Pharmacology II NR406B Exam 1 (Endocrine, Genitourinary, Acne) Regis University 2015
A patient is placed on Accutane. He finishes the course of 20 weeks, and gets about 85% improvement of his acne. He talks to the nurse about getting a second course of the medication. How should the nurse respond?
"If the doctor approves a second course of Accutane, you will have to wait 2 months before starting it".
Long lasting oral med with mineralcorcoid & mod glucorticoid activity. -prescribed for long term tx addisons disease -help restore electrolyte balance
(Florinef) Fludocortisone Acetate
The following are 3 true statements regarding the iPledge Program.
1. Each female patient must use two effective forms of birth control, even if one of them is tubal ligation or vasectomy of the male partner. 2. For female patients, pregancy must be ruled out before the initial prescription and again before each monthly refill. Two pregnancy tests are required prior to the initial prescription. 3. All transactions involving Isotretinoin must be processed through a central automated system. Rules will apply to the prescriber, patient, pharmacist and wholesale.
Name 3 conditions PDE5 Inhibitors can be used for?
1. Erectile Dysfunction 2. BPH 3. Pulmonary Hypertension
Aside from P. acnes what are at least 2 other possible causes of acne?
1. Excessive sebum production 2. Androgenic hormonal triggers
What agents will reduce the number of vasomotor symptoms (hotflashes) in women experiencing menopause? (Name 3)
1. SSRI's and SNRI's Also reduces depression 2. Clonidine (Catapres) Antihypertensive agent 3. Gabapentin (Neurontin) Antiseizure agent
What is true regarding drugs for the treatment of BPH? (2 things)
1. These drugs will alleviate symptoms, but will not cure the disorder. 2. They will be taken for the remainder of the patients life
A nurse is giving instructions to a patient on acne treatment. Name 2 important things she should implement for this patient when cleaning his skin to treat acne.
1. Use warm water and a MOISTURIZER FREE mild facial soap. 2. Make sure to avoid vigorous scrubbing as that can irritate the skin
What is diabetes insipidus?
1. central DI - underproduction f ADH 2. nephrogenic DI - decreased renal response to ADH
Gonadotropic hormone includes what 2 hormones?
1. follicle-stimulating hormone (FSH) 2. luteinizing hormone (LH)
What hormones originate in the anterior pituitary gland? (6)
1. growth hormone 2. thyroid stimulating hormone 3. adrenocorticotropin hormone 4. gonadotropic hormone 5. melanocyte stimulating hormone 6. prolactin
What are 4 clinical manifestations of SIADH?
1. hyponatremia (muscle cramps, pin, weakness) 2. thirst 3. decreased urinary output 4. increased weight
Corticosteroids are best known for? (3 things)
1. metabolism 2. stress response 3. anti-inflammatory
List 3 true statements regarding the treatment of acne.
1.Mild acne can typically be treated with topical antimicrobial agents and topical retinoids. 2.The choice of drug therapy for acne is determined by the severity of the symptoms. 3.Adolescence with acne should be instructed to avoid the use of oil-based moisturizers.
It is recommended that benzoyl peroxide be used in patients with mild acne of what age?
12 and older
How long does it take to see good results in acne from systemic medications?
3-6 months
How long will it take for the person to see results when acne is being treated?
4 to 6 weeks
What drug class is recommended to be used in combination with selective and non-selective Alpha 1 antagonists ?
5a-Reductase Inhibitor
What is a comedone?
A common lesion in mild acne. (The comedone appears as a blackhead if open, and a whitehead if the comedone is closed).
How long is a single course of Isotretinoin (Accutane)?
A course of therapy is typically 15 - 20 weeks.
The client reports using benzoyl peroxide (Fostex) for treatment of acne. The action of this drug is:
A keratolytic effect. Benzoyl peroxide (Fostex) is the main OTC medication used to treat acne-related disorders. Benzoyl peroxide has a keratolytic effect, which helps dry out and shed the outer layer of epidermis
The function of the thyroid hormone is to: A) stimulate cellular metabolism. B) provide for fatty deposits. C) promote water excretion. D) assist with carbohydrate metabolism
A) stimulate cellular metabolism.
A client taking hydrocortisone for adrenocortical insufficiency (Addison's disease) is admitted to the hospital for a total hip arthroplasty. Which of the following actions is the highest priority? A. Administration of supplemental doses of hydrocortisone B. Instruction on coughing and deep breathing C. Insertion of an indwelling urinary catheter D. Requesting a referral for physical therapy
A. Administration of supplemental doses of hydrocortisone
A male is most likely to get a UTI with which of the following conditions? A. BPH B. Hemorrhoids C. Vigorous sexual activities D. Anal fistula surgery
A. BPH
A client is taking levothyroxine (synthroid). For which adverse effect would the nurse monitor the client? A. Tachycardia B. Drowsiness C. Constipation D. Weight gain
A. Tachycardia
This medication Decreases sebum production Decreases inflammation Lowers the skin population of P. acnes
Accutane
The overproduction of growth hormone (overgrowth of bones/soft tissues) can cause?
Acromegly
What causes adrenocortical insufficiency?
Addison's Disease
Describe what a comedone is.
An UNINFECTED sebaceous plug impacted within the follicles
What is Priapisim?
An erection lasts > 4 hours
Increase of what hormone causes increased sebum production?
Angrogens (Testosterone)
How many lesions must be present for a patient to be diagnosed with Moderate acne?
Approximately 100 lesions
The teaching plan for a 24-year-old female receiving isotretinoin (Accutane) for treatment of acne must include:
Avoiding pregnancy while taking this drug. Isotretinoin (Accutane) is a vitamin A metabolite that aids in reducing the size of sebaceous glands, thereby decreasing oil production and the occurrence of clogged pores. Isotretinoin is not recommended during pregnancy, due to potential harmful effects to the fetus.
A 51 year old white male tax accountant presents to your clinic with a chief complaint that he is unable of maintaining an erection. After a detailed history and physical is completed you decide to put this patient on a medication to help with his problem. What class of drug is the standard of treatment for males with ED? A - Bisphosphonates B - Phosphodiesterase-5 Inhibitors C - 5-Alpha Reductase Inhibitors D - HMG CoA Reductase Inhibitors
B - Phosphodiesterase-5 Inhibitors
Which of the following is NOT a risk factor for prostate cancer? A Increasing age B Benign prostatic hypertrophy C High dietary fat intake D African American race
B Benign prostatic hypertrophy
Olivia has dry itchy skin, constipation, and muscle cramps at night due to a lack of thyroxine. What endocrine disorder does she have? A) Diabetes mellitis B) Hypothyroidism C) Cushing Syndrome D) Diabetes insipidus
B) Hypothyroidism
Parathyroid hormone tends to increase the concentration of: A) sodium in the kidneys. B) calcium in the blood. C) iron in the liver. D) endorphins in the brain.
B) calcium in the blood.
A client receiving propylthiouracil asks the nurse how this medication will help relieve symptoms. Which statement is the nurse's best response? A. "Propylthiouracil inactivates any circulating thyroid hormone, thus decreasing signs and symptoms of hyperthyroidism." B. "This medication inhibits the formation of new thyroid hormone, thus gradually returning your metabolism to normal." C. "Propylthiouracil helps the thyroid gland use iodine and synthesize hormones better." D. "This medication stimulates the pituitary gland to secrete thyroid-stimulating hormone, which inhibits the production of hormones by the thyroid gland."
B. "This medication inhibits the formation of new thyroid hormone, thus gradually returning your metabolism to normal."
A 58 year old white male comes to your clinic complaining of hesitancy and postvoid dribbling when he urinates. You perform a digital rectal examination. What would be your expected findings if the man has BPH? A. A spongy, indurated prostate B. A smooth, firm, elastic enlargement of prostate C. A nodular enlargement of prostate D. A soft, atrophic prostate
B. A smooth, firm, elastic enlargement of prostate
A 60 year old males comes into your clinic complaining of increased urinary frequency, increased urinary urgency and urinary hesitation. He has a family history of BPH. DRE and PSA both confirm the diagnosis of BPH. You prescribe this patient Tamsulosin (Flomax). Which of the following is not true about this medication? It is a pregnancy class B B. It may cause hypertension C. It causes vasodilation of veins and arterioles D. Improves irritative and obstructive voiding symptoms
B. It may cause hypertension
What is the first step in the management of erectile dysfunction? A. Prescribe Sildenafil (viagra) to a patient B. Taking a thorough sexual, medical, and psychosocial history C. Nocturnal Tumescence test D. Targeted physical exam that includes secondary sexual characteristics, penile abnormalities, gynecomastia, groin and peripheral pulses, and blood pressure.
B. Taking a thorough sexual, medical, and psychosocial history
A patient with a head injury develops SIADH. Symptoms the nurse would expect include: A. hypernatremia and edema B. low urinary output and thirst C. muscle spasticity and hypertension D. weight gain and decreased glomerular filtration rate
B. low urinary output and thirst
Import nursing intervention(s) when caring for a patient with Cushing syndrome include: a. restricting protein intake b. monitoring blood glucose levels c. observing for signs of hypotension d. administering medications in equal doses e. protecting patient from exposure to infection
B. monitoring blood glucose levels & E. protecting patient from exposure to infection
Nurse Ivy is implementing a teaching plan to a group of adolescents regarding the causes of acne. Which of the following is an appropriate nursing statement regarding the cause of this disorder? A."Acne is caused by oily skin" B."The actual cause is not known" C."Acne is caused by eating chocolate" D."Acne is caused as a result of exposure to heat and humidity"
B."The actual cause is not known"
This condition ccurs in most men as they get older Nearly 50% of men over the age of 60 Nearly 90% of men over the age of 85
BPH
What is the first-line drug for mild to moderate acne?
Benzoyl peroxide
Why should you apply sunscreen after using benzoyl peroxide?
Benzoyl peroxide increases your sensitivity to the sun
Which acne agent needs to be left on the face for 15 minutes before washing off?
Benzoyl peroxide.
________________ can be used to manage tachycardia, anxiety, and tremors associated with hyperthyroidism
Beta-blockers
What are comedones?
Blackheads and white heads
A priority nursing diagnosis for a 16-year-old client with severe acne is:
Body Image, Disturbed related to facial lesions. The nurse working with teenagers with acne should establish rapport, as many clients with acne might be embarrassed, or have an altered body image or self-esteem disturbance because of their acne.
How does Benzoyl Peroxide work against acne?
By suppressing the growth of P. Acnes.
Explain how Retinoids work against acne?
By unplugging existing comedones and preventing development of new ones.
The nurse is caring for a patient admitted with suspected hyperparathyroidism. Because of the potential effects of this disease on electrolyte balance, the nurse should assess this patient for which of the following manifestations? A) Neurologic irritability B) Declining urine output C) Lethargy and weakness D) Hyperactive bowel sounds
C) Lethargy and weakness
Patient has been taking oral prednisone for the past several weeks after having a severe reaction to poison ivy. The nurse has explained the procedure for gradual reduction rather than sudden cessation of the drug. What is the rationale for this approach to drug administration? A) Prevention of hypothyroidism B) Prevention of diabetes insipidus C) Prevention of adrenal insufficiency D) Prevention of cardiovascular complications
C) Prevention of adrenal insufficiency
A client is given desmopressin acetate (DDAVP). The nurse knows that this drug is to treat which condition? A. Gigantism B. Diabetes mellitus C. Diabetes insipidus D. Adrenal insufficiency
C. Diabetes insipidus
Which nursing diagnosis is the highest priority for a client receiving desmopressin? A. Potential for injury B. Alteration in comfort C. Potential for fluid volume excess D. Knowledge deficit
C. Potential for fluid volume excess
When assessing for potential side effects of fludrocortisone (Florinef), what is a priority for the nurse to monitor? A. Serum sodium levels for potential hyponatremia B. Serum calcium levels for hypercalcemia C. Serum potassium levels for hypokalemia D. Intake and output for potential fluid volume deficit
C. Serum potassium levels for hypokalemia
Symptoms of BPH include all of the following except: A. Nocturia B. Urgency incontinence C. Strong urinary stream flow D. Straining to void
C. Strong urinary stream flow
A client has adrenocortical insufficiency and was taking hydrocortisone (Solu-Cortef) 240 mg every 12 hours IV. Before discharge the drug was switched to prednisone (Deltasone). Which is appropriate teaching for discharging a client with oral cortisone? A. Stop the drug when feeling better. B. Prednisone is always given by injection. C. The dose needs to be tapered off over 5 to 10 days. D. Weight loss and hypoglycemia are common.
C. The dose needs to be tapered off over 5 to 10 days.
A nurse is caring for a client who is taking levothyroxine (Synthroid). For which of the following should the nurse monitor to identify levothyroxine toxicity? A. Hair loss B. Lethargy C. Weight loss D. Cold intolerance
C. Weight loss
Drug that Treats hypoparathyroidism and hypocalcemia.
Calcitrol
Hydration and diuretics can enhance excretion of ______________ in patients with hyperparathyroidism
Calcium
Postoperatively for thyroidectomy, check for _____________ deficiency due to removal of parathyroid
Calcium
The client asks how too much calcium could be dangerous. The nurse explains that hypercalcemia could cause:
Cardiac dysrhythmias
How is acne classified and what are the classifications?
Classified by the number of lesions. May be mild, moderate or Severe?
Name 2 topical agents that can be used to treat acne.
Clindamycin and erythromycin
What are some examples of topical antibiotics to treat acne? (Name 3)
Clindamycin, erythromycin and metronidazole
The client has new onset of benign prostatic hyperplasia (BPH) with related urinary symptoms. What factor most likely underlies the client's urinary symptoms?
Compression of the urethra
Affects women ages 20 to 40 Symptoms include weight gain, facial hair, amenorrhea, frequent bruising and acne, causes changes in fat distribution, adipose tissue accumulates in the trunk, face (moonfaace) and dorsocervical areas (buffalo hump)
Cushing's syndrome
An elevated PSA indicates ... A Prostate Cancer B Prostatitis C Benign Prostatic Hypertrophy D All of the above
D All of the above
Which of the following is NOT a symptom of hyperthyroidism? A) Weight loss B) Increased appetite C) Nervous irritability D) Fatigue
D) Fatigue
Which of the following is a symptom of hyperthyroidism? A) Decreased appetite B) Fatigue C) Depression D) Nervous irritability
D) Nervous irritability
Ethan is 8 feet tall and weighs 260 pounds. Which of the following glands may be responsible for his size? A) pancreas B) parathyroid C) testes D) pituitary
D) pituitary
Accidental removal of the parathyroid glands could cause: A) leukemia. B) diabetes. C) menopause. D) tetany.
D) tetany.
A nurse has been teaching a client about levothyroxine (Synthroid). Which side effect should the nurse observe for? A. Somnolence B. Bradycardia C. Constipation D. Nervousness
D. Nervousness
This drug... -Acts on kidneys & blood vessels, helps prevent the loss of water from the body by reducing urine output, raises BP by constricting blood vessels - Tx-DI -Helps prevent the loss of water from the body by reducing urine ouput.
Desmopressin (DDAVP) (ADH-Antidiuretic hormone)
What is a drug that mimics the antidiuretic hormone?
Desmopressin acetate (DDAVP)
Hyposecretion of ADH causing polyuria, polydipsia, hypernatremia, weight loss, and dehydration
Diabetes Insipidus
What antibiotics are used orally for treatment of acne? (Name 2)
Doxycycline or minocycline
Benzoyl peroxide may normally produce what 2 topical side effects?
Drying and peeling of the skin.
What is the most common treatment regimen for osteoporosis in women?
Estrogen Replacement (HRT)
What is Cushing syndrome?
Excess of corticosteroids (mostly glucocorticoids)
Name the 2 5a-Reductase Inhibitors that Reduce the size of the prostate gland, but may take 6 - 12 months to see improvement.
Finasteride (Proscar) Dutasteride (Avodart
Name 2 medications that reduce the size of the prostate gland, but it may take 6-12 months before you see an improvement?
Finasteride (Proscar) Dutasteride (Avodart) ***Have the suffix "asteride"***
Prevents the release of substances in the body that cause inflammation. Used to treat conditions in which the body does not produce enough of its own steroids such as addisons disease, help restore electrolyte balance.
Florinef (fludrocortsone)
How many Accutane courses are needed to treat acne?
For most patients, a single course of drug therapy is effective.
The most common type of hyperthyroidism caused by hyperfunction of the thyroid gland. It is characterized by a rapid pulse, palpations, excessive perspiration, heat intolerance, nervousness, irritability, exopthalmos, and weight loss.
Grave's Disease
How many lesions must be present for a patient to be diagnosed with Severe acne?
Greater than 100 lesions
Most common cause of hypothyroidism? An autoimmune disorder, causes wt gain, decreased appetite, constipation, lethargy, dry cool skin, brittle nails, coarse hair, muscle cramps, weakness and sleep apnea
Hashimoto's thyroiditis
What are contraindications for HRT?
History of endometrial cancer Personal history of breast cancer History of thromboembolic disorders Acute or chronic liver disease Coronary artery disease Undiagnosed vaginal bleeding
An increase in T4 and T3. Tachycardia, palpitations, excess sweating, heat intolerance, nervousness, irritability, exophthalmos, weight loss.
Hyperthyroidism
A 54-year-old patient with pulmonary tuberculosis (lung infection) is evaluated for syndrome of inappropriate ADH secretion (SIADH). Which of the following electrolyte imbalances would be expected in this patient?
Hyponatremia
Signs of __________________ include paresthesia, muscle creamps and tetany, Chvostek's and Trousseau's signs, alopecia, dry skin, and painful menstruation
Hypoparathyroidism
This endocrine disorder is caused by a hyposecretion of calcitonin resulting in hypocalcemia and hyperphosphatemia
Hypoparathyroidism
Decrease in thyroid hormone secretion. Lethargy, apathy, memory impairment, slow speech, edema of eyelids and face, thick dry skin, slow pulse, weight gain, cold intolerance.
Hypothyroidism
Bad Effects of Estogren Replacement in Menopause? (Name 4)
Increase breast cancer risk. Increase Uterine cancer risk. Increase Blood clot risk. Increase Myocardial Infarction.
Name the common medication used to treat severe acne?
Isotretinoin (Accutane)
What type of drug is Benzoyl peroxide?
It is a keratolytic
What are important nursing
It is recommended that application of Benzoyl Peroxide should be once daily in the beginning, and over time the frequency of administration can be increased to a maximum of three times daily.
How many lesions must be present for a patient to be diagnosed with Mild acne?
Less than 30
Self treatable acne is classified as?
Mild
This disorder is a hyposecretion of thyroxine (T4) and T3 causing weakness and fatigue; increased sensitivity to cold, constipation, dry skin, unexplained weight gain, depression, facial edema, goiter, nonpitting puffy appearance
Myxedema
A 50-year-old male patient presents with polyuria and extreme thirst. he was given exogenous ADH. For which of the following conditions would this treatment be effective?
Neurogenic diabetes insipidus
What drug class is contraindicated with PDE5 Inhibitors?
Nitrates
A patient calls to report having a nose bleed after starting Isotretinoin (Accutane). He asks if he should stop the medication. How should the nurse respond?
No... he should not stop the medication. Nose bleeds are common in patients who are taking Isotretinoin (Accutane).
A woman is needing to be put on HRT (Estrogen). Can she be prescribes estrogen alone?
Only if she has had her uterus removed. Every woman with a uterus also receives a progestin
An explanation of the disease process of osteoporosis is included in the discharge teaching for a client. The nurse explains that the most common risk factor for this disorder is:
Onset of menopause.
What drug class is the first line therapy for erectile dysfunction?
PDE-5 Inhibitors
What is present in Inflammatory acne?
Papules and Pustules
Name possible medications that can lead to Acne (P.I.M.P.L.E.S)
Phenytoin Isoniazide Moisturizers Phenobarbital Lithium Ethionamide Steroids
What are the clinical manifestations of diabetes insipidus?
Polydipsia Polyuria (5-20 L/day with low specific gravity of <1.005) Elevated serum osmolality (>295 mOsm/kg) if severe, fluid volume deficit
For women, being ____________________ is a risk Factors for Osteoporosis.
Postmenopausal
What is Menopause?
Progressive decrease in estrogen secretion by the ovaries Leads to many unpleasant symptoms
Anaerobic bacteria that lives primarily on the fatty acids in the sebacious glands?
Propionibacterium Acnes (P. Acnes)
This microbe converts sebum into irritant fatty acids, thus intensifying the symptoms of acne.
Propionibacterium acnes (P. Acnes)
Drug used to treat thyrotoxic crisis, preparation for subtotal thyroidectomy.
Propylthioruacil (PTU)
Mineralocorticoids are best known for?
Regulates sodium & potassium balance and water balance
Benefits of HRT: (Name 5)
Relief of hot flashes Decrease in urogenital atrophy Prevention of osteoporosis Improved quality of life Prevention of colorectal cancer
What should patients do if they start feeling depressed while taking Isotretinoin?
Report signs of depression or thoughts of suicide. (There is some concern regarding a correlation between Accutane and depression) .
This drug class are derivatives of vitamin A?
Retinoids
Risks of HRT: Increase risk of: (Name 7)
Risks of HRT: Increase risk of: Thromboembolic disease CAD (Coronary Artery Disease) CVD (Coronary Vascular Disease) Endometrial cancer Breast Cancer Ovarian Cancer Diementia
Name 4 PDE5 Inhibitors.
Sildenafil (Viagra) Tadalafil (Cialis) Vardenafil (Levitra) Avanafil (Stendra)
A 35-year-old female with Graves disease is admitted to a medical-surgical unit. Which of the following symptoms would the nurse expect to find before treatment?
Skin host and moist, rapid heart rate
Growth hormone is also known as?
Somatotropin
Good Effects of Estogren Replacement in Menopause? (Name 4)
Strenthens bones. Lowers LDL Cholestrol. Increase HDL Cholesterol. Reduces menopausal symptoms.
What is SIADH?
Syndrome of Inappropriate Antidiuretic Hormone and is the overproduction of ADH
What instructions do you give to a client taking tetracycline?
Take it on an empty stomach and avoid the sunlight (photosensitivity)
Name the 2 Selective Alpha 1 Adrenergic Antagonists that treat BPH and have little effect of blood pressure?
Tamsulosin (Flomax) Silodosin (Rapaflo) ***Have the suffix "osin"***
What selective Alpha 1 Adrenergic Antagonist may be used to treat BPH and have little effect on blood pressure?
Tamsulosin (Flomax) Silodosin (Rapaflo) ***Have the word "flo" in it***
What non-selective Alpha 1 Adrenergic Antagonist may be used to treat BPH and Hypertension? (Name 3)
Terazosin (Hytrin) Doxazosin (Cardura) Alfuzosin (Uroxatral ***Suffix of "zosin"***
Name the Nonselective Alpha 1 Adrenergic Antagonists that are commonly used for hypertension, but can be used to treat BPH? (Name 3)
Terazosin (Hytrin) Doxazosin (Cardura) Alfuzosin (Uroxatral) ***Have the suffix "zosin"***
What is the antibiotic most commonly given to clients with acne?
Tetracycline
A 22-year-old woman comes to the clinic because of a severe sunburn and states, "I was just out in the sun for a couple of minutes." The nurse begins a medication review with her, paying special attention to which medication class?
Tetracyclines for acne
How done Clindamycin and Erythromycin work agains acne?
They work by suppressing P. Acnes.
Diabetes insipidus, diabetes mellitus (DM), and SIADH share which of the following assessment manifestations?
Thirst
When treating acne, why should clindamycin and Erythromycin be used with benzoyl peroxide?
To avoid resistance that results from monotherapy
Why was the iPledge Program designed?
To ensure that no woman starting isotretinoin (Accutane) is pregnant or becomes pregnant while on the medication.
Patients must have what lab drawn prior to starting Isotretinoin (Accutane) and periodically thereafter?
Triglyceride levels
True or false Estrogen therapy will prevent bone loss in postmenopausal women with osteoporosis?
True
Wallace Guterman, a 36-year-old construction manager, is being seen by a physician in the primary care group where you practice nursing. He presents with a huge lower jaw, bulging forehead, large hands and feet and frequent headaches. What could be causing his symptoms? a) Hyperpituitarism b) Panhyperpituitarism c) Hypopituitarism d) Panhypopituitarism
a) Hyperpituitarism
Lydia Kranston, a three-year-old female, is being seen by a physician in the endocrinology group where you practice nursing. She has a significant height deficit and is being seen for diagnostic purposes. What could be the cause of her disorder? a) Pituitary disorder b) Adrenal disorder c) Thyroid disorder d) Parathyroid disorder
a) Pituitary disorder
An older male comes to the emergency room with a history of urinary frequency, urgency, and low back pain. The nurse recognizes that these are symptoms of which of the following? a. Benign Prostatic Hypertrophy b. Herniated intervertebral disk c. Kidney stones d. Renal failure
a. Benign Prostatic Hypertrophy
Desmopressin acetate (DDAVP) is prescribed for the treatment of diabetes insipidus. The nurse monitors the client after medication administration for which therapeutic response? a. Decreased urinary output b. Decreased blood pressure c. Decreased peripheral edema d. Decreased blood glucose level
a. Decreased urinary output
Desmopressin acetate (DDAVP) is prescribed for the treatment of diabetes insipidus. The nurse monitors the client after medication administration for which therapeutic response? a. Decreased urinary output b. Decreased blood pressure c. Decreased peripheral edema d. Decreased blood glucose leve
a. Decreased urinary output
Desmopressin acetate (DDAVP) is prescribed for the treatment of diabetes insipidus. The nurse monitors the client after medication administration for which therapeutic response? a. Decreased urinary output b. Decreased blood pressure c. Decreased peripheral edema d. Decreased blood glucose level
a. Decreased urinary output
Which of the following alpha-blocking agents are currently prescribed for persons with BPH? (Select all that apply.) a. Tamsulosin (Flomax) b. Doxazosin mesylate (Cardura) c. Verapamil (Calan) d. Tamoxifen (Nolvadex)
a. Tamsulosin (Flomax) b. Doxazosin mesylate (Cardura)
A client with severe acne is seen in the clinic and the health care provider (HCP) prescribes isotretinoin. The nurse reviews the client's medication record and would contact the (HCP) if the client is taking which medication? a. Vitamin A b. Digoxin (Lanoxin) c. Furosemide (Lasix) d. Phenytoin (Dilantin)
a. Vitamin A
The client is being treated with growth hormone. During treatment, the nurse monitors the client closely for evidence of: a. diabetes mellitus. b. gastrointestinal distress. c. hypotension. d. dwarfism.
a. diabetes mellitus.
Excess parathyroid hormone levels can lead to _____________? a. hypercalcemia b. hypocalcemia c. hypernatremia d. hyponatremia
a. hypercalcemia
The client is being treated with a glucocorticoid medication. The nurse plans to monitor him closely for evidence of: a. hypertension. b. hypoglycemia. c. hypovolemia. d. hyperkalemia.
a. hypertension.
You are caring for a pt who is taking levoxythroxine (Synthroid) to treat hypothyroidism. The pt reports palpitations, weight loss, and diarrhea. You suspect which of the following effects of this drug? a. hyperthyroidism b. addison's disease c. myxedema d. hyperglycemia
a. hyperthyroidism
A client is found to be deficient in a mineralocorticoid. The nurse assesses the client for manifestation of this deficiency by noting evidence of: a. hypotension. b. hypertension. c. bradycardia. d. edema.
a. hypotension.
A client is noted to have Cushing syndrome. The highest priority nursing intervention related to the client's electrolyte levels is to monitor for evidence of: a. sodium retention. b. water depletion. c. hypocalcemia. d. hyperkalemia.
a. sodium retention.
The nurse determines that the patient in acute adrenal insufficiency is responding favorably to treatment when a. the patient appears alert and oriented b. the patient's urinary output has increased c. pulmonary edema is reduced as evidenced by clear lung sounds d. laboratory tests reveal elevations of potassium and glucose serum levels and a decrease in the sodium level
a. the patient appears alert and oriented
This disorder (Crisis) is caused by deficiencies of cortisol and aldosterone?
addisonian crisis
What is the most common cause of hyperaldosteronism?
adrenal adenoma
What does growth hormone target?
all tissues
A nurse provides instructions to a client regarding the use of tretinoin (Retin-A). Which statement by the client indicates the need for further instructions? a. "Optimal results will be seen after 6 weeks." b. "I should apply a very thin layer to my skin." c. "I should wash my hands thoroughly after applying the medication." d. "I should cleanse my skin thoroughly before applying the medication."
b. "I should apply a very thin layer to my skin."
A nurse is monitoring a client receiving desmopressin acetate (DDAVP) for adverse effects to the medication. Which of the following indicates the presence of an adverse effect? a. Insomnia b. Drowsiness c. Weight loss d. Increased urination
b. Drowsiness *Recall that this medication is used to treat diabetes insipidus to eliminate weight loss and increased urination.*
A nurse performs an admission assessment on a client who visits a health care clinic for the first time. The client tells the nurse that propylthiouracil (PTU) is taken daily. The nurse continues to collect data from the client, suspecting that the client has a history of: a. Myxedema b. Graves' disease c. Addison's disease d. Cushing's syndrome
b. Graves' disease
A nurse performs an admission assessment on a client who visits a health care clinic for the first time. The client tells the nurse that propylthiouracil (PTU) is taken daily. The nurse continues to collect data from the client, suspecting that the client has a history of: a. Myxedema b. Graves' disease c. Addison's disease d. Cushing's syndrome
b. Graves' disease
Client teaching on proper administration of a thyroid replacement drug includes which instruction? a. Advise the client to report symptoms of hypothyroidism. b. Instruct the client to take the drug at the same time each day. c. Instruct the client to eat foods that inhibit thyroid secretion. d. Teach the client to take the medication on a full stomach.
b. Instruct the client to take the drug at the same time each day.
A nurse reinforces medication instructions to a client who is taking levothyroxine (Synthroid). The nurse instructs the client to notify the health care provider (HCP) if which of the following occurs? a. Fatigue b. Tremors c. Cold intolerance d. Excessively dry skin
b. Tremors
A nurse reinforces medication instructions to a client who is taking levothyroxine (Synthroid). The nurse instructs the client to notify the health care provider (HCP) if which of the following occurs? a. Fatigue b. Tremors c. Cold intolerance d. Excessively dry skin
b. Tremors
Isotretinoin is prescribed for a client with severe acne. Before the administration of this medication, the nurse anticipates that which laboratory test will be prescribed? a. Platelet count b. Triglyceride level c. Complete blood count d. White blood cell count
b. Triglyceride level
What diagnostic tests are used to differentiate BPH from prostate cancer? Slect all that apply. a. pelvic u/s b. digital rectal exam c. blood chemistry d. PSA level e. sperm count
b. digital rectal exam d. PSA level
Dietary instructions for the client who is being treated with glucocorticoids includes eating a diet high in: a. vitamin A. b. potassium. c. iron. d. magnesium.
b. potassium.
The enlarging prostate in BPH typically is manifested by assessment of problems w/ which of the following? a. bowel eleimination b. urinary elimination c. peripheral vascular function d. skin integrity
b. urinary elimination
What is the most common side effect of accutane and Tetracycline?
birth defects
Which symptoms indicate a patient should reduce the frequency of Benzoyl Peroixde? (Name 4)
burning blistering scaling swelling
A 16-year-old adolescent who is 6 weeks pregnant has acne that has been exacerbated during the pregnancy. She asks the nurse if she can resume taking her isotretinoin (Accutane) prescription. The best response by the nurse is: a) "you should reduce your accutane dose by half during pregnancy" b) "you should check with your doctor at your next visit" c) "Accutane is known to cause birth defects; you should never take it during pregnancy" d) "since you have a prescription for Accutane, it is safe to take"
c) "Accutane is known to cause birth defects; you should never take it during pregnancy"
Before discharge, what should a nurse instruct a client with Addison's disease to do when exposed to periods of stress? a) Perform capillary blood glucose monitoring four times daily. b) Drink 8 oz of fluids. c) Administer hydrocortisone I.M. d) Continue to take his usual dose of hydrocortisone.
c) Administer hydrocortisone I.M.
A client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate? a) Infusing I.V. fluids rapidly as ordered b) Administering glucose-containing I.V. fluids as ordered c) Restricting fluids d) Encouraging increased oral intake
c) Restricting fluids
A nurse is caring for a client with hyperparathyroidism and notes that the client's serum calcium level is 13 mg/dL. Which medication should the nurse prepare to administer as prescribed to the client? a. Calcium chloride b. Calcium gluconate c. Calcitonin (Miacalcin) d. Large doses of vitamin D
c. Calcitonin (Miacalcin)
A nurse reinforces instructions to a client who is taking levothyroxine (Synthroid). The nurse tells the client to take the medication: a. With food b. At lunchtime c. On an empty stomach d. At bedtime with a snack
c. On an empty stomach
A patient using Benzoyl Perioxide calls and reports symptoms of blistering and swelling of his face. What should the nurse instruct this patient to do? a. Go to the ER immediately. b. Stop the medication as his symptoms indicate he is having an allergic reaction. c. Reduce the frequency of the medication d. Do nothing as these symptoms should be expected with this medication.
c. Reduce the frequency of the medication
A nurse is reinforcing instructions for a client regarding intranasal desmopressin acetate (DDAVP). The nurse tells the client that which of the following is a side effect of the medication? a. Headache b. Vulval pain c. Runny nose d. Flushed skin
c. Runny nose
A nurse is caring for a client after thyroidectomy and notes that calcium gluconate is prescribed for the client. The nurse determines that this medication has been prescribed to: a. Treat thyroid storm. b. Prevent cardiac irritability. c. Treat hypocalcemic tetany. d. Stimulate the release of parathyroid hormone.
c. Treat hypocalcemic tetany.
A nurse is caring for a client after thyroidectomy and notes that calcium gluconate is prescribed for the client. The nurse determines that this medication has been prescribed to: a. Treat thyroid storm. b. Prevent cardiac irritability. c. Treat hypocalcemic tetany. d. Stimulate the release of parathyroid hormone.
c. Treat hypocalcemic tetany.
Sildenafil (Viagra) is prescribed to treat a client with erectile dysfunction. A nurse reviews the client's medical record and would question the prescription if which of the following is noted in the client's history? a. Neuralgia b. Insomnia c. Use of nitroglycerin d. Use of multivitamins
c. Use of nitroglycerin
A patient has been taking oral prednisone for several weeks. The nurse explains to gradually reduce predisone use rather than sudden cessation for the prevention of: a. hypothyroidism b. diabetes insipidus c. adrenal insufficiency d. cardiovascular complications
c. adrenal insufficiency
An IV hydrocortisone infusion is started before a patient is taken to surgery for a bilateral adrenalectomy. The nurse explains to the patient that this is done to a. prevent sodium and water retention after surgery b. prevents clots from forming in the legs during recovery from surgery c. provide substances to respond to stress after removal of the adrenal glands d. stimulate the inflammatory response to promote wound healing
c. provide substances to respond to stress after removal of the adrenal glands
A clinic nurse provides instructions to a client who will be taking isotretinoin (Accutane) for severe cystic acne. Which statement by the client indicates the need for further instructions? a) I need to return to the clinic for a blood test to check my triglyceride level b) the medication may cause my lips to burn c) the medication may cause dryness and burning in my eyes
d) I need to take vitamin A supplements to improve the effectiveness of this treatment In severe cystic acne, isotretinoin is used to inhibit inflammation. Adverse effects include elevated triglycerides, skin dryness, eye discomfort such as dryness and burning, and cheilitis (lip inflammation). Close medical follow-up is required, and dry skin and cheilitis can be decreased by the use of emollients and lip balms. Vitamin A supplements are stopped during this treatment.
A client is receiving long-term treatment with high-dose corticosteroids. Which of the following would the nurse expect the client to exhibit? a) Weight loss b) Pale thick skin c) Hypotension d) Moon face
d) Moon face
Desmopressin is used to treat: a. type 2 DM b. hypoglycemia c. thyroid cancer d. diabetes insipidus
d. diabetes insipidus
A patient's recent medical history is indictive of diabetes insipidus. The nurse would perform patient education related to which of the following diagnostic tests? a. thyroid scan b. fasting glucose test c. oral glucose tolerance d. water deprivation/restriction test
d. water deprivation/restriction test
The nurse teaches the client the signs and symptoms of hypothyroidism. The client is taught to self-monitor closely for: a. tachycardia. b. palpitations. c. intolerance to heat. d. weight gain.
d. weight gain.
What is adrenocortical insufficiency?
decreased hypofunction of the adrenal cortex -primary: Addison's disease (decreased glucocorticoids, mineralocorticoids & androgens) -secondary: lack of pituitary ACTH secretion (decreased corticosteroids & androgens)
Substances that affect carb, fat, and protein metabolism; affect stress reactions and the inhibition of the inflammatory process (cortisol, cortisone, corticosterone)
glucocorticoids
What condition can cause a peaked T wave?
hyperkalemia
Causes goiter, nervousness, heat intolerance and weight loss despite increased appetite
hyperthyroidism
What are symptoms of Addisnian Crisis?
hypotensin, tachycardia, dehydration, hyponatremia, hyperkalemia, hypoglycemia, weakness, confusion, V/D, abdominal pain, and possibly circulatory collapse
A drug that promotes shedding of the horny layer of the skin. Effects range from peeling to extensive desquamation.
keratolytic agent
This form of medication regulates sodium and electrolyte balance (aldosterone, corticosterone, deoxycorticosterone)
mineralocorticoids
How does Antidiuretic hormone work?
promotes reabsorption of water, vasoconstriction
"A client visits the physician's office complaining of agitation, restlessness, and weight loss. The physical examination reveals exophthalmos, a classic sign of Graves' disease. Based on history and physical findings, the nurse suspects hyperthyroidism. Exophthalmos is characterized by:
protruding eyes and a fixed stare.
How is SIADH diagnosed? (3 lab findings)
serum Na <145 urine specific gravity 1.005 serum osmolality <280 mOsm/kg
Aldosterone makes you retain: and makes you lose:
sodium and water potassium
What are the clinical manifestations of Cushing syndrome?
thin hair, acne, moon face, buffalo hump, supraclavicular fat pad, weight gain, truncal obesity, purple striae, thin extremities, wasting muscles, thin skin, slow healing wounds
How often should the client with acne wash his face each day?
twice a day
Prolonged estrogen replacement is not recommended due to an increase risk of ______________________
uterine cancer and breast cancer.
Antidiuretic hormone is also known as?
vasopressin
Name 4 symptoms of hypocortisolism?
vomiting, weakness, dehydration and hypotension. Steroids should be given before surgery (hypophysectomy) to prevent hypocortisolism from occuring
What are clinical manifestations of adrenocortical insufficiency?
weakness, fatigue weight loss, anorexia skin hyperpigmentation orthostatic hypotension hyponatremia salt craving hyperkalemia N/V/D
