Endocrine Medication
PITUITARY MEDICATIONS
• A.Description
– 1.Anterior pituitary gland: Secretes growth
hormone (GH), thyroid-stimulating hormone
(TSH), adrenocorticotropic hormone (ACTH), and
gonadotropins (follicle-stimulating hormone, FSH,
and luteinizing hormone, LH)
– 2.Posterior pituitary gland: Secretes antidiuretic
hormones (ADH, vasopressin) and oxytocin
Growth hormones
• B. Growth hormones and related medications
– 1.Uses and side effects (Table 45-1)
– 2.Interventions
• a.Assess child's physical growth and compare growth
with standards
• b.Recommend annual bone age determinations for
children receiving growth hormones
• c.Monitor blood and urine glucose levels
• d.Teach the client and family about the importance of
follow-up regarding blood and urine glucose testing
Growth Hormones
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TABLE 45-1 Growth Hormones and Related Medications
Medication(s)
Use
Side Effects
Somatrem (Protropin)
Growth failure (adults)
Development of antibodies to growth hormone (GH)
Somatropin (Humatrope)
Growth failure (children)
Headache, muscle pain, weakness, mild hyperglycemia, hypertension, allergic
reaction (rash, swelling), pain at injection site
Bromocriptine (Parlodel)
Acromegaly
Nausea, headache, dizziness
Octreotide (Sandostatin)
Acromegaly
Diarrhea, nausea, abdominal discomfort, increased or decreased glucose level
ANTIDIURETIC HORMONES
• ANTIDIURETIC HORMONES (Box 45-1)
• A.Description
– 1.Enhance reabsorption of water in the kidneys,
promoting an antidiuretic effect and regulating
fluid balance
– 2.Used in diabetes insipidus
ANTIDIURETIC HORMONES
• . B.Side effects
– 1.Flushing
– 2.Headache
– 3.Nausea and abdominal cramps
– 4.Water intoxication
– 5.Hypertension with water intoxication
– 6.Nasal congestion with nasal administration
ANTIDIURETIC HORMONES
• C.Interventions
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1.Monitor weight
2.Monitor intake and output (I&O) and urine osmolality
3.Monitor electrolytes
4.Restrict fluid intake as prescribed to prevent water
intoxication
5.Monitor for signs of water intoxication, such as
drowsiness, listlessness, and headache
6.Monitor blood pressure
7.Instruct the client in how to use the intranasal
medication
8.Instruct the client to report signs of water intoxication or
symptoms of headache or shortness of breath
ANTIDIURETIC HORMONES
• BOX 45-1 Antidiuretic Hormones
• Desmopressin acetate (DDAVP, Stimate)
• Vasopressin (Pitressin Synthetic)
THYROID HORMONES
• THYROID HORMONES (Box 45-2)
• A.Description
– 1.Control the metabolic rate of tissues and accelerate heat production
and oxygen consumption
– 2.Used to replace thyroid hormone deficit in the treatment of
hypothyroidism, myxedema, or cretinism
– 3.Enhance the action of oral anticoagulants, sympathomimetics, and
antidepressants, and decrease the action of insulin, oral
hypoglycemics, and digitalis preparations; the action of thyroid
hormones is decreased by phenytoin (Dilantin) and carbamazepine
(Tegretol)
– 4.Should be given at least 4 hours apart from multivitamins, aluminum
and magnesium hydroxide, simethicone, calcium carbonate, bile acid
sequestrants, iron, and sucralfate, because these medications
decrease the absorption of thyroid replacements
THYROID HORMONES
• . B.Side effects
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1.Nausea and decreased appetite
2.Cramps and diarrhea
3.Weight loss
4.Nervousness and tremors
5.Headache
6.Hypertension
7.Tachycardia and dysrhythmias
8.Sweating and heat intolerance
9.Insomnia
10.Toxicity: Hyperthyroidism
THYROID HORMONES
• Interventions
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1.Check with the client for a history of medications currently being taken
2.Monitor vital signs
3.Monitor weight
4.Monitor triiodothyronine (T3), thyroxine (T4), and thyroid-stimulating
hormone (TSH) levels
5.Instruct the client to take the medication at the same time each day,
preferably in the morning without food
6.Instruct the client in how to monitor pulse rate
7.Advise the client to report symptoms of hyperthyroidism, such as
tachycardia, chest pain, palpitations, and excessive sweating
8.Instruct the client to avoid foods that can inhibit thyroid secretion, such as
strawberries, peaches, pears, cabbage, turnips, spinach, kale, brussels sprouts,
cauliflower, radishes, and peas
9.Advise the client to avoid over-the-counter medications
10.Instruct the client to wear a Medic-Alert bracelet
THYROID HORMONES
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BOX 45-2 Thyroid Hormones
Levothyroxine (Synthroid, Levothroid, Levoxyl)
Liothyronine (Cytomel)
Liotrix (Thyrolar)
Thyroid, desiccated (Thyrar)
ANTITHYROID MEDICATIONS
• ANTITHYROID MEDICATIONS (Box 45-3)
• A.Description
– 1.Inhibit the synthesis of thyroid hormone
– 2.Used for hyperthyroidism, or Graves' disease
ANTITHYROID MEDICATIONS
• B.Side effects
– 1.Nausea and vomiting
– 2.Diarrhea
– 3.Hypersensitivity with skin rash
– 4.Agranulocytosis with leukopenia
– 5.Toxicity: Hypothyroidism
– 6.Iodism: Characterized by vomiting, abdominal
pain, metallic taste in the mouth, rash, and sore
salivary glands
ANTITHYROID MEDICATIONS
• C.Interventions
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1.Monitor vital signs
2.Monitor T3, T4, and TSH levels
3.Monitor weight
4.Instruct the client to take medication with meals to
avoid gastrointestinal (GI) upset
– 5.Instruct the client about how to monitor the pulse
rate
– 6.Inform the client of side effects and when to notify
the physician
– 7.Advise the client to contact the physician if a fever
or sore throat develops
ANTITHYROID MEDICATIONS
– 8.Instruct the client in the signs of hypothyroidism
– 9.Instruct the client regarding the importance of
medication compliance and that abruptly stopping the
medication could cause thyroid storm
– 10.Instruct the client to monitor for signs and symptoms of
thyroid storm (fever, flushed skin, confusion and
behavioral changes, tachycardia, dysrhythmias, and signs
of heart failure)
– 11.Instruct the client to monitor for signs of iodism
– 12.Advise the client to consult physician before eating
iodized salt and iodine-rich foods
– 13.Instruct the client to avoid acetylsalicylic acid (aspirin)
and medications containing iodine
ANTITHYROID MEDICATIONS
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BOX 45-3 Antithyroid Medications
Strong iodine solution (Lugol solution)
Methimazole (Tapazole)
Propylthiouracil (PTU)
PARATHYROID MEDICATIONS
• PARATHYROID MEDICATIONS (Box 45-4)
• A.Description
– 1.Parathyroid hormone regulates serum calcium
levels
– 2.Low serum levels of calcium stimulate
parathyroid hormone release
– 3.Hyperparathyroidism results in a high serum
calcium level and bone demineralization, and
medication is used to lower the serum calcium
level
PARATHYROID MEDICATIONS
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BOX 45-4 Medications to Treat Calcium Disorders
CALCIUM SUPPLEMENTS
Calcium carbonate (Caltrate 600, Rolaids, Tums)
Calcium carbonate, oyster-shell derived (Os-Cal
500, Oysco 500, Oyst-Cal 500)
Calcium citrate (Citracal)
Calcium glubionate (Calcionate, Neo-Calglucon)
Calcium gluconate
Calcium lactate
Dibasic calcium phosphate
Tribasic calcium phosphate (Posture)
PARATHYROID MEDICATIONS
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VITAMIN D SUPPLEMENTS
Calcifediol (Calderol)
Calcitriol (Calcijex, Rocaltrol)
Dihydrotachysterol (DHT, Hytakerol)
Ergocalciferol (Calciferol, Drisdol)
CALCIUM REGULATORS
Alendronate (Fosamax)
Calcitonin human (Cibacalcin)
Calcitonin salmon (Calcimar, Miacalcin)
Etidronate (Didronel)
Pamidronate (Aredia)
Risedronate (Actonel)
Tiludronate (Skelid)
PARATHYROID MEDICATIONS
• ANTIHYPERCALCEMICS
• Gallium nitrate (Ganite)
– 4.Hypoparathyroidism results in a low serum calcium
level, which increases neuromuscular excitability;
treatment includes calcium and vitamin D
supplements
– 5.Parathyroid and antihypercalcemic agents may
cause hypermagnesemia
– 6.Calcium salts administered with digoxin (Lanoxin)
increase the risk of digoxin toxicity
– 7.Oral calcium salts reduce the absorption of
tetracycline hydrochloride
PARATHYROID MEDICATIONS
• B.Interventions
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1.Monitor electrolyte and calcium levels
2.Monitor for signs and symptoms of hypocalcemia and hypercalcemia
3.Monitor for symptoms of tetany in the client with hypocalcemia
4.Instruct the client in the signs and symptoms of hypercalcemia and
hypocalcemia
– 5.Instruct the client to check over-the-counter medication labels for
the possibility of calcium content
– 6.Instruct the client receiving oral calcium to maintain an adequate
intake of vitamin D, because vitamin D enhances absorption of calcium
– 7.Instruct clients receiving calcium regulators such as alendronate
sodium (Fosamax) to swallow tablet whole with water at least 30
minutes before breakfast and not to lie down for at least 30 minutes
after taking medication
ADRENOCORTICOTROPIC HORMONES
• ADRENOCORTICOTROPIC HORMONES (ACTH)
(Box 45-5)
• A.Description
– 1.Stimulate the adrenal cortex to secrete cortisol
– 2.Produce an anti-inflammatory effect
– 3.Used to diagnose adrenocortical disorders (Box
45-6)
– 4.Used to treat acute multiple sclerosis
ADRENOCORTICOTROPIC HORMONES
• B.Side effects
– 1.Nausea and vomiting
– 2.Gastric irritation with tendency to develop peptic ulcer
disease
– 3.Mood swings
– 4.Petechiae
– 5.Water and sodium retention, hypertension
– 6.Hypokalemia
– 7.Hypocalcemia, osteoporosis
– 8.Increased susceptibility to infection
– 9.Cataracts
– 10.Hirsuitism, acne, fragile skin, bruising
ADRENOCORTICOTROPIC HORMONES
• C.Interventions
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1.Monitor vital signs
2.Monitor I&O, weight, and for edema
3.Monitor for signs of infection
4.Monitor electrolyte and calcium levels
5.Avoid administering to the client with adrenocortical hyperfunction
6.Instruct the client to decrease salt intake
7.Instruct the client to report side effects such as muscle weakness,
edema, petechiae, ecchymosis, decrease in growth, delayed wound
healing, and menstrual irregularities
– 8.Monitor for adverse effects when the medication is discontinued;
dose should be tapered and not stopped abruptly, because adrenal
hypofunction may result
– 9.Advise the client to wear Medic-Alert bracelet
ADRENOCORTICOTROPIC HORMONES
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BOX 45-5 Medications for Adrenal Replacement Therapy
Betamethasone (Celestone)
Cortisone (Cortone)
Fludrocortisone (Florinef)
Hydrocortisone (Cortef)
Triamcinolone (Aristocort, Kenacort)
Dexamethasone (Decadron)
Methylprednisolone (Medrol Dosepak, Depo-Medrol, SoluMedrol)
• Prednisolone (Delta-Cortef, Prelone, Orapred, Pediapred)
• Prednisone (Orasone, Deltasone, Meticorten)
(GLUCOCORTICOIDS)
• CORTICOSTEROIDS (GLUCOCORTICOIDS) (See Box 45-5)
• A.Description
– 1.Produce metabolic effects
– 2.Alter the normal immune response and suppress
inflammation
– 3.Promote sodium and water retention and potassium
excretion
– 4.Produce anti-inflammatory, antiallergic, and antistress
effects
– 5.May be used as a replacement for adrenocortical
insufficiency
(GLUCOCORTICOIDS)
• B.Side effects
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1.Hyperglycemia
2.Hypokalemia
3.Sodium and water retention
4.Edema
5.Cause muscle wasting, osteoporosis, growth
retardation in children, peptic ulcer, increased serum
glucose levels, hypertension, convulsions, mood
swings, cataracts, glaucoma, fragile skin, hirsutism,
altered fat distribution
– 6.Mask the signs and symptoms of infection
(GLUCOCORTICOIDS)
• BOX 45-6 Medications Used in Diagnosing
Adrenal Gland Dysfunction
• Corticotropin repository (H.P. Acthar Gel,
ACTH gel)
• Cosyntropin (Cortrosyn)
(GLUCOCORTICOIDS)
• C.Contraindications and cautions
1.Contraindicated in hypersensitivity, psychosis,
and fungal infections
– 2.Use with caution in diabetes mellitus
– 3.Dexamethasone (Decadron) decreases the effects of
oral anticoagulants and oral antidiabetic agents
– 4.Increase the potency of medications taken
concurrently, such as aspirin and nonsteroidal antiinflammatory drugs (NSAIDs), thus increasing the risk
of GI bleeding and ulceration
– 5.Use of potassium-wasting diuretics increases
potassium loss, resulting in hypokalemia
(GLUCOCORTICOIDS)
– 6.Barbiturates, phenytoin (Dilantin), and rifampin
(Rifadin) decrease the effect of prednisone
– 7.The action of dexamethasone (Decadron) is
decreased by the use of phenytoin (Dilantin),
theophylline, rifampin (Rifadin), barbiturates, and
antacids
– 8.NSAIDs, aspirin, and estrogen increase the effect of
dexamethasone (Decadron)
– 9.Should be used with extreme caution in clients with
infections because they mask the signs and symptoms
of an infection
– 10.Advise the client to wear Medic-Alert bracelet
(GLUCOCORTICOIDS)
• D.Interventions
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1.Monitor vital signs
2.Monitor serum electrolyte and blood glucose levels
3.Monitor for hypokalemia and hyperglycemia
4.Monitor I&O, weight, and for edema
5.Monitor for hypertension
6.Check the client's medical history for glaucoma, cataracts,
peptic ulcer, mental health disorders, or diabetes mellitus
– 7.Monitor the older client for signs and symptoms of increased
osteoporosis
– 8.Monitor for changes in muscle strength
– 9.Prepare a schedule for the client on short-term, tapered doses
(GLUCOCORTICOIDS)
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10.Instruct the client to take at mealtime or with food
11.Advise the client to eat foods high in potassium
12.Instruct the client to avoid individuals with respiratory infections
13.Advise the client to inform all health care providers about taking
the medication
14.Instruct the client to report signs and symptoms of a medication
overdose or Cushing's syndrome, including a moon face, puffy eyelids,
edema in the feet, increased bruising, dizziness, bleeding, and
menstrual irregularities
15.Note that the client may need additional doses during periods of
stress, such as surgery
16.Instruct the client not to stop medication abruptly, because abrupt
withdrawal can result in severe adrenal insufficiency
17.Advise the client to consult with the physician before receiving
vaccinations
18.Advise the client to wear Medic-Alert bracelet
Mineralocorticoids
• Mineralocorticoids
•
– 1.Description
• a.Steroid hormones that enhance the reabsorption of
sodium and chloride and promote the excretion of
potassium and hydrogen from the renal tubules,
thereby helping to maintain fluid and electrolyte
balance
• b.Used for replacement therapy in primary and
secondary adrenal insufficiency in Addison's disease
– 2.Medication: Fludrocortisone (Florinef)
Mineralocorticoids
– 3.Side effects
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a.Sodium and water retention, hypertension
b.Hypokalemia
c.Hypocalcemia
d.Increased susceptibility to infection
e.Delayed wound healing
f.GI distress, tendency to develop peptic ulcer
g.Osteoporosis, compression fractures
h.Increased appetite and weight gain
i.Insomnia
j.Mood swings
k.Abdominal distention
Mineralocorticoids
– 4.Interventions
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a.Monitor vital signs
b.Monitor weight
c.Monitor electrolyte and calcium levels
d.Instruct the client to take medication with food or milk
e.Instruct the client to consume a high-potassium diet
f.Instruct the client not to stop the medication abruptly
g.Instruct the client to notify the physician if signs of infection,
muscle aches, sudden weight gain, or headaches occur
• h.Instruct the client to avoid exposure to disease or trauma
• i.Instruct the client not to take aspirin or any other medication
without consulting the physician
• j.Instruct the client to wear a Medic-Alert bracelet
ANDROGENS
• ANDROGENS (Box 45-7)
• A.Description
– 1.Used either to replace deficient hormones or to treat
hormone-sensitive disorders
– 2.Can cause bleeding if the client is taking oral anticoagulants
(increase the effect of anticoagulants)
– 3.Cause decreased serum glucose concentration, thereby
reducing insulin requirements in the client with diabetes
mellitus
– 4.Hepatotoxic medications are avoided with the use of
androgens because of the risk of additive damage to the liver
– 5.Usually avoided in men with known prostatic or breast
carcinoma because androgens often stimulate growth of these
tumors
ANDROGENS
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BOX 45-7 Androgens
Fluoxymesterone (Halotestin)
Methyltestosterone (Android, Testred, Virilon)
Testosterone (Androderm, Testoderm)
Testosterone (Testopel pellets)
Testosterone cypionate (Andronate, DepoTestosterone)
• Testosterone enanthate (Delatestryl)
ANDROGENS
– B.Side effects
• 1.Masculine secondary sexual characteristics (body hair growth, lowered
voice, muscle growth)
• 2.Bladder irritation and urinary tract infections
• 3.Breast tenderness
• 4.Gynecomastia
• 5.Priapism
• 6.Menstrual irregularities
• 7.Virilism
• 8.Sodium and water retention with edema
• 9.Nausea, vomiting, or diarrhea
• 10.Acne
• 11.Changes in libido
• 12.Hepatotoxicity, jaundice
• 13.Hypercalcemia
ANDROGENS
• C.Interventions
• CHAPTER 45 Endocrine Medications (page 13 of 33 — printed page 589)
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1.Monitor vital signs
2.Monitor for edema, weight gain, and skin changes
3.Monitor mental status and neurological function
4.Monitor for signs of liver dysfunction, including right upper quadrant
abdominal pain, malaise, fever, jaundice, pruritus
5.Monitor for the development of secondary sexual characteristics
6.Instruct the client to take with meals or a snack
7.Instruct the client to notify the physician if priapism develops
8.Instruct the client to notify the physician if fluid retention occurs
9.Instruct women to use a nonhormonal contraceptive while on therapy
10.For women, monitor for menstrual irregularities and decreased breast size
ESTROGENS AND PROGESTINS
• ESTROGENS AND PROGESTINS
• A.Description
– 1.Estrogens are steroids that stimulate female
reproductive tissues
– 2.Progestins are steroids that specifically stimulate the
uterine lining
– 3.Estrogen and progestin preparations may be used to
stimulate endogenous hormones to restore hormonal
balance or to treat hormone-sensitive tumors
(suppress tumor growth), or for contraception (Boxes
45-8 and 45-9)
ESTROGENS AND PROGESTINS
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BOX 45-8 Estrogens
Diethylstilbestrol (DES)
Estradiol (Estrace, Climara, Estraderm, Vivelle)
Estradiol cypionate (Depo-Estradiol)
Estradiol valerate (Delestrogen)
Estrogens, congugated (Premarin)
Estrone (Kestrone 5)
Estropipate (Ogen)
Top of Form
Bottom of Form
BOX 45-9 Progestins
Medroxyprogesterone, tablets (Provera)
Medroxyprogesterone, injection (Depo-Provera)
Medroxyprogesterone and conjugated estrogens (Premphase, Prempro)
Megestrol (Megace)
Norethindrone acetate (Aygestin)
Progesterone, micronized (Prometrium)
Progesterone (Crinone, Progestasert)
ESTROGENS AND PROGESTINS
• B.Contraindications and cautions
– 1.Estrogens
• a.Contraindicated in clients with breast cancer, endometrial
hyperplasia, endometrial cancer, history of thromboembolism,
known or suspected pregnancy, or lactation
• b.Use with caution in hypertension, gall bladder disease, liver, or
kidney dysfunction
• c.Increase the risk of toxicity when used with hepatotoxic
medications
• d.Barbiturates, phenytoin, (Dilantin), and rifampin (Rifadin)
decrease the effectiveness of estrogen
– 2.Progestins: Contraindicated in clients with
thromboembolitic disorders, and avoided in clients with
breast tumors or hepatic disease
ESTROGENS AND PROGESTINS
• C.Side effects
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1.Breast tenderness, menstrual changes
2.Nausea, vomiting, and diarrhea
3.Malaise, depression, excessive irritability
4.Weight gain
5.Edema and fluid retention
6.Atherosclerosis
7.Hypertension, stroke, myocardial infarction
8.Thromboembolism (estrogen)
9.Migraine headaches and vomiting (estrogen)
ESTROGENS AND PROGESTINS
• D.Interventions
– 1.Monitor vital signs
– 2.Monitor for hypertension
– 3.Monitor for edema and weight gain
– 4.Advise the client not to smoke
– 5.Advise the client to undergo routine breast and
pelvic examinations
ORAL CONTRACEPTIVES
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•
ORAL CONTRACEPTIVES
A.Description
– 1.These medications contain a combination of estrogen and a progestin or a progestin alone
– 2.Estrogen-progestin combinations suppress ovulation and change the cervical mucus, making
it difficult for sperm to enter
– 3.Medications that contain only progestins are less effective than the combined medications
– 4.Usually taken for 21 consecutive days and stopped for 7 days; then the administration cycle
is repeated
– 5.Provide reversible prevention of pregnancy
– 6.Useful in controlling irregular or excessive menstrual cycles
– 7.Risk factors associated with the development of complications related to the use of oral
contraceptives include smoking, obesity, and hypertension
– 8.Contraindicated in women with hypertension, thromboembolitic disease, cerebrovascular or
coronary disease, estrogen-dependent cancers, pregnancy
– 9.Avoided with the use of hepatotoxic medications
– 10.Interfere with the activity of bromocriptine (Parlodel) and anticoagulants and increase the
toxicity of tricyclic antidepressants
– 11.May alter blood glucose levels
ORAL CONTRACEPTIVES
• B.Side effects
– 1.Breakthrough bleeding
– 2.Excessive cervical mucus formation
– 3.Breast tenderness
– 4.Hypertension
– 5.Nausea, vomiting
ORAL CONTRACEPTIVES
• C.Interventions
– 1.Monitor vital signs and weight
– 2.Instruct the client in the administration of the medication (it may take up to
1 week for full contraceptive effect to occur when the medication is begun)
– 3.Instruct the client with diabetes mellitus to monitor blood glucose levels
carefully
– 4.Instruct the client to report signs of thromboembolitic complications
– 5.Instruct the client to notify the physician if vaginal bleeding or menstrual
irregularities occur or if pregnancy is suspected
– 6.Inform the client that many medications interfere with the effectiveness of
birth control pills
– 7.Instruct the client to perform breast self-examination monthly and about the
importance of yearly physical examinations
– 8.If the client decides to discontinue the oral contraceptive to become
pregnant, recommend that the client use an alternative form of birth control
for 2 months after discontinuation to ensure more complete excretion of
hormonal agents before conception
FERTILITY MEDICATIONS
• FERTILITY MEDICATIONS (Box 45-10)
• A.Description
– 1.Act to stimulate follicle development and ovulation
in functioning ovaries; combined with human
chorionic gonadotropin (hCG) to maintain the follicles
once ovulation has occurred
– 2.Contraindicated in the presence of primary ovarian
function, thyroid or adrenal dysfunction, ovarian cysts,
pregnancy, or idiopathic uterine bleeding
– 3.Used with caution in clients with thromboembolitic
or respiratory diseases
FERTILITY MEDICATIONS
• B.Side effects
– 1.Risk of multiple births and birth defects
– 2.Ovarian overstimulation (abdominal pain, distention, ascites,
pleural effusion)
– 3.Headache, irritability
– 4.Fluid retention and bloating
– 5.Nausea, vomiting
– 6.Uterine bleeding
– 7.Ovarian enlargement
– 8.Gynecomastia
– 9.Rash
– 10.Orthostatic hypotension
– 11.Febrile reactions
FERTILITY MEDICATIONS
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BOX 45-10 Fertility Medications
Bromocriptine (Parlodel)
Chorionic gonadotropin (A.P.L., Profasi)
Clomiphene (Clomid)
Follitropin alfa (Gonal-F)
Follitropin beta (Follistim)
Menotropins (Pergonal)
FERTILITY MEDICATIONS
• C.Interventions
– 1.Instruct the client regarding administration of the
medication
– 2.Provide a calendar of treatment days and
instructions on when intercourse should occur to
increase therapeutic effectiveness of the medication
– 3.Provide information about the risks and hazards of
multiple births
– 4.Instruct the client to notify the physician if signs of
ovarian stimulation occur
– 5.Inform the client about the need for regular followup for evaluation
MEDICATIONS FOR PENILE ERECTION
DYSFUNCTION
• MEDICATIONS FOR PENILE ERECTION DYSFUNCTION
• A.Description
– 1.Alprostadil (Caverject, Muse) is a prostaglandin that relaxes smooth
muscle and promotes blood flow into the corpus cavernosum
– 2.Sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra) cause smooth
muscle relaxation and allow blood flow into the corpus cavernosum
– 3.Contraindicated in the presence of any anatomical obstruction or
condition that might predispose to priapism and in clients with penile
implants
– 4.Caution should be used in clients with bleeding disorders
– 5.Sildenafil, tadalafil, and vardenafil are used cautiously in clients with
coronary artery disease, active peptic ulcer, bleeding disorders, or
retinitis pigmentosa
– 6.Sildenafil, tadalafil, and vardenafil cannot be administered to clients
taking nitrates, nitroprusside, or alpha blockers
MEDICATIONS FOR PENILE ERECTION
DYSFUNCTION
• B.Side effects
– 1.Alprostadil: Pain at the injection site, infection,
priapism, fibrosis, rash, hypertension
– 2.Sildenafil, tadalafil, and vardenafil: Headache,
flushing, dyspepsia, urinary tract infection,
diarrhea, dizziness, rash
– 3.Blurred vision and changes in color vision
MEDICATIONS FOR PENILE ERECTION
DYSFUNCTION
• C.Interventions
– 1.Obtain a thorough health and medication
history
– 2.Instruct the client regarding administration of
the medication; alprostadil is injected, and
sildenafil, tadalafil, and vardenafil are taken orally
– 3.Inform the client of the side effects necessitating
the need to notify the physician
MEDICATIONS FOR DIABETES
MELLITUS
• MEDICATIONS FOR DIABETES MELLITUS
• A.Insulin and oral hypoglycemic medications
– 1.Description
• a.Insulin increases glucose transport into cells and
promotes conversion of glucose to glycogen, decreasing
serum glucose levels
• b.Oral hypoglycemic agents stimulate the pancreas to
produce more insulin, increase the sensitivity of
peripheral receptors to insulin, decrease hepatic
glucose output or delay intestinal absorption of
glucose, thus decreasing serum glucose levels
MEDICATIONS FOR DIABETES
MELLITUS
• 2.Contraindications and concerns
• a.Insulin is contraindicated in clients with hypersensitivity
• b.Oral hypoglycemic agents are contraindicated in type 1 diabetes mellitus
• c.Sulfonylureas can affect cardiac function and oxygen consumption and lead
to cardiac dysrhythmias
• d.Use of hypoglycemic medications with beta-adrenergic blocking agents
masks signs and symptoms of hypoglycemia
• e.Anticoagulants, chloramphenicol (Chloromycetin), salicylates, propranolol
(Inderal), monoamine oxidase inhibitors (MAOIs), pentamidine (Pentam 300),
and sulfonamides may cause hypoglycemia
• f.Corticosteroids, sympathomimetics, thiazide diuretics, phenytoin (Dilantin),
thyroid preparations, oral contraceptives, and estrogen compounds may cause
hyperglycemia
• g.Side effects of the sulfonylureas include gastrointestinal symptoms and
dermatological reactions; hypoglycemia can occur when an excessive dose is
administered or when meals are omitted or delayed, food intake is decreased,
or activity is increased
• h.Sulfonylureas, such as chlorpropamide (Diabinese), can cause a disulfiram
(Antabuse) type of reaction when alcohol is ingested
MEDICATIONS FOR DIABETES
MELLITUS
• B.Oral hypoglycemic medications
• 1.Prescribed for clients with type 2 diabetes mellitus
• 2.Sulfonylureas (Box 45-11)
– a.May be classified as first- or second-generation
sulfonylureas
– b.Stimulate the beta cells to produce more insulin
• 3.Nonsulfonylureas (see Box 45-11)
– a.Affect the hepatic and gastrointestinal production of glucose
– b.May be used alone or in combination with a sulfonylurea
MEDICATIONS FOR DIABETES
MELLITUS
• 4.Interventions
– a.Assess the client's knowledge of diabetes mellitus and the use
of oral antidiabetic agents
– b.Obtain a medication history regarding the medications that the
client is currently taking
– c.Monitor vital signs and blood glucose levels
– d.Instruct the client to recognize symptoms of hypoglycemia and
hyperglycemia
– e.Instruct the client to avoid over-the-counter medications unless
prescribed by the health care provider
– f.Instruct the client not to ingest alcohol with sulfonylureas
– g.Inform the client that insulin may be needed during stress,
surgery, or infection
– h.Instruct the client in the necessity of compliance with
prescribed medication
– i.Advise the client to obtain a Medic-Alert bracelet
MEDICATIONS FOR DIABETES
MELLITUS
• . C.Insulin (Table 45-2)
• 1.Primarily acts in the liver, muscle, and adipose tissue by attaching to
receptors on cellular membranes and facilitating the passage of
glucose, potassium, and magnesium
• 2.Prescribed for clients with type 1 diabetes mellitus
• 3.Storing insulin (Box 45-12)
• 4.Insulin injection sites
– a.The main areas for injections are the abdomen, arms (posterior surface),
thighs (anterior surface), and hips
– b.Insulin injected into the abdomen may absorb more evenly and rapidly than
at other sites
– c.Systematic rotation within one anatomical area is recommended to prevent
lipodystrophy; client should be instructed not to use the same site more than
once in a 2- to 3-week period
– d.Injections should be 1.5 inches apart within the anatomical area
– e.Heat, massage, and exercise of the injected area can increase absorption
rates and may result in hypoglycemia
– f.Injection into scar tissue may delay absorption of insulin
MEDICATIONS FOR DIABETES
MELLITUS
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
BOX 45-11 Sulfonylureas and Nonsulfonylureas
SULFONYLUREAS
Acetohexamide (Dymelor)
Chlorpropamide (Diabinese)
Glimepiride (Amaryl)
Glipizide (Glucotrol)
Glyburide (Diabeta, Micronase)
Tolazamide (Tolinase)
Tolbutamide (Orinase)
NONSULFONYLUREAS
Alpha-Glucosidase Inhibitor
Acarbose (Precose)
Miglitol (Glyset)
Biguanide
Metformin (Glucophage)
Meglitinides
Nateglinide (Starlix)
Repaglinide (Prandin)
Thiazolidinediones
Pioglitazone (Actos)
Rosiglitazone (Avandia)
The following will reflects the type, onset, peak
(hours), and duration (hours)
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
TABLE 45-2 Common Types of Insulin
RAPID-ACTING INSULIN
Insulin lispro (Humalog)
15 minutes
½ to 1½
4–5
Insulin aspart (NovoLog)
5–10 minutes
1–3
3–5
SHORT-ACTING INSULIN
Regular (Humulin R, Novolin R)
30–60 minutes
2–4
5–7
INTERMEDIATE-ACTING INSULIN
NPH (Humulin N, Novolin N)
1–2 hours
6–14
24
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
The following will reflects the type,
onset, peak (hours), and duration
(hours)
Lente (Humulin L, Novolin L)
1–3 hours
6–14
24
LONG-ACTING INSULIN
Ultralente (Humulin U)
6 hours
18–24
36
Insulin glargine (Lantus)
—
—
24
PREMIXED INSULIN
70% NPH/30% Regular (Humulin 70/30)
30–60 minutes
2–12
18–24
50% NPH/50% Regular (Humulin 50/50)
30 minutes
3–5
24
75% insulin lispro protamine/25% lispro
10–15 minutes
1–6
24
MEDICATIONS FOR DIABETES
MELLITUS
• BOX 45-12 Storing Insulin
• Exposure to extremes in temperature should be
avoided.
• Insulin should not be frozen or kept in direct
sunlight or a hot car.
• Before injection, insulin should be at room
temperature.
• If a vial of insulin will be used up in a month, it
may be kept at room temperature; otherwise, the
vial should be refrigerated.
Administering insulin
• 5.Administering insulin
– a.To prevent dosage errors, be certain that the insulin concentration
noted on the vial matches with the calibration of units on the insulin
syringe; the usual concentration of insulin is Units 100 (100 units/mL)
– b.Most insulin syringes have a 27- to 29-gauge needle that is
approximately 0.5 inch long
– c.Before use, roll the insulin bottle to ensure that the insulin and
ingredients are mixed well; otherwise, an inaccurate dose will be drawn;
shaking the bottle will cause bubbles to form
– d.Premixed insulins (NPH and Regular insulin) are available as 70/30
(most commonly used) and 50/50; (premixed insulin lispro protamine
and insulin lispro 75/25 are also available)
– e.Mixtures of insulin in prefilled syringes should be kept in the
refrigerator, where they will be stable for at least 1 week; prefilled
syringes should be kept flat or with the needle in an upright position to
avoid clogging the needle
Administering insulin
– f.Inject air into the insulin bottle (a vacuum makes it difficult to
draw up the insulin)
– g.When mixing insulins, draw up the Regular (shorter acting)
insulin first
– h.Regular insulin may be mixed with any other type of insulin
– i.Insulin zinc suspensions may be mixed only with each other and
Regular insulin, not with other types of insulin
– j.Administer a mixed dose of insulin within 5 to 15 minutes of
preparation; after this time, the Regular insulin binds with the
NPH insulin and its action is reduced
– k.Aspiration is generally not recommended with self-injection of
insulin
– l.Administer insulin at a 45- to 90-degree angle and at a 45- to 60degree angle in thin persons
– m.Remember: Regular insulin is the only type of insulin that can
be administered by IV
Glucagon
– D.Glucagon
• 1.A hormone secreted by the alpha cells of the islets of Langerhans in
the pancreas
• 2.Increases blood glucose level by stimulating glycogenolysis in the
liver
• 3.Can be administered by the subcutaneous, intramuscular, or
intravenous route
• 4.Used to treat insulin-induced hypoglycemia when the client is
semiconscious or unconscious and cannot ingest liquids
• 5.The blood glucose level begins to increase within 5 to 20 minutes
after administration
• 6.Instruct the family in the procedure for administration
• 7.See Chapter 44 for additional information regarding interventions
for severe hypoglycemia
Glucagon
– E.Diazoxide (Proglycem)
• 1.Increases blood glucose level by inhibiting insulin
release from the beta cells and stimulating the release
of epinephrine from the adrenal medulla
• 2.Used to treat chronic hypoglycemia caused by
hyperinsulinism resulting from islet cell cancer or
hyperplasia
• 3.It is not used for hypoglycemic reactions from insulin
• 1.Somatren (Protropin) is administered to a
client with pituitary dwarfism. The expected
therapeutic effect of this medication is to:
– 1.Promote weight gain
– 2.Stimulate linear growth
– 3.Increase bone density
– 4.Decrease the mobilization of fats
• 1.Answer: 2Rationale: Protropin is a growth stimulator used in the
long-term treatment of growth failure resulting from growth
hormone deficiency. It stimulates linear growth, increases the
number and size of muscle cells, and red cell mass. It affects
carbohydrate metabolism by antagonizing the action of insulin,
increasing mobilization of fats, and increasing cellular protein
synthesis.Test-Taking Strategy: Use the client diagnosis in the
question to assist in the process of elimination in answering the
question. Note the relationship between “dwarfism” in the
question and “growth” in the correct option. Review the action of
this medication if you had difficulty with this question.Level of
Cognitive Ability: AnalysisClient Needs: Physiological
IntegrityIntegrated Process: Nursing Process/EvaluationContent
Area: PharmacologyReference: Hodgson, B., & Kizior, R. (2005).
Saunders nursing drug handbook 2005. Philadelphia: W.B. Saunders,
p. 981.
• 2.A nurse is monitoring a client receiving
desmopressin (DDAVP). Which of the
following, if noted in the client, would indicate
an adverse effect of the medication?
– 1.Increased urination
– 2.Weight loss
– 3.Drowsiness
– 4.Insomnia
• 2.Answer: 3Rationale: Water intoxication or hyponatremia is an
adverse reaction to DDAVP. Early signs include drowsiness,
listlessness, and headache. Decreased urination, rapid weight gain,
confusion, seizures, and coma may also occur in overhydration.TestTaking Strategy: Use the process of elimination. Knowledge that
this medication is used in the treatment of diabetes insipidus will
assist in eliminating options 1 and 2. Recalling the action of the
medication will assist you in determining that water intoxication is
an adverse reaction. This thought process will assist in directing you
to option 3. Review the adverse effects of reactions related to this
medication if you had difficulty with this question.Level of
Cognitive Ability: AnalysisClient Needs: Physiological
IntegrityIntegrated Process: Nursing Process/Data
CollectionContent Area: PharmacologyReference: Hodgson, B., &
Kizior, R. (2005). Saunders nursing drug handbook 2005.
Philadelphia: W.B. Saunders, p. 303.
• 3.A nurse reinforces instructions to a client
taking levothyroxine (Synthroid). The nurse
determines that the teaching was effective if
the client states that he or she will take the
medication:
– 1.With food
– 2.On an empty stomach
– 3.At bed time
– 4.At lunch time
• 3.Answer: 2Rationale: Oral doses of levothyroxine should be taken
on an empty stomach to enhance absorption. The medication
should be taken in the morning before breakfast.Test-Taking
Strategy: Use the process of elimination. Eliminate options 1 and 4
first because they are similar. From the remaining options, recalling
the purpose of the medication and that it is administered in the
morning will direct you to option 2. Review this medication if you
had difficulty with this question.Level of Cognitive Ability:
AnalysisClient Needs: Physiological IntegrityIntegrated Process:
Nursing Process/EvaluationContent Area: PharmacologyReferences:
Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook
2005. Philadelphia: W.B. Saunders, p. 632.McKenry, L., & Salerno, E.
(2003). Mosby's pharmacology in nursing (21st ed.). St. Louis:
Mosby, p. 842.
• 4.Thyroid replacement therapy is prescribed for a
client diagnosed with hypothyroidism. The client
asks the nurse when the medication will no
longer be needed. The nurse makes which
response to the client?
– 1.“You will need to ask your physician.”
– 2.“Most clients require medication therapy for about
1 year.”
– 3.“It depends on the results of the laboratory values.”
– 4.“The medication will need to be continued for life.”
• 4.Answer: 4Rationale: For most hypothyroid clients, replacement
therapy must be continued for life. Treatment provides
symptomatic relief but does not produce a cure. The client should
be told that although therapy will improve symptoms, these
improvements do not constitute a reason to interrupt or
discontinue the medication.Test-Taking Strategy: Use the process
of elimination. Recalling the physiology associated with
hypothyroidism will direct you to option 4. If you are unfamiliar
with this disorder and the medication therapy associated with it,
review this content.Level of Cognitive Ability: ApplicationClient
Needs: Physiological IntegrityIntegrated Process: Nursing
Process/ImplementationContent Area: PharmacologyReference:
Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook
2005. Philadelphia: W.B. Saunders, p. 633.
• 5.A nurse reinforces medication instructions
to a client taking levothyroxine (Synthroid).
The nurse instructs the client to notify the
physician if which of the following occurs?
– 1.Cold intolerance
– 2.Tremors
– 3.Excessively dry skin
– 4.Fatigue
• 5.Answer: 2Rationale: Excessive doses of levothyroxine can
produce signs and symptoms of hyperthyroidism (thyrotoxicosis).
These include tachycardia, angina, tremors, nervousness, insomnia,
hyperthermia, heat intolerance, and sweating. The client should be
instructed to notify the physician if these occur. Options 1, 3, and 4
are signs of hypothyroidism.Test-Taking Strategy: Use the process
of elimination, recalling the symptoms associated with
hypothyroidism, the purpose of administering levothyroxine, and
the effects of the medication. Options 1, 3, and 4 are symptoms
related to hypothyroidism. Review the adverse effects of the
medication if you are unfamiliar with it.Level of Cognitive Ability:
ApplicationClient Needs: Physiological IntegrityIntegrated Process:
Nursing Process/ImplementationContent Area:
PharmacologyReference: Hodgson, B., & Kizior, R. (2005). Saunders
nursing drug handbook 2005. Philadelphia: W.B. Saunders, p. 633.
• 6.A nurse reviews the health record of a client
seen in the physician's office and noted that
the client is taking propylthiouracil (PTU) daily.
The nurse suspects that the client has a
history of:
– 1.Cushing's syndrome
– 2.Addison's disease
– 3.Myxedema
– 4.Graves' disease
• 6.Answer: 4Rationale: PTU inhibits thyroid hormone synthesis and
is used to treat hyperthyroidism or Graves' disease. Myxedema
indicates hypothyroidism. Cushing's syndrome and Addison's
disease are disorders related to adrenal function.Test-Taking
Strategy: Knowledge regarding the action of the medication and
the treatment measures for Graves' disease is required to answer
the question. Remember, PTU inhibits thyroid hormone synthesis
and is used to treat hyperthyroidism or Graves' disease. If you are
unfamiliar with either of these, review this content.Level of
Cognitive Ability: AnalysisClient Needs: Physiological
IntegrityIntegrated Process: Nursing Process/Data
CollectionContent Area: PharmacologyReferences: Hodgson, B., &
Kizior, R. (2005). Saunders nursing drug handbook 2005.
Philadelphia: W.B. Saunders, p. 904.McKenry, L., & Salerno, E.
(2003). Mosby's pharmacology in nursing (21st ed.). St. Louis:
Mosby, p. 825.
• 7.A nurse is reinforcing instructions to a client
regarding the administration of lypressin
(Diapid). The nurse instructs the client that
the medication will be taken by which of the
following routes?
– 1.Oral
– 2.Subcutaneous
– 3.Intranasal
– 4.Intramuscular
• 7.Answer: 3Rationale: Lypressin is administered by the
intranasal route. It is used for diabetes insipidus. The usual
adult dosage is one or two sprays into each nostril four
times daily. Options 1, 2, and 4 are incorrect.Test-Taking
Strategy: Knowledge that lypressin is administered by the
nasal route is required to answer the question. Review this
medication if you had difficulty with this question.Level of
Cognitive Ability: ApplicationClient Needs: Physiological
IntegrityIntegrated Process: Nursing
Process/ImplementationContent Area:
PharmacologyReference: McKenry, L., & Salerno, E. (2003).
Mosby's pharmacology in nursing (21st ed.). St. Louis:
Mosby, p. 833.
• 8.A client is seen by the physician for complaints
of fatigue, a lack of energy, constipation, and
depression. Following diagnostic studies,
hypothyroidism is diagnosed. Levothyroxine
(Synthroid) is prescribed. The nurse tells the
client that the primary expected outcome of the
medication is to:
–
–
–
–
1.Increase energy levels
2.Achieve normal thyroid hormone levels
3.Increase blood glucose levels
4.Alleviate depression
• 8.Answer: 2Rationale: Laboratory determination of the serum thyroidstimulating hormone level (TSH) is an important means of evaluation of
therapy with levothyroxine. Effective therapy will cause the elevated TSH
levels to decrease. These levels will begin their decline within hours of the
onset of therapy and will continue to drop as plasma levels of thyroid
hormone build up. If an adequate dosage is established, TSH levels will
remain suppressed for the duration of the therapy. Although energy levels
are expected to increase, the primary expected outcome is measured by
thyroid hormone levels. Options 3 and 4 are unrelated to this
medication.Test-Taking Strategy: Note the key words, primary and
expected outcome. Relate the diagnosis of hypo“thyroidism” with
“thyroid” hormone levels in the correct option. If you had difficulty with
this question, review the therapeutic effects of levothyroxine.Level of
Cognitive Ability: ApplicationClient Needs: Physiological
IntegrityIntegrated Process: Nursing Process/ImplementationContent
Area: PharmacologyReference: Hodgson, B., & Kizior, R. (2005). Saunders
nursing drug handbook 2005. Philadelphia: W.B. Saunders, p. 632.
• 9.Propylthiouracil (PTU) is prescribed for a client
with hyperthyroidism and the nurse reinforces
instructions to the client regarding the
medication. The nurse informs the client to notify
the physician if which of the following signs
occur?
–
–
–
–
1.Drowsiness
2.Sore throat
3.Polyuria
4.Dry mouth
• 9.Answer: 2Rationale: An adverse effect of PTU is agranulocytosis.
The client needs to be informed of the early signs of this adverse
effect, which includes fever or sore throat. Drowsiness is an
occasional side effect of the medication. Polyuria and dry mouth
are unrelated to this medication.Test-Taking Strategy: Use the
process of elimination. Recalling that agranulocytosis is an adverse
effect of PTU will direct you to option 2. Review this medication if
you had difficulty with this question.Level of Cognitive Ability:
ApplicationClient Needs: Health Promotion and
MaintenanceIntegrated Process: Nursing
Process/ImplementationContent Area: PharmacologyReference:
McKenry, L., & Salerno, E. (2003). Mosby's pharmacology in nursing
(21st ed.). St. Louis: Mosby, p. 848.
• 10.A client is scheduled for subtotal
thyroidectomy. Iodine solution (Lugol solution) is
prescribed. The nurse understands that the
therapeutic effect of this medication is to:
–
–
–
–
1.Increase thyroid hormone production
2.Suppress thyroid hormone production
3.Replace thyroid hormone
4.Prevent the oxidation of iodide
• 10.Answer: 2Rationale: Lugol solution is administered to
hyperthyroid individuals in preparation for thyroidectomy to
suppress thyroid function. Initial effects develop within 24 hours;
peak effects develop in 10 to 15 days. Options 1, 3, and 4 are
incorrect.Test-Taking Strategy: Use the process of elimination.
Elim-inate options 1 and 3 first because they are similar. From the
remaining options, select option 2 because of its relationship to the
issue of the question. If you had difficulty with this question, review
the purpose of this medication.Level of Cognitive Ability:
ComprehensionClient Needs: Physiological IntegrityIntegrated
Process: Nursing Process/EvaluationContent Area:
PharmacologyReference: McKenry, L., & Salerno, E. (2003). Mosby's
pharmacology in nursing (21st ed.). St. Louis: Mosby, p. 845.
• 11.A nurse reinforces instructions to the client
taking fludrocortisone (Florinef). The nurse
tells the client to notify the physician if which
of the following occurs?
– 1.Weight loss
– 2.Nausea
– 3.Swelling of the feet
– 4.Fatigue
• 11.Answer: 3Rationale: Excessive doses of fludrocortisone cause
retention of sodium and water and excessive excretion of
potassium, resulting in expansion of blood volume, hypertension,
cardiac enlargement, edema, and hypokalemia. The client needs to
be informed about the signs of sodium and water retention, such as
unusual weight gain or swelling of the feet or lower legs. If these
signs occur, the physician needs to be notified.Test-Taking Strategy:
Use the process of elimination. Recalling that fludrocortisone can
cause water retention will direct you to option 3. If you are
unfamiliar with the adverse effects associated with this medication,
review this content.Level of Cognitive Ability: ApplicationClient
Needs: Health Promotion and MaintenanceIntegrated Process:
Nursing Process/ImplementationContent Area:
PharmacologyReference: Hodgson, B., & Kizior, R. (2005). Saunders
nursing drug handbook 2005. Philadelphia: W.B. Saunders, p. 445.
• 12.Calcium carbonate (Os-Cal 500) is
prescribed for a client with hypocalcemia. The
nurse tells the client to take the medication:
– 1.With meals
– 2.One hour after meals
– 3.One hour before meals
– 4.One hour before breakfast
• 12.Answer: 2Rationale: The client should be instructed to
take oral calcium 30 to 60 minutes after meals to promote
absorption. The client should take the medication with a
full glass of water.Test-Taking Strategy: Use the process of
elimination. Elim-inate options 3 and 4 first because they
are similar. From the remaining options, it is necessary to
know that this medication is taken after meals. Review this
medication if you had difficulty with this question.Level of
Cognitive Ability: ApplicationClient Needs: Physiological
IntegrityIntegrated Process: Teaching/LearningContent
Area: PharmacologyReference: Mosby's 2005 drug consult
for nurses. (2005). St. Louis: Mosby, p. 1279.
• 13.Calcitriol (Rocaltrol) is prescribed for the client
with hypocalcemia and the nurse provides dietary
instructions to the client. Which food item would
the nurse instruct the client to avoid while taking
this medication?
–
–
–
–
1.Oysters
2.Milk
3.Whole-grain cereals
4.Sardines
• 13.Answer: 3Rationale: The client taking an antihypocalcemic
medication should be instructed to avoid eating foods that can
suppress calcium absorption. These foods include Swiss chard,
beets, bran, and whole-grain cereals.Test-Taking Strategy: Use the
process of elimination. Note that the client's diagnosis is
“hypocalcemia” and note the key word, avoid. Eliminate options 1
and 4 first because they are similar. From the remaining options,
recalling the food items that can suppress calcium absorption will
direct you to option 3. Review these foods if you had difficulty with
this question.Level of Cognitive Ability: ApplicationClient Needs:
Health Promotion and MaintenanceIntegrated Process: Nursing
Process/ImplementationContent Area: PharmacologyReference:
Hodgson, B., & Kizior, R. (2004). Saunders nursing drug handbook
2004. Philadelphia: W.B. Saunders, p. 1117.
• 14.A daily dose of prednisone (Deltasone) is prescribed for a client. A nurse provides instructions
to the client regarding administration of the
medication and tells the client that the best time
to take this medication is:
–
–
–
–
1.At bedtime
2.At noon
3.Early morning
4.Any time, at the same time, each day
• 14.Answer: 3Rationale: Glucocorticoids should be administered
before 9 am, and the client should be instructed to do so.
Administration at this time helps minimize adrenal insufficiency and
mimics the burst of glucocorticoids released naturally by the
adrenals each morning.Test-Taking Strategy: Knowledge regarding
the administration of glucocorticoids is required to answer this
question. Remember, glucocorticoids should be administered
before 9 am. If you had difficulty with this question, review the
guidelines associated with administering glucocorticoids.Level of
Cognitive Ability: ApplicationClient Needs: Physiological
IntegrityIntegrated Process: Nursing
Process/ImplementationContent Area: PharmacologyReference:
Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook
2005. Philadelphia: W.B. Saunders, p. 883.
• 15.Sildenafil citrate (Viagra) is prescribed to
treat a client with erectile dysfunction. A
nurse reviews the client's medical record and
would question the prescription if which of
the following is noted in the client's history?
– 1.Neuralgia
– 2.Use of nitroglycerin
– 3.Use of multivitamins
– 4.Insomnia
• 15.Answer: 2Rationale: Sildenafil citrate (Viagra) enhances the
vasodilation effect of nitric oxide in the corpus cavernosus of the
penis, thus sustaining an erection. Because of the effect of the
medication, it is contraindicated with concurrent use of organic
nitrates and nitroglycerin. It is not contraindicated with the use of
vitamins. Neuralgia and insomnia are side effects of the
medication.Test-Taking Strategy: Use the process of elimination
and note the key words, would question the prescription. Recalling
the action of the medication will direct you to option 2. If you had
difficulty with this question, review the contraindications associated
with the use of this medication.Level of Cognitive Ability:
AnalysisClient Needs: Physiological IntegrityIntegrated Process:
Nursing Process/ImplementationContent Area:
PharmacologyReference: Mosby's 2005 drug consult for nurses.
(2005). St. Louis: Mosby, p. 1358.
• 16.A nurse is teaching the client how to mix
Regular insulin and NPH insulin in the same
syringe. Which of the following actions, if
performed by the client, would indicate the need
for further teaching?
– 1.Injects air into NPH insulin vial first
– 2.Injects the amount of air equal to the desired dose
of insulin into the vial
– 3.Withdraws the NPH insulin first
– 4.Withdraws the Regular insulin first
• 16.Answer: 3Rationale: When preparing a mixture of Regular insulin with
another insulin preparation, the Regular insulin should be drawn into the
syringe first. This sequence will avoid contaminating the vial of Regular
insulin with insulin of another type. Options 1, 2, and 4 are correct.TestTaking Strategy: Use the process of elimination and note the key words,
need for further teaching. These words indicate a false response question
and that you need to select the incorrect client statement. Recalling the
appropriate method of preparing insulin for injection will direct you to
option 3. Review this procedure if you had difficulty with this
question.Level of Cognitive Ability: AnalysisClient Needs: Health
Promotion and MaintenanceIntegrated Process:
Teaching/LearningContent Area: PharmacologyReferences: Black, J., &
Hawks, J. (2005). Medical-surgical nursing: Clinical management for
positive outcomes (7th ed.). Philadelphia: W.B. Saunders, p.
1264.Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook
2005. Philadelphia: W.B. Saunders, pp. 570-571.McKenry, L., & Salerno, E.
(2003). Mosby's pharmacology in nursing (21st ed.). St. Louis: Mosby, p.
870.
• 17.A nurse is reinforcing home care instructions
to a client recently diagnosed with diabetes
mellitus. The client is taking NPH insulin daily and
asks the nurse how to store the unopened vials of
insulin. The nurse tells the client to:
–
–
–
–
1.Freeze the insulin
2.Refrigerate the insulin
3.Keep the insulin at room temperature
4.Keep in a dark, dry place
• 17.Answer: 2Rationale: Unopened vials of insulin should be stored
under refrigeration until needed. Vials should not be frozen. Open
vials in use may be kept at room temperature and should be kept
away from heat and direct light.Test-Taking Strategy: Use the
process of elimination and note the key word, store, in the
question. Remembering that insulin should not be frozen will assist
in eliminating option 1. Eliminate options 3 and 4 first because they
are similar. Review client teaching points related to insulin if you
had difficulty with this question.Level of Cognitive Ability:
ApplicationClient Needs: Health Promotion and
MaintenanceIntegrated Process: Teaching/LearningContent Area:
PharmacologyReferences: Hodgson, B., & Kizior, R. (2005). Saunders
nursing drug handbook 2005. Philadelphia: W.B. Saunders, p.
570.McKenry, L., & Salerno, E. (2003). Mosby's pharmacology in
nursing (21st ed.). St. Louis: Mosby, p. 868.
• 18.A client with diabetes mellitus is selfadministering NPH insulin from a vial that is kept
at room temperature. The client asks the nurse
about the length of time an unrefrigerated vial of
insulin will maintain its potency. The appropriate
response is which of the following?
–
–
–
–
1.Two weeks
2.One month
3.Two months
4.Six months
• 18.Answer: 2Rationale: An unrefrigerated insulin vial
will maintain its potency for up to 1 month. Direct
sunlight and heat must be avoided.Test-Taking
Strategy: Note the key word, unrefrigerated, to assist
in directing you to the correct option. Review the
concepts related to insulin stability if you had difficulty
with this question.Level of Cognitive Ability:
ApplicationClient Needs: Health Promotion and
MaintenanceIntegrated Process: Nursing
Process/ImplementationContent Area:
PharmacologyReferences: McKenry, L., & Salerno, E.
(2003). Mosby's pharmacology in nursing (21st ed.). St.
Louis: Mosby, p. 868.
• 19.Lispro insulin (Humalog), a rapid-acting
form of insulin, is prescribed for a client. The
nurse instructs the client to administer the
insulin:
– 1.Immediately before eating
– 2.30 minutes before eating
– 3.45 minutes before eating
– 4.60 minutes before eating
• 19.Answer: 1Rationale: The effect of lispro insulin begins within 5
minutes of subcutaneous injection and persists for 2 to 4 hours.
Lispro insulin acts more rapidly than Regular insulin but has a
shorter duration of action. Because of its rapid onset, it can be
administered immediately before eating. In contrast, Regular insulin
is generally administered 30 to 60 minutes before meals.TestTaking Strategy: Use the process of elimination. Noting the key
words rapid-acting will assist in eliminating options 3 and 4. From
the remaining options, remember that the question is asking about
lispro, not Regular, insulin. Review this type of insulin if you had
difficulty with this question.Level of Cognitive Ability:
ApplicationClient Needs: Health Promotion and
MaintenanceIntegrated Process: Teaching/LearningContent Area:
PharmacologyReference: Black, J., & Hawks, J. (2005). Medicalsurgical nursing: Clinical management for positive outcomes (7th
ed.). Philadelphia: W.B. Saunders, pp. 1254-1255.
• 20.Tolbutamide (Orinase) is prescribed for the
client with diabetes mellitus. The nurse
instructs the client to avoid which of the
following while taking this medication?
– 1.Carbonated beverages
– 2.Organ meats
– 3.Alcohol
– 4.Whole-grain cereals
• 20.Answer: 3Rationale: When alcohol is combined with
tolbutamide, a disulfiram-like reaction may occur. This syndrome
includes flushing, palpitations, and nausea. Also, alcohol can
potentiate the hypoglycemic effects of tolbutamide. Clients mustbe
warned about alcohol consumption while taking this
medication.Test-Taking Strategy: Use the process of elimination.
Elim-inate options 1, 2, and 4 because these food items are allowed
in a diabetic diet. From the remaining options, remembering that
alcohol can affect the action of many medications will assist in
directing you to option 3. Review this medication if you had
difficulty with this question.Level of Cognitive Ability:
ApplicationClient Needs: Physiological IntegrityIntegrated Process:
Teaching/LearningContent Area: PharmacologyReference: McKenry,
L., & Salerno, E. (2003). Mosby's pharmacology in nursing (21st ed.).
St. Louis: Mosby, p. 1018.