Pharm Endocrine System
A 26-year-old woman's gradual development of a "moon face," coupled with protracted weight gain, has caused the nurse practitioner to suspect the possibility of Cushing's disease. When explaining this health problem to the patient, how should the nurse describe it? A. "Cushing's disease most often happens when people are taking corticosteroid medications and stop them abruptly." B. "Cushing's disease happens when your pituitary gland doesn't stimulate your other glands enough." C. "Cushing's disease often results from a growth on your kidney that causes inadequate production of steroids." D. "Cushing's disease is a result of an overproduction of steroid hormones by your kidneys."
"Cushing's disease is a result of an overproduction of steroid hormones by your kidneys." The cause of Cushing's disease is adrenocortical excess. Cessation of exogenous steroids can precipitate addisonian crisis. Dysfunction of pituitary gland is an atypical cause. Tumors may cause overproduction, not underproduction, of corticosteroids.
A nurse educator is explaining the pathophysiology of diabetes to a newly diagnosed patient. The patient does not understand why she had a "constant, insatiable thirst" in the months preceding her diagnosis. What phenomenon should the nurse describe? A. "The excess glucose in your blood accumulates in your blood vessels and neurons, including the neurons that control thirst." B. "Increased thirst is your body's attempt to dilute your blood because it contains too much glucose." C. "Excess glucose pulled more water through your kidneys and the increased urination caused thirst." D. "When your body cells are starved for useful glucose, they signal your body to increase food and fluid intake."
"Excess glucose pulled more water through your kidneys and the increased urination caused thirst." When large amounts of glucose are present, water is pulled into the renal tubule. This results in a greatly increased urine output (polyuria). The excessive loss of fluid in urine leads to increased thirst (polydipsia). Glucose does not directly affect the thirst center.
A 38-year-old patient has been living with Addison's disease for many years and has achieved adequate symptom control through lifestyle modifications and drug therapy. However, the patient has now been admitted to the hospital in addisonian crisis. Which of the nurse's following assessment questions is most appropriate? A. "Have you been under an unusual amount of stress lately?" B. "Has your urine output been typical for the past few days?" C. "When was the last time that you drank any alcohol?" D. "How would you describe your diet over the last few days?"
"Have you been under an unusual amount of stress lately?" Acute adrenal crisis, or addisonian crisis, is a life-threatening condition that occurs when Addison's disease is the underlying problem and the patient is exposed to minor illness or increased stress. Diet, alcohol use, and impaired urinary function are less likely contributors.
A patient in his mid-30s has received a diagnosis of type 2 diabetes. Following his diagnosis, he has been meeting with a nurse regularly as well as performing extensive online research. Which of the patient's statements should prompt the nurse to perform further teaching? A. "I don't like getting this diagnosis, but I know that treatment now can prevent future health consequences." B. "People always tried to encourage me to lose weight, and I suppose they might have been right." C. "I'm disappointed, but I take some solace in the fact that I won't ever have to have insulin injections." D. "From what I've learned, I know that the basic problem is that my pancreas can't keep up with my insulin needs."
"I'm disappointed, but I take some solace in the fact that I won't ever have to have insulin injections." Among people with type 2 diabetes, 20% to 30% require exogenous insulin at some point in their lives. Obesity is a major cause, and vigilant treatment can prevent future sequelae. The essence of type 2 diabetes is the pancreas' inability to meet insulin needs.
An older adult patient has been using levothyroxine (Synthroid) for several years on an outpatient basis. The patient has recently sought care, with complaints that are consistent with hypothyroidism. To which of the patient's following statements may the nurse attribute the decreased effect of Synthroid? A. "I've been using a lot of antacids lately because of my indigestion." B. "My daughter and I have started the Atkin's diet to try to lose some weight." C. "Overall, I'd say that I'm under a lot of stress lately." D. "I've stopped taking aspirin for my arthritis and started using Tylenol."
"I've been using a lot of antacids lately because of my indigestion." Antacids may decrease the effect of levothyroxine. Acetaminophen, stress, and high protein intake do not have this effect.
During a teaching session on the care of the diabetic patient, a family member asks why her daughter has a different insulin than her best friend. The nurse should make which of the following statements to explain the differences in insulin? A. "Insulin is prescribed based on the insurer's criteria for reimbursement." B. "Insulins have different onsets and durations of action." C. "Insulin type is matched with the appropriate oral hypoglycemic agent." D. "Insulin is prescribed based on the patient's age."
"Insulins have different onsets and durations of action." When insulin therapy is indicated, the physician may choose from several preparations that vary in composition, onset, duration of action, and other characteristics. Insulin is not prescribed based solely on cost. Insulin is not prescribed based solely on the patient's age. Insulin is not usually matched with oral hypoglycemic agents.
An 80-year-old woman has experienced recent declines in bone density and has consequently been deemed a candidate for treatment with alendronate (Fosamax). During health education, what teaching point should the nurse emphasize? A. "It's important that you not lie down for half an hour after taking your Fosamax." B. "Make sure to let your care provider know promptly if you experience bone pain." C. "Your Fosamax will be most effective if you couple it with an increase in your consumption of dairy products." D. "You'll have less stomach upset if you take your Fosamax with some bland food."
"It's important that you not lie down for half an hour after taking your Fosamax." The person must remain upright (with head elevated 90 degrees if in bed, sitting upright in a chair, or standing) for at least 30 minutes after administration of Fosamax. It is always necessary to take the drug with a full glass of water, not juice or coffee, at least 30 minutes before breakfast and before taking other drugs. Bone pain is a possible adverse effect, but prevention of esophageal ulceration is a priority. Increased dairy consumption is not vital.
The nurse is providing health education to an 80-year-old woman who has just been diagnosed with osteoporosis. Which of the following represents an accurate statement when teaching her about this diagnosis? A. "Osteoporosis occurs only in women." B. "Osteoporosis causes a risk for fractures." C. "Osteoporosis is usually a result of a bone injury." D. "Osteoporosis results from nonmodifiable risk factors."
"Osteoporosis causes a risk for fractures." Osteoporosis results when bone strength is impaired, leading to increased porousness and vulnerability to fracture. Osteoporosis is not a result of fracture. Osteoporosis is partially preventable. Osteoporosis is not limited to the female gender.
A patient asks the nurse why a quick-acting sugar given by mouth is better in the regulation of insulin than the use of intravenous glucose for a low blood sugar. Which of the following statements by the nurse represents the most appropriate response to this question? A. "The ingestion of food allows the digestive tract to stimulate vagal activity and the release of incretins." B. "You are mistaken. The intravenous glucose yields a higher blood glucose through the release of incretins." C. "Both food and intravenous glucose will produce changes similarly in the gastrointestinal tract to increase blood sugar." D. "The combination of insulin and food will yield a higher blood sugar than intravenous glucose."
"The ingestion of food allows the digestive tract to stimulate vagal activity and the release of incretins." Oral glucose is more effective than intravenous glucose because glucose or food in the digestive tract stimulates vagal activity and induces the release of gastrointestinal hormones called incretins. The combination of insulin and food does not yield a higher blood glucose than intravenous insulin. Food stimulates the vagal nerve activity, but intravenous glucose does not. A statement that indicates that the patient is mistaken will belittle the patient and should be rephrased.
The results of a young man's plasma corticotropin (ACTH) stimulation test have confirmed a diagnosis of Addison's disease. The nurse has consequently provided health education around the necessity of hormone replacement therapy. The patient has asked the nurse, "How long am I going to have to take these medications?" How should the nurse best respond? A. "You'll have to take these until you can pass the corticotropin stimulation test without them." B. "You'll have to take these until your kidneys regain their normal level of function." C. "You'll need to take these until your symptoms have been stable for at least 6 months." D. "You'll need to take these for the rest of your life."
"You'll need to take these for the rest of your life." Lifetime hormone replacement is necessary in persons with Addison's disease.
Laboratory testing reveals that a patient is in a severely hyperthyroid state and propylthiouracil (PTU) has been prescribed. When providing health education related to this drug, what should the nurse teach the patient? A. "You'll need to take these pills every 8 hours." B. "It's best to inject PTU into your abdomen rather than your arm." C. "I'm going to show you how to perform your daily injection." D. "At first, you'll come to the outpatient clinic for your IV infusion once per day."
"You'll need to take these pills every 8 hours." PTU is well absorbed with oral administration. Because the half-life in the thyroid is relatively short, PTU must be given every 8 hours.
A hospital patient is to receive 4 units of regular insulin prior to lunch. The nurse knows that the lunch trays are usually distributed at approximately 12:15. The nurse should plan to administer the patient's insulin at what time? A. 12:10 B. 11:15 C. 11:45 D. 12:15
11:45 With regular insulin before meals, it is very important that the medication be injected 30 to 45 minutes before meals so that the insulin is available when blood sugar increases after meals.
A 75-year-old patient with overall good health is to begin taking vitamin D supplements. What is the recommended supplement for her age? A. 600 International Units daily B. 800 International Units daily C. 200 International Units daily D. 100 International Units daily
800 International Units daily The recommended dietary allowance, or RDA, for vitamin D is 600 International Units for people 1 to 70 years of age and 800 International Units daily for adults 71 years and older to prevent and treat osteoporosis.
A 69-year-old woman has been taking metformin for the treatment of type 2 diabetes for several years. Which of the following changes in the woman's laboratory values may demonstrate a need to discontinue the medication? A. A decrease in hemoglobin and hematocrit B. An increase in white blood cells C. A decrease in glomerular filtration rate D. A decrease in potassium accompanied by an increase in sodium
A decrease in glomerular filtration rate It is essential to discontinue metformin if renal impairment occurs. The other listed changes in laboratory values do not necessarily indicate that metformin should be discontinued.
A patient with Cushing's disease will soon begin treatment with ketoconazole. When planning the patient's care, the nurse should be cognizant of the black box warning for this drug and consequently monitor what laboratory values? A. AST, ALT, and GGT B. White blood cell differential C. Blood urea nitrogen and creatinine D. Hemoglobin, hematocrit, and red blood cell count
AST, ALT, and GGT The FDA has issued a black box warning stating that ketoconazole can cause hepatotoxicity. As a result, monitoring of liver function may be a priority over assessment of white cells, red cells, and renal function.
An adult patient has been experiencing severe lethargy and fatigue over the past several days, and she describes herself as feeling "shaky." Random blood glucose testing reveals a glucose level of 38 mg/dL, but the woman denies any significant change in her diet. The care team should suspect the possibility of what health problem? A. Adrenal insufficiency B. Cushing's disease C. Acute renal failure D. Chronic renal failure
Adrenal insufficiency Any patient with unexplained severe hypoglycemia requires assessment for adrenal insufficiency. Cushing's disease and kidney disease do not result in hypoglycemia.
A patient is to be administered glipizide (Glucotrol). Which of the following factors would contraindicate the administration of glipizide (Glucotrol) to this patient? A. Increase in alkaline phosphatase B. The ingestion of carbohydrates C. Allergy to sulfonamides D. A diagnosis of hypertension
Allergy to sulfonamides Sulfonylureas are contraindicated in patients with hypersensitivity to them, with severe renal or hepatic impairment, and who are pregnant. A diagnosis of hypertension does not cause contraindication of sulfonylureas. The patient should consume carbohydrates in association with the oral hypoglycemic agent. An increase in alkaline phosphatase does not result in the contraindication of glipizide (Glucotrol).
A child has been referred to a pediatric endocrinologist and has begun treatment with octreotide acetate. What nursing diagnosis should be noted in the child's plan of nursing care? A. Risk for deficient fluid volume B. Altered growth and development C. Delayed growth and development D. Excess fluid volume
Altered growth and development Acromegaly is the major clinical indication for the use octreotide. In this condition, growth is excessive, not delayed. Fluid volume is not directly affected.
A patient has been involved in a motor vehicle accident. Which hormone will be released in response to his blood loss? A. Oxytocin B. Melanocyte-stimulating hormone C. Luteinizing hormone (LH) D. Antidiuretic hormone (ADH)
Antidiuretic hormone (ADH) Antidiuretic hormone is also called vasopressin and is released in response to blood loss. Luteinizing hormone is important in ovulation. Oxytocin functions in childbirth and lactation. Melanocyte-stimulating hormone plays a role in skin pigmentation.
Following the completion of diagnostic testing, an adult patient has received a diagnosis of hyperthyroidism. What nursing diagnosis should the nurse prioritize in this patient's care? A. Anxiety related to hyperthyroidism B. Risk for hypothermia related to hyperthyroidism C. Risk for imbalanced nutrition: less than body requirements related to hyperthyroidism D. Constipation related to hyperthyroidism
Anxiety related to hyperthyroidism Anxiety is characteristic of a hyperthyroid state. Constipation, cold intolerance, and loss of appetite are associated with hypothyroidism.
A patient who has been taking oral prednisone for several months abruptly ceased treatment several days ago on the advice of a family member. The patient has now been admitted to the emergency department with signs and symptoms that are characteristic of addisonian crisis. When assessing this patient, the nurse should prioritize what assessment? A. Assessment of urine for ketones B. Assessment for venous thromboembolism C. Assessment for adventitious lung sounds D. Assessment of serum potassium levels
Assessment of serum potassium levels In addisonian crisis, the loss of sodium leads to retention of potassium, resulting in symptoms of hyperkalemia. As a result, vigilant monitoring of serum potassium levels is more important than respiratory effects, urinalysis, or hypercoagulation.
A hospital patient with a diagnosis of type 1 diabetes is ordered Humulin R on a sliding scale. Based on the patient's blood glucose reading, the nurse administered 8 units of insulin at 07:45. The nurse recognizes the need to follow up this intervention and will reassess the patient's blood glucose level when the insulin reaches peak efficacy. The nurse should consequently check the patient's blood glucose level at what time? A. Between 11:15 and 11:45 B. 08:15 C. Between 09:45 and 10:45 D. Between 08:45 and 09:45
Between 09:45 and 10:45 Humulin R peaks between 2 and 3 hours after administration.
An adolescent is being treated with growth hormone. When assessing for potential adverse effects, what assessment should the nurse prioritize? A. Level of anxiety B. Blood glucose C. Deep tendon reflexes D. Respiratory rate
Blood glucose Somatropin decreases insulin sensitivity, resulting in hyperglycemia. Patients most at risk for increased insulin sensitivity are those with obesity, Turner's syndrome, or a family history of diabetes mellitus. Growth hormone can cause anxiety, but is not a priority assessment in this case. The respiratory rate is not the most important objective assessment in this case.
When a patient has an increased serum level of ionized calcium, which hormone will be released? A. PTH B. Insulin C. Estrogen D. Calcitonin
Calcitonin Calcitonin is a hormone from the thyroid gland whose secretion is controlled by the concentration of ionized calcium in the blood flowing through the thyroid gland. When the serum level of ionized calcium is increased, secretion of calcitonin is increased. The serum level of calcium will not affect the release of insulin or estrogen. PTH is a response to low calcium levels.
An elderly patient has been diagnosed with Paget's disease. Which serum electrolyte is altered in this disease process? A. Calcium B. Potassium C. Chloride D. Sodium
Calcium Disorders of calcium and bone metabolism include hypocalcemia, hypercalcemia, osteoporosis, Paget's disease, and bone breakdown associated with breast cancer and multiple myeloma. Sodium, potassium, and chloride alterations are not primarily associated with Paget's disease.
A patient will soon begin long-term treatment with hydrocortisone after being diagnosed with Addison's disease. In order to mitigate the potentially adverse effect of this treatment regimen, the nurse should encourage the patient to increase her intake of what nutrient? A. Potassium B. Water C. Calcium D. Sodium
Calcium Due to the potential for reduced bone density, patients should be encouraged to increase calcium intake if hydrocortisone is administered for a prolonged period. Increased sodium, potassium, and water intake are not recommended.
A patient's low ionized calcium levels have necessitated an infusion of an IV calcium preparation. During the administration of this medication, the nurse should prioritize what assessment? A. Assessment for visual changes B. Cardiac monitoring C. Oxygen saturation levels D. Assessment of cognition
Cardiac monitoring Calcium imbalances can result in alterations in heart rate and rhythm; cardiac monitoring is thus necessary. The patient is less likely to experience alterations in respiratory function, cognition, or vision.
A 55-year-old woman is diagnosed with a vitamin D deficit. What disorder results from this deficit? A. Chondromalacia B. Chondritis C. Osteopenia D. Osteomalacia
Osteomalacia In adults, vitamin D deficiency causes osteomalacia, a condition characterized by decreased bone density and strength. Chondromalacia is characterized as a softening of the patella. Chondritis is an inflammation of the cartilage. Osteopenia is a decrease in bone tissue.
A patient is being treated for hypothyroidism and has developed symptoms of adrenal insufficiency. What medication will be added to the patient's medication regimen? A. Antiadrenergic agent B. Anti-infective agent C. Nonsteroidal anti-inflammatory agent D. Corticosteroid agent
Corticosteroid agent When hypothyroidism and adrenal insufficiency coexist, the adrenal insufficiency should be treated with a corticosteroid drug before starting thyroid replacement. Anti-infective agents, nonsteroidal anti-inflammatory agents, or antiadrenergic agents are not administered for adrenal insufficiency.
A patient is suspected of having adrenal insufficiency. Which hormone may be administered to diagnose Addison's disease? A. Octreotide (Sandostatin) B. Somatotropin (Humatrope) C. Leuprolide (Lupron) D. Corticotropin (ACTH)
Corticotropin (ACTH) Corticotropin (ACTH) is sometimes used as a diagnostic test to differentiate primary adrenal insufficiency (Addison's disease). Somatotropin is therapeutically equivalent to endogenous growth hormone. Octreotide (Sandostatin) is used for acromegaly. Leuprolide causes a decrease in testosterone and estrogen.
A patient is suspected of having Cushing's disease. What hormone is used in the diagnosis of this disorder? A. Adrenocorticotropic hormone B. Thyroid-stimulating hormone C. Growth hormone D. Corticotropin-releasing hormone
Corticotropin-releasing hormone Corticotropin-releasing hormone can be used in the diagnosis of Cushing's disease. Growth hormone is released in response to low blood levels of growth hormone. Corticotropin-releasing hormone causes the release of corticotropin (adrenocorticotropic hormone) in response to stress. Thyroid-stimulating hormone regulates the secretion of thyroid hormones.
A patient is scheduled for an exploratory surgery for cancer. What will cause the release of adrenocorticotropic hormone in response to this patient's psychological and physiological stress? A. Growth hormone-releasing hormone (GHRH) B. Corticotropin-releasing hormone or factor (CRH or CRF) C. Thyrotropin-releasing hormone (TRH) D. Growth hormone release-inhibiting hormone (Somatostatin)
Corticotropin-releasing hormone or factor (CRH or CRF) Corticotropin-releasing hormone or factor (CRH or CRF) causes release of corticotropin (adrenocorticotropic hormone) in response to stress and threatening stimuli. Growth hormone release-inhibiting hormone (somatostatin) inhibits release of growth hormone. Growth hormone-releasing hormone causes the release of growth hormone in response to low blood levels of GH. Thyrotropin-releasing hormone causes the release of TSH in response to stress, such as cold.
A child has received a diagnosis of Addison's disease, and the nurse is providing health education to the child's family around hormone replacement therapy. When planning this child's care, the nurse should know that hormone replacement therapy constitutes a risk for what nursing diagnosis? A. Delayed growth and development B. Latex allergic response C. Deficient fluid volume D. Impaired gas exchange
Delayed growth and development Hydrocortisone may affect growth velocity. It is unlikely to affect allergy response, or respiration. Fluid volume excess, not deficit, is a possibility.
A 79-year-old woman has been diagnosed with osteoporosis, and the nurse is reviewing the risks and benefits of Fosamax, which her care provider has prescribed. The patient should be instructed to seek prompt medical attention if she develops which of the following? A. Musculoskeletal pain B. Esophageal bleeding C. Fever D. Sudden fatigue
Esophageal bleeding Esophageal erosion and ulcers can result in hemorrhage, which is a medical emergency. Fever, fatigue, and musculoskeletal pain warrant follow-up, but none is an emergency.
A patient is being administered propranolol (Inderal) to treat hypertension related to hyperthyroidism. Which condition will warrant the tapering and discontinuation of the propranolol (Inderal)? A. Hyperthyroidism B. Hypertension C. Euthyroid state D. Angina pectoris
Euthyroid state When the patient becomes euthyroid and hyperthyroid symptoms are controlled by definitive treatment measures, propranolol should be tapered and discontinued. Hyperthyroidism, hypertension, and angina pectoris all warrant the administration of propranolol (Inderal).
A patient is started on levothyroxine (Synthroid) for treatment of hypothyroidism. During patient teaching, how frequently can the dosage be increased until symptoms are relieved? A. Every 2 weeks B. Every 3 to 5 days C. Monthly D. Weekly
Every 2 weeks Dosage is influenced by the choice of drug. As a general rule, initial dosage is relatively small. Dosage is gradually increased at approximately 2-week intervals until symptoms are relieved. The dosage is not increased in 3 to 5 days. The dosage is not increased in 1 week. The dosage is not increased monthly.
A patient is diagnosed with type 1 diabetes. What distinguishing characteristic is associated with type 1 diabetes? A. The disease always starts in childhood. B. Oral agents can control blood sugar. C. Exogenous insulin is required for life. D. Blood glucose levels can be controlled by diet.
Exogenous insulin is required for life. Type 1 diabetes will result in eventual destruction of beta cells, and no insulin is produced. The blood glucose level can only be controlled by diet in type 2 diabetes. In type 2 diabetes, oral agents can be administered. Type 1 diabetes is diagnosed at many ages, not only in childhood.
A patient of Italian descent has been prescribed antidiabetic medications. Heavy intake of which of the following herbs should be avoided by this patient? A. Garlic B. Basil C. Anise D. Oregano
Garlic Garlic has been known to cause hypoglycemia when taken with antidiabetic medications. Anise, basil, and oregano are not noted to carry this risk.
A young man has begun weight training. Which hormone will be released in response to the increase in the size and number of muscle cells? A. Corticotropin-releasing hormone B. Thyroid-stimulating hormone C. Growth hormone D. Adrenocorticotropic hormone
Growth hormone Growth hormone stimulates the growth of body tissues, including growth of muscle cells. Corticotropin-releasing hormone causes the release of corticotropin (adrenocorticotropic hormone) in response to stress. Thyroid-stimulating hormone regulates the secretion of thyroid hormones.
An adult is diagnosed with an increased low-density lipoprotein cholesterol level. What hormone level may be low based on this diagnosis? A. Growth hormone B. Adrenocorticotropic hormone (ACTH) C. Somatostatin D. Oxytocin
Growth hormone In adults, deficient growth hormone can cause increased fat, reduced skeletal and heart muscle mass, reduced strength, reduced ability to exercise, and worsened cholesterol levels (increased low-density lipoprotein cholesterol). Adrenocorticotropic hormone, oxytocin, and somatostatin do not affect low-density lipoprotein.
A patient's medication administration record specifies that the patient is to receive 20 units of NPH insulin at 08:00. Before administering this medication, the nurse must do which of the following? A. Have a colleague confirm the dosage. B. Assess the patient's urine for the presence of glucose. C. Assess the patient's understanding of diabetes. D. Massage the chosen injection site.
Have a colleague confirm the dosage. Before administering insulin, patient safety requires that two nurses always check the dosage. Assessing the patient's understanding of the disease may or may not be appropriate or necessary at this time. Injection sites are not massaged before administration. It is not necessary to assess urine for the presence of glucose.
A nurse who provides care at a long-term care facility is preparing to administer a resident's scheduled dose of levothyroxine (Synthroid). What assessment should the nurse perform prior to administration? A. Oxygen saturation level B. Level of consciousness and orientation C. Respiratory rate D. Heart rate
Heart rate Regular monitoring of blood pressure and pulse is essential in older adults receiving Synthroid. As a general rule, levothyroxine should not be given if the resting heart rate is more than 100 beats per minute.
A home care nurse observes that a client's supply of Synthroid has run out in less than half the time that it should have. What assessment findings would be most consistent with overuse of Synthroid? A. Constipation and abdominal distention B. Bradycardia and hypotension C. Joint pain and decreased mobility D. Hyperactivity and insomnia
Hyperactivity and insomnia Adverse effects of levothyroxine include signs and symptoms of hyperthyroidism. Other more serious adverse effects are tachycardia, cardiac dysrhythmias, angina pectoris, myocardial infarction, and heart failure. Nervousness, hyperactivity, insomnia, diarrhea, abdominal cramps, nausea, vomiting, weight loss, fever, and an intolerance to heat have also been reported. Bradycardia and constipation are associated with hypothyroidism.
A patient has been diagnosed with hyperplasia of the parathyroid gland. Which of the following alterations in blood values will you expect to observe? A. Hypoparathyroidism B. Hyperthyroidism C. Hypercalcemia D. Hypocalcemia
Hypercalcemia Hyperparathyroidism is most often caused by a tumor or hyperplasia of a parathyroid gland. Hypoparathyroidism, hyperthyroidism, and hypothyroidism are not associated with hyperplasia of the parathyroid gland. Clinical manifestations and treatment of hyperparathyroidism are the same as those of hypercalcemia.
A patient with a traumatic head injury and a diagnosis of diabetes insipidus is being treated with intravenous vasopressin (Pitressin). What change in the patient's status would prompt the immediate cessation of the drug infusion? A. A rapid increase in blood glucose B. The appearance of blood in the patient's urine C. A sudden decrease in urine output D. Infiltration at the IV site
Infiltration at the IV site When administering vasopressin intravenously, it is essential to use extreme caution due to the risk of extravasation of the medication, leading to tissue necrosis. Decreased urine output is a goal of treatment. Blood in the urine and changes in blood glucose levels are atypical events.
A woman is started on propylthiouracil (PTU). What is the primary mode of action for propylthiouracil? A. Destroys part of the thyroid gland B. Suppresses the anterior pituitary hormones C. Stimulates the thyroid cells D. Inhibits production of thyroid hormone
Inhibits production of thyroid hormone The thioamide drugs inhibit synthesis of thyroid hormone. Iodine preparations inhibit the release of thyroid hormones and cause them to be stored within the thyroid gland. Propylthiouracil does not destroy part of the thyroid gland. Propylthiouracil does not suppress the anterior pituitary hormones. Propylthiouracil does not sedate the central nervous system or suppress the cardiac output.
An elderly adult woman has been diagnosed with postmenopausal osteoporosis and has been prescribed calcitonin. The nurse should anticipate administration by what route? A. Intranasal B. Oral C. Topical D. Intravenous
Intranasal Calcitonin can be administered by the intranasal route for the treatment of osteoporosis. It is not given orally, topically, or intravenously.
A child is born with cretinism. What element was lacking in the mother's diet during pregnancy? A. Iodine B. Potassium C. Sodium D. Magnesium
Iodine Cretinism is uncommon in the United States but may occur with a lack of iodine in the mother's diet. A lack of potassium, sodium, and magnesium in the mother's diet will not cause cretinism.
A patient has been prescribed acarbose (Precose). What is the advantage of acarbose over alternative drugs? A. It can replace the use of insulin. B. It prevents alkalosis. C. The patient does not have to limit food intake. D. It delays the digestion of complex carbohydrates
It delays the digestion of complex carbohydrates. Acarbose delays the digestion of complex carbohydrates into glucose and other simple sugars. Acarbose may be combined with insulin or an oral agent, usually a sulfonylurea. The patient will still need to remain on a diabetic dietary regime. The drug does not directly prevent acid-base imbalances.
An 8-month-old infant is admitted to the pediatric floor of the community hospital with a new diagnosis of diabetes. The patient is to receive 1 unit of regular insulin subcutaneously. How will that 1 unit be administered? A. It is administered as U-10. B. It is administered as U-5. C. It is administered with a TB syringe. D. It is administered orally.
It is administered as U-10. An infant should receive the dosage in a dilution strength of U-10. It is not administered orally, as U-5, or in a TB syringe.
A patient with a diagnosis of diabetes is prescribed pramlintide (Symlin). How will this drug assist in controlling the patient's blood sugar? A. It blocks the absorption of food. B. It is absorbed by insulin. C. It increases the release of insulin. D. It slows gastric emptying.
It slows gastric emptying. Pramlintide slows gastric emptying, helping to regulate the postprandial rise in blood sugar. Pramlintide does not block the absorption of food. Pramlintide is not absorbed by insulin. Pramlintide does not increase the release of insulin.
Sitagliptin (Januvia) is prescribed for a patient who has been diagnosed with type 2 diabetes. What is the action of sitagliptin (Januvia)? A. It inhibits hydrogen, potassium, and ATPase. B. It is a synthetically prepared monosodium salt. C. It blocks the S phase of the cell cycle. D. It slows the rate of inactivation of the incretin hormones.
It slows the rate of inactivation of the incretin hormones. Sitagliptin (Januvia) minimizes the rate of inactivation of the incretin hormones to increase hormone levels and prolong their activity. Sitagliptin does not block the S phase of the cell cycle. Sitagliptin is not a synthetically prepared monosodium salt. Sitagliptin does not inhibit hydrogen, potassium, and ATPase.
A girl who is 7 1/2 years old has received a diagnosis of precocious puberty from the pediatric endocrinologist. The nurse who collaborates with this physician should anticipate the administration of what drug? A. Menotropins (Pergonal) B. Leuprolide acetate (Lupron) C. Cosyntropin (Cortrosyn D. Thyrotropin alfa (Thyrogen)
Leuprolide acetate (Lupron) Leuprolide is useful for the treatment of central precocious puberty in children. Menotropins (Pergonal) stimulates ovulation. Cosyntropin (Cortrosyn) stimulates the adrenal cortex to synthesize and secrete adrenocortical hormones. Thyrotropin alfa (Thyrogen) stimulates the secretion of thyroglobulin.
A patient's recent symptoms of unexplained fatigue and listlessness have prompted a referral to the endocrinology department. A plasma corticotropin (ACTH) stimulation test for adrenal insufficiency is being performed. Following the administration of ACTH, what finding would confirm the suspected diagnosis? A. Signs of Cushing's disease B. Increased levels of CRH C. Low cortisol levels D. Stupor
Low cortisol levels Confirming the diagnosis of adrenocortical insufficiency requires a short plasma corticotropin (ACTH) stimulation test. The examiner administers corticotropin in the morning, and a subnormal blood cortisol level in the morning and afternoon confirms the diagnosis. CRH is a precursor to ACTH, and would not be directly affected. Cushing's disease is adrenocortical excess, with high cortisol levels.
When teaching young women about the hormones of reproduction, the nurse explains how the follicle matures and ruptures in ovulation. Which hormone is needed for this change? A. Luteinizing hormone (LH) B. Leydig's cells C. Follicle-stimulating hormone (FSH) D. Thyrotropin (TSH)
Luteinizing hormone (LH) LH is important in the maturation and rupture of the ovarian follicle. TSH regulates the secretion of thyroid hormones. FSH stimulates the functions of sex glands. Leydig's cells are stimulated by LH in men to secrete androgens.
A patient is diagnosed with infertility. What medication may the nurse administer for the treatment of infertility? A. Thyrotropin alfa (Thyrogen) B. Pegvisomant (Somavert) C. Somatotropin (Humatrope) D. Menotropins (Pergonal)
Menotropins (Pergonal) Menotropins (Pergonal) is administered in combination with HCG to induce ovulation. Thyrotropin alfa (Thyrogen) is a synthetic formulation of TSH used as a diagnostic adjunct for serum thyroglobulin. Pegvisomant (Somavert) is a growth hormone receptor antagonist used in the treatment of acromegaly in adults. Somatotropin (Humatrope) is administered to children for impaired growth.
A 5-year-old child is diagnosed with hypothyroidism. What will the patient likely develop if the condition is left untreated? A. Paralytic ileus B. Mental retardation C. Renal dysfunction D. An immune disorder
Mental retardation If cretinism is untreated until the child is several months old, permanent mental retardation is likely to result. The patient will not suffer from renal dysfunction, an immune disorder, or paralytic ileus.
A patient who regularly takes metformin has developed a severe infection. How will the infection change his diabetic regimen? A. Metformin will allow the patient to decrease the absorption of glucose. B. Metformin will be given more frequently to decrease blood sugar. C. Metformin will result in better regulation of blood sugar. D. Metformin is contraindicated in the presence of an infection.
Metformin is contraindicated in the presence of an infection. Metformin is contraindicated in patients with diabetes complicated by fever, severe infections, severe trauma, major surgery, acidosis, and pregnancy. Metformin will not be given more frequently to decrease blood sugar. Metformin should be discontinued and is not administered for better regulation of blood sugar. Metformin will not decrease the absorption of glucose in this patient.
A patient suffers from hyponatremia, hypoglycemia, and lactic acidosis. What condition is most consistent with this clinical presentation? A. Congenital hypothyroidism B. Cretinism C. Myxedema coma D. Psychotic depression
Myxedema coma Myxedema coma is severe, life-threatening hypothyroidism characterized by coma, hypothermia, cardiovascular collapse, hypoventilation, and severe metabolic disorders, such as hyponatremia, hypoglycemia, and lactic acidosis.
A patient has been diagnosed with myxedema. She currently takes ibuprofen (Motrin) for knee pain. For what is this patient at increased risk? A. Pulmonary congestion B. Nephrotoxicity C. Apnea D. Tachycardia
Nephrotoxicity A patient diagnosed with myxedema cannot metabolize and excrete drugs, so she is at an increased risk of developing nephrotoxicity. Pulmonary congestion, tachycardia, and apnea are not adverse effects related to myxedema or the administration of ibuprofen (Motrin).
A patient has been diagnosed with acromegaly. Which of the following medications may be ordered to treat this endocrine disorder? A. Gonadorelin acetate (Lutrepulse) B. Octreotide (Sandostatin) C. Nafarelin (Synarel) D. Gonadorelin hydrochloride (Factrel)
Octreotide (Sandostatin) Prescribers order octreotide for patients with acromegaly to reduce levels of GH. Gonadorelin hydrochloride, nafarelin, and gonadorelin acetate are not administered to treat acromegaly.
An older adult patient has been on oral corticosteroids to decrease the symptoms of chronic obstructive pulmonary disease. What is the patient at risk for developing? A. Osteoporosis B. Oat cell carcinoma C. Osteoarthritis D. Paget's disease
Osteoporosis Drugs used for hypercalcemia, such as corticosteroids, place the patient at risk for developing osteoporosis due to the demineralization of the bone. The patient is not at risk for developing osteoarthritis or oat cell carcinoma. Paget's disease is an inflammatory condition and is not caused by corticosteroid use.
A patient suffers from numbness and tingling around the mouth and has a positive Trousseau's sign after a thyroidectomy. Which of the following medications will be administered? A. Parenteral calcium gluconate B. Parenteral potassium chloride C. Parenteral digoxin (Lanoxin) D. Parenteral normal saline
Parenteral calcium gluconate The patient has acute hypocalcemia as evidenced by numbness and tingling around the mouth and a positive Trousseau's sign. An intravenous calcium salt, such as calcium gluconate, is given for acute symptomatic hypocalcemia. Parenteral normal saline may be administered, but it will not increase the calcium level. The administration of potassium chloride parenterally must be diluted and will not affect the calcium level. Parenteral digoxin (Lanoxin) will not be administered.
A 58-year-old patient who has been living with diabetes since age 14 states he has pain in his feet and hands. What is this pain most likely a result of? A. Hypertension resulting from diabetes B. An autoimmune disorder C. Peripheral neuropathy D. A diabetes-related infectious process
Peripheral neuropathy Pain in the feet and hands is related to changes in small blood vessels resulting in neuropathy. The long-term effect of diabetes can result in an infectious process, but the pain described is not indicative of an infection. Latent autoimmune diabetes of the adult has an onset in adulthood and thus is not a long-term disorder. Hypertension is a long-term chronic effect of diabetes but is not what has been described with pain in the feet and hands.
An older adult resident of a long-term care facility has been prescribed calcium citrate to address her decreasing bone density. The nurse should review the resident's medication administration record knowing that what medication may decrease the effects of calcium? A. Hydrochlorothiazide B. Prednisone C. Ibuprofen D. Diltiazem (Cardizem)
Prednisone Corticosteroids reduce the effects of calcium by various mechanisms. Thiazide diuretics have the opposite effect. NSAIDs and calcium channel blockers do not appreciably affect the pharmacokinetics of calcium supplements.
A patient is scheduled for a thyroidectomy to treat thyroid cancer. What is the medication of choice administered preoperatively? A. Methimazole (Tapazole) B. Propranolol (Inderal) C. Propylthiouracil (PTU) D. Sodium iodide 131I (Iodotope)
Propylthiouracil (PTU) Propylthiouracil (PTU) is administered preoperatively for thyroidectomy. Sodium iodide131 (Iodotope) is a radioactive iodide that is used to destroy thyroid tissue. Methimazole (Tapazole) is similar to PTU but is not the drug of choice preoperatively. Propranolol (Inderal) is used to treat cardiovascular conditions, such as hypertension. It is not used in the preoperative phase of thyroidectomy.
A patient is in diabetic ketoacidosis. The patient blood glucose level is over 600 mg/dL. The physician has ordered the patient to receive an initial dose of 25 units of insulin intravenously. What type of insulin will most likely be administered? A. Ultralente insulin B. Lente insulin C. Regular insulin D. NPH insulin
Regular insulin Regular insulin has rapid onset of action and can be given via IV. It is the drug of choice for acute situations, such as diabetic ketoacidosis. Isophane insulin (NPH) is used for long-term insulin therapy. Lente insulin is an intermediate-acting insulin. Ultralente insulin is a long-acting insulin.
A patient is scheduled to begin a drug regimen for the treatment of hyperthyroidism. Prior to administering propylthiouracil (PTU), the nurse has reviewed the relevant black box warning and should teach the patient about the need for what form of follow-up? A. Serial complete blood counts B. Routine liver function testing C. Daily nonfasting blood glucose testing D. Chest radiographs every 3 months
Routine liver function testing The FDA has issued a black box warning for PTU stating that severe liver injury resulting in death or acute liver failure may occur within 6 months of treatment. All patients should receive instructions about the signs and symptoms of acute liver failure. Routine liver function testing to assess for liver failure is important. There is no specific need for chest radiographs, CBCs, or glucose monitoring.
A patient is to receive a medication that the nurse recognizes as an expectorant that is normally administered for the treatment of hyperthyroidism. Which medication will be administered? A. Propylthiouracil (PTU) B. Saturated solution of potassium iodide (SSKI) C. Methimazole (Tapazole) D. Sodium iodide131I (Iodotope)
Saturated solution of potassium iodide (SSKI) Saturated solution of potassium iodide (SSKI) is more often used as an expectorant but may be given as a preparation for thyroidectomy. Propylthiouracil (PTU) is not administered as an expectorant. Methimazole (Tapazole) is not administered as an expectorant. Sodium iodide 131I (Iodotope) is not administered as an expectorant.
A 55-year-old female patient was successfully treated for thyroid storm earlier in the year. In subsequent health education, the nurse should caution the patient against excessive intake of what foods? A. Seafood and kelp B. Leafy green vegetables and beef C. Purine-rich foods D. Red wine and aged cheeses
Seafood and kelp Iodine is associated with thyroid storm and is present in foods (especially seafood and kelp) and in radiographic contrast dyes. Reports of iodine-induced hyperthyroidism have been reported after ingestion of dietary sources of iodine.
A patient has suffered from hypoglycemia twice in the past week. She states she eats one meal per day and snacks the rest of the day. What patient education will you provide for this patient? A. She should limit her alcohol with meals. B. She should increase her caloric intake. C. She should increase her protein intake during snacks. D. She should not eat at sporadic times.
She should not eat at sporadic times. A regular dietary intake associated with the administration of insulin or oral hypoglycemic will prevent episodes of hypoglycemia. The patient should limit her alcohol consumption, but alcohol consumption does not contribute to hypoglycemia. The patient should not necessarily increase her caloric or protein intake. The patient should coordinate her exercise with her dietary intake, but dietary intake is not the cause of her hypoglycemia
A patient who is being cared for in the intensive care unit (ICU) is receiving desmopressin. In light of the black box warning that accompanies this drug, the ICU nurse should prioritize the assessment of which of the patient's laboratory values? A. Sodium B. Hematocrit C. Calcium D. Platelets
Sodium The FDA has issued a black box warning stating that patients taking desmopressin can develop hyponatremia, leading to seizures. Consequently, assessment of sodium levels takes precedence over hematocrit, calcium, and platelet levels.
A patient has been diagnosed with hyperthyroidism. She is scheduled to receive a medication to destroy the thyroid gland. Which medication will be administered? A. Sodium iodide 131I (Iodotope) B. Propylthiouracil (PTU) C. Methimazole (Tapazole) D. Saturated solution of potassium iodide (SSKI)
Sodium iodide 131I (Iodotope) Sodium iodide 131I (Iodotope) is a radioactive isotope of iodine. Therapeutic doses act by emitting beta and gamma rays, which destroy thyroid tissue and thereby decrease the production of thyroid hormones. Propylthiouracil (PTU) is not administered to destroy thyroid tissue. Methimazole (Tapazole) is not administered to destroy thyroid tissue. Saturated solution of potassium iodide (SSKI) is not administered to destroy thyroid tissue.
A 72-year-old woman has been diagnosed with osteoporosis and has begun taking alendronate (Fosamax). The nurse should be aware that this drug can increase the woman's bone density by which of the following means? A. Decreasing renal excretion of calcium B. Enhancing the function of osteoblasts C. Suppressing the function of osteoclasts D. Increasing the binding of vitamin D to calcium ions
Suppressing the function of osteoclasts Alendronate suppresses osteoclast activity on newly formed resorption surfaces, which reduces bone turnover. This means that bone formation exceeds resorption at remodeling sites, leading to progressive gains in bone mass. Fosamax does not enhance osteoblast function or affect the renal excretion of calcium. It does not influence the chemical interaction between vitamin D and calcium.
A patient has been prescribed alendronate (Fosamax). Which of the following instructions should the patient be given regarding the administration of this medication? A. Take the medication and lie down for 30 minutes. B. Take the medication with whole milk. C. Take the medication on an empty stomach. D. Take the medication to increase bone resorption.
Take the medication on an empty stomach. Alendronate (Fosamax) must be taken on an empty stomach. Alendronate (Fosamax) should not be taken with milk or food. The patient should be sitting up or ambulatory for 30 minutes after taking the medication. The medication decreases bone resorption, not increases it.
A patient with hypothyroidism is started on levothyroxine (Synthroid). What should the patient be taught regarding medication administration in the home setting? A. Do not exercise with the medication. B. Take the medication on an empty stomach. C. Levothyroxine has a short half-life. D. Take medication with milk or food.
Take the medication on an empty stomach. Levothyroxine (Synthroid) should be taken on an empty stomach to increase absorption. The medication should not be taken with food. Exercise has no effect on the administration of the medication. Levothyroxine has a long half-life of about 6 to 7 days.
Somatropin has been prescribed for a child who has been diagnosed with growth hormone deficiency. When providing health education to the child's parents, what teaching point should then nurse prioritize? A. The rationale for not crushing the extended-release tablet B. The need to limit the child's activity level for the duration of treatment C. The correct technique for daily injections of the drug D. The importance of regular blood pressure monitoring
The correct technique for daily injections of the drug Somatropin is administered by daily injections. Blood pressure monitoring and activity limitations are not necessary.
A 13-year-old boy who is in the first percentile of height for his age has been referred for care. Which of the following assessment findings would contraindicate the safe and effective use of somatropin to treat his growth deficiency? A. The sutures of the boy's skull have not yet fully closed. B. The boy has low serum albumin levels. C. The epiphyses of the boy's long bones have closed. D. The boy has not yet begun puberty.
The epiphyses of the boy's long bones have closed. Somatropin is ineffective when impaired growth is present after puberty, when the epiphyses of the long bones have closed. Low albumin is not a contraindication to the use of somatropin. The sutures of the skull close early in life.
A patient with suspected adrenal insufficiency has been administered 1 mcg of cosyntropin (Cortrosyn) as an IV bolus. Serum testing 30 minutes later reveals a markedly elevated level of cortisol. What conclusion should the nurse infer from this finding? A. The patient has secondary adrenal insufficiency. B. The patient has normal adrenocortical function. C. The patient has primary adrenal insufficiency. D. The patient has Addison's disease.
The patient has normal adrenocortical function. The low-dose test involves the administration of 1 mcg of cosyntropin (Cortrosyn) as an IV bolus. In people with normal adrenocortical function, an increase in cortisol occurs in 20 minutes.
A patient with a long-standing diagnosis of Addison's disease has been taking hydrocortisone for several years, achieving adequate symptom control. In recent weeks, the patient has experienced profound stress resulting from the collapse of his small business and subsequent conflict with his business partner. How might the presence of these stressors affect the patient's medication regimen? A. The patient should take his scheduled hydrocortisone later in the day. B. The patient's hydrocortisone should be temporarily withheld. C. The ratio of mineralocorticoids to glucocorticoids should be adjusted. D. The patient may temporarily require a higher dose of hydrocortisone.
The patient may temporarily require a higher dose of hydrocortisone. During times of increased stress, the dosage of the medication may need to be increased. There would be no need to change the ratio of mineralocorticoids to glucocorticoids or to take the medications later in the day.
A patient will soon begin treatment for diabetes using glyburide. Which of the following conditions must be met in order for treatment to be effective? A. The patient must have functioning pancreatic beta cells. B. The patient must have hemoglobin A1C of ≤7%. C. The patient must be able to self-administer the medication. D. The patient must not have hyperglycemia.
The patient must have functioning pancreatic beta cells. Because glyburide stimulates pancreatic beta cells to produce more insulin, it is effective only when functioning pancreatic beta cells are present. The presence of normal blood glucose levels would render the medication unnecessary. Self-administration is common but not absolutely necessary.
A patient with a diagnosis of Addison's disease has had fludrocortisone acetate (Florinef Acetate) added to his medication regimen by his endocrinologist. What is the most plausible rationale for this change in treatment? A. The patient's anterior pituitary gland is overstimulated. B. The patient's adrenal cortex has become resistant to hydrocortisone. C. The patient requires increased mineralocorticoid supplementation. D. The patient's GI tract is unable to tolerate hydrocortisone.
The patient requires increased mineralocorticoid supplementation. If a patient with Addison's disease requires additional mineralocorticoid supplementation, then fludrocortisone acetate (Florinef Acetate) may be indicated. Pituitary dysfunction, GI intolerance, and resistance to hydrocortisone are not plausible rationales.
A patient's current drug regimen includes intranasal administration of desmopressin acetate (DDAVP, Stimate). In this patient's plan of nursing care, what is the most likely desired outcome of treatment? A. The patient will ovulate at least once over the next 8 weeks. B. The patient will gain 2 cm in height over the next 6 months. C. The patient's vertical growth will cease in the next 4 weeks. D. The patient's urine output will not exceed 80 mL/h.
The patient's urine output will not exceed 80 mL/h. Desmopressin acetate (DDAVP, Stimate) is the prototype posterior pituitary hormone medication. It is used to treat diabetes insipidus. Consequently, reduced urine output is the primary goal of treatment. The drug does not influence growth or ovulation.
A patient has had surgery. After the surgical procedure, the patient starts to shiver and chill. What hormone will be released in response to the reaction to cold? A. Somatostatin B. Luteinizing hormone C. Thyroid-stimulating hormone D. Corticotropin
Thyroid-stimulating hormone Thyroid-stimulating hormone is released in response to stress, such as exposure to cold. Luteinizing hormone is released in response to gonadotropin-releasing hormone. Corticotropin stimulates the adrenal cortex to produce corticosteroids. Somatostatin inhibits the release of growth hormone.
A patient has a decreased calcium level. Which of the following will participate in raising the patient's calcium level? A. Vitamin C B. Vitamin D C. Vitamin B12 D. Ferrous sulfate
Vitamin D Vitamin D is a fat-soluble vitamin that plays an important role in calcium and bone metabolism. Vitamin C, ferrous sulfate, and vitamin B12 do not play a role in calcium and bone metabolism.
A community health nurse is leading a health promotion workshop during a community health fair. A participant has asked the nurse for advice on the necessity of calcium supplements. The nurse should respond in the knowledge that which of the following demographic groups frequently have low calcium levels? Select all that apply. A. Elementary-aged children B. Middle-aged women C. Older women D. Young women E. Middle-aged men
Young women & Older women Experts believe that the diets of most people of all ages, but especially of young women and older adults, are deficient in calcium.
When assessing for therapeutic effects of mitotane in a patient with adrenocortical carcinoma, the nurse should expect to identify A. a decrease in urine output. B. a decrease in blood pressure. C. a decrease in agitation. D. an audible S3.
a decrease in blood pressure. A decrease in blood pressure is an expected therapeutic effect of mitotane. An audible S3 is not expected. Mitotane does not address agitation or high urine output.
A patient has been admitted in acute hypercalcemia and has been determined to have a serum calcium level of 12.9 mg/dL. The emergency department nurse's priority intervention is A. oxygen supplementation. B. subcutaneous administration of exogenous parathyroid hormone (PTH). C. administration of IV normal saline. D. administration of IV calcitonin.
administration of IV normal saline. Acute hypercalcemia is a medical emergency, and rehydration is a priority; it is essential to administer an IV saline solution. Calcitonin is not administered by the IV route. PTH is not administered exogenously and would exacerbate hypercalcemia.
Hydrocortisone has been prescribed to a patient for the treatment of Addison's disease, and the patient will soon be discharged. The nurse should encourage the patient to take this medication A. with an antacid. B. at least 30 minutes before or 2 hours after meals. C. before 9 AM D. at bedtime.
before 9 AM Administration of hydrocortisone should take place every morning before 9 AM. This minimizes HPA suppression. People should take the oral preparation with food to decrease gastric irritation.
A nurse reviews the current medication administration record of a patient who has recently been prescribed octreotide. The nurse performs this important safety action in order to prevent drug interactions that could result in A. anaphylaxis. B. increased growth. C. cardiac complications. D. respiratory arrest.
cardiac complications. Numerous medications combine with octreotide to result in a prolonged QT interval with an increased risk of ventricular dysrhythmia and cardiac arrest. Increased growth, anaphylaxis, and respiratory arrest are not noted adverse effects or the result of drug interactions with octreotide.
A patient has been diagnosed with hypothyroidism and admits to the nurse that she has heard of her thyroid gland but does not know the function of thyroid hormone. The nurse should explain the fact that thyroid hormone is responsible for A. stimulating the brain and sex organs. B. controlling the rate of cell metabolism throughout the body. C. regulating the levels of most other hormones in the body. D. regulating levels of glucose in the blood and body tissues.
controlling the rate of cell metabolism throughout the body. Thyroid hormones control the rate of cellular metabolism and thus influence the functioning of virtually every cell in the body. The heart, skeletal muscle, liver, and kidneys are especially responsive to the stimulating effects of thyroid hormones. The brain, spleen, and gonads are less responsive. Thyroid hormone does not primarily influence glucose levels or the function of the endocrine system.
An adult patient has been diagnosed with a posterior pituitary lesion that has resulted in diabetes insipidus. The characteristic sign of this health problem is A. copious urine production. B. hematuria. C. hyperglycemia that is unresponsive to exogenous insulin. D. blood glucose levels ≥ 400 mg/dL.
copious urine production. Characteristic features of DM include polyuria, with excretion of dilute urine ranging from 4 L to as much as 30 L. Hematuria does not normally occur, and blood glucose levels are not directly affected.
A patient with a diagnosis of Cushing's disease has been admitted to the emergency department after taking a fall on the sidewalk outside her apartment building. This patient's underlying disease process creates increased risks of A. bruising and hematoma. B. fractures and impaired wound healing. C. hemorrhage and impaired hemostasis. D. neurovascular complications and rhabdomyolysis.
fractures and impaired wound healing. Cushing's disease results in low bone density and impaired wound healing. It does not typically cause impaired hemostasis or neurovascular problems.
A middle-aged patient is proud of the fact that she is proactive with her health maintenance and tells the nurse that she has been taking 2400 International Units of vitamin D daily, stating, "More is better when it comes to vitamins." The nurse should provide health teaching to the patient because her current vitamin D intake creates a risk for A. hyperphosphatemia. B. tetany. C. hypocalcemia. D. hypercalcemia.
hypercalcemia. It is important to take vitamin D supplements cautiously and not overuse them; excessive amounts can cause serious problems, including hypercalcemia. Tetany is associated with hypocalcemia. Hypophosphatemia typically accompanies hypercalcemia.
A patient has undergone a thyroidectomy in which his parathyroid glands were also inadvertently removed. The patient's morning blood work reveals a serum calcium level of 3.1 mg/dL (normal 8.5 to 10.5 mg/dL). The nurse should consequently assess this patient's A. level of consciousness. B. muscle tone. C. respiratory rhythm. D. respiratory rate.
muscle tone. Low calcium levels can result in tetany. Decreased LOC and altered respiratory function are not characteristic of hypocalcemia.
