Page 1473 - Saunders Comprehensive Review For NCLEX-RN

It is incorrect to instruct the client to take the medication after eating, as it will not
achieve its full therapeutic effect.
Test-Taking Strategy: Focus on the subject, client instructions regarding
pramlintide as it pertains to administration. Use knowledge regarding the action of
the medication and treatment measures for diabetes mellitus to answer the question.
Remember that this medication is used in conjunction with insulin to prevent
postprandial rise in blood glucose, and that hypoglycemia is a potential adverse
effect. Also remember that this medication causes delayed gastric emptying and
should not be taken with other medications.
Level of Cognitive Ability: Applying
Client Needs: Physiological Integrity
Integrated Process: Teaching and Learning
Content Area: Pharmacology: Endocrine Medications: Oral Hypoglycemics
Health Problem: Adult Health: Endocrine: Diabetes mellitus
Priority Concepts: Client Education; Safety
Reference: Ignatavicius, Workman, Rebar (2018), p. 1293.

525. Answer: 2, 5

Rationale: In diabetes insipidus, there is a deficiency in antidiuretic hormone
(ADH), resulting in large urinary losses. Desmopressin is an antidiuretic hormone
that enhances reabsorption of water in the kidney. Clients with diabetes insipidus
drink high volumes of fluid (polydipsia) as a compensatory mechanism to
counteract urinary losses and maintain fluid balance. Once desmopressin is started,
oral fluids should be decreased to prevent water intoxication. Therefore, clients with
diabetes insipidus should decrease their oral fluid intake when they start
desmopressin. Headache and drowsiness are signs of water intoxication in the client
taking desmopressin and should be reported to the primary health care provider.
Desmopressin does not turn urine orange. The amount of urine should decrease, not
increase, when desmopressin is started. Desmopressin does not cause pancreatitis.
Test-Taking Strategy: Focus on the subject, understanding of desmopressin.
Recall that in diabetes insipidus there is a deficiency of ADH and that desmopressin
is an antidiuretic hormone. Recalling the pathophysiology of this disorder will assist
you in answering correctly.
Level of Cognitive Ability: Evaluating
Client Needs: Physiological Integrity
Integrated Process: Nursing Process—Evaluation
Content Area: Pharmacology: Endocrine Medications: Antidiuretics
Health Problem: Adult Health: Endocrine: Pituitary disorders
Priority Concepts: Client Education; Fluids and Electrolytes
Reference: Skidmore-Roth (2017), pp. 343-344.

526. Answer: 3

Rationale: Corticosteroids (glucocorticoids) should be administered before 9 a.m.
Administration at this time helps minimize adrenal insufficiency and mimics the
burst of glucocorticoids released naturally by the adrenal glands each morning.

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