exam 3 Flashcards
The nurse has just administered the morning dose of a patient’s lispro (Humalog) insulin. Just after the injection, the dietary department calls to inform the patient care unit that breakfast trays will be 45 minutes late. What will the nurse do next?
Inform the patient of the delay.
Check the patient’s blood glucose levels.
Call the dietary department to send a tray immediately.
Give the patient food, such as cereal and skim milk, and juice.
Give the patient food, such as cereal and skim milk, and juice.
A nurse is completing a nursing history for a client who currently takes simvastatin (Zocor). The provider recommends adding ezetimibe to the client’s medications. Which of the following disorders is a contraindication to adding ezetimibe (Zetia) to the client’s medications?
A. History of severe constipation
B. History of hypertension
C. Active hepatitis C
D. Type 2 diabetes mellitus
Active hepatitis C
Mechanism of Action/Drug effects
Competitively bind to aldosterone receptors
Block resorption of sodium and water usually induced by aldosterone,
Interfere with sodium-potassium exchange
Potassium-Sparing Diuretics
Also known as aldosterone-inhibiting diuretics
Examples;
spironolactone (Aldactone)
Onset 1-2 hr, Duration: 24 hr
Clear, colorless solution
Usually dosed once daily, referred to as basal insulin
Examples:
glargine (Lantus), detemir (Levemir)
Long-acting insulins
Indications
Hypertension (first line for HTN)
Others: edematous states, idiopathic hypercalciuria
Thiazide and Thiazide-like Diuretics
Glucocorticoids are used for ____
antiinflammatories or immune suppressant
Adrenal steroid
Mechanism of Action/Drug Effects
Work in the proximal tubule, no absorbable, producing an osmotic effect
Pull water into the renal tubules from the surrounding tissues
mannitol (Osmitrol)
Osmotic Diuretics:
Intravenous infusion only, use filter is required
May crystallize when exposed to low temperatures
restores the diabetic patient’s ability to:
Metabolize carbohydrates, fats, and proteins
Store glucose in the liver, convert glycogen to fat stores
Insulins
The nurse should teach a patient taking an oral corticosteroid to take the medication at what time?
8:00 AM
12 noon
5:00 PM
8:00 PM
8:00 AM
Powder forms must be taken with a liquid, mixed thoroughly but not stirred, and never taken dry
Other medications should be taken 1 hour before or 4 to 6 hours after meals to avoid interference with absorption
Bile acid sequestrant
A patient who is taking a thyroid replacement medication tells the nurse that she is starting to experience cold intolerance, depression, constipation, and dry skin. The nurse anticipates that these manifestations are caused by
inadequate doses of the medication.
possible overdose of the medication.
worsening of the underlying disease.
drug interactions with another medication.
inadequate doses of the medication.
Mechanism of action:
Delay breakdown of incretin hormones by inhibiting the enzyme DPP-IV
Incretin hormones increase insulin synthesis and lower glucagon secretion
Reduce fasting and postprandial glucose concentrations
Examples:
sitagliptin (Januvia)
saxagliptin (Onglyza)
linagliptin (Tradjenta)
Dipeptidyl peptidase-IV (DPP-IV) inhibitors “gliptin”
Used in the treatment of Cushing’s syndrome, metastatic breast cancer, and adrenal cancer
Adrenal steroid inhibitor
aminoglutethimide (Cytadren)
The patient is being discharged home with furosemide (Lasix). When providing discharge teaching, which instruction will the nurse include?
Avoid prolonged exposure to the sun.
Avoid foods high in potassium content
.
Stop taking the medication if you feel dizzy.
Weigh yourself once a week and report a gain or loss of more than 1 pound.
Avoid prolonged exposure to the sun.
A patient with a new prescription for a HMG-CoA (statin) drug is instructed to take the medication with the evening meal or at bedtime. The patient asks why it must be taken at this time of day. The reason is:
The medication is better absorbed at this time.
This timeframe correlates better with the natural diurnal rhythm of cholesterol production.
There will be fewer adverse effects if taken at night instead of with the morning meal.
This timing reduces the incidence of myopathy.
This timeframe correlates better with the natural diurnal rhythm of cholesterol production.
Result in the removal of sodium and water
Used in the treatment of hypertension, heart failure, and renal failure
Diuretic Drugs
Adverse effects:
FDA: postmarketing cases of acute pancreatitis
Hypoglycemia can occur and is more common if used in conjunction with a sulfonylurea
Dipeptidyl peptidase-IV (DPP-IV) inhibitors “gliptin”
When administering aminoglutethimide (Cytadren) to a patient, it is most important for the nurse to monitor:
serum electrolytes. cardiac enzymes. liver enzymes. arterial blood gases.
liver enzymes.
Adverse Effects
Serious: Myopathy (muscle pain), possibly leading to the serious condition rhabdomyolysis
Common: Elevations in liver enzymes or liver disease, Mild, transient GI disturbances,
Antilipemics
HMGs, or “statin”s
Interactions:
Oral anticoagulants and Statins (Risk for myopathy is increased)
Laboratory test reactions: (lactate dehydrogenase level, Decreased H/H, wbc , Increased aPTT, and bilirubin level)
gemfibrozil (Lopid), fenofibrate (Tricor)
Fibric Acid Derivatives “fibrate”
Indications
Edema associated with HF or hepatic or renal disease, HTN
hypercalcemia– increase renal excretion of calcium
Loop Diuretics
bumetanide (Bumex), furosemide (Lasix),torsemide (Demadex)
Adverse effects:
Serious: hyperkalemia,
Common: GI cramp, nausea, vomiting, etc
Potassium-Sparing Diuretics
Also known as aldosterone-inhibiting diuretics
Examples;
spironolactone (Aldactone)
A patient is receiving prednisone as part of treatment for severe arthritis. He is also receiving furosemide (a loop diuretic), levothyroxine (for hypothyroidism), and a proton pump inhibitor and antacid (for gastroesophageal reflux disease [GERD]). Which drug does the nurse identify as most likely to be a concern during the therapy with prednisone?
Furosemide
Levothyroxine
Proton pump inhibitor
Antacid
Furosemide
Fish oil products, used to reduce cholesterol
May cause rash, belching, allergic reactions
Potential interactions with anticoagulant drugs
Omega-3 Fatty Acids
Adverse effects:
Cardiac dysrhythmia is the most significant adverse effect
May also cause:
Tachycardia, palpitations, angina, hypertension, insomnia, tremors, headache, anxiety, nausea, diarrhea, menstrual irregularities, weight loss, sweating, heat intolerance, fever, others
Levothyroxine
Regular insulin (Humulin R)
Onset 30 to 60 minutes;Duration: 6-10 hr
The only insulin can be given by IV or even IM
Short-acting insulins
During pregnancy,
treatment for hypothyroidism should _______
otherwise Fetal growth may be retarded
continue
is the combination of triglyceride or cholesterol with apolipoprotein
Lipoprotein
Prevent resorption of bile acids from small intestine
Bile acids are necessary for absorption of cholesterol
Bile Acid Sequestrants
(cholestyramine (Questran),
A male patient who has a history of type 2 diabetes mellitus is admitted to the medical unit with a diagnosis of pneumonia. The patient has many questions regarding his care and asks the nurse why everyone keeps telling him about hemoglobin A1C. The nurse will inform the patient that hemoglobin A1C provides information regarding:
which type of diabetes the patient has.
if he has an infection.
patient compliance with treatment regimen for several months previously.
current fasting blood glucose level.
patient compliance with treatment regimen for several months previously.
Adverse effects:
Serious: Hepatitis and myopathy
ezetimibe (Zetia
Cholesterol Absorption Inhibitor
A woman who has type II diabetes is now pregnant. She wants to know whether to take her oral antidiabetic medication. What instructions will she receive?
She should continue the antidiabetic medication at the same dosage.
The antidiabetic medication dosage will be increased gradually throughout her pregnancy.
She will be switched to insulin therapy while she is pregnant.
She will not receive any antidiabetic medication while pregnant and will need to monitor her dietary intake closely.
She will be switched to insulin therapy while she is pregnant.
The patient is being discharged home with insulin aspart (NovoLog) and insulin isophane suspension (NPH). Which information does the nurse include when providing discharge teaching to the patient?
Store the insulins in the refrigerator
Shake the insulins for 1 full minute before use.
Administer the injection at a 30-degree angle to your skin.
Draw up the insulin aspart (NovoLog) first, then the insulin isophane suspension (NPH) into the same syringe.
Draw up the insulin aspart (NovoLog) first, then the insulin isophane suspension (NPH) into the same syringe.
Adverse Effects
Common: Constipation, heartburn, nausea, belching, bloating- tend to disappear over time
(cholestyramine (Questran)
The patient was taking metformin before this hospitalization. To facilitate better glucose control, the patient has been switched to insulin therapy while hospitalized. The patient asks the nurse why it is so important to time meals with the insulin injection and to give him an example of a long-acting insulin. Which drug will the nurse tell the patient is a long-acting insulin?
Insulin glulisine (Apidra) Insulin isophane suspension (NPH) Insulin detemir (Levemir) Regular insulin (Humulin R)
Insulin detemir (Levemir)
Preferred method of treatment for hospitalized diabetic patients
Mimics a healthy pancreas by delivering basal insulin constantly as a basal and then as needed as a bolus
Basal insulin is a long-acting insulin (insulin glargine) Bolus insulin (insulin lispro or insulin aspart)
Basal-Bolus Insulin Dosing
A patient has been taking levothyroxine for 6 months. After this month’s laboratory work, the nurse practitioner tells the nurse that the patient is “euthyroid.” What does that term mean?
The patient is experiencing hyperthyroidism.
The patient is experiencing hypothyroidism.
The patient’s thyroid hormone levels are within normal limits.
The patient’s thyroid hormone levels are still fluctuating.
The patient’s thyroid hormone levels are within normal limits.
Which information will the nurse include when teaching a patient about thyroid replacement therapy?
“Take the medication before bed.”
“You will experience beneficial effects of the drug after one week of treatment.”
“Stop taking the drug if you experience insomnia.”
“Take the medication on an empty stomach.”
“Take the medication on an empty stomach.”
