Pharm Sem 4 Part 2

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Vancomycin (Vancocin) linezolid (Zyvox), and dalfopristin/quinupristin (Synercid) are all antibiotics indicated for the treatment of infections caused by what organism? 1. Pseudomonas aeruginosa. 2. Klebsiella. 3. Candida. 4. Methicillin-resistant Staphylococcus aureus.

4. Vancomycin, linezolid, and dalfopristin/quinupristin are used for the treatment of methicillin-resistant Staphylococcus aureus.

A client with a history of cirrhosis has a new prescription for lactulose 30 mL four times a day. What does the nurse explain to the client about this medication? 1. It will decrease intestinal absorption of ammonia 2. It will facilitate diuresis of excess fluid 3. It will promote renal excretion of bilirubin 4. It will reduce portal pressure contributing to esophageal varices

1. Lactulose is a syruplike liquid that decreases intestinal ammonia absorption in patients with liver disease and hepatic encephalopathy. Hepatic encephalopathy occurs when the failing liver does not adequately detoxify ammonia in the body, leading to changes in mental status and death if not adequately and promptly treated. The lactulose dosing frequency should be adjusted to ensure 2-3 soft stools per day with no confusion or lethargy.

The client has hepatic encephalopathy. She is receiving lactulose. What is the expected outcome of the medication? a) increased level of awareness b) increased albumin levels c) increased number of stools d) increased serum protein levels

A - lactulose inhibits ammonia formation and relieves hepatic encephalopathy

The nurse enters a patient's room to find that his heart rate is 120, his blood pressure is 70/50, and he has red blotching of his face and neck. Vancomycin (Vancocin) is running IVPB. The nurse believes that the patient is experiencing a severe adverse effect called "red man syndrome". What action will the nurse take? A) stop the infusion and call the laboratory. B) Reduce the infusion to 10mg/min. C) Encourage the patient to drink more oral fluids up to 2L/day D) Report onset of Stevens'Johnson syndrome to health care provider.

A) stop the infusion and call the laboratory.

You are developing a care plan on Sally, a 67 y.o. patient with hepatic encephalopathy. Which of the following do you include? 1. Administering a lactulose enema as ordered. 2. Encouraging a protein-rich diet. 3. Administering sedatives, as necessary. 4. Encouraging ambulation at least four times a day.

A. You may administer the laxative lactulose to reduce ammonia levels in the colon.

The nurse evaluates that zofran (ondansetron) is effective in a client undergoing chemotherapy if which of the following is observed? a) urine output is 1,500 ml/day b) the client can tolerate mechanically soft diet c) the client's anxiety is relieved d) the client was able to sleep

B. zofran is antiemetic. The drug is effective if the client is no longer experiencing nausea and vomiting. Therefore, the client can already tolerate food.

A client's serum ammonia level is elevated, and the physician orders 30 mL of lactulose (Cephulac). Which of the following is an adverse effect of this drug? A. Increased urine output B. Improved level of consciousness C. Increased bowel movements D. Nausea and vomiting

C. Lactulose (Cephulac) increases intestinal motility, thereby trapping and expelling ammonia in the feces. An increase in the number of bowel movements is expected as an adverse effect. Lactulose does not affect urine output. Any improvements in mental status would be the result of increased ammonia elimination, not an adverse effect of the drug. Nausea and vomiting are not common adverse effects of lactulose.

A patient unable to tolerate oral medications may be prescribed which of the following proton pump inhibitors to be administered intravenously? A. lansoprazole (Prevacid) B. omeprazole (Prilosec) C. pantoprazole (Protonix) D. esomeprazole (Nexium)

C. Pantoprazole is the only proton pump inhibitor that is available for intravenous administration. The other medications in this category may only be administered orally.

The physician has ordered Vancomycin 500mg IV every six hours for a client with MRSA. The medication should be administered: A. IVP B. Over 15 minutes C. Over 30 minutes D. Over 60 minutes

D. Vancomycin should be administered slowly to prevent "redman" syndrome. Answer A is incorrect because the medication is not given IVP. Answers B and C are incorrect because they allow the medication to be given too rapidly.

What insulin type can be given by IV? Select all that apply A. Glipizide (Glucotrol) B. Lispro (Humalog) C. NPH insulin D. Glargine (Lantus) E. Regular insulin

E. The only insulin that can be given by IV is regular insulin

The health care provider orders lactulose for a patient with hepatic encephalopathy. The nurse will monitor for effectiveness of this medication for this patient by assessing which of the following? a) Relief of constipation b) Relief of abdominal pain c) Decreased liver enzymes d) Decreased ammonia levels

d Hepatic encephalopathy is a complication of liver disease and is associated with elevated serum ammonia levels. Lactulose traps ammonia in the intestinal tract. Its laxative effect then expels the ammonia from the colon, resulting in decreased serum ammonia levels and correction of hepatic encephalopathy.

A 71-year-old male patient who is currently undergoing coronary artery bypass graft (CABG) surgery has just experienced intraoperative vomiting. The nurse should consequently anticipate the use of which of the following drugs? a) Midazolam (Versed) b) Fentanyl (Sublimaze) c) Meperidine (Demerol) d) Ondansetron (Zofran)

d Ondansetron (Zofran) is an antiemetic, whereas midazolam (Versed) is a benzodiazepine, fentanyl (Sublimaze) and meperidine (Demerol) are opioid analgesics.

Oral lactulose (Chronulac) is prescribed for the client with a hepatic disorder and the nurse provides instructions to the client regarding this medication. Which statement by the client indicates a need for further instructions? a. "I need to take the medication with water'" b. " I need to increase fluid intake while taking the medication" c. " I need to increase fiber in the diet" d. "I need to notify the physician of nausea occurs"

d. Lactulose retains ammonia in the colon, promotes increased peristalsis and bowel evacuation, expelling ammonia from the colon. It should be taken with water or juice to aid in softening the stool. An increased fluid intake and a high-fiber diet will promote defecation. If nausea occurs, the client should be instructed to drink cola, eat unsalted crackers, or dry toast. It is not necessary to notify the physician.

Penicillin should be taken on an empty stomach? A. True B. False

The healthcare provider is assessing the glucose level of a patient with a diagnosis of diabetes. Which of these is most helpful in evaluating this patient's long-term glucose management? Please choose from one of the following options. A. Fasting blood glucose level B. Hemoglobin A1c C. Urine specific gravity D. The patient's food diary

Inhibits bacterial cell wall synthesis: A. streptomycin B. vancomycin (Vancocin) C. doxycycline (Vibramycin, Doryx) D. gentamicin (Garamycin)

Rotating injection sites when administering insulin prevents which of the following complications? A. Insulin edema B. Insulin lipodystrophy C. Insulin resistance D. Systemic allergic reactions

B. Insulin lipodystrophy produces fatty masses at the injection sites, causing unpredictable absorption of insulin injected into these sites.

A college student who has type 1 diabetes normally walks each evening as part of an exercise regimen. The student now plans to take a swimming class every day at 1:00 PM. The clinic nurse teaches the patient to a. delay eating the noon meal until after the swimming class. b. increase the morning dose of neutral protamine Hagedorn (NPH) insulin on days of the swimming class. c. time the morning insulin injection so that the peak occurs while swimming. d. check glucose level before, during, and after swimming.

d. check glucose level before, during, and after swimming. Rationale: The change in exercise will affect blood glucose, and the patient will need to monitor glucose carefully to determine the need for changes in diet and insulin administration. Because exercise tends to decrease blood glucose, patients are advised to eat before exercising. Increasing the morning NPH or timing the insulin to peak during exercise may lead to hypoglycemia, especially with the increased exercise.

A patient with type 2 diabetes that is controlled with diet and metformin (Glucophage) also has severe rheumatoid arthritis (RA). During an acute exacerbation of the patient's arthritis, the health care provider prescribes prednisone (Deltasone) to control inflammation. The nurse will anticipate that the patient may a. require administration of insulin while taking prednisone. b. develop acute hypoglycemia during the RA exacerbation. c. have rashes caused by metformin-prednisone interactions. d. need a diet higher in calories while receiving prednisone.

A Rationale: Glucose levels increase when patients are taking CORTICOsteroids, and insulin may be required to control blood glucose. Hypoglycemia is not a complication of RA exacerbation or prednisone use. Rashes are not an adverse effect caused by taking metformin and prednisone simultaneously. The patient is likely to have an increased appetite when taking prednisone, but it will be important to avoid weight gain for the patient with RA.

The insulin that has the most rapid onset of action would be: A. Lente B. Lispro C. Ultralente D. Humulin N

B. Lispro has an immediate onset, a peak of 30-90 minutes, and duration of 2-4 hours.

A nurse administers piperacillin/tazobactam (Zosyn) intravenously to a patient with aspiration pneumonia. The patient has never taken a penicillin antibiotic. The nurse should assess for which indication that a serious adverse effect is developing? A. Constipation B. Confusion C. Urticaria D. Bradycardia

A patient with type 1 diabetes who uses glargine (Lantus) and lispro (Humalog) insulin develops a sore throat, cough, and fever. When the patient calls the clinic to report the symptoms and a blood glucose level of 210 mg/dl, the nurse advises the patient to a. use only the lispro insulin until the symptoms of infection are resolved. b. monitor blood glucose every 4 hours and notify the clinic if it continues to rise. c. decrease intake of carbohydrates until glycosylated hemoglobin is less than 7%. d. limit intake to non-calorie-containing liquids until the glucose is within the usual range.

B Rationale: Infection and other stressors increase blood glucose levels and the patient will need to test blood glucose frequently, treat elevations appropriately with insulin, and call the health care provider if glucose levels continue to be elevated. Discontinuing the glargine will contribute to hyperglycemia and may lead to DKA. Decreasing carbohydrate or caloric intake is not appropriate as the patient will need more calories when ill. Glycosylated hemoglobins are not used to test for short-term alterations in blood glucose.

A patient with type 2 diabetes is scheduled for an outpatient coronary arteriogram. Which information obtained by the nurse when admitting the patient indicates a need for a change in the patient's regimen? a. The patient's most recent hemoglobin A1C was 6%. b. The patient takes metformin (Glucophage) every morning. c. The patient uses captopril (Capoten) for hypertension. d. The patient's admission blood glucose is 128 mg/dl.

B Rationale: To avoid lactic acidosis, metformin should not be used for 48 hours after IV contrast media are administered. The other patient data indicate that the patient is managing the diabetes appropriately.

Dr. Shrunk orders intravenous (IV) insulin for Rita, a client with a blood sugar of 563. Nurse AJ administers insulin lispro (Humalog) intravenously (IV). What does the best evaluation of the nurse reveal? Select all that apply. A. The nurse could have given the insulin subcutaneously. B. The nurse should have contacted the physician. C. The nurse should have used regular insulin (Humulin R). D. The nurse used the correct insulin.

B. C. Regular insulin is the only insulin that can be given intravenously (IV). The nurse did not use correct insulin as it was not regular insulin. Contact the provider to clarify the order, regular insulin is the only insulin that can be given intravenously (IV). The nurse cannot give the insulin subcutaneously when it is ordered to be given intravenously (IV).

The nurse is admitting a client with hypoglycemia. Identify the signs and symptoms the nurse should expect. Select all that apply. A. Thirst B. Palpitations C. Diaphoresis D. Slurred speech E. Hyperventilation

B. C. D. Palpitations, an adrenergic symptom, occur as the glucose levels fall; the sympathetic nervous system is activated and epinephrine and norepinephrine are secreted causing this response. Diaphoresis is a sympathetic nervous system response that occurs as epinephrine and norepinephrine are released. Slurred speech is a neuroglycopenic symptom; as the brain receives insufficient glucose, the activity of the CNS becomes depressed.

A diabetic patient has the following presentation: unresponsive to voice or touch, tachycardia, diaphoresis, and pallor. Which of the following actions by the healthcare provider is the priority? Please choose from one of the following options. A. Send blood to the laboratory for analysis B. Administer oxygen per nasal cannula C. Administer 50% dextrose IV per protocol D. Administer the prescribed insulin

The blood glucose of a patient who is newly diagnosed with type 1 diabetes mellitus has a blood glucose level of 340 mg/dL. Which type of insulin prescribed for the patient is appropriate to administer at this time? Please choose from one of the following options. A. NPH + regular (70/30) B. NPH C. Regular D. Glargine

A client with type 1 DM has a fingerstick glucose level of 258mg/dl at bedtime. An order for sliding scale insulin exists. The nurse should: A. Call the physician B. Encourage the intake of fluids C. Administer the insulin as ordered D. Give the client ½ c. of orange juice

C. A value of 258mg/dl is above the expected range of 70-105 mg/dl; the nurse should administer the insulin as ordered.

Genevieve has diabetes type 1 and receives insulin for glycemic control. She tells the nurse that she likes to have a glass of wine with dinner. What will the best plan of the nurse for client education include? A. The alcohol could cause pancreatic disease. B. The alcohol could cause serious liver disease. C. The alcohol could predispose you to hypoglycemia. D. The alcohol could predispose you to hyperglycemia.

C. Alcohol can potentiate hypoglycemic, not hypoglycemic, effects in the client. Alcohol can cause pancreatic disease, but the client's pancreas is not producing any insulin currently. Alcohol can cause liver disease, but the more immediate concern is hypoglycemia.

Serge who has diabetes mellitus is taking oral agents, 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 client his oral medications? A. Administer the oral agents immediately after the test. B. Notify the the diagnostic department and request orders. C. Notify the physician and request orders. D. Administer the oral agents with a sip of water before the test.

C. It is best to notify the client's physician and request orders. The client 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 client may still need to be NPO. The radiologist in the diagnostic department might give orders, but it would be best to check with the client's physician first.

Nurse Matt makes a home visit to the client with diabetes mellitus. During the visit, Nurse Matt notes the client's additional insulin vials are not refrigerated. What is the best action by the nurse at this time? A. Instruct the client to label each vial with the date when opened. B. Tell the client there is no need to keep additional vials. C. Have the client place the insulin vials in the refrigerator. D. Have the client discard the vials.

C. Vials not in use should be refrigerated to preserve drug potency. There is no need to discard the vials. The client should always have additional vials of insulin available. Writing the date of opening on the vial is good practice, but does not address the need to refrigerate additional vials.

Which of the following adverse effects is specific to the biguanide diabetic drug metformin (Glucophage) therapy? a. Hypoglycemia b. GI distress c. Lactic acidosis d. Somulence

C. Lactic acidosis is the most dangerous adverse effect of metformin administration with death resulting in approximately 50 percent of individuals who develop lactic acidosis while on this drug. Metformin does not induce insulin production; thus, administration does not result in hypoglycemic events. Some nausea, vomiting, and diarrhea may develop but is usually not severe. NVD is not specific for metformin. Metformin does not induce sleepiness.

The nurse is teaching a client newly diagnosed with type 1 diabetes how to self-administer subcutaneous insulin injections. How does the nurse best evaluate the effectiveness of her teaching? A. Have the client repeat the steps back to the nurse. B. Give the client a written test on self-administration of insulin. C. Ask the client to write out the steps for self-administration of insulin injections. D. Ask the client to give a return demonstration of self-administration of insulin.

D Asking the client to give a return demonstration of his injection technique is the best way to assess whether the client can perform the procedure. It also gives the nurse the opportunity to provide feedback. Asking the client to recite the steps, pass a written test, or write out the steps shows the nurse whether the client is able to recall the steps but doesn't show that he has the necessary motor skills or the ability to perform the procedure.

A patient with type 1 diabetes has received diet instruction as part of the treatment plan. The nurse determines a need for additional instruction when the patient says, a. "I may have an occasional alcoholic drink if I include it in my meal plan." b. "I will need a bedtime snack because I take an evening dose of NPH insulin." c. "I will eat meals as scheduled, even if I am not hungry, to prevent hypoglycemia." d. "I may eat whatever I want, as long as I use enough insulin to cover the calories."

D Rationale: Most patients with type 1 diabetes need to plan diet choices very carefully. Patients who are using intensified insulin therapy have considerable flexibility in diet choices but still should restrict dietary intake of items such as fat, protein, and alcohol. The other patient statements are correct and indicate good understanding of the diet instruction

The nurse teaches the diabetic patient who rides a bicycle to work every day to administer morning insulin into the a. thigh. b. buttock. c. arm. d. abdomen.

D Rationale: Patients should be taught not to administer insulin into a site that will be exercised because exercise will increase the rate of absorption. The thigh, buttock, and arm are all exercised by riding a bicycle.

A program of weight loss and exercise is recommended for a patient with impaired fasting glucose (IFG). When teaching the patient about the reason for these lifestyle changes, the nurse will tell the patient that a. the high insulin levels associated with this syndrome damage the lining of blood vessels, leading to vascular disease. b. although the fasting plasma glucose levels do not currently indicate diabetes, the glycosylated hemoglobin will be elevated. c. the liver is producing excessive glucose, which will eventually exhaust the ability of the pancreas to produce insulin, and exercise will normalize glucose production. d. the onset of diabetes and the associated cardiovascular risks can be delayed or prevented by weight loss and exercise.

D Rationale: The patient with IFG is at risk for developing type 2 diabetes, but this risk can be decreased with lifestyle changes. Glycosylated hemoglobin levels will not be elevated in IFG and the Hb A1C test is not included in prediabetes testing. Elevated insulin levels do not cause the damage to blood vessels that can occur with IFG. The liver does not produce increased levels of glucose in IFG

One of the benefits of Glargine (Lantus) insulin is its ability to: a. Release insulin rapidly throughout the day to help control basal glucose. b. Release insulin evenly throughout the day and control basal glucose levels. c. Simplify the dosing and better control blood glucose levels during the day. d. Cause hypoglycemia with other manifestation of other adverse reactions.

b. Release insulin evenly throughout the day and control basal glucose levels. Glargine (Lantus) insulin is designed to release insulin evenly throughout the day and control basal glucose levels.

A client with DM states, "I cannot eat big meals; I prefer to snack throughout the day." The nurse should carefully explain that the: A. Regulated food intake is basic to control B. Salt and sugar restriction is the main concern C. Small, frequent meals are better for digestion D. Large meals can contribute to a weight problem

A. An understanding of the diet is imperative for compliance. A balance of carbohydrates, proteins, and fats usually apportioned over three main meals and two-between meals snacks needs to be tailored to the client's specific needs, with due regard for activity, diet, and therapy.

Lactulose (Chronulac) has been prescribed for a client with advanced liver disease. Which of the following assessments would the nurse use to evaluate the effectiveness of this treatment? A) An increase in appetite B) A decrease in fluid retention C) A decrease in lethargy D) A reduction in jaundice

C. A decrease in lethargy. Lactulose produces an acid environment in the bowel and traps ammonia in the gut; the laxative effect then aids in removing the ammonia from the body. This decreases the effects of hepatic encephalopathy, including lethargy and confusion.

The client diagnosed with chronic obstructive pulmonary disease is prescribed methylprednisolone (Solu-Medrol), a glucocorticoid, IVP. Which laboratory test should the nurse monitor? A. The BUN and creatinine. B. The white blood cell (WBC) count. C. The hemoglobin and hematocrit. D. The blood glucose level.

D. Steroid therapy interferes with glucose metabolism and increases insulin resistance. The blood glucose levels should be monitored to determine if an intervention is needed.

The nurse cares for a patient in the emergency department who arrives with hyperkalemia and a prolonged QRS interval on electrocardiogram. Which of the following would the nurse not anticipate as a treatment for hyperkalemia? A. Calcium chloride IV. B. 50 ml 50% dextrose & 10 units insulin IV. C. Albuterol nebulizer. D. Lactulose PO.

D. Lactulose is used to reduce the amount of ammonia in the blood by drawing ammonia from the blood into the colon where it is removed from the body. Calcium changes the electrical threshold of the heart. Albuterol is a beta 2 agonist, forcing potassium into the cells. Dextrose and insulin also force potassium into the cell.

The nurse is preparing a plan of care for a client receiving the glucocorticoid methylprednisolone (Solu-Medrol). Which nursing diagnosis reflects a problem related to this medication that should be included in the care plan?

Risk for infection

The nurse is admitting an adult client with a wound infection. The client has a prescription for intravenous vancomycin. The nurse should ask the nursing assistant to closely monitor the client's a. voice tone and quality b. gait c. daily weight d. intake and output

The correct answer is D. Vancomycin can cause elevated blood urea nitrogen (BUN) and creatinine levels as well as diarrhea. The nurse should ask the nursing assistant to closely monitor the client's intake and output.

The adult client with hepatic encephalopathy has a serum ammonia level of 95 mcg/dL and receives treatment with lactulose (Chronulac). The nurse determines that the client had the best and most realistic response if the serum ammonia level changed to which value after medication administration? 1. 5 mcg/dL 2. 10 mcg/dL 3. 40 mcg/dL 4. 90 mcg/dL

3. 40 mcg/dL

A client with portal-systemic encephalopathy is receiving oral lactulose (Chronulac) daily. The nurse should check which item to determine the effectiveness of this medication? 1. Lung sounds 2. Blood pressure 3. Blood ammonia level 4. Serum potassium level

3. Blood ammonia level

After the home health nurse has taught a patient and family about how to use glargine and regular insulin safely, which action by the patient indicates that the teaching has been successful? a. The patient disposes of the open insulin vials after 4 weeks. b. The patient draws up the regular insulin in the syringe and then draws up the glargine. c. The patient stores extra vials of both types of insulin in the freezer until needed. d. The patient's family prefills the syringes weekly and stores them in the refrigerator.

A Rationale: Insulin can be stored at room temperature for 4 weeks. Glargine should not be mixed with other insulins or prefilled and stored. Freezing alters the insulin molecule and should not be done.

A nurse is caring for a patient who has cirrhosis. Which of the following medications can the nurse expect that she will be administering to the patient? (Select all that apply). A. Diuretic B. Opioid analgesic C. Lactulose D. Sedative E. Beta-blocker

A, C, E In cirrhosis, diuretics will facilitate removing excess fluid from the body. Lactulose is ordered for a patient who has cirrhosis in order to eliminate ammonia that has built up in the bloodstream. Beta-blockers are administered to a patient with cirrhosis to prevent any bleeding from varices. Opioid analgesics and sedatives are metabolized in the liver, so they should not be administered to a patient with cirrhosis.

A client has been given Ondansetron (Zofran). For which condition should the nurse administer this medication to the postoperative patient? A. Vomiting. B. Incisional pain. C. Abdominal infection. D. Atelectasis.

A. Ondansetron is used to prevent nausea and vomiting that may be caused by surgery or by medicine to treat cancer (chemotherapy or radiation). Options B, C, and D, are not related to this medication.

A client receiving chemotherapy for breast cancer has an order for Zofran (ondansetron) 8mg PO to be given 30 minutes before induction of the chemotherapy. The purpose of the medication is to: A. Prevent anemia B. Promote relaxation C. Prevent nausea D. Increase neutrophil counts

Glyburide (DiaBeta) daily is prescribed for a client. What instruction will the nurse include in the client's teaching plan? 1. The medication is used to prevent foot infections. 2. Take the medication in the morning before breakfast. 3. Expect skin color change from pink to yellow and also pale-colored stools. 4. Contact the health care provider (HCP) immediately if an altered taste sensation is noted.

After administering a dose of promethazine (Phenergan), the nurse explains that which common temporary adverse effect may occur? 1 Urinary retention 2 Tinnitus 3 Drowsiness 4 Sensation of falling

3 Although being given to this patient as an antiemetic, promethazine also has sedative and amnesic properties. For this reason, the patient is likely to experience drowsiness as an adverse effect of the medication. Urinary retention, tinnitus, and a sensation of falling are not considered common adverse effects of promethazine.

A client with acute hepatitis is prescribed lactulose. The nurse knows this medication will: A. Prevent the absorption of ammonia from the bowel. B. Prevent hypoglycemia. C. Remove bilirubin from the blood. D. Mobilize iron stores from the liver

The nurse is administering ondansetron to a client receiving chemotherapy. The nurse evaluates the drugs is having the desired effect when the client says: A. "I don't have as much nausea as I did before." B. "The pain is better. My headache is almost gone." C. "I'm so much more alert now. I'm not so groggy." D. The tingling in my feet is better."

A. Ondansetron is given to decrease the incidence and severity of nausea and vomiting associated with chemotherapy. Headaches and sedation are expected side effects. Neuropathies are not associated with Zofran therapy.

When lactulose (Cephulac) 30 ml QID is ordered for a patient with advanced cirrhosis, the patient complains that it causes diarrhea. The nurse explains to the patient that it is still important to take the drug because the lactulose will a. promote fluid loss. b. prevent constipation. c. prevent gastrointestinal (GI) bleeding. d. improve nervous system function.

d. improve nervous system function. Rationale: The purpose for lactulose in the patient with cirrhosis is to lower ammonia levels and prevent encephalopathy. Although the medication may promote fluid loss through the stool, prevent constipation, and prevent bearing down during bowel movements (which could lead to esophageal bleeding), the medication is not ordered for these purposes for this patient.

What side effect reported by the patient taking piperacillin should concern the nurse? A. Nausea B. Diarrhea C. Headache D. Increased bruising

D. Increased bruising

client newly diagnosed with diabetes mellitus has been stabilized with daily insulin injections. A nurse prepares a discharge teaching plan regarding the insulin and plans to reinforce which of the following concepts? a) always keep insulin vials refrigerated b) ketones in the urine signify a need for less insulin c) increase the amount of insulin before unusual exercise d) systematically rotate insulin injections within one anatomic site

d) systematically rotate insulin injections within one anatomic site Insulin doses should not be adjusted nor increased before unusual exercise. If ketones are found in the urine, it possibly may indicate the need for additional insulin. To minimize the discomfort associated with insulin injections, insulin should be administered at room temperature. Injection sites should be rotated systematically within one anatomic site.

Dr. Wijangco orders insulin lispro (Humalog) 10 units for Alicia, a client with diabetes mellitus. When will the nurse administer this medication? A. When the client is eating B. Thirty minutes before meals C. fifteen minutes before meals D. When the meal trays arrive on the floor

A. The onset action for the insulin lispro (Humalog) is 10 to 15 minutes so it must be given when the client is eating to prevent hypoglycemia. It must be given when the client is eating, not when the meal trays arrive on the floor and not thirty minutes before meals.

A 63-year-old patient with type 2 diabetes is admitted to the nursing unit with an infected foot ulcer. Despite previous good control on glyburide (Micronase), his blood sugar has been elevated the past several days and he requires sliding scale insulin. The most likely for this is: A. It is a temporary condition related to the stress response with increased glucose release. B. He is converting to a type 1 diabetic. C. The oral hypoglycemic drug is no longer working for him. D. Diabetics who are admitted to the hospital are switched to insulin for safety and tighter control.

A. The stress of hospitalization and infection may cause the release of glucose as a response to this stress. Blood glucose levels will continue to be monitored and control may improve as the infection clears and the patient is discharged. The pathogenesis of type I and type II diabetes is different. Type II diabetics may eventually need insulin but for reasons other than the pathogenesis of type I. Immediate changes in response to an oral hypoglycemic drug are not known and diabetics may continue to take all-oral medications while in the hospital.

A client with type 2 diabetes has a hemoglobin A1C level of 8.8 after 6 months of oral therapy with metformin (Glucophage®). The client tells the nurse that she often forgets to take her medication and doesn't really follow her diet. Which of the following is the nurse's best first response? A. "If you don't get control of your blood sugar, you'll need to take insulin." B. "It can be hard to get used to having a disease like diabetes. What are some of the things you find challenging about it?" C. "Uncontrolled diabetes can lead to eye problems and kidneys problems." D. "Many people have diabetes."

B Acknowledging that the client is going through changes and allowing her to express her concerns will help the nurse assess her needs. Hemoglobin AIC shows the average blood glucose levels over a 3-month period. Diabetes should maintain the AIC <7%. Lecturing, threatening and comparing the clients to others belittles the client and discourages discussion, but the patient must be provided adequate information in order to make informed decisions about self-care.

A newly diagnosed type 1 diabetic patient likes to run 3 miles several mornings a week. Which teaching will the nurse implement about exercise for this patient? a. "You should not take the morning NPH insulin before you run." b. "Plan to eat breakfast about an hour before your run." c. "Afternoon running is less likely to cause hypoglycemia." d. "You may want to run a little farther if your glucose is very high."

B Rationale: Blood sugar increases after meals, so this will be the best time to exercise. NPH insulin will not peak until mid-afternoon and is safe to take before a morning run. Running can be done in either the morning or afternoon. If the glucose is very elevated, the patient should postpone the run.

A client diagnosed with type 1 diabetes receives insulin. He asks the nurse why he can't just take pills instead. What is the best response by the nurse? A. "Insulin must be injected because it needs to work quickly." B. "Insulin can't be in a pill because it is destroyed in stomach acid." C. "Have you talked to your doctor about taking pills instead?" D. "I know it is tough, but you will get used to the shots soon."

B. Insulin must be injected because it is destroyed in the stomach acid if taken orally. Telling he will get used to shots does not answer his question and is condescending. Insulin must be injected because it is destroyed in stomach acid if taken orally; the onset of action is not the issue here. The nurse should answer the client's question, not refer him back to the physician.

Which of the following nursing interventions should be taken for a client who complains of nausea and vomits one hour after taking his glyburide (DiaBeta)? Which of the following nursing interventions should be taken for a client who complains of nausea and vomits one hour after taking his glyburide (DiaBeta)? A. Give subcutaneous insulin and monitor blood glucose B. Monitor blood glucose closely, and look for signs of hypoglycemia C. Monitor blood glucose, and assess for signs of hyperglycemia

B. When a client who has taken an oral antidiabetic agent vomits, the nurse would monitor glucose and assess him frequently for signs of hypoglycemic. Most of the medication has probably been absorbed. Therefore, repeating the dose would further lower glucose levels later in the day. Giving insulin would also lower the glucose levels, causing hypoglycemic. The client wouldn't have hyperglycemia if the glyburide was absorbed.

Which of the following statements from a newly diagnosed client with diabetes indicated more instruction is needed? A. "I need to check my feet daily for sores." B. "I need to store my insulin in the refrigerator." C. "I can use my plastic insulin syringe more than once." D. "I need to see my physician for follow-up examinations."

B. Insulin only needs to be stored in the refrigerator if it won't be used within 6 weeks after being opened; it should be at room temperature when given to decrease pain and prevent lipodystrophy. According to a poll by the Juvenile Diabetes Foundation, a very high percentage of diabetics reuse their insulin syringes. However, it's recommended they be carefully recapped and placed in the refrigerator to prevent bacterial growth. The remaining statements show that the client understands his condition and the importance of preventing complications.

A client is taking NPH insulin daily every morning. The nurse instructs the client that the most likely time for a hypoglycemic reaction to occur is: A. 2-4 hours after administration B. 6-14 hours after administration C. 16-18 hours after administration D. 18-24 hours after administration

B. NPH is intermediate acting insulin. The onset of action is 1-2 hours, it peaks in 6-14 hours, and it's duration of action is 24 hours. Hypoglycemic reactions most likely occur during peak time.

When a client is in diabetic ketoacidosis, the insulin that would be administered is: A. Human NPH insulin B. Human regular insulin C. Insulin lispro injection D. Insulin glargine injection

B. Regular insulin (Humulin R) is a short-acting insulin and is administered via IV with an initial dose of 0.3 units/kg, followed by 0.2 units/kg 1 hour later, followed by 0.2 units/kg every 2 hours until blood glucose becomes <13.9 mmol/L (<250 mg/dL). At this point, insulin dose should be decreased by half, to 0.1 units/kg every 2 hours, until the resolution of DKA.

Jansen receives metformin (Glucophage). What will the best plan of the nurse include with regard to patient education with this drug? Select all that apply. A. It stimulates the pancreas to produce more insulin. B. It must be taken with meals. C. It decreases sugar production in the liver. D. It inhibits absorption of carbohydrates. E. It reduces insulin resistance.

B. C. E. Metformin (Glucophage) reduces insulin resistance, decreases sugar production in the liver, and should be taken with meals for the best absorption and effect. It does not stimulate the pancreas to produce more insulin and does not inhibit the absorption of carbohydrates.

A clinical instructor teaches a class for the public about diabetes mellitus. Which individual does the nurse assess as being at highest risk for developing diabetes? A. The 50-year-old client who does not get any physical exercise B. The 56-year-old client who drinks three glasses of wine each evening C. The 42 year-old client who is 50 pounds overweight D. The 38 year-old client who smokes one pack of cigarettes per day

C. Obesity increases the likelihood of developing diabetes mellitus due to over stimulation of the endocrine system. Exercise is important, but lack of exercise is not as big a risk factor as obesity. Smoking is a serious health concern, but is not a specific risk factor for diabetes. Consuming alcohol is associated with liver disease but is not as high a risk factor for diabetes as obesity.

A 60-year-old diabetic is taking glyburide (Diabeta) 1.25mg daily to treat Type II diabetes mellitus. Which statement indicates the need for further teaching? A. "I will keep candy with me just in case my blood sugar drops." B. "I need to stay out of the sun as much as possible." C. "I often skip dinner because I don't feel hungry." D. "I always wear my medical identification."

C. The client should be taught to eat his meals even if he is not hungry, to prevent a hypoglycemic reaction. Answers A, B, and D are incorrect because they indicate knowledge of the nurse's teaching.

The nurse cares for a patient who takes metformin daily. The patient complains of muscle pain, nausea, and feeling tired. What laboratory test should the nurse perform first? a.Complete blood count. b.Liver function test. c.C-reactive protein. d.Arterial blood gas.

d. Metformin causes lactic acidosis by reducing pyruvate dehydrogenase activity and mitochondrial transport of reducing agents, and thus enhances anaerobic metabolism. The quickest way to assess for lactic acidosis is an arterial blood gas. Acidosis is characterized by an arterial pH < 7.35.

A frail elderly patient with a diagnosis of type 2 diabetes mellitus has been ill with pneumonia. The client's intake has been very poor, and she is admitted to the hospital for observation and management as needed. What is the most likely problem with this patient? a. Insulin resistance has developed. b. Diabetic ketoacidosis is occurring. c. Hypoglycemia unawareness is developing. d. Hyperglycemic hyperosmolar non-ketotic coma

d. Hyperglycemic hyperosmolar non-ketotic coma Illness, especially with the frail elderly patient whose appetite is poor, can result in dehydration and HHNC. Insulin resistance usually is indicated by a daily insulin requirement of 200 units or more. Diabetic ketoacidosis, an acute metabolic condition, usually is caused by absent or markedly decreased amounts of insulin.

Albert refuses his bedtime snack. This should alert the nurse to assess for: A. Elevated serum bicarbonate and a decreased blood pH. B. Signs of hypoglycemia earlier than expected. C. Symptoms of hyperglycemia during the peak time of NPH insulin. D. Sugar in the urine

The patient receiving chemotherapy rings the call bell and reports an onset of nausea. The nurse should prepare a prn dose of which of the following medications? A) Morphine sulfate B) Zolpidem (Ambien) C) Ondansetron (Zofran) D) Dexamethasone (Decadron)

C) Ondansetron (Zofran) (Ondansetron is a 5-HT3 receptor antagonist antiemetic that is especially effective in reducing cancer chemotherapy-induced nausea and vomiting.)

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

a. Age over 45 years b. Overweight with a waist/hip ratio >1 d. Maintaining a sedentary lifestyle Aging results in reduced ability of beta cells to respond with insulin effectively. Overweight with waist/hip ratio increase is part of the metabolic syndrome of DM II. There is an increase in atherosclerosis with DM due to the metabolic syndrome and sedentary lifestyle.

Which one of the following methods/techniques will the nurse use when giving insulin to a thin person? A. Pinch the skin up and use a 90 degree angle B. Use a 45 degree angle with the skin pinched up C. Massage the area of injection after injecting the insulin D. Warm the skin with a warmed towel or washcloth prior to the injection

a. Pinch the skin up and use a 90 degree angle The best angle for a thin person is 90 degrees with the skin pinched up. The area is not massaged and it is not necessary to warm it.

Which of the following diabetes drugs acts by decreasing the amount of glucose produced by the liver? a. Sulfonylureas b. Meglitinides c. Biguanides d. Alpha-glucosidase inhibitors

c. Biguanides Biguanides, such as metformin, lower blood glucose by reducing the amount of glucose produced by the liver. Sulfonylureas and Meglitinides stimulate the beta cells of the pancreas to produce more insulin. Alpha-glucosidase inhibitors block the breakdown of starches and some sugars, which helps to reduce blood glucose levels

A patient received 6 units of REGULAR INSULIN 3 hours ago. The nurse would be MOST concerned if which of the following was observed? a. kussmaul respirations and diaphoresis b. anorexia and lethargy c. diaphoresis and trembling d. headache and polyuria

c. diaphoresis and trembling indicates hypoglycemia

The doctor writes an order for piperacillin (Pipracil) 3 g IV q6h for an adult client. Before administering this drug, the nurse should 1. check for known allergies to medications. 2. ensure that the client's respiratory rate is over 12. 3. administer dexamethasone sodium phosphate (Decadron) 2 mg IV stat. 4. check the client's blood pressure both sitting and standing.

(1) correct—assessment, piperacillin (Pipracil) is a semisynthetic broad-spectrum penicillin, should not be administered to clients with known allergies (2) assessment, not relevant for administration of this medication (3) implementation, not relevant for administration of this medication (4) assessment, not relevant for administration of this medication

The client with gastroesophageal reflux disease (GERD) has a new prescription for pantoprazole (Protonix). Which instruction should the nurse provide to the client? 1. Chew the pill thoroughly. 2. Swallow the tablet whole. 3. Headache is expected to occur. 4. Crush the pill if it is difficult to swallow.

2. Swallow the tablet whole.

The nurse is administering a dose of ondansetron hydrochloride (Zofran) to a client for nausea and vomiting. Which frequent side effect of this medication should the nurse tell the client to report? 1. Dizziness 2. Blurred vision 3. A warm feeling 4. Urinary frequency

1. Ondansetron hydrochloride is a selective receptor antagonist used as an antinause and antiemetic. Frequent side effects include anxiety, drowsiness, dizziness, headache, fatigue, constipation, diarrhea, urinary retention, and hypoxia. Occasional side effects include abdominal pain, diminished saliva secretion, fever, feeling of paresthesia, and weakness. Rare side effects include hypersensitivity reaction and blurred vision. Priority nursing tip: antiemetics can cause drowsiness; therefore, a priority intervention is to protect the client from injury. Test-taking strategy: focus on the subject, a frequent side effect. Noting that the medication is used to treat nausea and vomiting and that this medication is a selective receptor antagonist will direct you to the correct option.

The nurse is preparing to administer prescribed medications to a client with hepatic encephalopathy. The nurse anticipates that the health care provider's prescriptions will include which medication? 1. Bisacodyl (Dulcolax) 2. Lactulose (Chronulac) 3. Magnesium hydroxide (Milk of Magnesia) 4. Psyllium hydrophilic mucilloid (Metamucil)

2. Lactulose (Chronulac)

The nurse receives an order for a parenteral dose of promethazine (Phenergan) and prepares to administer the medication to a 38-year-old male patient with nausea and repeated vomiting. Which action is most important for the nurse to take? 1. Administer the medication subcutaneously for fast absorption. 2. Administer the medication into an arterial line to prevent extravasation. 3. Administer the medication deep into the muscle to prevent tissue damage. 4. Administer the medication with 0.5 mL of lidocaine to decrease injection pain.

3. Promethazine (Phenergan) is an antihistamine administered to relieve nausea and vomiting. Deep muscle injection is the preferred route of injection administration. This medication should not be administered into an artery or under the skin because of the risk of severe tissue injury, including gangrene. When administered IV, a risk factor is that it can leach out from the vein and cause serious damage to surrounding tissue.

A client in the intensive care unit is receiving IV vancomycin and gentamicin. The nurse should monitor for which potential complication with the administration of these medications? 1. Blood in nasogastric tube drainage 2. Decrease in red blood cell (RBC) count 3. Increase in serum creatinine level 4. Onset of muscle aches and cramping

3. Vancomycin and aminoglycosides (eg. gentamicin. amikacin, tobramycin) are strong antibiotics that can cause nephrotoxicity and ototoxicity. The client receiving these medications simultaneously would be at an even higher risk for these adverse reactions. The nurse should monitor the client's renal function by assessing blood urea nitrogen (BUN) and creatinine levels and measuring urinary output. Increased levels of BUN and creatinine may indicate kidney damage. The health care provider should be notified before continuing these medications

Lactulose (Chronulac) is prescribed for a client with a diagnosis of hepatic encephalopathy. The nurse should determine that this medication has had a therapeutic effect if assessment reveals which finding? 1. Increased protein level 2. Increased red blood cell count 3. Decreased serum ammonia level 4. Decreased white blood cell count

3. Decreased serum ammonia level

Which technique should the nurse use to effectively administer a dose of promethazine (Phenergan) by the intramuscular (IM) route? 1 Numb the area with ice before injection. 2 Administer in the flank area to increase absorption. 3 Inject at a 45-degree angle. 4 Use the Z-track technique

4 Promethazine can be irritating to tissues; therefore, the medication should be injected into the upper outer quadrant of the buttock with the use of the Z-track technique. It is not required to numb the area before injection. This medication should not be administered subcutaneously in the flank because of irritation to tissues. Intramuscular injections always should be administered at a 90-degree angle.

What action should be a priority for a client who is receiving vancomycin (Vancocin) over 30 minutes and begins presenting with a flushed neck and face? 1.Assess the client's temperature immediately. 2.Administer the antihistamine that was ordered. 3.Immediately discontinue the med. and call Dr. 4.Slow the rate of the medication infusion.

A client admitted to the hospital with chest pain and history of type 2 diabetes mellitus is scheduled for cardiac catheterization. Which of the following medications would need to be withheld for 48 hours before and after the procedure? 1. Regular insulin 2. Glipizide (Glucotrol) 3. Repaglinide (Prandin) 4. Metformin (Glucophage)

4. Metformin (Glucophage) needs to be withheld 48 hours before and after cardiac catheterization because of the injection of contrast medium during the procedure. If the contrast medium affects kidney function, with metformin in the system, the client would be at increased risk for lactic acidosis. The medications in options 1, 2, and 3 do not need to be withheld 48 hours before or after cardiac catheterization.

The nurse is developing a care plan for a client with hepatic encephalopathy. Which of the following treatments should the nurse include? A. Administering a lactulose enema as ordered. B. Encouraging a protein-rich diet. C. Administering sedatives as necessary. D. Encouraging ambulation at least four times a day.

A Hepatic encephalopathy is a degenerative disease of the brain that is a complication of cirrhosis. For the client with hepatic encephalopathy, the nurse may administer the laxative lactulose (Chronulac®) to reduce ammonia levels in the colon. Protein intake is usually restricted to reduce serum ammonia levels until the client's mental status begins to improve. Sedatives are avoided because they can cause respiratory or circulatory failure. Bed rest is encouraged because physical activity increases metabolism, leading to an increased production of ammonia.

A patient is prescribed high-dose methylprednisolone for an acute exacerbation of multiple sclerosis (MS). Which of these findings, if identified in the patient, would indicate the patient is experiencing an adverse effect of the medication? A. Hypokalemia B. Angioedema C. Hyperglycemia D. Candida infection E. Epigastric pain F. Paralytic ileus

A, C, D, E Methylprednisolone is a corticosteroid. Corticosteroids suppress the inflammatory response. Corticosteroids are also referred to as glucocorticoids. By suppressing the inflammatory response, methylprednisolone inhibits the actions of leukocytes, thereby increasing the risk of opportunistic infections (e.g. Candida). Suppressing the inflammatory response also involves inhibition of COX-1, thereby increasing the patient's risk of gastric ulcers (which may be manifested by epigastric pain). Glucocorticoids such as methylprednisolone increases blood glucose levels and decreases serum potassium levels.

A client is receiving a hyperosmotic treatment for occasional constipation. Which of the following medications should the nurse not expect to be used for this condition? A. Lactulose (cephulac) B. Polyethylene (Miralax) C. Glycerin (Glycerol) D. Bisacodyl (Dulcolax)

An inflammatory response characterised by chills, tachycardia, syncope and flushing of the face and trunk following rapid bolus administration of vancomycin is termed as: Copyright@ www.nursingplanet.com/Quiz A. Red neck syndrome B. Anaphylactic reaction C. Rabit syndrome D. Idiosyncrasy

When administering Protonix, the nurse would exercise poor judgement when she:_____________ A. Crushes the tablet B. Puts it into a medication dispenser cup C. Mixes it with juice D. Gives it one hour after a meal

Which drug class is used in 1st line therapy for gonorrhea and syphillis? A. Penicillins B. Macrolides C. Sulfanomides D. Cephalosporins

A client with cirrhosis is receiving Lactulose (Cephulac). During the assessment the nurse notes increased confusion and asterixis. The nurse should: A. Assess for GI bleeding B. Hold the Lactulose (Cephalic) C. Increase protein in the diet D. Monitor serum bilirubin levels

A. Clients with cirrhosis can develop hepatic encephalopathy caused by increased ammonia levels. Asterixis, a flapping tremor, is a characteristic symptom of increased ammonia levels. Bacterial action on increased protein in the bowel will increase ammonia levels and cause the encephalopathy to worsen. GI bleeding and protein consumed in the diet increases protein in the intestine and can elevate ammonia levels. Lactulose is given to reduce ammonia formation in the intestine and should not be held since neurological symptoms are worsening. Bilirubin is associated with jaundice.

ThephysicianhasprescribedProtonix(pantoprazole)foraclientwithburns.Thenurserecognizes that the medication will help prevent the development of: A. Curling's ulcer B. Myoglobinuria C. Hyperkalemia D. Paralytic ileus Curling's ulcer Myoglobinuria Hyperkalemia Paralytic ileus

A. Curling's ulcer, a stress ulcer, is a common occurrence in clients with burns. Protonix, a proton pump inhibitor, is effective in preventing ulcer forma- tion. Answers B, C, and D are common in clients with burns but are not prevented by the use of Protonix, so they are incorrect.

Which assessment finding indicates that lactulose is effective in decreasing the ammonia level in the client with hepatic encephalopathy? A. Passage of two or three soft stools daily B. Evidence of watery diarrhea C. Daily deterioration in the client's handwriting D. Appearance of frothy, foul-smelling stools

A. Lactulose reduces serum ammonia levels by inducing catharsis, subsequently decreasing colonic pH and inhibiting fecal flora from producing ammonia from urea. Ammonia is removed with the stool. Two or three soft stools daily indicate effectiveness of the drug. Watery diarrhea indicates overdose. Daily deterioration in the client's handwriting indicates an increase in the ammonia level and worsening of hepatic encephalopathy. Frothy, foul-smelling stools indicate steatorrhea, caused by impaired fat digestion.

A client with diabetes mellitus visits a health care clinic. The client's diabetes previously had been well controlled with glyburide (Diabeta), 5 mg PO daily, but recently the fasting blood glucose has been running 180-200mg/dl. Which medication, if added to the clients regimen, may have contributed to the hyperglycemia? A. Prednisone (Deltasone) B. Atenolol (Tenormin) C. Phenelzine (Nardil) D. Allopurinol (Zyloprim)

A. Prednisone may decrease the effect of oral hypoglycemics, insulin, diuretics, and potassium supplements.

A client with advanced cirrhosis of the liver is not tolerating protein well, as eveidenced by abnormal laboratory values. The nurse anticipates that which of the following medications will be prescribed for the client? a. lactulose (Chronulac) b. ethacrynic acid (Edecrin) c. folic acid (Folvite) d. thiamine (Vitamin B1)

A. The client with cirrhosis has impaired ability to metabolize protein because of liver dysfunction. Administration of lactulose acids in the clearance of ammonia via the gastrointestinal tract. Ethacrynic acid is a diuretic. Folic acid and thiamine are vitamins, which may be used in clients with liver disease as supplemental therapy.

A client with advanced cirrhosis of the liver is not tolerating protein well, as eveidenced by abnormal laboratory values. The nurse anticipates that which of the following medications will be prescribed for the client? A. lactulose (Chronulac) B. ethacrynic acid (Edecrin) C. folic acid (Folvite) D. thiamine (Vitamin B1)

A. The client with cirrhosis has impaired ability to metabolize protein because of liver dysfunction. Administration of lactulose aids in the clearance of ammonia via the gastrointestinal (GI) tract. Ethacrynic acid is a diuretic. Folic acid and thiamine are vitamins, which may be used in clients with liver disease as supplemental therapy.

Vancomycin (Vancocin), linezolid (Zyvox), and dalfopristin/quinupristin (Synercid) are all antibiotics indicated for the treatment of infections caused by what organism? A: Pseudomonas aeruginosa. B: Klebsiella. C: Candida. D: Methicillin-resistant Staphylococcus aureus.

A. Vancomycin, linezolid, and dalfopristin/quinupristin are used for the treatment of methicillin-resistant Staphylococcus aureus.

A nurse is preparing a child for abdominal irradiation. Which medications should the nurse plan to administer to prevent nausea and vomiting? A. Ondansetron (Zofran) and dexamethasone (Decadron) B. Promethazine (Phenergan) and cyclophosphamide (Cytoxan) C. Metoclopramide (Reglan) and methotrexate (Amethopterin) D. Marijuana and L-asparaginase (Elspar)

A. Ondansetron is an antiemetic used to control nausea and vomiting. Dexamethasone is a corticosteroid anti-inflammatory agent used in the adjunctive management of nausea and vomiting from chemotherapy. Promethazine is a phenothiazine-type antiemetic, but cyclophosphamide is chemotherapeutic agent. Metoclopramide is an antiemetic, but it causes extrapyramidal reaction in children. Methotrexate is a chemotherapeutic agent. Marijuana is not approved for use in the U.S., but synthetic cannabinoids are now being used in children. L-asparaginase is a chemotherapeutic agent.

A nurse is developing a care plan for a client with hepatic encephalopathy. Which of the following are goals for the care for this client? Select all that apply. A. Preventing constipation B. Administering lactulose (Cephulac) C. Monitoring coordination while walking D. Checking the pupil reaction E. Providing food and fluids high in carbohydrate F. Encouraging physical activity

A. B. C. D. E. Constipation leads to increased ammonia production. Lactulose (Cephulac) is a hyperosmotic laxative that reduces blood ammonia by acidifying the colon contents, which retards diffusion of non-ionic ammonia from the colon to the blood while promoting its migration from the blood to the colon. Hepatic encephalopathy is considered a toxic or metabolic condition that causes cerebral edema; it affects a person's coordination and pupil reaction to light and accommodation. Food and fluids high in carbohydrates should be given because the liver is not synthesizing and storing glucose. Because exercise produces ammonia as a byproduct of metabolism, physical activity should be limited, not encouraged.

Select the side effects of penicillins (check all that apply). A. Nausea/Vomiting/Diarrhea B. Hepatoxicity C. Nephratoxicity D. Thrombocytopenia E. Anaphalaxis

A. C. D. E.

A nurse is administering intravenous ondansetron (Zofran) for the treatment of nausea. Which of the following indicates that the patient is experiencing an adverse effect of this medication? A. Headache B. Hypertension C. Bradycardia D. Hyperkalemia

A. Headache Ondansetron (Zofran) is very well tolerated and has few adverse effects. Common side effects include headache, dizziness, diarrhea, constipation, and fever. Hypertension, bradycardia, and hyperkalemia are not associated with the use of ondansetron (Zofran)

A client receiving Vancocin (vancomycin) has a serum level of 20mcg/mL. The nurse knows that the therapeutic serum level for vancomycin is: A. 5-10 mcg/mL B. 10-25 mcg/mL C. 25-40 mcg/mL D. 40-60 mcg/mL

A post-operative client has an order for Demerol (meperidine) 75mg and Phenergan (promethazine) 25mg IM every 3-4 hours as needed for pain. The combination of the two medications produces a/an: A. Agonist effect B. Synergistic effect C. Antagonist effect D. Excitatory effect

Penicillins are part of which pregnancy category? A. A B. B C. C D. D E. X

The client has an order for a trough to be drawn on the client receiving Vancomycin. The nurse is aware that the nurse should contact the lab for them to collect the blood: A. 15 minutes after the infusion B. 30 minutes before the infusion C. 1 hour after the infusion D. 2 hours after the infusion

B. A trough level should be drawn 30 minutes before the third or fourth dose. The times in answers A, C, and D are incorrect times to draw blood levels.

The physician has ordered Cephulac (Lactulose) for a client with increased serum ammonia. The nurse knows the medication is having its desired effect if the client experiences: A. Increase urination B. Diarrhea C. Increased appetite D. Decreased weight

B. Lactulose is given to produce diarrhea, which lowers the client's serum ammonia levels. Answers A, C, and D are not associated with the use of Lactulose.

Probenecid (Benemid) can be given concurrently with penicillin to decrease serum levels of penicillin. A. True B. False

B. Probenecid increases serum levels of penicillin.

A client is to be discharged with a prescription for lactulose (Cephulac). The nurse teaches the client and the client's spouse how to administer this medication. Which of the following statements would indicate that the client has understood the information? A. "I'll take it with Maalox." B. "I'll mix it with apple juice." C. "I'll take it with a laxative." D. "I'll mix the crushed tablets in some gelatin."

B. The taste of lactulose (Cephulac) is a problem for some clients. Mixing it with fruit juice, water, or milk can make it more palatable. Lactulose should not be given with antacids, which may inhibit its action. Lactulose should not be taken with a laxative because diarrhea is an adverse effect of the drug. Lactulose comes in the form of syrup for oral or rectal administration.

A client with an SCI is receiving methylprednisolone. Which finding would the nurse interpret as indicating a possible complication of this therapy? A. The client's urine specific gravity is increased. B. The client's stools are positive for blood. C. The client reports seeing halos around lights. D. The client complains of a metallic taste.

B. Use of steroids increases risk for gastric ulceration.

After administering a dose of promethazine (Phenergan) to a patient with nausea and vomiting, what common temporary adverse effect of the medication does the nurse explain may be experienced? A. Tinnitus B. Drowsiness C. Reduced hearing D. Sensation of falling

B. Drowsiness Although being given to this patient as an antiemetic, promethazine also has sedative and amnesic properties. For this reason, the patient is likely to experience drowsiness as an adverse effect of the medication. Tinnitus, reduced hearing, and loss of balance are not side effects of promethazine.

A client's serum ammonia level is elevated, and the physician order 30 ml of lactulose (Cephulac). Which of the following side effects of this drug would the nurse expect to see? a. Increased urine output b. Improved level of consciousness c. Increased bowel movements d. Nausea and vomiting

C - Lactulose increases intestinal motility, thereby trapping and expelling ammonia in the feces. An increase in the number of bowel movements is expected as a side effect. Lactulose does not affect urine output. Any improvements in mental status would be the result of increased ammonia elimination, not side effect of the drug. Nausea and vomiting are not common side effects of lactulose.

The client with cirrhosis of the liver is receiving Lactulose. The nurse is aware that the rationale for the order for Lactulose is: A. To lower the blood glucose level B. To lower the uric acid level C. To lower the ammonia level D. To lower the creatinine level

C. Lactulose is administered to the client with cirrhosis to lower ammonia levels. Answers A, B, and C are incorrect because this does not have an effect on the other lab values.

Which client will the nurse assess first? A) The client who just started azithromycin therapy with a fever B) The client who is taking clindamycin (Cleocin) and has gastric upset C) The client who is taking vancomycin (Vancocin) with furosemide (Lasix) D) The client who is taking telithromycin (Ketek) and is 18 years old

C. The risk of ototoxicity with vancomycin is increased for clients taking furosemide. The nurse should assess this client first. A client who has started antibiotic therapy would be expected to have a fever. Gastric upset is common with this antibiotic. This medication is recommended for clients 18 years and older.

The health care provider orders administration of IV methylprednisolone (Solu-Medrol) for the first 24 hours to a patient who experienced a spinal cord injury at the T10 level 3 hours ago. When evaluating the effectiveness of the medication the nurse will assess a. blood pressure and heart rate. b. respiratory effort and O2 saturation. c. motor and sensory function of the legs. d. bowel sounds and abdominal distension.

Correct Answer: C Rationale: The purpose of methylprednisolone administration is to help preserve neurologic function; therefore, the nurse will assess this patient for lower-extremity function. Sympathetic nervous system dysfunction occurs with injuries at or above T6, so monitoring of BP and heart rate will not be useful in determining the effectiveness of the medication. Respiratory and GI function will not be impaired by a T10 injury, so assessments of these systems will not provide information about whether the medication is effective.

The nurse is caring for a client who is receiving a dose of prescribed vancocin (Vancomycin) via IV piggyback. The nurse observes that the client's vital signs remain within the client's baseline and the client has facial flushing. Which of the following actions would be appropriate for the nurse to take? a. Obtain the emergency cart. b. Stop the infusion. c. Slow the rate of flow. d. Inform the client that this is normal.

D Red man's syndrome may occur with vancomycin and this causes a flushed appearance to the face or neck. The client should be reassured that this is a common, non life-threatening side effect. note: it should be slowed...???

A patient has a blood glucose of 400. Which of the following medications could be the cause of this? A. Glyburide B. Atenolol C. Bactrim D. Prednisone

A patient with cirrhosis of the liver is given a lactulose (Cephulac) retention enema. Which of these findings would indicate to the nurse that the treatment has been effective? A. Appetite improves B. Temperature returns to normal C. Diarrhea diminishes D. Serum ammonia level decreases

D. Patients with cirrhosis of the liver often develop hepatic encephalopathy due to the ammonia released by nitrogenous waste in the intestine. Lactulose leads to less ammonia production by inhibiting bacterial urea degradation. It also reduces colonic transit time, thus reducing the time available for ammonia production and expediting ammonia elimination.

What is the hypersensitivity reaction to rapid administration of vancomycin that manifests as tachycardia, hypotension and erythematous rash involving the face, neck and upper torso? A. Reye's syndrome. B. Steven Jackson syndrome. C. Red-Stevenson syndrome. D. Red-Man syndrome.

D. The most common adverse reaction to vancomycin is "red man syndrome". It is an idiopathic infusion reaction that is characterized by flushing, erythema, and pruritus. Pain and muscle spasms may occur also.

A type 2 diabetic has been NPO since midnight for surgery in the morning. He has been on a combination of oral hypoglycemic agents (OHAs). What would be the best action for the nurse to take concerning the administration of his medications? A. Hold all medications as per the NPO order. B. Give him the medications with a sip of water. C. Give him half the original dose. D. Contact the health care provider for further orders.

D. The health care provider should be contacted for further orders. The need for oral hypoglycemic medication may have been overlooked or other measures, such as insulin, to treat glucose needs during the surgery may be planned. Contacting the provider ensures that the provider is aware that the patient is a diabetic and is aware that no medications for diabetes were ordered. Holding all medications as ordered will not address the patient's glucose needs during surgery. Intravenous fluids during this time may contain glucose solutions, resulting in a hyperglycemic condition. It is not within the nurse's scope of practice to independently change a medication dosage order or to give medications when an NPO order has been written. The provider should be contacted before these decisions are carried out.

A patient reports having a dry mouth and asks for something to drink. The nurse recognizes that this symptom can most likely be attributed to a common adverse effect of which medication that the patient is taking? A. Digoxin (Lanoxin) B. Cefotetan (Cefotan) C. Famotidine (Pepcid) D. Promethazine (Phenergan)

D. Promethazine (Phenergan) A common adverse effect of promethazine, an antihistamine/antiemetic agent, is dry mouth; another is blurred vision. Common side effects of digoxin are yellow halos and bradycardia. Common side effects of cefotetan are nausea, vomiting, stomach pain, and diarrhea. Common side effects of famotidine are headache, abdominal pain, constipation, or diarrhea.

Which of the following is accurate pertaining to physical exercise and type 1 diabetes mellitus? a. Physical exercise can slow the progression of diabetes mellitus. b. Strenuous exercise is beneficial when the blood glucose is high. c. Patients who take insulin and engage in strenuous physical exercise might experience hyperglycemia. d. Adjusting insulin regimen allows for safe participation in all forms of exercise.

a. Physical exercise can slow the progression of diabetes mellitus. Physical exercise slows the progression of diabetes mellitus, because exercise has beneficial effects on carbohydrate metabolism and insulin sensitivity. Strenuous exercise can cause retinal damage, and can cause hypoglycemia. Insulin and foods both must be adjusted to allow safe participation in exercise.

A patient's peak Vancomycin level comes back elevated. Which lab values are most important for the nurse to assess? a) Lipase and amylase b) BUN and creatinine c) ALT, AST, alkaline phosphatase, and biliruibin d) Hemoglobin and hematocrit

A patient has been taking oral prednisone for the past several weeks after having a severe reaction to poison ivy. The nurse has explained the procedure for gradual reduction rather than sudden cessation of the drug. What is the rationale for this approach to drug administration? a) Prevention of hypothyroidism b) Prevention of diabetes insipidus c) Prevention of adrenal insufficiency d) Prevention of cardiovascular complications

c Sudden cessation of corticosteroid therapy can precipitate life-threatening adrenal insufficiency. Diabetes insipidus, hypothyroidism, and cardiovascular complications are not common consequences of stopping corticosteroid therapy suddenly.

The nurse is teaching the client with insulin-dependent diabetes the signs of hypoglycemia. Which of the following signs is associated with hypoglycemia? A. Tremulousness B. Slow pulse C. Nausea D. Flushed skin

A client with type 1 DM calls the nurse to report recurrent episodes of hypoglycemia with exercise. Which statement by the client indicated an inadequate understanding of the peak action of NPH insulin and exercise? A. "The best time for me to exercise is every afternoon." B. "The best time for me to exercise is right after I eat." C. "The best time for me to exercise is after breakfast." D. "The best time for me to exercise is after my morning snack."

A patient diagnosed with type 2 diabetes mellitus is admitted to the medical unit with pneumonia. The patient's oral antidiabetic medication has been discontinued and the patient is now receiving insulin for glucose control. Which of the following statements best explains the rationale for this change in medication? Please choose from one of the following options. A. Stress-related states such as infections increase risk of hyperglycemia B. Infection has compromised beta cell function so the patient will need insulin from now on C. Insulin administration will help prevent hypoglycemia during the illness D. Acute illnesses like pneumonia will cause increased insulin resistance

Metformin is a commonly used anti-diabetic medication in the class of biguanides. The most common side effect is: A. Lactic acidosis B. Myocardial infarction C. Excessive weight gain. D. Pyschosis E. None of the above

Piperacillin is a type of A. Misc. anti-infective B. Carbapenem C. Extended spectrum penicillin

A nurse in the health care clinic is reviewing the record of a client with diabetes mellitus who is seen by the physician. The nurse notes that the physician has prescribed metformin (Glucophage). Which of the following preexisting disorders, if noted in the client's record, would indicate a need to collaborate with the physician before instructing the client to take medication? A. Hypertension B. Foot ulcer C. Emphysema D. Hypothyroidism

Answer: C Metformin should be used with caution in clients with kidney or liver disease, heart failure, chronic lung disease, and a history of heavy alcohol consumption. Options A, B, and D are not associated caution of contraindications in the use of this medication.

A patient with Type 2 Diabetes is started on the medication Glyburide. Which of the following statements by the patient causes concern? A. "I will monitor my blood glucose regularly because I know this medication can cause a low blood sugar." B. "I will consume no more than 8 oz. of alcohol per week." C. "I will continue monitoring my diet and participating in exercise while taking this medication." D. "This medication works by stimulating the beta cells in the pancreas to make insulin."

B. Glyburide is a sulfonylureas diabetic medication and a patient should NEVER consume alcohol while taking this medication because it can cause severe hypoglycemia.

Albert, a 35-year-old insulin dependent diabetic, is admitted to the hospital with a diagnosis of pneumonia. He has been febrile since admission. His daily insulin requirement is 24 units of NPH. Every morning Albert is given NPH insulin at 0730. Meals are served at 0830, 1230, and 1830. The nurse expects that the NPH insulin will reach its maximum effect (peak) between the hours of: A. 1130 and 1330 B. 1330 and 1930 C. 1530 and 2130 D. 1730 and 2330

Patients should avoid acidic fluids with with drug class? A. Carbapenems B. Penicillin C. Cephalosporins D. Fluoroquinolones E. Tetracycline

Rosemary has been taking Glargine (Lantus) to treat her condition. One of the benefits of Glargine (Lantus) insulin is its ability to: A. Release insulin rapidly throughout the day to help control basal glucose. B. Release insulin evenly throughout the day and control basal glucose levels. C. Simplify the dosing and better control blood glucose levels during the day. D. Cause hypoglycemia with other manifestation of other adverse reactions.

B. Glargine (Lantus) insulin is designed to release insulin evenly throughout the day and control basal glucose levels.

A physician orders regular insulin 10 units I.V. along with 50 ml of dextrose 50% for a client with acute renal failure. What electrolyte imbalance is this client most likely experiencing? a. Hyperglycemia b. Hypercalcemia c. Hyperkalemia d. Hypernatremia

C Rationale: Administering regular insulin I.V. concomitantly with 50 ml of dextrose 50% helps shift potassium from the extracellular fluid into the cell, which normalizes serum potassium levels in the client with hyperkalemia. This combination doesn't help reverse the effects of hypercalcemia, hypernatremia, or hyperglycemia.

The nurse is initiating discharge teaching with the newly diagnosed diabetic. Which of the following statements indicates that the patient needs additional teaching? A. "If I am experiencing hypoglycemia, I should drink ½ cup of apple juice." B. "My insulin needs may increase when I have an infection." C. "I must draw the NPH insulin first if I am mixing it with regular insulin." D. "If my blood glucose levels are less than 70 mg/dL, I should notify my health care provider."

C. Additional teaching is needed. The clear solution (regular insulin) should be drawn into the syringe first followed by the cloudy solution (NPH). The other options demonstrate an understanding of discharge instructions.

A bedtime snack is provided for Albert. This is based on the knowledge that intermediate-acting insulins are effective for an approximate duration of: A. 6-8 hours B. 10-14 hours C. 16-20 hours D. 24-28 hours

A client with Type II diabetes has an order for regular insulin 10 units SC each morning. The client's breakfast should be served within: A. 15 minutes B. 20 minutes C. 30 minutes D. 45 minutes

A client with insulin-dependent diabetes takes 20 units of NPH insulin at 7 a.m. The nurse should observe the client for signs of hypoglycemia at: A. 8 a.m. B. 10 a.m. C. 3 p.m. D. 5 a.m.

A 10-year old child monitors and adjust his own insulin. Which respond reflects an understanding of appropriate adjustment of insulin dosage when the child has the flu? A. "I withhold all insulin because I'm not eating." B. "I'l take my usual dose of regular and NPH insulin" C. I'll perform fingerstick blood sugar testing and adjust my insulin according to the results." D. "I'll perform fingerstick blood sugar testing and record the results."

C. Because of the stress of illness, serum glucose will likely be elevated during an episode of the flu. Appropriate adjustment of insulin dosage will help prevent the child from becoming hypoglycemic or ketoacidotic.

Dr. Hugo has prescribed sulfonylureas for Rebecca in the management of diabetes mellitus type 2. As a nurse, you know that the primary purpose of sulfonylureas, such as long-acting glyburide (Micronase), is to: A. Induce hypoglycemia by decreasing insulin sensitivity. B. Improve insulin sensitivity and decrease hyperglycemia. C. Stimulate the beta cells of the pancreas to secrete insulin. D. Decrease insulin sensitivity by enhancing glucose uptake.

C. Sulfonylureas such as glyburide are used only with patients who have some remaining pancreatic-beta cell function. These drugs stimulate insulin secretion, which reduces liver glucose output and increases cell uptake of glucose, enhancing the number of and sensitivity of cell receptor sites for interaction with insulin.

A hospitalized diabetic patient receives 12 U of regular insulin mixed with 34 U of NPH insulin at 7:00 AM. The patient is away from the nursing unit for diagnostic testing at noon, when lunch trays are distributed. The most appropriate action by the nurse is to a. save the lunch tray to be provided upon the patient's return to the unit. b. call the diagnostic testing area and ask that a 5% dextrose IV be started. c. ensure that the patient drinks a glass of milk or orange juice at noon in the diagnostic testing area. d. request that the patient be returned to the unit to eat lunch if testing will not be completed promptly.

D Rationale: Consistency for mealtimes assists with regulation of blood glucose, so the best option is for the patient to have lunch at the usual time. Waiting to eat until after the procedure is likely to cause hypoglycemia. Administration of an IV solution is unnecessarily invasive for the patient. A glass of milk or juice will keep the patient from becoming hypoglycemic but will cause a rapid rise in blood glucose because of the rapid absorption of the simple carbohydrate in these items.

A patient screened for diabetes at a clinic has a fasting plasma glucose level of 120 mg/dl (6.7 mmol/L). The nurse will plan to teach the patient about a. use of low doses of regular insulin. b. self-monitoring of blood glucose. c. oral hypoglycemic medications. d. maintenance of a healthy weight.

D Rationale: The patient's impaired fasting glucose indicates pre-diabetes and the patient should be counseled about LIFESTYLE CHANGES to prevent the development of type 2 diabetes. The patient with prediabetes does not require insulin or the oral hypoglycemics for glucose control and does not need to self-monitor blood glucose.

A client newly diagnosed with diabetes mellitus has been stabilized with daily insulin injections. A nurse prepares a discharge teaching plan regarding the insulin and plans to reinforce which of the following concepts? a) always keep insulin vials refrigerated b) ketones in the urine signify a need for less insulin c) increase the amount of insulin before unusual exercise d) systematically rotate insulin injections within one anatomic site

D - Insulin doses should not be adjusted nor increased before unusual exercise. If ketones are found in the urine, it possibly may indicate the need for additional insulin. To minimize the discomfort associated with insulin injections, insulin should be administered at room temperature. Injection sites should be rotated systematically within one anatomic site.

During the morning rounds, Nurse AJ accompanied the physician in every patient's room. The physician writes orders for the client with diabetes mellitus. Which order would the nurse validate with the physician? A. Use Humalog insulin for sliding scale coverage. B. Metformin (Glucophage) 1000 mg per day in divided doses. C. Administer regular insulin 30 minutes prior to meals. D. Lantus insulin 20U BID.

D. Lantus insulin is usually prescribed once-a-day so an order for BID dosing should be validated with the physician. Humalog insulin can be prescribed for sliding scale coverage. Regular insulin is administered 30 minutes before meals. Metformin (Glucophage) is often prescribed in divided doses of 1000 mg per day.

Nurse Andy has finished teaching a client with diabetes mellitus how to administer insulin. He evaluates the learning has occurred when the client makes which statement? A. "I should check my blood sugar immediately prior to the administration." B. "I should provide direct pressure over the site following the injection." C. "I should use the abdominal area only for insulin injections." D. "I should only use calibrated insulin syringe for the injections."

D. To ensure the correct insulin dose, a calibrated insulin syringe must be used. Insulin injections should 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.

Insulin forces which of the following electrolytes out of the plasma and into the cells? A. Calcium B. Magnesium C. Phosphorus D. Potassium

D. Insulin forces potassium out of the plasma, back into the cells, causing hypokalemia. Potassium is needed to help transport glucose and insulin into the cells. Calcium, magnesium, and phosphorus aren't affected by insulin.

Ben injects his insulin as prescribed, but then gets busy and forgets to eat. What will the best assessment of the nurse reveal? A. The client will be very thirsty. B. The client will complain of nausea. C. The client will need to urinate. D. The client will have moist skin.

D. Moist skin is the sign of hypoglycemia, which the client would experience if he injected himself with insulin and did not eat. Thirst, nausea, and and increased urination are signs of hyperglycemia.

An external insulin pump is prescribed for a client with diabetes mellitus and the client asks the nurse about the functioning of the pump. The nurse bases the response on the information that the pump: a) is timed to release programmed doses of regular or NPH insulin into the bloodstream at specific intervals b) continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels c) is surgically attached to the pancreas and infuses regular insulin into the pancreas, which in turn releases the insulin into the bloodstream d) gives a small continuously dose of regular insulin subcutaneously, and the client can self-administer a bolus with an additional dose form the pump before each meal

D.) gives a small continuously dose of regular insulin subcutaneously, and the client can self-administer a bolus with an additional dose form the pump before each meal An insulin pump provides a small continuous dose of regular insulin subcutaneously throughout the day and night, and the client can self-administer a bolus with an additional dose from the pump before each meal as needed. Regular insulin is used in an insulin pump. An external pump is not attached surgically to the pancreas.

A 9-year old boy with diabetes tests his glucose level before lunch in the nurse's office. According to his sliding scale of insulin, he's due for 1 unit of regular insulin. What steps should a nurse follow after confirming the medication order, washing her hands, drawing up the appropriate dose, verifying the boy's identity, and putting on gloves? Put the following steps in ascending chronological order. Use all the options. 1. Pinch the skin around the injection site. 2. Release the skin and give the injection. 3. Clean the injection site with alcohol and loosen the needle cover. 4. Select an appropriate injection site, being sure to discuss with the client so the sites are rotated. 5. Cover the site with an alcohol pad. Press but don't rub the site 6. Uncover the needle; insert it at a 45-90 degree angle.

4. 3. 1. 6. 2. 5.

The nurse prepares the client for an IV pyelography (IVP) scheduled in 2 hours. The nurse should contact the physician if the client states which of the following? A. "I take metformin (Glucophage) for type 2 diabetes." B. "I completed the bowel prep last evening." C. "I ate a light meal last evening." D. "I had an IVP 3 years ago."

A. (1) correct—should discontinue 48 hours prior to procedure, contrast media can cause life-threatening lactic acidosis (2) appropriate action; removes feces, fluid, and air from bowel so kidneys, ureters, and bladder will not be obscured (3) appropriate action (4) no reason to contact the physician

The patient is scheduled to receive 5 units of Humalog and 25 units of NPH(Isophane) insulin prior to breakfast. What nursing intervention is most appropriate for this patient? A. Make sure the patient's breakfast is ready to eat before administering this insulin. B. Offer the patient a high-carbohydrate snack in 6 hours. C. Hold the insulin if the blood glucose level is greater than 100 mg/dL. D. Administer the medications in two separate syringes.

A. Humalog is a rapid-acting insulin that is administered for elevated glucose levels and should be given 0 to 15 minutes before breakfast. Hypoglycemic reactions may occur rapidly if Humalog insulin is not supported by sufficient food intake. The medication can be mixed in one syringe.

Steven John has type 1 diabetes mellitus and receives insulin. Which laboratory test will the nurse assess? A. Potassium B. AST (aspartate aminotransferase) C. Serum amylase D. Sodium

A. Insulin causes potassium to move into the cell and may cause hypokalemia. There is no need to monitor the sodium, serum amylase, and AST levels.

The client is scheduled to begin treatment with Metformin. The nurse plans to closely monitor which laboratory values?

Liver function tests Metformin tends to create alteration in the client's liver function tests.

A client is learning to mix regular insulin and NPH insulin in the same syringe. Which action, if performed by the client, would indicate the need for FURTHER teaching? a. Withdrawing the NPH insulin first b. Injecting air into the NPH insulin bottle fir

a. Withdrawing NPH insulin first. Regular insulin is ALWAYS withdrawn first so it won't become contaminated with NPH insulin. The client is instructed to inject air into the NPH insulin bottle equal to the amt of insulin to be withdrawn because there will be regular insulin in the syringe and he won't be able to inject air when he needs to withdraw the NPH. It's necessary to remove the air bubbles to ensure a correct dosage before drawing u p the second insulin.

A 1200-calorie diet and exercise are prescribed for a patient with newly diagnosed type 2 diabetes. The patient tells the nurse, "I hate to exercise! Can't I just follow the diet to keep my glucose under control?" The nurse teaches the patient that the major purpose of exercise for diabetics is to a. increase energy and sense of well-being, which will help with body image. b. facilitate weight loss, which will decrease peripheral insulin resistance. c. improve cardiovascular endurance, which is important for diabetics. d. set a successful pattern, which will help in making other needed changes.

b. facilitate weight loss, which will decrease peripheral insulin resistance. Rationale: Exercise is essential to decrease insulin resistance and improve blood glucose control. Increased energy, improved cardiovascular endurance, and setting a pattern of success are secondary benefits of exercise, but they are not the major reason.

Which nursing intervention should be taken for a client who complains of N & V 1 hour after taking his morning glyburide? a. give glyburide again b. give subQ insulin and monitor BG c. Monitor blood glucose closely, and look for signs of hypoglycem

c. Monitor blood glucose closely, and look for signs of hypoglycemia When a client who has taken an oral antidiabetic agent vomits, the nurse should monitor glucose and assess him frequently for signs of hypoglycemia. Most of the medication has probably been absorbed. Therefore, repeating the dose would further lower glucose levels later in the day. giving insulin also will lower glucose levels, causing hypoglycemia client wouldn't have hyperglycemia if they glyburide was absorbed.

Which symptom is indicative of hypoglycemia? a. irritability b. drowsiness c. abdominal pain d. N & V

A. Irritability: signs of hypoglycemia include irritability, shaky feeling, hunger, headache, dizziness. Drowsiness, abdominal pain, nausea, and vomiting are signs of HYPERglycemia.

D - An insulin pump provides a small continuous dose of regular insulin subcutaneously throughout the day and night, and the client can self-administer a bolus with an additional dose from the pump before each meal as needed. Regular insulin is used in an insulin pump. An external pump is not attached surgically to the pancreas.

The healthcare provider administers NPH insulin to a patient who has diabetes at 6:00 AM. When will the patient be at highest risk of experiencing hypoglycemia? Please choose from one of the following options. A. 7:00 AM B. 7:30 AM C. 9:00 AM D. 10:00 AM

The healthcare provider is caring for a patient who has diabetes and is also diagnosed with hypertension. Which of the following medications on the patient's medication administration record will cause the most concern? Please choose from one of the following options. A. Angiotensin receptor blocker B. ACE inhibitor C. Calcium channel clocker D. Beta-blocker

The physician orders 36 units of NPH and 12 units of regular insulin. The nurse plans to administer these drugs in 1 syringe. Identify the steps in this procedure by listing them in priority order. 1. Inject air equal to NPH dose into NPH vial 2. Invert regular insulin bottle and withdraw regular insulin dose 3. Inject air equal to regular dose into regular dose 4. Invert NPH vial and withdraw NPH dose. A. 1, 2, 3, 4. B. 1, 4, 3, 2. C. 1, 4, 2, 3, D. 1, 3, 2, 4.

Which of the following methods of insulin administration would be used in the initial treatment of hyperglycemia in a client with diabetic ketoacidosis? A. Subcutaneous B. Intramuscular C. IV bolus only D. IV bolus, followed by continuous infusion

D. An IV bolus of insulin is given initially to control the hyperglycemia; followed by a continuous infusion, titrated to control blood glucose. After the client is stabilized, subcutaneous insulin is given. Insulin is never given intramuscularly.

The client taking glyburide (Diabeta) should be cautioned to: A. Avoid eating sweets B. Report changes in urinary pattern C. Allow three hours for onset D. Check the glucose daily

D. Diabeta (glyburide) is an anti diabetic medication that can result in hypoglycemia. Answers A, B, and C are incorrect because they are not related to Diabeta (glyburide).

A patient newly diagnosed with Type I DM is being seen by the home health nurse. The doctors orders include: 1200 calorie ADA diet, 15 units NPH insulin before breakfast, and check blood sugar qid. When the nurse visits the patient at 5 pm, the nurse observes the man performing blood sugar analysis. The result is 50 mg/dL. The nurse would expect the patient to be a. confused with cold, clammy skin an pulse of 110 b. lethargic with hot dry dkin and rapid deep respirations c. alert and cooperative with BP of 130/80 and respirations of 12 d. short of breath, with distended neck veins and bounding pulse of 96.

a. confused with cold, clammy skin an pulse of 110 hypoglycemia

A client is on NPH 12 units and Humalog 6 units each in the morning. Place the following actions in ascending chronological order of how a nurse would demonstrate how to mix insulins. Use all the options. 1. Withdraw 12 units of NPH insulin. 2. Inject 12 units of air into NPH vial. 3. Inject 6 units of air into Humalog vial. 4. Wipe off vials with alcohol swab. 5. Withdraw 6 units of Humalog insulin.

4. 2. 3. 5. 1. The insulin bottles should be cleaned of contaminants before each use. Air is injected into the NPH vial first, without touching the insulin. Then, the proper amount of air is inserted into the fast-acting insulin and drawn up into the syringe. Fast or rapid-acting insulin is drawn into the syringe first to avoid the risk of mixing the long-acting insulin into the vial and delaying the onset of action of the regular insulin in an emergency. Intermediate or long-acting insulin is drawn into the syringe last. Insulin glargine (Lantus should never be mixed with another insulin because a precipitate will form and inactivate the drug.

The nurse recognizes that additional teaching is necessary when the client who is learning alternative site testing (AST) for glucose monitoring says: A. "I need to rub my forearm vigorously until warm before testing at this site." B. "The fingertip is preferred for glucose monitoring if hyperglycemia is suspected." C. "I have to make sure that my current glucose monitor can be used at an alternate site." D. "Alternate site testing is unsafe if I am experiencing a rapid change in glucose levels."

B. The fingertip is preferred for glucose monitoring if hypoglycemia, not hyperglycemia, is suspected.

Pharm Sem 4 Part 2

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