Question 1

The nurse, preparing medications for a client with diabetes, recognizes that ____-___ percent of adults with diabetes take oral agents only.

Accepted Answer

50-60 %

Question 2

Which of the following substance should the nurse instruct the client to avoid while taking sulfonylureas?&#10;A) Antacids&#10;B) Calcium products&#10;C) Alcohol&#10;D) Antibiotics&#10;

Accepted Answer

Rationale 1: Antacids do not need to be avoided when taking a sulfonylurea medication.
Rationale 2: Calcium products do not need to be avoided when taking a sulfonylurea medication.
Rationale 3: When administered with alcohol, sulfonylureas can cause a disulfiram-like reaction with flushing, palpations, and nausea.
Rationale 4: Antibiotics do not need to be avoided when taking a sulfonylurea medication.

Question 3

Nursing students have just completed their class on the pharmacology of oral anti-hyperglycaemics. They are asked by their instructor to identify the medications that work by increasing insulin secretion by the pancreas. Which Answer by one of the students indicate the need for further study?

A) Biguanides
B) Sulfonylureas
C) Thiazolidinediones
D) Meglitinides
E) Incretin enhancers

Biguanides
Thiazolidinediones

Accepted Answer

Ratioanle 1. Biguanides decrease production and release of glucose from the liver. 
Rationale 2. Sulfonyureas stimulates insulin release; decreases insulin resistance.
Rationale 3. Thiazolidinediones decrease production and release of glucose from the liver. 
Rationale 4. Meglitinides stimulates insulin release. 
Rationale 5. Incretin enhancers increases insulin secretion and slows the breakdown of insulin, keeping it circulating in the blood longer.

Question 4

The nurse decides to withhold a prescribed dose of metformin to a client after reviewing the medical record. For which conditions is this medication contraindicated or used with caution?&#10;A) Impaired renal function&#10;B) Recent alcohol intake&#10;C) Hyperthyroidism&#10;D) Septicemia&#10;E) Sleep apnea&#10;

Accepted Answer

Rationale 1: Metformin is contraindicated in clients with impaired renal function.
Rationale 2: Metformin is contraindicated in clients drinking alcohol.
Rationale 3: Metformin is used with caution in clients with hyperthyroidism.
Rationale 4: Metformin is contraindicated in clients with a concurrent serious infection.
Rationale 5: Metformin is not contraindicated in clients with sleep apnea.

Question 5

What dietary instructions should the nurse provide a client who is prescribed glyburide (DiaBeta)?&#10;A) Avoid the intake of St John's Wort.&#10;B) Avoid using garlic.&#10;C) Drink decaffeinated beverages only.&#10;D) Avoid green leafy vegetables.&#10;E) Avoid the intake of ginseng.&#10;

Accepted Answer

Rationale 1: The concurrent intake of grapefruit juice with repaglinide may result in increased drug levels and hypoglycemia.
Rationale 2: Garlic may increase the hypoglycemic effects of the medication.
Rationale 3: St John's Wort does not interact with caffeine.
Rationale 4: This medication does not interact with green leafy vegetables.
Rationale 5: Ginseng may increase the hypoglycemic effects of the medication

Question 6

Which statements indicate that instruction provided to a client with type 1 diabetes mellitus regarding exercise has been effective?&#10;A) &#34;I should start any new exercise regimen slowly.&#34;&#10;B) &#34;I should exercise an hour after a meal.&#34;&#10;C) &#34;I should have a snack of 10 to 15 grams of carbohydrate before exercising.&#34;&#10;D) &#34;I should take 10- to 15-gram carbohydrate snacks with me to the gym if I plan to exercise longer than 30 minutes.&#34;&#10;E) &#34;I should withhold my routine insulin dose if I plan to exercise that day.&#34;&#10;

Accepted Answer

Rationale 1: The client should be instructed to begin any new exercise routine or increase in exercise gradually.
Rationale 2: The client should be instructed to exercise an hour after a meal.
Rationale 3: The client should be instructed to exercise after a 10- to 15-gram carbohydrate snack.
Rationale 4: The client should be instructed to have small frequent carbohydrate snacks every 30 minutes during exercise to maintain the blood sugar level.
Rationale 5: The nurse should not instruct the client to alter the routine insulin dose according to the exercise schedule.

Question 7

A client is diagnosed with hyperthyroidism. Which medications are considered routine treatment for this disorder?&#10;A) Propylthiouracil (PTU)&#10;B) Methimazole (Tapazole)&#10;C) Propranolol (Inderal)&#10;D) Esmolol (Brevibloc)&#10;E) Metoprolol (Toprol)&#10;

Accepted Answer

Rationale 1: Propylthiouracil (PTU) is used to treat hyperthyroidism.
Rationale 2: Methimazole (Tapazole) is used to treat hyperthyroidism.
Rationale 3: Propranolol (Inderal) is not used to treat hyperthyroidism.
Rationale 4: Esmolol (Brevibloc) is not used to treat hyperthyroidism.
Rationale 5: Metoprolol (Toprol) is not used to treat hyperthyroidism.

Question 8

A client with inflammatory bowel disease is prescribed budesonide (Entocort-EC) and asks why this drug is ordered. The nurse correctly explains:&#10;A) &#34;The pharmacist will be making rounds this shift, and will explain the rationale to you at that time.&#34;&#10;B) &#34;Your health care provider ordered this medication to treat the underlying disease pathology.&#34;&#10;C) &#34;This is a corticosteroid that is not absorbed and remains in the intestine to treat the inflammation locally, without causing significant systemic effects.&#34;&#10;D) &#34;This is a systemic corticosteroid that will decrease system wide inflammation.&#34;&#10;

Accepted Answer

Rationale 1: The nurse must know the rationale for medications and must articulate this to the client as part of client education.
Rationale 2: This response does not give the client any information.
Rationale 3: Budesonide is a locally acting anti-inflammatory without significant systemic effects.
Rationale 4: Budesonide does not prevent system wide inflammation.

Question 9

A client on long-term corticosteroid therapy tells the nurse that the plan is to stop taking the medication when the current prescription is completed. How should the nurse respond?&#10;A) &#34;You could develop nausea, vomiting, and other problems if you stop this medication abruptly.&#34;&#10;B) &#34;Your body will not be able to produce the steroid that you need and you will become very ill.&#34;&#10;C) &#34;Why do you plan to stop taking the medication?&#34;&#10;D) &#34;I'm sure you know what is best for your health.&#34;&#10;E) &#34;You will feel sick for a short while after stopping the medication, but it will go away.&#34;&#10;

Accepted Answer

Rationale 1: If the corticosteroid medication is abruptly withdrawn, symptoms of adrenal crisis will appear.
Rationale 2: If the corticosteroid medication is abruptly withdrawn, symptoms of adrenal crisis will appear.
Rationale 3: The nurse should determine the reasons for the patient's actions.
Rationale 4: This response does not address the physiologic effects that will occur if the medication is abruptly stopped.
Rationale 5: If left untreated, the symptoms will not go away, and the client may go into shock.

Deck 12: Pharmacotherapy of Diabetes Mellitus