Topic 14: Endocrine - Performance PDF

Performance Exit Topic 14: Endocrine Due Aug 11, 2024 by 11:59 pm Final Score 26% 13 out of 50 questions answered correctly Completed on Aug 10, 2024 10:41 pm...

Performance Exit Topic 14: Endocrine Due Aug 11, 2024 by 11:59 pm Final Score 26% 13 out of 50 questions answered correctly Completed on Aug 10, 2024 10:41 pm Incorrect (37) Report content error Which action would the nurse take when caring for a patient who is on levothyroxine and warfarin? Take daily weights. Assess peripheral pulses. Monitor for cardiac dysrhythmias. Monitor for increased risk of bleeding. Rationale Levothyroxine can compete with protein-binding sites of warfarin, allowing more warfarin to be unbound, or free, thereby increasing the effects of warfarin and the risk for bleeding. Thus the nurse would monitor for an increased risk of bleeding. This drug combination would not place the patient at increased risk for weight loss, deep vein thrombosis, or dysrhythmias. p. 617 Report content error Which alteration in fluid and electrolyte balance would the nurse assess for in a patient taking fludrocortisone? Hypovolemia  Hypokalemia Hyponatremia Hypercalcemia Rationale Fludrocortisone has mineralocorticoid properties, resulting in sodium and fluid retention along with potassium excretion, which leads to hypokalemia. Thus the nurse would assess the patient for hypokalemia. The most common adverse effect of fertility drugs is hypovolemia. Hyponatremia is an adverse effect of adrenal crisis. Hypercalcemia is an adverse effect of teriparatide. Test-Taking Tip: Start by reading each of the answer options carefully. Usually at least one of them will be clearly wrong. Eliminate this one from consideration. Now you have reduced the number of response choices by one and improved the odds. Continue to analyze the options. If you can eliminate one more choice in a four-option question, you have reduced the odds to 50/50. While you are eliminating the wrong choices, recall often occurs. One of the options may serve as a trigger that causes you to remember what a few seconds ago seemed completely forgotten. p. 620  Report content error 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? Moon face Productive cough Increased appetite Respiratory rate of 18 breaths per minute Rationale Methylprednisolone is a systemic corticosteroid. Sometimes excess levels of systemic corticosteroids may lead to Cushing syndrome. Moon face, acne, an increase in fat pads, and swelling are symptoms of Cushing syndrome; therefore the nurse would instruct the patient to report any of these symptoms to the health care provider. A productive cough, an increased appetite, and a respiratory rate of 18 breaths per minute are all normal or expected assessment findings and would not need to be reported to the health care provider. Test-Taking Tip: Read every word of each question and option before responding to the item. Glossing over the questions just to get through the examination quickly can cause you to misread or misinterpret the real intent of the question. p. 613 Report content error 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. One, some, or all responses may be correct. Some correct answers were not selected Insomnia Palpitations Tachycardia Weight loss Dysrhythmias Rationale Levothyroxine is a thyroid hormone replacement medication. This medication interacts with digoxin and reduces its effectiveness. This impairs cardiovascular function, which may result in tachycardia, chest pain (angina), palpitations, and dysrhythmias. Thus the nurse would assess the patient for palpitations, tachycardia, and dysrhythmias. Insomnia is caused by stimulation of the central nervous system (CNS). Weight loss, fever, and sweating are caused by impaired thermoregulation and electrolyte imbalances. The interaction between levothyroxine and digoxin would not cause CNS stimulation or electrolyte imbalances. Therefore the patient would not have insomnia or weight loss. pp. 615,617 Report content error 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. One, some, or all responses may be correct. Iron Sodium Vitamins Calcium Potassium Rationale A patient with Addison disease would be prescribed corticosteroids for treatment. If the patient is taking both a corticosteroid and a loop diuretic, the patient may have hypocalcemia and hypokalemia due to a drug-drug interaction that causes excessive loss of potassium and calcium. Therefore the nurse would expect to incorporate calcium and potassium supplements into the patient’s plan of care. Sodium concentrations would not be significantly altered in the patient; thus sodium supplements would not be included in the patient’s plan of care. Loop diuretics do not cause iron deficiency and do not impair the absorption of vitamins; thus the nurse would not expect to incorporate iron and vitamin supplements into the patient’s plan of care. p. 620 Report content error Which information would the nurse include when teaching a patient about prednisone therapy? Discontinue the medication if there are adverse effects. Take the medication with food to diminish the risk of gastric irritation.  Take the medication only every other day to decrease the risk for adrenal hyperplasia. Take the medication in the early evening to coincide with the natural secretion pattern of the adrenal cortex. Rationale Glucocorticoids can cause gastric distress and should be administered with food. Thus the nurse would instruct the patient to take prednisone with food. Glucocorticoids should be tapered off slowly to prevent adrenal crisis. The patient takes the medication daily, although the health care provider may prescribe alternate-day dosing for long-term therapy. The normal circadian secretion of the adrenal cortex is early morning to wake the person up, not early evening. Test-Taking Tip: Multiple-choice questions can be challenging because students think that they will recognize the right answer when they see it or that the right answer will somehow stand out from the other choices. This is a dangerous misconception. The more carefully the question is constructed, the more each of the choices will seem like the correct response. p. 622  Report content error Which statement by the student nurse indicates effective learning if the nurse teaches the student nurse about various drug interactions with thyroid drugs? “Thyroid drugs may increase serum Digitalis levels.” “Thyroid drug absorption is increased by cholestyramine.” “Thyroid drugs may decrease the activity of oral anticoagulants.” “Thyroid drugs may decrease the activity of hypoglycemic drugs.” Rationale The student nurse’s statement that thyroid drugs may decrease the activity of hypoglycemic drugs indicates effective learning. Thyroid drugs interact with hypoglycemic drugs and reduce the hypoglycemic activity of the medications. Therefore diabetic patients who are taking thyroid drugs may require increased doses of hypoglycemic drugs. Thyroid drugs may decrease serumDigitalis levels when administered concurrently with Digitalis. Cholestyramine decreases the absorption of thyroid drugs by binding to thyroid hormone in the gastrointestinal tract; this may reduce the absorption of both drugs. Thyroid drugs may increase the activity of oral anticoagulants. p. 616 Report content error 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? Irritability Brittle nails Intolerance to cold Weight gain of 3 pounds in the last week Rationale Irritability is a symptom of hyperthyroidism. This could be a sign that the medication dose is too high. Brittle nails, intolerance to cold, and weight gain could be symptoms of hypothyroidism and would be expected in a patient who has just begunlevothyroxine therapy. p. 615  Report content error Which assessment helps determine the dosage of thyroid replacement drug for a patient? Physical parameters of the patient The patient’s knowledge of thyroid therapy The medication history of the patient and the patient’s family The patient’s serum thyroid-stimulating hormone (TSH) levels Rationale Before prescribing a thyroid replacement drug to a patient with hypothyroidism, the nurse and primary health care provider have to check the patient’s serum TSH level. This helps them determine the underlying pathologic condition and helps them prescribe the right medication and dosage for the patient. Apart from the patient’s TSH level, the patient’s free thyroid hormone levels should also be checked. Doing a physical assessment would help determine the optimal dosage for the patient in order to prevent adverse effects. The nurse would not expect the patient to have prior knowledge of thyroid therapy. After evaluating the TSH level, the nurse would check the patient’s history; this would help to rule out possible contraindications and allergies. p. 614 Report content error Which response by the patient indicates a need for further teaching if the nurse teaches the patient about the dosage regimen of long-term corticosteroid drug therapy? “I will take this medication with food or milk regularly.” “I will not touch or interact with people who have infections.” “I will report to you immediately if I have a fever or a sore throat.” “I will stop taking this medication if I have any adverse effects.” Rationale A patient who is receiving corticosteroid drug therapy should not stop the medication abruptly because this may lead to a sudden decrease in the production of endogenous glucocorticoid, which could cause adrenal insufficiency in the patient. Thus the patient’s statement about stopping the medication if adverse effects occur indicates a need for further teaching. In long-term therapy, alternate-day dosing of glucocorticoids can help to minimize adrenal suppression. A common side effect of corticosteroid therapy is gastrointestinal distress; therefore these drugs should be administered with food or milk. Because corticosteroids suppress the immune system, patients who take them need to avoid contact with people who have infections. Fever, sore throat, increased weakness, and lethargy are common side effects of these drugs, and the patient should contact the nurse or primary health care provider immediately if they occur. p. 620 Report content error Which response would the nurse offer to a patient on levothyroxine who asks when the symptoms of hypothyroidism will stop? “The medication will be effective in a couple of days.” “It can take 2 to 4 weeks before the medication is effective.” “You will need to be patient because this medication takes 2 months to start working.”  “This is long-term therapy, and it will take at least 6 weeks before the medication is effective.” Rationale The nurse would inform the patient that it may take up to 2 to 4 weeks to see the full therapeutic effects of thyroid drugs. Thyroid medications are not fast-acting, so levothyroxine would not start working in a couple of days. However, thyroid drugs do not take 6 weeks or 2 months to become fully effective. p. 617 Report content error Which adverse effect is associated with the long-term use of prednisone therapy? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Weight gain Hypoglycemia Increased sleep Personality changes  Loss of muscle bulk Peptic ulcer disease Rationale The patient is at high risk for osteoporosis as a result of long-term glucocorticoid therapy because glucocorticoids are associated with bone demineralization. Weight gain and personality changes also are associated with glucocorticoid therapy. Glucocorticoids can cause muscle wasting. Long-term use of glucocorticoid therapy predisposes a patient to the development of peptic ulcer disease related to the erosive gastrointestinal effects of the drug. Glucocorticoid therapy using prednisone causes insomnia and hyperglycemia, not increased sleep or hypoglycemia. Test-Taking Tip: Come to your test prep with a positive attitude about yourself, your nursing knowledge, and your test-taking abilities. A positive attitude is achieved through self-confidence gained by effective study. This means (a) answering questions (assessment), (b) organizing study time (planning), (c) reading and further study (implementation), and (d) answering questions (evaluation). p. 622  Report content error Which phrase about glucocorticoids is accurate? They are not produced during stressful situations. They influence carbohydrate, fat, and protein metabolism. They stimulate defense mechanisms to produce immunity. They decrease serum sodium and glucose concentrations. Rationale Glucocorticoids play a major role in carbohydrate, lipid, and protein metabolism within the body. They are produced in increasing amounts during stress. They cause an increase in serum sodium and serum glucose concentrations, thus precipitating hypernatremia and hyperglycemia as adverse effects, respectively. They are used as immunosuppressants. Therefore they are not involved in stimulating defense mechanisms; rather, they suppress them. p. 620  Report content error For which condition would the nurse assess the patient before initiating steroid therapy? Septic shock Rheumatoid arthritis Uncontrolled diabetes mellitus Chronic obstructive pulmonary disease (COPD) Rationale A common adverse effect of steroid therapy is hyperglycemia. Therefore the nurse would assess the patient for uncontrolled diabetes mellitus before initiating steroid therapy. Destruction of red blood corpuscles leads to septic shock. Rheumatoid arthritis is a chronic autoimmune disorder that commonly causes inflammation and tissue damage in joints; it is not directly linked with steroid therapy. Steroid therapy is a treatment for COPD. Test-Taking Tip: Once you have decided on an answer, look at the stem again. Does your choice answer the question that was asked? If the question stem asks “why,” be sure that the response you have chosen is a reason. If the question stem is singular, be sure that the option is singular, and the same goes for plural stems and plural responses. Many times, checking to make sure that the choice makes sense in relation to the stem will reveal the correct answer. pp. 613,622 Report content error Which intervention would the nurse perform if a patient diagnosed with type 2 diabetes reports taking ginseng to help increase memory? Take no action because ginseng does not affect type 2 diabetes. Determine what type of memory deficits the patient is experiencing. Explain that herbs are dangerous and the patient should not take them. Determine whether the patient is currently taking any type of antidiabetic medication. Rationale The nurse would determine if the patient is taking any medication, especially oral hypoglycemics, because many oral hypoglycemics interact with herbs. Ginseng may increase the hypoglycemic effects of oral hypoglycemics. Taking no action would be inappropriate because if the patient takes an oral hypoglycemic that interacts with ginseng, there could be serious low blood sugar consequences. The type of memory deficits that the patient is experiencing is not relevant to the situation. It is inappropriate, negative, and judgmental to tell the patient that herbs are dangerous, as some herbs may be beneficial to the patient. The nurse would assess the patient and determine if an herb is detrimental to the patient’s disease process or affects the patient’s routine medication regimen before making this type of statement. p. 631 Report content error 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.? Aspart Lispro Regular Glulisine Rationale Regular insulin peaks about 2.5 hours (range of 1.5 to 3.5 hr) after the drug’s administration. If the drug is given at 8:30 a.m., it will have its peak effects at about 11:00 a.m., and at that time the nurse would observe for signs of hypoglycemia. Insulin lispro, insulin aspart, and insulin glulisine are all considered rapid-action insulin. The onset of action for these drugs is about 15 minutes, and the effects do not last as long as other classes of insulin. p. 627 Report content error Which clinical indicator of hypoglycemia would the nurse include when teaching a patient with type 1 diabetes? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Headaches Sweating Polyphagia Weight loss  Dehydration Tachycardia Rationale The effects of hypoglycemia are largely attributable to stimulation of the central nervous system because low blood glucose stresses the body. When hypoglycemia occurs, the sympathetic nervous system responds in an attempt to increase blood glucose. Clinical indicators of hypoglycemia mimic sympathetic nervous system stimulation. They include tachycardia, palpitations, headaches, tremors, sweating, and anxiety, not polyphagia, weight loss, or dehydration. p. 629 Report content error A patient is to receive insulin on the following sliding scale: 110 to 150 mg/dL = 5 units of Humulin R 151 to 200 mg/dL = 10 units Humulin R 201 to 250 mg/dL = 15 units Humulin R Over 250 mg/dL = call health care provider If the patient’s blood sugar is 175 mg/dL, how many units of Humulin R would the nurse administer? Record your answer using a whole number. 0 10 units Humulin R Rationale According to the sliding scale, a blood glucose level of 175 mg/dL would result in 10 units of Humulin R. p. 628 Report content error Which statement about the administration of metformin is correct? It is excreted in the feces. Green tea can lead to hyperglycemia. It is recommended for patients with renal impairment. Gastrointestinal (GI) side effects are common. Rationale GI side effects such as nausea and diarrhea are common with metformin, and the higher the dose, the more likely this is to occur. Metformin is eliminated unchanged in the urine, not the feces. The drug is not recommended for patients with renal impairment. Green tea consumption with metformin can lead to hypoglycemia, not hyperglycemia. Report content error Which hemoglobin A1C (HbA1c) level indicates a diagnosis of diabetes mellitus in a patient? Less than 5% 5% Between 5.7% and 6.4%  Greater than 6.5% Rationale An HbA1c level greater than 6.5% indicates a diagnosis of diabetes mellitus. It indicates that the amount of sugar in the hemoglobin is higher than normal. For diagnostic purposes, an HbA1c level of less than or equal to 5% indicates that the patient does not have diabetes. An HbA1c level of 5.7% to 6.4% indicates prediabetes, and an HbA1c level greater than or equal to 6.5% indicates a diagnosis of diabetes mellitus. p. 626 Report content error Which factor contributes to the onset of type 2 diabetes mellitus? Obesity Medications Viral infection Environmental conditions Rationale Some sources say that obesity and heredity are the major factors that contribute to the onset of type 2 diabetes. Obesity causes stress in the endoplasmic reticulum, which suppresses the signals of insulin receptors. Viral infections and environmental conditions are factors that contribute to the onset of type 1 diabetes mellitus. Medications such as glucocorticoids can contribute to secondary diabetes, which disappears when the medication is discontinued in most cases. p. 625 Report content error Which nursing intervention would the nurse perform after administering 10 units of insulin aspart at 7:00 a.m.? Flush the intravenous line. Perform a fingerstick blood sugar test. Have the patient void and dipstick the urine. Make sure that the patient eats breakfast immediately. Rationale Insulin aspart is a rapid-acting insulin that acts in 15 minutes or less. It is imperative that the patient eat as it starts to work. Thus the nurse would make sure that the patient eats breakfast immediately. This medication is given subcutaneously, not intravenously. The patient should have had a fingerstick blood sugar test done before receiving the medication. There would be no need to check the urine. Test-Taking Tip: Do not spend too much time on one question because it can compromise your overall performance. There is no deduction for incorrect answers, so you are not penalized for guessing. You cannot leave an answer blank; therefore guess. Go for it! Remember that you do not have to get all of the questions correct to pass. p. 626 Report content error Which type of insulin can be administered intravenously? Lispro Glargine  Regular Isophane Rationale Regular insulin is the only insulin that can be administered intravenously. Insulin lispro is a rapid-actinghuman recombinant insulin analogue. Insulin glargine is a long-acting recombinant- DNA-produced insulin analogue, and it provides a constant level of insulin in the body. Isophane insulin suspension, also known as NPH insulin, is the only available intermediate-acting insulin product. p. 636 Report content error Which response by the nurse is correct if a patient newly diagnosed with diabetes asks, “How does insulin normally work in my body?” “It stimulates the pancreas to reabsorb glucose.” “It promotes synthesis of amino acids into glucose.” “It stimulates the liver to convert glycogen to glucose.”  “It promotes the uptake of glucose, amino acids, and fatty acids.” Rationale Insulin promotes the uptake of glucose, amino acids, and fatty acids and converts them into substances that are stored in cells. This response by the nurse is correct. After or during a meal, the glucose that is ingested stimulates the pancreas to secrete insulin. Insulin does not promote the synthesis of amino acids into glucose. Insulin stimulates the liver to convert glucose to glycogen, not vice versa. Test-Taking Tip: Look for answers that focus on the patient or that are directed toward the patient’s feelings. p. 626 Report content error Which symptom of hypoglycemia would the nurse instruct the patient’s family to treat with a fast-acting carbohydrate source? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Chills Tremors Sweating Confusion Nervousness Rationale Early symptoms of hypoglycemia involve the central nervous system, as the brain needs a constant supply of glucose to function. Thus tremors, sweating, confusion, and nervousness are symptoms of hypoglycemia seen in patients. When these symptoms occur, the family should have the patient immediately ingest a fast-acting carbohydrate source, such as glucagon, milk, or juice. Chills are not generally an early sign of hypoglycemia. p. 629  Report content error Which information would the nurse include when teaching a patient about the administration of metformin for the treatment of type 2 diabetes mellitus? “Take the medication with food.” “If you miss a meal, you should skip the dose” “You should report any nausea immediately.” “Check your blood sugar before each dose due to a risk for hypoglycemia.” Rationale Metformin acts by decreasing hepatic production of glucose from stored glycogen. Serum glucose is then decreased after a meal and blunts the degree of postprandial hyperglycemia. Metformin causes gastrointestinal disturbances; therefore the nurse would advise the patient to take the medication with food because it helps lessen the adverse effects. The nurse would not advise the patient to miss any meals or doses, because this may not have therapeutic effects. It is not necessary to report nausea, as it can be lessened by taking the medication with food. Metformin does not cause hypoglycemia, so it is not necessary for the patient to check the blood glucose level before each dose. pp. 634-635  Report content error Which intervention would the nurse implement when finding a patient with type 1 diabetes mellitus unresponsive, cold, and clammy? Start an insulin drip. Administer glucagon. Draw blood and send it to the laboratory for glucose level analysis. Administer subcutaneous regular insulin immediately. Rationale The nurse would immediately administer glucagon, as glucagon stimulates glycogenolysis, which would raise serum glucose levels in this patient, who is showing signs of hypoglycemia. The patient is hypoglycemic, and insulin would further reduce the glucose level. Drawing blood and sending it to the laboratory for glucose level analysis takes time that is more appropriately spent administering glucagon before the patient dies. Immediately administering subcutaneous regular insulin would further reduce the glucose level in a patient who is already hypoglycemic. Test-Taking Tip: Be alert for grammatical inconsistencies. If the response is intended to complete the stem (an incomplete sentence) but makes no grammatical sense to you, it might be a distractor rather than the correct response. Question writers typically try to eliminate these inconsistencies. p. 637 Report content error Which statement by the patient indicates a need for further instruction if the nurse teaches a patient with type 2 diabetes about the administration of glipizide? “I can still have one glass of wine with my evening meal.” “I should eat immediately after taking this medication daily.” “I will need to check my blood glucose level at least once a day.” “I will avoid green tea and green tea–containing products.” Rationale The nurse would take immediate action to intervene after hearing the patient’s statement about drinking a glass of wine with dinner, as the combination of alcohol and glipizide can produce a disulfiram-like reaction. The patient with type 2 diabetes must adhere to the prescribed diet to keep the blood glucose level within the normal range. Delaying or missing a meal could cause hypoglycemia; however, there is no need for the nurse to immediately intervene in this scenario. The patient should check blood glucose levels to determine if the medication is effective. Green tea can potentiate hypoglycemia in a patient receiving glipizide. Therefore, this statement is correct. Test-Taking Tip: Keywords or phrases in the question stem, such as first, primary, early, or best,are important. Similarly, words such as only, always, never, and all in the alternatives are frequently evidence of a wrong response. No real absolutes exist in life; every rule has its exceptions, so answer with care. p. 631 Report content error Which intervention would the nurse implement when preparing to administer insulin lispro to a patient diagnosed with type 1 diabetes? Ensure that the patient is wearing a medical alert bracelet. Administer the dose according to the regular insulin sliding scale. Shake the vial prior to administration. Make sure that the patient eats the food on the bedside meal tray within the next 10 to 15 minutes. Rationale Insulin lispro is to be administered 10 to 15 minutes before eating, so the nurse would ensure that the patient eats the food on the bedside meal tray; the patient needs to eat shortly after the medication is administered to prevent hypoglycemia. Because the patient is in the hospital, the patient must have a hospital identification band. A medical alert bracelet would only be needed when the patient is not in the hospital. Because insulin lispro is a fast-acting insulin (not regular insulin), it is not administered according to the regular insulin sliding scale. The peak time for insulin lispro is 30 minutes to 1 hour; regular insulin peaks in 2 to 4 hours. The vial of lispro insulin would not need to be shaken. It is not a suspension, and insulins that are suspensions would be gently rolled in the palm of the hand, not shaken. p. 626  Report content error Which statement by the patient indicates a need for additional teaching if the nurse is teaching a patient with type 1 diabetes about required insulin therapy? “I will inject my insulin in my abdomen for best absorption.” “I will check my blood glucose with my glucometer at least once a day.” “I will inject my insulin in the same spot each day.” “If I have a headache or start getting nervous, I will drink some orange juice.” Rationale The patient’s statement about injecting insulin in the same spot each day indicates a need for additional teaching. Insulin injection sites should be rotated to prevent lipodystrophy, tissue atrophy, and hypertrophy, all of which can interfere with insulin absorption. The abdominal area best absorbs insulin. Monitoring and documenting the blood glucose level is encouraged to determine the effectiveness of the treatment regimen. Headaches, nervousness, sweating, tremors, and a rapid pulse are signs of a hypoglycemic reaction and should be treated with a simple-acting carbohydrate, such as orange juice, sugar-containing drinks, or hard candy. p. 626 Report content error To which patient would the nurse administer glucagon for the treatment of insulin-induced hypoglycemia? The conscious patient who is able to swallow orange juice and has a blood glucose level of 35 mg/dL The conscious patient who is able to suck on a hard candy and has a blood glucose level of 45 mg/dL The unconscious patient who has a blood glucose level of 40 mg/dL The semiconscious patient who has a blood glucose level of 80 mg/dL Rationale Glucagon is available for parenteral use (subcutaneous, intramuscular [IM], and intravenous [IV]). It is used to treat insulin-induced hypoglycemia when other methods of providing glucose are not available; therefore the nurse would administer glucagon to the unconscious patient who has a blood glucose level of 40 mg/dL. The conscious patient who is able to swallow orange juice or suck on a hard candy would not require glucagon. The semiconscious patient who has a blood glucose level of 80 mg/dL does not meet the criteria for glucagon administration because the patient is not currently hypoglycemic. p. 637 Report content error The nurse administers regular insulin to a patient subcutaneously at 1100. At which time does the nurse recognize the insulin will peak? 1130 1300 1500 1730 Rationale The action of subcutaneous regular insulin peaks in 1.5 to 3.5 hours; therefore the nurse recognizes it should be peaking at 1300. Times of 1130, 1500, and 1700 do not fall within the 1.5 to 3.5 hour window for peak insulin activity to occur. p. 629 Report content error The nurse has provided discharge information to a patient newly prescribed insulin. Which patient statement indicates an understanding of the teaching? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected “I can continue to smoke as long as I do it in moderation.” “I will need to wear this medical alert bracelet at all times.” “If I start feeling nervous and shaky, I should drink some orange juice.” “It is important to always draw up my NPH insulin before my regular insulin.” “I will need to schedule follow-up appointments to check my hemoglobin A1c (HbA1c) levels regularly.” Rationale Patients with diabetes taking insulin should wear a medical alert bracelet at all times. It should include information on their condition and insulin dosage. If a patient starts feeling nervous or having tremors, it could indicate a hypoglycemic reaction; they should be instructed to drink orange juice or a sugary drink or chew on hard candy. It is important for patients with diabetes to follow up with their health care providers regularly to monitor their HbA1c levels. Patients on insulin should stop smoking because smoking can increase blood glucose levels. Additionally, smoking increases the risk for cardiovascular disease, which is a concern in patients with diabetes. Regular insulin should be drawn up before NPH insulin if using the same syringe. Test-Taking Tip:Do not read information into questions, and avoid speculating. Reading into questions creates errors in judgment. p. 630 Report content error The nurse is providing discharge education to a patient recently prescribed an oral antidiabetic medication. Which statement will the nurse include in the teaching? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected “You will need to keep sugar-containing drinks or hard candy near you at all times.” “You may require insulin during times of stress, such as surgery or major infections.” “It is okay to drink alcohol while on these medications as long as you do it in moderation.” “Because you are on these medications, you will not have to check your blood sugar at home.” “Seek medical attention if you experience symptoms such as increased thirst or a fruity odor to your breath.” Rationale Patients taking antidiabetic medications need to be instructed to keep sugar-containing drinks or hard candy near them at all times in case of a hypoglycemic reaction. During times of stress, insulin may need to be used in place of oral antidiabetic medications to maintain stricter blood glucose control. Patients need to be instructed to seek medical attention if experiencing symptoms such as increased thirst or a fruity breath odor, as these could indicate a hyperglycemic reaction. Alcohol should be avoided when taking oral antidiabetic medications, as it can cause a hypoglycemic reaction. Patients need to be taught to check their blood glucose levels at home using a glucometer. p. 636 Report content error Which antidiabetic medication is classified as a biguanide? Miglitol Metformin Nateglinide Dapagliflozin-metformin Rationale Metformin is classified as a biguanide. Miglitol is classified as an alpha-glucosidase inhibitor. Nateglinide is classified as a meglitinide. Dapagliflozin-metformin is classified as a fixed- combination oral antidiabetic drug. pp. 634,635  Report content error Which statement would be appropriate to provide a patient with a hemoglobin A1c (HbA1c) of 8.5%? “Your HbA1c level does not indicate that you have diabetes.” “Based on your laboratory results, I can tell that your blood sugars have been well controlled.” “The goal is to maintain your HbA1c level at less than 9% because you have diabetes.” “Your HbA1c level indicates a diagnosis of diabetes." Rationale An HbA1c level of 6.5% or greater indicates diabetes. This patient's HbA1c is 8.5%, which indicates the patient has diabetes. Because red blood cells have a life span of approximately 120 days, HbA1c levels reflect the patient’s average glucose level over the last 3 months.Based on the laboratory results, the patient's blood sugar level has not been well controlled over the last several months. An HbA1c value of less than 5% indicates that a patient does not have diabetes, so a value of 8.5% would indicate that the patient has diabetes. The goal is to maintain HbA1c below 7%, not 9%. p. 626  Report content error Which patient parameter requires immediate action by the nurse for a patient taking metformin? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Reports nausea and diarrhea Serum creatinine of 3.2 mg/dL Reports drinking a six-pack of beer every day Reports taking metformin with black iced tea Scheduled for a CT scan with contrast the next morning Rationale An elevated serum creatinine indicates renal failure, which is a contraindication for metformin. The nurse would contact the health care provider about discontinuing or changing the dosage of the metformin. Alcohol abuse can interfere with the mechanism of action of metformin. The patient should be provided with resources to assist with alcohol cessation. Metformin should be held for 48 hours before receiving IV contrast due to a risk for lactic acidosis or acute renal failure. The nurse should contact the health care provider to reschedule the scan. Nausea and diarrhea  are expected side effects of metformin. It is fine to take metformin with black tea, but taking it with green tea can result in hypoglycemia. Test-Taking Tip:If the question asks for an immediate action or response, all the answers may be correct, so base your selection on identified priorities for action. p. 635 Correct (13) Report content error Which assessment finding would the nurse monitor for in a patient with type 1 diabetes mellitus who is receiving growth hormone? Hypertension Hypercalciuria Hyperglycemia Hypothyroidism Rationale Growth hormone increases blood glucose. In a nondiabetic patient, this increased blood glucose stimulates the release of insulin to maintain the blood glucose level within a normal range. In type 1 diabetes mellitus, however, growth hormone causes hyperglycemia because of an insufficient serum level of insulin. Thus the nurse would monitor the patient for hyperglycemia. Hypertension is high blood pressure, which is not a common adverse effect of growth hormone. Hypercalciuria and hypothyroidism are common adverse effects of growth hormone intake, but they are not related to type 1 diabetes mellitus. p. 614 Report content error Which information would the nurse include when teaching a patient about the safe administration of levothyroxine? “Always take the medication three times a day, after meals.” “Take this medication with at least 250 mL of orange juice regularly.”  “There are no dietary restrictions for you to incorporate while taking this medication.” “Consult your health care provider (HCP) before taking over-the-counter medications.” Rationale Patients who have been prescribed thyroid hormone replacements or antithyroid drugs would be advised to avoid taking over-the- counter medicines without first consulting their HCPs. This would help to prevent adverse effects caused by drug interactions. The nurse would instruct the patient to take the medication once a day on an empty stomach, half an hour before breakfast. This would enhance the absorption of the drug. Taking the medication three times a day, after meals, may reduce the therapeutic effectiveness of the medication and cause adverse effects. This medication should be taken with water rather than orange juice because water helps enhance the disintegration and absorption of the drug. The patient should avoid eating foods that could reduce thyroid hormone production or reduce the effectiveness of the medication. Therefore the nurse would not falsely state that the patient does not need to follow any dietary restrictions. p. 615  Report content error 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? “I should take the thyroid tablet every night after dinner.” “I should take the tablet every morning on an empty stomach.” “I should take the tablet twice daily, before breakfast and after breakfast.” “I can stop the medication whenever I want without consulting my primary health care provider.” Rationale Food decreases the absorption of the thyroid drug. The patient should take the thyroid drug every morning on an empty stomach to achieve maximum absorption of the drug. Thus the patient’s statement that the tablet should be taken every morning on an empty stomach indicates that the nurse’s teaching was effective. The therapeutic effect of the drug would decrease if the patient takes the tablet after meals. Administering the drug twice daily would lead to drug overdose and adverse effects. The drug therapy should not be withdrawn without informing the primary health care provider, as this would worsen the hypothyroidism. p. 615 Report content error Which preferred medication for pain management would be included in discharge teaching for a patient receiving glucocorticoids? Aspirin Ibuprofen Acetaminophen Naproxen Rationale Acetaminophen would be included in discharge teaching for a patient receiving glucocorticoids. Acetaminophen does not cause gastric distress, unlike aspirin, ibuprofen, naproxen, and glucocorticoids. This medication would be the least likely to cause additive effects, as the patient on glucocorticoids is already at risk for gastric distress. p. 620 Report content error Which instruction will the nurse give to a patient prescribed levothyroxine? “Increase your intake of broccoli and soy products while taking this medicine.” “If you miss a dose, take the medicine immediately.” “Have the medicine with food to avoid side effects.” “Tell your health care provider if you have profuse sweating and palpitations while taking this medicine.” Rationale Excess sweating and palpitation are adverse effects of levothyroxine, a thyroid replacement drug. The patient should be instructed to report these symptoms immediately to the nurse or health care provider. Broccoli and soy products should be strictly avoided when on a thyroid replacement drug, as these foods can alter the absorption rate of the thyroid hormone. The doses are needed to be taken at the same time every day. Taking the medicine at a different time may result in thyroid dysfunction. It is recommended to take levothyroxine at least 30 to 60 minutes before a meal, as taking it with a meal can lower its absorption rate. Test-Taking Tip: Have confidence in the initial response to an item because it more than likely is the correct answer. p. 617 Report content error Which statement by the nurse about insulin administration indicates a need for further education? “Regular insulin is short-acting.” “Insulin is administered intramuscularly.” “Insulin will be administered at a 45- to 60-degree angle in a thin patient with little fatty tissue.” “Insulin should be given even if the patient is ill.” Rationale Insulin is given subcutaneously, not intramuscularly. The nurse’s statement about insulin being administered intramuscularly indicates a need for further education. Regular insulin is short- acting and may be given intravenously. Insulin would be administered at a 45- to 60-degree angle in a patient who is thin with little fatty tissue. Illness and stress increase insulin requirements, so insulin should be given even if the patient is ill. Anticipating a dosage increase might be warranted. p. 626 Report content error Which action would the nurse take after a patient reports taking regular-release glipizide with food? Notify the health care provider immediately. Immediately check the patient’s blood glucose level. Inform the patient that the medication must be taken 15 minutes after a meal. Inform the patient that it is better to take the medication 30 minutes before a meal. Rationale The nurse would inform the patient that glipizide should be taken 30 minutes before a meal. Regular-release glipizide has an onset of action of 90 minutes, with a peak of 1 to 3 hours. This gives the drug time to work by the time the patient eats a meal. The health care provider would not have to be called; the nurse should intervene. The blood glucose level does not have to be obtained right away. The medication is not to be taken after a meal. p. 631 Report content error 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.? 10:00 a.m. 2:00 p.m. 5:00 p.m. 8:00 p.m. Rationale Breakfast would cover the onset of isophane insulin suspension, and lunch would cover the 2:00 p.m. time frame. If the patient does not eat a midafternoon snack, however, the insulin may peak just before dinner, without sufficient glucose on hand to prevent hypoglycemia. At 5:00 p.m., the patient is at highest risk for hypoglycemia. p. 627 Report content error Which information would the nurse include when teaching a patient how to administer insulin? Avoid injecting the insulin into the arm. Do not mix any insulins in the same syringe. Inject the insulin at a 30-degree angle between the fat and muscle. Inject the insulin into the abdomen for the most consistent absorption. Rationale The abdomen has the most consistent absorption because the blood flow to the subcutaneous tissue is typically not as affected by muscular movements as it could be in the arm or thigh. Insulin can be administered in the arm. The nurse or patient can mix certain types of insulin in the same syringe for administration. The patient would be instructed to inject insulin at a 45- to 90-degree angle, not a 30-degree angle. p. 626 Report content error Which instruction would the nurse give to a patient who is receiving metformin therapy and is scheduled for an angiography? “There are chances of liver failure after the test.” “Your blood glucose levels need to be reevaluated right before the test.” “You can take the medication an hour after the test.” “Do not take your metformin for 2 days before the test.” Rationale Angiography uses iodinated radiologic contrast media, which interacts with metformin and may cause acute renal failure or lactic acidosis. Thus the nurse would instruct the patient to discontinue the drug 2 days before the test. Metformin can be taken 48 hours after the test to prevent any adverse effects. There are chances of renal failure after the test only if metformin is taken during the test. Liver failure is not a concern. Blood glucose levels are regularly evaluated in patients with diabetes; however, they would not need to be measured right before the test. p. 634 Report content error The nurse has just educated a patient about subcutaneous insulin administration. Which action indicates that the teaching has been successful? The patient shakes a cloudy insulin bottle until it is well mixed. The patient draws up the NPH insulin first, then the regular insulin. The patient injects insulin in the same spot on the abdomen for each administration. The patient states the need to decrease the insulin dose when planning vigorous exercise. Rationale Less insulin is usually needed with increased exercise, as exercise promotes glucose uptake into the cells. The patient should roll, not shake, cloudy insulin bottles until they are well mixed. Regular insulin should be drawn up before NPH insulin. Injection sites should be rotated often to prevent lipodystrophy, which can interfere with insulin absorption. p. 626 Report content error Which type of diabetes mellitus is the most common? Type 1 diabetes Type 2 diabetes Gestational diabetes Secondary diabetes related to medications or hormonal changes Rationale Type 2 diabetes is the most common type of diabetes, accounting for approximately 85 to 90% of cases. Type 1 diabetes accounts for approximately 10 to 12% of cases. Gestational diabetes accounts for approximately 1% of cases or in 2 to 5% of all pregnancies. Secondary diabetes caused by medications or hormonal changes accounts for approximately 2 to 3% of cases. p. 625 Report content error Which medication will the nurse anticipate administering to a patient with a blood glucose level of 48 mg/dL? Glipizide Glucagon Glimepiride Glyburide-metformin Rationale This patient is experiencing hypoglycemia, as evidenced by the blood glucose level of 48 mg/dL. Glucagon is used to treat hypoglycemia. Glipizide, glimepiride, and glyburide-metformin are all antidiabetic medications that lower blood glucose levels; therefore administering these medications would make the patient’s hypoglycemia worse. pp. 634,637