Adams4e Tif Ch44

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/EChapter 44Question 1Type: MCMA

The client has been diagnosed with diabetes mellitus type 1. He asks the nurse what this means. What is the best response by the nurse?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. "The exocrine function of your pancreas is to secrete insulin and it is not working."

2. "Without insulin you will develop ketoacidosis (DKA)."

3. "The endocrine function of your pancreas is to secrete insulin, but it isn’t working."

4. "Your alpha cells should be able to secrete insulin, but cannot."

5. "It means your pancreas cannot secrete insulin."

Correct Answer: 2,3,5

Rationale 1: The endocrine, not the exocrine, function of the pancreas is to secrete insulin.

Rationale 2: A consequence of diabetes mellitus type 1 is that without insulin, severe metabolic disturbances, such as diabetic ketoacidosis (DKA) will result.

Rationale 3: The endocrine function of the pancreas is to secrete insulin.

Rationale 4: Insulin is secreted by the beta, not the alpha, cells of the pancreas.

Rationale 5: One function of the pancreas is to secrete insulin.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Physiological AdaptationNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 44-1

Question 2Type: MCSAAdams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

The physician orders insulin lispro (Humalog), 10 units for the client. When will the nurse administer this medication?

1. Thirty minutes before meals

2. Five minutes before a meal

3. When the meal trays arrive on the floor

4. Fifteen minutes after meals

Correct Answer: 2

Rationale 1: The onset of action for insulin lispro (Humalog) is 10 to 15 minutes so it must be given when the client is eating, not 30 minutes before meals, to prevent hypoglycemia.

Rationale 2: The onset of action for insulin lispro (Humalog) is 10 to 15 minutes so it must be given 5 to 10 minutes before the client eats.

Rationale 3: The onset of action for insulin lispro (Humalog) is 10 to 15 minutes so it must be given just before the client eats, not when meal trays arrive on the floor, to prevent hypoglycemia.

Rationale 4: The onset of action for insulin lispro (Humalog) is 10 to 15 minutes so it must be given when the client is eating, not 15 minutes after meals, to prevent hypoglycemia.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 44-3

Question 3Type: MCSA

The physician writes orders for the client with diabetes mellitus. Which order would the nurse validate with the physician?

1. Lantus insulin 20U BID

2. Administering regular insulin 30 minutes prior to meals

3. 5 units of Humalog/10 units NPH daily

4. Metformin (Glucophage) 1000 mg per day in divided doses

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Correct Answer: 1

Rationale 1: Lantus insulin is usually prescribed in once-a-day dosing so an order for BID dosing should be validated with the physician.

Rationale 2: Regular insulin is administered 30 minutes before meals.

Rationale 3: Humalog and NPH insulin can be mixed.

Rationale 4: Metformin (Glucophage) is often prescribed in divided doses of 1000 mg per day.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 44-8


A client with diabetes mellitus type 1 is found unresponsive in the clinical setting. Which nursing action is a priority?

1. Call a code.

2. Treat the client for hypoglycemia.

3. Call the physician STAT.

4. Assess the client's vital signs.

Correct Answer: 2

Rationale 1: Assessment for ABCs should precede calling a code; there is no information that the client is not breathing.

Rationale 2: When a client with diabetes mellitus type 1 is found unresponsive, the nurse should focus on and treat for hypoglycemia, as this is more likely than hyperglycemia.

Rationale 3: .This is an emergency situation where the nurse must act before calling the physician.

Rationale 4: Vital signs should be taken after the client is treated for hypoglycemia.

Global Rationale:


Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 44-4


The nurse makes a home visit to a client with diabetes mellitus. During the visit, the nurse notes that the client's 3-month supply of insulin vials that were delivered a week ago are not refrigerated. What is the best action by the nurse at this time?

1. Have the client place the insulin vials in the refrigerator.

2. Have the client discard the vials.

3. Instruct the client to label each vial with the date when opened.

4. Tell the client this is too much insulin to have on hand.

Correct Answer: 1

Rationale 1: Vials can be stored at room temperature up to one month. For longer storage, they should be refrigerated.

Rationale 2: There is no need to discard the vials.

Rationale 3: Writing the date of opening on the vial is good practice, but does not address the need to refrigerate additional vials.

Rationale 4: There is no indication that this is too much insulin to have on hand.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Reduction of Risk PotentialNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 44-8


The nurse has finished teaching a client with diabetes mellitus how to administer insulin. The nurse evaluates that learning has occurred when the client makes which statement?Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

1. "I should only use a calibrated insulin syringe for the injections."

2. "I should check my blood sugar immediately prior to the administration."

3. "I should use the abdominal area only for insulin injections."

4. "I should provide direct pressure over the site following the injection."

Correct Answer: 1

Rationale 1: To ensure the correct insulin dose, a calibrated insulin syringe must be used.

Rationale 2: There is no need to check blood glucose immediately prior to the injection.

Rationale 3: Insulin injections should also be rotated to the arm and thigh, not just the abdominal area.

Rationale 4: There is no need to apply direct pressure over the site following an insulin injection.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 44-8


A client with diabetes mellitus is taking oral agents, and is scheduled for a diagnostic test that requires him to be NPO (nothing by mouth) and to have contrast dye. What is the best plan by the nurse with regard to giving the client his oral medications?

1. Notify the diagnostic department and request orders.

2. Notify the physician and request orders.

3. Administer the oral agents immediately after the test.

4. Administer the oral agents with a sip of water before the test.

Correct Answer: 2

Rationale 1: The radiologist in the diagnostic department might give orders, but it would be best to check with the client's physician first.


Rationale 2: It is best to notify the client's physician and request orders.

Rationale 3: Some oral medications should not be given for up to 2 days after receiving IV contrast.

Rationale 4: The client should not receive the medication during NPO (nothing by mouth) status unless directed by the physician. Some oral medications should not be given for 2 days before receiving IV contrast.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Reduction of Risk PotentialNursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 44-8


The client has diabetes mellitus type 2. The nurse has taught the client about the illness and evaluates that learning has occurred when the client makes which statement?

1. "My beta cells just cannot produce enough insulin for my cells."

2. "My peripheral cells have increased sensitivity to insulin."

3. "My cells have increased their receptors, but there is not enough insulin."

4. "My cells cannot use the insulin my pancreas makes."

Correct Answer: 4

Rationale 1: The beta cells continue to produce insulin with type 2 diabetes.

Rationale 2: Peripheral cells have a decreased, not an increased, sensitivity to insulin.

Rationale 3: There is a decrease, not an increase, in receptor sites with type 2 diabetes.

Rationale 4: With type 2 diabetes mellitus, the pancreas produces insulin, but the cells cannot use it.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Physiological AdaptationNursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 44-5



The client has type 1 diabetes and receives insulin. He asks the nurse why he can't just take pills instead. What is the best response by the nurse?

1. "I know it is tough, but you will get used to the shots soon."

2. "Have you talked to your doctor about taking pills instead?"

3. "Insulin can't be in a pill because it is destroyed in stomach acid."

4. "Insulin must be injected because it needs to work quickly."

Correct Answer: 3

Rationale 1: Telling the client he will get used to the shots does not answer his question and is condescending.

Rationale 2: The nurse should answer the client's question, not refer him back to the physician.

Rationale 3: Insulin must be injected because it is destroyed in stomach acid if taken orally.

Rationale 4: Insulin must be injected because it is destroyed in stomach acid if taken orally; the onset of action is not the issue here.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 44-3


The nurse teaches a class for the public about diabetes mellitus. Which individual does the nurse assess as being at highest risk for developing diabetes?

1. The 38-year-old client who smokes one pack of cigarettes per day

2. The 42-year-old client who is 50 pounds overweight

3. The 50-year-old client who does not get any physical exercise


4. The 56-year-old client who drinks three glasses of wine each evening

Correct Answer: 2

Rationale 1: Smoking is a serious health concern, but is not a specific risk factor for diabetes.

Rationale 2: Obesity increases the likelihood of developing diabetes mellitus due to overstimulation of the endocrine system.

Rationale 3: Exercise is important, but a lack of exercise is not as big of a risk factor as obesity.

Rationale 4: Consuming alcohol is associated with liver disease, but is not as high a risk factor for diabetes as obesity.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Reduction of Risk PotentialNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 45-8


The client injects his insulin as prescribed, but then gets busy and forgets to eat. What is the nurse’s most likely assessment finding?

1. The client will be very thirsty.

2. The client will need to urinate.

3. The client will have moist skin.

4. The client will complain of nausea.

Correct Answer: 3

Rationale 1: Thirst is a sign of hyperglycemia; the client would experience hypoglycemia if he did not eat.

Rationale 2: Increased urination is a sign of hyperglycemia; the client would experience hypoglycemia if he did not eat.

Rationale 3: Moist skin is a sign of hypoglycemia, which the client would experience if he injected insulin and did not eat.

Rationale 4: Nausea is a sign of hyperglycemia; the client would experience hypoglycemia if he did not eat. Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Physiological AdaptationNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 44-4

Question 12Type: MCMA

The client receives metformin (Glucophage). What will the best plan by the nurse include with regard to patient education with this drug?



1. It decreases sugar production in the liver.

2. It inhibits absorption of carbohydrates.

3. It stimulates the pancreas to produce more insulin.

4. It reduces insulin resistance.

5. It increases energy use.

Correct Answer: 1,4

Rationale 1: Metformin (Glucophage) decreases sugar production (gluconeogenesis) in the liver.

Rationale 2: Metformin (Glucophage) does not inhibit the absorption of carbohydrates.

Rationale 3: Metformin (Glucophage) reduces insulin resistance.

Rationale 4: Metformin (Glucophage) reduces insulin resistance.

Rationale 5: Metformin (Glucophage) does not increase energy use.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: Planning


Learning Outcome: 44-6


The client has diabetes type 1 and receives insulin for glycemic control. The client tells the nurse that she likes to have a glass of wine with dinner. What will the best plan by the nurse for client education include?

1. The alcohol could cause pancreatic disease and decrease insulin production.

2. The alcohol could predispose you to hypoglycemia.

3. The alcohol could cause serious liver disease.

4. The alcohol could predispose you to hyperglycemia.

Correct Answer: 2

Rationale 1: Alcohol can cause pancreatic disease, but the client's pancreas is not producing any insulin currently.

Rationale 2: Alcohol can potentiate hypoglycemic effects in the client.

Rationale 3: Alcohol can cause liver disease, but the more immediate concern is hypoglycemia.

Rationale 4: Alcohol can potentiate hypoglycemic, not hyperglycemic, effects in the client.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Reduction of Risk PotentialNursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 44-8


The client has type 1 diabetes mellitus and receives insulin. Which laboratory test will the nurse assess?

1. Potassium

2. Serum amylase

3. AST (aspartate aminotransferase)

4. Sodium


Correct Answer: 1

Rationale 1: Insulin causes potassium to move into the cell and may cause hypokalemia.

Rationale 2: There is no need to monitor the serum amylase level.

Rationale 3: There is no need to monitor the AST (aspartate aminotransferase) level.

Rationale 4: There is no need to monitor the sodium level.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Physiological AdaptationNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 44-7


The physician orders intravenous (IV) insulin for the client with a blood sugar of 563. The nurse administers insulin lispro (Humalog) intravenously (IV). What does the best evaluation by the nurse reveal?

1. The nurse used the correct insulin.

2. The nurse should have contacted the physician.

3. The nurse should have used regular insulin (Humulin R).

4. The nurse could have given the insulin subcutaneously.

Correct Answer: 3

Rationale 1: The nurse did not use the correct insulin as it was not regular insulin.

Rationale 2: There was no need to contact the physician; regular insulin is the only insulin that can be given intravenously (IV). The physician should be contacted now.

Rationale 3: Regular insulin is the only insulin that can be given intravenously (IV).

Rationale 4: The nurse cannot give the insulin subcutaneously when it is ordered to be given intravenously (IV).

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityAdams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Client Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 44-7


Insulin is released when

1. blood glucose stays the same.

2. blood glucose increases.

3. blood glucose decreases.

4. glucagon increases.

Correct Answer: 2

Rationale 1: Insulin would not be released.

Rationale 2: Insulin is released when blood glucose increases.

Rationale 3: Glucagon is released when glucose decreases.

Rationale 4: Glucagon increases when insulin is not needed.

Global Rationale:

Cognitive Level: RememberingClient Need: Physiological IntegrityClient Need Sub: Physiological AdaptationNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 44-1


What is the primary function of the islets of Langerhans in the pancreas?

1. Secretion of enzymes

2. Acting as exocrine

3. Secretion of glucagon and insulin


4. Absorption of insulin

Correct Answer: 3

Rationale 1: Secretion of enzymes relates to the exocrine function, which is to release enzymes for chemical digestion of nutrients.

Rationale 2: Other cells of the pancreas are responsible for exocrine function.

Rationale 3: The cluster of cells within the pancreas (islets of Langerhans) is responsible for the endocrine function, which is to release insulin and glucagon.

Rationale 4: These are secretory cells, not absorptive cells.

Global Rationale:



Which sign or symptom is most typical of an untreated client with type 1 diabetes?

1. Increased energy

2. Weight gain

3. Fatigue

4. Decreased hunger

Correct Answer: 3

Rationale 1: Clients with type 1 DM do not experience increased energy; a typical sign/symptom is fatigue.

Rationale 2: Clients with type 1 DM typically experience weight loss as opposed to weight gain.

Rationale 3: Fatigue is a typical sign/symptom of type 1 DM due to sustained hyperglycemia.

Rationale 4: Clients with type 1 DM typically experience polyphagia—increased hunger—as opposed to decreased hunger.

Global Rationale: Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.



The nurse understands that which of the following drugs falls under the classification of biguanides?

1. Metformin HCI (Glucophage)

2. Repaglinide (Prandin)

3. Tolbutamide (Orinase)

4. Acarbose (Precose)

Correct Answer: 1

Rationale 1: Metformin HCI is the only drug that falls within the classification of biguanides.

Rationale 2: Repaglinide falls within the classification of meglitinides.

Rationale 3: Tolbutamide falls within the classification of sulfonylureas.

Rationale 4: Acarbose falls within the classification of alpha-glucosidase inhibitors.

Global Rationale:

Cognitive Level: RememberingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 44-6


The mechanism of action of regular insulin is to

1. stimulate the pancreas to produce insulin.

2. promote entry of glucose into the cells.


3. promote the entry of glucose into the bloodstream.

4. stimulate the pancreas to secrete more insulin.

Correct Answer: 2

Rationale 1: Oral hypoglycemic drugs, such as glipizide, stimulate the pancreas to produce insulin.

Rationale 2: The action of regular insulin is to promote entry of glucose into the cells, thereby lowering glucose.

Rationale 3: Insulin would not promote glucose into the bloodstream.

Rationale 4: Oral hypoglycemic drugs, such as glipizide, stimulate the pancreas to secrete insulin.

Global Rationale:

Cognitive Level: RememberingClient Need: Physiological IntegrityClient Need Sub: Physiological AdaptationNursing/Integrated Concepts: Learning Outcome: 44-1


The mother of a 4-year-old boy states, “I can’t believe my son has type 1 diabetes. We eat well and I was so careful during the pregnancy. What could have caused this?” How should the nurse respond?



1. “There must have been something you were exposed to during your pregnancy that caused it.”

2. “Are there others in your family that have type 1 diabetes?”

3. “He must have been allowed to eat too much sugar.”

4. “We are not certain what causes type 1 diabetes.”

5. “It is thought to be a combination of factors.”


Rationale 1: There is no known factor that would cause type 1 diabetes if the mother was exposed.


Rationale 2: There is a genetic factor associated with type 1 diabetes.

Rationale 3: This is not a therapeutic statement and supports the urban myth that diabetes is caused by sugar ingestion.

Rationale 4: The specific factors that cause Type 1 diabetes are still undiscovered.

Rationale 5: It is thought that type 1 diabetes is caused by a number of interrelated factors.

Global Rationale:

Cognitive Level: ApplyingClient Need: Psychosocial IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 44.2


A client, newly diagnosed with type 1 diabetes, says, “I have heard this is a bad disease. What complications could I have?” How should the nurse respond?



1. “Problems with arteries can occur that may cause such problems as heart disease, stroke, kidney disease, or blindness.”

2. “Let’s not talk about that now, but rather focus on keeping you healthy.”

3. “You could have nerve problems that lead to numbness or tingling in your feet or hands.”

4. “One of the most serious complications is diabetic ketoacidosis.”

5. “You may experience inability to think and difficulty with memory.”


Rationale 1: Arterial damage can lead to the problems listed.

Rationale 2: The client is interested in this topic today and the topic should be addressed.

Rationale 3: Neuropathy may occur, causing numbness, tingling, or loss of sensation in the limbs.

Rationale 4: DKA is one of the most serious complications of type 1 diabetes.Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Rationale 5: While these symptoms may occur related to CVA, they are not primary complications of type 1 diabetes.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Physiological AdaptationNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 44.2


A client has been prescribed exenatide (Byetta). What medication education should the nurse provide?



1. “Drink an 8 ounce glass of water with this pill.”

2. “You should take this medication twice each day.”

3. “You may experience dryness of the mouth while taking this drug.”

4. “You may develop diarrhea while taking this drug.”

5. “This drug will help you secrete more insulin.”


Rationale 1: Exenatide is an injectable drug.

Rationale 2: Exenatide is often injected twice daily.

Rationale 3: This is not an expected adverse reaction.

Rationale 4: Diarrhea is an expected adverse effect of this drug.

Rationale 5: One of the actions of this drug is to increase secretion of insulin.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesAdams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Nursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 44.6


A nurse has provided education regarding type 2 diabetes to a newly diagnosed client. Which statements would the nurse interpret as indicating need for additional education?



1. “Well, at least the medications I will be on will help me lose weight.”

2. “I can take an oral medication and will never have to inject myself.”

3. “I can increase my body’s ability to use the insulin I make by exercising regularly.”

4. “I have several lifestyle changes to make.”

5. “I don’t run the risk of blindness and kidney disease like type 1 diabetics.”


Rationale 1: Some of the medications used for type 2 diabetes cause weight gain.

Rationale 2: As type 2 diabetes progresses, the cells that produce insulin may fail, causing the need for insulin. Some medications especially designed to treat type 2 diabetes are injected.

Rationale 3: The activity of insulin receptors can be increased by physical exercise.

Rationale 4: Lifestyle changes can help the type 2 diabetic avoid complications.

Rationale 5: If type 2 diabetes is poorly managed these complications can occur.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Physiological AdaptationNursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 44.5



A nurse is reviewing the blood work of a client who has recently begun treatment for type 2 diabetes. Which results would indicate that the client is on target with therapy?



1. HBA1C level is 8.4%.

2. HBA1C level is 6.3%.

3. Fasting blood glucose is 130 g/dL.



Correct Answer: 2,4

Rationale 1: This level is too high.

Rationale 2: Target level is 6.5% or less.

Rationale 3: This is too high.

Rationale 4: Goal is 110 g/dL.

Rationale 5: A FBG of 68 g/dL is too low.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Physiological AdaptationNursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 44.8


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Adams4e Tif Ch44