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The overgrowth of normal body flora or of opportunistic organisms no longer held in check by normal, beneficial flora.

Superinfections are an adverse effect commonto all antibiotic therapy. The best description of a superinfection is:
1 An initial infection so overwhelming that it requires multiple antimicrobial agents to treat successfully.
2 Bacterial resistance that creates infections difficult to treat and often resistant to multiple drugs.
3 Infections requiring high-dose antimicrobial therapy with increased chance of organ toxicity.
4 The overgrowth of normal body flora or of opportunistic organisms no longer held in check by normal, beneficial flora.

The entire prescription must be finished.

A patient has been discharged with a prescription for penicillin. Discharge instructions include that:
Penicillins can be taken while breast-feeding.
The entire prescription must be finished.
All penicillins can be taken without regard to eating.
Some possible side effects include abdominal pain and constipation.

Is contraindicated in children younger than 8 years

A patient has been prescribed tetracycline. When providing information regarding this drug, the nurse would be correct in stating that tetracycline:
Is classified as a narrow-spectrum antibiotic and only treats a few infections
Is used to treat a wide variety of disease processes
Has been identified to be safe during pregnancy
Is contraindicated in children younger than 8 years

A serious side effect is hearing loss.

Important information to include in the patient's education regarding taking fluoroquinolones is that:
The drug can cause discoloration of teeth.
Fluid intake should be decreased to prevent urine retention.
This drug is primarily given orally because it is absorbed in the GI tract.
A serious side effect is hearing loss.

"It is critical to continue therapy for at least 6 to 12
months."
2. "Two or more drugs may be used to prevent resistance."
3. "These drugs may be used to prevent tuberculosis also."
4. "No special precautions are required"

A patient has been diagnosed with tuberculosis. While his
medicine is being administered, he asks questions regarding his treatment. What teaching should the nurse supply
to this patient! (Select all that apply. )
1. "It is critical to continue therapy for at least 6 to 12
months."
2. "Two or more drugs may be used to prevent resistance."
3. "These drugs may be used to prevent tuberculosis also."
4. "No special precautions are required"
5. "After I month of treatment, the medication will be
discontinued.."

Ask her about oral contraceptive use and recommend an alternative method for the duration of the ampicillin course.

A 32-year-old female has been started on ampicillin for a severe UTI. Before sending her home with this prescription, the nurse will:
Teach her to wear sunscreens.
Ask her about oral contraceptive use and recommend an alternative method for the duration of the ampicillin course.
Assess for hearing loss.
Recommend taking the pill with some antacid to prevent GI upset.

1. Report unusual heel, lower leg or calf pain or difficulty
walking.
2. Avoid taking the medicine with milk products and
antacids.

Teaching for a patient redceiving a prescription for ciprofloxacin (Cipro) should include (Select all that apply):
1. Report unusual heel, lower leg or calf pain or difficulty walking.
2. Avoid taking the medicine with milk products and antacids.
3. Limit vitamin C, both dietary and oral vitamin forms.
4. Take her pill with an antihistamine to avoid side effects.

1. Your patient has been switched from valproic acid (Depakote) to gabepentin (Neurontin). Which of the following is a false statement?

a. Gabapentin (Neurontin) is also used for bipolar disorder therapy
b. Gabapentin (Neurontin) requires more frequent hepatic monitoring
c. Gabapentin (Neurontin) is also used for migraine therapy
d. Gabapentin (Neurontin) should not be given concurrently with antacids containing magnesium

b. Gabapentin (Neurontin) requires more frequent hepatic monitoring

2. In the administration of a drug such as levothyroxine (Synthroid), the nurse should teach the client:

A) That therapy typically lasts about 6 months.
B) That weekly laboratory tests for T4 levels will be required.
C) To report weight loss, anxiety, insomnia, and palpitations.
D) That the drug may be taken every other day if diarrhea occurs.

C) To report weight loss, anxiety, insomnia, and palpitations.

3. A patient with hyperthyroidism is taking propylthiouracil (PTU). The nurse will monitor the patient for:

A) gingival hyperplasia and lycopenemia.
B) dyspnea and a dry cough.
C) blurred vision and nystagmus.
D) fever and sore throat.

D) fever and sore throat.

4. A type I diabetic patient comes to the clinic for a follow-up appointment. The patient is taking NPH insulin, 30 units every day. A nurse notes that the patient is also taking metoprolol (Lopressor). What education should the nurse provide to the patient?

A) "You need to increase your insulin to allow for the agonist effects of metoprolol."
B) "Metoprolol may potentiate the effects of the insulin, so the dose should be reduced."
C) "Metoprolol has no effects on diabetes mellitus or on your insulin requirements."
D) "Metoprolol may mask signs of hypoglycemia, so you need to monitor your blood glucose closely."

D) "Metoprolol may mask signs of hypoglycemia, so you need to monitor your blood glucose closely."

5. A physician has prescribed propylthiouracil (PTU) for a client with hyperthyroidism and the nurse develops a plan of care for the client. A priority nursing assessment to be included in the plan regarding this medication is to assess for:

a) relief of pain
b) signs of renal toxicity
c) signs and symptoms of hyperglycemia
d) signs and symptoms of hypothyroidism

d) signs and symptoms of hypothyroidism


Excessive dosing with propylthiouracil (PTU) may convert the client from a hyperthyroid state to a hypothyroid state. If this occurs, the dosage should be reduced. Temporary administration of thyroid hormone may be required. Propylthiouracil is not used for pain and does not cause hyperglycemia or renal toxicity.

6. A physician prescribes levothyroxine sodium (Synthroid), 0.15 mg orally daily, for a client with hypothyroidism. The nurse will prepare to administer this medication:

a) in the morning to prevent insomnia
b) only when the client complains of fatigue and cold intolerance
c) at various times during the day to prevent tolerance from occurring
d) three times daily in equal doses of 0.5 mg each to ensure consistent serum drug levels

a) in the morning to prevent insomnia


Levothyroxine (Synthroid) is a synthetic thyroid hormone that increases cellular metabolism. Levothyroxine should be given in the morning in a single dose to prevent insomnia and should be given at the same time each day to maintain an adequate drug level. Therefore, options B, C, and D are incorrect.

7. A nurse is monitoring a client newly diagnosed with diabetes mellitus for signs of complications. Which of the following, if exhibited in the client, would indicate hyperglycemia and warrant physician notification?

a) polyuria
b) diaphoresis
c) hypertension
d) increased pulse rate

a) polyuria

Classic symptoms of hyperglycemia include polydipsia, polyuria, and polyphagia. Options B, C, and D are not signs of hyperglycemia.

8. Myxedema, which includes fatigue, general weakness, and muscle cramps, is a symptom of which endocrine disorder treated with levothyroxine (Synthroid)?

a. Hyperthyroidism
b. Hypothyroidism
c. Cushing's syndrome
d. Addison's disease

b. Hypothyroidism

9. Which disease is characterized by increased body metabolism, tachycardia, increased body temperature, and anxiety, and treated with Prophylthiouracil (PTU)?

a.) Hashimoto's thyroiditis
b.) Graves' disease
c.) Addison's disease
d.) Cushing's syndrome

b.) Graves' disease

10. In the administration of hydrocortisone (Aeroseb-HC, Alphadern, Cetacort), it is vital that the nurse recognize that this drug might mask which symptoms?

a.) Signs and symptoms of infection
b.) Signs and symptoms of heart failure
c.) Hearing loss
d.) Skin infections

a.) Signs and symptoms of infection

11. When hydrocortisone use is discontinued, the nurse must recognize the possibility of what side effect, if this drug is stopped abruptly?

a.) Development of myxedema
b.) Circulatory collapse
c.) Development of Cushing's syndrome
d.) Development of diabetes insipidus

b.) Circulatory collapse

12. A client who is taking levothyroxine (Synthroid) begins to develop weight loss, diarrhea, and intolerance. The nurse should be aware that this might be an indication of what hormonal condition?

a.) Addison's disease
b.) Hyperthyroidism
c.) Cushing's syndrome
d.) Development of acromegaly

b.) Hyperthyroidism

13. Which organ is destroyed when administering radioactive I-131?

a.) Pituitary gland
b.) Adrenals
c.) Parathyroid
d.) Hypothalamus

radioactive I-131 destroys the thyroid because the thyroid cells are the only cells in the body that can take up iodine

14. Of what precautions should a client receiving radioactive iodine-131 be made aware?

a.) Drink plenty of fluids, especially those high in calcium.

b.) Avoid close contact with children or pregnant women for one week after administration of drug.

c.) Be aware of the symptoms of tachycardia, increased metabolic rate, and anxiety.

d.) Wear a mask if around children or pregnant women.

b.) Avoid close contact with children or pregnant women for one week after administration of drug.

15. In the administration of a drug such as levothyroxine (Synthroid), the nurse must teach the client: (Select all that apply.)

a.) Therapy could take three weeks or longer.

b.) Periodic lab tests for T4 levels are required.

c.) Report weight loss, anxiety, insomnia, and palpitations.

d.) Jaundice

Therapy could take three weeks or longer.

Periodic lab tests for T4 levels are required.

Report weight loss, anxiety, insomnia, and palpitations.

A,B,C

16. The client scheduled for electroconvulsive therapy tells the nurse, "I'm so afraid. What will happen to me during the treatment?" Which of the following statements is most therapeutic for the nurse to make?

A. "You will be given medicine to relax you during the treatment."

B. "The treatment will produce a controlled grand mal seizure."

C.
The treatment might produce nausea and headache.

d. You can expect to be sleepy and confused for a time after the treatment.

A.

The patient will receive medication that relaxes skeletal muscles and produces mild sedation.

17. Which information should be given to the client taking phenytoin (Dilantin)?

A. Taking the medication with meals will increase its effectiveness.

B. The medication can cause sleep disturbances

C. More frequent dental appointments will be needed for special gum care.

D. The medication decreases the effects of oral contra- ceptives.

C. More frequent dental appointments will be needed for special gum care.

Gingival hyperplasia is a side effect of phenytoin. The client will need more frequent dental visits.

Answers A, B, and D do not apply to the medication; therefore, they are incorrect.

18. The nurse is teaching the client with insulin-dependent diabetes the signs of hypoglycemia. Which of the following signs is associ- ated with hypoglycemia?

A. Tremulousness
B. Slow pulse
C. Nausea
D. Flushed skin

Answer A is correct.

Tremulousness (a state of trembling or quivering) is an early sign of hypoglycemia.

Answers B,C, and D are incorrect because they are symptoms of hyperglycemia.

19. A patient taking Dilantin (phenytoin) for a seizure disorder is experiencing breakthrough seizures. A blood sample is taken to determine the serum drug level. Which of the following would indicate a sub-therapeutic level?

A. 15 mcg/mL.
B. 4 mcg/mL.
C. 10 mcg/dL.
D. 5 mcg/dL.

B. 4 mcg/mL.

The therapeutic serum level for Dilantin is 10 - 20 mcg/mL. A level of 4 mcg/mL is sub-therapeutic and may be caused by patient non-compliance or increased metabolism of the drug. A leve of 15 mcg/mL is therapeutic. Choices C and D are expressed in mcg/dL, which is the incorrect unit of measurement.

20. A patient arrives at the emergency department complaining of back pain. He reports taking at least 3 acetaminophen tablets every three hours for the past week without relief. Which of the following symptoms suggests acetaminophen toxicity?

A. Tinnitus.
B. Diarrhea.
C. Hypertension.
D. Hepatic damage.

Answer: D

Acetaminophen in even modestly large doses can cause serious liver damage that may result in death. Immediate evaluation of liver function is indicated with consideration of N-acetylcysteine administration as an antidote. Tinnitus is associated with ASPIRIN overdose, not acetaminophen. Diarrhea and hypertension are not associated with acetaminophen.

21. A nurse is caring for a cancer patient receiving subcutaneous morphine sulfate for pain. Which of the following nursing actions is most important in the care of this patient?

A. Monitor urine output.
B. Monitor respiratory rate.
C. Monitor heart rate.
D. Monitor temperature.

Answer: B

Morphine sulfate can suppress respiration and respiratory reflexes, such as cough. Patients should be monitored regularly for these effects to avoid respiratory compromise. Morphine sulfate does not significantly affect urine output, heart rate, or body temperature.

22. A nurse is administering blood to a patient who has a low hemoglobin count. The patient asks how long to RBC's last in my body? The correct response is.

A. The life span of RBC is 45 days.
B. The life span of RBC is 60 days.
C. The life span of RBC is 90 days.
D. The life span of RBC is 120 days.

D. The life span of RBC is 120 days.

23. A client has been newly diagnosed with hypothyroidism and will take levothyroxine (Synthroid) 50 mcg/day by mouth. As part of the teaching plan, the nurse emphasizes that this medication:

A) Should be taken in the morning
B) May decrease the client's energy level
C) Must be stored in a dark container
D) Will decrease the client's heart rate

A) Should be taken in the morning

24. Your patient is taking valproic acid (Depakote). Which of the following is a false statement?

a. Valproic acid requires hepatic monitoring
b. Valproic acid has the lowest seizure relapse rate when discontinued
c. Valproic acid is also used in migraine therapy
d. Valproic acid is also used in bipolar disorder therapy

b. Valproic acid has the lowest seizure relapse rate when discontinued

25. Your patient has been switched from valproic acid (Depakote) to gabepentin (Neurontin). Which of the following is a false statement?

a. Gabapentin (Neurontin) is also used for bipolar disorder therapy
b. Gabapentin (Neurontin) requires more frequent hepatic monitoring
c. Gabapentin (Neurontin) is also used for migraine therapy
d. Gabapentin (Neurontin) should not be given concurrently with antacids containing magnesium

b. Gabapentin (Neurontin) requires more frequent hepatic monitoring

26. Your patient has been stabilized taking only primidone (Mysoline). Which drug besides primidone may be assayed during his stay in the hospital to monitor his therapy?

a. pentobarbital
b. phenobarbital
c. valproic acid
d. phenytoin

b. phenobarbital

27. Fosphenytoin (Cerebyx)

a. is a controversial agent for depression
b. is used to control tremors due to Parkinsonism
c. can be administered intravenously
d. is ineffective after 5 days of therapy

c. can be administered intravenously

28. Antidote for warfarin overdose

a. protamine zinc insulin
b. protamine sulfate
c. vitamin K
d. warfarin

c. vitamin K

29. Antidote for heparin overdose
a. protamine sulfate
b. vitamin K
c. vitamin E
d. cyanocobolamine

a. protamine sulfate

30. Antiplatelet agents include all of the following except

a. acetylsalicylic acid
b. acetaminophen
c. ticlopidine (Ticlid)
d. dipyridamole (Persantine)

b. acetaminophen

31. A classic drug interaction, greatly involving an increased bleeding time, involves warfarin and

a. vitamin B-6
b. acetaminophen
c. acetylsalicylic acid
d. all of the above

c. acetylsalicylic acid

32. A young woman makes an appointment to see a physician at the clinic. She complains of tiredness, weight gain, muscle aches and pains, and constipation. The physician will likely order:

1. T3 and T4 serum level laboratory tests.
2. glucose tolerance test.
3. cerebral computed tomography (CT) scan.
4. adrenocortical stimulating test.

1. T3 and T4 serum level laboratory tests.

These complaints are strongly suggestive of thyroid disorder; T3 and T4 laboratory tests are the most useful diagnostic tests.

33. The patient asks about his lab test, which showed a high level of TSH and a low level of T4. You explain:

1. "It means that you have an inconsistency in your thyroid tests, and you will need more testing."
2. "I am sorry. You will have to ask your doctor about your lab results. We are not allowed to discuss them."
3. "The TSH is sending a message to your thyroid gland to increase production, but your thyroid isn't doing that."
4. "That means that you will have to go on hormone therapy for the rest of your life."

3. "The TSH is sending a message to your thyroid gland to increase production, but your thyroid isn't doing that."

The test determines if the problem is in the pituitary or in the thyroid. In this case the high TSH is coming from the pituitary as it should but the thyroid is not responding.

34. The nurse instructs the patient is scheduled to have a radioactive iodine uptake test to:

1. watch for any signs of bleeding or swelling from the biopsy site.
2. avoid contact with others until notified otherwise.
3. wash hands with soap and water after each urination for 24 hours after the test.
4. this test demonstrates the effectiveness of the pituitary gland on the thyroid gland.

3. wash hands with soap and water after each urination for 24 hours after the test.

Radiation dose is small and will not harm others.

35. The patient, newly diagnosed with hypothyroidism, seems very anxious to begin her drug regimen. The nurse's instructions include:

1. "Be certain that no dose is skipped."
2. "If a dose is skipped one day, double the dose the next day."
3. "Know the signs and symptoms of hyperthyroidism."
4. "You will be able to notice the benefits of thyroid replacement therapy right away."

3. "Know the signs and symptoms of hyperthyroidism."


Her enthusiasm may lead her to overdose on the thyroid replacement pills. She needs to be aware of the proper prescription and the reasons for following the prescribed dosage.

36. Mr. Jessie Ray, a newly admitted patient, has a seizure disorder which is being treated with medication. Which of the following drugs would the nurse question if ordered for him?

A. Phenobarbitol, 150 mg hs
B. Amitriptylene (Elavil), 10 mg QID.
C. Valproic acid (Depakote), 150 mg BID
D. Phenytoin (Dilantin), 100 mg TID

B.

Elavil is an antidepressant that lowers the seizure threshold, so would not be appropriate for this patient. The other medications are anti-seizure drugs.

37. A nurse is preparing the client's morning NPH insulin dose and notices a clumpy precipitate inside the insulin vial. The nurse should:

A. draw up and administer the dose
B. shake the vial in an attempt to disperse the clumps
C. draw the dose from a new vial
D. warm the bottle under running water to dissolve the clump

C.

The nurse should always inspect the vial of insulin before use for solution changes that may signify loss of potency. NPH insulin is normally uniformly cloudy. Clumping, frosting, and precipitates are signs of insulin damage. In this situation, because potency is questionable, it is safer to discard the vial and draw up the dose from a new vial.

38. A patient who has type 2 diabetes has a glycated hemoglobin (HbA1c) result of 10%. A nurse should make which of these changes to the nursing care plan?

A) Refer to a diabetic educator, there is poor glycemic control.
B) Glycemic control is adequate, no changes are needed.
C) Hypoglycemia is a risk, teach the patient the symptoms.
D) Instruct the patient to limit activity and weekly exercise.

A) Refer to a diabetic educator, there is poor glycemic control.

39. Which of these instructions should the nurse provide when teaching a patient to mix regular insulin and NPH insulin in the same syringe?

A) Draw up the clear regular insulin first, followed by the cloudy NPH insulin.
B) It is not necessary to rotate the NPH insulin vial when it is mixed with regular insulin.
C) The order of drawing up insulin does not matter as long as the insulin is refrigerated.
D) Rotate each day subcutaneous injection sites among the arm, thigh, and abdomen.

A) Draw up the clear regular insulin first, followed by the cloudy NPH insulin.

To ensure a consistent response, only NPH insulin is appropriate for mixing with a short-acting insulin. Unopened vials of insulin should be refrigerated; current vials can be kept at room temperature for up to 1 month. Drawing up the regular insulin into the syringe first prevents accidental mixture of NPH insulin into the vial of regular insulin, which could alter the pharmacokinetics of subsequent doses taken out of the regular insulin vial. NPH insulin is a cloudy solution, and it should always be gently rotated to evenly disperse the particles before loading the syringe. Subcutaneous injections should be made using one region of the body (e.g., the abdomen or thigh) and rotated within that region for 1 month.

40. NPH INSULIN

intermediate acting insulin

41. A patient is scheduled to start taking insulin glargine (Lantus). On the care plan a nurse should include which of these outcomes related to the therapeutic effects of the medication?

A) Blood glucose control for 24 hours
B) Mealtime coverage of blood glucose
C) Less frequent blood glucose monitoring
D) Peak effect achieved in 2 to 4 hours

A) Blood glucose control for 24 hours


Insulin glargine is administered as a once-daily subcutaneous injection for patients who have type 1 diabetes. It is used for basal insulin coverage, not mealtime coverage. It has a prolonged duration up to 24 hours with no peaks. Blood glucose monitoring is still an essential component to achieve tight glycemic control.

42. At 5 PM a patient who is taking NPH insulin develops hunger, shakiness, and sweating. A nurse assesses the medication administration record (MAR) and should recognize that the patient's symptoms are related to an injection of NPH insulin at which of these times?

A) 2 AM
B) 8 AM
C) 1 PM
D) 3 PM

A) 2 AM

The patient is exhibiting symptoms of hypoglycemia at 5 PM. NPH has a peak action of 8 to 10 hours after administration. Based on the duration of action of NPH insulin, the patient's hypoglycemic symptoms are from the 8 AM injection of NPH insulin. An injection of NPH insulin at 2 AM, 1 PM, or 3 PM would not cause hypoglycemic symptoms based on the average duration of action from NPH insulin.

43. A teaching plan for a patient who is taking lispro (Humalog) should include which of these instructions by the nurse?

A) "Inject this insulin with your first bite of food because it is very fast acting."
B) "The duration of action for this insulin is about 8 to 10 hours, so you'll need a snack."
C) "This insulin needs to be mixed with regular insulin to enhance the effects."
D) "To achieve tight glycemic control, this is the only type of insulin you'll need."

A) "Inject this insulin with your first bite of food because it is very fast acting."


Lispro is a rapid-acting insulin and has an onset of 15 to 30 minutes with a peak action of about 2 hours, not 8 to 10 hours. Because of its rapid onset, it is administered immediately before a meal or with meals to control blood glucose rise after meals. Lispro insulin must be combined with intermediate- or long-acting insulin not regular insulin, which is also a short-duration insulin, for glucose control between meals and at night. To achieve tight glycemic control, patients must combine different types of insulin based on duration of action.

44. A patient who is newly diagnosed with type 1 diabetes asks a nurse, "How does insulin normally work in my body?" The nurse explains that normal insulin has which of these actions in the body?

A) Stimulates the pancreas to reabsorb glucose
B) Promotes synthesis of amino acids into glucose
C) Stimulates the liver to convert glycogen to glucose
D) Promotes the passage of glucose into cells for energy

D) Promotes the passage of glucose into cells for energy

Insulin is a hormone that promotes the passage of glucose into cells, where it is metabolized for energy. Insulin does not stimulate the pancreas to reabsorb glucose or synthesize amino acids into glucose. It does not stimulate the liver to convert glycogen into glucose.

45. A patient is taking glipizide (Glucotrol) and a beta-adrenergic medication. A nurse is teaching hypoglycemia awareness and should tell the patient that which of these symptoms may not occur?

A) Vomiting
B) Muscle cramps
C) Tachycardia
D) Chills

C) Tachycardia

Glipizide is a sulfonylurea oral hypoglycemic medication that acts to promote insulin release from the pancreas. Beta-adrenergic blockers can mask early signs of sympathetic system responses (most importantly, tachycardia) to hypoglycemia, which is the most common adverse effect of glipizide. Vomiting, muscle cramps, and chills are not symptoms of activation of the sympathetic nervous system that arise when glucose levels fall.

46. A nurse assesses a patient who is taking pramlintide (Symlin) with mealtime insulin. Which of these findings should require immediate follow-up by the nurse?

A) Skin rash
B) Sweating
C) Itching
D) Pedal edema

B) Sweating

Pramlintide is a new type of antidiabetic medication that is used as a supplement to mealtime insulin in type 1 and 2 diabetes. Hypoglycemia, which is manifested by sweating, tremors, and tachycardia, is the adverse reaction of most concern. Skin rash, itching, and edema are not adverse effects of pramlintide.

47. Which of these characteristics should a nurse associate with a patient who has type 2 diabetes? (Select all that apply.)

A) Exercise and diet may be sufficient treatment
B) Is often obese with difficulty managing weight
C) Prone to ketosis and ketoacidosis complications
D) Genetics and strong familial links are causal factors
E) Insulin resistance and inappropriate secretion

A
B
D
E

48. A nurse caring for a patient who has diabetic ketoacidosis recognizes which of these characteristics in the patient? (Select all that apply.)

A) Occurs mainly in type 2 diabetes patients
B) Altered fat metabolism leading to ketones
C) Arterial blood pH of 7.35 to 7.45
D) Sudden onset, triggered by acute illness
E) Plasma osmolality of 300 to 320 milliosmoles/L

B
D
E

49. A postoperative patient has an epidural infusion of morphine sulfate (Astramorph). The patient's respiratory rate declines to 8 breaths/min. Which medication would the nurse anticipate administering?

A) Naloxone (Narcan)
B) Acetylcysteine (Mucomyst)
C) Methylprednisolone (Solu-Medrol)
D) Protamine sulfate

A) Naloxone (Narcan)

Naloxone is a narcotic antagonist that can reverse the effects, both adverse and therapeutic, of opioid narcotic analgesics.

50. The nurse is planning care for a patient receiving morphine sulfate (Duramorph) by means of a patient-controlled analgesia (PCA) pump. Which intervention may be required because of a potential adverse effect of this drug?

A) Administer cough suppressant.
B) Insert Foley catheter.
C) Administer antidiarrheal.
D) Monitor liver function tests.

B) Insert Foley catheter.

Morphine can cause urinary hesitancy and urinary retention. If bladder distention or the inability to void is noted, the prescriber should be notified. Urinary catheterization may be required. Morphine acts as a cough suppressant and an antidiarrheal, so neither of those drugs would need to be administered to counteract an adverse effect of morphine. Liver toxicity is not a common adverse effect of morphine.

51. A patient admitted to the hospital with a diagnosis of pneumonia asks the nurse, "Why am I receiving codeine? I don't have any pain." The nurse's response is based on the knowledge that codeine also has which effect?

A) Immunostimulant
B) Antitussive
C) Expectorant
D) Immunosuppressant

B) Antitussive

Codeine provides both analgesic and antitussive therapeutic effects.

52. A patient takes oxycodone (OxyContin), 40 mg PO twice daily, for the management of chronic pain. Which intervention should be added to the plan of care to minimize the gastrointestinal adverse effects?

A) Take an antacid with each dose.
B) Eat foods high in lactobacilli.
C) Take the medication on an empty stomach.
D) Increase fluid and fiber in the diet.

D) Increase fluid and fiber in the diet.

Narcotic analgesics reduce intestinal motility, leading to constipation. Increasing fluid and fiber in the diet can help manage this adverse effect.

53. OxyContin

Oxycodone, Narcotic pain reliever, analgesic

54. Which agent below is most likely to cause serious respiratory depression as a potential adverse reaction?

A) Morphine (Duramorph)
B) Pentazocine (Talwin)
C) Hydrocodone (Lortab)
D) Nalmefene (Revex)

A) Morphine (Duramorph)

Morphine is a strong opioid agonist and as such has the highest likelihood of respiratory depression. Pentazocine, a partial agonist, and hydrocodone, a moderate to strong agonist, may cause respiratory depression but not as often and serious as morphine. Nalmefene is an opioid antagonist and would be used to reverse respiratory depression with opioids.

55. The nurse is working on a postoperative unit where pain management is part of routine care. Which statement below is the most helpful in guiding clinical practice in this setting?

A) At least 30% of the U.S. population is prone to drug addiction and abuse.
B) The development of opioid dependence is rare when opioids are used for acute pain.
C) Morphine is a common drug of abuse in the general population.
D) The use of PRN (as needed) dosing provides the most consistent pain relief without risk of addiction.

B) The development of opioid dependence is rare when opioids are used for acute pain.

56. A nurse administers naloxone (Narcan) to a postoperative patient experiencing respiratory sedation. What undesirable effect would the nurse anticipate after giving this medication?

A) Drowsiness
B) Tics and tremors
C) Increased pain
D) Nausea and vomiting

C) Increased pain

Naloxone is a medication that reverses the effects of narcotics. Although the patient's respiratory status will improve after the administration of naloxone, pain will be more acute.

57. The client informs the nurse that he has experienced pain in the lower extremities for the past eight months. The nurse recognizes that this pain is classified as:


a.) Moderate.
b.) Severe.
c.) Acute.
d.) Chronic.

d.) Chronic.

Chronic pain persists longer than six months.

58. A client who incurred an arm injury describes his pain as "sharp and localized to the lower arm." The nurse recognizes that this type of pain would be relieved best by administration of which type of medication?

a.) Muscle relaxant
b.) Acetaminophen
c.) Narcotic analgesics
d.) Ice packs

c.) Narcotic analgesics

Injury to tissues produces nociceptor pain, which usually responds to conventional analgesic pain medications such as opiates or NSAIDS.

59. The nurse teaches the client relaxation techniques and guided imagery as an adjunct to medication for treatment of pain. The nurse explains that the major benefit of these techniques is that they:

a.) Are less costly.
b.) Allow lower doses of drugs with fewer side effects.
c.) Can be used at home or in any environment.
d.) Do not require self-injection.

b.) Allow lower doses of drugs with fewer side effects.

When used concurrently with medication, non-pharmacologic techniques can allow for lower doses, and possibly fewer drug-related adverse effects. The other options also are advantages to guided imagery and relaxation, but not the major one.

60. The nurse recognizes that opioid analgesics exert their action by interacting with a variety of opioid receptors. Drugs such as morphine act by activating

Mu and kappa

61. The client admitted with hepatitis B is prescribed Vicodin tabs 2 for treatment of pain. The appropriate nursing action is to:


a.) Administer the drug as ordered.
b.) Administer one tablet only.
c.) Question the physician about the order.
d.) Hold the drug until the physician arrives.

c.) Question the physician about the order.

Vicodin is a combination drug of hydrocodone and acetaminophen. Acetaminophen can be hepatotoxic, and is contraindicated in liver disease.

62. The nurse administers morphine sulfate 4 mg IV to a client for treatment of severe pain. Which of the following assessments requires immediate nursing interventions?

a.) Blood pressure 110/70
b.) The client is drowsy.
c.) Pain is unrelieved in 15 minutes.
d.) Respiratory rate 10/minute

d.) Respiratory rate 10/minute

Opioids activate mu and kappa receptors that can cause profound respiratory depression. Respiratory rate should remain above 12. The BP is not significantly low. Drowsiness is an expected effect of morphine. Unrelieved pain warrants further assessment, but not as immediately as do decreased respirations.

63. Nursing intervention for a client receiving opioid analgesics over an extended period of time should include:

a.) Referring the client to a drug treatment center.
b.) Encouraging increased fluids and fiber in the diet.
c.) Monitoring for G.I. bleeding.
d.0 Teaching the client to take her own blood pressure.

b.) Encouraging increased fluids and fiber in the diet.

Opioids suppress intestinal contractility, increase anal sphincter tone, and inhibit fluids into the intestines, which can lead to constipation. There is nothing to indicate the drug is related to addiction problems. Opioids do not cause GI bleeding.

64. Naloxone (Narcan) is administered to a client with severe respiratory depression and suspected drug overdose. After 20 minutes, the client remains unresponsive. The most likely explanation for this is:


a.) The client did not use an opioid drug.
b.) The dose of naloxone was inadequate.
c.) The client is resistant to this drug.
d.) The drug overdose is irreversible.

a.) The client did not use an opioid drug.

If opioid antagonists (Naloxone) fail to reverse symptoms of respiratory depression quickly, the overdose was likely due to a non-opioid substance.

65. Celecoxib (Celebrex) is added to the treatment regimen of a client with arthritis. The nurse explains that the major advantage of this drug is:


a.) The drug is less expensive.
b.) The drug has no known side effects.
c.) The drug has anti-inflammatory properties.
d.) The drug's effectiveness is the same as opioids.

c.) The drug has anti-inflammatory properties.

Celecoxib (Celebrex) has anti-inflammatory properties. It is not less expensive, has many side effects, and is less potent than opioids.

66. The client is prescribed ketorolac tromethamine (Toradol) for treatment of pain following a surgical procedure. The nurse should question which of the following drug orders?

a.) Toradol 10 mg p.o. b.i.d.
b.) Toradol 20 mg p.o. b.i.d
c.) Toradol 5 mg p.o. t.i.d.
d.) Toradol 20 mg p.o q.i.d

b.) Toradol 20 mg p.o. b.i.d

The maximum daily dose of Toradol is 40 mg.

67. Blood sugar is well controlled when Hemoglobin A1C is:

a. Below 7%
b. Between 12%-15%
c. Less than 180 mg/dL
d. Between 90 and 130 mg/dL

a. Below 7%

A1c measures the percentage of hemoglobin that is glycated and determines average blood glucose during the two to three months prior to testing. Used as a diagnostic tool, A1C levels of 6.5% or higher on two tests indicate diabetes. A1C of 6% to 6.5% is considered prediabetes.

68. Untreated hyperglycemia may lead to all of the following complications except:

a. Hyperosmolar syndrome
b Vitiligo
c. Diabetic ketoacidosis
d. Coma

B.

Excessively high blood sugar or prolonged hyperglycemia can cause diabetic ketoacidosis, the condition in which the body breaks down fat for energy and ketones spill into the urine. Diabetic hyperosmolar syndrome occurs when blood sugar is excessively high and available insulin is ineffective. In this case, the body cannot use glucose or fat for energy and glucose is excreted in the urine. Without immediate medical attention, both conditions may result in coma or death.

69. Which of the following diabetes drugs acts by decreasing the amount of glucose produced by the liver?

a. Sulfonylureas
b. Meglitinides
c. Biguanides
d. Alpha-glucosidase inhibitors

c. Biguanides

Biguanides, such as metformin, lower blood glucose by reducing the amount of glucose produced by the liver.

Sulfonylureas and Meglitinides stimulate the beta cells of the pancreas to produce more insulin.

Alpha-glucosidase inhibitors block the breakdown of starches and some sugars, which helps to reduce blood glucose levels

70. The benefits of using an insulin pump include all of the following except:

a. By continuously providing insulin they eliminate the need for injections of insulin
b. They simplify management of blood sugar and often improve A1C
c. They enable exercise without compensatory carbohydrate consumption
d. They help with weight loss

d. They help with weight loss

Using an insulin pump has many advantages, including fewer dramatic swings in blood glucose levels, increased flexibility about diet, and improved accuracy of insulin doses and delivery; however, the use of an insulin pump has been associated with weight gain.

71. Which of the following regimens offers the best blood glucose control for persons with type 1 diabetes?

a. A single anti-diabetes drugs
b. Once daily insulin injections
c. A combination of oral anti-diabetic medications
d. Three or four injections per day of different types of insulin.

D. Three or four injections per day of different types of insulin.

Because persons with type 1 diabetes do not produce insulin, they require insulin and cannot be treated with oral anti-diabetic drugs.

Several injections of insulin per day, calibrated to respond to measured blood glucose levels, offer the best blood glucose control and may prevent or postpone the retinal, renal, and neurological complications of diabetes.

72. A patient has just been diagnosed with diabetes mellitus. His doctor has requested glucagon for emergency use at home. The nurse instructs the patient that the purpose of this drug is to treat:

A. Hyperglycemia from insufficient insulin injection.
B. Hyperglycemia from eating a large meal.
C. Hypoglycemia from insulin overdose.
D. Lipohypertrophy from inadequate insulin absorption.

C. Hypoglycemia from insulin overdose.

Glucagon is for emergency use for insulin overdose. The patient will usually arouse within 20 minutes if unconscious.

The family should also be instructed how to use the glucagon injection as well.

73. Which of the following statements from a newly diagnosed client with diabetes indicates more instruction is needed?

A.) i need to check my feet daily for sores
B.) i need to store my insulin in the refrigerator
C.) i can use my plastic insulin syringe more than once
D.) i need to see my doctor for follow up exams

B.) i need to store my insulin in the refrigerator


Insulin only needs to be stored in the refrigerator if it wont be used within 6 weeks, after being opened. It should be at room temperature when given to decrease pain and prevent lipodystrophy.

74. Following heparin treatment for a pulmonary embolism, a client is being discharged with a prescription for warfarin (Coumadin). In conducting discharge teaching, the nurse advises the client to have which diagnostic test monitored regularly after discharge?

A) Perfusion scan
B) Prothrombin Time (PT/INR)
C) Activated partial thromboplastin (APTT)
D) Serum Coumadin level (SCL

B) Prothrombin Time (PT/INR)

75. The healthcare provider prescribes naproxen (Naproxen) twice daily for a client with osteoarthritis of the hands. The client tells the nurse that the drug does not seem to be effective after three weeks. Which is the best response for the nurse to provide?

A) The frequency of the dosing is necessary to increase the effectiveness.

B) Therapeutic blood levels of this drug are reached in 4 to 6 weeks.

C) Another type of nonsteroidal antiinflammatory drug may be indicated.

D) Systemic corticosteroids are the next drugs of choice for pain relief

C) Another type of nonsteroidal antiinflammatory drug may be indicated.

76. The nurse instructs a patient about how insulin affects blood glucose. Arrange the events in sequence.

1. Beta cells are stimulated to release insulin.
2. Glucose enters the bloodstream.
3. Glycogen is converted to glucose by alpha cells (glycogenesis).
4. Glycogen is stored in the liver.
5. Insulin transports glucose to muscle cells.

2
1
5
4
3

77. The teaching plan for a diabetic is focused on smoking cessation and control of hypertension for the avoidance of microvascular complications, such as (select all that apply):

1. macular degeneration.
2. end-stage renal disease (ESRD).
3. coronary artery disease (CAD).
4. peripheral vascular disease (PVD).
5. cerebrovascular accident (CVA).

ANS: 1, 2
Macular degeneration and ESRD are both microvascular complications. CAD, PVD, and CVA are all macrovascular complications.

78. The patient has been admitted with hyperglycemic hyperosmolar nonketotic syndrome (HHNKS). Her blood glucose level is very high (880 mg/dL on admission). The physician believes that her condition is to the result of large amounts of glucose solutions administered intravenously during kidney dialysis. The nurse would anticipate that the patient would exhibit:

1. a fruity breath and high level of
ketones in her urine.
2. severe dehydration and hypernatremia caused by the hyperglycemia.
3. exactly the same symptoms and signs as diabetic ketoacidosis.
4. Kussmaul's respirations, nausea, and vomiting.

2. severe dehydration and hypernatremia caused by the hyperglycemia.

IV solutions containing glucose will bypass the digestive system, so there is no trigger for the pancreas to release insulin, but there is just enough insulin to prevent the breakdown of fatty acids and the formation of ketones.

79. The nurse giving Humulin R 20 U at 7 AM is aware that this drug will peak in:

1. 15 minutes.
2. 30 minutes.
3. 1 hour.
4. 2 hours.

Humulin R has its onset in about 15 minutes, but its peak is in 2 hours.

80. When the Type 1 diabetic patient asks why his 7 AM insulin has been changed from NPH insulin to 70/30 premixed insulin, the nurse explains that 70/30 insulin:
1. is absorbed more rapidly into the bloodstream.
2. has no peak action time and lasts all day.
3. makes insulin administration easier and safer.
4. give a bolus of rapid-acting insulin to prevent hyperglycemia after breakfast.

the morning meal.

4. give a bolus of rapid-acting insulin to prevent hyperglycemia after breakfast.



70/30 insulin is 30% rapid-acting and 70% intermediate-acting insulin. The rapid action of the 7 AM premixed insulin prevents hyperglycemia after the morning meal.

81. The type 1 diabetic patient has an insulin order for NPH insulin, 35 U, to be given at 7 AM. The patient is also NPO for laboratory work that will not be drawn until 10 AM. The nurse
should:

1. give the insulin as ordered.
2. give the insulin with a small snack.
3. inform the charge nurse.
4. hold the insulin until after the blood draw.

4. hold the insulin until after the blood


Holding the insulin for the NPO order is appropriate. The patient will not be getting food until after the blood draw, so will not need the insulin until then. Giving the insulin as ordered will create a possibility of hypoglycemia before the blood is drawn. Giving a snack to a patient who is NPO is inappropriate.

82. A patient has come to the doctor's office after finding out that her blood glucose level was 135 mg/dL. She states that she had not eaten before the test and was told to come and see her doctor. She asks you if she has
diabetes. The nurse responds:

1. "Having a fasting serum glucose that high certainly indicates diabetes."
2. "That test indicates that we need to do more tests that are specific for diabetes."
3. "How do you feel? Do you have any other signs of diabetes?"
4. "Do you have a family history of diabetes, stroke, or heart disease? We need to know before making a diagnosis."

2. "That test indicates that we need to do more tests that are specific for diabetes

The nurse needs to answer the patient's question in a way that gives information and is not misleading. Although 135 is high, there may be a nonpathologic explanation. More tests should be done to evaluate the patient.

83. A patient has come into the emergency room with her friend. Her friend states that she had been acting very strangely and confused. The friend states that the patient has diabetes and takes insulin. The nurse knows that signs and symptoms of hypoglycemia include:

1. slow pulse rate and low blood pressure.
2. irritability, anxiety, confusion, and dizziness.
3. flushing, anger, and forgetfulness.
4. sleepiness, edema, and sluggishness.

2. irritability, anxiety, confusion, and dizziness

When blood sugar levels fall, hormones are activated to increase serum glucose. One of the hormones is epinephrine, which causes these symptoms.

84. The nurse is drawing up a teaching plan for a patient who has type 1 diabetes. The doctor has ordered two types of insulin, 10 U of regular insulin and 35 U of NPH insulin. The proper procedure is to:

1. draw up the insulins in two separate syringes so that there can be no confusion.

2. draw up the regular insulin before drawing up the NPH insulin.

3. inject air into the NPH insulin, draw it up to 35 U, then inject air into the clear regular insulin and withdraw to 45 U.

4. inject 35 U air into the NPH insulin, inject 10 U air into the regular insulin, withdraw 10 U of the regular insulin, and withdraw 35 U of the NPH insulin.

4. inject 35 U air into the NPH insulin, inject 10 U air into the regular insulin, withdraw 10 U of the regular insulin, and withdraw 35 U of the NPH insulin.


When drawing up two insulins, the vials are injected with air and the regular insulin is drawn first. This slow and time-consuming activity has been greatly reduced with the advent of premixed insulins.

85. The home health nurse is assessing a type 1 diabetic patient who has been controlled for 6 months. The nurse is surprised and concerned about a blood glucose reading of 52. This episode of hypoglycemia is probably caused by the patient's having:

1. taken a new form of birth control pill this morning.
2. used large amounts of sugar substitute in her tea this morning.
3. had a 2-hour long exercise class at the spa this morning.
4. underdosed herself with insulin this morning.

ANS: 3
Excessive exercise used up the glucose that was made available by the insulin taken by the patient. The patient now has too much insulin for the available glucose and has become hypoglycemic.

86. The patient with type 2 diabetes shows a blood sugar reading of 72 at 6 AM. Based on the reading of 72, the nurse should:

1. notify the charge nurse of the reading.
2. give regular insulin per sliding scale.
3. give him cup of milk.
4. administer the oral hyperglycemic tablet.

ANS: 3 milk

The patient is hypoglycemic and needs an immediate source of glucose, such as milk or orange juice. The oral hyperglycemic agent will not work quickly enough. Notifying the charge nurse can be done later. Giving insulin per sliding scale would lower the blood sugar level.

87. When the type 2 diabetic patient says, "Why in the world are they looking at my hemoglobin? I thought my problem was with my blood sugar." The nurse responds that the level of hemoglobin A1c:

1. shows how a high glucose level can cause a significant drop in the hemoglobin level.
2. shows what the glucose level has done for the last 3 months.
3. indicates a true picture of the patient's nutritional state.
4. reflects the effect of high glucose levels on the ability to produce red blood cells.

ANS: 2

By analyzing the amount of glucose bound to the hemoglobin, the level of blood glucose can be evaluated for the last 3 months, because the glucose stays bound to the hemoglobin for the life of the red blood cell (RBC).

88. When a newly diagnosed type 2 diabetes mellitus patient asks the nurse why she has to take a pill instead of insulin, you reply that in type 2 diabetes, the body makes insulin but:

1. overweight and underactive people simply cannot use the insulin produced.
2. metabolism is slowed in some people so they have to take a pill to speed up their metabolism.
3. sometimes the autoimmune system works against the action of the insulin.
4. the cells become resistant to the action of insulin. Pills are given to increase the sensitivity.

ANS: 4

Type 2 diabetes mellitus is a disease in which the cells become resistant to the action of insulin and the blood glucose level rises. Oral hyperglycemic agents make the cells more sensitive.

89. The nurse is caring for a patient whose seizures are characterized by a 10- to 30-second loss of consciousness with mild symmetric eye blinking. Which seizure type does this most closely illustrate?

A) Tonic-clonic
B) Absence
C) Atonic
D) Myoclonic

B) Absence


This scenario accurately describes absence seizures.

Tonic-clonic seizures present with convulsions and muscle rigidity followed by muscle jerks. Patients may experience urinary incontinence and loss of consciousness.

Atonic seizures cause sudden loss of muscle tone.

Myoclonic seizures present with sudden muscle contractions that last but a second.

90. The nurse is teaching a patient who is newly diagnosed with epilepsy about her disease. Which statement made by the nurse best describes the goals of
antiepilepsy medication therapy?

A) "With proper treatment we can completely eliminate your seizures."

B) "Our goal is to reduce your seizures to an extent that helps you live a normal life."

C) "Epilepsy medication does not reduce seizures in most patients."

D) "These drugs will help control your seizures until you have surgery."

B) "Our goal is to reduce your seizures to an extent that helps you live a normal life."

Epilepsy is treated successfully with medication in a majority of patients. However, the dosages needed to completely eliminate seizures may cause intolerable side effects. Neurosurgery is indicated only for patients in whom medication therapy is unsuccessful.

91. The nurse is assessing a patient receiving valproic acid (Depakene) for potential adverse effects associated with this drug. Which item represents the most common problem with this drug?

A) Increased risk for infection
B) Reddened, swollen gums
C) Nausea, vomiting, and indigestion
D) Central nervous system depression

D) Central nervous system depression

Valproic acid is generally well tolerated.
It does not cause hematologic effects resulting in increased risk for infection nor does it cause gingival hyperplasia.

It causes minimal sedation.

Gastrointestinal effects, which include nausea, vomiting, and indigestion, are the most common problems but tend to subside with use and can be lessened by giving with food.

92. The nurse is preparing to give ethosuximide (Zarontin). The nurse understands that this drug is only indicated for which seizure type?

A) Tonic-clonic
B) Absence
C) Simple partial
D) Complex partial

B) Absence

Absence seizures are the only indication for ethosuximide. The drug effectively eliminates absence seizures in approximately 60% of patients and effectively controls 80% to 90% of cases.

93. The nurse is conducting discharge teaching related to a new prescription for phenytoin (Dilantin). Which statements are appropriate to include in the teaching for this patient and his family? Select all that apply.

A) "Be sure to call the clinic if you or your family notice increased anxiety or agitation."

B) "You may have some mild sedation. Do not drive until you know how this drug will affect you."

C) "This drug may cause easy bruising. If you notice this, call the clinic immediately."

D) "It is very important to have good oral hygiene and visit your dentist regularly."

E) "You may continue to have wine with your evening meals but only in moderation."

A, B, D

Patients receiving an antiepileptic drug are at increased risk for suicidal thoughts and behavior beginning early in their treatment. The U.S. Food and Drug Administration (FDA) advises that patients, families, and caregivers be informed of the signs that may precede suicidal behavior and be encouraged to report these immediately. Mild sedation can occur in patients taking phenytoin even at therapeutic levels.

Carbamazepine(Tegretol), not phenytoin, increases the risk for hematologic effects, such as easy bruising.

Phenytoin causes gingival hyperplasia in about 20% of patients who take it. Dental hygiene is important.

Patients receiving phenytoin should avoid alcohol and other central nervous system depressants because they have an additive depressant effect.

94. The nurse receives a lab report indicating that the phenytoin (Dilantin) level for the patient she saw in the clinic yesterday is 16 mcg/mL. Which intervention is most appropriate?

A) Continue as planned since the level is within normal limits.
B) Tell the patient to hold today's dose and return to the clinic.
C) Consult the prescriber to recommend an increased dose.
D) Have the patient call 911 and meet the patient in the emergency department.

A) Continue as planned since the level is within normal limits

95. Which of the following statements made by a client taking phenytoin indicates understanding of the nurse's teaching?

A. "I will increase the dose if my seizures don't stop."
B. "I don't need to contact my health care provider before taking an over-the-counter cold remedy."
C. "I will take good care of my teeth and see my dentist regularly."
D. "I cannot take this drug with food."

C. "I will take good care of my teeth and see my dentist regularly."

96. A 20-year-old client presents to the clinic with complaints of breast tenderness, nausea, vomiting, and absence of menses for 2 months. She has a history of a seizure disorder well controlled with carbamazepine (Tegretol). She tells the nurse that she has been taking her oral contraceptives as directed, but she wonders if she might be pregnant. The nurse's best response to her concern should be which of the following?

A. "You can't be pregnant if you have been taking your oral contraceptives correctly."
B. "Carbamazepine can decrease the effectiveness of oral contraceptive drugs, so we need to do a pregnancy test."
C. "There is no need to worry. Oral contraceptives are very effective."
D. "Taking antiseizure drugs with oral contraceptives significantly decreases your risk of getting pregnant."

B. "Carbamazepine can decrease the effectiveness of oral contraceptive drugs, so we need to do a pregnancy test.

97. A client in the trauma ICU is experiencing deep, throbbing pain. The nurse will provide medication for this pain because:


A.) The pain is being transmitted over C fibers and the enkephalins will not be
effective to control the pain.

B.) The pain is being transmitted over A beta fibers and beta-endorphins will not be effective to control the pain.

c.) The pain is being transmitted over delta fibers and dynorphins will not be effective to control the pain.

d.) The pain is being transmitted over A beta fibers and the dynophins will not be effective to control the pain.

A.) The pain is being transmitted over C fibers and the enkephalins will not be
effective to control the pain.

98. A client in the ICU tells the nurse he is experiencing severe pain. Prior to administering a narcotic analgesic to this client, the nurse will conduct a pain assessment to include:

a.) Pain
b.) Nociception
c.) Pain behaviors
d.) Suffering

c.) pain behavior

There is a theory that addresses pain as having four facets: nociception, pain, suffering, and pain behaviors. Of these four facets, only the fourth, pain behavior, can be observed. This nurse will only be able to assess the client's pain behavior in the pain assessment.

99. A client in the ICU who sustained a traumatic abdominal injury 1 week ago continues to complain of severe pain. The nurse notes his vital signs are normal. Which of the following would be appropriate for the nurse to do?



a.) Encourage early return to ambulation.
b.) Offer nonnarcotic analgesics for pain.
c.) Utilize distraction
d.) Provide the client with pain medication.

D.) Provide the client with pain medication.

100. The nurse is creating a pain management plan for a client with a previous history of substance abuse. Which of the following should be included in this plan?

a.) Ask the physician to prescribe short-acting analgesics.
b.) Ask the physician to prescribe a medication similar to the one the client abused.
c.) Ask the physician to prescribe all analgesics for the oral route.
d.) Keep a dose of Narcan at the bedside.

C.) Ask the physician to prescribe all analgesics for the oral route.

Extended-release and long-acting analgesics are recommended for clients with a history of abuse.
Specific interventions should avoid analgesics similar to the abused drug, utilize long-acting analgesics, avoid Narcan, and administer medications through the oral route.

101. The safest narcotic choice for an elderly client with acute pain is:


a. Meperidine (Demerol).
b. Oxycodone.
c. Fentanyl transdermal patch.
d. Morphine sulfate.

d. Morphine sulfate.

Rationale: Morphine is the "gold standard" of narcotics for acute pain. The other choices are incorrect.

102. An elderly client had abdominal surgery six hours earlier. When the nurse asks the client about pain, the client responds that there is none. The best intervention on the part of the nurse is:

a. Administer a PRN dose of IV pain medication as ordered.
b. Assist the client into a sitting position in preparation for ambulation.
c. Question the client further about discomfort to assess the meaning of pain.
d. Assess the abdominal dressing and consult the surgeon about findings.

c. Question the client further about discomfort to assess the meaning of pain.

103. A resident of the nursing home has quite severe arthritis. When administering an analgesic to this elderly resident, the nurse should:


a. Give the medication before the activity session in the day room.
b. Give the medication when the resident states the pain is at 6 or higher on a 1-10 pain scale.
c. Give the pain medication at mealtime.
d. Make sure that the medication is not a narcotic.

a. Give the medication before the activity session in the day room.

104. Two days after surgery, an elderly client refuses a PRN dose of analgesic dose for fear of becoming "hooked." The nurse should respond by stating that:


a. It is impossible to become hooked on PRN narcotics.
b. Short-term use of narcotics is not likely to cause a person to become dependent on them.
c. Side effects that occur in the elderly mean that medications will be discontinued as soon as possible.
d. The elderly are least likely to become dependent on narcotics.

b. Short-term use of narcotics is not likely to cause a person to become dependent on them.

105. When an elderly client with cancer experiences "breakthrough pain," the nurse should expect that pharmacological treatment will include:


a. Initiation of a placebo after every third dose of narcotic.
b. More aggressive chemotherapy.
c. Giving narcotics every hour.
d. Increasing the dose of the narcotic.

d. Increasing the dose of the narcotic.

106. A patient with newly diagnosed type 2 diabetes mellitus asks the nurse what "type 2" means in relation to diabetes. The nurse explains to the patient that type 2 diabetes differs from type 1 diabetes primarily in that with type 2 diabetes

a. the patient is totally dependent on an outside source of insulin.
b. there is decreased insulin secretion and cellular resistance to insulin that is produced.
c. the immune system destroys the pancreatic insulin-producing cells.
d. the insulin precursor that is secreted by the pancreas is not activated by the liver.

B

Rationale: In type 2 diabetes, the pancreas produces insulin, but the insulin is insufficient for the body's needs or the cells do not respond to the insulin appropriately. The other information describes the physiology of type 1 diabetes.

107. A patient screened for diabetes at a clinic has a fasting plasma glucose level of 120 mg/dl (6.7 mmol/L). The nurse will plan to teach the patient about

a. use of low doses of regular insulin.
b. self-monitoring of blood glucose.
c. oral hypoglycemic medications.
d. maintenance of a healthy weight.

D

Rationale: The patient's impaired fasting glucose indicates prediabetes and the patient should be counseled about lifestyle changes to prevent the development of type 2 diabetes. The patient with prediabetes does not require insulin or the oral hypoglycemics for glucose control and does not need to self-monitor blood glucose.

108. When assessing the patient experiencing the onset of symptoms of type 1 diabetes, which question should the nurse ask?

a. "Have you lost any weight lately?"
b. "Do you crave fluids containing sugar?"
c. "How long have you felt anorexic?"
d. "Is your urine unusually dark-colored?"

A
Rationale: Weight loss occurs because the body is no longer able to absorb glucose and starts to break down protein and fat for energy. The patient is thirsty but does not necessarily crave sugar- containing fluids. Increased appetite is a classic symptom of type 1 diabetes. With the classic symptom of polyuria, urine will be very dilute.

109. During a clinic visit 3 months following a diagnosis of type 2 diabetes, the patient reports following a reduced-calorie diet. The patient has not lost any weight and did not bring the glucose-monitoring record. The nurse will plan to obtain a(n)

a. fasting blood glucose level.
b. urine dipstick for glucose.
c. glycosylated hemoglobin level.
d. oral glucose tolerance test.

C


Rationale: The glycosylated hemoglobin (Hb A1C) test shows the overall control of glucose over 90 to 120 days.

A fasting blood level indicates only the glucose level at one time.

Urine glucose testing is not an accurate reflection of blood glucose level and does not reflect the glucose over a prolonged time.

Oral glucose tolerance testing is done to diagnose diabetes, but is not used for monitoring glucose control once diabetes has been diagnosed.

101. A college student who has type 1 diabetes normally walks each evening as part of an exercise regimen. The student now plans to take a swimming class every day at 1:00 PM. The clinic nurse teaches the patient to

a. delay eating the noon meal until after the swimming class.
b. increase the morning dose of neutral protamine Hagedorn (NPH) insulin on days of the swimming class.
c. time the morning insulin injection so that the peak occurs while swimming.
d. check glucose level before, during, and after swimming.

D
Rationale: The change in exercise will affect blood glucose, and the patient will need to monitor glucose carefully to determine the need for changes in diet and insulin administration. Because exercise tends to decrease blood glucose, patients are advised to eat before exercising. Increasing the morning NPH or timing the insulin to peak during exercise may lead to hypoglycemia, especially with the increased exercise.

1) A nurse is caring for a client with hyperparathyroidism and notes that the client's serum calcium level is 13 mg/dL. Which medication should the nurse prepare to administer as prescribed to the client?
1. Calcium chloride
2. Calcium gluconate
3. Calcitonin (Miacalcin)
4. Large doses of vitamin D

3. Calcitonin (Miacalcin)
Rationale:
The normal serum calcium level is 8.6 to 10.0 mg/dL. This client is experiencing hypercalcemia. Calcium gluconate and calcium chloride are medications used for the treatment of tetany, which occurs as a result of acute hypocalcemia. In hypercalcemia, large doses of vitamin D need to be avoided. Calcitonin, a thyroid hormone, decreases the plasma calcium level by inhibiting bone resorption and lowering the serum calcium concentration.

2.) Oral iron supplements are prescribed for a 6-year-old child with iron deficiency anemia. The nurse instructs the mother to administer the iron with which best food item?
1. Milk
2. Water
3. Apple juice
4. Orange juice

4. Orange juice
Rationale:
Vitamin C increases the absorption of iron by the body. The mother should be instructed to administer the medication with a citrus fruit or a juice that is high in vitamin C. Milk may affect absorption of the iron. Water will not assist in absorption. Orange juice contains a greater amount of vitamin C than apple juice.

3.) Salicylic acid is prescribed for a client with a diagnosis of psoriasis. The nurse monitors the client, knowing that which of the following would indicate the presence of systemic toxicity from this medication?
1. Tinnitus
2. Diarrhea
3. Constipation
4. Decreased respirations

1. Tinnitus
Rationale:
Salicylic acid is absorbed readily through the skin, and systemic toxicity (salicylism) can result. Symptoms include tinnitus, dizziness, hyperpnea, and psychological disturbances. Constipation and diarrhea are not associated with salicylism.

4.) The camp nurse asks the children preparing to swim in the lake if they have applied sunscreen. The nurse reminds the children that chemical sunscreens are most effective when applied:
1. Immediately before swimming
2. 15 minutes before exposure to the sun
3. Immediately before exposure to the sun
4. At least 30 minutes before exposure to the sun

4. At least 30 minutes before exposure to the sun
Rationale:
Sunscreens are most effective when applied at least 30 minutes before exposure to the sun so that they can penetrate the skin. All sunscreens should be reapplied after swimming or sweating.

5.) Mafenide acetate (Sulfamylon) is prescribed for the client with a burn injury. When applying the medication, the client complains of local discomfort and burning. Which of the following is the most appropriate nursing action?
1. Notifying the registered nurse
2. Discontinuing the medication
3. Informing the client that this is normal
4. Applying a thinner film than prescribed to the burn site

3. Informing the client that this is normal
Rationale:
Mafenide acetate is bacteriostatic for gram-negative and gram-positive organisms and is used to treat burns to reduce bacteria present in avascular tissues. The client should be informed that the medication will cause local discomfort and burning and that this is a normal reaction; therefore options 1, 2, and 4 are incorrect

6.) The burn client is receiving treatments of topical mafenide acetate (Sulfamylon) to the site of injury. The nurse monitors the client, knowing that which of the following indicates that a systemic effect has occurred?
1.Hyperventilation
2.Elevated blood pressure
3.Local pain at the burn site
4.Local rash at the burn site

1.Hyperventilation
Rationale:
Mafenide acetate is a carbonic anhydrase inhibitor and can suppress renal excretion of acid, thereby causing acidosis. Clients receiving this treatment should be monitored for signs of an acid-base imbalance (hyperventilation). If this occurs, the medication should be discontinued for 1 to 2 days. Options 3 and 4 describe local rather than systemic effects. An elevated blood pressure may be expected from the pain that occurs with a burn injury.

7.) Isotretinoin is prescribed for a client with severe acne. Before the administration of this medication, the nurse anticipates that which laboratory test will be prescribed?
1. Platelet count
2. Triglyceride level
3. Complete blood count
4. White blood cell count

2. Triglyceride level
Rationale:
Isotretinoin can elevate triglyceride levels. Blood triglyceride levels should be measured before treatment and periodically thereafter until the effect on the triglycerides has been evaluated. Options 1, 3, and 4 do not need to be monitored specifically during this treatment.

8.) A client with severe acne is seen in the clinic and the health care provider (HCP) prescribes isotretinoin. The nurse reviews the client's medication record and would contact the (HCP) if the client is taking which medication?
1. Vitamin A
2. Digoxin (Lanoxin)
3. Furosemide (Lasix)
4. Phenytoin (Dilantin)

1. Vitamin A
Rationale:
Isotretinoin is a metabolite of vitamin A and can produce generalized intensification of isotretinoin toxicity. Because of the potential for increased toxicity, vitamin A supplements should be discontinued before isotretinoin therapy. Options 2, 3, and 4 are not contraindicated with the use of isotretinoin.

9.) The nurse is applying a topical corticosteroid to a client with eczema. The nurse would monitor for the potential for increased systemic absorption of the medication if the medication were being applied to which of the following body areas?
1. Back
2. Axilla
3. Soles of the feet
4. Palms of the hands

2. Axilla
Rationale:
Topical corticosteroids can be absorbed into the systemic circulation. Absorption is higher from regions where the skin is especially permeable (scalp, axilla, face, eyelids, neck, perineum, genitalia), and lower from regions in which permeability is poor (back, palms, soles).

10.) The clinic nurse is performing an admission assessment on a client. The nurse notes that the client is taking azelaic acid (Azelex). Because of the medication prescription, the nurse would suspect that the client is being treated for:
1. Acne
2. Eczema
3. Hair loss
4. Herpes simplex

1. Acne
Rationale:
Azelaic acid is a topical medication used to treat mild to moderate acne. The acid appears to work by suppressing the growth of Propionibacterium acnes and decreasing the proliferation of keratinocytes. Options 2, 3, and 4 are incorrect.

11.) The health care provider has prescribed silver sulfadiazine (Silvadene) for the client with a partial-thickness burn, which has cultured positive for gram-negative bacteria. The nurse is reinforcing information to the client about the medication. Which statement made by the client indicates a lack of understanding about the treatments?
1. "The medication is an antibacterial."
2. "The medication will help heal the burn."
3. "The medication will permanently stain my skin."
4. "The medication should be applied directly to the wound."

3. "The medication will permanently stain my skin."
Rationale:
Silver sulfadiazine (Silvadene) is an antibacterial that has a broad spectrum of activity against gram-negative bacteria, gram-positive bacteria, and yeast. It is applied directly to the wound to assist in healing. It does not stain the skin.

12.) A nurse is caring for a client who is receiving an intravenous (IV) infusion of an antineoplastic medication. During the infusion, the client complains of pain at the insertion site. During an inspection of the site, the nurse notes redness and swelling and that the rate of infusion of the medication has slowed. The nurse should take which appropriate action?
1. Notify the registered nurse.
2. Administer pain medication to reduce the discomfort.
3. Apply ice and maintain the infusion rate, as prescribed.
4. Elevate the extremity of the IV site, and slow the infusion.

1. Notify the registered nurse.
Rationale:
When antineoplastic medications (Chemotheraputic Agents) are administered via IV, great care must be taken to prevent the medication from escaping into the tissues surrounding the injection site, because pain, tissue damage, and necrosis can result. The nurse monitors for signs of extravasation, such as redness or swelling at the insertion site and a decreased infusion rate. If extravasation occurs, the registered nurse needs to be notified; he or she will then contact the health care provider.

13.) The client with squamous cell carcinoma of the larynx is receiving bleomycin intravenously. The nurse caring for the client anticipates that which diagnostic study will be prescribed?
1. Echocardiography
2. Electrocardiography
3. Cervical radiography
4. Pulmonary function studies

4. Pulmonary function studies
Rationale:
Bleomycin is an antineoplastic medication (Chemotheraputic Agents) that can cause interstitial pneumonitis, which can progress to pulmonary fibrosis. Pulmonary function studies along with hematological, hepatic, and renal function tests need to be monitored. The nurse needs to monitor lung sounds for dyspnea and crackles, which indicate pulmonary toxicity. The medication needs to be discontinued immediately if pulmonary toxicity occurs. Options 1, 2, and 3 are unrelated to the specific use of this medication.

14.) The client with acute myelocytic leukemia is being treated with busulfan (Myleran). Which laboratory value would the nurse specifically monitor during treatment with this medication?
1. Clotting time
2. Uric acid level
3. Potassium level
4. Blood glucose level

2. Uric acid level
Rationale:
Busulfan (Myleran) can cause an increase in the uric acid level. Hyperuricemia can produce uric acid nephropathy, renal stones, and acute renal failure. Options 1, 3, and 4 are not specifically related to this medication.

15.) The client with small cell lung cancer is being treated with etoposide (VePesid). The nurse who is assisting in caring for the client during its administration understands that which side effect is specifically associated with this medication?
1. Alopecia
2. Chest pain
3. Pulmonary fibrosis
4. Orthostatic hypotension

4. Orthostatic hypotension
Rationale:
A side effect specific to etoposide is orthostatic hypotension. The client's blood pressure is monitored during the infusion. Hair loss occurs with nearly all the antineoplastic medications. Chest pain and pulmonary fibrosis are unrelated to this medication.

16.) The clinic nurse is reviewing a teaching plan for the client receiving an antineoplastic medication. When implementing the plan, the nurse tells the client:
1. To take aspirin (acetylsalicylic acid) as needed for headache
2. Drink beverages containing alcohol in moderate amounts each evening
3. Consult with health care providers (HCPs) before receiving immunizations
4. That it is not necessary to consult HCPs before receiving a flu vaccine at the local health fair

3. Consult with health care providers (HCPs) before receiving immunizations
Rationale:
Because antineoplastic medications lower the resistance of the body, clients must be informed not to receive immunizations without a HCP's approval. Clients also need to avoid contact with individuals who have recently received a live virus vaccine. Clients need to avoid aspirin and aspirin-containing products to minimize the risk of bleeding, and they need to avoid alcohol to minimize the risk of toxicity and side effects.

17.) The client with ovarian cancer is being treated with vincristine (Oncovin). The nurse monitors the client, knowing that which of the following indicates a side effect specific to this medication?
1. Diarrhea
2. Hair loss
3. Chest pain
4. Numbness and tingling in the fingers and toes

4. Numbness and tingling in the fingers and toes
Rationale:
A side effect specific to vincristine is peripheral neuropathy, which occurs in almost every client. Peripheral neuropathy can be manifested as numbness and tingling in the fingers and toes. Depression of the Achilles tendon reflex may be the first clinical sign indicating peripheral neuropathy. Constipation rather than diarrhea is most likely to occur with this medication, although diarrhea may occur occasionally. Hair loss occurs with nearly all the antineoplastic medications. Chest pain is unrelated to this medication.

18.) The nurse is reviewing the history and physical examination of a client who will be receiving asparaginase (Elspar), an antineoplastic agent. The nurse consults with the registered nurse regarding the administration of the medication if which of the following is documented in the client's history?
1. Pancreatitis
2. Diabetes mellitus
3. Myocardial infarction
4. Chronic obstructive pulmonary disease

1. Pancreatitis
Rationale:
Asparaginase (Elspar) is contraindicated if hypersensitivity exists, in pancreatitis, or if the client has a history of pancreatitis. The medication impairs pancreatic function and pancreatic function tests should be performed before therapy begins and when a week or more has elapsed between administration of the doses. The client needs to be monitored for signs of pancreatitis, which include nausea, vomiting, and abdominal pain. The conditions noted in options 2, 3, and 4 are not contraindicated with this medication.

19.) Tamoxifen is prescribed for the client with metastatic breast carcinoma. The nurse understands that the primary action of this medication is to:
1. Increase DNA and RNA synthesis.
2. Promote the biosynthesis of nucleic acids.
3. Increase estrogen concentration and estrogen response.
4. Compete with estradiol for binding to estrogen in tissues containing high concentrations of receptors.

4. Compete with estradiol for binding to estrogen in tissues containing high concentrations of receptors.
Rationale:
Tamoxifen is an antineoplastic medication that competes with estradiol for binding to estrogen in tissues containing high concentrations of receptors. Tamoxifen is used to treat metastatic breast carcinoma in women and men. Tamoxifen is also effective in delaying the recurrence of cancer following mastectomy. Tamoxifen reduces DNA synthesis and estrogen response.

20.) The client with metastatic breast cancer is receiving tamoxifen. The nurse specifically monitors which laboratory value while the client is taking this medication?
1. Glucose level
2. Calcium level
3. Potassium level
4. Prothrombin time

2. Calcium level
Rationale:
Tamoxifen may increase calcium, cholesterol, and triglyceride levels. Before the initiation of therapy, a complete blood count, platelet count, and serum calcium levels should be assessed. These blood levels, along with cholesterol and triglyceride levels, should be monitored periodically during therapy. The nurse should assess for hypercalcemia while the client is taking this medication. Signs of hypercalcemia include increased urine volume, excessive thirst, nausea, vomiting, constipation, hypotonicity of muscles, and deep bone and flank pain.

21.) A nurse is assisting with caring for a client with cancer who is receiving cisplatin. Select the adverse effects that the nurse monitors for that are associated with this medication. Select all that apply.
1. Tinnitus
2. Ototoxicity
3. Hyperkalemia
4. Hypercalcemia
5. Nephrotoxicity
6. Hypomagnesemia

1. Tinnitus
2. Ototoxicity
5. Nephrotoxicity
6. Hypomagnesemia
Rationale:
Cisplatin is an alkylating medication. Alkylating medications are cell cycle phase-nonspecific medications that affect the synthesis of DNA by causing the cross-linking of DNA to inhibit cell reproduction. Cisplatin may cause ototoxicity, tinnitus, hypokalemia, hypocalcemia, hypomagnesemia, and nephrotoxicity. Amifostine (Ethyol) may be administered before cisplatin to reduce the potential for renal toxicity.

22.) A nurse is caring for a client after thyroidectomy and notes that calcium gluconate is prescribed for the client. The nurse determines that this medication has been prescribed to:
1. Treat thyroid storm.
2. Prevent cardiac irritability.
3. Treat hypocalcemic tetany.
4. Stimulate the release of parathyroid hormone.

3. Treat hypocalcemic tetany.
Rationale:
Hypocalcemia can develop after thyroidectomy if the parathyroid glands are accidentally removed or injured during surgery. Manifestations develop 1 to 7 days after surgery. If the client develops numbness and tingling around the mouth, fingertips, or toes or muscle spasms or twitching, the health care provider is notified immediately. Calcium gluconate should be kept at the bedside.

23.) A client who has been newly diagnosed with diabetes mellitus has been stabilized with daily insulin injections. Which information should the nurse teach when carrying out plans for discharge?
1. Keep insulin vials refrigerated at all times.
2. Rotate the insulin injection sites systematically.
3. Increase the amount of insulin before unusual exercise.
4. Monitor the urine acetone level to determine the insulin dosage.

2. Rotate the insulin injection sites systematically.
Rationale:
Insulin dosages should not be adjusted or increased before unusual exercise. If acetone is found in the urine, it may possibly indicate the need for additional insulin. To minimize the discomfort associated with insulin injections, the insulin should be administered at room temperature. Injection sites should be systematically rotated from one area to another. The client should be instructed to give injections in one area, about 1 inch apart, until the whole area has been used and then to change to another site. This prevents dramatic changes in daily insulin absorption.

24.) A nurse is reinforcing teaching for a client regarding how to mix regular insulin and NPH insulin in the same syringe. Which of the following actions, if performed by the client, indicates the need for further teaching?
1. Withdraws the NPH insulin first
2. Withdraws the regular insulin first
3. Injects air into NPH insulin vial first
4. Injects an amount of air equal to the desired dose of insulin into the vial

1. Withdraws the NPH insulin first
Rationale:
When preparing a mixture of regular insulin with another insulin preparation, the regular insulin is drawn into the syringe first. This sequence will avoid contaminating the vial of regular insulin with insulin of another type. Options 2, 3, and 4 identify the correct actions for preparing NPH and regular insulin.

25.) A home care nurse visits a client recently diagnosed with diabetes mellitus who is taking Humulin NPH insulin daily. The client asks the nurse how to store the unopened vials of insulin. The nurse tells the client to:
1. Freeze the insulin.
2. Refrigerate the insulin.
3. Store the insulin in a dark, dry place.
4. Keep the insulin at room temperature.

2. Refrigerate the insulin.
Rationale:
Insulin in unopened vials should be stored under refrigeration until needed. Vials should not be frozen. When stored unopened under refrigeration, insulin can be used up to the expiration date on the vial. Options 1, 3, and 4 are incorrect.

26.) Glimepiride (Amaryl) is prescribed for a client with diabetes mellitus. A nurse reinforces instructions for the client and tells the client to avoid which of the following while taking this medication?
1. Alcohol
2. Organ meats
3. Whole-grain cereals
4. Carbonated beverages

1. Alcohol
Rationale:
When alcohol is combined with glimepiride (Amaryl), a disulfiram-like reaction may occur. This syndrome includes flushing, palpitations, and nausea. Alcohol can also potentiate the hypoglycemic effects of the medication. Clients need to be instructed to avoid alcohol consumption while taking this medication. The items in options 2, 3, and 4 do not need to be avoided.

27.) Sildenafil (Viagra) is prescribed to treat a client with erectile dysfunction. A nurse reviews the client's medical record and would question the prescription if which of the following is noted in the client's history?
1. Neuralgia
2. Insomnia
3. Use of nitroglycerin
4. Use of multivitamins

3. Use of nitroglycerin
Rationale:
Sildenafil (Viagra) enhances the vasodilating effect of nitric oxide in the corpus cavernosum of the penis, thus sustaining an erection. Because of the effect of the medication, it is contraindicated with concurrent use of organic nitrates and nitroglycerin. Sildenafil is not contraindicated with the use of vitamins. Neuralgia and insomnia are side effects of the medication.

28.) The health care provider (HCP) prescribes exenatide (Byetta) for a client with type 1 diabetes mellitus who takes insulin. The nurse knows that which of the following is the appropriate intervention?
1. The medication is administered within 60 minutes before the morning and evening meal.
2. The medication is withheld and the HCP is called to question the prescription for the client.
3. The client is monitored for gastrointestinal side effects after administration of the medication.
4. The insulin is withdrawn from the Penlet into an insulin syringe to prepare for administration.

2. The medication is withheld and the HCP is called to question the prescription for the client.
Rationale:
Exenatide (Byetta) is an incretin mimetic used for type 2 diabetes mellitus only. It is not recommended for clients taking insulin. Hence, the nurse should hold the medication and question the HCP regarding this prescription. Although options 1 and 3 are correct statements about the medication, in this situation the medication should not be administered. The medication is packaged in prefilled pens ready for injection without the need for drawing it up into another syringe.

29.) A client is taking Humulin NPH insulin daily every morning. The nurse reinforces instructions for the client and tells the client that the most likely time for a hypoglycemic reaction to occur is:
1. 2 to 4 hours after administration
2. 4 to 12 hours after administration
3. 16 to 18 hours after administration
4. 18 to 24 hours after administration

2. 4 to 12 hours after administration
Rationale:
Humulin NPH is an intermediate-acting insulin. The onset of action is 1.5 hours, it peaks in 4 to 12 hours, and its duration of action is 24 hours. Hypoglycemic reactions most likely occur during peak time.

30.) A client with diabetes mellitus visits a health care clinic. The client's diabetes mellitus previously had been well controlled with glyburide (DiaBeta) daily, but recently the fasting blood glucose level has been 180 to 200 mg/dL. Which medication, if added to the client's regimen, may have contributed to the hyperglycemia?
1. Prednisone
2. Phenelzine (Nardil)
3. Atenolol (Tenormin)
4. Allopurinol (Zyloprim)

1. Prednisone
Rationale:
Prednisone may decrease the effect of oral hypoglycemics, insulin, diuretics, and potassium supplements. Option 2, a monoamine oxidase inhibitor, and option 3, a β-blocker, have their own intrinsic hypoglycemic activity. Option 4 decreases urinary excretion of sulfonylurea agents, causing increased levels of the oral agents, which can lead to hypoglycemia.

31.) A community health nurse visits a client at home. Prednisone 10 mg orally daily has been prescribed for the client and the nurse reinforces teaching for the client about the medication. Which statement, if made by the client, indicates that further teaching is necessary?
1. "I can take aspirin or my antihistamine if I need it."
2. "I need to take the medication every day at the same time."
3. "I need to avoid coffee, tea, cola, and chocolate in my diet."
4. "If I gain more than 5 pounds a week, I will call my doctor."

1. "I can take aspirin or my antihistamine if I need it."
Rationale:
Aspirin and other over-the-counter medications should not be taken unless the client consults with the health care provider (HCP). The client needs to take the medication at the same time every day and should be instructed not to stop the medication. A slight weight gain as a result of an improved appetite is expected, but after the dosage is stabilized, a weight gain of 5 lb or more weekly should be reported to the HCP. Caffeine-containing foods and fluids need to be avoided because they may contribute to steroid-ulcer development.

32.) Desmopressin acetate (DDAVP) is prescribed for the treatment of diabetes insipidus. The nurse monitors the client after medication administration for which therapeutic response?
1. Decreased urinary output
2. Decreased blood pressure
3. Decreased peripheral edema
4. Decreased blood glucose level

1. Decreased urinary output
Rationale:
Desmopressin promotes renal conservation of water. The hormone carries out this action by acting on the collecting ducts of the kidney to increase their permeability to water, which results in increased water reabsorption. The therapeutic effect of this medication would be manifested by a decreased urine output. Options 2, 3, and 4 are unrelated to the effects of this medication.

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