Nurs 615 Exam IV Questions with Complete Solutions | Verified & Updated

Nurs 615 Exam IV Questions with Complete Solutions | Verified & Updated How will you prescribe lipase, protease, and amylase components? - Answer ️️ - Patients with cystic fibrosis are often prescribed enzyme replacement for pancreatic secretions each replacement drug has amylase, lipase and protease components, however the drug is prescribed in units of lipase What is the medication of choice for hypertensive crisis with pheochromocytoma? - Answer ️️ -Surgical resection of the tumor is the first treatment of choice either my open laparotomy or laparoscopy either surgical option requires prior treatment of nonspecific irreversible adrenergic adraonoreceptor blocker phenoxybenzamine or a shorter acting alpha antagonists, prazosin, terazosin, and doxazosin. Mainly use phenozibenamine in practice. Doing so promotes the surgery to proceed while minimizing the likelihood of severe intraoperative hypertension which is likely when the tumor is manipulated. What is the onset of action, peak of action, and duration of action of each insulin preparation? - Answer ️️ -(Intermediate Acting) NPH Onset-60-90 min after administration, Peak 48 hrs Duration 10-18 hrs. (Short Acting) Regular Onset 30-60 min Peak 2-4 hrs Duration 6-10 hrs (Long Acting) Aspart, Lispro, Glulisine Onset less than 15 min Peak 1-2 hrs Duration 3-6 hrs (Long Acting) Glargine, Detemir Onset 1-2 hrs Peak NO PEAK Duration 24 hrs Identify the symptoms of hypoglycemia, hyperglycemia, and ketoacidosis. - Answer ️️ -Hypoglycemia- dizziness, confusion, diaphoresis, tachycardia Hyperglycemia- polyphagia, polydipsia, polyuria, blurred vision, and fatigue Ketoacidosis- hallmark symptoms include acetone breath like nail polish remover or fruity breath. Also abdominal pain, nausea, vomiting and sob. When changing from NPH to glargine insulin, how will you adjust the patient's dose? - Answer ️️ -The initial dose of glargine is reduced by 20% to prevent hypoglycemia. How does metformin work? - Answer ️️ -Decreases hyperglycemia by decreasing hepatic glucose production called hepatic gluconeogenesis. The average person with type 2 diabetes has three times the rate of gluconeogenesis, metformin treatment reduces this by over 1/3rd. The molecular mechanism of metformin isn't completely understood. In addition to suppressing hepatic glucose production, metformin increases insulin sensitivity, enhances peripheral glucose uptake by inducing the phosphorilization of glu4 enhancer factor, decreases insulin induced suppression of fatty acid oxidation, and decreases absorption of glucose from the GI tract. Also of note** Metformin helps reduce LDL cholesterol and triglyceride levels and is not associated with weight gain, in some people it helps promote weight loss** What diagnostic testing is required before and throughout therapy with metformin? - Answer ️️ -Metformin is not metabolized, it is cleared from the body by tubular secretion and is secreted unchanged in the urine. Metformin is undetectable in blood plasma within 24 hrs of a single oral dose the average elimination half-life in plasma is 6.2 hrs as it is secreted in the urine you should check a serum crt to assess renal function. What is the action of gliptin? - Answer ️️ -The mechanism of DDP-4 inhibitors is to increase incretin levels incretin are GLP1 and GIP which inhibit glucagon release in which in turn increases insulin secretion, decreases gastric emptying, and decreases blood glucose levels How do GLP agonists work? - Answer ️️ -They bind directly to a receptor in the pancreatic beta cell. These agents work in the same pathway as the DPP-4 inhibitors as mentioned above but are generally considered more potent. When should exenatide be administered? - Answer ️️ -60 minutes prior to the morning and evening meal How will you assess for granulocytopenia? - Answer ️️ -Signs of a Cold or flu including fever and sore throat What are the adverse effects of propylthiouracil? - Answer ️️ -Agranulocytosis, thrombocytopenia, and fulminant liver failure as stated above, pt's on PTU when they develop fever or sore throat, it would be important to check a CBC preferably with a smear and a diff. What are the adverse effects of levothyroxine? - Answer ️️ -Tachycardia and angina in the elderly A patient develops a toxic goiter. What is the recommended treatment? - Answer ️️ -Methimazole for one month then radioactive iodine (p. 641) What are the adverse effects of PTU and methimazole? - Answer ️️ -PTU- Fatal agranulocytopenia look for fever and sore throat and TEMPORARY ALOPECIA What is the action of biphosphonates? - Answer ️️ -Bone undergoes constant turnover and is kept in balance by osteoblasts creating bone and osteoclasts destroying bone. Bisphosphonates inhibit the digestion of bone by encouraging osteoclasts to undergo apoptosis or cell death there by slowing bone loss. Oral bisphosphonates can cause upset stomach and inflammation as well as erosion. Erosions of the esophagus which is the main problem of oral and containing preparations. This can be prevented by sitting upright for 30-60 minutes after taking the medication. If the patient does develop some type of gastric distress, give them oral 30ml of Maalox 3 hrs aft