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Four patients are due to receive their morning insulin and breakfast will be served in 15 minutes. Which patient should the nurse administer insulin to first?
- A. The patient with a pre-meal glucose level of 90 mg/dL, scheduled to receive 10 units of NPH.
- B. The patient with a pre-meal glucose level of 70 mg/dL, scheduled to receive 2 units of aspart (Novolog) insulin.
- C. The patient with a pre-meal glucose level of 120 mg/dL, scheduled to receive 15 units of NPH.
- D. The patient with a pre-meal glucose level of 170 mg/dL, scheduled to receive 5 units of lispro (Humalog) insulin.
- G. D
Correct Answer: 90 mg/dL (NPH) and 70 mg/dL (aspart) are normal/low, less urgent. 120 mg/dL (NPH) is mildly high. 170 mg/dL with rapid-acting lispro needs priority due to significant elevation.
Rationale: The correct answer is D: The patient with a pre-meal glucose level of 170 mg/dL, scheduled to receive 5 units of lispro (Humalog) insulin. This choice is correct because a glucose level of 170 mg/dL is significantly elevated, indicating a need for immediate insulin administration to prevent further hyperglycemia. Lispro is a rapid-acting insulin, which should be administered promptly before breakfast to control the high blood sugar effectively. Choices A, B, and C have glucose levels within normal or slightly elevated ranges, making them less urgent for immediate insulin administration. Choice D is the most critical due to the high glucose level and the type of insulin being rapid-acting, requiring prompt action to manage the patient's blood sugar levels effectively.
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Class of drugs derived from barbituric acid that act as CNS depressants and are used for their sedative and anti- seizure effect are known as _
- A. Antidepressants
- B. Anxiolytics
- C. Barbiturates
- D. Benzodiazepines
- G. C
Correct Answer: Antidepressants treat mood disorders. Anxiolytics reduce anxiety but aren't barbituric-derived. Barbiturates fit the description. Benzodiazepines aren't barbituric-based.
Rationale: The correct answer is C: Barbiturates. Barbiturates are drugs derived from barbituric acid, acting as CNS depressants for sedative and anti-seizure effects. Antidepressants (A) are used for mood disorders, not CNS depression. Anxiolytics (B) are for anxiety and not all are barbituric-derived. Benzodiazepines (D) are a different class of CNS depressants, not derived from barbituric acid. Therefore, choice C is the most appropriate based on the specific description provided in the question.
A nurse is reinforcing teaching with a client who was newly prescribed paroxetine (Paxil) (an SSRI) for treatment of panic disorder. Sort the following information by what the nurse should include vs what not to include.
- A. Take this medication just before bedtime to promote sleep.
- B. Herbal medication can be combined with this medication.
- C. Monitor for weight changes while taking this medication.
- D. It can take several weeks before you feel like the medication is helping.
- G. A,C
Correct Answer: Bedtime dosing helps with side effects like drowsiness. Herbal combinations risk serotonin syndrome and should be avoided. Weight changes are a side effect to monitor. It takes weeks for full effect, but this was mislabeled; A and C are correct inclusions.
Rationale: The correct answer is G: A,C. The rationale for this is as follows:
1. A: Taking the medication just before bedtime can help minimize side effects like drowsiness, which is common with SSRIs like paroxetine.
2. C: Monitoring for weight changes is important because weight gain or loss can be a side effect of paroxetine.
3. B: Combining herbal medications with paroxetine can increase the risk of serotonin syndrome, a potentially life-threatening condition.
4. D: It is true that it can take several weeks before feeling the full benefits of paroxetine, but this information was not provided in the question stem.
In summary, A and C are the correct inclusions because they provide important information related to the medication's side effects and administration, while B and D are incorrect because they introduce potential risks and irrelevant information.
A student nurse is studying drugs for anxiety and insomnia. Which of the following should be avoided as they counteract anxiolytics and sedatives and may worsen anxiety symptoms?
- A. Coffee
- B. Tea
- C. Chocolate
- D. All of the above
- G. D
Correct Answer: Coffee, tea, and chocolate contain caffeine, a stimulant that counteracts anxiolytics/sedatives and may worsen anxiety.
Rationale: The correct answer is D: All of the above. Caffeine, found in coffee, tea, and chocolate, is a stimulant that can counteract the effects of anxiolytics and sedatives, potentially worsening anxiety symptoms. Consuming these items can lead to increased heart rate, restlessness, and jitteriness, which are opposite effects of anxiolytics and sedatives. Therefore, it is advisable for a student nurse studying drugs for anxiety and insomnia to avoid these stimulant-containing products to prevent any interference with the effectiveness of anxiolytics and sedatives.
Which of the following triggers the pancreas to secrete insulin?
- A. Hypoglycemia
- B. Hyperglycemia
- C. Glucagon
- D. Ketoacids
- G. B
Correct Answer: Hypoglycemia triggers glucagon, not insulin. Hyperglycemia prompts insulin release to lower blood sugar. Glucagon opposes insulin. Ketoacids indicate low glucose, not insulin trigger.
Rationale: The correct answer is B: Hyperglycemia. When blood sugar levels are high, the pancreas responds by releasing insulin to facilitate the uptake of glucose by cells, thereby lowering blood sugar levels. This is a crucial mechanism to maintain glucose homeostasis in the body. Hypoglycemia (A) triggers the release of glucagon to raise blood sugar levels, not insulin. Glucagon (C) is released in response to low blood sugar levels and opposes the action of insulin. Ketoacids (D) indicate a state of low glucose, not a trigger for insulin secretion. Therefore, the correct trigger for the pancreas to secrete insulin is hyperglycemia.
What would the nurse teach a client to avoid when taking barbiturates?
- A. Nicotine
- B. Alcohol
- C. Bananas
- D. Caffeine
- G. B
Correct Answer: Nicotine and caffeine don't critically interact. Alcohol, a CNS depressant, dangerously enhances barbiturate sedation. Bananas are unrelated.
Rationale: The correct answer is B: Alcohol. Barbiturates and alcohol are both central nervous system depressants, and when taken together, they can dangerously enhance sedation and respiratory depression. This can lead to overdose and even death. Nicotine (choice A) and caffeine (choice D) do not have critical interactions with barbiturates, so there is no specific teaching to avoid them. Bananas (choice C) are unrelated to barbiturate use and do not pose any risk. It is crucial for the nurse to educate the client on the dangers of combining barbiturates with alcohol to prevent adverse effects and ensure the client's safety.