Test Pharmacology Made Easy 4.0 - Endocrine System

A nurse is educating the parents of a child who has a new diagnosis of Prader-Willi Syndrome (PWS) and has been prescribed somatropin. Which of the following statements by a parent indicates an understanding of the teaching? a. "We will use a different spot for injection each time we give the medication," b. "We'll give the shot in the thigh muscle rather than fatty tissue to decrease injection pain." c. "We'll watch our child for signs of low blood sugar while use somatropin." d. "We should stop the medication if our child loses weight."

a. "We will use a different spot for injection each time we give the medication," To avoid atrophy of tissue, injection sites should be rotated each time. The parents should administer somatropin subcutaneously NOT IM in the thigh muscle. Growth hormone can cause diabetes mellitus and increase risk of hyperglycemia NOT low blood sugar. Parents should closely monitor the child for the 3 P's - polyuria, polydipsia & polyphagia. A healthy loss of weight is not a concern. Pediatric clients with PWS must be weighed often to assess for weight gain. Obesity is a contraindication for using somatropin in clients with PWS.

A nurse is providing teaching to a client who is about to begin exenatide therapy to treat type 2 diabetes. Which of the following instructions should the nurse include? (select all that apply) a. inject the drug subcutaneously b. expect the peak effect in 2 hr c. use the drug as a supplement to an oral hypoglycemic d. inject the drug 1 hr after a meal e. discard used pens 10 days after the 1st use

a. inject the drug subcutaneously b. expect the peak effect in 2 hr c. use the drug as a supplement to an oral hypoglycemic Inject exenatide (an incretin mimetic) subQ into the thigh, upper arm or abdomen. Levels peak after 2 hr. and then gradually decrease (half life of 2.4 hr) Exenatide supplements the action of oral hypoglycemics such as sulfonylurea or metformin. Inject exenatide twice per day up to 60 min. prior to the morning and evening meals, NOT 1 hr. after a meal. Can keep prefilled exenatide injector pens in use at room temperature up to 30 days (NOT 10 days).

A nurse administers pramlintide at 0800 to a client who has type 1 diabetes. At which of the following times should the nurse expect the drug to exert its peak action? 0820 0900 1030 1100

0820 Pramlintide is an amylin mimetic that peaks 20 minutes after administration. The nurse should monitor for indications of hypoglycemia, such as tremors and diaphoresis. It is NOT likely to cause severe hypoglycemia 1 hr., 2.5 hrs., or 3 hours after administration. Aspart insulin exerts peak action in 1 hr. Regular insulin exerts peak action in 2.5 to 3.0 hr.

A nurse is teaching a client who has a prescription for glipizide (Glucotrol) therapy to treat type 2 diabetes mellitus. Which of the following should the nurse include? a) Avoid drinking alcohol b) Sit or stand for 30 minute after taking the drug c) Urinate every 4 hour d) Take the drug 2 hour after a meal

a) Avoid drinking alcohol Alcohol can interact with glipizide (a sulfonylurea) causing nausea, palpitations, and flushing. Alcohol also increases the drug's hypoglycemic effects. It is NOT likely to cause esophagitis so there is no need to stand or sit after. It can cause GI distress with heartburn. It is NOT likely to cause urinary retention It can cause diarrhea and client's should maintain hydration by drinking plenty of electrolyte-rich fluids. It helps control hyperglycemia and should be taken 30 minutes BEFORE the first meal of the day.

A nurse is caring for a client who is taking metformin (Glucophage) to treat type 2 diabetes mellitus and reports muscle pain. Which of the following adverse reactions should the nurse report? a) Lactic acidosis b) Anticholinergic effects c) Extrapyramidal symptoms d) Hypophosphatemia

a) Lactic acidosis Metformin can cause lactic acidosis, a life-threatening complication that manifests as muscle aches, sleepiness, malaise, and hyperventilation. The client should stop taking the drug and seek immediate medical care. Metformin is NOT likely to cause anticholinergic effects but can cause nausea, diarrhea, and anorexia. These effects should diminish with continued therapy. Metformin is NOT likely to cause extrapyramidal effects. It can cause dizziness and fatigue. Metform Is NOT likely to cause hypophosphatemia but can cause vitamin B12 or folic acid deficiencies, which would manifest as weakness, fatigue, pallor or a reddened tongue.

A nurse is caring for a client who is about to begin taking pioglitazone (Actos) to treat type 2 diabetes mellitus. The nurse should explain to the patient the need to monitor which of the following laboratory tests? (Select all that apply) a) Thyroid-stimulating hormone (TSH) b) Alanine aminotransferase (ALT) c) LDL d) CBC e) Creatinine clearance

b) Alanine aminotransferase (ALT) c) LDL Pioglitazone can cause liver injury. ALT should be monitored at the start of therapy & then every 3 to 6 months after. The client should report jaundice, dark-colored urine or abdominal pain. Pioglitazone can cause elevations in both HDL (beneficial) and LDL (detrimental) and LDLs should be monitored at the start of therapy to indicate baseline and periodically afterward. Pioglitazone is NOT likely to alter TSH or T4. Levothyroxine is an example of a drug that requires monitoring of TSH and T4. Pioglitazone is NOT likely to alter CBC. Hydrocortisone is an example of a drug that requires monitoring of CBC. Pioglitazone is NOT likely to alter creatine clearance Desmopressin is an example of a drug that requires monitoring of creatinine clearance.

A patient who is taking propylthiouracil (PTU) contacts the health care professional to report weight gain, drowsiness, and depression. The health care professional should suspect which of the following adverse reactions to the propylthiouracil? a) Thyrotoxicosis b) Hypothyroidism c) Lactic acidosis d) Radiation sickness

b) Hypothyroidism PTU is an antithyroid drug that can cause hypothyroidism, which manifests as drowsiness, depression, weight gain, edema, and bradycardia. The nurse should request the provider prescribe a lower dosage of the drug. PTU is used to treat thyrotoxicosis (indicated by anxiety, palpitations & weight loss). It does NOT cause it. PTU is NOT likely to cause lactic acidosis. Sitagliptin is an endocrine drug that can cause lactic acidosis, manifested as muscle aches, sleepiness, malaise, and hyperventilation. PTU is NOT likely to cause radiation sickness. Radioactive iodine-131 is an endocrine drug that can cause radiation sickness manifested as hematemesis, epistaxis, intense nausea and vomiting.

1. A health care professional is caring for a patient who is about to begin taking propylthiouracil (PTU) to treat hyperthyroidism. The health care professional should tell the patient to report which of the following adverse effects? (Select all that apply) a) Sore throat b) Muscle pain c) Insomnia d) Bradycardia e) Rash

a) sore throat b) muscle pain d) bradycardia e) rash PTU is an antithyroid drug. It can cause agranulocytosis. The nurse should monitor the client's CBS and instruct them to report fever or sore throat. It can also cause arthralgia and myalgia which should be reported. OTC analgesics can provide relief for muscle and joint pain. PTU is more likely to cause drowsiness than insomnia. PUT can cause hypothyroidism which manifests as bradycardia, drowsiness, & weight gain. PTU can also cause urticaria and skin rash which should be reported.

A nurse is caring for a patient who is about to begin pramlintide (Symlin) therapy to treat type 1 DM. Which of the following instructions should the nurse include? a) Mix pramlintide with insulin b) administer pramlintide before meals c) Take pramlintide at bedtime d) Inject pramlintide into the upper arm

b) administer pramlintide before meals The nurse should instruct the client to inject pramlintide 20 minutes before any meal containing at least 30 g of carbohydrates. Pramlintide supplements the effects of insulin and oral hypoglycemic drugs. Clients should NOT mix it in the same syringe as insulin. Pramlintide is taken 3 times a day with meals. Metformin is an example of a drug that is taken once a day with the evening meal, NOT bedtime. Pramlintide is injected SubQ into the abdomen or thigh, NOT the upper arm.

A nurse should recognize that a provider will prescribe a lower dose of sitagliptin (Januvia) for a patient who has type 2 diabetes mellitus and who also has which of the following? a) Thyroid disease b) Bronchitis c) Heart failure d) Renal impairment

d) Renal impairment Sitagliptin requires cautious use with clients who have renal dysfunction and low creatinine clearance because the kidneys eliminate the drug virtually intact. The provider should prescribe a lower dose for this client or prescribe a different hypoglycemic drug. Clients with thyroid disease can take a regular prescribed dose of sitagliptin. Glipizide is an endocrine drug that requires cautious use with clients who have thyroid disease. Clients with bronchitis can take a regular prescribed dose of sitagliptin. However it requires cautious use in clients with a history of pancreatitis. Clients with heart failure can take a regular prescribed dose of sitagliptin. Metformin is an endocrine drug that is contraindicated for clients with heart failure.

Which of the following drugs should a nurse have available for a client who is experiencing insulin toxicity? a. Naloxone b. Diphenhydramine c. Acetylcysteine d. glucagon

d. glucagon Glucagon is a hyperglycemic agent that can be given SQ, IM, or IV to treat severe hypoglycemia from insulin toxicity in clients who are unconscious and for whom IV glucose is not readily available. If the client does not respond to glucagon, the nurse should administer IV glucose solution. Naloxone is an opiate antagonist that treats opioid toxicity. Diphenhydramine is a cholinergic antagonist and antihistamine used to treat drug-induced extrapyramidal effects. Acetylcysteine is a mucolytic that treats acetaminophen (tylenol) toxicity.

A health care professional is caring for a patient who is about to begin acarbose (Precose) therapy to treat type 2 diabetes mellitus. Which of the following instructions should the healthcare professional include when talking with the patient about the drug? a) Eat more iron-rich foods b) Avoid drinking grapefruit juice c) Increase fiber intake d) Avoid drinking green tea

a) Eat more iron-rich foods Acarbose is an alpha-glucosidase inhibitor that can cause iron-deficiency anemia. The nurse should monitor the client's CBC. Grapefruit juice is NOT likely to alter its affects. Drinking more than 1 L a day can increase the hypoglycemic effects of repaglinide. It is NOT likely to cause constipation. It can cause diarrhea & flatulence. Metformin can worse then GI effects. Green tea is NOT likely to affect acarbose. It can increase the hypoglycemic effects of pioglitazone, another glitazone oral antidiabetic drug.

A nurse is providing teaching to a client about taking fludrocortisone to treat adrenocortical insufficiency. Which of the following instructions should the nurse include? (Select all that apply) a) Obtain weight measurement daily b) Report weakness or palpitations c) Have blood pressure checked regularly d) Eat more iron-rich foods e) Avoid drinking grapefruit juice

a) Obtain weight measurement daily b) Report weakness or palpitations c) Have blood pressure checked regularly Fludrocortisone is a mineralocorticoid that can cause fluid and electrolyte imbalances such as hypernatremia. Tracking weight on a daily basis can help identify weight gain and edema. Fludrocortisone can cause hypokalemia. The nurse should monitor potassium levels and tell the client to report muscle weakness or palpitations. Fludrocortisone can cause fluid retention and hypertension. The nurse should monitor the client's fluid balance and blood pressure. Fludrocortisone does not cause iron-deficiency anemia. It can cause thrombocytopenia. Fludrocortisone is NOT altered by grapefruit juice.

A nurse at a provider's office is assessing a client who has been taking hydrocortisone for adrenal insufficiency. The client reports fatigue and feeling overwhelmed by personal responsibilities. Which of the following findings should the nurse identify as an indication that the provider might need to increase the client's dosage? a) hypotension b) hyperglycemia c) weight gain d) fat redistribution

a) hypotension Hypotension and fatigue are findings of adrenal insufficiency. During times of stress, the client might need a dosage increase and the nurse should report this to the provider. Hypoglycemia (NOT hyperglycemia) indicates that the dosage is too low. Weight loss (NOT weight gain) indicates the clients dosage is too low. Fat redistribution or a moon face appearance are Cushingoid findings which indicate the dosage is too high.

When considering replacement therapy options for a client who has chronic adrenocortical insufficiency, a nurse should recognize that the provider will choose which of the following drugs? a. Somatropin b. Hydrocortisone c. Glucagon d. Desmopressin

b. Hydrocortisone Hydrocortisone is a glucocorticoid that provides replacement therapy for acute and chronic adrenocortical insufficiency such as Addison's disease. Hydrocortisone is identical to the cortisol that the adrenal cortex generates as its primary glucocorticoid. Somatropin is a growth hormone that treat's GH deficiencies such as Turner's syndrome. Glucagon is a hyperglycemic that treats severe hypoglycemia from insulin toxicity. Desmopressin is an antidiuretic hormone that treats diabetes insipidus.

A nurse is speaking with a client who is taking glipizide to treat type 2 diabetes mellitus and has called to report feeling shaky, hungry, and fatigued. Which of the following actions should the nurse instruct the client to take? a. Drink 16 oz. of water b. Perform a fingerstick blood glucose check c. Take another glipizide tablet d. Lie down and rest

b. Perform a fingerstick blood glucose check Glipizide, a sulfonylurea, can cause hypoglycemia, manifest as diaphoresis, shakiness, hunger, and fatigue. The nurse should tell the client to check their blood glucose level and if it indicates hypoglycemia, consume a snack of 15 to 20 g of carboydrates, and then retest in 15 to 20 minutes. Repeat the snack if the blood glucose level is still low. Glipizide can cause diarrhea and clients should maintain hydration but their symptoms indicate a different adverse reaction. Glipizide treats hyperglycemia and clients take it only once a day. It would be inappropriate to double the dose and could make the hypoglycemia worse. Lying down and resting can help with fatigue but they do not address the hypoglycemic adverse reaction.

A nurse is caring for a client who is taking desmopressin. The nurse should make which of the following assessments to evaluate the drug's effectiveness? a. peripheral pulses b. urine output c. skin integrity d. blood glucose

b. urine output Desmopressin is an antidiuretic hormone that treats diabetes insipidus. The nurse should monitor fluid I/O, serum osmolality, and blood pressure. Desmopressin is NOT likely to alter peripheral pulses and does not alter hemodynamics. Vasopressin however can cause vasoconstriction and angina pectoris. Desmopressin is NOT likely to alter skin integrity. PTU, an antithyroid drug, requires integumentary monitoring because it can cause a rash. Desmopressin is NOT likely to alter blood glucose. It can cause hyponatremia and serum sodium levels should be monitored.

A nurse is caring for a client who is about to begin insulin glargine (Lantus) therapy. The nurse should identify the need for additional precautions because the client also takes which of the follow types of drugs? a) Oral contraceptives b) Calcium supplements c) Beta blockers d) Iron supplements

c) Beta blockers Clients who take beta blockers and insulin are at risk for failing to promptly recognize the symptoms of hypoglycemia because beta blockers mask symptoms such as tachycardia and tremors. Beta blockers also increase hypoglycemic effects. Oral contraceptives do NOT interact with insulin. Another drug, exenatide slows the absorption of oral contraceptives. Calcium supplements do NOT interact with insulin. They do reduce absorption of levothyroxine. Iron supplements do NOT interact with insulin. They do reduce the absorption of levothyroxine.

A health care professional is caring for a patient who is about to begin levothyroxine (Synthroid) therapy to treat hypothyroidism. Which of the following instructions should the health care professional include when talking with the patient about taking the drug? a) take levothyroxine with food to increase absorption. b) take levothyroxine with an antacid to reduce GI effects. c) Expect life-long therapy with the drug. d) Carry a carbohydrate snack at all times

c) Expect life-long therapy with the drug. Levothyroxine is thyroid hormone replacement therapy and usually continues for life because no other therapies restore thyroid function. Food reduces the absorption of levothyroxine and clients should take it on an empty stomach at least 30 minutes before eating NOT with food. Antacids reduce the absorption of levothyroxine. Allow at least 4 hour between taking levothyroxine and an antacid. Levothyroxine does NOT cause hypoglycemia so carrying a carbohydrate snack is not necessary.

A nurse l is caring for a patient who is about to begin taking somatropin (Genotropin). The nurse should explain the need to monitor which of the following laboratory values? (Select all that apply) a) Blood amylase b) Creatinine clearance c) Urine calcium d) Blood glucose e) CBC

c) Urine calcium d) Blood glucose Somatropin is a growth hormone that can cause hypercalcuria and hyperglycemia. The nurse should monitor the client's urine calcium and instruct them to report flank pain, urinary frequency, or hematuria. The nurse should also monitor blood glucose levels and instruct the client to report polyphagia, polydipsia, and polyuria. Somatropin is NOT likely to alter blood amylase levels. Sitagliptin, an antithyroid drug, is an endocrine drug that requires monitoring of amylase levels because it can cause pancreatitis. Somatropin is NOT likely to alter creatinine clearance. Desmopressin is an antidiuretic hormone that requires monitoring of creatinine clearance. Somatropin is NOT likely to alter CBC. Radioactive iodine-131 is an antithyroid drug that requires monitoring CBC due to bone marrow depression.

A nurse is caring for a client who is taking pioglitazone to treat type 2 DM. The nurse should monitor for which of the following findings? a) joint pain b) constipation c) weight gain d) dilated pupils

c) weight gain Pioglitazone is a thiazolidinedione which may cause fluid retention. Client should be monitored for weight gain and other indications of fluid retention or heart failure (dyspnea, crackles, wheezing). It is more likely to cause muscle pain NOT joint pain. It is more likely to cause diarrhea NOT constipation. It is more likely to cause blurred vision NOT dilated pupils.

A nurse is caring for a client who is taking metformin and is scheduled to undergo angiography using iodine-containing contrast dye. The nurse should identify that an interaction between metformin & the IV contrast dye increases the client's risk for which of the following conditions?a. hypokalemia b. hyperglycemia c. acute renal failure d. acute pancreatitis

c. acute renal failure Metformin is a biguanide that can interact with iodine-containing contrast dye and cause acute renal failure and lactic acidosis. The nurse should withhold metformin for 48 hours prior to the procedure and monitor the client for indications of acute renal failure or lactic acidosis such as reduced urine output, hyperventilation, and abdominal pain. It is NOT likely to cause hypokalemia. Regular insulin is an endocrine drug that can cause hypokalemia. It is NOT likely to cause hyperglycemia. Glucagon is an endocrine drug that can cause hyperglycemia. It is NOT likely to cause acute pancreatitis. Exenatide is an endocrine drug that can cause acute pancreatitis.

A nurse is caring for a client who takes repaglinide 15 to 30 min before each meal to treat type 2 diabetes. The client asks, "If I skip a meal, what should I do?" Which of the following responses shold the nurse make? a. double the dose before the next meal b. take half the dose c. skip the dose d. take the usual dose

c. skip the dose To avoid a sudden and serious drop in blood glucose level, the client should skip the dose or repaglinide whenever skipping a meal. The nurse should isntruct the client to try to avoid skipping meals. Taking double the dose puts the client at risk for hypoglycemia. Taking half the dose without a meal puts the client at risk for hypoglycemia Taking the full dose without a meal puts the client at risk for hypoglycemia

A nurse is teaching a client about self-administering regular insulin. The nurse should instruct the client to rotate injection sites to prevent which of the following? a. Rapid absorption b. Intradermal injection c. Injection pain d. lipohypertrophy

d. lipohypertrophy Lipohypertrophy is a proliferation of fat at the sites of repeated insulin injections. It affects skin sensitivity and appearance. To prevent it, clients should rotate injection sites, keeping them at least 1 inch apart and avoid using the same spot within the same month. Rotating sites does NOT prevent rapid absorption. Using the abdomen speeds absorption whereas using the thigh allows for the slowest absorption. Rotating sites does NOT affect the risk for intradermal injection. Rotating sites is NOT likely to affect injection pain. The depth of the injection affects pain. Deeper IM injections are more painful and inappropriate for insulin injection.

A nurse is assessing a client who has a new prescription for levothyroxine. The nurse should identify which of the following findings as a contraindication for this drug? a. bacterial skin infections b. diabetes insipidus c. immunosuppression d. recent myocardial infarction

d. recent myocardial infarction Levothyroxine can cause tachycardia, palpitations, and hypertension, especially when the client requires a dosage adjustment. It is contraindicated for clients who have recently had a MI. Clients with skin infections can take levothyroxine. Fludrocortisone is an endocrine drug that requires cautious use with clients with bacterial skin infections. Clients with diabetes insipidus can take levothyroxine. It requires cautious use with clients who have diabetes mellitus. Clients who are immunosuppressed can take levothyroxine. PTU is an endocrine drug that requires cautious use with clients who are immunosupressed.