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When teaching about hypoglycemia, the nurse should make sure that the patient is aware of the early signs of hypoglycemia, including

• Hypothermia and seizures.

• Nausea and diarrhea.

• Irritability and confusion.

• Fruity, acetone odor to the breath.

The nurse is teaching a group of patients about self-administration of insulin. What teaching is important to include?

• Patients should use the injection site that is the most accessible.

• During times of illness, patients should increase their insulin dosage by 25%.

• When mixing insulins, the cloudy (such as NPH) insulin should be drawn up into the syringe first.

• When mixing insulins, the clear (such as Regular) insulin should be drawn up into the syringe first.

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)

• Random blood glucose level above 170 mg/dL.

• Blood glucose level of less than 50 mg/dL after meals.

• Fasting blood glucose level between 70 and 100 mg/dL.

• Evening blood glucose level below 70 mg/dL.

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?

• “Take this medication in the evening, with a snack.”

• “Take this medication in the morning, 30 minutes before breakfast.”

• “This medication should be taken after the midday meal.”

• “It does not matter what time of day you take this medication.”

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?

• Giving her half the original dose

• Withholding all medications as ordered

• Contacting the prescriber for further orders

• Giving her the medication with a sip of water

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?

• “I will call my doctor right away.”

• “I will give myself the Regular insulin.”

• “I will take an oral form of glucose.”

• “I will rest until the symptoms pass.”

The nurse is teaching patients about self-injection of insulin. Which statement is true regarding injection sites?

• Avoid the abdomen because absorption there is irregular.

• Choose a different site at random for each injection.

• Give the injection in the same area each time to promote consistent absorption.

• Rotate sites within the same location for about 1 week before rotating to a new location.

The nurse is administering rapid-acting insulin. Which statement is true regarding its administration?

• It should be given within 15 minutes of the patient beginning a meal.

• It should be given after the meal has been completed.

• It is administered once daily at the time of the midday meal.

• It is taken only in the evenings with a snack before bedtime.

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?

• Hemoglobin levels

• Hemoglobin A1C level

• Fingerstick fasting blood glucose level

• Serum insulin levels

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?

• Call the lab to order a fasting blood glucose level.

• Have the patient eat glucose tablets.

• Have the patient consume fruit juice, a nondiet soft drink, or crackers.

• Give him intravenous glucose.

The nurse is preparing to administer insulin intravenously. Which statement about intravenous insulin is true?

• Insulin aspart or lispro can be administered intravenously, although there must be a 50% dose reduction.

• Any form of insulin can be administered intravenously at the same dose as that ordered for subcutaneous administration.

• Only Regular insulin can be administered intravenously.

• Insulin should never be given intravenously.

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?

• The antibiotics may cause an increase in glucose levels.

• The corticosteroids may cause an increase in glucose levels.

• His type 2 diabetes has converted to type 1.

• The hypoxia caused by the chronic obstructive pulmonary disease causes an increased need for insulin.

The nurse knows to administer acarbose (Precose), an alpha-glucosidase inhibitor, at which time?

• 30 minutes before breakfast

• With the first bite of each main meal

• 30 minutes after breakfast

• Once daily at bedtime

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

• Increase the pancreatic secretion of insulin.

• Decrease insulin resistance.

• Increase blood glucose levels.

• Decrease the pancreatic secretion of insulin.

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?

• Give the drug as ordered 30 minutes before breakfast.

• Hold the drug and check the order with the prescriber.

• Give the drug and monitor for adverse effects.

• Give a reduced dose of the drug with breakfast.

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?

• Glitazone

• Insulin

• Metformin

• Sulfonylurea

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?

The nurse is administering adrenal drugs to a patient. Which of the following actions is appropriate for this patient?

• Administering oral drugs before meals to maximize absorption

• Rinsing the oral cavity after using steroid inhalers

• Administering the corticosteroids before bedtime to minimize adrenal suppression

• Discontinuing the medication immediately if a weight gain of more than 5 pounds in 1 week is experienced

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

• Nonsteroidal antiinflammatory drugs.

• Antibiotics.

• Opioid analgesics.

• Antidepressants.

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?

• Weight loss

• Weight gain

• Pale skin color

• Loss of hair

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?

• It may cause severe postural hypotension.

• It should be taken with food or milk to minimize gastrointestinal upset.

• The medication should be stopped immediately if nausea or vomiting occurs.

• Weight gain of 5 pounds or more within a week is an expected adverse effect.

A patient is receiving aminoglutethimide (Cytadren) therapy. The nurse knows that this medication is used for which condition?

• Acute asthma

• Addison’s disease

• Chronic obstructive pulmonary disease

• Cushing’s syndrome

When monitoring a patient who is taking a systemically administered glucocorticoid, the nurse should monitor for signs of which condition?

• Dehydration

• Hypokalemia

• Hyponatremia

• Hypoglycemia

The nurse expects that a patient is experiencing undersecretion of adrenocortical hormones when which condition is found upon assessment?

• Osteoporosis

• Steroid psychosis

• Dehydration and weight loss

• Water retention

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?

• Hypotension

• Delayed wound healing

• Muscle weakness

• Osteoporosis

Which conditions are indications for glucocorticoid drugs? Select all that apply.

• Glaucoma

• Cerebral edema

• Chronic obstructive pulmonary disease and asthma

• Organ transplantation

• Varicella

• Septicemia

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?

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

• Double-up on the medication if a dose is missed.

• Not be concerned about breast lumps or bumps that occur.

• Report any weight gain of more than 5 pounds per week.

• Take the medication on an empty stomach to enhance absorption.

The nurse recognizes that use of estrogen drugs is contraindicated in which of the following patients?

• A patient who has atrophic vaginitis

• A patient who has inoperable prostate cancer

• A woman who has just given birth and wants to prevent postpartum lactation

• A woman with a history of thrombophlebitis

A patient is being treated for primary amenorrhea. The nurse expects which drug to be used to treat this problem?

• Oxytocin (Pitocin)

• Estradiol transdermal (Estraderm)

• Raloxifene (Evista)

• Medroxyprogesterone (Provera)

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?

• Dizziness

• Drowsiness

• Dysmenorrhea

• Increased appetite

A patient is receiving oxytocin (Pitocin) to induce labor. During administration of this medication, the nurse will also implement which action?

• Giving magnesium sulfate along with the oxytocin

• Administering the medication in an intravenous bolus

• Administering the medication with an IV infusion pump

• Monitoring fetal heart rate and maternal vital signs every 6 hours

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?

• Prevention of preterm labor in the 15th week of pregnancy

• Prevention of preterm labor in the 22nd week of pregnancy

• Stimulation of contractions in prolonged labor

• Stimulation of ovulation as part of infertility treatments

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

• Pregnancy.

• Breast cancer.

• Stress fractures.

• Venous thromboembolism.

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

• Incidence of nausea.

• Tendency to bleed during menstruation.

• Levels of triglycerides.

• Risk for thrombosis.

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?

• Monophasic

• Biphasic

• Triphasic

• Long-acting

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?

• Complete blood count

• Urinalysis

• Vaginal cultures

• Pregnancy test

The nurse should instruct a patient who will be taking bisphosphonate alendronate (Fosamax) to take this medication at which time?

• In the evening just before bedtime

• In the morning with an 8-ounce glass of water

• With the first bite of the morning meal

• Between meals on an empty stomach

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?

• She should stop taking the drug at least 72 hours before the trip.

• She must remember to take this drug with a full glass of water each morning.

• She should increase the calcium supplements that she takes with the drug.

• No change in interventions is needed.

When reviewing the risk factors for osteoporosis, the nurse recognizes that which of the following is considered a risk factor?

• White or Asian race

• African American race

• History of participation in active sports

• Obesity

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?

• She should continue to take the alendronate with water.

• She should not take the alendronate until she can sit up for 30 minutes.

• She can take the medication with breakfast.

• She should stop taking the medication 72 hours before her surgery.

While discussing options for osteoporosis prevention, a patient asks if she will be using estrogen patches. What is the nurse’s best response?

• “Estrogen patches are still the first choice for osteoporosis prevention.”

• “Estrogen patches are often used as long-term therapy for osteoporosis prevention.”

• “Estrogen patches are associated with a high risk for cardiovascular problems and are not the first choice for osteoporosis prevention.”

• “Estrogen patches will be prescribed if the patient prefers patches to oral medications.”

The nurse is preparing to administer the contraceptive form of medroxyprogesterone (Depo-Provera). What route should be planned?

• Oral

• Intramuscular

• Vaginal

• Transdermal

When couples are treated for infertility with ovulation-inducing drugs, the nurse will include instruction about the increased likelihood of

• Severe weight gain.

• Irregular menses.

• Multiple births.

• Alopecia.

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

• Thyroid replacement therapy.

• Oral anticoagulant therapy.

• Nonsteroidal antiinflammatory drugs.

• Beta blockers.

A patient taking an oral contraceptive should be aware of potential drug interactions with which medications? Select all that apply.

• Cephalexin (Keflex)

• Guaifenesin (Robitussin)

• Warfarin (Coumadin)

• Isoniazid (INH)

• Ibuprofen (Motrin)

• Theophylline (Uniphyl)

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.

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?

• “The patch allows for blood levels to increase quickly.”

• “If you don’t take the patch, you will have to have injections instead.”

• “Oral forms are not absorbed well by the body. The patch allows for better absorption of the medication.”

• “You will only have to wear the patch weekly.”