Endocrine Pharm

Which of the following should be included in a teaching plan for a client newly diagnosed with type 2 diabetes? (Select all that apply.) 1. "Check your blood glucose levels less frequently when not feeling well." 2. "Take an extra dose of the oral hypoglycemic agent the next day if you miss a dose." 3. "Carry a fast-acting glucose source." 4. "Eat a snack prior to planned exercise." 5. "Inspect feet surfaces daily"

"Carry a fast-acting glucose source.", "Eat a snack prior to planned exercise.", "Inspect feet surfaces daily"

A nurse is providing teaching to a ct who has type 2 diabetes mellitus and is starting repaglinide (Prandin). Which of the following statements made by the ct indicates understanding of the administration of this medication? a. "I'll take this medication with my meals." b. "I'll take this medication 30 minutes before I eat." c. "I'll take this medication just before I go to bed." d. "I'll take this medication as soon as I wake up in the morning."

"I'll take this medication 30 minutes before I eat."

A nurse is providing teaching to a client who has type 2 diabetes mellitus and is starting repaglinide (Prandin). Which of the following statements made by the client indicates understanding of the administration of this medication? A. "I'll take this medicine with my meals." B. "I'll take this medicine 30 minutes before I eat." C. "I'll take this medicine just before I go to bed." D. "I'll take this medicine as soon as I wake up in the morning."

"I'll take this medicine 30 minutes before I eat."

In teaching a pt newly prescribed acarbose (Precose) to control type II diabetes mellitus, which of the follow instructions should not be included: a. "Watch for and report fatigue, pallor and shortness of breath as these are signs of anemia, which is an adverse effect." b. "Take 30 mins before meals, three times a day." c. "Consume glucotabs or dextrose instead of juice if you become hypoglycemic." d. "Dark urine, abdominal pain, vomiting or fatigue could indicate liver dysfunction, an adverse effect of this medication."

"Take 30 mins before meals, three times a day."

You give a pt five units of lispro insulin (Humalog) and 10 units of insulin glargine subcut at 1400. Based on your instructions, the pt should expect her blood glucose level to be lowest at which of the following times? a. You give a pt five units of lispro insulin (Humalog) and 10 units of insulin glargine subcut at 1400. Based on your instructions, the pt should expect her blood glucose level to be lowest at which of the following times? a. 1430 b. 1530 c. 1630 d. 1730

1430

What drug is used for chronic adrenocortical insufficiency?

Hydrocortisone, Prednisone, dexamethason, fludrocortisone.

Four clients need to receive morning insulin. Breakfast trays are due in 15 min. A nurse should first administer insulin to which of the following clients? A. Client with a glucose level of 70 mg/dL, scheduled to receive NPH insulin (Humulin N) 3 units B. Client with acglucose level of 90 mg/dL, scheduled to receive Regular insulin (Humulin R) 5 units C. Client with a glucose level of 120 mg/dL, scheduled to receive NPH (Humulin N) 15 units insulin and Regular insulin 6 units D. Client with a glucose level of 170 mg/dL, scheduled to receive lispro insulin (Humalog) 5 unit

Client with a glucose level of 170 mg/dL, scheduled to receive lispro insulin (Humalog) 5 unit

Glipizide, an oral antidiabetic, can have adverse effects. Which of the following interventions might need to be taken? (select all that apply) 1. Discontinuation of glipizide due to excessive gastrointestinal side effects such as abdominal distention, diarrhea and gas. 2. Administer IV glucose if pt is unconscious and is severely hypoglycemic (<70mg/dL blood glucose) 3. Treat conscious, hypoglycemic pt with 2 oz of grape juice. 4. Monitor carefully for lactic acidosis. 5. Monitor hemoglobin and iron levels and discontinue medication if pt becomes anemic

Discontinuation of glipizide due to excessive gastrointestinal side effects such as abdominal distention, diarrhea and gas, administer IV glucose if pt is unconscious and is severely hypoglycemic (<70mg/dL blood glucose), Treat conscious, hypoglycemic pt with 2 oz of grape juice, Monitor hemoglobin and iron levels and discontinue medication if pt becomes anemic

How should pramlintide (Symlin) be given and in particular, when should the pt expect it to have the most effect (peak)?

Expect peak about 20 minutes after dosing, don't mix w/ insulin in same syringe, give subcut in thigh or abdomen prior to meals that contain > 30 g of carbs, rotate injection sites; keep vials in use at room temp for up to 28 days

Adverse effects of pioglitazone (oral antidiabetic):

Fluid retention, hepatotoxicity, increased LDLs

What are some of the side and/or adverse effects of the antithyroid drug propylthiouricil [PTU] (Propyl-Thyracil)?

Hypothyroidism: drowsiness, depression, weight gain, dry skin, edema, bradycardia, anorexia, cold intolerance, heavy bleeding Agranulocytosis: sore throat, fever Rash Arthralgia, myalgia, headache

Your pt is taking insulin glargine. What drug precautions do they need to be aware of?

Sulfonylureas, beta-blockers, salicyclates & alcohol increase hypoglycemic effects Thiazide and loop diuretics, sympathomimetics, thyroid hormones, and glucocorticoids increase blood glucose levels

Pt teaching for levothyroxine:

Take on empty stomach, before breakfast. Lifelong. Watch for/report: s/s hyperthroidism report s/s of bleeding if taking warfarin Check with provider before switching brands

A nurse is providing teaching to a ct who has an rx for pramlintide (Symlin) for type 1 diabetes mellitus. Which of the following should the nurse include in the teaching? (Select all that apply) a. Take oral medications 1 hr before injection b. use upper arms as preferred injection site c. mix pramlintide with breakfast dose of insulin d. inject pramlintide just before a meal e. discard open vials after 28 days.

Take oral medications 1 hr before injection, inject pramlintide just before a meal, discard open vials after 28 days.

How can you advise a pt to decrease the side effects of fludrocortisone?

Take with food to decrease gastric distress, taper off dosage if discontinuing. Administer prophylactic H2 antagonists, give orally daily or 3x/week

Contraindications for levothyroxine

Thryotoxicosis

What are some contraindications that would make taking the gliptin drug sitagliptim (Januvia) risky for the patient?

Type 1 diabetes mellitus, lactiv acidosis

A patient is about to start taking sustained release glipizide (Glucotrol) to treat type 2 diabetes mellitus. Which of the following instructions should you include when talking with the patient about this drug? a. chew the tablet completely before swallowing it b. take it once a day, 30 min before selected meals c. take in the evening before bedtime d. drink 16 oz of water right after taking it

take it once a day, 30 min before selected meals

Radioactive iodine-131 is used to treat: a. type 2 diabetes mellitus b. hypoglycemia c. thyroid cancer d. diabetes insipidus

thyroid cancer

You are caring for a pt who takes acarbose (Precose) and a sulfonylurea to treat type 2 diabetes mellitus. Which of the following is an indication of an adverse reaction to this drug combination? a. polyuria b. tremors c. bradycardia d. thirst

tremors

Glipizide is used to treat: a. type 2 diabetes mellitus b. hypoglycemia c. thyroid cancer d. diabetes insipidus

type 2 diabetes mellitus

A nurse is providing teaching to a client who is prescribed pramlintide (Symlin) for type 1 diabetes. Which of the following should the nurse include in the teaching? A. "Take oral medications 1 hr before injection." B. "Use upper arms as preferred injection sites." C."Mix medication with breakfast dose of insulin." D. "Freeze unopened vials of medication." E. "Discard open vials after 28 days."

"Take oral medications 1 hr before injection.", "Discard open vials after 28 days."

Desmopressin acetate (DDAVP) is prescribed for the treatment of diabetes insipidus. The nurse monitors the client after medication administration for which therapeutic response? 1. Decreased urinary output 2. Decreased blood pressure 3. Decreased peripheral edema 4. Decreased blood glucose level

Decreased urinary output

A client taking hydrocortisone for adrenocortical insufficiency (Addison's disease) is admitted to the hospital for a total hip arthroplasty. Which of the following actions is the highest priority? A. Administration of supplemental doses of hydrocortisone B. Instruction on coughing and deep breathing C. Insertion of an indwelling urinary catheter D. Requesting a referral for physical therapy

Administration of supplemental doses of hydrocortisone

A client taking glipizide (Glucotrol) for control of type 2 diabetes mellitus should be cautioned against the use of which of the following? A. Magnesium hydroxide (Milk of Magnesia) B. Hydrocortisone acetate cream C. Calcium supplements D. Alcohol

Alcohol

What is the treatment for insulin overdose?

Check blood glucose to confirm. Give 15-20g of carbohydrates (4 oz OJ, 2 oz grape juice, 8 oz milk, 1 TBSP honey, glucose tablets). For unconscious pts, administer glucose or glucagon parenterally (such as IV glucose or subcut/IM glucagon)

Labs to monitor when a pt is taking pioglitazone, an oral antidiabetic.

Cholesterol, Liver function tests

A nurse is collecting data from a client receiving pioglitazone (Actos) 30 mg orally daily. Which finding indicates that the client is experiencing the expected result of the action of this medication?

Decreased fasting blood glucose and reduced hemoglobin A1C (HbA1c)

A nurse is caring for a client who is prescribed somatropin (Genotropin) to stimulate growth. The nurse should plan to monitor the client's laboratory values for which of the following? A. Anemia B. Hyperglycemia C. Decreased urine specific gravity D. Increased urine amylase

Hyperglycemia

Adverse effects of propylthiouracil (antithyroid meds)

Hypothyroidism, agranulocytosis, liver injury, hepatitis

Clients taking metformin (Glucophage) should be monitored for which of the following? A. Lactic acidosis B. Hypertension. C. Hyperlipidemia. D. Respiratory alkalosis.

Lactic acidosis

What should you monitor for with a patient taking desmopressin?

Water intoxication, Headache, confusion, sleepiness, I&O and urine/plasma osmolality Monitor for MI, angina pectoris, cardiac insufficiency, chest pain/pressure

A nurse is caring for a client who is taking levothyroxine (Synthroid). For which of the following should the nurse monitor to identify levothyroxine toxicity? A. Hair loss B. Lethargy C. Weight loss D. Cold intolerance

Weight loss

What labs should be monitored when a pt is taking somatropin? (select all that apply)

blood glucose urine calcium baseline thyroid function growth hormone levels monitor monthly

As you speak with your diabetic client about managing her diabetes with regular insulin (Humulin R), you should include which of the following instructions? (Select all that apply) A. self-inject chilled insulin b. carry a carbohydrate snack c. rotate injection sites d. wear a medical alert bracelet e. expect to adjust the dosage during illness

carry a carbohydrate snack, rotate injection sites, wear a medical alert bracelet, expect to adjust the dosage during illness

Desmopressin is used to treat: a. type 2 DM b. hypoglycemia c. thyroid cancer d. diabetes insipidus

diabetes insipidus

A pt is self-injecting eight units of NPH insulin and four units of regular insulin each day before breakfast. As you show the pt how to self administer insulin, you should include which of the following instructions? (select all that apply) a. draw the regular insulin into the syringe first, then the NPH insulin b. inject the insulin mixture into a large muscle c. discard any unused premixed syringes within 5 days d. use a 5-mL syringe when mixing two types of insulins e. use one syringe to reduce the number of injections

draw the regular insulin into the syringe first, then the NPH insulin, use one syringe to reduce the number of injections

Two hours after self-administering regular insulin subcutaneously, the pt contacts you at the provider's office to report that she is sweaty, shaky, and has a rapid pulse. Which of the following actions should you advise her to take?(select all that apply) A. drink 4 oz of orange juice B. Check her blood glucose C. take an oral hypoglycemic D. measure her urine output E. self-administer a long-acting insulin

drink 4 oz of orange juice, Check her blood glucose

A patient is about to start taking hydrocortisone (Cortef) to treat adrenocortical insufficiency. You should instruct the pt to do which of the following to help reduce her risk for adverse effects of the drug? (Select all that apply) 1. expect lifelong therapy 2. carry extra doses of the drug 3. expect periodic blood sampling 4. urinate q 4 hr 5. report increased stress

expect lifelong therapy, carry extra doses of the drug, expect periodic blood sampling, report increased stress

A pt is about to start taking somatotropin (Genotropin). You plan to evaluate the effectiveness of this drug with which of the following assessments? a. level of consciousness b. ECG c. height and weight d. breath sounds and respiratory rate

height and weight

You are caring for a pt who is taking levoxythroxine (Synthroid) to treat hypothyroidism. The pt reports palpitations, weight loss, and diarrhea. You suspect which of the following effects of this drug? a. hyperthyroidism b. addison's disease c. myxedema d. hyperglycemia

hyperthyroidism

Glucagon is used to treat: a. type 2 diabetes mellitus b. hypoglycemia c. thyroid cancer d. diabetes insipidus

hypoglycemia

When talking with a patient about self-administering regular insulin (Humulin R), you should include which of the following instructions? a. shake the vial vigorously b. expect the solution to appear cloudy c. store unopened vials at room temperature d. inject the insulin subcutaneously

inject the insulin subcutaneously

A nurse is caring for client with a rx for metformin (Glucophage). The nurse should monitor the client for which of the following effects? a. lactic acidosis b. hypoglycemia c. hyperlipidemia d. respiratory alkalosis

lactic acidosis

A nurse is caring for a client in an outpatient facility who has been taking acarbose (Precose) for type 2 DM. Which of the following laboratory tests should the nurse plan to monitor? a. WBC b. serum potassium c. platelet count d. liver function tests

liver function tests

Instruct the patient receiving insulin to watch for and report the following indications of an adverse reaction to insulin? a. palpitations b. weight gain c. low urine output d. constipation

palpitations

You are caring for a patient who is taking exenatide (Byetta) to treat type 2 diabetes mellitus. The patient reports severe abdominal pain. You suspect which of the following adverse reactions to this medication? A. Peptic ulcer disease b. hyperkalemia c. hyperglycemia d. pancreatitis

pancreatitis

A nurse is teaching clients in an outpatient facility about the use of insulin to treat type 1 diabetes mellitus. For which of the following types of insulin should the nurse tell the cts to expect a peak effect 1-5 hr after administration? a. insulin glargine (Lantus) b. NPH c. regular insulin d. insulin lispro (Humalog)

regular insulin

When talking with a 30 year old woman who will receive radioactive iodine-131 to treat Graves' disease, you should include which of the following instructions? (Select all that apply). a. report weight gain and edema b. use effective contraception c. allow 2-3 months for full effects d. expect periodic blood sampling e. obtain regular eye examinations

report weight gain and edema, use effective contraception, allow 2-3 months for full effects, expect periodic blood sampling