Pharmacology 2017 #4A (Chapter 32, 36, and 37)

Question 1

Which laboratory test would give the most accurate evidence of a diabetic patient’s treatment compliance and glucose management over the past few months?

1. Serum albumin
2. Fasting serum glucose level
3. 2-hour postprandial blood glucose
4. Glycosylated hemoglobin (HbA1C)

Answer 1

Glycosylated hemoglobin (HbA1C)

HbA1c indicates glucose concentrations over the past 3 to 4 months and thus demonstrates patient compliance and illness management over time. The serum albumin test helps to determine the level of natural protein in blood. The fasting serum glucose test helps to assess whether the patient has elevated blood glucose concentrations. A 2-hour postprandial blood glucose test determines the amount of glucose in the blood after a meal.

Question 2

A patient newly diagnosed with type 2 diabetes mellitus has been ordered insulin glargine. What information is essential for the nurse to teach this patient?

1. “This medication has a duration of action of 24 hours.”
2. “This medication should be mixed with the regular insulin each morning.”
3. “This medication is very short-acting. You must be sure you eat after injecting it.”
4. “This medication is very expensive, but you will be receiving it only a short time.”

Answer 2

“This medication has a duration of action of 24 hours.”

Insulin glargine has a duration of action of 24 hours with no peaks, mimicking the natural, basal insulin secretion of the pancreas. This medication cannot be mixed with other insulins and is not a short-acting insulin. The patient may need to receive this medication for a long time.

Question 3

The nurse is teaching a patient who has asthma about the frequency of inhalation of salmeterol. Which statement by the patient indicates effective learning?

1. “I will inhale it once a day upon waking.”
2. “I will inhale it once a day before bedtime.”
3. “I will inhale it twice a day at my convenience.”
4. “I will inhale it twice a day approximately 12 hours apart.”

Answer 3

“I will inhale it twice a day approximately 12 hours apart.”

The action of salmeterol starts in a patient with asthma within 30 to 48 minutes after inhalation; the peak effect occurs in 3 to 4 hours, and the duration of action is 12 hours. Thus, the bronchodilator inhalation dose for adults and children older than 12 years is one puff twice daily, morning and evening, approximately 12 hours apart. The drug will not exhibit the correct therapeutic effect if used once a day or at the convenience of the patient.

Question 4

The nurse is teaching a patient who has been prescribed repaglinide. Which information will the nurse include in the teaching plan?

1. “This medication will not cause hypoglycemia.”
2. “You will need to be sure you eat as soon as you take this medication.”
3. “You do not have to worry about side effects when taking this medication.”
4. “When taking this medication, use aspirin rather than acetaminophen for pain relief.”

Answer 4

“You will need to be sure you eat as soon as you take this medication.”

Repaglinide is short acting. The drug’s very fast onset of action allows patients to take the drug with meals and skip a dose when they skip a meal. Hypoglycemia is a side effect of this medication, and there are many other possible side effects of this medication. The effects of repaglinide are enhanced when taken with aspirin and other nonsteroidal antiinflammatory drugs, which may result in increased hypoglycemia.

Question 5

A patient comes to the emergency department with urticaria after contact with shrubs. Which type of drug should the nurse expect to be included in the treatment plan?

1. Antitussive
2. Expectorant
3. Decongestant
4. Antihistamine

Answer 5

Antihistamine

Urticaria after contact with shrubs indicates an allergic reaction. All allergic reactions are mediated by histamines. Therefore, an antihistamine should be included in the treatment plan. Antitussives are medications that help to suppress the cough reflex. Expectorants help in coughing up excessive mucus and clearing the airway. Decongestants usually relieve congestion of the upper and lower respiratory tract.

Question 6

A patient is prescribed inhaled corticosteroids. Why should the nurse ask the patient to rinse the mouth after each dose?

1. To relieve the patient’s dry mouth
2. To minimize the chance of nasal congestion
3. To reduce the risk of sore throat and infection
4. To prevent the development of oral candidiasis

Answer 6

To prevent the development of oral candidiasis

It is recommended that patients rinse their mouth immediately after use of the inhaler or nebulizer dosage forms of corticosteroids. It helps to prevent overgrowth of oral fungi and subsequent development of oral candidiasis (thrush). Dry mouth, nasal congestion, and sore throat are not side effects of corticosteroid inhaler use.

Question 7

A patient who reports nasal congestion is prescribed naphazoline, 2 drops in each nostril, every 6 hours, for 5 days. The patient reports increased nasal congestion after 10 days. On assessment the nurse learns that the patient had increased the drug frequency to every 3 hours for 10 days. What should the nurse interpret from this information?

1. The patient has developed an allergic reaction.
2. The patient has developed rebound congestion.
3. The patient has developed paradoxical reaction.
4. The patient has experienced a side effect of the drug.

Answer 7

The patient has developed rebound congestion.

Nasal decongestants should be used as directed, in the prescribed dose, and for the prescribed time period. Frequent, long-term use or overdose may lead to rebound congestion. When the patient stops the drug, the symptoms may worsen, so the patient may overdose to get relief from symptoms. Allergic reactions rarely occur with decongestants, and rebound congestion is not a symptom of allergic reaction. Paradoxical reactions are related to antihistamine use in older adults and pediatric patients. Side effects of decongestants include nervousness, insomnia, palpitations, and tremor.

Question 8

A patient taking an oral theophylline drug is due for the next dose and has a blood pressure of 100/50 mm Hg and a heart rate of 110 beats/min. The patient is irritable. What is the nurse’s best action?

1. Administer oxygen at 2 L per minute via nasal cannula.
2. Continue to monitor the patient and give the medication.
3. Hold the next dose of theophylline and assess the patient.
4. Call the health care provider to request an increased dose.

Answer 8

Hold the next dose of theophylline and assess the patient.

The patient is displaying possible adverse reactions to theophylline such as tachycardia and irritability, and the blood level should be assessed before another dose of the medication is given. These symptoms may also be related to hypoxia. The nurse should assess for hypoxia before administering oxygen. The nurse should hold the medication and evaluate the cause for these symptoms. Until the serum theophylline level is known, an increased dose is not indicated.

Question 9

A patient receiving inhaled ipratropium therapy visits the clinic for a follow-up. Which complaint should the nurse anticipate from the patient?

1. Insomnia
2. Dry mouth
3. Anginal pain
4. Vascular headache

Answer 9

Dry mouth

The most commonly reported adverse effects of ipratropium therapy are caused by the anticholinergic effects of the drug and include dry mouth or throat, nasal congestion, heart palpitations, gastrointestinal distress, urinary retention, increased intraocular pressure, headache, coughing, and anxiety. Insomnia, anginal pain, and vascular headache are the adverse effects of alpha-adrenergic agonists.

Question 10

Which anticholinergic effect is seen in a patient who takes brompheniramine?

1. Frequent urination
2. Dry mouth
3. Blue-green vision
4. Excessive watering of eyes

Answer 10

Dry mouth

Antihistamines such as brompheniramine cause reduced salivary flow, leading to dry mouth. Anticholinergic effects of antihistamines, such as blurred vision, are common, not colored vision. They may also cause urinary retention, not frequent urination. Antihistamines help relieve excessive watering of eyes.

Question 11

A patient is prescribed albuterol. The nurse is explaining the most common route of administration of albuterol to the patient. Which route should the nurse discuss?

1. Inhalation
2. Intravenous
3. Subcutaneous
4. Intramuscular

Answer 11

Inhalation

The most preferred route of administration of albuterol is inhalation. Oral routes also are sometimes used. Intravenous, subcutaneous, and intramuscular routes are not suitable for administering albuterol.

Question 12

For what will the nurse assess in a patient who is prescribed metformin for treatment of type 2 diabetes?

1. Headache
2. Weight gain
3. Renal function
4. Cholesterol level

Answer 12

Renal function

Because metformin is excreted by the kidneys, it is necessary to assess the patient’s renal function. If the patient’s kidneys are not able to excrete the drug, it will accumulate in the patient’s system, thereby causing lactic acidosis. Headaches are not caused by metformin. One of the adverse effects of metformin is weight loss, not weight gain. Cholesterol levels may be high in some diabetic patients but can be treated with medications and lifestyle changes.

Question 13

A patient is prescribed oral albuterol to treat bronchitis. What instruction should the nurse give to the patient to prevent gastrointestinal (GI) upset?

1. “Take the prescribed medication with food.”
2. “Increase fluid intake up to 2500 mL a day.”
3. “Avoid sleeping with the head in an elevated position.”
4. “Take the prescribed medication on an empty stomach.”

Answer 13

“Take the prescribed medication with food.”

Albuterol is a beta agonist. Beta agonists can cause GI. Therefore, the nurse should instruct the patient to take the medication with food to avoid GI upset. Although food may slightly decrease absorption of the drug, it has the benefit of minimizing GI upset. An increase in fluid intake is helpful for maintaining hydration but not for minimizing GI upset. Keeping the head elevated is comfortable but does not help to minimize GI upset.

Question 14

The nurse is caring for a child who has been prescribed an inhaler for asthma control. The child is having difficulty using the inhaler. What should the nurse do?

1. Teach the child to use a spacer.
2. Tell the parent to hold the inhaler for the child.
3. Ask the health care provider to switch to oral medications.
4. Tell the parent that young children should not use inhalers.

Answer 14

Teach the child to use a spacer.

If a child is unable to use the inhaler, the medication will be trapped in the mouth. Using a spacer helps the medication to be deposited to the lungs.

Question 15

Which medications inhibit the enzyme alpha-glucosidase in the treatment of type 2 diabetes mellitus? Select all that apply.

1. Miglitol
2. Glipizide
3. Acarbose
4. Nateglinide
5. Pioglitazone

Answer 15

Miglitol & Acarbose

Alpha-glucosidase inhibitors are a class of antidiabetic drugs used to inhibit the alpha-glucosidase enzyme. Miglitol and acarbose are drugs that inhibit the alpha-glucosidase enzyme. Glipizide is a sulfonylurea that stimulates the release of insulin. Nateglinide is a glinide that increases insulin secretion. Pioglitazone is a thiazolidinedione that decreases insulin resistance by enhancing the sensitivity of insulin receptors.

Question 16

A patient who is obese is newly diagnosed with type 2 diabetes and is instructed to make dietary changes and perform aerobic exercise daily. The patient asks for insulin therapy for prompt management of diabetes. However, the patient is prescribed oral medications for lowering glucose levels. What is the reason for delaying insulin therapy?

1. Insulin therapy is initiated when other methods have failed.
2. Insulin therapy is not generally prescribed for obese patients.
3. Insulin therapy is ineffective without initial oral drug therapy.
4. Insulin therapy may cause congestive heart failure to develop.

Answer 16

Insulin therapy is initiated when other methods have failed.

For patients with Type 2 diabetes mellitus, insulin therapy is usually reserved for when other treatment methods are unsuccessful. It is more important to start oral drug therapy and initiate lifestyle changes as an initial treatment for diabetes mellitus management. Insulin is prescribed for obese patients if the initial drug therapy and lifestyle changes are ineffective in lowering glucose levels. Insulin therapy is used for diabetic management and is used along with oral drug therapy. Insulin therapy does not cause congestive heart failure in patients. It is more a concern in patients who take pioglitazone.

Question 17

The nurse observes that a patient has moon face, acne, an increase in fat pads, and swelling. After checking the patient history, the nurse finds that the patient is taking methylprednisolone for bronchospastic disorder. What will the nurse infer from the assessment?

1. The patient has thyrotoxicosis.
2. The patient has hypothyroidism.
3. The patient is in Addisonian crisis.
4. The patient has Cushing’s syndrome.
   .

Answer 17

The patient has Cushing’s syndrome.

Methylprednisolone is a systemic corticosteroid. Sometimes excess levels of systemic corticosteroids may lead to Cushing’s syndrome. Moon face, acne, an increase in fat pads, and swelling are symptoms of Cushing’s syndrome. Corticosteroids do not interact with thyroid activity. Therefore, the symptoms would not indicate that the patient has thyrotoxicosis or hypothyroidism. If a systemic corticosteroid is abruptly discontinued, Addisonian crisis may occur. Nausea, shortness of breath, joint pain, weakness, and fatigue are symptoms of Addisonian crisis

Question 18

Which medication can cause paradoxical reactions in children?

1. Antacid
2. Antitussive
3. Decongestant
4. Antihistamine

Answer 18

Antihistamine

An antihistamine can cause paradoxical reaction in children. Dizziness, confusion, sedation, and hypotension are symptoms associated with paradoxical reaction. An antacid may cause constipation or other reactions with an overdose. An antitussive can cause drowsiness or dizziness in the patient. A decongestant can cause rebound congestion with frequent use or overdose.

Question 19

The nurse is caring for multiple patients on the pulmonary unit. The nurse should question the administration of prescribed epinephrine to which patient?

1. A patient who is 16 years old
2. A patient with a history of emphysema
3. A patient with a history of type 2 diabetes
4. A patient with atrial fibrillation with a rate of 100 beats/min

Answer 19

A patient with atrial fibrillation with a rate of 100 beats/min

The side effects of epinephrine include tachycardia, dysrhythmias, and palpitations. A patient with atrial fibrillation and a rate of 100 beats/min therefore should not receive epinephrine. There is no contraindication for giving epinephrine to adolescents or to patients with a history of emphysema or type 2 diabetes.

Question 20

Which are second-generation sulfonylureas? Select all that apply.

1. Glipizide
2. Glyburide
3. Metformin
4. Glimepiride
5. Pioglitazone

Answer 20

Glipizide, Glyburide & Glimepiride

Glipizide, glyburide, and glimepiride are second-generation sulfonylureas. Metformin is a biguanide. Pioglitazone is a thiazolidinedione.

Question 21

An older adult who presents with a cough is instructed not to use diphenhydramine. What is the possible reason for this?

1. Diphenhydramine causes seizures.
2. Diphenhydramine causes constipation.
3. Diphenhydramine causes lightheadedness.
4. Diphenhydramine causes a “hangover” effect.

Answer 21

Diphenhydramine causes a “hangover” effect.

Diphenhydramine is not administered to older adults because it produces a “hangover” effect and increases the risk for falls, which may cause severe injury. Diphenhydramine does not produce seizure, constipation, or lightheadedness. Seizure is a side effect of over-the-counter cough and cold products. Constipation and lightheadedness are side effects of codeine and hydrocodone.

Question 22

Which medication is a mast cell stabilizer?

1. Zileuton
2. Cromolyn
3. Montelukast
4. Arformoterol

Answer 22

Cromolyn

Cromolyn is a mast cell stabilizer drug. It is used for the treatment of exercise-induced asthma. It works by stabilizing the cell membranes of mast cells to prevent the release of inflammatory mediators such as histamine. Zileuton and montelukast are leukotriene receptor antagonists. Arformoterol is a long-acting beta agonist. These are not used to treat exercise asthma. These drugs are effective in asthma, chronic bronchitis, and emphysema.

Question 23

Which side effect of a histamine (H1) antagonist is used therapeutically for patients with allergic rhinitis?

1. Dryness
2. Drowsiness
3. Palpitations
4. Constipation

Answer 23

Dryness

H1 antagonists exert anticholinergic effects, including constipation, dry mouth, and blurred vision. The drugs’ capacity for drying the mucous membranes makes them useful in treating upper respiratory infections and allergic rhinitis. Drowsiness, palpitations, and constipation are adverse effects of H1 antagonists that should be reported immediately to the primary health care provider.

Question 24

The nurse should instruct a patient to avoid caffeine and stimulants when the individual is using which medication?

1. Albuterol
2. Flunisolide
3. Tiotropium
4. Montelukast

Answer 24

Albuterol

The nurse should instruct a patient who self-administers albuterol to avoid substances such as caffeine and other stimulants that will augment the sympathetic stimulation of albuterol. Excessive stimulation may result in severe hypertension, angina, and serious dysrhythmias. Flunisolide, tiotropium, and montelukast should not induce such stimulation in the patient.

Question 25

During the assessment of a patient, the nurse finds symptoms of dizziness, confusion, sedation, and hypotension. After reviewing the patient’s medical history, the nurse finds that the patient is taking diphenhydramine for treatment of nighttime insomnia. What should the nurse interpret from the assessment?

1. It is an allergic reaction.
2. It is a dystonic reaction.
3. It is rebound congestion.
4. It is a paradoxical reaction.

Answer 25

It is a paradoxical reaction.

Diphenhydramine is an antihistaminic drug. Antihistaminic drugs may produce paradoxical reactions such as dizziness, confusion, sedation, and hypotension in older adults. These are not allergic reactions to the drug. In cases of dystonic reaction, sustained muscle contractions cause twisting and repetitive movements or abnormal postures. Rebound congestion results from long-term use, or overdose, of nasal decongestants.

Question 26

The health care provider indicates that the patient will be prescribed an expectorant. Which medication does the nurse anticipate the provider will prescribe?

1. Guaifenesin
2. Brompheniramine maleate
3. Chlorpheniramine maleate
4. Dexchlorpheniramine maleate

Answer 26

Guaifenesin

Guaifenesin is classified as an expectorant. Brompheniramine, chlorpheniramine, and dexchlorpheniramine are classified as traditional antihistamines.

Question 27

Which patients are the best candidates to receive antitussive cough medication?

1. Patients with pharyngitis and rhinitis
2. Patients with chronic paranasal sinusitis
3. Patients who have undergone hernia surgery
4. Patients with bronchitis with productive cough

Answer 27

Patients who have undergone hernia surgery

Antitussives are administered to patients who have recently undergone hernia surgery to enhance their comfort and reduce respiratory distress. Expectorants are used to relieve productive cough in patients with pharyngitis and bronchitis. Nasal decongestants are used to relieve nasal congestion in patients with rhinitis. In patients with chronic paranasal sinusitis, expectorants are used for cough suppression.

Question 28

Which clinical findings may indicate diabetes mellitus in a patient? Select all that apply.

1. Hemoglobin A1C (A1C) level greater than 6.5%
2. Casual plasma glucose level of 130 mg/dL or higher
3. Fasting plasma glucose level of 126 mg/dL or higher
4. Two-hour plasma glucose level of 120 mg/dL or higher
5. Random blood glucose level between 70 and 100 mg/dL

Answer 28

Hemoglobin A1C (A1C) level greater than 6.5%
&
Fasting plasma glucose level of 126 mg/dL or higher

A hemoglobin A1C (A1C) level greater than 6.5% is another indication of diabetes mellitus. It indicates that the amount of sugar in the hemoglobin is higher than normal. A fasting plasma glucose level of 126 mg/dL or higher indicates hyperglycemia. It indicates that there are excessive concentrations of glucose in the blood. A casual plasma glucose level of 200 mg/dL or higher and a two-hour plasma glucose level of 200 mg/dL or higher indicate diabetes. Serum blood glucose levels of 70 to 100 mg/dL indicate normal glucose homeostasis.

Question 29

The nurse is caring for a patient who is taking a traditional antihistamine. What is the most important information for the nurse to teach the patient?

1. “Do not drive after taking this medication.”
2. “Take this medication on an empty stomach.”
3. “Do not take this medication for more than 2 days.”
4. “Make sure you drink a lot of liquids while on this medication.”

Answer 29

“Do not drive after taking this medication.”

Traditional antihistamines cause drowsiness. There is no evidence to indicate that the patient should take the medication on an empty stomach, place the medication on hold for any period of time, or force fluids.

Question 30

What is the most important thing for the nurse to teach a patient who is switching allergy medications from diphenhydramine to loratadine?

1. Loratadine has fewer sedative effects.
2. Loratadine causes less gastrointestinal upset.
3. Loratadine can potentially cause dysrhythmias.
4. Loratadine has increased bronchodilating effects.

Answer 30

Loratadine has fewer sedative effects.

Loratadine does not affect the central nervous system and, therefore, is nonsedating. There is insufficient evidence to indicate that loratadine causes less gastrointestinal upset than other comparable medications, can cause dysrhythmias, or can act as a bronchodilator.

Question 31

A nursing student is caring for a patient who is receiving ipratropium therapy. The student asks the nurse about the time required to reach the peak effect after the administration of the drug. What should the nurse tell the student?

1. “It takes about 1.6 hours.”
2. “It takes about 1 to 2 hours.”
3. “It takes about 4 to 5 hours.”
4. “It takes about 5 to 15 minutes.”

Answer 31

“It takes about 1 to 2 hours.”

Ipratropium is the oldest and most commonly used anticholinergic bronchodilator. The peak effect of ipratropium occurs 1 to 2 hours after administration. The half-life elimination of ipratropium is 1.6 hours. The duration of action lasts about 4 to 5 hours. The onset of action occurs in 5 to 15 minutes.

Question 32

A patient with chronic paranasal sinusitis and cough is found to have glaucoma. What is the best choice of treatment for management of cough in this situation?

1. Loratadine
2. Naphazoline
3. Guaifenesin
4. Fexofenadine

Answer 32

Guaifenesin

Guaifenesin is the best choice of treatment for management of cough associated with chronic paranasal sinusitis. It works by loosening and thinning the secretions and facilitating expectoration of the secretions. Loratadine, naphazoline, and fexofenadine are contraindicated in patients with glaucoma. Loratadine is used for the treatment of allergic rhinitis and chronic urticaria. Naphazoline is used to treat nasal congestion. Fexofenadine is a nonsedating antihistamine and is useful for the treatment of allergic rhinitis and urticaria.

Question 33

The nurse is caring for a patient in the clinic who states being afraid of taking antihistamines because of being a truck driver. What is the best information for the nurse to give this patient?

1. “Take the medication only when you are not driving.”
2. “You are correct; you should not take antihistamines.”
3. “Take a lower dose than normal when you have to drive.”
4. “You may be able to safely take a nonsedating antihistamine.”

Answer 33

“You may be able to safely take a nonsedating antihistamine.”

Nonsedating antihistamines may be safer for the patient to take, but the patient should still monitor for signs of sedation. If sedation occurs, the patient should be instructed to avoid taking these drugs while driving. Taking a lower dose will decrease the drug’s effectiveness.

Question 34

The primary health care provider prescribes oxymetazoline to a patient with sinusitis who complains of nasal congestion and difficulty in breathing. About which possible adverse effect should the nurse teach to the patient?

1. Dry mouth
2. Palpitations
3. Constipation
4. Gastrointestinal irritation

Answer 34

Palpitations

Oxymetazoline impairs blood flow and can cause cardiovascular disorders such as palpitations and hypertension. Oxymetazoline does not have anticholinergic action and does not cause dry mouth or constipation. Oxymetazoline does not increase acidic levels of gastric fluid and does not cause gastrointestinal irritation.

Question 35

A patient receives isophane suspension (neutral protamine Hagedorn [NPH]) insulin at 8:00 AM. The patient eats breakfast at 8:30 AM, lunch at noon, and dinner at 6:00 PM. At what time is this patient at the highest risk for hypoglycemia?

1. 2:00 PM
2. 5:00 PM
3. 8:00 PM
4. 10:00 AM

Answer 35

5:00 PM

Breakfast eaten at 8:30 AM would cover the onset of isophane suspension (NPH) insulin, and lunch will cover the 2:00 PM time frame. If the patient does not eat a mid-afternoon snack, however, the NPH insulin may peak just before dinner without sufficient glucose on hand to prevent hypoglycemia.

Question 36

What action will the nurse take before administering glucagon to an unconscious patient?

1. Assess the patient’s oxygen saturation levels
2. Ensure that the patient is rolled onto one side
3. Initiate cardiopulmonary resuscitation (CPR)
4. Administer an incretin mimetic intravenously

Answer 36

Ensure that the patient is rolled onto one side

The nurse rolls the patient onto one side because administration of glucagon may induce vomiting. Assessing oxygen saturation levels is a necessity in a patient with respiratory problems. Here the priority is to administer glucagon to the patient as a quick response to severe hypoglycemia. The nurse needs to use cardiopulmonary resuscitation if the patient has cardiac arrest. Intravenous glucose and 50% dextrose in water (D50W) are most often used for treating acute hypoglycemia. Incretin mimetics are administered subcutaneously to lower blood glucose levels.

Question 37

A patient with chronic bronchitis is prescribed theophylline. An alteration in which parameter should lead the nurse to immediately notify the primary health care provider?

1. Serum level of drug
2. Serum calcium levels
3. Serum uric acid levels
4. Serum creatinine levels

Answer 37

Serum level of drug

During each follow-up visit, the nurse should monitor the serum level of drug. Blood levels of theophylline need to be between 5 and 15 mcg/mL and must be frequently monitored. If the level of theophylline is too high, unwanted adverse effects will occur. If the level of theophylline is too low, then the patient receives little therapeutic benefit. If any change occurs in the serum level of theophylline, the nurse should report it to the primary health care provider. Theophylline does not affect calcium, uric acid, or serum creatinine levels. Therefore, these changes are not related to the theophylline treatment.

Question 38

The laboratory results for a diabetic patient indicate markedly elevated blood glucose levels. After assessing the patient, the nurse obtains a prescription for intravenous insulin therapy from the primary health care provider. Which other assessment finding is present in the patient’s reports?

1. Increased weight
2. Extreme onset of hypoglycemia
3. Presence of ketones in the serum
4. High levels of endogenous insulin

Answer 38

Presence of ketones in the serum

The presence of ketones in the serum along with elevated glucose levels indicates diabetic ketoacidosis. Hence, intravenous insulin therapy is started immediately to prevent acute hyperglycemia, which may cause coma or death. Weight gain is not an emergency in this case and may be caused by other factors, such as congestive heart failure. Extreme hyperglycemia is seen in the patient due to elevated glucose levels. Low levels or lack of endogenous insulin causes diabetic ketoacidosis.

Question 39

A patient is prescribed ipratropium for the treatment of chronic obstructive pulmonary disease. For what should the nurse assess to ensure safe administration of ipratropium?

1. Joint pain
2. Peanut allergy
3. Banana allergy
4. Migraine headaches

Answer 39

Peanut allergy

Ipratropium is an anticholinergic drug commonly prescribed for the treatment of chronic obstructive pulmonary disease. The nurse should ask the patient about peanut allergy, because ipratropium causes severe anaphylactic reactions in patients who have peanut allergy. A history of joint pain, banana allergy, or migraine pain does not have any impact on ipratropium therapy; therefore, ipratropium is safe for patients with these conditions.

Question 40

A patient complains that symptoms of allergic rhinitis are persistent even after taking fexofenadine. After checking the patient’s history, the nurse finds that the patient is taking phenytoin for the treatment of seizures. What should the nurse interpret from this information?

1. It indicates drug tolerance.
2. It indicates dystonic reaction.
3. It indicates paradoxical reaction.
4. It indicates drug-drug interaction.

Answer 40

It indicates drug-drug interaction.

Phenytoin decreases the fexofenadine level in the body. Therefore, the drug does not have the desired therapeutic effect. The persistent allergic rhinitis is caused by drug interaction, not drug tolerance. Dystonic reaction is related to muscle contractions. Twisting and repetitive movements or abnormal postures can be observed in this condition. Paradoxical reaction is observed in older adults and children from the use of antihistaminic drugs.