Endocrine questions

A nurse is caring for a patient who is taking repaglinide (Prandin) 15 to 30 min before each meal to treat type 2 DM. The patient asks the nurse what to do if he skips a meal. What is the appropriate response?

skip the dose

A nurse is caring for a patient who is taking rosiglitazone (Avandia) to treat type 2 DM. The nurse should monitor for which finding that indicates an adverse effect?

weight gain

A client is taking glyburide (DiaBeta), 1.25 mg P.O. daily, to treat type 2 diabetes. Which statement indicates the need for further client teaching about managing this disease? a) "I always carry hard candy to eat in case my blood sugar level drops." b) "I avoid exposure to the sun as much as possible." c) "I skip lunch when I don't feel hungry." d) "I always wear my medical identification bracelet."

"I skip lunch when I don't feel hungry." Explanation: The client requires further teaching if he states that he skips meals. A client who is receiving an oral antidiabetic agent should eat meals on a regular schedule because skipping a meal increases the risk of hypoglycemia. Carrying hard candy, avoiding exposure to the sun, and always wearing a medical identification bracelet indicate effective teaching.

Which instruction should a nurse give to a client with diabetes mellitus when teaching about "sick day rules"? a) "It's okay for your blood glucose to go above 300 mg/dl while you're sick." b) "Test your blood glucose every 4 hours." c) "Follow your regular meal plan, even if you're nauseous." d) "Don't take your insulin or oral antidiabetic agent if you don't eat."

"Test your blood glucose every 4 hours." Explanation: The nurse should instruct a client with diabetes mellitus to check his blood glucose levels every 3 to 4 hours and take insulin or an oral antidiabetic agent as usual, even when he's sick. If the client's blood glucose level rises above 300 mg/dl, he should call his physician immediately. If the client is unable to follow the regular meal plan because of nausea, he should substitute soft foods, such as gelatin, soup, and custard.

A nurse is teaching a client with diabetes mellitus about self-management of his condition. The nurse should instruct the client to administer 1 unit of insulin for every: a) 20 g of carbohydrates. b) 15 g of carbohydrates. c) 10 g of carbohydrates. d) 25 g of carbohydrates.

15 g of carbohydrates. Explanation: The nurse should instruct the client to administer 1 unit of insulin for every 15 g of carbohydrates.

What is the duration of regular insulin? a) 4 to 6 hours b) 24 hours c) 12 to 16 hours d) 3 to 5 hours

4 to 6 hours Explanation: The duration of regular insulin is 4 to 6 hours; 3 to 5 hours is the duration for rapid-acting insulin such as Novolog. The duration of NPH insulin is 12 to 16 hours. The duration of Lantus insulin is 24 hours.

A patient who is taking metoformin (Glucophage) to treat type 2 diabetes mellitus plans to undergo angiography using iodine-containing contrast dye. The nurse recognizes that an interaction between metformin and the IV contrast dye can increase the patient's risk for which of the following?

Acute renal failure

A nurse is caring for a patient who is about to begininsulin glargine (Lantus) therapy. The nurse should recognize the need for additional precautions because the patient also takes which type of drug?

Beta blockers

The actions of parathyroid hormone (PTH) are increased in the presence of which vitamin? a) B b) E c) C d) D

D Explanation: The actions of PTH are increased by the presence of vitamin D.

When talking with a patient who is about to begin repaglinide (Prandin) therapy to treat type 2 DM, the nurse should include what instructions? Do not drink more that 1 L of grapefruit juice per day Carry a high-protein snack at all times Drink 16 oz of water after taking the drug

Do not drink more that 1 L of grapefruit juice per day

What drug should a nurse have available for a patient who is experiencing an insulin overdose?

Glucagon (GlucaGen)

When considering replacement therapy options for a patient who has chronic adrenocortical insufficiency, the physician should choose which drug? Somatropin (Genotrpoin) Glucagon (GlucaGen) Hydrocortison (Hydrocortone)

Hydrocortison (Hydrocortone)

A patient who is taking propylthiouracil (PTU) contacts the nurse to report weight gain, drowsiness, and depression. The nurse should suspect what adverse reaction of PTU?

Hypothyroidism

A patient who is taking metformin to treat type 2 diabetes mellitus contacts the nurse to report muscle pain. The nurse should suspect what adverse reaction?

Lactic acidosis

A nurse is talking to a patient about self-injecting regular insulin (Humulin). The nurse should tell the patient to rotate injection sites to prevent which of the following?

Lipohypertrophy

Which intervention is the most critical for a client with myxedema coma? a) Warming the client with a warming blanket b) Measuring and recording accurate intake and output c) Administering an oral dose of levothyroxine (Synthroid) d) Maintaining a patent airway

Maintaining a patent airway Explanation: Because respirations are depressed in myxedema coma, maintaining a patent airway is the most critical nursing intervention. Ventilatory support is usually needed. Although myxedema coma is associated with severe hypothermia, a warming blanket shouldn't be used because it may cause vasodilation and shock. Gradual warming with blankets is appropriate. Thyroid replacement is administered I.V., not orally. Although recording intake and output is important, these interventions aren't critical at this time.

A patient who is taking glipizide (Glucotrol) to treat type 2 DM contacts the nurse to report feeling shaky, hungry, and fatigued. The nurse should tell the patient to do what?

Perform a fingerstick blood glucose check

Beta-blockers are used in the treatment of hyperthyroidism to counteract which of the following effects? a) Respiratory effects b) Parasympathetic c) Sympathetic d) Gastrointestinal effects

Sympathetic Explanation: Beta-adrenergic blocking agents are important in controlling the sympathetic nervous system effects of hyperthyroidism. For example, propranolol is used to control nervousness, tachycardia, tremor, anxiety, and heat intolerance.

A client with diabetes mellitus develops sinusitis and otitis media accompanied by a temperature of 100.8° F (38.2° C). What effect do these findings have on his need for insulin? a) They have no effect. b) They increase the need for insulin. c) They cause wide fluctuations in the need for insulin. d) They decrease the need for insulin.

They increase the need for insulin. Explanation: Insulin requirements increase in response to growth, pregnancy, increased food intake, stress, surgery, infection, illness, increased insulin antibodies, and some medications. Insulin requirements are decreased by hypothyroidism, decreased food intake, exercise, and some medications.

When talking with a patient about taking fludrocortisone (Florinef) to treat adrenocortical insuffiency, the nurse should tell the patient to do what to reduce the risk of adverse reactions? (Select all that apply) a. weigh yourself daily b. report weakness or palpitations c. have your blood pressure checked regularly d. eat more iron-rich foods e. avoid drinking grapefruit juice

a b c

When talking with a patient who is about to begin exenatide (Byetta) therapy to treat type 2 DM, the nurse should include what instruction? (select all that apply) a. Inject the drug subcutaneously b. expect the peak effect in 2 hr c. use the drug as a supplement to an oral hypoglycemic d. inject the drug 1 hr after a meal e. discard used pens 10 days after the first use

a b c

A nurse is caring for a patient who is about to begin takin propylthiouracil (PTU) to treat hyperthyroidism. The nurse should tell the patient to report what adverse effects? a. sore throat b. muscle pain c. insomnia d. bradycardia e. rash

a b d e

A nurse should question the use of levothyroxine (Synthroid) for a patient who has -- bacterial skin infections diabetes insipidus immonosuppression a myocardial infarction

a myocardial infarction

When talking to a patient who is about to begin glipizide (Glucotrol) therapy to treat type 2 DM, the nurse should include what instructions?

avoid drinking alcohol

A nurse is caring for a patient who is about to being taking rosiglitaxone (Avandia) to treat type 2 DM. The nurse should explain to the patient the need to monitor what lab tests? (select all that apply) a. TSH b. ALT c. LDL d. CBC e. Creatinine clearance

b c e

A nurse is caring who begin taking somatropin (Genotropin). The nurse should explain the need to monitor what lab tests? (Select all that apply) a. blood amylase b. creatinine clearance c. urine calcium d blood glucose e. CBC

c d

A nurse is caring for a patient who is about to begin acarbose (Precose) therapy to treat type 2 DM. What instruction should the nurse include when talking with the patient about the drug.

eat more iron rich foods

To determine the effectiveness of desmopressin (DDAVP), a nurse should monitor a patient's

urine output

During a class on exercise for clients with diabetes mellitus, a client asks the nurse educator how often to exercise. To meet the goals of planned exercise, the nurse educator should advise the client to exercise: a) at least once per week. b) at least three times per week. c) at least five times per week. d) every day.

at least three times per week. Explanation: Clients with diabetes must exercise at least three times per week to meet the goals of planned exercise — lowering the blood glucose level, reducing or maintaining the proper weight, increasing the serum high-density lipoprotein level, decreasing serum triglyceride levels, reducing blood pressure, and minimizing stress. Exercising once per week wouldn't achieve these goals. Exercising more than three times per week, although beneficial, would exceed the minimum requirement.

A nurse administers pramlintide (Symlin) at 0800 to a patient who has type 1 diabetes mellitus. At what time should the patient expect drug to exert its peak action?

0820

The preferred preparation for treating hypothyroidism includes which of the following? a) Radioactive iodine b) Methimazole (Tapazole) c) Levothyroxine (Synthroid) d) Propylthiouracil (PTU)

Explanation: Synthetic levothyroxine (Synthroid or Levothroid) is the preferred preparation for treating hypothyroidism and suppressing nontoxic goiters (enlargements of the thyroid gland). Radioactive iodine is the most common form of treatment for Graves' disease in North America. Both PTU and Tapazole are used for hyperthyroidism.

Which of the following statements is correct regarding glargine (Lantus) insulin? a) It is given twice daily. b) It cannot be mixed with any other type of insulin. c) It is absorbed rapidly. d) Its peak action occurs in 2 to 3 hours.

It cannot be mixed with any other type of insulin. Explanation: Because this insulin is in a suspension with a pH of 4, it cannot be mixed with other insulins because this would cause precipitation. There is not a peak in action. It is approved to give once daily.

A 53-year-old client is brought to the ED, via squad, where you practice nursing. He is demonstrating fast, deep, labored breathing and has a fruity odor to his breath. He has a history of type 1 diabetes. What could be the cause of his current serious condition? a) Hyperosmolar hyperglycemic nonketotic syndrome b) Hepatic disorder c) Ketoacidosis d) All options are correct

Ketoacidosis Explanation: Kussmaul respirations (fast, deep, labored breathing) are common in ketoacidosis. Acetone, which is volatile, can be detected on the breath by its characteristic fruity odor. If treatment is not initiated, the outcome of ketoacidosis is circulatory collapse, renal shutdown, and death. Ketoacidosis is more common in people with diabetes who no longer produce insulin, such as those with type 1 diabetes. The most likely cause is ketoacidosis. People with type 2 diabetes are more likely to develop hyperosmolar hyperglycemic nonketotic syndrome because with limited insulin, they can use enough glucose to prevent ketosis but not enough to maintain a normal blood glucose level. The most likely cause is ketoacidosis.

What is the only insulin that can be given intravenously? a) Lantus b) Ultralente c) Regular d) NPH

Regular Explanation: Insulins other than regular are in suspensions that could be harmful if administered IV.

The physician should prescribe a lower dose of sitagliptin (Januvia) for a patient who has type 2 DM and who also has what? thyroid disease bronchitis heart failure Renal impairment

Renal impairment

A nurse is caring for a patient who is about to begin levothyroxine (Synthroid) therapy to treat hypothyroidism. Which instructions should the nurse include when talking with the patient about the drug?

expect life-long therapy with the drug

A nurse is caring for a patient who is about to begin pramilintide (Symlin) therapy to treat type 2 DM. What instructions should the nurse include when taking with the patient about using the drug?

inject pramlintide before meals