Chapter 19 Drug for thyroid and adrenal Problem Chapter 20 Drug therapy for diabetes

c) Take the medication on an empty stomach in the morning.

Rationale: Levothyroxine is best absorbed on an empty stomach, typically in the morning, to ensure consistent absorption.

A patient with hypothyroidism is prescribed levothyroxine (Synthroid). Which of the following instructions should the nurse include in the patient's teaching?

a) Take the medication with food.

b) Take the medication at bedtime.

c) Take the medication on an empty stomach in the morning.

d) Take the medication with calcium supplements.

b) Agranulocytosis

Rationale: Methimazole can cause agranulocytosis, a severe decrease in white blood cells, increasing the risk of infection.

A patient with hyperthyroidism is prescribed methimazole. Which of the following adverse effects should the nurse monitor for?

a) Hyperglycemia

b) Agranulocytosis

c) Hypertension

d) Weight gain

b) Monitor for signs of Cushing's syndrome.

Rationale: Hydrocortisone is a glucocorticoid, and long-term use can lead to Cushing's syndrome.

A patient with Addison's disease is prescribed hydrocortisone. Which of the following is an important nursing consideration?

a) Monitor for signs of hypothyroidism.

b) Monitor for signs of Cushing's syndrome.

c) Monitor for signs of hypoglycemia.

d) Monitor for signs of hyperkalemia.

b) Moon face and buffalo hump

Rationale: Cushing's syndrome is characterized by excess cortisol, leading to characteristic features like moon face and buffalo hump.

A patient with Cushing's syndrome is likely to exhibit which of the following signs and symptoms?

a) Hypotension and weight loss

b) Moon face and buffalo hump

c) Hyperkalemia and hypoglycemia

d) Bradycardia and dry skin

c) Lispro insulin

Rationale: Lispro insulin is a rapid-acting insulin with the fastest onset.

Which of the following insulin types has the fastest onset of action?

a) NPH insulin

b) Regular insulin

c) Lispro insulin

d) Glargine insulin

b) Take the medication with food.

Rationale: Metformin is often associated with GI upset, which can be minimized by taking it with food.

A patient taking metformin reports gastrointestinal upset. Which of the following instructions should the nurse provide?

a) Stop taking the medication immediately.

b) Take the medication with food.

c) Increase the dose of the medication.

d) Take the medication on an empty stomach.

c) Hypoglycemia

Rationale: Sulfonylureas stimulate insulin release, increasing the risk of hypoglycemia.

Which of the following is a common adverse effect of sulfonylureas?

a) Hyperglycemia

b) Weight loss

c) Hypoglycemia

d) Diarrhea

c) Canagliflozin

Rationale: SGLT2 inhibitors, like canagliflozin, increase glucose excretion in the urine, creating a favorable environment for fungal growth.

Which medication increases the risk of genital mycotic infections?

a) Metformin

b) Glipizide

c) Canagliflozin

d) Sitagliptin

b) Stimulate insulin release and decrease glucagon secretion

Rationale: GLP-1 receptor agonists mimic incretin hormones, enhancing insulin release and suppressing glucagon.

What is the primary action of GLP-1 receptor agonists?

a) Increase hepatic glucose production

b) Stimulate insulin release and decrease glucagon secretion

c) Increase insulin resistance

d) Decrease glucose reabsorption in the kidneys

c) Glucagon

Rationale: Glucagon is used to treat severe hypoglycemia by increasing blood glucose levels.

A patient is experiencing severe hypoglycemia. What medication should the nurse administer?

a) Insulin glargine

b) Metformin

c) Glucagon

d) Lisinopril

a) Fatigue

c) Bradycardia

e) Constipation

Which of the following are signs and symptoms of hypothyroidism? (Select all that apply.)

a) Fatigue

b) Weight loss

c) Bradycardia

d) Heat intolerance

e) Constipation

b) Tachycardia

c) Anxiety

d) Heat intolerance

e) Diarrhea

Which of the following are signs and symptoms of hyperthyroidism? (Select all that apply.)

a) Weight gain

b) Tachycardia

c) Anxiety

d) Heat intolerance

e) Diarrhea

a) Moon face

b) Buffalo hump

d) Hyperglycemia

e) Thin skin

Which of the following are signs and symptoms of Cushing's syndrome? (Select all that apply.)

a) Moon face

b) Buffalo hump

c) Hypotension

d) Hyperglycemia

e) Thin skin

a) Sweating

b) Tremors

c) Tachycardia

d) Confusion

Which of the following are signs and symptoms of hypoglycemia? (Select all that apply.)

a) Sweating

b) Tremors

c) Tachycardia

d) Confusion

e) Polyuria

a) Polyuria

b) Polydipsia

c) Polyphagia

d) Blurred vision

Which of the following are signs and symptoms of hyperglycemia? (Select all that apply.)

a) Polyuria

b) Polydipsia

c) Polyphagia

d) Blurred vision

e) Bradycardia

a) Osteoporosis

b) Increased risk of infection

c) Hyperglycemia

e) Adrenal suppression

Which of the following are potential adverse effects of long term corticosteroid use? (Select all that apply)

a) Osteoporosis

b) Increased risk of infection

c) Hyperglycemia

d) Weight loss

e) Adrenal suppression

a) Rotate injection sites

b) Monitor for signs of hypoglycemia

c) Educate on proper storage

e) Monitor for signs of hyperglycemia.

Which of the following are nursing considerations for a patient taking insulin? (Select all that apply)

a) Rotate injection sites

b) Monitor for signs of hypoglycemia

c) Educate on proper storage

d) Mix long acting insulin with short acting insulin.

e) Monitor for signs of hyperglycemia.

a) Take with food.

b) Report signs of lactic acidosis.

c) Alcohol should be avoided.

d) Monitor for signs of hypoglycemia.

Which of the following are patient education points for a patient taking Metformin? (Select all that apply)

a) Take with food.

b) Report signs of lactic acidosis.

c) Alcohol should be avoided.

d) Monitor for signs of hypoglycemia.

e) This medication can cause weight gain.

a) Take on an empty stomach.

b) Take at the same time each day.

c) Do not take with calcium or iron supplements.

d) Report signs of hyperthyroidism.

e) Monitoring of TSH levels will be required.

Which of the following are patient education points for a patient taking Levothyroxine? (Select all that apply)

a) Take on an empty stomach.

b) Take at the same time each day.

c) Do not take with calcium or iron supplements.

d) Report signs of hyperthyroidism.

e) Monitoring of TSH levels will be required.

a) Obesity

b) Family history

c) Sedentary lifestyle

e) Advanced age

Which of the following are risk factors for Type 2 diabetes? (Select all that apply)

a) Obesity

b) Family history

c) Sedentary lifestyle

d) Autoimmune disease

e) Advanced age

False

Rationale: Levothyroxine is used to treat hypothyroidism.

True or False: Levothyroxine is used to treat hyperthyroidism.

False

Rationale: Radioactive iodine is used to treat hyperthyroidism.

True or False: Radioactive iodine is used to treat hypothyroidism

False

Rationale: Addison's disease results from a deficiency in cortisol and aldosterone.

True or False: Addison's disease results from excess cortisol production.

True

Rationale: Excess cortisol in Cushing's syndrome leads to these effects.

True or False: Cushing's syndrome is characterized by hypertension and hyperglycemia.

False

Rationale: NPH insulin is an intermediate-

True or False: NPH insulin is a rapid-acting insulin.

False

Rationale: Metformin primarily works by decreasing hepatic glucose production and increasing insulin sensitivity, not by directly stimulating insulin release.

True or False: Metformin can cause hypoglycemia as a primary adverse effect

True

Rationale: Glucagon stimulates the liver to release stored glucose, raising blood sugar.

True or False: Glucagon is administered to increase blood glucose levels.

True

Rationale: SGLT2 inhibitors increase glucose excretion in the urine, creating an environment favorable for bacterial growth.

True or False: SGLT2 inhibitors can increase the risk of urinary tract infections.

False

Rationale: Rapid-acting insulin should be administered 15 minutes before or immediately with meals.

True or False: Rapid-acting insulin should be administered 30 minutes before meals.

True

Rationale: Beta-blockers help manage the adrenergic symptoms of hyperthyroidism.

True or False: Beta-blockers are used to treat the symptoms of hyperthyroidism, such as tachycardia.

c) Stimulating insulin release from pancreatic beta cells

Rationale: Sulfonylureas work by directly stimulating the beta cells to release more insulin.

Which of the following is the primary mechanism of action of sulfonylureas?

a) Decreasing hepatic glucose production

b) Increasing insulin sensitivity in peripheral tissues

c) Stimulating insulin release from pancreatic beta cells

d) Increasing glucose excretion in the urine

a) Increasing the evening dose of intermediate-acting insulin

Rationale: The dawn phenomenon is characterized by an early-morning rise in blood glucose due to hormonal changes; increasing the evening intermediate-acting insulin can help counteract this.

A patient with type 1 diabetes is experiencing the "dawn phenomenon." Which of the following insulin adjustments is most appropriate?

a) Increasing the evening dose of intermediate-acting insulin

b) Decreasing the morning dose of rapid-acting insulin

c) Administering a dose of rapid-acting insulin at bedtime

d) Skipping the evening dose of long acting insulin.

c) Hemoglobin A1c

Rationale: Hemoglobin A1c provides an average of blood glucose levels over the past 2-3 months.

Which of the following laboratory values is most important for monitoring the long-term effectiveness of diabetes management?

a) Fasting blood glucose

b) Postprandial blood glucose

c) Hemoglobin A1c

d) Random blood glucose

a) Hypokalemia

Rationale: Fludrocortisone is a mineralocorticoid that promotes sodium retention and potassium excretion, leading to hypokalemia.

A patient taking fludrocortisone should be monitored for which of the following electrolyte imbalances?

a) Hypokalemia

b) Hyperkalemia

c) Hyponatremia

d) Hypercalcemia

b) Avoid contact with pregnant women and infants.

Rationale: Radioactive iodine emits radiation, requiring precautions to protect others from exposure.

What is the most important teaching point for a patient who is prescribed radioactive iodine (I-131)?

a) Increase fluid intake.

b) Avoid contact with pregnant women and infants.

c) Take the medication with food.

d) Monitor for signs of hyperglycemia.

b) Pioglitazone

Rationale: Thiazolidinediones like pioglitazone can cause fluid retention and exacerbate heart failure.

Which of the following medications is contraindicated in patients with a history of heart failure?

a) Metformin

b) Pioglitazone

c) Glipizide

d) Sitagliptin

c) Suggest the patient eat small, frequent meals.

Rationale: Nausea is a common side effect of GLP-1 receptor agonists; small, frequent meals can help alleviate it.

A patient taking a GLP-1 receptor agonist reports persistent nausea. What is the most appropriate nursing intervention?

a) Instruct the patient to stop taking the medication immediately.

b) Advise the patient to take the medication on an empty stomach.

c) Suggest the patient eat small, frequent meals.

d) Administer an antiemetic medication as needed.

b) Beta-blockers

Rationale: Beta-blockers can block the adrenergic symptoms of hypoglycemia, such as tachycardia and tremors.

Which of the following medications can mask the signs and symptoms of hypoglycemia?

a) Metformin

b) Beta-blockers

c) Sulfonylureas

d) SGLT2 inhibitors

b) Hydrocortisone

Rationale: Adrenal crisis is treated with rapid replacement of glucocorticoids, such as hydrocortisone.

A patient with adrenal crisis requires immediate treatment. Which of the following medications is administered?

a) Levothyroxine

b) Hydrocortisone

c) Methimazole

d) Glucagon

b) Oral candidiasis

Rationale: Inhaled corticosteroids can lead to oral candidiasis (thrush) due to local immunosuppression.

Which of the following is a common adverse effect of long term use of inhaled corticosteroids?

a) Hypoglycemia

b) Oral candidiasis

c) Tachycardia

d) Weight gain

a) Stimulate insulin release from beta cells in the pancreas

What is the primary mechanism of action of sulfonylureas?

a) Abdominal pain and diarrhea

Which of the following is a common side effect of sulfonylureas?

a) Before meals

When should meglitinides be taken to prevent hypoglycemia?

a) Repaglinide

Which of the following medications is a meglitinide?

a) Beta-blockers

What is a key interaction that enhances the risk of hypoglycemia in patients on insulin stimulants?

a) Risk of lactic acidosis

What is the main adverse reaction associated with metformin?

a) Discontinue metformin 24 hours before and restart 48 hours after

What should be done before using contrast dye for imaging in patients on metformin?

a) Improve insulin sensitivity by activating PPAR-γ receptors

What is the primary mechanism of action of thiazolidinediones (TZDs)?

a) Weight gain and edema

Which side effect is commonly associated with thiazolidinediones?

a) Pioglitazone

Which drug is a thiazolidinedione (TZD)?

a) They delay carbohydrate absorption

What is the effect of alpha-glucosidase inhibitors (AGIs) on carbohydrate absorption?

a) Gas and bloating

Which of the following is a common side effect of alpha-glucosidase inhibitors?

a) Take glucose

What is the proper treatment for hypoglycemia caused by alpha-glucosidase inhibitors?

a) Type 2 diabetes

Which type of diabetes is treated with incretin mimetics (GLP-1 receptor agonists)?

a) Weight loss

What is a common side effect of GLP-1 receptor agonists?

a) Liraglutide

Which GLP-1 receptor agonist is used for weight management?

a) Pancreatitis

What serious adverse reaction is associated with GLP-1 receptor agonists?

a) Mimic amylin to inhibit glucagon secretion and slow gastric emptying

What is the mechanism of action of amylin analogs?

a) In combination with insulin to control post-meal blood sugar

What is the primary use of pramlintide (Symlin)?

a) Severe hypoglycemia

Which of the following is a potential adverse reaction of pramlintide?

a) Inhibit the breakdown of incretin hormones to increase insulin secretion

What is the mechanism of action of DPP-4 inhibitors (gliptins)?

a) Saxagliptin

Which of the following drugs is a DPP-4 inhibitor?

a) Genital infections

Which of the following is a common side effect of SGLT2 inhibitors?

a) Diabetic ketoacidosis (DKA)

What serious adverse reaction is associated with SGLT2 inhibitors?

a) Hypoglycemia is more likely when insulin is combined with sulfonylureas or GLP-1 agonists

What is a key consideration when using insulin with oral antidiabetic agents?

a) Increased risk of hypoglycemia

What is the risk of combining sulfonylureas with insulin?

a) Glargine

Which type of insulin is considered long-acting?

a) When oral medications are insufficient to control blood glucose

What is the primary therapeutic use of insulin in type 2 diabetes?

a) Beta-blockers

Which drug interaction can mask the symptoms of hypoglycemia?

a) Severe hypoglycemia

What is a common adverse reaction of insulin therapy?

a) Heartburn

c) Nausea

d) Abdominal pain

Which of the following are common side effects of sulfonylureas? (Select all that apply)

· a) Heartburn

· b) Weight loss

· c) Nausea

· d) Abdominal pain

a) Aspirin

b) ACE inhibitors (ACEIs)

c) Beta blockers

Which of the following drugs can increase the risk of hypoglycemia when combined with insulin or sulfonylureas? (Select all that apply)

· a) Aspirin

· b) ACE inhibitors (ACEIs)

· c) Beta blockers

· d) Corticosteroids

a) Pancreatitis

b) Thyroid cancer (medullary thyroid carcinoma)

c) Hypoglycemia

Which of the following are common adverse reactions of GLP-1 receptor agonists (incretin mimetics)? (Select all that apply)

· a) Pancreatitis

· b) Thyroid cancer (medullary thyroid carcinoma)

· c) Hypoglycemia

· d) Increased appetite

a) Liraglutide (Victoza, Saxenda)

b) Semaglutide (Ozempic, Wegovy)

Which of the following drugs can be used to treat type 2 diabetes and may also aid in weight loss? (Select all that apply)

· a) Liraglutide (Victoza, Saxenda)

· b) Semaglutide (Ozempic, Wegovy)

· c) Metformin

· d) Canagliflozin (Invokana)

a) Genital infections

b) Hypotension

d) Urinary tract infections (UTIs)

Which of the following are common side effects of SGLT2 inhibitors? (Select all that apply)

· a) Genital infections

· b) Hypotension

· c) Weight gain

· d) Urinary tract infections (UTIs)

A) Levothyroxine

Which of the following is the preferred medication for hypothyroidism?

A) Take the medication in the morning on an empty stomach

A patient taking levothyroxine should be instructed to:

A) Heat intolerance

Which of the following is a symptom of hyperthyroidism?

A) Methimazole and beta-blockers

What is the first-line treatment for a patient experiencing a thyroid storm?

A) Adrenal crisis

A patient with Addison's disease suddenly stops taking their corticosteroid medication. Which life-threatening condition may occur?

A) Long-term corticosteroid use

What is the most common cause of Cushing's syndrome?

A) Hyperglycemia

A nurse is reviewing lab results for a patient on long-term corticosteroid therapy. Which electrolyte imbalance is most concerning?

A) Liver toxicity and agranulocytosis

A patient taking methimazole for hyperthyroidism should be monitored for:

A) Addison's disease

Fludrocortisone (Florinef) is primarily used to treat:

A) Moon face, central obesity, and hyperglycemia

A patient with Cushing's syndrome may present with which of the following symptoms?