Chapter 57: Drugs for Diabetes
A 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?
"Sulfonylurea increases beta-cell stimulation to secrete insulin, and your beta cells do not contain insulin."
Which clinical findings may indicate diabetes mellitus in a patient? Select all that apply.
-Hemoglobin A1C level greater than 6.5% -Fasting plasma glucose level of 126 mg/dL or higher
Which hormones play a role in the regulation of glucose homeostasis? Select all that apply.
-Insulin -Glucagon
Which assessment findings in a patient with diabetes mellitus are indicative of diabetic ketoacidosis? Select all that apply.
-Ketones in the urine -Isotonic dehydration -Electrolyte imbalances -Exteme hyperglycemia
Which are rapid-acting insulins that can be administered to patients with diabetes mellitus? Select all that apply.
-Lispro (Humalog) -Aspart (Novolog) -Glulisine (Apidra)
Which lifestyle changes should the nurse instruct a patient to implement in order to successfully manage diabetes mellitus? Select all that apply.
-Reduce the amount of alcohol you consume -Incorporate daily physical exercise into your life -Decrease the amount of carbohydrates in your diet
Which early symptoms of hypoglycemia should the nurse instruct a patient's family to treat with a fast-acting carbohydrate source? Select all that apply.
-Tremor -Irritability -Sweating -Confusion
A nurse caring for a patient who has diabetic ketoacidosis recognizes which characteristics in the patient? Select all that apply.
-Triggered by acute illness -Altered fat metabolism leading to ketones -Plasma osmolality of 300 mOsm/L to 320 mOsm/L
Which precautions should the nurse take before administering isophane insulin, also known as neutral protamine hagedorn (NPH) insulin suspension to a patient? Select all that apply
-Verify that insulin syringes are used -Rotate the injection locations every week -Monitor the patients fasting serum glucose level
The nurse is teaching a patient who has type 1 diabetes mellitus how to prevent hypoglycemia. Which clinical indicators of hypoglycemia should the nurse identify for the patient and family? Select all that apply.
-sweating -headache -tachycardia
A patient receives isophane suspension, also known as neutral protamine Hagedorn (NPH) insulin at 8:00 AM. The patient eats breakfast at 8:30 AM, lunch at noon, and dinner at 6:00 PM. At what time is this patient at the highest risk for hypoglycemia?
5:00 PM
Which patient may receive insulin lispro (Humalog)?
A patient with type 2 diabetes mellitus who take metformin (Glucophage)
Which site should be used for injecting insulin for the most consistent absorption?
Abdomen
Which is the nurse's best action when finding a patient with type 1 diabetes mellitus unresponsive, cold, and clammy?
Administer intravenous glucose
Which drug interacts with insulin and increases the risk for unrecognized hypoglycemia in a patient?
Beta-adrenergic blockers
Before administering metformin [Glucophage], the nurse should notify the prescriber about which laboratory value?
Creatinine (Cr) level of 2.1 mg/dL
A patient with type 2 diabetes mellitus receives a prescription for metformin [Glucophage]. Which finding should the nurse recognize as a contraindication to therapy?
Creatinine 1.6 mg/dL
Which instruction should the nurse give when a patient receiving metformin [Glucophage] therapy will undergo angiography?
Do not take your metformin on the day of the test
Which instruction should the nurse provide when teaching a patient to mix regular insulin and neutral protamine Hagedorn (NPH) insulin in the same syringe?
Draw up the clear regular insulin first, followed by the cloudy NPH insulin
Which technique is most appropriate regarding mixing insulin when a patient must administer 30 units regular insulin and 70 units neutral protamine Hagedorn (NPH) insulin in the morning?
Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin.
Which condition is seen in a patient with hyperosmolar nonketotic syndrome (HHNS)?
Extreme hyperglycemia
Which laboratory test would give the most accurate evidence of a diabetic patient's treatment compliance and glucose management over the past few months?
Glycosylated hemoglobin (HbA1c)
Which statement indicates that the patient needs additional teaching on oral hypoglycemic agents?
I will take the medication only when I need it
he patient has been prescribed lispro [Humalog] for treatment of type 1 diabetes mellitus. The nurse should give the patient which instruction?
Inject this insulin with meals because it is very fast acting
Which long-acting insulin mimics natural, basal insulin with its duration of 24 hours?
Insulin glargine (Lantus)
Which insulin should the nurse administer to supplement basal insulin to imitate the pancreatic surge of insulin that accompanies eating?
Insulin glulisine (Apidra)
A patient newly diagnosed with diabetes asks, "How does insulin normally work in my body?" Which response by the nurse is correct?
It promotes the passage of glucose into cells for energy
A patient with type 1 diabetes mellitus has been ordered insulin aspart [NovoLog] 10 units at 7:00 AM. Which nursing intervention should the nurse perform after administering this medication?
Make sure the patient eats breakfast immediately
The nurse administers neutral protamine hagedorn (NPH) insulin at 8 AM. Which intervention is essential for the nurse to perform?
Make sure the patient eats by 5pm
Which statement made by a patient about type 1 diabetes mellitus indicates effective learning?
Patients with type 1 diabetes mellitus require exogenous insulin
The laboratory results for a diabetic patient indicate markedly elevated blood glucose levels. After assessing the patient, the nurse obtains a prescription for intravenous insulin therapy from the primary healthcare provider. Which other assessment finding is likely present in the patient's reports?
Presence of ketones in the serum
The nurse is reviewing the lab results and nursing care plan of a patient with type 2 diabetes mellitus. The nurse notes the patient's glycosylated hemoglobin A1c (HbA1c) is 10%. The nurse should make which addition to the nursing care plan?
Refer the patient to a diabetes educator because the result reflects poor glycemic control
An operating room nurse prepares a patient who has type 2 diabetes for surgery. Which type of insulin should the nurse administer?
Regular insulin (Humulin R)
The nurse administers insulin to a patient at 8:30 AM and knows it will peak about 2.5 hours after administration. Which insulin did the nurse administer?
Regular insulin (Humulin R)
The nurse is caring for a patient who has been taking metformin [Glucophage] for several months. The patient reports abdominal pain. Upon assessment, the nurse detects an irregular heartbeat. What else should the nurse assess to determine the severity of the patient's condition?
Renal function
What should the nurse assess in a patient who is prescribed metformin [Glucophage] for treatment of type 2 diabetes?
Renal function
The nurse observes that A1C levels are elevated in a patient who is taking metformin [Glucophage] for type 2 diabetes. Which class of drugs is likely to be prescribed to this patient?
Sulfonylureas
A patient is taking glipizide [Glucotrol] and a propranolol. A nurse is teaching hypoglycemia awareness and should warn the patient about the absence of which symptom caused by the propranolol?
Tachycardia
A patient is scheduled to start taking insulin glargine [Lantus]. Which information should the nurse give the patient regarding this medication?
This medication provides blood glucose control for 24 hours
Which statement by a nursing student about insulin glargine [Lantus] indicates effective learning?
You cannot mix this insulin in the same syringe with regular insulin
The nurse should include which statement when teaching a patient about insulin glargine [Lantus]?
You cannot mix this insulin with any other insulin in the same syringe
How should the nurse instruct a patient who takes neutral protamine Hagedorn (NPH) insulin?
You must agitate the suspension before administration
What should the nurse teach a patient who takes metformin [Glucophage] for type 2 diabetes?
You should take the medication with food
A patient who is obese is newly diagnosed with type 2 diabetes and is instructed to make dietary changes and perform aerobic exercises daily. The patient insists on insulin therapy for prompt management of diabetes. However, the patient is prescribed oral medications for lowering glucose levels. Which is the most likely reason for delaying insulin therapy?
insulin therapy is initiated when other methods have failed