Test 4

The nurse is caring for a client who is on insulin therapy. The client may need to increase the insulin dose if he is also required to take which drug? Select all that apply.

Morphine sulfate Furosemide Nicotine (via cigarettes

You are the nurse educator at the diabetes clinic. When talking to a class of adolescent diabetics, you tell them that the main methods of self-monitoring glycemic control are testing of

blood glucose and urine ketone levels.

The nurse is aware that premixed insulins (those that contain both regular and NPH insulin) are least effective in what type of client?

client who has difficulty controlling his diabetes

A pregnant client asks about the safety of taking thyroid hormone replacement drugs during her pregnancy. What is the nurse's best response?

"Thyroid hormones are pregnancy category A drugs and should be taken during pregnancy."

What question is important for the nurse to ask a client who is scheduled to receive a first dose of radioactive iodine for hyperthyroidism?

"Do you have any trouble swallowing?"

What instructions would be important to give to a 50-year-old client with type 2 diabetes who has been switched from glyburide (DiaBeta), a sulfonylurea, to repaglinide, a meglitinide?

"It stimulates insulin production, so you need to eat soon after taking the medication."

A 59-year-old man with type 2 diabetes is prescribed metformin. When the patient returns to the clinic, he reports that he has lost 8 pounds in a month. How should the nurse respond?

"Please continue taking the medication and monitoring your weight. This is an expected outcome of this drug therapy."

The nurse is asked to explain how to administer somatropin (Saizen) to the parent of a 6-year-old. How would the nurse explain how this drug is administered?

"This delivers a fine mist through the skin without needles and far less discomfort."

A patient who has been taking ketoconazole for 1 month reports fatigue. What assessment findings are causes for concern related to this therapy? (Select all that apply.)

-A reported change in bowel movements to a lighter color -A yellow tint to the patient's skin - Yellow coloring around the patient's irises

A nurse completing discharge counseling should advise a client taking vasopressin (Pressyn) to notify the physician if which adverse reactions occur? (Select all that apply.)

-Changes in urine output -Abdominal cramps -Skin blanching

hat is true of the hormone vasopressin? (Select all that apply.)

-Vasopressin is secreted when body fluids must be conserved. -Vasopressin regulates the reabsorption of water from the kidney.

The nurse assesses a patient's blood glucose level after administering insulin. Which result would the nurse interpret as indicative of severe hypoglycemia?

34 mg/dL

The nurse is providing discharge instructions to a client who has just been diagnosed with type 1 diabetes. What instructions are most important for the client to follow related to diet? (Select all that apply.)

Avoid drinking beer, wine, or liquor. Use artificial sweeteners instead of sugar in tea and coffee. Read food labels carefully to look for hidden sources of sugar.

The nurse is caring for a client in the immediate postoperative period following cardiac transplantation who is receiving mycophenolate (CellCept) IV. What should the nurse teach the client regarding drug therapy? Select all that apply.

> "The drug will be given orally as soon as possible. > "It's important to avoid people with contagious diseases." > "Ask a pharmacist about drug-drug interactions before taking any over-the-counter (OTC) drug once you're discharged." > "Never miss a dose of medication."

The nurse is caring for a client with an acute infection that resulted in a prompt immune reaction. What symptoms exhibited by the client would the nurse recognize as being mediated by interleukins? Select all that apply.

> Fever > Joint pain > Muscle pain

A 24-year-old woman presents with fever and painful, swollen cervical lymph nodes. Her blood work indicates neutrophilia with a shift to the left. She most likely has:

A severe bacterial infection

A patient asks the nurse why a quick-acting sugar given by mouth is better in the regulation of insulin than the use of intravenous glucose for a low blood sugar. Which of the following statements by the nurse represents the most appropriate response to this question?

A. "The ingestion of food allows the digestive tract to stimulate vagal activity and the release of incretins." Oral glucose is more effective than intravenous glucose because glucose or food in the digestive tract stimulates vagal activity and induces the release of gastrointestinal hormones called incretins. The combination of insulin and food does not yield a higher blood glucose than intravenous insulin. Food stimulates the vagal nerve activity, but intravenous glucose does not. A statement that indicates that the patient is mistaken will belittle the patient and should be rephrased.

A client has sought care because of seasonal allergies that are having a negative effect on the client's quality of life. The nurse should recognize the role of what immunoglobulin in this client's health problem?

IgE

Which finding is most characteristic of Paget's disease?

Abnormal bone remodeling

Binding of a hormone to a receptor on the target organ may result in the release of a "second messenger." What is the function of the second messenger?

Activation of intracellular structures

A diabetic patient has been admitted to the ICU with diabetic ketoacidosis (DKA). What is the first step in the treatment of this patient?

Administration of IV fluids

An 8-year-old male is being treated for asthma, a chronic inflammatory disease of the airways. What hormone might the physician order to treat this patient?

Adrenal cortex hormones

An adult patient has been experiencing severe lethargy and fatigue over the past several days, and she describes herself as feeling "shaky." Random blood glucose testing reveals a glucose level of 38 mg/dL, but the woman denies any significant change in her diet. The care team should suspect the possibility of what health problem? A. Adrenal insufficiency B. Cushing's disease C. Acute renal failure D. Chronic renal failure

Adrenal insufficiency Any patient with unexplained severe hypoglycemia requires assessment for adrenal insufficiency. Cushing's disease and kidney disease do not result in hypoglycemia.

A client is prescribed methimazole for the treatment of hyperthyroidism. Which is a rare adverse effect or set of effects related to the administration of methimazole?

Agranulocytosis

A patient is to be administered glipizide (Glucotrol). Which factor would prohibit the administration of glipizide (Glucotrol) to this patient?

Allergy to sulfonamides

A patient who has been taking oral prednisone for several months abruptly ceased treatment several days ago on the advice of a family member. The patient has now been admitted to the emergency department with signs and symptoms that are characteristic of addisonian crisis. When assessing this patient, the nurse should prioritize what assessment? A. Assessment of urine for ketones B. Assessment for venous thromboembolism C. Assessment for adventitious lung sounds D. Assessment of serum potassium levels

Assessment of serum potassium levels In addisonian crisis, the loss of sodium leads to retention of potassium, resulting in symptoms of hyperkalemia. As a result, vigilant monitoring of serum potassium levels is more important than respiratory effects, urinalysis, or hypercoagulation.

A nurse is caring for a patient receiving metformin drug therapy to improve glycemic control. What adverse reaction to the drug should the nurse monitor the patient for?

Asthenia

A nurse is caring for a 48-year-old woman who has been hospitalized after injecting the wrong type of insulin. Which sign of hypoglycemia will the nurse be careful to observe for?

Blurred vision

A hospital patient's medication administration record specifies a dose of NPH insulin to be administered subcutaneously at 8 AM. The nurse has checked the patient's blood glucose level prior to administering the drug and it is 55 mg/dl. How should the nurse respond to this assessment finding?

C. Hold the dose of insulin and consult with the patient's primary care provider.

A female client is admitted to the hospital with hypoglycemia, nausea, muscle weakness, and depression. What is the most likely cause?

Characteristics of Addison disease include those related to glucocorticoid deficiency, such as hypoglycemia, anorexia, nausea, vomiting, flatulence, diarrhea, hyperpigmentation of skin, anxiety, depression, and loss of mental acuity, and those related to mineralocorticoid deficiency, such as fluid and electrolyte imbalance, orthostatic hypotension, hyponatremia, hyperkalemia, general malaise, muscle weakness, muscle pain, and cardiac arrhythmias. Hypertension, stroke, and Cushing disease are not associated with this array of signs and symptoms.

The pharmacology instructor is discussing hormones with the nursing students. What hormone, important in the digestive process, is secreted by the gastrointestinal mucosa?

Cholecystokinin

A client is to undergo fertility treatment and is to receive an agent that induces ovulation because her ovaries are functioning. Which agent would this most likely be?

Chorionic gonadotropin

An 11-year-old patient with growth failure due to lack of growth hormone has somatropin (Saizen) administered. What outcome would indicate that the drug should be stopped?

Closure of the epiphyses in long bones

The nurse assesses a client closely for which serious adverse reaction associated with methimazole and propylthiouracil?

agranulocytosis

Which hormone would a nurse identify as being involved in diurnal rhythm?

Corticotropin-releasing factor

A clent is diagnosed with Graves disease. Propylthiouracil (PTU) is prescribed. After 8 weeks of therapy, the client reports a fever and sore throat. The nurse is concerned that this symptoms may be early signs of:

agranulocytosis.

The treatment protocol for a client with hyperthyroidism includes antithyroid medication and propranolol. The purpose of propranolol is to do which of the following?

Decrease tachycardia

The nurse is caring for a client newly diagnosed with hypothyroidism. The client also takes theophylline to control asthma symptoms. What change may need to be made to the client's theophylline dose?

Decrease theophylline dosage immediately.

A patient with a recent diagnosis of type 2 diabetes has begun taking metformin. This drug will help the patient achieve adequate blood sugar control through which of the following mechanisms? (Select all that apply)

Decreasing glucose production by the liver Improving insulin sensitivity Decreasing glucose absorption in the GI tract

The nurse is caring for an older adult who will be beginning thyroid hormone replacement therapy. The nurse should be alert to which signs and symptoms of hypothyroidism that may be confused with other conditions associated with aging? (Select all that apply.)

Depression Unsteady gait Weight gain Confusion

A patient with type 1 diabetes has been admitted to the hospital for orthopedic surgery and the care team anticipates some disruptions to the patient's blood glucose levels in the days following surgery. Which of the following insulin regimens is most likely to achieve adequate glycemic control?

Doses of basal insulin twice daily with regular insulin before each meal

Receptors may be decreased when there are excessive amounts of hormone. This is known as:

Down-regulation.

Which is released in response to decreased oxygenated blood flowing through the kidneys?

Erythropoietin

The client with hypothyroidism takes levothyroxine daily and has triiodothyronine (T3), thyroxine (T4), and thyroid-stimulating hormone (TSH) levels drawn in the laboratory to check appropriateness of prescribed dosage. What results would the nurse analyze as indicating the need for a higher dosage of medication?

Elevated TSH, reduced T3 and T4 levels

The nurse is administering an antidiabetic agent by subcutaneous injection within 60 minutes of the patient's breakfast. Which agent would the nurse most likely be administering?

Exenatide

Which is a non-insulin injectable antidiabetic drug?

Exenatide (Byetta)

A nurse should recognize that a client taking antithyroid medication may be developing thyrotoxicosis if the client exhibits which of the following symptoms?

Extreme tachycardia

Which insulin would the nurse need to administer as a separate injection if the order also included NPH insulin?

Glargine

After teaching a group of students about sulfonylureas, the instructor determines that the teaching was successful when the students identify which agent as a second-generation sulfonylurea? (Select all that apply.)

Glimepiride Glyburide

A nurse should advise patient, especially elderly patients, to eat within 30 minutes of the administration of which of the following antidiabetic drugs to prevent hypoglycemia?

Glyburide

Which of the following drugs help lower blood glucose by increasing the production of insulin by beta cells in the pancreas? Select all that apply:

Glyburide (Diabeta) Glipizide (Glucotrol)

The nurse would contact the physician prior to administering desmopressin to a client with a history of what condition?

Heart attack

A clinic nurse is following a 9-year-old boy who is taking somatropin. What will the nurse monitor periodically?

Height

Which of the following insulin is always clear? (Choose one)

Humulin R

A female client is admitted with nausea, vomiting, weight loss, and severe hypoglycemia. A female client is diagnosed with adrenocortical insufficiency. What are other clinical manifestations associated with this condition?

Hyperpigmentation of the gums and mucous membranes Diminished axillary and public hair Generalized muscle weakness

What would expected findings during an assessment of a client with hyperthyroidism include? (Select all that apply.)

Increased appetite Tachycardia Goiter

A patient is undergoing metformin therapy at a health care facility. The patient is also prescribed glucocorticoids. What effect of interaction of these two drugs should the nurse assess for in the patient?

Increased risk of lactic acidosis

When describing the effects of incretins on blood glucose control to a group of students, which would an instructor include?

Increases insulin release

A patient is receiving acarbose. What would the nurse incorporate into the teaching plan for this patient about the action of the drug?

Inhibits an enzyme to delay glucose absorption

The nurse educator works at the diabetes clinic. When talking to a class of adolescent diabetics, the educator tells the students that the most recognized signs of diabetes are: hyperglycemia and glycosuria. Insulin analogs are synthesized in the laboratory by altering the type or sequence of amino acids in insulin molecules. Which of the following insulin analogs is a short-acting

Insulin lispro (Humalog), insulin aspart (NovoLog), and insulin glulisine (Apidra) are all short-acting (or "rapid-acting") products. They have a rapid onset and a short duration of action.

The nurse is assessing a new client admitted to a nursing home. The client asks the nurse to explain interleukins. The nurse would include which information?

Interleukins help the immune system with inflammation."

A patient has been prescribed acarbose (Precose). What is the advantage of acarbose?

It delays the digestion of complex carbohydrates.

A client diagnosed with hyperthyroidism is unsure about the need for the prescribed propranolol, stating, "I looked this up online and it's for high blood pressure, not thyroid problems." What statement concerning beta-adrenergic blockers should the nurse use as a basis for the response?

It will block stimulation of the sympathetic nervous system.

The nurse admits a client who has been diagnosed with diabetic ketoacidosis, and will look for what assessment findings consistent with this diagnosis? (Select all that apply.)

Ketones in the urine Flushed, dry skin

The nurse admits a client with type 2 diabetes who takes metformin (Glucophage), and indicates that the client has a nursing diagnosis of ineffective breathing pattern. What complication of the client's current drug therapy does the nurse believe the client is experiencing?

Lactic acidosis

Which of the following represent the American Diabetes Association recommended HbA1c goal?

Less than 7%

A group of students are reviewing information about thyroid and parathyroid hormones. The students demonstrate understanding of the information when they identify what as being stored in the follicular cells of the thyroid? (Select all that apply.)

Levothyroxine Liothyronine

After teaching a class about the various drugs used to control blood glucose, the instructor determines that the teaching was successful when the class identifies what as a biguanide?

Metformin

The nurse is caring for a client, age 77 years, who has type 2 diabetes and chronic kidney disease. Which drugs will be used with great caution in this client? (Select all that apply.)

Metformin (Glucophage) Exenatide (Byetta) Miglitol (Glyset)

Your client is scheduled to undergo diagnostic testing with the administration of parenteral radiographic contrast media containing iodine. Since your client is taking metformin, you know that

Metformin should be discontinued at least 48 hours before and after diagnostic tests.

What medication will be a likely component of therapy for a client admitted with a diagnosis of thyroid storm? Select all that apply. propranolol A client has a history of atrial fibrillation and is taking an oral anticoagulant. The client has been newly diagnosed with hypothyroidism and placed on levothyroxine (Synthroid). What assessment should the nurse prioritize?

Monitoring the client for increased bruising

A patient is experiencing a prolonged labor and her contractions are ineffective. Which agent would the nurse expect to be ordered?

Oxytocin

The nurse has admitted an elderly client in thyroid crisis to the unit. Since surgery is not an option, the client requires an antithyroid drug. What would be the best choice of drug for this client?

Radioactive iodine (Generic)

The physician prescribes glyburide for Tim, a newly diagnosed type 2 diabetic. The nurse knows that this medication acts by which mechanism?

Produces hypoglycemia by increasing insulin secretion from the pancreas

A student asks the nursing instructor what insulin has the quickest therapeutic effect once administered. What would be the best response?

Regular (Humulin R)

Which of the hormones is responsible for the growth of the body during childhood, especially the growth of muscles and bones?

Somatotropin

What needs to be used in a child prior to the closure of the bone epiphyses in order to exert its effects?

Somatropin

Growth hormones cause all of the following EXCEPT:

Suppression of triglyceride synthesis.

What would the nurse identify as a vaccine that is a toxoid?

Tetanus

A client is experiencing an immune response and the only immunoglobulin that is currently in circulation is IgM. How should the nurse best interpret this fact?

The client has very recently been exposed to the antigen

A client is seen in the clinic and diagnosed with hyperthyroidism. Before administering the prescribed potassium iodide, the nurse reviews the client's health record. What finding would cause the nurse to alter the plan of care?

The client takes digoxin 0.125 mg daily.

The pharmacology professor is discussing negative feedback systems with the introduction to pharmacology class. What does the negative feedback system work like?

The law of supply and demand

James, age 35, begins the administration of glyburide for treatment of diabetes mellitus type 2. As the nurse caring for John, you instruct him about the medication. Which statement would NOT be appropriate advice for James?

The medication can be taken at dinner time.

Which patient should not receive ketoconazole (Nizoral) as ordered for Cushing's disease?

The medication has a Black Box Warning: It can cause hepatotoxicity and should be given with caution to patients with known liver dysfunction. The medication may cause a headache or fatigue; however, this is not a contraindication. The patient recently diagnosed with hepatitis C needs to have liver function tests performed to see if liver function is an issue at this time.

What is the duration of action of water-soluble, protein-derived hormones compared to that of lipid-soluble steroid and thyroid hormones?

The water-soluble hormones have a shorter duration of action.

What main difference between alpha-glucosidase inhibitors, such as acarbose and miglitol, and insulin or metformin therapy would the nurse include during patient education?

They inhibit the absorption of regular cane sugar.

A client is receiving immunizations before traveling to a storm-stricken region of the tropics where cholera, typhoid, and malaria are in epidemic. While specific immunizations to combat specific diseases would be administered, why would an injection of IgA also be administered?

To increase local antibody response

The pharmacology instructor is talking about the drug propylthiouracil (PTU). What would the instructor cite as the primary mode of action for propylthiouracil (PTU)?

To inhibit production of thyroid hormone

In what condition is human insulin not recommended for diabetic patients?

Type 2 diabetes controlled by diet

What medication is used to treat diabetes insipidus caused by hypofunction of the posterior pituitary gland?

Vasopressin (Pitressin)

A 23-year-old client is prescribed a thyroid-hormone antagonistic drug. Which should a nurse determine during an ongoing assessment and evaluation of the drug therapy?

Whether the client has become intolerant to cold

The nurse instructs a client who has been prescribed extended-release metformin (Glucophage XR) to take the medication at what time?

With evening meal

When describing desmopressin to a group of students, the instructor explains that it is a synthetic form of:

antidiuretic hormone

what occurs whenthe body produces antibodies against itself?

autoimmune diseas

A child has responded favorably to treatment with somatropin and has grown several centimeters in recent months. When monitoring this client's progress during therapy, the nurse should be aware of the results from what diagnostic tests? Select all that apply.

blood glucose levels thyroid function tests eye examinations

A client is undergoing sodium iodine drug therapy for the treatment of hyperthyroidism. Which adverse reactions to the drug should the nurse monitor for in the client?

bone marrow depression

A patient will soon begin long-term treatment with hydrocortisone after being diagnosed with Addison's disease. In order to mitigate the potentially adverse effect of this treatment regimen, the nurse should encourage the patient to increase her intake of what nutrient? A. Potassium B. Water C. Calcium D. Sodium

calcium (for bone density)

An increase in what specific physiological effect is an expected outcome of thyroid hormone therapy? Select all that apply.

carbohydrate metabolism cellular metabolism oxygen consumption cardiac output

A nurse is preparing an ordered dose of sodium iodide 131I. The nurse should proceed knowing that this drug will help to resolve hyperthyroidism by what means?

destroying thyroid tissue

A nurse must be aware that thyroid hormone can worsen control of which disease or condition necessitating close client observation?

diabetes

The pathophysiology class is studying diabetes. A student asks the instructor what is considered a sign of a hypoglycemic reaction. The instructor's response would be:

diaphoresis.

A nurse is caring for a 70-year-old patient who is taking desmopressin (DDAVP). The patient has a history of cardiovascular disease. The nurse will prioritize the assessment of:

electrolyte levels

Pramlintide is administered orally.

false subcutanious

A 65-year-old client was involved in a motor vehicle accident and sustained a closed head injury. He is diagnosed with diabetes insipidus and is prescribed vasopressin for the management of this condition. Which condition would pose a risk for this client as a vasopressin recipient?

has a history of left ventricular enlargement

What is a common cause of primary hypothyroidism? Select all that apply.

hyperthyroidism medication therapy Hashimoto's thyroiditis radiation to the neck

Insulin is a hormone released by the pancreatic beta cells in response to a rise in glucose levels and what else?

incretins

A client with a diagnosis of Cushing's is not a surgical candidate and is consequently being treated with ketoconazole. The nurse should be aware that ketoconazole achieves a therapeutic effect by what means?

inhibiting the enzymes that contribute to cortisol synthesis

A newborn is diagnosed with hypothyroidism. What will the client likely develop if the condition is left untreated?

intellectual disability

A client about to receive an injection of influenza vaccination should be informed of the possibility of experiencing which short-term adverse effect? Select all that apply.

malaise muscle aches low-grade fever erythema at the injection site

A client about to receive an injection of influenza vaccination should be informed of the possibility of experiencing which short-term adverse effect? Select all that apply.

malaise muscle aches low-grade fever erythema at the injection site

A client admitted to the hospital with hyperthyroidism treated with propylthiouracil suddenly develops a skin rash. Which action would the nurse implement first? Notify the primary health care provider. A client, diagnosed with hypothyroidism, is currently taking an opioid for knee pain. This client is at increased risk for developing which adverse reaction?

myxedema coma

After teaching a group of nursing students about antidiabetic drugs, the instructor determines that the teaching was successful when the students identify which as an example of a hormone mimetic? Select all that apply.

sitagliptin exenatide Pramlintide

A male patient is to begin glyburide (Diabeta) for type 2 diabetes. Before the drug therapy begins, a priority action by the nurse will be to assess the patient's

use of alcohol

The nurse should advise a client who is taking levothyroxine for the first time that resolution of hypothyroid symptoms may not occur for how long after therapy is started?

weeks