NURS 167 - Exam 3 Review

The nurse is caring for a patient who is receiving octreotide and notes that the patient has a long QT interval on the electrocardiogram. Which drug may this patient be taking in addition to octreotide? 1 Cyclosporine 2 Ciprofloxacin 3 Demeclocycline 4 Carbamazepine

2 Ciprofloxacin

Type 1 DM

Insulin-Dependent Usually a rapid onset; seen in younger people Connected in many cases to viral destruction of the beta cells of the pancreas

The nurse is providing education to a patient about the time to take gliburide . For maximum benefit, the nurse will tell the patient to administer glipizide at which time? A. In the morning B. 30 minutes before a meal C. 15 minutes postprandial D. At bedtime

B. 30 minutes before a meal

The nurse will advise the patient to treat hypoglycemia with which drug? A. propranolol B. glucagon C. acarbose D. Bumetanide

B. glucagon

A patient is receiving vasopressin. Which symptoms warrant immediate notification of the primary health care provider? Select all that apply. 1 Diarrhea 2 Pale skin 3 Yellow eyes 4 Hypertension 5 Abdominal cramping

1 Diarrhea 4 Hypertension 5 Abdominal cramping

The nurse is assessing an older adult who has asthma and has been prescribed an inhaled corticosteroid. Which information would the nurse teach the patient to prevent oral candidiasis? 1 "Rinse your mouth after inhaling the medication." 2 "Do not drink water immediately after inhalation." 3 "Minimize the use of the inhaler to every other day." 4 "Report any throat irritation to the primary health care provider."

1 "Rinse your mouth after inhaling the medication." Use of inhaled glucocorticoids may lead to fungal infections (candidiasis) of the oral mucosa and oral cavity, larynx, and pharynx. Therefore the patient must rinse the mouth and oral mucous membranes with lukewarm water after inhaling the medication to help to prevent fungal overgrowth and further complications. Drinking water immediately after inhalation may increase the risk of side effects because it may cause the medicine to enter into the bloodstream. Minimizing the use of an inhaler to every other day is not helpful in the prevention of oral candidiasis, and the less frequent dosing may exacerbate asthma. Hoarseness, throat irritation, and dry mouth are also possible side effects associated with the use of inhaled glucocorticoids, but reporting these does not decrease the risk or prevent oral candidiasis.

A patient is prescribed nateglinide for the treatment of type 2 diabetes. On assessment, the nurse finds that the patient has erratic eating habits. Which instruction is correct for this patient? 1 "Skip the dose when you skip a meal." 2 "You need to change your eating habits." 3 "Take a dose before bedtime every night." 4 "You need to eat three to four meals every day."

1 "Skip the dose when you skip a meal." The nurse advises the patient to skip the dose of nateglinide if he or she misses a meal, to prevent hypoglycemia. The patient may not change eating habits, and therefore, instructing the patient to do so may not be effective in this case. The nateglinide dose is taken only when the patient is planning to consume a meal. Asking the patient to eat three to four meals a day will not be effective in a patient who has erratic eating habits.

Which statement describes what the nurse would teach a patient who has a first-time prescription for the antithyroid drug propylthiouracil? Select all that apply. 1 "You need to be aware of the manifestations of hypothyroidism." 2 "Take the medication along with a meal to prevent stomach upset." 3 "You need to avoid eating salt, shellfish, and foods high in iodine." 4 "This drug is given to raise the thyroid hormone levels in your blood." 5 "Take the medication daily on an empty stomach to reduce liver damage."

1 "You need to be aware of the manifestations of hypothyroidism." 2 "Take the medication along with a meal to prevent stomach upset." 3 "You need to avoid eating salt, shellfish, and foods high in iodine." Propylthiouracil is a thioamide antithyroid drug that is indicated in hyperthyroidism. Propylthiouracil has to be administered for at least 2 weeks so that the manifesting symptoms improve. The patient should be aware of the manifestations of hypothyroidism and should notify the primary health care provider if symptoms occur. Taking the medication after meals reduces stomach upset and increases the absorption of the drug. Consumption of iodized salt, shellfish, or other foods high in iodine causes exacerbation of the symptoms of hyperthyroidism, so the patient should be instructed to avoid such foods. Taking the medication on an empty stomach increases stomach upset and does not prevent liver damage.

Which instruction will the nurse give a patient who is prescribed repaglinide for type 2 diabetes to do? 1 "You need to eat a meal before each dose." 2 "You can take sulfonylureas with repaglinide." 3 "You can skip one dose if you eat three meals." 4 "Skipping two doses will cause hypoglycemia."

1 "You need to eat a meal before each dose." The nurse instructs the patient to eat a meal before each dose of repaglinide because skipping a meal can cause hypoglycemia. Repaglinide is not combined with sulfonylureas because they share a similar mechanism of action. The dose must be taken before each meal and skipping either the meal or the dose will fluctuate the glucose levels in the body. Skipping two doses of repaglinide will cause hyperglycemia in the patient because glucose levels will increase.

The nurse is caring for a patient who has salt-losing adrenogenital syndrome. Which prescription would the nurse expect to find in the patient's treatment regimen? 1 0.1 mg of oral fludrocortisone 2 0.75 mg of oral betamethasone 3 0.2 mg of intravenous prednisone 4 0.5 mg of intravenous methylprednisolone

1 0.1 mg of oral fludrocortisone Oral fludrocortisone, in a dose of 0.1 mg, is the only adrenal drug used in patients with salt-losing adrenogenital syndrome. Oral betamethasone is the drug of choice for patients in premature labor to accelerate fetal lung maturation. Intravenous prednisone is used to treat exacerbations of chronic respiratory illnesses such as asthma and chronic bronchitis. Intravenous methylprednisolone is used primarily as an antiinflammatory drug and is not used in salt-losing adrenogenital syndrome.

Which patient may receive insulin lispro? 1 A patient with type 2 diabetes mellitus who takes metformin 2 A patient with type 2 diabetes mellitus who is taking glipizide 3 A breastfeeding mother who is at high risk for developing diabetes mellitus 4 A 2-year-old child who was recently diagnosed with type 1 diabetes mellitus

1 A patient with type 2 diabetes mellitus who takes metformin Insulin lispro is used for patients with diabetes because it acts like endogenous insulin in response to a meal. Insulin lispro can be administered to a patient who takes metformin for type 2 diabetes mellitus because it has no interaction. The patient needs to stop glipizide in order to start insulin therapy to avoid any interaction. Insulin is excreted into human milk. It is very important that insulin therapy and diet be well controlled for a nursing mother because inadequate or excessive glycemic control may reduce milk production. Insulin lispro cannot be used in children below the age of 3 years for safety reasons.

Which process is characterized by destruction of the thyroid gland? 1 Ablation 2 Desiccation 3 Thyroid storm 4 Thyroidectomy

1 Ablation Destroying the thyroid gland by using radioactive iodine is called ablation. Desiccation is the drying process to prepare the thyroid. Exacerbation of hyperthyroidism symptoms is known as thyroid storm. Thyroidectomy is the surgical resection of the thyroid gland.

The nurse would question a prescription for an antiadrenal drug for a patient who has been diagnosed with which condition? 1 Addison's disease 2 Adrenal malignancy 3 Cushing's syndrome 4 Metastatic breast cancer

1 Addison's disease Antiadrenal drugs suppress the adrenal cortex. Addison's disease presents with decreased adrenal secretion; thus the nurse would not want to exacerbate this by administering an antiadrenal drug. These drugs are indicated for adrenal malignancy, Cushing's syndrome, and metastatic breast cancer.

Which adrenal medication is the drug of choice to accelerate fetal lung maturation in premature neonates? 1 Betamethasone 2 Fludrocortisone 3 Aminoglutethimide 4 Methylprednisolone

1 Betamethasone Betamethasone accelerates fetal lung maturation in premature neonates. Fludrocortisone is the most commonly prescribed mineralocorticoid used to treat Addison's disease. Aminoglutethimide is used in the treatment of Cushing's syndrome and is available only in oral form. Methylprednisolone is the preferred oral glucocorticoid for antiinflammatory or immunosuppressant purposes.

A patient with primary hypothyroidism receives levothyroxine and regular insulin. Which finding does the nurse monitor in the patient to help prevent complications of the pharmacotherapy? 1 Blood glucose 2 Heat intolerance 3 Fatigue and edema 4 Anxiety and warmth

1 Blood glucose The nurse would assess a patient who receives levothyroxine and insulin for clinical indicators of hyperglycemia because the combination therapy decreases the effectiveness of insulin. Because the insulin is less effective when administered with levothyroxine, the patient's blood sugar is likely to increase with levothyroxine therapy, or more insulin will be required to maintain a steady serum glucose level. Heat intolerance is a clinical indicator of hyperthyroidism. Fatigue and edema are signs of hypothyroidism. Anxiety and warmth are clinical indicators of hypoglycemia.

Which condition is a contraindication to the use of fludrocortisone? 1 Candidiasis 2 Hyperkalemia 3 Addison's disease 4 Adrenogenital syndrome

1 Candidiasis Candidiasis is a systemic fungal infection of Candida albicans that can be caused by glucocorticoid inhalers such as fludrocortisone. Thus a patient with this infection should not receive a mineralocorticoid (fludrocortisone) because it may proliferate the fungal infection. Hyperkalemia might actually be improved with fludrocortisone use because fludrocortisone is likely to cause hypokalemia during its administration. Fludrocortisone is used as partial replacement therapy for adrenocortical insufficiency in Addison's disease. It is widely used in the treatment of salt-losing adrenogenital syndrome.

Which are the symptoms of hypothyroidism? Select all that apply. 1 Depression 2 Cold intolerance 3 Increased appetite 4 Altered menstrual cycle 5 Dry, brittle hair and nails

1 Depression 2 Cold intolerance 5 Dry, brittle hair and nails Hypothyroidism is decreased levels of thyroid hormones, which results in symptoms such as depression; cold intolerance; and dry, brittle hair and nails. Increased appetite and altered menstrual cycle are symptoms of hyperthyroidism, which is increased levels of thyroid hormones.

Which symptoms are clinical indicators of Graves' disease? Select all that apply. 1 Diarrhea 2 Flushing 3 Bradycardia 4 Heat intolerance 5 Cold intolerance 6 Altered menstrual flow

1 Diarrhea 2 Flushing 4 Heat intolerance 6 Altered menstrual flow Graves' disease is a type of hyperthyroidism characterized by excessive thyroid hormone secretion, resulting in an increase in the metabolic rate. Clinical manifestations include diarrhea, flushing, heat intolerance, altered menstrual flow, increased appetite, muscle weakness, fatigue, palpitations, irritability, nervousness, and sleep disorders. Bradycardia and cold intolerance are not typical symptoms of Graves' disease.

Which class of medication increases blood glucose levels when administered with insulin? 1 Diuretics 2 Salicylates 3 Sulfa antibiotics 4 Anabolic steroids

1 Diuretics When a diuretic is administered with insulin, an increased blood glucose level will result because the diuretic antagonizes the effect of insulin Salicylates, sulfa antibiotics, and anabolic steroids increase the risk of hypoglycemia when administered with insulin.

A patient is prescribed cosyntropin. Which side effect will the nurse expect? 1 Edema 2 Hypotension 3 Inflammation 4 Scar formation

1 Edema Cosyntropin travels to the adrenal cortex of the kidney and promotes renal retention, which results in edema. This action is followed by an increase in blood pressure or hypertension, not hypotension. The process is associated with an antiinflammatory action. Scar formation in the tissue is also reduced.

The primary health care provider has instructed the nurse to administer HP Acthar Gel subcutaneously. Which adverse effect of this exogenous corticotropin will the nurse anticipate in the patient? 1 Edema 2 Seizures 3 Heartburn 4 Hyperglycemia

1 Edema HP Acthar Gel is an exogenous corticotropin that is available for subcutaneous administration. It helps to increase cortisol levels, which may cause renal retention of sodium that, in turn, results in edema. Cortisol does not aggravate seizure activity, as it has no effect on the muscles. Cortisol does not increase the risk of heartburn. Cortisol also does not alter the blood glucose levels, so there is no risk of hyperglycemia.

Which common adverse effects associated with the use of adrenal medications will the nurse assess for? Select all that apply. 1 Fatigue 2 Sodium retention 3 Increased intraocular pressure 4 Decreased blood glucose levels 5 Increased serum potassium levels

1 Fatigue 2 Sodium retention 3 Increased intraocular pressure The adverse effects of adrenal medications include fatigue, sodium retention, and increased intraocular pressure. Patients who are on adrenal medications should be closely assessed for exacerbation of any pre-existing edema. Other adverse effects include increased blood glucose levels and decreased serum potassium levels.

What is the function of aldosterone? 1 Fluid and water retention 2 Stimulation of the erythroid cells 3 Production of glycogen in the liver 4 Inhibition of inflammatory and immune responses

1 Fluid and water retention The main function of aldosterone is fluid and water retention. Through this retention, aldosterone is responsible for blood pressure maintenance. Stimulation of the erythroid cells, production of glycogen in the liver, and inhibition of inflammatory and immune responses are the main effects of glucocorticoids.

The nurse is caring for a patient with Addison's disease who has been prescribed corticosteroids. Prior to administering the medication, which conditions would the nurse assess for in the patient? Select all that apply. 1 Glaucoma 2 Septicemia 3 Liver disorder 4 Ulcerative colitis 5 Diabetes mellitus

1 Glaucoma 2 Septicemia 5 Diabetes mellitus Corticosteroids are contraindicated in patients with septicemia, glaucoma, and diabetes mellitus. Corticosteroids may increase the intraocular pressure and further worsen the symptoms of glaucoma. Because corticosteroids possess immunosuppressant properties, they are contraindicated in patients with septicemia, systemic fungal infections, and varicella infection. Suppression of the immune system by corticosteroids worsens these infections. Corticosteroids are contraindicated in patients with diabetes mellitus because they increase the blood glucose concentration and lead to hyperglycemia. Liver disorder is assessed when antiadrenal drugs are prescribed. Corticosteroids are used to treat ulcerative colitis, so they are not contraindicated in patients with ulcerative colitis.

Which are second-generation sulfonylureas? Select all that apply. 1 Glipizide 2 Glyburide 3 Metformin 4 Glimepiride 5 Pioglitazone

1 Glipizide 2 Glyburide 4 Glimepiride Glipizide, glyburide, and glimepiride are second-generation sulfonylureas. Metformin is a biguanide. Pioglitazone is a thiazolidinedione.

A pediatric patient is prescribed somatropin. Which parameter will the nurse monitor during the follow-up visit? Select all that apply. 1 Height 2 Weight 3 Skin turgor 4 Motor skills 5 Visual acuity

1 Height 2 Weight 4 Motor skills Somatropin is an anterior pituitary hormone. It is used in the treatment of growth hormone deficiency. Somatropin affects the normal physical development. The nurse would assess the height, weight, motor skills, and growth parameters in the pediatric patient. Somatropin does not affect the skin turgor or visual acuity, so these parameters need not be monitored during the follow-up visit.

Which clinical findings may indicate diabetes mellitus in a patient? Select all that apply. 1 Hemoglobin A1C level greater than 6.5% 2 Casual plasma glucose level of 130 mg/dL or higher 3 Fasting plasma glucose level of 126 mg/dL or higher 4 Two-hour plasma glucose level of 120 mg/dL or higher 5 Random blood glucose level between 70 and 100 mg/dL

1 Hemoglobin A1C level greater than 6.5% 3 Fasting plasma glucose level of 126 mg/dL or higher A hemoglobin A1C level greater than 6.5% is an indication of diabetes mellitus. It indicates that the amount of glucose on the hemoglobin is higher than normal. A fasting plasma glucose level of 126 mg/dL or higher indicates hyperglycemia. It indicates that there are excessive concentrations of glucose in the blood. A casual plasma glucose level of 200 mg/dL or higher and a 2-hour plasma glucose level of 200 mg/dL or higher indicate diabetes. Random blood glucose levels of 70 to 100 mg/dL indicate normal glucose homeostasis.

The nurse is caring for a patient who has Addison's disease. The primary health care provider prescribes fludrocortisone. For which adverse effect will the nurse monitor this patient? 1 Hypokalemia 2 Hyponatremia 3 Hypocalcemia 4 Hypoglycemia

1 Hypokalemia Fludrocortisone has mineralocorticoid properties, resulting in sodium and fluid retention along with potassium excretion. It causes a reduction in serum potassium concentrations. Hence the nurse would monitor whether the patient has hypokalemia. If Addison's 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. When corticosteroids are administered with nonpotassium-sparing diuretics, the adverse effects of hypocalcemia need to be monitored. Fludrocortisone causes an elevation in serum blood glucose concentrations. Therefore the medication would cause hyperglycemia in this patient but not hypoglycemia.

Which hormones play a role in the regulation of glucose homeostasis? Select all that apply. 1 Insulin 2 Ketone 3 Dextrose 4 Glucagon 5 Glycogen

1 Insulin 4 Glucagon

A patient newly diagnosed with type 2 diabetes is instructed to make dietary changes and perform aerobic exercise daily. For which reason would insulin therapy be delayed? 1 Insulin therapy is initiated when other methods have failed. 2 It is not generally prescribed for obese patients. 3 It is ineffective without initial oral drug therapy. 4 Insulin therapy may cause heart failure to develop.

1 Insulin therapy is initiated when other methods have failed. For patients with type 2 diabetes mellitus, insulin therapy is usually reserved for when other treatment methods are unsuccessful. It is more important to start oral drug therapy and initiate lifestyle changes as an initial treatment for diabetes mellitus management. Insulin is prescribed for obese patients if the initial drug therapy and lifestyle changes are ineffective in lowering glucose levels. Insulin therapy is used for diabetic management and is used along with oral drug therapy. Insulin therapy does not cause congestive heart failure in patients. It is more of a concern in patients who take pioglitazone.

The nurse is assessing a patient undergoing levothyroxine therapy. Which symptom makes the nurse suspect excessive thyroid replacement? 1 Irritability 2 Drowsiness 3 Bradycardia 4 Intolerance to cold

1 Irritability Irritability is a symptom of hyperthyroidism. Drowsiness, bradycardia, and intolerance to cold are signs of hypothyroidism.

A patient newly diagnosed with type 2 diabetes mellitus has been ordered insulin glargine. Which information is essential for the nurse to teach this patient? 1 It has a duration of action of 24 hours. 2 Mix it with the regular insulin each morning. 3 It is very short-acting; eat after injecting it. 4 It is expensive but administered only a short time.

1 It has a duration of action of 24 hours. Insulin glargine has a duration of action of 24 hours with no peaks, mimicking the natural, basal insulin secretion of the pancreas. This medication cannot be mixed with other insulins and is not a short-acting insulin. The patient may need to receive this medication for a long time.

Which conditions in a patient with diabetes mellitus are indicative of diabetic ketoacidosis? Select all that apply. 1 Ketones in the urine 2 Severe hypothermia 3 Isotonic dehydration 4 Electrolyte imbalances 5 Extreme hyperglycemia

1 Ketones in the urine 3 Isotonic dehydration 4 Electrolyte imbalances 5 Extreme hyperglycemia

A patient walks into a clinic, shivering and looking depressed and tired. The caregiver reports, "The patient was normal until last month but then suddenly started to gain weight." Further assessment from the primary health care provider shows brittle hair and fingers. Which medication would the nurse expect in the patient's prescription? 1 Liotrix 50 mg/day orally 2 Methimazole 20 mg/day orally 3 Propylthiouracil 300 mg/day orally 4 Levothyroxine 300 mcg intravenous (IV)

1 Liotrix 50 mg/day orally Weight gain, depression, fatigue, brittle fingers and hair, and cold intolerance are the symptoms associated with hypothyroidism. The nurse will expect a thyroid drug. Liotrix 50 mg/day orally is prescribed for patients with hypothyroidism. Methimazole 20 mg/day orally and propylthiouracil 300 mg/day orally are antithyroid drugs prescribed for hyperthyroidism. Administering these drugs to the patient will further worsen the patient's condition. Levothyroxine 300 mcg by IV is also a thyroid drug, but it is prescribed IV during myxedema coma, which is a severe condition of hypothyroidism.

Which adverse effects are possible from octreotide therapy? Select all that apply. 1 Malaise 2 Dyspnea 3 Arthralgia 4 Constipation 5 Hypercalciuria

1 Malaise 2 Dyspnea 3 Arthralgia Octreotide is useful in treating potentially life-threatening hypotension associated with a carcinoid crisis. Malaise, dyspnea, and arthralgia are side effects of octreotide. Octreotide causes diarrhea and not constipation. Octreotide does not cause hypercalciuria. Hypercalciuria is an adverse effect of growth hormone analogs.

The nurse is assessing a pregnant patient in the second trimester who has hyperthyroid activity. Which would the nurse expect the health care provider to order? 1 Methimazole 2 Propylthiouracil 3 Avoid the drug for 2 weeks 4 Avoid folic acid supplements

1 Methimazole The pregnant patient in the second trimester with hyperthyroid activity should be prescribed methimazole. Propylthiouracil is an antithyroid drug that is prescribed in the first trimester of pregnancy. Antithyroid drugs are usually prescribed for a lifetime and are not discontinued. Folic acid is one of the many important supplements for pregnant women, so it should not be stopped due to hyperthyroid activity.

Which medications inhibit the enzyme alpha-glucosidase in the treatment of type 2 diabetes mellitus? Select all that apply. 1 Miglitol 2 Glipizide 3 Acarbose 4 Nateglinide 5 Pioglitazone

1 Miglitol 3 Acarbose Alpha-glucosidase inhibitors are a class of antidiabetic drugs used to inhibit the alpha-glucosidase enzyme. Miglitol and acarbose are drugs that inhibit the alpha-glucosidase enzyme. Glipizide is a sulfonylurea that stimulates the release of insulin. Nateglinide is a glinide that increases insulin secretion. Pioglitazone is a thiazolidinedione that decreases insulin resistance by enhancing the sensitivity of insulin receptors. pp. 502, 506

The nurse administers repaglinide to a patient at 8:00 a.m. When is the patient at the highest risk for hypoglycemia? 1 Noon 2 9:00 a.m. 3 10:00 a.m. 4 11:00 a.m.

1 Noon Repaglinide is a rapid-acting oral hypoglycemic agent whose action peaks within 1 hour of the drug's administration. If the drug is given at 8:00 a.m., it will have its peak effects at 9:00 a.m. The drug reaches its elimination half-life phase within the next few hours; in this case, from 10:00 a.m. to noon.

A patient with carcinoid crisis has severe diarrhea, flushing, and life-threatening hypotension. Which drug will be ordered to manage the patient's condition? 1 Octreotide 2 Somatropin 3 Vasopressin 4 Desmopressin

1 Octreotide Carcinoid crisis is the immediate onset of debilitating and life-threatening symptoms; it is associated with carcinoid syndrome. The patient has severe diarrhea, flushing, and life-threatening hypotension due to carcinoid crisis. Octreotide is a somatostatin analog. It is useful in alleviating symptoms of carcinoid tumors. Somatropin is used in the treatment of growth hormone deficiency. Vasopressin is used in the treatment of diabetes insipidus, vasodilatory shock, gastrointestinal hemorrhage, and esophageal varices. Desmopressin is useful in the treatment of hemophilia A and type I von Willebrand's disease.

Which dermatological change would the nurse monitor for in a patient receiving long-term corticosteroid therapy? 1 Cysts 2 Bruising 3 Jaundice 4 Cyanosis

2 Bruising The nurse would assess the skin for bruising and skin tears because corticosteroids can thin the skin and cause bleeding. Corticosteroids do not cause cyst development. Liver disease leads to jaundice. Cyanosis occurs from hypoxia.

The nurse is caring for a patient who has esophageal varices. Which drug will the nurse expect to administer to this patient? 1 Octreotide 2 Cosyntropin 3 Somatropin 4 Desmopressin

1 Octreotide Octreotide is used in the treatment of esophageal varices. Cosyntropin is not used in the treatment of esophageal varices. It only helps in the enhancement of cortisol levels. Somatropin is a growth hormone that is indicated in the treatment of growth failure due to inadequate endogenous growth hormone secretion. It is also used for patients with HIV infection with wasting (i.e., cachexia) in conjunction with antiviral therapy. Desmopressin is used to treat dehydration caused by vasopressin deficiency.

The nurse admitting a patient with acromegaly anticipates administering which medication? 1 Octreotide 2 Somatropin 3 Corticotropin 4 Desmopressin

1 Octreotide Octreotide suppresses growth hormone, which causes acromegaly. The other medications do not suppress growth hormone.

A patient who has undergone organ transplantation shows symptoms of organ rejection despite taking cyclosporine. Which drug would the nurse check for in the medication history of the patient? 1 Octreotide 2 Somatropin 3 Vasopressin 4 Desmopressin

1 Octreotide The nurse would check the history of octreotide in the patient because octreotide interacts with cyclosporine and suppresses the effect of cyclosporine; this may result in organ rejection. Somatropin, vasopressin, and desmopressin do not interact with cyclosporine. These drugs are safer in patients with organ transplantation. Somatropin interacts with glucocorticoids and reduces the growth effects. Vasopressin interacts with carbamazepine and enhances the antidiuretic effect. Desmopressin interacts with carbamazepine and enhances the effect of desmopressin.

Which side effect of long-term treatment with corticosteroids requires patients to undergo an annual bone density exam? 1 Osteoporosis 2 Addison's disease 3 Type 1 diabetes mellitus 4 Chronic obstructive pulmonary disease (COPD)

1 Osteoporosis Long-term use of corticosteroids can cause osteoporosis; therefore patients undergoing treatment need to receive annual bone density exams. Although Addison's disease is treated with corticosteroids, the disorder itself does not necessitate annual bone density exams. Type 1 diabetes mellitus and chronic obstructive pulmonary disease (COPD) do not affect bone density.

A patient who has been on propylthiouracil for 2 weeks approaches the nurse for a routine medical checkup. Which is a priority assessment for this patient? 1 Platelet count 2 Glucose levels 3 Calcium levels 4 Creatinine levels

1 Platelet count

A patient with stage III laryngeal cancer underwent laryngectomy with concurrent removal of the thyroid gland. Which type of hypothyroidism will occur in this case? 1 Primary hypothyroidism 2 Tertiary hypothyroidism 3 Secondary hypothyroidism 4 Quaternary hypothyroidism

1 Primary hypothyroidism When the thyroid gland is completely removed during laryngectomy, there is no release of thyroid hormones. Primary hypothyroidism stems from an abnormality in the thyroid gland. This is the most common type of hypothyroidism. Secondary hypothyroidism is caused by an abnormal release of thyroid-stimulating hormone (TSH) by the pituitary gland. TSH is needed to trigger the release of stored thyroid hormones. Tertiary hypothyroidism is caused by the reduced secretion of thyrotropin-releasing hormone from the hypothalamus. There is no term called quaternary hypothyroidism.

A patient who routinely takes regular insulin therapy is prescribed pramlintide, which may increase the patient's risk for hypoglycemia. Which nursing intervention is correct in this case? 1 Reduce the needed insulin dose by 50%. 2 Reduce the needed pramlintide dose by 50%. 3 Obtain a new prescription to change the medication. 4 Give insulin an hour after administering pramlintide.

1 Reduce the needed insulin dose by 50%. The nurse needs to reduce the regular insulin dose by 50% so that it does not result in hypoglycemia in the patient. Reducing the pramlintide dose may not produce therapeutic effects. It is not necessary to obtain a prescription to change the drug because a reduction in the insulin dose will help prevent hypoglycemia. The nurse would contact the primary care provider to verify the insulin dosage and enter it into the patient's record. Administering insulin an hour after administering pramlintide will not prevent the interaction between the two medications.

The nurse is performing a follow-up assessment of a patient who is being treated with glucocorticoids for an exacerbation of chronic obstructive pulmonary disease (COPD). Which assessment findings indicate that the treatment is effective? Select all that apply. 1 Respiratory rate of 16 breaths/min 2 Temperature of 100.6°F (38.1°C) 3 Oxygen saturation of 95% 4 Weight gain of 4.4 lb (2 kg) over a week 5 Random blood glucose concentration of 150 mg/dL

1 Respiratory rate of 16 breaths/min 3 Oxygen saturation of 95% 5 Random blood glucose concentration of 150 mg/dL Glucocorticoids may affect hormone production, which can affect many systems in the body. A respiratory rate of 16 breaths/min and an oxygen saturation of 95% are normal findings and indicate effective treatment of COPD. Glucocorticoids tend to increase blood glucose concentration. A temperature of 100.6°F (38.1°C) indicates infection and implies that treatment needs to be adjusted. Weight gain of 4.4 lb (2 kg) and elevated blood glucose indicate side effects of the therapy.

A patient is prescribed a somatropin injection subcutaneously. Which nursing intervention promotes safe administration of the drug? 1 Rotating the injection site 2 Shaking the vial vigorously 3 Administering in the ventral gluteal site 4 Administering if the drug in the vial is cloudy

1 Rotating the injection site Somatropin is a form of growth hormone and is used to treat growth retardations. The drug can be administered intravenously and subcutaneously. However, the site of injection should be rotated to prevent tissue damage. The vial should not be shaken vigorously; instead, it should be swirled gently. The medication is injected into the ventral gluteal site if the route of administration is intramuscular. The medication should be administered only if the solution is clear.

The nurse observes that A1C levels are elevated in a patient who is taking metformin for type 2 diabetes. Which class of drugs is likely to be prescribed to this patient? 1 Sulfonylureas 2 Incretin mimetics 3 Alpha-glucosidase inhibitors 4 Dipeptidyl peptidase-IV inhibitors

1 Sulfonylureas Sulfonylureas are prescribed to a patient whose A1C levels are elevated even after taking metformin. The drugs bind to specific receptors on beta cells in the pancreas to stimulate the release of insulin. Incretin mimetics are used to reduce postprandial glucagon production. The alpha-glucosidase inhibitors are used to control high postprandial glucose levels. The dipeptidyl peptidase-IV inhibitors are indicated as an adjunct to diet and exercise to improve glycemic control.

The nurse counsels a patient about preventing insomnia caused by liotrix. Which information would the nurse provide? 1 Take the drug before breakfast. 2 Take the drug along with meals. 3 Take the drug 1 hour after meals. 4 Take a nap during the day, after lunch.

1 Take the drug before breakfast. The nurse would suggest taking the drug early in the morning before breakfast to avoid insomnia. The drug activity is better achieved on an empty stomach; therefore the nurse would not ask the patient to take it with a meal. Rather, the nurse instructs the patient to take the medication before meals. Administering the drug 1 hour after meals will decrease the absorption of drug and cannot prevent insomnia. Taking a nap during the day will not alter the insomniac effect of the drug.

Which precautions will the nurse take before administering insulin isophane suspension (NPH) to a patient? Select all that apply. 1 Verify that insulin syringes are used. 2 Identify the intramuscular injection site. 3 Shake the drug vial gently for some time. 4 Rotate the injection locations every week. 5 Monitor the patient's fasting serum glucose level.

1 Verify that insulin syringes are used. 4 Rotate the injection locations every week. 5 Monitor the patient's fasting serum glucose level. The nurse ensures that insulin syringes are used in order to administer an accurate dose. The nurse rotates the general injection site every week to prevent lipodystrophy. Lipodystrophy is damage to the adipose tissue due to continued insulin injections to a specific area. The nurse monitors the patient's fasting serum glucose levels before administering insulin to prevent hypoglycemia. The nurse injects insulin into the subcutaneous tissue, not the muscle. The nurse does not shake the vial because shaking causes bubbles. Instead the nurse would gently roll the vial to mix the contents.

Which are the adverse effects of antithyroid medication? Select all that apply. 1 Vertigo 2 Cramps 3 Tremor 4 Leukopenia 5 Loss of taste

1 Vertigo 4 Leukopenia 5 Loss of taste Antithyroid medication causes vertigo. These medications also decrease the leukocyte count and cause a loss of the sense of taste. Cramps and tremors are adverse effects of thyroid medications.

Which baseline measurements does the nurse obtain before administering pituitary hormones? Select all that apply. 1 Weight 2 Blood pressure 3 Liver enzyme levels 4 Blood glucose levels 5 Renal function studies

1 Weight 2 Blood pressure 4 Blood glucose levels

A patient with a history of asthma frequently receives prednisone for acute bronchitis. Which adverse effects would the nurse anticipate that the patient may experience with continuous use of the therapy? Select all that apply. 1 Weight gain 2 Hypoglycemia 3 Increased sleep 4 Personality changes 5 Loss of muscle bulk 6 Loss of bone density

1 Weight gain 4 Personality changes 5 Loss of muscle bulk 6 Loss of bone density

A client received 20 units of NPH insulin subcutaneously at 8:30 AM. Breakfast was eaten at 0900 and lunch was eaten at 1200. The nurse should check the client for a potential hypoglycemic reaction at what time? 1. 3:00 PM 2. 10:00 AM 3. 9:00 AM 4. 1:00 PM

1. 3:00 PM Rationale: NPH is intermediate-acting insulin. Its onset of action is 1 to 21⁄2 hours, it peaks in 4 to 6 hours, and its duration of action is 24 hours. Hypoglycemic reactions most likely occur during peak time. Breakfast eaten at 9:00 AM would cover the onset of NPH insulin of 0900 and 1000 and lunch will cover the 1 PM time frame. However, if the patient does not eat a mid-afternoon snack, the NPH insulin may be peaking just before dinner without sufficient glucose on hand to prevent hypoglycemia.

Glimepiride (Amaryl) is prescribed for a client with diabetes mellitus. A nurse reinforces instructions for the client and tells the client to avoid which of the following while taking this medication? 1. Alcohol 2. Organ meats 3. Whole-grain cereals 4. Carbonated beverages

1. Alcohol Rationale:When alcohol is combined with glimepiride (Amaryl), a disulfiram-like reaction may occur. This syndrome includes flushing, palpitations, and nausea. Alcohol can also potentiate the hypoglycemic effects of the medication. Clients need to be instructed to avoid alcohol consumption while taking this medication. The items in options 2, 3, and 4 do not need to be avoided.

A client with diabetes mellitus visits a health care clinic. The client's diabetes mellitus previously had been well controlled with glyburide (DiaBeta) daily, but recently the fasting blood glucose level has been 180 to 200 mg/dL. Which medication, if added to the client's regimen, may have contributed to the hyperglycemia? 1. Prednisone 2. Phenelzine (Nardil) 3. Atenolol (Tenormin) 4. Allopurinol (Zyloprim)

1. Prednisone Rationale:Prednisone may decrease the effect of oral hypoglycemics, insulin, diuretics, andpotassium supplements. Option 2, a monoamine oxidase inhibitor, and option 3, a β- blocker, have their own intrinsic hypoglycemic activity. Option 4 decreases urinary excretion of sulfonylurea agents, causing increased levels of the oral agents, which can lead to hypoglycemia.

The nurse instructs a nursing student to administer vasopressin to a patient. The student observes visible particles in the vasopressin solution and notifies the nurse. Which instruction will the nurse give the student to ensure safe administration of vasopressin? 1 "Heat the medicine before administration." 2 "Do not administer the drug to the patient." 3 "Shake the medication before administration." 4 "Keep the bottle in warm water before administration."

2 "Do not administer the drug to the patient." The presence of visible particles in vasopressin solution indicates contamination. Administration of this contaminated solution may lead to the loss of its therapeutic effect and cause severe reactions in the patient. The nurse would instruct the student nurse not to administer vasopressin to the patient. Vasopressin should not be heated before administration because this may affect its potency. Shaking the medication may not have any effect on the drug if vasopressin solution contains visible particles. The nurse would not keep the bottle in warm water because this does not reduce the risk of complication. In contrast, it may increase the chance of contamination.

The nurse is educating a patient who is taking thyroid hormone replacement therapy. Which response given by the patient indicates effective learning? 1 "I should take the thyroid tablet every night after dinner." 2 "I should take the tablet every morning with an empty stomach." 3 "I should take the tablet twice daily, before breakfast and after breakfast." 4 "I can stop the medication whenever I want without consulting my primary health care provider."

2 "I should take the tablet every morning with an empty stomach." Food decreases the absorption of the thyroid drug. The patient should take the thyroid drug every morning on an empty stomach to achieve maximum absorption of the drug. The therapeutic effect of the drug decreases if the patient takes the tablet after meals. Administering the drug twice daily leads to drug overdose and adverse effects. The drug therapy should not be withdrawn without informing the primary health care provider because this would worsen the hypothyroidism.

Which lifestyle changes will the nurse instruct the patient to implement to successfully manage diabetes mellitus? Select all that apply. 1 "Restrict sodium in your diet." 2 "Reduce the amount of alcohol you consume." 3 "Include rest periods between physical activities." 4 "Incorporate daily physical exercise into your life." 5 "Decrease the amount of carbohydrates in your diet."

2 "Reduce the amount of alcohol you consume." 4 "Incorporate daily physical exercise into your life." 5 "Decrease the amount of carbohydrates in your diet."

The nurse is teaching a patient who has been prescribed a daily oral dose of prednisone about the medication regimen. Which instructions will the nurse provide the patient to ensure safe administration? Select all that apply. 1 "Take aspirin with the prednisone." 2 "Take each dose with milk or food." 3 "Take the medication early evening." 4 "Take the medication early morning." 5 "Take the medication on an empty stomach."

2 "Take each dose with milk or food." 4 "Take the medication early morning." Glucocorticoids can cause gastrointestinal (GI) distress and should be administered with milk or food to minimize GI upset. Prednisone, which is a synthetic glucocorticoid, should be administered in the early morning because the adrenal glands secrete the maximum amount of hormones during the early morning. This helps to prevent adrenal suppression. This drug is ulcerogenic; hence, the administration of aspirin and other nonsteroidal antiinflammatory drugs should be avoided to prevent gastric irritation and gastric bleeding. It should not be administered early in the evening because the adrenocortical secretion levels are low during evenings. This medication should not be administered on an empty stomach because it would enhance the effects of gastric irritation.

Which plan would the nurse recommend for a patient beginning prednisone therapy? 1 "Discontinue the medication if there are adverse effects." 2 "Take the medication with food to diminish the risk of gastric irritation." 3 "Take the medication only every other day to decrease the risk of adrenal hyperplasia." 4 "Take the medication in the early evening to coincide with the natural secretion pattern of the adrenal cortex."

2 "Take the medication with food to diminish the risk of gastric irritation."

A nursing student is asked to administer prednisone to a patient. Which statement by the nursing student reflects effective planning? 1 "The medication is administered on a strict, unchanging schedule to prevent adverse effects." 2 "The medication should be administered with food to diminish the risk of gastric irritation." 3 "The medication should not be administered intravenously because of the risk of hypotension." 4 "The medication is administered early in the evening to coincide with the natural secretion of the adrenal cortex."

2 "The medication should be administered with food to diminish the risk of gastric irritation." Prednisone and other glucocorticoids can cause gastrointestinal distress and should be administered with food. These medications should be tapered slowly to prevent adrenal crisis; they can be administered intravenously as well. The normal circadian secretion by the adrenal cortex occurs in the early morning to wake up a person, not early evening. The schedule of administration will not prevent adverse effects.

Which medication, when given with desmopressin, causes increased water retention? 1 Thioridazine 2 Carbamazepine 3 Acetaminophen 4 Norepinephrine

2 Carbamazepine

Which are the adverse effects of thyroid replacement drugs? Select all that apply. 1 Fatigue 2 Chest pain 3 Palpitations 4 Weight gain 5 Cold intolerance

2 Chest pain 3 Palpitations Chest pain and palpitations are adverse effects of thyroid replacement drugs. Fatigue, weight gain, and cold intolerance are symptoms of hypothyroidism.

A nursing student is caring for an elderly patient who has Cushing's syndrome. The nursing instructor asks the student about the characteristics that can be observed in patients with Cushing's syndrome. Which response by the student is correct? 1 "The patient has redistribution of body fat from the face, shoulders, trunk, and abdomen to the arms and legs." 2 "The patient has muscle weakness because of increased carbohydrate metabolism." 3 "The patient has hypokalemia because of a decrease in blood potassium concentrations." 4 "The patient has dehydration because of a decrease in blood aldosterone concentrations."

2 "The patient has muscle weakness because of increased carbohydrate metabolism." Cushing's syndrome leads to muscle weakness from potassium loss. In Cushing's syndrome, the hypersecretion of glucocorticoids results in the redistribution of body fat from the arms and legs to the face, shoulders, trunk, and abdomen, which leads to the characteristic "moon face." The undersecretion (hyposecretion) of adrenocortical hormones causes a condition known as Addison's disease. It is associated with decreased blood sodium and glucose levels, increased potassium levels, dehydration, and weight loss.

The nurse would include which statement when teaching a patient about insulin glargine? 1 "You can mix this insulin with NPH insulin to enhance its effects." 2 "You cannot mix this insulin with any other insulin in the same syringe." 3 "You should inject this insulin just before meals because it is very fast-acting." 4 "The duration of action for this insulin is approximately 8 to 10 hours, so you will need to take it twice a day."

2 "You cannot mix this insulin with any other insulin in the same syringe." Insulin glargine should not be mixed with any other insulins. The insulin is not fast acting. It is a long-acting insulin with a duration of action up to 24 hours.

Which information will the nurse include in the teaching plan for repaglinide? 1 "This medication will not cause hypoglycemia." 2 "You will need to be sure you eat as soon as you take this medication." 3 "You do not have to worry about side effects when taking this medication." 4 "When taking this medication, use aspirin rather than acetaminophen for pain relief."

2 "You will need to be sure you eat as soon as you take this medication." Repaglinide is short acting. The drug's very fast onset of action allows patients to take the drug with meals and skip a dose when they skip a meal. Hypoglycemia is a side effect of this medication, and there are many other possible side effects of this medication. The effects of repaglinide are enhanced when taken with aspirin and other nonsteroidal antiinflammatory drugs, which may result in increased hypoglycemia.

A patient who is taking propylthiouracil complains, "It's been 10 days since I started taking the medication, but my hunger is still not suppressed." Which explanation would the nurse provide? 1 "Increase the amount of fiber in your diet." 2 "Your hunger will subside in another 10 days." 3 "Take the drug on an empty stomach before breakfast." 4 "Make an appointment with your primary health care provider."

2 "Your hunger will subside in another 10 days." The antithyroid drug propylthiouracil is used to treat hyperthyroid symptoms, and its therapeutic benefits are achieved after 2 weeks. Therefore the nurse advises the patient that the increased hunger, which is a symptom of hyperthyroidism, will be reduced eventually. Increased intake of fibrous food would increase the patient's hunger and is not effective in this case. Antithyroid drugs are best prescribed to be taken after meals to prevent gastric irritation. If the symptoms of hyperthyroidism are prevalent in the patient even after 2 weeks of therapy, the nurse will make the patient an appointment with the primary health care provider.

A patient receives isophane suspension (neutral protamine Hagedorn [NPH]) insulin at 8:00 a.m. The patient eats breakfast at 8:30 a.m., lunch at noon, and dinner at 6:00 p.m. At which time is this patient at the highest risk for hypoglycemia? 1 2:00 p.m. 2 5:00 p.m. 3 8:00 p.m. 4 10:00 a.m.

2 5:00 p.m. Breakfast eaten at 8:30 a.m. would cover the onset of isophane suspension (NPH) insulin, and lunch will cover the 2:00 p.m. time frame. If the patient does not eat a mid-afternoon snack, however, the NPH insulin may peak just before dinner without sufficient glucose on hand to prevent hypoglycemia.

Which patient will benefit from taking glipizide? 1 A patient who is also prescribed sitagliptin 2 A patient with type 2 diabetes who has renal failure 3 A diabetic patient who takes sulfasalazine for arthritis 4 A patient with type 1 diabetes at risk for hypoglycemia

2 A patient with type 2 diabetes who has renal failure Glipizide is administered to patients with type 2 diabetes to stimulate the release of insulin. Unlike other oral hypoglycemic drugs, glipizide can be administered to patients with renal failure because it does not cause toxicity. Concurrent use of glipizide and sitagliptin results in hypoglycemia. Glipizide interacts with sulfasalazine and increases the patient's risk for hypoglycemia. Glipizide is contraindicated in type 1 diabetes.

For which condition would daily fludrocortisone be prescribed? 1 Organ transplant 2 Addison's disease 3 Rheumatoid arthritis 4 Chronic obstructive pulmonary disease (COPD)

2 Addison's disease

Which hormone is affected by renal failure? 1 Epinephrine 2 Aldosterone 3 Norepinephrine 4 Corticotropin

2 Aldosterone Aldosterone is a mineralocorticoid hormone produced by the adrenal cortex that acts on the renal tubule, regulating sodium and potassium levels. This hormone would not be effective in a patient with renal failure. Epinephrine and norepinephrine affect the cardiovascular system. Corticotropin is secreted by the pituitary gland and works on the adrenal glands.

Which corticosteroid drug is safe to use during pregnancy? 1 Prednisone 2 Betamethasone 3 Fludrocortisone 4 Methylprednisolone

2 Betamethasone Betamethasone is the drug of choice for patients experiencing premature labor. It helps to accelerate fetal lung maturation. Prednisone, fludrocortisone, and methylprednisolone are pregnancy category C drugs, which are not safe to use during pregnancy. These drugs cross the placenta and may cause fetal abnormalities.

A patient is administered somatropin for growth improvement. Which biochemical parameter will the nurse closely monitor after administration? 1 Uric acid level 2 Blood glucose level 3 Creatinine clearance test 4 Complete blood count result

2 Blood glucose level

Which assessment will the nurse perform for a patient with a history of heart failure who is prescribed corticosteroids? 1 Bowel sounds 2 Breath sounds 3 Capillary refill 4 Peripheral pulses

2 Breath sounds Corticosteroids can cause fluid volume overload in patients with heart failure, which may lead to respiratory congestion. Capillary refill and peripheral pulses are assessed in patients with impaired circulation. Corticosteroids will not alter bowel sounds or gastrointestinal transit.

The nurse is caring for a patient with an adrenal tumor. The health care provider has prescribed an antiadrenal drug to the patient. Which therapeutic responses will the nurse assess in this patient? Select all that apply. 1 Decrease in inflammation 2 Decrease in the tumor size 3 Decrease in lymphocyte count 4 Decrease in adrenal suppression 5 Decrease in Cushing's syndrome symptoms

2 Decrease in the tumor size 5 Decrease in Cushing's syndrome symptoms

A patient is diagnosed with type 2 diabetes mellitus, gastroparesis, and dysphagia. The patient's blood glucose level is 220 mg/dL. Metformin and glitazone have not proven effective. Which medication does the nurse expect will be ordered by the health care provider? 1 Acarbose 2 Exenatide 3 Sitagliptin 4 Pramlintide

2 Exenatide Exenatide is indicated only for patients with type 2 diabetes who have been unable to achieve blood glucose control with metformin, a sulfonylurea, and/or a glitazone. Acarbose and sitagliptin can also be given, but they are oral antidiabetic medications that are not appropriate for a patient diagnosed with dysphagia. Pramlintide is an amylin agonist, which is an injectable antidiabetic medication. It can also reduce postprandial blood glucose levels, but it is contraindicated in patients who have gastroparesis.

Which corticosteroid has exclusive mineralocorticoid activity? 1 Alclometasone 2 Fludrocortisone 3 Beclomethasone 4 Aminoglutethimide

2 Fludrocortisone

A patient has been prescribed a beclomethasone inhaler. When teaching the patient about the use of inhalers, the nurse instructs the patient to rinse the mouth with warm water after using the inhaler. Which side effect is the nurse trying to prevent? 1 Adrenal crisis 2 Fungal infection 3 Addison's disease 4 Cushing's syndrome

2 Fungal infection Beclomethasone is an inhaled corticosteroid. These medications may promote local fungal growth because immunity is suppressed. Therefore the nurse would instruct the patient to rinse the mouth with warm water after using the inhaler. Adrenal crisis is a life-threatening condition in which cortisol is deficient or very low in the body. It cannot be prevented by rinsing the mouth with warm water. Addison's disease occurs when the adrenal glands do not produce enough cortisol. This disease cannot be prevented by rinsing the mouth with warm water. Cushing's syndrome is an adverse effect of long-term or frequent use of corticosteroids and is characterized by "moon face," obesity in the trunk area, impaired glucose metabolism, and a "buffalo hump." Cushing's syndrome cannot be prevented by rinsing the mouth with warm water.

Which medication will the nurse administer to treat hypoglycemia in a patient brought to the emergency department who was experiencing tremors, sweating, and irritability before losing consciousness? 1 Insulin 2 Glucagon 3 Exenatide 4 Liraglutide

2 Glucagon Tremors, sweating, irritability, seizure activity, and unconsciousness are all clinical manifestations of hypoglycemia. The treatment of choice for this patient is an intravenous infusion of glucagon. Insulin should never be given to a patient who is already hypoglycemic. Exenatide and liraglutide are incretins that would be appropriate to treat hyperglycemia, not hypoglycemia.

What are signs and symptoms of an adrenal crisis? Select all that apply. 1 Buffalo hump 2 Hyperkalemia 3 Hypernatremia 4 Delayed wound healing 5 Drop in extracellular fluid volume

2 Hyperkalemia 5 Drop in extracellular fluid volume An adrenal crisis is a life-threatening state of profound adrenocortical insufficiency and requires immediate medical management. The symptoms of adrenal crisis include hyperkalemia, a drop in extracellular fluid volume, and hyponatremia. A buffalo hump is a clinical manifestation of Cushing's syndrome. Delayed wound healing is a clinical manifestation of long-term glucocorticoid therapy.

Which effect results from drug therapy for growth hormone deficiency in children? Select all that apply. 1 Lower plasma albumin levels 2 Increased lipid mobilization 3 Retention of potassium levels 4 Increased retention of sodium 5 Improved tissue-building processes

2 Increased lipid mobilization 4 Increased retention of sodium 5 Improved tissue-building processes The drugs that mimic growth hormone (GH) are somatropin and somatrem. These drugs promote growth by stimulating various anabolic (tissue-building) processes, liver glycogenolysis (to raise blood sugar levels), lipid mobilization from body fat stores, and retention of sodium, potassium, and phosphorus. These drugs do not cause lower plasma albumin levels or retention of potassium levels, however. Both drugs promote linear growth in children who lack normal amounts of the endogenous hormone.

The health care provider prescribes radioactive iodine to an adult patient who has thyroid cancer. Which is the reason for prescribing this drug to the patient? 1 It acts as a prophylactic agent against radiation exposure. 2 It takes up beta rays into the follicles of the thyroid gland. 3 It increases the cellular metabolic rate and oxygen consumption. 4 It inhibits the conversion of T4 to T3 in the peripheral circulation.

2 It takes up beta rays into the follicles of the thyroid gland. 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, rather than antithyroid drugs. Propylthiouracil inhibits the conversion of T4 to T3 in the peripheral circulation to decrease the level of thyroid hormone, so this is not the reason for prescribing radioactive iodine.

The nurse administers NPH insulin at 8:00 a.m. Which intervention is essential for the nurse to perform? 1 Monitor fingerstick at 2:00 p.m. 2 Make sure patient eats by 5:00 p.m. 3 Administer the insulin via IV pump. 4 Assess for hyperglycemia by 10:00 a.m.

2 Make sure patient eats by 5:00 p.m. NPH insulin may be peaking just before dinner without sufficient glucose on hand to prevent hypoglycemia. The patient needs to eat by 5:00 p.m. A fingerstick is not necessary at 2:00 p.m. The insulin should not be routinely administered IV. The patient would not be at high risk for hyperglycemia at 10:00 a.m.

A patient with a thyroid disorder states, "I am unable to distinguish between the tastes of different foods." Which medication would the nurse expect is responsible for this condition? 1 Liotrix 2 Methimazole 3 Levothyroxine 4 Desiccated thyroid

2 Methimazole

The nurse is assessing an older adult who has a dermatologic disorder and has been prescribed methylprednisolone. During the assessment, the nurse learns that the patient has myasthenia gravis and is taking anticholinesterase medications. Which adverse effect would the nurse expect if methylprednisolone is administered to this patient? 1 Memory loss 2 Muscle weakness 3 Impaired hearing ability 4 Inflammation of the joints

2 Muscle weakness Simultaneous administration of corticosteroids such as methylprednisolone and anticholinesterase medication in patients with myasthenia gravis would cause muscle weakness from a drug-drug interaction. This effect is usually caused by alterations of potassium and acetylcholine concentrations. Loss of memory may result from depletion of acetylcholine concentration but not a drug-drug interaction. Unlike aminoglycosides, methylprednisolone and anticholinesterase medications do not cause ototoxicity. Therefore the patient would not develop a hearing impairment. Corticosteroids are usually prescribed for the treatment of osteoarthritis to reduce inflammation and do not cause inflammation at the joints.

Which oral drug is used in patients with type 2 diabetes who have not had success with metformin or glipizide? 1 Glimepiride 2 Pioglitazone 3 Troglitazone 4 Rosiglitazone

2 Pioglitazone Pioglitazone is a glitazone that is reserved for patients who cannot achieve glucose control with metformin or the sulfonylureas. The drug decreases insulin resistance by enhancing the sensitivity of insulin receptors. Glimepiride is a drug that belongs to the class of sulfonylureas. Troglitazone is a glitazone that was discontinued from the market because it causes liver toxicity. Rosiglitazone is also no longer prescribed because it causes cardiac problems.

What role does the release of cortisol play in the stress response? 1 Decreases oxygen delivery 2 Provides more fuel for cells 3 Decreases coagulability of blood 4 Reduces blood flow to vital organs

2 Provides more fuel for cells In response to stress, the adrenal cortex secretes increased amounts of glucocorticoids, and the adrenal medulla secretes increased amounts of epinephrine. Working together, glucocorticoids and epinephrine help to augment and increase the blood glucose concentration, blood pressure, coagulation factors, and oxygenation as part of the fight-or-flight mechanism (stress response). Thus they provide more fuel for cells. Cortisol increases oxygen delivery to the vital organs by increasing the blood flow. Blood coagulability also increases.

Which clinical finding indicates water intoxication in the patient who is taking vasopressin? 1 Polyuria 2 Seizures 3 Polydipsia 4 Hypotension

2 Seizures Vasopressin can cause excessive water retention, progressing to water intoxication. Clinical manifestations include drowsiness, headache, listlessness, seizures, and coma. Vasopressin and desmopressin are used to prevent or control polyuria, polydipsia (excessive thirst), and dehydration in patients with diabetes insipidus caused by a deficiency of endogenous antidiuretic hormone (ADH).

When assessing for potential side effects of fludrocortisone, which assessment is a priority for the nurse to monitor? 1 Serum calcium levels for hypercalcemia 2 Serum potassium levels for hypokalemia 3 Serum sodium levels for potential hyponatremia 4 Intake and output for potential fluid volume deficit

2 Serum potassium levels for hypokalemia Fludrocortisone has mineralocorticoid properties, which can result in potassium excretion and lead to hypokalemia. It can also cause sodium and fluid retention, leading to hypernatremia and fluid volume excess. Calcium levels are not a concern.

Which genitourinary adverse effects does the nurse expect in the patient who is on therapy with antithyroid medication? Select all that apply. 1 Bleeding 2 Smoky urine 3 Decreased urinary output 4 Increased blood urea nitrogen 5 Increased serum creatinine levels

2 Smoky urine 3 Decreased urinary output A patient on antithyroid medication experiences various adverse effects. Smoky urine and decreased urinary output are genitourinary adverse effects of antithyroid medication. Bleeding is a hematologic adverse effect. Increased blood urea nitrogen and increased serum creatinine levels are renal adverse effects.

The nurse is assessing a patient who has been prescribed thyroid replacement drugs for the first time. The nurse asks the patient to take the daily medication every morning on an empty stomach. Which are the reasons for this instruction? Select all that apply. 1 To minimize the therapeutic effects 2 To decrease the likelihood of insomnia 3 To increase the likelihood of daytime sleep 4 To decrease the risk of drug-drug interactions 5 To maintain consistent blood levels of the drug

2 To decrease the likelihood of insomnia 4 To decrease the risk of drug-drug interactions 5 To maintain consistent blood levels of the drug

Which drug is used to treat pulseless cardiac arrest according to the Advanced Cardiac Life Support (ACLS) guidelines? 1 Somatropin 2 Vasopressin 3 Desmopressin 4 Luteinizing hormone

2 Vasopressin

A nurse is monitoring a client receiving desmopressin acetate (DDAVP) for diabetes insipidus. Which of the following indicates the presence of an adverse effect? 1. Insomnia 2. Drowsiness 3. Weight loss 4. Increased urination

2. Drowsiness Rationale: Water intoxication (overhydration) or hyponatremia is an adverse effect to desmopressin. Early signs include drowsiness, listlessness, and headache. Decreased urination, rapid weight gain, confusion, seizures, and coma also may occur in overhydration.

Which medication would be prescribed for a patient experiencing an exacerbation of chronic obstructive pulmonary disease (COPD)? 1 Aldosterone 2 Betamethasone 3 Fludrocortisone 4 Methylprednisolone

4 Methylprednisolone Methylprednisolone is a corticosteroid administered intravenously to treat COPD exacerbations to reduce bronchial inflammation. Aldosterone controls renal absorption of electrolytes. Betamethasone is available as a topical corticosteroid used to treat dermatological conditions and is also used intravenously to accelerate fetal lung development. Fludrocortisone is prescribed to control Addison's disease.

The health care provider (HCP) prescribes exenatide (Byetta) for a client with type 1 diabetes mellitus who takes insulin. The nurse knows that which of the following is the appropriate intervention? 1. The medication is administered within 60 minutes before the morning and evening meal. 2. The medication is withheld and the HCP is called to question the prescription for the client. 3. The client is monitored for gastrointestinal side effects after administration of the medication. 4. The insulin is withdrawn from the Penlet into an insulin syringe to prepare for administration.

2. The medication is withheld and the HCP is called to question the prescription for the client. Rationale:Exenatide (Byetta) is an incretin mimetic used for type 2 diabetes mellitus only. It is not recommended for clients taking insulin. Hence, the nurse should hold the medication and question the HCP regarding this prescription. Although options 1 and 3 are correct statements about the medication, in this situation the medication should not be administered. The medication is packaged in prefilled pens ready for injection without the need for drawing it up into another syringe.

The nurse is caring for a patient scheduled to undergo a cardiac catheterization procedure utilizing iodine-based contrast material. The nurse would question an order for which medication to be given to this patient the day of the scheduled procedure? 1. acarbose (Precose) 2. metformin (Glucophage) 3. repaglinide (Prandin) 4. pioglitazone (Actos)

2. metformin (Glucophage) The concurrent use of metformin and iodinated (iodine-containing) radiologic contrast media has been associated with both acute renal failure and lactic acidosis. Therefore metformin should be discontinued at least 48 hours prior to any radiologic study requiring such contrast media and should be held for at least 48 hours after the procedure.

Which instruction does the nurse give when a patient receiving metformin therapy will undergo angiography? 1 "There are chances of renal failure after the test." 2 "Your blood glucose levels need to be reevaluated." 3 "Do not take your metformin on the day of the test." 4 "You can take the medication an hour after the test."

3 "Do not take your metformin on the day of the test."

The nurse teaches a patient receiving long-term corticosteroid drug therapy about the dosage regimen. Which response by the patient indicates the need for further teaching? 1 "I will take this medication with food or milk regularly." 2 "I will not touch or interact with people who have infections." 3 "I will stop taking this medication if I have any adverse effects." 4 "I will report to you immediately if I have fever or a sore throat."

3 "I will stop taking this medication if I have any adverse effects." A patient who is receiving corticosteroid drug therapy should not stop medications abruptly because it may lead to a sudden decrease in the production of endogenous glucocorticoid. This may cause adrenal insufficiency in the patient. In long-term therapy, alternate-day dosing of glucocorticoids will help to minimize adrenal suppression. A common side effect of corticosteroid therapy is gastrointestinal distress; hence, these drugs should be administered with food or milk. Fever, sore throat, increased weakness, and lethargy are potential adverse effects of these drugs, and the patient should contact the nurse or the primary health care provider immediately if they occur. Because these medications suppress the immune system, patients taking corticosteroids need to avoid contact with people who have an infection.

A patient with type 1 diabetes mellitus asks the nurse, "Why can't I take a sulfonylurea like my friend who has diabetes?" Which response is correct? 1 "You must be mistaken. If your friend has diabetes mellitus, she is taking insulin." 2 "Sulfonylurea will lower your blood sugar too much, and you will be hypoglycemic." 3 "Sulfonylurea increases beta-cell stimulation to secrete insulin, and your beta cells do not contain insulin." 4 "You are unable to store glucose because you do not have insulin, and sulfonylurea helps with glucose storage."

3 "Sulfonylurea increases beta-cell stimulation to secrete insulin, and your beta cells do not contain insulin." Sulfonylurea agents reduce serum glucose levels by increasing beta-cell stimulation for insulin release and decreasing hepatic glucose production. It is administered for type 2 diabetes mellitus but will not be effective in individuals with type 1 diabetes. Not all patients with type 2 diabetes require insulin, but patients with type 1 diabetes require insulin. Patients with type 1 diabetes are able to store glucose as glycogen. Sulfonylureas do not help the liver store glucose.

The nurse is caring for several patients who are receiving glucocorticoid therapy. Which patient would the nurse assess first? 1 A patient with septic shock 2 A patient with rheumatoid arthritis 3 A patient with uncontrolled diabetes mellitus 4 A patient experiencing an exacerbation of asthma

3 A patient with uncontrolled diabetes mellitus A common side effect of steroid therapy is hyperglycemia. A patient with uncontrolled diabetes mellitus could suffer a severe hyperglycemic episode. Glucocorticoids are contraindicated in patients with diabetes mellitus. The risks and benefits should be considered. Patients with septic shock, rheumatoid arthritis, or asthma should not experience life-threatening side effects from glucocorticoid therapy.

Which condition is contraindicated with somatrem? 1 Polyuria 2 Polydipsia 3 Acromegaly 4 Hypopituitary dwarfism

3 Acromegaly Somatrem is a synthetic form of growth hormone. Acromegaly is caused by excessive growth hormone; therefore this drug would be contraindicated. Polyuria and polydipsia cannot be treated with somatrem. Hypopituitary dwarfism is treated by administering somatrem.

Which condition would a nurse expect in a patient who abruptly withdraws from a glucocorticoid medication? 1 Cataracts 2 Osteoporosis 3 Addison's disease 4 Cushing's syndrome

3 Addison's disease Abrupt withdrawal of glucocorticoid medication causes a rapid drop in cortisol levels and may lead to Addison's disease. Cataracts, osteoporosis, and Cushing's syndrome are effects of long-term corticosteroid use.

Which laboratory findings would the nurse expect for an adult patient with hyperosmolar hyperglycemic syndrome (HHS)? Select all that apply. 1 Low pH 2 Low serum HCO3 level 3 High serum sodium level 4 Serum osmolality of 380 mOsm/kg 5 Serum glucose level over 600 mg/dL

3 High serum sodium level 4 Serum osmolality of 380 mOsm/kg 5 Serum glucose level over 600 mg/dL Hyperosmolar hyperglycemic syndrome (HHS) is caused by hyperglycemia. It occurs most often in patients who are over 40 years of age. In this condition, the serum sodium level is high, the serum osmolality is greater than 350 mOsm/kg, and the serum glucose level is above 600 mg/dL. A low pH and a low serum HCO3 level are the clinical findings for a patient with diabetic ketoacidosis.

While assessing a patient who has hypoglycemia, a nursing student finds that the patient has severe weight loss. The patient's laboratory reports suggest that there is a decrease in the sodium concentration and increase in potassium concentration. Which condition does the nursing student suspect? 1 Hypothyroidism 2 Insulin resistance 3 Addison's disease 4 Cushing's syndrome

3 Addison's disease Hypoglycemia, weight loss, decrease in sodium concentration, and increase in potassium concentration are all symptoms of Addison's disease. Addison's disease is caused by the hyposecretion of adrenocortical hormones. This results in a reduction in the levels of glucose from impaired functioning of beta cells. This patient also has a loss of sodium and an increase in potassium concentrations because of impaired renal function. Hypothyroidism results from reduced thyroid hormone secretion. It is characterized by impaired metabolism and weight gain. Insulin resistance may cause hyperglycemia and diabetes mellitus. It would not cause this patient's hypoglycemia. Cushing's syndrome is characterized by "moon face," caused by the redistribution of fat from the arms and legs to the face and shoulders.

The nurse is caring for a patient who has undergone nasal surgery for the removal of polyps. Which treatment strategy would the nurse expect to be used to prevent the recurrence of polyps? 1 Suggesting deep-breathing exercises 2 Administering antibiotics to the patient 3 Administering glucocorticoids to the patient 4 Suggesting avoiding drinking grape and citrus fruit juices

3 Administering glucocorticoids to the patient The health care provider would prescribe nasal administration of glucocorticoids to manage rhinitis associated with polyps and to prevent the recurrence of polyps. Long-term glucocorticoid therapy is effective in managing and preventing the recurrence of polyps. A 1-week tapered course of oral corticosteroids may be prescribed along with glucocorticoid nasal spray. Deep-breathing exercises may cause only temporary relief, and these are very challenging in these patients. Antibiotics are prescribed to control any underlying infections before corticosteroid therapy is initiated, but they are less effective in preventing the recurrence of polyps after surgical removal. Grape and citrus fruit juices help in tissue repair and healing. They will not cause the polyps to recur.

A health care provider prescribes a drug for a patient who is underweight and shows symptoms of diarrhea, increased appetite, and flushing. Which other drug in the patient's medication history would be of concern for the nurse? 1 Antidiabetics 2 Antihistamines 3 Anticoagulants 4 Beta-lactam antibiotics

3 Anticoagulants Symptoms such as reduced weight, diarrhea, increased appetite, and flushing are consequences of increased metabolism caused by hyperactivity of the thyroid gland. Antithyroids are used in treating this condition, and the dosage is adjusted when the patient is already taking anticoagulants. Antidiabetics are contraindicated with thyroid drugs but not with antithyroids. Antihistamines and beta-lactam antibiotics are not contraindicated in a patient who is on antithyroids.

Which laboratory value would the nurse monitor in a patient receiving methylprednisolone? 1 Sodium 2 Magnesium 3 Blood glucose 4 Carbon dioxide (CO2)

3 Blood glucose Glucocorticoids such as methylprednisolone can elevate blood glucose levels. These drugs do not affect sodium, magnesium, or CO2 levels.

Which conditions can be treated with glucocorticoid drugs? Select all that apply. 1 Glaucoma 2 Septicemia 3 Cerebral edema 4 Varicella infection 5 Systemic lupus erythematous 6 Chronic obstructive pulmonary disease

3 Cerebral edema 5 Systemic lupus erythematous 6 Chronic obstructive pulmonary disease

Which drug is used to diagnose adrenocortical insufficiency? 1 Octreotide 2 Somatropin 3 Cosyntropin 4 Desmopressin

3 Cosyntropin Cosyntropin is used for the diagnosis of adrenocortical insufficiency. The test involves injecting a small amount of the drug, after which the cortisol levels are measured in response to the drug. Octreotide is useful in alleviating symptoms of carcinoid tumors. Somatropin is used in the treatment of growth hormone deficiency. Desmopressin is useful in the treatment of hemophilia A and type I von Willebrand disease.

Which drug may cause hypervolemia? 1 Oxytocin 2 Octreotide 3 Cosyntropin 4 Thyroid hormone

3 Cosyntropin Cosyntropin, a synthetic adrenocorticotropic hormone, stimulates the adrenal cortex to release cortisol. Cortisol is a glucocorticoid that promotes renal reabsorption of sodium, leading to the passive movement of water with the sodium. Oxytocin stimulates uterine contractions, octreotide helps diminish the watery diarrhea associated with acquired immunodeficiency syndrome (AIDS), and thyroid hormone is replacement therapy for inadequate thyroid levels.

Blood glucose analysis indicates the patient taking glipizide is hypoglycemic. Which other medication in the patient's medical history would the nurse suspect as the cause of this condition? 1 Rifampin 2 Phenytoin 3 Fluconazole 4 Carbamazepine

3 Fluconazole Glipizide is a second-generation sulfonylurea drug. When glipizide is administered with fluconazole, it enhances the effects of glipizide, resulting in hypoglycemia. Rifampin, phenytoin, and carbamazepine decrease the effectiveness of metformin by increasing its metabolism when taken with metformin. These medications would cause the patient to experience hyperglycemia.

A patient is being treated for secondary adrenocortical insufficiency. If the patient's adrenal glands are still intact, which medication used in the treatment of primary adrenocortical insufficiency would the nurse avoid? 1 Prednisone 2 Cosyntropin 3 Fludrocortisone 4 Glargine insulin

3 Fludrocortisone Adrenocorticotropic hormone (ACTH) is released from the anterior pituitary gland in response to a deficient circulating concentration of cortisol. Secondary adrenocortical insufficiency is usually caused by glucocorticoid administration; for this reason, the nurse would avoid giving this patient fludrocortisone because the patient's adrenal glands are intact and still produce aldosterone. Prednisone is indicated in the treatment of primary and secondary adrenocortical insufficiency. Cosyntropin, a synthetic ACTH, is not indicated in the treatment of primary or secondary adrenocortical deficiency. Glargine insulin may be indicated if the patient also has diabetes mellitus.

Which hormones are produced by the anterior pituitary gland? Select all that apply. 1 Thyroxine 2 Aldosterone 3 Growth hormone (GH) 4 Thyroid-stimulating hormone (TSH) 5 Thyrotropin-releasing hormone (TRH) 6 Adrenocorticotropic hormone (ACTH)

3 Growth hormone (GH) 4 Thyroid-stimulating hormone (TSH) 6 Adrenocorticotropic hormone (ACTH) Growth hormone (GH), thyroid-stimulating hormone (TSH), and adrenocorticotropic hormone (ACTH) are produced by the anterior pituitary gland. Thyroxine is released from the thyroid gland. Aldosterone is secreted from the adrenal cortex. Thyrotropin-releasing hormone (TRH) is released from the hypothalamus.

The nurse is caring for a patient who has myxedema. The nurse administers a hypothyroid drug and later learns that the drug was improperly mixed and that an increased dose of the drug was administered to the patient. For which symptom would the nurse initially assess? 1 Bloody stools 2 Increased sleep 3 Increased heart rate 4 Reduced urine output

3 Increased heart rate Myxedema is a condition where thyroid activity is diminished. Hypothyroid drugs such as levothyroxine are prescribed to treat it. When this drug is given in high doses, the patient's cardiac activity may be altered, so the nurse would check for increased heart rate. Diarrhea is also observed as a side effect in the event of an overdose. However, bloody stools are not observed. Patients who are administered an overdose of the drug develop insomnia as a side effect. Irregularities in urine output are a symptom of declined renal function. However, they may not be caused by an overdose of thyroid hormones.

Which mechanism of action of desmopressin is the rationale for prescribing it to a patient with hemophilia A? 1 Constricts the blood vessels 2 Increases the water reabsorption 3 Increases the percentage of clotting factor VIII 4 Stimulates the release of von Willebrand factor

3 Increases the percentage of clotting factor VIII Hemophilia A is a hereditary disorder characterized by lack of blood-clotting factor VIII. This absence may lead to bleeding from even a small injury. Desmopressin is used to increase the percentage of clotting factor VIII in the blood and control the bleeding. Vasopressin and desmopressin have other mechanisms of action that are useful in therapy of other conditions. Vasopressin increases the peripheral vascular resistance, which, in turn, increases arterial blood pressure. Vasopressin and desmopressin regulate the retention of water in the body by increasing the water reabsorption in the collecting ducts of the kidney to treat dehydration. Desmopressin is used to treat type I von Willebrand disease by stimulating the release of von Willebrand factor, a multimeric protein that plays a major role in blood coagulation.

Which long-acting insulin mimics natural, basal insulin with its duration of 24 hours? 1 Insulin aspart 2 Regular insulin 3 Insulin glargine 4 Ultralente insulin

3 Insulin glargine Insulin glargine has a duration of action of 24 hours with no peaks, mimicking natural, basal insulin secretion by the pancreas. Insulin aspart is a rapid-acting human insulin analogue used to lower blood glucose, which has a different dosage. Regular insulin has its duration of action of 6 to 10 hours, with a peak plasma concentration of 2.5 hours. Ultralente insulin has an active duration of 28 hours.

Which insulin will the nurse administer to supplement basal insulin to imitate the pancreatic surge of insulin that accompanies eating? 1 Insulin detemir 2 Insulin glargine 3 Insulin glulisine 4 Neutral protamine Hagedorn (NPH) insulin

3 Insulin glulisine The nurse would administer a rapid-acting form of regular insulin, such as insulin glulisine, because the onset of action occurs 15 minutes after its administration. Insulin detemir and insulin glargine are basal insulins. NPH insulin is an intermediate-acting insulin that would take too long to act in this situation.

Which medication is used to treat myxedema coma? 1 Liotrix 2 Methimazole 3 Levothyroxine 4 Propylthiouracil

3 Levothyroxine Levothyroxine is a synthetic thyroid hormone (T4) used to treat myxedema coma. Liotrix is a thyroid supplement used in the treatment of hypothyroidism. Methimazole and propylthiouracil are the two thioamide derivatives used in the treatment of hyperthyroidism.

The nurse is caring for a patient who has congenital hypothyroidism. Which medication would the nurse expect the primary health care provider to prescribe? 1 Liotrix 2 Methimazole 3 Levothyroxine 4 Propylthiouracil

3 Levothyroxine Levothyroxine is a thyroid drug used to treat congenital hypothyroidism. Liotrix is a thyroid drug used to treat hypothyroidism but not congenital hypothyroidism. Methimazole and propylthiouracil are the antithyroid drugs used to treat hyperthyroidism but not congenital hypothyroidism.

Which thyroid preparation, considered the purest form of thyroxine (T4), is the drug of choice for hypothyroidism? 1 Liotrix 2 Liothyronine 3 Levothyroxine 4 Propylthiouracil

3 Levothyroxine The drug of choice for thyroid hormone replacement therapy is the purest form of thyroxine, levothyroxine. Liotrix is a combination of liothyronine and levothyroxine and is not considered the purest form. Propylthiouracil is an antithyroid medication used in the treatment of hyperthyroidism.

The nurse teaches a nursing student about liotrix. Which statement made by the nurse is appropriate? 1 Liotrix contains T3 alone. 2 Liotrix contains T4 alone. 3 Liotrix contains T4 and T3 in a 4:1 ratio. 4 Liotrix contains T4 combined with calcium.

3 Liotrix contains T4 and T3 in a 4:1 ratio.

Which assessment findings would the nurse expect in a child who has cretinism? Select all that apply. 1 Weight gain 2 Heat intolerance 3 Mental Retardation 4 Low metabolic rate 5 Dullness of the skin

3 Mental Retardation 4 Low metabolic rate

A nurse is caring for a patient who is prescribed metformin therapy. The patient's blood glucose level is 200 mg/dL. Which assessment findings indicate lactic acidosis? Select all that apply. 1 Diarrhea 2 Bloating 3 Muscle pain 4 Abdominal pain 5 Cold, clammy skin

3 Muscle pain 4 Abdominal pain 5 Cold, clammy skin Lactic acidosis is a rare but lethal adverse reaction associated with metformin, particularly in the patient with renal impairment. Clinical manifestations of lactic acidosis include muscle pain, abdominal pain, and cold, clammy skin. The most common adverse effects of metformin are gastrointestinal disturbances. Metformin can cause abdominal bloating, nausea, cramping, a feeling of fullness, and diarrhea, especially at the start of therapy. Diarrhea and bloating do not indicate lactic acidosis.

The nurse finds that a patient with type 2 diabetes mellitus who is taking glipizide is also prescribed sitagliptin. Which action will the nurse take? 1 Decrease the oral dose of glipizide. 2 Administer both medications simultaneously. 3 Notify the prescribing primary health care provider. 4 Give both drugs and checks the patient's blood glucose.

3 Notify the prescribing primary health care provider. Concurrent use of glipizide and sitagliptin results in hypoglycemia. Hence the nurse needs to notify the primary health care provider who ordered the medications to obtain a prescription to change the drug regimen. Reducing the glipizide dose is not safe because the drug interacts with sitagliptin. Administering both medications will result in hypoglycemia. The nurse does not administer sitagliptin to the patient because it may compromise the patient's safety.

Which statement made by the patient about type 1 diabetes mellitus indicates effective learning? 1 Endogenous insulin levels are elevated early in the disease. 2 Type 1 diabetes mellitus accounts for 90% of all diabetic cases. 3 Patients with type 1 diabetes mellitus require exogenous insulin 4 Type 1 diabetes mellitus leads to developing acute hypoglycemia.

3 Patients with type 1 diabetes mellitus require exogenous insulin Type 1 diabetes involves lack of insulin production. Hence patients with type 1 diabetes require exogenous insulin to lower the blood glucose level. There is little or no endogenous insulin, as the patient's body is unable to produce insulin. The disease accounts for 10% of all cases and is usually seen in patients younger than 20 years. Type 1 diabetes results in acute hyperglycemia due to lack of insulin.

A nurse is preparing to administer an intraarticular injection of a glucocorticoid medication. Which action by the nurse is correct? 1 Instruct the patient to rest the area for 8 hours. 2 Apply a pressure bandage to the injection site. 3 Place a cold pack over the injection site to minimize pain. 4 Monitor the patient's vital signs every 30 minutes for 4 hours.

3 Place a cold pack over the injection site to minimize pain. When providing care to a patient who received an intraarticular injection of a glucocorticoid medication, the nurse would place a cold pack over the injection site to minimize pain. The cold pack can be used for up to 24 hours. The patient would be educated to rest the area of the injection for 48 hours. A pressure bandage is not required after this procedure. The nurse would monitor the patient's vital signs as per the health care provider's prescription. It is not necessary to monitor the patient's vital signs every 30 minutes for a 4-hour period.

Which reason is the likely cause of a decrease in milk production for a breastfeeding woman with type 1 diabetes? 1 Large weight gain 2 Second generation sulfonylureas 3 Poor glycemic control of blood sugars 4 Lack of sleep at night

3 Poor glycemic control of blood sugars Both hyperglycemia and hypoglycemia in a breastfeeding patient can lead to a decrease in milk production. Hence the patient's insulin therapy and diet need to be well controlled. Large weight gain may increase fetal complications. Oral drugs are not used in individuals with type 1 diabetes. If the woman is breastfeeding at night, lack of sleep at night would not decrease milk production.

The nurse is caring for a patient who has systemic lupus erythematosus who has been taking prednisone for several years. Which change in the patient will the nurse assess to detect complications from long-term therapy? 1 Hair loss 2 Pale skin 3 Presence of belly fat 4 Sudden increase in height

3 Presence of belly fat Long-term use of prednisone therapy would result in Cushing's syndrome, which is characterized by obesity of the trunk area (referred to as belly fat), facial erythema, and "moon face." Prednisone therapy is not associated with hair loss. The patient may have darkened rather than pale skin. The patient may have decreased height because the drug suppresses growth, especially in children. Therefore a sudden increase in height is not an adverse effect of prednisone.

The laboratory results for a patient indicate markedly elevated blood glucose levels. After assessing the patient, the nurse obtains a prescription for intravenous insulin therapy from the primary health care provider. Which other assessment finding is present in the patient's reports? 1 Increased weight 2 Extreme hypoglycemia 3 Presence of ketones in the serum 4 High levels of endogenous insulin

3 Presence of ketones in the serum The presence of ketones in the serum along with elevated glucose levels indicates diabetic ketoacidosis. Hence intravenous insulin therapy is started immediately to prevent acute hyperglycemia, which may cause coma or death. Weight gain is not an emergency in this case and may be caused by other factors, such as heart failure. Extreme hypoglycemia is seen in patients due to low glucose levels. Low levels or lack of endogenous insulin causes diabetic ketoacidosis.

The nurse is assessing a patient who is experiencing pain, muscle weakness, and edema. The patient's laboratory reports indicate the patient has increased concentrations of sodium. Which condition do these findings suggest? 1 Addison's disease 2 Primary hypotension 3 Primary aldosteronism 4 Type 1 diabetes mellitus

3 Primary aldosteronism Increased sodium concentration and amounts of water indicate primary aldosteronism, which is caused by the hypersecretion of aldosterone. This is characterized by muscle pain, which results from a loss of potassium. Addison's disease is characterized by a loss, not increase, of sodium. An increase in fluid and sodium may cause hypertension, not hypotension. Diabetes mellitus is caused by an increase in blood glucose concentrations, and it cannot be inferred from sodium concentration.

The nurse is caring for a patient with Addison's disease who has been prescribed a combination of oral prednisone and fludrocortisone. After a few days the patient reports severe gastrointestinal upset. Which treatment does the nurse expect to be prescribed for the patient? 1 Extra oral adrenal medication 2 Decreased dose of prednisone 3 Proton pump inhibitor medication 4 Decreased dose of fludrocortisone

3 Proton pump inhibitor medication Corticosteroids such as prednisone and fludrocortisone cause severe gastrointestinal upset when administered orally because of their ulcerative properties. Hence to prevent ulcer formation, the health care provider prescribes a proton pump inhibitor or a histamine 2 (H2)-receptor antagonist. The inclusion of an extra oral adrenal drug in the prescription may reduce the risk of Addison's disease but further increase the gastrointestinal upset. Decreased doses of prednisone and fludrocortisone may increase the risk of Addison's disease.

Which function of somatropin is therapeutic for a patient who has human immunodeficiency virus (HIV)? 1 Decreases growth 2 Reduces fat levels 3 Reduces weight loss 4 Decreases fluid retention

3 Reduces weight loss Somatropin is given in conjunction with antiviral therapy to treat the wasting syndrome (i.e., cachexia) associated with HIV. Somatropin helps in treating the complications of the wasting syndrome, such as weight loss, muscle atrophy, fatigue, weakness, and loss of appetite. Somatropin mimics the growth hormone and stimulates growth by providing the required supplies by a different mechanism. Somatropin does not reduce, but instead mobilizes, lipids from the fat stores to make them available for use. Somatropin increases sodium levels by promoting sodium and fluid retention.

Assuming the patient eats breakfast at 9:00 AM, lunch at noon, and dinner at 6:00 PM, he or she is at highest risk of hypoglycemia following an 8:30 AM dose of NPH insulin at what time? 1) 10 AM 2) 2 AM 3) 3 PM 4) 8 PM

3) 3PM Breakfast eaten at 9:00 AM would cover the onset of NPH insulin, and lunch will cover the 1 PM time frame. However, if the patient does not eat a mid-afternoon snack, the NPH insulin may be peaking just before dinner without sufficient glucose on hand to prevent hypoglycemia.

The nurse administers insulin to a patient at 8:30 a.m. and knows it will peak about 2.5 hours after administration. Which insulin did the nurse administer if this is true? 1 Insulin lispro 2 Insulin aspart 3 Regular insulin 4 Insulin glulisine

3 Regular insulin Regular insulin peaks about 2.5 hours after the drug's administration. If the drug is given at 8:30 a.m., it will have its peak effects at 11:00 a.m., and at that time, the nurse would observe for signs of hypoglycemia. Insulin lispro, insulin aspart, and insulin glulisine are all considered rapid-acting insulin. The onset of action for these drugs is about 15 minutes, and the effects do not last as long as with other classes of insulin.

A patient with diabetes mellitus has recently undergone pancreas transplantation. According to the prescription, the nurse administers a long-acting depot formulation of methylprednisolone. The next day, the patient's blood glucose concentration and blood pressure are higher than the normal levels. Which factor may be the reason for the high blood glucose concentration? 1 Failure of the pancreas transplantation 2 Complete elimination of the drug from the body 3 Release of excess drug from the depot formulation 4 Presence of benzyl alcohol in the depot formulation

3 Release of excess drug from the depot formulation Methylprednisolone has the same actions as aldosterone. It increases blood glucose concentrations in patients with diabetes as well as water and sodium retention. Therefore the increase in blood glucose concentration is an adverse effect of the drug. If the pancreas transplantation is a failure, then only the blood glucose concentration would increase; the blood pressure would remain normal. If the drug is completely eliminated from the body, there would not be increase in blood pressure because of the reduced concentration of drug. Benzyl alcohol is harmful only in infants younger than 28 days.

Which assessment will the nurse make for a patient who is prescribed metformin for treatment of type 2 diabetes? 1 Edema 2 Weight gain 3 Renal function 4 Cholesterol level

3 Renal function Because metformin is excreted by the kidneys, it is necessary to assess the patient's renal function. If the patient's kidneys are not able to excrete the drug, it will accumulate in the patient's system, thereby causing lactic acidosis. Edema is not an adverse effect of metformin. One of the adverse effects of metformin is weight loss, not weight gain. Cholesterol levels may be high in some diabetic patients but can be treated with medications and lifestyle changes.

The nurse finds that, after 6 months of treatment for hyperthyroidism, a patient has little evidence of hyperthyroidism. Which condition does this imply regarding the patient's present condition? 1 The patient is receiving a higher dose of drug than prescribed. 2 The disease is progressing silently without any manifestations. 3 The patient has met the predicted outcomes of the treatment regimen. 4 The patient needs a slightly higher dose to resolve the condition completely.

3 The patient has met the predicted outcomes of the treatment regimen. Any intervention should be evaluated to deduce the outcomes. The treatment regimen is rigorously evaluated to reduce the possible adverse effects. After a thorough assessment, the nurse evaluates the prognosis of the patient's condition. Here, based on the findings, the nurse interprets that the patient has good prognosis with the predicted outcomes. The disease is not progressing silently because the patient is doing well in every aspect of life. The dosage cannot suddenly be reduced or discontinued. After thoroughly assessing and observing the patient's blood parameters, the primary health care provider will make the appropriate decision. The patient has been doing well with the current dosage for 6 months, so the patient does not need an increased dosage in the regimen.

A patient is receiving long-term prednisone therapy. During the follow-up visit, the nurse finds that the patient has gained weight and has low levels of adrenal hormone. Which actions by the patient would have led to an alteration in the adrenal hormone level? 1 The patient took the medication with milk. 2 The patient took the medication after meals. 3 The patient took the medication during the night. 4 The patient included high-protein food in the diet.

3 The patient took the medication during the night. Adrenal suppression may cause a decrease in the hormone levels and an increase in weight. Usually corticosteroid hormones should be taken early in the morning to synchronize with the circadian rhythm of the adrenal glands. Adrenal glands secrete a large amount of adrenal hormone during the early morning hours, so taking the medication during the night may cause adrenal suppression. The medications should be taken with milk or food to prevent gastric upset. Including protein-rich food in the diet would not affect drug metabolism and does not interact with the drug.

Which statement about glucocorticoids is correct? 1 They are not produced during stressful situations. 2 They decrease serum sodium and glucose concentrations. 3 They influence carbohydrate, fat, and protein metabolism. 4 They stimulate defense mechanisms to produce immunity.

3 They influence carbohydrate, fat, and protein metabolism. Glucocorticoids play a major role in carbohydrate, lipid, and protein metabolism within the body. They are produced in increasing amounts during stress. They cause an increase in serum sodium and serum glucose concentrations, thus precipitating hypernatremia and hyperglycemia as adverse effects, respectively. They are used as immunosuppressants. Hence they are not involved in stimulating defense mechanisms; rather, they suppress them.

A patient is about to receive steroid therapy. Which disorder would contraindicate administration of the medication? 1 Asthma 2 Rheumatoid arthritis 3 Uncontrolled diabetes mellitus 4 Chronic obstructive pulmonary disease

3 Uncontrolled diabetes mellitus A common adverse effect of steroid therapy is hyperglycemia. Therefore the nurse would look for uncontrolled diabetes mellitus in the patient. Rheumatoid arthritis is a chronic autoimmune disorder that commonly causes inflammation and tissue damage in joints, and it is not directly linked with steroid therapy. Steroid therapy is a remedy for chronic obstructive pulmonary disease and asthma.

A patient has septic shock. Which drug will the nurse expect to administer? 1 Oxytocin 2 Octreotide 3 Vasopressin 4 Cosyntropin

3 Vasopressin Vasopressin is a potent vasoconstrictor that is used in the treatment of vasodilatory shock. Oxytocin, octreotide, and cosyntropin would not be administered to a patient for the treatment of toxic shock.

A nurse is caring for a client with hyperparathyroidism and notes that the client's serum calcium level is 13 mg/dL. Which medication should the nurse prepare to administer as prescribed to the client? 1. Calcium chloride 2. Calcium gluconate 3. Calcitonin (Miacalcin) 4. Large doses of vitamin D

3. Calcitonin (Miacalcin) Rationale: The normal serum calcium level is 8.6 to 10.0 mg/dL. This client is experiencing hypercalcemia. Calcium gluconate and calcium chloride are medications used for the treatment of tetany, which occurs as a result of acute hypocalcemia. In hypercalcemia, large doses of vitamin D need to be avoided. Calcitonin, a thyroid hormone, decreases the plasma calcium level by inhibiting bone resorption and lowering the serum calcium concentration.

Which instruction will the nurse give a patient who self-administers regular insulin injections? 1 "Insert the insulin needle at a 30-degree angle." 2 "Rotate the insulin injection site every 2 weeks." 3 "Administer the insulin 15 minutes before meals." 4 "Administer the insulin injection subcutaneously."

4 "Administer the insulin injection subcutaneously." The nurse instructs the patient to administer the injection in the subcutaneous tissue for safety and effective absorption of insulin. The injection is administered at a 45- to 90-degree angle depending on the patient's size. The injection sites need to be rotated every week to prevent lipodystrophy. Regular insulin is a short-acting insulin and needs to be taken 30 minutes before meals.

The nurse is teaching safe administration of medication to a patient who has been prescribed levothyroxine. Which statement would the nurse include in the teaching session? 1 "Always take the medication thrice a day, after meals." 2 "Take this medication with 250 mL of orange juice regularly." 3 "There are no dietary restrictions while taking this medication." 4 "Consult your provider before taking over-the-counter medications."

4 "Consult your provider before taking over-the-counter medications." Patients who are prescribed thyroid replacements or antithyroid drugs should be advised to avoid taking over-the-counter medicines without first consulting with their primary health care providers. This helps prevent adverse effects caused by drug interactions. The nurse would instruct the patient to take the medication once a day on an empty stomach, half an hour before breakfast. This helps enhance the absorption of the drug. Taking the medication thrice a day after meals may reduce the therapeutic effectiveness of the medication and cause adverse effects. This medication should be taken with water rather than orange juice because it helps enhance the disintegration and absorption of the drug. A patient needs to avoid eating foods that may reduce thyroid hormone production and reduce the effectiveness of the medication. Therefore the nurse would not give false information that the patient need not follow dietary restrictions.

The nurse is teaching a patient who is prescribed desmopressin and who has polyuria, polydipsia, and dehydration. Which statement by the patient indicates the need for additional teaching? 1 "I will avoid taking demeclocycline." 2 "I will avoid consuming alcohol along with the drug." 3 "I will decrease intake of juices and water in my diet." 4 "I will take medicines immediately upon getting up in the morning."

4 "I will take medicines immediately upon getting up in the morning." Desmopressin 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. Demeclocycline interacts with desmopressin and may reduce the effect of desmopressin; therefore it should be avoided. Desmopressin interacts with alcohol, so it is necessary to avoid alcohol consumption with this drug. Because the patient has dehydration, it is necessary to drink large amounts of fluid.

The nurse is caring for a patient who has recently undergone an adrenalectomy. During preparation for discharge, the nurse teaches the patient's family members about care to be given at home. Which instruction would the nurse include in the teaching? 1 "Maintain a regular diabetic diet." 2 "Report fat deposition at the abdomen." 3 "Do mild to moderate exercises regularly." 4 "Immediately report any wound infection."

4 "Immediately report any wound infection." Adrenalectomy is an operation during which one or two adrenal glands are removed. The patient may have decreased or no production of adrenal hormones, and this in turn reduces the patient's immunity. Therefore the nurse would instruct the patient's family members to report any wound infection, which, if left untreated, could become fatal. The instruction to eat a diabetic diet is given if prednisone is prescribed because prednisone increases blood glucose concentrations. Deposition of fat occurs in the case of excess secretion of adrenocortical hormone. In this case, there is reduced secretion of adrenocortical hormone, so the patient may not have fat deposition in the abdomen. Exercise will induce profuse sweating, thereby increasing the loss of electrolytes from the body. The patient is advised to avoid exercising after the surgery.

Which patient statement demonstrates understanding of the nurse's teaching for levothyroxine? 1 "I will take this medication first thing in the morning." 2 "I can expect to see relief of my symptoms within 1 week." 3 "I will double my dose if I gain more than 1 pound per day." 4 "It is best to take the medication with food to prevent gastrointestinal upset."

4 "It is best to take the medication with food to prevent gastrointestinal upset." Levothyroxine increases basal metabolism and thus wakefulness. It should be taken first thing in the morning. Depending on the symptoms, some symptoms may take weeks to improve. The patient should not increase the dose. The medication is absorbed best on an empty stomach.

A patient newly diagnosed with diabetes asks, "How does insulin normally work in my body?" Which response by the nurse is correct? 1 "It stimulates the pancreas to reabsorb glucose." 2 "It promotes synthesis of amino acids." 3 "It stimulates the liver to convert glycogen to glucose." 4 "It promotes the passage of glucose into cells for energy."

4 "It promotes the passage of glucose into cells for energy." Insulin promotes the passage of glucose into cells, where it is metabolized for energy. After or during a meal, the glucose that is ingested stimulates the pancreas to secrete insulin. Insulin stimulates the synthesis of proteins and not amino acids. Insulin stimulates the liver to convert glucose to glycogen.

A nursing student is caring for an older adult patient with Addison's disease. The nursing instructor asks the student about the characteristics that can be observed in patients with Addison's disease. What is the best answer given by the student? 1 "The patient has weight gain because of the deposition of excess fat in the body." 2 "The patient has muscle weakness because of increased carbohydrate metabolism." 3 "The patient has hypokalemia because of a decrease in blood potassium concentrations." 4 "The patient has dehydration because of a decrease in blood aldosterone concentrations."

4 "The patient has dehydration because of a decrease in blood aldosterone concentrations." Addison's disease is caused by a reduction in the glucocorticoid, mineralocorticoid, and androgenic hormones in the blood. The mineralocorticoid aldosterone regulates sodium and potassium balance in the blood. A decrease in blood aldosterone concentrations results in dehydration because the hormone aldosterone is used to regulate the balance of salt and water. Addison's disease leads to weight loss and is not characterized by the deposition of fat in the body. Cushing's syndrome leads to muscle weakness from potassium loss. Addison's disease leads to weight loss because of decreased, not increased, carbohydrate metabolism.

Which instruction will the nurse give a patient who takes isophane suspension (NPH) insulin? 1 "You need to obtain your blood glucose levels every hour." 2 "Unused vials can be stored in the refrigerator for 5 months." 3 "Discontinue insulin if you are undergoing diagnostic studies." 4 "You should eat 30 to 45 minutes before taking the NPH insulin."

4 "You should eat 30 to 45 minutes before taking the NPH insulin." Insulin isophane suspension (NPH) is an intermediate-acting insulin product that has an onset of action of 1 to 2 hours. Hence the nurse instructs the patient to eat meals 30 to 45 minutes before administering the injection. It is not necessary to obtain blood glucose levels every hour. Unused vials are stored in the refrigerator for only 3 months to maintain drug stability. It is not necessary to stop insulin for any diagnostic tests because insulin does not interact with any agents used in diagnostic tests.

Which method of administering glipizide is correct? 1 With food 2 At bedtime 3 15 minutes postprandial 4 30 minutes before a meal

4 30 minutes before a meal Glipizide is the only sulfonylurea agent that should be administered 30 minutes before a meal. This is because the insulin secreted by the drug corresponds with the elevation in blood glucose concentrations induced by the meal. Food inhibits the absorption of glipizide. Hence it cannot be administered with food or in a postprandial stage or at bedtime.

Which patient had indications for treatment with somatropin? 1 A 17-year-old who is 5 feet tall 2 An 8-year-old with a pituitary tumor 3 A 10-year-old of short stature who has severe asthma 4 A 7-year-old diagnosed with growth hormone deficiency

4 A 7-year-old diagnosed with growth hormone deficiency For somatropin to be used, the patient has to be diagnosed with a growth hormone deficiency and the growth plates must not be closed, so the child needs to be young. An age of 17 years, neoplastic disease, and a severe respiratory condition are contraindications to this medication.

A provider prescribes octreotide to treat the symptoms of a patient diagnosed with carcinoid tumors. Which adverse effect will the nurse instruct the patient to report immediately? 1 Vertigo 2 Drowsiness 3 Bleeding gums 4 Abdominal stress

4 Abdominal stress

The nurse is caring for a patient who has hyperthyroidism. The health care provider has prescribed methimazole. Which assessment is a priority? 1 Assess the patient's urine output. 2 Assess signs of cardiac irregularities. 3 Assess the patient's serum creatinine levels. 4 Assess signs and symptoms of thyroid storm.

4 Assess signs and symptoms of thyroid storm. Thyroid storm is an exacerbation of hyperthyroidism symptoms. Thyroid storm (thyroid crisis) is a potentially life-threatening condition found in people who have hyperthyroidism. Thyroid storm happens when the thyroid gland suddenly releases large amounts of thyroid hormone in a short period of time. Urine output is assessed after the therapy, as methimazole decreases urine output. Signs of cardiac irregularities need to be assessed for thyroid drugs, not antithyroid drugs. Serum creatinine levels are also assessed after the therapy because methimazole increases serum creatinine levels.

Which drug interacts with insulin and increases the risk for unrecognized hypoglycemia in a patient? 1 Aspirin 2 Codeine 3 Thiazide diuretics 4 Beta-adrenergic blockers

4 Beta-adrenergic blockers Beta-adrenergic blockers block the initial sympathetic response to hypoglycemia; therefore, the patient will not exhibit the initial symptoms of nervousness, diaphoresis, and sweating that typically alert the patient to the onset of hypoglycemia. Aspirin and other salicylates can cause hypoglycemia by stimulating insulin secretion. There are no known interactions of codeine and insulin. Thiazide diuretics worsen insulin sensitivity.

Which medication would the nurse withhold for a patient with type 2 diabetes mellitus who is scheduled for a computed tomography (CT) scan with contrast? 1 Glipizide 2 Glimepiride 3 Humalog insulin 4 Metformin

4 Metformin Metformin is contraindicated with the use of contrast media. Therefore it should be held due to the risk of renal failure and lactic acidosis the day of the test and for 48 hours after the test. Glipizide, glimepiride, and Humalog insulin are safe to administer with contrast media.

The nurse is caring for a patient who has been taking metformin for several months. The patient reports abdominal pain. Upon assessment, the nurse detects an irregular heartbeat. Which will the nurse assess to determine the severity of the patient's condition? 1 Renal function 2 Vitamin B12 levels 3 The patient's weight 4 Blood glucose levels

4 Blood glucose levels Abdominal pain and irregular heartbeat in a patient taking metformin may be indicative of lactic acidosis. If the patient has lactic acidosis, the blood glucose levels will be very high as well. Therefore the nurse needs to assess the patient's blood glucose levels to confirm the condition. Renal function is assessed before administering the drug to prevent renal impairment. Reduction in B12 levels is a side effect of metformin but does not cause abdominal pain or irregular heartbeat. Assessing the patient's weight is not a priority in this case.

The nurse is caring for a patient who has Addison's disease who takes a loop diuretic medication. Which other medications would the nurse likely find in the patient's prescription to provide effective treatment? Select all that apply. 1 Iron supplements 2 Sodium supplements 3 Vitamin supplements 4 Calcium supplements 5 Potassium supplements

4 Calcium supplements 5 Potassium supplements A patient with Addison's disease would be prescribed corticosteroids for treatment. If the patient is taking corticosteroids and loop diuretic medications, then the patient may develop hypocalcemia and hypokalemia because of a drug-drug interaction caused by excessive loss of potassium and calcium. Therefore calcium and potassium supplements will likely be included in the patient's prescription. Loop diuretic medications do not cause iron deficiency and do not impair the absorption of vitamins; thus iron and vitamin supplements would not be prescribed. Sodium concentrations are not altered much in the patient; hence, sodium supplements would not be included in the patient's prescriptions.

A patient who has syndrome of inappropriate antidiuretic hormone (SIADH) is prescribed vasopressin. Which drug in the patient's history would be of concern to the nurse? 1 Thioridazine 2 Cyclosporine 3 Ciprofloxacin 4 Carbamazepine

4 Carbamazepine Vasopressin acts by reducing urine output. The drug carbamazepine acts as an agonist and enhances the effects of the drug, which could result in edema and hypertension in the patient if these two drugs are combined. Thioridazine interacts with octreotide, cyclosporine interacts with octreotide, and ciprofloxacin interacts with octreotide. Therefore only carbamazepine would be of concern for this patient who was prescribed vasopressin.

The health care provider prescribes a thyroid replacement drug to a patient with hypothyroidism. Which is the first intervention that helps determine the dosage of thyroid replacement drug for the patient? 1 Checking the physical parameters of the patient 2 Checking the patient's knowledge of thyroid therapy 3 Checking the medication history of patient and family 4 Checking the patient's serum thyroid-stimulating hormone levels

4 Checking the patient's serum thyroid-stimulating hormone levels Before prescribing the thyroid replacement drug to the patient with hypothyroidism, the nurse and primary health care provider have to check the patient's serum thyroid-stimulating hormone (TSH) level. This helps them know the underlying pathologic condition and helps them prescribe the right dosage and medication to the patient. Apart from the patient's TSH level, the patient's free thyroid hormone levels should also be checked. Doing a physical assessment would help calculate the optimal dosage for the patient to prevent adverse effects. The nurse does not expect the patient to have prior knowledge of thyroid therapy. After monitoring the TSH level, the nurse would check the patient's history; this helps rule out possible contraindications and allergies.

A patient with a history of inflammatory bowel disease is prescribed insulin therapy and acarbose for the treatment of high postprandial glucose levels. Which nursing action is a priority in this case? 1 Assess blood glucose levels before administering insulin. 2 Ask the patient about allergic reactions to any drugs. 3 Assess the patient's weight before administering the drug. 4 Consult the primary health care provider before administering acarbose.

4 Consult the primary health care provider before administering acarbose. Acarbose has adverse gastrointestinal effects and is contraindicated in patients with inflammatory bowel disease. Hence the nurse needs to consult with the primary health care provider before administering the drug. The nurse needs to administer insulin and the oral diabetic drugs as instructed by the primary health care provider to prevent fluctuations in the patient's glucose levels. The nurse needs to ask about allergic reactions before administering any drug; however, it is not a priority in this case. Assessing the patient's weight is not a priority in this case because acarbose does not cause weight gain.

Which outcome is expected in a patient who has been prescribed an alpha glucosidase inhibitor? 1 Stimulation of pancreatic insulin release 2 Increased sensitivity of insulin receptor sites 3 Adverse effects if combined with other antidiabetic agents 4 Delayed absorption of carbohydrates from the intestines

4 Delayed absorption of carbohydrates from the intestines Alpha glucosidase is an enzyme necessary for the absorption of glucose from the gastrointestinal tract. Inhibiting this enzyme inhibits glucose absorption, delaying rises in postprandial serum glucose levels. The drug does not have systemic effects, so it does not stimulate the pancreas to release insulin or increase the sensitivity of insulin receptor sites. The drug is commonly used with other antidiabetic agents.

A patient who has been receiving long-term corticosteroid therapy has undergone surgery for the treatment of an abdominal hernia. Which potential effect of this therapy would the nurse expect to have the most impact on the patient's recovery? 1 Hypotension 2 Osteoporosis 3 Muscle weakness 4 Delayed wound healing

4 Delayed wound healing Muscle weakness and osteoporosis may result from long-term therapy, but delayed wound healing would have the most impact on the patient's recovery from abdominal surgery. Long-term corticosteroid therapy causes hypertension rather than hypotension. Therefore hypotension, osteoporosis, and muscle weakness would not affect the patient's recovery.

A patient who has a VIPoma tumor reports severe watery diarrhea and sudden reddening of the face. The primary health care provider instructs the nurse to administer octreotide. Which form of octreotide dosage is preferred? 1 Oral tablet 2 Capsule dosage 3 Injection (IV/IM) 4 Depot suspension

4 Depot suspension The patient should receive octreotide depot suspension to treat symptoms produced by excessive substances that are produced by tumors. Oral dosage forms, such as tablets and capsules, are not manufactured. The nurse would not confuse the depot form of dosage with octreotide injection, as the latter formulation mimics the actions of somatostatin.

A 5-year-old child is diagnosed with type I von Willebrand disease. Which drug will the nurse expect the primary health care provider to prescribe to the patient? 1 Octreotide 2 Somatropin 3 Cosyntropin 4 Desmopressin

4 Desmopressin Type I von Willebrand disease is a bleeding disorder seen in people who have low levels of von Willebrand factor. Desmopressin is useful in the treatment of type I von Willebrand disease because it affects the various blood-clotting factors. Octreotide is prescribed to reduce the effect of the growth hormone in a tumor condition. Somatropin is a growth hormone; it does not affect blood-clotting factors. Cosyntropin increases the cortisol levels, so it is not prescribed for type 1 von Willebrand disease.

Which condition is seen in a patient with hyperosmolar hyperglycemic syndrome (HHS)? 1 Acute pancreatitis 2 Recurrent headaches 3 Insidious weight gain 4 Extreme hyperglycemia

4 Extreme hyperglycemia Extreme hyperglycemia triggers HHS. Acute pancreatitis is an inflammation of the pancreas. This usually happens due to chronic alcohol abuse or due to a gallstone becoming lodged in the pancreatic ducts. Headaches are not caused by HHS. A patient with HHS may have electrolyte imbalances, which may cause dehydration and weight loss, not weight gain.

The adrenal cortex is essential for survival through the secretion of which substance? 1 Aldosterone 2 Epinephrine 3 Corticotrophins 4 Glucocorticoids

4 Glucocorticoids Glucocorticoids, which are essential for survival because they regulate protein, carbohydrate, and lipid metabolism and inhibit the release of corticotrophins, are secreted by the zona fasciculata. Aldosterone is secreted from the zona glomerulosa of the adrenal gland; the medullary layer of the adrenal gland secretes epinephrine; and corticotrophins are released from the pituitary gland.

Which laboratory test provides evidence of adequate glucose management and adherence to a diabetes treatment regimen over the past few months? 1 Serum albumin 2 Fasting serum glucose level 3 2-hour postprandial blood glucose 4 Glycosylated hemoglobin (HbA1C)

4 Glycosylated hemoglobin (HbA1C) HbA1C indicates glucose concentrations over the past 3 to 4 months and thus demonstrates patient adherence to therapy and illness management over time. The serum albumin test helps to determine the level of natural protein in blood. The fasting serum glucose test helps to assess whether the patient has elevated blood glucose concentrations. A 2-hour postprandial blood glucose test determines the amount of glucose in the blood after a meal.

Which information would the nurse obtain prior to giving glucocorticoids to a 10-year-old patient? 1 Visual acuity 2 Bone density 3 Blood glucose 4 Height and weight

4 Height and weight Glucocorticoid therapy can cause growth suppression in children receiving long-term adrenal drug therapy. Therefore the nurse would obtain baseline height and weight and monitor these values throughout treatment. Visual acuity can be affected in patients with glaucoma taking glucocorticoids. Bone density is affected in older patients. Blood glucose levels are affected in patients with diabetes mellitus receiving glucocorticoids.

Which medication would the nurse expect to administer to a patient with adrenal insufficiency if the patient is unable to produce it endogenously? 1 Prednisone 2 Epinephrine 3 Regular insulin 4 Hydrocortisone

4 Hydrocortisone A patient with adrenal insufficiency lacks an endogenous source of cortisol, so treatment consists of synthetic cortisol in the form of hydrocortisone. Prednisone is the most commonly used oral glucocorticoid for antiinflammatory or immunosuppressant purposes. A patient with adrenal insufficiency produces endogenous epinephrine and regular insulin.

Upon reviewing the laboratory reports of a patient with hypoglycemia, the nurse expects that the patient would be prescribed a combination of fludrocortisone and prednisone. Which findings did the nurse observe in the patient's laboratory reports to suggest such a conclusion? 1 Hyperlipidemia 2 Hypernatremia 3 Hypercalcemia 4 Hyperkalemia

4 Hyperkalemia A combination of fludrocortisone and prednisone is prescribed to patients with Addison's disease, which is caused by reduced secretion of adrenocortical hormones. Addison's disease is characterized by hypoglycemia and an increase in potassium concentration because of a decrease in the elimination of potassium from the body. Therefore these medications would help restore electrolyte levels. Addison's disease is usually characterized by loss of weight; therefore the patient would not have increased cholesterol levels. Unlike antiadrenal drugs, fludrocortisone and prednisone are not prescribed to reduce sodium concentration, which occur in Cushing's syndrome. Calcium concentrations are not affected in patients with Addison's disease.

A patient has been prescribed corticosteroids for adrenal suppression. Which behavior process may be observed in the patient because of this? 1 Memory loss 2 Hallucinations 3 Impaired thinking 4 Impaired stress response

4 Impaired stress response Patients who have adrenal suppression may have impaired response to stress because of alterations in epinephrine release. Acetylcholine and dopamine concentrations are not altered by adrenal suppression. Therefore the patient would not have memory loss, hallucinations, or impaired thinking.

Which action would the nurse take when a patient reports typically taking glipizide with food? 1 Immediately call the health care provider. 2 Immediately check the patient's blood glucose level. 3 Inform the patient to take the medication 15 minutes after a meal. 4 Inform the patient to take the medication 30 minutes before a meal.

4 Inform the patient to take the medication 30 minutes before a meal. Food inhibits the absorption of glipizide; it is the only sulfonylurea agent that should be given 30 minutes before a meal. The health care provider does not have to be called; the nurse would intervene. The blood glucose level does not have to be taken right away. The medication is not to be taken after a meal.

The nurse is caring for a patient who has hypertension and is on continuous corticosteroid therapy to treat adrenal insufficiency. The electrocardiograph shows a steady slowing of the patient's heart beat. The patient's blood pressure is 140/96 mm Hg. Which medication may contribute to the patient's symptoms? 1 Hydantoins 2 Barbiturates 3 Cholinergics 4 Loop diuretic

4 Loop diuretic A decreased heart rate results from an increased concentration of sodium and a decreased concentration of potassium in the body. To compensate for the low heart rate, blood pressure will increase steadily. In this case, the use of a corticosteroid resulted in hypokalemia and hypernatremia. Since the patient is hypertensive, a loop diuretic may be prescribed to treat hypertension. Corticosteroids increase the retention of sodium and the excretion of potassium from the body. Potassium excretion would be worsened with use of a potassium-wasting (loop) diuretic. Hydantoins and barbiturates increase the metabolism of corticosteroids, thus reducing the loss of potassium. Cholinergics interact with corticosteroids and cause weakness in patients taking both.

Which adrenal drug is available in a long-acting (depot) formulation? 1 Prednisone 2 Betamethasone 3 Fludrocortisone 4 Methylprednisolone

4 Methylprednisolone Methylprednisolone is an adrenal drug that is available in a long-acting (depot) formulation. Prednisone is a synthetic intermediate-acting glucocorticoid available in oral from but not in long-acting (depot) formulation. Betamethasone is an adrenal drug available in topical, oral, and inhaled forms but not as a depot formulation. Fludrocortisone is a synthetic mineralocorticoid available in oral form only.

The nurse is caring for a patient who is taking levothyroxine and warfarin. Which intervention is a priority for the nurse? 1 Monitor the patient for cardiac dysrhythmias. 2 Assess peripheral pulses and Homan's sign daily. 3 Weigh the patient daily for excessive weight loss. 4 Monitor the patient for increased risk of bleeding.

4 Monitor the patient for increased risk of bleeding. Levothyroxine can compete with protein-binding sites of warfarin, allowing more warfarin to be unbound or free, thus increasing the effects of warfarin and the risk of bleeding. This combination does not place the patient at increased risk of dysrhythmias, deep vein thrombosis, or weight loss.

Which medication, administered with vasopressin, impairs the action of vasopressin to conserve water? 1 Thioridazine 2 Carbamazepine 3 Acetaminophen 4 Norepinephrine

4 Norepinephrine When administered concurrently with vasopressin, norepinephrine decreases the antidiuretic effect of vasopressin. Thioridazine can prolong the QTc interval when given with octreotide. Carbamazepine can increase the antidiuretic effect of vasopressin. Acetaminophen would have no effect on vasopressin's action.

A patient with Addison's disease is prescribed corticosteroids. During the follow-up visit the nurse finds that the patient is taking oral contraceptives and has severe insomnia and osteoporosis. Which is a possible reason for insomnia and osteoporosis in the patient? 1 Irregular administration of corticosteroids 2 Completely stopping corticosteroid administration 3 Rapid elimination of corticosteroids from the blood 4 Presence of corticosteroids in the blood for longer lengths of time

4 Presence of corticosteroids in the blood for longer lengths of time Insomnia and osteoporosis are adverse effects of corticosteroids acting on the central nervous system and musculoskeletal system, respectively. Oral contraceptives can increase the half-life of adrenal drugs in the body. This results in long-term presence of adrenal drugs and increases their concentration in the body. This leads to various adverse effects such as insomnia and osteoporosis. Irregular administration of corticosteroids or completely stopping corticosteroid administration would worsen the symptoms of Addison's disease. Rapid elimination of corticosteroids from the blood may lead to insufficient drug availability, and the medication may not exert its therapeutic effect.

Which medication is used to treat hyperthyroidism during the first trimester of pregnancy? 1 Liotrix 2 Methimazole 3 Levothyroxine 4 Propylthiouracil

4 Propylthiouracil Propylthiouracil is an antithyroid medication used in the first trimester of pregnancy to treat hyperthyroidism. Methimazole is recommended after the first trimester of pregnancy because it causes fetal adverse effects like scalp abnormalities, goiter, and cretinism. Liotrix and levothyroxine are hypothyroid medications that are used to treat hypothyroidism.

The nurse administers fludrocortisone to a patient who has acute primary adrenocortical insufficiency. Which adverse effect of the therapy is a priority for the nurse to prevent? 1 Hypertension 2 Gastric erosion 3 Peptic ulcers 4 Pulmonary edema

4 Pulmonary edema Fludrocortisone, a synthetic mineralocorticoid, is indicated in the treatment of primary adrenocortical insufficiency because the cortical production of aldosterone, an endogenous mineralocorticoid, is inadequate. Just like aldosterone, fludrocortisone causes sodium and water retention, so the nurse's priority is the prevention of pulmonary edema, which is associated with hypervolemia and is likely to impair oxygenation and ventilation. Hypertension, gastric erosion, and peptic ulcers are adverse effects of fludrocortisone; however, it is less important that these problems be prevented than pulmonary edema because a clear airway and ability to breathe are the patient's most basic needs. The nurse would deal with these adverse effects after dealing with the pulmonary edema.

A patient is receiving dexamethasone to prevent cerebral edema caused by a motor vehicle accident. Which nursing intervention will help to prevent complications of the pharmacotherapy? 1 Elevating the head of the bed 30° 2 Performing frequent oral suctioning 3 Requesting a prescription for aluminum hydroxide 4 Requesting a prescription for a proton pump inhibitor

4 Requesting a prescription for a proton pump inhibitor Dexamethasone falls under the category of glucocorticoids. Patients taking glucocorticoids are at high risk for gastric erosion and bleeding because the drugs are ulcerogenic; these agents are likely to erode the gastric mucosa during treatment. To prevent this serious complication of therapy, the nurse provides effective preventive care in the form of a proton pump inhibitor. In addition, the nurse would monitor the patient's stool for occult blood and the serum hemoglobin for early detection of gastrointestinal bleeding. Elevating the head of the bed is beneficial for the cerebral edema but is unlikely to help prevent complications of glucocorticoid therapy. Oral suctioning will not reduce the risks associated with use of glucocorticoids. Administering aluminum hydroxide is likely to be ineffective as monotherapy.

Which would the nurse include in patient education on the side effects of inhaled glucocorticoids? 1 Assess for edema. 2 Obtain daily weights. 3 Measure blood glucose. 4 Rinse out mouth after use.

4 Rinse out mouth after use. Inhaled glucocorticoids can lead to oral fungal infections. Therefore the nurse would instruct patients to rinse the mouth after each use to prevent fungal overgrowth. Edema, fluid volume overload, and hyperglycemia can occur with the use of systemic glucocorticoids, not inhaled glucocorticoids.

A patient is taking an antithyroid medication. Which foods would the nurse teach the patient to avoid eating? 1 Ham and cheese omelet, rye toast with butter, orange juice 2 Hamburger on sesame roll, salad with French dressing, milk 3 Chicken salad sandwich with mayonnaise, vegetable soup, milk 4 Shrimp cocktail, boiled lobster, spinach salad without dressing, milk

4 Shrimp cocktail, boiled lobster, spinach salad without dressing, milk Seafood contains high amounts of iodine. The other choices do not. The nurse instructs a patient taking an antithyroid medication to avoid foods high in iodine.

In the process of thyroid hormone development, what happens after the synthesis of T3 and T4? 1 Iodine is sequestered in the thyroid gland. 2 Triiodothyronine is released into the blood. 3 Thyroxine is released into the blood slowly. 4 T3 and T4 are stored in a complex with thyroglobulin.

4 T3 and T4 are stored in a complex with thyroglobulin. Once synthesized, T3 and T4 (triiodothyronine and thyroxine, respectively) are stored in the follicle of the thyroid gland with thyroglobulin, a protein that contains tyrosine and an amino acid. Iodine sequestration in the thyroid gland occurs early in the formation of thyroxine. T3 and T4 are not released into the blood until the presence of thyroid-stimulating hormone (TSH) signals the need for them. The presence of thyroid-stimulating hormone (TSH) in the serum is a signal for the complex containing T3 and T4 in the blood.

The nurse is assessing an older adult who has been taking liotrix for 6 months. The nurse finds that the patient has anxiety, tremors, and insomnia. Which would the nurse interpret from these findings? 1 The patient is hypersensitive to thyroid drugs. 2 The patient has common age-related symptoms. 3 The patient is not responding to the thyroid drugs. 4 The patient is experiencing adverse effects of the thyroid drugs.

4 The patient is experiencing adverse effects of the thyroid drugs. Anxiety, tremors, and insomnia are the adverse effects of liotrix. These adverse effects may be due to accumulation of the drug in the body or due to overdose of the medication. If the patient has an allergic reaction immediately after taking the drug or within 24 hours after drug administration, it indicates that the patient is hypersensitive to the medication. An elderly patient would not necessarily have anxiety, tremors, and insomnia. Therefore the nurse would avoid generalizing the symptoms and avoid considering them common age-related symptoms. If the patient were not responding to the medication, the patient would have decreased thyroid hormone levels.

During an assessment of a patient with hyperthyroidism, the nurse learns that the patient's provider has recommended thyroidectomy. Which statement could describe the reason for opting for such treatment for the patient? 1 The patient is obese. 2 The patient is elderly. 3 The patient is diabetic. 4 The patient is pregnant.

4 The patient is pregnant. Usually antithyroid medications are prescribed for the treatment of hyperthyroidism, but they have teratogenic effects. Thyroidectomy is recommended for patients who are intolerant to, or whose conditions contraindicate, antithyroid medications. Therefore to prevent complications, thyroidectomy is recommended for pregnant patients. Antithyroid medications do not impair pancreatic function or the metabolism of fat, so these medications are prescribed to obese and diabetic patients for the treatment of hyperthyroidism. Antithyroid medications are safe to be prescribed to elderly patients. Therefore obesity, old age, and diabetes are not reasons to recommend thyroidectomy for the patient.

After a patient assessment, the nurse concludes that the patient has undersecretion of adrenocortical hormones. Which finding would cause the nurse to arrive at this conclusion? 1 Osteoporosis 2 Fluid volume excess 3 Steroid-induced psychosis 4 Unexplained weight loss

4 Unexplained weight loss Dehydration and weight loss are caused by the undersecretion of adrenocortical hormones, which may cause Addison's disease. Osteoporosis, steroid psychosis, and water retention are caused by excess production of glucocorticoids. Prolonged therapy with adrenal drugs may exacerbate musculoskeletal system problems and precipitate osteoporosis. The adverse effects of corticosteroid therapy seen in hospitalized patients include steroid psychosis and hyperglycemia. Most corticosteroids cause edema and hypertension from water retention.

Which information should be included in a teaching plan for patients taking oral hypoglycemic drugs? (Select all that apply.) A. Limit your alcohol consumption. B. Report symptoms of anorexia and fatigue C. Take your medication only as needed. D. Notify your physician if blood glucose levels rise above the level set for you.

A. Limit your alcohol consumption. B. Report symptoms of anorexia and fatigue D. Notify your physician if blood glucose levels rise above the level set for you.

A patient receives regular insulin at 0800. The nurse would be alert for signs and symptoms of hypoglycemia at which time? A.BETWEEN 1000 AND 1200 B.BETWEEN 0830 AND 0930 C.BETWEEN 1400 AND 1600D.BETWEEN 1200 AND 1800

A.BETWEEN 1000 AND 1200

The nurse is reviewing the various types of insulins. For each insulin listed below, place in order from shortest duration (1) to longest duration (4). A. Glargine insulin B. Aspart insulin C. Regular insulin D. NPH insulin

B. Aspart insulin C. Regular insulin D. NPH insulin A. Glargine insulin

When administering morning medications for a newly admitted patient, the nurse notes that the patient has an allergy to sulfa drugs. There is an order for the sulfonylurea glipizide (Glucotrol). Which action by the nurse is correct? A. Give the drug as ordered 30 minutes before breakfast. B. Hold the drug, and check the order with the prescriber. C. Give a reduced dose of the drug with breakfast. D. Give the drug, and monitor for adverse effects.

B. Hold the drug, and check the order with the prescriber.

When caring for a patient newly diagnosed with gestational diabetes, the nurse would question an order for which drug? A. insulin glargine B. glipizide C. insulin glulisine D. NPH insulin

B. glipizide

Which oral hypoglycemic drug has a quick onset and short duration of action, enabling the patient to take the medication 30 minutes before eating and skip the dose if he or she does not eat? A. Stigliptin B. metformin C. glipiside D. pioglitazone

C. glipiside

When teaching a patient who is starting metformin (Glucophage), which instruction by the nurse is correct? A. "Take metformin if your blood glucose level is above 150 mg/dL." B. "Take this 60 minutes after breakfast." C. "Take the medication on an empty stomach 1 hour before meals." D. "Take the medication with food to reduce gastrointestinal (GI) effects."

D. "Take the medication with food to reduce gastrointestinal (GI) effects."

A patient is admitted to the Emergency Department in diabetic ketoacidosis (DKA) with a blood glucose level of 533. The physician orders an initial dose of 25 U insulin INtravaneously(IV). Which type of insulin will be administered? A. ISOPHANE INSULIN B. LISPRO INSULIN C. GLARGINE INSULIN D. REGULAR INSULIN

D. REGULAR INSULIN

A patient with diabetes insipidus is taking Vasopressin . He is complaining of drowsiness, lightheadedness, and headache. What does the nurse suspect that he is experiencing? A. An allergic reaction B. Dehydration C. Depression D. Water intoxication

D. Water intoxication

The nurse prepares to administer an initial dose of propylthiouracil to a patient with toxic nodular disease of the thyroid gland. Which baseline patient assessment is a priorityfor the nurse before the start of therapy? 1 Skin condition 2 Leukocyte count 3 Size of the thyroid 4 Coloration of the urine

Leukocyte count The provider orders a white blood cell count to establish a baseline for future comparison because propylthiouracil can cause bone marrow suppression, leading to agranulocytosis. This is the nurse's priority baseline patient assessment because agranulocytosis impairs the patient's immune system and increases the risk of severe bacterial and fungal infections. Propylthiouracil can cause rash and pruritus, an enlarged thyroid, and smoky-colored urine; however, because these issues do not present potentially life-threatening complications, the prevention of serious infection is more important.

The nurse is providing care to a patient following a non-accidental traumatic brain injury. The patient has developed diabetes insipidus due to the injury. What medication is most often used in the management of diabetes insipidus? desmopressin (DDAVP) corticotrophin (Acthar) octreotide (Sandostatin) somatropin (Humatrope)

desmopressin (DDAVP)

A patient with type 1 diabetes mellitus has been ordered insulin aspart 10 units at 7:00 a.m. Which nursing intervention will the nurse perform after administering this medication? 1 Flush the IV. 2 Perform a fingerstick blood glucose test. 3 Have the patient void and dipstick the urine. 4 Make sure the patient eats breakfast immediately.

Make sure the patient eats breakfast immediately. Insulin aspart is a rapid-acting insulin that acts in 15 minutes or less. It is imperative that the patient eat as it starts to work. This medication is given subcutaneously, not IV. The patient should have a fingerstick blood sugar test done before receiving the medication. There is no need to check the urine.

Type 2 DM

Non-Insulin-DependentUsually occurs in mature adults Has a slow and progressive onset

A nurse reinforces instructions to a client who is taking levothyroxine (Synthroid). The nurse tells the client to take the medication: 1. With food 2. At lunchtime 3. On an empty stomach 4. At bedtime with a snack

On an empty stomach Rationale:Oral doses of levothyroxine (Synthroid) should be taken on an empty stomach to enhance absorption. Dosing should be done in the morning before breakfast. *Note that options 1, 2, and 4 are comparable or alike in that these options address administering the medication with food.*

A nurse is caring for a client after thyroidectomy and notes that calcium gluconate is prescribed for the client. The nurse determines that this medication has been prescribed to: 1. Treat thyroid storm. 2. Prevent cardiac irritability. 3. Treat hypocalcemic tetany. 4. Stimulate the release of parathyroid hormone.

Treat hypocalcemic tetany. Rationale:Hypocalcemia can develop after thyroidectomy if the parathyroid glands are accidentally removed or injured during surgery. Manifestations develop 1 to 7 days after surgery. If the client develops numbness and tingling around the mouth, fingertips, or toes or muscle spasms or twitching, the health care provider is notified immediately. Calcium gluconate should be kept at the bedside.

A nurse reinforces medication instructions to a client who is taking levothyroxine (Synthroid). The nurse instructs the client to notify the health care provider (HCP) if which of the following occurs? 1. Fatigue 2. Tremors 3. Cold intolerance 4. Excessively dry skin

Tremors Rationale: Excessive doses of levothyroxine (Synthroid) can produce signs and symptoms of hyperthyroidism. These include tachycardia, chest pain, tremors, nervousness, insomnia, hyperthermia, heat intolerance, and sweating. The client should be instructed to notify the HCP if these occur. Options 1, 3, and 4 are signs of hypothyroidism.

The nurse would question an order for steroids in a patient with which condition? Uncontrolled diabetes mellitus Rheumatoid arthritis Septic shock Exacerbation of chronic obstructive pulmonary disease (COPD)

Uncontrolled diabetes mellitus

The patient is prescribed 30 units regular insulin and 70 units NPH insulin subcutaneously every morning. The nurse will provide which instruction to the patient? a) "Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin." b) "Mixing insulins will help increase insulin production." c) "Rotate sites at least once weekly." d) "Use a 23- to 25-gauge syringe with a 1-inch needle for maximum absorption."

a) "Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin." Drawing up the regular insulin into the syringe first prevents accidental mixture of NPH insulin into the vial of regular insulin, which could cause an alteration in the onset of action of the regular insulin.

The nurse is administering lispro (Humalog) insulin and will keep in mind that this insulin will start to have an effect within which time frame? a) 15 minutes b) 1 to 2 hours c) 80 minutes d) 3 to 5 hours

a) 15 minutes The onset of action for lispro insulin is 15 minutes. The peak plasma concentration is 1 to 2 hours; the elimination half-life is 80 minutes; and the duration of action is 3 to 5 hours.

An operating room nurse prepares a patient who has type 2 diabetes for surgery. Which type of insulin that can be given intravenously does the nurse administer? a) Regular insulin b) Insulin glargine c) Insulin zinc suspension d) Isophane insulin suspension (NPH insulin)

a) Regular insulin Regular insulin is the only type of insulin that can be given intravenously. The other variants of insulin, including insulin glargine, insulin zinc suspension, and isophane insulin suspension (NPH insulin), are administered through the subcutaneous route.

Which long-acting insulin mimics natural, basal insulin with no peak action and a duration of 24 hours? a) insulin glargine (Lantus) b) insulin glulisine (Apidra) c) regular insulin (Humulin R) d) NPH insulin

a) insulin glargine (Lantus) Insulin glargine has a duration of action of 24 hours with no peaks, mimicking the natural, basal insulin secretion of the pancreas.

A patient has been diagnosed with metabolic syndrome and is started on the biguanide metformin (Glucophage). The nurse knows that the purpose of the metformin, in this situation, is which of these? a) To increase the pancreatic secretion of insulin b) To decrease insulin resistance c) To increase blood glucose levels d) To decrease the pancreatic secretion of insulin

b) To decrease insulin resistance Metformin decreases glucose production by the liver; decreases intestinal absorption of glucose; and improves insulin receptor sensitivity in the liver, skeletal muscle, and adipose tissue, resulting in decreased insulin resistance. The other options are incorrect.

The nurse admitting a patient with acromegaly anticipates administering which medication? desmopressin (DDAVP) corticotropin (Acthar) somatropin (Nutropin) octreotide (Sandostatin)

octreotide (Sandostatin)

What is the best method of administering glipizide? a) With food b) At bedtime c) 15 minutes postprandial d) 30 minutes before a meal

d) 30 minutes before a meal Glipizide is the only sulfonylurea agent that should be administered 30 minutes before a meal. This is because the insulin secreted by the drug corresponds with the elevation in blood glucose concentrations induced by the meal. Food inhibits the absorption of glipizide. Hence, it cannot be administered with food or in a postprandial stage or at bedtime.