Endocrine

A nurse is discussing health maintenance with the parent of a newborn infant. Which statement by the parent indicates understanding of ways to reduce the incidence of otitis media? "I should hold my baby in an upright position during feeding." "I should keep my baby out of day care during cold and flu season." "My baby should not use a pacifier after 6 months of age." No answer text provided.

"I should keep my baby out of day care during cold and flu season."

A nurse is teaching a group of lifeguards about safe sunning. Which statement by a lifeguard indicates understanding of the teaching? "Sunscreen should be applied 30 minutes before going outside." "I do not need sunscreen when it is cloudy outside." "I should reapply sunscreen after swimming." "UV radiation does not penetrate through water."

"I should reapply sunscreen after swimming."

A provider has told a parent that a 3-year-old child has a minor ear infection and that an antibiotic would be prescribed in a couple of days if the child's symptoms worsened. The parent asks the nurse why the child cannot get an antibiotic today. Which response by the nurse is correct? "If the eardrum ruptures, we can culture the fluid to determine which antibiotic is best." "Most ear infections are caused by viruses, so antibiotics are not effective." "Most ear infections will resolve on their own without antibiotics." "Your child will develop tolerance to antibiotics if they are prescribed too often."

"Most ear infections will resolve on their own without antibiotics."

A patient has had dilation of the eyes with an anticholinergic agent. What will the nurse say when preparing this patient to go home after the examination? Systemic side effects will not occur with this agent." "You may experience an increased heart rate, but this is a harmless side effect." "You may need to wear dark glasses until this medication wears off." "You will be able to read as soon as the exam is completed."

"You may need to wear dark glasses until this medication wears off."

What happens when you combine glipizide with alcohol? (2)

- disulfiram-like reaction may occur • Flushing, palpitations and nausea -Alcohol can potentiate drug and lead to hypoglycemic effects

If a pregnant pt is diagnosed with hypothyroidism-why does she need to take med for this condition? •

-In first trimester can result in permanent neuropsychologic deficits in the child.... developmental problems and lower IQ -During first trimester, fetus cannot produce its own TH, so needs mother's. If mother is Hypothyroidal... we have a problem, which is why its VERY important to detect it early on.

how many times a day do you administer insulin glargine?

-Prolonged duration of action (up to 24 hours) -Once-daily subQ dosing to treat adults and children with type 1 diabetes and adults with type 2 diabetes -Clear solution

Important facts about levothyroxine (when do you take it, etC)

-always on an empty stomach (30 min before breakfast) -• Should NOT be taken with antacids because they reduce its absorption

Adverse effects of it?

-bad taste ➢ Burning sensation in the mouth and throat ➢ Soreness of the teeth and gums ➢ Frontal headache ➢ Coryza ➢ Salivation

how do you take bisacodyl

-they are enteric coated to prevent gastric irritation... swallow them intact,, without chewing or crushing. -these should be administered no sooner than 1 hour after ingesting milk and antacids because they accelerate the dissolution of the enteric coating

What is blood glucose level for someolne with ketoacidosis?

> or = to 250 mg/dL

dangerous toxicity of methimazole? Signs of it?

Agranulocytosis= is a serious condition characterized by a dramatic reduction in circulating granulocytes, a type of WBC needed to fight infection ***Signs= FEVER AND SORE THROAT

The nurse instructs a patient about taking levothyroxine [Synthroid]. Which statement by the patient indicates the teaching has been effective? "To prevent an upset stomach, I will take the drug with food." "If I have chest pain or insomnia, I should call my doctor." "This medication can be taken with an antacid." "The drug should be taken before I go to bed at night."

Answer: B Rationale: Levothyroxine overdose may produce the following symptoms: tachycardia, angina, tremor, nervousness, insomnia, hyperthermia, heat intolerance, and sweating; the patient should contact the prescriber if these symptoms are noted. Levothyroxine should be taken in the morning on an empty stomach 30 minutes before a meal. Levothyroxine should not be taken with antacids, which reduce the absorption of levothyroxine.

The nurse instructs a patient in the administration of Lugol's solution. The nurse determines that teaching has been effective if the patient makes which statement? "I'll need to take this solution for the rest of my life." "The medication should be diluted in fruit juice." "To prevent stains on my teeth, I'll use a straw." "The solution should be placed under my tongue."

Answer: B Rationale: Lugol's solution is administered in a dosage of drops and should be mixed with juice or some other beverage to mask its unpleasant taste. Lugol's solution is used for a short time (usually less than 10 days) to suppress thyroid function in preparation for thyroidectomy or during a thyrotoxic crisis. Lugol's solution does not stain teeth. The solution should not be placed under the tongue.

A patient takes levothyroxine [Synthroid] 0.75 mcg every day. It is most appropriate for the nurse to monitor which laboratory test to determine whether a dose adjustment is needed? Thyrotropin-releasing hormone (TRH) Thyroid-stimulating hormone (TSH) Serum free T4 test Serum iodine level

Answer: B Rationale: Serum thyroid-stimulating hormone (TSH) is the preferred laboratory test for monitoring replacement therapy in patients with hypothyroidism.

The nurse identifies which of the following as the most common type of laxative abused by the general public? A. Magnesium hydroxide [Milk of Magnesia] B. Docusate sodium [Colace] C. Bisacodyl [Dulcolax] D. Polyethylene glycol [MiraLax]

Answer: C stimulant: Durolax Rationale: Stimulant laxatives (bisacodyl, senna, castor oil) are most commonly abused by the general public. The nurse should discourage use of these drugs for occasional relief of constipation.

A patient who has been taking a long-acting morphine to treat severe pain for a few months complains of constipation. The nurse anticipates which of the following will be prescribed for the patient? A. Polycarbophil [FiberCon] B. Mineral oil C. Psyllium [Metamucil] D. Senna [Senokot]

Answer: D Rationale: Stimulant laxatives are commonly used to treat opioid-induced constipation

A patient is prescribed bisacodyl. Which of the following should the nurse include in patient teaching? A. Your urine will turn yellow-brown when taking this medication. B. Crush the bisacodyl tablet and sprinkle it on your food. C. Chew the bisacodyl tablet. D. Do not take the bisacodyl with an antacid.

Answer: D Rationale: Instruct patients to take oral bisacodyl no sooner than 1 hour after ingesting milk or antacids. Instruct patients to swallow the tablets intact, without crushing or chewing. Inform patients that bisacodyl suppositories may cause a burning sensation, and warn them that prolonged use can cause proctitis. Senna can cause the patient's urine to turn a harmless yellow-brown or pink.

A patient begins using timolol (Timoptic) to treat primary open-angle glaucoma (POAG). The nurse gives a dose and notes that the patient develops shortness of breath. The nurse assesses the patient and auscultates wheezes in both lungs. The nurse will ask this patient about a history of which condition? Asthma Atrioventricular heart block Pulmonary hypertension Sinus bradycardia

Asthma

antibiotic regimen

Clarithromycin, amoxicillin, bismuth, metronidazole, and tetracycline None is effective alone If these drugs are used alone, the risk of resistance developing increases

A teenage female patient has begun to develop acne and asks a nurse how to minimize pimple formation. What will the nurse recommend? Asking the provider about oral contraceptives Cleansing the face gently 2 to 3 times daily Eliminating greasy foods from the diet

Cleansing the face gently 2 to 3 times daily

A patient with hyperthyroidism is taking propylthiouracil (PTU). It is most important for the nurse to assess the patient for which adverse effects? Gingival hyperplasia and dysphagia Dyspnea and a dry cough Blurred vision and nystagmus Fever and sore throat

Fever and sore throat =signs of most dangerous toxicity, which is agranulocytosis Agranulocytosis= is a serious condition characterized by a dramatic reduction in circulating granulocytes, a type of WBC needed to fight infection

A patient with severe allergic conjunctivitis who has been using cromolyn ophthalmic drops for 2 days calls the nurse to report persistence of the symptoms. When the nurse explains that it takes several weeks for maximum benefit to occur, the patient asks if there is something else to use in the meantime. The nurse will suggest that the patient discuss which drug with the provider? An ophthalmic demulcent H1 -receptor antagonists Glucocorticoid drops Ocular decongestants

H1- receptor antagonists

What is ranitidine?

H2 receptor antagonist

Short term complications of diabetes

Hyperglycemia Hypoglycemia Ketoacidosis

Which insulins can we mix together?

NPH (Humalin N and novolin N) and short-acting

What is Lugol's solution?

Non-radioactive iodine -Used to suppress thyroid function in preparation for thyroidectomy

drugs to prevent ulcers

PPI and histamine blockers

A patient has been using latanoprost (Xalatan) ophthalmic drops. The patient tells the nurse, "My eyes used to be greenish-brown, but now they're brown." What will the nurse do? Reassure the patient that this is a harmless side effect. Report this toxic effect to the patient's provider. Tell the patient that this indicates an increased risk of migraine headaches. Tell the patient that this effect will reverse when the medication is withdrawn.

Reassure pt that this is a harmless side effect

What is glipizide? In what patients is it used for?

Sulfonylurea -its a anti-hyperglycemic drug (releases insulin and is used only in DM2)

What is Levothyroxine? What is another name for it?

Synthetic T4 -drug for hypothyroidism AKA: Synthroid

What should you measure to see the effectiveness of it?

TSH serum levels -if effective--> TSH levels will FALL

A child with eczema has been treated unsuccessfully with a topical glucocorticoid for a year and has skin atrophy and hypopigmentation. The nurse will suggest discussing which drug with the provider? Higher potency topical glucocorticoids Topical keratolytic agents Topical immunosuppressants Topical nonsteroidal anti-inflammatory drugs (NSAIDs

Topical immunosuppressants

An infant has a severe contact diaper dermatitis. The provider orders triamcinolone acetonide (Kenalog) 0.1% cream to be applied 3 times daily. When teaching the infant's parents about this medication, the nurse will instruct them to apply: a thick layer and massage the cream into the skin. a thin layer and leave the diaper open as much as possible the cream and place an occlusive dressing over the area. the cream and put the infant's diaper on tightly

a thin layer and leave the diaper open as much as possible

What is methimazole?

antithyroid drug - Suppresses synthesis of thyroid hormone

Adverse effect you should report to your doctor (signs of overdose)

chest pain (angina), tachycardia, nervousness, insomnia, heat intolerance, sweating

Discharge instructions

dilute it with juice to get rid of bad taste

What happens when beta blockers interact with insulin? Why?

increase risk for hypoglycemia Why? -They mask signs of hypoglycemia (which are stimulation of SNS) so pts are unaware they have it -Make insulin-induced hypoglycemia worse by preventing the body's natural couterregulatory response

What is Insulin glargine (short, intermediate, or long acting)

long acting insulin =gLARGine... large amount of time

effects of NSAIDS

may produce ulcers -inhibits biosynthesis of prostaglandins -which decreases submucosal blood flow, suppresses secretion of mucus and bicarbonate, and promotes secretion of gastric acid

which is only insulin that is cloudy?

nph

examples of stimulant laxatives

senna (Senekot) bisacodyl (Dulcolax)

interaction between synthroid and warfarin

warden's effects are enhanced -levothyoxine [sythroid] accelerates degradation of Vit. K-dependent clotting factors, which enhances the effects of warfarin (anticoagulant) ... must reduce dosage of warfarin