pharm prepu 41 diabetes mellitus

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." Explanation: 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.

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

"I'll plan to take my glyburide each night before I go to bed." Explanation: Glyburide is normally taken in the morning, before breakfast. No drug cures diabetes; the goal of therapy is the maintenance of safe blood glucose levels. The client should check before taking other drugs and should indeed be aware of the risk of hypoglycemia.

A client with type 1 diabetes has been prescribed 12 units of regular insulin and 34 units of NPH insulin in the morning. How should the nurse explain why two different types of insulin are required to control the client's blood glucose?

"The different onsets and peaks of the two types provide better overall glucose control." Explanation: Regular insulin will begin working within 30 to 60 minutes and peak within 2 to 4 hours and a 6- to 12-hour duration of action, whereas NPH insulin has an onset of 60 to 90 minutes and peaks in 4 to 12 hours, with a 24-hour duration of action. By giving both drugs at once, the client gets rapid blood glucose control within 30 minutes from the regular insulin, and the control lasts 24 hours due to NPH's long duration of action. NPH has no effect on the breakdown of regular insulin, and there is not necessarily a reduced risk of adverse effects. NPH does not stimulate the pancreas toward increased insulin production.

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?

06:45 Explanation: With short-acting insulins like lispro, aspart, or glulisine, it is important to inject the medication about 15 minutes before eating.

The nurse is discussing diabetes mellitus with a group of people who are involved in a weight loss program. The nurse relates to the group that the parameters for a diagnosis of diabetes are a fasting plasma glucose test (FPG) greater than or equal to what level on two separate occasions?

126 mg/dL Explanation: A FPG result (126 mg/dL) on two separate occasions is diagnostic of diabetes, values of 100 to 125 mg/dL are termed impaired fasting glucose, and values less than 100 mg/dL are considered normal.

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 Explanation: Studies indicate that insulin is absorbed fastest from the abdomen, followed by the deltoid, thigh, and hip.

A nurse is teaching a client about acarbose. The nurse determines the teaching is successful when the client correctly states which instruction to follow when administering the drug at home?

Administer the drug with the first bite of the meal. Explanation: Acarbose should administer with the first bite of the meal. Glyburide needs to administer with breakfast. An oral sulfonylurea will likely be added to metformin if the client does not experience a response in 4 weeks using the maximum dose of metformin. Clients taking metformin may experience unusual somnolence, of which the nurse should inform the primary health care provider.

Which strategy will NOT increase the therapeutic effect of insulin?

All insulin should be stored in a refrigerator but never frozen. Explanation: Store opened vials of regular insulin at room temperature. Extra supplies are stored in the refrigerator, not the freezer. Extreme temperatures (<2°C or >30°C) should be avoided to prevent the loss of maximum function. Administer regular insulin with an insulin syringe into an appropriate subcutaneous site. Regular insulin is administered about 30 to 60 minutes before eating. To promote regular absorption, one anatomic area should be selected for regular insulin injections (e.g., the abdomen). Frequent monitoring of blood glucose by fingersticks and periodic determinations of hemoglobin A1C levels help determine the therapeutic effect of insulin and overall consistency of diabetic control.

The nurse is assessing a client who was administered metformin and notes hyperventilation, nausea, and somnolence. The nurse determines which nursing diagnosis should be prioritized for this client?

Altered Breathing Pattern Explanation: When taking metformin, the client is at risk for lactic acidosis manifested by unexplained hyperventilation, myalgia, malaise, GI symptoms, or unusual somnolence. Thus, a nursing diagnosis of Altered Breathing Pattern would be most likely. There are no problems with fluid balance. Acute Confusion would be appropriate if the client was experiencing hypoglycemia. Anxiety would be appropriate for a client who is newly diagnosed with diabetes and having difficulty accepting the diagnosis.

A nurse is preparing to administer insulin glargine to a client. What precaution should the nurse take when administering this drug?

Avoid mixing glargine with other insulins. Explanation: When administering insulin glargine to the client, the nurse should avoid mixing it with other insulins or solutions. It will precipitate in the syringe when mixed. If glargine is mixed with another solution, it will lose glucose control, resulting in decreased effectiveness of the insulin. Glargine is administered via the subcutaneous route once daily at bedtime. The nurse should not shake the vial vigorously before withdrawing insulin. The vial should be gently rotated between the palms of the hands and tilted gently end to end immediately before withdrawing the insulin. The nurse administers insulin from vials at room temperature. Vials are stored in the refrigerator if they are to be stored for about 3 months for later use.

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. Explanation: After preparing the syringe with insulin, the nurse should then have the medication and dosage checked by a second nurse to make sure that it is correct. It is not necessary to recheck the client's blood sugar again. It is important to know when the client will be eating again; make sure that it is within the next 30 minutes. However, this is not the nurse's next step. Then the nurse will administer the insulin to the client.

The nurse is preparing to administer insulin glargine to a client. Which actions will the nurse perform when preparing the insulin? Select all that apply. Check the expiration date on the vial. Shake the vial vigorously. Check the health care provider's orders for the type and dosage of insulin. Remove all air bubbles from the syringe barrel. Mix with short-acting insulin prior to administration.

Check the expiration date on the vial. Check the health care provider's orders for the type and dosage of insulin. Remove all air bubbles from the syringe barrel. Explanation: Prior to administering insulin glargine to a client, the nurse must complete the following preadministration steps: carefully check the health care provider's order for the type and dosage of insulin, check the expiration date on the vial, gently rotate the vial between the palms of the hands, gently tilt end to end before withdrawing the insulin, and remove all air bubbles from the syringe barrel. The nurse should never mix or dilute insulin glargine with any other insulin or solution because the insulin will not be effective.

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. Explanation: The American Diabetes Association (ADA) suggests a target A1C of less than 7%. A1C should be measured every 3 to 6 months. An A1C of 9 indicates that the client's average blood glucose is consistently above normal.

A nurse is preparing to administer exenatide to a client with type 2 diabetes. The nurse will question this order if which condition is noted in the client's medical record?

Diabetic ketoacidosis Explanation: GLP-1 agonists are contraindicated in clients with diabetic ketoacidosis and type 1 diabetes. Thiazolidinediones are contraindicated in clients with severe heart failure and used with caution in clients with kidney disease, severe heart failure, and liver disease.

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. Explanation: Clients who take pramlintide should not be injected into the same site where insulin is administered.

A nurse has determined a client has developed a hypoglycemic reaction. Which interventions should the nurse perform if the client can adequately demonstrate swallowing and gag reflexes?

Give oral fluids or candy. Explanation: The nurse should administer oral fluids or candy to the hypoglycemic client with swallowing and gag reflexes. If the client is unconscious, the nurse should administer glucose or glucagon parenterally. The nurse should administer insulin through an insulin pump for diabetic clients who are pregnant or have had a renal transplant. Oral antidiabetic drugs are administered to clients with type 2 diabetes.

A man is brought to the emergency department. He is nonresponsive, and his blood glucose level is 32 mg/dL. Which would the nurse expect to be ordered?

Glucagon Explanation: The client is significantly hypoglycemic and needs emergency treatment. Glucagon would be the agent of choice to raise the client's glucose level because it can be given intravenously and has an onset of approximately 1 minute. Diazoxide can be used to elevate blood glucose levels, but it must be given orally. Lispro and regular insulin would be used to treat hyperglycemia.

Which would a nurse identify as an example of a sulfonylurea?

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

After administering insulin detemir to a client with diabetes, the nurse suspects that the client is developing hypoglycemia based on which assessment findings? Select all that apply. Increased thirst Increased urination Headache Confusion Diaphoresis

Headache Confusion Diaphoresis Explanation: The symptoms of hypoglycemia include fatigue, weakness, nervousness, agitation, confusion, headache, diplopia, convulsions, dizziness, unconsciousness, hunger, nausea, diaphoresis, and numbness or tingling of the lips or tongue. Increased thirst and urination suggest hyperglycemia.

When describing the effects of incretins on blood glucose control to a group of students, which would an instructor include?

Increases insulin release Explanation: Incretins increase insulin release, decrease glucagon release, slow GI emptying, and stimulate the satiety center. Growth hormone increases protein building.

A nurse is preparing to administer insulin to the client. Which interventions should the nurse perform before administering each insulin dose?

Inspect the previous injection site for inflammation. Explanation: The nurse should check the previous injection site before administering each insulin dose. The injection sites should be rotated to prevent lipodystrophy. Prefilled syringes should not be kept horizontally; they should be kept in a vertical or oblique position to avoid plugging the needle. The nurse checks for symptoms of myalgia or malaise when administration of metformin leads to lactic acidosis. Insulin should not be mixed with other drugs in the syringe. Some types of insulin may be combined in one syringe, but sterile water is never used.

After teaching an in-service presentation to a group of nurses about diabetes and insulin, the presenter determines that the session was successful when the group correctly chooses which insulins as rapid-acting? Select all that apply.

Insulin aspart Insulin glulisine Explanation: Insulin aspart and insulin glulisine are rapid-acting insulins. Isophane insulin suspension is an intermediate-acting insulin. Insulin glargine and detemir are long-acting insulins.

The nurse admitted a 4-year-old child with type 1 diabetes mellitus. The nurse educates the parents that hypoglycemia can occur as an adverse effect of insulin. The nurse helps the parents to understand that in young children, hypoglycemia may manifest as what signs or symptoms Irritability Anorexia Impaired mental functioning Hallucinations Lethargy

Irritability Impaired mental functioning Lethargy Explanation: In young children, hypoglycemia may be manifested by changes in behavior, including severe hunger, irritability, and lethargy. In addition, mental functioning may be impaired in all age groups, even with mild hypoglycemia. Anytime hypoglycemia is suspected, blood glucose should be tested.

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 decreases intestinal absorption of glucose and improves insulin sensitivity. Explanation: 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.

Which would be least appropriate when administering insulin by subcutaneous injection?

Massaging the site after removing the needle Explanation: Gentle pressure should be applied to the injection after the needle is withdrawn. Massaging could contribute to erratic or unpredictable absorption.

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 Explanation: Metformin is classified as a biguanide. Miglitol is an alpha-glucosidase inhibitor. Tolbutamide is a first generation sulfonylurea. Glipizide is a second generation sulfonylurea.

A client who has been prescribed metformin is scheduled to undergo diagnostic testing with the administration of parenteral radiographic contrast media containing iodine. What fact should direct the nurse's plan of care for this client?

Metformin should be discontinued at least 48 hours before and after diagnostic tests that use contrast medias. Explanation: Metformin should be discontinued at least 48 hours before diagnostic tests are performed with contrast media and should not be resumed for at least 48 hours after the tests are done and tests indicate renal function is normal. None of the other options are required.

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

Oral Explanation: Sitagliptin is administered orally.

The nurse monitoring a client receiving insulin glulisine notices the client has become confused, diaphoretic, and nauseated; and has a blood glucose of 60 mg/dL. Which emergent treatment would the nurse most likely give? Select all that apply. Orange or other fruit juice Glucose tablets Insulin glargine Hard candy Insulin detemir

Orange or other fruit juice Glucose tablets Hard candy Explanation: Methods of terminating a hypoglycemic reaction include the administration of one or more of the following: orange or other fruit juice, hard candy or honey, glucose tablets, glucagon, or glucose 10% or 50% IV.

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

Regular (Humulin R) Explanation: Regular insulin has the quickest onset of 30-60 minutes. PZI and ultralente have an onset of 4-8 hours. NPH has an onset of 60-90 minutes.

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 Explanation: Although other delivery systems are available for insulin administration such as the jet injector, insulin pen, and external pump, subcutaneous injection remains the primary delivery system.

A 35-year-old client has begun the administration of glyburide for treatment of diabetes mellitus type 2. The nurse caring for this client provides education regarding this medication. Which statement would NOT be an appropriate instruction for this client?

The medication should have a fixed dose which cannot be manipulated. Explanation: Manipulating the dosing of glyburide can often reduce the unpleasant reactions. The primary adverse effect associated with glyburide (and the other sulfonylureas) is hypoglycemia. Concomitant alcohol use increases the rate of glyburide metabolism and may cause a disulfiram-like reaction. Administer glyburide before breakfast or the first main meal of the day in order to stimulate insulin production. It is important to caution clients to avoid taking OTC medications and herbal or dietary supplements without first consulting the prescriber.

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

Thiazolidinediones Explanation: Thiazolidinediones (TZDs) may be used as monotherapy with diet and exercise or in combination with metformin a sulfonylurea, or an incretin agent (sitagliptin). Repaglinide, a sitagliptin, or an incretin agent are incorrect answers for this question.

A 2-month-old male child is diagnosed with diabetes. His parents are having difficulty measuring 2 units of insulin in the U-100 syringe. What would the nurse expect the health care provider to order?

U-10 (10 units/mL) insulin Explanation: Administration of insulin for infants and toddlers who weigh less than 10 kg or require less than 5 units of insulin per day can be difficult because small doses are hard to measure in a U-100 syringe. Use of diluted insulin allows more accurate administration. The most common dilution strength is U-10 (10 units/mL), and a diluent is available from insulin manufacturers for this purpose.

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

asthenia Explanation: The nurse should monitor the client for asthenia, abnormal physical weakness or lack of energy, which is an adverse reaction to metformin. UTI, back pain, and flu symptoms are adverse reactions to nateglinide.

The stress response triggered by illness will result in the increase secretion of what hormone? Select all that apply. cortisol glucagon growth thyroxine epinephrine

cortisol glucagon growth epinephrine Explanation: Illness may affect diabetes control by triggering a stress response, resulting in increased secretion of glucagon, catecholamines, epinephrine, growth hormone, and cortisol and the presence of ketosis. Thyroxine, a thyroid hormone, is not affected.

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:

hyperglycemia. Explanation: 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).

Which are risk factors for type-2 diabetes that a nurse should recognize in a client? Select all that apply: younger age impaired glucose tolerance Caucasian race obesity history of gestational diabetes

impaired glucose tolerance obesity history of gestational diabetes Explanation: A nurse should be able to identify all the risk factors for type-2 diabetes in a client. These include: obesity, older age, family history of diabetes, history of gestational diabetes, impaired glucose tolerance, minimal or no physical activity, and race/ethnicity (Black Americans, Hispanic/Latino Americans, Native Americans, and some Asian Americans).

The health care provider prescribes glyburide for a client who is a newly diagnosed type 2 diabetic. The nurse knows that this medication produces hypoglycemia by:

increasing insulin secretion from the pancreas. Explanation: The hypoglycemic action of glyburide results from the stimulation of pancreatic beta cells, leading to increased insulin secretion.

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 glargine Explanation: Insulin glargine is an example of a long-acting insulin. Insulin lispro and insulin aspart are rapid-acting insulin. Isophane insulin suspension is an intermediate-acting insulin.

Rosiglitazone is being considered for the treatment of diabetes in an adult client. Before the initiation of rosiglitazone therapy, the nurse should review what laboratory work recently drawn?

liver enzymes Explanation: Rosiglitazone has been associated with hepatotoxicity and requires monitoring of liver enzymes. Liver function tests (e.g., serum aminotransferase enzymes) should be checked before starting therapy and every 2 months for 1 year, then periodically. Platelets, d-dimer, and tests of renal function are less significant to the safety and efficacy of treatment.

When considering the management of diabetic ketoacidosis (DKA), what type of insulin can be administered intravenously?

regular Explanation: Regular insulin (insulin injection) has a rapid onset of action and can be given intravenously. Therefore, it is the insulin of choice during acute situations, such as DKA, severe infection or other illness, and surgical procedures. All the other options are administered subcutaneously.

A nurse is preparing to administer an insulin that is clear. Which insulin would the nurse likely administer?

short-acting insulin Explanation: Short-acting or regular insulin and rapid-acting insulin such as lispro, aspart, and glulisine are clear, whereas intermediate-acting (Humulin N and Humulin L) and long-acting (Humulin U) insulins are cloudy. There is no insulin classified as ultra-short insulin.

The nurse is caring for a client who is taking insulin. The nurse suspects the client is experiencing hypoglycemia when the client displays what signs?

weakness, sweating, and decreased mentation. Explanation: Symptoms of hypoglycemia include shakiness, dizziness or light-headedness, sweating, nervousness or irritability, sudden changes in behavior or mood, weakness, pale skin, and hunger. The other signs are more consistent with hyperglycemia.

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. Explanation: Insulin is needed in type 1 diabetes because the beta cells of the pancreas are no longer functioning. With type 2 diabetes, insulin is produced, but perhaps not enough to maintain glucose control or the insulin receptors are not sensitive enough to insulin.

A nurse is caring for a patient diagnosed with type 2 diabetes. What should the nurse inform the patient are risk factors associated with type 2 diabetes?

Obesity Explanation: The nurse informs the patient that obesity is a risk factor associated with type 2 diabetes. Young age and regular exercise are not risk factors for type 2 diabetes. Polyuria is a symptom of diabetes and not a risk factor leading to type 2 diabetes.

A client diagnosed with diabetic ketoacidosis has been admitted to the intensive care unit. The client is prescribed an intravenous insulin drip, so the nurse knows that what type of insulin will be administered?

Regular. Explanation: Regular insulin (insulin injection) has a rapid onset of action and can be given intravenously. Therefore, it is the insulin of choice during acute situations, such as DKA, severe infection or other illness, and surgical procedures. All the other options are administered subcutaneously.

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?

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

The nurse is caring for a postoperative client whose diabetes has been well controlled on acarbose. The client is not allowed to take anything orally following complications of abdominal surgery and is receiving high-glucose total parenteral nutrition via a central IV line. What medication can the nurse administer intravenously to control the client's blood glucose level?

regular insulin Explanation: Only regular insulin can be administered IV. No other insulins or oral antidiabetic medications can be given IV.

After teaching a group of nursing students about antidiabetic drugs, the instructor determines that the teaching was successful when the students correctly choose which drugs as producing the glucose-lowering effects by delaying the digestion and absorption of carbohydrates in the intestine? Select all that apply.

Miglitol Acarbose Explanation: The alpha-glucosidase inhibitors, acarbose and miglitol, produce their glucose-lowering effects by delaying the digestion and absorption of carbohydrates in the intestine. Glimepiride is a sulfonylurea. Metformin sensitizes the liver to circulating insulin levels and reduces hepatic glucose production. Pioglitazone decreases insulin resistance and increases insulin sensitivity by modifying several processes, resulting in decreased hepatic glucogenesis (formation of glucose from glycogen) and increased insulin-dependent muscle glucose uptake.

A nurse is caring for a client with diabetes mellitus who is receiving an oral antidiabetic drug. Which ongoing assessments should the nurse prioritize when caring for this client?

Observe the client for hypoglycemic episodes. Explanation: As the ongoing assessment activity, the nurse should observe the client for hypoglycemic episodes. Documenting family medical history and assessing the client's skin for ulcers, cuts, and sores should be completed before administering the drug. Lipodystrophy occurs if the sites of insulin injection are not rotated.