diabetes meds
Which statement by a nursing student about insulin glargine indicates effective learning?
""The duration of action of this insulin is about 8 to 10 hours." "You can mix this insulin with regular insulin to enhance its effects." "You cannot mix this insulin in the same syringe with regular insulin."- "This insulin is injected just before meals because it is very fast acting." Insulin glargine is a long-acting insulin with a duration of action up to 24 hours. Hence, it can be given at bedtime to provide up to 24 hours of insulin coverage. It should not be mixed with any other insulin. It is given alone because of the low pH of the diluent.
The patient has been prescribed lispro for treatment of type 1 diabetes mellitus. The nurse should give the patient which instruction?
"Inject this insulin with meals because it is very fast acting."- "This insulin needs to be mixed with regular insulin to enhance the effects." "To achieve tight glycemic control, this is the only type of insulin you'll need." "The duration of action for this insulin is about 8 to 10 hours, so you'll need a snack." Lispro is a fast-acting insulin and has an onset action of 15 to 30 minutes with a peak action of about 2 hours, not 8 to 10 hours. Because of its rapid onset, it is administered immediately before a meal or with meals to control the blood glucose rise after meals. Lispro insulin must be combined with an intermediate- or a long-acting insulin, not regular insulin (which also is a short-duration insulin), for glucose control between meals and at night. To achieve tight glycemic control, patients must combine different types of insulin based on their duration of action.
A patient newly diagnosed with diabetes asks, "How does insulin normally work in my body?" Which response by the nurse is correct?
"It stimulates the pancreas to reabsorb glucose." "It promotes synthesis of amino acids into glucose." "It stimulates the liver to convert glycogen to glucose." "It promotes the passage of glucose into cells for energy."- Insulin promotes the passage of glucose into cells, where it is metabolized for energy. During or after a meal, the glucose that is ingested stimulates the pancreas to secrete insulin. Insulin stimulates the synthesis of proteins and not amino acids. Insulin stimulates the liver to convert glucose to glycogen.
A patient newly diagnosed with type 2 diabetes mellitus has been ordered insulin glargine. Which information is essential for the nurse to teach this patient?
"This medication has a duration of action of 24 hours."- "This medication should be mixed with the regular insulin each morning." "This medication is very expensive, but you will be receiving it only a short time." "This medication is very short-acting. You must be sure you eat after injecting it." Insulin glargine has a duration of action of 24 hours with no peaks, mimicking the natural, basal insulin secretion of the pancreas. This medication cannot be mixed with other insulins and is not a short-acting insulin. The patient may need to receive this medication for life.
A patient with type 1 diabetes mellitus asks, "Why can't I take a sulfonylurea like my friend who has diabetes?" What is the nurse's best response?
"You must be mistaken. If your friend has diabetes mellitus, she is taking insulin." "Sulfonylurea will lower your blood sugar too much, and you will be hypoglycemic." "Sulfonylurea increases beta-cell stimulation to secrete insulin, and your beta cells do not contain insulin."- "You are unable to store glucose, because you do not have insulin, and sulfonylurea helps with glucose storage." Sulfonylurea agents reduce serum glucose levels by increasing beta-cell stimulation for insulin release, decreasing hepatic glucose production, and increasing insulin sensitivity. It is administered for type 2 diabetes mellitus but will not be effective in type 1. Not all patients with type 2 diabetes require insulin, but patients with type 1 diabetes require insulin.
What should the nurse teach a patient who takes metformin for type 2 diabetes?
"You should take the medication with food."- "You should report any nausea immediately." "If you miss a meal, you should skip the dose." "You have an increased risk of lactic acidosis." Metformin causes side effects such as abdominal bloating, nausea, a feeling of fullness, and diarrhea at the start of the therapy, so the nurse should advise the patient to take the medication with food as it helps lessen the side effects. The nurse should not advise the patient to miss any meals or doses as the medication may not have therapeutic effects. It is not necessary to report nausea, because it can be lessened by taking the medication with food. Lactic acidosis is an extremely rare occurrence in patients who take metformin.
A patient receives isophane suspension, also known as neutral protamine Hagedorn insulin at 8:00 AM. The patient eats breakfast at 8:30 AM, lunch at noon, and dinner at 6:00 PM. At what time is this patient at the highest risk for hypoglycemia?
2:00 PM 5:00 PM- 8:00 PM 10:00 AM Breakfast eaten at 8:30 AM would cover the onset of isophane insulin suspension, also known as neutral protamine Hagedorn, and lunch will cover the 2:00 PM time frame. If the patient does not eat a midafternoon snack, however, the neutral protamine Hagedorn insulin may peak just before dinner without sufficient glucose on hand to prevent hypoglycemia.
The nurse administers repaglinide to a patient at 8:00 AM. When is the patient at the highest risk for hypoglycemia?
9:00 AM- 10:00 AM 11:00 AM Noon Repaglinide is a rapid-acting oral hypoglycemic agent whose action peaks within 1 hour of the drug's administration. If the drug is given at 8:00 AM, it will have its peak effects at 9:00 AM. The drug reaches its elimination half-life phase within the next few hours: in this case from 10:00 AM to noon.
Which patient may receive insulin lispro?
A patient with type 2 diabetes mellitus who takes metformin- A patient with type 2 diabetes mellitus who is taking glipizide A breastfeeding mother who is at high risk for developing diabetes mellitus A 2-year-old child who was recently diagnosed with type 1 diabetes mellitus Insulin lispro is used for patients with diabetes because it acts like endogenous insulin in response to a meal. Insulin lispro can be administered to a patient who takes metformin for type 2 diabetes mellitus because it has no interaction. This insulin cannot be used in children younger than the age of 3 years for safety reasons. A patient needs to stop glipizide in order to start insulin therapy to avoid any interaction. This medication should not be used while pregnant or breastfeeding.
A patient with a history of inflammatory bowel disease is prescribed insulin therapy and acarbose for the treatment of high postprandial glucose levels. Which nursing action is a priority in this case?
Administer insulin and acarbose simultaneously. Ask the patient about allergic reactions to any drugs. Assess the patient's weight before administering the drug. Consult the primary healthcare provider before administering acarbose.- Acarbose has adverse gastrointestinal effects and is contraindicated in patients with inflammatory bowel disease. Hence, the nurse should consult with the primary healthcare provider before administering the drug. The nurse needs to administer insulin and the oral diabetic drugs as instructed by the primary healthcare provider to prevent fluctuations in the patient's glucose levels. Assessing the patient's weight is not a priority in this case as acarbose does not cause weight gain. The nurse needs to ask about allergic reactions before administering any drug; however, it is not a priority in this case.
A patient with type 2 diabetes mellitus receives a prescription for metformin. Which finding should the nurse recognize as a contraindication to therapy?
Arterial blood pH 7.4 Creatinine 1.6 mg/dL Alanine aminotransferase 55 U/L Fasting blood glucose 131 mg/dL The risk of lactic acidosis is greater in a patient with altered renal function. A creatinine level higher than 1.5 mg/dL in males or higher than 1.4 mg/dL in females indicates renal dysfunction. Because metformin can cause lactic acidosis, the nurse should avoid administering the medication to this patient because the kidneys clear excess acid by excreting hydrogen ions and because metformin is eliminated by the kidneys. The arterial pH is normal. The alanine aminotransferase reading does not constitute a contraindication to metformin therapy. The increased blood glucose is an indication for therapy.
Which site should be used for injecting insulin for the most consistent absorption?
Deltoid Abdomen- Vastus lateralis Gluteus maximus The abdomen has the most consistent absorption capacity because muscular movements do not affect the blood flow to subcutaneous tissue as much. The deltoid is used for immunization of children and adults. The vastus lateralis is used for immunization of infants. The gluteus maximus is not recommended for injections because of its close proximity to the sciatic nerve and major blood vessels.
Which is the nurse's best action when finding a patient with type 1 diabetes mellitus unresponsive, cold, and clammy?
Gradual onset Family history of diabetes mellitus Onset typically during childhood or adolescence- Treatment must be combined with reduced-calorie diet and exercise Type I diabetes mellitus is most often diagnosed during childhood or adolescence. Its onset is typically sudden and occurs in patients who do not have a family history of diabetes. Dietary control is necessary but not necessarily in the form of reduced calories, and insulin treatment is always necessary. Type II diabetes has a gradual onset and most often occurs in patients who have family histories of diabetes. Insulin is not always necessary; sometimes patients will be prescribed oral antidiabetics or non-insulin injectables, but whatever the pharmacological treatment is, the patient will need to be on a reduced-calorie diet and participate in appropriate exercise.
Which clinical findings may indicate diabetes mellitus in a patient? Select all that apply.
Hemoglobin A 1C (A 1C) level greater than 6.5%- Casual plasma glucose level of 130 mg/dL or higher Fasting plasma glucose level of 126 mg/dL or higher- 2-hour plasma glucose level of 120 mg/dL or higher Random blood glucose level between 70 and 100 mg/dL A fasting plasma glucose level of 126 mg/dL or higher indicates hyperglycemia. It indicates that there are excessive concentrations of glucose in the blood. A hemoglobin A 1C (A 1C) level greater than 6.5% is another indication of diabetes mellitus. It indicates that the amount of sugar in the hemoglobin is higher than normal. Serum blood glucose levels of 70 to 100 mg/dL indicate normal glucose homeostasis. A casual plasma glucose level of 200 mg/dL or higher and a 2-hour plasma glucose level of 200 mg/dL or higher indicates diabetes.
Which statement indicates that the patient needs additional teaching on oral hypoglycemic agents?
I will monitor my blood sugar daily." "I will limit my alcohol consumption." "I will take the medication only when I need it."- "I will report symptoms of fatigue and loss of appetite." Oral hypoglycemic agents must be taken on a daily scheduled basis to maintain euglycemia and prevent long-term complications of diabetes. When alcohol is ingested with certain oral hypoglycemic drugs, the hypoglycemic effect can be intensified. The patient may experience fatigue and loss of appetite as side effects of the medication, and these should be reported to the healthcare provider. The patient needs to closely monitor blood sugar.
The laboratory results for a patient with diabetes indicate markedly elevated blood glucose levels. After assessing the patient, the nurse obtains a prescription for intravenous insulin therapy from the primary healthcare provider. Which other assessment finding is likely present in the patient's reports?
Increased weight Extreme onset of hypoglycemia High levels of endogenous insulin Presence of ketones in the serum- The presence of ketones in the serum, along with elevated glucose levels, indicates diabetic ketoacidosis. Hence, intravenous insulin therapy would be started immediately to prevent acute hyperglycemia, which may further cause coma or death. Extreme hyperglycemia is seen in the patient due to elevated glucose levels. Weight gain is not an emergency in this case and may be caused by other factors such as congestive heart failure. Low levels or lack of endogenous insulin causes diabetic ketoacidosis.
Which insulin should the nurse administer to supplement basal insulin to imitate the pancreatic surge of insulin that accompanies eating?
Insulin glargine Insulin glulisine- Insulin detemir Neutral protamine Hagedorn (NPH) insulin The nurse should administer a rapid-acting form of regular insulin, such as insulin glulisine, because the onset of action occurs 15 minutes after its administration. Insulin glargine and insulin detemir are basal insulins. NPH insulin is an intermediate-acting insulin that would take too long to act in this condition.
An operating room nurse prepares a patient who has type 2 diabetes for surgery. Which type of insulin should the nurse administer?
Insulin glargine Regular insulin- Insulin zinc suspension Isophane insulin suspension The nurse should administer regular insulin intravenously. The other variants of insulin, including neutral protamine Hagedorn, also known as isophane insulin suspension; insulin zinc suspension; and insulin glargine are administered through the subcutaneous route.
A patient has a serum glucose concentration of 375 mg/dL, urine output of 450 mL/hr, and an arterial pH of 7.1. The sliding scale requires intravenous insulin for a blood glucose concentration of more than 350 mg/dL. Which type of insulin is the nurse most likely to administer?
Insulin lispro Insulin glargine Regular insulin- Neutral protamine Hagedorn insulin This patient has clinical indicators of diabetic ketoacidosis. The patient would require regular insulin in its intravenous form to reduce the concentration of serum glucose. The nurse should prepare to administer regular insulin because it is the only insulin that can be administered intravenously. Insulin lispro is a human recombinant rapid-acting insulin analogue. Insulin glargine is a long-acting recombinant DNA-produced insulin analogue, and it provides a constant level of insulin in the body. Insulin isophane suspension, also known as neutral protamine Hagedorn insulin, is the only available intermediate-acting insulin product.
The nurse administers insulin to a patient at 8:30 AM and knows it will peak about 2.5 hours after administration. Which insulin did the nurse administer?
Insulin lispro Insulin glulisine Insulin aspart Regular insulin- Regular insulin peaks about 2.5 hours after the drug's administration. If the drug is given at 8:30 AM, it will have its peak effects at 11:00, and at that time the nurse would observe for signs of hypoglycemia. Insulin lispro, insulin aspart, and insulin glulisine are all considered rapid-action insulin. The onset of action for these drugs is about 15 minutes, and the effects do not last as long as other classes of insulin.
Which hormones play a role in the regulation of glucose homeostasis? Select all that apply.
Insulin- Ketone Dextrose Glucagon- Glycogen Insulin and glucagon are the two hormones produced by the pancreas that play an important role in the regulation of glucose homeostasis. They are responsible for the use, mobilization, and storage of glucose by the body. Excess glucose in the blood is converted into glycogen and stored in the liver. When the body breaks down fatty acids for fuel, ketones are produced as a metabolic by-product. Dextrose is the simplest form of carbohydrate found in the body.
A patient newly diagnosed with type 1 diabetes asks a nurse, "How does insulin normally work in my body?" The nurse should base his or her response on which understanding of the mechanism of insulin?
It promotes the passage of glucose into cells.- It stimulates the pancreas to reabsorb glucose. It stimulates the liver to convert glycogen to glucose. It promotes the synthesis of amino acids into glucose. The hormone insulin promotes the passage of glucose into cells where it is metabolized for energy. Insulin does not stimulate the pancreas to reabsorb glucose or synthesize amino acids into glucose. It does not stimulate the liver to convert glycogen into glucose.
Which assessment findings in a patient with diabetes mellitus are indicative of diabetic ketoacidosis? Select all that apply.
Ketones in the urine- Isotonic dehydration- Severe hypothermia Electrolyte imbalances- Extreme hyperglycemia- If the body is unable to produce insulin, fatty acids are used for fuel, which produces ketones as a metabolic by-product. When this happens to a sufficient degree, it results in diabetic ketoacidosis. It involves extreme hyperglycemia, presence of ketones in the urine, isotonic dehydration, and electrolyte imbalances. Hypothermia is seen in cases of hypoglycemia.
Which are rapid-acting insulins that can be administered to patients with diabetes mellitus? Select all that apply.
Lispro- Aspart- Glulisine- Glargine Regular insulin Lispro, aspart, and glulisine are rapid-acting insulins that have an onset of action of 15 minutes. Regular insulin is a short-acting insulin that has an onset of action of 30 to 60 minutes. Glargine is a long-acting insulin, which is dosed every 12-24 hours depending on the patient's glycemic response.
Which oral drug is used in patients with type 2 diabetes who have not had success with metformin or glipizide?
Pioglitazone- Glimepiride Troglitazone Rosiglitazone Pioglitazone is a glitazone that is reserved for patients who cannot achieve glucose control with biguanides or sulfonylureas. The drug decreases insulin resistance by enhancing the sensitivity of insulin receptors. Troglitazone is a glitazone that is discontinued from the market as it causes liver toxicity. Rosiglitazone is also no longer prescribed, because it causes cardiac problems. Glimepiride is a drug that belongs to the class of sulfonylureas.
Before administering metformin, the nurse should notify the prescriber about which laboratory value?
Platelet count of 120,000/mm 3 Creatinine (Cr) level of 2.1 mg/dL- Sodium (Na) level of 131 mEq/dL Hemoglobin (Hgb) level of 9.5 g/dL Metformin can reach toxic levels in individuals with renal impairment, which is indicated by a rise in the serum creatinine level. The prescriber may have to be notified of the hemoglobin, sodium, and platelet values, but those would not affect the administration of metformin.
Which is a rare but potentially fatal complication of metformin use in the management of type 2 diabetes mellitus?
Renal failure Heart failure Lactic acidosis- Hypoglycemia Metformin inhibits mitochondrial oxidation of lactic acid and thereby can cause lactic acidosis, a medical emergency with a 50% mortality rate. Fortunately, lactic acidosis is rare when metformin is used in recommended doses and by patients with good renal function. Metformin is not metabolized by the kidneys; it is excreted unchanged, so in the event of renal impairment, metformin can accumulate to toxic levels but it does not cause renal failure. Heart failure is not a side effect, but because heart failure can predispose a patient to lactic acidosis, metformin is contraindicated for people with heart failure. Metformin does not actively drive blood glucose levels down, so there is little to no risk of hypoglycemia when the drug is used alone.
The nurse is caring for a patient who has been taking metformin for several months. The patient reports abdominal pain. Upon assessment, the nurse detects an irregular heartbeat. What else should the nurse assess to determine the severity of the patient's condition?
Renal function- Vitamin B 12 levels Blood glucose levels The patient's weight Abdominal pain and irregular heartbeat in a patient taking metformin may be indicative of lactic acidosis. Renal function is assessed before administering the drug to prevent renal impairment. If the patient has lactic acidosis, the blood glucose levels will be very high as well. Therefore, the nurse should assess the patient's blood glucose levels to confirm the condition. Reduction in B 12 levels is a less common side effect of metformin. Assessing the patient's weight is not a priority in this case.
The nurse is teaching a patient who has type 1 diabetes mellitus how to prevent hypoglycemia. Which clinical indicators of hypoglycemia should the nurse identify for the patient and family? Select all that apply.
Sweating- Headache- Polyphagia Weight loss Dehydration Tachycardia- The effects of hypoglycemia are largely attributable to stimulation of the central nervous system because low blood glucose stresses the body. When hypoglycemia occurs, the sympathetic nervous system responds in an attempt to increase blood glucose. Clinical indicators of hypoglycemia mimic sympathetic nervous system stimulation; they include headaches, diaphoresis (sweating), tachycardia, palpitations, and anxiety. Polyphagia and weight loss are symptoms of untreated diabetes. Dehydration can occur with severe hyperglycemia, as seen with ketoacidosis.
A patient who took neutral protamine Hagedorn (NPH) insulin at 8:00 AM reports feeling weak and tremulous at 5:00 PM. Which action should the nurse take first?
Take the patient's blood pressure. Check the patient's capillary blood sugar.- Give the patient's as-needed dose of insulin. Advise the patient to lie down with the legs elevated. The patient is showing symptoms of hypoglycemia at 5:00 PM. NPH has a peak action of 8 to 10 hours after administration. Based on the duration of action of NPH insulin, the patient's hypoglycemic symptoms are from the 8:00 AM injection of NPH insulin. It may also be necessary to take the patient's blood pressure, but the nurse is aware of the risks for hypoglycemia with insulin administration. Insulin should not be administered until the patient's blood sugar is determined. Lying down with the legs elevated will not help the hypoglycemic patient.
A patient is scheduled to start taking insulin glargine. Which information should the nurse give the patient regarding this medication?
This medication provides blood glucose control for 24 hours.- The peak effect of this medication is achieved in 2 to 4 hours. This medication provides mealtime coverage of blood glucose. Less frequent blood glucose monitoring is required when taking this medication. Insulin glargine is administered as a once-daily subcutaneous injection for patients with type 1 and type 2 diabetes. It is used for basal insulin coverage, not mealtime coverage. It has a prolonged duration, up to 24 hours, with no peaks. Blood glucose monitoring is still an essential component to achieve tight glycemic control.
Which statement made by a patient about type 1 diabetes mellitus indicates effective learning?
Type 1 diabetes mellitus accounts for 90% of all diabetic cases. The endogenous insulin levels are elevated early in the disease. Patients with type 1 diabetes mellitus require exogenous insulin.- Type 1 diabetes mellitus leads to developing acute hypoglycemia. Type 1 diabetes involves lack of insulin production. Hence, patients with type 1 diabetes require exogenous insulin to lower the blood glucose level. Type 1 diabetes results in acute hyperglycemia due to lack of insulin. The disease accounts for 10% of all cases and is usually seen in patients younger than 20 years. There is little or no endogenous insulin, because the patient's body is unable to produce insulin.
A nurse caring for a patient who has diabetic ketoacidosis recognizes which characteristics in the patient? Select all that apply.
Type 2 diabetes Triggered by acute illness- Arterial blood pH of 7.35 to 7.45 Altered fat metabolism leading to ketones- Plasma osmolality of 300 mOsm/L to 320 mOsm/L- Diabetic ketoacidosis is the most severe manifestation of insulin deficiency in patients with type 1 diabetes. It develops and worsens acutely over several hours to days. Alterations in fat metabolism lead to the production of ketones and ketoacids. Increased ketoacid levels lead to a fall in arterial blood pH below 7.35. Altered glucose metabolism leads to hyperglycemia, water loss, and an elevated plasma osmolality (normal 285 to 295 mOsm/L).
Which technique is most appropriate regarding mixing insulin when a patient must administer 30 units regular insulin and 70 units neutral protamine Hagedorn (NPH) insulin in the morning?
Use the Z-track method for administration. Draw the medication into two separate syringes but inject into the same spot. Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin.- Administer these insulins at least 10 minutes apart, so you will know when they are working. Drawing up the regular insulin into the syringe first prevents accidental mixture of NPH insulin into the vial of regular insulin, which could cause an alteration in the onset of action of the regular insulin. The medications do not have to be in separate syringes and can be administered together. The Z-track method is an intramuscular technique that is not used with insulin, which is administered subcutaneously.
Which precautions should the nurse take before administering isophane insulin, also known as neutral protamine Hagedorn insulin suspension to a patient? Select all that apply.
Verify that insulin syringes are used. - Identify the intramuscular injection site. Shake the drug vial gently for some time. Rotate the injection locations every week.- Monitor the patient's fasting serum glucose level.- The nurse should monitor the patient's fasting serum glucose levels before administering insulin in order to prevent hypoglycemia. The nurse rotates the general injection site every week in order to prevent lipodystrophy. Lipodystrophy is damage to the adipose tissue due to continued insulin injections to a specific area. The nurse ensures that insulin syringes are used in order to administer an accurate dose. The nurse does not shake the vial because it causes bubbles. Instead, the nurse should gently roll the vial to mix the contents. The nurse injects insulin into the subcutaneous tissue.
