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Focus Review Flashcards

1
Q

What is difference between Hypothyroidism and Graves’ Disease?

A

Hypothyroidism: Decrease in T3 & T4, Watch TSH
Graves: Patient is at risk for thyroid storm

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2
Q

** What are the signs and symptoms of hypothyroidism?

A

Lethargy, Fatigue, Weight Gain, Cold Intolerance, Bradycardia

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3
Q

** Know the signs and symptoms of Graves’ disease

A

TACHYCARDIA, Heat intolerance (excessive sweating), Tremors, Bulging eyes (Exophthalmos), Decrease Weight, Insomnia, Restlessness, Muscle Weakness

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4
Q

What patient educations would you include when taking Synthroid?

A

Take in the AM at the same time; 30 minutes Before breakfast

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5
Q

What are the side effects of Synthroid?

A

Nervousness, Insomnia, Weight loss, Tremors, N/V, Diarrhea, Cramps, TACHYCARDIA, Palpitations, Hypertension, Dysrhythmias, Angina, or Thyroid Crisis

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6
Q

What are the long term side effects of PTU and Tapazole?

A

Anti-thyroid meds, Treat HYPERthyroidism, Liver damage, Liver failure, Death, Wean off of it, do not abruptly stop, Interact w/anticoagulants (increases), Decreases effects of Antidiabetics

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7
Q

Describe the signs and symptoms of Thyroid storm?

A

Fever, Tachycardia (Give beta blocker to bring heart rate down), High BP, Visit to ICU

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8
Q

What is the difference between Type I and Type II Diabetes?

A

Type 1 – Insulin dependent, NO ORAL MEDS Type 2 – Insulin resistance. Can be managed with diet and Oral meds, if that isn’t working you may need to switch to Insulin SubQ

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9
Q

What is the treatment of Type I?

A

Will look Up

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10
Q

What is the treatment of Type II?

A

Will look Up

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11
Q

** What is the difference Hypoglycemia and Hyperglycemia

A

HYPO- tremors, clammy, sweating, faintness, confusion, fast heartbeat
HYPER- blurry vision, THIRST, dry skin, hunger, need to urinate often

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12
Q

Patient and family education when managing Type I or Type II diabetes.

A

Will look up

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13
Q

What is the Peak, Onset, and duration for Insulin?

A

Onset (5 to 15 minutes) Peak (30 minutes to 1 hour) Duration (2 to 4 hours)

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14
Q

Patient education regarding Insulin Pumps and Insulin

A

Keep in fridge, Exp dates, how to administer

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15
Q

Nursing considerations with Insulin administration

A

Check blood glucose, expiration dates, and fridge, throw away after 30 days

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16
Q

Patient education for the Diabetic patient on Glucophage

A

Stop 24 – 48 hours before scans with iodine contrast, False positive result Do not give dextrose, if NPO/fluid hanging because of protein

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17
Q

Signs and symptoms of the patient with DKA and management of the patient with DKA

A

Fruity breath, Blood glucose over 600  confused, extreme thirst, kassmual breathing
Management: IV drip Insulin (Regular)  Check blood sugar every hour ICU

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18
Q

Describe possible side effects and patient education regarding the use of steroids

A

Prednisone, Increase appetite, Steroid induced diabetes, COPD patients

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19
Q

Know the difference between Addison’s Disease and Cushing’s Disease

A

Addison’s: Low electrolytes & fluid deficits

Cushing’s: Too much/overflow, take away glucocorticoids

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20
Q

What medications are used to treat Addison’s and Cushing’s Disease?

A

Gluccoroticoids (Florinef): Watch for increase appetite (watch diet), watch mood (agitated or depressed), urinary output, hypertension, take as prescribed

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21
Q

Review Nursing Process for the patient with Addison’s and Cushing’s

A

Addison’s: Watch HYPOTENSION, Dysrhythmias, Bradycardia, watch electrolytes, if untreated = fatal

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22
Q

What is heart failure & S/S?

A 
Right = peripheral edema (feet, hands)
Left = pulmonary edema, fluid in the lungs, congested (rales/crackles), Lung disease, Risk for right sided heart failure
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23
Q

List important patient teaching for patients are Digoxin

A

Check pulse: less than 60 do not give
Half life = 36 to 48 hours
Antidote = Digamide
Lab: If greater than 2.5 = TOXIC

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24
Q

List signs and symptoms of Digoxin Toxicity

A

Bradycardia, Nausea, Very confused, Halos (white/green), older adults with renal impairments

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25
Q

Non-pharmacological measure to help the patient with heart failure

A

Control Sodium intake – 1 Teaspoon a day, proper rest, decrease stress, no extreme weather changes, avoid smoking, relaxation techniques

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26
Q

How to treat the patient with Angina

A

Nitro – 5 minutes apart – Sublingual times 3, call doctor after

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27
Q

**Which medications are used to treat Stable, Unstable and Variant Angina?

A

Stable: Excessive stress/strenuous activity Med = betablocker (propranolol) not for asthmatics, lung disease, or COPD
Unstable: Progressive (not related to activity) Med = Nitro or Isosoribide
Variant: Channel Calcium blockers (Cardizem)

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28
Q

Know when Nitro is used

A

Unstable

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29
Q

Know side effects to monitor for Nitrates

A

Weak, dizziness, confused, headaches, risk for orthostatic hypotension, lightheadedness
Teach Keep out of sunlight, throw away after 6 months, check expiration dates.

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30
Q

Which medications should be avoided with the patient with Heart block?

A

Calcium Channel Blockers

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31
Q

Know the management of Hypertension

A

Decrease sodium, exercise, decrease stress, diet, smoking, Coronary artery disease

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32
Q

Why are diuretics used?

A

Decrease blood pressure and fluid

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33
Q

Know the difference between Thiazides, Loop, Osmotic, and Potassium sparing

A

Thiazides (HCTZ): long-term and maintenance, used with antihypertensives, edema, “water pill”

Loop Diuretics: Bumex, Furosemide,“tequila” works fast and hard- AT RISK FOR electrolyte imbalance watch K+ levels

Osmotic: to decrease ICP , Mannitol  watch cerebral edema, medication is working if patient becomes alert. Trip to ICU if changes in consciousness, committing, seizure

Potassium Sparing: Watch potassium levels, use with anti-hypertensives

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34
Q

Nursing considerations for patients on thiazides

A

Watch diabetics because they can go into HYPERglycemia

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35
Q

Know labs to monitor for the patient on thiazides

A

Glucose, electrolytes

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36
Q

When do we use osmotic diuretics?

A

Intercranial Pressure

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37
Q

What are nursing considerations for patient on diuretics?

A

Watch electrolyte imbalance, BP, Kidney Function, Potassium

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38
Q

What are nursing considerations for patients on Antihypertensive?

A

Check blood pressure, Make sure there is no heart block, coronary heart disease

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39
Q

Dietary restrictions for the patient on ACE inhibitor’s

A

Watch potassium and salt substitutes, give herbs and natural foods instead

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40
Q

Common side effects of ACE inhibitors

A

Nagging Cough, Give ARBs, Diavan

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41
Q

When are ARB’s used?

A

Nagging Cough

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42
Q

Dietary restrictions for patient on Loop diuretics

A

Bum ex && feurosimide –diuretics

Watch out for potassium levels

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43
Q

Know the management of the patient that we suspect he had a stroke

A

Will look up

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44
Q

What type of thrombolytic therapy would be used with if a stroke has been confirmed?

A

Will look up

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45
Q

What lab values should be monitored when on Antiplatelet therapy?

A

PTT – aPTT (Heparin)

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46
Q

What is Protamine Sulfate used for?

A

Antidote for Heparin

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47
Q

What is the antidote for Coumadin?

A

Vitamin K

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48
Q

Know the difference between Cardio selective and non-cardio selective

A

Cardio selective: Only heart

Non cardio selective: Heart & Lungs, Do not give properolol if they have lung disease

49
Q

What medication is use for dysrhythmia? How do we know if it has been effective?

A

Adenosin

If EKG is normal sinus rhythm

50
Q

Know dietary restrictions for a patient of ACE inhibitors

A

Use salt substitutes

51
Q

Know the labs to monitor for patients on Anticoagulant therapy

A

PT – INR

52
Q

What lab values are monitored with hyperlipidemia? 

A

HDLs & LDLs

53
Q

What type of medication is commonly used?

A

Lipitor “Statins” only take at night to get an reaction

54
Q

What important education should the nurse provide regarding side effects and adverse reactions to Statins?

A

Adverse Reaction = Rhabdo (muscle weakness, nerve endings), if leg pain occurs call doctor

55
Q

What are commonly used Statin’s?

A

lower cholesterol

56
Q

When are statin’s usually taken and why?

A

At night because cholesterol is highest

57
Q

Know non pharmacological ways to manage the patient with Nausea and Vomiting

A

Banannas Rice Apple Toast
Flat sodas/weak teas
Gatorade = vomiting

58
Q

Know the management of patient with Diarrhea

A

Lomotil: has atropine = dry up, if working it will decrease diarrhea

59
Q

Know the management of the patient with Constipation

A

Typically seen with pain management patients

60
Q

Commonly used antiemetic for patient’s on chemotherapy and when is it administered

A

30 minutes before treatment - Zofran

61
Q

Know the treatment for H. Pylori

A

Flagyll, Pepto Bismo, Amoxicillin, Prilosec

62
Q

Patient teaching for Laxative use and Antidiarrheal medications

A

Dependency - people abuse them.

63
Q

Know how to determine if medications for GI disorders are effective

A

Will look up

64
Q

Commonly used medication with liver disease know how to determine its effectiveness

A

Lactolose - mental status goes back to normal & is alert, decrease in ammonia levels

65
Q

Know important patient education regard the use of Carafate

A

30 minutes before meals 3 times a day & once before bed

66
Q

Disease resulting from deficient glucose metabolism

A

Diabetes Mellitus

67
Q

Protein secreted from the beta cells of the pancreas

A

Insulin

68
Q

Reaction to low blood sugar

A

Hypoglycemic reaction

69
Q

Type of diabetes with no beta cell function

A

Type 1 Diabetes

70
Q

Diabetic Acidosis

A

Ketoacidosis

71
Q

Tissue Atrophy

A

Lipodystrophy

72
Q

Increased thirst

A

Polydipsia

73
Q

Increased Hunger

A

Polyphagia

74
Q

Increased Urine Output

A

Polyuria

75
Q

Hyperglycemia on Awakening

A

Dawn Phenomenon

76
Q

Intermediate-acting insulin

A

NPH insulin

77
Q

Tissue Atrophy (What drug)

A

Lipoatrophy

78
Q

Oral hypoglycemia drug group

A

Sulfonylureas

79
Q

Hyperglycemic hormone that stimulates glycogenolysis

A

Glucagon

80
Q

Rapid-acting insulin

A

Lispro Insulin

81
Q

Nursing Intervention: Monitor blood glucose levels (What is the Rationale?)

A

Prevents incidences of hyper and hypoglycemia

82
Q

Nursing Intervention: Instruct the patient to report signs and symptoms of “insulin shock” (Hypoglycemic reaction) (What is the Rationale?)

A

Signs and symptoms include nervousness, tremors, cold and clammy skin, and slurred speech.

83
Q

Nursing Intervention: Inform the patient to have orange juice or a sugar-containing drink available if hypoglycemic reaction occurs(What is the Rationale?)

A

Orange juice or a sweetened beverage adds sugar to the body for insulin utilization

84
Q

Nursing Intervention: Instruct the patient to check the blood sugar daily (What is the Rationale?)

A

Done to make sure it is within normal levels

85
Q

Nursing Intervention: Instruct the patient to adhere to the prescribed diet (What is the rationale?)

A

Diet is prescribed according to amount of insulin given per day

86
Q

Nursing Intervention: Instruct family members on how to administer glucagon by injection for a hypoglycemic reaction (What is the rationale?)

A

Patient may be unable to swallow orange juice

87
Q

Advise the patient to obtain a Medic-Alert card or tag (What is the Rationale?)

A

Needed in case of a severe hypoglycemic reaction where the patient ma be unconscious

88
Q

What is/are the major symptoms that characterize diabetes?

A

Polydipsia, Polyphagia, and Polyuria

89
Q

Which drugs may cause hyperglycemia?

A

Epinephrine, Hydrochlorothiazide, and Prednisone

90
Q

What is the rationale for rotation of insulin injection sites?

A

It prevents lipodystrophy

91
Q

What is the only type of insulin that may be administered IV?

A

Regular.. DKA patients, Type 1 patients

92
Q

Which clinical manifestations may be seen in a patient experiencing a hypoglycemic (insulin) reaction?

A

Headache, excessive perspiration, nervousness, tremor, and vomiting.

93
Q

Which clinical manifestations ay be seen in a patient experiencing diabetic ketoacidosis (Hyperglycemia)?

A

Dry mucous membranes, Fruity breath odor, Kussmaul’s respirations, polyuria, and thirst.

94
Q

The patient has Type 1 diabetes. Which medication should the patient not use to control his diabetes?

A

Tolazamide (Tolinase) – Type 1: insulin dependent

95
Q

Which information should be included in health teaching for patient taking insulin?

A

Adhere to the prescribed diet, Be sure to exercise, Monitor blood glucose level, Recognize signs of hypoglycemic reaction, take insulin as prescribed

96
Q

Which information should be included in health teaching for patients taking oral anti diabetic (hypoglycemic) drugs?

A

Adhere to prescribed diet, monitor blood glucose levels, monitor weight, and participate in regular exercise.

97
Q

Lipoatrophy is a complication that occurs when insulin is injected repeatedly in one site. What is the physiologic effect that occurs?

A

Raised lump or knot on the skin surface

98
Q

Where should the patient who takes insulin daily be taught to store the opened insulin?

A

In a cool place

99
Q

How should the nurse or patient prepare insulin prior to administration?

A

Roll the bottle in the hands

100
Q

The nurse is preparing to give a patient his daily insulin. The patient receives both NPH and regular insulin. What is the best action by the nurse?

A

Prepare one injection; draw up regular insulin first.

101
Q

Which type of syringe should be used to administer a patient’s daily insulin dose of 6 units of U100 regular and 14 units of U100 NPH?

A

Prepare one injection; draw up regular insulin first.

102
Q

The patient needs to develop a “site rotation pattern” for insulin injections. The American Diabetes Association suggests which actions?

A

Choose an injection site for a week, Inject insulin each day at the injection site at 1 1/2 inches apart. With two daily injection times, use the right side in the morning and the left side in the evening.

103
Q

When should the nurse expect that the patient may experience a hypoglycemic reaction to regular insulin if administration occurs at 0700 and the patient does not eat?

A

0800-0900

104
Q

How long after NHP administration would the nurse expect the patient’s insulin peak?

A

6-12 hours

105
Q

Lantus is a long-acting insulin. Which statements best describes Lantus?

A

It is given in the evening, it is available in a 3-mL cartridge insulin pen, and some patients complain of pain at the injection site.

106
Q

What is a method to determine if the patient has developed an allergy to insulin?

A

Skin test with different insulin preparations

107
Q

The insulin pump, though expensive, has become popular in the management of insulin. What does the nurse know about this method of insulin delivery?

A

It is more effective in decreasing the number of hypoglycemic reactions

108
Q

What is an action of an oral hypoglycemic agent?

A

It increases the number of insulin cell receptors

109
Q

The patient asks if Prandin is oral insulin. What is the nurse’s best response?

A

No, it is not the same as insulin. Prandin can be used only when there is some beta cell function.

110
Q

Which effect is/are representative of econd-generation sulfonylureas?

A

Effective doses are less than with first generation sulfonylureas. They have less displacement from protein-binding sites by other highly protein-bound drugs.

111
Q

The nonsulfonylureas are used to control serum glucose levels after a meal. What best describes their action?

A

They decrease hepatic production of glucose from store glycogen.

112
Q

A patient newly diagnosed with type 2 diabetes has been prescribed acarbose (Precose), and he asks the nurse how the medication works if it is not insulin. What is the nurse’s best response?

A

It works through inhibiting digestive enzymes in the small intestine, which releases glucose from the complex carbohydrates in the diet (less sugar is available).

113
Q

The patient has Type 2 diabetes and has just not been prescribed pioglitazone HCI (Actos). This medication is in the thiazolidinedione of nonsulfonylureas. How does this group of oral antidiabetics work?

A

They increase insulin sensitivity for improving blood glucose levels.

114
Q

In 2007 the FDA added a warning to rosiglitazone (Avandia). What was the warning regarding?

A

Increased risk of heart attack.

115
Q

Patients taking thiazolidinedione drugs such as pioglitazone (Actos) and rosiglitazone (Avandia) should have which laboratory test monitored?

A

Liver enzymes

116
Q

Herb-drug interaction must be assessed in patients taking herbs and antidiabetic agents. How do ginseng and garlic affect insulin or oral antidiabetic drugs?

A

They can lower the blood glucose level, thus causing a hypoglycemic effect.

117
Q

What is/are the recommended guidelines for use of oral antidiabetics in patients with diabetes?

A

Fating blood sugar

118
Q

***Which drugs or categories of drugs will interact with sulfonylurea?

A

Anticoagulants, Anticonvulsants, Aspirin, and Sulfonamides.

119
Q

What is/are contraindications for the use of oral antidiabetic drugs?

A

Breastfeeding, pregnancy, renal dysfunction, and severe infection.

Pharm (3 decks)

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