CH 38 Agents to Control Blood Glucose Levels PrepU

A client who began treatment for type 2 diabetes 8 months ago is now meeting with a diabetic nurse for a scheduled follow-up. How can the nurse best assess the client's glycemic control since beginning treatment? A. Assess the most recent hemoglobin A1C levels. B. Review and discuss the data contained in the client's written blood glucose log. C. Arrange to have the client's random blood glucose measured. D. Dialogue with the client about implemented management strategies.

A. Assess the most recent hemoglobin A1C levels.

Which would the nurse identify as an effect of somatostatin on blood glucose? A. Decreased glucagon release B. Increased GI emptying C. Increased insulin release D. Decreased insulin sensitivity

A. Decreased glucagon release

The older diabetic client often experiences several different chronic organ related conditions. Which assessment should the nurse focus upon when attempting to manage this complex situation? A. Drug interactions B. Treatment adherence C. Visual dysfunctions D. Kidney dysfunction

A. Drug interactions

Which produce their glucose lowering effect by decreasing insulin resistance and increasing insulin sensitivity? (Select all that apply.) A. Pioglitazone (Actos) B. Acarbose (Precose) C. Rosiglitazone (Avandia) D. Miglitol (Glyset) E. Metformin (Glucophage)

A. Pioglitazone (Actos) C. Rosiglitazone (Avandia)

As the first-line treatment, a client with type 2 diabetes has tried diet and exercise. When these fail, what may be added as monotherapy or in combination with metformin to control their disease process? A. Thiazolidinediones B. Repaglinide C. An incretin agent D. A sitagliptin

A. Thiazolidinediones

After reviewing information about different insulin preparations, a nursing student demonstrates understanding of the information when the student identifies which medication as an example of a long-acting insulin? A. insulin glargine B. insulin aspart C. insulin lispro D. isophane insulin suspension

A. insulin glargine

A nurse is assigned to administer glargine to a patient at a health care facility. What precaution should the nurse take when administering glargine? A. Administer glargine via IV route. B. Avoid mixing glargine with other insulin. C. Administer insulin that has been refrigerated. D. Shake the vial vigorously before withdrawing insulin.

B. Avoid mixing glargine with other insulin.

What would alert the nurse to suspect that a client is developing ketoacidosis? A. Hunger B. Fruity breath odor C. Blurred vision D. Fluid retention

B. Fruity breath odor

A nurse is working with a newly diagnosed diabetic client on understanding hypoglycemia and insulin reactions. Which action would be most important for the client to understand when planning the response to an insulin reaction? A. Notify your health care provider immediately. B. Take an oral dose of some form of glucose as soon as possible. C. Inject a prescribed dose of insulin as soon as you suspect the reaction is occurring. D. Stay calm and still until the reaction subsides.

B. Take an oral dose of some form of glucose as soon as possible.

A client's current condition requires rapid reduction of blood sugar levels. Which type of insulin will have the most rapid onset of action? A. isophane (NPH) B. insulin lispro C. Humulin R D. isophane (NPH)

B. insulin lispro

The nurse has just completed discharge instructions to a client who will be using a pen device to deliver his insulin dose. What statement by the client indicates a need for further instruction? A. "I determine my dosage by the number of clicks that I hear." B. "I need to turn the dial on the pen and listen for the locking ring before administering my insulin." C. "If I forget to take my insulin pen, I will be able to use the one that my wife uses." D. "This will make it easier for me to give my own insulin because of my poor eyesight."

C. "If I forget to take my insulin pen, I will be able to use the one that my wife uses."

The client is scheduled to get a breakfast tray at 07:00. At what time should the client receive a prescribed dose of insulin lispro? A. 06:00 B. 07:00 C. 06:45 D. 06:20

C. 06:45

The nurse is educating a newly diagnosed diabetic who must learn how to give himself insulin injections. The nurse tells the client that insulin is absorbed fastest from which area of injection? A. Deltoid B. Hip C. Abdomen D. Thigh

C. Abdomen

As the nurse caring for a young child is diagnosed with type 1 diabetes (IDDM), you know that they become at high risk for what and you include assessment and management of this in their care plan? A. Disturbed sleep pattern B. Self-care deficit C. Delayed growth and development D. Anxiety

C. Delayed growth and development

The two major classifications of diabetes are type 1 and type 2. What is a distinguishing characteristic of type 1 diabetes? A. It always starts in childhood. B. Oral agents can control the disease process. C. Lifelong exogenous insulin is required. D. Blood glucose level can be controlled with diet.

C. Lifelong exogenous insulin is required.

A nurse is caring for a patient with diabetes mellitus who is receiving an oral antidiabetic drug. Which of following ongoing assessments should the nurse perform when caring for this patient? A. Document family medical history. B. Monitor the patient for lipodystrophy. C. Observe the patient for hypoglycemic episodes. D. Assess the skin for ulcers, cuts, and sores.

C. Observe the patient for hypoglycemic episodes.

A female client visits the health care provider's office after routine labs are drawn. The nurse notes that her A1C is 9. How does the nurse interpret this finding? A. Client is in good glycemic control. B. Client's blood glucose levels are not consistent. C. Client's blood glucose demonstrates longstanding hypoglycemia. D. Client's average blood glucose is above normal.

D. Client's average blood glucose is above normal.

A client has been noncompliant with the diabetic medication regimen and develops diabetic ketoacidosis. Which would the nurse assess? A. Edema B. Decreased blood glucose levels C. Sour breath odor D. Deep respirations

D. Deep respirations

A nurse is caring for a patient who has developed a hypoglycemic reaction. Which intervention should the nurse perform if swallowing and gag reflexes are present in the patient? A. Administer oral antidiabetics to the patient. B. Administer the insulin via insulin pump. C. Administer glucagon by the parenteral route. D. Give oral fluids or candy.

D. Give oral fluids or candy.

A patient at a health care facility has been prescribed diazoxide for hypoglycemia due to hyperinsulinism. What adverse reactions to the drug should the nurse monitor for in the patient? A. Epigastric discomfort B. Flatulence C. Myalgia D. Tachycardia

D. Tachycardia

The nurse educator works at the diabetes clinic. When talking to a class of adolescent diabetics, the educator tells the students that the most recognized signs of diabetes are: A. protein intake and hyperglycemia. B. carbohydrate use and insulin levels. C. hypoglycemia and glucagon levels. D. hyperglycemia and glycosuria.

D. hyperglycemia and glycosuria.

The nurse monitoring a client receiving insulin glulisine notices the client has become confused, diaphoretic, and nauseated. The nurse checks the client's blood glucose and it is 60 mg/dL (3.33 mmol/L). Which can a nurse give to treat a client with a hypoglycemic episode? (Select all that apply.) A. Orange or other fruit juice B. Glucose tablets C. Insulin detemir (Levemir) D. Insulin glargine (Lantus) E. Hard candy

A. Orange or other fruit juice B. Glucose tablets E. Hard candy

The nurse is preparing to administer insulin intravenously to a client with a blood glucose level over 600 mg/dL (33.33 mmol/L). What type of insulin will the nurse most likely give? A. Ultralente insulin B. Lente insulin C. Regular insulin D. NPH insulin

C. Regular insulin

A client diagnosed with type 2 diabetes several months ago has presented for a scheduled follow-up appointment. Which stated behavior most clearly indicates that the client has established effective health maintenance? A. The client can describe the differences between type 1 and type 2 diabetes. B. The client exercises two to three times per week. C. The client frequently checks blood glucose levels. D. The client reports having gone on a diet.

C. The client frequently checks blood glucose levels.

The nurse is caring for a client who has been prescribed glyburide. Which factor, if identified in the client history, would cause the nurse to inform the health care provider of a contraindication to use? A. The ingestion of carbohydrates B. Increase in alkaline phosphatase C. A diagnosis of hypertension D. Allergy to sulfonamides

D. Allergy to sulfonamides

An older adult client has been prescribed metformin for the treatment of type 2 diabetes for several years. Which change in the client's laboratory values may demonstrate a need to discontinue the medication? A. A decrease in hemoglobin and hematocrit B. An increase in white blood cells C. A decrease in potassium accompanied by an increase in sodium D. An increase in serum lactate

D. An increase in serum lactate

The nurse is preparing to administer a mixture of 12 units regular insulin and 45 units NPH insulin to a client with a blood sugar of 378 mg/dL. After the nurse draws the medication into the syringe, what is the nurse's next action? A. Check the dosage with another nurse. B. Administer the insulin to the client. C. Ensure a meal tray is available. D. Check the client's blood sugar again.

A. Check the dosage with another nurse.

A nurse is preparing to administer a rapid-acting insulin. Which medication would the nurse likely administer? A. insulin lispro B. insulin detemir C. isophane insulin suspension D. insulin glargine

A. insulin lispro

A nurse is providing client education to a 13-year-old girl who was just diagnosed with type 1 diabetes mellitus. Which statement by the client will alert the nurse that special instructions regarding insulin are necessary? A. "I walk two blocks to school every day." B. "I am on the middle school track team." C. "We live in a two-story house." D. "My mother is going to give me my insulin."

B. "I am on the middle school track team."

The nurse is preparing to administer 20 units of NPH insulin to a client. Before administering the medication, the nurse should implement which intervention? A. Assess the client's urine for the presence of glucose. B. Have a colleague confirm the dosage. C. Assess the client's understanding of diabetes. D. Massage the chosen injection site.

B. Have a colleague confirm the dosage.

When describing the effects of incretins on blood glucose control to a group of students, which would an instructor include? A. Increases GI emptying B. Increases insulin release C. Increases protein building D. Increases glucagon release

B. Increases insulin release

A nurse at a health care facility is assigned to administer insulin to the patient. Which intervention should the nurse perform before administering each insulin dose? A. Do not administer insulin kept at room temperature. B. Inspect the previous injection site for inflammation. C. Check for symptoms of myalgia or malaise. D. Keep prefilled syringes horizontally.

B. Inspect the previous injection site for inflammation.

Which would be appropriate to include in teaching a client with type 2 diabetes? A. If you drink alcohol, it may be necessary to increase your oral antidiabetic medication. B. It is possible with weight loss and exercise to discontinue the use of antidiabetic medication. C. Clients with type 2 diabetes always progress to insulin injections if they do not follow dietary guidelines. D. Until you need to start insulin injections, you do not have to check your blood sugar.

B. It is possible with weight loss and exercise to discontinue the use of antidiabetic medication.

After teaching a class about the various drugs used to control blood glucose, the instructor determines that the teaching was successful when the class identifies what as a biguanide? A. Glipizide B. Miglitol C. Tolbutamide D. Metformin

D. Metformin

A nurse is caring for a patient diagnosed with type 2 diabetes. What should the nurse inform the patient are risk factors associated with type 2 diabetes? A. Young age B. Regular exercise C. Polyuria D. Obesity

D. Obesity

The school nurse identifies more children with type 2 diabetes each year and recognizes that this trend is mainly attributed to what issue? A. Economics B. Lack of after-school programs due to budget constraints C. Working parents D. Obesity and inadequate exercise

D. Obesity and inadequate exercise

A client is prescribed sitagliptin. The nurse would expect to administer this drug by which route? A. Intravenous B. Subcutaneous C. Intramuscular D. Oral

D. Oral

A client diagnosed with diabetic ketoacidosis has been admitted to the intensive care unit. The client is prescribed an intravenous insulin drip, so the nurse knows that what type of insulin will be administered? A. Isophane insulin (NPH). B. Lispro. C. Insulin glargine. D. Regular.

D. Regular.

The nurse is providing education to a client who has been prescribed therapy with an antidiabetic medication. During teaching, the nurse will caution the client against heavy intake of which herb? A. Garlic B. Basil C. Anise D. Oregano

A. Garlic

A man is brought to the emergency department. He is nonresponsive, and his blood glucose level is 32 mg/dL. Which would the nurse expect to be ordered? A. Glucagon B. Diazoxide C. Regular insulin D. Insulin lispro

A. Glucagon

Which is the best indicator of overall diabetic control? A. Glycosylated hemoglobin levels B. Fasting blood glucose levels C. Absence of acetone in the urine D. 2-hour postprandial blood glucose levels

A. Glycosylated hemoglobin levels

Which would be least appropriate when administering insulin by subcutaneous injection? A. Massaging the site after removing the needle B. Injecting the insulin slowly C. Using a 25 gauge 1/2-inch needle D. Inserting the needle at a 45-degree angle

A. Massaging the site after removing the needle

The nurse is discussing diabetes with a group of individuals who are at risk for the disease. Which statement by a participant indicates an understanding of the role of insulin in the disease? A. "Insulin is used to move carbohydrate particles from the gastrointestinal system to the liver." B. "Insulin assists glucose molecules to enter the cells of muscle and fat tissues." C. "Insulin is stimulated by the liver to break down proteins and provide the body with nutrients." D. "Insulin causes fat to be broken down to provide energy for the body."

B. "Insulin assists glucose molecules to enter the cells of muscle and fat tissues."

The nurse is providing education to the parents of a child newly diagnosed with type 1 diabetes. What distinguishing characteristic of the disorder does the nurse include in the teaching? A. Blood glucose levels can be controlled by diet. B. The disease always starts in childhood. C. Exogenous insulin is required for life. D. Oral agents can control blood sugar.

C. Exogenous insulin is required for life.

Which would a nurse identify as an example of a sulfonylurea? A. Acarbose B. Metformin C. Glyburide D. Miglitol

C. Glyburide

A student asks the nursing instructor what insulin has the quickest therapeutic effect once administered. What would be the best response? A. Ultralente (Humulin U Ultralente) B. PZI (Humulin U) C. Regular (Humulin R) D. NPH (Humulin N)

C. Regular (Humulin R)

Insulin binds with and activates receptors on cell membranes. Once insulin-receptor binding occurs, the membranes become highly permeable to glucose. Which action does this enable? A. Storage of glucagon in the cells B. Release of glucagon from the cells C. Entry of glucose into the cells D. Interruption of glucose movement across the membrane

C. Entry of glucose into the cells

When considering the management of diabetic ketoacidosis (DKA), what type of insulin can be administered intravenously? A. isophane insulin (NPH) B. lispro C. regular D. insulin glargine

C. regular

The nurse is interviewing a client who was diagnosed with type 2 diabetes four months ago. The client does not record glucometer readings. What laboratory test does the nurse anticipate the health care provider will order for this client? A. HbA1c B. Fasting blood glucose in the AM C. Insulin level D. Stat urine for glucose

A. HbA1c

When administering insulin, what would be most appropriate? A. Insert the needle at a 45-degree angle for injection. B. Massage the injection site firmly after removing the needle and syringe. C. Firmly spread the skin of the area of the intended site of injection. D. Shake the vial vigorously to ensure thorough mixing before drawing up the dose.

A. Insert the needle at a 45-degree angle for injection.

A client newly diagnosed with type 1 diabetes asks the nurse why the client cannot just take a pill. The nurse would incorporate what knowledge when responding to this client? A. Insulin is needed because the beta cells of the pancreas are no longer functioning. B. The insulin is more effective in establishing control of blood glucose levels initially. C. The client most likely does not exercise enough to control his glucose levels. D. More insulin is needed than that which the client can produce naturally.

A. Insulin is needed because the beta cells of the pancreas are no longer functioning.

A female client is a newly diagnosed diabetic. She is a stay-at-home mother and responsible for meal planning and management of the home. What will the home care nurse teach this client? (Select all that apply.) A. Watch the client draw up and administer her insulin. B. Assist the client in making menus that will meet the needs of both the client and the family. C. Instruct the client to go to the emergency department immediately if she develops a cold or upper respiratory infection. D. Reinforce instructions on dealing with hypoglycemia. E. Encourage the client to check her blood glucose every hour.

A. Watch the client draw up and administer her insulin. B. Assist the client in making menus that will meet the needs of both the client and the family. D. Reinforce instructions on dealing with hypoglycemia.

What is the expected action of sitagliptin on type 2 diabetes? A. It inhibits hydrogen, potassium, and ATPase. B. It slows the rate of inactivation of the incretin hormones. C. It is a synthetically prepared monosodium salt. D. It blocks the S phase of the cell cycle.

B. It slows the rate of inactivation of the incretin hormones.

A client diagnosed with type 1 diabetes suddenly reports feeling weak, shaky, and dizzy. What should be the nurse's initial response? A. Have the client drink a 4-ounce (120-mL) glass of orange juice. B. Administer 1 ampule of 50% dextrose intravenously. C. Perform a blood sugar analysis. D. Administer 10 units of regular insulin subcutaneously.

C. Perform a blood sugar analysis.

The nurse is caring for a client who is taking insulin. The nurse suspects the client is experiencing hypoglycemia when the client displays what signs? A. increased thirst and increased urine output. B. increased pulse rate and fruity smelling breath. C. weakness, sweating, and decreased mentation. D. decreased respiratory rate and hot, dry skin.

C. weakness, sweating, and decreased mentation.

A client newly diagnosed with type 2 diabetes has attended educational sessions to provide insight into the diagnosis. Which of the client's statements should prompt the nurse to provide further teaching? A. "From what I've learned, I know that the basic problem is that my pancreas can't keep up with my insulin needs." B. "People always tried to encourage me to lose weight, and I suppose they might have been right." C. "I don't like getting this diagnosis, but I know that treatment now can prevent future health consequences." D. "I'm disappointed, but I take some solace in the fact that I won't ever have to have insulin injections."

D. "I'm disappointed, but I take some solace in the fact that I won't ever have to have insulin injections."

After teaching a group of students about the various methods for the delivery of insulin, the instructor determines that the teaching was successful when the students identify which method as most commonly used for administration? A. Insulin pen B. Implantable infusion pump C. Jet injector D. Subcutaneous injection

D. Subcutaneous injection

Rosiglitazone is being considered for the treatment of diabetes in an adult client. Before the initiation of rosiglitazone therapy, the nurse should review what laboratory work recently drawn? A. creatinine B. platelet count C. d-dimer D. liver enzymes

D. liver enzymes

A client with diabetes is undergoing testing for glycosylated hemoglobin. The nurse instructs the client that this test measures average blood glucose over what time period? A. the past 1 or 2 months B. the past 7 to 10 days C. the past 12 to 24 hours D. the past 3 or 4 months

D. the past 3 or 4 months