Unit 2 Review
While reviewing the medication history of a client receiving alendronate, the nurse notes that the client also takes a multivitamin. Which instruction would be most appropriate?
"Separate taking the two drugs by about a half hour." Alendronate can interact with a multivitamin, decreasing the absorption of the bisphosphonate. Therefore, the drugs should be separated by at least a half hour. The multivitamin does not need to be stopped. The alendronate should be taken on arising in the morning before anything else. Antacids also can decrease the absorption of alendronate, and these should also be separated by at least a half hour.
A female client visits the health care provider's office after routine labs are drawn. The nurse notes that her A1C is 9. How does the nurse interpret this finding?
Client's average blood glucose is above normal. The American Diabetes Association (ADA) suggests a target A1C of less than 7%. A1C should be measured every 3 to 6 months. An A1C of 9 indicates that the client's average blood glucose is consistently above normal.
More patients experience hyperthyroidism than hypothyroidism.
False Hypothyroidism is the most common type of thyroid dysfunction.
Glycosylated hemoglobin levels provide reliable evidence of blood glucose control.
True Glycosylated hemoglobin levels, or an HbA1c test, provide a 3-month average of glucose levels.
The nurse is educating a newly diagnosed diabetic who must learn how to give himself insulin injections. The nurse tells the client that insulin is absorbed fastest from which area of injection?
Abdomen Studies indicate that insulin is absorbed fastest from the abdomen, followed by the deltoid, thigh, and hip.
The nurse is educating a client who will be adding an injection of pramlintide to his insulin regimen. What information is most important for the nurse to share with this client to ensure safe medication administration?
Do not give pramlintide in the same site where insulin is administered. Clients who take pramlintide should not be injected into the same site where insulin is administered.
The older diabetic client often experiences several different chronic organ related conditions. Which assessment should the nurse focus upon when attempting to manage this complex situation?
Drug interactions The older patient is more likely to experience end organ damage related to the diabetes—loss of vision, kidney problems, coronary artery disease, and infections—and the drug regimen of these patients can become quite complex. Careful screening for drug interactions is an important aspect of the assessment of these patients.
Insulin binds with and activates receptors on cell membranes. Once insulin-receptor binding occurs, the membranes become highly permeable to glucose. Which action does this enable?
Entry of glucose into the cells After insulin-receptor binding occurs, cell membranes become highly permeable to glucose and allow rapid entry of glucose into the cells.
The nurse is administering an antidiabetic agent by subcutaneous injection within 60 minutes of the client's breakfast. Which agent would the nurse most likely be administering?
Exenatide Exenatide is administered by subcutaneous injection within 60 minutes before morning and evening meals. Rosiglitazone would be administered as a single oral dose. Repaglinide is used orally before meals. Miglitol is given orally with the first bite of each meal
What distinguishing characteristic is associated with type 1 diabetes?
Exogenous insulin is required for life. Type 1 diabetes will result in eventual destruction of beta cells, and no insulin is produced. The blood glucose level can only be controlled by diet in type 2 diabetes. In type 2 diabetes, oral agents can be administered. Type 1 diabetes is diagnosed in ages 4 through 20 years, not only in childhood.
A client presents at the clinic reporting weight loss despite an increased appetite. For which condition should this client be assessed?
Hyperthyroidism Hyperthyroidism is manifested by increased appetite and metabolism. Without treatment, it may be difficult for hyperthyroid individuals to consume enough calories to prevent weight loss. Hypothyroidism, which may be caused by thyroiditis, causes decreased appetite and metabolism, and hypothyroid patients frequently experience weight gain.
A nurse should monitor a client taking glimepiride (Amaryl) for which of adverse effects? (Select all that apply.)
Hypoglycemia Heartburn Nausea Adverse reactions associated with sulfonylureas, like glimepiride (Amaryl), include hypoglycemia, anorexia, nausea, vomiting, epigastric discomfort, weight gain, heartburn, and various vague neurologic symptoms, such as numbness and weakness of the extremities.
A client is brought to the emergency department after taking an overdose of levothyroxine. When assessing this client, what adverse effects would the nurse expect to find?
Nervousness and tachycardia Excessive doses of levothyroxine, a thyroid drug, can cause the same signs and symptoms that occur with hyperthyroidism. These include nervousness and tachycardia.
What best describes type 1 diabetes? (Select all that apply.)
Occurs before age 20 Insulin supplementation is required for survival Type 1 diabetes is formerly known as insulin-dependent diabetes mellitus. It usually has a rapid onset and occurs before age 20. Those with type 1 diabetes produce insulin in insufficient amounts, and therefore must have insulin supplementation to survive. Type 1 diabetes is an autoimmune disorder therefore obesity is not a risk factor.
The nurse monitoring a client receiving insulin glulisine (Apidra) notices the client has become confused, diaphoretic, and nauseated. The nurse checks the client's blood glucose and it is 60 mg/dL (3.33 mmol/L). Which can a nurse give to treat a client with a hypoglycemic episode? (Select all that apply.)
Orange or other fruit juice Glucose tablets Hard candy Methods of terminating a hypoglycemic reaction include the administration of one or more of the following: orange or other fruit juice, hard candy or honey, glucose tablets, glucagon, or glucose 10 percent or 50 percent IV.
Which agent would a nurse expect to administer as a single oral dose in the morning?
Rosiglitazone Rosiglitazone would be administered as a single oral dose. Repaglinide is used orally before meals. Exenatide is administered by subcutaneous injection within 60 minutes before morning and evening meals. Miglitol is given with the first bite of each meal.
A nurse is preparing an in-service presentation for a group of staff members on diabetes. Which would the nurse include as the primary delivery system for insulin?
Subcutaneous injection Although other delivery systems are available for insulin administration such as the jet injector, insulin pen, and external pump, subcutaneous injection remains the primary delivery system.
After teaching a group of students about the various methods for the delivery of insulin, the instructor determines that the teaching was successful when the students identify which method as most commonly used for administration?
Subcutaneous injection Subcutaneous injection currently is the most common method for administering insulin.
A client is prescribed levothyroxine. The nurse understands that this drug contains:
T4 Levothyroxine is a synthetic salt of T4; desiccated thyroid contains both T3 and T4. Liothyronine contains T3. Iodine is an antithyroid agent. Calcitriol is a form of vitamin D.
Common causes of primary hypothyroidism include all of the following EXCEPT:
Treatment with steroid medications. Common causes of primary hypothyroidism include chronic (Hashimoto's) thyroiditis, an autoimmune disorder characterized by inflammation of the thyroid gland, and treatment of hyperthyroidism with antithyroid drugs, radiation therapy, or surgery. Treatment with steroid medications does not cause or cure primary hypothyroidism.
Calcitonin balances the effects of parathyroid hormone.
True Cells found around the follicle of the thyroid gland are called parafollicular cells. These cells produce another hormone, calcitonin, which affects calcium levels and acts to balance the effects of the parathyroid hormone (PTH), parathormone.
Amylin is a peptide hormone secreted with insulin by the beta cells of the pancreas and is important in the regulation of glucose control during the postprandial period. True or false?
True Pramlintide (Symlin) is a synthetic analog of amylin, a peptide hormone secreted with insulin by the beta cells of the pancreas, important in the regulation of glucose control during the postprandial period.
Which factor would prohibit the administration of glipizide?
allergy to sulfonamides Sulfonylureas are contraindicated in clients with hypersensitivity to them, with severe renal or hepatic impairment, and who are pregnant. A diagnosis of hypertension does not cause contraindication of sulfonylureas. The client should consume carbohydrates in association with the oral hypoglycemic agent. An increase in alkaline phosphatase does not result in the contraindication of glipizide.
What is the most common cause of subclinical hyperthyroidism?
excess thyroid hormone therapy The most common cause of subclinical hyperthyroidism is excess thyroid hormone therapy. Clients should be monitored closely for hypothyroidism while taking antithyroid drugs, which usually develops within a year after receiving treatment for hyperthyroidism. Common causes of primary hypothyroidism include treatment of hyperthyroidism with radiation therapy or surgery. Predisposing factors for myxedema coma include administration of central nervous system depressants. Untreated osteoporosis is not relevant to subclinical hyperthyroidism.
Heavy intake of which herb should be avoided by a client who is prescribed an antidiabetic medication?
garlic Garlic has been known to cause hypoglycemia when taken with antidiabetic medications. Anise, basil, and oregano are not noted to carry this risk.
After reviewing information about different insulin preparations, a nursing student demonstrates understanding of the information when the student identifies which medication as an example of a long-acting insulin?
insulin glargine Insulin glargine is an example of a long-acting insulin. Insulin lispro and insulin aspart are rapid-acting insulin. Isophane insulin suspension is an intermediate-acting insulin
A nurse is preparing to administer a rapid-acting insulin. Which medication would the nurse most likely administer?
insulin lispro Insulin lispro is an example of a rapid-acting insulin. Insulin glargine and insulin detemir are long-acting insulin. Isophane insulin suspension is an intermediate-acting insulin.
When describing thyroid function, the nurse would emphasize the need for intake of:
iodine Iodine intake is necessary for the production of thyroid hormones.
A nurse is preparing to administer a scheduled dose of levothyroxine to an elderly client who is being treated in the hospital for a respiratory infection. Prior to administering the drug, the nurse should perform what assessment?
measurement of blood pressure In older adults receiving levothyroxine, regular monitoring of blood pressure and pulse is essential. Temperature, pupillary response, and chest auscultation are not necessary before safe administration of this medication.
When considering the management of diabetic ketoacidosis (DKA), what type of insulin can be administered intravenously?
regular Regular insulin (insulin injection) has a rapid onset of action and can be given intravenously. Therefore, it is the insulin of choice during acute situations, such as DKA, severe infection or other illness, and surgical procedures. All the other options are administered subcutaneously.
A client with diabetes is undergoing testing for glycosylated hemoglobin. The nurse instructs the client that this test measures average blood glucose over what time period?
the past 3 or 4 months Glycosylated hemoglobin measures glucose control over the past 3 to 4 months. When blood glucose levels are high, glucose molecules attach to hemoglobin in the red blood cell. The longer the hyperglycemia lasts, the more glucose binds to the red blood cell and the higher the glycosylated hemoglobin. This binding lasts for the life of the red blood cell (about 4 months) so the other time frames would not be accurate.
The nurse is caring for a client taking insulin. The nurse realizes the client is experiencing symptoms of hypoglycemia when the client displays
weakness, sweating, and decreased mentation. Symptoms of hypoglycemia include shakiness, dizziness, or light-headedness, sweating, nervousness or irritability, sudden changes in behavior or mood, weakness, pale skin, and hunger.
The nurse is caring for a client taking insulin. The nurse realizes the client is experiencing symptoms of hypoglycemia when the client displays:
weakness, sweating, and decreased mentation. Symptoms of hypoglycemia include shakiness, dizziness, or light-headedness, sweating, nervousness or irritability, sudden changes in behavior or mood, weakness, pale skin, and hunger.
A community health nurse is leading a health promotion workshop during a community health fair. A participant has asked the nurse for advice on the necessity of calcium supplements. The nurse should respond in the knowledge that which demographic group frequently has low calcium levels? Select all that apply.
young women older women Experts believe that the diets of most people of all ages, but especially of young women and older adults, are deficient in calcium.
A client, being evaluated for diabetes, asks how a blood glucose test is used to diagnosis this disease. What is the nurse's best response?
"A fasting blood sugar result of 126 mg/dL (6.99 mmol/L) or more on two separate occasions is diagnostic of diabetes." A major clinical manifestation of hyperglycemia is fasting blood glucose levels exceeding 126 mg/dL (6.99 mmol/L). A person with a fasting blood glucose level between 100 and 125 mg/dL (5.55 to 6.94 mmol/L) is said to have impaired fasting glucose or prediabetes. The normal hemoglobin A1C level is under 7.
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?" Radioactive iodine is given orally, either as a solution or in a gelatin capsule. Since it is not given intravenously, any questions regarding needles or veins is not necessary. Radioactive iodine is given for the treatment of hyperthyroidism or cancer of the thyroid. The question states this client is taking radioactive iodine for hyperthyroidism.
The nurse is teaching a patient who is prescribed calcitriol about the drug. Which patient statement indicates that the teaching was successful?
"I need to have my calcium levels checked periodically." Calcitriol increases serum calcium levels, therefore periodic monitoring is important to ensure effectiveness of therapy without causing hypercalcemia. The drug may be taken with food if GI upset occurs. Antacids containing magnesium should be avoided due to the increased risk for hypermagnesemia. Calcitriol is often combined with dietary supplementation of calcium. Dairy products are a good source of calcium and should not be limited.
The nurse has just completed discharge instructions to a client who will be using a pen device to deliver his insulin dose. What statement by the client indicates a need for further instruction?
"If I forget to take my insulin pen, I will be able to use the one that my wife uses." Insulin pens are client-specific because the needle may be used multiple times and may be contaminated with blood. Also, the pen is prefilled with a specific type of insulin. The client selects the desired units by turning a dial and listening for a locking ring. The insulin dose is determined by the number of clicks heard. It is a useful method for clients who have poor eyesight.
The nurse is discussing diabetes with a group of individuals who are at risk for the disease. Which statement by a participant indicates an understanding of the role of insulin in the disease?
"Insulin assists glucose molecules to enter the cells of muscle and fat tissues." Insulin appears to activate a process that helps glucose molecules enter the cells of striated muscle and adipose tissue. It also stimulates the synthesis of glycogen by the liver, promotes protein synthesis, and helps the body store fat by preventing its breakdown for energy.
What statement would be appropriately included in the teaching concerning type 2 diabetes?
"Regular exercise makes your body better able to use the insulin it produces." People who need less than 0.5 units/kg/d may produce some endogenous insulin, or their tissues may be more responsive to insulin because of exercise and good physical conditioning. Exercise is an extremely strong hypoglycemic agent. Diabetics need to check their blood sugar level regardless of whether they are or are not prescribed insulin. The need for insulin injections is determined by the function of the pancreas and its ability to produce sufficient quantities of insulin. It is not correct to assume diet is the only factor in this process. Alcohol should be avoided, and the dosage of oral antidiabetic medication should not be altered without guidance from a health care provider.
The nurse is caring for a 42-year-old client who recently had a total hysterectomy that involved removal of her ovaries. What statement by the client suggests that she understands her risk of developing osteoporosis?1
"The surgery increased my risk of developing the disease." A loss of estrogen, which helps maintain calcium levels in bone, can lead to the development of osteoporosis. The removal of the patient's ovaries prevent her from producing estrogen.
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." Thyroid hormones are classified as pregnancy category A and should be continued by hypothyroid women during pregnancy. Thyroid hormones are not used as treatment for obesity or infertility. Thyroid hormones are used cautiously for clients with heart disease but are safe during pregnancy.
The client is scheduled to get a breakfast tray at 07:00. At what time should the client receive a prescribed dose of insulin lispro?
0645 With short-acting insulins like lispro, aspart, or glulisine, it is important to inject the medication about 15 minutes before eating.
Methimazole (Tapazole) 30 mg /day orally divided in 3 doses is prescribed for a client diagnosed with Graves' disease. The pharmacy has 5 mg tablets available. How many tablets should the nurse administer with each dose?
2 30 mg/day divided in 3 doses = 10 mg/dose; 10 mg / 5 mg tablets = 2 tablets per dose
client, diagnosed with hypothyroidism began treatment with levothyroxine several weeks ago, telephones the clinic to report missing yesterday's dose. The nurse should base his/her response on what understanding concerning the length of the half-life of this medication.
9 to 10 days Levothyroxine has a long half-life, about 6 to 7 days in euthyroidism (normal thyroid function), but it is prolonged to 9 to 10 days in hypothyroidism and shortened to 3 to 4 days in hyperthyroidism.
A 54-year-old male client is diagnosed with chronic renal failure and hyperglycemia. He asks if he can be prescribed sulfonylurea because it works well for his friend. If he were to be given sulfonylurea, this client's renal impairment may lead to what effect?
Accumulation and hypoglycemia Sulfonylureas and their metabolites are excreted mainly by the kidneys; renal impairment may lead to accumulation and hypoglycemia. They should be used cautiously, with close monitoring of renal function, in clients with mild to moderate renal impairment and are contraindicated in severe renal impairment.
A primary health care provider has prescribed levothyroxine to a client with hypothyroidism. Which information would the nurse include in the teaching plan to promote an optimal response to the drug therapy?
Administer the drug early in the morning before breakfast. he nurse should instruct the client to administer the drug early in the morning before breakfast to promote an optimal response to the drug therapy since an empty stomach increases the absorption of the oral preparation. When methimazole and propylthiouracil are administered to the client, the nurse should recommend that the client record the pulse rates and bring the record to the primary health care provider. If the client expresses a concern about the dosage schedule, the nurse can offer suggestions to the client about the dosage schedule. If the client experiences a rash while taking methimazole or propylthiouracil, the nurse needs to inform the client to apply soothing creams or lubricants.
A nurse is assigned to administer glargine to a patient at a health care facility. What precaution should the nurse take when administering glargine?
Avoid mixing glargine with other insulin. When administering glargine to the patient, the nurse should avoid mixing it with other insulin or solutions. It will precipitate in the syringe when mixed. If glargine is mixed with another solution, it will lose glucose control, resulting in decreased effectiveness of the insulin. Glargine is administered via SC once daily at bedtime. The nurse should not shake the vial vigorously before withdrawing insulin. The vial should be gently rotated between the palms of the hands and tilted gently end-to-end immediately before withdrawing the insulin. The nurse administers insulin from vials at room temperature. Vials are stored in the refrigerator if it is to be stored for about three months for later use.
A patient has hypocalcemia secondary to hypoparathyroidism. Which would the nurse expect to be ordered?
Calcitriol Calcitriol is an antithypocalcemic agent used to treat hypoparathyroidism. Levothyroxine would be used to treat a deficiency of thyroid hormone or hypothyroidism. Methimazole is an antithyroid agent used to treat hyperthyroidism. Propylthiouracil is an antithyroid agent used to treat hyperthyroidism
The nurse should review which lab result before advising a client about taking the first dose of ibandronate (Boniva)?
Calcium When bisphosphonates are administered, serum calcium levels are monitored before, during, and after therapy.
Clients with type 2 diabetes have nonfunctioning beta pancreatic cells.
False Type 2 diabetes reflects an inability to produce enough insulin as needed or a change in insulin receptor sensitivity.
During ongoing assessment of clients receiving insulin detemir (Levemir), the nurse assesses the client for symptoms of hypoglycemia that include which symptoms? (Select all that apply.)
Headache Confusion Diaphoresis The symptoms of hypoglycemia include fatigue, weakness, nervousness, agitation, confusion, headache, diplopia, convulsion, dizziness, unconsciousness, hunger, nausea, diaphoresis, and numbness or tingling of the lips or tongue.
The nurse is preparing to administer levothyroxine to a client. Which assessment finding would cause the nurse to hold the medication?
Heart rate of 110 beats per minute Levothyroxine should be held if the client's heart rate is over 100 beats per minute.
What is the best position for the client after the administration of a bisphosphonate medication?
High Fowler's The client should be instructed to remain upright (avoid lying down - supine, prone, or lateral recumbent) for at least 30 minutes after taking bisphosphonate drugs. Therefore, the best position is high Fowler's.
All of the following are specific physiological effects of thyroid hormones, EXCEPT:
Increased pituitary secretion of TSH. Some specific physiologic effects of thyroid hormones include increased rate of cellular metabolism and oxygen consumption, with a resultant increase in heat production; increased heart rate, force of contraction, and cardiac output; increased carbohydrate metabolism; increased fat metabolism, including increased lipolytic effects of other hormones and metabolism of cholesterol to bile acids; and inhibition of pituitary secretion of TSH.
When describing the effects of incretins on blood glucose control to a group of students, which would an instructor include?
Increases insulin release Incretins increase insulin release, decrease glucagon release, slow GI emptying, and stimulate the satiety center. Growth hormone increases protein building.
The pharmacology instructor is providing education regarding propylthiouracil to the nursing students. What would the instructor identify as the primary mode of action for this medication?
Inhibition of production of thyroid hormone Propylthiouracil acts by inhibiting production of thyroid hormones and peripheral conversion of thyroxine (T4) to the more active triiodothyronine (T3).
A nurse at a health care facility is assigned to administer insulin to the patient. Which intervention should the nurse perform before administering each insulin dose?
Inspect the previous injection site for inflammation. The nurse should check the previous injection site before administering each insulin dose. The injection sites should be rotated to prevent lipodystrophy. Prefilled syringes should not be kept horizontally; they should be kept in a vertical or oblique position to avoid plugging the needle. The nurse checks for symptoms of myalgia or malaise when administration of metformin leads to lactic acidosis. Insulin should be kept at room temperature for administration. Insulin is refrigerated if it needs to be stored for up to three months for later use.
The nurse admitted a 4-year-old child with type 1 diabetes mellitus. The nurse educates the parents that hypoglycemia can occur as an adverse effect of insulin. The nurse helps the parents to understand that in young children, hypoglycemia may manifest as what signs or symptoms? (Select all that apply.)
Irritability Impaired mental functioning Lethargy In young children, hypoglycemia may be manifested by changes in behavior, including severe hunger, irritability, and lethargy. In addition, mental functioning may be impaired in all age groups, even with mild hypoglycemia. Anytime hypoglycemia is suspected, blood glucose should be tested.
Which would be appropriate to include in teaching a client with type 2 diabetes?
It is possible with weight loss and exercise to discontinue the use of antidiabetic medication. Exercise is perhaps the best therapy for the prevention of both type 2 diabetes and the metabolic syndrome. Exercise is an extremely strong hypoglycemic agent.
What is the expected action of sitagliptin on type 2 diabetes?
It slows the rate of inactivation of the incretin hormones. Sitagliptin minimizes the rate of inactivation of the incretin hormones to increase hormone levels and prolong their activity. Sitagliptin does not block the S phase of the cell cycle. Sitagliptin is not a synthetically prepared monosodium salt nor does it inhibit hydrogen, potassium, and ATPase.
A patient receives 25 units of NPH insulin at 7 AM. At what time of day should the nurse advise the patient to be most alert for a potential hypoglycemic reaction?
Late afternoon After an early morning dose of NPH insulin, the patient should be alert for a possible hypoglycemic reaction during mid- to late afternoon. The lengthy peak action time produces additional risks for hypoglycemic reactions.
An older adult has been prescribed a thyroid hormone replacement medication. The nurse should first clarify which prescription?
Levothyroxine (Synthroid) 150 mcg orally once per day ynthroid is prescribed 100-125 mcg/day orally. A dose of 150 mcg orally once per day is outside of the normally prescribed range. The other medication doses are within recommended parameters. In addition, older adults are at higher risk of adverse reactions; therefore, a smaller dose is started initially and increased in small increments over a period of weeks.
A client diagnosed with diabetes is demonstrating slow, deep respirations and is difficult to arouse. Which nursing intervention is directed specifically at treating this serious complication of diabetes?
Maintaining adequate intravenous fluid delivery Hyperglycemia, or high blood sugar, results when there is an increase in glucose in the blood. Clinical signs include Kussmaul respirations, impaired orientation and alertness, and the presence of a fruit breath resulting for a build up ketones being excreted via the lungs. Fluid and electrolytes are lost through the kidneys causing dehydration that must be addressed through the introduction of adequate IV fluids. The remaining options are appropriate assessment activities but do not address the focus of the question; a specific intervention.
The nurse is preparing to administer insulin lispro (Humalog) to a client at 7 AM. What is the nurse's priority intervention related to this medication?
Make sure the client's breakfast is available in the next 5-10 minutes. Insulin lispro has an onset of 5-10 minutes, so it is most important to ensure that there is food for the client after administration. Its peak is 30 min-1.5 hours so blood sugar would be most affected between 7:30 AM and 8:30 AM. Cleansing the site with soap and water is not necessary unless there is visible dirt on the skin, and lying quietly is not an intervention.
A female client's diagnoses include hyperthyroidism, congestive heart failure, and type 2 diabetes mellitus. What effect will the treatment of hyperthyroidism have on her routine medications?
Metabolism will be faster than normal, and the dose will be increased. Treatment of hyperthyroidism changes the rate of body metabolism, including the rate of metabolism of many drugs. In the hyperthyroid state, drug metabolism may be very rapid, and higher doses of most drugs may be necessary to achieve therapeutic results. When the client becomes euthyroid, the rate of drug metabolism is decreased. Consequently, doses of all medications should be evaluated and probably reduced to avoid severe adverse effects.
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 Metformin is classified as a biguanide. Miglitol is an alpha-glucosidase inhibitor. Tolbutamide is a first generation sulfonylurea. Glipizide is a second generation sulfonylurea.
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. Whenever a client develops a skin rash after taking propylthiouracil, the nurse must notify the primary health care provider immediately because it may be an adverse reaction. The other measures are important to protect the skin integrity: avoid soap and apply soothing cream to affected areas. Recording the weight and reporting weight gain or loss are also important.
The nurse is caring for a client who is seeking care for a chronic condition. The nurse is aware that the FDA has issued a black box warning regarding the use of thyroid hormones for the treatment of what condition?
Obesity The FDA has issued a black box warning regarding the use of thyroid hormones for the treatment of obesity or for weight loss, either alone or with other therapeutic agents. Significant and serious complications may develop in euthyroid people taking thyroid hormones
A nurse is caring for a patient with diabetes mellitus who is receiving an oral antidiabetic drug. Which of following ongoing assessments should the nurse perform when caring for this patient?
Observe the patient for hypoglycemic episodes. As the ongoing assessment activity, the nurse should observe the patient for hypoglycemic episodes. Documenting family medical history and assessing the patient's skin for ulcers, cuts, and sores on the body is a pre-administration assessment activity performed by the nurse. Lipodystrophy occurs if the sites of insulin injection are not rotated.
A client is admitted to the intensive care unit with diabetic ketoacidosis. The nurse knows that the client will be placed on an intravenous insulin drip. The only type of insulin that can be administered intravenously is:
Regular. In general, regular insulin, a short-acting insulin, is used with major surgery or surgery requiring general anesthesia. IV administration of insulin is preferred because it provides more predictable absorption than subcutaneous injections. Only regular insulin is administered IV.
The nurse should monitor a client for which effect of a drug interaction in a client taking thyroid hormones and a beta blocker?
Tachycardia Beta blockers and thyroid hormones interact, leading to decreased effectiveness of the beta blocker (i.e., cardiac drug, adrenergic blocker). Hypoglycemia may occur when thyroid hormones are taken with oral antidiabetic agents and insulin. Prolonged bleeding can occur when thyroid hormones and oral anticoagulants are taken together. Visual changes do not occur when beta blockers are taken with thyroid hormones.
A client is receiving a thyroid hormone to treat hypothyroidism. Which would indicate to the nurse that the client needs a reduced dosage of the drug?
Tachycardia Tachycardia suggests hyperthyroidism due to excessive thyroid hormone; this would require a reduction in dosage. The other responses suggest hypothyroidism and drug ineffectiveness.
A nurse is caring for a patient undergoing thyroid hormone replacement therapy. What should the nurse inform this patient regarding administration of the drug?
Take the drug before breakfast. The nurse should inform the patient undergoing thyroid hormone replacement therapy to take the drug in the morning, preferably before breakfast. The nurse should not ask the patient to take the drug before bedtime, just before dinner, or after lunch as that is not generally recommended by the health care provider.
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 Sitagliptin, exenatide, and pramlintide are examples of hormone mimetic agents. Acarbose and miglitol are alpha-glucosidase inhibitors.
Following an assessment by her primary care provider, a 70-year-old resident of an assisted living facility has begun taking daily oral doses of levothyroxine. Which assessment finding should prompt the nurse to withhold a scheduled dose of levothyroxine?
The resident's apical heart rate is 112 beats/minute with a regular rhythm If the pulse rate is greater than 100 bpm, it is necessary to withhold a levothyroxine dose in an older adult. Anorexia, recent vaccination, and recent falls do not necessary indicate a need to withhold this medication.
Regular insulin may be administered intravenously or intramuscularly in an emergency situation.
True Regular insulin is given IM or IV in emergency situations.
The nurse is assisting a client who has just begun medication therapy for hypothyroidism. Which nursing assessment is most important in this client?
Vital signs Vital signs would be the most important assessment because cardiac difficulties may occur early in treatment for hypothyroidism.
A client is prescribed calcitriol. Which instruction would be most important for the nurse to include in the teaching plan?
"Have your calcium levels checked periodically." Calcitriol increases serum calcium levels; therefore, periodic monitoring is important to ensure effectiveness of therapy without causing hypercalcemia. Antacids containing magnesium should be avoided due to the increased risk for hypermagnesemia. Calcitriol is often combined with dietary supplementation of calcium. Dairy products are a good source of calcium and should not be limited. The drug can cause nausea, vomiting, and dry mouth. Taking the drug with food may help alleviate these effects.
A female client with hyperthyroidism reports nervousness and "racing" heart one week after starting antithyroid medication. How should the nurse respond to the client's report?
"It may take three to four weeks for the effects of this medication to be seen." Therapeutic effects of the antithyroid drugs may not be observed for three to four weeks. Counting the resting heart rate doesn't address the client's reports. Increasing the dosage is not initially recommended until the client has been taking the medication at least three to four weeks.
A nurse is providing education to a client who will soon begin taking levothyroxine for the first time. Which teaching point should the nurse include in this education session?
"You'll most likely take this drug for the rest of your life." Levothyroxine is normally taken for the duration of the client's life. It is only administered by the IV route in cases of myxedema coma. It does not require a strict diet of high protein and low carbohydrates and it does not create a need for blood glucose monitoring. The medication should be taken on an empty stomach at least one hour before breakfast or two hours after a meal.
During a general health assessment, a client indicates taking thyroid medication to increase weight loss. What statement should be the basis of the nurse's response?
Taking excessive or unnecessary thyroid medication may produce serious or life-threatening manifestations of toxicity. The FDA has issued a black box warning regarding the use of thyroid hormones for the treatment of obesity or weight loss, either alone or with other therapeutic agents. Significant and serious complications may develop in euthyroid clients talking thyroid hormones.
A client who began treatment for type 2 diabetes 8 months ago is now meeting with a diabetic nurse for a scheduled follow-up. How can the nurse best assess the client's glycemic control since beginning treatment?
Assess the most recent hemoglobin A1C levels. Health care providers also look at the glycosylated hemoglobin (hemoglobin A1C) levels to assess the effectiveness of treatment. Because glucose stays attached to hemoglobin for the life of the red blood cell, which is about 120 days, the hemoglobin A1C level reflects the average blood glucose level over the past 3 months. Reviewing blood glucose readings, measuring the client's random blood glucose, and dialoguing with the client are all therapeutic strategies, but hemoglobin A1C is most accurate.
The home care nurse is caring for an elderly female patient who has been diagnosed with osteoporosis. When explaining the disease and its treatment to the patient, what should the nurse identify as a potentially serious complication?
Bone fracture Bone fracture is a major complication of osteoporosis, a disease characterized by reduced bone mineral density. Estrogen deficiency and negative calcium balance contribute to osteoporosis; they do not result from it. Anorexia is a potential side effect of medications used to treat the disease
A home care nurse is caring for a 70-year-old female client who has been diagnosed with osteoporosis. When developing a plan of care for this client, the nurse should include measures to prevent what complication of the disease?
Bone fracture Bone fracture is a major complication of osteoporosis, a disease characterized by reduced bone mineral density. Low levels of estrogen and calcium increase the risk of developing the disease, but they do not cause it.
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 Glimepiride is a second generation sulfonylurea. Glyburide is a second generation sulfonylurea. Tolazamide is a first generation sulfonylurea. Pramlintide is a human amylin agent. Repaglinide is a meglitinide agent.
A client newly diagnosed with type 1 diabetes asks the nurse why the client cannot just take a pill. The nurse would incorporate what knowledge when responding to this client?
Insulin is needed because the beta cells of the pancreas are no longer functioning. Insulin is needed in type 1 diabetes because the beta cells of the pancreas are no longer functioning. With type 2 diabetes, insulin is produced, but perhaps not enough to maintain glucose control or the insulin receptors are not sensitive enough to insulin.
A client is prescribed sitagliptin. The nurse would expect to administer this drug by which route?
Oral Sitagliptin is administered orally.
A nurse is teaching a client about a prescribed thyroid supplement and describes a drug that is relatively inexpensive, requires once-a-day dosing, and has a more uniform potency than do other thyroid hormone replacement drugs. Which drug is the nurse describing?
levothyroxine Levothyroxine is the drug of choice for hypothyroidism because it is relatively inexpensive, requires once-a-day dosing, and has a more uniform potency than do other thyroid hormone replacement drugs. Propylthiouracil and methimazole are used to treat hyperthyroidism and are given in 8-hour intervals. Liotrix is used to treat hypothyroidism, given once a day, however, it is more expensive and does not have a more uniform potency.
Based on the nurse's knowledge about thyroid hormone supplements, the nurse administers levothyroxine cautiously to a client who has recently had which condition or disorder?
myocardial infarction A nurse should be cautious not to administer levothyroxine to a client who has recently had a myocardial infarction. Drug interactions with oral antidiabetics and insulin with hormone supplements can cause hyperglycemia. Seizure and cataract surgery are not contraindicated with the use of levothyroxine.
A client diagnosed with excessive parathyroid production is prone to develop:
osteopenia. Most of the symptoms of parathyroid disease are "neurological" in origin. The most common symptoms are fatigue and tiredness. Other very common symptoms are lack of energy, memory problems, depression, problems with concentration, and problems sleeping. However, these symptoms are improved after intervention. Thus, although it may contribute to an existing diagnosis of Alzheimer's, it is not the cause. Hypertension is not commonly associated with this disorder. Excess parathyroid hormone acts directly on the bones to remove calcium from the bones. The calcium levels may cause abnormalities in heart function, but they do not cause heart disease.
What organ provides the control over the amount of calcium in the blood?
parathyroid glands Parathyroid chief cells are cells in the parathyroid glands that produce parathyroid hormone. The end result of increased secretion by the chief cells of a parathyroid gland is an increase in the serum level of calcium. Parathyroid chief cells constitute one of the few cell types of the body that regulate intracellular calcium levels as a consequence of extracellular (or serum) changes in calcium concentration. The thyroid controls how quickly the body burns energy and makes proteins, and how sensitive the body should be to other hormones. The pituitary releases ACTH (adrenocorticotropic hormone), which in turn tells the adrenal cortex to release cortisol and aldosterone into the blood. The kidneys are complicated organs that have numerous biological roles. Their primary role is to maintain the homeostatic balance of bodily fluids by filtering and secreting metabolites (such as urea) and minerals from the blood and excreting them, along with water, as urine.
A hospital client's current medication administration record specifies oral administration of propylthiouracil (PTU) every 8 hours. What sign or symptom may have originally prompted the care provider to prescribe this drug?
persistent tachycardia Propylthiouracil (PTU) is used for the treatment of hyperthyroidism; one of the characteristic symptoms of this disease is tachycardia. Tinnitus, visual disturbances, and hypotension are not associated with hyperthyroidism.
