TEST 2

Question 1

DEFINITION: increased formation and secretion of urine

Answer 1

Diuresis

Question 2

DEFINITION: Abnormally low blood pressure that occurs when a person assumes a standing position from a sitting or lying position

Answer 2

Orthostatic hypotension

Question 3

DEFINITION: Abnormally high potassium concentration in the blood, most often because of defective kidney excretion, but it can also be due to excessive dietary potassium

Answer 3

Hyperkalemia

Question 4

DEFINITION: Gout (elevated uric acid); the arthritis caused by tissue buildup of uric acid crystals

Answer 4

Hyperuricemia

Question 5

DEFINITION: Abnormally low sodium concentration in the blood, caused by either inadequate excretion of water or excessive water in the bloodstream

Answer 5

Hyponatremia

Question 6

DEFINITION: The abnormal accumulation of fluid in interstitial spaces

Answer 6

Edema

Question 7

DEFINITION: An abnormal intraperitoneal accumulation of fluid (defined as a volume of 500 mL or greater) containing large amounts of protein and electrolytes

Answer 7

Ascites

Question 8

WHICH DRUG?

MECHANISM OF ACTION: Prevents reabsorption of sodium and water

Answer 8

loop diuretic (water pill): furosemide (LASIX)

Question 9

WHICH DRUG?

COMMON SIDE EFFECTS
Dehydration
Hypotension
Hypokalemia
Hyponatremia
Nausea, dizziness, and others

Answer 9

loop diuretic (water pill): furosemide (LASIX)

Question 10

WHICH DRUG?

DRUG INTERACTIONS

1. Aminoglycosides
2. Corticosteroids

Answer 10

loop diuretic (water pill): furosemide (LASIX)

Question 11

WHICH DRUG?

MECHANISM OF ACTION: Prevents reabsorption of sodium and water and prevents excretion of potassium

Answer 11

potassium-sparing diuretic: spironolactone

Question 12

WHICH DRUG?

COMMON SIDE EFFECTS
Hyperkalemia
Hyponatremia
Dehydration
Hypotension

Answer 12

potassium-sparing diuretic: spironolactone

Question 13

WHICH DRUG?

DRUG INTERACTIONS

1. Lithium
2. Angiotensin converting enzyme inhibitors
3. Potassium supplements

Answer 13

potassium-sparing diuretic: spironolactone

Question 14

WHICH DRUG?

MECHANISM OF ACTION: Prevents reabsorption of sodium and water and not as potent an action as with furosemide

Answer 14

Thiazide and Thiazide-Like Diuretics: hydrochlorothiazide

Question 15

WHICH DRUG?

COMMON SIDE EFFECTS
Hypokalemia
Hypotension
Hypovolemia
Hyponatremia

Answer 15

Thiazide and Thiazide-Like Diuretics: hydrochlorothiazide

Question 16

WHICH DRUG?

DRUG INTERACTIONS

1. Corticosteroids
2. Digoxin

Answer 16

Thiazide and Thiazide-Like Diuretics: hydrochlorothiazide

Question 17

WHICH DRUG?

RELATED NURSING DIAGNOSIS
Risk for injury related to possible fall from postural hypotension (a side effect of the diuretic)

Answer 17

Thiazide and Thiazide-Like Diuretics: hydrochlorothiazide

Question 18

WHICH DRUG?

MECHANISM OF ACTION: It produces an osmotic pressure in the glomerular filtrate, which, in turn, pulls fluid, primarily water, into the renal tubules from the surrounding tissues, resulting in diuresis

Answer 18

Osmotic Diuretics: MANNITOL

Question 19

WHICH DRUG?

COMMON SIDE EFFECTS
Headaches
Chest pains
Tachycardia
Blurred vision Chills
Fever

Answer 19

Osmotic Diuretics: MANNITOL

Question 20

Why is it dangerous to administer both a potassium supplement and agents such as spironolactone?

Answer 20

Spironolactone is a potassium-sparing diuretic. If it is given with a potassium supplement, the client could develop hyperkalemia, which could cause cardiac irregularities, and, if potassium levels are severely high, cardiac arrest could occur.

Question 21

Crystalloids are indicated in which conditions or disorders?

Answer 21

Crystalloids are substances in a solution that diffuse through a semi-permeable membrane. They are most commonly used as maintenance fluids, to promote urinary flow, and to replace body fluids when there are deficits. They are also used to manage fluid and electrolyte disturbances and treat shock, acute nephrosis, and acute liver failure.

Question 22

DEFINITION:
plasma proteins that increase the colloidal osmotic pressure and help move fluid from the interstitial compartment to the plasma compartment by pulling the fluid into the blood vessels.

Answer 22

Colloids

Question 23

___________ ___________ are administered either orally or through intravenous infusion but only if the intravenous dose is adequately diluted.

Answer 23

Potassium supplements

Question 24

Signs and symptoms of early _____________ include anorexia, lethargy, confusion, nausea, muscle weakness, and hypotension.

Answer 24

hypokalemia

Question 25

Normal serum potassium levels range from ____TO_____ mmol/L, and normal serum sodium levels range from ____TO_____ mmol/L.

Answer 25

3.5 to 5

135 to 145

Question 26

________ __________ and packed _____ ___________ cells are currently the most commonly used oxygen-carrying resuscitation fluids.

Answer 26

Whole blood

red blood

Question 27

What type of caution would you give a client who is beginning treatment with a potassium-sparing diuretic?

Answer 27

Potassium-sparing diuretics are often combined with other types of diuretics to prevent hypokalemia.

However, extreme caution should be used, and the client and his or her laboratory values should be monitored closely, especially if he or she is also taking potassium supplements or using a salt substitute. Hyperkalemia, which can be fatal if left untreated, may result.

Question 28

Loop diuretics, which are very potent, work on the ascending loop of Henle to block ________ and ________ reabsorption.

Answer 28

sodium

chloride

Question 29

Loop diuretics also block ________ reabsorption, resulting in diuresis and a reduction of preload and central venous pressure.

Answer 29

water

Question 30

Loop diuretics also reduce peripheral resistance. With a decreased volume and a decreased peripheral resistance, _________ __________ also decreases.

Answer 30

blood pressure

Question 31

______________ dehydration is caused by a loss of sodium and water from the body leading to a decrease in extracellular fluid (ECF) volume. Diarrhea, vomiting, or both are often causes.

Answer 31

Isotonic

Question 32

______________ dehydration results when sodium loss is greater than water loss.

Answer 32

Hypotonic

Question 33

The higher concentrations of solute inside the cells pull fluid from ___________ the cells (i.e., plasma and interstitial) into the cells.

Answer 33

outside

Question 34

____________ dehydration is usually the result of renal insufficiency and inadequate aldosterone secretion.

Answer 34

Hypotonic

Question 35

____________ dehydration occurs when water loss is more than sodium loss.

Answer 35

Hypertonic

Question 36

____________ dehydration results in a concentration of solutes outside the cells and causes fluid in the cell to move outside the cell to the ECF; dehydration of the cells occurs.

Answer 36

Hypertonic

Question 37

____________ dehydration usually occurs with fever accompanied by perspiration.

Answer 37

Hypertonic

Question 38

______________ are fluids that supply water and sodium to maintain the osmotic gradient between extravascular and intravascular compartments.

Answer 38

Crystalloids

Question 39

_____________ are generally used to maintain fluids for insensible fluid losses, to correct body fluid deficits, and to treat specific fluid and electrolyte disturbances.

Answer 39

Crystalloids

Question 40

Examples are _____________ normal saline, hypertonic saline, D5W, Plasma-Lyte, and lactated Ringer’s.

Answer 40

Crystalloids

Question 41

Other uses of _____________ include shock conditions, renal dialysis, burns, acute nephrosis, and cardiopulmonary bypass.

Answer 41

crystalloids

Question 42

A _____________ is a large molecule or an aggregate of molecules that do not precipitate and are dispersed in another medium.

Answer 42

colloid

Question 43

______________ are a substance in a solution that diffuses through a semi-permeable membrane.

Answer 43

Crystalloids

Question 44

______________ solutions contain fluids and electrolytes normally found in the body.

Answer 44

Crystalloid

Question 45

______________ do not contain proteins or colloids that are needed to maintain the colloid osmotic pressure to prevent water from leaving the plasma compartment.

Answer 45

Crystalloids

Question 46

Compared to colloids, crystalloids are distributed ___________ into the interstitial and intracellular compartments, making them better for the treatment of _____________ than for expanding volume, as with hypovolemic shock.

Answer 46

faster

dehydration

Question 47

_______________ cannot expand the plasma volume as well as the colloids because of the protein factor.

Answer 47

Crystalloids

Question 48

The main purpose of ____________ is to remove excess water and sodium which relieves the symptoms associate with heart failure, hypertension and renal disease

Answer 48

diuretics

Question 49

Diuretics act directly upon the __________ within the _____________ to accomplish removal of water and sodium

Answer 49

nephrons

kidneys

Question 50

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

Answer 50

b

Hydrochlorothiazide can cause hyperglycemia.

Question 51

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

Answer 51

b

Spironolactone (Aldactone) is a potassium-sparing diuretic; furosemide (Lasix) is a potassium-losing diuretic. Giving these together minimizes electrolyte imbalance.

Question 52

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

Answer 52

A

Furosemide (Lasix) is a potent loop diuretic, resulting in the loss of potassium as well as water, sodium, and chloride.

Question 53

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

Answer 53

C

Furosemide (Lasix) is effective in patients with creatinine clearance as low as 25 L/min (normal 125 L/min).

Question 54

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

Answer 54

C

Spironolactone (Aldactone) is a potassium-sparing diuretic that could potentially cause hyperkalemia. Bananas are high in potassium and thus should be avoided.

Question 55

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

Answer 55

B

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.

Question 56

Which of the following symptoms is directly related to hyporkalemia?
A Dry mouth
B Ataxia
C Impotence
D Abdominal cramps

Answer 56

D

Muscle-related symptoms, such as abdominal cramps, are associated with hypokalemia.

Question 57

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.”

Answer 57

D

Spironalactone (Aldactone) is a potassium-sparing diuretic, and additional potassium ingestion would put the patient at risk for hyperkalemia.

Question 58

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)

Answer 58

D

Spironolactone (Aldactone) is the direct antagonist for aldosterone.

Question 59

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)

Answer 59

B

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.

Question 60

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

Answer 60

C

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.

Question 61

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

Answer 61

D

Serum potassium levels less than 3.0 mmol/L indicate that additional potassium supplements are required.

Question 62

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

Answer 62

C

To minimize Gwen’s risk for falling at night, a commode should be placed at her bedside.

Question 63

1 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

Answer 63

a

Question 64

2 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

Answer 64

C

Question 65

3 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

Answer 65

C

Question 66

4 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.”

Answer 66

A

Question 67

5 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.”

Answer 67

D

Question 68

Describe the antihypertensive effects of loop diuretics in the treatment of hypertension.

Answer 68

Loop diuretics, which are potent, work on the ascending loop of Henle to block sodium and chloride reabsorption. Thus, they also block water reabsorption, resulting in diuresis and a reduction of preload and central venous pressure. These drugs also reduce peripheral resistance. With a decreased volume and a decreased peripheral resistance, blood pressure also decreases.

Question 69

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

Answer 69

B

Too rapid an infusion of potassium can cause cardiac arrhythmias. Therefore, an intravenous infusion pump must always be a used.

Question 70

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

Answer 70

D

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.

Question 71

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

Answer 71

A

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.

Question 72

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

Answer 72

A

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.

Question 73

2 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

Answer 73

D

Question 74

3 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

Answer 74

A

Question 75

4 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

Answer 75

D

Question 76

5 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

Answer 76

C

Question 77

The five main types of diuretics are:

Answer 77

1. CAIs and loop,
2. osmotic,
3. potassiumsparing,
4. thiazide,
5. thiazide-like diuretics.

Question 78

THE 4 most commonly used DIURETICS:

Answer 78

loop,
potassiumsparing,
thiazide,
thiazide-like diuretics are

Question 79

The nurse must remember that the loop diuretics are more ____________ than the thiazides, combination diuretics, and potassiumsparing diuretics.

Answer 79

potent

Question 80

The two most commonly prescribed loop diuretics are ____________ and _____________.

Answer 80

furosemide

bumetanide

Question 81

________________ is considered the prototypical thiazide diuretic and is used as adjunctive therapy to manage liver cirrhosis, edema, and heart failure.

Answer 81

Hydrochlorothiazide

Question 82

Methods for monitoring for excess and deficit fluid volume states include THE FOLLOWING 4 ASSESSMENTS:

Answer 82

1. ASSESSMENT OF SKIN & MUCOUS MEMBRANES
2. PULSE RATE
3. INTAKE AND OUTPUT
4. DAILY WEIGHTS

Question 83

Several days before transplant surgery, immunosuppressant therapy should begin by the _______ ___________, if at all possible, to help minimize the risk of ___________ that may be caused by _________ __________.

Answer 83

oral route
infection
intramuscular injections

Question 84

This drug is used only for the prevention of liver and kidney transplant rejection.

Answer 84

tacrolimus

Question 85

The primary immunosuppressant agent used in the prevention of kidney, liver, heart, and bone marrow transplant rejection.

Answer 85

cyclosporine

Question 86

This drug is used with cyclosporine and corticosteroid therapy to prevent rejection of transplanted kidney grafts.

Answer 86

daclizumab

Question 87

This drug is used as an adjunct medication to prevent rejection of kidney transplants and to treat severe rheumatoid arthritis.

Answer 87

azathioprine

Question 88

This is the only immunosuppressant currently indicated for the treatment of multiple sclerosis. It reduces the frequency of MS relapses.

Answer 88

glatiramer acetate

Question 89

Common side effects of ______________ include leukopenia, thrombocytopenia, and hepatotoxicity.

Answer 89

azathioprine

Question 90

Cyclosporine is used in the prevention of ________ OF __________, such as with heart, liver, and kidney transplant.

Answer 90

rejection of organs

Question 91

What laboratory studies should be done and monitored prior to the use of immunosuppressants.

Answer 91

Laboratory studies include hemoglobin, hematocrit, white blood cell, and platelet counts. Kidney and liver function studies should also be done

Question 92

Which agents are used for prophylaxis of organ rejection?

Answer 92

IMMUNOSUPPRESSANTS

Question 93

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

Answer 93

B

Immunosuppressants inhibit T lymphocyte synthesis, thus preventing an immune response to organ transplants.

Question 94

Which of the following is an anticipated adverse effect of azathioprine (Imuran)?
A Alopecia
B Nausea
C Tinnitus
D Thrombocytopenia

Answer 94

D

Common adverse effects of azathioprine (Imuran) include leukopenia, thrombocytopenia, and hepatotoxicity.

Question 95

The nurse would anticipate administering which of the following medications to a patient demonstrating acute organ rejection?
A sirolimus (Rapamune)
B azathioprine (Imuran)
C basiliximab (Simulect)
D cyclosporine (Neoral)

Answer 95

D

Cyclosporine (Neoral) is the primary immunosuppressant that is used to both prevent and treat organ rejection.

Question 96

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

Answer 96

D

Adverse reactions to immunosuppressants include neurotoxicity, renal toxicity, hepatotoxicity, and hypertension.

Question 97

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

Answer 97

C

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.

Question 98

1 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

Answer 98

D

Question 99

2 Which of the following would be a contraindication for glatiramer acetate?

a. Acute myalgia
b. Fluid overload
c. Polycythemia
d. Allergy to mannitol

Answer 99

D

Question 100

3 During therapy with azathioprine (Imuran), which adverse effect must the nurse monitor for?

a. Diarrhea
b. Vomiting
c. Bradycardia
d. Thrombocytopenia

Answer 100

D

Question 101

4 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.”

Answer 101

D

Question 102

A 58-year-old recipient of a heart transplant is currently taking cyclosporine to prevent his immune system from rejecting his transplanted heart. How does cyclosporine prevent this patient’s immune system from attacking his transplanted heart?

Answer 102

Cyclosporine works by inhibiting the activation of T cells by blocking the production and release of the cytokine mediator interleukin-2 (IL-2). This prevents IL-2 from attacking cells that appear to be foreign cells, such as cells of a transplanted organ.

Question 103

Mr. G. is about to undergo a right lung transplant. Why should intramuscular injections be kept to a minimum during the time before his surgery?

Answer 103

Medications should be given orally if possible to prevent the risk of infection caused by altering the intact skin, which is the main means of protection and which provides a barrier to bacteria.

Question 104

Patients taking immunosuppressants should be encouraged to avoid ____________ to minimize the risk for infection.

Answer 104

crowds

Question 105

Patients should be educated about the adverse effects of _____________, which include headache and tremor, and advised to avoid consumption of grapefruit and grapefruit juice because of the potential for increase in blood concentrations.

Answer 105

cyclosporine

Question 106

Patients who are to undergo transplant surgery and who are receiving cyclosporine should know that several days before surgery, they may be told to take it with ____________, and they may also be given an oral _______________ as prophylaxis for Candida infections.

Answer 106

corticosteroids

antifungal

Question 107

_________________ decrease or prevent the body’s immune response and include drugs such as azathioprine, cyclosporine, sirolimus, and tacrolimus.

Answer 107

Immunosuppressants

Question 108

Nursing considerations include the possible administration of oral ________________ often given with immunosuppressants to treat oral ______________ that occurs as a result of immunosuppression and fungal overgrowth.

Answer 108

antifungals

candidiasis

Question 109

WHAT KIND OF IMMUNIZING BIOLOGICAL? Antigenic (foreign) preparations of bacterial exotoxins

Answer 109

Toxoids

Question 110

WHAT KIND OF IMMUNIZING BIOLOGICAL?

• Detoxified with chemicals or heat
• Weakened or “attenuated” (killed)
• Cannot regress to a toxic form

Answer 110

TOXOIDS

Question 111

WHAT KIND OF IMMUNIZING BIOLOGICAL? Suspensions of live, attenuated (weakened) or killed (inactivated) microorganisms

Answer 111

VACCINES

Question 112

Vaccinations with live bacteria or virus provide ____________ immunity

Answer 112

lifelong

Question 113

Vaccinations with killed bacteria or virus provide ____________ immunity, and ___________ shots are needed periodically

Answer 113

partial

booster

Question 114

The amount of antibodies produced can be measured in the blood through a ___________ _________

Answer 114

antibody titre

Question 115

THIS KIND OF IMMUNIZATION IS WHEN THE body is exposed to a relatively harmless form of an antigen (either weakened or dead)

Answer 115

ACTIVE IMMUNIZATION

Question 116

LIVE VACCINATIONS given S/Q

Answer 116

Measles, mumps, and rubella virus vaccine

Question 117

THIS KIND OF IMMUNIZATION IS WHEN serum or concentrated immune globulins from humans or animals are injected into a person

Answer 117

PASSIVE IMMUNIZATION

Question 118

THIS KIND OF IMMUNIZATION IS WHEN the immune system is bypassed

Answer 118

PASSIVE

Question 119

THIS KIND OF IMMUNIZATION IS short-lived, but it works more quickly

Answer 119

PASSIVE

Question 120

THIS KIND OF IMMUNIZATION is naturally acquired passive immunity
From mother to fetus through the placenta
From mother to infant through breast milk

Answer 120

PASSIVE

Question 121

2 Passive Immunization Drugs

Answer 121

Antitoxins

Immunoglobulins

Question 122

INDICATIONS OF WHAT KIND OF IMMUNIZATION?

• Prevents infection caused by bacterial toxins or viruses
• Provides long-lasting or permanent immunity

Answer 122

ACTIVE

Question 123

INDICATIONS OF WHAT KIND OF IMMUNIZATION?
Provides quick immunity before a person’s own immune system has a chance to make antibodies (such as in cases of exposure to hepatitis B or rabies viruses)

Answer 123

PASSIVE

Question 124

2 CONTRAINDICATIONS TO IMMUNIZATION

Answer 124

Drug allergy and allergy to egg products

Febrile illness or temporary immunocompromised state (administration is best deferred until after recovery)

Question 125

SERIOUS ADVERSE REACTIONS TO IMMUNIZATION

Answer 125

Fever higher than 39.4°C, encephalitis, convulsions, anaphylactic reaction, dyspnea, others

Question 126

2 NURSING IMPLICATIONS TO GIVING IMMUNIZATIONS

Answer 126

1. Assess patient’s health history, medication history, allergies, pregnancy status
2. If discomfort occurs at the injection site, apply warm compresses and give acetaminophen

Question 127

3 Key components to the Pandemic Preparedness and Response PLAN

Answer 127

1. Preparedness
2. Response
3. Recovery

Question 128

You are caring for a 56 year old man who has recently been admitted because he is in a state of acute rejection of his transplanted heart which he received over a year ago. This client has been on cyclosporine, azathioprine, and prednisone at home and has now had muromonab added to help stop the acute rejection. There has been an outbreak of the influenza virus at your hospital. One of your co-workers suggests vaccinating your client with the flu vaccine that employees have been receiving. How should you respond to this co-worker?

Answer 128

Vaccines contain suspensions of live, attenuated, or killed micro-organisms that are used to promote artificially acquired immunity through activation of the injected individual’s immune system. If the injected individual’s immune system is pharmacologically immunosuppressed (and/or immunosuppressed because of a disease), then he or she cannot mount an antibody response to this foreign substance and runs the risk of actually acquiring the flu.

This is especially true with vaccines other than those that are “killed” suspensions because the compromised or even the “aged” immune system could react with the non-killed forms of vaccines. Some immunizing agents are best deferred until after recovery from a febrile illness or temporary immunocompromised state (e.g., after cancer chemotherapy, and in this scenario, the client’s immune system has become compromised from the antirejection drugs).

So you need to educate your colleague regarding the above scenario and share your knowledge and information (current drug references, pharmacist) with him or her.

Question 129

What are the implications of not having a child properly immunized?

Answer 129

If not properly immunized, children are at risk for the diseases that are covered by the vaccines. Immunizations help produce dramatic declines in the transmission of these infectious, communicable diseases. All risks and benefits should be explained to every child advocate, parent, or legal guardian.

Question 130

What impact have the changes to Canadian immunization schedules had on clients?

Answer 130

Healthcare reform has been invaluable to the goal of having every child immunized throughout the country

Ontario is the only jurisdiction in North America to make the influenza vaccine available free to all residents.

Question 131

Varicella infections occur mostly in which group(s) of people?

Answer 131

primarily occurs in children less than 8 years of age OR

in individuals with compromised immune systems,

Question 132

Explain the reasoning behind the use of the live oral poliovirus vaccine.

Answer 132

Live oral poliovirus vaccine (OPV) should be reserved for mass vaccination campaigns in developing countries to control outbreaks of paralytic polio. It results in increased herd immunity but can cause vaccine associated paralytic polio VAPP

Question 133

List the side effects of immunizing agents.

Answer 133

fever, 
adenopathy, 
minor rash, 
soreness at the injection site, 
arthritis, 
urticaria, 
fever greater than 39°C, 
encephalitis, 
convulsions, 
peripheral neuropathy, 
unconsciousness, 
dyspnea, 
and cyanosis.

Question 134

Rh0(D) immune globulin is indicated for what type of condition?

Answer 134

Rh0(D) immune globulin is indicated for postpartum antibody suppression

Question 135

If a bite occurs from an animal suspected of rabies, what is the schedule for immunization?

Answer 135

a total of five 1 ml intramuscular injections on days 0, 3, 7, 14, and 28 following an animal bite when there is concern for rabies transmission (bites from any animal whose rabies immunization status is unknown or when the animal escapes and cannot be observed for signs of rabies).

Question 136

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

Answer 136

C

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.

Question 137

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

Answer 137

B

Anaphylaxis is a potential life-threatening adverse reaction to vaccines. Pain and myalgias can occur but are not life threatening.

Question 138

Which of the following instructions is important for patients 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 for 4 weeks.

Answer 138

C

Myalgia at the injection site is a common adverse effect of tetanus toxoid.

Question 139

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

Answer 139

B

The human papillomavirus is responsible for a large proportion of cervical cancers.

Question 140

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

Answer 140

C

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.

Question 141

1 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

Answer 141

B

Question 142

2 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

Answer 142

D

Question 143

3 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

Answer 143

C

Question 144

4 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.”

Answer 144

D

Question 145

is the process in which a complete and long-lasting immunity to infection develops because the body is exposed to a disease antigen. It can be a natural immunization (having the disease) or an artificial immunization (having received a vaccine or toxoid).


Answer 145

Active immunization

Question 146

is the process in which substances that contain antibodies or antitoxins that can kill or inactivate pathogens by binding to their antigens are administered. These substances are directly injected into a person (host), and they provide that host with the means to fend off infection, bypassing the host’s own immune system. This is not a long-term type of immunity.

Answer 146

Passive immunization

Question 147

____________ and ____________ are synthetic chemicals that are structurally similar to ADH (Antidiuretic hormone)

Answer 147

vasopressin

desmopressin

Question 148

Somatropin and somatrem are the two __________ _____________ products that are made through recombinant measures.

Answer 148

growth hormone

Question 149

Your client is excited that he is beginning therapy with pituitary agents and is positive about a cure. What would be your most appropriate response and why?

Answer 149

After the client has spoken with the physician, and with others involved in his or her care, about the disease and its symptomatic treatment, you would need to explain to the client that the use of pituitary agents does not produce a cure. These agents provide symptomatic improvement, such as normal fluid volume and electrolyte status and a positive body image. Suggest and encourage support groups and psychotherapy if the client is distressed enough to require this type of supportive regimen.

Question 150

The target of the adrenocorticotropic hormone is the ____________ gland.

Answer 150

adrenal

Question 151

Growth hormone regulates ____________ and __________ processes and promotes skeletal and muscle ___________.

Answer 151

growth
anabolic
growth

Question 152

Antidiuretic hormone has the function of increasing water _____________. It concentrates the urine and causes potent _______________.

Answer 152

reabsorption

vasoconstriction

Question 153

______________ mimics the antidiuretic hormone.

Answer 153

Vasopressin

Question 154

______________ targets mammary glands, stimulates the ejection of milk, and contracts uterine smooth muscle.

Answer 154

Oxytocin

Question 155

The contraindications for ________________ are in people whose bones have not stopped growing and a client who has any evidence of an active tumour.

Answer 155

somatropin

Question 156

In which of the following conditions is somatropin (Humatrope) contraindicated?
A Dwarfism
B Acromegaly
C Hypopituitarism
D Addison’s disease

Answer 156

B

Somatropin (Humatrope) is a synthetic form of growth hormone. Acromegaly is caused by excessive growth hormone, and thus this drug would be contraindicated.

Question 157

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

Answer 157

C

Desmopressin (DDAVP) is a form of antidiuretic hormone, which increases sodium and water retention, leading to an alteration in fluid volume. Although the nursing diagnoses of potential for injury, alteration in comfort, and knowledge deficit may be appropriate, they are not a priority using Maslow’s hierarchy of needs.

Question 158

Which of the following would the nurse monitor to assess the therapeutic effectiveness of vasopressin (Pressyn)?
A Relief of pain
B Serum albumin levels
C Urine specific gravity
D Reduced inflammation

Answer 158

C

Vasopressin (Pressyn) 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.

Question 159

Patients should be encouraged to avoid abrupt _______________ of pituitary drugs because of the negative impact on pituitary hormones and the impact on blood levels of the hormones.

Answer 159

discontinuation

Question 160

Pituitary drugs are used to either ___________ or ______________ the action of endogenous pituitary hormones.

Answer 160

mimic

antagonize

Question 161

Drugs that ___________ the action of endogenous pituitary hormones include cosyntropin, somatropin, vasopressin, and desmopressin.

Answer 161

mimic

Question 162

Drugs that _______________ the actions of endogenous pituitary hormones include octreotide, which suppresses or inhibits certain symptoms related to carcinoid tumours.

Answer 162

antagonize

Question 163

somatropin is a(n) __________ pituitary drug

Answer 163

Anterior

Question 164

vasopressin (Pressyn) and desmopressin (DDAVP) are __________ pituitary drugs

Answer 164

posterior

Question 165

THE FOLLOWING ARE USES OF WHAT KIND OF DRUGS?

• Diagnostic aids to determine hypofunction or hyperfunction of a specific hormonal function
• Replacement therapy to make up for hormone deficiency

Answer 165

PITUITARY

Question 166

WHAT PITUITARY DRUG?

• Are recombinantly made growth hormones (GH)
• Stimulate skeletal growth in patients with deficient GH, such as hypopituitary dwarfism
• AIDS wasting syndrome

Answer 166

somatropin (Humatrope) and somatrem

Question 167

WHAT PITUITARY DRUG?

Carcinoid tumours secrete vasoactive intestinal polypeptide (VIP)

Answer 167

octreotide (Sandostatin)

Question 168

WHAT PITUITARY DRUG?

• Used in the treatment of diabetes insipidus
• Used in the treatment of various types of bleeding, especially gastrointestinal (GI) bleeding
• Used for bed wetting

Answer 168

vasopressin (Pressyn) and desmopressin (DDAVP)

Question 169

desmopressin (DDAVP) and vasopressin (Pressyn) should ___________ severe thirst and ____________ urinary output

Answer 169

reduce

decrease

Question 170

3 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

Answer 170

B

Question 171

5 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

Answer 171

A

Question 172

Your client has been taking thyroid agents for about 16 months and has recently noted palpitations and some heat intolerance. Should you be concerned about this or is this a fairly benign reaction to thyroid replacement? Explain your answer.

Answer 172

Yes, you should be concerned. Increased pulse rate, palpitations, chest pain, irritability, nervousness, heat intolerance, and increased sweating may indicate excessive amounts of thyroid supplements and the need for a reduction in dosage by the physician.

Question 173

Levothyroxine may be safely interchanged with other agents without any concern to the client. True or false?

Answer 173

False. It is recommended that clients not switch agents to avoid a variance in therapeutic effects and adverse effects.

Question 174

Propylthioruracil is used for ______________

Answer 174

hyperthyroidism.

Question 175

Omitting doses of thyroid hormone could possibly result in _________________

Answer 175

hypothyroidism.

Question 176

Too much _______________ hormone may result in depression, constipation, loss of appetite, weight gain, cold intolerance, syncope, nervousness, irritability, and tachycardia.

Answer 176

thyroid

Question 177

Drug interactions associated with ____________ hormones include other antithyroid medications, oral anticoagulants, digitalis glycosides, cholestyramine, hypoglycemic agents, and epinephrine.

Answer 177

thyroid

Question 178

Radioactive iodine (131I) works by destroying the ___________ ___________ and is used to treat thyroid ____________.

Answer 178

thyroid gland

cancer

Question 179

WHAT THYROID CONDITION?
Caused by hyposecretion of thyroid hormone during youth
Characterized by low metabolic rate, retarded growth and sexual development, possibly mental retardation
Identified in newborn screening with heel stick

Answer 179

CRETINISM

Question 180

WHAT THYROID CONDITION?
Characterized by decreased metabolic rate, loss of mental and physical stamina, weight gain, loss of hair, firm edema, yellow dullness of the skin
- Underactive thyroid = slug

Answer 180

Myxedema

Question 181

A _____________, an enlargement of the thyroid gland, may result from overstimulation by elevated levels of TSH

Answer 181

goitre

Question 182

WHICH Thyroid Augmentation Drug?

Synthetic thyroid hormone T4

Answer 182

levothyroxine (Eltroxin, Euthyrox, Synthroid)

Question 183

TRUE OR FALSE? THYROID DRUGS CAN BE INTERCHANGED FREELY.

Answer 183

FALSE

Question 184

________________ is the preferred thyroid augmentation drug because its hormonal content is standardized; therefore, its effect is predictable

Answer 184

levothyroxine

Question 185

TOO MUCH thyroid augmentation MEDS LEAD TO WHAT ADVERSE EFFECT?

Answer 185

HYPERTHYROIDISM-LIKE SYMPTOMS

OPPOSITE OF SLUG

Question 186

The metabolism of many drugs is affected by the altered body metabolism of hypothyroid states.
Consequently, dosages of many drugs may need to be ______________

Answer 186

adjusted

Question 187

Thyroid drugs increase the degradation of vitamin K–dependent ______________ factors

Answer 187

clotting

Question 188

levothyroxine can increase requirements for ____________ and _____________

Answer 188

INSULIN

digoxin

Question 189

IF SOMEONE TAKES _______________ MEDS, THEY MAY NEED HIGHER SYNTHROID DOSES TO GET TO OPTIMAL LEVELS

Answer 189

SEIZURE

Question 190

WHICH THYROID DRUG HAS A REALLY LONG Half-life: of 9 to 10 days

Answer 190

levothyroxine sodium (Eltroxin, Euthyrox, Synthroid)

Question 191

Which of the following statements demonstrates understanding of discharge medications for a patient receiving levothyroxine (Eltroxin)?
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 on an empty stomach.”
D “I will take this medication in the morning so as not to interfere with sleep.”

Answer 191

D

Levothyroxine (Eltroxin) increases basal metabolism and thus wakefulness.

Question 192

With which of the following manifestations would the nurse suspect excessive thyroid replacement in a patient taking levothyroxine (Eltroxin)?
A Irritability
B Bradycardia
C Weight gain
D Intolerance to cold

Answer 192

A

Irritability is a symptom of hyperthyroidism. Irritability is an indication of levothyroxine (Eltroxin) toxicity.

Question 193

Patients taking levothyroxine (Eltroxin) and warfarin (Coumadin) 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

Answer 193

D

Levothyroxine (Eltroxin) can compete with protein-binding sites of warfarin (Coumadin), allowing more warfarin to be unbound (or free), thus increasing effects of warfarin and risk of bleeding.

Question 194

A patient receiving propylthiouracil (PTU) asks the nurse to explain the connection between the medication and his symptoms. What is the nurse’s best response?
A “PTU helps your thyroid gland use iodine and synthesize hormones better.”
B “PTU inhibits the formation of new thyroid hormone, thus gradually returning your metabolism to normal.”
C “PTU inactivates any circulating thyroid hormone, thus decreasing signs and symptoms of hyperthyroidism.”
D “PTU stimulates the pituitary gland to secrete thyroid-stimulating hormone (TSH), which inhibits the production of hormones by the thyroid gland.”

Answer 194

B

Propylthiouracil (PTU) is an antithyroid medication used to treat hyperthyroidism. It works by inhibiting the synthesis of new thyroid hormone. It does not inactivate present hormone.

Question 195

Which of the following foods should the nurse teach patients taking antithyroid medications to avoid?
A Milk
B Eggs
C Seafood
D Chicken

Answer 195

C

Seafood contains high amounts of iodine and regular consumption could lead to toxicity.

Question 196

Which of the following statements demonstrates patient 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.”

Answer 196

D

Radioactive iodine is an antithyroid medication that is administered orally for one or two doses only. It concentrates in the thyroid gland, enabling the radiation to destroy the hyperplastic cells.

Question 197

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

Answer 197

A

Several blood dyscrasias, including thrombocytopenia and leukopenia can occur, with antithyroid drugs. A CBC is the blood test to monitor thrombocyte (platelet) and white blood cell counts.

Question 198

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.”

Answer 198

B

A symptom of hypothyroidism is depression. Therefore, effective hormone replacement should elevate the patient’s affect.

Question 199

Thyroxine (T4) and triiodothyronine (T3) are the two hormones produced by the ____________ gland; thyroid hormone is made by iodination and coupling with the amino acid tyrosine

Answer 199

thyroid

Question 200

Thyroid ___________ is generally done carefully by a health care provider, with frequent monitoring of serum levels until there appears to be stabilization. Nurses must monitor and review laboratory values to be sure that serum levels are within normal limits to avoid possible _____________.

Answer 200

replacement

toxicity

Question 201

Hyperthyroidism is caused by ___________ secretion of thyroid hormone from the thyroid gland and may be attributed to different diseases (Graves’ disease, Plummer’s disease, and multinodular disease) or drugs.

Answer 201

excessive

Question 202

Patients should report the occurrence of excitability, _____________, or anxiety to their health care provider because these symptoms may indicate _____________ toxicity.

Answer 202

irritability

levothyroxine

Question 203

1 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

Answer 203

D

Question 204

2 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.”

Answer 204

D

Question 205

3 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

Answer 205

D

Question 206

4 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.

Answer 206

A

Question 207

5 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

Answer 207

C

Question 208

form of hyperthyroidism that can be precipitated by stress, or by an infection, or by the sudden withdrawal of thyroid hormones (owing to a thyroidectomy or an abrupt withdrawal of antithyroid drugs).

Answer 208

THYROID STORM

Question 209

DEFINITION: A type of glucose intolerance that develops during pregnancy.

Answer 209

gestational

Question 210

DEFINITION: The hormone that stimulates the conversion of glycogen to glucose.

Answer 210

glucagon

Question 211

DEFINITION: In hypoglycemia, the blood glucose level is less than ____.

Answer 211

2.8 mmol/L

Question 212

DEFINITION: The condition in which the blood glucose level is greater than 7 mmol/L.

Answer 212

hyperglycemia

Question 213

DEFINITION: An eye disorder resulting from long-term uncontrolled diabetes.

Answer 213

retinopathy

Question 214

DEFINITION: Inflammation or degeneration of the peripheral nerves resulting from long-term uncontrolled diabetes.

Answer 214

neuropathy

Question 215

DEFINITION: This type of diabetes most commonly occurs in children or adolescents.

Answer 215

type 1

Question 216

DEFINITION: This type of diabetes is the most common form.

Answer 216

TYPE 2

Question 217

DEFINITION: A rapid-acting insulin.

Answer 217

lispro insulin

Question 218

DEFINITION: A long-acting insulin.

Answer 218

insulin glargine

Question 219

DEFINITION: A second-generation sulphonylurea used as an oral antidiabetic agent.

Answer 219

gliclazide

Question 220

DEFINITION: An oral antihyperglycemic agent that increases the sensitivity of peripheral tissue to insulin.

Answer 220

metformin

Question 221

DEFINITION: Chronic excessive intake of water.

Answer 221

polydipsia

Question 222

DEFINITION: Excessive eating.

Answer 222

polyphagia

Question 223

DEFINITION: A severe metabolic complication of uncontrolled type 1 diabetes.

Answer 223

diabetic ketoacidosis

Question 224

Signs and symptoms of _____________ include restlessness, hunger, irritability, nervousness, tachycardia, shakiness, pallor, sweating, headache, confusion, and memory difficulties.

Answer 224

hypoglycemia

Question 225

Common causes of ______________ include too much medication or medication administered at the wrong time; delayed, missed, or inadequate food intake; increased activity/exercise; and alcohol ingestion.

Answer 225

hypoglycemia

Question 226

Clients with _________ __________ should avoid alcohol consumption because alcohol is broken down in the body to simple carbohydrates, which leads to increases in blood glucose. In addition, alcohol can increase insulin’s ____________ effects.

Answer 226

diabetes mellitus

hypoglycemic

Question 227

Oral hypoglycemics may be used in type 1 diabetes at any time during treatment. True or false?

Answer 227

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.

Question 228

___________ ___________ insulin dosing is a method in which regular insulin doses are adjusted according to blood glucose test results at regular intervals during the day.

Answer 228

Sliding scale

Question 229

3 main symptoms of Diabetes Mellitus

Answer 229

Polyuria - PEEING
Polydipsia - THIRST
Polyphagia - HUNGER

Question 230

TYPE 1 OR TYPE 2 DIABETES?

• characterized by a lack of insulin production or the production of defective insulin
• affected patients need exogenous insulin

Answer 230

TYPE 1

Question 231

TYPE 1 OR TYPE 2 DIABETES?

• most common type of diabetes mellitus
• caused by insulin deficiency and insulin resistance

Answer 231

TYPE 2

Question 232

2 Major Long-Term Complications of Diabetes Mellitus

Answer 232

1. Macrovascular (atherosclerotic plaque)
   Coronary arteries
   Cerebral arteries
   Peripheral vessels
2. Microvascular (capillary damage)
   Retinopathy
   Neuropathy
   Nephropathy

Question 233

WHICH ACUTE DIABETIC COMPLICATION:
Extreme hyperglycemia
Presence of ketones in the serum
Acidosis
Dehydration
Electrolyte imbalances
Leads to coma and death if not treated

Answer 233

Diabetic ketoacidosis

Question 234

Fasting plasma glucose (FPG) levels MORE THAN ________ mmol/L but less than ________ mmol/L may indicate “prediabetes”

Answer 234

6

6.9

Question 235

Treatment for Diabetes Mellitus - TYPE 1?

Answer 235

INSULIN THERAPY

Question 236

Treatment for Diabetes Mellitus - TYPE 2?

Answer 236

• Lifestyle changes
• Oral drug therapy
• Insulin when the above no longer provide glycemic control

Question 237

WHICH KIND OF INSULIN?

• Have a rapid onset of action (10 to 15 minutes)
• CLEAR
• MAKE SURE FOOD IS AVAILABLE
• Have a shorter duration of action

Include:
insulin aspart (NovoRapid)
insulin lispro (Humalog)
insulin glulisine (Apidra)

Answer 237

Rapid-acting insulins

Question 238

WHICH KIND OF INSULIN?

• Onset of 30 to 60 minutes
• regular insulin (Humulin R, Novolin ge Toronto)
• The only insulin product that can be given by IV bolus, IV infusion, or even intramuscularly

Answer 238

Short-acting insulins

Question 239

WHICH KIND OF INSULIN?

• insulin isophane, also called NPH (Humulin-N, Novolin ge NPH)
• Has a CLOUDY appearance
• Is slower in onset and has a more prolonged duration than endogenous insulin

Answer 239

Intermediate-acting

Question 240

EXMPLE OF COMBINATION INSULIN PRODUCT

Answer 240

regular insulin 30% and NPH 70% (Humulin 30/70;

Question 241

DEFINITION: Subcutaneous short-acting or regular insulin doses are adjusted according to blood glucose test results

Answer 241

Sliding-Scale Insulin Dosing

Question 242

TRUE OR FALSE? Oral antidiabetic drugs may not be effective unless the patient also makes behavioural or lifestyle changes

Answer 242

TRUE

Question 243

WHICH Oral Antidiabetic Drug?

First generation: chlorpropamide (Novo-Propamide), tolbutamide
Second generation: glyburide (Diabeta, Euglucon, generic)

Answer 243

Sulfonylureas

Question 244

WHICH Oral Antidiabetic Drug?

metformin (Glucophage)
Should be first-line therapy

Answer 244

Biguanides

Question 245

WHICH Oral Antidiabetic Drug?

also known as glitazones
pioglitazone (Actos), rosiglitazone (Avandia)

Answer 245

Thiazolidinediones

Question 246

Mechanism of Action: Sulfonylureas (GLIBURIDE)

• Stimulate insulin secretion from the ________ cells of the ___________, thus increasing insulin levels
• Result: lower blood glucose levels

Answer 246

beta

pancreas

Question 247

Mechanism of Action: Biguanides (METFORMIN)

• ____________ production of glucose
• Do not increase insulin secretion from the ____________
• Make you produce ________ blood sugar

Answer 247

Decrease
pancreas
less

Question 248

Mechanism of Action: Thiazolidinediones (AVANDIA)
Decrease insulin ______________
Are referred to as insulin-____________ drugs

Answer 248

resistance

sensitizing

Question 249

Mechanism of Action: ALPHA-glucosidase inhibitors

Must be taken with ___________ to prevent excessive postprandial blood glucose elevations

Answer 249

meals

Question 250

2 CONTRAINDICATIONS TO ORAL DIABETIC DRUGS:

Answer 250

• Severe liver or kidney disease

- Active hypoglycemia

Question 251

ADVERSE EFFECTS: Sulfonylureas

Answer 251

Hypoglycemia, hematological effects, nausea, epigastric fullness, heartburn, many others

Question 252

ADVERSE EFFECTS: metformin (Glucophage)

Answer 252

Primarily affects gastrointestinal (GI) tract: abdominal bloating, nausea, cramping, diarrhea, feeling of fullness

Question 253

metformin Does not cause _______________

Answer 253

hypoglycemia

Question 254

ADVERSE EFFECTS: Thiazo’liverd’inediones

Answer 254

hepatic toxicity—monitor liver alanine aminotransferase (ALT) levels

Question 255

DEFINITION: Abnormally low blood glucose level (below 2.8 mmol/L)

Answer 255

HYPOGLYCEMIA

Question 256

SYMPTOMS OF HYPOGLYCEMIA

Answer 256

Confusion, irritability, tremor, sweating

Question 257

TRUE OR FALSE?

When drawing up two types of insulin in one syringe, always withdraw the regular or rapid-acting insulin first

Answer 257

TRUE

Question 258

TRUE OR FALSE?

metformin is on an empty stomach

Answer 258

FALSE

taken with meals to reduce GI effects

Question 259

TRUE OR FALSE?

alpha-glucosidase inhibitors are given with the first bite of each main meal

Answer 259

TRUE

Question 260

WHAT ARE THE NURSING ACTIONS If hypoglycemia occurs:

Answer 260

Give glucagon

Have the patient eat glucose tablets or gel, corn syrup, honey, fruit juice, or nondiet soft drink

Have the patient eat a small snack such as crackers or half a sandwich

Question 261

Which rapid-acting insulin starts working in less than 15 minutes after administration?
A insulin lispro (Humalog)
B insulin glargine (Lantus)
C regular insulin (Humulin-R)
D insulin detemir (Levemir)

Answer 261

A

Insulin lispro (Humalog) is a rapid-acting insulin. Insulin glargine (Lantus) and insulin detemir (Levemir) are long acting. Regular insulin (Humalin-R) is short acting.

Question 262

Which new long-acting insulin mimics natural, basal insulin with its duration of 24 hours?
A insulin lispro (Humalog)
B insulin glargine (Lantus)
C regular insulin (Humulin-R)
D insulin detemir (Levemir)

Answer 262

B

Insulin glargine (Lantus) has a duration of action of 24 hours with no peaks, mimicking the natural, basal insulin secretion of the pancreas.

Question 263

Which insulin is used for continuous intravenous infusions?
A insulin lispro (Humalog)
B insulin glargine (Lantus)
C regular insulin (Humulin-R)
D insulin detemir (Levemir)

Answer 263

C

Regular insulin (Humulin-R) is the only insulin used for intravenous therapy.

Question 264

Into which of the following sites should insulin be injected for the most consistent absorption?
A Arm
B Thigh
C Abdomen
D Buttocks

Answer 264

C
The abdomen has the most consistent absorption because the blood flow to the subcutaneous tissue typically is not as affected by muscular movements as it could be in the arm or thigh; therefore, it should be used for insulin injection.

Question 265

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

Answer 265

C
Breakfast eaten at 8:30 AM would cover the onset of NPH insulin, and lunch at noon will cover the 2 PM time frame. However, if the client does not eat a mid-afternoon snack, the NPH insulin may be peaking just before dinner at 6 PM, without sufficient glucose on hand to prevent hypoglycemia.

Question 266

How do α-glucosidase inhibitors differ from the sulfonylureas?
A α-glucosidase inhibitors stimulate pancreatic insulin release
B α-glucosidase inhibitors increase the sensitivity of insulin receptor sites
C α-glucosidase inhibitors delay the absorption of glucose, leading to lower glucose levels
D α-glucosidase inhibitors cannot be used in combination with other antidiabetic agents

Answer 266

C

α-glucosidase is an enzyme necessary for the absorption of glucose from the gastrointestinal tract. Inhibiting this enzyme inhibits glucose absorption, delaying rises in postprandial serum glucose levels.

Question 267

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

Answer 267

A

The three major pharmacodynamic actions of sulfonylurea drugs include increasing β-cell stimulation for insulin release, decreasing hepatic glucose production, and increasing insulin sensitivity.

Question 268

Which of the following drugs will put the patient at risk for unrecognized hypoglycemia if he or she has insulin concurrently prescribed?
A acetylsalicylic acid (aspirin)
B codeine
C Thiazide diuretics
D β-adrenergic blockers

Answer 268

D

β-adrenergic blockers block the initial sympathetic response to hypoglycemia; therefore, the patient will not exhibit the initial symptoms of nervousness, diaphoresis, and sweating that typically alert the patient to the onset of hypoglycemia.

Question 269

Which of the following is important when mixing 30 units regular insulin and 70 units NPH insulin in the same syringe?
A Rotate sites at least once weekly and label the sites used on a diagram
B Inform the patient 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-cm needle for maximum absorption

Answer 269

C

Drawing up the regular insulin into the syringe first prevents accidental mixture of NPH insulin into the vial of regular insulin, which could cause an alteration in the onset of action of the regular insulin.

Question 270

Which of the following drugs would be recommended during diabetes teaching to treat hypoglycemia?
A acarbose (Glucobay)
B glucagon
C proponolol
D bumetanide

Answer 270

B

Glucagon stimulates glycogenolysis, raising serum glucose levels.

Question 271

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

Answer 271

C

Sliding scale regimes are normally ordered during times of additional stress in the life of a person with diabetes. An operative procedure is an example of an additional stressor that will cause a rise in blood glucose levels in response to the stressor.

Question 272

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.”

Answer 272

A

Once serum glucose levels are regulated, signs of hyperglycemia should disappear. Having energy stores to draw from to complete activities of daily living is an indicator that the insulin is sufficient to remove glucose from the blood into energy stores. Thirst, polyuria, and hunger are signs of extreme hyperglycemia.

Question 273

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

Answer 273

B

Insulin pumps allow both tight control and flexibility in management of type 1 diabetes. Normal blood glucose levels can be tightly managed by administering both a basal rate of insulin and bolus amount when needed.

Question 274

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)

Answer 274

B

All currently available oral hypoglycemic drugs are contraindicated for pregnant patients due to the lack of consistent evidence that firmly supports the safe use for pregnant patients.

Question 275

1 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.

Answer 275

c

Question 276

2 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.”

Answer 276

c

Question 277

3 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

Answer 277

c

Question 278

4 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

Answer 278

b

Question 279

5 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.”

Answer 279

b

Question 280

What actions would be necessary in the nursing care of the patient with type 1 diabetes mellitus who is on NPO status for surgery but has orders for the usual morning dose of Humulin N insulin? Explain your answer. (al 616)
al, Linda Lane Lilley et. Pharmacology for Canadian Health Care Practice, 2nd Edition. Elsevier Health Sciences, 2011. .

Answer 280

If the patient is to have nothing by mouth (i.e., is NPO) in preparation for surgery and still receives the usual morning dosage of Humulin N insulin, there will be no carbohydrates for the insulin to work on. Therefore, the individual’s blood sugar will drop significantly with hypoglycemia, and subsequent patient injury (tachycardia, palpitations, confusion, drowsiness) is possible; if the hypoglycemia is severe, convulsions and coma are possible. The insulin should not be given to a patient who is NPO, but the physician should be notified and orders clarified.

Question 281

Insulin normally facilitates removal of ___________ from the blood and its storage as glycogen in the ______________.

Answer 281

glucose

liver

Question 282

The nurse should always check for allergies to specific medications and to ____________ before giving insulin.

Answer 282

pork

Question 283

Information on __________ care and the prevention of ____________ should be part of the patient education given to individuals with diabetes.

Answer 283

foot

infection

Question 284

The nurse must remember that oral antidiabetic drugs are not to be used in __________ ___________.

Answer 284

pregnant women

Question 285

Patients should be encouraged to avoid ___________ and _____________, follow all dietary instructions, and never skip meals or skip insulin. (al 614)
al, Linda Lane Lilley et. Pharmacology for Canadian Health Care Practice, 2nd Edition. Elsevier Health Sciences, 2011. .

Answer 285

smoking

alcohol

Question 286

QUICK TREATMENT FOR HYPOGLYCEMIA:

Answer 286

having quick sources of glucose on hand such as candy, sugar packets, OTC glucose tablets, sugar cubes, honey, corn syrup, orange juice, and nondiet soda beverages

Question 287

QUICK TREATMENT FOR HYPERGLYCEMIA:

Answer 287

having more insulin on hand

Question 288

Patients should be informed about situations or conditions that lead to altered serum glucose SUCH AS:

Answer 288

fever, 
illness, 
stress, 
increased activity or exercise, 
surgery, 
emotional distress

Question 289

Patients should be informed to notify the physician if the patient notes any:

Answer 289

yellow discoloration of the skin, 
dark urine, 
fever, 
sore throat, 
weakness, 
unusual bleeding
easy bruising (with any antidiabetic drug regimen)

Question 290

Patients should be educated about not skipping _____________ or _______________; if problems with either occur, patients should contact their health care provider.

Answer 290

meals

MEDICATIONS

Question 291

TRUE OR FALSE?

Some of the oral antihyperglycemic drugs cause sensitivity to light

Answer 291

TRUE

thus patients should always wear protective eyewear and sunscreen and avoid unprotected sun exposure (including use of tanning beds).

Question 292

Prednisone may be used to treat a variety of disorders and conditions.

Answer 292

Oral prednisone is often used with autoimmune disorders, collagen disorders, inflammatory conditions, immunosuppression, and palliative effects of selected neoplasms.

Question 293

Fludrocortisone is a synthetic mineralocorticoid used as replacement therapy in adrenocortical insufficiency and with those suffering from chronic severe __________ ______________.

Answer 293

postural hypotension

Question 294

LIST 5 COMMON SIDE EFFECTS OF PREDNISON

Answer 294

gastrointestinal upset, 
fragile skin
hyperglycemia
heart failure
edema

Question 295

____________ (pregnancy category C) can cross the placenta and produce fetal abnormalities. They may also be secreted in breast milk and cause ______________ in the nursing infant.

Answer 295

Corticosteroids

abnormalities

Question 296

All adrenal cortex hormones are ___________ hormones

Answer 296

steroid

Question 297

_________________ inhibit or help control inflammatory and immune responses

Answer 297

Glucocorticoids

Question 298

Different adrenal drugs differ in their potency, duration of action, and the extent to which they cause salt and fluid ______________

Answer 298

retention

Question 299

adrenal drug indications

Answer 299

Dermatological diseases

Exacerbations of chronic respiratory illnesses, such as asthma and COPD

Organ transplant (decrease immune response)

Question 300

adverse effects of adrenal drugs:

Answer 300

1. hyperglycemia
2. fragile skin
3. peptic ulcers
4. cardiac problems (hypertension) related to electrolyte imbalance
5. steroid psychosis
6. muscle weakness

Question 301

Sudden discontinuation of these adrenal drugs can precipitate an ________ __________ caused by a sudden drop in serum levels of cortisone

Answer 301

adrenal crisis

Question 302

Biological functions of ______________ include anti-inflammatory actions; maintenance of normal blood pressure; carbohydrate, protein, and fat metabolism; and stress effects.

Answer 302

glucocorticoids

Question 303

Biological functions of _______________ include sodium and water reabsorption, blood pressure control, and maintaining of potassium levels and pH levels of blood.

Answer 303

mineralcorticoids

Question 304

1 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.

Answer 304

a

Question 305

2 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.”

Answer 305

d

Question 306

3 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

Answer 306

b

Question 307

4 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

Answer 307

c

Question 308

5 Which teaching is appropriate for a patient who is taking an inhaled glucocorticoid for asthma?

a. “Blow your nose after taking the medication.”
b. “Do not rinse the mouth after taking the medication.”
c. “Exhale while pushing in on the canister of the inhaler.”
d. “Rinse the mouth thoroughly after taking the medication.”

Answer 308

d

Question 309

1 A 19-year-old man is admitted through the emergency department after a motorcycle accident. He is conscious upon admission, has stable vital signs, and has minimal cuts and abrasions on the left side of his body. You perform a thorough neurological examination and find absence of sensation to light touch and pinprick and lower extremity paralysis. Reflexes are absent below the groin area. The physician orders high-dose intravenous methylprednisolone. What is the purpose of this medication.

Answer 309

Methylprednisolone most likely was ordered to help decrease the cerebral edema associated with head injury after the accident and to decrease any swelling around the spinal cord.

Question 310

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

Answer 310

A

Glucocorticoids can cause gastrointestinal distress and should be administered with food. The normal circadian secretion of the adrenal cortex is early morning to wake the patient up, not early evening. These medications should be tapered off slowly to prevent adrenal crisis, and they can be administered intravenously.

Question 311

Which of the following statements about glucocorticoids is most accurate?
A They decrease serum sodium and glucose levels
B They influence carbohydrate, lipid, and protein metabolism
C They are produced in decreased amounts during times of stress
D They stimulate defense mechanisms to produce immunity

Answer 311

B

Glucocorticoids play a major role in carbohydrate, lipid, and protein metabolism within the body. They suppress the immune system, increase sodium and glucose levels, and they are produced in increasing amounts during stress.

Question 312

Which of the following patient conditions would cause the nurse to question a corticosteroid order?
A Septic shock
B Chronic obstructive pulmonary disease (COPD) exacerbation
C Rheumatoid arthritis
D Uncontrolled diabetes mellitus

Answer 312

D

A common adverse effect of steroid therapy is hyperglycemia.

Question 313

Which of the following signs and symptoms would the nurse monitor for when assessing for potential adverse effects of fludrocortisones (Florinef)?
A Hypoatremia
B Hypercalcemia
C Hypokalemia
D Hypovolemia

Answer 313

C

Fludrocortisone (Florinef) has mineralocorticoid properties, resulting in sodium and fluid retention along with potassium excretion.

Question 314

Discharge teaching for a patient receiving glucocorticoid therapy should include the preferred use of which of the following medications for pain management?
A acetylsalicylic acid (aspirin)
B ibuprofen (Advil)
C acetaminophen (Tylenol)
D naproxen sodium

Answer 314

C

Acetaminophen (Tylenol) does not cause gastrointestinal distress, as do acetylsalicylic acid (aspirin), ibuprofen (Advil), naproxen sodium, and glucocorticoids.

Question 315

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

Answer 315

C

Abruptly stopping long-term steroid therapy puts the patient at risk for Addisonian crisis or adrenal insufficiency, a life-threatening condition.

Question 316

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

Answer 316

A

A complication of steroid inhaler use is the development of oral (fungal) candidiasis. Rinsing the mouth after each use decreases the risk of fungal overgrowth in the oral cavities.