PHARM: EXAM 3

The patient is prescribed 30 units regular insulin and 70 units NPH insulin subcutaneously every morning. The nurse will provide which instruction to the patient?

"Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin."

Which statement indicates to the nurse that the patient needs additional teaching on oral hypoglycemic agents? I will limit my alcohol consumption." "I will report symptoms of fatigue and loss of appetite." "I will take the medication only when I need it." "I will monitor my blood sugar daily."

"I will take the medication only when I need it."

Which statement by the patient demonstrates an understanding of discharge instructions on the use of levothyroxine (Synthroid)?

"I will take this medication in the morning so as not to interfere with sleep."

A 19-year-old student was diagnosed with hypothyroidism and has started thyroid replacement therapy with levothyroxine (Synthroid). After 2 days, she called the clinic to report that she does not feel better. Which response from the nurse is correct? a. "It will probably require surgery for a cure to happen."b. "The full therapeutic effects may not occur for 3 to 4 weeks."c. "Is it possible that you did not take your medication as instructed?"d. "Let's review your diet; it may be causing absorption problems."

"The full therapeutic effects may not occur for 6 to 8 weeks."

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

1

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

1 alcohol

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

1 prednisone

Desmopressin acetate (DDAVP) is prescribed for the treatment of diabetes insipidus. The nurse monitors the client after medication administration for which therapeutic response? 1. Decreased urinary output 2. Decreased blood pressure 3. Decreased peripheral edema 4. Decreased blood glucose level

1. Decreased urinary output

The nurse is administering lispro (Humalog) insulin and will keep in mind that this insulin will start to have an effect within which time frame?

15 minutes

A nurse performs an admission assessment on a client who visits a health care clinic for the first time. The client tells the nurse that propylthiouracil(PTU) is taken daily. The nurse continues to collect data from the client, suspecting that the client has a history of: 1. Myxedema 2. Graves' disease 3. Addison's disease 4. Cushing's syndrome

2

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

2

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

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

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

2. The medication is withheld and the HCP is called to question the prescription for the client.

A daily dose of prednisone is prescribed for a client. A nurse reinforces instructions to the client regarding administration of the medication and instructs the client that the best time to take this medication is: 1. At noon 2. At bedtime 3. Early morning 4. Anytime, at the same time, each day

3

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

3

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

3

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

3

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

3 PM

Prednisone is prescribed for a client with diabetes mellitus who is taking Humulinneutral protamine Hagedorn (NPH) insulin daily. Which of the following prescription changes does the nurse anticipate during therapy with the prednisone? 1. An additional dose of prednisone daily 2. A decreased amount of daily HumulinNPH insulin 3. An increased amount of daily HumulinNPH insulin 4. The addition of an oral hypoglycemic medication daily

3. An increased amount of daily HumulinNPH insulin

What is the best method of administering glipizide?

30 minutes before a meal

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

B glucagon

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

B, C, D, A

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

B. To decrease insulin resistance

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

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

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

B.glipizide

THE NURSE IS CARING FOR A 10-YEAR-OLD BOY WITH GROWTH HORMONE DEFICIENCY. THE CHILD ASKS THE NURSE HOW LONG HE WILL BE ABLE TO TAKE HIS MEDICINE. WHAT IS THE NURSES BEST RESPONSE? a. Until you decide to stop b. Until you are 13 c. Until your epiphyseal plates closed. D. Until you get as tall as you want to be

C

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

C.glipiside

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

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

When reviewing the laboratory values of a patient who is taking the antithyroid drug PTU, the nurse will monitor for which adverse effect?

Decreased white blood cell count

A 33 year old man, newly admitted to the medical-surgical unit from the stepdown ICU, underwent a thyroidectomy 2 days earlier. The nurse reviews the orders and this patient is to receive thyroid medication upon arrival to the unit. The written orders specify that 25mcg of levothyroxine is to be given once daily. However, the pharmacy only has liothyroxine25 mcg in stock. What is the nurses priority action?

Do not give. This is NOT the same medication. It is synthetic T3. The Doctor ordered synthetic T4

Which is a priority nursing diagnosis for a patient receiving desmopressin (DDAVP)?

Excess fluid volume

What is the best way for the nurse to measure the patient's response to the drug therapy?

Expect a growth of 3-5 inches with in the first year of therapy

Patients taking levothyroxine (Synthroid) and warfarin (Coumadin) concurrently would be monitored for which adverse effect?

Increased risk of bleeding

The nurse is discussing with a patient the time of day for taking prednisone. What information would the nurse include in the teaching based on knowledge of glucocorticoids?

It should be administered with food to diminish the risk of gastric irritation.

A patient is taking thyroid drugs for about 16 months and has recently noted palpitations and some heat intolerance, What are the nurses priority actions at this time?

Notify the healthcare provider of possible toxicity of the medication

An operating room nurse prepares a patient who has type 2 diabetes for surgery. Which type of insulin that can be given intravenously does the nurse administer?

Regular insulin

The nurse would question an order for steroids in a patient with which condition?

Uncontrolled diabetes mellitus

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

a, b, d

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

b 30 minutes before a meal

A 25-year-old woman has been diagnosed with type 1 diabetes mellitus. She has been placed on a 1500-calorie diabetic diet and is to be started on insulin glargine. Today she has received teaching about her diet, about insulin injections, and about management of diabetes. She received the first dose of insulin glargine at 9 PM; the next morning she complained of feeling "dizzy." The nurse assesses that she is diaphoretic, weak, and pale, with a heart rate of 110 beats/min. What is the nurse's priority action? What is the best explanation for these symptoms?

check the blood sugar

While making morning rounds, the nurse assesses a patient's ordered medications and finds that the patient is to be given NPH insulin each morning but is also on orders to receive nothing by mouth because of a scheduled surgical procedure. What is the nurse's priority action at this time regarding the administration of the insulin?

contact provider about insulin. monitor BS closely

The nurse is providing care to a patient following a non-accidental traumatic brain injury. The patient has developed diabetes insipidus due to the injury. What medication is most often used in the management of diabetes insipidus?

desmopressin (DDAVP)

Which long-acting insulin mimics natural, basal insulin with no peak action and a duration of 24 hours?

insulin glargine (Lantus)

The nurse is caring for a patient scheduled to undergo a cardiac catheterization procedure utilizing iodine-based contrast material. The nurse would question an order for which medication to be given to this patient the day of the scheduled procedure?

metformin (Glucophage)

The nurse admitting a patient with acromegaly anticipates administering which medication?

octreotide (Sandostatin)

The nurse is teaching the patient taking an antithyroid medication to avoid foods high in iodine. Which food will the nurse advise the patient against?

seafood

A Child is experiencing delayed Growth due to an endocrine disorder. Which pituitary drug is used to treat this condition?

somatropin