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Pharm > Assess 2 > Flashcards

Assess 2 Flashcards

1
Q

Which priority assessment finding should the clinic nurse discuss with the health care provider for Diabetes? ​

A

high blood sugar (hyperglycemia) in the blood stream (viscosity of the blood)​

polyuria (increased urine output), polydipsia (increased thirst), and polyphagia (increased hunger) Weight loss (type 1)​

Glucosuria​

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2
Q

Which statement by the client should the nurse evaluate as a good understanding of the disease process of Diabetes I? ​

A

Chronic disorder of the pancreas (type 1)​
Absolute lack of insulin secretion for DM I due to autoimmune destruction of pancreatic islet cells and secretes and releases enzymes for chemical digestion of nutrients​

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3
Q
  1. What should the nurse include in the discharge teaching on blood glucose levels?
A

Fasting blood glucose > 126 mg/dL (x 2) – hyperglycemia​

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4
Q

Which statement by the client should the nurse evaluate as a good understanding of the disease process of DM I?I​ (4)

A
  • Target cells become unresponsive to insulin (defective insulin receptor function); blood glucose levels rise​
  • Cells cannot use the Insulin the pancreas makes​
  • Pancreas secretes more insulin; hypersecretion leads to beta cell exhaustion and death​
  • Eventual deficiency in insulin secretion + insulin resistance
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5
Q

What should the nurse include in the discharge teaching for type I?​

A

-Dietary restrictions​

  • Exercise​
  • Insulin therapy via Insulin pump
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6
Q

What should the nurse include in the discharge teaching for type II?​

A

Healthy diet and exercise can reverse insulin resistance​

  • Oral hyperglycemics and Insulin​

​

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7
Q

Which statements by the client should the nurse evaluate as a good understanding of the teaching provided on if person does not stick to the regimen for diabetes? (5)

A
  • Cardiovascular damage – heart disease​
    Nervous system damage​
    Kidney disease​
    Blindness​
    Numbness/tingling in feet or hands
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8
Q

How should the nurse analyze this statement? Endocrine function of pancreas is not working​

A

Beta cells does not produce enough Insulin​

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9
Q

How should the nurse analyze this statement? Cells cannot use the Insulin the pancreas makes​

A
  • Pancreas secretes more insulin; hypersecretion leads to beta cell exhaustion and death​
  • Eventual deficiency in insulin secretion + insulin resistance​
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10
Q

What action should the nurse include in the care plan to assess a possible complication from DMI?

A

Diabetic Ketoacidosis - serious symptom​

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11
Q

Which priority assessment finding should the clinic nurse discuss with the health care provider for diabetes?

A

when have you had problems?
Do you have a family history of diabetes or obesity

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12
Q

What action should the nurse take next? How should the nurse response for rapid-acting,

A

Administer 0.5 to 1 unit/kg/dose 5 minutes or just before meals.
Take your insulin 5 minutes before meals. ​

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13
Q

Which statement by the client should the nurse evaluate as a good understanding of the teaching provided for rapid- acting insulin? ​

A

0.5 to 1 unit/kg/dose 5 minutes or just before meals.

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14
Q

What action should the nurse take next? How should the nurse response for short-acting,

A

Administer less than 10 units - 30 minutes before meals

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15
Q

Which statement by the client should the nurse evaluate as a good understanding of the teaching provided for onset, peak, and duration of short- acting insulin? ​

A

Onset 30 minutes to 1 hour. ​
Peaks in 2-4 hours. ​
Lasts 6-8 hours.

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16
Q

What are some rapid acting insulins?

A

Lispro (human analog) (Humalog)
human Insulin aspart (rDNA origin) (NovoLog)

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17
Q

What assessment finding should the nurse expect for someone with moderate hypoglycemia? Nervousness, hunger, headache, shakiness, dizziness, confusion, weakness, diaphoresis (sweating/moist skin). ​

A

Nervousness, hunger
headache
shakiness/dizziness, weakness
confusion
diaphoresis (sweating/moist skin). ​

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18
Q

How should the nurse respond to the client’s condition with BS<70?

A

For moderate hypogycemia,
treat with Treat with 3-4 glucose tablets
3 oz. regular soda
1 T sugar or honey
5-6 hard candy
Give 4-8 oz milk and half a cheese sandwich (this is the best answer because it will not allow them to crash)​

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19
Q

What assessment finding should the nurse expect for someone with severe hypoglycemia?

A

Confusion, combativeness, unresponsiveness, coma. ​

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20
Q

Which nursing action should nurse take next for severe hypoglycemia? ​

A

Treat with glucagon 1M and/or dextrose 5 IV drip or 50 IV push

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21
Q

What action might the nurse take next after Alpha- glucosidase inhibitors is used? ​

A

May be used with insulin, sulfonylureas and biguanides.

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22
Q

What assessment finding should the nurse expect as a possible complication from alpha-glucosidase inhibitors?

A

ADR: Abdominal pain, flatulence, diarrhea.
may increase risk of hypoglycemia when used with sulfonylureas or insulin

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23
Q

​

Which statement by the client should the nurse recognize as effectiveness of the medication and goal of alpha-glucosidase inhibitors?

A

Inhibit the enzyme from the pancreas that breaks down complex carbohydrates into glucose. ​

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24
Q

What are examples of alpha-glucosidase inhibitors?

A

acarbose (Precose) and miglitol (Glyset)

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25
Q

How should the nurse respond if a child’s growth is well below the standard for a specific age​?

A

Refer to endocrinologist

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26
Q

Which risk factors of a child should the nurse expect to find upon review of the client’s medical record for GH deficiency? ​

A

Child is short for stature/low percentile ​
Growth deficiency may be diagnosed, and dwarfism can result

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27
Q

Which client statement should the nurse interpret as GH replacement is having its desired effects? ​

A

GH replacement – Drug of Choice – Somatropin (Genotropin)​
Several years of tx can increase height (growth)​

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28
Q

Which statement by the client should the nurse evaluate as a good understanding of the teaching provided on pituitary GH deficiency?​

A

Has the same amino acid as HGH​

Promotes bone growth at the epiphyseal plates of long bones​

Must be given before fusing of the epiphysis occurs​

Several years of tx can increase height (growth)​

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29
Q

What action should the nurse include in the care plan to assess a possible complication from GH replacement? ​

A

prolonged use can cause DM because it increase serum in blood, so refer to endocrinologist

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30
Q

Which priority assessment finding should the clinic nurse discuss with the health care provider for hypothyroidism? ​

A

Decreased T4 and elevated TSH levels​- primary
Lack of TSH secretion- secondary
lack of TRH (Free T4 and serum TSH are low)- tertiary

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31
Q

What assessment findings should the nurse expect with primary hypothyroidism? ​
(primary and five findings)

A

Decreased T4 and elevated TSH levels​
Lethargy, apathy, memory impairment, slow speech, edema in eyelids and face

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32
Q

What assessment finding should the nurse expect with secondary hypothyroidism? ​

A

Lack of TSH secretion-

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33
Q

What assessment finding should the nurse expect with tertiary hypothyroidism? ​

A

lack of TRH (Free T4 and serum TSH are low)

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34
Q

Which priority assessment finding should the clinic nurse discuss with the health care provider when seeing severe hypothyroidism in children?​

A

Congenital Cretinism in children

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35
Q

Which priority assessment finding should the clinic nurse discuss with the health care provider when seeing severe hypothyroidism in adults?​

A

Myxedema in adults

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36
Q

What should the nurse include in the discharge teaching of when the full benefits of synthroid will kick in?​

A

It take a few weeks – up to 3 weeks to see the full benefits from the drug​

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37
Q

Which statement by the client should the nurse recognize as effectiveness of the medication and goal of the synthroid? ​

A

It take a few weeks – up to 3 weeks to see the full benefits from the drug​
will reverse the effects of Lethargy, apathy, memory impairment, slow speech, edema in eyelids and face

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38
Q

What action should the nurse include in the care plan to assess a possible complication from synthroid?​

A

Tachycardia, irregular heart rate, hypertension, nervousness, weight loss, diarrhea, heat intolerance and excess fatigue, slow speech, hoarseness or slow pulse bone density. ​

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39
Q

Which statement by the client should the nurse recognize as the client needing additional/further teaching for Synthroid ?​

A

I take it in the morning

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40
Q

What should the nurse include in the discharge teaching for synthroid?​ (3)

A

lifelong use
Causes insomnia​
Take with plenty of water to avoid gagging. ​

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41
Q

Which statement by the client should the nurse evaluate as a good understanding of the increase in circulating T4 and T3 levels?​ (3)

A

Graves disease or thyrotoxicosis​
Most common type of hyperthyroidism ​
Caused by hyperfunction of the thyroid gland

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42
Q

Which statement by the client should the nurse recognize as the effectiveness of the medication and goal of the therapy? ​(3)

A

I do not have any more palpitations ​
I do not feel as hot anymore​
I am not perspiring as I did before I am not as anxious, nervous, or irritable as I did before

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43
Q

Which statement by the client should the nurse evaluate as a good understanding of the disease process of the adrenal medulla?​

A

Adrenal medulla​- Produces epinephrine and norepinephrine

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44
Q

Which statement by the client should the nurse evaluate as a good understanding of the disease process of the adrenal cortex?​

A

Adrenal cortex​- Produces glucocorticoids (cortisol)​, Mineralocorticoids (aldosterone)

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45
Q

What secretion causes Addison’s disease?

A

Glucocorticoid hyposecretion​

46
Q

What secretion causes Cushing syndrome?

A

Glucocorticoid hypersecretion​

47
Q

What assessment findings should the nurse expect for side effects of high or prolonged glucocorticoid use? ​(3)

A

Cushing’s syndrome
Upper body obesity, abnormal fat deposits in face (moon face) and trunk (dowager’s or buffalo hump)
increased blood sugar

48
Q

How should the nurse analyze this statement? I am having HTN, euphoria, decreased extremity size and psychosis

A

Addisonian crisis

49
Q

Which statement by the client should the nurse evaluate as a good understanding of the teaching provided on long term glucocorticoid use? ​(3)

A

adrenal atrophy (loss of adrenal gland function), muscle wasting, osteoporosis

50
Q

Which lifestyle risk factors of PUD should the nurse expect to find upon review of the client’s medical record?​ (5)

A

Alcohol
Smoking tobacco​
Caffeine
Drugs (corticosteroids, N S A I D s, platelet inhibitors)​
N S A I D s (most common cause in those who are not infected with H. pylori)
Excessive psychological stress​

51
Q

Which general risk factors of PUD should the nurse expect to find upon review of the client’s medical record?​ (3)

A

Infection with Helicobacter pylori​
Close family history of P U D​
Blood group O

52
Q

What assessment finding should the nurse expect with H. Pylori?​

A

Primary cause of peptic ulcers​
Gram-negative bacterium will release 13CO2

53
Q
  1. What should the best plan by the nurse include for H. Pylori suspicion?
A

Noninvasive test ​and Administering 13C urea​

54
Q

What assessment finding should the nurse expect with non-H. Pylori? related causes of PUD?​

A

Secretion of excess gastric acid​
inadequate mucus​ secretion
N S A I D s

55
Q

What should the nurse include in the discharge teaching on PPI endings?​

A

end in “zole”
ex: Prilosec (omeprazole)​

56
Q

What should the nurse include in the discharge teaching about PPI’s?​ (2)

A

Reduce acid better​
Have a longer DOA

57
Q

Which statement by the client should the nurse evaluate as a good understanding of the teaching provided on H2-receptor antagonists?​

A

I will take B to avoid deficiency when taking Zantac or Tagamet

58
Q

How should the nurse analyze this: client is missing vitamin B? ​

A

patient may be taking H2-receptor antagonists?

59
Q

What should the best plan by the nurse include for PUD? ​

A

best combination PPI & triple Abx​

60
Q

What action should the nurse take next after taking antacids such as sucralfate? ​

A

give H2-receptors​ one hour after

61
Q

Which statement by the client should the nurse evaluate as a good understanding of the teaching on mucosal protective drugs? ​

A

I will take H2-receptors​ one hour after the antacid because the drug coats the gastric lining from the gastric acids​

62
Q

What action should the nurse include in the care plan to assess a possible complication from Misoprostol (Cytotec)? ​(2)

A

Gastric distress from long-term NSAIDs therapy​
Category X​- Sometimes terminate pregnancy ​

63
Q

Which assessment finding should be of concern to the nurse to tell the client to not use this drug Misoprostol (Cytotec)?​

A

pregnancy possibility and confirmed pregnancy

64
Q

Which client statement should the nurse interpret as the PUD treatment is having its desired effects?

A

H. pylori infection eliminated, bacteria eradicated, and ulcers heal more rapidly, prevent recurrence

65
Q

Which statement by the client should the nurse evaluate as a good understanding of the teaching on how the PPI works?

A

reduces acid secretion in stomach by binding irreversibly to enzyme​ H+, K+, and ATPase

66
Q

What action should the nurse include in the care plan to assess a possible complication from PPI’s?

A

Use short term only 4-8 weeks of therapy for ulcers and GERD

67
Q

What should the nurse include in the discharge teaching for PPI’s?

A

on an empty stomach before breakfast with antacids optional and swallowed, not chewed

68
Q

What should the nurse include in the discharge teaching for PPI’s? How to take, and ADR’s

A

on an empty stomach before breakfast with antacids optional and swallowed, not chewed

69
Q

Which assessment finding should be of concern to the nurse to tell the client not to use PPI’s

A

Use of more than two months and pregnant

70
Q

Which statement by the client should the nurse evaluate as a good understanding of the disease process and the drug?

A

Full effect can take several days to weeks and must take consistently and ulcer can completely heal

71
Q

Which statement by the client should the nurse evaluate as a good understanding of the teaching provided on PUD?

A

I will take the drug consistantly
I will notify the HCP if my gastric discomfort worsens after several weeks
I will report any emesis
I will return periodically for lab work

72
Q

Which statement by the client should the nurse recognize as effectiveness of the medication and goal of therapy of PUD?

A

Promotes ulcer healing
Healing should occurs in 4-8 weeks and pain subsides after 10 days
Ulcers can remain in remission longer

73
Q

Which statement by the client should the nurse recognize as effectiveness of the medication and goal of therapy

A

H. Pylori can have a very high recurrence if H. Pylor is not eradicated

74
Q

Wha should the best plans by the nurse be to treat a patient with vomiting, diarrhea, and/or constipation?

A

Antiemetics
Emetics
Antidiarrheals
Laxatives

75
Q

What assessment finding should the nurse expect in dietary habits when a client has constipation

A

Lack of fiber
Chronic laxative use
Insufficient water intake

76
Q

What assessment finding should the nurse expect in lifestyle habits when a client has constipation

A

Fecal/bowel obstruction
Neuro disorder
Ignoring urge to defecate
Lack of exercise
Various drugs

77
Q

What are some priority questions a nurse should ask the client prior to administration of constipation meds?

A

How have your bowel movements been?
Have you been taking any laxatives?

78
Q

Which statement by the client should the nurse recognize as effectiveness of the medication and goal of Docusate Sodium/Colace/mineral oil?​

A

Prevent constipation and
Decrease straining during defecation

79
Q

Which client statement should the nurse interpret as the stool softener is having its desired effects? ​

A

Lowers surface tension
Promotes water accumulation in intestine and stool
Emulsify and lubricate feces for easier passage

80
Q

What should the nurse include in the discharge teaching?​

A

Nausea vomiting and diarrhea should make you stop taking the medication
Cramping is serious
Any of these indication should make you ask your provider

81
Q

Which statement by the client should the nurse evaluate as a good understanding of laxative uses?​

A

Promotes soft stool
Cathartics promote soft to water stool with cramping (Metamucil)
Purgatives promote water stool with cramping

82
Q

What are some types of laxatives?

A

Osmotic (saline
Stimulant (irritants)
Bulk-forming
Emollient (stool softener)

83
Q

Which statement by the client should the nurse evaluate as a good understanding of the teaching provided for laxatives?

A

Take with enough water to prevent obstruction

84
Q

Which priority assessment finding should the clinic nurse discuss with the health care provider?​

A

Do you have cramping

85
Q

Which assessment finding should be of concern to the nurse to tell the client to not use this drug?​

A

Psyllium may decrease the absorption and effects of warfarin, digoxin, nitrofurantoin, antibiotics, tricyclic antidepressants, carbamazepine, and salicylates.

86
Q

Which statement by the client should the nurse evaluate as a good understanding of the teaching provided? Name and bulk-forming medication and MOA​

A

Psyllium mucilloid
Swells and increases size of fecal mass

87
Q

How should the nurse respond to a patient who has undiagnosed abdominal pain, intestinal obstruction, or fecal impaction?

A

Stop or don’t take the Metamucil and notify provider

88
Q

Which statement by the client should the nurse evaluate as a good understanding of the adverse reactions of bulk forming laxatives?​

A

Absorbs water into intestines
Increases bulk and peristalsis
Promotes large, soft stools

89
Q

Which statement by the client should the nurse evaluate as a good understanding of the adverse reactions of bulk forming laxatives?​

A

Cramps
N/V
Farting/diarrhea
Insufficient fluid intake causes intentional obstruction

90
Q

What assessment finding should the nurse expect in DM 2 patients taking psyllium muccilloid? ​

A

Reduction of serum glucose levels

91
Q

Which assessment finding should be of concern to the nurse to tell the client to not use this drug?​

A

Psyllium may decrease the absorption and effects of warfarin, digoxin, nitrofurantoin, antibiotics, tricyclic antidepressants, carbamazepine, and salicylates.​

92
Q

How should the nurse respond? I have severe diarrhea, what treatments are there?​

A

Diphenoxylate with Atropine (Lomotil)

93
Q

What are medications for mild diarrhea?

A

Loperamide (Imodium)​
Bismuth subsalicylate (Pepto-Bismol)​
Psyllium preparations (adjunct)​
Probiotic supplements (Lactobacillus)​

94
Q

Which statement by the client should the nurse evaluate as a good understanding of the disease process of constipation?

A

Helps with symptoms, but not with pain, no driving​

95
Q

Which statement by the client should the nurse evaluate as a good understanding of the disease process?

A

Helps with symptoms, but not with pain, no driving​

96
Q

What should the nurse include in the discharge teaching for Diphenoxylate??​

A

Doesn’t have analgesic properties
Drug is well tolerated at normal doses
Some ADRs are dizziness, drowsiness, and do not operate heavy machinery

97
Q

Which risk factors of IBS should the nurse expect to find upon review of the client’s medical record?(4)

A

Spastic colon or mucous colitis
Ulcers in the lower GI with cramping, bloating, and gas
Constipation alternating with diarrhea and mucous in stool
At least three days / past three months
Recurrent abdominal pain

98
Q

How should the nurse respond when a patient can’t swallow and has a nonfunctioning GI tract? ​

A

TPN

99
Q

What should the best plan by the nurse include if a patient is malnourished and have dysphagia and has a functioning GI tract?​

A

NG tube for short term
Peg/G tube for long term

100
Q

What should a client understand about a G tube?

A

Longer term treatment where a tube is surgically placed into the client’s stomach

101
Q

Which nursing action should nurse take with G tubes? ​

A

Don’t crush enteric coated drugs into G-tubes
Flush routinely to maintain latency
If drug form is a pill can cannot be crushed, contact the physician

102
Q

What is also known as hyperalimentation?

A

TPN

103
Q

What demonstrates a good understanding by the client about the difference between peripheral and central TPN and how they are administered?

A

Peripheral veins are for short-term and central is for long term and they are both

104
Q

What action should the nurse include in the care plan to assess a possible complication from TPN?

A

Use an infusion pump
Change rates gradually and avoid abrupt discontinuation
Remove from fridge 30 minutes prior to hanging

105
Q

How should the nurse respond to the client’s condition of irritation at the TPN site​

A

Make sure to bring the solution up to room temp before hanging

106
Q

What should the nurse include in the discharge teaching for successful TPN feeding?​

A

Use the pump for precision
Change rates gradually and abrupt discontinuation of TPN
Don’t put in cold infusions
Can cause hyperglycemia

107
Q

Which statement by the client should the nurse evaluate as a good understanding of the teaching provided about why the patient can get hyperglycemic?

A

The solution has lots of sugar

108
Q

What assessment finding should the nurse for enteral feedings?​

A

Skin turgor and mucous membranes​

109
Q

What action should the nurse take next after an enteral feeding?​

A

Provide water between bolus feedings
Clean the area around the insertion site
Clean the equipment between each feeding
Refrigerate any feeding not needed for a feeding

110
Q

What should the nurse include in the discharge teaching?​

A

Consume small amounts of water if allowed
Teach patient to monitor for dry mouth on lips, or tenting, for dehydration

111
Q
A

Pharm (10 decks)

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