Chapter 38: Agents to Control Blood Glucose Levels

Oral anti-diabetic agents can be used in various combinations for what purpose? Maximum effects Additive effects Minimalistic effects Synergistic effects

Additive effects Rationale: There are five types of oral anti-diabetic agents, all of which may be used to treat type 2 diabetes when diet and exercise alone fail to control the disorder. The drugs lower blood sugar by different mechanisms and may be used in various combinations for additive effects.

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

Fruity breath odor Rationale: Fruity breath odor would be noted as ketones build up in the system and are excreted through the lungs. Dehydration would be noted as fluid and electrolytes are lost through the kidneys. Blurred vision and hunger would be associated with hypoglycemia.

A client is receiving acarbose. What would the nurse incorporate into the teaching plan for this client about the action of the drug? Inhibits an enzyme to delay glucose absorption Decreases insulin resistance Binds to potassium channels on pancreatic beta cells Increases the uptake of glucose

Inhibits an enzyme to delay glucose absorption Rationale: Acarbose inhibits alpha glucosidase, an enzyme, thereby delaying the absorption of glucose. Thiazolidinediones, such as rosiglitazone, decrease insulin resistance. Second-generation sulfonylureas bind to potassium channels on the pancreatic beta cells to improve insulin binding to insulin receptors and increase the number of insulin receptors. Biguanides, such as metformin, increase the uptake of glucose.

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: hyperglycemia and glycosuria. protein intake and hyperglycemia. hypoglycemia and glucagon levels. carbohydrate use and insulin levels.

hyperglycemia and glycosuria. Rationale: The most frequently recognized clinical signs of diabetes are hyperglycemia (fasting blood sugar level greater than 106 mg/dL) and glycosuria (the presence of sugar in the urine).

When reviewing the medication list of a client being seen in the clinic, the nurse notes that the client is receiving glipizide. Based on the nurse's understanding, this drug is used to treat: hypokalemia. hyperkalemia. hypoglycemia. hyperglycemia.

hyperglycemia. Rationale: Glipizide is an antidiabetic agent with the desired action of lowering the blood glucose level. It is used to treat hyperglycemia. It would worsen, not treat, hypoglycemia, and it has no role in treating abnormal potassium levels (hypokalemia or hyperkalemia).

The nurse is instructing a client how to take a prescribed pramlintide. Which would be most appropriate? "Give it by subcutaneous injection immediately before your major meals." "Take the drug orally once a day, preferably in the morning." "Give yourself an injection 1 hour before you eat breakfast and dinner." "Take the drug orally with the first bite of each meal."

"Give it by subcutaneous injection immediately before your major meals." Rationale: Pramlintide is administered subcutaneously immediately before major meals. Numerous antidiabetic drugs are taken orally, often once a day in the morning. Exenatide is given subcutaneously within 1 hour before the morning and evening meals. Miglitol should be taken orally with the first bite of each meal.

What hormone, secreted with insulin, increases satiety and suppresses glucagon secretion? Amylin Amylase Aldosterone Anti-diuretic hormone

Amylin Rationale: Amylin, a hormone secreted with insulin, delays gastric emptying, increases satiety, and suppresses glucagon secretion, thus complementing the effects of insulin on the blood sugar.

Which would a nurse identify as an example of a sulfonylurea? Glyburide Metformin Acarbose Miglitol

Glyburide Rationale: Glyburide is an example of a sulfonylurea. Metformin is classified as a biguanide. Acarbose and miglitol are alpha-glucosidase inhibitors.

A female client is prescribed metformin to decrease her blood glucose levels associated with diabetes mellitus type 2. Which statement accurately describes the action of metformin? It stimulates insulin release from the beta cells of the pancreas. It increases intestinal absorption of glucose and improves insulin sensitivity. It decreases intestinal absorption of glucose and improves insulin sensitivity. It reduces postprandial glucose levels substantially in combination with insulin.

It decreases intestinal absorption of glucose and improves insulin sensitivity. Rationale: Metformin reduces the production of glucose by the liver and decreases the intestinal absorption of glucose to increase insulin sensitivity, while glyburide works by stimulating insulin release from the beta cells of the pancreas and reducing glucose output from the liver. On the other hand, postprandial glucose levels substantially are reduced by acarbose and miglitol when administered either alone or in combination with insulin or sulfonylurea.

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? Myalgia Tachycardia Flatulence Epigastric discomfort

Tachycardia Rationale: The nurse should monitor for tachycardia, congestive heart failure, sodium and fluid retention, hyperglycemia, and glycosuria as the adverse reactions in the patient receiving diazoxide drug therapy. Myalgia, fatigue, and headache are the adverse reactions observed in patients undergoing pioglitazone HCl drug therapy. Flatulence is one of the adverse reactions found in patients receiving metformin drug therapy. Epigastric discomfort is one of the adverse reactions observed in patients receiving acetohexamide drugs.

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? Inject a prescribed dose of insulin as soon as you suspect the reaction is occurring. Stay calm and still until the reaction subsides. Notify your health care provider immediately. Take an oral dose of some form of glucose as soon as possible.

Take an oral dose of some form of glucose as soon as possible. Rationale: The initial action of the client should be to take some form of oral glucose. It would also be appropriate to call the provider, but this will delay self-treatment and should be done after the administration of the glucose. Injecting insulin would cause further harm to the client and is not an option. It is good to stay calm, but the reaction will not subside without intervention.