Pharm chapter 42

Patients with type 2 diabetes have nonfunctioning beta pancreatic cells.

False

A patient is undergoing metformin therapy at a health care facility. The patient is also prescribed glucocorticoids. What effect of interaction of these two drugs should the nurse assess for in the patient?

Increased risk of lactic acidosis

A male patient is to begin glyburide (Diabeta) for type 2 diabetes. Before the drug therapy begins, a priority action by the nurse will be to assess the patient's

use of alcohol

Which strategy will NOT increase the therapeutic effect of insulin?

All insulin should be stored in a refrigerator but never frozen.

Which is a non-insulin injectable antidiabetic drug?

Exenatide (Byetta)

A student asks the nursing instructor what insulin has the quickest therapeutic effect once administered. What would be the best response?

Regular (Humulin R)

Glycosylated hemoglobin levels provide reliable evidence of blood glucose control.

True

A nurse is providing patient education to a 13-year-old girl who was just diagnosed with type 1 diabetes mellitus. Which statement by the patient will alert the nurse that special instructions regarding insulin are necessary?

"I am on the middle school track team."

The nurse is reinforcing teaching about acarbose (Precose) to a client with newly diagnosed type 2 diabetes. Which statement by the client indicates a need for further understanding?

"I must take this medication one hour before I eat."

A young man has been diagnosed with type 2 diabetes and has been prescribed glyburide. Which of the following statements suggests that the nurse should perform further health education?

"I'll plan to take my glyburide each night before I go to bed."

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?

"If I forget to take my insulin pen, I will be able to use the one that my wife uses."

The client is scheduled to get her breakfast tray at 0700. At what time should she receive her prescribed dose of NPH insulin?

0630 (6:30 am)

The nurse assesses a patient's blood glucose level after administering insulin. Which result would the nurse interpret as indicative of severe hypoglycemia?

34 mg/dL

A diabetic patient has been admitted to the ICU with diabetic ketoacidosis (DKA). What is the first step in the treatment of this patient?

Administration of IV fluids

Insulin analogs are synthesized in the laboratory by altering the type or sequence of amino acids in insulin molecules. Which of the following insulin analogs is a short-acting product?

All the above Explanation: Insulin lispro (Humalog), insulin aspart (NovoLog), and insulin glulisine (Apidra) are all short-acting (or "rapid-acting") products. They have a rapid onset and a short duration of action.

A patient is to be administered glipizide (Glucotrol). Which factor would prohibit the administration of glipizide (Glucotrol) to this patient?

Allergy to sulfonamides

A nurse is caring for a patient receiving metformin drug therapy to improve glycemic control. What adverse reaction to the drug should the nurse monitor the patient for?

Asthenia

The nurse is providing discharge instructions to a client who has just been diagnosed with type 1 diabetes. What instructions are most important for the client to follow related to diet? (Select all that apply.)

Avoid drinking beer, wine, or liquor. Use artificial sweeteners instead of sugar in tea and coffee. Read food labels carefully to look for hidden sources of sugar.

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 nurse is caring for a 48-year-old woman who has been hospitalized after injecting the wrong type of insulin. Which sign of hypoglycemia will the nurse be careful to observe for?

Blurred vision

The nurse is preparing to administer a mixture of 12 units regular insulin and 45 units NPH insulin to a client with a blood sugar of 378 mg/dL. After the nurse draws the medication into the syringe, what is the nurse's next action?

Check the dosage with another nurse.

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

The nurse is caring for a client who takes miglitol (Glyset) for type 2 diabetes. The client reports feeling slightly confused and the stat glucometer reading is 56 mg/dL. What should the nurse provide for this client to increase the blood glucose?

Commercial glucose tablets

The nurse teaches the male client with type 1 diabetes that insulin needs vary depending upon certain conditions. The client requires additional teaching when he learns that his insulin needs may increase because of what condition? (Select all that apply.)

Decreased food intake Exercise

A patient with type 1 diabetes has been admitted to the hospital for orthopedic surgery and the care team anticipates some disruptions to the patient's blood glucose levels in the days following surgery. Which of the following insulin regimens is most likely to achieve adequate glycemic control?

Doses of basal insulin twice daily with regular insulin before each meal

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

Ms. Newton, a newly diagnosed diabetic, is prescribed glyburide. As the nurse providing instruction, you identify which occurrence as a classic symptom of hyperglycemia?

Excessive urination

Which insulin would the nurse need to administer as a separate injection if the order also included NPH insulin?

Glargine

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.)

Glimepiride Glyburide

A patient is brought to the Emergency Department (ED) with severe hypoglycemia. What drug would the nurse prepare to administer intravenously?

Glucagon (GlucaGen)

A nurse should advise patient, especially elderly patients, to eat within 30 minutes of the administration of which of the following antidiabetic drugs to prevent hypoglycemia?

Glyburide

A diabetic patient is taking regular and NPH insulin to manage his diabetes. What is the best evaluation tool to measure the overall patient response to the insulin therapy?

Glycosylated hemoglobin (HbAlc) levels

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

Which of the following insulin is always clear? (Choose one)

Humulin R

The physician has ordered a change of prescription from rapid-acting insulin to an intermediate-acting type. Which adverse effect must the nurse closely monitor for in the patient?

Hypoglycemia

A patient is receiving acarbose. What would the nurse incorporate into the teaching plan for this patient about the action of the drug?

Inhibits an enzyme to delay glucose absorption

Which is an example of long acting insulin?

Insulin glargine (Lantus)

What is an example of rapid acting insulin?

Insulin lispro (Humalog)

A patient has been prescribed acarbose (Precose). What is the advantage of acarbose?

It delays the digestion of complex carbohydrates.

A nurse is presenting an educational event at a local senior citizens' club about diabetes. What would the nurse tell the attendees at the event about diabetes?

It is a complicated disorder that alters the metabolism of glucose.

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 admits a client with type 2 diabetes who takes metformin (Glucophage), and indicates that the client has a nursing diagnosis of ineffective breathing pattern. What complication of the client's current drug therapy does the nurse believe the client is experiencing?

Lactic acidosis

Which of the following represent the American Diabetes Association recommended HbA1c goal?

Less than 7%

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

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 nurse walks into the room of a client with type 1 diabetes and finds the client pale and diaphoretic. The client reports a headache and being hungry. Immediately, the client is unable to talk. What is the nurse's immediate intervention for this client?

Place glucose gel between the gums and cheek.

The physician prescribes glyburide for Tim, a newly diagnosed type 2 diabetic. The nurse knows that this medication acts by which mechanism?

Produces hypoglycemia by increasing insulin secretion from the pancreas

The nurse is assisting a client in learning insulin self-injection technique. Which way is most helpful for the client to understand how to rotate injection sites?

Provide the client with a manufacturer's template for site rotation.

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:

Regular

A patient is admitted to the Emergency Department in diabetic ketoacidosis (DKA) with a blood glucose level of 33 mmol/L. The physician orders an initial dose of 25 U insulin IV. Which type of insulin will be administered?

Regular insulin

A patient is admitted to the emergency department in diabetic ketoacidosis (DKA). The physician orders an initial dose of 25 units insulin IV. Which type of insulin will be administered?

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

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

A nurse is working with a newly diagnosed diabetic patient on understanding hypoglycemia and insulin reactions. Which action would be most important for the patient to understand when planning the response to an insulin reaction?

Take an oral dose of some form of glucose as soon as possible.

A client calls the clinic and tells the nurse that his new medication, glyburide (a sulfonylurea), is causing a lot of nausea. What does the nurse expect the health care provider to order for this client?

Take half the dose twice a day.

James, age 35, begins the administration of glyburide for treatment of diabetes mellitus type 2. As the nurse caring for John, you instruct him about the medication. Which statement would NOT be appropriate advice for James?

The medication can be taken at dinner time.

Glycosylated hemoglobin measures average blood glucose over what time period?

The past 3 or 4 months

A 4-year-old child with type 1 diabetes mellitus becomes angry and then lethargic. The parent should be taught that a change in behavior may indicate hypoglycemia. True or false?

True

In what condition is human insulin not recommended for diabetic patients?

Type 2 diabetes controlled by diet

The nurse instructs a client who has been prescribed extended-release metformin (Glucophage XR) to take the medication at what time?

With evening meal

A home care nurse is caring for several clients with diabetes. The nurse's role in caring for these clients includes:

all the above tasks.

You are the nurse educator at the diabetes clinic. When talking to a class of adolescent diabetics, you tell them that the main methods of self-monitoring glycemic control are testing of

blood glucose and urine ketone levels.

The pathophysiology class is studying diabetes. A student asks the instructor what is considered a sign of a hypoglycemic reaction. The instructor's response would be:

diaphoresis.

Pramlintide is administered orally.

false subcutanious

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.

Insulin is a hormone released by the pancreatic beta cells in response to a rise in glucose levels and what else?

incretins

The brother of a client who uses insulin for management of type 1 diabetes will be prefilling the client's insulin syringes. The nurse knows that these prefilled syringes may be kept in the refrigerator for how long?

one week

A nurse at a health care facility is caring for a patient who has been prescribed insulin for the first time. Which preadministration assessment should be performed by the nurse before the first dose of insulin is given?

General assessment of the skin

The nurse is caring for a client who is on insulin therapy. The client may need to increase the insulin dose if he is also required to take which drug? Select all that apply.

Morphine sulfate Furosemide Nicotine (via cigarettes

As the first line treatment, a patient with type 2 diabetes has diet and exercise. When these fail, what may be added as monotherapy or in combination with metformin to control their disease process?

Thiazolidinediones

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."

During a teaching session on the care of the diabetic patient, a family member asks why her daughter has a different insulin than her best friend. The nurse should make which statement to explain the differences in insulin?

"Insulins have different onsets and durations of action."

What instructions would be important to give to a 50-year-old client with type 2 diabetes who has been switched from glyburide (DiaBeta), a sulfonylurea, to repaglinide, a meglitinide?

"It stimulates insulin production, so you need to eat soon after taking the medication."

A 59-year-old man with type 2 diabetes is prescribed metformin. When the patient returns to the clinic, he reports that he has lost 8 pounds in a month. How should the nurse respond?

"Please continue taking the medication and monitoring your weight. This is an expected outcome of this drug therapy."

A patient with a recent diagnosis of type 2 diabetes has begun taking metformin. This drug will help the patient achieve adequate blood sugar control through which of the following mechanisms? (Select all that apply)

Decreasing glucose production by the liver Improving insulin sensitivity Decreasing glucose absorption in the GI tract

The nurse's assessment of a patient who has presented to the emergency department reveals hyperglycemia. Which type of insulin will have the most rapid effect on the patient's blood sugar levels?

Aspart

A diabetic patient has just received an insulin pump. What would be important to include in patient teaching?

Check blood glucose frequently.

The nurse is administering an antidiabetic agent by subcutaneous injection within 60 minutes of the patient's breakfast. Which agent would the nurse most likely be administering?

Exenatide

The two major classifications of diabetes are type 1 and type 2. What is a distinguishing characteristic of type 1 diabetes?

Exogenous insulin is required for life.

When learning about type 1 diabetes, what would the student nurses learn is a distinguishing characteristic of this disease?

Exogenous insulin is required for life.

An athlete eats a high-protein meal. The breakdown of protein by insulin will yield an increased production of glycerol. True or false?

False

The average adult pancreas secretes less than 30 units of insulin daily. True or false?

False

Which is the best indicator of overall diabetic control?

Glycosylated hemoglobin levels

During insulin teaching, when should the nurse advise the patient to administer insulin aspart (Apidra)? (Choose one)

Immediately before a meal

As a diabetic educator, the nurse is teaching a newly diagnosed diabetic about aspects of the disease process. What would the nurse tell the patient about the body's control of glucose?

It is related to fat and protein metabolism

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.)

Ketones in the urine Flushed, dry skin

The nurse is caring for a client, age 77 years, who has type 2 diabetes and chronic kidney disease. Which drugs will be used with great caution in this client? (Select all that apply.)

Metformin (Glucophage) Exenatide (Byetta) Miglitol (Glyset)

Your client is scheduled to undergo diagnostic testing with the administration of parenteral radiographic contrast media containing iodine. Since your client is taking metformin, you know that

Metformin should be discontinued at least 48 hours before and after diagnostic tests.

A patient is prescribed sitagliptin. The nurse would expect to administer this drug by which route?

Oral

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.

What main difference between alpha-glucosidase inhibitors, such as acarbose and miglitol, and insulin or metformin therapy would the nurse include during patient education?

They inhibit the absorption of regular cane sugar.

The nurse is caring for a client taking insulin. The nurse realizes the client is experiencing symptoms of hypoglycemia when the client displays:

weakness, sweating, and decreased mentation