Unit 10: Medications Affecting the Endocrine System

A nurse is preparing to administer insulin lispro. When should the nurse expect the medication to reach its peak effect?

The peak effect of insulin lispro occurs $0.5$ to $3$ hr after administration.

What is the expected duration of action for short-acting regular insulin?

The duration of regular insulin is $4$ to $12$ hr.

For a client receiving NPH insulin, at what time interval after injection is the risk for hypoglycemia highest?

The risk is highest during the peak, which occurs $4$ to $14$ hr after administration.

Which type of insulin is characterized by a minimal peak and a duration of up to $24$ hr?

Insulin glargine $U-100$ is a long-acting insulin with a minimal peak and $24$ hr duration.

A client is prescribed a premixed insulin of $70\%$ NPH and $30\%$ regular; what types of insulin are included in this mixture?

This mixture contains intermediate-acting and short-acting insulin.

What blood glucose level defines hypoglycemia according to ATI standards?

Hypoglycemia occurs when blood glucose is less than $70$ mg/dL.

Which autonomic nervous system manifestations should a nurse expect in a client with an abrupt onset of hypoglycemia?

Sympathetic nervous system effects include tachycardia, palpitations, diaphoresis, and shakiness.

How should a nurse treat hypoglycemia in a conscious client who can swallow?

Administer $15$ g of carbohydrates, such as $4$ oz of orange juice or glucose tablets.

Why is it necessary to monitor clients on large doses of insulin for muscle cramping and dysrhythmias?

Insulin can cause hypokalemia by moving potassium into cells along with glucose.

What patient education is essential to prevent lipohypertrophy from insulin injections?

Systematically rotate injection sites and maintain $1$ inch between injection points.

How do beta blockers complicate the management of diabetes in clients taking insulin?

Beta blockers can mask tachycardia and tremors, making it difficult for clients to identify hypoglycemia.

What is the correct sequence for drawing up regular and NPH insulin in the same syringe?

Draw the short-acting (clear) insulin first, followed by the longer-acting (cloudy) insulin.

Which two long-acting insulins should never be mixed in a syringe with any other insulin?

Insulin glargine and insulin detemir should not be mixed with other insulins.

In what order do subcutaneous absorption rates increase among the abdomen, thigh, and upper arm?

Absorption rates increase from the thigh to the upper arm and are fastest in the abdomen.

What safety action must a nurse take when initiating an IV insulin infusion to account for medication binding to the tubing?

Allow $50$ mL of the insulin solution to flow through the IV tubing and waste it before connecting to the client.

A client is starting glipizide for type 2 diabetes; when should the nurse instruct the client to take this medication?

Glipizide should be taken $30$ min before breakfast.

What is a potential adverse reaction when a client taking glipizide consumes alcohol?

The client may experience a disulfiram-like reaction, including intense nausea, vomiting, and palpitations.

A nurse is teaching a client about repaglinide; what instruction should be given regarding missed meals?

Instruct the client to take the dose within $30$ min of mealtime and to withhold the dose if a meal is skipped.

What serious complication is associated with metformin use, especially in clients with renal insufficiency?

Lactic acidosis, characterized by hyperventilation, myalgia, and somnolence, is a life-threatening risk.

Why must a client discontinue metformin $24$ to $48$ hr before a procedure involving iodine-containing contrast media?

The combination can result in acute kidney failure.

Which oral antidiabetic medication is associated with a risk for fluid retention and heart failure?

Pioglitazone, a thiazolidinedione, can cause significant fluid retention.

What should a nurse monitor to screen for adverse effects in a client taking acarbose long-term?

The nurse should monitor liver function tests because acarbose can cause hepatotoxicity with long-term use.

A client taking acarbose experiences hypoglycemia; why must the nurse use glucose tablets rather than table sugar (sucrose)?

Acarbose inhibits the breakdown of sucrose, making it ineffective for rapid glucose elevation.

Which finding should a nurse instruct a client taking canagliflozin to report immediately?

Report manifestations of infection, such as cystitis or candidiasis, as the drug increases glucose in the urine.

A client with type 1 diabetes is prescribed pramlintide; how should the nurse instruct the client to time their oral medications?

Oral medications should be taken $1$ hr before or $2$ hr after pramlintide injections due to delayed gastric emptying.

What is the critical timing for administering exenatide in relation to meals?

Exenatide must be injected within $60$ min before the morning and evening meals, never after a meal.

What should the nurse do if a client is found unconscious from hypoglycemia and IV access is unavailable?

Administer glucagon subcutaneously or intramuscularly and turn the client to their left side.

Why should a nurse turn a client to their left side after administering glucagon for an emergency?

Glucagon can cause nausea and vomiting, and the side-lying position reduces the risk of aspiration.

A nurse is teaching a client about levothyroxine for hypothyroidism; when should the medication be taken?

Levothyroxine should be taken daily on an empty stomach $30$ to $60$ min before breakfast.

What are the manifestations of thyrotoxicosis that a client taking levothyroxine should report?

Report anxiety, tachycardia, chest pain, nervousness, tremors, and heat intolerance.

Why is it important to monitor prothrombin time ($PT$) in a client taking both levothyroxine and warfarin?

Levothyroxine can increase the anticoagulant effects of warfarin by breaking down vitamin K.

What is the recommended dosage schedule for an older adult client starting levothyroxine?

The client should start with a low dose that increases gradually over several weeks to avoid cardiac stress.

How long does it typically take to see the full therapeutic effect of levothyroxine?

The full effect of levothyroxine can take $6$ to $8$ weeks.

A client is prescribed propylthiouracil ($PTU$); for which serious adverse effect should the nurse monitor?

Monitor for agranulocytosis, indicated by early signs like sore throat and fever.

Which thionamide medication is associated with a specific risk for liver injury and hepatitis?

Propylthiouracil ($PTU$) carries a risk for severe liver injury.

Why might a client with hyperthyroidism be prescribed propranolol in addition to antithyroid medications?

Propranolol is used as an adjunct to decrease tremors and tachycardia caused by high thyroid levels.

A client is receiving radioactive iodine ($I-131$) for thyroid cancer; what distance should they maintain from others?

The client should maintain a distance of $6$ feet from others.

What instruction should be given to a client taking Lugol's solution regarding its administration?

Dilute the solution with juice to mask the metallic taste and improve compliance.

What are the early manifestations of iodism (iodine toxicity) that a client should report?

Report a metallic taste, stomatitis, sore teeth and gums, and a frontal headache.

A nurse is caring for a child taking somatropin; what metabolic complication should be monitored?

Monitor for hyperglycemia, as somatropin decreases the use of glucose.

At what point in a child's development must somatropin treatment be discontinued?

Treatment should be stopped prior to epiphyseal closure.

What is the primary therapeutic use for desmopressin?

Desmopressin is the agent of choice for treating diabetes insipidus ($DI$).

A client taking desmopressin for diabetes insipidus reports a pounding headache and sleepiness; what should the nurse suspect?

These are manifestations of water intoxication or overhydration.

Why is vasopressin contraindicated in clients with coronary artery disease?

Vasopressin causes powerful vasoconstriction which can lead to myocardial ischemia or infarction.

What is the target urine output for a client being treated for diabetes insipidus with desmopressin?

The goal is to reduce urine output to normal levels, which is $1.5$ to $2$ L per $24$ hr.

Which laboratory value is critical to monitor in a client taking fludrocortisone for adrenal insufficiency?

Monitor blood potassium levels, as fludrocortisone can cause hypokalemia.

A client is taking hydrocortisone for Addison's disease; what should they be taught about medication timing during stress?

The dosage of hydrocortisone needs to be increased during times of stress, such as infection or surgery.

What are the common manifestations of Cushing's syndrome that can occur with long-term glucocorticoid use?

Manifestations include muscle weakness, moon face, buffalo hump, and cutaneous striations.

What GI teaching is important for a client taking glucocorticoids like prednisone?

Take the medication with food and report coffee-ground emesis or tarry stools, which indicate peptic ulcers.

A nurse is administering octreotide to a client with acromegaly; for what common GI complication should the nurse monitor?

Monitor for the development of cholesterol gallstones, which can occur within a year of treatment.

Where should the nurse avoid injecting octreotide when using the IM route?

The deltoid muscle should be avoided for IM injections of octreotide.

A client with diabetes takes beta blockers; what is the primary nursing instruction regarding hypoglycemia monitoring?

The client should monitor blood glucose levels regularly and not rely on symptoms like tachycardia as an alert.

Which insulin should appear cloudy and must be gently rotated before withdrawal?

NPH and premixed insulins should appear cloudy and require resuspension.

A client taking metformin is scheduled for an elective $CT$ scan with contrast; when should they resume metformin?

Metformin can be resumed $48$ hr after the test if lab results indicate normal kidney function.

What is the expected pharmacological action of SGLT-2 inhibitors like canagliflozin?

They promote glucose excretion through the urine by preventing its reabsorption in the kidney.

A client on propylthiouracil ($PTU$) reports dark urine and jaundice; what is the priority nursing action?

Notify the provider and expect liver function tests, as these are signs of liver injury.

Why is it dangerous for a client on glucocorticoids to stop taking the medication abruptly?

Abrupt withdrawal can cause acute adrenal insufficiency (adrenal crisis).

How should a nurse instruct a client to handle an octreotide injection to minimize pain?

Allow the medication to reach room temperature before administering it slowly.

A client taking sitagliptin reports severe abdominal pain that radiates to the back; what condition does the nurse suspect?

The nurse should suspect pancreatitis, a rare but serious adverse effect of DPP-4 inhibitors.

What is the primary contraindication for the use of acarbose?

Acarbose is contraindicated for clients with gastrointestinal disorders, such as inflammatory bowel disease or obstruction.

In a client with type 1 diabetes taking pramlintide, how much should the premeal insulin dose be reduced?

The premeal rapid- or short-acting insulin dose should be decreased by $50\%$.

What is the nursing priority for a client following radioactive iodine treatment regarding body waste?

Instruct the client to dispose of body wastes (saliva, stool, emesis) exactly as instructed to prevent radiation exposure.

Which laboratory monitoring is required for a client taking pioglitazone specifically to monitor for hepatotoxicity?

The nurse should perform baseline and periodic liver function tests.

A client taking levothyroxine reports a rapid heartbeat and palpitations; what does this indicate?

These manifestations suggest overmedication and potential thyrotoxicosis.

Which medication is used for the emergency treatment of myxedema coma?

Levothyroxine administered via the IV route is used for myxedema coma.

A client taking hydrocortisone for Addison's disease should carry what item for emergencies?

The client should carry an extra supply of glucocorticoids and wear a medical alert bracelet.

What is the effect of concurrent use of glucocorticoids and somatropin?

Glucocorticoids can counteract the growth-promoting effects of somatropin.

A client taking fludrocortisone reports muscle weakness and an irregular pulse; what electrolyte imbalance is suspected?

The nurse should suspect hypokalemia.

Which antidiabetic medication class works by slowing carbohydrate absorption and digestion?

Alpha-glucosidase inhibitors, such as acarbose, slow carbohydrate absorption.

A nurse is teaching a client about storage of insulin vials currently in use; what is the correct instruction?

Store the vial in use at room temperature, away from sunlight and heat, and discard after $1$ month.

What is the prototype medication for meglitinides?

Repaglinide is the prototype medication for meglitinides.

What is a common but self-limiting complication of amylin mimetics like pramlintide?

Reaction at the injection site is a common, self-limiting complication.

Why is it important to monitor blood glucose levels when a client on insulin begins taking a thiazide diuretic?

Thiazide diuretics can raise blood glucose levels and counteract the effects of insulin.

What specific patient education is required for a client using an inhaled human insulin inhaler?

Ensure the correct dose is administered, which may require using multiple cartridges for a single dose.

A client is prescribed glimepiride; in which condition is this oral antidiabetic medication contraindicated?

Glimepiride and all other oral antidiabetics are contraindicated for the treatment of diabetic ketoacidosis ($DKA$).

Which medication is indicated for the management of acromegaly when surgery or radiation has failed?

Octreotide is used to suppress growth hormone release in acromegaly.

What instruction should the nurse give a client taking acarbose regarding missed doses?

If a dose is missed, take it at the next meal but do not take two doses at once.

What is the expected pharmacological action of biguanides like metformin?

Metformin reduces glucose production in the liver and increases glucose uptake in muscles.

Which antidiabetic agent is the first choice medication for most clients with type 2 diabetes?

Metformin is typically the first-choice medication for type 2 diabetes.

How does semaglutide assist with weight loss in clients with type 2 diabetes?

It mimics incretin hormones that decrease appetite and slow gastric emptying.