Nokea
Which of the following statements is correct regarding insulin glargine?
- A. It is primarily used to control postprandial hyperglycemia
- B. It is a 'peakless' insulin
- C. The prolonged duration of activity is due to slow dissociation from albumin
- D. It should not be used in a regimen with insulin lispro or glulisine
Correct Answer: B
Rationale: Insulin glargine is a long-acting, peakless insulin providing steady glucose control.
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The nurse is caring for a patient who is receiving gentamicin, 250 mg and fluconazole (Diflucan), 500 mg at the same time. The nurse knows that if these two drugs competed with each other for protein-binding sites, what would this do?
- A. Make the patient gentamicin deficient
- B. Make the patient fluconazole deficient
- C. Counteract any positive benefit the drugs would have
- D. Alter the effectiveness of both drugs
Correct Answer: D
Rationale: Some drugs compete with each other for protein-binding sites, altering effectiveness or causing toxicity when the two drugs are given together. Nothing in the scenario would indicate that the patient would be either Gentamicin or Diflucan deficient, nor does it indicate that these drugs cannot be given together because they would counteract each other.
A nurse has been administering a drug to a patient intramuscularly (IM). The physician discontinued the IM dose and wrote an order for the drug to be given orally. The nurse notices that the oral dosage is considerably higher than the parenteral dose and understands that this is due to:
- A. Passive diffusion
- B. Active transport
- C. Glomerular filtration
- D. First-pass effect
Correct Answer: D
Rationale: The first-pass effect involves drugs that are absorbed from the small intestine directly into the portal venous system, which delivers the drug molecules to the liver. Once in the liver, enzymes break the drug into metabolites, which may become active or may be deactivated and readily excreted from the body. A large percentage of the oral dose is usually destroyed and never reaches tissues. Oral dosages account for the phenomenon to ensure an appropriate amount of the drug in the body to produce a therapeutic action. Passive diffusion is the major process through which drugs are absorbed into the body. Active transport is a process that uses energy to actively move a molecule across a cell membrane and is often involved in drug excretion in the kidney. Glomerular filtration is the passage of water and water-soluble components from the plasma into the renal tubule.
Larry has heart failure, which is being treated with digoxin because it exhibits:
- A. Negative inotropism
- B. Positive chronotropism
- C. Both 1 and 2
- D. Neither 1 nor 2
Correct Answer: D
Rationale: Digoxin has positive inotropic effects, increasing contractility, not negative or chronotropic.
A client with diabetes mellitus visits a health care clinic. The client's diabetes mellitus previously had been well controlled with glyburide (DiaBeta) daily, but recently the fasting blood glucose level has been 180 to 200 mg/dL. Which medication, if added to the client's regimen, may have contributed to the hyperglycemia?
- A. Prednisone
- B. Phenelzine (Nardil)
- C. Atenolol (Tenormin)
- D. Allopurinol (Zyloprim)
Correct Answer: A
Rationale: Prednisone may decrease the effect of oral hypoglycemics, insulin, diuretics, and potassium supplements. Option 2, a monoamine oxidase inhibitor, and option 3, a β-blocker, have their own intrinsic hypoglycemic activity. Option 4 decreases urinary excretion of sulfonylurea agents, causing increased levels of the oral agents, which can lead to hypoglycemia.
Anaphylactic shock is a:
- A. Type I reaction, called immediate hypersensitivity reaction
- B. Type II reaction, called cytotoxic hypersensitivity reaction
- C. Type III allergic reaction, called immune complex hypersensitivity
- D. Type IV allergic reaction, called delayed hypersensitivity reaction
Correct Answer: A
Rationale: Anaphylactic shock is a Type I immediate hypersensitivity reaction , IgE-mediated, unlike cytotoxic (II), immune complex (III), or delayed (IV).