test Flashcards
What would the nurse assess when monitoring for the therapeutic effectiveness of vasopressin?
fluid balance
The nurse admitting a patient with acromegaly anticipates administering which medication?
octreotide (Sandostatin)
After administering somatropin (Serostim), the nurse would assess for adverse effects by monitoring which parameters?
serum glucose levels
when administering vasopressin, which is the priority vital sign for the nurse to monitor?
blood pressure
which nursing diagnosis is most appropriate for a patient who is receiving a pituitary drug?
disturbed body image
the nurse will instruct a patient taking desmopressin as a nasal spray for the treatment of DI to preform which action to obtain maximum benefit of the drug?
clear the nasal passages before spraying the medication
what 2 drugs can be used to treat DI?
vasopressin or desmopressin
function of ADH
promotes renal conservation of H2O by increasing permeability of collecting ducts;
regulated by the hypothalamus
adverse effects of vasopressin
increased BP (r/t excess vasoconstriction); HA; dizziness; uterine cramping; H2O intoxication
growth hormone-kids
- deficiency?
- excess?
- short stature
2. gigantism
growth hormone- adults
- deficiency?
- excess?
- decreased muscle mass; reduced exercise tolerance
2. acromegaly
adverse effect of GH therapy
hyperglycemia; neutralizing that bind with GH; fatality in Prader Willi
adverse effects of Somatropin
hyperglycemia; hypothyroidism; antibodies against GH
use growth hormone cautiously in which patients?
migraine; asthma; epilepsy
thyroid hormone regulates what body processes?
basal metabolic rate;
lipid/carb metabolism (essential for normal growth and development)
heart regulation
hypothyroidism lab test
high TSH
hypothyroidism in pregnancy effects?
can cause neuropsych problems in child
hypothyroidism in adults (symptoms)
many not be noticed if mild
if moderate to severe: pale face; cold skin; lethargy; goiter
congenital hypothyroidism
failure of thyroid development in utero; part of newborn screen
most common cause of hyperthyroidism
Graves Disease
**affects women 6x more than men
symptoms of grave’s disease
tachycardia CNS stimulation Increased metabolic rate weight loss exophthalmos (bulging eyes)
treatment for graves disease
surgery
destruction w/ iodine
suppression w/ antithyroid drugs
treatment for hypothyroidism (drug)
levothyroxine
treatment for hyperthyroidism
PTU (adjunct w/ surgery/radiation)
Which statement by the patient demonstrates an understanding of discharge instructions on the use of levothyroxine (Synthroid)?
“I will take this medication in the morning so as not to interfere with sleep.”
The nurse would suspect excessive thyroid replacement in a patient taking levothyroxine (Synthroid) when the patient is exhibiting which adverse effect?
irritability
Patients taking levothyroxine (Synthroid) and warfarin (Coumadin) concurrently would be monitored for which adverse effect?
increased risk of bleeding
A patient receiving propylthiouracil (PTU) asks the nurse how this medication will help relieve his symptoms. What is the nurse’s best response?
“Propylthiouracil inhibits the formation of new thyroid hormone, thus gradually returning your metabolism to normal.”
The nurse is teaching the patient taking an antithyroid medication to avoid foods high in iodine. Which food will the nurse advise the patient against?
seafood
Which patient statement demonstrates understanding of radioactive iodine (I-131) therapy?
“This drug will be taken up by the thyroid gland and destroy the cell to reduce my hyperthyroidism”
When assessing for potential toxicity to PTU, the nurse will monitor the patient for changes in which laboratory test?
CBC
The nurse is reviewing adverse effects of antithyroid medications with a patient who has been taking PTU. What adverse effects does the nurse include in the teaching? (Select all that apply.)
liver and bone marrow toxicity
A patient who is beginning therapy with levothyroxine ask the nurse when the medication will start working. The best response is?
within a few weeks
A pt wants to switch brands of levothyroxine . What is the nurses best response?
“You should check with your provider before switching brands”
Pt teaching for a pt taking antithyroid medication will include the need to avoid which foods?
soy products and seafood
Which statement by the patient indicates a need for further teaching about thyroid replacement therapy?
“Sometimes this medication can make my heart skip beats, but that’s a normal side effect”
diabetes mellitus blood sugar level
above 126 (fasting blood glucose)
signs and symptoms of DM (7)
polyuria polydipsia polyphagia glucosuria unexplained wt loss fatigue hyperglycemia
treatment for DM
- type 1
- type 2
- insulin
2. lifestyle change, oral drug therapy; insulin as last resort
Insulin lispro (Humalog)
similar to endogenous insulin
- *Rapid acting (5 - 15 minutes)
- *given subQ or subQ insulin pump
Regular Insulin (Humanlin R)
onset 30-60 minutes; clear
**the only insulin that may be given IV infusion or drip or IM
Isophane insulin suspension (NPH)
- cloudy
* *slower onset and more prolonged duration than endogenous insulin
glargine (Lantus), detemir (Levemir)
- long-acting
* *referred to as basal insulin
Which is a rapid-acting insulin with an onset of action of less than 15 minutes?
insulin aspart (Novolog)
Which long-acting insulin mimics natural, basal insulin with no peak action and a duration of 24 hours?
insulin glargine (Lantus)
Which insulin can be administered by continuous intravenous infusion?
regular insulin (Humalin R)
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 medication to be given to this patient the day before the scheduled procedure?
metformin (Glucophage)
The patient is prescribed 30 units regular insulin and 70 units NPH insulin subcutaneously every morning. The nurse will provide which instruction to the patient?
“Draw up regular insulin into the syringe first, followed by the cloudy NPH insulin”
The nurse is providing education to a patient about the time to take glipizide (Glucotrol). For maximum benefit, the nurse will tell the patient to administer glipizide at which time?
30 minutes before a meal
The nurse will advise the patient to treat hypoglycemia with which drug?
glucagon
Which information should be included in a teaching plan for patients taking oral hypoglycemic drugs?
- limit your alcohol consumption
- report symptoms of anorexia and fatigue
- notify your physician if blood glucose levels rise above the level set for you
when administering insulin, the nurse must keep in mind that which is the most immediate and serious adverse effect?
hypoglycemia
a dose of long-acting insulin has been ordered for bedtime for a diabetic pt. the nurse expects to administer which insulin?
Glargine
signs of hypoglycemia
irritability, sweating, and confusion
oral anti-diabetic drugs
used to treat type 2 diabetes
**only effective w/ lifestyle/diet changes
metformin
oral anti-diabetic drug
**does not decrease insulin production so can’t cause hypoglycemia
***lactic acidosis rare but fatal
adrenal medulla
secretes catecholamines
epi and norepi
adrenal cortex
secretes corticosteroids (glucocorticoids and mineralcorticoids [primarily aldosterone])
“moon face”
Cushing’s syndrome
**increased secretion of adrenal corticoid hormone
Addison’s disease
under secretion
- *decreased Na and glucose
- *increased K+, dehydration and wt loss
glucocorticoids inhalation used for?
bronchospasms
glucocorticoids nasally used for?
rhinitis
glucocorticoids topically used for?
inflammation of eye, ear, skin
a patient is taking an inhaled corticosteroid for asthma. After the pt takes a dose, the nurse’s priority should be to:
instruct the pt to rinse his mouth with warm water
what lab values may change with glucocorticoids
blood glucose and electrolytes
patients taking glucocorticoids should be told to avoid?
sick people; it can be an immunosuppressant
what can happen with sudden discontinuation of glucocorticoids?
adrenal crisis r/t sudden drop in cortisone levels
a patient taking glucocorticoids needs to avoid what drugs?
alcohol, NSAIDs, and aspirin
A patient will be receiving somatropin. The nurse expects that the patient has which disorder?
hypopituitary dwarfism
A women who has hypothyroidism will have to stop her thyroid replacement therapy now that she is pregnant.
True or false?
False
Fetal growth may be retarded if maternal hypothyroidism is untreated during preg.
A patient who is taking thyroid replacement medication begins to experience cold intolerance, depression, constipation and dry skin. What is the concern?
Inadequate doses of the medication
what effect can corticosteroids have on insulin?
antagonistic–resulting in elevated blood glucose levels
The nurse has just administered the morning dose of a patient’s lispro insulin. Just after the injection, the dietary department calls to inform the patient care unit that breakfast trays will be 45 minutes late. What should the nurse do next?
Give the patient food.
rationale: Lispro onset of action is 15 minutes. It is essential that a diabetic pt eat a meal after the injection to avoid hypoglycemia
T/F
Oral corticosteroids should be taken once daily in the morning to minimize adrenal suppression
True–
**take with milk or food to minimize GI upset
A patient is receiving prednisone as part of treatment for severe arthritis. He is also receiving furosemide (a loop diuretic), levothyroxine (for hypothyroidism), and a proton pump inhibitor (for gastroesophageal reflux disease [GERD]). Which drug may be a concern during the therapy with prednisone?
The furosemide
rationale: loop diuretic with corticosteroids may result in hypokalemia b/c of K+ loss with both drugs
The nurse will monitor which lab for a patient on aminoglutethimide?
Liver enzymes
**the drug may cause hepatotoxicity
progestin
- produced by?
- effect?
- corpus luteum, placenta
2. suppresses uterine contractions
anabolic steroids
increase tissue synthesis
**schedule III b/c highly abused by athletes
use of androgen inhibitors
for prostate hyperplasia
Which adverse effect can result if tetracycline is administered to children under 8 y/o?
permanent discoloration of teeth
A patient who is allergic to penicillin is at increased risk for an allergy to which drug?
cefazolin (Ancef)
When planning care for a patient receiving a sulfonamide antibiotic, it is important for the nurse to perform which action?
encourage fluid intake
When administering a nonsteroidal antiinflammatory drug (NSAID) and penicillin concurrently, displacement of the penicillin antibiotic from the protein-binding sites results in
increased free drug in blood
During antibiotic therapy, the nurse will assess the patient for a condition that may occur due to the disruption of normal flora. The nurse recognizes this as:
superinfection
A patient prescribed azithromycin (Zithromax) expresses concern regarding gastrointestinal upset that he experienced when previously taking erythromycin. What is the nurse’s best response?
“This drug is like erythromycin with less severe GI side effects”
n an effort to prevent superinfections of the gastrointestinal tract (e.g., from Clostridium difficile), the nurse will instruct patients to eat which foods?
cultured dairy products such as yogurt
The nurse would monitor which laboratory values in a patient receiving intravenous gentamicin (Garamycin)?
BUN and creatinine
Which is a complication of vancomycin infusions?
red man syndrome
When teaching a patient being discharged on linezolid (Zyvox) to treat methicillin-resistant Staphylococcus aureus (MRSA), the nurse must emphasize the importance of
avoid ingestion of foods contains tyramine
he nurse should assess a patient for nephrotoxicity and ototoxicity when administering which antimicrobial?
gentamicin
When planning care for a patient receiving once-daily intravenous gentamicin therapy, the nurse schedules a trough drug level to be drawn
12 hours after completing the infusion
The nurse would teach a patient receiving metronidazole (Flagyl) to avoid ingestion of which drink?
wine
The patient’s culture has grown gram-positive cocci, and the patient is prescribed two different antibiotics, one of which is gentamicin. To treat this type of infection, which type of drug is typically prescribed with gentamicin?
a penicillin
A patient is prescribed metronidazole (Flagyl) for a gynecologic infection, and she provides a list of medications she takes routinely to the nurse. Which medication would lead the nurse to question the order for Flagyl?
litium
The nurse bases the plan of care regarding administration of eardrops on knowledge that
warming the eardrops to room temp
A patient is complaining of excessive earwax, leading to diminished hearing ability. The nurse will expect to teach the patient regarding administration of which medication to correct this problem?
carbamide peroxide
The nurse is providing education to a patient diagnosed with otitis externa (OE). Which statement by the patient indicates an understanding of the OE treatment plan?
“I will use the ear drops in the ear canal to treat this condition”
The health care provider has ordered ciprofloxacin/dexamethasone (Ciprodex) otic drops for a patient with OE. The nurse knows the combination medication has both antibacterial medication and topical steroid medication. What is the purpose of the steroid in this medication?
reduce inflammation
A mother of a young child asks what she can use to help keep her child’s ears clean from wax. What over-the-counter medication will the nurse suggest?
debrox
The nurse is teaching the mother of a 1-year-old patient how to instill ear drops for OE. What instructions on instillation does the nurse provide to the mother?
“hold the pinna down and back”
The nurse is evaluating the effectiveness of the otic medication used for OE. What will the nurse evaluate for to determine if the goals of therapy have been met?
improved hearing
A 14-year-old patient is diagnosed with perforated tympanic membrane, OE, and otitis media. What does the nurse anticipate the provider will prescribe?
otic and oral antimicrobials
