The Endocrine System

A nurse is educating the parents of a child who has a new diagnosis of Prader-Willi Syndrome (PWS) and has been prescribed somatropin. Which of the following statements by a parent indicates understanding of the teaching? "We will use a different spot for injection each time we give the medication." "We'll give the shot in the thigh muscle rather than fatty tissue to decrease injection pain." "We'll watch our child for signs of low blood sugar while using somatropin." "We should stop the medica

"We will use a different spot for injection each time we give the medication." Rationale: To avoid atrophy of the tissue, administration of somatropin includes rotating the injection site each time. The nurse should identify this statement as an understanding of somatropin administration.

A nurse administers pramlintide at 0800 to a client who has type 1 diabetes mellitus. At which of the following times should the nurse expect the drug to exert its peak action? 0820 0900 1030 1100

0820 Rationale: Pramlintide, an amylin mimetic, peaks 20 min after administration. The nurse should monitor the client for indications of hypoglycemia, such as diaphoresis and tremors.

A nurse is teaching a client who has a prescription for glipizide therapy to treat type 2 diabetes mellitus. Which of the following instructions should the nurse include? Avoid drinking alcohol. Sit or stand for 30 min after taking the drug. Urinate every 4 hr. Take the drug 2 hr after a meal.

Avoid drinking alcohol. Rationale: The nurse should instruct the client to avoid drinking alcohol. Alcohol can interact with glipizide, a sulfonylurea, causing nausea, palpitations, and flushing. Alcohol also increases the drug's hypoglycemic effects.

A nurse is caring for a client who is about to begin taking pioglitazone to treat type 2 diabetes mellitus. The nurse should explain to the client about the need to monitor which of the following laboratory values? (Select all that apply.) Thyroid-stimulating hormone (TSH) Alanine aminotransferase (ALT) LDL CBC Creatinine clearance

Alanine aminotransferase (ALT) LDL Rationale: Pioglitazone can cause liver injury. The nurse should monitor ALT at the start of therapy and then every 3 to 6 months thereafter. The nurse should tell the client to report jaundice, dark-colored urine, or abdominal pain. Rationale: Pioglitazone can cause elevations in both high-density lipoproteins, which is a beneficial effect, and LDLs, which is a detrimental effect. The nurse should monitor the client's plasma lipid levels at baseline and periodically throughout drug therapy.

A nurse is caring for a client who is taking metformin and is scheduled to undergo angiography using iodine-containing contrast dye. The nurse should identify that an interaction between metformin and the IV contrast dye increases the client's risk for which of the following conditions? Hypokalemia Hyperglycemia Acute renal failure Acute pancreatitis

Acute renal failure Rationale: Metformin, a biguanide, can interact with iodine-containing contrast dye and cause acute renal failure and lactic acidosis. The nurse should withhold metformin for 48 hr prior to and following the procedure. The nurse should also monitor the client for indications of acute renal failure or lactic acidosis, such as reduced urine output, hyperventilation, and abdominal pain.

A nurse is teaching a client who has a prescription for pramlintide therapy to treat type 1 diabetes mellitus. Which of the following instructions should the nurse include? Mix pramlintide with insulin in the syringe. Administer pramlintide before meals. Take pramlintide once daily at bedtime. Inject pramlintide into the upper arm.

Administer pramlintide before meals. Rationale: The nurse should instruct the client to inject pramlintide, an amylin mimetic, 20 min before any meal that contains at least 30 g of carbohydrates.

When considering replacement therapy options for a client who has chronic adrenocortical insufficiency, a nurse should recognize that the provider will choose which of the following drugs? Somatropin Hydrocortisone Glucagon Desmopressin

Hydrocortisone Rationale: Hydrocortisone, a glucocorticoid, provides replacement therapy for acute and chronic adrenocortical insufficiency, such as Addison's disease. Hydrocortisone is identical to cortisol, the primary glucocorticoid the adrenal cortex generates.

A nurse is caring for a client who is about to begin insulin glargine therapy. The nurse should identify the need for additional precautions because the client also takes which of the following types of drugs? Oral contraceptives Calcium supplements Beta blockers Iron supplements

Beta blockers Rationale: Clients who take both insulin and beta blockers are at risk for failing to promptly recognize the symptoms of hypoglycemia because beta blockers mask symptoms such as tachycardia and tremors. Beta blockers also increase hypoglycemic effects.

A nurse is teaching a client about acarbose therapy to treat type 2 diabetes mellitus. Which of the following instructions should the nurse include? Eat more iron-rich foods. Avoid drinking grapefruit juice. Increase fiber intake. Avoid drinking green tea.

Eat more iron-rich foods. Rationale: Acarbose, an alpha-glucosidase inhibitor, can cause iron-deficiency anemia. The nurse should instruct the client to increase their intake of iron-rich foods, such as red meat, spinach, and grains. The nurse should also monitor the client's CBC.

A nurse is providing teaching to a client who is about to begin levothyroxine therapy to treat hypothyroidism. Which of the following instructions should the nurse include? Take levothyroxine with food to increase absorption. Take levothyroxine with an antacid to reduce gastrointestinal effects. Expect life-long therapy with the drug. Carry a carbohydrate snack at all times.

Expect life-long therapy with the drug. Rationale: Therapy with levothyroxine, a thyroid replacement hormone, usually continues for life because there are no other therapies that can restore thyroid function.

Which of the following drugs should a nurse have available for a client who is experiencing insulin toxicity? Naloxone Diphenhydramine Acetylcysteine Glucagon

Glucagon Rationale: Glucagon, a hyperglycemic that can be given subcutaneously, IM, or IV, is used to treat severe hypoglycemia from insulin toxicity in clients who are unconscious and for whom IV glucose is not readily available. If the client does not respond to glucagon, the nurse should administer a glucose solution IV.

A nurse at a provider's office is assessing a client who has been taking hydrocortisone for adrenal insufficiency. The client reports fatigue and feeling overwhelmed by personal responsibilities. Which of the following findings should the nurse identify as an indication the provider might need to increase the client's dosage? Hypotension Hyperglycemia Weight gain Fat redistribution

Hypotension Rationale: Hypotension and fatigue are findings of adrenal insufficiency. During times of stress, the client might need a dosage increase to prevent adrenal insufficiency. The nurse should report the findings to the provider.

A nurse is caring for a client who is taking propylthiouracil (PTU) and reports weight gain, drowsiness, and depression. The nurse should identify that the client is experiencing which of the following adverse reactions to the drug? Thyrotoxicosis Hypothyroidism Lactic acidosis Radiation sickness

Hypothyroidism Rationale: Propylthiouracil, an antithyroid drug, can cause hypothyroidism, which manifests as drowsiness, depression, weight gain, edema, and bradycardia. The nurse should request that the provider prescribe a lower dosage of the drug for the client.

A nurse is providing teaching to a client who is about to begin exenatide therapy to treat type 2 diabetes mellitus. Which of the following instructions should the nurse include? (Select all that apply.) Inject the drug subcutaneously. Expect the peak effect in 2 hr. Use the drug as a supplement to an oral hypoglycemic. Inject the drug 1 hr after a meal. Discard used pens 10 days after the first use.

Inject the drug subcutaneously. Expect the peak effect in 2 hr. Use the drug as a supplement to an oral hypoglycemic. Rationale: The client should inject exenatide, an incretin mimetic, into the subcutaneous tissue of the thigh, upper arm, or abdomen. Rationale: Levels of exenatide peak 2 hr after administration and then decrease gradually, with a half-life of 2.4 hr. Rationale: Exenatide supplements the action of an oral hypoglycemic, such as a sulfonylurea or metformin.

A nurse is caring for a client who is taking metformin to treat type 2 diabetes mellitus and reports muscle pain. Which of the following adverse reactions should the nurse suspect? Lactic acidosis Anticholinergic effects Extrapyramidal effects Hypophosphatemia

Lactic acidosis Rationale: Metformin, a biguanide, can cause lactic acidosis, which is a life-threatening complication that manifests as muscle aches, sleepiness, malaise, and hyperventilation. The client should stop taking the drug and seek medical care immediately.

A nurse is teaching a client about self-administering regular insulin. The nurse should instruct the client to rotate injection sites to prevent which of the following? Rapid absorption Intradermal injection Injection pain Lipohypertrophy

Lipohypertrophy Rationale: Lipohypertrophy is a proliferation of fat at the sites of repeated insulin injections. It affects skin sensitivity and appearance. To prevent it, the client should rotate injection sites, keeping them at least 2.5 cm (1 in) apart, and avoid using the same spot within the same month.

A nurse is providing teaching to a client about taking fludrocortisone to treat adrenocortical insufficiency. Which of the following instructions should the nurse include? (Select all that apply.) Obtain weight measurement daily. Report weakness or palpitations. Have blood pressure checked regularly. Eat more iron-rich foods. Avoid drinking grapefruit juice.

Obtain weight measurement daily. Report weakness or palpitations. Have blood pressure checked regularly. Rationale: Fludrocortisone, a mineralocorticoid, can cause fluid and electrolyte imbalances, such as hypernatremia. Tracking weight on a daily basis can help identify weight gain and edema; reporting it can expedite any essential interventions. Rationale: Fludrocortisone can cause hypokalemia. The nurse should monitor the client's potassium levels and tell the client to report muscle weakness or palpitations. Rationale: Fludrocortisone can cause fluid retention and hypertension. The nurse should monitor the client's fluid balance and blood pressure to expedite any essential interventions.

A nurse is speaking with a client who is taking glipizide to treat type 2 diabetes mellitus and has called to report feeling shaky, hungry, and fatigued. Which of the following actions should the nurse instruct the client to take? Drink 16 oz of water. Perform a fingerstick blood glucose check. Take another glipizide tablet. Lie down and rest.

Perform a fingerstick blood glucose check. Rationale: Glipizide, a sulfonylurea, can cause hypoglycemia, which can manifest as diaphoresis, shakiness, hunger, and fatigue. The nurse should tell the client to check their blood glucose level and, if it indicates hypoglycemia, to consume a snack of 15 to 20 g (0.5 to 0.7 oz) of carbohydrates, retest in 15 to 20 min, and repeat if their blood glucose level is still low.

A nurse is assessing a client who has a new prescription for levothyroxine. The nurse should identify which of the following findings as a contraindication for this drug? Bacterial skin infections Diabetes insipidus Immunosuppression Recent myocardial infarction

Recent myocardial infarction Rationale: Levothyroxine, a thyroid replacement hormone, can cause tachycardia, palpitations, and hypertension, especially when the client requires a dosage adjustment. Therefore, it is contraindicated for clients who have recently had a myocardial infarction.

A nurse should recognize that a provider will prescribe a lower dose of sitagliptin for a client who has type 2 diabetes mellitus and who also has which of the following? Thyroid disease Bronchitis Heart failure Renal impairment

Renal impairment Rationale: Sitagliptin, a gliptin, requires cautious use with clients who have renal dysfunction and low creatinine clearance because the kidneys eliminate the drug virtually intact. The provider should prescribe a lower dose for this client or prescribe a different hypoglycemic drug.

A nurse is caring for a client who takes repaglinide 15 to 30 min before each meal to treat type 2 diabetes mellitus. The client asks, "If I skip a meal, what should I do?" Which of the following responses should the nurse make? Double the dose before the next meal. Take half the dose. Skip the dose. Take the usual dose.

Skip the dose. Rationale: To avoid a sudden and serious drop in blood glucose level, the client should skip the dose of repaglinide, a meglitinide, whenever skipping a meal. The nurse should also instruct the client to try to avoid skipping meals.

A nurse is caring for a client who is about to begin taking propylthiouracil (PTU) to treat hyperthyroidism. The nurse should instruct the client to report which of the following adverse effects? (Select all that apply.) Sore throat Joint pain Insomnia Bradycardia Rash

Sore throat Joint pain Bradycardia Rash Rationale: Propylthiouracil, an antithyroid drug, can cause agranulocytosis. The nurse should monitor the client's CBC and instruct the client to report fever or sore throat. Rationale: Propylthiouracil can cause arthralgia and myalgia. The nurse should instruct the client to report these effects and take over-the-counter analgesics for pain relief. Rationale: Propylthiouracil can cause hypothyroidism, which manifests as bradycardia, drowsiness, and weight gain. The nurse should instruct the client to report these effects. Rationale: Propylthiouracil can cause urticaria or a skin rash. The nurse should instruct the client to report these effects.

A nurse is caring for a client who is about to begin taking somatropin. The nurse should explain the need to monitor which of the following laboratory values? (Select all that apply.) Blood amylase Creatinine clearance Urine calcium Blood glucose CBC

Urine calcium Blood glucose Rationale: Somatropin can cause hypercalciuria. The nurse should monitor the client's urine calcium and instruct the client to report flank pain, urinary frequency, or hematuria. Rationale: Somatropin can cause hyperglycemia. The nurse should monitor the client's blood glucose levels and instruct the client to report polyphagia, polydipsia, and polyuria.

A nurse is caring for a client who is taking desmopressin. The nurse should make which of the following assessments to evaluate the drug's effectiveness? Peripheral pulses Urine output Skin integrity Blood glucose

Urine output Rationale: Desmopressin, an antidiuretic hormone, treats diabetes insipidus. The nurse should monitor the client's fluid intake and urine output along with urine and serum osmolality and blood pressure.

A nurse is caring for a client who is taking pioglitazone to treat type 2 diabetes mellitus. The nurse should monitor for which of the following findings? Joint pain Constipation Weight gain Dilated pupils

Weight gain Rationale: Pioglitazone, a thiazolidinedione, can cause fluid retention. The nurse should monitor the client for weight gain and other indications of fluid retention or heart failure, including dyspnea, crackles, and wheezing.