Chapter 38 PrepU

The nurse is instructing a client how to take a prescribed pramlintide. Which would be most appropriate?

"Give it by subcutaneous injection immediately before your major meals."

A nurse is providing patient education to a 13-year-old girl who was just diagnosed with type 1 diabetes mellitus. Which statement by the patient will alert the nurse that special instructions regarding insulin are necessary?

"I am on the middle school track team."

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."

During a teaching session on the care of the diabetic patient, a family member asks why her daughter has a different insulin than her best friend. The nurse should make which statement to explain the differences in insulin?

"Insulins have different onsets and durations of action."

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.

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.)

-Insulin glargine (Lantus) -Insulin detemir (Levemir)

The nurse monitoring a client receiving insulin glulisine (Apidra) notices the client has become confused, diaphoretic, and nauseated. The nurse checks the client's blood glucose and it is 60 mg/dL. 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

Which produce their glucose lowering effect by decreasing insulin resistance and increasing insulin sensitivity? (Select all that apply.)

-Rosiglitazone (Avandia) -Pioglitazone (Actos)

The nurse assesses a patient's blood glucose level after administering insulin. Which result would the nurse interpret as indicative of severe hypoglycemia?

34 mg/dL

A patient receives a dose of insulin lispro at 8 AM. The nurse would be alert for signs and symptoms of hypoglycemia at which time?

Between 8:30 AM and 9:30 AM

The nurse is educating a client who is beginning therapy with acarbose and tells the client to take the medication with the first bite of each main meal to help prevent what adverse effect?

Bloating and diarrhea

A female client visits the physician's office after routine labs are drawn. The nurse notes that her A1C is 9. How does the nurse interpret this finding?

Client's average blood glucose is above normal.

The nurse is educating a client who will be adding an injection of pramlintide to his insulin regimen. What information is most important for the nurse to share with this client to ensure safe medication administration?

Do not give pramlintide in the same site where insulin is administered.

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 two major classifications of diabetes are type 1 and type 2. What is a distinguishing characteristic of type 1 diabetes?

Exogenous insulin is required for life.

Patients with type 2 diabetes have nonfunctioning beta pancreatic cells.

False

Stress typically results in hypoglycemia.

False

What would alert the nurse to suspect that a client is developing ketoacidosis?

Fruity breath odor

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.

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

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

Glyburide

The nurse is interviewing a client who was diagnosed with type 2 diabetes about four months ago. The client never records glucometer readings but says that everything is just fine. What laboratory test does the nurse anticipate the health care provider will order for this client?

HbA1c

The physician 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 patient?

Hypoglycemia

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

Increases insulin release

A nurse at a health care facility is assigned to administer insulin to the patient. Which intervention should the nurse perform before administering each insulin dose?

Inspect the previous injection site for inflammation.

Which is an example of long acting insulin?

Insulin glargine (Lantus)

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 an example of rapid acting insulin?

Insulin lispro (Humalog)

The nurse is preparing to administer insulin lispro (Humalog) to a client at 7 AM. What is the nurse's top priority intervention related to this medication?

Make sure the client's breakfast is available in the next 5-10 minutes.

Which would be least appropriate when administering insulin by subcutaneous injection?

Massaging the site after removing the needle

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

Oral

A client is admitted to the intensive care unit with diabetic ketoacidosis. The nurse knows that the client will be placed on an intravenous insulin drip. The only type of insulin that can be administered intravenously is:

Regular.

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

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

Glycosylated hemoglobin measures average blood glucose over what time period?

The past 3 or 4 months

Amylin is a peptide hormone secreted with insulin by the beta cells of the pancreas and is important in the regulation of glucose control during the postprandial period. True or false?

True

Regular insulin may be administered intravenously or intramuscularly in an emergency situation.

True

The brother of a client who uses insulin for management of type 1 diabetes will be prefilling the client's insulin syringes. The nurse knows that these prefilled syringes may be kept in the refrigerator for how long?

one week

The nurse is caring for a client taking insulin. The nurse realizes the client is experiencing symptoms of hypoglycemia when the client displays:

weakness, sweating, and decreased mentation.

A 54-year-old male client is diagnosed with chronic renal failure and hyperglycemia. He asks if he can be prescribed sulfonylurea because it works well for his friend. If he were to be given sulfonylurea, this client's renal impairment may lead to what effect?

Accumulation and hypoglycemia

A patient is to be administered glipizide (Glucotrol). Which factor would prohibit the administration of glipizide (Glucotrol) to this patient?

Allergy to sulfonamides