Edition 5 Pahrm quiz 6 PDF

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Phamacology quiz 6. Using book adams 5th edition...

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Adams, Pharmacology for Nurses: A Pathophysiologic Approach, 5/E Chapter 45 Drugs for Diabetes mellitus Question 1 Type: MCMA The client has been diagnosed with type 1 diabetes mellitus. He asks the nurse what this means. What is the best response by the nurse? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "The exocrine function of your pancreas is to secrete insulin, and it is not working." 2. "Without insulin you will develop ketoacidosis (DKA)." 3. "The endocrine function of your pancreas is to secrete insulin, but it isn’t working." 4. "Your alpha cells should be able to secrete insulin, but cannot." 5. "It means your pancreas cannot secrete insulin." Correct Answer: 2,3,5 Rationale 1: The endocrine, not the exocrine, function of the pancreas is to secrete insulin. Rationale 2: A consequence of diabetes mellitus type 1 is that, without insulin, severe metabolic disturbances, such as diabetic ketoacidosis (DKA) will result. Rationale 3: The endocrine function of the pancreas is to secrete insulin. Rationale 4: Insulin is secreted by the beta, not the alpha, cells of the pancreas. Rationale 5: One function of the pancreas is to secrete insulin. Global Rationale: A consequence of diabetes mellitus type 1 is that, without insulin, severe metabolic disturbances, such as diabetic ketoacidosis (DKA) will result. The endocrine function of the pancreas is to secrete insulin. One function of the pancreas is to secrete insulin. The endocrine, not the exocrine, function of the pancreas is to secrete insulin. Insulin is secreted by the beta, not the alpha, cells of the pancreas. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials 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: 45-1 Explain how blood glucose levels are maintained within narrow limits by insulin and glucagon. MNL Learning Outcome: 9.2.1 Examine etiology, pathophysiology, and clinical manifestations. Page Number: 769 Question 2 Type: MCSA The physician orders insulin lispro (Humalog), 10 units for the client. When will the nurse administer this medication? 1. Thirty minutes before meals 2. Five minutes before a meal 3. When the meal trays arrive on the floor 4. Fifteen minutes after meals Correct Answer: 2 Rationale 1: The onset of action for insulin lispro (Humalog) is 10 to 15 minutes so it must be given when the client is eating, not 30 minutes before meals, to prevent hypoglycemia. Rationale 2: The onset of action for insulin lispro (Humalog) is 10 to 15 minutes so it must be given 5 to 10 minutes before the client eats. Rationale 3: The onset of action for insulin lispro (Humalog) is 10 to 15 minutes so it must be given just before the client eats, not when meal trays arrive on the floor, to prevent hypoglycemia. Rationale 4: The onset of action for insulin lispro (Humalog) is 10 to 15 minutes so it must be given when the client is eating, not 15 minutes after meals, to prevent hypoglycemia. Global Rationale: The onset of action for insulin lispro (Humalog) is 10 to 15 minutes so it must be given when the client is eating, not 30 minutes before meals, not when meal trays arrive on the floor, and not 15 minutes after meals, to prevent hypoglycemia. 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 processes. AACN Essentials 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: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 45-3 Compare and contrast types of insulin.

MNL Learning Outcome: 9.2.2 Compare the classes of medications used in pharmacologic management. Page Number: 771 Question 3 Type: MCSA The physician writes orders for the client with diabetes mellitus. Which order would the nurse validate with the physician? 1. Lantus insulin 20U BID 2. Administering regular insulin 30 minutes prior to meals 3. 5 units of Humalog/10 units NPH daily 4. Metformin (Glucophage) 1000 mg per day in divided doses Correct Answer: 1 Rationale 1: Lantus insulin is usually prescribed in once-a-day dosing so an order for BID dosing should be validated with the physician. Rationale 2: Regular insulin is administered 30 minutes before meals. Rationale 3: Humalog and NPH insulin can be mixed. Rationale 4: Metformin (Glucophage) is often prescribed in divided doses of 1000 mg per day. Global Rationale: Lantus insulin is usually prescribed in once-a-day dosing so an order for BID dosing should be validated with the physician. Regular insulin is administered 30 minutes before meals. Humalog and NPH insulin can be mixed. Metformin (Glucophage) is often prescribed in divided doses of 1000 mg per day. Cognitive Level: Analyzing 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 Essentials 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: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 45-8 Use the nursing process to care for patients receiving pharmacotherapy for diabetes mellitus. MNL Learning Outcome: 9.2.3 Apply the nursing process to the administration of insulin and oral hypoglycemic agents. Page Number: 771

Question 4 Type: MCSA A client with diabetes mellitus type 1 is found unresponsive in the clinical setting. Which nursing action is a priority? 1. Call a code. 2. Treat the client for hypoglycemia. 3. Call the physician STAT. 4. Assess the client's vital signs. Correct Answer: 2 Rationale 1: Assessment for ABCs should precede calling a code; there is no information that the client is not breathing. Rationale 2: When a client with diabetes mellitus type 1 is found unresponsive, the nurse should focus on and treat for hypoglycemia, as this is more likely than hyperglycemia. Rationale 3: This is an emergency situation where the nurse must act before calling the physician. Rationale 4: Vital signs should be taken after the client is treated for hypoglycemia. Global Rationale: When a client with diabetes mellitus type 1 is found unresponsive, the nurse should focus on and treat for hypoglycemia, as this is more likely than hyperglycemia. Assessment for ABCs should precede calling a code; there is no information that the client is not breathing. This is an emergency situation where the nurse must act before calling the physician. Vital signs should be taken after the client is treated for hypoglycemia. 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 processes. AACN Essentials 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: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 45-4 Describe the signs and symptoms of insulin overdose and underdose. MNL Learning Outcome: 9.2.2 Compare the classes of medications used in pharmacologic management. Page Number: 774 Question 5 Type: MCSA

The nurse makes a home visit to a client with diabetes mellitus. During the visit, the nurse notes that the client's 3month supply of insulin vials that were delivered a week ago are not refrigerated. What is the best action by the nurse at this time? 1. Instruct the client that the insulin should be stored away from direct sunlight or excessive heat. 2. Have the client discard the vials. 3. Instruct the client to label each vial with the date when opened. 4. Tell the client this is too much insulin to have on hand. Correct Answer: 1 Rationale 1: Unopened vials can be stored at room temperature but should be stored away from direct sunlight or direct heat. Rationale 2: There is no need to discard the vials. Rationale 3: Writing the date of opening on the vial is good practice but does not address the need to refrigerate additional vials. Rationale 4: There is no indication that this is too much insulin to have on hand. Global Rationale: Unopened vials can be stored at room temperature but should be stored away from direct sunlight or direct heat. There is no need to discard the vials. Writing the date of opening on the vial is good practice but does not address the need to refrigerate additional vials. There is no indication that this is too much insulin to have on hand. 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 Essentials 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: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 45-8 Use the nursing process to care for patients receiving pharmacotherapy for diabetes mellitus. MNL Learning Outcome: 9.2.3 Apply the nursing process to the administration of insulin and oral hypoglycemic agents. Page Number: 777 Question 6 Type: MCSA

The nurse has finished teaching a client with diabetes mellitus how to administer insulin. The nurse evaluates that learning has occurred when the client makes which statement? 1. "I should only use a calibrated insulin syringe for the injections." 2. "I should check my blood sugar immediately prior to the administration." 3. "I should use the abdominal area only for insulin injections." 4. "I should provide direct pressure over the site following the injection." Correct Answer: 1 Rationale 1: To ensure the correct insulin dose, a calibrated insulin syringe must be used. Rationale 2: There is no need to check blood glucose immediately prior to the injection. Rationale 3: Insulin injections should also be rotated to the arm and thigh, not just the abdominal area. Rationale 4: There is no need to apply direct pressure over the site following an insulin injection. Global Rationale: To ensure the correct insulin dose, a calibrated insulin syringe must be used. There is no need to check blood glucose immediately prior to the injection. Insulin injections should also be rotated to the arm and thigh, not just the abdominal area. There is no need to apply direct pressure over the site following an insulin injection. 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 processes. AACN Essentials 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: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 45-4 Describe the signs and symptoms of insulin overdose and underdose. MNL Learning Outcome: 9.2.2 Compare the classes of medications used in pharmacologic management. Page Number: 775 Question 7 Type: MCSA A client with diabetes mellitus is taking oral agents and is scheduled for a diagnostic test that requires him to be NPO (nothing by mouth) and to have contrast dye. What is the best plan by the nurse with regard to giving the client his oral medications? 1. Notify the diagnostic department and request orders.

2. Notify the physician and request orders. 3. Administer the oral agents immediately after the test. 4. Administer the oral agents with a sip of water before the test. Correct Answer: 2 Rationale 1: The radiologist in the diagnostic department might give orders, but it would be best to check with the client's physician first. Rationale 2: It is best to notify the client's physician and request orders. Rationale 3: Some oral medications should not be given for up to 2 days after receiving IV contrast. Rationale 4: The client should not receive the medication during NPO (nothing by mouth) status unless directed by the physician. Some oral medications should not be given for 2 days before receiving IV contrast. Global Rationale: It is best to notify the client's physician and request orders. The radiologist in the diagnostic department might give orders, but it would be best to check with the client's physician first. Some oral medications should not be given for up to 2 days after receiving IV contrast. The client should not receive the medication during NPO (nothing by mouth) status unless directed by the physician. Cognitive Level: Analyzing 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 Essentials 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: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 45-8 Use the nursing process to care for patients receiving pharmacotherapy for diabetes mellitus. MNL Learning Outcome: 9.2.3 Apply the nursing process to the administration of insulin and oral hypoglycemic agents. Page Number: 779 Question 8 Type: MCSA The client has type 2 diabetes mellitus. The nurse has taught the client about the illness and evaluates that learning has occurred when the client makes which statement? 1. "My beta cells just cannot produce enough insulin for my cells." 2. "My peripheral cells have increased sensitivity to insulin."

3. "My cells have increased their receptors, but there is not enough insulin." 4. "My cells cannot use the insulin my pancreas makes." Correct Answer: 4 Rationale 1: The beta cells continue to produce insulin with type 2 diabetes. Rationale 2: Peripheral cells have a decreased, not an increased, sensitivity to insulin. Rationale 3: There is a decrease, not an increase, in receptor sites with type 2 diabetes. Rationale 4: With type 2 diabetes mellitus, the pancreas produces insulin, but the cells cannot use it. Global Rationale: With type 2 diabetes mellitus, the pancreas produces insulin, but the cells cannot use it. The beta cells continue to produce insulin with type 2 diabetes. Peripheral cells have a decreased, not an increased, sensitivity to insulin. There is a decrease, not an increase, in receptor sites with type 2 diabetes. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials 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: Evaluation Learning Outcome: 45-5 Explain the etiology of type 2 diabetes mellitus. MNL Learning Outcome: 9.2.1 Examine etiology, pathophysiology, and clinical manifestations. Page Number: 776 Question 9 Type: MCSA The client has type 1 diabetes mellitus and receives insulin. He asks the nurse why he can't just take pills instead. What is the best response by the nurse? 1. "I know it is tough, but you will get used to the shots soon." 2. "Have you talked to your doctor about taking pills instead?" 3. "Insulin can't be in a pill because it is destroyed in stomach acid." 4. "Insulin must be injected because it needs to work quickly." Correct Answer: 3 Rationale 1: Telling the client he will get used to the shots does not answer his question and is condescending. Rationale 2: The nurse should answer the client's question, not refer him back to the physician.

Rationale 3: Insulin must be injected because it is destroyed in stomach acid if taken orally. Rationale 4: Insulin must be injected because it is destroyed in stomach acid if taken orally; the onset of action is not the issue here. Global Rationale: Insulin must be injected because it is destroyed in stomach acid if taken orally. Telling the client he will get used to the shots does not answer his question and is condescending. The nurse should answer the client's question, not refer him back to the physician. Insulin must be injected because it is destroyed in stomach acid if taken orally; the onset of action is not the issue here. 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 processes. AACN Essentials 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: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 45-3 Compare and contrast types of insulin. MNL Learning Outcome: 9.2.2 Compare the classes of medications used in pharmacologic management. Page Number: 771 Question 10 Type: MCSA The nurse teaches a class for the public about diabetes mellitus. Which individual does the nurse assess as being at highest risk for developing diabetes? 1. The 38-year-old client who smokes one pack of cigarettes per day 2. The 42-year-old client who is 50 pounds overweight 3. The 50-year-old client who does not get any physical exercise 4. The 56-year-old client who drinks three glasses of wine each evening Correct Answer: 2 Rationale 1: Smoking is a serious health concern but is not a specific risk factor for diabetes. Rationale 2: Obesity increases the likelihood of developing diabetes mellitus due to overstimulation of the endocrine system. Rationale 3: Exercise is important, but a lack of exercise is not as big of a risk factor as obesity. Rationale 4: Consuming alcohol is associated with liver disease but is not as high a risk factor for diabetes as obesity.

Global Rationale: Obesity increases the likelihood of developing diabetes mellitus due to ove...