Pharmacology Study Question Set: Test 3

An adolescent who has been prescribed prednisone (Meticorten) and vincristine (Oncovin) for leukemia tells the nurse that he is very constipated. What should the nurse cite as the probable cause of the constipation? 1 It is a side effect of the vincristine. 2 The spleen is compressing the bowel. 3 It is a toxic effect from the prednisone. 4 The leukemic mass is obstructing the bowel.

1. Constipation is a side effect of vincristine (Oncovin) because it slows gastrointestinal motility. An enlarged spleen will put pressure on the stomach and diaphragm, not on the large bowel. Constipation is not a toxic effect of prednisone (Meticorten). It is unlikely that leukemia is causing an obstruction.

A nurse prepares to administer metformin (Glucophage XR) to an older adult who has asked that it be crushed because it is difficult to swallow. The nurse explains that this drug cannot be crushed because it: 1 Is released slowly. 2 Is difficult to crush. 3 Irritates mucosal tissue. 4 Has an unpleasant taste if crushed.

1. The slow-release formulary will be compromised, and the client will not receive the entire dose if it is chewed or crushed. The capsules are not difficult to crush. Irritation of the mucosal tissue is not the reason the medication should not be crushed; however, this drug should be given with meals to prevent gastrointestinal irritation. Although taste could be a factor, it is not the priority issue.

An adolescent with type 1 diabetes who has a history of inadequate adherence to therapy is admitted to the hospital with a blood glucose level of 700 mg/dL. A continuous insulin infusion is started. What complication should the nurse make a priority of detecting while the adolescent is receiving the infusion? 1 Hypovolemia 2 Hypokalemia 3 Hypernatremia 4 Hypercalcemia

2. Insulin causes potassium to move into the cells along with glucose, thereby reducing the serum potassium level. Hypokalemia can lead to lethal cardiac dysrhythmias. Insulin does not result in reduced blood volume, alter the sodium level directly, or affect calcium mobilization.

A client with type 2 diabetes is taking one glyburide (Micronase) tablet daily. The client asks whether an extra pill should be taken before exercise. What is the nurse's best reply? 1 "You will need to decrease how much you are exercising." 2 "An extra pill will help your body use glucose when exercising." 3 "The amount of medication you need to take is not related to exercising." 4 "Do not take an extra pill because you may become hypoglycemic when exercising."

4. Exercise improves glucose metabolism; exercise is associated with a risk for hypoglycemia, not hyperglycemia; an additional antidiabetic agent is contraindicated. Exercise should not be decreased because it improves glucose metabolism. Also, this response does not answer the client's question. An extra tablet probably will result in hypoglycemia because exercise alone improves glucose metabolism. Control of glucose metabolism is achieved through balanced diet, exercise, and pharmacologic therapy.

A nurse is teaching a 10-year-old child with type 1 diabetes about insulin requirements. When should the nurse explain that insulin needs will decrease? 1 When puberty is reached 2 When infection is present 3 When emotional stress occurs 4 When active exercise is performed

4. Exercise reduces the body's need for insulin. Increased muscle activity accelerates transport of glucose into muscle cells, thus producing an insulin-like effect. With increased growth and associated dietary intake, the need for insulin increases during puberty. An infectious process may require increased insulin. Emotional stress increases the need for insulin.

Metformin (Glucophage) 2 g by mouth is prescribed for a client with type 2 diabetes. Each tablet contains 500 mg. How many tablets should the nurse administer? Record your answer using a whole number. _____ tablets.

First convert 2 g to its equivalent in mg by multiplying by 1000 (move the decimal 3 places to the right). 500x=2000 x=4 tablets

What should a nurse teach the client to do to avoid lipodystrophy when self-administering insulin therapy? 1 Exercise regularly. 2 Rotate injection sites. 3 Use the Z-track technique. 4 Avoid massaging the injection site.

2. Fibrous scar tissue can result from the trauma of repeated injections at the same site. Exercise is unrelated to lipodystrophy, but it reduces blood glucose, which decreases insulin requirements. Insulin is given subcutaneously; the Z-track technique is used with some intramuscular injections. Gentle pressure over the injection site after insulin administration promotes absorption.

A client with type 1 diabetes is diagnosed with diabetic ketoacidosis and initially treated with intravenous (IV) fluids followed by an IV bolus of regular insulin. The nurse anticipates that the health care provider will prescribe a continuous infusion of: 1 Novolin L insulin. 2 Novolin R insulin. 3 Novolin N insulin. 4 Novolin U insulin.

2. Regular insulin is the only insulin that is administered intravenously. Novolin L insulin cannot be administered intravenously. Novolin N insulin cannot be administered intravenously. Novolin U insulin cannot be administered intravenously.

A health care provider prescribes 36 units of NPH insulin (Novolin N) and 12 units of regular insulin (Novolin R). The nurse plans to administer these drugs in one syringe. Identify the steps in this procedure by listing the numbers by each picture next to the step below in priority order. (Start with the number of the picture that represents the first step and end with the number by the picture that represents the last step.)

Air should be injected into the NPH insulin vile first, which allows withdrawal of the NPH insulin at a later step in the procedure without having to instill air into the vial from a syringe that contains regular insulin. Instilling air into the regular insulin vile increases the pressure in the vile, facilitating removal of the required dose. Removing the desired dose of insulin while the needle is still in the vile reduces the risk of contamination by repeated punctures, and maintains the sharpness of the needle. Having the syringe contain regular insulin first prevents the need to withdraw the regular insulin into a syringe that contains NPH insulin and inadvertently contaminating the regular insulin vial with the longer-acting NPH insulin; contaminating regular insulin with NPH insulin will reduce the speed at which the regular insulin functions, which in turn will delay treatment of a hyperglycemic event. Finally, the required dose of NPH insulin can be removed from the NPH insulin vile.

A client newly diagnosed with type 2 diabetes is receiving glyburide (Micronase) and asks the nurse how this drug works. The nurse explains that glyburide: 1 Stimulates the pancreas to produce insulin 2 Accelerates the liver's release of stored glycogen 3 Increases glucose transport across the cell membrane 4 Lowers blood glucose in the absence of pancreatic function

1. Glyburide, an antidiabetic sulfonylurea, stimulates insulin production by the beta cells of the pancreas. Accelerating the liver's release of stored glycogen occurs when serum glucose drops below normal levels. Increasing glucose transport across the cell membrane occurs in the presence of insulin and potassium. Antidiabetic medications of the chemical class of biguanide improve sensitivity of peripheral tissue to insulin, which ultimately increases glucose transport into cells. Beta cells must have some function to enable this drug to be effective.

A 40-year-old male is prescribed Metformin XL (Glucophage) to control his type 2 diabetes mellitus. Which statement made by this client indicates the need for further education? 1"I will take the drug with food." 2 "I must swallow my medication whole and not crush or chew it." 3 "I will stop taking Metformin for 24 hours before and after having a test involving dye." 4 "I will notify my doctor if I develop muscular or abdominal discomfort."

3. Metformin must be withheld for 48 hours before the use of iodinated contrast materials to prevent lactic acidosis. Metformin is restarted when kidney function has returned to normal. Metformin is taken with food to avoid adverse gastrointestinal effects. If crushed or chewed, Metformin XL will be released too rapidly and may lead to hypoglycemia. Muscular and abdominal discomfort is a potential sign of lactic acidosis and must be reported to the health care provider.

A client with type 2 diabetes is admitted for elective surgery. The health care provider prescribes regular insulin even though oral antidiabetics were adequate before the client's hospitalization. The nurse concludes that regular insulin is needed because the: 1. Client will need a higher serum glucose level while on bed rest. 2. Possibility of acidosis is greater when a client is on oral hypoglycemics. 3 Dosage can be adjusted to changing needs during recovery from surgery. 4. Stress of surgery may precipitate uncontrollable periods of hypoglycemia.

3. There is better control of blood glucose levels with short-acting (regular) insulin. The level of glucose must be maintained as close to normal as possible. The occurrence of acidosis is greater when the client is receiving exogenous insulin. The stress of surgery will precipitate hyperglycemia, which is best controlled with exogenous insulin

A 16-year-old adolescent with recently diagnosed type 1 diabetes will receive NPH (Novolin N) insulin subcutaneously. The nurse teaches the adolescent about peak action of the drug and the risk for hypoglycemia. How many hours after the drug does the NPH peak? 1 1 to 2 hours 2 2 to 4 hours 3 5 to 10 hours 4 4 to 12 hours

4. NPH (Novolin N) insulin peaks in 4 to 12 hours; it has an onset time of 1½ to 4 hours and a duration of 18 to 24 hours. NPH insulin does not peak 1 to 2 hours, 2 to 4 hours, or 5 to 10 hours after administration.

An 8-year-old child is being given insulin glargine (Lantus) before breakfast. What is the most appropriate information for the nurse to give the parents concerning a bedtime snack? 1 Offer a snack to prevent hypoglycemia during the night. 2 Give the child a snack if signs of hyperglycemia are present. 3 Avoid a snack because the child is being treated with long-acting insulin. 4 Keep a snack at the bedside in case the child gets hungry during the night.

1. Insulin glargine is released continuously throughout the 24-hour period; a bedtime snack will prevent hypoglycemia during the night. Providing a snack when signs of hyperglycemia are present is unsafe because it intensifies hyperglycemia; if hyperglycemia is present, the child needs insulin. Because insulin glargine is a long-acting insulin, bedtime snacks are recommended to prevent a hypoglycemic episode during the night. When hypoglycemia develops, the child will be asleep; the snack should be eaten before going to bed.

The nurse is teaching an adolescent with type 1 diabetes about taking a combination of regular insulin (Novolin R) and an intermediate-acting insulin (Novolin N). The nurse asks the adolescent at what time of day the second dose of Novolin N should be administered. Which response by the adolescent demonstrates that the teaching has been understood? 1 At lunch 2 At dinnertime 3 1 hour after lunch 4 1 hour after dinner

2. The second dose of the intermediate-acting insulin (Novolin N) should be given at dinnertime. Novolin N insulin peaks in 4 to 12 hours. A second dose is often prescribed approximately 10 to 12 hours after the first dose. A blood glucose reading at bedtime will determine the evening dose of regular insulin (Novolin R). At lunch is too early because it may precipitate a hypoglycemic reaction. One hour after lunch is too early because it may precipitate a hypoglycemic reaction. One hour after dinner is too late.

A 13-year-old-child with type 1 diabetes is receiving 15 units of Novolin R insulin and 20 units of Novolin N insulin at 7 am each day. At what time should the nurse anticipate a hypoglycemic reaction from the Novolin N to occur? 1. Before noon 2 In the afternoon 3 Within 30 minutes 4 During the evening

C. Novolin N is an intermediate-acting insulin that peaks approximately 6 to 8 hours after administration. It was administered at 7 am, so between 1 and 3 pm is when the nurse should anticipate that a hypoglycemic reaction will occur. During the evening or night is when a reaction from a long-acting insulin is expected. Long-acting insulin has a small peak 10 to 16 hours after administration. Noon is when a reaction from a short-acting insulin is expected. Short-acting insulin peaks in 2 to 4 hours after administration. Within 30 minutes of administration is when a reaction from a rapid-acting insulin is expected. Rapid-acting insulin peaks 30 to 60 minutes after administration.