Pharm Chapter 38: Agents to Control Blood Glucose Level
Which would a nurse identify as an example of a sulfonylurea?
Glyburide
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 caring for a client who has been prescribed glyburide. Which factor, if identified in the client history, would cause the nurse to inform the health care provider of a contraindication to use?
Allergy to sulfonamides
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.
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 client has been noncompliant with the diabetic medication regimen and develops diabetic ketoacidosis. Which would the nurse assess?
Deep respirations
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
What would alert the nurse to suspect that a client is developing ketoacidosis?
Fruity breath odor
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.
The nurse is preparing a presentation for a local community group about diabetes. Which facts should the nurse include when explaining type 1 diabetes? Select all that apply.
Occurs before age 20 Insulin supplementation required for survival
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 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.)
Orange or other fruit juice Glucose tablets Hard candy
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 client with hyperinsulinism has been prescribed diazoxide. After administration, which adverse reaction should the nurse prioritize?
Tachycardia
Which condition must be met in order for repaglinide treatment to be effective for the client with type 2 diabetes?
The client must have functioning pancreatic beta cells.
A nurse is preparing a teaching session for a client who is prescribed miglitol. The nurse would instruct the client to administer this drug at which time?
Three times a day with the first bite of a meal
The stress response triggered by illness will result in the increase secretion of what hormone? Select all that apply.
cortisol glucagon growth epinephrine
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
Rosiglitazone is being considered for the treatment of diabetes in an adult client. Before the initiation of rosiglitazone therapy, the nurse should review what laboratory work recently drawn?
liver enzymes
A client with type 1 diabetes has a medication regimen that includes insulin NPH. The nurse has administered the scheduled dose at 0800 and will expect to first assess for the medication's onset of action at what time?
0900
When administering insulin, what would be most appropriate?
Insert the needle at a 45-degree angle for injection.
A nurse is preparing to administer a long-acting insulin to a client. Which insulin might the nurse administer? Select all that apply.
Insulin glargine Insulin detemir
A nurse is caring for a client with diabetes mellitus who is receiving an oral antidiabetic drug. Which ongoing assessments should the nurse prioritize when caring for this client?
Observe the client for hypoglycemic episodes
The nurse is providing education to the parents of a child newly diagnosed with type 1 diabetes. What distinguishing characteristic of the disorder does the nurse include in the teaching?
The child will eventually produce no insulin
A client with diabetes has been prescribed pramlintide 15 mcg subcutaneously before meals. The nurse will recognize which additional aspect of the client's diabetes management regimen?
The client also takes insulin before meals.
A client diagnosed with type 2 diabetes several months ago 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 blood glucose levels.
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
When reviewing the medication list of a client being seen in the clinic, the nurse notes that the client is receiving glipizide. Based on the nurse's understanding, this drug is used to treat:
hyperglycemia.
The nurse is assessing a client who was administered metformin and notes hyperventilation, nausea, and somnolence. The nurse determines which nursing diagnosis should be prioritized for this client?
Altered Breathing Pattern
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 Aspart has an onset of action of 5 to 10 minutes, making the most rapidly acting insulin. NPH, regular, and 30/70 all take significantly longer to have an effect on blood glucose levels.
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 preparing to administer insulin glargine to a client. Which actions will the nurse perform when preparing the insulin? Select all that apply.
Check the expiration date on the vial. Check the health care provider's orders for the type and dosage of insulin. Remove all air bubbles from the syringe barrel.
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
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 Exenatide is administered by subcutaneous injection within 60 minutes before morning and evening meals. Rosiglitazone would be administered as a single oral dose. Repaglinide is used orally before meals. Miglitol is given orally with the first bite of each meal.
The nurse is providing education to a client who has been prescribed therapy with an antidiabetic medication. During teaching, the nurse will caution the client against heavy intake of which herb?
Garlic
A nurse has determined a client has developed a hypoglycemic reaction. Which interventions should the nurse perform if the client can adequately demonstrate swallowing and gag reflexes?
Give oral fluids or candy.
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.
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.
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 nurse is preparing to administer a rapid-acting insulin. Which medication would the nurse likely administer?
insulin lispro
When considering the management of diabetic ketoacidosis (DKA), what type of insulin can be administered intravenously?
regular
After administering insulin detemir to a client with diabetes, the nurse suspects that the client is developing hypoglycemia based on which assessment findings? Select all that apply.
Headache Confusion Diaphoresis
When describing the effects of incretins on blood glucose control to a group of students, which would an instructor include?
Increases insulin release
After teaching a class about the various drugs used to control blood glucose, the instructor determines that the teaching was successful when the class identifies what as a biguanide?
Metformin
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 two major classifications of diabetes are type 1 and type 2. What is a distinguishing characteristic of type 1 diabetes?
Lifelong exogenous insulin is required
The two major classifications of diabetes are type 1 and type 2. What is a distinguishing characteristic of type 1 diabetes?
Lifelong exogenous insulin is required.
The nurse is assessing a client for risk factors associated with type 2 diabetes. Which findings would the nurse prioritize? Select all that apply.
Obesity History of gestational diabetes impaired glucose tolerance
A client diagnosed with type 1 diabetes suddenly reports feeling weak, shaky, and dizzy. What should be the nurse's initial response?
Perform a blood sugar analysis
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
A student asks the nursing instructor what insulin has the quickest therapeutic effect once administered. What would be the best response?
Regular (Humulin R) Regular insulin has the quickest onset of 30-60 minutes. PZI and ultralente have an onset of 4-8 hours. NPH has an onset of 60-90 minutes.
A client with type 1 diabetes is diagnosed with diabetic ketoacidosis and is prescribed regular insulin IV at 5 units/hr. The infusion container has 250 units in 1000 ml of normal saline. How many milliliters per hour (ml/hr) should the nurse set the infusion pump to administer the insulin infusion? Record your answer using a whole number.
20 The equation 5 units/hr = 250 units/1000 ml can be used. With cross multiplication, 5 units x 1000 ml = 250 units x; then, solve for x or 5000/250 = 20 ml. The infusion pump should be set to deliver 20 ml/hr.
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 The client is significantly hypoglycemic and needs emergency treatment. Glucagon would be the agent of choice to raise the client's glucose level because it can be given intravenously and has an onset of approximately 1 minute. Diazoxide can be used to elevate blood glucose levels, but it must be given orally. Lispro and regular insulin would be used to treat hyperglycemia.
Which is the best indicator of overall diabetic control?
Glycosylated hemoglobin levels