Pharmacology Made Easy 5.0 The Endocrine System

Which of the following interventions are priority for the nurse to make?

Select all that apply.

Administer bolus of 50% dextrose in water IV.

Check blood glucose in 15 min.

When taking action, the nurse should administer 50% dextrose in water IV and check the client's blood glucose in 15 min. These interventions are supported by evidence-based practice. The client has manifestations of hypoglycemia and a blood glucose level of 48 mg/dL. Immediate action needs to be taken to reverse hypoglycemia. The client has a patent IV and administering intravenous dextrose works faster than administering glucagon. To determine the effectiveness of administering 50% dextrose in water, the nurse should check the client's blood glucose in 15 min.

Which of the following actions should the nurse plan to take?

Select all that apply.

Give glargine insulin in morning

Give lispro insulin 15 min before meals

Inject medications in abdomen

When generating solutions, the nurse should give glargine insulin in the morning, give lispro insulin 15 min before meals, and inject medications in abdomen. Glargine insulin is a long-acting insulin that provides basal glycemic control for the client. Lispro insulin is a short-acting insulin, and the onset of working begins 15 to 30 minutes after administration. Giving a short-acting insulin prior to a meal helps provide postprandial glycemic control. Together, the intensive basal/bolus strategy mimics the pancreas. The preferred site of injecting insulin is the abdomen because the medication absorbs faster and more consistently there. The slowest absorption site is the thigh.

A nurse is caring for a client who is taking pioglitazone to treat type 2 diabetes mellitus. The nurse should monitor for which of the following findings?

weight gain

Pioglitazone, a thiazolidinedione, can cause fluid retention. The nurse should monitor the client for weight gain and other indications of fluid retention or heart failure, including dyspnea, crackles, and wheezing.

A nurse is caring for a client who is about to begin taking pioglitazone to treat type 2 diabetes mellitus. The nurse should explain to the client about the need to monitor which of the following laboratory values? (Select all that apply.)

Alanine aminotransferase (ALT): Pioglitazone can cause liver injury. The nurse should monitor ALT at the start of therapy and then every 3 to 6 months thereafter. The nurse should tell the client to report jaundice, dark-colored urine, or abdominal pain.

Low-density lipoproteins (LDL): Pioglitazone can cause elevations in both high-density lipoproteins (HDL), which is a beneficial effect, and low-density lipoproteins (LDL), which is a detrimental effect. The nurse should monitor the client's plasma lipid levels at baseline and periodically throughout medication therapy.

When considering replacement therapy options for a client who has chronic adrenocortical insufficiency, a nurse should recognize that the provider will choose which of the following medications?

Hydrocortisone

Hydrocortisone, a glucocorticoid, provides replacement therapy for acute and chronic adrenocortical insufficiency, such as Addison's disease. Hydrocortisone is identical to cortisol, the primary glucocorticoid the adrenal cortex generates.

A nurse is educating the parents of a child who has a new diagnosis of Prader-Willi syndrome (PWS) and has been prescribed somatropin. Which of the following statements by a parent indicates understanding of the teaching?

"We will use a different spot for injection each time we give the medication."

To avoid atrophy of the tissue, administration of somatropin includes rotating the injection site each time. The nurse should identify this statement as an understanding of somatropin administration.

A nurse is caring for a client who is about to begin taking propylthiouracil (PTU) to treat hyperthyroidism. The nurse should instruct the client to report which of the following adverse effects? (Select all that apply.)

Sore throat

Joint pain

Rash

Sore throat: Propylthiouracil, an antithyroid drug, can cause agranulocytosis. The nurse should monitor the client's CBC and instruct the client to report fever or sore throat.

Joint pain: Propylthiouracil can cause arthralgia and myalgia. The nurse should instruct the client to report these effects and take over-the-counter analgesics for pain relief.

Rash: Propylthiouracil can cause urticaria or a skin rash. The nurse should instruct the client to report these effects.

A nurse is caring for a client who is taking metformin to treat type 2 diabetes mellitus and reports muscle pain. Which of the following adverse reactions should the nurse suspect?

lactic acidosis

Metformin, a biguanide, can cause lactic acidosis, which is a life-threatening complication that manifests as muscle aches, sleepiness, malaise, and hyperventilation. The client should stop taking the medication and seek medical care immediately.

A nurse is caring for a client who is about to begin insulin glargine therapy.The nurse should identify the need for additional precautions because the client also takes which of the following types of medications?

Beta blockers

Clients who take both insulin and beta blockers are at risk for failing to promptly recognize the manifestations of hypoglycemia because beta blockers mask manifestations such as tachycardia and tremors. Beta blockers also increase hypoglycemic effects.

A nurse administers pramlintide and regular insulin at 0800 to a client who has type 1 diabetes mellitus. At which of the following times should the nurse expect the pramlintide to exert its peak action and increase the risk for hypoglycemia?

1100

Pramlintide, an amylin mimetic, is likely to cause severe hypoglycemia 3 hr after administration. Regular insulin is an injectable hypoglycemic medication that can exert its peak action at this time. The nurse should monitor the client for manifestations of hypoglycemia, such as diaphoresis and tremors.

A nurse is teaching a client who has a prescription for glipizide therapy to treat type 2 diabetes mellitus. Which of the following instructions should the nurse include?

Avoid drinking alcohol

The nurse should instruct the client to avoid drinking alcohol. Alcohol can interact with glipizide, a sulfonylurea, causing nausea, palpitations, and flushing. Alcohol also increases the medication's hypoglycemic effects.

A nurse is caring for a client who is taking propylthiouracil (PTU) and reports weight gain, drowsiness, and depression. The nurse should identify that the client is experiencing which of the following adverse reactions to the medication?

Hypothyroidism

Propylthiouracil, an antithyroid medication, can cause hypothyroidism, which manifests as drowsiness, depression, weight gain, edema, and bradycardia. The nurse should request that the provider prescribe a lower dosage of the medication for the client.

A nurse is caring for a client who is taking metformin and is scheduled to undergo angiography using iodine-containing contrast dye. The nurse should identify that an interaction between metformin and the IV contrast dye increases the client's risk for which of the following conditions?

Acute renal failure

Metformin, a biguanide, can interact with iodine-containing contrast dye and cause acute renal failure and lactic acidosis. The nurse should withhold metformin for 48 hr prior to and following the procedure. The nurse should also monitor the client for indications of acute renal failure or lactic acidosis, such as reduced urine output, hyperventilation, and abdominal pain.

A nurse is providing teaching to a client who is about to begin exenatide therapy to treat type 2 diabetes mellitus. Which of the following instructions should the nurse include? (Select all that apply.)

Inject the medication subcutaneously: The client should inject exenatide, an incretin mimetic, into the subcutaneous tissue of the thigh, upper arm, or abdomen.

Expect the peak effect in 2 hrs: Levels of exenatide peak 2 hr after administration and then decrease gradually, with a half-life of 2.4 hr.

Use the medication as a supplement to an oral hypoglycemic: Exenatide supplements the action of an oral hypoglycemic, such as a sulfonylurea or metformin.

A nurse is caring for a client who is taking desmopressin. The nurse should make which of the following assessments to evaluate the medication's effectiveness?

Urine Output

Desmopressin, an antidiuretic hormone, treats diabetes insipidus. The nurse should monitor the client's fluid intake and urine output along with urine and serum osmolality and blood pressure.

A nurse is caring for a client who is about to begin taking somatropin. The nurse should explain the need to monitor which of the following laboratory values? (Select all that apply.)

Thyroid-stimulating hormone (TSH): Somatropin, a growth hormone, can suppress the thyroid gland and cause hypothyroidism. The nurse should monitor TSH levels.

Blood glucose: Somatropin can cause hyperglycemia. The nurse should monitor the client's blood glucose levels and instruct the client to report polyphagia, polydipsia, and polyuria.

A nurse is assessing a client who has a new prescription for levothyroxine. The nurse should identify which of the following findings as a contraindication for this medication?

Recent myocardial infarction

Levothyroxine, a thyroid replacement hormone, can cause tachycardia, palpitations, and hypertension, especially when the client requires a dosage adjustment. Therefore, it is contraindicated for clients who have recently had a myocardial infarction.

A nurse is providing teaching to a client who is about to begin levothyroxine therapy to treat hypothyroidism. Which of the following instructions should the nurse include?

Expect lifelong therapy with the medication

Therapy with levothyroxine, a thyroid replacement hormone, usually continues for life because there are no other therapies that can restore thyroid function.

A nurse is speaking with a client who is taking glipizide to treat type 2 diabetes mellitus and has called to report feeling shaky, hungry, and fatigued. Which of the following actions should the nurse instruct the client to take?

Perform a fingerstick blood glucose check.

Glipizide, a sulfonylurea, can cause hypoglycemia, which can manifest as diaphoresis, shakiness, hunger, and fatigue. The nurse should tell the client to check their blood glucose level and, if it indicates hypoglycemia, to consume a snack of 15 to 20 g (0.5 to 0.7 oz) of carbohydrates, retest in 15 to 20 min, and repeat if their blood glucose level is still low.

A nurse is teaching a client who has a prescription for pramlintide therapy to treat type 1 diabetes mellitus. Which of the following instructions should the nurse include?

Administer pramlintide before meals.

The nurse should instruct the client to inject pramlintide, an amylin mimetic, 20 min before any meal that contains at least 30 g of carbohydrates.

A nurse is caring for a client who takes repaglinide 15 to 30 min before each meal to treat type 2 diabetes mellitus.The client asks, "If I skip a meal, what should I do?" Which of the following responses should the nurse make?

Skip the dose

To avoid a sudden and serious drop in blood glucose level, the client should skip the dose of repaglinide, a meglitinide, whenever skipping a meal. The nurse should also instruct the client to try to avoid skipping meals.

A nurse at a provider's office is assessing a client who has been taking hydrocortisone for adrenal insufficiency. The client reports fatigue and feeling overwhelmed by personal responsibilities. Which of the following findings should the nurse identify as an indication the provider might need to increase the client's dosage

Hypotension

Hypotension and fatigue are findings of adrenal insufficiency. During times of stress, the client might need a dosage increase to prevent adrenal insufficiency. The nurse should report the findings to the provider.

A nurse is providing teaching to a client about taking fludrocortisone to treat adrenocortical insufficiency. Which of the following instructions should the nurse include? (Select all that apply.)

Obtain weight measurement daily: Fludrocortisone, a mineralocorticoid, can cause fluid and electrolyte imbalances, such as hypernatremia. Tracking weight on a daily basis can help identify weight gain and edema; reporting it can expedite any essential interventions.

Report weakness or heart palpitations: Fludrocortisone can cause hypokalemia. The nurse should monitor the client's potassium levels and tell the client to report muscle weakness or heart palpitations.

Have blood pressure checked regularly: Fludrocortisone can cause fluid retention and hypertension. The nurse should monitor the client's fluid balance and blood pressure to expedite any essential interventions.

A nurse should recognize that a provider will prescribe a lower dose of sitagliptin for a client who has type 2 diabetes mellitus and which of the following conditions?

Renal impairment

Sitagliptin, a gliptin, requires cautious use with clients who have renal dysfunction and low creatinine clearance because the kidneys eliminate the medication virtually intact. The provider should prescribe a lower dose for this client or prescribe a different hypoglycemic medication.

The nurse is teaching the client about pioglitazone. Which of the following client statements indicate an understanding of the teaching?

For each client statement, click to specify if the statement indicates understanding or a need for further teaching. There must be at least 1 selection in every row. There does not need to be a selection in every column.

Understand:

- "I need to call the provider if I have nausea, vomiting and abdominal pain."

- "I need to have my liver enzymes checked every 6 months."

- "I need to call the provider if I notice blood in my urine."

- "I could start my menstrual cycle again and need to use contraception."

Needs for further teaching

- "I can take this medication before each meal."

- "It is expected that I will gain weight rapidly and my legs will swell."

- "I don't need to exercise anymore since this medication will take care of my blood glucose."

When evaluating outcomes, the nurse should identify that the following client statements indicate understanding of pioglitazone: "I need to call the provider if I have nausea, vomiting and abdominal pain", "I need to have my liver enzymes checked every 6 months", "I need to call the provider if I notice blood in my urine", and "I could start my menstrual cycle again and need to use contraception."

Pioglitazone is an oral hyperglycemic agent that is categorized as a thiazolinidione (glitazone) and used to treat type 2 diabetes mellitus. The nurse should instruct clients about the adverse effects of medications and when to report them. Clients who take pioglitazone have an increased risk for liver failure, heart failure, bladder cancer, and ovulation if not currently ovulating.

Clients should report jaundice, dark urine, abdominal pain, vomiting, or fatigue, which are manifestations of liver failure. Clients will need to have their liver function enzymes checked for an increase that could indicate hepatotoxicity. The nurse should obtain the client's baseline liver function values and then every 3 to 6 months thereafter. 

The nurse should instruct the client to expect some swelling and edema but to report significant swelling, weight gain, or shortness of breath immediately, as these could indicate heart failure. The client should report swelling, rapid weight gain, dyspnea, and atypical fatigue to their provider.

Clients should be informed of the manifestations of bladder cancer, such as hematuria and dysuria, and instructed to contact the provider immediately if these occur. Clients should only take a glitazone orally once a day, with or without food; not with each meal. Glitazone can promote ovulation in premenopausal clients who are not having menstrual cycles and therefore clients should be educated about contraception. When a client takes oral hypoglycemic agents, they need to continue an exercise routine and eat a diabetic diet. Medications do not replace a healthy lifestyle.