ATI Pharm Made Easy: Endocrine

A nurse is caring for a client on a medical-surgical unit. Exhibit 1 Nurses' Notes Today, 0700:Client admitted 12 days ago for abdominal pain. Diagnosed with bowel obstruction. Open partial colectomy 3 days ago. Client has history of type 1 diabetes mellitus.Alert and orientated to person, place, and time. Respiratory sounds are clear to auscultation. Heart sounds regular, rate and rhythm. Pedal pulses +2 bilaterally. Bowel sounds hypoactive in all four quadrants. Pain at surgical site. IV site left forearm: patent, no manifestations of infiltration or phlebitis. Currently receiving diabetic, full liquid diet.Today, 1600:Client reports nausea.Today, 1615:Administered ondansetron per provider prescription.Today, 1930:Client found diaphoretic, unconscious, and not responding to verbal or physical stimuli. Bedside blood glucose done. Which of the following interventions are priority for the nurse to make? (SATA)

Administer bolus of 50% dextrose in water IV. Check blood glucose in 15 min. R: When taking action, the nurse should administer 50% dextrose in water IV and check the client's blood glucose in 15 min. These interventions are supported by evidence-based practice. The client has manifestations of hypoglycemia and a blood glucose level of 48 mg/dL. Immediate action needs to be taken to reverse hypoglycemia. The client has a patent IV and administering intravenous dextrose works faster than administering glucagon. To determine the effectiveness of administering 50% dextrose in water, the nurse should check the client's blood glucose in 15 min.

A nurse is caring for a client who is about to begin taking pioglitazone to treat type 2 diabetes mellitus. The nurse should explain to the client about the need to monitor which of the following laboratory values? (Select all that apply.) Thyroid-stimulating hormone (TSH) Alanine aminotransferase (ALT) LDL CBC Creatinine clearance

Alanine aminotransferase (ALT) LDL R: Thyroid-stimulating hormone (TSH) is incorrect. Pioglitazone, a thiazolidinedione, is unlikely to alter T4 or TSH. Levothyroxine, a thyroid hormone replacement, is an endocrine system medication that requires monitoring of T4 and TSH. Alanine aminotransferase (ALT) is correct. Pioglitazone can cause liver injury. The nurse should monitor ALT at the start of therapy and then every 3 to 6 months thereafter. The nurse should tell the client to report jaundice, dark-colored urine, or abdominal pain. Low-density lipoproteins (LDL) is correct. Pioglitazone can cause elevations in both high-density lipoproteins (HDL), which is a beneficial effect, and low-density lipoproteins (LDL), which is a detrimental effect. The nurse should monitor the client's plasma lipid levels at baseline and periodically throughout medication therapy. CBC is incorrect. It is not necessary to monitor CBC for clients who are taking pioglitazone. Hydrocortisone, a glucocorticoid, is an endocrine system medication that requires monitoring of CBC. Creatinine clearance is incorrect. It is not necessary to monitor creatinine clearance for clients who are taking pioglitazone. Desmopressin, an antidiuretic hormone, is an endocrine system medication that requires monitoring of creatinine clearance.

A nurse is providing teaching to a client who is about to begin exenatide therapy to treat type 2 diabetes mellitus. Which of the following instructions should the nurse include? (Select all that apply.) Inject the drug subcutaneously. Expect the peak effect in 2 hr. Use the drug as a supplement to an oral hypoglycemic. Inject the drug 1 hr after a meal. Discard used pens 10 days after the first use.

Inject the drug subcutaneously. Expect the peak effect in 2 hr. Use the drug as a supplement to an oral hypoglycemic. R: Inject the medication subcutaneously is correct. The client should inject exenatide, an incretin mimetic, into the subcutaneous tissue of the thigh, upper arm, or abdomen. Expect the peak effect in 2 hr is correct. Levels of exenatide peak 2 hr after administration and then decrease gradually, with a half-life of 2.4 hr. Use the medication as a supplement to an oral hypoglycemic is correct. Exenatide supplements the action of an oral hypoglycemic, such as a sulfonylurea or metformin. Inject the medication 1 hr after a meal is incorrect. The client should inject exenatide twice per day up to 60 min prior to the morning and evening meals, rather than after a meal. Discard used pens 10 days after the first use is incorrect. The client can keep prefilled exenatide injector pens in use at room temperature for up to 30 days.

A nurse is teaching a client about self-administering regular insulin. The nurse should instruct the client to rotate injection sites to prevent which of the following? Rapid absorption Intradermal injection Injection pain Lipohypertrophy

Lipohypertrophy

A nurse is caring for a client who takes repaglinide 15 to 30 min before each meal to treat type 2 diabetes mellitus. The client asks, "If I skip a meal, what should I do?" Which of the following responses should the nurse make? Double the dose before the next meal. Take half the dose. Skip the dose. Take the usual dose.

Skip the dose R: To avoid a sudden and serious drop in blood glucose level, the client should skip the dose of repaglinide, a meglitinide, whenever skipping a meal. The nurse should also instruct the client to try to avoid skipping meals.

A nurse is educating the parents of a child who has a new diagnosis of Prader-Willi Syndrome (PWS) and has been prescribed somatropin. Which of the following statements by a parent indicates understanding of the teaching? "We will use a different spot for injection each time we give the medication." "We'll give the shot in the thigh muscle rather than fatty tissue to decrease injection pain." "We'll watch our child for signs of low blood sugar while using somatropin." "We should stop the medication if our child loses weight."

"We will use a different spot for injection each time we give the medication." R: To avoid atrophy of the tissue, administration of somatropin includes rotating the injection site each time. The nurse should identify this statement as an understanding of somatropin administration.

A nurse administers pramlintide at 0800 to a client who has type 1 diabetes mellitus. At which of the following times should the nurse expect the drug to exert its peak action? 0820 0900 1030 1100

1100 R: Pramlintide, an amylin mimetic, is likely to cause severe hypoglycemia 3 hr after administration. Regular insulin is an injectable hypoglycemic medication that can exert its peak action at this time. The nurse should monitor the client for manifestations of hypoglycemia, such as diaphoresis and tremors.

A nurse is caring for a client who is taking metformin and is scheduled to undergo angiography using iodine-containing contrast dye. The nurse should identify that an interaction between metformin and the IV contrast dye increases the client's risk for which of the following conditions? Hypokalemia Hyperglycemia Acute renal failure Acute pancreatitis

Acute renal failure R: Metformin, a biguanide, can interact with iodine-containing contrast dye and cause acute renal failure and lactic acidosis. The nurse should withhold metformin for 48 hr prior to and following the procedure. The nurse should also monitor the client for indications of acute renal failure or lactic acidosis, such as reduced urine output, hyperventilation, and abdominal pain.

A nurse is teaching a client who has a prescription for pramlintide therapy to treat type 1 diabetes mellitus. Which of the following instructions should the nurse include? Mix pramlintide with insulin in the syringe. Administer pramlintide before meals. Take pramlintide once daily at bedtime. Inject pramlintide into the upper arm.

Administer pramlintide before meals. R: The nurse should instruct the client to inject pramlintide, an amylin mimetic, 20 min before any meal that contains at least 30 g of carbohydrates.

A nurse is teaching a client who has a prescription for glipizide therapy to treat type 2 diabetes mellitus. Which of the following instructions should the nurse include? Avoid drinking alcohol. Sit or stand for 30 min after taking the drug. Urinate every 4 hr. Take the drug 2 hr after a meal.

Avoid drinking alcohol. R: The nurse should instruct the client to avoid drinking alcohol. Alcohol can interact with glipizide, a sulfonylurea, causing nausea, palpitations, and flushing. Alcohol also increases the medication's hypoglycemic effects.

A nurse is caring for a client who is about to begin insulin glargine therapy. The nurse should identify the need for additional precautions because the client also takes which of the following types of drugs? Oral contraceptives Calcium supplements Beta blockers Iron supplements

Beta blockers R: Clients who take both insulin and beta blockers are at risk for failing to promptly recognize the manifestations of hypoglycemia because beta blockers mask manifestations such as tachycardia and tremors. Beta blockers also increase hypoglycemic effects.

A nurse is teaching a client about acarbose therapy to treat type 2 diabetes mellitus. Which of the following instructions should the nurse include? Eat more iron-rich foods. Avoid drinking grapefruit juice. Increase fiber intake. Avoid drinking green tea.

Eat more iron-rich foods.

A nurse is providing teaching to a client who is about to begin levothyroxine therapy to treat hypothyroidism. Which of the following instructions should the nurse include? Take levothyroxine with food to increase absorption. Take levothyroxine with an antacid to reduce gastrointestinal effects. Expect life-long therapy with the drug. Carry a carbohydrate snack at all times.

Expect life-long therapy with the drug. R: Therapy with levothyroxine, a thyroid replacement hormone, usually continues for life because there are no other therapies that can restore thyroid function.

Which of the following drugs should a nurse have available for a client who is experiencing insulin toxicity? Naloxone Diphenhydramine Acetylcysteine Glucagon

Glucagon

When considering replacement therapy options for a client who has chronic adrenocortical insufficiency, a nurse should recognize that the provider will choose which of the following drugs? Somatropin Hydrocortisone Glucagon Desmopressin

Hydrocortisone R: Hydrocortisone, a glucocorticoid, provides replacement therapy for acute and chronic adrenocortical insufficiency, such as Addison's disease. Hydrocortisone is identical to cortisol, the primary glucocorticoid the adrenal cortex generates.

A nurse at a provider's office is assessing a client who has been taking hydrocortisone for adrenal insufficiency. The client reports fatigue and feeling overwhelmed by personal responsibilities. Which of the following findings should the nurse identify as an indication the provider might need to increase the client's dosage? Hypotension Hyperglycemia Weight gain Fat redistribution

Hypotension R: Hypotension and fatigue are findings of adrenal insufficiency. During times of stress, the client might need a dosage increase to prevent adrenal insufficiency. The nurse should report the findings to the provider.

A nurse is caring for a client who is taking metformin to treat type 2 diabetes mellitus and reports muscle pain. Which of the following adverse reactions should the nurse suspect? Lactic acidosis Anticholinergic effects Extrapyramidal effects Hypophosphatemia

Lactic acidosis R: Metformin, a biguanide, can cause lactic acidosis, which is a life-threatening complication that manifests as muscle aches, sleepiness, malaise, and hyperventilation. The client should stop taking the medication and seek medical care immediately.

A nurse is providing teaching to a client about taking fludrocortisone to treat adrenocortical insufficiency. Which of the following instructions should the nurse include? (Select all that apply.) Obtain weight measurement daily. Report weakness or palpitations. Have blood pressure checked regularly. Eat more iron-rich foods. Avoid drinking grapefruit juice.

Obtain weight measurement daily. Report weakness or palpitations. Have blood pressure checked regularly. R: Obtain weight measurement daily is correct. Fludrocortisone, a mineralocorticoid, can cause fluid and electrolyte imbalances, such as hypernatremia. Tracking weight on a daily basis can help identify weight gain and edema; reporting it can expedite any essential interventions. Report weakness or heart palpitations is correct. Fludrocortisone can cause hypokalemia. The nurse should monitor the client's potassium levels and tell the client to report muscle weakness or heart palpitations. Have blood pressure checked regularly is correct. Fludrocortisone can cause fluid retention and hypertension. The nurse should monitor the client's fluid balance and blood pressure to expedite any essential interventions. Eat more iron-rich foods is incorrect. Fludrocortisone does not cause iron-deficiency anemia. However, it can cause thrombocytopenia. Avoid drinking grapefruit juice is incorrect. Grapefruit juice is unlikely to alter the effects of fludrocortisone.

A nurse is speaking with a client who is taking glipizide to treat type 2 diabetes mellitus and has called to report feeling shaky, hungry, and fatigued. Which of the following actions should the nurse instruct the client to take? Drink 16 oz of water. Perform a fingerstick blood glucose check. Take another glipizide tablet. Lie down and rest.

Perform a fingerstick blood glucose check. R: Glipizide, a sulfonylurea, can cause hypoglycemia, which can manifest as diaphoresis, shakiness, hunger, and fatigue. The nurse should tell the client to check their blood glucose level and, if it indicates hypoglycemia, to consume a snack of 15 to 20 g (0.5 to 0.7 oz) of carbohydrates, retest in 15 to 20 min, and repeat if their blood glucose level is still low.

A nurse is assessing a client who has a new prescription for levothyroxine. The nurse should identify which of the following findings as a contraindication for this drug? Bacterial skin infections Diabetes insipidus Immunosuppression Recent myocardial infarction

Recent myocardial infarction R: Levothyroxine, a thyroid replacement hormone, can cause tachycardia, palpitations, and hypertension, especially when the client requires a dosage adjustment. Therefore, it is contraindicated for clients who have recently had a myocardial infarction.

A nurse should recognize that a provider will prescribe a lower dose of sitagliptin for a client who has type 2 diabetes mellitus and who also has which of the following? Thyroid disease Bronchitis Heart failure Renal impairment

Renal impairment R: Sitagliptin, a gliptin, requires cautious use with clients who have renal dysfunction and low creatinine clearance because the kidneys eliminate the medication virtually intact. The provider should prescribe a lower dose for this client or prescribe a different hypoglycemic medication.

A nurse is caring for a client who is taking desmopressin. The nurse should make which of the following assessments to evaluate the drug's effectiveness? Peripheral pulses Urine output Skin integrity Blood glucose

Urine output R: Desmopressin, an antidiuretic hormone, treats diabetes insipidus. The nurse should monitor the client's fluid intake and urine output along with urine and serum osmolality and blood pressure.

A nurse is caring for a client who is taking pioglitazone to treat type 2 diabetes mellitus. The nurse should monitor for which of the following findings? Joint pain Constipation Weight gain Dilated pupils

Weight gain R: Pioglitazone, a thiazolidinedione, can cause fluid retention. The nurse should monitor the client for weight gain and other indications of fluid retention or heart failure, including dyspnea, crackles, and wheezing.

A nurse is caring for a client who is taking propylthiouracil (PTU) and reports weight gain, drowsiness, and depression. The nurse should identify that the client is experiencing which of the following adverse reactions to the drug? Thyrotoxicosis Hypothyroidism Lactic acidosis Radiation sickness

Hypothyroidism R: Propylthiouracil, an antithyroid medication, can cause hypothyroidism, which manifests as drowsiness, depression, weight gain, edema, and bradycardia. The nurse should request that the provider prescribe a lower dosage of the medication for the client.

FLAG A nurse is caring for a client who is about to begin taking propylthiouracil (PTU) to treat hyperthyroidism. The nurse should instruct the client to report which of the following adverse effects? (Select all that apply.) Sore throat Joint pain Insomnia Bradycardia Rash

Sore throat Joint pain Rash R: Sore throat is correct. Propylthiouracil, an antithyroid drug, can cause agranulocytosis. The nurse should monitor the client's CBC and instruct the client to report fever or sore throat. Joint pain is correct. Propylthiouracil can cause arthralgia and myalgia. The nurse should instruct the client to report these effects and take over-the-counter analgesics for pain relief. Insomnia is incorrect. Propylthiouracil is more likely to cause drowsiness than insomnia. Leukocytosis is incorrect. Propylthiouracil can cause bone marrow depression, which may result in leukopenia and agranulocytosis. Rash is correct. Propylthiouracil can cause urticaria or a skin rash. The nurse should instruct the client to report these effects.

A nurse is caring for a client who is about to begin taking somatropin. The nurse should explain the need to monitor which of the following laboratory values? (Select all that apply.) Blood amylase Creatinine clearance Urine calcium or TSH Blood glucose CBC

Urine calcium or TSH Blood glucose R: Blood amylase is incorrect. Somatropin, a growth hormone, is unlikely to alter blood amylase levels. Sitagliptin, an antithyroid medication, is an endocrine system medication that requires monitoring of blood amylase levels because it can cause pancreatitis. Creatinine clearance is incorrect. Somatropin is unlikely to alter creatinine clearance. Desmopressin, an antidiuretic hormone, is an endocrine system medication that requires monitoring of creatinine clearance. Thyroid-stimulating hormone (TSH) is correct. Somatropin, a growth hormone, can suppress the thyroid gland and cause hypothyroidism. The nurse should monitor TSH levels. Blood glucose is correct. Somatropin can cause hyperglycemia. The nurse should monitor the client's blood glucose levels and instruct the client to report polyphagia, polydipsia, and polyuria. CBC is incorrect. Somatropin is unlikely to alter the client's CBC. Radioactive iodine-131, an antithyroid medication, is an endocrine system medication that requires monitoring CBC.