Karch's Focus on Pharmacology 8th Ed. | Chapter 38
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
What hormone, secreted with insulin, increases satiety and suppresses glucagon secretion?
Amylin
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 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."
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 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 client is scheduled to get a breakfast tray at 07:00. At what time should the client receive a prescribed dose of insulin lispro?
06:45
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?
Delayed growth and development
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?
Detemir
The nurse is caring for a client with diabetes and administered the client's scheduled dose of regular insulin and NPH insulin at 08:00. At 09:30 the nurse checks the client's blood glucose level, which is 140 mg/dL. What is the nurse's best action?
Document the finding and check the client's blood glucose level in one hour
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
Which insulin would the nurse need to administer as a separate injection if the order also included NPH insulin?
Glargine
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
Which is the best indicator of overall diabetic control?
Glycosylated hemoglobin levels (A1C)
The nurse is preparing to administer 20 units of NPH insulin to a client. Before administering the medication, the nurse should implement which intervention?
Have a colleague confirm the dosage.
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)
A nurse is preparing to administer a rapid-acting insulin. Which medication would the nurse most likely administer?
Insulin lispro
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?
It decreases intestinal absorption of glucose and improves insulin sensitivity.
As a diabetic educator, the nurse is teaching a newly diagnosed diabetic client about aspects of the disease process. What would the nurse tell the client about the body's control of glucose?
It is related to fat and protein metabolism
What is the expected action of sitagliptin on type 2 diabetes?
It slows the rate of inactivation of the incretin hormones.
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
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?
The client frequently checks his/her blood glucose levels.
Which condition must be met in order for glyburide treatment to be effective?
The client must have functioning pancreatic beta cells.
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.)
Watch the client draw up and administer her insulin. Reinforce instructions on dealing with hypoglycemia. Assist the client in making menus that will meet the needs of both the client and the family.
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?
Widespread changes in the blood vessels
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
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?
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.
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 a thiazide diuretic, a corticosteroid, and estrogens. The nurse understands that this client is at risk for what condition?
Hyperglycemia Rationale: 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.
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?
Hypoglycemia
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.)
Impaired mental functioning Lethargy Irritability
The nurse is explaining the action of exenatide to a patient. Which would the nurse include?
Increase insulin resistance
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.
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
The nurse walks into the room of a client with type 1 diabetes and finds the client pale and diaphoretic. The client reports a headache and being hungry. Immediately, the client is unable to talk. What is the nurse's immediate intervention for this client?
Place glucose gel between the gums and cheek.
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
Which would be least appropriate when administering insulin by subcutaneous injection?
Massaging the site after removing the needle
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?
Meals should be eaten at regular times.
Which strategy will NOT increase the therapeutic effect of insulin?
All insulin should be stored in a refrigerator but never frozen. Rationale: 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.
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 hospital client with a diagnosis of type 1 diabetes is prescribed Humulin R on a sliding scale. Based on the client's blood glucose reading, the nurse administered 8 units of insulin at 07:45. The nurse should consequently check the client's blood glucose level at what time to monitor peak effectiveness of the medication?
Between 09:45 and 10:45
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
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.)
Hard candy Glucose tablets Orange or other fruit juice
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.
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.)
Metformin (Glucophage) Acarbose (Precose) Miglitol (Glyset)
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. Rationale: Since metformin does not directly stimulate insulin secretion, hypoglycemia risk may be lower than for that of other oral antidiabetes drugs. However, hypoglycemia in patients using metformin may occur in association with strenuous physical activity or fasting.
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?
Metformin should be discontinued at least 48 hours before and after diagnostic tests that use contrast medias.
A client is prescribed sitagliptin. The nurse would expect to administer this drug by which route?
Oral
What should be the nurse's initial response when a client diagnosed with type 1 diabetes suddenly reports feeling weak, shaky, and dizzy?
Perform a blood sugar analysis.
When considering the management of diabetic ketoacidosis (DKA), what type of insulin can be administered intravenously?
Regular
A student asks the nursing instructor what insulin has the quickest therapeutic effect once administered. What would be the best response?
Regular (Humulin R)
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
Because of the risk for lactic acidosis, metformin is contraindicated in which client?
an 82-year-old diagnosed with type 2 diabetes
A client is receiving metformin therapy at a health care facility. The client is also prescribed glucocorticoids. The nurse would be alert for which adverse reaction due to the interaction of these two drugs?
increased risk of lactic acidosis
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?
liver enzymes
