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A nurse should recognize that a provider will prescribe a lower dose of sitagliptin for a client who has type 2 diabetes mellitus and who also has which of the following? Thyroid disease Bronchitis Heart failure Renal impairment

Thyroid disease Clients who have thyroid disease can take a regular prescribed dose of sitagliptin, a gliptin. Glipizide is an endocrine-system drug that requires cautious use with clients who have thyroid disease. Bronchitis Clients who have bronchitis can take a regular prescribed dose of sitagliptin, a gliptin. The drug requires cautious use with clients who have a history of pancreatitis. Heart failure Clients who have heart failure can take a regular prescribed dose of sitagliptin, a gliptin. Metformin is an endocrine-system drug that is contraindicated for clients who have heart failure. CORRECT ANSWER Renal impairment Sitagliptin, a gliptin, requires cautious use with clients who have renal dysfunction and low creatinine clearance because the kidneys eliminate the drug virtually intact. The provider should prescribe a lower dose for this client or prescribe a different hypoglycemic drug.

A nurse is assessing a client who has a new prescription for levothyroxine. The nurse should identify which of the following findings as a contraindication for this drug? Bacterial skin infections Diabetes insipidus Immunosuppression Recent myocardial infarction

Bacterial skin infections Clients who have bacterial skin infections can take levothyroxine, a thyroid replacement hormone. Fludrocortisone is an endocrine-system drug that requires cautious use with clients who have bacterial skin infections. Diabetes insipidus Clients who have diabetes insipidus can take levothyroxine, a thyroid replacement hormone. It requires cautious use with clients who have diabetes mellitus. Immunosuppression Clients who are immunosuppressed can take levothyroxine, a thyroid replacement hormone. Propylthiouracil (PTU) is an endocrine-system drug that requires cautious use with clients who are immunosuppressed. CORRECT ANSWER Recent myocardial infarction++++ Levothyroxine, a thyroid replacement hormone, can cause tachycardia, palpitations, and hypertension, especially when the client requires a dosage adjustment. Therefore, it is contraindicated for clients who have recently had a myocardial infarction.

A nurse is caring for a client who is about to begin taking somatropin. The nurse should explain the need to monitor which of the following laboratory values? (Select all that apply.) Blood amylase Creatinine clearance Urine calcium++++ Blood glucose++++ CBC

Blood amylase is incorrect. Somatropin, a growth hormone, is unlikely to alter blood amylase levels. Sitagliptin, an antithyroid drug, is an endocrine-system drug that requires monitoring of blood amylase levels because it can cause pancreatitis. Creatinine clearance is incorrect. Somatropin is unlikely to alter creatinine clearance. Desmopressin, an antidiuretic hormone, is an endocrine-system drug that requires monitoring of creatinine clearance. Urine calcium is correct. Somatropin can cause hypercalciuria. The nurse should monitor the client's urine calcium and instruct the client to report flank pain, urinary frequency, or hematuria. Blood glucose is correct. Somatropin can cause hyperglycemia. The nurse should monitor the client's blood glucose levels and instruct the client to report polyphagia, polydipsia, and polyuria. CBC is incorrect. Somatropin is unlikely to alter the client's CBC. Radioactive iodine-131, an antithyroid drug, is an endocrine-system drug that requires monitoring CBC.

A nurse administers pramlintide at 0800 to a client who has type 1 diabetes mellitus. At which of the following times should the nurse expect the drug to exert its peak action? 0820 0900 1030 1100

CORRECT ANSWER 0820 Pramlintide, an amylin mimetic, peaks 20 min after administration. The nurse should monitor the client for indications of hypoglycemia, such as diaphoresis and tremors. 0900 Pramlintide, an amylin mimetic, is unlikely to cause severe hypoglycemia 1 hr after administration. Aspart insulin is an injectable hypoglycemic drug that can exert its peak action at that time. 1030 Pramlintide, an amylin mimetic, is unlikely to cause severe hypoglycemia 2.5 hr after administration. Regular insulin is an injectable hypoglycemic drug that can exert its peak action at that time. 1100 Pramlintide, an amylin mimetic, is unlikely to cause severe hypoglycemia 3 hr after administration. Regular insulin is an injectable hypoglycemic drug that can exert its peak action at that time.

A nurse is caring for a client who is taking metformin and is scheduled to undergo angiography using iodine-containing contrast dye. The nurse should identify that an interaction between metformin and the IV contrast dye increases the client's risk for which of the following conditions? Hypokalemia Hyperglycemia Acute renal failure Acute pancreatitis

CORRECT ANSWER Acute renal failure Metformin, a biguanide, can interact with iodine-containing contrast dye and cause acute renal failure and lactic acidosis. The nurse should withhold metformin for 48 hr prior to and following the procedure. The nurse should also monitor the client for indications of acute renal failure or lactic acidosis, such as reduced urine output, hyperventilation, and abdominal pain. Hypokalemia Metformin, a biguanide, is unlikely to cause hypokalemia when used with iodine-containing contrast dye. Regular insulin is an endocrine-system drug that can cause hypokalemia. Hyperglycemia Metformin, a biguanide, is unlikely to cause hyperglycemia when used with iodine-containing contrast dye. Glucagon is an endocrine-system drug that can cause hyperglycemia. Acute pancreatitis Metformin, a biguanide, is unlikely to cause acute pancreatitis when used with iodine-containing contrast dye. Exenatide is an endocrine-system drug that can cause can cause acute pancreatitis.

A nurse is teaching a client who has a prescription for glipizide therapy to treat type 2 diabetes mellitus. Which of the following instructions should the nurse include? Avoid drinking alcohol. Sit or stand for 30 min after taking the drug. Urinate every 4 hr. Take the drug 2 hr after a meal.

CORRECT ANSWER Avoid drinking alcohol. The nurse should instruct the client to avoid drinking alcohol. Alcohol can interact with glipizide, a sulfonylurea, causing nausea, palpitations, and flushing. Alcohol also increases the drug's hypoglycemic effects. Sit or stand for 30 min after taking the drug. Glipizide, a sulfonylurea, is unlikely to cause esophagitis. However, it can cause gastrointestinal distress with heartburn. Urinate every 4 hr. Glipizide, a sulfonylurea, is unlikely to cause urinary retention. However, it can cause diarrhea. Clients who develop this adverse reaction should maintain hydration by drinking plenty of electrolyte-rich fluids. Take the drug 2 hr after a meal. Glipizide, a sulfonylurea, helps control hyperglycemia caused by type 2 diabetes mellitus. The client should take the drug 30 min before the first meal of the day.

A nurse is caring for a client who is taking metformin to treat type 2 diabetes mellitus and reports muscle pain. Which of the following adverse reactions should the nurse suspect? Lactic acidosis++++++++ Anticholinergic effects Extrapyramidal effects Hypophosphatemia

CORRECT ANSWER Lactic acidosis++++++++ Metformin, a biguanide, can cause lactic acidosis, which is a life-threatening complication that manifests as muscle aches, sleepiness, malaise, and hyperventilation. The client should stop taking the drug and seek medical care immediately. Anticholinergic effects Metformin, a biguanide, is unlikely to cause anticholinergic effects, but it can cause nausea, diarrhea, and anorexia. The nurse should inform the client that these effects should diminish with continued therapy. Extrapyramidal effects Metformin, a biguanide, is unlikely to cause extrapyramidal effects, but it can cause dizziness and fatigue. Hypophosphatemia Metformin, a biguanide, is unlikely to cause hypophosphatemia, but it can cause vitamin B12 or folic acid deficiencies, which would manifest as weakness, fatigue, pallor, or a reddened tongue.

A nurse is teaching a client about acarbose therapy to treat type 2 diabetes mellitus. Which of the following instructions should the nurse include? Eat more iron-rich foods. Avoid drinking grapefruit juice. Increase fiber intake. Avoid drinking green tea.

CORRECT RESPONSE Eat more iron-rich foods.+++ Acarbose, an alpha-glucosidase inhibitor, can cause iron-deficiency anemia. The nurse should instruct the client to increase their intake of iron-rich foods, such as red meat, spinach, and grains. The nurse should also monitor the client's CBC. Avoid drinking grapefruit juice. Grapefruit juice is unlikely to alter the effects of acarbose, an alpha-glucosidase inhibitor. More than 1 L of grapefruit juice per day can increase the hypoglycemic effects of repaglinide, a meglitinide. Increase fiber intake. Acarbose, an alpha-glucosidase inhibitor, is unlikely to cause constipation. It can cause diarrhea and flatulence. Metformin can worsen the gastrointestinal effects of the drug. Avoid drinking green tea. Green tea is unlikely to alter the effects of acarbose, an alpha-glucosidase inhibitor. Green tea can increase the hypoglycemic effects of pioglitazone, another endocrine-system drug.

A nurse is educating the parents of a child who has a new diagnosis of Prader-Willi Syndrome (PWS) and has been prescribed somatropin. Which of the following statements by a parent indicates understanding of the teaching? "We will use a different spot for injection each time we give the medication." "We'll give the shot in the thigh muscle rather than fatty tissue to decrease injection pain." "We'll watch our child for signs of low blood sugar while using somatropin." "We should stop the medication if our child loses weight."

CORRECT ANSWER "We will use a different spot for injection each time we give the medication." -To avoid atrophy of the tissue, administration of somatropin includes rotating the injection site each time. The nurse should identify this statement as an understanding of somatropin administration. "We'll give the shot in the thigh muscle rather than fatty tissue to decrease injection pain." -The parents should administer the somatropin injection subcutaneously rather than intramuscularly to decrease pain. This does not alter drug effectiveness. "We'll watch our child for signs of low blood sugar while using somatropin." -Growth hormone administration can cause diabetes mellitus and can increase the occurrence of hyperglycemia for clients who have diabetes. The parents should closely monitor the child for polyphagia, polydipsia, and polyuria while on growth hormone therapy. "We should stop the medication if our child loses weight." -A heathy loss of weight in clients who are taking somatropin is not a concern. Pediatric clients who have PWS and are taking growth hormone must be weighed often to assess for weight gain that could become problematic. Obesity is a contraindication for using somatropin for clients who have PWS.

When considering replacement therapy options for a client who has chronic adrenocortical insufficiency, a nurse should recognize that the provider will choose which of the following drugs? Somatropin Hydrocortisone Glucagon Desmopressin

Somatropin Somatropin, a growth hormone, treats growth hormone deficiencies, such as Turner's syndrome, rather than adrenocortical insufficiency. CORRECT ANSWER Hydrocortisone Hydrocortisone, a glucocorticoid, provides replacement therapy for acute and chronic adrenocortical insufficiency, such as Addison's disease. Hydrocortisone is identical to cortisol, the primary glucocorticoid the adrenal cortex generates. Glucagon Glucagon, a hyperglycemic, treats severe hypoglycemia from insulin toxicity, rather than adrenocortical insufficiency. Desmopressin Desmopressin, an antidiuretic hormone, treats diabetes insipidus, rather than adrenocortical insufficiency.

A nurse is caring for a client who takes repaglinide 15 to 30 min before each meal to treat type 2 diabetes mellitus. The client asks, "If I skip a meal, what should I do?" Which of the following responses should the nurse make? Double the dose before the next meal. Take half the dose. Skip the dose. Take the usual dose.

Double the dose before the next meal. Taking a double dose of repaglinide, a meglitinide, before the next meal puts the client at risk for hypoglycemia. Take half the dose. Taking half the dose of repaglinide, a meglitinide, without the meal puts the client at risk for hypoglycemia. CORRECT ANSWER Skip the dose.++++ To avoid a sudden and serious drop in blood glucose level, the client should skip the dose of repaglinide, a meglitinide, whenever skipping a meal. The nurse should also instruct the client to try to avoid skipping meals. Take the usual dose. Taking the full dose of repaglinide, a meglitinide, without the meal puts the client at risk for hypoglycemia.

A nurse at a provider's office is assessing a client who has been taking hydrocortisone for adrenal insufficiency. The client reports fatigue and feeling overwhelmed by personal responsibilities. Which of the following findings should the nurse identify as an indication the provider might need to increase the client's dosage? Hypotension. Hyperglycemia Weight gain Fat redistribution

CORRECT ANSWER Hypotension. Hypotension and fatigue are findings of adrenal insufficiency. During times of stress, the client might need a dosage increase to prevent adrenal insufficiency. The nurse should report the findings to the provider.

Which of the following drugs should a nurse have available for a client who is experiencing insulin toxicity? Acetylcysteine Glucagon Diphenhydramine Naloxone

Naloxone Naloxone, an opiate antagonist, treats opioid toxicity, not insulin toxicity. Diphenhydramine Diphenhydramine, a cholinergic antagonist and an antihistamine, treats drug-induced extrapyramidal effects. Diphenhydramine is ineffective for insulin toxicity. Acetylcysteine Acetylcysteine, a mucolytic, treats acetaminophen toxicity, not insulin toxicity. CORRECT ANSWER Glucagon Glucagon, a hyperglycemic that can be given subcutaneously, IM, or IV, is used to treat severe hypoglycemia from insulin toxicity in clients who are unconscious and for whom IV glucose is not readily available. If the client does not respond to glucagon, the nurse should administer a glucose solution IV.

A nurse is caring for a client who is about to begin insulin glargine therapy. The nurse should identify the need for additional precautions because the client also takes which of the following types of drugs? Oral contraceptives Calcium supplements Beta blockers Iron supplements

Oral contraceptives Oral contraceptives do not specifically interact with insulin. Exenatide, another endocrine-system drug, slows the absorption of oral contraceptives. Calcium supplements Calcium supplements do not specifically interact with insulin. They do, however, reduce the absorption of levothyroxine, another endocrine-system drug. CORRECT ANSWER Beta blockers++++ Clients who take both insulin and beta blockers are at risk for failing to promptly recognize the symptoms of hypoglycemia because beta blockers mask symptoms such as tachycardia and tremors. Beta blockers also increase hypoglycemic effects. Iron supplements Iron supplements do not specifically interact with insulin. They do, however, reduce the absorption of levothyroxine, another endocrine-system drug.

A nurse is caring for a client who is taking propylthiouracil (PTU) and reports weight gain, drowsiness, and depression. The nurse should identify that the client is experiencing which of the following adverse reactions to the drug? Thyrotoxicosis Hypothyroidism Lactic acidosis Radiation sickness

Hypothyroidism+++ CORRECT ANSWER Propylthiouracil, an antithyroid drug, can cause hypothyroidism, which manifests as drowsiness, depression, weight gain, edema, and bradycardia. The nurse should request that the provider prescribe a lower dosage of the drug for the client. Lactic acidosis Propylthiouracil, an antithyroid drug, is unlikely to cause lactic acidosis. Sitagliptin is an endocrine-system drug that can cause lactic acidosis, which manifests as muscle aches, sleepiness, malaise, and hyperventilation. Radiation sickness Propylthiouracil, an antithyroid drug, is unlikely to cause radiation sickness. Radioactive iodine-131 is an endocrine-system drug that can cause radiation sickness, which manifests as hematemesis, epistaxis, and intense nausea and vomiting. Thyrotoxicosis Propylthiouracil, an antithyroid drug, treats thyrotoxicosis, or hyperthyroidism. Indications of thyrotoxicosis include anxiety, palpitations, and weight loss.

A nurse is caring for a client who is taking pioglitazone to treat type 2 diabetes mellitus. The nurse should monitor for which of the following findings? Constipation Joint pain Weight gain Dilated pupils

Joint pain Pioglitazone, a thiazolidinedione, is more likely to cause muscle pain than joint pain. constipation Pioglitazone, a thiazolidinedione, is more likely to cause diarrhea than constipation. CORRECT ANSWER Weight gain Pioglitazone, a thiazolidinedione, can cause fluid retention. The nurse should monitor the client for weight gain and other indications of fluid retention or heart failure, including dyspnea, crackles, and wheezing. Dilated pupils Pioglitazone, a thiazolidinedione, is more likely to cause blurred vision than dilated pupils.

A nurse is teaching a client who has a prescription for pramlintide therapy to treat type 1 diabetes mellitus. Which of the following instructions should the nurse include? Mix pramlintide with insulin in the syringe. Administer pramlintide before meals. Take pramlintide once daily at bedtime. Inject pramlintide into the upper arm.

Mix pramlintide with insulin in the syringe. -Pramlintide, an amylin mimetic, supplements the effects of insulin and oral hypoglycemic drugs. However, clients should not mix it in the same syringe with insulin. CORRECT ANSWER Administer pramlintide before meals. -The nurse should instruct the client to inject pramlintide, an amylin mimetic, 20 min before any meal that contains at least 30 g of carbohydrates. Take pramlintide once daily at bedtime. -Clients should take pramlintide, an amylin mimetic, three times per day with meals. Metformin, a biguanide, is an endocrine-system drug that clients take orally once per day with their evening meal. Inject pramlintide into the upper arm. -Clients should inject pramlintide, an amylin mimetic, subcutaneously into the abdomen or thigh, rather than the upper arm.

A nurse is speaking with a client who is taking glipizide to treat type 2 diabetes mellitus and has called to report feeling shaky, hungry, and fatigued. Which of the following actions should the nurse instruct the client to take? Drink 16 oz of water. Perform a fingerstick blood glucose check. Take another glipizide tablet. Lie down and rest.

Drink 16 oz of water. Glipizide, a sulfonylurea, can cause diarrhea. Clients who develop this adverse reaction should maintain hydration by drinking plenty of fluids. However, the client's symptoms indicate a different adverse reaction to the drug. CORRECT ANSWER Perform a fingerstick blood glucose check. Glipizide, a sulfonylurea, can cause hypoglycemia, which can manifest as diaphoresis, shakiness, hunger, and fatigue. The nurse should tell the client to check their blood glucose level and, if it indicates hypoglycemia, to consume a snack of 15 to 20 g (0.5 to 0.7 oz) of carbohydrates, retest in 15 to 20 min, and repeat if their blood glucose level is still low. Take another glipizide tablet. Glipizide, a sulfonylurea, treats hyperglycemia from type 2 diabetes mellitus. Clients do not take the drug PRN, but rather on a fixed, once-daily dosing schedule. It would be inappropriate to double the dosage within the same 24-hr period, even if the client were experiencing hyperglycemia. Lie down and rest. Lying down and resting can help the client feel less fatigued, but these actions do not address the adverse reaction the client is having to glipizide, a sulfonylurea.

A nurse is providing teaching to a client who is about to begin exenatide therapy to treat type 2 diabetes mellitus. Which of the following instructions should the nurse include? (Select all that apply.) Inject the drug subcutaneously.+ Expect the peak effect in 2 hr.+ Use the drug as a supplement to an oral hypoglycemic.+ Inject the drug 1 hr after a meal. Discard used pens 10 days after the first use.

Inject the drug subcutaneously is correct. The client should inject exenatide, an incretin mimetic, into the subcutaneous tissue of the thigh, upper arm, or abdomen. Expect the peak effect in 2 hr is correct. Levels of exenatide peak 2 hr after administration and then decrease gradually, with a half-life of 2.4 hr. Use the drug as a supplement to an oral hypoglycemic is correct. Exenatide supplements the action of an oral hypoglycemic, such as a sulfonylurea or metformin. Inject the drug 1 hr after a meal is incorrect. The client should inject exenatide twice per day up to 60 min prior to the morning and evening meals, rather than after a meal. Discard used pens 10 days after the first use is incorrect. The client can keep prefilled exenatide injector pens in use at room temperature for up to 30 days.

A nurse is providing teaching to a client about taking fludrocortisone to treat adrenocortical insufficiency. Which of the following instructions should the nurse include? (Select all that apply.) Obtain weight measurement daily.+ Report weakness or palpitations.+ Have blood pressure checked regularly.+ Eat more iron-rich foods. Avoid drinking grapefruit juice.

Obtain weight measurement daily is correct. Fludrocortisone, a mineralocorticoid, can cause fluid and electrolyte imbalances, such as hypernatremia. Tracking weight on a daily basis can help identify weight gain and edema; reporting it can expedite any essential interventions. Report weakness or palpitations is correct. Fludrocortisone can cause hypokalemia. The nurse should monitor the client's potassium levels and tell the client to report muscle weakness or palpitations. Have blood pressure checked regularly is correct. Fludrocortisone can cause fluid retention and hypertension. The nurse should monitor the client's fluid balance and blood pressure to expedite any essential interventions. Eat more iron-rich foods is incorrect. Fludrocortisone does not cause iron-deficiency anemia. However, it can cause thrombocytopenia. Avoid drinking grapefruit juice is incorrect. Grapefruit juice is unlikely to alter the effects of fludrocortisone.

A nurse is caring for a client who is taking desmopressin. The nurse should make which of the following assessments to evaluate the drug's effectiveness? Top of Form Peripheral pulses Urine output Skin integrity Blood glucose

Peripheral pulses Desmopressin, an antidiuretic hormone, is unlikely to alter peripheral pulses. Vasopressin, another antidiuretic hormone, can cause vasoconstriction and angina pectoris. Desmopressin does not alter hemodynamics. CORRECT ANSWER Urine output++++ Desmopressin, an antidiuretic hormone, treats diabetes insipidus. The nurse should monitor the client's fluid intake and urine output along with urine and serum osmolality and blood pressure. Skin integrity Desmopressin, an antidiuretic hormone, is unlikely to alter skin integrity. Propylthiouracil (PTU), an antithyroid drug, is an endocrine-system drug that requires integumentary monitoring because it can cause a rash. Blood glucose Desmopressin, an antidiuretic hormone, is unlikely to alter blood glucose. However, it can cause hyponatremia. The nurse should monitor the client's sodium levels.

A nurse is teaching a client about self-administering regular insulin. The nurse should instruct the client to rotate injection sites to prevent which of the following? Rapid absorption Intradermal injection Injection pain Lipohypertrophy

Rapid absorption Rotating insulin injection sites does not prevent rapid absorption. Using the same injection site, specifically the abdomen, speeds absorption, while using the thigh allows for the slowest absorption. Intradermal injection Rotating insulin injection sites does not affect the risk for intradermal injection because the appropriate areas for insulin injection contain adequate subcutaneous tissue in most clients. Injection pain Rotating insulin injection sites is unlikely to affect injection pain. The depth of the injection affects pain; deeper IM injections are more painful and are also inappropriate for insulin injection. CORRECT ANSWER Lipohypertrophy Lipohypertrophy is a proliferation of fat at the sites of repeated insulin injections. It affects skin sensitivity and appearance. To prevent it, the client should rotate injection sites, keeping them at least 2.5 cm (1 in) apart, and avoid using the same spot within the same month.

A nurse is caring for a client who is about to begin taking propylthiouracil (PTU) to treat hyperthyroidism. The nurse should instruct the client to report which of the following adverse effects? (Select all that apply.) Sore throat Joint pain Insomnia Bradycardia Rash

Sore throat is correct. Propylthiouracil, an antithyroid drug, can cause agranulocytosis. The nurse should monitor the client's CBC and instruct the client to report fever or sore throat. Joint pain is correct. Propylthiouracil can cause arthralgia and myalgia. The nurse should instruct the client to report these effects and take over-the-counter analgesics for pain relief. Insomnia is incorrect. Propylthiouracil is more likely to cause drowsiness than insomnia. Bradycardia is correct. Propylthiouracil can cause hypothyroidism, which manifests as bradycardia, drowsiness, and weight gain. The nurse should instruct the client to report these effects. Rash is correct. Propylthiouracil can cause urticaria or a skin rash. The nurse should instruct the client to report these effects.

A nurse is providing teaching to a client who is about to begin levothyroxine therapy to treat hypothyroidism. Which of the following instructions should the nurse include? Take levothyroxine with food to increase absorption. Take levothyroxine with an antacid to reduce gastrointestinal effects. Expect life-long therapy with the drug. Carry a carbohydrate snack at all times.

Take levothyroxine with food to increase absorption. Food reduces the absorption of levothyroxine, a thyroid replacement hormone. The nurse should instruct the client to take it on an empty stomach at least 30 min before eating. Take levothyroxine with an antacid to reduce gastrointestinal effects. Antacids reduce the absorption of levothyroxine, a thyroid replacement hormone. The nurse should instruct the client to allow 4 hr between taking levothyroxine and taking an antacid. CORRECT ANSWER Expect life-long therapy with the drug. Therapy with levothyroxine, a thyroid replacement hormone, usually continues for life because there are no other therapies that can restore thyroid function. Carry a carbohydrate snack at all times. Levothyroxine, a thyroid replacement hormone, does not cause hypoglycemia, so this precaution is not necessary. Clients who are taking hypoglycemics, such as exenatide, should always carry a carbohydrate snack to treat hypoglycemia.

A nurse is caring for a client who is about to begin taking pioglitazone to treat type 2 diabetes mellitus. The nurse should explain to the client about the need to monitor which of the following laboratory values? (Select all that apply.) Thyroid-stimulating hormone (TSH) Alanine aminotransferase (ALT)+ LDL+ CBC Creatinine clearance

Thyroid-stimulating hormone (TSH) is incorrect. Pioglitazone, a thiazolidinedione, is unlikely to alter T4 or TSH. Levothyroxine, a thyroid hormone replacement, is an endocrine-system drug that requires monitoring of T4 and TSH. Alanine aminotransferase (ALT) is correct. Pioglitazone can cause liver injury. The nurse should monitor ALT at the start of therapy and then every 3 to 6 months thereafter. The nurse should tell the client to report jaundice, dark-colored urine, or abdominal pain. LDL is correct. Pioglitazone can cause elevations in both high-density lipoproteins, which is a beneficial effect, and LDLs, which is a detrimental effect. The nurse should monitor the client's plasma lipid levels at baseline and periodically throughout drug therapy. CBC is incorrect. It is not necessary to monitor CBC for clients who are taking pioglitazone. Hydrocortisone, a glucocorticoid, is an endocrine-system drug that requires monitoring of CBC. Creatinine clearance is incorrect. \ It is not necessary to monitor creatinine clearance for clients who are taking pioglitazone. Desmopressin, an antidiuretic hormone, is an endocrine-system drug that requires monitoring of creatinine clearance.