chapter 38
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? 06:00 06:20 06:45 07:00
06:45
A 54-year-old male client is diagnosed with chronic renal failure and hyperglycemia. He asks if he can be prescribed sulfonylurea because it works well for his friend. If he were to be given sulfonylurea, this client's renal impairment may lead to what effect? Decreased absorption of the sulfonylurea Accumulation and hyperglycemic reactions Hypersensitivity to sulfonylurea Accumulation and hypoglycemia
Accumulation and hypoglycemia
The nurse is caring for a client who has been prescribed glyburide. Which factor, if identified in the client history, would cause the nurse to inform the health care provider of a contraindication to use? The ingestion of carbohydrates Increase in alkaline phosphatase Allergy to sulfonamides A diagnosis of hypertension
Allergy to sulfonamides
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? Assess the most recent hemoglobin A1C levels. Dialogue with the client about implemented management strategies. Review and discuss the data contained in the client's written blood glucose log. Arrange to have the client's random blood glucose measured.
Assess the most recent hemoglobin A1C levels.
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 2 PM and 4 PM Between 12 noon and 8 PM Between 10 AM and 12 noon Between 8:30 AM and 9:30 AM
Between 8:30 AM and 9:30 AM
The nurse is educating a client who is beginning therapy with acarbose and tells the client to take the medication with the first bite of each main meal to help prevent what adverse effect? Nausea and vomiting Bloating and diarrhea Dizziness Chest pain
Bloating and diarrhea
When describing the effects of incretins on blood glucose control to a group of students, which would an instructor include? Increases protein building Increases insulin release Increases glucagon release Increases GI emptying
Increases insulin release
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 blood glucose demonstrates longstanding hypoglycemia. Client's blood glucose levels are not consistent. Client's average blood glucose is above normal.
Client's average blood glucose is above normal.
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. Client's blood glucose levels are not consistent. Client's blood glucose demonstrates longstanding hypoglycemia. Client is in good glycemic control.
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. Inject pramlintide in the same site where insulin is administered. Mix pramlintide in the same syringe with insulin. Pramlintide should only be injected in the hip.
Do not give pramlintide in the same site where insulin is administered.
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? Entry of glucose into the cells Interruption of glucose movement across the membrane Storage of glucagon in the cells Release of glucagon from the cells
Entry of glucose into the cells
The nurse is providing education to the parents of a child newly diagnosed with type 1 diabetes. What distinguishing characteristic of the disorder does the nurse include in the teaching? Exogenous insulin is required for life. Oral agents can control blood sugar. Blood glucose levels can be controlled by diet. The disease always starts in childhood.
Exogenous insulin is required for life.
What would alert the nurse to suspect that a client is developing ketoacidosis? Fruity breath odor Hunger Fluid retention Blurred vision
Fruity breath odor
The nurse is providing education to a client who has been prescribed therapy with an antidiabetic medication. During teaching, the nurse will caution the client against heavy intake of which herb? Oregano Anise Basil Garlic
Garlic
The nurse monitoring a client receiving insulin glulisine 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.) Glucose tablets Insulin glargine (Lantus) Hard candy Insulin detemir (Levemir) Orange or other fruit juice
Glucose tablets Hard candy Orange or other fruit juice
When administering insulin, what would be most appropriate? Insert the needle at a 45-degree angle for injection. Firmly spread the skin of the area of the intended site of injection. Massage the injection site firmly after removing the needle and syringe. Shake the vial vigorously to ensure thorough mixing before drawing up the dose.
Insert the needle at a 45-degree angle for injection.
Which would be appropriate to include in teaching a client with type 2 diabetes? Until you need to start insulin injections, you do not have to check your blood sugar. Clients with type 2 diabetes always progress to insulin injections if they do not follow dietary guidelines. It is possible with weight loss and exercise to discontinue the use of antidiabetic medication. If you drink alcohol, it may be necessary to increase your oral antidiabetic medication.
It is possible with weight loss and exercise to discontinue the use of antidiabetic medication.
What is the expected action of sitagliptin on type 2 diabetes? It slows the rate of inactivation of the incretin hormones. It blocks the S phase of the cell cycle. It inhibits hydrogen, potassium, and ATPase. It is a synthetically prepared monosodium salt.
It slows the rate of inactivation of the incretin hormones.
Which would be least appropriate when administering insulin by subcutaneous injection? Massaging the site after removing the needle Using a 25 gauge 1/2-inch needle Inserting the needle at a 45-degree angle Injecting the insulin slowly
Massaging the site after removing the needle
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? Lispro. Regular. Insulin glargine. Isophane insulin (NPH).
Regular.
A nurse is caring for a client with elevated blood glucose levels who is to receive alpha-glucosidase inhibitor drug therapy. The nurse understands that this therapy would be contraindicated if the client had which condition? Select all that apply. chronic intestinal diseases type I diabetes colonic ulceration severe heart failure cirrhosis
cirrhosis chronic intestinal diseases colonic ulceration
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? "This will make it easier for me to give my own insulin because of my poor eyesight." "I need to turn the dial on the pen and listen for the locking ring before administering my insulin." "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."
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 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."
"Insulin assists glucose molecules to enter the cells of muscle and fat tissues."
A patient is taking chlorpropamide. The nurse warns the patient about the possibility of hypoglycemia within approximately which time frame after taking the drug? 2 to 3 hours 3 to 4 hours 1 to 2 hours 4 to 5 hours
3 to 4 hours
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? Hypoglycemia Bradycardia Hypotension Lipodystrophy
Hypoglycemia
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. Do not administer insulin kept at room temperature. Check for symptoms of myalgia or malaise. Keep prefilled syringes horizontally.
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? Assess the skin for ulcers, cuts, and sores. Document family medical history. Observe the patient for hypoglycemic episodes. Monitor the patient for lipodystrophy.
Observe the patient for hypoglycemic episodes.
A student asks the nursing instructor what insulin has the quickest therapeutic effect once administered. What would be the best response? PZI (Humulin U) Ultralente (Humulin U Ultralente) NPH (Humulin N) Regular (Humulin R)
Regular (Humulin R)
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 lispro insulin aspart isophane insulin suspension insulin glargine
insulin glargine
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 isophane (NPH) isophane (NPH) insulin lispro
insulin lispro
A client's current condition requires rapid reduction of blood sugar levels. Which type of insulin will have the most rapid onset of action? insulin lispro isophane (NPH) Humulin R isophane (NPH)
insulin lispro
A nurse is preparing to administer a rapid-acting insulin. Which medication would the nurse most likely administer? isophane insulin suspension insulin glargine insulin lispro insulin detemir
insulin lispro
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? d-dimer platelet count liver enzymes creatinine
liver enzymes
When considering the management of diabetic ketoacidosis (DKA), what type of insulin can be administered intravenously? isophane insulin (NPH) lispro insulin glargine regular
regular
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 1 or 2 months the past 12 to 24 hours the past 7 to 10 days the past 3 or 4 months
the past 3 or 4 months
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 12 to 24 hours the past 3 or 4 months the past 7 to 10 days the past 1 or 2 months
the past 3 or 4 months
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? decreased respiratory rate and hot, dry skin. increased thirst and increased urine output. increased pulse rate and fruity smelling breath. weakness, sweating, and decreased mentation.
weakness, sweating, and decreased mentation.
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? Assess the skin for ulcers, cuts, and sores. Observe the patient for hypoglycemic episodes. Document family medical history. Monitor the patient for lipodystrophy.
Observe the patient for hypoglycemic episodes.
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 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." "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 assists glucose molecules to enter the cells of muscle and fat tissues."