ch 58, 59, 60, 72 lehne & porth ch 33 nurs 223 test 3
A client with a new diagnosis of type 2 diabetes mellitus states, "I am really worried that I might need to take injections. Is there something I can do to avoid that?" What is the best response by the nurse? "You could regulate your diet, exercise regularly, and lose weight." "Diabetes management is complicated; you can't avoid injections." "A support group could help you cope with stress and learn helpful tips." "If you exercise weekly, you won't need injections."
"You could regulate your diet, exercise regularly, and lose weight." p807
The healthcare provider orders 150 mcg of levothyroxine [Synthroid] PO every morning. The medication available is levothyroxine [Synthroid] 75 mcg tablets. How many tablets will the nurse administer? 1 2 4 0.5
2 The ordered dose is 150 mcg. The available tablets are 75 mcg; 75 multiplied by 2 equals 150. Therefore, two tablets are the correct dose. p. 708
Which manifestation indicates a client is at risk for developing diabetes mellitus? Serum potassium 4.2 mEq/dl 2 hour oral GTT 175 mg/dl Hemoglobin A1c 5.0% Fasting blood glucose level 75 mg/dl
2 hour oral GTT 175 mg/dl p805
The nurse educates a patient newly diagnosed with diabetes regarding diet and energy requirements. The nurse knows that one gram of fat will provide _____ kcal of energy.
9 p794
A woman with poorly controlled type 1 diabetes has been admitted to a hospital unit for the treatment of ketoacidosis. Place the following events in the pathophysiology of ketoacidosis in the correct chronological order. Use all the options. Low serum insulin levels Decrease in pH Ketone production by the liver Production of fatty acids and glycerol Breakdown of triglycerides
Decrease in pH Breakdown of triglycerides Low serum insulin levels Ketone production by the liver Production of fatty acids and glycerol p810
A patient is diagnosed with hyperglycemic hyperosmolar state (HHS). Which of the following factors contribute to the severe hyperglycemia that precipitates HHS? Select all that apply Glycosuria and dehydration Hepatic glycogenolysis Hyperglucagonemia Fluid overload Insulin deficiency
Hyperglucagonemia Glycosuria and dehydration Hepatic glycogenolysis Insulin deficiency p812
A man is brought into the emergency department by paramedics who state that the client passed out on the street. The man smells of alcohol, and when roused says he has not eaten since yesterday. He is wearing a medic alert bracelet that says he is a diabetic. What would the nurse suspect as a diagnosis? Hyperglycemia Hypernatremia Hypoglycemia Hyponatremia
Hypoglycemia p812
Research has identified a cycle of insulin-induced posthypoglycemic episodes. What is this phenomenon called? Dawn phenomenon Sunset effect Somogyi effect Joslin phenomenon
Somogyi effect p813
The obstetrical nurse is caring for a client who has been treated for gestational diabetes. When teaching the client about the causes of gestational diabetes, the nurse should include which of these risk factors in the teaching? Woman who has had a child under 5 pounds Woman with a family history of diabetes First birth occurring during the teenage years First pregnancy
Woman with a family history of diabetes p804
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]? "Administer the drug using a filter needle." "Do not administer the drug to the patient." "Shake the medication before administration." "Keep the bottle in warm water before administration."
"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.
A 15 year-old boy with type 1 diabetes is exasperated by his regimen of blood sugar monitoring and insulin administration, and has told his mother that he wants to scale both back. Which of the following responses by his mother is most accurate? "You need to be vigilant now if you want to be free of diabetes when you grow up." "I know it's not fun, but you're even more susceptible to complications when you're young if you don't stay on top of your diabetes." "Even though it's hard to do, you need to continue so you don't go blind or need a kidney transplant down the road." "Even though you might save some time and energy by doing this, remember that high blood sugars cause a lot of pain and will cause you to gain weight."
"Even though it's hard to do, you need to continue so you don't go blind or need a kidney transplant down the road." p813
The nurse is teaching a patient who is prescribed desmopressin [DDAVP] and who has polyuria, polydipsia, and dehydration. Which statement by the patient indicates the need for additional teaching? "I will take this medicine 1 hour before breakfast." "I will avoid consuming alcohol along with this drug." "I will increase intake of juices and water in my diet." "I will notify my provider if I develop excessive drowsiness or headaches."
"I will increase intake of juices and water in my diet." Desmopressin [DDAVP] is a pituitary drug. It should be taken with food or at mealtimes to reduce gastrointestinal upset. It should not be taken right after waking up, when the stomach is empty. DDAVP interacts with alcohol, so it is necessary to avoid alcohol consumption with this drug. As the patient has dehydration, it is necessary to take high amounts of fluids. DDAVP can cause water intoxication. Excessive water retention can cause water intoxication. Early signs include drowsiness, listlessness, and headache. Severe water intoxication progresses to convulsions and terminal coma. Patients experiencing early symptoms should notify their prescriber.
A patient has been given instructions about levothyroxine [Synthroid]. Which statement by the patient indicates understanding of these instructions? "I'll plan to double my dose if I gain more than 1 pound per day." "I'll be glad when I don't have to take this medication in a few months." "It is best to take the medication with food so I don't have any nausea." "I'll take this medication in the morning so as not to interfere with sleep."
"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. pp. 707-709
A patient with Graves' disease is treated with iodine-131 therapy. Which statement by the patient indicates an understanding of the treatment's effects? "I'll need to take this drug on a daily basis for at least 1 year." "I'll tell my doctor if I have fatigue, hair loss, or cold intolerance." "I'm looking forward to feeling better immediately after this treatment." "I'll have to isolate myself from my family so I don't expose them to radiation."
"I'll tell my doctor if I have fatigue, hair loss, or cold intolerance." Iodine-131 usually is given as a single treatment to produce remission of Graves' disease. Fatigue, hair loss, and cold intolerance are signs of hypothyroidism, which is a complication of the treatment. Dosages of iodine-131 for treating Graves' disease are low and iodine-131 has a quick radioactive decay and half-life of 8 days; therefore, isolation is not needed, but it can take up to 2 months for the desired response to develop. Treatment of thyroid cancer with higher doses of iodine-131 requires proper disposal of radioactive body wastes. pp. 710-711
The mother of a 2-year-old newly diagnosed with type 1 diabetes asks why insulin has to be given by injection. The best response by the nurse is: "When your child gets old enough, you will not have to administer injections." "Your child is not old enough to swallow the pills needed to treat her diabetes." "Insulin is destroyed by the stomach contents and has to be administered by injection." "Insulin needs to go directly into the vein to work best."
"Insulin is destroyed by the stomach contents and has to be administered by injection." p807
A patient is receiving desmopressin [DDAVP] for the treatment of diabetes insipidus. Which instruction is the priority for a nurse to give the patient? "Weigh yourself several times each week." "Rotate the nostril you use daily to prevent irritation." "You'll quickly see the results of a lower urine amount." "Reduce your water intake to prevent water intoxication."
"Reduce your water intake to prevent water intoxication." Failure to reduce the fluid intake while using desmopressin results in water intoxication leading to seizures and coma. DDAVP is administered intranasally; therefore, rotating the nostril used is important to prevent irritation. Monitoring weekly weights for volume status and understanding that a rapid treatment response occurs are also important; however, they are not as important as reducing the fluid intake to prevent water intoxication. pp. 720-721
The health care provider has prescribed Repaglinide 2 mg for a client diagnosed with type 2 diabetes. The most important information for the nurse to give the client would be: "Take the medication 15 to 30 minutes before each meal." "Keep the medication refrigerated until used." "Use a different injection site for each injection." "Adjust the dosing based on recent blood glucose readings."
"Take the medication 15 to 30 minutes before each meal." p808
The nurse is teaching safe administration of medication to a patient who has been prescribed levothyroxine [Levoxyl]. Which statement should the nurse include in the teaching session? "Take this medication with 250 mL of orange juice." "Always take the medication three times a day, after meals." "There are no dietary restrictions while taking this medication." "Take this medicine on an empty stomach in the morning, at least 30 to 60 minutes before eating."
"Take this medicine on an empty stomach in the morning, at least 30 to 60 minutes before eating." Patients who are prescribed thyroid replacements or antithyroid drugs should be advised to take the medicine on an empty stomach in the morning, at least 30 to 60 minutes before eating. This helps enhance the absorption of the drug. Taking the medication twice a day after meals may reduce the therapeutic effectiveness of the medication and cause adverse effects. A patient needs to avoid eating foods that may reduce thyroid hormone production and reduce the effectiveness of the medication. Therefore, the nurse should not give false information that the patient need not follow dietary restrictions. This medication should be taken with water rather than orange juice, as it helps enhance the disintegration and absorption of the drug. p. 712
A three year-old girl has just been diagnosed with type 1A diabetes. Her parents are currently receiving education from the diabetes education nurse. How can the nurse best explain to the parents the etiology (cause) of their daughter's diabetes? "Environmental and lifestyle factors are known to play a part in the fact that her pancreas secretes and withholds insulin at the wrong times." "It's not known exactly why your daughter has completely stopped making insulin, and treatment will consist of your rigidly controlling her diet." "This tendency to produce insufficient amounts of insulin is likely something that she inherited." "The problem that underlies her diabetes is that her own body has destroyed the cells in her pancreas that produce insulin."
"The problem that underlies her diabetes is that her own body has destroyed the cells in her pancreas that produce insulin." p801
The clinical instructor asks the nursing student about various drug interactions of thyroid drugs. Which statement by the nursing student indicates effective learning? "Thyroid drugs may increase serum digitalis levels." "Thyroid drugs should not be taken to treat obesity." "Thyroid drug absorption is increased by cholestyramine." "Thyroid drugs may decrease the activity of oral anticoagulants."
"Thyroid drugs should not be taken to treat obesity." Thyroid drugs should not be taken to treat obesity. Thyroid drugs may increase the activity of oral anticoagulants. Thyroid drugs may decrease serum digitalis levels when administered concurrently. Cholestyramine decreases the absorption of thyroid drugs by binding to thyroid hormone in the gastrointestinal tract. This may reduce the absorption of both drugs. p. 707
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? "I can take my full dose in the morning." "When I am traveling for work I will take lower doses." "I understand that I shouldn't experience many adverse effects." "I can break up my dose and take some in the afternoon if I get tired."
"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. p. 728
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 24 mg at night instead." "You can take 12 mg in the morning and 12 mg at night." "You can take 16 mg in the morning and 8 mg in the afternoon." "This is an adverse effect and you should stop taking the medication."
"You can take 16 mg in the morning and 8 mg in the afternoon." 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.
Which statement is the most important for a nurse to make to a patient who is taking methimazole [Tapazole]? "Headache and dizziness may occur but not very frequently." "Another medication can be given if you experience any nausea." "You may experience some muscle soreness with this medicine." "You need to notify your doctor if you have a sore throat and fever."
"You need to notify your doctor if you have a sore throat and fever." Agranulocytosis (the absence of granulocytes to fight infection) is the most serious toxicity associated with methimazole. Sore throat and fever may be the earliest signs. Nausea, muscle soreness, headache, and dizziness are other adverse effects of methimazole that are less serious than agranulocytosis. pp. 709-710
During an assessment, a patient asks the nurse, "What should I do if I miss two or three doses of thyroid replacement drug in a row?" Which is the nurse's best response? "You should consult your primary healthcare provider." "You can take the dose immediately when you remember it." "Skip the missed dose and resume your usual dosage schedule." "If it is almost the time for your next dose, then take a double dose of drug."
"You should consult your primary healthcare provider." If a patient misses two or more doses of thyroid replacement drug in a row, then the patient should consult the primary healthcare provider. This will help the primary healthcare provider plan effective treatment and avoid probable complications by modifying the dosage regimen. Taking doses at irregular periods, skipping a dose, or taking a double dose are not appropriate. These actions may cause adverse effects, and the treatment may not be effective. p. 709
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. 0 mL
0.25 ml 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. p. 722
The healthcare provider orders hydrocortisone sodium succinate [Solu-Cortef] 500 mg IV. The available medication is hydrocortisone sodium succinate [Solu-Cortef] 1000 mg/mL. How many milliliters will the nurse administer? Record your answer using two decimal places. Use a leading zero if applicable. __mL
0.50 mL Divide 500 mg by 1000 mg/mL, which equals 0.50 mL.
The nurse instructs a nursing student to administer vasopressin [Pitressin] to a patient. The nursing student asks the nurse about the duration of antidiuretic action. Which is the correct response? 1 hour 30 minutes 2 to 8 hours 1 to 2 hours
2 to 8 hours Vasopressin [Pitressin] is a natural or synthetic antidiuretic hormone. Its duration of antidiuretic action is 2 to 8 hours. p. 721, Table 59-2
The nurse is giving an intravenous injection of levothyroxine [Synthroid] to a child who has congenital hypothyroidism. The prescription reads: levothyroxine [Synthroid], 0.1 mg, intravenous, once a day for 3 days. The drug is available as a 200 mcg vial. What quantity of the drug should the nurse administer every day? Record your answer using one decimal place. __mL
2.5 mL The 200 mcg of powder present in the vial must be reconstituted with 5 mL of 0.9% NaCl. This makes a concentration of 40 mcg/mL. As we know, 1 milligram is equal to 1000 micrograms, so 0.1 mg = 100 mcg. If 1 mL = 40 mcg, then 2.5 mL of reconstituted drug contains 100 mcg = 0.1 mg. Therefore, the nurse should administer 2.5 mL of medication intravenously to the child. p. 709
A 6-year-old child with SHOX deficiency who weighs 20 kg is prescribed somatropin [Humatrope] to promote normal growth. Which dosage of the drug should be administered to the child? 7 mg/week IM 2 mg/day SC 8 mg/hour IM 10 mg once SC
7 mg/week IM Somatropin [Humatrope] is a growth hormone, and its fixed dosage is 0.35mg/kg/week in children. 0.35 × 20 kg = 7 mg/week. p. 724
A 60 year-old man has long managed his type 1 diabetes effectively with a combination of vigilant blood sugar monitoring, subcutaneous insulin administration and conscientious eating habits. This morning, however, his wife has noted that he appears pale and clammy and appears to be in a stupor, though he is responsive. She suspects that he has made an error in his insulin administration and that he is experiencing a hypoglycemic episode. Which of the following actions should be the wife's first choice? Administration of subcutaneous glucagon. Administration of 15 to 20 g of glucose in a concentrated carbohydrate source. IV infusion of 50% dextrose and water solution. Careful monitoring for level of consciousness and resolution of hypoglycemia.
Administration of 15 to 20 g of glucose in a concentrated carbohydrate source. p812
A 60 year-old man has long managed his type 1 diabetes effectively with a combination of vigilant blood sugar monitoring, subcutaneous insulin administration and conscientious eating habits. This morning, however, his wife has noted that he appears pale and clammy and appears to be in a stupor, though he is responsive. She suspects that he has made an error in his insulin administration and that he is experiencing a hypoglycemic episode. Which of the following actions should be the wife's first choice? IV infusion of 50% dextrose and water solution. Administration of subcutaneous glucagon. Administration of 15 to 20 g of glucose in a concentrated carbohydrate source. Careful monitoring for level of consciousness and resolution of hypoglycemia.
Administration of 15 to 20 g of glucose in a concentrated carbohydrate source. p812
Hypoglycemia has a sudden onset with a progression of symptoms. What are the signs and symptoms of hypoglycemia? Muscle spasms and headache Altered cerebral function and muscle spasms Altered cerebral function and headache Difficulty problem solving and muscle spasms
Altered cerebral function and headache p812
While reviewing the role of glucagon in regards to regulation of blood glucose, the nurse knows which of the following situations could lead to an inhibition of glucagon release? A sharp decrease in blood glucose concentration. Recent intake of large amounts of protein-rich food. An increase in glucose levels. Recent strenuous physical activity
An increase in glucose levels. p798
The primary healthcare provider prescribes a thyroid replacement drug to a patient with hypothyroidism. How should the nurse monitor for return to a euthyroid state? Assess for anxiety and palpitations. Verify the medication history of patient and family. Evaluate the patient's knowledge of thyroid therapy. Analyze the patient's serum thyroid-stimulating hormone levels.
Analyze the patient's serum thyroid-stimulating hormone levels. Drug efficacy is assessed by monitoring the thyroid-stimulating hormone [1] [2] (TSH) levels. The nurse will also monitor other thyroid tests, if ordered, and will assess for symptom improvement. Anxiety and palpitations would indicate a hyperthyroid state, which could occur with drug accumulation or excess. The other items, while important, do not address monitoring for a euthyroid (normal) state.
A nurse should consider which diagnostic test a priority to obtain before a patient receives iodine-131? Creatinine level Electrocardiogram (ECG) White blood cell count (WBC) Beta human chorionic gonadotropin (hCG) test
Beta human chorionic gonadotropin (hCG) test Any female patient of reproductive age requires a negative result on a beta hCG (pregnancy hormone) test before iodine-131 ( 131I) can be administered. Iodine-131 is a radioactive isotope used to treat hyperthyroidism and is contraindicated in pregnancy and lactation. A WBC, ECG, and creatinine levels are not indicated before treatment with iodine-131. p. 711
The nurse and nursing student are caring for a client undergoing a severe stressor with release of epinephrine into the bloodstream. Which of these effects on blood glucose levels does the nurse teach the student epinephrine will cause? Hypoglycemia will occur. Gluconeogenesis will occur. An unusable form of glucose will be released. Blood glucose will elevate.
Blood glucose will elevate. p798
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 pH Blood pressure Respiratory rate Body temperature
Blood pressure Vasopressin is a potent vasoconstrictor. Benefits derive from increased blood flow to the heart and brain during CPR. The blood pH, body temperature, and respiratory rate are not affected by vasopressin. p. 721
When caring for the client with diabetic ketoacidosis, the nurse recognizes that fatty acids and ketones may be used for energy by most organs. Which of these organs does the nurse recognize is reliant on glucose as the major energy source? Spleen Lungs Brain Heart
Brain p812
The nurse is caring for a client who is being treated for HHS (hyperosmolar hyperglycemic state). The nurse is aware that the client should be assessed for: Polyuria Cerebral edema Glycosuria Dehydration
Cerebral edema p812
A client with diabetes mellitus has sudden onset of slurred speech, incoordination, and cool, clammy skin. What will the nurse do first? Notify the physician Administer glucose Provide cheese and crackers Check blood glucose
Check blood glucose p812
A client with diabetes mellitus reports morning hyperglycemia for several days. What action should taken? Reduce the evening snack Begin evening exercises Check blood glucose at 2 AM Increase the morning insulin
Check blood glucose at 2 AM p813
Peripheral neuropathies occur in people with diabetes mellitus. With the loss of sensation in the lower extremities, diabetics become predisposed to what? Clawing of toes and denervation of the small muscles of the foot Denervation of the large muscles of the foot and bunions Displacement of the submetatarsal fat pad posteriorly and hammer toes Impairment of temperature and touch sensations
Clawing of toes and denervation of the small muscles of the foot p814
Which of the following criteria about insulin would prompt a diagnosis of type 1 diabetes? Large amounts of insulin secreted Small amounts of insulin secreted Insulin not efficiently used Complete failure of insulin secretion
Complete failure of insulin secretion p801
For which conditions is diabetes mellitus a risk factor? Select all that apply. Gastroenteritis Rheumatoid arthritis Chronic kidney disease Cerebrovascular accident Coronary artery disease
Coronary artery disease Cerebrovascular accident Chronic kidney disease p813
The patient is having an overnight dexamethasone suppression test performed to diagnose Cushing's syndrome. A nurse administers dexamethasone [Decadron] 1 mg, at 11:00 PM. During shift change report, the nurse should instruct the oncoming nurse to draw blood for which test at 8:00 AM? Cortisol Sodium Glucose Potassium
Cortisol The overnight dexamethasone suppression test is used to diagnose Cushing's syndrome. Normally, dexamethasone acts to suppress the release of adrenocorticotropic hormone (ACTH), thereby suppressing the release of cortisol. In a patient with Cushing's disease, no cortisol suppression occurs. Potassium, glucose, and sodium are not used as measures of adrenal function.
Which drug is used to diagnose adrenocortical insufficiency? Cosyntropin [Cortrosyn] Desmopressin [DDAVP] Octreotide [Sandostatin] Somatropin [Humatrope]
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. p. 720
A patient with diabetes is being evaluated for the disease's potential chronic complications. The nurse knows that a patient with distal symmetric neuropathy will have which of the following signs and symptoms? Select all that apply. Risk of foot injuries Risk for falling Stocking-glove pattern function loss Decreased pain perception Orthostatic hypotension
Decreased pain perception Risk for falling Stocking-glove pattern function loss Risk of foot injuries p814
The primary healthcare provider prescribes vasopressin [Pitressin] to a patient. Which side effects would the nurse expect in the patient? Confusion Drowsiness Frequent thirst Decreased urination
Decreased urination The drug vasopressin [Pitressin] mimics the action of antidiuretic hormone, which results in a decrease in urine output. A lower urine output may cause the patient to feel less thirsty. There are no reported symptoms of confusion with vasopressin [Pitressin]. Sedative action is also not reported with vasopressin [Pitressin]. p. 721
The nurse is planning care for a patient with signs of acute adrenal insufficiency. What is the priority patient problem? Pain and discomfort Deficient fluid volume Excessive caloric intake Shortness of breath upon exertion
Deficient fluid volume Acute adrenal insufficiency (adrenal crisis) is characterized by hypotension, dehydration, weakness, lethargy, and gastrointestinal symptoms of nausea and vomiting. Rapid replacement of fluid, salt, and glucocorticoids is essential to prevent shock and death. Comfort, nutrition, and activity are important to address once fluid balance has been restored.
Which is the drug of choice to treat diabetes insipidus? Tolvaptan [Samsca] Conivaptan [Vaprisol] Desmopressin [DDAVP] Pegvisomant [Somavert]
Desmopressin [DDAVP] Diabetes insipidus may be treated with either desmopressin [DDAVP] or vasopressin [Pitressin]. However, DDAVP is the agent of choice because it has a long duration of action, is easy to administer, and lacks significant side effects. Conivaptan [Vaprisol] is indicated for short-term intravenous therapy of hyponatremia in euvolemic and hypervolemic hospitalized patients. Tolvaptan [Samsca] is an oral vasopressin antagonist indicated for reducing hyponatremia in patients with euvolemic or hypervolemic hyponatremia. Pegvisomant [Somavert] is a growth hormone receptor antagonist and may be the most effective drug for acromegaly. p. 721
A 5-year-old child is diagnosed with type I von Willebrand's disease. Which drug would the nurse expect the primary healthcare provider to prescribe to the patient? Desmopressin [DDAVP] Cosyntropin [Cortrosyn] Octreotide [Sandostatin] Somatropin [Humatrope]
Desmopressin [DDAVP] Type I von Willebrand's disease is a bleeding disorder seen in people who have low levels of von Willebrand factor. Desmopressin [DDAVP] is useful in treatment of type I von Willebrand's disease as it affects the various blood clotting factors. Cosyntropin [Cortrosyn] increases the cortisol levels, so it would not be prescribed. Octreotide (Sandostatin] is antagonistic to growth hormone and is prescribed to reduce the effect of the growth hormone in a tumor condition. Somatropin [Humatrope] is a growth hormone. It does not affect blood clotting factors. p. 721
A nurse is developing a plan of care for a patient with Addison's disease who is taking hydrocortisone [Cortef]. Which outcome is of the highest priority for this patient's care plan? The patient wears a medical ID bracelet at all times. During times of stress, the patient increases the glucocorticoid dose. The patient carries an injectable form and an oral form of glucocorticoid. The patient divides the daily dose taking two-thirds of it in the morning and one-third in the afternoon.
During times of stress, the patient increases the glucocorticoid dose. Patients with adrenal insufficiency require lifelong replacement doses of glucocorticoids. Failure to increase the dosage at times of stress and illness can be life threatening. Wearing a medical ID bracelet, carrying injectable and oral forms of glucocorticoid, and dividing the daily glucocorticoid dose are important for a patient taking hydrocortisone, but they are not priorities over understanding the need to increase the dose during times of stress.
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 therapeutic response? Increased cortisol synthesis Increased resistance to infection Enhanced radiation effect to the brain Increased adrenocorticotropic hormone (ACTH) production
Enhanced radiation effect to the brain Ketoconazole is used as an adjunct to radiation or surgery in patients with Cushing's syndrome to enhance the radiation effect to the brain. It is an antifungal drug that inhibits (not increases) glucocorticoid (cortisol) synthesis very effectively. Increased ACTH production and resistance to infection are not actions of ketoconazole.
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? Atrophy of sweat glands Enlarged heart on chest x-ray Blood glucose below 70 mg/dL Elevation of liver function test results
Enlarged heart on chest x-ray Gigantism caused by excess GH can cause children not only to grow very tall but also to develop complications such as headache, profuse sweating, cardiomegaly (enlarged heart), and diabetes. Because of its effect on carbohydrate metabolism, excess GH may cause an elevated blood glucose level, not hypoglycemia. It does not damage the liver; therefore, liver function tests are not affected. It also does not cause the sweat glands to atrophy. p. 717
Which finding in a patient taking levothyroxine [Synthroid] and warfarin [Coumadin] would require follow-up by a nurse? Excessive bruising Weight loss of 5 kg Shortness of breath Cardiac dysrhythmias
Excessive bruising Levothyroxine intensifies the effect of warfarin, an anticoagulant that increases the patient's risk for bleeding. The warfarin dose may need to be reduced if there is excessive bruising. Cardiac dysrhythmias, weight loss, and shortness of breath are not effects associated with interactions of levothyroxine and warfarin. p. 708
A 15-year-old girl who has just been diagnosed with type 1 diabetes says she read on the Internet that diabetes is the leading cause of acquired blindness among Canadians. She asks nurse if she will lose her sight. In addition to explaining that new treatment technologies are being worked on every day, which response would be the most appropriate? Reassure her that only type 2 diabetes is a risk factor for blindness. Tell her to expect that she will likely begin to lose her eyesight gradually by the time she is 25. Explain that most people with type 1 diabetes do experience some loss of sight by about 20 years from the onset of their disease. Tell her there is about a 50% chance that she will suffer some diabetes-related sight loss by the time she is 50.
Explain that most people with type 1 diabetes do experience some loss of sight by about 20 years from the onset of their disease. p813
A patient hospitalized with type 1 diabetes has been administered a scheduled dose of regular insulin. Which of the following are processes of insulin? Select all that apply. Promotion of glycogenolysis Glucose uptake by muscle and adipose tissue Fat storage Protein synthesis Gluconeogenesis
Fat storage Glucose uptake by muscle and adipose tissue Protein synthesis p795
The nurse is creating a care plan for a patient receiving desmopressin [DDAVP]. Interventions for which patient problem will be most important to implement? Pain and discomfort Knowledge deficiency Fluid and electrolyte imbalance Shortness of breath while walking
Fluid and electrolyte imbalance Desmopressin is a form of antidiuretic hormone that increases sodium and water retention leading to an alteration in fluid volume. Monitoring of urine volumes and body weight is essential to prevent complications. Alteration in comfort, deficient knowledge of the condition, and activity intolerance are important nursing problems; however, they are not priorities in the patient receiving desmopressin. pp. 720-721
Which complications may be experienced by a client with diabetic neuropathies? Select all that apply. Gastroparesis Foot ulcers Erectile dysfunction Urinary retention Pathologic fractures
Foot ulcers Gastroparesis Erectile dysfunction Urinary retention p815
A patient with diabetes asks the nurse for advice in controlling between-meal blood glucose levels. Which of the following might the nurse suggest as a long-acting insulin to provide a consistent basal level? Glargine (Lantus) Aspart (Novolog) Regular Glulisine (Apidra)
Glargine (Lantus) p810
The primary healthcare provider is administering somatropin [Humatrope] to a patient. Which assessments are necessary? . Glucose levels Platelet counts Thyroid function Potassium levels Growth hormone levels
Glucose levels Thyroid function Growth hormone levels Somatropin [Humatrope] is a growth hormone that is administered to manage inadequate growth in children. Thyroid function, growth hormone levels, and glucose levels are monitored, and motor skills of the patients are assessed.
Which of the following statements best describes an aspect of the normal process of glucose metabolism? Blood glucose levels are primarily a result of the timing, quantity and character of food intake. Glucose that exceeds metabolic needs is converted and stored by the liver. Blood glucose levels are kept in a steady state by selective excretion and reuptake by the kidneys. Ingested glucose that is not needed for cellular metabolism circulates in the blood until it is taken up to meet cellular needs.
Glucose that exceeds metabolic needs is converted and stored by the liver. p794
The nurse is instructing a patient about the use of insulin. Which of the following insulins are rapid acting? Select all that apply. Glargine Regular Aspart Neutral protamine Hagedorn (NPH)
Glulisine Aspart p809
A client is diagnosed with type 2 diabetes mellitus and begins to follow a nutritional plan at home. What result at the follow-up visit indicates a successful outcome? Blood pressure 148/90 HDL 35 mg/dl Fasting blood glucose 155 mg/dl Glycosylated hemoglobin 5.2%
Glycosylated hemoglobin 5.2% p805
A client tells the health care provider that he has been very compliant over the last 2 months in the management of his diabetes .The best diagnostic indicator that would support the client's response would be: Glycosylated hemoglobin, hemoglobin A1C (HbA1C) Urine test Capillary blood glucose sample Fasting blood glucose level
Glycosylated hemoglobin, hemoglobin A1C (HbA1C) p806
When educating a patient about glargine (Lantus), the nurse should explain that this medication: Is a combination with short acting and intermediate acting insulin so it is safe to take anytime throughout the day. Since this medication will have a peak effect within 30 minutes, it can be taken after a meal. Has a rapid onset and peaks in about 5 minutes after injection so they will need to eat food immediately after injection. Has a prolonged absorption rate and provides a relatively constant concentration for 12-24 hours.
Has a prolonged absorption rate and provides a relatively constant concentration for 12-24 hours. p810
A patient is receiving vasopressin [Pitressin]. Which symptoms warrant immediate notification of the primary healthcare provider? Pale skin Headache Drowsiness Listlessness Bloodshot eyes
Headache Drowsiness Listlessness During the follow-up visit, the nurse should monitor for symptoms such as drowsiness, listlessness, and headache. These are adverse effects of vasopressin [Pitressin]. If these symptoms persist, severe complications may arise, so the nurse should notify the primary healthcare provider immediately if these symptoms are present. Vasopressin [Pitressin] does not cause problems that would contribute to pallor or bloodshot eyes.
A patient has been admitted with diabetic ketoacidosis. The Emergency Department starts an IV to improve circulatory volume. If there is a sudden change in extracellular fluid osmolality which results in a too rapid blood glucose lowering, the nurse will likely observe which of the following clinical manifestations? Headaches, dizziness, change in level of consciousness. Increase urine output, thirst, vomiting. Chills, profuse sweating, weakness. Rapid, deep respirations, palpitations, low BP.
Headaches, dizziness, change in level of consciousness. p812
A 62-year-old man who is overweight has just been diagnosed with type 2 diabetes. The nurse educator is instructing him in the ways his diabetes can be controlled. The nurse should initially prioritize which action? Educating the client the risks and management of hypoglycemia. Teaching the client about the action and safe administration of insulin. Assisting the client with the appropriate choice of oral antihyperglycemics. Helping the client make meaningful changes to his diet and activity level.
Helping the client make meaningful changes to his diet and activity level. p806
Which laboratory values for a newly admitted client indicate a diagnosis of diabetes mellitus? Select all that apply. Serum potassium 4.2 mEq/dl Fasting blood glucose level 75 mg/dl 2 hour oral GTT 245 mg/dl Hemoglobin A1c 9.1%
Hemoglobin A1c 9.1% 2 hour oral GTT 245 mg/dl p805
A 30-year-old male who manages his type 1 diabetes with glyburide presents at the emergency room complaining of headache, confusion, and tachycardia. He has come from a party at which he drank two beers to celebrate running his first half-marathon. Which of the following is likely to be the cause of his complaints? Diabetic ketoacidosis Hyperosmolar hyperglycemic state Somogyi effect Hypoglycemia
Hypoglycemia p812
The nurse is caring for a patient who has Addison's disease. The primary healthcare provider prescribes fludrocortisone [Florinef]. Which adverse effect should the nurse monitor in this patient? Hypokalemia Hyponatremia Hypocalcemia Hypoglycemia
Hypokalemia Fludrocortisone [Florinef] has mineralocorticoid properties, resulting in sodium and fluid retention along with potassium excretion. It causes a reduction in serum potassium concentrations. Hence, the nurse should monitor whether the patient has hypokalemia. When corticosteroids are administered with non-potassium-sparing diuretics, the adverse effects of hypocalcemia needs to be monitored. If Addison's disease disease is left untreated, the condition may lead to an adrenal crisis or a life-threatening state of profound adrenocortical insufficiency. Signs and symptoms of adrenocortical insufficiency include a decrease in extracellular fluid volume, hyponatremia, and hyperkalemia. Fludrocortisone [Florinef] causes an elevation in serum blood glucose concentrations. Therefore, the medication would cause hyperglycemia in this patient but not hypoglycemia. p. 730
A nurse is caring for a patient with decreased triiodothyronine (T 3) and thyroxine (T 4) and elevated thyroid-stimulating hormone (TSH) levels. The nurse knows the patient is likely suffering from which condition? Thyrotoxicosis Hypothyroidism Graves' disease Hyperthyroidism
Hypothyroidism The anterior pituitary increases production of TSH when thyroid hormone levels of T 3 and T 4 are reduced reflecting primary hypothyroidism. Patients may experience fatigue caused by a lowered basal metabolic rate. Thyrotoxicosis, hyperthyroidism, and Graves' disease are medical conditions indicative of excessive thyroid activity. p. 705
Which of the following interventions is important for the nurse to teach a patient diagnosed with distal symmetric neuropathy related to diabetes? Select all that apply. Rotate insulin injection sites once a week. Wear comfortable, open-toe shoes. Inspect the feet daily for blisters. Wear well-fitted shoes. Decrease daily walking activity.
Inspect the feet daily for blisters. Wear well-fitted shoes. p817
The diagnosis of type 1 diabetes would be confirmed by: Insulin is not available for use by the body. Insulin is produced but unavailable for use in the body. Small amounts of insulin are produced daily. Insulin is present in large amounts for use by the body.
Insulin is not available for use by the body. p801
The endocrinologist prescribes radioactive iodine to an adult patient who has thyroid cancer. What is the reason for prescribing this drug to the patient? It destroys cancerous or overactive thyroid tissue. It acts as a prophylactic agent against radiation exposure. It inhibits the conversion of T 4 to T 3 in the peripheral circulation. It increases the cellular metabolic rate and oxygen consumption.
It destroys cancerous or overactive thyroid tissue. Radioactive iodine is a commonly used treatment for both hyperthyroidism and thyroid cancer. It emits destructive beta rays into the follicles of the thyroid gland, destroying it in a process known as ablation. Potassium iodide is used as prophylaxis for radiation exposure. Thyroid replacement drugs increase the cellular metabolic rate and oxygen consumption as the endogenous thyroid hormones. Propylthiouracil inhibits the conversion of T 4 to T 3 in the peripheral circulation to decrease the level of thyroid hormone. Test-Taking Tip: Notice how the subjects of the questions are related and, through that relationship, the answers to some of the questions may be provided within other questions of the test. p. 710
The nurse administering hydrocortisone to a patient recognizes which statement(s) as true regarding the medication? It is a synthetic steroid identical to cortisol. It should not be given during times of stress. It has glucocorticoid and mineralocorticoid actions. It is a preferred drug for adrenocortical insufficiency. It is given intravenously for chronic replacement therapy.
It is a synthetic steroid identical to cortisol. It has glucocorticoid and mineralocorticoid actions. It is a preferred drug for adrenocortical insufficiency. Hydrocortisone is a synthetic steroid with a structure identical to that of cortisol. Hydrocortisone is a preferred drug for all forms of adrenocortical insufficiency. Oral hydrocortisone is ideal for chronic replacement therapy. Parenteral administration is used for acute adrenal insufficiency and to supplement oral doses during times of stress. Despite being classified as a glucocorticoid, hydrocortisone also has mineralocorticoid actions. pp. 729-730
How does somatropin [Genotropin] help children with growth hormone deficiency? It increases protein levels. It stimulates skeletal growth. It decreases serum glucose levels. It increases endogenous growth hormone.
It stimulates skeletal growth. The drug somatropin [Genotropin] acts by stimulating skeletal growth. It is an analogue of the growth hormone. It promotes protein synthesis but does not increase serum protein levels. Somatropin [Genotropin] may cause hyperglycemia, which can be pronounced in people with diabetes. None of the growth hormone analogues acts by increasing the endogenous growth hormone. pp. 718, 723
Diabetics are at higher risk than are the majority of the population for injury to organ systems in the body. Which organs are most at risk? Pancreas and eyes Liver and eyes Kidneys and eyes Kidneys and liver
Kidneys and eyes p815
An adult patient who has a growth hormone (GH) deficiency is receiving somatropin [Nutropin]. An increase in which characteristic would indicate to the nurse that the patient is experiencing the desired effect of the medication? Lean body mass Physical strength Height (by 3 inches) Joint range of motion
Lean body mass Nutropin is a form of GH. In adults with GH deficiency, replacement therapy does not cause long bone growth or an increase in height because the epiphyses are already closed. It does increase lean body mass and reduces adipose tissue. Although it increases muscle mass, Nutropin does not increase strength. Joint range of motion is not affected. p. 718
The patient newly diagnosed with hypothyroidism has been prescribed levothyroxine. The nurse should give the patient which instruction(s)? Levothyroxine should be taken with food. Levothyroxine brands should not be changed, if possible. Levothyroxine can affect the metabolism of other medications. Levothyroxine should be taken at night to avoid adverse effects. Levothyroxine can be given intravenously but is usually taken orally.
Levothyroxine brands should not be changed, if possible. Levothyroxine can affect the metabolism of other medications. Levothyroxine can be given intravenously but is usually taken orally.
The nurse has just completed teaching a client newly diagnosed with type 1 diabetes about rapid-acting insulin. The nurse determines that teaching was effective when the client selects: Glargine Regular NPH Lispro
Lispro p809
Gestational diabetes mellitus is a disorder of glucose intolerance that occurs during pregnancy. It is associated with increased risk for developing type 2 diabetes and with fetal abnormalities. What fetal abnormalities are associated with gestational diabetes mellitus? Macrosomia and hypocalcemia Hypoglycemia and hypercalcemia Hypercalcemia and hyperbilirubinemia Microsomia and polycythemia
Macrosomia and hypocalcemia p804
A client with diabetic retinopathy develops a retinal bleed and asks the nurse, "How can I prevent this from happening again?" What response provides the most effective information? Control stress and monitor vision changes. Maintain healthy blood pressure and blood sugar levels. Wear glasses when reading and limit computer time. Visit your eye health professional for annual exams.
Maintain healthy blood pressure and blood sugar levels. p816
A client with diabetic retinopathy develops a retinal bleed and asks the nurse, "How can I prevent this from happening again?" What response provides the most effective information? Visit your eye health professional for annual exams. Maintain healthy blood pressure and blood sugar levels. Wear glasses when reading and limit computer time. Control stress and monitor vision changes.
Maintain healthy blood pressure and blood sugar levels. p816
The nurse screening for diabetes mellitus at a health fair does not have enough supplies for all of the clients attending. Which clients should be given screening priority? Male age 65, hypertension Male age 45, BMI 32 Female age 30, history GDM Female age 37, Caucasian Female age 28, two children
Male age 45, BMI 32 Female age 30, history GDM Male age 65, hypertension p804
When assessing a patient who has Cushing's syndrome, the nurse recognizes which characteristics as clinical manifestations of this disorder? Ketonuria Moon face Glycosuria Mood swings Osteoporosis
Moon face Glycosuria Mood swings Osteoporosis Cushing's syndrome results from excess secretion of adrenocorticotropic hormone (ACTH), and these effects result in manifestations such as redistribution of fat to the face and belly, excess blood sugar, mood changes, and calcium loss from bone. Ketonuria does not occur. p. 727
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? Syncope Weight loss Muscle weakness Numbness and tingling
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 a large pituitary tumor. Which drug would the nurse expect to administer to this patient? Somatostatin Cosyntropin [Cortrosyn] Octreotide [Sandostatin] Desmopressin [DDAVP]
Octreotide [Sandostatin] Octreotide [Sandostatin] is used in the treatment of large pituitary tumors. Cosyntropin [Cortrosyn] is not used in the treatment of large pituitary tumors. It is used as a diagnostic test to differentiate primary adrenal from secondary (pituitary) adrenocortical insufficiency. Desmopressin [DDAVP] is used to treat dehydration caused by vasopressin deficiency. p. 718
While reviewing the medical report of a patient, the nurse notes that the patient has acromegaly. Which medication would the nurse anticipate administering? Vasopressin [Pitressin] Desmopressin [DDAVP] Octreotide [Sandostatin] Somatropin [Humatrope]
Octreotide [Sandostatin] Octreotide [Sandostatin] is used to treat acromegaly, along with surgery and radiation if indicated. Vasopressin [Pitressin] is used in the treatment of diabetes insipidus, vasodilatory shock, gastrointestinal hemorrhage, esophageal varices. 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. p. 718
A client with severe hypoglycemia is unconscious. Which method of providing glucose should be avoided? Orange juice orally Dextrose IV IM glucagon injection Glucose gel in the buccal pocket
Orange juice orally p813
After delivery, a patient develops uterine atony and increased bleeding. Which medication would the nurse expect to administer? Oxytocin [Pitocin] Cosyntropin [Cortrosyn] Octreotide [Sandostatin] Somatropin [Humatrope]
Oxytocin [Pitocin] During the postpartum phase, the intensity of uterine contractions may decrease and become uncoordinated. It is essential that the uterus remains firm and well contracted. The primary healthcare provider instructs the nurse to administer oxytocin [Pitocin] to the patient to promote uterine contractions. Cosyntropin [Cortrosyn], octreotide [Sandostatin], and somatropin [Humatrope] have no effect on the uterus. Thus, these drugs are not useful for uterine contractions. Cosyntropin [Cortrosyn] is used for diagnosis of adrenocortical insufficiency. Octreotide [Sandostatin] is useful in alleviating symptoms of carcinoid tumors. Somatropin [Humatrope] is useful in the treatment of growth hormone deficiency.
A male patient is being evaluated for metabolic syndrome. Which of the following are diagnostic criteria for this syndrome? Select all that apply. Patient's resting heart rate is 90 to 95 beats per minute. Patient's high-density lipoprotein (HDL) cholesterol is 25. Patient does less than 30 minutes of strenuous physical activity each week. Patient's blood pressure (BP) is 150/90 mm Hg. Patient's body mass index (BMI) is 31.
Patient's body mass index (BMI) is 31. Patient's high-density lipoprotein (HDL) cholesterol is 25. Patient's blood pressure (BP) is 150/90 mm Hg. p804
The nurse knows that increased blood glucose levels will pull water out of cells and result in which of the following? Select all that apply. Polydysplasia Polyuria Polydipsia Polyphagia Fatigue
Polydipsia Polyuria p805
Select the most common symptoms of diabetes. Select all that apply. Polyuria Polycythemia Polydipsia Polyhydramnios Polyphagia
Polydipsia Polyuria Polyphagia p805
What are the hallmark signs of diabetes mellitus? Polyuria, polydipsia, and polyphagia Polyuria, polydipsia, and pheochromocytoma Polyuria, polyphagia, and polycythemia Polycythemia, polydipsia, and pheochromocytoma
Polyuria, polydipsia, and polyphagia p805
A patient with hemophilia A is prescribed desmopressin [DDAVP]. What is the mechanism of action of desmopressin [DDAVP] in this case? Constricts the blood vessels Increases water reabsorption Promotes release of clotting factor VIII Stimulates the release of von Willebrand factor
Promotes release of clotting factor VIII Hemophilia A is a hereditary disorder characterized by lack of blood clotting factor VIII. This absence may lead to bleeding even with a small injury. Vasopressin [Pitressin] is used to increase the percentage of clotting factor VIII in the blood and control bleeding. Vasopressin [Pitressin] regulates the retention of water in the body by increasing the water reabsorption in the collecting ducts of the kidney to treat dehydration. Vasopressin [Pitressin] is used to treat type I von Willebrand's disease by stimulating the release of von Willebrand factor, a multimeric protein that plays a major role in blood coagulation. Vasopressin [Pitressin] increases the peripheral vascular resistance, which in turn increases arterial blood pressure.
Infections are common in people with diabetes. Which infection is thought to be related to a neurogenic bladder? Urinary retention Urinary incontinence Nephrotic syndrome Pyelonephritis
Pyelonephritis p817
The nurse screening for diabetes mellitus at a health fair obtains these results. Which client should be referred to a primary healthcare provider for further evaluation? Random blood glucose 195 mg/dl Hemoglogin A1c 6.0% Urine ketones 0 Fasting blood glucose 89 mg/dl
Random blood glucose 195 mg/dl p805
A woman in her 28th week of pregnancy tests positive for gestational diabetes mellitus and begins to follow a nutritional plan at home. What result at the follow-up visit indicates a successful outcome? Gained 5 pounds in one week 1% ketones present in urine Random blood glucose 85 mg/dl Glycosylated hemoglobin 7.2%
Random blood glucose 85 mg/dl p805
A client with diabetes carries insulin with him at all times. At 11:35, he obtains a blood glucose reading of 12.1 mmol/l and self-administers a dose of insulin in anticipation of eating lunch at noon. What type of insulin did he most likely inject? Long acting Premixed Short acting Intermediate acting
Short acting p809
Which outcome should a nurse establish for a patient who has acromegaly and is receiving octreotide [Sandostatin]? Normal urine volume Softening of facial features Increase in long-bone growth Stimulation of the milk reflex
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.
Which hormone inhibits the release of growth hormone? Somatropin Somatolactin Somatostatin Choriomammotropin
Somatostatin The hormone that inhibits growth is somatostatin. It is otherwise called growth hormone inhibitor and is released from the digestive system and brain. Somatolactin is a hormone that induces oxytocin. Somatropin is a growth-stimulating hormone. Choriomammotropin belongs to the family of somatropin. p. 722
Research has identified a cycle of insulin-induced posthypoglycemic episodes. What is this phenomenon called? Somogyi effect Joslin phenomenon Sunset effect Dawn phenomenon
Somogyi effect p813
The endocrinologist orders lanreotide [Somatuline Depot] for a patient with acromegaly. Which should the nurse identify as the reason for prescribing this drug? Relief of bone pain Prevention of osteopenia Promotion of epiphyseal closure Suppression of growth hormone release
Suppression of growth hormone release The somatostatin analogs—octreotide and lanreotide—are the most effective drugs for suppressing growth hormone (GH) release. Benefits derive from mimicking the suppressant actions of somatostatin on the pituitary (see Fig. 59-3 in the text). The somatostatin analogs can be used as primary therapy for acromegaly or as an adjunct to surgery and/or radiation. In both cases, the objective is to normalize levels of GH and insulin-like growth factor-1.
Which manifestations should a nurse investigate first when monitoring a patient who is taking levothyroxine [Synthroid]? Tremors Insomnia Irritability Tachycardia
Tachycardia High doses of levothyroxine may cause 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. p. 708
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 a full stomach. Take on an empty stomach. Take immediately after arising. Take immediately before bedtime.
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.
A patient is managing his type 2 diabetes with exercise and diet. He has a fasting blood sugar level (FBS) of 80 mg/dL and a hemoglobin A1C of 5%. Based on these findings, which of the following can the nurse assume? The patient is achieving normal glycemic control. The patient needs to modify his diet related to the low readings. The patient is at risk for developing hyperglycemia. The patient is at risk for an insulin reaction.
The patient is achieving normal glycemic control. p805
The nurse is assessing an elderly patient who has been taking levothyroxine [Synthroid] for 6 months. The nurse finds that the patient has anxiety, tachycardia, and insomnia. What should the nurse interpret from these findings? The patient is hypersensitive to thyroid drugs. The patient has common age-related symptoms. The patient is not responding to the thyroid drugs. The patient is experiencing adverse effects of the thyroid drugs.
The patient is experiencing adverse effects of the thyroid drugs. Anxiety, tachycardia, and insomnia are among the adverse effects of levothyroxine [Synthroid]. These adverse effects may be due to accumulation of the drug in the body; thus, they appear as symptoms of hyperthyroidism. These are not signs and symptoms of an allergic (hypersensitivity) reaction. Anxiety, tachycardia, and insomnia are not anticipated age-related symptoms. If the patient was not responding to the medication, then the patient would have decreased thyroid hormone levels, which would more likely be manifested by bradycardia and increased drowsiness or sleep.
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 cretinism. The patient may have myxedema. The patient may have Graves' disease. The patient may have Plummer's disease.
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. p. 705
The nurse is teaching a client about a sulfonylurea medication. Which of these points should be included in the discussion? Select all that apply. Insulin is a type of sulfonylurea. Hypoglycemia may result from this type of medication. These medications cause insulin to be released from the pancreas. A sulfonylurea is useful in type 1 diabetes. If all beta cells are destroyed, this medication is useful.
These medications cause insulin to be released from the pancreas. Hypoglycemia may result from this type of medication. p808
A patient with the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is prescribed tolvaptan [Samsca]. Which are common adverse effects of this drug? Thirst Diarrhea Polyuria Dry mouth Hypoglycemia
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). p. 722
The patient reports that she had to switch pharmacies to save money. She noted that her thyroid pill looked different. The nurse anticipates that the healthcare provider will order which test? Creatinine level Electrocardiogram (ECG) Thyroid stimulating hormone (TSH) Beta human chorionic gonadotropin (hCG) test
Thyroid stimulating hormone (TSH) If a switch is made (from one branded product to another, from a branded product to a generic product, or from one generic product to another), retest serum TSH in 6 weeks and adjust the levothyroxine dosage as indicated. p. 708
How does insulin participate in cellular metabolism? Select all that apply. Increases amino acid conversion to glucose Increases use of fatty acids as fuel Promotes triglyceride synthesis in the liver Transports glucose into skeletal muscle Promotes glycogen conversion to glucose
Transports glucose into skeletal muscle Promotes triglyceride synthesis in the liver Increases use of fatty acids as fuel p795
A patient who has hypothalamic diabetes insipidus is receiving desmopressin [DDAVP]. Which laboratory test should a nurse obtain to evaluate the effectiveness of the medication? Creatinine Urine ketones Urine osmolality Blood urea nitrogen (BUN)
Urine osmolality Diabetes insipidus is characterized by a decrease in the urine osmolality because of the excretion of large volumes of dilute urine. Desmopressin acts to prevent fluid loss through the renal tubules and increases the urine specific gravity. Urine ketones are present in type 1 diabetes mellitus. The BUN and creatinine are indicators of renal function but not of the effectiveness of treatment of hypothalamic diabetes insipidus. pp. 720-721
The nurse is caring for a client with diabetes who has developed gastroparesis. Which of these symptoms does the nurse expect the client to report? Intolerance to fats Weight gain Vomiting after eating Diarrhea
Vomiting after eating p815
