pharm exam 3
A patient with type 1 diabetes takes 12 units of regular insulin and 34 units of NPH insulin in the morning. How would the nurse explain why two different types of insulin are required to control the patient's blood sugar?
"Different onsets and peak effects extends blood glucose control."
What statement by the 62-year-old patient indicates that the patient understand the nurse's teaching about diuretics?
"I will weigh myself daily and report significant changes."
A patient with type 2 diabetes presents at the clinic for a routine follow-up appointment. The patient asks the nurse whether she can take the herbal supplement ginseng. What is the correct response by the nurse?
"It increases the risk for low blood glucose levels."
The nurse is caring for a patient with cryptorchidism who is 28 years old and taking testosterone to treat his condition. What statement by this patient would lead the nurse to believe that he has understood the teaching provided about the drug?
"My body hair may increase."
A patient with a seizure disorder taking phenytoin (Dilantin) requests a prescription for an oral contraceptive. What is the nurse's priority response?
"The effect of oral contraceptives containing progestin and estrogen is reduced by phenytoin."
A patient receives regular insulin at 8am. The nurse would be alert for signs and symptoms of hypoglycemia at which time? A) Between 10am-12pm B) Between 830am-930am C) Between 2pm-4pm D) Between 12pm-8pm
10am-12pm Rationale: Regular insulin peaks in 2-4 hours, so the nurse would be alert for signs and symptoms of hypoglycemia at this time. If insulin lispro were administered, peak effects would occur in 30-90 min. If insulin detemir were administered, peak effects would occur in 6-8 hours. If NPH insulin were administered, peak effects would occur in 4-12 hours.
A nurse is preparing a syringe that contains regular and NPH insulin. To ensure effectiveness, the nurse would administer the insulins within which time frame? A) 10 min B) 15 min C) 30 min D) 60 min
15 min Rationale: To ensure therapeutic effectiveness and appropriate suspension of the mixed insulin, the nurse would need to administer the injection within 15 min of mixing the insulins in the syringe.
A patient is taking metformin as part of his treatment for diabetes. The nurse would warn the patient that he may experience signs and symptoms of hypoglycemia within approximately which time frame? A) 1 hour B) 2 hours C) 3 hours D) 4 hours
2 hours Rationale: Metformin peaks in approximately 1-1.5 hours; thus, the patient should be alert for possible signs and symptoms of hypoglycemia.
A nurse is caring for an adolescent with hypogonadism who has been prescribed fluoxymesterone (Androxy) for replacement. What adverse effect of this drug will the nurse alert the patient to that could result in self-esteem concerns?
Acne
The patient with diabetes asks the nurse why different oral antidiabetic agents are ordered instead of just one drug. What is the nurse's best explanation of the benefit of combining different agents?
Additive effects
Hormone that increases insulin sensitivity
Adiponectin
(Drug class) Action: interferes with carbohydrate breakdown and absorption; acts locally in GI tract with little systemic absorption Nursing considerations: Common GI effects; hypoglycemia can occur if combines with another oral drug; if this occurs, treat with glucose; take with meals
Alpha-Glucosidase Inhibitors
A patient is receiving glipizide as treatment for his type 2 diabetes. The nurse understands that this drug acts by which of the following? A) Binding to potassium channels on pancreatic beta cells B) Inhibiting alpha-glucosidase to delay glucose absorption C) increasing the uptake of glucose D) decreasing insulin resistance
Binding to potassium channels on pancreatic beta cells. Rationale: Glipizide is a 2nd-generation sulfonylurea that binds to potassium channels on the pancreatic beta cells to improve insulin binding to insulin receptors and increase the number of insulin receptors. Acarbose and miglitol insulin inhibit alpha-glucosidase, thereby delaying the absorption of glucose. Metformin increases the uptake of glucose. Thiazolidinediones such as rosiglitazone decrease insulin resistance.
What outcome would best indicate the nurse's teaching was effective and that drug therapy was appropriate?
Blood glucose level is stable with no diabetic complications.
A patient is using a progestin vaginal gel. What possible adverse effects should the nurse tell the patient about?
Breast enlargement
Inhibits the reabsorption of bicarbonate ion in the proximal tubule
Carbonic anhydrase inhibitors
Infection of the bladder.
Cystitis
The nurse gives a class at the local high school on the use of anabolic steroids. The nurse explains that one of the most serious and all too common side effects of using these drugs without a prescription and medical follow-up is what?
Death
After teaching a group of students about the various insulin preparations, the instructor determines that the teaching was successful when the students identify that which type of insulin cannot be mixed with other types? A) Regular B) Lente C) Detemir D) Lispro
Detemir Rationale: Insulin detemir cannot be mixed in solution with any other drug, including other insulins. Regular, Lente, and Lispro can be mixed.
The nurse suspects the diabetic patient may be having a hypoglycemic reaction when what manifestation is assessed?
Diaphoresis
Drugs that increase sodium excretion
Diuretics
A small group of nursing students are giving an oral presentation to their classmates about urinary tract infections (UTIs). What is a measure that can be used to encourage patients to use to reduce the risk of recurrent urinary tract infections?
Drink 2,000 to 3,000 mL of fluid daily.
The diabetes nurse educator describes type 1 diabetes with what statement?
Exogenous insulin is required for life.
A reflex action of the body to the loss of fluid or sodium; the hypothalamus causes the release of antidiuretic hormone, which retains water, and stress related to fluid loss combines with the decreased blood flow to the kidneys to active the renin-angiotensin-aldosterone system, leading to further water and sodium retention.
Fluid rebound
Which of the following would alert the nurse to suspect that the patient is developing ketoacidosis? A) Fluid retention B) Blurred vision C) Hunger D) Fruity breath odor
Fruity breath odor Rationale: Fruity breath odor would be noted as ketones buildup in the system and are excreted through the lungs. Dehydration would be noted as fluid and electrolytes are lost through the kidneys. Blurred vision and hunger are associated with hypoglycemia.
The nurse admits a patient to the emergency department and recognizes the patient is in diabetic ketoacidosis (DKA) when what manifestations are assessed? (Select all that apply.)
Fruity breath, Dehydration, slow and deep respirations
A patient is brought to the emergency department with severe hypoglycemia. What drug would the nurse prepare to administer intravenously?
Glucagon (GlucaGen)
What type of insulin would the nurse administer if the fastest therapeutic effects are needed?
Glulisine (Apidra)
Onset: 2-5 min Peak: 30-90 min Duration: 2 hours
Glulysine (Apidra)
Which of the following would a nurse identify as an example of a sulfonylurea? A) Glyburide B) Metformin C) Acarbose D) Miglitol
Glyburide Rationale: Glyburide is an example of a sulfonylurea. Metformin is classified as a biguanide. Acarbose and miglitol are both alpha-glucosidase inhibitors.
Storage form of glucose
Glycogen
Term for glucose in the urine
Glycosuria
A diabetic patient is taking regular and NPH insulin to manage his diabetes. What is the best evaluation tool to measure the overall patient response to the insulin therapy?
Glycosylated hemoglobin (HbAlc) levels
The nurse is caring for a female patient who would like to start taking oral contraceptives. What assessment finding may indicate the patient is not a good candidate for these drugs?
History of deep vein thrombosis
A patient comes to the clinic for a 1-month follow-up appointment. The patient tells the nurse he or she has been taking chlorothiazide (Diruil) for a month and now has leg cramps and "feels tired all the time." What will the nurse consider as the cause of the patient's symptoms?
Hypokalemia
Peptides produced in the gastrointestinal tract
Incretins
Hormone of the pancreatic beta cells
Insulin
The nurse is caring for a pregnant patient diagnosed with pregnancy-induced diabetes. What antidiabetic agent is best suited for administration to this patient?
Insulin
A patient newly diagnosed with type 1 diabetes asks the nurse why he cannot just take a pill. The nurse would incorporate knowledge of which of the following when responding to the patient? A) Insulin is needed because the beta cells of the pancreas are no longer functioning B) The insulin is more effective in establishing control of blood glucose levels initially C) More insulin is needed than that which the patient can produce naturally D) The patient most likely does not exercise enough to control his glucose levels
Insulin is needed because the beta cells of the pancreas are no longer functioning Rationale: Insulin is needed in type 1 DM because the beta cells of the pancreas are no longer functioning. With type 2 DM, insulin is produced, but perhaps not enough to maintain glucose control or the insulin receptors are not sensitive enough to insulin.
The nurse assesses the patient taking anabolic steroids for what serious adverse effects?
Jaundice
Term that describes the breakdown of fats for energy
Ketosis
Act on the ascending limb of the loop of Henle to block the reabsorption of sodium, chloride, and water. Excretion of potassium is increased.
Loop diuretics
Bumetanide, Furosemide, and Ethacrynic acid belong t which drug class?
Loop diuretics
The nurse is caring for a patient with a severe head injury. An osmotic diuretic is ordered. The nurse understands which drug is an osmotic diuretic?
Mannitol (Osmitrol)
A female athlete is using high doses of anabolic steroids to enhance her performance. The nurse warns this patient that such use of anabolic steroids is likely to result in what?
Masculinization
Which of the following would be least appropriate when administering insulin by subcut. injection? A) Using a 25 gauge 1/2 in needle B) Inserting the needle at a 45 degree angle C) Injecting the insulin slowly D) Massaging the site after injection
Massaging the site after injection Rationale: Gentle pressure should be applied to the injection after the needle is withdrawn. Massaging could contribute to erratic or unpredictable absorption.
Class: Other antidiabetic agents Decreases production and increases reuptake of glucose. Does not cause hypoglycemia as sulfonylureas do. Associated with development of lactic acid. Approved for use of children 10 and older. Treatment of women with polycystic ovary syndrome.
Metformin
Route: Oral Onset: slow Peak: 2-2.5 hours Duration: 10-16 hours
Metformin
The nurse is caring for a patient with polycystic ovary syndrome. What antidiabetic drug would the nurse anticipate will be ordered?
Metformin
What antidiabetic agent is approved for the nurse to administer to children 10 years old and older with type 2 diabetes?
Metformin
Drug used to prevent and treat osteoporosis in postmenopausal women.
Raloxifene
A clinic patient has been prescribed phenazopyridine (Pyridium) for aid in treating a UTI. This patient should be informed that Pyridium will turn urine what color?
Reddish-orange
Acts on the proximal tubule and the loop of Henle to create an osmotic force that pulls water into the nephron and increases the excretion of nearly all electrolytes
Osmotic diuretics
Mannitol is under which drug class?
Osmotic diuretics
The patient, newly diagnosed with diabetic retinopathy, asks what caused this disorder. What is the nurse's best response?
Oxygen cannot diffuse rapidly across the membrane to tissues in the eye
Increased thirst
Polydipsia
Increased hunger
Polyphagia
The nurse is providing discharge instruction to a patient who has just begun using diuretics. The nurse counsels the patient that it is most important to monitor the intake of foods that contain which element?
Potassium
Act on the late distal tubule and collecting ducts to block the reabsorption of sodium and reduce the secretion of potassium (sodium-potassium exchange). Excretion of potassium is not increased.
Potassium-sparing diuretics
Amiloride, Spironolactone, and Triametrene belong to which drug class?
Potassium-sparing diuretics
The home care nurse is caring for an older adult patient with visual impairment who cannot see the numbers on the syringe when preparing insulin for administration and cannot afford the increased cost of prefilled auto syringes. What strategy might the nurse use to help this patient comply with insulin needs between visits?
Prepare a week's supply of syringes and refrigerate.
The patient calls to report perineal pain and breast enlargement. What medication does the nurse expect to find the patient is taking on reviewing the medical record?
Progesterone
The clinic nurse is admitting a 39-year-old woman who has come to the clinic complaining of left-sided tenderness, fever, chills, and flank pain. What does the nurse suspect the patient has?
Pyelonephritis
Action: increases bone mineral density without stimulating the endometrium; modulates effects of endogenous estrogen at specific receptor sites Route: PO Onset: varies Peak: 4-7hours Duration: 24 hours
Raloxifene
A patient is admitted to the emergency department in diabetic ketoacidosis (DKA) with a blood glucose level of 485 mg/dL. The physician orders an initial dose of 25 U insulin IV. Which type of insulin will be administered?
Regular insulin
The nurse is caring for a postoperative patient whose diabetes has been well controlled on acarbose (Precose). The patient is not allowed to take anything orally following abdominal surgery and is receiving high-glucose total parenteral nutrition via a central IV line. What medication can the nurse administer IV to control the patient's blood glucose level?
Regular insulin
Which agent would a nurse expect to administer as a single oral dose in the morning? A) Repaglinide B) Rosiglitazone C) Exenatide D) Miglitol
Rosiglitazone Rationale: Rosiglitazone would be administered as a single oral dose. Repaglinide is used orally before meals. Exenatide is administered by subcut. injection within 60 min before morning and evening meals. Miglitol is given with the first bite of every meal.
A patient is being treated for benign prostatic hyperplasia (BPH). The patient asks the nurse how the medicine used to treat BPH is supposed to work. The nurse explains that the drug therapy is designed to relieve the symptoms associated with this condition by doing what?
Shrinking the gland and/or relaxing the sphincter of the bladder
The nurse is caring for a patient who is taking a urinary anti-infective. What would the nurse need to assess this patient for?
Signs and symptoms of continuing urinary tract infection (UTI)
A patient is in the clinic for a follow-up visit after having been on hormone replacement therapy for 3 months. Which report by the patient would immediately concern the nurse?
Smoking a pack of cigarettes a day
(Drug class) Action: stimulate insulin release, decrease insulin resistance Nursing Considerations: can cause hypoglycemia, GI disturbance, rash; cross sensitivity with sulfa drugs and thiazide diuretics; possible disulfiram response with alcohol
Sulfonylureas
(Drug class) Therapeutic actions and indications: stimulate insulin release from the beta cells, improbe insulin binding to insulin receptors, used as an adjunct to diet and exercise Contrainications and cautions: known allergy, pregnancy and lactation, DM complicated by fever, severe infection, trauma, major surgery, ketoacidosis, severe renal/hepatic disease, Type 1 diabetes Adverse effects: hypoglycemia, GI distress Drug-Drug Interacitons: any drug that acidifies urine; beta-blockers; alcohol; herbal therapies
Sulfonylureas
The nurse attributes what assessment finding to the use of androgens by the male patient?
Testicular atrophy
The nurse is caring for a woman with a new prescription for oral contraceptives. What outcome would be most important for the nurse to evaluate?
The patient can verbalize how and when to take medication even if a pill is missed.
An type 1 (insulin-dependent) diabetic reports recurrent hypoglycemia late in the morning. After collecting his health history what finding would the nurse suspect is causing the late morning hypoglycemia?
The patient jogs 2 miles in the morning before he goes to work.
The nurse, working in the emergency department, receives a patient following a motor vehicle accident whose medical history is unknown with a blood glucose level of 325 mg/dL. What rationale does the nurse provide explaining this elevated blood glucose level?
The stress reaction caused an increase in blood sugar.
Urinary anti-infectives are used only to treat urinary tract infections (UTIs). What causes urinary anti-infectives to be so effective in treating UTIs?
They act specifically within the urinary tract.
A female patient has a history of frequent bladder infections. Which classification of diuretic would not be recommended for this patient?
Thiazide and thiazide-like diuretics
The nurse is caring for a patient who has just been diagnosed with essential hypertension. The nurse is aware that the health care provider will begin therapy with which classification of diuretics?
Thiazide and thiazide-like diuretics
Act on the early distal tubule to block the reabsorption of sodium, chloride, and water. Excretion of potassium is increased.
Thiazide diuretics
The class of diuretics that act to block the chloride pump in the distal convoluted tubules and leads to a loss of sodium and potassium and a minor loss of water is what?
Thiazide diuretics
Class: first-generation sulfonylureas Preferred for patients with renal dysfunction because it is easily cleared from the body.
Tolbutamide
With what patient would the nurse question the administration of human insulin?
Type 2 diabetes controlled by diet
Class: Insulin Onset: 4-8 hours Peak: 10-30 hours Duration: 20-36 hours
Ultralente insulin
