1.
The nurse is administering lispro insulin and should keep in mind that this insulin will start to have an effect within which time frame?
Correct Answer
A. 15 minutes
Explanation
The onset of action for lispro insulin is 15 minutes. The peak plasma concentration is 1 to 2 hours; the elimination half-life is 80 minutes; and the duration is 3 to 5 hours.
2.
When teaching about hypoglycemia, the nurse should make sure that the patient is aware of the early signs of hypoglycemia, including
Correct Answer
C. Irritability and confusion.
Explanation
Early symptoms of hypoglycemia include the central nervous system (CNS) manifestations of confusion, irritability, tremor, and sweating. The other options are incorrect.
3.
The nurse is teaching a group of patients about self-administration of insulin. What teaching is important to include?
Correct Answer
D. When mixing insulins, the clear (such as Regular) insulin should be drawn up into the syringe first.
Explanation
If mixing insulins in one syringe, the clear (Regular) insulin should always be drawn up in to the syringe first. Patients should always rotate injection sites and should notify their physician if they become ill. Patients should never adjust their own insulin doses!
4.
When monitoring a patient’s response to oral antidiabetic drugs, the nurse knows that the laboratory results that would indicate a therapeutic response would be a(n)
Correct Answer
C. Fasting blood glucose level between 70 and 100 mg/dL.
Explanation
A fasting blood glucose level between 70 and 100 mg/dL indicates a therapeutic response to glucose-elevating drugs. The other options are incorrect.
5.
A 75-year-old woman with type 2 diabetes has recently been placed on glyburide, 10 mg daily. She asks the nurse when the best time would be to take this medication. What is the nurse’s best response?
Correct Answer
B. “Take this medication in the morning, 30 minutes before breakfast.”
Explanation
The medication should be taken in the morning, 30 minutes before breakfast. When taken at that time it has a longer duration of action, causing it to release a constant amount of insulin. This may be beneficial in controlling blood glucose levels throughout the day.
6.
A patient who has type 2 diabetes is scheduled for a colonoscopy and has been NPO (nothing by mouth) since midnight. She is concerned because her medications are being held. What is the best action regarding the administration of her oral antidiabetic drugs?
Correct Answer
C. Contacting the prescriber for further orders
Explanation
When the diabetic patient is NPO, the prescriber should be contacted for further orders regarding the administration of the oral antidiabetic drugs. The other options are not correct.
7.
The nurse is reviewing instructions for a patient with type 2 diabetes who also gives herself insulin injections as part of the therapy. The nurse asks the patient, “What should you do if your fasting blood glucose is 47 mg/dL?” Which response by the patient is correct?
Correct Answer
C. “I will take an oral form of glucose.”
Explanation
Hypoglycemia can be reversed if the patient eats glucose tablets or gel, corn syrup, or honey; or drinks fruit juice or a nondiet soft drink or other quick sources of glucose, which should always be kept at hand. She should not wait for instructions from her physician nor delay taking the glucose by resting. The Regular insulin would only lower her blood glucose levels more.
8.
The nurse is teaching patients about self-injection of insulin. Which statement is true regarding injection sites?
Correct Answer
D. Rotate sites within the same location for about 1 week before rotating to a new location.
Explanation
Patients taking insulin injections should be instructed to rotate sites, but to do so within the same location for about 1 week (so that all injections would be rotated in one area—for example, the right arm—before rotating to a new location, such as the left arm). Also, each injection should be at least to 1 inch away from the previous site.
9.
The nurse is administering rapid-acting insulin. Which statement is true regarding its administration?
Correct Answer
A. It should be given within 15 minutes of the patient beginning a meal.
Explanation
Rapid-acting insulins, such as insulin lispro and insulin aspart, are able to mimic closely the body’s natural rapid insulin output after eating a meal; for this reason, both insulins are usually administered within 15 minutes of the patient beginning a meal. The other options are incorrect.
10.
After starting treatment for type 2 diabetes mellitus 6 months earlier, a patient is in the office for a follow-up examination. Which laboratory test will best reflect the patient’s adherence to the antidiabetic therapy over the past few months?
Correct Answer
B. Hemoglobin A1C level
Explanation
The hemoglobin A1C level reflects the patient’s adherence to the therapy regimen for several months previously, thus evaluating how well the patient has been doing with diet and drug therapy. The other options are not correct.
11.
A patient in the emergency department was showing signs of hypoglycemia and had a fingerstick glucose level of 34 mg/dL. He has just become unconscious. What is the nurse’s first action?
Correct Answer
D. Give him intravenous glucose.
Explanation
Intravenous glucose raises blood glucose levels when the patient is unconscious and unable to take oral forms of glucose.
12.
The nurse is preparing to administer insulin intravenously. Which statement about intravenous insulin is true?
Correct Answer
C. Only Regular insulin can be administered intravenously.
Explanation
Regular insulin is the usual insulin product to be dosed via intravenous bolus, intravenous infusion, or even intramuscularly. These routes, especially the intravenous infusion route, are often used in cases of diabetic ketoacidosis, or coma associated with uncontrolled type 1 diabetes.
13.
A patient with a history of chronic obstructive pulmonary disease and type 2 diabetes has been treated for pneumonia for the past week. He has been receiving intravenous corticosteroids as well as antibiotics as part of his therapy. At this time, his pneumonia has resolved, but when monitoring his blood glucose levels, the nurse notices that his blood glucose level is still elevated, and he has required small amounts of sliding-scale insulin coverage. What is the best explanation for this elevation?
Correct Answer
B. The corticosteroids may cause an increase in glucose levels.
Explanation
Corticosteroids can antagonize the hypoglycemic effects of insulin, resulting in elevated blood glucose levels. The other options are not correct.
14.
The nurse knows to administer acarbose (Precose), an alpha-glucosidase inhibitor, at which time?
Correct Answer
B. With the first bite of each main meal
Explanation
When an alpha-glucosidase inhibitor is taken with the first bite of a meal, excessive postprandial blood glucose elevation (a glucose spike) can be reduced or prevented.
15.
A 48-year-old is diagnosed with metabolic syndrome and is started on metformin (Glucophage). The purpose of the metformin, in this situation, is to
Correct Answer
B. Decrease insulin resistance.
Explanation
Metformin decreases glucose production by the liver; decreases intestinal absorption of glucose; and improves insulin receptor sensitivity in the liver, skeletal muscle, and adipose tissue, resulting in decreased insulin resistance.
16.
When administering morning medications for a newly admitted patient, the nurse notes that the patient has an allergy to sulfa drugs. There is an order for the sulfonylurea glipizide (Glucotrol). What is the nurse’s best action?
Correct Answer
B. Hold the drug and check the order with the prescriber.
Explanation
There is a potential for cross allergy in patients who are allergic to sulfonamide antibiotics. Although such an allergy is listed as a contraindication by the manufacturer, most clinicians do prescribe sulfonylureas for such patients. The order should be clarified.
17.
The nurse is reviewing a patient’s medication list and notes that sitagliptin (Januvia) is ordered. The nurse should question an additional order for which drug or drug class?
Correct Answer
B. Insulin
Explanation
Sitagliptin is indicated for management of type 2 diabetes either as monotherapy or in combination with metformin, a sulfonylurea, or a glitazone, but not with insulin.
18.
The insulin order reads, “Check blood glucose levels before meals and at bedtime. For every 5 mg/dL over 150, give one unit of Regular Humulin insulin, subcutaneously.” The patient’s blood glucose level at 11:30, before lunch, was 203 mg/dL. In units, how much insulin will the nurse will give?
Correct Answer
10 units
Explanation
203 mg/dL is 53 mg/dL more than 150 mg/dL (203 – 150)
53 / 5 units = 10.6
One cannot administer “0.6” of a unit, so the answer is 10 units.
19.
The nurse is administering adrenal drugs to a patient. Which of the following actions is appropriate for this patient?
Correct Answer
B. Rinsing the oral cavity after using steroid inhalers
Explanation
After the patient has used the steroid inhalers, cleaning the oral cavity helps to prevent possible oral fungal infections from developing. Adrenal drugs should be taken with meals to minimize gastrointestinal upset and in the mornings to minimize adrenal suppression, and they should be discontinued by weaning, not abruptly.
20.
When starting a patient’s drug therapy with corticosteroids, the nurse is aware that some drug classes can have adverse interactions with corticosteroids, such as
Correct Answer
A. Nonsteroidal antiinflammatory drugs.
Explanation
Corticosteroids are known to increase the risk of gastrointestinal bleeding and ulcers. Nonsteroidal anti-inflammatory drugs (NSAIDs) also have the same side effects, therefore, combining corticosteroids with NSAIDs can further increase the risk of gastrointestinal complications. This is why the nurse should be aware of this adverse interaction and monitor the patient closely for any signs of bleeding or ulcers when starting corticosteroids. Antibiotics, opioid analgesics, and antidepressants do not have the same adverse interaction with corticosteroids.
21.
A patient is concerned about the body changes that have resulted from long-term prednisone therapy for the treatment of lupus erythematosus. Which effect of this drug therapy would be present to support the nursing diagnosis of disturbed body image?
Correct Answer
B. Weight gain
Explanation
Facial erythema, weight gain, hirsutism, and “moon face” (characteristic of Cushing’s syndrome) are possible body changes that may occur with long-term prednisone therapy.
22.
A patient is taking fludrocortisone for Addison’s disease, and his wife is concerned about all the problems that may occur with this therapy. When teaching them about therapy with this drug, the nurse should include which information?
Correct Answer
B. It should be taken with food or milk to minimize gastrointestinal upset.
Explanation
Patients receiving fludrocortisone should take it with food or milk to minimize gastrointestinal upset; weight gain of more than 5 pounds a week should be reported to the physician; abrupt withdrawal is not recommended because it may precipitate an adrenal crisis.
23.
A patient is receiving aminoglutethimide (Cytadren) therapy. The nurse knows that this medication is used for which condition?
Correct Answer
D. Cushing’s syndrome
Explanation
Aminoglutethimide (Cytadren) is an adrenal steroid inhibitor that is used in the treatment of Cushing’s syndrome.
24.
When monitoring a patient who is taking a systemically administered glucocorticoid, the nurse should monitor for signs of which condition?
Correct Answer
B. Hypokalemia
Explanation
Systemic glucocorticoid drugs may cause potassium depletion, hyperglycemia, and hypernatremia.
25.
The nurse expects that a patient is experiencing undersecretion of adrenocortical hormones when which condition is found upon assessment?
Correct Answer
C. Dehydration and weight loss
Explanation
Dehydration and weight loss are the result of undersecretion of adrenocortical hormones, or Addison’s disease. The other responses are possible effects of glucocorticoid excess.
26.
A patient who has been on long-term corticosteroid therapy has had surgery to correct an abdominal hernia. The nurse keeps in mind that which potential effect of this medication may have the most impact on the patient’s recovery?
Correct Answer
B. Delayed wound healing
Explanation
Muscle weakness and osteoporosis may also result from long-term therapy, but delayed wound healing would have the most impact on the patient’s recovery from abdominal surgery at this time. Hypertension, not hypotension, may result from long-term corticosteroid therapy.
27.
Which conditions are indications for glucocorticoid drugs? Select all that apply.
Correct Answer(s)
B. Cerebral edema
C. Chronic obstructive pulmonary disease and asthma
D. Organ transplantation
Explanation
Glaucoma, varicella, and septicemia are all contraindications to glucocorticoid therapy. The others are indications for glucocorticoid therapy.
28.
A patient has been admitted for an exacerbation of chronic obstructive pulmonary disease and will be receiving methylprednisolone (Solu-Medrol) 30 mg, intravenously every 4 hours. The medication is available in 40-mg/mL vials. How many mL will the nurse draw up for this dose?
Correct Answer(s)
0.75 mL
Explanation
40 mg : 1 mL :: 30 mg : x mL
Solve for x:
(40 X x) = (1 X 30); 40x = 30; x = 0.75, therefore x = 0.75 mL
29.
The nurse is providing teaching for a patient who is to receive estrogen replacement therapy. Which statement is correct to include in the teaching session? The patient should
Correct Answer
C. Report any weight gain of more than 5 pounds per week.
Explanation
Patients taking oral estrogen therapy should report weight gain of more than 5 pounds per week to a physician. The other statements are not true for estrogen replacement therapy.
30.
The nurse recognizes that use of estrogen drugs is contraindicated in which of the following patients?
Correct Answer
D. A woman with a history of thrombopHlebitis
Explanation
Estrogenic drugs are contraindicated in people who have active thromboembolic disorders and in those with histories of thromboembolic disease. Atrophic vaginitis and inoperable prostate cancer are potential indications for estrogen therapy. Estrogen is not used to prevent lactation.
31.
A patient is being treated for primary amenorrhea. The nurse expects which drug to be used to treat this problem?
Correct Answer
D. Medroxyprogesterone (Provera)
Explanation
Medroxyprogesterone, a progestin, is one of the drugs most commonly used for primary amenorrhea. Primary amenorrhea is not an indication for the other drugs listed.
32.
The nurse is teaching a patient about the adverse effects of fertility drugs such as clomiphene (Clomid). Which is a potential adverse effect of this drug?
Correct Answer
A. Dizziness
Explanation
Dizziness is one of the possible adverse effects of the fertility drugs. They may also cause restlessness and anorexia.
33.
A patient is receiving oxytocin (Pitocin) to induce labor. During administration of this medication, the nurse will also implement which action?
Correct Answer
C. Administering the medication with an IV infusion pump
Explanation
Oxytocin is infused via an infusion pump, not via an intravenous bolus. Magnesium sulfate is not administered with oxytocin (but should be kept at the bedside for emergency use in case of severe hypertension). And fetal heart rate and maternal vital signs should be monitored continuously.
34.
The nurse notes in the patient’s medication orders that the patient is taking the tocolytic drugs terbutaline (Brethine). Based on this finding, the nurse interprets that the drug has been ordered for which problem?
Correct Answer
B. Prevention of preterm labor in the 22nd week of pregnancy
Explanation
Tocolytics relax uterine smooth muscles and stop the uterus from contracting.
35.
A 51-year-old woman will be taking selective estrogen receptor modulators (SERMs) as part of the treatment for postmenopausal osteoporosis. The nurse reviews potential adverse effects with this patient, including the possible occurrence of
Correct Answer
D. Venous thromboembolism.
Explanation
SERMs such as raloxifene increase the risk for venous thromboembolism. Postmenopausal women taking raloxifene were no more likely to develop breast, uterine, or ovarian cancer than were women taking a placebo. The other options are not correct.
36.
During a follow-up visit, a patient who has been on estrogen therapy admits that she has continued to smoke cigarettes. The nurse will remind the patient that smoking while on estrogen may lead to increased
Correct Answer
D. Risk for thrombosis.
Explanation
Smoking should be avoided during estrogen therapy because it adds to the risk for thrombosis formation. The other options are not correct.
37.
When considering the various types of contraceptive drugs, the nurse is aware that which type most closely duplicates the normal hormonal levels of the female menstrual cycle?
Correct Answer
C. TripHasic
Explanation
The triphasic products most closely duplicate the normal hormonal levels of the female menstrual cycle.
38.
A woman visits a health center requesting oral contraception. Which lab test is most important for the nurse to assess before the patient begins oral contraception therapy?
Correct Answer
D. Pregnancy test
Explanation
Pregnancy should be ruled out before beginning oral contraceptive therapy because the medications can be harmful to the fetus—pregnancy category X.
39.
The nurse should instruct a patient who will be taking bisphosphonate alendronate (Fosamax) to take this medication at which time?
Correct Answer
B. In the morning with an 8-ounce glass of water
Explanation
Bisphosphonates must be taken in the morning, with 6 to 8 ounces of plain water, to prevent esophageal erosion. In addition, the patient must sit upright for 30 minutes after taking them.
40.
A female patient who lives in New York City is preparing to take a plane trip to Australia. She has been taking the SERM raloxifene (Evista). The nurse will provide which instructions to this patient?
Correct Answer
A. She should stop taking the drug at least 72 hours before the trip.
Explanation
A patient taking a SERM should be informed that the drug must be discontinued 72 hours before and during prolonged immobility so as to prevent the development of a thrombosis.
41.
When reviewing the risk factors for osteoporosis, the nurse recognizes that which of the following is considered a risk factor?
Correct Answer
A. White or Asian race
Explanation
Risk factors for postmenopausal osteoporosis include white or Asian descent, slender body build, early estrogen deficiency, smoking, alcohol consumption, low-calcium diet, sedentary lifestyle, and family history of osteoporosis.
42.
A patient who is taking the bisphosphonate alendronate (Fosamax) has been instructed to lie flat in bed for 2 days after having plastic surgery. Which intervention is appropriate at this time?
Correct Answer
B. She should not take the alendronate until she can sit up for 30 minutes.
Explanation
The nurse must emphasize that the patient should remain upright in either a standing or sitting position for approximately 30 minutes after taking a bisphosphonate so as to help prevent esophageal erosion or irritation.
43.
While discussing options for osteoporosis prevention, a patient asks if she will be using estrogen patches. What is the nurse’s best response?
Correct Answer
C. “Estrogen patches are associated with a high risk for cardiovascular problems and are not the first choice for osteoporosis prevention.”
Explanation
Studies performed as part of the Women’s Health Initiative have indicated that because of a high incidence of cardiovascular problems, estrogen therapy is not considered the first choice for osteoporosis prevention.
44.
The nurse is preparing to administer the contraceptive form of medroxyprogesterone (Depo-Provera). What route should be planned?
Correct Answer
B. Intramuscular
Explanation
Depo-Provera is a progestin-only injectable contraceptive that is given by the intramuscular route.
45.
When couples are treated for infertility with ovulation-inducing drugs, the nurse will include instruction about the increased likelihood of
Correct Answer
C. Multiple births.
Explanation
Multiple births are a possible consequence of treatment for infertility with ovulation-inducing drugs.
46.
A patient wants to try an oral soy product to relieve perimenopausal symptoms. The nurse will assess the patient’s medication history for potential drug interactions, including
Correct Answer
A. Thyroid replacement therapy.
Explanation
Orally administered soy may interfere with thyroid hormone absorption, so concurrent use should be avoided.
47.
A patient taking an oral contraceptive should be aware of potential drug interactions with which medications? Select all that apply.
Correct Answer(s)
A. CepHalexin (Keflex)
C. Warfarin (Coumadin)
D. Isoniazid (INH)
F. TheopHylline (UnipHyl)
Explanation
Patients must be educated about the need to use alternative birth control methods for at least 1 month during and after taking any of the following drugs: antibiotics (especially penicillins and cephalosporins); barbiturates; isoniazid; and rifampin. The effectiveness of other drugs, such as anticonvulsants, beta-blockers, hypnotics, antidiabetic drugs, warfarin, theophylline, tricyclic antidepressants, and vitamins, may be reduced when they are taken with oral contraceptives.
48.
The patient is to receive medroxyprogesterone (Depo-Provera) 500 mg, weekly, intramuscularly, on Mondays for 4 weeks as part of palliative therapy for cancer. The medication is available in vials of 400 mg/mL. How many milliliters will the nurse draw up and administer with each injection? Round to the nearest tenth.
Correct Answer(s)
1.3 mL
Explanation
400 mg : 1 mL :: 500 mg : x mL
Solve for x: (400 X x) = (1 X 500); 400x = 500; x = 1.25, rounded to 1.3 mL
49.
A patient is to receive testosterone therapy via a transdermal patch. He asks the nurse, “Why am I getting a patch? Can’t I just take a pill?” What is the nurse’s best response?
Correct Answer
C. “Oral forms are not absorbed well by the body. The patch allows for better absorption of the medication.”
Explanation
The transdermal form allows for better absorption of testosterone because of its high first-pass effect. Oral forms are poorly absorbed, and the transdermal form is preferable to an injection and is preferred for hormonal replacement therapy. The patch is changed daily.
50.
When a male patient is receiving androgen therapy, the nurse should monitor for signs of excessive androgens such as
Correct Answer
A. Fluid retention.
Explanation
Fluid retention is an undesirable effect of androgens. The other options are incorrect.