ATI GI/Endocrine Pharmacology
A nursing is teaching a client with Addison's disease and a prescription for hydrocortisone. Which statement should they include?
"Carry a supply of pills and single-use injectable preparation with you at all times" This can be taken for unexpected stress. Normally the medication should be taking in the morning.
A nurse is monitoring a client who received diphenoxylate-atropine. Which statement made by the client indicates to the nurse that the medication has been effective?
"I have not had a bowel movement today" Diphenoxylate-atropine is an opioid used to treat diarrhea. Adverse effects include morphine-like drowsiness, dry mouth, and asthma-like manifestations.
A nurse is teaching a client who is about to start taking propylthiouracil to treat hyperthyroidism. Which statement indicates the treatment has been effective?
"I will need laboratory tests to check my liver function." Propylthiouracil is hepatotoxic. Patient should report any dark urine or aundice. Other common side effects include rash and drowsiness.
A nurse is teaching a client about the adverse effects of omeprazole. Which client statements indicates an understanding?
"If i experience severe diarrhea, I will call my doctor." Clients who experience diarrhea while taking PPis should report this immediately. Omeprazole and other PPis are associated with a risk of C Diff
A nurse is teaching a client who has type II DM about a prescription for insulin lispro. Which statement should they include in the teaching?
"Insulin lispro has an onset of about 15 minutes" Lispro effects last for 3-6 hours. A patient taking lispro should take the insulin within 15 minutes before eating because of the quick onset. A client can administer lispro subcutaneously or via insulin pump.
A patient is taking chenodiol for gall stones. Which statement indicates understanding?
"Liver function tests are required when taking this med." Treatment with chenodiol usually lasts two years and can cause diarrhea.
A nurse is administering a client's first dose of sucralfate. Which explanation should the nurse give about the action of sucralfate?
"Sucralfate forms a gel-like substance that protects ulcers"
A nurse is administering insulin glulisine 10 units subq at 0730. When is the onset of action?
0745 Onset of rapid acting insulins lispro and glulisine = 15m Onset of regular insulin=30-360min NPH onset=1-2h
A nurse is caring for a client who has peptic ulcer disease and reports a headache. Which medication should the nurse plan to administer?
Acetaminophon No NSAIDS like aspirin, naproxen, or ibuprofen.
A nurse is caring for a client who is receiving IV famotidine. Which adverse effect should the nurse report immediately?
Bloody Stools Bloody stools are urgent because famotidine might cause thrombocytopenia. Other expected effects of famotidine are drowsiness and headaches.
A nurse is providing teaching to a client who has hypothyroidism and is taking levothyroxine. The nurse should instruct the client that which finding is an indication of thyrotoxicosis?
Chest pain Thyrotoxicosis can result if a patient takes too much levothyroxine. Manifestations include chest pain, tachycardia, insomnia, tremors, hyperthermia, heat intolerance, and diaphoresis.
A client is about to start taking aluminum hydroxide tablets to reduce gastric acid. Which instructions should you include?
Chew the tablet thoroughly, drink a glass of water after taking, and increase fluid and fiber. Advise eating 6 small meals, can be taken up to 6x/day
A nurse is caring for a client who has diabetes insipidus. Which of the following lab values should the nurse identify as reflecting a contraindication to receiving vasopressin to treat this disorder?
Creatinine clearance 50mL/min Creatinine clearance indicates renal impariment, a contraindication for vasopressin.
What teaching should be included for a patient taking misoprostol to treat peptic ulcer disease?
DO NOT GET PREGNANT misoprostol is an analog of prostaglandin E, it's prevents gastric ulcers in patients taking NSAIDs
A nurse is caring for a client who has been taking metformin for 6 months. Which finding would the nurse identify as an expected therapeutic effect of the medication?
Decreased blood glucose level Metfformin can also cause weight loss, nausea, vomiting, bloating and diarrhea. Metformin can decrease absorption of B12.
A nurse is caring for a client taking acarbose to treat type II DM. Which adverse effect should the nurse monitor for?
Diarrhea. Most adverse effects of acarbose are GI related--diarrhea, abdominal distention, cramping, and flatulence. Acarbose should be taken with food. Acarbose slows the digestion of carbs, so it needs to be taken with the first bite of a meal 3x/day.
You're about to administer ondansetron to prevent anesthesia-induced nausea and vomiting. You monitor the client for which adverse effect?
Dizziness ondansetron is a serotonin antagonist, can cause dizziness, lightheadedness and sedation.
A nurse is caring for a client who has been taking cimetidine for the treatment of a duodenal ulcer. What manifsetation should the nurse report?
Emesis that looks like coffee grounds Coffee-ground emesis is a manifestation of a GI bleed as a result of the duodenal ulcer. Other adverse effects of cimetidine that don't require reporting include myalgia, muscle pain, erectile dysfunction, and gynocomastia.
A nurse is caring for a client who has a prescription for levothyroxine to treat hypothyroidism. What finding indicates the client requires intervention?
HR 106/min Basically look for any manifestation of hyperthyroidism. Common things that are seen with hypothyroidism and wouldn't be report worthy are dry skin and lethargy.
A nurse is reviewing the laboratory results of a client who is taking medication and notes the tests show an elevated level of AST and ALT. The nurse should recognize that these findings are potential indications of which condition?
Hepatic toxicity AST and ALT are enzymes that test liver function. Elevated levels indicate the medication is damaging the liver.
What is an adverse effect of fludrocortisone?
Hypokalemia due to excess sodium and water retention, resulting in the loss of excessive potassium.
A patient has a new rx for sucralfate for a duodenal ulcer. Which statement indicates an understanding?
I should wait at least 30 min before taking this medicine after I take an antacid. Sucralfate should also be taken 1 hour before meals and at bedtime for optimal effectiveness.
A nurse is providing teaching to a newly licensed nurse about metoclopramide. The nurse should highlight that which of the following conditions is a contraindication?
Intestinal obstruction Metoclopramide, aka Reglan, reduces nausea and vomiting by increasing gastric motility and promoting gastric emptying.
A nurse is providing teaching to a client who has ulcerative colitis and a new prescription for sulfasalazine. The nurse should instruct the client to monitor for which of the following adverse effects?
Jaundice. Sulfasalazine may also cause diarrhea, stomatitis, headache, and peripheral neuropathy.
A nurse is reviewing lab values for a client who reports fatigue and cold intolerance. The client has increased TSH and decreased T3 & T4. What rx should the nurse anticipate?
Levothyroxine . This pt has hypothyroidism. Propylthiouracil is for hypERthyroidism.
A patient with Addison's disease has been placed on long-term mineralcorticoid therapy with fludrocortisone. What info should the nurse provide about the purpose of this therapy?
Mineralcorticoids maintain electrolyte and fluid balance. Addison's disease results in a deficiency of cortisol and aldosterone and requires supplementation. Addison's = LOW sodium and HIGH potassium Cushing's = HIGH sodium and LOW potassium
A nurse is providing teaching to a client who has type II DM and a new prescription for metformin. Which of the following adverse effects of metformin should the nurse instruct the client to watch for and report?
Myalgia Myalgia, malaise, somnolence, and hyperventilation are manifestations of lactic acidosis, which can rarely occur when taking metformin due to the blockage of lactic acid oxidation. Metfformin can also cause weight loss, nausea, vomiting, bloating and diarrhea. Metformin can decrease absorption of B12.
A nurse is caring for a client who is taking glucocorticoid adrenal replacement meds for long-term Addison's disease treatment. What is an adverse effect?
Osteoporosis Long-term glucocorticoid use can also result in weight gain due to sodium and water retention, restlessness, agitation, anxiety, lethargy.
You're caring for a client taking exenatide to treat type II DM, the client reports severe abdominal pain. What do you suspect?
Pancreatitis
A nurse is caring for a client who is taking glucocorticoids. The nurse should monitor the patient for what adverse effect?
Peptic ulcer Glucocorticoids can cause peptic ulcer disease due to irritation of the gastric mucosa. Check stool for occult blood periodically. Glucocorticoids may also cause weight gain, hypokalemia, cataracts, and glaucoma.
What should a nurse monitor for in a patient taking glucocorticoids?
Peptic ulcers Can cause irritation of gastric mucosa
A nurse is teaching a client who has type 1 DM about a new subcutaneous insulin infusion pump. Which piece of information should the nurse include in the teaching?
Plan to use a short-duration insulin in the infusion pump The client should use short-duration insulin, such as regular, lispro, aspart, or glulisine insulin in the infusion pump to deliver a baseline of insulin. The patient should also administer bolus doses before each meal. The client should replace the infusion set every 1-3 days. The client should not remove or turn off the pump with the exception of removing the device on special occasions for 1-2 hours. The client should move the catheter infusion site at least 1" away from the old site to maintain tissue integrity.
A nurse is caring for a client with DKA and a rx for IV insulin. What type of insulin with the nurse document was administered?
Regular Insulin is the only insulin that can be administered IV.
What instructions would you give for radioactive iodinie-131
Report weight gain/edema, use contraception, 2-3 months for effects, periodic blood sampling (CBC, TSH)
A nurse is teaching self-administration of NPH insulin. Which should the nurse include?
Rotate injection sites within the same area. Also, keep them about 1" apart in the same anatomical area to prevent lipodystrophy. Roll the vials between the palms; do not shake. NPH is a cloudy suspension.
A client is about to start taking sulfasalazine to treat IBD. You instruct the client to report?
Sore throat, fever. Sulffasalazine is an anti-inflammatory that can cause agranulocytosis. Tell patients to avoid crowds, people with communicble infections and report fever, sore throat, or other indications of infection. it doesn't typically cause arthralgia, dry mouth, or diarrhea.
A nurse is teaching a client about storing unopened vials of insulin. Which information should the nurse include in the teaching?
Store unopened vials in the refrigerator. Once opened, a vial can be left at room temperature for one month.
A nurse is teaching a client who has dyspepsia about prescribed antacids. Which of the following statements should the nurse include in the teaching?
Take antacids 1 hour apart from other medications. Antacids can cause sodium loading because many contain sodium in their preparations. Antacids can cause constipation or diarrhea (magnesium type). Antacids are typically scheduled to be administered up to 7x/day 1-3 hours after meals.
A client is about to start taking sustained release glipizide for type II DM. What instruction do you give?
Take once daily, 30 min before breakfast.
A patient is taking levothyroxine for hypothyroidism and has a new prescription for a calcium supplement. What info should the nurse include in the teaching?
Take the calcium supplement 4 hours after the levothyroxine. Levothyroxine should be given in the morning on an empty stomach.. Food or supplements can bind to levothyroxine and prevent absorption.
A nurse is teaching administration of acarbose to a patient with type II DM. What should they include?
Take this medication with food. Acarbose is taken with food and slows digestion of carbs. Take with first bite of meal 3x/day.
A 20 month old child got a Hep A vaccine 3 days ago and has loss of appetite. What tdo you say?
Tell parents this reaction should only last for a couple of days.
A nurse is preparing to administer levothyroxine to a client who has hypothyroidism. The nurse should identify which of the following laboratory results as supporting the administration of this medicine?
Thyroid-stimulating hormone (TSH) 8 microunites/mL TSH reference range is 0.3-5 microunites/mL. With primary hypothyroidism, the TSH level is elevated in an attempt to normalize the thyroid gland's function. TSH levels should return to normal after treatment. With primary hypothyroidism, we'd see low T3 and T4.
A nurse is assessing a client with hypothyroidism who takes levothyroxine. What finding is indicative of an acute levothyroxine overdose?
Tremors Also, tachycardia, heat intolerance, and hyperthermia. Similar findings to those seen in hyperthyroidism, or graves disease.
A client is taking acarbose and a sulfonylurea to treat type II DM. Which is an adverse reaction to this combination?
Tremors. this can cause hypoglycemia.
What are the side effects of hydrocortisone?
bone loss, peptic ulcer disease, hypernatremia no urinary retention, but may have fluid retention d/t hypernatremia
A client is about to take somatropin. How will you evaluate the effectiveness?
height and weight somatropin is a growth hormone, seen for turner's syndrome
A nurse is teaching a client with Peptic ulcer disease about their prescription for bismuth subsalicylate. Which statement should the client make about the drug's action?
"This medication can decrease bacteria in the gastrointestinal tract" Bismuth subsalicylate can assist by eliminating the bacteria H pylori, which can cause PUD.
A nurse is providing teaching to a client with a rx for famotidine to treat a gastric ulcer. What statement should they include in the teaching?
"This medication is less effective for people who smoke." Food doesn't affect the absorption, so famotidine can be take without regard to food intake. Do wait at least 30-60 min post antacids. Dizziness is an AE.
A nurse is teaching a client who had a bleeding duodenal ulcer and has been prescribed omeprazole. What statement should the nurse include in the teaching?
"You should take this medication before breakfast every day" Omeprazole, a protein pump inhibitor used for duodenal ulcer or GERD, should be taking once daily before meals. Food decreases effectiveness. Omeprazole shouldn't be used for longer than 8 weeks because it can cause hypomagensium and fractures.
A client is about to start taking alosetron to treat diarrhea. What do you tell the client to report?
Constipation, can cause impaction.
A client is about to start taking omeprazole to treat a duodenal ulcer. Which instruction should you include?
Consume adequate amounts of fluids. Take PPIs 1 hour before meals and with plenty of fluids.
A nurse is caring for a client who has suspected adrenal insufficiency. Which of the following medications should the nurse anticipate the provider using to determine the presence of adrenal insufficiency?
Cosyntropin Cosyntropin will be inected, if the adrenal response causes cortisol levels to elevate, the response is normal, if cortisol level does not elevate, the provider should determine that the client has adrenal insufficiency. Prednisone is a medication used for lifelong glucocorticoid replacement therapy for adrenal insufficiency. Dexamethasone is a synthetic steroid used to determine if a client has Cushing's syndrome, as indicated by minimal or no suppression of cortisol production. Ketaconazole is used to suppress the synthesis of adrenal steroids in clients who have Cushing's as an adjunct to surgery or radiation.
A patient with cystic fibrosis is being treated with pancreatic enzymes. What info indicates a therapeutic response?
The client is having 1-2 bowel movements per day. This indicates the absorption of food is occurring.
