Chapters 33, 44, and 45 (for Quiz)

A client takes intranasal antidiuretic hormone​ (ADH). Which question should the nurse ask the​ client?

"Do you have​ nosebleeds?" Nasal irritation and nosebleeds might occur with intranasal ADH.

The nurse is teaching about nonsteroidal​ anti-inflammatory drugs​ (NSAIDs). Which statement should the nurse​ include?

"Most NSAIDs exhibit the same inhibitory​ actions, meaning they perform the same action in the body​ (inhibiting prostaglandins) whether the inflammation is caused by an​ injury, autoimmune​ disease, or allergy.

A client is prescribed a corticosteroid for rheumatoid arthritis. Which client statement should indicate that teaching about this medication was​ effective?

"This drug will help relieve the pain​ I'm experiencing." Rheumatoid arthritis is an autoimmune disorder in which the​ body's immune system attacks the​ joints, causing inflammation. Corticosteroids are administered to help relieve the pain and inflammation associated with rheumatoid arthritis.

A client is prescribed aspirin​ (acetylsalicylic acid) for fever control. Which client risk factor should the nurse address before administering the​ medication?

A potential adverse effect of aspirin is GI​ bleeding, and this risk increases with higher doses. The risk versus benefit of the medication should be considered.

A client is prescribed aspirin​ (acetylsalicylic acid). Which therapeutic response should the nurse​ anticipate?

A therapeutic response of aspirin is a lower body temperature.

A client is prescribed acetaminophen​ (Tylenol). For which therapeutic response should the nurse​ monitor?

Acetaminophen will decrease moderate pain.

A client is experiencing adrenal crisis. Which finding should the nurse expect to​ assess?

Adrenal crisis occurs as a result of the adrenal​ gland's inability to secrete sufficient corticosteroids. Indications of an adrenal crisis include hypotension and tachycardia.​

The nurse is assessing a client prescribed nateglinide​ (Starlix). Which symptom should the nurse recognize as an adverse​ reaction?

Adverse reactions to nateglinide include flulike​ symptoms, upper respiratory​ infection, back​ pain, and hypoglycemia.​

A client is taking propylthiouracil​ (PTU) for the management of hyperthyroidism. For which adverse effect should the nurse monitor this​ client's temperature?

Agranulocytosis is the depletion of white blood​ cells, and this places the client at risk for infection. Because of​ this, the​ client's temperature should be assessed.

A client is diagnosed with hypoglycemia. Which factor should the nurse recognize as contributing to this​ diagnosis?

Alcohol inhibits the​ liver's ability to release glucose into the​ blood, which can result in hypoglycemia.​ Stress, surgery, and corticosteroids contribute to hyperglycemia and not hypoglycemia.

The nurse is discussing the pathophysiology of inflammation. Which information should the nurse​ include?

Antigen exposure causes permeability of vessels and allows phagocytic cells to reach the antigen.When the body is exposed to a foreign substance​ (antigen), nearby blood vessels become permeable to allow phagocytic cells to reach and neutralize the antigen.

A client taking insulin glulisine​ (Apidra) asks when eating should occur. Which response should the nurse​ provide?

Because insulin glulisine is rapid acting with an onset of 15 to 30​ minutes, the client should take this medication 15 minutes before eating.

A client has an allergy to salicylates. Which medication prescription should the nurse​ question?

Clients with a hypersensitivity to aspirin​ (acetylsalicylic acid) will also likely be hypersensitive to other nonsteroidal​ anti-inflammatory drugs​ (NSAIDs). Meloxicam,​ ketorolac, salsalate, and choline magnesium trisalicylate are NSAIDs.

A client is diagnosed with diabetes insipidus​ (DI). Which medication should the nurse prepare to​ administer?

DI is caused by under-secretion of antidiuretic hormone. Desmopressin is the drug of choice for treating DI.

The nurse is reviewing medications taken by a client prescribed metformin​ (Glucophage). Which medication should the nurse find most​ concerning?

Digoxin may decrease renal excretion of metformin.​

A client is scheduled for a bilateral oophorectomy. Which hormone level should the nurse anticipate being affected by the​ procedure?

Estrogen and progesterone are the two main hormones secreted by the ovaries. Removal of the ovaries means that these hormones are no longer​ produced, and their level will be severely affected. Prolactin and oxytocin are secreted by the pituitary gland. Testosterone is secreted by the testes.

An adult client develops​ kyphosis, enlarged bones of the​ hands, feet,​ face, and​ skull, and elevated growth hormone​ (GH) levels. Which health problem should the nurse​ suspect?

Excess GH secretion in adults causes acromegaly. Manifestations of acromegaly include kyphosis and​ enlarged, deformed bones of the​ face, hands,​ feet, and skull. Excess secretion of GH in children causes gigantism. GH deficiency in children causes dwarfism.​ Turner's syndrome is a genetic chromosomal disorder that produces short stature in girls.

A​ client's nonsteroidal​ anti-inflammatory medication is changed from diclofenac​ (Cataflam, Voltaren) to celecoxib​ (Celebrex). Which conclusion should the nurse​ draw?

Gastrointestinal​ (GI) irritation may decrease. The risk for GI​ irritation, GI​ bleeding, and ulcer formation is lower with celecoxib than diclofenac because celecoxib inhibits​ cyclooxygenase-2 (COX-2) but does not inhibit​ cyclooxygenase-1 (COX-1).

The nurse is teaching a client about herbal preparations to avoid when taking ibuprofen​ (Advil, Motrin). Which herb should the nurse include in the​ discussion?

Herbal medications such as​ feverfew, ginger,​ garlic, and ginkgo increase the risk of bleeding when combined with ibuprofen.

A client has been on a high dose of hydrocortisone​ (Cortef, Hydrocortone,​ others). Which assessment finding should be of greatest concern to the​ nurse?

Hydrocortisone contains​ mineralocorticoids, responsible for the retention of sodium and water. Edema can indicate that​ Cushing's syndrome has developed.

A client takes acetaminophen​ (Tylenol) for arthritic pain. Which laboratory value should the nurse monitor for this​ client?

Ibuprofen may increase bleeding time as well as aspartate aminotransferase​ (AST) and alanine aminotransferase​ (ALT) levels. It may decrease hemoglobin and hematocrit.​

The nurse administers octreotide​ (Sandostatin) to a client with acromegaly. For which adverse effect should the nurse assess this​ client?

In addition to suppressing the action of growth​ hormone, octreotide also suppresses the secretion of pancreatic​ peptides, gastrin,​ insulin, and glucagon. This action produces the adverse effects of​ edema, gallstones, elevated liver​ enzymes, and​ nausea, vomiting, and diarrhea.

A client with type 1 diabetes mellitus​ (DM) is diagnosed with a respiratory infection. Which assessment finding should the nurse recognize as the most important to​ monitor?

Infection in a client with type 1 DM may result in​ hyperglycemia, so it is most important for the nurse to monitor any polyuria that is present because it is a symptom that occurs with​ hyperglycemia, which can lead to diabetic ketoacidosis.

A client is experiencing inflammation. Which statement should the nurse include when teaching the client about this health​ problem?

Inflammation is a​ self-limiting, natural process for ridding the body of antigens. Inflammation is a symptom of an underlying​ disorder; it is not a disease. When​ applicable, topical medications should be used instead of oral medications because they have fewer adverse effects. Ice packs and rest are​ nonpharmacologic, useful treatments for inflammation.

A client is prescribed human regular insulin​ (Humulin R). For which electrolyte imbalance should the nurse monitor the​ client?

Insulin facilitates intracellular uptake of​ potassium, so the client is at risk for hypokalemia.​

A client is diagnosed with hyperosmolar hyperglycemic state​ (HHS). Which assessment finding should the nurse​ anticipate?

In​ HHS, a large osmotic diuresis occurs causing marked​ dehydration, confusion, and lethargy. Hypotension is a finding related to the diuresis. Tachycardia occurs because of a drop in fluid volume. Ketoacidosis and fruity breath odor are associated with diabetic ketoacidosis​ (DKA), which occurs with type 1 diabetes mellitus.

The nurse is reviewing protocols for the administration of radioactive iodine for hyperthyroidism. Which client should the nurse exclude from this treatment​ option?

Ionizing radiation is the treatment of choice by many endocrinologists as a​ long-term management of hyperthyroidism.​ However, it is contraindicated in pregnant clients because of the risk of fetal exposure to ionizing radiation.

A client with hypothyroidism is beginning treatment with levothyroxine​ (Synthroid). Which adverse effect should the nurse include in the​ teaching?

Medications that are used to treat hypothyroidism have adverse effects such as​ tremors, headaches, and menstrual abnormalities. An intolerance to cold is a symptom of hypothyroidism. Agranulocytosis is an adverse effect of methimazole​ (Tapazole) and propylthiouracil​ (PTU).

A​ client's medication is switched from celecoxib​ (Celebrex) to ibuprofen​ (Advil, Motrin). Which change should the nurse​ expect?

New onset gastrointestinal​ (GI) irritation and Increased platelet aggregation. Ibuprofen is a​ cyclooxygenase-1 (COX-1) and​ cyclooxygenase-2 (COX-2)​ inhibitor, but celecoxib only blocks​ COX-2. Unlike celecoxib​ (Celebrex), ibuprofen​ (Advil, Motrin) can cause platelet aggregation and GI irritation.

The nurse is teaching a client about the effects of radioactive iodine in controlling hyperthyroidism. Which information should the nurse explain as the goal of​ treatment?

Radioactive iodine is used to destroy a portion of the thyroid gland to decrease thyroid hormone production.

A client is prescribed aspirin​ (acetylsalicylic acid). Which factor should the nurse recognize increases the risk of gastrointestinal​ (GI) bleeding with this​ medication?

Smoking, alcohol​ use, and Helicobacter pylori infection increase the risk for​ aspirin-induced GI bleeding. Age greater than 60 is a risk factor, not 40.

A​ client's laboratory report shows severely decreased levels of​ thyroid-stimulating hormone​ (TSH). Which structure should the nurse recognize as secreting this​ hormone?

TSH is secreted by the anterior lobe of the pituitary​ gland, along with many other​ hormones, including adrenocorticotropic​ hormone, growth​ hormone, prolactin,​ follicle-stimulating hormone, luteinizing​ hormone, and​ melanocyte-stimulating hormone.

A client needs to take subcutaneous insulin every day. Which instruction should the nurse include when teaching about​ self-administration of​ insulin?

The client should be instructed to rotate administration sites weekly to avoid lipodystrophy. If insulins are​ mixed, the​ quickest-acting insulin should be drawn up first. Insulin should be injected at a​ 90-degree angle and can be stored open at room temperature for up to 1 month.

The nurse is reviewing the endocrine system. Which statement should the nurse use to explain this​ system?

The effects of hormones produced by the endocrine system last significantly longer than those of the nervous​ system, and they can have a​ systemic, not just​ local, effect.​ However, the effects of the hormones are much slower than the effects of the nervous​ system, which occur in milliseconds after stimulation. Some hormones can cause a reaction within a few​ seconds, whereas others can take a few days or even months to produce an action.

The nurse is providing dietary teaching to a client with hyperthyroidism. Which food choice should indicate that the client needs additional​ instruction?

The iodine in salt can stimulate the synthesis of thyroid​ hormone, which would be contraindicated in the client with hyperthyroidism.​

A client is diagnosed with a tumor of the posterior lobe of the pituitary gland. Which hormone should the nurse anticipate being​ affected?

The posterior lobe of the pituitary gland secretes antidiuretic​ hormone, which works on the​ kidneys, and​ oxytocin, which acts on the smooth muscle of the uterus.​ Prolactin, testosterone, and growth hormone are all secreted by the anterior lobe of the pituitary gland.

The nurse is reviewing feedback loops. Which example should the nurse use to describe negative feedback​ loops?

The rise of blood sugar stimulates insulin​ release, which lowers blood sugar levels. Negative feedback loops occur when the production of one substance shuts down the production of another.

A client has been taking methimazole​ (Tapazole) for the treatment of hyperthyroidism. Which should the nurse assess to determine drug​ effectiveness?

Tri-iodothyronine, thyroxine, and TSH levels should be assessed to determine drug effectiveness.

A client with hyperthyroidism asks why potassium iodide​ (Thyro-Block) was prescribed. Which response should the nurse​ provide?

When a client is preparing to undergo surgical resection of the thyroid​ gland, potassium iodide is administered to decrease the risk of​ bleeding, fragility, and size of the thyroid gland.

A client with type 1 diabetes mellitus​ (DM) has a glucose level of 98​ mg/dL. Which question should the nurse​ ask?

​"Do you have any concerns about your treatment​ plan?" The client should be asked about treatment concerns because a blood glucose of 98​ mg/dL is within a normal range. Because the levels are within a normal​ range, assessing intake is not pertinent. The glucose levels are not out of​ range, nor do they reflect noncompliance with insulin administration.

A client taking a sulfonylurea is experiencing hypoglycemia. Which question should the nurse ask the​ client?

​"Have you skipped any​ meals?" Hypoglycemia is a common adverse effect of a sulfonylurea and occurs due to the client skipping meals or taking too much medication.

The nurse suspects that a client is experiencing type 2 diabetes mellitus​ (DM) . Which statement should the nurse recognize as most commonly associated with this​ diagnosis?

​"I am heavier than I have ever been in my​ life." Clients with type 2 DM are usually overweight or obese.​ Nocturia, which is secondary to​ polyuria, occurs in type 1 DM. Polyphagia is a symptom of both types of​ diabetes, but clients with type 1 DM are more likely to be underweight. Hypoglycemia is characterized by shakiness and sweating and is associated with type 1 DM.

The nurse is caring for clients with inflammatory health problems. Which client statement should concern the​ nurse?

​"I have been taking a corticosteroid for the past 3​ months." Corticosteroids may have serious​ long-term adverse effects and are usually prescribed for only 1 to 3 weeks.

A client is prescribed acetaminophen​ (Tylenol) for a headache. Which client statement should indicate that teaching about this medication was​ effective?

​"I should report any skin rash or​ itching." Acetaminophen may cause serious allergic reactions with symptoms of​ angioedema, difficulty​ breathing, itching, or rash.

A client is prescribed NPH insulin and insulin aspart. Which client statement should indicate that teaching about the medication was​ effective?

​"I will draw up the aspart​ first, and then the​ NPH." Aspart must be drawn up first. Insulin aspart can be given with NPH. It is important for the client to understand that the drugs can be mixed in the same​ syringe, but they need to be drawn up in a specific order and given immediately.

The nurse is teaching a client about glucose monitoring in relation to exercise. Which client statement should indicate that further teaching is​ required?

​"I will monitor my blood sugar only if I participate in any strenuous​ exercise." A client should monitor blood glucose level before and up to 48 hours after​ exercising, not just when the client participates in strenuous exercise. If a client is participating in heavy​ exercise, blood glucose should be monitored​ before, during, and after that exercise.

A client is prescribed glargine and aspart. Which client statement should indicate that teaching was​ effective?

​"I will take the glargine in the​ morning." The glargine should be taken at the same time every day to provide consistent blood levels. Glargine cannot be mixed with any other insulin. Glargine is only taken once a​ day, and it has duration of up to 24 hours and can be taken without regard to meals. It does not have a peak​ onset, so there is no risk of hypoglycemia with aspart.

A client is prescribed a sulfonylurea. Which should indicate to the nurse that additional teaching about this medication is​ required?

​"If I notice my urine looks​ dark, I will increase my fluid​ intake." Clients taking sulfonylureas are at risk for hepatotoxicity. Darkened urine could indicate hepatotoxicity or cholestatic jaundice and needs to be reported to the healthcare provider.

The nurse is reviewing the classifications of drugs used to treat type 2 diabetes mellitus​ (DM). Which information should the nurse include in the​ discussion?

​"It can take up to 4 months for therapy with a thiazolidinedione to be​ effective."

A client is prescribed a nonsteroidal​ anti-inflammatory drug​ (NSAID) for ophthalmic inflammation. Which client statement should indicate to the nurse that teaching was​ effective?

​"My feet should not swell while taking the​ medication."

A client is prescribed​ extended-release metformin. Which instruction should the nurse​ include?

​"Notify the healthcare provider if you have an​ infection." The client should be instructed to notify the healthcare provider if an infection should develop. A general infection may develop into a severe​ infection, which increases the​ client's risk for lactic acidosis.​ Extended-release metformin should be taken with food to increase the absorption.

A client is prescribed a corticosteroid. Which information should the nurse include when teaching about this​ medication?

​"Schedule eye exams twice a​ year." Corticosteroids may cause increased intraocular​ pressure, a risk factor for​ glaucoma, and may cause cataracts. The client should be instructed to have eye examinations twice yearly or more frequently if indicated by the healthcare provider.

A client is prescribed lispro​ (Humalog). Which instruction should the nurse include in the​ teaching?

​"Take the insulin 15 minutes before​ eating." Insulin lispro is a​ rapid-acting analog of regular​ insulin, with effects beginning within 15 to 30 minutes of subcutaneous injection. Humalog can be mixed with NPH and is administered more than one time per day because it has a duration of 5 hours or less.

A client is taking a nonsteroidal​ anti-inflammatory drug​ (NSAID) for osteoarthritis. Which instruction should the nurse​ provide?

​"Take the medication with food or​ milk." NSAIDs should be taken with food or milk to prevent gastrointestinal​ (GI) upset.

A client is prescribed a nonsteroidal​ anti-inflammatory drug​ (NSAID) for rheumatoid arthritis. For which client statement should the nurse provide​ follow-up teaching?

​"Taking two NSAIDs together will provide greater pain​ relief." Taking two NSAIDs together should be avoided as this may cause serious adverse gastrointestinal​ (GI) effects.

A client is prescribed insulin degludec​ (Tresiba). Which instruction should the nurse​ include?

​"This insulin will provide coverage for 24​ hours." Insulin degludec can provide coverage for up to 42 hours. This insulin may be taken at any time of​ day, regardless of​ meals, and cannot be mixed with any other insulin.

A client diagnosed with type 2 diabetes mellitus​ (DM) asks how the disease developed. Which explanation should the nurse​ provide?

​"Your cells are not responding to the insulin your body is​ producing." Type 2 DM occurs as a result of insulin resistance due to a defect in the insulin cell receptor function. The pancreas can still produce enough​ insulin, and the insulin produced is capable of lowering the blood​ glucose,. The problem lies with the cellular receptor sites. The target cells are not​ dying, but they do not recognize the insulin being produced.

A client is experiencing a bleeding gastric ulcer. Which medication should the nurse question before​ administering?

​Etodolac, diflunisal,​ ibuprofen, and oxaprozin are nonsteroidal​ anti-inflammatory drugs​ (NSAIDs) and will further increase the​ client's risk for GI ulcers.

An older client has been prescribed a nonsteroidal​ anti-inflammatory drug​ (NSAID) for acute shoulder pain. Which assessment should the nurse include before administering the

​Ibuprofen-like NSAIDs inhibit platelet aggregation and increase the risk for​ bleeding, nephrotoxicity,​ ototoxicity, and myocardial infarction. Cardiac enzymes do not specifically require measuring before starting NSAID therapy.

A client is diagnosed with severe salicylate poisoning. Which treatment prescription should the nurse​ expect?

​N-acetylcysteine