Pharmacology Exam #4 Chapters 13,14, and 35
The nurse is caring for a patient with a new diagnosis of type 1 diabetes mellitus. When assisting with the plan of care, which goal set by the patient will require revision?
Patient will discontinue insulin use within 1 year.
Why are benzodiazepines often preferred over barbiturates? (Select all that apply.)
They have selective action at specific receptor sites. There is a wide range of safety between therapeutic and lethal levels. REM sleep is decreased to a lesser extent. Accidental overdoses are well tolerated.
The nurse is administering Somnote to a patient. When providing medication education to the patient, the nurse will include that Somnote should be:
taken with a full glass of water.
The nurse is educating a patient with diabetes mellitus regarding urine testing for ketones. Information provided will include that ketone testing should be done: (Select all that apply.)
when illness occurs .during pregnancy. when blood glucose is above usual range.
Which statement(s) regarding type 2 diabetes mellitus would be correct? (Select all that apply.)
Type 2 diabetes is more prevalent in overweight people older than 45 years. A genetic predisposition exists for the development of type 2 diabetes mellitus. Type 2 diabetes is often diagnosed after complications have resulted. Women have a higher incidence of type 2 diabetes.
A third subclass of diabetes mellitus includes additional types of diabetes that are part of other diseases having features not generally associated with the diabetic state. Which disorder(s) may have an associated diabetic component? (Select all that apply.)
Patients receiving high dose corticosteroid therapy for disease maintenance. Cushing's syndrome. Acromegaly, Malnutrition
Which instruction is most important for the nurse to teach a patient with diabetes who is receiving metformin?
Stop taking the drug 24 to 48 hours prior to radiopaque dye procedures.
The nurse finds that a patient is extremely agitated, yells frequently, and is attempting to get out of bed without assistance. What is the nurse's initial action?
Spend uninterrupted time listening to the patient.
The nurse is instructing a patient about insulin administration. Which statement by the patient indicates a need for further teaching?
"Once I open my insulin, I will store it in the refrigerator."
A patient with type 2 diabetes mellitus, which was previously controlled with an oral antidiabetic agent, is hospitalized for treatment of a leg ulcer. The health care provider has ordered sliding scale insulin coverage with regular insulin for hyperglycemia. The nurse brings the injection into the room, and the patient becomes upset, stating "I don't want to start taking that drug! I'll need it the rest of my life." What is the nurse's best response?
"Your body is under stress right now, which raises your blood glucose level. This does not mean you will be on this drug permanently. Once you're feeling better, your provider will determine if your oral medication is all you will need."
A patient received the evening dose of Lispro subcutaneously at 1630. What time will symptoms of hypoglycemia likely occur?
1830
What test determines glycemic control over the previous 8 to 10 weeks?
A1c test
Which instruction by the nurse is accurate to include when providing teaching to a patient recently diagnosed with diabetes who has been prescribed insulin?
Beta blockers can mask symptoms of hypoglycemia.
Which dietary control measures are used in the management of diabetes mellitus? (Select all that apply.)
Consistent carbohydrate diabetes meal plan, 50% intake of carbohydrates daily, Adjustments to daily meals according to age, metabolic stress, pregnancy, and advanced age and/or older adults, 20% intake of proteins daily
In addition to facilitating sleep, what is another benefit of sedatives?
Decreased patient anxiety
Which is the most important for the successful management of diabetes mellitus?
The level of self management
The nurse is preparing to begin administration of apomorphine to a patient. Before administering, the nurse will perform a baseline assessment of the patient's: (Select all that apply.)
mobility, orientation, alertness, vital signs
What laboratory test is the preferred screening test for diabetes in children and nonpregnant adults?
FPG (fasting plasma glucose)
Which statement(s) regarding gestational diabetes would be true? (Select all that apply.)
Fetal development may be complicated as a result of gestational diabetes. The risk of developing diabetes after pregnancy is increased. Most women with gestational diabetes have normal glucose tolerance postpartum. Women need to be re evaluated postpartum to determine their classification with respect to glucose tolerance.
When is the best time for the nurse to administer Lispro?
Within 10 to 15 minutes of eating
It is 2:00 PM and a patient who has been NPO since 12 AM for a bronchoscopy is complaining of a headache and shakiness, and is extremely irritable. Vital signs are within normal limits, and a one touch glucose reads 50 mg/dL. Which action is most important for the nurse to take?
Administer glucagon subcutaneously.
The nurse is administering sulfonylurea drugs to four different patients diagnosed with type 2 diabetes. Which patient should not receive the medication as ordered?
An 80-year-old woman with an allergy to sulfa
What can occur as a result of rapid withdrawal from long-term use of barbiturate therapy? (Select all that apply.)
Anxiety, Delirium, Weakness, Grand mal seizures.
What point(s) should be included when teaching a patient about the use of apomorphine for treatment of Parkinson's disease? (Select all that apply.)
Apomorphine does not have any opioid activity. A multidose injector pen is commonly used to administer apomorphine. You may experience nausea and vomiting, which can be treated with trimethobenzamide (Tigan). You may experience sleep attacks or episodes of daytime sleepiness.
A 65-year-old man is diagnosed with type 2 diabetes mellitus. Which patient symptom(s) would indicate type 1 diabetes mellitus, and not type 2? (Select all that apply.)
Increased thirst over the past week. A 10-pound weight loss within the past month. Polyphagia. Ketoacidosis
The patient asks the nurse how sulfonylureas normalize glucose levels. Which response by the nurse is correct?
By stimulating pancreatic secretion of insulin
The nurse is assessing an older patient with Parkinson's disease who was started on entacapone 1 week ago. The patient has a history of coronary artery disease and takes an antihypertensive and aspirin. Which information would support the need for a reduction in medication dosage by the healthcare provider?
Dizziness
What is the rationale for administering levodopa instead of dopamine for treatment of Parkinson's disease?
Dopamine does not cross the blood-brain barrier when administered orally.
After a blood glucose reading, it is determined that the patient should receive 4 units of Lispro and 8 units of NPH. Which action will the nurse take to administer these medications?
Draw up the Lispro first and then the NPH using the same syringe.
What is the pharmacologic action of entacapone, a potent catechol O methyl transferase (COMT) inhibitor?
Reduces the destruction of dopamine in peripheral tissues.
Barbiturates have which common adverse effect(s)? (Select all that apply.)
Residual daytime sedation, Headache, Blurred vision, Impaired coordination.
The nurse is assessing a patient who is being evaluated in an outpatient clinic for complaints of back pain. The patient reports taking diphenhydramine for insomnia related to job stress. Which statement by the nurse is accurate regarding this medication?
"This medication should only be taken for 1 week."
The nurse is assessing a patient prior to discharge from same day surgery following an incisional breast biopsy. When assessing the patient's central nervous system (CNS) function following sedative-hypnotic therapy, what will the nurse include? (Select all that apply.)
Level of alertness, Orientation, Ability to perform motor functions.
Parkinson's disease has which characteristic symptom(s)? (Select all that apply.)
Muscle tremors, Posture alterations, Slow body movement.
An older adult patient received a hypnotic agent at 9:00 PM. At 2:00 AM, the nurse discovers that the patient has removed her gown and is attempting to get out of bed without assistance. What type of medication effect is the patient exhibiting?
Paradoxical
