Pharm 167 3rd Exam

The patient is prescribed 30 units regular insulin and 70 units NPH insulin subcutaneously every morning. The nurse will provide which instruction to the patient? Answers: "Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin." "Mixing insulins will help increase insulin production." "Rotate sites at least once weekly." "Use a 23- to 25-gauge syringe with a 1-inch needle for maximum absorption."

"Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin."

Which statement indicates to the nurse that the patient needs additional teaching on oral hypoglycemic agents Answers: "I will monitor my blood sugar daily." "I will limit my alcohol consumption." "I will take the medication only when I need it." "I will report symptoms of fatigue and loss of appetite."

"I will take the medication only when I need it."

Which statement by the patient demonstrates an understanding of discharge instructions on the use of levothyroxine (Synthroid)? Answers "I will take this medication in the morning so as not to interfere with sleep." "I will double my dose if I gain more than 1 pound per day." "I will stop the medication immediately if I lose more than 2 pounds in a week." "I can expect to see relief of my symptoms within 1 week."

"I will take this medication in the morning so as not to interfere with sleep."

A 19-year-old student was diagnosed with hypothyroidism and has started thyroid replacement therapy with levothyroxine (Synthroid). After 2 days, she called the clinic to report that she does not feel better. Which response from the nurse is correct? Answers: "It will probably require surgery for a cure to happen." "The full therapeutic effects may not occur for 6 to 8 weeks." "Is it possible that you did not take your medication as instructed?" "Let's review your diet; it may be causing absorption problems."

"The full therapeutic effects may not occur for 6 to 8 weeks."

The nurse should question a prescription for an antiadrenal drug for a patient who has been diagnosed with which condition? 1 Addison's disease 2 Adrenal malignancy 3 Cushing's syndrome 4 Metastatic breast cancer

1 Addison's disease Antiadrenal drugs suppress the adrenal cortex. Addison's disease presents with decreased adrenal secretion; thus the nurse would not want to exacerbate this by administering an antiadrenal drug. These drugs are indicated for adrenal malignancy, Cushing's syndrome, and metastatic breast cancer.

Which condition is a contraindication to the use of fludrocortisone? 1 Candidiasis 2 Hyperkalemia 3 Addison's disease 4 Adrenogenital syndrome

1 Candidiasis Candidiasis is a systemic fungal infection of Candida albicans that can be caused by glucocorticoid inhalers such as fludrocortisone. Thus, a patient with this infection should not receive a mineralocorticoid (fludrocortisone), because it may proliferate the fungal infection. Hyperkalemia might actually be improved with fludrocortisone use, because fludrocortisone is likely to cause hypokalemia during its administration. Fludrocortisone is used as partial replacement therapy for adrenocortical insufficiency in Addison's disease. It is widely used in the treatment of salt-losing adrenogenital syndrome. Test-Taking Tip: The following are crucial requisites for doing well on the NCLEX exam: (1) A sound understanding of the subject; (2) The ability to follow explicitly the directions given at the beginning of the test; (3) The ability to comprehend what is read; (4) The patience to read each question and set of options carefully before deciding how to answer the question; (5) The ability to use the computer correctly to record answers; (6) The determination to do well; (7) A degree of confidence.

The nurse is performing a follow-up assessment of a patient who is being treated with glucocorticoids. Which assessment findings indicate that the treatment is effective? Select all that apply. 1 Respiratory rate of 16 breaths/min 2 Temperature of 100.6° F (38.1° C) 3 No complaints of sore throat or joint pain 4 Weight gain of 4.4 lbs (2 kg) over a week 5 Random blood glucose concentration of 110 mg/dL

1 Respiratory rate of 16 breaths/min 3 No complaints of sore throat or joint pain 5 Random blood glucose concentration of 110 mg/dL Glucocorticoids may affect hormone production, which can affect many systems in the body. A respiratory rate of 16 breaths/min is a normal finding and indicates effective treatment. Sore throat and joint pain are early symptoms of infection. Because the patient has reduced immune function and is at risk of contracting infection, the absence of sore throat and joint pain indicates effective treatment. Glucocorticoids tend to increase blood glucose concentration. A random blood glucose concentration of 110 mg/dL is normal and indicates that treatment is effective. A temperature of 100.6° F (38.1° C) indicates infection and implies that treatment needs to be improved. Weight gain of 4.4 lbs (2 kg) indicates an adverse effect of the therapy.

A patient is prescribed somatropin injection subcutaneously. Which nursing intervention promotes safe administration of the drug? 1 Rotating the injection site 2 Shaking the vial vigorously 3 Administering in the ventral gluteal site 4 Administering if the drug in the vial is cloudy

1 Rotating the injection site Somatropin is a form of growth hormone and is used to treat growth retardations. The drug can be administered intravenously and subcutaneously. However, the site of injection should be rotated to prevent tissue damage. The vial should not be shaken vigorously. Instead, it should be swirled gently. The medication is injected in the ventral gluteal site if the route of administration is intramuscular. The medication should be administered only if the solution is clear.

What are the adverse effects of antithyroid medication? Select all that apply. 1 Vertigo 2 Cramps 3 Tremor 4 Leukopenia 5 Loss of taste

1 Vertigo 4 Leukopenia 5 Loss of taste Antithyroid medication causes vertigo. These medications also decrease the leukocyte count and cause a loss of the sense of taste. Cramps and tremors are adverse effects of thyroid medications.

The nurse is caring for a patient with Addison's disease who has been prescribed corticosteroids. For what will the nurse check in the patient's medical history before administering the medication? Select all that apply. 1 Whether the patient has glaucoma 2 Whether the patient has septicemia 3 Whether the patient has a liver disorder 4 Whether the patient has ulcerative colitis 5 Whether the patient has diabetes mellitus

1 Whether the patient has glaucoma 2 Whether the patient has septicemia 5 Whether the patient has diabetes mellitus Corticosteroids are contraindicated in patients with septicemia, glaucoma, and diabetes mellitus. Corticosteroids may increase the intraocular pressure and further worsen the symptoms of glaucoma. Because corticosteroids possess immunosuppressant properties, they are contraindicated in patients with septicemia, systemic fungal infections, and varicella infection. Suppression of the immune system by corticosteroids worsens these infections. Corticosteroids are contraindicated in patients with diabetes mellitus because they increase the blood glucose concentration and lead to hyperglycemia, which is a risk factor for diabetes mellitus. Liver disorder is assessed when antiadrenal drugs are prescribed. Corticosteroids are used to treat ulcerative colitis, so they are not contraindicated in patients with ulcerative colitis.

Before a child begins drug therapy with growth hormone, the nurse should stress which teaching point with the parents? 1. "your childs expected growth rate is 3-5 inches during the first year of treatment" 2. "you need to measure your childs height and weight daily" 3. "Growth hormone therapy, once started, must be taken until the child reaches the age of 21" 4. "The amount of subcutaneous fat your child has will increase during the treatment period

1. "your childs expected growth rate is 3-5 inches during the first year of treatment"

Before surgery, propranolol is prescribed for a client with hyperthyroidism. The nurse should assess for which set of intended outcomes? 1. Change in heart rate, reduced anxiety, reduced sweating 2. Regrowth of scalp hair, increased tolerance of extreme temperature changes 3. Weight gain, improved respiratory status 4. Decreased insomnia, decreased restlessness

1. Change in heart rate, reduced anxiety, reduced sweating

When the nurse teaches a client about insulin administration, what information about the client alerts the nurse that special instruction is needed? 1. Client closely restricts foods high in carbohydrates 2. Client wants spouse to learn to administer insulin 3. Client performs 30 minutes of aerobic exercise every other day 4. Client takes nap each day in the afternoon

1. Client closely restricts foods high in carbohydrates

The nurse is reviewing a clients medication record and notes that levothyroxine is prescribed. The nurse considers that the client may have which condition?SATA 1. Cretinism 2. Thyroid cancer 3. Myxedema coma 4. Adrenal insufficiency 5. Type 2 diabetes mellitus

1. Cretinism 2. Thyroid cancer 3. Myxedema coma

Several weeks ago calcitonin was prescribed for a client with Paget disease. To determine therapeutic effectiveness, the nurse should review which follow up testing results for this client? 1. Decreased alkaline phosphate levels 2. Increased serum Calcium levels 3. Bone xrays for return of bones to normal 4. Magnetic resonanace imaging(MRI) results of skull deformities

1. Decreased alkaline phosphate levels

A client recently diagnosed with type 2 diabetes mellitus is beginning drug therapy with tolbutamide. The nurse should conduct a drug history with special emphasis on which drugs? SATA 1. Ginseng, which increases hypoglycemic effects 2. Alcoholic beverages which cause a disulfram-like reaction 3. Thiazide diuretics, which increase risk for aplastic anemia 4. Beta blockers, which mask signs and symptoms of hypoglycemic reaction 5. Garlic, which increases risk of bleeding

1. Ginseng, which increases hypoglycemic effects 2. Alcoholic beverages which cause a disulfram-like reaction 4. Beta blockers, which mask signs and symptoms of hypoglycemic reaction

A client is taking a high dose of fludrocortisone to treat Addison disease. The nurse should provide which instruction to the client? 1. Keep a log of weekly early morning weights 2. Report weight loss greater than 2.3 kg(5 lb) per week 3. There will be reduced ability to resist infection 4. It is important to measure postural blood pressures.

1. Keep a log of weekly early morning weights

The nurse is administering lispro (Humalog) insulin and will keep in mind that this insulin will start to have an effect within which time frame? Answers: 15 minutes 1 to 2 hours 80 minutes 3 to 5 hours

15 minutes

A patient with hypothyroidism reports severe sleeping disturbances. Which statement given by the patient is helpful in identifying the reason for the insomnia? 1 "I always take the same brand of tablet." 2 "I take the tablet every evening at the same time." 3 "I take the tablet every morning at the same time." 4 "I take the tablet every morning on an empty stomach."

2 "I take the tablet every evening at the same time." Taking a thyroid tablet in the evening results in insomnia. When administered in the evening, the drug shows its effects at bedtime, resulting in sleep disturbances. If the patient regularly takes the same brand of tablet every day at the same time, it helps reduce the problems with the bioequivalence of drugs from different manufacturers. If the patient takes the tablet every morning at the same time, it increases the effectiveness of the medication, which is highly beneficial to the patient. If the patient takes the tablet every morning on an empty stomach, it maximizes the therapeutic effects of the drug and does not cause insomnia. Test-Taking Tip: You have at least a 25% chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses.

A nursing student is caring for an elderly patient who has Cushing's syndrome. The nursing instructor asks the student about the characteristics that can be observed in patients with Cushing's syndrome. What is the best answer given by the student? 1 "The patient has redistribution of body fat from the face, shoulders, trunk, and abdomen to the arms and legs." 2 "The patient has muscle weakness because of increased carbohydrate metabolism." 3 "The patient has hypokalemia because of a decrease in blood potassium concentrations." 4 "The patient has dehydration because of a decrease in blood aldosterone concentrations."

2 "The patient has muscle weakness because of increased carbohydrate metabolism." Cushing's syndrome leads to muscle weakness from potassium loss. In Cushing's syndrome, the hypersecretion of glucocorticoids results in the redistribution of body fat from the arms and legs to the face, shoulders, trunk, and abdomen, which leads to the characteristic "moon face." The undersecretion (hyposecretion) of adrenocortical hormones causes a condition known as Addison's disease. It is associated with decreased blood sodium and glucose levels, increased potassium levels, dehydration, and weight loss.

Which corticosteroid drug is safe to use during pregnancy? 1 Prednisone 2 Betamethasone 3 Fludrocortisone 4 Methylprednisolone

2 Betamethasone Betamethasone is the drug of choice for patients experiencing premature labor. It helps to accelerate fetal lung maturation. Prednisone, fludrocortisone, and methylprednisolone are pregnancy category C drugs, which are not safe to use during pregnancy. These drugs cross the placenta and cause fetal abnormalities.

Which medication, when given with desmopressin, causes increased water retention? 1 Thioridazine 2 Carbamazepine 3 Acetaminophen 4 Norepinephrine

2 Carbamazepine When given with desmopressin, carbamazepine can cause an increase in the effects of desmopressin, including water retention. Thioridazine, acetaminophen, and norepinephrine do not have any water retention impact on desmopressin.

The primary health care provider prescribes vasopressin to a patient. What side effects will the nurse expect in the patient? 1 Frequent thirst 2 Decreased urination 3 Drowsiness and sleep 4 Confusion and irritation

2 Decreased urination The drug vasopressin mimics the action of antidiuretic hormone, which results in a decrease in urine output. A lower urine output may cause the patient to feel less thirsty. Sedative action is also not reported with vasopressin. There are no reported symptoms of confusion with vasopressin.

A patient has been prescribed a beclomethasone inhaler. When teaching the patient about the use of inhalers, the nurse instructs the patient to rinse the mouth with warm water after using the inhaler. Which adverse effect is the nurse trying to prevent? 1 Adrenal crisis 2 Fungal infection 3 Addison's disease 4 Cushing's syndrome

2 Fungal infection Beclomethasone is an inhaled corticosteroid. These medications may promote local fungal growth, because immunity is suppressed. Therefore, the nurse should instruct the patient to rinse the mouth with warm water after using the inhaler. Adrenal crisis is a life-threatening condition in which cortisol is deficient or very low in the body. It cannot be prevented by rinsing the mouth with warm water. Addison's disease occurs when the adrenal glands do not produce enough cortisol. This disease cannot be prevented by rinsing the mouth with warm water. Cushing's syndrome is an adverse effect of long-term or frequent use of corticosteroids and is characterized by "moon face," obesity in the trunk area, impaired glucose metabolism, and a "buffalo hump." Cushing's syndrome cannot be prevented by rinsing the mouth with warm water.

What are the common signs and symptoms of an adrenal crisis? Select all that apply. 1 Buffalo hump 2 Hyperkalemia 3 Hypernatremia 4 Delayed wound healing 5 Drop in extracellular fluid volume

2 Hyperkalemia 5 Drop in extracellular fluid volume An adrenal crisis is a life-threatening state of profound adrenocortical insufficiency and requires immediate medical management. The symptoms of adrenal crisis include hyperkalemia, a drop in extracellular fluid volume, and hyponatremia. A buffalo hump is a clinical manifestation of Cushing's syndrome. Delayed wound healing is a clinical manifestation of long-term glucocorticoid therapy.

What assessment finding indicates to the nurse that vasopressin has been effective? 1 Relief of pain 2 Increased urine specific gravity 3 Increased serum albumin levels 4 Decreased adrenocorticotropic hormone levels

2 Increased urine specific gravity Vasopressin causes decreased water excretion in the renal tubule, thus increasing urine specific gravity. It is used to treat diabetes insipidus, which presents with a low urine specific gravity. This medication does not decrease pain, affect serum albumin levels, or decrease adrenocorticotropic hormone levels. STUDY TIP: Determine whether you are a "lark" or an "owl." Larks, day people, do best getting up early and studying during daylight hours. Owls, night people, are more alert after dark and can remain up late at night studying, catching up on needed sleep during daylight hours. It is better to work with natural biorhythms than to try to conform to an arbitrary schedule. You will absorb material more quickly and retain it better if you use your most alert periods of each day for study. Of course, it is necessary to work around class and clinical schedules. Owls should attempt to register in afternoon or evening lectures and clinical sections; larks do better with morning lectures and day clinical sections.

Liotrix is prescribed for a client with hypothyroidism. The nurse should include which important statement as part of client teaching prior to discharge? 1. "Measure the body temperature every morning" 2. " Report chest pain or palpitations to your healthcare provider immediately" 3. "You may experience sleepiness while taking this drug" 4. "You may experience nervousness while taking this drug"

2. " Report chest pain or palpitations to your healthcare provider immediately"

After ingesting high dosages of glucocorticoids for several weeks, the client asks the nurse about stopping drug therapy. Which statement would be the nurses best response? 1. "Even at high doses, adverse reactions are unlikely if the medication is abrupt;y withdrawn" 2. "It is dangerous for steroids to be withdrawn suddenly" 3. "You may experience severe psychological symptoms when the medication is withdrawn" 4. "Tapering of the medication requires daily bloodwork to measure serum chemistries

2. "It is dangerous for steroids to be withdrawn suddenly"

When making a home visit to a male client who has been receiving insulin for 2 weeks, the nurse should include which statements in follow up client teaching? SATA 1. "A family member also needs to learn how to administer insulin injections" 2. "Visual changes can occur over time if blood glucose is not sufficiently controlled with insulin" 3. "You may experience impotence as an effect of the disease process" 4. "Loss of sight and toe or leg amputation are common in clients with diabetes who take insulin" 5. "A high glucose level is not always an indication for an increase in insulin damage"

2. "Visual changes can occur over time if blood glucose is not sufficiently controlled with insulin" 3. "You may experience impotence as an effect of the disease process" 5. "A high glucose level is not always an indication for an increase in insulin damage"

A client who has received metyrapone experiences an adrenal crisis. The nurse considers that which condition most likely predisposed the client to this occurence 1. Hyperaldosteronism 2. Adrenal insufficiency 3. Pheochromocytoma 4. Type 1 diabetes mellitus

2. Adrenal insufficiency

A nurse is providing client education regarding prescribed intranasal desmopressin(DDAVP). What items of information should the nurse include during the teaching session? SATA 1. Shake the drug rigorously prior to use. 2. Keep a record of each nights sleep and record incidents of bed wetting 3. Angle the tip of the nasal spray low into the cavity when administering this drug 4. Report a rapid weight gain to the prescriber immediately 5. Report drowsiness to the prescriber

2. Keep a record of each nights sleep and record incidents of bed wetting 4. Report a rapid weight gain to the prescriber immediately 5. Report drowsiness to the prescriber

A client taking digoxin is scheduled to receive an injection of intravenous calcium. The nurse should prepare to intervene if which signs of drug interaction occurs? 1. Hypertension and tingling around the mouth 2. Sustained, significant bradycardia 3. Nausea and vomiting and diarrhea 4. Sloughing of tissue at the injection site

2. Sustained, significant bradycardia

A client who recently started taking desmopressin reports onset of a headache, lethargy, and drowsiness. The nurse should make which assessment of the client next? 1. History of recent streptococcal infection 2. Whether client also takes carbamazepine 3. If client has developed hypertension 4. Signs and symptoms of dehydration

2. Whether client also takes carbamazepine

A client with adrenal insufficiency is prescribed to take hydrocortisone three times daily on a long term basis. What should the nurse include in client teaching? SATA 1. "Immediately stop taking the medication if weight gain or diarrhea occurs" 2."Alcohol and caffeine should be avoided while taking this medication" 3."You will likely notice an improvement in your daily blood glucose levels and hemoglobin A1C levels" 4. "Report symptoms of persistent heartburn or indigestion" 5."Report any wound that will not heal or is healing very slowly"

2."Alcohol and caffeine should be avoided while taking this medication" 4. "Report symptoms of persistent heartburn or indigestion" 5."Report any wound that will not heal or is healing very slowly"

The nurse teaches a patient receiving long-term corticosteroid drug therapy about the dosage regimen. Which response by the patient indicates the need for further teaching? 1 "I will take this medication with food or milk regularly." 2 "I will not touch or interact with people who have infections." 3 "I will stop taking this medication if I have any adverse effects." 4 "I will report to you immediately if I have fever or a sore throat."

3 "I will stop taking this medication if I have any adverse effects." A patient who is receiving corticosteroid drug therapy should not stop medications abruptly, because it may lead to a sudden decrease in the production of endogenous glucocorticoid. This may cause adrenal insufficiency in the patient. In long-term therapy, alternate-day dosing of glucocorticoids will help to minimize adrenal suppression. A common side effect of corticosteroid therapy is gastrointestinal distress; hence these drugs should be administered with food or milk. Fever, sore throat, increased weakness, and lethargy are common side effects of these drugs, and the patient should contact the nurse or the primary health care provider immediately if they occur. Because these medications suppress the immune system, patients taking corticosteroids need to avoid contact with people who have an infection.

During an assessment, a patient asks the nurse, "What should I do if I miss two or three doses of thyroid replacement drug in a row?" What is the best response given by the nurse? 1 "You can take the dose immediately when you remember it." 2 "Skip the missed dose and resume your usual dosage schedule." 3 "You should consult your primary health care provider immediately." 4 "If it is almost time for your next dose; at that time take a double dose of drug."

3 "You should consult your primary health care provider immediately." If a patient misses two or more doses of thyroid replacement drug in a row, the patient should consult the primary health care provider. This will help the primary health care provider plan effective treatment and avoid probable complications by modifying the dosage regimen. Taking doses at irregular periods, skipping a dose, or taking a double dose is not appropriate. These situations may cause adverse effects, and the treatment may not be effective.

Which condition is contraindicated with somatrem? 1 Polyuria 2 Polydipsia 3 Acromegaly 4 Hypopituitary dwarfism

3 Acromegaly Somatrem is a synthetic form of growth hormone. Acromegaly is caused by excessive growth hormone, and thus this drug would be contraindicated. Polyuria and polydipsia cannot be treated with somatrem. Hypopituitary dwarfism is treated by administering somatrem.

A patient is being treated for secondary adrenocortical insufficiency. If the patient's adrenal glands are still intact, which medication used in the treatment of primary adrenocortical insufficiency should the nurse avoid? 1 Prednisone 2 Cosyntropin 3 Fludrocortisone 4 Glargine insulin

3 Fludrocortisone Adrenocorticotropic hormone (ACTH) is released from the anterior pituitary gland in response to a deficient circulating concentration of cortisol. Secondary adrenocortical insufficiency is usually caused by glucocorticoid administration; for this reason, the nurse should avoid giving this patient fludrocortisone, because the patient's adrenal glands are intact and still produce aldosterone. Prednisone is indicated in the treatment of primary and secondary adrenocortical insufficiency. Cosyntropin, a synthetic ACTH, is not indicated in the treatment of primary or secondary adrenocortical deficiency. Glargine insulin may be indicated if the patient also has diabetes mellitus.

A patient is diagnosed with hypersecretion of adrenocorticoid hormones, leading to symptoms of weight gain and hypertension. Which subjective findings would the nurse expect in this patient? Select all that apply. 1 Consumption of a protein-rich diet 2 History of diabetes mellitus 3 Frequent use of corticosteroids 4 Increased frequency of urination 5 Rapid, deep breathing

3 Frequent use of corticosteroids 4 Increased frequency of urination Adrenocorticoid hormone hypersecretion may be the result of excessive use of corticosteroids, which is required for the production of these hormones. The patient is likely to report frequent use of these medications. Weight gain and hypertension are symptoms associated with the hypersecretion of adrenocorticoid hormones due to retention of sodium and water in the body. The patient is likely to report frequent urination related to this. Hypersecretion of adrenocorticoid hormones is not related to consumption of increased proteins or a history of diabetes mellitus. It also will not cause a rapid, deep respiratory pattern. Topics

The nurse is caring for a patient who has myxedema. The nurse administers a hypothyroid drug and later learns that the drug was improperly mixed and that an increased dose of the drug was administered to the patient. For what symptoms will the nurse initially assess? 1 Bloody stools 2 Increased sleep 3 Increased heart rate 4 Reduced urine output

3 Increased heart rate Myxedema is a condition where thyroid activity is diminished. Hypothyroid drugs such as levothyroxine are prescribed to treat it. When this drug is given in high doses, the patient's cardiac activity may be altered, so the nurse should check for increased heart rate. Diarrhea is also observed as a side effect in the event of an overdose. However, bloody stools are not observed. Patients who are administered an overdose of the drug develop insomnia as a side effect. Irregularities in urine output are a symptom of declined renal function. However, they may not be caused by an overdose of thyroid hormones.

A patient who was previously receiving anticoagulant therapy has been prescribed long-term corticosteroid therapy. Which laboratory results will the nurse assess while caring for this patient? 1 Serum sodium concentration 2 Serum glucose concentration 3 International normalized ratio 4 Serum potassium concentration

3 International normalized ratio Oral anticoagulants interact with adrenal drugs in ways that can affect the international normalized ratio (INR). A common side effect associated with corticosteroid drug therapy is gastrointestinal bleeding, which increases upon interaction with oral anticoagulants. Therefore, the INR should be checked to determine the prothrombin time. Serum sodium, glucose, and potassium concentrations need to be checked when corticosteroids are administered alone to identify the side effects.

The nurse is caring for a patient who has congenital hypothyroidism. Which medication will the nurse expect the primary health care provider to prescribe? 1 Liotrix 2 Methimazole 3 Levothyroxine 4 Propylthiouracil

3 Levothyroxine Levothyroxine is a thyroid drug used to treat congenital hypothyroidism. Liotrix is a thyroid drug used to treat hypothyroidism but not congenital hypothyroidism. Methimazole and propylthiouracil are the antithyroid drugs used to treat hyperthyroidism but not congenital hypothyroidism.

The nurse teaches a nursing student about liotrix. Which statement made by the nurse is appropriate? 1 Liotrix contains T3 alone. 2 Liotrix contains T4 alone. 3 Liotrix contains T4 and T3 in a 4:1 ratio. 4 Liotrix contains T4 combined with calcium

3 Liotrix contains T4 and T3 in a 4:1 ratio. Liotrix is used in treating hypothyroidism, and it contains T4 and T3 in a 4:1 ratio, which replaces the diminished hormone levels of the body. None of the thyroid drugs contain T3 alone. Levothyroxine is the only drug that contains only T4. Calcium is not combined with T4 in liotrix.

Assuming the patient eats breakfast at 9:00 AM, lunch at noon, and dinner at 6:00 PM, he or she is at highest risk of hypoglycemia following an 8:30 AM dose of NPH insulin at what time? Answers: 10:00 AM 0200 am 3 PM 8:00 PM

3 PM

The nurse is caring for a patient who has systemic lupus erythematosus who has been taking prednisone for a long time. What changes in the patient will the nurse assess to prevent complications from this long-term therapy? 1 Hair loss 2 Pale skin 3 Presence of belly fat 4 Sudden increase in height

3 Presence of belly fat Long-term use of prednisone therapy would result in Cushing's syndrome, which is characterized by obesity of the trunk area (referred to as belly fat), facial erythema, and "moon face." Prednisone therapy is not associated with hair loss. The patient may have darkened rather than pale skin. The patient may have decreased height, because the drug suppresses growth, especially in children. Therefore, a sudden increase in height is not an adverse effect of prednisone.

The nurse is caring for a patient with Addison's disease who has been prescribed a combination of oral prednisone and fludrocortisone. After a few days the patient reports severe gastrointestinal upset. What should the nurse expect to be prescribed for the patient? 1 Extra oral adrenal medication 2 Decreased dose of prednisone 3 Proton pump inhibitor medication 4 Decreased dose of fludrocortisone

3 Proton pump inhibitor medication Corticosteroids such as prednisone and fludrocortisone cause severe gastrointestinal upset when administered orally because of their ulcerative properties. Hence, to prevent ulcer formation, the primary health care provider prescribes a proton pump inhibitor or an H2-receptor antagonist. The inclusion of an extra oral adrenal drug in the prescription may reduce the risk of Addison's disease but further increase the gastrointestinal upset. Decreased doses of prednisone and fludrocortisone may increase the risk of Addison's disease.

While assessing a patient who has hypoglycemia, a nursing student finds that the patient has severe weight loss. The patient's laboratory reports suggest that there is a decrease in the sodium concentration and increase in potassium concentration. What should the student infer from this? 1 The patient has hypothyroidism. 2 The patient has insulin resistance. 3 The patient has Addison's disease. 4 The patient has Cushing's syndrome.

3 The patient has Addison's disease. Hypoglycemia, weight loss, decrease in sodium concentration, and increase in potassium concentration are all symptoms of Addison's disease. Addison's disease is caused by the hyposecretion of adrenocortical hormones. This results in a reduction in the levels of glucose from impaired functioning of beta cells. This patient also has a loss of sodium and an increase in potassium concentrations because of impaired renal function. Hypothyroidism results from reduced thyroid hormone secretion. It is characterized by impaired metabolism and weight gain. Insulin resistance may cause hyperglycemia and diabetes mellitus. It would not cause this patient's hypoglycemia. Cushing's syndrome is characterized by "moon face," caused by the redistribution of fat from the arms and legs to the face and shoulders.

Which statement about glucocorticoids is most accurate? 1 They decrease serum sodium and glucose concentrations. 2 They stimulate defense mechanisms to produce immunity. 3 They influence carbohydrate, lipid, and protein metabolism. 4 They are produced in decreased amounts during times of stress

3 They influence carbohydrate, lipid, and protein metabolism. Glucocorticoids play a major role in carbohydrate, lipid, and protein metabolism within the body. They increase sodium and glucose concentrations, suppress the immune system, and are produced in increasing amounts during stress.

Parents are concerned that their 5 yr old son is not growing fast enough and ask the nurse if he should be receiving growth hormone (GH). Which response by the nurse would be most appropriate? 1. "Growth hormone will only affect your childs short bones" 2. "Can your son swallow pills easily?" 3. "Scientific evidence is required before growth hormone can be administered to children" 4. "How tall do you think your son should be?"

3. "Scientific evidence is required before growth hormone can be administered to children"

What is the best method of administering glipizide? Answers: With food At bedtime 15 minutes postprandial 30 minutes before a meal

30 minutes before a meal

After taking propylthiouracil for 6 weeks, a client with Graves disease reports a sore throat and fever. What should the outpatient clinic nurse do next as a priority? 1. Ask client about exposure to the common cold 2. Measure clients body temperature and ask about history of fever over last few weeks 3. Review laboratory report for clients WBC count with differential 4. Ask about current mental stressors that could be weakening the immune system

3. Review laboratory report for clients WBC count with differential

The nurse is evaluating a clients knowledge of the treatment of an insulin reaction. The nurse would place highest priority on determining that the client understands which point? 1. Symptoms indicating the need to notify the healthcare provider 2. When to schedule fasting blood glucose level 3. When to ingest orange juice and crackers with peanut butter 4. Importance of maintaining sufficient oral fluid intake

3. When to ingest orange juice and crackers with peanut butter

The nurse is caring for a patient who has recently undergone an adrenalectomy. During preparation for discharge, the nurse teaches the patient's family members about care to be given at home. Which instruction should the nurse include in the teaching? 1 "Maintain a regular diabetic diet." 2 "Report fat deposition at the abdomen." 3 "Do mild to moderate exercises regularly." 4 "Immediately report any wound infection."

4 "Immediately report any wound infection. Adrenalectomy is an operation during which one or two adrenal glands are removed. The patient may have decreased or no production of adrenal hormones, and this in turn reduces the patient's immunity. Therefore, the nurse should instruct the patient's family members to report any wound infection, which, if left untreated, could become fatal. The instruction to eat a diabetic diet is given if prednisone is prescribed, because prednisone increases blood glucose concentrations. Deposition of fat occurs in the case of excess secretion of adrenocortical hormone. In this case, there is reduced secretion of adrenocortical hormone, so the patient may not have fat deposition in the abdomen. Exercise will induce profuse sweating, thereby increasing the loss of electrolytes from the body. The patient is advised to avoid exercising after the surgery.

A nursing student is caring for an older adult patient with Addison's disease. The nursing instructor asks the student about the characteristics that can be observed in patients with Addison's disease. What is the best answer given by the student? 1 "The patient has weight gain because of the deposition of excess fat in the body." 2 "The patient has muscle weakness because of increased carbohydrate metabolism." 3 "The patient has hypokalemia because of a decrease in blood potassium concentrations." 4 "The patient has dehydration because of a decrease in blood aldosterone concentrations."

4 "The patient has dehydration because of a decrease in blood aldosterone concentrations." Addison's disease is caused by a reduction in the glucocorticoid, mineralocorticoid, and androgenic hormones in the blood. The mineralocorticoid aldosterone regulates sodium and potassium balance in the blood. A decrease in blood aldosterone concentrations results in dehydration, because the hormone aldosterone is used to regulate the balance of salt and water. Addison's disease leads to weight loss and is not characterized by the deposition of fat in the body. Cushing's syndrome leads to muscle weakness from potassium loss. Addison's disease leads to weight loss because of decreased, not increased, carbohydrate metabolism.

The nurse is caring for a patient who has Addison's disease who takes a loop diuretic medication. Which other medications would the nurse likely find in the patient's prescription to provide effective treatment? Select all that apply. 1 Iron supplements 2 Sodium supplements 3 Vitamin supplements 4 Calcium supplements 5 Potassium supplements

4 Calcium supplements 5 Potassium supplements A patient with Addison's disease would be prescribed corticosteroids for treatment. If the patient is taking corticosteroids and loop diuretic medications, then the patient would have severe hypocalcemia and hypokalemia because of a drug-drug interaction caused by excessive loss of potassium and calcium. Therefore, calcium and potassium supplements will likely be included in the patient's prescription. Loop diuretic medications do not cause iron deficiency and do not impair the absorption of vitamins; thus iron and vitamin supplements would not be prescribed. Sodium concentrations are not altered much in the patient; hence sodium supplements would not be included in the patient's prescriptions.

A patient has been prescribed corticosteroids for adrenal suppression. Which behavior process would be observed in the patient because of this? 1 Memory loss 2 Hallucinations 3 Impaired thinking 4 Impaired stress response

4 Impaired stress response Patients who have adrenal suppression may have impaired response to stress because of alterations in epinephrine release. Acetylcholine and dopamine concentrations are not altered by adrenal suppression. Therefore, the patient would not have memory loss, hallucinations, or impaired thinking. Test-Taking Tip: Try putting questions and answers in your own words to test your understanding.

The nurse is caring for a patient who has hypertension and is on continuous corticosteroid therapy to treat adrenal insufficiency. The electrocardiograph shows a steady slowing of the patient's heart beat. The patient's blood pressure is 140/96 mm Hg. Which drug is the nurse most likely to find while reviewing the patient's medication history? 1 Hydantoins 2 Barbiturates 3 Cholinergics 4 Loop diuretic

4 Loop diuretic A decreased heart rate results from an increased concentration of sodium and a decreased concentration of potassium in the body. To compensate for the low heart rate, blood pressure will increase steadily. In this case, the use of a corticosteroid resulted in hypokalemia and hypernatremia. Because the patient is hypertensive, a loop diuretic would be prescribed to treat hypertension. Corticosteroids increase the retention of sodium and the excretion of potassium from the body. The use of a potassium-sparing diuretic would decrease the loss of potassium. Hydantoins and barbiturates increase the metabolism of corticosteroids, thus reducing the loss of potassium. Cholinergics interact with corticosteroids and cause weakness in patients taking both.

Which adrenal drug is available in a long-acting (depot) formulation? 1 Prednisone 2 Betamethasone 3 Fludrocortisone 4 Methylprednisolone

4 Methylprednisolone Methylprednisolone is an adrenal drug that is available in a long-acting (depot) formulation. Prednisone is a synthetic intermediate-acting glucocorticoid available in oral from but not in long-acting (depot) formulation. Betamethasone is an adrenal drug available in topical, oral, and inhaled forms but not as a depot formulation. Fludrocortisone is a synthetic mineralocorticoid available in oral form only.

The nurse is assessing an older adult who has been taking liotrix for 6 months. The nurse finds that the patient has anxiety, tremors, and insomnia. What will the nurse interpret from these findings? 1 The patient is hypersensitive to thyroid drugs. 2 The patient has common age-related symptoms. 3 The patient is not responding to the thyroid drugs. 4 The patient is experiencing adverse effects of the thyroid drugs.

4 The patient is experiencing adverse effects of the thyroid drugs. Anxiety, tremors, and insomnia are the adverse effects of liotrix. These adverse effects may be due to accumulation of the drug in the body or due to overdose of the medication. If the patient has an allergic reaction immediately after taking the drug or within 24 hours after drug administration, it indicates that the patient is hypersensitive to the medication. An elderly patient would not necessarily have anxiety, tremors, and insomnia. Therefore, the nurse should avoid generalizing the symptoms and avoid considering them common age-related symptoms. If the patient were not responding to the medication, the patient would have decreased thyroid hormone levels. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. Example: If you are being asked to identify a diet that is specific to a certain condition, your knowledge about that condition would help you choose the correct response (e.g., cholecystectomy = low-fat, high-protein, low-calorie diet).

Because the client with hypocalcemia needs to increase the level of calcium absorption, which activity should the nurse perform as part of the therapeutic plan of care? 1. Administer magnesium sulfate PO 2. Encourage increase in exercise 3. Administer verapamil 80mg PO q8h 4. Administer ergocalciferol (Vit D)

4. Administer ergocalciferol (Vit D)

A female client with a tumor on the posterior pituitary gland is taking cabergoline 0.25 mg by mouth twice weekly. The nurse should monitor for which of the following therapeutic outcomes? 1. Normal serum calcium levels 2. Reduced number of hot flashes per day 3. Lowering of Blood pressure 4. Relief from inappropriate lactation

4. Relief from inappropriate lactation

The nurse is reviewing the various types of insulins. For each insulin listed below, place in order from shortest duration (1) to longest duration (4). A. Glargine insulin B. Aspart insulin C. Regular insulin D. NPH insulin

B. Aspart insulin C. Regular insulin D. NPH insulin A. Glargine insulin

When reviewing the laboratory values of a patient who is taking the antithyroid drug PTU, the nurse will monitor for which adverse effect? Answers: Decreased glucose levels Decreased white blood cell count Increased red blood cell count Increased platelet count

Decreased white blood cell count

Which is a priority nursing diagnosis for a patient receiving desmopressin (DDAVP)? Answers: Risk for injury Acute pain Excess fluid volume Deficient knowledge regarding medication

Excess fluid volume

Patients taking levothyroxine (Synthroid) and warfarin (Coumadin) concurrently would be monitored for which adverse effect Answers: Cardiac arrhythmias Increased risk of bleeding Excessive weight loss Increased risk of deep vein thrombosis

Increased risk of bleeding Response Feedback: Levothyroxine can compete with protein-binding sites of warfarin, allowing more warfarin to be unbound or free, thus increasing effects of warfarin and risk of bleeding.

The nurse is discussing with a patient the time of day for taking prednisone. What information would the nurse include in the teaching based on knowledge of glucocorticoids? Answers: It is usually administered early in the evening to coincide with the natural secretion pattern of the adrenal cortex. It is usually administered on a strict, unchanging schedule in order to prevent adverse reactions. It should be administered with food to diminish the risk of gastric irritation. It should be administered with the patient's morning coffee to enhance its effects.

It should be administered with food to diminish the risk of gastric irritation.

An operating room nurse prepares a patient who has type 2 diabetes for surgery. Which type of insulin that can be given intravenously does the nurse administer? Answers: Regular insulin Insulin glargine Insulin zinc suspension Isophane insulin suspension (NPH insulin)

Regular insulin

The nurse is teaching the patient taking an antithyroid medication to avoid foods high in iodine. Which food will the nurse advise the patient against? Answers: Milk Eggs Seafood Chicken

Seafood

A patient has been diagnosed with metabolic syndrome and is started on the biguanide metformin (Glucophage). The nurse knows that the purpose of the metformin, in this situation, is which of these? Answers: To increase the pancreatic secretion of insulin To decrease insulin resistance To increase blood glucose levels To decrease the pancreatic secretion of insulin

To decrease insulin resistance

The nurse would question an order for steroids in a patient with which condition? Answers: Uncontrolled diabetes mellitus Rheumatoid arthritis Septic shock Exacerbation of chronic obstructive pulmonary disease (COPD)

Uncontrolled diabetes mellitus

The nurse is providing care to a patient following a non-accidental traumatic brain injury. The patient has developed diabetes insipidus due to the injury. What medication is most often used in the management of diabetes insipidus? Answers: desmopressin (DDAVP) corticotrophin (Acthar) octreotide (Sandostatin) somatropin (Humatrope)

desmopressin (DDAVP)

Which long-acting insulin mimics natural, basal insulin with no peak action and a duration of 24 hours? Answers: insulin glargine (Lantus) insulin glulisine (Apidra) regular insulin (Humulin R) NPH insulin

insulin glargine (Lantus)

The nurse is caring for a patient scheduled to undergo a cardiac catheterization procedure utilizing iodine-based contrast material. The nurse would question an order for which medication to be given to this patient the day of the scheduled procedure? Answers: acarbose (Precose) metformin (Glucophage) repaglinide (Prandin) pioglitazone (Actos)

metformin (Glucophage) Response Feedback: The concurrent use of metformin and iodinated (iodine-containing) radiologic contrast media has been associated with both acute renal failure and lactic acidosis. Therefore metformin should be discontinued at least 48 hours prior to any radiologic study requiring such contrast media and should be held for at least 48 hours after the procedure

The nurse admitting a patient with acromegaly anticipates administering which medication? Answers: desmopressin (DDAVP) corticotropin (Acthar) somatropin (Nutropin) octreotide (Sandostatin)

octreotide (Sandostatin) Response Feedback: Octreotide suppresses growth hormone, the culprit of acromegaly.