pharm week 13

A patient receiving propylthiouracil asks the nurse how this medication will help relieve symptoms. Which statement explains the action of the medication?

"This medication inhibits the formation of new thyroid hormone, thus gradually returning your metabolism to normal." Propylthiouracil is an antithyroid medication used to treat hyperthyroidism. It works by inhibiting the synthesis of new thyroid hormone. It does not assist the thyroid gland or the pituitary gland to synthesize thyroid hormone. It does not inactivate hormone already present.

Which instruction does the nurse give when a patient receiving metformin therapy will undergo angiography?

"Do not take your metformin on the day of the test." Angiography uses iodinated (iodine-containing) radiologic contrast media, which interact with metformin and may cause acute renal failure or lactic acidosis. Hence the nurse instructs the patient to discontinue the drug on the day of the test. There are chances of renal failure after the test only if metformin is taken during the test. Blood glucose levels are regularly evaluated in patients with diabetes, but it is not a priority in this case. Metformin can be taken 48 hours after the test to prevent any adverse effects.

Which statement made by a student nurse about hypothyroidism needs correction?

"Graves' disease is the most common cause of hypothyroidism." Graves' disease is the most common cause of hyperthyroidism. Therefore this statement needs correction. Hypothyroidism can lead to cretinism due to hyposecretion of thyroid hormone. Tertiary hypothyroidism is caused by reduced levels of thyrotropin-releasing hormone. Reduced secretion of thyroid-stimulating hormone results in secondary hypothyroidism.

The nurse is teaching a patient who is prescribed desmopressin and who has polyuria, polydipsia, and dehydration. Which statement by the patient indicates the need for additional teaching?

"I will take medicines immediately upon getting up in the morning." Desmopressin is a pituitary drug. It should be taken with food or at mealtimes to reduce gastrointestinal upset. It should not be taken right after waking up when the stomach is empty. Demeclocycline interacts with desmopressin and may reduce the effect of desmopressin; therefore it should be avoided. Desmopressin interacts with alcohol, so it is necessary to avoid alcohol consumption with this drug. Because the patient has dehydration, it is necessary to drink large amounts of fluid.

Which statement indicates to the nurse that the patient needs additional teaching on oral hypoglycemic agents?

"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.

Which patient statement demonstrates understanding of the nurse's teaching for levothyroxine?

"I will take this medication first thing in the morning." Levothyroxine increases basal metabolism and thus wakefulness. It should be taken first thing in the morning. Depending on the symptoms, some symptoms may take weeks to improve. The patient should not increase the dose. The medication is absorbed best on an empty stomach.

A patient with type 1 diabetes mellitus asks the nurse, "Why can't I take a sulfonylurea like my friend who has diabetes?" Which response is correct?

"Sulfonylurea increases beta-cell stimulation to secrete insulin, and your beta cells do not contain insulin." Sulfonylurea agents reduce serum glucose levels by increasing beta-cell stimulation for insulin release and decreasing hepatic glucose production. It is administered for type 2 diabetes mellitus but will not be effective in individuals with type 1 diabetes. Not all patients with type 2 diabetes require insulin, but patients with type 1 diabetes require insulin. Patients with type 1 diabetes are able to store glucose as glycogen. Sulfonylureas do not help the liver store glucose.

Which instruction will the nurse give a patient who takes isophane suspension (NPH) insulin?

"You should eat 30 to 45 minutes before taking the NPH insulin." Insulin isophane suspension (NPH) is an intermediate-acting insulin product that has an onset of action of 1 to 2 hours. Hence the nurse instructs the patient to eat meals 30 to 45 minutes before administering the injection. It is not necessary to obtain blood glucose levels every hour. Unused vials are stored in the refrigerator for only 3 months to maintain drug stability. It is not necessary to stop insulin for any diagnostic tests because insulin does not interact with any agents used in diagnostic tests.

While assessing a patient who is receiving levothyroxine therapy, the nurse advises the patient to take the oral dose before breakfast. Which dosage is the patient ordered in the prescription?

100mcg Levothyroxine is usually prescribed in micrograms. They are administered orally at a range of 25 to 200 mcg and intravenously at 300 to 500 mcg. Hence the nurse would have advised a dosage of 100 mcg. Antithyroid drugs like propylthiouracil are given in milligrams, but levothyroxine, a thyroid drug, is not. Administering 200 or 400 mg of levothyroxine results in severe adverse effects due to drug overdose. A dose of 300 mcg of levothyroxine is administered by the intravenous route, not by the oral route.

A patient receives isophane suspension (neutral protamine Hagedorn [NPH]) insulin at 8:00 a.m. The patient eats breakfast at 8:30 a.m., lunch at noon, and dinner at 6:00 p.m. At which time is this patient at the highest risk for hypoglycemia?

5:00pm Breakfast eaten at 8:30 a.m. would cover the onset of isophane suspension (NPH) insulin, and lunch will cover the 2:00 p.m. time frame. If the patient does not eat a mid-afternoon snack, however, the NPH insulin may peak just before dinner without sufficient glucose on hand to prevent hypoglycemia.

Which patient had indications for treatment with somatropin?

A 7-year-old diagnosed with growth hormone deficiency For somatropin to be used, the patient has to be diagnosed with a growth hormone deficiency and the growth plates must not be closed, so the child needs to be young. An age of 17 years, neoplastic disease, and a severe respiratory condition are contraindications to this medication.

Which condition is contraindicated with somatrem?

Acromegaly Somatrem is a synthetic form of growth hormone. Acromegaly is caused by excessive growth hormone; therefore this drug would be contraindicated. Polyuria and polydipsia cannot be treated with somatrem. Hypopituitary dwarfism is treated by administering somatrem.

The health care provider prescribes a thyroid replacement drug to a patient with hypothyroidism. Which is the first intervention that helps determine the dosage of thyroid replacement drug for the patient?

Checking the patient's serum thyroid-stimulating hormone levels Before prescribing the thyroid replacement drug to the patient with hypothyroidism, the nurse and primary health care provider have to check the patient's serum thyroid-stimulating hormone (TSH) level. This helps them know the underlying pathologic condition and helps them prescribe the right dosage and medication to the patient. Apart from the patient's TSH level, the patient's free thyroid hormone levels should also be checked. Doing a physical assessment would help calculate the optimal dosage for the patient to prevent adverse effects. The nurse does not expect the patient to have prior knowledge of thyroid therapy. After monitoring the TSH level, the nurse would check the patient's history; this helps rule out possible contraindications and allergies.

A patient with a history of inflammatory bowel disease is prescribed insulin therapy and acarbose for the treatment of high postprandial glucose levels. Which nursing action is a priority in this case?

Consult the primary health care provider before administering acarbose Acarbose has adverse gastrointestinal effects and is contraindicated in patients with inflammatory bowel disease. Hence the nurse needs to consult with the primary health care provider before administering the drug. The nurse needs to administer insulin and the oral diabetic drugs as instructed by the primary health care provider to prevent fluctuations in the patient's glucose levels. The nurse needs to ask about allergic reactions before administering any drug; however, it is not a priority in this case. Assessing the patient's weight is not a priority in this case because acarbose does not cause weight gain.

Which technique would the nurse teach the patient about mixing insulin when the patient must administer 30 units regular insulin and 70 units NPH insulin in the morning?

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. Z-track is an intramuscular technique that is not used with insulin. The medications do not have to be in separate syringes and can be administered together.

After delivery, a patient develops uterine atony and increased bleeding. Which medication will the nurse expect to administer?

During the postpartum phase, the intensity of uterine contractions may decrease and become uncoordinated. It is essential that the uterus remain firm and well contracted. The primary health care provider instructs the nurse to administer oxytocin to the patient to promote uterine contractions. Octreotide, somatropin, and cosyntropin have no effect on the uterus; thus these drugs are not useful for uterine contractions. Octreotide is useful in alleviating symptoms of carcinoid tumors. Somatropin is useful in the treatment of growth hormone deficiency. Cosyntropin is used for the diagnosis of adrenocortical insufficiency.

Which are second-generation sulfonylureas? Select all that apply.

Glipizide, glyburide, and glimepiride are second-generation sulfonylureas. Metformin is a biguanide. Pioglitazone is a thiazolidinedione.

Which laboratory test provides evidence of adequate glucose management and adherence to a diabetes treatment regimen over the past few months?

HbA1C indicates glucose concentrations over the past 3 to 4 months and thus demonstrates patient adherence to therapy and illness management over time. The serum albumin test helps to determine the level of natural protein in blood. The fasting serum glucose test helps to assess whether the patient has elevated blood glucose concentrations. A 2-hour postprandial blood glucose test determines the amount of glucose in the blood after a meal.

Which clinical findings may indicate diabetes mellitus in a patient? Select all that apply.

Hemoglobin A1C level greater than 6.5% Fasting plasma glucose level of 126 mg/dL or higher A hemoglobin A1C level greater than 6.5% is an indication of diabetes mellitus. It indicates that the amount of glucose on the hemoglobin is higher than normal. A fasting plasma glucose level of 126 mg/dL or higher indicates hyperglycemia. It indicates that there are excessive concentrations of glucose in the blood. A casual plasma glucose level of 200 mg/dL or higher and a 2-hour plasma glucose level of 200 mg/dL or higher indicate diabetes. Random blood glucose levels of 70 to 100 mg/dL indicate normal glucose homeostasis.

The nurse is educating a patient who is taking thyroid hormone replacement therapy. Which response given by the patient indicates effective learning?

I should take the tablet every morning with an empty stomach." Food decreases the absorption of the thyroid drug. The patient should take the thyroid drug every morning on an empty stomach to achieve maximum absorption of the drug. The therapeutic effect of the drug decreases if the patient takes the tablet after meals. Administering the drug twice daily leads to drug overdose and adverse effects. The drug therapy should not be withdrawn without informing the primary health care provider because this would worsen the hypothyroidism.

A patient with hypothyroidism reports severe sleeping disturbances. Which statement given by the patient is helpful in identifying the reason for the insomnia?

I take the tablet every evening at the same time." Taking a thyroid tablet in the evening results in insomnia. When administered in the evening, the drug shows its effects at bedtime, resulting in sleep disturbances. If the patient regularly takes the same brand of tablet every day at the same time, it helps reduce the problems with the bioequivalence of drugs from different manufacturers. If the patient takes the tablet every morning at the same time, it increases the effectiveness of the medication, which is highly beneficial to the patient. If the patient takes the tablet every morning on an empty stomach, it maximizes the therapeutic effects of the drug and does not cause insomnia.

Which medication, when given with desmopressin, causes increased water retention?

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.

Which long-acting insulin mimics natural, basal insulin with its duration of 24 hours?

Insulin glargine has a duration of action of 24 hours with no peaks, mimicking natural, basal insulin secretion by the pancreas. Insulin aspart is a rapid-acting human insulin analogue used to lower blood glucose, which has a different dosage. Regular insulin has its duration of action of 6 to 10 hours, with a peak plasma concentration of 2.5 hours. Ultralente insulin has an active duration of 28 hours.

A patient newly diagnosed with type 2 diabetes mellitus has been ordered insulin glargine. Which information is essential for the nurse to teach this patient?

Insulin glargine has a duration of action of 24 hours with no peaks, mimicking the natural, basal insulin secretion of the pancreas. This medication cannot be mixed with other insulins and is not a short-acting insulin. The patient may need to receive this medication for a long time.

A patient newly diagnosed with type 2 diabetes is instructed to make dietary changes and perform aerobic exercise daily. For which reason would insulin therapy be delayed?

Insulin therapy is initiated when other methods have failed. For patients with type 2 diabetes mellitus, insulin therapy is usually reserved for when other treatment methods are unsuccessful. It is more important to start oral drug therapy and initiate lifestyle changes as an initial treatment for diabetes mellitus management. Insulin is prescribed for obese patients if the initial drug therapy and lifestyle changes are ineffective in lowering glucose levels. Insulin therapy is used for diabetic management and is used along with oral drug therapy. Insulin therapy does not cause congestive heart failure in patients. It is more of a concern in patients who take pioglitazone.

A patient with type 1 diabetes mellitus has been ordered insulin aspart 10 units at 7:00 a.m. Which nursing intervention will the nurse perform after administering this medication?

Make sure the patient eats breakfast immediately. Insulin aspart is a rapid-acting insulin that acts in 15 minutes or less. It is imperative that the patient eat as it starts to work. This medication is given subcutaneously, not IV. The patient should have a fingerstick blood sugar test done before receiving the medication. There is no need to check the urine.

The nurse finds that a patient with type 2 diabetes mellitus who is taking glipizide is also prescribed sitagliptin. Which action will the nurse take?

Notify the prescribing primary health care provider. Concurrent use of glipizide and sitagliptin results in hypoglycemia. Hence the nurse needs to notify the primary health care provider who ordered the medications to obtain a prescription to change the drug regimen. Reducing the glipizide dose is not safe because the drug interacts with sitagliptin. Administering both medications will result in hypoglycemia. The nurse does not administer sitagliptin to the patient because it may compromise the patient's safety.

A patient with carcinoid crisis has severe diarrhea, flushing, and life-threatening hypotension. Which drug will be ordered to manage the patient's condition?

Octreotide Carcinoid crisis is the immediate onset of debilitating and life-threatening symptoms; it is associated with carcinoid syndrome. The patient has severe diarrhea, flushing, and life-threatening hypotension due to carcinoid crisis. Octreotide is a somatostatin analog. It is useful in alleviating symptoms of carcinoid tumors. Somatropin is used in the treatment of growth hormone deficiency. Vasopressin is used in the treatment of diabetes insipidus, vasodilatory shock, gastrointestinal hemorrhage, and esophageal varices. Desmopressin is useful in the treatment of hemophilia A and type I von Willebrand's disease.Carcinoid crisis is the immediate onset of debilitating and life-threatening symptoms; it is associated with carcinoid syndrome. The patient has severe diarrhea, flushing, and life-threatening hypotension due to carcinoid crisis. Octreotide is a somatostatin analog. It is useful in alleviating symptoms of carcinoid tumors. Somatropin is used in the treatment of growth hormone deficiency. Vasopressin is used in the treatment of diabetes insipidus, vasodilatory shock, gastrointestinal hemorrhage, and esophageal varices. Desmopressin is useful in the treatment of hemophilia A and type I von Willebrand's disease.

Which statement made by the patient about type 1 diabetes mellitus indicates effective learning?

Patients with type 1 diabetes mellitus require exogenous insulin Type 1 diabetes involves lack of insulin production. Hence patients with type 1 diabetes require exogenous insulin to lower the blood glucose level. There is little or no endogenous insulin, as the patient's body is unable to produce insulin. The disease accounts for 10% of all cases and is usually seen in patients younger than 20 years. Type 1 diabetes results in acute hyperglycemia due to lack of insulin.

A patient who has been taking levothyroxine is experiencing weight loss, tremors, and hypertension. Which pharmacokinetic property of levothyroxine is responsible for causing toxic manifestations?

Prolonged half-life of 10 days Toxic side effects may occur with levothyroxine due to its prolonged half-life of 10 days. It means the drug remains in the body for 10 days and shows its effect, which results in symptoms of toxicity. The onset of action is not a reason for toxic effect. This is evident from the fact that the adverse effects are observed in patients whether the drug is administered by the oral or the intravenous route. Duration of action is also a factor that can cause toxicity, but the duration of action of levothyroxine is 24 hours when given by the oral route. The intravenous dose is normally 50% less when compared to the oral dose; however, toxicity is observed whether the drug is administered by the oral or the intravenous route.

Which medication is used to treat hyperthyroidism during the first trimester of pregnancy?

Propylthiouracil Propylthiouracil is an antithyroid medication used in the first trimester of pregnancy to treat hyperthyroidism. Methimazole is recommended after the first trimester of pregnancy because it causes fetal adverse effects like scalp abnormalities, goiter, and cretinism. Liotrix and levothyroxine are hypothyroid medications that are used to treat hypothyroidism.

Which medication would the nurse withhold for a patient with type 2 diabetes mellitus who is scheduled for a computed tomography (CT) scan with contrast?

metformin Metformin is contraindicated with the use of contrast media. Therefore it should be held due to the risk of renal failure and lactic acidosis the day of the test and for 48 hours after the test. Glipizide, glimepiride, and Humalog insulin are safe to administer with contrast media.

The nurse counsels a patient about preventing insomnia caused by liotrix. Which information would the nurse provide?

Take the drug before breakfast.The nurse would suggest taking the drug early in the morning before breakfast to avoid insomnia. The drug activity is better achieved on an empty stomach; therefore the nurse would not ask the patient to take it with a meal. Rather, the nurse instructs the patient to take the medication before meals. Administering the drug 1 hour after meals will decrease the absorption of drug and cannot prevent insomnia. Taking a nap during the day will not alter the insomniac effect of the drug.

Which information would the nurse include when teaching a patient with a new prescription for levothyroxine? Select all that apply.

Take the medication 30 minutes prior to breakfast. Check your heart rate prior to administration of the drug. Levothyroxine should be administered in the morning 30 minutes before breakfast and without any other medications or food. The nurse would instruct the patient to obtain the heart rate prior to administering the drug because the medication can cause tachycardia. The patient taking antithyroid drugs such as methimazole would avoid the use of iodized salt or shellfish. Antacids should not be administered with levothyroxine because they can interfere with absorption.

Which instruction will the nurse give a patient who self-administers regular insulin injections?

The nurse instructs the patient to administer the injection in the subcutaneous tissue for safety and effective absorption of insulin. The injection is administered at a 45- to 90-degree angle depending on the patient's size. The injection sites need to be rotated every week to prevent lipodystrophy. Regular insulin is a short-acting insulin and needs to be taken 30 minutes before meals.

The nurse finds that, after 6 months of treatment for hyperthyroidism, a patient has little evidence of hyperthyroidism. Which condition does this imply regarding the patient's present condition?

The patient has met the predicted outcomes of the treatment regimen.Any intervention should be evaluated to deduce the outcomes. The treatment regimen is rigorously evaluated to reduce the possible adverse effects. After a thorough assessment, the nurse evaluates the prognosis of the patient's condition. Here, based on the findings, the nurse interprets that the patient has good prognosis with the predicted outcomes. The disease is not progressing silently because the patient is doing well in every aspect of life. The dosage cannot suddenly be reduced or discontinued. After thoroughly assessing and observing the patient's blood parameters, the primary health care provider will make the appropriate decision. The patient has been doing well with the current dosage for 6 months, so the patient does not need an increased dosage in the regimen.

A patient with hypothyroidism has been taking 50 mg of levothyroxine for 2 years. On reviewing the lab reports, the nurse finds that the patient's thyroid hormone levels are constantly fluctuating, even though he takes the medication regularly. Which error during the self-administration of the medication may have caused this?

The patient takes 50 mg of levothyroxine of different brands. Frequently switching brands of medication may cause destabilization of the treatment. This would lead to fluctuations in the patient's thyroid hormone levels. Therefore taking different brands of medication based on their availability is the reason for the constant fluctuations in the patient's hormone levels. Levothyroxine has a long half-life, so usually the medication is taken once a day before meals. Cheese and legumes will not affect the metabolism of the medication, so consuming them will not alter thyroid hormone levels. If a patient misses taking a dose of medication, the patient should not take a double dose the next day because it may cause drug overdose and lead to adverse effects.

The nurse is caring for a patient who is taking levothyroxine and

monitor patient for increased risk of bleeding Levothyroxine can compete with protein-binding sites of warfarin, allowing more warfarin to be unbound or free, thus increasing the effects of warfarin and the risk of bleeding. This combination does not place the patient at increased risk of dysrhythmias, deep vein thrombosis, or weight loss.

During an assessment, a patient asks the nurse, "What should I do if I miss two or three doses of thyroid replacement drug in a row?" Which response would be given by the nurse?

You should consult your primary health care provider immediately." If a patient misses two or more doses of thyroid replacement drug in a row, the patient should consult the primary health care provider. This will help the primary health care provider plan effective treatment and avoid probable complications by modifying the dosage regimen. Taking doses at irregular periods, skipping a dose, or taking a double dose is not appropriate. These situations may cause adverse effects, and the treatment may not be effective

Which patient will benefit from taking glipizide?

a patient with type 2 diabetes and renal failure Glipizide is administered to patients with type 2 diabetes to stimulate the release of insulin. Unlike other oral hypoglycemic drugs, glipizide can be administered to patients with renal failure because it does not cause toxicity. Concurrent use of glipizide and sitagliptin results in hypoglycemia. Glipizide interacts with sulfasalazine and increases the patient's risk for hypoglycemia. Glipizide is contraindicated in type 1 diabetes.

Which site should be used for injecting insulin?

abdomen

Which action does the nurse take when finding a hospitalized patient with type 1 diabetes mellitus unresponsive, cold, and clammy?

administer iv glucose This patient is showing signs of hypoglycemia. In the hospital setting or when the patient is unconscious, intravenous glucose is used to treat hypoglycemia. Administering insulin via drip or subcutaneous injection would worsen hypoglycemia. Drawing a blood sample and sending it to the laboratory is not necessary because bedside glucose testing is faster and as accurate.

The nurse is caring for a patient who has hyperthyroidism and who has been prescribed propylthiouracil. Which action would the nurse take to prevent stomach upset in the patient?

administer medications after meals Propylthiouracil may cause stomach upset, so the nurse would administer the medication with meals, or just before or after meals. This helps to prevent gastrointestinal irritation. Only disintegrating tablets can be dissolved in water for administration. Propylthiouracil is not available as disintegrating tablets, so the nurse would not dissolve the medications in water. Taking antacids 1 hour before taking the drug would not help because antacids can reduce the acid levels in the stomach fluids but cannot prevent stomach upset. Drinking milk will not cause stomach upset because it does not interact with the medication.

Which drug interacts with insulin and increases the risk for unrecognized hypoglycemia in a patient?

beta-adrenergic blockers Beta-adrenergic blockers block the initial sympathetic response to hypoglycemia; therefore, the patient will not exhibit the initial symptoms of nervousness, diaphoresis, and sweating that typically alert the patient to the onset of hypoglycemia. Aspirin and other salicylates can cause hypoglycemia by stimulating insulin secretion. There are no known interactions of codeine and insulin. Thiazide diuretics worsen insulin sensitivity.

A patient with primary hypothyroidism receives levothyroxine and regular insulin. Which finding does the nurse monitor in the patient to help prevent complications of the pharmacotherapy?

blood glucose The nurse would assess a patient who receives levothyroxine and insulin for clinical indicators of hyperglycemia because the combination therapy decreases the effectiveness of insulin. Because the insulin is less effective when administered with levothyroxine, the patient's blood sugar is likely to increase with levothyroxine therapy, or more insulin will be required to maintain a steady serum glucose level. Heat intolerance is a clinical indicator of hyperthyroidism. Fatigue and edema are signs of hypothyroidism. Anxiety and warmth are clinical indicators of hypoglycemia.

A patient is administered somatropin for growth improvement. Which biochemical parameter will the nurse closely monitor after administration?

blood glucose level The nurse would assess the patient's blood glucose level because administration of somatropin may alter the blood glucose levels and lead to hypoglycemia or hyperglycemia. Somatropin has no effect on uric acid level, creatinine level, or blood cells, so testing for uric acid level, creatinine clearance, and complete blood count is not required after administering somatropin.

A patient who has syndrome of inappropriate antidiuretic hormone (SIADH) is prescribed vasopressin. Which drug in the patient's history would be of concern to the nurse?

carbamazepine Vasopressin acts by reducing urine output. The drug carbamazepine acts as an agonist and enhances the effects of the drug, which could result in edema and hypertension in the patient if these two drugs are combined. Thioridazine interacts with octreotide, cyclosporine interacts with octreotide, and ciprofloxacin interacts with octreotide. Therefore only carbamazepine would be of concern for this patient who was prescribed vasopressin.

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 drug may this patient be taking in addition to octreotide?

ciprofloxacin Octreotide, 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.

Which drug is used to diagnose adrenocortical insufficiency?

cosyntropin Cosyntropin is used for the diagnosis of adrenocortical insufficiency. The test involves injecting a small amount of the drug, after 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?

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.

The nurse is taking the history of a female patient who has been prescribed thyroid replacement drugs. The nurse finds that the patient is receiving estrogen supplements as part of hormone replacement therapy. Which possible drug interaction may the nurse anticipate?

decreased thyroid drug activity The patient who is on multiple drug therapies may have adverse effects due to drug-drug interactions. Thyroid replacement drugs interact with estrogen supplements and thereby reduce the thyroid activity, which in turn destabilizes the thyroid treatment. The alteration in glucose levels can be observed in diabetic patients who are taking oral hypoglycemic medication and thyroid medication. Therefore a patient on estrogen therapy may not have a decrease or increase in glucose level. Thyroid drugs do not alter estrogen levels.

The primary health care provider prescribes vasopressin to a patient. Which side effects will the nurse expect in the patient?

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 side effects are not reported with vasopressin. Confusion and irritation are not side effects of vasopressin.

A patient who has a VIPoma tumor reports severe watery diarrhea and sudden reddening of the face. The primary health care provider instructs the nurse to administer octreotide. Which form of octreotide dosage is preferred?

depot suspension The patient should receive octreotide depot suspension to treat symptoms produced by excessive substances that are produced by tumors. Oral dosage forms, such as tablets and capsules, are not manufactured. The nurse would not confuse the depot form of dosage with octreotide injection, as the latter formulation mimics the actions of somatostatin.

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?

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 the treatment of type I von Willebrand disease because it affects the various blood-clotting factors. Octreotide 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 for type 1 von Willebrand disease.

Which medications inhibit the enzyme alpha-glucosidase in the treatment of type 2 diabetes mellitus? Select all that apply.

milglitol, acarbose Alpha-glucosidase inhibitors are a class of antidiabetic drugs used to inhibit the alpha-glucosidase enzyme. Miglitol and acarbose are drugs that inhibit the alpha-glucosidase enzyme. Glipizide is a sulfonylurea that stimulates the release of insulin. Nateglinide is a glinide that increases insulin secretion. Pioglitazone is a thiazolidinedione that decreases insulin resistance by enhancing the sensitivity of insulin receptors.

A patient is receiving vasopressin. Which symptoms warrant immediate notification of the primary health care provider? Select all that apply.

diarrhea hypertension abdominal cramping During the follow-up visit, the nurse would 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 would 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. Vasopressin does not cause liver impairment, so yellow eyes from jaundice are not symptoms related to vasopressin therapy.

Which class of medication increases blood glucose levels when administered with insulin?

diuretics When a diuretic is administered with insulin, an increased blood glucose level will result because the diuretic antagonizes the effect of insulin Salicylates, sulfa antibiotics, and anabolic steroids increase the risk of hypoglycemia when administered with insulin.

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. Which instruction will the nurse give the student to ensure safe administration of vasopressin?

do not administer the drug to the patient The presence of visible particles in vasopressin solution indicates contamination. Administration of this contaminated solution may lead to the loss of its therapeutic effect and cause severe reactions in the patient. The nurse would 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 the medication may not have any effect on the drug if vasopressin solution contains visible particles. The nurse would 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.

A patient is prescribed cosyntropin. Which side effect will the nurse expect?

edema 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.

The primary health care provider has instructed the nurse to administer HP Acthar Gel subcutaneously. Which adverse effect of this exogenous corticotropin will the nurse anticipate in the patient?

edema The primary health care provider has instructed the nurse to administer HP Acthar Gel subcutaneously. Which adverse effect of this exogenous corticotropin will the nurse anticipate in the patient?

Which action will the nurse take before administering glucagon to an unconscious patient?

ensure patient is rolled to one side The nurse rolls the patient onto one side because administration of glucagon may induce vomiting. Here the priority is to administer glucagon to the patient as a quick response to severe hypoglycemia. Assessing oxygen saturation levels is a necessity in a patient with respiratory problems. The nurse needs to use cardiopulmonary resuscitation if the patient has cardiac arrest. Intravenous glucose and 50% dextrose in water (D50W) are most often used for treating acute hypoglycemia. Incretin mimetics are administered subcutaneously to lower blood glucose levels.

Which condition is seen in a patient with hyperosmolar hyperglycemic syndrome (HHS)?

extreme hyperglycemia Extreme hyperglycemia triggers HHS. Acute pancreatitis is an inflammation of the pancreas. This usually happens due to chronic alcohol abuse or due to a gallstone becoming lodged in the pancreatic ducts. Headaches are not caused by HHS. A patient with HHS may have electrolyte imbalances, which may cause dehydration and weight loss, not weight gain.

Which medication will the nurse administer to treat hypoglycemia in a patient brought to the emergency department who was experiencing tremors, sweating, and irritability before losing consciousness?

glucagon Tremors, sweating, irritability, seizure activity, and unconsciousness are all clinical manifestations of hypoglycemia. The treatment of choice for this patient is an intravenous infusion of glucagon. Insulin should never be given to a patient who is already hypoglycemic. Exenatide and liraglutide are incretins that would be appropriate to treat hyperglycemia, not hypoglycemia.

Which hormones are produced by the anterior pituitary gland? Select all that apply.

growth hormone thyroid-stimulating hormone adrenocorticotropic hormone

The nurse is assessing a patient who has been taking propylthiouracil for the past 2 weeks and has normal thyroid-stimulating hormone (TSH) levels. Which symptom would the nurse primarily monitor the patient?

heart palpitations Hyperthyroid symptoms characterized by hypertension and palpitations may occur; this is called thyroid storm. This is a serious, life-threatening condition. The nurse would primarily monitor symptoms of hyperthyroidism, like heart palpitations, to prevent this condition. Symptoms like loss of appetite, cold intolerance, and weight gain are symptoms of hypothyroidism, not hyperthyroidism.

A pediatric patient is prescribed somatropin. Which parameter will the nurse monitor during the follow-up visit? Select all that apply.

height weight 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 would 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.

Which mechanism of action of desmopressin is the rationale for prescribing it to a patient with hemophilia A?

increase the percentage of clotting factor VIII Hemophilia A is a hereditary disorder characterized by lack of blood-clotting factor VIII. This absence may lead to bleeding from even a small injury. Desmopressin is used to increase the percentage of clotting factor VIII in the blood and control the bleeding. Vasopressin and desmopressin have other mechanisms of action that are useful in therapy of other conditions. Vasopressin increases the peripheral vascular resistance, which, in turn, increases arterial blood pressure. Vasopressin and desmopressin regulate the retention of water in the body by increasing the water reabsorption in the collecting ducts of the kidney to treat dehydration. Desmopressin is used to treat type I von Willebrand disease by stimulating the release of von Willebrand factor, a multimeric protein that plays a major role in blood coagulation.

Which effects are possible from drug therapy growth hormone deficiency in children? Select all that apply.

increased lipid mobilization increased retention of sodium imporved tissue building processes The drugs that mimic growth hormone are somatropin and somatrem. They promote growth by lipid mobilization from body fat stores, retention of sodium, and phosphorus; stimulation of various anabolic (tissue-building) processes; and liver glycogenolysis (to raise blood sugar levels). 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.

The nurse is assessing a patient who has loss of memory, hair loss, and yellow discoloration of the skin. Which laboratory findings would the nurse suspect from these observations?

increased thyroid-stimulating hormone Loss of memory, hair loss, and yellow discoloration of the skin indicate that the patient has myxedema. It is caused by insufficient production of thyroid hormone, and the patient would need to take thyroid hormones, but this condition does elevate thyroid-stimulating hormone (TSH) levels. Increased TSH levels are observed in hypothyroid conditions. A decrease in thyroxine levels is observed in patients with myxedema. Calcitonin levels may also be reduced. Calcitonin is primarily responsible for calcium metabolism rather than thyroid function. Increased triiodothyronine levels are observed in hyperthyroidism but not in myxedema.

Which assessment finding indicates to the nurse that vasopressin has been effective?

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.

Which action would the nurse take when a patient reports typically taking glipizide with food?

inform the patient to take the medication 30 minutes before a meal. Food inhibits the absorption of glipizide; it is the only sulfonylurea agent that should be given 30 minutes before a meal. The health care provider does not have to be called; the nurse would intervene. The blood glucose level does not have to be taken right away. The medication is not to be taken after a meal.

Which hormones play a role in the regulation of glucose homeostasis? Select all that apply.

insulin and glucagon Insulin and glucagon are the two hormones produced by the pancreas that play an important role in the regulation of glucose homeostasis. They are responsible for the use, mobilization, and storage of glucose by the body. When the body breaks down fatty acids for fuel, ketones are produced as a metabolic by-product. Dextrose is an isomer of glucose (D-glucose) found in plants and honey and administered to patients, for example, as D50 W. Excess glucose in the blood is converted into glycogen and stored in the liver.

The nurse is caring for a patient who has just started taking levothyroxine. Which assessment finding is necessary for the nurse to address?

irritability Irritability is a symptom of hyperthyroidism. This could be a sign that the medication dosage is too high. Brittle nails, intolerance to cold, and weight gain could be symptoms of hypothyroidism and are expected in this patient, who just began medication therapy.

Which thyroid preparation, considered the purest form of thyroxine (T4), is the drug of choice for hypothyroidism?

levothyroxine The drug of choice for thyroid hormone replacement therapy is the purest form of thyroxine, levothyroxine. Liotrix is a combination of liothyronine and levothyroxine and is not considered the purest form. Propylthiouracil is an antithyroid medication used in the treatment of hyperthyroidism.

The nurse is reviewing the prescription of a patient who has myxedema coma. Which drug would the nurse expect the health care provider to prescribe to the patient?

levothyroxine Levothyroxine is the most commonly prescribed synthetic thyroid hormone, with better, more predictable outcomes than the other thyroid preparations. Another advantage is that it is available in both oral and intravenous forms, with a long enough half-life that it needs to be administered only once in a day. Liotrix is preferred after levothyroxine; however, it should be administered twice or thrice daily, which is a tedious process for the patient. Liothyronine is least preferable, and it is available in oral form. Methimazole is incorrect; it is a contraindicated drug in hypothyroidism/myxedema because it reduces the secretion of thyroid hormones.

The nurse is caring for a child diagnosed with growth hormone deficiency. The nurse will instruct the child's parents to report which symptom?

limping Growth hormone promotes bone and muscle growth. Its deficiency reduces the bone mass that may cause 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.

Which adverse effects are possible from octreotide therapy? Select all that apply.

malaise dyspnea arthralgia

While reading the history and the lab reports of an adult patient, the nurse finds that the patient has decreased metabolic rate, weight gain, and hair loss. Which condition can the nurse interpret from these findings?

myxedema Hyposecretion of thyroid hormone as an adult may lead to myxedema. The manifestations of myxedema are decreased metabolic rate, weight gain, hair loss, and yellowish discoloration of the skin. Hyposecretion of thyroid hormone during youth leads to cretinism. The characteristics are a low metabolic rate, retarded growth and sexual development, and possible mental retardation. Graves' disease and Plummer's disease are caused by excessive secretion of thyroid hormones.

The nurse administers repaglinide to a patient at 8:00 a.m. When is the patient at the highest risk for hypoglycemia?

noon Repaglinide is a rapid-acting oral hypoglycemic agent whose action peaks within 1 hour of the drug's administration. If the drug is given at 8:00 a.m., it will have its peak effects at 9:00 a.m. The drug reaches its elimination half-life phase within the next few hours; in this case, from 10:00 a.m. to noon.

Which medication, administered with vasopressin, impairs the action of vasopressin to conserve water?

norepinephrine When administered concurrently with vasopressin, norepinephrine decreases the antidiuretic effect of vasopressin. Thioridazine can prolong the QTc interval when given with octreotide. Carbamazepine can increase the antidiuretic effect of vasopressin. Acetaminophen would have no effect on vasopressin's action.

The nurse admitting a patient with acromegaly anticipates administering which medication?

octreotide

The nurse is caring for a patient who has esophageal varices. Which drug will the nurse expect to administer to this patient?

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. 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 (i.e., cachexia) in conjunction with antiviral therapy. Desmopressin is used to treat dehydration caused by vasopressin deficiency.

A patient who has undergone organ transplantation shows symptoms of organ rejection despite taking cyclosporine. Which drug would the nurse check for in the medication history of the patient?

octreotide The nurse would check the history of octreotide in the patient because octreotide interacts with cyclosporine and suppresses the effect of cyclosporine; this may result in organ rejection. Somatropin, vasopressin, and desmopressin do not interact with cyclosporine. These drugs are safer in patients with organ transplantation. Somatropin interacts with glucocorticoids and reduces the growth effects. Vasopressin interacts with carbamazepine and enhances the antidiuretic effect. Desmopressin interacts with carbamazepine and enhances the effect of desmopressin.

The nurse observes that a patient has yellow dullness of the skin, weight gain, and severe hair loss. Which would the nurse suspect?

patient has hypothyroidism A decreased metabolic rate, loss of mental and physical stamina, weight gain, hair loss, firm edema, and yellow dullness of the skin are the signs and symptoms associated with hypothyroidism. A goiter is an enlargement of the thyroid gland resulting from its overstimulation by elevated levels of thyroid-stimulating hormone (TSH). Weight gain and hair loss are not associated with goiters. Thyroid storm (i.e., thyroid crisis) is the exacerbation of thyroid symptoms associated with hyperthyroidism. It is not associated with the symptoms observed in the patient. Hyperthyroidism is associated with weight loss due to an increased rate of metabolism.

Which reason is the likely cause of a decrease in milk production for a breastfeeding woman with type 1 diabetes?

poor glycemic control of blood sugars Both hyperglycemia and hypoglycemia in a breastfeeding patient can lead to a decrease in milk production. Hence the patient's insulin therapy and diet need to be well controlled. Large weight gain may increase fetal complications. Oral drugs are not used in individuals with type 1 diabetes. If the woman is breastfeeding at night, lack of sleep at night would not decrease milk production.

The laboratory results for a patient indicate markedly elevated blood glucose levels. After assessing the patient, the nurse obtains a prescription for intravenous insulin therapy from the primary health care provider. Which other assessment finding is present in the patient's reports?

presence of ketones in the serum The presence of ketones in the serum along with elevated glucose levels indicates diabetic ketoacidosis. Hence intravenous insulin therapy is started immediately to prevent acute hyperglycemia, which may cause coma or death. Weight gain is not an emergency in this case and may be caused by other factors, such as heart failure. Extreme hypoglycemia is seen in patients due to low glucose levels. Low levels or lack of endogenous insulin causes diabetic ketoacidosis.

Which function of somatropin is therapeutic for a patient who has human immunodeficiency virus (HIV)?

reduces weight loss Somatropin is given in conjunction with antiviral therapy to treat the wasting syndrome (i.e., 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 mimics the growth hormone and stimulates growth by providing the required supplies by a different mechanism. Somatropin does not reduce, but instead mobilizes, lipids from the fat stores to make them available for use. Somatropin increases sodium levels by promoting sodium and fluid retention.

Which assessment will the nurse make for a patient who is prescribed metformin for treatment of type 2 diabetes?

renal function Because metformin is excreted by the kidneys, it is necessary to assess the patient's renal function. If the patient's kidneys are not able to excrete the drug, it will accumulate in the patient's system, thereby causing lactic acidosis. Edema is not an adverse effect of metformin. One of the adverse effects of metformin is weight loss, not weight gain. Cholesterol levels may be high in some diabetic patients but can be treated with medications and lifestyle changes.

A patient is prescribed a somatropin injection subcutaneously. Which nursing intervention promotes safe administration of the drug?

rotating the injection site Somatropin is a form of growth hormone and is used to treat growth retardations. The drug can be administered intravenously and subcutaneously. However, the site of injection should be rotated to prevent tissue damage. The vial should not be shaken vigorously; instead, it should be swirled gently. The medication is injected into the ventral gluteal site if the route of administration is intramuscular. The medication should be administered only if the solution is clear.

The nurse is providing prenatal counseling for a patient who has hyperthyroidism and is prescribed methimazole. The nurse instructs the patient to discuss discontinuing the medication with the provider in the event of conception. Which fetal abnormality is the nurse trying to prevent?

scalp abnormality Methimazole is classified as a pregnancy category D drug. Scalp abnormalities may occur when methimazole is used during the second and third trimesters of the pregnancy. Abnormalities in eating, walking, and breathing are not associated with methimazole.

Which food should a patient avoid while taking antithyroid medications?

seafood Patients taking antithyroid medications must avoid eating foods high in iodine, such as tofu and other soy products, turnips, seafood, iodized salt, and some breads. Milk, eggs, and chicken do not contain excess amounts of iodine.

Which clinical finding indicates water intoxication in the patient who is taking vasopressin?

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?

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.

The nurse observes that A1C levels are elevated in a patient who is taking metformin for type 2 diabetes. Which class of drugs is likely to be prescribed to this patient?

sulfonylureas Sulfonylureas are prescribed to a patient whose A1C levels are elevated even after taking metformin. The drugs bind to specific receptors on beta cells in the pancreas to stimulate the release of insulin. Incretin mimetics are used to reduce postprandial glucagon production. The alpha-glucosidase inhibitors are used to control high postprandial glucose levels. The dipeptidyl peptidase-IV inhibitors are indicated as an adjunct to diet and exercise to improve glycemic control.

The nurse is assessing an older adult who has been taking liotrix for 6 months. The nurse finds that the patient has anxiety, tremors, and insomnia. Which would the nurse interpret from these findings?

the patient is experiencing adverse effects of the thyroid drugs Anxiety, tremors, and insomnia are the adverse effects of liotrix. These adverse effects may be due to accumulation of the drug in the body or due to overdose of the medication. If the patient has an allergic reaction immediately after taking the drug or within 24 hours after drug administration, it indicates that the patient is hypersensitive to the medication. An elderly patient would not necessarily have anxiety, tremors, and insomnia. Therefore the nurse would avoid generalizing the symptoms and avoid considering them common age-related symptoms. If the patient were not responding to the medication, the patient would have decreased thyroid hormone levels.

How do somatropin and somatrem help children with growth hormone deficiency?

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

A patient has septic shock. Which drug will the nurse expect to administer?

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.

Which drug is used to treat pulseless cardiac arrest according to the Advanced Cardiac Life Support (ACLS) guidelines?

vasopression Vasopressin is a drug that acts as a potent vasoconstrictor and is ideal in pulseless cardiac arrest, as per ACLS guidelines. It increases the blood pressure and promotes cardiac activity. Somatropin is not an appropriate remedy to treat the condition, as it is a growth hormone. Desmopressin is a synthetic analog of vasopressin; however, it is not an ideal drug for this case and is used to treat diabetes insipidus. Luteinizing hormone is not associated with this condition.

Which baseline measurements does the nurse obtain before administering pituitary hormones? Select all that apply.

weight blood pressure blood glucose levels In the assessment of patients receiving pituitary hormones, the nurse would measure weight, measure baseline vital signs, and review blood glucose levels. Liver enzyme levels and renal function studies are mandatory studies while administering epinephrine.

Which instruction will the nurse give a patient who is prescribed repaglinide for type 2 diabetes to do?

you need to eat a meal before each dose The nurse instructs the patient to eat a meal before each dose of repaglinide because skipping a meal can cause hypoglycemia. Repaglinide is not combined with sulfonylureas because they share a similar mechanism of action. The dose must be taken before each meal and skipping either the meal or the dose will fluctuate the glucose levels in the body. Skipping two doses of repaglinide will cause hyperglycemia in the patient because glucose levels will increase.