Week 2 quiz questions - Diabetes

At what blood glucose level are the kidneys involved? A. 180 mg/dl B. 200 mg/dl C. 126 mg/dl D. 300 mg/dl

A

When using IV insulin to slowly bring down blood sugar levels, we are preventing which of the following? (Select all that apply) A. Hypoglycemia B. Hypoxia C. Cerebral edema D. Pulmonary edema

A and C

Select all that apply: Why is it important to administer Insulin through an IV when treating someone for DKA? A. You don't want to overcorrect them into hypoglycemia B. A sudden fluid shift from water into cells can lead to cerebral edema C. A sudden shift in potassium levels can lead to heart problems D. You can regulate the rate you bring blood sugar down

A, B, C, D. Administering insulin through an IV is important because you do not want to overcorrect someone too quickly. Using an IV you are able to regulate and control the rate the blood sugar is brought down. This also prevents an extreme fluid shift, preventing cerebral edema and heart problems.

Which of the following are presentations of DKA? (Select All That Apply) A. Acetone breath B. Ketones in urine C. Hyperreflexia D. Abdominal pain

A, B, D

What differential(s) indicate diabetic ketoacidosis (slect all that apply)? a)Acidic arterial blood gasses b)High potassium c)Presence of ketones in urine d)Blood glucose value of 140 mg/dl

A, C

Diabetic ketoacidosis (DKA) can be characterized by which of the following? (Select all that apply) A. Acidosis B. Alkalosis C. Dehydration D. Hyperglycemia

A, C, D

Select All That Apply: Which of the following are signs or symptoms associated with diabetic ketoacidosis? A. ketones in urine B. hyperkalemia C. shortness of breath D. nausea and vomiting E. blood glucose >60

A, C, D

Which of the following are signs or symptoms of DKA? (select all that apply) a. Positive ketones in the urine b. Oliguria c. Polydipsia d. Abdominal pain

A, C, D

Your patient has been recently been diagnosed with Type 2 Diabetes and is having some trouble learning. What are the best methods for education? Select all that apply. a. Handout regarding the disease process b. Video on how to get blood sugar levels at home c. Making a schedule with them d. Introducing them to a diabetic educator

A,B,C,D

A nurse is reviewing the health history of a client who has type 1 diabetes mellitus. Which of the following are risk factors for hyperglycemic hyperosmolar state (HHS)? (Select all that apply.) A. Evidence of recent myocardial infarction B. BUN 35 mg/dL C. Takes a calcium blocker D. Age 77 years E. Daily insulin injections

A,B,C,D A: Due to the increased hormone production during illness or stress, which can stimulate the liver to produce glucose and decrease the effects of insulin B: A BUN of 35mg/dL because it is an indication of decreased kidney function and the inability of the kidney to filter high levels of blood glucose into the urine C: Calcium channel blocker is one of several medications that increase the risk for HHS in a client who has type 2 diabetes mellitus D: The older adult client is at risk for developing type 2 diabetes mellitus and can be unaware of associated manifestations, increasing the risk for HHS E: Taking insulin does not increase the risk for HHS. When a client is experiencing hyperglycemia, insulin prevents the client from developing DKA

Which of the following are manifestations of hypoglycemia? A. Cold, clammy skin B. Dizziness C. Increased urination D. Confusion E. Increased thirst

A,B,D- increased urination and increased thirst are signs of hyperglycemia When blood glucose levels are too low it causes cool, clammy skin, confusion and dizziness this is due to the body not having enough energy as glucose is a main source of energy

Which of the following are signs and symptoms of diabetic ketoacidosis (DKA)? Select all that apply: A. Positive ketones in the urine B. Oliguria C. Fruity breath D. Cough E. Polydipsia

A,C,E

Select all that apply A nurse is reviewing morning labs for a comatose diabetic teen receiving treatment for DKA related to non-compliance. Treatment includes IV crystalloid fluids, electrolyte replacement and drip insulin. The nurse calls the doctor to report concern over which of the following lab trends: A. Potassium 0400 4.4.mg/dl 0700 labs -3.3 mg/dl Normal range ( 3.5-4.5mg/dl) B. Blood glucose 0500 labs -450mg/dl 0600 labs- 375mg/dl 0700 labs 300mg/dl Normal range (70-120mg/dl) C. Sodium 0400 - 128mg/dl 0700 current shift -139mg/dl Normal range ( 135-145 mg/dl), desired correction rate ( 6-8mg/dl/day)

A/B/C Insulin drives potassium into the cell. When administering insulin it is important to monitor potassium for electrolyte imbalances. Rapid glucose reduction can result in cerebral edema. Suggested reduction rate is 36-54mg/dl/hr. Rapid correction and or overcorrection in electrolyte levels, and administration of insulin decreasing K+ levels in further complications such as Cardiac arrythmias (hypokalemia), Osmotic demyelination syndrome (sodium, sodium correction range 6-8 mg/dl/day), and cerebral edema.

A nurse is reviewing the medical record for a client who is to begin therapy for DKA. Which of the following prescriptions should the nurse expect? A. Administer a slow IV infusion of 3 % sodium chloride B. Rapidly administer an IV infusion of 0.9% sodium chloride C. Administer an IV infusion of regular insulin at 0.3 unit/kg/hr D. Add glucose to the IV infusion when blood glucose is 350 mg/dL

ANSWER: B A: Expect to administer a 3% sodium chloride solution to a client who has hyponatremia B: Expect to rapidly administer an IV infusion of 0.9% sodium chloride, an isotonic fluid, as prescribed to maintain blood perfusion to vital organs. The initial infusion for a client who has an elevated sodium would be 0.45% sodium chloride. C: Expect to administer an IV infusion of regular insulin at 0.1 unit/kg/hr to gradually lower blood glucose to prevent cerebral edema D: Add glucose to the IV infusion when the blood glucose is 250 mg/dL, not 350 mg/dL, to prevent hypoglycemia and minimize cerebral edema

A nurse caring for a patient who is in DKA which of the following treatment would the nurse expect to be ordered? A. IV push of potassium B. A SQ injection of Humalog C. IV regular insulin D. 1 unit of packed RBCs

ANSWER: The correct answer is C! Patients in DKA are treated with IV regular insulin. Regular insulin is the only type of insulin that is given intravenously and is given to help lower the patient's high blood sugar slowly.

A patient with suspected Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS) would present with which of the following signs and symptoms: (Select all that apply) A. A blood sugar of 380 B. Ketones in the urine C. A sweet fruity breath D. A blood sugar over 600

ANSWER: The correct answer is D all other answer choices are signs and symptoms of diabetic ketoacidosis (DKA).

A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the ER. Which finding would a nurse expect to note as confirming this diagnosis? A. Elevated blood glucose level and a low plasma bicarbonate B. Decreased urine output C. Increased respiration and an increase in pH D. Comatose state

Answer: A Rationale Option A: In diabetic acidosis, the arterial pH is less than 7.35. Plasma bicarbonate is less than 15mEq/L, and the blood glucose level is higher than 250mg/dl and ketones are present in the blood and urine Options B and C: The client would be experiencing polyuria, and Kussmaul's respirations would be present. Option D: A comatose state may occur if DKA is not treated, but coma would not confirm the diagnosis

What lab values are diagnostics for diabetic ketoacidosis? (Select all that apply) A. Ketones found in the urine B. High serum pH C. Low bicarbonate D. Bradycardia

Answer: A and C. Patients with DKA typically will present with a low serum pH and tachycardia.

Which of the following factors are risks for the development of diabetes mellitus? (Select all that apply.) A. Age over 45 years B. Overweight with a waist/hip ratio >1 C. Having a consistent HDL level above 40 mg/dl D. Maintaining a sedentary lifestyle

Answer: A, B, D Rationale Older adults are at high risk for the development of type 2 diabetes due to the combined effects of increasing insulin resistance and impaired pancreatic islet function with aging. A healthy HDL level is above 40mg/dl.

Which of the following labs are consistent with a patient in Diabetic Ketoacidosis to present with? (Select all that apply). A. HCO3: 18 B. Anion gap: 14 mEq/L C. pH: 7.5 D. Positive ketones in the urine E. BUN: 22

Answer: A, B, D, E. Bicarbonate will be decreased less than 22, Anion gap will be wide (greater than 11), pH should be less than 7.35, Ketones will be present in the urine, BUN will be greater than 20.

Which patients are most at risk for developing diabetic ketoacidosis? Select all that apply. A. An 18-year old with type 1 diabetes whose insulin pump malfunctioned last night B. An elderly pastor with renal failure C. A middle-age type 2 diabetic who is obese and works for the stock market D. A type 2 diabetic who developed an infection after stepping on a rusty nail and is not regularly taking Metformin E. All of the above

Answer: A, C, D DKA most often occurs in younger patients with type 1 diabetes. However, people with type 2 diabetes are susceptible to DKA during stressful conditions, such as a recent injury, trauma, or infection.

A 75 year old patient is admitted to the Enloe Medical Center with a blood sugar of 395, after administering a bolus of IV insulin the patients blood sugar drops to 45 what is occuring or may occur in the patient's body as their blood sugar rapidly drops (Select all that apply): A. The water molecules follow the glucose molecules into extracellular fluid B. Water molecules shift with the glucose molecules into the intracellular fluid C. Cerebral edema may occur due to rapid fluid exchange D. Intracranial pressure is increased

Answer: A, C, and D As a patient's blood sugar drops rapidly, water molecules follow the glucose molecules in a shift from the intracellular fluid to the extracellular fluid. As the fluid builds up in the extracellular space, intracranial pressure is increased and cerebral edema may occur.

Which of the following diagnostics indicate Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS) NOT diabetic ketoacidosis? Select all that apply A. A blood glucose level over 600 mg/dL B. Glomerular Filtration Rate >60 C. Urinalysis shows low presence of ketones D. Nausea and vomiting

Answer: A, C. Blood glucose levels over 600 mg/dL in conjunction with a urinalysis showing a low presence of ketones in needed to rule out DKA. A low GFR could be indicative of a number of conditions not just HHNS. N/V are just symptoms not diagnostic values.

Which of the following is an age related change with a client who has diabetes? (select all that apply) A. Deteriation of vision B. Peripheral neuropathy C. Decrease in Renal function D. Increase skin integrity

Answer: A,B,C, Diabetes is a progressive disease that will eventually effect every organ in the body from the increased levels of sugar in the blood. Eventually the sugar will deteriorate blood vessels effecting perfusion of the organs, damaging nerves, decreasing skin integrity and increasing infection rates throughout the body.

Which of the following are NOT symptoms of type 2 diabetes? (Select all that apply) A. Polydipsia B. Energized C. Polyuria D. Fast-healing wounds E. Frequent infections

Answer: B & D: Diabetic patients are usually tired rather than full of energy. Also, wounds are usually slow healing due to poor circulation.

What type of insulin do you expect a doctopr would orders for a patient who is in DKA? A. IV NovoLog B. IV Regular C. IV Lantus D. IV NPH

Answer: B, Regular insulin is the only insulin that can be administered through IV infusion.

One difference between DKA and HHS is: A. DKA only happens in type I diabetes, whereas HHS only happens in type II diabetes B. A patient in DKA will show ketones in the urine, while a patient in HHS will not C. DKA is related to hyperglycemia, whereas HHS is related to hypoglycemia D. DKA has a higher mortality rate than HHS

Answer: B. Rationale: both DKA and HHS can occur in either type I or type II diabetes. DKA is more common in type I diabetes and HHS is more common in type II diabetes, but they both may be seen in either type. In DKA, there is a complete lack of insulin so ketosis occurs, but in HHS there is a sufficient amount of insulin to prevent ketosis. Both DKA and HHS are related to hyperglycemia. The mortality rate of HHS is 5%-10%, while the mortality rate of DKA is around 0.2%-2%

Which of these lab values would corrleate with a patient in DKA? a.) Blood glucose of 130 b.) arterial blood pH of 7.29 c.) Bicarbonate of 24 d.) None of the above

Answer: B. The blood glucose would be >250 mg/dL, the arterial blood ph is correct because a patient in DKA would have an acidotic blood pH of <7.30, and the bicarbonate would be less than 16, 24 would be in the normal range.

A 70 year old patient is admitted to the ED with DKA. What type of insulin would be administered to the patient through IV bolus? A. Humalog (rapid acting insulin) B. Humulin N (intermediate acting insulin) C. Humulin R (regular acting insulin) D. Lantus (long acting insulin)

Answer: C The only insulin that should be administered through an IV is Human Regular insulin. Humulin R is the only one that falls into this category.

What manifestations differentiate DKA from HHS? (Multiple Choice) A. Ketones in urine, N/V, normal pH, "fruity breath" B. "Fruity" breath, shallow breaths, severe dehydration C. Normal pH, ketones in urine, N/V, slow development D. N/V, Kussmaul respirations, acidic pH, ketones in urine

Answer: D, nausea and vomiting, deep and rapid respirations, acidic pH from elevated ketones all cause these manifestations in DKA. HHS has normal pH, shallow breaths rather than deep, slow development, and severe dehydration.

Which electrolyte must be closely monitored during insulin administration with patients in diabetic ketoacidosis? A. Sodium B. Phosphate C. Magnesium D. Potassium

Answer: D. Potassium and water both follow glucose into the cell, so if insulin is causing the rapid uptake of glucose, then potassium is also being absorbed.

Which of the following is the most life-threatening complication of Diabetic Ketoacidosis? A. Dangerous blood glucose levels B. Dehydration C. Potassium shifts D. Fluid shifts

Answer: D. While dangerous blood glucose levels and dehydration can worsen symptoms of DKA, it isn't necessarily life threatening unless left untreated. Potassium shifts can cause cardiac complications but can be monitored and managed so it is not the MOST life threatening. In regards to fluid shifts, we must consider the complication of cerebral edema, which is the most common cause of death for pediatric DKA patients. This is the most life-threatening complication of DKA.

Which electrolyte must be monitored during IV insulin administration to a patient with DKA? A. Chloride B. Phosphate C. Calcium D. Potassium

Answer: D: Potassium will move into the cells during insulin administration resulting in hypokalemia, which can lead to arrhythmias.

What statements would alert you that the patient is at risk for recurrence of diabetic complications at discharge? (Select all that apply) A. "I don't know if I can afford these medications" B. "My daughter is coming down to help us out" C. "My wife is a stay-at-home mom and I can't work now because of all this" D. "I don't understand how this happened, my parents didn't have any of this"

Answers: A, C, D (Without an adequate source of income or insurance, diabetic management with medications and PCP follow-ups cannot be paid for, increasing the risk of diabetic complications. Help from family members can help patients adhere to diabetic lifestyle changes such as diet and exercise. Insufficient knowledge of one's disease process can also increase the risk of diabetic complications, not understanding why certain lifestyle changes need to be made or why follow-ups are needed is what increases the risk for more severe diabetic complications.

Which of the following characterize DKA? (Select all that apply) a.) Hypoglycemia b.) Ketosis c.) Alkalosis d.) Dehydration

Answers: B & D. DKA is characterized by hyperglycemia not hypoglycemia, ketosis, acidosis not alkalosis, and dehydration.

What lab value should be closely monitored for a patient in DKA? (Select all that apply) A. Calcium B. ABG's C. Hgb and Hct D. Potassium E. Blood glucose

Answers: B, D and E Rationale: While calcium is an important value to monitor for all patients because it is a key factor in bone structure, it is not significant in a diagnosis of DKA. ABG's should be closely monitored because as more ketones are produced, the blood will become more acidic. Thus this value helps the provider determine the severity of the syndrome. Hct and Hgb levels help diagnose anemia and are not relevant to DKA. Potassium is important to monitor for patients in DKA because it moves out of cells during DKA, which will cause an increase in serum levels. Increased serum potassium can lead to adverse outcomes such as cardiac issues. Lastly, blood glucose will be significantly spiked in patients with DKA, and as it increases the syndrome will get worse.

Which medication order would you expect to see for a DKA patient? A) Glucophage (Metformin) 500mg PO daily B) Regular insulin by continuous IV infusion (0.1 unit/kg/hr) C) Lantus 8 units SQ qhs D) Humalog (insulin lispro) SQ per sliding scale

B

Which respiration/breathing pattern is associated with diabetic ketoacidosis (DKA)? A. Apneustic breathing B. Kussmaul respirations C. Cheyne-Stokes D. Paroxysmal nocturnal dyspnea

B

The non-compliant teen is ready for discharge. The nurse teaches the teen about the complications of DKA and continued non-compliance. The nurse identifies the patient needs further education when she states: A. If I don't start taking my insulin and following my diet plan, I could end up blind, and have trouble with my hands and feet later in life. B. I can skip my insulin if I need to lose a few pounds if I don't do it all the time. C. I need to check my body for cuts, such as in my mouth because my healing may be slower than usual. D. I can set-up a medical ID on my apple watch so that if I ever become unresponsive again, people will know what to do.

B Skipping insulin for any reason other than if not medically indicated, can result in vascular damage. Not only does this patient need additional teaching, further education and psychological aid may be needed as abuse of insulin for weight loss is a form of eating disorder.

Which of the following hormones released due to stress contribute to hyperglycemia? A. Calcitonin B. Cortisol C. Erythropoietin D. Epinephrine E. PTH (Parathyroid hormone)

B & D* - Under stress, cortisol and epinephrine is released. Epinephrine (adrenaline) is released from nerve endings and the adrenals, and acts directly on the liver to promote sugar production (via glycogenolysis). Cortisol is a steroid hormone also secreted from the adrenal gland. It makes fat and muscle cells resistant to the action of insulin, and enhances the production of glucose by the liver.

What is the renal threshold for blood glucose level? A. 160 mg/dL B. 180 mg/dL C. 200 mg/dL D. 220 md/dL

B, 180 mg/dL. Once the blood glucose reaches 180 mg/dL, glucose begins to be excreted in the kidneys.

What are the characteristics of diabetic ketoacidosis? Select all that apply. A. Presence of ketones in blood and urine B. Blood glucose >600 mg/dL C. Rapid onset D. Seizures, myoclonic jerking

B, C

Which of the following applies to Diabetic Ketoacidosis? Select all that apply. A). blood sugar of <60 B). Presence of Ketones in the urine C). Kussmaul respirations D) vomiting

B, C, D

Which of the following is a characteristic of diabetic ketoacidosis (DKA)? Select all that apply. A. Absent ketones B. Elevated blood urea nitrogen (BUN) and creatinine C. More common in type 1 diabetes D. Normal arterial pH level E. Rapid onset

BCE

A nurse is reviewing laboratory reports of a client who has HHS. Which of the following should the nurse expect? A. Potassium 3.9 mg/dL B. Blood pH 7.3 C. Blood creatine 1.8mg/dL

C

A nurse is working in the emergency department. A patient presents with the following symptoms: excessive thirst, fast, deep breathing, fruity smelling breath, and extreme fatigue. The nurse decides to check the patient's blood sugar, and it comes back as 397. What is the nurse's priority intervention in this case? A) Test the patient for Covid-19 B) Nothing, the patient is fine C) Administer insulin as appropriate and begin treating the patient for DKA. D). Do a chest X-ray

C

Before initiating an insulin drip, which electrolyte is most important to check? a. Calcium b. Sodium c. Potassium d. Magnesium

C

Which of the following symptoms is associated with diabetic ketoacidosis? A. Hypoglycemia B. Hypokalemia C. Ketones in urine D. Alkalosis

C

Why is it important to bring blood glucose levels down slowly? a)Quickly dropping blood glucose can cause rebound hyperglycemia b)It causes ketones to form c)It prevents a quick shift of water, sugar and K+ into the cells which could cause cerebral edema. d)Quickly dropping blood glucose will make the patient really hungry

C

Which electrolyte must be closely monitored before and during IV insulin and fluid therapy for patients in diabetic ketoacidosis? A. Calcium B. Sodium C. Potassium D. Magnesium

C* - Insulin promotes the uptake of potassium into cells, which may lead to hypokalemia, which further can lead to arrhythmias and breathing problems.

A patient being treated for diabetic ketoacidosis is on an insulin drop and maintenance fluids of normal saline, the patient now has a blood glucose level of 250mg/dl. A 5% dextrose infusion has just been started, which of the following is a concern? A.Patient complains of nausea B. Patient has urine frequency C. Patient has a potassium level of 2.3 D. Patient complains of dry mouth

C. Serum potassium levels should be monitored because insulin administration can decrease potassium levels. Hypokalemia prevention is important as insulin pushes potassium into cells

A patient has a 10-year history of diabetes mellitus. The patient is admitted to the critical care unit with complaints of increased lethargy. Serum laboratory values validate the diagnosis of DKA. Which of the following statements best describes the rationale for administrating potassium supplements with the patient's insulin therapy? A. Potassium replaces losses incurred with diuresis. B. The patient has been in a long-term malnourished state. C. IV potassium renders the infused solution isotonic. D. Insulin drives the potassium back into the cells.

D

A patient is being discharged after recovering from DKA. Which patient response is a correct understanding of teaching? A. "It is okay if I happen to forget to take my Metformin-nothing will happen." B. "If I become sick with the cold, I will limit my intake of food so I don't have to check my blood sugars more regularly." C. "I will check my blood sugars when I wake up and when I go to bed." D. "If I have the stomach flu, and I cannot control my blood sugar levels, I should contact my doctor right away."

D

What type of insulin do you expect the doctor to order for the treatment of DKA? a. IV Novolog b. IV Levemir c. IV NPH d. IV Regular Insulin

D

You are a nurse providing care for a patient in Diabetic Ketoacidosis. What ABG results would you anticipate? A. pH 7.41, HCO3 25 B. pH 7.46, HCO3 27 C. pH 7.39, HCO3 22 D. pH 7.29, HCO3 20

D. ABG will reflect metabolic acidosis with a pH less than 7.35 and a bicarbonate of less than 22.

A patient is in DKA, why is an insulin drip the preferred method of insulin therapy? (Select all that apply) A. Fast-acting B. Resuscitation fluids are not required C. Less bedside patient care D. The ability to titrate insulin

Regular insulin is the only type of insulin to be used IV and is rapid-acting.

A patient is on an insulin drip, what type of insulin is running? A. Insulin glargine B. Regular insulin C. NPH insulin D. Humalog Mix 50

Regular insulin is the only type of insulin to be used IV and is rapid-acting.

The patient with HHS presented with a glucose level of 800 mg/dL and is started on IV fluids and insulin. What action do you anticipate when the patient's glucose reaches 250 mg/dL? A. Assess cardiac monitor for peaked T waves B. Slow the infusion rate to 20mL/hr C. Administer IV maintenance fluids with 5% dextrose D. Administer sodium polystyrene sulfate (Kayexalate)

The answer is c. IV fluids containing glucose are administered to prevent hypoglycemia. Kayexalate is used in the treatment of hyperkalemia, which causes peaked T waves on cardiac monitoring. In HHS hypokalemia may result from insulin moving the potassium intracellularly. infusion rate of 20 mL/hour is not the appropriate replacement rate.

Which of the following may part of the treatment plan for DKA and HHNS? (select all that apply) A. IV potassium solution B. Isotonic fluids C. Bicarbonate D. IV fast-acting insulin

The answers are a & b. Bicarbonate is not used in the treatment of DKA or HHNS and regular, not fast-acting IV insulin is used

Which of the following are important to educate a patient who has been newly diagnosed with Diabetes regarding. a. Medication Administration b. Diet c. Insulin Dosage d. Lifestyle

a, b, c, d- All of the answers are correct it is important for someone who has a new diagnosis of Diabetes to be familiar with the management of the chronic condition which includes proper insulin dosage and administration as well as diet and lifestyle. This may be supplemented with the help of a Diabetes educator.

Signs of diabetes include (Select all that apply): A. Polyuria B. Polydipsia C. Weight gain D. Fatigue

a, b, d Rationale: polyuria is due to glycosuria and water loss, polydipsia is due to dehydration, and fatigue is due to poor energy utilization. A person with diabetes may have weight loss due to loss of body tissue and water, not weight gain.

A patient in diabetic ketoacidosis has the following arterial blood gasses: pH 7.25; pCO2 30 mm Hg; HCO3- 16. The patient has rapid, regular respirations. The nurse's best response would be to A. ask the patient to breathe into a paper bag to retain CO2. B. administer sodium bicarbonate. C. administer insulin and fluids intravenously. D. prepare for intubation.

c

Which fasting blood glucose range is considered "pre-diabetes?" A. <100 B. 126+ C. 100-125 D. 110-200

c Rationale: the fasting blood glucose in someone with pre-diabetes is 100-125. Less than 100 is considered normal and greater than 126 is considered diabetes.

In a case where the patient presents with DKA, how should the Insulin be administered? a. IM b. PO c. SQ d. IV

d- The medication should be administered via IV due to the faster response and metabolization of the drug as well as increased control since the administration should be monitored carefully due to potential side effects.