GCC Pharmacology
Total Questions : 52
Showing 25 questions, Sign in for moreThe nurse is instructing a patient who will take psyllium (Metamucil) to treat constipation.
What information will the nurse include when teaching this patient?
Explanation
The correct answer is c. The importance of consuming adequate amounts of water.
Rationale for Choice A:
- Statement:The need to monitor for systemic side effects.
- Rationale:It's not accurate to prioritize monitoring for systemic side effects when teaching a patient about psyllium (Metamucil).Psyllium is a bulk-forming laxative that primarily acts within the gastrointestinal tract,and systemic side effects are rare.While it's essential to be aware of potential side effects,focusing on them during initial teaching might cause unnecessary anxiety.
Rationale for Choice B:
- Statement:The need to use the dry form of Metamucil to prevent cramping.
- Rationale:This statement is incorrect.It's generally recommended to mix psyllium with water or another liquid before ingestion.Consuming the dry form can increase the risk of choking and might not adequately hydrate stool.
Rationale for Choice C:
- Statement:The importance of consuming adequate amounts of water.
- Rationale:This is the most crucial information to emphasize when teaching about psyllium.Psyllium works by absorbing water and forming a bulky gel that softens stool and promotes bowel movements.Without sufficient water intake,psyllium can cause constipation to worsen or lead to intestinal obstruction.
Rationale for Choice D:
- Statement:The onset of action of 30 to 60 minutes after administration.
- Rationale:This statement is inaccurate.Psyllium is not a fast-acting laxative.It typically takes 12-72 hours to produce a bowel movement.Informing patients about the expected time frame for results is essential to manage expectations and prevent unnecessary medication overuse.
The client is 34 years old and has recently started taking theophylline.
The nurse knows that medication teaching has been successful when the client agrees to what activity?
Explanation
It works by relaxing the smooth muscles of the airways and increasing airflow to the lungs.
However, theophylline has a narrow therapeutic range and can cause side effects such as nausea, vomiting, insomnia, tremors, and cardiac arrhythmias if the blood level is too high.
Caffeine is a stimulant that can increase the effects of theophylline and raise the risk of toxicity.
Therefore, patients taking theophylline should avoid caffeine-containing beverages such as coffee, tea, cola, and energy drinks.
Choice A is wrong because eating foods high in potassium has no effect on theophylline metabolism or action.
Potassium is an electrolyte that is important for nerve and muscle function, but it does not interact with theophylline.
Choice C is wrong because taking the medication on an empty stomach can increase the absorption of theophylline and cause gastric irritation.
Theophylline should be taken with food or milk to reduce stomach upset and prevent fluctuations in blood levels.
Choice D is wrong because limiting fluid intake to 1,000 mL a day can cause dehydration and increase the concentration of theophylline in the blood.
Theophylline
A college student with migraine headaches that cause nausea and vomiting has been prescribed trimethobenzamide.
The nurse should caution the student to avoid using which substance?
Explanation
The nurse should caution the student to avoid using alcohol with trimethobenzamide because this combination can cause side effects such as drowsiness, dizziness, and impaired reactions. Alcohol can also worsen the symptoms of nausea and vomiting.
Choice A is wrong because St.
John’s wort is a herbal supplement that is used to treat depression and anxiety.
It does not interact with trimethobenzamide.
Choice C is wrong because calcium channel blockers are a class of medications that are used to treat high blood pressure and heart problems.
They do not interact with trimethobenzamide.
Choice D is wrong because selective serotonin reuptake inhibitors (SSRIs) are a class of medications that are used to treat depression and anxiety.
They do not interact with trimethobenzamide.
Trimethobenzamide is an antihistamine that works by blocking the D receptor in the brain and suppressing the chemoreceptor trigger zone that causes nausea and vomiting.
It is available as an oral capsule or an intramuscular injection.
It can cause side effects such as skin rash, tremors, parkinsonism, and jaundice.
It should not be used in children or people with liver or kidney disease.
The nurse teaches the client to best promote optimal GI function by including what in the daily routine?
Explanation
This is because a nutritious diet provides adequate fiber and nutrients for the GI tract, avoiding alcohol prevents dehydration and irritation of the GI mucosa, and cautious use of laxatives prevents dependency and electrolyte imbalance.
Choice A is wrong because caffeine can stimulate the GI motility and cause diarrhea or cramps.
Choice C is wrong because some prescription medications can affect the GI function, such as antibiotics, opioids, or antacids.
Increased fluid intake is good, but not enough to promote optimal GI function.
Vigorous exercise can also cause GI distress or dehydration.
Choice D is wrong because adequate fluid intake is essential for preventing constipation and maintaining hydration.
Exercise can also help with bowel movements and overall health.
Normal ranges for GI function vary depending on the individual, but generally, a person should have at least one bowel movement every 3 days and no more than 3 bowel movements per day.
The stool should be soft, formed, and easy to pass.
A client who has chronic bronchial asthma has had a mast cell stabilizer prescribed.
What drug would the provider prescribe?
Explanation
Cromolyn is the only available mast cell stabilizer.
Mast cell stabilizers work by preventing the release of inflammatory mediators from mast cells, which are involved in allergic reactions and asthma. Cromolyn can be used as a prophylactic agent to prevent asthma attacks, but it is not effective during an acute attack.
Choice A is wrong because ipratropium and budesonide are not mast cell stabilizers.
Ipratropium is a cholinergic-blocking drug that blocks the action of acetylcholine in the bronchi, causing bronchodilation.
Budesonide is an inhaled corticosteroid that reduces inflammation and mucus production in the airways.
Choice B is wrong because isoetharine and montelukast are not mast cell stabilizers.
Isoetharine is a beta-adrenergic agonist that stimulates the beta receptors in the bronchi, causing bronchodilation.
Montelukast is a leukotriene receptor antagonist that blocks the action of leukotrienes, which are inflammatory mediators that cause bronchoconstriction and mucus secretion.
Choice D is wrong because aminophylline and caffeine are not mast cell stabilizers.
Aminophylline is a xanthine derivative that inhibits phosphodiesterase, an enzyme that breaks down cyclic adenosine monophosphate (cAMP), which is involved in bronchodilation.
The home care nurse is caring for an older adult client who has type 1 diabetes. The client has visual impairment and cannot read the numbers on the syringe when preparing insulin for administration nor afford the cost of prefilled auto syringes.
What strategy might the nurse use to help this client comply with insulin needs between visits?
Explanation
This strategy can help the client read the numbers on the syringe and prepare the correct dose of insulin. A magnifying glass is also an affordable and accessible tool for the client.
Choice A is wrong because preparing a week’s supply of syringes and refrigerating them can affect the potency and sterility of insulin.
It can also increase the risk of errors or confusion.
Choice B is wrong because asking a neighbor to come over every day to prepare the medication can compromise the client’s privacy and independence.
It can also be unreliable and inconvenient for both parties.
Choice D is wrong because changing the client to oral antidiabetics is not possible for type 1 diabetes.
People with type 1 diabetes need to take insulin for life because their pancreas cannot make insulin.
Oral antidiabetics are only effective for people with type 2 diabetes who have functioning pancreatic beta cells
The nurse is caring for a client with renal dysfunction who requires an oral antidiabetic agent.
What drug will the nurse expect to see ordered?
Explanation
Tolbutamide is preferred for clients with renal dysfunction, who may not be able to excrete chlorpropamide, because it is more easily cleared from the body.
Choice B. Tolazamide is wrong because it is a first-generation sulfonylurea that is used less frequently and is usually tried after tolbutamide and chlorpropamide have been shown to be ineffective.
Choice C. Chlorpropamide is wrong because it is a first-generation sulfonylurea that may accumulate in clients with renal dysfunction and cause hypoglycemia.
Choice D. Chlorpromazine is wrong because it is an antipsychotic agent, not an oral antidiabetic agent.
First-generation sulfonylureas are oral antidiabetic agents that stimulate insulin secretion from the pancreas.
They are used to treat type 2 diabetes mellitus.
The normal range of blood glucose level is 70 to 110 mg/dL.
A client with type 2 diabetes presents at the clinic for a routine follow-up appointment. The client asks the nurse whether he or she can take the herbal supplement ginseng.
What is the correct response by the nurse?
Explanation
Ginseng is a herbal supplement that may have some antidiabetic effects, such as improving glucose tolerance and insulin resistance. However, ginseng may also interact with certain diabetes medications, especially insulin and sulfonylureas, and cause hypoglycemia (low blood sugar)2. Therefore, the nurse should inform the client about this potential risk and advise them to consult their doctor before taking ginseng.
Choice B is wrong because there is a reason ginseng cannot be taken by people with diabetes without medical supervision.
As explained above, ginseng may lower blood glucose levels too much and cause hypoglycemia.
Choice C is wrong because there is some research to indicate what effect ginseng will have on diabetes.
Several studies have shown that ginseng may have beneficial effects on blood glucose control, but also some adverse effects such as hypoglycemia.
Choice D is wrong because ginseng does not increase the risk for high blood
The client, newly diagnosed with diabetic retinopathy, asks what caused this disorder.
What is the nurse’s best response?
Explanation
Oxygen cannot diffuse rapidly across the membrane to tissues in the eye. Diabetic retinopathy is caused by damage to the blood vessels of the retina, which is the light-sensitive tissue at the back of the eye. This damage can reduce the oxygen supply to the retina and lead to vision problems.
Choice A is wrong because cells in the eye can reproduce normally, but they may not function properly due to high blood sugar levels or lack of oxygen.
Choice B is wrong because diabetic retinopathy does not affect the production of aqueous humor, which is the fluid that fills the front part of the eye.
However, diabetes can cause another eye condition called glaucoma, which is caused by increased pressure from too much aqueous humor.
Choice C is wrong because diabetic retinopathy does not affect the nerve innervations throughout the eye.
However, diabetes can cause another eye condition called diabetic neuropathy, which is caused by damage to the nerves that control eye movement and pupil dilation.
The client, newly diagnosed with diabetic retinopathy, asks what caused this disorder.
What is the nurse’s best response?
Explanation
Oxygen cannot diffuse rapidly across the membrane to tissues in the eye. This is because diabetic retinopathy is a condition that occurs when high blood sugar levels damage the tiny blood vessels that nourish the retina, the light-sensitive tissue at the back of the eye. As a result, the retina becomes ischemic (lacking oxygen) and tries to grow new blood vessels that are fragile and leaky.
Choice A is wrong because inability of cells in the eye to reproduce is not a cause of diabetic retinopathy.
The retina has a high metabolic rate and needs a constant supply of oxygen and nutrients to function properly.
Choice B is wrong because increase of aqueous humor in the eye is not a cause of diabetic retinopathy.
Aqueous humor is the clear fluid that fills the front part of the eye, not the retina.
An increase of aqueous humor can cause glaucoma, which is a different eye disorder that affects the optic nerve.
Choice C is wrong because decrease of nerve innervations throughout the eye is not a cause of diabetic retinopathy.
Nerve innervations are the connections between nerves and other tissues, such as muscles or glands.
Diabetic retinopathy affects the blood vessels, not the nerves, of the retina.
With what client should the nurse question the administration of human insulin?
Explanation
The nurse should question the administration of human insulin to this client because they do not need exogenous insulin to maintain normal blood glucose levels. Human insulin is indicated for clients who have type 1 diabetes or type 2 diabetes that cannot be controlled by oral antidiabetic agents, diet, or exercise.
Choice A is wrong because a client who has been diagnosed with gestational diabetes may need human insulin to control their blood glucose levels during pregnancy, as oral antidiabetic agents are contraindicated.
Choice B is wrong because a client with type 2 diabetes, controlled with oral antidiabetic agents, who has a systemic infection may need human insulin to manage their blood glucose levels during periods of stress, as infection can increase blood glucose levels and impair the action of oral antidiabetic agents.
Choice D is wrong because a client who has been living with type 1 diabetes for 20 years needs human insulin to replace the endogenous insulin that their pancreas cannot produce.
A client with type 1 diabetes presents to the diabetes educator and asks about a change in insulin. The client’s occupation requires long international flights, and the client does not want to administer insulin on the plane.
What kind of insulin would best meet this client’s needs?
Explanation
Glargine is a long-acting insulin that can provide a steady level of insulin for up to 24 hours. This would be suitable for a client who does not want to administer insulin on the plane, as they would only need one injection per day.
Choice A. Aspart is wrong because aspart is a rapid-acting insulin that has a peak effect within 1 to 3 hours and lasts for 3 to 5 hours.
This would require frequent injections and monitoring of blood glucose levels.
Choice B. Lispro is wrong because lispro is also a rapid-acting insulin that has a similar onset and duration as aspart.
It would not provide adequate coverage for a long international flight.
Choice C. Glulisine is wrong because glulisine is another rapid-acting insulin that has an onset of 15 minutes and a duration of 2 to 4 hours.
It would also require multiple injections and frequent blood glucose checks.
Normal ranges for blood glucose levels are 70 to 130 mg/dL before meals and less than 180 mg/dL after meals.
What type of insulin would the nurse administer if the fastest therapeutic effects are needed?
Explanation
Glulisine is a rapid-acting insulin that has an onset of action of 2 to 5 minutes and peaks in 30 to 90 minutes, making it the fastest among the choices. Some possible explanations for the other choices are:
Choice A. Aspart is also a rapid-acting insulin, but it has a slightly longer onset of action (10 to 20 minutes) and peak time (1 to 3 hours) than glulisine.
Choice B. Lispro is another rapid-acting insulin, but it has a similar onset of action (<15 minutes) and peak time (30 to 90 minutes) as glulisine, so it is not the fastest.
Choice C. Regular is a short-acting insulin that has a much longer onset of action (30 to 60 minutes) and peak time (2 to 4 hours) than glulisine, so it is not suitable for fast therapeutic effects.
Normal ranges for blood glucose levels are 70 to 130 mg/dL before meals and less than 180 mg/dL after meals.
Insulin doses are adjusted based on blood glucose monitoring, carbohydrate intake, physical activity, and other factors.
The nurse suspects the client with diabetes may be having a hypoglycemic reaction when what manifestation is assessed?
Explanation
Diaphoresis means excessive sweating, which is one of the symptoms of hypoglycemia. Hypoglycemia occurs when the blood sugar level is lower than the normal range, which can cause dizziness, confusion, weakness, hunger, and other signs.
Choice B is wrong because flushing of the face is not a symptom of hypoglycemia.
Flushing can be caused by other conditions, such as fever, allergic reactions, or rosacea.
Choice C is wrong because fruity breath is a symptom of hyperglycemia, not hypoglycemia.
Hyperglycemia means high blood sugar level, which can cause the body to produce ketones that give the breath a fruity odor.
Choice D is wrong because unpredictable behaviors are not a specific symptom of hypoglycemia.
However, hypoglycemia can cause confusion, irritability, or anxiety, which may affect the behavior of some people.
The normal range of blood sugar level for most people is between 70 and 130 mg/dL (3.9 and 7.2 mmol/L) before meals and less than 180 mg/dL (10 mmol/L) after meals.
However, this may vary depending on the individual and the type of diabetes.
It is important to monitor the blood sugar level regularly and treat hypoglycemia promptly by eating or drinking a simple sugar source.
A client has a history of atrial fibrillation and is taking an oral anticoagulant. The client has been newly diagnosed with hypothyroidism and placed on levothyroxine.
What assessment should the nurse prioritize?
Explanation
This is because levothyroxine can increase the anticoagulant effect of oral anticoagulants and increase the risk of bleeding. The nurse should check the client’s prothrombin time and international normalized ratio (INR) regularly and report any abnormal values to the prescriber.
Choice B is wrong because hypothyroidism does not increase the risk of infection.
Choice C is wrong because hypothyroidism does not affect the level of consciousness unless it is severe and causes myxedema coma.
Choice D is wrong because hypothyroidism does not cause electrolyte imbalances.
Normal ranges for prothrombin time are 11 to 13.5 seconds and for INR are 0.8 to 1.22.
The nurse administers teriparatide and evaluates the drug as effective in achieving desired effects when what is assessed?
Explanation
This is because teriparatide affects calcium and phosphorus metabolism in a pattern consistent with the known actions of endogenous PTH (eg, increases serum calcium and decreases serum phosphorus)12.
Choice A is wrong because teriparatide does not decrease serum calcium, but increases it.
Choice C is wrong because teriparatide does not increase serum phosphorus, but decreases it.
Choice D is wrong because teriparatide does not decrease serum calcium, but increases it.
Normal ranges for serum calcium are 8.5 to 10.2 mg/dL and for serum phosphorus are 2.5 to 4.5 mg/dL.
The nurse is caring for a pediatric client with a new onset of hypercalcemia.
What condition would be most likely to cause this altered serum calcium level?
Explanation
Hypercalcemia is a condition caused by having too much calcium in the blood, which can affect the function of nerves, muscles, kidneys and heart. Hypercalcemia can occur in children due to various causes, both acquired and genetic. One of the most common causes of hypercalcemia in children is cancer, especially cancers that affect the bones or produce substances that mimic parathyroid hormone (PTH), which regulates calcium levels.
Choice A is wrong because liver failure does not directly cause hypercalcemia, although it can affect vitamin D metabolism and calcium absorption.
Choice B is wrong because radiation injury does not cause hypercalcemia, unless it damages the parathyroid glands or causes bone destruction.
Choice D is wrong because hypothyroidism does not cause hypercalcemia, although it can affect bone turnover and calcium excretion.
The client is 8 weeks pregnant and requires an antithyroid medication.
The nurse identifies what drug as the drug of choice for this client?
Explanation
This is an antithyroid medication that can be used safely during pregnancy, as it has a lower risk of causing birth defects or fetal hypothyroidism than other drugs. Propylthiouracil inhibits the synthesis of thyroid hormones and also blocks their conversion to the more active form.
Choice A is wrong because radioactive iodine is contraindicated during pregnancy, as it can cross the placenta and damage the fetal thyroid gland.
Radioactive iodine is used to destroy overactive thyroid cells and treat hyperthyroidism.
Choice B is wrong because alendronate is not an antithyroid medication, but a bisphosphonate that is used to treat osteoporosis and prevent bone loss.
Alendronate should not be used during pregnancy, as it may affect fetal bone development and mineralization.
Choice D is wrong because methimazole is another antithyroid medication, but it is not the drug of choice for pregnant women, as it has a higher risk of causing birth defects or fetal hypothyroidism than propylthiouracil.
Methimazole also inhibits the synthesis of thyroid hormones, but does not block their conversion to the more active form.
The nurse is caring for a client newly diagnosed with hypothyroidism. The client also takes theophylline to control asthma symptoms.
What change may need to be made to the client’s theophylline dose?
Explanation
This is because hypothyroidism can reduce the metabolism and clearance of theophylline, leading to higher serum levels and increased risk of toxicity. Therefore, when the thyroid function is restored by levothyroxine or liothyronine, the dose of theophylline may need to be lowered to avoid excessive effects.
Choice A is wrong because decreasing theophylline dosage immediately may result in suboptimal control of asthma symptoms.
The dose adjustment should be based on serum theophylline levels and clinical response.
Choice C is wrong because discontinuing the client’s theophylline may cause worsening of asthma and potentially life-threatening complications.
Theophylline is an important bronchodilator that should not be stopped abruptly without medical supervision.
Choice D is wrong because increasing theophylline dosage immediately may cause overdose and adverse effects such as nausea, vomiting, headache, tachycardia, arrhythmias, seizures and even death.
The dose of theophylline should be carefully titrated according to serum levels and clinical response.
The nurse is caring for a client with hypothyroidism who has a history of myocardial infarction and heart failure.
What thyroid replacement drug would the nurse expect to be ordered?
Explanation
Levothyroxine is a synthetic form of thyroxine, the hormone that the thyroid gland normally produces.It is used to treat hypothyroidism by replacing the missing hormone and restoring the normal metabolism.
Some explanations for the other choices are:
• Choice B. Thyroid desiccated is a natural thyroid hormone derived from animal thyroid glands.
It contains both T4 and T3 hormones, which may cause side effects or complications in some people with hypothyroidism.It is not recommended as a first-line treatment for hypothyroidism.
• Choice C. Methimazole is an antithyroid drug that blocks the production of thyroid hormones.
It is used to treat hyperthyroidism, not hypothyroidism.Giving methimazole to someone with hypothyroidism would worsen their condition.
• Choice D. Liothyronine is a synthetic form of T3, the active thyroid hormone.
It is sometimes used in combination with levothyroxine to treat hypothyroidism, but it is not a standard treatment.It has a shorter half-life and more variable effects than levothyroxine, and it may increase the risk of cardiac arrhythmias or osteoporosis.
Normal ranges for thyroid function tests vary depending on the laboratory and the method used, but generally they are:
• TSH: 0.4 to 4.0 mIU/L
• Free T4: 0.8 to 2.0 ng/dL
• Free T3: 2.3 to 4.2 pg/mL
After administering propylthiouracil (PTU), what effect would the nurse anticipate the drug will have in the client’s body?
Explanation
Propylthiouracil (PTU) is an antithyroid drug that blocks the synthesis of thyroid hormones by interfering with the oxidation of iodine and the coupling of iodotyrosines.
This reduces the levels of triiodothyronine (T) and thyroxine (T) in the blood and relieves the symptoms of hyperthyroidism.
Choice A is wrong because PTU does not destroy any part of the thyroid gland.
It only inhibits the production of thyroid hormones within the gland.
Choice B is wrong because PTU does not suppress the anterior pituitary gland’s secretion of thyroid-stimulating hormone (TSH).
TSH is a hormone that stimulates the thyroid gland to produce thyroid hormones.
PTU does not affect the feedback loop between the hypothalamus, pituitary, and thyroid glands.
Choice D is wrong because PTU does not suppress the hypothalamus’s production of thyrotropin-releasing hormone (TRH).
TRH is a hormone that stimulates the pituitary gland to secrete TSH.
PTU does not affect the feedback loop between the hypothalamus, pituitary, and thyroid glands.
Normal ranges for T are 80 to 220 ng/dL, for T are 4.5 to 11.2 mcg/dL, and for TSH are 0.4 to 4.0 mIU/L.
The nurse is teaching the client with a new prescription for ibandronate how to take the medication.
Which instruction provided by the nurse is correct?
Explanation
This is the recommended dosage for the prevention and treatment of osteoporosis in postmenopausal women.
Choice B is wrong because 70 mg once a week is the dosage for alendronate (Fosamax), not ibandronate.
Choice C is wrong because 400 mg/d is the dosage for etidronate (Didronel), not ibandronate.
Choice D is wrong because ibandronate should be taken on an empty stomach, at least 60 minutes before food or drink.
The nurse is providing client teaching regarding the administration of levothyroxine.
What is the nurse’s priority teaching point?
Explanation
Levothyroxine is a synthetic thyroid hormone that is used to treat hypothyroidism. It should be taken on an empty stomach, preferably in the morning, with a full glass of water to facilitate absorption and prevent choking. Taking the medication with food or other substances may interfere with its effectiveness.
Choice A is wrong because levothyroxine does not need to be taken after breakfast.
In fact, taking it after breakfast may reduce its absorption and efficacy.
Choice C is wrong because levothyroxine does not require the patient to remain in the upright position for 30 minutes after administering.
This instruction is more applicable to bisphosphonates, which are drugs used to treat osteoporosis.
Choice D is wrong because levothyroxine should not be taken at night.
Taking it at night may cause insomnia, as well as reduced absorption and efficacy.
The nurse is working with a client who is newly diagnosed with hypothyroidism. Diagnostic testing has indicated that the client’s health problem is caused by anterior pituitary dysfunction.
This client’s hypothyroidism is rooted in a deficiency of:
Explanation
Choice A is wrong because tetraiodothyronine is another name for thyroxine (T), which is a hormone produced by the thyroid gland, not the anterior pituitary gland.14
Choice C is wrong because triiodothyronine (T) is also a hormone produced by the thyroid gland, not the anterior pituitary gland.14
Normal ranges for TSH are 0.4 to 4.0 mIU/L, for T are 100 to 200 ng/dL, and for T are 4.5 to 11.2 mcg/dL.1
The nurse is caring for a client who works night shift from 22:00 to 06:00 and normally sleeps from 08:00 (8 AM) until 16:00 (4 PM) each day.
The nurse should teach this client to take the prescribed corticosteroid at what time of the day?
Explanation
This is because cortisol exhibits a proper 24-h circadian rhythm that affects the cardiovascular system and other organs. Cortisol levels are normally low at the beginning of sleep and high at the moment of awakening. Taking corticosteroids at this time mimics the natural cortisol rhythm and may reduce side effects such as adrenal suppression, sleep disturbances and cardiovascular complications.
Choice A is wrong because taking corticosteroids at 08:00 may not coincide with the client’s natural cortisol peak and may cause insomnia or unpleasant dreams.
Choice B is wrong because taking corticosteroids at 22:00 may disrupt the client’s sleep quality and increase the risk of nocturnal hypertension.
Choice D is wrong because taking corticosteroids at 16:00 may interfere with the client’s natural cortisol decline and cause hyperglycemia or dyslipidemia.
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