https://www.stuvia.com/user/nursecare
CMN 548 Module 2 Study Guide 2026 THE BEST
UPDATE
1. What is the most reliable indicator of a patient’s blood sugar status if they have
been taking a 2nd generation antipsychotic? Dr. Baker PPT, Sadock p. 1063-1064,
Fishbach page 335
a. Fasting blood glucose levels and glycosylated hemoglobin levels (hemoglobin
A1C) should be followed regularly as some of these medications can cause
abnormal glucose tolerance and may lead to diabetes.
b. A1C shows the mean serum glucose concentration over the preceding 8-12
weeks, with a normal A1c level below 5.7 percent. A level of 6.5 or above
indicated diabetes mellitus. A good target range for diabetics is an A1c of 7.0 or
below
Pg. 141 (pdf CMN 548 readings), 1064 Sadock
Atypical antipsychotic agents have been associated with abnormalities in serum glucose
levels, including the development of diabetes mellitus. Many clinicians monitor their
patients who take atypical antipsychotic agents for the development of hyperglycemia by
obtaining fasting blood glucose levels and glycosylated hemoglobin levels on a quarterly or
semiannual basis.
Sadock, Chapter 7.6, Table 7.6-2, page 1063
Hemoglobin A1C, fasting blood glucose. Monitor at 12 weeks, 1 year, then annually.
2. How long can the following be detected in urine? Sadock Table 7.6-1 p.1059
c. Alcohol – 7-12 hours
d. Marijuana – 2-7 days
e. Benzodiazepines – 3 days
f. Amphetamines – 48-72 hours
Reference for table?? Answers are different than above
Drugs Tested Screening Length of
Cutoff levels Detection
Alcohol 20 ng/mL 12 h
Ethanol (all methods)
Amphetamines 1,000 ng/mL 2–3 d
Δ-Amphetamine
Methamphetamine
Barbiturates 200 ng/mL Up to 30 d
Secobarbital
Benzodiazepines 200 ng/mL Up to 40 d
Nordiazepam
Marijuana 50 ng/mL 30–60 d
https://www.stuvia.com/user/nursecare
,https://www.stuvia.com/user/nursecare
3. What are some likely causes of a decrease in blood urea nitrogen (BUN)?
Fischbach p.407 (Page 355 in 11th edition)
Decreased BUN levels are associated with the following conditions:
a. Liver failure (severe liver disease), such as that resulting from hepatitis, drugs,
or poisoning
b. Acromegaly
c. Malnutrition, low-protein/ high carb diets
d. Impaired absorption (celiac disease)
e. Nephrotic syndrome (occasional)
f. Syndrome of inappropriate antidiuretic hormone (SIADH)
Interfering Factors:
· Women and children because they have less muscle mass than adult men
· Overhydration (Exclusive IV feedings)
· Late pregnancy r/t increased plasma volume (physiologic hydremia)
· Many drugs
·
Fishbach, Table E.1, page 1117
See table for specific drugs leading to increase/decrease
4. What symptoms may be present due to an elevated blood urea nitrogen (BUN)?
Fischbach p. 406 (Page 355 in 11th edition)
Increased BUN levels (azotemia) occur in the following conditions:
a. Impaired renal function caused by the following conditions:
1. Congestive heart failure
2. Salt and water depletion
3. Shock
4. Stress
5. Acute MI
b. Chronic renal disease such as glomerulonephritis and pyelonephritis
c. Urinary tract obstruction
d. Hemorrhage into GI tract
e. Diabetes mellitus with ketoacidosis
f. Excessive protein intake or protein catabolism as occurs in burns or cancer
g. Anabolic steroid use
Interfering factors: Older persons may have an increased BUN when kidneys are not able to
concentrate urine adequately.
Elevated BUN can indicate kidney dysfunction, and symptoms may include
fatigue, swelling (edema), frequent urination, confusion, dry mouth and excessive
thirst, pale skin, and rapid heart rate as the body compensates for reduced kidney
function.
Sadock, Chapter 7.6, page 1051
https://www.stuvia.com/user/nursecare
,https://www.stuvia.com/user/nursecare
Elevated BUN is common in dehydration
Fishbach, Table E.1, page 1117
See table for specific drugs leading to increase/decrease
5. What do basophils do? Fischbach p. 146 (Chapter 2, page 74-45 in 11th edition)
· Basophils constitute a small percentage of the total leukocyte count and are
considered phagocytic. The basophilic granules contain heparin, histamines, and
serotonin. Tissue basophils are called mast cells and are similar to blood
basophils. Normally, mast cells are not found in peripheral blood and are rarely
seen in healthy bone marrow.
· Basophil counts are used to study chronic inflammation - There is a positive
correlation between high basophil counts and high concentrations of blood
histamines, although this correlation does not imply cause and effect.
· Normal Findings:
a. Absolute count: 15 to 50/mm3 or 0.02 to 0.05 × 10 9 /L
b. Differential: 0% to 1.0% of total WBC count
Clinical Implications
Basophilia (>50)
Common associations: granulocytic leukemia, acute basophilic leukemia, myeloid
metaplasia, meta proliferative disorders, Hodkin disease.
Less common associations: Inflammation, allergy, sinusitis, polycythemia vera, chronic
hemolytic anemia, post-splenectomy, post-ionizing radiation, hypothyroidism, infections
(TB, smallpox, chickenpox, influenza), foreign protein injection
Basopenia (<20, difficult to diagnose)
Acute phase of infection, hyperthyroidism, stress reactions (pregnancy, MI), prolonged
steroid therapy, chemotherapy, radiation, hereditary absence, acute rheumatic fever in
children
6. Identify what might create a false positive blood sugar value above 140? Fishbach
p.385 (Chapter 6, page 333 in 11th Edition)
· Elevated glucose can occur with:
a. Steroids, diuretics, other drugs (see Appendix E)
b. Pregnancy (a slight blood glucose elevation normally occurs)
c. Surgical procedures, anesthesia, and hospitalization in intensive care unit (ICU)
d. Obesity or sedentary lifestyle
e. Parenteral glucose administration (e.g., from total parenteral nutrition)
f. Intravenous (IV) glucose (recent or current)
https://www.stuvia.com/user/nursecare
, https://www.stuvia.com/user/nursecare
g. Heavy smoking
https://www.stuvia.com/user/nursecare
CMN 548 Module 2 Study Guide 2026 THE BEST
UPDATE
1. What is the most reliable indicator of a patient’s blood sugar status if they have
been taking a 2nd generation antipsychotic? Dr. Baker PPT, Sadock p. 1063-1064,
Fishbach page 335
a. Fasting blood glucose levels and glycosylated hemoglobin levels (hemoglobin
A1C) should be followed regularly as some of these medications can cause
abnormal glucose tolerance and may lead to diabetes.
b. A1C shows the mean serum glucose concentration over the preceding 8-12
weeks, with a normal A1c level below 5.7 percent. A level of 6.5 or above
indicated diabetes mellitus. A good target range for diabetics is an A1c of 7.0 or
below
Pg. 141 (pdf CMN 548 readings), 1064 Sadock
Atypical antipsychotic agents have been associated with abnormalities in serum glucose
levels, including the development of diabetes mellitus. Many clinicians monitor their
patients who take atypical antipsychotic agents for the development of hyperglycemia by
obtaining fasting blood glucose levels and glycosylated hemoglobin levels on a quarterly or
semiannual basis.
Sadock, Chapter 7.6, Table 7.6-2, page 1063
Hemoglobin A1C, fasting blood glucose. Monitor at 12 weeks, 1 year, then annually.
2. How long can the following be detected in urine? Sadock Table 7.6-1 p.1059
c. Alcohol – 7-12 hours
d. Marijuana – 2-7 days
e. Benzodiazepines – 3 days
f. Amphetamines – 48-72 hours
Reference for table?? Answers are different than above
Drugs Tested Screening Length of
Cutoff levels Detection
Alcohol 20 ng/mL 12 h
Ethanol (all methods)
Amphetamines 1,000 ng/mL 2–3 d
Δ-Amphetamine
Methamphetamine
Barbiturates 200 ng/mL Up to 30 d
Secobarbital
Benzodiazepines 200 ng/mL Up to 40 d
Nordiazepam
Marijuana 50 ng/mL 30–60 d
https://www.stuvia.com/user/nursecare
,https://www.stuvia.com/user/nursecare
3. What are some likely causes of a decrease in blood urea nitrogen (BUN)?
Fischbach p.407 (Page 355 in 11th edition)
Decreased BUN levels are associated with the following conditions:
a. Liver failure (severe liver disease), such as that resulting from hepatitis, drugs,
or poisoning
b. Acromegaly
c. Malnutrition, low-protein/ high carb diets
d. Impaired absorption (celiac disease)
e. Nephrotic syndrome (occasional)
f. Syndrome of inappropriate antidiuretic hormone (SIADH)
Interfering Factors:
· Women and children because they have less muscle mass than adult men
· Overhydration (Exclusive IV feedings)
· Late pregnancy r/t increased plasma volume (physiologic hydremia)
· Many drugs
·
Fishbach, Table E.1, page 1117
See table for specific drugs leading to increase/decrease
4. What symptoms may be present due to an elevated blood urea nitrogen (BUN)?
Fischbach p. 406 (Page 355 in 11th edition)
Increased BUN levels (azotemia) occur in the following conditions:
a. Impaired renal function caused by the following conditions:
1. Congestive heart failure
2. Salt and water depletion
3. Shock
4. Stress
5. Acute MI
b. Chronic renal disease such as glomerulonephritis and pyelonephritis
c. Urinary tract obstruction
d. Hemorrhage into GI tract
e. Diabetes mellitus with ketoacidosis
f. Excessive protein intake or protein catabolism as occurs in burns or cancer
g. Anabolic steroid use
Interfering factors: Older persons may have an increased BUN when kidneys are not able to
concentrate urine adequately.
Elevated BUN can indicate kidney dysfunction, and symptoms may include
fatigue, swelling (edema), frequent urination, confusion, dry mouth and excessive
thirst, pale skin, and rapid heart rate as the body compensates for reduced kidney
function.
Sadock, Chapter 7.6, page 1051
https://www.stuvia.com/user/nursecare
,https://www.stuvia.com/user/nursecare
Elevated BUN is common in dehydration
Fishbach, Table E.1, page 1117
See table for specific drugs leading to increase/decrease
5. What do basophils do? Fischbach p. 146 (Chapter 2, page 74-45 in 11th edition)
· Basophils constitute a small percentage of the total leukocyte count and are
considered phagocytic. The basophilic granules contain heparin, histamines, and
serotonin. Tissue basophils are called mast cells and are similar to blood
basophils. Normally, mast cells are not found in peripheral blood and are rarely
seen in healthy bone marrow.
· Basophil counts are used to study chronic inflammation - There is a positive
correlation between high basophil counts and high concentrations of blood
histamines, although this correlation does not imply cause and effect.
· Normal Findings:
a. Absolute count: 15 to 50/mm3 or 0.02 to 0.05 × 10 9 /L
b. Differential: 0% to 1.0% of total WBC count
Clinical Implications
Basophilia (>50)
Common associations: granulocytic leukemia, acute basophilic leukemia, myeloid
metaplasia, meta proliferative disorders, Hodkin disease.
Less common associations: Inflammation, allergy, sinusitis, polycythemia vera, chronic
hemolytic anemia, post-splenectomy, post-ionizing radiation, hypothyroidism, infections
(TB, smallpox, chickenpox, influenza), foreign protein injection
Basopenia (<20, difficult to diagnose)
Acute phase of infection, hyperthyroidism, stress reactions (pregnancy, MI), prolonged
steroid therapy, chemotherapy, radiation, hereditary absence, acute rheumatic fever in
children
6. Identify what might create a false positive blood sugar value above 140? Fishbach
p.385 (Chapter 6, page 333 in 11th Edition)
· Elevated glucose can occur with:
a. Steroids, diuretics, other drugs (see Appendix E)
b. Pregnancy (a slight blood glucose elevation normally occurs)
c. Surgical procedures, anesthesia, and hospitalization in intensive care unit (ICU)
d. Obesity or sedentary lifestyle
e. Parenteral glucose administration (e.g., from total parenteral nutrition)
f. Intravenous (IV) glucose (recent or current)
https://www.stuvia.com/user/nursecare
, https://www.stuvia.com/user/nursecare
g. Heavy smoking
https://www.stuvia.com/user/nursecare
