Exam 5 Q's - Patho
Diabetes Incipitus has several possible causes. What are they?
-neurogenic (lack of ADH), -nephrogenic (failure to respond to ADH by kidneys) -psychogenic (psychosomatic) -gestational (placenta destroys ADH)
what are the functions of the liver?
-secrete hormones -metabolism of nutrients -blood clotting -urea and bile synthesis -detoxification of hormones and drugs
1. The nurse working on a high-acuity medical-surgical unit is prioritizing care for four patients who were just admitted. Which patient should the nurse assess first? a. The NPO patient with a blood glucose level of 80 mg/dL who just received 20 units of 70/30 Novolin insulin b. The patient with a pulse of 58 beats per minute who is about to receive digoxin (Lanoxin) c. The patient with a blood pressure of 136/92 mm Hg who complains of having a headache d. The patient with an allergy to penicillin who is receiving an infusion of vancomycin (Vancocin)
A
6. When metronidazole (Flagyl) is a component of the H. pylori treatment regimen, the patient must be instructed to do what? a. Avoid any alcoholic beverages b. Avoid foods containing tyramine c. Take the drug on an empty stomach d. Take the drug with food
A
A 1-year-old child with cretinism has been receiving 8 mcg/kg/day of levothyroxine (Synthroid). The child comes to the clinic for a well-child check up. The nurse will expect the provider to: a. change the dose of levothyroxine to 6 mcg/kg/day. b. discontinue the drug if the child's physical and mental development is normal. c. increase the dose to accommodate the child's increased growth. d. stop the drug for 4 weeks and check the child's TSH level.
A
A nurse administers which medication to inhibit an enzyme that makes gastric acid in a patient who has a duodenal ulcer? a. Omeprazole [Prilosec] b. Famotidine [Pepcid] c. Misoprostol [Cytotec] d. Ranitidine [Zantac]
A
A nurse explains to a nursing student why opioid antidiarrheal medications are classified as drugs with little or no abuse potential. Which statement by the student indicates a need for further teaching? a. "Formulations for the treatment of diarrhea have very short half-lives." b. "Opioid antidiarrheal drugs contain other drugs with unpleasant side effects at higher doses." c. "Some opioid antidiarrheal drugs do not cross the blood-brain barrier." d. "Some opioid antidiarrheal medications are not water soluble and cannot be given parenterally."
A
A nurse instructs a female patient with peptic ulcer disease who is to start a treatment regimen that includes ranitidine [Zantac] and bismuth subsalicylate [Pepto-Bismol]. Which statement by the patient indicates that the teaching has been effective? a. "While I'm taking these medications, my bowel movements could look black." b. "I have a medicine at home to take when I start having some loose diarrhea stools." c. "I'm so glad that my allergies will be helped while I'm taking these medications." d. "I'll include more calcium and vitamin D in my diet to prevent osteoporosis."
A
A nurse teaches a nursing student about the differences between desmopressin (DDAVP) and vasopressin (Pitressin). Which statement by the student indicates a need for further teaching? a. "Desmopressin has a shorter duration of action than vasopressin." b. "Desmopressin is easier to administer than vasopressin." c. "Vasopressin can be used in cardiac resuscitation." d. "Vasopressin can cause serious adverse cardiovascular effects."
A
A nursing student is discussing with a nurse the plan of care for a patient about to undergo a third round of chemotherapy with cisplatin. Which statement by the nursing student about the treatment of CINV is correct? a. "Aprepitant (Emend) will be necessary to treat CINV caused by cisplatin." b. "Antiemetics are most effective if given just as the chemotherapy is finished." c. "Lorazepam probably would not be helpful for this patient." d. "This patient will need intravenous antiemetics for best effects."
A
A patient has been taking levothyroxine for several years and reports that "for the past 2 weeks, the drug doesn't seem to work as well as before." What will the nurse do? a. Ask the patient when the prescription was last refilled. b. Expect the patient to have an elevated temperature and tachycardia. c. Suggest that the patient begin taking calcium supplements. d. Tell the patient to try taking the medication with food.
A
A patient is diagnosed with peptic ulcer disease. The patient is otherwise healthy. The nurse learns that the patient does not smoke and that he drinks 1 or 2 glasses of wine with meals each week. The nurse anticipates that the provider will prescribe which drugs? a. Amoxicillin (Amoxil), clarithromycin, and omeprazole (Prilosec) b. Amoxicillin (Amoxil), metronidazole (Flagyl), and cimetidine (Tagamet) c. Clarithromycin, metronidazole (Flagyl), and omeprazole (Prilosec) d. Tetracycline, cimetidine (Tagamet), and lansoprazole (Prevacid)
A
A patient is having high-volume output from a new ileostomy. A nurse develops a plan that includes teaching the patient to take which antidiarrheal agent? a. Loperamide [Imodium] b. Alosetron [Lotronex] c. Bismuth subsalicylate [Pepto-Bismol] d. Paregoric (camphorated opium tincture)
A
A patient is hospitalized with head trauma after a motor vehicle accident. The nurse caring for the patient notes a marked increase in the output of pale, dilute urine. The nurse suspects which condition? a. Diabetes insipidus b. Diabetes mellitus c. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) d. Water intoxication
A
A patient is receiving desmopressin [DDAVP] for the treatment of diabetes insipidus. Which instruction is the priority for a nurse to give the patient? a. "Reduce your water intake to prevent water intoxication" b. "Rotate the nostril you use daily to prevent irritation." c. "Weigh yourself several times each week." d. "You'll quickly see the results of a lower urine amount."
A
A patient newly diagnosed with PUD reports taking low-dose aspirin (ASA) for prevention of cardiovascular disease. The nurse learns that the patient drinks 2 to 3 cups of coffee each day and has a glass of wine with dinner 3 or 4 nights per week. The patient eats three meals a day. The nurse will counsel this patient to: a. change the meal pattern to five or six smaller meals per day. b. discontinue taking aspirin, because it can irritate the stomach. c. stop drinking wine or any other alcoholic beverage. d. switch to a decaffeinated coffee and reduce the number of servings.
A
A patient who is in her first trimester of pregnancy asks the nurse to recommend nonpharmaceutical therapies for morning sickness. What will the nurse suggest? a. Avoiding fatty and spicy foods b. Consuming extra clear fluids c. Eating three meals daily d. Taking foods later in the day
A
A patient with acromegaly asks the nurse about treatments for this condition. What will the nurse tell the patient? a. Drugs are generally used after surgical and radiation therapies have been tried. b. Drug therapy is easy to administer. c. Drug therapy is inexpensive. d. Drug therapy is generally short term.
A
A patient with type 1 diabetes reports mixing NPH and regular insulin to allow for one injection. What should the nurse tell the patient? a. This is an acceptable practice. b. These two forms of insulin are not compatible and cannot be mixed. c. Mixing these two forms of insulin may increase the overall potency of the products. d. NPH insulin should only be mixed with insulin glargine.
A
A postoperative patient is scheduled to start taking a daily oral dose of bisacodyl [Dulcolax]. When does the nurse administer the medication? a. Just before bedtime b. Before the morning bath c. At the evening meal d. After ambulating
A
An adolescent patient recently attended a health fair and had a serum glucose test. The patient telephones the nurse and says, "My level was 125 mg/dL. Does that mean I have diabetes?" What is the nurse's most accurate response? a. "Unless you were fasting for longer than 8 hours, this does not necessarily mean you have diabetes." b. "At this level, you probably have diabetes. You will need an oral glucose tolerance test this week." c. "This level is conclusive evidence that you have diabetes." d. "This level is conclusive evidence that you do not have diabetes."
A
The nurse assesses a newly diagnosed patient for short-term complications of diabetes. What does this assessment include? a. Evaluation for hyperglycemia, hypoglycemia, and ketoacidosis b. Cranial nerve testing for peripheral neuropathy c. Pedal pulse palpation for arterial insufficiency d. Auscultation of the carotids for bruits associated with atherosclerosis
A
The nurse is providing education to a patient who has been prescribed both an antacid and ranitidine (Zantac). Which instruction should the nurse give the patient about taking the medications? a. "Take the antacid 1 hour after the ranitidine." b. "The antacid and ranitidine should be taken at the same time for better effect." c. "Take the antacid 15 minutes before the ranitidine." d. "Take the antacid 30 minutes after the ranitidine."
A
Which instruction should the nurse provide when teaching a patient to mix regular insulin and NPH insulin in the same syringe? a. "Draw up the clear regular insulin first, followed by the cloudy NPH insulin." b. "It is not necessary to rotate the NPH insulin vial when it is mixed with regular insulin." c. "The order of drawing up insulin does not matter as long as the insulin is refrigerated." d. "Rotate subcutaneous injection sites each day among the arm, thigh, and abdomen."
A
Which manifestations should a nurse investigate first when monitoring a patient who is taking levothyroxine [Synthroid]? a. tachycardia b. tremors c. insomnia d. irritability
A
Which statement is correct about the contrast between acarbose and miglitol? a. Miglitol has not been associated with hepatic dysfunction. b. With miglitol, sucrose can be used to treat hypoglycemia. c. Miglitol is less effective in African Americans. d. Miglitol has no gastrointestinal side effects.
A
A patient who has type 2 diabetes has a glycated hemoglobin A1c (HbA1c) of 10%. The nurse should make which change to the nursing care plan? a. Refer the patient to a diabetes educator because the result reflects poor glycemic control. b. Glycemic control is adequate; no changes are needed. c. Hypoglycemia is a risk; teach the patient the symptoms. d. Instruct the patient to limit activity and weekly exercise.
A (Glycated hemoglobin (HbA1c) is a measure of plasma glucose levels on average over the previous 2- to 3-month period. The target value is 6.5% or lower. If it is greater than 6.5%, a diabetes educator is an additional resource who can facilitate lifestyle, exercise, and medication changes.)
A patient is scheduled to start taking insulin glargine [Lantus]. On the care plan, a nurse should include which of these outcomes related to the therapeutic effects of the medication? a. Blood glucose control for 24 hours b. Mealtime coverage of blood glucose c. Less frequent blood glucose monitoring d. Peak effect achieved in 2 to 4 hours
A (Insulin glargine is administered as a once-daily subcutaneous injection for patients with type 1 diabetes. It is used for basal insulin coverage, not mealtime coverage. It has a prolonged duration, up to 24 hours, with no peaks. Blood glucose monitoring is still an essential component to achieve tight glycemic control.)
The patient reports that she had to switch pharmacies to save money. She noticed that her "thyroid pill" looks different. The nurse anticipates that the healthcare provider will order what? a. Thyroid stimulating hormone (TSH) b. Electrocardiogram (ECG) c. Beta human chorionic gonadotropin (hCG) test d. Creatinine level
A (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)
An adult patient in a physician's office reports severe diarrhea after returning from a trip to Mexico. Which medication might be prescribed for this patient? a. Ciprofloxacin [Cipro] 500 mg twice daily b. Sulfasalazine [Azulfidine] 500 mg daily c. Metoclopramide [Reglan] 10 mg three times daily 30 minutes before meals and at bedtime d. Ondansetron [Zofran] 8 mg three times daily
A (Traveler's diarrhea, when severe, can be treated with ciprofloxacin, levofloxacin, or norfloxacin. Sulfasalazine is indicated for the treatment of mild to moderate ulcerative colitis; it is not used for the treatment of infection. Oral metoclopramide, a prokinetic agent, is administered for the treatment of diabetic gastroparesis and suppression of gastroesophageal reflux. Ondansetron is used for the treatment of emesis related to chemotherapy, radiation, and anesthetic agents.)
A nurse administers metoclopramide [Reglan] to a patient who is having nausea and vomiting postoperatively. The nurse should expect which therapeutic action if the medication is having the desired result? a. Blocking of serotonin and dopamine receptors b. Inactivation of histaminergic (H1)receptors c. Activation of chloride channels in the intestine d. Reduced motility in the small intestine
A Metoclopramide works by blocking serotonin and dopamine receptors in the chemoreceptor trigger zone (CTZ) and by increasing motility in the small intestine. This action minimizes gastric distention and the accompanying stimulation of the vomiting center. Metoclopramide does not block H1 receptors or activate chloride channels in the intestine.
A teaching plan for a patient who is taking lispro [Humalog] should include which instruction by the nurse? a. "Inject this insulin with your first bite of food, because it is very fast acting." b. "The duration of action for this insulin is about 8 to 10 hours, so you'll need a snack." c. "This insulin needs to be mixed with regular insulin to enhance the effects." d. "To achieve tight glycemic control, this is the only type of insulin you'll need."
A (Lispro is a rapid-acting insulin and has an onset of 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)
Which medications are used in the treatment plan for chemotherapy-induced nausea and vomiting? Select all that apply. a. Lorazepam [Ativan] b. Meclizine [Antivert] c. Dolasetron [Anzemet] d. Loperamide [Imodium] e. Dexamethasone [Decadron]
A (Lorazepam, a benzodiazepine, is used in combination regimens to suppress CINV. Dolasetron and dexamethasone also are used in the treatment of CINV. Meclizine is most often used to treat motion sickness, and loperamide is used to treat diarrhea)
Before administering metformin [Glucophage], the nurse should notify the prescriber about which laboratory value? a. Creatinine (Cr) level of 2.1 mg/dL b. Hemoglobin (Hgb) level of 9.5 gm/dL c. Sodium (Na) level of 131 mEq/dL d. Platelet count of 120,000/mm3
A (Metformin can reach toxic levels in individuals with renal impairment, which is indicated by a rise in the serum creatinine level)
A nurse should associate which factors with the pathophysiology of peptic ulcer disease? Select all that apply. a. Poor submucosal gastric blood flow b. Presence of Zollinger-Ellison syndrome c. Reduced stomach production of bicarbonate d. Increased synthesis of prostaglandins e. Gastrointestinal (GI) tract colonized with Haemophilus influenzae
A, B, C
The nurse expects laxatives to be ordered for which of the following patients? Select all that apply. a. A patient with chronic pain b. A patient recovering from cardiac surgery c. A patient who recently delivered a child d. A patient with acute food poisoning e. A patient with no bowel sounds
A, B, C (Laxatives are used for correcting constipation associated with certain drugs, especially opioid analgesics, which would probably be used for chronic pain. By softening the stool, laxatives can reduce the painful elimination that can be associated with episiotomy and with hemorrhoids associated with child birth. In patients with cardiovascular diseases (eg, aneurysm, myocardial infarction, disease of the cerebral or cardiac vasculature), softening the stool decreases the amount of strain needed to defecate, thereby avoiding dangerous elevation of blood pressure.)
When assessing a patient who has Cushing's syndrome, a nurse associates which clinical manifestations with this disorder? Select all that apply. a. Osteoporosis b. Moon face c. Glycosuria d. Ketonuria e. Mood swings
A, B, C (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. Ketoacidosis does not occur)
The nurse is aware that laxatives are contraindicated in patients with which of the following? Select all that apply. a. Abdominal pain b. Diverticulitis c. Constipation d. Bowel obstruction e. Pregnancy
A, B, D
2. Which types of drugs are used to treat inflammatory bowel disease (IBD)? (Select all that apply.) a. Aminosalicylates b. Glucocorticoids c. Immunomodulators d. Opioid antidiarrheals e. Sulfonamide antibiotics
A,B,C
Which are indications for discontinuing growth hormone (GH) therapy in children with documented growth hormone deficiency? (Select all that apply.) a. Epiphyseal closure has begun. b. A satisfactory adult height has been achieved. c. Serum GH levels have been normal for 12 consecutive months. d. Normal serum growth hormone levels occur. e. The child no longer responds to the hormone.
A,B,E
Which behavior can be used to reduce symptoms of gastroesophageal reflux disease? (Select all that apply.) a. Avoiding late-night meals b. Consuming a glass of wine with meals c. Drinking soft drinks d. Losing weight e. Stopping smoking
A,E
12. The nurse prepares a patient with Graves' disease for radioactive iodine (131I) therapy. Which statement made by the patient best demonstrates understanding of 131I therapy? a. "I will have to isolate myself from my family for 1 week so that I don't expose them to radiation." b. "This drug will be taken up by the thyroid gland and will destroy the cells to reduce my hyperthyroidism." c. "This drug will help reduce my cold intolerance and weight gain." d. "I will need to take this drug on a daily basis for at least 1 year."
B
A nurse assesses a male patient who has developed gynecomastia while receiving treatment for peptic ulcers. Which medication from the patient's history should the nurse recognize as a contributing factor? a. Amoxicillin [Amoxil] b. Cimetidine [Tagamet] c. Metronidazole [Flagyl] d. Omeprazole [Prilosec]
B
A nurse caring for a patient notes that the patient has a temperature of 104° F and a heart rate of 110 beats per minute. The patient's skin is warm and moist, and the patient complains that the room is too warm. The patient appears nervous and has protuberant eyes. The nurse will contact the provider to discuss: a. cretinism. b. Graves' disease. c. myxedema. d. Plummer's disease.
B
A nurse is discussing the use of immunosuppressants for the treatment of inflammatory bowel disease (IBD) with a group of nursing students. Which statement by a student indicates understanding of the teaching? a. "Azathioprine (Imuran) helps induce rapid remission of IBD." b. "Cyclosporine (Sandimmune) can be used to induce remission of IBD." c. "Cyclosporine (Sandimmune) does not have serious adverse effects." d. "Methotrexate is used long term to maintain remission of IBD."
B
A nurse is educating the staff nurses about ketoacidosis. To evaluate the group's understanding, the nurse asks, "Which sign and symptoms would not be consistent with ketoacidosis?" The group gives which correct answer? a. Blood glucose level of 600 mg/dL b. Blood glucose level of 60 mg/dL c. Acidosis d. Ketones in the urine
B
A nurse is preparing to administer a dose of growth hormone and reconstitutes the medication. After adding the diluent, the nurse notices that the preparation is cloudy. What will the nurse do? a. Administer the drug as ordered. b. Discard the drug and prepare another dose. c. Notify the prescriber. d. Shake the drug to dissipate the particles.
B
A nurse is providing teaching to a nursing student about to care for a woman with irritable bowel syndrome with diarrhea (IBS-D) who is receiving alosetron (Lotronex). Which statement by the student indicates a need for further teaching? a. "I should evaluate the patient's abdomen for distension and bowel sounds." b. "Patients with diverticulitis and IBS-C may take this drug." c. "There are no known serious drug interactions with alosetron." d. "This drug is given only to women with severe IBS-D."
B
A nurse is teaching a patient who will begin taking methimazole (Tapazole) for Graves' disease about the medication. Which statement by the patient indicates understanding of the teaching? a. "Because of the risk for liver toxicity, I will need frequent liver function tests." b. "I should report a sore throat or fever to my provider if either occurs." c. "I will need a complete blood count every few months." d. "It is safe to get pregnant while taking this medication."
B
A nurse monitors a patient who has peptic ulcer disease and is taking antibacterial medications. If the treatment has been effective, the patient's breath test result should reveal the absence of what? a. Bicarbonate b. H. pylori c. Histamine2 d. Prostaglandins
B
A patient admitted to the hospital has a history of peptic ulcer disease. The patient takes ranitidine (Zantac) and sucralfate (Carafate). The patient tells the nurse that discomfort is usually controlled but that symptoms occasionally flare up. What will the nurse do? a. Ask the provider about ordering an endoscopic examination. b. Contact the provider to discuss serologic testing and an antibiotic. c. Contact the provider to discuss switching to a proton pump inhibitor. d. Counsel the patient to avoid beverages containing caffeine.
B
A patient going on a vacation cruise is prescribed a scopolamine transdermal patch for motion sickness. The nurse teaches the patient to recognize which side effect? a. Increased heart rate b. Dry mouth c. Irritability d. Urinary frequency
B
A patient has been taking docusate sodium [Colace] daily for 1 year. Which statement by the patient would indicate a complication associated with use of this drug? a. "My doctor says that I've developed colon polyps." b. "I only have a bowel movement when I take the medicine." c. "The dental hygienist said I was losing the enamel on my teeth." d. "I've noticed that I'm having tremors now in my left hand."
B
A patient is admitted to the hospital and will begin taking levothyroxine (Synthroid). The nurse learns that the patient also takes warfarin (Coumadin). The nurse will notify the provider to discuss _____ the _____ dose. a. reducing; levothyroxine b. reducing; warfarin c. increasing; levothyroxine d. increasing; warfarin
B
A patient is taking bismuth subsalicylate (Pepto-Bismol) to prevent diarrhea. The nurse performing an assessment notes that the patient's tongue is black. What will the nurse do? a. Assess further for signs of gastrointestinal (GI) bleeding. b. Reassure the patient that this is an expected side effect of this drug. c. Request an order for liver function tests to evaluate for hepatotoxicity. d. Withhold the drug, because this is a sign of bismuth overdose.
B
A patient who experiences motion sickness is about to go on a cruise. The prescriber orders transdermal scopolamine (Transderm Scop). The patient asks the nurse why an oral agent is not ordered. The nurse will explain that the transdermal preparation: a. can be applied as needed at the first sign of nausea. b. has less intense anticholinergic effects than the oral form. c. is less sedating than the oral preparation. d. provides direct effects, because it is placed close to the vestibular apparatus of the ear.
B
A pregnant patient who is taking ondansetron (Zofran) for morning sickness tells the nurse she is experiencing headache and dizziness. What will the nurse tell her? a. It is not safe to take this drug during pregnancy. b. These are common side effects of ondansetron. c. She should stop taking the ondansetron immediately. d. She should report these adverse effects to her provider.
B
Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) are products of which structure? a. Hypothalamus b. Anterior pituitary gland c. Posterior pituitary gland d. Ovaries
B
The nurse is caring for a pregnant patient recently diagnosed with hypothyroidism. The patient tells the nurse she does not want to take medications while she is pregnant. What will the nurse explain to this patient? a. Hypothyroidism is a normal effect of pregnancy and usually is of no consequence. b. Neuropsychologic deficits in the fetus can occur if the condition is not treated. c. No danger to the fetus exists until the third trimester. d. Treatment is required only if the patient is experiencing symptoms.
B
The nurse is providing education to a patient with ulcerative colitis who is being treated with sulfasalazine (Azulfidine). What statement by the patient best demonstrates understanding of the action of sulfasalazine? a. "It treats the infection that triggers the condition." b. "It reduces the inflammation." c. "It enhances the immune response." d. "It increases the reabsorption of fluid."
B
Which finding in a patient taking levothyroxine [Synthroid] and warfarin [Coumadin] would require follow-up by a nurse? a. Cardiac dysrhythmias b. Excessive bruising c. Weight loss of 5 kg d. Shortness of breath
B
Which manifestation would the nurse most clearly associate with a tumor of the hypothalamus? a. Mood swings b. Unstable body temperature c. Irregular respirations d. Increased heart rate
B
The nurse reviews the patient's medication record and notes the following: sucralfate [Carafate] 1 gram orally four times daily before meals (7:30 AM, 11:30 AM, and 4:30 PM) and at bedtime (10:00 PM); phenytoin [Dilantin] 200 mg orally daily at 8 AM. Which modifications, if any, should be made to the medication regimen? a. The medications can be administered as ordered. b. The nurse should obtain a prescriber order to administer the phenytoin at 9:30 AM daily. c. The nurse should obtain a prescriber order for intravenous phenytoin to avoid a drug interaction. d. The nurse should administer the phenytoin with the 7:30 AM dose of sucralfate [Carafate], because this is more time efficient.
B (Sucralfate can impede the absorption of phenytoin; therefore, a period of 2 hours should separate these drugs)
Instruction by the nurse regarding alcohol abstinence is essential when a patient will be discharged taking which medication? a. Tetracycline b. Metronidazole c. Bismuth subsalicylate d. Clarithromycin
B (A disulfiram-like reaction can occur if metronidazole is used with alcohol; therefore, alcohol must be avoided during treatment with this drug. Although the use of alcohol is not promoted in patients who take the other medications, it does not create an adverse reaction)
The nurse prepares to administer a bisacodyl suppository to a patient who has not had a bowel movement in several days. When should the nurse administer the PRN medication? a. In the morning, before breakfast b. In the morning, after breakfast c. In the afternoon, before lunch d. In the evening, before bed
B (Bisacodyl suppositories act rapidly (in 15 to 60 minutes). They can be given at any time, but for patient convenience, they should not be given at bed time so as to avoid disrupting sleep. For convenience and patient ease, a fast acting laxative should not be given before a meal, which could cause the urge to have a bowel movement during the meal.)
A nurse is caring for a patient with decreased triiodothyronine (T3) and thyroxine (T4) and elevated thyroid-stimulating hormone (TSH) levels. The nurse knows the patient is likely suffering from what? a. Thyrotoxicosis b. Hypothyroidism c. Hyperthyroidism d. Graves' disease
B (The anterior pituitary increases production of TSH when thyroid hormone levels of T3 and T4, 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)
What are the effects of prolactin secretion in males? (Select all that apply.) a. Breast development b. Decreased libido c. Delayed puberty d. Galactorrhea e. Infertility
B,C,D
Which patients would be candidates for the use of dronabinol (Marinol) to treat nausea and vomiting? (Select all that apply.) a. A patient with a history of a psychiatric disorder b. A patient with acquired immunodeficiency syndrome (AIDS)-induced anorexia c. A patient with chemotherapy-induced nausea and vomiting d. A patient with nausea who has used marijuana in the past e. A patient with postoperative nausea and vomiting
B,C,D
A patient newly diagnosed with diabetes expresses concern about losing her vision. Which interventions should be included in the plan of care to reduce this risk? (Select all that apply.) a. Initiation of reliable contraception to prevent pregnancy b. Ways to reduce hyperglycemic episodes c. Use of a prokinetic drug (e.g., metoclopramide) d. Smoking cessation e. Emphasis on the importance of taking antihypertensive drugs consistently
B,D,E
A nurse counsels a patient with diabetes who is starting therapy with an alpha-glucosidase inhibitor. The patient should be educated about the potential for which adverse reactions? (Select all that apply.) a. Hypoglycemia b. Flatulence c. Elevated iron levels in the blood d. Fluid retention e. Diarrhea
B,E
A 30-year-old male patient will begin a three-drug regimen to treat peptic ulcer disease. The regimen will consist of bismuth subsalicylate, tetracycline, and cimetidine (Tagamet). The nurse will include which information when teaching this patient about this drug regimen? a. Black discoloration of the tongue and stools should be reported immediately. b. Central nervous system depression and confusion are likely to occur. c. Decreased libido, impotence, and gynecomastia are reversible side effects. d. Staining of the teeth may occur and is an indication for discontinuation of these drugs.
C
A nurse caring for a patient who is undergoing a third round of chemotherapy is preparing to administer ondansetron (Zofran) 30 minutes before initiation of the chemotherapy. The patient tells the nurse that the ondansetron did not work as well the last time as it had the first time. What will the nurse do? a. Administer the ondansetron at the same time as the chemotherapy. b. Contact the provider to suggest using high-dose intravenous dolasetron (Anzemet). c. Request an order to administer dexamethasone with the ondansetron. d. Suggest to the provider that loperamide (Lomotil) be given with the ondansetron.
C
A nurse is admitting a patient to the hospital who reports having recurrent, crampy abdominal pain followed by diarrhea. The patient tells the nurse that the diarrhea usually relieves the pain and that these symptoms have occurred daily for the past 6 months. The patient undergoes a colonoscopy, for which the findings are normal. The nurse will plan to teach this patient to: a. use antispasmodic medications. b. avoid food containing lactose and gluten. c. keep a food, stress, and symptom diary. d. use antidiarrheal drugs to manage symptoms.
C
A nurse is providing teaching for a nondiabetic adult who develops growth hormone deficiency and who will begin treatment with somatropin (Humatrope). Which statement by the patient indicates understanding of the teaching? a. "Intramuscular dosing is more effective than subcutaneous dosing." b. "I will have increased muscle mass and strength as well as increased height." c. "I will need to monitor my blood pressure frequently while taking this drug." d. "I will need to take insulin while using this, because it causes hyperglycemia."
C
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? a. Respiratory rate b. Blood pH c. Blood pressure d. Body temperature
C
A patient in her twenties with Graves' disease who takes methimazole (Tapazole) tells a nurse that she is trying to conceive and asks about disease management during pregnancy. What will the nurse tell her? a. Methimazole is safe to take throughout pregnancy. b. Propylthiouracil should be taken throughout her pregnancy. c. The patient should discuss changing to propylthiouracil from now until her second trimester with her provider. d. The patient should discuss therapy with iodine-131 instead of medications with her provider.
C
A patient is being treated for chemotherapy-induced nausea and vomiting (CINV) with ondansetron (Zofran) and dexamethasone. The patient reports getting relief during and immediately after chemotherapy but has significant nausea and vomiting several days after each chemotherapy treatment. What will the nurse do? a. Contact the provider to discuss increasing the dose of ondansetron. b. Suggest giving prolonged doses of dexamethasone. c. Suggest adding aprepitant (Emend) to the medication regimen. d. Tell the patient to ask the provider about changing the ondansetron to aprepitant.
C
A patient is diagnosed with Zollinger-Ellison syndrome. Which medication does the nurse expect the provider to order for this patient? a. Cimetidine (Tagamet) b. Esomeprazole (Nexium) c. Ranitidine (Zantac) d. Sucralfate (Carafate)
C
A patient is receiving intravenous promethazine (Phenergan) 25 mg for postoperative nausea and vomiting. What is an important nursing action when giving this drug? a. Giving the dose as an IV push over 3 to 5 minutes b. Infusing the dose with microbore tubing and an infusion pump c. Observing the IV insertion site frequently for patency d. Telling the patient to report dry mouth and sedation
C
A patient is taking fludrocortisone [Florinef]. A nurse should recognize that the patient is at risk for developing an electrolyte imbalance if the patient reports which symptom? a. Syncope b. Weight loss c. Muscle weakness d. Numbness and tingling
C
A patient who takes nonsteroidal anti-inflammatory drugs (NSAIDs) for arthritis asks a nurse what can be done to prevent ulcers. The nurse will recommend asking the provider about using which medication? a. Antacids b. Antibiotics c. Antisecretory agents d. Mucosal protectants
C
A patient who took NPH insulin at 0800 reports feeling weak and tremulous at 1700. Which action should the nurse take? a. Take the patient's blood pressure. b. Give the patient's PRN dose of insulin. c. Check the patient's capillary blood sugar. d. Advise the patient to lie down with the legs elevated.
C
A patient with Crohn's disease will begin receiving an initial infusion of infliximab (Remicade). The nurse explains how this drug works to treat this disease. Which statement by the patient indicates a need for further teaching? a. "I may have an increased risk of infections, such as tuberculosis, when taking infliximab." b. "I should report chills, fever, itching, and shortness of breath while receiving the infusion." c. "This drug sometimes provides a complete cure of inflammatory bowel disease." d. "I will take the second dose in 2 weeks, the third dose in 6 weeks, and then a dose every 8 weeks thereafter."
C
A patient with hypothyroidism begins taking PO levothyroxine (Synthroid). The nurse assesses the patient at the beginning of the shift and notes a heart rate of 62 beats per minute and a temperature of 97.2° F. The patient is lethargic and difficult to arouse. The nurse will contact the provider to request an order for which drug? a. Beta blocker b. Increased dose of PO levothyroxine c. Intravenous levothyroxine d. Methimazole (Tapazole)
C
A patient with renal impairment requires bowel cleansing before a diagnostic procedure. The nurse prepares to administer which laxative? a. Mineral oil b. Polyethylene glycol-electrolyte solution [GoLYTELY] c. Magnesium salts (magnesium citrate) d. Docusate sodium [Colace]
C
A patient with type 1 diabetes recently became pregnant. The nurse plans a blood glucose testing schedule for her. What is the recommended monitoring schedule? a. Before each meal and before bed b. In the morning for a fasting level and at 4 PM for the peak level c. Six or seven times a day d. Three times a day, along with urine glucose testing
C
An older adult patient with severe gastroesophageal reflux disease (GERD) has had only minimal relief using a histamine2-receptor antagonist (H2RA). The patient is to begin taking omeprazole (Prilosec). What will the nurse teach this patient? a. A complete cure is expected with this medication. b. Lifestyle changes can be as effective as medication therapy. c. Long-term therapy may be needed. d. The medication will be used until surgery can be performed.
C
Insulin glargine is prescribed for a hospitalized patient who is diabetic. When will the nurse administer this drug? a. Approximately 15 to 30 minutes before each meal b. In the morning and at 4 PM c. Once daily at bedtime d. After meals and at bedtime
C
Which instruction should the nurse give a patient who is to take bismuth subsalicylate for eradication of H. pylori? a. "Nausea and diarrhea are common side effects." b. "Do not drink alcohol while taking this medication." c. "The drug can cause your bowel movements to be black." d. "Take the medication through a straw to prevent staining of your teeth."
C
Which nursing diagnosis should be the priority for a patient who is receiving desmopressin [DDAVP]? a. Activity intolerance b. Alteration in comfort c. Fluid volume imbalance d. Deficient knowledge
C
A patient is taking glipizide [Glucotrol] and a beta-adrenergic medication. A nurse is teaching hypoglycemia awareness and should warn the patient about the absence of which symptom? a. Vomiting b. Muscle cramps c. Tachycardia d. Chills
C (Glipizide is a sulfonylurea oral hypoglycemic medication that acts to promote insulin release from the pancreas. Beta-adrenergic blockers can mask early signs of sympathetic system responses to hypoglycemia; the most important of these is tachycardia, which is the most common adverse effect of glipizide)
A patient who has peptic ulcer disease and is receiving magnesium hydroxide (milk of magnesia) is experiencing an increased number of bowel movements. Which is the nurse's priority action? a. Ask the healthcare provider for a reduction in dose. b. Encourage the patient to increase dietary fiber. c. Administer the drug with an aluminum hydroxide antacid. d. Instruct the patient to keep an accurate stool count.
C (Magnesium hydroxide is a rapid-acting antacid with a prominent adverse effect of diarrhea. To compensate, it usually is administered in combination with aluminum hydroxide, which promotes constipation)
An 80-year-old patient with a history of renal insufficiency recently was started on cimetidine. Which assessment finding indicates that the patient may be experiencing an adverse effect of the medication? a. +3 pitting edema b. Pain with urination c. New onset of disorientation to time and place d. Heart rate changes from a baseline of e. 70 to 80 beats per minute (bpm) to 110 to 120 bpm
C (Effects on the central nervous system are most likely to occur in elderly patients who have renal or hepatic impairment. Patients may experience confusion, hallucinations, lethargy, restlessness, and seizure)
A nurse should consider which diagnostic test a priority to obtain before a patient receives iodine-131? a. White blood cell (WBC) count b. Electrocardiogram (ECG) c. Beta human chorionic gonadotropin (hCG) test d. Creatinine level
C (contraindicated in pregnancy or lactation)
A 7-year-old child who is otherwise healthy is receiving mecasermin (Increlex) replacement therapy to treat severe primary deficiency of insulin-like growth factor-1 (IGF-1). The child develops tonsillar hypertrophy. The nurse anticipates that the provider will recommend: a. antibiotics. b. reducing the dose of mecasermin. c. discontinuing the mecasermin. d. tonsillectomy.
D
A child with Prader-Willi syndrome (PWS) has short stature, and the provider is considering treatment with growth hormone. Which aspect of this child's history should the nurse report to the provider? a. Behavior problems b. Low muscle tone c. Mental impairment d. Sleep apnea
D
A nurse is caring for a patient with cancer who has been undergoing chemotherapy. The patient has oral mucositis as a result of the chemotherapy, and the provider has ordered palifermin (Kepivance). Which is an appropriate nursing action when giving this drug? a. Administering the drug as a slow IV infusion b. Flushing the IV line with heparin before infusing the drug c. Giving the drug within 6 hours of the chemotherapy d. Warning the patient about the potential for distortion of taste
D
A nurse is planning care for a patient who has peptic ulcer disease and is taking amoxicillin [Amoxil]. The nurse is aware that the action of this medication is which of the following? a. Inhibition of an enzyme to block acid secretion b. Coating of the ulcer crater as a barrier to acid c. Selective blockade of parietal cell histamine2 receptors d. Disruption of the bacterial cell wall, causing lysis and death
D
A nurse is teaching a patient who has been diagnosed with hypothyroidism about levothyroxine (Synthroid). Which statement by the patient indicates a need for further teaching? a. "I should not take heartburn medication without consulting my provider." b. "I should report insomnia, tremors, and an increased heart rate to my provider." c. "If I take a multivitamin with iron, I should take it 4 hours after the Synthroid." d. "If I take calcium supplements, I may need to decrease my dose of Synthroid."
D
A nurse obtaining an admission history on an adult patient notes that the patient has a heart rate of 62 beats per minute, a blood pressure of 105/62 mm Hg, and a temperature of 96.2° F. The patient appears pale and complains of always feeling cold and tired. The nurse will contact the provider to discuss tests for which condition? a. Cretinism b. Graves' disease c. Hypothyroidism d. Plummer's disease
D
A nurse provides dietary counseling for a patient newly diagnosed with type 1 diabetes. Which instruction should be included? a. "You may eat any foods you want and cover the glucose increase with sliding scale, regular insulin." b. "Most of the calories you eat should be in the form of protein to promote fat breakdown and preserve muscle mass." c. "Your total caloric intake should not exceed 1800 calories in a 24-hour period." d. "Most of your calories should be in the form of carbohydrates and monounsaturated fats."
D
A nursing student is caring for a patient who is taking sucralfate (Carafate) and ciprofloxacin (Cipro) to treat peptic ulcer disease. The student asks the nurse about the pharmacokinetics of sucralfate. Which statement by the student indicates a need for further teaching? a. "Sucralfate adheres to the ulcer and blocks the back-diffusion of hydrogen ions." b. "Sucralfate and ciprofloxacin should be administered 1 hour apart." c. "Sucralfate does not cause systemic side effects." d. "Sucralfate has a moderate acid-neutralizing capacity."
D
A patient arrives in the emergency department with a heart rate of 128 beats per minute and a temperature of 105° F. The patient's skin feels hot and moist. The free T4 level is 4 ng/dL, the free T3 level is 685 pg/dL, and the TSH level is 0.1 microunits/mL. The nurse caring for this patient will expect to administer: a. intravenous levothyroxine. b. iodine-131 (131I). c. methimazole (Tapazole). d. propylthiouracil (PTU).
D
A patient has a free T4 level of 0.6 ng/dL and a free T3 of 220 pg/dL. The patient asks the nurse what these laboratory values mean. How will the nurse respond? a. "These laboratory values indicate that you may have Graves' disease." b. "These results suggest you may have hyperthyroidism." c. "We will need to obtain a total T4 and a total T3 to tell for sure." d. "We will need to obtain a TSH level to better evaluate your diagnosis."
D
A patient is preparing to travel to perform missionary work in a region with poor drinking water. The provider gives the patient a prescription for ciprofloxacin (Cipro) to take on the trip. What will the nurse instruct this patient to do? a. Combine the antibiotic with an antidiarrheal medication, such as loperamide. b. Start taking the ciprofloxacin 1 week before traveling. c. Take 1 tablet of ciprofloxacin with each meal for best results. d. Use the drug if symptoms are severe or do not improve in a few days.
D
A patient stops taking a proton pump inhibitor (PPI) after 6 weeks of therapy for treatment of peptic ulcer disease. The patient reports symptoms of dyspepsia to the nurse. The nurse will tell this patient to: a. come to the clinic to be tested for Clostridium difficile. b. resume taking the PPI, because long-term therapy is necessary. c. resume taking the PPI until symptoms resolve completely. d. try an antacid to see whether it relieves these symptoms.
D
A patient with antidiuretic hormone deficiency is receiving desmopressin (DDAVP). The nurse will teach this patient to: a. avoid grapefruit juice. b. increase sodium intake. c. monitor blood pressure. d. reduce fluid intake.
D
A patient with gastroesophageal reflux disease (GERD) is to begin taking oral metoclopramide (Reglan). The patient asks the nurse about the medication. Which response by the nurse is correct? a. "After 3 months, if the drug is not effective, you may need to increase the dose." b. "Metoclopramide may cause hiccups, especially after meals." c. "Serious side effects may occur but will stop when the drug is discontinued." d. "You should take the drug 30 minutes before each meal and at bedtime."
D
A patient with type 1 diabetes is eating breakfast at 7:30 AM. Blood sugars are on a sliding scale and are ordered before a meal and at bedtime. The patient's blood sugar level is 317 mg/dL. Which formulation of insulin should the nurse prepare to administer? a. No insulin should be administered. b. NPH c. 70/30 mix d. Lispro (Humalog)
D
A patient with type 1 diabetes who takes insulin reports taking propranolol for hypertension. Why is the nurse concerned? a. The beta blocker can cause insulin resistance. b. Using the two agents together increases the risk of ketoacidosis. c. Propranolol increases insulin requirements because of receptor blocking. d. The beta blocker can mask the symptoms of hypoglycemia.
D
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? a. Blood glucose below 70 mg/dL b. Elevation of liver function test results c. Atrophy of sweat glands d. Enlarged heart on chest x-ray
D
An older adult patient is diagnosed with hypothyroidism. The initial free T4 level is 0.5 mg/dL, and the TSH level is 8 microunits/mL. The prescriber orders levothyroxine (Levothroid) 100 mcg/day PO. What will the nurse do? a. Administer the medication as ordered. b. Contact the provider to discuss giving the levothyroxine IV. c. Request an order to give desiccated thyroid (Armour Thyroid). d. Suggest that the provider lower the dose.
D
The nurse is caring for a patient receiving desmopressin (Stimate). The nurse is performing a physical assessment and notes that the patient is drowsy and listless and complains of a recent onset of headache. Which finding would be most consistent with these symptoms? a. Hyperglycemia b. Hypernatremia c. Hypertension d. Water intoxication
D
What is the most reliable measure for assessing diabetes control over the preceding 3-month period? a. Self-monitoring blood glucose (SMBG) graph report b. Patient's report c. Fasting blood glucose level d. Glycosylated hemoglobin level
D
Which statement is accurate about the long-term complications of diabetes? a. Long-term complications are almost always the result of hypoglycemia and ketoacidosis. b. The complication rates for patients with tightly controlled type 2 diabetes are the same as for those whose disease is not tightly controlled. c. Tightly controlling type 1 diabetes produces excessive episodes of life-threatening hypoglycemia. d. Tightly controlling both types of diabetes reduces the risk of eye, kidney, and nerve damage.
D
A patient who has diabetes insipidus is receiving desmopressin [DDAVP]. Which laboratory test should a nurse obtain to evaluate the effectiveness of the medication? a. Urine ketones b. Blood urea nitrogen (BUN) c. Creatinine d. Urine specific gravity
D (Diabetes insipidus is characterized by a decrease in the urine specific gravity because of the excretion of large volumes of dilute urine)
A nurse is planning care for a patient undergoing chemotherapy. The care plan includes medications to reduce chemotherapy-induced nausea and vomiting (CINV). Which regimen should the nurse recognize as effective? a. Scopolamine [Transderm Scop] and lorazepam [Ativan] b. Prochlorperazine [Compazine] and diphenhydramine [Benadryl] c. Ondansetron [Zofran] and dimenhydrinate [Dramamine] d. Aprepitant [Emend] and ondansetron [Zofran]
D (Regimens for preventing CINV may include medications such as a serotonin receptor antagonist (ondansetron); the substance P/neurokinin1 antagonist aprepitant; and a benzodiazepine (lorazepam). Scopolamine and dimenhydrinate are indicated for motion sickness, not CINV; diphenhydramine is an antihistamine indicated for allergic reactions)
A patient newly diagnosed with type 1 diabetes asks a nurse, "How does insulin normally work in my body?" The nurse explains that normal insulin has which action in the body? a. It stimulates the pancreas to reabsorb glucose. b. It promotes the synthesis of amino acids into glucose. c. It stimulates the liver to convert glycogen to glucose. d. It promotes the passage of glucose into cells for energy.
D (The hormone insulin promotes the passage of glucose into cells, where it is metabolized for energy)
Aggressive factors for ulcers are:
H pylori, NSAIDS, Pepsin, Smoking, Caffeine, ETOH, stress
Cimetidine (Tagamet), Famotidine (Pepsid), Nizatidine (Axid) , Rantidine (Zantac) are examples of?
H2 antagonist
This organ exerts control over the anterior pituitary by Releasing or inhibiting hormones:
Hypothalamus
Which drug is used to slow gastric emptying and suppress glucagon secretion?
Incretin ex. Byetta, Januvia, Onglyza
Which drug is used to decrease ammonia levels
Lactulose
Which drugs are used to treat ascites caused by cirrhosis?
Lasix and Spironolactone
What is an example of an intermediate acting insulin?
Neutral protamine Hagedorn (NPH)
Tests for measuring thyroid function are ___,____,_____?
T3,T4,TSH, anti-thyroid antibody titer, RAIU
Synthroid is a synthetic preparation of _________?
T4 (thyroxine) converts to T3 (Takes one month to reach plateau)
Metabolic syndrome includes:
abdominal obesity, elevated triglycerides, blood pressure, fasting blood glucose
Treatment for ulcers includes:
antibiotics, antisecretory agents, mucosal protectants, antacids
Symptoms of liver failure include:
bleeding, edema, spider nevi, asterixis, increased ammonia levels, hepatic encephalopathy, jaundice
Glucagon is secreted by ____ Glucose levels?
decreased (alpha cells)
______ has a dual blood supply
liver
The vomiting center is located in the:
medulla
The response of a target cell to the hormone Varies on ___and____?
number of receptors on a cell and the ph of body fluids can affect the affinity of receptors.
Scopolamine is a muscarinic antagonist used to:
suppress nerve impulses from inner ear to vomiting center
Peripheral neuropathy is caused by:
thickening of the walls of the vessels supplying the nerve and demyelination of Schwann cell