Pharm final practice

What statement would be appropriately included in the teaching concerning type 2 diabetes? a. "Regular exercise makes your body better able to use the insulin it produces." b. "Until you need to start insulin injections, you do not have to check your blood sugar." c. "Clients with type 2 diabetes always progress to insulin injections if they do not follow dietary guidelines." d. "If you drink alcohol, it may be necessary for you to increase your oral antidiabetic medication."

"Regular exercise makes your body better able to use the insulin it produces."

A nurse is preparing a syringe that contains regular and NPH insulin. To ensure effectiveness, the nurse would administer the insulins within which time frame? -10 minutes -60 minutes -15 minutes -30 minutes

-15 minutes To ensure therapeutic effectiveness and appropriate suspension of the mixed insulin, the nurse would need to administer the injection within 15 minutes of mixing the insulins in the syringe.

Which strategy will NOT increase the therapeutic effect of insulin? -Insulin should be administered in the subcutaneous tissue. -Blood glucose levels should be monitored several times per day. -Regular insulin should be administered 30 minutes before meals. -All insulin should be stored in a refrigerator but never frozen.

-All insulin should be stored in a refrigerator but never frozen. Store opened vials of regular insulin at room temperature. Extra supplies are stored in the refrigerator, not the freezer. Extreme temperatures (<2°C or >30°C) should be avoided to prevent the loss of maximum function. Administer regular insulin with an insulin syringe into an appropriate subcutaneous site. Regular insulin is administered about 30 to 60 minutes before eating. To promote regular absorption, one anatomic area should be selected for regular insulin injections (e.g., the abdomen). Frequent monitoring of blood glucose by fingersticks and periodic determinations of hemoglobin A1C levels help determine the therapeutic effect of insulin and overall consistency of diabetic control.

The nurse's assessment of a client who has presented to the emergency department reveals hyperglycemia. Which type of insulin will have the most rapid effect on the client's blood sugar levels? -Regular -30/70 -Aspart -NPH

-Aspart Aspart has an onset of action of 5 to 10 minutes, making the most rapidly acting insulin. NPH, regular, and 30/70 all take significantly longer to have an effect on blood glucose levels.

A nurse is assigned to administer glargine to a patient at a health care facility. What precaution should the nurse take when administering glargine? -Administer insulin that has been refrigerated. -Shake the vial vigorously before withdrawing insulin. -Administer glargine via IV route. -Avoid mixing glargine with other insulin.

-Avoid mixing glargine with other insulin. When administering glargine to the patient, the nurse should avoid mixing it with other insulin or solutions. It will precipitate in the syringe when mixed. If glargine is mixed with another solution, it will lose glucose control, resulting in decreased effectiveness of the insulin. Glargine is administered via SC once daily at bedtime. The nurse should not shake the vial vigorously before withdrawing insulin. The vial should be gently rotated between the palms of the hands and tilted gently end-to-end immediately before withdrawing the insulin. The nurse administers insulin from vials at room temperature. Vials are stored in the refrigerator if it is to be stored for about three months for later use.

A man is brought to the emergency department. He is nonresponsive, and his blood glucose level is 32 mg/dL. Which would the nurse expect to be ordered? -Insulin lispro -Diazoxide -Glucagon -Regular insulin

-Glucagon The client is significantly hypoglycemic and needs emergency treatment. Glucagon would be the agent of choice to raise the client's glucose level because it can be given intravenously and has an onset of approximately 1 minute. Diazoxide can be used to elevate blood glucose levels, but it must be given orally. Lispro and regular insulin would be used to treat hyperglycemia.

Which would a nurse identify as an example of a sulfonylurea? -Miglitol -Metformin -Acarbose -Glyburide

-Glyburide Glyburide is an example of a sulfonylurea. Metformin is classified as a biguanide. Acarbose and miglitol are alpha-glucosidase inhibitors.

A nurse at a health care facility is assigned to administer insulin to the patient. Which intervention should the nurse perform before administering each insulin dose? -Inspect the previous injection site for inflammation. -Do not administer insulin kept at room temperature. -Check for symptoms of myalgia or malaise. -Keep prefilled syringes horizontally.

-Inspect the previous injection site for inflammation. The nurse should check the previous injection site before administering each insulin dose. The injection sites should be rotated to prevent lipodystrophy. Prefilled syringes should not be kept horizontally; they should be kept in a vertical or oblique position to avoid plugging the needle. The nurse checks for symptoms of myalgia or malaise when administration of metformin leads to lactic acidosis. Insulin should be kept at room temperature for administration. Insulin is refrigerated if it needs to be stored for up to three months for later use.

The nurse admitted a 4-year-old child with type 1 diabetes mellitus. The nurse educates the parents that hypoglycemia can occur as an adverse effect of insulin. The nurse helps the parents to understand that in young children, hypoglycemia may manifest as what signs or symptoms? (Select all that apply.) -Hallucinations -Lethargy -Anorexia -Impaired mental functioning -Irritability

-Irritability -Impaired mental functioning -Lethargy In young children, hypoglycemia may be manifested by changes in behavior, including severe hunger, irritability, and lethargy. In addition, mental functioning may be impaired in all age groups, even with mild hypoglycemia. Anytime hypoglycemia is suspected, blood glucose should be tested.

Which would be appropriate to include in teaching a client with type 2 diabetes? -It is possible with weight loss and exercise to discontinue the use of antidiabetic medication. -If you drink alcohol, it may be necessary to increase your oral antidiabetic medication. -Until you need to start insulin injections, you do not have to check your blood sugar. -Clients with type 2 diabetes always progress to insulin injections if they do not follow dietary guidelines.

-It is possible with weight loss and exercise to discontinue the use of antidiabetic medication. Exercise is perhaps the best therapy for the prevention of both type 2 diabetes and the metabolic syndrome. Exercise is an extremely strong hypoglycemic agent.

The client is scheduled to get a breakfast tray at 07:00. At what time should the client receive a prescribed dose of insulin lispro? a. 06:00 b. 06:20 c. 06:45 d. 07:00

06:45 Explanation: With short-acting insulins like lispro, aspart, or glulisine, it is important to inject the medication about 15 minutes before eating.

The nurse assesses a client's blood glucose level after administering insulin. Which result would the nurse interpret as indicative of severe hypoglycemia? -65 mg/dL -34 mg/dL -72 mg/dL -48 mg/dL

34 mg/dL Blood glucose levels below 40 mg/dL are indicative of severe hypoglycemia.

An immunocompromised 3-year-old has been exposed to avian flu. The patient is brought to the clinic and the mother reports that the patient has had "flu-like symptoms" for the past 12 hours. What medication would you expect the physician to order for this patient?

A) Oseltamivir (Tamiflu)

The nurse administers amitriptyline hydrochloride to a patient with chronic depression. For which potential effects of the medication should the nurse monitor the patient? (Choose all that apply.) A) Constipation B) Hypotension C) Hyperpyrexia D) Hyperglycemia E) Improved sleep F) Urine retention

A, B, E, F Amitriptyline is a tricyclic antidepressant that can induce such anticholinergic effects as constipation and urine retention. It can also cause dopaminergic- and adrenergic-blocker effects such as hypotension. Histamine blockade generally causes sedation and improves sleep. Tricyclic antidepressants should not cause hyperpyrexia or hyperglycemia.

A patient who is diagnosed with shingles is taking topical acyclovir, and the nurse is providing instructions about adverse effects. The nurse will discuss which adverse effects of topical acyclovir therapy? a. Insomnia and nervousness b. Temporary swelling and rash c. Burning when applied d. This medication has no adverse effects.

ANS: C Transient burning may occur with topical application of acyclovir. The other options are incorrect.

A patient is taking a combination of antiviral drugs as treatment for early stages of a viralinfection. While discussing the drug therapy, the patient asks the nurse if the drugs will killthe virus. When answering, the nurse keeps in mind which fact about antiviral drugs? a. They are given for palliative reasons only. b. They will be effective as long as the patient is not exposed to the virus again. c. They can be given in large enough doses to eradicate the virus without harming thebody's healthy cells. d. They may also kill healthy cells while killing viruses.

ANS: D Because viruses reproduce in human cells, selective killing is difficult; consequently, manyhealthy human cells, in addition to virally infected cells, may be killed in the process, and thisresults in the serious toxicities that are involved with these drugs. The other options areincorrect.

What are the most common adverse effects of lovastatin (Mevacor)? A) Nausea, flatulence, and constipation B) Increased appetite and blood pressure C) Confusion and mental disorientation D) Hiccups, sinus congestion, and dizziness

Ans: A Feedback: GI problems such as nausea, vomiting, flatulence, constipation, or diarrhea can occur with lovastatin. Increased appetite is not associated with lovastatin but patients may think that taking this drug means they can now eat anything they want and this would indicate the need for further teaching. Confusion and mental disorientation are not associated with this drug. Hiccups, sinus congestion, and dizziness would require exploration for cause because they are not normally associated with lovastatin therapy.

3. A patient has been prescribed losartan (Cozaar) for hypertension. What patient teaching points will the nurse include about this drug include? A) Report onset of a cough or fever to health care provider. B) Limit fluid intake to decrease urinary output. C) Monitor blood pressure once a week. D) Take the drug late in the day to prevent sleepiness.

Ans: A Feedback: Losartan is an angiotensin IIreceptor blocker that is associated with a cough, back pain, fever, muscle weakness, and upper respiratory tract infections, so the patient should be taught to report a fever or cough to his health care provider. Fluid intake should be normal and the drug is best taken in the morning. Blood pressure should be monitored daily, especially when first starting the drug when adverse effects are not yet known.

The patient receives a prescription for niacin and the nurse is teaching his or her about the medication.The nurse instructs the patient to call the provider if what common adverse effect of niacin occurs? A) Hypotension B) Abdominal pain C) Vomiting D) Diarrhea

Ans: B Feedback: Niacin is associated with intense cutaneous flushing, nausea, and abdominal pain, making its use somewhat limited. It also increases serum levels of uric acid and may predispose patients to the development of gout. Hypotension, vomiting, and diarrhea are not normally associated with the drug.

A patient taking diltiazem (Cardizem) for hypertension has come to the clinic for a follow-upappointment. What adverse effects would the nurse assess the patient for? A) Chest pain and pale skin B) Shortness of breath and wheezing C) Peripheral edema and bradycardia D) Tachycardia and increased energy level

Ans: C Feedback: Cardiovascular adverse effects of diltiazem include bradycardia, peripheral edema, and hypotension. Skin flushing and rash may occur. There should be no effect on the lungs and usually this drug causes fatigue rather than increased energy levels.

A patient taking a calcium channel blocker is seen in the clinic and diagnosed with drug toxicity. When collecting the nursing history, what finding would indicate the likely cause of this drug toxicity? A) Intake of alcohol B) The use of eggs in the diet C) The ingestion of grapefruit juice D) Intake of aged cheese

Ans: C Feedback: The calcium channel blockers are a class of drugs that interact with grapefruit juice. When grapefruit juice is present in the body, the concentrations of calcium channel blockers increase, sometimes to toxic levels. Advise patients to avoid drinking grapefruit juice taking a calcium channel blocker. If a patient on a calcium channel blocker reports toxic effects, ask whether he or she is drinking grapefruit juice. Use of alcohol could be important if the patient was ingesting large amounts, but that would not be the most likely cause of drug toxicity. Eggs and cheese should not exert any food-drug interaction.

The nurse is caring for a pregnant woman diagnosed with HIV on prenatal drug screening. What medication would the nurse expect to administer to reduce the risk of maternal to fetal transmission of the virus?

B) Zidovudine (Retrovir)

The nurse is obtaining a medication history from a client diagnosed with genital herpes. Which drug would the nurse expect this client to be prescribed? A. Ribavirin (Virazole) B. Acyclovir (Zovirax) C. Zidovudine (Retrovir) D. Amantadine (Symmetrel)

B. Acyclovir (Zovirax)

When providing health promotion teaching at a senior citizen center, the nurse would include information about which medication used to decrease the duration of influenza A and B?A. Indinavir (Crixivan) B. Enfuvirtide (Fuzeon) C. Oseltamivir (Tamiflu) D. Ganciclovir (Cytovene)

C. Oseltamivir (Tamiflu)

The nurse instructs a patient who is undergoing therapy with monoamine oxidase inhibitors (MAOIs) to avoid tyramine-containing foods. What medical emergency may occur if the patient eats these foods while taking MAOIs? A. Gastric hemorrhage B. Toxic shock C. Cardiac arrest D. Hypertensive crisis

D

Which insulin would the nurse need to administer as a separate injection if the order also included NPH insulin? A. Regular B. Lispro C. Lente D. Glargine

D. Glargine Insulin glargine cannot be mixed in solution with any other insulin.

during treatment with Zidovudine the nurse needs to monitor for which potential adverse effect A. retinitis B. Deep vein thrombosis C. Kaposi's sarcome D. Bone marrow suppression

D. bone marrow suppression

A client is prescribed sitagliptin. The nurse would expect to administer this drug by which route? a. Oral b. Subcutaneous c. Intramuscular d. Intravenous

Oral Explanation: Sitagliptin is administered orally.

After teaching a group of students about the various methods for the delivery of insulin, the instructor determines that the teaching was successful when the students identify which method as most commonly used for administration? a. Subcutaneous injection b. Insulin pen c. Jet injector d. Implantable infusion pump

Subcutaneous injection Explanation: Subcutaneous injection currently is the most common method for administering insulin.

A patient is receiving a diuretic as part of his treatment plan for hypertension. The nurse would monitor the patient for signs and symptoms of hyperkalemia if the patient was receiving which agent? a. Spironolactone b. Indapamide c. Chlorthalidone d. Hydrochlorothiazide

a. Spironolactone (Rationale: Spironolactone is a potassium-sparing diuretic that can lead to hyperkalemia. Hydrochlorothiazide, indapamide, and chlorthalidone are associated with causing hypokalemia.)

Which factor would prohibit the administration of glipizide? -the ingestion of carbohydrates -increase in alkaline phosphatase -a diagnosis of hypertension -allergy to sulfonamides

allergy to sulfonamides Sulfonylureas are contraindicated in clients with hypersensitivity to them, with severe renal or hepatic impairment, and who are pregnant. A diagnosis of hypertension does not cause contraindication of sulfonylureas. The client should consume carbohydrates in association with the oral hypoglycemic agent. An increase in alkaline phosphatase does not result in the contraindication of glipizide.

The nurse is administering a beta-blocker to a patient with hypertension. What effects would the nurse anticipate will occur? (Select all that apply.) a. Increased renin release b. Decreased heart rate c. Increased renal blood flow d. Blocked vasodilation e. Decreased cardiac muscle contraction

b. Decreased heart rate c. Increased renal blood flow e. Decreased cardiac muscle contraction (Rationale: A beta-blocker blocks vasoconstriction, decreases heart rate, decreases cardiac muscle contraction, and increases blood flow to the kidneys, leading to a decrease in the release of renin.)

The nurse is caring for a client who is taking glyburide as treatment for type 2 diabetes mellitus. The health care provider has added a corticosteroid to this client's medication regimen for treatment of a severe allergic reaction. The nurse knows that this drug combination may cause what adverse effect on this client? -hypoglycemia -rash and fever -hyperglycemia -nausea and vomiting

hyperglycemia Corticosteroids increase insulin needs, so the client may develop hyperglycemia.

After reviewing information about different insulin preparations, a nursing student demonstrates understanding of the information when the student identifies which medication as an example of a long-acting insulin? -insulin glargine -insulin lispro -isophane insulin suspension -insulin aspart

insulin glargine Insulin glargine is an example of a long-acting insulin. Insulin lispro and insulin aspart are rapid-acting insulin. Isophane insulin suspension is an intermediate-acting insulin.