Pharm Quiz 1

Pharm Quiz 1 - Type 1 Diabetes
ENDOCRINE PRACTICE QUESTIONS
A Client with Type 1 Diabetes
1.The nurse administered 25 units of Humulin N to a client with Type 1

diabetes at 1600. Which intervention should the nurse implement?
1.Assess the client for hypoglycemia around 1800.
2.Ensure the client eats the nighttime snack.
3.Check the clients serum blood glucose level.
4.Serve the client the supper tray.
ANSWER
1.Humulin N is an intermediate-actinginsulin that peaks 68 hours after
adminis-tration; therefore, the client would experi-ence signs of
hypoglycemia around22002400.
2.The nurse needs to ensure the client eats the nighttime (HS) snack to
helpprevent nighttime hypoglycemia.
3.A serum blood glucose level would have tobe done with a venipuncture and
the bloodsample must be taken to the laboratory. If the client needed
the blood glucose checked,it should be done with a glucometer at
thebedside.
4.The supper tray would not help prevent ahypoglycemic reaction because
theHumulin N is an intermediate-actinginsulin that peaks in 68 hours.
2.The nurse is teaching the client with Type 1 diabetes how to use an insulin
pen injec-tor. Which information should the nurse discuss with the client?
1.Instruct the client to dial in the number of insulin units needed to inject.
2.Demonstrate the proper way to draw up the insulin in an insulin syringe.
3.Discuss that the insulin pen injector must be used in the abdominal area
only.
4.Explain that the traditional insulin syringe is less painful than the injector
pen.
ANSWER
1.The insulin pen injector resembles a fountain pen. It contains a disposable
needle and insulin-lled cartridge. When the client operates the insulin pen,
the correct dose is obtained by turning the dial to the number of insulin units
needed.
2.The insulin pen injector does not require drawing up insulin in a syringe.
3.The insulin pen injector can be used in any subcutaneous site that
traditional insulin can be injected.
4.Most clients state that there is less injection pain associated with the insulin
pen than with the traditional insulin syringe.
3.The nurse is teaching a client with newly diagnosed Type 1 diabetes about
insulin therapy. Which statement indicates the client needs more teaching
concerning insulin therapy?
1.If I have a headache or start getting nervous, I will drink some orange
juice.
2.If I pass out at home, a family member should give me a glucagon
injection.
3.Because I am taking my insulin daily I do not have to adhere to a diabetic
diet.
4.I will check my blood glucose with my glucometer at least once a day.
ANSWER
1.Headache, nervousness, sweating, tremors, and rapid pulse are signs of a

hypoglycemic reaction and should be treated with a simple-acting
carbohydrate, such as orange juice, sugar-containing drinks, and hard candy.
This statement indicates the client understands the teaching.
2.If a client cannot drink or eat a simple carbohydrate for hypoglycemia, then
the client should receive a glucagon injection to treat the hypoglycemic
reaction. This indicates the client understands the teaching.
3.Even with insulin therapy the client should adhere to the American
Diabetic Association diet, which recommends carbohydrate counting. This
statement indicates the client needs more teaching.
4.Monitoring and documenting the blood glucose level is encouraged to
determine the effectiveness of the treatment regimen. This indicates the
client understands the client teaching.
4. The nurse administered 12 units of regular insulin to the patient with Type
1 diabetes at 0700. Which meal would prevent the client from experiencing
hypoglyce-mia?
1.Breakfast.
2.Lunch.
3.Supper.
4.HS snack.
ANSWER
1.Regular insulin peaks in 2 - 4 hours; therefore, the breakfast meal would
prevent the client from developing hypoglycemia.
2.Lunch would cover a 0700 dose of HumulinN, an intermediate-acting
insulin.
3.Supper would cover a 1600 dose of HumulinR, a short-acting insulin.
4.The HS (nighttime) snack would cover a1600 dose of Humulin N, an
intermediate-acting insulin.
5.The client diagnosed with Type 1 diabetes is complaining of a dry mouth,

extreme thirst, and increased urination. Which action should the nurse
implement?
1.Administer one amp of intravenous 50% glucose.
2.Prepare to administer intravenous regular insulin.
3.Inject Humulin N subcutaneously in the abdomen.
4.Hang an intravenous infusion of D5W at a keep open rate
ANSWER
1.One amp of 50% glucose would be used to treat a severe hypoglycemic
reaction, and this client does not have signs or symptoms that indicate
hypoglycemia. In fact, the client has signs and symptoms of hyperglycemia.
2.The clients signs and symptoms indicate the client is experiencing diabetic
ketoacidosis (DKA), which is treated with intravenous regular insulin.
3.Humulin N is an intermediate-acting insulin, which is not used to treat
hyperglycemia.4.An IV of D5W would cause the client to have further signs
and symptoms of diabetic ketoacidosis (DKA); therefore, the nurse should not
administer the IV.
6. The client newly diagnosed with Type 1 diabetes asks the nurse, Why
should I get an external portable insulin pump? Which statement is the
nurses best response?
1.It will cause you to have fewer hypoglycemic reactions and it will control
blood glucose levels better.
2.Insulin pumps provide an automatic memory of the date and time of the
last 24boluses.
3.The pump injects intermediate-acting insulin automatically into the vein to
maintain a normal blood glucose level.
4.The portable pump is the easiest way to administer insulin to someone
with Type1 diabetes and is highly recommended.
ANSWER
1. A portable insulin pump is a battery-operated device that uses rapidacting insulinLispro, Humalog, or NovoLog. It delivers both basal insulin
infusion (continuous release of a small amount of insulin) and bolus doses
with meals. This provides fewer hypoglycemic reactions and better blood
glucose levels.
2.The pumps do provide a memory of boluses, but that is not the nurses best
response to explain why a client should get an external portable insulin
pump.
3.External portable insulin pumps are only used to deliver rapid-acting insulin
subcutaneously. Intermediate- and long-acting insulin's are not used with an
external portable insulin pump because of unpredictable control of blood
glucose.
4.The insulin pump is not recommended as the initial way to administer
insulin because the success of the insulin pump depends on the clients
knowledge and compliance. Initially most clients start injecting insulin with a
syringe and then graduate to the pumps
7. The nurse in the medical department is preparing to administer Humalog,

a rapid-acting insulin, to a client diagnosed with Type 1 diabetes. Which
intervention should the nurse implement?
1.Ensure the client is wearing a Medic Alert bracelet.
2.Administer the dose according to the regular insulin sliding scale.
3.Assess the client for hyperosmolar, hyperglycemic, nonketotic coma.
4.Make sure the client eats the food on the meal tray that is at the bedside.
ANSWER
1. Because the client is in the hospital the client must have a hospital
identication band; a Medic Alert bracelet would be needed when the client is
not in the hospital.
2.Humalog is not regular insulin; it is fast-acting insulin. It is not administered
according to the regular insulin sliding scale. Thepeak time for Humalog is 30
minutes to 1hour; regular insulin peaks in 24 hours.
3.A client with Type 1 diabetes will experi-ence diabetic ketoacidosis; a client
with Type 2 diabetes will experience hyperosmo-lar, hyperglycemic,
nonketotic coma.
4.Humalog peaks in 30 minutes to 1 hour;therefore, the client needs to eat
when or shortly after the medication is admin-istered to prevent
hypoglycemia.
MEDICATION MEMORY JOGGER:
Remember that the different types of insulin peak at different times, and the
nurse must beknowledgeable about the peak times toensure that the client
does not experiencehypoglycemia. Only the insulin product Lantus has no
peak time
8. Which assessment data best indicate the client with Type 1 diabetes is
adhering tothe medical treatment regimen?
1.The clients fasting blood glucose is 100 mg/dL.
2.The clients urine specimen has no ketones.
3.The clients glycosylated hemoglobin is 5.8%.
4.The clients glucometer reading is 120 mg/dL.
ANSWER
1.The fasting blood glucose level is obtained after the client is NPO for 8
hours; this blood result does not indicate adherence to the treatment
regimen.
2.If the client has no ketones in the urine, it indicates that the body is not
breaking down fat for energy, but it does not indicate adherence to the
treatment regimen.
3.A glycosylated hemoglobin (A1C) gives the average of the blood glucose
level over the last 3 months and indicates adherence to the medical
treatment regimen. A glycosylated hemoglobin level of 5.8% is close to
normal and indicates that the client is adhering to the treatment regimen.
The following table shows blood glucose levels and
corresponding glycosylated hemoglobin results:
Blood Glucose
Glycosylated Hemoglobin Results
70110
4.0 - 5.5% Norma;
135
6%
170
7%
205
8%
240
9%
275
10%
310
11%
345
12%
4.A glucometer reading of 120 mg/dL indicates a normal blood glucose level,
but it is a one-time reading and does not indicate adherence to the medical
treatment regimen.
9.
The nurse is discussing storage of insulin vials with the client. Which
statement indi-cates the client understands the teaching concerning the
storage of insulin?1.I will keep my unopened vials of insulin in the
refrigerator.2.I can keep my insulin in the trunk of my car so I will have it at
all times.3.It is all right to put my unopened insulin vials in the freezer.4.If
I prell my insulin syringes, I must use them within 12 days.
ANSWER
1.This statement indicates the client understands the medication teaching.
Keeping the insulin in the refrigerator will maintain the insulins strength and
potency. Once the insulin vial is open edit may be kept at room temperature
for 1 month.
2.Insulin vials should not be placed in direct Sunlight or in a high-temperature
area, such as the trunk of a car, because it will lose its strength.
3.Insulin should not be kept in the freezer because freezing will cause the
insulin to break down and lose its effectiveness.
4.Prelled syringes should be stored in the refrigerator and should be used

within12 weeks, not 12 days.
10.Which statement best describes the pharmacodynamics of insulin?

1.Insulin causes the pancreas to secrete glucose into the bloodstream.
2.Insulin is metabolized by the liver and muscle and excreted in the urine.
3.Insulin is needed to maintain colloidal osmotic pressure in the bloodstream.
4.Insulin lowers blood glucose by promoting use of glucose in the body cells.
ANSWER
1.The pancreas does not secrete glucose. It secretes insulin, which is the
key that opens the door to allow glucose to enter the body cells. Glucose
enters the body through the gastro intestinal system.
2.This statement explains the pharmacokinetics of insulin and how the body
metabolizes and excretes urine. Pharmacokinetics is the process of drug
movement to achieve drug interaction.
3.Insulin does not maintain colloidal osmotic pressure. Albumin, a product of
protein, maintains colloidal osmotic pressure.
4. This is the statement that explains the pharmacodynamics, which is the
drugs mechanism of action or way that insulin is utilized by the body.
Over time, elevated glucose levels in the bloodstream can cause longterm complications, including nephropathy, retinopathy, and neuropathy.
Insulin lowers blood glucose by promoting the use of glucose in body cells.
A Client with Type 2 Diabetes

11.
1.The client diagnosed with Type 2 diabetes is prescribed the sulfonylurea
glipizide(Glucotrol). Which statement by the client would warrant intervention
by the nurse?
1.I have to eat my diabetic diet even if I am taking this medication.

2.I will need to check my blood glucose level at least once a day.
3.I usually have one glass of wine with my evening meal.
4.I do not like to walk every day, but I will if it will help my diabetes.
ANSWER
1.The client with Type 2 diabetes must adhere to the prescribed diet to help
keep the blood glucose level within the normal range. Delaying or missing a
meal can cause hypoglycemia. This statement would not warrant intervention
by the nurse.
2.The client should check blood glucose levels to determine if the medication
is effective; therefore, this statement would not warrant intervention by the
nurse.
3. Sulfonylureas and biguanides may cause an Antabuse-like reaction when
taken with alcohol, causing the client to become nauseated and vomit.
Advise the client to abstain from alcohol and to avoid liquid over-the-counter
(OTC)medications that may contain alcohol. Alcohol also increases the halflife of the medication and can cause a hypo-glycemic reaction.
4.The client with Type 2 diabetes does not need to walk daily to keep the
glucose level within normal limits; walking three times a week will help
control stress and help decrease weight if the client is overweight.
12. Which statement best describes the scientic rationale for prescribing
the biguanide metformin (Glucophage)?
1.This medication decreases insulin resistance, improving blood glucose
control.
2.This medication allows the carbohydrates to pass slowly through the large
intestine.
3.This medication will decrease the hepatic production of glucose from stored
glycogen.
4.This medication stimulates the beta cells to release more insulin into the
blood-stream
ANSWER
1.A thiazolidinedione, pioglitazone (Actos)or rosiglitazone (Avandia), not a
biguanide like metformin, is prescribed to decrease insulin resistance.2.An
alpha-glucosidase inhibitor, acarbose (Precose) or miglitol (Glyset), is
administered to allow carbohydrates to pass slowly through the intestine.
Glucophage does not do this.
3.The scientic rationale for administering metformin (Glucophage) is that
it diminishes the increase in serum glucose following a meal and blunts the
degree of postprandial hyperglycemia by preventing gluconeogenesis.
4.A meglitinide, repaglinide (Prandin),sulfonylurea, or nateglinide (Starlix) is
prescribed to stimulate the beta cells to release more insulin into the
bloodstream.
13.The nurse is discussing the oral hypoglycemic medication Micronase with

the client diagnosed with Type 2 diabetes. Which information should the
nurse discuss with the client?
1.Instruct the client to take the oral hypoglycemic medication with food.
2.Explain that hypoglycemia will not occur with oral medications.
3.Tell the client to notify the HCP if a headache, nervousness, or sweating
occurs.
4.Recommend the client check the ketones in the urine every morning.
ANSWER
1. The oral hypoglycemic medication should be administered with food to
decrease gastric upset.
2.The client receiving oral hypoglycemic medications can experience
hypoglycemic reactions, as can clients receiving insulin.
3.These are signs or symptoms of hypoglycemia, and the client should be
able to treat this without notifying the healthcare provider.
4.Ketones are a byproduct of the break down of fats, which usually does not
occur in clients with Type 2 diabetes because the client has enough insulin to
prevent break-down of fats but not enough to keep the blood glucose level
within an acceptable level.
14.The client diagnosed with Type 2 diabetes is receiving the combination

oral antidiabetic medication glyburide/metformin (Glucovance). Which data
indicate the medication is effective?1.The clients skin turgor is elastic.
2.The clients urine ketones are negative.
3.The serum blood glucose level is 118 mg/dL.
4.The clients glucometer level is 170 mg/dL.
ANSWER
1.An elastic skin turgor is expected and normal, but it does not indicate that
the antidiabetic medication is effective.
2.Urine ketones should be negative because there should not be a breakdown
of fat in clients with Type 2 diabetes, but this does not indicate the
effectiveness of the medication.
3.The serum blood glucose level should be within normal limits, which is70
110 mg/dL. A level of 118 mg/dL is close to normal; therefore, the medication
can be considered effective.
4.A self-monitoring blood glucose level of 170 mg/dL is above a normal
glucose level; this indicates the medication is not effective.
The nurse determines the effectiveness of a medication by assessing for the
symptoms, or lack thereof, for which the medication was prescribed.
15.The client with Type 2 diabetes is admitted into the medical department
with a wound on the left leg that will not heal. The HCP prescribes slidingscale insulin. The client tells the nurse, I dont want to have to take shots. I
take pills at home. Which statement would be the nurses best response?
1.If you cant keep your glucose under control with pills, you must take
insulin.
2.You should discuss the insulin order with your HCP because you dont want
to take it.
3.You are worried about having to take insulin. I will sit down and we can
talk.
4.During illness you may need to take insulin to keep your blood glucose
level down.
ANSWER
1.During illness, the client with Type 2diabetes may need insulin to help keep
glucose levels under control, but this is a threatening type of statement and
is not the nurses best response.
2.Insulin may need to be prescribed in times of stress, surgery, or serious
infection; therefore, the nurse should explain this to the client and not refer
the client to the HCP.
3.This is a therapeutic response and the client needs to have factual
information. Therapeutic responses are used to encourage the client to
ventilate feelings.
4.Blood glucose levels elevate during times of stress, surgery, or serious
infection. The client with Type 2diabetes may need to be given
insulin temporarily to help keep the blood glucose level with normal limits.
16.The nurse is caring for the client diagnosed with Type 2 diabetes. The
client is complaining of a headache, jitteriness, and nervousness. Which
action should the nurse implement rst?
1.Check the clients serum blood glucose level.
2.Give the client a glass of orange juice.
3.Determine when the last antidiabetic medication was administered.
4.Assess the clients blood pressure and apical pulse.
ANSWER
1.The clients serum blood glucose level is checked by drawing a
venipuncture blood sample and sending it to the laboratory. This would take
too long. The nurse must take care of the client; therefore, drawing a blood
sample and awaiting results is not the rst intervention.
2.The client is experiencing signs of a hypoglycemic reaction and the nurse

must treat the client by administering some type of simple-acting
glucose. This is the rst intervention.
3.Determining when the last oral hypo-glycemic medication was administered
is an intervention that could be implemented, but it is not the rst
intervention. The nurse needs to take care of the client
4.The nurse could assess the clients vital signs, but this is not the rst
intervention; the nurse should take care of the clients signs and symptoms.
When answering test questions or when caring for clients at the bedside, the
nurse should remember that assessing the client might not be the rst action
to take when the client is in distress. The nurse may need to intervene
directly to help the client.
17.The overweight client diagnosed with Type 2 diabetes reports to the clinic
nurse thathe has lost 35 pounds in the last 4 months. Which action should the
nurse imple-ment rst?1.Determine if the client has had an increase in
hypoglycemic reactions.2.Instruct the client to make an appointment with the
health-care provider.3.Ask the client if he has been trying to lose weight or
has it happened naturally.4.Check the clients last weight in the chart with the
weight obtained in the clinic.
ANSWER
1.Changes in weight will affect the Amount of medication needed to control
blood glucose. The nurse should determine if the clients medication dose is
too high by determining if the client has had an increase in hypo-glycemic
reactions. This is the nurses rst intervention.
2.A signicant weight loss may require a decrease or discontinuation of oral
hypo-glycemic medication, but the nurse should rst determine if the client
has had symptoms of hypoglycemia before referring him or her to the HCP.
3.Determining if the client was deliberately losing weight or was losing
without trying is signicant because a 35-pound weight loss in 4 months
would warrant intervention, depending on what caused the weight loss.
However, this should not be the nurses rst intervention.
4.The nurse should conrm the clients weight loss with the clinic scale and
the last weight in the clients chart, but it is not the clinic nurses rst
intervention.

Remember that the rst step in the nursing process is assessment. Words
such as check, monitor, determine, ask, take, auscultate, and palpate
indicate that the nurse is assessing the client. Assessment should be done
before implementing an independent nursing action or notifying the healthcare provider, except in certain serious or life-threatening situations.
18.The female client diagnosed with Type 2 diabetes tells the clinic nurse
that she started taking ginseng to help increase her memory. Which action
should the clinic nurse take?
1.Take no action because ginseng does not affect Type 2 diabetes.
2.Determine what type of memory decits the client is experiencing.
3.Explain that herbs are dangerous and she should not be taking them.
4.Determine if the client is currently taking any type of antidiabetic
medication.
ANSWER
1.The nurse should investigate any herb the client is taking because most
herbs do affect a disease process or the medication being taken for the
disease process.
2.The nurse should determine if ginseng affects the clients Type 2 diabetes
or medications that the client is taking for the disease process.
3.This is a negative, judgmental statement. Many herbs are benecial to the
client. The nurse should always assess the client and determine if the herb is
detrimental to the clients disease process or affects the clients routine
medication regimen prior to making this type of statement.
4.The nurse should determine if the client is taking any medication because
many oral hypoglycemics interact with herbs. Ginseng and garlic may
increase the hypoglycemic effects of oral hypoglycemics.
Some herbal preparations are effective, some are not, and a few can be
harmful or even deadly. If a client is taking an herbal supplement and a
conventional medicine, the nurse should investigate to determine if the
herbal preparation would cause harm to the client. The nurse should always
be the clients advocate.
19.The school nurse is teaching a class about Type 2 diabetes to elementary

school teachers. Which information is most important for the nurse to discuss
with the teachers?
1.The importance of not allowing students to eat candy in the classroom.
2.The increase in the number of students developing Type 2 diabetes.
3.The signs and symptoms of hypoglycemia and the immediate treatment.
4.The need to have the students run or walk for 20 minutes during the recess
period.
ANSWER
1.The students with Type 2 diabetes should not eat candy, but it is not the
most important intervention for the school nurse to teach.
2.This is pertinent information, but it is not the most important information.
3.The most important information for the teachers to know is how to
treat potentially life-threatening complications secondary to the medications
used to treat Type 2 diabetes. The school nurse should discuss issues that
keep the students safe.
4.Exercise is important in helping to control Type 2 diabetes, but empowering
the teachers to be condent when handling complications secondary to
medication is priority for the safety of the students.
20.The client newly diagnosed with Type 2 diabetes who has been prescribed
an oral hypoglycemic medication calls the clinic and tells the nurse that the
sclera has a yellow color. Which action should the clinic nurse implement?
1.Ask the client if he or she has been exposed to someone with hepatitis.
2.Determine if the client has a history of alcohol use or is currently drinking
alcohol.
3.Check to see if the client is taking the cardiac glycoside digoxin.
4.Make an appointment for the client to come to the health-care providers

office.
ANSWER
1.Jaundiced sclera may indicate the client has hepatitis, but because the
client has been prescribed oral hypoglycemic medications, their possible role
in the development of the jaundice should be assessed.
2.The nurse should not jump to the conclusion that the client is an alcoholic
just because the sclera is jaundiced.
3.Digoxin toxicity results in the client having a yellow haze, not the clients
sclera being yellow.
4.Oral hypoglycemics are metabolized in the liver and may cause elevations
in liver enzymes; the client should be instructed to report the rst signs
of ellow skin, sclera, pale stools, or dark urine to the HCP.
A Client with Pancreatitis
21.The nurse is administering medications. Which medication would the

nurse question administering?
1.Morphine sulfate, an opioid, to a client diagnosed with pancreatitis.
2.Diphenhydramine (Benadryl), an H1blocker, to a client with an allergic
reaction.
3.Methylprednisolone (Solu-Medrol), a glucocorticoid, to a client with Type2
diabetes.
4.Vasopressin (DDAVP), a hormone, to a client diagnosed with diabetes
insipidus.
ANSWER
1.Morphine can cause spasm of the pancreatic ducts and the sphincter
of Oddi. Therefore, the nurse would question administering this medication.
2.Diphenhydramine is a histamine 1blocker that blocks the release of

histamine 1that occurs during allergic reactions. The nurse would not
question this medication.
3.Clients with diabetes mellitus may at times have a need for a steroid
medication. The medication may elevate the clients glucose levels, and
these levels should be monitored. The nurse would not question this
medication.
4.Vasopressin is the hormone that is lacking in clients diagnosed with
diabetes insipidus(DI) and is the treatment for DI. The nurse would not
question administering this medication.
The nurse must be knowledgeable about accepted standards of practice for
disease processes and conditions. If the nurse administers a medication the
health-care provider has prescribed and it harms the client, the nurse could
be held account-able. Remember that the nurse is a client advocate.
22.The nurse has received the morning report. Which medication should be
administered rst?1.Levothyroxine (Synthroid), a hormone, to a client
diagnosed with hypothyroidism.
2.Pantoprazole (Protonix), a proton-pump inhibitor, to a client diagnosed with
GERD.
3.Acetaminophen (Tylenol) to a client with a migraine headache of 7 on the
pain scale.
4.Pancreatin (Donnazyme), an enzyme, to a client diagnosed with chronic
pancreatitis.
ANSWER
1.Synthroid is a daily medication and can be administered at any time.
2.Protonix is a daily medication and can be administered at any time.
3.Tylenol is for mild to moderate pain; this client would require a more potent
analgesic. The nurse should assess the clients medications and discuss other
medications with the HCP. This would not be the rst medication to
administer.
4.Pancreatic enzymes are administered with every meal and snack. The
nurse should administer this medication so the medication and the breakfast
foods arrive in the small intestine simultaneously.
23.The client diagnosed with chronic pancreatitis has a nasogastric tube. The
charge nurse observes the primary nurse instill an antacid down the tube and
then clamp the tube. Which action should the charge nurse take?
1.Tell the nurse to reconnect the tube to suction.
2.Notify the unit manager of the nurses actions.
3.Do nothing because this is the correct procedure.
4.Instruct the nurse to administer the medication orally.
ANSWER
1.The nurse is following a correct procedure for administering medications
through a nasogastric tube that is connected to suction. The tube should
remain clamped for 1 hour before it is reconnected tosuction.2.The nurse
followed correct procedure; there is no reason to notify the manager.
3.The nurse is following a correct procedure for administering medications
through a nasogastric tube that is connected to suction. The tube should
remain clamped for 1 hour before it is reconnected to suction to allow the
medication to be absorbed.
4.The medication is ordered to be administered through the tube, not orally.
24.The HCP prescribed chlordiazepoxide (Librium), a sedative hypnotic, for a

55-year-old male client diagnosed with chronic pancreatitis. Which statement
is the scientic rationale for prescribing this medication?
1.Librium acts as an adjunct to pain medication.
2.Librium limits complications related to alcohol withdrawal.
3.Librium prevents the nausea related to pancreatitis.
4.Librium is used as a sleep aid for clients who are NPO.
ANSWER
1.The Librium may act as an adjunct to pain relief, but this is not the reason
for prescribing the medication to this client.
2.Librium is useful in preventing delirium tremens in clients withdrawing from
alcohol. The majority of clients diagnosed with chronic pancreatitis(75%) are
middle-aged males who also have chronic alcoholism.
3.Librium may have some antiemetic properties, but this is not the reason for
prescribing the medication to this client.
4.Librium can cause drowsiness, but it is not the drug of choice as a sleep aid
fora client who is NPO.
25.The client diagnosed with acute pancreatitis is complaining of severe

abdominal pain. Which interventions should the nurse implement? Select all
that apply.
1.Ask the client to rate the pain on a 110 pain scale.
2.Determine when the client received the last dose of medication.
3.Administer hydrocodone (Vicodin), a narcotic pain medication.
4.Assist the client to a semi-Fowlers position.5.Apply oxygen at 4 L/minute
via nasal cannula.
ANSWER
1.Clients should be asked to rate their pain on a scale so the nurse can
objectively evaluate the effectiveness of the interventions.
2.The nurse abides by the ve rights of medication administration,
including the right time. Pain medication is prescribed at specic time
intervals. The nurse must make sure the time interval has passed and it is
time for more medication.
3.A client diagnosed with severe acute pancreatitis will be NPO, and Vicodin is
an oral narcotic medication. The nurse would administer an IV medication.
4.The client should be placed in a semi-Fowlers position to relieve pressure
on the abdomen, thereby decreasing the clients pain.
5.There is no indication that the client requires oxygenation at this time.
26.The client diagnosed with acute pancreatitis is placed on total parenteral

nutrition(TPN). Which intervention should the nurse implement?
1.Monitor blood glucose levels daily.
2.Assess the peripheral intravenous site.
3.Check the clients complete blood count.
4.Change the tubing with every new bag of TPN
ANSWER
1.Blood glucose levels should be monitored every 46 hours, not daily.
2.TPN requires a central line for administration, not a peripheral line. The high
concentration of dextrose in TPN causes phlebitis in peripheral veins.
3.The clients electrolytes and magnesium levels are monitored, not the
complete blood count.
4.The TPN solution contains all the required nutrients to sustain life. It also
makes an ideal medium for bacterial growth. Infection control
safety measures include using new tubing with every bag of TPN.
27.The nurse is administering pancreatic secretin, a stimulatory hormone, to

a client to rule out chronic pancreatitis. Which procedure should the nurse
follow?
1.Have the client lie on the right side during the administration of the
medication.
2.Make sure the client has signed a permit for an investigational procedure.
3.Aspirate gastric and duodenal contents before and after the medication.
4.Place the client in the Trendelenburg position before beginning the
medication.
ANSWER
1.The client will be in a Fowlers or semi-Fowlers position to use gravity to
pool secretions near the gastric/duodenal tube.
2.This is not an investigational procedure. The general treatment permission
form the client signed when entering the hospital is sufficient.
3.The gastric and duodenal contents are aspirated and sent to the laboratory
for analysis before and after the administration of secretin, which stimulates
the pancreas to secrete enzymes.
4.The client is not placed in a head-down position for this procedure.
28.Which intervention should be implemented when discharging a client

diagnosed with chronic pancreatitis who has been receiving high doses of
meperidine (Demerol), an opioid, for the past 4 weeks?
1.Tell the client to monitor his or her stools and to avoid constipation.
2.Taper the medication slowly over several days prior to discharge.
3.Refer the client to a drug withdrawal clinic to stop taking the Demerol.
4.Discuss signs and symptoms of drug dependence to report to the HCP.
ASNWER
1.The nurse should have been monitoring the client for constipation while in
the hospital. The client should not be discharged on Demerol.
2.To prevent withdrawal after weeks of administration of Demerol, the
client should be tapered off the medication over several days.
3.The client should be tapered off the medication prior to leaving the
hospital, not sent to a drug withdrawal center.
4.Withdrawal from the medication should be accomplished prior to
discharging the client, so the symptoms of withdrawal should occur while the
client is still in the hospital.
29. The male client diagnosed with pancreatitis is prescribed octreotide

(Sandostatin),a hormone. Which data indicates the medication has been
effective?
1.The client reports that the diarrhea has subsided.
2.The client states that he has grown 1 inch.
3.The client has no muscle cramping or pain.
4.The client has no complaints of heartburn.
ANSWER
1.Octreotide stimulates uid and electrolyte absorption from the
gastrointestinal tract and prolongs intestinal transit time, thereby decreasing
diarrhea.
2.Octreotide is prescribed for clients with acromegaly to prevent growth, not
stimulate it.
3.Octreotide is helpful in preventing or treating diarrhea and associated
abdominal pain, but not muscle cramping or pain.
4.Octreotide does not treat acid reux.
30.The client diagnosed with pancreatitis is complaining of polydipsia and

polyuria. Which medication should the nurse prepare to administer?
1.Humalog, a fast-acting insulin intravenously, and then monitor glucose
levels.2.Pancrelipase (Cotazym) sprinkled on the clients food with
meals.3.Humulin R subcutaneously after assessing the blood glucose
level.4.Ranitidine (Zantac), a histamine 2 receptor blocker, orally.
ASNWER
1.Humalog is not administered intravenously, and glucose levels should be
monitored prior to insulin administration.
2.The clients symptoms should indicate hyperglycemia to the nurse, not

pancreatic enzyme deciency.
3.Humulin R insulin is administered by sliding scale to decrease blood
glucose levels. Clients with pancreatitis should be monitored for the
development of diabetes mellitus. Polydipsia and polyuria are classic signs of
diabetes mellitus.
4.Zantac would not treat the clients symptoms.
A Client with Adrenal Disorders
31.The client diagnosed with Addisons disease is being discharged. Which

statement indicates the client needs more discharge teaching?
1.I will be sure to keep my dose of steroid constant and not vary.
2.I may have to take two forms of steroids to remain healthy.
3.I will get weak and dizzy if I dont take my medication.
4.I need to notify any new HCP of the medications I take.
ANSWER
1. The dose of corticosteroids may have to be increased during the stress of
an infection or surgery. It is imperative that under these circumstances the
client receives enough medication to replicate the bodys own responses to
stress (see the table).
2.The client usually will need to take mineral and glucocorticoid replacement
therapy. This statement does not need more teaching.
3.The client will experience symptoms of adrenal insufficiency if not taking
the medications. This statement does not need more teaching.
4.Clients should be taught to inform all health-care providers of all
medications, prescribed and over the counter, that they are taking. This
statement does not need more teaching.
32.The client diagnosed with Cushings disease is prescribed alendronate

(Fosamax), abisphosphonate regulator, to prevent osteoporosis. Which
information should theclinic nurse teach?1.Take the medication with food to
prevent esophageal irritation.2.Take the medication just before going to
bed.3.Take the medication with an antacid to alleviate gastric
disturbances.4.Take the medication at least 30 minutes before breakfast.
ANSWER
1.The medication should be taken at least30 minutes before food or uid is
consumed for the day. The client should drink a full glass of water with the
medication and remain in an upright position for at least 30 minutes after
taking Fosamax to prevent esophageal erosion and ulceration.
2.The medication is taken the rst thing in the morning when the stomach is
empty. Taking Fosamax and then lying down would cause esophageal reux,
resulting in erosion and ulceration of the esophagus.
3.An antacid will interfere with the absorption of Fosamax
4.The medication should be taken at least 30 minutes before food or uid is
consumed for the day. The client should drink a full glass of water with the
medication and remain in an upright position for at least 30 minutes after
taking Fosamax to prevent esophageal erosion and ulceration.
33. The client is scheduled for a bilateral adrenalectomy for Cushings

disease. Which information regarding the prescribed glucocorticoid
prednisone (Deltasone) should the nurse teach? Select all that apply.
1.When discontinuing this medication, it must be tapered.
2.Take the medication regularly; do not skip doses.
3.Stop taking the medication if you develop a round face.
4.Notify the HCP if you start feeling thirsty all the time.
5.Wear a Medic Alert bracelet in case of an emergency.
ANSWER
1.The medication cannot be discontinued; a bilateral adrenalectomy means

that all the hormones normally produced by the adrenal glands must be
replaced. The client now has adrenal insufficiency (Addisons disease).
2.The glucocorticosteroids and mineralocorticosteroids, as well as the
androgens produced by the adrenal glands, must be replaced regularly; doses
should not be skipped.
3.The client cannot stop taking the medication. Doing so could result in a lifethreatening situation. The development of a round face is a side effect
of glucocorticoids that may indicate that the dose is too high. The client
should notify the HCP to review the dosage.
4.Excess glucocorticoids may induce diabetes mellitus; the HCP should be
notied if the client experiences symptoms of diabetes such as feeling
thirsty all the time.
5.All clients with a chronic medical condition should wear a Medic
Alert bracelet or necklace.
34.The emergency department nurse is caring for a client in an Addisonian

crisis. Which intervention should the nurse implement rst?
1.Draw serum electrolyte levels.
2.Administer methylprednisolone (Solu-Medrol) IV.
3.Start an 18-gauge catheter with normal saline.
4.Ask the client what medications he or she is taking.
ANSWER
1.The nurse will monitor the clients electrolytes, especially sodium and
potassium and glucose levels, but this is not the rstaction.2.The nurse
should be prepared to replace the corticosteroids, but this is not the rst
action.
3.The nurse must treat an Addisonian crisis as all other shock situations.
An IV and uid replacement are imperative to prevent or treat shock. This is
the rst action.
4.This is important, but it will not prevent or treat shock.
The stem of the previous question told the test taker that the situation is a
crisis. The rst step in many crises is to make sure that an IV access is
available to administer uids and medications.
35. The client diagnosed with Cushings disease is prescribed pantoprazole

(Protonix), a proton-pump inhibitor. Which statement is the scientic rationale
for prescribing this medication?1.Protonix increases the clients ability to
digest food.
2.Protonix decreases the excess amounts of gastric acid.
3.Protonix absorbs gastric acid and eliminates it in the bowel.
4.Protonix coats the stomach and prevents ulcer formation.
ANSWER
1.Protonix does not increase the ability to digest food.
2.Protonix decreases the production of stomach acid by inhibiting the protonpump step in gastric acid production.
3.Protonix does not absorb gastric acid; it prevents its production.
4.Sucralfate (Carafate) is a mucosal barrier agent that coats the stomach
lining. Protonix does not coat the stomach.
36.The client has developed Cushings syndrome as a result of long-term

steroid therapy. Which assessment ndings would indicate this condition?
1.The client is short of breath on exertion and has pale mucous membranes.
2.The client has a round face and multiple ecchymotic areas on the arms.
3.The client has pink, frothy sputum and jugular vein distention.
4.The client has petechiae on the trunk and sclerosed veins.
ANSWER
1.Shortness of breath and pale mucous membranes do not indicate longterm
steroid use or Cushings syndrome.
2. A round face (moon face) indicates are distribution of fat from steroid
therapy. Multiple ecchymotic areas on the arms indicate a redistribution of
subcutaneous fats away from the arm (thin extremities). Both are side effects
of long-term steroid therapy.
3.Pink, frothy sputum and jugular vein distention are symptoms of congestive
heart failure, not long-term steroid therapy.
4.Petechiae indicate a low platelet count, and sclerosed veins indicate the
use of IV access for medication administration. These are not signs of steroid
therapy.
37.The client has developed Cushings syndrome as a result of an ectopic

production of ACTH by a bronchogenic tumor. Which medication would the
nurse anticipate the health-care provider prescribing?
1.Ketoconazole (Nizoral), an anti-infective.
2.Methylprednisolone (Solu-Medrol), a corticosteroid.
3.Propylthiouracil (PTU), a hormone substitute.
4.Vasopressin (DDAVP), an antidiuretic hormone.
ANSWER
1. Ketoconazole is an anti-infective that also suppresses the production of
adrenal hormones. This side effect makes it useful in treating the
overproduction of adrenal hormones that results from secretion of ACTH by
tumors that cannot be removed surgically.
2.Methylprednisolone is a steroid, and ACTH stimulates the production of
adrenal hormones. This would increase the clients symptoms.
3.Propylthiouracil is used to suppress the production of thyroid hormones, not
adrenal hormones.
4.Vasopressin is a pituitary hormone that prevents diuresis; it is not an
adrenal hormone.
38.The male client diagnosed with iatrogenic Cushings disease calls the
clinic nurse and informs the nurse that he has a temperature of 100.1F.
Which action should the nurse take?
1.Tell the client to take acetaminophen and drink liquids.
2.Instruct the client to come to the clinic for an antibiotic.
3.Have the client go to the nearest emergency department.
4.Encourage the client to discuss his feelings about the disease.
ANSWER
1.The client diagnosed with Cushings disease is at risk for infections because
of the immune suppression that occurs as a result of excess cortisol
production. This client should be seen by the HCP.
2.Clients diagnosed with Cushings disease are at risk for developing
infections related to the excess production of cortisol by the adrenal glands.
The client must be seen by an HCP and antibiotics must be initiated.
3.The client is not in an emergent situation; the client can go to an HCP office
or clinic to be seen.
4.The client has a physiological problem, not a psychosocial problem. The
client does not need therapeutic conversation.
39.The client diagnosed with Addisons disease asks the nurse, Why do I
have to take udrocortisone (Florinef), a mineral corticosteroid? Which
statement is the nurses best response?
1.It will keep you from getting high blood sugars.
2.Florinef helps the body retain sodium.
3.Florinef prevents muscle cramping.
4.It stimulates the pituitary gland to secrete ACTH.
ANSWER
1.Florinef is not an oral hypoglycemic medication. It is a steroid and
may increase the blood glucose, not decrease it.
2.Mineral corticosteroids help the body to maintain the correct serum
sodium levels. Florinef is the preferred medication for Addisons disease,
primary hypoaldosteronism, and congenital adrenal hyperplasia when sodium
wasting occurs.
3.Florinef does not prevent muscle cramps. If the Florinef dose is too high,
then potassium wasting will occur, resulting in muscle cramping.
4.Florinef does not stimulate the pituitary gland. The pituitary gland produces
hormones that stimulate the adrenal gland. The adrenal gland does not
produce hormones that stimulate the pituitary gland.
40.The client being admitted with primary adrenal insufficiency provides the
nurse with a list of home medications. Which medication would the nurse
question?
1.Prednisone (Orasone).
2.Ginseng.
3.Mitotane (Lysodren).
4.Testosterone.
ANSWER
1.Replacement corticosteroids are necessary for clients with adrenal
insufficiency. The nurse would not question
administeringprednisone.2.Ginseng is an herb that enhances the adrenal
function. The nurse would not question this medication.
3.Mitotane is a medication that suppresses adrenal functioning. The nurse
would question this medication in a patient with adrenal insufficiency.
4.In both males and females, the adrenal glands produce androgens,
including testosterone. Replacing this hormone would not be unusual in a
client with adrenal insufficiency.

be held accountable. Remember that the nurse is a client advocate.
herbal preparation will cause harm to the client. The nurse should always be
the clients advocate.
A Client with Pituitary Disorders
41.The client diagnosed with diabetes insipidus is prescribed desmopressin

(DDAVP). Which comorbid condition would warrant a change in medication?
1.Renal calculi.
2.Diabetes mellitus Type 2.
3.Sinusitis.
4.Hyperthyroidism.
ANSWER
1.DDAVP acts on the kidney to concentrate urine, but kidney stones would
not warrant a change in the medication.
2.Diabetes mellitus Type 2 would not be a reason to change the medication.
3.DDAVP is administered intranasally, and a sinus infection could
interfere with absorption of the medication. Vasopressin comes in an
intramuscular form, and the client may need to take this form of vasopressin
until the sinus infection has resolved.
4.Hyperthyroidism would not warrant a change in medication or route.
42.The middle-aged client with a pituitary tumor has enlarged viscera and
bone deformities. Which medication would the nurse administer?
1.Octreotide (Sandostatin), a synthetic hormone analog.
2.Somatrem (Protropin), a human growth hormone.
3.Ketorolac (Toradol), a nonsteroidal anti-inammatory drug.
4.CortiTropin (ACTH), a pituitary hormone.
ANSWER
1.Octreotide suppresses the pituitary glands secretion of human
growth hormone, which, in adults, causes enlarged viscera, bone
deformities ,and other signs and symptoms of acromegaly. The nurse would
expect to administer this medication.(Acromegaly in children results
in gigantism.)
2.Somatrem is a growth hormone and would increase the clients symptoms.
3.NSAIDs are administered to clients diagnosed with nephrogenic diabetes
insipidus to inhibit prostaglandin production.
4.The client has symptoms of acromegaly, an overproduction of human
growth hormone. ACTH would not suppress this production.
43.The client diagnosed with diabetes insipidus is admitted in acute distress.

Which interventions would the nurse implement? Select all that apply.
1.Start an IV with lactated Ringers.
2.Insert an indwelling catheter.
3.Monitor the urine specic gravity.
4.Administer furosemide (Lasix) IVP.
5.Assess the intake and output every shift.
ANSWER
1.The client diagnosed with diabetes insipidus is excreting large amounts

of dilute urine because the body is unable to conserve water and concentrate
the urine. The client requires uid-volume replacement. The nurse would
insert an IV. The client would have a high sodium level (because of the lack
of uid in the vascular system); lactated Ringers solution would be preferred
to normal saline.
2.The client should be on hourly output measurements. An indwelling
catheter is needed to measure the clients output. The client requires rest,
and voiding many liters of urine every day would leave the client exhausted
from lack of sleep.
3.The urine specic gravity indicates the clients ability to concentrate urine
and should be monitored.
4.Lasix would increase the clients urinary output; this is opposite to the
effect that isneeded.5.In this situation, intake and output measurements are
monitored every hour, not every shift.
44.The client diagnosed with mild diabetes insipidus is prescribed

chlorpropamide (Diabinese), a sulfonylurea. Which discharge instruction
should the nurse teach the client?
1.Discontinue the medication if feeling dizzy.
2.Chew sugarless gum to alleviate dry mouth.
3.Take the medication before meals.
4.Discuss signs and symptoms of an insulin reaction.
ANSWER
1.Diabinese can cause weakness, jitteriness, nervousness, and other signs of
a hypo-glycemic reaction. The client should be aware of this and be prepared
to treat the reaction with a source of simple carbohydrate. This is not a
reason to discontinue the medication.
2.Diabinese is not a cholinergic medication with a side effect of a dry mouth.
3.Clients with Type 2 diabetes mellitus usually take the medication prior to
meals. The effects of Diabinese can last 23 days. This client can take the
medication after a meal.
4.Diabinese potentiates the action of vasopressin in clients with residual

hypothalamic function. The sulfonylureas are used mostly to treat Type
2diabetes mellitus because they stimulate the pancreas to secrete
insulin. The client should be aware that an insulin reaction (hypoglycemic
reac-tion) can occur.
45.The 30-year-old female client is prescribed chorionic gonadotrophin

(Chorigon), a hormone substitute. Which intervention should the nurse
implement?
1.Have the lab draw an FSH level every week.
2.Schedule for regular pelvic sonograms.
3.Discuss not becoming pregnant while taking this drug.
4.Teach to take the medication with food.
ANSWEER
1.This medication is given to cause maturation of the ovarian follicle and
trigger ovulation. An FSH level would have been done prior to prescribing
Chorigon.
2.This medication is given to cause maturation of the ovarian follicle and
trigger ovulation. The client is monitored for overstimulation of the ovaries by
pelvic sonograms.
3.The medication is a category X medication, which indicates that it is known
to cause harm to fetuses, but it is given to stimulate ovulation to achieve a
pregnancy. It also is given to maintain the corpus luteum after LH decreases
during a normal pregnancy.
4.The medication is given parenterally, not orally.
46.The HCP ordered furosemide (Lasix) for a client diagnosed with syndrome
of inappropriate antidiuretic hormone (SIADH). Which laboratory test would
be monitored to determine the effectiveness of the medication?
1.Serum sodium levels.
2.Serum potassium levels.
3.Creatinine levels.
4.Serum ACTH levels.
ANSWER
1.In SIADH, the body retains too much water. Elevated uid levels in the
body result in dilutional hyponatremia. Hyponatremia can cause seizures and
other central nervous system dysfunction. The sodium level is monitored to
determine the effectiveness of the intervention.
2.The serum potassium level is important to monitor, but it will not measure
the effectiveness of Lasix in treating this condition.
3.The problem in SIADH is in the pituitary gland; it is not a kidney problem.
4.The pituitary gland produces ACTH, but ACTH production is not the problem
in SIADH. SIADH is an overproduction of vasopressin, the antidiuretic
hormone.
medication administration, including which client assessment data and
laboratory data should be monitored prior to administering the medication.
47.Which medication would the nurse administer to the client diagnosed with
nephrogenic diabetes insipidus?1.Clobrate (Atromid-S),
an antilipemic.2.Ibuprofen (Motrin), a prostaglandin inhibitor.3.Furosemide
(Lasix), a loop diuretic.4.Desmopressin (DDAVP), a pituitary hormone.
ANSWER
1.Clobrate is an antilipemic that has an antidiuretic effect on clients with
neuro-genic diabetes insipidus, but it would not have an effect on a client
whose diabetes insipidus is caused by the kidneys inability to respond to the
medication.
2.NSAIDs inhibit prostaglandin production and are used to treat nephrogenic
diabetes insipidus.
3.Lasix is a diuretic and would increase the urinary output in a client whose
problem is too much urinary output.
4.Desmopressin is a form of vasopressin, the antidiuretic hormone, but

production of the hormone is not in question in nephrogenic diabetes
insipidus; the pituitary gland is producing the hormone. The problem is that
the kidneys are unable to respond to it.
48.The female client diagnosed with Hodgkins disease is prescribed

vincristine(Oncovin), a vinca alkaloid. Since the last treatment the client
complains that she cannot wear her rings or most of her shoes because of
weight gain. Which action should the nurse take rst?
1.Administer a diuretic before the Oncovin to prevent uid overload.
2.Monitor the client for signs of infection.
3.Discuss a low-sodium diet with the client.
4.Weigh the client and report the ndings to the oncologist.
ANSWER
1.The problem is that the client is in uid- volume overload probably as a
result of the medication vincristine. A diuretic may be administered, but as a
treatment, not as not as prophylactic measure.
2.Weight gain is not a sign of an infection. These symptoms indicate SIADH.
3.The clients diet is not responsible for the uid weight gain.
4. Vincristine, the phenothiazines, antidepressants, thiazide diuretics, and
smoking are known to stimulate the pituitary gland, resulting in an
overproduction of vasopressin. The clients symptoms indicate SIADH. The
nurse should assess the weight gain, hold the medication, and notify the HCP.
49.The client diagnosed with neurogenic diabetes insipidus is prescribed

vasopressin tannate in oil. Which instructions should the nurse teach?
1.Sleep with the head of the bed elevated.
2.Use a tuberculin syringe to administer medication.
3.Administer the medication in the evening.
4.Alternate nares when taking the medication.
ANSWER
1.Sleeping with the head of the bed elevated will not affect this medication.
2.The medication is administered intra-muscularly. A tuberculin syringe is
used for subcutaneous or intradermal injections.
3.The medication should be administered in the evening for maximum effect
during the sleeping hours, so the client will not be up to void frequently.
4.DDAVP, not vasopressin tannate in oil, is administered intranasally.
The test taker could eliminate option 4 by reading in oil. Oil preparations
are not usually administered in the nose.
50.
The nurse is administering morning medications. Which medication would
the nursequestion?1.Black cohosh, an herb, to a client with dysmenorrhea
and cramping.
2.Desmopressin (DDAVP), to a client with diabetes insipidus and angina.
3.Hydrochlorothiazide (Diuril), to a client with SIADH from a head injury.
4.Calcitonin (Cibacalcin) a hormone, to a client with hypercalcemia from lung
cancer.
ANSWER
1.Black cohosh is an over-the-counter herb that is sometimes used to treat
dysmenorrhea, premenstrual syndrome (PMS), and menopausal symptoms.
The nurse would not question this medication.
2.Desmopressin causes vasoconstriction and is contraindicated in clients
with angina because of the coronary vasoconstriction.
3.Diuril would be administered to a client with SIADH. SIADH may be caused

by ahead injury, pituitary tumors, tumors that secrete hormones, some
medications, and smoking. The nurse would not question this medication.
4.Calcitonin is administered to decrease calcium levels. The nurse would not
question this medication.
be held account-able. Remember that the nurse is a client advocate
A Client with Thyroid Disorders
51.The client diagnosed with hypothyroidism is prescribed levothyroxine

(Synthroid). Which assessment data would support that the client is not
taking enough medication?
1.The client has a 2-kg weight loss.
2.The client complains of being too hot
.3.The clients radial pulse rate is 110 bpm.
4.The client complains of being constipated.
ANSWER
1.The client would have signs or symptoms of hypothyroidism if the client is
not taking enough medication. Weight loss is a sign of hyperthyroidism, which
indicates the client is taking too much Synthroid.
2.The client would have signs or symptoms of hypothyroidism if the client is
not taking enough medication. Intolerance to heat is a sign of
hyperthyroidism and indicates the client is taking too much medication.
3.Tachycardia, a heart rate greater than 100,is a sign of hyperthyroidism and
indicates the client is taking too much medication.
4.Decreased metabolism and constipation indicate that the client is

not taking enough of the thyroid hormone.
52.Which complication should the nurse assess for in the elderly client newly
diagnosed with hypothyroidism who has been prescribed levothyroxine
(Synthroid)?
1.Cardiac dysrhythmias.
2.Respiratory depression.
3.Paralytic ileus.
4.Thyroid storm.
ANSWER
1.Synthroid increases the basal metabolic rate, which can precipitate cardiac
dysrhythmias in clients with undiagnosed heart disease, especially in elderly
clients. Synthroid can also cause cardiovascular collapse. Therefore the
clients cardiovascular function should be assessed by the nurse.
2.Respiratory depression is not a complication of thyroid hormone therapy.
3.The client with hypothyroidism may experience a paralytic ileus due to
decreased metabolism. This would not be an expected complication in a
client taking Synthroid.
4.A thyroid storm may occur when the thyroid gland is manipulated during a
thyroidectomy, not when the client starts taking Synthroid.
53.The client with hyperthyroidism is administered radioactive iodine (I-131).

Which intervention should the nurse implement?
1.Explain that the medication will destroy the thyroid gland completely.
2.Instruct the client to avoid close contact with children for 1 week.
3.Discuss the need to take the medication at night for 7 days.
4.Administer the radioactive iodine in 8 ounces of cold orange juice.
ANSWER
1.The goal of radioactive iodine treatment is to destroy just enough of the
thyroid gland so that the levels of thyroid function return to normal; it does
not destroy the entire gland.
2.The client should not be in close contact with children or pregnant women
for 1 week following administration of the medication because the client will
be emitting small amounts of radiation.
3.Most clients require a single dose of radioactive iodine, but some may need
additional treatments.
4.The radioactive iodine is a clear, odorless, tasteless liquid that does not
need to be administered with cold orange juice.
54.The client with hyperthyroidism is prescribed the thioamide

propylthiouracil (PTU). Which laboratory data should the nurse monitor?1.The
clients arterial blood gases.2.The clients serum potassium level.3.The
clients red blood cell count (RBC).4.The clients white blood cell count (WBC).
ANSWER
1.The clients arterial blood gases are not affected by PTU.
2.The clients potassium level is not affected by PTU.
3.The clients red blood cell count is not affected by PTU.
4.The client receiving PTU is at risk for agranulocytosis; therefore, the
clients white blood cell count should be checked periodically. Because
agranulocytosis puts the client at greater risk for infection, efforts to control
invasion of microbes should be strictly observed.
55.The nurse is preparing to administer liothyronine (Cytomel), a thyroid

hormone, to a client diagnosed with hypothyroidism. Which data would cause
the nurse to question administering the medication?
1.The client is complaining of being nervous.
2.The clients oral temperature is 98.9F.
3.The clients blood pressure is 110/70.

4.The client is complaining of being tired.
ANSWER
1.Nervousness, jitteriness, and irritability are signs or symptoms of
hyperthyroidism; therefore, the nurse should question administering thyroid
hormone.
2.A normal temperature would indicate the client is in a euthyroid state;
therefore, the nurse would not question administering this medication.
3.A normal blood pressure would indicate the client is in a euthyroid state;
therefore, the nurse would not question administering this medication.
4.The nurse would not question administering the medication because fatigue
is a sign of hypothyroidism, which is why the client has been prescribed
thyroid hormone.
If the client verbalizes a complaint, if the nurse assesses data, or if laboratory
data indicates an adverse effect secondary to a medication, the nurse must
intervene. The nurse must implement an independent intervention or notify
the health-care provider because medications can result in serious or even
life-threatening complications.
56.The nurse is discussing the thyroid hormone levothyroxine (Synthroid)

with the client diagnosed with hypothyroidism. Which intervention should the
nurse discuss with the client?
1.Encourage the client to decrease the ber in the diet.
2.Discuss the need to monitor the T3, T4 levels daily.
3.Tell the client to take the medication with food only.
4.Instruct the client to report any signicant weight changes.
ANSWER
1.The nurse should discuss ways to help cope with the symptoms of
hypothyroidism. The client should increase ber intake to help prevent
constipation.2.The T3, T4, and TSH levels are monitored to help determine
the effectiveness of the medication, but this is not done daily by the client.
Serum blood levels are monitored monthly initially and then every 6
months.3.The medication should be taken on an empty stomach because
thyroid hormones have their optimum effect when taken on an empty
stomach.
4.The clients weight should be monitored weekly. Weight loss is expected as
a result of the increased metabolic rate, and weight changes help to determine the effectiveness of the drug therapy.
57.The client diagnosed with hyperthyroidism who received radioactive

iodine, I-131,tells the nurse, I dont think the medication is working. I dont
feel any different. Which statement would be the nurses best response?
1.You should notify your health-care provider immediately.
2.You may need to have two or three more doses of the medication.
3.It may take up to several months to get the full benets of the treatment.
4.You dont feel any different. Would you like to sit down and talk about it?
ANSWER
1.There is no reason for the client to notify the HCP because it takes several
months to attain the euthyroid state.
2.Most clients only need one dose of radioactive iodine, but it takes several
months to attain the euthyroid state.
3.The goal of radioactive therapy for hyperthyroidism is to destroy
just enough of the thyroid gland so that levels of thyroid function return to
normal. Full benets may take several months.
4.This is a therapeutic response, which is not appropriate because the client
needs factual information.
58.The nurse is discussing the thyroid hormone levothyroxine (Synthroid)

with a client diagnosed with hypothyroidism. Which intervention should be
included in the client teaching?
1.Discuss the importance of not using iodized salt.

2.Explain the importance of not taking medication with grapefruit juice.
3.Instruct the client to take the medication in the morning.
4.Teach the client to monitor daily glucose levels.
ANSWER
1.This would be appropriate if the client is taking antithyroid medication, not
thyroid hormones. Iodine increases the production of thyroid hormones, which
is not desirable in clients taking antithyroid medications.
2.Grapefruit juice is contraindicated when taking some medications, but not
thyroid hormone therapy.
3.The medication should be taken in the morning to decrease the incidence
of drug-related insomnia.
4.Thyroid medications do not affect the clients blood glucose level; therefore,
there is no need for the client to monitor the glucose level.
Grape-fruit juice can inhibit the metabolism of certain
medications. Specically, grapefruit juice inhibits cytochrome P450-3A4
found in the liver and the intestinal wall. The nurse should investigate any
medications the client is taking if the client drinks grapefruit juice.
59. The client diagnosed with hyperthyroidism is prescribed the antithyroid

medication propylthiouracil (PTU). Which statement by the client warrants
immediate intervention by the nurse?
1.I seem to be drowsy and sleepy all the time.
2.I have a sore throat and have had a fever.
3.I have gained 2 pounds since I started taking PTU.
4.Since taking PTU I am not as hot as I used to be.
ANSWER
1.Antithyroid medications may cause drowsiness; therefore, this
statement would not warrant immediate intervention by the nurse.
2.The antithyroid medication may affect the bodys ability to defend
itself against bacteria and viruses; therefore, the nurse should intervene if
the client has any type of sore throat, fever, chills, malaise, or weakness.
3.As a result of slower metabolism from the PTU, weight gain is expected;
therefore, this statement would not warrant intervention by the nurse.
4.This indicates the medication is effective; the signs of hyperthyroidism
which include feeling hot much of the timeare decreasing. This would not
warrant immediate intervention by the nurse.
60The client diagnosed with hyperthyroidism is prescribed an antithyroid

medication. Which interventions should the nurse implement? Select all that
apply.
1.Monitor the clients thyroid function tests.
2.Monitor the clients weight weekly.
3.Monitor the client for gastrointestinal distress.
4.Monitor the clients vital signs.5.Monitor the client for activity intolerance
ANSWER
1. Thyroid function tests are used to determine the effectiveness of
drug therapy.
2.Weight gain is expected as a result of a slower metabolism.
3.Antithyroid medication may cause nausea or vomiting.
4.Changes in metabolic rate will be manifested as changes in blood pressure,
pulse, and body temperature.
5.Hyperthyroidism results in protein catabolism, overactivity, and increased

metabolism, which lead to exhaustion; therefore, the nurse should
monitor for activity intolerance
Endocrine System Comprehensive

Examination
Sunday, September 4, 2016
1:00 AM
1. The client diagnosed with Addisons disease tells the clinic nurse that he is
taking licorice every day to help the disease process. Which action should the
nurse implement?
1.Tell the client licorice is a candy and will not help Addisons disease.
2.Praise the client because licorice increases aldosterone production.
3.Ask the client why he thinks licorice will help the disease process.
4.Determine if the licorice has caused any mouth ulcers or sores.
ANSWER
1.This is a false statement, and the nurse should investigate any type of
alternative treatment before making this statement.
2.Licorice is a avoring for candy, but it is also used as an herbal medication
in tablet, tea, or tincture form. Licorice increases the aldosterone effect,
which helps treat Addisons disease.
3.This is an aggressive-type judgmental question, and the client does not owe
the nurse an explanation.
4.Licorice is used to treat mouth ulcers; it does not cause them.
herbal preparation will cause harm to the client. The nurse should always be
the clients advocate.
2.The client is diagnosed with primary hyperaldosteronism and prescribed

the aldosterone agonist spironolactone (Aldactone). Which data would
support that the medication is effective?
1.The clients potassium level is 4.2 mEq/L.
2.The clients urinary output is 30 mL/hr.
3.The clients blood pressure is 140/96.
4.The clients serum sodium is 137 mEq/L.
ANSWER
Hyperaldosteronism causes hypokalemia, metabolic alkalosis, and
hypertension. Spironolactone, a potassium-sparing diuretic, normalizes
potassium levels in clients with hyperaldosteronism within 2 weeks;
therefore, a normal potassium level, which is 4.2 mEq/L, indicates the
medication is effective.
2.The urinary output is not used to determine the effectiveness of this
medication in a client with hyperaldosteronism.
3.The client does have hypertension, but this blood pressure is above normal
limits and does not indicate the medication is effective.
4.The serum sodium level is not used to determine the effectiveness of this
medication in a client with hyperaldosteronism.
3.The client diagnosed with diabetes insipidus (DI) is receiving desmopressin

(DDAVP),a pituitary hormone, intranasally. Which assessment data would
warrant the client notifying the health-care provider?
1.The client does not feel thirsty all the time.

2.The client is able to sleep throughout the night.
3.The client has gained 2 kg in the last 24 hours.
4.The client has to urinate at least ve times daily.
ANSWER
1.The major symptom with DI is polyuria resulting in polydipsia (extreme
thirst);therefore, the client not being thirsty indicates the medication is
effective.
2.The client being able to sleep through the night indicates that he or she is
not getting up to urinate because of polyuria and thus that the medication is
effective.
3. A weight gain of 4.4 pounds indicates the client is experiencing water
intoxication, which would indicate the client is receiving too much medication
and the HCP should be notied.
4.The client urinating ve times a day indicates the medication is effective;
therefore, the client would not have to notify the HCP.
If the client verbalizes a complaint, if the nurse assesses data, or if laboratory
data indicates an adverse effect secondary to a medication, the nurse must
intervene. The nurse must implement an independent intervention or notify
the health-care provider because medications can result in serious or
even life-threatening complications.
4.The 2-year-old child has just been diagnosed with cystic brosis (CF). Which
intervention should the nurse discuss with the childs mother?
1.Do not administer over-the-counter mucolytic agents.
2.Administer cough suppressants at night only.
3.Check the childs blood glucose level four times a day.
4.Sprinkle pancreatic enzymes on the childs food.
ANSWER
1.Mucolytic medications are administered to help liquefy thick tenacious
secretions characteristic of CF.
2.The child would not receive cough suppressants (antitussives) because the
thick tenacious secretions need to be expectorated, not suppressed.
3.Eventually the beta cells will become clogged as a result of the thick
tenacious secretions in the pancreas, but this would not be a problem in the
initial stage after diagnosis.
4.The thick tenacious secretions clog the pancreatic ducts, resulting in a
decrease of the pancreatic enzymes amylase and lipase in the small
intestines. The mother must administer these enzymes with every meal or
snack to ensure digestion of carbohydrates and fats.
5.The 36-year-old female client who had an abdominal hysterectomy is

prescribed the estrogen hormone replacement Premarin. The client calls the
nurse in the Womens Health Clinic and reports she is producing breast milk.
Which intervention should the nurse tell the client?
1.Explain that this is an expected side effect and it will stop.
2.Determine if the client is having abdominal cramping.
3.Ask if this mainly occurs during sexual intercourse.
4.Discontinue taking the estrogen until seen by the HCP.
ANSWER
1.This is not an expected side effect and is caused by the estrogen
stimulating the hypothalamus to produce prolactin. The estrogen dosage
must be adjusted or discontinued.
2.Abdominal cramping is a symptom associated with menses and the client
does not have a uterus; therefore, this is not an appropriate question.
3.The breast discharge is unrelated to sexual intercourse.
4.The medication should be stopped until the HCP can be seen because
this warrants a dosage adjustment or discontinuation permanently. The
estrogen stimulates the hypothalamus to produce prolactin, which causes the

breast milk.
6.The 10-year-old male client is receiving the growth hormone somatropin

(Humatrope). Which signs or symptoms would warrant intervention by the
nurse?
1.A 3-cm increase in height.
2.A moon face and buffalo hump.
3.Polyuria, polydipsia, and polyphagia.
4.T 99.4F, P 108, R 22, and B/P 121/70.
ANSWER
1.The child has grown a little more than 1inch (2.54 cm equals 1 inch).
Because the child has been prescribed the growth hormone to increase
growth, this would indicate that the medication is effective and no
intervention on the part of the nurse is needed.
2.These are side effects of steroid therapy, not growth hormones.
3.Growth hormone is diabetogenic; there-fore, any signs of diabetes mellitus,
such as polyuria, polydipsia, and polyphagia, should be reported to the HCP
immediately. These are the 3 Ps of diabetes mellitus.
4.The nurse must know the normal parameters for children (T 97.5 F to
98.6F), so a temperature of 99.4F would not warrant notication of the HCP.
Normal pulse rate is 70110, respiratory rate is 1622, systolic B/P is 83121,
and diastolic B/P is 4379. These vital signs do not warrant notifying the HCP.
7.The female client has secondary adrenal insufficiency and is prescribed

adrenocorticotrophic hormone ACTH (Acthar). Which information should the
nurse discuss with client?
1.Explain ACTH will increase metabolism.
2.Instruct the client to limit dietary salt
.3.Inform the client that an increase in growth may occur.
4.Tell the client that normal menses is expected.
ANSWER
1.Thyroid hormones, not ACTH, would increase the clients metabolism.
2.ACTH is administered as an adrenal stimulant when the pituitary gland is
unable to perform this function. This medication will cause the absorption
of sodium and cause edema; therefore, the client should decrease salt intake.
3.This medication may decrease the clients growth.
4.This medication causes abnormal menses.
8. The client is diagnosed with hypothyroidism and is taking the thyroid

hormone
levothyroxine (Synthroid). Which data indicates the medication is effective?
1.The clients apical pulse is 84 and the blood pressure is 134/78.
2.The clients temperature is 96.7F and respiratory rate is 14.
3.The client reports having a soft, formed stool every 4 days.
4.The client tells the nurse that the client only needs 3 hours of sleep
ANSWER
1.If the thyroid medication is effective, the clients metabolism should be
within normal limits, and this pulse and blood pressure support this.
2.These vital signs are subnormal, indicating hypothyroidism.
3.A stool every 4 days indicates constipation and constipation is a sign of
hypothyroidism. This indicates the medication is not effective.
4.Six to 8 hours of sleep would be normal. Three hours would indicate
hyperactivity, which is a sign of hyperthyroidism; perhaps a dosage
adjustment in the medication is needed.
9.The nurse is administering the following medications. Which medication

would the nurse question administering?
1.The sulfonylurea glyburide (Micronase) to a client with Type 1 diabetes.
2.The loop diuretic furosemide (Lasix) to a client with SIADH.
3.The narcotic analgesic meperidine (Demerol) to a client with pancreatitis.
4.The sliding-scale regular insulin to a client with Type 2 diabetes.
ANSWER
1. The sulfonylureas stimulate beta-cell production of insulin. Clients
diagnosed with Type 1 diabetes have no functioning beta cells; therefore,
they cannot be stimulated. The nurse should question administering this
medication.
2.The client with SIADH would be receiving a loop diuretic to decrease excess
uid volume.
3.Demerol is the drug of choice to treat pain from pancreatitis. Morphine
stimulates the sphincter of Oddi.
4.A client with Type 2 diabetes is often prescribed insulin during times of
stress or illness.
be held account-able. Remember that the nurse is a client advocate.
10.The client with Type 1 diabetes is scheduled for a CT scan of the abdomen
with contrast. The client is taking metformin (Glucophage), a biguanide, and
70/30 insulin24 units at 0700 and 1600. Which instruction should the nurse
give the client?
1.Administer the 70/30 insulin the morning of the test.
2.Take half the dose of the morning insulin on the day of the test.
3.Do not take the Glucophage after the procedure until the HCP approves.
4.Take the medications as prescribed because they will not affect the test.
ANSWER
1.Because the client is NPO for the test, the insulin should be held.
2.Because the client is NPO for the test, the insulin should be held. In
addition, the nurse cannot prescribe medication or change the dosage.
3.Glucophage has a potential side effect of producing lactic acid. When it is
administered simultaneously or within a close time span of the contrast dye
used for the CT scan, lactic acidosis could result. It is recommended to hold
the medication prior to and up to48 hours after the scan. The HCP should
obtain a BUN and creatinine to determine kidney function prior to restarting
Glucophage.
4.Insulin should be held when the client is NPO, and Glucophage will be held
because of the contrast dye.
Any time the client is having a diagnostic test the nurse should question
administering any medication.
11.The client with chronic pancreatitis is prescribed the pancreatic enzyme

Pancrease. Which data indicate that the dosage should be increased?
1.No bowel movement for 3 days.
2.Fatty, frothy, foul-smelling stools.
3.A decrease in urinary output.
4.An increase in midepigastric pain.
ANSWER
1.Constipation does not determine the effectiveness of the Pancrease.
2.Steatorrhea (fatty, frothy, foul-smelling stools) or diarrhea indicates a lack
of pancreatic enzymes in the small intestines. This would indicate the dosage
is too small and needs to be increased.
3.Urine output does not determine effectiveness of Pancrease.4.An

increase in midepigastric pain is a symptom of peptic ulcer disease or
gastrointestinal reux disease and does not indicate the effectiveness of the
pancreatic enzyme. The client with chronic pancreatitis may have abdominal
pain, but the pancreatic enzymes are administered for digestion of food, not
to alleviate pain.
12. The client with Addisons disease is prescribed prednisone. Which

laboratory data would the nurse expect this medication to alter?1.Glucose.
2.Sodium.
3.Calcium.
4.Creatinine.
ANSWER
1.Prednisone is a glucocorticoid medication, which affects the glucose
metabolism; therefore, the nurse should expect the glucose level to be
altered.
2.Sodium is not affected by prednisone.
3.Calcium is not affected by prednisone.
4.Creatinine is not affected by prednisone.
13.The client is prescribed prednisone, a glucocorticoid, for poison ivy. Which

information should the nurse discuss with the client? Select all that apply.
1.Take the medication with food.
2.The medication must be tapered.
3.Avoid going in the sunlight.
4.Monitor the blood glucose level.
5.Do not eat green, leafy vegetables.
ANSWER
1.Prednisone is very irritating to the stomach and must be taken with food to
avoid gastritis or peptic ulcer disease.
2.To avoid adrenal insufficiency or Addisonian crisis, the client must taper the
medication.
3.Prednisone does not cause photosensitivity.
4.Because the prednisone is used short term for treating poison ivy, the blood
glucose level would not need to be monitored.
5.Green, leafy vegetables are high in vitamin K and would be contraindicated
in anticoagulant treatment with Coumadin but not with prednisone treatment.
14.The client diagnosed with hyperthyroidism undergoes a bilateral

thyroidectomy. Which statement indicates the client understands the
discharge instructions?
1.I must take my PTU medication at night only.
2.I should not take my medication if I am nauseated.
3.I will take my thyroid hormone pill every day.
4.I need to check my thyroid level daily.
ANSWER
1.PTU is an antithyroid medication and the client has had the thyroid gland
removed.
2.The client must take the thyroid hormone daily or the client will experience
signs of hypothyroidism.
3.Because the clients thyroid has been removed the client now has
hypothyroidism and must take a thyroid replacement daily for the rest of his
or her life.
4.There is no daily test for thyroid level; it is checked by a venipuncture test
every few months.
15.The unlicensed assistive personnel (UAP) noties the primary nurse that
the client is complaining of being jittery and nervous and is diaphoretic. The
client is diagnosed with diabetes mellitus. Which interventions should the
primary nurse implement? Rank in order of performance.
1.Have the UAP check the clients glucose level.
2.Tell the UAP to get the client some orange juice.
3.Check the clients medication administration record.
4.Immediately go to the room and assess the client.5.Assist the UAP in
changing the clients bed linens.
ANSWER. 4, 1, 2, 3, 5.
4.These are symptoms of a hypoglycemic reaction and the nurse should
assess the client immediately; therefore, this is the rst intervention.
1.Because the nurse is assessing the client in the room, the UAP can take the
glucometer reading. The nurse cannot delegate care of an unstable client but
can delegate a task because the nurse is in the room with the client.
2.The treatment of choice for a conscious client experiencing a hypoglycemic
reaction is to administer food or a source of glucose. Orange juice is a source
of glucose, and the UAP can get it.
3.The nurse should check the MAR to determine when the last dose of
insulin or oral hypoglycemic medication was administered.
5.When the client has been stabilized, then the linens should be changed to
make the client comfortable.
16.The client with Type 1 diabetes is diagnosed with diabetic ketoacidosis.

The HCP prescribes intravenous regular insulin by continuous infusion. Which
intervention should the intensive care nurse implement when administering
this medication?
1.Flush the tubing with 50 mL of the insulin drip before administering to the
client.
2.Monitor the clients serum glucose level every hour and document it on the
MAR.
3.Draw the clients arterial blood gas results daily and document them in the
clients chart.
4.Administer the clients regular insulin drip via gravity at the prescribed rate
ANSWER
1.The regular insulin adheres to the lining of the plastic intravenous tubing;
therefore, the nurse should ush the tubing with at least 50 mL of the insulin
solution so that insulin will adhere to the tubing before the prescribed dosage
is administered to the client. If this is not done, the client will not receive the
correct dose of insulin during the rst few hours of administration.
2.To monitor serum glucose, the nurse would need to perform an
hourly venipuncture. This is painful, is more expensive, and takes a longer
time to provide glucose results. Therefore, a capillary (nger stick) bedside
glucometer will be used to monitor the clients blood glucose level every
hour.
3.The nurse does not draw arterial blood gases; this is done by the
respiratory therapist or the HCP.
4.A regular insulin drip must be administered by an infusion-controlled device
(IV pump). It may not be given via gravity because it is a very dangerous
medication and could kill the client if not administered correctly.
17.The nurse is administering medications to a client diagnosed with Type 1

diabetes. The clients 1100 glucometer reading is 310. Which action should
the nurse implement?
1.Have the laboratory verify the glucose results.

2.Notify the health-care provider of the results.
3.Administer 8 units of regular insulin subcutaneously.
4.Recheck the clients glucometer reading at 1130.
ANSWER
1.According to the sliding scale, blood glucose results should be veried when
less than 60 or greater than 400.
2.The HCP does not need to be notied unless the blood glucose is greater
than400.
3.The clients reading is 310; therefore, the nurse should administer 8 units
of regular insulin as per the HCPs order.
4.There is no reason for the nurse to recheck the results.
18.The client with Type 2 diabetes is prescribed exenatide (BYETTA), a

subcutaneous antidiabetic medication. Which information should the nurse
discuss with the client?1.Keep the BYETTA pen at room temperature after
opening the pen.
2.Instruct the client to notify the health-care provider if nauseated.
3.Tell the client to take the medication 1 hour before the morning and
evening meals.
4.Explain that this medication is a type of regular-acting insulin.
ANSWER
1.All BYETTA pens, used and unused, must be kept refrigerated or kept cold at
36F.
2.The most common side effects with BYETTA include nausea, vomiting,
diarrhea, dizziness, headache, and jitteriness. Nausea is most common when
rst starting BYETTA, but it decreases over time in most clients
3.BYETTA is injected twice a day, at any time within 1 hour of the clients
morning and evening meal. The client should not take BYETTA after the meal.
4.BYETTA is not insulin or a substitute for insulin. Clients whose diabetes
requires insulin must not use BYETTA.
19. Which statement by the client with Type 2 diabetes indicates the client
understands the medication teaching concerning exenatide (BYETTA), a
subcutaneous antidiabetic medication?
1.I will throw away my pen in 30 days, even if there is medicine in the pen.
2.I always keep the needle on my pen, even when it is in the refrigerator.
3.This medication cost so much I use my pen past the expiration date.
4.I should not take any other diabetic medication when I take BYETTA.
ANSWER
The BYETTA pen should only be used for 30 days. The client should
throw away the used BYETTA pen after 30days, even if some medicine
remains in the pen.
2.The needle should be removed from the pen when storing the medication in
the refrigerator because some medicine may leak from the BYETTA pen or air
bubbles may form in the cartridge.
3.The BYETTA pen should not be used after the expiration date printed on the
label.
4.BYETTA is used with metformin(Glucophage) or other types of antidiabetic
medicine called sulfonylureas.
20.The client with diabetes is prescribed Exubera, insulin human (rDNA

origin) inhalation powder. Which statement indicates the client needs more
medication teaching?
1.With this medication I will be taking 10 times my regular insulin dose.
2.My medication will be in a large canister that I must carry with me.
3.I am glad that I dont have to worry about an insulin reaction
with Exubera.
4.If I get a cold or pneumonia, I will call my health-care provider.
ANSWER
1.The client must take 10 times the amount of injectable insulin because only
10% of the medication is absorbed by the body. This statement indicates the
client under-stands the medication teaching.2.The medication comes in a
very large canister with an inhalation mouth piece; the client understands the
medication teaching.
3.This is insulin, and the client is still subject to hypoglycemia. This
statement indicates the client needs more medication teaching.
4.Because the medication is absorbed in the lungs the client should call the
HCP if the lungs are unable to absorb the medication. This indicates the client
understands the discharge teaching

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Pharm Quiz 1 - Type 1 Diabetes

ENDOCRINE PRACTICE QUESTIONS

A Client with Type 1 Diabetes

1.The nurse administered 25 units of Humulin N to a client with Type 1

1.Headache, nervousness, sweating, tremors, and rapid pulse are signs of a

5.The client diagnosed with Type 1 diabetes is complaining of a dry mouth,

7. The nurse in the medical department is preparing to administer Humalog,

Glycosylated Hemoglobin Results

4.0 - 5.5% Norma;

4.Prelled syringes should be stored in the refrigerator and should be used

10.Which statement best describes the pharmacodynamics of insulin?

A Client with Type 2 Diabetes

1.I have to eat my diabetic diet even if I am taking this medication.

13.The nurse is discussing the oral hypoglycemic medication Micronase with

14.The client diagnosed with Type 2 diabetes is receiving the combination

2.The client is experiencing signs of a hypoglycemic reaction and the nurse

MEDICATION MEMORY JOGGER:

19.The school nurse is teaching a class about Type 2 diabetes to elementary

4.Make an appointment for the client to come to the health-care providers

A Client with Pancreatitis

21.The nurse is administering medications. Which medication would the

2.Diphenhydramine is a histamine 1blocker that blocks the release of

24.The HCP prescribed chlordiazepoxide (Librium), a sedative hypnotic, for a

25.The client diagnosed with acute pancreatitis is complaining of severe

5.There is no indication that the client requires oxygenation at this time.

26.The client diagnosed with acute pancreatitis is placed on total parenteral

27.The nurse is administering pancreatic secretin, a stimulatory hormone, to

28.Which intervention should be implemented when discharging a client

29. The male client diagnosed with pancreatitis is prescribed octreotide

30.The client diagnosed with pancreatitis is complaining of polydipsia and

2.The clients symptoms should indicate hyperglycemia to the nurse, not

A Client with Adrenal Disorders

31.The client diagnosed with Addisons disease is being discharged. Which

32.The client diagnosed with Cushings disease is prescribed alendronate

33. The client is scheduled for a bilateral adrenalectomy for Cushings

1.The medication cannot be discontinued; a bilateral adrenalectomy means

34.The emergency department nurse is caring for a client in an Addisonian

35. The client diagnosed with Cushings disease is prescribed pantoprazole

36.The client has developed Cushings syndrome as a result of long-term

37.The client has developed Cushings syndrome as a result of an ectopic

The nurse must be knowledgeable about accepted standards of practice for

A Client with Pituitary Disorders

41.The client diagnosed with diabetes insipidus is prescribed desmopressin

43.The client diagnosed with diabetes insipidus is admitted in acute distress.

1.The client diagnosed with diabetes insipidus is excreting large amounts

44.The client diagnosed with mild diabetes insipidus is prescribed

4.Diabinese potentiates the action of vasopressin in clients with residual

45.The 30-year-old female client is prescribed chorionic gonadotrophin

4.Desmopressin is a form of vasopressin, the antidiuretic hormone, but

48.The female client diagnosed with Hodgkins disease is prescribed

49.The client diagnosed with neurogenic diabetes insipidus is prescribed

4.Alternate nares when taking the medication.

3.Diuril would be administered to a client with SIADH. SIADH may be caused

A Client with Thyroid Disorders

51.The client diagnosed with hypothyroidism is prescribed levothyroxine

4.Decreased metabolism and constipation indicate that the client is

53.The client with hyperthyroidism is administered radioactive iodine (I-131).

54.The client with hyperthyroidism is prescribed the thioamide

55.The nurse is preparing to administer liothyronine (Cytomel), a thyroid

3.The clients blood pressure is 110/70.

56.The nurse is discussing the thyroid hormone levothyroxine (Synthroid)

57.The client diagnosed with hyperthyroidism who received radioactive

58.The nurse is discussing the thyroid hormone levothyroxine (Synthroid)