Ch 45 Drugs for Diabetes Mellitus
-Once daily at bedtime
Insulin glargine is prescribed for a hospitalized patient who has diabetes. When will the nurse expect to administer this drug? -Approximately 15 to 30 minutes before each meal -In the morning and at 4:00 PM -Once daily at bedtime -After meals and at bedtime
-Just before breakfast
The nurse administers glipizide (Glucotrol): -Subcutaneously only -After meals -At bedtime -Just before breakfast
-Same time each day
The nurse plans to administer glargine (Lantus) to apatient with type 1 diabetes: -Before meals -With meals -Only at bedtime -Same time each day
-Subcutaneous
When giving insulin, the nurse plans on administering itby what route? -Oral -Intradermal -Subcutaneous -Intramuscular
-Somogyi phenomenon
During the assessment, the client states, "My blood glucose levels range between 4.5-5.5 mmol/L, but my early-morning blood glucose levels are 11 mmol/L." This phenomenon is best known as _________. -Hyperosmolarity -Somogyi phenomenon -Insulin resistance -Diabetic ketoacidosis
Allergic reaction, redness at injection, and changes in tissue
Fill in the blank:Adverse effects of insulin may include __________, _________, and _________.
-Bromocriptine (Cycloset)
This drug is approved for Parkinson's disease, pituitary adenoma, acromegaly, for women with amernorrhea, and infertility caused by prolactin sercretion. -Tolbutamide (Orinase) -Glipizide (Glucotrol) -Glyburide micronized (Glynase) -Bromocriptine (Cycloset)
True
True or False:Almost all insulin today is human insulin obtained through recombinant DNA technology because it is more effective, causes fewer allergies, and has a lower incidence of resistance?
True
True or False:Combination of antidiabetic drugs have been developed to maximize the therapeutic effects and minimize adverse effects?
False
True or False:For treatment of hypoglycemia patients in the hospital, nurse routinely administer glucose via the intravenous (IV) route?
True
True or False:Giving food or drink containing glucose (sugar) can reverse mild to moderate hypoglycemia symptoms in diabetic patients?
False
True or False:The typical signs and symptoms of diabetes are fasting blood glucose greater than 200 mg/dL on at least two separate occasions, along with polyuria, polyphagia, polydipsia, glucosuria, weight loss, and fatigue?
True
True or False:Therapy with type 2 antidiabetic drugs is not effective for persons with type 1 diabetes mellitus?
-Make sure the client's snack is ready to eat before administering this insulin.
The client is scheduled to receive 5 units of Humalog and 25 units of glargine (Lantus) insulin prior to bedtime for a blood sugar of 14 mmol/L. What nursing intervention is most appropriate for this client? -Make sure the client's snack is ready to eat before administering this insulin. -Offer the client a high-carbohydrate snack in six hours. -Hold the insulin if the blood glucose level is <100 mg/dl. -Administer the medications in two separate syringes.
-Diaphoresis
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 what? -Dry, flaky skin -Diaphoresis -Fruity breath -Flushing of the face
-Monitor blood glucose levels before and after exercise.
What information should the nurse give to the diabetic client who is planning an exercise program? -Monitor blood glucose levels before and after exercise. -at a complex carbohydrate at the first sign of hypoglycemia. -Exercise does not increase insulin needs. -Withhold insulin prior to engaging in strenuous exercise.
-Glucagon
Which of the following hormones maintains adequate levels of glucose in the blood between meals? -Insulin -Glucagon -Cortisol -Epinephrine
-Glycosylated hemoglobin levels
Which of the following is the best indicator of overall diabetic control? -Fasting blood glucose levels -2-hour postprandial blood glucose levels -Glycosylated hemoglobin levels -Absence of acetone in the urine
-Optimal control of both types of diabetes reduces the risk of eye, kidney, and nerve damage
Which statement is accurate about the long-term complications of diabetes? -Long-term complications are almost always the result of hypoglycemia and ketoacidosis. -The complication rates for patients with optimally controlled type 2 diabetes are the same as for those whose disease is not optimally controlled. -Optimal control of type 1 diabetes produces excessive episodes of life-threatening hypoglycemia. -Optimal control of both types of diabetes reduces the risk of eye, kidney, and nerve damage
-"Please continue taking the medication and monitoring your weight. This is an expected outcome of this drug therapy."
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." -"You should discontinue this medication immediately. I will contact your physician." -"We should really report this to your physician. He will likely change medications." -"We should really report this to your physician. The metformin dosage will need to be decreased."
-Flatulence -Diarrhea
A nurse counsels a patient with diabetes who is starting therapy with an alpha-glucosidase inhibitor. The patient should be educated about the potential for which adverse reactions? (Select all that apply.) -Hypoglycemia -Flatulence -Elevated iron levels in the blood -Fluid retention -Diarrhea
regular insulin, insulin aspart, and insulin glulisine
__________________ are also approved for use in external insulin pumps that administer a sub-Q continuous infusion.
-"Unless you were fasting for longer than 8 hours, this does not necessarily mean you have diabetes."
An adolescent patient recently attended a health fair and had a serum glucose test. The patient telephones the nurse and says, "My level was 125 mg/dL. Does that mean I have diabetes?" What is the nurse's most accurate response? -"Unless you were fasting for longer than 8 hours, this does not necessarily mean you have diabetes." -"At this level, you probably have diabetes. You will need an oral glucose tolerance test this week." -"This level is conclusive evidence that you have diabetes." -"This level is conclusive evidence that you do not have diabetes."
-One tablet
The physician starts a patient on 500 mg, po, twice a day. The pharmacy provides him or her with scored 1,000 mg tablets. How many tablets will he or she take in a day? -One tablet -Two tablets -One and one-half -One-half tablet
-Avoid mixing glargine with other insulin.
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 glargine via IV route -Administer insulin that has been refrigerated. -Avoid mixing glargine with other insulin. -Shake the vial vigorously before withdrawing insulin.
-Lispro [Humalog]
A patient with type 1 diabetes is eating breakfast at 7:30 AM. Blood sugars are on a sliding scale and are ordered before a meal and at bedtime. The patient's blood sugar level is 317 mg/dL. Which formulation of insulin should the nurse prepare to administer? -No insulin should be administered. -NPH. -70/30 mix. -Lispro [Humalog].
-Six or seven times a day
A patient with type 1 diabetes recently became pregnant. The nurse plans a blood glucose testing schedule for her. What is the recommended monitoring schedule? -Before each meal and before bed -In the morning for a fasting level and at 4:00 PM for the peak level -Six or seven times a day -Three times a day, along with urine glucose testing
-Below 8.0
An elderly patient who has type 2 diabetes has a history of severe hypoglycemia. The patient's spouse asks the nurse what the optimum A1c level is for the patient. Which is correct? -Between 6.5 and 7.0 -Below 7.0 -Below 8.0 -Between 7.0 and 8.5
insulin, glucagon
Fill in the blank:Although many factors contribute to maintaining a stable blood glucose level, the two pancreatic hormones play major roles: __________ acts to DECREASE blood glucose levels and ___________ acts to INCREASE blood glucose levels.
Type 2
Fill in the blank:Because _____________ first appeared in middle-aged adults, it has been referred to as adult-onset diabetes or maturity-onset diabetes.
CBC, electrolyte, glucose, HbA1C, lipid profile, liver, and renal
Fill in the blank:For patients requiring diabetic therapy, the nurse should monitor periodic laboratory work including _________, _________, _________, ___________, __________, _________, and _________ function studies.
Unresponsive
Fill in the blank:In type 2 diabetes mellitus, insulin receptors in the target tissues have become ___________ to the hormone.
Insulin analogs
Fill in the blank:Pharmacologists have modified human insulin to create forms that have a more rapid onset of action or a more prolonged duration of action. These modified forms modified forms are called ____________.
Insulin pump
Fill in the blank:The _________ is usually abdominally anchored and is programmed to release small subcutaneous doses of insulin into the abdomen at predetermined intervals, with larger amounts administered manually at mealtime if necessary.
Hypoglycemia
Fill in the blank:The most serious adverse effect from insulin therapy is __________.
Blood glucose levels
Fill in the blank:The treatment goal with insulin therapy is to maintain __________ within strict, normal limits.
Type 1
Fill in the blank:__________ previously called juvenile-onset diabetes, is one of the most common disease of childhood?
D. Sulfonylureas
Matching: Glyburide (DiaBeta, Micronase) A. Alpha-glucosidase inhibitor B. Biguanide C. Meglitinide D. Sulfonylureas E. Thiazolidinedione (or glitazone)
A. Rapid action, onset 15 minutes
Matching: Insulin aspart (NovoLog) A. Rapid action, onset 15 minutes B. Rapid action, onset 15-30 minutes C. Short action, onset 30-60 minutes D. Intermediate onest, 1-2 hours E. Long onset, gradual onset over 24 hours
E. Long onset, gradual onset over 24 hours
Matching: Insulin glargine (Lantus) A. Rapid action, onset 15 minutes B. Rapid action, onset 15-30 minutes C. Short action, onset 30-60 minutes D. Intermediate onest, 1-2 hours E. Long onset, gradual onset over 24 hours
B. Rapid action, onset 15-30 minutes
Matching: Insulin glulisine (Apidra) A. Rapid action, onset 15 minutes B. Rapid action, onset 15-30 minutes C. Short action, onset 30-60 minutes D. Intermediate onest, 1-2 hours E. Long onset, gradual onset over 24 hours
D. Intermediate onest, 1-2 hours
Matching: Insulin isophane (NPH, Humulin N, Novolin N, ReliOn N) A. Rapid action, onset 15 minutes B. Rapid action, onset 15-30 minutes C. Short action, onset 30-60 minutes D. Intermediate onest, 1-2 hours E. Long onset, gradual onset over 24 hours
C. Short action, onset 30-60 minutes
Matching: Insulin regular (Humulin R, Novolin R) A. Rapid action, onset 15 minutes B. Rapid action, onset 15-30 minutes C. Short action, onset 30-60 minutes D. Intermediate onest, 1-2 hours E. Long onset, gradual onset over 24 hours
B. Biguanide
Matching: Merformin A. Alpha-glucosidase inhibitor B. Biguanide C. Meglitinide D. Sulfonylureas E. Thiazolidinedione (or glitazone)
A. Alpha-glucosidase inhibitor
Matching: Miglitol (Glyset) A. Alpha-glucosidase inhibitor B. Biguanide C. Meglitinide D. Sulfonylureas E. Thiazolidinedione (or glitazone)
C. Meglitinide
Matching: Repaglinide (Prandin) A. Alpha-glucosidase inhibitor B. Biguanide C. Meglitinide D. Sulfonylureas E. Thiazolidinedione (or glitazone)
E. Thiazolidinedione (or glitazone)
Matching: Rosiglitazone (Avandia) A. Alpha-glucosidase inhibitor B. Biguanide C. Meglitinide D. Sulfonylureas E. Thiazolidinedione (or glitazone)
-Regular insulin
The client is newly admitted with clinical manifestations of type 1 diabetes ketoacidosis. Which of the following medications would the nurse anticipate administering to this client via IV access immediately? -Cimetadine (Tagamet) -Pancreatin (Viokase) -Glargine (Lantus) -Regular insulin
-1600
The client received NPH (Novolin ge) insulin at 0730. Based on an understanding of peak time, the nurse should assess the client for hypoglycemia at which of the following times? -1000 -1200 -1400 -1600
-Evaluation for hyperglycemia, hypoglycemia, and ketoacidosis
The nurse assesses a newly diagnosed patient for short-term complications of diabetes. What does this assessment include? -Evaluation for hyperglycemia, hypoglycemia, and ketoacidosis -Cranial nerve testing for peripheral neuropathy -Pedal pulse palpation for arterial insufficiency -Auscultation of the carotids for bruits associated with atherosclerosis
-Exercise -Diet -Illness
The nurse informs a group of patients, newly diagnosed with type 1 DM, that the following factors can influence the amount of insulin needed to control blood glucose levels: (Select all that apply.) -Exercise -Diet -Illness -Sleep
-Increase in insulin resistance
The nurse is explaining the action of exenatide to a patient. Which of the following would the nurse include? -Increase in protein building -Increase in glucagon release -Increase in insulin resistance -Increase in GI emptying
False
True or False:If mixing insulin, such as rapid or short-acting with an intermediate-acting, the intermediate-acting insulin is always drawn into the syringe first.
-"It stimulates insulin production, so you need to eat soon after taking the medication."
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 is more potent and longer lasting, so you should take it every other day." -"It is less potent, so you will need to take a larger dose." -"The two medications are virtually the same." -"It stimulates insulin production, so you need to eat soon after taking the medication."
-Polyphagia -Polyuria -Polydipsia
While collecting information from a patient, the nursenotes which of the following symptoms of type I diabetes? (Select all that apply.) -Polyphagia -Polyuria -Polydipsia -Weight gain
-Give oral fluids or candy.
A nurse is caring for a patient who has developed a hypoglycemic reaction. Which of the following interventions should the nurse perform if swallowing and gag reflexes are present in the patient? -Give oral fluids or candy. -Administer glucagon by the parenteral route. -Administer the insulin via insulin pump. -Administer oral antidiabetics to the patient.
-Diabetic ketoacidosis
A nurse is caring for a patient with type 2 diabetes receiving a meglitinide. For which of the following conditions of the patient is meglitinides contraindicated? -Kidney disease -Severe heart failure -Liver disease -Diabetic ketoacidosis
-Blood glucose level of 60 mg/dL
A nurse is educating the staff nurses about ketoacidosis. To evaluate the group's understanding, the nurse asks, "Which sign or symptom would not be consistent with ketoacidosis?" The group gives which correct answer? -Blood glucose level of 600 mg/dL -Blood glucose level of 60 mg/dL -Acidosis -Ketones in the urine
-"I am on the middle school track team."
A nurse is providing patient education to a 13-year-old girl who was just diagnosed with type 1 diabetes mellitus. Which of the following statements by the patient will alert the nurse that special instructions regarding insulin are necessary? -"We live in a two-story house." -"My mother is going to give me my insulin." -"I walk two blocks to school every day." -"I am on the middle school track team."
-"You should use a carbohydrate counting approach to maintain glycemic control."
A nurse provides dietary counseling for a patient newly diagnosed with type 1 diabetes. Which instruction should be included? -"You may eat any foods you want and cover the glucose increase with sliding scale, regular insulin." -"Most of the calories you eat should be in the form of protein to promote fat breakdown and preserve muscle mass." -"Your total caloric intake should not exceed 1800 calories in a 24-hour period." -"You should use a carbohydrate counting approach to maintain glycemic control."
-Regular Insulin
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 -Humulin N Insulin -NPH Insulin -Humulin L Insulin
-Ways to reduce hyperglycemic episodes -Smoking cessation -Emphasis on the importance of taking antihypertensive drugs consistently
A patient newly diagnosed with diabetes expresses concern about losing her vision. Which interventions should be included in the plan of care to reduce this risk? (Select all that apply.) -Initiation of reliable contraception to prevent pregnancy -Ways to reduce hyperglycemic episodes -Use of a prokinetic drug (eg, metoclopramide) -Smoking cessation -Emphasis on the importance of taking antihypertensive drugs consistently
-The risk for hypoglycemia
A patient receives NPH and regular insulin every morning. The nurse, verifying that the patient understands that there are two different peak times to be aware of for this insulin combination, questions the patient because: -The patient needs to plan the next insulin injection around the peak times. -Additional insulin may be needed at peak times to avoid hyperglycemia. -It is best to plan exercise or other activities around the peak insulin activity. -The risk for hypoglycemia
-"I may continue to have a glass of wine with dinner."
A patient who has type 2 diabetes will begin taking glipizide [Glucotrol]. Which statement by the patient is concerning to the nurse? -"I will begin by taking this once daily with breakfast." -"It is safe to drink grapefruit juice while taking this drug." -"I may continue to have a glass of wine with dinner." -"I will need to check my blood sugar once daily or more."
-This is an acceptable practice.
A patient with type 1 diabetes reports mixing NPH and regular insulin to allow for one injection. What should the nurse tell the patient? -This is an acceptable practice. -These two forms of insulin are not compatible and cannot be mixed. -Mixing these two forms of insulin may increase the overall potency of the products. -NPH insulin should only be mixed with insulin glargine.-
-The beta blocker can mask the symptoms of hypoglycemia.
A patient with type 1 diabetes who takes insulin reports taking propranolol for hypertension. Why is the nurse concerned? -The beta blocker can cause insulin resistance. -Using the two agents together increases the risk of ketoacidosis. -Propranolol increases insulin requirements because of receptor blocking. -The beta blocker can mask the symptoms of hypoglycemia.
-Stimulate insulin release from the pancreas.
A patient, who has just been prescribed an incretin enhancer (oral hypoglycemic medication), asks the nurse how it works. The nurse informs the patient that these types of medications: -Decrease the uptake of glucose by body cells. -Stimulate insulin release from the pancreas. -Increase insulin production by the pancreas. -Decrease the amount of insulin produced by the pancreas.
-"I'll plan to take my glyburide each night before I go to bed."
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 know that glyburide won't cure my diabetes, but it will help me have safe blood sugar levels." -"I'll plan to take my glyburide each night before I go to bed." -"I'll make sure to check with my doctor before I start taking any other medications." -"I'll keep in mind that glyburide can possibly cause me to have low blood sugar."
-"Do you have any known liver function abnormalities?"
The nurse is initiating client education about taking the medication Glucophage (metformin). Which of the following questions is most important to ask the client prior to beginning therapy on metformin? -"Do you have any known liver function abnormalities?" -"Are you able to limit your fluid intake to avoid bloating?" -"Do you have a way to crush your pills prior to mixing with food?" -"Will you have difficulty eating only three main meals per day?"
-"I must draw the NPH insulin first if I am mixing it with regular insulin."
The nurse is initiating discharge teaching with the newly diagnosed diabetic. Which of the following statements indicates that the client needs additional teaching? -"If I am experiencing hypoglycemia, I should drink half a cup of apple juice." -"My insulin needs might increase when I have an infection." -"I must draw the NPH insulin first if I am mixing it with regular insulin." -"If my blood glucose levels are greater than 300mg/dl, I must check my urine for ketones."
-The NPO patient with a blood glucose level of 80 mg/dL who just received 20 units of 70/30 Novolin insulin.
The nurse working on a high-acuity medical-surgical unit is prioritizing care for four patients who were just admitted. Which patient should the nurse assess first? -The NPO patient with a blood glucose level of 80 mg/dL who just received 20 units of 70/30 Novolin insulin. -The patient with a pulse of 58 beats per minute who is about to receive digoxin [Lanoxin]. -The patient with a blood pressure of 136/92 mm Hg who complains of having a headache. -The patient with an allergy to penicillin who is receiving an infusion of vancomycin [Vancocin].
-Decreases glucose in the blood thus decreasing the need for more insulin just after exercise.
The patient with diabetes has decided to start an exercise program. He remembers that the nurse told him that exercise: -Increases glucose in the blood thus increasing the need for insulin just after exercise. -Decreases glucose in the blood thus decreasing the need for more insulin just after exercise. -Does not affect glucose or the need for insulin. -Decreases glucose
True
True or False:Regular insulin interacts with many drugs. For example, alcohol, salicylates, monoamine oxidase inhibitors (MAOIs), and anabolic steroids may increase hypoglycemic effects?
False
True or False:Research has definitively proven that supplementation of the diet with omega-3 fatty acids improves the risk of developing cardiovascular disease among diabetic patients?
True
True or false: Because normal insulin secretion varies greatly in response to daily activities, glucose monitoring and insulin administration must be carefully planned?
-Lantus should not be mixed with any other insulin.
What information should the nurse give to the diabetic client who is starting on glargine (Lantus)? -Lantus should not be mixed with any other insulin. -Eat a complex carbohydrate within 15 minutes of administration to prevent hypoglycemia. -Stress does not increase insulin needs. -Withhold insulin if you are feeling better.
-Glycosylated hemoglobin level
What is the most reliable measure for assessing diabetes control over the preceding 3-month period? -Self-monitoring blood glucose (SMBG) graph report -Patient's report -Fasting blood glucose level -Glycosylated hemoglobin level
-Exenatide (Byetta)
Which of the following medications prescribed for a type 2 diabetic client is needed to optimize the secretion of insulin, slows glucose absorption, and decreases action of glucagons? -Exenatide (Byetta) -Repaglinide (Prandin) -Rosiglitazone (Avandia) -Glucophage (Metformin)
-Miglitol has not been associated with hepatic dysfunction.
Which statement is correct about the contrast between acarbose and miglitol? -Miglitol has not been associated with hepatic dysfunction. -With miglitol, sucrose can be used to treat hypoglycemia. -Miglitol is less effective in African Americans. -Miglitol has no gastrointestinal side effects.
-Regular
Your client is admitted to the intensive care unit with diabetic ketoacidosis. You know that your client will be placed on an intravenous insulin drip. The only type of insulin which can be administered intravenously is: -NPH. -Ultralente. -Regular. -Lente.
