NURS 601 Pharm Endocrine Medications Questions and Answers- University of San Francisco
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NURS 601 Pharm Endocrine Medications Questions and Answers- University of San Francisco/NURS 601 Pharm Endocrine Medications Questions and Answers- University of San Francisco/NURS 601 Pharm Endocrine Medications Questions and Answers- University of San Francisco/NURS 601 Pharm Endocrine Medication...
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KEY:
All un-highlighted questions are required for Patho-Pharm 1
Red Text = Should Understand
Green Text = Absolutely Should Know
Yellow Highlight = Patho-Pharm 2 Material (Skip in Patho-Pharm 1)
Blue Highlight = Skip (In both Patho-Pharm 1 & 2)
Endocrine Medications
1. The nurse is teaching a client how to mix regular insulin and NPH insulin in the same syringe.
Which action, if performed by the client, indicates the need for further teaching?
1. Withdraws the NPH insulin first
2. Withdraws the regular insulin first
3. Injects air into NPH insulin vial first
4. Injects an amount of air equal to the desired dose of insulin into each vial
Correct answer: 4
Rationale: When preparing a mixture of short-acting insulin, such as regular insulin, with
another insulin preparation, the short-acting insulin is drawn into the syringe first. This
sequence will avoid contaminating the vial of short-acting insulin with insulin of another type.
Options 2, 3, and 4 identify correct actions for preparing NPH and short-acting insulin.
2. The home care nurse visits a client recently diagnosed with diabetes mellitus who is taking
Humulin NPH insulin daily. The client asks the nurse how to store the unopened vials of insulin.
The nurse should tell the client to take which action?
1. Freeze the insulin.
2. Refrigerate the insulin.
3. Store the insulin in a dark, dry place.
4. Keep the insulin at room temperature.
Correct answer: 2
Rationale: Insulin in unopened vials should be stored under refrigeration until needed. Vials
should not be frozen. When stored unopened under refrigeration, insulin can be used up to the
expiration date on the vial. Options 1, 3, and 4 are incorrect.
,3. Glimepiride is prescribed for a client with diabetes mellitus. The nurse instructs the client that
which food items are most acceptable to consume while taking this medication? Select all that
apply.
Correct answer: 2, 3, 5
Rationale: When alcohol is combined with glimepiride {Oral Hpoglycemic med}, a disulfiram-
like reaction may occur. This syndrome includes flushing, palpitations, and nausea. Alcohol can
also potentiate the hypoglycemic effects of the medication. Clients need to be instructed to
avoid alcohol consumption while taking this medication. Low-calorie desserts should also be
avoided. Even though the calorie content may be low, carbohydrate content is most likely high
and can affect the blood glucose. The items in options 2, 3, and 5 are acceptable to consume.
4. The nurse is providing discharge teaching for a client newly diagnosed with type 2 diabetes
mellitus who has been prescribed metformin. Which client statement indicates the need for
further teaching?
1. "It is okay if I skip meals now and then."
2. "I need to constantly watch for signs of low blood sugar."
3. "I need to let my health care provider know if I get unusually tired."
4. "I will be sure to not drink alcohol excessively while on this medication."
Correct answer: 2
Rationale: Metformin is classified as a biguanide and is the most commonly used medication for
type 2 diabetes mellitus initially. It is also often used as a preventive medication for those at
high risk for developing diabetes mellitus. When used alone, metformin lowers the blood sugar
after meal intake as well as fasting blood glucose levels. Metformin does not stimulate insulin
release and therefore poses little risk for hypoglycemia. For this reason, metformin is well
suited for clients who skip meals. Unusual somnolence, as well as hyperventilation, myalgia,
and malaise, are early signs of lactic acidosis, a toxic effect associated with metformin. If any of
these signs or symptoms occur, the client should inform the health care provider immediately.
While it is best to avoid consumption of alcohol, it is not always realistic or feasible for clients to
quit drinking altogether; for this reason, clients should be informed that excessive alcohol intake
can cause an adverse reaction with metformin.
5. The health care provider (HCP) prescribes exenatide for a client with type 1 diabetes mellitus
who takes insulin. The nurse should plan to take which most appropriate intervention?
,1. Withhold the medication and call the HCP, questioning the prescription for the client.
2. Administer the medication within 60 minutes before the morning and evening meal.
3. Monitor the client for gastrointestinal side effects after administering the medication.
4. Withdraw the insulin from the prefilled pen into an insulin syringe to prepare for
administration.
Correct answer: 1
Rationale: Exenatide is an incretin mimetic used for type 2 diabetes mellitus only. It is not
recommended for clients taking insulin. Hence, the nurse should withhold the medication and
question the HCP regarding this prescription. Although options 2 and 3 are correct statements
about the medication, in this situation the medication should not be administered. The
medication is packaged in prefilled pens ready for injection without the need for drawing it up
into another syringe.
6. A client is taking Humulin NPH insulin and regular insulin every morning. The nurse should
provide which instructions to the client? Select all that apply.
1. Hypoglycemia may be experienced before dinnertime.
2. The insulin dose should be decreased if illness occurs.
3. The insulin should be administered at room temperature.
4. The insulin vial needs to be shaken vigorously to break up the precipitates.
5. The NPH insulin should be drawn into the syringe first, then the regular insulin.
Correct answer: 1, 3
Rationale: Humulin NPH is an intermediate-acting insulin. The onset of action is 60 to 120
minutes, it peaks in 6 to 14 hours, and its duration of action is 16 to 24 hours. Regular insulin is
a short-acting insulin. Depending on the type, the onset of action is 30 to 60 minutes, it peaks in
1 to 5 hours, and its duration is 6 to 10 hours. Hypoglycemic reactions most likely occur during
peak time. Insulin should be at room temperature when administered. Clients may need their
insulin dosages increased during times of illness. Insulin vials should never be shaken vigorously.
Regular insulin is always drawn up before NPH.
7. The home health care nurse is visiting a client who was recently diagnosed with type 2
diabetes mellitus. The client is prescribed repaglinide and metformin. The nurse should provide
which instructions to the client? Select all that apply.
1. Diarrhea may occur secondary to the metformin.
2. The repaglinide is not taken if a meal is skipped.
3. The repaglinide is taken 30 minutes before eating.
4. A simple sugar food item is carried and used to treat mild hypoglycemia episodes.
5. Muscle pain is an expected effect of metformin and may be treated with
acetaminophen.
, 6. Metformin increases hepatic glucose production to prevent hypoglycemia associated
with repaglinide.
Correct answer: 1, 2, 3, 4
Rationale: Repaglinide, a rapid-acting oral hypoglycemic agent that stimulates pancreatic insulin
secretion, should be taken before meals (approximately 30 minutes before meals) and should
be withheld if the client does not eat. Hypoglycemia is a side effect of repaglinide and the client
should always be prepared by carrying a simple sugar at all times. Metformin is an oral
hypoglycemic given in combination with repaglinide and works by decreasing hepatic glucose
production. A common side effect of metformin is diarrhea. Muscle pain may occur as an
adverse effect from metformin but it might signify a more serious condition that warrants
health care provider notification, not the use of acetaminophen.
8. A client with hyperthyroidism has been given methimazole. Which nursing considerations are
associated with this medication? Select all that apply.
1. Administer methimazole with food.
2. Place the client on a low-calorie, low-protein diet.
3. Assess the client for unexplained bruising or bleeding.
4. Instruct the client to report side and adverse effects such as sore throat, fever, or
headaches.
5. Use special radioactive precautions when handling the client's urine for the first 24
hours following initial administration.
Correct answer: 1, 3, 4
Rationale: Common side effects of methimazole include nausea, vomiting, and diarrhea. To
address these side effects, this medication should be taken with food. Because of the increase in
metabolism that occurs in hyperthyroidism, the client should consume a high-calorie diet.
Antithyroid medications can cause agranulocytosis with leukopenia and thrombocytopenia. Sore
throat, fever, headache, or bleeding may indicate agranulocytosis and the health care provider
should be notified immediately. Methimazole is not radioactive and should not be stopped
abruptly, due to the risk of thyroid storm.
10. The nurse is monitoring a client receiving levothyroxine sodium for hypothyroidism. Which
findings indicate the presence of a side effect associated with this medication? Select all that
apply.
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