UWorld Pharm: Endocrine and GI
What effect does insulin have on potassium?
Insulin shifts glucose and potassium from the intravascular to the intracellular space. This shift of potassium into cells may cause or worsen hypokalemia (could cause v tach or v fib)
How many times a day can NPH be given?
2 times/day - has a duration of 12-18 hours - NEVER IV push
What is insulin aspart? (novolog)
It is a rapid acting insulin
What is orlistat?
Orlistat, a lipase inhibitor, prevents the absorption of fat from the gastrointestinal tract and is used with diet (eg, low-fat) and exercise to promote weight loss.
A parent rushes a 4-year-old child to the emergency department after finding the child sitting on the kitchen floor holding an empty bottle of aspirin. The parent has no idea how many tablets were left in the container. The child is sniffling and quietly crying. The nurse anticipates initially implementing which treatment?
Activated Charcoal - IV sodium bicarbonate is also used for treating aspirin overdose after treatment with activated charcoal has been initiated.
A nurse is assessing a client with type 2 diabetes mellitus who was recently started on pioglitazone. Which client data obtained by the nurse is most important to bring to the attention of the health care provider?
Bilateral pitting edema in the ankles - Thiazolidinediones (rosiglitazone [Avandia] and pioglitazone [Actos]) are used to treat type 2 diabetes mellitus. These agents improve insulin sensitivity but do not release excess insulin, leading to a low risk for hypoglycemia (similar to metformin).
Which client finding would be a contraindication for the nurse to administer dicyclomine hydrochloride for irritable bowel syndrome?
Bladder scan showing 500mL - Anticholinergic drugs are contraindicated when smooth muscle relaxation is already a concern. Commonly cited contraindications include narrow-angle glaucoma, urinary retention (including benign prostatic hyperplasia), and bowel ileus/obstruction.
A client who has been on long-term omeprazole therapy for gastroesophageal reflux disease is admitted to the hospital for a urinary tract infection. The nurse recognizes that this client is at highest risk for which complication due to omeprazole use?
C diff infection - Long-term use of PPIs (Prazoles - omeprazole, lansoprazole, pantoprazole, rebeprazole) has been associated with decreased bone density (calcium malabsorption) and increased risk for C difficile-associated diarrhea and pneumonia.
What are the 2 primary side effects of corticosteroids?
Corticosteroids commonly cause hyperglycemia and worsen hypertension. - When taken in combination with NSAIDs, they can increase the risk of peptic ulcer disease.
When should orlistat be taken?
within an hour of meals that contain fat
The nurse provides medication teaching to a client with primary adrenal insufficiency (Addison's disease) who is prescribed hydrocortisone 10 mg by mouth 3 times a day. Which instructions should be included in the client's teaching plan?
1) Go to the optomitrist yearly to check for cataracts 2) Report even a low grade fever to the HCP immediately 3) Report signs of hyperglycemia including increased urination,hunger, and thirst
The nurse administers a dose of radioactive iodine to a female client for treatment of hyperthyroidism. Which of the following precautions should the nurse teach the client to follow on discharge?
Follow these for 1 week: 1) Avoid close contact with pregnant women, infants, and children 2) Use a separate toilet from your family and flush 2-3 times 3) Use disposable plates and utensils; do not share food with others 4) Wash your clothes and towels separately from your family's 5) Sleep in a separate bed from others. 6) Do not sit near others for a prolonged time (eg, train or flight travel)
The nurse administers 15 units of aspart insulin subcutaneously to a hospitalized client with type 1 diabetes mellitus at 7:00 AM for a fasting blood glucose of 180 mg/dL (10 mmol/L). Which nursing action is a priority?
Give the patient breakfast within 15 mins
A client has been on long-term therapy with esomeprazole. What is essential for the nurse to ask the client?
Have you had a bone density test done recently - Long-term use of PPIs (eg, omeprazole, pantoprazole, esomeprazole) is associated with osteoporosis, C difficile infection, and pneumonias. Clients should be encouraged to increase calcium and vitamin D intake to help prevent osteoporosis.
What are the adverse effects of glyburide?
Hypoglycemia and weight gain - can also cause sunburn
The nurse is speaking to a client who takes desmopressin nasal spray for diabetes insipidus. Which statement by the client is most important for the nurse to report to the health care provider?
I've recently started to experience frequent headaches - Clients taking desmopressin for diabetes insipidus are at risk for water intoxication and hyponatremia. - Client reports of headache, mental status change, and/or muscle weakness may indicate hyponatremia from water intoxication and should be reported to the health care provider immediately.
What effect does desmopressin have on urine specific gravity?
If desmopressin therapy is effective, the client's urine specific gravity will be higher due to the urine output decreasing and becoming less dilute.
How should levothyroxine be taken?
In the morning on an empty stomach, at least 30 to 60 minutes before breakfast. - 4 hours before or after prenatal vitamin
The nurse in an outpatient clinic is caring for a client with Addison disease who has been taking hydrocortisone 20 mg daily for the last 8 years. Which client data is most important to report to the health care provider?
Low grade fever - this is important since corticosteroids can cause weakened immune response = infection
A nurse conducting rounds checks on a client receiving continuous total parenteral nutrition (TPN). The infusion pump is found to be powered down, and TPN is no longer infusing. Which action should the nurse take first?
Obtain a stat finger prick BG reading - assess patient first
The nurse is caring for a client who had surgery yesterday. When administering omeprazole, the client asks "What is that for? I don't take it at home." Which reply by the nurse is most appropriate?
Omeprazole helps prevent gastric ulcers due to the stress of surgery
Waht can sulfa drugs do to the kidneys?
Sulfa drugs can crystallize in the kidneys - check Urine spec gravity
The nurse is providing education to a pregnant client diagnosed with symptomatic hypothyroidism regarding levothyroxine therapy during pregnancy. Which is appropriate teaching for the nurse to include?
Symptoms should start improving in 4 weeks of starting levothyroxine
A nurse is observing a nursing student reinforce teaching to a client on how to take sucralfate. Which statement made by the student would require intervention by the nurse?
Take this with your other stomach medications - wait 30 mins before taking other stomach meds such as PPI's and H2 meds - all other medications should be taken ≥1-2 hours before or after sucralfate.
How are corticosteriods prescribed and taken in terms of strength?
They are prescribed at a higher dose and then tapered off to prevent an adrenal crisis
What is desmopressin and what is it used for?
Desmopressin is often used to treat central diabetes insipidus, a disease characterized by reduced antidiuretic hormone (ADH) levels that may result in dehydration and hypernatremia.
What is the mechanism of action of desmopressin?
Desmopressin mimics the effects of naturally occurring ADH, which increases renal water resorption and concentrates urine. However, this effect also increases the risk for water intoxication from decreased urine output.
The nurse obtains a health history from a client who states, "I skip dinner most nights to lose weight. I don't want to get low blood sugar, so I don't take my evening dose of metformin when I skip dinner." Which response by the nurse is appropriate?
The risk of low BS is minimal when metformin is taken without food
A diabetic client is prescribed metoclopramide. Which of the following side effects must the nurse teach the client to report immediately to the health care provider?
This medication can cause extrapyramidal side effects - excessive blinking eyes - lip smaking -puffing of cheeks - chewing movements - twisting fingers
What is glyburide used for?
Adjunct therapy for type II diabetes (it is a sulfonylurea medications) (eg, glyburide, glipizide, glimepiride)
A nurse is caring for a client with an exacerbation of chronic obstructive pulmonary disease (COPD) and a history of type 2 diabetes mellitus requiring insulin. The client has been prescribed prednisone. The nurse anticipates which need?
Increasing the insulin dose - All glucocorticoids can cause an increase in blood sugar.
The nurse is reviewing prescriptions for the assigned clients. Which prescription should the nurse question?
Dicyclomine for a client with IBS who develops paralytic ileus
A client with primary hypothyroidism has been taking levothyroxine for a year. Laboratory results today show high levels of TSH. Which statement by the nurse to the client is appropriate?
The dosage of levothyroxine may need to be increased since the TSHH levels are high - In primary hypothyroidism, the thyroid does not produce enough hormones (T3, T4). In response to low circulating thyroid hormones, the pituitary continues to release TSH, resulting in high levels of circulating TSH. Levothyroxine is usually started or increased to lead to a euthyroid (normal) state.
What should patients taking desmopressin be monitored for?
Their fluid and electrolyte status should be closely monitored for symptoms of water intoxication/hyponatremia (eg, headache, mental status changes, weakness). The nurse should immediately notify the health care provider (HCP) of client reports of water intoxication symptoms, as severe hyponatremia may progress to seizure, neurologic damage, or death (Option 4).
What is the adverse effect of piolitazone?
These drugs can worsen heart failure by causing fluid retention and increase the risk of bladder cancer. Heart failure or volume overload is a contraindication to thiazolidinedione use. These medications also increase the risk of cardiovascular events such as myocardial infarction.
What is pioglitazone used for?
Thiazolidinedione use increase insulin sensitivity but carries a low risk for hypoglycemia (similar to metformin).
The nurse is caring for a client with diabetes who is being discharged with a prescription for glyburide. Which statement by the client indicates a need for further instruction?
This medication will help me lose weight -
The nurse evaluates the effectiveness of desmopressin use for diabetes insipidus in a client with a pituitary tumor. Which client assessment finding indicates that the medication is having the desired effect?
Urine output has decreased - Use of desmopressin acetate (DDAVP) in clients with diabetes insipidus will lower urinary output and cause the urine specific gravity to increase.