Pharm Exam 3- ATI endocrine

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)

-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.

A nurse is providing teaching to a client who is about to begin exenatide tx to treat type 2 diabetes mellitus. Which of the following instructions should the nurse include? (Select all that apply)

-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.

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?

Acute renal failure rationale: 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.

A nurse is teaching a client who has a rx for glipizide tx to treat type 2 diabetes mellitus. Which of the following instructions should the nurse include?

Avoid drinking alcohol rationale: 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.

A nurse is caring for a client who is about to begin insulin glargine tx. The nurse should identify the need for additional precautions because the client also takes which of the following types of drugs?

Beta blockers rationale: 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.

A nurse is providing teaching to a client who is about to begin levothyroxine tx to treat hypothyroidism. Which of the following instructions should the nurse include?

Expect life-long tx with the drug rationale: Tx with levothyroxine, a thyroid replacement hormone, usually continues for life because there are no other therapies that can restore thyroid function

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

Glucagon rationale: 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 taking metformin to treat type 2 diabetes mellitus and report muscle pain. Which of the following ADR the nurse should suspect?

Lactic acidosis rationale: 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.

You are caring for a client who takes acarbose (Precose) and a sulfonylurea to treat 2 diabetes mellitus. Which of the following is an indication of an adverse reaction to this drug combination?

Tremors rationale: This drug combination can cause hypoglycemia. Indications of a hypoglycemic reaction include hunger, tachycardia, shakiness, tremors, and diaphoresis. Polyuria and thirst are indications of hyperglycemia, not hypoglycemia. Tachycardia, not bradycardia, is an indication of hypoglycemia. Acarbose, with or without sulfonylurea tx, is unlikely to cause bradycardia

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?

Weight gain rationale: 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.

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 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.

You are caring for a client who is taking levothyroxine to treat hypothyroidism. The client reports palpitations, weight loss, and diarrhea. You suspect which of the following adverse effects of this drug?

Hyperthyroidism rationale: levothyroxine, a thyroid hormone drug, can cause hyperthyroidism if the prescribed dose exceeds what the client requires to remain euthyroid. Monitor thyroid function via T4 and TSH levels. Instruct the client to watch for and report indications of hyperthyroidism, such as anxiety, insomnia, tachycardia, palpitations, diarrhea, and weight loss. Levothyroxine does not cause myxedema or addison's disease. Addison's disease is due to adrenal insufficiency, and levothyroxine treats myxedema coma. Levothyroxine is unlikely to cause hyperglycemia. Injectable hypoglycemics, such as insulin, can cause 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 rationale: Hypotension and fati

When talking with a client about self-administering regular insulin (Humulin R), you should include which of the following instructions?

Inject the insulin subcutaneously rationale: make sure the client understands how to inject insulin subcutaneously. Tell him or her not to shake the vial vigorously but to rotate it gently to disperse the partibles. Do not use insulin that appears cloudy or discolored. Remind them to refrigerate unopened vials until their expiration date and opened vials can be left out at room temperature up to 1 month

A nurse is teaching a client about self-administering regular insulin. The nurse should the client to rotate injection sites to prevent which of the following?

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.

You are caring for a client who is taking exenatide (Byetta) to treat type 2 diabetes mellitus. The client reports severe abdominal pain. You suspect which of the following adverse reactions to this drug?

Pancreatitis rationale: exenatide, an incretin mimetic agent, can cause acute pancreatitis. you instructed the client to watch for and report severe or persistent abdominal pain, someties radiating to the back, may or may not be accompanied by vomiting at beginning of tx and with dose increases, so you should now inform the primary care provider and tell the client to stop taking the drug. Exenatide is unlikely to cause hyperkalemia, an effect much more likely with insulin. For clients taking insulin, monitor potassium levels and instruct them to report muscle weakness or palpitations. Exenatide is more likely to cause hypoglycemia than hyperglycemia, so monitor blood glucose levels carefully and administer a carbohydrate for hypoglycemia. Indications of hypoglycemia include tachycardia, diaphoresis, shakiness, and weakness

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 fatigues. Which of the following actions should the nurse instruct the client to take?

Perform a fingerstick blood glucose check rationale: 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.

A nurse is assessing a client who has a new rx for levothyroxine. The nurse should identify which of the following findings as a contraindication for this drug?

Recent myocardial infarction rationale: 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 client is about to start taking sustained release glipizide to treat type 2 diabetes mellitus. Which of the following instructions should you include when talking with the client about taking this drug?

take it once a day, 30 min before breakfast rationale: Instruct the client to take sustained-release glipizide, a sulfonylurea, 30 min before the first meal of the day. Tell the client not to chew or crush the sustained-release tablets. It is not necessary to drink 16 oz of water after taking the drug, but it is not harmfull to do so, either. Because glipizide peaks in 1 to 2 hr, it is inappropriate to take it at bedtime and appropriate to have a meal after taking it. Be sure to monitor the client for signs of hypoglycemia, such as diaphoresis and tachycardia, sweating, hunger, weakness, dizziness, tremor, tachycardia, anxiety. Also, monitor heart rate and ECG. Instruct the client to watch and report palpitations