NCLEX Practice Exam for Pharmacology: Endocrine Medications

EXPLANATION

✔Correct answer:

Within 2-4 hours after administration. Insulin glargine (commonly known by the brand name Lantus) is a long-acting insulin designed to provide a steady level of insulin over an extended period. The onset of action for insulin glargine typically occurs within 2-4 hours after administration.

Insulin glargine is formulated to be released slowly and steadily into the bloodstream. Unlike rapid-acting or short-acting insulins, which begin to work almost immediately, long-acting insulins like glargine provide basal insulin coverage, mimicking the body's natural, low-level release of insulin over a 24-hour period. This helps to maintain stable blood glucose levels throughout the day and night.

Think of insulin glargine as a slow-release fertilizer for plants. Instead of giving a quick burst of nutrients (like fast-acting insulin), it provides a steady supply over time, ensuring the plants (your blood sugar levels) remain nourished consistently throughout the day.

Nurses should ensure patients understand the timing and function of insulin glargine to effectively manage their blood sugar levels and prevent both hyperglycemia and hypoglycemia.

• Instruct the patient to take insulin glargine at the same time every day to maintain consistent blood levels.
• Explain that insulin glargine should not be mixed with other insulins in the same syringe, as this can alter its action.
• Reassure the patient that while insulin glargine does not have a pronounced peak, it provides continuous coverage and helps stabilize blood glucose levels.
• Encourage the patient to monitor their blood glucose regularly, especially when starting a new insulin regimen, to ensure it is effective and to make any necessary adjustments with their healthcare provider.

✘Incorrect answer options:

Within 4-12 hours after administration. This timing is more characteristic of intermediate-acting insulins, such as NPH insulin. Insulin glargine has an onset within 2-4 hours, not this delayed window.

Within 6-12 hours after administration. This is also incorrect as it refers to the timing for some intermediate or mixed insulins. Insulin glargine begins its action sooner, within the 2-4 hour range.

Within 18-24 hours after administration. This timeframe represents the duration of action for insulin glargine, not the onset. Insulin glargine works for about 24 hours but begins to take effect within 2-4 hours after administration.

EXPLANATION

✔Correct answer:

Decreased urinary output. Desmopressin acetate (DDAVP) is a synthetic analog of vasopressin (antidiuretic hormone, ADH) used primarily to treat diabetes insipidus, a condition characterized by excessive thirst and urination due to the kidneys' inability to conserve water. The therapeutic goal of desmopressin is to mimic the action of natural ADH, thereby reducing urinary output and preventing dehydration.

In diabetes insipidus, the body either does not produce enough ADH (central diabetes insipidus) or the kidneys do not respond properly to ADH (nephrogenic diabetes insipidus). Desmopressin acetate acts on the kidneys to promote water reabsorption by increasing the permeability of the renal collecting ducts. This action reduces the volume of urine produced, helping to maintain fluid balance and prevent excessive urination.

Think of the kidneys as a sieve that filters water out of the bloodstream. In diabetes insipidus, the sieve holes are too large, allowing too much water to pass through and be lost as urine. Desmopressin acts like a mesh that covers the sieve, reducing the size of the holes and allowing the kidneys to retain more water, thus decreasing urine output.

Nurses should monitor patients for signs of fluid balance, ensuring that the desmopressin treatment is effective and that the patient is not experiencing adverse effects.

• Monitor daily weights and intake/output ratios to assess fluid balance.
• Educate the patient on the importance of adhering to the medication schedule to maintain consistent therapeutic effects.
• Assess for signs of water intoxication, such as headache, confusion, or seizures, and report these symptoms to the healthcare provider immediately.
• Encourage the patient to report any significant changes in urinary output or symptoms of fluid overload.

✘Incorrect answer options:

Reduced attention span. Desmopressin does not directly affect cognitive function or attention span. Any changes in attention span are unlikely to be related to the therapeutic action of this medication.

Reduced blood sugar levels. Desmopressin does not have an effect on blood sugar levels. It is not used in the management of blood glucose and does not influence insulin or glucagon activity.

Lowered blood pressure. While desmopressin can have mild vasopressor effects, its primary action is on the kidneys to reduce urinary output. It is not primarily used to manage blood pressure and is unlikely to cause significant changes in blood pressure in the therapeutic doses used for diabetes insipidus.

EXPLANATION

✔Correct answer:

Graves' disease. Propylthiouracil (PTU) is an antithyroid medication used to manage hyperthyroidism by inhibiting the synthesis of thyroid hormones. It is commonly prescribed for conditions such as Graves' disease, which is an autoimmune disorder leading to hyperthyroidism. Patients with Graves' disease have an overactive thyroid gland, producing excess thyroid hormones that cause symptoms like weight loss, increased heart rate, and anxiety. PTU helps to reduce these symptoms by decreasing thyroid hormone production.

Graves' disease is characterized by the presence of thyroid-stimulating immunoglobulins (TSIs) that stimulate the thyroid gland to produce excessive amounts of thyroid hormones (T3 and T4). PTU works by inhibiting the enzyme thyroid peroxidase, which plays a critical role in the synthesis of these hormones. Additionally, PTU inhibits the conversion of T4 to the more active T3 in peripheral tissues.

Imagine the thyroid gland as a factory that produces too many products (thyroid hormones). PTU acts like a supervisor who slows down the production line to ensure that fewer products are made, thus balancing the production with the body's needs.

Nurses should take several key steps to ensure the effective management of patients taking PTU. These include monitoring the patient’s thyroid function, educating them about the medication, and observing for potential side effects.

• Monitor the patient's thyroid hormone levels regularly to assess the effectiveness of the medication and adjust dosages as needed.
• Educate the patient about potential side effects of PTU, such as agranulocytosis (a drop in white blood cells), and instruct them to report any signs of infection immediately.
• Advise the patient to adhere strictly to the medication regimen and attend all follow-up appointments for ongoing assessment and management.

✘Incorrect answer options:

Myxedema. Myxedema refers to severe hypothyroidism, which is characterized by an underactive thyroid gland. PTU would not be used to treat myxedema, as it would further inhibit thyroid hormone production, worsening the condition.

Addison's disease. Addison's disease is a disorder of the adrenal glands, leading to insufficient production of cortisol and aldosterone. It is not related to thyroid hormone production, and PTU would not be used in its treatment.

Cushing's syndrome. Cushing's syndrome is characterized by excessive cortisol production, often due to prolonged use of corticosteroids or a tumor in the adrenal gland. PTU is not relevant in the management of Cushing's syndrome as it targets thyroid hormone production, not cortisol.

EXPLANATION

✔Correct answer:

Use of nitroprusside. Sildenafil (Viagra) is contraindicated in patients who are using nitroprusside or any nitrate medications. This is due to the risk of severe hypotension (low blood pressure) when these medications are combined. Sildenafil works by inhibiting phosphodiesterase type 5 (PDE5), which increases the levels of cyclic guanosine monophosphate (cGMP), leading to vasodilation and increased blood flow. Nitroprusside, a potent vasodilator, also increases cGMP levels. When used together, the combined effects can cause a dangerous drop in blood pressure.

Both sildenafil and nitroprusside cause vasodilation by different mechanisms that converge on the same pathway, increasing cGMP. Sildenafil inhibits PDE5, preventing the breakdown of cGMP, while nitroprusside directly releases nitric oxide (NO), which then increases cGMP production. The synergistic effect of these medications can lead to profound vasodilation, resulting in severe hypotension, syncope (fainting), and even cardiovascular collapse.

Think of sildenafil and nitroprusside as two people pushing a door open. One person (sildenafil) is already pushing the door open slowly (increasing cGMP levels), and the other person (nitroprusside) suddenly gives a strong push. Together, they might push the door open too forcefully (cause too much vasodilation), making it slam wide open (leading to severe hypotension).

Nurses should review a patient's medication history carefully to ensure they are not taking any nitrate medications before prescribing or administering sildenafil. They should also educate the patient about the risks of combining these medications.

• Instruct the patient to inform all healthcare providers that they are taking sildenafil to avoid any accidental prescription of nitrate-containing medications.
• Advise the patient to report any episodes of dizziness, fainting, or chest pain immediately, as these could be signs of severe hypotension.
• Educate the patient about the importance of adhering to prescribed medication regimens and not taking any over-the-counter medications without consulting their healthcare provider.

✘Incorrect answer options:

Neuralgia. Neuralgia, or nerve pain, is not specifically contraindicated with sildenafil use. While sildenafil may have some side effects, neuralgia is not directly impacted by this medication.

Use of vitamins. Vitamins generally do not interact significantly with sildenafil. While some vitamins may affect overall health, they do not contraindicate the use of sildenafil.

Blurred vision. Blurred vision can be a side effect of sildenafil, but it is not a contraindication for its use. Patients experiencing significant visual changes should consult their healthcare provider, but this condition does not inherently prevent the use of sildenafil.

EXPLANATION

✔Correct answer:

Drowsiness. Drowsiness can be a sign of water intoxication or hyponatremia, which may occur if the dosage of antidiuretic hormone (ADH) is too high. ADH therapy, such as desmopressin, helps manage diabetes insipidus by reducing urine output and conserving water in the body. However, excessive ADH can lead to water retention, dilution of blood sodium levels (hyponatremia), and resultant symptoms such as drowsiness, headache, confusion, and seizures. Therefore, experiencing drowsiness would indicate the need to decrease the medication dosage to prevent serious complications.

Antidiuretic hormone acts on the kidneys to promote water reabsorption, reducing urine output. In diabetes insipidus, there is a deficiency of ADH, leading to excessive urine production and dehydration. When treated with ADH therapy, if the dose is too high, it can cause an excessive retention of water, leading to dilutional hyponatremia. The brain is particularly sensitive to changes in sodium levels, and symptoms such as drowsiness and confusion are early indicators of hyponatremia.

Imagine a sponge soaking up water to prevent a spill. If the sponge absorbs too much water, it becomes overly saturated and starts dripping. Similarly, too much ADH can cause the body to retain too much water, leading to drowsiness as a warning sign.

Nurses should monitor patients on ADH therapy for signs of water intoxication and hyponatremia. Patient education on the symptoms to watch for and the importance of adherence to prescribed dosages is crucial.

• Monitor serum sodium levels regularly to detect hyponatremia early.
• Assess the patient for symptoms of water intoxication, such as drowsiness, headache, and confusion.
• Educate the patient to report any symptoms of drowsiness or changes in mental status promptly.
• Adjust fluid intake recommendations based on the patient's response to therapy and laboratory results.
• Collaborate with the healthcare provider to adjust the ADH dosage if symptoms of overmedication are observed.

✘Incorrect answer options:

Jaundice Jaundice, a yellowing of the skin and eyes, is typically associated with liver dysfunction and is not a common side effect of ADH therapy.

Alopecia Alopecia, or hair loss, is not associated with ADH therapy and would not indicate the need to adjust the medication dosage.

Diarrhea Diarrhea is not a known side effect of ADH therapy. While it could be indicative of other health issues, it is not relevant to the dosage of ADH medication.

EXPLANATION

✔Correct answer:

Runny nose. Intranasal Vasopressin (Pitressin) is administered through the nasal route, which makes local nasal side effects like a runny nose (rhinorrhea) more relevant. When administered intranasally, vasopressin can irritate the nasal mucosa, leading to increased mucus production and nasal discharge.

The intranasal delivery of vasopressin involves direct contact with the nasal mucosa. This contact can cause irritation or mild inflammation, leading to symptoms like a runny nose. This is similar to how nasal decongestants or other intranasal medications might cause local side effects in the nasal passages.

Imagine watering a plant with a spray bottle. If you spray too much water directly onto the leaves, they can become overly wet and start dripping. Similarly, when vasopressin is sprayed into the nose, it can cause the nasal tissues to become overly moist, leading to a runny nose.

Nurses should inform clients about this potential side effect and advise them on how to manage it if it occurs. Here are some nursing interventions and patient education points:

• Instruct clients to gently blow their nose before administration to clear nasal passages.
• Advise clients to keep their head upright during administration to ensure proper absorption and reduce nasal irritation.
• Recommend the use of a saline nasal spray to soothe and moisten nasal passages if irritation occurs.
• Encourage clients to report persistent or severe nasal symptoms to their healthcare provider.

✘Incorrect answer options:

Headache. While vasopressin can cause headaches due to vasoconstriction, this side effect is more commonly associated with systemic administration rather than the intranasal route. The local effect of a runny nose is more specific to the intranasal administration of vasopressin.

Nausea. Nausea is a less common side effect for intranasal vasopressin and is more frequently associated with systemic medications that affect the gastrointestinal system.

Flushing. Flushing typically results from vasodilators rather than vasoconstrictors like vasopressin. Therefore, flushing is not a significant side effect of intranasal vasopressin.

EXPLANATION

✔Correct answer:

Verify the prescription with the healthcare provider. Exenatide (Bydureon) is a GLP-1 receptor agonist used primarily to manage type 2 diabetes mellitus. It is not typically indicated for type 1 diabetes mellitus because it works by enhancing insulin secretion in response to meals, an effect that relies on the presence of functioning beta cells in the pancreas. In type 1 diabetes, where beta cells are destroyed, exenatide would not be effective. Therefore, Nurse Lee should verify the prescription with the healthcare provider to ensure it is appropriate for the patient’s condition.

Exenatide mimics the incretin hormones, which increase insulin secretion, decrease glucagon secretion, and slow gastric emptying. These mechanisms help control blood glucose levels in individuals with type 2 diabetes. However, in type 1 diabetes, these effects cannot occur due to the lack of functional beta cells, rendering the medication ineffective and potentially unsafe.

Think of Exenatide like a special tool designed to work with a specific type of engine. In type 2 diabetes, the engine (pancreas with functional beta cells) is there but needs assistance. In type 1 diabetes, the engine is not functional, so the tool cannot be used effectively.

Nurses should ensure that medications prescribed are appropriate for the patient's specific type of diabetes and should clarify any questionable orders with the prescribing healthcare provider.

• Verify the prescription with the healthcare provider to confirm its appropriateness for a patient with type 1 diabetes.
• Educate the patient about the purpose and proper use of their prescribed medications, ensuring they understand why certain medications are suitable or not for their condition.
• Monitor the patient for any signs of adverse reactions if the medication is administered, and report these to the healthcare provider immediately.

✘Incorrect answer options:

Administer the medication orally once daily. Exenatide is not administered orally; it is given by subcutaneous injection. Furthermore, its use in type 1 diabetes is not appropriate.

Administer the medication via subcutaneous injection once weekly. While this is the correct administration route for Exenatide (Bydureon) in type 2 diabetes, it is not suitable for type 1 diabetes.

Mix the medication with insulin for a combined injection. Exenatide should not be mixed with insulin in the same syringe, and it is not indicated for type 1 diabetes.

EXPLANATION

✔Correct answer:

On an empty stomach. Levothyroxine (Synthroid) is a synthetic form of the thyroid hormone thyroxine (T4), which is used to treat hypothyroidism. For optimal absorption, levothyroxine should be taken on an empty stomach. This is because food, certain beverages (like coffee and milk), and other medications can interfere with the absorption of levothyroxine, reducing its effectiveness.

The absorption of levothyroxine occurs primarily in the small intestine. When taken with food or certain medications, the rate and extent of absorption can be significantly reduced. Taking it on an empty stomach, ideally 30 to 60 minutes before breakfast, ensures that the medication is absorbed more efficiently and consistently, leading to better control of thyroid hormone levels.

Think of levothyroxine like a sponge absorbing water. If you try to use the sponge when it’s already saturated with other substances (like food or drink), it won't be able to absorb as much water. Taking levothyroxine on an empty stomach is like using a dry sponge, which can absorb the maximum amount of water effectively.

Nurses should provide clear instructions to patients on the importance of taking levothyroxine on an empty stomach and help them establish a routine for taking the medication correctly.

• Instruct the patient to take levothyroxine first thing in the morning, at least 30 to 60 minutes before eating breakfast or consuming any other medications.
• Advise the patient to take the medication with a full glass of water to aid in swallowing and absorption.
• Explain the importance of consistency in the timing and manner of taking the medication to maintain stable thyroid hormone levels.
• Educate the patient on potential interactions with other medications and supplements, such as calcium or iron, and to take these at least 4 hours apart from levothyroxine.

✘Incorrect answer options:

After lunch. Taking levothyroxine after lunch would likely reduce its absorption due to the presence of food in the stomach and intestines, leading to less effective treatment of hypothyroidism.

At bedtime. While taking levothyroxine at bedtime can be effective for some individuals, it is not generally recommended due to potential interference from evening meals or snacks. Consistency is key, and most patients are better able to adhere to a morning routine.

With food. Taking levothyroxine with food significantly reduces its absorption and effectiveness. This can lead to suboptimal management of hypothyroidism and fluctuating thyroid hormone levels.

EXPLANATION

✔Correct answer:

Early in the morning. Prednisone is a corticosteroid that mimics the effects of cortisol, a hormone naturally produced by the adrenal glands. Cortisol levels in the body naturally peak in the early morning and gradually decrease throughout the day. Taking prednisone early in the morning helps align the medication with the body’s natural rhythm of cortisol production, minimizing the risk of adrenal suppression and reducing potential side effects.

Administering prednisone in the morning takes advantage of the body’s circadian rhythm, which controls the release of cortisol. This timing helps to reduce the risk of disrupting the hypothalamic-pituitary-adrenal (HPA) axis, which could lead to adrenal insufficiency if the body’s natural cortisol production is suppressed.

Think of the body's cortisol levels like a natural sunrise. Cortisol levels naturally rise in the morning, similar to the sun rising at dawn. Taking prednisone in the morning is like turning on an extra light at sunrise, enhancing the natural brightness. Taking it at other times could be like turning on a bright light at night, which disrupts the natural cycle.

Nurses should educate clients on the importance of taking prednisone early in the morning and provide guidance on how to incorporate it into their daily routine.

• Instruct clients to take prednisone with food to reduce gastrointestinal discomfort.
• Explain the importance of adhering to the prescribed dosage schedule to avoid potential side effects.
• Encourage clients to take the medication at the same time each day to maintain consistent blood levels.
• Advise clients to report any side effects such as increased appetite, mood changes, or signs of infection to their healthcare provider.

✘Incorrect answer options:

At lunch. Taking prednisone at lunch may not align with the body’s natural cortisol rhythm and can increase the risk of adrenal suppression and insomnia due to its stimulating effects.

Before bedtime. Administering prednisone before bedtime can interfere with sleep due to its stimulating effects and does not align with the body’s natural cortisol production, potentially leading to increased side effects.

At any time of the day. Taking prednisone at any time of the day can lead to inconsistent blood levels of the medication and disrupt the body’s natural cortisol rhythm, increasing the risk of side effects and adrenal suppression.

EXPLANATION

✔Correct answer:

Mild elevation in blood glucose levels. Somatropin (Humatrope) is a form of human growth hormone important for the growth of bones and muscles. It is commonly used in patients with Turner syndrome to help increase height. One of the known side effects of somatropin therapy is a mild elevation in blood glucose levels. This occurs because growth hormone has anti-insulin effects, leading to decreased insulin sensitivity and an increase in glucose production by the liver.

Growth hormone increases the breakdown of glycogen to glucose in the liver and decreases glucose uptake in muscle and fat tissues, leading to higher blood glucose levels. It can also promote lipolysis, increasing free fatty acids in the blood, which can further contribute to insulin resistance.

Imagine a town where the bakery (liver) makes extra bread (glucose) and the grocery stores (muscle and fat tissues) are less efficient at storing the bread (glucose uptake). As a result, there is an excess of bread (blood glucose) circulating in the town (body).

Nurses should monitor the patient's blood glucose levels regularly to detect any elevation early and manage it appropriately. Educating the patient and family about potential side effects and the importance of regular blood glucose monitoring is crucial.

• Monitor blood glucose levels periodically to detect hyperglycemia.
• Educate the patient on recognizing symptoms of hyperglycemia, such as increased thirst and urination.
• Encourage adherence to a balanced diet and regular exercise to help manage blood glucose levels.
• Collaborate with a dietitian for nutritional guidance tailored to the patient's needs.
• Report any significant changes in blood glucose levels to the healthcare provider for potential adjustment of therapy.

✘Incorrect answer options:

Episodes of hypotension. Somatropin is not typically associated with causing hypotension. It does not directly affect blood pressure regulation, and hypotension is not a common side effect of this medication.

Reduction in ALT and AST levels. Somatropin does not typically cause a reduction in liver enzymes such as ALT (alanine aminotransferase) and AST (aspartate aminotransferase). These enzymes are more relevant to liver function, and somatropin does not have a significant impact on their levels.

Symptoms of water intoxication. Water intoxication, which includes symptoms like hyponatremia (low sodium levels), is not a common side effect of somatropin. This condition is more commonly associated with excessive antidiuretic hormone (ADH) or excessive water intake, rather than growth hormone therapy.

EXPLANATION

✔Correct answer:

In the refrigerator. Unopened vials of Humulin NPH insulin should be stored in the refrigerator to maintain their potency and ensure they are safe to use. Insulin is a protein that can degrade if exposed to improper temperatures, and refrigeration helps preserve its efficacy.

Insulin is sensitive to temperature extremes. Storing insulin in the refrigerator (typically at 36°F to 46°F or 2°C to 8°C) keeps it within the recommended temperature range that prevents degradation. Freezing insulin can cause the proteins to denature, making it ineffective, while storing it at room temperature for extended periods can lead to reduced potency.

Think of insulin like fresh produce. Just as you would store fruits and vegetables in the refrigerator to keep them fresh and prevent them from spoiling, insulin needs to be kept in the refrigerator to maintain its effectiveness.

Nurses should educate patients on the proper storage techniques for insulin to ensure they receive the full therapeutic benefits from their medication.

• Instruct the patient to store unopened vials of Humulin NPH insulin in the refrigerator, away from the freezer compartment to avoid freezing.
• Explain that opened vials can be stored at room temperature (below 86°F or 30°C) for up to 28 days but should be kept away from direct sunlight and heat.
• Advise the patient to always check the expiration date on the insulin vial and not to use it beyond this date, even if stored correctly.
• Encourage the patient to inspect the insulin before each use, looking for any changes in color or consistency, and to discard any insulin that appears cloudy or contains particles.

✘Incorrect answer options:

In the freezer. Freezing insulin can damage its molecular structure, making it ineffective. Insulin should never be stored in the freezer.

At room temperature. While opened vials of insulin can be stored at room temperature for short periods (up to 28 days), unopened vials should be refrigerated to maintain their potency over time.

In a sunny, dry place. Exposing insulin to direct sunlight and heat can degrade the protein, reducing its effectiveness. Insulin should be stored in a cool, dark place, typically the refrigerator, to prevent this degradation.

EXPLANATION

✔Correct answer:

Withdrawing NPH insulin first. When mixing regular (short-acting) insulin and NPH (intermediate-acting) insulin in the same syringe, the correct procedure is to draw up the regular insulin before the NPH insulin. Withdrawing NPH insulin first can lead to contamination of the regular insulin vial with the cloudy NPH insulin, which can alter the action of the regular insulin.

Regular insulin is clear, while NPH insulin is cloudy due to the presence of a protein that extends its action. Drawing up regular insulin first ensures that the clear insulin does not get contaminated with the cloudy NPH insulin. This maintains the proper action and efficacy of both types of insulin.

Think of mixing paint colors. If you have a clear paint and a cloudy paint, you want to keep the clear paint from becoming cloudy. Always draw up the clear paint first to prevent contamination.

Nurses should ensure patients understand the correct procedure for mixing insulins to maintain the efficacy and safety of their insulin therapy.

• Instruct the patient to always inject air into both vials first: into NPH first, then into regular insulin.
• Teach the patient to withdraw the regular (clear) insulin first, followed by the NPH (cloudy) insulin.
• Reinforce the importance of checking for air bubbles in the syringe and ensuring accurate dosing.
• Demonstrate the procedure and have the patient perform a return demonstration to confirm understanding.

✘Incorrect answer options:

Injecting an amount of air equivalent to the desired dose of insulin. This is a correct step. Injecting air into the vials equal to the desired dose helps to equalize pressure in the vials and makes withdrawing the insulin easier and more accurate.

Withdrawing regular insulin first. This is the correct procedure. Regular insulin should be withdrawn first to prevent contamination of the regular insulin vial with NPH insulin.

Injecting air into the NPH insulin vial first. This is a correct step. Injecting air into the NPH vial first helps to equalize pressure without contaminating the regular insulin vial.

EXPLANATION

✔Correct answer:

Increase in the dosage of Humulin 70/30. Prednisone is a corticosteroid that can cause an increase in blood glucose levels by promoting gluconeogenesis and reducing the uptake of glucose into tissues. Therefore, a patient with diabetes mellitus who starts prednisone therapy is likely to experience elevated blood glucose levels. To manage these elevated levels, the dosage of insulin, in this case, Humulin 70/30, typically needs to be increased to maintain proper glycemic control.

Prednisone affects carbohydrate metabolism by increasing glucose production in the liver and decreasing the sensitivity of peripheral tissues to insulin. This results in hyperglycemia, which can be particularly problematic in diabetic patients who already have impaired glucose metabolism. Therefore, to counteract the hyperglycemic effect of prednisone, an increase in the insulin dosage is required.

Think of insulin as a key that helps glucose enter the cells (like a door). When taking prednisone, it's as if the locks (cells) become harder to open and more glucose keys (insulin) are needed to get the same effect.

Nurses should closely monitor the patient’s blood glucose levels, educate the patient on the potential effects of prednisone on blood sugar, and collaborate with the healthcare provider to adjust the insulin dosage accordingly. Patient education should include recognizing symptoms of hyperglycemia and understanding the importance of adherence to the adjusted insulin regimen.

• Monitor blood glucose levels more frequently to detect and manage hyperglycemia promptly.
• Educate the patient about the symptoms of hyperglycemia, such as increased thirst, frequent urination, and fatigue.
• Encourage adherence to the prescribed insulin regimen and dietary recommendations.
• Coordinate with the healthcare provider to adjust the insulin dosage based on blood glucose readings.
• Provide support and education about the temporary nature of dosage adjustments during prednisone therapy.

✘Incorrect answer options:

Increase in the dosage of prednisone. Increasing the dosage of prednisone would likely exacerbate hyperglycemia rather than address the issue. The goal is to manage the side effects of prednisone, not to increase its dosage unnecessarily.

Decrease in the dosage of Humulin 70/30. Decreasing the insulin dosage would be inappropriate because prednisone tends to increase blood glucose levels. A decrease in insulin would likely result in poorer glycemic control.

Addition of an oral hypoglycemic medication. While adding an oral hypoglycemic medication might be considered in some cases, it is not the most immediate and direct intervention for managing increased blood glucose levels due to prednisone. Insulin dosage adjustments are more directly controllable and titratable in response to blood glucose monitoring.

EXPLANATION

✔Correct answer:

Oral contraceptives. Oral contraceptives do not cause hypoglycemia. These medications contain hormones (estrogens and progestins) used to prevent pregnancy. They do not affect blood glucose levels in a way that would lead to hypoglycemia.

Oral contraceptives primarily work by inhibiting ovulation, altering the cervical mucus to prevent sperm penetration, and changing the endometrial lining to prevent implantation. These actions do not interfere with glucose metabolism or insulin secretion, thus not contributing to hypoglycemia.

Think of oral contraceptives as a lock on a door (preventing pregnancy) that has no connection to the thermostat (blood sugar levels). Adjusting the lock does not change the room temperature.

Nurses should focus on educating patients about the specific actions and side effects of their medications, ensuring they understand which medications can impact their blood glucose levels and why.

• Review the patient’s medication list to identify any drugs that could contribute to hypoglycemia.
• Educate the patient on recognizing symptoms of hypoglycemia and managing them appropriately.
• Encourage the patient to monitor their blood glucose levels regularly, especially when taking medications known to affect glucose metabolism.
• Provide dietary recommendations to help maintain stable blood glucose levels.

✘Incorrect answer options:

Sulfonamides. Sulfonamides are a class of antibiotics that can cause hypoglycemia, particularly in patients with underlying risk factors such as renal impairment. They may potentiate the effects of insulin or oral hypoglycemic agents, leading to low blood sugar levels.

Salicylates. Salicylates, such as aspirin, can enhance the hypoglycemic effects of insulin and sulfonylureas by increasing insulin secretion and improving peripheral insulin sensitivity.

Anticoagulants. Some anticoagulants, such as warfarin, can potentiate the effects of hypoglycemic agents by displacing them from protein-binding sites or altering their metabolism, thus contributing to hypoglycemia.

EXPLANATION

✔Correct answer:

Insulin glargine. Insulin glargine (Lantus) is a long-acting insulin that provides a steady level of insulin over an extended period, usually up to 24 hours. It has a unique formulation that ensures it releases slowly and steadily into the bloodstream. Mixing insulin glargine with any other type of insulin can alter its pharmacokinetic properties, leading to unpredictable absorption and efficacy.

Insulin glargine is formulated to be injected subcutaneously and to form microprecipitates in the subcutaneous tissue. These microprecipitates release insulin slowly over time. Mixing it with other insulins can disrupt this process, potentially causing erratic blood glucose levels and reducing the overall effectiveness of the insulin regimen.

Think of insulin glargine like a time-release capsule that dissolves slowly over the day. Mixing it with another type of insulin is like opening the capsule and mixing it with another medication, which could disrupt its slow-release mechanism and make it work unpredictably.

Nurses should educate patients on the correct use of insulin glargine and emphasize that it should not be mixed with other insulins. They should also provide guidance on how to administer multiple types of insulin if required.

• Instruct the patient to administer insulin glargine as a separate injection, ensuring it is not mixed with other insulins.
• Educate the patient on the proper timing and technique for injecting different types of insulin if they are prescribed multiple insulins.
• Explain the importance of following their insulin regimen as prescribed to maintain stable blood glucose levels.
• Monitor the patient's understanding and adherence to their insulin regimen during follow-up visits.

✘Incorrect answer options:

Insulin lispro. Insulin lispro (Humalog) is a rapid-acting insulin that can be mixed with intermediate-acting insulins like NPH for convenience in a single injection.

Insulin isophane. Insulin isophane (NPH) is an intermediate-acting insulin that can be mixed with short-acting insulins like regular insulin or rapid-acting insulins like lispro or aspart.

Insulin aspart. Insulin aspart (NovoLog) is another rapid-acting insulin that can be mixed with intermediate-acting insulins such as NPH.

EXPLANATION

✔Correct answer:

Tremors. Tremors can be a sign of overmedication with levothyroxine, indicating hyperthyroidism. Hyperthyroidism can occur if the dosage of levothyroxine is too high, leading to an excess of thyroid hormone in the body. Symptoms of hyperthyroidism include tremors, rapid heartbeat, weight loss, and anxiety. Therefore, it is crucial for patients to notify their physician if they experience tremors, as this may necessitate a dosage adjustment.

Levothyroxine is a synthetic form of the thyroid hormone thyroxine (T4) and is used to treat hypothyroidism. The goal of therapy is to normalize thyroid hormone levels. However, too much levothyroxine can push the thyroid state into hyperthyroidism, causing symptoms associated with increased metabolic activity, such as tremors.

Imagine taking a vitamin supplement for better health. If you take too much, you might start feeling jittery and over-energized. Similarly, too much levothyroxine can make the body feel overstimulated, leading to symptoms like tremors.

Nurses should educate patients on recognizing signs of both hypothyroidism and hyperthyroidism. Patients should be instructed to take levothyroxine exactly as prescribed and report any adverse symptoms to their healthcare provider.

• Instruct patients to take levothyroxine on an empty stomach, typically 30 minutes to an hour before breakfast, to ensure proper absorption.
• Advise patients to avoid taking levothyroxine with calcium or iron supplements, as these can interfere with its absorption.
• Teach patients to recognize and report symptoms of hyperthyroidism, such as tremors, rapid heartbeat, and weight loss.
• Encourage regular follow-up appointments to monitor thyroid hormone levels and adjust the dosage as needed.
• Provide information on the importance of consistent daily dosing and not to discontinue the medication without consulting their physician.

✘Incorrect answer options:

Muscle cramps Muscle cramps are not typically associated with hyperthyroidism or levothyroxine overmedication. They can occur for various reasons, including electrolyte imbalances or dehydration.

Cold intolerance Cold intolerance is a symptom of hypothyroidism, indicating that the levothyroxine dose may be insufficient. While important to report, it does not indicate an immediate need for urgent medical attention compared to symptoms of hyperthyroidism.

Coarse, dry hair Coarse, dry hair is another symptom of hypothyroidism, suggesting under-treatment with levothyroxine. Like cold intolerance, it is important but does not necessitate urgent notification to the physician as tremors do.

EXPLANATION

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Alcohol. Patients taking glipizide (Glucotrol), a sulfonylurea used to manage type 2 diabetes mellitus, should avoid alcohol. Alcohol can interact with glipizide and other sulfonylureas, increasing the risk of hypoglycemia (low blood sugar). Additionally, alcohol can cause a disulfiram-like reaction with symptoms such as flushing, headache, nausea, vomiting, and palpitations.

Glipizide works by stimulating the release of insulin from the pancreas, which lowers blood sugar levels. Alcohol can potentiate the hypoglycemic effect of glipizide by interfering with gluconeogenesis in the liver. This inhibition of gluconeogenesis means the liver is less able to release glucose into the bloodstream, leading to lower blood sugar levels. The combined effects can result in severe hypoglycemia.

Think of your blood sugar level as a tightrope walker. Glipizide acts like a safety net, catching the walker if they fall. However, alcohol cuts a hole in the safety net, making it more likely for the walker (your blood sugar) to fall dangerously low without being caught.

Nurses should educate patients on the importance of avoiding alcohol while taking glipizide and provide guidelines on recognizing and managing hypoglycemia.

• Instruct the patient to avoid alcoholic beverages and products containing alcohol.
• Educate the patient on the signs and symptoms of hypoglycemia, such as shakiness, sweating, confusion, and dizziness, and what to do if these occur.
• Advise the patient to carry a source of fast-acting carbohydrate, like glucose tablets or candy, in case of hypoglycemia.
• Encourage the patient to wear a medical alert bracelet indicating they have diabetes and are taking glipizide.

✘Incorrect answer options:

Organ meats. Organ meats are not specifically contraindicated with glipizide. However, they are high in cholesterol and may not be recommended for overall cardiovascular health, especially in diabetic patients, but they do not interact directly with glipizide.

Whole grain cereals. Whole grain cereals are a healthy choice for patients with diabetes as they are high in fiber and have a low glycemic index, which helps in maintaining stable blood sugar levels. They do not have a contraindicated interaction with glipizide.

Soft drinks. While it is generally advisable for diabetic patients to avoid sugary soft drinks due to their high glycemic index and potential to spike blood sugar levels, they do not interact with glipizide in a contraindicated manner. Diabetic patients should opt for diet or sugar-free options to better manage their blood sugar levels.

EXPLANATION

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Do not skip the dose if a meal is missed. The statement "Do not skip the dose if a meal is missed" is not true for repaglinide (Prandin). Repaglinide is a meglitinide analog used to treat type 2 diabetes mellitus by stimulating the pancreas to release insulin in response to meals. If a meal is skipped, the dose of repaglinide should also be skipped to avoid the risk of hypoglycemia.

Repaglinide works by rapidly increasing insulin secretion from the beta cells of the pancreas. Its effect is closely tied to meal intake, as it helps to manage postprandial blood glucose levels. Taking repaglinide without eating can lead to an excessive drop in blood glucose, resulting in hypoglycemia.

Think of repaglinide like a car’s accelerator that you press to go faster. You only press the accelerator when you want the car to move (when you eat). Pressing the accelerator (taking repaglinide) without intending to move (without eating) can lead to a crash (hypoglycemia).

Nurses should educate patients on the proper use of repaglinide, emphasizing the importance of timing the medication with meals to prevent hypoglycemia.

• Instruct the patient to take repaglinide within 30 minutes before each meal.
• Advise the patient to skip the dose of repaglinide if they miss a meal to avoid hypoglycemia.
• Educate the patient about recognizing signs and symptoms of hypoglycemia, such as shakiness, sweating, confusion, and dizziness.
• Encourage the patient to carry a source of fast-acting glucose, such as glucose tablets or candy, to treat hypoglycemia if it occurs.

✘Incorrect answer options:

Used to treat type II diabetes mellitus. This statement is true. Repaglinide is indicated for the treatment of type 2 diabetes mellitus to help control blood glucose levels.

Has a quicker onset and shorter duration of action. This statement is true. Repaglinide has a rapid onset of action and a short duration, making it effective for controlling postprandial blood glucose levels.

Dizziness may occur as a side effect. This statement is true. Dizziness can occur as a side effect of repaglinide, particularly if blood glucose levels drop too low, leading to hypoglycemia.

EXPLANATION

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Digoxin .When thyroid hormone is taken concurrently with digoxin, the action of digoxin can be decreased. Thyroid hormones increase the metabolic rate and can enhance the clearance of digoxin from the body, reducing its effectiveness. Patients on digoxin therapy who begin thyroid hormone treatment may require dose adjustments to maintain therapeutic efficacy and avoid suboptimal cardiac function.

Digoxin is used to treat heart failure and atrial fibrillation by increasing the force of myocardial contraction and controlling heart rate. Thyroid hormones, on the other hand, increase the basal metabolic rate and influence cardiovascular function. When thyroid hormone therapy is initiated, the metabolic clearance of digoxin increases, thereby reducing its plasma levels and its pharmacologic effects.

Think of digoxin in the body like a thermostat-controlled heating system (digoxin levels) in a house. Adding thyroid hormone is like opening windows on a cold day, which causes the heat to escape more quickly. To maintain the same warmth in the house, you need to turn up the thermostat (increase digoxin dosage) to compensate for the increased loss.

Nurses should monitor patients closely when they start or adjust thyroid hormone therapy if they are also taking digoxin. Frequent assessment of digoxin levels and signs of digoxin toxicity or subtherapeutic effects is critical. Nurses should educate patients on the potential interaction and the importance of adherence to follow-up appointments for blood level monitoring and dose adjustments.

• Monitor digoxin serum levels regularly to detect any decrease in drug concentration.
• Assess for signs and symptoms of heart failure or atrial fibrillation exacerbation, such as fatigue, palpitations, or shortness of breath.
• Collaborate with the healthcare provider to adjust digoxin dosage as needed based on patient response and lab results.
• Educate the patient on recognizing signs of digoxin toxicity, such as nausea, vomiting, visual disturbances, and bradycardia.
• Ensure the patient understands the importance of consistent medication adherence and follow-up visits.

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Warfarin Warfarin's action is typically potentiated (increased) rather than decreased when taken with thyroid hormones. Thyroid hormones can increase the catabolism of vitamin K-dependent clotting factors, thus enhancing warfarin's anticoagulant effect.

Insulin The action of insulin is not directly decreased by thyroid hormones. However, thyroid hormone therapy can affect glucose metabolism, potentially necessitating adjustments in insulin dosage. The interaction is more complex and variable, often depending on the patient's thyroid status.

Metoprolol Metoprolol, a beta-blocker, does not typically have its action decreased by thyroid hormones. Instead, thyroid hormones may require adjustments in beta-blocker dosing due to their effects on heart rate and metabolic rate, but this does not equate to a direct decrease in the drug's action.

EXPLANATION

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Avoid foods high in potassium. Patients taking prednisone should not avoid foods high in potassium. In fact, prednisone can cause the body to lose potassium, so it is important for patients to maintain an adequate intake of potassium-rich foods to prevent hypokalemia.

Prednisone, a corticosteroid, can increase the excretion of potassium through the kidneys, leading to a potential decrease in blood potassium levels. This can cause muscle weakness, cramps, and cardiac arrhythmias. Therefore, patients on prednisone should ensure they consume sufficient potassium to counteract this effect.

Imagine your body as a bank account. Potassium is like money in the account. Prednisone causes the body to spend potassium (money) more quickly, so you need to make sure you are depositing enough potassium (money) by eating potassium-rich foods, like bananas and oranges, to keep your balance healthy.

Nurses should educate patients on the importance of dietary potassium and monitor for signs of hypokalemia. They should also provide dietary recommendations and assess the patient's understanding and adherence to the prescribed dietary guidelines.

• Encourage the patient to eat potassium-rich foods such as bananas, oranges, spinach, and potatoes.
• Monitor the patient's serum potassium levels regularly to detect and manage hypokalemia early.
• Educate the patient about the signs and symptoms of hypokalemia, such as muscle weakness, cramping, and irregular heartbeats.

✘Incorrect answer options:

Avoid products containing aspirin. Patients on prednisone should avoid products containing aspirin because both medications can increase the risk of gastrointestinal bleeding and ulceration. Prednisone itself can irritate the stomach lining, and aspirin is a known gastric irritant.

Avoid contact with individuals who have respiratory infections. Prednisone suppresses the immune system, making patients more susceptible to infections. It is crucial for patients on prednisone to avoid exposure to infectious agents, particularly respiratory infections, to prevent illness.

Avoid drinks with caffeine. While not as critical as the other points, avoiding drinks with caffeine can be beneficial. Prednisone can cause side effects such as insomnia and increased blood pressure. Caffeine, being a stimulant, can exacerbate these side effects, making it prudent to limit or avoid caffeine intake.