Pharmacology Chapter 42: Cardiac Glycosides, Antianginals, and Antidysrhythmics, CH. 27 Antilipemic Drugs, Ch. 32 Antidiabetic Drugs, Pharm II Exam 2 study guide, Pharmacology Chapter 52: Antidiabetics

When teaching about hypoglycemia, the nurse will make sure that the patient is aware of the early signs of hypoglycemia, including

Confusion and sweating

The nurse will monitor for myopathy (muscle pain) when a patient is taking which class of antilipemic drugs?

HMG-CoA reductase inhibitors

The insulin order reads, "Give 10 units of NPH insulin and 5 units of regular insulin, subcut, every morning before breakfast." Choose the proper syringe for this injection.

Insulin syringe marked in units

A patient with elevated lipid levels has a new prescription for nicotinic acid (niacin). The nurse informs the patient that which adverse effects may occur with this medication?

Pruritus, cutaneous flushing

Pseudomembranous colitis

The nurse is managing care for a client prescribed a cephem antibiotic who is reporting frequent episodes of diarrhea. The nurse plans to monitor this client for:

Performing a culture prior to administering the first dose of the anti-infective

The nurse is preparing to administer a broad-spectrum antibiotic medication to a client. An important nursing intervention prior to administration of the anti-infective is:

Determine which antibiotic is most effective against the infecting microorganism.

The nurse sending a wound culture to the laboratory knows that the purpose of culture and sensitivity testing is to:

Penicillin

Which type of antibiotic carries the highest risk of an allergic response?

A patient who takes digoxin to treat heart failure will begin taking a vasodilator. The patient asks the nurse why this new drug has been ordered. The nurse will explain that the vasodilator is used to a. decrease ventricular stretching. b. improve renal perfusion. c. increase cardiac output. d. promote peripheral fluid loss.

a. decrease ventricular stretching.

A patient with chronic obstructive pulmonary disease (COPD) has increasing dyspnea and is being evaluated for heart failure (HF). Which test will be ordered to help differentiate between dyspnea due to lung dysfunction and dyspnea due to HF? a. Atrial natriuretic hormone (ANH) level b. Brain natriuretic peptide (BNP) level c. Cardiac enzymes d. Electrocardiogram (ECG)

b. Brain natriuretic peptide (BNP) level

The nurse is preparing to administer digoxin to a patient who has a serum digoxin level of 2.5 ng/mL. The patient takes 0.25 mg of digoxin per day. What action will the nurse take? a. Administer the next dose as ordered. b. Notify the provider of digoxin toxicity. c. Request an order to decrease the digoxin dose. d. Suggest that the patient may need an increased digoxin dose.

b. Notify the provider of digoxin toxicity.

A patient is concerned about the adverse effects of the fibric acid derivative she is taking to lower her cholesterol level. Which is an adverse effect of this class of medication?

Diarrhea

When monitoring a patient's response to oral antidiabetic drugs, the nurse knows that which laboratory result would indicate a therapeutic response?

Fasting blood glucose level between 70 and 100 mg/dL

Which action is most appropriate regarding the nurse's administration of a rapid-acting insulin to a hospitalized patient?

Give it within 15 minutes of mealtime

After starting treatment for type 2 diabetes mellitus 6 months earlier, a patient is in the office for a follow-up examination. The nurse will monitor which laboratory test to evaluate the patient's adherence to the antidiabetic therapy over the past few months?

Hemoglobin A1C level

A patient with risk factors for coronary artery disease asks the nurse about the "good cholesterol" laboratory values. The nurse knows that "good cholesterol" refers to which lipids?

High-density lipoproteins (HDLs)

The nurse is teaching patients about self-injection of insulin. Which statement is true regarding injection sites?

Rotate sites within the same location for about 1 week before rotating to a new location.

Selective Toxicity

The ability of an antibiotic to target pathogens without effects on human cells is termed:

Acquired Resistence

The ability of an organism to become unresponsive over time to an anti-infecttive is termed:

A patient has been diagnosed with metabolic syndrome and is started on the biguanide metformin (Glucophage). The nurse knows that the purpose of the metformin, in this situation, is which of these?

To decrease insulin resistance

A patient is taking a sulfonylurea medication for new-onset type 2 diabetes mellitus. When reviewing potential adverse effects during patient teaching, the nurse will include information about which of these effects? (Select all that apply.)

-Hypoglycemia -Nausea -Weight gain

Do not treat the diarrhea, and bring the child to the office.

The mother of a 4-yr old calls the nurse to report her child has been having diarrhea since be began taking an antibiotic 48 hours ago. What should the nurse instruct the mother to do?

monitor the client closely for hypersensitivity with the first dose.

The nurse is administering the first dose of ampicillin intramuscularly to a client with a servere infection. In addition to the six rights of med admin, an important priority nursing action is to:

.b. beta-lactamase inhibitor to prevent the excretion of penicillin

The nurse would explain that Augmentin is a combination drug containing the antibiotic amoxicillin and potassium clavulanate, which is a(n): a. secondary antibiotic b. beta-lactamase inhibitor to prevent the excretion of penicillin c. anti-inflammatory to prevent allergic reactions.

The nurse is teaching a group of patients about self-administration of insulin. What content is important to include?

When mixing insulins, the clear (such as regular) insulin is drawn up into the syringe first.

The full course of prescribed drug therapy must be completed

Which instruction should take priority in client teaching for any antibiotic therapy?

Central Nervous System

Which location is the most difficult to reach with antibiotic therapy?

The nurse knows to administer acarbose (Precose), an alpha-glucosidase inhibitor, at which time?

With the first bite of each meal.

9. A patient is ordered to receive insulin lispro at mealtimes. The nurse will instruct this patient to administer the medication at which time? a. 5 minutes before eating b. 15 minutes after eating c. 30 minutes before eating d. 10 minutes after eating

a. 5 minutes before eating

A patient who has type 2 diabetes mellitus asks the nurse why the provider has changed the oral antidiabetic agent from tolbutamide (Orinase) to glipizide (Glucotrol). The nurse will explain that glipizide a. has a longer duration of action. b. has fewer gastrointestinal side effects. c. may be taken on an as-needed basis. d. results in less hypoglycemic potential.

a. has a longer duration of action.

The nurse is teaching a patient who is newly diagnosed with type 1 diabetes mellitus about insulin administration. Which statement by the patient indicates a need for further teaching? a. "I may use a chosen site daily for up to a week." b. "I should give each injection a knuckle length away from a previous injection." c. "I will not be concerned about a raised knot under my skin from injecting insulin." d. "Insulin is absorbed better from subcutaneous sites on my abdomen.

c. "I will not be concerned about a raised knot under my skin from injecting insulin."

The nurse is caring for a patient who is taking digoxin to treat heart failure. The patient's electrocardiogram shows a ventricular dysrhythmia. The nurse will notify the provider and will anticipate an order for which medication? a. Digoxin immune Fab (Digibind) b. Furosemide (Lasix) c. Phenytoin (Dilantin) d. Potassium

c. Phenytoin (Dilantin)

The nurse performs a medication history and learns that the patient takes a thiazide diuretic and digoxin (Lanoxin). The nurse will question the patient to ensure that the patient is also taking which medication? a. Cortisone b. Lidocaine c. Nitroglycerin d. Potassium

d. Potassium

A patient is ordered to receive a nitrate to relieve stable angina. What side effect(s) will the nurse anticipate in a patient receiving this medication? a. Nausea and vomiting b. Increased blood pressure c. Pruritus and skin rash d. Pounding headache

d. Pounding headache

A patient who is overweight is being evaluated for diabetes. The patient has a blood glucose level of 160 mg/dL and a hemoglobin A1c of 5.8%. The nurse understands that this patient has which condition? a. Diabetes mellitus b. Hypoglycemia c. Normal blood levels d. Prediabetes

d. Prediabetes

b. Location of the infection

A client is admitted to the ER for an infection. The nurse recognizes that all of the following HOST factors that play a role in the selection of anti-infective therapy EXcept: a. status of immune system b. location of the infection c. history of allergic reactions d. results of the culture and sensitivity (C&S)

Delivers the medication directly to the site, resulting in lower doses and fewer systematic side effects

A client is learning metered-dose inhaler technique. The client says, " I dont understand why I have to use this thing. Can't I just take pills? The nurse responds that the inhalation route:

Albuterol (Proventil) beta agonist

A nurse is caring for several clients receiving bronchodilator therapy for asthma. The nurse has noted that some clients develop hyperglycemia during therapy. Which bronchodilator would the nurse consider problematic?

The nurse is reviewing a patient's medication list and notes that sitagliptin (Januvia) is ordered. The nurse will question an additional order for which drug or drug class?

insulin

A patient who has insulin-dependent diabetes mellitus must take a glucocorticoid medication for osteoarthritis. When teaching this patient, the nurse will explain that there may be a need to a. decrease the glucocorticoid dose. b. decrease the insulin dose. c. increase the glucocorticoid dose. d. increase the insulin dose.

d. increase the insulin dose.

A patient who has Wolff-Parkinson-White syndrome is given intravenous adenosine (Adenocard). The nurse will explain that the medication is effective because it a. controls atrial flutter. b. deepens myocardial excitability. c. prevents multifocal ventricular contractions. d. prolongs repolarization.

d. prolongs repolarization.

A patient who has begun taking nifedipine (Procardia) to treat variant angina has had a recurrent blood pressure of 90/60 mm Hg or less. The nurse will anticipate that the provider will a. add digoxin to the drug regimen. b. change to a beta blocker. c. order serum liver enzymes. d. switch to diltiazem (Cardizem).

d. switch to diltiazem (Cardizem).

The parent of a junior high-school child who has type 1 diabetes asks the nurse if the child can participate in sports. The nurse will tell the parent a. that strenuous exercise is not recommended for children with diabetes. b. that the child must be monitored for hyperglycemia while exercising. c. to administer an extra dose of regular insulin prior to exercise. d. to send a snack with the child to eat just prior to exercise.

d. to send a snack with the child to eat just prior to exercise.

The nurse is conducting a class about antilipemic drugs. The antilipemic drug ezetimibe (Zetia) works by which mechanism?

Inhibiting cholesterol absorption in the small intestine

The nurse is teaching a group of patients about management of diabetes. Which statement about basal dosing is correct?

"Basal dosing delivers a constant dose of insulin."

The nurse is reviewing instructions for a patient with type 2 diabetes who also takes insulin injections as part of the therapy. The nurse asks the patient, "What should you do if your fasting blood glucose is 47 mg/dL?" Which response by the patient reflects a correct understanding of insulin therapy?

"I will take an oral form of glucose."

When teaching a patient who is starting metformin (Glucophage), which instruction by the nurse is correct?

"Take the medication with food to reduce gastrointestinal (GI) effects."

A 75-year-old woman with type 2 diabetes has recently been placed on glyburide (Diabeta), 10 mg daily. She asks the nurse when the best time would be to take this medication. What is the nurse's best response?

"Take this medication in the morning, 30 minutes before breakfast."

Which of these characteristics are considered to be risk factors for coronary heart disease? (Select all that apply.)

-Being male, 45 years of age or older -Having an HDL level of 30 mg/dL -Having a history of diabetes mellitus

The nurse is administering lispro (Humalog) insulin and will keep in mind that this insulin will start to have an effect within which time frame?

15 Minutes

A patient in the emergency department was showing signs of hypoglycemia and had a fingerstick glucose level of 34 mg/dL. The patient has just become unconscious. What is the nurse's next action?

Administer intravenous glucose (50% dextrose).

While a patient is receiving antilipemic therapy, the nurse knows to monitor the patient closely for the development of which problem?

Liver Dysfunction

Benefit of receiving a nebulizer albuterol treatment

Suspension of the medication in liquid and delivery over a longer period increases the bronchodilators effectiveness

A patient reports having adverse effects with nicotinic acid (niacin). The nurse can suggest performing which action to minimize these undesirable effects?

Take an aspirin tablet 30 minutes before taking the drug.

0930

The patient will be receiving an IV antibiotic at 1000 which will take one hour to administer. At what time is the trough drawn?

Un-warranted use of antibiotics

The primary factor in the development of drug-resistant bacteria is the:

Less swelling and mucus formation, and decreased hyperresponsiveness to allergens.

The use of corticosteroid inhaler prior to discharge. The expected outcome of this therapy is:

The nurse receives the following order for insulin: IV NPH (Humulin NPH) 10 units. The nurse will perform which action? a. Administer the dose as ordered. b. Clarify the insulin type and route. c. Give the drug subcutaneously. d. Question the insulin dose.

b. Clarify the insulin type and route.

A patient asks the nurse why nitroglycerin is given sublingually. The nurse will explain that nitroglycerin is administered by this route for which reason? a. To avoid hypotension b. To increase absorption c. To minimize gastrointestinal upset d. To prevent hepatotoxicity

b. To increase absorption

The nurse is teaching a group of nursing students about diabetes. The nurse explains that which type of diabetes is the most common? a. Type 1 diabetes mellitus b. Type 2 diabetes mellitus c. Diabetes insipidus d. Secondary diabetes

b. Type 2 diabetes mellitus

A patient who is unconscious and has a pulse is brought to the emergency department. The patient is wearing a Medic-Alert bracelet indicating type 1 diabetes mellitus. The nurse will anticipate an order to administer a. cardiopulmonary resuscitation (CPR). b. glucagon. c. insulin. d. orange juice.

b. glucagon.

The nurse is teaching a patient about home administration of insulin. The patient will receive regular (Humulin R) and NPH (Humulin NPH) insulin at 0700 every day. What is important to teach this patient? a. "Draw up the medications in separate syringes." b. "Draw up the NPH insulin first." c. "Draw up the regular insulin first." d. "Draw up the medications after mixing them in a vial."

c. "Draw up the regular insulin first."

The nurse provides teaching for a patient who has a ventricular dysrhythmia who is prescribed acebutolol (Spectral) 200 mg twice daily. Which statement by the patient indicates understanding of the teaching? a. "Diuretics may decrease the effectiveness of this drug." b. "Dizziness, nausea, and vomiting indicate a severe reaction." c. "I should eat fruits and vegetables to increase potassium intake." d. "I should not stop taking this drug abruptly to avoid palpitations."

d. "I should not stop taking this drug abruptly to avoid palpitations."

The patient asks the nurse about storing insulin. Which response by the nurse is correct? a. "All insulin vials must be refrigerated." b. "Insulin will last longer if kept in the freezer." c. "Opened vials of insulin must be discarded." d. "Some combination pens do not require refrigeration."

d. "Some combination pens do not require refrigeration."

A patient who has heart failure receives digoxin (Lanoxin) and an angiotension-converting enzyme (ACE) inhibitor. The patient will begin taking spironolactone (Aldactone). The patient asks why the new drug is necessary. The nurse will tell the patient that spironolactone will be given for which reason? a. To enhance potassium excretion b. To increase cardiac contractility c. To minimize fluid losses d. To provide cardioprotective effects

d. To provide cardioprotective effects

A patient who has atrial fibrillation is taking digoxin. The nurse expects which medication to be given concurrently to treat this condition? a. Hydrochlorothiazide (HydroDIURIL) b. Inamrinone (Inocor) c. Milrinone (Primacore) d. Warfarin (Coumadin)

d. Warfarin (Coumadin)

Inhaled steroids are very useful in managing reactive airways, with a fairly good safety profile.

A client says, "I don't think I should be using steroids. I see steroids labeled as bed in the news at least once a week". The nurse's response is based on the fact that:

A patient who has type 2 diabetes is scheduled for an oral endoscopy and has been NPO (nothing by mouth) since midnight. What is the best action by the nurse regarding the administration of her oral antidiabetic drugs?

Contact the prescriber for further orders

The nurse is teaching a review class to nurses about diabetes mellitus. Which statement by the nurse is correct?

"Insulin therapy is possible during pregnancy if managed carefully."

A patient who has recently started therapy on a statin drug asks the nurse how long it will take until he sees an effect on his serum cholesterol. Which statement would be the nurse's best response?

"It takes 6 to 8 weeks to see a change in cholesterol levels."

Antilipemic drug therapy is prescribed for a patient, and the nurse is providing instructions to the patient about the medication. Which instructions will the nurse include? (Select all that apply.)

-Eat extra servings of raw vegetables and fruit. -Report abnormal or unusual bleeding or yellow discoloration of the skin. -Drug interactions are rare with antilipemics.

compensate for decreased dexterity

A client with degenerative arthritis is provided with a spacer along with a corticosteroid metered-dose inhaler. The nurse recognizes that the spacer assists this client to:

When reviewing patients' histories, the nurse recognizes that which patient would be a likely candidate for drug therapy for cholesterol reduction?

A patient who has coronary heart disease and an LDL level of 165 mg/dL

A patient has congestive heart failure and has been taking digoxin (Lanoxin) for 9 years. The patient is admitted with signs and symptoms of digoxin toxicity. Which signs and symptoms are associated with digoxin toxicity? (Select all that apply.) a. Dysuria b. Vomiting c. Tachycardia d. Yellow haloes in the visual field e. Diarrhea f. Insomnia

B, D, E

When teaching a patient who is beginning antilipemic therapy about possible drug-food interactions, the nurse will discuss which food?

Grapefruit juice

When administering morning medications for a newly admitted patient, the nurse notes that the patient has an allergy to sulfa drugs. There is an order for the sulfonylurea glipizide (Glucotrol). Which action by the nurse is correct?

Hold the drug, and check the order with the prescriber.

A patient calls the clinic office saying that the cholestyramine (Questran) powder he started yesterday clumps and sticks to the glass when he tries to mix it. The nurse will suggest what method for mixing this medication for administration?

Mix the powder with food or fruit, or at least 4 to 6 ounces of fluid.

The nurse is preparing to administer insulin intravenously. Which statement about the administration of intravenous insulin is true?

Only regular insulin can be administered intravenously.

A patient with a history of chronic obstructive pulmonary disease and type 2 diabetes has been treated for pneumonia for the past week. The patient has been receiving intravenous corticosteroids as well as antibiotics as part of his therapy. At this time, the pneumonia has resolved, but when monitoring the blood glucose levels, the nurse notices that the level is still elevated. What is the best explanation for this elevation?

The corticosteroids may cause an increase in glucose levels.

The client will report improved ease of breathing by discharge.

The nurse is collaboratively setting goals for the impatient management of new-onset asthma in a child. The nurse prioritizes the client's nursing diagnosis and gives which goal the highest priority?

A patient who has stable angina pectoris is given nitroglycerin to use as needed. In addition to pharmacotherapy, the nurse will give the patient which instruction? a. Avoid extremes in weather. b. Begin a rigorous exercise program. c. Drink glass of red wine daily. d. Seek medical care at first sign of pain.

a. Avoid extremes in weather.

The nurse administers a dose of digoxin (Lanoxin) to a patient who has heart failure and returns to the room later to reassess the patient. Which finding indicates that the medication is effective? a. Decreased dyspnea b. Decreased urine output c. Increased blood pressure d. Increased heart rate

a. Decreased dyspnea

A patient who has type 1 diabetes mellitus asks the nurse about using a combination insulin product such as Humalog 75/25. The nurse will tell the patient that use of this product a. depends on individual insulin needs. b. is useful for patient with insulin resistance. c. means less rotation of injection sites. d. requires refrigeration at all times.

a. depends on individual insulin needs.

A patient has administered regular insulin 30 minutes prior but has not received a breakfast tray. The patient is experiencing nervousness and tremors. What is the nurse's first action? a. Administer glucagon. b. Give the patient orange juice. c. Notify the kitchen to deliver the tray. d. Perform bedside glucose testing.

b. Give the patient orange juice.

The nurse is preparing to administer digoxin to a patient who has heart failure. The patient reports nausea, vomiting, and a headache. The nurse notes a respiratory rate of 18 breaths per minute, a heart rate of 58 beats per minute, and a blood pressure of 120/78 mm Hg. What will the nurse do next? a. Administer the next dose as ordered since these are mild side effects. b. Hold the dose and notify the provider of possible digoxin toxicity. c. Reassure the patient that these are common, self-limiting side effects. d. Request an order for an antiemetic and an analgesic medication.

b. Hold the dose and notify the provider of possible digoxin toxicity.

The nurse is teaching a patient about the use of a transdermal nitroglycerin patch. Which statement by the patient indicates understanding of the teaching? a. "I will apply the patch as needed when I experience anginal pain." b. "I will remove the old patch and replace it with a new one at bedtime each day." c. "I should rotate sites when changing the patch to prevent skin irritation." d. "When I am symptom-free, I may stop using the patch on a regular basis."

c. "I should rotate sites when changing the patch to prevent skin irritation."

A patient who has been taking a sulfonylurea antidiabetic medication will begin taking metformin (Glucophage). The nurse understands that this patient is at increased risk for which condition? a. Hypoglycemia b. Hyperglycemia c. Renal failure d. Respiratory distress

c. Renal failure

A patient develops type 2 diabetes mellitus. The nurse will explain that this type of diabetes a. is generally triggered by medications. b. is not as common as type 1 diabetes. c. is often related to heredity and obesity. d. will not require insulin therapy.

c. is often related to heredity and obesity.

A 45-year-old patient who is overweight has had a diagnosis of type 2 diabetes for 2 years. The patient uses 20 units of insulin per day. The patient's fasting blood glucose (FBG) is 190 mg/dL. The patient asks the nurse about using an oral antidiabetic agent. The nurse understands that oral antidiabetic agents a. cannot be used if the patient is overweight. b. cannot be used once a patient requires insulin. c. may be used since this patient meets criteria. d. may not be used since this patient's fasting blood glucose is too high.

c. may be used since this patient meets criteria.

The nurse is teaching a patient how to administer insulin. The patient is thin with very little body fat. The nurse will suggest injecting insulin a. by pinching up the skin and injecting straight down. b. in the abdomen only with the needle at a 90-degree angle. c. subcutaneously with the needle at a 45- to 60-degree angle. d. using the thigh and buttocks areas exclusively.

c. subcutaneously with the needle at a 45- to 60-degree angle.

Which statement by a patient who will begin using an external insulin pump indicates understanding of this device? a. "I will have an increased risk for hypoglycemia." b. "I will leave this on when bathing or swimming." c. "I will not need to count carbohydrates anymore." d. "I will still need to monitor serum glucose."

d. "I will still need to monitor serum glucose."

A patient is diagnosed with heart failure, and the prescriber has ordered digoxin. The patient asks what lifestyle changes will help in the management of this condition. The nurse will recommend which changes? a. Aerobic exercise and weight lifting 2 or 3 times weekly b. Changing from cigarette smoking to pipe smoking c. Consuming 2 teaspoons or less of salt every day d. Having no more than one alcoholic beverage per day

d. Having no more than one alcoholic beverage per day

The nurse will administer parenteral insulin to a patient who will receive a mixture of NPH (Humulin NPH) and regular (Humulin R). The nurse will give this medication via which route? a. Intradermal b. Intramuscular c. Intravenous d. Subcutaneous

d. Subcutaneous

A patient who uses transdermal nitroglycerin reports having headaches. The nurse will counsel the patient to perform which action? a. Call 911 when this occurs. b. Notify the provider. c. Reapply the patch three times daily. d. Take acetaminophen as needed.

d. Take acetaminophen as needed.

The nurse is teaching a patient about sublingual nitroglycerin administration. What information will the nurse include when teaching this patient? a. Call 911 if pain does not improve after three doses. b. If pain persists after one dose, administer a second dose. c. Swallow the tablet with small sips of water. d. Take the first tablet while sitting or lying down.

d. Take the first tablet while sitting or lying down.

A patient who has been taking nitroglycerin for angina has developed variant angina, and the provider has added verapamil (Calan) to the patient's regimen. The nurse will explain that verapamil is given for which purpose? a. To facilitate oxygen use by the heart b. To improve renal perfusion c. To increase cardiac contractility d. To relax coronary arteries

d. To relax coronary arteries

A patient tells the nurse that he likes to eat large amounts of garlic "to help lower his cholesterol levels naturally." The nurse reviews his medication history and notes that which drug has a potential interaction with the garlic?

warfarin (Coumadin)