Test 2 Flashcards
INCREASED URINE FORMATION
DIURESIS
A drop of 20 mm Hg or more in systolic blood pressure and of 10 mm Hg in diastolic blood pressure within 3 minutes when the client rises from a lying or sitting position to a standing position
ORTHOSTATIC HYPOTENSION
A greater-than-normal amount of potassium in
the blood.
MORE THAN 5.0 mmol/L
HYPERKALEMIA
A level of uric acid in the blood that is abnormally high.
Hyperuricemia
LOW SODIUM
BELOW 135 mmol/L
HYPONATREMIA
An excess of fluid in the interstitial compartment.
EDEMA
Abnormal accumulation of fluid in the peritoneal cavity.
ASCITES
WHAT TYPE OF DRUG accelerates the rate of urine formation?
DIURETIC DRUGS
WHAT TYPE OF DRUG?
First-line drugs in the treatment of hypertension and heart failure
Result: removal of sodium and water
DIURETICS
WHICH DRUG REDUCES:
extracellular fluid volume
plasma volume
cardiac output
DIURETICS
WHICH TYPE OF DRUG DOES THIS LIST OF DRUG CLASSES BELONG TO: Loop diuretics Osmotic diuretics Potassium-sparing diuretics Thiazide and thiazide-like diuretics Carbonic Anhydrase Inhibitors (CAIs)
Diuretic Drugs - Classes
USES FOR WHICH TYPE OF DRUG
• Treat edema that involves fluid volume excess resulting from a number of
disorders of the heart, liver, or kidney
• Hypertension
DIURETICS
IF WATER IS NOT ABSORBED IT IS SECRETED AS _______.
URINE
COMMON DRUGS FROM WHICH CLASS OF DIURETICS?
furosemide (Lasix) **
LOOP DIURETICS
____________ ____________ ____________ CAUSES:
Reduced blood pressure (BP)
Reduced pulmonary vascular resistance
Reduced systemic vascular resistance
Reduced central venous pressure
Reduced left ventricular end-diastolic pressure
DECREASED FLUID VOLUME
CONTRAINDICATIONS FOR WHICH TYPE OF DRUG:
• Dehydration, hyponatremia, hypochloremia, hypokalemia
• Unusual tiredness, weakness, dizziness
• Irregular heart beat, weak pulse, orthostatic hypotension
• Tinnitus, hyperglycemia, hyperuricemia, hearing loss (Lasix)
DIURETICS
PRECAUTIONS FOR WHICH TYPE OF DRUG
• Fluid and electrolyte depletion, gout
• Clients taking digitalis, lithium, nonsteroidal antiinflammatory drugs (NSAIDs), and other antihypertensive medications
DIURETICS
WHAT CLASS OF DIURETICS IS INDICATED FOR HYPERCALCEMIA?
LOOP DIURETICS - INCREASES THE RENAL SECRETION OF CALCIUM
Potassium-Sparing Diuretics: Indications for ____________
Hyperaldosteronism
Hypertension *****
To reverse the potassium loss caused by potassium-losing drugs
Certain cases of heart failure
spironolactone (Aldactone)
COMMON DRUGS FROM WHICH CLASS OF DIURETIC
mannitol (Osmitrol) ** IV ONLY
OSMOTIC DIURETICS
Thiazide and Thiazide-Like Diuretics
COMMON _________ diuretics
hydrochlorothiazide **
Thiazide
________ _________ Diuretics
spironolactone (Aldactone)*****
Potassium-Sparing Diuretics
Also known as aldosterone-inhibiting diuretics
POTASSIUM-SPARING DIURETICS PROMOTES THE _________ OF SODIUM & WATER.
EXCRETION
______________ DIURETICS: Significant drug interactions with:
lithium
angiotensin-converting enzyme (ACE) Inhibitors
Potassium supplements
Potassium-Sparing Diuretics
Thiazide and Thiazide-Like Diuretics COMMON \_\_\_\_\_\_\_\_\_\_\_ diuretics chlorthalidone indapamide metolazone (Zaroxolyn)
THIAZIDE-LIKE
THIAZIDE OR THIAZIDE-LIKE DIURETICS?
___________ should not be used if creatinine clearance is less than 30 to 50 mL/min (normal is 125 mL/min)
(Should not be used if kidneys are not functioning well)
Thiazides
GROUP OF DRUGS MOST PRESCRIBED FOR HYPERTENSION.
THIAZIDE & THIAZIDE-LIKE DIURETICS
NURSING IMPLICATIONS - DIURETICS:
Assess ___________ fluid volume status, intake and output, serum electrolyte values, weight, and vital signs—especially postural BPs
BASELINE
NURSING IMPLICATIONS - DIURETICS:
Instruct patients to take in the morning as much as possible to avoid interference with _______ patterns
SLEEP
NURSING IMPLICATIONS - DIURETICS:
Teach patients to maintain proper _______________ & ________ volume status
nutritional and fluid
NURSING IMPLICATIONS - DIURETICS:
MONITOR SERUM ___________ LEVELS DURING THERAPY
POTASSIUM
NURSING IMPLICATIONS - DIURETICS:
Potassium supplements are usually not recommended when potassium levels exceed _____ mmol/L
THREE
NURSING IMPLICATIONS - DIURETICS:
Teach patients to eat more potassium-rich foods when taking any BUT the ______________ drugs
potassium-sparing
NURSING IMPLICATIONS - DIURETICS:
Patients taking diuretics along with a __________ preparation should be taught to monitor for
__________ toxicity
DIGITALIS
NURSING IMPLICATIONS - DIURETICS:
Diabetic patients who are taking thiazide and/or loop diuretics should be told to monitor ________ _________ and to watch for elevated levels.
blood glucose
NURSING IMPLICATIONS - DIURETICS:
Encourage patients to keep a _____ of their daily weight
log
NURSING IMPLICATIONS - DIURETICS:
Patients who have been ill with _________, __________, _____________, or a combination of these should notify their physician because fluid loss may be dangerous
nausea, vomiting, diarrhea
NURSING IMPLICATIONS - DIURETICS:
Signs and symptoms of _______________ include muscle weakness, constipation, irregular pulse rate, and overall feeling of lethargy
HYPOKALEMIA
NURSING IMPLICATIONS - DIURETICS:
Instruct patients to notify the physician immediately if they experience ______ _______ ______ OR ________
rapid heart rates or syncope (reflects hypotension or fluid loss)
NURSING IMPLICATIONS - DIURETICS:
Excessive consumption of __________ can lead to an additive hypokalemia in patients taking thiazides
licorice
NURSING IMPLICATIONS - DIURETICS:
Monitor for _________ __________
Metabolic alkalosis, drowsiness, lethargy, hypokalemia, tachycardia, hypotension, leg
cramps, restlessness, decreased mental alertness
adverse effects
NURSING IMPLICATIONS - DIURETICS:
Monitor for ____________ with potassium-sparing diuretics
hyperkalemia
NURSING IMPLICATIONS - DIURETICS: Monitor for \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_ Reduction in edema, fluid volume overload, heart failure Reduction of hypertension Return to normal intraocular pressures
therapeutic effects
Which of the following laboratory values should the nurse assess to identify an adverse response to hydrochlorothiazide? A. Sodium levels B. Glucose levels C. Calcium levels D. Chlorine levels
B - Glucose levels
Hydrochlorothiazide can cause hyperglycemia
Which of the following principles would the nurse use in teaching a patient why spironolactone (Aldactone) and furosemide (Lasix) are prescribed together?
A. This combination prevents dehydration and hypovolemia
B. This combination promotes diuresis but decreases the risk of hypokalemia
C. Using two drugs increases osmolality of plasma and the glomerular filtration rate
D. Moderate doses of two different types of diuretics are more effective than a large dose of one type
B. This combination promotes diuresis but decreases the risk of hypokalemia
Spironolactone (Aldactone) is a potassium-sparing diuretic; furosemide (Lasix) is a potassium-losing diuretic. Giving these together minimizes electrolyte imbalance.
For which of the following adverse effects will the nurse check the laboratory values of a patient who has started on furosemide (Lasix)? A. Hypokalemia B. Hypernatremia C. Hyperchloremia D. Hypophosphatemia
A. Hypokalemia
Furosemide (Lasix) is a potent loop diuretic, resulting in the loss of potassium as well as water, sodium, and chloride.
A patient admitted to the hospital with pneumonia and a history of chronic renal insufficiency is ordered furosemide (Lasix) 40 mg twice a day. Which of the following rationales explains the reason for the furosemide order?
A. Will increase blood oxygen levels
B. Will not cause potassium loss
C. Is effective in treating persons with renal insufficiency
D. Is effective in treating persons with pulmonary congestion
C. Is effective in treating persons with renal insufficiency
Furosemide (Lasix) is effective in patients with creatinine clearance as low as 25 L/min (normal 125 L/min).
Which of the following dietary recommendations would the nurse make to a patient taking spironolactone (Aldactone)?
A. Avoid foods high in sodium, such as apples
B. To reduce the risk for low blood sugar, eat squash daily
C. Avoid foods high in potassium, such as bananas
D. Iron will interfere with the drug’s action, so avoid liver
C. Avoid foods high in potassium, such as bananas
Spironolactone (Aldactone) is a potassium-sparing diuretic that could potentially cause hyperkalemia. Bananas are high in potassium and thus should be avoided.
The nurse would question the use of mannitol (Osmitrol) in which of the following patients?
A. 21-year-old patient with head injury
B. 47-year-old patient with anuria
C. 67-year-old patient who ingested a poisonous substance
D. 55-year-old patient with generalized edema
B. 47-year-old patient with anuria
Mannitol (Osmitrol) is not metabolized but is excreted unchanged by the kidneys. Potential water intoxication could occur if mannitol is given to a patient without urine output and thus renal function.
Acetazolamide (Acetazolam) therapy is contraindicated for which of the following medical conditions? A. Edema B. Seizures C. Acute glaucoma D. Metabolic acidosis
D. Metabolic acidosis
Acetazolamide (Acetazolam) causes excretion of bicarbonate, which would worsen metabolic acidosis. It is used to treat metabolic alkalosis, edema, seizures, and acute glaucoma.
Which of the following symptoms is directly related to hypokalemia? A. Dry mouth B. Ataxia C. Impotence D. Abdominal cramps
D. Abdominal cramps
Muscle-related symptoms, such as abdominal cramps, are associated with hypokalemia.
Which of the following would be the nurse’s best response when a patient asks about taking potassium supplements while taking spironalactone (Aldactone)?
A. “I will call your doctor and let him know of your concern.”
B. “That is a question for the doctor; nurses don’t know this information.”
C. “I agree. I will suggest that the dietician add potassium-rich foods to your diet.”
D. “You are on a diuretic that is potassium sparing, so there is no need for extra potassium.”
D. “You are on a diuretic that is potassium sparing, so there is no need for extra potassium.”
Spironalactone (Aldactone) is a potassium-sparing diuretic, and additional potassium ingestion would put the patient at risk for hyperkalemia.
The nurse would expect to administer which of the following diuretics to treat a patient diagnosed with primary hyperaldosteronism? A. amiloride (Midamor) B. furosemide (Lasix) C. triamterene D. spironolactone (Aldactone)
D. spironolactone (Aldactone)
Spironolactone (Aldactone) is the direct antagonist for aldosterone.
The nurse prepares to administer which of the following diuretics to treat a patient suffering from acute pulmonary edema? A. amiloride (Midamor) B. furosemide (Lasix) C. triamterene D. spironolactone (Aldactone)
B. furosemide (Lasix)
Furosemide (Lasix) is a potent, rapid-acting diuretic that would be the drug of choice to treat acute pulmonary edema. Amiloride, triamterene, and spironolactone are not potent enough to cause the strong diuresis necessary to treat acute pulmonary edema
Which of the following therapeutic effects of mannitol (Osmitrol) would the nurse anticipate? A. Rapid loss of potassium B. Pulmonary edema C. Decreased intracranial pressure D. Decreased intracranial bleeding
C. Decreased intracranial pressure
Mannitol (Osmitrol) is an osmotic diuretic that pulls fluid from extravascular spaces into the bloodstream to be excreted in urine. This will decrease intracranial pressure caused by cerebral edema.
Which of the following adverse effects of spironolactone would the nurse specifically monitor for? A. Hypokalemia B. Hypoglycemia C. Hyperkalemia D. Hypernatremia
C. Hyperkalemia
spironolactone (Aldactone) is a potassium-sparing diuretic.
Which of the following responses best explains why a patient is prescribed the diuretic acetazolamide (Acetazolam) to treat glaucoma?
A. Increase the outflow of aqueous humour
B. Decrease the outflow of aqueous humour
C. Increase the inflow of aqueous humour
C. Decrease the inflow of aqueous humour
A. Increase the outflow of aqueous humour
Acetazolamide (Acetazolam) is used effectively in the treatment of open angle glaucoma by increasing the outflow of aqueous humour. As a result, intraocular pressure is decreased.
The “ALLHAT” research study found that one diuretic had fewer cardiovascular adverse effects as well as lowered systolic blood pressure better than other diuretics. Which of the following drugs were suggested by the researchers to be the first-line drug in the treatment of hypertension? A. chlorthialidone B. amlodipine (Norvasc) C. lisinopril (Prinvil) D. doxazosine
A. chlorthialidone
Researchers, based on the “ALLHAT” study, suggested chlorthialidone as the first-line drug in the treatment of hypertension.
Gwen, 90, lives in a long-term care facility. She is ambulatory and continent but requires direction for her activities of daily living. Her medical diagnoses include congestive heart failure and Alzheimer’s disease. Gwen has a number of medications to treat her conditions, including digoxin (Lanoxin), furosemide (Lasix), and potassium supplements.
What potassium serum level result indicates that Gwen’s potassium supplement may not be adequate?
A. 3.1 mmol/L
B. 3.5 mmol/L
C. 4.2 mmol/L
D. 2.2 mmol/L
D. 2.2 mmol/L
Serum potassium levels less than 3.0 mmol/L indicate that additional potassium supplements are required.
Gwen, 90, lives in a long-term care facility. She is ambulatory and continent but requires direction for her activities of daily living. Her medical diagnoses include congestive heart failure and Alzheimer's disease. Gwen has a number of medications to treat her conditions, including digoxin (Lanoxin), furosemide (Lasix), and potassium supplements. How often should Gwen be weighed? A. Twice a day B. Daily C. Weekly D. Monthly
B. Daily
Patients should be weighed daily, at the same time of day. Fluctuations in weight indicate fluid retention or loss.
Gwen, 90, lives in a long-term care facility. She is ambulatory and continent but requires direction for her activities of daily living. Her medical diagnoses include congestive heart failure and Alzheimer’s disease. Gwen has a number of medications to treat her conditions, including digoxin (Lanoxin), furosemide (Lasix), and potassium supplements.
What nursing action recognizes that Gwen is at risk for falls related to her diuretic therapy?
A. Restrain Gwen in a chair during waking hours
B. Change Gwen’s transfer to a mechanical lift
C. Place a commode at Gwen’s bedside at night
D. Put an incontinent device on Gwen for sleeping hours
C. Place a commode at Gwen’s bedside at night
To minimize Gwen’s risk for falling at night, a commode should be placed at her bedside.
A substance in a solution that diffuses
through a semipermeable membrane.
Crystalloids
CRYSTALLOIDS DO NOT CONTAIN ______________
PROTEINS
CRYSTALLOIDS - Contain ___________ & ___________ that are normally found in the body
fluids and electrolytes
COLLOIDS OR CRYSTALLOIDS
Better for treating dehydration than for expanding the plasma volume
CRYSTALLOIDS
COLLOIDS OR CRYSTALLOIDS
Used as maintenance fluids
To compensate for insensible fluid losses (like sweating, vomiting, diarrhea)
To replace fluids
To manage specific fluid and electrolyte disturbances
To promote urinary flow
CRYSTALLOIDS
TYPES OF COLLOIDS OR CRYSTALLOIDS?
Normal saline (0.9% sodium chloride) Hypertonic saline (3% sodium chloride) Lactated Ringer’s D5W Plasma-Lyte
CRYSTALLOIDS
_____________ FOR CRYSTALLOIDS
Acute liver failure Acute nephrosis Adult respiratory distress syndrome Burns Cardiopulmonary bypass Hypoproteinemia Reduction of the risk of deep vein thrombosis (DVT) Kidney dialysis Shock
INDICATIONS
CONTRAINDICATIONS FOR _______________ OR ___________
Known drug allergy to a specific product
Hypervolemia
Severe electrolyte disturbance (depending on the type of crystalloid used)
COLLOIDS OR CRYSTALLOIDS
CRYSTALLOIDS May have ____-lived effects
SHORT
CRYSTALLOID INTERACTIONS ARE _____
RARE
CRYSTALLOIDS:
Certain electrolytes in _________ ________ solution may form a chemical precipitate with other electrolytes
lactated Ringer’s
COLLOIDS TREAT A __________ OF CONDITIONS
VARIETY
COLLOIDS ARE SUPERIOR TO CRYSTALLOIDS IN ________ ____________ EXPANSION BUT MORE EXPENSIVE.
PERIPHERAL VASCULAR
COLLOIDS ARE USUALLY _______
SAFE
ADVERSE EFFECTS:
COLLOIDS MAY CAUSE ALTERED ____________ RESULTING IN BLEEDING
COAGULATION
ADVERSE EFFECTS:
COLLOIDS HAVE NO _________ FACTORS OR _________-CARRYING CAPACITY
CLOTTING
OXYGEN
OXYGEN-CARRYING RESUSCITATION FLUIDS
BLOOD PRODUCTS
________ _________ ARE THE ONLY CLASS OF FLUIDS ABLE TO CARRY OXYGEN
BLOOD PRODUCTS
BLOOD PRODUCTS _______________ TISSUE OXYGENATION.
INCREASE
BLOOD PRODUCTS _______________ PLASMA VOLUME.
INCREASE
BLOOD PRODUCTS ARE THE MOST EXPENSIVE AND LEAST AVAILABLE BECAUSE THEY REQUIRE _____________ DONORS
HUMAN
CRYOPRECIPITATE AND PLASMA PROTEIN FACTORS (PPF) MANAGE ______ _________
ACUTE BLEEDING
GREATER THAN 50% BLOOD LOSS SLOWLY OR 20% ACUTELY
FRESH FROZEN PLASMA (FFP) ______________ CLOTTING FACTOR LEVELS IN PATIENTS WITH DEMONSTRATED DEFICIENCY.
INCREASES
________ RED BLOOD CELLS & ______ BLOOD INCREASE OXYGEN-CARRYING CAPACITY IN PATIENTS WITH ANEMIA OR BIGTIME HEMOGLOBIN DEFICITS
PACKED
WHOLE
PACKED RBCs INCREASE OXYGEN-CARRYING CAPACITY IN CLIENTS WHO HAVE LOST ____ _____ ______ OF THEIR TOTAL BLOOD VOLUME
UP TO 25%
WHOLE BLOOD IS USED FOR CLIENTS WHO HAVE LOST ______ ______ OF THEIR TOTAL BLOOD VOLUME.
OVER 25%
BLOOD PRODUCTS - ADVERSE EFFECTS:
______________ WITH RECIPIENT’S IMMUNE SYSTEM
INCOMPATIBILITY
BLOOD PRODUCTS - ADVERSE EFFECTS:
TRANSMISSION OF ________ TO RECIPIENT
PATHOGENS
FLUIDS & ELECTROLYTES - ADVERSE EFFECTS OF ?
ANAPHYLAXIS & TRANSFUSION REACTION
BLOOD PRODUCTS
PRINCIPAL EXTRACELLULAR FLUID ELECTROLYTES (2)
SODIUM
CHLORIDE
PRINCIPAL INTRACELLULAR FLUID ELECTROLYTE (1)
POTASSIUM
OTHER ELECTROLYTES
CALCIUM, MAGNESIUM & PHOSPHORUS
Excess dietary potassium is excreted via ______
kidneys
HYPOKALEMIA is more a result of _______ __________ ______ than poor dietary intake
excessive potassium loss
Hypokalemia, in the presence of __________ therapy, can cause _______ toxicity
digoxin
DIGOXIN TOXICITY CAN RESULT IN SERIOUS _______ _______________
VENTRICULAR DYSRHYTHMIAS
Main indication is the treatment or prevention of potassium depletion when dietary means are inadequate
POTASSIUM
_______________ CONTRAINDICATIONS:
Known drug allergy to a specific drug product
Hyperkalemia from any cause
Severe kidney disease
Acute dehydration
Untreated Addison’s disease
Severe hemolytic disease
Conditions involving extensive tissue breakdown (e.g., multiple trauma, severe burns)
POTASSIUM
______ PREPARATIONS OF POTASSIUM CAN CAUSE ADVERSE EFFECTS SUCH AS:
- DIARRHEA
- NAUSEA
- VOMITING
- GI BLEEDING
- ULCERATION
ORAL
_______________ ADMINISTRATION OF POTASSIUM:
- PAIN AT INJECTION SITE
- PHLEBITIS
IV
______________ ADMINISTRATION OF POTASSIUM:
- HYPERKALEMIA
- TOXIC EFFECTS
EXCESSIVE
TOXIC EFFECTS OF WHICH ELECTROLYTE
Muscle weakness, paraesthesia, paralysis, cardiac rhythm irregularities (leading to possible ventricular fibrillation and cardiac arrest)
POTASSIUM
TREAT SEVERE ______________ WITH:
- IV SODIUM BICARBONATE, CALCIUM SALTS, DEXTROSE WITH INSULIN
- SODIUM POLYSTYRENE SULFONATE (KAYEXALATE) OR HEMODIALYSIS
HYPERKALEMIA
_______________ INTERACTS WITH ACE INHIBITORS, DIURETICS, AMPHOTERICIN B, AND MINERALOCORTICOSTEROIDS
POTASSIUM
SYMPTOMS OF ____________ INCLUDE:
Lethargy, stomach cramps, hypotension, vomiting, diarrhea, seizures
HYPONATREMIA
SYMPTOMS OF ____________ INCLUDE:
- Water retention (edema), hypertension
- Red, flushed skin; dry, sticky mucous membranes, increased thirst, elevated temperature, decreased urine output
HYPERNATREMIA
Main indication is the treatment or prevention of sodium depletion when dietary measures are inadequate
SODIUM
_____ ADMINISTRATION FOR SODIUM ADVERSE EFFECTS
Nausea, vomiting, cramps
ORAL
____ administration FOR SODIUM ADVERSE EFFECTS
Venous phlebitis
IV administration
NURSING IMPLICATIONS - FLUIDS & ELECTROLYTES:
Assess ____________ fluid volume and electrolyte status
baseline
NURSING IMPLICATIONS - FLUIDS & ELECTROLYTES:
Assess skin, mucous membranes, daily weights, ______ & _______
INTAKE & OUTPUT
NURSING IMPLICATIONS - FLUIDS & ELECTROLYTES:
Before giving potassium, assess ___________
electrocardiogram
NURSING IMPLICATIONS - FLUIDS & ELECTROLYTES:
Monitor ________ ___________ levels during therapy
serum electrolyte
NURSING IMPLICATIONS - FLUIDS & ELECTROLYTES:
Observe for _______ and other complications of IV therapy
infiltration
NURSING IMPLICATIONS - FLUIDS & ELECTROLYTES:
Parenteral infusions of potassium must be monitored closely:
Rate should not exceed ____ mmol/hr
20
NURSING IMPLICATIONS - FLUIDS & ELECTROLYTES:
NEVER GIVE PARENTERAL INFUSIONS OF POTASSIUM AS AN ____ _______ OR _________
IV BOLUS OR UNDILUTED
NURSING IMPLICATIONS - FLUIDS & ELECTROLYTES:
Oral forms of potassium:
Must be diluted in ______ OR _____ ______ to minimize GI distress or irritation
water or fruit juice
NURSING IMPLICATIONS - FLUIDS & ELECTROLYTES:
ADMINISTER ________ SLOWLY
COLLOIDS
NURSING IMPLICATIONS - FLUIDS & ELECTROLYTES:
MONITOR FOR FLUID _______ AND POSSIBLE _______ __________.
OVERLOAD
HEART FAILURE
NURSING IMPLICATIONS - FLUIDS & ELECTROLYTES:
Monitor closely for signs of ________ reactions
TRANSFUSION
Which of the following would be the priority nursing intervention when administering intravenous potassium?
A. Administer potassium as a bolus over 10 minutes
B. Administer medication using an intravenous pump
C. Apply ice packs to the site of intravenous administration
D. Teach the patient and family signs and symptoms of hypokalemia
B. Administer medication using an intravenous pump
Too rapid an infusion of potassium can cause cardiac arrhythmias. Therefore, an intravenous infusion pump must always be a used.
Which of the following signs and symptoms of overdose manifestations would the nurse monitor when planning administration of hypertonic saline solution to treat a patient with severe hyponatremia? A. Confusion and seizures B. Vomiting and diarrhea C. Lethargy and hypotension D. Flushed skin and increased thirst
D. Flushed skin and increased thirst
Flushed skin and increased thirst are signs and symptoms of hypernatremia. Confusion and seizures, vomiting and diarrhea, and lethargy and hypotension are signs and symptoms of hyponatremia.
A patient receiving a unit of red blood cells suddenly develops shortness of breath, chills, and a fever. What is the nurse’s best action?
A. Discontinue the infusion of packed cells
B. Reassure the client that this is an expected reaction
C. Notify the physician while a peer monitors the blood transfusion
D. Decrease the infusion rate and reassess the client in 15 minutes
A. Discontinue the infusion of packed cells
Shortness of breath, chills, and a fever are signs and symptoms of a blood transfusion reaction that could escalate to anaphylaxis. Therefore, it is a priority to immediately stop the blood transfusion.
Along with platelet transfusions, the nurse would expect to administer which of the following to increase deficient clotting factors? A. Fresh frozen plasma B. Albumin C. Plasma protein factors D. Whole blood
A. Fresh frozen plasma
Fresh frozen plasma is indicated to increase clotting factors in patients with a known deficiency. Albumin and plasma protein factors do not contain clotting factors. Although whole blood does contain the same ingredients as fresh frozen plasma, the amount of volume that must be administered to give the patient the necessary clotting factors may be prohibitive in a patient with renal insufficiency
The nurse is reviewing the medications that have been ordered for a patient who has received a new prescription for a loop diuretic. Which of the following may have a possible interaction with the loop diuretic?
a. NSAIDs
b. warfarin
c. penicillins
d. vitamin C
a. NSAIDs
When monitoring laboratory test results for patients receiving loop and thiazide diuretics, which of the following must the nurse look for?
a. Decreased serum glucose levels
b. Increased serum levels of sodium
c. Decreased serum levels of potassium
d. Increased serum levels of potassium
c. Decreased serum levels of potassium
When the nurse is checking the laboratory data for a patient taking spironolactone (Aldactone), which result would be a potential concern?
a. Serum sodium level of 140 mmol/L
b. Serum potassium level of 3.6 mmol/L
c. Serum potassium level of 5.8 mmol/L
d. Serum magnesium level of 0.8 mmol/L
c. Serum potassium level of 5.8 mmol/L
Which of the following statements should be included in patient education for an 81-year-old female with heart failure who is taking daily doses of spironolactone (Aldactone)?
a. “Avoid foods that are high in potassium.”
b. “Be sure to eat foods that are high in potassium.”
c. “A weight gain of 1–1.25 kg in 24 hours is normal.”
d. “Change positions slowly because this drug causes severe hypertension-induced syncope.
a. “Avoid foods that are high in potassium.”
A patient with diabetes has a new prescription for a
thiazide diuretic. Which statement should the nurse
include when teaching the patient about the thiazide
drug?
a. “There is nothing for you to be concerned about
when you are taking the thiazide.”
b. “You should take the thiazide at night to avoid interactions
with the diabetes medicine.”
c. “Monitor your blood glucose closely because the
thiazide may cause the levels to decrease.”
d. “Monitor your blood glucose closely because the
thiazide may cause the levels to increase.”
d. “Monitor your blood glucose closely because the
thiazide may cause the levels to increase.”
While setting up a transfusion of packed red blood cells, which principle must the nurse remember to follow?
a. Check the patient’s vital signs after the infusion is
completed.
b. Flushed skin and fever are expected reactions to a blood transfusion.
c. The intravenous line should be flushed with NS
before the blood is added to the infusion.
d. The intravenous line should be flushed with dextrose before the blood is added to the infusion.
c. The intravenous line should be flushed with NS
before the blood is added to the infusion.
When preparing an intravenous solution that contains potassium, which of the following must the nurse know is a contraindication to the potassium infusion?
a. Diarrhea
b. Dehydration
c. Serum potassium of 2.8 mmol/L
d. Serum potassium of 5.6 mmol/L
d. Serum potassium of 5.6 mmol/L
Which of the following is a contraindication for albumin when assessing a patient who has an order for albumin administration?
a. Heart failure
b. Severe burns
c. Acute liver failure
d. Fluid-volume deficit
a. Heart failure
The nurse is preparing an infusion for a patient who has deficient clotting due to hemophilia. Which type of infusion will this patient receive?
a. Albumin 5%
b. Packed red blood cells
c. Whole blood
d. Fresh frozen plasma
d. Fresh frozen plasma
While monitoring a patient who is receiving an infusion of 3% NS, which of the following should the nurse look for?
a. Bradycardia
b. Hypotension
c. Fluid overload
d. Decreased skin turgor
c. Fluid overload
__________ and __________ are currently the most commonly used oxygen-carrying resuscitation fluids.
Whole blood and packed red blood cells
______________________ are used to treat low levels of potassium and are generally administered via what routes?
Potassium supplements are administered either orally or through intravenous infusion but only if the intravenous dose is adequately diluted.
Primarily indicated for the prevention of organ rejection
IMMUNOSUPPRESSANTS
cyclosporine (Neoral, Sandimmune)
CORTICOSTEROIDS
CORTICOSTEROIDS ARE _____________________
IMMUNOSUPPRESANTS
WHICH CORTICOSTEROID is the primary immunosuppressant agent used in the prevention of kidney, liver, heart, and bone marrow transplant rejection.
cyclosporine
CONTRAINDICATIONS FOR _______________:
Known drug allergy Pregnancy (except in urgent situations) Kidney or liver failure* Hypertension* Concurrent radiation therapy*
- Relative contraindication
IMMUNOSUPPRESSANTS
GRAPEFRUIT JUICE HAS A NEGATIVE EFFECT ON ____________
CYCLOSPORINE
All immunosuppressed patients have a heightened susceptibility to opportunistic ________
infections
NURSING IMPLICATIONS - _____________
Thorough assessment should be performed before administering these drugs:
- Renal, liver, and cardiovascular function studies
- Central nervous system (CNS) baseline function
- Respiratory assessment
- Baseline vital signs
- Baseline laboratory studies, including hemoglobin, hematocrit, white blood cell, and platelet counts
IMMUNOSUPPRESSANTS
NURSING IMPLICATIONS - IMMUNOSUPPRESSANTS
Monitor white blood cell counts throughout therapy; if the count drops below _________, the drug should be discontinued, but only after contacting the physician
3 X10 to the 9 mm/L
Oral immunosuppressants should be taken _____ ______to minimize gastrointestinal (GI) upset
with food
NURSING IMPLICATIONS - IMMUNOSUPPRESSANTS
Oral forms are used when possible to decrease the risk of _________ that may occur with parenteral injections
infection
NURSING IMPLICATIONS - IMMUNOSUPPRESSANTS
Oral antifungal drugs are usually given with these drugs to treat oral ___________, which may occur
candidiasis
NURSING IMPLICATIONS - IMMUNOSUPPRESSANTS
Observe the oral cavity often for ______ _____ on the tongue, mucous membranes, and oral pharynx
white patches
NURSING IMPLICATIONS - IMMUNOSUPPRESSANTS
Oral _______ solution must be mixed in a glass container
cyclosporine
NURSING IMPLICATIONS - IMMUNOSUPPRESSANTS
___________ containers should not be used because the drug adheres to the inside wall of the container
Styrofoam
Patients need to be told that ________ therapy with immunosuppressants is indicated with organ transplantation
lifelong
Patients taking immunosuppressants should be encouraged to take measures to reduce the risk of infection SUCH AS? (2)
Avoiding crowds
Avoiding people with colds or other infections
NURSING IMPLICATIONS - IMMUNOSUPPRESSANTS
Patients should be told to report any fever, sore throat, chills, joint pain, fatigue, or other signs of a ________ ________ immediately
severe infection
In general, by which of the following actions do immunosuppressants work?
A. Increasing antibody response
B. Suppressing T-lymphocytes
C. Increasing natural killer (NK) cellular activity
D. Suppressing hepatic metabolism of steroids
B. Suppressing T-lymphocytes
Immunosuppressants inhibit T-lymphocyte synthesis, thus preventing an immune response to organ transplants.
Which of the following is not an anticipated side effect of azathioprine? A. Alopecia B. Leukopenia C. Hepatotoxicity D. Thrombocytopenia
A. Alopecia
Common side effects of azathioprine include leukopenia, thrombocytopenia, and hepatotoxicity. Alopecia (hair loss) is not an expected side effect.
The nurse would anticipate administering which of the following medications to a client demonstrating acute organ rejection? A. sirolimud B. azathioprine C. basiliximab D. cyclosporine
D. cyclosporine
Cyclosporine is used to both prevent and treat organ rejection.
When assessing a patient who is to begin therapy with cyclosporine, which of the following patient conditions should the nurse recognize as one with which the drug must be used cautiously?
a. Anemia
b. Myalgia
c. Glaucoma
d. Kidney dysfunction
d. Kidney dysfunction
Which of the following would be a contraindication for glatiramer acetate?
a. Acute myalgia
b. Fluid overload
c. Polycythemia
d. Allergy to mannitol
d. Allergy to mannitol
During therapy with azathioprine (Imuran), which
adverse effect must the nurse monitor for?
a. Diarrhea
b. Vomiting
c. Bradycardia
d. Thrombocytopenia
d. Thrombocytopenia
Before administering an immunosuppressant drug, the nurse should assess which of the following?
A. Hepatic enzymes
B. Blood urea nitrogen (BUN) and creatinine levels
C. Level of consciousness
D. All of the above
D. All of the above
Adverse reactions to immunosuppressants include neurotoxicity, renal toxicity, hepatotoxicity, and hypertension.
During a patient teaching session for a patient receiving an immunosuppressant drug, which statement should the nurse include?
a. “You will remain on antibiotics to prevent
infections.”
b. “Be sure to take your medications with grapefruit
juice to enhance its effects.”
c. “It is better to use oral forms of these drugs to prevent the occurrence of thrush.”
d. “It is important to use some form of contraception
during treatment and for up to 12 weeks after the
end of therapy.”
d. “It is important to use some form of contraception
during treatment and for up to 12 weeks after the
end of therapy.”
During drug therapy with basiliximab (Simulect), the
nurse monitors for signs of cytokine release syndrome. Which of the following are signs of this condition?
a. Hepatotoxicity
b. Neurotoxicity
c. Polycythemia
d. An allergic-type reaction
d. An allergic-type reaction
Before administering intravenous basiliximab (Simulect), the nurse would anticipate giving which of the following medications?
A. methylprednisolone sodium (Depo-Medrol)
B. diphenhydramine
C. acetaminophen (Tylenol)
D. meperidine
A. methylprednisolone sodium (Depo-Medrol)
Methylprednisolone sodium (Depo-Medrol) is administered 30 minutes before a basiliximab (Simulect) injection to prevent or minimize acute allergic-type reactions associated with this medication
The nurse would teach a patient prescribed cyclosporine (Neoral) to avoid which of the following? A. Sunscreen B. Chocolate milk C. Grapefruit juice D. Acetaminophen
C. Grapefruit juice
Patients should avoid consuming grapefruit or grapefruit juice because they will increase the blood concentrations of cyclosporine. Sunscreen should be used to avoid photosensitivity, and the medication should be taken with food or chocolate milk to prevent gastrointestinal upset.
_____________ are used to prevent, treat, or cure infectious diseases
Biologics
Vaccinations with _____ bacteria or virus provide lifelong immunity
live
Antitoxins
Antisera
Toxoids
Vaccines
BIOLOGICS
_________ stimulate the production of antigens against a specific antibody
Vaccines
Vaccinations with killed bacteria or virus provide _______ immunity, and booster shots are needed periodically
partial
- The body is exposed to a relatively harmless form of an antigen
- The immune system is stimulated, and “remembers” this antigen if subsequent exposures occur
Active Immunization
Serum or concentrated immune globulins from humans or animals are injected into a person
PASSIVE IMMUNIZATION
_______ EFFECTS OF IMMUNIZING DRUGS ARE:
Fever, minor rash, soreness at injection site, itching, adenopathy
MINOR
The substances needed to fight off invading microorganisms are given directly to a person
PASSIVE IMMUNIZATION
PASSIVE IMMUNIZATION _________ THE IMMUNE SYSTEM
BYPASSES
Passive immunization is ________ compared to active immunization, but it works more ______
short-lived
quickly
TYPE OF IMMUNITY
From mother to fetus through the placenta
From mother to infant through breast milk
Naturally acquired passive immunity
TYPE OF IMMUNITY
Acquired from an external source, such as injection of antibodies or immunoglobulins
Artificially acquired passive immunity
ADVERSE EFFECTS OF IMMUNIZATING DRUGS CAN RANGE FROM ______ & _______ TO ________ OR __________.
MILD & TRANSIENT
VERY SERIOUS OR LIFE THREATNING
NURSING IMPLICATIONS - IMMUNIZING DRUGS
Assess for contraindications, including _______________
immunosuppression
NURSING IMPLICATIONS - IMMUNIZING DRUGS
If discomfort occurs at the injection site, apply ______ compresses and give _____________
WARM
ACETAMINOPHEN
_______ EFFECTS OF IMMUNIZING DRUGS ARE:
Fever higher than 39.4°C, encephalitis, convulsions, anaphylactic reaction, dyspnea, others
SEVERE
________ serious or unusual reactions to the Canadian Adverse Events Following Immunization Surveillance System (CAEFISS)
REPORT
Do not give __________________ to children (Reyes syndrome)
acetylsalicylic acid (Aspirin)
Which of the following statements most accurately describes the pharmacodynamics of vaccines?
A. Vaccines provide passive immunity
B. Vaccines work by suppressing immunoglobulins
C. Vaccines work by stimulating the humoral immune system
D. Vaccines prevent the formation of antibodies against a specific antigen
C. Vaccines work by stimulating the humoral immune system
Vaccines work by stimulating the humoral immune system, which synthesizes immunoglobulins. They also stimulate the formation of antibodies against their specific antigen, providing active immunity.
Which of the following would the nurse monitor for when administering vaccinations? A. Myalgias B. Anaphylaxis C. Pain at the injection site D. Signs and symptoms of infection
B. Anaphylaxis
Anaphylaxis is a potential life-threatening adverse reaction to vaccines. Pain and myalgias can occur but are not life-threatening.
When assessing a patient who will be receiving a passive immunizing drug, which condition will the nurse consider to be a possible contraindication?
a. Anemia
b. Pregnancy
c. Ear infection
d. Common cold
b. Pregnancy
Which of the following provides passive immunity? A. Hepatitis B vaccine B. Pneumococcal vaccine C. Rabies virus vaccine D. Hepatitis B immune globulin
D. Hepatitis B immune globulin
Vaccines provide active immunity by stimulating the humoral immune system. Immunoglobulins provide passive immunity by giving the client substances to fight specific antigens.
Which of the following instructions is important for clients receiving tetanus toxoid to receive?
A. To increase fluid and fibre in diet to prevent constipation
B. That soreness at injection site is a common reaction
C. That they will have a lifetime immunity from this injection
D. That this medication must be repeated weekly x 4
B. That soreness at injection site is a common reaction
Myalgia at the injection site is a common side effect of tetanus toxoid
- Which of the following statements is true of the human papillomavirus (HPV) vaccine (Gardasil)?
A. It is recommended for all prepubescent adolescents
B. It is useful in preventing cervical cancer
C. Most women have passive immunity and do not require the vaccine
D. It is only indicated for women who have abnormal pap smear results
B. It is useful in preventing cervical cancer
The human papillomavirus is responsible for a large proportion of cervical cancers.
Canadian pandemic preparedness planning is focused on which of the following types of pandemic?
A. Anthrax
B. Methicillin-resistant Staphylococcus aureus (MRSA)
C. Influenza
D. Hepatitis
C. Influenza
A type of influenza pandemic is suspected in the near future, and Canadian efforts are designed to prepare the public in terms of immunity through vaccinations
When giving a vaccination to an infant, which adverse effect should the nurse tell the mother to expect?
a. Chills
b. Dyspnea
c. Fever over 39.4°C
d. Soreness at the injection site
d. Soreness at the injection site
After a suspected hepatitis B exposure, prophylactic doses of which of the following would be given to the individual?
a. Immune serum globulin
b. Hepatitis B virus vaccine
c. Hepatitis B immune globulin
d. Rh0(D) immune globulin
c. Hepatitis B immune globulin
During a routine checkup, a 72-year-old patient is
advised to receive an influenza vaccine injection. He questions this, saying, “I had one last year. Why do I need another one?” What is an appropriate response from the nurse?
a. “The effectiveness of the vaccine wears off after
6 months.”
b. “When you reach age 65, you need boosters on an annual basis.”
c. “Taking the flu vaccine each year allows you to build your immunity to a higher level each time.”
d. “Each year a new vaccine is developed on the basis of flu strains that are likely to be in circulation.”
d. “Each year a new vaccine is developed on the basis of flu strains that are likely to be in circulation.”
A patient is in the urgent care centre after stepping on a rusty tent nail. The nurse evaluates the patient’s immunity status. Which of the following is true to necessitate a tetanus booster?
a. It has been a year since his last booster shot.
b. It has been 2 years since his last booster shot.
c. It has been 5 years since his last booster shot.
d. It has been 10 years since his last booster shot.
d. It has been 10 years since his last booster shot.
USES FOR PITUITARY DRUGS
Replacement therapy to make up for _______ deficiency
HORMONE
MECHANISM OF ACTION - PITUITARY DRUGS
Either _________ or __________ the natural effects of the pituitary hormones
augments or antagonizes
INDICATIONS - WHICH PITUITARY DRUG
- Used in the treatment of diabetes insipidus
- Used in the treatment of various types of bleeding, especially gastrointestinal (GI) bleeding
vasopressin (Pressyn) and desmopressin (DDAVP)
INDICATIONS - WHICH PITUITARY DRUG
- Used in the treatment of hemophilia A
- Used in the treatment of type I von Willebrand’s disease
- Bed wetting in children – nocturnal anuresis
desmopressin (DDAVP)
NURSING IMPLICATIONS - PITUITARY DRUGS
Maintain adequate _________ when administering corticotropin.
hydration
NURSING IMPLICATIONS - PITUITARY DRUGS
While taking corticotropin, ________ & _______ intake should be decreased
SODIUM & POTASSIUM
NURSING IMPLICATIONS - PITUITARY DRUGS
Avoid _________ during drug therapy WITH CORTICOTROPIN
vaccinations
NURSING IMPLICATIONS - PITUITARY DRUGS
Monitor for therapeutic effects:
______________should increase growth in children
somatropin (Humatrope)
NURSING IMPLICATIONS - PITUITARY DRUGS
Monitor for therapeutic effects:
__________________ & _____________ should reduce severe thirst and decrease urinary output
desmopressin (DDAVP) and vasopressin (Pressyn)
The contraindications for _____________ are in people whose bones have not stopped growing and a client who has any evidence of an active tumour.
somatropin
NURSING IMPLICATIONS - PITUITARY DRUGS
Monitor for therapeutic effects:
__________ should reduce symptoms of carcinoid crisis
octreotide (Sandostatin)
Identify human GH products made by recombinant DNA techniques
Somatropin and somatrem
In which of the following conditions is somatropin contraindicated? In clients with: A. Dwarfism B. Acromegaly C. Hypopituitarism D. Addison’s disease
B. Acromegaly
Acromegaly is caused by excessive growth hormone, and thus this drug would be contraindicated,
When assessing a patient receiving corticotropin, the nurse notes muscle spasms when the blood pressure cuff is inflated. Based on these assessment findings, the nurse would suspect the patient is experiencing which adverse effects associated with corticotropin therapy? A. Hypokalemia B. Hypocalcemia C. Hypothyroidism D. Hyperglycemia
B. Hypocalcemia
Which of the following would be a priority nursing diagnosis for a client receiving desmopressin (DDAVP)? A. Potential for injury B. Alteration in comfort C. Alteration in fluid volume D. Knowledge deficit
C. Alteration in fluid volume
Desmopressin is a form of antidiuretic hormone, which increases sodium and water retention, leading to an alteration in fluid volume. Although the other nursing diagnoses may be appropriate they are not a priority using Maslow’s hierarchy of needs.
Which of the following points would the nurse include when teaching a client regarding the correct administration of desmopressin (DDAVP)?
A. “Rotate nostrils daily to prevent irritation.”
B. “Take in the morning to prevent nocturia.”
C. “The dose is based upon your chemstick results.”
D. “Weigh yourself daily and take if you gain more than 0.45 kg per day.”
A. “Rotate nostrils daily to prevent irritation.”
Desmopressin works to decrease urine output; thus the client would retain fluid and gain weight. It should be taken at night if used to treat nocturnal enuresis. Because it is administered intranasally, it can be irritating; thus nostrils should be rotated.
Which of the following would the nurse monitor to assess the therapeutic effectiveness of vasopressin?
A. Relief of pain
B. Serum albumin levels
C. Urine specific gravity
D. Adrenocorticotropic hormone (ACTH) levels
C. Urine specific gravity
Vasopressin causes decreased water excretion in the renal tubule, thus increasing urine specific gravity. It is used to treat diabetes insipidus, which presents with a low urine specific gravity.
The nurse admitting a client with acromegaly anticipates administering which of the following medications? A. octreotide B. somatropin C. corticotropin D. desmopressin
A. octreotide
Octreotide suppresses growth hormone, the culprit of acromegaly.
Which of the following is expected with long-term cosyntropin (Cortrosyn) therapy? A. Epistaxis B. Urinary urgency C. Abdominal distention D. Moon face
D. Moon face
Cosyntropin (Cortrosyn) is used as hormone replacement therapy and is associated with anti-inflammatory and immunosuppresant qualities
Which of the following teaching elements is critical to include for patients placed on long-term cosyntropin (Cortrosyn) therapy?
A. Discontinue the drug if blood appears in stool
B. Avoid immunizations
C. Limit fluid intake to 1000 mL per day
D. Avoid exposure to sunlight
B. Avoid immunizations
Cosyntropin (Cortrosyn) will cause immunosuppression, which will hinder the patient’s ability to fight infection. Therefore, immunizations should be avoided.
During a teaching session for a patient who will be taking cosyntropin, which statement should the nurse include?
a. “Restrict fluids to avoid fluid volume excess.”
b. “Vaccinations should be avoided while on this
medication.”
c. “Stop taking the medication if you experience
adverse effects.”
d. “Be sure to increase your sodium and potassium intake while on this drug.”
c. “Stop taking the medication if you experience
adverse effects.”
During an assessment of a patient who has been taking cosyntropin for 4 weeks, which assessment finding should the nurse recognize as being a possible indication of hypocalcemia?
a. Joint pain
b. Muscle twitching
c. Decreased reflexes
d. Visual disturbances
b. Muscle twitching
The nurse is reviewing the medication list for a patient who will be starting therapy with somatropin. Which drug has effects that need to be addressed before the patient starts this new drug?
a. Penicillin
b. Thyroid hormones
c. Antidepressant therapy
d. NSAID therapy for arthritis
b. Thyroid hormones
A patient who is about to be given cosyntropin is also taking a diuretic, intravenous heparin, penicillin, and an opioid as needed for pain. What possible interaction should the nurse should observe for?
a. Decreased effectiveness of the penicillin
b. Increased sedation if the opioid is given
c. Hypokalemia because of interaction with the diuretic
d. Decreased anticoagulation because of interaction with the heparin
c. Hypokalemia because of interaction with the diuretic
When monitoring the therapeutic effects of intranasal desmopressin in a patient who has diabetes insipidus, which assessment would the nurse look for as an indication that the medication therapy is successful?
a. Decreased thirst
b. Decreased diarrhea
c. Improved nasal patency
d. Increased insulin levels
a. Decreased thirst
There are ______ types of HYPOTHYROID deficiencies.
THREE
a condition characterized by low
metabolic rate, retarded growth and sexual development, and possibly intellectual disabilities.
cretinism
Common symptoms of HYPO OR HYPERTHYROIDISM Thickened skin Hair loss Constipation Lethargy Anorexia
HYPOTHYROIDISM
SLUG
Caused by hyposecretion of thyroid hormone during youth
CRETINISM
Characterized by decreased metabolic rate, loss of mental and physical stamina, weight gain, loss of hair, firm edema, yellow dullness of the skin
Myxedema
Caused by hyposecretion of thyroid hormone during adulthood
Myxedema
an enlargement of the thyroid gland (results from overstimulation by elevated levels of TSH)
goitre
MOST COMMON THYROID AUGMENTING DRUG
levothyroxine (Synthroid)
THYROID DRUGS WORK THE SAME WAY AS ______________ ______________
THYROID HORMONES
________ drugs treat all three forms of hypothyroidism
Thyroid
_____________ is the preferred drug because its hormonal content is standardized; therefore, its effect is predictable
levothyroxine
____________ ________ are also used for thyroid replacement in patients whose thyroid glands have been surgically removed or destroyed by radioactive iodine in the treatment of thyroid cancer or hyperthyroidism
thyroid drugs
CONTRAINDICATIONS - \_\_\_\_\_\_\_ DRUGS Known drug allergy to a given drug product Recent myocardial infarction (MI) *** Adrenal insufficiency Hyperthyroidism
THYROID
ADVERSE EFFECTS - THYROID DRUGS
______ ________IS the most significant adverse effect
Cardiac dysrhythmia
ADVERSE EFFECTS - ________ DRUGS
Others include:
Tachycardia, palpitations, angina, hypertension, insomnia, tremors, headache, anxiety, nausea, diarrhea, menstrual irregularities, weight loss, appetite changes, sweating, heat intolerance, others
THYROID
INTERACTIONS - THYROID DRUGS
The metabolism of _____ ______ is affected by the altered body metabolism of hypothyroid states
many drugs
INTERACTIONS - THYROID DRUGS
Dosages of many drugs may need to be __________
adjusted
Thyroid drugs increase the degradation of ___________ ___________ clotting factors
vitamin K–dependent
levothyroxine can increase requirements for _______ & _______
insulin and digoxin
Increased _________ ________ to epinephrine, dopamine, or dobutamine
cardiac responsiveness
Clients taking ________ ___________may need higher synthroid doses to get to optimal levels
SEIZURE MEDICATIONS SUCH AS
phenytoin
carbamazepine
Phenobarbital
Thyroid meds Should be taken on an _____ ________, about an hour before eating in the morning.
empty stomach
Excessive Thyroid Hormones
Hyperthyroidism:
____________ Caused by several diseases
Graves’ disease (most often seen)
HYPERTHYDROIDISM
HYPERTHYROIDISM Affects multiple body systems, resulting in an overall ___________ ___ _____________
increase in metabolism
HYPERTHYROIDISM OR HYPOTHYROIDISM Diarrhea Flushing Increased appetite Muscle weakness Sleep disorders Altered menstrual flow Fatigue Palpitations Nervousness Heat intolerance Irritability
HYPERTHYROIDISM
ENERGIZER BUNNY
Radioactive iodine (131I) works by destroying the ________ _________
thyroid gland
Surgery to remove all or part of the thyroid gland is an effective way to treat __________________
hyperthyroidism
Antithyroid drugs: __________ ___________
methimazole (Tapazole)
propylthiouracil
thioamide derivatives
____________ _________are used to palliate hyperthyroidism and to prevent the surge in thyroid hormones that occurs after surgical treatment or during radioactive iodine treatment for hyperthyroidism
Antithyroid Drugs
WHICH THYROID DRUGS?
May cause liver and bone marrow toxicity
Antithyroid Drugs
WHICH THYROID DRUG Half-life of 9 to 10 days Onset of action of 2 days Peak effects within 3 to 4 weeks Duration of action of 1 to 3 weeks Risk of toxicity
Synthroid - levothyroxine sodium
Levothyroxine may be safely interchanged with other agents without any concern to the client. True or false?
False. It is recommended that clients not switch agents to avoid a variance in therapeutic effects and adverse effects.
NURSING IMPLICATIONS - THYROID DRUGS
ANTITHYROID medication is better tolerated when taken ______ food
with
NURSING IMPLICATIONS - THYROID DRUGS
ANTITHYROID medication should be taken at the ______ ______ each day to maintain consistent blood levels
same time
NURSING IMPLICATIONS - THYROID DRUGS
ANTITHYROID medication should never be _________ _____________
stopped abruptly
NURSING IMPLICATIONS - THYROID DRUGS
PERSONS TAKING ANTITHYROID medication should avoid eating foods high in ______ (seafood, soy sauce, tofu, and iodized salt)
iodine
Propylthioruracil is used for _______________________________.
hyperthyroidism.
Omitting doses of thyroid hormone could possibly result in ________________________.
hypothyroidism.
Which of the following statements demonstrates understanding of discharge medications for a client receiving levothyroxine?
A. “I will double my dose if I gain more than 0.45 kg per day.”
B. “I can expect to see relief of my symptoms within 1 week.”
C. “It is best to take the medication with food to prevent GI upset.”
D. “I will take this medication in the morning so as not to interfere with sleep.”
D. “I will take this medication in the morning so as not to interfere with sleep.”
With which of the following manifestations would the nurse suspect excessive thyroid replacement in a client taking levothyroxine? A. Irritability B. Bradycardia C. Weight gain D. Intolerance to cold
A. Irritability
Clients taking levothyroxine and warfarin should be monitored for which of the following?
A. Cardiac arrhythmias
B. Excessive weight loss
C. Increased risk of bleeding
D. Increased risk of deep vein thrombosis
C. Increased risk of bleeding
Which of the following would be the nurse’s best response to a client receiving propylthiouracil (PTU) who asks the nurse how this medication will help relieve his symptoms? Propylthiouracil:
A. “Helps your thyroid gland use iodine and synthesize hormones better.”
B. “Inhibits the formation of new thyroid hormone, thus gradually returning your metabolism to normal.”
C. “Inactivates any circulating thyroid hormone, thus decreasing signs and symptoms of hyperthyroidism.”
D. “Stimulates the pituitary gland to secrete thyroid-stimulating hormone (TSH), which inhibits the production of hormones by the thyroid gland.”
B. “Inhibits the formation of new thyroid hormone, thus gradually returning your metabolism to normal.”
Which of the following foods high in iodine should the nurse teach clients taking antithyroid medications to avoid? A. Milk B. Eggs C. Seafood D. Chicken
C. Seafood
Which of the following statements demonstrates client understanding of radioactive iodine (I-131) therapy?
A. “I will need to take this drug on a daily basis for at least 1 year.”
B. “This drug will help decrease my cold intolerance and weight gain.”
C. “I will have to isolate myself from my family for 1 week so as not to expose them to radiation.”
D. “This drug will be taken up by the thyroid gland and destroy the cells to reduce my hyperthyroidism.”
D. “This drug will be taken up by the thyroid gland and destroy the cells to reduce my hyperthyroidism.”
When assessing for potential toxicity to propylthiouracil, the nurse will monitor the patient for changes in which of the following laboratory tests? A. Complete blood count (CBC) B. B-type natriuretic peptide (BNP) C. Liver enzymes D. Renal function tests
A. Complete blood count (CBC)
Which patient statement indicates that drug treatment for hypothyroidism is effective?
A. “My heart has stopped palpating.”
B. “I feel more optimistic and not gloomy all the time.”
C. “I am sleeping better and feel rested.”
D. “My menstrual periods have returned.”
B. “I feel more optimistic and not gloomy all the time.”
When monitoring the lab values of a patient who is taking antithyroid drugs, which of the following should the nurse know to watch for?
a. Decreased blood urea nitrogen
b. Increased platelet counts
c. Increased blood glucose levels
d. Decreased white blood cell counts
d. Decreased white blood cell counts
The pharmacy has called a patient to notify her that the current brand of thyroid replacement hormone is on back order. The patient calls the clinic to ask what she should do. What is the best response by the nurse?
a. “You should stop the medication until your current brand is available.”
b. “Go ahead and take the other brand that the pharmacy has available for now.”
c. “You can split the thyroid pills that you have left so that they will last longer.”
d. “Let me ask your physician what should be done; we will need to watch how you do if you switch brands.”
d. “Let me ask your physician what should be done; we will need to watch how you do if you switch brands.”
When assessing the older adult patient, which of the following nonspecific symptoms of hypothyroidism should the nurse look for?
a. Leukopenia, anemia
b. Weight loss, dry cough
c. Loss of appetite, polyuria
d. Cold intolerance, depression
d. Cold intolerance, depression
To help with the insomnia associated with thyroid
hormone replacement therapy, which of the following should the nurse encourage the patient to do?
a. Take the dose first thing in the morning.
b. Use a sedative to assist with falling asleep.
c. Reduce the dosage as needed if sleep is impaired.
d. Take one half the dose at lunch time and the other half 2 hours later.
a. Take the dose first thing in the morning.
The nurse is teaching a patient who has a new prescription for thyroid hormone. Which adverse effect should the patient notify the physician of?
a. Anxiety
b. Headache
c. Palpitations
d. Appetite changes
c. Palpitations
A type of glucose intolerance that develops during pregnancy.
Gestational Diabetes:
The hormone that stimulates the conversion of glycogen to glucose.
Glucagon:
In hypoglycemia, the blood glucose level is less than _______
2.8 MMOL/L
The condition in which the blood glucose level is greater than 7 mmol/L.
Hyperglycemia
An eye disorder resulting from long-term uncontrolled diabetes.
Retinopathy
Inflammation or degeneration of the peripheral nerves resulting from long-term uncontrolled diabetes.
Neuropathy:
This type of diabetes most commonly occurs in children or adolescents.
Type 1:
This type of diabetes is the most common form.
Type 2:
NovoRapid (insulin aspart)
A rapid-acting insulin
Novolin ge NPH (regular)
Short acting
Novolin ge NPH (isophane insulin suspension [NPH])
Intermediate Acting -
Lantus (insulin glargine)
Long acting –
insulin (30/70), biosynthetic
Mixed Human Insulins
A second-generation sulphonylurea used as an oral antidiabetic agent.
glyburide (Diabeta)
An oral antihyperglycemic agent that increases the sensitivity of peripheral tissue to insulin.
Metformin:
Chronic excessive intake of water
Polydipsia:
Excessive eating.
Polyphagia:
A severe metabolic complication of uncontrolled type 1 diabetes
Diabetic ketoacidosis
Symptoms FOR ? (3 Ps – hunger, thirst, peeing) Polyuria Polydipsia Polyphagia Unexplained weight loss Fatigue Hyperglycemia – sign
DIABETES MELLITUS
_____ ____ diabetes mellitus is characterized by a lack of insulin production or the production of defective insulin
Type 1
Complications of which type of diabetes include: Diabetic ketoacidosis (DKA) Hyperosmolar nonketotic syndrome (HNKS)
type 1
Oral hypoglycemics may be used in type 1 diabetes at any time during treatment. True or false?
False. In order for the oral agents to work there must be functioning beta cells in the pancreas. Clients who are insulin dependent do not have any functioning beta cells.
WHICH TYPE OF DIABETES is caused by insulin deficiency and insulin resistance
TYPE 2
IN WHICH TYPE OF DIABETES?
Many tissues are resistant to insulin as a result of reduced number of insulin receptors & less responsive insulin receptors
TYPE 2
\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_Is characterized by: Extreme hyperglycemia Presence of ketones in the serum Acidosis Dehydration Electrolyte imbalances Leads to coma and death if not treated Sweet smelling breath
Diabetic ketoacidosis (really high blood sugar)
Fasting plasma glucose (FPG) levels higher than or equal to ____ mmol/L but less than ____ mmol/L may indicate “prediabetes”
- 1
6. 9
Types of Antidiabetic Drugs
Insulins
Oral hypoglycemic drugs
INSULIN Restores the diabetic patient’s ability to:
_________ carbohydrates, fats, and proteins
________glucose in the liver
______ glycogen to fat stores
Metabolize
Store
Convert
INSULIN AIMS TO ________ the incidence and ________ the onset of long-term complications
REDUCE
DELAY
WHICH TYPE OF INSULIN:
Have a rapid onset of action (10 to 15 minutes)
Rapid-acting insulins
Rapid-acting insulins may be given subcutaneously or via continuous subcutaneous infusion pump (but not ______)
IV
WHICH TYPE OF INSULIN:
Onset of 30 to 60 minutes
Short-acting insulins
WHICH TYPE OF INSULIN:
The only insulin product that can be given by IV bolus, IV infusion, or even intramuscularly
Short-acting insulins - REGULAR INSULIN
WHICH TYPE OF INSULIN:
Is slower in onset and has a more prolonged duration than endogenous insulin
Intermediate-acting
Oral antidiabetic drugs are used for _____ ______ ________
type 2 diabetes
Oral antidiabetic drugs may not be effective unless the patient also makes _________ OR _____________ __________
behavioural or lifestyle changes
Sulfonylureas Meglitinides Biguanides Thiazolidinediones ALPHA-glucosidase inhibitors
Oral antidiabetic drug classes
glyburide (Diabeta)
Sulfonylureas
metformin (Glucophage)
Biguanides
first line therapy for newly diagnosed type 2 diabetes
Biguanides - metformin (Glucophage)
rosiglitazone (Avandia)
Thiazolidinediones
WHICH ORAL ANTIDIABETIC:
Enhances pancreases sensitivity to insulin
Stops prediabetic from becoming diabetic
Thiazolidinediones
WHICH ORAL ANTIDIABETICS MAY CAUSE HYPOGLYCEMIA?
SULFONYLUREAS
glyburide (Diabeta)
WHICH ORAL ANTIDIABETIC:
Decrease production of glucose
Increase uptake of glucose by tissues
Do not increase insulin secretion from the pancreas (do not cause hypoglycemia)
Biguanides
metformin (Glucophage)
WHICH ORAL ANTIDIABETIC:
Decrease insulin resistance
Increase glucose uptake and use in skeletal muscle
Inhibit glucose and triglyceride production in the liver
Thiazolidinediones
rosiglitazone (Avandia)
WHICH ORAL ANTIDIABETIC:
Result in delayed absorption of glucose
Must be taken with meals to prevent excessive postprandial blood glucose elevations (with the first bite of a meal)
ALPHA-glucosidase inhibitors
INDICATIONS FOR WHICH ANTIDIABETIC DRUG?
Used alone or in combination with other drugs, with diet and lifestyle changes, or with both to lower the blood glucose levels in patients with type 2 diabetes
ORAL ANTIDIABETIC
CONTRAINDICATIONS - ________ ANTIDIABETIC DRUG
Known drug allergy
Active hypoglycemia
Severe liver or kidney disease, depending on the required metabolic pathways of the drug
ORAL
ADVERSE EFFECTS OF WHICH ORAL ANTIDIABETIC:
Hypoglycemia, hematological effects, nausea, epigastric fullness, heartburn, many others
Sulfonylureas
ADVERSE EFFECTS OF WHICH ORAL ANTIDIABETIC:
Headache, hypoglycemic effects, dizziness, weight gain, joint pain, upper respiratory infection or flulike symptoms
Meglitinides
ADVERSE EFFECTS OF WHICH ORAL ANTIDIABETIC:
Can cause lactic acidosis, which is rare but lethal if it occurs
Primarily affects gastrointestinal (GI) tract
metformin (Glucophage)
ADVERSE EFFECTS OF WHICH ORAL ANTIDIABETIC:
May cause hepatic toxicity
Thiazolidinediones
ADVERSE EFFECTS OF WHICH ORAL ANTIDIABETIC:
Can cause flatulence, diarrhea, abdominal pain
Do not cause hypoglycemia, hyperinsulinemia, or weight gain
α-glucosidase inhibitors
INTERACTIONS FOR WHICH ORAL ANTIDIABETIC DRUGS
Hypoglycemic effect increases when taken with alcohol, anabolic steroids, many other drugs
Sulfonylureas
INTERACTIONS FOR WHICH ORAL ANTIDIABETIC DRUGS
Allergic cross-sensitivity may occur with loop diuretics and sulfonamide antibiotics
Sulfonylureas
\_\_\_\_\_\_\_\_\_\_\_\_\_\_ SYMPTOMS Early: Confusion, irritability, tremor, sweating Later: Hypothermia, seizures Coma and death will occur if not treated
Hypoglycemia Symptoms
Oral forms of concentrated glucose Buccal tablets, semisolid gel 50% dextrose in water (D50W) Glucagon diazoxide
Glucose-Elevating Drugs
NURSING IMPLICATIONS - ANTIDIABETIC DRUGS
Keep in mind that overall concerns for any diabetic patient________ when the patient:
Is under stress
Has an infection
Has an illness or trauma
Is pregnant or lactating
increase
Check blood glucose level _______ giving insulin
before
_________ vials between hands to mix suspensions instead of shaking them
Roll
Ensure correct timing of insulin dose with _______
meals
When drawing up two types of insulin in one syringe, always withdraw the ___________ insulin first
regular or rapid-acting
Provide thorough patient ______ regarding self-administration of insulin injections, including timing of doses, monitoring blood glucoses, and injection site rotations
education
ORAL ANTIDIABETICS:
Give _____ minutes before meals (usually)
30
ORAL ANTIDIABETICS:
___________ are given with the first bite of each main meal
ALPHA-glucosidase inhibitors
ORAL ANTIDIABETICS:
metformin is taken with meals to reduce ____ _______
GI effects
If _______________ occurs:
Give glucagon
or
Have the patient eat glucose tablets or gel, corn syrup, honey, fruit juice, or nondiet soft drink
or
Have the patient eat a small snack such as crackers or half a sandwich
HYPOGLYCEMIA
Measure hemoglobin A1c to monitor ______________compliance to diet and drug therapy
long-term
Which rapid-acting insulin starts working in less than 15 minutes after administration? A. insulin aspart B. insulin glargine C. insulin Regular D. insulin Ultralente
A. insulin aspart
Which new long-acting insulin mimics natural, basal insulin with its duration of 24 hours? A. insulin aspart B. insulin glargine C. insulin Regular D. insulin Ultralente
B. insulin glargine
Which insulin is used for continuous intravenous infusions? A. insulin glargine B. insulin aspart C. insulin Regular D. insulin Ultralente
C. insulin Regular
Into which of the following sites should insulin be injected for the most consistent absorption? A. Arm B. Thigh C. Abdomen D. Buttocks
C. Abdomen
Which is NOT part of a teaching plan for clients taking oral hypoglycemic agents?
A. Limit your alcohol consumption
B. Report symptoms of anorexia and fatigue
C. Take your medication only as needed
D. Notify your physician if blood glucose levels rise above the level set for you
C. Take your medication only as needed
Which of the following drugs has been associated with a decrease in triglycerides and low-density lipoproteins (LDLs) as well as an increase in HDLs? A. acarbose B. metformin C. repaglinide D. rosiglitazone
B. metformin
Which of the following differentiates alpha-glucosidase inhibitors from the sulphonylureas? Alpha-glucosidase inhibitors:
A. Greatly stimulate pancreatic insulin release
B. Greatly increase the sensitivity of insulin receptor sites
C. Delay the absorption of glucose, leading to lower glucose levels
D. Cannot be used in combination with other antidiabetic agents
C. Delay the absorption of glucose, leading to lower glucose levels
By which of the following actions do sulphonylureas reduce serum glucose? By:
A. Increasing beta-cell stimulation, causing insulin release
B. Decreasing hepatic glucose production
C. Increasing number or sensitivity of insulin receptors
D. All of the above
D. All of the above
Which of the following oral hypoglycemic agents has a quick onset and short duration of action, enabling the client to take the medication immediately before eating and skipping medication if the client does not eat? A. acarbose B. metformin C. repaglinide D. rosiglitazone
C. repaglinide
With which of the following drugs is a client taking insulin at risk for unrecognized hypoglycemia if concurrently prescribed? A. Aspirin B. Codeine C. Thiazide diuretics D. Beta-adrenergic blockers
D. Beta-adrenergic blockers
Which of the following should the nurse do when administering 30 units regular insulin and 70 units NPH insulin?
A. Rotate sites at least once weekly and label the sites used on a diagram
B. Inform the client that mixing insulins will help increase insulin production
C. Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin
D. Use a 23- to 25-gauge syringe with a 1-inch needle for maximum absorption
C. Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin
The nurse would include which of the following statements when teaching a client about insulin glargine?
A. “You can mix this insulin with Lente insulin to enhance its effects.”
B. “You should inject this insulin just before meals because it is fast-acting.”
C. “You cannot mix this insulin with regular insulin and thus will have to take two injections.”
D. “The duration of action for this insulin is approximately 8 to10 hours, so you will need to take it twice a day.”
C. “You cannot mix this insulin with regular insulin and thus will have to take two injections.”
Which of the following methods of administration would achieve the most beneficial effect when the nurse plans to administer glipizide? A. With food B. At bedtime C. 15 minutes post-prandial D. 30 minutes before a meal
D. 30 minutes before a meal
Which of the following drugs would be recommended during diabetic teaching to treat hypoglycemia? A. Acarbose B. Glucagon C. Proponolol D. Bumetanide
B. Glucagon
Assuming the patient eats breakfast at 8:30 AM, lunch at noon, and dinner at 6:00 PM, at what time is the patient at the highest risk of hypoglycemia following an 8:00 AM dose of neutral protamine Hagedorn (NPH) insulin? A. 10 AM B. 2 PM C. 5 PM D. 8 PM
C. 5 PM
Which of the following statements is important to include in a teaching plan for patients taking oral hypoglycemic agents?
A. Eliminate all natural sugars in your diet
B. Expect symptoms of anorexia and fatigue
C. Take your medication only as needed
D. It is important to check your blood glucose levels
D. It is important to check your blood glucose levels
How do the sulfonylureas lower serum glucose levels?
A. By increasing β-cell stimulation to release insulin
B. By delaying glucose absorption in the gut
C. By blocking adipose deposit conversion to glucose
D. By blocking the action of glucagon on muscle stores
A. By increasing β-cell stimulation to release insulin
Which of the following Hbg A1C results indicate that a patient’s diabetes management is effective? A. 0% B. 3% C. 7% D. 10%
C. 7%
A sliding scale insulin administration regime is more likely to be ordered for which of the following patients?
A. Type 1 diabetes management for a healthy 2-year-old child
B. Type 1 diabetes management for a 16-year-old girl starting menses
C. Type 2 diabetes management for a freshly postoperative older adult patient
D. Type 2 diabetes management for a patient with glaucoma
C. Type 2 diabetes management for a freshly postoperative older adult patient
Which of the following patient statements indicate that medication therapy for a patient with type 2 diabetes is effective?
A. “I have more energy to perform my daily activities.”
B. “I am drinking more water to satisfy my extreme thirst.”
C. “I always have to know where the public washrooms are as I urinate frequently.”
D. “I am gaining weight as I am hungry most of the day.”
A. “I have more energy to perform my daily activities.”
Which of the following statements accurately reflects the advantages of using an insulin pump?
A. Insulin delivery goes directly into the bloodstream, thereby mimicking the action of a healthy pancreas
B. Normal blood glucose levels are maintained through the basal/bolus insulin action
C. Hypoglycemia is reduced through the glucose bolus delivery option on the pump
D. Increasing the occurrence of the dawn phenomenon thereby reduces periods of extreme hyperglycemia
B. Normal blood glucose levels are maintained through the basal/bolus insulin action
The nurse is caring for a patient scheduled to undergo a cardiac catheterization procedure utilizing iodine-based contrast material. The nurse would question an order for which of the following medications to be given to this patient the day before the scheduled procedure? A. acarbose (Glucobay) B. metformin (Glucophage) C. repaglinide (GlucoNorm) D. rosiglitazone (Avandia)
B. metformin (Glucophage)
When caring for a patient newly diagnosed with gestational diabetes, the nurse would question which of the following medication orders? A. Insulin glargine (Lantus) B. glipizide C. Insulin glulisine (Apidra) D. NPH insulin (Humulin-N)
B. glipizide
Which of the following is most appropriate regarding
the nurse’s administration of lispro to a hospitalized
patient?
a. It should be given half an hour before a meal.
b. It should be given half an hour after a meal.
c. It should given 15 minutes before the patient begins a meal.
d. The timing of the insulin injection does not matter
with lispro.
c. It should given 15 minutes before the patient begins a meal.
Which of the following statements would be appropriate
to include in the patient teaching for type 2 diabetics?
a. “Insulin injections are never used with type 2
diabetes.”
b. “Because you are not taking insulin injections, it
is not necessary to measure your blood glucose
levels.”
c. “Alcohol should be avoided because it can cause
your blood glucose to fall to lower-than-normal
levels.”
d. “Patients with type 2 diabetes usually have better
control over their diabetes than those with type 1
diabetes.”
c. “Alcohol should be avoided because it can cause
your blood glucose to fall to lower-than-normal
levels.”
Which of the following is a therapeutic response to oral antihyperglycemic drugs?
a. Weight gain of 5 kg
b. Fewer episodes of DKA
c. Hemoglobin A1c levels of 6%
d. Glucose levels of 9.5 mmol/L
c. Hemoglobin A1c levels of 6%
When teaching the patient about drugs that interact
with insulin, which of the following over-the-counter
products should the nurse instruct the patient to avoid, unless otherwise instructed by the physician?
a. Vitamin C
b. Cough syrups
c. Iron supplements
d. Acetaminophen products
b. Cough syrups
A patient with type 2 diabetes has a new prescription for repaglinide (GlucoNorm). After a week, she calls the office to ask what to do because she keeps missing meals. “I work right through lunch sometimes, and I’m not sure if I should take it or not. What should I do?” What is the nurse’s best response?
a. “Go ahead and take the pill when you first remember that you missed it.”
b. “You should try not to skip meals, but if that happens, you should also skip that dose of repaglinide.”
c. “Take both pills with the next meal and try to eat
a little extra to make up for what you missed at
lunchtime.”
d. “We will probably need to change your prescription to insulin injections because you can’t eat meals on a regular basis.”
b. “You should try not to skip meals, but if that happens, you should also skip that dose of repaglinide.”
Glucocorticoids
Mineralocorticoids
Adrenal steroid inhibitors
Adrenal Drugs
WHICH Adrenal Drugs?
Topical, systemic, inhaled, nasal
Glucocorticoids
WHICH Adrenal Drugs?
Systemic
Mineralocorticoids
Adrenal steroid inhibitors
Glucocorticoids inhibit or help control __________ & ___________
inflammatory and immune responses
ADRENAL DRUGS MODIFY __________ ACTIVITY
ENZYME
ADRENAL DRUGS HAVE _________ EFFECTS ON ______ BODY SYSTEMS
POTENT
ALL
SYSTEMIC FORMS OF ADRENAL DRUGS MAY NOT BE GIVEN ______________
SUBCUTANEOUSLY
Oral forms of adrenal drugs should be given with ______ or _____ to minimize GI upset
food or milk
Teach patients on corticosteroids to avoid contact with people with ________ and to report any fever, increased weakness, lethargy, or sore throat
infections
Patients should be taught to take all adrenal medications at the _____ ______ every day, usually in the morning, with meals or food
same time
Adrenal medications should not be taken with ________, _______, or _______________
alcohol, aspirin, or nonsteroidal anti-inflammatory drugs (NSAIDs)
With knowledge of which of the following facts about glucocortcoids does the nurse plan administration of prednisone? Glucocorticoids:
A. Should be administered with food to diminish the risk of gastric irritation
B. Are usually administered on a strict, unchanging schedule in order to prevent adverse reactions
C. Should not be administered intravenously secondary to the risk of hypotension when given parenterally
D. Are usually administered early in the evening to coincide with the natural secretion pattern of the adrenal cortex
A. Should be administered with food to diminish the risk of gastric irritation
Which of the following statements about glucocorticoids is most accurate? Glucocorticoids:
A. decrease serum sodium and glucose levels.
B. influence carbohydrate, lipid, and protein metabolism.
C. are produced in decreased amounts during times of stress.
D. stimulate defense mechanisms to produce immunity.
B. influence carbohydrate, lipid, and protein metabolism.
For a client with which of the following conditions would the nurse question an order for steroids? A. Septic shock B. COPD exacerbation C. Rheumatoid arthritis D. Uncontrolled diabetes mellitus
D. Uncontrolled diabetes mellitus
Which of the following signs and symptoms would the nurse monitor for when assessing for potential side effects of fludrocortisone? A. Hyponatremia B. Hypercalcemia C. Hypokalemia D. Hypovolemia
C. Hypokalemia
Discharge teaching for a client receiving glucocorticoids should include the preferred use of which of the following medications for pain management? A. aspirin B. ibuprofen C. acetaminophen D. naproxen sodium
C. acetaminophen
For which of the following conditions would aromatase inhibitors be recommended?
A. Addison’s disease
B. Adrenal malignancy
C. Cushing’s syndrome
D. Hormone receptor-positive breast cancer.
D. Hormone receptor-positive breast cancer.
When preparing to administer prednisone, the nurse is influenced by which of the following facts about glucocorticoids?
A. Glucocorticoids should be administered with food to diminish the risk of gastric irritation
B. Glucocorticoids are usually administered on a strict, unchanging schedule in order to prevent adverse reactions
C. Glucocorticoids should not be administered intravenously secondary to the risk of hypotension when given parenterally
D. Glucocorticoids are usually administered early in the evening to coincide with the natural secretion pattern of the adrenal cortex
A. Glucocorticoids should be administered with food to diminish the risk of gastric irritation
Abrupt withdrawal of long-term corticoid steroid therapy puts the patient at risk for what type of condition? A. Cushing’s syndrome B. Thyroid storm C. Adrenal insufficiency D. Candidiasis septic shock
C. Adrenal insufficiency
What teaching content should the nurse include for a patient using a steroid inhaler?
A. Rinse the mouth after each use
B. Minimize use of an inhaler to every other day
C. Swish and swallow with mycostatin after each use
D. Boil the mouth piece every week
A. Rinse the mouth after each use
Which of the following statements is correct regarding corticosteroids?
a. They have few adverse effects.
b. They are often used for their anti-inflammatory effects.
c. They may be administered only by inhalant dosage forms.
d. They may be used long term without major
complications
a. They have few adverse effects.
Which statement of the patient shows a poor understanding of the teaching about oral corticosteroid therapy that the patient has received?
a. “I should take this drug with food or milk.”
b. “I will report any fever or sore throat symptoms.”
c. “I will stay away from anyone who has a cold or
infection. ”
d. “I can stop this medication if I have severe adverse effects.”
d. “I can stop this medication if I have severe adverse effects.”
During long-term corticosteroid therapy, the nurse
should monitor the patient for Cushing’s syndrome.
Which of the following characteristics is usually manifested by this syndrome?
a. Weight loss
b. Truncal obesity
c. Muscle thickening
d. Thickened hair growth
b. Truncal obesity
A patient has been prescribed a daily dose of prednisone. At what time of day should the patient take the medication to help reduce adrenal suppression?
a. In the morning
b. At lunchtime
c. At dinnertime
d. At bedtime
c. At dinnertime
