Chapter 38: course point

A nurse is preparing to administer a long-acting insulin to a client. Which insulin might the nurse administer? Select all that apply.

Insulin glargine Insulin detemir

After teaching an in-service presentation to a group of nurses about diabetes and insulin, the presenter determines that the session was successful when the group correctly chooses which insulins as rapid-acting? Select all that apply.

Insulin glulisine Insulin aspart

A client, being evaluated for diabetes, asks how a blood glucose test is used to diagnosis this disease. What is the nurse's best response?

"A fasting blood sugar result of 126 mg/dL (6.99 mmol/L) or more on two separate occasions is diagnostic of diabetes."

A client newly diagnosed with diabetes reports "constant, insatiable thirst." When providing teaching to the client, how should the nurse explain the symptom?

"Excess glucose pulled more water through your kidneys and the increased urination caused thirst."

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?

"I'm disappointed, but I take some solace in the fact that I won't ever have to have insulin injections."

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?

"If I forget to take my insulin pen, I will be able to use the one that my wife uses."

The nurse is educating a client regarding the use of pramlintide acetate for the treatment of diabetes mellitus type 1. What statement made by the client indicates that further education is required?

"Since I am on this new medication, I don't have to take my insulin any longer."

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?

Allergy to sulfonamides

The nurse is assessing a client who was administered metformin and notes hyperventilation, nausea, and somnolence. The nurse determines which nursing diagnosis should be prioritized for this client?

Altered Breathing Pattern

An older adult client has been prescribed metformin for the treatment of type 2 diabetes for several years. Which change in the client's laboratory values may demonstrate a need to discontinue the medication?

An increase in serum lactate

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.

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.)

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.

The nurse is providing discharge instructions to a client who has just been diagnosed with type 1 diabetes. What instructions are most important for the client to follow related to diet? (Select all that apply.)

Avoid drinking beer, wine, or liquor. Use artificial sweeteners instead of sugar in tea and coffee. Read food labels carefully to look for hidden sources of sugar.

A nurse is assigned to administer glargine to a patient at a health care facility. What precaution should the nurse take when administering glargine?

Avoid mixing glargine with other insulin.

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?

Blurred vision

A nurse is preparing to administer exenatide to a client with type 2 diabetes. The nurse will question this order if which condition is noted in the client's medical record?

Diabetic ketoacidosis

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?

Glucagon

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

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?

Exenatide

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?

Garlic

A nurse has determined a client has developed a hypoglycemic reaction. Which interventions should the nurse perform if the client can adequately demonstrate swallowing and gag reflexes?

Give oral fluids or candy.

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?

Give oral fluids or candy.

Which is the best indicator of overall diabetic control?

Glycosylated hemoglobin levels

The nurse is interviewing a client who was diagnosed with type 2 diabetes four months ago. The client does not record glucometer readings. What laboratory test does the nurse anticipate the health care provider will order for this client?

HbA1c

After administering insulin detemir to a client with diabetes, the nurse suspects that the client is developing hypoglycemia based on which assessment findings? Select all that apply.

Headache Confusion Diaphoresis

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?

Hyperglycemia

The nurse is explaining the action of exenatide to a patient. Which would the nurse include?

Increase in insulin release

When describing the effects of incretins on blood glucose control to a group of students, which would an instructor include?

Increases insulin release

A client is receiving acarbose. What would the nurse incorporate into the teaching plan for this client about the action of the drug?

Inhibits an enzyme to delay glucose absorption

When administering insulin, what would be most appropriate?

Insert the needle at a 45-degree angle for injection.

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?

Insulin is needed because the beta cells of the pancreas are no longer functioning.

What is the expected action of sitagliptin on type 2 diabetes?

It slows the rate of inactivation of the incretin hormones.

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?

Lactic acidosis

A client with diabetes has had a myocardial infarction. Which medication that the client takes on a regular basis should be discontinued and replaced with another diabetic medication?

Metformin

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?

Metformin

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?

Observe the patient for hypoglycemic episodes.

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?

Metformin does not cause hypoglycemia.

A client diagnosed with type 2 diabetes has been prescribed a meglitinide. The nurse should inform the client that the medication should be taken at what time relative to meals?

No more than 30 minutes before the meal

A nurse is caring for a patient diagnosed with type 2 diabetes. What should the nurse inform the patient are risk factors associated with type 2 diabetes?

Obesity

The nurse is assessing a client for risk factors associated with type 2 diabetes. Which findings would the nurse prioritize? Select all that apply.

Obesity History of gestational diabetes Impaired glucose tolerance

A nurse is caring for a client with diabetes mellitus who is receiving an oral antidiabetic drug. Which ongoing assessments should the nurse prioritize when caring for this client?

Observe the client for hypoglycemic episodes.

A client is prescribed sitagliptin. The nurse would expect to administer this drug by which route?

Oral

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.)

Orange or other fruit juice Glucose tablets Hard candy

A student asks the nursing instructor what insulin has the quickest therapeutic effect once administered. What would be the best response?

Regular (Humulin R)

Which agent would a nurse expect to administer as a single oral dose in the morning?

Rosiglitazone

A nurse is instructing a patient in the administration of regular insulin by the subcutaneous route. Which strategy would the nurse suggest if the goal is to promote absorption of the regular insulin?

Select one anatomic area for regular insulin injections and then use serial locations within that area.

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?

Signs of hypoglycemia may be masked.

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?

Subcutaneous injection

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?

Subcutaneous injection

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?

The client frequently checks blood glucose levels.

Which condition must be met in order for repaglinide treatment to be effective for the client with type 2 diabetes?

The client must have functioning pancreatic beta cells.

A nurse is preparing a teaching session for a client who is prescribed miglitol. The nurse would instruct the client to administer this drug at which time?

Three times a day with the first bite of a meal

The nurse is providing care for several clients who have diabetes. Which client should the nurse monitor most closely for signs and symptoms of hypoglycemia?

a client who received 12 units of Humulin R 45 minutes ago

A home care nurse is caring for several clients with diabetes. The nurse's role in caring for these clients includes:

all the above tasks.

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:

hyperglycemia

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:

hyperglycemia and glycosuria.

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 glargine

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?

liver enzymes

When considering the management of diabetic ketoacidosis (DKA), what type of insulin can be administered intravenously?

regular

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 assists glucose molecules to enter the cells of muscle and fat tissues."

A client with hyperinsulinism has been prescribed diazoxide. After administration, which adverse reaction should the nurse prioritize?

Tachycardia

A nurse is preparing to administer insulin glargine to a client. What precaution should the nurse take when administering this drug?

Avoid mixing glargine with other insulins.

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?

Check the dosage with another nurse.

The nurse is preparing to administer insulin glargine to a client. Which actions will the nurse perform when preparing the insulin? Select all that apply.

Check the health care provider's orders for the type and dosage of insulin. Remove all air bubbles from the syringe barrel. Check the expiration date on the vial.

Which would a nurse identify as an example of a sulfonylurea?

Glyburide

The nurse monitoring a client receiving insulin glulisine notices the client has become confused, diaphoretic, and nauseated; and has a blood glucose of 60 mg/dL. Which emergent treatment would the nurse most likely give? Select all that apply.

Orange or other fruit juice Glucose tablets Hard candy

A client diagnosed with type 1 diabetes suddenly reports feeling weak, shaky, and dizzy. What should be the nurse's initial response?

Perform a blood sugar analysis.

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?

Regular insulin

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?

Take an oral dose of some form of glucose as soon as possible.

A client with diabetes has been prescribed pramlintide 15 mcg subcutaneously before meals. The nurse will recognize which additional aspect of the client's diabetes management regimen?

The client also takes insulin before meals.

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

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?

weakness, sweating, and decreased mentation.

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?

"I am on the middle school track team."

The older diabetic client often experiences several different chronic organ related conditions. Which assessment should the nurse focus upon when attempting to manage this complex situation?

Drug interactions

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?

Tachycardia