PrepU Chapter 41: Drug Therapy for Diabetes Mellitus

The nurse assesses a client's blood glucose level after administering insulin. Which result would the nurse interpret as indicative of severe hypoglycemia?

34 mg/dL Blood glucose levels below 40 mg/dL are indicative of severe hypoglycemia.

A client with type 1 diabetes has been prescribed insulin glargine for the first time. What will the nurse teach the client about this medication?

"This insulin will provide a steady amount of insulin over 24 hours." Long-acting insulin preparations such as insulin glargine provide a basal amount of insulin through 24 hours, similar to normal, endogenous insulin secretion. They do not need to be as closely aligned with meals as other, more rapidly-acting, insulins.

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. Prior to administering insulin glargine to a client, the nurse must complete the following preadministration steps: carefully check the health care provider's order for the type and dosage of insulin, check the expiration date on the vial, gently rotate the vial between the palms of the hands, gently tilt end to end before withdrawing the insulin, and remove all air bubbles from the syringe barrel. The nurse should never mix or dilute insulin glargine with any other insulin or solution because the insulin will not be effective.

The nurse is assessing a client for risk factors associated with type 2 diabetes. Which findings would the nurse prioritize? Select all that apply.

-Impaired glucose tolerance -Obesity -History of gestational diabetes Risks include obesity, older age, family history of diabetes, history of gestational diabetes, impaired glucose tolerance, minimal or no physical activity, and race/ethnicity (African Americans, Hispanic/Latino Americans, Native Americans, and some Asian Americans).

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

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. Clients who take pramlintide should not be injected into the same site where insulin is administered.

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 Glipizide is an antidiabetic agent with the desired action of lowering the blood glucose level. It is used to treat hyperglycemia.

When describing the effects of incretins on blood glucose control to a group of students, which would an instructor include?

Increases insulin release Incretins increase insulin release, decrease glucagon release, slow GI emptying, and stimulate the satiety center.

A nurse is preparing to administer insulin to the client. Which interventions should the nurse perform before administering each insulin dose?

Inspect the previous injection site for inflammation. The nurse should check the previous injection site before administering each insulin dose. The injection sites should be rotated to prevent lipodystrophy.

A nurse instructs an older adult client to eat within 30 minutes of the administration of which antidiabetic drugs to prevent hypoglycemia?

glipizide A nurse should advise a client, especially an older adult client, to eat within 30 minutes of the administration of sulfonylureas like glipizide to prevent hypoglycemia.

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 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

After teaching a group of students about the various methods for the delivery of insulin, the instructor determines that the teaching was successful when the students identify which method as most commonly used for administration?

Subcutaneous injection

A client with hyperinsulinism has been prescribed diazoxide. After administration, which adverse reaction should the nurse prioritize?

Tachycardia The nurse should monitor for tachycardia, congestive heart failure, sodium and fluid retention, hyperglycemia, and glycosuria as the adverse reactions in the client receiving diazoxide drug therapy.

The health care provider prescribes glyburide for a client who is a newly diagnosed type 2 diabetic. The nurse knows that this medication produces hypoglycemia by:

increasing insulin secretion from the pancreas. The hypoglycemic action of glyburide results from the stimulation of pancreatic beta cells, leading to increased insulin secretion.

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?

lispro - 15 min before meals -> 06:45

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 Rosiglitazone has been associated with hepatotoxicity and requires monitoring of liver enzymes. Liver function tests (e.g., serum aminotransferase enzymes) should be checked before starting therapy and every 2 months for 1 year, then periodically.

What instructions would be important to give to a 50-year-old client with type 2 diabetes who has been switched from glyburide , a sulfonylurea, to repaglinide, a meglitinide?

"It stimulates insulin production, so you need to eat soon after taking the medication." Glyburide's onset of action is 2 to 4 hours, and its duration is 24 hours. Repaglinide's onset of action is within 30 minutes, peak is 1 hour, and duration is approximately 3 to 4 hours. Repaglinide is taken 15 to 30 minutes before each meal because it stimulates the pancreas to secrete insulin to correspond to the food intake. If there is no food intake, the person is at risk of hypoglycemia. Glyburide, a sulfonylurea, also stimulates pancreatic cells, but not until 2 to 4 hours after it is taken.