Pharmacology PrepU Chapter 38: Agents for Blood Glucose Levels
True or False: Stress typically results in hypoglycemia.
False
The nurse is instructing a client how to take a prescribed pramlintide. Which would be most appropriate? -"Give yourself an injection 1 hour before you eat breakfast and dinner." -"Take the drug orally once a day, preferably in the morning." -"Take the drug orally with the first bite of each meal." -"Give it by subcutaneous injection immediately before your major meals."
"Give it by subcutaneous injection immediately before your major meals."
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." -"This will make it easier for me to give my own insulin because of my poor eyesight." -"I determine my dosage by the number of clicks that I hear." -"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."
A female client is a newly diagnosed diabetic. She is a stay-at-home mother and responsible for meal planning and management of the home. What will the home care nurse teach this client? (Select all that apply.) -Reinforce instructions on dealing with hypoglycemia. -Instruct the client to go to the emergency department immediately if she develops a cold or upper respiratory infection. -Assist the client in making menus that will meet the needs of both the client and the family. -Watch the client draw up and administer her insulin. -Encourage the client to check her blood glucose every hour.
-Assist the client in making menus that will meet the needs of both the client and the family. -Watch the client draw up and administer her insulin. -Reinforce instructions on dealing with hypoglycemia.
A client receives a dose of insulin lispro at 8 AM. The nurse would be alert for signs and symptoms of hypoglycemia at which time? -Between 12 noon and 8 PM -Between 10 AM and 12 noon -Between 2 PM and 4 PM -Between 8:30 AM and 9:30 AM
Between 8:30 AM and 9:30 AM
A client is receiving glipizide as treatment for his type 2 diabetes. The nurse understands that this drug acts by: -Inhibiting alpha-glucosidase to delay glucose absorption -Binding to potassium channels on pancreatic beta cells -Increasing the uptake of glucose -Decreasing insulin resistance
Binding to potassium channels on pancreatic beta cells
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? -Administer the insulin to the client. -Check the dosage with another nurse. -Check the client's blood sugar again. -Ensure a meal tray is available.
Check the dosage with another nurse
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? -Release of glucagon from the cells -Storage of glucagon in the cells -Entry of glucose into the cells -Interruption of glucose movement across the membrane
Entry of glucose into the cells
Before administering a prescribed 20 units of NPH insulin to a client, the nurse should implement which intervention? -Have a colleague confirm the dosage. -Assess the client's urine for the presence of glucose. -Assess the client's understanding of diabetes. -Massage the chosen injection site.
Have a colleague confirm the dosage.
When describing the effects of incretins on blood glucose control to a group of students, which would an instructor include? -Increases GI emptying -Increases glucagon release -Increases protein building -Increases insulin release
Increases insulin release
A nurse is preparing to administer a rapid-acting insulin. Which medication would the nurse most likely administer? -insulin detemir -isophane insulin suspension -insulin lispro -insulin glargine
Insulin lispro
What is the expected action of sitagliptin on type 2 diabetes? -It slows the rate of inactivation of the incretin hormones. -It inhibits hydrogen, potassium, and ATPase. -It is a synthetically prepared monosodium salt. -It blocks the S phase of the cell cycle.
It slows the rate of inactivation of the incretin hormones
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? -creatinine -liver enzymes -D-dimer -platelet count
Liver enzymes
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? -Cleanse the administration site with soap and water before administration. -Have the client lie quietly for 45 minutes. -Monitor the client for a hypoglycemic reaction at noon. -Make sure the client's breakfast is available in the next 5-10 minutes.
Make sure the client's breakfast is available in the next 5-10 minutes.
A client, who experienced hypoglycemia twice in the past week, eats one meal per day and snacks the rest of the day. What client education will the nurse provide for a client who reports regularly experiencing hypoglycemic symptoms? -Daily snacks should increase protein intake. -Meals should be eaten at regular times. -Daily caloric intake should be increased by 200 calories. -Alcohol should be limited and taken only with meals.
Meals should be eaten at regular times.
What should be the nurse's initial response when a client diagnosed with type 1 diabetes suddenly reports feeling weak, shaky, and dizzy? -Administer 1 ampule of 50% dextrose intravenously (IV). -Perform a blood sugar analysis. -Administer 10 units of regular insulin subcutaneously (sub-Q). -Have the client drink a 4-ounce glass of orange juice.
Perform blood sugar analysis
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 -Insulin pen -External pump -Jet injector
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 -Jet injector -Insulin pen -Subcutaneous injection
Subcutaneous injection
A client with diabetes is undergoing testing for glycosylated hemoglobin. The nurse instructs the client that this test measures average blood glucose over what time period? -the past 7 to 10 days -the past 1 or 2 months -the past 12 to 24 hours -the past 3 or 4 months
The past 3 or 4 months
True or False: Regular insulin may be administered intravenously or intramuscularly in an emergency situation.
True
Which factor would prohibit the administration of glipizide? -increase in alkaline phosphatase -the ingestion of carbohydrates -allergy to sulfonamides -a diagnosis of hypertension
allergy to sulfonamides
Because of the risk for lactic acidosis, metformin is contraindicated in which client? -a 50-year-old who has undergone surgery 2 weeks ago -a 37-year-old woman who takes oral contraceptives -an 82-year-old diagnosed with type 2 diabetes -a 16-year-old with a diagnosis of anorexia nervosa
an 82-year-old diagnosed with type 2 diabetes
A nurse is providing client education to a 13-year-old girl who was just diagnosed with type 1 diabetes mellitus. Which statement by the client will alert the nurse that special instructions regarding insulin are necessary? -"We live in a two-story house." -"I walk two blocks to school every day." -"My mother is going to give me my insulin." -"I am on the middle school track team."
"I am on the middle school track team."
What statement would be appropriately included in the teaching concerning type 2 diabetes? -"If you drink alcohol, it may be necessary for you to increase your oral antidiabetic medication." -"Until you need to start insulin injections, you do not have to check your blood sugar." -"Regular exercise makes your body better able to use the insulin it produces." -"Clients with type 2 diabetes always progress to insulin injections if they do not follow dietary guidelines."
"Regular exercise makes your body better able to use the insulin it produces."
A nurse should monitor a client taking glimepiride (Amaryl) for which of adverse effects? (Select all that apply.) -Nausea -Edema -Heartburn -Hypoglycemia -Lactic acidosis
-Hypoglycemia -Heartburn -Nausea
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) -Insulin glargine (Lantus) -Insulin zinc suspension (Humulin L) -Insuline glulisine (Apidra) -Isophane insulin suspension (Novolin N)
-Insulin aspart (NovoLog) -Insuline glulisine (Apidra)
Which would be least appropriate when administering insulin by subcutaneous injection? -Injecting the insulin slowly -Massaging the site after removing the needle -Inserting the needle at a 45-degree angle -Using a 25 gauge 1/2-inch needle
Massaging the site after removing the needle
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? -Implantable infusion pump -Jet injector -Subcutaneous injection -Insulin pen
Subcutaneous injection
Which would a nurse identify as an example of a sulfonylurea? -Glyburide -Miglitol -Acarbose -Metformin
glyburide
A client's current condition requires rapid reduction of blood sugar levels. Which type of insulin will have the most rapid onset of action? -Humulin R -insulin lispro -isophane (NPH) -isophane (NPH)
insulin lispro
A client who began treatment for type 2 diabetes 8 months ago is now meeting with a diabetic nurse for a scheduled follow-up. How can the nurse best assess the client's glycemic control since beginning treatment? -Arrange to have the client's random blood glucose measured. -Dialogue with the client about implemented management strategies. -Assess the most recent hemoglobin A1C levels. -Review and discuss the data contained in the client's written blood glucose log.
Assess the most recent hemoglobin A1C levels
The nurse is caring for a client taking insulin. The nurse realizes the client is experiencing symptoms of hypoglycemia when the client displays: -increased pulse rate and fruity smelling breath. -decreased respiratory rate and hot, dry skin. -increased thirst and increased urine output. -weakness, sweating, and decreased mentation.
Weakness, sweating, and decreased mentation
A patient with type 1 diabetes has come to the clinic for a routine follow-up appointment. While assessing the patient's skin, the nurse observes brown spots on his lower legs. What might these spots indicate? -Impaired glucose tolerance -Infection -Poor insulin injection technique -Widespread changes in the blood vessels
Widespread changes in the blood vessels
The nurse is providing teaching to a client with type 1 diabetes. The client requires additional teaching when he learns that his insulin needs may increase because of what condition? (Select all that apply.) -Fever -Anxiety -Stress -Decreased food intake -Exercise
-Decreased food intake -Exercise
True or False: Pramlintide is administered orally.
False
What distinguishing characteristic is associated with type 1 diabetes? -The disease always starts in childhood. -Oral agents can control blood sugar. -Blood glucose levels can be controlled by diet. -Exogenous insulin is required for life.
Exogenous insulin is required for life.
True or False: Clients with type 2 diabetes have nonfunctioning beta pancreatic cells.
False -Type 2 diabetes reflects an inability to produce enough insulin as needed or a change in insulin receptor sensitivity
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? -Give 8 oz orange juice. -Place glucose gel between the gums and cheek. -Administer regular insulin subcutaneously. -Raise the head of the bed.
Place glucose gel between the gums an cheek
A nurse is caring for a patient who has developed a hypoglycemic reaction. Which intervention should the nurse perform if swallowing and gag reflexes are present in the patient? -Administer glucagon by the parenteral route. -Administer the insulin via insulin pump. -Give oral fluids or candy. -Administer oral antidiabetics to the patient.
Give oral fluids or candy.
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." -"Insulin causes fat to be broken down to provide energy for the body." -"Insulin is stimulated by the liver to break down proteins and provide the body with nutrients." -"Insulin is used to move carbohydrate particles from the gastrointestinal system to the liver."
"Insulin assists glucose molecules to enter the cells of muscle and fat tissues."
What statement would be appropriately included in the teaching concerning type 2 diabetes? -"Until you need to start insulin injections, you do not have to check your blood sugar." -"Regular exercise makes your body better able to use the insulin it produces." -"Clients with type 2 diabetes always progress to insulin injections if they do not follow dietary guidelines." -"If you drink alcohol, it may be necessary for you to increase your oral antidiabetic medication."
"Regular exercise makes your body better able to use the insulin it produces."
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.) -Lose 10-15 pounds. -If you skip a meal, increase your next insulin dosage. -Use artificial sweeteners instead of sugar in tea and coffee. -Read food labels carefully to look for hidden sources of sugar. -Avoid drinking beer, wine, or liquor.
-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.
The nurse is caring for an older adult client 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) -Chlorpropamide (Diabinese) -Miglitol (Glyset) -Regular insulin -Acarbose (Precose)
-Metformin (Glucophage) -Acarbose (Precose) -Miglitol (Glyset)
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 (3.33 mmol/L). Which can a nurse give to treat a client with a hypoglycemic episode? (Select all that apply.) -Isulin detemir (Levemir) -Insulin glargine (Lantus) -Orange or other fruit juice -Hard candy -Glucose tablets
-Orange or other fruit juice -Glucose tablets -Hard candy
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? -07:00 -06:45 -06:00 -06:20
06:45
Heavy intake of which herb should be avoided by a client who is prescribed an antidiabetic medication? -oregano -basil -garlic -anise
Garlic
The nurse's assessment of a client who has presented to the emergency department reveals hyperglycemia. Which type of insulin will have the most rapid effect on the client's blood sugar levels? -30/70 -Regular -NPH -Aspart
Aspart
A nurse is assigned to administer glargine to a patient at a health care facility. What precaution should the nurse take when administering glargine? -Administer insulin that has been refrigerated. -Administer glargine via IV route. -Avoid mixing glargine with other insulin. -Shake the vial vigorously before withdrawing insulin.
Avoid mixing glargine with other insulin
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 is in good glycemic control. -Client's average blood glucose is above normal. -Client's blood glucose demonstrates longstanding hypoglycemia. -Client's blood glucose levels are not consistent.
Client's average blood glucose is above normal
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
The nurse is caring for a client who is taking glyburide as treatment for type 2 diabetes mellitus. The health care provider has added a corticosteroid to this client's medication regimen for treatment of a severe allergic reaction. The nurse knows that this drug combination may cause what adverse effect on this client? -hyperglycemia -hypoglycemia -rash and fever -nausea and vomiting
Hyperglycemia
The health care provider 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 client? -Bradycardia -Lipodystrophy -Hypoglycemia -Hypotension
Hypoglycemia
When administering insulin, what would be most appropriate? -Shake the vial vigorously to ensure thorough mixing before drawing up the dose. -Firmly spread the skin of the area of the intended site of injection. -Massage the injection site firmly after removing the needle and syringe. -Insert the needle at a 45-degree angle for injection.
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. -Keep prefilled syringes horizontally. -Check for symptoms of myalgia or malaise. -Do not administer insulin kept at room temperature.
Inspect the previous injection site for inflammation
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? -Monitor the patient for lipodystrophy. -Observe the patient for hypoglycemic episodes. -Document family medical history. -Assess the skin for ulcers, cuts, and sores.
Observe the patient for hypoglycemic episodes.
When considering the management of diabetic ketoacidosis (DKA), what type of insulin can be administered intravenously? -regular -isophane insulin (NPH) -insulin glargine -lispro
Regular
A patient at a health care facility has been prescribed diazoxide for hypoglycemia due to hyperinsulinism. What adverse reactions to the drug should the nurse monitor for in the patient? -Epigastric discomfort -Tachycardia -Myalgia -Flatulence
Tachycardia
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. -Inject a prescribed dose of insulin as soon as you suspect the reaction is occurring. -Stay calm and still until the reaction subsides. -Notify your health care provider immediately.
Take an oral dose of some form of glucose as soon as possible.
A client was diagnosed with type 2 diabetes several months ago and has presented for a scheduled follow-up appointment. Which stated behavior most clearly indicates that the client has established effective health maintenance? -The client can describe the differences between type 1 and type 2 diabetes. -The client exercises two to three times per week. -The client tells the nurse that he/she has gone on a diet. -The client frequently checks his/her blood glucose levels.
The client frequently checks his/her blood glucose levels
Which condition must be met in order for glyburide treatment to be effective? -The client must have hemoglobin A1C of ≤7%. -The client must have functioning pancreatic beta cells. -The client must not have hyperglycemia. -The client must be able to self-administer the medication.
The client must have functioning pancreatic beta cells.
