Endocrine Fall 2017
A health care professional administers pramlintide (Symlin) at 0800 to a patient who has type 1 diabetes mellitus. At which of the following times should the patient expect the drug to exert its peak action? 0820 0900 1000 1100
0820 Pramlintide, an amylin mimetic, peaks 20 min after administration. The health care professional should monitor the patient for indications of hypoglycemia, such as diaphoresis and tremors.
1. Desmopressin (DDAVP) 2. Glucagon (GlucaGen) 3. Glipizide (Glucotrol) 4. Radioactive iodine-131 (Iodotope) A. Type 2 diabetes mellitus B. Hypoglycemia C. Thyroid cancer D. Diabetes insipidus
1. Desmopressin (DDAVP)-- D. Diabetes insipidus 2. Glucagon (GlucaGen)-- B. Hypoglycemia 3. Glipizide (Glucotrol)-- A. Type 2 diabetes mellitus 4. Radioactive iodine-131 (Iodotope)-- C. Thyroid cancer Desmopressin, an antidiuretic hormone, treats diabetes insipidus. Glucagon, a hyperglycemic drug, treats hypoglycemia due to an insulin overdose. Glipizide, a sulfonylurea, is an oral antidiabetic drug that treats type 2 diabetes mellitus. Radioactive iodine-131, an antithyroid drug, treats hyperthyroidism from Graves' disease and also thyroid cancer.
1. Hydrocortisone (Cortef) 2. Somatropin (Genotropin) 3. Propylthiouracil (PTU) 4. Levothyroxine (Synthroid) A. Hypothyroidism B. Thyrotoxic crisis C. Addison's disease D. Turner's syndrome
1. Hydrocortisone (Cortef)--C. Addison's disease 2. Somatropin (Genotropin)--D. Turner's syndrome 3. Propylthiouracil (PTU)-- B. Thyrotoxic crisis 4. Levothyroxine (Synthroid)--A. Hypothyroidism Hydrocortisone, a glucocorticoid, treats acute and chronic adrenocortical insufficiency. Somatropin, a growth hormone, treats growth hormone deficiencies, such as Turner's syndrome. Propylthiouracil, an antithyroid drug, treats hyperthyroidism or Graves' disease and thyrotoxic crisis. Levothyroxine, a thyroid replacement hormone, treats hypothyroidism.
You give the patient five units of lispro insulin (Humalog) and 10 units of insulin glargine subcutaneously at 1400. Based on your instructions, the patient should expect her blood glucose level to be the lowest at which of the following times? 1430 1530 1630 1730
1430 Lispro insulin is a rapid-acting insulin that has an onset of less than 15 minutes and peaks at 30 minutes to an hour. The patient's glucose should be the lowest between 1430 and 1500. Lispro insulin has a duration of 3 to 4 hours, so the patient should continue to check her blood glucose and watch for indications of hypoglycemia, such as tremors, headache, and weakness. Insulin glargine does not have a peak and lasts up to 24 hours.
The patient will self-inject eight units of NPH insulin and four units of regular insulin each day before breakfast. As you show the patient how to self-administer insulin, you should include which of the following instructions? (Select all that apply.) A. Draw the regular insulin into the syringe first, then the NPH insulin. B. Inject the insulin mixture into a large muscle. C. Discard any unused premixed syringes within 5 days. D. Use a 5-mL syringe when mixing two types of insulins. E. Use one syringe to reduce the number of injections.
A. Draw the regular insulin into the syringe first, then the NPH insulin. E. Use one syringe to reduce the number of injections. You should instruct the patient to draw the regular insulin into the syringe first to prevent mixing NPH insulin into the vial of regular insulin, which could cause a change in the onset of action of the regular insulin. The patient should inject insulin subcutaneously, not into a large muscle. The patient may store premixed syringes for 1 to 2 weeks refrigerated and vertical with the needles pointing upward. The patient should resuspend the insulin gently prior to injection, and must always use an insulin syringe to prevent errors in dosing. The patient may mix NPH insulin and regular insulin in the same syringe to reduce the number of injections. The patient should not mix insulin glargine or insulin detemir with any other insulin.
The next day, two hours after self-administering regular insulin subcutaneously, the patient contacts you at the provider's office to report that she is sweating, shaky, and has a rapid pulse. Which of the following actions should you advise her to take? A. Drink 4 oz of orange juice. B. Check her blood glucose level. C. Take an oral hypoglycemic. D. Measure her urine output. E. Self-administer a long-acting insulin.
A. Drink 4 oz of orange juice. B. Check her blood glucose level. Subcutaneous regular insulin peaks in 2 to 3 hours and can cause hypoglycemia. The patient knows to watch for indications of hypoglycemia, such as tachycardia, hunger, shakiness, and diaphoresis. At this point, she should check her blood glucose level and, if it is low, consume 15 to 20 grams of carbohydrates to treat hypoglycemia. She should retest in 15 to 20 minutes and repeat the carbohydrate snack if she is still hypoglycemic. She should not take an oral hypoglycemic or a long-acting hypoglycemic for indications of hypoglycemia, because those options would worsen her hypoglycemic state. Regular insulin is unlikely to affect urine output.
A patient is about to start taking hydrocortisone (Cortef) to treat adrenocortical insufficiency. You should instruct the patient to do which of the following to help reduce her risk for adverse effects of this drug? (Select all that apply.) A. Expect lifelong therapy. B. Carry extra doses of the drug. C. Expect periodic blood sampling. D. Urinate every 4 hr. E. Report increased stress.
A. Expect lifelong therapy. B. Carry extra doses of the drug. C. Expect periodic blood sampling. E. Report increased stress. Hydrocortisone therapy must continue for life because there are no other therapies that can restore adrenocortical function. It is important for the patient to carry an emergency supply of hydrocortisone because she might need to take more during times of physical and emotional stress. Hydrocortisone therapy requires obtaining CBC, electrolyte, glucose, and glucocorticoid levels at baseline and periodically thereafter to monitor efficacy of hydrocortisone in restoring the body's ability to maintain and balance these levels. Hydrocortisone is unlikely to cause urinary retention, although it can cause urinary urgency and frequency. Tell the patient to report increased stress, as her dosage might require an adjustment during stressful times.
When talking with a patient who is about to begin exenatide (Byetta) therapy to treat type 2 diabetes mellitus, the health care professional should include which of the following instructions? (Select all that apply.) A. Inject the drug subcutaneously. B. Expect the peak effect in 2 hr. C. Use the drug as a supplement to an oral hypoglycemic. D. Inject the drug 1 hr after a meal. E. Discard used pens 10 days after the first use.
A. Inject the drug subcutaneously is correct. The patient should inject exenatide, an incretin mimetic, into the subcutaneous tissue of the thigh, upper arm, or abdomen. B. Expect the peak effect in 2 hr is correct. Levels of exenatide peak 2 hr after administration and then decrease gradually, with a half-life of 2.4 hr. C. Use the drug as a supplement to an oral hypoglycemic is correct. Exenatide supplements the action of an oral hypoglycemic, such as a sulfonylurea or metformin (Glucophage).
When talking with a 30-year-old woman who will receive radioactive iodine-131 (Iodotope) to treat Graves' disease, you should include which of the following instructions? (Select all that apply.) A. Report weight gain and edema. B. Use effective contraception. C. Allow 2 to 3 months for full effects. D. Expect periodic blood sampling. E. Obtain regular eye examinations.
A. Report weight gain and edema. B. Use effective contraception. C. Allow 2 to 3 months for full effects. D. Expect periodic blood sampling. Radioactive iodine-131, an antithyroid drug, can cause hypothyroidism. Instruct the patient to report any indications of hypothyroidism, such as drowsiness, depression, weight gain, or edema. Radioactive iodine-131 is a pregnancy risk category X drug. Confirm a negative pregnancy test prior to therapy and tell the patient to use effective contraception throughout treatment. It may take 2 to 3 months to see the full effects of radioactive iodine-131. This drug can cause bone marrow suppression, so make sure the patient expects periodic blood sampling to detect bone marrow suppression, such as CBCs, as well as thyroid hormone levels. Radioactive iodine-131 is unlikely to affect the patient's eyes. Fludrocortisone is an example of an endocrine-system drug that can cause cataracts and glaucoma with long-term use.
A health care professional is caring for a patient who is about to begin taking propylthiouracil (PTU) to treat hyperthyroidism. The health care professional should tell the patient to report which of the following adverse effects? (Select all that apply.) A. Sore throat B. Muscle pain C. Insomnia D. Bradycardia E. Rash
A. Sore throat is correct. Propylthiouracil, an antithyroid drug, can cause agranulocytosis. The health care professional should monitor the patient's CBC, and tell the patient to report fever or sore throat. B. Muscle pain is correct. Propylthiouracil can cause arthralgia and myalgia. The health care professional should tell the patient to report these effects and take over-the-counter analgesics for pain relief. D. Bradycardia is correct. Propylthiouracil can cause hypothyroidism, manifesting as bradycardia, drowsiness, and weight gain. The health care professional should tell the patient to report these effects. E. Rash is correct. Propylthiouracil can cause urticaria or a skin rash. The health care professional should tell the patient to report these effects.
When talking with a patient about taking fludrocortisone to treat adrenocortical insufficiency, the health care professional should tell the patient to do which of the following to reduce the risk of adverse reactions? (Select all that apply.) A. Weigh yourself daily. B. Report weakness or palpitations. C. Have your blood pressure checked regularly. D. Eat more iron-rich foods. E. Avoid drinking grapefruit juice.
A. Weigh yourself daily is correct. Fludrocortisone, a mineralocorticoid, can cause fluid and electrolyte imbalances, such as hypernatremia. Tracking weight on a daily basis can help identify weight gain and edema; reporting it can expedite any essential interventions. B. Report weakness or palpitations is correct.Fludrocortisone can cause hypokalemia. The health care professional should monitor the patient's potassium levels, and tell her to report muscle weakness or palpitations. C. Have your blood pressure checked regularly is correct. Fludrocortisone can cause fluid retention and hypertension. The health care professional should monitor the patient's fluid balance and blood pressure to expedite any essential interventions.
A patient who is taking metformin (Glucophage) to treat type 2 diabetes mellitus plans to undergo angiography using iodine-containing contrast dye. The health care professional should recognize that an interaction between metformin and the IV contrast dye can increase the patient's risk for which of the following? Hypokalemia Hyperglycemia Acute renal failure Acute pancreatitis
Acute renal failure Metformin, a biguanide, can interact with iodine-containing contrast dye, causing acute renal failure and lactic acidosis. The health care professional should withhold metformin for 48 hr prior to and following the procedure. The health care professional should also monitor the patient for indications of acute renal failure or lactic acidosis, such as reduced urine output, hyperventilation, and abdominal pain.
Prophylthiouracil (PTU) Methimazole (Tapazole)
Anti-Thyroid Drugs/Propylthiouracil
Desmopressin (DDAVP, Stimate, Minirin) Vasopressin (Pitressin)
Antidiuretic Hormone
When talking to a patient who is about to begin glipizide (Glucotrol) therapy to treat type 2 diabetes mellitus, the health care professional should include which of the following instructions? Avoid drinking alcohol. Sit or stand for 30 min after taking the drug. Urinate every 4 hr. Take the drug 2 hr after a meal.
Avoid drinking alcohol. Alcohol can interact with glipizide, a sulfonylurea, causing a reaction similar to disulfiram (Antabuse), manifesting as nausea, palpitations, and flushing. Alcohol also increases the drug's hypoglycemic effects. The health care professional should tell the patient to avoid drinking alcohol.
A health care professional is caring for a patient who is about to begin taking pioglitazone (Actos) to treat type 2 diabetes mellitus. The health care professional should explain to the patient the need to monitor which of the following laboratory tests? (Select all that apply.) A. Thyroid-stimulating hormone (TSH) B. Alanine aminotransferase (ALT) C. LDL D. CBC E. Creatinine clearance
B. ALT is correct. Pioglitazone can cause liver injury. The health care professional should monitor ALT at the start of therapy and every 3 to 6 months thereafter. The health care professional should tell the patient to report jaundice, dark-colored urine, or abdominal pain. C. LDL is correct. Pioglitazone can cause elevations in both high-density lipoproteins, which is a beneficial effect, and LDLs, which is a detrimental effect. The health care professional should monitor the patient's plasma lipid levels at baseline and periodically throughout drug therapy.
As you continue to talk with the patient about managing her diabetes with regular insulin (Humulin R), you should include which of the following instructions? (Select all that apply.) A. Self-inject chilled insulin. B. Carry a carbohydrate snack. C. Rotate injection sites. D. Wear a medical alert bracelet. E. Expect to adjust the dosage during illness.
B. Carry a carbohydrate snack. C. Rotate injection sites. D. Wear a medical alert bracelet. E. Expect to adjust the dosage during illness. Injectable insulin can cause lipohypertrophy, an accumulation of subcutaneous fat. Injecting room temperature insulin and rotating injection sites helps minimize this adverse effect. The patient should carry a carbohydrate snack with her at all times in case of hypoglycemia. She should also wear a medical alert bracelet in case of hypoglycemia that causes a loss of consciousness, so that health care professionals will know to administer glucose or glucagon parenterally. The patient should anticipate insulin dosage adjustments during stress, illness, infection, or pregnancy.
A health care professional is caring for a patient who is about to begin insulin glargine (Lantus) therapy. The health care professional should recognize the need for additional precautions because the patient also takes which of the follow types of drugs? Oral contraceptives Calcium supplements Beta blockers Iron supplements
Beta blockers Patients who take insulin and also take beta blockers are at risk for failing to promptly recognize the symptoms of hypoglycemia because they mask symptoms such as tachycardia and tremors. They also increase hypoglycemic effects.
A health care professional is caring for a patient who is about to begin taking somatropin (Genotropin). The health care professional should explain the need to monitor which of the following laboratory tests? (Select all that apply.) A. Blood amylase B. Creatinine clearance C. Urine calcium D. Blood glucose E. CBC
C. Urine calcium is correct. Somatropin can cause hypercalciuria. The health care professional should monitor the patient's urine calcium, and tell the patient to report flank pain, urinary frequency, or hematuria. D. Blood glucose is correct. Somatropin can cause hyperglycemia. The health care professional should monitor the patient's blood glucose levels, and tell the patient to report polyphagia, polydipsia, and polyuria.
When talking with a patient who is about to begin repaglinide (Prandin) therapy to treat type 2 diabetes mellitus, the health care professional should include which of the following instructions? Do not drink more than 1 L of grapefruit juice per day. Carry a high-protein snack at all times. Drink 16 oz of water after taking the drug. Use ginseng to reduce nausea.
Do not drink more than 1 L of grapefruit juice per day. More than 1 L of grapefruit juice per day can increase the hypoglycemic effects of repaglinide, a meglitinide. The health care professional should tell the patient to avoid drinking large amounts of grapefruit juice.
A health care professional is caring for a patient who is about to begin acarbose (Precose) therapy to treat type 2 diabetes mellitus. Which of the following instructions should the health care professional include when talking with the patient about the drug? Eat more iron-rich foods. Avoid drinking grapefruit juice. Increase fiber intake. Avoid drinking green tea.
Eat more iron-rich foods. Acarbose, an alpha-glucosidase inhibitor, can cause iron-deficiency anemia. The health care professional should tell the patient to increase his intake of iron-rich foods, such as red meat, spinach, and grains, and monitor the patient's CBC.
A health care professional is caring for a patient who is about to begin taking radioactive iodine-131 (Iodotope) to treat Graves' disease. Which of the following instructions should the health care professional include when talking with the patient about the drug? Take the drug once daily for 5 days. Expect a bitter, acid-like taste. Restrict fluid intake after taking the drug. Expect full effects in 2 to 3 months.
Expect full effects in 2 to 3 months. The full therapeutic effects of radioactive iodine-131, an antithyroid drug, take 2 to 3 months, and with successful treatment, hypothyroidism can result.
A health care professional is caring for a patient who is about to begin levothyroxine (Synthroid) therapy to treat hypothyroidism. Which of the following instructions should the health care professional include when talking with the patient about taking the drug? Take levothyroxine with food to increase absorption. Take levothyroxine with an antacid to reduce GI effects. Expect life-long therapy with the drug. Carry a carbohydrate snack at all times.
Expect life-long therapy with the drug. Therapy with levothyroxine, a thyroid replacement hormone, usually continues for life because there are no other therapies that can restore thyroid function.
Signs of hypocortisolism
Fatigue Weakness Weight loss Hypoglycemia
Which of the following drugs should a health care professional have available for a patient who is experiencing an insulin overdose? Naloxone Diphenhydramine Acetylcysteine (Acetadote) Glucagon (GlucaGen)
Glucagon (GlucaGen) Glucagon, a hyperglycemic that can be given subcutaneously, IM, or IV, treats severe hypoglycemia from an insulin overdose in patients who are unconscious and for whom IV glucose is not readily available. If the patient does not respond to glucagon, the health care professional should administer a glucose solution IV.
Hydrocortisone (Hydrocortone, Solu-Cortef) Prednisone (Deltasone) Dexamethasone (Decadron)
Glucocorticoids
Somatropin (Genotropin, Nutropin, Humatrope,Serostim)
Growth Hormone
A patient is about to start taking somatropin (Genotropin). You plan to evaluate the effectiveness of this drug therapy with which of the following assessments? Level of consciousness ECG Height and weight Breath sounds and respiratory rate
Height and weight Somatropin, a growth hormone, increases growth in patients who have insufficient growth hormone. Gradual increases in weight and height reflect effective therapy, so you'll monitor the patient's weight and height on an ongoing basis. Somatropin is unlikely to affect heart rate or rhythm, level of consciousness, or respiratory status. It can, however, cause hyperglycemia and hypercalciuria. Be sure to monitor serum glucose and urine calcium and instruct the patient to watch for and report polyphagia, polyuria, or flank pain.
When considering replacement therapy options for a patient who has chronic adrenocortical insufficiency, the primary care provider should choose which of the following drugs? Somatropin (Genotropin) Hydrocortisone (Cortef) Glucagon (GlucaGen) Desmopressin (DDAVP)
Hydrocortisone (Cortef) Hydrocortisone, a glucocorticoid, provides replacement therapy for acute and chronic adrenocortical insufficiency, such as Addison's disease.Hydrocortisone is identical to cortisol, the primary glucocorticoid the adrenal cortex generates.
Signs of hypercortisolism
Hyperglycemia Fat redistribution Osteoporosis
You are caring for a patient who is taking levothyroxine (Synthroid) to treat hypothyroidism. The patient reports palpitations, weight loss, and diarrhea. You suspect which of the following adverse effects of this drug? Hyperthyroidism Addison's disease Myxedema Hyperglycemia
Hyperthyroidism Levothyroxine, a thyroid hormone replacement drug, can cause hyperthyroidism if the prescribed dose exceeds what the patient requires to remain euthyroid. Monitor thyroid function via T4 and TSH levels. Instruct the patient to watch for and report indications of hyperthyroidism, such as anxiety, insomnia, tachycardia, palpitations, diarrhea, and weight loss. Levothyroxine does not cause myxedema or Addison's disease. Addison's disease is due to adrenal insufficiency, and levothyroxine treats myxedema coma. Levothyroxine is unlikely to cause hyperglycemia. Injectable hypoglycemics, such as insulin, can cause hypoglycemia.
A patient who is taking propylthiouracil (PTU) contacts the health care professional to report weight gain, drowsiness, and depression. The health care professional should suspect which of the following adverse reactions to the propylthiouracil? Thyrotoxicosis Hypothyroidism Lactic acidosis Radiation sickness
Hypothyroidism Propylthiouracil, an antithyroid drug, can cause hypothyroidism, manifesting as drowsiness, depression, weight gain, edema, and bradycardia. The health care professional should request that the primary care provider prescribe a lower dosage of the drug for the patient.
A health care professional is caring for a patient who is about to begin pramlintide (Symlin) therapy to treat type 1 diabetes mellitus. Which of the following instructions should the health care professional include when talking with the patient about using the drug? Mix pramlintide with insulin. Inject pramlintide before meals. Take pramlintide at bedtime. Inject pramlintide into the upper arm.
Inject pramlintide before meals. The patient should inject pramlintide, an amylin mimetic, 20 min before a meal that contains at least 30 g of carbohydrates.
When talking with a patient about self-administering regular insulin (Humulin R), you should include which of the following instructions? Shake the vial vigorously. Expect the solution to appear cloudy. Store unopened vials at room temperature. Inject the insulin subcutaneously.
Inject the insulin subcutaneously. Make sure the patient understands how to inject insulin subcutaneously. Tell him not to shake the vial vigorously but to rotate it gently to disperse the particles. He should not use insulin that appears cloudy or discolored. Tell him to refrigerate unopened vials until their expiration date and to keep opened vials at room temperature up to 1 month.
NPH (Humulin N) Insulin detemir (Levemir)
Intermediate Acting
A patient who is taking metformin (Glucophage) to treat type 2 diabetes mellitus contacts the health care professional to report muscle pain. The health care professional should suspect which of the following adverse reactions? Lactic acidosis Anticholinergic effects Extrapyramidal symptoms Hypophosphatemia
Lactic acidosis Metformin, a biguanide, can cause lactic acidosis, which is a life-threatening complication, manifesting as muscle aches, sleepiness, malaise, and hyperventilation. The patient should stop taking the drug and seek medical care immediately.
A health care professional is talking to a patient about self-injecting Regular insulin (Humulin). The health care professional should tell the patient to rotate injection sites to prevent which of the following? Rapid absorption Intradermal injection Injection pain Lipohypertrophy
Lipohypertrophy Lipohypertrophy, also called lipodystrophy, is a proliferation of fat at the sites of repeated insulin injections. It affects skin sensitivity and appearance. To prevent it, the patient should rotate injection sites, keeping them at least 1 inch apart, and avoid using the same spot within the same month.
Insulin glargine (Lantus)
Long Acting
Treat Type 2 DM Usually first line for newly diagnosed diabetics. Decrease absorption glucose from intestine. Decrease synthesis of glucose by liver Increase sensitivity of insulin receptors in tissues.
Metformin (Biguanides)
Fludrocortisone (Forinef)
Mineralocorticoids
Sulfonylureas Meglitinides Biguanides Thiazolidinediones Alpha-glycosidase inhibitors Gliptins
Oral Hypoglycemics
You instruct the patient to watch for and report which of the following indications of an adverse reaction to insulin? Palpitations Weight gain Low urine output Constipation
Palpitations Insulin can cause hypokalemia. You should monitor potassium levels and ECG and instruct the patient to watch for and report muscle weakness, nausea, palpitations, or paresthesias. Insulin can cause hypoglycemia, which causes tachycardia, palpitations, and diaphoresis. Insulin is unlikely to cause weight gain. Desmopressin, whose brand name is DDAVP, is an example of an endocrine-system drug that can cause fluid retention and weight gain. Insulin is unlikely to cause reduced urine output, although hyperglycemia can cause polyuria. Insulin is unlikely to cause constipation. Repaglinide, whose brand name is Prandin, is a meglitinide that can cause diarrhea.
You are caring for a patient who is taking exenatide (Byetta) to treat type 2 diabetes mellitus. The patient reports severe abdominal pain. You suspect which of the following adverse reactions to this drug? Peptic ulcer disease Hyperkalemia Hyperglycemia Pancreatitis
Pancreatitis Exenatide, an incretin mimetic agent, can cause acute pancreatitis. You instructed the patient to watch for and report severe or persistent abdominal pain, so you should now inform the provider and tell the patient to stop taking the drug. Exenatide is unlikely to cause hyperkalemia, an effect much more likely with insulin. For patients taking insulin, monitor potassium levels and instruct them to report muscle weakness or palpitations. Exenatide is more likely to cause hypoglycemia than hyperglycemia, so monitor blood glucose levels carefully and administer a carbohydrate for hypoglycemia. Indications of hypoglycemia include tachycardia, diaphoresis, shakiness, and weakness.
A patient who is taking glipizide (Glucotrol) to treat type 2 diabetes mellitus contacts the health care professional to report feeling shaky, hungry, and fatigued. The health care professional should tell the patient to do which of the following? Drink 16 oz of water. Perform a fingerstick blood glucose check. Take another glipizide tablet. Lie down and rest.
Perform a fingerstick blood glucose check. Glipizide, a sulfonylurea, can cause hypoglycemia, which can manifest as diaphoresis, shakiness, hunger, and fatigue. The health care professional should tell the patient to check her blood glucose level, and if it indicates hypoglycemia, consume a snack of 15 to 20 g of carbohydrates, retest in 15 to 20 min, and repeat if her blood glucose level is still low.
Concurrent used of thiazide diuretics and glucocorticoids may do what?
Raise blood glucose levels
Lispro (Humalog) Insulin aspart (NovoLog)
Rapid Acting
A primary care provider should prescribe a lower dose of sitagliptin (Januvia) for a patient who has type 2 diabetes mellitus and who also has which of the following? Thyroid disease Bronchitis Heart failure Renal impairment
Renal impairment Sitagliptin, a gliptin, requires cautious use with patients who have renal dysfunction and low creatinine clearance because the kidneys eliminate the drug virtually intact. The primary care provider should prescribe a lower dose for this patient or prescribe a different hypoglycemic drug.
Regular (Humulin R) Regular (Novolin R)
Short acting
A health care professional is caring for a patient who is taking repaglinide (Prandin) 15 to 30 min before each meal to treat type 2 diabetes mellitus. The patient asks the health care professional what to do if he skips a meal. Which of the following is the appropriate response? Double the dose before the next meal. Take half the dose. Skip the dose. Take the usual dose.
Skip the dose. To avoid a sudden and serious drop in blood glucose level, the patient should skip the dose of repaglinide, a meglitinide, whenever he skips a meal, and try to avoid skipping meals.
A patient is about to start taking sustained release glipizide (Glucotrol) to treat type 2 diabetes mellitus. Which of the following instructions should you include when talking with the patient about taking this drug? Chew the tablet completely before swallowing it. Take it once a day, 30 min before selected meals. Take it in the evening before bedtime. Drink 16 oz of water right after taking it.
Take it once a day, 30 min before selected meals. Instruct the patient to take sustained-release glipizide, a sulfonylurea, 30 min before the first meal of the day. Other drugs in this category require one to three doses per day before selected meals. Tell her not to chew or crush the sustained-release tablets. It is not necessary to drink 16 oz of water after taking the drug, but it is not harmful to do so, either. Because glipizide peaks in 1 to 2 hr, it is inappropriate to take it at bedtime and appropriate to have a meal after taking it. Be sure to monitor the patient for signs of hypoglycemia, such as diaphoresis and tachycardia. Also, monitor heart rate and ECG. Instruct the patient to watch for and report palpitations.
Levothyroxine (Synthroid) Liothyronine (Cytomel) Liotrix (Thyrolar) Thyroid (Thyroid USP)
Thyroid Replacements
You are caring for a patient who takes acarbose (Precose) and a sulfonylurea to treat type 2 diabetes mellitus. Which of the following is an indication of an adverse reaction to this drug combination? Polyuria Tremors Bradycardia Thirst
Tremors This drug combination can cause hypoglycemia. Indications of a hypoglycemic reaction include hunger, tachycardia, shakiness, tremors, and diaphoresis. Polyuria and thirst are indications of hyperglycemia, not hypoglycemia. Tachycardia, not bradycardia, is an indication of hypoglycemia. Acarbose, with or without sulfonylurea therapy, is unlikely to cause bradycardia.
A health care professional is caring for a patient who is taking pioglitazone (Actos) to treat type 2 diabetes mellitus. The health care professional should monitor for which of the following findings that indicates an adverse effect? Joint pain Constipation Weight gain Dilated pupils
Weight gain Pioglitazone, a thiazolidinedione, can cause fluid retention. The health care professional should monitor weight or other indications of fluid retention or heart failure, including dyspnea, crackles, and wheezing.
A health care professional should question the use of levothyroxine (Synthroid) for a patient who has bacterial skin infections. diabetes insipidus. immunosuppression. a myocardial infarction.
a myocardial infarction. Levothyroxine, a thyroid replacement hormone, can cause tachycardia, palpitations, and hypertension, especially when the patient requires a dosage adjustment; therefore, it is contraindicated for patients who have recently had a myocardial infarction.
A nurse is admitting a client to an acute care facility for a total hip athroplasty. The client takes hydrocortisone for Addison's disease. Which of the following actions is the nurse's priority? a. administering supplemental dose of hydrocortisone b. instructing the client about coughing and deep breathing c. collecting additional information from the client about his hx of Addison's disease d. Inserting an indwelling urinary catheter
a. administering supplemental dose of hydrocortisone Acute adrenal insufficiency (adrenal crisis) is the greatest risk to a client how has Addison's disease, is taking a glucocorticoid, and is undergoing surgery. To prevent acute adrenal insufficiency, supplemental doses are administered during times of increased stress.
A nurse is caring for a client who is taking propylthiouracil. For which of the following adverse effects of this medication should the nurse monitor? a. bradycardia b. insomnia c. heat intolerance d. weight loss
a. bradycardia
A nurse is providing teaching for a client who has a new prescription for metformin. Which of the following adverse effects of metformin should the nurse instruct the patient to report to the provider? a. somnolence b. constipation c. fluid retention d. weight gain
a. somnolence Somnolence can indicate lactice acidosis, which is manifested by extreme drowsiness, hyperventilation, and muscle pain. It is a rare but very serious adverse effect caused by metformin and should be reported to the provider.
A nurse is providing teaching to a client who has T2DM and is starting repaglinide. Which of the following statements by the client indicates understanding of the administration of the medication? a. "I'll take this medicine with my meals." b. "I'll take this medicine 30 minutes before I eat." c. "I'll take this medicine just before I go to bed." d. "I'll take this medicine as soon as I wake up in the morning."
b. "I'll take this medicine 30 minutes before I eat." Repaglinide causes a rapid, short-lived release of insulin. The client should take this med within 30 minutes before each meal so that insulin is available when food is digested.
A nurse is teaching a client who has Grave's disease about her prescribed medications. Which of the following statements by the client indicates an understanding of the use of propranolol in the treatment of Grave's disease? a. "Propranolol helps increase blood flow to my thyroid gland." b. "Propranolol is used to prevent excess glucose in my blood." c. "Propranolol will decrease my tremors and fast heart beat." d. "Propranolol promotes a decrease of thyroid hormone in my body."
c. "Propranolol will decrease my tremors and fast heart beat."
A nurse is teaching clients in an outpatient facility about the use of insulin to treat T1DM. For which of the following types of insulin should the nurse tell the clients to expect a peak affect 1 to 5 hours after administration? a. insulin glargine b. NPH insulin c. Regular insulin d. Insulin lispro
c. Regular insulin
A nurse is providing teaching to a client who has a prescription for pramlintide for T1DM. Which of the following should the nurse include in the teaching? (Select all that apply) a. "Take oral medications 1 hour before injection." b. "Use upper arms as preferred injection sites." c. "Mix pramlintide with breakfast dose of insulin." d. "Inject pramlintide just before a meal." e. "Discard open vials after 28 days."
d. "Inject pramlintide just before a meal." Pramlintide can cause hypoglycemia, especially when the client also takes insulin, so it is important to eat a meal after injecting this medicine. e. "Discard open vials after 28 days." Unused medication in the open pramlintide vial should be discarded after 28 days
A nurse is caring for an older adults client in the LTC facility who has hypothyroidism and a new prescription for levothyroxine. Which of the following dosage schedules should the nurse expect for this client? a. The client will start at a high dose, and the dose will be tapered down as needed. b. The client will remain on the initial dosage during the course of treatment. c. The client's dosage will be adjusted daily based on blood levels. d. The client will start on a low dose, which will be gradually increased.
d. The client will start on a low dose, which will be gradually increased.
A nurse is caring for a client who is taking somatropin to stimulate growth. The nurse should plan to monitor the client's urine for which of the following? a. bilirubin b. protein c. potassium d. calcium
d. calcium client is at risk for renal calculi
A nurse is assessing a client who takes desmopressin for diabetes insipidus. For which of the following adverse effects should the nurse monitor? a. hypovolemia b. hypercalcemia c. agitation d. headache
d. headache This is an indication of water intoxication
A nurse is caring for a client in an outpatient facility who has been taking acarbose for T2DM. Which of the following lab tests should the nurse plan to monitor? a. WBC b. serum potassium c. platelet count d. liver function tests
d. liver function tests Acarbose can cause liver toxicity when taken long-term. Liver function tests should be monitored periodically while the client takes this medication.
Severe lactic acidosis requires _____________________.
hemodialysis
Beta blockers may mask SNS response to hypoglycemia, making it difficult to recognize __________.
hypoglycemia
Patients who don't respond to sulfonylureas won't respond to _______________.
meglitinides
To determine the effectiveness of desmopressin (DDAVP), a health care professional should monitor a patient's peripheral pulses. urine output. skin integrity. blood glucose.
urine output. Desmopressin, an antidiuretic hormone, treats diabetes insipidus. The health care professional should monitor the patient's fluid intake and urine output along with urine and serum osmolality and blood pressure.
