Quiz 17

Biguanide: EXPECTED ACTION Metformin

- *FIRST CHOICE of med for most pts with DM2 - *CANNOT take with prednisone (medications that increase plasma glucose levels are contraindicated and prednisone is a corticosteroids; corticosteroids increase plasma levels of glucose and can cause hyperglycemia) - reduce production of glucose within the liver thru suppression of gluconeogenesis - increase glucose uptake and use in fat and skeletal muscles - decrease glucose absorption in GI tract

Biguanide: COMPLICATIONS (GI EFFECTS) Metformin

- anorexia, nausea, diarrhea, weight loss - effects usually subside with use - monitor severity of these effects - D/C the med if necessary

Biguanide: COMPLICATIONS (LACTIC ACIDOSIS) Metformin

- hyperventilation, myalgia, sluggishness, somnolence (50% mortality rate) - severe lactic acidosis acan be treated with hemodialysis - pts with renal insufficiency SHOULD NOT use metformin (can rapidly accumulate to toxic levels) - withhold med if these findings occur, notify pcp imediately

A nurse is caring for a client who has a DVT, who received IV heparin for the past 5 days, and now has a new prescription for oral warfarin in addition to the heparin. The client asks the nurse if both medications are necessary. Which of the following is an appropriate response by the nurse? a. "The Coumadin (warfarin) takes several days to work, so the IV heparin will be used until the Coumadin (warfarin) reaches a therapeutic level." b. "I will call the provider to get a prescription for discontinuing the IV heparin today." c. "Both heparin and Coumadin (warfarin) work together to dissolve the clots." d. "The IV heparin increases the effects of Coumadin (warfarin) and decreases the length of your hospital stay."

. "The Coumadin (warfarin) takes several days to work, so the IV heparin will be used until the Coumadin (warfarin) reaches a therapeutic level."

Insulin expected action

1. decrease glucose levels 2. convert glucose > glycogen + promote energy storage 3. move potassium + glucose into cells

Insulin therapeutic uses

1. used for glycemic control for both DM 1/22. DM 2 requires insulin when... - oral meds + diet + exercise unable to control blood glucose level - severe renal/liver disease - painful neuropathy present

Insulin Complications - HYPOGLYCEMIA

<70 mg/dLresults from: toxic dose of insulin, too little food, vomit + diarrhea, alcohol intake, strenuous exercise, childbirth *administer 15 g carbs + wait 15 min (15 RULE)

Premixed Insulin

> 70% NPH + 30% regular = intermediate + regular > 75% lispro protamine + 25% lispro = intermediate + rapid

A nurse is reinforcing teaching with a client who is to start subcutaneous heparin. Which of the following information should the nurse include in the teaching? a. Use a soft bristle toothbrush b. Take the medication with a meal c. Limit to only two cups of coffee in the morning. d. Count your pulse rate before taking the medication

a. Use a soft bristle toothbrush

Short-acting REGULAR

Onset: 0.5 - 1 hr Peak: 1 - 5 hr Duration: 6 - 10 hr *the only type to be allowed administered intravenenously

Intermediate-acting NPH

Onset: 1 - 2 hr Peak: 4 - 14 hr Duration: 14 - 24 hr

Long-acting GLARGINE U-100 / INSULIN DETEMIR

Onset: 1 - 4 hr Peak: none Duration: 24 hr *insulin detemir is dose-dependent; the higher the dose the longer the duration, up to 24 hr with higher dosage *insulin glargine and insulin detemir are both clear in color, not administered thru IV, should NOT be mixed with other insulins

Rapid-acting LISPRO

Onset: 15 - 30 min Peak: 0.5 - 3 hr Duration: 3 - 5 hr *aspart, glulisine, inhaled human insulin

A nurse administers nitroglycerin sublingually to a client who has angina pectoris and experienced chest pain. The client states that his chest pain is relieved but now he has a headache. Which of the following responses by the nurse is appropriate? (Select all that apply) a. "A headache is a common adverse effect of this medication, but it will probably occur less often over time." b. "This is actually a result of your angina, not the nitroglycerin." c. "I'll contact your care provider. This may mean that nitroglycerin is not the right drug for you." d. "This is a common adverse effect of nitroglycerin; try taking acetaminophen to treat your headache."e. "If you can take your nitroglycerin on a full stomach, it might reduce the frequency and severity of your headaches."

a. "A headache is a common adverse effect of this medication, but it will probably occur less often over time." d. "This is a common adverse effect of nitroglycerin; try taking acetaminophen to treat your headache."

A nurse is caring for a client who has hypertension and is afraid to take medication. Which of the following nursing responses uses reflection? a. "You seem upset about taking your blood pressure medication." b. "Why do you feel afraid to take your medication?" c. "You won't get better until you take your medication?" d. "Did your symptoms occur before or after you took the medication?"

a. "You seem upset about taking your blood pressure medication."

Just before breakfast, the nurse accidentally administers 4 units of insulin glargine (Lantus) instead of 4 units of insulin aspart (Novolog)/ the patient has Type 2 Diabetes. What are the possible consequences for this patient's blood glucose? a. Blood glucose after breakfast will increase more than usual b. The insulin will have a cloudy appearance in the vial. c. The patient should mix Lantus with the intermediate-acting insulin. d. The patient will have less risk of hypoglycemic reactions with this insulin.

a. Blood glucose after breakfast will increase more than usual

A nurse at a provider's office receives a telephone call from a client who reports nausea and has unrelieved chest pain after taking a nitroglycerin tablet 5 min ago. Which of the following is an appropriate response by the nurse? a. Instruct the client to call 911 b. Go to the emergency room c. Take another tablet

a. Instruct the client to call 911

4. Which of the following statements is true about insulin? a. Insulin is administered subcutaneously .b. Abdomen provides the fastest absorption. c. Heat, massage, and exercise increase absorption. d. Insulin is not necessary for protein metabolism. e. Insulin stimulates gluconeogenesis.

a. Insulin is administered subcutaneously. b. Abdomen provides the fastest absorption. c. Heat, massage, and exercise increase absorption.

A nurse is reinforcing teaching with a client who is about to start taking captopril to treat hypertension. Which of the following instructions should the nurse include to help the client manage these medications' effects? a. Take the medication on an empty stomach b. Expect stools to turn black c. Anticipate the tablets to smell like vinegar d. Monitor for tinnitus

a. Take the medication on an empty stomach

A nurse is reinforcing teaching with a client who is taking metformin XR for type II diabetes mellitus. Which of the following information should the nurse include in the teaching? a. Take the medication with a meal b. You may crush of chew the medication c. This medication can cause an increase in perspirationd. This medication can turn your urine orange

a. Take the medication with a meal

Insulin Therapy - BASAL BOLUS (INTENSIVE THERAPY)

achieve tight control; may require 3-4 injections daily, home blood glucose monitoring

A nurse is reinforcing teaching with a client who has hypertension and is taking propranolol. Which of the following statements by the client indicates an understanding of the following statements by the client indicates an understanding of the teaching? a. "Stop taking the medication immediately." b. "I will sit on the side of the bed before I stand up." c. "I will schedule you to visit the health care provider today." d. "Cut the pill in half and take a reduced dosage."

b. "I will sit on the side of the bed before I stand up."

A nurse is caring for four clients. After administering morning medications, she realizes that the nifedipine prescribed for one client was inadvertently administered to another client. Which of the following actions should the nurse take first? a. Notify the client's provider. b. Check the client's vital signs. c. Fill out an occurrence form. d. Administer the medication to the correct client.

b. Check the client's vital signs.

A nurse is reinforcing teaching for a client who has Type 2 Diabetes Mellitus and is prescribed glipizide. The client should be taught that glipizide works in which of the following ways? a. Glipizide promotes the breakdown of glycogen to glucose. b. Glipizide stimulates the pancreas to release adequate insulin c. Glipizide blocks glucose production in the liver d. Glipizide slows gastric emptying and decreases appetite.

b. Glipizide stimulates the pancreas to release adequate insulin

A nurse is preparing to administer heparin subcutaneously to a client who has a deep vein thrombosis. Which of the following actions should the nurse take? a. Aspirate the syringe prior to injecting the heparin. b. Insert the needle at a 90° angle. c. Use the Z-track method to administer the medication. d. Grasp skin between thumb and forefinger throughout the injection.

b. Insert the needle at a 90° angle.

A nurse in a provider's office is collecting data from a client who takes furosemide daily for heart failure. Which of the following findings is a manifestation of hypokalemia? a. Sodium 136 mEq/L b. Potassium 2.3 mEq/L c. Magnesium 1.4 mEq/L d. Calcium 10 mg/dL

b. Potassium 2.3 mEq/L

4. A nurse is collecting data from a client who has diabetes mellitus. The client is confused, flushed, and has an acetone odor on his breath. The nurse should anticipate a prescription for which of the following types of insulin to treat the client? a. Detemir b. Regular c. Glargine d. NPH

b. Regular

A nurse in a provider's office is collecting data from a client who takes furosemide daily for heart failure. Which of the following findings is a manifestation of hypokalemia? a. Reports of numbness in the feet b. Reports of fatigue c. Increased bowel sounds d. Positive Trousseau's sign

b. Reports of fatigue

A nurse is reinforcing teaching with a client who has a prescription for lisinopril. Which of the following statements indicates an understanding of the teaching? a. "I will increase daily food that's high in potassium." b. "I will take the medication with grapefruit juice." c. "I will contact my provider if I become pregnant while taking this medication" d. "I will hold my breath for at least 10 seconds after inhalation."

c. "I will contact my provider if I become pregnant while taking this medication"

A client with Type 1 Diabetes Mellitus received regular insulin at 0700. The clients should be monitored for hypoglycemia at which time? a. 0730 b. 1400 c. 1000 d. 1700

c. 1000

Biguanide: COMPLICATIONS (VIT. B12 AND FOLIC ACID DEFICIENCY) Metformin

caused by altered absorptionprovide supplements as needed

A nurse is reinforcing teaching with a client who is taking warfarin about monitoring its therapeutic effect. The nurse should issue which of the following statements about the providers use of the international normalized ratio (INR) a. "You will need to fast 12 hours prior to having the test." b. "This is the only test available for anticoagulant therapy monitoring." c. "You will need the test done twice per month starting this medication." d. "This is a standardized test, so it eliminates the variations different labs report in prothrombin times."

d. "This is a standardized test, so it eliminates the variations different labs report in prothrombin times."

A nurse is reinforcing teaching with a client about nutrition. The client has hypertension and is taking a potassium-wasting diuretic. Which of the following dietary instructions should the nurse include in the teaching? a. Increase consumption of canned tuna and salmon. b. Limit intake of dried fruits c. Avoid cow's milk d. Consume oranges and bananas

d. Consume oranges and bananas

A nurse is reinforcing discharge teaching with a client prescribed verapamil to treat angina. Which of the following instructions should the nurse include? a. Check the apical pulse with a Doppler device. b. Use the diaphragm of the stethoscope to listen to the apical pulsations. c. Press the stethoscope firmly against the client's skin. d. Count the apical pulse for a full minute to monitor for increased heart rate while taking this medication.

d. Count the apical pulse for a full minute to monitor for increased heart rate while taking this medication

A nurse is reinforcing teaching with a client who is to start taking atorvastatin. The nurse should instruct the client that she will need which of the following baseline examinations prior to starting therapy? a. cardiac rhythm b. blood pressure c. oxygen saturation d. blood glucose levels e. liver function tests

e. liver function tests

Sulfonylureas: COMPLICATIONS Chloropropamide (1st gen) Glipizide (2nd gen)

hypoglycemia: - monitor for manifestations of hypoglycemia - ensure pt is aware of how to treat hypoglycemia orally, or that glucagon is available

Insulin Complications - HYPOKALEMIA

insulin can decrease K+ levels; patients taking large doses of insulin are at risk - muscle cramping + cardiac dysrhythmias

Sulfonylureas: EXPECTED ACTIONChloropropamide (1st gen) Glipizide (2nd gen)

insulin release from pancreas; can increase tissue sensitivity to insulin over time -antidiabetic agents control blood glucose levels in clients who have DM2 and are used in conjunction with exercise and diet *metformin first, then metformin + glipizide; if hba1c is over 7.5%, insulin is prescribed

Insulin Therapy - INSULIN PUMP

needle is inserted subcutaneously; pump is programmed to deliver a steady trickle of insulin throughout the day and can provide a bolus of insulin at mealtimes

Insulin Complications - LIPOHYPERTROPHY

rotate injection sites + allow 1 inch btwn injection sites

Insulin Therapy - CONVENTIONAL THERAPY

typically uses combo of short acting and intermediate OR long acting insulin