Discharge teaching for a patient receiving glucocorticoids will include the preferred use of which medication for pain management?
1
Aspirin
2
Acetaminophen (Tylenol)
3
Ibuprofen (Motrin)
4
Naproxen sodium (Naprosyn)
Acetaminophen (Tylenol)
Acetaminophen (Tylenol) does not cause gastric distress as do aspirin, ibuprofen, naproxen sodium, and glucocorticoids. This medication would be the least likely to cause additive effects, because the patient on steroids is already
When assessing for potential side effects of fludrocortisone (Florinef), what is a priority for the nurse to monitor?
1
Serum sodium levels for potential hyponatremia
2
Serum calcium levels for hypercalcemia
3
Serum potassium levels for hypokalemia
4
Inta
Serum potassium levels for hypokalemia
Fludrocortisone (Florinef) has mineralocorticoid properties, resulting in sodium and fluid retention along with potassium excretion. The other assessments are not priorities for this medication administration
What plan is best for the patient beginning prednisone therapy?
1
Administer the medication early evening to coincide with the natural secretion pattern of the adrenal cortex.
2
Plan to keep a strict, unchanging schedule to prevent adverse reactions.
3
Ta
Take the medication with food to diminish the risk of gastric irritation.
Glucocorticoids can cause gastric distress and should be administered with food. The normal circadian secretion of the adrenal cortex is early morning to wake the person up, not ear
The nurse is caring for a patient who has just started taking levothyroxine (Synthroid). What assessment finding is a priority for the nurse to address?
1
Heart rate 55 beats per minute
2
Intolerance to cold
3
Weight gain of 3 pounds in the last week
4
Ir
Irritability
Irritability is a symptom of hyperthyroidism. This could be a sign that the medication dose is too high. A lowered heart rate, weight gain, and intolerance to cold could be symptoms of hypothyroidism and are expected in this patient who just
Which patient statement demonstrates understanding of the nurse's teaching for levothyroxine (Synthroid)?
1
"I will take this medication first thing in the morning."
2
"I will double my dose if I gain more than 1 pound per day."
3
"It is best to take the
I will take this medication first thing in the morning."
Levothyroxine (Synthroid) increases basal metabolism and thus wakefulness. It should be taken first thing in the morning. The patient should not increase the dose. The medication is absorbed best o
A patient is about to receive steroid therapy. What symptoms should the nurse assess?
1
Uncontrolled diabetes mellitus
2
Rheumatoid arthritis
3
Septic shock
4
Chronic obstructive pulmonary disease
Uncontrolled diabetes mellitus
A common adverse effect of steroid therapy is hyperglycemia. Therefore, the nurse should look for uncontrolled diabetes mellitus in the patient. Rheumatoid arthritis is a chronic autoimmune disorder that commonly causes infl
A patient with a history of asthma frequently receives prednisone (Deltasone) for acute bronchitis. The nurse anticipates that the patient may experience which adverse effects with continuous use of the therapy? Select all that apply.
1
Weight gain
2
Incr
1
Weight gain
4
Loss of bone density
5
Personality changes
6
Loss of muscle bulk
The patient is at high risk for osteoporosis as a result of glucocorticoid therapy because glucocorticoids are associated with bone demineralization. Weight gain and personal
A patient who is on long-term corticosteroid therapy has undergone surgery for the treatment of an abdominal hernia. Which potential effect of this therapy will the nurse expect to have the most impact on the patient's recovery?
1
Hypotension
2
Osteoporos
Delayed wound healing
Muscle weakness and osteoporosis may result from long-term therapy, but delayed wound healing would have the most impact on the patient's recovery from abdominal surgery. Long-term corticosteroid therapy causes hypertension rather th
The nurse teaches a patient receiving long-term corticosteroid drug therapy about the dosage regimen. Which response by the patient indicates the need for further teaching?
1
"I will report to you immediately if I have fever or a sore throat."
2
"I will t
I will stop taking this medication if I have any adverse effects."
The patient who is receiving corticosteroid drug therapy should not stop medications abruptly because it may lead to a sudden decrease in the production of endogenous glucocorticoid. This
The nurse is assessing a patient who has been prescribed thyroid replacement drugs for the first time. The nurse asks the patient to take the daily medication every morning on an empty stomach. What are the reasons for this instruction? Select all that ap
2
To decrease the likelihood of insomnia
3
To decrease the risk of drug-drug interactions
5
To maintain consistent blood levels of the drug
Administering the drug in the morning decreases the likelihood of insomnia, and drug-drug interactions may also be
The clinical instructor asks the nursing student about various drug interactions of thyroid drugs. Which statement by the nursing student indicates effective learning?
1
"Thyroid drugs may decrease the activity of oral anticoagulants."
2
"Thyroid drugs ma
Thyroid drugs may decrease the activity of hypoglycemic drugs."
Thyroid drugs interact with hypoglycemic drugs and reduce the hypoglycemic activity of the medications. Therefore, diabetic patients who are taking a thyroid drug may require an increased do
Which clinical sign is most characteristic of diabetic ketoacidosis (hyperglycemic reaction)?
extreme thirst
Which factor contributes to the onset of type 2 diabetes mellitus?
1
Obesity
2
Genetics
3
Viral infection
4
Environmental conditions
Obesity
Obesity contributes to the onset of type 2 diabetes mellitus. Obesity causes stress in the endoplasmic reticulum, which suppresses the signals of insulin receptors. Genetic factors, viral infections, and environmental conditions are factors that c
What is the nurse's best action when finding a patient with type 1 diabetes mellitus unresponsive, cold, and clammy?
1
Administer subcutaneous regular insulin immediately.
2
Administer glucagon.
3
Start an insulin drip.
4
Draw blood glucose level and send
Administer glucagon.
Glucagon stimulates glycogenolysis, raising serum glucose levels. The patient is showing signs of hypoglycemia. The nurse should not administer any form of inuslin because the patient's blood glucose could further decrease. The nurse
The nurse would include which statement when teaching a patient about insulin glargine (Lantus)?
1
"You should inject this insulin just before meals because it is very fast-acting."
2
"The duration of action for this insulin is approximately 8 to 10 hours
You cannot mix this insulin with any other insulin in the same syringe."
Insulin glargine (Lantus) is a long-acting insulin with a duration of action up to 24 hours. It should not be mixed with any other insulins. The insulin is not fast-acting.
The nurse is teaching a patient who has been prescribed repaglinide (Prandin). Which information will the nurse include in the teaching plan?
1
"You will need to be sure you eat as soon as you take this medication."
2
"This medication is compatible with a
You will need to be sure you eat as soon as you take this medication."
Repaglinide (Prandin) is short-acting. The drug's very fast onset of action allows patients to take the drug with meals and skip a dose when they skip a meal. Prandin interacts with b
The patient with type 1 diabetes mellitus asks, "Why can't I take a sulfonylurea like my friend who has diabetes?" What is the nurse's best response?
1
"Sulfonylurea increases beta-cell stimulation to secrete insulin, and with your type of diabetes, the b
Sulfonylurea increases beta-cell stimulation to secrete insulin, and with your type of diabetes, the beta cells do not contain insulin. This medication will not work for you."
Sulfonylurea agents reduce serum glucose levels by increasing beta-cell stimul
Which statement indicates to the nurse that the patient needs additional teaching on oral hypoglycemic agents?
1
"I will limit my alcohol consumption."
2
"I will report symptoms of fatigue and loss of appetite."
3
"I will take the medication only when I n
I will take the medication only when I need it.
The patient newly diagnosed with type 2 diabetes mellitus has been ordered insulin glargine (Lantus). What information is essential for the nurse to teach this patient?
1
"This medication should be mixed with the regular insulin each morning."
2
"This med
This medication has a duration of action of 24 hours."
Insulin glargine (Lantus) has a duration of action of 24 hours with no peaks, mimicking the natural, basal insulin secretion of the pancreas. This medication cannot be mixed with other insulins and i
A patient with type 1 diabetes mellitus has been ordered insulin aspart (Novolog) 10 units at 7:00 AM. What nursing intervention will the nurse perform after administering this medication?
1
Perform a fingerstick blood sugar test.
2
Have the patient void
Ensure the patient starts to eat as the medication is given
Insulin aspart (Novolog) is a rapid-acting insulin that acts in 5 to 15 minutes to decrease the blood glucose level. The patient can be eating as it is administered, or the patient should eat rig
The nurse administers NPH insulin at 8 AM. What intervention is essential for the nurse to perform?
1
Assess the patient for hyperglycemia by 10 AM.
2
Monitor fingerstick at 2 PM.
3
Make sure patient eats by 5 PM.
4
Administer the insulin via IV pump.
Make sure patient eats by 5 PM.
NPH insulin may be peaking just before dinner without sufficient glucose on hand to prevent hypoglycemia. The patient needs to eat by 5 PM. The patient would not be at high risk for hypoglycemia at 10 AM. A fingerstick is n
What is the nurse's best action when finding a patient with type 1 diabetes mellitus unresponsive, cold, and clammy?
1
Administer subcutaneous regular insulin immediately.
2
Administer intravenous glucose.
3
Start an insulin drip.
4
Draw blood glucose lev
Administer intravenous glucose.
This patient is showing signs of hypoglycemia. In the hospital setting or when the patient is unconscious, intravenous glucose is an obvious option to treat hypoglycemia.
Which drug interacts with insulin and increases the risk for unrecognized hypoglycemia in a patient?
1
Aspirin
2
Thiazide diuretics
3
?-Adrenergic blockers
4
Codeine
?-Adrenergic blockers
?-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 him or her to the onset of hypo
A patient newly diagnosed with diabetes asks, "How does insulin normally work in my body?" Which response by the nurse is correct?
1
"It stimulates the pancreas to reabsorb glucose."
2
"It promotes synthesis of amino acids into glucose."
3
"It stimulates
It promotes the passage of glucose into cells for energy."
Insulin promotes the passage of glucose into cells, where it is metabolized for energy. After or during a meal, the glucose that is ingested stimulates the pancreas to secrete insulin. Insulin st
The nurse administers insulin to a patient at 8:30 am and knows it will peak about 2.5 hours after administration. Which insulin did the nurse administer if this is true?
1
Insulin lispro (Humalog)
2
Regular insulin (Humulin R)
3
Insulin aspart (Novo-Log)
Regular insulin (Humulin R)
Regular insulin (Humulin R) peaks about 2.5 hours after the drug's administration. If the drug is given at 8:30 am, it will have its peak effects at 11:00, and at that time the nurse would observe for signs of hypoglycemia. Ins
A patient with type 2 diabetes mellitus receives a prescription for metformin (Glucophage). Which finding does the nurse recognize as a contraindication to therapy?
1
Arterial blood pH 7.4
2
Alanine aminotransferase 55 U/L
3
Fasting blood glucose 131 mg/d
Creatinine clearance 1.6 mg/dL
The risk of lactic acidosis is greater in a patient with altered renal function. A creatinine clearance level higher than 1.5 mg/dL in males or higher than 1.4 mg/dL in females indicates renal dysfunction. Because metformin
The nurse is teaching a patient who has type 1 diabetes mellitus how to prevent hypoglycemia. Which clinical indicators of hypoglycemia will the nurse identify for the patient and family? Select all that apply.
1
Headache
2
Sweating
3
Polyphagia
4
Weight
1
Headache
2
Sweating
6
Tachycardia
The effects of hypoglycemia are largely attributable to stimulation of the central nervous system because low blood glucose stresses the body. When hypoglycemia occurs, the sympathetic nervous system responds in an atte
A patient is prescribed nateglinide (Starlix) for the treatment of type 2 diabetes. On assessment, the nurse finds that the patient has erratic eating habits. Which is the most important instruction for this patient?
1
"You need to eat three to four meals
Skip the dose when you skip a meal."
The nurse advises the patient to skip the dose if he or she misses a meal, in order to prevent hypoglycemia. Asking the patient to eat three to four meals a day will not be effective in a patient who has erratic eatin
What will the nurse teach a patient who takes isophane suspension (NPH) insulin?
1
"Unused vials can be stored in the refrigerator for 5 months."
2
"You should eat 30 to 45 minutes after taking the NPH insulin."
3
"You need to obtain your blood glucose le
You should eat 30 to 45 minutes after taking the NPH insulin."
Insulin isophane suspension (NPH) is an intermediate-acting insulin product that has an onset of action of 1 to 2 hours. Hence the nurse instructs the patient to eat meals 30 to 45 minutes be
Which are rapid-acting insulins that can be administered to patients with diabetes mellitus? Select all that apply.
1
Lispro (Humalog)
2
Regular insulin (Humulin R)
3
Aspart (NovoLog)
4
Glulisine (Apidra)
5
Glargine (Lantus)
1
Lispro (Humalog)
3
Aspart (NovoLog)
4
Glulisine (Apidra)
Lispro (Humalog), Aspart (NovoLog), and Glulisine (Apidra) are rapid-acting insulins that have an onset of action of 15 minutes. Regular insulin (Humulin R) is a short-acting insulin that has an o
What will the nurse assess in a patient who is prescribed metformin (Glucophage) for treatment of type 2 diabetes?
1
Weight gain
2
Renal function
3
Headache
4
Cholesterol level
Renal function
Because metformin is excreted by the kidneys, it is necessary to assess the patient's renal function. If the patient's kidneys are not able to excrete the drug, it will accumulate in the patient's system, thereby causing lactic acidosis. On
What will the nurse teach a patient who takes metformin (Glucophage) for type 2 diabetes?
1
"You should take the medication with food."
2
"If you miss a meal, you should skip the dose."
3
"You should report any nausea immediately."
4
"You have an increase
You should take the medication with food."
Metformin causes adverse effects like abdominal bloating, nausea, a feeling of fullness, and diarrhea at the start of the therapy. So the nurse advises the patient to take the medication with food because it hel
Which statement made by the patient about type 1 diabetes mellitus indicates effective learning?
1
Type 1 diabetes mellitus leads to developing acute hypoglycemia.
2
Patients with type 1 diabetes mellitus require exogenous insulin.
3
Type 1 diabetes melli
Patients with type 1 diabetes mellitus require exogenous insulin.
Type 1 diabetes involves lack of insulin production. Hence patients with type 1 diabetes require exogenous insulin to lower the blood glucose level. Type 1 diabetes results in acute hypergl