Calcium supplements/bone meds
A nurse is caring for a young adult client whose serum calcium is 8.8 mg/dL. Which of the following medications should the nurse anticipate administering to this client?
A. Calcitonin-salmon
B. Calcium carbonate
C. Zoledronic acid
D. Ibandronate
B
Calcium carbonate is an oral calcium supplement that can help treat hypocalcemia (that is non-emergent). It is also important to intake plenty of vitamin D as well when taking a calcium supplement.
A patient of yours was just prescribed levothyroxine to treat hypothyroidism. What is a s/s that they are getting too much and need a dose adjustment?
A. Constipation
B. Cold intolerance
C. Tachycardia
D. Weight gain
C
Levothyroxin is synthetic TH and if a patient gets too much, you can start to see s/s of hyperthyroidism like tachycardia, heat intolerance, weight loss, diarrhea, etc.
This type of insulin is rapid acting and has an onset of 0.5-2.5 hours.
Insulin Lispro
Onset is also 15-30 in and the duration is 3-6 hr
What are some s/s of hypocalcemia? (select all)
A. numbness and tingling of the lips, fingers, and toes
B. Constipation
C. Muscle spasms
D. Positive Chvostek's sign
E. Drowsiness
A, C, D
Hypocalcemia (<8.5 mg/dl) can also cause facial twitching, larygospasms, seizures, and a positive, Trousseau's sign
What are some s/s of diabetes insipidus (DI) and what would be given to treat it?
S/S: severe urine output, dehydration, tachycardia, hypotension, hypernatremia (electrolyte imbalances), dry mucus membranes, increased thirst
Treatment: vasopressors (desmopressin, vasopressin), fluid + electrolyte replacement
This calcium supplement is given IV and is the supplement of choice to treat severe hypocalcemia.
Calcium gluconate
Make sure to dilute this to a proper level and to push it slow due to it's risk of causing severe bradycardia. Also watch for phlebitis and IV site pain when giving this.
A nurse is assessing a client who takes desmopressin for diabetes insipidus. For which of the following adverse effects should the nurse monitor?
A. Hypovolemia
B. Hypercalcemia
C. Agitation
D. Headache
D
Headache is a sign of increasing BP and can indicate fluid retention and overload.
One of your patients just received an injection of NPH insulin. When should you check to see when they may be most at risk for hypoglycemia?
A. 6-14 hr later
B. 16-24 hr after
C. 1-5 hr after
D. 3-6 hr after
A.
The onset of NPH insulin (intermediate acting) is 6-14 hr after administration and the peak time is when your patients are most at risk for hypoglycemia.
One of your patients is on glipizide. How does this medication work to lower blood glucose?
A. Makes cells less resistant to insulin
B. Reduces the release of glucagon from the pancreas and reduced glycogenolysis in the liver
C. Slows the digestion of glucose postprandial
D. Increases the amount of insulin the pancreas produces
D.
Sulfonylureas (like glipizide) cause the pancreas to release more insulin.
One of your patients is taking calcium citrate to help treat osteoporosis and hypocalcemia. What are some teaching points to go over with them about taking this? (select all)
A. Take this medication with meals
B. Avoid taking this along with tetracyclines or fluoroquinolones
C. Take this with a full glass of water
D. Report signs of weakness, drowsiness, and/or constipation
B, C, D
Calcium supplements should be taken with a full glass of water on an empty stomach, it can inhibit the absorption of tetracyclines and fluoroquinolones, and they should report signs of hypercalcemia (constipation, muscle weakness, drowsiness, etc.)
What are some s/s of hypercalcemia? (calcium >10.5)
decreased muscle tone/weakness, dysrhythmias, drowsiness, constipation, N/V, abdominal pain, apathy, and depression
A patient was just prescribed Propylthiouracil (PTU) to treat hyperthyroidism. What s/s of adverse effects should you monitor for? (select all)
A. Bradycardia
B. Sweating
C. Jaundice
D. A fever
E. Weight gain
A, C, D, E
PTU blocks the production of TH from the thyroid so it can cause s/s of hypothyroidism (bradycardia, weight gain, cold intolerance, fatigue). It is also liver toxic and can cause agranulocytosis (watch for s/s of liver injury and infection)
This type of insulin is the only type that can be given IV and is used to treat conditions like DKA.
Regular insulin
Onset: 0.5-1 hr
Peak: 1-5 hr
duration: 6-10 hr
One of your patients is post-op from a partial thyroidectomy and is starting to complain of tingling and numbness in their fingers and toes and starts to have severe muscle tetany. What do you think may be causing this and how would you fix it?
Thyroid surgery can inadvertently damage the parathyroid glands and cause hypoparathyroidism. This will result in low blood calcium levels (<8.5 mg/dl) and the s/s of hypocalcemia. This patient may need IV calcium (calcium chloride, calcium gluconate) in order to fix this problem.
A nurse is providing teaching to a client who is taking raloxifene (a SERM)to prevent postmenopausal osteoporosis. The nurse should advise the client that which of the following are adverse effects of this medication? (Select all that apply.)
A. Hot flashes
B. Lump in breast
C. Swelling or redness in calf
D. Shortness of breath
E. Difficulty swallowing
A, C, D
Raloxifene can cause hot flashes or increase existing hot flashes, it can cause thrombophlebitis, and it raise the risk of DVTs leading to PEs. It can also be protective against breast and endometrial cancers.
What are some teaching points to go over with your patient who was just prescribed Alendronate (a bisphosphonate)? (select all)
A. Swimming is a good form of exercise to help strengthen bones
B. Remain upright for at least 30 minutes after taking this medication
C. Increase your intake of calcium and vitamin D (dairy products, seafood, eggs)
D. Take it with food to avoid stomach upset
E. Report any heartburn, indigestion, or dysphagia
B, C, E
Weight bearing exercise (walking, running, weight lifting) is recommended to strengthen bones/prevent bone breakdown. Patients should also take this medication 30 minutes before breakfast with a full glass of water.
A nurse is caring for a client who is taking for somatropin to stimulate growth. The nurse should plan to monitor the client’s urine for which of the following?
A. Bilirubin
B. Protein
C. Potassium
D. Calcium
D
A large amount of calcium can be present in the urine of a client who takes somatropin. This puts the client at risk for renal calculi.
A nurse is providing teaching for a client who has a new prescription for metformin. Which of the following adverse effects of metformin should the nurse instruct the client to report to the provider?
A. Somnolence
B. Constipation
C. Fluid retention
D. Weight gain
A
Somnolence can indicate lactic acidosis, which is manifested by extreme drowsiness, hyperventilation, and muscle pain. It is a rare but very serious adverse effect caused by metformin and should be reported to the provider.
Why is it important to monitor blood glucose closely on a diabetic patient who is on a beta blocker?
Beta blockers can mask the s/s of hypoglycemia so it is important to watch these patients' blood glucose more closely.
One of your patients received insulin a few hours ago and is now complaining of a headache, shakiness, feeling hungry, and weakness. You check their blood glucose and it is 60. What should you do?
Give them a sugary drink or snack (juice, soda, candy, glucose tablets), wait 15 minutes to see if symptoms subside and check their BG again. If it is still below 70, give them another drink/snack and recheck again 15 minutes later.
What are some adverse effects of alendronate? (select all)
A. Esophagitits
B. Constipation
C. Jaw pain
D. Muscle tetany/pain
E. Bradycardia
A, C, D
Bisphosphonates, like alendronate, can cause esophogitis/gi ulceration, osteonecrosis of the jaw, low serum calcium (muscle tetany) as well as headaches, visual disturbances, and atypical femur fractures.
What are some s/s of Addison's disease and what kind of medications would be given to treat it?
S/s of Addison's (hypoadrenalism) include: darkening of skin, fatigue, weight loss, N/V, constipation, salt cravings, muscle/joint pain.
Medications used to treat it are corticosteroids (hydrocortisone and fludrocortisone in particular)
A nurse is providing teaching to a client who has type 2 diabetes mellitus and is starting repaglinide. Which of the following statements by the client indicates understanding of the administration of this medication?
A. “I’ll take this medication after I eat.”
B. “I’ll take this medicine 30 minutes before I eat.”
C. “I’ll take this medicine just before I go to bed.”
D. “I’ll take this medicine as soon as I wake up in the morning.”
B
Repaglinide causes a rapid, short-lived release of insulin from the pancreas. The client should take this medication within 30 min before each meal so that insulin is available when food is digested.
One of your patients was just given iodine-131 to treat hyperthyroidism. What are some s/s of adverse effects of this you should monitor for? (select all)
A. N/V
B. Diarrhea
C. Sweating
D. Signs of infection (fever, chills)
E. Bradycardia
A, D, E
Iodine-131 is radioactive and so can cause radiation sickness (N/V, hematemesis, epistaxis), bone marrow suppression (look for infections, anemia, and bleeding), and it can cause hypothyroidism (bradycardia, cold intolerance, constipation, fatigue, etc.)
A nurse is caring for an older adult client in a long-term care facility who has hypothyroidism and a new prescription for levothyroxine. Which of the following dosage schedules should the nurse expect for this client?
A. The client will start at a high dose, and the dose will be tapered as needed.
B. The client will remain on the initial dosage during the course of treatment.
C. The client’s dosage will be adjusted daily based on blood levels.
D. The client will start on a low dose, which will be gradually increased.
D.
The nurse should expect that levothyroxine will be started at a low dose and gradually increased over several weeks. This is especially important in older adult clients to prevent toxicity.