ATI - Endocrine

1 - 0820 1. Pramlintide, an amylin mimetic, peaks 20 min after administration. The nurse should monitor the client for indications of hypoglycemia, such as diaphoresis and tremors 2. Pramlintide, an amylin mimetic, is unlikely to cause severe hypoglycemia 1 hr after administration. Aspart insulin is an injectable hypoglycemic drug that can exert its peak action at that time 3. Pramlintide, an amylin mimetic, is unlikely to cause severe hypoglycemia 2.5 hours after administration. Regular insulin is an injectable hypoglycemic drug that can exert its peak action at that time 4. Pramlintide, an amylin mimetic, is unlikely to cause severe hypoglycemia 3 hr after administration. Regular insulin is an injectable hypoglycemic drug that can exert its peak action at that time

A nurse administer pramlintide at 0800 to a client who has type 1 diabetes mellitus. At which of the following times should the nurse expect the drug to exert its peak action? 1. 0820 2. 0900 3. 1030 4. 1100

1 - hypotension 1. Hypotension and fatigue are findings of adrenal insufficiency. During times of stress, the client might need a dosage increase to prevent adrenal insufficiency. The nurse should report the findings to the provider 2. The nurse should identify hypoglycemia as an indication that the client's dosage is too low 3. The nurse should identify weight loss as an indication that the client's dosage is too low 4. Fat redistribution or a moon face appearance are Cushingoid findings. The nurse should identify fat redistribution as an indication that the client's dosage is too high.

A nurse at a provider's office is assessing a client who has been taking hydrocortisone for adrenal insufficiency. The client reports fatigue and feeling overwhelmed by personal responsibilities. Which of the following findings should the nurse identify as an indication the provider might need to increase the client's dosage? 1. Hypotension 2. Hyperglycemia 3. Weight gain 4. Fat redistribution

4 - recent myocardial infarction 1. Clients who have bacterial skin infections can take levothyroxine, a thyroid replacement hormone. Fludrocortisone is an endocrine-system drug that requires cautious use with clients who have bacterial skin infections 2. Clients who have diabetes insipidus can take levothyroxine, a thyroid replacement hormone. It requires cautious use with clients who have diabetes mellitus 3. Clients who are immunosuppressed can take levothyroxine, a thyroid replacement hormone. Propylthiouracil (PTU) is an endocrine-system drug that requires cautious use with clients who are immunosuppressed 4. Levothyroxine, a thyroid replacement hormone, can cause tachycardia, palpitations, and hypertension, especially when the client requires a dosage adjustment. Therefore, ti is contraindicated for clients who have recently had a myocardial infarction

A nurse is assessing a client who has a new prescription for levothyroxine. The nurse should identify which of the following findings as a contraindication for this drug? 1. Bacterial skin infections 2. Diabetes insipidus 3. Immunosuppression 4. Recent myocardial infarction

1, 2, 4, 5 1. Propylthiouracil, an antithyroid drug, can cause agranulocytosis. The nurse should monitor the client's CBC and instruct the client to report fever or sore throat Propylthiouracil can cause arthralgia and myalgia. The nurse should instruct the client to report these effects and take OTC analgesics for pain relief Propylthiouracil is more likely to cause drowsiness than insomnia Propylthiouracil can cause hypothyroidism, which manifests as bradycardia, drowsiness, and weight gain. The nurse should instruct the client to report these effects Propylthiouracil can cause urticaria or a skin rash. The nurse should instruct the client to report these effects

A nurse is caring for a client who is about to begin taking propylthiouracil (PTU) to treat hyperthyroidism. The nurse should instruct the client to report which of the following adverse effects? (Select all that apply.) 1. Sore throat 2. Joint pain 3. Insomnia 4. Bradycardia 5. Rash

3, 4 1. Somatropin, a growth hormone, is unlikely to alter blood amylase levels. Sitagliptin, an antithyroid drug, is an endocrine-system drug that requires monitoring of blood amylase levels because it can cause pancreatitis 2. Somatropin is unlikely to alter creatinine clearance. Desmopressin, an antidiuretic hormone, is an endocrine-system drug that requires monitoring of creatinine clearance 3. Somatropin can cause hypercalciuria. The nurse should monitor the client's urine calcium and instruct the client to report flank pain, urinary frequency, or hematuria 4. Somatropin can cause hyperglycemia. The nurse should monitor the client's blood glucose levels and instruct the client to report polyphagia, polydipsia, and polyuria. 5. Somatropin is unlikely to alter the client's CBC. Radioactive iodine-131, an antithyroid drug, is an endocrine-system drug that requires monitoring CBC

A nurse is caring for a client who is about to begin taking somatropin. The nurse should explain the need to monitor which of the following laboratory values? (Select all that apply.) 1. Blood amylase 2. Creatinine clearance 3. Urine calcium 4. Blood glucose 5. CBC

1 - lactic acidosis 1. Metformin, a biguanide, can cause lactic acidosis, which is a life-threatening complication that manifests as muscle aches, sleepiness, malaise, and hyperventilation. The client should stop taking the drug and seek medical care immediately 2. Metformin, a biguanide, is unlikely to cause anticholinergic effects, but it can cause nausea, diarrhea, and anorexia. The nurse should inform the client that these effects should diminish with continued therapy 3. Metformin, a biguanide, is unlikely to cause extrapyramidal effects, but it can cause dizziness and fatigue 4. Metformin, a biguanide, is unlikely to cause hypophosphatemia, but it can cause vitamin B12 or folic acid deficiencies, which would manifest as weakness, fatigue, pallor, or a reddened tongue

A nurse is caring for a client who is taking metformin to treat type 2 diabetes mellitus and reports muscle pain. Which of the following adverse reactions should the nurse suspect? 1. Lactic acidosis 2. Anticholinergic effects 3. Extrapyramidal effects 4. Hypophosphatemia

3 - weight gain 1. Pioglitazone, a thiazolidinedione, is more likely to cause muscle pain than joint pain 2. Pioglitazone, a thiazolidinedione, is more likely to cause diarrhea than constipation 3. Pioglitazone, a thiazolidinedione, can cause fluid retention. The nurse should monitor the client for weight gain and other indications of fluid retention or heart failure, including dyspnea, crackles, and wheezing 4. Pioglitazone, a thiazolidinedione, is more likely to cause blurred vision than dilated pupils

A nurse is caring for a client who is taking pioglitazone to treat type 2 diabetes mellitus. The nurse should monitor for which of the following findings? 1. Joint pain 2. Constipation 3. Weight gain 4. Dilated pupils

1, 2, 3 1. Fludrocortisone, a mineralocorticoid, can cause fluid and electrolyte imbalances, such as hypernatremia. Tracking weight on a daily basis can help identify weight gain and edema; reporting it can expedite any essential interventions 2. Fludrocortisone can cause hypokalemia. The nurse should monitor the client's potassium levels and tell the client to report muscle weakness or palpitations 3. Fludrocortisone can cause fluid retention and hypertension. The nurse should monitor the client's fluid balance and blood pressure to expedite any essential interventions 4. Fludrocortisone does not cause iron-deficiency anemia. However, it can cause thrombocytopenia 5. Grapefruit juice is unlikely to alter the effects of fludrocortisone

A nurse is providing teaching to a client about taking fludrocortisone to treat adrenocortical insufficiency. Which of the following instructions should the nurse include? (Select all that apply.) 1. Obtain weight measurement daily 2. Report weakness or palpitations 3. Have blood pressure checked regularly 4. Eat more iron-rich foods 5. Avoid drinking grapefruit juice

1, 2, 3 1. The client should inject exenatide, an incretin mimetic, into the subcutaneous tissue of the thigh, upper arm, or abdomen 2. Levels of exenatide peak 2 hr after administration and then decrease gradually, with the half-life of 2.4 hours 3. Exenatide supplements the action of an oral hypoglycemic, such as a sulfonylurea or metformin 4. The client should inject exenatide twice per day up to 60 min prior to the morning and evening meals, rather than after a meal The client can keep prefilled exenatide injector pens in use at room temperature for up to 30 days.2.

A nurse is providing teaching to a client who is about to begin exenatide therapy to treat type 2 diabetes mellitus. Which of the following instructions should the nurse include? (Select all that apply.) 1. Inject the drug subcutaneously 2. Expect the peak effect in 2 hr 3. Use the drug as a supplement to an oral hypoglycemic 4. Inject the drug 1 hr after a meal 5. Discard used pens 10 days after the first use

4 - Glucagon 1. Naloxone, an opiate antagonist, treats opioid toxicity, not insulin toxicity 2. Diphenhydramine, a cholinergic antagonist and an antihistamine, treats drug-induced extrapyramidal effects. Diphenhydramine is ineffective for insulin toxicity 3. Acetylcysteine, a mucolytic, treats acetaminophen toxicity, not insulin toxicity 4. Glucagon, a hyperglycemic that can be given subcutaneously, IM, or IV, is used to treat severe hypoglycemia from insulin toxicity in clients who are unconscious and for whom IV glucose is not readily available. If the client does not respond to glucagon, the nurse should administer a glucose solution IV.

Which of the following drugs should a nurse have available for a client who is experiencing insulin toxicity? 1. Naloxone 2. Diphenhydramine 3. Acetylcysteine 4. Glucagon

3 - beta blockers 1. Oral contraceptives do not specifically interact with insulin. Exenatide, another endocrine-system drug, slows the absorption of oral-contraceptives 2. Calcium supplements do not specifically interact with insulin. They do, however, reduce the absorption of levothyroxine, another endocrine-system drug. 3. Clients who take both insulin and beta blockers are at risk for failing to promptly recognize the symptoms of hypoglycemia because beta blockers mask symptoms such as tachycardia and tremors. Beta blockers also increase hypoglycemic effects 4. Iron supplements do not specifically interact with insulin. They do, however, reduce the absorption of levothyroxine, another endocrine-system drug

A nurse is caring for a client who is about to begin insulin glargine therapy. The nurse should identify the need for additional precautions because the client also takes which of the following types of drugs? 1. Oral contraceptives 2. Calcium supplements 3. Beta blockers 4. Iron supplements

2 - urine output 1. Desmopressin, an antidiuretic hormone, is unlikely to alter peripheral pulses. Vasopressin, another antidiuretic hormone, can cause vasoconstriction and angina pectoris. Desmopressin does not alter hemodynamics 2. Desmopressin, an antidiuretic hormone, treats diabetes insipidus. The nurse should monitor the client's fluid intake and urine output along with urine and serum osmolality and blood pressure 3. Desmopressin, an antidiuretic hormone, is unlikely to alter skin integrity. Propylthiouracil (PTU), an antithyroid drug, is an endocrine-system drug that requires integumentary monitoring because it can cause a rash 4. Desmopressin, an antidiuretic hormone, is unlikely to alter blood glucose. However, it can cause hyponatremia. The nurse should monitor the client's sodium levels

A nurse is caring for a client who is taking desmopressin. The nurse should make which of the following assessments to evaluate the drug's effectiveness? 1. Peripheral pulses 2. Urine output 3. Skin integrity 4. Blood glucose

2 - hypothyroidism 1. Propylthiouracil, an antithyroid drug, treats thyrotoxicosis, or hyperthyroidism. Indications of thyroxicosis include anxiety, palpitations, and weight loss 2. Propylthiouracil, an antithyroid drug, can cause hypothyroidism, which manifests as drowsiness, depression, weight gain, edema, and bradycardia. The nurse should request that the provider prescribe a lower dosage of the drug for the client 3. Propylthiouracil, an antithyroid drug, is unlikely to cause lactic acidosis. Sitagliptin is an endocrine-system drug that can cause lactic acidosis, which manifests as muscle aches, sleepiness, malaise, and hyperventilation 4. Propylthiouracil, an antithyroid drug, is unlikely to cause radiation sickness. Radioactive iodine-131 is an endocrine-system drug that can cause radiation sickness, which manifests as hematemesis, epistaxis, and intense nausea and vomiting

A nurse is caring for a client who is taking propylthiouracil (PTU) and reports weight gain, drowsiness, and depression. The nurse should identify that the client is experiencing which of the following adverse reactions to the drug? 1. Thyrotoxicosis 2. Hypothyroidism 3. Lactic acidosis 4. Radiation sickness

1 - eat more iron-rich foods 1. Acarbose, an alpha-glucosidase inhibitor, can cause iron-deficiency anemia. The nurse should instruct the client to increase their intake of iron-rich foods, such as red meat, spinach, and grains. The nurse should also monitor the client's CBC 2. Grapefruit juice is unlikely to alter the effects of acarbose, an alpha-glucosidase inhibitor. More than 1 L of grapefruit juice per day can increase the hypoglycemic effects of repaglinide, a meglitinide 3. Acarbose, an alpha-glucosidase inhibitor, is unlikely to cause constipation. It can cause diarrhea and flatulence. Metformin can worsen the GI effects of the drug 4. Green tea is unlikely to alter the effects of acarbose, an alpha-glucosidase inhibitor. Green tea can increase the hypoglycemic effects of pioglitazone, another endocrine-system drug

A nurse is teaching a client about acarbose therapy to treat type 2 diabetes mellitus. Which of the following instructions should the nurse include? 1. Eat more iron-rich foods 2. Avoid drinking grapefruit juice 3. Increase fiber intake 4. Avoid drinking green tea

2, 3 1. Pioglitazone, a thiazolidinedione, is unlikely to alter T4 or TSH. Levothyroxine, a thyroid hormone replacement, is an endocrine-system drug that requires monitoring of T4 and TSH 2. Pioglitazone can cause liver injury. The nurse should monitor ALT at the start of therapy and then every 3-6 months thereafter. The nurse should tell the client to report jaundice, dark-colored urine, or abdominal pain 3. Pioglitazone can cause elevations in both high-density lipoproteins, which is a beneficial effect, and LDLs, which is a detrimental effect. The nurse should monitor the client's plasma lipid levels at baseline and periodically throughout drug therapy 4. It is not necessary to monitor CBC for clients who are taking pioglitazone. Hydrocortisone, a glucocorticoid, is an endocrine-system drug that requires monitoring of CBC 5. It is not necessary to monitor creatinine clearance for clients who are taking pioglitazone. Desmopressin, an antidiuretic hormone, is an endocrine-system drug that requires monitoring of creatinine clearance.

A nurse is caring for a client who is about to begin taking pioglitazone to treat type 2 diabetes mellitus. The nurse should explain to the client about the need to monitor of the following laboratory values? (Select all that apply.) 1. Thyroid-stimulating hormone (TSH) 2. Alanine aminotransferase (ALT) 3. LDL 4. CBC 5. Creatinine clearance

3 - acute renal failure 1. Metformin, a biguanide, is unlikely to cause hypokalemia when used with iodine-containing contrast dye. Regular insulin is an endocrine-system drug that can cause hypokalemia 2. Metformin, a biguanide, is unlikely to cause hyperglycemia when used with iodine-containing contrast dye. Glucagon is an endocrine-system drug that can cause hyperglycemia 3. Metformin, a biguanide, can interact with iodine-containing contrast dye and cause acute renal failure and lactic acidosis. The nurse should withhold metformin for 48 hr prior to and following the procedure. The nurse should also monitor the client for indications of acute renal failure or lactic acidosis, such as reduced urine output, hyperventilation, and abdominal pain 4. Metformin, a biguanide, is unlikely to cause acute pancreatitis when used with iodine-containing contrast dye. Exenatide is an endocrine-system drug that can cause acute pancreatitis

A nurse is caring for a client who is taking metformin and is scheduled to undergo angiography using iodine-containing contrast dye. The nurse should identify that an interaction between metformin and the IV contrast dye increases the client's risk for which of the following conditions? 1. Hypokalemia 2. Hyperglycemia 3. Acute renal failure 4. Acute pancreatitis

3 - skip the dose 1. Taking a double dose of repaglinide, a meglitinide, before the next meal puts the client at risk for hypoglycemia 2. Taking half the dose of repaglinide, a meglitinide, without the meal puts the client at risk for hypoglycemia 3. To avoid a sudden and serious drop in blood glucose level, the client should skip the dose of repaglinide, a meglitinide, whenever skipping a meal. The nurse should also instruct the client to try to avoid skipping meals 4. Taking the full dose of repaglinide, a meglitinide, without the meal puts the client at risk for hypoglycemia

A nurse is caring for a client who takes a repaglinide 15-30 minutes before each meal to treat type 2 diabetes mellitus. The client asks, "If I skip a meal, what should I do?" Which of the following responses should the nurse make? 1. Double the dose before the next meal 2. Take half the dose 3. Skip the dose 4. Take the usual dose

1 - different spot for injection 1. To avoid atrophy of the tissue, administration of somatropin includes rotating the injection site each time. The nurse should identify this statement as an understanding of somatropin administration 2. The parents should administer the somatropin injection subcutaneously rather than intramuscularly to decrease pain. This does not alter drug effectiveness 3. Growth hormone administration can cause diabetes mellitus and can increase the occurrence of hyperglycemia for clients who have diabetes. The parents should closely monitor the child for polyphagia, polydipsia, and polyuria while on growth hormone therapy 4. A healthy loss of weight in clients who are taking somatropin is not a concern. Pediatric clients who have PWS and are taking growth hormone must be weight often to assess for weight gain that could become problematic. Obesity is a contraindication for using somatropin for clients who have PWS.

A nurse is educating the parents of a child who has a new diagnosis of Prader-Willi Syndrome (PWS) and has been prescribed somatropin. Which of the following statements by a parent indicates understanding of the teaching? 1. "We will use a different spot for injection each time we give the medication." 2. "We'll give the shot in the thigh muscle rather than fatty tissue to decrease injection pain." 3. "We'll watch our child for signs of low blood sugar while using somatropin." 4. "We should stop the medication if our child loses weight."

3 - expect life-long therapy with the drugs 1. Food reduces the absorption of levothyroxine, a thyroid replacement hormone. The nurse should instruct the client to take it on an empty stomach at least 30 minutes before eating 2. Antacids reduce the absorption of levothyroxine, a thyroid replacement hormone. The nurse should instruct the client to allow 4 hours between taking levothyroxine and taking an antacid 3. Therapy with levothyroxine, a thyroid replacement hormone, usually continues for life because there are no other therapies that can restore thyroid function 4. Levothyroxine, a thyroid replacement hormone, does not cause hypoglycemia, so this precaution is not necessary. Clients who are taking hypoglycemics, such as exenatide, should always carry a carbohydrate snack to treat hypoglycemia.

A nurse is providing teaching to a client who is about to begin levothyroxine therapy to treat hypothyroidism. Which of the following instructions should the nurse include? 1. Take levothyroxine with food to increase absorption 2. Take levothyroxine with an antacid to reduce gastrointestinal effects 3. Expect life-long therapy with the drug 4. Carry a carbohydrate snack at all times

3 - perform a fingerstick blood glucose check 1. Glipizide, a sulfonylurea, can cause diarrhea. Clients who develop this adverse reaction should maintain hydration by drinking plenty of fluids. However, the client's symptoms indicate a different adverse reaction to the drug 2. Glipizide, a sulfonylurea, can cause hypoglycemia, which can manifest as diaphoresis, shakiness, hunger and fatigue. The nurse should tell the client to check their blood glucose level, and if it indicates hypoglycemia, to consume a snack of 15-20 g (0.5-0.7 oz) of carbohydrates, retest in 15-20 minutes, and repeat if their blood glucose level is still low 3. Glipizide, a sulfonylurea, treats hyperglycemia from type 2 diabetes mellitus. Clients do not take the drug PRN, but rather on a fixed, once-daily dosing schedule. It would be inappropriate to double the dosage within the same 24-hr period, even if the client were experiencing hyperglycemia 4. Lying down and resting can help the client feel less fatigues, but these actions do not address the adverse reaction the client is having to glipizide, a sulfonylurea

A nurse is speaking with a client who is taking glipizide to treat type 2 diabetes mellitus and has called to report feeling shaky, hungry, and fatigued. Which of the following actions should the nurse instruct the client to take? 1. Drink 16 oz of water 2. Perform a fingerstick blood glucose check 3. Take another glipizide tablet 4. Lie down and rest

4 - Lipohypertrophy 1. Rotating insulin injection sites does not prevent rapid absorption. Using the same injection site, specifically the abdomen, speeds absorption, while using the thigh allows for the slowest absorption 2. Rotating insulin injection sites does not affect the risk for intradermal injection because the appropriate areas for insulin injection contain adequate subcutaneous tissue in most clients 3. Rotating insulin injection sites is unlikely to affect injection pain. The depth of the injection affects pain; deeper IM injections are more painful and are also inappropriate for insulin injection 4. Lipohypertrophy is a proliferation of fat at the sites of repeated insulin injections. It affects skin sensitivity and appearance. To prevent it, the client should rotate injection sites, keeping them at least 2.5 cm (1 in) apart, and avoid using the same spot within the same month

A nurse is teaching a client about self-administering regular insulin. The nurse should instruct the client to rotate injection sites to prevent which of the following? 1. Rapid absorption 2. Intradermal injection 3. Injection pain 4. Lipohypertrophy

1 - avoid drinking alcohol 1. The nurse should instruct the client to avoid drinking alcohol. Alcohol can interact with glipizide, a sulfonylurea, causing nausea, palpitations, and flushing. Alcohol also increases the drug's hypoglycemic effects 2. Glipizide, a sulfonylurea, is unlikely to cause esophagitis. However, it can cause gastrointestinal distress with heartburn 3. Glipizide, a sulfonylurea, is unlikely to cause urinary retention. However, it can cause diarrhea. Clients who develop this adverse reaction should maintain hydration by drinking plenty of electrolyte-rich fluids 4. Glipizide, a sulfonylurea, helps control hyperglycemia caused by type 2 diabetes mellitus. The client should take the drug 30 min before the first meal of the day

A nurse is teaching a client who has a prescription for glipizide therapy to treat type 2 diabetes mellitus. Which of the following instructions should the nurse include? 1. Avoid drinking alcohol 2. Sit or stand for 30 min after taking the drug 3. Urinate every 4 hours 4. Take the drug 2 hr after a meal

3 - administer pramlintide before meals 1. Pramlintide, an amylin mimetic, supplements the effects of insulin and oral hypoglycemic drugs. However, clients should not mix it in the same syringe with insulin 2. The nurse should instruct the client to inject pramlintide, an amylin mimetic, 20 min before any meal that contains at least 30 g of carbohydrates 3. Clients should take pramlintide, an amylin mimetic, three times per day with meals. Metformin, a biguanide, is an endocrine-system drug that clients take orally once per day with their evening meal 4. Clients should inject pramlintide, an amylin mimetic, subcutaneously into the abdomen or thigh, rather than the upper arm.

A nurse is teaching a client who has a prescription for pramlintide therapy to treat type 1 diabetes mellitus. Which of the following instructions should the nurse include? 1. Mix pramlintide with insulin in the syringe 2. Administer pramlintide before meals 3. Take pramlintide once daily at bedtime 4. Inject pramlintide into the upper arm

4 - renal impairment 1. Clients who have thyroid disease can take a regular prescribed dose of sitagliptin, a gliptin. Glipizide is an endocrine-system drug that requires cautious use with clients who have thyroid disease 2. Clients who have bronchitis can take a regular prescribed dose of sitagliptin, a gliptin. The drug requires cautious use with clients who have a history of pancreatitis 3. Clients who have heart failure can take a regular prescribed dose of sitagliptin, a gliptin. Metformin is an endocrine-system drug that is contraindicated for clients who have heart failure 4. Sitagliptin, a gliptin, requires cautious use with clients who have renal dysfunction and low creatinine clearance because the kidneys eliminate the drug virtually intact. The provider should prescribe a lower dose for this client or prescribe a different hypoglycemic drug

A nurse should recognize that a provider will prescribe a lower dose of sitagliptin for a client who has type 2 diabetes mellitus and who also has which of the following? 1. Thyroid disease 2. Bronchitis 3. Heart failure 4. Renal impairment

2 - hydrocortisone 1. Somatropin, a growth hormone, treats growth hormone deficiencies, such as Turner's syndrome, rather than adrenocortical insufficiency 2. Hydrocortisone, a glucocorticoid, provides replacement therapy for acute and chronic adrenocortical insufficiency, such as Addison's disease. Hydrocortisone is identical to cortisol, the primary glucocorticoid the adrenal cortex generates 3. Glucagon, a hyperglycemic, treats severe hypoglycemia from insulin toxicity, rather than adrenocortical insufficiency 4. Desmopressin, an antidiuretic hormone, treats diabetes insipidus, rather than adrenocortical insufficiency

When considering replacement therapy options for a client who has chronic adrenocortical insufficiency, a nurse should recognize that the provider will choose which of the following drugs? 1. Somatropin 2. Hydrocortisone 3. Glucagon 4. Desmopressin