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South Tampa University, Exam 3 Pharmacology

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Total Questions : 48

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Question 1:

A patient with diabetes has been administered 38 units of NPH insulin at 7:00 AM. By 1:00 PM, the patient has been away from the nursing unit for 2 hours and missed lunch while waiting for a chest X-ray.
What is the most appropriate action for the nurse to prevent hypoglycemia?

A. Request that if testing is further delayed, the patient will eat lunch first. B. Plan to discontinue the evening dose of insulin. C. Save the lunch tray for the patient’s later return. D. Send a glass of orange juice to the patient in the diagnostic testing area.

Answer and Explanation

Choice A:

Requesting that the patient eat lunch first if testing is further delayed is the most appropriate action to prevent hypoglycemia for the following reasons:

1. Timing of NPH Insulin Peak:

NPH insulin is an intermediate-acting insulin with a peak action time of 4-12 hours after administration.

In this case, the patient received NPH insulin at 7:00 AM, meaning its peak effect is likely to occur between 11:00 AM and 5:00 PM.

Delaying lunch beyond 1:00 PM significantly increases the risk of hypoglycemia as the insulin's action peaks without adequate food intake to balance glucose levels.

2. Ensuring Consistent Mealtimes:

Consistency in meal timing is crucial for managing blood glucose levels in diabetic patients. Delaying meals can disrupt the balance between insulin and glucose, leading to hypoglycemia.

Prioritizing lunch at the usual time, even amidst testing delays, helps maintain a more predictable glucose pattern.

3. Addressing Acute Hypoglycemia Risk:

Hypoglycemia is a serious complication of diabetes that can occur if blood glucose levels fall too low. Symptoms can include shakiness, sweating, dizziness, confusion, and even loss of consciousness.

Promptly addressing potential delays in food intake is essential to prevent hypoglycemia and its associated risks.

Choice B:

Choice B: Discontinuing the evening dose of insulin does not address the immediate risk of hypoglycemia due to the missed lunch. It could lead to hyperglycemia later in the day or overnight.

Choice C:

Choice C: Saving the lunch tray for later may not be feasible if testing is significantly delayed. It also does not prevent hypoglycemia in the immediate timeframe.

Choice D:

Choice D: While a glass of orange juice can provide a quick source of glucose, it is a short-term solution and does not replace a balanced meal. It could also lead to a rapid rise in blood glucose followed by a subsequent drop.

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Question 2:

What specific administration techniques should the nurse employ when administering NPH insulin?

A. Never mix with another insulin. B. Roll the vial gently to mix the suspension. C. Only administer this insulin at bedtime. D. When mixing with another insulin, draw the NPH into the syringe first.

Answer and Explanation

Choice A:

NPH insulin can be mixed with certain other insulins, such as regular insulin, to achieve different effects and better control blood glucose levels. Therefore, stating that it should never be mixed with another insulin is incorrect.

Choice B:

NPH insulin is a suspension, meaning the insulin particles are not fully dissolved in the liquid. Therefore, it's essential to roll the vial gently between the palms to evenly distribute the insulin particles throughout the solution. This ensures that the patient receives the correct dose and prevents injection of an uneven mixture, which could lead to unpredictable blood glucose levels. Key points to remember: NPH insulin is an intermediate-acting insulin that starts working within 1 to 2 hours, peaks in 4 to 12 hours, and lasts for 12 to 18 hours. It can be mixed with regular insulin to provide both short-acting and longer-acting insulin coverage. Always follow the specific instructions provided by the insulin manufacturer and healthcare provider. Proper mixing of NPH insulin is crucial for accurate dosing and optimal glucose control.

Choice C:

NPH insulin is an intermediate-acting insulin that can be administered at various times of the day, depending on the individual's needs and blood glucose patterns. It is not restricted to bedtime administration only.

Choice D:

When mixing NPH insulin with another insulin, the order of mixing does not significantly affect its action. The crucial aspect is to ensure proper mixing of the insulins before administration.

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Question 3:

A client is brought to the emergency room unconscious, with a pulse, and with a blood glucose of 40. The client is wearing a Medic-Alert bracelet indicating that he has Type 1 diabetes mellitus.
What order should the nurse anticipate?

A. Give glucagon. B. Give orange juice. C. Perform CPR. D. Give insulin.

Answer and Explanation

Choice A:

Glucagon directly addresses the underlying issue of severe hypoglycemia: In a patient with Type 1 diabetes mellitus, a blood glucose level of 40 mg/dL signifies a critical condition known as severe hypoglycemia. This condition occurs when blood sugar levels drop dangerously low, depriving the brain and other vital organs of glucose, their primary source of energy. Glucagon, a hormone that acts opposite to insulin, is the most effective and rapid treatment for severe hypoglycemia. It works by stimulating the liver to release stored glucose into the bloodstream, quickly raising blood sugar levels and restoring normal brain function. Rationale for other choices:

Choice B:

B: Give orange juice: While orange juice contains carbohydrates that can raise blood sugar, it is not ideal for treating severe hypoglycemia due to its slower absorption rate compared to glucagon. In an unconscious patient, there's also a risk of aspiration if given orally.

Choice C:

C: Perform CPR: CPR is not indicated in this scenario as the patient has a pulse. CPR is a lifesaving technique that is only used when a person's heart has stopped beating.

Choice D:

D: Give insulin: Insulin, which lowers blood glucose, would be contraindicated in this situation as the patient is already experiencing severe hypoglycemia. Administering insulin would further decrease blood sugar levels, worsening the patient's condition. Key points to remember: Severe hypoglycemia is a medical emergency that requires prompt treatment with glucagon. Glucagon is the only medication that can effectively and quickly raise blood glucose levels in severe hypoglycemia. It's crucial to administer glucagon as soon as possible to prevent irreversible brain damage or even death. Healthcare professionals should be proficient in recognizing the signs and symptoms of severe hypoglycemia and administering glucagon appropriately.

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Question 4:

The nurse is instilling erythromycin ointment to the lower lid of the newborn’s eyes. Why is this medication being given to the newborn?

A. To provide moisture. B. To prevent chemical conjunctivitis. C. To prevent infection. D. To treat infection.

Answer and Explanation

Choice A:

Erythromycin ointment does not have moisturizing properties. Its primary purpose is to prevent bacterial infection, not to provide moisture to the eyes. While some ointments may have a slight moisturizing effect, this is not the main reason for using erythromycin ointment in newborns. If moisture is the primary concern, other products specifically designed to lubricate the eyes would be more appropriate.

Choice B:

Chemical conjunctivitis is typically caused by exposure to irritants such as chlorine in swimming pools or strong chemicals. Erythromycin ointment is not effective in preventing chemical conjunctivitis. In fact, it could potentially worsen the irritation if used in cases of chemical conjunctivitis. If chemical conjunctivitis is suspected, flushing the eyes with water or saline solution and seeking medical attention would be the appropriate course of action.

Choice C:

Erythromycin ointment is primarily used to prevent eye infections in newborns. It is effective against a variety of bacteria that can cause conjunctivitis, including Neisseria gonorrhoeae (the bacteria that causes gonorrhea) and Chlamydia trachomatis (the bacteria that causes chlamydia). These bacteria can be passed from the mother to the baby during childbirth, and if left untreated, they can cause serious eye infections that can lead to vision loss. By applying erythromycin ointment to the newborn's eyes shortly after birth, the risk of these infections can be significantly reduced.

Choice D:

Erythromycin ointment is an antibiotic, but it is not typically used to treat active infections in newborns. If a newborn has a suspected eye infection, a healthcare provider would likely prescribe a different antibiotic eye drop or ointment that is more effective in treating the specific infection. However, erythromycin ointment can be used as a prophylactic measure to prevent eye infections, which is why it is commonly administered to newborns shortly after birth.

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Question 5:

A patient is prescribed metformin (Glucophage). Which side effect/adverse effect almost always occurs when clients take metformin (Glucophage)?

A. Fever. B. Insomnia. C. Bitter or metallic taste. D. Seizures.

Answer and Explanation

Choice A:

Fever is not a common side effect of metformin. While it's possible for a minority of patients to experience a mild fever as their bodies adjust to the medication, it's not considered a typical or expected adverse effect. Fevers typically occur due to infections or inflammation, and metformin does not directly cause either of these processes. If a patient taking metformin develops a fever, it's crucial to rule out other potential causes, such as infections or other medications, before attributing it to metformin.

Choice B:

Insomnia is also not a common side effect of metformin. In fact, some studies have suggested that metformin may even have a positive effect on sleep quality in some individuals. While sleep disturbances can occur with any medication, they are not specifically associated with metformin. If a patient experiences insomnia while taking metformin, it's essential to consider other potential factors, such as stress, anxiety, or other medications, that could be contributing to sleep problems.

Choice C:

Bitter or metallic taste is a very common side effect of metformin, experienced by approximately 30-40% of patients. This taste disturbance is thought to be caused by metformin's interaction with taste receptors on the tongue. The taste is often described as metallic, bitter, or similar to the taste of pennies. While it can be unpleasant, it's generally not considered a serious side effect and does not usually require discontinuation of the medication. Some strategies to manage the metallic taste include: Taking metformin with meals or snacks to mask the taste. Chewing sugar-free gum or sucking on hard candy after taking the medication. Rinsing the mouth with water or mouthwash after taking the medication. Switching to an extended-release formulation of metformin, which may have a less pronounced metallic taste.

Choice D:

Seizures are a rare but serious side effect of metformin. They are most likely to occur in patients with underlying kidney problems or those taking certain other medications that can interact with metformin. If a patient taking metformin experiences a seizure, it's critical to seek immediate medical attention.

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Question 6:

The RN is aware that a long-term side effect of amiodarone is:

A. Stevens-Johnsons Syndrome. B. Ventricular Tachycardia. C. Pulmonary fibrosis. D. QT Prolongation.

Answer and Explanation

Choice A:

Stevens-Johnson syndrome (SJS) is a rare, serious skin condition that is typically caused by an allergic reaction to medication. While amiodarone has been associated with a few cases of SJS, it is not considered a common long-term side effect.

Choice B:

Ventricular tachycardia (VT) is a type of fast heart rhythm that originates in the ventricles of the heart. Amiodarone is actually used to treat VT, so it would be counterintuitive to list it as a long-term side effect.

Choice C:

Pulmonary fibrosis is a condition characterized by scarring of the lung tissue. While amiodarone can cause pulmonary toxicity, which includes pulmonary fibrosis, this is a relatively rare side effect. Moreover, it's usually associated with high doses or long-term use of the medication.

Choice D:

QT prolongation is a condition in which the heart's electrical activity takes longer than normal to recharge between beats. This can lead to a potentially fatal arrhythmia called torsades de pointes. Amiodarone is known to prolong the QT interval, and this is considered one of its most significant long-term side effects. It's important to monitor patients on amiodarone for QT prolongation and to adjust the dose or discontinue the medication if necessary.

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Question 7:

The nurse is caring for a client who has experienced head trauma in a motor vehicle accident.

The client is having excessive urine output.
Which medication should the nurse anticipate administering?

A. Prednisolone (Prelone) B. Corticotropin (ACTH or adrenocorticotropic hormone) C. Vasopressin (Pitressin) D. Calciferol (Ergocalciferol)

Answer and Explanation

Choice A:

Prednisolone is a corticosteroid that has anti-inflammatory and immunosuppressant effects. It does not have a direct effect on urine output. While it may be used in some cases of head trauma to reduce inflammation, it would not be the first-line choice to address excessive urine output. Prolonged use of prednisolone can have adverse effects such as fluid retention, weight gain, hypertension, and hyperglycemia.

Choice B:

Corticotropin (ACTH) is a hormone that stimulates the adrenal glands to produce cortisol. Cortisol has a variety of effects, including increasing blood pressure and blood sugar levels. It does not have a direct effect on urine output and would not be used to address this issue. ACTH can have significant side effects, including fluid retention, electrolyte imbalances, and mood changes.

Choice C:

Vasopressin is a hormone that regulates fluid balance in the body. It works by increasing water reabsorption in the kidneys, which can help to reduce urine output. It is the most appropriate medication to administer to a client with excessive urine output following head trauma. Vasopressin can be administered intravenously or subcutaneously. It is important to monitor the client's fluid intake and output closely when administering vasopressin, as it can lead to fluid overload if not used carefully.

Choice D:

Calciferol is a form of vitamin D that helps to regulate calcium and phosphorus levels in the body. It does not have a direct effect on urine output. It would not be used to address excessive urine output in a client with head trauma. Excessive doses of calciferol can lead to hypercalcemia, which can cause kidney stones, bone pain, and other serious problems.

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Question 8:

What is the rationale for rotating insulin injection sites?

A. It prevents insulin resistance B. It prevents an allergic reaction C. It avoids the development of lipodystrophy D. It decreases the potential for insulin shock

Answer and Explanation

Choice A:

Insulin resistance is a condition in which the body's cells become less responsive to insulin, requiring more insulin to maintain normal blood glucose levels. It's primarily caused by factors such as obesity, physical inactivity, and genetic predisposition. Rotating injection sites does not directly address these underlying causes of insulin resistance. It can help ensure consistent insulin absorption, but it's not the primary mechanism for preventing insulin resistance.

Choice B:

Allergic reactions to insulin are rare but can occur. They typically manifest as localized symptoms at the injection site, such as redness, swelling, itching, or pain. In severe cases, systemic reactions like hives, difficulty breathing, or anaphylaxis can occur. Rotating injection sites might reduce the risk of localized allergic reactions by preventing repeated exposure to insulin in the same area of skin. However, it does not prevent systemic allergic reactions, which are immune-mediated and not dependent on the injection site.

Choice C:

Lipodystrophy is a condition characterized by abnormal changes in fat distribution under the skin. It can occur as a complication of repeated insulin injections at the same site. There are two main types of lipodystrophy: Lipohypertrophy: This involves the accumulation of excess fatty tissue at injection sites, creating visible lumps or bumps. Lipoatrophy: This involves the loss of fatty tissue at injection sites, leading to depressions or indentations in the skin. Both lipohypertrophy and lipoatrophy can interfere with insulin absorption, leading to unpredictable blood glucose control. Rotating injection sites helps to prevent lipodystrophy by distributing insulin injections over a wider area of skin, reducing the likelihood of repeated trauma to the same tissue.

Choice D:

Insulin shock, also known as hypoglycemia, is a condition that occurs when blood glucose levels drop too low. It can be caused by several factors, including excessive insulin dosing, missed meals, or increased physical activity. Rotating injection sites does not directly affect the risk of insulin shock. It's essential for individuals using insulin to monitor their blood glucose levels regularly, adjust insulin doses as needed, and follow a balanced diet and exercise plan to prevent hypoglycemia.

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Question 9:

A newly diagnosed client with type I diabetes was admitted to the ICU with the diagnosis of diabetic ketoacidosis.
After being transferred to the med/surg unit, he asks if he can receive today’s NPH and regular insulin the same way to avoid being “stuck” since there is still an IV access.
Which information should be included in the nurse’s response?

A. Only regular insulin may be given IV and you will now receive your insulins subcutaneously as ordered B. Mixing these two insulins may increase their potency and increase the risk of hypoglycemia C. These two insulins are not compatible and cannot be mixed together D. NPH Insulin can only be given IV in the ICU environment as an insulin drip

Answer and Explanation

Choice A:

Regular insulin is the only insulin formulation that can be safely administered intravenously. It is a rapid-acting insulin that starts working within 15 minutes and peaks in 1-2 hours, making it ideal for urgent glucose control in situations like diabetic ketoacidosis.

NPH insulin is an intermediate-acting insulin that is not suitable for IV administration. It is designed to be absorbed slowly over several hours, and injecting it intravenously could lead to unpredictable and potentially dangerous fluctuations in blood glucose levels.

Subcutaneous (SQ) injection is the standard route of administration for both regular and NPH insulin outside of acute care settings. This route allows for a more gradual and consistent absorption of insulin, which is essential for maintaining stable blood glucose control.

The patient's transfer to the med/surg unit indicates that their condition has stabilized and no longer requires the aggressive glucose control that is achieved with an IV insulin infusion. Therefore, it is appropriate to transition them to SQ insulin injections.

Choice B:

While mixing insulins can potentially alter their absorption rates and action profiles, the primary concern with mixing NPH and regular insulin is not an increased risk of hypoglycemia. It is the incompatibility of the formulations for IV administration.

Choice C:

NPH and regular insulin can be mixed together for subcutaneous injection, but they are not compatible for intravenous administration.

Choice D:

While NPH insulin can be administered as part of an IV insulin drip in the ICU, this is typically done in specific situations where a continuous infusion of both rapid-acting and intermediate-acting insulin is required. It is not the standard practice for NPH insulin administration.

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Question 10:

For which of the following patients would the RN anticipate an order for sodium bicarbonate IVP?

A. A patient with a PH of 6.9 per arterial blood gas (ABG) B. A patient who did not respond to calcium carbonate C. A patient with a PH of 7.6 per arterial blood gas (ABG) D. A patient who has extremely low serum sodium (Na) levels

Answer and Explanation

Choice A:

Severe acidemia: A pH of 6.9 indicates severe acidemia, a condition where the blood is too acidic. Sodium bicarbonate is an alkalizing agent that can help raise the blood pH back to a normal range. Rapid correction: Intravenous (IVP) administration of sodium bicarbonate allows for rapid correction of acidemia, which is crucial in severe cases to prevent life-threatening complications. Buffering action: Sodium bicarbonate acts as a buffer, accepting excess hydrogen ions (H+) in the blood and converting them into water and carbon dioxide (CO2), which can be exhaled. Specific indications: Sodium bicarbonate is typically used in cases of severe acidemia caused by metabolic acidosis, such as diabetic ketoacidosis or lactic acidosis. It may also be considered in cases of respiratory acidosis, but other interventions like ventilatory support are often prioritized.

Choice B:

Calcium carbonate is not a direct treatment for acidemia: It is primarily used as an antacid to neutralize stomach acid and as a calcium supplement for bone health. While it can have a mild alkalizing effect, it is not as effective as sodium bicarbonate in rapidly correcting severe acidemia.

Choice C:

Alkalemia: A pH of 7.6 indicates alkalemia, a condition where the blood is too alkaline. Administration of sodium bicarbonate in this situation would worsen the alkalemia and potentially lead to serious complications.

Choice D:

Hyponatremia: Low serum sodium levels do not directly require treatment with sodium bicarbonate. Sodium bicarbonate is primarily used to address acid-base imbalances, not electrolyte imbalances.

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South Tampa University, Exam 3 Pharmacology

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