Patho/Pharm: Endocrine System Saunder's ?'s: MEDICATIONS

The nurse is preparing to discharge a client who has had a parathyroidectomy. The discharge instructions include medication administration of oral calcium supplements that the client will need daily. Which statement by the nurse would be most appropriate regarding the oral calcium supplement therapy? 1. Take the tablets following a meal. 2. Store the tablets in the refrigerator to maintain potency. 3. Avoid sunlight because the medication can cause skin color changes. 4. Check the pulse daily; if it is less than 60 beats/minute, do not take the tablets.

Correct answer: 1 Rationale: Oral calcium supplements can be administered with food to enhance its absorption as well as to decrease gastrointestinal irritation. The remaining options are unrelated to oral calcium therapy.

A client with diabetes mellitus visits a health care clinic. The client's diabetes mellitus previously had been well controlled with glyburide daily, but recently the fasting blood glucose level has been 180 to 200 mg/dL (10.2 to 11.4 mmol/L). Which medication, if added to the client's regimen, may have contributed to the hyperglycemia? 1. Prednisone 2. Atenolol 3. Phenelzine 4. Allopurinol

Correct answer: 1 Rationale: Prednisone may decrease the effect of oral hypoglycemics, insulin, diuretics, and potassium supplements. Option 2, a beta blocker, and option 3, a monoamine oxidase inhibitor, have their own intrinsic hypoglycemic activity. Option 4 decreases urinary excretion of sulfonylurea agents, causing increased levels of the oral agents, which can lead to hypoglycemia.

The nurse determines that the client needs further instruction about prescribed thyroid replacement medication if which statement is made? 1. "I should expect full therapeutic effect from the medication within 3 to 5 days." 2. "I should take my medication in the morning about 1 hour before eating breakfast." 3. "I need to make sure that I store the medication in the dark container I received it in." 4. "I should check with my health care provider before taking any over-the-counter medications."

Correct answer: 1 Rationale: The client should be taught that it may take up to 3 to 4 weeks to see the full therapeutic effects of thyroid medications, so expecting a full therapeutic effect in 3 to 5 days indicates a need for additional teaching. The medication should be taken in the morning to prevent insomnia at night and on an empty stomach. All thyroid tablets must be protected from light. The client taking thyroid medications should consult with the health care provider before taking any over-the-counter medications, and labels should be read thoroughly.

The nurse is instructing a client who is taking levothyroxine and tells the client that full therapeutic benefits will be seen when? 1. Immediately 2. In 1 to 3 weeks 3. Within 24 hours 4. Within 3 to 5 days

Correct answer: 2 Rationale: It takes up to 1 month for plateau levels of levothyroxine to be achieved, so clients must be told that full benefits will not be seen for 1 to 3 weeks. Therefore, the remaining options are incorrect.

The nurse monitors the blood glucose level of the client who received NPH insulin at 7 a.m. with an understanding that the client may experience a hypoglycemic reaction during which time frame? 1. 9 a.m. to 11 a.m. 2. 11 a.m. to 7 p.m. 3. 7 p.m. to 11 p.m. 4. Midnight to 6 a.m.

Correct answer: 2 Rationale: NPH insulin is an intermediate-acting insulin. It peaks in 4 to 12 hours after administration. (Its onset is in 1.5 hours, and its duration is 16 to 24+ hours.) If the medication was given at 7 a.m., the nurse would monitor for hypoglycemia during the time of peak action, which would be between 11 a.m. and 7 p.m.

A hospitalized client with diabetes mellitus receives NPH insulin in the morning. The nurse monitors the client for hypoglycemia, knowing that the peak action is expected to occur how soon after the medication administration? 1. 2 to 4 hours after administration 2. 4 to 12 hours after administration 3. 12 to 16 hours after administration 4. 18 to 24 hours after administration

Correct answer: 2 Rationale: NPH insulin is an intermediate-acting insulin. Its onset of action is 3 to 4 hours, it peaks in 4 to 12 hours, and its duration of action is 16 to 20 hours.

The nurse teaches the client being discharged to home with a prescription for a daily dose of prednisone to take the medication at which best time? 1. Any time of the day 2. In the early morning 3. In the middle of the day 4. An hour before bedtime

Correct answer: 2 Rationale: The client should be instructed to take glucocorticoids (corticosteroids) before 9 a.m. This helps minimize adrenal insufficiency and also mimics the burst of glucocorticoids released naturally by the adrenal glands each morning. Therefore, in the middle of the day, an hour before bedtime, and any time of the day are incorrect.

A client received 20 units of Humulin N insulin subcutaneously at 08:00. At what time should the nurse plan to assess the client for a hypoglycemic reaction? 1. 10:00 2. 11:00 3. 17:00 4. 24:00

Correct answer: 3 Rationale: Humulin N is an intermediate-acting insulin. The onset of action is 60 to 120 minutes, it peaks in 6 to 14 hours, and the duration of action is 16 to 24 hours. Hypoglycemic reactions most likely occur during peak time.

The nurse provides instructions to a client who is taking levothyroxine. The nurse should tell the client to take the medication in which way? 1. With food 2. At lunchtime 3. On an empty stomach 4. At bedtime with a snack

Correct answer: 3 Rationale: Oral doses of levothyroxine should be taken on an empty stomach to enhance absorption. Dosing should be done in the morning before breakfast.

A client with diabetes mellitus calls the clinic and tells the nurse that he has been nauseated during the night. The client asks the nurse if the morning insulin should be administered. Which is the most appropriate nursing response? 1. Omit the insulin. 2. Administer half of the prescribed dose. 3. Administer the full dose as prescribed. 4. Wait until noon before making a decision.

Correct answer: 3 Rationale: When the client with diabetes mellitus becomes ill, control is more difficult. Insulin is not omitted, and the client is encouraged to consume liquid carbohydrates if unable to eat regular meals. The client is instructed to notify the health care provider if vomiting or diarrhea occurs or if the illness progresses past 2 days. Prescribed medication is not altered by the nurse.

A client with aldosteronism is being treated with spironolactone. Which finding indicates to the nurse that the medication is effective? 1. A decrease in body metabolism 2. A decrease in sodium excretion 3. A decrease in potassium excretion 4. A decrease in aldosterone production

Correct answer: 4 Rationale: Aldactone antagonizes the effect of aldosterone and decreases circulating volume by inhibiting tubular reabsorption of sodium and water. Thus it produces a decrease in blood pressure. It increases the excretion of sodium and plasma potassium. It has no effect on body metabolism.

A medication has been prescribed for a client with hypoparathyroidism for management of hypocalcemia. The client arrives at the clinic for follow-up evaluation and complains of chronic constipation since beginning the medication. The nurse provides information to the client regarding measures to alleviate the constipation and determines that the client needs additional information when the client makes which statement? 1. "I will increase my daily fluid intake." 2. "I will increase my activity level as tolerated." 3. "I will increase my daily intake of high-fiber foods." 4. "I will add ½ ounce of mineral oil to my daily diet.

Correct answer: 4 Rationale: Clients taking medications to treat hypocalcemia should be instructed to avoid the use of mineral oil as a laxative because mineral oil decreases vitamin D absorption and vitamin D is needed to assist in the absorption of calcium. The remaining options are basic measures to alleviate constipation.

A nurse provides instructions to a client taking fludrocortisone acetate. The nurse instructs the client to notify the health care provider (HCP) if which manifestation occurs? 1. Nausea 2. Fatigue 3. Weight loss 4. Swelling of the feet

Correct answer: 4 Rationale: Excessive levels of fludrocortisone acetate {Aldosterone} cause retention of sodium and water and excessive excretion of potassium, resulting in expansion of blood volume, hypertension, cardiac enlargement, edema, and hypokalemia. The client needs to be informed about the signs of sodium and water retention, such as unusual weight gain or swelling of the feet or lower legs. If these signs occur, the HCP needs to be notified.

A client arrives at the clinic complaining of fatigue, lack of energy, constipation, and depression. Following diagnostic studies, hypothyroidism is diagnosed and levothyroxine is prescribed. The nurse informs the client that which is the expected outcome of the medication? 1. Alleviate depression. 2. Increase energy levels. 3. Increase blood glucose levels. 4. Achieve normal thyroid hormone levels.

Correct answer: 4 Rationale: Laboratory determinations of serum thyroid stimulating hormone (TSH) level are an important means of evaluation. Successful therapy will cause elevated TSH levels to fall. These levels will begin their decline within hours of the onset of therapy and will continue to drop as plasma levels of thyroid hormone build up. If an adequate dosage is administered, TSH levels will remain suppressed for the duration of therapy. Although energy levels may increase, this occurs as a result of achievement of the normal thyroid hormone levels. Alleviation of depression and increased blood glucose levels are not expected outcomes.

The nurse is teaching a client with hyperthyroidism about the prescribed medication, propylthiouracil. The nurse determines that teaching has been successful if the client states to report which symptom to the health care provider (HCP)? 1. Fever 2. Fatigue 3. Excitability 4. Nervousness

Correct answer: 1 Rationale: An adverse effect of propylthiouracil is agranulocytosis. The client should be alert for this adverse effect by noting the presence of fever or sore throat, which should be reported to the HCP immediately. Excitability is not a side or adverse effect of this medication. Fatigue may be an occasional side effect of the medication but does not warrant HCP notification.

A client with previously well-controlled diabetes mellitus has had fasting blood glucose levels ranging from 180 to 200 mg/dL. The client takes glyburide 5 mg orally daily. In reviewing the client's medication list, the home health care nurse suspects that which newly added medications could be contributing to the elevated blood glucose levels? 1. Prednisone 2. Ranitidine 3. Cimetidine 4. Ciprofloxacin

Correct answer: 1 Rationale: Corticosteroids, thiazide diuretics, and lithium may decrease the effect of glyburide, thus causing hyperglycemia. The medications listed in the incorrect options increase the effect of glyburide, leading to hypoglycemia.

A client with diabetes mellitus taking daily NPH insulin has been started on therapy with dexamethasone. The nurse anticipates that which adjustments in medication dosage will be made? 1. An increased dose of NPH insulin 2. A change to oral diabetic medications 3. A lower dose of dexamethasone than usual 4. An increase in the amount of daily dietary calories

Correct answer: 1 Rationale: Dexamethasone is a glucocorticoid (corticosteroid) and therefore can elevate the blood glucose level. Diabetic clients may need their dosage of insulin or oral hypoglycemic medications increased during glucocorticoid therapy. This is most often a temporary change, needed to compensate for the actions of the medication. The client would not change to an oral diabetic medication if taking daily insulin. Additional calories would not be required. The client would not take a lower dose of dexamethasone than usual to compensate.

The nurse is monitoring a client receiving glipizide. The nurse knows that which finding would indicate a therapeutic outcome for this client. 1. A decrease in polyuria 2. An increase in appetite 3. A glycosylated hemoglobin of 10% 4. A fasting blood glucose of 220 mg/dL (12.6 mmol/L)

Correct answer: 1 Rationale: Glipizide is an oral hypoglycemic agent given to reduce the serum glucose level and the signs and symptoms of hyperglycemia. Therefore, a decrease in polyuria (a symptom of hyperglycemia) would denote a beneficial response to glipizide. Excessive appetite (polyphagia) also is a symptom of hyperglycemia. Thus, an increase in appetite would not signify a therapeutic effect. A therapeutic fasting blood glucose should be less than 100 mg/dL, and the glycosylated hemoglobin should be less than 7%.

A client has been taking glucocorticoids to control rheumatoid arthritis. Which laboratory abnormality is the client at risk for as a result of taking this medication? 1. Increased serum glucose 2. Decreased serum sodium 3. Elevated serum potassium 4. Increased white blood cells

Correct answer: 1 Rationale: Glucocorticoids have 3 primary uses: replacement therapy for adrenal insufficiency, immunosuppressive therapy, and antiinflammatory therapy. Exogenous glucocorticoids cause the same effects on cellular activity as those of the naturally produced glucocorticoids; however, exogenous glucocorticoids also may have undesired effects. The glucocorticoids stimulate appetite and increase caloric intake. They also increase the availability of glucose for energy. These combined effects cause the blood glucose levels to rise, making the client prone to hyperglycemia. Glucocorticoids can also lead to hypokalemia. The remaining options are not expected effects of the use of glucocorticoids.

The nurse is preparing a dose of 10 units of regular insulin and 35 units of NPH insulin for a client with type 1 diabetes mellitus. The nurse obtains an insulin syringe, gently rotates the insulin solutions, cleans the tops of the vials of insulin, and injects an amount of air equal to the dose prescribed into each vial. What is the next nursing action? 1. Draws up 10 units of regular insulin and checks the syringe contents with another nurse before drawing up the NPH insulin 2. Draws up 10 units of regular insulin, draws up 35 units of NPH insulin, and checks the syringe contents with another nurse 3. Draws up 35 units of NPH insulin and checks the syringe contents with another nurse before drawing up the regular insulin 4. Draws up 35 units of NPH insulin, draws up 10 units of regular insulin, and checks the syringe contents with another nurse

Correct answer: 1 Rationale: Insulin dosages are verified by another nurse before administration. When 2 types of insulins are mixed, the doses must be verified after each is drawn up so as to verify the dosage for each one. The regular insulin is drawn into the syringe first.

Insulin glargine is prescribed for a client with diabetes mellitus. The nurse should tell the client that it is best to take the insulin at which time? 1. At bedtime every day 2. 1 hour after each meal 3. 15 minutes before the morning and evening meals 4. Before each meal, on the basis of the blood glucose level

Correct answer: 1 Rationale: Insulin glargine is a long-acting recombinant DNA human insulin that is used to treat type 1 and type 2 diabetes mellitus. It has a 24-hour duration of action and is administered once a day, usually at bedtime. Therefore, the remaining options are incorrect times.

The nurse administers 20 units of insulin isophane recombinant to a hospitalized client with diabetes mellitus at 7:00 a.m. The nurse should monitor the client most closely for a hypoglycemic reaction at which time? 1. 4:00 p.m. 2. 9:00 a.m. 3. 10:00 a.m. 4. 12:00 midnight

Correct answer: 1 Rationale: Insulin isophane recombinant is an intermediate-acting insulin with an onset of action in 3 to 4 hours, a peak action in 6 to 12 hours, and a duration of action of 18 to 28 hours. A hypoglycemic reaction is most likely to occur at peak time. The correct option is the only one that represents a time within the peak hours after administration of the insulin.

The nurse is preparing to administer an intravenous (IV) insulin injection. The vial of regular insulin has been refrigerated. On inspection of the vial, the nurse finds that the medication is frozen. Which should the nurse do? 1. Discard the insulin and obtain another vial. 2. Wait for the insulin to thaw at room temperature. 3. Check the temperature settings of the refrigerator. 4. Rotate the vial between the hands until the medication becomes liquid.

Correct answer: 1 Rationale: Insulin should not be frozen. If the nurse notes that the vial of insulin is frozen, the insulin is discarded and a new vial is obtained. The remaining options are incorrect actions.

A nurse is caring for a client with a diagnosis of hyperthyroidism. Laboratory studies are performed and the serum calcium level is 12.0 mg/dL (3 mmol/L). Which medication should the nurse anticipate to be prescribed for the client? 1. Calcitonin 2. Calcium chloride 3. Calcium gluconate 4. Large doses of vitamin D

Correct answer: 1 Rationale: The normal serum calcium level is 9 to 10.5 mg/dL (2.25 to 2.75 mmol/L). This client is experiencing hypercalcemia. Calcitonin, a thyroid hormone, decreases the plasma calcium level by increasing the incorporation of calcium into the bones, thus keeping it out of the serum. Calcium chloride and calcium gluconate are medications used for the treatment of tetany that occurs from acute hypocalcemia. In hypercalcemia, large doses of vitamin D need to be avoided.

The nurse is preparing the client's morning insulin isophane dose. The nurse notices a clumpy precipitate inside the insulin vial. What is the most appropriate nursing action related to this finding? 1. Draw the dose from a new vial. 2. Draw up and administer the dose. 3. Shake the vial in an attempt to disperse the clump. 4. Warm the bottle under running water to dissolve the clump.

Correct answer: 1 Rationale: The nurse should always inspect the vial of insulin before use for changes that may signify loss of potency. Insulin isophane normally is uniformly cloudy. Clumping, frosting, and precipitates are signs of insulin damage. In this situation, because potency is questionable, it is safer to discard the vial and draw up the dose from a new vial. Therefore, the remaining options are incorrect.

The nurse is teaching a client how to mix regular insulin and NPH insulin in the same syringe. Which action, if performed by the client, indicates the need for further teaching? 1. Withdraws the NPH insulin first 2. Withdraws the regular insulin first 3. Injects air into NPH insulin vial first 4.Injects an amount of air equal to the desired dose of insulin into each vial

Correct answer: 1 Rationale: When preparing a mixture of short-acting insulin, such as regular insulin, with another insulin preparation, the short-acting insulin is drawn into the syringe first. This sequence will avoid contaminating the vial of short-acting insulin with insulin of another type. Options 2, 3, and 4 identify correct actions for preparing NPH and short-acting insulin.

The nurse is preparing to care for a client admitted to the emergency department with a diagnosis of diabetic ketoacidosis (DKA). The nurse gathers supplies and obtains which type of insulin, anticipating that it will be initially prescribed for the client? Click on the image to indicate your answer. Figure from Kee, Marshall [2012], p. 160.)

Correct answer: 1 Rationale: A component of initial therapy for the treatment of DKA is the administration of regular insulin by the intravenous (IV) route.

The nurse is monitoring a client receiving levothyroxine sodium for hypothyroidism. Which findings indicate the presence of a side effect associated with this medication? Select all that apply. 1. Insomnia 2. Weight loss 3. Bradycardia 4. Constipation 5. Mild heat intolerance

Correct answer: 1, 2, 5 Rationale: Insomnia, weight loss, and mild heat intolerance are side effects of levothyroxine sodium. Bradycardia and constipation are not side effects associated with this medication, and rather are associated with hypothyroidism, which is the disorder that this medication is prescribed to treat.

A client is taking Humulin NPH insulin and regular insulin every morning. The nurse should provide which instructions to the client? Select all that apply. 1. Hypoglycemia may be experienced before dinnertime. 2. The insulin dose should be decreased if illness occurs. 3. The insulin should be administered at room temperature. 4. The insulin vial needs to be shaken vigorously to break up the precipitates. 5. The NPH insulin should be drawn into the syringe first, then the regular insulin.

Correct answer: 1, 3 Rationale: Humulin NPH is an intermediate-acting insulin. The onset of action is 60 to 120 minutes, it peaks in 6 to 14 hours, and its duration of action is 16 to 24 hours. Regular insulin is a short-acting insulin. Depending on the type, the onset of action is 30 to 60 minutes, it peaks in 1 to 5 hours, and its duration is 6 to 10 hours. Hypoglycemic reactions most likely occur during peak time. Insulin should be at room temperature when administered. Clients may need their insulin dosages increased during times of illness. Insulin vials should never be shaken vigorously. Regular insulin is always drawn up before NPH.

A client with hyperthyroidism has been given methimazole. Which nursing considerations are associated with this medication? Select all that apply. 1. Administer methimazole with food. 2. Place the client on a low-calorie, low-protein diet. 3. Assess the client for unexplained bruising or bleeding. 4. Instruct the client to report side and adverse effects such as sore throat, fever, or headaches. 5. Use special radioactive precautions when handling the client's urine for the first 24 hours following initial administration.

Correct answer: 1, 3, 4 Rationale: Common side effects of methimazole include nausea, vomiting, and diarrhea. To address these side effects, this medication should be taken with food. Because of the increase in metabolism that occurs in hyperthyroidism, the client should consume a high-calorie diet. Antithyroid medications can cause agranulocytosis with leukopenia and thrombocytopenia. Sore throat, fever, headache, or bleeding may indicate agranulocytosis and the health care provider should be notified immediately. Methimazole is not radioactive and should not be stopped abruptly, due to the risk of thyroid storm.

A client with a recent history of total thyroidectomy has developed iatrogenic hypoparathyroidism. Which observed findings does the nurse determine are associated with the hypoparathyroidism? Select all that apply. 1. Laryngospasm 2. Nephrolithiasis 3. Muscle weakness 4. Positive Chvostek's sign 5. Positive Trousseau's sign

Correct answer: 1, 4, 5 Rationale: Hypoparathyroidism is an uncommon condition associated with inadequate circulating parathyroid hormone (PTH). It is characterized by hypocalcemia resulting from a lack of PTH to maintain serum calcium levels. The most common cause is iatrogenic; for example, accidental removal of the parathyroid gland during neck surgery. Signs and symptoms of hypocalcemia include laryngospasm and positive Chvostek's and Trousseau's signs. The remaining options are incorrect.

A client with diabetes mellitus is self-administering NPH insulin from a vial that is kept at room temperature. The client asks the nurse about the length of time an unrefrigerated vial of insulin will maintain its potency. What is the most appropriate response to the client? 1. 2 weeks 2. 1 month 3. 2 months 4. 6 months

Correct answer: 2 Rationale: An insulin vial in current use can be kept at room temperature for up to 1 month without significant loss of activity. Direct sunlight and heat must be avoided.

The nurse should tell the client, who is taking levothyroxine, to notify the health care provider (HCP) if which problem occurs? 1. Fatigue 2. Tremors 3. Cold intolerance 4. Excessively dry skin

Correct answer: 2 Rationale: Excessive doses of levothyroxine can produce signs and symptoms of hyperthyroidism. These include tachycardia, chest pain, tremors, nervousness, insomnia, hyperthermia, extreme heat intolerance, and sweating. The client should be instructed to notify the HCP if these occur. Options 1, 3, and 4 are signs of hypothyroidism.

A client newly diagnosed with diabetes mellitus is instructed by the health care provider to obtain glucagon for emergency home use. The client asks the home care nurse about the purpose of the medication. The nurse should instruct the client that the purpose of the medication is to treat which problem? 1. Lipoatrophy from insulin injections 2. Hypoglycemia from insulin overdose 3. Hyperglycemia from insufficient insulin 4. Lipohypertrophy from inadequate insulin absorption

Correct answer: 2 Rationale: Glucagon is used to treat hypoglycemia resulting from insulin overdose. The family of the client is instructed in how to administer the medication. In an unconscious client, arousal usually occurs within 20 minutes of glucagon injection. Once consciousness has been regained, oral carbohydrates should be given. Lipoatrophy and lipohypertrophy result from insulin injections.

Glyburide daily is prescribed for a client. What instruction should the nurse include in the client's teaching plan? 1. The medication is used to prevent foot infections. 2. Take the medication in the morning before breakfast. 3. Expect skin color change from pink to yellow and pale-colored stools. 4. Contact the health care provider (HCP) immediately if an altered taste sensation is noted.

Correct answer: 2 Rationale: Glyburide is a second-generation sulfonylurea used to treat diabetes mellitus. The client is instructed to take a single daily dose 15 to 30 minutes before breakfast. The medication is not used to prevent foot infections. Cholestatic jaundice is a potential adverse effect, and if the client exhibits signs of jaundice (skin color changes or pale stools), the HCP needs to be notified. Altered taste sensation is a frequent side or adverse effect and does not warrant HCP notification.

The nurse is caring for a client after insertion of an implanted insulin pump. Which statement by the client indicates a need for further instruction? 1. "I should expect to gain less weight with this pump." 2. "I need to make sure I still give my insulin before I eat." 3. "This will help me to have better control of my blood sugar." 4. "This pump delivers a continuous infusion of insulin throughout the day."

Correct answer: 2 Rationale: Insulin devices are implanted in the abdomen either intraperitoneally or intravenously. They deliver a basal insulin infusion plus a bolus dose with meals. The client should not self-administer mealtime insulin when he or she has an insulin pump. These pumps allow for better glycemic control and cause less hypoglycemia and less weight gain. They can potentially improve the overall quality of life.

The home care nurse visits a client recently diagnosed with diabetes mellitus who is taking Humulin NPH insulin daily. The client asks the nurse how to store the unopened vials of insulin. The nurse should tell the client to take which action? 1. Freeze the insulin. 2. Refrigerate the insulin. 3. Store the insulin in a dark, dry place. 4. Keep the insulin at room temperature.

Correct answer: 2 Rationale: Insulin in unopened vials should be stored under refrigeration until needed. Vials should not be frozen. When stored unopened under refrigeration, insulin can be used up to the expiration date on the vial. Options 1, 3, and 4 are incorrect.

The nurse in the health care clinic is reviewing the record of a client with diabetes mellitus who was just seen by the health care provider (HCP). The nurse notes that the HCP has prescribed metformin. What preexisting disorder, if noted in the client's record, would indicate a need to collaborate with the HCP before instructing the client to take the medication? 1. Foot ulcer 2. Emphysema 3. Hypertension 4. Hypothyroidism

Correct answer: 2 Rationale: Metformin is an antidiabetic agent and acts by decreasing hepatic production of glucose. Metformin should be used with caution in clients with kidney or liver disease, heart failure, chronic lung disease, or a history of heavy alcohol consumption. The presence of a foot ulcer, hypertension, and hypothyroidism are not contraindications associated with use of this medication.

The nurse is providing discharge teaching for a client newly diagnosed with type 2 diabetes mellitus who has been prescribed metformin. Which client statement indicates the need for further teaching? 1. "It is okay if I skip meals now and then." 2. "I need to constantly watch for signs of low blood sugar." 3. "I need to let my health care provider know if I get unusually tired." 4. "I will be sure to not drink alcohol excessively while on this medication."

Correct answer: 2 Rationale: Metformin is classified as a biguanide and is the most commonly used medication for type 2 diabetes mellitus initially. It is also often used as a preventive medication for those at high risk for developing diabetes mellitus. When used alone, metformin lowers the blood sugar after meal intake as well as fasting blood glucose levels. Metformin does not stimulate insulin release and therefore poses little risk for hypoglycemia. For this reason, metformin is well suited for clients who skip meals. Unusual somnolence, as well as hyperventilation, myalgia, and malaise, are early signs of lactic acidosis, a toxic effect associated with metformin. If any of these signs or symptoms occur, the client should inform the health care provider immediately. While it is best to avoid consumption of alcohol, it is not always realistic or feasible for clients to quit drinking altogether; for this reason, clients should be informed that excessive alcohol intake can cause an adverse reaction with metformin.

The emergency department nurse is caring for a client admitted with diabetic ketoacidosis. The health care provider prescribes intravenous (IV) insulin. The nurse plans to prepare which type of insulin for the client? 1. Insulin glargine 2. Regular insulin 3. Insulin isophane 4. 50% human insulin isophane/50% human insulin

Correct answer: 2 Rationale: Regular insulin can be administered by the IV route. Insulin glargine is a long-acting insulin. Insulin isophane and 50% human insulin isophane/50% human insulin are intermediate-acting insulins.

A nurse caring for a 23-year-old client newly diagnosed with type 1 diabetes mellitus teaches the client insulin administration. Which statement by the client indicates a need for further teaching? 1. "It is not necessary for me to aspirate before injecting my insulin." 2. "I will rotate my insulin injection between my arms, thighs, and abdomen on a daily basis." 3. "I will perform a capillary blood glucose measurement before I administer my insulin regimen." 4. "My glargine insulin is long acting and should be administered once a day, but insulin lispro is given just before I eat."

Correct answer: 2 Rationale: Rotation of insulin injections should be done within 1 anatomical site to maintain consistent absorption of insulin. The remaining options are correct statements regarding insulin administration and thus do not indicate a need for additional client teaching.

A client scheduled to undergo subtotal thyroidectomy is taking a potassium iodide solution. The client complains to the nurse that she is experiencing a brassy taste in her mouth when taking the medication. Which instruction should the nurse provide to the client? 1. Dilute the medication in 8 ounces of water. 2. Report the symptom to the health care provider (HCP). 3. Continue to take the medication because the symptom is normal. 4. Take one half dose of the prescribed medication for the next 2 days.

Correct answer: 2 Rationale: The client should be instructed about symptoms of iodism that can occur with the administration of potassium iodide solution. These symptoms include a brassy taste, burning sensation in the mouth, and soreness of the gums and teeth. The client should be instructed to withhold the medication and notify the HCP if these symptoms are noted.

When teaching the client with adrenal insufficiency about cortisone, the nurse should include which items? Select all that apply. 1. Increase intake of sodium. 2. Take the medication with food. 3. Increase intake of potassium-rich foods. 4. Stay away from people with active infections. 5. Discontinue the medication when symptoms subside. 6. Notify the health care provider if illness occurs or surgery is anticipated.

Correct answer: 2, 3, 4, 6 Rationale: Glucocorticoids should not be abruptly discontinued because acute adrenal insufficiency could occur. Because glucocorticoids cause sodium and water to be retained while causing loss of potassium, the client should limit sodium intake and increase potassium intake. These medications can increase the risk of infection; therefore, the client should avoid contact with clients who are ill. Taking the medication with food helps prevent stomach upset. Individuals may need an increase in dosage during illness or times of stress (surgery).

Glimepiride is prescribed for a client with diabetes mellitus. The nurse instructs the client that which food items are most acceptable to consume while taking this medication? Select all that apply. 1. Alcohol 2. Red meats 3. Whole-grain cereals 4. Low-calorie desserts 5. Carbonated beverages

Correct answer: 2, 3, 5 Rationale: When alcohol is combined with glimepiride {Oral Hpoglycemic med}, a disulfiram-like reaction may occur. This syndrome includes flushing, palpitations, and nausea. Alcohol can also potentiate the hypoglycemic effects of the medication. Clients need to be instructed to avoid alcohol consumption while taking this medication. Low-calorie desserts should also be avoided. Even though the calorie content may be low, carbohydrate content is most likely high and can affect the blood glucose. The items in options 2, 3, and 5 are acceptable to consume.

The nurse teaches a client newly diagnosed with type 1 diabetes about storing Humulin N insulin. Which statement indicates to the nurse that the client understood the discharge teaching? 1. "I should keep the insulin in the cabinet during the day only." 2. "I know I have to keep my insulin in the refrigerator at all times." 3. "I can store the open insulin bottle in the kitchen cabinet for 1 month." 4."The best place for my insulin is on the window sill, but in the cupboard is just as good."

Correct answer: 3 Rationale: An insulin vial in current use can be kept at room temperature for 1 month without significant loss of activity. Direct sunlight and heat must be avoided. Therefore, options 1, 2, and 4 are incorrect.

A daily dose of prednisone is prescribed for a client. The nurse provides instructions to the client regarding administration of the medication and should instruct the client that which time is best to take this medication? 1. At noon 2. At bedtime 3. Early morning 4. Any time, at the same time, each day

Correct answer: 3 Rationale: Corticosteroids (glucocorticoids) should be administered before 9 a.m. Administration at this time helps to minimize adrenal insufficiency and mimics the burst of glucocorticoids released naturally by the adrenal glands each morning. Options 1, 2, and 4 are incorrect.

Thyroid replacement therapy is prescribed for the client diagnosed with hypothyroidism. The client asks the nurse when the medication will no longer be needed. Which is the appropriate nursing response? 1. "It depends on the results of the laboratory tests." 2. "Most clients require medication for about 1 year." 3. "The medication will need to be continued for life." 4. "You will need to ask your health care provider."

Correct answer: 3 Rationale: For most clients with hypothyroidism, replacement therapy must be continued for life. Treatment provides symptomatic relief but does not produce a cure. The client should be told that although therapy will cause symptoms to improve, these improvements do not constitute a reason to interrupt or discontinue the medication. The outcome of the laboratory results does not bear influence on the length of time the client will need the medication. The statement that indicates that most clients need the medication for about a year implies that the disease is curable, so this option should be eliminated. Referring the client to the health care provider places the client's question on hold.

A client newly diagnosed with diabetes mellitus is instructed by the health care provider to obtain glucagon for emergency home use. The client asks a home care nurse about the purpose of the medication. What is the nurse's best response to the client's question? 1. "It will boost the cells in your pancreas if you have insufficient insulin." 2. "It will help to promote insulin absorption when your glucose levels are high." 3. "It is for the times when your blood glucose is too low from too much insulin." 4. "It will help to prevent lipoatrophy from the multiple insulin injections over the years."

Correct answer: 3 Rationale: Glucagon is used to treat hypoglycemia resulting from insulin overdose. The family of the client is instructed in how to administer the medication. In an unconscious client, arousal usually occurs within 20 minutes of glucagon injection. When consciousness has been regained, oral carbohydrates should be given. Lipoatrophy and lipohypertrophy result from insulin injections.

Glyburide is prescribed for a client with type 2 diabetes mellitus. What is the most important instruction the nurse should provide to the client? 1. Monitor for signs of infection. 2. Weigh himself or herself daily. 3. Assess for signs of hypoglycemia. 4. Observe for lower extremity edema.

Correct answer: 3 Rationale: Glyburide is a sulfonylurea that acts primarily by stimulating the release of insulin from pancreatic islets. It causes a dose-dependent reduction in blood glucose and can thereby cause hypoglycemia. Importantly, regardless of what the glucose level is—high, normal, or low—sulfonylureas will lead to a low blood glucose level. If the level is high, reducing it will be therapeutic. However, if the level is normal, reducing it will cause mild hypoglycemia. If the level is already low, reducing it can cause severe hypoglycemia. The correct option is 3. Option 1 is incorrect, as infections are not a side or adverse effect of sulfonylureas. Option 2 is incorrect; although weight gain is associated with sulfonylureas, it is not the most important instruction. Option 4 is incorrect, as edema is an adverse effect of thiazolidinediones, not sulfonylureas.

The nurse is providing education to a client with type 2 diabetes about starting insulin glargine to help with improved glycemic control. Which statement made by the client indicates understanding? 1. "It has a distinct peak." 2. "It can be given intravenously." 3. "It has a decreased risk for hypoglycemia." 4. "I don't have to perform fingerstick glucose monitoring."

Correct answer: 3 Rationale: In contrast to other long-acting insulins, insulin glargine achieves blood levels that are relatively steady over 24 hours. As a result, there is less risk of hypoglycemia or hyperglycemia. The only insulins that can be administered intravenously are the short-acting insulins. All medications used to treat diabetes mellitus require fingerstick monitoring.

Levothyroxine is prescribed for a client diagnosed with hypothyroidism. Upon review of the client's record, the nurse notes that the client is taking warfarin. Which modification to the plan of care should the nurse review with the client's health care provider? 1. A decreased dosage of levothyroxine 2. An increased dosage of levothyroxine 3. A decreased dosage of warfarin sodium 4. An increased dosage of warfarin sodium

Correct answer: 3 Rationale: Levothyroxine accelerates the degradation of vitamin K-dependent clotting factors. As a result, the effects of warfarin are enhanced. If thyroid hormone replacement therapy is instituted in a client who has been taking warfarin, the dosage of warfarin should be reduced.

A client diagnosed with hypothyroidism is taking levothyroxine. The client returns to the clinic 1 week after beginning the medication and tells the nurse that the medication has not helped. What is the appropriate nursing response to the client? 1. A higher dosage is required. 2. The medication may need to be changed. 3. Full therapeutic effect may take 1 to 3 weeks. 4. Full therapeutic effect may take up to 4 months.

Correct answer: 3 Rationale: Levothyroxine is used in the treatment of hypothyroidism. Although therapy with levothyroxine may begin with small doses that are gradually increased, the most appropriate response is to inform the client that the full therapeutic effect may take 1 to 3 weeks. Therefore, the remaining options are incorrect.

The health care provider has prescribed regular insulin 6 units and NPH insulin 20 units subcutaneously to be administered every morning. How should the nurse prepare to administer insulin? 1. Shake the NPH insulin vial to distribute the suspension. 2. Administer regular insulin and NPH insulin in separate syringes. 3. Draw up the regular insulin first and then the NPH insulin in the same syringe. 4. Draw up the NPH insulin first and then the regular insulin in the same syringe.

Correct answer: 3 Rationale: Regular insulin is always drawn up before NPH insulin, and NPH insulin can be drawn into the same syringe as the regular insulin. Insulins usually are administered 15 to 30 minutes before a meal. To mix the NPH insulin suspension, the vial should be rotated gently. Shaking introduces air bubbles into the solution.

A nurse is administering a prescribed dose of dexamethasone to a client following cranial surgery. Which would the nurse implement to assess for a common side effect of this medication? 1. Monitor for hair loss. 2. Assess for decreased skin turgor. 3. Perform blood glucose monitoring. 4. Monitor laboratory test results for hyperkalemia.

Correct answer: 3 Rationale: Side effects of dexamethasone include delayed wound healing, hyperglycemia, fluid overload, hirsutism, and hypokalemia. Hair loss, decreased skin turgor, and hyperkalemia are unrelated to the side effects of this medication.

A client who has sustained an eye injury has been prescribed prednisolone. The nurse would most carefully monitor for side and adverse effects of this medication if the client has which health problem listed on the medical record? 1. Cirrhosis 2. Hypertension 3. Diabetes mellitus 4. Chronic constipation

Correct answer: 3 Rationale: The client with diabetes mellitus is especially at risk for side and adverse effects when taking this medication, which is a glucocorticoid. The client may experience elevations in the blood glucose level, which should be monitored frequently. Cirrhosis, hypertension, and chronic constipation are not a concern with the administration of this medication.

The nurse is completing a health history for an insulin-dependent client who has been self-administering insulin for 40 years. The client reports experiencing periods of hypoglycemia followed by periods of hyperglycemia. What is the most likely cause for this pattern of blood glucose fluctuation? 1. Eating snacks between meals 2. Initiating the use of the insulin pump 3. Injecting insulin at a site of lipodystrophy 4. Adjusting insulin according to blood glucose levels

Correct answer: 3 Rationale: Tissue hypertrophy (lipodystrophy) involves thickening of the subcutaneous tissue at the injection sites. This dense tissue can interfere with the absorption of insulin, resulting in erratic blood glucose levels. Because the client has been on insulin for many years, this is the most likely cause of poor control. The remaining options are appropriate for use in regulating blood glucose levels.

The client with hyperparathyroidism is taking alendronate. Which statements by the client indicate understanding of the proper way to take this medication? Select all that apply. 1. "I should take this medication with food." 2. "I should take this medication at bedtime." 3. "I should sit up for at least 30 minutes after taking this medication." 4. "I should take this medication first thing in the morning on an empty stomach." 5. "I can pick a time to take this medication that best fits my lifestyle as long as I take it at the same time each day."

Correct answer: 3, 4 Rationale: Alendronate is a bisphosphonate used in hyperparathyroidism to inhibit bone loss and normalize serum calcium levels. Esophagitis is an adverse effect of primary concern in clients taking alendronate. For this reason the client is instructed to take alendronate first thing in the morning with a full glass of water on an empty stomach, not to eat or drink anything else for at least 30 minutes after taking the medication, and to remain sitting upright for at least 30 minutes after taking it. A daily dosing schedule and a once-weekly dosing schedule is available for clients taking alendronate.

The clinic nurse develops a plan of care for a client with emphysema who will be started on long-term corticosteroid therapy. Which specific instruction should the nurse include in the plan of care? 1. Instruct the client to maintain a low-potassium diet. 2. Encourage the client to consume a fluid intake of 3000 mL/day. 3. Encourage the client to increase the amount of sodium intake in the diet. 4. Instruct the client to return to the clinic for monitoring of blood glucose levels.

Correct answer: 4 Rationale: Corticosteroid therapy can cause calcium and potassium depletion, sodium retention, and glucose intolerance. The client should be monitored for hyperglycemia. Also, an increase in potassium and a decrease in sodium intake are recommended to prevent potassium depletion and sodium retention while taking the corticosteroid. Although increased fluids are important for the client with emphysema to maintain thin respiratory secretions, this action is not specific to the use of corticosteroids.

Insulin lispro is prescribed for the client, and the client is instructed to administer the insulin before meals. When should the nurse instruct the client to administer the insulin? 1. 45 minutes before eating 2. 60 minutes before eating 3. 90 minutes before eating 4. Immediately before eating

Correct answer: 4 Rationale: Insulin lispro acts more rapidly than regular insulin and has a shorter duration of action. The effect of insulin lispro begins within 25 minutes after subcutaneous injection, peaks in 0.5 to 1.5 hours, and has a duration of action of approximately 5 hours. Because of its rapid onset, it can be administered from 15 minutes to immediately before eating. In contrast, regular insulin is generally administered 30 minutes before meals.

A client arrives at the clinic complaining of fatigue, lack of energy, constipation, and depression. Hypothyroidism is diagnosed, and levothyroxine is prescribed. What is an expected outcome of the medication? 1. Alleviate depression 2. Increase energy levels 3. Increase blood glucose levels 4. Achieve normal thyroid hormone levels

Correct answer: 4 Rationale: Laboratory determinations of the serum thyroid-stimulating hormone (TSH) level are an important means of evaluation. Successful therapy causes elevated TSH levels to decline. These levels begin their decline within hours of the onset of therapy and continue to decrease as plasma levels of thyroid hormone build up. If an adequate dosage is administered, TSH levels remain suppressed for the duration of therapy. Although energy levels may increase and the client's mood may improve following effective treatment, these are not noted until normal thyroid hormone levels are achieved with medication therapy. An increase in the blood glucose level is not associated with this condition.

The nurse provides education to the client with hyperthyroidism about potassium iodide before medication administration. The client is scheduled for a subtotal thyroidectomy. Which response by the client indicates understanding? 1. "It replaces thyroid hormone." 2. "It prevents iodine absorption." 3. "It increases thyroid hormone." 4. "It suppresses thyroid hormone."

Correct answer: 4 Rationale: Potassium iodide is administered to hyperthyroid individuals in preparation for thyroidectomy to suppress thyroid function. Initial effects develop within 24 hours. Peak effects develop in 10 to 15 days. In most cases, plasma levels of thyroid hormone are reduced with propylthiouracil before potassium iodide therapy is initiated. Then potassium iodide, along with propylthiouracil, is administered for the last 10 days before surgery. Therefore, the remaining options are incorrect.

The diabetes nurse specialist conducts a teaching session to a group of nursing students regarding sulfonylureas, oral hypoglycemic medications used for type 2 diabetes mellitus. Which statement, describing the primary action of these medications, should the nurse include in the teaching session? 1. "Sulfonylureas decrease insulin resistance." 2. "Sulfonylureas inhibit carbohydrate digestion." 3. "Sulfonylureas decrease glucose production by the liver." 4. "Sulfonylureas promote insulin secretion by the pancreas."

Correct answer: 4 Rationale: Sulfonylureas promote insulin secretion by the pancreas and may also increase tissue response to insulin. Thiazolidinediones decrease insulin resistance. α-Glucosidase inhibitors inhibit carbohydrate digestion. Biguanides decrease glucose production by the liver.

The nurse is providing instructions to a client with a diagnosis of Addison's disease regarding the administration of prescribed glucocorticoids. The nurse should provide which instruction to the client? 1. To stop the medication if side effects occur 2. To avoid taking the medication if nausea occurs 3. That minimal side effects will occur with use of this medication 4. That an increased dose of medication may be needed during times of stress

Correct answer: 4 Rationale: The client with Addison's disease will require lifelong replacement of adrenal hormones. The medications must be taken daily, and an alternate route of administration must be used if the client cannot take oral medications for any reason, such as nausea and vomiting. Additional doses of glucocorticoids will be needed during times of stress. The nurse must emphasize that the client must call the health care provider (HCP) to obtain a prescription for a dosage increase when experiencing stressful situations. Abrupt withdrawal of this medication can result in addisonian crisis. Although side effects are mild at lower doses, more severe side effects occur with long-term glucocorticoid administration. It is very unsafe to stop taking the medication without first consulting the HCP.

Metformin is prescribed for a client with type 2 diabetes mellitus. The nurse should tell the client that which is the most common side or adverse effect of the medication? 1. Weight gain 2. Hypoglycemia 3. Flushing and palpitations 4. Gastrointestinal (GI) disturbances

Correct answer: 4 Rationale: The most common side effect of metformin is GI disturbances, including decreased appetite, nausea, and diarrhea. These generally subside over time. This medication does not cause weight gain; in fact, clients lose an average of 7 to 8 lb because the medication causes nausea and decreased appetite. Although flushing, palpitations, and hypoglycemia can occur, they are not the most common side effects.

Metformin is prescribed for a client with type 2 diabetes mellitus. What is the most common side effect that the nurse should include in the client's teaching plan? 1. Weight gain 2. Hypoglycemia 3. Flushing and palpitations 4. Gastrointestinal disturbances

Correct answer: 4 Rationale: The most common side effect of metformin is gastrointestinal disturbances, including decreased appetite, nausea, and diarrhea. These generally subside over time. This medication does not cause weight gain; clients lose an average of 7 to 8 lb (3.2 to 3.6 kg) because the medication causes nausea and decreased appetite. Although hypoglycemia can occur, it is not the most common side effect. Flushing and palpitations are not specifically associated with this medication.

Cortisone acetate is prescribed for a client with adrenal insufficiency. The nurse provides instructions to the client regarding the medication. Which statement, if made by the client, indicates a need for further instruction? 1. "I will limit my sodium intake." 2. "I will avoid people with colds." 3. "I will eat a good breakfast every day." 4. "I will stop the medication when I feel better."

Correct answer: 4 Rationale: To prevent acute adrenal insufficiency, glucocorticoids should not be abruptly discontinued. These medications can cause sodium and water retention and the loss of potassium, so clients should be instructed to limit sodium intake and consume potassium-rich foods. These medications can increase the risk of infection, and the client should avoid contact with clients who are ill. Additionally, adequate dietary intake is important.