TEST BANK FOR CLAYTON’S BASIC PHARMACOLOGY FOR NURSES 19TH EDITION BY MICHELLE J. WILLIHNGANZ, SAMUEL L. GUREVITZ,BRUCE CLAYTON CHAPTER 1-48.

9. The patient asks the nurse how sulfonylureas normalize glucose levels. Which response by the nurse is correct? a. By stimulating pancreatic secretion of insulin b. By inhibiting secretion of insulin by the pancreas c. By increasing glucose production in the liver d. By increasing insulin metabolism in the liver ANS: A Sulfonylureas stimulate the pancreas to secrete more insulin. They also diminish glucose production and metabolism of insulin by the liver. The net effect is a normalization of insulin and glucose levels. Sulfonylureas decrease glucose production and hepatic metabolism of insulin. DIF: Cognitive Level: Application REF: p. 564 OBJ: 5 TOP: Nursing Process Step: Implementation MSC: NCLEX Client Needs Category: Physiological Integrity 10. The nurse is instructing a patient about insulin administration. Which statement by the patient indicates a need for further teaching? a. “I may need more insulin if I have surgery.” b. “Once I open my insulin, I will store it in the refrigerator.” c. “I will date the insulin bottle when I open it.” d. “I will keep a spare bottle of insulin on hand.” ANS: B Once insulin is opened and being used, it can be stored at room temperature for up to 1 month. The patient may need more insulin if undergoing surgery, should date the insulin bottle after opening, and should keep a spare bottle of insulin on hand. DIF: Cognitive Level: Application REF: p. 570 | p. 577 OBJ: 6 TOP: Nursing Process Step: Implementation MSC: NCLEX Client Needs Category: Physiological Integrity 11. Which instruction by the nurse is accurate to include when providing teaching to a patient recently diagnosed with diabetes who has been prescribed insulin? a. Beta blockers can mask symptoms of hypoglycemia. b. Lipodystrophy increases the absorption of insulin. c. Infection will decrease the need for insulin. d. Excessive exercise will increase the need for insulin. ANS: A Beta adrenergic blocking agents (e.g., propranolol, timolol, nadolol, pindolol) may mask many symptoms of hypoglycemia. Lipodystrophy does not increase the absorption of insulin. Infection does not decrease the need for insulin. Excessive exercise does not increase the need for insulin. DIF: Cognitive Level: Application REF: p. 578 OBJ: 4 | 6 TOP: Nursing Process Step: Implementation MSC: NCLEX Client Needs Category: Physiological Integrity 12. Which instruction is most important for the nurse to teach a patient with diabetes who is receiving metformin? a. Take the medication before meals. b. This medication will cause the pancreas to secrete more insulin. c. Stop taking the drug 24 to 48 hours prior to radiopaque dye procedures. d. There may be an increase in the triglyceride level. ANS: C Radiopaque dyes often induce temporary renal insufficiency, so metformin should be discontinued 24 to 48 hours before procedures in which radiopaque dye will be administered. Metformin is not administered before meals. The pancreas does not secrete more insulin as a result of taking this medication. Metformin does not increase triglyceride levels. DIF: Cognitive Level: Application REF: p. 579 OBJ: 5 | 6 TOP: Nursing Process Step: Implementation MSC: NCLEX Client Needs Category: Physiological Integrity 13. The nurse is caring for a patient with a new diagnosis of type 1 diabetes mellitus. When assisting with the plan of care, which goal set by the patient will require revision? a. Patient will participate in 20 minutes of cardiovascular exercise 5 days a week. b. Patient will discontinue insulin use within 1 year. c. Patient will consume 20% of caloric intake from fat. d. Patient will demonstrate accurate self glucose testing skills. ANS: B Type 1 diabetes mellitus requires the administration of insulin injections to replace the insulin that the body is no longer able to make. Participation in a regular exercise program is a realistic goal. A diabetic diet includes 20% to 35% of calories from fat. A person diagnosed with diabetes should be able to perform glucose testing. DIF: Cognitive Level: Analysis REF: p. 562 | p. 567 OBJ: 1 | 6 TOP: Nursing Process Step: Planning 17. Which dietary control measures are used in the management of diabetes mellitus? (Select all that apply.) a. Specific daily caloric requirements b. Consistent carbohydrate diabetes meal plan c. 50 % intake of carbohydrates daily d. Adjustments to daily meals according to age, metabolic stress, pregnancy, and advanced age and/or older adults e. 20 % intake of proteins daily ANS: B, C, D, E Meal planning systems are used with the diabetic patient. The consistent carbohydrate diabetes meal plan is used, with an emphasis on consistency of timing of meals and snacks. Daily meals and snacks provide 1500 to 2000 calories, with 50% of the calories from carbohydrates, 20% from protein, and 30% from fat. Individualized adjustments may be required with children, adolescents, metabolically stressed patients, pregnant women, and geriatric patients. Specific daily caloric requirement is not a primary consideration in calculating calorie requirements for a diabetic patient. DIF: Cognitive Level: Comprehension REF: p. 563 | pp. 568-569 OBJ: 3 TOP: Nursing Process Step: Implementation MSC: NCLEX Client Needs Category: Physiological Integrity 18. Which statement(s) regarding type 2 diabetes mellitus would be correct? (Select all that apply.) a. Type 2 diabetes is more prevalent in overweight people older than 45 years. b. A genetic predisposition exists for the development of type 2 diabetes mellitus. c. Type 2 diabetes requires lifelong insulin replacement. d. Type 2 diabetes is often diagnosed after complications have resulted. e. Women have a higher incidence of type 2 diabetes. ANS: A, B, D, E Contributing factors to the development of type 2 diabetes mellitus include being older than 45 years, being overweight, and having a family predisposition to the disease. The early symptoms of this type of diabetes are minimal; therefore, many patients do not seek medical assistance until the complications have appeared. Contributing factors to the development of type 2 diabetes mellitus include being female. In type 2 diabetes mellitus, the pancreas continues to secrete insulin. Patients may be diet controlled or regulated with oral hypoglycemics. Insulin is only used if the other treatments are not effective.