Saunders-Pharmacology: Encocrine
The 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 is taken daily. The nurse continues to collect data from the client, suspecting that the client has a history of which disorder?
"I should treat hypoglycemic episodes due to metformin with glucose tablets only." Metformin may be used alone or with other medications, including insulin, to treat type 2 diabetes. Metformin is in a class of drugs called biguanides. Metformin helps control the amount of glucose in your blood. It decreases the amount of glucose absorbed from food and the amount of glucose made by the liver. Metformin also increases the body's response to insulin, a natural substance that controls the amount of glucose in the blood. Gastrointestinal side effects such as flatulence and diarrhea can occur from this medication. Lactic acidosis can occur from the interaction of contrast dye and metformin; therefore, as prescribed, metformin is withheld for 48 hours after certain diagnostic tests that use dye.
The home care nurse is visiting a client who was recently diagnosed with type 2 diabetes mellitus. The client, prescribed repaglinide and metformin, asks the nurse to explain these medications. The nurse should reinforce which instructions to the client? Select all that apply.
1.Diarrhea can occur secondary to metformin. 2.The repaglinide is not taken if a meal is skipped. 3.The repaglinide is taken 30 minutes before eating. 4.Candy or another simple sugar is carried and used to treat mild hypoglycemia episodes. Repaglinide is a rapid-acting oral hypoglycemic agent that stimulates pancreatic insulin secretion that should be taken before meals and that should be withheld if the client does not eat. Hypoglycemia is a side effect of repaglinide, and the client should always be prepared by carrying a simple sugar with her or him at all times. Metformin is an oral hypoglycemic given in combination with repaglinide and works by decreasing hepatic glucose production. A common side effect of metformin is diarrhea. Muscle pain may occur as an adverse effect from metformin, but it also might signify a more serious condition that warrants PHCP notification, not the use of acetaminophen.
Prednisone 10 mg orally daily has been prescribed for a client. The nurse provides instructions to the client regarding the medication. Which statement by the client indicates that further teaching is needed?
"I can take acetylsalicylic acid (aspirin) or my antihistamine if I need it."
The home care nurse visits a client at home who has been prescribed prednisone 5 mg orally daily. The nurse reinforces teaching for the client about the medication. Which statement made by the client indicates a need for further teaching?
"I can take aspirin or my antihistamine if I need it." Aspirin and other over-the-counter medications should not be taken unless the client consults with the PHCP. The client needs to take the medication at the same time every day and should be instructed not to stop. A slight weight gain as a result of an improved appetite is expected, but after the dosage is stabilized, a weight gain of 5 lb or more weekly should be reported to the PHCP. Caffeine-containing foods and fluids need to be avoided because they may contribute to steroid-ulcer development.
The nurse realizes that the client taking metformin needs further teaching when the client makes which statement?
"I should treat hypoglycemic episodes due to metformin with glucose tablets only."
Cortisone acetate is prescribed for a client with adrenal insufficiency, and the nurse reinforces instructions to the client regarding the medication. Which statement by the client would indicate a need for further teaching?
"I will stop the medication when I feel better."
The nurse is collecting data from a client receiving pioglitazone 30 mg orally daily. Which finding indicates that the client is experiencing the expected result of the action of this medication?
"I will take the lispro 10 to 15 minutes before I eat breakfast, lunch, and dinner."
An adult client with hypothyroidism is admitted to the hospital. When reviewing the client's health record, the nurse notes that the client is taking a maintenance dose of levothyroxine. The nurse is also reviewing instructions concerning taking levothyroxine with the client. There is a need for further teaching when the client makes which statement?
"I will take the pill with milk to keep from upsetting my stomach."
The client plans to give his lispro insulin injection at 0800 right before eating breakfast. The nurse knows that the client understood the education provided when the client states which time presents the greatest risk for hypoglycemia?
0930
Fludrocortisone is prescribed for a client with Addison's disease. The primary health care provider needs to be notified if the client experiences which conditions? Select all that apply.
1.Edema 2.Chest pain 4.Muscle cramps
A client received a dose of regular insulin this morning at 7:00 am. At which time should the nurse likely anticipate the potential for a hypoglycemic reaction to occur?
10:00 am
The nurse is caring for a client with Paget's disease who has an elevated serum calcium level of 12.3 mEq/L. The nurse should expect the primary health care provider to prescribe which? Select all that apply.
2.Calcitonin 3.Furosemide 4.Assist to ambulate PRN
A client has been prescribed acarbose for treatment of diabetes mellitus. Client teaching regarding this medication should include which instructions? Select all that apply.
3.Abdominal cramping is common. 4.Side effects include excessive flatulence. 5.The medication should be taken with each meal.
A licensed practical nurse (LPN) is assisting in the care of a client who is receiving oxytocin to induce labor. The LPN plans to notify the registered nurse immediately if which signs and symptoms are noted? Select all that apply.
3.Decreased blood pressure, increased pulse 4.Contractions greater than 1 minute in duration
A client received 20 units of NPH insulin subcutaneously at 8:00 am. The nurse should check the client for a potential hypoglycemic reaction at which time?
5:00 pm NPH insulin is intermediate-acting insulin. Its onset of action is 60 to 120 minutes, it peaks in 6 to 14 hours, and its duration of action is 16 to 24 hours. Hypoglycemic reactions most likely occur during peak time.
A client is taking Humulin NPH insulin daily every morning. The nurse reinforces instructions to the client and should tell the client that which is the most likely time for a hypoglycemic reaction to occur?
6 to 14 hours after administration Humulin NPH is an intermediate-acting insulin. The onset of action is 1 to 2 hours, it peaks in 6 to 14 hours, and its duration of action is 16 to 24 hours. Hypoglycemic reactions most likely occur during peak time.
A client informs the nurse that she has been taking acarbose as prescribed. The nurse determines that a therapeutic effect of the medication has occurred if which laboratory value is noted?
A 2-hour postprandial serum glucose of 120 mg/dL
The nurse is asked to prefill syringes containing NPH and regular insulin for a diabetic client who lives at home alone and has difficulty with seeing and accurately preparing dosages. Considering the stability of insulin, which number of prefilled syringes should the nurse prepare for the client?
A 7-day supply
The nurse is monitoring a client receiving glipizide. Which outcome indicates an ineffective response from the medication?
A glycosylated hemoglobin level of 12% Glipizide is an oral hypoglycemic agent administered to decrease the serum glucose level and the signs and symptoms of hyperglycemia. Therefore, a decrease in both polyuria and polyphagia would indicate a therapeutic response. Laboratory values are also used to monitor a client's response to treatment. A fasting blood glucose level of 100 mg/dL (5.7 mmol/L) is within normal limits. However, glycosylated hemoglobin of 12% indicates poor glycemic control.
A client with myasthenia gravis verbalizes complaints of feeling much weaker than normal. The primary health care provider plans to implement a diagnostic test to determine if the client is experiencing a myasthenic crisis and administers edrophonium. Which data would indicate that the client is experiencing a myasthenic crisis?
A temporary improvement in the condition
When discussing the rationale for levothyroxine with a client with hypothyroidism, the nurse should emphasize that the client can anticipate which primary expected outcome?
Achieving normal thyroid hormone levels
A client with diabetes mellitus calls the clinic and tells the nurse that she has been nauseated during the night. The client asks the nurse if the morning insulin should be administered. Which is the appropriate nursing response?
Administer the full dose as prescribed.
A hospitalized client with severe seborrheic dermatitis is receiving treatments of topical glucocorticoid applications followed by the application of an occlusive dressing. The nurse monitors the client for which systemic effect that can occur as a result of this treatment?
Adrenal suppression
A client newly diagnosed with diabetes mellitus is instructed by the primary health care provider to obtain glucagon hydrochloride for emergency home use. The client asks the nurse about the purpose of the medication. The nurse tells the client that the purpose of the medication is to treat which aspect of diabetes?
Hypoglycemia from insulin overdose
Levothyroxine sodium is prescribed for a client with hypothyroidism. When should the nurse encourage the client to take the medication?
In the morning
The nurse is reinforcing instructions to a client regarding the administration of lypressin. The nurse instructs the client that the medication will be taken by which routes?
Intranasal
The nurse is assisting in reinforcing a teaching plan for a client given a prescription for pioglitazone. The nurse plans to reinforce instructions to the client about which information related to this medication?
Signs of hypoglycemia
The nurse is reinforcing instructions to the client about insulin glargine. The nurse determines that the client understands the action of the medication if the client makes which statement?
"I will give myself this medication subcutaneously once each night before bed."
The nurse needs to mix Regular insulin (clear) and NPH insulin (cloudy) in the same syringe. Arrange the actions in the order that they should be performed. All options must be used.
-Inject air into the NPH insulin vial. -Inject air into the regular insulin vial. -Draw up the regular insulin into the syringe. -Draw up the NPH insulin into the syringe.
A client has self-administered his first injection of regular insulin at 7:30 am, before breakfast. This client should be instructed to closely monitor for signs of hypoglycemia at which time?
11:00 am
A client receiving desmopressin begins to complain of a headache. The nurse notes that the client is listless and falls asleep easily. The nurse interprets that the client is most likely experiencing which reaction?
Adverse medication effects
Glimepiride is prescribed for a client with diabetes mellitus. The nurse reinforces instructions for the client and tells the client to avoid which while taking this medication?
Alcohol When alcohol is combined with glimepiride, 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.
A client is diagnosed with hypothyroidism, and levothyroxine is prescribed. The nurse notes that the client is presently taking warfarin sodium and anticipates that the primary health care provider will alter which medication dosage?
Decrease the dosage of warfarin sodium.
A client diagnosed with hypothyroidism is taking levothyroxine. The client returns to the clinic 1 week after beginning the medication and tells the nurse that the medication has not helped. The appropriate nursing response to the client is based on which information?
Full therapeutic effect may take 1 to 3 weeks.
Metformin is prescribed for a client with type 2 diabetes mellitus. Which should the nurse tell the client is a common side effect of the medication?
Gastrointestinal (GI) disturbances
A client diagnosed with diabetes insipidus is beginning medication therapy with lypressin. The nurse realizes the client understands instructions if the client comments the medicine will be taken in which manner?
Intranasally to promote water reabsorption
A client diagnosed with hyperthyroidism will be taking propylthiouracil. The nurse reinforces medication instructions and determines that the client understands the information if the client states that it is most important to report which symptoms to the primary health care provider?
Sore throat
A client who exhibits fatigue, lack of energy, constipation, and depression is diagnosed with hypothyroidism. The primary health care provider prescribes levothyroxine. To increase the likelihood of medication compliance in the early course of treatment, the nurse plans to reinforce which information?
The full therapeutic effect may take 1 to 3 weeks.
A client is seen in the clinic for complaints of thirst, frequent urination, and headaches. Following diagnostic studies, diabetes insipidus is diagnosed. Desmopressin acetate is prescribed for the client. What would the nurse explain to the client as the purpose of the medication?
To increase water reabsorption
The client with Cushing's syndrome had bilateral adrenalectomies and is now on corticosteroid therapy. The client also has a history of seizures. The nurse giving discharge instructions concerning corticosteroid therapy realizes there is a need for further teaching when the client makes which statement?
"I know my doctor can now decrease my dosage of phenytoin."
A client is suspected of having myasthenia gravis, and the primary health care provider administers edrophonium to determine the diagnosis. After administration of this medication, which sign/symptom would indicate the presence of myasthenia gravis?
An increase in muscle strength
Prednisone is prescribed for a client with diabetes mellitus who is taking Humulin neutral protamine Hagedorn (NPH) insulin daily. Which prescription change does the nurse anticipate during therapy with the prednisone?
An increased amount of daily Humulin NPH insulin
A client with an exacerbation of chronic obstructive pulmonary disease (COPD) has been on oral glucocorticoids and is being weaned to triamcinolone by inhalation. The nurse determines that the client understands the potential adverse effects to watch for during this medication change when the client states to monitor for which?
Anorexia, nausea, weakness, and fatigue
A client is admitted with chest pain related to atrial fibrillation. Based on her blood glucose reading, metformin is prescribed for the client. As the nurse reviews the client's chart and prescriptions, which finding would require the nurse to verify the metformin prescription? Refer to chart.
Creatinine result
Lispro insulin is prescribed three times a day, with the amount based on blood glucose levels. The nurse determines that the client understands teaching regarding lispro insulin if which statement is made?
Decreased fasting blood glucose and reduced hemoglobin A1c (HbA1c)
Desmopressin acetate is prescribed for the treatment of diabetes insipidus. The nurse monitors the client after medication administration for which therapeutic response?
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 manifested by a decreased urine output.
A client has a fasting blood glucose of 268 mg/dL at 7:30 am. The sliding scale prescriptions are blood glucose 151 to 200 mg/dL, administer 3 units Humalog insulin; 201 to 250, administer 6 units Humalog insulin; 251 to 300 mg/dL, administer 9 units Humalog insulin; over 300 mg/dL contact the primary health care provider. Therefore, at 7:30 am, how many units of Humalog should be administered?
Humalog 9 units
The nurse is teaching a client, newly diagnosed with diabetes mellitus, to mix 24 units NPH and 12 units regular insulin in the same syringe. Which instructions should the nurse give to the client to take after wiping the vials with an alcohol wipe?
Inject 24 units of air into the NPH insulin vial.
An oral hypoglycemic medication, a sulfonylurea, is prescribed for a client with type 2 diabetes mellitus. The nurse is reviewing the medical record and needs to contact the primary health care provider if there is a history of which condition?
Liver disease
Potassium iodide is prescribed for a client. The client calls the nurse at the clinic and complains of a brassy taste and burning sensations in the mouth. How should the nurse respond?
Notify the primary health care provider.
Insulin glargine is prescribed for a client with diabetes mellitus. The nurse tells the client that which is the best time to take the insulin?
Once daily at the same time each day
Lispro insulin is prescribed for a child with type 1 diabetes mellitus. The nurse is reinforcing a teaching session with the child and mother about the onset, peak, and duration times of the insulin. The nurse provides which information about this type of insulin?
Onset of 15 to 30 minutes from injection time, peak of 2 to 4 hours later, and duration time of 4 to 8 hours
The nurse preparing a client for surgery reviews the client's medication record. The client is to receive nothing by mouth (NPO) after midnight. Which medication noted on the client's record should the nurse question?
Prednisone
A client with diabetes mellitus visits a healthcare clinic. The client's diabetes mellitus previously had been well controlled with glyburide daily, but recently the fasting blood glucose level has been 180 mg/dL to 200 mg/dL (10.2 mmol/L to 11.4 mmol/L). Which medication, added to the client's regimen, may have contributed to the hyperglycemia?
Prednisone Prednisone may decrease the effect of oral hypoglycemics, insulin, diuretics, and potassium supplements.
The homecare nurse visits a client recently diagnosed with diabetes mellitus who is taking Humulin NPH insulin daily. The client asks the nurse how to store the unopened vials of insulin. The nurse should provide which information?
Refrigerate the insulin. Insulin in unopened vials should be stored under refrigeration until needed. Vials should not be frozen because freezing affects the chemical composition of the insulin. When stored unopened under refrigeration, insulin can be used up to the expiration date on the vial. Freezing insulin, storing insulin in a dark, dry place and keeping the insulin at room temperature are all incorrect actions.
The nurse is reinforcing instructions to a client regarding intranasal desmopressin acetate. The nurse should tell the client that the medication has which side effect?
Runny nose Desmopressin administered by the intranasal route can cause a runny or stuffy nose. Headache, vulval pain, and flushed skin are side effects if the medication is administered by the intravenous (IV) route.
A client is scheduled for subtotal thyroidectomy. Potassium iodide is prescribed. The nurse understands that which outcome is the therapeutic effect of this medication?
Suppress thyroid hormone production.
A client is newly diagnosed with hypothyroidism. Levothyroxine is prescribed. The nurse should reinforce to the client which instructions about the medication?
Take on an empty stomach.
The nurse reinforces instructions to a client who is taking levothyroxine. Which instruction should the nurse give the client?
Take the medication on an empty stomach. Oral doses of levothyroxine should be taken on an empty stomach to enhance absorption. Dosing should be done in the morning before breakfast. Therefore, the remaining options are incorrect times of administration.
A client with a partial right adrenalectomy is placed on corticosteroid replacement therapy. Which data would indicate that the client is experiencing an adverse effect related to the pharmacological treatment?
Tarry stools
Somatrem is administered to a client with pituitary dwarfism. Which is the expected therapeutic effect of this medication?
To stimulate linear growth
The nurse reinforces medication instructions to a client who is taking levothyroxine. The nurse instructs the client to notify the primary health care provider (PHCP) if which sign/symptom occurs?
Tremors Excessive doses of levothyroxine 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 PHCP if these occur.
Thyroid replacement therapy is prescribed for a client diagnosed with hypothyroidism. The client asks the nurse when the medication will no longer be needed. Which response by the nurse would be accurate?
"The medication will need to be continued for life."
Which instruction should the nurse reinforce to the client with diabetes mellitus receiving acarbose? Select all that apply.
2."Take the medication with each meal." 4."Side effects include abdominal bloating and flatus." 5."Take some form of glucose if hypoglycemia occurs." 6."Report symptoms such as shortness of breath or tiredness."
Potassium iodide is prescribed for a client. The nurse reinforces instructions to the client that the primary health care provider should be notified if the client experiences which symptom? Select all that apply.
2.A burning in the mouth 4.A brassy taste in the mouth 5.Soreness of the gums and teeth
Prednisone is prescribed for a client with diabetes mellitus who is taking NPH insulin daily. Which prescription should the nurse anticipate during therapy with the prednisone?
An increased amount of daily NPH insulin
The nurse assists with creating a plan of care for a client with hyperparathyroidism receiving calcitonin-human. Which outcome has the highest priority regarding this medication?
Reaching normal serum calcium levels Hypercalcemia can occur in clients with hyperparathyroidism, and calcitonin is used to lower plasma calcium levels. The highest-priority outcome in this client situation would be a reduction in serum calcium level. Option 1 is unrelated to this medication. Although options 2 and 4 are expected outcomes, they are not the highest priority for administering this medication.
The nurse is reinforcing teaching for a client regarding how to mix regular insulin and NPH insulin in the same syringe. Which action performed by the client indicates the need for further teaching?
Withdraws the NPH insulin first When preparing a mixture of regular insulin with another insulin preparation, the regular insulin is drawn into the syringe first. This sequence will avoid contaminating the vial of regular insulin with insulin of another type.
A client who will undergo thyroidectomy at a later date has been started on medication therapy with potassium iodide As the licensed practical nurse (LPN) prepares to administer a scheduled dose, the client states that there is a burning sensation and a brassy taste in the mouth. Which action should the LPN take?
Withhold the medication and notify the RN.
A client who has sustained an eye injury has been prescribed corticosteroid eye drops. The nurse should most carefully monitor for side effects of this medication if the client has which health problem listed on the medical record?
Diabetes mellitus
The nurse is preparing to administer an injection of regular insulin. The vial of the regular insulin has been refrigerated. On inspection of the vial, the nurse finds that the medication is frozen. Which action should the nurse take?
Discard the insulin and obtain another vial.
A glucocorticoid is prescribed for a client with adrenal insufficiency, and the nurse reinforces medication instructions to the client. The nurse determines that the client needs further teaching if the client states which action is necessary?
Discontinue the medication when symptoms subside.
The nurse is monitoring a client receiving desmopressin acetate for adverse effects to the medication. Which sign/symptom indicates the presence of an adverse effect?
Drowsiness Water intoxication (overhydration) or hyponatremia is an adverse effect of desmopressin. Early signs include drowsiness, listlessness, and headache. Decreased urination, rapid weight gain, confusion, seizures, and coma also may occur in overhydration.
Which statement indicates that a client with Addison's disease knows how to safely manage a medication regimen that consists of daily doses of glucocorticoids?
"I will need to call my doctor for an increase in medication dose when I'm experiencing a lot of stress."
The nurse reinforces instructions to a client with myxedema about the dosage, method of administration, and side effects of levothyroxine sodium. Which statement by the client indicates an understanding of the nurse's instructions?
"I will report any episodes of palpitations, chest pain, or dyspnea."
The nurse is collecting data from a client seen in the health care clinic for the first time. When the nurse asks the client about current prescribed medications, the client tells the nurse that metformin is taken daily. Based on this finding, the nurse elicits data from the client regarding the presence of which condition?
Diabetes mellitus
A daily dose of prednisone is prescribed for a client. The nurse reinforces instructions to the client regarding administration of the medication and instructs the client to take this medication at which time?
Early morning Corticosteroids (glucocorticoids) should be administered before 9:00 am. Administration at this time helps minimize adrenal insufficiency and mimics the burst of glucocorticoids released naturally by the adrenal glands each morning.
The nurse is monitoring a client receiving levothyroxine sodium for hypothyroidism. Which findings indicate the presence of a side effect associated with this medication? Select all that apply.
1.Insomnia 2.Weight loss 5.Mild heat intolerance Insomnia, weight loss, and mild heat intolerance are side effects of levothyroxine sodium. Bradycardia and constipation are not side effects associated with this medication, but rather are associated with hypothyroidism, which is the disorder that this medication is prescribed to treat.
