38 PHARM PU

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 walk two blocks to school every day." "My mother is going to give me my insulin." "We live in a two-story house." "I am on the middle school track team."

"I am on the middle school track team." Because the client is on the track team, she will have increased exercise at various times that will require increased insulin and special instructions related to hypoglycemia that may come hours after she has ceased exercising. Walking two blocks every day and walking up stairs would not be considered increased physical exercise and would not be a factor. Wanting to have her mother administer the insulin is not uncommon for this age client, and the nurse would normally instruct both the mother and the daughter in the administration of the drug.

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 is stimulated by the liver to break down proteins and provide the body with nutrients." "Insulin assists glucose molecules to enter the cells of muscle and fat tissues." "Insulin is used to move carbohydrate particles from the gastrointestinal system to the liver." "Insulin causes fat to be broken down to provide energy for the body."

"Insulin assists glucose molecules to enter the cells of muscle and fat tissues." Insulin appears to activate a process that helps glucose molecules enter the cells of striated muscle and adipose tissue. It also stimulates the synthesis of glycogen by the liver, promotes protein synthesis, and helps the body store fat by preventing its breakdown for energy.

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? 07:00 06:45 06:00 06:20

06:45 With short-acting insulins like lispro, aspart, or glulisine, it is important to inject the medication about 15 minutes before eating.

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. Encourage the client to check her blood glucose every hour. Instruct the client to go to the emergency department immediately if she develops a cold or upper respiratory infection.

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. Reinforce instructions on dealing with hypoglycemia. The home care nurse would assist the client and family to know how to plan meals that meet the needs of the client and the family. The nurse would also want to assure that the client knows how to administer insulin correctly and would need to make sure that the client understands how to deal with hypoglycemia.

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 12 noon and 8 PM Between 2 PM and 4 PM Between 8:30 AM and 9:30 AM Between 10 AM and 12 noon

Between 8:30 AM and 9:30 AM With insulin lispro, peak effects would occur in 30 to 90 minutes or between 8:30 AM and 9:30 AM. Regular insulin peaks in 2 to 4 hours, so the nurse would be alert for signs and symptoms of hypoglycemia at this time, which would be between 10 AM and 12 noon. With insulin detemir, peak effects would occur in 6 to 8 hours, or between 2 PM and 4 PM. With NPH insulin, peak effects would occur in 4 to 12 hours, or between 12 noon and 8 PM.

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? Administer the insulin to the client. Ensure a meal tray is available. Check the dosage with another nurse. Check the client's blood sugar again.

Check the dosage with another nurse. After preparing the syringe with insulin, the nurse should then have the medication and dosage checked by a second nurse to make sure that it is correct. It is not necessary to recheck the client's blood sugar again. It is important to know when the client will be eating again; make sure that it is within the next 30 minutes. However, this is not the nurse's next step. Then the nurse will administer the insulin to the client.

A female client visits the health care provider's office after routine labs are drawn. The nurse notes that her A1C is 9. How does the nurse interpret this finding? Client's blood glucose demonstrates longstanding hypoglycemia. Client's average blood glucose is above normal. Client is in good glycemic control. Client's blood glucose levels are not consistent.

Client's average blood glucose is above normal. The American Diabetes Association (ADA) suggests a target A1C of less than 7%. A1C should be measured every 3 to 6 months. An A1C of 9 indicates that the client's average blood glucose is consistently above normal.

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? Kidney dysfunction Visual dysfunctions Treatment adherence Drug interactions

Drug interactions The older patient is more likely to experience end organ damage related to the diabetes—loss of vision, kidney problems, coronary artery disease, and infections—and the drug regimen of these patients can become quite complex. Careful screening for drug interactions is an important aspect of the assessment of these patients.

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 Storage of glucagon in the cells Release of glucagon from the cells Interruption of glucose movement across the membrane

Entry of glucose into the cells After insulin-receptor binding occurs, cell membranes become highly permeable to glucose and allow rapid entry of glucose into the cells.

What would alert the nurse to suspect that a client is developing ketoacidosis? Blurred vision Fruity breath odor Fluid retention Hunger

Fruity breath odor Fruity breath odor would be noted as ketones build up in the system and are excreted through the lungs. Dehydration would be noted as fluid and electrolytes are lost through the kidneys. Blurred vision and hunger would be associated with hypoglycemia.

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. Administer the insulin via insulin pump. Administer oral antidiabetics to the patient. Administer glucagon by the parenteral route.

Give oral fluids or candy. The nurse should administer oral fluids or candy to the hypoglycemic patient with swallowing and gag reflexes. If the patient is unconscious the nurse should administer glucose or glucagon parenterally. The nurse should administer insulin through an insulin pump to special categories of diabetic patients, such as pregnant women with diabetes and renal transplantation. Oral antidiabetic drugs are administered to patients with type 2 diabetes.

Which would a nurse identify as an example of a sulfonylurea? Acarbose Glyburide Miglitol Metformin

Glyburide Glyburide is an example of a sulfonylurea. Metformin is classified as a biguanide. Acarbose and miglitol are alpha-glucosidase inhibitors.

Which is the best indicator of overall diabetic control? Glycosylated hemoglobin levels Fasting blood glucose levels 2-hour postprandial blood glucose levels Absence of acetone in the urine

Glycosylated hemoglobin levels The glycosylated hemoglobin indicates glucose bound to hemoglobin in red blood cells (RBCs) when RBCs are exposed to hyperglycemia. The binding is irreversible and lasts for the lifespan of RBCs (approximately 120 days). The test reflects the average blood sugar level during the previous 2 to 3 months. The goal is usually less than 7% (blood level 0.07). The range for people without diabetes is approximately 4% to 6% (blood level 0.04 to 0.06).

The nurse is interviewing a client who was diagnosed with type 2 diabetes four months ago. The client does not record glucometer readings. What laboratory test does the nurse anticipate the health care provider will order for this client? Fasting blood glucose in the AM Stat urine for glucose Insulin level HbA1c

HbA1c The nurse anticipates that the glycosylated hemoglobin (HbA1c) will be ordered for this client because it provides an average of the client's blood glucose level for the last three- to four-month period. It will also tell how well controlled the client's blood glucose is. A stat urine for glucose and an FBG in the AM will only indicate the client's current blood glucose level, not how well it is being controlled. An insulin level will not give the information needed to understand the client's control of blood glucose.

When administering insulin, what would be most appropriate? Massage the injection site firmly after removing the needle and syringe. Shake the vial vigorously to ensure thorough mixing before drawing up the dose. Insert the needle at a 45-degree angle for injection. Firmly spread the skin of the area of the intended site of injection.

Insert the needle at a 45-degree angle for injection. The vial should be gently rotated and vigorous shaking is to be avoided to ensure uniform suspension of the insulin. Typically the area is pinched to allow access to the loose connective tissue layer. The needle is inserted at a 45-degree angle for subcutaneous administration. Gentle pressure should be applied at the injection site.

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? Do not administer insulin kept at room temperature. Check for symptoms of myalgia or malaise. Keep prefilled syringes horizontally. Inspect the previous injection site for inflammation.

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. Prefilled syringes should not be kept horizontally; they should be kept in a vertical or oblique position to avoid plugging the needle. The nurse checks for symptoms of myalgia or malaise when administration of metformin leads to lactic acidosis. Insulin should be kept at room temperature for administration. Insulin is refrigerated if it needs to be stored for up to three months for later use.

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? (Select all that apply.) Isophane insulin suspension (Novolin N) Insulin zinc suspension (Humulin L) Insulin aspart (NovoLog) Insulin glulisine (Apidra) Insulin glargine (Lantus)

Insulin aspart (NovoLog) Insulin glulisine (Apidra) Insulin aspart (NovoLog) and insulin glulisine (Apidra) are rapid-acting insulins with a duration of one to five hours depending on the individual product.

Which would be appropriate to include in teaching a client with type 2 diabetes? It is possible with weight loss and exercise to discontinue the use of antidiabetic medication. Clients with type 2 diabetes always progress to insulin injections if they do not follow dietary guidelines. If you drink alcohol, it may be necessary to increase your oral antidiabetic medication. Until you need to start insulin injections, you do not have to check your blood sugar.

It is possible with weight loss and exercise to discontinue the use of antidiabetic medication. Exercise is perhaps the best therapy for the prevention of both type 2 diabetes and the metabolic syndrome. Exercise is an extremely strong hypoglycemic agent.

The two major classifications of diabetes are type 1 and type 2. What is a distinguishing characteristic of type 1 diabetes? It always starts in childhood. Blood glucose level can be controlled with diet. Lifelong exogenous insulin is required. Oral agents can control the disease process.

Lifelong exogenous insulin is required. Type 1 diabetes results from an autoimmune disorder that destroys pancreatic beta cells. Insulin is the only effective treatment for type 1 diabetes, because pancreatic beta cells are unable to secrete endogenous insulin and metabolism is severely impaired. Insulin cannot be given orally, because it is destroyed by proteolytic enzymes in the GI tract. Although the onset of type 1 diabetes frequently occurs in childhood, it can also occur in adulthood.

A client diagnosed with diabetes is demonstrating slow, deep respirations and is difficult to arouse. Which nursing intervention is directed specifically at treating this serious complication of diabetes? Providing respiratory assistance as prescribed Monitoring for a fruity breath Maintaining adequate intravenous fluid delivery Assessing orientation and level of alertness

Maintaining adequate intravenous fluid delivery Hyperglycemia, or high blood sugar, results when there is an increase in glucose in the blood. Clinical signs include Kussmaul respirations, impaired orientation and alertness, and the presence of a fruit breath resulting for a build up ketones being excreted via the lungs. Fluid and electrolytes are lost through the kidneys causing dehydration that must be addressed through the introduction of adequate IV fluids. The remaining options are appropriate assessment activities but do not address the focus of the question; a specific intervention.

Which would be least appropriate when administering insulin by subcutaneous injection? Massaging the site after removing the needle Using a 25 gauge 1/2-inch needle Inserting the needle at a 45-degree angle Injecting the insulin slowly

Massaging the site after removing the needle Gentle pressure should be applied to the injection after the needle is withdrawn. Massaging could contribute to erratic or unpredictable absorption.

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. Daily snacks should increase protein intake. Daily caloric intake should be increased by 200 calories. Alcohol should be limited and taken only with meals.

Meals should be eaten at regular times. A regular dietary intake associated with the administration of insulin or oral hypoglycemic will prevent episodes of hypoglycemia. The client should limit alcohol consumption, but alcohol consumption does not contribute to hypoglycemia. The client should not increase caloric or protein intake. The client should coordinate exercise with her dietary intake, but dietary intake is not the cause of the hypoglycemia.

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? Miglitol Metformin Tolbutamide Glipizide

Metformin Metformin is classified as a biguanide. Miglitol is an alpha-glucosidase inhibitor. Tolbutamide is a first generation sulfonylurea. Glipizide is a second generation sulfonylurea.

A nurse is caring for a patient with diabetes mellitus who is receiving an oral antidiabetic drug. Which of following ongoing assessments should the nurse perform when caring for this patient? Observe the patient for hypoglycemic episodes. Monitor the patient for lipodystrophy. Assess the skin for ulcers, cuts, and sores. Document family medical history.

Observe the patient for hypoglycemic episodes. As the ongoing assessment activity, the nurse should observe the patient for hypoglycemic episodes. Documenting family medical history and assessing the patient's skin for ulcers, cuts, and sores on the body is a pre-administration assessment activity performed by the nurse. Lipodystrophy occurs if the sites of insulin injection are not rotated.

A student asks the nursing instructor what insulin has the quickest therapeutic effect once administered. What would be the best response? Ultralente (Humulin U Ultralente) Regular (Humulin R) PZI (Humulin U) NPH (Humulin N)

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.

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.) Insulin glargine (Lantus) Orange or other fruit juice Hard candy Insulin detemir (Levemir) Glucose tablets

Orange or other fruit juice Hard candy Glucose tablets Methods of terminating a hypoglycemic reaction include the administration of one or more of the following: orange or other fruit juice, hard candy or honey, glucose tablets, glucagon, or glucose 10 percent or 50 percent IV.

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? Diet sodas, clear juices, and regular gelatin desserts IV Ringer's solution Regular sodas, clear juices, and regular gelatin desserts IV saline 0.9%

Regular sodas, clear juices, and regular gelatin desserts During illness, children are highly susceptible to dehydration, and an adequate fluid intake is very important. Many clinicians recommend sugar-containing liquids (e.g., regular sodas, clear juices, regular gelatin desserts) if blood glucose values are lower than 250 mg/dL. If blood glucose values are above 250 mg/dL, diet soda, unsweetened tea, and other fluids without sugar should be given.

A client diagnosed with diabetic ketoacidosis has been admitted to the intensive care unit. The client is prescribed an intravenous insulin drip, so the nurse knows that what type of insulin will be administered? Lispro. Insulin glargine. Regular. Isophane insulin (NPH).

Regular. Regular insulin (insulin injection) has a rapid onset of action and can be given intravenously. Therefore, it is the insulin of choice during acute situations, such as DKA, severe infection or other illness, and surgical procedures. All the other options are administered subcutaneously.

A client diagnosed with diabetic ketoacidosis has been admitted to the intensive care unit. The client is prescribed an intravenous insulin drip, so the nurse knows that what type of insulin will be administered? Lispro. Isophane insulin (NPH). Insulin glargine. Regular.

Regular. Regular insulin (insulin injection) has a rapid onset of action and can be given intravenously. Therefore, it is the insulin of choice during acute situations, such as DKA, severe infection or other illness, and surgical procedures. All the other options are administered subcutaneously.

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? External pump Subcutaneous injection Insulin pen Jet injector

Subcutaneous injection Although other delivery systems are available for insulin administration such as the jet injector, insulin pen, and external pump, subcutaneous injection remains the primary delivery system.

Which condition must be met in order for glyburide treatment to be effective? The client must be able to self-administer the medication. The client must not have hyperglycemia. The client must have functioning pancreatic beta cells. The client must have hemoglobin A1C of ≤7%.

The client must have functioning pancreatic beta cells. Because glyburide stimulates pancreatic beta cells to produce more insulin, it is effective only when functioning pancreatic beta cells are present. The presence of normal blood glucose levels would render the medication unnecessary. Self-administration is common but not absolutely necessary.

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 Infection Poor insulin injection technique Impaired glucose tolerance

Widespread changes in the blood vessels Diabetes can cause significant vascular problems. Brown spots on the lower legs of a diabetic patient are caused by small hemorrhages into the skin and may indicate widespread changes in the blood vessels.

A home care nurse is caring for several clients with diabetes. The nurse's role in caring for these clients includes: mobilizing community resources. monitoring health status. helping obtain diabetic supplies. all the above tasks.

all the above tasks. Some aspects of the nursing role include mobilizing and coordinating health care providers and community resources; teaching and supporting patients and caregivers; monitoring the patient's health status and progress in disease management; assisting the patient to obtain diabetic supplies for monitoring and medication administration; and preventing or solving problems.

A nurse is preparing to administer a rapid-acting insulin. Which medication would the nurse most likely administer? isophane insulin suspension insulin glargine insulin detemir insulin lispro

insulin lispro Insulin lispro is an example of a rapid-acting insulin. Insulin glargine and insulin detemir are long-acting insulin. Isophane insulin suspension is an intermediate-acting insulin.

When considering the management of diabetic ketoacidosis (DKA), what type of insulin can be administered intravenously? lispro insulin glargine regular isophane insulin (NPH)

regular Regular insulin (insulin injection) has a rapid onset of action and can be given intravenously. Therefore, it is the insulin of choice during acute situations, such as DKA, severe infection or other illness, and surgical procedures. All the other options are administered subcutaneously.

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 12 to 24 hours the past 1 or 2 months the past 3 or 4 months the past 7 to 10 days

the past 3 or 4 months Glycosylated hemoglobin measures glucose control over the past 3 to 4 months. When blood glucose levels are high, glucose molecules attach to hemoglobin in the red blood cell. The longer the hyperglycemia lasts, the more glucose binds to the red blood cell and the higher the glycosylated hemoglobin. This binding lasts for the life of the red blood cell (about 4 months) so the other time frames would not be accurate.

The nurse is caring for a client who is taking insulin. The nurse suspects the client is experiencing hypoglycemia when the client displays what signs? decreased respiratory rate and hot, dry skin. increased thirst and increased urine output. increased pulse rate and fruity smelling breath. weakness, sweating, and decreased mentation.

weakness, sweating, and decreased mentation. Symptoms of hypoglycemia include shakiness, dizziness or light-headedness, sweating, nervousness or irritability, sudden changes in behavior or mood, weakness, pale skin, and hunger. The other signs are more consistent with hyperglycemia.

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? The ingestion of carbohydrates Increase in alkaline phosphatase A diagnosis of hypertension Allergy to sulfonamides

Allergy to sulfonamides Sulfonylureas are contraindicated in clients with hypersensitivity to them, with severe renal or hepatic impairment, and who are pregnant. A diagnosis of hypertension does not cause contraindication of sulfonylureas. The client should consume carbohydrates in association with the oral hypoglycemic agent. An increase in alkaline phosphatase does not result in the contraindication of glyburide.

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? The client most likely does not exercise enough to control his glucose levels. Insulin is needed because the beta cells of the pancreas are no longer functioning. More insulin is needed than that which the client can produce naturally. The insulin is more effective in establishing control of blood glucose levels initially.

Insulin is needed because the beta cells of the pancreas are no longer functioning. Insulin is needed in type 1 diabetes because the beta cells of the pancreas are no longer functioning. With type 2 diabetes, insulin is produced, but perhaps not enough to maintain glucose control or the insulin receptors are not sensitive enough to insulin.