pathopharm Chapter 38: Agents to Control Blood Glucose Levels

Which produce their glucose lowering effect by decreasing insulin resistance and increasing insulin sensitivity?

Rosiglitazone (Avandia) Pioglitazone (Actos)

A nurse is presenting an educational event at a local senior citizens' club about diabetes. What would the nurse tell the attendees at the event about diabetes?

It is a complicated disorder that alters the metabolism of glucose.

A patient receives 25 units of NPH insulin at 7 AM. At what time of day should the nurse advise the patient to be most alert for a potential hypoglycemic reaction?

Late afternoon

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.

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 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 nurse educator, explaining the pathophysiology of diabetes to a newly diagnosed client, should provide what explanation for the client's "constant, insatiable thirst"?

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

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 nurse is reinforcing teaching about acarbose (Precose) to a client with newly diagnosed type 2 diabetes. Which statement by the client indicates a need for further understanding?

"I must take this medication one hour before I eat."

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 42-year-old male client is prescribed glargine insulin for management of his type 2 diabetes mellitus. The nurse caring for the client develops a teaching plan regarding glargine insulin therapy. Which statement made by the client indicates that the client needs additional teaching?

"The medication will peak in 3 hours."

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

A nurse is preparing a syringe that contains regular and NPH insulin. To ensure effectiveness, the nurse would administer the insulins within which time frame?

15 minutes

A patient is taking chlorpropamide. The nurse warns the patient about the possibility of hypoglycemia within approximately which time frame after taking the drug?

3 to 4 hours

Which strategy will NOT increase the therapeutic effect of insulin?

All insulin should be stored in a refrigerator but never frozen.

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

Oral anti-diabetic agents can be used in various combinations for what purpose?

Additive effects

When planning diabetic screenings, which populations should receive the nurse's priority? Select all that apply.

Black clients Native American clients Hispanic immigrant clients

What hormone, secreted with insulin, increases satiety and suppresses glucagon secretion?

Amylin

The nurse's assessment of a client who has presented to the emergency department reveals hyperglycemia. Which type of insulin will have the most rapid effect on the client's blood sugar levels?

Aspart

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?

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 client receives regular insulin at 8:00 AM. The nurse would be alert for signs and symptoms of hypoglycemia at which time?

Between 10:00 AM and 12:00 PM

A client 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

A client is receiving glipizide as treatment for his type 2 diabetes. The nurse understands that this drug acts by:

Binding to potassium channels on pancreatic beta cells

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 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 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 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

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 aware that premixed insulins (those that contain both regular and NPH insulin) are least effective in what type of client?

Client who has difficulty controlling his diabetes

Which would the nurse identify as an effect of somatostatin on blood glucose?

Decreased glucagon release

A client has been noncompliant with the diabetic medication regimen and develops diabetic ketoacidosis. Which would the nurse assess?

Deep respirations

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 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

The nurse is working with a client who uses an insulin pump for management of type 1 diabetes. The nurse should remind the client that the needle on the pump needs to be changed how often?

Every 1-3 days

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

Heavy intake of which herb should be avoided by a client who is prescribed an antidiabetic medication?

Garlic

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 insulin would the nurse need to administer as a separate injection if the order also included NPH insulin?

Glargine

After teaching a group of students about sulfonylureas, the instructor determines that the teaching was successful when the students identify which agent as a second-generation sulfonylurea?

Glimepiride Glyburide

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

Before administering a prescribed 20 units of NPH insulin to a client, the nurse should implement which intervention?

Have a colleague confirm the dosage.

During ongoing assessment of clients receiving insulin detemir (Levemir), the nurse assesses the client for symptoms of hypoglycemia that include which symptoms?

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

A nurse should monitor a client taking glimepiride (Amaryl) for which of adverse effects?

Hypoglycemia Heartburn Nausea

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

Increase in 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

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?

Insulin glargine (Lantus) Insulin detemir (Levemir)

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 best describes type 1 diabetes? (Select all that apply.)

Insulin supplementation is required for survival Occurs before age 20

A nurse must recognize the duration of insulin so as not to cause harm to the client with administration of the improper type of insulin. Which insulins are rapid acting?

Insuline glulisine (Apidra) Insulin aspart (NovoLog)

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?

Irritability Impaired mental functioning Lethargy

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

A client with a diagnosis of diabetes is prescribed pramlintide. How will this drug assist in controlling the client's blood sugar?

It slows gastric emptying.

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

It slows the rate of inactivation of the incretin hormones.

The nurse who has admited a client with diabetic ketoacidosis should look for what assessment findings that are consistent with this diagnosis?

Ketones in the urine Flushed, dry skin

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

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.

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.

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 (Apidra) 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?

Orange or other fruit juice Glucose tablets Hard candy

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

Perform a blood sugar analysis.

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.

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 4-year-old female child is diabetic with a blood glucose level of 120 mg/dL. The child's mother brings her to the health care provider's office with symptoms of the flu and dehydration. What would the nurse expect the provider to order?

Regular sodas, clear juices, and regular gelatin desserts

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?

Reinforce instructions on dealing with hypoglycemia. 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.

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 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 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 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.

The nurse is conducting a class for newly diagnosed adult diabetic patients. What would the nurse educate the patients about?

The disease

As the first-line treatment, a client with type 2 diabetes has tried diet and exercise. When these fail, what may be added as monotherapy or in combination with metformin to control their disease process?

Thiazolidinediones

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

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

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 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 client with elevated blood glucose levels who is to receive alpha-glucosidase inhibitor drug therapy. The nurse understands that this therapy would be contraindicated if the client had which condition?

cirrhosis chronic intestinal diseases colonic ulceration

Which medication would a nurse identify as a noninsulin injectable antidiabetic drug?

exenatide

A nurse at a health care facility is caring for a client who has been prescribed insulin for the first time. Which preadministration assessments should the nurse perform before the first dose of insulin is given?

general assessment of the skin

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 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

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

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

After teaching a group of nursing students about antidiabetic drugs, the instructor determines that the teaching was successful when the students identify which as an example of a hormone mimetic?

sitagliptin exenatide pramlintide

A client with diabetes is undergoing testing for glycosylated hemoglobin. The nurse instructs the client that this test measures average blood glucose over what time period?

the past 3 or 4 months

The demonstration of what symptom would suggest that an insulin-dependent client is experiencing a hypoglycemic reaction?

weakness diaphoresis mental confusion increased pulse rate