Pharm 2 Midterm
Insulin is used to treat both types of diabetes. It acts by: 1.Increasing beta cell response to low blood-glucose levels 2.Stimulating hepatic glucose production 3.Increasing peripheral glucose uptake by skeletal muscle and fat 4.Improving the circulation of free fatty acids
3.Increasing peripheral glucose uptake by skeletal muscle and fat
The nurse should teach a patient taking an oral corticosteroid to take the medication at what time? A. 8:00 am B. 12 noon C. 5:00 pm D. 8:00 pm
A. 8:00 am Oral corticosteroids should be taken in the morning to minimize adrenal suppression and lessen insomnia.
Which of the following medications may be affected by estrogen therapy? (select all that apply) A. Warfarin B. Phenytoin C. Digoxin D. Thyroid hormones
A. Warfarin B. Phenytoin D. Thyroid hormones
Which of the following medications may be affected by androgen therapy? A. Warfarin B. Phenytoin C. Oral antidiabetic medication D. corticosteroids
A. Warfarin C. Oral antidiabetic medication D. corticosteroids
The patient improves within the first 3 months of treatment with methotrexate. Six months later, the patient experiences worsening of symptoms. The prescriber will most likely order which monoclonal antibody for the treatment of RA? A.adalimumab (Humira) B.trastuzumab (Herceptin) C.rituximab (Rituxan) D.cetuximab (Erbitux)
A. adalimumab (Humira) Adalimumab (Humira) is indicated for the treatment of severe, progressive RA for which other RA therapies have failed.
A patient is receiving prednisone as part of treatment for severe arthritis. He is also receiving furosemide (a loop diuretic), levothyroxine (for hypothyroidism), and a proton pump inhibitor and antacid (for gastroesophageal reflux disease). Which drug does the nurse identify as most likely to be a concern during the therapy with prednisone? A.Furosemide B.Levothyroxine C.Proton pump inhibitor D.Antacid
A.Furosemide Coadministration of a loop diuretic with a corticosteroid may result in hypokalemia because of the potassium loss caused by both drugs.
Before administering methotrexate, it is most important for the nurse to assess the patient for: A.allergy to eggs. B.congestive heart failure. C.latent tuberculosis. D.hypothyroidism.
A.allergy to eggs and C.latent tuberculosis. Before administering DMARDs, it is important for the nurse to assess the patient for contraindications to the use of DMARDs such as active bacterial infections, active herpes, active or latent tuberculosis, and acute or chronic hepatitis B or C.
A patient who is taking a thyroid replacement medication tells the nurse that she is starting to experience cold intolerance, depression, constipation, and dry skin. The nurse anticipates that these manifestations are caused by A.inadequate doses of the medication. B.possible overdose of the medication. C.worsening of the underlying disease. D.drug interactions with another medication.
A.inadequate doses of the medication. A return of the symptoms of hypothyroidism indicates that the patient is receiving inadequate doses of the medication.
A 40-year-old female patient is seen in the clinic. She has been newly diagnosed with RA. Which medication does the nurse anticipate being ordered for the patient? A.methotrexate B.adalimumab C.infliximab D.etanercept
A.methotrexate For the treatment of RA, the recommend therapy with nonbiologic DMARDs usually begins with methotrexate or leflunomide for most patients. Biologic DMARDs are generally reserved for patients whose disease does not respond to methotrexate or leflunomide. The biologic DMARDs include etanercept, infliximab, adalimumab, abatacept, and rituximab.
A patient is in pulseless cardiac arrest. Which medication does the nurse anticipate administering? A.vasopressin B.desmopressin C.cosyntropin D.somatropin
A.vasopressin Vasopressin is also a potent vasoconstrictor in larger doses and is therefore used in certain hypotensive emergencies, such as vasodilatory shock (septic shock). It is also used in the ACLS guidelines for treatment of pulseless cardiac arrest.
A patient is taking an inhaled corticosteroid for asthma. After the patient takes a dose of the inhaler, the nurse's priority should be to A. listen to the patient's breath sounds. B. have the patient rinse his mouth with warm water C. instruct the patient to cough and deep breathe D. take the patient's apical pulse for 1 minute
B. have the patient rinse his mouth with warm water The patient should rinse his mouth with water immediately after taking an inhaled corticosteroid to avoid oral fungal infections and other oral irritations.
A client with a high level of glucocorticoids would be expected to also have a high: A. serum potassium level B. serum glucose level C. urinary sodium level D. glycosylated hemoglobin (A1c)
B. serum glucose level
When administering Octreotide (Sandostatin) to a patient, it is most important for the nurse to assess which parameter? A.Urine output B.Blood sugar C.Liver function tests D.Electrocardiogram
B.Blood sugar Octreotide (Sandostatin) may cause alterations in blood glucose levels; closely monitor blood glucose during drug therapy.
A patient will be receiving somatropin. The nurse expects that the patient has which disorder? A.Adrenocortical insufficiency B.Hypopituitary dwarfism C.Esophageal varices D.Septic shock
B.Hypopituitary dwarfism Somatropin is human GH that is used for the treatment of hypopituitary dwarfism. .
Conjugated estrogen (Premarin) is prescribed during menopause for: A. Amenorrhea B. Breast cancer C. Hot flashes D. Breakthrough uterine bleeding
C. Hot flashes
A patient with systemic lupus erythematosus is prescribed prednisone. It is most important for the nurse to monitor the patient for what? A. Hypotension B. Elevated potassium levels C. Neck and back pain D. Hypoglycemia
C. Neck and back pain Neck and back pain from a vertebral compression fracture may occur because of the development of osteoporosis as a result of glucocorticoid therapy.
A patient's chemotherapy has ended at 1800 on a Tuesday afternoon. When is it appropriate to start therapy with filgrastim NEUPOGEN? A.1800 on Tuesday B.0600 on Wednesday C.1800 on Wednesday D.1 week later, 1800 the next Tuesday
C.1800 on Wednesday Filgrastim and sargramostim have significant drug interactions when given with myelosuppressive antineoplastic drugs. Typically, filgrastim and sargramostim are not given within 24 hours of administration of myelosuppressive antineoplastics
The nurse is caring for a patient who received chemotherapy 24 hours ago. The patient's white blood cell count is 4,400 mcL. Which symptom, if experienced by the patient, should the nurse report to the prescriber immediately? A.Fatigue B.Diarrhea C.Fever D.Nausea and vomiting
C.Fever Fever is the principal early sign of infection, especially in those with a low white blood cell count. The presence of a fever is of utmost concern and should be reported immediately
Which statement regarding use of MABs in the treatment of cancer does the nurse identify as being true? A.MABs are not as effective as other chemotherapy drugs. B.MABs have few adverse effects. C.MABs may cause flulike effects but do not cause the typical adverse effects associated with chemotherapy. D.MABs are only used in cases of last resort when other chemotherapy drugs have failed.
C.MABs may cause flulike effects but do not cause the typical adverse effects associated with chemotherapy. : Because these drugs only target cancer cells, they do not have the adverse effects that are typically associated with chemotherapy. However, they do cause acute symptoms that are similar to classic allergy or flulike symptoms. As a result, these symptoms are managed during therapy.
A patient has been prescribed pharmacologic doses of glucocorticoids. It is most important for the nurse to teach the patient to do what? A.Increase intake of dietary sodium. B.Take antibiotics to prevent infection. C.Never abruptly withdraw therapy. D.Have an eye examination every year.
C.Never abruptly withdraw therapy. Abrupt withdrawal of glucocorticoids may cause adrenal insufficiency or an adrenal crisis.
A woman who has type 2 DM is now pregnant. She wants to know whether to take her oral antidiabetic medication. What instructions will she receive? A.She should continue the antidiabetic medication at the same dosage. B.The antidiabetic medication dosage will be increased gradually throughout her pregnancy. C.She will be switched to insulin therapy while she is pregnant. D.She will not receive any antidiabetic medication while pregnant and will need to monitor her dietary intake closely.
C.She will be switched to insulin therapy while she is pregnant. Oral antidiabetic medications are generally not recommended for pregnant patients because of a lack of firm safety data. Insulin therapy is the currently recommended drug therapy for pregnant women.
Which information will the nurse include when teaching a patient about thyroid replacement therapy? A."Take the medication before bed." B."You will experience beneficial effects of the drug after 1 week of treatment." C."Stop taking the drug if you experience insomnia." D."Take the medication on an empty stomach."
D. "Take the medication on an empty stomach." Thyroid replacement drugs are best taken ½ to 1 hour before breakfast on an empty stomach to enhance their absorption orally, maintain constant hormone levels, and help prevent insomnia.
The patient is scheduled for discharge. Which information does the nurse include when teaching the patient about methotrexate therapy? A.You can expect to develop mouth sores that will improve with time when taking this medication. B.Administer the methotrexate injection daily in the early morning. C.Mix the methotrexate with sterile saline before administration. D.Administer the methotrexate subcutaneously into the thigh, abdomen, or upper arm, rotating injection sites.
D.Administer the methotrexate subcutaneously into the thigh, abdomen, or upper arm, rotating injection sites. Methotrexate should be administered subcutaneously into the thigh, abdomen, or upper arm, rotating injection sites. Methotrexate should not be administered with other solutions and without use of a filter. Methotrexate is taken weekly. The development of stomatitis should be reported to the prescriber immediately.
The nurse has just administered the morning dose of a patient's lispro (Humalog) insulin. Just after the injection, the dietary department calls to inform the patient care unit that breakfast trays will be 45 minutes late. What will the nurse do next? A.Inform the patient of the delay. B.Check the patient's blood glucose levels. C.Call the dietary department to send a tray immediately. D.Give the patient food, such as cereal and skim milk, and juice.
D.Give the patient food, such as cereal and skim milk, and juice. Lispro insulin's onset of action is within 15 minutes. It is essential that a patient with DM eat a meal after injection. Otherwise, profound hypoglycemia may result.
Which would be the best menu choice for a patient who is taking an antithyroid medication? A.A seafood platter B.Sushi C.Tofu burger D.Pasta with marinara sauce
D.Pasta with marinara sauce The patient should avoid foods high in iodine, such as soy, tofu, and seafood.
A patient with type 1 DM is admitted to the medical unit with an acute exacerbation of chronic obstructive pulmonary disease. He is placed on IV piggyback antibiotics, nebulizer treatments with albuterol, and an IV corticosteroid, and he is also taking a proton pump inhibitor for GERD. He takes a dose of glargine insulin every evening. This evening the nurse notes that his blood glucose level is 170 mg/dL. The next morning, his fasting glucose level is 202 mg/dL. What is the most likely cause of his elevated glucose levels? A.The albuterol B.The antibiotics C.The proton pump inhibitor D.The corticosteroid
D.The corticosteroid Corticosteroids antagonize the hypoglycemic effects of insulin, resulting in elevated blood glucose levels.
A patient will begin chemotherapy with cisplatin. Which medications will the nurse expect to administer to offset this agent's side effects? a. Amifostine (Ethyol), diuretics, and antiemetics b. Antiemetics, vitamin B12, and glucocorticoids c. Dexamethasone, antiemetics, and vistonuridine d. Folic acid, gabapentin, and vitamin B12 Clear my choice
a. Amifostine (Ethyol), diuretics, and antiemetics Amifostine and diuretics are given to help minimize kidney damage with cisplatin. Antiemetics are given to minimize nausea and vomiting, which can be severe with this drug.
A patient is receiving intravenous vincristine (Oncovin). The patient complains of pain at the IV insertion site. The nurse examines the site and notes an area of erythema and edema. What will the nurse do? a. Change the IV site and notify the provider of the extravasation. b. Contact the provider to suggest using a different chemotherapeutic agent. c. Obtain an order for a topical anesthetic to minimize discomfort. d. Slow the rate of infusion to reduce the patient's discomfort.
a. Change the IV site and notify the provider of the extravasation.
A 43-year-old patient with a strong family history of breast cancer considers taking tamoxifen (Nolvadex) for cancer prevention. Which assessment finding is a possible contraindication? a. History of deep vein thrombosis (DVT) b. History of osteoporosis c. Hyperlipidemia d. Prior hysterectomy
a. History of deep vein thrombosis (DVT) The patient's age and DVT history place her at risk for thrombosis. Tamoxifen would not be indicated for this patient.
The nurse should include which food choice when providing dietary teaching for a patient scheduled to receive external beam radiation for abdominal cancer? a. broiled chicken b. raw vegetables c. whole grain cereals d. ham ad bean soup
a. broiled chicken The key is to remember that dietary teaching for prevention of cancer is very different from dietary teaching to prevent side effects in patients undergoing cancer treatments. In a patient receivign abdominal radiation -- keep in mind these patients are susceptible to diarrhea, flatulence, and infection. Everything should be cooked (no raw vegetables or fruits or poorly cooked meats), and gas-producing or bulk-producing foods (whole grains). Low-fat proteins such as cooked chicken meet these criteria. Most meat proteins produce little/no gas.
Tamoxifen and raloxifene are similar in that they both decrease the activity of some a. estrogen receptors and are used to prevent breast cancer recurrence b. progesterone receptors and are used to prevent ovarian cancer recurrence c. testosterone receptors and are used to prevent testicular cancer recurrence d. androgen receptors and are used to prevent prostate cancer recurrence
a. estrogen receptors and are used to prevent breast cancer recurrence Many if not most breast cancer tumors are estrogen receptor positive; that is, their growth is enhanced in the presence of estrogen. Tamoxifen and raloxifen interfere with responsiveness of these receptors and therefore can prevent recurrence in patients with estrogen-receptor positive breast cancer.
Nurses who are considered "at risk for" pregnancy should not be assigned to care for patients receiving which of the following cancer treatments? a. interstitial brachytherapy b. external beam teletherapy c. cell cycle non-specific chemotherapy d. oncogene inhibiting genetic therapy
a. interstitial brachytherapy Patients receiving interstitial brachytherapy are emitting low intensity radiation, therefore anyone "at risk for pregnancy" (all women who are physiologically capable of becoming pregnant, regardless of self-reported level of sexual activity are considered "at risk") should not be assigned to these patients.
A nurse provides teaching to a patient who will begin taking oral cyclophosphamide to treat non-Hodgkin's lymphoma. Which statement by the patient indicates an understanding about how to minimize side effects while taking this drug? a. "I don't need to worry about bone marrow suppression with this drug." b. "I should drink plenty of fluids while taking this drug." c. "I should take this drug on an empty stomach." d. "If I shampoo less often, I can prevent hair loss."
b. "I should drink plenty of fluids while taking this drug." Acute hemorrhagic cystitis can occur; this can be minimized by maintaining adequate hydration and taking mesna (Mesnex), a protective agent.
The nurse is providing patient education to a patient who will begin taking fludrocortisone (Florinef) as adjunctive therapy to hydrocortisone. Which statement by the patient indicates understanding of the teaching? a. "I should move from sitting to standing slowly." b. "I should report any swelling of my hands and feet." c. "I should report weight loss to my provider." d. "I should report excessive urine output."
b. "I should report any swelling of my hands and feet." Fludrocortisone is a mineralocorticoid that regulates sodium, potassium, and water balance. Water and sodium retention is a particular concern, so the patient should be taught to report any signs of fluid retention, such as swelling of the hands and feet. Fludrocortisone elevates the blood pressure, so hypotension is not a concern. Because fluid retention causes weight gain, patients should be taught to report any increase in weight. Patients should report decreased urine output.
The nurse prepares a patient with Graves' disease for radioactive iodine (131I) therapy. Which statement made by the patient best demonstrates understanding of 131I therapy? a. "I will have to isolate myself from my family for 1 week so that I don't expose them to radiation." b. "This drug will be taken up by the thyroid gland and will destroy the cells to reduce my hyperthyroidism." c. "This drug will help reduce my cold intolerance and weight gain." d. "I will need to take this drug on a daily basis for at least 1 year."
b. "This drug will be taken up by the thyroid gland and will destroy the cells to reduce my hyperthyroidism." Iodine-131 can be used to destroy thyroid tissue in patients with hyperthyroidism; no further teaching is necessary.
A nurse is preparing to administer a dose of growth hormone and reconstitutes the medication. After adding the diluent, the nurse notices that the preparation is cloudy. What will the nurse do? a. Administer the drug as ordered. b. Discard the drug and prepare another dose. c. Notify the prescriber. d. Shake the drug to dissipate the particles.
b. Discard the drug and prepare another dose. The medication should not be injected if the preparation is cloudy or contains particulate matter. The drug should be discarded and another dose drawn up and administered. There is no need to notify the prescriber. The preparation should never be shaken.
A patient is taking fludrocortisone (Florinef) for Addison's disease, and his wife is concerned about all of the problems that may occur with this therapy. When teaching them about therapy with this drug, the nurse will include which information? a. It may cause severe postural hypotension. b. It needs to be taken with food or milk to minimize gastrointestinal upset. c. The medication needs to be stopped immediately if nausea or vomiting occurs. d. Weight gain of 5 pounds or more in 1 week is an expected adverse effect.
b. It needs to be taken with food or milk to minimize gastrointestinal upset. Patients receiving fludrocortisone need to take it with food or milk to minimize gastrointestinal upset; weight gain of 5 pounds or more in 1 week needs to be reported to the physician; abrupt withdrawal is not recommended because it may precipitate an adrenal crisis. Adverse effects are related to the fluid retention and may include heart failure and hypertension.
When monitoring a patient who is taking a thyroid replacement hormone, which adverse effect needs to be reported to the prescriber? a. Weakness b. Palpitations c. Constipation d. Drowsiness
b. Palpitations The signs of excess dosages of thyroid replacement hormone mimic those of hyperthyroidism. Instruct the patient to report immediately any of the following to the prescriber: chest pain, weight loss, palpitations, tremors, sweating, nervousness, shortness of breath, or insomnia.
A patient is concerned about the body changes that have resulted from long-term prednisone therapy for the treatment of asthma. Which effect of this drug therapy would be present to support the nursing diagnosis of disturbed body image? a. Weight loss b. Weight gain c. Pale skin color d. Hair loss
b. Weight gain Facial erythema, weight gain, hirsutism, and "moon face" (characteristic of Cushing's syndrome) are possible body changes that may occur with long-term prednisone therapy.
A patient is admitted to the hospital and will begin taking levothyroxine (Synthroid). The nurse learns that the patient also takes warfarin (Coumadin). The nurse will notify the provider to discuss _____ the _____ dose. a. reducing; levothyroxine b. reducing; warfarin c. increasing; levothyroxine d. increasing; warfarin
b. reducing; warfarin Levothyroxine accelerates the degradation of vitamin K-dependent clotting factors, which enhances the effects of warfarin. Patients taking warfarin who start taking levothyroxine may need to have their warfarin dose reduced.
Which of the following patients should the nurse caution to not use ginkgo biloba? a.A patient with Alzheimer's disease and hypertension b.A patient with arterial fibrillation taking warfarin c.A patient taking sildenafil (Viagra) for erectile dysfunction d.A patient who has been prescribed fluoxedtine (Prozac) for depression
b.A patient with arterial fibrillation taking warfarin
A patient with a BMI of 32 is prescribed sibutramine (Meridia). Which of the following adverse effects will the nurse teach the patient to report to the health care provider for further follow-up? a.Bleeding b.Rapid heart rate c.Fatty or oily stools d.Dizziness
b.Rapid heart rate Meridia works like serotonin agents so may speed things up. Meridia can increase heart rate and blood pressure.
A nurse is preparing a class on vitamin supplementation. Which of the following will be included in the class content? a.Vitamin B12 supplements during pregnancy will decrease the risk of neural tube defects b.Vitamin K is required to prevent bleeding c.Vitamin E supplementation will reduce the risk of cancer d.Taking a daily multi-vitamin will prevent against the development of chronic disease
b.Vitamin K is required to prevent bleeding
A nurse is providing teaching for a nondiabetic adult who develops growth hormone deficiency and who will begin treatment with somatropin (Humatrope). Which statement by the patient indicates understanding of the teaching? a. "Intramuscular dosing is more effective than subcutaneous dosing." b. "I will have increased muscle mass and strength as well as increased height." c. "I will need to monitor my blood pressure frequently while taking this drug." d. "I will need to take insulin while using this, because it causes hyperglycemia."
c. "I will need to monitor my blood pressure frequently while taking this drug." Growth hormone in adults causes an increase in systolic blood pressure, so patients should be taught to monitor blood pressure while taking the drug. Subcutaneous dosing is as effective as IM dosing and is preferred, because it is less painful. Although muscle mass will increase, strength and height will not. Growth hormone is diabetogenic but causes significant problems in patients with pre-existing diabetes.
When administering chemotherapy for treatment of cancer, the nurse implements which intervention that treats or even prevents chemotherapy-induced nausea and vomiting? a. Instructing the patient to avoid caffeine while on chemotherapy b. Giving an antiemetic when the chemotherapy is started c. Giving an antiemetic 30 to 60 minutes before the chemotherapy is started. d. Increasing mobility before and during chemotherapy
c. Giving an antiemetic 30 to 60 minutes before the chemotherapy is started. Premedication with antiemetics 30 to 60 minutes before administration of the antineoplastics is the preferred treatment protocol to help reduce nausea and vomiting, prevent dehydration and malnutrition, and promote comfort.
A nurse obtaining an admission history on an adult patient notes that the patient has a heart rate of 62 beats per minute, a blood pressure of 105/62 mm Hg, and a temperature of 96.2° F. The patient appears pale and complains of always feeling cold and tired. The nurse will contact the provider to discuss tests for which condition? a. Cretinism b. Graves' disease c. Hypothyroidism d. Plummer's disease
c. Hypothyroidism
A patient with non-Hodgkin's lymphoma is about to begin chemotherapy with methotrexate (Rheumatrex). The nurse will expect to administer which medication concurrently with this drug? a. Dexamethasone b. Folic acid c. Leucovorin d. Vitamin B12
c. Leucovorin Leucovorin is used to protect normal cells when large doses of methotrexate are given.
A 16-year-old boy who is taking somatropin comes into the office because he had an asthma attack during a race at school. Because of this new development, the nurse expects which intervention to occur next? a. He will need to stop participating in school physical education classes. b. The somatropin must be discontinued immediately. c. The somatropin dosage may be adjusted. d. His growth will be documented and monitored for changes.
c. The somatropin dosage may be adjusted. Somatropin is to be used with caution in acute or chronic illnesses, such as migraine headaches, epilepsy, and asthma. It will not have to be immediately discontinued but will require close monitoring. The patient's growth will be measured and documented throughout therapy with somatropin.
A patient is taking oristat (Xenical) for weight loss. Which of the following statements made by the patient indicates an understanding of medication teaching? a."I may experience headache, dry mouth, and restlessness." b."I can expect to lose 5-10 pounds per month." c."I will take a multivitamin before bedtime." d."I will increase fat intake to prevent gas, bloating
c."I will take a multivitamin before bedtime." You must space vitamin supplementation a minimum of 2 hours from taking the medication. Additionally, xenical can reduce the absorption of fat soluble vitamins (ADEK) so taking a multivitamin is a good idea to ensure you are getting adequate amounts of vit ADEK.
In which of the following patients will the nurse suspect a thiamin deficiency? a.A 14 year old patient who has a diet that is deficient in citrus fruits and juices b.A 28 year old patient who is pregnant and not taking prenatal vitamins c.A 42 year old patient with alcoholism who has diplopia, ataxia, and memory loss d.A 76 year old patient with lung cancer who is undergoing chemotherapy
c.A 42 year old patient with alcoholism who has diplopia, ataxia, and memory loss Alcoholics and post gastric bypass patients are at highest risk for B vitamin deficiencies.
A patient is receiving her third course of 5-fluorouracil therapy and knows that stomatitis is a potential adverse effect of antineoplastic therapy. What will the nurse teach her about managing this problem? a. "You can take aspirin to prevent stomatitis." b. "Be sure to watch for and report black, tarry stools immediately." c. "You need to increase your intake of foods containing fiber and citric acid." d. "Be sure to examine your mouth daily for bleeding, painful areas, and ulcerations."
d. "Be sure to examine your mouth daily for bleeding, painful areas, and ulcerations." The symptoms of stomatitis consist of pain or burning in the mouth, difficulty swallowing, taste changes, viscous saliva, dryness, cracking, and fissures, with or without bleeding mucosa. Teach patients to avoid consuming foods containing citric acid and foods that are hot or spicy or high in fiber. Assessing stools is important but is not related to stomatitis, and aspirin must not be used during this therapy.
A patient who has been newly diagnosed with adrenal hormone deficiency will begin taking hydrocortisone. The nurse provides teaching for this patient. Which statement by the patient indicates understanding of the teaching? a. "I may take all of my daily dose in the morning or divide it in half and take it twice daily." b. "I will need to take this medication until my symptoms completely clear, and then I may stop." c. "Side effects are common with hydrocortisone, even with therapeutic doses." d. "When I am sick, I should take three times the normal dose for 3 days in a row."
d. "When I am sick, I should take three times the normal dose for 3 days in a row." Patients who take hydrocortisone as replacement need to be taught to increase their daily dose during times of stress, because the drug causes adrenal suppression, and the adrenals will not be able to release cortisone as usual during stress. A general rule of thumb is the "3 by 3 rule": take 3 times the usual dose for 3 days when sick.
When a patient is receiving vasopressin (Pitressin), the nurse will monitor for which therapeutic response? a. Improved appetite b. Increased serum albumin levels c. Increased serum potassium levels d. Decreased urinary output
d. Decreased urinary output Decreased severe thirst and decreased urinary output are the therapeutic responses expected with vasopressin.
The order reads, "Give levothyroxine (Synthroid), 200 mg, PO once every morning." Which action by the nurse is correct? a. Give the medication as ordered. b. Change the dose to 200 mcg, because that is what the prescriber meant. c. Hold the drug until the prescriber returns to see the patient. d. Question the order because the dose is higher than 200 mcg.
d. Question the order because the dose is higher than 200 mcg. Levothyroxine is dosed in micrograms. A common medication error is to write the intended dose in milligrams instead of micrograms. If not caught, this error would result in a thousandfold overdose. Doses higher than 200 mcg need to be questioned in case this error has occurred.
An older adult patient is diagnosed with hypothyroidism. The initial free T4 level is 0.5 mg/dL, and the TSH level is 8 microunits/mL. The prescriber orders levothyroxine (Levothroid) 100 mcg/day PO. What will the nurse do? a. Administer the medication as ordered. b. Contact the provider to discuss giving the levothyroxine IV. c. Request an order to give desiccated thyroid (Armour Thyroid). d. Suggest that the provider lower the dose.
d. Suggest that the provider lower the dose. In older adult patients, initial dosing of levothyroxine should start low and be increased gradually. A typical starting dose for an elderly patient is 25 to 50 mcg/day.
A patient arrives in the emergency department with a heart rate of 128 beats per minute and a temperature of 105° F. The patient's skin feels hot and moist. The free T4 level is 4 ng/dL, the free T3 level is 685 pg/dL, and the TSH level is 0.1 microunits/mL. The nurse caring for this patient will expect to administer: a. intravenous levothyroxine. b. iodine-131 (131I). c. methimazole (Tapazole). d. propylthiouracil (PTU).
d. propylthiouracil (PTU). Propylthiouracil is used for patients experiencing thyroid storm, and this patient is showing signs of that condition. Levothyroxine is given IV for hypothyroidism. 131I is used in patients over age 30 who have not responded to other therapies. Methimazole is used long term to treat hyperthyroidism, but PTU is more useful for emergency treatment.
A patient with diabetes mellitus type 2 is taking an oral hypoglycemic agent and asks the nurse about the beneficial effects of garlic to lower blood glucose levels. The nurse should: a.Inform the patient that garlic may interfere with absorption of the oral hypoglycemic agent b.Caution the patient against taking any herbal supplement c.Warn the patient that garlic can potentiate the effect of the oral hypoglycemic agent d.Teach the patient that ingestion of garlic will not affect blood glucose levels
d.Teach the patient that ingestion of garlic will not affect blood glucose levels
