PATHO PHARM WEEK 2

In autoimmune type (1, 2) diabetes, pancreatic beta cells are destroyed by autoreactive (cytotoxic T lymphocytes, natural killer cells).

1; cytotoxic T lymphocytes

Metabolic syndrome increases the risk of developing type (1, 2) diabetes

2

Incretin

A-Hormone secreted by intestinal endocrine cells

Pheochromocytoma

A-Hypertension, tachycardia, palpitations, severe headache, diaphoresis, heat intolerance, weight loss, constipation

A nurse caring for a patient who has diabetic ketoacidosis recognizes which characteristics in the patient? (Select all that apply.) Type 2 diabetes Altered fat metabolism leading to ketones Arterial blood pH of 7.35 to 7.45 Sudden onset, triggered by acute illness Plasma osmolality of 300 to 320 mOsm/L

Altered fat metabolism leading to ketones Correct. Sudden onset, triggered by acute illness Correct Plasma osmolality of 300 to 320 mOsm/L Correct Diabetic ketoacidosis is the most severe manifestation of insulin deficiency in patients with type 1 diabetes. It develops and worsens acutely over several hours to days. Alterations in fat metabolism lead to the production of ketones and ketoacids. Increased ketoacid levels lead to a fall in arterial blood pH below 7.35. Altered glucose metabolism leads to hyperglycemia, water loss, and an elevated plasma osmolality (285 to 295 mOsm/L).

Ectopic hormone

B. Hormone secreted by nonendocrine tissues

Diabetes insipidus

B. Polydipsia, nocturia, polyuria, hypernatremia, increased plasma osmolality, large volume of dilute urine

A nurse should consider which diagnostic test a priority to obtain before a patient receives iodine-131? White blood cell (WBC) count Electrocardiogram (ECG) Beta human chorionic gonadotropin (hCG) test Creatinine level

Beta human chorionic gonadotropin (hCG) test Correct Any female patient of reproductive age requires a negative result on a beta hCG (pregnancy hormone) test before iodine-131 (131I) can be administered. 131I is a radioactive isotope used to treat hyperthyroidism and is contraindicated in pregnancy and lactation. A WBC count, ECG, and creatinine level are not indicated before treatment with iodine-131.

A patient is scheduled to start taking insulin glargine [Lantus]. On the care plan, a nurse should include which of these outcomes related to the therapeutic effects of the medication? Blood glucose control for 24 hours Mealtime coverage of blood glucose Less frequent blood glucose monitoring Peak effect achieved in 2 to 4 hours

Blood glucose control for 24 hours Correct Insulin glargine is administered as a once-daily subcutaneous injection for patients with type 1 diabetes. It is used for basal insulin coverage, not mealtime coverage. It has a prolonged duration, up to 24 hours, with no peaks. Blood glucose monitoring is still an essential component to achieve tight glycemic control.

Myxedema

C. Nonpitting boggy edema caused by infiltration of mucopolysaccharides and proteins between connective tissue fibers in the dermis

Type 1 diabetes mellitus

C. Polydipsia, nocturia, polyuria, increased appetite, weight loss, hyperglycemia, glycosuria

A patient who took NPH insulin at 0800 reports feeling weak and tremulous at 1700. Which action should the nurse take? Take the patient's blood pressure. Give the patient's PRN dose of insulin. Check the patient's capillary blood sugar. Advise the patient to lie down with the legs elevated.

Check the patient's capillary blood sugar. Correct The patient is showing symptoms of hypoglycemia at 5:00 PM. NPH has a peak action of 8 to 10 hours after administration. Based on the duration of action of NPH insulin, the patient's hypoglycemic symptoms are from the 8:00 AM injection of NPH insulin. An injection of NPH insulin at 2:00 AM, 1:00 PM, or 3:00 PM would not cause hypoglycemic symptoms based on the average duration of action of NPH insulin.

Before administering metformin [Glucophage], the nurse should notify the prescriber about which laboratory value? Creatinine (Cr) level of 2.1 mg/dL Hemoglobin (Hgb) level of 9.5 gm/dL Sodium (Na) level of 131 mEq/dL Platelet count of 120,000/mm3

Creatinine (Cr) level of 2.1 mg/dL Correct Metformin can reach toxic levels in individuals with renal impairment, which is indicated by a rise in the serum creatinine level. The prescriber may have to be notified of the hemoglobin, sodium, and platelet values, but they would not affect the administration of metformin.

Three disorders caused by a problem in the anterior pituitary gland: ____________ ____________ ____________

Cushing disease; secondary hyperthyroidism; secondary hypothyroidism

Hirsutism

D. Excessive growth of facial and body hair

Addison disease

D. Weakness, fatigue, hypotension, hyperkalemia, hypoglycemia, elevated ACTH

Which instruction should the nurse provide when teaching a patient to mix regular insulin and NPH insulin in the same syringe? "Draw up the clear regular insulin first, followed by the cloudy NPH insulin." "It is not necessary to rotate the NPH insulin vial when it is mixed with regular insulin." "The order of drawing up insulin does not matter as long as the insulin is refrigerated." "Rotate subcutaneous injection sites each day among the arm, thigh, and abdomen."

Draw up the clear regular insulin first, followed by the cloudy NPH insulin." Correct To ensure a consistent response, only NPH insulin is appropriate for mixing with a short-acting insulin. Unopened vials of insulin should be refrigerated; current vials can be kept at room temperature for up to 1 month. Drawing up the regular insulin into the syringe first prevents accidental mixture of NPH insulin into the vial of regular insulin, which could alter the pharmacokinetics of subsequent doses taken out of the regular insulin vial. NPH insulin is a cloudy solution, and it should always be rotated gently to disperse the particles evenly before loading the syringe. Subcutaneous injections should be made using one region of the body (eg, the abdomen or thigh) and rotated within that region for 1 month.

Which finding in a patient taking levothyroxine [Synthroid] and warfarin [Coumadin] would require follow-up by a nurse? Cardiac dysrhythmias Excessive bruising Weight loss of 5 kg Shortness of breath

Excessive bruising Correct Levothyroxine intensifies the effect of warfarin, an anticoagulant that increases the patient's risk for bleeding. The warfarin dose may need to be reduced. Bruising, weight loss, and shortness of breath are not effects associated with interactions of levothyroxine and warfarin.

SIADH

F. Lethargy, hyponatremia, perhaps seizure, decreased plasma osmolality, concentrated urine

Hypoglycemia

G. Tachycardia, diaphoresis, tremor, pallor, confusion, decreased level of consciousness, perhaps seizure

Adrenal adenoma causing hypersecretion of androgens in a woman

H. Virilization: lack of breast development, hirsutism, increased

A nurse is caring for a patient with decreased triiodothyronine (T3) and thyroxine (T4) and elevated thyroid-stimulating hormone (TSH) levels. The nurse knows the patient is likely suffering from what? Thyrotoxicosis Hypothyroidism Hyperthyroidism Graves' disease

Hypothyroidism Correct The anterior pituitary increases the production of TSH when thyroid hormone levels of T3 and T4 are reduced, reflecting primary hypothyroidism. Patients may experience fatigue caused by a lowered basal metabolic rate. Thyrotoxicosis, hyperthyroidism, and Graves' disease are medical conditions indicative of excessive thyroid activity.

A patient has been given instructions about levothyroxine [Synthroid]. Which statement by the patient indicates understanding of these instructions? "I'll take this medication in the morning so as not to interfere with sleep." "I'll plan to double my dose if I gain more than 1 pound per day." "It is best to take the medication with food so I don't have any nausea." "I'll be glad when I don't have to take this medication in a few months."

I'll take this medication in the morning so as not to interfere with sleep." Correct Levothyroxine is used to treat hypothyroidism by increasing the basal metabolism and thus wakefulness. It is administered as a once-daily dose and is a lifelong therapy. It is best taken on an empty stomach to enhance absorption.

A patient with Graves' disease is treated with iodine-131 therapy. Which statement by the patient would indicate understanding of the treatment's effects? "I'll have to isolate myself from my family so I don't expose them to radiation." "I'm looking forward to feeling better immediately after this treatment." "I'll tell my doctor if I have fatigue, hair loss, or cold intolerance." "I'll need to take this drug on a daily basis for at least 1 year."

I'll tell my doctor if I have fatigue, hair loss, or cold intolerance." Correct Iodine-131 usually is given as a single treatment to produce remission of Graves' disease. Fatigue, hair loss, and cold intolerance are signs of hypothyroidism, which is a complication of the treatment. Iodine-131 has a quick radioactive decay and half-life; therefore, isolation is not needed, but it can take up to 2 months for the desired response to develop.

A teaching plan for a patient who is taking lispro [Humalog] should include which instruction by the nurse? "Inject this insulin with your first bite of food, because it is very fast acting." "The duration of action for this insulin is about 8 to 10 hours, so you'll need a snack." "This insulin needs to be mixed with regular insulin to enhance the effects." "To achieve tight glycemic control, this is the only type of insulin you'll need."

Inject this insulin with your first bite of food, because it is very fast acting." Correct Lispro is a rapid-acting insulin and has an onset of action of 15 to 30 minutes with a peak action of about 2 hours, not 8 to 10 hours. Because of its rapid onset, it is administered immediately before a meal or with meals to control the blood glucose rise after meals. Lispro insulin must be combined with an intermediate- or a long-acting insulin, not regular insulin (which also is a short-duration insulin), for glucose control between meals and at night. To achieve tight glycemic control, patients must combine different types of insulin based on their duration of action.

A patient newly diagnosed with type 1 diabetes asks a nurse, "How does insulin normally work in my body?" The nurse explains that normal insulin has which action in the body? It stimulates the pancreas to reabsorb glucose. It promotes the synthesis of amino acids into glucose. It stimulates the liver to convert glycogen to glucose. It promotes the passage of glucose into cells for energy.

It promotes the passage of glucose into cells for energy. Correct The hormone insulin promotes the passage of glucose into cells, where it is metabolized for energy. Insulin does not stimulate the pancreas to reabsorb glucose or synthesize amino acids into glucose. It does not stimulate the liver to convert glycogen into glucose.

Primary hyperaldosteronism

J. Hypertension, hypokalemia, increased blood pH, increased urine potassium

Which statements about levothyroxine [Synthroid] are correct? (Select all that apply.) Levothyroxine should be taken with food. Levothyroxine can be given by IV but is usually taken orally. Levothyroxine brands should not be changed if possible. Levothyroxine should be taken at night to avoid adverse effects. Levothyroxine can affect the metabolism of other medications.

Levothyroxine can be given by IV but is usually taken orally. Correct Levothyroxine brands should not be changed if possible. CorrectLevothyroxine can affect the metabolism of other medications. Correct Levothyroxine is almost always administered by mouth. Oral doses should be taken once daily on an empty stomach (to enhance absorption). Dosing is usually done in the morning, at least 30 to 60 minutes before breakfast. Maintain patients on the same brand-name levothyroxine product. Intravenous administration is used for myxedema coma and for patients who cannot take levothyroxine orally. Levothyroxine affects the metabolism of other medications, including warfarin.

Two disorders caused by a problem within the thyroid gland: ____________ ____________

Primary hyperthyroidism; primary hypothyroidism

A patient who has type 2 diabetes is taking nateglinide [Starlix]. Which response should a nurse expect the patient to have if the medication is achieving the desired therapeutic effect? Inhibition of carbohydrate digestion Promotion of insulin secretion Decreased insulin resistance Inhibition of ketone formation

Promotion of insulin secretion Correct Nateglinide is a meglitinide medication that acts to increase pancreatic insulin release. It is used as an adjunct to calorie restriction and exercise to maintain glycemic control in patients with type 2 diabetes. It does not act to reduce insulin resistance or inhibit carbohydrate digestion. It should not be used to manage diabetic ketone formation, because its glucose-lowering effects are too slow to be of benefit.

A patient who has type 2 diabetes has a glycated hemoglobin A1c (HbA1c) of 10%. The nurse should make which change to the nursing care plan? Refer the patient to a diabetes educator because the result reflects poor glycemic control. Glycemic control is adequate; no changes are needed. Hypoglycemia is a risk; teach the patient the symptoms. Instruct the patient to limit activity and weekly exercise.

Refer the patient to a diabetes educator because the result reflects poor glycemic control. Correct Glycated hemoglobin (HbA1c) is a measure of plasma glucose levels on average over the previous 2- to 3-month period. The target value is 6.5% or lower. If it is greater than 6.5%, a diabetes educator is an additional resource who can facilitate lifestyle, exercise, and medication changes. Hypoglycemia is not a concern, because elevated HbA1c levels indicate poor glycemic control. Exercise should be part of an overall management program, because it counteracts insulin resistance.

Two disorders caused by posterior pituitary dysfunction: ____________ ____________

SIADH; diabetes insipidus

A nurse assesses a patient who is taking pramlintide [Symlin] with mealtime insulin. Which finding requires immediate follow-up by the nurse? Skin rash Sweating Itching Pedal edema

Sweating Correct Pramlintide is a new type of antidiabetic medication used as a supplement to mealtime insulin in patients with type 1 and 2 diabetes. Hypoglycemia, which is manifested by sweating, tremors, and tachycardia, is the adverse reaction of most concern. Skin rash, itching, and edema are not adverse effects of pramlintide.

A patient is taking glipizide [Glucotrol] and a beta-adrenergic medication. A nurse is teaching hypoglycemia awareness and should warn the patient about the presence of which symptom? Vomiting Muscle cramps Tachycardia Chills

Tachycardia Correct Glipizide is a sulfonylurea oral hypoglycemic medication that acts to promote insulin release from the pancreas. Beta-adrenergic blockers can mask early signs of sympathetic system responses to hypoglycemia; the most important of these is tachycardia, which is the most common adverse effect of glipizide. Vomiting, muscle cramps, and chills are not symptoms of activation of the sympathetic nervous system that arise when glucose levels fall.

Which manifestations should a nurse investigate first when monitoring a patient who is taking levothyroxine [Synthroid]? Tachycardia Tremors Insomnia Irritability

Tachycardia Correct High doses of levothyroxine may cause thyrotoxicosis, a condition of profound excessive thyroid activity. Tachycardia is the priority assessment, because it can lead to severe cardiac dysfunction. Tremors, insomnia, and irritability are other symptoms of thyrotoxicosis and should be assessed after tachycardia.

The patient reports that she had to switch pharmacies to save money. She noticed that her "thyroid pill" looks different. The nurse anticipates that the healthcare provider will order what? Thyroid stimulating hormone (TSH) Electrocardiogram (ECG) Beta human chorionic gonadotropin (hCG) test Creatinine level

Thyroid stimulating hormone (TSH) Correct If a switch is made (from one branded product to another, from a branded product to a generic product, or from one generic product to another), retest serum TSH in 6 weeks, and adjust the levothyroxine dosage as indicated.

Which statement is the most important for a nurse to make to a patient who is taking methimazole? "You need to notify your doctor if you have a sore throat and fever." "Another medication can be given if you experience any nausea." "You may experience some muscle soreness with this medicine." "Headache and dizziness may occur but not very frequently."

You need to notify your doctor if you have a sore throat and fever." Correct Agranulocytosis (the absence of granulocytes to fight infection) is the most serious toxicity associated with methimazole. Sore throat and fever may be the earliest signs. Nausea, muscle soreness, and headache and dizziness are other adverse effects of methimazole that are not as serious as agranulocytosis.

People who have type 1 diabetes have a deficit of insulin and (glucagon, amylin) and a relative excess of (glucagon, amylin

amylin; glucagon

Hashimoto disease is (viral, autoimmune) thyroiditis

autoimmune

In diabetes, microvascular disease refers to (accelerated atherosclerosis, destruction of capillaries), whereas macrovascular disease refers to (accelerated atherosclerosis, destruction of capillaries).

destruction of capillaries; accelerated atherosclerosis

Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is characterized by (high, low) levels of ADH in the absence of normal control mechanisms.

high

An active anterior pituitary adenoma usually causes (hyposecretion, hypersecretion) of hormones from the adenoma itself and (hyposecretion, hypersecretion) of hormones from the surrounding pituitary cells.

hypersecretion; hyposecretion

Individuals who have gestational diabetes have (decreased, increased) risk for type 2 diabetes later in life.

increased

The healthcare provider orders 150 mcg of levothyroxine [Synthroid] PO every morning. The medication available is levothyroxine [Synthroid] 75-mcg tablets. How many tablets will the nurse administer? 0.5 1 2 4

2 Correct The ordered dose is 150 mcg. The available tablets are 75 mcg. 75 multiplied by 2 equals 150. Therefore, 2 tablets is the correct dose.

Ghrelin

E. Hormone secreted by gastric cells and epsilon cells in the pancreatic islets

Hypothyroidism

E. Lethargy, cold intolerance, hoarseness, nonpitting boggy edema around eyes, coarse hair, decreased body temperature

Diabetic ketoacidosis

I. Polyuria, decreased level of consciousness, Kussmaul breathing, acetone smell to breath, hyperglycemia, decreased blood pH, ketonuria, glycosuria