Pharm Exam 2 (Enwequiz3 ATI, Endocrine Drugs Pptx, Pharm Medications)

type 2 diabetes patients should be screened and treated for

Hypertension, nephropathy, retinopathy, neuropathy, dyslipidemias

Cardiac Glycosides/inotropic - digoxin (Lanoxin) Precautions

Hypokalemia Concurrent use of diuretics

vasopression: admin routes

IM, subQ (given when there is a decrease in urine output

what is the preferred treatment for severe hypoglycemia

IV glucose (Glucagon can be used if IV glucose is not available)

biguanides include

Metformin

Nitrates - nitroglycerin, isosorbide (Isordil)- Interactions

PDE5 inhibitors, such as sildenafil (Viagra) may cause severe hypotension

what are the infusion options for subcutaneous infusers

Portable insulin pumps and Implantable insulin pumps

ACE Inhibitors - captopril (Capoten) Interactions

Potassium-sparing diuretics, potassium supplements, or use of salt substitutes increase risk for hyperkalemia• Antihypertensive drugs, diuretics, and nitrates (such as nitroglycerin) increase risk for hypotension ACE inhibitors may cause lithium toxicity

ARBs - losartan (Cozaar) Therapeutic Use

Prevents stroke Manages diabetic nephropathy Treats heart failure Prevents migraine headache

Insulin aspart and insulin lisper are described as

Rapid-acting analog of regular insulin

what are that four approved routes of administration for regular insulin

SubQ, SubQ infusion, IM (used rarely), and oral inhalation

What does Glimepiride, gliclazide, glyburide do?

Sulfonylurea that stimulates pancreas to release insulin, patients should avoid alcohol when taking this drug

Apidra is described as

Synthetic analog of natural human insulin

what are the injector options for subcutaneous injections

Syringe, needle, Pen injectors, Jet injectors

Aldosterone antagonists - spironolactone (Aldactone) Interventions

hyperkalemia

Meglitinides adverse affects:

hypoglycemia

Loop diuretics - furosemide (Lasix) Therapeutic Use

pulmonary edema edema caused by renal hepatic or cardiac failure

Calcium Channel Blockers (dihydropyridines) - nifedipine (Adalat, Procardia) Client Instructions

rapid heartbeat swelling of feet and legs

diabetic ketoacidosis includes

-Type 1 Diabetics - No insulin-No sugar in cell body - Burning fat as fuel causing ketones -Faster onset and in younger patients - Fruity breath -Kussmaul Respirations

A nurse is caring for a 2-year-old child who is receiving phenytoin (Dilantin) in suspension form. Which of the following actions should the nurse take before administering each dose? 1. Shake the container vigorously. 2. Be sure the child has not eaten within the hour. 3. Perform mouth care. 4. Check the child's blood pressure.

1. Shake the container vigorously.

Diabetic ketoacidosis (treatment)

1. insulin replacement 2. bicarbonate for acidosis 3. water & sodium replacement 4. potassium replacement 5. normalization of glucose levels

A nurse is assessing a client who is taking digoxin to treat heart failure. Which of the following findings is a manifestation of digoxin toxicity? 1. Bruising 2. Report of metallic taste 3. Muscle pain 4. Report of anorexia

4. Report of anorexia

A nurse is giving a presentation about caring for clients who are receiving diuretic therapy to treat heart failure. The nurse should explain that which of the following medications puts clients at risk for both hyperkalemia and hyponatremia? 1. Furosemide (Lasix) 2. Hydrochlorothiazide (HCTZ) 3. Mannitol (Osmitrol) 4. Spironolactone (Aldactone)***

4. Spironolactone (Aldactone)

A nurse is talking with a client who is about to start taking nitroglycerin oral, sustained-release capsules (Nitro-Time). Which of the following instructions should the nurse include? 1. Take one capsule at the onset of anginal pain. 2. Stop taking the medication if side effects are troublesome. 3. Take the medication with meals. 4. Swallow the capsules whole.

4. Swallow the capsules whole.

A nurse is talking with a client who is about to start taking nitroglycerin oral, sustained-release capsules (Nitro-Time). Which of the following instructions should the nurse include? 1. Take one capsule at the onset of anginal pain. 2. Stop taking the medication if side effects are troublesome. 3. Take the medication with meals. 4. Swallow the capsules whole.***

4. Swallow the capsules whole.***

A nurse is caring for a client who has been on levothyroxine (Synthroid) for several months. If the dose of this medication has been adequate, the nurse should expect to see a decrease in the? 1. Thyroxine (T4). 2. Free thyroxine (FT4). 3. Tri-iodothyronine (T3). 4. Thyroid stimulating hormone (TSH).***

4. Thyroid stimulating hormone (TSH).***

when is rapid acting insulin administered?

5 to 10 minutes before meals

what is the duration of regular insulin

5-7 hours

Levothyroxine half life

7 days

what are the target values for blood glucose before meals

70 to 130 mg/dL

What A1C goal is good for most patients?

<7%

A nurse is providing teaching to a client who has a new prescription for digoxin. The nurse should instruct the client to monitor and report which of the following adverse effects that is a manifestation digoxin toxicity? (Select all that apply.) A. Fatigue B. Constipation C. Anorexia D. Rash E. Blurred vision

A, C, E A. CORRECT: Fatigue and weakness are early CNS findings that can indicate digoxin toxicity. B. Nausea, vomiting, and diarrhea, rather than constipation, are GI manifestations of digoxin toxicity. C. CORRECT: GI disturbances, such as anorexia, are manifestations of digoxin toxicity. D. Rash is not a manifestation of digoxin toxicity. E. CORRECT: Visual changes, such as blurred and yellow‑tinged vision, are manifestations of digoxin toxicity.

A nurse is providing information to a client who has a new prescription for hydrochlorothiazide. Which of the following information should the nurse include? A. Take the medication with food. B. Plan to take the medication at bedtime. C. Expect increased swelling of the ankles. D. Fluid intake should be limited in the morning.

A. Take the medication with food.

Potassium-sparing diuretics - spironolactone (Aldactone) Interactions

ACE inhibitors, ARBs, direct renin blockers, potassium supplements, salt substitutes increase risk of hyperkalemia Increased risk of hypotension can occur with concurrent ingestion of alcohol, nitrates of other antihypertensives

Pioglitazone

Actos

Pioglitazone indication:

Adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes

ARBs - losartan (Cozaar) Adverse Drug Reactions

Angieoedema Hypertension

what reduces risk of diabetic nephropathy and manages hyperntension?

Angiotensin-converting enzyme (ACE) inhibitor or angiotensin II receptor blocker (ARB)

Centrally acting alpha2 agonists - clonidine (Catapres) Contraindications

Anticoagulant therapy

insulin glulisine generic name

Apidra

Priority assement for a total thyroidecetomy

Audible stridor

A nurse is administering a dopamine infusion at a low dose to a client who has severe heart failure. Which of the following findings is an expected effect of this medication? A. Lowered heart rate B. Increased urine output C. Decreased conduction through the AV node D. Vasoconstriction of renal blood vessels

B A. At a moderate dose, dopamine stimulates beta1 receptors, which increases heart rate. At high doses, dopamine also stimulates alpha1 receptors, which can decrease heart rate. B. CORRECT: Expect dopamine to cause increased urinary output as a result of increased renal perfusion. This occurs due to the activation of the dopamine receptors in the kidneys when dopamine is administered at low doses. C. At a moderate dose, dopamine stimulates beta1 receptors, which increases conduction through the AV node. D. In high doses, dopamine stimulates alpha1 receptors, which can constrict renal blood vessels

A nurse is caring for a client who has a new prescription for digoxin and takes multiple other medications. The nurse should recognize that concurrent use of which of the following medications places the client at risk for digoxin toxicity? A. Phenytoin B. Verapamil C. Warfarin D. Aluminum hydroxide

B A. Phenytoin, an antiseizure and antidysrhythmic medication, does not increase a client's risk for digoxin toxicity. When given as an antidysrhythmic, phenytoin can treat dysrhythmias caused by digoxin toxicity. B. CORRECT: Verapamil, a calcium‑channel blocker, can increase digoxin levels. If these medications are given concurrently, the digoxin dosage might be decreased and the nurse should monitor digoxin levels carefully. C. Warfarin does not interact with digoxin to increase digoxin levels. D. Antacids, such as aluminum hydroxide, decrease absorption of digoxin and can decrease digoxin levels and effectiveness

A nurse is planning care for a client who is has a new prescription for torsemide. The nurse should plan to monitor for which of the following conditions as potential adverse reactions of this medication? (Select all that apply.) A. Respiratory acidosis B. Hypokalemia C. Hypotension D. Ototoxicity E. Ventricular dysrhythmias

B, C, D, E A. Plan to monitor for metabolic alkalosis. B. CORRECT: Plan to monitor for hypokalemia, which is an adverse effect of a loop diuretic. C. CORRECT: Plan to monitor for hypotension. D. CORRECT: Plan to monitor the client for ototoxicity. E. CORRECT: Plan to monitor for ventricular dysrhythmias, which is a manifestation of hypokalemia, an adverse effect of torsemide.

A nurse is caring for a client who has a new prescription for alirocumab to reduce cholesterol. The nurse should monitor for which of the following findings as an adverse effect of alirocumab? (Select all that apply.) A. Muscle aches B. Vasculitis C. Hearing loss D. Urticaria E. Jaundice

B, D, E A. Myopathy (muscles aches) can occur with statins and other antilipemic medications, but this is not an adverse effect of alirocumab. B. CORRECT: A severe hypersensitivity reaction to alirocumab can result in vasculitis. C. Hearing loss is not an adverse effect of taking niacin. D. CORRECT: A severe hypersensitivity reaction to alirocumab can result in urticaria. E. CORRECT: Statins can cause liver disorders, so the nurse should monitor for jaundice, abdominal pain, and anorexia

What does metformin cause and when should it be stopped?

Biguanide that causes GI upset and somnolence in patients This drug must be stopped before certain imaging tests due to contrasting and can be resumed again after 48 hours due to increase risk of kidney damage and lactic acidosis

oral hypoglycemics include

Biguanides, Sulfonylureas, Thiazolidinediones, and meglitinides

Beta blockers - atenolol (Tenormin), metoprolol (Lopressor) Adverse Drug Reactions

Bradycardia due to blockade of beta1 receptors Heart failure - shortness of breath, edema, coughing at night Rebound excitation causing angina pain or MI with sudden withdrawal

A nurse is monitoring a client who is receiving spironolactone. Which of the following findings should the nurse report to the provider? A. Blood sodium 144 mEq/L B. Urine output 120 mL in 4 hr C. Blood potassium 5.2 mEq/L D. Blood pressure 140/90 mm Hg

C A. Blood sodium of 144 mEq/L is within the expected reference range. B. Urine output of 30 mL/hr or 120 mL in 4 hr is within the expected reference range. C. CORRECT: Blood potassium of 5.2 mEq/L indicates hyperkalemia. Because spironolactone causes potassium retention, withhold the medication and notify the provider. D. A blood pressure of 140/90 mm Hg is within the expected reference range.

A nurse in a provider's office is monitoring blood electrolytes for four clients who take digoxin. Which of the following electrolyte values increases a client's risk for digoxin toxicity? A. Calcium 9.2 mg/dL B. Calcium 10.3 mg/dL C. Potassium 3.4 mEq/L D. Potassium 4.8 mEq/L

C A. Calcium 9.2 mg/dL is within the expected reference range and does not put a client at risk for digoxin toxicity. B. Calcium 10.3 mg/dL is within the expected reference range and does not put a client at risk for digoxin toxicity. C. CORRECT: Potassium 3.4 mEq/L is below the expected reference range and puts a client at risk for digoxin toxicity. Low potassium can cause fatal dysrhythmias, especially in older clients who take digoxin. Notify the provider, who might prescribe a potassium supplement or a potassium‑sparing diuretic for the client. D. A potassium level of 4.8 mEq/L is within the expected reference range and does not put a client at risk for digoxin toxicity.

A nurse is caring for a client who has a new prescription for captopril for hypertension. The nurse should monitor the client for which of the following as an adverse effect of this medication? A. Hypokalemia B. Hypernatremia C. Neutropenia D. Bradycardia

C A. Hyperkalemia is an adverse effect of ACE inhibitors. B. Hyponatremia is an adverse effect of ACE inhibitors. C. CORRECT: Neutropenia is a serious adverse effect that can occur in clients taking an ACE inhibitor. Monitor the client's CBC and teach the client to report indications of infection to the provider. D. Tachycardia is an adverse effect of ACE inhibitors.

A nurse is teaching a client who has Grave's disease and a new prescription for propranolol. Which of the following client statements indicates effective teaching? A. "Propranolol helps increase blood flow to my thyroid gland." B. "Propranolol is used to prevent excess glucose in my blood." C. "Propranolol will decrease my tremors and fast heart beat." D. "Propranolol promotes a decrease of thyroid hormone in my body."

C A. Propranolol lowers blood pressure, but does not increase blood flow to the thyroid gland. B. Propranolol does not help prevent hyperglycemia. C. CORRECT: Propranolol is a beta‑adrenergic antagonist that decreases heart rate and controls tremors. D. Propranolol does not promote a decrease of thyroid hormone

S/S of hypoglycemia

Cold, clammy skin, diaphoresis, dizzness, tremors

A nurse is caring for a client who is taking for somatropin to stimulate growth. The nurse should plan to monitor the client's urine for which of the following? A. Bilirubin B. Protein C. Potassium D. Calcium

D A. Bilirubin can be present in the urine with liver or biliary disorders, but is not monitored during somatropin therapy. B. Protein can be present in the urine during stress, infection, or glomerular disorders, but is not monitored during somatropin therapy. C. Potassium is not expected to be present in a urine specimen. D. CORRECT: A large amount of calcium can be present in the urine of a client who takes somatropin. This puts the client at risk for renal calculi.

A nurse is assessing a client who is taking digoxin to treat heart failure. Which of the following findings is a manifestation of digoxin toxicity? A. Bruising B. Report of metallic taste C. Muscle pain D. Report of anorexia

D A. Bruising is an adverse effect of anticoagulants and antiplatelet medications. B. Metallic taste is an adverse effect of captopril and certain antibiotics. C. Weakness is a manifestation of digoxin toxicity, not muscle pain. D. CORRECT: Anorexia, blurred vision, stomach pain, and diarrhea are manifestations of digoxin toxicity

A nurse is reviewing the medical record of a client who takes desmopressin for diabetes insipidus. Which of the following findings is an adverse effect of desmopressin? A. Hypovolemia B. Hypercalcemia C. Agitation D. Headache

D A. Edema and hypervolemia, rather than hypovolemia, are adverse effects of desmopressin. B. Calcium imbalance is not an adverse effect of desmopressin. C. Sleepiness, rather than agitation, is an adverse effect of desmopressin, which can indicate water intoxication. D. CORRECT: Headache during desmopressin therapy is an indication of water intoxication.

A nurse is caring for a client who is prescribed isosorbide mononitrate for chronic stable angina and develops reflex tachycardia. Which of the following medications should the nurse expect to administer? A. Furosemide B. Captopril C. Ranolazine D. Metoprolol

D A. Furosemide, a loop diuretic, treats hypertension and edema associated with heart failure. It is not used to treat tachycardia. B. Captopril, an ACE inhibitor, treats hypertension or heart failure. It is not used to treat tachycardia. C. Ranolazine, an antianginal medication, treats stable angina pectoris. It is not used to treat tachycardia. D. CORRECT: Metoprolol, a beta adrenergic blocker, is used to treat hypertension and stable angina pectoris, and is often prescribed to decrease heart rate in clients who have tachycardia.

A nurse is caring for a client who has been taking acarbose for type 2 diabetes mellitus. Which of the following laboratory tests should the nurse plan to monitor? A. WBC B. Amylase C. Platelet count D. Liver function tests

D A. Infection is not an adverse effect of acarbose. It is not necessary to monitor WBC while the client is taking this medication. B. Sitagliptin and exenatide can cause rare pancreatitis. Recommend checking the amylase and lipase for a client taking those medications if the client reports uncontrolled abdominal pain. C. Acarbose does not affect the platelet levels. Acarbose can lead to iron deficiency anemia, so ensure monitoring of the client's hemoglobin. D. CORRECT: Acarbose can cause liver toxicity when taken long‑term. Ensure the client's liver function is monitored while taking this medication.

Miglitol is

Glyset

Loop diuretics - furosemide (Lasix) Contraindications

anuria

a Statin

atorvastatin

A patient is prescribed insulin glargine [Lantus]. Which statement should the nurse include in the discharge instructions? A. The insulin will have a cloudy appearance in the vial. B. The insulin should be injected twice daily (before breakfast and dinner). C. The patient should mix Lantus with the intermediate-acting insulin. D. The patient will have less risk of hypoglycemic reactions with this insulin.

b

Select the long duration Insulins a. Insulin Lispro b. Insulin glargine c. Insulin glulisine d. insuline determine e. regular Insulin f. Insulin aspart g. neutral protamine hagedorn insulin

b

levermis is used to provide

basal glycemic control

Signs and symptoms of hyperthyroidism?

bulging eyes, palpation (tachycardia)

The nurse teaches a patient with hypothalamic diabetes insipidus about desmopressin [DDAVP]. The nurse determines that the teaching was effective if the patient makes which statement? A. "I should increase my fluid intake to prevent dehydration." B. "The medication should be taken every day for 6 months." C. "I can expect to urinate more often while taking this drug." D. "The medication can be taken by inhaling through my nose."

d

Select the intermediate duration Insulins a. Insulin Lispro b. Insulin glargine c. Insulin glulisine d. insuline detemir e. regular Insulin f. Insulin aspart g. neutral protamine hagedorn insulin

d g

Loop diuretics - furosemide (Lasix) Adverse Reactions

dehydrations hypokalemia hypotension ototoxicity increased uric acid levels with possible gouty arthritis

types of antidiuretic hormone

desmospressin and vasopressin

IV insulin is for

diabetic ketoacidosis

what are the acute complications of poor glycemic control

diabetic ketoacidosis and hyperosmolar hyperglycemic state

Cardiac Glycosides/inotropic - digoxin (Lanoxin) Adverse Drug Reactions

digoxin toxicity GI symptoms - early signs of toxicity• Nausea, vomiting, anorexia CNS symptoms• Fatigue, visual disturbances, such as yellow vision and blurred vision

insulin should be kept out of

direct sunlight and extreme heat

Elevated TSH is an indicator of

hypothyroidism

Potassium-sparing diuretics - spironolactone (Aldactone) Instructions

report palpitations, irregular pulse, or other signs of hyperkalemia Avoid potassium supplements, large amounts of high potassium foods, and salt substitutes

Thiazide diuretics - hydrochlorothiazide (Microzide, Oretic) Interactions

Increased risk of digoxin toxicity Corticosteroids and amphotericin B increase risk for hypokalemia

desmopression: admin routes

Intranasal, PO, subQ, IV

Clear & should not be mixed w/ other insulins:

Lantus

insulin detemir generic name

Levemir

what is used to Treat all forms of hypothyroidism

Levothyroxine (Synthroid)

Effectiveness of what drug to treat hypothyroidism?

Levothyroxine: if is effect it will increase in energy and decrease in TSH levels

ACE Inhibitors - captopril (Capoten) Client Instructions

Lie supine if lightheadedness Report Rash Report metallic taste Refrain from using potassium supplements and potassium-containing salt substitutes Do not take an ACE inhibitor if you are pregnant or breastfeeding

Which insulin has a peak effect between 0.5 - 2.5?

Lispro (rapidacting)

Aldosterone antagonists - spironolactone (Aldactone) Administration

Maximum effect of eplerenone may take up to 4 weeks

Potassium-sparing diuretics - spironolactone (Aldactone) Adverse Reactions

Menstrual irregularities, abnormal hair growth (e.g. on face), and deepening of voice may occur in women, gynecomastia (growth of breast tissue) and impotence may occur in men

Beta blockers - atenolol (Tenormin), metoprolol (Lopressor) Administration

Metoprolol is available as an immediate-release tablet (Lopressor) or in a sustained-release dose (Toprol XL) which must not be crushed and must be swallowed whole

what oral hypoglycemic is Especially effective among Latinos and African Americans

Miglitol

ACE Inhibitors - captopril (Capoten) Interventions

Monitor BP following first dose Treat severe angioedema with IV epinephrine

when using increntin mimetic the patient should report persistent _______ because these drugs can lead to ________

abdominal pain; pancreatitis

name the adverse effects high dose therapy with hydrocortisone

adrenal suppression and Cushing's syndrome

non insulin injectable drugs

amylin mimetics and incretin mimetics

ARBs - losartan (Cozaar) Interventions

angioedema monitor Blood pressure before administering

Fludrocortisone (Florinef): therapeutic use

-Addison's disease -Primary hypoaldosteronism -Congenital adrenal hyperplasia

What causes Addison's disease?

-Adrenal failure -Pituitary failure -Inadequate doses of corticosteroids or abrupt withdrawal

therapeutic use for hydrocortisone

-Adrenal insufficiency -Allergic reactions to inflammation -Cancer

Fludrocortisone (Florinef): adverse effects

-Hypertension -Edema -Cardiac enlargement -Hypokalemia

treatment for thyroid storm

-Methimazole -Beta blocker -Sedation, cooling, glucocorticoids, IV fluids

hypothyroidism in adults: clinical presentation

-Pale, puffy face -Cold, dry skin -Brittle hair or loss of hair -Lowered heart rate and temperature -Lethargy and fatigue -Intolerance to cold -Impaired mentality

comprehensive plan for Type 1 diabetes

-Physical activity -Insulin replacement -Management of hypertension -Dyslipidemia

treatment for acute adrenal insufficiency

-Rapid replacement of fluid, salt, and glucocorticoids (hydrocortisone) -Glucose: Normal saline with dextrose

treatment for hyperthyroidism

-Surgical removal of thyroid tissue - Destruction of thyroid tissue -Suppression of thyroid hormone synthesis -Beta blockers (eg, propranolol) -Nonradioactive iodine

how long can insulin be kept after opening?

1 month

Mixtures of insulin in vials are stable for ________ at room temperature and for ______ under refrigeration

1 month; 3 months

Mixtures in prefilled syringes should be stored in a refrigerator for at least_________; they should be stored __________ with the needle pointing ___

1 week; vertically; up

A nurse is caring for a client who has supraventricular tachycardia. In addition to an electrocardiogram, which of the following assessment parameters should the nurse monitor closely during IV administration of verapamil (Calan)? 1. Respiratory rate 2. Blood pressure*** 3. Urine output 4. Level of consciousness

2. Blood Pressure

A nurse is reinforcing teaching with a client who is taking atorvastatin (Lipitor) daily. Which of the following statements by the client indicates understanding? 1. "I will avoid drinking grapefruit juice."*** 2. "I must take this medication without food." "It is best if I take this medication in the morning." "It is not necessary to have any routine lab tests done."

1. "I will avoid drinking grapefruit juice."***

A nurse receives a new prescription from the provider which reads "give 14 units of regular insulin and 28 units of long-acting insulin to be given subcutaneously at the breakfast hour." What is the total number of units of insulin that the nurse will prepare in the insulin syringe? 1. 14 units 2. 28 units 3. 32 units 4. 42 units

1. 14 units

A nurse on a medical unit is caring for a client who has angina pectoris and reports chest pain with a severity of 6 on a 0 to 10 scale. The nurse administers sublingual nitroglycerin (Nitrostat). After 5 min, the client states that his chest pain is now a 2. Which of the following actions should the nurse take? 1. Administer another nitroglycerin tablet.*** 2. Measure the client's blood pressure. 3. Check the client's apical heart rate. 4. Obtain an ECG

1. Administer another nitroglycerin tablet.***

A nurse is assessing an older adult client who is receiving digoxin (Lanoxin). To evaluate the client for digoxin toxicity, the nurse should check for which of the following manifestations? 1. Anorexia***. 2. Ataxia 3. Photosensitivity 4. Jaundice

1. Anorexia***.

A client has a new prescription for transdermal nitroglycerin (Nitro-Dur) to treat angina pectoris. When talking with the patient about using this drug, the nurse should include which of the following instructions? (Select all that apply.) 1. Apply the patch to a hairless area and rotate sites.*** 2. Apply a new patch each morning.*** 3. Remove the patch for 10 to 12 hr daily.*** 4. Apply the patch to dry skin and cover the area with plastic wrap.

1. Apply the patch to a hairless area and rotate sites.*** 2. Apply a new patch each morning.*** 3. Remove the patch for 10 to 12 hr daily.***

A nurse in a clinic is performing a routine examination for a client. The client has a blood pressure of 170/104 mm Hg, and the provider prescribes propranolol (Inderal). The nurse should question the prescription after noting in the client's medical record a history of 1. Asthma. 2. Glaucoma. 3. Depression. 4. Migraines.

1. Asthma.

A nurse in a clinic is performing a routine examination for a client. The client has a blood pressure of 170/104 mm Hg, and the provider prescribes propranolol (Inderal). The nurse should question the prescription after noting in the client's medical record a history of? 1. Asthma.*** 2. Glaucoma. 3. Depression. 4. Migraines.

1. Asthma.***

A nurse is caring for a client who received IV verapamil to treat supraventricular tachycardia (SVT). The client's pulse rate is now 98/ min and the blood pressure is 74/44 mg Hg. The nurse should expect a prescription for which of the following IV medications? 1. Calcium gluconate 2. Sodium bicarbonate 3. Potassium chloride 4. Magnesium sulfate

1. Calcium gluconate

A nurse is caring for a client who was admitted to the hospital with congestive heart failure (CHF) and is taking digoxin (Lanoxin) 0.25 mg daily. The client refused breakfast and is complaining of nausea and generalized weakness. Which of the following actions should the nurse perform first? 1. Check the client's vital signs.**** 2. Request a dietitian consult. 3. Suggest that the client rests before eating the meal. 4. Request an order for an antiemetic.

1. Check the client's vital signs.****

A nurse is caring for a client who is taking lisinopril (Zestril). Which of the following outcomes should the nurse anticipate? 1. Decreased blood pressure*** 2. Diarrhea 3. Chest pain 4. Impotence

1. Decreased blood pressure***

A nurse is talking with a client who is about to start taking captopril (Capoten) to treat hypertension. Which of the following instructions should the nurse include to help the client manage this medication's adverse effects? 1. Do not use salt substitutes while taking this medication.**** 2. Eat a meal before taking the medication. 3. Count your pulse rate before taking the medication. 4. Expect to gain weight while taking this medication.

1. Do not use salt substitutes while taking this medication.****

A client who is taking digoxin (Lanoxin) develops ECG changes and other indications of severe digoxin toxicity. Which of the following medications should the nurse prepare to administer? 1. Fab antibody fragments (Digibind)*** 2. Flumazenil (Mazicon) 3. Acetylcysteine (Mucomyst) 4. Naloxone (Narcan)

1. Fab antibody fragments (Digibind)***

nurse is preparing to administer atenolol (Tenormin) to a client. Which of the following should prompt the nurse to withhold the medication? 1. Heart rate 56/min*** 2. Oxygen saturation 90% 3. Respiratory rate 18/min 4. Blood pressure 160/94 mm Hg

1. Heart rate 56/min***

A nurse is reviewing the following vital signs: heart rate 86/min, blood pressure 80/40 mm Hg, respirations 28/min with stridor, and temperature 101.5o F (38.6o C). Which of the following actions should the nurse take next? 1. Hold captopril (Capoten).**** 2. Hold albuterol (Proventil). 3. Administer furosemide (Lasix). 4. Administer erythromycin (Erythrocin)

1. Hold captopril (Capoten).****

A nurse is caring for a client in liver failure with ascities who is receiving spironolactone (Aldactone). Which of the following outcomes should the nurse expect from the client's medication therapy? 1. Increased sodium excretion 2. Decrease urinary output 3. Increased potassium excretion 4. Decrease chloride excretion

1. Increased sodium excretion

A nurse is caring for a client who is taking levothyroxine (Synthroid). Which of the following manifestations should suggest to the nurse that the client may have taken an overdose of levothyroxine? 1. Insomnia*** 2. Constipation 3. Drowsiness 4. Hypoactive deep-tendon

1. Insomnia***

A nurse is talking with a client who is about to start using transdermal nitroglycerin (Nitro-Dur) to treat angina pectoris. Which of the following is an appropriate instruction for this medication therapy? 1. Apply a new transdermal patch once a week. 2. Apply the transdermal patch in the morning.*** 3. Apply the transdermal patch below the level of the waist. 4. Wait 24 hr to apply a new patch if the applied patch falls off.

2. Apply the transdermal patch in the morning.***

A nurse is preparing to administer 10 units of regular insulin and 20 units of NPH insulin to a client. What is the sequence of events the nurse should follow? (Move the steps of mixing insulin on the left into the box on the right, placing them in the selected order of performance. All steps must be used.). 1. Inspect vials for contaminants 2. Roll NPH vial between palms of hands 3. Inject air into NPH insulin vial 4. Inject air into regular insulin vial 5. Withdraw short-acting insulin into syringe 6. Withdraw intermediate insulin to syringe

1. Inspect vials for contaminants 2. Roll NPH vial between palms of hands 3. Inject air into NPH insulin vial 4. Inject air into regular insulin vial 5. Withdraw short-acting insulin into syringe 6. Withdraw intermediate insulin to syringe

A nurse is reinforcing teaching to a client who is to start therapy with Regular insulin (Humuin R) and NPH insulin (Humulin N). Which of the following should the nurse include in the teaching? 1. Keep the open vial of insulin at room temperature. 2. Inject the insulin into a large muscle. 3. Aspirate the medication prior to administration. 4. Administer the insulin in two separate injections.

1. Keep the open vial of insulin at room temperature.

A nurse is reinforcing teaching to a client who is to start therapy with Regular insulin (Humuin R) and NPH insulin (Humulin N). Which of the following should the nurse include in the teaching? 1. Keep the open vial of insulin at room temperature. **** 2. Inject the insulin into a large muscle. 3. Aspirate the medication prior to administration. 4. Administer the insulin in two separate injections.

1. Keep the open vial of insulin at room temperature. ****

A nurse is caring for a client who receives furosemide (Lasix) to treat heart failure. Which of the following laboratory values should the nurse be sure to monitor specifically for this client? 1. Potassium*** 2. Albumin 3. Chloride 4. Bicarbonate

1. Potassium***

A client experienced angioedema in response to losartan (Cozaar). Which of the following data indicates a therapeutic response to treatment? 1. Respirations are unlabored.*** 2. Client reports decreased groin pain of 3 on a 1-10 scale. 3. Blood pressure when arising from resting position is at premedication levels. 4. Client tolerates ordered dose of medication with no greater than 1+ peripheral edema.

1. Respirations are unlabored.***

A client who has left ventricular failure and a high pulmonary capillary wedge pressure (PCWP) is receiving dopamine IV to improve ventricular function. Which of the following changes indicates to the nurse that the medication is having a therapeutic effect? 1. Systolic blood pressure increases. 2. QRS width increases. 3. Apical heart rate increases. 4. PCWP increases.

1. Systolic blood pressure increases.

A nurse is providing teaching to a client who is starting Simvastatin. Which of the following information should the nurse include in the teaching? 1. Take this medication in the evening. 2. Change position slowly when rising from a chair. 3. Maintain a steady intake of green leafy vegetables. 4. Consume no more than 1 L/day of fluid.

1. Take this medication in the evening.

what are the target values for blood glucose at bedtime

100 to 140 mg/dL

the common insulin concentrations

100 units/mL or 500 units/mL

NPH insulin is inject _____________ times daily to provide _________ control between meals and during the night

2 or 3; glycemic

A nurse is caring for a client who is newly diagnosed with diabetes mellitus and is prescribed glipizide (Glucotrol). When instructing the client about this medication, the nurse should describe its method of action with which of the following statements? 1. "Glucotrol absorbs the excess carbohydrates in your system." 2. "Glucotrol stimulates your pancreas to release adequate insulin. 3. "Glucotrol replaces insulin that is not being produced by your pancreas." 4. "Glucotrol prevents your liver from destroying your insulin."

2. "Glucotrol stimulates your pancreas to release adequate insulin.

A nurse is caring for a client who is newly diagnosed with diabetes mellitus and is prescribed glipizide (Glucotrol). When instructing the client about this medication, the nurse should describe its method of action with which of the following statements? 1. "Glucotrol absorbs the excess carbohydrates in your system." 2. "Glucotrol stimulates your pancreas to release adequate insulin."*** 3. "Glucotrol replaces insulin that is not being produced by your pancreas." 4. "Glucotrol prevents your liver from destroying your insulin."

2. "Glucotrol stimulates your pancreas to release adequate insulin."***

A nurse is reinforcing teaching with a client whose medication was changed from metoprolol (Lopressor) to metoprolol/hydrochlorothiazide (Lopressor HCT). Which of the following statements by the client indicates understanding of the teaching? 1. "Now I will not have to diet to lose weight." 2. "With the new medication, I should experience fewer side effects."**** 3. "I will not have to do anything different because it is the same medication." 4. "The extra letters after the name of medication means it is a stronger dose."

2. "With the new medication, I should experience fewer side effects."****

A nurse is preparing to administer an IV injection of phenytoin (Dilantin) to a client. Which of the following nursing actions is appropriate? 1. Administer the drug rapidly. 2. Administer a saline solution after injection. 3. Hold the injection if seizure activity is present. 4. Dilute the medication with dextrose 5% in water.

2. Administer a saline solution after injection.

A nurse is providing discharge teaching for a client who has pulmonary edema and is about to start taking furosemide (Lasix). Which of the following instructions should the nurse include? 1. Take aspirin if headaches develop. 2. Eat foods that contain plenty of potassium.*** 3. Expect some swelling in the hands and feet. 4. Take the medication at bedtime.

2. Eat foods that contain plenty of potassium.***

A nurse is caring for a client who takes levothyroxine (Synthroid) 88 mcg/dayPO, furosemide (Lasix) 100 mg/day PO, acyclovir (Zovirax) 200 mg PO BID, and cimetidine (Tagamet) 300 mg PO QID. Which one of the following medications poses the highest risk for life-threatening adverse effects? 1. Levothyroxine 2. Furosemide*** 3. Acyclovir 4. Cimetidine

2. Furosemide

Client who has angina pectoris is experiencing chest pain and has taken three nitroglycerin tablets sublingually. The client reports relief from the chest pain but now reports a headache. The nurse should explain to the client that this symptom: 1. Could mean an allergy to the medication. 2. Is an expected side effect of the medication.*** 3. Indicates tolerance to the medication. 4. Is probably a result of anxiety about the chest pain.

2. Is an expected side effect of the medication.***

A nurse is preparing to administer lisinopril (Prinivil). Which of the following findings should be reported to the provider immediately? 1. Rash and impaired sense of taste 2. Swelling of the tongue and oral pharynx*** 3. Decreased blood pressure and pulse rate 4. Low urine output and white blood cell count

2. Swelling of the tongue and oral pharynx***

A nurse is assessing a client who has taken procainamide to treat dysrhythmias for the last 12 months. The nurse should assess the client for which of the following manifestations as an adverse effect of this medication? (Select all that apply.) 1. Hypertension 2. Widened QRS complex 3. Narrowed QT interval 4. Easy bruising 5. Swollen joints

2. Widened QRS complex 4. Easy bruising 5. Swollen joints

Insulin glargine's duration of action is up to

24 hours

A nurse is caring for a client with diabetes mellitus who receives 25 units of NPH insulin every morning if her blood glucose level is above 200 mg/dL. The nurse monitors this client for hypoglycemia because NPH insulin peaks how long after administration? 1. 30 min to 1 hr 2. 2 to 3 hr 3. 4 to 12 hr*** 4. 18 to 24 hr

3. 4 to 12 hr***

A nurse is preparing to administer propranolol to a client who has a dysrhythmia. Which of the following actions should the nurse plan to take? 1. Hold propranolol for an apical pulse greater than 100/min. 2. Administer propranolol to increase the client's blood pressure. 3. Assist the client when sitting up or standing after taking this medication. 4. Check for hypokalemia frequently due to the risk for propranolol toxicity.

3. Assist the client when sitting up or standing after taking this medication.

A nurse is teaching a client who has angina pectoris about starting therapy with nitroglycerin (Nitrostat) tablets. The nurse should instruct the client to take the medication? 1. After each meal and at bedtime. 2. Every 15 min during an acute attack. 3. At the first indication of chest pain.*** 4. With 8 oz of water

3. At the first indication of chest pain.***

A nurse is preparing to teach a client how to draw up regular insulin and neutral protamine hagedorn (NPH) insulin into the same syringe. Which of the following instructions is appropriate for the nurse to provide? 1. Inject air into the regular insulin first. 2. Shake the NPH insulin until it is well mixed. 3. Discard any regular insulin that appears cloudy.****

3. Discard any regular insulin that appears cloudy.****

A nurse is caring for a client whose serum potassium level is 5.3 mEq/L. Which of the following scheduled medications should the nurse plan to administer? 1. Lisinopril (Zestril) 2. Digoxin (Lanoxin) 3. Furosemide (Lasix) 4. Potassium iodide (SSKI)

3. Furosemide (Lasix)

A nurse is caring for a client whose serum potassium level is 5.3 mEq/L. Which of the following scheduled medications should the nurse plan to administer? 1. Lisinopril (Zestril) 2. Digoxin (Lanoxin) 3. Furosemide (Lasix)***. 4. Potassium iodide (SSKI

3. Furosemide (Lasix)***.

A nurse is caring for a client who is prescribed furosemide (Lasix). For which of the following adverse effects should the nurse monitor? 1. Hypervolemia 2. Hypertension 3. Hypokalemia*** 4. Hypoglycemia

3. Hypokalemia***

A nurse is caring for a client who is receiving liothyronine (Cytomel) for treatment of hypothyroidism. Which of the following should the nurse recognized as a therapeutic response? 1. Loss of appetite 2. Increase in daily weight 3. Improvement of overall mood 4. Decrease in body temperature

3. Improvement of overall mood

A client has developed agranulocytosis as a result of taking propylthiouracil (PTU) to treat hyperthyroidism. When preparing to counsel the client, the nurse should base her instructions on the fact that the client is at serious risk for which of the following? 1. Excessive bleeding 2. Ecchymosis. 3. Infection 4. Hyperglycemia

3. Infection

A nurse is collecting data from a client who is taking gemfibrozil. Which of the following assessment findings should the nurse identify as an adverse effect of this medication? 1. Mental status changes 2. Tremor 3. Jaundice 4. Pneumonia

3. Jaundice

A client is telling the nurse in the clinic that he gets a headache after he takes sublingual nitroglycerin (Nitrostat) for his angina pain. Which of the following should the nurse instruct the client to do? 1. Reduce the nitroglycerin dose. 2. Ask the provider to prescribe a strong analgesic. 3. Lie down in a cool environment and rest.*** 4. Ask the provider to prescribe a different medication.

3. Lie down in a cool environment and rest.***

A nurse is caring for a client who receives digoxin (Lanoxin). Before administering this medication, which of the following actions should the nurse take? 1. Offer the client a light snack. 2. Measure the client's blood pressure. 3. Measure the client's apical pulse.**** 4. Weigh the client.

3. Measure the client's apical pulse.****

A nurse is caring for a client who has a diagnosis of diabetes mellitus and hypertension and recently began taking propranolol (Inderal). When the client reports dizziness upon standing, the nurse should perform which of the following actions? 1. Auscultate lung sounds bilaterally. 2. Check the heart rate and capillary refill. 3. Monitor blood pressure lying, sitting, and standing.****. 4. Obtain a capillary glucose level with a glucometer.

3. Monitor blood pressure lying, sitting, and standing.****.

A nurse is caring for a client who is to begin therapy (furosemide) Lasix. The nurse notes that the client has not been receiving supplemental electrolytes. Which laboratory value is a priority for the nurse to check before administering furosemide? 1. Bicarbonate 2. Chloride 3. Potassium** 4. Phosphate

3. Potassium**

A nurse is talking with a client who has type 2 diabetes mellitus that has responded well to oral hypoglycemic medication. The client reports morning fasting blood glucose levels above 180 mg/dL for the past week. In reviewing the client's medication history, the nurse should identify which of the following medications as a possible contributing factor to the recent change in glycemic control? 1. Ranitidine (Zantac) 2. Cephalexin (Keflex) 3. Prednisone. (Deltasone) 4. Levothyroxine (Synthroid)

3. Prednisone. (Deltasone)

A nurse is assessing a client who is taking amiodarone to treat atrial fibrillation. Which of the following findings is a manifestation of amiodarone toxicity? 1. Light yellow urine 2. Report of tinnitus 3. Productive cough 4. Blue-gray skin discoloration

3. Productive cough

A nurse is caring for client who has a prescription for phenytoin (Dilantin). For which of the following findings should the nurse instruct the client to notify the provider? 1. Headache 2. Insomnia 3. Skin rash 4. Gastric discomfort

3. Skin rash

A nurse is providing teaching to a client who has hypothyroidism and has a new prescription for levothyroxine (Synthroid). The nurse should instruct the client to avoid which of the following herbal supplements? 1. Saw palmetto 2. Cranberry 3. Soy isoflavones*** 4. Garlic

3. Soy isoflavones***

A client provides a nurse with a list of home medications. Which of the following should the nurse recognize as incompatible? 1. Furosemide and digoxin 2. Alprazolam and zolpidem 3. Warfarin solution and multivitamins 4. Gentamicin sulfate and fluconazole

3. Warfarin solution and multivitamins

when do the effects of regular insulin begin and when does it peak?

30 to 60 minutes and 2 to 4 hours

Calcium Channel Blockers (dihydropyridines) - nifedipine (Adalat, Procardia) Contraindications

3rd degree AV block Concurrent use with grapefruit, rifampin, rifabutin, phenobarbital, phenytoin, carbamazepine, or St. John's wort

A nurse is reinforcing teaching with a client who is receiving continuous subcutaneous insulin via an external insulin pump. Which of the following client statements indicates a need for further teaching? 1. "I will change the needle every 3 days." 2. "I should store all unused insulin in the refrigerator." 3. "If I skip lunch, I will skip my mealtime dose of insulin." 4. "I will adjust my dosages of Lantus insulin according to my blood glucose results.****

4. "I will adjust my dosages of Lantus insulin according to my blood glucose results.****

A nurse is reinforcing medication instruction to a group of clients. Which of the following statements indicates a need for further clarification? 1. "I will take ibuprofen for arthritis." 2. "I will take morphine sulfate during sickle cell crisis." 3. "I will take propranolol hydrochloride to manage high blood pressure." 4. "I will take aspirin for headaches like I did when I had a stroke."

4. "I will take aspirin for headaches like I did when I had a stroke."

A nurse is teaching a client who has angina pectoris about starting therapy with nitroglycerin (Nitrostat) sublingual tablets. The nurse verifies the client's understand when the client states which of the following? 1. "I'll dial 911 if I still have pain after taking three tablets 5 minutes apart." 2. "I'll dial 911 if I still have pain after taking four nitroglycerin tablets over a 20-minute period." 3. "I'll dial 911 when I have pain and then take the nitroglycerin tablets." 4. "I'll dial 911 if one tablet does not relieve my pain and then take up to two more 5 minutes apart while waiting.***

4. "I'll dial 911 if one tablet does not relieve my pain and then take up to two more 5 minutes apart while waiting.***

A nurse is teaching a client who is taking digoxin and has a new prescription for colesevelam. Which of the following instructions should the nurse include in the teaching? 1. "Take digoxin with your morning dose of colesevelam." 2. "Your sodium and potassium levels will be monitored periodically while taking colesevelam." 3. "Watch for bleeding or bruising while taking colesevelam." 4. "Take colesevelam with food and at least one glass of water."

4. "Take colesevelam with food and at least one glass of water."

A nurse is caring for a client who received an injection of penicillin G procaine (Bicillin). The client experiences dyspnea and states, "My tongue feels swollen." Which of the following should be the nurse's priority action? 1. Obtain intravenous fluids for administration. 2. Record the observed data in medical record. 3. Deliver a dose of albuterol (Proventil) by inhalation. 4. Administer epinephrine (Adrenalin) subcutaneously.***

4. Administer epinephrine (Adrenalin) subcutaneously.***

A nurse in the emergency department is assessing a client. The client's laboratory values are obtained, and she is now requesting an alcoholic beverage. After reviewing the client's admission laboratory results, which of the following medication prescriptions should the nurse question? Sodium 144 mEq/L Potassium 3.5 mEq/L Chloride 106 mEq/L Carbon dioxide 32 mEq/L BUN 55 mg/dL Glucose 468 mg/dL Creatinine 5 mg/dL 1. Oxazepam (Serax) 2. Glipizide (Glucotrol) 3. Regular insulin (Humulin R) 4. Amphotericin B (Fungizone)

4. Amphotericin B (Fungizone) Would question Glucose and Creatinine

A nurse is preparing to administer digoxin (Lanoxin) to a client who has heart failure. Which of the following actions is appropriate? 1. Withholding the medication if the heart rate is above 100/min 2. Instructing the client to eat foods that are low in potassium 3. Measuring apical pulse rate for 30 seconds before administration 4. Evaluating the client for nausea, vomiting, and anorexia

4. Evaluating the client for nausea, vomiting, and anorexia

A nurse is preparing to administer digoxin (Lanoxin) to a client who has heart failure. Which of the following actions is appropriate? 1. Withholding the medication if the heart rate is above 100/min 2. Instructing the client to eat foods that are low in potassium 3. Measuring apical pulse rate for 30 seconds before administration 4. Evaluating the client for nausea, vomiting, and anorexia***

4. Evaluating the client for nausea, vomiting, and anorexia***

A nurse is to administer subcutaneous short-acting insulin combinedwith long acting insulin to the client before he eats breakfast at 8:00 AM. Which of the following should the nurse do? 1. Give the insulin at 7:00 2. Give the insulin when the breakfast tray arrives. 3. Give the insulin one half hour after breakfast with other routine medicines. 4. Give the insulin at 7:30 AM after checking the blood glucose level results.

4. Give the insulin at 7:30 AM after checking the blood glucose level results.

A nurse is talking with a client who has hypertension and stable angina pectoris and is about to start taking verapamil (Calan). The nurse should instruct the client to avoid taking this medication with 1. Milk. 2. Orange Juice 3. Coffee 4. Grapefruit juice.****

4. Grapefruit Juice

A nurse is caring for a client that is experiencing Cushing's Triadfollowing a subdural hematoma. The client exhibits a widening pulse pressure (increased systolic and decreased diastolic blood pressure), a decrease in pulse rate, and altered respiratory pattern. Which of the following should the nurse administer? 1. Albumin 25 2. Dextran 70 3. Hydroxyethyl glucose (Hetastarch or Hespan) 4. Mannitol 25%

4. Mannitol 25%

A nurse is providing information to a client who has a new prescription for hydrochlorothiazide. Which of the following information should the nurse include? A. Take the medication with food. B. Plan to take the medication at bedtime. C. Expect increased swelling of the ankles. D. Fluid intake should be limited in the morning.

A A. CORRECT: The client should take hydrochlorothiazide with or after meals to prevent gastrointestinal upset. B. The client should take hydrochlorothiazide in the morning or no later than 1400, and not at bedtime, to prevent nocturia. C. The client should expect decreased swelling of the ankles. D. The client should maintain an adequate fluid intake (1,500 mL) throughout the day unless contraindicated.

A nurse is admitting a client for a total hip arthroplasty. The client takes hydrocortisone for Addison's disease. Which of the following actions is the nurse's priority? A. Administering a supplemental dose of hydrocortisone B. Instructing the client about coughing and deep breathing C. Collecting additional information about the client's history of Addison's disease D. Inserting an indwelling urinary catheter

A A. CORRECT: Acute adrenal insufficiency (adrenal crisis) is the greatest risk to a client who has Addison's disease, is taking a glucocorticoid, and is undergoing surgery. To prevent acute adrenal insufficiency, supplemental doses are administered during times of increased stress. B. Instruction on coughing and deep breathing can prevent postoperative complications, but it is not the priority. C. Obtaining additional data can help with later treatment plans, but it is not the priority. D. Inserting an indwelling urinary catheter will promote postoperative I&O monitoring but it is not the priority

A nurse is caring for a client who is taking propylthiouracil. Which of the following findings should the nurse monitor for as an adverse effect of this medication? A. Bradycardia B. Insomnia C. Heat intolerance D. Weight loss

A A. CORRECT: Bradycardia is an adverse effect of propylthiouracil. Monitor for bradycardia. B. Drowsiness, rather than insomnia, is an adverse effect of propylthiouracil. C. Cold intolerance rather than heat intolerance is an adverse effect of propylthiouracil. D. Weight gain, rather than weight loss, is an adverse effect of propylthiouracil.

A nurse is teaching a client who has a new prescription for nitroglycerin transdermal patch for angina pectoris. Which of the following instructions should the nurse include? A. Remove the patch each evening. B. Cut each patch in half if angina attacks are under control. C. Take off the nitroglycerin patch for 30 min if a headache occurs. D. Apply a new patch every 48 hr

A A. CORRECT: In order to prevent tolerance to nitroglycerin, the client should remove the patch for 10 to 12 hr during each 24‑hr period. B. The client should always apply a whole patch to ensure he receives the prescribed dosage. The patches are available in many dosages. C. Do not instruct the client to remove patches for a 30‑min period if a headache occurs. The client should notify the provider if headaches do not resolve because the dose of nitroglycerin might need to be decreased. D. The client should apply a new patch every 24 hr.

A nurse is teaching a client who has a new prescription for verapamil to control hypertension. Which of the following instructions should the nurse include? A. Increase the amount of fiber in the diet. B. Drink grapefruit juice daily to increase vitamin C intake. C. Decrease the amount of calcium in the diet. D. Withhold food for 1 hr after the medication is taken.

A A. CORRECT: Increasing dietary fiber intake can help prevent constipation, an adverse effect of verapamil. B. Clients should be taught to avoid drinking grapefruit juice when taking verapamil to prevent toxicity. It is not necessary to take extra vitamin C when taking verapamil. C. There is no restriction on dietary calcium intake for clients taking verapamil. D. There is no restriction regarding food when taking verapamil. Clients can take verapamil with food to prevent GI upset.

A nurse is reviewing the health record of a client who asks about using propranolol to treat hypertension. The nurse should recognize which of the following conditions is a contraindication for taking propranolol? A. Asthma B. Glaucoma C. Hypertension D. Tachycardia

A A. CORRECT: Propranolol is a nonselective beta‑adrenergic blocker that blocks both beta1 and beta2 receptors. Blockade of beta2 receptors in the lungs causes bronchoconstriction, so it is contraindicated in clients who have asthma. B. Propranolol is not contraindicated in clients who have glaucoma. C. Propranolol is prescribed to treat hypertension. It is not contraindicated for clients who have this disorder. D. Propranolol is prescribed to treat tachydysrhythmias, such as tachycardia. It is contraindicated in clients who have bradycardia and heart block

A nurse is caring for a client who received IV verapamil to treat supraventricular tachycardia (SVT). The client's pulse rate is now 98/min and the blood pressure is 74/44 mg Hg. The nurse should expect a prescription for which of the following IV medications? A. Calcium gluconate B. Sodium bicarbonate C. Potassium chloride D. Magnesium sulfate

A A. CORRECT: Reverse severe hypotension caused by verapamil with calcium gluconate, given slowly IV. The calcium counteracts vasodilation caused by verapamil. Other measures to increase blood pressure can include IV fluid therapy and placing the client in a modified Trendelenburg position. B. IV sodium bicarbonate is used to treat metabolic acidosis. It is not used to increase blood pressure in clients who have received verapamil. C. IV potassium chloride is used to treat hypokalemia. It is not used to increase blood pressure in clients who have received verapamil. D. IV magnesium sulfate is used to treat ventricular dysrhythmias, such as torsades de pointes. It is not used to increase blood pressure in clients who have received verapamil.

A nurse is providing teaching for a client who has a new prescription for metformin. Which of the following findings should the nurse instruct the client to report as an adverse effect of metformin? A. Somnolence B. Constipation C. Fluid retention D. Weight gain

A A. CORRECT: Somnolence can indicate lactic acidosis, which is manifested by extreme drowsiness, hyperventilation, and muscle pain. It is a rare but very serious adverse effect caused by metformin and should be reported to the provider. B. Diarrhea is an adverse effect of metformin. C. Fluid retention is an adverse effect of pioglitazone. D. Anorexia and weight loss are adverse effects of metformin.

A nurse is teaching a client who has a new prescription for digoxin to treat heart failure. Which of the following instructions should the nurse include in the teaching? A. Contact provider if heart rate is less than 60/min. B. Check pulse rate for 30 seconds and multiply result by 2. C. Increase intake of sodium. D. Take with food if nausea occurs.

A A. CORRECT: The client should contact the provider for a heart rate less than 60/min. B. The client should check their pulse rate for 1 full minute before each dose. C. The client should reduce intake of sodium and avoid excess fluids. D. The client should report nausea to the provider because it is a manifestation of digoxin toxicity.

A nurse is providing teaching to a client who is starting simvastatin. Which of the following information should the nurse include in the teaching? A. Take this medication in the evening. B. Change position slowly when rising from a chair. C. Maintain a steady intake of green leafy vegetables. D. Consume no more than 1 L/day of fluid.

A A. CORRECT: The client should take simvastatin in the evening because nighttime is when the most cholesterol is synthesized in the body. Taking statin medications in the evening increases medication effectiveness. B. Changing position slowly might be necessary when taking an antihypertensive medication, but it is not necessary after taking simvastatin. C. Consuming a steady intake of green vegetables is important for clients taking warfarin, but does not help lower cholesterol when taking simvastatin. D. There is no indication for taking less than 1 L/day of fluid when taking simvastatin

A nurse is teaching a client who has angina how to use nitroglycerin transdermal ointment. The nurse should include which of the following instructions? A. "Remove the prior dose before applying a new dose." B. "Rub the ointment directly into your skin until it is no longer visible." C. "Cover the applied ointment with a clean gauze pad." D. "Apply the ointment to the same skin area each time."

A A. CORRECT: The client should remove the prior dose before applying a new dose to prevent toxicity. B. The ointment should not be rubbed directly onto the skin. It is also important to tell the client not to touch the ointment with the fingers. The client should use the applicator that comes with the ointment to measure the correct dose and then spread the ointment onto the premarked paper, before applying the ointment‑covered paper to the skin. C. The client should cover the applied ointment with a transparent dressing and tape securely to the skin. Do not cover the medication with gauze. D. The client should rotate application sites each time the ointment is applied. The client should select a clean, hairless area of the body.

A nurse is taking a medication history from a client who has angina and is to begin taking ranolazine. The nurse should report which of the following medications in the client's history that can interact with ranolazine? (Select all that apply.) A. Digoxin B. Simvastatin C. Verapamil D. Amlodipine E. Nitroglycerin transdermal patch

A, B, C, A. CORRECT: Concurrent use with ranolazine increases blood levels of digoxin, so digoxin toxicity can result. B. CORRECT: Concurrent use with ranolazine increases blood levels of simvastatin, so liver toxicity can result. C. CORRECT: Verapamil is an inhibitor of CYP3A4, which can increase levels of ranolazine and lead to the dysrhythmia torsades de pointes. D. Amlodipine, a calcium channel blocker, is used for hypertension and stable angina. It is prescribed along with ranolazine to treat angina. E. Nitroglycerin transdermal patches are prescribed along with ranolazine to treat angina.

A nursing is planning care for a client who is receiving furosemide IV for peripheral edema. Which of the following interventions should the nurse include in the plan of care? (Select all that apply.) A. Assess for tinnitus. B. Report urine output 50 mL/hr. C. Monitor blood potassium levels. D. Elevate the head of bed slowly before ambulation. E. Recommend eating a banana daily.

A, C, D, E A. CORRECT: An adverse effect of furosemide is ototoxicity. Manifestations of tinnitus should be reported to the provider. B. A urine output of 50 mL/hr is within the expected reference range. A urine output less than 30 mL/hr is a manifestation of dehydration, and the provider should be notified. C. CORRECT: A decrease in blood potassium levels is an adverse effect of furosemide, and the provider should be notified. D. CORRECT: Slowly elevating the head of the bed will prevent the client from developing orthostatic hypotension, which is a manifestation of hypovolemia. E. CORRECT: A banana is high in potassium. Encourage the client to eat foods high in potassium to prevent hypokalemia.

A nursing is planning care for a client who is receiving furosemide iV for peripheral edema. Which of the following interventions should the nurse include in the plan of care? (Select all that apply) A. Assess for tinnitus. B. Report urine output 50 mL/hr. C. Monitor blood potassium levels. D. Elevate the head of bed slowly before ambulation. E. Recommend eating a banana daily.

A. Assess for tinnitus. C. Monitor blood potassium levels. D. Elevate the head of bed slowly before ambulation. E. Recommend eating a banana daily.

A nurse is providing teaching to a client who has type 2 diabetes mellitus and is starting repaglinide. Which of the following statements by the client indicates understanding of the administration of this medication? A. "I'll take this medication after I eat." B. "I'll take this medicine 30 minutes before I eat." C. "I'll take this medicine just before I go to bed." D. "I'll take this medication at least 1 hour before I eat."

B A. Repaglinide peaks within 1 hr after administration; taking it after meals would not be effective in helping the client process the carbohydrates consumed during the meal. B. CORRECT: Repaglinide causes a rapid, short‑lived release of insulin. The client should take this medication within 30 min before each meal so that insulin is available when food is digested. C. Repaglinide is only effective for about 4 hr, so taking the medication before bedtime would not help with management of mealtime carbohydrate intake. D. Repaglinide has a rapid onset and the risk of hypoglycemia would be high if the client takes the medication an hr before eating.

A nurse is teaching a client who has angina pectoris and is learning how to treat acute anginal attacks. The clients asks, "What is my next step if I take one tablet, wait 5 minutes, but still have anginal pain?" Which of the following responses should the nurse make? A. "Take two more sublingual tablets at the same time." B. "Call the emergency response team." C. "Take a sustained‑release nitroglycerin capsule." D. "Wait another 5 minutes then take a second sublingual tablet."

B A. The client should not take two sublingual doses at once. B. CORRECT: The next step is to call 911 and then take a second sublingual tablet. If the first tablet does not work, the client might be having a myocardial infarction. The client can take a third tablet if the second one has not relieved the pain after waiting an additional 5 minutes. C. Taking an oral sustained‑release capsule is not indicated to treat an acute anginal attack. D. The client should not wait an additional 5 minutes before taking a second tablet. The client should call 911 because they might be having a myocardial infarction.

A nurse is assessing a client who has taken procainamide to treat dysrhythmias for the last 12 months. The nurse should assess the client for which of the following manifestations is an adverse effect of this medication. (Select all that apply.) A. Hypertension B. Widened QRS complex C. Narrowed QT interval D. Easy bruising E. Swollen joints

B, D, E A. Hypotension, rather than hypertension, is an adverse effect of procainamide. B. CORRECT: On the ECG, procainamide can cause a widened QRS complex, which is a manifestation of cardiotoxicity if the QRS complex becomes widened by more than 50% of the expected reference range. C. On the ECG, procainamide can cause a prolonged QT interval, a manifestation of cardiotoxicity. D. CORRECT: Procainamide can cause bone marrow depression, with neutropenia (infection) and thrombocytopenia (easy bruising, bleeding). E. CORRECT: Systemic lupus erythematosus‑like syndrome can occur as an adverse effect of procainamide. Manifestations include swollen, painful joints. Clients who take procainamide in large doses or for more than 1 year are at risk.

A nurse is planning to administer a first dose of captopril to a client who has hypertension. Which of the following medications can intensify first dose hypotension? (Select all that apply.) A. Simvastatin B. Hydrochlorothiazide C. Phenytoin D. Clonidine E. Aliskiren

B, D, E A. Simvastatin, an antilipemic medication that lowers cholesterol, does not interact with captopril and does not intensify first‑dose hypotension. B. CORRECT: Hydrochlorothiazide, a thiazide diuretic, is often used to treat hypertension. Diuretics can intensify first‑dose orthostatic hypotension caused by captopril and can continue to interact with antihypertensive medications to cause hypotension. Monitor clients carefully for hypotension, especially after the first dose of captopril and keep the client safe from injury. C. Phenytoin, an antiseizure medication, does not interact with captopril and does not intensify first dose hypotension. D. CORRECT: Clonidine, a centrally acting alpha2 agonist, is an antihypertensive medication that can interact with captopril to intensify first‑dose orthostatic hypotension. E. CORRECT: Aliskiren, a direct renin inhibitor, is an antihypertensive medication that can interact with captopril to intensify its first‑dose orthostatic hypotension

What provides an index of average glucose levels over the prior 2 to 3 months?

Hemoglobin A1c

A nurse in an acute care facility is caring for a client who is receiving IV nitroprusside for hypertensive crisis. Which of the following conditions should the nurse monitor the client for as an adverse effect of this medication? A. Intestinal ileus B. Neutropenia C. Delirium D. Hyperthermia

C A. Headache is an adverse effect of nitroprusside, not intestinal ileus. B. Bradycardia is an adverse effect of nitroprusside, not neutropenia. C. CORRECT: Delirium and other mental status changes can occur in thiocyanate toxicity when IV nitroprusside is infused at a high dosage. Monitor thiocyanate level during therapy to remain below 10 mg/dL. D. Hypotension is an adverse effect of nitroprusside, not hyperthermia.

A nurse is teaching clients about the use of insulin to treat type 1 diabetes mellitus. For which of the following types of insulin should the nurse tell the clients to expect a peak effect 1 to 5 hr after administration? A. Insulin glargine . NPH insulin C. Regular insulin D. Insulin lispro

C A. Insulin glargine, a long‑acting insulin, does not have a peak effect time, but is fairly stable in effect after metabolized. B. NPH insulin has a peak effect around 6 to 14 hr following administration. C. CORRECT: Regular insulin has a peak effect around 1 to 5 hr following administration. D. Insulin lispro has a peak effect around 30 min to 2.5 hr following administration.

A nurse is assessing a client who is taking amiodarone to treat atrial fibrillation. Which of the following findings is a manifestation of amiodarone toxicity? A. Light yellow urine B. Report of tinnitus C. Productive cough D. Blue‑gray skin discoloration

C A. Light yellow urine is an expected finding and does not indicate toxicity. B. Ototoxicity can occur with aminoglycoside antibiotics, but does not indicate amiodarone toxicity. C. CORRECT: Productive cough can indicate pulmonary toxicity or heart failure. The nurse should assess for cough, chest pain, and shortness of breath. D. A blue‑gray skin discoloration can occur in clients who are taking amiodarone with sun exposure and should resolve

A nurse is collecting data from a client who is taking gemfibrozil. Which of the following assessment findings should the nurse identify as an adverse effect of this medication? A. Mental status changes B. Tremor C. Jaundice D. Pneumonia

C A. Mental status changes do not occur as adverse effects of gemfibrozil. B. Tremor does not occur as an adverse effect of gemfibrozil. C. CORRECT: Jaundice, anorexia, and upper abdominal discomfort can be findings in liver impairment, which can occur in clients taking gemfibrozil. D. Pneumonia is not an adverse effect of gemfibrozil

A nurse is preparing to administer propranolol to a client who has a dysrhythmia. Which of the following actions should the nurse plan to take? A. Hold propranolol for an apical pulse greater than 100/min. B. Administer propranolol to increase the client's blood pressure. C. Assist the client when sitting up or standing after taking this medication. D. Check for hypokalemia frequently due to the risk for propranolol toxicity

C A. Propranolol is a beta‑adrenergic blocker that is used to slow tachydysrhythmias. The nurse should not hold the medication for a pulse greater than 100/min, but should hold it for a very low pulse rate, such as less than 50/min. B. Propranolol is used to treat hypertension and is not administered to increase the client's blood pressure. C. CORRECT: Propranolol can cause orthostatic hypotension, so it is important assess for dizziness during ambulation or when moving to a sitting position. D. Propranolol can increase potassium level. The client is at risk for toxicity with digoxin, rather than propranolol, when the blood potassium is low

A nurse is caring for a client who has increased intracranial pressure and is receiving mannitol. Which of the following findings should the nurse report to the provider? A. Blood glucose 150 mg/dL B. Urine output 40 mL/hr C. Dyspnea D. Bilateral equal pupil size

C A. This blood glucose is within the expected reference range. B. Urine output of 40 mL/hr is within the expected reference range. C. CORRECT: Dyspnea is a manifestation of heart failure, an adverse effect of mannitol. Stop the medication and notify the provider. D. Bilateral equal pupil size is an expected finding and can indicate reduction in intracranial pressure.

A nurse is completing a nursing history for a client who takes simvastatin. The nurse should identify which of the following disorders as a contraindication to adding ezetimibe to the client's medications? A. History of severe constipation B. History of hypertension C. Active hepatitis C D. Type 2 diabetes mellitus

C A. Unlike the bile‑acid sequestrants, ezetimibe does not cause constipation and is not contraindicated in clients who have a history of constipation. B. A history of hypertension is not a contraindication to taking ezetimibe along with simvastatin. C. CORRECT: Ezetimibe is contraindicated in clients who have an active moderate‑to‑severe liver disorder, especially if the client is already taking a statin (simvastatin). D. Type 2 diabetes mellitus is not a contraindication to taking ezetimibe along with simvastatin

Centrally acting alpha2 agonists - clonidine (Catapres) Adverse Drug Reactions

CNS effects: drowsiness, dizziness Dry mouth Rebound hypertensive crisis may result if clonidine is abruptly discontinued

Nitrates - nitroglycerin, isosorbide (Isordil)- Interventions

Caregivers should avoid touching ointment its peak effect is from 30 min to an hour for transdermal forms

Beta blockers - atenolol (Tenormin), metoprolol (Lopressor) Client Instruction

Check pulse rate daily before taking drug and report to provider for pulse slower than 60 beats/minute

Beta blockers - atenolol (Tenormin), metoprolol (Lopressor) Precautions

Clients with Heart failure controlled by digitalis and diuretics Diabetes mellitus

HHS management:

Correct hyperglycemia and dehydration with IV insulin, fluids, and electrolytes

Thiazide diuretics - hydrochlorothiazide (Microzide, Oretic) Interventions

If hypokalemia occurs, monitor for dysrhythmias If hypokalemia is a risk (e.g. client also taking digoxin) hydrochlorothiazide may be combined with a potassium supplemetn for potassium sparing diuretic Monitor Blood glucose Monitor uric Acid levels

A nurse is teaching a client who is taking digoxin and has a new prescription for colesevelam. Which of the following instructions should the nurse include in the teaching? A. "Take digoxin with your morning dose of colesevelam." B. "Your sodium and potassium levels will be monitored periodically while taking colesevelam." C. "Watch for bleeding or bruising while taking colesevelam." D. "Take colesevelam with food and at least one glass of water."

D A. Many medications, including digoxin, should be taken 1 hr before colesevelam or 4 hr after to prevent decreased absorption of the other medications. B. Blood electrolytes are not checked periodically while taking colesevelam. However, total cholesterol, LDL, HDL, and triglycerides are checked, as well as blood glucose and HbA1C levels for clients who have diabetes mellitus. C. Bleeding and bruising are not expected effects caused by colesevelam. D. CORRECT: Colesevelam should be taken with food and at least 8 oz of water

A nurse is caring for an older adult client who has hypothyroidism and a new prescription for levothyroxine. Which of the following dosage schedules should the nurse expect for this client? A. The client will start at a high dosage, and the amount will be tapered as needed. B. The client will remain on the initial dosage during the course of treatment. C. The client's dosage will be adjusted daily based on blood levels. D. The client will start on a low dosage, which can be gradually increased.

D A. Starting a new medication at a high dosage can cause harm. B. The client's dosage will change periodically throughout treatment. C. The client's dosage will be based on blood levels, but daily monitoring is not required. D. CORRECT: Expect that levothyroxine will be started at a low dosage and gradually increased over several weeks. This is especially important in older adult clients to prevent toxicity

A nurse is providing teaching to a client who has a prescription for pramlintide for type 1 diabetes mellitus. Which of the following should the nurse include in the teaching? (Select all that apply.) A. "Take oral medications 30 min before injection." B. "Use upper arms as preferred injection sites." C. "Mix pramlintide with the breakfast dose of insulin." D. "Inject pramlintide just before a meal." E. "Discard open vials after 28 days."

D, E A. Pramlintide delays oral medication absorption, so oral medications should be taken 1 hr before or 2 hr after pramlintide injection. B. The thigh or abdomen, rather than the upper arms, are preferred sites for pramlintide injection. C. Pramlintide should not be mixed in a syringe with any type of insulin. D. CORRECT: Pramlintide can cause hypoglycemia, especially when the client also takes insulin, so it is important to eat a meal after injecting this medication. E. CORRECT: Unused medication in the open pramlintide vial should be discarded after 28 days

DKA versus HHS: in which condition do symptoms evolve quickly, within hours or days?

DKA

When should levothyroxine be taken?

In the morning before breakfast

Which disorders s/s ; high urine output, increased thirst, high blood serum osmolarity

Diabetes insipidus

ACE Inhibitors - captopril (Capoten) Therapeutic Use

Diabetic nephropathy

Beta blockers - atenolol (Tenormin), metoprolol (Lopressor) interactions

Digoxin has an additive effect Beta blockers with oral hypoglycemic agents may increase risk for hypoglycemia

Loop diuretics - furosemide (Lasix) Interactions

Digoxin toxicity is a high risk with hypokalemia NSAIDs can decrease diuretic Amphotericin B and corticosteroids increase risk for hypokalemia Other ototoxic drugs (e.g., aminoglycoside antibiotics) increase risk for ototoxicity

Aldosterone antagonists - spironolactone (Aldactone) Client Instructions

Do not take potassium supplements, use potassium-containing salt substitutes or drugs which raise potassium levels Report palpitations, muscle twitching, weakness, or paresthesia

Loop diuretics - furosemide (Lasix) Client Instructions

Eat foods rich in potassium (if indicated), such as citrus fruits, potatoes and bananas Report signs of electrolyte imbalance, such as confusion, muscle twitching or weakness, irregular pulse, and nausea Report dizziness, syncope Avoid hazardous activities (driving) new onset of hearing loss, ringing in ears, or vertigo to provider history of gout need to report symptom

Cardiac Glycosides/inotropic - digoxin (Lanoxin) Interactions

Erythromycin and some other antibiotics increase digoxin levels (verapamil, quinidine, amiodarone, flecainide) increase digoxin levels; decrease digoxin dosage for concurrent administration Diuretics increase risk for digoxin toxicity by decreasing potassium levels Herbal ginseng increases risk of digoxin toxicity; St. John's wort decreases digoxin levels

S/S of hyperthyroidism

Exophthalmos, tachycardia, diaphoresis

True or False: NPH insulins are described as clear and must avoid agitations before administration

False

what is the treatment for a conscious patient that is hypoglycemic

Fast-acting oral sugar (eg, glucose tablets, orange juice, sugar cubes, nondiet soda)

metformin's most common side effect is

GI disturbances

Pioglitazone adverse effects:

Generally well tolerated; most common reactions are upper respiratory tract infection, headache, sinusitis, and myalgia

Alpha1 blockers - doxazosin (Cardura) Administration

Give at bedtime - especially first dose

ACE Inhibitors - captopril (Capoten) Administration

Give captopril 1 hr before meals for adequate absorption

Calcium Channel Blockers (dihydropyridines) - nifedipine (Adalat, Procardia) Interventions

Give nifedipine along with an ordered beta-blocker to prevent reflex tachycardia facial flushing edema monitor blood pressure regular dental care

Centrally acting alpha2 agonists - clonidine (Catapres) Administration

Give oral dose at bedtime to prevent daytime sedation Begin oral dosage low and gradually increase to prevent severe hypotension• Apply transdermal patch to a dry, relatively hairless area of skin on the upper outer arm or anterior chest once every 7 days• Rotate transdermal sites and monitor skin for inflammation, irritation• Be sure to remove the old patch before applying a new patch

Thiazide diuretics - hydrochlorothiazide (Microzide, Oretic) Administration

Give with food to minimize GI effects Give last dose of day by 3 p.m. to prevent nocturia and sleep loss

Which class of medication would elevate blood sugar without patients being diabetes?

Glucocorticoid

treatment for congenital adrenal hyperplasia

Glucocorticoids—Hydrocortisone, dexamethasone, prednisone

generic name for metformin

Glucophage

Two Forms of Hyperthyroidism

Graves disease and toxic nodular goiter (Plummer's disease)

what is the most common form of hyperthyroidism that affects women age 20 to 40 and causes exophthalmos?

Graves' disease

DKA versus HHS: in which condition is Hyperglycemia more severe?

HHS

DKA versus HHS: ion which condition is ketoacidosis absent

HHS

what disease can cause hypothyroidism

Hashimoto's disease

Nitrates - nitroglycerin, isosorbide (Isordil) Adverse Drug Reaction

Headache (severe at first, reduced with treatment) tolerance

insulin lispro generic name

Humalog

regular insulin generic name

Humulin R, Novolin R

diabetic ketoacidosis characteristics

Hyperglycemia Ketoacids HemoconcentrationAcidosis Coma

what are the cardinal features of both conditions?

Hyperglycemic crisis and associated loss of fluid and electrolyte

ARBs - losartan (Cozaar) Precautions

Hyperkalemia

Potassium-sparing diuretics - spironolactone (Aldactone) Therapeutic Use

Hypertension Edema caused by heart failure Cirrhosis of the liver Nephrotic syndrome

what is the treatment for a unconscious patient that is hypoglycemic

IV glucose or parenteral glucagon is the preferred treatment

Alpha1 blockers - doxazosin (Cardura) Interventions

Monitor for orthostatic hypotension and pulse 2 to 6 hours after 1st dose or after dosage increased Report significant drop of >20 mm Hg systolic between lying/standing to provider, report tachycardia

Beta blockers - atenolol (Tenormin), metoprolol (Lopressor) Interventions

Monitor heart rate and report rate slower than 60 beats/minute Teach client not to stop beta blocker suddenly On discontinuation, taper dose slowly over 1 to 2 weeks

Potassium-sparing diuretics - spironolactone (Aldactone) Interventions

Monitor serum potassium If hyperkalemia occurs, monitor for cardiac dysrhythmias may be combined with a thiazide or loop diuretic

Insulin has a peak of 6-14 hours

NPH

which insulin is the only one suitable for mixing with short-acting insulins?

NPH insulin

which drug's Pharmacology is nearly identical to that of repaglinide?

Nateglinide [Starlix]

antidiuretic hormone therapeutic goal

Normalization of urinary water excretion in patients with hypothalamic diabetes insipidus

insulin aspart generic name

NovoLog

Alpha1 blockers - doxazosin (Cardura) Adverse Drug Reactions

Orthostatic hypotension - especially with first dose and with dosage increases Reflex tachycardia may also occur Headache or dizziness

Novolog and Humalog are describe as

Rapid-acting analog of regular insulin

Nitrates - nitroglycerin, isosorbide (Isordil) Therapeutic Use

Rapid-acting forms (only transmucosal tablets, translingual spray and sublingual tablets treat an angina attack IV nitroglycerin is used for severe unstable angina attack

Which insulin has a peak effect of 0.5-2.5 hours after administration?

Rapid-acting, Lizpro

Calcium Channel Blockers (dihydropyridines) - nifedipine (Adalat, Procardia) Adverse Drug Reactions

Reflex tachycardia Headache, Lightheadedness, dizziness (caused by vasodilation) Facial flushing, perception of heat (caused by vasodilation) Peripheral edema of feet and legs Arrhythmias Gingival hyperplasia (growth of gum tissue, bleeding gums) - rare

What Inuslin that can be given IV, subcutaneous, and subcutaneous infusion?

Regular insulin

Meglitinides

Repaglinide (Prandin) Nateglinide (Starlix)

treatment for Addison's disease

Replacement therapy with adrenocorticoids Hydrocortisone is drug of choice

Alpha1 blockers - doxazosin (Cardura) Client Instructions

Report dizziness, syncope rapid heartbeat or palpitations to provider Take this drug at bedtime Rise slowly from lying to sitting or standing to prevent injury

Cardiac Glycosides/inotropic - digoxin (Lanoxin) Client Instructions

Report nausea, loss of appetite, or vomiting to provider• Report headache, visual disturbances to provider Report heart palpitations to provider To decrease risk of toxicity or low serum levels, take digoxin at the same time each day; do not skip or double dose Report signs of hypokalemia such as muscle weakness

Thiazide diuretics - hydrochlorothiazide (Microzide, Oretic) Client Instructions

Report signs of electrolyte imbalances eat food rich in potassium such as citrus fruits, potatoes, bananas

ARBs - losartan (Cozaar) Client Instructions

Report swelling of mouth Report frequent headaches or insomnia to provider• Report episodes of fainting, dizziness to provider

Calcium Channel Blockers (dihydropyridines) - nifedipine (Adalat, Procardia) Interactions

Rifampin, rifabutin, phenobarbital, phenytoin or carbamazepine can significantly decrease the efficacy of the nifedipine and is contraindicated St. John's wort decreases blood levels Grapefruit juice may potentiate the effects

Which technique should be used to give insulin to disperse particles throughout the vial?

Roll vial

Cardiac Glycosides/inotropic - digoxin (Lanoxin) Therapeutic Use

Second-line drug for Heart Failure

diabetic ketoacidosis causes

SepsisSicknessStressSkipping InsulinMetabolic Acidosis(body trying to get rid of acid)

ACE Inhibitors - captopril (Capoten) Adverse Drug Reactions

Severe hypotension following first dose Dry, nonproductive cough due to increase in bradykinin Rash and report of metallic taste Angioedema (swelling of mouth, throat due to inhibition of kinase II) Hyperkalemia Neutropenia (decrease in white blood cells with increased risk of infection)

Alpha1 blockers - doxazosin (Cardura) Interactions

Sildenafil (Viagra) and other phosphodiesterase inhibitors may increase risk for hypotension

Beta blockers - atenolol (Tenormin), metoprolol (Lopressor) Contraindications

Sinus bradycardia or greater than 1st degree heart block Cardiogenic shock Atenolol: peripheral vascular disease, Raynaud's disease Metoprolol: children younger than 6 years of age

Levothyroxine adverse effects

Tachycardia Angina Tremors

Warn patients that weight gain and peripheral edema are common effects of what?

Thiazolidinediones (oral hyperglycemics)

Beta blockers - atenolol (Tenormin), metoprolol (Lopressor) Therapeutic Use

Treat hypertension (all beta blockers except esmolol, sotalol)• Treat angina pectoris (some beta blockers including atenolol, metopropol) Treatment to decrease mortality following MI Treat cardiac dysrhythmias Treat heart failure

Thiazide diuretics - hydrochlorothiazide (Microzide, Oretic) Therapeutic Use

Treats heart failure Treats cirrhosis of the liver and renal failure Treats hypertension

Centrally acting alpha2 agonists - clonidine (Catapres) THERAPEUTIC USE

Treats hypertension Severe pain relief (administered by epidural infusion) ADHD (attention deficit hyperactivity disorder)

Alpha1 blockers - doxazosin (Cardura) Therapeutic Use

Treats hypertension Treats benign prostatic hypertrophy (BPH)

what are the two active hormones whose synthesis is stimulated by low plasma levels of iodine produced by the thyroid?

Triiodothyronine and thyroxine

True or False: insulin detemir most not be given IV

True

regular insulin is describe as

Unmodified human insulin

Effectiveness of this drugs that treats diabetes insipidus is measured by a decrease in urine output

Vasopressin

Centrally acting alpha2 agonists - clonidine (Catapres) INTERVENTIONS

When discontinued, taper dose slowly over several days

A patient is prescribed NPH insulin. Which statement should the nurse include in the discharge instructions? A. The insulin will have a cloudy appearance in the vial. B. The onset of action is rapid. C. The patient should not mix Lantus with short-acting insulin. D. The patient will have no risk of allergic reactions with this insulin.

a

A patient with which condition would most likely be prescribed a glucocorticoid in low doses for replacement therapy? A. Addison's disease B. Rheumatoid arthritis C. Systemic lupus erythematosus D. Cushing's syndrome

a

List the long term Microvascular damages of diabetes (select all that apply) a. retinopathy b. stroke c. nephropathy d. heart disease e. sensory and motor neuropathy f. gastroparesis g. amputation secondary to infection h. hypertension i. erectile dysfunction

a c e f g i

Select the Rapid acting Insulins a. Insulin Lispro b. Insulin glargine c. Insulin glulisine d. insuline determir e. regular Insulin f. Insulin aspart g. neutral protamine hagedorn insulin

a c f

List the long term Macrovascular damages of diabetes (select all that apply) a. heart disease b. hypotension c. seizures d. hypertension e. stroke f. polyuria g. hyperglycemia h. altered lipid metabolism

a d e g h

describe the only approved route of administration for NPH insulin

subQ injection

the first oral anti diabetic available is

sulphonylureas

Nitrates - nitroglycerin, isosorbide (Isordil)- Client Education

take analgesic for unrelieved headaches Report dizziness, syncope Move slowly from lying down to sitting Take pulse and report tachycardia

Describe the appearance of all insulin except for NPH made in the United States.

clear and colorless

Select the slower acting Insulins a. Insulin Lispro b. Insulin glargine c. Insulin glulisine d. insuline detemir e. regular Insulin f. Insulin aspart g. neutral protamine hagedorn insulin

e

Incretin Mimetics

exenatide, semaglutide, dulaglutide

true or false: miglitol has been associated with live dysfunction

false

When is an A1c <8% acceptable?

for patients with a history of severe hypoglycemia, limited life expectancy, or advanced microvascular or macrovascular complications

Repaglinide (Prandin) drug interaction:

gemfibrozil

congenital adrenal hyperplasia

genetic disease in which the adrenal gland is overdeveloped, resulting in a deficiency of certain hormones and an overproduction of others

Loop diuretics - furosemide (Lasix) Administration

give oral with food second dose given by early afternoon to prevent nocturia and sleep loss give IV slowly to prevent ototoxicity

Thiazolidinediones

glitazone

Synthetic steroid with a structure identical to that of cortisol

hydrocortisone

Calcium Channel Blockers (dihydropyridines) - nifedipine (Adalat, Procardia) Therapeutic Use

hypertension Treats stable (exertional) angina and variant (vasospastic) anginas

major side effect of sulphonylureas include

hypoglycemia and weight gain

if a patient's blood glucose is below 70mg/dL they are

hypoglycemic

Thiazide diuretics - hydrochlorothiazide (Microzide, Oretic) Adverse Drug Use

hypokalemia hyperglycemia increased uric acid levels with possible gouty

Loop diuretics - furosemide (Lasix) Interventions

hypokalemia occurs, monitor for cardiac dysrhythmias If hypokalemia is a risk (e.g., client also taking digoxin) furosemide can be combined with a potassium sparing diuretics Monitor blood pressure Monitor for hearing loss, tinnitus, and vertigo Monitor blood glucose Monitor uric acid

Where do alpha-glucosidase inhibitors act and why?

in the intestine to delay absorption of carbohydrates

what is a sign of overdose when taking levothyroxine

insomnia

Nitrates - nitroglycerin, isosorbide (Isordil)- Administration

isosorbide dinitrate (Isordil) available in regular, chewable, sublingual or sustained release isosorbide mononitrate (Ismo, Imdur) available in sustained release and immediate release capsules Place sublingual tablets under tongue to dissolve when chest pain start, if not relieved in 5 minutes call 911, take a second tablet, take a third after 5 minutes later if no relief sublingual tablets, no more than 3 in a 15 min period not swallow transdermal or transmucosal tablets; may need to moisten mouth to help tablet dissolve Store tablets in a dark tightly closed container for no more than 24 months after opening Transdermal patches are for prevention only; apply to a hairless area and rotate sites. Remove patches for 10-12 hours daily to prevent tolerance; apply patch in mornings remove at night taper dose to prevent vasospasm

what is a rare but potentially fate complication of metformin

lactic acidosis

in HHS what results in dehydration and loss of blood volume

large amounts of glucose excreted in urine

Replacement therapy with thyroid hormones; in almost all cases, treatment must continue

lifelong

An ACE inhibitor

lisinopril

an angiotensin 2 receptor blocker

losartan

thyroid hormones have a profound effect on

metabolism, cardiac function, growth and development

Drug of choice for initial therapy in most patients with type 2 diabetes

metformin

Fludrocortisone (Florinef)

mineralocorticoid

Lantus is describe as

modified human insulin

implement glycemic control by

modifying diet, physical activity and implementing drug therapy

incretin mimetic act like

natural hormones that work with insulin to lower blood glucose levels by reducing liver glucose production

Addison's disease

occurs when the adrenal glands do not produce enough of the hormones cortisol or aldosterone

when using insulin glargine describe the necessary dosing to treat adults and children with type 1 diabetes and adults with type 2 diabetes

once daily subQ

what is the onset and duration of rapid acting insulin?

onset (<15 minutes) Duration (5 hours)

Calcium Channel Blockers (dihydropyridines) - nifedipine (Adalat, Procardia) Administration

oral use in capsules and sustained-release Sustained-release form must be swallowed whole and not chewed or crushed

antidiuretic hormone contraindications

patients with coronary artery disease (CAD) and vascular disease

diabetic ketoacidosis is the most common complication is ________ patient and the leading cause of death

pediatric

What Reduces insulin resistance and may also decrease glucose production

pioglitazone

what are the Preferred drugs for oral therapy of chronic adrenal insufficiency?

prednisone and dexamethasone

ARBs - losartan (Cozaar) Contraindications

pregnancy- teratogenic

how does thiazolidinediones reduce glucose levels?

primarily by decreasing insulin resistance

when mixing insulins what is drawn up first short acting or NPH?

short acting

an adverse effect of metformin is

somnolence

what type of products should be avoided when taking levothyroxine

soy

what reduces risk of diabetic dyslipidemia?

statins

Potassium-sparing diuretics - spironolactone (Aldactone) Contraindications

teratogenic

ACE Inhibitors - captopril (Capoten) Contraindications

teratogenic effects

This drugs only indication is type 2 diabetes, mainly as an add-on to metformin

thiazolidinediones

what causes hyperthyroidism

thyroid-stimulating immunoglobulins

thyrotoxic crisis

toxic condition characterized by hyperthermia, tachycardia, nervous symptoms, tremor, unconsciousness, coma, hypotension, heart failure and rapid metabolism; also known as thyroid storm.

True or False: HHS has little to no change in ketoacid levels and blood pH

true

True or False: sulfonylureas can be only be used for type 2 diabetes

true

True or False: treatment for DKA and HHS is similar

true

HHS occurs most frequently with

type 2 diabetes with acute infection, acute illness, or some other stress

Synthetic form of ADH:

vasopressin, desmopressin

Cardiac Glycosides/inotropic - digoxin (Lanoxin) Contraindications

ventricular dysrhythmias AV block

Cardiac Glycosides/inotropic - digoxin (Lanoxin) Interventions

vomiting can cause hypokalemia, which increases risk for digoxin toxicity report GI symptoms report CNS effects Take apical pulse for 1 full minute before administering digoxin; withhold drug if pulse falls below 60 bpm monitor digoxin levels monitor serum potassium For severe digoxin toxicity, digoxin immune FAB (Digibind) is administered IV as an antidote to neutralize digoxin