NUR 2474 Pharmacology Final Exam 1

NUR 2474 Pharmacology Final Exam 1

• The nurse working on a high-acuity medical-surgical unit is prioritizing care for four

patients who were just admitted. Which patient should the nurse assess first?

• The NPO patient with a blood glucose level of 80 mg/dL who just received 20 units of 70/30

Novolin insulin.

• The patient with a pulse of 58 beats per minute who is about to receive digoxin (Lanoxin)
• The patient with a blood pressure of 136/92 mm Hg who complains of having a headache
• The patient with an allergy to penicillin who is receiving an infusion of vancomycin

(Vancocin)

Answer a.The NPO patient with a blood glucose level of 80 mg/dL who just received 20 units of 70/30 Novolin insulin.

*low/normal BGL and insulin will continue to drop glucose level. At risk for hypo- glycemia.

• A patient with type 1 diabetes is eating breakfast at 7

Answer 30 AM. Blood sugars are on a sliding scale and are ordered before a meal and at bedtime. The patient's blood sugar level is 317 mg/dL. Which formulation of insulin should the nurse prepare to administer?

• No insulin should be administered.
• NPH
• 70/30 mix
• Lispro (Humalog)

Answer

• Lispro (Humalog)

*high blood sugar needs rapid acting insulin.

• A patient with type 1 diabetes recently became pregnant. The nurse plans a blood glucose

testing schedule for her. What is the recommended monitoring schedule?

• Before each meal and before bed 1 / 4

• In the morning for a fasting level and at 4 PM for the peak level
• Six or seven times a day
• Three times a day, along with urine glucose testing

Answer

• Six or seven times a day

*pregnancy can effect glucose levels. Frequent monitoring required.

• An adolescent patient recently attended a health fair and had a serum glucose test. The

patient telephones the nurse and says, "My level was 125 mg/dL. Does that mean I have diabetes?" What is the nurse's most accurate response?

• "Unless you were fasting for longer than 8 hours, this does not necessarily mean you have

diabetes."

• "At this level, you probably have diabetes.You will need an oral glucose tolerance test this

week."

• "This level is conclusive evidence that you have diabetes."
• "This level is conclusive evidence that you do not have diabetes."

Answer

• "Unless you were fasting for longer than 8 hours, this does not necessarily mean you have

diabetes."

*could be a normal level without fasting and does not mean diabetes unless it was high for a fasting blood glucose level.

• Insulin glargine is prescribed for a hospitalized patient who is diabetic. When will the

nurse administer this drug?

• Approximately 15 to 30 minutes before each meal
• In the morning and at 4 PM
• Once daily at bedtime
• After meals and at bedtime

Answer

• Once daily at bedtime

*goodnight glargine 2 / 4

• A patient with type 1 diabetes who takes insulin reports taking propra- nolol for

hypertension. Why is the nurse concerned?

• The beta blocker can cause insulin resistance.
• Using the two agents together increases the risk of ketoacidosis.
• Propranolol increases insulin requirements because of receptor blocking.
• The beta blocker can mask the symptoms of hypoglycemia.

Answer

• The beta blocker can mask the symptoms of hypoglycemia.

*beta blockers block adrenaline which signals the liver to release glucose in the blood when glucose is low to avoid hypoglycemia.

• Which statement is correct about the contrast between a carbose and miglitol?
• Miglitol has not been associated with hepatic dysfunction.
• With miglitol, sucrose can be used to treat hypoglycemia.
• Miglitol is less effective in African Americans.
• Miglitol has no gastrointestinal side effects.

Answer

• Miglitol has not been associated with hepatic dysfunction.

*key difference is that acarbose has been associated with rare cases of hepatic dysfunction

• A nurse counsels a patient with diabetes who is starting therapy with an alpha-

glucosidase inhibitor. The patient should be educated about the potential for which adverse reactions? (Select all that apply.)

• Hypoglycemia
• Flatulence
• Elevated iron levels in the blood
• Fluid retention
• Diarrhea

Answer

• Flatulence 3 / 4

• Diarrhea

*due to build up of gasses (flatulence) from to undigested carbohydrates reaching the colon and causing an osmotic effect (diarrhea)

• The nurse is caring for a pregnant patient recently diagnosed with hypothyroidism. The

patient tells the nurse she does not want to take medications while she is pregnant. What will the nurse explain to this patient?

• Hypothyroidism is a normal effect of pregnancy and usually is of no consequence.
• Neuropsychologic deficits in the fetus can occur if the condition is not treated.
• No danger to the fetus exists until the third trimester.
• Treatment is required only if the patient is experiencing symptoms.

Answer

• Neuropsychologic deficits in the fetus can occur if the condition is not treated.

*Thyroid hormones are crucial for the normal development of the fetal brain and nervous system and must be treated in pregnancy.

• 10. A nurse is teaching a patient who has been diagnosed with hypothyroidism about

levothyroxine (Synthroid). Which statement by the patient indicates a need for further teaching?

• "I should not take heartburn medication without consulting my provider."
• "I should report insomnia, tremors, and an increased heart rate to my provider." c. "If I take

a multivitamin with iron, I should take it 4 hours after the Synthroid." d."If I take calcium supplements, I may need to decrease my dose of Synthroid."

Answer d."If I take calcium supplements, I may need to decrease my dose of Synthroid."

*this statement is incorrect since calcium interferes with the absorption of Synthroid, it may need to be increased not decreased.

• 11. A patient with hypothyroidism begins taking PO levothyroxine (Synthroid).The nurse

assesses the patient at the beginning of the shift and notes a heart rate of 62 beats per minute and a temperature of 97.2° F. The patient is lethargic and difficult to arouse. The nurse will contact the provider to request an order for which drug?

• Beta blocker
• Increased dose of PO levothyroxine
• Intravenous levothyroxine
• / 4