A nurse is preparing to administer levothyroxine. which finding would require further assessment?

1. Surgical removal of part of the thyroid gland is an effective means of treating hyperthyroidism
   

   Inhaltsverzeichnis Show

   • What information concerning levothyroxine should you communicate to the patient?
   • What are side effects of levothyroxine?
   • What would expected findings during an assessment of a client with hyperthyroidism include?
   • Which agent would a nurse expect to administer to a client with hypothyroidism?

   True

2. Primary hypothyroidism is a result of a disorder of the pituitary gland in which inadequate TSH is released
   

   False

3. Somatropin is usually administered once weekly
   

   True

4. To enhance absorption, calcium products are given at least 60 minutes after meals.
   

   True

5. The nurse monitors the client for hypocalcemia, which may occur if excessive amounts of phosphate are given.
   

   True

6. When caring for clients with endocrine disorders, the nurse understands that the purpose of the parathyroid gland is to:

   a.
   secrete hormones that facilitate the thyroid gland’s control of metabolism.
   b.
   secrete an enzyme that increases the serum phosphate level.
   c.
   secrete a hormone that acts to increase the serum calcium level.
   d.
   secrete calcitonin to maintain serum calcium levels within defined limits.

   c. secrete a hormone that acts to increase the serum calcium level

7. A nurse is administering levothyroxine to a client. The nurse should monitor the client for which adverse effects of this agent?

   a.
   constipation
   b.
   tachycardia
   c.
   lethargy
   d.
   weight gain

   b. tachycardia

8. The nurse is preparing to administer intravenous calcium. During the infusion, the nurse should:

   a.
   monitor the client’s blood pressure during and after infusion.
   b.
   infuse the calcium solution as rapidly as possible.
   c.
   monitor the infusion site for extravasation, which can cause tissue necrosis.
   d.
   maintain the client’s room temperature below 70° F to keep the infusion cool.

   c. monitor the infusion site for extravasation, which can cause tissue necrosis

9. In planning the care of the client receiving thyroid medication, the nurse would identify which of the following as an appropriate nursing diagnosis:

   a.
   Risk for injury related to altered calcium levels.
   b.
   Disturbed sleep pattern related to thyroid dysfunction.
   c.
   Knowledge deficit related to effects of deficiency of thyroid hormone.
   d.
   Pain related to ulcerogenic effects of thyroid hormone preparations.

   b. Disturbed sleep pattern related to thyroid dysfunction

10. The nurse is teaching the parents of a child receiving somatropin. Which comment by the parents indicates an understanding of the instruction?

    a.
    “Even with long-term use, this medication cannot cure his parathyroid disease.”
    b.
    “This medication is administered intranasaly once a day.”
    c.
    “We should administer this medication as soon as Danny gets up in the morning.”
    d.
    “We need to treat Danny based on his growth and developmental age.”

    d. “We need to treat Danny based on his growth and developmental age.”

11. Following the intravenous infusion of calcium, the nurse should:

    a.
    instruct the client to not to get out of bed without assistance.
    b.
    place the client on an ECG monitor.
    c.
    monitor the client for muscle spasms.
    d.
    administer oral etidronate disodium.

    a. instruct the client to not to get out of bed without assistance

12. When providing instructions to a client following administration of a tracer dose of I 131, the nurse should?

    a.
    place the client in a private room for 24 hours following administration of the dose.
    b.
    have the client’s bed linen and eating utensils cleaned separately from those of other clients.
    c.
    instruct the client to avoid close contact with children for about one week.
    d.
    tell the client’s family that the client will be radioactive for approximately 48 hours.

    c. instruct the client to avoid close contact with children for about one week

13. What signs or symptoms associated with propylthiouracil use should be reported promptly to the health care provider?

    a.
    skin rash or sore throat
    b.
    nausea and dizziness
    c.
    gastrointestinal distress
    d.
    dry eyes and mouth

    a. skin rash or sore throat

14. What factor might explain why a client would receive 100 mg of propylthiouracil (PTU) daily instead of the usual initial daily dose of 300 mg?

    a.
    the client’s age
    b.
    the fact that hyperthyroidism is caused by a nodule, not hypertrophy
    c.
    the length of time the client has had the condition
    d.
    the client’s history of hypersensitivity to the drug

    a. the client’s age

15. When teaching a client receiving propylthiouracil (PTU), which client response indicates a need for further instruction?

    a.
    “I should let my doctor know right away if I get flu-like symptoms.”
    b.
    “I should have my platelet count monitored.”
    c.
    “I should dilute my medication and drink it through a straw.”
    d.
    “I will be sure to keep all of my follow-up appointments.”

    c. “I should dilute my medication and drink it through a straw.”

16. When administering thyroid preparations to clients with hypothyroidism, the nurse should:

    a.
    take radiation safety precautions.
    b.
    check the client’s pulse rate before administration.
    c.
    discontinue the medication if the client seems drowsy.
    d.
    administer the medication late in the evening.

    b. check the client’s pulse rate before administration

17. Clients with hypothyroidism are very sensitive to:

    a.
    vitamin and mineral preparations.
    b.
    antacids.
    c.
    sedatives and hypnotics.
    d.
    antibiotics.

    c. sedatives and hypnotics

18. The nurse monitors a client with hypothyroidism receiving thyroid replacement therapy. Which of the following would indicate the client is moving toward a euthyroid state as a result of treatment?

    a.
    weight gain
    b.
    decreased irritability
    c.
    increase in pulse rate
    d.
    decrease in gastric motility

    c. increase in pulse rate

19. The nurse understands that the client with untreated diabetes insipidus:

    a.
    experiences weight gain.
    b.
    exhibits excessive salivation.
    c.
    develops severe hyponatremia.
    d.
    excretes large volumes of urine.

    d. excretes large volumes of urine.

20. The nurse provides teaching for the client who is prescribed medication for hypothyroidism. Which client response indicates the client understands the instructions?

    a.
    “This medication probably will help me gain weight.”
    b.
    “I should only take my medication when the resting pulse over 100 bpm.”
    c.
    “It may take several weeks before I reach a euthroid state.”
    d.
    “Once I feel better, I can take my medication just when I need it.”

    c. “It may take several weeks before I reach a euthroid state.”

21. A client is prescribed intranasal desmopressin acetate (DDAVP). The nurse should instruct the client to:

    a.
    hold the container of spray upright for administration.
    b.
    lie in a supine position with the head hyperextended for administration.
    c.
    take this medication after breakfast to prevent nausea.
    d.
    never adjust the dosage of the medication without consulting with the doctor.

    a. hold the container of spray upright for administration.

22. In monitoring a client receiving iodine-based antithyroid medications, the nurse should be alert for which adverse effects of this therapy:

    a.
    rapid pulse rate and pretibial edema.
    b.
    sore throat and increase in body weight.
    c.
    soreness of gums and excessive salivation.
    d.
    increased appetite and difficulty sleeping.

    c. soreness of gums and excessive salivation.

23. The nurse understands which is true concerning I 131 treatment for hyperthyroidism?

    a.
    It is safe for use in pregnant women.
    b.
    It may result in hypothyroidism as long as 10 years following treatment.
    c.
    Clients must be isolated in a private room following treatment.
    d.
    After treatment, clients pose a serious radiation hazard to other clients and to staff.

    b. It may result in hypothyroidism as long as 10 years following treatment

24. The nurse should instruct clients taking oral anticoagulants who are then started on propylthiouracil (PTU) to:

    a.
    ask their health care providers if they should have both drug dosages decreased.
    b.
    get a lower propylthiouracil (PTU) dose than is usually prescribed.
    c.
    discuss with health care provider about having the oral anticoagulant dose decreased.
    d.
    discuss with health care provider about having the oral anticoagulant dose increased.

    c. discuss with health care provider about having the oral anticoagulant dose decreased

25. The drug that is used during the treatment of thyroid storm is:

    a.
    iodine.
    b.
    thyroid extract.
    c.
    methimazole.
    d.
    propranolol.

    d. propranolol.

26. Which statement applies to the use of antithyroid drugs?

    a.
    They are safe for use in nursing mothers.
    b.
    They are safe for use during pregnancy. c.
    They are unsafe for use during pregnancy and by nursing mothers.
    d.
    They must be used during pregnancy to prevent thyroid abnormalities in the fetus.

    c. They are unsafe for use during pregnancy and by nursing mothers.

27. The nurse caring for a client being treated for hypoparathyroidism should:

    a.
    instruct the client that adding vitamin D to her diet will increase calcium absorption.
    b.
    monitor the client for adverse effects of medication including hypocalcemia.
    c.
    teach the client how to administer a subcutaneous injection.
    d.
    monitor the client’s platelet level for indications of hypoprothrombinemia.

    a. instruct the client that adding vitamin D to her diet will increase calcium absorption

28. Which of the following is true about corticotropin (ACTH)?

    a.
    Clients with diabetes taking ACTH may experience a need for an increase in their insulin dosage.
    b.
    ACTH is not a commonly prescribed medication because of severe adverse effects.
    c.
    ACTH can be given orally, intravenously, or intramuscularly.
    d.
    ACTH is the treatment of choice for hyperpituitarism.

    a. Clients with diabetes taking ACTH may experience a need for an increase in their insulin dosage

29. Nursing assessment of clients taking vasopressin should include:

    a.
    daily weight.
    b.
    hourly intake and output.
    c.
    hourly blood pressure.
    d.
    every-two-hour neurological assessment.

    a. daily weight

30. Clients with hyperthyroidism generally exhibit which one of the following symptoms?

    a.
    weight gain
    b.
    constipation
    c.
    tachycardia
    d.
    lowered body temperature

    c. tachycardia

31. In monitoring clients on propylthiouracil (PTU), the nurse must be particularly watchful for:

    a.
    cardiac arrest.
    b.
    hypertensive crisis
    c.
    hepatitis.
    d.
    agranulocytosis.

    d. agranulocytosis

32. The nurse understands a reason for limiting the use of iodides in the treatment of hyperthyroidism is:

    a.
    the instability of iodide products.
    b.
    the danger of thyroid “escape.”
    c.
    the development of blood dyscrasias.
    d.
    that they must be administered parenterally.

    b. the danger of thyroid “escape.”

33. A client with hyperthyroidism is prescribed propranolol and asks the nurse why she is prescribed this medication. The nurse’s best response is:

    a.
    “Perhaps this was prescribed to treat your slow heart rate.”
    b.
    “Propranolol is prescribed to treat the cardiovascular effects of hyperthyroidism.”
    c.
    “Propranolol prolongs the action of antithyroid drugs.”
    d.
    “Did you ask your doctor why prescribed this drug was prescribed?”

    b. “Propranolol is prescribed to treat the cardiovascular effects of hyperthyroidism

34. In understanding thyroid function, the nurse knows which of the following statements is true?

    a.
    T3 is partially converted to T4 in the body.
    b.
    T4 has a longer duration of action than T3.
    c.
    T4 has four times the potency of T3.
    d.
    TSH is secreted by the thyroid gland.

    b. T4 has a longer duration of action than T3.

35. When caring for a client receiving liothyronine sodium, the nurse notes the client is exhibiting diaphoresis, restlessness, and tachycardia. The nurse should:

    a.
    administer oral diazepam.
    b.
    reassure the client that this is a normal reaction to liothyronine.
    c.
    notify the health care provider of the client’s symptoms.
    d.
    decrease the client’s 0.9% normal saline IV infusion.

    c. notify the health care provider of the client’s symptoms.

36. The nurse is teaching a client who has just received I 131. The nurse should tell the client:

    a.
    “Foods high in calcium should be avoided until your follow-up visit with the health care provider.”
    b.
    “This medication may cause temporary growth retardation.”
    c.
    “Temporary swelling and tenderness of the thyroid gland may occur several days later.”
    d.
    “You need to take care not to expose your family to your radioactivity for 48 hours.”

    c. “Temporary swelling and tenderness of the thyroid gland may occur several days later

37. Most persons with diabetes are insulin dependent, or type I.
    

    False

38. Insulin is normally injected at a 90-degree angle.
    

    True

39. Novolin Mix 70/30 insulin contains 70 units of NPH insulin per milliliter.
    

    True

40. Insulin pumps should not be disconnected for more than one hour.
    

    True

41. Children with diabetes should be involved in self-care as soon as emotionally and physiologically capable
    

    True

42. Clients with type 2 diabetes may temporarily require insulin therapy during times of illness or surgery.
    

    True

43. The most commonly used insulins in the United States are pork-based.
    

    False

44. When instructing a new nurse on the client with diabetes, which response by the new nurse would indicate the need for further teaching:

    a.
    This strength insulin is reserved for clients who take 200 or more units of insulin/day.
    b.
    This strength insulin is more likely to cause lipodystrophy.
    c.
    This is the strength insulin used in insulin pumps.
    d.
    This usually is used only for clients with marked insulin resistance.

    b. This strength insulin is more likely to cause lipodystrophy

45. Which of the following is the correct procedure for mixing two types of insulin in the same syringe?

    a.
    withdraw the regular insulin prior to any other type of insulin
    b.
    withdraw the regular insulin after other types of insulin
    c.
    draw each insulin in a separate syringe, then combine the two
    d.
    two types of insulin should not be mixed in the same syringe

    a. withdraw the regular insulin prior to any other type of insulin

46. When evaluating the electrolyte levels of a client experiencing diabetic ketoacidosis (DKA), the nurse would be most concerned about which finding?

    a.
    sodium level > 145 mEq/L
    b.
    sodium level 133 mEq/L
    c.
    potassium 3.1 mEq/L
    d.
    potassium 5.2 mEq/L

    c. potassium 3.1 mEq/L

47. When teaching the client about the advantages of using an insulin pump, the nurse should include:

    a.
    that it provides less expensive management for diabetes.
    b.
    that the client will experience moderate weight gain.
    c.
    that it allows the client flexibility in when and what he or she eats.
    d.
    that required training is minimal.

    c. that it allows the client flexibility in when and what he or she eats.

48. When caring for clients receiving oral hypoglycemic agents, the nurse must understand their mechanism of action. For example, glitazones act to:

    a.
    block the breakdown of starches.
    b.
    sensitize the body to the insulin that is currently present.
    c.
    stimulate insulin release in the pancreas.
    d.
    assist the pancreas in the production of insulin.

    b. sensitize the body to the insulin that is currently present.

49. The nurse understands that which of the following insulins has the shortest onset of action?

    a.
    glargine
    b.
    regular
    c.
    NPH
    d.
    lispro, apart

    d. lispro, apart

50. Which of the following is not a symptom usually associated with clients with type 2 (NIDDM) diabetes?

    a.
    polydipsia
    b.
    ketosis
    c.
    polyuria
    d.
    fatigue

    b. ketosis

51. When teaching a client with type 1 diabetes, the nurse recognizes that further teaching is needed when the client includes which of the following as an action of insulin?

    a.
    promotes conversion of glycogen to glucose
    b.
    decreases gastrointestinal absorption of dietary glucose
    c.
    enhances protein synthesis
    d.
    inhibits lipolysis

    b. decreases gastrointestinal absorption of dietary glucose

52. The nurse is preparing to administer an intermediate-acting insulin. An example of this type of insulin is:

    a.
    glulisine.
    b.
    NPH.
    c.
    ultralente.
    d.
    regular.

    b. NPH.

53. When preparing to administer intravenous insulin, the nurse knows that the insulin that may be given intravenously is:

    a.
    regular.
    b.
    NPH.
    c.
    lente.
    d.
    ultralente.

54. The nurse is teaching a client the technique for mixing and administering regular and NPH insulin. The client demonstrates understanding when he responds:

    a.
    “I can premix my morning dose of insulin the night before.”
    b.
    “If I draw up my evening insulins at the same time as my morning dose, I need to refrigerate the evening dose.”
    c.
    “I need to administer my insulins within 30 minutes after mixing them.”
    d.
    “I should always draw up the regular insulin after the NPH insulin.”

    c. “I need to administer my insulins within 30 minutes after mixing them

55. When preparing insulin for injection, the nurse should first:

    a.
    put on disposable gloves.
    b.
    wash hands
    c.
    check the insulin prescription.
    d.
    cleanse the vial stopper.

56. In most cases the major nursing goal in working with a diabetic client is to:

    a.
    teach the client how to inject insulin.
    b.
    assist the client become independent in self-care.
    c.
    monitor the client’s diet.
    d.
    help the client avoid insulin reactions.

    b. assist the client become independent in self-care.

57. The nurse understands that the most common reason for hypoglycemia in a client with type 1 diabetes is:

    a.
    omission of meals.
    b.
    lack of exercise.
    c.
    overeating.
    d.
    improper measurement of insulin dosage.

    a. omission of meals.

58. When teaching clients how to minimize local skin reactions from insulin injections, the nurse should instruct the clients to:

    a.
    keep insulin refrigerated until ready to draw up and administer.
    b.
    inject insulin slowly.
    c.
    give insulin in divided doses.
    d.
    bring the insulin to room temperature before injection.

    d. bring the insulin to room temperature before injection

59. When teaching a client about how to prevent complications associated with use of an insulin pump, the nurse recognizes that best indicator of client understanding of the teaching is when she:

    a.
    changes the needle insertion site every 48 hours.
    b.
    wears the pump on a belt.
    c.
    verbalizes the need to cleanse the needle insertion site with needle changes.
    d.
    replaces the pump battery if two blood glucose levels of 110 mg/dL occur.

    a. changes the needle insertion site every 48 hours

60. A insulin reaction can occur in the presence of:

    a.
    inadequate insulin.
    b.
    diabetic ketoacidosis.
    c.
    excessive exercise.
    d.
    increased food intake.

    c. excessive exercise

61. If a person known to have type 1 diabetes is found unconscious and the nurse does not know the reason, it is best to:

    a.
    administer regular insulin SC.
    b.
    administer intramuscular glucagon.
    c.
    wait until blood glucose test results have returned from the laboratory.
    d.
    administer four ounces of orange juice.

    b. administer intramuscular glucagon.

62. A client prescribed glyburide/metformin should be instructed to:

    a.
    take medication on an empty stomach.
    b.
    have liver function monitored yearly.
    c.
    take medication with meals.
    d.
    monitor for hypoglycemia within 30 minutes of taking medication.

    c. take medication with meals.

63. The nurse understands that exenatide is:

    a.
    an oral hypoglycemic agent used to treat type 2 diabetes.
    b.
    an oral insulin used to treat people with type 1 diabetes.
    c.
    a parenteral treatment for people with type 2 diabetes.
    d.
    a rapid-acting insulin used to treat people with type 1 diabetes.

    c. a parenteral treatment for people with type 2 diabetes.

64. Family members of a client with type 1 diabetes should be taught that after receiving intramuscular glucagon, the client should be responsive within:

    a.
    15 minutes.
    b.
    immediately.
    c.
    30 minutes.
    d.
    2 hours.

    a. 15 minutes

65. The nurse recognizes which of the following drugs as an example of a “second generation” sulfonylurea agent?

    a.
    chlorpropamide
    b.
    repaglinide
    c.
    tolbutamide
    d.
    glyburide

    d. glyburide

66. Clients using a sulfonylurea drug need instruction regarding drug interactions that can increase the risk of hypoglycemia if they also use:

    a.
    antimicrobial agents.
    b.
    acetaminophen.
    c.
    nonsteroidal anti-inflammatory agents (NSAIDs).
    d.
    caffeine.

    c. nonsteroidal anti-inflammatory agents (NSAIDs).

67. When teaching a client prescribed exenatide, the nurse explains that this drug:

    a.
    facilitates glucose production in type 2 diabetics.
    b.
    is administered orally in conjunction with other hypoglycemic agents.
    c.
    replaces regular insulin therapy for clients who are newly diagnosed with type 2 diabetes.
    d.
    causes insulin release from the pancreas only when serum glucose levels are elevated.

    d. causes insulin release from the pancreas only when serum glucose levels are elevated

68. Clients who take metformin should be aware that:

    a.
    the drug should be withheld for at least 48 hours after the use of IV contrast.
    b.
    they may self-adjust the dosage of the drug as needed.
    c.
    some clients develop respiratory acidosis as an adverse effect of this therapy.
    d.
    the drug acts by decreasing pancreatic glucose production.

    a. the drug should be withheld for at least 48 hours after the use of IV contrast

69. When teaching a client newly diagnosed with type 1 diabetes, the nurse recognizes the need for further teaching when the client responds:

    a.
    “I don’t need to wear gloves when I administer my insulin shots.”
    b.
    “I need to rotate my insulin injection sites to prevent lipodystrophy.”
    c.
    “If I inject my insulin in a site I seldom use, it may cause my blood sugar to drop too much.”
    d. “As long as I keep a mental schedule of rotating injection sites, I don’t need to keep a written record.”

    d. “As long as I keep a mental schedule of rotating injection sites, I don’t need to keep a written record.”

70. After the nurse instructs a client prescribed insulin glargine about her insulin, which comment by the client indicates to the nurse that further teaching is needed?

    a.
    “This is a long-acting insulin that I inject subcutaneously.”
    b.
    “This insulin doesn’t have a peak, so it won’t cause hypoglycemia.”
    c.
    “I only need to inject this insulin once a day.”
    d.
    “I can’t mix any other insulin with insulin glargine.”

    b. “This insulin doesn’t have a peak, so it won’t cause hypoglycemia.”

71. A client asks the nurse about the disadvantages of transplantation of islet cells. The nurse’s best response is:

    a.
    “It is a minor procedure compared to other transplant procedures.”
    b.
    “You will have to take immunosuppressant agents after the procedure.”
    c.
    “There is no need for immunosuppressant therapy after the procedure.”
    d.
    “Insulin will no longer be needed after the procedure is completed.”

    b. “You will have to take immunosuppressant agents after the procedure

72. When caring for an older client prescribed glipizide, the nurse should:

    a.
    question a prescription for half the usual initial dose.
    b.
    instruct the client to take the medication with meals.
    c.
    question a prescription for a usual initial dose.
    d.
    monitor the client for manifestations of metabolic alkalosis.

    c. question a prescription for a usual initial dose

73. A hospitalized adult client with a history of type 1 diabetes uses the call light system to tell the nurse, “I need a glass of orange juice with a packet of sugar in it right away.” The nurse should:

    a.
    immediately take the orange juice to the client as requested.
    b.
    ask the nursing assistant to check the client’s blood glucose level.
    c.
    notify the health care provider of the client’s request.
    d.
    take the client a 12-ounce can of diet soda.

    a. immediately take the orange juice to the client as requested.

What information concerning levothyroxine should you communicate to the patient?

What are side effects of levothyroxine?

What would expected findings during an assessment of a client with hyperthyroidism include?

Which agent would a nurse expect to administer to a client with hypothyroidism?