Pharm Final: ENDOCRINE (18 on exam)

Which period of time would a nurse recognize as the greatest risk of hypoglycemia when caring for a client who receives regular insulin daily at 8:00 AM? 8:30 AM to 9:30 AM 8:00 PM to 12:00 AM 1:00 PM to 8:00 PM 10:00 AM to 1:00 PM

10:00 AM to 1:00 PM

Which period of time would a nurse recognize as the greatest risk of hypoglycemia when caring for a client who receives regular insulin daily at 8:00 AM? 8:30 AM to 9:30 AM 8:00 PM to 12:00 AM 1:00 PM to 8:00 PM 10:00 AM to 1:00 PM

10:00 AM to 1:00 PM · Peaks 2-4 hours AND IV OK

Peak time for Short acting insulin

2-4 hrs

Peak time for Rapid acting insulin (Aspart, Lispro, Glulisine)

30-90 min

Peak time of Intermediate-Acting Insulin (NPH)

4-12 hrs

A nurse is reviewing laboratory data for a client taking pramlintide for diabetes management. Which clinical finding indicates medication effectiveness? A Postprandial glucose of 160 mg/dL B Hemoglobin A1c of 8.5% C Fasting blood glucose of 135 mg/dL D Preprandial glucose of 150 mg/dL

A Postprandial glucose of 160 mg/dL • "Lower the Glucose"-tide x i · LAB we check... o Postprandial (after ya eat) glucose levels below 180 mg/dL..

Which finding would lead the nurse to recheck the blood glucose level of a diabetic client before administering a mealtime insulin dose? Select all that apply. One, some, or all responses may be correct. Confusion Drowsiness Diaphoresis Nervousness Heart rate 110 beats/min

All are s/s of hypoglycemia

At 9 am, the nurse administers 10 units of insulin aspart subcutaneously to a client with a blood sugar of 322 mg/dL. At approximately what time should the nurse expect the insulin to peak? A At 9:30 am B At 10:00 am C At noon D This insulin does not peak because it acts over 24 hours.

B Peaks 30-60 minutes

At the client's request, the nurse performs a fingerstick to test the client's blood glucose and the results are 322 mg/dL (17.9 mmol/L). Following the insulin sliding scale orders, the nurse administers 3 units of insulin lispro at 11:00 AM. When does the nurse anticipate the insulin lispro will begin to act? A 3:00 pm B 11:15 am C 1:00 pm D 12:00 PM

B 11:15 am

A client asks the nurse if glipizide (Glucotrol) is an oral insulin. Which response should the nurse provide? A. "Yes, it is an oral insulin and has the same actions and properties as intermediate insulin." B. "Yes, it is an oral insulin and is distributed, metabolized, and excreted in the same manner as insulin." C. "No, it is not an oral insulin and can be used only when some beta cell function is present." D. "No, it is not an oral insulin, but it is effective for those who are resistant to injectable insulins."

C

A client has been diagnosed with hypothyroidism. Which medication should the nurse administer to treat the client's bradycardia? A Epinephrine B Adenosine C Levothyroxine D Atropine

C

The nurse understands that the prescribed levothyroxine is effective when the client with hypothyroidism makes which statement? A "I still feel lethargic and fatigued." B "I have to change my sheets in the morning because I sweat a lot at night." C "I have been having daily, formed bowel movements." D "I was reprimanded at work after becoming angry with my boss."

C

A nurse is educating a client with diabetes type 2 about newly prescribed glipizide. Which statement by the nurse best describes the action of glipizide? A "This medication absorbs the excess carbohydrates from your intestinal tract." B "This medication will inhibit the release of glucose stored in the liver." C "This medication will stimulate your pancreas to release insulin." D "This medication works by increasing the ability of the cells to uptake glucose."

C "This medication will stimulate your pancreas to release insulin."

A nurse is preparing to administer insulin to a client with diabetes mellitus type 1. The client has regular insulin and insulin glargine prescribed. How will the nurse prepare these medications? A Draw up the glargine insulin before the regular insulin B Mix the insulins in a larger syringe C Use a separate syringe for each insulin D Draw up the regular insulin before the glargine insulin

C Use a separate syringe for each insulin · CANNOT mix with other insulins · CANNOT give via IV Infusion (like NPH)

Which medication will the nurse expect the health care provider to prescribe to a client who had a thyroidectomy and is pale with spasms of the hand when taking the blood pressure? Calcium Magnesium Bicarbonate Potassium chloride

Ca

The client is newly diagnosed with type 1 diabetes mellitus. Which of these approaches would be the best strategy for the nurse to use when teaching insulin injection techniques? A Give written pre and post tests B Allow another diabetic to assist C Ask questions during practice D Observe a return demonstration

D Observe a return demonstration

A client with hyperthyroidism is to receive potassium iodide solution before a subtotal thyroidectomy is performed. Which purpose would the nurse include when explaining why this medication is prescribed? Decreases the total basal metabolic rate Maintains the function of the parathyroids Blocks the formation of thyroxine by the thyroid gland Decreases the size and vascularity of the thyroid gland

Decreases the size and vascularity of the thyroid gland

The nurse is caring for a client with type 1 diabetes. Which signs or symptoms may indicate that the client has insulin-induced hypoglycemia? Select all that apply. One, some, or all responses may be correct. Excessive hunger Weakness Diaphoresis Excessive thirst Deep respirations

Excessive hunger Weakness Diaphoresis · ***Signs and Symptoms*** o *Diaphoresis x 4 Excessive hunger is associated with hypoglycemia because the body needs glucose for cellular metabolism. Excessive thirst is associated with hyperglycemia because fluid shifts, along with the excess glucose being excreted by the kidneys, result in polyuria.

The nurse prepares to administer extended-release metformin to an older adult who has asked that it be crushed because it is difficult to swallow. Which rationale will prompt the nurse to ask the provider for a different form of metformin? This medication has a wax matrix frame that is difficult to crush. The medication has an unpleasant taste, which most clients find intolerable if crushed. If crushed, this medication irritates mucosal tissue and can cause oral and esophageal ulcer formation. Extended-release formulations are designed to be released slowly and crushing the tablet will prevent this from occurring.

Extended-release formulations are designed to be released slowly and crushing the tablet will prevent this from occurring. Don't crush Extended Release ever...

A client who receives NPH insulin every morning reports feeling nervous at 4:30 PM. The nurse observes that the client's skin is moist and cool. Which condition is the client likely experiencing? Hyperosmolar hyperglycemic nonketotic state Ketoacidosis Glycogenesis Hypoglycemia

Hypoglycemia Peak of NPH is 4-12 hrs

A client with type 1 diabetes receives 30 units of neutral protamine Hagedorn (NPH) insulin at 7:00 AM. At 3:30 PM, the client becomes diaphoretic, weak, and pale. With which condition would the nurse determine that these physiological responses are associated? Diabetic coma Hyperosmolar hyperglycemic nonketotic syndrome Diabetic ketoacidosis Hypoglycemic reaction

Hypoglycemic reaction NPH leak is 4-12 hrs

Intravenous fluids and insulin are prescribed to treat a client's diabetic ketoacidosis. The client develops peripheral paresthesias and shortness of breath. The cardiac monitor shows the appearance of a U wave. Which complication would the nurse suspect? Hypokalemia Hypoglycemia Hypernatremia Hypercalcemia

Hypokalemia o IV Insulin + Dextrose(or glucose in your blood) = DROP in your Potassium Level

Which insulin will the nurse prepare for the emergency treatment of ketoacidosis? Glargine NPH insulin Insulin aspart Insulin detemir

Insulin aspart Peaks 30-60 minutes • Rapid Acting Insulin is G.A.L. x i • glulisine (Apidra), aspart (Novolog), lispro (Humalog)

A client with diabetes mellitus is scheduled to receive an intravenous (IV) administration of 25 units of insulin in 250 mL normal saline. Which type of insulin would the nurse recognize as compatible with IV solutions? NPH insulin Insulin lispro Insulin detemir Insulin glargine

Insulin lispro

The health care provider prescribes metformin as monotherapy for the client with type 2 diabetes. The nurse will teach the client to monitor for which adverse effect? Weight gain Constipation Lactic acidosis Hypoglycemia

Lactic acidosis

The nurse identifies a nontender 5-cm indurated region on the upper arm of a client with type 1 diabetes. The client says to the nurse, 'That is where I give myself insulin shots.' The nurse concludes that the nodule is a result of which condition? Callus An allergy An infection Lipodystrophy

Lipodystrophy

Intravenous (IV) insulin is prescribed for a client in. Which insulin can be administered IV? Select all that apply. One, some, or all responses may be correct. Lispro insulin Aspart insulin Regular insulin Glargine insulin Glulisine insulin

Lispro, Aspart, Regular, Glulisine insulin GAL and Regular: IV only

In addition to clients who are receiving insulin for type 1 diabetes, the nurse will assess for signs and symptoms of hypoglycemia in clients who have which diagnosis? Liver failure Anemia Hyperthyroidism Stage 3 hypertension

Liver failure

Which independent nursing action would be included in the plan of care for a client after an episode of ketoacidosis? Monitoring for signs of hypoglycemia resulting from treatment Withholding glucose in any form until the situation is corrected Giving fruit juices, broth, and milk as soon as the client is able to take fluids orally Regulating insulin dosage according to the client's urinary ketone levels

Monitoring for signs of hypoglycemia resulting from treatment

A client with type 1 diabetes self-administers neutral protamine Hagedorn (NPH) insulin every morning at 8:00 AM. The nurse evaluates that the client understands the action of the insulin when the client identifies which time range as the highest risk for hypoglycemia? 9:00 AM to 10:00 AM 10:00 AM to 11:00 AM Noon to 8:00 PM 8:00 PM to midnight

Noon to 8:00 PM Peaks in 4-12 hours AND NOOOO IV

The nurse is planning an evening snack for a child receiving NPH insulin. The nurse offers a snack for which reason? It encourages the child to stay on the diet. Energy is needed for immediate utilization. Extra calories will help the child gain weight. Nourishment helps counteract late insulin activity.

Nourishment helps counteract late insulin activity.

Which purpose of insulin would a nurse identify when caring for a client prescribed insulin added to a solution of 10% dextrose in water after an intravenous solution containing potassium inadvertently was infused too rapidly? Glucose with insulin increases metabolism, which accelerates potassium excretion. Increased potassium causes a temporary slowing of the pancreatic production of insulin. Increased insulin accelerates the excretion of glucose and potassium, thereby decreasing the serum potassium level. Potassium follows glucose into the cells of the body, thereby raising the intracellular potassium level.

Potassium follows glucose into the cells of the body, thereby raising the intracellular potassium level.

A client is scheduled to have a thyroidectomy. Which medication is indicated for decreasing the size and vascularity of the thyroid gland before surgery? Vasopressin Levothyroxine Propylthiouracil Potassium iodide

Potassium iodide

Which advice will the nurse give the client to avoid lipodystrophy when self-administering insulin therapy? Exercise regularly. Rotate injection sites. Use the Z-track technique. Vigorously massage the injection site.

Rotate injection sites.

Which time for medication scheduling would a nurse teach to a client prescribed the oral pancreatic enzymes pancrelipase? At bedtime With meals One hour before meals On arising each morning

With meals

When would the nurse plan to administer pancrelipase to a child with cystic fibrosis? With meals and snacks In the morning and at bedtime On awakening and every 3 hours while the child is awake After each bowel movement and after postural drainage is performed

With meals and snacks

The nurse is preparing to teach a client with type 2 diabetes mellitus about their newly prescribed exenatide pen. Which instructions should the nurse include? Select all that apply. Take the exenatide immediately after meals. You may experience some weight loss. Take any oral medications 1 hour before the exenatide. Inject yourself in the abdominal or thigh area. After use, store the injector pen in the refrigerator.

You may experience some weight loss. Take any oral medications 1 hour before the exenatide. Inject yourself in the abdominal or thigh area. • "Lower the Glucose"-tide x i

peak time for long acting insulin

no peak time

Which explanation will the nurse give as to why potassium iodide solution should be taken before a subtotal thyroidectomy? "The metabolic rate of the body will increase." "It will reduce the risk of hemorrhage during surgery." "It will maintain the functioning of the parathyroid glands." "The amount of thyroid hormones being secreted will decrease."

"It will reduce the risk of hemorrhage during surgery." • Potassium Iodide x I (for hyperthyroid) · Decreases size and vascularity of thyroid gland

Which response would a nurse give to a client taking an oral hypoglycemic tablet daily who asks if an extra tablet should be taken before exercise? "You will need to decrease your exercise." "An extra tablet will help your body use glucose correctly." "When taking medicine, your diet will not be affected by exercise." "No, but you should observe for signs of hypoglycemia while exercising."

"No, but you should observe for signs of hypoglycemia while exercising."

Which is the priority short-term goal when teaching a client with type 1 diabetes who is placed on an insulin pump to control the diabetes? "The client will adhere to the medical regimen." "The client will remain normoglycemic for 3 weeks." "The client will demonstrate correct use of the insulin pump." "The client will list three self-care activities that are necessary to control the diabetes."

"The client will demonstrate correct use of the insulin pump."

A child is prescribed insulin glargine before breakfast. Which instruction is most appropriate for the nurse to give the parents regarding a bedtime snack? 'Offer a snack to prevent hypoglycemia during the night.' 'Give the child a snack if signs of hyperglycemia are present.' 'Avoid a snack because the child is being treated with long-acting insulin.' 'Keep a snack at the bedside in case the child gets hungry during the night.'

'Offer a snack to prevent hypoglycemia during the night.'