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Basic Pharmacology for Nurses 15th Edition Clayton Stock Cooper Test Bank

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Basic Pharmacology for Nurses 15th Edition Clayton Stock Cooper Test Bank

ISBN-13: 978-0323057806

ISBN-10: 0323057802

 

Description

Basic Pharmacology for Nurses 15th Edition Clayton Stock Cooper Test Bank

ISBN-13: 978-0323057806

ISBN-10: 0323057802

 

 

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Below you will find some free nursing test bank questions from this test bank:

Clayton: Basic Pharmacology for Nurses, 15th Edition

 

Chapter 36: Drugs Used to Treat Diabetes Mellitus

 

Test Bank

 

MULTIPLE CHOICE

 

  1. A patient received the evening dose of Lispro subcutaneously at 1630. What time will symptoms of hypoglycemia likely occur?
A. 1900
B. 1830
C. 0130
D. 0600

 

 

ANS:   B

 

  Feedback
A This would be past the peak of action and after signs of hypoglycemia would have appeared.
B The most rapid-acting insulin, Lispro, peaks within 1 to 2 hours after administration. The peak time of insulin is when patients would most likely exhibit symptoms of hypoglycemia, particularly if they have inadequate dietary intake.
C This is long after the peak of action and the time when signs of hypoglycemia would have appeared.
D This is long after the peak of action and the time when signs of hypoglycemia would have appeared.

 

 

DIF:    Cognitive Level: Application             REF:    566

TOP:    Nursing Process Step: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity

 

  1. It is 1400 and a patient who has been NPO since 12 AM for a bronchoscopy is complaining of a headache and shakiness, and is extremely irritable. Vital signs are within normal limits, and a one-touch glucose reads 50 mg/dL. Which action is most important for the nurse to take?
A. Have the patient eat a snack and drink milk.
B. Administer glucagon subcutaneously.
C. Call the bronchoscopy room to follow up with the delay.
D. Obtain an A1c test.

 

 

ANS:   B

 

  Feedback
A Having the patient eat a snack and drink milk is not an appropriate response.
B Irritability, nervousness, headache, tremors, dizziness, apprehension, sweating, cold and clammy skin, and hunger are symptoms of hypoglycemia. The patient has not eaten since the prior day. A blood glucose of 50 mg/dL is true hypoglycemia and needs to be dealt with immediately. Glucagon is preferred over PO intake given that an endoscopy is scheduled.
C Calling the bronchoscopy room is not the priority response.
D Obtaining an A1c test is not an appropriate response.

 

 

DIF:    Cognitive Level: Analysis                  REF:    573

TOP:    Nursing Process Step: Diagnosis

MSC:   NCLEX Client Needs Category: Health Promotion and Maintenance

 

  1. After a blood glucose reading, it is determined that the patient should receive 4 units of Lispro and 8 units of NPH. Which action will the nurse take to administer these medications?
A. Draw up each insulin in separate syringes and administer two injections.
B. Draw up the NPH first and then the Lispro using the same syringe.
C. Administer the Lispro before the meal and the NPH after the meal.
D. Draw up the Lispro first and then the NPH using the same syringe.

 

 

ANS:   D

 

  Feedback
A There is no reason to administer a second injection.
B The long-acting insulin is drawn up last when mixing.
C Insulin is to be administered before meals.
D Lispro, an insulin analogue, is the most rapid-acting insulin. Insulin analogues are compatible with intermediate (NPH) or long-acting insulin. When combining two types of insulin, the short-acting insulin is drawn up before the intermediate-acting insulin.

 

 

DIF:    Cognitive Level: Application             REF:    568

TOP:    Nursing Process Step: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity

 

  1. A patient with type 2 diabetes mellitus, which was previously controlled with an oral antidiabetic agent, is hospitalized for treatment of a leg ulcer. The health care provider has ordered sliding scale insulin coverage with regular insulin for hyperglycemia. The nurse brings the injection into the room, and the patient becomes upset, stating “I don’t want to start taking that drug! I’ll need it the rest of my life.” What is the nurse’s best response?
A. “This is the same drug as the oral medication you were taking. It’s a stronger dose while you are in the hospital.”
B. “Don’t worry. You shouldn’t need this too often. As you feel better, your blood glucose level will drop.”
C. “Your body is under stress right now, which raises your blood glucose level. This does not mean you will be on this drug permanently. Once you’re feeling better, your provider will determine if your oral medication is all you will need.”
D. “Your disease is progressing and your pancreas is producing less insulin. I know this is a hard time for you. Do you want to talk about it?”

 

 

ANS:   C

 

  Feedback
A This is not a true statement.
B This is inaccurate and misleading.
C Type 2 diabetes mellitus patients normally controlled with oral hypoglycemics may require insulin during situations of increased physiologic and psychological stress. The stress response stimulates epinephrine and norepinephrine, which raises the blood glucose level. Examples of stressors include pregnancy, surgery, and infections.
D This is not necessarily a true statement.

 

 

DIF:    Cognitive Level: Application             REF:    554

TOP:    Nursing Process Step: Implementation

MSC:   NCLEX Client Needs Category: Psychological Integrity

 

  1. What test determines glycemic control over the previous 8 to 10 weeks?
A. 24-hour glucose clearance test
B. Fructosamine test
C. Fasting blood sugar
D. A1c test

 

 

ANS:   D

 

  Feedback
A The GTT is never conducted over an interval this long.
B The fructosamine test measures the amount of glucose bonded to a protein, fructosamine. This reflects the average blood glucose level attained over the past 1 to 3 weeks.
C The FBS measures the amount of glucose in the blood before eating.
D The A1c test measures the percentage of hemoglobin that has been irreversibly glycosylated because of high blood sugar levels. This test reflects the average blood sugar level attained over the past 8 to 10 weeks.

 

 

DIF:    Cognitive Level: Comprehension      REF:    562

TOP:    Nursing Process Step: Assessment

MSC:   NCLEX Client Needs Category: Health Promotion and Maintenance

 

  1. When is the best time for the nurse to administer Lispro?
A. After the patient has started eating
B. Within 10 to 15 minutes of eating
C. 30 minutes before a meal
D. 45 to 60 minutes before a meal

 

 

ANS:   B

 

  Feedback
A Insulin is administered before eating.
B Insulin analogues, such as Lispro and Aspart, are the most rapid-acting insulins. The onset of these insulins is within 10 minutes of the injection, they peak within 1 to 2 hours, and their duration is 3 to 5 hours. Patients should be eating their meal within 10 to 15 minutes of the injection.
C Fast-acting insulins must be given closer to mealtime.
D Fast-acting insulins must be given closer to mealtime.

 

 

DIF:    Cognitive Level: Application             REF:    566

TOP:    Nursing Process Step: Implementation

MSC:   NCLEX Client Needs Category: Health Promotion and Maintenance

 

  1. Which is the most important for the successful management of diabetes mellitus?
A. A network of community resources
B. The level of self-management
C. Preventative education
D. Frequent follow-up with the health care provider

 

 

ANS:   B

 

  Feedback
A No outside source can overcome the failure of the patient to participate.
B Teaching patients to self-manage all aspects of their disease, including treatment modalities and preventing complications, is critical to patient success. Patients must be proficient in the entire therapeutic regimen—diet, activity level, blood or urine testing, medication, self-injection techniques, prevention of complications, and effective management of hypoglycemia or hyperglycemia.
C Teaching the patient to prevent complications of his or her disease is important, but patient participation in managing the disease is crucial.
D No health care provider can overcome the failure of the patient to participate.

 

 

DIF:    Cognitive Level: Application             REF:    556-557

TOP:    Nursing Process Step: Evaluation

MSC:   NCLEX Client Needs Category: Health Promotion and Maintenance

 

  1. What laboratory test is the preferred screening test for diabetes in children and nonpregnant adults?
A. FPG
B. ECG
C. GTT
D. A1c

 

 

ANS:   A

 

  Feedback
A The fasting plasma glucose (FPG) is the preferred test used to screen for diabetes in children and nonpregnant adults.
B Electrocardiograms (ECGs) are used to monitor electrical activity of the heart.
C The glucose tolerance test (GTT) is not recommended for routine clinical use, but may be required in the evaluation of patients with IFG or when diabetes is still suspected, despite a normal FPG, as with the postpartum evaluation of women with GDM.
D The A1c test is used to monitor diabetes management over 90-day intervals, the life of a red blood cell.

 

 

DIF:    Cognitive Level: Knowledge             REF:    556

TOP:    Nursing Process Step: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity

 

  1. The patient asks the nurse how sulfonylureas normalize glucose levels. Which response by the nurse is correct?
A. By stimulating pancreatic secretion of insulin
B. By inhibiting secretion of insulin by the pancreas
C. By increasing glucose production in the liver
D. By increasing insulin metabolism in the liver

 

 

ANS:   A

 

  Feedback
A Sulfonylureas stimulate the pancreas to secrete more insulin. They also diminish glucose production and metabolism of insulin by the liver. The net effect is a normalization of insulin and glucose levels.
B Sulfonylureas stimulate the pancreas to secrete more insulin.
C Sulfonylureas decrease glucose production.
D Sulfonylureas decrease hepatic metabolism of insulin.

 

 

DIF:    Cognitive Level: Application             REF:    570

TOP:    Nursing Process Step: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity

 

  1. The nurse is instructing a patient about insulin administration. Which statement by the patient indicates a need for further teaching?
A. “I may need more insulin if I have surgery.”
B. “Once I open my insulin, I will store it in the refrigerator.”
C. “I will date the insulin bottle when I open it.”
D. “I will keep a spare bottle of insulin on hand.”

 

 

ANS:   B

 

  Feedback
A It is true that the patient may need more insulin if undergoing surgery.
B Once insulin is opened and being used, it can be stored at room temperature for up to 1 month.
C It is true that the patient should date the insulin bottle after opening.
D The patient should keep a spare bottle of insulin on hand.

 

 

DIF:    Cognitive Level: Application             REF:    566

TOP:    Nursing Process Step: Evaluation

MSC:   NCLEX Client Needs Category: Physiological Integrity

 

  1. Which instruction by the nurse is accurate to include when providing teaching to a patient recently diagnosed with diabetes who has been prescribed insulin?
A. Beta blockers can mask symptoms of hypoglycemia.
B. Lipodystrophy increases the absorption of insulin.
C. Infection will decrease the need for insulin.
D. Excessive exercise will increase the need for insulin.

 

 

ANS:   A

 

  Feedback
A Beta-adrenergic blocking agents (e.g., propranolol, timolol, nadolol, pindolol) may mask many symptoms of hypoglycemia.
B Lipodystrophy does not increase the absorption of insulin.
C Infection does not decrease the need for insulin.
D Excessive exercise does not increase the need for insulin.

 

 

DIF:    Cognitive Level: Application             REF:    575

TOP:    Nursing Process Step: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity

 

  1. Which instruction is most important for the nurse to teach a patient with diabetes who is receiving metformin?
A. Take the medication before meals.
B. This medication will cause the pancreas to secrete more insulin.
C. Stop taking the drug 24 to 48 hours prior to radiopaque dye procedures.
D. There may be an increase in the triglyceride level.

 

 

ANS:   C

 

  Feedback
A Metformin is not administered before meals.
B The pancreas does not secrete more insulin as a result of taking this medication.
C Radiopaque dyes often induce temporary renal insufficiency, so metformin should be discontinued 24 to 48 hours before procedures in which radiopaque dye will be administered.
D Metformin does not increase triglyceride levels.

 

 

DIF:    Cognitive Level: Application             REF:    570

TOP:    Nursing Process Step: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity

 

MULTIPLE RESPONSE

 

  1. A third subclass of diabetes mellitus includes additional types of diabetes that are part of other diseases having features not generally associated with the diabetic state. Which disorders may have an associated diabetic component? (Select all that apply.)
A. Patients receiving high-dose corticosteroid therapy for disease maintenance
B. Cushing’s syndrome
C. Alzheimer’s disease
D. Acromegaly
E. Malnutrition

 

 

ANS:   A, B, D, E

 

  Feedback
Correct Drugs and chemicals that induce hyperglycemia are included in the third subclass of diabetes mellitus.

Cushing’s syndrome is included in the third subclass of diabetes mellitus.

Acromegaly is included in the third subclass of diabetes mellitus.

Malnutrition is included in the third subclass of diabetes mellitus.

Incorrect Alzheimer’s disease is not included in the third subclass of diabetes mellitus.

 

 

DIF:    Cognitive Level: Comprehension      REF:    551

TOP:    Nursing Process Step: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity

 

  1. A 65-year-old man is diagnosed with type 2 diabetes mellitus. Which patient symptoms would indicate type 1 diabetes mellitus, and not type 2? (Select all that apply.)
A. Impotence
B. Increased thirst over the past week
C. A 10-pound weight loss within the past month
D. Polyphagia
E. Ketoacidosis

 

 

ANS:   B, C, D, E

 

  Feedback
Correct Diabetes type 2 symptoms are insidious and patients present when symptoms may have been apparent for a prolonged time. Polydipsia is a symptom associated with type 1 diabetes mellitus.

Diabetes type 2 symptoms are insidious and patients present when symptoms may have been apparent for a prolonged time. A 10-pound weight loss over this short period (1 month) indicates type 1 diabetes mellitus.

Polyphagia is associated with type 1 diabetes.

Ketoacidosis is associated with type 1 diabetes.

Incorrect Onset of diabetes type 2 symptoms is usually in the fourth decade of life. Impotence is a symptom associated with type 2 diabetes mellitus.

 

 

DIF:    Cognitive Level: Application             REF:    551

TOP:    Nursing Process Step: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity

 

  1. Which dietary control measures are used in the management of diabetes mellitus? (Select all that apply.)
A. Specific daily caloric requirements
B. Consistent-carbohydrate diabetes meal plan
C. 50% intake of carbohydrates daily
D. Adjustments to daily meals according to age, metabolic stress, pregnancy, and advanced age and/or older adults
E. 20% intake of proteins daily

 

 

ANS:   B, C, D, E

 

  Feedback
Correct Meal planning systems are used with the diabetic patient. The consistent-carbohydrate diabetes meal plan is used, with an emphasis on consistency of timing of meals and snacks.

Daily meals and snacks provide 1500 to 2000 calories, with 50% of the calories from carbohydrates, 20% from protein, and 30% from fat.

Individualized adjustments may be required as with children, adolescents, metabolically stressed patients, pregnant women, and geriatric patients.

Twenty percent of calories from protein is part of the consistent-carbohydrate diabetes meal plan.

Incorrect Specific daily caloric requirement is not a primary consideration in calculating calorie requirements for a diabetic patient.

 

 

DIF:    Cognitive Level: Comprehension      REF:    559-560

TOP:    Nursing Process Step: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity

 

  1. Which statements are correct regarding type 2 diabetes mellitus? (Select all that apply.)
A. Type 2 diabetes is more prevalent in overweight people older than 45 years.
B. A genetic predisposition exists for the development of type 2 diabetes mellitus.
C. Type 2 diabetes requires lifelong insulin replacement.
D. Type 2 diabetes is often diagnosed after complications have resulted.
E. Women have a higher incidence of type 2 diabetes.

 

 

ANS:   A, B, D, E

 

  Feedback
Correct Contributing factors to the development of type 2 diabetes mellitus include being older than 45 years and being overweight.

Contributing factors to the development of type 2 diabetes mellitus include a family predisposition to the disease.

The early symptoms of this type of diabetes are minimal; therefore, many patients do not seek medical assistance until the complications have appeared.

Contributing factors to the development of type 2 diabetes mellitus include being female.

Incorrect In type 2 diabetes mellitus, the pancreas continues to secrete insulin. Patients may be diet-controlled or regulated with oral hypoglycemics. Insulin is only used if the other treatments are not effective.

 

 

DIF:    Cognitive Level: Application             REF:    551

TOP:    Nursing Process Step: Assessment

MSC:   NCLEX Client Needs Category: Health Promotion and Maintenance

 

  1. Which statements are true about gestational diabetes? (Select all that apply.)
A. It is diagnosed in about 2% of all pregnancies in the United States.
B. It includes diabetic women who become pregnant.
C. Fetal development may be complicated as a result of gestational diabetes.
D. The risk of developing diabetes after pregnancy is increased.
E. Most women with gestational diabetes have normal glucose tolerance post partum.
F. Women need to be reevaluated postpartum to determine their classification with respect to glucose tolerance.

 

 

ANS:   C, D, E, F

 

  Feedback
Correct Gestational diabetic individuals are put into a separate category because of the special clinical features of diabetes that develop during pregnancy and the complications associated with fetal involvement.

These women are also at a greater risk of developing diabetes 5 to 10 years after pregnancy.

The majority of individuals with gestational diabetes have normal glucose tolerance post partum.

Gestational diabetes patients must be reclassified 6 weeks after delivery into one of the following categories—diabetes mellitus, impaired fasting glucose, impaired glucose tolerance, or normoglycemia.

Incorrect Gestational diabetes is diagnosed in about 4% of all pregnancies in the United States.

Gestational diabetes does not include diabetic women who become pregnant.

 

 

DIF:    Cognitive Level: Comprehension      REF:    551-552

TOP:    Nursing Process Step: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity