emergency medical help if you have any of these signs of an allergic reaction to Glucophage: hives; difficult breathing; swelling of your face, lips, tongue, or throat. This medication may cause lactic acidosis

Foods that increase Cyclosporine

Grapefruit juice

A nurse is caring for a patient with decreased triiodothyronine (T3) and thyroxine (T4) and elevated thyroid-stimulating hormone (TSH) levels. The nurse knows the patient is likely suffering from what?

Hypothyroidism

The patient taking steroids demonstrates effective teaching when he states

I will not stop taking my Steroids abruptly; tapering the drug gives the adrenal glands time to return to their normal patterns of secretion.

A patient has been given instructions about levothyroxine (Synthroid). Which statement by the patient indicates understanding of these instructions?

I'll take this medication in the morning so as not to interfere with sleep."

The nurse is developing a plan to minimize the risk of adrenal insufficiency for a patient who is receiving long-term glucocorticoid therapy. Which outcome should be included?

Increases or supplements dosage of glucocorticoid at times of stress

A patient who takes cyclosporine (Sandimmune) also is receiving ketoconazole (Nizoral). The nurse should expect which therapeutic outcome from the combined medications?

Inhibition of cyclosporine metabolism

hydrocortisone (Cortef)

It is used to treat a number of different conditions, such as inflammation (swelling), severe allergies, adrenal problems, arthritis, asthma, blood or bone marrow problems, eye or vision problems, lupus, skin conditions, ulcerative colitis, and flare-ups of multiple sclerosis.

A patient newly diagnosed with type 1 diabetes asks a nurse, "How does insulin normally work in my body?" The nurse explains that normal insulin has which action in the body?

It promotes the passage of glucose into cells for energy.

An adult patient who has GH deficiency is receiving somatropin (Nutropin). An increase in which finding would indicate to the nurse that the patient is improving?

Lean body mass

cell-mediated immunity

Macrophages and T lymphocytes are involved these cells directly attack targets. Neutrophils phagocytize bacteria and foreign particles.

Which characteristic of the immune system produces faster and prolonged symptoms after initial exposure to an antigen?

Memory

The nurse is preparing to administer the first dose of intravenous muromonab-CD3 (Orthoclone). Which premedication will the nurse administer?

Methylprednisolone sodium (Solu-Medrol)

A patient is taking fludrocortisone (Florinef). A nurse should recognize that the patient is at risk for developing an electrolyte imbalance if the patient reports which symptom?

Muscle weakness

While reviewing a patient's laboratory results, the nurse identifies an increase in eosinophils. The patient most likely has which condition?

Parasitic worms

A patient takes glucocorticoids and digoxin (Lanoxin). It is most important for the nurse to monitor which electrolyte?

Potassium

A patient who has type 2 diabetes is taking nateglinide (Starlix). Which response should a nurse expect the patient to have if the medication is achieving the desired therapeutic effect?

Promotion of insulin secretion

A patient is receiving desmopressin (DDAVP) for the treatment of diabetes insipidus. Which instruction is the priority for a nurse to give the patient?

Reduce your water intake to prevent water intoxication."

A patient who has type 2 diabetes has a glycated hemoglobin A1c (HbA1c) of 10%. The nurse should make which change to the nursing care plan?

Refer the patient to a diabetes educator because the result reflects poor glycemic control.

Which outcome should a nurse establish for a patient who has acromegaly and is receiving octreotide (Sandostatin)?

Softening of facial features

A transplant recipient is receiving cyclosporine (Sandimmune). Which response should a nurse expect if the medication is having the desired effect?

Suppression of T lymphocytes

A nurse assesses a patient who is taking pramlintide (Symlin) with mealtime insulin. Which finding requires immediate follow-up by the nurse?

Sweating

A patient is taking glipizide (Glucotrol) and a beta-adrenergic medication. A nurse is teaching hypoglycemia awareness and should warn the patient about the absence of which symptom?

Tachycardia

Which manifestations should a nurse investigate first when monitoring a patient who is taking levothyroxine (Synthroid)?

Tachycardia

primary hypothyroidism.

The anterior pituitary increases production of TSH when thyroid hormone levels of T3 and T4, are reduced, Patients may experience fatigue caused by a lowered basal metabolic rate.

A teaching plan for a patient who is taking lispro (Humalog) should include which instruction by the nurse?

The duration of action for this insulin is about 8 to 10 hours, so you'll need a snack."

medical conditions indicative of excessive thyroid activity

Thyrotoxicosis, hyperthyroidism, and Graves' disease

Which manifestation would the nurse most clearly associate with a tumor of the hypothalamus?

Unstable body temperature

A patient who has diabetes insipidus is receiving desmopressin (DDAVP). Which laboratory test should a nurse obtain to evaluate the effectiveness of the medication?

Urine specific gravity

Which statement is the most important for a nurse to make to a patient who is taking methimazole?

You need to notify your doctor if you have a sore throat and fever."

Which instruction should be the priority for the nurse to teach a patient scheduled to start taking sirolimus (Rapamune)?

You'll need to notify your doctor if you experience any sore throat or fever.

thyrotoxicosis

a condition of profound excessive thyroid activity. Tachycardia is the priority assessment, because it can lead to severe cardiac dysfunction. Tremors, insomnia, and irritability are other symptoms of thyrotoxicosis and should be assessed after tachycardia.

nateglinide (Starlix)

acts to increase pancreatic insulin release. It does not act to reduce insulin resistance or inhibit carbohydrate digestion. It should not be used to manage diabetic ketone formation, because its glucose-lowering effects are too slow to be of benefit.

glargine (Lantus)

administered as a once-daily subcutaneous injection for patients with type 1 diabetes. It is used for basal insulin coverage, not mealtime coverage.

A patient has adrenal hyperplasia, the nurse should anticipate administering what?

aldosterone antagonist such as antimineralocorticoid spironolactone

Antibodies or Immunoglobbins

are substances made by the body's immune system in response to bacteria, viruses, fungus, animal dander, or cancer cells. Antibodies attach to the foreign substances so the immune system can destroy them.

IgE

binds to surface of mast cells, stimulates release of histamine, heparin, and other mediators causing an allergy response. Binds to parasatic worms which eosinophils bind to IgE, compounds released lyse the worms

Cosyntropin (Cortrosyn)

can be used to diagnose Addison's disease. A failure for serum cortisol levels to increase after administration of cosyntropin makes a diagnosis of primary adrenocortical insufficiency more likely.

Acute adrenal insufficiency (adrenal crisis)

characterized by hypotension, dehydration, weakness, lethargy, and gastrointestinal (GI) symptoms of nausea and vomiting. Rapid replacement of fluid, salt, and glucocorticoids is essential to prevent shock and death.

the nurse recognizes the signs and syptoms of Hypoglycemia as what?

cold and clammy skin, confusion, poor balance, feeling faint and rapid heartbeat. provide sugary drinks such as orange juice and soda, or place pure sugar under the tongue and inside the mouth.

Glucagon

first aid in cases of severe hypoglycemia The dose for an adult is typically 1 milligram, and the glucagon is given by intramuscular, intravenous or subcutaneous injection. causes the liver to convert stored glycogen into glucose, which is released into the bloodstream.

Oral antidiabetes drugs (Metformin)

first-line medication used for treatment of type 2 diabetes. In general, it is prescribed at initial diagnosis in conjunction with exercise and weight loss,

IgD

found only on surface of mature B cells, serves as receptor for antigen recognition (IgM)

Methylprednisolone sodium (Solu-Medrol)

glucocorticoid, is administered intravenously 30 minutes before injection of muromonab-CD3 to prevent or minimize a first-dose adverse reaction.

The nurse should question the order for beta blockers in the patient with diabetes, why?

if hypoglycemia occurs in someone who is using this type of drug, he/she may not experience the typical adrenergic warning symptoms such as tremor and palpitations. Of all the hypoglycemia symptoms, sweating is typically not blocked by beta blockers.

Graves' disease

immune system disorder that results in the overproduction of thyroid hormones (hyperthyroidism).

How does the use of glucocorticoids effect the liver?

increase in hepatic glucose output. Most people can produce enough extra insulin to compensate for this effect and maintain normal glucose levels

hyperthyroid symptoms

increased heartbeat, muscle weakness, disturbed sleep, and irritability. It can also affect the eyes, causing bulging eyes (exophthalmos).

Dexamethasone

is a Glucocorticoid may be given to women at risk of delivering prematurely to promote maturation of the fetus' lungs.

Sirolimus (Rapamune)

is an immunosuppressant approved only for preventing renal transplant rejection. It raises the risk of infection Side effects include rash, joint pain, diarrhea, and increased levels of cholesterol, and taking sirolimus with grapefruit juice inhibits the drug's metabolism; these are lower levels of priority than the infection risk.

IgG

major antibody in the blood. promotes target-cell lysis, enhances phagocytosis. Transferred across placenta to the fetal circulation

Glucocorticoid replacement therapy

may be required in patients who have adrenal suppression following successful treatment of Cushing syndrome or after withdrawal of glucocorticoids that have been used for therapeutic purposes.

Thyoid Hormones

primarily responsible for regulation of metabolism. Iodine is required for the production of T3 and T4

lispro (Humalog)

rapid-acting insulin and has an onset of action of 15 to 30 minutes with a peak action of about 2 hours. Lispro insulin must be combined with an intermediate- or a long-acting insulin, not regular insulin (which also is a short-duration insulin),

Humoral immunity

refers to immune responses mediated by antibodies produced by B lymphocytes.

The patient is experiencing Diabetic Ketoacidosis, what is the nurses first priority?

replacing the lost fluids and electrolytes while suppressing the high blood sugars and ketone production with insulin.

Cushing's syndrome

results from excess secretion of adrenocorticotropic hormone (ACTH),

Effects of aldosterone on the kidney

sodium retention in the kidney, leading to water retention and increased blood volume

Sirolimus (Rapamune) is often given with what other drug?

tacrolimus (Prograf) to prevent the body from rejecting a transplanted organ

levothyroxine (Synthroid).

used to treat hypothyroidism by increasing the basal metabolism and thus wakefulness. It is administered as a once-daily dose and is a lifelong therapy. It is best taken on an empty stomach to enhance absorption.