Chapter 47 Antidiabetics
A patient is prescribed metformin. Which is a side effect/adverse effect common to metformin? A.Seizures B.Constipation C.Bitter or metallic taste D.Polyuria and polydipsia
C Metformin has a bitter or metallic taste. Seizures, constipation, polyuria, and polydipsia are not side effects/adverse effects of metformin.
A nurse is teaching a patient how to recognize symptoms of hypoglycemia. Which symptoms should be included in the teaching? (Select all that apply) a. Headache b. Nervousness c. Bradycardia d. sweating e. thirst f. sweet breath odor
A, B, D
The nurse is teaching a patient who has been prescribed repaglinide. Which information should the nurse include in the teaching plan? A. "This medication is compatible with all of your cardiac medications." B. "This medication will not cause hypoglycemia." C. "This medication has no side effects." D. "You will need to be sure you eat as soon as you take this medication."
D Repaglinide is ashort-acting antidiabetic agent . The drug's very fast onset of action allows patients to take the drug with meals and skip a dose when they skip a meal. Repaglinide interacts with beta-adrenergic blockers as well as other medications. Hypoglycemia is a side effect of this medication, and there are many other possible side effects of this medication.
Antidibetic drugs are designed to control sings and symptoms of Diabetes mellitus. The nurse primarily expects decrease in which ? a. blood glucose b. fat metabolism c. glycogen storage d. protein mobilization
A
The patient newly diagnosed with type 2 diabetes mellitus has been ordered insulin glargine. What information is essential for the nurse to teach this patient? A. "This medication has a duration of action of 24 h." B."This medication should be mixed with the regular insulin each morning." C. "This medication is very expensive, but you will be receiving it only a short time." D. "This medication is very short acting. You must be sure you eat after injecting it."
A Insulin glargine has a duration of action of 24 h with no peaks, mimicking the natural, basal insulin secretion of the pancreas. This medication cannot be mixed with other insulins and is not a short-acting insulin. The patient may need to receive this medication for a long time.
A patient with type 1 diabetes mellitus has been ordered insulin aspart 10 units at 7:00 AM. What nursing intervention should the nurse perform after administering this medication? A. Make sure the patient eats breakfast immediately. B. Perform a fingerstick blood sugar test. C. Flush the IV. D. Have the patient void and dipstick the urine.
A Insulin aspart is a rapid-acting insulin that acts in 15 min or less. It is imperative that the patient eats as it starts to work. The patient should have had a fingerstick blood sugar test done before receiving the medication. There is no need to check the urine. This medication is given subcutaneously.
The nurse should include which statement when teaching a patient about insulin glargine? A. "You cannot mix this insulin with any other insulin in the same syringe." B. "You can mix this insulin with Lente insulin to enhance its effects." C. "The duration of action for this insulin is approximately 8-10 h, so you will need to take it twice a day." D. "You should inject this insulin just before meals because it is very fast acting."
A Insulin glargine is a long-acting insulin with a duration of action up to 24 h. It should not be mixed with any other insulins. The insulin is not fast acting.
Which statement indicates to the nurse that the patient needs additional teaching on oral hypoglycemic agents? A. "I will take the medication only when I need it." B. "I will report symptoms of fatigue and loss of appetite." C. "I will limit my alcohol consumption." D. "I will monitor my blood sugar daily."
A Oral hypoglycemic agents must be taken on a daily scheduled basis to maintain euglycemia and prevent long-term complications of diabetes. When alcohol is ingested with certain oral hypoglycemic drugs, the hypoglycemic effect can be intensified. The patient may experience fatigue and loss of appetite as side effects of the medication, and these should be reported to the health care provider. The patient needs to closely monitor blood sugar.
Which statement by a patient taking glipizide indicates that more teaching is indicated? • A."I will use a new needle every time I take the medication." B."I will take the medication once a day in the morning." C."I will eat my breakfast very soon after taking my Glucotrol." D."This medication stimulates my pancreatic cells to make insulin."
A Glipizide (Glucotrol) is an oral antidiabetic agent. It is well absorbed from the GI tract and is highly protein-bound. Parenteral administration of this medication is not indicated. All other options are correct.
A patient received regular insulin at 7:30 am. At 9:30 am the patient feels slightly hungry and has a dull headache. The nurse should • A.test the patient's blood glucose level. B.ensure that the patient has a meal. C.provide the patient with 4 ounces of orange juice. D.administer the next dose of insulin.
A The peak time for regular insulin is 2 to 4 hours. It is most important for the nurse to check the patient's blood glucose level to prevent a possible hypoglycemic reaction (insulin shock).
A patient with type 1 diabetes mellitus is ordered insulin therapy once daily to be administered at bedtime. What is the type of insulin the patient is most likely receiving? A.Insulin glargine B.Lente insulin C.Lispro insulin Regular insulin
ANS: A Insulin glargine (Lantus) is long-acting insulin with an onset of 1 hour. It is evenly distributed over a 24-hour duration of action; thus, it is administered once a day, usually at bedtime. Intermediate-acting insulins include neutral-protamine-Hagedorn (NPH), Lente, and Humulin N. Rapid-acting insulins include insulin lispro. Regular insulin is short acting.
A client with type II diabetes has been prescribed canagliflozin. Which statement made by the client indicates understanding of the teaching provided by the nurse? A. "I do not need to worry about hypoglycemia with this medication, since it is not insulin." B. "I will monitor for signs and symptoms of urinary tract infections while taking this medication." C. "Since I will be urinating more, I can stop taking my diuretic medication." D. "I will increase potassium in my diet to counteract side effects of this medication."
B
A nurse is providing teaching for a patient who has to administer a mixed insuling dose of 30 units regular insulin and 70 units NPH insulin. Which technique is most appropriate for the nurse to include in patient teaching? A. Administer these insulins at least 10 min apart, so that you will know when they are working. B. Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin. C. Use the Z-track method for administration. D. Draw the medication into two separate syringes but inject into the same spot.
B
A patient is to receive insulin before breakfast, and the time of breakfast time delivery is variable. The nurse know that which insulin should not be administered until the breakfast tray has arrived and the patient is ready to eat? a. NPH b. Lispro c. Glargine d. Regular
B
The nurse is preparing to administer neutral protamine Hagedorn (NPH) insulin 16 units and regular insulin 14 units in the same syringe. Which order of actions below represents the correct steps in combining these medications? A. Verify the medication order, inject air into the regular insulin vial, inject air into the NPH vial, draw up 16 units NPH insulin into the syringe, and draw up 14 units regular insulin into the syringe. B. Verify medication order, inject air into the NPH vial, inject air into the regular insulin vial, draw up 14 units regular insulin into syringe, and draw up 16 units NPH insulin into syringe. C. Verify medication order, inject air into the regular insulin vial, inject air into the NPH vial, draw up 14 units regular insulin into syringe, and draw up 16 units NPH insulin into syringe. D. Inject air into the NPH vial, inject air into the regular insulin vial, draw up 14 units regular insulin into syringe, draw up 16 units NPH insulin into syringe, and verify medication order.
B
The nurse is providing patient teaching for the drug miglitol for the patient with a diagnosis of type 2 diabetes. Which group of side effects should the nurse include in the patient teaching? A. Dehydration, hypoglycemia, and thirst B. Flatulence, hypoglycemia, and diarrhea C. Rash, gingivitis, and hypoglycemia D. Hypoglycemia, diaphoresis, and hypokalemia
B Side effects of miglitol include flatulence, diarrhea, and abdominal pain.
Which time frame would be most appropriate for administering sliding-scale lispro insulin? A.Within 30 minutes of consuming breakfast B.When the breakfast tray is served and ready to eat C.Within 1 hour of obtaining blood glucose measurement D.Within 15 minutes of obtaining blood glucose measurement
B Lispro should be given 5 minutes before eating because the onset of action is 5 to 15 minutes
A patient is prescribed Glipizide. The nurse knows that which side effects and adverse effects may be expected? (Select all that apply) a. Tachypnea b. Tachycardia c. Increased Alertness d. increased weight gain e. visual disturbances f. Hunger
B, E, F
A patient is newly diagnosed with type 1 diabetics mellitus and requires daily insulin injections. Which instructions should the nurse include in the teaching of insulin administration? (Select all that apply) a. Teach family members how to administer glucagon by injection when the patient has a hyperglycemic reaction b. Instruct the patient about the necessity for compliance with prescribed insulin therapy c. Teach the patient that hypoglycemic reactions are more likely to occur the onset of action time d. Instruct the patient in the care and handling of the insulin container and syringe
B,D
A male patient 24 h post-op tells the nursing student that his nurse "gave him an extra shot of insulin and there must be some mistake." The nursing student verifies the patient received a sliding scale dose of insulin. What information should the nursing student provide to the patient? A. "The effects of surgery result in a decrease in your metabolic rate; this increases secretion of glucagon and increases your glucose levels." B. "You received extra insulin today because you have not been eating." C. "Surgery can produce stress, which can produce stress; an additional small amount of insulin helps provide a constant glucose level." D. "Surgery often results in infection, and infection raises your glucose levels."
C
A patient is diagnosed with type 2 DM. The nurse is aware that which statement is true about this patient? a. The patient is most likely a teenager b. The patient is most likely a child younger that 10 years c. Heredity and obesity are major causative factors d. Viral infections contribute most to disease development
C
A patient is receiving daily dose of NPH insulin at 7:30 a.m. The nurse expects the peak effect of this drug to occur at what time? a. 8:15 am b. 10:30am c. 5:00 pm d. 11:00 pm
C
The nurse administers NPH insulin at 8 AM. What intervention is essential for the nurse to perform? A. Administer the insulin via IV pump. B. Monitor fingerstick at 2 PM. C. Make sure patient eats by 5 PM. D. Assess the patient for hyperglycemia by 10 AM
C NPH insulin may be peaking just before dinner without sufficient glucose on hand to prevent hypoglycemia. The patient needs to eat by 5 PM. The patient would not be at high risk for hypoglycemia at 10 AM. A fingerstick is not necessary at 2 PM. The insulin should not be routinely administered via IV.
A nurse gives a patient NPH insulin at 8:00 am. At 2:00 pm the nurse finds the patient extremely lethargic but conscious. The patient is diaphoretic and slightly combative. The nurse should • A.call the health care provider. B.ensure that the patient has a meal. C.provide the patient with 4 ounces of orange juice. administer the next dose of insulin.
C NPH is an intermediate-acting insulin that peaks in 6 to 12 hours. Because the patient is conscious, it is most important for the nurse to provide the orange juice to prevent a possible hypoglycemic reaction (insulin shock).
The patient with type 1 diabetes mellitus asks, "Why can't I take a sulfonylurea like my friend who has diabetes?" What is the nurse's best response? A. "You are unable to store glucose, because you do not have insulin, and sulfonylurea helps with glucose storage." B. "Sulfonylurea will lower your blood sugar too much, and you will be hypoglycemic." C. "Sulfonylurea increases beta-cell stimulation to secrete insulin, and with your type of diabetes, the beta cells do not contain insulin. This medication will not work for you." D. "You must be mistaken. If your friend has diabetes mellitus, she is taking insulin."
C Sulfonylurea agents reduce serum glucose levels by increasing beta-cell stimulation for insulin release, decreasing hepatic glucose production, and increasing insulin sensitivity. It is administered for type 2 diabetes mellitus but will not be effective in type 1 as the beta cells are not functional.
The patient experiences the Somogyi effect. Which statement regarding the Somogyi effect does the nurse identify as being true? A.This is a hyperglycemic condition. B.The condition usually occurs immediately after dinner. C.It is a response to excessive insulin. D.Management usually requires increase of the bedtime insulin dose.
C The Somogyi effect is a response to excessive insulin resulting in a hypoglycemic condition usually occurring in the predawn hours of 2:00 to 4:00 am. A rapid decrease in blood glucose during the nighttime hours stimulates a release of hormones (e.g., cortisol, glucagon, epinephrine) to increase blood glucose by lipolysis, gluconeogenesis, and glycogenolysis, thus creating the Somogyi effect. Management of the Somogyi effect involves monitoring blood glucose between 2:00 am and 4:00 am and reducing the bedtime insulin dosage.
When teaching the patient about the storage of insulin, which statement will the nurse include? A.Keep the insulin in the freezer. B.Warm the insulin in the microwave before administration. C.Do not place insulin in sunlight or a warm environment. D.Open insulin vials lose their strength after one year.
C Unopened insulin vials are refrigerated until needed. Once an insulin vial has been opened, it may be kept (1) at room temperature for 1 month or (2) in the refrigerator for 3 months. Insulin is less irritating to the tissues when injected at room temperature. Insulin vials should not be put in the freezer. In addition, insulin vials should not be placed in direct sunlight or in a high-temperature area. Prefilled syringes should be stored in the refrigerator and should be used within 1 to 2 weeks. Opened insulin vials lose their strength after approximately 3 months.
A nurse is reviewing a client's most recent hemoglobin A1c level of 8.7%. What instruction will the nurse provide to the client based upon this finding? A. "This test is not a diagnostic measurement of diabetes." B. "Your hemoglobin A1c lab value is normal, and no further action needs to be taken at this time." C. "The lab value can be altered significantly since you were not fasting. We should repeat this test in 2 weeks." D. "This result indicates that your diabetes is not well controlled. Your provider may adjust your medication regimen."
D
What information will the nurse teach the patient who has been prescribed an alpha glucosidase inhibitor? A. "This medication will increase the sensitivity of insulin receptor sites." B. "This medication cannot be used in combination with other antidiabetic agents." C. "This medication will stimulate pancreatic insulin release." D. "This medication will delay the absorption of carbohydrates from the intestines."
D Alpha glucosidase is an enzyme necessary for the absorption of glucose from the GI tract. Inhibiting this enzyme inhibits glucose absorption, delaying rises in postprandial serum glucose levels.
Which is the most appropriate action for the nurse who is told that a patient typically takes his glipizide with food? A. Inform the patient that the medication must be taken 15 min after a meal. B. Immediately check the patient's blood glucose level. C. Immediately call the health care provider. D. Inform the patient that it is better to take the medication 30 min before a meal.
D Food inhibits the absorption of glipizide, the only sulfonylurea agent that should be given 30 min before a meal. The blood glucose level does not have to be taken right away. The medication is not to be taken after a meal. The health care provider does not have to be called; the nurse should intervene.
What is the nurse's best action when finding a patient with type 1 diabetes mellitus unresponsive, cold, and clammy? A. Administer subcutaneous regular insulin immediately B. Start an insulin drip. C. Draw blood glucose level and send to the laboratorY D. Administer glucagon.
D Glucagon stimulates glycogenolysis, raising serum glucose levels. The patient is showing signs of hypoglycemia.
A client is newly diagnosed with Type II diabetes mellitus and has been prescribed metformin. The client works overnight as a security guard. What is the appropriate education for the client for this medication regimen? A. "Metformin should not be taken if the client is going to skip a meal." B. "Metformin can result in hypoglycemia, and blood sugars should be checked daily." C. "The client should take the metformin prior to an overnight shift to avoid drops in blood sugar." D. "Metformin can be taken without regard to meals, and doses should not be skipped."
D Metformin decreases glucose production without increasing insulin production, causing no risk of hypoglycemia. The blood sugar value does not need to be checked daily while taking metformin unless it is combined with insulin or another medication that risks hypoglycemia. It may be taken
A client with type I diabetes takes neutral protamine Hagedorn (NPH) insulin, 15 units at 0800 daily. At 1400, the client becomes agitated and confused. What is the most appropriate nursing action based on these findings? A. Administer an additional 15 units of NPH insulin. B. Check the client's oral temperature and urine output. C. Provide the client a simple carbohydrate snack. D. Assess the capillary blood glucose level.
D NPH insulin peaks anywhere from 6 to 14 hours after administration. During peak action of the insulin, hypoglycemia is most likely to occur. Symptoms of hypoglycemia include altered mental status, hunger, tremors, and diaphoresis. Prior to intervening, the nurse must confirm that the patient is experiencing hypoglycemia by checking the capillary blood glucose level. The nurse would then administer a simple carbohydrate to increase the blood glucose level. Administering more insulin would worsen the hypoglycemic state and is contraindicated. Checking the oral temperature and urine output are not priority nursing actions during a hypoglycemic episode.
The nurse is teaching the patient how to administer insulin. What information is essential to include in the plan? A. "Inject the insulin at a 30-degree angle between the fat and muscle." B. "Do not mix any insulins in the same syringe." C. "Avoid administering the insulin into your arm." D. "For the most consistent absorption, inject the insulin into the abdomen."
D The abdomen has the most consistent absorption because the blood flow to the subcutaneous tissue typically is not as affected by muscular movements as it could be in the arm or thigh. Insulin can be administered in the arm. The patient should be instructed to inject insulin at a 45- to 90-degree angle, not a 30-degree angle. Most insulins can be mixed.