Pharm Chapter 35 PDF

Pharm chapter 35 1. Which time will symptoms of hypoglycemia likely occur if a patient received theevening dose of Lispro subcutaneously at 1630 PM? a. 1900 b. 1830 c. 0130 d. 0600 ANS: B The most rapid-acting insulin, Lispro, peaks within 1 to 2 hours after administration. thepeak time of insul...

Pharm chapter 35 1. Which time will symptoms of hypoglycemia likely occur if a patient received theevening dose of Lispro subcutaneously at 1630 PM? a. 1900 b. 1830 c. 0130 d. 0600 ANS: B The most rapid-acting insulin, Lispro, peaks within 1 to 2 hours after administration. thepeak time of insulin is when patients would most likely exhibit symptoms of hypoglycemia, particularly if they have inadequate dietary intake. thetime of 19:00 would be past thepeak of action and after signs of hypoglycemia would have appeared. thetimes of 01:30 and 06:00 are long after thepeak of action and thetime when signs of hypoglycemia would have appeared. 2. It is 2:00 PM and a patient who has been NPO since 12:00 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 thenurse to take? a. Have thepatient eat a snack and drink milk. b. Administer glucagon subcutaneously. c. Call thebronchoscopy room to follow up with thedelay. d. Obtain an A1c test. ANS: B Irritability, nervousness, headache, tremors, dizziness, apprehension, sweating, cold and clammy skin, and hunger are symptoms of hypoglycemia. thepatient has not eaten since theprior day. A blood glucose of 50 mg/dL is true hypoglycemia and needs to be dealt with immediately. Glucagon is preferred over PO intake, given that an endoscopy is scheduled. Having thepatient eat a snack and drink milk, calling thebronchoscopy room, and obtaining an A1c test are not appropriate responses. 3. After a blood glucose reading, it is determined that thepatient should receive 4 units of Lispro and 8 units of NPH. Which action will thenurse take to administer these medications? a. Draw up each insulin in separate syringes and administer two injections. b. Draw up theNPH first and then theLispro using thesame syringe. c. Administer theLispro before themeal and theNPH after themeal. d. Draw up theLispro first and then theNPH using thesame syringe. ANS: D Lispro, an insulin analogue, is themost rapid-acting insulin. Insulin analogues are compatible with intermediate- (NPH) or long-acting insulin. When combining two types of insulin, theshort-acting insulin is drawn up before theintermediate-acting insulin. There is no reason to administer a second injection. thelong-acting insulin is drawn up last when mixing. Insulin is to be administered before meals. 4. A patient with type 2 diabetes mellitus, which was previously controlled with an oral antidiabetic agent, is hospitalized for treatment of a leg ulcer. thehealthcare provider has ordered sliding scale insulin coverage with regular insulin for hyperglycemia. thenurse brings theinjection into theroom, and thepatient becomes upset, stating ―I don‘t want to start taking that drug! I‘ll need it therest of my life.‖ Which response is best? a. ―This is thesame drug as theoral medication you were taking. It‘s a stronger dose while you are in thehospital.‖ b. ―Don‘t worry. You shouldn‘t need this too often. As you feel better, your blood glucose level will drop.‖ c. ―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.‖ d. ―Your disease is progressing and your pancreas is producing less insulin. I know this is a hard time for you. Do you want to talk about it?‖ ANS: C Type 2 diabetes mellitus patients normally controlled with oral hypoglycemics may require insulin during situations of increased physiologic and psychological stress. thestress response stimulates epinephrine and norepinephrine, which raises theblood glucose level. Examples of stressors include pregnancy, surgery, and infections. 5. Which test determines glycemic control over theprevious 8 to 10 weeks? a. 24-hour glucose clearance test (GTT) b. Fructosamine test c. Fasting blood sugar (FBS) d. A1c test ANS: D The A1c test measures thepercentage of hemoglobin that has been irreversibly glycosylated because of high blood sugar levels. This test reflects theaverage blood sugar level attained over thepast 8 to 10 weeks. theGTT is never conducted over an interval this long. thefructosamine test measures theamount of glucose bonded to a protein, fructosamine. This reflects theaverage blood glucose level attained over thepast 1 to 3 weeks. theFBS measures theamount of glucose in theblood before eating. 6. Which time is best for thenurse to administer Lispro? a. After thepatient has started eating b. Within 10 to 15 minutes of eating c. 30 minutes before a meal d. 45 to 60 minutes before a meal ANS: B Insulin analogues, such as Lispro and Aspart, are themost rapid-acting insulins. theonset of these insulins is within 10 minutes of theinjection, they peak within 1 to 2 hours, and their duration is 3 to 5 hours. Patients should be eating their meal within 10 to 15 minutes of theinjection. 7. Which intervention is most important for thesuccessful management of diabetes mellitus? a. A network of community resources b. The level of self-management c. Preventative education d. Frequent follow-up with thehealthcare provider ANS: B Teaching patients to self-manage all aspects of their disease, including treatment modalities and preventing complications, is critical to patient success. Patients must be proficient in theentire therapeutic regimen—diet, activity level, blood or urine testing, medication, self-injection techniques, prevention of complications, and effective management of hypoglycemia or hyperglycemia. No outside source can overcome thefailure of thepatient to participate. Teaching thepatient to prevent complications of his or her disease is important, but patient participation in managing thedisease is crucial. No healthcare provider can overcome thefailure of thepatient to participate. 8. Which laboratory test is thepreferred screening test for diabetes in children and nonpregnant adults? a. FPG b. ECG c. GTT d. A1c ANS: A The fasting plasma glucose (FPG) is thepreferred test used to screen for diabetes in children and nonpregnant adults. Electrocardiograms (ECGs) are used to monitor electrical activity of theheart. theGTT is not recommended for routine clinical use but may be required in theevaluation of patients with impaired fasting glucose or when diabetes is still suspected, despite a normal FPG, as with thepostpartum evaluation of women with gestational diabetes mellitus. theA1c test is used to monitor diabetes management over 90-day intervals, thelife of a red blood cell. 9. Which response by thenurse is correct when a patient asks thenurse how sulfonylureas normalize glucose levels? a. Stimulates pancreatic secretion of insulin b. Inhibits secretion of insulin by thepancreas c. Increases glucose production in theliver d. Increases insulin metabolism in theliver ANS: A Sulfonylureas stimulate thepancreas to secrete more insulin. They also diminish glucose production and metabolism of insulin by theliver. thenet effect is a normalization of insulin and glucose levels. Sulfonylureas decrease glucose production and hepatic metabolism of insulin. 10. Which statement by thepatient indicates a need for further teaching about insulin administration? a. ―I may need more insulin if I have surgery.‖ b. ―Once I open my insulin, I will store it in therefrigerator.‖ c. ―I will date theinsulin bottle when I open it.‖ d. ―I will keep a spare bottle of insulin on hand.‖ ANS: B Once insulin is opened and being used, it can be stored at room temperature for up to 1 month. thepatient may need more insulin if undergoing surgery, should date theinsulin bottle after opening, and should keep a spare bottle of insulin on hand. 11. Which instruction by thenurse is accurate to include when providing teaching to a patient recently diagnosed with diabetes who has been prescribed insulin? a. Beta blockers can mask symptoms of hypoglycemia. b. Lipodystrophy increases theabsorption of insulin. c. Infection will decrease theneed for insulin. d. Excessive exercise will increase theneed for insulin. ANS: A Beta-adrenergic blocking agents (e.g., propranolol, timolol, nadolol, pindolol) may mask many symptoms of hypoglycemia. Lipodystrophy does not increase theabsorption of insulin. Infection does not decrease theneed for insulin. Excessive exercise does not increase theneed for insulin. 12. Which instruction is most important for thenurse to teach a patient with diabetes who is receiving metformin? a. Take themedication before meals. b. This medication will cause thepancreas to secrete more insulin. c. Stop taking thedrug 24 to 48 hours prior to radiopaque dye procedures. d. There may be an increase in thetriglyceride level. ANS: C Radiopaque dyes often induce temporary renal insufficiency, so metformin should be discontinued 24 to 48 hours before procedures in which radiopaque dye will be administered. Metformin is not administered before meals. thepancreas does not secrete more insulin as a result of taking this medication. Metformin does not increase triglyceride levels. 13. The nurse is caring for a patient with a new diagnosis of type 1 diabetes mellitus. Which goal set by thepatient will require revision? a. Patient will participate in 20 minutes of cardiovascular exercise 5 days a week. b. Patient will discontinue insulin use within 1 year. c. Patient will consume 20% of caloric intake from fat. d. Patient will demonstrate accurate self-glucose testing skills. ANS: B Type 1 diabetes mellitus requires theadministration of insulin injections to replace theinsulin that thebody is no longer able to make. Participation in a regular exercise program is a realistic goal. A diabetic diet includes 20% to 35% of calories from fat. A person diagnosed with diabetes should be able to perform glucose testing. 14. The nurse is administering sulfonylurea drugs to four different patients diagnosed with type 2 diabetes. Which patient should not receive themedication as ordered? a. A 42-year-old man with hypertension b. A 50-year-old woman with shingles c. An 80-year-old woman with an allergy to sulfa d. A 37-year-old man with a blood glucose level of 140 ANS: C In general, sulfonylureas should not be administered to patients who are allergic to sulfonamides. These patients may also be allergic to sulfonylureas. There is no contraindication for administering sulfonylurea drugs to a 42-year-old man with hypertension, a 50-year-old woman with shingles, or a 37-year-old man with a blood glucose level of 140. Multiple responses 1. A third subclass of diabetes mellitus includes additional types of diabetes that are part of other diseases having features not generally associated with thediabetic state. Which disorder(s) may have an associated diabetic component? (Select all that apply.) a. Patients receiving high-dose corticosteroid therapy for disease maintenance b. Cushing‘s syndrome c. Alzheimer‘s disease d. Acromegaly e. Malnutrition ANS: A, B, D, E Drugs and chemicals that induce hyperglycemia are included in thethird subclass of diabetes mellitus. Cushing‘s syndrome, acromegaly, and malnutrition are included in thethird subclass of diabetes mellitus. Alzheimer‘s disease is not included in thethird subclass of diabetes mellitus. 2. 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.) a. Impotence b. Increased thirst over thepast week c. A 10-lb weight loss within thepast month d. Polyphagia e. Ketoacidosis ANS: B, C, D, E Diabetes type 2 symptoms are insidious and patients present when symptoms may have been apparent for a prolonged time. Polydipsia, a 10-lb weight loss over this short period (1 month), polyphagia, and ketoacidosis are associated with type 1 diabetes. Onset of diabetes type 2 symptoms is usually in thefourth decade of life. Impotence is a symptom associated with type 2 diabetes mellitus. 3. Which dietary control measures are used in themanagement of diabetes mellitus? (Select all that apply.) a. Specific daily caloric requirements b. Consistent carbohydrate diabetes meal plan c. 50% intake of carbohydrates daily d. Adjustments to daily meals according to age, metabolic stress, pregnancy, and advanced age and/or older adults e. 20% intake of proteins daily ANS: B, C, D, E Meal planning systems are used with thediabetic patient. theconsistent carbohydrate diabetes meal plan is used, with an emphasis on consistency of timing of meals and snacks. Daily meals and snacks provide 1500 to 2000 calories, with 50% of thecalories from carbohydrates, 20% from protein, and 30% from fat. Individualized adjustments may be required with children, adolescents, metabolically stressed patients, pregnant women, and geriatric patients. Specific daily caloric requirement is not a primary consideration in calculating calorie requirements for a diabetic patient. 4. Which statement(s) regarding type 2 diabetes mellitus would be correct? (Select all that apply.) a. Type 2 diabetes is more prevalent in overweight people older than 45 years. b. A genetic predisposition exists for thedevelopment of type 2 diabetes mellitus. c. Type 2 diabetes requires lifelong insulin replacement. d. Type 2 diabetes is often diagnosed after complications have resulted. e. Women have a higher incidence of type 2 diabetes. ANS: A, B, D, E Contributing factors to thedevelopment of type 2 diabetes mellitus include being older than 45 years, being overweight, and having a family predisposition to thedisease. theearly symptoms of this type of diabetes are minimal; therefore, many patients do not seek medical assistance until thecomplications have appeared. Contributing factors to thedevelopment of type 2 diabetes mellitus include being female. In type 2 diabetes mellitus, thepancreas continues to secrete insulin. Patients may be diet controlled or regulated with oral hypoglycemics. Insulin is only used if theother treatments are not effective 4. Which statement(s) regarding type 2 diabetes mellitus would be correct? (Select all that apply.) a. Type 2 diabetes is more prevalent in overweight people older than 45 years. b. A genetic predisposition exists for thedevelopment of type 2 diabetes mellitus. c. Type 2 diabetes requires lifelong insulin replacement. d. Type 2 diabetes is often diagnosed after complications have resulted. e. Women have a higher incidence of type 2 diabetes. ANS: A, B, D, E Contributing factors to thedevelopment of type 2 diabetes mellitus include being older than 45 years, being overweight, and having a family predisposition to thedisease. theearly symptoms of this type of diabetes are minimal; therefore, many patients do not seek medical assistance until thecomplications have appeared. Contributing factors to thedevelopment of type 2 diabetes mellitus include being female. In type 2 diabetes mellitus, thepancreas continues to secrete insulin. Patients may be diet controlled or regulated with oral hypoglycemics. Insulin is only used if theother treatments are not effective 5. Which statement(s) regarding gestational diabetes would be true? (Select all that apply.) a. It is diagnosed in about 2% of all pregnancies in theUnited States. b. It includes diabetic women who become pregnant. c. Fetal development may be complicated as a result of gestational diabetes. d. The risk of developing diabetes after pregnancy is increased. e. Most women with gestational diabetes have normal glucose tolerance postpartum. f. Women need to be reevaluated postpartum to determine their classification with respect to glucose tolerance. ANS: C, D, E, F Gestational diabetic individuals are put into a separate category because of thespecial clinical features of diabetes that develop during pregnancy and thecomplications associated with fetal involvement. These women are also at a greater risk of developing diabetes 5 to 10 years after pregnancy. themajority of individuals with gestational diabetes have normal glucose tolerance postpartum. Gestational diabetes patients must be reclassified 6 weeks after delivery into one of thefollowing categories: diabetes mellitus, impaired fasting glucose, impaired glucose tolerance, or normoglycemia. Gestational diabetes is diagnosed in about 4% of all pregnancies in theUnited States. Gestational diabetes does not include diabetic women who become pregnant. 6. Which information will be provided regarding thetiming of testing when educating a patient with diabetes mellitus regarding urine testing for ketones? (Select all that apply.) a. When illness occurs b. During pregnancy c. Before and after physical exercise d. e. Every morning upon awakening ANS: A, B, D Ketone testing should be done when illness occurs, during pregnancy, and whenever blood glucose is elevated above theindividual‘s usual range. It is not necessary to test urine for ketones before and after physical exercise or every morning upon awakening.