Week 15: Endocrine
The nurse observes as a nursing student administers vasopressin [Pitressin] to a patient. The student notes visible particles in the vasopressin [Pitressin] solution. Which instruction should the nurse give the student to ensure safe administration of vasopressin [Pitressin]?
"Do not administer the drug to the patient." Presence of visible particles in vasopressin [Pitressin] solution indicates contamination. Administration of this contaminated solution may lead to the loss of therapeutic effect and cause severe reactions in the patient. The nurse should instruct the student nurse to not administer vasopressin [Pitressin] to the patient. Vasopressin [Pitressin] should not be heated before administration as heating may affect its potency. Shaking of the medication may not have any effect on the drug if vasopressin [Pitressin] solution contains visible particles. The nurse should not keep the bottle in warm water because it does not reduce the risk of complication. Furthermore, it may increase the chance of contamination.
Which instruction should the nurse give when a patient receiving metformin [Glucophage] therapy will undergo angiography?
"Do not take your metformin on the day of the test." Angiography uses iodinated (iodine-containing) radiologic contrast media, which interact with metformin [Glucophage] and may cause acute renal failure or lactic acidosis. Hence, the nurse should instruct the patient to discontinue the drug on the day of the test. To prevent any adverse effects, metformin [Glucophage] can be taken 48 hours after the test. Chances of renal failure after the test only occur if metformin is taken during the test. Blood glucose levels are regularly evaluated in diabetic patients, but it is not a priority in this case.
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." Levothyroxine is 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. The dosage should not be changed unless directed to do so by the prescribing provider.
The patient has been prescribed lispro [Humalog] for treatment of type 1 diabetes mellitus. The nurse should give the patient which instruction?
"Inject this insulin with meals because it is very fast acting." Lispro is a fast-acting insulin and has an onset action of 15 to 30 minutes with a peak action of about 2 hours, not 8 to 10 hours. Because of its rapid onset, it is administered immediately before a meal or with meals to control the blood glucose rise after meals. Lispro insulin must be combined with an intermediate- or a long-acting insulin, not regular insulin (which also is a short-duration insulin), for glucose control between meals and at night. To achieve tight glycemic control, patients must combine different types of insulin based on their duration of action.
A patient with type 1 diabetes mellitus asks, "Why can't I take a sulfonylurea like my friend who has diabetes?" What is the nurse's best response?
"Sulfonylurea increases beta-cell stimulation to secrete insulin, and your beta cells do not contain insulin." Sulfonylurea agents reduce serum glucose levels by increasing beta-cell stimulation for insulin release, decreasing hepatic glucose production, and increasing insulin sensitivity. It is administered for type 2 diabetes mellitus but will not be effective in type 1. Not all patients with type 2 diabetes require insulin, but patients with type 1 diabetes require insulin.
The nurse is teaching the patient about oral steroid therapy for chronic adrenal insufficiency. Which statement by the patient indicates a need for further teaching?
"When I am traveling for work I will take lower doses." To mimic normal cortisol secretion, patients can take the entire daily dose in the morning immediately after waking. If this schedule results in afternoon or evening fatigue, patients may split the dosage, taking two-thirds in the morning and one-third around 4:00 in the afternoon. Stress, such as travel for work, may require an increase in medication.
The patient states that when he takes hydrocortisone 24 mg in the morning, he is very tired by mid-afternoon. Which statement by the nurse is correct?
"You can take 12 mg in the morning and 12 mg at night." To mimic normal cortisol secretion, patients can take the entire daily dose in the morning, immediately after waking. If this schedule results in afternoon or evening fatigue, patients may split the dosage, taking two-thirds in the morning and one-third around 4:00 in the afternoon. Patients should not stop taking their medication unless advised by their healthcare provider.
How should the nurse instruct a patient who takes neutral protamine Hagedorn (NPH) insulin?
"You must agitate the suspension before administration." Neutral protamine Hagedorn (NPH), also known as isophane insulin suspension, is an intermediate-acting insulin product that has an onset of action of 1 to 2 hours. NPH insulins are supplied as cloudy suspensions that must be agitated prior to administration. Unused vials are stored in the refrigerator for only 3 months to maintain drug stability. It is not necessary to stop insulin for any diagnostic tests, as insulin does not interact with any agents used in diagnostic tests.
What should the nurse instruct a patient who is prescribed repaglinide [Prandin] for type 2 diabetes?
"You need to eat a meal after each dose." The nurse should instruct the patient to eat a meal after each dose, as skipping a meal can cause hypoglycemia. Skipping two doses of repaglinide [Prandin] will cause hyperglycemia in the patient, as glucose levels will increase. The dose must be taken before each meal, and skipping either the meal or the dose will cause the glucose levels in the body to fluctuate. Repaglinide [Prandin] is not combined with sulfonylureas, as they share a similar mechanism of action.
The healthcare provider orders octreotide [Sandostatin] 250 mcg SC for a patient with acromegaly. The available medication is octreotide [Sandostatin] 1000 mcg/mL. How many milliliters will the nurse inject into the patient? Record your answer using two decimal places. Use a leading zero if applicable. _____ mL
0.25 The ordered dose is 250 mcg, and the available medication is 1000 mcg/mL. Divide 250 mcg by 1000 mcg/mL, which equals 0.25 mL. The nurse will give one-fourth or 25% of 1 mL.
A patient receives isophane suspension, also known as neutral protamine Hagedorn (NPH) insulin at 8:00 AM. The patient eats breakfast at 8:30 AM, lunch at noon, and dinner at 6:00 PM. At what time is this patient at the highest risk for hypoglycemia?
5:00 PM Breakfast eaten at 8:30 AM would cover the onset of isophane insulin suspension, also known as neutral protamine Hagedorn (NPH), and lunch will cover the 2:00 PM time frame. If the patient does not eat a midafternoon snack, however, the NPH insulin may peak just before dinner without sufficient glucose on hand to prevent hypoglycemia.
Which drug is used to diagnose adrenocortical insufficiency?
Cosyntropin [Cortrosyn] Cosyntropin [Cortrosyn] is used for diagnosis of adrenocortical insufficiency. The test involves injecting a small amount of the drug and then measuring the cortisol levels in response to the drug. Octreotide [Sandostatin] is useful in alleviating symptoms of acromegaly. Desmopressin [DDAVP] is useful in the treatment of hemophilia A and type I von Willebrand's disease. Somatropin [Humatrope] is used in treatment of growth hormone deficiency.
A patient with type 2 diabetes mellitus receives a prescription for metformin [Glucophage]. Which finding should the nurse recognize as a contraindication to therapy?
Creatinine 1.6 mg/dL The risk of lactic acidosis is greater in a patient with altered renal function. A creatinine level higher than 1.5 mg/dL in males or higher than 1.4 mg/dL in females indicates renal dysfunction. Because metformin [Glucophage] can cause lactic acidosis, the nurse should avoid administering the medication to this patient because the kidneys clear excess acid by excreting hydrogen ions and because metformin [Glucophage] is eliminated by the kidneys. The arterial pH is normal. The alanine aminotransferase reading does not constitute a contraindication to metformin [Glucophage] therapy. The increased blood glucose is an indication for therapy.
A patient is taking fludrocortisone [Florinef]. A nurse should recognize that which symptom, if reported by the patient, indicates the patient is experiencing a life-threatening electrolyte imbalance caused by fludrocortisone therapy?
Muscle weakness Muscle weakness is a sign of hypokalemia, which can occur because fludrocortisone has mineralocorticoid properties resulting in sodium and fluid retention and potassium excretion. Syncope and weight loss do not occur because of salt and water retention. Numbness and tingling may be associated with other problems but are not related to fludrocortisone.
The nurse is caring for a patient who has been taking metformin [Glucophage] for several months. The patient reports abdominal pain. Upon assessment, the nurse detects an irregular heartbeat. What else should the nurse assess to determine the severity of the patient's condition?
Renal function Abdominal pain and irregular heartbeat in a patient taking metformin [Glucophage] may be indicative of lactic acidosis. Renal function is assessed before administering the drug to prevent renal impairment. If the patient has lactic acidosis, the blood glucose levels will be very high as well. Therefore, the nurse should assess the patient's blood glucose levels to confirm the condition. Reduction in B12 levels is a less common side effect of metformin [Glucophage]. Assessing the patient's weight is not a priority in this case.
Which outcome should a nurse establish for a patient who has acromegaly and is receiving octreotide [Sandostatin]?
Softening of facial features Octreotide suppresses growth hormone (GH), which is excessive in acromegaly and results in coarse facial features, splayed teeth, and large hands and feet. Treatment with octreotide reduces the continued development of these effects and the softening of facial features. The epiphyses have closed in adults, so height is not affected. Urine volume is affected by antidiuretic hormone. Prolactin stimulates the milk reflex.
A patient is taking glipizide [Glucotrol] and a propranolol. A nurse is teaching hypoglycemia awareness and should warn the patient about the absence of which symptom caused by the propranolol?
Tachycardia Glipizide is a sulfonylurea oral hypoglycemic medication that acts to promote insulin release from the pancreas. Beta-adrenergic blockers, such as propranolol, can mask early signs of sympathetic system responses to hypoglycemia; the most important of these are tachycardia and palpitations, which are the most common adverse effects of glipizide. Vomiting, muscle cramps, and chills are not symptoms of activation of the sympathetic nervous system that arise when glucose levels fall.
A patient diagnosed with thyroid cancer undergoes a thyroidectomy and is prescribed levothyroxine sodium [Synthroid]. What instructions should the nurse give the patient about taking this medication?
Take on an empty stomach. The medication is to be taken on an empty stomach. There is no specification for it to be taken just before bedtime or immediately upon arising in the morning.
While reviewing the history and the lab reports of an adult patient, the nurse finds that the patient has decreased metabolic rate, weight gain, and hair loss. What can the nurse interpret from these findings?
The patient may have myxedema. Hyposecretion of thyroid hormone as an adult may lead to myxedema. The manifestations of myxedema are decreased metabolic rate, weight gain, hair loss, and yellowish discoloration of the skin. Hyposecretion of thyroid hormone during youth leads to cretinism. The characteristics are a low metabolic rate, retarded growth and sexual development, and possible mental retardation. Graves' disease and Plummer's disease are caused by excessive secretion of thyroid hormones.
A patient with the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is prescribed tolvaptan [Samsca]. Which are common adverse effects of this drug? Select all that apply.
Thirst Polyuria Dry mouth Tolvaptan [Samsca] is used for patients with syndrome of inappropriate secretion of antidiuretic hormone (SIADH) and some common adverse effects of this drug include thirst, dry mouth, polyuria, hyperglycemia (not hypoglycemia), and constipation (not diarrhea).