Archer Pharmacology - Endocrine
This nurse is caring for a client who is receiving prescribed tolvaptan. Which of the following findings would indicate a therapeutic response? A. Fasting blood glucose 100 mg/dL B. Urine specific gravity 1.010 C. Total cholesterol 176 mg/dL D. BUN 5 mg/dL Submit Answer
Choice B is correct. Tolvaptan is a vasopressin antagonist and is indicated in treating the syndrome of inappropriate antidiuretic hormone (SIADH). In SIADH, the client retains water which causes fluid retention without edema. Classic manifestations of SIADH include polydipsia, hemodilution, and oliguria. This medication promotes free water excretion, normalizing sodium levels and increasing urine output. This urine-specific gravity is normal (1.005 - 1.025) and indicates that the medication is having its therapeutic effect because a client with SIADH would have a high USG from the limited water spilled into the urine. Choices A, C, and D are incorrect. Tolvaptan has no direct impact on cholesterol or glucose. A BUN of 5 mg/dL would be expected with SIADH as the excessive water causes a decrease in this value. The normal level for BUN is 10-20 mg/dL. Additional Info ✓ SIADH may be caused by pulmonary tuberculosis and certain lung malignancies. ✓ Clinical features of SIADH include hyponatremia because of excessive water. Other features include increased urine-specific gravity, oliguria, and hemodilution. ✓ Treatment includes prescribed fluid restrictions and tolvaptan. ✓ Tolvaptan causes the excretion of free water, which raises sodium levels. ✓ The client's sodium needs to be monitored carefully while administering this medication because it may cause hypernatremia. ✓ This medication is very hepatotoxic, and the liver function tests should be monitored closely. Last Updated - 01, Feb 2023
The nurse is assisting a client with their insulin pump. The nurse understands which insulin is commonly loaded into the pump? A. Rapid acting B. Short acting C. Intermediate acting D. Long acting Submit Answer
Explanation Choice A is correct. A rapid-acting insulin is the most common insulin used in insulin pumps. A rapid-acting insulin is correctional insulin and should be appropriately dosed 10-15 minutes before a client's meal or while actively eating. Choices B, C, and D are incorrect. The advantage of an insulin pump is that a client may dose themselves with insulin without using syringes and needles. Most pumps operate with the client having the ability to input their blood glucose for a preprogrammed amount of insulin. Finally, users may also give themselves appropriate bolus doses if they eat additional carbohydrates. Additional Info ✓ The three rapid-acting insulins are lispro, aspart, and glulisine. ✓ The client needs to take this insulin 10-15 minutes before a meal or while actively eating. ✓ A rapid-acting insulin is utilized as correctional insulin before meals to prevent post-prandial hyperglycemia. ✓ This type of insulin is commonly loaded into an insulin pump. Last Updated - 04, Jan 2023
The nurse has provided medication instruction to a client who has been prescribed metformin. Which of the following statements, if made by the client, would indicate a correct understanding of the teaching? A. "This medication may cause me to have bloating or loose stools." B. "I will need to take my blood glucose prior to taking this medication." C. "If I eat fewer carbohydrates in a day, I should skip a dose." D. "The goal of this medication is to increase my hemoglobin A1C." Submit Answer
Explanation Choice A is correct. The most common side-effect associated with Metformin is gastrointestinal upset. This side-effect typically occurs at the start of the therapy and subsides over time. To minimize these effects, the client should take this medication with meals, or they may be prescribed the extended-release form. Choices B, C, and D are incorrect. Metformin does not cause hypoglycemia, and the client is not required to take their blood glucose before a dose. Other classes of anti-diabetic drugs such as sulfonylureas and insulin cause hypoglycemia. A blood glucose check is recommended before taking bolus doses of insulin. Because Metformin does not cause symptomatic hypoglycemia, clients should not skip the drug based on their carbohydrate intake. The goal of Metformin is to decrease the hemoglobin A1C - not an increase. Learning Objective Recognize that the most common side effect of Metformin is gastrointestinal upset which can be minimized by taking the drug with meals. While hypoglycemia is a frequent side effect with sulfonylureas, Metformin, when taken by itself, does not induce hypoglycemia. Additional Info Source : Archer Review Metformin is the first-line therapy for type II diabetes mellitus. Metformin is efficacious in having clients lose weight and decrease their hemoglobin A1C. The most common side-effect associated with Metformin initiation is gastrointestinal side effects such as bloating, diarrhea, nausea, or vomiting. The nurse should counsel the client that these side effects are transient and may be lessened by taking the medication with food. Metformin should not be taken within 48 hours of a contrast procedure because should contrast-related nephrotoxicity occur, Metformin metabolites accumulate and cause lactic acidosis. Last Updated - 21, Nov 2022
The nurse is caring for a client who is receiving newly prescribed prednisone. Which of the following medications should the client avoid while receiving this medication? A. Valsartan B. Naproxen C. Omeprazole D. Acetaminophen Submit Answer
Explanation Choice B is correct. Naproxen should not be administered concomitantly with corticosteroids. These two medications taken together will increase the risk of gastrointestinal bleeding. Choices A, C, and D are incorrect. Valsartan, omeprazole, and acetaminophen should be administered concomitantly with corticosteroids. Acetaminophen is highly preferred over non-steroidal anti-inflammatory drugs (NSAIDs) because it does not raise the risk of gastrointestinal bleeding. Additional Info Corticosteroids may cause an array of adverse effects while they mitigate inflammation. This includes peptic ulcer disease, edema, hypokalemia, hyperglycemia, and hypernatremia. The client should be educated to maintain a low sodium and high potassium diet while taking prednisone, if not contraindicated. Last Updated - 07, Nov 2022
The nurse is caring for a client experiencing an adrenal crisis (Addisonian crisis). The nurse should be prepared to administer which intravenous fluid? A. Lactated Ringers (LR) B. 0.9% saline C. Dextrose 5% in water (D5W) D. Dextrose 5% in water and Lactated Ringers (D5LR) Submit Answer
Explanation Choice B is correct. A client experiencing an adrenal crisis (Addisonian crisis) tends to have significant hypovolemia and hyponatremia. Because of the deficiency of steroid hormones, distributive shock may follow. Restoring the circulatory volume is essential in the management of this crisis. Isotonic solutions such as 0.9% saline or D5NS ( dextrose 5% in water combined with 0.9% saline) must be used. Isotonic saline can address both hypovolemia and hyponatremia in the adrenal crisis. If there is concomitant hypoglycemia, the D5NS solution is preferred to increase the glucose, sodium, and circulatory volume. Choices A, C, and D are incorrect. Although lactated ringers (LR) is an isotonic solution, it is inappropriate in managing an adrenal crisis because the client is experiencing concomitant hyponatremia. LR will not correct the hyponatremia ( Choice A). D5W is hypotonic and would be detrimental if given by itself because it would increase the free water and lower the sodium further by dilution ( Choice C). D5LR has a limited benefit in an adrenal crisis because of its inability to raise sodium levels ( Choice D). Learning Objective Understand that the Addisonian crisis can result in a distributive shock and hyponatremia. Isotonic ( 0.9%) saline or D5NS are preferred fluids in managing the Addisonian crises. Additional Info Addison's disease is an autoimmune condition in which the client has insufficient cortisol and aldosterone. The mainstay treatment is lifelong corticosteroid replacement with hydrocortisone. The dosage of replacement hormones may need to be increased if the client experiences increased demands from stressful events or illnesses. Failure to increase the replacement doses to meet the demand will result in adrenal crisis and shock. During an adrenal crisis, the priority treatment is administering hydrocortisone intravenously. The client is often volume depleted, hypoglycemic, and hyponatremic and will need rapid fluid resuscitation. Dangerously high potassium levels ( hyperkalemia) are also evident in an adrenal crisis and require cardiac monitoring and potassium-reducing medications such as sodium polystyrene. Last Updated - 28, Jul 2022
The nurse is caring for a client who recently had a dosage increase of prescribed levothyroxine. Which of the following is a priority? A. Weight B. Heart rate C. Activity status D. Oral temperature Submit Answer
Explanation Choice B is correct. For a client who has a dosage increase of levothyroxine, the nurse should assess the client for hyperthyroidism. Signs and symptoms of hyperthyroidism would include tachycardia, weight loss, increased temperature, and increased motor activity. It is a priority to assess the client's heart rate because tachydysrhythmias may occur. Choices A, C, and D are incorrect. It is important to monitor weight, activity status, and oral temperature while a client is taking levothyroxine. However, an increase of these would not be imminently life-threatening as tachydysrhythmias. Additional Info When a client is prescribed levothyroxine, the nurse should educate the client to: Take the medication first thing in the morning. Do not take the medication with food or other medications. Follow-up with prescribed laboratory tests to monitor thyroid function. Report signs of hyperthyroidism as that could indicate that the dose needs to be decreased. Last Updated - 01, Jul 2022
The nurse is reviewing newly prescribed medications for assigned clients. Which of the following prescribed medications should the nurse question? A. Levothyroxine for a client with a myxedema coma B. Hydrochlorothiazide for a client with hyperparathyroidism C. Hydrocortisone for a client with adrenal insufficiency D. Regular insulin for a client with diabetic ketoacidosis Submit Answer
Explanation Choice B is correct. Hyperparathyroidism causes hypercalcemia, and the treatment for hyperparathyroidism is a combination of 0.9% saline infusion followed by furosemide. Hydrochlorothiazide is a thiazide diuretic and causes the retention of calcium. This would be detrimental for a client experiencing hypercalcemia. This prescribed medication requires follow-up with the prescriber. Choices A, C, and D are incorrect. Levothyroxine is the essential treatment for myxedema, a severe form of hypothyroidism. Hydrocortisone is a priority treatment for adrenal insufficiency as the hallmark of this disease is an insufficient amount of mineralocorticoids and glucocorticoids. DKA is an endocrine emergency and requires aggressive fluid resuscitation and intravenous regular insulin. Additional Info Hyperparathyroidism is a disorder in which parathyroid secretion of parathyroid hormone is increased, resulting in hypercalcemia (excessive serum calcium levels) and hypophosphatemia (inadequate serum phosphorus levels). Diuretic and hydration therapies help reduce serum calcium levels. Furosemide, a diuretic that increases kidney excretion of calcium, is used along with IV saline in large volumes to promote calcium excretion. Last Updated - 18, May 2022
A nurse is caring for a client receiving metformin. Which of the following laboratory data should be reported to the provider? A. Decreased blood urea nitrogen (BUN) level B. Decreased glomerular filtration rate (GFR) C. Decreased fasting plasma glucose D. Decreased hemoglobin A1C Submit Answer
Explanation Choice B is correct. Metformin is an oral anti-diabetic indicated for type 2 diabetes mellitus. Metformin may cause renal impairment and a decrease in glomerular filtration rate (GFR) would be such evidence. During Metformin therapy, the client's renal function will be periodically monitored. Choices A, C, and D are incorrect. A reduction in the blood urea nitrogen (BUN) level does not indicate nephrotoxicity (a high creatinine would indicate nephrotoxicity). A decrease in both the hemoglobin A1C and fasting plasma glucose would be the therapeutic effect of the medication. Additional Info Source : Archer Review Metformin is the first-line therapy for type II diabetes mellitus. Metformin is efficacious in having clients lose weight and decrease their hemoglobin A1C. The most common side-effect associated with Metformin initiation is gastrointestinal side effects such as bloating, diarrhea, nausea, or vomiting. The nurse should counsel the client that these side effects are transient and may be lessened by taking the medication with food. Metformin should not be taken within 48 hours of a contrast procedure because should contrast-related nephrotoxicity occur, Metformin metabolites accumulate and cause lactic acidosis. Last Updated - 22, Nov 2022
A client is scheduled to undergo a computed tomography scan with iodine-based contrast dye. Which of the following medications may cause interaction and should be withheld for 24 hours before the procedure? A. Labetolol B. Metformin C. Levodopa D. Ondansetron Submit Answer
Explanation Choice B is correct. Metformin, a medication used to treat type 2 diabetes, should be held 24 hours before a procedure that uses iodine dye to reduce the risk of lactic acidosis. The drug may be resumed about 48 hours after the procedure. Choice A is incorrect. Labetalol is used to treat hypertension and is safe to take before and after an iodine-based computed tomography scan. Choice C is incorrect. Levodopa, a medication used to treat Parkinson's disease, is safe to take before and after an iodine-based computed tomography scan. Choice D is incorrect. Ondansetron, a medication used to treat nausea and vomiting, is safe to take before and after an iodine-based computed tomography scan. Additional Info Source : Archer Review The most common side-effect associated with Metformin initiation is gastrointestinal side effects such as bloating, diarrhea, nausea, or vomiting. The nurse should counsel the client that these side effects are transient and may be lessened by taking the medication with food. Metformin should not be taken within 48 hours of a contrast procedure because should contrast-related nephrotoxicity occur, Metformin metabolites accumulate and cause lactic acidosis. Last Updated - 22, Nov 2022
This nurse is caring for a client who is receiving prescribed sitagliptin. The nurse understands that this medication is intended to treat which condition? A. Hyperlipidemia B. Diabetes mellitus C. Hypothyroidism D. Hypertension Submit Answer
Explanation Choice B is correct. Sitagliptin is a DPP-4 Inhibitor used in managing diabetes mellitus type II. This medication reduces blood glucose levels by delaying gastric emptying and slowing the rate of nutrient absorption into the blood. Choices A, C, and D are incorrect. Sitagliptin is not indicated for hyperlipidemia, hypothyroidism, or hypertension. ✓ Medications used to treat hyperlipidemia would be statin medications. ✓ Medications used to treat hypothyroidism would be levothyroxine. ✓ Medications used to treat hypertension would be lisinopril, diltiazem, propranolol, or candesartan. Additional Info Sitagliptin is a treatment that may be prescribed for type II diabetes mellitus ✓ Persistent abdominal pain should be reported because pancreatitis is the major adverse effect of this medication. ✓ Other medications in this class include linagliptin, saxagliptin, and alogliptin. Last Updated - 01, Feb 2023
This nurse is caring for a client who is receiving prescribed sitagliptin. Which assessment findings indicate the client is experiencing a severe adverse effect? A. Nasal stuffiness B. Abdominal pain C. Headache D. Occasional dry cough Submit Answer
Explanation Choice B is correct. Sitagliptin is a DPP-4 Inhibitor used in managing diabetes mellitus type II. This medication reduces blood glucose levels by delaying gastric emptying and slowing the rate of nutrient absorption into the blood. The most common adverse effect associated with this medication is pancreatitis. Pancreatitis is manifested by abdominal pain, nausea, and persistent vomiting. Choices A, C, and D are incorrect. Sitagliptin may cause headaches, nasal stuffiness, and an occasional dry cough. Respiratory congestion is common with this medication, but it is not as severe as a client with pancreatitis, which could die without treatment. Pancreatitis causes significant dehydration, which, if untreated, may lead to hypovolemic shock. Additional Info Sitagliptin is a treatment that may be prescribed for type II diabetes mellitus ✓ Persistent abdominal pain should be reported because pancreatitis is the major adverse effect of this medication. ✓ Other medications in this class include linagliptin, saxagliptin, and aloglipt
The nurse has administered prescribed five units of regular insulin and ten units of NPH insulin. The nurse anticipates that the soonest this insulin will peak will be within A. thirty minutes. B. two to four hours. C. four to six hours. D. ten to twelve hours. Submit Answer
Explanation Choice B is correct. This client was administered regular insulin that peaks within two to four hours. Additionally, this client received NPH insulin which peaks within four to twelve hours. It would be appropriate for the nurse to assess the client for hypoglycemia when the regular insulin peaks as it peaks sooner. Choices A, C, and D are incorrect. Rapid-acting insulin (such as lispro) may peak as early as thirty minutes after it is administered. This is not appropriate for regular and NPH. NPH may peak within four to twelve hours; however, the regular would have already peaked, causing the client to potentially develop hypoglycemia. Long-acting insulin, such as detemir peaks within six to eight hours. Glargine, a long-acting insulin, has no peak. Additional Info Source : Archer Review Last Updated - 07, Nov 2022
A patient is scheduled to have a thyroidectomy. The nurse understands that the primary reason for giving Lugol's solution to a patient preoperatively is to: A. Decrease the risk of agranulocytosis postoperatively. B. Prevent tetany while the client is under general anesthesia. C. Reduce the size and vascularity of the thyroid and prevent hemorrhage. D. Potentiate the effect of the other preoperative medication so less medicine can be used while the client is under anesthesia. Submit Answer
Explanation Choice C is correct. Hyperthyroidism is related to hemodynamic variations, including increased heart rate and cardiac contractility, as well as decreased peripheral resistance due to serum thyroid hormone excess. Preoperative preparation of the patient is crucial to avoid intraoperative or postoperative complications and to minimize the vascularity of the gland. The incidence of complications is low in experienced hands; however, a small amount of intraoperative bleeding can reduce the visualization and preservation of the surrounding nerves, vasculature, and parathyroid glands. Lugol's solution (inorganic iodide) has been given preoperatively to patients to limit intraoperative bleeding and related complications resulting from thyroid gland vascularization. Choice A is incorrect. Doses of over 30 mg/day may increase the risk of agranulocytosis. The client may receive an iodine solution (Lugol's solution) for 10 to 14 days before surgery to decrease vascularity of the thyroid and thus prevent excess bleeding. Choice B is incorrect. Lugol's solution does not act to prevent tetany. Calcium is used to treat tetany. Choice D is incorrect. Lugol's solution does not potentiate any other preoperative medication. NCSBN Client Need Topic: Physiological Integrity, Subtopic: Pharmacological Therapies Last Updated - 15, Feb 2022
The nurse is observing the newly registered nurse prepare and administer insulin to a patient. Which action by the new RN would necessitate further instructions from the supervising nurse? A. The new RN asks the client which site the insulin was last injected. B. The new RN checks the client's blood glucose levels prior to administering the insulin injection. C. The new RN shakes the insulin vial before withdrawing insulin. D. The new RN places the insulin in the medication fridge after drawing the needed amount of insulin. Submit Answer
Explanation Choice C is correct. The new RN should not shake the vial but gently rotate it to ensure uniform suspension of insulin. Choice A is incorrect. Insulin injection sites should be rotated to prevent lipodystrophy. Asking the patient where the insulin was last injected gives the nurse an idea of where to insert the insulin next. Choice B is incorrect. The nurse should check the client's blood glucose levels before the administration of insulin to prevent hypoglycemia and to assess if the insulin dose needs to be adjusted. Choice D is incorrect. The insulin should be stored in a cool place away from direct sunlight. After it's opened; storing the insulin vial either in a refrigerator or at room temperature are both acceptable actions. Storing it in the fridge is recommended by the drug manufacturers. Injecting refrigerated insulin can be painful so patients may choose to store it at the room temperature after it is opened. Because both storing in the fridge or at room temperature are acceptable for the opened insulin vial, D is an appropriate nursing action and does not need further instructions. Last Updated - 22, Nov 2021
A 16-year-old female client has been recently diagnosed with Graves' disease and subsequently admitted. Which of the following prescriptions, if ordered by the health care provider (HCP), should the nurse question? A. Atenolol B. Propylthiouracil C. Radioactive iodine (I-131) D. Methimazole Submit Answer
Explanation Choice C is correct. The nurse should question the order written for radioactive iodine (I-131) in this 16-year-old female client, as this client is of childbearing potential. A woman of childbearing potential is defined as any woman or adolescent who has begun menstruation and can conceive. When given radioactive iodine (also referred to as RAI), RAI is taken up by the thyroid, causing the destruction of thyroid tissue. Radioactive iodine is highly effective and is the treatment of choice for Graves' disease in nearly all clients except pregnant clients, breastfeeding clients, or clients who hope to become pregnant within the next 12 months. Iodine, including radioactive isotopes, is readily transferred across the placenta, thus affecting the developing thyroid gland of a developing fetus. Therefore, in any female of childbearing potential, the American Thyroid Association recommends obtaining a beta-hCG within the 72 hours preceding the initiation of RAI therapy to rule out pregnancy. Choice A is incorrect. Atenolol is a beta-blocker used to treat hypertension or tachycardia. Based solely on the information contained within this question, this 16-year-old patient with Graves' disease could take atenolol. Choice B is incorrect. Propylthiouracil is one of the most commonly used anti-thyroid medications. Propylthiouracil works by impairing thyroid hormone synthesis and can be prescribed for clients below 18 years of age. Choice D is incorrect. Methimazole blocks thyroid hormone production from the thyroid gland and is FDA-approved for clients with Graves' disease. Learning Objective Understand that ionizing radiation is harmful to a fetus. Therefore, a beta-hCG test is mandatory before administering radioactive medications (i.e., radioactive iodine) to females of childbearing potential. Additional Info A woman of childbearing potential is defined as any woman or adolescent who has begun menstruation and can conceive (typically, 12 to 50 years of age, although deviations in the age ranges occur). Ionizing radiation sources include various radiology scans/tests and the administration of radioactive medications. The American College of Radiology (ACR) practice guideline for the performance of therapy with unsealed radiopharmaceutical sources states that pregnancy should be ruled out using one of the following four criteria: (1) A negative hCG test obtained within 72 hours before administration of the radiopharmaceutical, (2) Documented history of hysterectomy, (3) A postmenopausal state with absence of menstrual bleeding for two years, or (4) Premenarche in a child age of 10 years or younger. Last Updated - 07, Oct 2022
The nurse is preparing to administer a regular insulin IV bolus to a client. The primary health care provider (PHCP) has prescribed an initial bolus dose of 0.1 unit/kg. The client weighs 242 lbs. How much regular insulin should the nurse administer to the client as an IV bolus? A. 9 units B. 10 units C. 11 units D. 12 units Submit Answer
Explanation Choice C is correct. To solve this problem, the client's weight needs to be converted to kilograms. 242 lbs / 2.2 = 110 kg. Next, multiply the ordered dose of 0.1 units by the weight of 110 kg. This should equate to 11 units. Choices A, B, and D are incorrect. The other answer choices are incorrect when dose x weight (kg) is calculated. Additional Info Regular insulin drips are ordered for clients experiencing diabetic ketoacidosis. Insulin is a high-risk medication, and the nurse must double-check the dose with another nurse prior to initiation. To solve this problem, the patient's weight needs to be converted to kilograms. 242 lbs / 2.2 = 110 kg. Next, multiply the ordered dose of 0.1 units by the weight of 110 kg. This should equate to 11 units. Last Updated - 14, Jan 2022
The nurse is reviewing newly prescribed medications for assigned clients. Which of the following prescribed medications should the nurse question? A. Furosemide for a client with hyperparathyroidism B. Methimazole for a client with hyperthyroidism C. Hydrocortisone for a client with diabetes insipidus D. Prazosin for a client with pheochromocytoma Submit Answer
Explanation Choice C is correct. Treatment for diabetes insipidus includes medications such as desmopressin, thiazide diuretics, and anti-inflammatories. Hydrocortisone is a short-acting corticosteroid and is indicated in the treatment of adrenal insufficiency. This requires follow-up because DI is not treated with hydrocortisone. Choices A, B, and D are incorrect. Hyperparathyroidism causes hypercalcemia, and the treatment for hyperparathyroidism is a combination of 0.9% saline infusion followed by furosemide. Hyperthyroidism requires antithyroid medications such as methimazole or propylthiouracil. The classic manifestation of pheochromocytoma is hypertension, and treatment of this condition involves antihypertensive such as prazosin, an alpha-adrenergic blocker. Additional Info Diabetes insipidus may be central (problem with the pituitary gland secreting antidiuretic hormone) or nephrogenic (resistance at the ADH site of action in the collecting tubules). The major symptoms of central diabetes insipidus (DI) are polyuria, nocturia, and polydipsia due to the concentrating defect. In treating central DI, desmopressin is utilized and can be administered either intranasally or by tablet. Last Updated - 18, May 2022
The nurse is educating a client about newly prescribed aspart insulin. The nurse should instruct the client to self-administer this insulin A. 30-45 minutes before a meal. B. one hour after a meal. C. 20-30 minutes before a meal. D. 10-15 minutes before a meal. Submit Answer
Explanation Choice D is correct. Aspart insulin is a rapid actin insulin that should be administered to the client no greater than 10-15 minutes prior to the meal or while the client is actively eating. Prior to the administration of this insulin, the client's blood glucose should be obtained. Choices A, B, and C are incorrect. These are inappropriate times to administer aspart insulin. Rapid onset insulins (lispro, aspart, glulisine) are given 10-15 minutes before a meal or while the client is actively eating. Additional Info Source : Archer Review The three rapid-acting insulins are lispro, aspart, and glulisine. The client needs to take this insulin 10-15 minutes before a meal or while actively eating. A rapid-acting insulin is utilized as correctional insulin before meals to prevent post-prandial hyperglycemia. This type of insulin is commonly loaded into an insulin pump. Last Updated - 07, Nov 2022
The nurse is educating a client about newly prescribed aspart insulin. The nurse should instruct the client to self-administer this insulin A. 30-45 minutes before a meal. B. one hour after a meal. C. 20-30 minutes before a meal. D. 10-15 minutes before a meal. Submit Answer
Explanation Choice D is correct. Aspart insulin is a rapid actin insulin that should be administered to the client no greater than 10-15 minutes prior to the meal or while the client is actively eating. Prior to the administration of this insulin, the client's blood glucose should be obtained. Choices A, B, and C are incorrect. These are inappropriate times to administer aspart insulin. Rapid onset insulins (lispro, aspart, glulisine) are given 10-15 minutes before a meal or while the client is actively eating. Additional Info The three rapid-acting insulins are lispro, aspart, and glulisine. The client needs to take this insulin 10-15 minutes before a meal or while actively eating. A rapid-acting insulin is utilized as correctional insulin before meals to prevent post-prandial hyperglycemia. This type of insulin is commonly loaded into an insulin pump. Last Updated - 31, Jul 2022
The nurse is teaching a client about storing their prescribed insulin. Which statement, if made by the client, would indicate a correct understanding of the teaching? A. Opened vials of insulin may be kept in the freezer." B. "My opened vial of insulin is good for 45 days." C. "If I travel, I can keep a vial of insulin in my car." D. "Unopened vials of insulin may be stored in the refrigerator." Submit Answer
Explanation Choice D is correct. Extra vials (unopened) of insulin may be stored in the refrigerator. Insulin should never be frozen or administered cold. Choices A, B, and C are incorrect. Insulin should never be stored in the freezer. Insulin may be kept on ice but should not be allowed to freeze. Insulin should be discarded 28-days after it has been opened. Keeping a vial of insulin in the car is not recommended. Car temperatures vary greatly and will damage the effects of insulin. Additional Info When counseling a client about insulin storage, the nurse should emphasize the following points: Refrigerate insulin that is not in use to maintain potency Prevent exposure to sunlight, and inhibit bacterial growth Insulin in use may be kept at room temperature for up to 28 days To prevent loss of drug potency, avoid exposing insulin to temperatures below 36°F (2.2°C) or above 86°F (30°C) Avoid excessive shaking, and protect insulin from direct heat and light Insulin should not be allowed to freeze Do not inject insulin that is cold Last Updated - 21, May 2022
The nurse is caring for a 34-year-old patient in the community clinic. The provider prescribes oral prednisone for the treatment of respiratory symptoms. The nurse's education to the patient should include information on the possible side effects of this medication including. Select all that apply. A. Blurred vision B. Fast heartbeat C. Decreased appetite D. Increased urine output Submit Answer
Explanation Choices A and B are correct. Any of the corticosteroids can cause many symptoms. Visual disturbances and increased pulse are two that are more common. In general, increased appetite and weight gain from increased intake are reported. If the urine output is affected, the patient will see a decreased urine output. Other common side effects include aggression, dizziness, headache, irritability, mood disturbances, shortness of breath, and swelling of the extremities. Choices C and D are incorrect. Decreased appetite and increased urine output are not side effects of prednisone. NCSBN Client Need Topic: Pharmacological and Parenteral Therapies, Sub-topic: Side Effects, Medication Administration Additional Info Last Updated - 10, Feb 2022
Which of the following are potential complications of dexamethasone administration? Select all that apply. A. Risk of infection B. Hypotension C. Hyperlipidemia D. Hypoglycemia Submit Answer
Explanation Choices A and C are correct. Like with any steroid, when a patient is receiving dexamethasone, they are at higher risk for infection. They should be monitored closely to evaluate for WBCs trending upwards, increased CRP, becoming febrile, and other indicators of disease (Choice A). Hyperlipidemia is a side effect of dexamethasone. Dexamethasone causes the development of cholesterol and can increase triglycerides as well as low-density lipoproteins (LDLs) (Choice C). Choice B is incorrect. Hypertension, not hypotension, is a side effect of dexamethasone. Choice D is incorrect. Hyperglycemia, not hypoglycemia, is a side effect of dexamethasone. NCSBN Client Need: Topic: Physiological Integrity Subtopic: Pharmacological and Parenteral Therapies Last Updated - 11, Jan 2022
The nurse is caring for a client with a prescribed subcutaneous (SQ) regular insulin sliding scale. The client's current blood glucose level is 360 mg/dL. Which of the following actions should the nurse take? See the exhibit. Select all that apply. View Exhibit A. Notify the primary health care provider (PHCP). B. Administer 8 units of regular insulin. C. Administer 10 units of regular insulin. D. Recheck the client's blood glucose in one hour. E. Administer the insulin intravenous (IV) push. Submit Answer
Explanation Choices A and C are correct. The client's blood glucose of 360 mg/dL indicates hyperglycemia. The healthcare provider should be notified, and the client should receive ten units of regular insulin subcutaneously. Choices B, D, and E are incorrect. The blood glucose level requires prescribed 10 units of insulin and not 8 units. Checking the blood glucose in one hour would not be useful as the peak of regular insulin is within 2 to 4 hours. Finally, regular insulin may be administered intravenously, but the prescription is for subcutaneous administration. Additional Info A sliding scale is a prescribed set of parameters to guide insulin correction. The sliding scale utilizes the blood glucose ranges to determine the appropriate amount of insulin to administer. The sliding scale may show the amount of rapid or short-acting insulin necessary based on the blood glucose. Source : Archer Review Last Updated - 02, Jan 2023
The nurse is reviewing a client's list of medications who has cystic fibrosis. The nurse anticipates a prescription for which medication? Select all that apply. A. Pancrelipase B. Aspirin C. Lactulose D. Multivitamin E. Clopidogrel Submit Answer
Explanation Choices A and D are correct. Pancrelipase is a digestive enzyme that is given to the client with meals. This allows the client to digest the food and absorb the vitamins and minerals. This is the exact reason that a multivitamin is necessary for the treatment of cystic fibrosis. Choices B, C, and E are incorrect. These medications are not indicated in the direct management of cystic fibrosis. Additional Info Cystic fibrosis is a multisystem disorder that has no cure. A well-balanced diet rich in calories, protein, and fat is recommended to help prevent (or treat) the malabsorption associated with CF. Foods rich in sodium are also recommended because of the salt loss through the skin. A multivitamin is commonly prescribed to help mitigate the vitamin deficiencies that may develop. Finally, pancrelipase is prescribed before snacks and meals to enable the digestion of the dietary items. Last Updated - 24, Aug 2022
The nurse is caring for a client diagnosed with a myxedema coma. The nurse should anticipate a prescription for which of the following medications? Select all that apply. A. Levothyroxine B. Methimazole C. Tolvaptan D. Hydrochlorothiazide E. Hydrocortisone Submit Answer
Explanation Choices A and E are correct. When a client experiences a myxedema coma, it is because of severe hypothyroidism. These dangerously low levels of thyroid hormone produce symptoms such as altered level of consciousness, hyponatremia, hypothermia, hypoventilation, and hypoglycemia. Treatment is essential and is geared towards the prompt administration of intravenous levothyroxine and liothyronine. Glucocorticoids are usually added to the treatment to help mitigate the hypotension and potential overlook of adrenal dysfunction. Choices B, C, and D are incorrect. Methimazole would be contraindicated in myxedema since this is a type of antithyroid medication. Furthermore, tolvaptan is not indicated because this medication is used to treat SIADH. HCTZ is a treatment for essential hypertension and nephrogenic diabetes inspidus. It has no role in a myxedema coma. Additional Info ✓ Myxedema coma is a rare but extremely serious complication associated with severe hypothyroidism. ✓ Manifestations of a myxedema coma include hyponatremia, hypothermia, hypoventilation, and hypoglycemia. ✓ The nurse must initiate medical and symptomatic treatment, such as intravenous levothyroxine and hydrocortisone. ✓ The nurse may also treat the client's symptoms with passive rewarming. Last Updated - 27, Jan 2023
The nurse is teaching a client about newly prescribed insulin glargine. The nurse recognizes the need for further instruction when the client makes the following statement? Select all that apply. A. "I will take this insulin right before my meals." B. "I should roll this vial of insulin before removing it with the syringe." C. "This insulin will help control my glucose for 24 hours." D. "I can only inject this insulin into my abdomen." E. "I'm glad to know I can mix this with my regular insulin." Submit Answer
Explanation Choices A, B, D, and E are correct. These statements are incorrect and require follow-up. Insulin glargine is a long-acting insulin that has no peak effect. Thus, it is not taken with meals. It is dosed once a day to provide glucose control for 24 hours. Insulin glargine is not a suspension; thus, it does not need to be rolled like NPH. This insulin is not mixed with any other insulin. Insulin glargine does not have to only be injected into the abdomen. Choice C is incorrect. This statement is factual and does not require additional teaching. Insulin glargine provides basal glucose control for up to 24 hours. This, combined with a carbohydrate-controlled diet, should decrease the client's reliance on correctional insulin. Additional Info Source : Archer Review Insulin glargine is a long-acting insulin that provides basal control of a client's glucose. This insulin is given daily and does not have to be given with meals. It is highly unlikely that the client would develop hypoglycemia from this insulin because it has no peak effect. Thus, it is usually safe to be given to a client who is a nothing-by-mouth (NPO) status. Last Updated - 19, Jan 2023
The nurse is caring for a client who has been prescribed prednisone. Which of the following statements, if made by the nurse, would be correct? Select all that apply. A. "This medication may make you gain weight." B. "It is best to take this medication in the morning with food." C. "If you have pain, it is okay to take ibuprofen." D. "Your blood pressure may decrease while taking this medication." E. "You may experience mood changes while on this medicine." Submit Answer
Explanation Choices A, B, and E are correct. Corticosteroids cause fluid retention because of their effects on aldosterone (sodium retention; potassium elimination). Therefore, as the client retains sodium, their weight increases because of water retention. Prednisone is best dosed early in the day. Prednisone commonly causes insomnia; therefore, taking it in the morning with food is recommended. Food is recommended because it will decrease gastric irritation. Prednisone can cause mood alterations, such as irritability, and may destabilize the client if they have mood disorders such as bipolar. Choices C and D are incorrect. Corticosteroids should not be taken concurrently with NSAIDs such as naproxen or ibuprofen. The steroid itself may increase the risk of a gastric ulcer; when combined with an NSAID, the risk of an ulcer increases tremendously. Since corticosteroids increase the amount of sodium, the amount of fluid retained increases and may increase blood pressure. Additional Info Corticosteroids are the mainstay treatment in an array of disease exacerbations such as multiple sclerosis, rheumatoid arthritis, asthma, and lupus. ➢ The nurse should instruct the client to take the medication in the morning with food ➢ Take the steroid as prescribed, do not self-discontinue, and anticipate weight gain. ➢ To prevent the development of ulcers, the nurse should instruct the client not to take any NSAIDs, such as ibuprofen or naproxen, while on the steroid. Last Updated - 05, Feb 2023
The nurse is evaluating a client taking levothyroxine for hypothyroidism. Which findings indicate that the client is experiencing an adverse effect? Select all that apply. A. Heat intolerance B. Palpitations C. Bradycardia D. Constipation E. Insomnia F. Weight gain Submit Answer
Explanation Choices A, B, and E are correct. Levothyroxine is indicated for hypothyroidism. Careful monitoring is necessary to ensure that the client does not develop hyperthyroidism due to over-correction. Manifestations include heat intolerance, palpitations, and insomnia. These findings would be adverse responses because the client is being overcorrected and requires the provider to intervene. Choices C, D, and F are incorrect. Bradycardia, constipation, and weight gain are associated with hypothyroidism and should not be apparent while the client takes levothyroxine. Additional Info Source : Archer ReviewSource : Archer ReviewSource : Archer ReviewSource : Archer Review Last Updated - 21, Jan 2023
The nurse is caring for a client who has been prescribed a 14-day course of prednisone. Which of the following statements, if made by the nurse, would be correct? Select all that apply. A. "This medication may make you gain weight." B. "It is best to take this medication in the morning with food." C. "If you have further pain, it is okay to take naproxen." D. "Your blood pressure may decrease while taking this medication." E. "Do not abruptly stop taking this medication." Submit Answer
Explanation Choices A, B, and E are correct. Prednisone is a corticosteroid and is indicated for various conditions, including exacerbations of rheumatoid arthritis. The medication potentiates aldosterone causing sodium and water retention, thereby allowing the client to gain weight. Steroids are best taken in the morning with food. Taking it with food decreases gastrointestinal upset. If the steroid is taken at nighttime, it may cause insomnia. The cessation of this drug should be tapered to avoid adrenal insufficiency. This medication should not be abruptly discontinued. Choices C and D are incorrect. Corticosteroids should not be combined with NSAIDs such as naproxen because that would hasten the risk of peptic ulcer disease. Blood pressure would increase because of fluid retention. Additional Info Source : Archer Review Corticosteroids may cause an array of adverse effects while they mitigate inflammation. This includes peptic ulcer disease, edema, hypokalemia, hyperglycemia, and hypernatremia. The client should be educated to maintain low sodium and high potassium diet while taking prednisone.
