Pharm Test 1

A patient asks why insulin isophane (Humulin N, NPH) is taken with insulin aspart (Fiasp, NovoLog). Which response should the nurse make?

- "Aspart has a short duration, so the isophane helps prolong it." - Aspart acts rapidly and has a short duration; therefore, it is usually given in combination with an intermediate or long-acting insulin. Aspart does not take longer than isophane to work, and another type of insulin is not required to increase the effectiveness of aspart. Isophane is the only intermediate-acting insulin and can be given with aspart, lispro, glulisine, or regular insulin, but it cannot be mixed with any long-acting insulin.

Which information should the nurse include in the teaching of a client with type 1 diabetes mellitus that would like to participate in sports?

- "Eat a meal 1 hour before the game and consume a carbohydrate snack and fluids during the game" Exercise should occur 1 hour after a meal or after 10 or 15 g carbohydrate snack to prevent hypoglycemia. If exercise is prolonged, small frequent carbohydrate snacks can be consumed every 30 minutes during exercise to maintain blood sugar

A patient is prescribed an alpha-glucosidase inhibitor. Which statement should indicate to the nurse that further teaching is needed?

- "I can eat whatever I want with this medication." - It is very important that a patient who has been prescribed an alpha-glucosidase inhibitor adhere to the prescribed diabetic diet. The gastrointestinal effects of the drug, such as diarrhea and flatulence, usually diminish as therapy progresses. However, they can worsen if the patient does not adhere to the prescribed diabetic diet. If the patient experiences hypoglycemia, they should take glucose and not sucrose. This type of medication blocks the absorption of sucrose. Garlic can cause hypoglycemia in patients taking this classification of drug. Alpha-glucosidase inhibitors include: · Acarbose (Precose). · Miglitol (Glyset).

A client with type 1 diabetes mellitus asks the nurse why they cannot receive insulin in a pill form. Which response should the nurse provide the client?

- "The stomach acid will destroy the insulin." The gastrointestinal (GI) tract destroys insulin, therefore it can not be give PO.

The nurse is providing education for a client prescribed albuterol (ProAir HFA). Which information should the nurse include in the teaching?

- Administer the prescription 15 to 30 minutes prior to the activity Albuterol should be administered 15 to 30 minutes prior to activity

Which priority question should the nurse ask the client prior to the administration of ipratropium (Atrovent)?

- Are you allergic to soy? Ipratropium is contraindicated in patients with hypersensitivity to soy as soya lecithin is used as a propellant in the inhaler.

A client tells the nurse "My healthcare provider told me that I have COPD and might develop emphysema. I always thought I had chronic bronchitis". Which response should the nurse provide the client?

- COPD is either asthma, chronic bronchitis, or emphysema, or a combination of those disorders - As COPD progresses it becomes emphysema - Both diagnoses are correct

A patient taking a sulfonylurea for type 2 diabetes mellitus (DM) is experiencing hypoglycemia. Which treatment should the nurse administer first?

- Dextrose - Hypoglycemia resulting from a sulfonylurea may be prolonged and requires the administration of dextrose to return serum glucose levels to normal. Glucose, glucagon, and a complex carbohydrate are not a first line of treatment for hypoglycemia related to the use of a sulfonylurea. First-generation sulfonylureas include:

Which information should the nurse include in the education for a client with asthma? Select all that apply. 1. Drink additional fluids 2. Eat small, frequent meals 3. Sleep in a warm room 4. Complete activity in the morning and rest in the afternoon 5. Avoid foods high in protein.

- Drink additional fluids - Eat small, frequent meals Drinking sufficient fluids will help liquefy and mobilize mucus. Small, frequent meals of calorie and nutrient dense foods help to prevent fatigue and maintain nutrition.

Which symptom is common for a client with untreated type 1 diabetes mellitus?

- Fatigue Fatigue is a typical sign/symptom of type 1 DM due to the sustained hyperglycemia. Other important symptoms include: Weight loss, decreased energy, polyphagia (increased hunger)

The nurse suspects that a patient with type 1 diabetes mellitus (DM) is experiencing neuropathy. Which assessment finding should confirm the nurse's suspicion?

- Finger tingling - Finger tingling is associated with neuropathy. Dysuria may be associated with a urinary tract infection. Hypertension is a risk factor for nephropathy. Polyuria is a symptom of hyperglycemia.

For which adverse effect should the nurse assess the client receiving methylxanthine?

- How have you been sleeping? Adverse effects of methylxanthine include insomina

Which statment made by a client provided education about the use of albuterol (VoSpire ER) indicates further education is required?

- I can use this for chronic asthma Albuterol is a short-acting beta agonist that is used as needed for acute episodes of asthma.

For which class of prescription should the nurse monitor a client for a fungal infection of the throat?

- Inhaled corticosteriod Glucocorticolds weaken the immune system and cause candidiasis of the throat

Which should the nurse recognize is a long-term control prescription used to treat asthma?

- Mast cell stabilizers Mast cell stabilizers are long-term control prescriptions used to treat asthma

Which long-term control prescriptions have an anti-inflammatory mechanism of action?

- Mast cell stabilizers - Leukotriene modifiers - Inhaled corticosteriods

A nurse is explaining the process of respiration to a client. Which information should be given?

- Moving air in and out of the lungs is called ventilation - Exchange of oxygen and carbon dioxide occurs across a thin capillary membrane - Respiration is not effective without perfusion - Your basic respiratory drive is determined by your brain

Which information should the nurse include in the education for the client prescribed inhaled ipratropium (Atrovent)?

- Report any increased dyspnea - Report any changes in urinary pattern - Use the medication consistently not occasionally The client should be advised to report any symptoms of deteriorating respiratory status such as increased dyspnea (difficulty breathing/shortness of breath) Anticholinergic drugs can result in urinary retention and the client should report any changes in their urinary patterns. To get the most benefits from ipratropium (Atrovent) it must be used consistently

Which condition is an adverse effect of a beta-adrenergic agent?

- Tachycardia Tachycardia is common along with restlessness

Which statement is true regarding dry powder inhalers (DPI)?

- The device is activated by inhalation

The nurse provided a client with asthma education about bronchodilators. Which statement made by the client indicates an understanding of the information?

- The prescription widens the airways because it stimulates the fight-or-flight response of the nervous system During the fight-or-flight response, beta2-andrenergic receptors of the sympathetic nervous system are stimulated, the bronchiolar smooth muscle relaxes and bronchodilation occurs.

The nurse has provided education for a client prescribed zafirlukast (Accolate). Which statement made by the client indicates an understanding of the information?

- This decreases the inflammation in my lungs. Zafirlukast prevents airway edema and inflammation by blocking leukotriene receptors in the airways.

Which information should the nurse include in the education for the client prescribed Montelukast (Singulair)?

- This prescription has very few side effects Montelukast has very few side effects

A patient taking ipratropium (Atrovent) receives a new prescription for tiotropium (Spiriva). Which teaching should the nurse provide about the new medication?

- Tiotropium is taken less frequently than ipratropium. - Tiotropium is taken once per day, whereas ipratropium is taken four or more times per day. The less frequent dosing decreases the chance of the patient missing a dose. Tiotropium is administered by dry powder inhaler, not metered-dose inhaler. Both medications are anticholinergics. The medications are closely related, but ipratropium is the only anticholinergic with a rapid onset that is suitable for treating acute asthma.

A client receiving ipratropium (Atrovent) tells the nurse they are going to stop taking their prescription because of the bitter taste left in their mouth after its use. Which response should the nurse provide to the client?

- You can decrease the side effect by rinsing your mouth after use. Ipratropium (Atrovent) produces a bitter taste which may be relieved by rinsing the mouth after use.

A client receiving insulin tells the nurse their blood glucose has been low the last few mornings. Which additional statement made by the client may be contributing factor to the decrease in blood glucose?

- "I have been taking a garlic supplement to prevent colds" Garlic may potentiate the hypoglycemic effect of insulin

The nurse instructs a patient about multiple inhaled medications for asthma. For which patient statement should the nurse provide additional teaching?

- "I should dry the inhaler and spacer with a hair dryer." - The patient should be instructed to permit the spacer and inhaler to air dry. Feeling nervous is a potential, yet not serious, adverse effect of inhaled medications. Caffeine should be avoided to help prevent nervousness, tremors, or palpitations. The patient should rinse the mouth after using inhalers, especially corticosteroids, to prevent fungal infections, localized reactions, and systemic absorption.

The nurse has provided client education about type 2 diabetes mellitus. Which statements made by the client indicate additional teaching is needed?

- "The prescriptions that I will be on will help me lose weight." - "I can take an oral prescription and will never have to inject myself." - I am not at risk for kidney disease like type 1 diabetics." Some of the prescriptions for type 2 diabetes cause weight gain. As type 2 diabetes progresses, the cells that produce insulin may fail resulting in the need for insulin. Some prescriptions used in the treatment of type 2 diabetes are injected. If the type 2 diabetes is poorly managed kidney disease may occur.

A patient's airways have suddenly become hyperresponsive to stimuli. Which health problem should the nurse suspect?

- Asthma attack - The airway smooth muscles of a patient with asthma are hyperresponsive to stimuli, which results in bronchospasm. The patient is most likely experiencing an asthma attack and not a COPD exacerbation, bacterial pneumonia, or ARDS.

Which triggers the release of insulin the body?

- Increase of blood glucose An increase in blood glucose triggers the release of insulin

The physician writes orders for the client with diabetes mellitus. Which order should the nurse clarify with the healthcare provider?

- Lantus insulin 20U BID Lantus is a long-acting insulin with a duration of 24 hours. Administering it BID (twice a day) places the client at risk for hypoglycemia

Which prescription is classified as a biguanide?

- Metformin HCl (Glucophage)

A patient taking montelukast (Singulair) is demonstrating symptoms of an overdose. Which treatment should the nurse anticipate?

- Supportive treatment - Since there is no specific treatment for overdose, treatment for suspected montelukast overdose is supportive. Isoproterenol and epinephrine are not indicated for montelukast overdose. Gastric lavage is indicated for theophylline overdose.

A patient with asthma asks how to avoid acute asthma attacks. Which response should the nurse make?

- "Avoid exposure to dust, pollen, and mold." - The patient should be instructed to avoid potential asthma triggers, such as cigarette smoke, dust, pollen, and mold. A cough suppressant will not prevent asthma attacks. A short-acting bronchodilator should be the first medication used during an acute asthma attack. In some patients, cold air can trigger an acute asthma attack.

Which describes the mechanism of action of regular insulin?

- Promote entry of glucose into the cells The action of regular insulin is to promote entry of glucose into the cells, thereby lowering glucose.

What are leukotriene modifiers primarily used for?

- Prophylaxis of asthma symptoms Leukotriene modifiers are used primarily for prophylaxis and reducing inflammatory components

A client prescribed an albuterol (Proventil) via inhaler asks the nurse why they can't just take a pill. Which response should the nurse provide?

"When you inhale the prescription the blood supply in the lungs absorbs it rapidly resulting in quicker effects" - The respiratory system offers a rapid and efficient mechanism for absorbing prescriptions. The enormous surface area of the bronchioles and alveoli and the rich blood supply to these areas results in almost instantaneous onset of action for inhaled substances

Which initial question should the nurse ask the client who is receiving chlorpropamide (Diabinese) and is experiencing nausea, flushing, and palpitations?

- "Have you had any alcoholic beverages to drink this week?" When alcohol is taken with sulfonylureas some patients experience a disulfiram-like reaction that includes flushing, palpitations and nausea.

Which statement made by a client indicates an understanding of the education about insulin administration?

- "I should only use a calibrated insulin syringe for the injections" To ensure the correct insulin dose, a calibrated insulin syringe must be used.

The nurse instructs a patient with type 1 diabetes mellitus (DM) about the prescribed insulin pump. Which patient statement should indicate the need for further teaching?

- "I will apply the pump to my upper thigh." - This pump is usually abdominally anchored and is programmed to release small subcutaneous doses of insulin into the abdomen at predetermined intervals, with larger boluses administered manually at mealtime if necessary. The schedule to change the location of the pump varies according to the type of pump being used.

A patient is prescribed pramlintide (Symlin). Which statement should indicate to the nurse that teaching was successful?

- "I will take this drug immediately before eating." - Pramlintide (Symlin) is an antihyperglycemic drug that is used with insulin in people with type 1 and type 2 diabetes. The drug is administered subcutaneously immediately before meals using a premeasured disposable injector. Hypoglycemia may be prolonged and severe, usually occurring within 3 hours after administration. Pramlintide cannot be mixed with insulin and must be administered in a different site.

A patient with chronic obstructive pulmonary disease (COPD) is allergic to corticosteroid medications. Which medication should the nurse expect to be prescribed?

- Cromolyn - Cromolyn reduces airway inflammation and may be prescribed if corticosteroids are contraindicated or have not been effective. Like corticosteroids, cromolyn is not effective for acute attacks. Flunisolide, budesonide (Pulmicort), and mometasone (Asmanex) are all corticosteroids.

The nurse teaches a patient about self-administration of multiple inhaled medications. Which statement should indicate to the nurse that teaching has been effective?

- "I will use the bronchodilator inhaler before using the corticosteroid inhaler." - The bronchodilator inhaler should be used before the corticosteroid inhaler. The corticosteroid inhaler should be used 5 to 10 minutes after the bronchodilator inhaler to ensure the medication reaches deep into the bronchial tree. The patient should clean the inhalers at least weekly. Inhalers, like all medications, have guidelines about frequency of use. The patient should be instructed to notify the healthcare provider if symptoms persist despite using the inhalers as directed.

A patient is prescribed ipratropium (Atrovent) for chronic obstructive pulmonary disease (COPD). Which teaching should the nurse provide?

- "Increase your fiber intake." - Because an anticholinergic medication, such as ipratropium, can cause constipation, the patient should be instructed to increase fiber and fluid intake. The patient may experience a bitter taste after taking the medication, and although it is problematic for some patients, it does not indicate an allergic reaction. The patient should notify the healthcare provider if difficulty urinating occurs, because this is an adverse effect of anticholinergic medications (especially if the patient has an enlarged prostate); however, this does not indicate renal failure. Additional adverse effects of ipratropium include: · Cough. · Drying of the nasal mucosa. · Hoarseness. · Bitter taste. · Epistaxis.

A patient is prescribed metformin (Glucophage, Riomet) for the treatment of type 2 diabetes mellitus (DM). Which information should the nurse include when teaching about this medication?

- "Increase your intake of foods high in vitamin B12 and folic acid." - Metformin decreases the absorption of vitamin B12 and folic acid. Metformin rarely causes hypoglycemia and is not associated with weight gain. Alcohol increases the risk for lactic acidosis and should be avoided. Metformin considerations include: · Classification: biguanide. · Preferred drug for managing type 2 diabetes. · Can be used alone or in combination with other drugs. · Comes in regular tablets, solution, or extended release. · Reduces fasting and postprandial glucose levels. · Does not cause hypoglycemia. · Lowers triglyceride levels. · Promotes weight loss.

The nurse compares oral albuterol (VoSpire ER) with inhaled albuterol (Proventil HFA, Ventolin HFA). Which statement should the nurse make about this comparison?

- "Inhaled albuterol works in about 15 minutes." - Compared with oral albuterol, inhaled albuterol works in about 15 minutes. Oral albuterol has a longer onset of action and should not be used for acute asthma attacks. Inhaled albuterol is a pregnancy category C drug. Potential adverse effects of albuterol (Proventil HFA, Ventolin HFA, VoSpire ER) include: · Palpitations. · Headaches. · Throat irritation. · Tremor. · Nervousness. · Restlessness. · Tachycardia. · Insomnia. · Dry mouth. · Chest pain (uncommon). · Paradoxical bronchospasm (uncommon). · Allergic reactions (uncommon).

The nurse is asked why a peak expiratory flowmeter is important in asthma management. Which information should the nurse provide in response?

- "It helps evaluate medication effectiveness." - Peak expiratory flowmeter results help to evaluate medication effectiveness. COPD is a chronic disease that is not curable. Peak expiratory flowmeter results do not determine whether the patient is a candidate for a lung transplant, nor do they determine the amount of mucus production.

The nurse is teaching a patient about glucose monitoring and exercise. Which statement should the nurse include?

- "Monitor yourself for hypoglycemia after exercising the next day or two." - Glucose should be monitored before and after exercise because it can lower blood glucose levels. The effects of exercise may occur for up to 48 hours, so it is important for a patient to continue to monitor for hypoglycemia in the day or two after exercise. The amount of insulin required is based on the blood glucose level, not the amount of exercise. Exercise assists the muscles to use more glucose, increases insulin receptor sites, and decreases blood glucose. Exercise helps the body use glucose more efficiently. Exercise and diabetes considerations include: · Blood glucose should be monitored before and after exercise. · Exercise should be increase gradually to avoid the risk of hypoglycemia. · Hypoglycemia is a risk for up to 48 hours after exercise.

Which statement made by a client indicates an understanding of type 2 diabetes mellitus?

- "My cells are resistant to the insulin my pancreas makes." With type 2 diabetes mellitus, the pancreas produces insulin but the cells cannot use it. Other important things to remember include: The beta cells CONTINUE to produce insulin with type 2 diabetes. Peripheral cells have a DECREASED not an increased sensitivity to insulin. There is a DECREASE in receptor sites with type 2 diabetes.

A patient asks if arformoterol (Brovana) can be used to terminate an acute asthma attack. Which response should the nurse provide?

- "No, because it takes longer to achieve maximum effects." - Arformoterol is a long-acting inhaled beta2-agonist (LABA) that should not be used to terminate acute asthma attacks because it has a relatively slow onset of action and will not abort an acute bronchospasm; an inhaled short-acting beta2-agonist should be used instead. Arformoterol has a black box warning that states asthma-related death is a risk. Risk for rebound bronchoconstriction is not why the medication is not used to terminate an acute asthma attack. The medication is not the newest LABA on the market, nor is it necessarily the safest. The medication takes longer to start acting. Additional examples of LABAs include: · Arformoterol. · Albuterol (VoSpire ER). · Formoterol. · Olodaterol. · Salmeterol.

A patient asks why it is important to rinse the mouth after using inhaled medications. Which should the nurse respond to this patient?

- "Rinsing helps prevent systemic absorption of the medications." - The patient should be instructed to rinse the mouth after using inhaled medications to help prevent systemic absorption and localized reactions. Rinsing does not decrease esophageal cancer risk, nor does it necessarily prevent the inhaled medications from interacting with other medications. Although rinsing may help prevent some adverse medication effects from occurring, rinsing does not prevent all adverse medication effects.

The nurse is reviewing the relationship between the respiratory and nervous systems. Which action should indicate the nervous system's control of ventilation?

- Changing the diameter of the airways - The nervous system, specifically the sympathetic and parasympathetic systems, controls ventilation by changing the diameter of the very small and abundant bronchioles. The nervous system does not play a role in decreasing gas exchange in the alveoli, increasing the amount of mucus production, or increasing intrathoracic pressure.

A patient with exercise-induced bronchospasm is prescribed a leukotriene modifier. Which teaching should the nurse provide?

- "Take the medication 2 or more hours before you exercise." - Montelukast (Singulair) is the only leukotriene modifier approved to prevent exercise-induced bronchospasm. The medication is effective if taken 2 or more hours before exercise. The medication will not terminate an acute asthma attack. There are no identified interactions with herbal preparations. If an acute asthma attack occurs, a short-acting beta2-agonist, such as albuterol (Proventil HFA, Ventolin HFA), should be used.

A patient is prescribed a continuous subcutaneous infusion device. Which should the nurse include when teaching about this device?

- "The insulin dose is programmed into the device." - This pump is usually abdominally anchored and is programmed to release small subcutaneous doses of insulin into the abdomen at predetermined intervals, with larger boluses administered manually at mealtime if necessary. The schedule to change the location of the pump varies according to the type of pump being used. Short or intermediate acting insulin is used in a pump.

The nurse is asked about Humulin 70/30 insulin. Which should the nurse explain about this insulin?

- "The majority of the insulin is long acting." - Humulin 70/30 is a premixed formulation of insulin that is 70% NPH insulin, which is an intermediate-acting insulin, and 30% regular insulin, which is a short-acting insulin. A dose does not need to be taken before each meal. It will take longer for the insulin to peak because of the percentage of NPH. Due to the percentage of NPH, only one dose is required.

The nurse is asked about the role brainstem neurons have in the respiratory system. Which response should the nurse provide?

- "They determine the rate at which ventilation occurs." - The rate at which ventilation occurs is determined by brainstem neurons. Brainstem neurons do not block gas exchange, cause bronchoconstriction, or promote inflammation. - The normal adult respiratory rate is 12-18 breaths/min. This rate may be modified by factors such as emotions, fever, stress, blood pH, and other medications.

A patient is prescribed detemir (Levemir) as treatment for type 1 diabetes mellitus (DM). Which explanation should the nurse include in the teaching?

- "This insulin cannot be mixed with any other insulins." - Detemir is a long-acting insulin that CANNOT be mixed with any other insulins. Detemir is effective up to 24 hours. Detemir is a long-acting insulin with a slow onset and does not need to be injected before meals to control postprandial hyperglycemia. - Detemir cannot be mixed with any other type of insulin and is only given by subcutaneous injection.

A patient is prescribed semaglutide (Ozempic).Which instruction should the nurse include in the teaching?

- "This medication is taken once a week." - Semaglutide (Ozempic) is used as an adjunct to diet and exercise to improve glycemic control and is administered subcutaneously once a week. The medication can be administered without regard to meals or time of day. The medication should not cause weight gain. It is important for the patient to continue to follow an exercise and diet program to help maintain glycemic control and avoid weight gain.

A patient is prescribed alogliptin (Nesina) for type 2 diabetes mellitus (DM) that is not controlled through exercise and diet alone. Which statement should the nurse provide to the patient?

- "This will help the slow the breakdown of insulin in your body." - Alogliptin is an incretin enhancer that slows the breakdown of insulin, allowing it more time to circulate in the blood. Biguanides and thiazolidinediones decrease the production and release of glucose from the liver. Sulfonylureas help stimulate the release of insulin from the pancreas and decrease insulin resistance. Alpha-glucosidase inhibitors interfere with carbohydrate breakdown and their absorption in the gastrointestinal tract.

A patient reports feeling dizzy when waking up since starting insulin. Which question should the nurse ask the patient first?

- "What is your blood glucose reading when the dizziness occurs?" - Dizziness is an adverse effect of insulin and could indicate a low blood glucose level. The patient should be instructed to assess a capillary blood glucose level when the dizziness occurs. There is no reason to assess the patient's breakfast meal. The amount of insulin may be too high regardless of the time it is taken with dinner. Dizziness is an abnormal assessment finding and the cause should be investigated, even if it resolves on its own. Manifestations of hypoglycemia include: · Pale, cool, moist skin. · Confusion. · Lightheadedness. · Weakness. · Anxiety. · Blood glucose less than 50 mg/dL.

A patient is prescribed lispro (Humalog). Which instruction should the nurse include in the teaching?

- "You can take this with insulin isophane." - Insulin isophane can be given with NPH. Lispro has a rapid onset and should be administered 5-10 minutes before a meal. Lispro should be given immediately after drawing it up, and it is often used with insulin pumps.

Which response should the nurse provide a client that asks about dawn phenomenon?

- "Your body naturally produces cortisol and growth hormone between 4:00 AM and 8:00 AM During the dawn phenomenon the body naturally produces cortisol and growth hormone between 4:00 AM and 8:00 AM which can result in hyperglycemia.

Which information should the nurse include in the education of a client when explaining type 1 diabetes mellitus?

- "Your pancreas cannot secrete insulin" The function of the pancreas is to secrete insulin. Secretion of insulin is an endocrine function. Target cells that are resistant to insulin is descriptive of the pathology for type 2 diabetes. Insulin is secreted by the beta cells of the pancreas.

A patient with type 1 diabetes mellitus (DM) asks why treatment is not with oral medication. Which response should the nurse make?

- - "Medications for diabetes do not contain insulin." - Insulin is destroyed in the gastrointestinal tract and therefore cannot be given in an oral form. Patients with type 1 DM do not have the ability to produce insulin due to destruction of the islet cells of the pancreas and therefore require exogenous insulin. Medications for the treatment of type 2 DM do not contain insulin. Insulin does not come in an oral form; it can be given subcutaneously, intravenously, or through a continuous infusion device.

Which are thought to be the contributing factors to the development of type I diabetes? Select all that apply 1. Gender 2. Genetics 3. Ethnicity 4. Environment 5. Immunology

- 2, 4, 5 - Genetics, Environment, Immunology Type 1 DM is caused by autoimmune destruction of pancreatic beta cells, resulting in lack of insulin secretion. The disease is thought to be an interaction of genetic, immunologic, and environmental factors.

A patient with type 1 diabetes mellitus (DM) is admitted to the hospital for an acute illness.Which site should the nurse use to administer the prescribed insulin?

- A site that is difficult for the patient to reach - The sites that should be used for the administration of insulin are ones that the patient has the most difficulty reaching or have been used less often. Using the same site repeatedly can lead to lipodystrophy. If the insulin is absorbed too rapidly, it can cause hypoglycemia. Sites for insulin administration should be rotated weekly, not daily. Considerations for insulin administration for the hospitalized patient include: · Rotate sites weekly. · Use sites that have been used less frequently. · Use sites that are difficult for the patient to reach.

A patient is prescribed rosiglitazone (Avandia) for the treatment of type 2 diabetes mellitus (DM). For which adverse effect should the nurse monitor the patient?

- Abnormal liver function - Rosiglitazone is a thiazolidinedione that reduces blood glucose by decreasing insulin resistance and inhibiting the generation of glucose. When monitoring a patient taking this drug, liver function should be monitored because thiazolidinediones may be hepatotoxic. The patient should also be monitored for weight gain, which may be attributed to heart failure. An electrolyte imbalance is not a direct adverse effect of the use of the drug but may occur in a patient who is experiencing heart failure. Hypoglycemia does not occur with drugs in this class. - Rosiglitazone (Avandia) contains a black box warning for heart failure and for increased risk for myocardial ischemia.

A patient experiences morning dizziness and low blood glucose levels after starting a new type of insulin. Which action should the nurse expect?

- Adjustment of the insulin prescription - A low blood glucose reading in conjunction with dizziness may require an adjustment to the insulin prescription. Dizziness is an abnormal assessment finding and should not be ignored. The healthcare provider is unlikely to discontinue the patient's insulin if no other adverse effects are present. Eating more carbohydrates does not address the cause of this patient's symptoms. Manifestations of hypoglycemia include: · Pale, cool, moist skin. · Confusion. · Lightheadedness. · Weakness. · Anxiety. · Blood glucose less than 50 mg/dL.

The nurse finds a client with diabetes mellitus type 1 unresponsive. Which is the priority nursing action?

- Administer glucagon When a client with diabetes mellitus type 1 is found unresponsive, the client should be treated as if they were hypoglycemic. Left untreated, severe hypoglycemia may result in death.

A patient is prescribed cromolyn for chronic obstructive pulmonary disease (COPD). Which should the nurse expect to see documented in the medical record?

- Allergy to corticosteroids - Cromolyn reduces airway inflammation and may be prescribed if corticosteroids are contraindicated or have not been effective. Cromolyn is not effective for acute attacks. Diagnoses of intermittent asthma and end-stage COPD alone do not indicate a need for cromolyn. Cromolyn reduces inflammation and is not prescribed as an antitussive.

A patient with type 2 diabetes mellitus (DM) is unable to achieve normal glucose levels through diet and exercise. Which medication should the nurse expect to be prescribed for this patient?

- Alogliptin (Nesina) - Alogliptin is an incretin enhancer that slows the breakdown of insulin, allowing it more time to circulate in the blood. Biguanides, such as metformin, and thiazolidinediones, such as pioglitazone, decrease the production and release of glucose from the liver. Sulfonylureas, such as glipizide, help stimulate the release of insulin and decrease insulin resistance.

Which information should the nurse include when teaching a client about proper subcutaneous injection techniques?

- Apply a pad to the site after injection A pad should be applied to the site after an injection. Other important things to remember include: The area should be injected using a 90 degree angle. Injections sites should be rotated WEEKLY The site should not be massaged after an injection.

Which assessment should the nurse conduct for the client receiving beclomethasone (Beconase) nasal spray?

- Assess the client's mouth for any sign of fungal infection - Assess if the client has blown his nose prior to administration of nasal spray - Assess if the client has had a change in taste - Assess the client for any hoarseness or change in voice Clients may develop candidiasis (thrush) so the mouth should be assessed. The client should gently blow the nose prior to the use to clear the nasal passages. Clients may experience a change in taste. Clients may experience a change in voice as a local effect.

A patient with chronic obstructive pulmonary disease (COPD) is at risk for osteoporosis. Which long-term medication prescription should the nurse question for this patient?

- Beclomethasone (Qvar) - When taken long term, oral and inhaled corticosteroids such as beclomethasone can affect bone physiology in adults and children. At-risk patients, including those with osteoporosis, should have periodic bone density tests, and the healthcare provider may prescribe a bisphosphonate medication to prevent fractures. Levalbuterol (Xopenex), formoterol (Foradil, Perforomist), and ipratropium (Atrovent) are medications commonly prescribed to treat COPD that do not affect bone physiology. Additional adverse effects of inhaled corticosteroids include: · Hoarseness. · Dry mouth. · Change in taste. · Cataract development. · Growth inhibition in children. · Oropharyngeal candidiasis.

A patient is prescribed albuterol (Proventil HFA, Ventolin HFA, VoSpire ER) for the treatment of asthma. Which type of medication should the nurse recall is contraindicated for use with albuterol?

- Beta blocker - Concurrent use with beta blockers will inhibit the bronchodilation effect of albuterol. Albuterol is not contraindicated with a corticosteroid, leukotriene modifier, or mast cell stabilizer. - Patients should avoid monoamine oxidase inhibitors within 14 days of beginning albuterol therapy because of the risk for hypertensive crisis.

The nurse reviews the physiology of ventilation. Which structure should the nurse identify that impacts the rate of ventilation?

- Brainstem - The rate at which ventilation occurs is determined by brainstem neurons. The bronchiolar smooth muscle, diaphragm, and airway play a role in the patient's respiratory status, but do not determine how many times ventilation occurs per minute. - The normal adult respiratory rate is 12-18 breaths/min. This rate may be modified by factors such as emotions, fever, stress, blood pH, and other medications.

A patient experiencing an asthma attack is given a dose of albuterol. Which outcome should the nurse assess to determine effectiveness?

- Decreased adventitious breath sounds - Albuterol is a bronchodilator that relieves asthma symptoms, such as wheezing. Decreased adventitious breath sounds indicate an improvement in asthma symptoms. A fast heart rate and low potassium level are adverse effects of the medication. The medication has no effect on pupil reaction.

A patient is prescribed an inhaled corticosteroid for long-term management of persistent asthma. Which therapeutic effect should the nurse expect?

- Decreased airway edema - Inhaled corticosteroids have an anti-inflammatory effect and decrease mucous production and edema in bronchial airways. An inhaled corticosteroid does not promote bronchodilation, prevent respiratory infections, or act as an expectorant.

Which information should the nurse include in the education about the mechanism of action for metformin (Glucophage)?

- Decreases sugar production in the liver - Reduces insulin resistance Metformin decreases sugar production (gluconeogenesis) in the liver. Metformin reduces insulin resistance.

A patient experiencing severe hypoglycemia receives glucagon. Which effect should indicate that this medication was effective?

- Elevated blood glucose level - Glucagon acts to increase blood glucose levels. Glucagon does not effect potassium level, heart rate, or metabolism of lactic acid.

A patient is demonstrating signs of type 1 diabetes mellitus (DM). Which symptom should the nurse expect to assess?

- Excessive urination - Excessive urination or polyuria is a major symptom of type 1 DM. Weight gain occurs in a patient with type 2 diabetes; patients with type 1 diabetes tend to lose weight. An elevated blood pressure level more often occurs with type 2 diabetes; it can occur in a patient with type 1, DM but it is not directly related to the disease process. Heart palpitations are a symptom commonly associated with hypoglycemia and not diabetes. Symptoms of type 1 DM include: · Hyperglycemia. · Polyuria. (excessive urination) · Polyphagia. (increased hunger) · Polydipsia. (increased thirst) · Glucosuria. (high levels of glucose in the urine) · Weight loss & Fatigue.

Which are the primary blood tests for diagnosing diabetes?

- Fasting plasma glucose - Hemoglobin A1C - Oral glucose tolerance test The primary blood test for diagnosing diabetes include the fasting plasma glucose, hemoglobin A1C, and oral glucose tolerance test.

When should the nurse administer a client's prescribed 10 units of lispro (Humalog)?

- Five minutes before a meal The onset action of insulin lispro (Humalog) is 15 to 30 minutes so it must be given 5 to 10 minutes before the client eats to prevent hypoglycemia.

A patient with chronic obstructive pulmonary disease (COPD) reports that an anticholinergic medication was changed to aid adherence with treatment. Which medication change should the nurse expect?

- From ipratropium (Atrovent) to tiotropium (Spiriva) - Tiotropium is taken once per day, whereas ipratropium is taken four or more times per day. The less frequent dosing decreases the chance of the patient missing a dose. Ipratropium and tiotropium are anticholinergics. Beclomethasone and budesonide are corticosteroids.

A patient with type 1 diabetes mellitus (DM) seeks treatment for "not feeling well." Which symptom should indicate to the nurse that the patient is experiencing diabetic ketoacidosis (DKA)?

- Fruity breath odor - Symptoms of DKA include a fruity breath odor caused by the metabolism of fats instead of glucose for energy. Flushed, dry, and warm skin occurs in hyperosmolar hyperglycemic state (HHS). Weight gain and peripheral edema are not symptoms of DKA.

A patient has an elevated blood glucose level. Which medication should the nurse suspect this patient received?

- Glucagon (GlucaGen) - Glucagon acts to increase blood glucose levels. Insulin, albiglutide, and glyburide lower blood glucose levels.

A patient is experiencing adverse effects from bromocriptine (Cycloset). Which assessment finding should the nurse anticipate?

- Headache - Bromocriptine is a dopamine receptor agonist. The most frequent adverse effects associated with bromocriptine are nausea, fatigue, dizziness, vomiting, and headache. Tremors are an adverse effect associated with hypoglycemia. Peripheral edema and abdominal pain are not adverse effects associated with bromocriptine.

A patient is diagnosed with type 2 diabetes mellitus (DM). Which assessment finding should the nurse anticipate?

- Hyperlipidemia - The majority of people with type 2 DM have obesity and dyslipidemias, and will need a medically supervised plan to reduce weight gradually and exercise safely. A patient with type 2 DM will not have a normal blood glucose. Postural hypotension is an autonomic neuropathy, and motor weakness is a somatic neuropathy. Both are associated with long-standing uncontrolled DM.

The nurse has completed client education about the use of a metered-dose inhaler (MDI) and spacer. Which statement made by the client indicates further teaching is required?

- I should keep the spacer moist between uses by storing it in a plastic zip bag The spacer and inhaler should be rinsed with water and allowed to air-dry

Which information should the nurse include when discussing inhalation therapy as part of a treatment plan for the client's asthma?

- Inhalation therapy is effective because it goes to the direct site of action in the respiratory tract. The a major advantage of aerosol therapy is that it delivers the drugs to their direct site of action.

A home health nurse observes a client's 3-month supply of insulin vials that are not refrigerated. Which action should the nurse take?

- Instruct the client that the insulin should be stored away from direct sunlight or excessive heat. Unopened vials can be stored at room temperature but should be stored away from direct sunlight or direct heat.

Which insulin has the longest onset? 1. Insulin determir (Levemir) 2. Insulin glulisine (Apidra) 3. Insulin lispro (Humalog) 4. Insulin isophane (NPH)

- Insulin detemir (Levemir) Insulin detemir has a onset of 1.6 hours

Which type of insulin should the nurse anticipate to administer intravenously to a client with a blood glucose of 563?

- Insulin regular (Humulin R) Regular insulin is the only insulin that can be give intravenously.

A patient reports increasing dietary fiber because of a prescribed medication for chronic obstructive pulmonary disease (COPD). Which medication should the nurse expect was prescribed for this patient?

- Ipratropium (Atrovent) - Ipratropium, an anticholinergic medication, can cause constipation. The patient should increase fiber and fluid intake. The patient would not have to increase fiber intake for theophylline, fluticasone (Flovent), or cromolyn. Additional adverse effects of ipratropium include: · Cough. · Drying of the nasal mucosa. · Hoarseness. · Bitter taste. · Epistaxis.

A patient is prescribed aspart (NovoLog) for the treatment of type 1 diabetes mellitus (DM). Which intermediate-acting insulin should the nurse anticipate will also be prescribed?

- Isophane (Humulin N, NPH) - Aspart acts rapidly and has a short duration; therefore, it is usually given in combination with an intermediate- or long-acting insulin. Isophane is the only intermediate-acting insulin and can be given with aspart. Lispro and glulisine are also rapid-acting insulins and would not be given with aspart. Detemir is a long-acting insulin, and while it can be given to a patient taking aspart, it is not an intermediate-acting insulin.

Which condition is a client at risk for who is prescribed a biguanide?

- Lactic acidosis There is a risk for lactic acidosis for a client receiving biguanide.

A patient with type 2 diabetes mellitus (DM) asks what personal actions can be taken to control the disease process. Which response should the nurse make?

- Lose weight and exercise - The majority of people with type 2 DM have obesity and dyslipidemias, and will need a medically supervised plan to reduce weight gradually and exercise safely. Losing weight and exercising are important lifestyle changes for such patients; they will need to maintain these healthy habits for their lifetime. A low-carbohydrate eating plan and eliminating sugar from the diet will not control the disease process. Medications should be taken as prescribed and not as needed.

A patient is diagnosed with emphysema. Which should the nurse recall about the pathophysiology of this health problem?

- Loss of bronchiolar elasticity - Emphysema, a chronic pulmonary condition, is characterized by a loss of bronchiolar elasticity and destruction of alveolar wall structures. Partial collapse of the airways occurs on exhalation. Emphysema results in decreased perfusion and gas exchange at the alveolus. Excess mucus production in the lower respiratory tract is a characteristic of chronic bronchitis.

A patient experiences persistent asthma that has not been well controlled. Which type of bronchodilator should the nurse expect to be prescribed?

- Methylxanthine - A methylxanthine, typically theophylline, may be prescribed as an alternative if more effective medications (e.g., anticholinergics, short- or long-acting beta2-adrenergic agonists) are not effective in relieving symptoms. Methylxanthines are used cautiously because of their narrow therapeutic index and interactions with multiple medications.

Which symptom should the nurse associate with hypoglycemia?

- Moist skin Moist skin is a symptom of hypoglycemia. Thirst, increased urination, and nausea are symptoms of hyperglycemia.

A patient is diagnosed with chronic obstructive pulmonary disease (COPD). Which should the nurse recall about this disease process when planning care?

- Most patients with COPD are lifelong tobacco users. - Most patients with COPD are lifelong smokers, accounting for 85-90% of all nonasthmatic COPD cases. Strict medication management can relieve symptoms, but they do not alter COPD progression. The patient is high risk for pulmonary infections because microbes thrive in mucus-rich environments. Mucolytics loosen thick bronchial secretions and are important for COPD management.

A patient with type 1 diabetes mellitus (DM) experiences tingling of the fingers Which complication should the nurse suspect is causing these symptoms?

- Neuropathy - Neuropathy can occur in both type 1 and type 2 DM and include finger tingling. Nephropathy, retinopathy, and vascular disease are complications of DM, but these are not associated with finger tingling.

Which lab test should the nurse monitor the client for who is receiving insulin?

- Potassium Insulin causes potassium to move into the cell and may cause hypokalemia

An older patient is prescribed long-term beclomethasone (Qvar). Which should the nurse consider before administering the medication?

- Recent diagnosis of osteoporosis - When taken long term, oral and inhaled corticosteroids such as beclomethasone can affect bone physiology in adults and children. At-risk patients, including those with osteoporosis, should have periodic bone mineral density tests, and the healthcare provider may prescribe a bisphosphonate medication to prevent fractures. There are no known food or medications that interact significantly with beclomethasone. A recent completion of antibiotic therapy is not of concern, although an active infection is a contraindication for the medication's use. Additional adverse effects of inhaled corticosteroids include: · Hoarseness. · Dry mouth. · Change in taste. · Cataract development. · Growth inhibition in children. · Oropharyngeal candidiasis.

A patient taking medication for type 2 diabetes mellitus (DM) has abnormal liver function tests. Which medication should the nurse suspect the patient is taking?

- Rosiglitazone (Avandia) - Rosiglitazone is a thiazolidinedione that reduces blood glucose by decreasing insulin resistance and inhibiting the generation of glucose. Liver function should be monitored because thiazolidinediones may be hepatotoxic. Metformin, acarbose, and liraglutide do not have abnormal liver function as an adverse effect. - Rosiglitazone (Avandia) contains a black box warning for heart failure and for increased risk for myocardial ischemia.

Which is the primary function of the islets of Langerhans?

- Secretion of glucagon The islets of Langerhans are responsible for its endocrine function: the secretion of glucagon and insulin.

A patient is newly diagnosed with intermittent asthma. Which type of inhaled medication should the nurse expect to be prescribed initially?

- Short-acting beta2-adrenergic agonist (SABA) - Short-acting beta agonists (SABAs) have a rapid onset of action, usually several minutes. SABAs are the most frequently prescribed drugs for aborting or terminating an acute asthma attack. Their effects, however, last only 2 to 6 hours, so the use of SABAs is generally limited to as-needed (prn) management of acute episodes. Inhaled corticosteroids (ICS) are used for the long-term prevention of asthmatic attacks. Long-acting beta agonists (LABAs) have therapeutic effects that last up to 12 hours. These medications have a relatively slow onset of action and will not abort an acute bronchospasm. The leukotriene modifiers are second-line medications to reduce inflammation and ease bronchoconstriction and are used as alternative drugs in the management of asthma symptoms. Examples of SABAs include: · Albuterol (Proventil HFA, Ventolin HFA, VoSpire ER). · Metaproterenol. · Levalbuterol (Xopenex). · Subcutaneous terbutaline.

Which client has the highest risk of developing type 2 diabetes mellitus?

- The 42-year-old client who is 50 pounds overweight The majority of people with type 2 DM have obesity and dyslipidemias and will need a medically supervised plan to reduce weight gradually and exercise safely.

A client with type 1 diabetes mellitus receiving insulin asks the nurse if they can have a glass of wine with their dinner. Which information should the nurse provide to the client?

- The alcohol can predispose you to hypoglycemia. Alcohol can potentiate hypoglycemic effects in the client.

A patient with persistent asthma is prescribed a methylxanthine bronchodilator. Which should the nurse suspect as the reason for this medication to be prescribed?

- The patient's asthma has been uncontrolled by other medications. - A methylxanthine, typically theophylline, may be prescribed as an alternative if more effective medications (e.g., anticholinergics, short- or long-acting beta2-adrenergic agonists) are not effective in relieving symptoms. There is not enough information to conclude that the patient experiences exercise-induced bronchospasms, has COPD, or has been nonadherent with other medications.

A client asks the nurse why they must continue to take their asthma prescription when they have not had an asthma attack in several months. Which response should the nurse provide to the client?

- The prescription is still needed to decrease inflammation in your airways and help prevent an attack Effective treatment of asthma includes long-term treatment to prevent attacks and decrease inflammation as well as short-term treatment when an attack occurs.

A patient is diagnosed with type 2 diabetes mellitus (DM). Which should the nurse include when teaching the patient about this health problem?

- The target cells become resistant to insulin. - The primary physiologic characteristic of type 2 DM is insulin resistance; target cells become unresponsive to insulin due to a defect in insulin receptor function. The pancreas produces sufficient amounts of insulin but target cells do not recognize it. Pancreatic beta cell death is a characteristic of type 1 DM. Insulin is the only treatment for type 1 DM. Type 2 DM does not cause a drop in blood pressure.

The nurse is teaching a patient about the pathogenesis of asthma. Which information should the nurse include about the action of the smooth muscles within the airway?

- They are hyperresponsive to stimuli. - The smooth muscles located in the airway are hyperresponsive to stimuli, which results in bronchospasm and inflammation in the patient with asthma. During an asthma attack, histamines and prostaglandins are released. Activation of beta2-adrenergic receptors would result in bronchodilation.

A patient is prescribed theophylline for asthma. Which should the nurse suspect as the reason this medication was prescribed?

- Treatment with a beta agonist was unresponsive. - Theophylline is currently used primarily for the long-term oral prophylaxis of asthma that is unresponsive to beta agonists or - inhaled corticosteroids. It is not the preferred treatment for asthma. Asthma was not recently diagnosed because other medications have to have been attempted. It has a narrow margin of safety.

The nurse is asked to explain the mechanism of insulin resistance. Which health problem should the nurse explain in response?

- Type 2 diabetes mellitus (DM) - The primary physiologic characteristic of type 2 DM is insulin resistance; target cells become unresponsive to insulin due to a defect in insulin receptor function. The pancreas produces sufficient amounts of insulin but target cells do not recognize it. Pancreatic beta cell death is a characteristic of type 1 DM. Hyperlipidemia is a health problem associated with type 2 DM. Pancreatitis does not cause insulin resistance.

The nurse is reviewing the blood work of a client suspected of having diabetes. Which result should the nurse be concerned about? 1. HBA1C level is 8.4% 2. Fasting plasma glucose is 115 g/dL 3. Fasting plasma glucose is 110 g/dL 4. Oral glucose tolerance test of 185 mg/dL

1. HBA1C level is 8.4% The target level for HBA1C is 6.5% or less A fasting plasma glucose of 126 mg/dL or higher indicates diabetes An oral glucose tolerance test value of 200 mg/dL or higher indicates diabetes