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Pharmacology Connections to Nursing 3rd Edition Adams Urban Test Bank

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Pharmacology Connections to Nursing 3rd Edition Adams Urban Test Bank

ISBN-13: 978-0133923612

ISBN-10: 0133923614

 

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Pharmacology Connections to Nursing 3rd Edition Adams Urban Test Bank

ISBN-13: 978-0133923612

ISBN-10: 0133923614

 

 

 

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Adams and Urban, Pharmacology: Connections to Nursing Practice, 3e Test Bank

Chapter 66

Question 1

Type: MCSA

Which body tissue or organ cannot synthesize glucose for its energy supply?

  1. The kidneys
  2. The lungs
  3. The heart
  4. The brain

Correct Answer: 4

Rationale 1: Most body tissues, such as the kidneys, can use fatty acids and protein for energy, if necessary.

Rationale 2: Most body tissues, such as the lungs, can use fatty acids and protein for energy, if necessary.

Rationale 3: Most body tissues, such as the heart, can use fatty acids and protein for energy, if necessary.

Rationale 4: Most body tissues can use fatty acids and protein for energy, if necessary. The brain cannot because it is unable to synthesize glucose, and it exhausts its supply after just a few minutes of activity.

Global Rationale: Most body tissues, such as those in the kidneys, lungs and heart, can use fatty acids and protein for energy, if necessary. The brain cannot because it is unable to synthesize glucose, and it exhausts its supply after just a few minutes of activity.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and principles

AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1. Explain how blood glucose levels are maintained within narrow limits by insulin and glucagon.

MNL Competencies: 9.1.1 Examine etiology, pathophysiology, and clinical manifestations.

Page Number:

 

Question 2

Type: MCSA

Even though the normal range for serum glucose is 60–100 mg/dL, the body usually tightly regulates this level to:

  1. 90–100 mg/dL.
  2. 80–90 mg/dL.
  3. 60–70 mg/dL.
  4. 70–80 mg/dL.

Correct Answer: 2

Rationale 1: The body does not regulate blood glucose at this level.

Rationale 2: The body attempts to maintain tight glucose control between 80 and 90 mg/dL to prevent complications associated with hypo- or hyperglycemic states.

Rationale 3: The body does not regulate blood glucose at this level.

Rationale 4: The body does not regulate blood glucose at this level.

Global Rationale: The body attempts to maintain tight glucose control between 80 and 90 mg/dL to prevent complications associated with hypo- or hyperglycemic states.

 

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and principles

AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1. Explain how blood glucose levels are maintained within narrow limits by insulin and glucagon.

MNL Competencies: 9.1.1 Examine etiology, pathophysiology, and clinical manifestations.

Page Number:

 

Question 3

Type: MCSA

When instructing a client with diabetes about glucose balance, the nurse explains that following a meal, glucose that is not needed for immediate energy needs is stored as:

  1. muscle tissue.
  2. glycogen.
  3. fat.
  4. glucagon.

Correct Answer: 2

Rationale 1: Glucose that is not needed for immediate energy needs is not stored as muscle tissue.

Rationale 2: The storage form of glucose is called glycogen.

Rationale 3: Glucose that is not needed for immediate energy needs is not stored as fat.

Rationale 4: Glucose that is not needed for immediate energy needs is not stored as glucagon.

Global Rationale: The storage form of glucose is called glycogen. This glucose is not stored as muscle tissue, fat, or glucagon.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and principles

AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1. Explain how blood glucose levels are maintained within narrow limits by insulin and glucagon.

MNL Competencies: 9.1.1 Examine etiology, pathophysiology, and clinical manifestations.

Page Number:

 

Question 4

Type: MCSA

When caring for a client with diabetes, the nurse knows that the client is experiencing a breakdown of fatty acids for fuel because of which serum laboratory finding?

  1. Leukocytes
  2. Protein
  3. Glucose
  4. Ketones

Correct Answer: 4

Rationale 1: Leukocytes are not associated with the breakdown of fatty acids for fuel.

Rationale 2: Protein in the blood does not occur because fatty acids are being broken down for fuel.

Rationale 3: Glucose in the blood does not occur because fatty acids are being broken down for fuel.

Rationale 4: When the body must metabolize fatty acids for fuel, ketones accumulate in the blood.

Global Rationale: When the body must metabolize fatty acids for fuel, ketones accumulate in the blood. Leukocytes, protein in the blood, and glucose in the blood do not occur because fatty acids are being used for fuel.

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and principles

AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2. Compare and contrast the etiology and pathogenesis of type 1, type 2, and gestational diabetes.

MNL Competencies: 9.1.1 Examine etiology, pathophysiology, and clinical manifestations.

Page Number:

 

Question 5

Type: MCSA

When instructing a client, the nurse explains that the primary factor contributing to the development of type 2 diabetes is:

  1. age.
  2. ethnicity.
  3. a sedentary lifestyle.
  4. obesity.

Correct Answer: 4

Rationale 1: Although age plays a role in the development of type 2 diabetes, another factor plays a greater role.

Rationale 2: Although ethnicity is a factor in the development of type 2 diabetes, another factor plays a greater role.

Rationale 3: Although a sedentary lifestyle plays a factor in the development of type 2 diabetes, another factor plays a greater role.

Rationale 4: Eighty percent of persons with type 2 diabetes are overweight.

Global Rationale: Eighty percent of persons with type 2 diabetes are overweight. Age, ethnicity, and sedentary lifestyles play as factors in the development of type 2 diabetes but are not as significant a risk as obesity.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and principles

AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2. Compare and contrast the etiology and pathogenesis of type 1, type 2, and gestational diabetes.

MNL Competencies: 9.1.1 Examine etiology, pathophysiology, and clinical manifestations.

Page Number:

 

Question 6

Type: MCMA

What will the nurse describe to a client as risk factors for developing type 2 diabetes?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Ethnicity
  2. Age below 45
  3. Obesity
  4. Race
  5. Family history

Correct Answer: 1,3,4,5

Rationale 1: Ethnicity is a risk factor for the development of type 2 diabetes.

Rationale 2: Age above, not below, 45 years is a risk factor for the development of type 2 diabetes.

Rationale 3: Obesity is a risk factor for the development of type 2 diabetes.

Rationale 4: Race is a risk factor for the development of type 2 diabetes.

Rationale 5: Family history is a risk factor for the development of type 2 diabetes.

Global Rationale: Risk factors for the development of type 2 diabetes include ethnicity, obesity, race, and family history. Age above 45 is also a risk factor.

 

Cognitive Level: Remembering

Client Need: Health Promotion and Maintenance

Client Need Sub:

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and principles

AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research

NLN Competencies: Context and Environment: Apply health-promotion/disease prevention strategies; apply health policy

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2. Compare and contrast the etiology and pathogenesis of type 1, type 2, and gestational diabetes.

MNL Competencies: 9.1.1 Examine etiology, pathophysiology, and clinical manifestations.

Page Number:

 

Question 7

Type: MCSA

A client with diabetes is experiencing polyuria. The nurse explains that polyuria is caused by:

  1. inflammation of the glomerulus.
  2. excessive fluid intake.
  3. lack of albumin.
  4. osmotic diuresis.

Correct Answer: 4

Rationale 1: Inflammation of the glomerulus does not lead to polyuria.

Rationale 2: Excessive fluid intake does not lead to polyuria.

Rationale 3: Lack of albumin does not lead to polyuria.

Rationale 4: Osmotic diuresis leads to polyuria, which is the passage of large amounts of urine as a result of increased osmotic pressure that can result from hyperglycemia.

Global Rationale: Osmotic diuresis leads to polyuria, which is the passage of large amounts of urine as a result of increased osmotic pressure that can result from hyperglycemia. Polyuria is not related to inflammation of the glomerulus, excessive fluid intake, or lack of albumin.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and principles

AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3. Describe the signs and diagnosis of diabetes.

MNL Competencies: 9.1.1 Examine etiology, pathophysiology, and clinical manifestations.

Page Number:

 

Question 8

Type: MCSA

A client is scheduled for a hemoglobin A1c laboratory test. The nurse explains to the client that this test monitors:

  1. the percentage of glucagon in the blood.
  2. the level of hemoglobin over time.
  3. the percentage of glucose present in the blood.
  4. the level of glucose over time.

Correct Answer: 4

Rationale 1: This test does not measure the percentage of glucagon in the blood.

Rationale 2: This test does not measure the percentage of hemoglobin over time.

Rationale 3: This test does not measure the percentage of glucose in the blood.

Rationale 4: Hemoglobin A1c measures the level of blood glucose over time because glucose molecules attach to the hemoglobin molecule for the life of the RBC, which is 120 days.

Global Rationale: Hemoglobin A1c measures the level of blood glucose over time because glucose molecules attach to the hemoglobin molecule for the life of the RBC, which is 120 days. This is not a test of the percentages of glucagon, hemoglobin, or glucose in the blood.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and principles

AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 3. Describe the signs and diagnosis of diabetes.

MNL Competencies: 9.1.1 Examine etiology, pathophysiology, and clinical manifestations.

Page Number:

 

Question 9

Type: MCSA

A client is acutely confused, sweating, and complaining of a headache. The nurse suspects hypoglycemia. The nurse’s next action is to obtain:

  1. a serum blood glucose.
  2. a glucose tolerance test.
  3. serum electrolytes.
  4. a capillary blood glucose level.

Correct Answer: 4

Rationale 1: A serum blood glucose test would not provide the immediate information needed to correct the hypoglycemia.

Rationale 2: A glucose tolerance test measures glucose levels after 2 hours; it would not provide the immediate information needed to correct the hypoglycemia.

Rationale 3: Serum electrolytes will not provide the level of blood sugar needed to intervene with hypoglycemia.

Rationale 4: Obtaining a finger-stick blood sugar takes 15 seconds and provides an opportunity for rapid nursing intervention, if needed.

Global Rationale: Obtaining a finger-stick blood sugar takes 15 seconds and provides an opportunity for rapid nursing intervention, if needed. A serum blood glucose test would not provide the immediate information needed to correct the hypoglycemia. A glucose tolerance test measures glucose levels after 2 hours; it would not provide the immediate information needed to correct the hypoglycemia. Serum electrolytes will not provide the level of blood sugar needed to intervene with hypoglycemia.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

QSEN Competencies: III.A.2 Describe EBP to include the components of research evidence, clinical expertise and patient/family values

AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care

NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4. Describe the acute complications of diabetes.

MNL Competencies: 9.1.1 Examine etiology, pathophysiology, and clinical manifestations.

Page Number:

 

Question 10

Type: MCSA

Which drug would alter a client’s ability to recognize the symptoms of hypoglycemia?

  1. beta blockers
  2. antibiotics
  3. diuretics
  4. oral hypoglycemic agents

Correct Answer: 1

Rationale 1: Beta blockers interfere with the symptoms of hypoglycemia, making it more difficult for the client to recognize symptoms.

Rationale 2: Antibiotics do not interfere with the symptoms of hypoglycemia.

Rationale 3: Diuretics do not interfere with the symptoms of hypoglycemia.

Rationale 4: Oral hypoglycemic agents do not interfere with the symptoms of hypoglycemia.

Global Rationale: Beta blockers interfere with the symptoms of hypoglycemia, making it more difficult for the client to recognize symptoms. Antibiotics, diuretics, and oral hypoglycemic agents do not have this adverse effect.

 

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: III.A.2 Describe EBP to include the components of research evidence, clinical expertise and patient/family values

AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4. Describe the acute complications of diabetes.

MNL Competencies: 9.1.2 Compare the classes of medications used in pharmacologic management.

Page Number:

 

Question 11

Type: MCSA

The nurse explains that the difference between diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) is that clients with HHS:

  1. do not manifest ketoacidosis.
  2. are dehydrated.
  3. are confused.
  4. have elevated glucose levels.

Correct Answer: 1

Rationale 1: Clients with HHS do not experience ketoacidosis.

Rationale 2: Dehydration is a symptom of both disorders.

Rationale 3: Confusion is a symptom of both disorders.

Rationale 4: Elevated glucose levels are seen in both disorders.

Global Rationale: Clients with HHS do not experience ketoacidosis. Dehydration, confusion, and elevated glucose levels are seen in both disorders.

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

QSEN Competencies: III.A.2 Describe EBP to include the components of research evidence, clinical expertise and patient/family values

AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4. Describe the acute complications of diabetes.

MNL Competencies: 9.1.1 Examine etiology, pathophysiology, and clinical manifestations.

Page Number:

 

Question 12

Type: MCSA

The nurse, instructing a group of community members on chronic health problems, explains that the leading cause of blindness in the United States is:

  1. glaucoma.
  2. cataracts.
  3. hypertension.
  4. diabetic retinopathy.

Correct Answer: 4

Rationale 1: Glaucoma is not the leading cause of blindness in the United States.

Rationale 2: Cataracts are not the leading cause of blindness in the United States.

Rationale 3: Hypertension is not the leading cause of blindness in the United States.

Rationale 4: The leading cause of blindness in the United States is retinopathy due to microvascular changes associated with the hyperglycemic states of diabetes.

Global Rationale: The leading cause of blindness in the United States is retinopathy due to microvascular changes associated with the hyperglycemic states of diabetes. Blindness from this cause exceeds rates of blindness from glaucoma, cataracts, and hypertension.

 

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

QSEN Competencies: III.A.2 Describe EBP to include the components of research evidence, clinical expertise and patient/family values

AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care

NLN Competencies: Context and Environment: Apply health-promotion/disease prevention strategies; apply health policy

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5. Identify the chronic complications of diabetes.

MNL Competencies: 9.1.1 Examine etiology, pathophysiology, and clinical manifestations.

Page Number:

 

Question 13

Type: MCMA

What should the nurse instruct a client who is diagnosed with diabetes?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Have eye examinations every 2 to 3 years.
  2. Monitor blood pressure carefully.
  3. Check feet daily for signs of irritation.
  4. Maintain glucose control.
  5. Quit smoking.

Correct Answer: 2,3,4,5

Rationale 1: The client with diabetes should have annual eye examinations, not every 2 to 3 years. Getting annual eye exams is an important teaching point to facilitate early diagnosis of any microvascular changes in the eyes.

Rationale 2: Monitoring blood pressure carefully is an important teaching point to aid recognition of hypertensive changes associated with diabetes.

Rationale 3: Checking the feet for signs of skin breakdown is an important teaching point because, due to peripheral neuropathy, the client might not sense small changes in skin integrity in the feet.

Rationale 4: Maintaining glucose control is an important teaching point because tight glucose control helps prevent the complications of diabetes.

Rationale 5: Quitting smoking in an important teaching point because nicotine is a vasoconstrictor, and clients with diabetes are at greater risk for microvascular changes.

Global Rationale: Monitoring blood pressure carefully is an important teaching point to aid recognition of hypertensive changes associated with diabetes. Checking the feet for signs of skin breakdown is an important teaching point because, due to peripheral neuropathy, the client might not sense small changes in skin integrity in the feet. Maintaining glucose control is an important teaching point because tight glucose control helps prevent the complications of diabetes. Quitting smoking in an important teaching point because nicotine is a vasoconstrictor, and clients with diabetes are at greater risk for microvascular changes. The client with diabetes should have annual eye examinations, not every 2 to 3 years. Getting annual eye exams is an important teaching point to facilitate early diagnosis of any microvascular changes in the eyes.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

QSEN Competencies: III.A.2 Describe EBP to include the components of research evidence, clinical expertise and patient/family values

AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care

NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5. Identify the chronic complications of diabetes.

MNL Competencies: 9.1.1 Examine etiology, pathophysiology, and clinical manifestations.

Page Number:

 

Question 14

Type: MCSA

The nurse, preparing medications for a client with diabetes, recognizes that what percentage of adults with diabetes take oral agents only?

  1. 60–70%
  2. 30–40%
  3. 50–60%
  4. 40–50%

Correct Answer: 3

Rationale 1: Not this many adults take oral agents only.

Rationale 2: More than 30–40% of adults take oral agents only.

Rationale 3: 58% of adults with diabetes take oral agents only.

Rationale 4: More than 40–50% of adults take oral agents only.

Global Rationale: 58% of adults with diabetes take oral agents only.

 

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and principles

AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research

NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 6. Compare and contrast the pharmacotherapy of the different types of diabetes.

MNL Competencies: 9.1.2 Compare the classes of medications used in pharmacologic management.

Page Number:

 

Question 15

Type: MCSA

A client is prescribed the insulin with the least rapid onset. Which insulin will the nurse administer to this client?

  1. Glulisine
  2. Regular
  3. Aspart
  4. Lispro

Correct Answer: 2

Rationale 1: The onset of glulisine is around 15 minutes.

Rationale 2: The onset of regular insulin is 30–60 minutes.

Rationale 3: The onset of aspart is is around 15 minutes.

Rationale 4: The onset of lispro is around 15 minutes.

Global Rationale: The onset of regular insulin is 30–60 minutes. The remaining forms of insulin may act is as little as 5 minutes up to 30 minutes. Most are around 10-15 minutes.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and principles

AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings

NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 7. For each type of insulin, identify the onset of action, peak action and duration of actions, administrations routes, when it is given related to meals, compatibility with other insulins and adverse effects.

MNL Competencies: 9.1.2 Compare the classes of medications used in pharmacologic management.

Page Number:

 

Question 16

Type: MCSA

A client is prescribed insulin via the intravenous (IV) route. Which insulin will the nurse administer to this client?

  1. Glulisine
  2. Regular
  3. Aspart
  4. Lispro

Correct Answer: 2

Rationale 1: Glulisine cannot be administered through the intravenous route.

Rationale 2: Only regular insulin can be administered through the intravenous route.

Rationale 3: Aspart cannot be administered through the intravenous route.

Rationale 4: Lispro cannot be administered through the intravenous route.

Global Rationale: Only regular insulin can be administered through the intravenous route. The remaining types are given subcutaneously.

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and principles

AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings

NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 7. For each type of insulin, identify the onset of action, peak action and duration of actions, administrations routes, when it is given related to meals, compatibility with other insulins and adverse effects

MNL Competencies: 9.1.3 Apply the nursing process to the administration of insulin and oral hypoglycemic agents.

Page Number:

 

Question 17

Type: MCSA

The nurse is instructing a client on the effects of insulin. What will the nurse include as the primary adverse effect?

  1. Somogyi phenomenon
  2. Swollen lymph glands
  3. Hypoglycemia
  4. Urticaria

Correct Answer: 3

Rationale 1: Somogyi phenomenon, a rapid decrease in blood glucose, is not the primary adverse effect.

Rationale 2: Swollen lymph glands can occur but are not the primary adverse effect of insulin.

Rationale 3: The primary adverse effect of insulin is hypoglycemia.

Rationale 4: Urticaria—itching hives—can occur but is not the primary adverse effect of insulin.

Global Rationale: The primary adverse effect of insulin is hypoglycemia. The remaining effects can occur but are not common or the primary adverse effect.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and principles

AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings

NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 7. For each type of insulin, identify the onset of action, peak action and duration of actions, administrations routes, when it is given related to meals, compatibility with other insulins and adverse effects

MNL Competencies: 9.1.4 Explore the nurse’s role in client education related to pharmacotherapy.

Page Number:

 

Question 18

Type: MCSA

When teaching a client about a prescribed second-generation sulfonylurea for blood glucose control, the nurse explains that the advantage of this medication is that it:

  1. exhibits fewer drug–drug interactions.
  2. does not cause hypoglycemia.
  3. can be administered in smaller doses.
  4. causes fewer adverse effects.

Correct Answer: 1

Rationale 1: The advantage of second-generation sulfonylureas is that they exhibit fewer drug–drug interactions.

Rationale 2: Second-generation sulfonylureas cause hypoglycemia.

Rationale 3: Smaller doses are not an advantage of second-generation sulfonylureas.

Rationale 4: Second-generation sulfonylureas do not cause fewer adverse effects.

Global Rationale: The advantage of second-generation sulfonylureas is that they exhibit fewer drug–drug interactions. They can still cause hypoglycemia, do not require smaller doses, and do not have fewer adverse effects.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: V.A.4 Delineate general categories of errors and hazards of care

AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings

NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 8. For each of the classes shown in the chapter outline identify the prototype and representative drugs and explain the mechanisms of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

MNL Competencies: 9.1.4 Explore the nurse’s role in client education related to pharmacotherapy.

Page Number:

 

Question 19

Type: MCSA

The nurse should instruct a client to avoid which substance while taking a sulfonylurea medication?

  1. Antacids
  2. Calcium products
  3. Alcohol
  4. Antibiotics

Correct Answer: 3

Rationale 1: Antacids do not need to be avoided when taking a sulfonylurea medication.

Rationale 2: Calcium products do not need to be avoided when taking a sulfonylurea medication.

Rationale 3: When administered with alcohol, sulfonylureas can cause a disulfiram-like reaction with flushing, palpations, and nausea.

Rationale 4: Antibiotics do not need to be avoided when taking a sulfonylurea medication.

Global Rationale: When administered with alcohol, sulfonylureas can cause a disulfiram-like reaction with flushing, palpations, and nausea. Antacids, calcium products, and antibiotics do not have to be avoided when taking sulfonylurea medications.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: V.A.4 Delineate general categories of errors and hazards of care

AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings

NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 8. For each of the classes shown in the chapter outline identify the prototype and representative drugs and explain the mechanisms of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

MNL Competencies: 9.1.4 Explore the nurse’s role in client education related to pharmacotherapy.

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Question 20

Type: MCSA

Prior to administering glyburide, the nurse will review a client’s allergies because this medication is contraindicated in clients who are allergic to:

  1. urea.
  2. milk products.
  3. eggs.
  4. sulfa drugs.

Correct Answer: 4

Rationale 1: Glyburide is not contraindicated in those who are allergic to urea.

Rationale 2: Glyburide is not contraindicated in those who are allergic to milk products.

Rationale 3: Glyburide is not contraindicated in those who are allergic to eggs.

Rationale 4: Glyburide is a sulfonylurea and is contraindicated in clients with a known sensitivity to sulfa drugs.

Global Rationale: Glyburide is a sulfonylurea and is contraindicated in clients with a known sensitivity to sulfa drugs. It is not contradicted in those with allergies to urea, milk products, or eggs.

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

QSEN Competencies: V.A.4 Delineate general categories of errors and hazards of care

AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings

NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 8. For each of the classes shown in the chapter outline identify the prototype and representative drugs and explain the mechanisms of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

MNL Competencies: 9.1.3 Apply the nursing process to the administration of insulin and oral hypoglycemic agents.

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Question 21

Type: MCSA

The nurse knows that the prescribed dose of insulin should not be administered in to a client whose blood glucose is lower than:

  1. 70 mg/dL.
  2. 80 mg/dL.
  3. 90 mg/dL.
  4. 100 mg/dL.

Correct Answer: 1

Rationale 1: The nurse should not administer insulin if blood glucose levels are lower than 70 mg/dL.

Rationale 2: The insulin can be administered if the blood glucose level is 80 mg/dL.

Rationale 3: The insulin can be administered if the blood glucose level is 90 mg/dL.

Rationale 4: The insulin can be administered if the blood glucose level is 100 mg/dL.

Global Rationale: The nurse should not administer insulin if blood glucose levels are lower than 70 mg/dL. Insulin can be administered at the remaining levels, but close observation of the patient may be necessary especially at the lower ends of the measurements.

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience

AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings

NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 9. Apply the nursing process to the care of patients receiving pharmacotherapy for diabetes.

MNL Competencies: 9.1.3 Apply the nursing process to the administration of insulin and oral hypoglycemic agents.

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Question 22

Type: MCSA

When administering insulin to a client, the nurse will rotate injection sites primarily to prevent:

  1. systemic absorption of insulin.
  2. lipodystrophy.
  3. abscess development.
  4. ineffective dosing.

Correct Answer: 2

Rationale 1: Insulin rotation would not prevent systemic absorption.

Rationale 2: Rotation of insulin sites helps to prevent lipodystrophy.

Rationale 3: Rotation of sites could help prevent abscess development, but primary reason.

Rationale 4: Insulin site rotation does not prevent ineffective dosing.

Global Rationale: Rotation of insulin sites helps to prevent lipodystrophy. This technique may help prevent abscess development, but primary rationale for its use. It will not prevent systemic absorption or ineffective dosing.

 

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience

AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings

NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 9. Apply the nursing process to the care of patients receiving pharmacotherapy for diabetes.

MNL Competencies: 9.1.3 Apply the nursing process to the administration of insulin and oral hypoglycemic agents.

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Question 23

Type: MCMA

What should the nurse include when teaching a client about insulin?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Rotate injection sites.
  2. Recognize the signs of hypoglycemia.
  3. Store insulin in the freezer.
  4. Carry a readily available supply of sugar.
  5. Wear a medic alert bracelet that explains the client has diabetes.

Correct Answer: 1,2,4,5

Rationale 1: Injection sites should be rotated to prevent lipodystrophy.

Rationale 2: Clients should understand the symptoms of hypoglycemia.

Rationale 3: Insulin should be stored at room temperature, not in the freezer.

Rationale 4: Diabetics should carry a readily available source of sugar.

Rationale 5: Clients should wear a medic alert bracelet identifying them as diabetics.

Global Rationale: Teaching should include rotating injections sites, recognizing signs of hypoglycemia, carrying a readily available source of sugar, and wearing a medical alert bracelet. Insulin should not be stored in the freezer.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience

AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings

NLN Competencies: Context and Environment: Apply health-promotion/disease prevention strategies; apply health policy

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 9. Apply the nursing process to the care of patients receiving pharmacotherapy for diabetes.

MNL Competencies: 9.1.4 Explore the nurse’s role in client education related to pharmacotherapy.

Page Number:

 

Question 24

Type: MCMA

The nurse is instructing a client on the role of the pancreas in controlling blood glucose levels. When does the pancreas excrete glucagon to maintain an adequate amount of glucose in the blood?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. During periods of fasting
  2. During exercise
  3. When drinking alcohol
  4. After eating a large meal
  5. When fighting an infection

Correct Answer: 1,2,3

Rationale 1: Glucagon is released from the pancreas during periods of fasting.

Rationale 2: Glucagon is released from the pancreas during exercise.

Rationale 3: Glucagon is released from the pancreas when alcohol is consumed.

Rationale 4: Glucagon is not released from the pancreas after a large meal.

Rationale 5: Glucagon is not released from the pancreas when the body is fighting an infection.

Global Rationale: Glucagon is released from the pancreas during periods of fasting, exercise, and when alcohol is consumed. It is not released in response to eating a large meal or when fighting an infection.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and principles

AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1. Explain how blood glucose levels are maintained within narrow limits by insulin and glucagon.

MNL Competencies: 9.1.1 Examine etiology, pathophysiology, and clinical manifestations.

Page Number:

 

Question 25

Type: MCMA

Which client statements indicate to the nurse that instruction about type 2 diabetes mellitus and insulin resistance has been effective?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. “Exercise will improve insulin resistance.”
  2. “Eating a healthy diet will reverse insulin resistance.”
  3. “Exercise will cure type 2 diabetes mellitus.”
  4. “Eating a healthy diet will cure type 2 diabetes mellitus.”
  5. “I can eat anything I want as long as I exercise afterwards.”

Correct Answer: 1,2

Rationale 1: The activity of insulin receptors can be increased by exercise.

Rationale 2: Adhering to a healthy diet has been shown to reverse insulin resistance.

Rationale 3: Exercise will not cure type 2 diabetes mellitus.

Rationale 4: Eating a healthy diet will not cure type 2 diabetes mellitus.

Rationale 5: The client with type 2 diabetes mellitus should not be instructed to eat anything that is desired as long as exercise is done afterwards.

Global Rationale: The activity of insulin receptors can be increased by exercise and eating a healthy diet has been shown to reverse insulin resistance. There is no cure for type 2 diabetes mellitus. The client with type 2 diabetes mellitus should not be instructed to eat anything that is desired as long as exercise is done afterwards.

 

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and principles

AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research

NLN Competencies: Context and Environment: Apply health-promotion/disease prevention strategies; apply health policy

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 2. Compare and contrast the etiology and pathogenesis of type 1, type 2, and gestational diabetes.

MNL Competencies: 9.1.4 Explore the nurse’s role in client education related to pharmacotherapy.

Page Number:

 

Question 26

Type: MCMA

The nurse is concerned that a client is at risk for developing gestational diabetes after collecting which assessment data?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Family history
  2. Obesity
  3. Previous spontaneous abortion
  4. Sedentary lifestyle
  5. Diagnosis of hypertension

Correct Answer: 1,2,3

Rationale 1: A family history of diabetes increases the client’s risk of developing gestational diabetes.

Rationale 2: Obesity increases the client’s risk of developing gestational diabetes.

Rationale 3: A previous spontaneous abortion increases the client’s risk of developing gestational diabetes.

Rationale 4: A sedentary lifestyle is not a risk factor for the development of gestational diabetes.

Rationale 5: A diagnosis of hypertension is not a risk factor for the development of gestational diabetes.

Global Rationale: Family history of diabetes, obesity, and previous spontaneous abortion increase the risk of a client developing gestational diabetes. Sedentary lifestyle and hypertension do not directly increase risk.

 

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and principles

AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research

NLN Competencies: Context and Environment: Apply health-promotion/disease prevention strategies; apply health policy

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2. Compare and contrast the etiology and pathogenesis of type 1, type 2, and gestational diabetes.

MNL Competencies: 9.1.1 Examine etiology, pathophysiology, and clinical manifestations.

Page Number:

 

Question 27

Type: MCMA

After an assessment, the nurse suspects that a client is experiencing signs of type 2 diabetes mellitus. What did the nurse assess in this client?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Excessive urination
  2. Excessive thirst
  3. Blurred vision
  4. Tingling of the fingers and toes
  5. Itchy skin rash

Correct Answer: 1,2,3,4

Rationale 1: Excessive urination or polyuria is a symptom of type 2 diabetes.

Rationale 2: Excessive thirst or polydipsia is a symptom of type 2 diabetes.

Rationale 3: Blurred vision is a symptom of type 2 diabetes.

Rationale 4: Tingling or paresthesias is a symptom of type 2 diabetes.

Rationale 5: Itchy skin rash is not a symptom of type 2 diabetes.

Global Rationale: Polyuria, polydipsia, blurred vision, and paresthesia are findings associated with type 2 diabetes mellitus. Itchy skin rash is not a finding associated with type 2 diabetes mellitus.

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and principles

AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care

NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 3. Describe the signs and diagnosis of diabetes.

MNL Competencies: 9.1.1 Examine etiology, pathophysiology, and clinical manifestations.

Page Number:

 

Question 28

Type: MCMA

The nurse is planning care for a client with diabetic ketoacidosis. What interventions will the nurse most likely perform for this client?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Administer intravenous fluids as prescribed
  2. Administer a loading dose of intravenous insulin as prescribed
  3. Administer electrolyte replacements as prescribed
  4. Administer intravenous antibiotics as prescribed
  5. Administer nebulized bronchodilators as prescribed

Correct Answer: 1,2,3

Rationale 1: Treatment of diabetic ketoacidosis includes fluid replacement therapy.

Rationale 2: Treatment of diabetic ketoacidosis includes a loading dose of intravenous insulin therapy.

Rationale 3: Treatment of diabetic ketoacidosis includes electrolyte replacements.

Rationale 4: Intravenous antibiotics are not a routine part of treatment for the client with diabetic ketoacidosis.

Rationale 5: Nebulized bronchodilators are not a routine part of treatment for the client with diabetic ketoacidosis.

Global Rationale: Treatment for DKA includes fluid replacement, administration of intravenous insulin, and electrolyte management. Antibiotics and bronchodilators are not routine parts of this treatment.

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: III.A.2 Describe EBP to include the components of research evidence, clinical expertise and patient/family values

AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care

NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4. Describe the acute complications of diabetes.

MNL Competencies: 9.1.3 Apply the nursing process to the administration of insulin and oral hypoglycemic agents.

Page Number:

 

Question 29

Type: MCMA

What should the nurse teach a client with diabetes about how to reduce the risk of cardiovascular complications from the disorder?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Stop smoking.
  2. Follow a low-fat diet.
  3. Take blood pressure medication as prescribed.
  4. Keep blood glucose levels within normal limits.
  5. Prevent constipation.

Correct Answer: 1,2,3,4

Rationale 1: Smoking cessation is a preventive measure to reduce the cardiovascular risk factors associated with diabetes.

Rationale 2: Lowering lipid levels is a preventive measure to reduce the cardiovascular risk factors associated with diabetes.

Rationale 3: Controlling blood pressure is a preventive measure to reduce the cardiovascular risk factors associated with diabetes.

Rationale 4: Optimal glucose control is a preventive measure to reduce the cardiovascular risk factors associated with diabetes.

Rationale 5: Preventing constipation is not a preventive measure to reduce the cardiovascular risk factors associated with diabetes.

Global Rationale: Smoking cessation, lowering lipid levels, controlling blood pressure, and optimizing glucose control are all preventative measures to reduce cardiovascular risk factors associated with diabetes. Preventing constipation will not prevent cardiovascular disease.

 

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

QSEN Competencies: III.A.2 Describe EBP to include the components of research evidence, clinical expertise and patient/family values

AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care

NLN Competencies: Context and Environment: Apply health-promotion/disease prevention strategies; apply health policy

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5. Identify the chronic complications of diabetes.

MNL Competencies: 9.1.4 Explore the nurse’s role in client education related to pharmacotherapy.

Page Number:

 

Question 30

Type: MCMA

When reviewing a client’s current medications, the nurse is concerned that the insulin dose will need to be adjusted because the client is currently prescribed which medications?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Beta blocker
  2. Monoamine oxidase inhibitor
  3. Angiotensin-converting enzyme inhibitor
  4. Cardiac glycoside
  5. Nonsteroidal anti-inflammatory agents

Correct Answer: 1,2,3

Rationale 1: Insulin must be used cautiously in conjunction with medications that can produce hypoglycemia, including beta blockers.

Rationale 2: Insulin must be used cautiously in conjunction with medications that can produce hypoglycemia, including monoamine oxidase inhibitors.

Rationale 3: Angiotensin-converting enzyme inhibitors increase insulin sensitivity and may enhance the hypoglycemic effects of insulin.

Rationale 4: Insulin does not need to be used cautiously in conjunction with cardiac glycosides.

Rationale 5: Insulin does not need to be used cautiously in conjunction with nonsteroidal anti-inflammatory agents.

Global Rationale: Insulin must be used cautiously in conjunction with medications that can produce hypoglycemia, including beta blockers, monoamine oxidase inhibitors, and angiotensin-converting enzyme inhibitors. Cardiac glycosides and NSAIDs do not interact with insulin.

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and principles

AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings

NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 7. For each type of insulin, identify the onset of action, peak action and duration of actions, administrations routes, when it is given related to meals, compatibility with other insulins and adverse effects

MNL Competencies: 9.1.3 Apply the nursing process to the administration of insulin and oral hypoglycemic agents.

Page Number:

 

Question 31

Type: MCMA

The nurse decides to withhold a prescribed dose of metformin to a client after reviewing the medical record. For which conditions is this medication contraindicated or used with caution?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Impaired renal function
  2. Congestive heart failure
  3. Hyperthyroidism
  4. Septicemia
  5. Sleep apnea

Correct Answer: 1,2,3,4

Rationale 1: Metformin is contraindicated in clients with impaired renal function.

Rationale 2: Metformin is contraindicated in clients with heart failure.

Rationale 3: Metformin is used with caution in clients with hyperthyroidism.

Rationale 4: Metformin is contraindicated in clients with a concurrent serious infection.

Rationale 5: Metformin is not contraindicated in clients with sleep apnea.

Global Rationale: Metformin is contraindicated in clients with impaired renal function, heart failure, hyperthyroidism, or a concurrent serious infection. It is not contraindicated in those with sleep apnea.

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

QSEN Competencies: V.A.4 Delineate general categories of errors and hazards of care

AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings

NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 8. For each of the classes shown in the chapter outline identify the prototype and representative drugs and explain the mechanisms of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

MNL Competencies: 9.1.3 Apply the nursing process to the administration of insulin and oral hypoglycemic agents.

Page Number:

 

Question 32

Type: MCMA

What dietary instructions should the nurse provide a client who is prescribed repaglinide (Prandin)?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Do not take with grapefruit juice.
  2. Avoid using garlic.
  3. Drink decaffeinated beverages only.
  4. Avoid green leafy vegetables.
  5. Limit the intake of milk products.

Correct Answer: 1,2

Rationale 1: The concurrent intake of grapefruit juice with repaglinide may result in increased drug levels and hypoglycemia.

Rationale 2: Garlic may increase the hypoglycemic effects of the medication.

Rationale 3: This medication does not interact with caffeine.

Rationale 4: This medication does not interact with green leafy vegetables.

Rationale 5: This medication does not interact with milk products.

Global Rationale: The concurrent intake of grapefruit juice with repaglinide may result in increased drug levels and hypoglycemia. Garlic may increase the hypoglycemic effects of the medication. The medication does not interact with caffeine, green leafy vegetables, or milk products.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: V.A.4 Delineate general categories of errors and hazards of care

AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings

NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 8. For each of the classes shown in the chapter outline identify the prototype and representative drugs and explain the mechanisms of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

MNL Competencies: 9.1.4 Explore the nurse’s role in client education related to pharmacotherapy.

Page Number:

 

Question 33

Type: MCMA

Which statements indicate that instruction provided to a client with type 1 diabetes mellitus regarding exercise has been effective?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. “I should start any new exercise regimen slowly.”
  2. “I should exercise an hour after a meal.”
  3. “I should have a snack of 10 to 15 grams of carbohydrate before exercising.”
  4. “I should take 10- to 15-gram carbohydrate snacks with me to the gym if I plan to exercise longer than 30 minutes.”
  5. “I should withhold my routine insulin dose if I plan to exercise that day.”

Correct Answer: 1,2,3,4

Rationale 1: The client should be instructed to begin any new exercise routine or increase in exercise gradually.

Rationale 2: The client should be instructed to exercise an hour after a meal.

Rationale 3: The client should be instructed to exercise after a 10- to 15-gram carbohydrate snack.

Rationale 4: The client should be instructed to have small frequent carbohydrate snacks every 30 minutes during exercise to maintain the blood sugar level.

Rationale 5: The nurse should not instruct the client to alter the routine insulin dose according to the exercise schedule.

Global Rationale: The client should be instructed to begin any new exercise routine or increase in exercise gradually. Exercising an hour after a meal or a 10 to 15 gram carbohydrate snack will help support blood glucose. The client should have small frequent carbohydrate snacks during exercise. The nurse should not instruct the client to alter the routine insulin dose according to the exercise schedule.

 

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience

AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings

NLN Competencies: Context and Environment: Apply health-promotion/disease prevention strategies; apply health policy

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome:  9. Apply the nursing process to the care of patients receiving pharmacotherapy for diabetes.

MNL Competencies: 9.1.4 Explore the nurse’s role in client education related to pharmacotherapy.

Page Number:

 

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