Endocrine Pharm pt.1 nclex review
A client is newly diagnosed with hypothyroidism. Levothyroxine (Synthroid) is prescribed. The nurse should reinforce to the client which instructions about the medication?
Take on an empty stomach. Levothyroxine should be taken on an empty stomach to enhance absorption. The client also is instructed to take the medication in the morning before breakfast.
Prednisone 10 mg orally daily has been prescribed for a client. The nurse provides instructions to the client regarding the medication. Which statement by the client indicates that further teaching is needed?
"I can take acetylsalicylic acid (aspirin) or my antihistamine if I need it." Aspirin and other over-the-counter medications should not be used unless the client consults with the health care provider.
The community health nurse visits a client at home who has been prescribed prednisone 5 mg orally daily. The nurse reinforces teaching for the client about the medication. Which statement made by the client indicates a need for further teaching?
"I can take aspirin or my antihistamine if I need it." Aspirin and other over-the-counter medications should not be taken unless the client consults with the health care provider (HCP).
The nurse realizes that the client taking metformin (Glucophage) needs further teaching when the client makes which statement?
"I should treat hypoglycemic episodes due to metformin with glucose tablets only." Metformin may be used alone or with other medications, including insulin, to treat type 2 diabetes. Metformin is in a class of drugs called biguanides. Metformin helps to control the amount of glucose in your blood. It decreases the amount of glucose absorbed from food and the amount of glucose made by the liver. Metformin also increases the body's response to insulin, a natural substance that controls the amount of glucose in the blood. Gastrointestinal side effects such as flatulence and diarrhea can occur from this medication. Lactic acidosis can occur from the interaction of contrast dye and metformin so as prescribed, metformin is withheld for 48 hours after certain diagnostic tests that use dye.
Which statement indicates that a client with Addison's disease knows how to safely manage a medication regimen that consists of daily doses of glucocorticoids?
"I will need to call my doctor for an increase in medication dose when I'm experiencing a lot of stress." The client with Addison's disease will require lifelong replacement of adrenal hormones. The medications must be taken daily, and an alternate route of administration must be used if the client cannot take oral medications for any reason, such as nausea and vomiting. Additional doses of glucocorticoids will be needed during times of acute stress. The nurse must emphasize to the client that the health care provider must be called to obtain a dosage increase when experiencing stressful situations.
The nurse reinforces instructions to a client with myxedema about the dosage, method of administration, and side effects of levothyroxine sodium (Synthroid). Which statement by the client indicates an understanding of the nurse's instructions?
"I will report any episodes of palpitations, chest pain, or dyspnea." A major concern when initiating thyroid hormone replacement therapy is that the dosage may be too high, which can lead to cardiovascular problems. As a result, clients need to be aware of the early signs and symptoms of toxicity and that they must report these immediately to their health care provider.
Thyroid replacement therapy is prescribed for a client diagnosed with hypothyroidism. The client asks the nurse when the medication will no longer be needed. Which response by the nurse would be accurate?
"The medication will need to be continued for life." For most hypothyroid clients, replacement therapy must be continued for life. Treatment provides symptomatic relief but does not produce a cure. The client should be told that although therapy will improve symptoms, these improvements do not constitute a reason to interrupt or discontinue the medication.
Prednisone is prescribed for a client with diabetes mellitus who is taking NPH insulin daily. Which prescription should the nurse anticipate during therapy with the prednisone?
An increased amount of daily NPH insulin Glucocorticoids can elevate blood levels of glucose. Diabetic clients may need their dosage of insulin or oral hypoglycemic medications increased during glucocorticoid therapy.
When discussing the rationale for levothyroxine (Synthroid) with a client with hypothyroidism, the nurse should emphasize that the client can anticipate which primary expected outcome?
Achieving normal thyroid hormone levels Laboratory determination of the serum thyroid-stimulating hormone level (TSH) is an important means of evaluation of therapy with levothyroxine.
A client receiving desmopressin (DDAVP) begins to complain of a headache. The nurse notes that the client is listless and falls asleep easily. The nurse interprets that the client is most likely experiencing which reaction?
Adverse medication effects DDAVP is used in the management of diabetes insipidus. Thus the action of the medication is to cause water retention. Adverse effects of DDAVP then could include water intoxication or hyponatremia. Early signs include drowsiness, listlessness, and headache.
The nurse is caring for a client with Paget's disease who has an elevated serum calcium level of 12.3 mEq/L. The nurse checks to see that which medication is available in the stock medication supply area for possible use to reverse this elevation?
Calcitonin (Calcimar) The normal serum calcium level is 4.5 to 5.5 mEq/L or 9 to 11 mg/dL. Calcitonin, a thyroid hormone, decreases the plasma calcium level by increasing the incorporation of calcium into the bones, thus keeping it out of the serum.
Potassium iodide (Lugol's solution) is prescribed for a client. The client calls the nurse at the clinic and complains of a brassy taste and burning sensations in the mouth. How should the nurse respond?
Contact the health care provider. Chronic ingestion of iodide can produce iodism. The client needs to be instructed about the symptoms of iodism, which include a brassy taste, burning sensations in the mouth, soreness of gums and teeth, frontal headache, coryza, salivation, and skin eruptions. The client needs to be instructed to notify the health care provider if these symptoms occur
A client is diagnosed with hypothyroidism, and levothyroxine (Synthroid) is prescribed. The nurse notes that the client is presently taking warfarin sodium (Coumadin) and anticipates that the health care provider will alter which medication dosage?
Decrease the dosage of warfarin sodium. Levothyroxine accelerates the degradation of vitamin K-dependent clotting factors. As a result, effects of warfarin sodium are enhanced. If thyroid hormone replacement therapy is instituted in a client who has been taking warfarin sodium, the dosage of warfarin sodium should be reduced.
A client who has sustained an eye injury has been prescribed corticosteroid eye drops. The nurse should most carefully monitor for side effects of this medication if the client has which health problem listed on the medical record?
Diabetes mellitus The client with diabetes mellitus is especially at risk for side effects when taking this medication, which is a corticosteroid. The client may experience elevations in blood glucose, which should be monitored routinely.
The nurse is collecting data from a client seen in the health care clinic for the first time. When the nurse asks the client about current prescribed medications, the client tells the nurse that metformin (Glucophage) is taken daily. Based on this finding, the nurse elicits data from the client regarding the presence of which condition?
Diabetes mellitus Metformin (Glucophage) is an antidiabetic medication used for clients with type 2 diabetes mellitus, and the medication reduces the blood glucose. It is used as an adjunct to diet and exercise.
A glucocorticoid is prescribed for a client with adrenal insufficiency, and the nurse reinforces medication instructions to the client. The nurse determines that the client needs further teaching if the client states which action is necessary?
Discontinue the medication when symptoms subside. Glucocorticoids should not be discontinued abruptly to prevent acute adrenal insufficiency. Because glucocorticoids cause sodium and water to be retained while causing loss of potassium, the client should limit sodium intake and increase potassium intake. These medications can increase the risk of infection, and the client should avoid contact with persons who are ill. Eating breakfast each day is a general health-promoting behavior.
The nurse is monitoring a client receiving desmopressin acetate (DDAVP) for adverse effects to the medication. Which sign/symptom indicates the presence of an adverse effect?
Drowsiness Water intoxication (overhydration) or hyponatremia is an adverse effect of desmopressin. Early signs include drowsiness, listlessness, and headache. Decreased urination, rapid weight gain, confusion, seizures, and coma also may occur in overhydration.
A daily dose of prednisone is prescribed for a client. The nurse reinforces instructions to the client regarding administration of the medication and instructs the client to take this medication at which time?
Early morning Corticosteroids (glucocorticoids) should be administered before 9:00 am. Administration at this time helps minimize adrenal insufficiency and mimics the burst of glucocorticoids released naturally by the adrenal glands each morning.
Metformin (Glucophage) is prescribed for a client with type 2 diabetes mellitus. Which should the nurse tell the client is a common side effect of the medication?
Gastrointestinal (GI) disturbances The most common side effect of metformin is GI disturbances, including decreased appetite, nausea, and diarrhea.
Levothyroxine sodium (Synthroid) is prescribed for a client with hypothyroidism. When should the nurse encourage the client to take the medication?
In the morning Synthetic levothyroxine sodium increases basal metabolic rate and is used to treat hypothyroidism. It is administered in the morning (on an empty stomach) to prevent insomnia.
The nurse is monitoring a client receiving levothyroxine sodium (Synthroid) for hypothyroidism. Which findings indicate the presence of a side effect associated with this medication? Select all that apply.
Insomnia Weight loss Mild heat intolerance Insomnia, weight loss, and mild heat intolerance are side effects of levothyroxine sodium. Bradycardia and constipation are not side effects associated with this medication, but rather are associated with hypothyroidism, which is the disorder that this medication is prescribed to treat.
The nurse preparing a client for surgery reviews the client's medication record. The client is to receive nothing by mouth (NPO) after midnight. Which medication noted on the client's record should the nurse question?
Prednisone Prednisone is a corticosteroid that can cause adrenal atrophy, which reduces the body's ability to withstand stress. Before and during surgery, dosages may be temporarily increased.
A client with diabetes mellitus visits a health care clinic. The client's diabetes mellitus previously had been well controlled with glyburide (DiaBeta) daily, but recently the fasting blood glucose level has been 180 to 200 mg/dL. Which medication, added to the client's regimen, may have contributed to the hyperglycemia?
Prednisone Prednisone may decrease the effect of oral hypoglycemics, insulin, diuretics, and potassium supplements.
The nurse assists in developing a plan of care for a client with hyperparathyroidism receiving calcitonin-human (Cibacalcin). Which outcome has the highest priority regarding this medication?
Reaching normal serum calcium levels Hypercalcemia can occur in clients with hyperparathyroidism, and calcitonin is used to lower plasma calcium levels. The highest-priority outcome in this client situation would be a reduction in serum calcium level.
The nurse is reinforcing instructions to a client regarding intranasal desmopressin acetate (DDAVP). The nurse should tell the client that the medication has which side effect?
Runny nose Desmopressin administered by the intranasal route can cause a runny or stuffy nose.
A client diagnosed with hyperthyroidism will be taking propylthiouracil (PTU). The nurse reinforces medication instructions and determines that the client understands the information if the client states that it is most important to report which symptoms to the health care provider?
Sore throat An adverse effect of PTU is agranulocytosis. The client should be alert for this effect by noting the presence of fever or sore throat, which should be reported immediately.
A client is scheduled for subtotal thyroidectomy. Potassium iodide (Lugol solution) is prescribed. The nurse understands that which outcome is the therapeutic effect of this medication?
Suppress thyroid hormone production. Lugol solution is administered to hyperthyroid individuals in preparation for thyroidectomy to suppress thyroid function.
A client is seen in the clinic for complaints of thirst, frequent urination, and headaches. Following diagnostic studies, diabetes insipidus is diagnosed. Desmopressin acetate (DDAVP) is prescribed for the client. What would the nurse explain to the client as the purpose of the medication?
To increase water reabsorption Desmopressin acetate is an antidiuretic hormone used in the treatment of diabetes insipidus. It promotes renal conservation of water by acting on the collecting ducts of the kidney to increase their permeability to water, which results in increased water reabsorption.
A client with a partial right adrenalectomy is placed on corticosteroid replacement therapy. Which data would indicate that the client is experiencing an adverse effect related to the pharmacological treatment?
Tarry stools Glucocorticoids increase gastric secretion, and this can result in peptic ulcers and gastrointestinal bleeding. A sign of gastrointestinal bleeding is the presence of tarry (black) stools. Corticosteroids increase the blood glucose.
A client who exhibits fatigue, lack of energy, constipation, and depression is diagnosed with hypothyroidism. The health care provider prescribes levothyroxine (Synthroid). To increase the likelihood of medication compliance in the early course of treatment, the nurse plans to reinforce which information?
The full therapeutic effect may take 1 to 3 weeks. The full therapeutic effect of this medication may not be seen for 1 to 3 weeks. Clients should be aware of this so that they do not discontinue the medication on their own due to lack of perceived effect.
Fludrocortisone (Florinef) is prescribed for a client with Addison's disease. Which is the primary action of this medication?
To enhance the reabsorption of sodium and chloride ions in the distal tubules of the kidney Fludrocortisone has mineralocorticoid activity and a glucocorticoid effect. It acts primarily on the kidneys distal tubules, enhancing the reabsorption of sodium and chloride ions and the excretion of potassium and hydrogen ions. It promotes water retention.
An oral hypoglycemic medication, a sulfonylurea, is prescribed for a client with type 2 diabetes mellitus. The nurse plans to administer the medication, knowing that what is the primary action of this medication?
To promote insulin secretion by the pancreas Sulfonylureas promote insulin secretion by the pancreas and may increase tissue response to insulin.
The nurse is caring for a client after a thyroidectomy and notes that calcium gluconate is prescribed for the client. The nurse determines that this medication has been prescribed for which reason?
Treat hypocalcemic tetany. If the client develops numbness and tingling around the mouth, fingertips, or toes, or muscle spasms or twitching, the health care provider is notified immediately. Calcium gluconate should be accessible for the client who underwent thyroidectomy.
The 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 sign/symptom occurs?
Tremors Excessive doses of levothyroxine (Synthroid) can produce signs and symptoms of hyperthyroidism. These include tachycardia, chest pain, tremors, nervousness, insomnia, hyperthermia, heat intolerance, and sweating. The client should be instructed to notify the HCP if these occur.
A client who will undergo thyroidectomy at a later date has been started on medication therapy with potassium iodide (SSKI). As the licensed practical nurse (LPN) prepares to administer a scheduled dose, the client states that there is a burning sensation and a brassy taste in the mouth. Which action should the LPN take?
Withhold the medication and notify the RN. Long-term ingestion of potassium iodide can produce iodism. Symptoms include a brassy taste, burning sensations in the mouth, soreness of gums and teeth, frontal headache, nasal congestion, salivation, and skin lesions. If these occur, the nurse should withhold the medication and notify the RN, who will then contact the health care provider.