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Questions and Answers
Which action would the nurse take when caring for a patient who is on levothyroxine and warfarin?
Which action would the nurse take when caring for a patient who is on levothyroxine and warfarin?
Which alteration in fluid and electrolyte balance would the nurse assess for in a patient taking fludrocortisone?
Which alteration in fluid and electrolyte balance would the nurse assess for in a patient taking fludrocortisone?
Which manifestation would the nurse instruct the patient to report to the health care provider if the patient is receiving methylprednisolone for the treatment of adrenocortical insufficiency?
Which manifestation would the nurse instruct the patient to report to the health care provider if the patient is receiving methylprednisolone for the treatment of adrenocortical insufficiency?
Which sign or symptom would the nurse look for in a patient who reports chest pain while receiving levothyroxine and digoxin therapy? (Select all that apply)
Which sign or symptom would the nurse look for in a patient who reports chest pain while receiving levothyroxine and digoxin therapy? (Select all that apply)
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Which supplement would the nurse expect to incorporate into the plan of care for a patient with Addison disease who is taking a loop diuretic? (Select all that apply)
Which supplement would the nurse expect to incorporate into the plan of care for a patient with Addison disease who is taking a loop diuretic? (Select all that apply)
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Which information would the nurse include when teaching a patient about prednisone therapy?
Which information would the nurse include when teaching a patient about prednisone therapy?
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Which statement by the student nurse indicates effective learning if the nurse teaches the student nurse about various drug interactions with thyroid drugs?
Which statement by the student nurse indicates effective learning if the nurse teaches the student nurse about various drug interactions with thyroid drugs?
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Which assessment finding is a priority for the nurse to address if the nurse is caring for a patient who has just begun levothyroxine therapy?
Which assessment finding is a priority for the nurse to address if the nurse is caring for a patient who has just begun levothyroxine therapy?
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Which assessment helps determine the dosage of thyroid replacement drug for a patient?
Which assessment helps determine the dosage of thyroid replacement drug for a patient?
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Which response by the patient indicates a need for further teaching about the dosage regimen of long-term corticosteroid drug therapy?
Which response by the patient indicates a need for further teaching about the dosage regimen of long-term corticosteroid drug therapy?
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Which response would the nurse offer to a patient on levothyroxine who asks when the symptoms of hypothyroidism will stop?
Which response would the nurse offer to a patient on levothyroxine who asks when the symptoms of hypothyroidism will stop?
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Which adverse effect is associated with the long-term use of prednisone therapy? (Select all that apply)
Which adverse effect is associated with the long-term use of prednisone therapy? (Select all that apply)
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Which phrase about glucocorticoids is accurate?
Which phrase about glucocorticoids is accurate?
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For which condition would the nurse assess the patient before initiating steroid therapy?
For which condition would the nurse assess the patient before initiating steroid therapy?
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Which intervention would the nurse perform if a patient diagnosed with type 2 diabetes reports taking ginseng to help increase memory?
Which intervention would the nurse perform if a patient diagnosed with type 2 diabetes reports taking ginseng to help increase memory?
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Which type of insulin did the nurse administer if the nurse administers insulin to the patient at 8:30 a.m. and observes for symptoms of hypoglycemia at about 11:00 a.m.?
Which type of insulin did the nurse administer if the nurse administers insulin to the patient at 8:30 a.m. and observes for symptoms of hypoglycemia at about 11:00 a.m.?
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Which antidiabetic medication is classified as a biguanide?
Which antidiabetic medication is classified as a biguanide?
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Which statement would be appropriate to provide a patient with a hemoglobin A1c (HbA1c) of 8.5%?
Which statement would be appropriate to provide a patient with a hemoglobin A1c (HbA1c) of 8.5%?
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Which patient parameter requires immediate action by the nurse for a patient taking metformin? (Select all that apply)
Which patient parameter requires immediate action by the nurse for a patient taking metformin? (Select all that apply)
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Which assessment finding would the nurse monitor for in a patient with type 1 diabetes mellitus who is receiving growth hormone?
Which assessment finding would the nurse monitor for in a patient with type 1 diabetes mellitus who is receiving growth hormone?
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Which information would the nurse include when teaching a patient about the safe administration of levothyroxine?
Which information would the nurse include when teaching a patient about the safe administration of levothyroxine?
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Which response by the patient indicates that the nurse’s teaching was effective if the nurse is educating a patient who is taking thyroid hormone replacement therapy?
Which response by the patient indicates that the nurse’s teaching was effective if the nurse is educating a patient who is taking thyroid hormone replacement therapy?
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Which preferred medication for pain management would be included in discharge teaching for a patient receiving glucocorticoids?
Which preferred medication for pain management would be included in discharge teaching for a patient receiving glucocorticoids?
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Which instruction will the nurse give to a patient prescribed levothyroxine?
Which instruction will the nurse give to a patient prescribed levothyroxine?
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Which statement by the nurse about insulin administration indicates a need for further education?
Which statement by the nurse about insulin administration indicates a need for further education?
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At which time is the patient at highest risk for hypoglycemia if the patient eats meals at 8:30 a.m., noon, and 6:00 p.m. and administers isophane insulin suspension at 8 a.m.?
At which time is the patient at highest risk for hypoglycemia if the patient eats meals at 8:30 a.m., noon, and 6:00 p.m. and administers isophane insulin suspension at 8 a.m.?
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Which instruction would the nurse give to a patient who is receiving metformin therapy and is scheduled for an angiography?
Which instruction would the nurse give to a patient who is receiving metformin therapy and is scheduled for an angiography?
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Which type of diabetes mellitus is the most common?
Which type of diabetes mellitus is the most common?
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Which medication will the nurse anticipate administering to a patient with a blood glucose level of 48 mg/dL?
Which medication will the nurse anticipate administering to a patient with a blood glucose level of 48 mg/dL?
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Which clinical indicators of hypoglycemia would the nurse include when teaching a patient with type 1 diabetes? (Select all that apply)
Which clinical indicators of hypoglycemia would the nurse include when teaching a patient with type 1 diabetes? (Select all that apply)
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If a patient's blood sugar is 175 mg/dL, how many units of Humulin R would the nurse administer?
If a patient's blood sugar is 175 mg/dL, how many units of Humulin R would the nurse administer?
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Which statement about the administration of metformin is correct?
Which statement about the administration of metformin is correct?
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Which hemoglobin A1C (HbA1c) level indicates a diagnosis of diabetes mellitus in a patient?
Which hemoglobin A1C (HbA1c) level indicates a diagnosis of diabetes mellitus in a patient?
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Which factor contributes to the onset of type 2 diabetes mellitus?
Which factor contributes to the onset of type 2 diabetes mellitus?
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Which nursing intervention would the nurse perform after administering 10 units of insulin aspart?
Which nursing intervention would the nurse perform after administering 10 units of insulin aspart?
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Which type of insulin can be administered intravenously?
Which type of insulin can be administered intravenously?
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Which response by the nurse is correct if a patient newly diagnosed with diabetes asks, 'How does insulin normally work in my body?'
Which response by the nurse is correct if a patient newly diagnosed with diabetes asks, 'How does insulin normally work in my body?'
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Which symptom of hypoglycemia would the nurse instruct the patient’s family to treat with a fast-acting carbohydrate source? (Select all that apply)
Which symptom of hypoglycemia would the nurse instruct the patient’s family to treat with a fast-acting carbohydrate source? (Select all that apply)
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Which information would the nurse include when teaching a patient about the administration of metformin?
Which information would the nurse include when teaching a patient about the administration of metformin?
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Which intervention would the nurse implement when finding a patient with type 1 diabetes mellitus unresponsive, cold, and clammy?
Which intervention would the nurse implement when finding a patient with type 1 diabetes mellitus unresponsive, cold, and clammy?
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Which statement by the patient indicates a need for further instruction about the administration of glipizide?
Which statement by the patient indicates a need for further instruction about the administration of glipizide?
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Which intervention would the nurse implement when preparing to administer insulin lispro to a patient diagnosed with type 1 diabetes?
Which intervention would the nurse implement when preparing to administer insulin lispro to a patient diagnosed with type 1 diabetes?
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Which statement by the patient indicates a need for additional teaching regarding required insulin therapy?
Which statement by the patient indicates a need for additional teaching regarding required insulin therapy?
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To which patient would the nurse administer glucagon for the treatment of insulin-induced hypoglycemia?
To which patient would the nurse administer glucagon for the treatment of insulin-induced hypoglycemia?
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At what time does the nurse recognize that regular insulin will peak if administered at 11:00 a.m.?
At what time does the nurse recognize that regular insulin will peak if administered at 11:00 a.m.?
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Which patient statement indicates an understanding of the discharge information provided regarding insulin administration? (Select all that apply)
Which patient statement indicates an understanding of the discharge information provided regarding insulin administration? (Select all that apply)
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Which statement will the nurse include in the teaching when providing discharge education to a patient recently prescribed an oral antidiabetic medication? (Select all that apply)
Which statement will the nurse include in the teaching when providing discharge education to a patient recently prescribed an oral antidiabetic medication? (Select all that apply)
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Study Notes
Levothyroxine and Warfarin Interaction
- Levothyroxine can displace warfarin from protein-binding sites, increasing unbound warfarin and bleeding risk.
- Nurses should monitor patients for signs of increased bleeding when both medications are in use.
Fludrocortisone and Electrolyte Balance
- Fludrocortisone causes sodium retention and potassium excretion, increasing the risk of hypokalemia.
- Nurses should assess patients for low potassium levels while on fludrocortisone.
Symptoms of Cushing Syndrome
- Methylprednisolone may lead to Cushing syndrome; symptoms include moon face, acne, and swelling.
- Patients should be instructed to report signs of Cushing syndrome to their healthcare provider.
Interaction between Levothyroxine and Digoxin
- Levothyroxine can reduce the effectiveness of digoxin and disrupt cardiovascular function, potentially leading to tachycardia, palpitations, and dysrhythmias.
- Symptoms such as insomnia and weight loss are less likely to be caused by this medication interaction.
Addison Disease and Loop Diuretics
- Patients with Addison disease on loop diuretics may require calcium and potassium supplements due to potential hypocalcemia and hypokalemia.
- Sodium supplementation is typically unnecessary in this context.
Prednisone Therapy Instructions
- Prednisone should be taken with food to reduce gastrointestinal irritation.
- Abrupt discontinuation can lead to adrenal crisis; patients should be advised to taper the medication slowly under medical guidance.
Thyroid Drug Interactions
- Thyroid drugs reduce the effectiveness of hypoglycemic medications, potentially requiring dose adjustments in diabetic patients.
- They may also decrease serum Digitalis levels when used concurrently.
Managing Levothyroxine Therapy
- Irritability can indicate hyperthyroidism and may suggest an overdosage of levothyroxine.
- Until stabilization is achieved, expect symptoms like brittle nails and intolerance to cold.
Determining Dosage of Thyroid Medications
- Serum TSH levels are critical for assessing the appropriate dosage of thyroid replacement medications.
- Regular monitoring helps tailor dosage according to the patient's response.
Corticosteroid Patient Education
- Patients should not stop corticosteroids if experiencing adverse effects, as this could lead to adrenal insufficiency.
- Regular communication about any symptoms like fever or sore throat is essential due to immune suppression from glucocorticoids.
Symptom Onset for Thyroid Medications
- Full effects of levothyroxine may take 2 to 4 weeks; patients should be informed of this timeline for better management of expectations.
Adverse Effects of Long-term Prednisone Use
- Long-term use can lead to weight gain, personality changes, muscle wasting, and increased risk of peptic ulcers.
- Glucocorticoids increase serum glucose and sodium, potentially leading to hyperglycemia and hypernatremia.
Role of Glucocorticoids
- Glucocorticoids influence metabolism of carbohydrates, fats, and proteins and increase blood glucose levels.
- They are produced more abundantly during stress and can suppress immune defense mechanisms.
Pre-assessment for Steroid Therapy
- Assessing for uncontrolled diabetes mellitus is crucial due to the risk of hyperglycemia when initiating steroid therapy.
Ginseng Use in Type 2 Diabetes
- Assess for interactions with antidiabetic medications when patients report using ginseng, as it may potentiate hypoglycemic effects.
Insulin Administration Peaks
- Regular insulin peaks at approximately 2.5 hours, making it suitable for monitoring hypoglycemia around that timeframe.
Indicators of Hypoglycemia
- Symptoms include tachycardia, sweating, headaches, and anxiety; not polyphagia or weight loss.
Sliding Scale Insulin Administration
- A blood glucose level of 175 mg/dL corresponds to the administration of 10 units of Humulin R according to the sliding scale protocol.
Metformin Administration
- Common side effects of metformin include gastrointestinal disturbances; it’s excreted in urine, not feces.
- Not recommended for patients with renal impairment due to increased risk of lactic acidosis.### Diabetes Diagnosis and Management
- An HbA1c level greater than 6.5% indicates a diagnosis of diabetes mellitus.
- HbA1c levels of 5.7% to 6.4% suggest prediabetes.
- Level below 5% indicates the absence of diabetes.
Factors Contributing to Type 2 Diabetes
- Obesity and hereditary factors significantly influence the onset of type 2 diabetes.
- Obesity leads to stress on the endoplasmic reticulum, impairing insulin receptor signaling.
- Viral infections and environmental factors are linked mainly to type 1 diabetes.
Insulin Administration and Action
- Insulin aspart is a rapid-acting insulin that works within 15 minutes and requires immediate meal consumption.
- Regular insulin is the only type that can be administered intravenously.
- Insulin lispro must be given just before meals and should not be confused with regular insulin.
Hypoglycemia Management
- Early symptoms include tremors, sweating, confusion, and nervousness; a fast-acting carbohydrate source should be administered when these appear.
- Glucagon is the preferred treatment for hypoglycemic patients who are unresponsive.
Metformin Administration
- Metformin should be taken with food to minimize gastrointestinal side effects.
- It does not cause hypoglycemia, so checking blood glucose regularly before doses is unnecessary.
- Contraindications for metformin include high serum creatinine levels and alcohol abuse.
Patient Education in Diabetes Management
- Patients on glipizide should avoid alcohol due to potential disulfiram-like reactions.
- Consistent blood glucose monitoring is essential, and symptoms such as increased thirst or fruity breath odor may indicate hyperglycemia.
Insulin Therapy Understanding
- Insulin injection sites must be rotated to avoid lipodystrophy and ensure proper absorption.
- Patients needing hospital care should wear medical alert bracelets when applicable.
Regular Follow-Up and Monitoring
- Importance of regular appointments to monitor HbA1c levels; recommended goal should be below 7% for effective diabetes control.
- Patients prescribed oral antidiabetic medications must understand the potential need for insulin during stress or illness.
Antidiabetic Medications
- Metformin is classified as a biguanide.
- Miglitol is an alpha-glucosidase inhibitor, while nateglinide falls under meglitinides.
Immediate Nursing Interventions
- Urgent nursing action is essential for any detected high serum creatinine, alcohol misuse, or planned imaging with contrast while on metformin.
- Monitoring for complications from growth hormone therapy in diabetic patients is crucial, specifically for hypertension and hyperglycemia.### Blood Glucose Regulation and Diabetes
- Non-diabetic individuals maintain normal blood glucose levels through insulin release.
- In type 1 diabetes, insufficient insulin leads to hyperglycemia, necessitating monitoring for high blood glucose.
- Common adverse effects of growth hormone include hypercalciuria and hypothyroidism; hypertension is not typically associated.
Levothyroxine Administration Guidelines
- Levothyroxine should be taken once daily on an empty stomach, preferably 30 minutes before breakfast, for optimal absorption.
- Water is recommended as a beverage for taking levothyroxine; orange juice should be avoided due to potential absorption interference.
- Patients on thyroid hormone replacement should consult with healthcare providers before taking over-the-counter medications to prevent adverse drug interactions.
Patient Education for Thyroid Hormone Replacement
- Effective patient understanding is indicated when they state that levothyroxine should be taken every morning on an empty stomach.
- Taking levothyroxine after meals or in divided doses could lower its efficacy and risk overdose if taken incorrectly.
Pain Management for Patients on Glucocorticoids
- Acetaminophen is recommended for pain management in patients taking glucocorticoids, as it poses less risk of gastric distress compared to NSAIDs.
Insulin Administration Practices
- Insulin is administered subcutaneously, not intramuscularly.
- Regular insulin is short-acting and can be given intravenously when needed.
- Insulin should be injected at a 45- to 60-degree angle in thin patients to ensure proper absorption.
Glipizide Administration
- Regular-release glipizide should be taken 30 minutes before meals to ensure therapeutic effectiveness; taking it with food delays its action.
Hypoglycemia Risk with Isophane Insulin
- Patients using isophane insulin suspension at 8 a.m. are at the highest risk for hypoglycemia at 5:00 p.m. if they do not have a midafternoon snack.
Metformin Therapy and Angiography
- Metformin should be discontinued 2 days prior to angiography due to the risk of acute renal failure after exposure to iodinated contrast media.
Injection Techniques for Insulin
- Patients should roll, not shake, cloudy insulin bottles prior to administration to maintain uniformity.
- Regular insulin must be drawn up before NPH insulin to avoid dilution errors in preparation.
Common Types of Diabetes
- Type 2 diabetes is the most prevalent, accounting for approximately 85-90% of cases.
- Type 1 diabetes comprises roughly 10-12%, gestational diabetes about 1%, and secondary diabetes 2-3% of cases.
Treatment of Hypoglycemia
- Glucagon is the appropriate treatment for a patient with hypoglycemia (blood glucose of 48 mg/dL), while antidiabetic medications would exacerbate the condition.
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Test your knowledge on the endocrine system with this quiz focusing on hormone interactions and patient care. Dive deep into medication management, including drugs like levothyroxine and warfarin. Perfect for nursing students and healthcare professionals.
