Endocrine 1
What are the typical signs of hypokalemia nurses should assess for?
Symptoms can include muscle weakness, life threatening arrhythmias (heart skipping beats or palpitations), numbness and tingling in extremities (paresthesia's)
What are key teaching points for a patient who is prescribed levothyroxine for newly diagnosed hypothyroidism?
1. Take on an empty stomach 30-60 minutes before breakfast
2. Watch for signs of hyperthyroidism (basically we overshot the mark)-nervousness, insomnia, headache, rapid heart rate, chest pain, tremors, heat intolerance, diarrhea.
A patient is taking methylphenidate for attention-deficit hyperactivity disorders. What is an important consideration the nurse should include in the teaching plan?
Answers can include:
The medication can cause high blood pressure
Instruct the client to avoid caffeine
Take medication early in the day (no later than 4pm or the evening meal) to avoid sleep impairment
Report increased weight loss
What would the serum PH be if someone was in lactic acidosis?
What medication has a risk for lactic acidosis?
The PH would be below 7.35 (remember normal levels are between 7.35 and 7.45)
Metformin
Round the following number using the rounding rules
0.36912
What is 0.37
A patient who has osteoporosis has been prescribed alendronate. To prevent possible adverse effects the nurse provides what client instructions?
Take the medication with a full glass of water and sit/stand for 30 minutes to ensure it passes into the stomach and dissolves.
Give the medication 30 minutes before other medications, beverages or food.
What is the difference between and agonist and an an antagonist?
Name an a frequently known example of an agonist and an antagonist?
Agonists are medications that bind with a receptor that yields a greater than typical response
Antagonists are medications that bind with a receptor and block a response
Common example: Morphine is an agonist and Narcan (naloxone) is an antagonist to opioid medications
What is the pathophysiology of why insulin lowers serum potassium levels (hypokalemia)?
Insulin lowers serum blood potassium by driving potassium from the bloodstream into the cells (thereby lowering serum K+ levels).
What is the fastest way to treat hypoglycemic episodes? (what medication works the fastest)
What is the best way to manage hypoglycemia in a conscious client? ( What would we teach them)
IV Glucose -(Remember that IV glucose does work faster than glucagon)
Give oral glucose in pill form, 2-3 tsp of sugar dissolved in water, orange juice
A nurse is teaching a client regarding a new prescription for levodopa/carbidopa for Parkinson's Disease. What are specific items the nurse should include in the teaching plan?
Answers include:
Nonharmful darkening of the urine and sweat may occur
It may take up to 6 months for a full response
Avoid high protein foods which can decrease absorption
Can cause orthostatic hypotension, ensure safe ambulation strategies
The nurse is administering medications on the medical surgical unit.
What are nursing actions related to the nursing process in the phase of: Assessment
Correct answers include:
Monitoring lab results
Checking if vital signs are in the appropriate range
Checking the allergy record
Ensuring the medication prescription has all the required elements.
Drug F 125 mcg PO every morning is ordered. Tablets are available in 0.25 mg per tablet.
How many tablets should the patient receive?
What is 0.5 tablets
The nurse is caring for a client with a new prescription for methotrexate. Appropriate client instructions would include?
Answers include:
Drink 2 liters of water daily to ensure excretion of the drug (assisting the kidneys with excretion to avoid kidney damage)
Report any manifestations of infection (fatigue, chills, fever due to immunosuppression)
Report abnormal bleeding, bruising and petechiae
What is meant by the therapeutic index?
It is the margin of safety. (Basically it compares the dose that has a therapeutic effect vs the dose that has toxic effects
What conditions increase insulin requirements that nurses should include in their teaching plan?
1. Stress
2. Pregnancy
3. Infection
What are signs of hypoglycemia?
What are signs of hyperglycemia?
Hypoglycemia: confusion, dizziness, diaphoresis, anxiety, tachycardia
Hyperglycemia: Polydipsia (increased thirst) excessive urination (polyuria) increased hunger (polyphagia) and fruity smelling breath, rapid respirations
A 28-year-old female is taking valproic acid for a seizure disorder she has had since childhood. She is discussing with the nurse that she would like to conceive a pregnancy. What information should the nurse discuss with this patient?
The patient should avoid pregnancy when taking valproic acid because it increases the risk of neural tube defects. Consult with provider about changing this medication before attempting to conceive a pregnancy
The nurse is giving an initial dose of IV penicillin in the emergency room for a diagnosis of cellulitis. 10 minutes into the infusion, the patient complains of severe itching and the nurse notes periorbital and angioedema (edema and swelling of the lips). What is the nurse's priority action?
Stop the infusion immediately
Drug C 175 mg orally every 12 hours is ordered. The oral suspension is available as 250 mg per tsp.
The nurse will document _____ mL(s) were given
What is 3.5 mL
A patient is being started on calcium citrate for osteoporosis. What are appropriate client instructions for the nurse to include in the plan of care?
Teach signs of hypercalcemia: constipation, nausea/vomiting, increased urine output and depression
Instruct to take calcium supplements 1-2 hours before or after taking calcium citrate
Instruct patients to report flank pain or blood in urine (risk is for kidney stones)
Take 1 hour after meals and at bedtime
What is the definition of onset of action?
What is the definition of peak action?
The amount of time it takes for the medication to demonstrate a therapeutic response
The time it takes for a medication to demonstrate its full therapeutic effect
A nurse who is working in the primary health clinic is checking in a patient for care. What data will they evaluate to determine if the metformin started at the last visit one month ago is effective?
Serum blood glucose levels.
A nurse is reviewing the labs of a patient who is presenting for care at the primary care clinic. The patient's chief complaint is fatigue, feeling cold and unexplained weight loss. The nurse notes an increased TSH and decreased total T3 and T4.
What diagnosis does the nurse suspect?
What medication does the nurse anticipate an order for?
1. Hypothyroidism
2. Prescription for Levothyroxine
What are important considerations in the plan of care for a patient who has been prescribed pramipexole for Parkinson's Disease.
Can cause orthostatic hypotension, ensure safe ambulation and check orthostatic blood pressures (lying, sitting then standing)
Avoid driving or performing activities that need alertness if drowsiness occurs
Avoid alcohol which will increase the risk for drowsiness
The nurse is administering medications on the medical surgical unit.
What are nursing actions related to the nursing process in the phase of: Evaluation
Identify and document the clients response to the medications administered
Document any adverse effects
Ask the client to explain what the understand about the medication and how to take them (teach back)
Drug E 450 mcg PO every morning is ordered. Tablets are available in 0.15 mg per tablet.
How many tablets should the patient receive
What is 3 tablets
A nurse is caring for a patient on a medical surgical unit who has a new prescription for calcitonin-salmon. The nurse understands that this medication is appropriate for the patient who has _____________
Answer: Hypercalcemia due to hyperparathyroidism.
Remember the medication decreases serum calcium due to increasing calcium excretion
Signs of hypocalcemia include muscle spasms and tingling of the fingers and toes.
The nurse is reviewing the patient labs and history in preparation for the morning medication administration. The nurse notes the patient has been admitted with an acute kidney injury due to ongoing gastroenteritis and the BUN and Creatinine are elevated. Based on this information, the nurse is concerned about what pharmacologic process in this client?
Excretion of the medication
What medication treats hyperthyroidism?
What are symptoms of hyperthyroidism?
What is an adverse effect of PTU and what would the nurse assess and monitor because of this?
1. Propylthiouracil (PTU) treats hyperthyroidism
2. Hypertension, tachycardia, fever
3. Agranulocytosis (meaning a decrease in leukocytes and neutrophils) meaning pt is at risk for infection. Monitor the CBC and for signs of infection
4. Also carries a risk of liver toxicity-will have periodic liver function tests
What is used medication is used to treat hyperthyroidism (Graves disease) and thyroid cancer?
How does this medication work?
What are some assessments the nurse will note?
1. Radioactive Iodine
2. They thyroid gland will take in the radioactive iodine and over time it will destroy the thyroid tissue.
3. Monitor for indications of thyroid dysfunction-drowsiness, depression, weight gain, cold intolerance and signs of radiation sickness
A nurse is working in an endoscopy clinic and has administered a dose of midazolam to a patient and is asked to give a second dose 10 seconds after the first dose is administered. What is the most appropriate action by the nurse?
Wait 2 minutes after giving the initial dose before giving the second dose
A nurse is caring for a client on the medical surgical floor with Type 2 diabetes and admitted with abdominal pain. A CT scan of the abdomen and pelvis is ordered. The nurse notes the patient takes Metformin BID. What action should the nurse take at this time?
What is the rationale for this?
Obtain order to hold metformin. Will typically be held both before and after if possible.
IV contrast and metformin are both hard on kidneys, so holding it is protecting kidney function
A provider orders Ceftriaxone 750 mg IM.
The medication is supplied in a vial labeled 1 gram (1000 mg) per 2 mL
How many mL will you administer?
1.5mL
The clinic nurse is caring for a client with chronic knee pain taking ibuprofen. The nurse provides the client with instructions on symptoms to watch for related to the adverse drug reaction of kidney dysfunction.
Fluid retention and weight gain.
The student nurse is reviewing the differences in the lifespan regarding the blood brain barrier for their pharmacology class. They know that in an infant the blood brain barrier is__________ so drugs enter the brain______________?
The blood brain barrier in infants is less effective, which allows medications to enter the brain easier.