A patient with type 1 diabetes who takes insulin reports taking propranolol for hypertension. Why would you be concerned?
Propranolol increases insulin requirements because of receptor blocking
The beta blocker can cause insulin resistance
Using the two agents together increases the risk of ketoacidosis
The beta blocker can mask the symptoms of hypoglycemia
The Correct Answer is D
A. Propranolol does not significantly increase insulin requirements through receptor blocking. While beta-blockers affect adrenergic receptors, they do not directly cause a predictable increase in insulin dosage needs.
B. Beta-blockers are not primarily associated with causing insulin resistance. Their main concern in diabetic patients is related to hypoglycemia awareness rather than altering insulin sensitivity.
C. The combination of insulin and propranolol does not directly increase the risk of diabetic ketoacidosis. Ketoacidosis is typically related to insufficient insulin, infection, or stress, not beta-blocker use.
D. Propranolol is a nonselective beta-blocker that can mask the adrenergic warning signs of hypoglycemia, such as tachycardia, tremors, and anxiety. This makes it more difficult for the patient to recognize low blood glucose levels early. Although sweating may still occur, the absence of typical warning signs increases the risk of severe hypoglycemia.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. While adherence is important, questioning the patient about taking medication may feel accusatory and is not the most appropriate initial response. Many patients do take their medication correctly but still do not feel better immediately due to the drug’s pharmacokinetics.
B. Diet can affect absorption (e.g., calcium or iron supplements), but this is not typically the primary reason a patient would not feel better after only 1 week of therapy. Focusing on diet at this early stage is premature.
C. Levothyroxine requires time to reach steady-state levelsin the blood, and clinical improvement is gradual. Most patients experience full therapeutic effects in 3 to 4 weeks. Early weeks may not show significant symptom relief, which is normal and should be explained to the patient to prevent unnecessary concern.
D. Surgery is not requiredfor typical hypothyroidism. The standard treatment is lifelong thyroid hormone replacement, and surgery is only indicated in specific conditions, such as large goiters or thyroid cancer.
Correct Answer is D
Explanation
A. Levothyroxine dosing is based on thyroid hormone levelsand patient response. The interaction with warfarin does not require reducing levothyroxine; in fact, reducing it unnecessarily could lead to hypothyroidism.
B. Levothyroxine increases the metabolism of vitamin K-dependent clotting factors, which can enhance the anticoagulant effect of warfarin. Reducing warfarin preemptively is not recommended without monitoring, as dose adjustments should be guided by INR results.
C. There is no interaction that necessitates increasing levothyroxine when warfarin is used. Thyroid dosing is independent of warfarin therapy.
D. Starting levothyroxine in a patient taking warfarin can enhance warfarin’s anticoagulant effect, increasing the risk of bleeding. In practice, the provider may need to adjust warfarin dosingbased on INR monitoring, especially during the initial weeks after starting or changing levothyroxine. The nurse should notify the provider so INR can be closely monitoredand warfarin dosage adjusted accordingly.
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