Pharm Exam 3
2.What nursing actions are indicated to maximize the therapeutic effects of methimazole and to reduce its adverse effects?
The nurse should instruct the patient to take the medication at evenly spaced intervals around the clock, monitor iodine intake, avoiding drastic increases or decreases, eat small, frequent meals. Dizziness may occur due to changes in pulse and blood pressure while on the medication.
use caution with ____ when taking corticosteroids
patients with diabetes
Lispro (Humalog)
rapid acting insulin
The nurse is caring for a patient with ulcerative colitis who is being treated with azathioprine. Which laboratory test result should be monitored periodically? A.Microscopic urine examination B.Complete blood count (CBC) with differential C.Immunoglobulin survey D.Serum albumin
B.Complete blood count (CBC) with differential
vincristine
Bone marrow sparing
A patient received NPH 20 units subcutaneously at 8:00 AM. The nurse should assess the patient for hypoglycemia reaction at: A.10:00 AM B.11:00 AM C.5:00 PM D.11:00 PM
C.5:00 PM
he nurse has finished teaching a patient with diabetes mellitus how to administer insulin. The nurse evaluates that learning has occurred when the patient makes which statement? A."I should use the abdominal area only for insulin injections." B."I should provide direct pressure over the site following the injection." C."I should check my blood sugar immediately prior to the administration." D."I should only use a calibrated insulin syringe for the injections."
D."I should only use a calibrated insulin syringe for the injections." Rationale: To ensure the correct insulin dose, a calibrated insulin syringe must be used. Insulin injections should also be rotated to the arm and thigh, not just the abdominal area.There is no need to apply direct pressure over the site following an insulin injection.There is no need to check blood glucose immediately prior to the injection.
type 2 diabetes
Diabetes of a form that develops especially in adults and most often obese individuals and that is characterized by high blood glucose resulting from impaired insulin utilization coupled with the body's inability to compensate with increased insulin production.
cyclophosphamide teaching
Increase fluids to 3 L / day
Metformin
Inhibits hepatic glucose production side effects: GI [30%]: slow dose titration Taste perversions Lactic acidosis
Hemoglobin A1C
Measures amount of hemoglobin that has been attached to glucose in red blood cells
1.What information should the nurse provide in explaining the rationale for the client's taking methimazole?
Ms. Kinsey is diagnosed with Graves' disease, a hyperthyroid condition She is being treated with a thyroid antagonist, methimazole, to reduce the amount of functional thyroid tissue. The drug acts by inhibiting the incorporation of iodine atoms into T3 and T4.
What role does the A1C play in monitoring glucose Control?
Way for healthcare provider to see how glucose is being managed over a 3 month period
What med do we have to be careful with that may mask hypoglycemia?
beta blockers!
doxorubicin side effects
cardiotoxicity, monitor EKG and CV assessment
Lactic Acidosis
cells of body do not get enough oxygen to survive; serious metformin adverse effect
Make sure the patient has what immediately after taking rapid acting?
food
intermediate acting insulin onset
1-2 hours
long acting insulin onset
1-2 hours
when blood glucose is above 401 give what?
12 units insulin
rapid acting insulin onset
15 minutes
Short acting insulin onset
30-60 minutes
optimal blood glucose levels
81-400
A patient who has type 2 diabetes will begin taking glipizide. Which statement by the patient is concerning to the nurse? A."I may continue to have a glass of wine with dinner." B."It is safe to drink grapefruit juice while taking this drug." C."I will begin by taking this once daily with breakfast." D."I will need to check my blood sugar once daily or more."
A."I may continue to have a glass of wine with dinner." Rationale: Alcohol causes hypoglycemia due to effects on the liver. Alcohol interferes with the normal process of hepatic glycogenolysis, where the liver breaks down storage of glucose. This process maintains blood sugar when fasting and overnight.
A patient with diarrhea has been prescribed methylcellulose. The patient asks the nurse, "I thought this was for constipation. Why am I getting it?" Select the most appropriate response from the nurse. A."Methylcellulose adds bulk to the stool to firm it up." B."Methylcellulose acts by reducing the volume of diarrhea." C."Methylcellulose reduces intestinal motility, slowing intestinal transit." D."Methylcellulose stimulates the bowel to eliminate the diarrhea, leaving only formed stools."
A."Methylcellulose adds bulk to the stool to firm it up."
The nurse is providing education to a patient who has been prescribed both an antacid and ranitidine. Which instruction should the nurse give the patient about taking the medications?A."Take the antacid 1 hour after the ranitidine." B."The antacid and ranitidine should be taken at the same time for better effect." C."Take the antacid 15 minutes before the ranitidine." D."Take the antacid 30 minutes after the ranitidine."
A."Take the antacid 1 hour after the ranitidine."
The physician orders insulin lispro 10 units for the patient. When will the nurse administer this medication? A.Fifteen minutes before meals B.When the meal trays arrive on the floor C.When the patient is eating D.Thirty minutes before meals
A.Fifteen minutes before meals Rationale: The onset of action for insulin lispro (Humalog) is 10 to 15 minutes so it must be given when the patient is eating to prevent hypoglycemia.
A patient with T2DM is ordered metformin as part of the management regime. Which is the best nursing explanation for the action of this drug in controlling glucose levels?A.Helps tissues use insulin more efficiently B.Increases the release of insulin from beta cells C.Increases intestinal uptake of glucose D.Prevents weight gain associated with hyperglycemia
A.Helps tissues use insulin more efficiently Rationale: metformin is an insulin sensitizer. Metformin sensitizes tissues such as skeletal muscles to promote transport of glucose into the cells.
A patient with newly diagnosed diabetes mellitus is instructed by the physician to obtain glucagon for emergency home use. The patient asks a home care nurse about the purpose of the medication. The nurse instructs the patient that the purpose of the medication is to treat which of the following? A.Hypoglycemia from insulin overdose B.Hyperglycemia from insufficient insulin C.Lipoatrophy from insulin injections D.Liperhypertrophy from inadequate insulin absorption
A.Hypoglycemia from insulin overdose
A patient has received a dose of ondansetron. The nurse evaluates the patient to determine whether which of the following symptoms has been relieved? A.Nausea and vomiting B.Constipation C.Diarrhea D.Abdominal cramping
A.Nausea and vomiting
The nurse is assessing a patient receiving metformin. Which of the following assessments is a priority? A.Renal function B.WBC cell count C.Deep tendon reflexes D.Hemoglobin
A.Renal function Rationale: Metformin is contraindicated with an eGFR < 30 ml/min/m2. Kidney dysfunction is a risk factor for lactic acidosis in patients on metformin.
The nurse working on a high-acuity medical-surgical unit is prioritizing care for four patients at the beginning of their shift at 3pm. Which patient should the nurse assess first? A.The NPO patient who received 20 units of 70/30 Novolin insulin at breakfast B.The patient with a blood glucose level of 168 who C.A patient with Type 2 diabetes who is due for metformin before dinner D.The patient with Type 2 diabetes who is complaining of feeling hungry
A.The NPO patient who received 20 units of 70/30 Novolin insulin at breakfast Rationale: A 70/30 combination of insulin represents 70% intermediate acting insulin and 30% short-acting insulin. Intermediate acting insulin will continue to act for 14-16 hours
A nurse is preparing to administer regular insulin and NPH to a patient with diabetes mellitus. Which of the following demonstrates that the nurse understands the correct procedure for preparing this medication? A.The short-acting insulin is withdrawn before the intermediate-acting insulin. B.The intermediate-acting insulin is withdrawn before the short-acting insulin. C.Different types of insulin are not to be mixed in the same syringe. D.If administered immediately, there is no requirement for withdrawing one type of insulin before another.
A.The short-acting insulin is withdrawn before the intermediate-acting insulin. Rationale: intermediate- and long-acting insulins contain additives to prolong the duration of action. If you introduce NPH insulin into a vial of regular insulin, you will introduce the additives. Therefore, the regular insulin may now be longer-acting.
Which of the following factors will cause hypoglycemia in a patient with diabetes? Select all that apply. A.Patient has been sleeping more than usual B.Patient has not consumed food and has taken insulin C.Patient is older than 65 years old D.Patient has been exercising more than usual E. Patient has been consuming a high fat diet
B. Patient has not consumed food and has taken insulin D.Patient has been exercising more than usual Rationale: Patients may be distracted or busy and take their insulin at the schedule time without eating. Exercise increases utilization of glucose by skeletal muscle and this removes glucose from the blood.
A hospitalized patient with diabetes mellitus received NPH insulin in the AM. A nurse monitors the patient for hypoglycemia knowing that peak action occurs: A.2 - 4 hours after administration B.4 - 12 hours after administration C.12 - 16 hours after administration D.18 - 24 hours after administration
B.4 - 12 hours after administration Rationale: NPH insulin is intermediate-acting and insulin concentrations will achieve their highest concentration (peak) at this time.
The nurse plans to assess a patient taking an antacid containing aluminum for which of the following adverse effects?A.Diarrhea B.Constipation C.Gastrointestinal upset D.Ulcers
B.Constipation
In caring for a patient with type 2 diabetes mellitus (DM), the nurse will teach the patient to report: A.Normal blood glucose B.Increased blood pressure and pulse C.Increased appetite D.Absence of fever
B.Increased blood pressure and pulse Rationale:Normal blood glucose is the expected outcome. An increased blood pressure and pulse are early signs of hypoglycemia. Increased appetite is an expected outcome. Patients should report a decrease in appetite. Absence of fever is an expected outcome. The nurse would have the patient report an increase in temperature.
The nurse is caring for a patient being discharged on an insulin pump. While teaching the patient about continuous subcutaneous insulin therapy, the nurse should tell him that the regimen includes the use of: A.Short and long acting insulins B.Rapid acting insulin only C.Rapid and intermediate acting insulins D.Intermediate and long acting insulin
B.Rapid acting insulin only Rationale: A continuous subcutaneous insulin is anchored into the abdomen and is programmed to release small subcutaneous basal rate and larger boluses manually at mealtime.
why does diabetes occur?
Body is unable to send necessary messages to normalize blood glucose
The nurse is caring for a patient with diabetes who has an infection. The nurse creates a plan of care for the patient based on a knowledge of the hypothalamic-pituitary response to stress by including which of the following nursing interventions in the plan of care?A.Restriction of dietary protein B.Measurement of intake/output C.Assessment for hyperglycemia D.Increasing insulin dosage
C. Assessment for hyperglycemia Rationale: The hypothalamic-pituitary response to stress includes stimulation of the adrenal cortex
The nurse is discussing the mechanism of action of omeprazole with a group of nursing students. Which statement by a student would best indicate understanding of the mechanism of action of omeprazole? A."The duration of action is short, because the drug has a short half-life." B."Absorption occurs in the stomach when the pH is greater than 5." C."It irreversibly inhibits the enzyme needed to produce stomach acid." D."The complete return of acid production occurs 24 hours after discontinuation."
C."It irreversibly inhibits the enzyme needed to produce stomach acid."
Which instruction should a nurse give to a patient with diabetes mellitus when teaching about "sick day rules"? A."Consume more fruit juices if you are unable to eat." B."Follow your meal plan even if you feel nausea." C."Test your blood glucose every four hours." D."It's okay if your blood glucose goes to 300."
C."Test your blood glucose every four hours." Rationale: The nurse should instruct a patient with diabetes mellitus to check his blood glucose levels every 3 to 4 hours and take insulin - even when he's sick. If the patient's blood glucose level rises above 300 mg/dl, he should call his physician immediately. If the patient is unable to follow the regular meal plan because of nausea, he should substitute soft foods, such as gelatin, soup, and custard.
A 30-year-old female patient is to be started on misoprostol for treatment of a gastric ulcer secondary to long-term ibuprofen use. Which of the following statements must the nurse include in the patient education? A."Start taking the drug at the end of your next menstrual period." B."Take the medication 1 hour before meals." C."Use a reliable method of birth control." D."Perform a breast self-examination weekly while on the medication."
C."Use a reliable method of birth control."
The nurse is reviewing the medication administration record to verify medications at the start of the shift. The nurse notes a new order for diphenoxylate. What assessment finding would cause the nurse to withhold the medication? A.Dehydration B.Diarrhea C.Constipation D.Dizziness
C.Constipation
A nurse counsels a patient with diabetes who is starting therapy with miglitol. The patient should be educated about the potential for which adverse reactions?A.Hypoglycemia B.Fluid retention C.Flatulence D.Shortness of breath
C.Flatulence
The nurse is caring for a patient with T2DM who is being treated for pneumonia with a temperature of 101.8F. What effect do these findings have on his need for insulin? A.They have no effect B.Decreased need for insulin C.Increased need for insulin D.Cause wide fluctuations in the need for insulin
C.Increased need for insulin Rationale: Review sick day procedures. Review conditions that increase need for insulin. Alcohol can potentiate hypoglycemic effects in the patient.
A patient tells the nurse that he often takes his insulin as ordered and then forgets to eat. The nurse will tell the patient to be alert for which signs and symptoms of hypoglycemia? A.Thirst B.Nausea C.Moist skin D.Polyuria
C.Moist skin Rationale: Moist skin is a sign of hypoglycemia, which the patient would experience if he injected insulin and did not eat. Thirst is a sign of hyperglycemia; the patient would experience hypoglycemia if he did not eat. Nausea is a sign of hyperglycemia; the patient would experience hypoglycemia if he did not eat. Increased urination is a sign of hyperglycemia; the patient would experience hypoglycemia if he did not eat.
A patient with diabetes mellitus is taking glyburide and is scheduled for a diagnostic test that requires him to be NPO. What is the best plan of the nurse with regard to giving the patient his oral medications?A.Administer the oral agents with a sip of water before the test. B.Administer the oral agents immediately after the test. C.Notify the physician and request orders. D.Notify the diagnostic department and request orders.
C.Notify the physician and request orders. Rationale: It is best to notify the patient's physician and request orders.The patient should not receive the medication during NPO status unless directed by the physician.The medications should not be given upon return unless the physician orders this; the patient may still need to be NPO.
A patient is placed on a multidrug regimen that includes bismuth for treatment of peptic ulcer disease. The nurse should include which of the following points when providing patient education? A.One week of therapy should heal ulcers, relieve symptoms, and eradicate H. pylori. B.Resolution of pain indicates that the ulcer has healed. C.The tongue and stool may turn black. D.A single-antibiotic regimen is preferable to a multi-antibiotic regimen whenever possible.
C.The tongue and stool may turn black.
The nurse is describing the action of insulin in the body to a patient newly diagnosed with type 1 diabetes. Which of the following would the nurse explain as being the primary action? A.It aids in the process of gluconeogenesis B.Stimulates pancreatic beta cells C.Decreases intestinal absorption of glucose D.Carries glucose into body cells
D.Carries glucose into body cells Rationale: glucose is used for energy in the body and to maintain and support growth of cells and tissues
Which of the following insulins are used for basal dosage?A.Aspart B.Lispro C.NPH D.Glargine
D.Glargine Rationale: Glargine causes a sustained concentration of insulin over a 24 hour period. This mimics the body's normal insulin concentration over the day, providing basal insulin during times of meals, in-between meals, and when at sleep.
A patient with type 1 diabetes who takes insulin reports taking propranolol for hypertension. Why is the nurse concerned?A.The beta blocker can cause insulin resistance. B.Using the two agents together increases the risk of ketoacidosis C.Propranolol increases insulin requirements because of receptor blocking. D.The beta blocker can mask the symptoms of hypoglycemia
D.The beta blocker can mask the symptoms of hypoglycemia Rationale: beta-blocker drugs mask cardiac symptoms that include tachycardia and tremor. These symptoms warn the patient of a hypoglycemic episode
The nurse is preparing a presentation for a group of adults at a local community center about diabetes. Which of the following would the nurse include as associated with type 2 diabetes? A.Onset most common during adolescence B.Less common than T1DM C.Little relation to prediabetes D.Weight loss is often helpful
D.Weight loss is often helpful
when blood glucose is between 0-80 give what?
D50
The patient is ordered 60 units 70/30 insulin. How much regular insulin in this this dose? How much NPH is in this dose?
NPH 42 unitsRegular 18 unit
causes of PUD
NSAIDs H. Pylori
Which insulins can be given IV?
Only regular insulin
paclitaxel
Premedicate with dexamethasone and diphenhydramine to prevent reaction
Which can be used in the insulin pump?
Rapid-acting
nursing care for gastrointestinal patients
Rinse the mouth with a solution of half 0.9% NSS and half peroxide at least twice a day
3.What can the nurse expect during evaluation of the patient that demonstrates effectiveness of the methimazole therapy?
The drug will help to stabilize thyroid hormone levels quickly, but full effects may take a week or longer to occur. Decreased tachycardia and increased weight demonstrate effectiveness of therapy.
nursing care for neutropenia
assess for early signs of infection have patient Remain in room no plants/have equipment always dedicated to that room avoid invasive procedures
type 1 diabetes mellitus
diabetes in which there is no beta cell production of insulin--the patient is dependent on insulin for survival
extraviation
during chemo needle goes out of vein into tissues causes extreme toxicity and burning of organs discontinue immediately
signs of hyperglycemia
extreme thirst, hunger, headache, peeing a lot, blurred vision, dry skin, drowsy, sick to stomach
symptoms of gerd
heartburn, acid regurgitation, epigastric pain, belching
insulin side effect
hypoglycemia
Sulfonylureas Adverse Effects
hypoglycemia, weight gain, GI upset
Humulin-R
insulin regular
cisplatin side effects
kidney damange; monitor BUN and SCr
What should the nurse include in the plan of care related to minimizing the adverse effects of the drug?
nervous system toxicity. assess the patient for symptoms of neurotoxicity, Changes may occur in deep tendon reflexes (DTRs), Myelosuppression may be severe and predispose to opportunistic infection; include teaching for infection-control measures, increase fluid intake to 2-3 liters per day to prevent nephrotoxicity.
Glucagon ___ the blood glucose level; insulin ____ blood glucose levels
raises; lowers
gerd
reflux of stomach contents into esophagus (backward flow)
how to draw up insulin
short acting then long acting
how is insulin given
subcutaneous injection
signs of hypoglycemia
sweating, tachycardia, headache, shaking, weakness, impaired vision
What considerations or precautions should the nurse take when administering vincristine (Oncovin) intravenously?
treat with warm compresses; a cold compress should not be used Hyaluronidase can be injected at the site to neutralize the drug and minimize the tissue damage.
Mrs. Marshall will also be receiving doxorubicin (Adriamycin). What are the most significant nursing considerations when a patient is receiving this drug?
treated immediately with local ice packs to reduce absorption of the drug. Acute infusion-related reactions may occur, including anaphylaxis. The most serious dose-limiting adverse effect = cardiotoxicity, tachycardia, bradycardia, delayed heart failure, acute left ventricular failure, and myocarditis. monitor complete blood count regularly.
methotrexate
use with Leucovorin "rescue" to protect healthy cells and reduce bone marrow suppression
