Endocrine & Vaccinations - Kahoot & ELSIEVER

Your patient has been taking corticosteroids for the last month and no longer needs them. What order would you expect to see?

Taper order

Which would the nurse identify as long acting insulin? a. Humulin N b. Glargine (Lantus) c. Humulin R d. Novolog

B

Which type of insulin may be given in the morning, peak around lunch & dinner? a. Short acting b. Rapid acting c. Intermediate d. Long acting

C

How does hydrocortisone effect potassium levels?

Lowers them

Which medication is preferred to treat hyperthyroidism in pregenancy>

Prophylthiouracil (PTU)

What should a nurse teach the client to do to avoid lipodystrophy when self-administering insulin therapy? a. Exercise regularly. b. Rotate injection sites. c. Use the Z-track technique. d. Avoid massaging the injection site

B: Fibrous scar tissue can result from the trauma of repeated injections at the same site. Exercise is unrelated to lipodystrophy, but it reduces blood glucose, which decreases insulin requirements. Insulin is given subcutaneously; the Z-track technique is used with some intramuscular injections. Gentle pressure over the injection site after insulin administration promotes absorption.

What are some findings of DI?

Decreased urine specific gravity, increased urinary output, and thirst

Which of these antidiabetic meds would cause flushing/sweating if taken with alcohol?

Glyburide

The protein binding capacity of drugs in infants is low. Which is an implication of this physiologic process? a. The free levels of a drug will increase b. The free levels of a drug will decrease c. The free levels of a drug will remain constant d. The free levels of a drug will disappear once administered

A: Drugs bind to serum albumin and endogenous compounds such as fatty acids and bilirubin. The levels of these compounds are relatively low in infants. Due to this availability of less binding sites, the free concentration of the drug molecules increases. In adults, the drugs undergo extensive binding, and free levels of a drug will decrease. Levels of a drug cannot remain constant after drug absorption, nor will they immediately disappear.

A client newly diagnosed with type 2 diabetes is receiving glyburide and asks the nurse how this drug works. What mechanism of action does the nurse provide? a. Stimulates the pancreas to produce insulin b. Accelerates the liver's release of stored glycogen c. Increases glucose transport across the cell membrane d. Lowers blood glucose in the absence of pancreatic function

A: Glyburide, an antidiabetic sulfonylurea, stimulates insulin production by the beta cells of the pancreas. Accelerating the liver's release of stored glycogen occurs when serum glucose drops below normal levels. Increasing glucose transport across the cell membrane occurs in the presence of insulin and potassium. Antidiabetic medications of the chemical class of biguanide improve sensitivity of peripheral tissue to insulin, which ultimately increases glucose transport into cells. Beta cells must have some function to enable this drug to be effective.

A client is diagnosed with diabetic ketoacidosis. Which insulin should the nurse expect the health care provider to prescribe? a. NPH insulin b. Inhaled insulin c. Regular insulin d. Insulin glargine

C: Regular insulin is short-acting and is usually used for the treatment of diabetic ketoacidosis (DKA). Insulin lispro is too rapid-acting and may cause rapid drops in serum glucose leading to cerebral edema. Insulin glargine is long-acting insulin, which is not indicated in an emergency. NPH insulin is intermediate-acting insulin; it is not indicated for use in an emergency.

Match for Addisons, Cushings, Graves, and Hashimoti: - Too much thyroid - Not enough thyroid - Too much corticosteroid - Not enough corticosteroid

Too much thyroid = Graves Not enough thyroid = Hashimoti Too much corticosteroid = Cushings Not enough corticosteroid = Addisons

A nurse concludes that a client has a hypoglycemic reaction to insulin. Which clinical findings support this conclusion? Select all that apply. a. Irritability b. Glycosuria c. Dry, hot skin d. Heart palpitations e. Fruity odor breath

A & D: Irritability, a neuroglycopenic symptom, occurs when the glucose in the brain declines to a low level. Heart palpitations, a neurogenic symptom, occur when the sympathetic nervous system responds to a rapid decline in blood glucose. Because the blood glucose level is decreased, the renal threshold is not exceeded, and there is no glycosuria. Dry, hot skin is consistent with dehydration, which often is associated with hyperglycemic states. Fruity odor of the breath is associated with hyperglycemia; it is caused by the breakdown of fats as a result of inadequate insulin supply.

Which strategies should be used to reduce pain during or after vaccination? Select all that apply. a. Applying topical anesthetic b. Providing tactile stimulation c. Holding the child upright during vaccination d. Performing intramuscular injections rapidly with prior aspiration e. Administering analgesics-antipyretics such as acetaminophen to reduce pain

A, B, C: Application of topical anesthetics on the skin before the injection numbs the skin and reduces the pain at the time of injection. Tactile stimulation at the injection site before and during injection results in reduced pain. Holding the child in an upright position provides a sense of control, can decrease fear, and help reduce pain. Avoiding aspiration prior to intramuscular injection, rather than encouraging it, reduces the pain. Administration of analgesics and antipyretics is avoided before and after vaccination because they reduce the immune response.

Which vaccine is administrated through the intranasal route? a. Rotavirus vaccine b. Influenza (live) vaccine c. Varicella virus vaccine d. HPV

B: Influenza (live) vaccine is administered through the intranasal route. The rotavirus vaccine is administered orally. The varicella virus vaccine is given as a subcutaneous injection. The human papillomavirus vaccine is given as intramuscular injection.

When is the first dose of Rotarix vaccine administered in infants? a. Birth to 6 weeks b. 6-12 weeks c. 12-18 weeks d. 18-24 weeks

B: The Rotarix vaccine prevents rotavirus gastroenteritis and diarrhea-related problems. The vaccination requires two doses. The first dose of Rotarix should be given between 6 and 12 weeks followed by the second dose, which is given four or more weeks after the first dose. Administering the vaccine before the age of 6 weeks is too early, and administering it at 12-18 weeks or 18-24 weeks is too late.

Which preparations use toxoids but not live viruses? Select all that apply. a. Rotarix b. Varivax c. M-M-R II d. PEDIARIX e. DAPTACEL

D & E: PEDIARIX consists of diphtheria and tetanus toxoids plus inactivated bacterial components of pertussis, inactive viral antigen of hepatitis B, and inactivated poliovirus vaccine. DAPTACEL is a preparation consisting of toxoids plus inactive bacterial and viral components of diphtheria and tetanus toxoids and acellular pertussis vaccine. Rotarix, Varivax, and M-M-R II are preparations containing live viruses.

Which drug class may cause kernicterus in neonates? a. Salicylates b. Tetracyclines c. Sulfonamides d. Glucocorticoids

c: Sulfonamides may cause kernicterus in neonates. Salicylates may cause Reye syndrome. Tetracyclines may cause the discoloration of developing teeth. Glucocorticoids may cause growth suppression.

Which group of the pediatric population is at a higher risk of developing respiratory complications upon administration of general anesthesia? a. infants b. children c. neonates d. adolescents

c: the physical characteristics of the larynx and small airway diameter, the structure of the respiratory system, and the high metabolic rate of neonates place them at a higher risk than infants, children, or adolescents of developing respiratory complications from anesthesia.

Which vaccine may cause intussusception in children? a. Rotavirus b. Hepatitis c. Measles, mumps, and rubella d. Diphtheria, tetanus, and pertussis

A: Rotavirus vaccines very rarely cause intussusception, a form of bowel obstruction in which the bowel telescopes in on itself. Hepatitis vaccines can cause anaphylactic reactions. The measles, mumps, and rubella vaccine may cause thrombocytopenia. The diphtheria, tetanus, and pertussis vaccine carries a small risk of causing acute encephalopathy, convulsions, and a shock-like state.

Which diseases are caused by viruses? Select all that apply. a. Mumps b. Tetanus c. Measles d. Hepatitis B e. Diphtheria

A, C & D: Mumps is a swelling of the parotid glands caused by a virus. Measles is a highly contagious viral disease characterized by rash and high fever. Hepatitis B (a serious liver infection) is caused by a virus. Tetanus is caused by Clostridium tetani and diphtheria is caused by Corynebacterium diphtheriae. Both are gram-positive bacilli bacterial strains

Which factors should the nurse consider when administering medications to adolescents? Select all that apply. a. Explanation of the medication administration procedure by the nurse to the client b. Interactive communication regarding the procedure of medication administration c. Implementation of comfort measures like holding d. Acceptance of aggressive behavior with certain limitations e. Encouragement of self-expression, individuality, and self-care

A,B,E: During administration of medication to the children of all age groups, the nurse should consider certain points. For adolescents, the nurse should provide a description regarding the procedure being conducted. The adolescent must be allowed to express fears and experiences regarding the administration, and self-expression, individuality, and self-care should be allowed and encouraged. Implementing comfort measures like holding are more appropriate for a younger age group, and accepting aggressive behavior with certain limitations is appropriate only for toddlers.

The nurse is caring for a child with Reye syndrome. Which nursing interventions would be beneficial to the child? Select all that apply. a. Maintain head & neck in a neutral position b. Administer aspirin for fever c. Assess vital signs of the child d. Monitor child for seizure activity e. Provide a quiet environment for the child

A,C,D,E: Several nursing interventions are beneficial to the child with Reye syndrome. Maintaining the head and neck in a neutral position helps to minimize increased intracranial pressure associated with cerebral edema, which is clinically manifested in Reye's syndrome. The vital signs and the neurologic status of the child are assessed to determine improvements or deterioration. Seizure activity is monitored because Reye syndrome can cause acute brain damage. A quiet environment is provided to reduce auditory and visual stimuli. Reye syndrome can be caused by aspirin, so its administration could cause further complications and should be avoided.

While the nurse is at the bedside of a client in acute renal failure, the client states, "My healthcare provider said that I will be getting some insulin. Do I also have diabetes?" What is the best nursing response? a. "No, the insulin will help your body handle the increased potassium level." b. "I suggest that you ask your healthcare provider that question." c. "You probably had an elevated blood glucose level, so your healthcare provider is being cautious." d. "No, but insulin will reduce the toxins in your blood by lowering your metabolic rate."

A: Insulin promotes the transfer of potassium into cells, which reduces the circulating blood level of potassium. The response "I suggest that you ask your healthcare provider that question" halts communication and is not supportive. Blood glucose levels usually are not elevated in acute renal failure. Insulin will not lower the metabolic rate.

Which condition may be the result of an adverse drug effect associated with administration of chloramphenicol in infants? a. Gray syndrome b. Tendon rupture c. Reye syndrome d. Sudden infant death syndrome

A: Administration of chloramphenicol in infants may cause Gray syndrome, also called Gray baby syndrome. This condition occurs due to limited drug-metabolizing capacity in infants. Fluoroquinolones may cause tendon rupture in pediatric clients. Administration of aspirin and other salicylates in infants and children may cause Reye syndrome. Phenothiazines may increase the risk of sudden infant death syndrome.

What will a nurse teach the parents of a toddler with newly diagnosed cystic fibrosis about the administration of vitamins A, D, E, and K? a. Offer them in a water-miscible form. b. Give them during meals and snack times. c. The dosage is based on the child's height and weight. d. Present them to the child with fruit juice rather than milk.

A: Because children with cystic fibrosis do not absorb fat-soluble vitamins effectively, they should be given in a water-miscible form. These vitamins may be given with other vitamins once a day; pancreatic enzymes are administered with meals and snacks. The nurse does not have to base the dosage of these vitamins on the child's height and weight. There is no reason to select juice over milk when administering these vitamins.

A pediatric client with a past history of chicken pox reports a fever and headache. Which drug should the nurse avoid giving to the client? a. Aspirin b. Tetracycline c. Nalidixic acid d. Chloramphenicol

A: Clients with a past history of chicken pox should not be administered aspirin because of the risk of the client developing Reye syndrome. Tetracycline generally causes discoloration of the teeth. Nalidixic acid sometimes causes cartilage erosion. Chloramphenicol is associated with Gray syndrome in children.

A client with type 1 diabetes comes to the clinic because of concerns regarding erratic control of blood glucose with the prescribed insulin therapy. The client has been experiencing a sudden fall in the blood glucose level, followed by a sudden episode of hyperglycemia. Which complication of insulin therapy should the nurse conclude that the client is experiencing? a. Somogyi effect b. Dawn phenomenon c. Diabetic ketoacidosis d. Hyperosmolar nonketotic syndrome

A: The Somogyi effect is a response to hypoglycemia induced by too much insulin; the body responds to the hypoglycemia by counterregulatory hormones stimulating lipolysis, gluconeogenesis, and glycogenolysis, resulting in rebound hyperglycemia. The Dawn phenomenon is hyperglycemia that is present on awakening in the morning because of the release of counterregulatory hormones in the predawn hours; it is thought that growth hormone or cortisol is related to this phenomenon. Diabetic ketoacidosis (diabetic coma) is a profound deficiency of insulin and is characterized by hyperglycemia, ketosis, acidosis, and dehydration. Hyperosmolar nonketotic syndrome occurs in clients with type 2 diabetes. It is a condition in which the client produces enough insulin to prevent diabetic ketoacidosis but not enough to prevent severe hyperglycemia, osmotic diuresis, and extracellular fluid depletion.

A nurse plans to teach a client with type 1 diabetes about the use of an insulin pump. What information will the nurse include in client teaching? a. Insulin pumps mimic the way a healthy pancreas works. b. The insulin pump's needle should be changed every day. c. Pumps are implanted in a subcutaneous pocket near the abdomen. d. The insulin pump's advantage is that it only requires glucose monitoring once a day.

A: The basal infusion rate mimics the low rate of insulin secretion during fasting, and the bolus before meals mimics the high output after meals. The subcutaneous needle may be left in place for as long as 3 days. Most insulin pumps are external to the body and access the body via a subcutaneous needle. Blood glucose monitoring is done a minimum of 4 times a day.

A client with type 1 diabetes self-administers NPH insulin every morning at 8 am. The nurse evaluates that the client understands the action of the insulin when the client identifies which time range as the highest risk for hypoglycemia? a. Noon to 8 pm b. 8 pm to noon c. 9 am to 10 am d. 10 am to 11 am

A: The time of greatest risk for hypoglycemia occurs when the insulin is at its peak. The action of intermediate-acting insulins peaks in four to 12 hours. Nine to 10 am and 10 am to 11 am are too soon for NPH to produce a hypoglycemic response. NPH insulin will have produced a hypoglycemic response before 8 pm and noon. A hypoglycemic response that occurs in 45 to 60 minutes after administration is associated with rapid-acting insulins.

A mother complains that her child's teeth have become yellow in color. With prolonged use, which medication may be responsible for the child's condition? a. Tetracycline b. Promethazine c. Chloramphenicol d. Fluoroquinolones

A: When administered to neonates and infants, tetracycline may cause staining of developing teeth. Promethazine can cause respiratory depression in children under 2 years of age. Chloramphenicol can cause Gray baby syndrome, and fluoroquinolones may cause tendon rupture in pediatric clients.

Which are indications for DDVAP? SATA a. Factor IX deficiency b. DI c. Nocturnal enuresis d. Factor XIII deficiency

B, C, & D

What are the pharmacokinetic reasons for drug sensitivity in infants? Select all that apply. a. Small body size b. Drug absorption c. Renal drug excretion d. Protein binding of drugs e. Hepatic drug metabolism

B, D, &E: Increased drug sensitivity in infants is a result of the immature state of pharmacokinetic processes such as drug absorption, renal drug excretion, protein binding of drugs, and hepatic drug metabolism. A small body is not a pharmacokinetic parameter.

Which statements regarding the adverse effects of immunization are true? Select all that apply. a. Only diphtheria vaccines cause acute encephalopathy. b. The oral poliovirus vaccine causes paralytic poliomyelitis. c. The hepatitis B vaccine is the safest vaccine because it does not cause any adverse side effects. d. Swelling of glands in the cheeks and neck is an adverse effect of the measles vaccine. e. Fever and erythema at the injection site are common adverse effects of all vaccines.

B,D, & E: Paralytic poliomyelitis is caused only by the poliovirus vaccine; it occurs when the live vaccine undergoes mutation in the intestine and enters the central nervous system. The swelling of glands in the cheeks and neck is a mild adverse effect of the measles vaccine. Almost all vaccines cause fever and erythema at the injection site; these effects are the result of activation of the body's defense mechanism. Acute encephalopathy is a serious side effect of not only the diphtheria vaccine but also the tetanus toxoid and acellular pertussis vaccine. Hepatitis B, with only mild side effects, is one of the safest vaccines.

Daily regular insulin has been prescribed for a client with type 1 diabetes. The nurse administers the insulin at 8 am. When should the nurse monitor the client for a potential hypoglycemic reaction? a. At breakfast b. Before lunch c.Before dinner d. In the early afternoon

B: Regular insulin is short acting and peaks in 2 to 4 hours, which in this case will be at or before lunch. Breakfast is too soon; regular insulin peaks in 2 to 4 hours. Before dinner is too late; regular insulin peaks in 2 to 4 hours. The early afternoon is too late; regular insulin peaks in 2 to 4 hours.

A nurse is teaching parents of toddlers about why children receiving specific medications should not receive varicella vaccines. Which medication will be included in the discussion? a. Insulin b. Steroids c. Antibiotics d. Anticonvulsants

B: Steroids have an immunosuppressive effect. It is thought that resistance to certain viral diseases, including varicella, is greatly decreased when a child takes steroids regularly. There is no known correlation between varicella and insulin. Because varicella is a viral disease, antibiotics will have no effect. There is no known correlation between varicella and anticonvulsants.

What medication does a nurse expect to administer to control bleeding in a child with hemophilia A? a. Albumin b. Fresh frozen plasma c. Factor VIII concentrate d.Factors II, VII, IX, X complex

C: Factor VIII is the missing plasma component necessary to control bleeding in a child with hemophilia A. Factor VIII is not provided by albumin. Although fresh frozen plasma does contain factor VIII, there is an insufficient amount in a plasma transfusion; a higher volume is required. A complex of factors II, VII, IX, and X is not useful in this situation.

The mother of an infant complains to the nurse, "My child is rejecting the oral medication because it tastes bitter." What suggestion should the nurse give to the mother? a. Mix the medication with honey b. Mix the medication into the child's formula c. Mix the medication with a teaspoon of sherbet d. Give the child a flavored frozen ice pop before administering the

C: Oral medications should be mixed with a teaspoon of sherbet or jelly to mask the bitter taste and make it palatable. Honey should not be given to infants because of the risk of botulism. Avoid mixing the medication in essential food items such as milk, formula, and orange juice because the child may reject that food later. A flavored frozen ice pop should be given after administering the medication but not before.

Which statement is true regarding drug absorption in infants? a. Absorption is decreased for acid-labile drugs. b. Absorption is increased when gastric emptying is decreased. c. Absorption of drugs through the intramuscular route is rapid. d. Absorption of drugs through the transdermal route is faster in an infant but no more so than that in a child.

D: Blood flow through the muscle is fast during the infancy; therefore, intramuscular absorption is rapid, more so than in neonates and older children. Acid-labile drugs have increased absorption because infants have low gastric acidity until 2 years of age. Absorption of drugs is not dependent on gastric emptying. This is because delayed gastric emptying for the drugs absorbed through the stomach results in faster absorption, while that in the intestine results in delayed absorption. The stratum corneum of the skin in infants is very thin, and the blood flow is much faster through it than in older children and adults. Therefore, transdermal drug absorption is much faster in infants than in children.

Which statement is true about the absorption of drugs in pediatrics? a. Gastric emptying time is delayed in early infancy, which affects absorption. b. Drug absorption following intramuscular injection is rapid in the neonate. c. Gastric acidity reaches adult values in 1 year of age, which affects absorption. d. Infants are at increased risk for toxicity through transdermal administration due to thinner skin increasing absorption.

D: Blood flow to the skin is higher in infants because they have thinner skin, so drug absorption is rapid through transdermal administration. This causes increased risk of toxicity. Gastric emptying time is prolonged and irregular in early infancy, enhancing absorption. Drug absorption through intramuscular injection is slow and erratic. Although lower gastric acidity does affect absorption, gastric acidity in children doesn't reach adult values until 2 years of age.

The nurse is teaching a parent of a 2-year-old toddler how to administer ear drops. In what direction does the nurse teach the parent to gently pull the pinna? a. Forward b. Up and back c. Straight back d. Down and back

D: In children younger than 3 years of age the eustachian tube is shorter, wider, and more horizontal. Pulling the pinna down and back facilitates passage of fluid by way of gravity to the eardrum. Pulling the pinna forward does not help position the canal for passage of the drops to the eardrum. Pulling the pinna up and back is the technique used for administering ear drops to children older than 3 years of age and adults. Pulling the pinna straight back does not position the canal for passage of the drops to the eardrum.

A 4-year-old child develops thrombocytopenia after vaccination. Which vaccination may be responsible? a. Rotavirus vaccine b. Varicella virus vaccine c.Human papillomavirus vaccine d. Measles, mumps, and rubella virus vaccine (MMR)

D: Measles, mumps, and rubella virus vaccine (MMR) may cause transient thrombocytopenia. It is generally benign and occurs only rarely. Rotavirus vaccine carries a small risk for intussusception. Varicella virus vaccine and human papillomavirus vaccine may cause mild effects such as fever and fainting.

A client is prescribed metformin extended release to control type 2 diabetes mellitus. Which statement made by this client indicates the need for further education? a. "I will take the drug with food." b. "I must swallow my medication whole and not crush or chew it." c. "I will notify my doctor if I develop muscular or abdominal discomfort." d. "I will stop taking metformin for 24 hours before and after having a test involving dye."

D: Metformin must be withheld for 48 hours before the use of iodinated contrast materials to prevent lactic acidosis. Metformin is restarted when kidney function has returned to normal. Metformin is taken with food to avoid adverse gastrointestinal effects. If crushed or chewed, metformin XL will be released too rapidly and may lead to hypoglycemia. Muscular and abdominal discomfort is a potential sign of lactic acidosis and must be reported to the health care provider.

At 4:30 pm, a client who is receiving NPH insulin every morning states, "I feel very nervous." The nurse observes that the client's skin is moist and cool. What is the nurse's most accurate interpretation of what the client is likely experiencing? a. Polydipsia b. Ketoacidosis c. Glycogenesis d. Hypoglycemia

D: The time of the client's response corresponds to the expected peak action (4 to 12 hours after administration) of the intermediate-acting insulin that was administered in the morning; this can result in hypoglycemia. Hypoglycemia triggers the sympathetic nervous system; epinephrine causes diaphoresis and nervousness. Osmotic diuresis causes thirst; this is related to hyperglycemia, not to hypoglycemia. Warm, dry, flushed skin and lethargy are associated with ketoacidosis. Glycogenesis, the formation of glycogen in the liver, is unrelated to nervousness and cool, moist skin.

A child has unknowingly swallowed a poisonous substance and has fallen unconscious. Which nursing intervention is advisable for the child? a. Administer ipecac immediately. b. Run tap water over the child's face for some time. c. Make a call to the national poison control hotline. d. Make arrangements so that the child is taken to the hospital

D: When the child has collapsed and is unconscious, an emergency call should be made to 911, and transport should be arranged for the child to be shifted to the hospital for treatment. Ipecac was once used as an emetic for poison, but it has since been banned from use by the American Academy of Pediatrics. Running tap water over the child's face would only counter the poison if the child's eyes or skin had been exposed. If the child was still conscious, then a call to the national poison control hotline would not be advisable.

When providing teaching about acarbose (Precose) which statement would the nurse include?

Hypoglycemia must be treated with glucose not sucrose (table sugar)