FINAL: Pharmacology NCLEX

FINAL: Pharmacology NCLEX

Questions

A client who has been newly diagnosed with diabetes mellitus has been stabilized with daily insulin injections. Which information should the nurse teach when carrying out plans for discharge?

• Keep insulin vials refrigerated at all times.
• Rotate the insulin injection sites systematically.
• Increase the amount of insulin before unusual exercise.
• Monitor the urine acetone level to determine the insulin dosage.
• Rotate the insulin injection sites systematically.

Rationale:

Insulin dosages should not be adjusted or increased before unusual exercise. If acetone is found in the urine, it may possibly indicate the need for additional insulin. To minimize the discomfort associated with insulin injections, the insulin should be administered at room temperature. Injection sites should be systematically rotated from one area to another. The client should be instructed to give injections in one area, about 1 inch apart, until the whole area has been used and then to change to another site. This prevents dramatic changes in daily insulin absorption.A nurse is reinforcing teaching for a client regarding how to mix regular insulin and NPH insulin in the same syringe. Which of the following actions, if performed by the client,

indicates the need for further teaching?

• Withdraws the NPH insulin first
• Withdraws the regular insulin first
• Injects air into NPH insulin vial first
• Injects an amount of air equal to the desired dose of insulin into the vial
• Withdraws the NPH insulin first

Rationale:

When preparing a mixture of regular insulin with another insulin preparation, the regular insulin is drawn into the syringe first. This sequence will avoid contaminating the vial of regular insulin with insulin of another type. Options 2, 3, and 4 identify the correct actions for preparing NPH and regular insulin.A home care nurse visits a client recently diagnosed with diabetes mellitus who is taking Humulin NPH insulin daily. The client asks the nurse how to store the unopened vials of

insulin. The nurse tells the client to:

• Freeze the insulin.
• Refrigerate the insulin.
• Store the insulin in a dark, dry place.
• Keep the insulin at room temperature.
• Refrigerate the insulin.

Rationale:

Insulin in unopened vials should be stored under refrigeration until needed. Vials should not be frozen. When stored unopened under refrigeration, insulin can be used up to the expiration date on the vial. Options 1, 3, and 4 are incorrect.

A client is taking Humulin NPH insulin daily every morning. The nurse reinforces instructions for the client and tells the client that the most likely time for a hypoglycemic

reaction to occur is:

• 2 to 4 hours after administration
• 4 to 12 hours after administration
• 16 to 18 hours after administration
• 18 to 24 hours after administration
• 4 to 12 hours after administration

Rationale:

Humulin NPH is an intermediate-acting insulin. The onset of action is 1.5 hours, it peaks in 4 to 12 hours, and its duration of action is 24 hours. Hypoglycemic reactions most likely occur during peak time.A client has been taking isoniazid (INH) for 2 months. The client complains to a nurse about numbness, paresthesias, and tingling in the extremities. The nurse interprets that the client is

experiencing:

• Hypercalcemia
• Peripheral neuritis
• Small blood vessel spasm
• Impaired peripheral circulation
• Peripheral neuritis

Rationale:

A common side effect of the TB drug INH is peripheral neuritis. This is manifested by numbness, tingling, and paresthesias in the extremities. This side effect can be minimized by pyridoxine (vitamin B6) intake. Options 1, 3, and 4 are incorrect.

A client is to begin a 6-month course of therapy with isoniazid (INH). A nurse plans to teach

the client to:

• Drink alcohol in small amounts only.
• Report yellow eyes or skin immediately.
• Increase intake of Swiss or aged cheeses.
• Avoid vitamin supplements during therapy.
• Report yellow eyes or skin immediately.

Rationale:

INH is hepatotoxic, and therefore the client is taught to report signs and symptoms of hepatitis immediately (which include yellow skin and sclera). For the same reason, alcohol should be avoided during therapy. The client should avoid intake of Swiss cheese, fish such as tuna, and foods containing tyramine because they may cause a reaction characterized by redness and itching of the skin, flushing, sweating, tachycardia, headache, or lightheadedness.The client can avoid developing peripheral neuritis by increasing the intake of pyridoxine (vitamin B6) during the course of INH therapy for TB.A client has been started on long-term therapy with rifampin (Rifadin). A nurse teaches the

client that the medication:

• Should always be taken with food or antacids
• Should be double-dosed if one dose is forgotten
• Causes orange discoloration of sweat, tears, urine, and feces
• May be discontinued independently if symptoms are gone in 3 months
• Causes orange discoloration of sweat, tears, urine, and feces

Rationale:

Rifampin should be taken exactly as directed as part of TB therapy. Doses should not be