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A 52-year-old overweight woman presents to the clinic for a diabetes management. She had not been doing well controlling her blood sugars with metformin. Her last hemoglobin A1c was 13.4%, despite her taking her medication every day. The physician decides to start her on a long-acting insulin that is injected only once a day for better glucose control. Also, he wants the insulin to have a minimal risk of hypoglycemia. What is the most likely medication given to this patient?
- A. Insulin aspart
- B. Insulin glargine
- C. Insulin lispro
- D. NPH insulin
Correct Answer: B
Rationale: Insulin glargine is a long-acting, peakless insulin administered once daily, with a lower risk of hypoglycemia compared to other insulins.
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Discharge planning for patients leaving the hospital should include instructions on the use of over-the-counter (OTC) drugs. Which comment by the patient would demonstrate a good understanding of OTC drugs?
- A. OTC drugs are always safe and will not cause bad effects.'
- B. OTC drugs have been around for years and have not been tested by the Food and Drug Administration (FDA).'
- C. OTC drugs are different from any drugs available by prescription and cost less.'
- D. OTC drugs are thought to be safe when taken as directed.'
Correct Answer: D
Rationale: OTC drugs are drugs that have been determined to be safe when taken as directed. They may have originally been prescription drugs that were tested by the FDA or they may have been grandfathered in when the FDA laws changed. OTC education should always be included as a part of the hospital discharge instructions.
What is medication reconciliation?
- A. Comparing the patient's current medication orders to all of the medications actually being taken
- B. The administration of high alert medications that have been ordered on admission to an acute care facility
- C. The completion of an incident report following a variance that resulted in a serious complication
- D. A printout of computerized patient data that identifies the times that all of the ordered medications are to be administered
Correct Answer: A
Rationale: Medication reconciliation is the process of comparing a patient's current medication orders to all of the medications that the patient is actually taking. Administering high alert medications and completing an incident report are not the same as medication reconciliation. A printout of computerized patient data that identifies the times that all of the ordered medications are to be administered is a description of the medication administration record (MAR), not a description of medication reconciliation.
A nurse is reviewing laboratory findings and notes that a client's plasma Lithium level is 2.1 mEq/L. Which of the following is an appropriate action by the nurse?
- A. Perform immediate gastric lavage.
- B. Prepare the client for hemodialysis.
- C. Administrative and additional oral dose of lithium.
- D. Request a stat repeat of the laboratory test
Correct Answer: B
Rationale: A level of 2.1 mEq/L indicates toxicity (normal 0.6-1.2 mEq/L); hemodialysis is used for severe cases.
An older adult experiencing shortness of breath is brought to the hospital by her daughter. While obtaining the medication history from the patient and her daughter, the nurse discovers that neither has a list of the patient's current medications or prescriptions. The patient has a weekly pill dispenser that contains four different pills. The prescriptions are filled through the local pharmacy. Which resource would be appropriate to use in determining the medication names and doses?
- A. Martindale-The Complete Drug Reference
- B. Drugs and Facts Comparisons
- C. Senior citizens' center
- D. Patient's home pharmacy
Correct Answer: D
Rationale: The patient's pharmacy maintains an accurate record of all current medications, making it the best resource for identifying the drugs and doses.
A patient comes to the ER having his quadriceps muscle constantly contracted, you should give him:
- A. Norepinephrine to stimulate the sympathetic nervous system
- B. An antagonist for Norepinephrine
- C. Agonist for acetylcholine
- D. Both B and C
Correct Answer: D
Rationale: Both B and C are correct: a norepinephrine antagonist (e.g., beta-blocker) or acetylcholine agonist (e.g., to relax via parasympathetic action) could relieve muscle contraction.