Silvestri-Endocrine meds

The health care provider (HCP) prescribes exenatide for a client with type 1 diabetes mellitus who takes insulin. The nurse should plan to take which most appropriate intervention?

Withhold the medication and call the HCP, questioning the prescription for the client.

A client with diabetes mellitus visits a health care clinic. The client's diabetes mellitus previously had been well controlled with glyburide daily, but recently the fasting blood glucose level has been 180 to 200 mg/dL (10.2 to 11.4 mmol/L). Which medication, if added to the client's regimen, may have contributed to the hyperglycemia?

Prednisone Rationale: Prednisone may decrease the effect of oral hypoglycemics, insulin, diuretics, and potassium supplements.

The nurse is preparing the client's morning insulin isophane dose. The nurse notices a clumpy precipitate inside the insulin vial. What is the most appropriate nursing action related to this finding?

Draw the dose from a new vial.

The nurse is instructing a client who is taking levothyroxine and tells the client that full therapeutic benefits will be seen when?

In 1 to 3 week It takes up to 1 month for plateau levels of levothyroxine to be achieved, so clients must be told that full benefits will not be seen for 1 to 3 weeks.

Acarbose is prescribed to treat a client with type 2 diabetes mellitus. Which instruction should the nurse provide when teaching the client about this medication?

Take the medication with the first bite of each regular meal.

Potassium iodide is prescribed for a client with thyrotoxic crisis. The client calls a clinic nurse and complains of a brassy taste in the mouth. Which instruction should the nurse provide the client?

Withhold the medication and notify the health care provider (HCP).

The nurse determines that the client needs further instruction about prescribed thyroid replacement medication if which statement is made?

"I should expect full therapeutic effect from the medication within 3 to 5 days."

A client with diabetes insipidus asks the nurse about the purpose of a new medication, vasopressin. The nurse provides teaching about the medication. Which statement by the client indicates successful teaching?

It prevents me from 'peeing' so much.

A client with hyperthyroidism has been given methimazole. Which nursing considerations are associated with this medication? Select all that apply.

Administer methimazole with food. Assess the client for unexplained bruising or bleeding. Instruct the client to report side and adverse effects such as sore throat, fever, or headaches.

A nurse is caring for a client with a diagnosis of hyperthyroidism. Laboratory studies are performed and the serum calcium level is 12.0 mg/dL (3 mmol/L). Which medication should the nurse anticipate to be prescribed for the client?

Calcitonin

A client with a history of coronary artery disease has developed diabetes insipidus as a result of cranial surgery. The client's medication therapy will include vasopressin. The nurse monitors this client most carefully for which sign or symptom that indicates a side or adverse effect of this medication?

Chest pain

A client is receiving somatropin. The nurse should monitor which most significant laboratory study during therapy with this medication?

Thyroid-stimulating hormone level

Somatropin, a growth hormone, is prescribed for a client. The nurse reviews the assessment data in the client's health record, knowing that the medication would be contraindicated for which client?

A 20-year-old with growth failure

A sulfonamide is prescribed for a client with a urinary tract infection. The client has diabetes mellitus and is receiving tolbutamide. Because the client will be taking these 2 medications, which prescription should the nurse anticipate for this client?

Decreased dosage of tolbutamide

The nurse is assigned to care for several male and female clients who take estrogen or progestins. For which complication should the nurse monitor these clients?

Deep vein thrombosis (DVT)

When teaching the client with adrenal insufficiency about cortisone, the nurse should include which items? Select all that apply

Take the medication with food. Increase intake of potassium-rich foods. Stay away from people with active infections. Notify the health care provider if illness occurs or surgery is anticipated.

Metformin is prescribed for a client with type 2 diabetes mellitus. The nurse should tell the client that which is the most common side or adverse effect of the medication?

Gastrointestinal (GI) disturbances Rationale: The most common side effect of metformin is GI disturbances, including decreased appetite, nausea, and diarrhea. These generally subside over time. This medication does not cause weight gain; in fact, clients lose an average of 7 to 8 lb because the medication causes nausea and decreased appetite. Although flushing, palpitations, and hypoglycemia can occur, they are not the most common side effects.

A client has been taking glucocorticoids to control rheumatoid arthritis. Which laboratory abnormality is the client at risk for as a result of taking this medication?

Increased serum glucose

The nurse provides family teaching to the mother of a 13-year-old client with pituitary dwarfism who is on growth hormone therapy. Which statement by the mother indicates that teaching has been successful?

"My child will have an immediate increase in growth.

The nurse administers 20 units of insulin isophane recombinant to a hospitalized client with diabetes mellitus at 7:00 a.m. The nurse should monitor the client most closely for a hypoglycemic reaction at which time?

04:00PM Rationale: Insulin isophane recombinant is an intermediate-acting insulin with an onset of action in 3 to 4 hours, a peak action in 6 to 12 hours, and a duration of action of 18 to 28 hours. A hypoglycemic reaction is most likely to occur at peak time. The correct option is the only one that represents a time within the peak hours after administration of the insulin.

The nurse monitors the blood glucose level of the client who received NPH insulin at 7 a.m. with an understanding that the client may experience a hypoglycemic reaction during which time frame

11 a.m. to 7 p.m NPH insulin is an intermediate-acting insulin. It peaks in 4 to 12 hours after administration. (Its onset is in 1.5 hours, and its duration is 16 to 24+ hours.) If the medication was given at 7 a.m., the nurse would monitor for hypoglycemia during the time of peak action, which would be between 11 a.m. and 7 p.m.

A client received 20 units of Humulin N insulin subcutaneously at 08:00. At what time should the nurse plan to assess the client for a hypoglycemic reaction?

1700 Rationale: Humulin N is an intermediate-acting insulin. The onset of action is 60 to 120 minutes, it peaks in 6 to 14 hours, and the duration of action is 16 to 24 hours. Hypoglycemic reactions most likely occur during peak time.

A hospitalized client with diabetes mellitus receives NPH insulin in the morning. The nurse monitors the client for hypoglycemia, knowing that the peak action is expected to occur how soon after the medication administration?

4 to 12 hours after administration NPH insulin is an intermediate-acting insulin. Its onset of action is 3 to 4 hours, it peaks in 4 to 12 hours, and its duration of action is 16 to 20 hours.

A nurse is providing teaching regarding acarbose. The nurse should tell the client that which expected side or adverse effect(s) may occur with this medication?

Abdominal distention and diarrhea

Octreotide acetate is prescribed for a client with acromegaly. The nurse monitors the client, knowing that which side or adverse effect is associated with the administration of this medication?

Abdominal pain

A client with diabetes mellitus calls the clinic and tells the nurse that he has been nauseated during the night. The client asks the nurse if the morning insulin should be administered. Which is the most appropriate nursing response?

Administer the full dose as prescribed. Rationale: When the client with diabetes mellitus becomes ill, control is more difficult. Insulin is not omitted, and the client is encouraged to consume liquid carbohydrates if unable to eat regular meals. The client is instructed to notify the health care provider if vomiting or diarrhea occurs or if the illness progresses past 2 days. Prescribed medication is not altered by the nurse.

Insulin glargine is prescribed for a client with diabetes mellitus. The nurse should tell the client that it is best to take the insulin at which time?

At bedtime every day Insulin glargine is a long-acting recombinant DNA human insulin that is used to treat type 1 and type 2 diabetes mellitus. It has a 24-hour duration of action and is administered once a day, usually at bedtime.

A client is started on tolbutamide once daily. When should the nurse tell the client to take the medication?

At breakfast

A client is started on tolbutamide once daily. The nurse should instruct the client to monitor for which intended effect of this medication?

Decreased blood glucose

The client with a traumatic brain injury (TBI) has begun excreting copious amounts of dilute urine through the Foley catheter. The client's urine output for the previous shift was 3000 mL. The nurse expects that the health care provider will prescribe which medication?

Desmopressin

The nurse is teaching the client about his prescribed prednisone. Which statement, if made by the client, indicates that further teaching is necessary?

I can take aspirin or my antihistamine if I need it." Rationale: Aspirin and other over-the-counter medications should not be taken unless the client consults with the HCP. The client needs to take the medication at the same time every day and should be instructed not to stop the medication. A slight weight gain as a result of an improved appetite is expected; however, after the dosage is stabilized, a weight gain of 5 pounds (2.25 kg) or more weekly should be reported to the HCP. Caffeine-containing foods and fluids need to be avoided because they may contribute to steroid-ulcer development.

The nurse is caring for a client after insertion of an implanted insulin pump. Which statement by the client indicates a need for further instruction?

I need to make sure I still give my insulin before I eat." Rationale: Insulin devices are implanted in the abdomen either intraperitoneally or intravenously. They deliver a basal insulin infusion plus a bolus dose with meals. The client should not self-administer mealtime insulin when he or she has an insulin pump. These pumps allow for better glycemic control and cause less hypoglycemia and less weight gain. They can potentially improve the overall quality of life.

The nurse teaches the client being discharged to home with a prescription for a daily dose of prednisone to take the medication at which best time?

In the early morning The client should be instructed to take glucocorticoids (corticosteroids) before 9 a.m. This helps minimize adrenal insufficiency and also 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.

Insomnia Weight loss Mild heat intolerance Rationale: Insomnia, weight loss, and mild heat intolerance are side effects of levothyroxine sodium. Bradycardia and constipation are not side effects associated with this medication, and rather are associated with hypothyroidism, which is the disorder that this medication is prescribed to treat.

Glimepiride is prescribed for a client with diabetes mellitus. The nurse instructs the client that which food items are most acceptable to consume while taking this medication? Select all that apply.

Red meats Whole-grain cereals Carbonated beverages

The nurse is educating a client about medroxyprogesterone. The nurse should provide the client with which information about the medication?

Should be administered intramuscularly every 3 months

The nurse is providing instructions to the client newly diagnosed with diabetes mellitus who has been prescribed pramlintide. Which instruction should the nurse include in the discharge teaching?

Take your prescribed pills 1 hour before or 2 hours after the injection."

An 8-year-old boy is being treated with desmopressin. Understanding the purpose of this medication, the nurse should set which client goal?

The boy will have 5 nights in sequence without enuresis.

A client with diabetes mellitus is self-administering NPH insulin from a vial that is kept at room temperature. The client asks the nurse about the length of time an unrefrigerated vial of insulin will maintain its potency. What is the most appropriate response to the client?

1 Month An insulin vial in current use can be kept at room temperature for up to 1 month without significant loss of activity. Direct sunlight and heat must be avoided.

A client arrives at the clinic complaining of fatigue, lack of energy, constipation, and depression. Hypothyroidism is diagnosed, and levothyroxine is prescribed. What is an expected outcome of the medication?

Achieve normal thyroid hormone levels Rationale: Laboratory determinations of the serum thyroid-stimulating hormone (TSH) level are an important means of evaluation. Successful therapy causes elevated TSH levels to decline. These levels begin their decline within hours of the onset of therapy and continue to decrease as plasma levels of thyroid hormone build up. If an adequate dosage is administered, TSH levels remain suppressed for the duration of therapy. Although energy levels may increase and the client's mood may improve following effective treatment, these are not noted until normal thyroid hormone levels are achieved with medication therapy. An increase in the blood glucose level is not associated with this condition.

A client with diabetes mellitus taking daily NPH insulin has been started on therapy with dexamethasone. The nurse anticipates that which adjustments in medication dosage will be made

An increased dose of NPH insulin Dexamethasone is a glucocorticoid (corticosteroid) and therefore can elevate the blood glucose level. Diabetic clients may need their dosage of insulin or oral hypoglycemic medications increased during glucocorticoid therapy. This is most often a temporary change, needed to compensate for the actions of the medication. The client would not change to an oral diabetic medication if taking daily insulin. Additional calories would not be required. The client would not take a lower dose of dexamethasone than usual to compensate.

The nurse monitors the client taking octreotide acetate for acromegaly for which most common side or adverse effect of this medication?

Diarrhea

The nurse is caring for a client who is receiving growth hormone replacement therapy. The nurse monitors the client for which option as an adverse effect of this therapy?

Hyperglycemia Hyperglycemia can occur as a result of the administration of growth hormone, particularly in a client with diabetes mellitus. Hypercalciuria can occur, particularly during the first 2 to 3 months of therapy. Growth hormone therapy is associated with a decline in thyroid function.

A client is being treated with spironolactone. The nurse should monitor the client for which fluid/electrolyte imbalance?

Hyperkalemia Rationale: Spironolactone is a potassium-sparing diuretic that may be prescribed to remove excess fluid from the body. It may also be prescribed to counteract the effects of excessive adrenal aldosterone production (hyperaldosteronism). Because it is a diuretic, the client is at risk for fluid volume deficit. Hyperkalemia can occur because it is a potassium-sparing diuretic. This medication can result in low sodium and low magnesium levels.

A client newly diagnosed with diabetes mellitus is instructed by the health care provider to obtain glucagon for emergency home use. The client asks the home care nurse about the purpose of the medication. The nurse should instruct the client that the purpose of the medication is to treat which problem?

Hypoglycemia from insulin overdose Glucagon is used to treat hypoglycemia resulting from insulin overdose. The family of the client is instructed in how to administer the medication. In an unconscious client, arousal usually occurs within 20 minutes of glucagon injection. Once consciousness has been regained, oral carbohydrates should be given. Lipoatrophy and lipohypertrophy result from insulin injections.

The nurse is providing education to a client with type 2 diabetes about starting insulin glargine to help with improved glycemic control. Which statement made by the client indicates understanding?

It has a decreased risk for hypoglycemia." In contrast to other long-acting insulins, insulin glargine achieves blood levels that are relatively steady over 24 hours. As a result, there is less risk of hypoglycemia or hyperglycemia. The only insulins that can be administered intravenously are the short-acting insulins. All medications used to treat diabetes mellitus require fingerstick monitoring.

A client newly diagnosed with diabetes mellitus is instructed by the health care provider to obtain glucagon for emergency home use. The client asks a home care nurse about the purpose of the medication. What is the nurse's best response to the client's question?

It is for the times when your blood glucose is too low from too much insulin."

Acarbose is prescribed for a client diagnosed with type 2 diabetes mellitus. What should the nurse include in the client's instructions?

Take the medication with the first bite of each meal.

Vasopressin is prescribed for a client with diabetes insipidus. The nurse should be particularly cautious in monitoring a client receiving this medication if the client has which preexisting condition?

Coronary artery disease

The nurse in the health care clinic is reviewing the record of a client with diabetes mellitus who was just seen by the health care provider (HCP). The nurse notes that the HCP has prescribed metformin. What preexisting disorder, if noted in the client's record, would indicate a need to collaborate with the HCP before instructing the client to take the medication?

Emphysema Rationale: Metformin is an antidiabetic agent and acts by decreasing hepatic production of glucose. Metformin should be used with caution in clients with kidney or liver disease, heart failure, chronic lung disease, or a history of heavy alcohol consumption. The presence of a foot ulcer, hypertension, and hypothyroidism are not contraindications associated with use of this medication.

The nurse is preparing to care for a client admitted to the emergency department with a diagnosis of diabetic ketoacidosis (DKA). The nurse gathers supplies and obtains which type of insulin, anticipating that it will be initially prescribed for the client? Click on the image to indicate your answer. Figure from Kee,

Humulin R Rationale: A component of initial therapy for the treatment of DKA is the administration of regular insulin by the intravenous (IV) route

Cortisone acetate is prescribed for a client with adrenal insufficiency. The nurse provides instructions to the client regarding the medication. Which statement, if made by the client, indicates a need for further instruction?

I will stop the medication when I feel better."

Metformin is prescribed for a client with type 2 diabetes mellitus. What is the most common side effect that the nurse should include in the client's teaching plan?

Gastrointestinal disturbances Rationale: The most common side effect of metformin is gastrointestinal disturbances, including decreased appetite, nausea, and diarrhea. These generally subside over time. This medication does not cause weight gain; clients lose an average of 7 to 8 lb (3.2 to 3.6 kg) because the medication causes nausea and decreased appetite. Although hypoglycemia can occur, it is not the most common side effect. Flushing and palpitations are not specifically associated with this medication.

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. What is the appropriate nursing response to the client?

Full therapeutic effect may take 1 to 3 weeks. Levothyroxine is used in the treatment of hypothyroidism. Although therapy with levothyroxine may begin with small doses that are gradually increased, the most appropriate response is to inform the client that the full therapeutic effect may take 1 to 3 weeks.

The nurse teaches the client, who is newly diagnosed with diabetes insipidus, about the prescribed intranasal desmopressin. Which statements by the client indicate understanding? Select all that apply.

I should decrease my oral fluids when I start this medication. "I should report headache and drowsiness to my health care provider since these symptoms could be related to my desmopressin."

Insulin lispro is prescribed for the client, and the client is instructed to administer the insulin before meals. When should the nurse instruct the client to administer the insulin?

Immediately before eating Rationale: Insulin lispro acts more rapidly than regular insulin and has a shorter duration of action. The effect of insulin lispro begins within 25 minutes after subcutaneous injection, peaks in 0.5 to 1.5 hours, and has a duration of action of approximately 5 hours. Because of its rapid onset, it can be administered from 15 minutes to immediately before eating. In contrast, regular insulin is generally administered 30 minutes before meals.

The client with hyperparathyroidism is taking alendronate. Which statements by the client indicate understanding of the proper way to take this medication? Select all that apply.

"I should sit up for at least 30 minutes after taking this medication." "I should take this medication first thing in the morning on an empty stomach."

A medication has been prescribed for a client with hypoparathyroidism for management of hypocalcemia. The client arrives at the clinic for follow-up evaluation and complains of chronic constipation since beginning the medication. The nurse provides information to the client regarding measures to alleviate the constipation and determines that the client needs additional information when the client makes which statement?

"I will add ½ ounce of mineral oil to my daily diet."

The nurse is monitoring a client receiving glipizide. The nurse knows that which finding would indicate a therapeutic outcome for this client?

A decrease in polyuria Rationale: Glipizide is an oral hypoglycemic agent given to reduce the serum glucose level and the signs and symptoms of hyperglycemia. Therefore, a decrease in polyuria (a symptom of hyperglycemia) would denote a beneficial response to glipizide. Excessive appetite (polyphagia) also is a symptom of hyperglycemia. Thus, an increase in appetite would not signify a therapeutic effect. A therapeutic fasting blood glucose should be less than 100 mg/dL, and the glycosylated hemoglobin should be less than 7%.

Glyburide is prescribed for a client with type 2 diabetes mellitus. What is the most important instruction the nurse should provide to the client?

Assess for signs of hypoglycemia. Glyburide is a sulfonylurea that acts primarily by stimulating the release of insulin from pancreatic islets. It causes a dose-dependent reduction in blood glucose and can thereby cause hypoglycemia. Importantly, regardless of what the glucose level is—high, normal, or low—sulfonylureas will lead to a low blood glucose level. If the level is high, reducing it will be therapeutic. However, if the level is normal, reducing it will cause mild hypoglycemia. If the level is already low, reducing it can cause severe hypoglycemia.

A nurse is providing teaching regarding nateglinide. A portion of the teaching involves time of administration, and the nurse should tell the client to take the medication at which time?

Before each meal

A client who has sustained an eye injury has been prescribed prednisolone. The nurse would most carefully monitor for side and adverse effects of this medication if the client has which health problem listed on the medical record?

Diabetes Mellitus The client with diabetes mellitus is especially at risk for side and adverse effects when taking this medication, which is a glucocorticoid. The client may experience elevations in the blood glucose level, which should be monitored frequently. Cirrhosis, hypertension, and chronic constipation are not a concern with the administration of this medication.

The nurse is preparing to administer an intravenous (IV) insulin injection. The vial of regular insulin has been refrigerated. On inspection of the vial, the nurse finds that the medication is frozen. Which should the nurse do?

Discard the insulin and obtain another vial. Insulin should not be frozen. If the nurse notes that the vial of insulin is frozen, the insulin is discarded and a new vial is obtained.

The health care provider has prescribed regular insulin 6 units and NPH insulin 20 units subcutaneously to be administered every morning. How should the nurse prepare to administer insulin?

Draw up the regular insulin first and then the NPH insulin in the same syringe.

A daily dose of prednisone is prescribed for a client. The nurse provides instructions to the client regarding administration of the medication and should instruct the client that which time is best to take this medication?

Early Morning Rationale: Corticosteroids (glucocorticoids) should be administered before 9 a.m. Administration at this time helps to minimize adrenal insufficiency and mimics the burst of glucocorticoids released naturally by the adrenal glands each morning.

Propylthiouracil is prescribed for a client with hyperthyroidism. The nurse provides instructions to the client regarding the medication and informs the client to notify the health care provider (HCP) if which sign or symptom occurs?

Fever

The nurse is teaching a client with hyperthyroidism about the prescribed medication, propylthiouracil. The nurse determines that teaching has been successful if the client states to report which symptom to the health care provider (HCP)?

Fever

The nurse evaluates that the family of a client newly diagnosed with diabetes mellitus correctly understands the reason for having glucagon on hand for emergency home use if the family indicates that the purpose of the medication is to treat which complication?

Hypoglycemia from insulin overdose Glucagon is used to treat hypoglycemia resulting from insulin overdose. The family of the client is instructed in how to administer the medication. In an unconscious client, consciousness usually returns within 20 minutes of glucagon injection. After the client has regained consciousness, oral carbohydrates should be given.

A nurse caring for a 23-year-old client newly diagnosed with type 1 diabetes mellitus teaches the client insulin administration. Which statement by the client indicates a need for further teaching?

I will rotate my insulin injection between my arms, thighs, and abdomen on a daily basis."

A client is seen in the clinic for complaints of thirst, frequent urination, and headaches. After diagnostic studies, diabetes insipidus is diagnosed. Desmopressin is prescribed. The client asks why this medication was prescribed. Which is a correct statement by the nurse?

It increases water reabsorption."

The home care 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 tell the client to take which action?

Refrigerate the insulin.

The nurse provides education to the client with hyperthyroidism about potassium iodide before medication administration. The client is scheduled for a subtotal thyroidectomy. Which response by the client indicates understanding?

It suppresses thyroid hormone."

A client with a recent history of total thyroidectomy has developed iatrogenic hypoparathyroidism. Which observed findings does the nurse determine are associated with the hypoparathyroidism? Select all that apply.

Laryngospasm Positive Chvostek's sign Positive Trousseau's sign

A nurse is administering a prescribed dose of dexamethasone to a client following cranial surgery. Which would the nurse implement to assess for a common side effect of this medication?

Perform blood glucose monitoring.

A client with previously well-controlled diabetes mellitus has had fasting blood glucose levels ranging from 180 to 200 mg/dL. The client takes glyburide 5 mg orally daily. In reviewing the client's medication list, the home health care nurse suspects that which newly added medications could be contributing to the elevated blood glucose levels?

Prednisone Rationale: Corticosteroids, thiazide diuretics, and lithium may decrease the effect of glyburide, thus causing hyperglycemia. The medications listed in the incorrect options increase the effect of glyburide, leading to hypoglycemia.

A client who has been taking iodine solution is admitted to the emergency department, and an iodine overdose is suspected. Gastric lavage is initiated to remove the iodine from the stomach. In addition to treatment with gastric lavage, the nurse anticipates that which medication will be administered?

Sodium thiosulfate

Somatropin is administered to a client with growth failure. A nurse monitors the client, knowing that which is the expected therapeutic effect of this medication?

Stimulate linear growth

The diabetes nurse specialist conducts a teaching session to a group of nursing students regarding sulfonylureas, oral hypoglycemic medications used for type 2 diabetes mellitus. Which statement, describing the primary action of these medications, should the nurse include in the teaching session?

Sulfonylureas promote insulin secretion by the pancreas."

Glyburide daily is prescribed for a client. What instruction should the nurse include in the client's teaching plan?

Take the medication in the morning before breakfast.

The nurse is preparing to discharge a client who has had a parathyroidectomy. The discharge instructions include medication administration of oral calcium supplements that the client will need daily. Which statement by the nurse would be most appropriate regarding the oral calcium supplement therapy?

Take the tablets following a meal.

The nurse is providing instructions to a client with a diagnosis of Addison's disease regarding the administration of prescribed glucocorticoids. The nurse should provide which instruction to the client?

That an increased dose of medication may be needed during times of stress

The nurse should tell the client, who is taking levothyroxine, to notify the health care provider (HCP) if which problem occurs?

Tremors Excessive doses of levothyroxine can produce signs and symptoms of hyperthyroidism. These include tachycardia, chest pain, tremors, nervousness, insomnia, hyperthermia, extreme heat intolerance, and sweating. The client should be instructed to notify the HCP if these occur.

The nurse is teaching a client how to mix regular insulin and NPH insulin in the same syringe. Which action, if performed by the client, indicates the need for further teaching?

Withdraws the NPH insulin first

A nurse is caring for a client recently diagnosed with type 2 diabetes mellitus who has been prescribed sustained-release glipizide. What is the most important point for the nurse to include in teaching this client about this medication?

Swallow the medication whole and never crush or chew it. Sustained-release glipizide is designed to be slowly absorbed form the gastrointestinal tract. Crushing or chewing the tablet alters absorption of the medication. It must be taken 30 minutes before eating because absorption is delayed by food. Hypoglycemia may occur when taking this medication, especially with insufficient caloric intake. Sustained-release glipizide has a duration of action of 24 hours and is taken once a day.

A nurse provides instructions to a client taking fludrocortisone acetate. The nurse instructs the client to notify the health care provider (HCP) if which manifestation occurs?

Swelling of the feet

Thyroid replacement therapy is prescribed for the client diagnosed with hypothyroidism. The client asks the nurse when the medication will no longer be needed. Which is the appropriate nursing response?

The medication will need to be continued for life For most clients with hypothyroidism, replacement therapy must be continued for life. Treatment provides symptomatic relief but does not produce a cure. The client should be told that although therapy will cause symptoms to improve, these improvements do not constitute a reason to interrupt or discontinue the medication. The outcome of the laboratory results does not bear influence on the length of time the client will need the medication. The statement that indicates that most clients need the medication for about a year implies that the disease is curable, so this option should be eliminated. Referring the client to the health care provider places the client's question on hold.

The emergency department nurse is caring for a client admitted with diabetic ketoacidosis. The health care provider prescribes intravenous (IV) insulin. The nurse plans to prepare which type of insulin for the client?

Regular Insulin Rationale: Regular insulin can be administered by the IV route. Insulin glargine is a long-acting insulin. Insulin isophane and 50% human insulin isophane/50% human insulin are intermediate-acting insulins.

Levothyroxine is prescribed for a client diagnosed with hypothyroidism. Upon review of the client's record, the nurse notes that the client is taking warfarin. Which modification to the plan of care should the nurse review with the client's health care provider?

A decreased dosage of warfarin sodium Rationale: Levothyroxine accelerates the degradation of vitamin K-dependent clotting factors. As a result, the effects of warfarin are enhanced. If thyroid hormone replacement therapy is instituted in a client who has been taking warfarin, the dosage of warfarin should be reduced.

A client arrives at the clinic complaining of fatigue, lack of energy, constipation, and depression. Following diagnostic studies, hypothyroidism is diagnosed and levothyroxine is prescribed. The nurse informs the client that which is the expected outcome of the medication?

Achieve normal thyroid hormone levels. Laboratory determinations of serum thyroid stimulating hormone (TSH) level are an important means of evaluation. Successful therapy will cause elevated TSH levels to fall. These levels will begin their decline within hours of the onset of therapy and will continue to drop as plasma levels of thyroid hormone build up. If an adequate dosage is administered, TSH levels will remain suppressed for the duration of therapy. Although energy levels may increase, this occurs as a result of achievement of the normal thyroid hormone levels. Alleviation of depression and increased blood glucose levels are not expected outcomes.

The home health care nurse is visiting a client who was recently diagnosed with type 2 diabetes mellitus. The client is prescribed repaglinide and metformin. The nurse should provide which instructions to the client? Select all that apply.

Diarrhea may occur secondary to the metformin. The repaglinide is not taken if a meal is skipped. The repaglinide is taken 30 minutes before eating. A simple sugar food item is carried and used to treat mild hypoglycemia episodes. Rationale: Repaglinide, a rapid-acting oral hypoglycemic agent that stimulates pancreatic insulin secretion, should be taken before meals (approximately 30 minutes before meals) and 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 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 might signify a more serious condition that warrants health care provider notification, not the use of acetaminophen.

The nurse is preparing a dose of 10 units of regular insulin and 35 units of NPH insulin for a client with type 1 diabetes mellitus. The nurse obtains an insulin syringe, gently rotates the insulin solutions, cleans the tops of the vials of insulin, and injects an amount of air equal to the dose prescribed into each vial. What is the next nursing action?

Draws up 10 units of regular insulin and checks the syringe contents with another nurse before drawing up the NPH insulin Rationale: Insulin dosages are verified by another nurse before administration. When 2 types of insulins are mixed, the doses must be verified after each is drawn up so as to verify the dosage for each one. The regular insulin is drawn into the syringe first.

The nurse teaches a client newly diagnosed with type 1 diabetes about storing Humulin N insulin. Which statement indicates to the nurse that the client understood the discharge teaching?

I can store the open insulin bottle in the kitchen cabinet for 1 month." Rationale: An insulin vial in current use can be kept at room temperature for 1 month without significant loss of activity. Direct sunlight and heat must be avoided.

The nurse is providing discharge teaching for a client newly diagnosed with type 2 diabetes mellitus who has been prescribed metformin. Which client statement indicates the need for further teaching?

I need to constantly watch for signs of low blood sugar." Rationale: Metformin is classified as a biguanide and is the most commonly used medication for type 2 diabetes mellitus initially. It is also often used as a preventive medication for those at high risk for developing diabetes mellitus. When used alone, metformin lowers the blood sugar after meal intake as well as fasting blood glucose levels. Metformin does not stimulate insulin release and therefore poses little risk for hypoglycemia. For this reason, metformin is well suited for clients who skip meals. Unusual somnolence, as well as hyperventilation, myalgia, and malaise, are early signs of lactic acidosis, a toxic effect associated with metformin. If any of these signs or symptoms occur, the client should inform the health care provider immediately. While it is best to avoid consumption of alcohol, it is not always realistic or feasible for clients to quit drinking altogether; for this reason, clients should be informed that excessive alcohol intake can cause an adverse reaction with metformin.

The nurse is completing a health history for an insulin-dependent client who has been self-administering insulin for 40 years. The client reports experiencing periods of hypoglycemia followed by periods of hyperglycemia. What is the most likely cause for this pattern of blood glucose fluctuation?

Injecting insulin at a site of lipodystrophy Rationale: Tissue hypertrophy (lipodystrophy) involves thickening of the subcutaneous tissue at the injection sites. This dense tissue can interfere with the absorption of insulin, resulting in erratic blood glucose levels. Because the client has been on insulin for many years, this is the most likely cause of poor control. The remaining options are appropriate for use in regulating blood glucose levels.

The clinic nurse develops a plan of care for a client with emphysema who will be started on long-term corticosteroid therapy. Which specific instruction should the nurse include in the plan of care?

Instruct the client to return to the clinic for monitoring of blood glucose levels.

The nurse provides instructions to a client who is taking levothyroxine. The nurse should tell the client to take the medication in which way?

On an empty stomach Rationale: Oral doses of levothyroxine should be taken on an empty stomach to enhance absorption. Dosing should be done in the morning before breakfast.

The nurse is caring for a client with a history of heart failure just diagnosed with type 2 diabetes mellitus. The health care provider prescribes an oral hypoglycemic for the client. Which oral hypoglycemic medication prescribed for this client should the nurse question?

Pioglitazone An adverse effect of pioglitazone is heart failure secondary to renal retention of fluid. For most clients, fluid retention is not clinically significant. However, for clients with heart failure, especially severe or uncompensated heart failure, increased fluid retention can make heart failure worse. Accordingly, pioglitazone should be used with caution in clients with mild heart failure and should be avoided by those with severe failure.

A client is taking Humulin NPH insulin and regular insulin every morning. The nurse should provide which instructions to the client? Select all that apply.

Hypoglycemia may be experienced before dinnertime. The insulin should be administered at room temperature.

A client scheduled to undergo subtotal thyroidectomy is taking a potassium iodide solution. The client complains to the nurse that she is experiencing a brassy taste in her mouth when taking the medication. Which instruction should the nurse provide to the client?

Report the symptom to the health care provider (HCP) Rationale: The client should be instructed about symptoms of iodism that can occur with the administration of potassium iodide solution. These symptoms include a brassy taste, burning sensation in the mouth, and soreness of the gums and teeth. The client should be instructed to withhold the medication and notify the HCP if these symptoms are noted.