N362 Exam 2

"Azole" anti-fungal adverse effects:

GI upset, HA, rash, liver toxicity

A nurse is preparing a teaching plan for a patient who is prescribed a meglitinide. What instruction should the nurse include in the teaching plan for the patient? A. Avoid drug administration in the case of a skipped meal. B. Take the drug one hour before the meal. C. Report respiratory distress or muscular aches. D. Use commercial weight-loss products with the drug.

A. Avoid drug administration in the case of a skipped meal.

A 54-year-old male client is diagnosed with chronic renal failure and hyperglycemia. He asks if he can be prescribed sulfonylurea because it works well for his friend. If he were to be given sulfonylurea, this client's renal impairment may lead to what effect? A. Accumulation and hypoglycemia B. Accumulation and hyperglycemic reactions C. Decreased absorption of the sulfonylurea D. Hypersensitivity to sulfonylurea

A. Accumulation and hypoglycemia

Systemic mycoses are increasing due to:

-HIV (immunocompromised pt) -use of immunosuppressant drug for transplant pt -prolonged use of IV catheters -prosthetic implantations -broad spectrum antibiotic use

How do you pretreat a patient who is going to receive Amphotericin B?

-Infuse 1L of saline prior to administration or bolus pre/post infusion -Diphenhydramine and acetaminophen -Steroids if severe reaction

A client, being evaluated for diabetes, asks how a blood glucose test is used to diagnosis this disease. What is the nurse's best response? A. "A fasting blood sugar result of 126 mg/dL (6.99 mmol/L) or more on two separate occasions is diagnostic of diabetes." B. "A fasting blood sugar result of 100 mg/dL (5.55 mmol/L) or more on two separate occasions is diagnostic of diabetes." C. "A fasting blood sugar result of 100 mg/dL (5.55 mmol/L) or more and an A1C of more than 6 on two separate occasions are diagnostic of diabetes." D. "Two consecutive glycosylated hemoglobin (hemoglobin A1C) results of 6 or more are diagnostic of diabetes."

A. "A fasting blood sugar result of 126 mg/dL (6.99 mmol/L) or more on two separate occasions is diagnostic of diabetes."

A client with type 1 diabetes has been prescribed 12 units of regular insulin and 34 units of NPH insulin in the morning. How should the nurse explain why two different types of insulin are required to control the client's blood glucose? A. "The different onsets and peaks of the two types provide better overall glucose control." B. "NPH prevents regular insulin from being broken down in the body, allowing the use of a lower dose." C. "The combination negates the risk of adverse effects that would likely accompany a single, larger dose.." D. "NPH stimulate the pancreas to produce more insulin, while regular insulin provides your body's short term needs."

A. "The different onsets and peaks of the two types provide better overall glucose control." Rationale: Regular insulin will begin working within 30 to 60 minutes and peak within 2 to 4 hours and a 6- to 12-hour duration of action whereas NPH insulin has an onset of 60 to 90 minutes and peaks in 4 to 12 hours, with a 24-hour duration of action. By giving both drugs at once, the client gets rapid blood glucose control within 30 minutes from the regular insulin and the control lasts 24 hours due to NPH's long duration of action.

A patient with a recent diagnosis of type 2 diabetes has begun taking metformin. This drug will help the patient achieve adequate blood sugar control through all of the following mechanisms except? A. Binding excess glucose to adipose tissue B. Decreasing glucose production by the liver C. Improving insulin sensitivity D. Decreasing glucose absorption in the GI tract

A. Binding excess glucose to adipose tissue Rationale: Metformin decreases hepatic glucose production, decreases intestinal absorption of glucose, and improves insulin sensitivity by increasing peripheral glucose uptake and use in skeletal muscle and adipose tissue through increased transport of glucose across the cell membrane. It does not bind it to adipose tissue.

A diabetic patient is taking regular and NPH insulin to manage his diabetes. What is the best evaluation tool to measure the overall patient response to the insulin therapy? A. HgbA1C B. fasting blood glucose C. blood pressure D. bilirubin level

A. HgbA1C Rationale: HbAlc levels provide a 3-month average of glucose levels, which provides the best evaluation tool to measure of the overall patient response to the treatment plan.

A patient is experiencing chemotherapy-induced nausea. Which prescribed medication would be most effective for this patient? A. Ondansetron (Zofran) B. Prochlorperazine (Compazine) C. Dexamethasone (Decadron) D. Promethazine (Phenergan)

A. Ondansetron (Zofran)

What should be the nurse's initial response when a client diagnosed with type 1 diabetes suddenly reports feeling weak, shaky, and dizzy? A. Perform a blood sugar analysis. B. Have the client drink a 4-ounce glass of orange juice. C. Administer 1 ampule of 50% dextrose intravenously (IV). D. Administer 10 units of regular insulin subcutaneously (sub-Q).

A. Perform a blood sugar analysis. Rationale: As long as the client is awake and verbally responsive, check the blood glucose level first. Hypoglycemia can make a client feel weak, confused, irritable, hungry, or tired, but assessment must precede interventions; this makes the other options inappropriate.

Which condition must be met in order for glyburide treatment to be effective? A. The client must have functioning pancreatic beta cells. B. The client must have hemoglobin A1C of ≤7%. C. The client must not have hyperglycemia. D. The client must be able to self-administer the medication.

A. The client must have functioning pancreatic beta cells. Rationale: Because glyburide stimulates pancreatic beta cells to produce more insulin, it is effective only when functioning pancreatic beta cells are present.

Adverse reactions associated with sulfonylureas, such as glimepiride (Amaryl) include hypoglycemia, weight gain and hunger. A. True B. False

A. True

A patient is being treated with chemotherapy that causes bone marrow suppression. Which of the following is MOST important, valid point in patient education regarding infection control? A. avoid large crowds of people B. eat fresh fruits and vegetables, but only if they have been washed well under water C. take leftover antibiotics when you think you may be getting sick D. it's okay to receive some vaccinations

A. avoid large crowds of people Rationale: Fruits and vegetables must well peeled and well washed or cooked/boiled, but sometimes it's advised that fruits and veggies are avoided altogether. There should never be leftover antibiotics. MOST important is not that it's ok to receive some vaccines.

A client's current condition requires rapid reduction of blood sugar levels. Which type of insulin will have the most rapid onset of action? A. insulin lispro B. isophane (NPH) C. isophane (NPH) D. Humulin R

A. insulin lispro Rationale: Insulin lispro has a 15-minute onset of action. NPH, 70/30, and regular insulin have longer onsets of action, a later peak, and a longer duration of action.

A male patient is to begin glyburide (Diabeta) for type 2 diabetes. Before the drug therapy begins, a priority action by the nurse will be to assess the patient's A. use of alcohol B. blood pressure C. potassium level D. use of salt in his diet

A. use of alcohol Rationale: The nurse should assess the patient's alcohol consumption before therapy is initiated. Concomitant alcohol use increases the rate of glyburide metabolism and may cause a disulfiram-like reaction.

The nurse tells a client who has been prescribed Glucophage XR (metformin) the best time to take the medication. What response by the client indicates a good understanding of the teaching session? A. with the evening meal B. right before bed C. take it twice a day-lunch and dinner D. on an empty stomach

A. with the evening meal

"______________" anti-fungal drugs may be used as an alternative to amphotericin B for systemic mycoses

Azole

A client with a recent diagnosis of type 2 diabetes has begun taking metformin. This drug will help the client achieve adequate blood sugar control through which mechanisms? (Select all that apply) A. Binding excess glucose to adipose tissue B. Decreasing glucose production by the liver C. Improving insulin sensitivity D. Decreasing glucose absorption in the GI tract E. Increasing urinary excretion of glucose

B, C, D

A nurse is providing client education to a 13-year-old girl who was just diagnosed with type 1 diabetes mellitus. Which statement by the client will alert the nurse that special instructions regarding insulin are necessary? A. "I walk two blocks to school every day." B. "I am on the middle school track team." C. "We live in a two-story house." D. "My mother is going to give me my insulin."

B. "I am on the middle school track team." Rationale: Because the client is on the track team, she will have increased exercise at various times that will require increased insulin and special instructions related to hypoglycemia that may come hours after she has ceased exercising.

A nurse is caring for a 48-year-old woman who has been hospitalized after injecting the wrong type of insulin. Which sign of hypoglycemia will the nurse be careful to observe for? A. Dry skin B. Blurred vision C. Fruity breath D. Flushing of the face

B. Blurred vision Rationale: Blurred or double vision (diplopia), fatigue, trembling, irritability, headache, nausea, numbness, muscle weakness, hunger, tachycardia, sweating, and nervousness are signs of a hypoglycemic reaction.

The nurse is preparing to administer a mixture of 12 units regular insulin and 45 units NPH insulin to a client with a blood sugar of 378 mg/dL. After the nurse draws the medication into the syringe, what is the nurse's next action? A. Administer the insulin to the client. B. Check the dosage with another nurse. C. Check the client's blood sugar again. D. Ensure a meal tray is available.

B. Check the dosage with another nurse.

A patient's finger stick blood sugar level is 59 mg/dL. The patient is awake and oriented but states he feels "a little foggy." After rechecking the blood sugar and getting a similar reading, which action by the nurse is most appropriate? A. Give 2 packets of table sugar B. Give oral glucose in the form of a semisolid gel C. Give 50% dextrose IV push D. Give the morning dose of insulin.

B. Give oral glucose in the form of a semisolid gel

A client prescribed metformin is scheduled to undergo diagnostic testing with the administration of parenteral radiographic contrast media containing iodine. What fact should direct the nurse's plan of care for this client? A. The client will be prescribed an extra dose of metformin due to address the contrast material's effect on the body. B. Metformin should be discontinued at least 48 hours before and after diagnostic tests that use contrast medias. C. The client needs to be encouraged to drink 1 to 2 L of water to flush the contrast media out the kidneys. D. The metformin will be temporarily substituted for with insulin, to address the risk of potential kidney failure.

B. Metformin should be discontinued at least 48 hours before and after diagnostic tests that use contrast medias.

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? A. Change the client to oral antidiabetics. B. Prepare a week's supply of syringes and refrigerate. C. Have the client use a magnifying glass. D. Ask a neighbor to come over every day to prepare the medication.

B. Prepare a week's supply of syringes and refrigerate.

A 59-year-old man with type 2 diabetes is prescribed metformin. When the client returns to the clinic, he reports that he has lost 8 pounds in a month. How should the nurse respond? A. "We should really report this to your health care provider. The metformin dosage will need to be decreased." B. "We should really report this to your health care provider. The provider will likely change medications." C. "Please continue taking the medication and monitoring your weight. This is an expected outcome of this drug therapy." D. "You should discontinue this medication immediately. I will contact your health care provider."

C. "Please continue taking the medication and monitoring your weight. This is an expected outcome of this drug therapy." Rationale: The nurse should advise the client to continue therapy as prescribed because weight loss is a beneficial adverse effect for type 2 diabetics.

Which of the following patients would be a poor candidate for a glitazone such as rosiglitazone (Avandia)? A. A patient with elevated HDL (high density lipoproteins) B. A person with type 2 diabetes C. A patient with heart failure D. A patient with hypertension

C. A patient with heart failure

For appropriate absorption, into which site should insulin be injected? A. Vastus lateralis B. Gluteus maximus C. Abdomen D. Deltoid

C. Abdomen Rationale: All of the other choices are muscles. Insulin should be injected into subcutaneous fat. Injections in the abdomen provide the most consistent insulin levels and effects.

A patient receives 25 units of NPH insulin at 7 AM. At what time of day should the nurse advise the patient to be most alert for a potential hypoglycemic reaction? A. After breakfast B. Before lunch C. Late afternoon D. Bedtime

C. Late afternoon Rationale: After an early morning dose of NPH insulin, the patient should be alert for a possible hypoglycemic reaction during mid- to late afternoon. The lengthy peak action time produces additional risks for hypoglycemic reactions.

The nurse walks into the room of a client with type 1 diabetes and finds the client pale and diaphoretic. The client reports a headache and being hungry. Immediately, the client is unable to talk. What is the nurse's immediate intervention for this client? A. Administer regular insulin subcutaneously. B. Give 8 oz orange juice. C. Place glucose gel between the gums and cheek. D. Raise the head of the bed.

C. Place glucose gel between the gums and cheek. Rationale: The glucose gel would absorb through the client's mucous membranes and would be the optimal way to provide the client with sugar, since the client is no longer able to talk.

A type 1 diabetic patient on insulin reports taking propranolol, a beta-blocker, for hypertension. This provokes the concern that: A. The beta blocker can produce insulin resistance B. Propranolol will increase insulin requirements because of receptor blocking C. The beta blocker can mask the symptoms of hypoglycemia D. The two agents used together will increase the risk of ketoacidosis

C. The beta blocker can mask the symptoms of hypoglycemia

A client was diagnosed with type 2 diabetes several months ago and has presented for a scheduled follow-up appointment. Which stated behavior most clearly indicates that the client has established effective health maintenance? A. The client exercises two to three times per week. B. The client tells the nurse that he/she has gone on a diet. C. The client frequently checks his/her blood glucose levels. D. The client can describe the differences between type 1 and type 2 diabetes.

C. The client frequently checks his/her blood glucose levels. Rationale: Vigilant blood glucose monitoring is imperative in the management of diabetes. This shows effective health maintenance even more clearly than exercising.

A hospital client with a diagnosis of type 1 diabetes is prescribed Humulin R on a sliding scale. Based on the client's blood glucose reading, the nurse administered 8 units of insulin at 07:45. The nurse should consequently check the client's blood glucose level at what time to monitor peak effectiveness of the medication? A. 08:15 B. between 08:45 and 09:45 C. between 09:45 and 10:45 D. between 11:15 and 11:45

C. between 09:45 and 10:45 Rationale: Humulin R peaks between 2 and 3 hours after administration, so monitoring should occur between 09:45 and 10:45.

What outcome would best indicate the nurse's teaching of a client newly-diagnosed with diabetes was effective and that drug therapy is appropriate? A. The client can explain how to take the medication. B. The client demonstrates the correct procedure for monitoring blood sugar. C. The client follows an appropriate diet. D. Blood glucose level is stable with no diabetic complications.

D. Blood glucose level is stable with no diabetic complications.

Which of the following regarding different types of insulin preparations is INACCURATE? A. Insulin lispro: onset is 15-30 min, peak is 0.5-2.5 hours B. Regular insulin: onset 30-60 min, peak 1-5 hours C. NPH insulin: onset 60-120 min, peak 6-14 hours D. Insulin glargine: onset 70 min, peak 10 hours

D. Insulin glargine: onset 70 min, peak 10 hours

Which medication is used to promote gastric ulcer healing by providing a protective barrier? A. Cimetidine B. Misoprostol C. Omeprazole D. Sucralfate

D. Sucralfate

The nurse in the emergency department receives a conscious client following a motor vehicle accident who has no known history of diabetes but whose blood glucose level is 325 mg/dL. What rationale does the nurse provide explaining this elevated blood glucose level? A. The client's accident was caused by undiagnosed hyperglycemia B. The client may have sustained pancreatic trauma. C. The client most likely ate a meal just before the accident D. The client's stress reaction likely caused an increase in blood sugar.

D. The client's stress reaction likely caused an increase in blood sugar. Rationale: The stress reaction elevates the blood glucose concentration above the normal range. In severe stress situations, the blood glucose level can be very high (300 to 400 mg/dL). The body uses that energy to fight the insult or flee from the stressor.

AG is a 22 year old with type 1 diabetes on your unit for DKA. He is now on SC insulin and a regular diet. You check on him and find him unresponsive. After calling a rapid response, you check his glucose and it is 38. What's the most appropriate treatment?

IV dextrose

Amphotericin B route:

IV over 2-4 hours

What agents are administered via injection but are not insulin?

Incretin mimetic or GLP1 receptor agonists

"Azole" anti fungal drugs used systemically:

Itraconazole, fluconazole, ketoconazole

Which oral agents are least likely to cause weight gain?

Metformin

_____________ is in the same class as Amphotericin B, but it's only used orally, vaginally and topically for fungal infections d/t toxicity of IV dosing

Nystatin

"Azole" anti fungal routes:

PO, topical, IV

What should the nurse watch for when administering Amphotericin B?

hypokalemia, phlebitis (must use central line), leukopenia and thrombocytopenia

Which oral agents are most likely to cause hypoglycemia?

Sulfonylureas bc they make you produce insulin no matter what (even if you don't eat)

Explain why sulfonylureas and meglitinides are inappropriate to use in T1DM.

Sulfonylureas promote insulin release from beta cells and meglitinides stimulate insulin release

Which agents are generally unsafe to use in a patient with heart failure?

Thiazolidinediones (TZDs) because heart failure symptoms may get worse d/t pt. holding water

Amphotericin B MOA:

binds to sterols in the fungal cell membrane and disrupts the cell membrane

Amphotericin B causes human toxicity because it binds to _____________ on cells

cholesterols

T/F Everyone should have a bowel movement each day

false

"Azole" anti fungals shouldn't be used in patients with __________ __________. Why?

heart failure; cardiotoxic

Amphotericin B causes what adverse reactions

infusion reactions (fever, chills, rigors, N/V) and nephrotoxicity

Major disadvantage of "azole" anti fungal drugs:

inhibit P450 drug-metabolizing enzymes and can increase the levels of many other drugs

May check _________ _____________ before treatment with "azole" anti-fungals

liver enzymes

Amphotericin has drug-drug interactions with what type of drugs?

nephrotoxic drugs

Amphotericin B use:

progressive and potentially fatal systemic fungal infections

People can become dependent on the need to use a laxative and "clean out," which then can take them days to have a bowel movement. Patients often think they are constipated again and continue to take laxatives, what can this do?

reduce natural defecatory reflexes

When a patient is abusing laxatives, what should be recommended?

stop using laxatives and encourage patient to increase fluids and fiber

T/F Amphotericin B has a black box warning for risk of toxicity and shouldn't be used for routine fungal infections

true

T/F Amphotericin B is either fungicidal or fungistatic depending on the serum concentration

true

T/F Fungal infections are difficult to treat without harming the patient

true