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The telephone triage nurse receives a call from a patient asking for a prescription for a narcotic to manage his surgical pain. The nurse explains that narcotic prescriptions must be written and cannot be called in to the pharmacy. The patient says, Why are narcotics so difficult to get a prescription for? What is the nurses best response?
- A. The Drug Enforcement Agency (DEA) determines the risk for addiction and the Food and Drug Administration (FDA) enforces their control.
- B. The increase in the number of drug addicts has made the rules stronger.
- C. The Centers for Disease Control and Prevention (CDC) regulates use of controlled substances to reduce the risk of injury.
- D. Controlled substances like narcotics are controlled by the FDA and the DEA.
Correct Answer: D
Rationale: Controlled substances are controlled by the FDA and the DEA: the DEA enforces control while the FDA determines abuse potential. Regulations related to controlled substances have remained strict and specific and have not been significantly impacted by substance abusers. The CDC is not involved in control of narcotics and other controlled substances.
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The nurse is talking with a group of nursing students who are doing clinical hours on the unit. A student asks if all intramuscular (IM) drugs are absorbed the same. What factor would the floor nurse tell the students to affect absorption of the IM administration of drugs?
- A. Perfusion of blood to the subcutaneous tissue
- B. Integrity of the mucous membranes
- C. Environmental temperature
- D. Blood flow to the gastrointestinal tract
Correct Answer: C
Rationale: A cold environmental temperature can cause blood vessels to vasoconstrict and decreases absorption or in a hot environment vasodilate and increase absorption of IM medications. Blood flow to the subcutaneous tissues interferes with subcutaneous injection and blood flow to the gastrointestinal (GI) tract causes alterations in absorption for oral medications. The condition of mucous membranes can interfere with sublingual (under the tongue) and buccal (in the cheek) administration of drugs.
Discharge summaries using information technology have several advantages. They can:
- A. Replace the need for oral instruction because the patient has printed material to read at home
- B. Be filed with the patient's chart to document patient teaching
- C. Both 1 and 2
- D. Neither 1 nor 2
Correct Answer: B
Rationale: IT discharge summaries document teaching but do not replace oral instructions.
The action of 'gliptins' is different from other antidiabetic agents because they:
- A. Have a low risk for hypoglycemia
- B. Are not associated with weight gain
- C. Close ATP-dependent potassium channels in the beta cell
- D. Act on the incretin system to indirectly increase insulin production
Correct Answer: D
Rationale: Gliptins enhance incretin activity, boosting insulin secretion without hypoglycemia risk , unlike sulfonylureas .
When administering an intradermal injection, the nurse would use a 1-mL syringe with which gauge of needle? Select one that does not apply.
- A. 26 gauge
- B. 27 gauge
- C. 29 gauge
- D. 25 gauge
Correct Answer: C
Rationale: A 1-mL syringe with a 25- to 27-gauge needle that is 1/4 to 5/8 inches long is best suited for intradermal injections.
Hypoglycemic effects of repaglinide and nateglinide is determined with:
- A. Closure of ATP sensitive K+ channels
- B. Increase numbers of insulin receptors
- C. Stimulation of PPAR-Y receptors
- D. Degradation of incretin
Correct Answer: A
Rationale: Repaglinide and nateglinide close ATP-sensitive K+ channels on beta cells, triggering insulin release.