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A 43-year-old female client is receiving thyroid replacement hormone following a
thyroidectomy. What adverse effects associated with thyroid hormone toxicity
should the nurse instruct the client to report promptly to the healthcare provider?
a. Tinnitus and dizziness.
b. Tachycardia and chest pain.
c. Dry skin and intolerance to cold.
d. Weight gain and increased appetite.
- answer-b. Tachycardia and chest pain.
Thyroid replacement hormone increases the metabolic rate of all tissues, so
common signs and symptoms of toxicity include tachycardia and chest pain (B).
(A, C, and D) do not indicate a thyroid hormone toxicity.
A category X drug is prescribed for a young adult female client. Which instruction
is most important for the nurse to teach this client?
a. Use a reliable form of birth control.
b. Avoid exposure to ultra violet light.
c. Refuse this medication if planning pregnancy.
d. Abstain from intercourse while on this drug.
- answer-a. Use a reliable form of birth control.
Drugs classified in the category X place a client who is in the first trimester of
pregnancy at risk for teratogenesis, so women in the childbearing years should be
counseled to use a reliable form of birth control (A) during drug therapy. (B) is not
a specific precaution with Category X drugs. The client should be encouraged to
discuss plans for pregnancy with the healthcare provider, so a safer alternative
prescription (C) can be provided if pregnancy occurs. Although the risk of birth
defects during pregnancy explains the restriction of these drugs during pregnancy,
(D) is not indicated.
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,A client asks the nurse if glipizide (Glucotrol) is an oral insulin. Which response
should the nurse provide?
a. "Yes, it is an oral insulin and has the same actions and properties as intermediate
insulin."
b. "Yes, it is an oral insulin and is distributed, metabolized, and excreted in the
same manner as insulin."
c. "No, it is not an oral insulin and can be used only when some beta cell function
is present."
d. "No, it is not an oral insulin, but it is effective for those who are resistant to
injectable insulins."
- answer-c. "No, it is not an oral insulin and can be used only when some beta cell
function is present."
An effective oral form of insulin has not yet been developed (C) because when
insulin is taken orally, it is destroyed by digestive enzymes. Glipizide (Glucotrol)
is an oral hypoglycemic agent that enhances pancreatic production of insulin. (A,
B, and D) do not provide accurate information.
A client has a continuous IV infusion of dopamine (Intropin) and an IV of normal
saline at 50 ml/hour. The nurse notes that the client's urinary output has been 20
ml/hour for the last two hours. Which intervention should the nurse initiate?
a. Stop the infusion of dopamine.
b. Change the normal saline to a keep open rate.
c. Replace the urinary catheter.
d. Notify the healthcare provider of the urinary output.
- answer-d. Notify the healthcare provider of the urinary output.
The main effect of dopamine is adrenergic stimulation used to increase cardiac
output, which should also result in increased urinary output. A urinary output of
less than 20 ml/hour is oliguria and should be reported to the healthcare provider
(D) so that the dose of dopamine can be adjusted. Depending on the current rate of
administration, the dose may need to be increased or decreased. If the dose is
decreased, it should be titrated down, rather than abruptly discontinued (A). Fluid
intake may need to be increased, rather than (B). The urinary catheter is draining
and does not need to be replaced (C).
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, A client has myxedema, which results from a deficiency of thyroid hormone
synthesis in adults. The nurse knows that which medication would be
contraindicated for this client?
a. Liothyronine (Cytomel) to replace iodine.
b. Furosemide (Lasix) for relief of fluid retention.
c. Pentobarbital sodium (Nembutal Sodium) for sleep.
d. Nitroglycerin (Nitrostat) for angina pain.
- answer-c. Pentobarbital sodium (Nembutal Sodium) for sleep.
Persons with myxedema are dangerously hypersensitive to narcotics, barbiturates
(C), and anesthetics. They do tolerate liothyronine (Cytomel) (A) and usually
receive iodine replacement therapy. These clients are also susceptible to heart
problems such as angina for which nitroglycerin (Nitrostat) (D) would be
indicated, and congestive heart failure for which furosemide (Lasix) (B) would be
indicated.
A client is admitted to the coronary care unit with a medical diagnosis of acute
myocardial infarction. Which medication prescription decreases both preload and
afterload?
a. Nitroglycerin.
b. Propranolol (Inderal).
c. Morphine.
d. Captopril (Capoten).
- answer-a. Nitroglycerin.
Nitroglycerin (A) is a nitrate that causes peripheral vasodilation and decreases
contractility, thereby decreasing both preload and afterload. (B) is a beta
adrenergic blocker that decreases both heart rate and contractility, but only
decreases afterload. Morphine (C) decreases myocardial oxygen consumption and
preload. Capoten (D) is an angiotensin converting enzyme (ACE) inhibitor that
acts to prevents vasoconstriction, thereby decreasing blood pressure and afterload.
A client is admitted to the hospital for diagnostic testing for possible myasthenia
gravis. The nurse prepares for intravenous administration of edrophonium chloride
(Tensilon). What is the expected outcome for this client following administration
of this pharmacologic agent?
a. Progressive difficulty with swallowing.
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