Test Bank For Lehne's Pharmacotherapeutics for Nurse
Practitioners and Physician Assistants 1st Edition By
Jacqueline Burchum, Laura Rosenthal 9780323447836 Chapter
1-89 Complete Guide
The nurse working on a high-acuity medical-surgical unit is prioritizing care for four patients who were
just admitted. Which patient should the nurse assess first?
a. The NPO patient with a blood glucose level of 80 mg/dL who just received 20 units of
70/30 Novolin insulin.
b. The patient with a pulse of 58 beats/minute who is about to receive digoxin [Lanoxin].
c. The patient with a blood pressure of 136/92 mmHg who complains of having a headache.
d. The patient with an allergy to penicillin who is receiving an infusion of vancomycin
[Vancocin]. - ANSWER: ANS: A
The NPO patient with hypoglycemia who just received 70/30 Novolin insulin takes priority, because
this patient needs to consume a good source of glucose immediately, or perhaps the NPO status will
be discontinued for this shift. The digoxin may be withheld for the patient with a pulse of 58
beats/minute, but this is not a priority action. The patient with a headache needs to be followed up,
but because the blood pressure is 136/92 mmHg, the headache is probably not caused by
hypertension. The patient with an allergy to penicillin will not have a reaction to the vancomycin.
A patient with type 1 diabetes recently became pregnant. The nurse plans a blood glucose testing
schedule for her. What is the recommended monitoring schedule?
a. Before each meal and before bed.
b. In the morning for a fasting level and at 4:00 PM for the peak level.
c. Six or seven times a day.
d. Three times a day, along with urine glucose testing. - ANSWER: ANS: C
A pregnant patient with type 1 diabetes must have frequent blood sugar monitoring (e.g., six or seven
times a day) to manage both the patient and the fetus so that no teratogenic effects occur.
Monitoring the blood sugar level before meals and at bedtime is not significant enough to provide the
necessary glycemic control. Morning and 4:00 PM monitoring is not enough to provide glycemic
control. Urine glucose testing is not sensitive enough to aid glycemic control, and monitoring three
times a day is not enough.
Which statement is correct about the contrast between acarbose and miglitol?
a. Miglitol has not been associated with hepatic dysfunction.
b. With miglitol, sucrose can be used to treat hypoglycemia.
c. Miglitol is less effective in African Americans.
d. Miglitol has no gastrointestinal side effects. - ANSWER: ANS: A
Unlike acarbose, miglitol has not been associated with hepatic dysfunction. Sucrose should not be
used to treat hypoglycemia with miglitol. Miglitol is more effective in African-American patients.
Miglitol has gastrointestinal side effects.
A nurse is educating the staff nurses about ketoacidosis. To evaluate the group's understanding, the
nurse asks, "Which sign or symptom would not be consistent with ketoacidosis?" The group gives
which correct answer?
a. Blood glucose level of 600 mg/dL
b. Blood glucose level of 60 mg/dL
c. Acidosis
d. Ketones in the urine - ANSWER: ANS: B
A patient with diabetic ketoacidosis (DKA) has a high glucose level(at least 500 mg/dL or higher);
therefore, a glucose level of 60 mg/dL would not be consistent with DKA. A blood glucose level of 600
mg/dL, acidosis, and ketones in the urine are consistent with DKA.
,The nurse assesses a newly diagnosed patient for short-term complications of diabetes. What does
this assessment include?
a. Evaluation for hyperglycemia, hypoglycemia, and ketoacidosis.
b. Cranial nerve testing for peripheral neuropathy.
c. Pedal pulse palpation for arterial insufficiency.
d. Auscultation of the carotids for bruits associated with atherosclerosis. - ANSWER: ANS: A
High blood sugar, low blood sugar, and ketoacidosis are short-term complications of diabetes.
Microvascular and macrovascular complications, such as peripheral neuropathy, are long-term
complications of diabetes. Arterial insufficiency and atherosclerosis also are long-term complications
of diabetes.
A patient with type 1 diabetes is eating breakfast at 7:30 AM. Blood sugars are on a sliding scale and
are ordered before a meal and at bedtime. The patient's blood sugar level is 317 mg/dL. Which
formulation of insulin should the nurse prepare to administer?
a. No insulin should be administered
b. NPH
c. 70/30 mix
d. Lispro [Humalog] - ANSWER: ANS: D
Regular insulin is indicated for sliding scale coverage. Insulin is definitely indicated for this high blood
sugar level. NPH is used for scheduled insulin doses and is a longer-acting insulin. A 70/30 mix is also
used for scheduled insulin coverage.
A patient with type 1 diabetes who takes insulin reports taking propranolol for hypertension. Why is
the nurse concerned?
a. The beta blocker can cause insulin resistance.
b. Using the two agents together increases the risk of ketoacidosis.
c. Propranolol increases insulin requirements because of receptor blocking.
d. The beta blocker can mask the symptoms of hypoglycemia. - ANSWER: ANS: D
Beta blockers can delay awareness of and response to hypoglycemia by masking signs associated with
stimulation of the sympathetic nervous system (e.g., tachycardia, palpitations) that hypoglycemia
normally causes. Furthermore, beta blockade impairs glycogenolysis, which is one means by which
the body can counteract a fall in blood glucose; beta blockers, therefore, can worsen insulin-induced
hypoglycemia. Propranolol does not cause insulin resistance. The incidence of DKA is not increased by
concurrent use of propranolol and insulin. Insulin requirements are not increased because of receptor
blocking by propranolol.
A nurse provides dietary counseling for a patient newly diagnosed with type 1 diabetes. Which
instruction should be included?
a. "You may eat any foods you want and cover the glucose increase with sliding scale, regular insulin."
b. "Most of the calories you eat should be in the form of protein to promote fat breakdown and
preserve muscle mass."
c. "Your total caloric intake should not exceed 1800 calories in a 24-hour period."
d. "You should use a carbohydrate counting approach to maintain glycemic control." - ANSWER: ANS:
D
Patients with diabetes should be given intensive insulin therapy education using either a carbohydrate
counting or experience-based estimation approach in achieving glycemic control. A patient with
diabetes cannot eat any foods desired and then cover the glucose increase with a sliding scale of
regular insulin. Evidence suggests that there is not an ideal percentage of calories that should be
ingested from carbohydrate, fat, or protein. Every patient with diabetes must be assessed individually
to determine the number of total calories the person should have daily. The total caloric intake should
be spread evenly throughout the day, with meals spaced 4 to 5 hours apart.
A patient with type 1 diabetes reports mixing NPH and regular insulin to allow for one injection. What
should the nurse tell the patient?
a. This is an acceptable practice.
b. These two forms of insulin are not compatible and cannot be mixed.
c. Mixing these two forms of insulin may increase the overall potency of the products.
,d. NPH insulin should only be mixed with insulin glargine. - ANSWER: ANS: A
NPH insulin is the only insulin suitable for mixing with short-acting insulins, such as insulin as part
[NovoLog]. These insulins are compatible and are mixed frequently for management of diabetics. The
overall potency of each insulin is not increased by mixing them. Insulin glargine cannot be mixed with
any other insulin for administration.
Which statement is accurate about the long-term complications of diabetes?
a. Long-term complications are almost always the result of hypoglycemia and ketoacidosis.
b. The complication rates for patients with optimally controlled type 2 diabetes are the same as for
those whose disease is not optimally controlled.
c. Optimal control of type 1 diabetes produces excessive episodes of life-threatening hypoglycemia.
d. Optimal control of both types of diabetes reduces the risk of eye, kidney, and nerve damage. -
ANSWER: ANS: D
In both types of diabetes, optimal control of the disease slows the development of microvascular
complications. Short-term complications are more apt to result from hypoglycemia and ketoacidosis.
Patients with type 2 diabetes have fewer complications if their blood sugar level is optimally
controlled. Hypoglycemia does not occur more frequently in patients with optimally controlled type 1
diabetes.
An elderly patient who has type 2 diabetes has a history of severe hypoglycemia. The patient's spouse
asks the nurse what the optimal A1c level is for the patient. Which is correct?
a. Between 6.5 and 7.0
b. Below 7.0
c. Below 8.0
d. Between 7.0 and 8.5 - ANSWER: ANS: C
For patients with a history of severe hypoglycemia and those with a limited life expectancy or
advanced micro- and macrovascular complications, the target A1c level should be below 8.0. For most
other patients with diabetes, the target is 7.0 and below.
An adolescent patient recently attended a health fair and had a serum glucose test. The patient
telephones the nurse and says, "My level was 125 mg/dL. Does that mean I have diabetes?" What is
the nurse's most accurate response?
a. "Unless you were fasting for longer than 8 hours, this does not necessarily mean you have
diabetes."
b. "At this level, you probably have diabetes. You will need an oral glucose tolerance test this week."
c. "This level is conclusive evidence that you have diabetes."
d. "This level is conclusive evidence that you do not have diabetes." - ANSWER: ANS: A
If a person has not fasted for 8 hours, a blood sugar level of 125 mg/dL would be considered normal,
because it is less than 200 mg/dL for a random sampling. Also, a person must have positive outcomes
on two separate days to be diagnosed with diabetes. This patient does not need to have an oral
glucose tolerance test, because the 125 mg/dL reading is so far below 200 mg/dL, which would
require further work-up. No conclusive evidence indicates that this patient has diabetes, because the
random sample value is so low, and the patient has not had two separate tests on different days.
However, this also is not conclusive evidence that the patient does not have diabetes.
A patient who has type 2 diabetes will begin taking glipizide [Glucotrol]. Which statement by the
patient is concerning to the nurse?
a. "I will begin by taking this once daily with breakfast."
b. "It is safe to drink grapefruit juice while taking this drug."
c. "I may continue to have a glass of wine with dinner."
d. "I will need to check my blood sugar once daily or more." - ANSWER: ANS: C
Glipizide is a sulfonylurea antidiabetic agent and can cause a disulfiram-like reaction when combined
with alcohol. Patients should be taught to avoid alcohol while taking this medication. The initial dosing
is once daily with breakfast. There is no drug interaction with grapefruit juice. Patients will need to
monitor their blood glucose.
What is the most reliable measure for assessing diabetes control over the preceding 3- month period?
, a. Self-monitoring blood glucose (SMBG) graph report
b. Patient's report
c. Fasting blood glucose level
d. Glycosylated hemoglobin level - ANSWER: ANS: D
The glycosylated hemoglobin level tells much about what the plasma glucose concentration has been,
on average, over the previous 2 to 3 months. The SMBG graph report is done by the patient and
indicates each blood sugar level the patient has on a daily basis. It is not as reliable as the glycosylated
hemoglobin level, because the equipment used might not be accurate and the testing may not reflect
actual measurements 100% of the time. The patient's report of blood sugar levels is not considered as
accurate as the glycosylated hemoglobin level for the same reason that the SMBG is not. One fasting
blood glucose level indicatesthe patient's blood sugar level for that one time when it was obtained.
Insulin glargine is prescribed for a hospitalized patient who has diabetes. When will the nurse expect
to administer this drug?
a. Approximately 15 to 30 minutes before each meal
b. In the morning and at 4:00 PM
c. Once daily at bedtime
d. After meals and at bedtime - ANSWER: ANS: C
Glargine insulin is indicated for once-daily subcutaneous administration to treat adults and children
with type 1 diabetes and adults with type 2 diabetes. According to the package labeling, the once-
daily injection should be given at bedtime. Glargine insulin should not be given more than once a day,
although some patients require bid dosing to achieve a full 24 hours of basal coverage.
A patient with hypothyroidism begins taking PO levothyroxine [Synthroid]. The nurse assesses the
patient at the beginning of the shift and notes a heart rate of 62 beats/minute and a temperature of
97.2°F. The patient is lethargic and difficult to arouse. The nurse will contact the provider to request
an order for which drug?
a. Beta blocker
b. Increased dose of PO levothyroxine
c. Intravenous levothyroxine
d. Methimazole [Tapazole] - ANSWER: ANS: C
Intravenous administration of levothyroxine is used for myxedema coma. This patient is showing signs
of severe hypothyroidism, or myxedema. A beta blocker is useful in patients who show signs of
hyperthyroidism to minimize cardiac effects. Because the half-life of oral levothyroxine is so long,
increasing the PO dose will not provide immediate relief of this patient's symptoms. Methimazole is
used to treat hyperthyroidism.
A patient has been taking levothyroxine for several years and reports that "for the past 2 weeks, the
drug does not seem to work as well as before." What will the nurse do?
a. Ask the patient when the prescription was last refilled.
b. Expect the patient to have an elevated temperature and tachycardia.
c. Suggest that the patient begin taking calcium supplements.
d. Tell the patient to try taking the medication with food. - ANSWER: ANS: A
Not all levothyroxine preparations have the same drug bioavailability; therefore, if a patient is
experiencing differing effects, the pharmacist may have switched brands. Asking a patient about a
recent refill may help to explain why the drug has different effects. An elevated temperature and
tachycardia would be signs of toxicity, not of a decrease in effectiveness. Calcium supplements and
food would only interfere with absorption and further reduce the drug's effectiveness.
A nurse is teaching a patient who will begin taking methimazole [Tapazole] for Graves disease about
the medication. Which statement by the patient indicates understanding of the teaching?
a. "Because of the risk for liver toxicity, I will need frequent liver function tests."
b. "I should report a sore throat or fever to my provider if either occurs."
c. "I will need a complete blood count every few months."
d. "It is safe to get pregnant while taking this medication." - ANSWER: ANS: B
Agranulocytosis is rare but can occur with methimazole, so patients should report signs of infection,
such as a sore throat or fever. Liver toxicity is not a side effect, so liver function tests are not
Practitioners and Physician Assistants 1st Edition By
Jacqueline Burchum, Laura Rosenthal 9780323447836 Chapter
1-89 Complete Guide
The nurse working on a high-acuity medical-surgical unit is prioritizing care for four patients who were
just admitted. Which patient should the nurse assess first?
a. The NPO patient with a blood glucose level of 80 mg/dL who just received 20 units of
70/30 Novolin insulin.
b. The patient with a pulse of 58 beats/minute who is about to receive digoxin [Lanoxin].
c. The patient with a blood pressure of 136/92 mmHg who complains of having a headache.
d. The patient with an allergy to penicillin who is receiving an infusion of vancomycin
[Vancocin]. - ANSWER: ANS: A
The NPO patient with hypoglycemia who just received 70/30 Novolin insulin takes priority, because
this patient needs to consume a good source of glucose immediately, or perhaps the NPO status will
be discontinued for this shift. The digoxin may be withheld for the patient with a pulse of 58
beats/minute, but this is not a priority action. The patient with a headache needs to be followed up,
but because the blood pressure is 136/92 mmHg, the headache is probably not caused by
hypertension. The patient with an allergy to penicillin will not have a reaction to the vancomycin.
A patient with type 1 diabetes recently became pregnant. The nurse plans a blood glucose testing
schedule for her. What is the recommended monitoring schedule?
a. Before each meal and before bed.
b. In the morning for a fasting level and at 4:00 PM for the peak level.
c. Six or seven times a day.
d. Three times a day, along with urine glucose testing. - ANSWER: ANS: C
A pregnant patient with type 1 diabetes must have frequent blood sugar monitoring (e.g., six or seven
times a day) to manage both the patient and the fetus so that no teratogenic effects occur.
Monitoring the blood sugar level before meals and at bedtime is not significant enough to provide the
necessary glycemic control. Morning and 4:00 PM monitoring is not enough to provide glycemic
control. Urine glucose testing is not sensitive enough to aid glycemic control, and monitoring three
times a day is not enough.
Which statement is correct about the contrast between acarbose and miglitol?
a. Miglitol has not been associated with hepatic dysfunction.
b. With miglitol, sucrose can be used to treat hypoglycemia.
c. Miglitol is less effective in African Americans.
d. Miglitol has no gastrointestinal side effects. - ANSWER: ANS: A
Unlike acarbose, miglitol has not been associated with hepatic dysfunction. Sucrose should not be
used to treat hypoglycemia with miglitol. Miglitol is more effective in African-American patients.
Miglitol has gastrointestinal side effects.
A nurse is educating the staff nurses about ketoacidosis. To evaluate the group's understanding, the
nurse asks, "Which sign or symptom would not be consistent with ketoacidosis?" The group gives
which correct answer?
a. Blood glucose level of 600 mg/dL
b. Blood glucose level of 60 mg/dL
c. Acidosis
d. Ketones in the urine - ANSWER: ANS: B
A patient with diabetic ketoacidosis (DKA) has a high glucose level(at least 500 mg/dL or higher);
therefore, a glucose level of 60 mg/dL would not be consistent with DKA. A blood glucose level of 600
mg/dL, acidosis, and ketones in the urine are consistent with DKA.
,The nurse assesses a newly diagnosed patient for short-term complications of diabetes. What does
this assessment include?
a. Evaluation for hyperglycemia, hypoglycemia, and ketoacidosis.
b. Cranial nerve testing for peripheral neuropathy.
c. Pedal pulse palpation for arterial insufficiency.
d. Auscultation of the carotids for bruits associated with atherosclerosis. - ANSWER: ANS: A
High blood sugar, low blood sugar, and ketoacidosis are short-term complications of diabetes.
Microvascular and macrovascular complications, such as peripheral neuropathy, are long-term
complications of diabetes. Arterial insufficiency and atherosclerosis also are long-term complications
of diabetes.
A patient with type 1 diabetes is eating breakfast at 7:30 AM. Blood sugars are on a sliding scale and
are ordered before a meal and at bedtime. The patient's blood sugar level is 317 mg/dL. Which
formulation of insulin should the nurse prepare to administer?
a. No insulin should be administered
b. NPH
c. 70/30 mix
d. Lispro [Humalog] - ANSWER: ANS: D
Regular insulin is indicated for sliding scale coverage. Insulin is definitely indicated for this high blood
sugar level. NPH is used for scheduled insulin doses and is a longer-acting insulin. A 70/30 mix is also
used for scheduled insulin coverage.
A patient with type 1 diabetes who takes insulin reports taking propranolol for hypertension. Why is
the nurse concerned?
a. The beta blocker can cause insulin resistance.
b. Using the two agents together increases the risk of ketoacidosis.
c. Propranolol increases insulin requirements because of receptor blocking.
d. The beta blocker can mask the symptoms of hypoglycemia. - ANSWER: ANS: D
Beta blockers can delay awareness of and response to hypoglycemia by masking signs associated with
stimulation of the sympathetic nervous system (e.g., tachycardia, palpitations) that hypoglycemia
normally causes. Furthermore, beta blockade impairs glycogenolysis, which is one means by which
the body can counteract a fall in blood glucose; beta blockers, therefore, can worsen insulin-induced
hypoglycemia. Propranolol does not cause insulin resistance. The incidence of DKA is not increased by
concurrent use of propranolol and insulin. Insulin requirements are not increased because of receptor
blocking by propranolol.
A nurse provides dietary counseling for a patient newly diagnosed with type 1 diabetes. Which
instruction should be included?
a. "You may eat any foods you want and cover the glucose increase with sliding scale, regular insulin."
b. "Most of the calories you eat should be in the form of protein to promote fat breakdown and
preserve muscle mass."
c. "Your total caloric intake should not exceed 1800 calories in a 24-hour period."
d. "You should use a carbohydrate counting approach to maintain glycemic control." - ANSWER: ANS:
D
Patients with diabetes should be given intensive insulin therapy education using either a carbohydrate
counting or experience-based estimation approach in achieving glycemic control. A patient with
diabetes cannot eat any foods desired and then cover the glucose increase with a sliding scale of
regular insulin. Evidence suggests that there is not an ideal percentage of calories that should be
ingested from carbohydrate, fat, or protein. Every patient with diabetes must be assessed individually
to determine the number of total calories the person should have daily. The total caloric intake should
be spread evenly throughout the day, with meals spaced 4 to 5 hours apart.
A patient with type 1 diabetes reports mixing NPH and regular insulin to allow for one injection. What
should the nurse tell the patient?
a. This is an acceptable practice.
b. These two forms of insulin are not compatible and cannot be mixed.
c. Mixing these two forms of insulin may increase the overall potency of the products.
,d. NPH insulin should only be mixed with insulin glargine. - ANSWER: ANS: A
NPH insulin is the only insulin suitable for mixing with short-acting insulins, such as insulin as part
[NovoLog]. These insulins are compatible and are mixed frequently for management of diabetics. The
overall potency of each insulin is not increased by mixing them. Insulin glargine cannot be mixed with
any other insulin for administration.
Which statement is accurate about the long-term complications of diabetes?
a. Long-term complications are almost always the result of hypoglycemia and ketoacidosis.
b. The complication rates for patients with optimally controlled type 2 diabetes are the same as for
those whose disease is not optimally controlled.
c. Optimal control of type 1 diabetes produces excessive episodes of life-threatening hypoglycemia.
d. Optimal control of both types of diabetes reduces the risk of eye, kidney, and nerve damage. -
ANSWER: ANS: D
In both types of diabetes, optimal control of the disease slows the development of microvascular
complications. Short-term complications are more apt to result from hypoglycemia and ketoacidosis.
Patients with type 2 diabetes have fewer complications if their blood sugar level is optimally
controlled. Hypoglycemia does not occur more frequently in patients with optimally controlled type 1
diabetes.
An elderly patient who has type 2 diabetes has a history of severe hypoglycemia. The patient's spouse
asks the nurse what the optimal A1c level is for the patient. Which is correct?
a. Between 6.5 and 7.0
b. Below 7.0
c. Below 8.0
d. Between 7.0 and 8.5 - ANSWER: ANS: C
For patients with a history of severe hypoglycemia and those with a limited life expectancy or
advanced micro- and macrovascular complications, the target A1c level should be below 8.0. For most
other patients with diabetes, the target is 7.0 and below.
An adolescent patient recently attended a health fair and had a serum glucose test. The patient
telephones the nurse and says, "My level was 125 mg/dL. Does that mean I have diabetes?" What is
the nurse's most accurate response?
a. "Unless you were fasting for longer than 8 hours, this does not necessarily mean you have
diabetes."
b. "At this level, you probably have diabetes. You will need an oral glucose tolerance test this week."
c. "This level is conclusive evidence that you have diabetes."
d. "This level is conclusive evidence that you do not have diabetes." - ANSWER: ANS: A
If a person has not fasted for 8 hours, a blood sugar level of 125 mg/dL would be considered normal,
because it is less than 200 mg/dL for a random sampling. Also, a person must have positive outcomes
on two separate days to be diagnosed with diabetes. This patient does not need to have an oral
glucose tolerance test, because the 125 mg/dL reading is so far below 200 mg/dL, which would
require further work-up. No conclusive evidence indicates that this patient has diabetes, because the
random sample value is so low, and the patient has not had two separate tests on different days.
However, this also is not conclusive evidence that the patient does not have diabetes.
A patient who has type 2 diabetes will begin taking glipizide [Glucotrol]. Which statement by the
patient is concerning to the nurse?
a. "I will begin by taking this once daily with breakfast."
b. "It is safe to drink grapefruit juice while taking this drug."
c. "I may continue to have a glass of wine with dinner."
d. "I will need to check my blood sugar once daily or more." - ANSWER: ANS: C
Glipizide is a sulfonylurea antidiabetic agent and can cause a disulfiram-like reaction when combined
with alcohol. Patients should be taught to avoid alcohol while taking this medication. The initial dosing
is once daily with breakfast. There is no drug interaction with grapefruit juice. Patients will need to
monitor their blood glucose.
What is the most reliable measure for assessing diabetes control over the preceding 3- month period?
, a. Self-monitoring blood glucose (SMBG) graph report
b. Patient's report
c. Fasting blood glucose level
d. Glycosylated hemoglobin level - ANSWER: ANS: D
The glycosylated hemoglobin level tells much about what the plasma glucose concentration has been,
on average, over the previous 2 to 3 months. The SMBG graph report is done by the patient and
indicates each blood sugar level the patient has on a daily basis. It is not as reliable as the glycosylated
hemoglobin level, because the equipment used might not be accurate and the testing may not reflect
actual measurements 100% of the time. The patient's report of blood sugar levels is not considered as
accurate as the glycosylated hemoglobin level for the same reason that the SMBG is not. One fasting
blood glucose level indicatesthe patient's blood sugar level for that one time when it was obtained.
Insulin glargine is prescribed for a hospitalized patient who has diabetes. When will the nurse expect
to administer this drug?
a. Approximately 15 to 30 minutes before each meal
b. In the morning and at 4:00 PM
c. Once daily at bedtime
d. After meals and at bedtime - ANSWER: ANS: C
Glargine insulin is indicated for once-daily subcutaneous administration to treat adults and children
with type 1 diabetes and adults with type 2 diabetes. According to the package labeling, the once-
daily injection should be given at bedtime. Glargine insulin should not be given more than once a day,
although some patients require bid dosing to achieve a full 24 hours of basal coverage.
A patient with hypothyroidism begins taking PO levothyroxine [Synthroid]. The nurse assesses the
patient at the beginning of the shift and notes a heart rate of 62 beats/minute and a temperature of
97.2°F. The patient is lethargic and difficult to arouse. The nurse will contact the provider to request
an order for which drug?
a. Beta blocker
b. Increased dose of PO levothyroxine
c. Intravenous levothyroxine
d. Methimazole [Tapazole] - ANSWER: ANS: C
Intravenous administration of levothyroxine is used for myxedema coma. This patient is showing signs
of severe hypothyroidism, or myxedema. A beta blocker is useful in patients who show signs of
hyperthyroidism to minimize cardiac effects. Because the half-life of oral levothyroxine is so long,
increasing the PO dose will not provide immediate relief of this patient's symptoms. Methimazole is
used to treat hyperthyroidism.
A patient has been taking levothyroxine for several years and reports that "for the past 2 weeks, the
drug does not seem to work as well as before." What will the nurse do?
a. Ask the patient when the prescription was last refilled.
b. Expect the patient to have an elevated temperature and tachycardia.
c. Suggest that the patient begin taking calcium supplements.
d. Tell the patient to try taking the medication with food. - ANSWER: ANS: A
Not all levothyroxine preparations have the same drug bioavailability; therefore, if a patient is
experiencing differing effects, the pharmacist may have switched brands. Asking a patient about a
recent refill may help to explain why the drug has different effects. An elevated temperature and
tachycardia would be signs of toxicity, not of a decrease in effectiveness. Calcium supplements and
food would only interfere with absorption and further reduce the drug's effectiveness.
A nurse is teaching a patient who will begin taking methimazole [Tapazole] for Graves disease about
the medication. Which statement by the patient indicates understanding of the teaching?
a. "Because of the risk for liver toxicity, I will need frequent liver function tests."
b. "I should report a sore throat or fever to my provider if either occurs."
c. "I will need a complete blood count every few months."
d. "It is safe to get pregnant while taking this medication." - ANSWER: ANS: B
Agranulocytosis is rare but can occur with methimazole, so patients should report signs of infection,
such as a sore throat or fever. Liver toxicity is not a side effect, so liver function tests are not
