Exam 3

A patient with diabetes insipidus has been prescribed desmopressin. Which questions will the nurse ask the patient during a follow-up visit to assess the effectiveness of treatment? Select all that apply. 1. "Do you feel very thirsty lately?" 2. "How many times do you urinate in a day?" 3. "Is there any change in the color of your urine?" 4. "Is there any change in the color of your sputum?" 5. "Do you have excessive bleeding due to minor injuries?"

1. "Do you feel very thirsty lately?" 2. "How many times do you urinate in a day?" In diabetes insipidus, the patient has polydipsia (excessive thirst) and polyuria (excessive urine). Desmopressin relieves symptoms of diabetes insipidus, so the nurse should ask the patient about excessive thirst and frequency of urination. Diabetes insipidus does not change the color of urine or sputum, so the nurse should not ask the patient about color change of urine or sputum. Diabetes insipidus does not cause excessive bleeding in the patient. In the case of hemophilia A, there may be excessive bleeding; however, the patient does not have hemophilia A.

The patient is prescribed 30 units regular insulin and 70 units NPH insulin subcutaneously every morning. The nurse will provide which instruction to the patient? 1. "Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin." 2. "Mixing insulins will help increase insulin production." 3. "Rotate sites at least once weekly." 4. "Use a 23- to 25-gauge syringe with a 1-inch needle for maximum absorption."

1. "Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin." Drawing up the regular insulin into the syringe first prevents accidental mixture of NPH insulin into the vial of regular insulin, which could cause an alteration in the onset of action of the regular insulin.

Which statement by the patient demonstrates an understanding of discharge instructions on the use of levothyroxine (Synthroid)? 1. "I will take this medication in the morning so as not to interfere with sleep." 2. "I will double my dose if I gain more than 1 pound per day." 3. "I will stop the medication immediately if I lose more than 2 pounds in a week." 4. "I can expect to see relief of my symptoms within 1 week."

1. "I will take this medication in the morning so as not to interfere with sleep." Levothyroxine increases basal metabolism and thus wakefulness. Patients should not double the dose or stop taking the medication abruptly. It may take up to 4 weeks for a therapeutic response to occur.

Before a child begins drug therapy with growth hormone, the nurse should stress which teaching point with the parents? 1. "Your child's expected growth rate is 7.6 to 12.7 cm (3-5 in) during the first year of treatment." 2. "You need to measure your child's height and weight daily." 3. "Growth hormone therapy, once started, must be taken until the child reaches the age of 21." 4. "The amount of subcutaneous fat your child has will increase during the treatment period."

1. "Your child's expected growth rate is 7.6 to 12.7 cm (3-5 in) during the first year of treatment." The expected growth rate with growth hormone therapy is 3-5 inches in the first year. Height and weight is measured monthly. Growth hormone is discontinued when optimum adult height is attained, fusion of epiphyseal plates has occurred, or when there is no response to growth hormone. Growth hormone is related to growth of long bones, not fat deposition.

The nurse is administering lispro (Humalog) insulin and will keep in mind that this insulin will start to have an effect within which time frame? 1. 15 minutes 2. 1 to 2 hours 3. 80 minutes 4. 3 to 5 hours

1. 15 minutes The onset of action for lispro insulin is 15 minutes. The peak plasma concentration is 1 to 2 hours; the elimination half-life is 80 minutes; and the duration of action is 3 to 5 hours.

A client received 20 units of NPH insulin subcutaneously at 8:30 AM. Breakfast was eaten at 0900 and lunch was eaten at 1200. The nurse should check the client for a potential hypoglycemic reaction at what time? 1. 3:00 PM 2. 10:00 AM 3. 9:00 AM 4. 1:00 PM

1. 3:00 PM NPH is intermediate-acting insulin. Its onset of action is 1 to 2½ hours, it peaks in 4 to 6 hours, and its duration of action is 24 hours. Hypoglycemic reactions most likely occur during peak time. Breakfast eaten at 9:00 AM would cover the onset of NPH insulin of 0900 and 1000 and lunch will cover the 1 PM time frame. However, if the patient does not eat a mid-afternoon snack, the NPH insulin may be peaking just before dinner without sufficient glucose on hand to prevent hypoglycemia.

Glimepiride (Amaryl) is prescribed for a client with diabetes mellitus. A nurse reinforces instructions for the client and tells the client to avoid which of the following while taking this medication? 1. Alcohol 2. Organ meats 3. Whole-grain cereals 4. Carbonated beverages

1. Alcohol When alcohol is combined with glimepiride (Amaryl), a disulfiram-like reaction may occur. This syndrome includes flushing, palpitations, and nausea. Alcohol can also potentiate the hypoglycemic effects of the medication. Clients need to be instructed to avoid alcohol consumption while taking this medication. The items in options 2, 3, and 4 do not need to be avoided.

A patient receives regular insulin at 0800. The nurse would be alert for signs and symptoms of hypoglycemia at which time? 1. Between 1000 and 1200 2. Between 0830 and 0930 3. Between 1400 and 1600 4. Between 1200 and 1800

1. Between 1000 and 1200

A pediatric patient is prescribed somatropin. Which parameter will the nurse monitor during the follow-up visit? Select all that apply. 1. Height 2. Weight 3. Skin turgor 4. Motor skills 5. Visual acuity

1. Height 2. Weight 4. Motor skills Somatropin is an anterior pituitary hormone. It is used in the treatment of growth hormone deficiency. Somatropin affects the normal physical development. The nurse should assess the height, weight, motor skills, and growth parameters in the pediatric patient. Somatropin does not affect the skin turgor or visual acuity, so these parameters need not be monitored during the follow-up visit.

Before surgery, propranolol is prescribed for a client with hyperthyroidism. The nurse should assess for which set of intended outcomes? 1. Change in heart rate, reduced anxiety, reduced sweating 2. Regrowth of scalp hair, increased tolerance of extreme temperature changes 3. Weight gain, improved respiratory status 4. Decreased insomnia, decreased restlessness

1. Change in heart rate, reduced anxiety, reduced sweating The excessive levels of thyroxine in hyperthyroidism lead to symptoms such as tachycardia, anxiety, and diaphoresis. Propranolol is a beta-adrenergic blocker and is used to treat sympathetic nervous system responses. Although the disease affects the volume of hair and heat tolerance, propranolol has no direct effect on heat tolerance or scalp hair. Because of the excessive thyroxine secretion, the metabolic process is increased, which results in dyspnea without exertion. The purpose of the propranolol is to reduce the cardiovascular signs and symptoms, not respiratory symptoms. Because propranolol reduces tachycardia and palpitations, the insomnia and restlessness may decrease, but this is not the primary purpose for the administration of the drug.

When the nurse teaches a client about insulin administration, what information about the client alerts the nurse that special instruction is needed? 1. Client closely restricts foods high in carbohydrates. 2. Client wants spouse to learn to administer insulin. 3. Client performs 30 minutes of aerobic exercise every other day. 4. Client takes nap each day in the afternoon.

1. Client closely restricts foods high in carbohydrates. Insulin contributes to the metabolism of fats, proteins, and carbohydrates. The client should ingest a balanced diet, not just restrict carbohydrates. It is appropriate for the spouse to learn to administer the insulin if the client becomes unable to. Regular exercise can increase peripheral use of glucose. Napping in the afternoon would have no significant impact on insulin administration.

The nurse is reviewing a client's medication record and notes that levothyroxine is prescribed. The nurse considers that the client may have which condition? Select all that apply. 1. Cretinism 2. Thyroid cancer 3. Myxedema coma 4. Adrenal insufficiency 5. Type 2 diabetes mellitus

1. Cretinism 2. Thyroid cancer 3. Myxedema coma Levothyroxine is indicated for use in clients with cretinism, congenital hypothyroidism, and for some types of thyroid cancer that contribute to hypothyroidism. Myxedema coma occurs in clients who have very low thyroid hormone levels. The use of levothyroxine and other forms of thyroid hormone replacement would be indicated. Glucocorticoid and mineralocorticoid replacement is expected for adrenal insufficiency. Oral and injectable hypoglycemic agents are used to treat type 2 diabetes mellitus.

Several weeks ago calcitonin was prescribed for a client with Paget disease. To determine therapeutic effectiveness, the nurse should review which follow-up testing results for this client? 1. Decreased alkaline phosphatase levels 2. Increased serum calcium levels 3. Bone x-rays for return of bones to normal 4. Magnetic resonance imaging (MRI) results of skull deformities

1. Decreased alkaline phosphatase levels Paget disease is characterized by overactive osteoblasts (cells that break down the bone), which stimulates an increase in alkaline phosphatase levels. Calcitonin decreases the cell turnover. This is evident in the reduced alkaline phosphate level. Calcitonin would decrease the calcium level rather than increase it. Bone deformity is permanent, not temporary, so bones will not return to normal. Skull deformities are common with Paget but are unrelated to therapeutic effectiveness.

Desmopressin acetate (DDAVP) is prescribed for the treatment of diabetes insipidus. The nurse monitors the client after medication administration for which therapeutic response? 1. Decreased urinary output 2. Decreased blood pressure 3. Decreased peripheral edema 4. Decreased blood glucose level

1. Decreased urinary output Desmopressin promotes renal conservation of water. The hormone carries out this action by acting on the collecting ducts of the kidney to increase their permeability to water, which results in increased water reabsorption. The therapeutic effect of this medication would be manifesterd by a decreased urine. Output. Options 2, 3. and 4 are unrelated to the effects of this medication.

A patient is receiving vasopressin. Which symptoms warrant immediate notification of the primary health care provider? Select all that apply. 1. Diarrhea 2. Pale skin 3. Yellow eyes 4. Hypertension 5. Abdominal cramping

1. Diarrhea 4. Hypertension 5. Abdominal cramping During the follow-up visit, the nurse should monitor for symptoms such as diarrhea, hypertension, and abdominal cramping. These are adverse effects of vasopressin. If these symptoms are persistent, severe complications may arise, so the nurse should notify the primary health care provider immediately if these symptoms are present. Vasopressin does not affect skin turgor or eyes, so symptoms such as pale skin and yellow eyes are not related to vasopressin treatment.

A patient is prescribed cosyntropin. What side effect will the nurse expect? 1. Edema 2. Hypotension 3. Inflammation 4. Scar formation

1. Edema The drug cosyntropin travels to the adrenal cortex of the kidney and promotes renal retention, which results in edema. This action is followed by an increase in blood pressure, or hypertension, not hypotension. The process is associated with an antiinflammatory action. Scar formation in the tissue is also reduced.

A client recently diagnosed with type 2 diabetes mellitus is beginning drug therapy with tolbutamide. The nurse should conduct a drug history with special emphasis on which drugs? Select all that apply. 1. Ginseng, which increases hypoglycemic effects 2. Alcoholic beverages, which cause a disulfiram-like reaction 3. Thiazide diuretics, which increase risk for aplastic anemia 4. Beta blockers, which mask signs and symptoms of hypoglycemic reaction 5. Garlic, which increases risk of bleeding

1. Ginseng, which increases hypoglycemic effects 2. Alcoholic beverages, which cause a disulfiram-like reaction 4. Beta blockers, which mask signs and symptoms of hypoglycemic reaction Ginseng lowers glucose levels. Tolbutamide interacting with alcohol can lead to a disulfiram-like reaction, causing complaints of headache and flushing of the skin. This is an important teaching point for the client who has a history of alcoholism, even if currently not drinking. Beta blockers reduce the sympathomimetic response to hypoglycemic reactions. Hence, signs and symptoms of hypoglycemia are less likely to occur. Aplastic anemia is a side effect of tolbutamide, not thiazide diuretics. Garlic does not interact with tolbutamide to increase the risk of bleeding.

A patient with diabetes insipidus is taking Vasopressin. He is complaining of drowsiness, lightheadedness, and headache. What does the nurse suspect that he is experiencing? 1. An allergic reaction 2. Dehydration 3. Depression 4. Water intoxication

4. Water intoxication

A client is taking a high dose of fludrocortisone to treat Addison disease. The nurse should provide which instruction to the client? 1. Keep a log of weekly early-morning weights. 2. Report weight loss greater than 2.3 kg (5 lb) per week. 3. There will be reduced ability to resist infection. 4. It is important to measure postural blood pressures.

1. Keep a log of weekly early-morning weights. High doses of fludrocortisone may result in excess retention of sodium and water, resulting in excessive weight gain. Because outcomes include sodium and fluid retention, the client is more likely to gain weight than lose it. A reduced ability to resist infection is associated with Cushing disease rather than Addison disease. Because of the risk of excess fluid retention, the client is not likely to experience hypovolemia.

Which information should be included in a teaching plan for patients taking oral hypoglycemic drugs? (Select all that apply.) 1. Limit your alcohol consumption. 2. Report symptoms of anorexia and fatigue 3. Take your medication only as needed. 4. Notify your physician if blood glucose levels rise above the level set for you.

1. Limit your alcohol consumption. 2. Report symptoms of anorexia and fatigue 4. Notify your physician if blood glucose levels rise above the level set for you.

The nurse is caring for a child diagnosed with growth hormone deficiency. The nurse educates the child's parents about the child's care. The nurse will instruct the child's parents to report which symptom? 1. Limping 2. Bleeding gums 3. Excessive thirst 4. Abdominal cramps

1. Limping Growth hormone promotes bone and muscle growth. Its deficiency reduces the bone mass that may result in limping. Bleeding gums are seen mostly due to the deficiency of vitamin C and any blood disorders. Growth hormone does not cause a vitamin deficiency or bleeding disorders. Excessive thirst occurs when there is an increased loss of water in the form of sweat or urine. Growth hormone does not promote any water loss which indicates the absence of excessive thirst in its deficiency. Growth hormone does not affect abdominal muscle tone and does not cause abdominal cramps.

The nurse is caring for a patient scheduled for VIPoma tumor surgery. The patient is experiencing diarrhea and facial flushing. After the treatment, the nurse finds that the patient has elevated glucose levels. Which drug will the nurse expect the provider to order? 1. Octreotide 2. Somatropin 3. Vasopressin 4. Cosyntropin

1. Octreotide Octreotide is prescribed for alleviation of symptoms like diarrhea and flushing of the face related to tumors. Octreotide affects glucose regulation and may cause hyperglycemia. Somatropin is a growth hormone, so it should not be administered to a patient with a tumor condition. Vasopressin is used to control excessive thirst and is used in treating hypotension and dehydration. Cosyntropin stimulates secretion of cortisol, so it is not administered because the patient has high glucose levels.

The nurse is caring for a patient who has esophageal varices. Which drug will the nurse expect to administer to this patient? 1. Octreotide 2. Cosyntropin 3. Somatropin 4. Desmopressin

1. Octreotide Octreotide is used in the treatment of esophageal varices. Cosyntropin is not used in the treatment of esophageal varices. It only helps in the enhancement of cortisol levels. Desmopressin is used to treat dehydration caused by vasopressin deficiency. Somatropin is a growth hormone that is indicated in the treatment of growth failure due to inadequate endogenous growth hormone secretion. It is also used for patients with HIV infection with wasting or cachexia in conjunction with antiviral therapy.

The nurse admitting a patient with acromegaly anticipates administering which medication? 1. Octreotide 2. Somatropin 3. Corticotropin 4. Desmopressin

1. Octreotide Octreotide suppresses growth hormone, which causes acromegaly. The other medications do not suppress growth hormone.

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, if added to the client's regimen, may have contributed to the hyperglycemia? 1. Prednisone 2. Phenelzine (Nardil) 3. Atenolol (Tenormin) 4. Allopurinol (Zyloprim)

1. Prednisone Prednisone may decrease the effect of oral hypoglycemics, insulin, diuretics, and potassium supplements. Option 2, a monoamine oxidase inhibitor, and option 3, a βblocker, have their own intrinsic hypoglycemic activity. Option 4 decreases urinary excretion of sulfonylurea agents, causing increased levels of the oral agents, which can lead to hypoglycemia.

Which therapeutic effect is achieved with somatrem? 1. Promotion of linear growth 2. Decrease in blood glucose levels 3. Inhibition of protein synthesis 4. Retention of fat stores in adipose tissues

1. Promotion of linear growth Somatrem promotes linear growth in children by stimulating various anabolic (tissue-building) processes. This includes liver glycogenolysis, which raises, not lowers, blood sugar levels. Protein synthesis is stimulated, not inhibited. Finally, lipids are also mobilized from body fat stores, not retained in them.

An operating room nurse prepares a patient who has type 2 diabetes for surgery. Which type of insulin that can be given intravenously does the nurse administer? 1. Regular insulin 2. Insulin glargine 3. Insulin zinc suspension 4. Isophane insulin suspension (NPH insulin)

1. Regular insulin Regular insulin is the only type of insulin that can be given intravenously. The other variants of insulin, including insulin glargine, insulin zinc suspension, and isophane insulin suspension (NPH insulin), are administered through the subcutaneous route.

Which history of symptoms and conditions will the nurse evaluate before administering desmopressin to prevent complications? Select all that apply. 1. Seizure 2. Asthma 3. Diabetes insipidus 4. Cardiovascular disease 5. Type I von Willebrand

1. Seizure 2. Asthma 4. Cardiovascular disease The nurse should check for a history of seizure, asthma, and cardiovascular diseases before administering desmopressin. While administering desmopressin to a patient with these symptoms, special precaution is required. Vital signs, heart sounds, and breath sounds should be carefully monitored. Diabetes insipidus and type I von Willebrand disease are an indication of desmopressin, and no special care is required with these conditions.

The nurse admitting a patient with acromegaly anticipates administering which medication? 1. desmopressin (DDAVP) 2. corticotropin (Acthar) 3. somatropin (Nutropin) 4. octreotide (Sandostatin)

4. octreotide (Sandostatin) Octreotide suppresses growth hormone, the culprit of acromegaly.

The primary health care provider is closely monitoring thyroid, glucose, and calcium levels in a patient, along with motor skills. Which drug is this patient receiving? 1. Somatropin 2. Vasopressin 3. Cosyntropin 4. Desmopressin

1. Somatropin Somatropin is a growth hormone that is administered to manage inadequate growth in children. Thyroid, glucose, and calcium levels are monitored, and motor skills of the patients are assessed. Vasopressin is used to prevent dehydration. It does not affect growth. Cosyntropin is administered to increase secretion of cortisol. Desmopressin is also used in the treatment of dehydration caused by a deficiency of antidiuretic hormone.

The nurse would question an order for steroids in a patient with which condition? 1. Uncontrolled diabetes mellitus 2. Rheumatoid arthritis 3. Septic shock 4. Exacerbation of chronic obstructive pulmonary disease (COPD)

1. Uncontrolled diabetes mellitus A common side effect of steroid therapy is hyperglycemia; therefore uncontrolled diabetes mellitus is a contraindication to steroid therapy.

The nurse is providing care to a patient following a non-accidental traumatic brain injury. The patient has developed diabetes insipidus due to the injury. What medication is most often used in the management of diabetes insipidus? 1. desmopressin (DDAVP) 2. corticotrophin (Acthar) 3. octreotide (Sandostatin) 4. somatropin (Humatrope)

1. desmopressin (DDAVP) Vasopressin (Pitressin) and desmopressin (DDAVP) are used to prevent or control polydipsia (excessive thirst), polyuria, and dehydration in patients with diabetes insipidus caused by a deficiency of endogenous antidiuretic hormone.

Which long-acting insulin mimics natural, basal insulin with no peak action and a duration of 24 hours? 1. insulin glargine (Lantus) 2. insulin glulisine (Apidra) 3. regular insulin (Humulin R) 4. NPH insulin

1. insulin glargine (Lantus) Insulin glargine has a duration of action of 24 hours with no peaks, mimicking the natural, basal insulin secretion of the pancreas.

A client with adrenal insufficiency is prescribed to take hydrocortisone three times daily on a long-term basis. What should the nurse include in client teaching? Select all that apply. 1. "Immediately stop taking this medication if weight gain or diarrhea occurs." 2. "Alcohol and caffeine should be avoided while taking this medication." 3. "You will likely notice an improvement in your daily blood glucose levels and hemoglobin A1C levels." 4. "Report symptoms of persistent heartburn or indigestion." 5. "Report any wound that will not heal or is healing very slowly."

2. "Alcohol and caffeine should be avoided while taking this medication." 4. "Report symptoms of persistent heartburn or indigestion." 5. "Report any wound that will not heal or is healing very slowly." Alcohol and caffeine should be avoided during long-term hydrocortisone therapy because they contribute to the development of peptic ulcer disease. Heartburn or indigestion should be reported; they are adverse effects of this medication and may signal peptic ulcer disease. Corticosteroids inhibit the inflammatory and immune response. A slow-healing wound should be reported to the healthcare provider. Replacement steroids should not be abruptly discontinued. If needed, the client should be tapered off the medication to avoid withdrawal symptoms and/or adrenal insufficiency. Replacement corticosteroids may contribute to secondary diabetes. It is unlikely that an improvement of blood glucose or hemoglobin A1C will occur.

The nurse instructs a nursing student to administer vasopressin to a patient. The student observes visible particles in the vasopressin solution and notifies the nurse. What instruction will the nurse give the student to ensure safe administration of vasopressin? 1. "Heat the medicine before administration." 2. "Do not administer the drug to the patient." 3. "Shake the medication before administration." 4. "Keep the bottle in warm water before administration."

2. "Do not administer the drug to the patient." Presence of visible particles in vasopressin solution indicates contamination. Administration of this contaminated solution may lead to the loss of therapeutic effect and cause severe reactions in the patient. The nurse should instruct the student nurse not to administer vasopressin to the patient. Vasopressin should not be heated before administration, because this may affect its potency. Shaking of the medication may not have any effect on the drug if vasopressin solution contains visible particles. The nurse should not keep the bottle in warm water, because this does not reduce the risk of complication. In contrast, it may increase the chance of contamination.

After ingesting high dosages of glucocorticoids for several weeks, the client asks the nurse about stopping drug therapy. Which statement would be the nurse's best response? 1. "Even at high doses, adverse reactions are unlikely if the medication is abruptly withdrawn." 2. "It is dangerous for steroids to be withdrawn suddenly." 3. "You may experience severe psychological symptoms when the medication is withdrawn." 4. "Tapering of the medication requires daily bloodwork to measure serum chemistries."

2. "It is dangerous for steroids to be withdrawn suddenly." Abrupt cessation of long-term steroid therapy can cause acute adrenal insufficiency, which could lead to death. Signs and symptoms include nausea and vomiting, lethargy, confusion, and coma. Because long-term glucocorticoid therapy results in shrinkage of the adrenal gland, it cannot produce an adequate level of the hormone. Abrupt withdrawal can cause problems. Central nervous system symptoms such as confusion and psychosis are adverse effects of steroids such as prednisone. Gradual reduction of dosages decreases the severity of the withdrawal signs and symptoms without bloodwork.

Liotrix is prescribed for a client with hypothyroidism. The nurse should include which important statement as part of client teaching prior to discharge? 1. "Measure the body temperature every morning." 2. "Report chest pain or palpitations to your healthcare provider immediately." 3. "You may experience sleepiness while taking this drug." 4. "You may experience nervousness while taking this drug."

2. "Report chest pain or palpitations to your healthcare provider immediately." Symptoms of adverse effects of liotrix include tachycardia and angina. Without treatment, these symptoms can result in cardiac damage. Assessing the heart rate is the most important assessment. Toxicity can result in slight hyperthermia, but this will have minimal impact on the client's health. Thus, Temperature does not have to be monitored. Sleepiness is a sign and symptom of the disease, which should decrease or resolve once drug therapy is started. Nervousness is a side effect of this drug, but this is less threatening than cardiac alterations.

A 19-year-old student was diagnosed with hypothyroidism and has started thyroid replacement therapy with levothyroxine (Synthroid). After 2 days, she called the clinic to report that she does not feel better. Which response from the nurse is correct? 1. "It will probably require surgery for a cure to happen." 2. "The full therapeutic effects may not occur for 6 to 8 weeks." 3. "Is it possible that you did not take your medication as instructed?" 4. "Let's review your diet; it may be causing absorption problems."

2. "The full therapeutic effects may not occur for 6 to 8 weeks." Patients need to understand that it may take up to 6 to 8 weeks to see the full therapeutic effects of thyroid drugs. The other options are incorrect.

When making a home visit to a male client who has been receiving insulin for 2 weeks, the nurse should include which statements in follow-up client teaching? Select all that apply. 1. "A family member also needs to learn how to administer insulin injections." 2. "Visual changes can occur over time if blood glucose is not sufficiently controlled with insulin." 3. "You may experience impotence as an effect of the disease process." 4. "Loss of sight and toe or leg amputation are common in clients with diabetes who take insulin." 5. "A high glucose level is not always an indication for an increase in insulin dosage."

2. "Visual changes can occur over time if blood glucose is not sufficiently controlled with insulin." 3. "You may experience impotence as an effect of the disease process." 5. "A high glucose level is not always an indication for an increase in insulin dosage." Visual changes can occur because of diabetic retinopathy, particularly in clients whose blood glucose is not well controlled. Changes in penile vasculature may cause impotence prior to diagnosis of diabetes mellitus; initial insulin therapy may increase this problem. Some clients experience a rebound hyperglycemia (Somogyi effect). It is helpful for a family member to be able to inject insulin, but the initial focus should be on teaching the client. With control of serum glucose levels, complications such as vision loss and loss of limbs due to accelerated atherosclerosis can be prevented or delayed.

The nurse instructs a nursing student to administer vasopressin to a patient. The nursing student asks the nurse about the elimination half-life of the drug. What is the correct response by the nurse? 1. 1 hour 2. 30 minutes 3. 2 to 8 hours 4. 1.7 to 1.9 hours

2. 30 minutes Vasopressin is a natural or synthetic antidiuretic hormone. Elimination half-life of vasopressin is 30 minutes. Peak plasma concentration of vasopressin is one hour. Duration of action of vasopressin is 2 to 8 hours. Elimination half-life of octreotide is 1.7 to 1.9 hours.

The nurse is providing education to a patient about the time to take gliburide . For maximum benefit, the nurse will tell the patient to administer glipizide at which time? 1. In the morning 2. 30 minutes before a meal 3. 15 minutes postprandial 4. At bedtime

2. 30 minutes before a meal

A client who has received metyrapone experiences an adrenal crisis. The nurse considers that which condition most likely predisposed the client to this occurrence? 1. Hyperaldosteronism 2. Adrenal insufficiency 3. Pheochromocytoma 4. Type 1 diabetes mellitus

2. Adrenal insufficiency In the presence of adrenal insufficiency, metyrapone may cause an adrenal crisis by reducing the synthesis of cortisol. The drug is utilized for diagnosis of Cushing disease. Aldosterone is a mineralocorticoid, while metyrapone influences glucocorticoids. Pheochromocytoma is related to excessive secretion of catecholamines and would not cause an adrenal crisis, which is related to decreased glucocorticoid level. Diabetes is more likely to develop with high levels of glucocorticoids.

The nurse is reviewing the various types of insulins. For each insulin listed below, place in order from shortest duration (1) to longest duration (4). 1. Glargine insulin 2. Aspart insulin 3. Regular insulin 4. NPH insulin

2. Aspart insulin 3. Regular insulin 4. NPH insulin 1. Glargine insulin

Which medication, when given with desmopressin, causes increased water retention? 1. Thioridazine 2. Carbamazepine 3. Acetaminophen 4. Norepinephrine

2. Carbamazepine When given with desmopressin, carbamazepine can cause an increase in the effects of desmopressin, including water retention. Thioridazine, acetaminophen, and norepinephrine do not have any water retention impact on desmopressin.

The nurse is caring for a patient who is receiving octreotide and notes that the patient has a long QT interval on the electrocardiogram. Which other drug may this patient be taking? 1. Cyclosporine 2. Ciprofloxacin 3. Demeclocycline 4. Carbamazepine

2. Ciprofloxacin Desmopressin, combined with ciprofloxacin, may cause a prolonged QT interval. Cyclosporine causes possible transplant rejection. Demeclocycline causes a reduced antidiuretic effect when given with vasopressin. Carbamazepine enhances the vasopressin effects.

The primary health care provider prescribes vasopressin to a patient. What side effects will the nurse expect in the patient? 1. Frequent thirst 2. Decreased urination 3. Drowsiness and sleep 4. Confusion and irritation

2. Decreased urination The drug vasopressin mimics the action of antidiuretic hormone, which results in a decrease in urine output. A lower urine output may cause the patient to feel less thirsty. Sedative action is also not reported with vasopressin. There are no reported symptoms of confusion with vasopressin.

When reviewing the laboratory values of a patient who is taking the antithyroid drug PTU, the nurse will monitor for which adverse effect? 1. Decreased glucose levels 2. Decreased white blood cell count 3. Increased red blood cell count 4. Increased platelet count

2. Decreased white blood cell count Antithyroid drugs may cause bone marrow suppression, resulting in agranulocytosis, leukopenia, thrombocytopenia, and other problems. The other options are incorrect.

A nurse is monitoring a client receiving desmopressin acetate (DDAVP) for diabetes insipidus. Which of the following indicates the presence of an adverse effect? 1. Insomnia 2. Drowsiness 3. Weight loss 4. Increased urination

2. Drowsiness Water intoxication (overhydration) or hyponatremia is an adverse effect to desmopressin. Early signs include drowsiness, listlessness, and headache. Decreased urination, rapid weight gain, confusion, seizures, and coma also may occur in overhydration.

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: 1. Myxedema 2. Graves' disease 3. Addison's disease 4. Cushing's syndrome

2. Graves' disease PTU inhibits thyroid hormone synthesis and is used to treat hyperthyroidism, or Graves' disease. Myxedema indicates hypothyroidism. Cushing's syndrome and Addison's disease are disorders related to adrenal function.

When administering morning medications for a newly admitted patient, the nurse notes that the patient has an allergy to sulfa drugs. There is an order for the sulfonylurea glipizide (Glucotrol). Which action by the nurse is correct? 1. Give the drug as ordered 30 minutes before breakfast. 2. Hold the drug, and check the order with the prescriber. 3. Give a reduced dose of the drug with breakfast. 4. Give the drug, and monitor for adverse effects.

2. Hold the drug, and check the order with the prescriber.

What are the possible effects of drugs used to treat growth hormone deficiency in children? Select all that apply. 1. Higher blood sugar levels 2. Increased lipid mobilization 3. Retention of potassium levels 4. Increased retention of sodium 5. Improved tissue-building processes

2. Increased lipid mobilization 4. Increased retention of sodium 5. Improved tissue-building processes The drugs that mimic growth hormone (GH) are somatropin and somatrem. These drugs promote growth by stimulating various anabolic (tissue-building) processes, liver glycogenolysis (to raise blood sugar levels), lipid mobilization from body fat stores, and retention of sodium, potassium, and phosphorus. These drugs do not cause higher blood sugar levels or retention of potassium levels, however. Both drugs promote linear growth in children who lack normal amounts of the endogenous hormone.

Patients taking levothyroxine (Synthroid) and warfarin (Coumadin) concurrently would be monitored for which adverse effect? 1. Cardiac arrhythmias 2. Increased risk of bleeding 3. Excessive weight loss 4. Increased risk of deep vein thrombosis

2. Increased risk of bleeding Levothyroxine can compete with protein-binding sites of warfarin, allowing more warfarin to be unbound or free, thus increasing effects of warfarin and risk of bleeding.

What assessment finding indicates to the nurse that vasopressin has been effective? 1. Relief of pain 2. Increased urine specific gravity 3. Increased serum albumin levels 4. Decreased adrenocorticotropic hormone levels

2. Increased urine specific gravity Vasopressin causes decreased water excretion in the renal tubule, thus increasing urine specific gravity. It is used to treat diabetes insipidus, which presents with a low urine specific gravity. This medication does not decrease pain, affect serum albumin levels, or decrease adrenocorticotropic hormone levels.

A nurse is providing client education regarding prescribed intranasal desmopressin (DDAVP). What items of information should the nurse include during the teaching session? Select all that apply. 1. Shake the drug rigorously prior to use. 2. Keep a record of each night's sleep and record incidents of bed-wetting. 3. Angle the tip of the nasal spray low into the cavity when administering this drug. 4. Report a rapid weight gain to the prescriber immediately. 5. Report drowsiness to the prescriber.

2. Keep a record of each night's sleep and record incidents of bed-wetting. 4. Report a rapid weight gain to the prescriber immediately. 5. Report drowsiness to the prescriber. A record of nocturnal enuresis should be maintained and discussed with the prescriber. Rapid increases in weight, heart rate, blood pressure, and shortness of breath should be reported to the prescriber because they may indicate water retention. Drowsiness, lethargy, or confusion may be signs of water intoxication and should be reported to the prescriber. The drug should not be shaken, as this may lead to drug breakdown. Desmopressin (DDAVP) nasal spray should be administered high up into the nasal cavity and not down the throat.

Which is a clinical indication of water intoxication in the patient who is taking vasopressin? 1. Polyuria 2. Seizures 3. Polydipsia 4. Hypotension

2. Seizures Vasopressin can cause excessive water retention, progressing to water intoxication. Clinical manifestations include drowsiness, headache, listlessness, seizures, and coma. Vasopressin and desmopressin are used to prevent or control polyuria, polydipsia (excessive thirst), and dehydration in patients with diabetes insipidus caused by a deficiency of endogenous antidiuretic hormone (ADH).

Which hormone inhibits the release of growth hormone? 1. Somatropin 2. Somatostatin 3. Somatolactin 4. Choriomammotropin

2. Somatostatin The hormone that inhibits growth hormone is somatostatin. It is otherwise called growth hormone inhibitor and is released from the digestive system and brain. Somatropin is a growth-stimulating hormone. Somatolactin is a hormone that induces oxytocin. Choriomammotropin belongs to the family of somatropins.

A client taking digoxin is scheduled to receive an injection of intravenous calcium. The nurse should prepare to intervene if which sign(s) of drug interaction occur(s)? 1. Hypertension and tingling around the mouth 2. Sustained, significant bradycardia 3. Nausea and vomiting and diarrhea 4. Sloughing of tissue at the injection site

2. Sustained, significant bradycardia Because calcium influences cardiac contractility and neural transmission, it can potentiate the actions of digoxin. The nurse should monitor for severe bradycardia. Hypotension is more likely to occur than hypertension, and tingling around the mouth is more indicative of hypocalcemia. Nausea and vomiting are side effects associated with digoxin, but not diarrhea. Neither is related to a drug interaction between calcium and digoxin. Sloughing of tissue at the site is associated with injection of calcium, but this is not a drug interaction.

The health care provider (HCP) prescribes exenatide (Byetta) for a client with type 1 diabetes mellitus who takes insulin. The nurse knows that which of the following is the appropriate intervention? 1. The medication is administered within 60 minutes before the morning and evening meal. 2. The medication is withheld and the HCP is called to question the prescription for the client. 3. The client is monitored for gastrointestinal side effects after administration of the medication. 4. The insulin is withdrawn from the Penlet into an insulin syringe to prepare for administration.

2. The medication is withheld and the HCP is called to question the prescription for the client. Exenatide (Byetta) is an incretin mimetic used for type 2 diabetes mellitus only. It is not recommended for clients taking insulin. Hence, the nurse should hold the medication and question the HCP regarding this prescription. Although options 1 and 3 are correct statements about the medication, in this situation the medication should not be administered. The medication is packaged in prefilled pens ready for injection without the need for drawing it up into another syringe.

A patient has been diagnosed with metabolic syndrome and is started on the biguanide metformin (Glucophage). The nurse knows that the purpose of the metformin, in this situation, is which of these? 1. To increase the pancreatic secretion of insulin 2. To decrease insulin resistance 3. To increase blood glucose levels 4. To decrease the pancreatic secretion of insulin

2. To decrease insulin resistance Metformin decreases glucose production by the liver; decreases intestinal absorption of glucose; and improves insulin receptor sensitivity in the liver, skeletal muscle, and adipose tissue, resulting in decreased insulin resistance. The other options are incorrect.

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? 1. Fatigue 2. Tremors 3. Cold intolerance 4. Excessively dry skin

2. 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. Options 1, 3, and 4 are signs of hypothyroidism.

A client who recently started taking desmopressin reports onset of a headache, lethargy, and drowsiness. The nurse should make which assessment of the client next? 1. History of recent streptococcal infection 2. Whether client also takes carbamazepine 3. If client has developed hypertension 4. Signs and symptoms of dehydration

2. Whether client also takes carbamazepine Desmopressin is a drug used to treat diabetes insipidus. The manifestations listed are all signs of water intoxication, which could occur as an excessive effect of the medication. Carbamazepine prolongs the effect of desmopressin and could lead to water retention. The drug has no known effects on the immune system. Hypertension may develop with overhydration, but the headache is related more to the swelling of the brain cells. The client's symptoms are not related to dehydration.

When caring for a patient newly diagnosed with gestational diabetes, the nurse would question an order for which drug? 1. insulin glargine 2. glipizide 3. insulin glulisine 4. NPH insulin

2. glipizide

The nurse will advise the patient to treat hypoglycemia with which drug? 1. propranolol 2. glucagon 3. acarbose 4. Bumetanide

2. glucagon

The nurse is caring for a patient scheduled to undergo a cardiac catheterization procedure utilizing iodine-based contrast material. The nurse would question an order for which medication to be given to this patient the day of the scheduled procedure? 1. acarbose (Precose) 2. metformin (Glucophage) 3. repaglinide (Prandin) 4. pioglitazone (Actos)

2. metformin (Glucophage) The concurrent use of metformin and iodinated (iodine-containing) radiologic contrast media has been associated with both acute renal failure and lactic acidosis. Therefore metformin should be discontinued at least 48 hours prior to any radiologic study requiring such contrast media and should be held for at least 48 hours after the procedure.

Which statement indicates to the nurse that the patient needs additional teaching on oral hypoglycemic agents? 1. "I will monitor my blood sugar daily." 2. "I will limit my alcohol consumption." 3. "I will take the medication only when I need it." 4. "I will report symptoms of fatigue and loss of appetite."

3. "I will take the medication only when I need it." Oral hypoglycemic agents must be taken on a daily scheduled basis to maintain euglycemia and to prevent long-term complications of diabetes. The patient needs to closely monitor blood sugar. When alcohol is ingested with certain oral hypoglycemic drugs, the hypoglycemic effect can be intensified. The patient may experience fatigue and loss of appetite as side effects of the medication, and these should be reported to the health care provider.

Parents are concerned that their 5-year-old son is not growing fast enough and ask the nurse if he should be receiving growth hormone (GH). Which response by the nurse would be most appropriate? 1. "Growth hormone will only affect your child's short bones." 2. "Can your son swallow pills easily?" 3. "Scientific evidence is required before growth hormone can be administered to children." 4. ""How tall do you think your son should be?"

3. "Scientific evidence is required before growth hormone can be administered to children." Growth hormone (GH) is only approved for use in children to treat a documented lack of growth hormone. It is available as a parenteral medication only, to be given IM or subcutaneously. Only long bones are affected. The nurse should answer the parent's question before exploring other areas.

Assuming the patient eats breakfast at 9:00 AM, lunch at noon, and dinner at 6:00 PM, he or she is at highest risk of hypoglycemia following an 8:30 AM dose of NPH insulin at what time? 1. 10:00 AM 2. 0200 am 3. 3 PM 4. 8:00 PM

3. 3 PM Breakfast eaten at 9:00 AM would cover the onset of NPH insulin, and lunch will cover the 1 PM time frame. However, if the patient does not eat a mid-afternoon snack, the NPH insulin may be peaking just before dinner without sufficient glucose on hand to prevent hypoglycemia.

A patient is prescribed desmopressin for treatment of hemophilia A. While teaching the patient about the drug, the nurse instructs the patient to avoid alcohol. What is the reason behind the instruction? 1. Alcohol produces an additive effect. 2. Alcohol causes prolongation of QT interval. 3. Alcohol reduces the effects of desmopressin. 4. Alcohol enhances the effects of desmopressin.

3. Alcohol reduces the effects of desmopressin. The nurse instructs the patient to avoid alcohol consumption because alcohol interacts with desmopressin and reduces the effects of desmopressin. Alcohol with desmopressin does not produce an additive effect. Alcohol does not cause prolongation of QT interval. Octreotide and thioridazine interaction causes prolongation of QT interval. Alcohol does not enhance the effects of desmopressin. Desmopressin and carbamazepine interaction enhances the effects of desmopressin.

Prednisone is prescribed for a client with diabetes mellitus who is taking Humulin neutral protamine Hagedorn (NPH) insulin daily. Which of the following prescription changes does the nurse anticipate during therapy with the prednisone? 1. An additional dose of prednisone daily 2. A decreased amount of daily Humulin NPH insulin 3. An increased amount of daily Humulin NPH insulin 4. The addition of an oral hypoglycemic medication daily

3. An increased amount of daily Humulin NPH insulin Glucocorticoids can elevate glucose levels. Clients with diabetes mellitus may need their dosages of insulin or oral hypoglycemic medications increased during flucocorticoid therapy. Therefore the other options are incorrect.

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? 1. Calcium chloride 2. Calcium gluconate 3. Calcitonin (Miacalcin) 4. Large doses of vitamin D

3. Calcitonin (Miacalcin) The normal serum calcium level is 8.6 to 10.0 mg/dL. This client is experiencing hypercalcemia. Calcium gluconate and calcium chloride are medications used for the treatment of tetany, which occurs as a result of acute hypocalcemia. In hypercalcemia, large doses of vitamin D need to be avoided. Calcitonin, a thyroid hormone, decreases the plasma calcium level by inhibiting bone resorption and lowering the serum calcium concentration.

Which drug is used to diagnose adrenocortical insufficiency? 1. Octreotide 2. Somatropin 3. Cosyntropin 4. Desmopressin

3. Cosyntropin Cosyntropin is used for diagnosis of adrenocortical insufficiency. The test involves injecting a small amount of the drug, following which the cortisol levels are measured in response to the drug. Octreotide is useful in alleviating symptoms of carcinoid tumors. Somatropin is used in the treatment of growth hormone deficiency. Desmopressin is useful in the treatment of hemophilia A and type I von Willebrand disease.

Which drug may cause hypervolemia? 1. Oxytocin 2. Octreotide 3. Cosyntropin 4. Thyroid hormone

3. Cosyntropin Cosyntropin, a synthetic adrenocorticotropic hormone, stimulates the adrenal cortex to release cortisol. Cortisol is a glucocorticoid that promotes renal reabsorption of sodium, leading to the passive movement of water with the sodium. Oxytocin stimulates uterine contractions, octreotide helps diminish the watery diarrhea associated with acquired immunodeficiency syndrome (AIDS), and thyroid hormone is replacement therapy for inadequate thyroid levels.

A daily dose of prednisone is prescribed for a client. A nurse reinforces instructions to the client regarding administration of the medication and instructs the client that the best time to take this medication is: 1. At noon 2. At bedtime 3. Early morning 4. Anytime, at the same time, each day

3. 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.

Which is a priority nursing diagnosis for a patient receiving desmopressin (DDAVP)? 1. Risk for injury 2. Acute pain 3. Excess fluid volume 4. Deficient knowledge regarding medication

3. Excess fluid volume Desmopressin is a form of antidiuretic hormone, which increases sodium and water retention, leading to an alteration in fluid volume. Although the other nursing diagnoses may be appropriate, they are not a priority using Maslow's hierarchy of needs.

A patient with type 1 diabetes mellitus is receiving growth hormone. Which assessment finding is the nurse's priority? 1. Hypertension 2. Hypercalciuria 3. Hyperglycemia 4. Hypothyroidism

3. Hyperglycemia Growth hormone increases blood glucose. In a nondiabetic patient, this increased blood glucose stimulates release of insulin to maintain the blood glucose level within the normal range. In type 1 diabetes mellitus, growth hormone causes hyperglycemia because of an insufficient serum level of insulin. Hypertension is high blood pressure, which is not a common adverse effect of growth hormone. Hypercalciuria and hypothyroidism are common adverse effects of growth hormone intake, but they are not related to type 1 diabetes mellitus.

The nurse is discussing with a patient the time of day for taking prednisone. What information would the nurse include in the teaching based on knowledge of glucocorticoids? 1. It is usually administered early in the evening to coincide with the natural secretion pattern of the adrenal cortex. 2. It is usually administered on a strict, unchanging schedule in order to prevent adverse reactions. 3. It should be administered with food to diminish the risk of gastric irritation. 4. It should be administered with the patient's morning coffee to enhance its effects.

3. It should be administered with food to diminish the risk of gastric irritation. Glucocorticoids can cause gastrointestinal distress and should be administered with food. The normal circadian secretion of the adrenal cortex is early morning to wake the person up, not early evening. These medications should be tapered off slowly to prevent adrenal crisis and can be administered intravenously. While glucocorticoids should be given in the morning, they should not be administered with coffee, which contains caffeine and may increase gastric irritation.

A nurse reinforces instructions to a client who is taking levothyroxine (Synthroid). The nurse tells the client to take the medication: 1. With food 2. At lunchtime 3. On an empty stomach 4. At bedtime with a snack

3. On an empty stomach Oral doses of levothyroxine (Synthroid) should be taken on an empty stomach to enhance absorption. Dosing should be done in the morning before breakfast.

The nurse is assessing four patients. Which patient can be prescribed octreotide to alleviate the symptoms? 1. Patient A - Esophageal varices with type 1 diabetes 2. Patient B - Carcinoid tumor and on ciprofloxacin 3. Patient C - Life-threatening hypotension due to vasoactive intestinal polypeptide (VIP) 4. Patient D - Severe diarrhea and flushing due to vasoactive intestinal polypeptide (VIP) with renal impairment

3. Patient C - Life-threatening hypotension due to vasoactive intestinal polypeptide (VIP) Patient C has life-threatening hypotension due to the secretion of VIP, which causes diarrhea and flushing. In such cases, octreotide can be prescribed to the patient. Patient A has esophageal varices, which can be treated with octreotide, but not if the patient has type 1 diabetes. Patient B has carcinoid tumor, which causes secretion of VIP, which in turn causes diarrhea and flushing. Octreotide can be given to control the symptoms, but not in the patient who is on ciprofloxacin. Patient D has severe diarrhea and flushing due to VIP, and octreotide could alleviate the symptoms; however, Patient D has renal impairment. Octreotide may further impair renal function and must be used with caution in patients with renal impairment.

Which action of the patient using intranasal desmopressin through a nasal pump may need correction during a demonstration? 1. Priming the nasal pump once in a week 2. Pressing the pump once to spray 10-mcg dose 3. Pressing down on the pump two times to prime it 4. Replacing the cap on the pump after the procedure

3. Pressing down on the pump two times to prime it Desmopressin can be administered intranasally through pumps. The pump needs to be primed by pressing it down four times, not two times. The nasal pump should be primed once in a week for maximum effectiveness. Each spray of the pump delivers a 10-mcg dose. The cap should be replaced after the procedure to prevent contamination.

After taking propylthiouracil for 6 weeks, a client with Graves disease reports a sore throat and fever. What should the outpatient clinic nurse do next as a priority? 1. Ask client about exposure to the common cold. 2. Measure client's body temperature and ask about history of fever over last few weeks. 3. Review laboratory report for client's white blood cell (WBC) count with differential. 4. Ask about current mental stressors that could be weakening the immune system.

3. Review laboratory report for client's white blood cell (WBC) count with differential. Agranulocytosis is the most serious toxic effect of this drug, and it can predispose the client to a variety of infections. Attempts to determine the risk for infection are important, but are not as important as reviewing the white blood cell count as an indicator of current ability to fight infection. Although stress can predispose the client to infection, the immediate concern is the client's actual condition and ability to combat infection, as evidenced by the WBC count.

The nurse is teaching the patient taking an antithyroid medication to avoid foods high in iodine. Which food will the nurse advise the patient against? 1. Milk 2. Eggs 3. Seafood 4. Chicken

3. Seafood Seafood contains high amounts of iodine. The other choices do not.

How do somatropin and somatrem help children with growth hormone deficiency? 1. They increase sugar levels. 2. They increase protein levels. 3. They stimulate skeletal growth. 4. They increase endogenous growth hormone.

3. They stimulate skeletal growth. The drugs somatropin and somatrem act by stimulating skeletal growth. They are analogs of the growth hormone. They have no direct effect on sugar or protein levels. None of the growth hormone analogs act by increasing the endogenous growth hormone.

The nurse is caring for a patient who has human immunodeficiency virus (HIV) and who is prescribed somatropin. What is the function of somatropin? 1. To decrease growth 2. To reduce fat levels 3. To reduce weight loss 4. To decrease fluid retention

3. To reduce weight loss Somatropin is given in conjunction with antiviral therapy to treat the wasting syndrome or cachexia associated with HIV. Somatropin helps in treating the complications of the wasting syndrome such as weight loss, muscle atrophy, fatigue, weakness, and loss of appetite. Somatropin increases the blood glucose and lipid levels by increasing the liver glycogenolysis and lipid mobilization from the stores of the body fat. Somatropin mimics the growth hormone and stimulates growth by providing the required supplies by a different mechanism. Somatropin does not reduce, but instead mobilizes, the lipids from the fat stores to make them available for use. Somatropin increases the sodium levels by promoting the sodium retention.

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: 1. Treat thyroid storm. 2. Prevent cardiac irritability. 3. Treat hypocalcemic tetany. 4. Stimulate the release of parathyroid hormone.

3. Treat hypocalcemic tetany. Hypocalcemia can develop after thyroidectomy if the parathyroid glands are accidentally removed or injured during surgery. Manifestations develop 1 to 7 days after surgery. 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 kept at the bedside.

The nurse is caring for a 10-year-old boy with growth hormone deficiency. The child asks the nurse how long he will be able to take his medicine. What is the nurses best response? 1. Until you decide to stop 2. Until you are 13 3. Until your epiphyseal plates close 4. Until you get as tall as you want to be

3. Until your epiphyseal plates close

A patient has septic shock. Which drug will the nurse expect to administer? 1. Oxytocin 2. Octreotide 3. Vasopressin 4. Cosyntropin

3. Vasopressin Vasopressin is a potent vasoconstrictor that is used in the treatment of vasodilatory shock. Oxytocin, octreotide, and cosyntropin would not be administered to a patient for the treatment of toxic shock.

The nurse is evaluating a client's knowledge of the treatment of an insulin reaction. The nurse would place highest priority on determining that the client understands which point? 1. Symptoms indicating the need to notify the healthcare provider 2. When to schedule fasting (serum) blood glucose level 3. When to ingest orange juice and crackers with peanut butter 4. Importance of maintaining sufficient oral fluid intake

3. When to ingest orange juice and crackers with peanut butter The priority learning need in treatment of an insulin reaction is that the client understands to take some form of oral glucose, such as orange juice or crackers with peanut butter. The protein prevents a rebound hypoglycemia. This is the most appropriate action because it fixes the problem within a reasonable time frame. The problem can be remedied most of the time without notifying the prescriber, so this is a lesser priority. Scheduling serum glucose levels would be routine and not in relation to an insulin reaction; instead, the client would monitor finger-stick glucose at home. Ingesting fluid would not contribute to the recovery from drug-induced hypoglycemia.

Which oral hypoglycemic drug has a quick onset and short duration of action, enabling the patient to take the medication 30 minutes before eating and skip the dose if he or she does not eat? 1. Stigliptin 2. metformin 3. glipiside 4. pioglitazone

3. glipiside

When teaching a patient who is starting metformin (Glucophage), which instruction by the nurse is correct? 1. "Take metformin if your blood glucose level is above 150 mg/dL." 2. "Take this 60 minutes after breakfast." 3. "Take the medication on an empty stomach 1 hour before meals." 4. "Take the medication with food to reduce gastrointestinal (GI) effects."

4. "Take the medication with food to reduce gastrointestinal (GI) effects."

What is the best method of administering glipizide? 1. With food 2. At bedtime 3. 15 minutes postprandial 4. 30 minutes before a meal

4. 30 minutes before a meal Glipizide is the only sulfonylurea agent that should be administered 30 minutes before a meal. This is because the insulin secreted by the drug corresponds with the elevation in blood glucose concentrations induced by the meal. Food inhibits the absorption of glipizide. Hence, it cannot be administered with food or in a postprandial stage or at bedtime.

The nurse is assessing four patients. Which patient can safely be administered octreotide? 1. A patient with small-bowel fistula having an acute asthma attack 2. A patient with esophageal varices and a history of type 2 diabetes 3. A patient with acromegaly having a serum creatinine level of 5.0 mg/dL 4. A patient with carcinoid tumors that secrete vasoactive intestinal peptide

4. A patient with carcinoid tumors that secrete vasoactive intestinal peptide Octreotide can be safely used in patients with a carcinoid tumor that secretes vasoactive intestinal peptide (VIP). Octreotide inhibits VIP and provides symptom relief. Small-bowel fistula can be treated with octreotide, but it should be used with caution in patients with asthma. A patient with esophageal varices can be treated with octreotide, but because the patient has type 2 diabetes, its use may cause hyperglycemia. Octreotide can be used to treat acromegaly, but it should not be used in patients with renal impairment, such as with the patient with a creatinine level of 5.0 mg/dL.

Which patient can be safely administered somatropin? 1. A patient with acute laryngitis 2. A patient who has a breast tumor 3. A cachexic patient with closed growth plates 4. A patient with human immunodeficiency virus (HIV) infection

4. A patient with human immunodeficiency virus (HIV) infection The patient with HIV infection may have wasting; therefore, somatropin can be used in this patient in conjunction with antiretroviral therapy. Somatropin is contraindicated in patients with acute infections such as acute laryngitis. The patient with a breast tumor is not an ideal candidate for somatropin because the medication may increase its growth. Somatropin is not given to patients with closed growth plates.

The nurse assesses a patient who has a closed head injury that has resulted in trauma to the hypothalamus. Which patient assessment finding is a clinical indicator of hypothalamic dysfunction? 1. Oozing blood 2. Watery diarrhea 3. Loss of consciousness 4. Abundant, dilute urine

4. Abundant, dilute urine Antidiuretic hormone is released from the posterior pituitary gland, so hypothalamic dysfunction may impair the kidney's ability to conserve water, resulting in excessive urine output. Oozing blood and watery diarrhea are indications for other pituitary medications. A patient with a closed head injury is likely to be obtunded or unconscious; however, the impaired level of consciousness is a result not of hypothalamic dysfunction but of increased intracranial pressure.

Because a client with hypocalcemia needs to increase the level of calcium absorption, which activity should the nurse perform as part of the therapeutic plan of care? 1. Administer magnesium sulfate PO. 2. Encourage increase in exercise. 3. Administer verapamil 80 mg PO q8h. 4. Administer ergocalciferol (vitamin D).

4. Administer ergocalciferol (vitamin D). Ergocalciferol (vitamin D) regulates calcium and phosphorus metabolism and increases blood levels of both elements. Magnesium may reduce calcium absorption. Exercise contributes to bone maintenance. Calcium may reduce the effects of verapamil. Absorption of calcium is not affected.

A 5-year-old child is diagnosed with type I von Willebrand disease. Which drug will the nurse expect the primary health care provider to prescribe to the patient? 1. Octreotide 2. Somatropin 3. Cosyntropin 4. Desmopressin

4. Desmopressin Type I von Willebrand disease is a bleeding disorder seen in people who have low levels of von Willebrand factor. Desmopressin is useful in treatment of type I von Willebrand disease, because it affects the various blood clotting factors. Octreotide is antagonistic to growth hormone that is prescribed to reduce the effect of the growth hormone in a tumor condition. Somatropin is a growth hormone. It does not affect blood clotting factors. Cosyntropin increases the cortisol levels, so it is not prescribed.

The nurse is caring for a child who is diagnosed with growth hormone deficiency and is receiving somatropin. Which medication may be the reason this child does not show improvement in linear growth? 1. Cyclosporine 2. Ciprofloxacin 3. Fludrocortisone 4. Glucocorticoids

4. Glucocorticoids Somatropin when administered with glucocorticoids decreases the therapeutic efficiency of somatropin. This results in reduced growth effects of somatropin. When somatropin is administered with cyclosporine, the growth effects are not affected. When somatropin is administered with ciprofloxacin, the growth improvements produced by somatropin are not retarded. When somatropin is administered with fludrocortisones, the efficiency of somatropin is not reduced.

A patient with vasodilatory shock is prescribed vasopressin. What action will the nurse expect to take when giving this medication? 1. Coadministering carbamazepine 2. Obtaining liver and renal function tests 3. Administering the vasopressin intravenously 4. Monitoring the patient in an intensive care unit

4. Monitoring the patient in an intensive care unit Vasopressin prescribed for vasodilatory shock may cause fever as an adverse effect. Consequently, it is necessary to assess the temperature of the patient while in the intensive care unit. Vasopressin must not be administered with carbamazepine because it enhances the effects of the drug, which could cause adverse effects. Liver and renal functions are assessed after administration of octreotide (not vasopressin) because patients with renal and hepatic dysfunction may require special dosing of octreotide. Vasopressin is usually given intramuscularly or subcutaneously, not intravenously.

A patient is admitted to the Emergency Department in diabetic ketoacidosis (DKA) with a blood glucose level of 533. The physician orders an initial dose of 25 U insulin intravaneously (IV). Which type of insulin will be administered? 1. Isophane insulin 2. Lispro insulin 3. Glargine insulin 4. Regular insulin

4. Regular insulin

A female client with a tumor on the posterior pituitary gland is taking cabergoline 0.25 mg by mouth twice weekly. The nurse should monitor for which of the following therapeutic outcomes? 1. Normal serum calcium levels 2. Reduced number of hot flashes per day 3. Lowering of blood pressure 4. Relief from inappropriate lactation

4. Relief from inappropriate lactation The primary purpose of the cabergoline is to reduce or eliminate lactation related to hyperprolactinemia. The drug has no effect on calcium levels. Hot flashes are a side effect of the drug. Hypotension is a common side effect.

The nurse notes that a patient who has cancer is prescribed octreotide. What is the rationale for prescribing this medication? 1. The patient has hypokalemia. 2. The patient has hyponatremia. 3. The patient has hypoglycemia. 4. The patient has orthostatic hypotension.

4. The patient has orthostatic hypotension. Octreotide is prescribed for carcinoid crisis. It also alleviates potentially life-threatening hypotension, so the patient probably has orthostatic hypotension. Octreotide does not affect potassium levels, so the patient cannot have hypokalemia. Octreotide does not cause loss of sodium ions, so there is no risk of hyponatremia. Octreotide causes hypoglycemia only if the patient is diabetic.