ATI Diabetes

A nurse is teaching about levothyroxine with a client who has primary HYPOthyroidism. Which of the following statements should the nurse use when teaching the client?

"Tremors, nervousness, and insomnia may indicate your dose is too high. This may indicate an overdose of the medication and they will need to notify the provider.

A nurse is teaching a client who has DM and receives 25 units of NPH insulin every morning if her blood glucose is above 200 mg/dL. Which of the following information should the nurse include?

Expect the NPH insulin to peak in 6-14 hours. It is an intermediate acting insulin with an onset of 1-2 hors, peaking at 6-14 hours, and duration of 16-24 hours. The client is at risk for HYPOglycemia during the peak time.

A nurse is providing teaching to a client who has a new diagnosis of HYPOthyroidism. On which of the following medications should the nurse prepare to instruct the client?

Levothyroxine is a synthetic hormone that is chemically identical to thyroxine (T4)

A nurse is a client who is taking metformin XR for type 2 DM. Which of the following instructions should the nurse include in the teaching?

"Take the medication with a meal." This will help the client avoid HYPOglycemia and GI upset and to provide the most absorption of the medication.

A nurse is preparing to administer lispro insulin to a client who has type 2 DM Which of the following actions should the nurse take?

Inject the insulin 15 minutes before a meal because it is a rapid-acting insulin that has an onset within 15-30 min. The client may develop HYPOglycemia quickly if they do not eat.

A nurse is providing teaching for a client who is newly diagnosed type 2 DM and has a prescription for glipizide. Which of the following statements made by the nurse best describes glipizide?

"Glipizide stimulates your pancreas to release insulin." It is an oral antidiabetic medication that is classified as a sulfonylurea agent. These medications help to lower blood glucose levels in clients who have type 2 DM using several methods including reducing glucose output by the liver, increasing sensitivity to insulin, and stimulating the release of insulin form the functioning beta cell in the pancreas.

A nurse is providing teaching about self-administration of insulin to the parent of a school-aged child who has a new onset of DM. Which of the following statement by the parent indicates a need for further teaching?

"I will be sure my child aspirates before injecting the insulin." This step is not necessary anymore.

A nurse is teaching a client who has DM and a new prescription for glimepiride. The nurse should teach the client to avoid which of the following drinks while taking this medication?

Alcohol to prevent disulfiram reaction such as nausea, headache, and HYPOglycemia

A nurse is reviewing the medical record of a client who has been on levothyroxine for several months. Which of the following findings indicates a therapeutic response to the medication?

Decrease in the level of thyroid stimulating hormone (TSH). In HYPOthyroidism, the nonfunctioning thyroid gland is unable to respond to the TSH and endogenous thyroid hormones are released. This results in an elevation of the TSH level as the anterior pituitary continues to release the TSH to stimulate the thyroid glans. Administration of exogenous thyroid hormones turns off this feedback loop, which results in a decreased level of TSH.

A nurse is assisting a client who has thyrotoxicosis after taking too high of a level of levothyroxine. Which of the following manifestations should the nurse expect?

Heat intolerance. A client with an acute overdose will exhibit heat intolerance, sweating, and hyperthermia. These manifestations are indication of excessive levels of thyroid hormones that could lead to death.

A nurse is assessing a client who is receiving liothyronine for treatment of hypothyroidism. The nurse should recognize which of the following finding is a therapeutic response to the medication?

Increase in energy. Depression, lethargy, and fatigue are manifestations of HYPOthyroidism and effective treatment will improve these manifestations.

A nurse is preparing to administer 10 units of regular insulin and 20 units of NPH insulin to a client who has DM. When mixing the 2 types of insulin, which of the actions should the nurse take first?

Inject 20 units of air into the NPH insulin vial because his insulin is the intermediate-acting insulin which will be drawn up last in order to avoid contaminating the regular insulin with the NPH insulin.

A nurse is assessing a client who is taking levothyroxine. The nurse should recognize that which of the following findings is a manifestation of levothyroxine overdose?

Insomnia. Levothyroxine overdose will result in HYPERthyroidism = insomnia, tachycardia, and hyperthermia.

A nurse is teaching a client who has a new prescription for regular insulin and NPH insulin. Which of the following instructions should the nurse include in the teaching?

Keep the open vial of insulin at room temperature to minimize tissue injury and to reduce the risk for lipodystrophy.

A nurse is caring for an adolescent client who has a long history of DM and is long admitted to the ED confused, flushed, and with an acetone odor on the breath . DKA is suspected. The nurse should anticipate using which of the following types of insulin to treat this client?

Regular insulin is classified as a short-acting insulin. It can be given IV with an onset of action of less than 30 min. This is the insulin that is most appropriate in emergency situations of severe HYPERglycemia and DKA.

A nurse is providing teaching to a client who has a new prescription for levothyroxine for HYPOthyroidism. The nurse should instruct the client to avoid which of the following herbal supplements?

Soy because it can reduce the effectiveness of levothyroxine.

A nurse is evaluating teaching with a client who is receiving continuous subcutaneous insulin via an external insulin pump. which of the following statements by the client indicates a need for further teaching?

"I will use insulin glargine in my insulin pump." The client should use a short-acting insulin in the pump. The pump is designed to administer rapid-acting or short acting insulin 24 hours a da. Glargine is classified as a long-acting insulin and is administered at the same time each day to maintain stable blood glucose concentration for a 24 hours period.

A nurse is teaching a client who has a new prescription for NPH insulin. Which of the following instructions should the nurse include?

"Eat a snack 8 hours after taking this medication." NPH insulin peaks in 6-14 hours after dosing. The client is at risk for HYPOglycemia and might require a snack at this time. Clients should check blood glucose 8-10 hours after administration of NPH insulin. If HYPOglycemic, consume a small snack of 15 grams of carbs and recheck blood glucose again in 15 min.

What is the correct order when mixing regular insulin and NPH insulin?

1. Inspect for contaminants. 2. Toll NPH (cloudy) between palm of hands. 3. Inject air into NPH insulin vial. 4. Inject air into regular insulin (clear) vial. 5. Withdraw short-acting insulin (clear) into syringe. 6. Add intermediate acting insulin (cloudy) to syringe. The mixture is stable for 28 days.

A nurse is teaching a client how to draw up regular insulin and NPH insulin into the same syringe. Which of the following instructions should the nurse include?

Discard regular insulin if cloudy as it should be clear. NPH insulin is the one that has a cloudy appearance since it is a suspension that needs to be rolled between your hands to mix.