NURS 317: Chap 45 Diabetes

19. The use of which of the following medications has the potential for causing the greatest reduction in Hgb A 1C? a. a biguanide b. a thiazolidinedione c. a sulfonylurea d. an insulin form

D

22. A pt with type 1 diabetes received her NPH insulin at 7:30 am. When would you most likely assess for a hypoglycemic reaction? a. mid-morning b. mid-afternoon c. at bedtime d. middle of the night

B - NPH peaks 4-12 hours after administration so watch for hypoglycemia mid-afternoon to supper time (3-5 pm)

28. The nurse on the medical unit is preparing to administer 0900 medications. Which medication should the nurse question administering? a. synthroid (levothyroxine) to the client diagnosed with hypothyroidism b. glucophage (metformin) to the type 2 diabetic who just had a CT scan with dye c. humulin N (NPH) insulin to the client with type 1 DM who is no longer NPO d. novolog (aspart) insulin 15 minutes prior to breakfast

B - metformin should be held for 24 hours after client has received any kind of contrast dye since it can cause renal failure

21. A pt with Type 1 diabetes received his scheduled dose of regular insulin at 7:30am. When would you most likely assess for a hypoglycemic reaction? a. mid-afternoon b. mid-morning c. at bedtime d. middle of the night

B - risk of hypoglycemia is greatest at the peak drug level; regular insulin peaks 2-3 hours after administration

10. An external insulin pump is prescribed for a client with diabetes mellitus and the client asks the nurse about the functioning of the pump. The nurse's best response is based on knowledge that the pump: a. is timed to release programmed doses of regular or NPH insulin into the bloodstream at specific intervals b. continuously infuses the small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels c. is surgically attached to the pancreas and infuses regular insulin into the pancreas, which in turn releases the insulin into the bloodstream d. gives a small continuous dose of regular insulin subcutaneously, and the client can self-administer a bolus with an additional dose from the pump before each meal

D

18. Which of the following classes of medications is most commonly prescribed as first-line therapy in the newly diagnosed person with type 2 diabetes? a. alpha-glucosidase inhibitor b. meglitinide c. thiazolidinedione d. biguanide (Metformin)

D

25. The critical care nurse has just received morning shift report on a client diagnosed with heart failure and who has pre-existing type 2 DM. The client has the following MAR: Metformin 100mg po BID - given at 0800, 1700 70/30 insulin 24 units subcut BID - given at 0800, 2000 Digoxin 0.125 mg IVP daily - given 0800 Rocephin 100 mg IVPB TID - given 0730, 1530 Which medication should the nurse administer first? a. administer metformin (Glucophage) 100 mg po b. administer digoxin 0.125 mg IVP c. administer rocephin (ceftriaxone) 100 mg IVPB d. administer 70/30 insulin subcut

D - 70/30 insulin contains both intermediate-acting and short-acting insulin and therefore due to the short-acting insulin must be given prior to a meal... therefore, this medication is priority

2. The client received NPH (isophane) insulin at 0730. Based on an understanding of peak time, the nurse should assess the client for hypoglycemia at which time? a. 1000 b. 1200 c. 1400 d. 1600

d

3. Nurse is reviewing pt's MAR in preparation for administration of rapid acting insulin at breakfast time. Physician has ordered a sliding scale coverage based on QID glucose level and the number of carbohydrates consumed (carb counting) at mealtimes. Pt ate all of his oatmeal (1 CHO), 1/2 of his yogurt with blueberries (0.75 CHO), none of his toast (0 CHO), and 1/2 of his milk (0.5 CHO). MAR reads blood glucose at 189, Novolog 2 units per CHO at mealtime. Sliding scale: <60 - notify HCP, <150 - 0 units, 151-200 - 2 units, 201-250 - 4 units, 251-300 - 6 units, 301-350 - 8 units, 351-400 - 10 units, >400 notify HCP Based on his MAR and meal slip, how much Novolog (aspart) insulin should the nurse plan to administer?

2.25 CHO consumed: 2.25 x 2 units per CHO = 4.5 units for CHO plus 2 units on sliding scale = 6.5 total units of Novolog insulin to be given

24. After receiving sift report, the 7pm to 7am nurse is reviewing the MAR of the client diagnosed with Type II DM. Which intervention should the nurse implement? Note: pt is on sliding scale insulin as well MAR: 0430 24 units of Humulin (NPH) given 0745 BS 55, 0 units Novolog given 1145 BS 245, 4 units given 1640 24 units of Humulin (NPH) given 1645 BS 398, 10 units given a. make sure client receives a snack at bedtime b. check the client's blood glucose levels immediately c. have the UAP give the client some orange juice d. teach the client about symptoms of diabetic ketoacidosis

A - client is receiving an intermediate-acting insulin at 1640 to cover basal insulin needs plus the sliding-scale insulin dose to lower the client's elevated blood glucose level at mealtime; the client should receive a bedtime snack to ensure the client does not experience a hypoglycemic reaction during the night; client's are at greatest risk for hypoglycemia when insulin is at its peak level; intermediate acting insulin generally peaks 6-8 hours after administration (or 2230-0030 for this client)

26. At 1000, the client diagnosed with type 1 DM is complaining of feeling jittery, having a headache, and being dizzy. Which intervention should the nurse implement first? a. give client glucose tablets b. provide client with the lunch meal c. request the lab to draw a serum glucose level d. determine the last time the client received insulin

A - symptoms indicate hypoglycemia so nurse should treat with a simple carbohydrate (glucose tablets). nurse can then follow with more complex carbohydrates (lunch) to prevent another episode of hypoglycemia

16. The mechanism of action of exanatide (Byetta) is as: a. a drug that stimulates insulin production in response to increase in plasma glucose b. a product virtually identical in action to sulfonylureas c. a drug that increases insulin action in peripheral tissues and reduces hepatic glucose production d. a facilitator of renal glucose excretion

A

17. What is the most common adverse effect noted with alpha-glucosidase inhibitor use? a. GI upset b. Hepatotoxicity c. Renal impairment d. symptomatic hypoglycemia

A

4. The nurse understands that insuline glargine (Lantus) is prescribed because of its: a. extended duration of action b. rapid onset of action c. ability to prevent diabetic end-organ damage d. ability to preserve pancreatic function

A

5. After use, the onset of action of lispro (Humalog) occurs in: a. less than 30 min b. approximately 1 hour c. 1-2 hours d. 3-4 hours

A

8. A client is scheduled to receive 5 units of Humalog and 25 units of glargine (Lantus) insulin prior to bedtime for a blood sugar of 252. What nursing intervention is most appropriate for this client? a. make sure client's snack is ready to eat before administering the insulin b. offer the client a high-carbohydrate snack in 6 hours c. hold the insulin if the blood glucose level is < 100 mg/dl d. administer the medications in two separate syringes

A

9. Which of the following statements best describes the Somogyi effect? a. insulin-induced hypoglycemia triggers excess secretion of glucagon and cortisol, leading to hyperglycemia b. early morning elevated blood glucose levels result in part from growth hormone and cortisol-triggering hepatic glucose release c. late evening hyperglycemia is induced by inadequate insulin dose d. episodes of postprandial hypoglycemia occur as a result of inadequate food intake

A

11. Which of the following medications should be used with caution in a person with suspected or unknown sulfa allergy? a. metformin b. glyburide c. rosiglitazone d. NPH insulin

B - glyburide is a sulfonylurea, which poses a potential allergy risk to pts with a sulfa allergy

15. Metformin should be discontinued for the day of and up to 48 hours after surgery because of increased risk of: a. hypoglycemia b. hepatic impairment c. lactic acidosis d. interaction with most anesthetic agents

C - especially in pts with renal impairment

20. Convert the hourly rate of insulin infusion: The order is a continuous rate of insulin 5 units per hour. The IV bag reads 100 units of regular insulin in the 500 mL 0.9% NS. Calculate the infusion rate in mL per hour.

100 units/500mL = 5 units/x mL 100x = 2500 x = 25 mL/hr

2. Sample physician order: novolog 2 units per CHO at mealtime. Meal: 8 oz skim milk = 1 carb side salad = 0 carbs cheeseburger hamburger helper = 1.5 carbs 1/2 cup mashed potatoes = 1 carb 1/2 cup lite peaches = 1 carb Calculate how many units pt should get if they eat the entire amount of food listed above.

9 units: 4.5 CHO x 2 units per carb = 9; if pt also has a sliding scale mealtime insulin ordered, this number should be added to the amount of insulin needed to cover carbs

14. The mechanism of action of sulfonylureas is as: a. an antagonist of insulin receptor site activity b. a product that enhances insulin release c. a facilitator of renal glucose excretion d. an agent that can reduce hepatic glucose production

B

23. A 48 year old woman newly diagnosed with type 2 diabetes mellitus is prescribed glyburide (Diabeta). The most important teaching aspect for this client is that medications should: a. never be taken with food b. be taken shortly after eating c. be discontinued if an infection develops d. not be taken if glucose levels are within normal limits

B

7. In a healthy person, what percentage of the body's total daily physiological insulin secretion is released as basally? a. 10% b. 25% c. 50% d. 75%

C

12. The mechanism of action of metformin (Glucophage) is as: a. an insulin-production enhancer b. a product virtually identical in action to sulfonylurea c. a drug that reduces hepatic glucose production and increases insulin action in the peripheral tissues d. a facilitator of renal glucose excretion

C

13. The mechanism of action of pioglitazone (Actos) is as: a. an insulin-production enhancer b. a reducer of pancreatic glucose output c. an insulin sensitizer d. a facilitator of renal glucose excretion

C

29. Which nursing intervention is a priority for the ICU nurse to implement when caring for the client diagnosed with diabetic ketoacidosis (DKA)? a. assess for fruity breath odor b. assess blood glucose levels every morning and evening c. monitor the client's pulse oximeter readings d. maintain the regular insulin IV rate on an infusion pump

D - decreasing pt's blood glucose level is the priority and therefore maintaining and monitoring the insulin drip is the priority nursing intervention

27. Which laboratory data should the nurse monitor for the client receiving IV Solu-Medrol (methylprednisolone)? a. potassium level b. sodium level c. liver enzymes d. glucose levels

D - endogenous corticosteroids are normally released in response to stress and increase glucose levels in order to provide fuel for increased energy needs; therefore, exogenous corticosteroids such as methylprednisolone will exert the same effect --> raise glucose levels --- nurse should monitor glucose levels in a pt taking corticosteroids

6. With an 8am dose of the following insulin forms, followed by inadequate dietary intake and/or excessive energy use, at approximately what time would hypoglycemia most likely occur? Lispro: ________________ Regular insulin: __________________ NPH insulin: __________________ Insulin glargine (Lantus): _______________

Lispro: approximately 8:30-9:30 am Regular insulin: approximately 10-11 am NPH insulin: approximately 2-8 pm (on average 8 hours after administration, so late afternoon sometime) Insulin glargine (Lantus): episode of hypoglycemia is unlikely d/t no peak

9. Which information should the nurse give to the client who has diabetes managed with insulin and who is planning to engage in an exercise program? a. monitor blood glucose levels before and after exercise b. eat a complex carbohydrate at the first sign of hypoglycemia c. exercise will not necessitate changes in insulin needs d. withhold insulin before engaging in strenuous exercise

a - client should monitor because strenuous activity may affect insulin needs

3. The client is scheduled to receive 5 units of Humalog and 25 units of glargine (Lantus) insulin prior to bedtime for a blood sugar of 252. Which nursing intervention is most appropriate for this client? a. make sure client eats a snack before going to sleep b. offer the client a high-carbohydrate snack at 6am c. do not administer the glargine (Lantus) insulin d. administer the medications together in one syringe

a - hypoglyc. can occur rapidly if Humalog insulin is not supported by sufficient food intake

10. Which information should the nurse give to the diabetic client who is starting on glargine (Lantus)? a. do not mix this medication with any other insulin b. eat a complex carbohydrate within 15 minutes of administration c. stress and illness does not require an increase in dosing needs d. withhold the dose if evening blood sugar is less than 200 mg/dL

a - lantus cannot be mixed - stress and illness may require increasing the dose of insulin, client should not hold the dose without speaking with the healthcare provider first

8. The nurse is initiating client education about the medication Glucophage (metformin). Which question is most important to ask the client before beginning therapy on metformin? a. "do you have any known liver function abnormalities?" b. "are you able to limit your fluid intake to avoid bloating?" c. "do you have a way to crush your pills before mixing them with food?" d. "will you have difficulty eating only three main meals per day?"

a - risk for lactic acidosis is increased in pt taking metformin, putting them at risk for increased lactic acid production, such as liver disease

1. Which info should the nurse emphasize with the client when teaching about the medication administration of glipizide (glucotrol)? a. the drug can decrease absorption of folate b. the drug should not be taken with alcohol c. the drug must be taken with evening meals d. the drug can affect renal and liver functions

b - alcohol with sulfonyurea medications = disulfiram-like rxn that includes flushing, palpitations, and nausea

1. Which of the following hormones maintains adequate levels of glucose in the blood between meals? a. insulin b. glucagon c. cortisol d. epinephrine

b - glucagon is released by alpha cells of pancreas in response to lower glucose levels that occurs between meals to maintain glucose levels between 70-100 mg/dL.

4. The client with type 2 diabetes is prescribed to take glyburide 10 mg by mouth daily. The client asks the nurse when would be the best time to take this medication. What is the nurse's best response? a. "take medication in the evening, with a snack" b. "take the medication in the morning, 30 min before breakfast" c. "this medication should be taken after the midday meal" d. "it does not matter what time of day you take this medication"

b - when taken at this time, it has a longer duration of action causing it to release a constant amount of insulin

5. A nurse is initiating discharge teaching with a newly diagnosed diabetic. Which statement indicates that the client needs additional teaching? a. "if I am experiencing hypoglycemia, I should drink half a cup of apple juice" b. "my insulin needs might increase when I have an infection" c. "I must draw the NPH insulin first, if I am mixing with regular insulin" d. "for blood sugar levels of 300 mg/dL or higher, I must check my urine for ketones"

c - client should draw up the regular insulin (clear) first followed by the NPH (cloudy)

6. A nurse administers regular insulin 4 units to a client with a blood sugar of 228 mg/dL. For which symptoms of hypoglycemia should the nurse monitor in the client? a. hypothermia and seizures b. nausea and diarrhea c. irritability and confusion d. fruity, acetone odor to the breath

c - early symptoms of hypoglyc = CNS manifestations of confusion, irritability, tremor, sweating

7. The client is newly admitted with clinical manifestations of type 1 diabetes ketoacidosis. Which medication should the nurse anticipate administering immediately to this client via intravenous access? a. glucagon b. pancreatin (Viokase) c. glargine (Lantus) d. regular insulin

d - regular insulin IV for systemic action to occur