1530 Exam 3 Study Guide

c. is given after tests prove that it is necessary. Growth hormone is given only when growth hormone deficiency is determined. It cannot be given orally. It antagonizes insulin secretion and thus can lead to the development of diabetes mellitus. It cannot be given after the epiphyses are fused.

1. The parents of an 11-year-old boy ask about growth hormone therapy for their child who is shorter than his 10-year-old sister. The nurse will tell the parents that growth hormone a. does not affect other hormones when given. b. is available as an oral tablet to be taken once daily. c. is given after tests prove that it is necessary. d. may be given until the child's desired height is reached.

a. Rapid eye movement (REM) sleep Vivid dreams occur during REM sleep.

A patient describes having vivid dreams to the nurse. The nurse understands that these occur during which stage of sleep? a. Rapid eye movement (REM) sleep b. Stage 2 nonrapid eye movement sleep c. Stage 3 nonrapid eye movement sleep d. Stage 4 nonrapid eye movement sleep

d. Myxedema Myxedema is severe hypothyroidism characterized by this woman's symptoms. Cretinism is congenital hypothyroidism. Early menopause is not characterized by memory loss, facial edema, dry skin, or bradycardia. Hyperthyroidism would include tachycardia and weight loss.

A 35-year-old woman reports lethargy, difficulty remembering things, facial edema, dry skin, and cessation of menses. The nurse notes a heart rate of 60 beats per minute and a weight increase of 5 pounds from a previous visit. The nurse will notify the provider of which possible condition? a. Cretinism b. Early menopause c. Hyperthyroidism d. Myxedema

c. may be used since this patient meets criteria. Patients who require less than 40 units of insulin per day and who have a fasting blood glucose less than or equal to 200 mg/dL are candidates for oral antidiabetic agents. Being overweight is an indication, not a contraindication.

A 45-year-old patient who is overweight has had a diagnosis of type 2 diabetes for 2 years. The patient uses 20 units of insulin per day. The patient's fasting blood glucose (FBG) is 190 mg/dL. The patient asks the nurse about using an oral antidiabetic agent. The nurse understands that oral antidiabetic agents a. cannot be used if the patient is overweight. b. cannot be used once a patient requires insulin. c. may be used since this patient meets criteria. d. may not be used since this patient's fasting blood glucose is too high.

a. Bromocriptine mesylate (Parlodel) Bromocriptine is a prolactin-release inhibitor and is used to inhibit release of growth hormone from the pituitary gland if the tumor cannot be destroyed by radiation. Octreotide may be used as well, but it is expensive and is typically used as adjunct therapy to radiation. Somatrem and somatropin are used to treat growth hormone deficiency and would make acromegaly worse.

A child exhibits acromegaly caused by a tumor that cannot be destroyed with radiation. Which medication will most likely be used to treat this child? a. Bromocriptine mesylate (Parlodel) b. Octreotide acetate (Sandostatin) c. Somatrem (Protropin) d. Somatropin (Genotropin)

ANS: A, C, D, F a. Constipation c. Bradycardia d. Weight gain f. Irregular menses These symptoms are indicative of hypothyroidism. The others indicate a hypermetabolic state.

A client is diagnosed with hypothyroidism. What is characteristic of this condition? (Select all that apply.) a. Constipation b. Vomiting c. Bradycardia d. Weight gain e. Racing heart beats f. Irregular menses g. Intolerance to heat

a. hypotension. A severe decrease in the mineralocorticoid aldosterone leads to hypotension and vascular collapse, such as in Addison's disease.

A client is found to be deficient in a mineralocorticoid. The nurse assesses the client for manifestation of this deficiency by noting evidence of: a. hypotension. b. hypertension. c. bradycardia. d. edema.

c. Administer glucagon. Glucagon is given to unconscious patients in order to stimulate an increase in blood sugar level.

A client is found unconscious with a Medic-Alert bracelet indicating type 1 diabetes mellitus. What is the highest priority nursing intervention? a. Administer insulin. b. Feed the client orange juice. c. Administer glucagon. d. Perform CPR.

a. sodium retention. Sodium and water levels are affected by Cushing syndrome.

A client is noted to have Cushing syndrome. The highest priority nursing intervention related to the client's electrolyte levels is to monitor for evidence of: a. sodium retention. b. water depletion. c. hypocalcemia. d. hyperkalemia.

a. does not peak. Lantus is evenly distributed over a 24-hour duration of action; thus, it is administered once a day, usually at bedtime.

A client is ordered to receive insulin glargine (Lantus) insulin. The nurse plans the client's care based on the fact that Lantus: a. does not peak. b. is less expensive. c. is short acting. d. requires multiple injections per day.

8, 1, 2, 5, 3, 7, 4, 6 8. Verify the doctor's ordered dosage 1. Draw up the insulin. 2. Clean the skin with alcohol. 5. Pinch the skin. 3. Insert the needle. 7. Inject the medication. 4. Count to five. 6. Remove the needle.

A client is ordered to receive insulin subcutaneously. What is the order of administration? 1. Draw up the insulin. 2. Clean the skin with alcohol. 3. Insert the needle. 4. Count to five. 5. Pinch the skin. 6. Remove the needle. 7. Inject the medication. 8. Verify the doctor's ordered dosage

b. 5 minutes before Lispro has an onset of 5 minutes.

A client is to receive Humalog (Lispro) insulin at breakfast. The nurse plans to administer the insulin _____ breakfast. a. 30 minutes before b. 5 minutes before c. with d. after

a. Reduction in urine output The medication secretes the hormone to retain fluid, causing a reduction in urine output.

A client sustains a brain injury. The client is being treated with desmopressin acetate. What would indicate a positive outcome from the medication? a. Reduction in urine output b. Increase in urine output c. Decrease in reabsorption of water in the renal tubules d. Elevation of the client's heart rate

b. Infection temporarily increases the need for insulin. Insulin needs increase in the presence of an infection.

A client with type 2 diabetes mellitus is admitted to the hospital with an infection. The client was taking oral hypoglycemic agents and is prescribed insulin in the hospital. What is the highest priority instruction that the nurse can give the client regarding insulin administration? a. Once the client begins to take insulin, she will always be on insulin. b. Infection temporarily increases the need for insulin. c. Hospitalized clients are always prescribed insulin. d. Oral hypoglycemics tend to interact with antibiotics.

b. draw up regular insulin first. The nurse or client draws up the regular insulin and then the NPH.

A client's insulin is administered at 7:00 AM daily. The client is to receive regular and NPH (Humulin N) insulins. The nurse is teaching the client how to prepare the syringe before injection. In preparing the syringe, the client should be taught to: a. withdraw each medication in a separate syringe. b. draw up regular insulin first. c. draw up NPH insulin first. d. recognize that order of medication withdrawal is not a priority.

a. arrhythmias and convulsions may occur. Caffeine and other stimulants can cause cardiac arrhythmias and seizures. Caffeine dependence may occur.

A college-age student is brought to the emergency department by friends after consuming NoDoz tablets along with several cups of coffee and a few energy drinks. The patient is complaining of nausea and diarrhea and appears restless. The nurse understands that a. arrhythmias and convulsions may occur. b. caffeine dependence does not occur. c. effects of the substances will wear off shortly. d. severe adverse effects do not occur.

c. is often related to heredity and obesity. Type 2 diabetes is often caused by obesity and hereditary factors. Secondary diabetes is triggered by medications. Type 2 diabetes is the most common type of diabetes. Patients with type 2 diabetes may become insulin-dependent.

A patient develops type 2 diabetes mellitus. The nurse will explain that this type of diabetes a. is generally triggered by medications. b. is not as common as type 1 diabetes. c. is often related to heredity and obesity. d. will not require insulin therapy

b. Give the patient orange juice. The patient is symptomatic and has hypoglycemia. The nurse should give orange juice. Glucagon is given for patients unable to ingest carbohydrates. The kitchen should be notified, and bedside glucose testing should be performed, but only after the patient is given carbohydrates.

A patient has administered regular insulin 30 minutes prior but has not received a breakfast tray. The patient is experiencing nervousness and tremors. What is the nurse's first action? a. Administer glucagon. b. Give the patient orange juice. c. Notify the kitchen to deliver the tray. d. Perform bedside glucose testing.

a. can cause cardiac dysrhythmias. Amphetamines can cause adverse effects in the central nervous, endocrine, gastrointestinal, and cardiovascular systems even when used as directed. Cardiac dysrhythmias can occur with continued use. Amphetamines do not cause narcolepsy or hypotension.

A patient has been using an amphetamine drug as an anorexiant for several weeks and asks the nurse about long-term adverse effects of this type of medication. The nurse will explain to the patient that these drugs a. can cause cardiac dysrhythmias. b. contribute to the development of narcolepsy. c. do not have severe effects when used properly. d. will cause orthostatic hypotension.

b. Calcitriol Calcitriol is given for management of hypocalcemia caused by parathyroid hormone deficiency. Calcitonin is used to treat hyperparathyroidism. Calcium and vitamin D are not useful in parathyroid deficiency.

A patient has hypocalcemia caused by parathyroid hormone deficiency. Which medication will the nurse anticipate giving to this patient? a. Calcitonin b. Calcitriol c. Calcium d. Vitamin D

b. Liothyronine (Cytomel) Liothyronine has a short half-life and rapid onset of action and is not recommended for maintenance therapy but is used as initial therapy for severe myxedema. Levothyroxine is the drug of choice for replacement therapy. Liotrix is a second-line drug. Thyroid desiccated is used for hypothyroidism to reduce goiter size.

A patient is admitted to the hospital to treat hypothyroidism. For rapid improvement in symptoms, the nurse will expect to administer which medication? a. Levothyroxine sodium (Synthroid) b. Liothyronine (Cytomel) c. Liotrix (Thyrolar) d. Thyroid desiccated (Armour Thyroid)

c. Doxapram (Dopram) Doxapram is given to treat respiratory depression caused by drug overdose.

A patient is brought to the emergency department with a drug overdose causing respiratory depression. Which drug will the nurse expect to administer? a. Albuterol (Proventil) b. Caffeine (Cafcit) c. Doxapram (Dopram) d. Methylphenidate (Ritalin)

a. 5 minutes before eating Lispro acts faster than other insulins, and patients should be taught to give this medication not more than 5 minutes before eating.

A patient is ordered to receive insulin lispro at mealtimes. The nurse will instruct this patient to administer the medication at which time? a. 5 minutes before eating b. 15 minutes after eating c. 30 minutes before eating d. 10 minutes after eating

b. Adrenocortical insufficiency Patients receiving glucocorticoids stop making their own cortisol. These drugs should be tapered slowly to allow the body to resume making this hormone. Acromegaly is associated with growth hormone hypersecretion. Hypertensive crisis and thyroid storm are associated with thyroid replacement.

A patient is receiving a glucocorticoid medication to treat an inflammatory condition, and the provider has ordered a slow taper in order to discontinue this medication. The nurse explains to the patient that this is done to prevent which condition? a. Acromegaly b. Adrenocortical insufficiency c. Hypertensive crisis d. Thyroid storm

c. high in protein. Patients receiving fludrocortisone are at risk for negative nitrogen balance and should consume a high-protein diet.

A patient is taking prednisolone and fludrocortisone (Florinef). When teaching this patient about dietary intake, the nurse will instruct the patient to consume a diet a. high in carbohydrates. b. high in fat. c. high in protein. d. low in potassium

c. Modafinil (Provigil) Modafinil is given to treat narcolepsy.

A patient reports difficulty staying awake during the daytime in spite of getting adequate sleep every night. Which medication will the nurse expect the provider to order for this patient? a. Caffeine (NoDoz) b. Methylphenidate (Ritalin) c. Modafinil (Provigil) d. Theophylline

a. Cluster headache Cluster headaches reoccur 1 to 3 times daily in a period lasting from approximately 2 weeks to 3 months. Migraine headaches are severe and characterized by an aura prior to the headache. Tension headaches are related to stress.

A patient reports having recurring headaches described as 1 to 2 headaches per day for several weeks. The nurse understands that these headaches are most likely descriptive of which type of headache? a. Cluster headache b. Migraine headache c. Simple headache d. Tension headache

c. Renal failure Metformin can lead to renal failure. It does not produce hypoglycemia or hyperglycemia. It does not increase the risk of respiratory distress.

A patient who has been taking a sulfonylurea antidiabetic medication will begin taking metformin (Glucophage). The nurse understands that this patient is at increased risk for which condition? a. Hypoglycemia b. Hyperglycemia c. Renal failure d. Respiratory distress

d. Shellfish Patients should be advised about the effects of iodine and its presence in foods such as shellfish. There is no need to avoid fava beans, purine, or grapefruit.

A patient who has hyperthyroidism will begin treatment with an antithyroid medication. The patient asks the nurse about dietary requirements. The nurse will counsel the patient to avoid which food(s)? a. Fava beans b. Foods high in purine c. Grapefruit d. Shellfish

d. increase the insulin dose. Glucocorticoids can cause hyperglycemia, so the insulin dose may need to be increased. Changing the glucocorticoid dose is not recommended. Decreasing the insulin dose will only compound the hyperglycemic effects.

A patient who has insulin-dependent diabetes mellitus must take a glucocorticoid medication for osteoarthritis. When teaching this patient, the nurse will explain that there may be a need to a. decrease the glucocorticoid dose. b. decrease the insulin dose. c. increase the glucocorticoid dose. d. increase the insulin dose.

a. depends on individual insulin needs. Combination products are convenient because the patient does not have to mix insulin, but the products depend on individual needs, since the doses are fixed. They are not used for patients with insulin resistance. Patients must continue to rotate injection sites. They do not require refrigeration after first use.

A patient who has type 1 diabetes mellitus asks the nurse about using a combination insulin product such as Humalog 75/25. The nurse will tell the patient that use of this product a. depends on individual insulin needs. b. is useful for patient with insulin resistance. c. means less rotation of injection sites. d. requires refrigeration at all times.

a. has a longer duration of action Glipizide is a second-generation oral antidiabetic agent. It has a longer duration of action than the first-generation antidiabetic agents such as tolbutamide. It has many gastrointestinal side effects. It is taken once daily, not as needed. It has greater hypoglycemic activity than first-generation antidiabetics.

A patient who has type 2 diabetes mellitus asks the nurse why the provider has changed the oral antidiabetic agent from tolbutamide (Orinase) to glipizide (Glucotrol). The nurse will explain that glipizide a. has a longer duration of action. b. has fewer gastrointestinal side effects. c. may be taken on an as-needed basis. d. results in less hypoglycemic potential

d. Prediabetes Patients with a hemoglobin A1c between 5.7% and 6.4% are considered to have prediabetes. A level of 6.5% or more indicates diabetes. The patient is hyperglycemic.

A patient who is overweight is being evaluated for diabetes. The patient has a blood glucose level of 160 mg/dL and a hemoglobin A1c of 5.8%. The nurse understands that this patient has which condition? a. Diabetes mellitus b. Hypoglycemia c. Normal blood levels d. Prediabetes

b. glucagon. This patient is most likely hypoglycemic and will need a carbohydrate. Glucagon is given parenterally if patients are unable to ingest a carbohydrate, such as orange juice. CPR is not indicated. Insulin will compound the hypoglycemia.

A patient who is unconscious and has a pulse is brought to the emergency department. The patient is wearing a Medic-Alert bracelet indicating type 1 diabetes mellitus. The nurse will anticipate an order to administer a. cardiopulmonary resuscitation (CPR). b. glucagon. c. insulin. d. orange juice.

d. Request an order for enteric-coated aspirin. Glucocorticoids can increase gastric distress, so an enteric-coated aspirin product is indicated. Glucocorticoids increase the risk of hypoglycemia, fluid retention, and hypertension.

A patient who takes high-dose aspirin to treat arthritis will need to take prednisone to treat an acute flare of symptoms. What action will the nurse perform? a. Observe the patient for hypoglycemia. b. Monitor closely for increased urine output. c. Observe the patient for hypotension. d. Request an order for enteric-coated aspirin.

a. hyperglycemia Insulin and oral antidiabetic drugs may need to be increased in patients taking levothyroxine. Patients should be taught to monitor for hyperglycemia, because of the reduced effects of these drugs.

A patient who takes the oral antidiabetic agent metformin (Glucophage) will begin taking levothyroxine (Synthroid). The nurse will teach this patient to monitor for a. hyperglycemia. b. hypoglycemia. c. hyperkalemia. d. hypokalemia.

c. Increased digoxin and decreased warfarin Thyroid preparations increase the effect of oral anticoagulants, so the warfarin dose may need to be decreased. Levothyroxine can decrease the effectiveness of digoxin, so this dose may need to be increased.

A patient who takes warfarin (Coumadin) and digoxin (Lanoxin) develops hypothyroidism and will begin taking levothyroxine (Synthroid). The nurse anticipates which potential adjustments in dosing for this patient? a. Decreased digoxin and decreased warfarin b. Decreased digoxin and increased warfarin c. Increased digoxin and decreased warfarin d. Increased digoxin and increased warfarin

c. Propylthiouracil (PTU) Propylthiouracil is a potent antithyroid drug used in preparation for a subtotal thyroidectomy. Liotrix and thyroid are used as thyroid replacement. Propranolol is used to treat hypertension associated with hyperthyroidism.

A patient with Graves disease exhibits tachycardia, heat intolerance, and exophthalmos. Prior to surgery, which drug is used to alter thyroid hormone levels? a. Liotrix (Thyrolar) b. Propranolol (Inderal) c. Propylthiouracil (PTU) d. Thyroid (Thyrotab)

b. Obesity Obesity is a contraindication for GH therapy, such as would be present in a client with Prader-Willi syndrome.

A school-aged client with growth hormone (GH) deficiency is recommended for growth hormone injections. What in the client's history would warrant contacting the primary healthcare provider? a. Asthma b. Obesity c. Apnea d. Seizure disorder

b. Nonrapid eye movement sleep Nightmares that occur in children take place during NREM sleep.

Children who experience nightmares have these during which stage of sleep? a. Early morning sleep b. Nonrapid eye movement sleep c. Rapid eye movement sleep d. Sleep induction

b. Instruct the client to take the drug at the same time each day. The drug works in concert with circadian rhythms and so should be taken at the same time each day and on an empty stomach.

Client teaching on proper administration of a thyroid replacement drug includes which instruction? a. Advise the client to report symptoms of hypothyroidism. b. Instruct the client to take the drug at the same time each day. c. Instruct the client to eat foods that inhibit thyroid secretion. d. Teach the client to take the medication on a full stomach.

b. potassium. Advise the client who is being treated with a glucocorticoid medication to eat foods rich in potassium, such as fresh and dried fruits, vegetables, meats, and nuts, because prednisone promotes potassium loss and hypokalemia.

Dietary instructions for the client who is being treated with glucocorticoids includes eating a diet high in: a. vitamin A. b. potassium. c. iron. d. magnesium.

d. Teach the client the signs and symptoms of excessive use of glucocorticoids. It is important to teach clients the signs and symptoms of excessive use.

Health teaching for the client receiving prednisone (Deltasone, Meticorten, Orasone, others) to decrease the inflammatory effects related to arthritis includes which instruction? a. Instruct the patient that the dose can be stopped as needed. b. Advise the patient to avoid foods rich in potassium. c. Inform the patient that prednisone should be taken between meals and without food. d. Teach the client the signs and symptoms of excessive use of glucocorticoids.

b. subcutaneous Insulin is injected into the subcutaneous tissue.

In administering an insulin injection to a client, the nurse anticipates that the injection of NPH (Humulin N) and regular (Humulin R) insulins will be administered via the _____ route. a. intradermal b. subcutaneous c. intramuscular d. intravenous

b. use birth control. The drug can cause increase resumption of ovulation in premenopausal women.

The client is being treated with rosiglitazone maleate (Avandia). The highest priority instruction to the client based on treatment with this medication is for the client to: a. increase the intake of calcium. b. use birth control. c. keep a food diary. d. use a respiratory inhaler.

a. has a fasting glucose level of 180 mg/dl. Criteria for use of oral antidiabetic drugs include onset of diabetes mellitus at age 40 years or older, diagnosis of diabetes for less than 5 years, normal weight or overweight, fasting blood glucose equal to or less than 200 mg/dl, fewer than 40 units of insulin required per day, and normal renal and hepatic function.

The best candidate for oral antidiabetic therapy is the client who: a. has a fasting glucose level of 180 mg/dl. b. has had a diagnosis of diabetes for 10 years. c. is 10 pounds under his optimal body weight. d. requires 60 units of insulin per day.

c. hypoglycemia caused by hyperinsulinism. Diazoxide (Proglycem) is used to treat hypoglycemia caused by hyperinsulinism.

The best candidate for treatment with Diazoxide (Proglycem) is the client who is experiencing: a. a hypoglycemic reaction. b. diabetic ketoacidosis. c. hypoglycemia caused by hyperinsulinism. d. insulin resistance reaction.

a. Avoid eating shellfish. Iodine is found in shellfish, and clients being treated with thyroid replacement therapy should avoid excessive iodine.

The client is being treated with thyroid replacement therapy. What is the highest priority nursing instruction regarding dietary requirements? a. Avoid eating shellfish. b. Avoid eating steak. c. Increase intake of spinach. d. Increase intake of strawberries.

a. can use the prepared amount of regular and NPH units. Clients must be able to take the predosed combinations since they may be required to mix a prescribed proportion.

The best candidate for treatment with a combination insulin such as Humulin 70/30 is the client who: a. can use the prepared amount of regular and NPH units. b. can adjust the amount of regular and NPH dosages. c. has difficulty mixing insulins. d. needs to learn how to administer insulins.

d. Reduced absorption of glucose from the small intestine Metformin is designed to reduce the absorption of glucose from the small intestine.

The client has been started on Metformin (Glucophage). What would be a positive outcome for this client as a result of the medication he is taking? a. Increased serum glucose level following a meal b. Decreased serum glucose level following a meal c. Increased absorption of glucose form the small intestine d. Reduced absorption of glucose from the small intestine

d. increased osteoporosis. Monitor older adults for signs and symptoms of increased osteoporosis because glucocorticoids promote calcium loss from bone

The client is an older adult who is being treated with a glucocorticoid medication. The highest priority nursing intervention with this client is to monitor for evidence of: a. cardiac dysrhythmias. b. visual disturbances. c. cognitive deterioration. d. increased osteoporosis.

d. life-threatening reaction to Life-threatening reactions to Glipizide include seizures, coma, and respiratory depression.

The client is being treated with Glipizide. She begins to exhibit difficulty breathing. The nurse recognizes that this may be indicative of a(n) ________ the medication. a. expected side effect of b. anaphylactic reaction to c. symptom that is not related to d. life-threatening reaction to

c. Decreased effect from the Humulin N The combination of Humulin N and an oral contraceptive will result in decreased hypoglycemia effect.

The client is being treated with Humulin N. She also takes an oral contraceptive. The nurse anticipates that the interaction of these two medications will result in which effect? a. Anaphylactic reaction b. Increased effect from the Humulin N c. Decreased effect from the Humulin N d. Neurological damage

b. potentiated hypoglycemia. The interaction of Metformin and furosemide will result in potentiated hypoglycemia.

The client is being treated with Metformin. He is also receiving furosemide. The nurse anticipates that the interaction of the two medications will result in: a. acute kidney failure. b. potentiated hypoglycemia. c. dawn phenomenon. d. potentiated hyperglycemia.

a. hypertension. Steroids may lead to fluid overload and hypertension.

The client is being treated with a glucocorticoid medication. The nurse plans to monitor him closely for evidence of: a. hypertension. b. hypoglycemia. c. hypovolemia. d. hyperkalemia.

d. a side effect of A side effect of treatment with calcitriol can be dizziness and photophobia.

The client is being treated with calcitriol. He complains of changes in his vision. The nurse recognizes that this symptom is most likely ________ the medication. a. an anaphylactic reaction to b. indicative of a toxic dosage of c. an adverse reaction to d. a side effect of

a. calcium The interaction of calcitriol and a thiazide diuretic will tend to increase the client's calcium level.

The client is being treated with calcitriol. Her treatment regimen includes thiazide diuretics. The highest priority nursing intervention based on this drug interaction is to monitor serum _____ level. a. calcium b. potassium c. sodium d. magnesium

a. diabetes mellitus. Growth hormone antagonizes insulin secretion and thus can lead to the development of diabetes mellitus.

The client is being treated with growth hormone. During treatment, the nurse monitors the client closely for evidence of: a. diabetes mellitus. b. gastrointestinal distress. c. hypotension. d. dwarfism.

c. Sip the medication through a straw. The client should sip the medication through a straw to avoid discoloration of the teeth.

The client is being treated with potassium iodide. In instructing the client on self-administration of the medication, what is the highest priority nursing instruction? a. Drink the medication at room temperature. b. Swallow the medication in the form of a wafer. c. Sip the medication through a straw. d. Chew the tablets thoroughly before swallowing.

b. increased effects from the prednisone. The interaction of prednisone and estrogen will result in increased effect from the prednisone.

The client is being treated with prednisone. Her treatment regimen includes estrogen replacement therapy. The nurse anticipates that the interaction of the two medications will result in: a. increased effects from the estrogen. b. increased effects from the prednisone. c. an anaphylactic reaction. d. toxicity from the prednisone dosage.

c. gastrointestinal The interaction of prednisone and aspirin will result in gastrointestinal toxicity.

The client is being treated with prednisone. His treatment regimen includes aspirin. The nurse anticipates that the interaction of the two medications will result in _____ toxicity. a. cardiac b. genitourinary c. gastrointestinal d. respiratory

d. 9:00 PM Lantus is evenly distributed over a 24-hour duration of action; thus, it is administered once a day, usually at bedtime.

The client is ordered to be treated with glargine (Lantus) insulin. Because of the type of insulin that the client is receiving, the nurse plans a dosage schedule that administers the medication at which time(s)? a. 7:00 AM b. 7:00 AM and 11:00 AM c. 11:00 AM and 9:00 PM d. 9:00 PM

a. Peptic ulcer Peptic ulcer is a contraindication for treatment with corticotropin.

The client is scheduled to be treated with corticotropin. Which aspect of her client history would cause the nurse to contact the primary healthcare provider? a. Peptic ulcer b. Arthritis c. Glaucoma d. Dysphagia

b. Liver function tests Metformin tends to create alteration in the client's liver function tests.

The client is scheduled to begin treatment with Metformin. The nurse plans to closely monitor which laboratory values? a. Cardiac enzymes b. Liver function tests c. Complete blood count d. Respiratory function tests

a. contact the healthcare provider to determine a tapering schedule. Prednisone must be tapered to avoid adrenal insufficiency.

The healthcare provider left an order to discontinue prednisone (Deltasone, Meticorten, Orasone, others). The highest priority action for the nurse is to: a. contact the healthcare provider to determine a tapering schedule. b. explain to the client that the drug will be immediately stopped. c. contact the pharmacist to determine a tapering schedule. d. begin gradually decreasing the prednisone dose.

c. initiating a slow taper of the phentermine. The nurse should discuss a gradual taper of the medication with the provider. Patients using anorexiants should not stop taking them abruptly because depression and withdrawal symptoms may occur. Phentermine-topiramate is recommended for short-term use only. Patients should not use these medications longer than 12 weeks, so increasing the dose is not indicated.

The nurse is performing a medication history on a patient who reports using phentermine HCl (Suprenza) 15 mg/day for the past 3 months as an appetite suppressant. The nurse will contact the patient's provider to discuss a. changing the medication to phentermine-topiramate (Qsymia). b. increasing the dose to 37.5 mg/day since tolerance has likely occurred. c. initiating a slow taper of the phentermine. d. stopping the drug immediately since long-term use is not recommended.

a. Notify the provider to discuss a possible non-functioning adrenal gland Corticotropin is given to diagnose adrenal gland disorders as well as to treat adrenal gland insufficiency. When given intravenously, the serum cortisol level should increase within 30 to 60 minutes if the adrenal gland is functioning. The nurse should report adrenal gland dysfunction. The provider will determine how to treat. Since the levels should increase in 30 to 60 minutes, there is no need to repeat the test in 1 to 2 hours.

The nurse administers intravenous corticotropin (Acthar) to a patient. A serum cortisol level drawn 60 minutes later shows no change in serum cortisol levels from prior to the dose. What is the nurse's first action? a. Notify the provider to discuss a possible non-functioning adrenal gland. b. Recognize the need for an increased dose to treat pituitary insufficiency. c. Request an order for a second dose of corticotropin to treat cortisone deficiency. d. Request an order to repeat the serum cortisol level in 1 to 2 hours.

a. nervousness and tremors. Signs and symptoms of hypoglycemia include nervousness and tremors.

The nurse assesses a client for evidence of hypoglycemic reaction. The highest priority nursing intervention is to assess for: a. nervousness and tremors. b. polyuria and polydipsia. c. dry skin. d. extreme thirst.

c. Electroencephalogram (EEG) A child with ADHD may have abnormal EEG findings. CT, MRI, and ECG tests are not diagnostic for ADHD.

The nurse is caring for a 7-year-old child who has difficulty concentrating and completing tasks and who cannot seem to sit still. Which diagnostic test may be ordered to assist with a diagnosis of attention deficit/hyperactivity disorder (ADHD) in this child? a. Computerized tomography (CT) of the head b. Electrocardiogram (ECG) c. Electroencephalogram (EEG) d. Magnetic resonance imaging (MRI) of the brain

d. Vasopressin (Pitressin) The posterior pituitary gland secretes antidiuretic hormone (ADH) (vasopressin). When there is a deficiency of ADH, sometimes caused by head trauma, patients excrete large amounts of dilute urine. ADH replacement is necessary to prevent fluid imbalance. Calcifediol is used to treat parathyroid disorders. Corticotropin and prednisolone do not prevent diuresis.

The nurse is caring for a patient who has experienced head trauma in a motor vehicle accident. The patient is having excessive output of dilute urine. The nurse will notify the provider and will anticipate administering which medication? a. Calcifediol (Calderol) b. Corticotropin (Acthar) c. Prednisolone (AK-Pred) d. Vasopressin (Pitressin)

d. Thyrotropin (Thytropar) Thyrotropin is a purified extract of thyroid-stimulating hormone and is used as a diagnostic agent to differentiate between primary and secondary hypothyroidism. Liothyronine and liotrix are thyroid replacement drugs. Methimazole is used to decrease thyroid hormone secretion.

The nurse is caring for a patient who has hypothyroidism. To assist in differentiating between primary and secondary hypothyroidism, the nurse will expect the provider to order which drug? a. Liothyronine sodium (Cytomel) b. Liotrix (Thyrolar) c. Methimazole (Tapazole) d. Thyrotropin (Thytropar)

a. "Avoid chocolate and caffeine." Triggering factors for migraine headache include foods such as chocolate, caffeine, and red wine. Intense physical exertion can trigger migraines. Prophylactic ibuprofen is not indicated.

The nurse is caring for a patient who has migraine headaches. The patient reports having these headaches more frequently. Which is an appropriate recommendation for this patient? a. "Avoid chocolate and caffeine." b. "Engage in strenuous exercise." c. "Have a glass of red wine with dinner." d. "Take ibuprofen prophylactically."

b. Check the patient's heart rate to assess for tachycardia. The patient has signs of a thyroid crisis, which can occur with excess ingestion of thyroid hormone. The nurse should evaluate heart rate before notifying the provider. These are not symptoms of hypoglycemia. The symptoms are not indicative of infection.

The nurse is caring for a patient who is being treated for hypothyroidism. The patient reports insomnia, nervousness, and flushing of the skin. Before notifying the provider, the nurse will perform which action? a. Assess serum glucose to evaluate possible hypoglycemia. b. Check the patient's heart rate to assess for tachycardia. c. Perform an assessment of hydration status. d. Take the patient's temperature to evaluate for infection.

d. Urine output and serum sodium Desmopressin is an antidiuretic hormone. The nurse should monitor intake and output as well as serum sodium levels.

The nurse is caring for a patient who is receiving desmopressin acetate (DDAVP). Which assessments are important while caring for this patient? a. Blood pressure and serum potassium b. Heart rate and serum calcium c. Lung sounds and serum magnesium d. Urine output and serum sodium

d. Serum glucose Growth hormone antagonizes insulin secretion, so serum glucose should be monitored.

The nurse is caring for a patient who is receiving growth hormone. Which assessment will the nurse monitor daily? a. Complete blood count b. Height and weight c. Renal function d. Serum glucose

b. Height, weight, and blood pressure Methylphenidate may cause growth suppression, so the child's height and weight should be assessed. Methylphenidate may also increase blood pressure, so the nurse should pay careful attention to blood pressure.

The nurse is checking an 8-year-old child who has attention deficit/hyperactivity disorder (ADHD) into a clinic for an annual well-child visit. The child takes methylphenidate HCl (Ritalin). Which assessments are especially important for this child? a. Heart rate, respiratory rate, and oxygen saturation b. Height, weight, and blood pressure c. Measures of fine- and gross-motor development d. Nausea, vomiting, and gastrointestinal upset

a. 9:00 AM to 11:00 AM Regular insulin peaks in 2 to 4 hours.

The nurse is monitoring a client for evidence of a hypoglycemic reaction. The client received Humulin R insulin at 7 AM. The nurse anticipates that the client will need to be most closely monitored for evidence of a hypoglycemic reaction at which time? a. 9:00 AM to 11:00 AM b. Noon to 3:00 PM c. 3:00 PM to 6:00 PM d. 8:00 PM to Midnight

d. serum electrolytes. Corticotropin can interact with piperacillin to cause hypokalemia, so serum electrolytes should be monitored. It is not necessary to change the antibiotic. Blood glucose monitoring and cardiac monitoring are not indicated.

The nurse is preparing to administer piperacillin to a patient to treat an infection caused by pseudomonas. The nurse learns that the patient receives corticotropin to treat multiple sclerosis. The nurse will request an order for a. a different antibiotic. b. blood glucose monitoring. c. cardiac monitoring. d. serum electrolytes.

b. "My child should avoid products containing caffeine." Methylphenidate is a stimulant, so other stimulants such as caffeine should be avoided because a high plasma caffeine level can be fatal. The medication should be taken in the morning. Patients should be taught not to stop the drug abruptly to avoid withdrawal symptoms. Weight loss is common.

The nurse is teaching a child and a parent about taking methylphenidate (Ritalin) to treat attention deficit/hyperactivity disorder (ADHD). Which statement by the parent indicates understanding of the teaching? a. "I should give this drug to my child at bedtime." b. "My child should avoid products containing caffeine." c. "The drug should be stopped immediately if my child develops aggression." d. "We should monitor my child's weight since weight gain is common."

b. Type 2 diabetes mellitus Type 2 diabetes mellitus is the most common type of diabetes.

The nurse is teaching a group of nursing students about diabetes. The nurse explains that which type of diabetes is the most common? a. Type 1 diabetes mellitus b. Type 2 diabetes mellitus c. Diabetes insipidus d. Secondary diabetes

a. "I should consult a pharmacist when giving my child OTC medications." Since many OTC medications contain stimulants, parents should consult a pharmacist or the provider before giving them with methylphenidate. Diet soft drinks often contain caffeine, a stimulant, and should be avoided with methylphenidate use. Behavioral therapy should still be an essential part of the treatment for ADHD. Weight loss is common.

The nurse is teaching a parent about methylphenidate (Ritalin) to treat attention deficit/hyperactivity disorder (ADHD). Which statement by the parent indicates understanding of the teaching? a. "I should consult a pharmacist when giving my child OTC medications." b. "I will only give my child diet soft drinks while administering this medication." c. "Medication therapy means that behavioral therapy will not be necessary." d. "Weight gain is a common side effect of this medication."

c. "Draw up the regular insulin first." Patients should be instructed to draw up regular insulin first so that NPH is not mixed into the vial of regular insulin. It is not necessary to use separate syringes. Patients do not mix the medications in a vial.

The nurse is teaching a patient about home administration of insulin. The patient will receive regular (Humulin R) and NPH (Humulin NPH) insulin at 0700 every day. What is important to teach this patient? a. "Draw up the medications in separate syringes." b. "Draw up the NPH insulin first." c. "Draw up the regular insulin first." d. "Draw up the medications after mixing them in a vial."

c. subcutaneously with the needle at a 45- to 60-degree angle. In a thin person, with little fatty tissue, the needle is inserted at a 45- to 60-degree angle. In other patients, a 45- to 90-degree angle is acceptable. There is no recommendation for preferring one site over another.

The nurse is teaching a patient how to administer insulin. The patient is thin with very little body fat. The nurse will suggest injecting insulin a. by pinching up the skin and injecting straight down. b. in the abdomen only with the needle at a 90-degree angle. c. subcutaneously with the needle at a 45- to 60-degree angle. d. using the thigh and buttocks areas exclusively.

c. "I will not be concerned about a raised knot under my skin from injecting insulin." Lipohypertrophy is a raised lump or knot on the skin surface caused by repeated injections into the same site, and this can interfere with insulin absorption. Patients are encouraged to use the same site for a week, giving each injection a knuckle length away from the previous injection. Insulin absorption is greater when given in abdominal areas.

The nurse is teaching a patient who is newly diagnosed with type 1 diabetes mellitus about insulin administration. Which statement by the patient indicates a need for further teaching? a. "I may use a chosen site daily for up to a week." b. "I should give each injection a knuckle length away from a previous injection." c. "I will not be concerned about a raised knot under my skin from injecting insulin." d. "Insulin is absorbed better from subcutaneous sites on my abdomen.

d. 100-unit insulin A 100-unit insulin syringe is the only insulin syringe currently used.

The nurse is teaching the client the proper procedure for administration of insulin. The nurse should direct the client to use a _____ syringe. a. 2-mL b. 5-mL c. 40-unit insulin d. 100-unit insulin

b. Caffeine (Cafcit) Caffeine is given to newborns that are experiencing apnea spells. The other drugs are not used for this purpose.

The nurse is working in a neonatal intensive care unit and is caring for an infant who is experiencing multiple periods of apnea and bradycardia. Which drug will the nurse expect to administer? a. Albuterol (Proventil) b. Caffeine (Cafcit) c. Doxapram (Dopram) d. Methylphenidate (Ritalin)

a. Regular (Humulin R) Only regular insulin can be given intravenously.

The nurse notes an order for insulin to be administered intravenously. The nurse recognizes that which insulin is the only type that can safely be administered intravenously? a. Regular (Humulin R) b. Lente (Humulin L) c. NPH (Humulin N) d. Insulin glargine (Lantus)

b. Rapid or racing heat rate An overaccumulation of Cytomel may increase thyroid stimulation and may cause tachycardia.

The nurse provides medication instructions to a client prescribed liothyronine sodium (Cytomel) for treatment of hypothyroidism. Which symptoms should the client be taught to monitor for that will indicate an overaccumulation of this drug? a. Dry mouth and lack of ability to urinate b. Rapid or racing heat rate c. Lethargy and fatigue d. Nausea and constipation

a. Bruising Ecchymosis is an adverse reaction to corticotropin and should be reported. Constipation and nausea are known side effects but are not serious. Myalgia is not common.

The nurse provides teaching for a patient receiving corticotropin. The nurse will instruct the patient to contact the provider if which condition occurs? a. Bruising b. Constipation c. Myalgia d. Nausea

b. Clarify the insulin type and route. Only regular insulin can be given intravenously. The nurse should clarify the order. It is not correct to give Humulin NPH insulin IV. The nurse should not administer the drug by a different route without first discussing with the provider.

The nurse receives the following order for insulin: IV NPH (Humulin NPH) 10 units. The nurse will perform which action? a. Administer the dose as ordered. b. Clarify the insulin type and route. c. Give the drug subcutaneously. d. Question the insulin dose.

d. weight gain. Hypothyroidism can lead to a hypometabolic state. This may be manifested by weight gain.

The nurse teaches the client the signs and symptoms of hypothyroidism. The client is taught to self-monitor closely for: a. tachycardia. b. palpitations. c. intolerance to heat. d. weight gain.

d. Subcutaneous Insulin is given by the subcutaneous route. Only regular insulin may be given IV.

The nurse will administer parenteral insulin to a patient who will receive a mixture of NPH (Humulin NPH) and regular (Humulin R). The nurse will give this medication via which route? a. Intradermal b. Intramuscular c. Intravenous d. Subcutaneous

a. "Avoid any products containing pseudoephedrine or caffeine." Adderall is a stimulant, so other stimulants, such as caffeine and pseudoephedrine, should be avoided because a high plasma caffeine level can be fatal.

The parent of a child who is taking amphetamine (Adderall) to treat attention deficit/hyperactivity disorder (ADHD) asks the provider to recommend an over-the-counter medication to treat a cold. What will the nurse tell the parent? a. "Avoid any products containing pseudoephedrine or caffeine." b. "Never give over-the-counter medications with Adderall." c. "Sudafed is a safe and effective decongestant." d. "Use any over-the-counter medication from the local pharmacy."

d. to send a snack with the child to eat just prior to exercise. Patients generally need less insulin with increased exercise, so the child should consume a snack to prevent hypoglycemia. Exercise is an integral part of diabetes management. Hypoglycemia is more likely to occur, and extra insulin is not indicated.

The parent of a junior high-school child who has type 1 diabetes asks the nurse if the child can participate in sports. The nurse will tell the parent a. that strenuous exercise is not recommended for children with diabetes. b. that the child must be monitored for hyperglycemia while exercising. c. to administer an extra dose of regular insulin prior to exercise. d. to send a snack with the child to eat just prior to exercise.

a. Ask the child whether the drug is being taken as prescribed. Nausea, vomiting, and headaches can occur with drug withdrawal, along with a recurrence of symptoms. The nurse should ask the child about drug compliance. Methylphenidate should be taken 30 to 45 minutes before meals, not with meals.

The parent of an adolescent who has taken methylphenidate 20 mg/day for 6 months for attention deficit/hyperactivity disorder (ADHD) brings the child to clinic for evaluation of a recent onset of nausea, vomiting, and headaches. The parent expresses concern that the child seems less focused and more hyperactive than before. What will the nurse do next? a. Ask the child whether the drug is being taken as prescribed. b. Contact the provider to discuss increasing the dose to 30 mg/day. c. Recommend taking the drug with meals to reduce gastrointestinal side effects. d. Report signs of drug toxicity to the patient's provider.

c. "Children under 12 years of age should not use weight loss drugs." Anorexiants should not be given to children under age 12 years.

The parent of an obese 10-year-old child asks the nurse about medications to aid in weight loss. Which response by the nurse is correct? a. "Anorexiants are often used to 'jump start' a weight loss regimen in children." b. "Children are able to use over-the-counter anorexiants on a long-term basis." c. "Children under 12 years of age should not use weight loss drugs." d. "Side effects of anorexiants occur less often in children."

d. "Using growth hormone to build muscle mass is not recommended." Athletes should be advised not to take growth hormone to build muscle because of its effects on blood sugar and other side effects.

The parents of a 16-year-old boy who plays football want their child to receive growth hormone to improve muscle strength. What will the nurse tell the parents? a. "Growth hormone may be used to improve strength in young athletes." b. "If the epiphyses are not fused, growth hormone may be an option." c. "Small doses of growth hormone may be used indefinitely for this purpose." d. "Using growth hormone to build muscle mass is not recommended."

d. "Some combination pens do not require refrigeration." Some combination pens do not require refrigeration after first use. Storing insulin in the freezer is not recommended. Opened vials may either be kept at room temperature for a month or refrigerated for 3 months.

The patient asks the nurse about storing insulin. Which response by the nurse is correct? a. "All insulin vials must be refrigerated." b. "Insulin will last longer if kept in the freezer." c. "Opened vials of insulin must be discarded." d. "Some combination pens do not require refrigeration."

d. "I will still need to monitor serum glucose." Patients using an insulin pump will still monitor serum glucose and count carbohydrates. The advantage of the pump is that it is programmed to deliver continuous rapid-acting insulin in varying amounts at different times throughout the day. Changes in food intake can alter the risk for hypoglycemia if the pump is not adjusted accordingly. They must be removed when bathing or swimming.

Which statement by a patient who will begin using an external insulin pump indicates understanding of this device? a. "I will have an increased risk for hypoglycemia." b. "I will leave this on when bathing or swimming." c. "I will not need to count carbohydrates anymore." d. "I will still need to monitor serum glucose."

d. Prader-Willi syndrome Fatalities associated with risks of taking growth hormone with Prader-Willi syndrome have been reported, so it is contraindicated in patients with this syndrome. It is not contraindicated in patients with asthma or enuresis. Dwarfism is an indication for hormone therapy.

Which would be a contraindication for hormone therapy with somatropin (Genotropin) in a school-age child? a. Asthma b. Dwarfism c. Enuresis d. Prader-Willi syndrome