A patient is prescribed NPH and regular insulin every morning by his CNP, who is verifying that the patient understands that there are two different peak times to be aware of for this insulin regimen.

Question 1A patient is prescribed NPH and regular insulin every morning by his CNP, who is verifying that the patient understands that there are two different peak times to be aware of for this insulin regimen. Why is this important for the provider to address?

 

Select one:

 

a.The risk for hypoglycemia is greatest around the peak of insulin activity.

 

b.It is best to plan exercise or other activities around peak insulin activity.

 

c.The client needs to plan the next insulin injection around the peak times.

 

d.Additional insulin may be needed at peak times to avoid hyperglycemia.

 

Question 2The CNP prescribes 5 units of Humalog and 25 units of NPH (Isophane) insulin prior to breakfast. The provider should tell the patient which of the following:

 

Select one:

 

a.Consume a high-carbohydrate snack in 6 hours.

 

b.Make sure your breakfast is available to eat before administering this insulin.

 

c.Administer the medications in two separate syringes.

 

d.Hold the insulin if your blood glucose level is greater than 100 mg/dL.

 

Question 3A 63- year-old client with type 2 diabetes is admitted with an infected foot ulcer. Despite previous good control on glyburide (Micronase), his blood glucose has been elevated the past several days and he now requires sliding-scale insulin. The CNP explains to the patient’s primary nurse that the most likely reason for the elevated glucose levels is:

 

Select one:

 

a.patients with diabetes who are admitted to the hospital are switched to insulin for safety and tighter control.

 

b.a temporary condition related to the stress response with increased glucose release.

 

c.the oral antidiabetic drug is no longer working for him.

 

d.the patient is converting to a type 1 diabetic.

 

Question 4Multiple studies, such as the Diabetes Mellitus Control and Complications Trial research group (DCCT) and the United Kingdom Prospective Diabetes Study (UKPDS), continue to show that intensive glucose control may prevent and/or delay the onset of complications:

 

Select one:

 

a.at or below glycosylated hemoglobin (A1c) of 7%.

 

b.at or below glycosylated hemoglobin (A1c) of 12%.

 

c.at or below glycosylated hemoglobin (A1c) of 10%.

 

d.at or below glycosylated hemoglobin (A1c) of 15%.

 

Question 5Onset of type 1 diabetes may occur:

 

Select one:

 

a.suddenly as with the onset of diabetic ketoacidosis.

 

b.slowly with less risk of ketoacidosis as in the case of latent autoimmune diabetes of adults (LADA).

 

c.Both a and b

 

d.Neither a nor b

 

Question 6Metformin has:

 

Select one:

 

a.no direct effect on the pancreas and therefore does not enhance insulin secretion.

 

b.direct effect on the pancreas and therefore does not enhance insulin secretion.

 

c.no direct effect on the panaceas and therefore does enhance insulin secretion.

 

d.direct effect on the pancreas and therefore does enhance insulin secretion.

 

Question 7As glucotoxicity and further β-cell dysfunction occur, the patient most likely will require:

 

Select one:

 

a.continuation of the current dose of medications to maintain HbA1c at goal.

 

b.lower doses of medications to maintain HbA1c at goal.

 

c.new agents only to maintain HbA1c at goal.

 

d.higher doses of medications or the addition of new agents to maintain HbA1c at goal.

 

Question 8Metformin is used now as the first-line choice for the pharmacologic treatment of type 2 diabetes. Which of the following are generally used as second-line treatments:

 

Select one:

 

a.sulfonylureas,

 

b.meglitinides,

 

c.α-glucosidase inhibitors

 

d.All of the above

 

Question 9A general approach to dosing theory for short- or rapid-acting insulin given prior to meals assumes that 1 unit of regular insulin covers:

 

Select one:

 

a.20 to 25 g of carbohydrate.

 

b.15 to 20 g of carbohydrate.

 

c.5 to 10 g of carbohydrate.

 

d.10 to 15 g of carbohydrate.

 

Question 10Currently, among the following options which is the most promising for good glucose control:

 

Select one:

 

a.rapid acting insulin given twice daily for basal coverage and for premeal bolus coverage.

 

b.long-acting insulin given only once a day for basal coverage with rapid-acting insulin for premeal bolus coverage.

 

c.long-acting insulin given once a day or twice daily for basal coverage with rapid-acting insulin for premeal bolus coverage.

 

d.long-acting insulin given twice daily for basal coverage with rapid-acting insulin for premeal bolus coverage.

 

Question 11The CNP has prescribed a PPI for her older adult patient diagnosed with a gastric ulcer, and informs him that the most appropriate time for him to take is lansoprazole (Prevacid) is:

 

Select one:

 

a.30 minutes after each meal

 

b.After fasting at least 2 hours

 

c.At night before bed

 

d.About 30 minutes before her morning meal

 

Question 12A 35-year-old male client has been prescribed omeprazole (Prilosec) for treatment of a GERD by his CNP. He returns for a follow-up visit approximately one month after starting treatment. Which of the following assessment findings would assist the provider to determine whether drug therapy has been effective? (Select all that apply.)

 

Select one or more:

 

a.Decreased “gnawing” upper abdominal pain on an empty stomach

 

b.Decreased belching

 

c.Decreased dysphagia

 

d.Decreased nausea

 

Question 13A 60-year-old patient with diabetes has a blood pressure reading of 150/96 mmHg. After three months of increased exercise and decreased calories, the patient has lost 10 lb (4.54 kg). The patient’s follow-up blood pressure is 142/94 mmHg. Which medication does the family nurse practitioner prescribe?

 

Select one:

 

a.Propranolol (Inderal).

 

b.Enalapril (Vasotec).

 

c.Hydrochlorothiazide (HydroDIURIL).

 

d.Furosemide (Lasix).

 

Question 14A patient with type 1 diabetes who takes insulin reports taking propranolol for hypertension. Why is the nurse practitioner concerned?

 

Select one:

 

a.The beta blocker can mask the symptoms of hypoglycemia.

 

b.The beta blocker can cause insulin resistance.

 

c.Propranolol increases insulin requirements because of receptor blocking.

 

d.Using the two agents together increases the risk of ketoacidosis.

 

Question 15A patient is admitted to the hospital and will begin taking levothyroxine [Synthroid]. The nurse practitioner learns that the patient also takes warfarin [Coumadin]. The nurse practitioner will have to  ____ the ____ dose.

 

Select one:

 

a.reduce; warfarin

 

b.increase; warfarin

 

c.increase; levothyroxine

 

d.reduce; levothyroxine

 

Question 16Type II diabetes treatment with sodium glucose cotransport 2 inhibitors has a side effect of:

 

Select one:

 

a.Increased risk of genitourinary infections

 

b.Weight gain

 

c.Metabolic acidosis

 

d.Increased hypoglycemia

 

Question 17Patients with a history of heart failure and type II diabetes should avoid:

 

Select one:

 

a.Biguanides

 

b.Thiazolidinediones

 

c.Furosemide

 

d.Insulin

 

Question 18When initiating a dipeptidyl peptidas-4 inhibitor in a patient with diabetes and a history of pancreatitis avoid:

 

Select one:

 

a.Saxagliptin

 

b.Sitagliptin

 

c.Linagliptin

 

d.Alogliptin

 

Question 19The dose of insulin to administer to a pre-pubescent child newly diagnosed with Type I diabetes is

 

Select one:

 

a.0.5 mg/kg

 

b.1.0 mg/kg

 

c.1.2 mg/kg

 

d.0.7 mg/kg

 

Question 20A patient with type II diabetes visits the NP for follow-up.  The HbA1c is 9.5 after three months of metformin therapy.  The NP should

 

Select one:

 

a.Add on a first line agent

 

b.Increase the metformin dosage until the maximum dosage is reached

 

c.Add on insulin

 

d.Add on a first line and second line agent.

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