Pharm Exam 3 Practice NCLEX style questions

In the administration of a drug such as levothyroxine (Synthroid), the nurse should teach the client: A) That therapy typically lasts about 6 months. B) That weekly laboratory tests for T4 levels will be required. C) To report weight loss, anxiety, insomnia, and palpitations. D) That the drug may be taken every other day if diarrhea occurs.

C) To report weight loss, anxiety, insomnia, and palpitations.

The nurse giving Humulin R 20 U at 7 AM is aware that this drug will peak in: 1. 15 minutes. 2. 30 minutes. 3. 1 hour. 4. 2 hours.

Humulin R has its onset in about 15 minutes, but its peak is in 2 hours.

The nurse recognizes that opioid analgesics exert their action by interacting with a variety of opioid receptors. Drugs such as morphine act by activating

Mu and kappa

Blood sugar is well controlled when Hemoglobin A1C is: a. Below 7% b. Between 12%-15% c. Less than 180 mg/dL d. Between 90 and 130 mg/dL

a. Below 7% A1c measures the percentage of hemoglobin that is glycated and determines average blood glucose during the two to three months prior to testing. Used as a diagnostic tool, A1C levels of 6.5% or higher on two tests indicate diabetes. A1C of 6% to 6.5% is considered prediabetes.

A nurse caring for a patient who has diabetic ketoacidosis recognizes which of these characteristics in the patient? (Select all that apply.) A) Occurs mainly in type 2 diabetes patients B) Altered fat metabolism leading to ketones C) Arterial blood pH of 7.35 to 7.45 D) Sudden onset, triggered by acute illness E) Plasma osmolality of 300 to 320 milliosmoles/L

B D E

A patient with newly diagnosed type 2 diabetes mellitus asks the nurse what "type 2" means in relation to diabetes. The nurse explains to the patient that type 2 diabetes differs from type 1 diabetes primarily in that with type 2 diabetes a. the patient is totally dependent on an outside source of insulin. b. there is decreased insulin secretion and cellular resistance to insulin that is produced. c. the immune system destroys the pancreatic insulin-producing cells. d. the insulin precursor that is secreted by the pancreas is not activated by the liver.

B Rationale: In type 2 diabetes, the pancreas produces insulin, but the insulin is insufficient for the body's needs or the cells do not respond to the insulin appropriately. The other information describes the physiology of type 1 diabetes.

The nurse is teaching a patient who is newly diagnosed with epilepsy about her disease. Which statement made by the nurse best describes the goals of antiepilepsy medication therapy? A) "With proper treatment we can completely eliminate your seizures." B) "Our goal is to reduce your seizures to an extent that helps you live a normal life." C) "Epilepsy medication does not reduce seizures in most patients." D) "These drugs will help control your seizures until you have surgery."

B) "Our goal is to reduce your seizures to an extent that helps you live a normal life." Epilepsy is treated successfully with medication in a majority of patients. However, the dosages needed to completely eliminate seizures may cause intolerable side effects. Neurosurgery is indicated only for patients in whom medication therapy is unsuccessful.

Untreated hyperglycemia may lead to all of the following complications except: a. Hyperosmolar syndrome b Vitiligo c. Diabetic ketoacidosis d. Coma

B. Excessively high blood sugar or prolonged hyperglycemia can cause diabetic ketoacidosis, the condition in which the body breaks down fat for energy and ketones spill into the urine. Diabetic hyperosmolar syndrome occurs when blood sugar is excessively high and available insulin is ineffective. In this case, the body cannot use glucose or fat for energy and glucose is excreted in the urine. Without immediate medical attention, both conditions may result in coma or death.

The nurse is caring for a patient whose seizures are characterized by a 10- to 30-second loss of consciousness with mild symmetric eye blinking. Which seizure type does this most closely illustrate? A) Tonic-clonic B) Absence C) Atonic D) Myoclonic

B) Absence This scenario accurately describes absence seizures. Tonic-clonic seizures present with convulsions and muscle rigidity followed by muscle jerks. Patients may experience urinary incontinence and loss of consciousness. Atonic seizures cause sudden loss of muscle tone. Myoclonic seizures present with sudden muscle contractions that last but a second.

A patient admitted to the hospital with a diagnosis of pneumonia asks the nurse, "Why am I receiving codeine? I don't have any pain." The nurse's response is based on the knowledge that codeine also has which effect? A) Immunostimulant B) Antitussive C) Expectorant D) Immunosuppressant

B) Antitussive Codeine provides both analgesic and antitussive therapeutic effects.

The nurse is planning care for a patient receiving morphine sulfate (Duramorph) by means of a patient-controlled analgesia (PCA) pump. Which intervention may be required because of a potential adverse effect of this drug? A) Administer cough suppressant. B) Insert Foley catheter. C) Administer antidiarrheal. D) Monitor liver function tests.

B) Insert Foley catheter. Morphine can cause urinary hesitancy and urinary retention. If bladder distention or the inability to void is noted, the prescriber should be notified. Urinary catheterization may be required. Morphine acts as a cough suppressant and an antidiarrheal, so neither of those drugs would need to be administered to counteract an adverse effect of morphine. Liver toxicity is not a common adverse effect of morphine.

A 20-year-old client presents to the clinic with complaints of breast tenderness, nausea, vomiting, and absence of menses for 2 months. She has a history of a seizure disorder well controlled with carbamazepine (Tegretol). She tells the nurse that she has been taking her oral contraceptives as directed, but she wonders if she might be pregnant. The nurse's best response to her concern should be which of the following? A. "You can't be pregnant if you have been taking your oral contraceptives correctly." B. "Carbamazepine can decrease the effectiveness of oral contraceptive drugs, so we need to do a pregnancy test." C. "There is no need to worry. Oral contraceptives are very effective." D. "Taking antiseizure drugs with oral contraceptives significantly decreases your risk of getting pregnant."

B. "Carbamazepine can decrease the effectiveness of oral contraceptive drugs, so we need to do a pregnancy test.

During a clinic visit 3 months following a diagnosis of type 2 diabetes, the patient reports following a reduced-calorie diet. The patient has not lost any weight and did not bring the glucose-monitoring record. The nurse will plan to obtain a(n) a. fasting blood glucose level. b. urine dipstick for glucose. c. glycosylated hemoglobin level. d. oral glucose tolerance test.

C Rationale: The glycosylated hemoglobin (Hb A1C) test shows the overall control of glucose over 90 to 120 days. A fasting blood level indicates only the glucose level at one time. Urine glucose testing is not an accurate reflection of blood glucose level and does not reflect the glucose over a prolonged time. Oral glucose tolerance testing is done to diagnose diabetes, but is not used for monitoring glucose control once diabetes has been diagnosed.

11. A nurse is preparing the client's morning NPH insulin dose and notices a clumpy precipitate inside the insulin vial. The nurse should: A. draw up and administer the dose B. shake the vial in an attempt to disperse the clumps C. draw the dose from a new vial D. warm the bottle under running water to dissolve the clump

C. The nurse should always inspect the vial of insulin before use for solution changes that may signify loss of potency. NPH insulin is normally uniformly cloudy. Clumping, frosting, and precipitates are signs of insulin damage. In this situation, because potency is questionable, it is safer to discard the vial and draw up the dose from a new vial.

The nurse is creating a pain management plan for a client with a previous history of substance abuse. Which of the following should be included in this plan? a.) Ask the physician to prescribe short-acting analgesics. b.) Ask the physician to prescribe a medication similar to the one the client abused. c.) Ask the physician to prescribe all analgesics for the oral route. d.) Keep a dose of Narcan at the bedside.

C.) Ask the physician to prescribe all analgesics for the oral route. Extended-release and long-acting analgesics are recommended for clients with a history of abuse. Specific interventions should avoid analgesics similar to the abused drug, utilize long-acting analgesics, avoid Narcan, and administer medications through the oral route.

Myxedema, which includes fatigue, general weakness, and muscle cramps, is a symptom of which endocrine disorder treated with levothyroxine (Synthroid)? a. Hyperthyroidism b. Hypothyroidism c. Cushing's syndrome d. Addison's disease

b. Hypothyroidism

Which of the following regimens offers the best blood glucose control for persons with type 1 diabetes? a. A single anti-diabetes drugs b. Once daily insulin injections c. A combination of oral anti-diabetic medications d. Three or four injections per day of different types of insulin.

D. Three or four injections per day of different types of insulin. Because persons with type 1 diabetes do not produce insulin, they require insulin and cannot be treated with oral anti-diabetic drugs. Several injections of insulin per day, calibrated to respond to measured blood glucose levels, offer the best blood glucose control and may prevent or postpone the retinal, renal, and neurological complications of diabetes.

The client is prescribed ketorolac tromethamine (Toradol) for treatment of pain following a surgical procedure. The nurse should question which of the following drug orders? a.) Toradol 10 mg p.o. b.i.d. b.) Toradol 20 mg p.o. b.i.d c.) Toradol 5 mg p.o. t.i.d. d.) Toradol 20 mg p.o q.i.d

b.) Toradol 20 mg p.o. b.i.d The maximum daily dose of Toradol is 40 mg.

An elderly client had abdominal surgery six hours earlier. When the nurse asks the client about pain, the client responds that there is none. The best intervention on the part of the nurse is: a. Administer a PRN dose of IV pain medication as ordered. b. Assist the client into a sitting position in preparation for ambulation. c. Question the client further about discomfort to assess the meaning of pain. d. Assess the abdominal dressing and consult the surgeon about findings.

c. Question the client further about discomfort to assess the meaning of pain.

The safest narcotic choice for an elderly client with acute pain is: a. Meperidine (Demerol). b. Oxycodone. c. Fentanyl transdermal patch. d. Morphine sulfate.

d. Morphine sulfate. Rationale: Morphine is the "gold standard" of narcotics for acute pain. The other choices are incorrect.

A young woman makes an appointment to see a physician at the clinic. She complains of tiredness, weight gain, muscle aches and pains, and constipation. The physician will likely order: 1. T3 and T4 serum level laboratory tests. 2. glucose tolerance test. 3. cerebral computed tomography (CT) scan. 4. adrenocortical stimulating test.

1. T3 and T4 serum level laboratory tests. These complaints are strongly suggestive of thyroid disorder; T3 and T4 laboratory tests are the most useful diagnostic tests.

A patient has come into the emergency room with her friend. Her friend states that she had been acting very strangely and confused. The friend states that the patient has diabetes and takes insulin. The nurse knows that signs and symptoms of hypoglycemia include: 1. slow pulse rate and low blood pressure. 2. irritability, anxiety, confusion, and dizziness. 3. flushing, anger, and forgetfulness. 4. sleepiness, edema, and sluggishness.

2. irritability, anxiety, confusion, and dizziness When blood sugar levels fall, hormones are activated to increase serum glucose. One of the hormones is epinephrine, which causes these symptoms.

The patient has been admitted with hyperglycemic hyperosmolar nonketotic syndrome (HHNKS). Her blood glucose level is very high (880 mg/dL on admission). The physician believes that her condition is to the result of large amounts of glucose solutions administered intravenously during kidney dialysis. The nurse would anticipate that the patient would exhibit: 1. a fruity breath and high level of ketones in her urine. 2. severe dehydration and hypernatremia caused by the hyperglycemia. 3. exactly the same symptoms and signs as diabetic ketoacidosis. 4. Kussmaul's respirations, nausea, and vomiting.

2. severe dehydration and hypernatremia caused by the hyperglycemia. IV solutions containing glucose will bypass the digestive system, so there is no trigger for the pancreas to release insulin, but there is just enough insulin to prevent the breakdown of fatty acids and the formation of ketones.

Two days after surgery, an elderly client refuses a PRN dose of analgesic dose for fear of becoming "hooked." The nurse should respond by stating that: a. It is impossible to become hooked on PRN narcotics. b. Short-term use of narcotics is not likely to cause a person to become dependent on them. c. Side effects that occur in the elderly mean that medications will be discontinued as soon as possible. d. The elderly are least likely to become dependent on narcotics.

b. Short-term use of narcotics is not likely to cause a person to become dependent on them.

The patient, newly diagnosed with hypothyroidism, seems very anxious to begin her drug regimen. The nurse's instructions include: 1. "Be certain that no dose is skipped." 2. "If a dose is skipped one day, double the dose the next day." 3. "Know the signs and symptoms of hyperthyroidism." 4. "You will be able to notice the benefits of thyroid replacement therapy right away."

3. "Know the signs and symptoms of hyperthyroidism." Her enthusiasm may lead her to overdose on the thyroid replacement pills. She needs to be aware of the proper prescription and the reasons for following the prescribed dosage.

The patient asks about his lab test, which showed a high level of TSH and a low level of T4. You explain: 1. "It means that you have an inconsistency in your thyroid tests, and you will need more testing." 2. "I am sorry. You will have to ask your doctor about your lab results. We are not allowed to discuss them." 3. "The TSH is sending a message to your thyroid gland to increase production, but your thyroid isn't doing that." 4. "That means that you will have to go on hormone therapy for the rest of your life."

3. "The TSH is sending a message to your thyroid gland to increase production, but your thyroid isn't doing that." The test determines if the problem is in the pituitary or in the thyroid. In this case the high TSH is coming from the pituitary as it should but the thyroid is not responding.

The nurse teaches the client relaxation techniques and guided imagery as an adjunct to medication for treatment of pain. The nurse explains that the major benefit of these techniques is that they: a.) Are less costly. b.) Allow lower doses of drugs with fewer side effects. c.) Can be used at home or in any environment. d.) Do not require self-injection.

b.) Allow lower doses of drugs with fewer side effects. When used concurrently with medication, non-pharmacologic techniques can allow for lower doses, and possibly fewer drug-related adverse effects. The other options also are advantages to guided imagery and relaxation, but not the major one.

When hydrocortisone use is discontinued, the nurse must recognize the possibility of what side effect, if this drug is stopped abruptly? a.) Development of myxedema b.) Circulatory collapse c.) Development of Cushing's syndrome d.) Development of diabetes insipidus

b.) Circulatory collapse

Nursing intervention for a client receiving opioid analgesics over an extended period of time should include: a.) Referring the client to a drug treatment center. b.) Encouraging increased fluids and fiber in the diet. c.) Monitoring for G.I. bleeding. d.0 Teaching the client to take her own blood pressure.

b.) Encouraging increased fluids and fiber in the diet. Opioids suppress intestinal contractility, increase anal sphincter tone, and inhibit fluids into the intestines, which can lead to constipation. There is nothing to indicate the drug is related to addiction problems. Opioids do not cause GI bleeding.

Which disease is characterized by increased body metabolism, tachycardia, increased body temperature, and anxiety, and treated with Prophylthiouracil (PTU)? a.) Hashimoto's thyroiditis b.) Graves' disease c.) Addison's disease d.) Cushing's syndrome

b.) Graves' disease

A client who is taking levothyroxine (Synthroid) begins to develop weight loss, diarrhea, and intolerance. The nurse should be aware that this might be an indication of what hormonal condition? a.) Addison's disease b.) Hyperthyroidism c.) Cushing's syndrome d.) Development of acromegaly

b.) Hyperthyroidism

A physician has prescribed propylthiouracil (PTU) for a client with hyperthyroidism and the nurse develops a plan of care for the client. A priority nursing assessment to be included in the plan regarding this medication is to assess for: a) relief of pain b) signs of renal toxicity c) signs and symptoms of hyperglycemia d) signs and symptoms of hypothyroidism

d) signs and symptoms of hypothyroidism Excessive dosing with propylthiouracil (PTU) may convert the client from a hyperthyroid state to a hypothyroid state. If this occurs, the dosage should be reduced. Temporary administration of thyroid hormone may be required. Propylthiouracil is not used for pain and does not cause hyperglycemia or renal toxicity.

A client who incurred an arm injury describes his pain as "sharp and localized to the lower arm." The nurse recognizes that this type of pain would be relieved best by administration of which type of medication? a.) Muscle relaxant b.) Acetaminophen c.) Narcotic analgesics d.) Ice packs

c.) Narcotic analgesics Injury to tissues produces nociceptor pain, which usually responds to conventional analgesic pain medications such as opiates or NSAIDS.

The client admitted with hepatitis B is prescribed Vicodin tabs 2 for treatment of pain. The appropriate nursing action is to: a.) Administer the drug as ordered. b.) Administer one tablet only. c.) Question the physician about the order. d.) Hold the drug until the physician arrives.

c.) Question the physician about the order. Vicodin is a combination drug of hydrocodone and acetaminophen. Acetaminophen can be hepatotoxic, and is contraindicated in liver disease.

Celecoxib (Celebrex) is added to the treatment regimen of a client with arthritis. The nurse explains that the major advantage of this drug is: a.) The drug is less expensive. b.) The drug has no known side effects. c.) The drug has anti-inflammatory properties. d.) The drug's effectiveness is the same as opioids.

c.) The drug has anti-inflammatory properties. Celecoxib (Celebrex) has anti-inflammatory properties. It is not less expensive, has many side effects, and is less potent than opioids.

A client in the ICU tells the nurse he is experiencing severe pain. Prior to administering a narcotic analgesic to this client, the nurse will conduct a pain assessment to include: a.) Pain b.) Nociception c.) Pain behaviors d.) Suffering

c.) pain behavior There is a theory that addresses pain as having four facets: nociception, pain, suffering, and pain behaviors. Of these four facets, only the fourth, pain behavior, can be observed. This nurse will only be able to assess the client's pain behavior in the pain assessment.

The benefits of using an insulin pump include all of the following except: a. By continuously providing insulin they eliminate the need for injections of insulin b. They simplify management of blood sugar and often improve A1C c. They enable exercise without compensatory carbohydrate consumption d. They help with weight loss

d. They help with weight loss Using an insulin pump has many advantages, including fewer dramatic swings in blood glucose levels, increased flexibility about diet, and improved accuracy of insulin doses and delivery; however, the use of an insulin pump has been associated with weight gain.

The nurse receives a lab report indicating that the phenytoin (Dilantin) level for the patient she saw in the clinic yesterday is 16 mcg/mL. Which intervention is most appropriate? A) Continue as planned since the level is within normal limits. B) Tell the patient to hold today's dose and return to the clinic. C) Consult the prescriber to recommend an increased dose. D) Have the patient call 911 and meet the patient in the emergency department.

A) Continue as planned since the level is within normal limits

Which of these instructions should the nurse provide when teaching a patient to mix regular insulin and NPH insulin in the same syringe? A) Draw up the clear regular insulin first, followed by the cloudy NPH insulin. B) It is not necessary to rotate the NPH insulin vial when it is mixed with regular insulin. C) The order of drawing up insulin does not matter as long as the insulin is refrigerated. D) Rotate each day subcutaneous injection sites among the arm, thigh, and abdomen.

A) Draw up the clear regular insulin first, followed by the cloudy NPH insulin. To ensure a consistent response, only NPH insulin is appropriate for mixing with a short-acting insulin. Unopened vials of insulin should be refrigerated; current vials can be kept at room temperature for up to 1 month. Drawing up the regular insulin into the syringe first prevents accidental mixture of NPH insulin into the vial of regular insulin, which could alter the pharmacokinetics of subsequent doses taken out of the regular insulin vial. NPH insulin is a cloudy solution, and it should always be gently rotated to evenly disperse the particles before loading the syringe. Subcutaneous injections should be made using one region of the body (e.g., the abdomen or thigh) and rotated within that region for 1 month.

Which agent below is most likely to cause serious respiratory depression as a potential adverse reaction? A) Morphine (Duramorph) B) Pentazocine (Talwin) C) Hydrocodone (Lortab) D) Nalmefene (Revex)

A) Morphine (Duramorph) Morphine is a strong opioid agonist and as such has the highest likelihood of respiratory depression. Pentazocine, a partial agonist, and hydrocodone, a moderate to strong agonist, may cause respiratory depression but not as often and serious as morphine. Nalmefene is an opioid antagonist and would be used to reverse respiratory depression with opioids.

A postoperative patient has an epidural infusion of morphine sulfate (Astramorph). The patient's respiratory rate declines to 8 breaths/min. Which medication would the nurse anticipate administering? A) Naloxone (Narcan) B) Acetylcysteine (Mucomyst) C) Methylprednisolone (Solu-Medrol) D) Protamine sulfate

A) Naloxone (Narcan) Naloxone is a narcotic antagonist that can reverse the effects, both adverse and therapeutic, of opioid narcotic analgesics.

A patient who has type 2 diabetes has a glycated hemoglobin (HbA1c) result of 10%. A nurse should make which of these changes to the nursing care plan? A) Refer to a diabetic educator, there is poor glycemic control. B) Glycemic control is adequate, no changes are needed. C) Hypoglycemia is a risk, teach the patient the symptoms. D) Instruct the patient to limit activity and weekly exercise.

A) Refer to a diabetic educator, there is poor glycemic control.

A client has been newly diagnosed with hypothyroidism and will take levothyroxine (Synthroid) 50 mcg/day by mouth. As part of the teaching plan, the nurse emphasizes that this medication: A) Should be taken in the morning B) May decrease the client's energy level C) Must be stored in a dark container D) Will decrease the client's heart rate

A) Should be taken in the morning

Which of these characteristics should a nurse associate with a patient who has type 2 diabetes? (Select all that apply.) A) Exercise and diet may be sufficient treatment B) Is often obese with difficulty managing weight C) Prone to ketosis and ketoacidosis complications D) Genetics and strong familial links are causal factors E) Insulin resistance and inappropriate secretion

A B D E

When the Type 1 diabetic patient asks why his 7 AM insulin has been changed from NPH insulin to 70/30 premixed insulin, the nurse explains that 70/30 insulin: 1. is absorbed more rapidly into the bloodstream. 2. has no peak action time and lasts all day. 3. makes insulin administration easier and safer. 4. give a bolus of rapid-acting insulin to prevent hyperglycemia after breakfast. the morning meal.

4. give a bolus of rapid-acting insulin to prevent hyperglycemia after breakfast. 70/30 insulin is 30% rapid-acting and 70% intermediate-acting insulin. The rapid action of the 7 AM premixed insulin prevents hyperglycemia after the morning meal.

The type 1 diabetic patient has an insulin order for NPH insulin, 35 U, to be given at 7 AM. The patient is also NPO for laboratory work that will not be drawn until 10 AM. The nurse should: 1. give the insulin as ordered. 2. give the insulin with a small snack. 3. inform the charge nurse. 4. hold the insulin until after the blood draw.

4. hold the insulin until after the blood Holding the insulin for the NPO order is appropriate. The patient will not be getting food until after the blood draw, so will not need the insulin until then. Giving the insulin as ordered will create a possibility of hypoglycemia before the blood is drawn. Giving a snack to a patient who is NPO is inappropriate.

The client informs the nurse that he has experienced pain in the lower extremities for the past eight months. The nurse recognizes that this pain is classified as: a.) Moderate. b.) Severe. c.) Acute. d.) Chronic.

d.) Chronic. Chronic pain persists longer than six months.

The nurse administers morphine sulfate 4 mg IV to a client for treatment of severe pain. Which of the following assessments requires immediate nursing interventions? a.) Blood pressure 110/70 b.) The client is drowsy. c.) Pain is unrelieved in 15 minutes. d.) Respiratory rate 10/minute

d.) Respiratory rate 10/minute Opioids activate mu and kappa receptors that can cause profound respiratory depression. Respiratory rate should remain above 12. The BP is not significantly low. Drowsiness is an expected effect of morphine. Unrelieved pain warrants further assessment, but not as immediately as do decreased respirations.

The teaching plan for a diabetic is focused on smoking cessation and control of hypertension for the avoidance of microvascular complications, such as (select all that apply): 1. macular degeneration. 2. end-stage renal disease (ESRD). 3. coronary artery disease (CAD). 4. peripheral vascular disease (PVD). 5. cerebrovascular accident (CVA).

ANS: 1, 2 Macular degeneration and ESRD are both microvascular complications. CAD, PVD, and CVA are all macrovascular complications.

When the type 2 diabetic patient says, "Why in the world are they looking at my hemoglobin? I thought my problem was with my blood sugar." The nurse responds that the level of hemoglobin A1c: 1. shows how a high glucose level can cause a significant drop in the hemoglobin level. 2. shows what the glucose level has done for the last 3 months. 3. indicates a true picture of the patient's nutritional state. 4. reflects the effect of high glucose levels on the ability to produce red blood cells.

ANS: 2 By analyzing the amount of glucose bound to the hemoglobin, the level of blood glucose can be evaluated for the last 3 months, because the glucose stays bound to the hemoglobin for the life of the red blood cell (RBC).

The home health nurse is assessing a type 1 diabetic patient who has been controlled for 6 months. The nurse is surprised and concerned about a blood glucose reading of 52. This episode of hypoglycemia is probably caused by the patient's having: 1. taken a new form of birth control pill this morning. 2. used large amounts of sugar substitute in her tea this morning. 3. had a 2-hour long exercise class at the spa this morning. 4. underdosed herself with insulin this morning.

ANS: 3 Excessive exercise used up the glucose that was made available by the insulin taken by the patient. The patient now has too much insulin for the available glucose and has become hypoglycemic.

The patient with type 2 diabetes shows a blood sugar reading of 72 at 6 AM. Based on the reading of 72, the nurse should: 1. notify the charge nurse of the reading. 2. give regular insulin per sliding scale. 3. give him cup of milk. 4. administer the oral hyperglycemic tablet.

ANS: 3 milk The patient is hypoglycemic and needs an immediate source of glucose, such as milk or orange juice. The oral hyperglycemic agent will not work quickly enough. Notifying the charge nurse can be done later. Giving insulin per sliding scale would lower the blood sugar level.

When a newly diagnosed type 2 diabetes mellitus patient asks the nurse why she has to take a pill instead of insulin, you reply that in type 2 diabetes, the body makes insulin but: 1. overweight and underactive people simply cannot use the insulin produced. 2. metabolism is slowed in some people so they have to take a pill to speed up their metabolism. 3. sometimes the autoimmune system works against the action of the insulin. 4. the cells become resistant to the action of insulin. Pills are given to increase the sensitivity.

ANS: 4 Type 2 diabetes mellitus is a disease in which the cells become resistant to the action of insulin and the blood glucose level rises. Oral hyperglycemic agents make the cells more sensitive.

The nurse is preparing to give ethosuximide (Zarontin). The nurse understands that this drug is only indicated for which seizure type? A) Tonic-clonic B) Absence C) Simple partial D) Complex partial

B) Absence Absence seizures are the only indication for ethosuximide. The drug effectively eliminates absence seizures in approximately 60% of patients and effectively controls 80% to 90% of cases.

The nurse instructs a patient about how insulin affects blood glucose. Arrange the events in sequence. 1. Beta cells are stimulated to release insulin. 2. Glucose enters the bloodstream. 3. Glycogen is converted to glucose by alpha cells (glycogenesis). 4. Glycogen is stored in the liver. 5. Insulin transports glucose to muscle cells.

2 1 5 4 3

A patient has come to the doctor's office after finding out that her blood glucose level was 135 mg/dL. She states that she had not eaten before the test and was told to come and see her doctor. She asks you if she has diabetes. The nurse responds: 1. "Having a fasting serum glucose that high certainly indicates diabetes." 2. "That test indicates that we need to do more tests that are specific for diabetes." 3. "How do you feel? Do you have any other signs of diabetes?" 4. "Do you have a family history of diabetes, stroke, or heart disease? We need to know before making a diagnosis."

2. "That test indicates that we need to do more tests that are specific for diabetes The nurse needs to answer the patient's question in a way that gives information and is not misleading. Although 135 is high, there may be a nonpathologic explanation. More tests should be done to evaluate the patient.

The nurse is drawing up a teaching plan for a patient who has type 1 diabetes. The doctor has ordered two types of insulin, 10 U of regular insulin and 35 U of NPH insulin. The proper procedure is to: 1. draw up the insulins in two separate syringes so that there can be no confusion. 2. draw up the regular insulin before drawing up the NPH insulin. 3. inject air into the NPH insulin, draw it up to 35 U, then inject air into the clear regular insulin and withdraw to 45 U. 4. inject 35 U air into the NPH insulin, inject 10 U air into the regular insulin, withdraw 10 U of the regular insulin, and withdraw 35 U of the NPH insulin.

4. inject 35 U air into the NPH insulin, inject 10 U air into the regular insulin, withdraw 10 U of the regular insulin, and withdraw 35 U of the NPH insulin. When drawing up two insulins, the vials are injected with air and the regular insulin is drawn first. This slow and time-consuming activity has been greatly reduced with the advent of premixed insulins.

When assessing the patient experiencing the onset of symptoms of type 1 diabetes, which question should the nurse ask? a. "Have you lost any weight lately?" b. "Do you crave fluids containing sugar?" c. "How long have you felt anorexic?" d. "Is your urine unusually dark-colored?"

A Rationale: Weight loss occurs because the body is no longer able to absorb glucose and starts to break down protein and fat for energy. The patient is thirsty but does not necessarily crave sugar- containing fluids. Increased appetite is a classic symptom of type 1 diabetes. With the classic symptom of polyuria, urine will be very dilute.

A teaching plan for a patient who is taking lispro (Humalog) should include which of these instructions by the nurse? A) "Inject this insulin with your first bite of food because it is very fast acting." B) "The duration of action for this insulin is about 8 to 10 hours, so you'll need a snack." C) "This insulin needs to be mixed with regular insulin to enhance the effects." D) "To achieve tight glycemic control, this is the only type of insulin you'll need."

A) "Inject this insulin with your first bite of food because it is very fast acting." Lispro is a rapid-acting insulin and has an onset of 15 to 30 minutes with a peak action of about 2 hours, not 8 to 10 hours. Because of its rapid onset, it is administered immediately before a meal or with meals to control blood glucose rise after meals. Lispro insulin must be combined with intermediate- or long-acting insulin not regular insulin, which is also a short-duration insulin, for glucose control between meals and at night. To achieve tight glycemic control, patients must combine different types of insulin based on duration of action.

At 5 PM a patient who is taking NPH insulin develops hunger, shakiness, and sweating. A nurse assesses the medication administration record (MAR) and should recognize that the patient's symptoms are related to an injection of NPH insulin at which of these times? A) 2 AM B) 8 AM C) 1 PM D) 3 PM

A) 2 AM The patient is exhibiting symptoms of hypoglycemia at 5 PM. NPH has a peak action of 8 to 10 hours after administration. Based on the duration of action of NPH insulin, the patient's hypoglycemic symptoms are from the 8 AM injection of NPH insulin. An injection of NPH insulin at 2 AM, 1 PM, or 3 PM would not cause hypoglycemic symptoms based on the average duration of action from NPH insulin.

A patient is scheduled to start taking insulin glargine (Lantus). On the care plan a nurse should include which of these outcomes related to the therapeutic effects of the medication? A) Blood glucose control for 24 hours B) Mealtime coverage of blood glucose C) Less frequent blood glucose monitoring D) Peak effect achieved in 2 to 4 hours

A) Blood glucose control for 24 hours Insulin glargine is administered as a once-daily subcutaneous injection for patients who have type 1 diabetes. It is used for basal insulin coverage, not mealtime coverage. It has a prolonged duration up to 24 hours with no peaks. Blood glucose monitoring is still an essential component to achieve tight glycemic control.

The nurse is conducting discharge teaching related to a new prescription for phenytoin (Dilantin). Which statements are appropriate to include in the teaching for this patient and his family? Select all that apply. A) "Be sure to call the clinic if you or your family notice increased anxiety or agitation." B) "You may have some mild sedation. Do not drive until you know how this drug will affect you." C) "This drug may cause easy bruising. If you notice this, call the clinic immediately." D) "It is very important to have good oral hygiene and visit your dentist regularly." E) "You may continue to have wine with your evening meals but only in moderation."

A, B, D Patients receiving an antiepileptic drug are at increased risk for suicidal thoughts and behavior beginning early in their treatment. The U.S. Food and Drug Administration (FDA) advises that patients, families, and caregivers be informed of the signs that may precede suicidal behavior and be encouraged to report these immediately. Mild sedation can occur in patients taking phenytoin even at therapeutic levels. Carbamazepine(Tegretol), not phenytoin, increases the risk for hematologic effects, such as easy bruising. Phenytoin causes gingival hyperplasia in about 20% of patients who take it. Dental hygiene is important. Patients receiving phenytoin should avoid alcohol and other central nervous system depressants because they have an additive depressant effect.

A client in the trauma ICU is experiencing deep, throbbing pain. The nurse will provide medication for this pain because: A.) The pain is being transmitted over C fibers and the enkephalins will not be effective to control the pain. B.) The pain is being transmitted over A beta fibers and beta-endorphins will not be effective to control the pain. c.) The pain is being transmitted over delta fibers and dynorphins will not be effective to control the pain. d.) The pain is being transmitted over A beta fibers and the dynophins will not be effective to control the pain.

A.) The pain is being transmitted over C fibers and the enkephalins will not be effective to control the pain.

36. The nurse is teaching the client with insulin-dependent diabetes the signs of hypoglycemia. Which of the following signs is associ- ated with hypoglycemia? A. Tremulousness B. Slow pulse C. Nausea D. Flushed skin

Answer A is correct. Tremulousness (a state of trembling or quivering) is an early sign of hypoglycemia. Answers B,C, and D are incorrect because they are symptoms of hyperglycemia.

Following heparin treatment for a pulmonary embolism, a client is being discharged with a prescription for warfarin (Coumadin). In conducting discharge teaching, the nurse advises the client to have which diagnostic test monitored regularly after discharge? A) Perfusion scan B) Prothrombin Time (PT/INR) C) Activated partial thromboplastin (APTT) D) Serum Coumadin level (SCL

B) Prothrombin Time (PT/INR)

A nurse assesses a patient who is taking pramlintide (Symlin) with mealtime insulin. Which of these findings should require immediate follow-up by the nurse? A) Skin rash B) Sweating C) Itching D) Pedal edema

B) Sweating Pramlintide is a new type of antidiabetic medication that is used as a supplement to mealtime insulin in type 1 and 2 diabetes. Hypoglycemia, which is manifested by sweating, tremors, and tachycardia, is the adverse reaction of most concern. Skin rash, itching, and edema are not adverse effects of pramlintide.

The nurse is working on a postoperative unit where pain management is part of routine care. Which statement below is the most helpful in guiding clinical practice in this setting? A) At least 30% of the U.S. population is prone to drug addiction and abuse. B) The development of opioid dependence is rare when opioids are used for acute pain. C) Morphine is a common drug of abuse in the general population. D) The use of PRN (as needed) dosing provides the most consistent pain relief without risk of addiction.

B) The development of opioid dependence is rare when opioids are used for acute pain.

Which of the following statements from a newly diagnosed client with diabetes indicates more instruction is needed? A.) i need to check my feet daily for sores B.) i need to store my insulin in the refrigerator C.) i can use my plastic insulin syringe more than once D.) i need to see my doctor for follow up exams

B.) i need to store my insulin in the refrigerator Insulin only needs to be stored in the refrigerator if it wont be used within 6 weeks, after being opened. It should be at room temperature when given to decrease pain and prevent lipodystrophy.

The healthcare provider prescribes naproxen (Naproxen) twice daily for a client with osteoarthritis of the hands. The client tells the nurse that the drug does not seem to be effective after three weeks. Which is the best response for the nurse to provide? A) The frequency of the dosing is necessary to increase the effectiveness. B) Therapeutic blood levels of this drug are reached in 4 to 6 weeks. C) Another type of nonsteroidal antiinflammatory drug may be indicated. D) Systemic corticosteroids are the next drugs of choice for pain relief

C) Another type of nonsteroidal antiinflammatory drug may be indicated.

A nurse administers naloxone (Narcan) to a postoperative patient experiencing respiratory sedation. What undesirable effect would the nurse anticipate after giving this medication? A) Drowsiness B) Tics and tremors C) Increased pain D) Nausea and vomiting

C) Increased pain Naloxone is a medication that reverses the effects of narcotics. Although the patient's respiratory status will improve after the administration of naloxone, pain will be more acute.

A patient is taking glipizide (Glucotrol) and a beta-adrenergic medication. A nurse is teaching hypoglycemia awareness and should tell the patient that which of these symptoms may not occur? A) Vomiting B) Muscle cramps C) Tachycardia D) Chills

C) Tachycardia Glipizide is a sulfonylurea oral hypoglycemic medication that acts to promote insulin release from the pancreas. Beta-adrenergic blockers can mask early signs of sympathetic system responses (most importantly, tachycardia) to hypoglycemia, which is the most common adverse effect of glipizide. Vomiting, muscle cramps, and chills are not symptoms of activation of the sympathetic nervous system that arise when glucose levels fall.

1. Which of the following statements made by a client taking phenytoin indicates understanding of the nurse's teaching? A. "I will increase the dose if my seizures don't stop." B. "I don't need to contact my health care provider before taking an over-the-counter cold remedy." C. "I will take good care of my teeth and see my dentist regularly." D. "I cannot take this drug with food."

C. "I will take good care of my teeth and see my dentist regularly."

A patient has just been diagnosed with diabetes mellitus. His doctor has requested glucagon for emergency use at home. The nurse instructs the patient that the purpose of this drug is to treat: A. Hyperglycemia from insufficient insulin injection. B. Hyperglycemia from eating a large meal. C. Hypoglycemia from insulin overdose. D. Lipohypertrophy from inadequate insulin absorption.

C. Hypoglycemia from insulin overdose. Glucagon is for emergency use for insulin overdose. The patient will usually arouse within 20 minutes if unconscious. The family should also be instructed how to use the glucagon injection as well.

A patient screened for diabetes at a clinic has a fasting plasma glucose level of 120 mg/dl (6.7 mmol/L). The nurse will plan to teach the patient about a. use of low doses of regular insulin. b. self-monitoring of blood glucose. c. oral hypoglycemic medications. d. maintenance of a healthy weight.

D Rationale: The patient's impaired fasting glucose indicates prediabetes and the patient should be counseled about lifestyle changes to prevent the development of type 2 diabetes. The patient with prediabetes does not require insulin or the oral hypoglycemics for glucose control and does not need to self-monitor blood glucose.

A college student who has type 1 diabetes normally walks each evening as part of an exercise regimen. The student now plans to take a swimming class every day at 1:00 PM. The clinic nurse teaches the patient to a. delay eating the noon meal until after the swimming class. b. increase the morning dose of neutral protamine Hagedorn (NPH) insulin on days of the swimming class. c. time the morning insulin injection so that the peak occurs while swimming. d. check glucose level before, during, and after swimming.

D Rationale: The change in exercise will affect blood glucose, and the patient will need to monitor glucose carefully to determine the need for changes in diet and insulin administration. Because exercise tends to decrease blood glucose, patients are advised to eat before exercising. Increasing the morning NPH or timing the insulin to peak during exercise may lead to hypoglycemia, especially with the increased exercise.

A type I diabetic patient comes to the clinic for a follow-up appointment. The patient is taking NPH insulin, 30 units every day. A nurse notes that the patient is also taking metoprolol (Lopressor). What education should the nurse provide to the patient? A) "You need to increase your insulin to allow for the agonist effects of metoprolol." B) "Metoprolol may potentiate the effects of the insulin, so the dose should be reduced." C) "Metoprolol has no effects on diabetes mellitus or on your insulin requirements." D) "Metoprolol may mask signs of hypoglycemia, so you need to monitor your blood glucose closely."

D) "Metoprolol may mask signs of hypoglycemia, so you need to monitor your blood glucose closely."

A patient who is newly diagnosed with type 1 diabetes asks a nurse, "How does insulin normally work in my body?" The nurse explains that normal insulin has which of these actions in the body? A) Stimulates the pancreas to reabsorb glucose B) Promotes synthesis of amino acids into glucose C) Stimulates the liver to convert glycogen to glucose D) Promotes the passage of glucose into cells for energy

D) Promotes the passage of glucose into cells for energy Insulin is a hormone that promotes the passage of glucose into cells, where it is metabolized for energy. Insulin does not stimulate the pancreas to reabsorb glucose or synthesize amino acids into glucose. It does not stimulate the liver to convert glycogen into glucose.

The nurse is assessing a patient receiving valproic acid (Depakene) for potential adverse effects associated with this drug. Which item represents the most common problem with this drug? A) Increased risk for infection B) Reddened, swollen gums C) Nausea, vomiting, and indigestion D) Central nervous system depression

D) Central nervous system depression Valproic acid is generally well tolerated. It does not cause hematologic effects resulting in increased risk for infection nor does it cause gingival hyperplasia. It causes minimal sedation. Gastrointestinal effects, which include nausea, vomiting, and indigestion, are the most common problems but tend to subside with use and can be lessened by giving with food.

A patient takes oxycodone (OxyContin), 40 mg PO twice daily, for the management of chronic pain. Which intervention should be added to the plan of care to minimize the gastrointestinal adverse effects? A) Take an antacid with each dose. B) Eat foods high in lactobacilli. C) Take the medication on an empty stomach. D) Increase fluid and fiber in the diet.

D) Increase fluid and fiber in the diet. Narcotic analgesics reduce intestinal motility, leading to constipation. Increasing fluid and fiber in the diet can help manage this adverse effect.

A patient with hyperthyroidism is taking propylthiouracil (PTU). The nurse will monitor the patient for: A) gingival hyperplasia and lycopenemia. B) dyspnea and a dry cough. C) blurred vision and nystagmus. D) fever and sore throat.

D) fever and sore throat.

A client in the ICU who sustained a traumatic abdominal injury 1 week ago continues to complain of severe pain. The nurse notes his vital signs are normal. Which of the following would be appropriate for the nurse to do? a.) Encourage early return to ambulation. b.) Offer nonnarcotic analgesics for pain. c.) Utilize distraction d.) Provide the client with pain medication.

D.) Provide the client with pain medication.

OxyContin

Oxycodone, Narcotic pain reliever, analgesic

In the administration of a drug such as levothyroxine (Synthroid), the nurse must teach the client: (Select all that apply.) a.) Therapy could take three weeks or longer. b.) Periodic lab tests for T4 levels are required. c.) Report weight loss, anxiety, insomnia, and palpitations. d.) Jaundice

Therapy could take three weeks or longer. Periodic lab tests for T4 levels are required. Report weight loss, anxiety, insomnia, and palpitations. A,B,C

A physician prescribes levothyroxine sodium (Synthroid), 0.15 mg orally daily, for a client with hypothyroidism. The nurse will prepare to administer this medication: a) in the morning to prevent insomnia b) only when the client complains of fatigue and cold intolerance c) at various times during the day to prevent tolerance from occurring d) three times daily in equal doses of 0.5 mg each to ensure consistent serum drug levels

a) in the morning to prevent insomnia Levothyroxine (Synthroid) is a synthetic thyroid hormone that increases cellular metabolism. Levothyroxine should be given in the morning in a single dose to prevent insomnia and should be given at the same time each day to maintain an adequate drug level. Therefore, options B, C, and D are incorrect.

A nurse is monitoring a client newly diagnosed with diabetes mellitus for signs of complications. Which of the following, if exhibited in the client, would indicate hyperglycemia and warrant physician notification? a) polyuria b) diaphoresis c) hypertension d) increased pulse rate

a) polyuria Classic symptoms of hyperglycemia include polydipsia, polyuria, and polyphagia. Options B, C, and D are not signs of hyperglycemia.

A resident of the nursing home has quite severe arthritis. When administering an analgesic to this elderly resident, the nurse should: a. Give the medication before the activity session in the day room. b. Give the medication when the resident states the pain is at 6 or higher on a 1-10 pain scale. c. Give the pain medication at mealtime. d. Make sure that the medication is not a narcotic.

a. Give the medication before the activity session in the day room.

In the administration of hydrocortisone (Aeroseb-HC, Alphadern, Cetacort), it is vital that the nurse recognize that this drug might mask which symptoms? a.) Signs and symptoms of infection b.) Signs and symptoms of heart failure c.) Hearing loss d.) Skin infections

a.) Signs and symptoms of infection

Naloxone (Narcan) is administered to a client with severe respiratory depression and suspected drug overdose. After 20 minutes, the client remains unresponsive. The most likely explanation for this is: a.) The client did not use an opioid drug. b.) The dose of naloxone was inadequate. c.) The client is resistant to this drug. d.) The drug overdose is irreversible.

a.) The client did not use an opioid drug. If opioid antagonists (Naloxone) fail to reverse symptoms of respiratory depression quickly, the overdose was likely due to a non-opioid substance.

Which of the following diabetes drugs acts by decreasing the amount of glucose produced by the liver? a. Sulfonylureas b. Meglitinides c. Biguanides d. Alpha-glucosidase inhibitors

c. Biguanides Biguanides, such as metformin, lower blood glucose by reducing the amount of glucose produced by the liver. Sulfonylureas and Meglitinides stimulate the beta cells of the pancreas to produce more insulin. Alpha-glucosidase inhibitors block the breakdown of starches and some sugars, which helps to reduce blood glucose levels

When an elderly client with cancer experiences "breakthrough pain," the nurse should expect that pharmacological treatment will include: a. Initiation of a placebo after every third dose of narcotic. b. More aggressive chemotherapy. c. Giving narcotics every hour. d. Increasing the dose of the narcotic.

d. Increasing the dose of the narcotic.