Endocrine System

11. 1. The client with type 2 diabetes must adhere to the prescribed diet to help keep the blood glucose level within the normal range. Delaying or missing a meal can cause hypoglycemia. This statement would not warrant intervention by the nurse. 2. The client should check blood glucose levels to determine if the medication is effective; therefore, this statement would not warrant intervention by the nurse. 3. Sulfonylureas and biguanides may cause an Antabuse-like reaction when taken with alcohol, causing the client to become nauseated and vomit. Advise the client to abstain from alcohol and to avoid liquid over-the-counter (OTC) medications that may contain alcohol. Alcohol also increases the half-life of the medication and can cause a hypoglycemic reaction. 4. The client with type 2 diabetes does not need to walk daily to keep the glucose level within normal limits; walking three times a week will help control stress and help decrease weight if the client is overweight.

11. The client diagnosed with type 2 diabetes is prescribed the sulfonylurea glipizide (Glucotrol). Which statement by the client warrants intervention by the nurse? 1. "I have to eat my diabetic diet even if I am taking this medication." 2. "I will need to check my blood glucose level at least once a day." 3. "I usually have one glass of wine with my evening meal." 4. "I do not like to walk every day, but I will if it will help my diabetes."

12. 1. A thiazolidinedione, pioglitazone (Actos) or rosiglitazone (Avandia), not a biguanide like metformin, is prescribed to decrease insulin resistance. 2. An alpha-glucosidase inhibitor, acarbose (Precose) or miglitol (Glyset), is administered to allow carbohydrates to pass slowly through the intestine. Glucophage does not do this. 3. The scientific rationale for administering metformin (Glucophage) is that it diminishes the increase in serum glucose following a meal and blunts the degree of postprandial hyperglycemia by preventing gluconeogenesis. 4. A meglitinide, repaglinide (Prandin), sulfonylurea, or nateglinide (Starlix) is prescribed to stimulate the beta cells to release more insulin into the bloodstream.

12. Which statement best describes the scientific rationale for prescribing the biguanide metformin (Glucophage)? 1. This medication decreases insulin resistance, improving blood glucose control. 2. This medication allows the carbohydrates to pass slowly through the large intestine. 3. This medication will decrease the hepatic production of glucose from stored glycogen. 4. This medication stimulates the beta cells to release more insulin into the bloodstream.

13. 1. The oral hypoglycemic medication should be administered with food to decrease gastric upset. 2. The client receiving oral hypoglycemic medications can experience hypoglycemic reactions, as can clients receiving insulin. 3. These are signs or symptoms of hypoglycemia, and the client should be able to treat this without notifying the health-care provider. 4. Ketones are a by-product of the breakdown of fats, which usually does not occur in clients with type 2 diabetes because the client has enough insulin to prevent breakdown of fats but not enough to keep the blood glucose level within an acceptable level.

13. The nurse is discussing the oral hypoglycemic medication Micronase with the client diagnosed with type 2 diabetes. Which information should the nurse discuss with the client? 1. Instruct the client to take the oral hypoglycemic medication with food. 2. Explain that hypoglycemia will not occur with oral medications. 3. Tell the client to notify the HCP if a headache, nervousness, or sweating occurs. 4. Recommend the client check the ketones in the urine every morning.

14. 1. An elastic skin turgor is expected and normal, but it does not indicate that the antidiabetic medication is effective. 2. Urine ketones should be negative because there should not be a breakdown of fat in clients with type 2 diabetes, but this does not indicate the effectiveness of the medication. 3. The serum blood glucose level should be within normal limits, which is 70-110 mg/dL. A level of 118 mg/dL is close to normal; therefore, the medication can be considered effective. 4. A self-monitoring blood glucose level of 170 mg/dL is above a normal glucose level; this indicates the medication is not effective. MEDICATION MEMORY JOGGER: The nurse determines the effectiveness of a medication by assessing for the symptoms, or lack thereof, for which the medication was prescribed.

14. The client diagnosed with type 2 diabetes is receiving the combination oral antidiabetic medication glyburide/metformin (Glucovance). Which data indicates the medication is effective? 1. The client's skin turgor is elastic. 2. The client's urine ketones are negative. 3. The serum blood glucose level is 118 mg/dL. 4. The client's glucometer level is 170 mg/dL.

15. 1. During illness, the client with type 2 diabetes may need insulin to help keep glucose levels under control, but this is a threatening type of statement and is not the nurse's best response. 2. Insulin may need to be prescribed in times of stress, surgery, or serious infection; therefore, the nurse should explain this to the client and not refer the client to the HCP. 3. This is a therapeutic response and the client needs to have factual information. Therapeutic responses are used to encourage the client to ventilate feelings. 4. Blood glucose levels elevate during times of stress, surgery, or serious infection. The client with type 2 diabetes may need to be given insulin temporarily to help keep the blood glucose level within normal limits.

15. The client with type 2 diabetes is admitted into the medical department with a wound on the left leg that will not heal. The HCP prescribes sliding-scale insulin. The client tells the nurse, "I don't want to have to take shots. I take pills at home." Which statement is the nurse's best response? 1. "If you can't keep your glucose under control with pills, you must take insulin." 2. "You should discuss the insulin order with your HCP because you don't want to take it." 3. "You are worried about having to take insulin. I will sit down and we can talk." 4. "During illness you may need to take insulin to keep your blood glucose level down."

16. 1. The client's serum blood glucose level is checked by drawing a venipuncture blood sample and sending it to the laboratory. This is an appropriate nursing intervention. 2. The client is experiencing signs of a hypoglycemic reaction and the nurse must treat the client by administering some type of simple-acting glucose. This is the first intervention. 3. Determining when the last oral hypoglycemic medication was administered is an appropriate intervention. 4. The nurse should assess the client's vital signs in any abnormal situation but these signs/symptoms address diabetes. 5. Insulin should be administered if the client is hyperglycemic, not hypoglycemic. MEDICATION MEMORY JOGGER: When answering test questions or when caring for clients at the bedside, the nurse should remember that assessing the client might not be the first action to take when the client is in distress. The nurse may need to intervene directly to help the client.

16. The nurse is caring for the client diagnosed with type 2 diabetes. The client is complaining of a headache, jitteriness, and nervousness. Which interventions should the nurse implement? Select all that apply. 1. Check the client's serum blood glucose level. 2. Give the client a glass of orange juice. 3. Determine when the last antidiabetic medication was administered. 4. Assess the client's blood pressure and apical pulse. 5. Administer prescribed insulin via sliding scale.

17. 1. Changes in weight will affect the amount of medication needed to control blood glucose. The nurse should determine if the client's medication dose is too high by determining if the client has had an increase in hypoglycemic reactions. This is the nurse's first intervention. 2. A significant weight loss may require a decrease or discontinuation of oral hypoglycemic medication, but the nurse should first determine if the client has had symptoms of hypoglycemia before referring him or her to the HCP. 3. Determining if the client was deliberately losing weight or was losing without trying is significant because a 35-pound weight loss in 4 months would warrant intervention, depending on what caused the weight loss. However, this should not be the nurse's first intervention. 4. The nurse should confirm the client's weight loss with the clinic scale and the last weight in the client's chart, but it is not the clinic nurse's first intervention. MEDICATION MEMORY JOGGER: Remember that the first step in the nursing process is assessment. Words such as check, monitor, determine, ask, take, auscultate, and palpate indicate that the nurse is assessing the client. Assessment should be done before implementing an independent nursing action or notifying the health-care provider, except in certain serious or life-threatening situations.

17. The overweight client diagnosed with type 2 diabetes reports to the clinic nurse that he has lost 35 pounds in the past 4 months. Which intervention should the nurse implement first? 1. Determine if the client has had an increase in hypoglycemic reactions. 2. Instruct the client to make an appointment with the health-care provider. 3. Ask the client if he has been trying to lose weight or has it happened naturally. 4. Check the client's last weight in the chart with the weight obtained in the clinic.

18. 1. The nurse should investigate any herb the client is taking because most herbs do affect a disease process or the medication being taken for the disease process. 2. The nurse should determine if ginseng affects the client's type 2 diabetes or medications that the client is taking for the disease process. 3. This is a negative, judgmental statement. Many herbs are beneficial to the client. The nurse should always assess the client and determine if the herb is detrimental to the client's disease process or affects the client's routine medication regimen prior to making this type of statement. 4. The nurse should determine if the client is taking any medication because many oral hypoglycemics interact with herbs. Ginseng and garlic may increase the hypoglycemic effects of oral hypoglycemics. MEDICATION MEMORY JOGGER: Some herbal preparations are effective, some are not, and a few can be harmful or even deadly. If a client is taking an herbal supplement and a conventional medicine, the nurse should investigate to determine if the herbal preparation would cause harm to the client. The nurse should always be the client's advocate.

18. The female client diagnosed with type 2 diabetes tells the clinic nurse she started taking ginseng to help increase her memory. Which intervention should the clinic nurse implement? 1. Take no action because ginseng does not affect type 2 diabetes. 2. Determine what type of memory deficits the client is experiencing. 3. Explain that herbs are dangerous and she should not be taking them. 4. Determine if the client is currently taking any type of antidiabetic medication.

19. 1. The students with type 2 diabetes should not eat candy, but it is not the most important intervention for the school nurse to teach. 2. This is pertinent information, but it is not the most important information. 3. The most important information for the teachers to know is how to treat potentially life-threatening complications secondary to the medications used to treat type 2 diabetes. The school nurse should discuss issues that keep the students safe. 4. Exercise is important in helping to control type 2 diabetes, but empowering the teachers to be confident when handling complications secondary to medication is priority for the safety of the students.

19. The school nurse is teaching a class about type 2 diabetes in children to elementary school teachers. Which information is most important for the nurse to discuss with the teachers? 1. The importance of not allowing students to eat candy in the classroom. 2. The increase in the number of students developing type 2 diabetes. 3. The signs and symptoms of hypoglycemia and the immediate treatment. 4. The need to have the students run or walk for 20 minutes during the recess period.

2. 1. The insulin pen injector resembles a fountain pen. It contains a disposable needle and insulin-filled cartridge. When the client operates the insulin pen, the correct dose is obtained by turning the dial to the number of insulin units needed. 2. The insulin pen injector does not require drawing up insulin in a syringe. 3. The insulin pen injector can be used in any subcutaneous site that traditional insulin can be injected. 4. Most clients state that there is less injection pain associated with the insulin pen than there is with the traditional insulin syringe.

2. The nurse is teaching the client with type 1 diabetes how to use an insulin pen injector. Which information should the nurse discuss with the client? 1. Instruct the client to dial in the number of insulin units needed to inject. 2. Demonstrate the proper way to draw up the insulin in an insulin syringe. 3. Discuss that the insulin pen injector must be used in the abdominal area only. 4. Explain that the traditional insulin syringe is less painful than the injector pen.

20. 1. Jaundiced sclera may indicate the client has hepatitis, but because the client has been prescribed oral hypoglycemic medications, their possible role in the development of the jaundice should be assessed. 2. The nurse should not jump to the conclusion that the client is an alcoholic just because the sclera is jaundiced. 3. Digoxin toxicity results in the client having a yellow haze, not the client's sclera being yellow. 4. Oral hypoglycemics are metabolized in the liver and may cause elevations in liver enzymes; the client should be instructed to report the first signs of yellow skin, sclera, pale stools, or dark urine to the HCP.

20. The client newly diagnosed with type 2 diabetes who has been prescribed an oral hypoglycemic medication calls the clinic and tells the nurse that the sclera has a yellow color. Which intervention should the clinic nurse implement? 1. Ask the client if he or she has been exposed to someone with hepatitis. 2. Determine if the client has a history of alcohol use or is currently drinking alcohol. 3. Check to see if the client is taking the cardiac glycoside digoxin. 4. Make an appointment for the client to come to the health-care provider's office.

21. 1. Morphine can cause spasm of the pancreatic ducts and the sphincter of Oddi. Therefore, the nurse would question administering this medication. 2. Diphenhydramine is a histamine1 blocker that blocks the release of histamine1 that occurs during allergic reactions. The nurse would not question this medication. 3. Clients with diabetes mellitus may at times have a need for a steroid medication. The medication may elevate the client's glucose levels, and these levels should be monitored. The nurse would not question this medication. 4. Vasopressin is the hormone that is lacking in clients diagnosed with diabetes insipidus (DI) and is the treatment for DI. The nurse would not question administering this medication. MEDICATION MEMORY JOGGER: The nurse must be knowledgeable about accepted standards of practice for disease processes and conditions. If the nurse administers a medication the health-care provider has prescribed and it harms the client, the nurse could be held accountable. Remember that the nurse is a client advocate.

21. The nurse is administering medications. Which medication should the nurse question administering? 1. Morphine sulfate, an opioid, to a client diagnosed with pancreatitis. 2. Diphenhydramine (Benadryl), an H1 blocker, to a client with an allergic reaction. 3. Methylprednisolone (Solu-Medrol), a glucocorticoid, to a client with type 2 diabetes. 4. Vasopressin (DDAVP), a hormone, to a client diagnosed with diabetes insipidus.

22. 1. Synthroid is a daily medication and can be administered at any time. 2. Protonix is a daily medication and can be administered at any time. 3. Tylenol is for mild to moderate pain; this client would require a more potent analgesic. The nurse should assess the client's medications and discuss other medications with the HCP. This would not be the first medication to administer. 4. Pancreatic enzymes are administered with every meal and snack. The nurse should administer this medication so the medication and the breakfast foods arrive in the small intestine simultaneously.

22. The nurse has received the morning report. Which medication should be administered first? 1. Levothyroxine (Synthroid), a hormone, to a client diagnosed with hypothyroidism. 2. Pantoprazole (Protonix), a proton-pump inhibitor, to a client diagnosed with gastroesophageal reflux disease (GERD). 3. Acetaminophen (Tylenol) to a client with a migraine headache rated 7 on the pain scale. 4. Pancreatin (Donnazyme), an enzyme, to a client diagnosed with chronic pancreatitis.

23. 1. The nurse is following a correct procedure for administering medications through a nasogastric tube that is connected to suction. The tube should remain clamped for 1 hour before it is reconnected to suction. 2. The nurse followed correct procedure; there is no reason to notify the manager. 3. The nurse is following a correct procedure for administering medications through a nasogastric tube that is connected to suction. The tube should remain clamped for 1 hour before it is reconnected to suction to allow the medication to be absorbed. 4. The medication is ordered to be administered through the tube, not orally.

23. The client diagnosed with chronic pancreatitis has a nasogastric tube. The charge nurse observes the primary nurse instill an antacid down the tube and then clamp the tube. Which action should the charge nurse take? 1. Tell the nurse to reconnect the tube to suction. 2. Notify the unit manager of the nurse's actions. 3. Do nothing because this is the correct procedure. 4. Instruct the nurse to administer the medication orally.

24. 1. The Librium may act as an adjunct to pain relief, but this is not the reason for prescribing the medication to this client. 2. Librium is useful in preventing delirium tremens in clients withdrawing from alcohol. The majority of clients diagnosed with chronic pancreatitis (75%) are middle-aged males who also have chronic alcoholism. 3. Librium may have some antiemetic properties, but this is not the reason for prescribing the medication to this client. 4. Librium can cause drowsiness, but it is not the drug of choice as a sleep aid for a client who is NPO.

24. The HCP prescribed chlordiazepoxide (Librium), a sedative hypnotic, for a 55-year-old male client diagnosed with chronic pancreatitis. Which statement is the scientific rationale for prescribing this medication? 1. Librium acts as an adjunct to pain medication. 2. Librium limits complications related to alcohol withdrawal. 3. Librium prevents the nausea related to pancreatitis. 4. Librium is used as a sleep aid for clients who are NPO.

25. 1. Clients should be asked to rate their pain on a scale so the nurse can objectively evaluate the effectiveness of the interventions. 2. The nurse abides by the five Rights of Medication Administration, including the right time. Pain medication is prescribed at specific time intervals. The nurse must make sure the time interval has passed and it is time for more medication. 3. A client diagnosed with severe acute pancreatitis will be NPO, and Vicodin is an oral narcotic medication. The nurse would administer an IV medication. 4. The client should be placed in a semi-Fowler's position to relieve pressure on the abdomen, thereby decreasing the client's pain. 5. There is no indication that the client requires oxygenation at this time.

25. The client diagnosed with acute pancreatitis is complaining of severe abdominal pain. Which interventions should the nurse implement? Select all that apply. 1. Ask the client to rate the pain on a 1-10 pain scale. 2. Determine when the client received the last dose of medication. 3. Administer hydrocodone (Vicodin), a narcotic pain medication. 4. Assist the client to a semi-Fowler's position. 5. Apply oxygen at 4 L/minute via nasal cannula.

26. 1. Blood glucose levels should be monitored every 4-6 hours. 2. TPN requires a central line for administration, not a peripheral line. The high concentration of dextrose in TPN causes phlebitis in peripheral veins. 3. The client's electrolytes and magnesium levels are monitored, not the complete blood count. 4. The TPN bag prepared by the pharmacy should be checked with the MAR to ensure the health-care provider's prescription is correct. 5. The TPN solution contains all the required nutrients to sustain life. It also makes an ideal medium for bacterial growth. Infection control safety measures include using new tubing with every bag of TPN.

26. The client diagnosed with acute pancreatitis is placed on total parenteral nutrition (TPN). Which interventions should the nurse implement? Select all that apply. 1. Monitor blood glucose levels every 6 hours. 2. Assess the peripheral intravenous site. 3. Check the client's complete blood count. 4. Check the TPN bag with the client's MAR. 5. Change the tubing with every new bag of TPN.

27. 1. The client will be in Fowler's or semi- Fowler's position to use gravity to pool secretions near the gastric/duodenal tube. 2. This is not an investigational procedure. The general treatment permission form the client signed when entering the hospital is sufficient. 3. The gastric and duodenal contents are aspirated and sent to the laboratory for analysis before and after the administration of secretin, which stimulates the pancreas to secrete enzymes. 4. The client is not placed in a head-down position for this procedure.

27. The nurse is administering pancreatic secretin, a stimulatory hormone, to a client to rule out chronic pancreatitis. Which procedure should the nurse follow? 1. Have the client lie on the right side during the administration of the medication. 2. Make sure the client has signed a permit for an investigational procedure. 3. Aspirate gastric and duodenal contents before and after the medication. 4. Place the client in the Trendelenburg position before beginning the medication.

28. 1. The nurse should have been monitoring the client for constipation while in the hospital. The client should not be discharged on Demerol. 2. To prevent withdrawal after weeks of administration of Demerol, the client should be tapered off the medication over several days. 3. The client should be tapered off the medication prior to leaving the hospital, not sent to a drug withdrawal center. 4. Withdrawal from the medication should be accomplished prior to discharging the client, so the symptoms of withdrawal should occur while the client is still in the hospital.

28. Which intervention should be implemented when discharging a client diagnosed with chronic pancreatitis who has been receiving high doses of meperidine (Demerol), an opioid, for the past 4 weeks? 1. Tell the client to monitor his or her stools and to avoid constipation. 2. Taper the medication slowly over several days prior to discharge. 3. Refer the client to a drug withdrawal clinic to stop taking the Demerol. 4. Discuss signs and symptoms of drug dependence to report to the HCP.

29. 1. Octreotide stimulates fluid and electrolyte absorption from the gastrointestinal tract and prolongs intestinal transit time, thereby decreasing diarrhea. 2. Octreotide is prescribed for clients with acromegaly to prevent growth, not stimulate it. 3. Octreotide is helpful in preventing or treating diarrhea and associated abdominal pain, but not muscle cramping or pain. 4. Octreotide does not treat acid reflux. MEDICATION MEMORY JOGGER: The nurse determines the effectiveness of a medication by assessing for the symptoms, or lack thereof, for which the medication was prescribed.

29. The male client diagnosed with pancreatitis is prescribed octreotide (Sandostatin), a hormone. Which data indicates the medication has been effective? 1. The client reports that the diarrhea has subsided. 2. The client states that he has grown 1 inch. 3. The client has no muscle cramping or pain. 4. The client has no complaints of heartburn.

3. 1. Headache, nervousness, sweating, tremors, and rapid pulse are signs of a hypoglycemic reaction and should be treated with a simple- acting carbohydrate, such as orange juice, sugar-containing drinks, and hard candy. This statement indicates the client understands the teaching. 2. If a client cannot drink or eat a simple carbohydrate for hypoglycemia, then the client should receive a glucagon injection to treat the hypoglycemic reaction. This indicates the client understands the teaching. 3. Even with insulin therapy the client should adhere to the American Diabetic Association diet, which recommends "carbohydrate counting." This statement indicates the client needs more teaching. 4. Monitoring and documenting the blood glucose level are encouraged to determine the effectiveness of the treatment regimen. This indicates the client understands the client teaching. 5. The abdominal area best absorbs insulin; therefore, the client does not need more teaching.

3. The nurse is teaching a client with newly diagnosed type 1 diabetes about insulin therapy. Which statements indicate the client needs more teaching concerning insulin therapy? Select all that apply. 1. "If I have a headache or start getting nervous, I will drink some orange juice." 2. "If I pass out at home, a family member should give me a glucagon injection." 3. "Because I am taking my insulin daily I do not have to adhere to a diabetic diet." 4. "I will check my blood glucose with my glucometer at least once a day." 5. "I should administer my insulin in my abdomen for best absorption."

30. 1. Humalog is not administered intravenously, and glucose levels should be monitored prior to insulin administration. 2. The client's symptoms should indicate hyperglycemia to the nurse, not pancreatic enzyme deficiency. 3. Humulin R insulin is administered by sliding scale to decrease blood glucose levels. Clients with pancreatitis should be monitored for the development of diabetes mellitus. Polydipsia and polyuria are classic signs of diabetes mellitus. 4. Zantac would not treat the client's symptoms.

30. The client diagnosed with pancreatitis is complaining of polydipsia and polyuria. Which medication should the nurse prepare to administer? 1. Humalog, a fast-acting insulin intravenously, and then monitor glucose levels. 2. Pancrelipase (Cotazym) sprinkled on the client's food with meals. 3. Humulin R subcutaneously after assessing the blood glucose level. 4. Ranitidine (Zantac), a histamine2 receptor blocker, orally.

31. 1. The dose of corticosteroids may have to be increased during the stress of an infection or surgery. It is imperative that under these circumstances the client receives enough medication to replicate the body's own responses to stress (see the table). 2. The client usually will need to take mineral and glucocorticoid replacement therapy. This statement does not need more teaching. 3. The client will experience symptoms of adrenal insufficiency if not taking the medications. This statement does not need more teaching. 4. Clients should be taught to inform all health-care providers of all medications, prescribed and over the counter, that they are taking. This statement does not need more teaching.

31. The client diagnosed with Addison's disease is being discharged. Which statement indicates the client needs more discharge teaching? 1. "I will be sure to keep my dose of steroid constant and not vary." 2. "I may have to take two forms of steroids to remain healthy." 3. "I will get weak and dizzy if I don't take my medication." 4. "I need to notify any new HCP of the medications I take."

32. 1. The client should remain in an upright position for at least 30 minutes after taking Fosamax to prevent esophageal erosion and ulceration. 2. The medication is taken the first thing in the morning when the stomach is empty. Taking Fosamax and then lying down would cause esophageal reflux, resulting in erosion and ulceration of the esophagus. 3. An antacid will interfere with the absorption of Fosamax. 4. The medication should be taken at least 30 minutes before food or fluid is consumed for the day to prevent esophageal erosion and ulceration. 5. The client should drink a full glass of water with the medication and remain in an upright position for at least 30 minutes after taking Fosamax to prevent esophageal erosion and ulceration.

32. The client diagnosed with Cushing's disease is prescribed alendronate (Fosamax), a biphosphonate regulator, to prevent osteoporosis. Which information should the clinic nurse teach? Select all that apply. 1. Take the medication and sit upright for 30 minutes. 2. Take the medication just before going to bed. 3. Take the medication with an antacid to alleviate gastric disturbances. 4. Take the medication at least 30 minutes before breakfast. 5. Take the medication with a full glass of water.

33. 1. The medication cannot be discontinued; a bilateral adrenalectomy means that all the hormones normally produced by the adrenal glands must be replaced. The client now has adrenal insufficiency (Addison's disease). 2. The glucocorticosteroids and mineralocorticosteroids, as well as the androgens produced by the adrenal glands, must be replaced regularly; doses should not be skipped. 3. The client cannot stop taking the medication. Doing so could result in a life-threatening situation. The development of a round face is a side effect of glucocorticoids that may indicate that the dose is too high. The client should notify the HCP to review the dosage. 4. Excess glucocorticoids may induce diabetes mellitus; the HCP should be notified if the client experiences symptoms of diabetes such as feeling thirsty all the time. 5. All clients with a chronic medical condition should wear a MedicAlert bracelet or necklace.

33. The client is scheduled for a bilateral adrenalectomy for Cushing's disease. Which information regarding the prescribed glucocorticoid prednisone (Deltasone) should the nurse teach? Select all that apply. 1. When discontinuing this medication, it must be tapered. 2. Take the medication regularly; do not skip doses. 3. Stop taking the medication if you develop a round face. 4. Notify the HCP if you start feeling thirsty all the time. 5. Wear a MedicAlert bracelet in case of an emergency.

34. 1. The nurse will monitor the client's electrolytes, especially sodium and potassium and glucose levels, but this is not the first action. 2. The nurse should be prepared to replace the corticosteroids, but this is not the first action. 3. The nurse must treat an addisonian crisis as all other shock situations. An IV and fluid replacement are imperative to prevent or treat shock. This is the first action. 4. This is important, but it will not prevent or treat shock. MEDICATION MEMORY JOGGER: The stem of the previous question told the test taker that the situation is a "crisis." The first step in many crises is to make sure that an IV access is available to administer fluids and medications.

34. The emergency department nurse is caring for a client in an addisonian crisis. Which intervention should the nurse implement first? 1. Draw serum electrolyte levels. 2. Administer methylprednisolone (Solu-Medrol) IV. 3. Start an 18-gauge catheter with normal saline. 4. Ask the client what medications he or she is taking.

35. 1. Protonix does not increase the ability to digest food. 2. Protonix decreases the production of stomach acid by inhibiting the protonpump step in gastric acid production. 3. Protonix does not absorb gastric acid; it prevents its production. 4. Sucralfate (Carafate) is a mucosal barrier agent that coats the stomach lining. Protonix does not coat the stomach.

35. The client diagnosed with Cushing's disease is prescribed pantoprazole (Protonix), a proton-pump inhibitor. Which statement is the scientific rationale for prescribing this medication? 1. Protonix increases the client's ability to digest food. 2. Protonix decreases the excess amounts of gastric acid. 3. Protonix absorbs gastric acid and eliminates it in the bowel. 4. Protonix coats the stomach and prevents ulcer formation.

36. 1. Shortness of breath and pale mucous membranes do not indicate long-term steroid use or Cushing's syndrome. 2. A round face (moon face) indicates a redistribution of fat from steroid therapy. Multiple ecchymotic areas on the arms indicate a redistribution of subcutaneous fats away from the arm (thin extremities). Both are side effects of long-term steroid therapy. 3. Pink, frothy sputum and jugular vein distention are symptoms of congestive heart failure, not long-term steroid therapy. 4. Petechiae indicate a low platelet count, and sclerosed veins indicate the use of IV access for medication administration. These are not signs of steroid therapy.

36. The client has developed Cushing's syndrome as a result of long-term steroid therapy. Which assessment findings support this condition? 1. The client is short of breath on exertion and has pale mucous membranes. 2. The client has a round face and multiple ecchymotic areas on the arms. 3. The client has pink, frothy sputum and jugular vein distention. 4. The client has petechiae on the trunk and sclerosed veins.

37. 1. Ketoconazole is an anti-infective that also suppresses the production of adrenal hormones. This side effect makes it useful in treating the overproduction of adrenal hormones that results from secretion of ACTH by tumors that cannot be removed surgically. 2. Methylprednisolone is a steroid, and ACTH stimulates the production of adrenal hormones. This would increase the client's symptoms. 3. Propylthiouracil is used to suppress the production of thyroid hormones, not adrenal hormones. 4. Vasopressin is a pituitary hormone that prevents diuresis; it is not an adrenal hormone.

37. The client has developed Cushing's syndrome as a result of an ectopic production of ACTH by a bronchogenic tumor. Which medication should the nurse anticipate the health-care provider prescribing? 1. Ketoconazole (Nizoral), an anti-infective. 2. Methylprednisolone (Solu-Medrol), a corticosteroid. 3. Propylthiouracil (PTU), a hormone substitute. 4. Vasopressin (DDAVP), an antidiuretic hormone.

38. 1. The client diagnosed with Cushing's disease is at risk for infections because of the immune suppression that occurs as a result of excess cortisol production. This client should be seen by the HCP. 2. Clients diagnosed with Cushing's disease are at risk for developing infections related to the excess production of cortisol by the adrenal glands. The client must be seen by an HCP and antibiotics must be initiated. 3. The client is not in an emergent situation; the client can go to an HCP office or clinic to be seen. 4. The client has a physiological problem, not a psychosocial problem. The client does not need therapeutic conversation.

38. The male client diagnosed with iatrogenic Cushing's disease calls the clinic nurse and informs the nurse he has a temperature of 100.1°F. Which intervention should the nurse implement? 1. Tell the client to take acetaminophen and drink liquids. 2. Instruct the client to come to the clinic for an antibiotic. 3. Have the client go to the nearest emergency department. 4. Encourage the client to discuss his feelings about the disease.

39. 1. Florinef is not an oral hypoglycemic medication. It is a steroid and may increase the blood glucose, not decrease it. 2. Mineral corticosteroids help the body to maintain the correct serum sodium levels. Florinef is the preferred medication for Addison's disease, primary hypoaldosteronism, and congenital adrenal hyperplasia when sodium wasting occurs. 3. Florinef does not prevent muscle cramps. If the Florinef dose is too high, then potassium wasting will occur, resulting in muscle cramping. 4. Florinef does not stimulate the pituitary gland. The pituitary gland produces hormones that stimulate the adrenal gland. The adrenal gland does not produce hormones that stimulate the pituitary gland.

39. The client diagnosed with Addison's disease asks the nurse, "Why do I have to take fludrocortisone (Florinef), a mineral corticosteroid?" Which statement is the nurse's best response? 1. "It will keep you from getting high blood sugars." 2. "Florinef helps the body retain sodium." 3. "Florinef prevents muscle cramping." 4. "It stimulates the pituitary gland to secrete ACTH."

40. 1. Replacement corticosteroids are necessary for clients with adrenal insufficiency. The nurse would not question administering prednisone. 2. Ginseng is an herb that enhances the adrenal function. The nurse would not question this medication. 3. Mitotane is a medication that suppresses adrenal functioning. The nurse would question this medication in a patient with adrenal insufficiency. 4. In both males and females, the adrenal glands produce androgens, including testosterone. Replacing this hormone would not be unusual in a client with adrenal insufficiency. MEDICATION MEMORY JOGGER: The nurse must be knowledgeable about accepted standards of practice for disease processes and conditions. If the nurse administers a medication the health-care provider has prescribed and it harms the client, the nurse could be held accountable. Remember that the nurse is a client advocate.

40. The client being admitted with primary adrenal insufficiency provides the nurse with a list of home medications. Which medication should the nurse question? 1. Prednisone (Orasone). 2. Ginseng. 3. Mitotane (Lysodren). 4. Testosterone.

41. 1. DDAVP acts on the kidney to concentrate urine, but kidney stones would not warrant a change in the medication. 2. Diabetes mellitus type 2 would not be a reason to change the medication. 3. DDAVP is administered intranasally, and a sinus infection could interfere with absorption of the medication. Vasopressin comes in an intramuscular form, and the client may need to take this form of vasopressin until the sinus infection has resolved. 4. Hyperthyroidism would not warrant a change in medication or route.

41. The client diagnosed with diabetes insipidus is prescribed desmopressin (DDAVP). Which comorbid condition warrants a change in medication? 1. Renal calculi. 2. Diabetes mellitus type 2. 3. Sinusitis. 4. Hyperthyroidism.

42. 1. Octreotide suppresses the pituitary gland's secretion of human growth hormone, which, in adults, causes enlarged viscera, bone deformities, and other signs and symptoms of acromegaly. The nurse would expect to administer this medication. (Acromegaly in children results in gigantism.) 2. Somatrem is a growth hormone and would increase the client's symptoms. 3. NSAIDs are administered to clients diagnosed with nephrogenic diabetes insipidus to inhibit prostaglandin production. 4. The client has symptoms of acromegaly, an overproduction of human growth hormone. ACTH would not suppress this production.

42. The middle-aged client with a pituitary tumor has enlarged viscera and bone deformities. Which medication should the nurse administer? 1. Octreotide (Sandostatin), a synthetic hormone analog. 2. Somatrem (Protropin), a human growth hormone. 3. Ketorolac (Toradol), a nonsteroidal anti-inflammatory drug. 4. Corticotropin (ACTH), a pituitary hormone.

43. 1. The client diagnosed with diabetes insipidus is excreting large amounts of dilute urine because the body is unable to conserve water and concentrate the urine. The client requires fluid-volume replacement. The nurse would insert an IV. The client would have a high sodium level (because of the lack of fluid in the vascular system); lactated Ringer's solution would be preferred to normal saline. 2. The client should be on hourly output measurements. An indwelling catheter is needed to measure the client's output. The client requires rest, and voiding many liters of urine every day would leave the client exhausted from lack of sleep. 3. The urine specific gravity indicates the client's ability to concentrate urine and should be monitored. 4. Lasix would increase the client's urinary output; this is opposite to the effect that is needed. 5. In this situation, intake and output measurements are monitored every hour, not every shift.

43. The client diagnosed with diabetes insipidus is admitted in acute distress. Which interventions should the nurse implement? Select all that apply. 1. Start an IV with lactated Ringer's. 2. Insert an indwelling catheter. 3. Monitor the urine specific gravity. 4. Administer furosemide (Lasix) IVP. 5. Assess the intake and output every shift.

44. 1. Diabinese can cause weakness, jitteriness, nervousness, and other signs of a hypoglycemic reaction. The client should be aware of this and be prepared to treat the reaction with a source of simple carbohydrate. This is not a reason to discontinue the medication. 2. Diabinese is not a cholinergic medication with a side effect of a dry mouth. 3. Clients with Type 2 diabetes mellitus usually take the medication prior to meals. The effects of Diabinese can last 2-3 days. This client can take the medication after a meal. 4. Diabinese potentiates the action of vasopressin in clients with residual hypothalamic function. The sulfonylureas are used mostly to treat type 2 diabetes mellitus because they stimulate the pancreas to secrete insulin. The client should be aware that an insulin reaction (hypoglycemic reaction) can occur.

44. The client diagnosed with mild diabetes insipidus is prescribed chlorpropamide (Diabinese), a sulfonylurea. Which discharge instruction should the nurse teach the client? 1. Discontinue the medication if feeling dizzy. 2. Chew sugarless gum to alleviate dry mouth. 3. Take the medication before meals. 4. Discuss signs and symptoms of an insulin reaction

45. 1. This medication is given to cause maturation of the ovarian follicle and trigger ovulation. An FSH level would have been done prior to prescribing Chorigon. 2. This medication is given to cause maturation of the ovarian follicle and trigger ovulation. The client is monitored for overstimulation of the ovaries by pelvic sonograms. 3. The medication is a category X medication, which indicates that it is known to cause harm to fetuses, but it is given to stimulate ovulation to achieve a pregnancy. It also is given to maintain the corpus luteum after LH decreases during a normal pregnancy. 4. The medication is given parenterally, not orally.

45. The 30-year-old female client is prescribed chorionic gonadotropin (Chorigon), a hormone substitute. Which intervention should the nurse implement? 1. Have the lab draw an FSH level every week. 2. Schedule for regular pelvic sonograms. 3. Discuss not becoming pregnant while taking this drug. 4. Teach to take the medication with food.

46. 1. In SIADH, the body retains too much water. Elevated fluid levels in the body result in dilutional hyponatremia. Hyponatremia can cause seizures and other central nervous system dysfunction. The sodium level is monitored to determine the effectiveness of the intervention. 2. The serum potassium level is important to monitor, but it will not measure the effectiveness of Lasix in treating this condition. 3. The problem in SIADH is in the pituitary gland; it is not a kidney problem. 4. The pituitary gland produces ACTH, but ACTH production is not the problem in SIADH. SIADH is an overproduction of vasopressin, the antidiuretic hormone. MEDICATION MEMORY JOGGER: The nurse must be knowledgeable about accepted standards of practice for medication administration, including which client assessment data and laboratory data should be monitored prior to administering the medication.

46. The HCP ordered furosemide (Lasix) for a client diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). Which laboratory test would be monitored to determine the effectiveness of the medication? 1. Serum sodium levels. 2. Serum potassium levels. 3. Creatinine levels. 4. Serum ACTH levels.

47. 1. Clofibrate is an antilipemic that has an antidiuretic effect on clients with neurogenic diabetes insipidus, but it would not have an effect on a client whose diabetes insipidus is caused by the kidney's inability to respond to the medication. 2. NSAIDs inhibit prostaglandin production and are used to treat nephrogenic diabetes insipidus. 3. Lasix is a diuretic and would increase the urinary output in a client whose problem is too much urinary output. 4. Desmopressin is a form of vasopressin, the antidiuretic hormone, but production of the hormone is not in question in nephrogenic diabetes insipidus; the pituitary gland is producing the hormone. The problem is that the kidneys are unable to respond to it.

47. Which medication should the nurse administer to the client diagnosed with nephrogenic diabetes insipidus? 1. Clofibrate (Atromid-S), an antilipemic. 2. Ibuprofen (Motrin), a prostaglandin inhibitor. 3. Furosemide (Lasix), a loop diuretic. 4. Desmopressin (DDAVP), a pituitary hormone. CHAPTER 6 ENDOCRINE SYSTEM 155

48. 1. The problem is that the client is in fluid-volume overload probably as a result of the medication vincristine. A diuretic may be administered, but as a treatment, not as a prophylactic measure. 2. Weight gain is not a sign of an infection. These symptoms indicate SIADH. 3. The client's diet is not responsible for the fluid weight gain. 4. Vincristine, the phenothiazines, antidepressants, thiazide diuretics, and smoking are known to stimulate the overproduction of vasopressin. The client's symptoms indicate SIADH. The nurse should assess the weight gain, hold the medication, and notify the HCP.

48. The female client diagnosed with Hodgkin's disease is prescribed vincristine (Oncovin), a vinca alkaloid. Since the last treatment the client complains that she cannot wear her rings or most of her shoes because of weight gain. Which intervention should the nurse implement first? 1. Administer a diuretic before the Oncovin to prevent fluid overload. 2. Monitor the client for signs of infection. 3. Discuss a low-sodium diet with the client. 4. Weigh the client and report the findings to the oncologist.

5. 1. One amp of 50% glucose would be used to treat a severe hypoglycemic reaction, and this client does not have signs or symptoms that indicate hypoglycemia. In fact, the client has signs and symptoms of hyperglycemia. 2. The client's signs and symptoms indicate the client is experiencing diabetic ketoacidosis (DKA), which is treated with intravenous regular insulin. 3. Humulin N is an intermediate-acting insulin, which is not used to treat hyperglycemia. 4. An IV of D5W would cause the client to have further signs and symptoms of DKA; therefore, the nurse should not administer the IV. 5. These are signs/symptoms of a DKA; therefore, checking the client's blood glucose level is an appropriate intervention.

5. The client diagnosed with type 1 diabetes is complaining of a dry mouth, extreme thirst, and increased urination. Which interventions should the nurse implement? Select all that apply. 1. Administer one amp of intravenous 50% glucose. 2. Prepare to administer intravenous regular insulin. 3. Inject Humulin N subcutaneously in the abdomen. 4. Hang an intravenous infusion of D5W at a keep open rate. 5. Check the client's blood glucose level via a glucometer.

50. 1. Black cohosh is an over-the-counter herb that is sometimes used to treat dysmenorrhea, premenstrual syndrome (PMS), and menopausal symptoms. The nurse would not question this medication. 2. Desmopressin causes vasoconstriction and is contraindicated in clients with angina because of the coronary vasoconstriction. 3. Diuril would be administered to a client with SIADH. SIADH may be caused by a head injury, pituitary tumors, tumors that secrete hormones, some medications, and smoking. The nurse would not question this medication. 4. Calcitonin is administered to decrease calcium levels. The nurse would not question this medication. MEDICATION MEMORY JOGGER: The nurse must be knowledgeable about accepted standards of practice for disease processes and conditions. If the nurse administers a medication the health-care provider has prescribed and it harms the client, the nurse could be held accountable. Remember that the nurse is a client advocate.

50. The nurse is administering morning medications. Which medication should the nurse question? 1. Black cohosh, an herb, to a client with dysmenorrhea and cramping. 2. Desmopressin (DDAVP), to a client with diabetes insipidus and angina. 3. Hydrochlorothiazide (Diuril), to a client with SIADH from a head injury. 4. Calcitonin (Cibacalcin), a hormone, to a client with hypercalcemia from lung cancer.

51. 1. The client would have signs or symptoms of hypothyroidism if the client is not taking enough medication. Weight loss is a sign of hyperthyroidism, which indicates the client is taking too much Synthroid. 2. The client complaining of being cold indicates the client has hypothyroidism and needs more thyroid hormone replacement. 3. Exophthalmos (bulging of the eyes) occurs with hyperthyroidism, not hypothyroidism. The client with hypothyroidism would be taking synthroid. 4. A normal radial pulse, 60 to 100, indicates the medication is effective and the client would not need to take more medication. 5. Decreased metabolism and constipation indicate that the client is not taking enough of the thyroid hormone.

51. The client diagnosed with hypothyroidism is prescribed levothyroxine (Synthroid). Which assessment data supports the client needs to take more medication? Select all that apply. 1. The client has a 2-kg weight loss. 2. The client complains of being too cold. 3. The client has exophthalmos. 4. The client's radial pulse rate is 90 bpm. 5. The client complains of being constipated.

52. 1. Synthroid increases the basal metabolic rate, which can precipitate cardiac dysrhythmias in clients with undiagnosed heart disease, especially in elderly clients. Synthroid can also cause cardiovascular collapse. Therefore, the client's cardiovascular function should be assessed by the nurse. 2. Respiratory depression is not a complication of thyroid hormone therapy. 3. The client with hypothyroidism may experience a paralytic ileus due to decreased metabolism. This would not be an expected complication in a client taking Synthroid. 4. A thyroid storm may occur when the thyroid gland is manipulated during a thyroidectomy, not when the client starts taking Synthroid.

52. Which complication should the nurse assess for in the elderly client newly diagnosed with hypothyroidism who has been prescribed levothyroxine (Synthroid)? 1. Cardiac dysrhythmias. 2. Respiratory depression. 3. Paralytic ileus. 4. Thyroid storm.

53. 1. The goal of radioactive iodine treatment is to destroy just enough of the thyroid gland so that the levels of thyroid function return to normal; it does not destroy the entire gland. 2. The client should not be in close contact with children or pregnant women for 1 week following administration of the medication because the client will be emitting small amounts of radiation. 3. Most clients require a single dose of radioactive iodine, but some may need additional treatments. 4. The radioactive iodine is a clear, odorless, tasteless liquid that does not need to be administered with cold orange juice.

53. The client with hyperthyroidism is administered radioactive iodine (I-131). Which intervention should the nurse implement? 1. Explain that the medication will destroy the thyroid gland completely. 2. Instruct the client to avoid close contact with children for 1 week. 3. Discuss the need to take the medication at night for 7 days. 4. Administer the radioactive iodine in 8 ounces of cold orange juice.

55. 1. Nervousness, jitteriness, and irritability are signs or symptoms of hyperthyroidism; therefore, the nurse should question administering thyroid hormone. 2. A normal temperature would indicate the client is in a euthyroid state; therefore, the nurse would not question administering this medication. 3. A normal blood pressure would indicate the client is in a euthyroid state; therefore, the nurse would not question administering this medication. 4. The nurse would not question administering the medication because fatigue is a sign of hypothyroidism, which is why the client has been prescribed thyroid hormone. MEDICATION MEMORY JOGGER: If the client verbalizes a complaint, if the nurse assesses data, or if laboratory data indicates an adverse effect secondary to a medication, the nurse must intervene. The nurse must implement an independent intervention or notify the health-care provider because medications can result in serious or even lifethreatening complications.

55. The nurse is preparing to administer liothyronine (Cytomel), a thyroid hormone, to a client diagnosed with hypothyroidism. Which data should cause the nurse to question administering the medication? 1. The client is complaining of being nervous. 2. The client's oral temperature is 98.9°F. 3. The client's blood pressure is 110/70. 4. The client is complaining of being tired.

56. 1. The nurse should discuss ways to help cope with the symptoms of hypothyroidism. The client should increase fiber intake to help prevent constipation. 2. The T3, T4, and TSH levels are monitored to help determine the effectiveness of the medication, but this is not done daily by the client. Serum blood levels are monitored monthly initially and then every 6 months. 3. The medication should be taken on an empty stomach because thyroid hormones have their optimum effect when taken on an empty stomach. 4. The client's weight should be monitored weekly. Weight loss is expected as a result of the increased metabolic rate, and weight changes help to determine the effectiveness of the drug therapy.

56. The nurse is discussing the thyroid hormone levothyroxine (Synthroid) with the client diagnosed with hypothyroidism. Which intervention should the nurse discuss with the client? 1. Encourage the client to decrease the fiber in the diet. 2. Discuss the need to monitor the T3, T4 levels daily. 3. Tell the client to take the medication with food only. 4. Instruct the client to report any significant weight changes.

57. 1. There is no reason for the client to notify the HCP because it takes several months to attain the euthyroid state. 2. Most clients only need one dose of radioactive iodine, but it takes several months to attain the euthyroid state. 3. The goal of radioactive therapy for hyperthyroidism is to destroy just enough of the thyroid gland so that levels of thyroid function return to normal. Full benefits may take several months. 4. This is a therapeutic response, which is not appropriate because the client needs factual information.

57. The client diagnosed with hyperthyroidism who received radioactive iodine, I-131, tells the nurse, "I don't think the medication is working. I don't feel any different." Which statement is the nurse's best response? 1. "You should notify your health-care provider immediately." 2. "You may need to have two or three more doses of the medication." 3. "It may take up to several months to get the full benefits of the treatment." 4. "You don't feel any different. Would you like to sit down and talk about it?"

58. 1. This would be appropriate if the client is taking antithyroid medication, not thyroid hormones. Iodine increases the production of thyroid hormones, which is not desirable in clients taking antithyroid medications. 2. Grapefruit juice is contraindicated when taking some medications, but not thyroid hormone therapy. 3. The medication should be taken in the morning to decrease the incidence of drug-related insomnia. 4. Thyroid medications do not affect the client's blood glucose level; therefore, there is no need for the client to monitor the glucose level. MEDICATION MEMORY JOGGER: Grapefruit juice can inhibit the metabolism of certain medications. Specifically, grapefruit juice inhibits cytochrome P450-3A4 found in the liver and the intestinal wall. The nurse should investigate any medications the client is taking if the client drinks grapefruit juice.

58. The nurse is discussing the thyroid hormone levothyroxine (Synthroid) with a client diagnosed with hypothyroidism. Which intervention should be included in the client teaching? 1. Discuss the importance of not using iodized salt. 2. Explain the importance of not taking medication with grapefruit juice. 3. Instruct the client to take the medication in the morning. 4. Teach the client to monitor daily glucose levels.

59. 1. Antithyroid medications may cause drowsiness; therefore, this statement would not warrant immediate intervention by the nurse. 2. The antithyroid medication may affect the body's ability to defend itself against bacteria and viruses; therefore, the nurse should intervene if the client has any type of sore throat, fever, chills, malaise, or weakness. 3. As a result of slower metabolism from the PTU, weight gain is expected; therefore, this statement would not warrant intervention by the nurse. 4. This indicates the medication is effective; the signs of hyperthyroidism—which include feeling hot much of the time—are decreasing. This would not warrant immediate intervention by the nurse.

59. The client diagnosed with hyperthyroidism is prescribed the antithyroid medication propylthiouracil (PTU). Which statement by the client warrants immediate intervention by the nurse? 1. "I seem to be drowsy and sleepy all the time." 2. "I have a sore throat and have had a fever." 3. "I have gained 2 pounds since I started taking PTU." 4. "Since taking PTU I am not as hot as I used to be."

6. 1. A portable insulin pump is a batteryoperated device that uses rapid-acting insulin—Lispro, Humalog, or NovoLog. It delivers both basal insulin infusion (continuous release of a small amount of insulin) and bolus doses with meals. This provides fewer hypoglycemic reactions and better blood glucose levels. 2. The pumps do provide a memory of boluses, but that is not the nurse's best response to explain why a client should get an external portable insulin pump. 3. External portable insulin pumps are only used to deliver rapid-acting insulin subcutaneously. Intermediate- and long-acting insulins are not used with an external portable insulin pump because of unpredictable control of blood glucose. 4. The insulin pump is not recommended as the initial way to administer insulin because the success of the insulin pump depends on the client's knowledge and compliance. Initially most clients start injecting insulin with a syringe and then graduate to the pumps.

6. The client newly diagnosed with type 1 diabetes asks the nurse, "Why should I get an external portable insulin pump?" Which statement is the nurse's best response? 1. "It will cause you to have fewer hypoglycemic reactions and it will control blood glucose levels better." 2. "Insulin pumps provide an automatic memory of the date and time of the last 24 boluses." 3. "The pump injects intermediate-acting insulin automatically into the vein to maintain a normal blood glucose level." 4. "The portable pump is the easiest way to administer insulin to someone with type 1 diabetes and is highly recommended."

60. 1. Thyroid function tests are used to determine the effectiveness of drug therapy. 2. Weight gain is expected as a result of a slower metabolism. 3. Antithyroid medication may cause nausea or vomiting. 4. Changes in metabolic rate will be manifested as changes in blood pressure, pulse, and body temperature. 5. Hyperthyroidism results in protein catabolism, overactivity, and increased metabolism, which lead to exhaustion; therefore, the nurse should monitor for activity intolerance.

60. The client diagnosed with hyperthyroidism is prescribed an antithyroid medication. Which interventions should the nurse implement? Select all that apply. 1. Monitor the client's thyroid function tests. 2. Monitor the client's weight weekly. 3. Monitor the client for gastrointestinal distress. 4. Monitor the client's vital signs. 5. Monitor the client for activity intolerance.

61. 1. This is a false statement, and the nurse should investigate any type of alternative treatment before making this statement. 2. Licorice is a flavoring for candy, but it is also used as an herbal medication in tablet, tea, or tincture form. Licorice increases the aldosterone effect, which helps treat Addison's disease. 3. This is an aggressive-type judgmental question, and the client does not owe the nurse an explanation. 4. Licorice is used to treat mouth ulcers; it does not cause them. MEDICATION MEMORY JOGGER: Some herbal preparations are effective, some are not, and a few can be harmful or even deadly. If a client is taking an herbal supplement and a conventional medicine, the nurse should investigate to determine if the herbal preparation will cause harm to the client. The nurse should always be the client's advocate.

61. The client diagnosed with Addison's disease tells the clinic nurse that he is taking licorice every day to help the disease process. Which intervention should the nurse implement? 1. Tell the client licorice is a candy and will not help Addison's disease. 2. Praise the client because licorice increases aldosterone production. 3. Ask the client why he thinks licorice will help the disease process. 4. Determine if the licorice has caused any mouth ulcers or sores.

62. 1. Hyperaldosteronism causes hypokalemia, metabolic alkalosis, and hypertension. Spironolactone, a potassium-sparing diuretic, normalizes potassium levels in clients with hyperaldosteronism within 2 weeks; therefore, a normal potassium level, which is 4.2 mEq/L, indicates the medication is effective. 2. The urinary output is not used to determine the effectiveness of this medication in a client with hyperaldosteronism. 3. The client does have hypertension, but this blood pressure is above normal limits and does not indicate the medication is effective. 4. The serum sodium level is not used to determine the effectiveness of this medication in a client with hyperaldosteronism. MEDICATION MEMORY JOGGER: The nurse determines the effectiveness of a medication by assessing for the symptoms, or lack thereof, for which the medication was prescribed.

62. The client is diagnosed with primary hyperaldosteronism and prescribed the aldosterone agonist spironolactone (Aldactone). Which data supports that the medication is effective? 1. The client's potassium level is 4.2 mEq/L. 2. The client's urinary output is 30 mL/hr. 3. The client's blood pressure is 140/96. 4. The client's serum sodium is 137 mEq/L.

63. 1. The major symptom with DI is polyuria resulting in polydipsia (extreme thirst); therefore, the client not being thirsty indicates the medication is effective. 2. The client being able to sleep through the night indicates that he or she is not getting up to urinate because of polyuria and thus that the medication is effective. 3. A weight gain of 4.4 pounds indicates the client is experiencing water intoxication, which indicates the client is receiving too much medication and the HCP should be notified. 4. The client urinating 20 to 30 times a day indicates the medication is ineffective; therefore, the nurse should notify the health-care provider. 5. The client is well hydrated; therefore, this data does not warrant intervention. MEDICATION MEMORY JOGGER: If the client verbalizes a complaint, if the nurse assesses data, or if laboratory data indicates an adverse effect secondary to a medication, the nurse must intervene. The nurse must implement an independent intervention or notify the health-care provider because medications can result in serious or even life-threatening complications.

63. The client diagnosed with diabetes insipidus (DI) is receiving desmopressin (DDAVP), a pituitary hormone, intranasally. Which assessment data warrants the client notifying the health-care provider? Select all that apply. 1. The client does not feel thirsty all the time. 2. The client is able to sleep throughout the night. 3. The client has gained 2 kg in the past 24 hours. 4. The client has to urinate 20-30 times daily. 5. The client has elastic skin turgor and moist mucosa.

64. 1. Mucolytic medications are administered to help liquefy thick, tenacious secretions characteristic of CF. 2. Postural drainage and chest percussion help cough up mucus from the lungs. 3. The child would not receive cough suppressants (antitussives) because the thick, tenacious secretions need to be expectorated, not suppressed. 4. Eventually the beta cells will become clogged as a result of the thick, tenacious secretions in the pancreas, but this would not be a problem in the initial stage after diagnosis. 5. The thick, tenacious secretions clog the pancreatic ducts, resulting in a decrease of the pancreatic enzymes amylase and lipase in the small intestines. The mother must administer these enzymes with every meal or snack to ensure digestion of carbohydrates and fats.

64. The 2-year-old child has just been diagnosed with cystic fibrosis (CF). Which interventions should the nurse discuss with the child's mother? Select all that apply. 1. Administer over-the-counter mucolytic agents. 2. Perform postural drainage and chest percussion. 3. Administer cough suppressants at night only. 4. Check the child's blood glucose level four times a day. 5. Sprinkle pancreatic enzymes on the child's food.

65. 1. This is not an expected side effect and is caused by the estrogen stimulating the hypothalamus to produce prolactin. The estrogen dosage must be adjusted or discontinued. 2. Abdominal cramping is a symptom associated with menses and the client does not have a uterus; therefore, this is not an appropriate question. 3. The breast discharge is unrelated to sexual intercourse. 4. The medication should be stopped until the HCP can be seen because this warrants a dosage adjustment or permanent discontinuation. The estrogen stimulates the hypothalamus to produce prolactin, which causes the breast milk.

65. The 36-year-old female client who had an abdominal hysterectomy is prescribed the estrogen hormone replacement Premarin. The client calls the nurse in the women's health clinic and reports she is producing breast milk. Which intervention should the nurse discuss with the client? 1. Explain that this is an expected side effect and it will stop. 2. Determine if the client is having abdominal cramping. 3. Ask if this mainly occurs during sexual intercourse. 4. Discontinue taking the estrogen until seen by the HCP.

66. 1. The child has grown a little more than 1 inch (2.54 cm equals 1 inch). Because the child has been prescribed the growth hormone to increase growth, this would indicate that the medication is effective and no intervention on the part of the nurse is needed. 2. These are side effects of steroid therapy, not growth hormones. 3. Growth hormone is diabetogenic; therefore, any signs of diabetes mellitus, such as polyuria, polydipsia, and polyphagia, should be reported to the HCP immediately. These are the 3 Ps of diabetes mellitus. 4. The nurse must know the normal parameters for children (T 97.5°F to 98.6°F), so a temperature of 99.4°F would not warrant notification of the HCP. Normal pulse rate is 70-110, respiratory rate is 16-22, systolic BP is 83-121, and diastolic BP is 43-79. These vital signs do not warrant notifying the HCP.

66. The 10-year-old male client is receiving the growth hormone somatropin (Humatrope). Which signs or symptoms warrant intervention by the nurse? 1. A 3-cm increase in height. 2. A moon face and buffalo hump. 3. Polyuria, polydipsia, and polyphagia. 4. T 99.4°F, P 108, R 22, and BP 121/70.

67. 1. Thyroid hormones, not ACTH, would increase the client's metabolism. 2. ACTH is administered as an adrenal stimulant when the pituitary gland is unable to perform this function. This medication will cause the absorption of sodium and cause edema; therefore, the client should decrease salt intake. 3. This medication may decrease the client's growth. 4. This medication causes abnormal menses

67. The female client has secondary adrenal insufficiency and is prescribed adrenocorticotrophic hormone ACTH (Acthar). Which information should the nurse discuss with client? 1. Explain ACTH will increase metabolism. 2. Instruct the client to limit dietary salt. 3. Inform the client that an increase in growth may occur. 4. Tell the client that normal menses is expected.

68. 1. If the thyroid medication is effective, the client's metabolism should be within normal limits, and this pulse and blood pressure support this. 2. These vital signs are subnormal, indicating hypothyroidism. 3. A stool every 4 days indicates constipation and constipation is a sign of hypothyroidism. This indicates the medication is not effective. 4. 6-8 hours of sleep would be normal. Three hours would indicate hyperactivity, which is a sign of hyperthyroidism; perhaps a dosage adjustment in the medication is needed.

68. The client is diagnosed with hypothyroidism and is taking the thyroid hormone levothyroxine (Synthroid). Which data indicates the medication is effective? 1. The client's apical pulse is 84 and the blood pressure is 134/78. 2. The client's temperature is 96.7°F and respiratory rate is 14. 3. The client reports having a soft, formed stool every 4 days. 4. The client tells the nurse that the client only needs 3 hours of sleep.

69. 1. The sulfonylureas stimulate beta-cell production of insulin. Clients diagnosed with type 1 diabetes have no functioning beta cells; therefore, they cannot be stimulated. The nurse should question administering this medication. 2. The client with SIADH would be receiving a loop diuretic to decrease excess fluid volume. 3. Demerol is the drug of choice to treat pain from pancreatitis. Morphine stimulates the sphincter of Oddi. 4. A client with type 2 diabetes is often prescribed insulin during times of stress or illness. MEDICATION MEMORY JOGGER: The nurse must be knowledgeable about accepted standards of practice for disease processes and conditions. If the nurse administers a medication the health-care provider has prescribed and it harms the client, the nurse could be held accountable. Remember that the nurse is a client advocate.

69. The nurse is administering the following medications. Which medication should the nurse question administering? 1. The sulfonylurea glyburide (Micronase) to a client with type 1 diabetes. 2. The loop diuretic furosemide (Lasix) to a client with SIADH. 3. The narcotic analgesic meperidine (Demerol) to a client with pancreatitis. 4. The sliding-scale regular insulin to a client with type 2 diabetes.

7. 1. Because the client is in the hospital the client must have a hospital identification band; a MedicAlert bracelet would be needed when the client is not in the hospital. 2. Humalog is not regular insulin; it is fastacting insulin. It is not administered according to the regular insulin sliding scale. The peak time for Humalog is 30 minutes to 1 hour; regular insulin peaks in 2-4 hours. 3. A client with type 1 diabetes will experience diabetic ketoacidosis; a client with type 2 diabetes will experience hyperosmolar, hyperglycemic, nonketotic coma. 4. Humalog peaks in 30 minutes to 1 hour; therefore, the client needs to eat when or shortly after the medication is administered to prevent hypoglycemia. MEDICATION MEMORY JOGGER: Remember that the different types of insulin peak at different times, and the nurse must be knowledgeable about the peak times to ensure that the client does not experience hypoglycemia. Only the insulin product Lantus has no peak time.

7. The nurse in the medical department is preparing to administer Humalog, a rapid-acting insulin, to a client diagnosed with type 1 diabetes. Which intervention should the nurse implement? 1. Ensure the client is wearing a MedicAlert bracelet. 2. Administer the dose according to the regular insulin sliding scale. 3. Assess the client for hyperosmolar, hyperglycemic, nonketotic coma. 4. Make sure the client eats the food on the meal tray that is at the bedside.

70. 1. Because the client is NPO for the test, the insulin should be held. 2. Because the client is NPO for the test, the insulin should be held. In addition, the nurse cannot prescribe medication or change the dosage. 3. Glucophage has a potential side effect of producing lactic acid. When it is administered simultaneously or within a close time span of the contrast dye used for the CT scan, lactic acidosis could result. It is recommended to hold the medication prior to and up to 48 hours after the scan. The HCP should obtain a BUN and creatinine to determine kidney function prior to restarting Glucophage. 4. Insulin should be held when the client is NPO, and Glucophage will be held because of the contrast dye. MEDICATION MEMORY JOGGER: Any time the client is having a diagnostic test the nurse should question administering any medication.

70. The client with Type 1 diabetes is scheduled for a CT scan of the abdomen with contrast. The client is taking metformin (Glucophage), a biguanide, and 70/30 insulin 24 units at 0700 and 1600. Which instruction should the nurse discuss with the client? 1. Administer the 70/30 insulin the morning of the test. 2. Take half the dose of the morning insulin on the day of the test. 3. Do not take the Glucophage after the procedure until the HCP approves. 4. Take the medications as prescribed because they will not affect the test.

71. 1. Constipation does not determine the effectiveness of the Pancrease. 2. Steatorrhea (fatty, frothy, foul-smelling stools) or diarrhea indicates a lack of pancreatic enzymes in the small intestines. This would indicate the dosage is too small and needs to be increased. 3. Urine output does not determine effectiveness of Pancrease. 4. An increase in midepigastric pain is a symptom of peptic ulcer disease or gastroesophageal reflux disease and does not indicate the effectiveness of the pancreatic enzyme. The client with chronic pancreatitis may have abdominal pain, but the pancreatic enzymes are administered for digestion of food, not to alleviate pain.

71. The client with chronic pancreatitis is prescribed the pancreatic enzyme Pancrease. Which data indicates the dosage should be increased? 1. No bowel movement for 3 days. 2. Fatty, frothy, foul-smelling stools. 3. A decrease in urinary output. 4. An increase in midepigastric pain.

72. 1. Prednisone is a glucocorticoid medication, which affects the glucose metabolism; therefore, the nurse should expect the glucose level to be altered. 2. Sodium is not affected by prednisone. 3. Calcium is not affected by prednisone. 4. Creatinine is not affected by prednisone.

72. The client with Addison's disease is prescribed prednisone. Which laboratory data should the nurse expect this medication to alter? 1. Glucose. 2. Sodium. 3. Calcium. 4. Creatinine.

73. 1. Prednisone is very irritating to the stomach and must be taken with food to avoid gastritis or peptic ulcer disease. 2. To avoid adrenal insufficiency or addisonian crisis, the client must taper the medication. 3. Prednisone does not cause photosensitivity. 4. Because the prednisone is used short term for treating poison ivy, the blood glucose level would not need to be monitored. 5. Green, leafy vegetables are high in vitamin K and would be contraindicated in anticoagulant treatment with Coumadin but not with prednisone treatment.

73. The client is prescribed prednisone, a glucocorticoid, for poison ivy. Which information should the nurse discuss with the client? Select all that apply. 1. Take the medication with food. 2. The medication must be tapered. 3. Avoid going into the sunlight. 4. Monitor the blood glucose level. 5. Do not eat green, leafy vegetables.

74. 1. PTU is an antithyroid medication and the client has had the thyroid gland removed. 2. The client must take the thyroid hormone daily or the client will experience signs of hypothyroidism. 3. Because the client's thyroid has been removed, the client now has hypothyroidism and must take a thyroid replacement daily for the rest of his or her life. 4. The thyroid level is checked by a venipuncture test every few months. 5. Diarrhea is a sign of hyperthyroidism and the client should report it to the doctor to determine if it is a need to decrease thyroid hormone or if it is secondary to gastroenteritis.

74. The client diagnosed with hyperthyroidism undergoes a bilateral thyroidectomy. Which statements indicate the client understands the discharge instructions? Select all that apply. 1. "I must take my PTU medication at night only." 2. "I should not take my medication if I am nauseated." 3. "I will take my thyroid hormone pill every day." 4. "I need to check my thyroid level frequently." 5. "If I have diarrhea I should contact my doctor."

75. 4, 1, 2, 3, 5 4. These are symptoms of a hypoglycemic reaction and the nurse should assess the client immediately; therefore, this is the first intervention. 1. Because the nurse is assessing the client in the room, the UAP can take the glucometer reading. The nurse cannot delegate care of an unstable client but can delegate a task because the nurse is in the room with the client. 2. The treatment of choice for a conscious client experiencing a hypoglycemic reaction is to administer food or a source of glucose. Orange juice is a source of glucose, and the UAP can get it. 3. The nurse should check the MAR to determine when the last dose of insulin or oral hypoglycemic medication was administered. 5. When the client has been stabilized, then the linens should be changed to make the client comfortable.

75. The unlicensed assistive personnel (UAP) notifies the nurse that the client is complaining of being jittery and nervous and is diaphoretic. The client is diagnosed with diabetes mellitus. Which interventions should the nurse implement? Rank in order of performance. 1. Have the UAP check the client's glucose level. 2. Tell the UAP to get the client some orange juice. 3. Check the client's medication administration record. 4. Immediately go to the room and assess the client. 5. Assist the UAP in changing the client's bed linens.

76. 1. The regular insulin adheres to the lining of the plastic intravenous tubing; therefore, the nurse should flush the tubing with at least 50 mL of the insulin solution so that insulin will adhere to the tubing before the prescribed dosage is administered to the client. If this is not done, the client will not receive the correct dose of insulin during the first few hours of administration. 2. To monitor serum glucose, the nurse would need to perform an hourly venipuncture. This is painful, is more expensive, and takes a longer time to provide glucose results. Therefore, a capillary (fingerstick) bedside glucometer will be used to monitor the client's blood glucose level every hour. 3. The nurse does not draw arterial blood gases; this is done by the respiratory therapist or the HCP. 4. A regular insulin drip must be administered by an infusion-controlled device (IV pump). It may not be given via gravity because it is a very dangerous medication and could kill the client if not administered correctly.

76. The client with type 1 diabetes is diagnosed with diabetic ketoacidosis. The HCP prescribes intravenous regular insulin by continuous infusion. Which intervention should the intensive care nurse implement when administering this medication? 1. Flush the tubing with 50 mL of the insulin drip before administering to the client. 2. Monitor the client's serum glucose level every hour and document it on the MAR. 3. Draw the client's arterial blood gas results daily and document them in the client's chart. 4. Administer the client's regular insulin drip via gravity at the prescribed rate.

77. 1. According to the sliding scale, blood glucose results should be verified when less than 60 or greater than 400. 2. The HCP does not need to be notified unless the blood glucose is greater than 400. 3. The client's reading is 310; therefore, the nurse should administer eight units of regular insulin as per the HCP's order. 4. There is no reason for the nurse to recheck the results

77. The nurse is administering medications to a client diagnosed with type 1 diabetes. The client's 1100 glucometer reading is 310. Which action should the nurse implement? 1. Have the laboratory verify the glucose results. 2. Notify the health-care provider of the results. 3. Administer eight units of regular insulin subcutaneously. 4. Recheck the client's glucometer reading at 1130.

78. 1. All BYETTA pens, used and unused, must be kept refrigerated or kept cold at 36°F. 2. The most common side effects with BYETTA include nausea, vomiting, diarrhea, dizziness, headache, and jitteriness. Nausea is most common when first starting BYETTA, but it decreases over time in most clients. 3. BYETTA is injected twice a day, at any time within 1 hour of the client's morning and evening meal. The client should not take BYETTA after the meal. 4. BYETTA is not insulin or a substitute for insulin. Clients whose diabetes requires insulin must not use BYETTA.

78. The client with type 2 diabetes is prescribed exenatide (BYETTA), a subcutaneous antidiabetic medication. Which information should the nurse discuss with the client? 1. Keep the BYETTA pen at room temperature after opening the pen. 2. Instruct the client to notify the health-care provider if nauseated. 3. Tell the client to take the medication 1 hour before the morning and evening meals. 4. Explain that this medication is a type of regular-acting insulin.

79. 1. The BYETTA pen should only be used for 30 days. The client should throw away the used BYETTA pen after 30 days, even if some medicine remains in the pen. 2. The needle should be removed from the pen when storing the medication in the refrigerator because some medicine may leak from the BYETTA pen or air bubbles may form in the cartridge. 3. The BYETTA pen should not be used after the expiration date printed on the label. 4. BYETTA is used with metformin (Glucophage) or other types of antidiabetic medicine called sulfonylureas.

79. Which statement by the client with type 2 diabetes indicates the client understands the medication teaching concerning exenatide (BYETTA), a subcutaneous antidiabetic medication? 1. "I will throw away my pen in 30 days, even if there is medicine in the pen." 2. "I always keep the needle on my pen, even when it is in the refrigerator." 3. "This medication cost so much I use my pen past the expiration date." 4. "I should not take any other diabetic medication when I take BYETTA."

8. 1. The fasting blood glucose level is obtained after the client is NPO for 8 hours; this blood result does not indicate adherence to the treatment regimen. 2. If the client has no ketones in the urine, it indicates that the body is not breaking down fat for energy, but it does not indicate adherence to the treatment regimen. 3. A glycosylated hemoglobin (A1C) gives the average of the blood glucose level over the past 3 months and indicates adherence to the medical treatment regimen. A glycosylated hemoglobin level of 5.8% is close to normal and indicates that the client is adhering to the treatment regimen. The following table shows blood glucose levels and correspond - ing glycosylated hemoglobin results 4. A glucometer reading of 120 mg/dL indicates a normal blood glucose level, but it is a one-time reading and does not indicate adherence to the medical treatment regimen

8. Which assessment data best indicates the client with type 1 diabetes is adhering to the medical treatment regimen? 1. The client's fasting blood glucose is 100 mg/dL. 2. The client's urine specimen has no ketones. 3. The client's glycosylated hemoglobin is 5.8%. 4. The client's glucometer reading is 120 mg/dL.

80. 1. The client must take 10 times the amount of injectable insulin because only 10% of the medication is absorbed by the body. This statement indicates the client understands the medication teaching. 2. The medication comes in a very large canister with an inhalation mouthpiece; the client understands the medication teaching. 3. This is insulin, and the client is still subject to hypoglycemia. This statement indicates the client needs more medication teaching. 4. Because the medication is absorbed in the lungs, the client should call the HCP if the lungs are unable to absorb the medication. This indicates the client understands the discharge teaching.

80. The client with diabetes is prescribed Exubera, insulin human (rDNA origin) inhalation powder. Which statement indicates the client needs more medication teaching? 1. "With this medication I will be taking 10 times my regular insulin dose." 2. "My medication will be in a large canister that I must carry with me." 3. "I am glad that I don't have to worry about an insulin reaction with Exubera." 4. "If I get a cold or pneumonia, I will call my health-care provider."

1. 1. Humulin N is an intermediate-acting insulin that peaks 6-8 hours after administration; therefore, the client would experience signs of hypoglycemia around 2200-2400. 2. The nurse needs to ensure the client eats the nighttime (HS) snack to help prevent nighttime hypoglycemia. 3. A serum blood glucose level would have to be done with a venipuncture and the blood sample must be taken to the laboratory. If the client needed the blood glucose checked, it should be done with a glucometer at the bedside. 4. The supper tray would not help prevent a hypoglycemic reaction because the Humulin N is an intermediate-acting insulin that peaks in 6-8 hours.

1. The nurse administered 25 units of Humulin N to a client with type 1 diabetes at 1600. Which intervention should the nurse implement? 1. Assess the client for hypoglycemia around 1800. 2. Ensure the client eats the nighttime (HS) snack. 3. Check the client's serum blood glucose level. 4. Serve the client the supper tray.

10. 1. The pancreas does not secrete glucose. It secretes insulin, which is the key that opens the door to allow glucose to enter the body cells. Glucose enters the body through the gastrointestinal system. 2. This statement explains the pharmacokinetics of insulin and how the body metabolizes and excretes urine. Pharmacokinetics is the process of drug movement to achieve drug interaction. 3. Insulin does not maintain colloidal osmotic pressure. Albumin, a product of protein, maintains colloidal osmotic pressure. 4. This is the statement that explains the pharmacodynamics, which is the drug's mechanism of action or way that insulin is utilized by the body. Over time, elevated glucose levels in the bloodstream can cause long-term complications, including nephropathy, retinopathy, and neuropathy. Insulin lowers blood glucose by promoting the use of glucose in body cells.

10. Which statement best describes the pharmacodynamics of insulin? 1. Insulin causes the pancreas to secrete glucose into the bloodstream. 2. Insulin is metabolized by the liver and muscle and excreted in the urine. 3. Insulin is needed to maintain colloidal osmotic pressure in the bloodstream. 4. Insulin lowers blood glucose by promoting use of glucose in the body cells.

4. 1. Regular insulin peaks in 2-4 hours; therefore, the breakfast meal would prevent the client from developing hypoglycemia. 2. Lunch would cover a 0700 dose of Humulin N, an intermediate-acting insulin. 3. Supper would cover a 1600 dose of Humulin R, a short-acting insulin. 4. The HS (nighttime) snack would cover a 1600 dose of Humulin N, an intermediate-acting insulin.

4. The nurse administered 12 units of regular insulin to the patient with type 1 diabetes at 0700. Which meal prevents the client from experiencing hypoglycemia? 1. Breakfast. 2. Lunch. 3. Supper. 4. HS snack.

49. 1. Sleeping with the head of the bed elevated will not affect this medication. 2. The medication is administered intramuscularly. A tuberculin syringe is used for subcutaneous or intradermal injections. 3. The medication should be administered in the evening for maximum effect during the sleeping hours, so the client will not be up to void frequently. 4. DDAVP, not vasopressin tannate in oil, is administered intranasally. MEDICATION MEMORY JOGGER: The test taker could eliminate option 4 by reading "in oil." Oil preparations are not usually administered in the nose.

49. The client diagnosed with neurogenic diabetes insipidus is prescribed vasopressin tannate in oil. Which instructions should the nurse teach? 1. Sleep with the head of the bed elevated. 2. Use a tuberculin syringe to administer medication. 3. Administer the medication in the evening. 4. Alternate nares when taking the medication

54. 1. The client's arterial blood gases are not affected by PTU. 2. The client's potassium level is not affected by PTU. 3. The client's red blood cell count is not affected by PTU. 4. The client receiving PTU is at risk for agranulocytosis; therefore, the client's white blood cell count should be checked periodically. Because agranulocytosis puts the client at greater risk for infection, efforts to control invasion of microbes should be strictly observed.

54. The client with hyperthyroidism is prescribed the thioamide propylthiouracil (PTU). Which laboratory data should the nurse monitor? 1. The client's arterial blood gases. 2. The client's serum potassium level. 3. The client's red blood cell (RBC) count. 4. The client's white blood cell (WBC) count.

9. 1. This statement indicates the client understands the medication teaching. Keeping the insulin in the refrigerator will maintain the insulin's strength and potency. Once the insulin vial is opened it may be kept at room temperature for 1 month. 2. Insulin vials should not be placed in direct sunlight or in a high-temperature area, such as the trunk of a car, because it will lose its strength. 3. Insulin should not be kept in the freezer because freezing will cause the insulin to break down and lose its effectiveness. 4. Prefilled syringes should be stored in the refrigerator and should be used within 1-2 weeks, not 1-2 days.

9. The nurse is discussing storage of insulin vials with the client. Which statement indicates the client understands the teaching concerning the storage of insulin? 1. "I will keep my unopened vials of insulin in the refrigerator." 2. "I can keep my insulin in the trunk of my car so I will have it at all times." 3. "It is all right to put my unopened insulin vials in the freezer." 4. "If I prefill my insulin syringes, I must use them within 1-2 days."