Pituitary/ Extra
A patient is giving desmopressin acetate. The nurse knows that this drug is used to treat which condition?
a. Gigantism
b. Diabetes mellitus
c. Diabetes insipidus
d. Adrenal insufficiency
C
The nurse provides instructions to a client who is taking levothyroxine. The nurse should tell the client to take the medication in which way?
1. With food
2. At lunchtime
3. On an empty stomach
4. At bedtime with a snack
3
Oral doses of levothyroxine should be taken on an empty stomach to enhance absorption. Dosing should be done in the morning before breakfast.
The nurse is teaching a client with diabetes mellitus how to mix regular insulin and NPH insulin in the same syringe. Which action, if performed by the client, indicates the need for further teaching?
1. Withdraws the NPH insulin first
2. Withdraws the regular insulin first
3. Injects air into NPH insulin vial first
4. Injects an amount of air equal to the desired dose of insulin into each vial
1.
When preparing a mixture of short-acting insulin, such as regular insulin, with another insulin preparation, the short-acting insulin is drawn into the syringe first. This sequence will avoid contaminating the vial of short-acting insulin with insulin of another type. Options 2, 3, and 4 identify correct actions for preparing NPH and short-acting insulin.
A client has been taking glucocorticoids to control rheumatoid arthritis. Which laboratory abnormality is the client at risk for as a result of taking this medication?
1. Increased serum glucose
2. Decreased serum sodium
3. Elevated serum potassium
4. Increased white blood cells
1
Glucocorticoids have 3 primary uses: replacement therapy for adrenal insufficiency, immunosuppressive therapy, and anti-inflammatory therapy. Exogenous glucocorticoids cause the same effects on cellular activity as those of the naturally produced glucocorticoids; however, exogenous glucocorticoids also may have undesired effects. The glucocorticoids stimulate appetite and increase caloric intake. They also increase the availability of glucose for energy. These combined effects cause the blood glucose levels to rise, making the client prone to hyperglycemia. Glucocorticoids can also lead to hypokalemia. The remaining options are not expected effects of the use of glucocorticoids.
The nurse is caring for a 56 year old patient who is post total knee replacement. The patient has been taking estrogen to relieve menopausal symptoms and to increase bone mineral density. Which new assessment finding would be of most concern to the nurse?
A. Dizziness with position changes
B. Dyspnea while resting
C. Nausea and vomiting
D. Vaginal spotting of sanguineous discharge
B. Dyspnea while resting
R.F = DVT/VTE, SOB is symptom of PE.
A patient is receiving the drug somatropin. Which drug action will the nurse anticipate?
a. Act as an anti-inflammatory agent
b. increase metabolic rate and oxygen consumption
c. Stimulate grow ion long bones at epiphyseal plates
d. promote water reabsorption from the renal tubes
Levothyroxine is prescribed for a client diagnosed with hypothyroidism. Upon review of the client's record, the nurse notes that the client is taking warfarin. Which modification to the plan of care should the nurse review with the client's primary health care provider?
1. A decreased dosage of levothyroxine
2. An increased dosage of levothyroxine
3. A decreased dosage of warfarin sodium
4. An increased dosage of warfarin sodium
3.
Levothyroxine accelerates the degradation of vitamin K–dependent clotting factors. As a result, the effects of warfarin are enhanced. If thyroid hormone replacement therapy is instituted in a client who has been taking warfarin, the dosage of warfarin should be reduced.
A client received 20 units of Humulin N insulin subcutaneously at 08:00. At what time should the nurse plan to assess the client for a hypoglycemic reaction?
1. 10:00
2. 11:00
3. 17:00
4. 24:00
3
Humulin N is an intermediate-acting insulin. The onset of action is 60 to 120 minutes, it peaks in 6 to 14 hours, and the duration of action is 16 to 24 hours. Hypoglycemic reactions most likely occur during peak time.
The nurse is providing instructions to a client with a diagnosis of Addison's disease regarding the administration of prescribed glucocorticoids. The nurse should provide which instruction to the client?
1. To stop the medication if side effects occur
2. To avoid taking the medication if nausea occurs
3. That minimal side effects will occur with use of this medication
4. That an increased dose of medication may be needed during times of stress
4
The client with Addison's disease will require lifelong replacement of adrenal hormones. The medications must be taken daily, and an alternate route of administration must be used if the client cannot take oral medications for any reason, such as nausea and vomiting. Additional doses of glucocorticoids will be needed during times of stress. The nurse must emphasize that the client must call the primary health care provider (PHCP) to obtain a prescription for a dosage increase when experiencing stressful situations. Abrupt withdrawal of this medication can result in Addisonian crisis. Although side effects are mild at lower doses, more severe side effects occur with long-term glucocorticoid administration. It is very unsafe to stop taking the medication without first consulting the PHCP.
The nurse is educating a client about medroxyprogesterone. The nurse should provide the client with which information about the medication?
1. Should be taken once daily by mouth
2. Should be administered intramuscularly every 3 months
3. Should be taken immediately following sexual intercourse
4. Provides some protection against sexually transmitted infections
2
Medroxyprogesterone is given intramuscularly in the deltoid or gluteus maximus muscle. Injections should be administered every 12 weeks. Advantages of medroxyprogesterone include contraceptive effectiveness comparable to combined oral contraceptives and long-lasting effects. Additionally, injections are required only 4 times a year. Disadvantages are prolonged amenorrhea or uterine bleeding, increased risk of venous thrombosis and thromboembolism, and no protection against sexually transmitted infections.
When assessing for potential side effects of fludrocortisone, what is a priority for the nurse to monitor?
a. Serum potassium levels for hypokalemia
b. Serum sodium levels for potential hyponatremia
c. Serum calcium levels for hypercalcemia
d. Intake and output for potential fluid volume deficit
A
A client scheduled to undergo subtotal thyroidectomy is taking a potassium iodide solution. The client complains to the nurse that she is experiencing a brassy taste in her mouth when taking the medication. Which instruction should the nurse provide to the client?
1. Dilute the medication in 8 oz of water.
2. Report the symptom to the primary health care provider (PHCP).
3. Continue to take the medication because the symptom is normal.
4. Take one half dose of the prescribed medication for the next 2 days.
2
The client should be instructed about symptoms of iodism that can occur with the administration of potassium iodide solution. These symptoms include a brassy taste, burning sensation in the mouth, and soreness of the gums and teeth. The client should be instructed to withhold the medication and notify the PHCP if these symptoms are noted.
The nurse teaches the client who is newly diagnosed with diabetes insipidus about the prescribed intranasal desmopressin. Which statements by the client indicate understanding? Select all that apply.
1. "This medication will turn my urine orange."
2. "I should decrease my oral fluids when I start this medication."
3. "The amount of urine I make should increase if this medicine is working."
4. "I need to follow a low-fat diet to avoid pancreatitis when taking this medicine."
5. "I should report headache and drowsiness to my doctor since these symptoms could be related to my desmopressin."
2, 5
In diabetes insipidus, there is a deficiency in antidiuretic hormone (ADH), resulting in large urinary losses. Desmopressin is an antidiuretic hormone that enhances reabsorption of water in the kidney. Clients with diabetes insipidus drink high volumes of fluid (polydipsia) as a compensatory mechanism to counteract urinary losses and maintain fluid balance. Once desmopressin is started, oral fluids should be decreased to prevent water intoxication. Therefore, clients with diabetes insipidus should decrease their oral fluid intake when they start desmopressin. Headache and drowsiness are signs of water intoxication in the client taking desmopressin and should be reported to the primary health care provider. Desmopressin does not turn urine orange. The amount of urine should decrease, not increase, when desmopressin is started. Desmopressin does not cause pancreatitis.
Cortisone acetate is prescribed for a client with adrenal insufficiency. The nurse provides instructions to the client regarding the medication. Which statement, if made by the client, indicates a need for further instruction?
1. "I will limit my sodium intake."
2. "I will avoid people with colds."
3. "I will eat a good breakfast every day."
4. "I will stop the medication when I feel better."
4
To prevent acute adrenal insufficiency, glucocorticoids should not be abruptly discontinued. These medications can cause sodium and water retention and the loss of potassium, so clients should be instructed to limit sodium intake and consume potassium-rich foods. These medications can increase the risk of infection, and the client should avoid contact with clients who are ill. Additionally, adequate dietary intake is important.
When a patient is prescribed an androgen, which adverse effect would be a priority for the nurse to report to the prescriber?
A. Breast Enlargement
B. Change in menstrual pattern
C. Edema in lower extremities
D. Increased libido
A. Breast Enlargement ~ Gynecomastia is adverse effect of Testosterone.
The nurse is administering vasopressin to a patient. Which nursing interventions are indicated when administering vasopressin?
(Select all that apply)
a. Record urinary output
b. Observe the patient's weight and note edema
c. Monitor the patient for decreased blood pressure
d. Closely monitor the patient's blood glucose levels
e. Monitor the patient's pulse for increased heart rate
f. Record the patient's daily calcium levels
A, B, C, E
The client with hyperparathyroidism is taking alendronate. Which statements by the client indicate understanding of the proper way to take this medication? Select all that apply.
1. "I should take this medication with food."
2. "I should take this medication at bedtime."
3. "I should sit up for at least 30 minutes after taking this medication."
4. "I should take this medication first thing in the morning on an empty stomach."
5. "I can pick a time to take this medication that best fits my lifestyle as long as I take it at the same time each day."
3, 4
Alendronate is a bisphosphonate used in hyperparathyroidism to inhibit bone loss and normalize serum calcium levels. Esophagitis is an adverse effect of primary concern in clients taking alendronate. For this reason the client is instructed to take alendronate first thing in the morning with a full glass of water on an empty stomach, not to eat or drink anything else for at least 30 minutes after taking the medication, and to remain sitting upright for at least 30 minutes after taking it.
A client with diabetes mellitus is taking Humulin NPH insulin and regular insulin every morning. The nurse should provide which instructions to the client? Select all that apply.
1. Hypoglycemia may be experienced before dinnertime.
2. The insulin dose should be decreased if illness occurs.
3. The insulin should be administered at room temperature.
4. The insulin vial needs to be shaken vigorously to break up the precipitates.
5. The NPH insulin should be drawn into the syringe first, then the regular insulin
1, 3
Humulin NPH is an intermediate-acting insulin. The onset of action is 60 to 120 minutes, it peaks in 6 to 14 hours, and its duration of action is 16 to 24 hours. Regular insulin is a short-acting insulin. Depending on the type, the onset of action is 30 to 60 minutes, it peaks in 1 to 5 hours, and its duration is 6 to 10 hours. Hypoglycemic reactions most likely occur during peak time. Insulin should be at room temperature when administered. Clients may need their insulin dosages increased during times of illness. Insulin vials should never be shaken vigorously. Regular insulin is always drawn up before NPH.
The nurse is caring for a client with an exacerbation of multiple sclerosis. Which medication(s) will the nurse expect to be prescribed to hasten recovery from the exacerbation?
1. Carbamazepine and phenytoin by mouth
2. Lioresal by mouth and diazepam intravenously
3. Phenytoin intravenously, then tapered to oral route
4. Methylprednisolone and cyclophosphamide intravenously
4
Intravenous methylprednisolone or adrenocorticotropic hormone in combination with cyclophosphamide may be prescribed to accelerate recovery from an exacerbation of multiple sclerosis. Carbamazepine may be prescribed for trigeminal neuralgia, and phenytoin may be prescribed to control seizures. Lioresal and diazepam are used to treat muscle spasticity
The labor and delivery nurse is preparing to administer ergonovine (methergine) to a woman who has just delivered the placenta. Before administering the medication, it is a priority for the nurse to assess the patient for?
A. Elevated BP
B. Lochia flow
C. Respiratory depression
D. Uterine firmness
A. Elevated BP ~ Methergine is contraindicated in patients with hypertension.
The nurse is administering prednisone to a newly admitted patient who is taking multiple other drugs. The nurse consider which drug interactions with prednisone? (Select all that apply)
a. Cardiac and central nervous system actions are increased when drug is taking with adrenergic agent.
b. Potassium-wasting diuretics increased potassium loss, resulting in hypokalemia
c. Risk for gastrointestinal bleeding and ulceration increases when drug is taken with aspirin or other NSAIDs
d. The action of prednisone is decreased when taking with phenytoin because phenytoin increases glucocorticoid metabolism.
e. Risk for dysrhythmias and digitalis toxicity increased when drug is taking with cardiac glycosides.
f. Dosage of anti-diabetic agent may need to be decreased when taken concurrently with glucocorticoids
B, C, D, E
The nurse is monitoring a client receiving levothyroxine sodium for hypothyroidism. Which findings indicate the presence of a side effect associated with this medication? Select all that apply.
1. Insomnia
2. Weight loss
3. Bradycardia
4. Constipation
5. Mild heat intolerance
1, 2, 5
Insomnia, weight loss, and mild heat intolerance are side effects of levothyroxine sodium. Bradycardia and constipation are not side effects associated with this medication, and rather, are associated with hypothyroidism, which is the disorder that this medication is prescribed to treat.
The home health care nurse is visiting a client who was recently diagnosed with type 2 diabetes mellitus. The client is prescribed repaglinide and metformin. The nurse should provide which instructions to the client? Select all that apply.
1. Diarrhea may occur secondary to the metformin.
2. The repaglinide is not taken if a meal is skipped.
3. The repaglinide is taken 30 minutes before eating.
4. A simple sugar food item is carried and used to treat mild hypoglycemia episodes.
5. Muscle pain is an expected effect of metformin and may be treated with acetaminophen.
6. Metformin increases hepatic glucose production to prevent hypoglycemia associated with repaglinide.
1, 2, 3, 4
Repaglinide, a rapid-acting oral hypoglycemic agent that stimulates pancreatic insulin secretion, should be taken before meals (approximately 30 minutes before meals) and should be withheld if the client does not eat. Hypoglycemia is a side effect of repaglinide and the client should always be prepared by carrying a simple sugar at all times. Metformin is an oral hypoglycemic given in combination with repaglinide and works by decreasing hepatic glucose production. A common side effect of metformin is diarrhea. Muscle pain may occur as an adverse effect from metformin, but it might signify a more serious condition that warrants primary health care provider notification, not the use of acetaminophen.
When teaching the client with adrenal insufficiency about cortisone, the nurse should include which items? Select all that apply.
1. Increase intake of sodium.
2. Take the medication with food.
3. Increase intake of potassium-rich foods.
4. Stay away from people with active infections.
5. Discontinue the medication when symptoms subside.
6. Notify the primary health care provider if illness occurs or surgery is anticipated.
2, 3, 4, 6
Glucocorticoids should not be abruptly discontinued because acute adrenal insufficiency could occur. Because glucocorticoids cause sodium and water to be retained while causing loss of potassium, the client should limit sodium intake and increase potassium intake. These medications can increase the risk of infection; therefore, the client should avoid contact with clients who are ill. Taking the medication with food helps prevent stomach upset. Individuals may need an increase in dosage during illness or times of stress (surgery).
Research suggests that hormone therapy does not provide which benefits? Select all that apply:
A. Cardiovascular protection
B. Increase in bone density
C. Prevention of vaginal atrophy
D. Protection from dementia
E. Relief from insomnia and hot flashes
A. Cardiovascular protection
D. Protection from dementia
HRT does/can provide relief from insomnia and hot flashes, Treatment & prevention of vaginal atrophy & Increase in/ preserve bone density.