Chapter 32: Antidiabetic Drugs
Which action is most appropriate regarding the nurse's administration of a rapid-acting insulin to a hospitalized patient? a. Give it within 15 minutes of mealtime. b. Give it after the meal has been completed. c. Administer it once daily at the time of the midday meal. d. Administer it with a snack before bedtime.
a. Give it within 15 minutes of mealtime.
A female patient with type 2 diabetes mellitus receives a prescription for metformin (Glucophage). Which finding does the nurse recognize as a contraindication to therapy? A. Arterial blood pH 7.4 B. Alanine aminotransferase (ALT) 55 U/L C. Fasting blood glucose 131 mg/dL D. Creatinine clearance 1.5 mg/dL
D. Creatinine clearance 1.5 mg/dL The risk of lactic acidosis is greater in a patient with altered renal function. A creatinine clearance level higher than 1.5 mg/dL in males or higher than 1.4 mg/dL in females indicates renal dysfunction. Because metformin can cause lactic acidosis, the nurse avoids administering metformin to this patient - both because the kidneys clear excess acid by excreting hydrogen ions and because metformin is eliminated by the kidneys. The arterial pH is normal. The ALT reading does not constitute a contraindication to metformin therapy. The increased blood glucose is an indication for therapy.
A patient has serum glucose concentration of 375 mg/dL, urine output of 450 mL/hr, and arterial pH of 7.1. The sliding scale requires intravenous insulin for a blood glucose level of more than 350 mg/dL. Which type of insulin is the nurse most likely to administer? A. Insulin lispro (Humalog) B. Insulin glargine (Lantus) C. NPH insulin (Humulin N) D. Regular insulin (Novolin R)
D. Regular insulin (Novolin R) This patient has clinical indicators of diabetic ketoacidosis and will therefore require intravenous insulin to control the reduction in serum glucose. The nurse prepares to administer regular insulin because it is the only insulin that can be administered intravenously.
A patient who has type 2 diabetes is scheduled for an oral endoscopy and has been NPO (nothing by mouth) since midnight. What is the best action by the nurse regarding the administration of her oral antidiabetic drugs? a. Administer half the original dose. b. Withhold all medications as ordered. c. Contact the prescriber for further orders. d. Give the medication with a sip of water.
c. Contact the prescriber for further orders.
When teaching about hypoglycemia, the nurse will make sure that the patient is aware of the early signs of hypoglycemia, including a. hypothermia and seizures. b. nausea and diarrhea. c. confusion and sweating. d. fruity, acetone odor to the breath.
c. confusion and sweating.
The insulin order reads, "Check blood glucose levels before meals and at bedtime. For every 5 mg/dL over 150, give 1 unit of regular Humulin insulin, subcutaneously." The patient's blood glucose level at 11:30 A.M., before lunch, was 253 mg/dL. In units, how much insulin will the nurse give?
20 units 253 mg/dL is 103 mg/dL more than 150 mg/dL (253 - 150) 103 ¸ 5 units = 20.6 One cannot administer "0.6" of a unit, so the answer is 20 units.
The nurse is teaching a group of patients about management of diabetes. Which statement about basal dosing is correct? a. "Basal dosing delivers a constant dose of insulin." b. "With basal dosing, you can eat what you want and then give yourself a dose of insulin." c. "Glargine insulin is given as a bolus with meals." d. "Basal-bolus dosing is the traditional method of managing blood glucose levels."
a. "Basal dosing delivers a constant dose of insulin."
The nurse is administering lispro (Humalog) insulin and will keep in mind that this insulin will start to have an effect within which time frame? a. 15 minutes b. 1 to 2 hours c. 80 minutes d. 3 to 5 hours
a. 15 minutes
A patient is taking a sulfonylurea medication for new-onset type 2 diabetes mellitus. When reviewing potential adverse effects during patient teaching, the nurse will include information about which of these effects? (Select all that apply.) a. Hypoglycemia b. Nausea c. Diarrhea d. Weight gain e. Peripheral edema
a. Hypoglycemia b. Nausea d. Weight gain
Which actions describe the beneficial effects produced by sulfonylurea oral hypoglycemics? (Select all that apply.) a. Stimulate insulin secretion from beta cells b. Increase hepatic glucose production c. Enhance action of insulin in various tissues d. Inhibit breakdown of insulin by liver
a. Stimulate insulin secretion from beta cells c. Enhance action of insulin in various tissues d. Inhibit breakdown of insulin by liver
When will the nurse administer the drug acarbose? a. with the first bit of a meal b. 15 minutes before a meal c. 30 minutes before a meal d. 1 hour after eating
a. with the first bit of a meal
After starting treatment for type 2 diabetes mellitus 6 months earlier, a patient is in the office for a follow-up examination. The nurse will monitor which laboratory test to evaluate the patient's adherence to the antidiabetic therapy over the past few months? a. Hemoglobin levels b. Hemoglobin A1C level c. Fingerstick fasting blood glucose level d. Serum insulin levels
b. Hemoglobin A1C level
When administering morning medications for a newly admitted patient, the nurse notes that the patient has an allergy to sulfa drugs. There is an order for the sulfonylurea glipizide (Glucotrol). Which action by the nurse is correct? a. Give the drug as ordered 30 minutes before breakfast. b. Hold the drug, and check the order with the prescriber. c. Give a reduced dose of the drug with breakfast. d. Give the drug, and monitor for adverse effects.
b. Hold the drug, and check the order with the prescriber.
Which is a rapid-acting insulin with an onset of action of less than 15 minutes? a. Insulin glargine (Lantus) b. Insulin aspart (NovoLog) c. Insulin detemir (Levemir) d. Regular insulin (Humulin R)
b. Insulin aspart (NovoLog)
When caring for a pregnant patient with gestational diabetes, the nurse should question a prescription for which drug? a. Insulin glargine (Lantus) b. Glipizide (Glucotrol) c. Insulin glulisine (Apidra) d. NPH insulin
b. Glipizide (Glucotrol)
The nurse is preparing to administer insulin intravenously. Which statement about the administration of intravenous insulin is true? a. Insulin is never given intravenously. b. Only regular insulin can be administered intravenously. c. Insulin aspart or lispro can be administered intravenously, but there must be a 50% dose reduction. d. Any form of insulin can be administered intravenously at the same dose as that is ordered for subcutaneous administration.
b. Only regular insulin can be administered intravenously.
A patient with a history of chronic obstructive pulmonary disease and type 2 diabetes has been treated for pneumonia for the past week. The patient has been receiving intravenous corticosteroids as well as antibiotics as part of his therapy. At this time, the pneumonia has resolved, but when monitoring the blood glucose levels, the nurse notices that the level is still elevated. What is the best explanation for this elevation? a. The antibiotics may cause an increase in glucose levels. b. The corticosteroids may cause an increase in glucose levels. c. His type 2 diabetes has converted to type 1. d. The hypoxia caused by the chronic obstructive pulmonary disease causes an increased need for insulin.
b. The corticosteroids may cause an increase in glucose levels.
The nurse knows to administer acarbose (Precose), an alpha-glucosidase inhibitor, at which time? a. 30 minutes before breakfast b. With the first bite of each main meal c. 30 minutes after breakfast d. Once daily at bedtime
b. With the first bite of each main meal
Which patient condition would the nurse identify as being a contraindication for the use of afrezza? a. kidney disease b. chronic lung disease c. chronic liver disease d. psoriasis
b. chronic lung disease
The nurse is reviewing a patient's medication list and notes that sitagliptin (Januvia) is ordered. The nurse will question an additional order for which drug or drug class? a. glitazone b. insulin c. metformin (Glucophage) d. sulfonylurea
b. insulin
The nurse will monitor for significant interactions if sitagliptan (Januvia) is given with which of these? a. corticosteroids b. sulfonylureas c. thyroid drugs d. nonsteroidal antiinflammatory drugs
b. sulfonylureas
The nurse is reviewing instructions for a patient with type 2 diabetes who also takes insulin injections as part of the therapy. The nurse asks the patient, "What should you do if your fasting blood glucose is 47 mg/dL?" Which response by the patient reflects a correct understanding of insulin therapy? a. "I will call my doctor right away." b. "I will give myself the regular insulin." c. "I will take an oral form of glucose." d. "I will rest until the symptoms pass."
c. "I will take an oral form of glucose."
Assuming the patient eats breakfast at 8:30 AM, lunch at noon, and dinner at 6:00 AM, he or she is at highest risk of hypoglycemia after an 8:00 AM dose of NPH insulin at what time? a. 10:00 AM b. 2:00 PM c. 5:00 PM d. 8:00 PM
c. 5:00 PM
A patient in the emergency department was showing signs of hypoglycemia and had a fingerstick glucose level of 34 mg/dL. The patient has just become unconscious. What is the nurse's next action? a. Have the patient eat glucose tablets. b. Have the patient consume fruit juice, a nondiet soft drink, or crackers. c. Administer intravenous glucose (50% dextrose). d. Call the lab to order a fasting blood glucose level.
c. Administer intravenous glucose (50% dextrose).
The nurse will instruct the patient to treat hypoglycemia with which drug? a. Acarbose (Precose) b. Propranolol (Inderal) c. Glucagon (GlucaGen) d. Bumetanide (Bumex)
c. Glucagon (GlucaGen)
The nurse is teaching a review class to nurses about diabetes mellitus. Which statement by the nurse is correct? a. "Patients with type 2 diabetes will never need insulin." b. "Oral antidiabetic drugs are safe for use during pregnancy." c. "Pediatric patients cannot take insulin." d. "Insulin therapy is possible during pregnancy if managed carefully."
d. "Insulin therapy is possible during pregnancy if managed carefully."
The nurse is preparing a patient for a computed tomography scan using iodine contrast media. Which medication should the nurse question if prescribed one day before the scheduled procedure? a. Acarbose (Precose) b. Pioglitazone (Actos) c. Repaglinide (Prandin) d. Metformin (Glucophage)
d. Metformin (Glucophage)
Which oral hypoglycemic drug has a quick onset and short duration of action, enabling the patient to take the medication 30 minutes before eating and skip the dose if he or she does not eat? a. Acarbose (Precose) b. Metformin (Glucophage) c. Repaglinide (Prandin) d. Pioglitazone (Actos)
c. Repaglinide (Prandin)
While monitoring a patient who is recieving insulin therapy, the nurse observes for which signs of hypoglycemia? a. decreased pulse rate and respiratory rates and flushed skin b. increased pulse rate and fruity, acetone breath odor c. irritability, sweating, and confusion d. increased urine output and edema
c. irritability, sweating, and confusion
Which insulin can be administered by continuous intravenous (IV) infusion? a. Insulin glargine (Lantus) b. Insulin aspart (Novolog) c. Insulin detemir (Levemir) d. Regular insulin (Humulin R)
d. Regular insulin (Humulin R)
The nurse is reviewing the history of a patient who will be taking the amylin mimetic drug pramlinitide (Symlin). Which condition is contraindication to the use of this drug? a. hypertension b. coronary artery disease c. hypothyroidism d. gastropaesis
d. gastropaesis
A dose of long-acting insulin has been ordered for bedtime for a patient with diabetes. The nurse expects to give which type of insulin? a. regular b. lispro c. NPH d. glargine
d. glargine
The nurse is reviewing the various types of insulins. For each insulin listed below, place in order from shortest duration (1) to longest duration (4). a. Glargine insulin b. Aspart insulin c. Regular insulin d. NPH insulin
1. A 2. B 3. C 4. D
The nurse administers repaglinide (Prandin) to a patient at 8 AM. When is the patient at the highest risk for hypoglycemia? A. 9 AM B. 10 AM C. 11 AM D. Noon
A. 9 AM Repaglinide is a rapid-acting oral hypoglycemic agent whose action peaks within 1 hour of the drug's administration. If the drug is given at 8 AM, it will have its peak effects at 9 AM.
The nurse is teaching a patient with type 1 diabetes mellitus how to prevent hypoglycemia. Which clinical indicators of hypoglycemia should the nurse instruct the patient and family to be alert to? (Select all that apply.) A. Headache B. Sweating C. Polyphagia D. Weight loss E. Dehydration F. Tachycardia
A. Headache B. Sweating F. Tachycardia The effects of hypoglycemia are attributable largely to stimulation of the central nervous system because low blood glucose is a stress to the body. When hypoglycemia occurs, the sympathetic nervous system responds in an attempt to increase the blood sugar. Clinical indicators of hypoglycemia mimic sympathetic nervous system stimulation; they include tachycardia, palpitations, headaches, diaphoresis, and anxiety.
The nurse is giving a patient insulin at 8:30 AM. When would the nurse most likely observe clinical manifestations of hypoglycemia? A. 9:00 AM B. 11:00 AM C. 11:45 AM D. 1:30 PM
B. 11:00 AM Regular insulin peaks about 2.5 hours after the drug's administration. If the drug is given at 8:30 AM, it will have its peak effects at 11:00 AM.
Which insulin should the nurse administer to supplement basal insulin to imitate the pancreatic surge of insulin that accompanies eating? A. Insulin glargine (Lantus) B. Insulin glulisine (Apidra) C. Insulin detemir (Levemir) D. NPH insulin (Humulin N)
B. Insulin glulisine (Apidra) The nurse should administer a rapid-acting form of regular insulin, such as insulin glulisine, because the onset of action is 15 minutes after administration. Insulin glargine and insulin detemir are basal insulins. NPH is an intermediate-acting insulin that would take too long to act in this scenario.
Which diagnostic test should the nurse review with the patient as a means of evaluating the patient's adherence to diabetic therapy? A. Examination of the retinal structures B. Evaluation of the glomerular filtration C. Arterial pH and venous potassium levels D. Glycosylated hemoglobin assay (HbA1c)
D. Glycosylated hemoglobin assay (HbA1c) The nurse reviews the findings of the HbA1c assay with the patient as a means of evaluating the patient's adherence to therapy. Because this test reflects the percentage of hemoglobin that is saturated with glucose and because the life of a red blood cell is 120 days, this serum test can be used to evaluate the relative frequency of hyperglycemia in the patient over the same period. If the patient has experienced hyperglycemia frequently, the HbA1c will be high because the red blood cells were exposed to hyperglycemia more frequently. A normal reading is less than 7%. The renal perfusion study and ophthalmic evaluation are not as sensitive as the HbA1c assay as indicators of patient adherence because it takes years of hyperglycemia to damage these structures. Serum pH and potassium readings are sensitive but not specific indicators of diabetic ketoacidosis.
A patient who has type 1 diabetes mellitus is admitted with acute obstructive pulmonary disease that requires treatment with methylprednisolone (Solu-Medrol). Which adverse effect of this combination therapy is the nurse's priority in planning preventive care? A. Hypokalemia B. Hypernatremia C. Acute dehydration D. Metabolic acidosis
D. Metabolic acidosis A patient with type 1 diabetes will receive insulin, so the nurse plans care to prevent metabolic acidosis because steroid therapy is likely to impair the hypoglycemic action of insulin, potentially leading to hyperglycemia, and because diabetic ketoacidosis is a complication of type 1 diabetes mellitus resulting from excessive hyperglycemia. However, the prevention of metabolic acidosis is the nurse's priority because hyperglycemia is much more likely to develop as a result of the hyperglycemic effects of methylprednisolone, thereby increasing the risk of diabetic ketoacidosis (DKA). If the nurse can prevent metabolic acidosis, hypokalemia, dehydration, and hyperglycemia will be controlled. In DKA, the patient is in a hyperosmolar state (a result of excessive hyperglycemia) wherein the patient eliminates huge amounts of water and electrolytes. At the same time, the cells are starving because the insulin required to drive glucose into the cells is inadequate, so the patient becomes dehydrated, acidotic as a result of the accumulation of ketones and other organic acids, and hypokalemic because of polyuria and the lack of insulin to drive potassium into the cells.
A patient is taking glipizide (Glucotrol) asks the nurse, "How does my insulin pill work, anyway?" Which information will the nurse provide to the patient regarding the mechanism of action of glipizide? a. "It increases insulin production" b. "It helps the body use insulin c. "It decreases the amount of glucose made by liver" d. "It decreases the amount of glucose the body takes in from food"
a. "It increases insulin production"
A 75-year-old woman with type 2 diabetes has recently been placed on glyburide (Diabeta), 10 mg daily. She asks the nurse when the best time would be to take this medication. What is the nurse's best response? a. "Take this medication in the morning, 30 minutes before breakfast." b. "Take this medication in the evening with a snack." c. "This medication needs to be taken after the midday meal." d. "It does not matter what time of day you take this medication."
a. "Take this medication in the morning, 30 minutes before breakfast."
Which long-acting insulin mimics natural, basal insulin with no peak action and a duration of 24 hours? a. Insulin glargine (Lantus) b. Insulin glulisine (Apidra) c. Regular insulin (Humulin R) d. NPH insulin
a. Insulin glargine (Lantus)
Pramlintide (Symlin) is prescribed as supplemental drug therapy to the treatment plan for a patient with type 1 diabetes mellitus. What information should the nurse include when teaching the patient about the action of this medication? a. Pramlintide slows gastric emptying. b. Pramlintide increases glucagon excretion. c. Pramlintide stimulates glucose production. d. Pramlintide corrects insulin receptor sensitivity.
a. Pramlintide slows gastric emptying.
A patient is to be given an insulin drip to control his high blood glucose levels. The nurse knows that the type of insulin would be used for this intravenous infusion would be which of these? a. regular b. lispro c. NPH d. glargine
a. regular
When teaching a patient about insulin glargine (Lantus), which statement by the nurse about this drug is correct? a. "You can mix this insulin with NPH insulin to enhance its effects on glucose metabolism." b. "You cannot mix this insulin with regular insulin and thus will have to take two injections." c. "It is often combined with regular insulin to decrease the number of insulin injections per day." d. "The duration of action for this insulin is 8 to10 hours, so you will need to take it twice a day."
b. "You cannot mix this insulin with regular insulin and thus will have to take two injections."
Which information should the nurse include in a teaching plan for patients taking oral hypoglycemic drugs? (Select all that apply.) a. Take your medication only as needed. b. Report symptoms of anorexia and fatigue. c. Explain dietary changes are not necessary. d. Advise to avoid smoking and alcohol consumption. e. Instruct that it is okay to skip breakfast 1 to 2 times per week.
b. Report symptoms of anorexia and fatigue. d. Advise to avoid smoking and alcohol consumption.
A patient has been diagnosed with metabolic syndrome and is started on the biguanide metformin (Glucophage). The nurse knows that the purpose of the metformin, in this situation, is which of these? a. To increase the pancreatic secretion of insulin b. To decrease insulin resistance c. To increase blood glucose levels d. To decrease the pancreatic secretion of insulin
b. To decrease insulin resistance
When administering insulin, the nurse must keep in mind that which is most immediate and serious adverse effect of insuling therapy? a. hyperglycemia b. hypoglycemia c. bradycardia d. orthostatic hyptosension
b. hypoglycemia
The major risk factor the development of typer II diabetes is which of the following? a. kidney disease b. liver disease c. obesity d. hypercholesteremia
b. liver disease
When monitoring a patient's response to oral antidiabetic drugs, the nurse knows that which laboratory result would indicate a therapeutic response? a. Random blood glucose level above 170 mg/dL b. Blood glucose level of less than 50 mg/dL after meals c. Fasting blood glucose level between 70 and 100 mg/dL d. Evening blood glucose level below 80 mg/dL
c. Fasting blood glucose level between 70 and 100 mg/dL
The patient is prescribed 30 units of regular insulin and 70 units of insulin isophane suspension (NPH insulin) subcutaneously every morning. The nurse should provide which instruction to the patient for insulin administration? a. "Inject the needle at a 30-degree angle." b. "Rotate sites at least once or twice a week." c. "Use a 23- to 25-gauge syringe with a 1-inch needle to increase insulin absorption." d. "Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin."
d. "Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin."
When teaching a patient who is starting metformin (Glucophage), which instruction by the nurse is correct? a. "Take metformin if your blood glucose level is above 150 mg/dL." b. "Take this 60 minutes after breakfast." c. "Take the medication on an empty stomach 1 hour before meals." d. "Take the medication with food to reduce gastrointestinal (GI) effects."
d. "Take the medication with food to reduce gastrointestinal (GI) effects."
The nurse is providing education to a patient for the prescription glipizide (Glucotrol). The nurse explains this medication is more effective when administered at which time? a. At bedtime b. In the morning c. 15 minutes postprandial d. 30 minutes before a meal
d. 30 minutes before a meal
Which A!C level represents the desired level for glycemic goal for patients with diabetes? a. 10 b. 9 c. 8 d. 7
d. 7
The nurse is teaching patients about self-injection of insulin. Which statement is true regarding injection sites? a. Avoid the abdomen because absorption there is irregular. b. Choose a different site at random for each injection. c. Give the injection in the same area each time. d. Rotate sites within the same location for about 1 week before rotating to a new location.
d. Rotate sites within the same location for about 1 week before rotating to a new location.
The nurse is teaching a group of patients about self-administration of insulin. What content is important to include? a. Patients need to use the injection site that is the most accessible. b. If two different insulins are ordered, they need to be given in separate injections. c. When mixing insulins, the cloudy (such as NPH) insulin is drawn up into the syringe first. d. When mixing insulins, the clear (such as regular) insulin is drawn up into the syringe first.
d. When mixing insulins, the clear (such as regular) insulin is drawn up into the syringe first.
