[M15] Diabetes/Thyroid

14) The nurse is instructing a client taking levothyroxine (Synthroid) that full therapeutic benefits will be seen: 1. immediately. 2. within 3 to 5 days. 3. in 1 to 3 weeks. 4. within 24 hours.

3. in 1 to 3 weeks. Explanation: One to 3 weeks might be required for full therapeutic benefits of levothyroxine.

17) The nurse would monitor carefully the client concurrently taking levothyroxine (Synthroid) and: 1. aspirin. 2. vitamin B12 supplementation. 3. warfarin. 4. penicillin.

3. warfarin. Explanation: A client taking warfarin and levothyroxine concurrently might need a decrease in the warfarin dosage to prevent bleeding.

18) For which client would the nurse question the use of levothyroxine (Synthroid)? 1. A child under age 2 2. A pregnant client 3. A client allergic to shellfish 4. A client allergic to aspirin

4. A client allergic to aspirin Explanation: Synthroid can cause allergic reaction in clients sensitive to aspirin.

4) When caring for a client with diabetes, the nurse knows that the client is experiencing a breakdown of fatty acids for fuel because of which serum laboratory finding? 1. Leukocytes 2. Protein 3. Glucose 4. Ketones

4. Ketones Explanation: When the body must metabolize fatty acids for fuel, ketones accumulate in the blood.

1) Which body tissue or organ cannot synthesize glucose for its energy supply? 1. The kidneys 2. The lungs 3. The heart 4. The brain

4. The brain Explanation: Most body tissues can use fatty acids and protein for energy, if necessary. The brain cannot because it is unable to synthesize glucose, and it exhausts its supply after just a few minutes of activity.

9) A client is acutely confused, sweating, and complaining of a headache. The nurse suspects hypoglycemia. The nurse's next action is to obtain: 1. a serum blood glucose. 2. a glucose tolerance test. 3. serum electrolytes. 4. a capillary blood glucose level.

4. a capillary blood glucose level. Explanation: Obtaining a fingerstick blood sugar takes 15 seconds and provides an opportunity for rapid nursing intervention, if needed

12) The nurse, instructing a group of community members on chronic health problems, explains that the leading cause of blindness in the United States is: 1. glaucoma. 2. cataracts. 3. hypertension. 4. diabetic retinopathy.

4. diabetic retinopathy. Explanation: The leading cause of blindness in the United States is retinopathy due to microvascular changes associated with the hyperglycemic states of diabetes.

5) When instructing a client, the nurse explains that the primary factor contributing to the development of type 2 diabetes is: 1. age. 2. ethnicity. 3. a sedentary lifestyle. 4. obesity.

4. obesity. Explanation: Eighty percent of individuals with type 2 diabetes are overweight.

7) A client with diabetes is experiencing polyuria. The nurse explains that polyuria is caused by: 1. inflammation of the glomerulus. 2. excessive fluid intake. 3. lack of albumin. 4. osmotic diuresis.

4. osmotic diuresis. Explanation: Osmotic diuresis leads to polyuria, which is the passage of large amounts of urine as a result of increased osmotic pressure that can result from hyperglycemia.

20) Prior to administering glyburide, the nurse will review a client's allergies because this medication is contraindicated in clients who are allergic to: 1. urea. 2. milk products. 3. eggs. 4. sulfa drugs.

4. sulfa drugs. Explanation: Glyburide is a sulfonylurea and is contraindicated in clients with a known sensitivity to sulfa drugs.

8) A client is scheduled for a hemoglobin A1c laboratory test. The nurse explains to the client that this test monitors: 1. the percentage of glucagon in the blood. 2. the level of hemoglobin over time. 3. the percentage of glucose present in the blood. 4. the level of glucose over time.

4. the level of glucose over time. Explanation: Hemoglobin A1c measures the level of blood glucose over time because glucose molecules attach to the hemoglobin molecule for the life of the RBC, which is 120 days.

What should the nurse instruct a client who is prescribed propylthiouracil (PTU)? Select all that apply. A. "A rash can occur when taking this medication." B. "Contact your health care provider with any changes in urine output at home." C. "You might experience a headache." D. "You might experience vertigo when taking this medication." E. "Nausea and vomiting are side effects of this medication."

A. "A rash can occur when taking this medication." B. "Contact your health care provider with any changes in urine output at home." C. "You might experience a headache." D. "You might experience vertigo when taking this medication."

2. A patient who takes the oral antidiabetic agent metformin (Glucophage) will begin taking levothyroxine (Synthroid). The nurse will teach this patient to monitor for A. Hyperglycemia B. Hypoglycemia C. Hyperkalemia D. Hypokalemia

A. Hyperglycemia Insulin and oral antidiabetic drugs may need to be increased in patients taking levothyroxine. Patients should be taught to monitor for hyperglycemia, because of the reduced effects of these drugs.

27) After an assessment, the nurse suspects that a client is experiencing signs of type 2 diabetes mellitus. What did the nurse assess in this client? Select all that apply. 1. Excessive urination 2. Excessive thirst 3. Blurred vision 4. Tingling of the fingers and toes 5. Itchy skin rash

1. Excessive urination 2. Excessive thirst 3. Blurred vision 4. Tingling of the fingers and toes Explanation: Excessive urination or polyuria is a symptom of type 2 diabetes. Excessive thirst or polydipsia is a symptom of type 2 diabetes. Blurred vision is a symptom of type 2 diabetes. Tingling or paresthesias is a symptom of type 2 diabetes.

15) A client is prescribed the insulin with the least rapid onset. Which insulin will the nurse administer to this client? 1. Glulisine 2. Regular 3. Aspart 4. Lispro

2. Regular Explanation: The onset of regular insulin is 30 to 60 minutes.

3) When instructing a client with diabetes about glucose balance, the nurse explains that following a meal, glucose that is not needed for immediate energy needs is stored as: 1. muscle tissue. 2. glycogen. 3. fat. 4. glucagon.

2. glycogen. Explanation: The storage form of glucose is called glycogen.

1. The nurse is teaching a patient who is newly diagnosed with type 1 diabetes mellitus about insulin administration. Which statement by the patient indicates a need for further teaching? "I should rotate my injection sites." "I should give each injection a knuckle length away from a previous injection." "I will not be concerned about a raised knot under my skin from injecting insulin." "Insulin is absorbed better from subcutaneous sites on my abdomen."

"I will not be concerned about a raised knot under my skin from injecting insulin." Lipohypertrophy presents as a raised lump or knot on the skin surface caused by repeated injections into the same site, and this can interfere with insulin absorption. Patients are encouraged to rotate injection sites, giving each injection at least a knuckle length away from the previous injection. Insulin absorption is most predictable when given in abdominal areas

10. Which statement by a patient who will begin using an insulin pump indicates understanding of this device? A. "I will have an increased risk for hypoglycemia." "I will leave this on when bathing or swimming." "I will not need to count carbohydrates anymore." "I will still need to monitor serum glucose."

"I will still need to monitor serum glucose." Patients using an insulin pump will still monitor serum glucose and count carbohydrates. The advantage of the pump is that it is programmed to deliver continuous rapid-acting insulin in varying amounts at different times throughout the day. Changes in food intake can alter the risk for hypoglycemia if the pump is not adjusted accordingly. Most devices must be removed when bathing or swimming.

8. The patient asks the nurse about storing insulin. Which response by the nurse is correct? "All insulin vials must be refrigerated before and during use." "Insulin will last longer if kept in the freezer." "Opened vials of insulin must be discarded after first use." "Some insulin products do not require refrigeration during use."

"Some insulin products do not require refrigeration during use." Some insulin products do not require refrigeration during use. Storing insulin in the freezer is not recommended. Opened vials may either be kept at room temperature or refrigerated. Drug information for each product should be reviewed for drug-specific storage information.

23) What should the nurse instruct a client who is prescribed propylthiouracil (PTU)? Select all that apply. 1. "A rash can occur when taking this medication." 2. "Contact your healthcare provider with any changes in urine output at home." 3. "You might experience a headache." 4. "You might experience vertigo when taking this medication." 5. "Nausea and vomiting are side effects of this medication."

1. "A rash can occur when taking this medication." 2. "Contact your healthcare provider with any changes in urine output at home." 3. "You might experience a headache." 4. "You might experience vertigo when taking this medication." Explanation: Serious hypersensitivity reactions are rare but may be serious and include rash. Serious hypersensitivity reactions are rare but may be serious and include glomerulonephritis. The nurse should instruct the client to alert the healthcare provider with any changes in urine output. The client may have headaches when taking this medication. Vertigo is an adverse effect of this medication.

25) Which client statements indicate to the nurse that instruction about type 2 diabetes mellitus and insulin resistance has been effective? Select all that apply. 1. "Exercise will improve insulin resistance." 2. "Eating a healthy diet will reverse insulin resistance." 3. "Exercise will cure type 2 diabetes mellitus." 4. "Eating a healthy diet will cure type 2 diabetes mellitus." 5. "I can eat anything I want as long as I exercise afterward."

1. "Exercise will improve insulin resistance." 2. "Eating a healthy diet will reverse insulin resistance." Explanation: The activity of insulin receptors can be increased by exercise. Adhering to a healthy diet has been shown to reverse insulin resistance.

22) When administering insulin to a client, the nurse will rotate injection sites primarily to prevent: 1. systemic absorption of insulin. 2. lipodystrophy. 3. abscess development. 4. ineffective dosing.

2. lipodystrophy. Explanation: Rotation of insulin sites helps to prevent lipodystrophy

28) The nurse is planning care for a client with diabetic ketoacidosis. What interventions will the nurse most likely perform for this client? Select all that apply. 1. Administer intravenous fluids as prescribed 2. Administer a loading dose of intravenous insulin as prescribed 3. Administer electrolyte replacements as prescribed 4. Administer intravenous antibiotics as prescribed 5. Administer nebulized bronchodilators as prescribed

1. Administer intravenous fluids as prescribed 2. Administer a loading dose of intravenous insulin as prescribed 3. Administer electrolyte replacements as prescribed Explanation: Treatment of diabetic ketoacidosis includes fluid replacement therapy. Treatment of diabetic ketoacidosis includes a loading dose of intravenous insulin therapy. Treatment of diabetic ketoacidosis includes electrolyte replacements.

30) When reviewing a client's current medications, the nurse is concerned that the insulin dose will need to be adjusted because the client is currently prescribed which medications? Select all that apply. 1. Beta blocker 2. Monoamine oxidase inhibitor 3. Angiotensin-converting enzyme inhibitor 4. Cardiac glycoside 5. Nonsteroidal anti-inflammatory agents (NSAIDs)

1. Beta blocker 2. Monoamine oxidase inhibitor 3. Angiotensin-converting enzyme inhibitor Explanation: Insulin must be used cautiously in conjunction with medications that can produce hypoglycemia, including beta blockers. Insulin must be used cautiously in conjunction with medications that can produce hypoglycemia, including monoamine oxidase inhibitors. Angiotensin-converting enzyme inhibitors increase insulin sensitivity and may enhance the hypoglycemic effects of insulin.

15) The nurse instructs a client with hypothyroidism about medications that accelerate the metabolism of levothyroxine, including: 1. warfarin. 2. phenytoin. 3. digoxin. 4. calcium.

2. phenytoin. Explanation: Phenytoin accelerates the metabolism of levothyroxine.

9) The nurse would anticipate the client with hypothyroidism to exhibit which symptom? 1. Constipation 2. Heat intolerance 3. Weight loss 4. Hypertension

1. Constipation Explanation: The client with hypothyroidism experiences a slowing in metabolic rate and constipation.

32) What dietary instructions should the nurse provide a client who is prescribed repaglinide (Prandin)? Select all that apply. 1. Do not take with grapefruit juice. 2. Avoid using garlic. 3. Drink decaffeinated beverages only. 4. Avoid green leafy vegetables.

1. Do not take with grapefruit juice. 2. Avoid using garlic. Explanation: The concurrent intake of grapefruit juice with repaglinide may result in increased drug levels and hypoglycemia. Garlic may increase the hypoglycemic effects of repaglinide.

24) The nurse is instructing a client on the role of the pancreas in controlling blood glucose levels. When does the pancreas excrete glucagon to maintain an adequate amount of glucose in the blood? Select all that apply. 1. During periods of fasting 2. During exercise 3. When drinking alcohol 4. After eating a large meal 5. When fighting an infection

1. During periods of fasting 2. During exercise 3. When drinking alcohol Explanation: Glucagon is released from the pancreas during periods of fasting. Glucagon is released from the pancreas during exercise. Glucagon is released from the pancreas when alcohol is consumed.

6) What will the nurse describe to a client as risk factors for developing type 2 diabetes? Select all that apply. 1. Ethnicity 2. Age younger than 45 3. Obesity 4. Race 5. Family history

1. Ethnicity 3. Obesity 4. Race 5. Family history Explanation: Ethnicity is a risk factor for the development of type 2 diabetes. Obesity is a risk factor for the development of type 2 diabetes. Race is a risk factor for the development of type 2 diabetes. Family history is a risk factor for the development of type 2 diabetes.

14) The nurse, preparing medications for a client with diabetes, recognizes that what percentage of adults with diabetes take oral agents only? 1. 60% to 70% 2. 30% to 40% 3. 50% to 60% 4. 40% to 50%

3. 50% to 60% Explanation: 58% of adults with diabetes take oral agents only.

26) The nurse is concerned that a client is at risk for developing gestational diabetes after collecting which assessment data? Select all that apply. 1. Family history 2. Obesity 3. Previous spontaneous abortion 4. Sedentary lifestyle 5. Diagnosis of hypertension

1. Family history 2. Obesity 3. Previous spontaneous abortion Explanation: A family history of diabetes increases the client's risk of developing gestational diabetes. Obesity increases the client's risk of developing gestational diabetes. A previous spontaneous abortion increases the client's risk of developing gestational diabetes.

31) The nurse decides to withhold a prescribed dose of metformin to a client after reviewing the medical record. For which conditions is this medication contraindicated or used with caution? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Impaired renal function 2. Heart failure 3. Hyperthyroidism 4. Septicemia 5. Sleep apnea

1. Impaired renal function 2. Heart failure 3. Hyperthyroidism 4. Septicemia Explanation: Metformin is contraindicated in clients with impaired renal function. Metformin is contraindicated in clients with heart failure. Metformin is used with caution in clients with hyperthyroidism. Metformin is contraindicated in clients with a concurrent serious infection.

19) A client is receiving thyroid hormone replacement therapy, which increases the number of beta1- and beta2-adrenergic receptors. The nurse knows that this increase in receptors will make the receptors more responsive to which neurotransmitters? Select all that apply. 1. Norepinephrine 2. Epinephrine 3. Dopamine 4. Serotonin 5. Melatonin

1. Norepinephrine 2. Epinephrine 3. Dopamine Explanation: Thyroid hormone increases the number of beta1- and beta2-adrenergic receptors and enhances their affinity to catecholamines such as norepinephrine. Thyroid hormone increases the number of beta1- and beta2-adrenergic receptors and enhances their affinity to catecholamines such as epinephrine. Thyroid hormone increases the number of beta1- and beta2-adrenergic receptors and enhances their affinity to catecholamines such as dopamine.

21) A client is diagnosed with hyperthyroidism. The nurse will prepare to administer which medications as routine treatment of this disorder? Select all that apply. 1. Propylthiouracil (PTU) 2. Methimazole (Tapazole) 3. Propranolol (Inderal) 4. Esmolol (Brevibloc) 5. Metoprolol (Toprol)

1. Propylthiouracil (PTU) 2. Methimazole (Tapazole) Explanation: Propylthiouracil (PTU) is used to treat hyperthyroidism. Methimazole (Tapazole) is used to treat hyperthyroidism

19) The nurse should instruct a client to avoid which substance while taking a sulfonylurea medication? 1. Antacids 2. Calcium products 3. Alcohol 4. Antibiotics

3. Alcohol Explanation: When administered with alcohol, sulfonylureas can cause a disulfiram-like reaction with flushing, palpations, and nausea.

17) The nurse is instructing a client on the effects of insulin. What will the nurse include as the primary adverse effect? 1. Somogyi phenomenon 2. Swollen lymph glands 3. Hypoglycemia 4. Urticaria

3. Hypoglycemia Explanation: The primary adverse effect of insulin is hypoglycemia.

23) What should the nurse include when teaching a client about insulin? Select all that apply. 1. Rotate injection sites. 2. Recognize the signs of hypoglycemia. 3. Store insulin in the freezer. 4. Carry a readily available supply of sugar. 5. Wear a medic-alert bracelet that explains the client has diabetes.

1. Rotate injection sites. 2. Recognize the signs of hypoglycemia. 4. Carry a readily available supply of sugar. 5. Wear a medic-alert bracelet that explains the client has diabetes. Explanation: Injection sites should be rotated to prevent lipodystrophy. Clients should understand the symptoms of hypoglycemia. Diabetics should carry a readily available source of sugar. Clients should wear a medic-alert bracelet that identifies them as having diabetes.

29) What should the nurse teach a client with diabetes about how to reduce the risk of cardiovascular complications from the disorder? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Stop smoking. 2. Follow a low-fat diet. 3. Take blood pressure medication as prescribed. 4. Keep blood glucose levels within normal limits. 5. Prevent constipation.

1. Stop smoking. 2. Follow a low-fat diet. 3. Take blood pressure medication as prescribed. 4. Keep blood glucose levels within normal limits. Explanation: Smoking cessation is a preventive measure to reduce the cardiovascular risk factors associated with diabetes. Lowering lipid levels is a preventive measure to reduce the cardiovascular risk factors associated with diabetes. Controlling blood pressure is a preventive measure to reduce the cardiovascular risk factors associated with diabetes. Optimal glucose control is a preventive measure to reduce the cardiovascular risk factors associated with diabetes.

6) Which laboratory value will the nurse monitor to determine the progression of thyroid disease in a client? 1. TSH 2. T3 3. Iodine 4. T4

1. TSH Explanation: TSH is the preferred laboratory value for monitoring the progression of thyroid disease.

16) In which instance would the nurse hold the dose of levothyroxine (Synthroid)? 1. The client complains of palpitations. 2. The client's blood pressure 118/78 mmHg. 3. The client's respiratory rate is 10 breaths/min. 4. The client is fatigued.

1. The client complains of palpitations. Explanation: An adverse effect of levothyroxine is palpitations, which should be reported before providing the scheduled dose.

10) Which drug would alter a client's ability to recognize the symptoms of hypoglycemia? 1. beta blockers 2. antibiotics 3. diuretics 4. oral hypoglycemic agents

1. beta blockers Explanation: Beta blockers interfere with the symptoms of hypoglycemia, making it more difficult for the client to recognize symptoms.

11) The nurse explains that the difference between diabetic ketoacidosis (DKA) and a hyperosmolar hyperglycemic state (HHS) is that clients with HHS: 1. do not manifest ketoacidosis. 2. are dehydrated. 3. are confused. 4. have elevated glucose levels.

1. do not manifest ketoacidosis. Explanation: Clients with HHS do not experience ketoacidosis.

18) When teaching a client about a prescribed second-generation sulfonylurea for blood glucose control, the nurse explains that the advantage of this medication is that it: 1. exhibits fewer drug—drug interactions. 2. does not cause hypoglycemia. 3. can be administered in smaller doses. 4. causes fewer adverse effects.

1. exhibits fewer drug—drug interactions. Explanation: The advantage of second-generation sulfonylureas is that they exhibit fewer drug—drug interactions.

21) The nurse knows that the prescribed dose of insulin should not be administered to a client whose blood glucose is: 1. lower than 70 mg/dL. 2. 80 mg/dL. 3. 90 mg/dL. 4. 100 mg/dL.

1. lower than 70 mg/dL. Explanation: The nurse should not administer insulin if blood glucose levels are lower than 70 mg/dL.

5. A patient is ordered to receive insulin lispro at mealtimes. The nurse will instruct this patient to administer the medication at which time? 10-15 min before eating 15 min after eating 30 min before eating 10 min after eating

10-15 min before eating Lispro acts faster than regular insulin, and patients should be taught to give this medication 10-15 minutes before eating.

2) Even though the normal range for serum glucose is 60 to 100 mg/dL, the body usually tightly regulates this level to: 1. 90 to 100 mg/dL. 2. 80 to 90 mg/dL. 3. 60 to 70 mg/dL. 4. 70 to 80 mg/dL.

2. 80 to 90 mg/dL. Explanation: The body attempts to maintain tight glucose control between 80 and 90 mg/dL to prevent complications associated with hypo- or hyperglycemic states.

13) What should the nurse instruct a client who is diagnosed with diabetes? Select all that apply. 1. Have eye examinations every 2 to 3 years. 2. Monitor blood pressure carefully. 3. Check feet daily for signs of irritation. 4. Maintain glucose control. 5. Quit smoking.

2. Monitor blood pressure carefully. 3. Check feet daily for signs of irritation. 4. Maintain glucose control. 5. Quit smoking. Explanation: Monitoring blood pressure carefully is an important teaching point to aid recognition of hypertensive changes associated with diabetes.

In which instance would the nurse hold the dose of levothyroxine (Synthroid)? A. The client complains of palpitations. B. The client's blood pressure 118/78 mmHg. C. The client's respiratory rate is 10. D. The client is fatigued.

A. The client complains of palpitations.

Which drug would alter a client's ability to recognize the symptoms of hypoglycemia? A. beta blockers B. antibiotics C. diuretics D. oral hypoglycemic agents

A. beta blockers

A client is prescribed insulin via the intravenous (IV) route. Which insulin will the nurse administer to this client? A. Glulisine B. Regular C. Aspart D. Lispro

B. Regular

The nurse decides to withhold a prescribed dose of metformin to a client after reviewing the medical record. For which situation is this medication contraindicated? A. pregnancy B. test with contrast dye C. hypothyroidism D. sleep apnea

B. test with contrast dye

The nurse is instructing a client on the effects of insulin. What will the nurse include as the primary adverse effect? A. Somogyi phenomenon B. Swollen lymph glands C. Hypoglycemia D. Urticaria

C. Hypoglycemia

The nurse is instructing a client taking levothyroxine (Synthroid) that full therapeutic benefits will be seen: A. immediately. B. within 3-5 days. C. in 1-3 weeks. D. within 24 hours.

C. in 1-3 weeks.

The nurse would monitor carefully the client concurrently taking levothyroxine (Synthroid) and: A. aspirin. B. vitamin B12 supplementation. C. warfarin. D. penicillin.

C. warfarin.

3. The nurse is caring for a patient who is being treated for hypothyroidism. The patient reports insomnia, nervousness, and flushing of the skin. Before notifying the provider, the nurse will perform which action? Assess serum glucose to evaluate possible hypoglycemia. Check the patient's heart rate to assess for tachycardia. Perform an assessment of hydration status. Take the patient's temperature to evaluate for infection.

Check the patient's heart rate to assess for tachycardia. The patient has signs of a thyroid crisis, which can occur with excess ingestion of thyroid hormone. The nurse should evaluate heart rate before notifying the provider. These are not symptoms of hypoglycemia. The symptoms are not indicative of infection.

2. The nurse receives the following order for insulin: IV NPH (Humulin NPH) 10 units. The nurse will perform which action? Administer the dose as ordered. Clarify the insulin type and route. Give the drug subcutaneously. Question the insulin dose.

Clarify the insulin type and route. NPH insulin is not indicated for intravenous administration. The nurse should clarify the order. The nurse should not administer the drug by a different route without first discussing the order with the provider.

The nurse would anticipate the client with hyperthyroidism to exhibit which symptom? A. Hypothermia B. Bradycardia C. Weight gain D. Hypertension

D. Hypertension

3. The nurse will administer parenteral insulin to a patient who will receive a mixture of NPH (Humulin NPH) and regular (Humulin R). The nurse will give this medication via which route.\ A. Intradermal B. Intramuscular C. Intravenous D. Subcutaneous

D. Subcutaneous Insulin is given by the subcutaneous route. NPH insulin is not indicated for intravenous use.

7. A patient was administered regular insulin 30 minutes ago but has not received a breakfast tray. The patient is experiencing nervousness and tremors. What is the nurse's first action? Administer glucagon. Give the patient orange juice. Notify the kitchen to deliver the tray. Perform bedside glucose testing.

Give the patient orange juice. The patient is symptomatic and has hypoglycemia. The nurse should give orange juice. Glucagon is given for patients unable to ingest carbohydrates. The kitchen should be notified, and bedside glucose testing should be performed, but only after the patient is given carbohydrates.

1. A patient who takes warfarin (Coumadin) and digoxin (Lanoxin) develops hypothyroidism and will begin taking levothyroxine (Synthroid). The nurse anticipates which potential adjustments in dosing for this patient? Decreased digoxin and decreased warfarin Decreased digoxin and increased warfarin Increased digoxin and decreased warfarin Increased digoxin and increased warfarin

Increased digoxin and decreased warfarin Thyroid preparations increase the effect of oral anticoagulants, so the warfarin dose may need to be decreased. Levothyroxine can decrease the effectiveness of digoxin, so this dose may need to be increased.

4. A patient reports that they are taking a rapid-acting insulin with meals but can't remember the name. Which of the following products is a rapid-acing insulin? Regular insulin (Novolin R) Insulin glargine (Lantus) Insulin lispro (Humalog) Insulin degludec (Tresiba)

Insulin lispro (Humalog) Insulin lispro (Humalog) is a rapid-acing insulin product. Regular insulin is considered a short-acting insulin. Insulin glargine and insulin degludec are long- acting insulins.

11. A patient who is unconscious and has a pulse is brought to the emergency department. The patient is wearing a Medic-Alert bracelet indicating type 1 diabetes mellitus. The nurse will anticipate an order to administer: cardiopulmonary resuscitation (CPR). glucagon. insulin. orange juice.

glucagon

12. A patient who has type 2 diabetes mellitus asks the nurse why the provider has changed the oral antidiabetic agent from tolbutamide (Orinase) to glipizide (Glucotrol). The nurse will explain that glipizide: has a longer duration of action. has fewer gastrointestinal side effects. may be taken on an as-needed basis. does not cause hypoglycemia.

has a longer duration of action. Glipizide is a second-generation sulfonylurea. It has a longer duration of action than the first-generation sulfonylurea tolbutamide. It has many gastrointestinal side effects. It is taken once daily, not as needed. All sulfonylureas can contribute to hypoglycemia.

6. The parent of a junior high school child who has type 1 diabetes asks the nurse if the child can participate in sports. The nurse will tell the parent: that strenuous exercise is not recommended for children with diabetes. that the child must be monitored for hyperglycemia while exercising. to administer an extra dose of regular insulin prior to exercise. to send a snack with the child to eat just prior to exercise.

to send a snack with the child to eat just prior to exercise. Patients generally need less insulin with increased exercise, so the child should consume a snack to prevent hypoglycemia. Exercise is an integral part of diabetes management. Hypoglycemia is more likely to occur, and extra insulin is not indicated.