Pharm Ch 38
A client, who is 42 years old and 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?
"I'm disappointed, but I take some solace in the fact that I won't ever have to have insulin injections."
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? "I need to turn the dial on the pen and listen for the locking ring before administering my insulin." "I determine my dosage by the number of clicks that I hear." "This will make it easier for me to give my own insulin because of my poor eyesight." "If I forget to take my insulin pen, I will be able to use the one that my wife uses."
"If I forget to take my insulin pen, I will be able to use the one that my wife uses."
What statement would be appropriately included in the teaching concerning type 2 diabetes?
"Regular exercise makes your body better able to use the insulin it produces."
Client recently dx w/diabetes would be early indicators of problem?
--- Lethargy, Fruity smelling breath, Weight loss, Getting up Noc to urinate.
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?
6:45
A patient is to be administered glipizide (Glucotrol). Which factor would prohibit the administration of glipizide (Glucotrol) to this patient? The ingestion of carbohydrates Increase in alkaline phosphatase Allergy to sulfonamides A diagnosis of hypertension
Allergy to sulfonamides
A nurse is assigned to administer glargine to a patient at a health care facility. What precaution should the nurse take when administering glargine? Shake the vial vigorously before withdrawing insulin. Administer insulin that has been refrigerated. Administer glargine via IV route. Avoid mixing glargine with other insulin.
Avoid mixing glargine with other insulin.
After preparing NPH insulin nurse should administer injection within what time frame? a. 10 minutes b. 15 minutes c. 30 minutes d. 60 minutes
b. 15 minutes
A patient receives a dose of insulin lispro at 8 AM. The nurse would be alert for signs and symptoms of hypoglycemia at which time?
Between 8:30 AM and 9:30 AM
A female client visits the physician's office after routine labs are drawn. The nurse notes that her A1C is 9. How does the nurse interpret this finding? Client is in good glycemic control. Client's blood glucose levels are not consistent. Client's blood glucose demonstrates longstanding hypoglycemia. Client's average blood glucose is above normal.
Client's average blood glucose is above normal.
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?
Entry of glucose into the cells
A patient is diagnosed with type 1 diabetes. What distinguishing characteristic is associated with type 1 diabetes?
Exogenous insulin is required for life.
A patient is diagnosed with type 1 diabetes. What distinguishing characteristic is associated with type 1 diabetes? It always starts in childhood. Oral agents can control blood sugar. Exogenous insulin is required for life. Blood glucose levels can be controlled by diet.
Exogenous insulin is required for life.
Patients with type 2 diabetes have nonfunctioning beta pancreatic cells.
False
What would alert the nurse to suspect that a client is developing ketoacidosis?
Fruity breath odor
After teaching a group of students about sulfonylureas, the instructor determines that the teaching was successful when the students identify which agent as a second-generation sulfonylurea? (Select all that apply.) Pramlintide Repaglinide Glimepiride Glyburide Tolazamide
Glimepiride Glyburide
The nurse is interviewing a client who was diagnosed with type 2 diabetes about four months ago. The client never records glucometer readings but says that everything is just fine. What laboratory test does the nurse anticipate the health care provider will order for this client?
HbA1c
The nurse is interviewing a client who was diagnosed with type 2 diabetes about four months ago. The client never records glucometer readings but says that everything is just fine. What laboratory test does the nurse anticipate the health care provider will order for this client? Stat urine for glucose Fasting blood glucose in the AM HbA1c Insulin level
HbA1c
A nurse should monitor a client taking glimepiride (Amaryl) for which of adverse effects? (Select all that apply.)
Hypoglycemia Heartburn Nausea
When administering insulin, what would be most appropriate?
Insert the needle at a 45-degree angle for injection.
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?
Inspect the previous injection site for inflammation.
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? Do not administer insulin kept at room temperature. Keep prefilled syringes horizontally. Check for symptoms of myalgia or malaise. Inspect the previous injection site for inflammation.
Inspect the previous injection site for inflammation.
A nurse must recognize the duration of insulin so as not to cause harm to the client with administration of the improper type of insulin. Which insulins are rapid acting? (Select all that apply.)
Insulin aspart (NovoLog) Insuline glulisine (Apidra)
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? Insulin is needed because the beta cells of the pancreas are no longer functioning. The insulin is more effective in establishing control of blood glucose levels initially. The client most likely does not exercise enough to control his glucose levels. More insulin is needed than that which the client can produce naturally.
Insulin is needed because the beta cells of the pancreas are no longer functioning.
What is an example of rapid acting insulin?
Insulin lispro (Humalog)
What is an example of rapid acting insulin? Insulin Glargine (Lantus) Isophane insulin suspension (Humulin N) Insulin detemir (Levemir) Insulin lispro (Humalog)
Insulin lispro (Humalog)
A patient is prescribed pramlintide (Symlin). How will it assist in controlling the patient's blood sugar?
It slows gastric emptying.
The nurse admits a client who has been diagnosed with diabetic ketoacidosis, and will look for what assessment findings consistent with this diagnosis? (Select all that apply.) Blood glucose 191 mg/dL Flushed, dry skin Ketones in the urine Lack of thirst Rectal pressure
Ketones in the urine Flushed, dry skin
The nurse is preparing to administer insulin lispro (Humalog) to a client at 7 AM. What is the nurse's top priority intervention related to this medication?
Make sure the client's breakfast is available in the next 5-10 minutes.
Which would be least appropriate when administering insulin by subcutaneous injection?
Massaging the site after removing the needle
Which would be least appropriate when administering insulin by subcutaneous injection? Inserting the needle at a 45-degree angle Massaging the site after removing the needle Using a 25 gauge 1/2-inch needle Injecting the insulin slowly
Massaging the site after removing the needle
The nurse monitoring a client receiving insulin glulisine (Apidra) notices the client has become confused, diaphoretic, and nauseated. The nurse checks the client's blood glucose and it is 60 mg/dL. Which can a nurse give to treat a client with a hypoglycemic episode? (Select all that apply.)
Orange or other fruit juice Glucose tablets Hard candy
Insulin is produced by which organ in the human body? Liver Spleen Kidney Pancreas
Pancreas
A client is admitted to the intensive care unit with diabetic ketoacidosis. The nurse knows that the client will be placed on an intravenous insulin drip. The only type of insulin that can be administered intravenously is: NPH. Regular. Lente. Ultralente.
Regular
A patient is in diabetic ketoacidosis. The patient blood glucose level is over 600. The physician has ordered the patient to receive an initial dose of 25 units of insulin. What type of insulin will be administered intravenously?
Regular insulin
A patient is in diabetic ketoacidosis. The patient blood glucose level is over 600. The physician has ordered the patient to receive an initial dose of 25 units of insulin. What type of insulin will be administered intravenously? Regular insulin NPH insulin Lente insulin Ultralente insulin
Regular insulin
A nurse is preparing an in-service presentation for a group of staff members on diabetes. Which would the nurse include as the primary delivery system for insulin?
Subcutaneous injection
A nurse is preparing an in-service presentation for a group of staff members on diabetes. Which would the nurse include as the primary delivery system for insulin? External pump Insulin pen Jet injector Subcutaneous injection
Subcutaneous injection
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?
Subcutaneous injection
Amylin is a peptide hormone secreted with insulin by the beta cells of the pancreas and is important in the regulation of glucose control during the postprandial period. True or false?
True
Amylin is a peptide hormone secreted with insulin by the beta cells of the pancreas and is important in the regulation of glucose control during the postprandial period. True or false? T/F?
True
Nurse instructed Pt w/Rx pramlintide to take medication when? a. Give it by subcutaneous immediately before major meals. b. take the drug orally once a day, preferably in morning c. give yourself an injection 1hr before you eat breakfast and dinner d. take the drug orally with the first bite of meal each day
a. Give it by subcutaneous immediately before major meals.
Which agent would nurse expect to administer single oral dose in morning? a. Repaglinide b. Rosiglitazone c. Exenatide d. Miglitol
b. Rosiglitazone Exenatide would be injected 60min before meal Miglitol would be administered with 1st bite of food
Man comes to ER with blood glucose level @32 nurse should expect to administer? a. Insulin lispro b. glucagon c. diazoxide d. regular insulin
b. glucagon (to increase levels)
Teaching students about various insulin preparations, it is successful when students identify which insulin cannot be mixed with other types? a. Regular b. Lente c. Detemir d. Lispro
c. Detemir
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?
inspect the previous injection site for inflammation
A nurse is preparing to administer a rapid-acting insulin. Which medication would the nurse most likely administer?
insulin lispro
Rosiglitazone is being considered for the treatment of diabetes in an adult male client. Before the initiation of rosiglitazone therapy, the nurse should review what laboratory work recently drawn?
liver enzymes
After teaching a group of nursing students about antidiabetic drugs, the instructor determines that the teaching was successful when the students identify which as an example of a hormone mimetic? Select all that apply.
sitagliptin exenatide pramlintide
What is the expected action of sitagliptin on type 2 diabetes?
slows the rate of inactivation of the incretin hormones
Which would be appropriate to include in teaching a client with type 2 diabetes?
it is possible with weight loss and exercise to discontinue the use of antidiabetic medication
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?
"Insulin assists glucose molecules to enter the cells of muscle and fat tissues."
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? "Insulin is used to move carbohydrate particles from the gastrointestinal system to the liver." "Insulin is stimulated by the liver to break down proteins and provide the body with nutrients." "Insulin causes fat to be broken down to provide energy for the body." "Insulin assists glucose molecules to enter the cells of muscle and fat tissues."
"Insulin assists glucose molecules to enter the cells of muscle and fat tissues."
A 42-year-old male client is prescribed glargine insulin for management of his type 2 diabetes mellitus. The nurse caring for the client develops a teaching plan regarding glargine insulin therapy. Which statement made by the client indicates that the client needs additional teaching? "I should not administer the insulin if it is cloudy." "The insulin is given only once per day, at night." "I must give this insulin alone and not mix with other insulins." "The medication will peak in 3 hours."
"The medication will peak in 3 hours."
Insulin is available in several forms or suspensions differs in?
----b. Onset and duration of action
Long term alteration in fat, carbohydrates, and protein metabolism associated w/diabetes mellitus result in?
----b. thickening of capillary basement membrane
Pt on fixed income would benefit from a 2nd generation sulfonyurea to control blood sugar, drug of choice would be?
----d. Glimepiride
Miglitol differs from sulfoylures in that it?
---c. Delays the absorption of glucose, leading to lower glucose levels.
Treatment of diabetes may include?
---replacement therapy w/insulin, control glucose absorption through GI, Drug that stimulates insulin release or increase sensitivity of insulin receptor sites, Slows gastric emptying, Diet & exercise program
The nurse is educating a client who will be adding an injection of pramlintide to his insulin regimen. What information is most important for the nurse to share with this client to ensure safe medication administration? Do not give pramlintide in the same site where insulin is administered. Pramlintide should only be injected in the hip. Inject pramlintide in the same site where insulin is administered. Mix pramlintide in the same syringe with insulin.
Do not give pramlintide in the same site where insulin is administered.
Which is an example of long acting insulin?
Insulin glargine (Lantus)
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?
Insulin is needed because the beta cells of the pancreas are no longer functioning.
Which would be appropriate to include in teaching a client with type 2 diabetes?
It is possible with weight loss and exercise to discontinue the use of antidiabetic medication.
Which would be appropriate to include in teaching a client with type 2 diabetes? It is possible with weight loss and exercise to discontinue the use of antidiabetic medication. Clients with type 2 diabetes always progress to insulin injections if they do not follow dietary guidelines. Until you need to start insulin injections, you do not have to check your blood sugar. If you drink alcohol, it may be necessary to increase your oral antidiabetic medication.
It is possible with weight loss and exercise to discontinue the use of antidiabetic medication.
The nurse is preparing to administer insulin lispro (Humalog) to a client at 7 AM. What is the nurse's top priority intervention related to this medication? Make sure the client's breakfast is available in the next 5-10 minutes. Monitor the client for a hypoglycemic reaction at noon. Cleanse the administration site with soap and water before administration. Have the client lie quietly for 45 minutes.
Make sure the client's breakfast is available in the next 5-10 minutes.
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?
Metformin
The school nurse identifies more children with type 2 diabetes each year and recognizes that this trend is mainly attributed to what issue?
Obesity and inadequate exercise
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?
Observe the patient for hypoglycemic episodes.
Glycosylated hemoglobin measures average blood glucose over what time period?
The past 3 or 4 months
Glycosylated hemoglobin measures average blood glucose over what time period? The past 12 to 24 hours The past 1 or 2 months The past 7 to 10 days The past 3 or 4 months
The past 3 or 4 months... From the book.. "a blood glucose marker that provides a 3-month average of blood glucose levels." AKA.. HgA1C
Glycosylated hemoglobin levels provide reliable evidence of blood glucose control.
True
Glycosylated hemoglobin levels provide reliable evidence of blood glucose control. T/F?
True
Regular insulin may be administered intravenously or intramuscularly in an emergency situation.
True
Regular insulin may be administered intravenously or intramuscularly in an emergency situation. T/F?
True
Patients with type 2 diabetes have nonfunctioning beta pancreatic cells. T/F? How about type 1??
Type 2: False, has functioning beta cells, there is just an insulin resistance. Type 1: True
Which of the following would nurse identify as example of sulfonyurea? a. Glyburide b. Metformin c. Acarbose d. Miglitol
a. Glyburide Metformin is in the Biguanide class
Pt recieves regular insulin 8am what time would you see signs of hypoglycemia ? a. between 10am -12 b. between 8:30-9:30 c. between 2:00-4:00 d. between 12:00-8:00
a. between 10am -12 (peaks) 2-4hrs
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?
abdomen
Which strategy will NOT increase the therapeutic effect of insulin?
all insulin should be stored in a refrigerator but never frozen
Which factor would prohibit the administration of glipizide?
allergy to sulfonamides
Pt taking metformin to treat diabetes. Nurse would warn pt s/s hypolycemia within which time frame? a. 1hr b. 2hr c. 3hr d. 4hr
b. 2Hrs (peaks2-21/2 hrs)
Pt receiving glipizide as treatment for type 2 diabetes, nurse understand this drug acts? a. binding to potassium channels on pancreatic beta cells b. inhibiting alpha-glucosidase to delay glucose absorption c. increasing the uptake of glucose d. decreasing insulin resistance
b. inhibiting alpha-glucosidase to delay glucose absorption
When describing the effects of Incretins on blood glucose control to group of students, which would instructor include? a. increased glucagan release b. increases GI emptying c. increases insulin release d. increases protein building
c. increases insulin release Also slows GI emptying, decreased glucagon release, stimulates satiety center
The nurse is aware that premixed insulins (those that contain both regular and NPH insulin) are least effective in what type of client?
client who has difficulty controlling his diabetes
What distinguishing characteristic is associated with type 1 diabetes?
exogenous insulin is required for life
Heavy intake of which herb should be avoided by a client who is prescribed an antidiabetic medication?
garlic
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?
insulin gargline
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?
insulin is needed because the beta cells of the pancreas are no longer functioning
The nurse is preparing to administer insulin lispro (Humalog) to a client at 7 AM. What is the nurse's priority intervention related to this medication?
make sure the client's breakfast is available in the next 5-10 minutes
Which would be least appropriate when administering insulin by subcutaneous injection?
massaging the site after removing the needle
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?
metformin
A nurse should monitor a client taking glimepiride (Amaryl) for which of adverse effects? (Select all that apply.)
nausea heartburn hypoglycocemia
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?
observe the patient for hypoglycemic episodes
A female client is diagnosed with type 1 diabetes. She suddenly reports feeling weak, shaky, and dizzy. What should the nurse's first response be?
perform a blood sugar analysis
Regular insulin may be administered intravenously or intramuscularly in an emergency situation.
true
Pt newly dx with type 1 diabetes asks why she can't just take a pill. Nurse responds? 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. more insulin is needed than that which the patient can produce naturally. d. the patient most likely does not exercise enough to control his glucose levels
a. Insulin is needed because the beta cells of the pancreas are no longer functioning.
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?
client's average blood glucose is above normal.
Which would alert the nurse the pt is suspected development of ketoacidosis? a. fluid retention b. blurred vision c. hunger d. fruity breath
d. fruity breath
Which would be least appropriate when administering insulin by subcutaneous injections? a. using a 25 huge 1/2in needle b. inserting the needle at 45-degree angle c. injecting the insulin slowly d. massaging the site afterwards
d. massaging the site afterwards
Primary way to deliver insulin is?
d. subcutaneous injection even though there are others.
The nurse is educating a client who will be adding an injection of pramlintide to his insulin regimen. What information is most important for the nurse to share with this client to ensure safe medication administration?
do NOT give pramlintide in the same site where insulin is administered
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?
entry of glucose into the cells
Which medication would a nurse identify as a noninsulin injectable antidiabetic drug?
exenatide
A nurse is preparing an in-service presentation for a group of staff members on diabetes. Which would the nurse include as the primary delivery system for insulin?
subcutaneous injection
Amylin is a peptide hormone secreted with insulin by the beta cells of the pancreas and is important in the regulation of glucose control during the postprandial period. True or false?
true
The nurse is caring for a client taking insulin. The nurse realizes the client is experiencing symptoms of hypoglycemia when the client displays: decreased respiratory rate and hot, dry skin. increased pulse rate and fruity smelling breath. weakness, sweating, and decreased mentation. increased thirst and increased urine output.
weakness, sweating, and decreased mentation.