Endocrine Practice Questions

The nurse teaches a patient with Addison's disease about hydrocortisone replacement therapy. Which statement, made by the patient, indicates that the teaching was effective?

"I should keep an emergency supply of this drug available at all times." -To ensure the availability of hydrocortisone in emergencies, the patient with Addison's disease should carry an adequate supply at all times. When given in the low doses required for replacement therapy, hydrocortisone is devoid of adverse effects, including hyperglycemia. During illness, the patient must increase the glucocorticoid dosage. Because levels of glucocorticoids normally peak in the morning, the usual practice is to take the entire daily dose immediately after waking. An alternative is to divide the daily dose, taking two-thirds in the morning and one-third in the afternoon.

The nurse instructs a patient about taking levothyroxine [Synthroid]. Which statement by the patient indicates the teaching has been effective?

"If I have chest pain or insomnia, I should call my doctor." -Levothyroxine overdose may produce the following symptoms: tachycardia, angina, tremor, nervousness, insomnia, hyperthermia, heat intolerance, and sweating; the patient should contact the prescriber if these symptoms are noted. Levothyroxine should be taken in the morning on an empty stomach 30 minutes before a meal. Levothyroxine should not be taken with antacids, which reduce the absorption of levothyroxine.

The nurse teaches a patient with hypothalamic diabetes insipidus about desmopressin [DDAVP]. The nurse determines that the teaching was effective if the patient makes which statement?

"The medication can be taken by inhaling through my nose." -Desmopressin can be administered by the intranasal route. Desmopressin must be taken lifelong. Urine volume will decrease while the patient is taking this medication. While the patient is taking desmopressin, fluid intake will be reduced to prevent water intoxication.

The nurse instructs a patient in the administration of Lugol's solution. The nurse determines that teaching has been effective if the patient makes which statement?

"The medication should be diluted in fruit juice." -Lugol's solution is administered in a dosage of drops and should be mixed with juice or some other beverage to mask its unpleasant taste. Lugol's solution is used for a short time (usually less than 10 days) to suppress thyroid function in preparation for thyroidectomy or during a thyrotoxic crisis. Lugol's solution does not stain teeth. The solution should not be placed under the tongue.

A patient with Cushing's syndrome is prescribed an antibiotic, ketoconazole [Nizoral] 600 mg/day, before an adrenalectomy. The patient asks the nurse why an antibiotic is needed. Which response by the nurse is best?

"The medication will block the adrenal gland from producing steroids." -Ketoconazole is an antifungal drug that also inhibits glucocorticoid synthesis. The dose for glucocorticoid synthesis inhibition is 600 to 800 mg/day; a dose of 600 mg/day is much higher than a dose for antifungal therapy.

A patient with which condition would most likely be prescribed a glucocorticoid in low doses for replacement therapy?

Addison's disease -Addison's disease is a disease of primary adrenocortical insufficiency that requires a physiologic dose for replacement therapy. Conditions such as rheumatoid arthritis and systemic lupus erythematosus require high-dose therapy with glucocorticoids. Cushing's syndrome is a disease of excess levels of circulating glucocorticoids.

A pediatric patient is prescribed somatropin [Humatrope] for growth hormone deficiency. It is most appropriate for the nurse to take which action?

Draw up the drug into a syringe and give it subcutaneously -Growth hormone (GH) is administered subcutaneously or intramuscularly.

A patient with a urinary creatinine clearance of 55 mL/min is prescribed desmopressin [DDAVP]. It is most important for the nurse to assess the patient for what?

Drowsiness, listlessness, and headache -The risk of water intoxication is increased if a patient taking desmopressin (or antidiuretic hormone [ADH] replacement) has renal impairment. If the creatinine clearance is below 50 mL/min, ADH should not be used. Early signs of water intoxication include drowsiness, listlessness, and headache. Severe intoxication progresses to convulsions and terminal coma.

A patient with hyperthyroidism is taking propylthiouracil (PTU). It is most important for the nurse to assess the patient for which adverse effects?

Fever and sore throat -Agranulocytosis is the most serious toxicity for patients taking PTU. Sore throat and fever may be the earliest indications.

A child with type 1 diabetes mellitus is diagnosed with growth hormone deficiency and is started on somatropin [Humatrope]. It is most appropriate for the nurse to monitor the child for which condition?

Hyperglycemia -Somatropin should be used with caution in children with diabetes mellitus because growth hormone can elevate plasma glucose levels, and an increase in insulin dosage will be needed.

A patient is prescribed metformin. Which statement about metformin does the nurse identify as true?

Metformin can delay the development of type 2 diabetes in high-risk individuals. -Metformin decreases absorption of vitamin B12 and folic acid and thereby can cause deficiencies of both. Metformin is considered a "weight-neutral" antidiabetic drug, in contrast with several other antidiabetic drugs that tend to increase weight ("weight-positive"). Metformin and other biguanides inhibit mitochondrial oxidation of lactic acid and can thereby cause lactic acidosis.

The nurse cares for a patient with primary hypoaldosteronism who took excessive doses of fludrocortisone [Florinef]. It is most important for the nurse to assess the patient for what?

Muscle weakness and an irregular heartbeat -Fludrocortisone is a potent mineralocorticoid used to treat primary hypoaldosteronism; excessive doses cause retention of sodium and water and excessive excretion of potassium, resulting in expansion of blood volume, hypertension, cardiac enlargement, edema, and hypokalemia. The nurse should assess the patient for signs of salt and water retention (for example, unusual weight gain, swelling of the feet or lower legs) and hypokalemia (for example, muscle weakness, irregular heartbeat).

A patient is prescribed NPH insulin. Which statement should the nurse include in the discharge instructions?

The insulin will have a cloudy appearance in the vial. -NPH insulins are supplied as cloudy suspensions. The onset of action of NPH insulin is delayed, and the duration of action is extended. NPH insulin is the only one suitable for mixing with short-acting insulins. Allergic reactions are possible with NPH insulins.

A patient is prescribed insulin glargine [Lantus]. Which statement should the nurse include in the discharge instructions?

The patient will have less risk of hypoglycemic reactions with this insulin. -Glargine [Lantus] insulin has a prolonged duration of action and is administered once per day at the same time. Glargine insulin is clear; glargine insulin should not be mixed with other insulins; and glargine insulin achieves blood levels that are relatively steady over 24 hours, so the risk of hypoglycemia is less.

A patient takes levothyroxine [Synthroid] 0.75 mcg every day. It is most appropriate for the nurse to monitor which laboratory test to determine whether a dose adjustment is needed?

Thyroid-stimulating hormone (TSH) -Serum thyroid-stimulating hormone (TSH) is the preferred laboratory test for monitoring replacement therapy in patients with hypothyroidism.