Antidiabetic PREPU

The nurse has just completed discharge instructions to a client who will be using a pen device to deliver his insulin dose. What statement by the client indicates a need for further instruction?

"If I forget to take my insulin pen, I will be able to use the one that my wife uses." Rationale: Insulin pens are client-specific because the needle may be used multiple times and may be contaminated with blood. Also, the pen is prefilled with a specific type of insulin. The client selects the desired units by turning a dial and listening for a locking ring. The insulin dose is determined by the number of clicks heard. It is a useful method for clients who have poor eyesight.

When preparing to administer an insulin injection, the nurse would use which sized needle?

25 gauge, ½ inch Rationale: Insulin is administered using an insulin syringe with a 25 gauge, ½ inch needle.

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

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

The nurse is educating a newly diagnosed diabetic who must learn how to give himself insulin injections. The nurse tells the client that insulin is absorbed fastest from which area of injection?

Abdomen Rationale: Studies indicate that insulin is absorbed fastest from the abdomen, followed by the deltoid, thigh, and hip.

Glycosylated hemoglobin measures average blood glucose over what time period? (Choose one)

The past 3 or 4 months Rationale: Glycosylated hemoglobin measures glucose control over the past 2 or 3 months.

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

Aspart Rationale: 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.

A nurse is assigned to administer glargine to a patient at a health care facility. What precaution should the nurse take when administering glargine?

Avoid mixing glargine with other insulin. Rationale: When administering glargine to the patient, the nurse should avoid mixing it with other insulin or solutions. It will precipitate in the syringe when mixed. If glargine is mixed with another solution, it will lose glucose control, resulting in decreased effectiveness of the insulin. Glargine is administered via SC once daily at bedtime. The nurse should not shake the vial vigorously before withdrawing insulin. The vial should be gently rotated between the palms of the hands and tilted gently end-to-end immediately before withdrawing the insulin. The nurse administers insulin from vials at room temperature. Vials are stored in the refrigerator if it is to be stored for about three months for later use.

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 Rationale: Clients who take acarbose should take the medication with the first bite of each main meal to prevent bloating and diarrhea.

When reviewing sites for insulin administration with a client, which site, if stated by the client as an appropriate site, indicates the need for additional teaching?

Buttocks Rationale: The buttocks would be an inappropriate site for administering insulin subcutaneously. The best sites include the upper arm, abdomen, and upper thigh.

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

Confusion Diaphoresis Headache Rationale: The symptoms of hypoglycemia include fatigue, weakness, nervousness, agitation, confusion, headache, diplopia, convulsion, dizziness, unconsciousness, hunger, nausea, diaphoresis, and numbness or tingling of the lips or tongue.

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

Which of the following would a nurse identify as an example of a sulfonylurea?

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

The physician has ordered a change of prescription from `rapid-acting insulin to an intermediate-acting type. Which of the following adverse effects must the nurse closely monitor for in the patient?

Hypoglycemia Rationale: Changing the type of insulin requires caution, and the patient should be carefully monitored for hypoglycemia or hyperglycemia, either of which may occur as the body adjusts to the different pharmacokinetics of the preparation. However, hypoglycemia may cause an increased sympathetic activity and manifest as tachycardia. Lipodystrophy is caused by the breakdown of subcutaneous fat because of repeated insulin injections at the same site. A change of insulin prescription is not known to cause hypotension.

Which of the following is an example of long acting insulin?

Insulin glargine (Lantus) Rationale: Insulin glargine (Lantus) is an example of long acting insulin.

A client newly diagnosed with type 1 diabetes asks the nurse why he cannot just take a pill. The nurse would incorporate knowledge of which of the following when responding to this client?

Insulin is needed because the beta cells of the pancreas are no longer functioning. Rationale: 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.

Which of the following is an example of rapid acting insulin?

Insulin lispro (Humalog)

The nurse admits a client with type 2 diabetes who takes metformin (Glucophage), and indicates that the client has a nursing diagnosis of ineffective breathing pattern. What complication of the client's current drug therapy does the nurse believe the client is experiencing?

Lactic acidosis Rationale: When taking metformin, the client is at risk for lactic acidosis, which causes hyperventilation, myalgia, malaise, GI symptoms, or unusual somnolence. Respiratory alkalosis, fluid overload, and hyperkalemia would be unlikely complications with metformin.

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. Rationale: 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.

Regular insulin may be administered intravenously or intramuscularly in an emergency situation.

True

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 physician's office with symptoms of the flu and dehydration. What would the nurse expect the physician to order?

Regular sodas, clear juices, and regular gelatin desserts Rationale: 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.

Which agent would a nurse expect to administer as a single oral dose in the morning?

Rosiglitazone Rationale: Rosiglitazone would be administered as a single oral dose. Repaglinide is used orally before meals. Exenatide is administered by subcutaneous injection within 60 minutes before morning and evening meals. Miglitol is given with the first bite of each meal.

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 Rationale: Subcutaneous injection currently is the most common method for administering insulin.

A nurse is preparing an in-service presentation for a group of staff members on diabetes. Which of the following would the nurse include as the primary delivery system for insulin?

Subcutaneous injection Rationale: 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.

Amylin is a peptide hormone secreted with insulin by the beta cells of the pancreas and is important in the regulation of glucose control during the postprandial period. True or false?

True Rationale: Pramlintide (Symlin) is a synthetic analog of amylin, a peptide hormone secreted with insulin by the beta cells of the pancreas, important in the regulation of glucose control during the postprandial period.

You are caring for a client taking insulin. You realize the client is experiencing symptoms of hypoglycemia when he displays the following symptoms:

Weakness, sweating, and decreased mentation. Rationale: Symptoms of hypoglycemia include shakiness, dizziness, or light-headedness, sweating, nervousness or irritability, sudden changes in behavior or mood, weakness, pale skin, and hunger.

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 Rationale: 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.

Meglitinides should be administered at what time?

With the first bite of a meal Rationale: Because meglitinides work quickly and do not stay in the body long, they need to be taken at each meal. By taking the medication at the time of the first bite, the possibility of a hypoglycemic episode is reduced. This allows flexibility for people who do not eat on the same schedule each day.

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." 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.

A patient is to be administered glipizide (Glucotrol). Which of the following factors would prohibit the administration of glipizide (Glucotrol) to this patient?

Allergy to sulfonamides Rationale: Sulfonylureas are contraindicated in patients 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 patient should consume carbohydrates in association with the oral hypoglycemic agent. An increase in alkaline phosphatase does not result in the contraindication of glipizide (Glucotrol)

A female client visits the physician's office after routine labs are drawn. The nurse notes that her A1C is 9. How does the nurse interpret this finding?

Client's average blood glucose is above normal. Rationale: 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.

Insulin binds with and activates receptors on cell membranes. Once insulin-receptor binding occurs, the membranes become highly permeable to glucose. Which of the following actions does this enable?

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

The two major classifications of diabetes are type 1 and type 2. What is a distinguishing characteristic of type 1 diabetes?

Exogenous insulin is required for life. Rationale: 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.

Patients with type 2 diabetes have nonfunctioning beta pancreatic cells.

False Rationale: Type 2 diabetes reflects an inability to produce enough insulin as needed or a change in insulin receptor sensitivity.

The nurse admits a client who has been diagnosed with diabetic ketoacidosis, and will look for what assessment findings consistent with this diagnosis? Select all that apply.

Flushed, dry skin Ketones in the urine Rationale: Signs/symptoms of DKA include: elevated blood glucose levels (greater than 200 mg/dL); headache; increased thirst; epigastric pain; nausea and vomiting; hot, dry, flushed skin; restlessness; and diaphoresis. The client would not experience rectal pressure.

Which of the following would alert the nurse to suspect that a client is developing ketoacidosis?

Fruity breath odor Rationale: 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 at a healthcare facility is caring for a patient who has been prescribed insulin for the first time. Which of following preadministration assessments should be performed by the nurse before the first dose of insulin is given?

General assessment of the skin Rationale: The nurse should perform a general assessment of the skin, mucous membranes, and extremities of the patient as a preadministration assessment before giving the first dose of insulin. The nurse need not assess for hypoglycemic episodes before administration of the first dose of insulin since the patient has not received any insulin or oral antidiabetic drugs. The nurse need not assess the dental health or the hearing ability of the patient as these are not pertinent to insulin administration.

The nurse is interviewing a client who was diagnosed with type 2 diabetes about four months ago. The client never records glucometer readings but says that everything is just fine. What laboratory test does the nurse anticipate the health care provider will order for this client?

HbA1c Rationale: 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 describing the effects of incretins on blood glucose control to a group of students, which of the following would an instructor include?

Increases insulin release Rationale: Incretins increase insulin release, decrease glucagon release, slow GI emptying, and stimulate the satiety center. Growth hormone increases protein building.

A patient is receiving acarbose. Which of the following would the nurse incorporate into the teaching plan for this patient about the action of the drug?

Inhibits an enzyme to delay glucose absorption Rationale: Acarbose inhibits alpha glucosidase, an enzyme, thereby delaying the absorption of glucose. Thiazolidinediones, such as rosiglitazone, decrease insulin resistance. Second generation sulfonylureas bind to potassium channels on the pancreatic beta cells to improve insulin binding to insulin receptors and increase the number of insulin receptors. Biguanides, such as metformin, increase the uptake of glucose.

When administering insulin, which of the following would be most appropriate?

Insert the needle at a 45-degree angle for injection. Rationale: 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 of the following interventions should the nurse perform before administering each insulin dose?

Inspect the previous injection site for inflammation. Rationale: 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.

Ms. Ross 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. Rationale: Metformin decreases the intestinal absorption of glucose and improves insulin sensitivity, while glyburide works by stimulating insulin release from the beta cells of the pancreas and reducing glucose output from the liver. On the other hand, postprandial glucose levels substantially are reduced by acarbose and miglitol when administered either alone or in combination with insulin or sulfonylurea.

Which of the following would be appropriate to include in teaching your client with type 2 diabetes?

It is possible with weight loss and exercise to discontinue the use of antidiabetic medication. Rationale: 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 nurse is preparing to administer insulin lispro (Humalog) to a client at 7 AM. What is the nurse's top priority intervention related to this medication?

Make sure the client's breakfast is available in the next 5-10 minutes. Rationale: Insulin lispro has an onset of 5-10 minutes, so it is most important to ensure that there is food for the client after administration. Its peak is 30 min-1.5 hours so blood sugar would be most affected between 7:30 AM and 8:30 AM. Cleansing the site with soap and water is not necessary unless there is visible dirt on the skin, and lying quietly is not an intervention.

Which of the following would be least appropriate when administering insulin by subcutaneous injection?

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

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 which of the following as a biguanide?

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

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. Which of the following 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 Rationale: 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.

Your client is admitted to the intensive care unit with diabetic ketoacidosis. You know that your client will be placed on an intravenous insulin drip. The only type of insulin which can be administered intravenously is:

Regular Insulin Rationale: In general, regular insulin, a short-acting insulin, is used with major surgery or surgery requiring general anesthesia. IV administration of insulin is preferred because it provides more predictable absorption than subcutaneous injections. Only regular insulin is administered IV.

A patient is in diabetic ketoacidosis. The patient blood glucose level is over 600. The physician has ordered the patient to receive an initial dose of 25 units of insulin. What type of insulin will be administered intravenously?

Regular insulin Rationale: Regular insulin has rapid onset of action and can be given via IV. It is the drug of choice for acute situations, such as diabetic ketoacidosis. Isophane insulin (NPH) is used for long-term insulin therapy. Lente insulin is an intermediate-acting insulin. Ultralente insulin is a long-acting insulin.

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 of the following insulins are rapid-acting insulin? Select all that apply:

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