Chapter 38: Agents to Control Blood Glucose Levels Questions

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.

A nurse is providing client education to a 13-year-old girl who was just diagnosed with type 1 diabetes mellitus. Which statement by the client will alert the nurse that special instructions regarding insulin are necessary? a. "I walk two blocks to school every day." b. "I am on the middle school track team." c. "We live in a two-story house." d. "My mother is going to give me my insulin."

"I am on the middle school track team." Explanation: Because the client is on the track team, she will have increased exercise at various times that will require increased insulin and special instructions related to hypoglycemia that may come hours after she has ceased exercising. Walking two blocks every day and walking up stairs would not be considered increased physical exercise and would not be a factor. Wanting to have her mother administer the insulin is not uncommon for this age client, and the nurse would normally instruct both the mother and the daughter in the administration of the drug.

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.

What statement would be appropriately included in the teaching concerning type 2 diabetes? a. "Regular exercise makes your body better able to use the insulin it produces." b. "Until you need to start insulin injections, you do not have to check your blood sugar." c. "Clients with type 2 diabetes always progress to insulin injections if they do not follow dietary guidelines." d. "If you drink alcohol, it may be necessary for you to increase your oral antidiabetic medication."

"Regular exercise makes your body better able to use the insulin it produces." Explanation: People who need less than 0.5 units/kg/d may produce some endogenous insulin, or their tissues may be more responsive to insulin because of exercise and good physical conditioning. Exercise is an extremely strong hypoglycemic agent. Diabetics need to check their blood sugar level regardless of whether they are or are not prescribed insulin. The need for insulin injections is determined by the function of the pancreas and its ability to produce sufficient quantities of insulin. It is not correct to assume diet is the only factor in this process. Alcohol should be avoided, and the dosage of oral antidiabetic medication should not be altered without guidance from a health care provider.

A 42-year-old male client is prescribed glargine insulin for management of his type 2 diabetes mellitus. The nurse caring for the client develops a teaching plan regarding glargine insulin therapy. Which statement made by the client indicates that the client needs additional teaching? a. "The insulin is given only once per day, at night." b. "I must give this insulin alone and not mix with other insulins." c. "The medication will peak in 3 hours." d. "I should not administer the insulin if it is cloudy."

"The medication will peak in 3 hours." Explanation: Insulin glargine (rDNA) is characterized by a chemical structure that regulates its release from the SC tissue into the circulation, providing a relatively constant glucose-lowering effect with no pronounced peak of action over a 24-hour period. Glargine, unlike NPH, is a clear insulin, similar to regular insulin in its appearance. Extreme caution must be used not to confuse glargine with regular insulin because serious adverse effects, including hypoglycemia, can occur. Glargine must not be diluted or mixed with any other insulin or solution because its onset of action may be delayed, and the solution will become cloudy. Insulin glargine is administered subcutaneously once daily at bedtime.

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? a. 06:00 b. 06:20 c. 06:45 d. 07:00

06:45 Explanation: With short-acting insulins like lispro, aspart, or glulisine, it is important to inject the medication about 15 minutes before eating.

Which strategy will NOT increase the therapeutic effect of insulin? a. All insulin should be stored in a refrigerator but never frozen. b. Insulin should be administered in the subcutaneous tissue. c. Regular insulin should be administered 30 minutes before meals. d. Blood glucose levels should be monitored several times per day.

All insulin should be stored in a refrigerator but never frozen. Explanation: Store opened vials of regular insulin at room temperature. Extra supplies are stored in the refrigerator, not the freezer. Extreme temperatures (<2°C or >30°C) should be avoided to prevent the loss of maximum function. Administer regular insulin with an insulin syringe into an appropriate subcutaneous site. Regular insulin is administered about 30 to 60 minutes before eating. To promote regular absorption, one anatomic area should be selected for regular insulin injections (e.g., the abdomen). Frequent monitoring of blood glucose by fingersticks and periodic determinations of hemoglobin A1C levels help determine the therapeutic effect of insulin and overall consistency of diabetic control.

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? a. Between 8:30 AM and 9:30 AM b. Between 10 AM and 12 noon c. Between 2 PM and 4 PM d. Between 12 noon and 8 PM

Between 8:30 AM and 9:30 AM Explanation: With insulin lispro, peak effects would occur in 30 to 90 minutes or between 8:30 AM and 9:30 AM. Regular insulin peaks in 2 to 4 hours, so the nurse would be alert for signs and symptoms of hypoglycemia at this time, which would be between 10 AM and 12 noon. With insulin detemir, peak effects would occur in 6 to 8 hours, or between 2 PM and 4 PM. With NPH insulin, peak effects would occur in 4 to 12 hours, or between 12 noon and 8 PM.

The nurse is aware that premixed insulins (those that contain both regular and NPH insulin) are least effective in what type of client? a. Client who has difficulty controlling his diabetes b. Client who strictly monitors his diet c. Client who encounters problems drawing up insulin into the syringe d. Client who has difficulty reading the markings on the syringes

Client who has difficulty controlling his diabetes Explanation: Premixed insulins are least effective for clients who have difficulty controlling their diabetes, because it is difficult to individualize the dosages of each type of insulin. It is helpful to clients to use premixed insulin if they have difficulty drawing up their insulin, or seeing the markings on the syringe. The strict monitoring of the diet assists in keeping diabetes in good control.

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: a) NPH. b) Ultralente. c) Regular. d) Lente.

Correct response: Regular. Explanation:In general, regular insulin, a short-acting insulin, is used with major surgery or surgery requiring general anesthesia. IV administration of insulin is preferred because it provides more predictable absorption than subcutaneous injections. Only regular insulin is administered IV.

After teaching a group of students about the various insulin preparations, the instructor determines that the teaching was successful when the students identify that which type of insulin cannot be mixed with other types? a. Regular b. Lente c. Detemir d. Lispro

Detemir Explanation: Insulin detemir cannot be mixed in solution with any other drug, including other insulins. Regular, lente, and lispro can be mixed.

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.

The nurse is working with a client who uses an insulin pump for management of type 1 diabetes. The nurse should remind the client that the needle on the pump needs to be changed how often? a. Every one month b. Every two weeks c. Every 5-7 days d. Every 1-3 days

Every 1-3 days Explanation: For an insulin pump, the needle is changed every 1 to 3 days.

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.

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 explaining the action of exenatide to a patient. Which would the nurse include? a. Increase in insulin resistance b. Increase in glucagon release c. Increase in GI emptying d. Increase in protein building

Increase in insulin resistance Explanation: Exenatide is an incretin mimetic, which increases insulin release, decreases glucagon release, stimulates the satiety center, and slows GI emptying.

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.

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 nurse must recognize the duration of insulin as to not cause harm to the client with administration of the improper type of insulin. Which insulins are long-acting insulin? (Select all that apply.) a. Insulin apart (NovoLog) b. Insulin lispro (Humalog) c. Insulin glargine (Lantus) d. Insulin detemir (Levemir) e. Insuline glulisine (Apidra)

Insulin glargine (Lantus) Insulin detemir (Levemir) Explanation: Insulin glargine (Lantus) and insulin detemir (Levemir) are long-acting insulins with a duration of 24 hours.

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.

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 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? a. Deficient fluid volume b. Lactic acidosis c. Fluid overload d. 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, who experienced hypoglycemia twice in the past week, eats one meal per day and snacks the rest of the day. What client education will the nurse provide for a client who reports regularly experiencing hypoglycemic symptoms? a. Alcohol should be limited and taken only with meals. b. Daily caloric intake should be increased by 200 calories. c. Daily snacks should increase protein intake. d. Meals should be eaten at regular times.

Meals should be eaten at regular times. Explanation: A regular dietary intake associated with the administration of insulin or oral hypoglycemic will prevent episodes of hypoglycemia. The client should limit alcohol consumption, but alcohol consumption does not contribute to hypoglycemia. The client should not increase caloric or protein intake. The client should coordinate exercise with her dietary intake, but dietary intake is not the cause of the hypoglycemia.

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? a. Assess the skin for ulcers, cuts, and sores. b. Observe the patient for hypoglycemic episodes. c. Monitor the patient for lipodystrophy. d. Document family medical history.

Observe the patient for hypoglycemic episodes. Explanation: As the ongoing assessment activity, the nurse should observe the patient for hypoglycemic episodes. Documenting family medical history and assessing the patient's skin for ulcers, cuts, and sores on the body is a pre-administration assessment activity performed by the nurse. Lipodystrophy occurs if the sites of insulin injection are not rotated.

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.

What should be the nurse's initial response when a client diagnosed with type 1 diabetes suddenly reports feeling weak, shaky, and dizzy? a. Perform a blood sugar analysis. b. Have the client drink a 4-ounce glass of orange juice. c. Administer 1 ampule of 50% dextrose intravenously (IV). d. Administer 10 units of regular insulin subcutaneously (sub-Q).

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.

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.

A nurse is preparing an in-service presentation for a group of staff members on diabetes. Which would the nurse include as the primary delivery system for insulin? a. Jet injector b. Insulin pen c. External pump d. Subcutaneous injection

Subcutaneous injection Explanation: Although other delivery systems are available for insulin administration such as the jet injector, insulin pen, and external pump, subcutaneous injection remains the primary delivery system.

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 nurse is working with a newly diagnosed diabetic client on understanding hypoglycemia and insulin reactions. Which action would be most important for the client to understand when planning the response to an insulin reaction? a. Inject a prescribed dose of insulin as soon as you suspect the reaction is occurring. b. Stay calm and still until the reaction subsides. c. Notify your health care provider immediately. d. Take an oral dose of some form of glucose as soon as possible.

Take an oral dose of some form of glucose as soon as possible. Explanation: The initial action of the client should be to take some form of oral glucose. It would also be appropriate to call the provider, but this will delay self-treatment and should be done after the administration of the glucose. Injecting insulin would cause further harm to the client and is not an option. It is good to stay calm, but the reaction will not subside without intervention.

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.

After teaching a group of students about sulfonylureas, the instructor determines that the teaching was successful when the students identify which agent as a second-generation sulfonylurea? (Select all that apply.) a. Glimepiride b. Glyburide c. Tolazamide d. Pramlintide e. Repaglinide

a. Glimepiride b. Glyburide Explanation: Glimepiride is a second generation sulfonylurea. Glyburide is a second generation sulfonylurea. Tolazamide is a first generation sulfonylurea. Pramlintide is a human amylin agent. Repaglinide is a meglitinide agent.

The nurse is caring for a client who is taking glyburide as treatment for type 2 diabetes mellitus. The health care provider has added a corticosteroid to this client's medication regimen for treatment of a severe allergic reaction. The nurse knows that this drug combination may cause what adverse effect on this client? a. hypoglycemia b. hyperglycemia c. nausea and vomiting d. rash and fever

hyperglycemia Explanation: Corticosteroids increase insulin needs, so the client may develop hyperglycemia.

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 nurse is preparing to administer a rapid-acting insulin. Which medication would the nurse most likely administer? a. insulin lispro b. insulin glargine c. insulin detemir d. isophane insulin suspension

insulin lispro Explanation: Insulin lispro is an example of a rapid-acting insulin. Insulin glargine and insulin detemir are long-acting insulin. Isophane insulin suspension is an intermediate-acting insulin.

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.

A nurse educator, explaining the pathophysiology of diabetes to a newly diagnosed client, should provide what explanation for the client's "constant, insatiable thirst"? a. "The excess glucose in your blood accumulates in your blood vessels and neurons, including the neurons that control thirst." b. "Excess glucose pulled more water through your kidneys and the increased urination caused thirst." c. "Increased thirst is your body's attempt to dilute your blood because it contains too much glucose." d. "When your body cells are starved for useful glucose, they signal your body to increase food and fluid intake."

"Excess glucose pulled more water through your kidneys and the increased urination caused thirst." Explanation: When large amounts of glucose are present, water is pulled into the renal tubule. This results in a greatly increased urine output (polyuria). The excessive loss of fluid in urine leads to increased thirst (polydipsia). Glucose does not directly affect the thirst center.

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? a. Client is in good glycemic control. b. Client's average blood glucose is above normal. c. Client's blood glucose levels are not consistent. d. Client's blood glucose demonstrates longstanding hypoglycemia.

Client's average blood glucose is above normal. Explanation: The American Diabetes Association (ADA) suggests a target A1C of less than 7%. A1C should be measured every 3 to 6 months. An A1C of 9 indicates that the client's average blood glucose is consistently above normal.

What distinguishing characteristic is associated with type 1 diabetes? 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. 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.

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.

A client was diagnosed with type 2 diabetes several months ago and 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 tells the nurse that he/she has gone on a diet. c. The client frequently checks his/her blood glucose levels. d. The client can describe the differences between type 1 and type 2 diabetes.

The client frequently checks his/her 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.

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.

A female client is a newly diagnosed diabetic. She is a stay-at-home mother and responsible for meal planning and management of the home. What will the home care nurse teach this client? (Select all that apply.) a. Instruct the client to go to the emergency department immediately if she develops a cold or upper respiratory infection. b. Assist the client in making menus that will meet the needs of both the client and the family. c. Watch the client draw up and administer her insulin. d. Reinforce instructions on dealing with hypoglycemia. e. Encourage the client to check her blood glucose every hour.

-Assist the client in making menus that will meet the needs of both the client and the family. -Watch the client draw up and administer her insulin. -Reinforce instructions on dealing with hypoglycemia. Explanation: The home care nurse would assist the client and family to know how to plan meals that meet the needs of the client and the family. The nurse would also want to assure that the client knows how to administer insulin correctly and would need to make sure that the client understands how to deal with hypoglycemia.

A client is receiving acarbose. What would the nurse incorporate into the teaching plan for this client about the action of the drug? a. Inhibits an enzyme to delay glucose absorption b. Decreases insulin resistance c. Binds to potassium channels on pancreatic beta cells d. Increases the uptake of glucose

Inhibits an enzyme to delay glucose absorption Explanation: Acarbose inhibits alpha glucosidase, an enzyme, thereby delaying the absorption of glucose. Thiazolidinediones, such as rosiglitazone, decrease insulin resistance. Second-generation sulfonylureas bind to potassium channels on the pancreatic beta cells to improve insulin binding to insulin receptors and increase the number of insulin receptors. Biguanides, such as metformin, increase the uptake of glucose.

A client prescribed metformin is scheduled to undergo diagnostic testing with the administration of parenteral radiographic contrast media containing iodine. What fact should direct the nurse's plan of care for this client? a. The client will be prescribed an extra dose of metformin due to address the contrast material's effect on the body. b. Metformin should be discontinued at least 48 hours before and after diagnostic tests that use contrast medias. c. The client needs to be encouraged to drink 1 to 2 L of water to flush the contrast media out the kidneys. d. The metformin will be temporarily substituted for with insulin, to address the risk of potential kidney failure.

Metformin should be discontinued at least 48 hours before and after diagnostic tests that use contrast medias. Explanation: Metformin should be discontinued at least 48 hours before diagnostic tests are performed with these materials and should not be resumed for at least 48 hours after the tests are done and tests indicate renal function is normal. By altering the metformin therapy, none of the other options are required.

Heavy intake of which herb should be avoided by a client who is prescribed an antidiabetic medication? 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.

Rosiglitazone is being considered for the treatment of diabetes in an adult male 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 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.

A patient receives 25 units of NPH insulin at 7 AM. At what time of day should the nurse advise the patient to be most alert for a potential hypoglycemic reaction? a. After breakfast b. Before lunch c. Late afternoon d. Bedtime

Late afternoon Explanation: After an early morning dose of NPH insulin, the patient should be alert for a possible hypoglycemic reaction during mid- to late afternoon. The lengthy peak action time produces additional risks for hypoglycemic reactions

Which factor would prohibit the administration of glipizide? 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 glipizide.

A nurse is caring for a 48-year-old woman who has been hospitalized after injecting the wrong type of insulin. Which sign of hypoglycemia will the nurse be careful to observe for? a. Dry skin b. Blurred vision c. Fruity breath d. Flushing of the face

Blurred vision Explanation: Blurred or double vision (diplopia), fatigue, trembling, irritability, headache, nausea, numbness, muscle weakness, hunger, tachycardia, sweating, and nervousness are signs of a hypoglycemic reaction. Fruity breath can be an indication of ketoacidosis, and flushing of the face is a sign of hyperglycemia. Dry skin is unrelated to hypoglycemia.

Before administering a prescribed 20 units of NPH insulin to a client, 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.

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.

What type of insulin will most likely be administered intravenously to a client with a blood glucose level over 600 mg/dL (33.33 mmol/L)? 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.

The nurse is interviewing a client who was diagnosed with type 2 diabetes four months ago. The client does not records glucometer readings but reports no concerns. What laboratory test does the nurse anticipate the health care provider will order for this client? a. HbA1c b. Stat urine for glucose c. Fasting blood glucose in the AM d. Insulin level

HbA1c Explanation: The nurse anticipates that the glycosylated hemoglobin (HbA1c) will be ordered for this client because it provides an average of the client's blood glucose level for the last three- to four-month period. It will also tell how well controlled the client's blood glucose is. A stat urine for glucose and an FBG in the AM will only indicate the client's current blood glucose level, not how well it is being controlled. An insulin level will not give the information needed to understand the client's control of blood glucose.

Which would be least appropriate when administering insulin by subcutaneous injection? a. Using a 25 gauge 1/2-inch needle b. Inserting the needle at a 45-degree angle c. Injecting the insulin slowly d. Massaging the site after removing the needle

Massaging the site after removing the needle Explanation: Gentle pressure should be applied to the injection after the needle is withdrawn. Massaging could contribute to erratic or unpredictable absorption.

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. a. cirrhosis b. chronic intestinal diseases c. colonic ulceration d. type I diabetes e. severe heart failure

a. cirrhosis b. chronic intestinal diseases c. colonic ulceration Explanation: The alpha-glucosidase inhibitors are contraindicated in clients with cirrhosis, chronic intestinal diseases, and colonic ulceration. Meglitinides are contraindicated in clients with type 1 diabetes. Thiazolidinediones are contraindicated in clients with severe heart failure.

The nurse is educating a newly diagnosed diabetic who must learn how to give himself insulin injections. The nurse tells the client that insulin is absorbed fastest from which area of injection? a. Deltoid b. Thigh c. Abdomen d. Hip

abdomen Explanation: Studies indicate that insulin is absorbed fastest from the abdomen, followed by the deltoid, thigh, and hip.

When considering the management of diabetic ketoacidosis (DKA), what type of insulin can be administered intravenously? a. regular b. isophane insulin (NPH) c. lispro d. insulin glargine

regular Explanation: Regular insulin (insulin injection) has a rapid onset of action and can be given intravenously. Therefore, it is the insulin of choice during acute situations, such as DKA, severe infection or other illness, and surgical procedures. All the other options are administered subcutaneously.