Spring- Pharm Exam 2
Which statement is especially important to teach a caregiver of an infant being treated with hydrocortisone?
"Avoid live virus vaccinations."
The nurse educates a client recently diagnosed with hypothyroidism about using the prescribed levothyroxine. The client has a history of diabetes. Which client statement establishes the need for further clarification?
"It does not matter which brand of the drug I take, they are all the same."
A nurse is providing health education to a client who will be discharged home with a prescription for hydrocortisone. What instruction should the nurse convey to the client?
"Make sure that you take this medication with food."
A client who has been prescribed hydrocortisone states, "I know quite a few different people who have had unpleasant adverse effects from steroids." How should the nurse best respond to the client's concern?
"Your health care team will monitor you thoroughly for indications of adverse reactions."
A client is receiving anticoagulant therapy and has an INR done. Which result would the nurse interpret as being therapeutic?
2.4
The client is learning to self-administer heparin daily. The home care nurse draws blood every 2 to 3 days to monitor the client's platelet levels. What platelet count would the nurse report to the health care provider as a critical laboratory result?
90,000
Somatropin would be prescribed for which of these patients?
A 5-year-old with short stature and Turner syndrome
Which client demonstrates the clearest indication for treatment with prednisone?
A 70-year-old man whose rheumatoid arthritis has not responded to OTC pain relievers
The health care provider suspects that a client has Addison disease. The nurse knows that the provider will perform what test to confirm this diagnosis?
ACTH stimulation test
Deficiency of which hormone causes excessive and frequent urination and excessive thirst?
ADH deficiency
A client has suddenly stopped corticosteroid (Prednisone) therapy because the symptoms are now under control. The nurse should assess the client for signs and symptoms similar to what disorder?
Addison disease
What is a strategy to minimize HPA suppression and risks of acute adrenal insufficiency?
Administering a systemic corticosteroid during high-stress situations in clients on long-term systemic therapy
A nurse is preparing to administer gonadotropin to a client. The nurse would question this order if which disorder is documented in the client's medical history?
Adrenal dysfunction
What is the most prevalent mineralocorticoid that regulates fluid balance?
Aldosterone
A client presents to the emergency department with an apparent reaction to recently started thyroid therapy. Which assessment finding would lead the nurse to question that this client is experiencing a thyroid storm?
Altered mental status
A nurse is caring for a client suffering from a severe form of hyperthyroidism called thyrotoxicosis or thyroid storm. What would the nurse observe for in the client as a characteristic of thyroid storm?
Altered mental status
A nurse is preparing to administer levothyroxine to a client. Which sign(s) or symptom(s) would the nurse expect to document on the preadministration assessment? Select all that apply.
Anorexia Coarse hair Cold intolerance
A nurse is completing an assessment on a client diagnosed with adrenocortical insufficiency. What are the expected clinical manifestations? Select all that apply.
Anorexia Weight loss Lethargy
Damage to which lobe of the pituitary gland would result in problems related to the function of stimulating hormones?
Anterior
A health care provider has prescribed thyroid drugs to a client with euthyroid goiter. Which should the nurse include in the nursing diagnosis checklist?
Anxiety related to symptoms, adverse reactions, and treatment regimen
A nurse is preparing to administer the first dose of warfarin to a client. Which assessment should the nurse prioritize for this client?
Assess PT and INR.
A nurse is teaching a client about the thyroid hormone replacement therapy which has been prescribed. The nurse determines the teaching session is successful when the client indicates which time to take the drug?
Before breakfast (On an empty stomach)
A 31-year-old client is being treated with fludrocortisone for Addison disease. In addition to monitoring the client's urinary output, what other assessment should the nurse prioritize?
Blood pressure
A nurse is preparing to administer liothyronine to a client with chronic thyroiditis. The nurse determines the drug needs to be administered cautiously after noting which disorder in the client's medical history?
Cardiac disease
All corticosteroids derived from which of the following substances?
Cholesterol
A client is to undergo fertility treatment and is to receive an agent that induces ovulation because her ovaries are functioning. Which agent would this most likely be?
Chorionic gonadotropin
A nurse is preparing to administer an antiplatelet drug. Which medication would the nurse likely administer?
Clopidogrel
A child is receiving growth hormone therapy. The nurse suspects possible thyroid dysfunction based on which assessment?
Cold intolerance
Which would a nurse expect to assess in a patient with an adrenocortical hormone deficiency?
Confusion Hyperkalemia Hyponatremia
The nurse has performed a general assessment of a hospitalized client who has been prescribed fludrocortisone, including auscultation of the client's apical heart rate. How should the nurse best follow up assessment of an audible S3?
Contact the care provider promptly.
Which would be used to diagnose adrenal function?
Corticotropin
The adrenal cortex influences glucose levels through the production of which hormone?
Cortisol
When the nurse administers warfarin, it is expected that the drug will have what effect on the body?
Decrease in production of vitamin K-dependent clotting factors
A 54-year-old woman with a history of asthma is prescribed prednisone to treat an exacerbation of her condition. The nurse is explaining to the client how this medication decreases the immune response. What mechanism of action of the drug causes this?
Decrease in the number of eosinophils
A nurse is caring for a patient with hypothyroidism. The nurse would know that the effects of hypothyroidism include:
Decreased cardiac output
The nurse is assessing a patient with adrenocortical insufficiency. What presenting symptom supports the patient's diagnosis?
Decreased cardiac output
A client is prescribed warfarin. The client also takes a diuretic for the treatment of cardiac problems. The nurse will monitor the client for which potential interaction?
Decreased effectiveness of the anticoagulant
A nurse is preparing to administer levothyroxine to a client who is also prescribed citalopram. The nurse predicts which assessment finding may occur in this client?
Decreased effectiveness of the thyroid drug
The nurse is caring for a client with severe hypothyroidism and knows to contact the health care provider if which symptoms of myxedema coma occur? (Select all that apply.)
Decreased level of consciousness Decreased respirations Decreased blood pressure
A client with Addison disease has been taking hydrocortisone for several weeks and has just told the nurse that the adverse effects are affecting her quality of life. She states that she stopped taking the medication three days ago and has an appointment booked to discuss the matter with her primary care provider two days from now. What is the nurse's best action?
Educate the client about the risks of suddenly discontinuing the medication.
The nurse is caring for a patient who has been prescribed fludrocortisone and furosemide (Lasix). What assessment is essential to monitor for potential complications with this patient?
Electrolytes
The client is prescribed warfarin. His INR is 5.2. At what level is this dose?
Elevated
Which drug, if combined with corticosteroids, would lead to possible toxic effects?
Erythromycin (antibiotic)
Which is released in response to decreased oxygenated blood flowing through the kidneys?
Erythropoietin
The most common cause of subclinical hyperthyroidism is:
Excess thyroid hormone therapy.
There are two pathways that can be activated by the coagulation process. One pathway begins when factor XII is activated. The other pathway begins when there is trauma to a blood vessel. What are these pathways?
Extrinsic and intrinsic pathways
Which would a nurse expect to assess in a client experiencing hyperthyroidism?
Flushed, warm skin
A client taking an anticoagulant drug tells the nurse she is having bleeding in the gums and teeth. When reviewing client history, the client states she has decided to try an herbal remedy. Which of the following is most likely the cause of increased bleeding?
Ginger
The release of FSH and LH are stimulated by what hormone?
Gonadotropin-releasing factor
A child diagnosed with adrenal insufficiency takes PO hydrocortisone daily. The client is followed regularly by a nurse, who assesses the child every 3 months. What assessment data should the nurse prioritize during these assessments?
Height and weight
The nurse is caring for a postpartum client admitted to the intensive care unit with a diagnosis of disseminated intravascular coagulation (DIC). What is the drug of choice to treat this problem?
Heparin
A female client is started on warfarin therapy. The client asks the nurse why she is no longer on heparin therapy. What differentiates heparin from warfarin?
Heparin is administered parenterally, while warfarin is administered orally.
A 45-year-old client is receiving somatropin for treatment of a growth hormone deficiency. The nurse educates the client that regular laboratory tests will be needed to monitor the client for which adverse effect?
Hyperglycemia
A client presents at the clinic reporting weight loss despite an increased appetite. For which condition should this client be assessed?
Hyperthyroidism
The nurse is assessing a client with adrenocortical excess resulting from long-term use of corticosteroids. What is not a side effect related to this client's corticosteroid use?
Hypotension
A nurse has administered levothyroxine to a client for hypothyroidism. The nurse determines the client is responding appropriately to the therapy based on which assessment finding?
Increased appetite
After teaching a group of students about the effects of mineralocorticoids, the instructor determines that additional teaching is needed when the students identify what as an effect?
Increased calcium retention
The nurse is monitoring a client who is receiving intravenous heparin. Which assessment(s) should the nurse prioritize for this client? Select all that apply.
Inflammation Pain Tenderness Itching
The pharmacology instructor is providing education regarding propylthiouracil to the nursing students. What would the instructor identify as the primary mode of action for this medication?
Inhibition of production of thyroid hormone
Which action is not a function of antidiuretic hormone?
Inhibition of thyrotropin
A nurse is providing care for a client diagnosed with thyroid cancer. Which drug would the nurse anticipate being prescribed for the client?
Iodine 131
A client has been prescribed hydrocortisone cypionate. How would the nurse describe the medication to the client?
It is a combination of a mineralocorticoid and adrenocorticoid.
In determining therapy for a child being treated for Cushing's disease, which medication would not be administered?
Ketoconazole (Nizoral)
The nurse is preparing to administer an anticoagulant to several clients. The nurse should question this order if which disorder(s) is noted in the client's medical record? Select all that apply.
Leukemia GI ulcers Tuberculosis
Which agent would a nurse expect to administer to a client with hypothyroidism?
Levothyroxine
A female client's diagnoses include hyperthyroidism, congestive heart failure, and type 2 diabetes mellitus. What effect will the treatment of hyperthyroidism have on her routine medications?
Metabolism will be faster than normal, and the dose will be increased.
Which hormones are secreted by the adrenal gland? (Select all that apply.)
Mineralocorticoids Glucocorticoids
A patient receiving hydrocortisone has started estrogen hormonal replacement therapy. What is the nurse's best intervention?
Monitor the patient's blood glucose levels frequently.
A client is receiving Warfarin and Clopidogrel. The nurse would expect to administer this drug by which route?
Oral
A patient is experiencing a prolonged labor and her contractions are ineffective. Which agent would the nurse expect to be ordered?
Oxytocin
After reviewing the hormonal secretion of the pituitary gland, the students demonstrate understanding when they identify which hormone as being released by the posterior lobe?
Oxytocin
When teaching a client about the prescribed levothyroxine therapy, the nurse determines that the teaching was successful when the client states that they will contact the primary health care provider if which symptom(s) occurs? Select all that apply.
Palpitations Excessive diaphoresis Significant weight changes Chest pain
A client is receiving heparin. Which would the nurse use to monitor the effects of the drug?
Partial thromboplastin time
A nurse is assessing a client who is prescribed warfarin and notes a positive occult blood screen, petechiae on both legs, and blood-tinged toothbrush. The nurse anticipates the health care provider will prescribe which antidote to counteract these findings?
Phytonadione
Naturally occurring aldosterone is regulated by which mechanism?
Pituitary ACTH levels
The nurse is scheduled to administer the following medications at 0900: heparin subcutaneous, cefazolin IVPB, and atenolol PO. The morning labs are platelets 150,000 mcL, WBC 10,000 mcL, and APTT 100 seconds. Which is the nurse's priority in this situation?
Place the client in supine position with legs elevated for BP 88/50 mm Hg.
A male client is receiving heparin by continuous intravenous infusion. The nurse will instruct the client and family members to report what should it occur?
Presence of blood in urine or stools
The health care provider discovers a clot in the client's left lower leg. Anticoagulant drugs are prescribed to prevent formation of new clots and to achieve which other effect?
Prevent extension of clots already present
The nursing class is studying family nursing. What hormone would the instructor tell the students plays a part in milk production?
Prolactin
The pharmacology instructor is discussing heparin with the students. How would the instructor explain the action of heparin?
Promotes the inactivation of clotting factors
Thioamide antithyroid drugs treat hyperthyroidism by inhibiting the synthesis of thyroid hormone. What is the prototype of the thioamide anti-thyroid drugs?
Propylthiouracil
A client exhibits signs and symptoms of heparin overdose. The nurse would anticipate administering:
Protamine sulfate
The nurse is caring for a client who is going home on warfarin. What lab test(s) will the client require to evaluate therapeutic effects of the drug?
Prothrombin time (PT) and international normalized ratio (INR)
What does release of antidiuretic hormone (ADH) cause?
Reabsorption of water
A nurse is caring for a patient with Addison disease. What therapy is recommended for this patient? (Select all that apply.)
Replacement of adrenocorticoids Replacement of mineralocorticoids
When monitoring a client who is receiving mineralocorticoid therapy, which assessment finding would be most important for the nurse to report?
Shortness of breath
Normal lab values for Sodium and Potassium?
Sodium 135 - 145 Potassium: 3.6 - 5.2
Which laboratory value monitored in a patient receiving fludrocortisone acetate requires immediate action by the nurse?
Sodium 150 mEq/L
After teaching a group of students about growth hormone agonists and antagonists, the instructor determines that additional teaching is needed when the students identify which agent as a growth hormone antagonist?
Somatropin
Which agent would the nurse identify as a growth hormone agonist?
Somatropin
A client is to receive enoxaparin. The nurse would administer this drug by which route?
Subcutaneous injection
The nurse is preparing to administer warfarin to a female client, who also uses oral contraceptives. Which assessment finding(s) should the nurse prioritize? Select all that apply.
Subtherapeutic INR Calf pain and warmth
A group of students demonstrate understanding of thyroid hormone secretion when they state:
T3 is much more active in the circulation than T4.
A client is prescribed levothyroxine. The nurse understands that this drug contains:
T4.
A nurse is caring for a patient who has been undergoing glucocorticoid therapy at a health care facility and is getting discharged. Which of the following instructions should the nurse include in the teaching plan for the patient and family?
Take the oral drug with meals or snacks.
The client is diagnosed with hepatitis A, diabetes type 1, and portal hypertension. The client develops a DVT, and the health care provider prescribes warfarin. The nurse is concerned for what reason?
The client is more likely to experience bleeding.
The nurse administers hydrocortisone cypionate (Cortef). What intervention is appropriate for this medication?
The nurse will monitor the patient's blood glucose level.
Which patient should not receive ketoconazole (Nizoral) as ordered for Cushing's disease?
The patient with elevated liver function tests
The nurse is administering hydrocortisone cypionate (Cortef) to an elderly patient. Which assessment finding requires immediate action?
The patient's blood pressure has decreased to 90/50 from 130/90 mm Hg.
The nurse is assessing the patient on mitotane therapy. Which assessment finding requires action by the nurse?
The patient's blood pressure is 140/90 mm Hg sitting and 90/50 mm Hg standing.
How are lipid-soluble steroid and thyroid hormones typically inactivated?
They are typically conjugated in the liver to inactive forms and then excreted in bile or urine
What would a nurse keep in mind about glucocorticoids when teaching a client?
They promote fat storage.
A 65-year-old client who has been on long-term corticosteroid therapy is admitted to the hospital and will need an IV inserted. What adverse effect of corticosteroid may negatively affect this procedure?
Thinning of the skin
The nurse is assessing a child who is receiving growth hormone therapy. What would the nurse identify as suggesting glucose intolerance?
Thirst
Which of the following hypothalamic hormones causes the release of TSH in response to stress, such as exposure to cold?
Thyrotropin-releasing hormone (TRH)
A 73-year-old client receiving warfarin (Coumadin) has blood in the urinary drainage bag this morning. After reporting these observations to the health care provider, the nurse will expect to administer what substance?
Vitamin K
Which laboratory values should the nurse review prior to the administration of hydrocortisone? Select all that apply.
White blood cell count Glucose level
The process in which hormone secretion is stimulated when hormones are needed and inhibited when they are not needed is known as:
a negative feedback system.
To compensate for clopidogrel's slow onset of action, the nurse should anticipate implementing which intervention?
administering a one-time loading dose that is higher than the maintenance dose
A client with a visible "buffalo hump" and a history of impaired wound healing has been referred for care to the endocrinology department. This client's signs and symptoms are most likely to be attributed to what factor?
adrenocortical excess
A client is diagnosed with Graves disease. Propylthiouracil (PTU) is prescribed. After 8 weeks of therapy, the client reports a fever and sore throat. The nurse is concerned that this symptoms may be early signs of:
agranulocytosis.
Which hormone is released in the presence of low blood volume?
antidiuretic hormone (ADH)
When describing desmopressin to a group of students, the instructor explains that it is a synthetic form of:
antidiuretic hormone.
A client with acute coronary syndrome is prescribed clopidogrel. Which additional medication will the nurse expect to be prescribed for this client?
aspirin
A 70-year-old resident of a long-term care facility has experienced increasing pain, swelling, and redness to her lower leg over the past 12 hours, prompting the care providers at the facility to have the woman brought to the local emergency department. Diagnostic testing has confirmed deep vein thrombosis (DVT) and an IV infusion of alteplase (Activase) has been initiated. Unlike anticoagulants, a thrombolytic such as alteplase can
break down existing clots.
Gonadotropins are classified in which pregnancy category?
category X
What is a releasing hormone?
chemical released by the hypothalamus into the anterior pituitary
A client with rheumatoid arthritis is taking a maintenance dose of prednisone every day. Which assessment findings indicate to the nurse that the medication has been effective? Select all that apply.
decreased pain increased mobility reduced edema of the joints ease of performing activities of daily living
A nurse is organizing the care of a child who takes somatropin. The desired outcome the nurse should prioritize in the planning of this child's care is that the client will:
demonstrate an increase in linear growth.
During physical examination of a client with a suspected endocrine disorder, the nurse assesses the body structures. The nurse gathers this data based on the understanding that it is an important aid in:
detecting evidence of hormone hypersecretion.
A client diagnosed with TSH suppression has been prescribed levothyroxine sodium (T4). The nurse caring for the client should monitor for which adverse reaction to levothyroxine sodium (T4)?
diarrhea
The nurse is caring for a school-age child who is receiving long-term hydrocortisone therapy to treat adrenal insufficiency. When providing ongoing care for the child, what assessment should the nurse prioritize?
growth and development
A nurse is caring for a 78-year-old client with rheumatoid arthritis. The health care provider has prescribed cortisone, a corticosteroid, to the client. The nurse would administer the drug cautiously to a client with which condition? Select all that apply.
heart failure decreased muscle mass osteoporosis
The nurse is caring for an older adult resident of long-term care who has fragile skin. The client experiences occasional skin tears despite careful repositioning and care. What component of the client's medication regimen should the nurse suspect?
hydrocortisone
A female client has a diagnosis of adrenocortical insufficiency and is steroid dependent. The client is to undergo surgery to remove her uterus. The nurse will explain to the client that in order to promote recovery after the stress of the surgery, her steroid dosage will be:
increased.
A client diagnosed with Cushing's disease is not a surgical candidate and is consequently being treated with ketoconazole. The nurse should be aware that ketoconazole achieves a therapeutic effect by what means?
inhibiting the enzymes that contribute to cortisol synthesis
A nurse is teaching a client about a prescribed thyroid supplement and describes a drug that is relatively inexpensive, requires once-a-day dosing, and has a more uniform potency than do other thyroid hormone replacement drugs. Which drug is the nurse describing?
levothyroxine
A nurse is preparing to administer a scheduled dose of levothyroxine to an older adult client who is being treated in the hospital for a respiratory infection. Prior to administering the drug, the nurse should perform what assessment?
measurement of blood pressure
The nurse should recognize that atrophy of the adrenal cortex is the result of what drug therapy?
mitotane
Based on the nurse's knowledge about thyroid hormone supplements, the nurse administers levothyroxine cautiously to a client who has recently had which condition or disorder?
myocardial infarction
What hormones does the pancreas produce and release that help moderate the body's varying blood glucose levels?
nsulin, glucagon, somatostatin
What drug type is most likely to cause respiratory depression and myxedema coma in clients with thyroid disorders?
opioid analgesics
A client accidentally ingested extra doses of warfarin at home and now presents with an elevated INR and bleeding. Which medication will the nurse prepare as prescribed to administer along with vitamin K?
prothrombin complex concentrate
The nurse is planning care for a client who has been prescribed long-term therapy for Addison's disease. The nurse should address what nursing diagnosis that results from the client's increased risk?
risk for infection related to medication therapy
A client with no history of diabetes has presented with a new onset of hypoglycemia. The nurse should anticipate which assessments and diagnostic testing? Select all that apply.
serum potassium level blood pressure monitoring serum sodium level
A client has been admitted to the emergency department with a diverse constellation of signs and symptoms. What diagnostic finding is most consistent with a diagnosis of Addison disease?
serum sodium 128 mEq/L (128 mmol/L)
Which hormones are responsible for the growth of the body during childhood, especially the growth of muscles and bones?
somatotropin
The nurse has completed an assessment of a client who takes hydrocortisone for the treatment of adrenal insufficiency. Which finding should the nurse report to the health care provider immediately?
temperature 99.9°F (37.7°C)
A client exhibits severe tachycardia, fever, dehydration, and heart failure. The nurse recognizes that these signs are consistent with what thyroid-associated health condition?
thyroid storm
An older adult client has been diagnosed with adrenal insufficiency and has responded well to hydrocortisone therapy. When assessing the client for adverse effects, the nurse should prioritize the risks posed by combining hydrocortisone with which of the client's medications?
warfarin
What medication creates a safety risk when combined with long-term fludrocortisone therapy?
warfarin
