Chapter 38: Agents to Control Blood Glucose Levels, Chapter 37: Thyroid and Parathyroid Agents
A female client with a six-month-old infant has been prescribed propylthiouracil (PTU). What is the most important question the nurse should ask this client?
"Are you breastfeeding your child?"
What question is important for the nurse to ask a client who is scheduled to receive a first dose of radioactive iodine for hyperthyroidism?
"Do you have any trouble swallowing?"
A client is prescribed calcitriol. Which instruction would be most important for the nurse to include in the teaching plan?
"Have your calcium levels checked periodically."
The nurse is teaching a patient who is prescribed calcitriol about the drug. Which patient statement indicates that the teaching was successful?
"I need to have my calcium levels checked periodically."
The nurse is caring for a 55-year-old client with Hashimoto's thyroiditis. During discharge teaching, which statement by the client tells the nurse the client understands the teaching?
"I should take this medication on an empty stomach in the morning."
A client, who is 42 years old and newly diagnosed with type 2 diabetes, has attended educational sessions to provide insight into the diagnosis. Which of the client's statements should prompt the nurse to provide further teaching?
"I'm disappointed, but I take some solace in the fact that I won't ever have to have insulin injections."
The nurse has just completed discharge instructions to a client who will be using a pen device to deliver his insulin dose. What statement by the client indicates a need for further instruction?
"If I forget to take my insulin pen, I will be able to use the one that my wife uses."
The nurse is discussing diabetes with a group of individuals who are at risk for the disease. Which statement by a participant indicates an understanding of the role of insulin in the disease?
"Insulin assists glucose molecules to enter the cells of muscle and fat tissues."
A female client with hyperthyroidism reports nervousness and "racing" heart one week after starting antithyroid medication. How should the nurse respond to the client's report?
"It may take three to four weeks for the effects of this medication to be seen."
What statement would be appropriately included in the teaching concerning type 2 diabetes?
"Regular exercise makes your body better able to use the insulin it produces."
While reviewing the medication history of a client receiving alendronate, the nurse notes that the client also takes a multivitamin. Which instruction would be most appropriate?
"Separate taking the two drugs by about a half hour."
A 42-year-old male client is prescribed glargine insulin for management of his type 2 diabetes mellitus. The nurse caring for the client develops a teaching plan regarding glargine insulin therapy. Which statement made by the client indicates that the client needs additional teaching?
"The medication will peak in 3 hours."
The nurse is caring for a 42-year-old client who recently had a total hysterectomy that involved removal of her ovaries. What statement by the client suggests that she understands her risk of developing osteoporosis?
"The surgery increased my risk of developing the disease."
A pregnant client asks about the safety of taking thyroid hormone replacement drugs during her pregnancy. What is the nurse's best response?
"Thyroid hormones are pregnancy category A drugs and should be taken during pregnancy."
A nurse is providing education to a client who will soon begin taking levothyroxine for the first time. Which teaching point should the nurse include in this education session?
"You'll most likely take this drug for the rest of your life."
The client is scheduled to get a breakfast tray at 07:00. At what time should the client receive a prescribed dose of insulin lispro?
06:45
Methimazole (Tapazole) 30 mg /day orally divided in 3 doses is prescribed for a client diagnosed with Graves' disease. The pharmacy has 5 mg tablets available. How many tablets should the nurse administer with each dose?
2
When learning about antithyroid drugs in their pharmacology class, the nursing students learn that strong iodine products are commonly administered for how long?
6 weeks
Serum levels of calcium must be maintained in a narrow range within the body. What is the normal range of serum calcium?
9 and 11 mg/dL
The nurse is educating a newly diagnosed diabetic who must learn how to give himself insulin injections. The nurse tells the client that insulin is absorbed fastest from which area of injection?
Abdomen
The nurse is caring for a child who needs replacement of the parathyroid hormone. A student nurse asks the nurse what the most common cause of hypoparathyroidism is. What would be the best correct response?
Accidental removal of glands
A primary health care provider has prescribed levothyroxine to a client with hypothyroidism. Which information would the nurse include in the teaching plan to promote an optimal response to the drug therapy?
Administer the drug early in the morning before breakfast.
A nurse is caring for a male client who has been seen for numerous broken ribs over the past year. He is diagnosed with osteoporosis. The nurse knows that the only bisphosphonate approved for use in treating osteoporosis in men is:
Alendronate (Fosamax).
A health care provider has ordered an iodine procedure. What should be included in the nurse's pre-administration assessment for the client? (Select all that apply.)
Allergy history Weight Pulse Temperature
The nurse should assess for an enlarged thyroid by palpating which area?
Anterior neck
A client taking methimazole develops a rash. What is the nurse's best recommendation to treat the rash?
Apply a soothing cream until the rash subsides.
A client who began treatment for type 2 diabetes 8 months ago is now meeting with a diabetic nurse for a scheduled follow-up. How can the nurse best assess the client's glycemic control since beginning treatment?
Assess the most recent hemoglobin A1C levels.
A nurse is assigned to administer glargine to a patient at a health care facility. What precaution should the nurse take when administering glargine?
Avoid mixing glargine with other insulin.
The nurse is preparing to administer a mixture of 12 units regular insulin and 45 units NPH insulin to a client with a blood sugar of 378 mg/dL. After the nurse draws the medication into the syringe, what is the nurse's next action?
Check the dosage with another nurse.
A home care nurse is caring for a 70-year-old female client who has been diagnosed with osteoporosis. When developing a plan of care for this client, the nurse should include measures to prevent what complication of the disease?
Bone fracture
The home care nurse is caring for an elderly female patient who has been diagnosed with osteoporosis. When explaining the disease and its treatment to the patient, what should the nurse identify as a potentially serious complication?
Bone fracture
A patient has hypocalcemia secondary to hypoparathyroidism. Which would the nurse expect to be ordered?
Calcitriol
The nurse should review which lab result before advising a client about taking the first dose of ibandronate (Boniva)?
Calcium
The nurse is preparing to administer methimazole to an 11-year-old client newly diagnosed with hyperthyroidism. What are the potential risks for the use of methimazole in children? (Select all that apply.)
Cancer caused by radioactive iodine Chromosome damage Chronic hypothyroidism
A female client visits the health care provider's office after routine labs are drawn. The nurse notes that her A1C is 9. How does the nurse interpret this finding?
Client's average blood glucose is above normal.
What would the nurse expect to assess if a client was receiving too much methimazole?
Decreased appetite
A nurse is caring for a patient with hypothyroidism. The nurse would know that the effects of hypothyroidism include:
Decreased cardiac output
The nurse is educating a client who will be adding an injection of pramlintide to his insulin regimen. What information is most important for the nurse to share with this client to ensure safe medication administration?
Do not give pramlintide in the same site where insulin is administered.
Insulin binds with and activates receptors on cell membranes. Once insulin-receptor binding occurs, the membranes become highly permeable to glucose. Which action does this enable?
Entry of glucose into the cells
What distinguishing characteristic is associated with type 1 diabetes?
Exogenous insulin is required for life.
More patients experience hyperthyroidism than hypothyroidism.
False
Which would a nurse expect to assess in a client experiencing hyperthyroidism?
Flushed, warm skin
What would alert the nurse to suspect that a client is developing ketoacidosis?
Fruity breath odor
A nurse is caring for a patient who has developed a hypoglycemic reaction. Which intervention should the nurse perform if swallowing and gag reflexes are present in the patient?
Give oral fluids or candy.
A man is brought to the emergency department. He is nonresponsive, and his blood glucose level is 32 mg/dL. Which would the nurse expect to be ordered?
Glucagon
Which would a nurse identify as an example of a sulfonylurea?
Glyburide
Before administering a prescribed 20 units of NPH insulin to a client, the nurse should implement which intervention?
Have a colleague confirm the dosage.
The nurse is interviewing a client who was diagnosed with type 2 diabetes four months ago. The client does not records glucometer readings but reports no concerns. What laboratory test does the nurse anticipate the health care provider will order for this client?
HbA1c
The nurse is preparing to administer levothyroxine to a client. Which assessment finding would cause the nurse to hold the medication?
Heart rate of 110 beats per minute
What is the best position for the client after the administration of a bisphosphonate medication?
High Fowler's
The nurse is caring for a client who is taking a thiazide diuretic, a corticosteroid, and estrogens. The nurse understands that this client is at risk for what condition?
Hyperglycemia
A client presents at the clinic reporting weight loss despite an increased appetite. For which condition should this client be assessed?
Hyperthyroidism
The health care provider has ordered a change of prescription from rapid-acting insulin to an intermediate-acting type. Which adverse effect must the nurse closely monitor for in the client?
Hypoglycemia
The nurse is explaining the action of exenatide to a patient. Which would the nurse include?
Increase in insulin resistance
Thyroid hormones are principally concerned with the increase in metabolic rate of tissues that can result in certain effects? What are some of these effects? (Select all that apply.)
Increased heart rate Increased body temperature Increased cardiac output
A client with diabetes has started thyroid hormone replacement therapy. The nurse should monitor closely for which effects?
Increased thirst
When describing the effects of incretins on blood glucose control to a group of students, which would an instructor include?
Increases insulin release
The pharmacology instructor is providing education regarding propylthiouracil to the nursing students. What would the instructor identify as the primary mode of action for this medication?
Inhibition of production of thyroid hormone
When administering insulin, what would be most appropriate?
Insert the needle at a 45-degree angle for injection.
A nurse at a health care facility is assigned to administer insulin to the patient. Which intervention should the nurse perform before administering each insulin dose?
Inspect the previous injection site for inflammation.
A nurse must recognize the duration of insulin so as not to cause harm to the client with administration of the improper type of insulin. Which insulins are rapid acting? (Select all that apply.)
Insulin aspart (NovoLog) Insuline glulisine (Apidra)
A client newly diagnosed with type 1 diabetes asks the nurse why the client cannot just take a pill. The nurse would incorporate what knowledge when responding to this client?
Insulin is needed because the beta cells of the pancreas are no longer functioning.
What is the rationale for a nurse to suggest avoiding whole grains to a client being treated for osteopenia?
Whole grains are known to interfere with calcium absorption.
The nurse admitted a 4-year-old child with type 1 diabetes mellitus. The nurse educates the parents that hypoglycemia can occur as an adverse effect of insulin. The nurse helps the parents to understand that in young children, hypoglycemia may manifest as what signs or symptoms? (Select all that apply.)
Irritability Impaired mental functioning Lethargy
Which would be appropriate to include in teaching a client with type 2 diabetes?
It is possible with weight loss and exercise to discontinue the use of antidiabetic medication.
What is the expected action of sitagliptin on type 2 diabetes?
It slows the rate of inactivation of the incretin hormones.
A client is receiving metformin therapy at a health care facility. The client is also prescribed glucocorticoids. The nurse would be alert for which adverse reaction due to the interaction of these two drugs?
increased risk of lactic acidosis
A client is diagnosed with liver disease. How would this affect the metabolism of the drugs used to treat the client's hypothyroidism?
It would be prolonged.
A patient receives 25 units of NPH insulin at 7 AM. At what time of day should the nurse advise the patient to be most alert for a potential hypoglycemic reaction?
Late afternoon
Which agent would a nurse expect to administer to a client with hypothyroidism?
Levothyroxine
An older adult has been prescribed a thyroid hormone replacement medication. The nurse should first clarify which prescription?
Levothyroxine (Synthroid) 150 mcg orally once per day
The two major classifications of diabetes are type 1 and type 2. What is a distinguishing characteristic of type 1 diabetes?
Lifelong exogenous insulin is required.
A nurse is performing patient education for a woman who has just been prescribed a bisphosphonate. Which diagnostic and history findings would have prompted the woman's care provider to prescribe a bisphosphonate?
Low bone density and a family history of osteoporosis
Which would be least appropriate when administering insulin by subcutaneous injection?
Massaging the site after removing the needle
A client, who experienced hypoglycemia twice in the past week, eats one meal per day and snacks the rest of the day. What client education will the nurse provide for a client who reports regularly experiencing hypoglycemic symptoms?
Meals should be eaten at regular times.
After teaching a class about the various drugs used to control blood glucose, the instructor determines that the teaching was successful when the class identifies what as a biguanide?
Metformin
The nurse is caring for an older adult client who has type 2 diabetes and chronic kidney disease. Which drugs will be used with great caution in this client? (Select all that apply.)
Metformin (Glucophage) Acarbose (Precose) Miglitol (Glyset)
A client is brought to the emergency department after taking an overdose of levothyroxine. When assessing this client, what adverse effects would the nurse expect to find?
Nervousness and tachycardia
A client taking levothyroxine (Synthroid) is starting a new job and will be using a new health insurance and pharmacy formulary. What teaching should the nurse provide to this client regarding Synthroid?
Notify the primary care provider if Synthroid is not covered by insurance.
A client admitted to the hospital with hyperthyroidism treated with propylthiouracil suddenly develops a skin rash. Which action would the nurse implement first?
Notify the primary health care provider.
A nurse is caring for a patient diagnosed with type 2 diabetes. What should the nurse inform the patient are risk factors associated with type 2 diabetes?
Obesity
A nurse is caring for a patient with diabetes mellitus who is receiving an oral antidiabetic drug. Which of following ongoing assessments should the nurse perform when caring for this patient?
Observe the patient for hypoglycemic episodes.
The nurse monitoring a client receiving insulin glulisine (Apidra) notices the client has become confused, diaphoretic, and nauseated. The nurse checks the client's blood glucose and it is 60 mg/dL (3.33 mmol/L). Which can a nurse give to treat a client with a hypoglycemic episode? (Select all that apply.)
Orange or other fruit juice, Glucose tablets, Hard candy
A nurse is reviewing the laboratory values of a client being treated for a diagnosis of hypocalcemia. The current serum calcium level is 8.1 mg/dL. What intervention does the nurse expect the prescriber to order?
Order an additional calcium supplement.
The nurse is discussing the use of corticosteroids with a group of nursing students and tells that students that both men and women who take corticosteroids are at risk for what side effect?
Osteoporosis
A nurse educating a client and their family about levothyroxine (Synthroid) for the treatment of hypothyroidism should advise the client to contact the health care provider if which occur? (Select all that apply.)
Palpitation Excessive diaphoresis Significant weight changes Chest pain
A client is admitted to the intensive care unit with diabetic ketoacidosis. The nurse knows that the client will be placed on an intravenous insulin drip. The only type of insulin that can be administered intravenously is:
Regular
A student asks the nursing instructor what insulin has the quickest therapeutic effect once administered. What would be the best response?
Regular (Humulin R)
Which agent would a nurse expect to administer as a single oral dose in the morning?
Rosiglitazone
A 25-year-old female client is diagnosed with hypothyroidism. The client is prescribed levothyroxine. Which instruction about the administration of this medication would be important?
She should take the medication in the morning before breakfast.
A nurse is preparing an in-service presentation for a group of staff members on diabetes. Which would the nurse include as the primary delivery system for insulin?
Subcutaneous injection
After teaching a group of students about the various methods for the delivery of insulin, the instructor determines that the teaching was successful when the students identify which method as most commonly used for administration?
Subcutaneous injection
A client diagnosed with hypothyroidism is to start thyroid hormone replacement therapy. Which lab value should the nurse review to assist the health care provider in determining the dosage?
TSH
A client is receiving a thyroid hormone to treat hypothyroidism. Which would indicate to the nurse that the client needs a reduced dosage of the drug?
Tachycardia
A nurse is caring for a patient with thyrotoxicosis. The physician prescribes liotrix to the patient. Which adverse reaction to the drug should the nurse monitor for in the patient?
Tachycardia
A patient at a health care facility has been prescribed diazoxide for hypoglycemia due to hyperinsulinism. What adverse reactions to the drug should the nurse monitor for in the patient?
Tachycardia
The nurse should monitor a client for which effect of a drug interaction in a client taking thyroid hormones and a beta blocker?
Tachycardia
A nurse is caring for a patient undergoing thyroid hormone replacement therapy. What should the nurse inform this patient regarding administration of the drug?
Take the drug before breakfast.
Which information about medication administration and meals should the nurse include in teaching a client prescribed calcium orally?
Take with or after meals.
During a general health assessment, a client indicates taking thyroid medication to increase weight loss. What statement should be the basis of the nurse's response?
Taking excessive or unnecessary thyroid medication may produce serious or life-threatening manifestations of toxicity.
A client was diagnosed with type 2 diabetes several months ago and has presented for a scheduled follow-up appointment. Which stated behavior most clearly indicates that the client has established effective health maintenance?
The client frequently checks his/her blood glucose levels.
Which condition must be met in order for glyburide treatment to be effective?
The client must have functioning pancreatic beta cells.
The nurse is caring for a client who has hypocalcemia. The client also has hypomagnesemia. The nurse knows that medications to correct these conditions will be administered in what manner?
The nurse will hold the calcium until the magnesium level is normal.
Following an assessment by her primary care provider, a 70-year-old resident of an assisted living facility has begun taking daily oral doses of levothyroxine. Which assessment finding should prompt the nurse to withhold a scheduled dose of levothyroxine?
The resident's apical heart rate is 112 beats/minute with a regular rhythm.
Which hormone regulates the production and release of thyroid hormone?
Thyroid-stimulating hormone (TSH)
Calcitonin balances the effects of parathyroid hormone.
True
The nurse is assisting a client who has just begun medication therapy for hypothyroidism. Which nursing assessment is most important in this client?
Vital signs
Which vitamin supplements should the nurse recommend while a postmenopausal client is taking alendronate (Fosamax)?
Vitamin D and calcium
Knowing that thyroid hormones are principally concerned with the increase in metabolic rate of tissues, which symptoms would a nurse observe in a client with uncontrolled hypothyroidism? (Select all that apply.)
Weight gain Bradycardia Sleepiness
Which statement reflects the relationship between calcium and phosphate?
When there is an increase in calcium, the phosphate is decreased.
A client has been admitted in acute hypercalcemia and has been determined to have a serum calcium level of 12.9 mg/dL (3.23 mmol/L). What is the emergency department nurse's priorityintervention?
administration of IV normal saline
A home care nurse is caring for several clients with diabetes. The nurse's role in caring for these clients includes:
all the above tasks.
Which factor would prohibit the administration of glipizide?
allergy to sulfonamides
Because of the risk for lactic acidosis, metformin is contraindicated in which client?
an 82-year-old diagnosed with type 2 diabetes
An increase in what specific physiological effect is an expected outcome of thyroid hormone therapy? Select all that apply.
carbohydrate metabolism cellular metabolism oxygen consumption cardiac output
A nurse is caring for a client with chronic lymphocytic thyroiditis. The health care provider has prescribed liothyronine. For which condition of the client should the nurse be cautious before administering the drug?
cardiac disease
Liothyronine is a thyroid hormone used in replacement therapy for hypothyroidism. The drug must be used with extreme caution in patients with:
cardiac problems.
The nurse knows that raloxifene achieves a therapeutic effect by altering the function of what hormone?
estrogen
What is the most common cause of subclinical hyperthyroidism?
excess thyroid hormone therapy
While the nurse is talking with a client, the client informs the nurse that the client has been under treatment for weight loss management. The client indicates taking antithyroid medication to increase weight loss. Included in client education about antithyroid medication is that taking:
excessive or unnecessary antithyroid medication may produce serious or life-threatening manifestations of toxicity.
Heavy intake of which herb should be avoided by a client who is prescribed an antidiabetic medication?
garlic
What assessment should the nurse perform prior to administration of a scheduled dose of levothyroxine?
heart rate
A middle-aged client is proactive with personal health maintenance and reports taking 2400 International Units of vitamin D daily, stating, "More is better when it comes to vitamins." The nurse should provide health teaching to the client associated with a risk for which disorder?
hypercalcemia
The nurse administers teriparatide (forteo) and evaluates the drug as effective in achieving desired effects when what is assessed?
increase in serum calcium and decrease in serum phosphorous
After reviewing information about different insulin preparations, a nursing student demonstrates understanding of the information when the student identifies which medication as an example of a long-acting insulin?
insulin glargine
A nurse is preparing to administer a rapid-acting insulin. Which medication would the nurse most likely administer?
insulin lispro
With regard to the functioning of the thyroid gland, which is an essential element for the manufacturing of thyroxine and triiodothyronine?
iodine
When describing thyroid function, the nurse would emphasize the need for intake of:
iodine.
A nurse is teaching a client about a prescribed thyroid supplement and describes a drug that is relatively inexpensive, requires once-a-day dosing, and has a more uniform potency than do other thyroid hormone replacement drugs. Which drug is the nurse describing?
levothyroxine
Rosiglitazone is being considered for the treatment of diabetes in an adult male client. Before the initiation of rosiglitazone therapy, the nurse should review what laboratory work recently drawn?
liver enzymes
A nurse is preparing to administer a scheduled dose of levothyroxine to an elderly client who is being treated in the hospital for a respiratory infection. Prior to administering the drug, the nurse should perform what assessment?
measurement of blood pressure
When providing care for a client who has been admitted with clinical hypothyroidism, the nurse should implement what intervention to address common characteristics of the disorder? Select all that apply.
monitor for constipation implement falls risk precautions maintain a warm room temperature
Based on the nurse's knowledge about thyroid hormone supplements, the nurse administers levothyroxine cautiously to a client who has recently had which condition or disorder?
myocardial infarction
The nurse should teach clients who are taking thyroid hormones to take the medication:
on an empty stomach.
What drug type is most likely to cause respiratory depression and myxedema coma in clients with thyroid disorders?
opioid analgesics
A client diagnosed with excessive parathyroid production is prone to develop:
osteopenia.
A hospital client's current medication administration record specifies oral administration of propylthiouracil (PTU) every 8 hours. What sign or symptom may have originally prompted the care provider to prescribe this drug?
persistent tachycardia
An older adult resident of a long-term care facility has been prescribed calcium citrate to address decreasing bone density. The nurse should review the resident's medication administration record knowing that what medication may decrease the effects of calcium?
prednisone
When considering the management of diabetic ketoacidosis (DKA), what type of insulin can be administered intravenously?
regular
What type of insulin will most likely be administered intravenously to a client with a blood glucose level over 600 mg/dL (33.33 mmol/L)?
regular insulin
Prior to administering propylthiouracil, the nurse has reviewed the relevant black box warning and should teach the client about the need for what form of follow-up?
routine liver function testing
A 55-year-old client was successfully treated for thyroid storm earlier in the year. In subsequent health education, the nurse should caution the client against excessive intake of what foods?
seafood and kelp
After teaching a group of nursing students about antidiabetic drugs, the instructor determines that the teaching was successful when the students identify which as an example of a hormone mimetic? Select all that apply.
sitagliptin exenatide pramlintide
Alendronate (Fosamax) is prescribed for a 67-year-old postmenopausal woman. In order to help prevent gastrointestinal distress, the nurse will advise the patient to:
stand or sit upright for at least 30 minutes after taking alendronate.
A client with diabetes is undergoing testing for glycosylated hemoglobin. The nurse instructs the client that this test measures average blood glucose over what time period?
the past 3 or 4 months
The demonstration of what symptom would suggest that an insulin-dependent client is experiencing a hypoglycemic reaction? Select all that apply.
weakness diaphoresis mental confusion increased pulse rate
The nurse is caring for a client taking insulin. The nurse realizes the client is experiencing symptoms of hypoglycemia when the client displays:
weakness, sweating, and decreased mentation.
The nurse should advise a client who is taking levothyroxine for the first time that resolution of hypothyroid symptoms may not occur for how long after therapy is started?
weeks
