Ch 57 58
An adolescent patient recently attended a health fair and had a serum glucose test. The patient telephones the nurse and says, "My level was 125 mg/dl. Does that mean Ihave diabetes?" What is the nurse's most accurate response? A) "Unless you were fasting for longer than 8 hours, this does not necessarily mean you have diabetes." B) "At this level, you probably have diabetes. You will need an oral glucose tolerance test this week." C) "This level is conclusive evidence that you have diabetes." D) "This level is conclusive evidence that you do not have diabetes."
A) "Unless you were fasting for longer than 8 hours, this does not necessarily mean you have diabetes."
A patient is diagnosed with peptic ulcer disease. The patient is otherwise healthy. The nurse learns that the patient does not smoke and that he drinks 1or 2 glasses of wine with meals each week. The nurse anticipates that the provider will prescribe which drugs? A) Amoxicillin (Amoxil), clarithromycin, and omeprazole (Prilosec) B) Amoxicillin (Amoxil), metronidazole (Fiagyl), and cimetidine (Tagamet), C) Clarlthromycin, metronidazole (Fiagyl), and omeprazole (Prilosec) D) Tetracycline, cimetidine (Tagamet), and lansoprazole (Prevacid)
A) Amoxicillin (Amoxil), clarithromycin, and omeprazole (Prilosec)
A patient has been taking levothyroxine for several years and reports that "for the past 2 weeks, the drug doesn't seem to work as well as before." What will the nurse do? A) Ask the patient when the prescription was last refilled. B) Expect the patient to have an elevated temperature and tachycardia. C) Suggest that the patient begin taking calcium supplements. D) Tell the patient to try taking the medication with food.
A) Ask the patient when the prescription was last refilled.
When metronidazole (Fiagyl) is a component of the H. pylori treatment regimen, the patient must be instructed to do what? A) Avoid any alcoholic beverages B) Avoid foods containing tyramine C) Take the drug on an empty stomach D) Take the drug with food
A) Avoid any alcoholic beverages
The nurse assesses a newly diagnosed patient for short-term complications of diabetes. What does this assessment include? A) Evaluation for hyperglycemia, hypoglycemia, and ketoacidosis B) Cranial nerve testing for peripheral neuropathy C) Pedal pulse palpation for arterial insufficiency D) Auscultation of the carotids for bruits associated with atherosclerosis
A) Evaluation for hyperglycemia, hypoglycemia, and ketoacidosis
A patient with type 1 diabetes reports mixing NPH and regular insulin to allow for one injection. What should the nurse tell the patient? A) This is an acceptable practice. B) These two forms of insulin are not compatible and cannot be mixed. C) Mixing these two forms of insulin may Increase the overall potency of the products. D) NPH insulin should only be mixed with insulin glargine.
A) This is an acceptable practice.
A 1-year-old child with cretinism has been receiving 8 mcg/kg/day of levothyroxine (Synthroid). The child comes to the clinic for a well-child check up. The nurse will expect the provider to: A) change the dose of levothyroxine to 6 mcg/kg/day. B) discontinue the drug if the child's physical and mental development is normal. C) increase the dose to accommodate the child's increased growth. D) stop the drug for 4 weeks and check the child's TSH level.
A) change the dose of levothyroxine to 6 mcg/kg/day.
A nurse is teaching a patient who will begin taking methimazole (Tapazole) for Graves' disease about the medication. Which statement by the patient indicates understanding of the teaching? A) "Because of the risk for liver toxicity, Iwill need frequent liver function tests." B) "I should report a sore throat or fever to my provider if either occurs." C) "I will need a complete blood count every few months." D) "It is safe to get pregnant while taking this medication."
B) "I should report a sore throat or fever to my provider if either occurs."
The nurse prepares a patient with Graves' disease for radioactive iodine (131 I) therapy. Which statement made by the patient best demonstrates understanding of 131 I therapy? A) "I will have to isolate myself from my family for 1week so that Idon't expose them to radiation." B) "This drug will be taken up by the thyroid gland and will destroy the cells to reduce my hyperthyroidism." C) "This drug will help reduce my cold intolerance and weight gain." D) "I will need to take this drug on a daily basis for at least 1 year."
B) "This drug will be taken up by the thyroid gland and will destroy the cells to reduce my hyperthyroidism."
A nurse is educating the staff nurses about ketoacidosis. To evaluate the group's understanding, the nurse asks, "Which sign and symptoms would not be consistent with ketoacidosis?" The group gives which correct answer? A) Blood glucose level of 600 mg/dL B) Blood glucose level of 60 mg/dL C) Acidosis D) Ketones in the urine
B) Blood glucose level of 60 mg/dL
A nurse caring for a patient notes that the patient has a temperature of 104° F arid a heart rate of 110 beats per minute. The patient's skin is warm and moist, and the patient complains that the room is too warm. The patient appears nervous and has protuberant eyes. The nurse will contact the provider to discuss: A) cretinism. B) Graves' disease. C) myxedema. D) Plummer's disease.
B) Graves' disease.
The nurse is caring for a pregnant patient recently diagnosed with hypothyrdfdism. The patient tells the nurse she does not want to take medications while she is pregnant. What will the nurse explain to this patient? A) Hypothyroidism is a normal effect of pregnancy and usually is of no consequence. B) Neuropsychologic deficits in the fetus can occur if the condition is not treated. C) No danger to the fetus exists until the third trimester. D) Treatment is required only if the patient is experiencing symptoms.
B) Neuropsychologic deficits in the fetus can occur if the condition is not treated.
A patient is admitted to the hospital and will begin taking levothyroxine (Synthroid). The nurse learns that the patient also takes warfarin (Coumadin). The nurse will notify the provider to discuss ____ the ____ dose. A) reducing; levothyroxine B) reducing; warfarin C) increasing; levothyroxine D) increasing; warfarin
B) reducing; warfarin
A nurse obtaining an admission history on an adult patient notes that the patient has a heart rate of 62 beats per minute, a blood pressure of 105/62 mm' Hg, and a temperature of 96.2° F. The patient appears pale and complains of always feeling cold and tired. The nurse will contact the provider to discuss tests for which condition? A) Cretinism B) Graves' disease C) Hypothyroidism D) Plummer's disease
C) Hypothyroidism
A patient with hypothyroidism begins taking PO levothyroxine (Synthroid). The nurse assesses the patient at the beginning of the shift and notes a heart rate of 62 beats per minute and a temperature of 97.2° F. The patient is lethargic and difficult to arouse. The nurse will contact the provider to request an order for which drug? A) Beta blocker B) Increased dose of PO levothyroxine C) Intravenous levothyroxine D) Methimazole (Tapazole)
C) Intravenous levothyroxine
The nurse is administering medications to a patient who is receiving cyclosporine (Sandimmune). Which medication, when administered concurrently with cyclosporine, would warrant a reduction in the dosage of cyclosporine? A) Phenytoin (Dilantin) B) Prednisone C) Ketoconazole (Nizoral) D) Trimethoprim/sulfamethoxazole (Bactrim)
C) Ketoconazole (Nizoral)
Insulin glargine is prescribed for a hospitalized patient who is diabetic. When will the nurse administer this drug? A) Approximately 15 to 30 minutes before each meal B) Inthe morning and at 4 PM C) Once daily at bedtime D) After meals and at bedtime
C) Once daily at bedtime
A patient with type 1 diabetes recently became pregnant. The nurse plans a blood glucose testing schedule for her. What is the recommended monitoring schedule? A) Before each meal and before bed B) In the morning for a fasting level and at 4 PM for the peak level C) Six or seven times a day D) Three times a day, along with urine glucose testing
C) Six or seven times a day
A patient in her twenties with Graves' disease who takes methimazole (Tapazole) tells a nurse that she is trying to conceive and asks about disease management during pregnancy. What will the nurse tell her? A) Methimazole is safe to take throughout pregnancy. B) Propylthiouracil should be taken throughout her pregnancy. C) The patient should discuss changing to propylthiouracil from now until her second trimester with her provider. D) The patient should discuss therapy with iodine-131 instead of medications with her provider.
C) The patient should discuss changing to propylthiouracil from now until her second trimester with her provider.
A nurse is teaching a patient who has been diagnosed with hypothyroidism about levothyroxine (Synthroid). Which statement by the patient indicates a need for further teaching? A) "I should not take heartburn medication without consulting my provider." B) "I should report insomnia, tremors, and an increased heart rate to my provider." C) "If Itake a multivitamin with iron, Ishould take it 4 hours after the Synthroid." D) "If Itake calcium supplements, Imay need to decrease my dose of Synthroid."
D) "If Itake calcium supplements, Imay need to decrease my dose of Synthroid."
A nurse provides dietary counseling for a patient newly diagnosed with type 1 diabetes. Which instruction should be included? A) "You may eat any foods you want and cover the glucose increase with sliding scale, regular insulin." B) "Most of the calories you eat should be in the form of protein to promote fat breakdown and preserve muscle mass." C) "Your total caloric intake should not exceed 1800 calories in a 24-hour period." D) "Most of your calories should be in the form of carbohydrates and monounsaturated fats."
D) "Most of your calories should be in the form of carbohydrates and monounsaturated fats."
A patient has a free T4 level of 0.6 ng/dL and a free T3 of 220 pg/dL. The patient asks the nurse what these laboratory values mean. How will the nurse respond? A) "These laboratory values indicate that you may have Graves' disease." B) "These results suggest you may have hyperthyroidism." C) "We will need to obtain a total T4 and a total T3 to tell for sure." D) "We will need to obtain a TSH level to better evaluate your diagnosis."
D) "We will need to obtain a TSH level to better evaluate your diagnosis."
What is the most reliable measure for assessing diabetes control over the preceding 3-month period? A) Self-monitoring blood glucose (SMBG) graph report B) Patient's report C) Fasting blood glucose level D) Glycosylated hemoglobin level
D) Glycosylated hemoglobin level
A patient with type 1 diabetes is eating breakfast at 7:30AM. Blood sugars are on a sliding scale and are ordered before a meal and at bedtime. The patient's blood sugar level is 317 mg/dL. Which formulation of insulin should the nurse prepare to administer? A) No insulin should be administered. B) NPH C) 70/30 mix D) Lispro (Humalog)
D) Lispro (Humalog)
An older adult patient Is diagnosed with hypothyroidism. The initial free T4 level is 0.5 mg/dl, and the TSH level is 8 microunits/mL. The prescriber orders levothyroxine (Levothroid) 100 mcg/day PO. What will the nurse do? A) Administer the medication as ordered. B) Contact the provider to discuss giving the levothyroxine IV. C) Request an order to give desiccated thyroid (Armour Thyroid). D) Suggest that the provider lower the dose.
D) Suggest that the provider lower the dose.
A patient with type 1 diabetes who takes insulin reports taking propranolol for hypertension. Why is the nurse concerned? A) The beta blocker can cause insulin resistance. B) Using the two agents together increases the risk of ketoacidosis. C) Propranolol increases insulin requirements because of receptor blocking. D) The beta blocker can mask the symptoms of hypoglycemia.
D) The beta blocker can mask the symptoms of hypoglycemia.
Which statement is accurate about the long-term complications of diabetes? A) Long-term complications are almost always the result of hypoglycemia and ketoacidosis. B) The complication rates for patients with tightly controlled type 2 diabetes are the same as for those whose disease is not tightly controlled. C) Tightly controlling type 1diabetes produces excessive episodes of life-threatening hypoglycemia. D) Tightly controlling both types of diabetes reduces the risk of eye, kidney, and nerve damage.
D) Tightly controlling both types of diabetes reduces the risk of eye, kidney, and nerve damage.
A patient arrives in the emergency department with a heart rate of 128 beats per minute and a temperature of 105° F. The patient's skin feels hot and moist. The free T4 level is 4 ng/dL, the free T3 level is 685 pg/dL, and the TSH level is 0.1 microunits/mL. The nurse caring for this patient will expect to administer: A) intravenous levothyroxine. B) iodine-131 (131 I). C) methimazole (Tapazole). D) propylthiouracil (PTU).
D) propylthiouracil (PTU).
