Chapter 38: Agents to Control Blood Glucose Levels
A nurse is caring for a client receiving metformin drug therapy to improve glycemic control. What adverse reaction to the drug should the nurse monitor the client for? A. asthenia B. UTI C. back pain D. flu symptoms
asthenia Explanation: The nurse should monitor the client for asthenia, abnormal physical weakness or lack of energy, which is an adverse reaction to metformin. UTI, back pain, and flu symptoms are adverse reactions to nateglinide.
The nurse is instructing a client how to take a prescribed pramlintide. Which would be most appropriate? A. "Give it by subcutaneous injection immediately before your major meals." B. "Take the drug orally once a day, preferably in the morning." C. "Give yourself an injection 1 hour before you eat breakfast and dinner." D. "Take the drug orally with the first bite of each meal."
"Give it by subcutaneous injection immediately before your major meals." Explanation: Pramlintide is administered subcutaneously immediately before major meals. Numerous antidiabetic drugs are taken orally, often once a day in the morning. Exenatide is given subcutaneously within 1 hour before the morning and evening meals. Miglitol should be taken orally with the first bite of each meal.
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? A. A diagnosis of hypertension B. The ingestion of carbohydrates C. Allergy to sulfonamides D. Increase in alkaline phosphatase
Allergy to sulfonamides Explanation: Sulfonylureas are contraindicated in clients with hypersensitivity to them, with severe renal or hepatic impairment, and who are pregnant. A diagnosis of hypertension does not cause contraindication of sulfonylureas. The client should consume carbohydrates in association with the oral hypoglycemic agent. An increase in alkaline phosphatase does not result in the contraindication of glyburide.
As the nurse caring for a young child is diagnosed with type 1 diabetes (IDDM), you know that they become at high risk for what and you include assessment and management of this in their care plan? A. Disturbed sleep pattern B. Anxiety C. Self-care deficit D. Delayed growth and development
Delayed growth and development Explanation: Effective management requires a consistent schedule of meals, snacks, blood glucose monitoring, insulin injections and dose adjustments, and exercise. Food intake must be synchronized with insulin injections and usually involves three meals and three snacks, all at regularly scheduled times. Such a schedule is difficult to maintain in children but extremely important in promoting normal growth and development. These children are not generally at risk for disturbed sleep patterns, anxiety, or self-care deficits.
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? A. Blood glucose levels can be controlled by diet. B. Exogenous insulin is required for life. C. Oral agents can control blood sugar. D. The disease always starts in childhood.
Exogenous insulin is required for life. Explanation: Type 1 diabetes will result in eventual destruction of beta cells, and no insulin is produced. Therefore, the client will require insulin supplementation (exogneous insulin) for life. The blood glucose level can only be controlled by diet in type 2 diabetes. In type 2 diabetes, oral agents can be administered. Type 1 diabetes is diagnosed in ages 4 through 20 years, not only in childhood.
What would alert the nurse to suspect that a client is developing ketoacidosis? A. Fluid retention B. Blurred vision C. Hunger D. Fruity breath odor
Fruity breath odor Explanation: Fruity breath odor would be noted as ketones build up in the system and are excreted through the lungs. Dehydration would be noted as fluid and electrolytes are lost through the kidneys. Blurred vision and hunger would be associated with hypoglycemia.
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? A. Garlic B. Anise C. Basil D. Oregano
Garlic Explanation: Garlic has been known to cause hypoglycemia when taken with antidiabetic medications. Anise, basil, and oregano are not noted to carry this risk.
Which is the best indicator of overall diabetic control? A. Fasting blood glucose levels B. 2-hour postprandial blood glucose levels C. Absence of acetone in the urine D. Glycosylated hemoglobin levels
Glycosylated hemoglobin levels Explanation: The glycosylated hemoglobin indicates glucose bound to hemoglobin in red blood cells (RBCs) when RBCs are exposed to hyperglycemia. The binding is irreversible and lasts for the lifespan of RBCs (approximately 120 days). The test reflects the average blood sugar level during the previous 2 to 3 months. The goal is usually less than 7% (blood level 0.07). The range for people without diabetes is approximately 4% to 6% (blood level 0.04 to 0.06).
The nurse is caring for a client who is taking a thiazide diuretic, a corticosteroid, and estrogens. The nurse understands that this client is at risk for what condition? A. Hypoglycemia B. Pulmonary hypertension C. Congestive heart failure D. Hyperglycemia
Hyperglycemia Explanation: Renal insufficiency may increase risks of adverse effects with antidiabetic drugs, and treatment with thiazide diuretics, corticosteroids, estrogens, and other drugs may cause hyperglycemia, thereby increasing dosage requirements for antidiabetic drugs.
When administering insulin, what would be most appropriate? A. Shake the vial vigorously to ensure thorough mixing before drawing up the dose. B. Firmly spread the skin of the area of the intended site of injection. C. Insert the needle at a 45-degree angle for injection. D. Massage the injection site firmly after removing the needle and syringe.
Insert the needle at a 45-degree angle for injection. Explanation: The vial should be gently rotated and vigorous shaking is to be avoided to ensure uniform suspension of the insulin. Typically the area is pinched to allow access to the loose connective tissue layer. The needle is inserted at a 45-degree angle for subcutaneous administration. Gentle pressure should be applied at the injection site.
A female client is prescribed metformin to decrease her blood glucose levels associated with diabetes mellitus type 2. Which statement accurately describes the action of metformin? A. It stimulates insulin release from the beta cells of the pancreas. B. It increases intestinal absorption of glucose and improves insulin sensitivity. C. It decreases intestinal absorption of glucose and improves insulin sensitivity. D. It reduces postprandial glucose levels substantially in combination with insulin.
It decreases intestinal absorption of glucose and improves insulin sensitivity. Explanation: Metformin reduces the production of glucose by the liver and decreases the intestinal absorption of glucose to increase insulin sensitivity, while glyburide works by stimulating insulin release from the beta cells of the pancreas and reducing glucose output from the liver. On the other hand, postprandial glucose levels substantially are reduced by acarbose and miglitol when administered either alone or in combination with insulin or sulfonylurea.
Which would be appropriate to include in teaching a client with type 2 diabetes? A. Until you need to start insulin injections, you do not have to check your blood sugar. B. Clients with type 2 diabetes always progress to insulin injections if they do not follow dietary guidelines. C. It is possible with weight loss and exercise to discontinue the use of antidiabetic medication. D. 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. Explanation: Exercise is perhaps the best therapy for the prevention of both type 2 diabetes and the metabolic syndrome. Exercise is an extremely strong hypoglycemic agent.
After teaching a class about the various drugs used to control blood glucose, the instructor determines that the teaching was successful when the class identifies what as a biguanide? A. Metformin B. Miglitol C. Tolbutamide D. Glipizide
Metformin Explanation: Metformin is classified as a biguanide. Miglitol is an alpha-glucosidase inhibitor. Tolbutamide is a first generation sulfonylurea. Glipizide is a second generation sulfonylurea.
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.) A. Regular insulin B. Metformin (Glucophage) C. Acarbose (Precose) D. Chlorpropamide (Diabinese) E. Miglitol (Glyset)
Metformin (Glucophage) Acarbose (Precose) Miglitol (Glyset) Explanation: Alpha (α)-Glucosidase Inhibitors (AGI) and metformin are contraindicated (or used with great caution) in clients with renal disease. Regular insulin and chlorpropamide, which is a sulfonylurea, can be used in clients with renal disease.
A client has refused a scheduled dose of metformin, stating that he/she is worried about inducing hypoglycemia because his/her blood glucose level is currently 66 mg/dL (3.66 mmol/L). The nurse should convey what teaching points to the client? A. Metformin does not cause hypoglycemia. B. Hypoglycemia is only a risk in clients with type 1 diabetes. C. Overuse of metformin creates a risk for hyperglycemia, not hypoglycemia. D. If the client has been taking metformin for more than 3 to 4 weeks, there is no risk for hypoglycemia.
Metformin does not cause hypoglycemia. Explanation: Experts prefer to call metformin an antihyperglycemic rather than a hypoglycemic because it does not cause hypoglycemia, even in large doses, when used alone. This fact about metformin makes the other statements inaccurate.
A client diagnosed with type 1 diabetes suddenly reports feeling weak, shaky, and dizzy. What should be the nurse's initial response? A. Perform a blood sugar analysis. B. Have the client drink a 4-ounce (120-mL) glass of orange juice. C. Administer 1 ampule of 50% dextrose intravenously. D. Administer 10 units of regular insulin subcutaneously.
Perform a blood sugar analysis. Explanation: As long as the client is awake and verbally responsive, check the blood glucose level first. Hypoglycemia can make a client feel weak, confused, irritable, hungry, or tired, but assessment must precede interventions; this makes the other options inappropriate.
A student asks the nursing instructor what insulin has the quickest therapeutic effect once administered. What would be the best response? A. PZI (Humulin U) B. NPH (Humulin N) C. Regular (Humulin R) D. Ultralente (Humulin U Ultralente)
Regular (Humulin R) Explanation: Regular insulin has the quickest onset of 30-60 minutes. PZI and ultralente have an onset of 4-8 hours. NPH has an onset of 60-90 minutes.
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? A. Myalgia B. Tachycardia C. Flatulence D. Epigastric discomfort
Tachycardia Explanation: The nurse should monitor for tachycardia, congestive heart failure, sodium and fluid retention, hyperglycemia, and glycosuria as the adverse reactions in the patient receiving diazoxide drug therapy. Myalgia, fatigue, and headache are the adverse reactions observed in patients undergoing pioglitazone HCl drug therapy. Flatulence is one of the adverse reactions found in patients receiving metformin drug therapy. Epigastric discomfort is one of the adverse reactions observed in patients receiving acetohexamide drugs.
A client diagnosed with type 2 diabetes several months ago has presented for a scheduled follow-up appointment. Which stated behavior most clearly indicates that the client has established effective health maintenance? A. The client exercises two to three times per week. B. The client reports having gone on a diet. C. The client frequently checks blood glucose levels. D. The client can describe the differences between type 1 and type 2 diabetes.
The client frequently checks blood glucose levels. Explanation: Vigilant blood glucose monitoring is imperative in the management of diabetes. This shows effective health maintenance even more clearly than exercising. Dietary modifications must be undertaken with care in people with diabetes to avoid health consequences. Explaining pathophysiology does not necessarily show effective health maintenance.
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? A. Infection B. Impaired glucose tolerance C. Poor insulin injection technique D. Widespread changes in the blood vessels
Widespread changes in the blood vessels Explanation: Diabetes can cause significant vascular problems. Brown spots on the lower legs of a diabetic patient are caused by small hemorrhages into the skin and may indicate widespread changes in the blood vessels.
Which medication would a nurse identify as a noninsulin injectable antidiabetic drug? A. exenatide B. sitagliptin C. glipizide D. pioglitazone
exenatide Explanation: Exenatide and pramlintide are noninsulin injectable antidiabetic drugs. Sitagliptin, glipizide, and pioglitazone are oral agents.
The nurse educator works at the diabetes clinic. When talking to a class of adolescent diabetics, the educator tells the students that the most recognized signs of diabetes are: A. hyperglycemia and glycosuria. B. hypoglycemia and glucagon levels. C. carbohydrate use and insulin levels. D. protein intake and hyperglycemia.
hyperglycemia and glycosuria. Explanation: The most frequently recognized clinical signs of diabetes are hyperglycemia (fasting blood sugar level greater than 106 mg/dL) and glycosuria (the presence of sugar in the urine).
When reviewing the medication list of a client being seen in the clinic, the nurse notes that the client is receiving glipizide. Based on the nurse's understanding, this drug is used to treat: A. hypokalemia. B. hyperkalemia. C. hypoglycemia. D. hyperglycemia.
hyperglycemia. Explanation: Glipizide is an antidiabetic agent with the desired action of lowering the blood glucose level. It is used to treat hyperglycemia. It would worsen, not treat, hypoglycemia, and it has no role in treating abnormal potassium levels (hypokalemia or hyperkalemia).
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? A. insulin glargine B. insulin lispro C. insulin aspart D. isophane insulin suspension
insulin glargine Explanation: Insulin glargine is an example of a long-acting insulin. Insulin lispro and insulin aspart are rapid-acting insulin. Isophane insulin suspension is an intermediate-acting insulin.
A 58-year-old male client, diagnosed with diabetes at age 14, reports having pain in both feet and hands. What is this pain most likely a result of? A. a diabetes-related infectious process B. peripheral neuropathy C. an autoimmune disorder D. hypertension resulting from diabetes
peripheral neuropathy Explanation: Pain in the feet and hands is related to changes in small blood vessels resulting in neuropathy. The long-term effect of diabetes can result in an infectious process, but the pain described is not indicative of an infection. Latent autoimmune diabetes of the adult has an onset in adulthood and thus is not a long-term disorder. Hypertension is a long-term chronic effect of diabetes but is not what has been described with pain in the feet and hands.
A client newly diagnosed with type 2 diabetes has attended educational sessions to provide insight into the diagnosis. Which of the client's statements should prompt the nurse to provide further teaching? A. "I don't like getting this diagnosis, but I know that treatment now can prevent future health consequences." B. "I'm disappointed, but I take some solace in the fact that I won't ever have to have insulin injections." C. "People always tried to encourage me to lose weight, and I suppose they might have been right." D. "From what I've learned, I know that the basic problem is that my pancreas can't keep up with my insulin needs."
"I'm disappointed, but I take some solace in the fact that I won't ever have to have insulin injections." Explanation: Among people with type 2 diabetes, 20% to 30% require exogenous insulin at some point in their lives. Obesity is a major cause, and vigilant treatment can prevent future sequelae. The essence of type 2 diabetes is the pancreas' inability to meet insulin needs.
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? A. Administer glucagon by the parenteral route. B. Administer the insulin via insulin pump. C. Administer oral antidiabetics to the patient. D. Give oral fluids or candy.
Give oral fluids or candy. Explanation: The nurse should administer oral fluids or candy to the hypoglycemic patient with swallowing and gag reflexes. If the patient is unconscious the nurse should administer glucose or glucagon parenterally. The nurse should administer insulin through an insulin pump to special categories of diabetic patients, such as pregnant women with diabetes and renal transplantation. Oral antidiabetic drugs are administered to patients with type 2 diabetes.
What is the expected action of sitagliptin on type 2 diabetes? A. It blocks the S phase of the cell cycle. B. It slows the rate of inactivation of the incretin hormones. C. It is a synthetically prepared monosodium salt. D. It inhibits hydrogen, potassium, and ATPase.
It slows the rate of inactivation of the incretin hormones. Explanation: Sitagliptin minimizes the rate of inactivation of the incretin hormones to increase hormone levels and prolong their activity. Sitagliptin does not block the S phase of the cell cycle. Sitagliptin is not a synthetically prepared monosodium salt nor does it inhibit hydrogen, potassium, and ATPase.
The nurse is preparing to administer insulin intravenously to a client with a blood glucose level over 600 mg/dL (33.33 mmol/L). What type of insulin will the nurse most likely give? A. NPH insulin B. Lente insulin C. Ultralente insulin D. Regular insulin
Regular insulin Explanation: Regular insulin has rapid onset of action and can be given via IV. It is the drug of choice for acute situations, such as diabetic ketoacidosis. Isophane insulin (NPH) is used for long-term insulin therapy. Lente insulin is an intermediate-acting insulin. Ultralente insulin is a long-acting insulin.
A client with hypertension is diagnosed with type 2 diabetes. For which reason would the nurse closely monitor the client when giving glyburide with metoprolol? A. Blood pressure will increase. B. Blood glucose levels will increase. C. Orthostatic hypotension can develop. D. Signs of hypoglycemia may be masked.
Signs of hypoglycemia may be masked. Explanation: Glyburide is a second-generation sulfonylurea used to treat type 2 diabetes. Caution should be used when giving this medication with a beta blocker such as metoprolol because the signs of hypoglycemia may be masked. Taking glyburide with metoprolol will not cause an increase in blood pressure or increase blood glucose levels. These medications will not cause the development of orthostatic hypotension.
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? A. "Insulin is used to move carbohydrate particles from the gastrointestinal system to the liver." B. "Insulin is stimulated by the liver to break down proteins and provide the body with nutrients." C. "Insulin assists glucose molecules to enter the cells of muscle and fat tissues." D. "Insulin causes fat to be broken down to provide energy for the body."
"Insulin assists glucose molecules to enter the cells of muscle and fat tissues." Explanation: Insulin appears to activate a process that helps glucose molecules enter the cells of striated muscle and adipose tissue. It also stimulates the synthesis of glycogen by the liver, promotes protein synthesis, and helps the body store fat by preventing its breakdown for energy.
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? A. Release of glucagon from the cells B. Entry of glucose into the cells C. Interruption of glucose movement across the membrane D. Storage of glucagon in the cells
Entry of glucose into the cells Explanation: After insulin-receptor binding occurs, cell membranes become highly permeable to glucose and allow rapid entry of glucose into the cells.
A nurse is assigned to administer glargine to a patient at a health care facility. What precaution should the nurse take when administering glargine? A. Administer glargine via IV route. B. Avoid mixing glargine with other insulin. C. Shake the vial vigorously before withdrawing insulin. D. Administer insulin that has been refrigerated.
Avoid mixing glargine with other insulin. Explanation: When administering glargine to the patient, the nurse should avoid mixing it with other insulin or solutions. It will precipitate in the syringe when mixed. If glargine is mixed with another solution, it will lose glucose control, resulting in decreased effectiveness of the insulin. Glargine is administered via SC once daily at bedtime. The nurse should not shake the vial vigorously before withdrawing insulin. The vial should be gently rotated between the palms of the hands and tilted gently end-to-end immediately before withdrawing the insulin. The nurse administers insulin from vials at room temperature. Vials are stored in the refrigerator if it is to be stored for about three months for later use.
A 6-month-old client is prescribed insulin therapy while in the neonatal intensive care unit (NICU). The client is crying and vigorously flailing about in the crib. What action should the nurse take to best assure safe, accurate delivery of the medication? A. Dilute the insulin to a volume that can be safely identified on the syringe. B. Check the calculation and dose with another registered nurse (RN). C. Use an insulin pump to deliver the prescribed medication dose. D. Have a nurse hold the client's extremities while administering the medication.
Check the calculation and dose with another registered nurse (RN). Explanation: The primary concern is the accuracy of the insulin dosage. Insulin dose, especially in infants, may be so small that it is difficult to calibrate. Insulin often needs to be diluted to a volume that can be detected on the syringe. Regardless of the route and/or delivery method, it is most important that a second registered nurse (RN) always check the calculations and dose of insulin being given to small children. While stabilizing the infant's extremities is appropriate, the critical intervention still focuses on the accurate dosage of the insulin.
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? A. Administer the insulin to the client. B. Check the dosage with another nurse. C. Check the client's blood sugar again. D. Ensure a meal tray is available.
Check the dosage with another nurse. Explanation: After preparing the syringe with insulin, the nurse should then have the medication and dosage checked by a second nurse to make sure that it is correct. It is not necessary to recheck the client's blood sugar again. It is important to know when the client will be eating again; make sure that it is within the next 30 minutes. However, this is not the nurse's next step. Then the nurse will administer the insulin to the client.
The nurse is administering an antidiabetic agent by subcutaneous injection within 60 minutes of the client's breakfast. Which agent would the nurse most likely be administering? A. Exenatide B. Rosiglitazone C. Repaglinide D. Miglitol
Exenatide Explanation: Exenatide is administered by subcutaneous injection within 60 minutes before morning and evening meals. Rosiglitazone would be administered as a single oral dose. Repaglinide is used orally before meals. Miglitol is given orally with the first bite of each meal.
A man is brought to the emergency department. He is nonresponsive, and his blood glucose level is 32 mg/dL. Which would the nurse expect to be ordered? A. Insulin lispro B. Glucagon C. Diazoxide D. Regular insulin
Glucagon Explanation: The client is significantly hypoglycemic and needs emergency treatment. Glucagon would be the agent of choice to raise the client's glucose level because it can be given intravenously and has an onset of approximately 1 minute. Diazoxide can be used to elevate blood glucose levels, but it must be given orally. Lispro and regular insulin would be used to treat hyperglycemia.
Which would a nurse identify as an example of a sulfonylurea? A. Glyburide B. Metformin C. Acarbose D. Miglitol
Glyburide Explanation: Glyburide is an example of a sulfonylurea. Metformin is classified as a biguanide. Acarbose and miglitol are alpha-glucosidase inhibitors.
The nurse is preparing to administer 20 units of NPH insulin to a client. Before administering the medication, the nurse should implement which intervention? A. Massage the chosen injection site. B. Assess the client's understanding of diabetes. C. Assess the client's urine for the presence of glucose. D. Have a colleague confirm the dosage.
Have a colleague confirm the dosage. Explanation: Before administering insulin, client safety requires that two nurses always check the dosage. Assessing the client's understanding of the disease may or may not be appropriate or necessary at this time. Injection sites are not massaged before administration. It is not necessary to assess urine for the presence of glucose.
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? A. Bradycardia B. Lipodystrophy C. Hypoglycemia D. Hypotension
Hypoglycemia Explanation: Changing the type of insulin requires caution, and the client should be carefully monitored for hypoglycemia or hyperglycemia, either of which may occur as the body adjusts to the different pharmacokinetics of the preparation. However, hypoglycemia may cause an increased sympathetic activity and manifest as tachycardia. Lipodystrophy is caused by the breakdown of subcutaneous fat because of repeated insulin injections at the same site. A change of insulin prescription is not known to cause hypotension.
When describing the effects of incretins on blood glucose control to a group of students, which would an instructor include? A. Increases glucagon release B. Increases GI emptying C. Increases insulin release D. Increases protein building
Increases insulin release Explanation: Incretins increase insulin release, decrease glucagon release, slow GI emptying, and stimulate the satiety center. Growth hormone increases protein building.
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? A. Inspect the previous injection site for inflammation. B. Keep prefilled syringes horizontally. C. Check for symptoms of myalgia or malaise. D. Do not administer insulin kept at room temperature.
Inspect the previous injection site for inflammation. Explanation: The nurse should check the previous injection site before administering each insulin dose. The injection sites should be rotated to prevent lipodystrophy. Prefilled syringes should not be kept horizontally; they should be kept in a vertical or oblique position to avoid plugging the needle. The nurse checks for symptoms of myalgia or malaise when administration of metformin leads to lactic acidosis. Insulin should be kept at room temperature for administration. Insulin is refrigerated if it needs to be stored for up to three months for later use.
A client newly diagnosed with type 1 diabetes asks the nurse why the client cannot just take a pill. The nurse would incorporate what knowledge when responding to this client? A. Insulin is needed because the beta cells of the pancreas are no longer functioning. B. The insulin is more effective in establishing control of blood glucose levels initially. C. More insulin is needed than that which the client can produce naturally. D. The client most likely does not exercise enough to control his glucose levels.
Insulin is needed because the beta cells of the pancreas are no longer functioning. Explanation: Insulin is needed in type 1 diabetes because the beta cells of the pancreas are no longer functioning. With type 2 diabetes, insulin is produced, but perhaps not enough to maintain glucose control or the insulin receptors are not sensitive enough to insulin.
The nurse admitted a 4-year-old child with type 1 diabetes mellitus. The nurse educates the parents that hypoglycemia can occur as an adverse effect of insulin. The nurse helps the parents to understand that in young children, hypoglycemia may manifest as what signs or symptoms? (Select all that apply.) A. Irritability B. Anorexia C. Impaired mental functioning D. Hallucinations E. Lethargy
Irritability Impaired mental functioning Lethargy Explanation: In young children, hypoglycemia may be manifested by changes in behavior, including severe hunger, irritability, and lethargy. In addition, mental functioning may be impaired in all age groups, even with mild hypoglycemia. Anytime hypoglycemia is suspected, blood glucose should be tested.
The nurse admits a client with type 2 diabetes who takes metformin (Glucophage).The nursing diagnosis given is ineffective breathing pattern. What complication of the client's current drug therapy does the nurse believe the client is experiencing? Deficient fluid volume Lactic acidosis Fluid overload Hyperkalemia
Lactic acidosis Explanation: When taking metformin, the client is at risk for lactic acidosis, which causes hyperventilation, myalgia, malaise, GI symptoms, or unusual somnolence. Respiratory alkalosis, fluid overload, and hyperkalemia would be unlikely complications with metformin.
A client is prescribed sitagliptin. The nurse would expect to administer this drug by which route? A. Oral B. Subcutaneous C. Intramuscular D. Intravenous
Oral Explanation: Sitagliptin is administered orally.
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.) A. Orange or other fruit juice B. Glucose tablets C. Insulin glargine (Lantus) D. Hard candy E. Insulin detemir (Levemir)
Orange or other fruit juice Glucose tablets Hard candy Explanation: Methods of terminating a hypoglycemic reaction include the administration of one or more of the following: orange or other fruit juice, hard candy or honey, glucose tablets, glucagon, or glucose 10 percent or 50 percent IV.
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? A. Subcutaneous injection B. Insulin pen C. Jet injector D. Implantable infusion pump
Subcutaneous injection Explanation: Subcutaneous injection currently is the most common method for administering insulin.
Which condition must be met in order for glyburide treatment to be effective? A. The client must have functioning pancreatic beta cells. B. The client must have hemoglobin A1C of ≤7%. C. The client must not have hyperglycemia. D. The client must be able to self-administer the medication.
The client must have functioning pancreatic beta cells. Explanation: Because glyburide stimulates pancreatic beta cells to produce more insulin, it is effective only when functioning pancreatic beta cells are present. The presence of normal blood glucose levels would render the medication unnecessary. Self-administration is common but not absolutely necessary.
The nurse is conducting a class for newly diagnosed adult diabetic patients. What would the nurse educate the patients about? A. Nutritional understanding B. Preservation of intact skin C. The disease D. Self-care
The disease Explanation: While it would be important to teach the patients about nutrition, the preservation of intact skin and self-care, adults need extensive education about the disease as well as the drug therapy. Warning signs and symptoms should be stressed repeatedly as the adult learns to juggle insulin needs with exercise, stressors, other drug effects, and diet.
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? A. liver enzymes B. platelet count C. d-dimer D. creatinine
liver enzymes Explanation: Rosiglitazone has been associated with hepatotoxicity and requires monitoring of liver enzymes. Liver function tests (e.g., serum aminotransferase enzymes) should be checked before starting therapy and every 2 months for 1 year, then periodically. Platelets, d-dimer, and tests of renal function are less significant to the safety and efficacy of treatment.
The nurse should include what information when educating a client prescribed insulin regarding the characteristics of hypoglycemia? Select all that apply. A. the onset of symptoms/signs is sudden B. characterized by feeling sluggish C. affected by increased emotion D. triggered by missing a regular meal E. associated with a lack of insulin
the onset of symptoms/signs is sudden affected by increased emotion triggered by missing a regular meal Explanation: Hypoglycemia, or a blood glucose concentration lower than 60 mg/dL, is associated with an increase in serum insulin levels. It is triggered by a lack of food, an increase in stress, either emotional or physical or a variety of other factors. This physiological state brings about a the sudden feeling of anxiety and the activity associated with the fight or flight reaction.
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? A. the past 3 or 4 months B. the past 7 to 10 days C. the past 1 or 2 months D. the past 12 to 24 hours
the past 3 or 4 months Explanation: Glycosylated hemoglobin measures glucose control over the past 3 to 4 months. When blood glucose levels are high, glucose molecules attach to hemoglobin in the red blood cell. The longer the hyperglycemia lasts, the more glucose binds to the red blood cell and the higher the glycosylated hemoglobin. This binding lasts for the life of the red blood cell (about 4 months) so the other time frames would not be accurate.
