Exam 1
A 31-year-old patient with type 1 diabetes uses about 25 units of Humalog insulin in a typical day. Using the 500 Rule, the approximate insulin-to-carbohydrate ratio for this patient would be: 1:10 1:25 1:20 1:15
"1:20" is correct. The insulin-to-carbohydrate ratio is a method of calculating carbohydrate needs when meal planning for a diabetic patient. The 500 rule assumes that a diabetic patient consumes approximately 500 grams of carbohydrates per day. To calculate the insulin-to-carbohydrate ratio, the nurse should take 500 and divide it by the total amount of insulin used each day. In this case, 500/25 equals 20, so the insulin-to-carbohydrate ratio would be 1:20
A patient uses Novolin R, a short-acting insulin, to control his blood glucose levels. The patient is reviewing the principles of glucose control with the nurse and asks about when he should take his insulin in relation to meals. Which response from the nurse is most accurate? "This type of insulin should be taken with meals." "You should only take this insulin once a day; it does not coincide with your meals." "Take this insulin about a half hour before you eat." "Give yourself a dose of this insulin about 30 minutes after you have started eating."
"Take this insulin about a half hour before you eat." is correct. Novolin R and other types of short-acting insulin preparations are designed to have an onset of approximately 30 to 45 minutes. This means that if a patient is getting ready to eat a meal, he should take the insulin about a half hour before eating so that the onset of the insulin will match the time that he eats.
The nurse has an order to given insulin to a client with acute renal failure. Which of the following is the purpose of giving insulin in this situation? To move potassium out of cells To reduce hyperglycemia To move potassium into cells To increase bloodstream sodium
"To move potassium into cells" is correct. Insulin administration in acute renal failure (ARF) helps to facilitate movement of potassium into the cells when potassium levels are dangerously high and dialysis is not immediately available.
Which process will provide active immunity? -Hepatitis B immune globulin for a needle-stick injury -Antibodies transferred through breast feeding -Polio vaccine to prevent poliomyelitis -Tetanus antitoxin
Active immunity confers a protected state owing to the body's immune response as a result of active infection or immunization such as with the polio vaccine.
The disease reaches its full intensity, and signs and symptoms attain their greatest severity.
Acute Phase
Which specialized cells are associated with the immune response? Monocytes Neutrophils Macrophages Lymphocytes
Antibodies are associated with the immune response. Antibodies are produced by B lymphocytes. Monocytes, neutrophils, and macrophages are associated with the response to infection.
Antibodies respond to antigens by which of the following? (Select all that apply.) -Forming bacterial toxins to neutralize antigens -Functioning as antitoxins by neutralizing bacterial toxin -Causing forming large complexes that precipitate out of solution -Opsonizing antigens to make them more recognizable to phagocytes -Initiating complement activation to help antibodies and phagocytic cells to attack pathogens
Antibodies function as antitoxins by neutralizing bacterial toxin. Agglutination, opsonization or coating antigens, and supporting complement activation are ways antibodies enhance the localization and removal of antigens from the body. Antibodies do not form bacterial toxins; they function as antitoxins by neutralizing bacterial toxin.
Glulisine: Route, appearance, when to administer, peak, onset, duration, brand name
Apidra, onset 10-15min, peak1-1.5hr, duration 3-5hr, clear, subQ 15min before meals or 20 min after meal, IV
Which condition occurs in the presence of cellular damage? -Cells shrink - ATP production increases - Osmotic pressure decreases -Sodium and water move into the cell
Cellular injury causes failure of the sodium-potassium pump, resulting in migration of sodium ions into the cell.
A critical event in the death of a cell is caused by -disruption of the plasma membrane's permeability barrier. -an increase in cellular protein content. -an accumulation of lipofuscin. -chronic nutrient insufficiency.
Disruption of the plasma membrane barrier, seen in necrosis, results in cellular death.
Metformin: List brands, mechanism of action, side effects, drug interactions, pt teaching, nursing guidelines
Fortamet, Glucophage, Glumetza, Riomet, Action:↓ Hepatic glucose production. ↓intestinal glucose absorption. ↑ sensitivity to insulin. Side Effects: Lactic Acidosis, GI Effects, Vitamin D def. Drug Interactions: hypoglycemic agents, hyperglycemic agents, beta blockers. Pt Teaching: teach early warning signs of acidosis, take as directed, eat with meals to reduce GI effects. Nursing guidelines: assess glucose, serum electrolytes, renal function, A1C,
List the long duration insulin(s)
Glargine (lantus) and detemir (levemir)
NPH Insulin: Route, appearance, when to administer, peak, onset, duration, brand name
Humulin N / Novolin N, cloudy, onset 60-120, peak 6-14, duration 16-24, subQ twice daily at the same time, gently agitate before use
Regular Insulin: Route, appearance, when to administer, peak, onset, duration, brand name
Humulin R/ Novolin R, onset 30-60min, peak 1-5hr, duration 6-10hr, clear, subQ 30 min before meals, IV
What type of hypersensitivity reaction is involved with allergies (allergic rhinitis)?
Immediate, Type I hypersensitivity
Describe a series of events which occur during acute inflammation resulting from cellular injury.
Immediately after injury, the precapillary arterioles around the injured area contract briefly. When phagocytosis is incomplete, a collection of dead neutrophils, bacteria, and cellular debris, called pus, may form at the site. After edema formation, blood flows through areas of inflammation, causing neutrophils to move to the sides of the blood vessels and roll along the endothelium of the vessel wall. After vessel constrictions, the increased pressure along with increased permeability pushes fluid out of the blood vessels and into the surrounding tissue contributing to local swelling.
IgE (immunoglobulin E)
Immunoglobulin that is part of the mast cells and releases histamine. They are present during allergic reactions
Which characteristic uniquely belongs to type 2 diabetes mellitus? A strong genetic component An absolute absence of insulin production A lower than normal basal insulin secretion An absent first-phase insulin response and diminished second-phase response
Individuals with type 2 diabetes mellitus ultimately have an absent first-phase insulin response and a diminished second-phase response.
A 35-year-old patient with type 1 diabetes is in the hospital following surgery. The patient has an order for combination insulin therapy to be administered on a sliding scale depending on his blood glucose levels. The nurse uses a rapid-acting insulin to achieve short term control and mixes it with another type. Which type of insulin may be used in combination with rapid-acting insulin for this type of therapy? Short-acting (Novolin R) Regular (Humulin R) Long-acting (Lantus) Intermediate-acting (NPH)
Intermediate-acting (NPH)" is correct. Intermediate-acting insulin has a range of duration that is between the short-acting and long-acting types of insulin. Intermediate insulin, such as NPH, is the only type of insulin that can be added to a short- or rapid-acting insulin to be used as part of combination insulin therapy.
Glargine: Route, appearance, when to administer, peak, onset, duration, brand name
Lantus, clear, onset 70min, no peak, 18-24hr duration, subQ inject once or twice daily at same time,
Detemir: Route, appearance, when to administer, peak, onset, duration, brand name
Levemir, clear, onset 60-120, no peak, 12-24 hr duration, subQ once or twice daily at same time each day
List the rapid acting insulins with a short duration.
Lispro (Humalog) Aspart (Novalog) Glulisine (Apidra)
List the Intermediate duration insulin(s)
NPH (Humulin N ,Novolin N)
Aspart: Route, appearance, when to administer, peak, onset, duration, brand name
Novolog, onset 10-20 min, peak 1-3 hr, duration 3-5hr, clear, subQ 5-10 min before meals, IV
List the Slower acting insulin(s) with a short duration
Regular Insulin (Humulin R & Novolin R)
Your patient must be started on an insulin drip STAT. What kind of insulin can be safely administered intravenously? Select all that apply. Regular Aspart Lantus NPH Levemir
Regular and Aspart. Rationale: For safe IV insulin administration, only short-acting and rapid-acting insulins are appropriate. Regular insulin is short acting and aspart is rapid-acting and therefore the only appropriate answers.
Type of prevention (appropriate in the stage of advanced disease or disability) includes rehabilitative and supportive care and attempts to alleviate disability and restore effective functioning.
Tertiary prevention
The appearance of the first signs and symptoms indicating the onset of a disease.
The Prodromal Period
Which substance activates the complement cascade? -Antigen -Histamine -Leukotrienes Incorrect -Prostaglandins
The complement cascade is activated by the alternative pathway on primary exposure to an antigen.
Which is a theory of aging? (Select all that apply.) -Apoptosis -Free radical -Immunologic -Nutritional injury -Programmed senescence
The free radical theory states that aging may also be a result of accumulated metabolic cell damage over time. The programmed senescence theory holds that aging is the result of an intrinsic genetic program.
Which type of hypersensitivity response is mediated by T cells?
Type IV hypersensitivity is mediated by T cells. Hypersensitivity types I, II, and III are mediated by antibodies produced by B lymphocytes.
Which is an example of active immunity? (Select all that apply.) Placental transfer of maternal antibodies Injection of pooled gamma globulin Yearly flu vaccination Pneumonia vaccine Breast feeding
Vaccinations, such as the yearly flu and pneumonia vaccines, stimulate the host immune system to mount an immune response and produce long-lived memory cells and antibody-secreting cells that provide lasting protection, a process called active immunity
Pro Drug
a biologically inactive compound which can be metabolized in the body to produce a drug.
IgA antibodies
causes phagocytosis by WBCs and prevent pathogens from adhering to mucous membranes
Lispro: Route, appearance, when to administer, peak, onset, duration, brand name,
clear, onset 15-30, peak 0.5-2.5, duration 3-6hr, subq give within 15 minutes before/after meals, IV, Humalog
IgM
first antibody produced
The health history of a 6-month-old breast-fed child reveals serious, recurrent bacterial and fungal infections. The most likely cause of these infections is
immune deficiency
Paradoxical reaction
is an effect of medical treatment, usually a drug, opposite to the effect which would normally be expected.
Cortisol has a catabolic effect on
lymphoid tissue, muscle and skin
Cortisol has an anabolic effect on what?
protein, leading to an increased rate of protein synthesis
IgG antibodies
the most prevalent in serum; provide naturally acquired passive immunity; neutralize bacterial toxins, participate in complement fixation and enhance phagocytosis
