Pharmacology Exam 4 Practice Questions
A patient is taking insulin glargine injection daily. The nurse instructed the client that the onset of action will likely happen? A. 2-4 hours after administration B. 4-12 hours after administration C. 6-12 hours after administration D. 18-24 hours after administration
A. 2-4 hours after administration Insulin glargine is a long-acting insulin with an onset of 2-4 hours, no peak, and its duration of action is 24 hours.
A nurse is preparing to administer 150 units/hr of regular insulin to a client. Regular insulin is available at 1,500 units in 0.9% sodium chloride 500 mL. The nurse should set the IV pump to deliver how many mL/hr?
50 ml/hr
Which of the following medications decreases their action while taking thyroid hormone? A. Metformin B. Warfarin C. Zoloft D. Epinephrine
A. Metformin Correct Answer: A. Metformin Metformin, an oral hypoglycemic drug when taken with a thyroid hormone decreases their action. Options B, C, & D: Warfarin (an anticoagulant), Zoloft (an antidepressant), and Epinephrine (a sympathomimetic) increases their action when taken with a thyroid hormone.
A nurse is administering insulin glulisine 10 units subcutaneously at 0730 to an adolescent client who has type 1 diabetes mellitus. The nurse should anticipate the onset of action of the insulin at which of the following times? A. 0800 B. 0745 C. 0900 D. 1030
B. 0745 Insulin glulisine has a very short onset of action of 15 minutes. The nurse should expect the onset of action around 0745 and ensure the client eats breakfast immediately following the administration of the insulin.
Desmopressin acetate (DDAVP) is given to a patient with diabetes insipidus. Which of the following therapeutic response should you expect? A. Decreased blood pressure B. Decreased attention span C. Decreased urinary output D. Decreased blood sugar
C. Decreased urinary output
The nurse has provided education to a client prescribed cisplatin to treat ovarian cancer. Which client statement indicates that further teaching is required? A "I will avoid getting an intranasal flu vaccine." B "I will call my healthcare provider if I experience flu-like symptoms." C "I will make sure to monitor my urinary output." D "Bruising while receiving this medication is expected. I just need to give it more time to heal."
D: "Bruising while receiving this medication is expected. I just need to give it more time to heal." The statement indicates the client requires further teaching. Cisplatin is associated with an increased risk of bleeding due to the possible development of thrombocytopenia. The client should immediately report any bruising to the healthcare provider.
The nurse is discussing side effects with a client receiving intravenous vancomycin for the first time. Which instructions should the nurse include in the teaching? A "You need to ring your call bell if you feel constipated." B "Let me know immediately if you hear ringing in your ears or start itching." C "If you develop blurry vision or tingling in your hands, let us know." D "Please let me know if you develop a dry mouth or extreme thirst."
B "Let me know immediately if you hear ringing in your ears or start itching." Vancomycin is an antibiotic that can cause significant adverse reactions, such as ototoxicity (hearing loss or ringing in the ears) and nephrotoxicity (kidney damage). Ototoxicity can cause ringing in the ears and may indicate the client has suffered hearing loss. Itching and flushing often occur when vancomycin is administered too quickly, causing an anaphylactic reaction known as vancomycin flushing syndrome.
Four hours ago the nurse administered NPH insulin to a client diagnosed with type 1 DM. Which symptom indicating a side effect of the medication should the nurse monitor the client for now? A Diarrhea B Diaphoresis C Decreased urinary output D Myalgia
B. Diaphoresis NPH peaks at 4-14 hrs. So you want to monitor for symptoms of hypoglycemia - Fast heartbeat, Shaking, Sweating. Nervousness or anxiety, Irritability or confusion, Dizziness, Hunger.
A nurse is caring for a client who is receiving cefotetan 1 g via intermittent IV bolus every 12 hr to treat a postoperative infection. Which of the following manifestations should the nurse monitor for as an adverse effect of the medication? A. Disorientation B. Epistaxis C. Constipation D. Jaundice
B. Epistaxis Cefotetan is an antibiotic that affects vitamin K levels, which can result in bleeding and epistaxis. The nurse should monitor the client for bleeding and notify the provider if this manifestation occurs so the medication can be discontinued.
Glucotrol (glipizide) is prescribed to a patient with diabetes mellitus. The nurse instructed the patient to avoid which of the following? A. Soft drinks B. Whole grain cereals C. Alcohol D. Organ meats
C. Alcohol Correct Answer: C. Alcohol Alcohol when combined with glipizide, a disulfiram-like reaction (flushing, headache, and nausea) happens. In addition, large amounts of alcohol cause hypoglycemia. Options A, B, & D: Soft drinks, whole grain cereals, and organ meats are not to be avoided.
A nurse is caring for a client who is taking acarbose to treat type 2 diabetes mellitus. For which of the following adverse effects of this medication should the nurse monitor the client? A. Insomnia B. Diarrhea C. Joint pain D. Polycythemia
B. Diarrhea The most common adverse effects of acarbose, an alpha-glucosidase inhibitor, are gastrointestinal. They include diarrhea, abdominal distention and cramping, and flatulence.
A nurse is teaching a client who has type 2 diabetes mellitus about a prescription for insulin lispro. Which of the following statements should the nurse include in the teaching? A. "The effects of the insulin lispro can last for 8 to 12 hours." B. "Administer insulin lispro 30 to 60 minutes before eating." C. "Insulin lispro has an onset of about 15 minutes." D. "This insulin can be given as a continuous intravenous bolus."
C. "Insulin lispro has an onset of about 15 minutes." Insulin lispro is a rapid-acting insulin and has an onset of 15 to 30 minutes.
A nurse is providing instruction to a client who is prescribed with repaglinide (Prandin). All of which is true regarding this medication, except? A. Do not skip the dose when a meal is not taken B. Dizziness may occur while taking it C. Has quicker and shorter duration of action D. Used to treat type II diabetes mellitus
A. Do not skip the dose when a meal is not taken Correct Answer: A. Do not skip the dose when a meal is not taken Repaglinide (Prandin) is a meglitinide type of antidiabetic that has a quick onset of action which allows a client to take the medication with meals and skip a dose when a meal is skipped. Options B, C, & D: Repaglinide is an oral antihyperglycemic agent used for the management of type II diabetes. It has a fast onset and duration of action making it a good medication for treating postprandial blood glucose spikes. Since the medication causes changes in the blood sugar, a client may experience signs of hypoglycemia such as dizziness or lightheadedness.
Which of the following insulin cannot be mixed with any other type of insulin? A. Insulin glargine B. Insulin aspart C. Insulin isophane D. Insulin lispro
A. Insulin glargine Insulin glargine when mixed with any other types of insulin changes its duration of action ( a combination of long-acting and short-acting insulin) so it is advised that it should not be mixed with any other type of insulin.
Which of the following statements involving Type II diabetes mellitus is correct? A. It involves inefficient insulin production. B. It involves cessation of Insulin production by the beta cells of the pancreas. C. It involves increased insulin receptor responsiveness. D. It involves the infant client.
A. It involves inefficient insulin production.
A nurse is assessing a child who has acute lymphocytic leukemia and is receiving vincristine sulfate. Which of the following findings is the nurse's priority? A. Paresthesia B. Alopecia C. Stomatitis D. Constipation
A. Paresthesia The greatest risk to this client is neurotoxicity. Vincristine, a cell-cycle specific chemotherapy agent, interrupts cellular reproduction at mitosis and can cause neurotoxicity. An early finding with neurotoxicity is paresthesia (numbing) of the peripheral extremities. As neurotoxicity progresses, the client can develop autonomic and central nervous system dysfunction. The nurse should report paresthesia immediately, as the provider might change the dosage or the therapy.
A nurse is providing teaching to a client who has a new prescription for doxycycline. The nurse should instruct the client to monitor for which of the following adverse effects? A. Photosensitivity B. Constipation C. Ototoxicity D. Blurred vision
A. Photosensitivity Correct Answer: A. Photosensitivity An adverse effect of doxycycline, a tetracycline antibiotic, is photosensitivity. This makes skin react abnormally to light, especially ultraviolet radiation or sunlight. Prevention involves avoiding direct exposure to sunlight and ultraviolet light, wearing protective clothing outdoors, and using sunscreen.
A nurse is teaching a client who has type 1 diabetes mellitus about a new subcutaneous insulin infusion pump. Which of the following pieces of information should the nurse include in the teaching? A. Plan to use a type of short-duration insulin in the infusion pump B. Replace the infusion pump set every 4 days C. Turn off the infusion pump for at least 3 hours each day D. Move the infusion pump catheter 1.27 cm (0.5 in) away from the old site
A. Plan to use a type of short-duration insulin in the infusion pump The client should plan to use short-duration insulin such as regular, lispro, aspart, or glulisine insulin in the infusion pump to deliver a baseline infusion of insulin. The client should also administer bolus doses of insulin before each meal.
A nurse is caring for a client who is at 6 weeks of gestation and has just received a diagnosis of hyperthyroidism. The nurse should anticipate a prescription from the provider for which of the following medications? A. Propylthiouracil B. Liothyronine C. Methimazole D. Iodine-131
A. Propylthiouracil Correct Answer: A. Propylthiouracil This medication is used to treat hyperthyroidism during the first trimester of pregnancy because it does not cross the placental barrier well, posing little risk to the fetus. However, methimazole is the preferred medication in the second and third trimesters of pregnancy.
A nurse is caring for a client with diabetic ketoacidosis who has a prescription for an intravenous infusion of insulin. The nurse should document that which of the following types of insulin was administered intravenously to treat ketoacidosis? A. Regular insulin B. Insulin lispro C. Insulin aspart D. Insulin glargine
A. Regular insulin Treatment for diabetic ketoacidosis is directed at correcting hyperglycemia and acidosis. Therefore, the client's insulin levels are restored with an initial IV bolus of regular insulin followed by continuous infusion.
A nurse is teaching a client with type 2 diabetes mellitus about self-administration of a new prescription for acarbose. Which of the following pieces of information should the nurse include in the teaching? A. Tell the client to take the medication with food B. Show the client how to perform an intramuscular injection C. Advise the client to avoid taking this medication with insulin D. Warn the client against exercising while taking this medication
A. Tell the client to take the medication with food Correct Answer: A. Tell the client to take the medication with food Acarbose should be taken with food. The nurse should advise the client that this medication should be taken with the first bite of a meal 3 times each day. Acarbose inhibits an enzyme in the intestines that slows the digestion of carbohydrates and results in a lower postprandial increase of blood glucose levels. Incorrect Answers: B. Acarbose is administered by mouth, not by intramuscular injection. Therefore, the nurse does not need to demonstrate to the client how to perform an intramuscular injection. C. Acarbose can be used alone or in combination with insulin, metformin, or a sulfonylurea. D. Acarbose is indicated for clients who have type 2 diabetes mellitus and is to be used in conjunction with a program of diet modification and exercise.
A nurse is preparing to administer levothyroxine to a client who has hypothyroidism. The nurse should identify which of the following laboratory results as supporting the administration of this medication? A. Thyroid-stimulating hormone (TSH) 8 microunits/mL B. Free triiodothyronine (T3) 300 pg/dL C. Free thyroxine (T4) 7 mcg/dL D. Thyroxine-binding globulin 2.3 mg/dL
A. Thyroid-stimulating hormone (TSH) 8 microunits/mL Correct Answer: A. Thyroid-stimulating hormone (TSH) 8 microunits/mL The expected reference range for TSH is 0.3 to 5 microunits/mL. When a client has primary hypothyroidism, the TSH level becomes elevated in an attempt to normalize the thyroid gland's function. When the client has had a therapeutic response to treatment, the TSH level returns to the expected reference range.
A 58-year-old man is going to have chemotherapy for lung cancer. He asks the nurse how the chemotherapeutic drugs will work. The most accurate explanation the nurse can give is which of the following? A. "Cancer cells are susceptible to drug toxins." B. "Chemotherapy affects all rapidly dividing cells." C. "Chemotherapy encourages cancer cells to divide." D. "The molecular structure of the DNA is altered."
B. "Chemotherapy affects all rapidly dividing cells." Option B: There are many mechanisms of action for chemotherapeutic agents, but most affect the rapidly dividing cells—both cancerous and noncancerous. Cancer cells are characterized by rapid cell division.
A diagnosis of Hodgkin's disease was made to a 58- year old man and is admitted for the initial cycle of chemotherapy. During the hospitalization, the nurse should watch out for the following complication, except? A. Fertility problems B. Benign prostatic hyperplasia C. Secondary cancer D. Infection
B. Benign prostatic hyperplasia Correct Answer: B. Benign prostatic hyperplasia Option B: Hodgkin's disease (Hodgkin's lymphoma) is a type of cancer that affects the lymphatic system (bone marrow, spleen, liver, and lymph node tissue. Symptoms include painless swelling of a lymph node, recurrent fever, night sweats, pruritus, and unexplained weight loss. Prostate involvement is rare in Hodgkin's disease.
A nurse is caring for a client who has been taking taken metformin for 6 months. Which of the following findings should the nurse identify as an expected therapeutic effect of the medication? A. Decreased vitamin B12 levels B. Decreased blood glucose level C. Abdominal bloating and diarrhea D. Decreased LDL level
B. Decreased blood glucose level A client who has taken metformin for 6 months should experience the expected therapeutic effect of a decrease in blood glucose levels. Metformin is a non-insulin medication for clients who have type 2 diabetes mellitus.
The nurse is teaching a 17-year old client and the client's family about what to expect with high-dose chemotherapy and the effects of neutropenia. What should the nurse teach as the most reliable early indicator of infection in a neutropenic client? A. Dyspnea B. Fever C. Tachycardia D. Chills
B. Fever A patient with neutropenia has a decreased number of neutrophils. These cells are responsible for fighting off bacteria once they enter the body. A complication of neutropenia is infection. An early sign is a fever that requires clinical intervention to identify potential causes.
When a client is experiencing diabetic ketoacidosis, the insulin that would be administered is: A. Human NPH insulin B. Human regular insulin C. Insulin lispro injection D. Insulin glargine injection
B. Human regular insulin
A nurse is providing teaching to a client who has type 2 diabetes mellitus and a new prescription for metformin. Which of the following adverse effects of metformin should the nurse instruct the client to watch for and report to the provider? A. Weight gain B. Myalgia C. Hypoglycemia D. Severe constipation
B. Myalgia Correct Answer: B. Myalgia Myalgia, malaise, somnolence, and hyperventilation are manifestations of lactic acidosis, which rarely occur while taking metformin due to the blockage of lactic acid oxidation. The nurse should instruct the client to report these findings promptly to the provider.
A nurse is reviewing the laboratory results for a client who has a prescription for filgrastim. An increase in which of the following values indicates a therapeutic effect of this medication? A. Erythrocyte count B. Neutrophil count C. Lymphocyte count D. Thrombocyte count
B. Neutrophil count Filgrastim increases neutrophil production. It is given to treat neutropenia and reduce the risk of infection in clients who are receiving chemotherapy for cancer or who have undergone bone marrow transplant.
A nurse is monitoring the laboratory values of a male client who has leukemia and is receiving weekly chemotherapy with methotrexate via IV infusion. Which of the following laboratory values should the nurse report to the provider? A. BUN 18 mg/dL B. Platelets 78,000/mm^3 C. Hemoglobin 14.2 g/dL D. Aspartate aminotransferase (AST) 35 units/L
B. Platelets 78,000/mm^3 The nurse should monitor the platelet count of a client who is taking methotrexate because the medication can cause thrombocytopenia. This client's platelet count is very low and puts the client at risk of severe bleeding. The nurse should report this finding promptly to the provider.
The nurse initiates an infusion of intravenous (IV) penicillin G at 1500 to a client diagnosed with syphilis. Several minutes into the infusion, the nurse reviews the client's intake and output flow sheet and obtains a new set of vital signs. The nurse's findings are below. Based on the information provided, which is the priority action by the nurse? 1400: BP 129/79 HR 78 Respirations 20 1505: BP 90/60 HR 120 Respirations 22 Intake 1000ml Output 30 ml A. Continue the infusion at the current rate B. Stop the infusion and notify the provider C. Increase the rate of the infusion D. Document the findings and continue to monitor the client
B. Stop the infusion and notify the provider The significant drop in blood pressure from 129/79 to 90/60, along with an increase in heart rate from 78 to 120 beats per minute, suggests the development of an adverse reaction to the penicillin G infusion, such as an anaphylactic reaction, which is a medical emergency. The low urine output of 30 mL despite receiving 1000 mL of fluid also indicates a decrease in perfusion. Therefore, the infusion should be stopped immediately, and the healthcare provider should be notified of the findings for further management. Option A, C, and D are incorrect because continuing the infusion, increasing the rate, or documenting the findings would delay necessary medical interventions and put the client's safety at risk.
Drew is diagnosed with Type I diabetes mellitus. As a nurse taking care of the client, you should know that in his condition: A. Insulin is produced but is malformed. B. The beta cells of the pancreas stop producing insulin. C. The client cannot be treated. D. Diagnosis is made in clients over age 50.
B. The beta cells of the pancreas stop producing insulin. In type I diabetes mellitus, the beta cells stop producing insulin completely. T1DM is characterized by the destruction of beta cells in the pancreas, typically secondary to the autoimmune destruction of beta cells. The result is the absolute destruction of beta cells, and consequentially, insulin is absent or extremely low.
A nurse is giving discharge instructions to a patient who is taking Synthroid (levothyroxine). The nurse instructs the client to notify the physician if which of the following occurs? A. Cold intolerance B. Tremors C. Coarse, dry hair D. Muscle cramps
B. Tremors Excessive doses of levothyroxine can produce signs and symptoms of hyperthyroidism which includes heat tolerance, tremors, nervousness, tachycardia, chest pain, hyperthermia, and insomnia.
A nurse is teaching a patient on how to mix regular insulin and NPH insulin in the same syringe. Which of the following actions, if performed by the patient , indicates the need for further teaching? A. Withdraws regular insulin first B. Withdraws NPH insulin first C. Injects an amount of air equivalent to the desired dose of insulin D. Injects air into the NPH insulin first
B. Withdraws NPH insulin first Correct Answer: B. Withdraws NPH insulin first The regular insulin is drawn into the syringe first then the NPH, this will avoid contaminating the regular insulin vial with another type. Options A, C, & D: These are appropriate actions when preparing regular and NPH insulin.
The student nurse is preparing to administer exenatide to a client with type 2 diabetes mellitus (DM). The student nurse asks the nursing instructor, "How will this medication work to decrease blood sugar?" Which is the best response by the nursing instructor? A. "Exenatide fully blocks the absorption of glucose in the intestines." B. "Exenatide increases the gastric emptying of food." C. "Exenatide stimulates the secretion of insulin." D. "Exenatide decreases cravings for carbohydrates."
C. "Exenatide stimulates the secretion of insulin." C. "Exenatide stimulates the secretion of insulin." Exenatide is a medication classified as a glucagon-like peptide-1 (GLP-1) receptor agonist. It works by binding to the GLP-1 receptor, which stimulates insulin secretion from the pancreas in response to food intake. This increase in insulin helps to regulate blood sugar levels in clients with type 2 DM.
A male nurse is providing a bedtime snack for his patient. This is based on the knowledge that intermediate-acting insulins are effective for an approximate duration of: A. 6-8 hours B. 10-14 hours C. 14-18 hours D. 24-28 hours
C. 14-18 hours Intermediate-acting insulins include Humulin N and Novolin N. They have an onset of two to four hours, a peak of 4 to 12 hours, and a duration of 14 to 18 hours. They are absorbed more slowly, and last longer. They are also used to control the blood sugar overnight while fasting and between meals.
A nurse is caring for a client with a pseudomonas infection who has a new prescription for ticarcillin-clavulanate. Which of the following data should the nurse collect before administering this medication? A. Indications of superinfection B. Peak and trough medication levels C. Baseline BUN and creatinine D. History of allergy to aminoglycoside antibiotics
C. Baseline BUN and creatinine Ticarcillin-clavulanate is a penicillin antibiotic and is excreted by the kidneys. Therefore, any renal impairment could result in a toxic level of the medication. The nurse should assess baseline BUN and creatinine levels and monitor these values throughout therapy.
The nurse is assessing a client who has been taking linezolid to treat a Staphylococcus aureus infection. Which of the following findings should the nurse report to the provider? A. Nausea B. Headaches C. Paresthesias D. Insomnia
C. Paresthesias Although these reactions are rare, some clients who take linezolid develop irreversible peripheral neuropathy and reversible optic neuropathy. The nurse should report this finding to the provider because it might warrant switching the client to another antibiotic.
A nurse is teaching a newly licensed nurse about contraindications to ceftriaxone. A severe allergy to which of the following medications is a contraindication to ceftriaxone? A. Gentamicin B. Clindamycin C. Piperacillin D. Sulfamethoxazole-trimethoprim
C. Piperacillin Clients who have a severe allergy to piperacillin, which is a penicillin, can have a cross-sensitivity reaction to ceftriaxone, a third-generation cephalosporin. Ceftriaxone is contraindicated for a client who has an allergy to cephalosporins or a severe allergy to penicillin.
A nurse is providing discharge teaching to a client who has a bacterial infection about adverse effects of imipenem to report to the provider. Which of the following pieces of information should the nurse include? A. "Seizures can occur with this medication." B. "You should observe for manifestations of bleeding." C. "Check your hands and feet for sensory dysfunction." D. "This medication can increase the risk of ototoxicity."
Correct Answer: A. "Seizures can occur with this medication." The nurse should tell the client that seizures can occur when receiving imipenem. The client should notify the provider immediately if these occur. Incorrect Answers: B. Imipenem does not increase the client's risk of bleeding. However, other antibiotics can increase the risk of bleeding such as some cephalosporins. C. Imipenem does not cause sensory dysfunction. However, sensory dysfunction is an adverse effect of penicillin G intramuscular injections as a result of accidental injection of the medication into a peripheral nerve. D. Imipenem does not have an adverse effect of ototoxicity. However, aminoglycosides antibiotics can cause this adverse effect.
Nausea and vomiting are common adverse effects of radiation and chemotherapy. When should a nurse administer antiemetics? A. When therapy is completed B. Immediately after nausea begins C. With the administration of therapy D. 30 minutes before the initiation of therapy
D. 30 minutes before the initiation of therapy Option D: Antiemetics are most beneficial when given before the onset of nausea and vomiting. To calculate the optimum time for administration, the first dose is given 30 minutes to 1 hour before nausea is expected, and then every 2, 4, or 6 hours for approximately 24 hours after chemotherapy.
A client with diabetes insipidus is taking antidiuretic hormone. Which of the following symptoms would alert the need to decrease the dosage? A. Alopecia B. Jaundice C. Diarrhea D. Drowsiness
D. Drowsiness One of the side effects of taking antidiuretic hormone is water intoxication which is manifested by a headache, drowsiness, light-headedness, and shortness of breath. This could indicate the need to reduce the dosage.
A client with diabetes mellitus type I was prescribed with exenatide (Bydureon). The nurse will take which of the following appropriate actions? A. Withdraw the insulin from the prefilled pen into an insulin syringe B. Monitor for signs of nausea, vomiting, and gastric upset C. Administer the medication twice a day during pre-meals D. Hold the medication and call the physician to question the prescription
D. Hold the medication and call the physician to question the prescription Correct Answer: D. Hold the medication and call the physician to question the prescription Exenatide (Bydureon) is only used to treat diabetes mellitus type 2 only. Therefore, holding the medication and calling the physician to question the order. Option A: Prefilled pens are ready for injection. Options B & C: Although these are correct about the medication, it should not be administered in this kind of situation.
Joseph who had a history of long-term smoking and alcoholism is diagnosed with oropharyngeal cancer. He is admitted into the chemo unit for the initiation of chemotherapy. Which of the following tests is performed before the infusion of chemotherapeutic agents? A. Complete blood count (CBC) B. Peripheral blood smear C. Lumbar puncture D. Liver function test
D. Liver function test Option D: Liver and kidney function studies are done before the initiation of chemotherapy to evaluate the client's ability to metabolize the chemotherapeutic agents.
A nurse is teaching a client who has type 2 diabetes mellitus about storing unopened vials of insulin. Which of the following pieces of information should the nurse include in the teaching? A. Store the vials in the freezer B. Store the vials at room temperature C. Store the vials by a window D. Store the vials in the refrigerator
D. Store the vials in the refrigerator
Which of the following medications usually is given to a client with leukemia as prophylaxis against P. carinii pneumonia? A. Vincristine (Oncovin) B. Prednisone (Deltasone) C. Oral nystatin suspension D. Sulfamethoxazole and trimethoprim (Bactrim)
D. Sulfamethoxazole and trimethoprim (Bactrim) Option D: The most frequent cause of death from leukemia is an overwhelming infection. P. carinii infection is lethal to a child with leukemia. As prophylaxis against P. carinii pneumonia, continuous low doses of co-trimoxazole (Bactrim) are frequently prescribed.
A nurse is giving instructions to a patient who is taking levothyroxine (Synthroid). The nurse tells the client that the best time to take this medication is? A. During bedtime B. After lunch C. Taken with food D. Taken on an empty stomach
D. Taken on an empty stomach It is taken on an empty stomach usually before breakfast to enhance absorption.
A nurse is preparing to administer cisplatin IV to a client who has lung cancer. The nurse should identify that which of the following findings is an adverse effect of this medication? A. Hallucinations B. Pruritus C. Hand and foot syndrome D. Tinnitus
D. Tinnitus An adverse effect of cisplatin is ototoxicity, which can cause tinnitus.
A nurse is preparing to administer 100 units of insulin glargine and 4 units of NPH insulin subcutaneously to a client. Which of the following actions should the nurse plan to take? A. Verify with the provider about giving insulin glargine at 1700 B. Ensure the insulin glargine is a cloudy suspension C. Request a prescription for giving insulin glargine twice daily D. Use separate syringes for administering insulin glargine and NPH insulin
D. Use separate syringes for administering insulin glargine and NPH insulin The nurse should not mix insulin glargine with any other insulin. The nurse should administer the NPH insulin and insulin glargine separately.
Angela, a clinical instructor is conducting a lecture about chemotherapy. Which of the following statements is correct about the rate of cell growth in relation to chemotherapy? A. Faster growing cells are more susceptible to chemotherapy B. Faster growing cells are less susceptible to chemotherapy C. Slower growing cells are more susceptible to chemotherapy D. Non-dividing cells are more susceptible to chemotherapy
A. Faster growing cells are more susceptible to chemotherapy Option A: The faster the cell grows, the more susceptible it is to chemotherapy and radiation therapy.
An external insulin pump is prescribed for a client with DM. The client asks the nurse about the functioning of the pump. The nurse bases the response on the information that the pump: A. Gives a small continuous dose of regular insulin subcutaneously, and the client can self-administer a bolus with an additional dosage from the pump before each meal. B. It is timed to release programmed doses of regular or NPH insulin into the bloodstream at specific intervals. C. It is surgically attached to the pancreas and infuses regular insulin into the pancreas, which in turn releases the insulin into the bloodstream. D. It continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels.
A. Gives a small continuous dose of regular insulin subcutaneously, and the client can self-administer a bolus with an additional dosage from the pump before each meal.
The nurse is admitting a patient diagnosed with type 2 diabetes mellitus. The nurse should expect the following symptoms during an assessment, except: A. Hypoglycemia B. Frequent bruising C. Ketonuria D. Dry mouth
A. Hypoglycemia Hypoglycemia does not occur in type 2 diabetes unless the patient is on insulin therapy or taking other diabetes medication. In T2DM, the response to insulin is diminished, and this is defined as insulin resistance. During this state, insulin is ineffective and is initially countered by an increase in insulin production to maintain glucose homeostasis, but over time, insulin production decreases, resulting in T2DM.
A nurse is providing teaching about exercise to a client who has type 1 diabetes mellitus. Which of the following statements should the nurse include? A. "You should exercise during a peak insulin time." B. "Wear a medical alert identification tag when you exercise." C. "Exercise can decrease the effects of insulin and cause your blood glucose levels to increase." D. "You will get the most benefit from exercise when your glucose levels are higher than normal."
B. "Wear a medical alert identification tag when you exercise." Correct Answer: B. "Wear a medical alert identification tag when you exercise." The client should wear a medical alert identification tag in the event of a hypoglycemic response because exercise can potentiate the effects of insulin and cause blood glucose levels to decrease. Incorrect Answers: A. The client should avoid exercising within 1 hour of receiving insulin or at the peak time of insulin. This is because exercise can increase the absorption of insulin at the injection site and cause a marked drop in blood sugar at the insulin peak time. The client should plan to eat at least 1 hour before exercise and drink a carbohydrate liquid to decrease the risk of a hypoglycemic response. C. A client who exercises can potentiate the effects of insulin and cause the blood glucose levels to decrease. D. A client who has poorly controlled insulin-dependent diabetes mellitus should not exercise when blood glucose levels are >250 mg/dL or if ketones are noted in the urine; this is because there is an inadequate amount of insulin for transporting glucose.
Albert, a 35-year-old insulin-dependent diabetic, is admitted to the hospital with a diagnosis of pneumonia. He has been febrile since admission. His daily insulin requirement is 24 units of NPH. Every morning Albert is given NPH insulin at 0730. Meals are served at 0830, 1230, and 1830. The nurse expects that the NPH insulin will reach its maximum effect (peak) between the hours of: A. 1130 and 1330 B. 1330 and 1930 C. 1530 and 2130 D. 1730 and 2330
B. 1330 and 1930 The peak time of insulin is the time it is working the hardest to lower blood glucose. NPH insulin is an intermediate-acting insulin that has an onset of 1 to 3 hours after injection, peaks 4 to 12 hours later, and is effective for about 12 to 16 hours.
A client is taking NPH insulin daily every morning. The nurse instructs the client that the most likely time for a hypoglycemic reaction to occur is: A. 2-4 hours after administration B. 6-14 hours after administration C. 16-18 hours after administration D. 18-24 hours after administration
B. 6-14 hours after administration The peak time of insulin is the time it is working the hardest to lower blood glucose. NPH insulin is an intermediate-acting insulin that has an onset of 1 to 3 hours after injection, peaks 4 to 12 hours later, and is effective for about 12 to 16 hours.
Nurse Casey is studying insulin administration. She should be knowledgeable that regular insulin: A. Is slow acting B. Is used IV C. Is a suspended insulin D. Peaks in 6 to 12 hours
B. Is used IV Regular insulin is the only insulin preparation that can be administered IV. When administered intravenously, U-100 administration should be with close monitoring of serum potassium and blood glucose. Do not use if the solution is viscous or cloudy; administration should only take place if it is colorless and clear.
The nurse is preparing to administer doxycycline for the treatment of Lyme disease for a client assigned female gender at birth. Which lab result should the nurse consider prior to administering this medication? A. Coagulation profile B. Pregnancy test C. Thyroid function D. Urinalysis
B. Pregnancy Test Doxycycline is classified as a tetracycline antibiotic that can cause harm to a developing fetus, particularly during the first trimester of pregnancy. Therefore, it is crucial to confirm the absence of pregnancy before initiating doxycycline therapy in women of childbearing potential.
A nurse is caring for a client who has a new diagnosis of oral candidiasis after taking tetracycline for 7 days. The nurse should recognize that candidiasis is a manifestation of which of the following adverse effects? A. Allergic response B. Superinfection C. Renal toxicity D. Hepatotoxicity
B. Superinfection A superinfection can develop from fungal overgrowth due to the antibacterial effect of tetracycline. The nurse should monitor the client for manifestations of a superinfection such as soreness of the mouth and a swollen tongue.
The oncology nurse is preparing to administer bendamustine to a client diagnosed with an ovarian tumor. The client asks, "Can you remind me how this helps to treat my cancer?" Which is the best response by the nurse? A "Bendamustine shrinks the size of the ovarian tumor." B "Bendamustine protects the blood vessels by stopping the tumor from growing into them." C "Bendamustine damages the DNA, stopping the cells from reproducing." D "Bendamustine stimulates white blood cell production to help stop the cancer cells from reproducing."
C "Bendamustine damages the DNA, stopping the cells from reproducing." Bendamustine is an alkylating agent that works by causing damage to the DNA of cancer cells, which in turn leads to their death. It specifically damages the cancer cells' ability to replicate and reproduce. This helps to slow down or stop the growth of the cancer cells, leading to the shrinkage of tumors and a reduction in the size of cancerous masses.
The nurse is reviewing the medical and surgical history of a client with type 2 diabetes mellitus (DM) who was recently prescribed exenatide. The nurse should notify the healthcare provider of which condition in the client's medical history prior to administering this medication? A Systemic lupus erythematosus (SLE) B Epilepsy C Hypothyroidism D Asthma
C Hypothyroidism Exenatide is CI with thyroid conditions. It may cause increased risk for thyroid cancers.
A nurse is monitoring a client who has diabetes insipidus and was administered desmopressin. Which of the following findings should indicate to the nurse the client is experiencing an adverse effect of this medication? A. Thirst B. Nocturia C. Headache D. Heart palpitations
C. Headache Headaches are an indicator of the adverse effect of water intoxication, which can occur as a result of taking desmopressin. This medication causes fluid retention and places the client at risk of water intoxication.
Prednisone is prescribed for a client with diabetes mellitus who is using Humulin 70/30 daily. Which of the following prescription changes does the nurse expect during the medication therapy? A. An addition of an oral hypoglycemic medication B. Increased dosage of prednisone C. Increased dosage of humulin 70/30 D. Decreased dosage of humulin 70/30
C. Increased dosage of humulin 70/30 Correct Answer: C. Increased dosage of humulin 70/30 Prednisone, a glucocorticoid, can cause an increase in blood glucose level due to the ability of the liver to be resistant to insulin during the medication therapy, hence people with diabetes need to increase the dosage of their insulin.
A nurse is reviewing laboratory values for a client who reports fatigue and cold intolerance. The client has an increased thyroid-stimulating hormone (TSH) level and a decreased total T3 and T4 level. The nurse should anticipate a prescription for which of the following medications? A. Methimazole B. Somatropin C. Levothyroxine D. Propylthiouracil
C. Levothyroxine Levothyroxine replaces thyroid hormone for a client who has hypothyroidism. Laboratory values for hypothyroidism include an increased TSH level and decreased total T3 and T4 levels. Clinical manifestations of hypothyroidism include fatigue, cold intolerance, and a decreased body temperature and pulse.
A nurse is teaching self-administration of NPH insulin to a client who has type 2 diabetes mellitus. Which of the following instructions should the nurse include? A. Alternate injecting doses between the abdomen and the thigh B. Shake the vial before withdrawing the dosage C. Rotate injection sites within the same area D. Discard the vial if the insulin is cloudy
C. Rotate injection sites within the same area To prevent lipodystrophy, the client should rotate injection sites and keep them about 2.5 cm (1 in) apart within the same anatomical area.
A nurse is administering ciprofloxacin and phenazopyridine to a client who has a severe urinary tract infection (UTI). The client asks why both medications are needed. Which of the following responses should the nurse make? A. "Phenazopyridine decreases the adverse effects of ciprofloxacin hydrochloride." B. "Combining phenazopyridine with ciprofloxacin hydrochloride shortens the course of therapy." C. "The use of phenazopyridine allows the doctor to prescribe a lower dosage of ciprofloxacin hydrochloride." D. "Ciprofloxacin hydrochloride treats the infection, and phenazopyridine treats pain."
D. "Ciprofloxacin hydrochloride treats the infection, and phenazopyridine treats pain." Ciprofloxacin hydrochloride is a broad-spectrum quinolone antibiotic, and phenazopyridine is a bladder analgesic/anesthetic that relieves burning and pain in the bladder mucosa caused by bladder spasm and inflammation.
A nurse is caring for a client who developed hypoglycemia following an insulin injection. The client is conscious and responds appropriately to verbal stimuli. Which of the following medications should the nurse plan to administer first? A. Oral glucose tablet B. 50% dextrose intravenously C. Glucagon intramuscularly D. Epinephrine intravenously
A. Oral glucose tablet Correct Answer: A. Oral glucose tablet Evidence-based practice indicates that a client who has mild hypoglycemia and is conscious and able to swallow should receive an oral agent such as an oral glucose tablet. If the client is unresponsive to the oral glucose tablet, another, more invasive form of treatment can be initiated.
A nurse is providing teaching to a client who has a prescription for ciprofloxacin following exposure to anthrax. Which of the following statements by the client indicates that further teaching is required? A. "I will limit my intake of coffee, tea, and carbonated beverages." B. "I will wear a large-brim hat and long sleeves if I am out in the sun." C. "I will take the ciprofloxacin with an antacid if I get an upset stomach." D. "I will avoid taking ciprofloxacin along with dairy products."
C. "I will take the ciprofloxacin with an antacid if I get an upset stomach." Ciprofloxacin is an antibiotic prescribed for a wide range of serious skin infections and is also effective against inhalation anthrax. Taking ciprofloxacin with antacids can impair the absorption of the medication, reducing its effectiveness.
A nurse is teaching a client who has diabetes mellitus about a new prescription for pioglitazone. Which of the following statements should the nurse include in the teaching? A. "Monitor for hypoglycemia 6 hours after taking the medication." B. "This medication cannot be taken if you have a sulfa allergy." C. "This medication can be taken when using insulin." D. "This medication is effective for people with type 1 diabetes mellitus."
C. "This medication can be taken when using insulin." The client can take pioglitazone when using insulin because pioglitazone increases the cellular response to insulin, and insulin is needed in order for the medication to be effective.
A nurse is teaching a client who has been taking an NSAID to treat rheumatoid arthritis. During the client's first month checkup, the provider prescribed methotrexate to be added to the medication regimen. Which of the following statements should the nurse include in the teaching about the purpose of this change in the client's medication? A. "Your current medication was not strong enough to manage this condition." B. "Once your blood levels of methotrexate are within the therapeutic range, the NSAID will be discontinued." C. "This medication was added to delay the disease progression." D. "Treating this disease with 2 medications will help protect you from becoming treatment-resistant."
C. "This medication was added to delay the disease progression." The nurse should inform the client that the provider prescribed methotrexate to be added to the medication regimen along with an NSAID to delay the progression of the disease and to delay joint damage or deformity that can result from the disease.
Signs of hypoglycemia include: A. Fruity breath, thirst, flushed skin B. Diarrhea, itching, hypertension C. Anxiety, weakness, pallor, sweating D. Muscle ache, fever, thirst
C. Anxiety, weakness, pallor, sweating These are signs of hypoglycemia, along with restlessness, chills, confusion, nausea, hunger, tachycardia, weakness, or headache. Neurogenic signs and symptoms can either be adrenergic (tremor, palpitations, anxiety) or cholinergic (hunger, diaphoresis, paresthesias). Neurogenic symptoms and signs arise from sympathoadrenal involvement (either norepinephrine or acetylcholine release) in response to perceived hypoglycemia.
A nurse is performing an assessment on a newly admitted patient who is taking propylthiouracil (PTU) daily. The nurse suspects that the client has a history of? A. Addison's disease B. Cushing's syndrome C. Grave's disease D. Myxedema
C. Grave's disease Graves' disease is an autoimmune disease that is characterized by overactivity of the thyroid gland resulting in the excessive production of thyroid hormone. The primary goal of treatment for graves disease is to eliminate excess thyroid hormone and decrease the occurrence of long term complications. It includes antithyroid medications such as propylthiouracil (PTU) which inhibits the synthesis of thyroid hormone. Options A & B: These are disorders related to adrenal function. Option D: Myxedema indicates hypothyroidism.
A major side effect of insulin use that can be life threatening is: A. Hyperglycemia B. Stomach upset C. Hypoglycemia D. Tremors
C. Hypoglycemia Correct Answer: C. Hypoglycemia The action of insulin will lower glucose levels, which may prove fatal if levels drop too low. Hypoglycemia is, by far, the most common adverse effect of insulin therapy. The other adverse effects of insulin therapy include weight gain, and rarely electrolyte disturbances like hypokalemia, especially when used along with other drugs causing hypokalemia.
The nurse is preparing to administer piperacillin/tazobactam [also Amoxicillin-Clavulanic acid] intravenously to a client diagnosed with appendicitis. Which client statement should the nurse recognize as a possible contraindication to this medication? A. I stopped taking oral contraceptives last month B. I take 81 mg aspirin by mouth every morning C. I am allergic to ceftriaxone. I develop a rash all over my body. D. I was diagnosed with gastroesophageal reflux disease (GERD) last week
C. I am allergic to ceftriaxone. I develop a rash all over my body. Ceftriaxone is a cephalosporin, which is a beta-lactam antibiotic that acts like penicillin. Clients who are allergic to other classes of beta-lactam antibiotics should not be administered piperacillin/tazobactam. Piperacillin/tazobactam is a beta-lactam/beta-lactamase inhibitor which contains penicillin.
The student nurse is preparing to administer intravenous (IV) tigecycline to a client diagnosed with pneumonia. The nursing instructor asks, "How does this medication work to treat bacterial infection?" Which is the best response by the student nurse? A "Tigecycline slows down the bacteria's ability to grow larger." B "Tigecycline directly kills the existing bacteria." C "Tigecycline interferes with RNA synthesis of the bacteria." D "Tigecycline stops protein synthesis in the bacteria."
D "Tigecycline stops protein synthesis in the bacteria." Tigecycline is a broad-spectrum antibiotic that belongs to the tetracycline family. It works by inhibiting bacterial protein synthesis by binding to the bacterial ribosome, which leads to the inhibition of bacterial growth and replication.
A nurse is providing teaching about food choices to a client who has diabetes mellitus. Which of the following statements by the client indicates an understanding of the teaching? A. "I will need to eliminate sweet desserts from my diet." B. "I should avoid using sucralose in my coffee." C. "I should consume alcohol between meals in moderation." D. "I should replace white bread with whole-grain bread."
D. "I should replace white bread with whole-grain bread." Clients with diabetes mellitus have the same fiber requirements as the general population. Fiber content can be increased by substituting white bread, which is made with refined grains, with whole-grain bread, which retains the outer layer of the grain that is higher in fiber.
A nurse in a provider's office is assessing a client who has been taking amoxicillin for 10 days and reports diarrhea and cramping. The nurse should recognize that these manifestations occur secondary to which of the following adverse effects? A. Development of gastric ulcers B. Development of milk intolerance C. Allergic reactions to the medication D. Alterations in gastrointestinal flora
D. Alterations in gastrointestinal flora Correct Answer: D. Alterations in gastrointestinal flora The typical gastrointestinal flora are often destroyed by broad-spectrum antibiotics like amoxicillin, causing poor digestion and possible superinfection with other bacteria.
The client with cancer is receiving chemotherapy and develops thrombocytopenia. The nurse identifies which intervention is the highest priority in the nursing plan of care? A. Monitoring temperature B. Monitoring for pathological factors C. Ambulation three times a day D. Monitoring the platelet count
D. Monitoring the platelet count Option D: Thrombocytopenia indicates a decrease in the number of platelets in the circulating blood. A major concern is monitoring for and preventing bleeding.
Giving instructions for breast self-examination is particularly important for clients with which of the following medical problems? A. Ovarian cancer B. Endometrial polyps C. Cervical dysplasia D. A dermoid cyst
A. Ovarian cancer Option A: Clients with ovarian cancer are at increased risk for breast cancer. Breast self-examination supports early detection and treatment and is very important.
Glycosylated hemoglobin (HbA1C) test measures the average blood glucose control of an individual over the previous three months. Which of the following values is considered a diagnosis of pre-diabetes? A. 6.5-7% B. 5.7-6.4% C. 5-5.6% D. >5.6%
B. 5.7-6.4% Correct Answer: B. 5.7-6.4% Glycosylated hemoglobin levels between 5.7%-6.4% are considered as pre-diabetes. The hemoglobin A1c (glycated hemoglobin, glycosylated hemoglobin, HbA1c, or A1c) test is used to evaluate a person's level of glucose control. The test shows an average of the blood sugar level over the past 90 days and represents a percentage. Anyone with an HbA1c value of 5.7 % to 6.4 % is considered to be prediabetic
A nurse went to a patient's room to do routine vital signs monitoring and found out that the patient's bedtime snack was not eaten. This should alert the nurse to check and assess for: A. Elevated serum bicarbonate and decreased blood pH B. Signs of hypoglycemia earlier than expected C. Symptoms of hyperglycemia during the peak time of NPH insulin D. Sugar in the urine
B. Signs of hypoglycemia earlier than expected
A nurse administered an antibiotic 10 min ago to a client who is now reporting wheezing and swelling of the eyelids. Which of the following actions should the nurse perform first? A. Give oral corticosteroids B. Administer dopamine C. Give diphenhydramine IV D. Administer epinephrine subcutaneously
D. Administer epinephrine subcutaneously Evidence-based practice indicates the nurse should first administer epinephrine, a catecholamine, which constricts blood vessels, increases cardiac output, and dilates bronchiole passages. Epinephrine is the first-line medication to administer for anaphylaxis and can be administered subcutaneously or via an IV or endotracheal tube. Other early signs of anaphylaxis are often related to the skin, characterized by warmth, redness, itching, hives, and swelling of the head and neck.
A nurse is caring for a client who has a new prescription for amphotericin B. The nurse should plan to monitor the client for which of the following adverse effects? A. Hyperkalemia B. Hypertension C. Constipation D. Nephrotoxicity
D. Nephrotoxicity Amphotericin B is an antifungal medication used to treat severe fungal infections; however, it can cause nephrotoxicity. The nurse should monitor the client's creatinine every 3 to 4 days and increase fluid intake. The dosage of amphotericin B should be reduced if the client's creatinine is 3.5 mg/dL or greater.
A client with type 1 diabetes mellitus calls the nurse to report recurrent episodes of hypoglycemia with exercise. Which statement by the client indicated an inadequate understanding of the peak action of NPH insulin and exercise? A. "The best time for me to exercise is every afternoon." B. "The best time for me to exercise is right after I eat." C. "The best time for me to exercise is after breakfast." D. "The best time for me to exercise is after my morning snack."
A. "The best time for me to exercise is every afternoon." Correct Answer: A. "The best time for me to exercise is every afternoon." A hypoglycemic reaction may occur in response to increased exercise. Clients should avoid exercise during the peak time of insulin. NPH insulin peaks at 6-14 hours; therefore afternoon exercise will occur during the peak of the medication.
Vasopressin is which of the following pituitary hormones? A. Antidiuretic hormone B. Desmopressin acetate C. Oxytocin D. ACTH
A. Antidiuretic hormone Vasopressin is an antidiuretic hormone. Vasopressin or antidiuretic hormone (ADH) or arginine vasopressin (AVP) is a nonapeptide synthesized in the hypothalamus. Science has known it to play essential roles in the control of the body's osmotic balance, blood pressure regulation, sodium homeostasis, and kidney functioning. ADH primarily affects the ability of the kidney to reabsorb water; when present, ADH induces expression of water transport proteins in the late distal tubule and collecting duct to increase water reabsorption.
