Pharmacology Final NUR202 (McCuistion: 9-11, 47)

Diabetes mellitus

a chronic disease that results from deficient glucose metabolism, is caused by insufficient insulin secretion from the beta cells. -result: HIGH blood glucose (hyperglycemia) -characterized by 3 p's: polyuria (increased urine output), polydipsia (increased thirst), polyphasic (increased hunger) -disorder of the pancreas -

Root cause analysis (RCA)

a method of problem solving used to identify potential workplace errors

Insulin

a protein secreted from the beta cells of the pancreas, is necessary for carbohydrate metabolism and plays an important role in protein and fat metabolism.

The nurse is preparing to five an oral dose of acetaminophen (Tylenol) to a child who weight 12 kg. The dose is 15 mg/kg. How many milligrams will the nurse administer for this dose?

180 mg

Type ________ is the most common type of diabetes.

2

A patient asks about disposal of medications. What are the nurse's best responses? (select all that apply) a. Mix medications with coffee grounds or cat litter before disposal. b. Pour medications down the sink c. Remove identifying information on the original container. d. Pulverize all tablets before disposal e. dilute the medication with bleach before disposal

Answers: a, c

A patient is to start on a lidocaine transdermal patch. What is essential for the nurse to include in the patient's teaching? (select all that apply) a. Wear gloves when applying the patch b. Cut the patch in half if a reduced dose is needed. c. Wear gloves when removing the patch. d. Rotate placement of patch to different sites. e. Remove the patch if it becomes loose.

Answers: a, c, d

The nurse prepares to administer medications. Which are complete drug orders? (select all that apply) a. Aspirin 81mg PO daily b. Multivitamin c. Vitamin D 2000 units PO d. Ciprofoxacin hydrochloride (Cipro) 500mg PO q12h x 7d e. Promethazine 50mg IV q3-6h PRN for nausea

Answers: a, d, e

The nurse educator on the unit receives a list of high-alert drugs. Which strategy is recommended to decrease the risk of errors with these medications? (select all that apply) a. store medications alphabetically on an easy-cess shelf for quick retrieval b. limit access to these drugs c. use special labels for these drugs d. provide increased information to staff. e. standardize the ordering and preparation of these drugs.

Answers: b, c, d, e

What information is essential for the nurse to know related to right documentation? (select all that apply) a. The necessity to document all medications given at the end of a shift. b. The correct site of injectable medication c. Patient response to an antiemetic d. Patient's blood pressure prior to giving and antihypertensive e. Date and time of dose and necessity for the nurse's initials/signature

Answers: b, c, d, e

_______________ is a long acting insulin, given at night, before bed, sub-Q.

Brand Name: Lantus Insulin glargine

When calculating pediatric dosages, the nurse understands which method is MOST accurate for dosing calculations? a. Use of drug reference recommendations based on mg/kg of body weight. b. Calculated doses based on body weight need to be increased by 10% because of immature renal and hepatic function c. Dosage calculation by body surface area because it takes into account the difference in size for children and neonates d. Medication dosing calculated according to body weight because it is based on maturational growth and development

C. Dosage calculation by body surface area because it takes into account the difference in size for children and neonates

2 examples of anti-coagulants include:

Heparin Coumadin aka Warfarin

What are common examples of short acting insulin (Regular)?

Humulin R Novolin R **Onset= 30 minutes to one hour

The major side effect of sulfonylureas is?

Hypoglycemia

Routes of administration:

IV (intravenous) IVPB (intravenous piggyback) KVO (keep vein open) PO (by mouth) ID (intradermal) Inj (injection) subQ, subcut, subcutaneous (subcutaneous) IM (intramuscular) Subling (sublingual or under tongue) TKO (to keep open) vag (vaginal)

The 2 groups of antidiabetic agents are?

Insulin and Oral Hypoglycemic (Anti-diabetic) drugs

A long-acting insulin is ___________.

Insulin glargine -it is evenly distributed over 24 hours -usually administered once a day at bedtime

Whats the short-acting insulin that is injected only at meal time?

Insulin lispro (humalog)

Why is there increased blood glucose in a patient with type 2 diabetes?

Insulin receptors become desensitized and glucose transport into the cell is inhibited

How does Metformin affect weight in obese patients?

It decreases it

Why is NPH insulin conjugated with protamine?

It decreases the absorption of the insulin (slows absorption)

what are some advantages of Metformin?

It does not cause hypoglycemia and decreases low-density lipoprotein

How does Metformin work?

It increases the number of insulin receptors and increases receptor sensitivity.

What is the only type of insulin that isn't a clear solution?

NPH

What are common examples of intermediate acting insulin? isophane suspension:

NPH Humulin N Novalin N **Onset= 1-1.5 hours

When a drug has a long half-life it is usually given __________ times a day.

One time a day

Oral Antidiabetic drugs are also called?

Oral Hypoglycemics

What kinds of insulin are there?

Rapid Acting Insulin Short Acting Insulin (Regular) Intermediate Acting Insulin (NPH) Long Acting Insulin Combination Insulin (Pre-mixed)

What insulin is the only one that can be administered via IV?

Rapid acting Insulin Ex; aspart (Novolog) lispro (Humalog) glulisine (Apidra) *May be given short term IV therapy with VERY CLOSE monitoring

What do portable insulin pumps do?

They deliver a constant basal infusion of insulin through a sub q needle placed in the abdomen

Why is there increased blood glucose in a patient with type 1 diabetes?

Too little insulin is synthesized and released from the beta cells of the pancreas.

True or False: a patient who uses sulfonyleura as his only therapy for type 2 diabetes will eventually "burn out" his pancreas and not be able to synthesis enough insulin

True

When is NPH injected?

Twice a day-- controls blood glucose during meals and during the night

Oral antidiabetics are used primarily to treat?

Type 2 diabetes, a chronic disease that affects carbohydrate metabolism

What are anti-coagulants used for?

Used for DVTs (Deep Vein Thrombosis) and those with mechanical heart valves

Drug measurements and drug forms:

cap (capsule) elix (exlixir) ER (extended release) SR (sustained release) g (gram) gtts (drops) kg (kilogram) L (liter) mcg (microgram) mg (milligram) mEq (milliequivalent) NKA (No known allergies) NKDA (No know DRUG allergies) Tbsp, tbs, T (tablespoon) tsp (teaspoon) oz (ounce) One-Half tablet (half-tablet)

Rapid and short-acting insulins are in a _________ solution without any added substance to prolong insulin action.

clear

Intermediate-acting insulin are _________ and may contain protamine, a protein that prolongs the action of insulin, or sic, which also slows the onset of action and prolongs the duration of activity.

cloudy

Unit dose method

drugs are individually wrapped and labeled for single-dose use for each patient. -reduces dosage errors -no calculations required

Just culture:

individuals would be encouraged to report drug errors so the system can be repaired and problems may be fixed. -does not hold individual practitioners responsible for failing system, although it does not tolerate disregard for a patient or gross misconduct.

Check blood glucose before giving ________________.

insulin

NPH is a ________-acting insulin.

intermediate

Data shows that ________________ are responsible for 45% of medications errors.

interruptions (create a distraction-free environment for collecting and administering medications)

Right Route

is ordered by health care provider and indicates the mechanism by which the medication enters the body -oral, IM, SubQ, IV, sublingual, buccal, suspension, elixir, topical, inhalation, suppository, and more. -rate of absorptions differs for various methods (know when to check back with patient)

Humalog is given with a ___________ ready.

meal tray -this is fast-acting glucose*

__________ of patients with Type 2 diabetes need insulin.

one third

Check respirations before giving ___________.

opioids

Right to Refuse

patient's have a right to refuse and it is up to the RN to determine the reason for the refusal, explain to the patient the risks involved with refusal, and reinforce the important benefits of and reasons for taking the medications -MUST DOCUMENT OF PATIENT REFUSES** -primary nurse and health care provider should be informed (omission could pose a threat to patient health/safety)

Always consult with a ______________ before cutting or crushing medications.

pharmacist

Diabetes insipidus is a disorder of the __________________.

posterior pituitary gland*

Right Documentation

requires RN to record immediately the appropriate information about the drug administered: 1. Drug given 2. Dose given 3. Route given 4. Date and time 5. Signature/initials (whatever hospital requires) -also document RECHECK (time, patient tolerating med or not, etc.)

Right to Education

requires that patients receive accurate and thorough information about the drugs they are taking and how each drug relates to their particular condition. -why are they taking it -what will it do/how it works -side effects -adverse reactions (when to call doctor) -Informed consent

Right Assessment

requires the collection of appropriate baseline data before administration of a drug. -ex. taking vital signs, checking lab values, apical pulse, K+ levels, etc. -Be sure to determine/identify if patient is "at risk" (allergies, elderly, pediatric, etc.)

Dispose of sharps in ______________ ____________.

sharps container (safety measures and prevents reusing of needles/sharps)

Drug reconciliation

the process of identifying the most accurate list of all medications that the patient is taking at transitions in care, which includes admissions and discharges from a hospital to another health care setting such as long-term care. -prevents discrepancies that can cause drug error.

Lipodystrophy

tissue atrophy or hypertrophy, which can interfere with insulin absorption -this is why you need to rotate sites (to avoid lipodystrophy*)

What is the most common cause of death in patients with type 1 diabetes? type 2?

type 1: Nephropathy (Kidney Disease) type 2: Cardiovascular Disease

Informed consent

which is the individual having the necessary knowledge to make a decision. -informed patients and families are critical to preventing medication errors

Rapid-acting insulins include:

-lispro -human insulin aspart -insulin glulisine -human oral inhalation insulin -administer 10-15min before meal time (food should be present before administering insulin)

Medication error:

"any preventable event that may cause or lead to inappropriate medication use or harm to a patient."

Convert 250 micrograms to milligrams using correct decimal placement

0.25 mg

Nasogastric and Gastrostomy Tubes

-ALWAYS CHECK PROPER TUBE PLACEMENT BEFORE ADMINISTRATION OF MEDS***** -place patient in high Fowler position, elevate HOB at least 30degrees -Make sure drug is crushable -allow medication to flow by gravity -administer 1 drug at a time -when finished flush with 30mL of water (record amount used) -clamp tube and remove syringe -if patient on suction; allow 30mins and then return suction, this way medication is absorbed

Signs and symptoms of Hypoglycemic reaction (insulin shock)

-Headache -Nervousness -Apprehension -Tremor -Excess perspiration; cold and clammy skin -Tachycardia -Slurred speech -Memory lapse, confusion, seizures -Blood glucose <60mg/dL

Types of insulin include:

-Rapid-acting -Short-acting -Intermediate-acting -Long-acting

Forms and routes of drug administration:

-Tablets and Capsules -Liquids -Transdermal -Topical -Instillations -Inhalations -Nasogastric and Gastrostomy Tubes -Suppositories -Parenteral Administration

The nurse is administering an intramuscular injection to a 5 year old child. Choose the correct site the nurse will use. a. Intravenous b. Dorsogluteal c. Deltoid d. Ventrogluteal

Answer: d

Suppositories

-a solid medical preparation that is cone- or spindle-shaped for insertion into the rectum, globular or egg shaped for use in the vagina, or pencil-shaped for insertion into the urethra -glycerinated gelatin or high-molecular weight polyethylene glycols -useful in babies, uncooperative patients, and incases of vomiting or certain digestive disorders

Oral hypoglycemic drugs

-aka Oral antidiabetic drugs -are synthetic preparations that stimulate insulin release or otherwise alter the metabolic response to hyperglycemia

Instillations

-are liquid medications usually administer as drops, ointments, or sprays -Eyedrops -Eye ointments -Eardrops -Nose drops and sprays

A nurse is teaching a patient how to recognize symptoms of hypoglycemia. Which symptoms should be included int he teaching? (select all that apply) a. Headache b. Nervousness c. Bradycardia d. Sweating e. Thirst f. Sweet breath odor

Answers: a, b, d

Vaginal Medications

-available in suppositories, foams, jellies, or creams -gloves should be worn -lithotomy position -times for laying still for absorption will vary depending on medication use and form -after insertion provide patient with sanitary pad -allow patient to insert/administer meds herself if she can/wishes to

Right Drug/Medication

-check before administer -scan barcode if hospital requires (scan patient wristband first, then med) -Perform assessments prior to administration (ex. respirations for morphine, Accu-check for insulin, etc.) -Verifying orders: if verbal confirm with doctor multiple times and have witness if possible; if over phone have another RN, write down everything and READ BACK to confirm, doctor must sign within 24hours. -Withhold if patient refuses, is unable to take, or other contraindications are present

Ketoacidosis

-diabetic acidosis or diabetic coma -the use of fatty acids (ketones) for energy causes this -reactions: extreme thirst, polyuria, fruity breath odor, Kussmal breathing, rapid/thready pulse, dry mucous membranes, poor skin turgor, blood glucose >250mg/dL

Intraosseous (IO)

-infusion of medication directly into the bone marrow. -used when IV access is NOT possible -maintained for 24-72hours -used mostly in infants and toddlers who have poor IV access and in emergency situations

Glucagon given IM may be ineffective in an emergency setting to counteract insulin overdose if:

The patient has not eaten in the last 24 hours

Pregnancy categories include:

-A, B, C, D & X

Hypoglemic reaction

-insulin shock -when more insulin is administered than is needed for glucose metabolism -patient may exhibit: nervousness, trembling, and lack of coordination; have cold and clammy skin; and complain of headache. (some can be combative or incoherent) -Give them SUGAR**

Rectal suppositories

-local and systemic absorption (small capillaries in rectum promote absorption) -lubricate before insertion (more comfortable for patient, easier to get in) -place suppository past internal anal sphincter (otherwise it will be expelled before being absorbed) -explain procedure to patient and provide privacy -use gloves -patient: lie in Sims position and breathe slowly to relax sphincters -water-soluble lubricant** -patient should remain on side, still for 30mins after administration to prevent expulsion

Intradermal (ID)

-local effect -for skin testing -sites: lightly pigmented, free of lesions, and hairless are preferred -needle: 25 to 27 gauge, 1/4 to 1/2 inch long, TB syringe -hold skin taut -10-15 degree angle -inject slowly to form bleb (or wheal) -Do NOT massage area*** -not recommended to put bandage over -assess for allergic reaction in 24-72hours -Syringe: 0.1mL-1mL

Inhalations

-metered dose inhalers (MDI's): are handheld devices used to deliver a number of common prescribed asthma and bronchitis drugs tot he lower respiratory tract -12-14% of drug into lower respiratory tract with each buff -Ask pharmacist if any contraindications are known, questionable -Spacers: devices used to enhance the delivery of medications from the MDI -Nebulizer: changes a liquid medication into a fine mist or aerosol that has the ability to reach the lower, smaller airways. -Place patient in semi-Fowler or high Fowler position

Tablets and Capsules

-most common -convenient and less expensive -not given if vomiting, lack gag reflex, difficulty swallowing -do not mix with large amounts of food or beverages -scored tabs can be cut -extended release= should NEVER be cut -sublingual (under the tongue) & buccal (between the cheek and gum) remain in place till completely absorbed

Topical

-most frequently applied to the skin by painting or spreading the medication over an area and applying a moist dressing or leaving the area exposed to air -can be applied with gloves on, with a tongue depressor, or cotton-tipped applicator. -clean and dry skin before application -never reinsert applicator or gloves that have come in contact with skin or surfaces back into clean container of medication.

Drug order components:

-patient name and birth date -date the order is written -provider signature or name if an electronic order, T/O, or V/O -Drug name and strength -Drug frequency or dose -Route of administration -Duration of administration -Number of patient refills -Number of pills to be dispensed -Any special instructions

"Do NOT Use" Abbreviations

-q.d. or Q.D. (write out "daily" or "every day") -q.o.d. or Q.O.D. (write "every other day") -U (write "unit") -IU (write "international unit") -MS, MSO4 (write "morphine sulfate") -MgSO4 (write "magnesium sulfate") -.5mg (write "0.5mg" need lead zero!) -1.0mg (write "1mg" no trailing zero!)

Z-track injection technique

-recommended when administering IM injections to help minimize local skin irritation by sealing the medication in the muscle tissue. -Ventrogluteal is preferred -Aseptic technique (use 1 needle for drawing med up, and another for sticking patient) -hold skin taut, insert deep into muscle -if no blood return on aspiration, slowly inject medication -allow needle to remain inserted for 10 seconds

Right Time

-refers to the time the prescribed dose is ordered to be administered -BID (twice a day) -TID (3 times a day) -QID (4 times a day) -Q6H (every 6 hours) -Q12H (every 12 hours) -Use military time (24hr clock)**** -CHECK EXPIRATION DATE***

Parenteral Administration of Medications

-safety is special concern -are administer via injection -ID, IM, subQ, IV, Z-track technique, IV, and intraosseous

Transdermal

-stored in a patch placed on the skin and is absorbed through the skin to produce a systemic effect -can be on for 12 hours up to 7 days -avoid GI absorption (first pass effect) -rotate sites, cleanse each area before applications -wear gloves when placing (don't want to get any medication on self) -NEVER cut in half -patient may secure it with tape, but must not be too tight (could alter drug delivery)

Intravenous (IV)

-systemic effect -more rapid than IM or subQ routes -sites: accessible peripheral vein preferred -needle: adult (20-12 gauge, 1 to 1.5 inch), infant (24 gauge, 1 inch), children (22 gauge, 1 inch), -larger bore for more viscous -flush the catheter with sodium chloride or sterile water to check for site patency -monitor: flow rate, distal pulses, skin color and temperature, and insertion site

Intramuscular (IM)

-systemic effect -more rapid than subQ -used for more viscous and irritating solutions -many risks (must be careful and watchful) -location: adequate muscle size and minimal major nerves and blood vessels in the area. -needle: 18 to 25 gauge, 5/8 to 1.5 inch -flatten skin area using the thumb and index finger and inject between them, insert needle at 90degrees -syringe: 1mL-3mL -Preferred sites: ventrogluteal, deltoid, vastus lateralis

Subcutaneous (subQ)

-systemic effect -sustained effect: absorbed mainly through capillaries -slower onset than IM -location: preferred adequate fat pad -rotate sites -needle: 25 to 27 gauge, 3/8 to 5/8 inch long -45 degree (for 5/8 inch) or 90 degree (for 3/8 inch) angle -Syringe: 1mL-3mL -grasp and gently pinch loose fatty tissue with fingers of non-dominant hand -Insert needle quickly -do NOT aspirate -insert meds slowly -apply gentle pressure to prevent bleeding or oozing into the tissue. -apply bandage as needed

Right patient

-two identifiers (DOB, full name, patient #, etc.) -check identification band -EHR that requires you to scan patient wristband (not all hospitals have) -color-coded ID bands (allergies, fall risk, diabetic, DNR, restrict extremity, etc.) -Verify EVERY time a med is given -"Name-alert" for patients with similar names or same last names

Right Dose

-verification by the RN that the dose administer is the amount ordered and that is it safe for the patient whom it is prescribed -Pediatric doses are less than adults (Peds are not little adults!!) Based on weight in kg** -Unit dose method

Type 1 diabetes mellitus factors:

-viral infections -environmental conditions -genetic factors

Consumers who do not have DEA-authorized collectors or medicine take-back programs can follow these simple steps for disposal:

1. Remove medication from original packaging and mix them with an unpalatable substance such as dirt, kitty litter, or used coffee grounds. This method is intended to make medications less attractive to people and animals 2. Place the mixture in a container such as a sealed plastic bag. 3. Throw the container in the household trash. 4. Scratch out all personal information on the prescription label before disposing of the empty container. -do NOT flush medications unless specifically instructed (may cause pollution, environmental damage)

5 Rights

1. Right patient 2. Right medication 3. Right dose 4. Right route 5. Right time (6. Right documentation)

Patients should be instructed to not do the following with medications:

1. Table splitting (cutting pills in half to use them longer, save money) 2. Buying drugs over the Internet (may not be getting exactly what is prescribed, cannot be 100% certain of what is in pills/tabs/liquid/etc.) Look for websites that require a prescription, have licensed pharmacist to answer questions or if problems occur, are located in the US, are licensed by state board of pharmacy. -some sites sells counterfeit drugs.

Nurses 6 Rights when Administering Medication:

1. The complete and clear order 2. The right to have the correct drug, route, and dose dispensed 3. the right to have access to information 4. the right to have policies to guide safe medication administration 5. the right to administer medications safely and to identify problems in the system 6. the right to stop, think, and be vigilant when administering medications.

IM, SubQ, IV mediations check back in ___________

15-20mins

The nurse is administering oral medications to a patient. Which are important considerations? (select all that apply) a. Administer irritating drugs with food. b. Avoid mixing medications in infant formula. c. Enteric-coated capsules may be chewed or crushed. d. Oral medication should be stopped if the patient is vomiting. e. Cut all transdermal patches to the correct dose.

Answers: a, b, d

Sulfonylureas are classified as 1st and 2nd generation drugs. What is the difference between the 2?

2nd generation sulfonylureas have a longer duration of action, are less likely to react with alcohol, have less potential to cause fluid retention, and cause fewer side effects than the 1st generation. 2nd generation drugs effective doses are lower then the 1st generation

Short-acting insulin has an onset of ________mins.

30 mins -Peak: 2.5-5 hours -Duration: 4-12 hours (Regular insulin is a short-acting insulin)

Oral medications check back in ____________.

30-60mins

Check apical heart rate and K+ levels before giving ______________.

digitalis

"5-plus-5"

Add these to the 5 Rights: 1. the right assessment 2. right documentation 3. patient's right to education 4. right evaluation 5. patient's right to refuse medication

Why do serum potassium levels play a role in diabetes?

Adequate levels of extra cellular potassium are key in the ability of insulin to drive glucose into the cell

Antidiabetic drugs are designed to control signs and symptoms of diabetes mellitus. The nurse primarily expects a decrease in which? a. Blood glucose b. Fat metabolism c. Glycogen storage d. Protein mobilization

Answer: a

The nurse prepares to administer oral medications to a patient. What nursing intervention is needed in addition to the 5-plus-5 rights to ensure safety? a. Assess the patient for risk of aspiration b. Mix 2 of the 4 medications into the meal c. Administer drugs on a full stomach if food interferes with medication absorption. d. Administer irritating drugs without food to decrease gastrointestinal discomfort.

Answer: a

The nurse is aware that The Joint Commission has recommended which abbreviation be on the "Do Not Use" list for ordering or documenting medications? a. qd b. NPO c. Subling d. bid

Answer: a. -instead write "daily" or "every day"

A 3 year old patient has an intramuscular medication ordered. What is the most appropriate approach to gain the child's cooperation? a. Engage the help of a second nurse to hold the child. b. Give a pretend injection to a toy animal. c. Restrain the patient's upper extremities. d. Ask family members to leave the room

Answer: b

A patient is to receive insulin before breakfast, and the time of breakfast tray delivery is variable. The nurse knows that which insulin should not be administered until the breakfast tray is arrived and the patient is ready to eat? a. NPH b. Lispro c. Glargine d. Regular

Answer: b

The nurse administers a variety of drugs to a patient. Which statement by the patient indicates a need for further teaching? a. I do not eat or drink when I have sublingual nitroglycerin in place. b. I mix all of these meds in my dessert and hope I am not too full to finish it. c. I keep the meds in their original labeled containers. d. I store medications away from children and pets.

Answer: b

The nurse is teaching a patient to use an inhaler. What common teaching point is essential for the nurse to include? a. Cleaning the metered-dose inhaler or nebulizer is not recommended b. The semi-Fowler or high Fowler position is recommended. c. Spacers decrease delivery of medication d. Nebulizers change medications to a large-particle powder mist.

Answer: b

A patient is diagnosed with type 2 diabetes mellitus. The nurse is aware that which statement is true about this patient? a. The patient is most likely a teenager b. The patient is most likely a child younger than 10 years. c. Heredity and obesity are major causative factors. d. Viral infections contribute most to disease development.

Answer: c

A patient is receiving a daily dose of NPH insulin at 7:30am. The nurse expects the peak effect of this drug to occur at what time? a. 8:15am b. 10:30am c. 5:00pm d. 11:00pm

Answer: c

A patient refuses to take the prescribed medication. Which is the nurse's best response to this patient? a. Explain the benefits and side effects of the drug. b. Leave the medication at the patient's bedside to be taken later. c. Persuade the patient to take the medication. d. Explain the risks of not taking the medication.

Answer: d

The clinic nurse is preparing to administer an intradermal injection. Which supplies are most appropriate for this procedure? a. 21 gauge, 5/8inch needle b. 27 gauge, 5/8inch needle and a 3mL syringe c. 25 gauge needle an insulin syringe d. 25 gauge needle and a tuberculin syringe.

Answer: d

A patient is newly diagnosed with type 1 diabetes mellitus and requires daily insulin injections. Which instructions should the nurse include int he teaching of insulin administration? (select all that apply) a. Teach family members how to administer glucagon by injection when the patient has a hyperglycemic reaction. b. Instruct that patient about the necessity for compliance with prescribed insulin therapy. c. Teach the patient that hypoglycemic reactions are more likely to occur at the onset of action time. d. Instruct the patient in the care and handling of the insulin container and syringe.

Answers: b, d

A patient is prescribed glipizide. The nurse knows that which side effects and adverse effects may be expected? (select all that apply) a. Tachypnea b. Tachycardia c. Increased alertness d. Increased weight gain e. Visual disturbances f. Hunger

Answers: b, e, f

How long can open vials of insulin be stored for?

As long as a month

When administering medications to pediatric patients, the nurse understand that the dosage calculations for pediatric patients are different than for adults because pediatric patients a. are more likely to develop edema b. have more stomach acid c. have skin that is less permeable d. have immature liver and kidney function, resulting in impaired drug metabolism and excretion

Correct answer: D Rationale: In pediatric patients, body temperature is less well regulated, and dehydration occurs easily; pediatric patients lack stomach acid to kill bacteria and have skin that is thinner and more permeable. It is true that pediatric patients have immature liver and kidney function, resulting in impaired drug metabolism and excretion.

__________________ is the most common sulfonylurea drug prescribed for type 2 diabetes mellitus.

Glipizide

When mixing NPH with a short-duration insulin, which should be drawn up first?

Short-duration insulin

How are insulin dosage prescribed?

The higher the patient's glucose level, the larger the dose of insulin needed

Which nursing action will increase the absorption of a medication administered intramuscularly (IM)? a. Massage the site after injection. b. Apply ice packs to the injection site. c. Lower the extremity below the level of the heart. d. Administer the medication via the Z-track method.

a. Massage the site after injection.

A drug given by which route is altered by the first-pass effect? a. Oral b. Sublingual c. Intravenous (IV) d. Subcutaneous (subcut)

a. Oral

All insulins can be administered ____________, but ONLY regular insulin can be given _______________.

a. subQ b. intravenously

Sentinel event

an unanticipated event in a health care setting that results in death or serious harm to a patient unrelated to the natural course of patient's illness.

Check blood pressure before giving _____________.

antihypertensive drugs

What are common examples of rapid acting insulin?

aspart (NovaLog) lispro (Humalog) glulisine (Apridra) **Onset= 5-15 minutes

What is the ratio between a drug's therapeutic effects and toxic effects called? a. Affinity b. Tolerance c. Therapeutic index d. Cumulative effect

c. Therapeutic index

Drug half-life is defined as the amount of time required for 50% of a drug to: a. be absorbed by the body. b. exert a response. c. be eliminated by the body. d. reach a therapeutic level.

c. be eliminated by the body

The nurse is reviewing medication orders. Which digoxin dose is written correctly? a. .25 mg b. .250 mg c. 0.250 mg d. 0.25 mg

d. 0.25mg

What is another term for biotransformation of a drug? a. Dilution b. Excretion c. Absorption d. Metabolism

d. Metabolism

Right Evaluation

determines the effectiveness of the drug based on the patient's response to the drug.