Ch 38 Karch
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." Explanation: A major clinical manifestation of hyperglycemia is fasting blood glucose levels exceeding 126 mg/dL (6.99 mmol/L). A person with a fasting blood glucose level between 100 and 125 mg/dL (5.55 to 6.94 mmol/L) is said to have impaired fasting glucose or prediabetes. The normal hemoglobin A1C level is under 7.
A client newly diagnosed with diabetes reports "constant, insatiable thirst." When providing teaching to the client, how should the nurse explain the symptom?
"Excess glucose pulled more water through your kidneys and the increased urination caused thirst." Explanation: When large amounts of glucose are present, water is pulled into the renal tubule. This results in a greatly increased urine output (polyuria). The excessive loss of fluid in urine leads to increased thirst (polydipsia). Glucose does not directly affect the thirst center.
The nurse is instructing a client how to take a prescribed pramlintide. Which would be most appropriate?
"Give it by subcutaneous injection immediately before your major meals." Explanation: Pramlintide is administered subcutaneously immediately before major meals. Numerous antidiabetic drugs are taken orally, often once a day in the morning. Exenatide is given subcutaneously within 1 hour before the morning and evening meals. Miglitol should be taken orally with the first bite of each meal.
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." Explanation: 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 assists glucose molecules to enter the cells of muscle and fat tissues." Explanation: 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 client has been newly diagnosed with type 2 diabetes. What statement would be appropriate for the nurse to include in the teaching?
"Regular exercise makes your body better able to use the insulin it produces." Explanation: Exercise is an extremely strong hypoglycemic agent, so the nurse should encourage the practice. Diabetics need to check their blood sugar level regardless of whether they are prescribed insulin. The need for insulin injections is determined by the function of the pancreas and its ability to produce sufficient quantities of insulin. It is not correct to assume diet is the only factor in this process. Alcohol should be avoided, and the dosage of oral antidiabetic medication should not be altered without guidance from a health care provider.
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 Explanation: With short-acting insulins like lispro, aspart, or glulisine, it is important to inject the medication about 15 minutes before eating.
A client who began treatment for type 2 diabetes 8 months ago is now meeting with a diabetic nurse for a scheduled follow-up. How can the nurse best assess the client's glycemic control since beginning treatment?
Assess the most recent hemoglobin A1C levels. Explanation: Health care providers look at the glycosylated hemoglobin (hemoglobin A1C) levels to assess the effectiveness of treatment. Because glucose stays attached to hemoglobin for the life of the red blood cell, which is about 120 days, the hemoglobin A1C level reflects the average blood glucose level over the past 3 months. Reviewing blood glucose readings, measuring the client's random blood glucose, and dialoguing with the client are all therapeutic strategies, but hemoglobin A1C is most accurate.
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 Explanation: 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.
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 Explanation: Blurred or double vision (diplopia), fatigue, trembling, irritability, headache, nausea, numbness, muscle weakness, hunger, tachycardia, sweating, and nervousness are signs of a hypoglycemic reaction. Fruity breath can be an indication of ketoacidosis, and flushing of the face is a sign of hyperglycemia. Dry skin is unrelated to hypoglycemia.
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. Explanation: 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 average blood glucose is above normal. Explanation: 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 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. Explanation: Clients who take pramlintide should not be injected into the same site where insulin is administered.
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 Explanation: After insulin-receptor binding occurs, cell membranes become highly permeable to glucose and allow rapid entry of glucose into the cells.
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?
Exogenous insulin is required for life. Explanation: Type 1 diabetes will result in eventual destruction of beta cells, and no insulin is produced. Therefore, the client will require insulin supplementation (exogneous insulin) for life. The blood glucose level can only be controlled by diet in type 2 diabetes. In type 2 diabetes, oral agents can be administered. Type 1 diabetes is diagnosed in ages 4 through 20 years, not only in childhood.
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 Explanation: Garlic has been known to cause hypoglycemia when taken with antidiabetic medications. Anise, basil, and oregano are not noted to carry this risk.
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. Explanation: 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.
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 Explanation: 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 would a nurse identify as an example of a sulfonylurea?
Glyburide Explanation: Glyburide is an example of a sulfonylurea. Metformin is classified as a biguanide. Acarbose and miglitol are alpha-glucosidase inhibitors.
When describing the effects of incretins on blood glucose control to a group of students, which would an instructor include?
Increases insulin release Explanation: Incretins increase insulin release, decrease glucagon release, slow GI emptying, and stimulate the satiety center. Growth hormone increases protein building.
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 Explanation: 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, what would be most appropriate?
Insert the needle at a 45-degree angle for injection. Explanation: 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 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? (Select all that apply.)
Insulin glargine (Lantus) Insulin detemir (Levemir) Explanation: Insulin glargine (Lantus) and insulin detemir (Levemir) are long-acting insulins with a duration of 24 hours.
What is the expected action of sitagliptin on type 2 diabetes?
It slows the rate of inactivation of the incretin hormones. Explanation: Sitagliptin minimizes the rate of inactivation of the incretin hormones to increase hormone levels and prolong their activity. Sitagliptin does not block the S phase of the cell cycle. Sitagliptin is not a synthetically prepared monosodium salt nor does it inhibit hydrogen, potassium, and ATPase.
A client is recently diagnosed with diabetes. In reviewing his past history, which of the following would be early indicators of the problem?
Lethargy Fruity-smelling breath Weight loss Getting up often at night to go to the bathroom
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. Explanation: 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 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. Explanation: Experts prefer to call metformin an antihyperglycemic rather than a hypoglycemic because it does not cause hypoglycemia, even in large doses, when used alone. This fact about metformin makes the other statements inaccurate.
A client who has been 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. Explanation: Metformin should be discontinued at least 48 hours before diagnostic tests are performed with contrast media and should not be resumed for at least 48 hours after the tests are done and tests indicate renal function is normal. None of the other options are required.
A nurse is caring for a patient diagnosed with type 2 diabetes. What should the nurse inform the patient are risk factors associated with type 2 diabetes?
Obesity Explanation: The nurse informs the patient that obesity is a risk factor associated with type 2 diabetes. Young age and regular exercise are not risk factors for type 2 diabetes. Polyuria is a symptom of diabetes and not a risk factor leading to type 2 diabetes.
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 Explanation: 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 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?
Regular. Explanation: 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.
Treatment of diabetes may include which of the following?
Replacement therapy with insulin Control of glucose absorption through the GI tract Drugs that stimulate insulin release or increase sensitivity of insulin receptor sites Slowing of gastric emptying Diet and exercise programs
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 Explanation: 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.
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. Explanation: Vigilant blood glucose monitoring is imperative in the management of diabetes. This shows effective health maintenance even more clearly than exercising. Dietary modifications must be undertaken with care in people with diabetes to avoid health consequences. Explaining pathophysiology does not necessarily show effective health maintenance.
A client with type 1 diabetes reports recurrent hypoglycemia late in the morning. After collecting the health history, the nurse suspects what finding is most likely causing the late morning hypoglycemia?
The client goes to the gym each day before work. Explanation: Physical exercise changes insulin requirements and may result in a delayed hypoglycemic reaction. Napping after lunch may be a result, not a cause, of hypoglycemia. Similarly, preferring an early lunch may be the client's response to hypoglycemia but not the cause of it. Eating oatmeal early in the morning would help stabilize blood sugars until later in the morning and would not likely cause hypoglycemia.
Which condition must be met in order for glyburide treatment to be effective?
The client must have functioning pancreatic beta cells. Explanation: 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.
Miglitol differs from the sulfonylureas in that it
delays the absorption of glucose, leading to lower glucose levels.
The nurse suspects the client with diabetes may be having a hypoglycemic reaction when what manifestation is assessed?
diaphoresis Explanation: Diaphoresis and cool clammy skin are signs of hypoglycemia. Fruity breath accompanies ketoacidosis. Flushing of the face is associated with hyperglycemia. The client's level of consciousness often changes, but uncharacteristic or unpredictable behaviors do not normally occur.
Teaching subjects for the patient with diabetes should include
diet and exercise changes that are needed.
A client with type 1 diabetes presents to the diabetes educator and asks about a change in insulin. The client's occupation requires long international flights, and the client does not want to administer insulin on the plane. What kind of insulin would best meet this client's needs?
glargine Explanation: Glargine has a duration of 24 hours, which may prevent the client from having to administer insulin on the airplane. Lispro has a duration of 2 to 5 hours and a peak time of 30 to 90 minutes. Glulisine has a duration of 1 to 2.5 hours and a peak time of 30 to 90 minutes. Aspart has a duration of 3 to 5 hours and a peak time of 1 to 3 hours. These would likely require administration on the plane.
A client is admitted to the emergency department in diabetic ketoacidosis (DKA) with a blood glucose level of 485 mg/dL. The client is prescribed an initial dose of 25 U insulin IV. Which type of insulin will be most likely to be administered?
regular insulin Explanation: Regular insulin is a short-acting insulin that manages the hyperglycemia and hyperkalemia resulting from DKA, which is a life-threatening complication that occurs with severe insulin deficiency. Furthermore, only regular insulin can be given IV and is the drug of choice in emergency situations. Humulin N, Humulin L, and NPH are intermediate-acting forms.
Currently, the medical management of diabetes mellitus is aimed at
regulating blood glucose levels.
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." Explanation: Acarbose is given three times a day with the first bite of the meal because food increases absorption. It may cause GI effects such as abdominal discomfort, flatulence, and diarrhea. Clients should be taught to check their blood sugar frequently when first diagnosed to help determine if the medication is effective.
The nurse transcribes an order for chlorpropamide. What is an appropriate dosage range for this medication?
100 to 250 mg/d Explanation: The appropriate dosage range for oral chlorpropamide is 100 to 250 mg/d. Tolbutamide is 0.25 to 3 g/d. Glimepiride is 1 to 4 mg/d. Glipizide is taken 5 mg PO daily.
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.)
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. Explanation: 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 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. Explanation: 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 preparing to administer 20 units of NPH insulin to a client. Before administering the medication, the nurse should implement which intervention?
Have a colleague confirm the dosage. Explanation: Before administering insulin, client safety requires that two nurses always check the dosage. Assessing the client's understanding of the disease may or may not be appropriate or necessary at this time. Injection sites are not massaged before administration. It is not necessary to assess urine for the presence of glucose.
The health care provider has ordered a change of prescription from rapid-acting insulin to an intermediate-acting type. Which adverse effect must the nurse closely monitor for in the client?
Hypoglycemia Explanation: Changing the type of insulin requires caution, and the client 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.
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?
Inspect the previous injection site for inflammation. Explanation: 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.
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? (Select all that apply.)
Irritability Impaired mental functioning Lethargy Explanation: In young children, hypoglycemia may be manifested by changes in behavior, including severe hunger, irritability, and lethargy. In addition, mental functioning may be impaired in all age groups, even with mild hypoglycemia. Anytime hypoglycemia is suspected, blood glucose should be tested.
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. Explanation: 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.
Which would be least appropriate when administering insulin by subcutaneous injection?
Massaging the site after removing the needle Explanation: 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 what as a biguanide?
Metformin Explanation: 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 school nurse identifies more children with type 2 diabetes each year and recognizes that this trend is mainly attributed to what issue?
Obesity and inadequate exercise Explanation: Type 2 diabetes is being increasingly identified in children. This trend is attributed mainly to obesity and inadequate exercise, because most children with type 2 are seriously overweight and have poor eating habits
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. Explanation: 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.
Insulin is available in several forms or suspensions, which differ in their
Onset and Duration of action
A client is prescribed sitagliptin. The nurse would expect to administer this drug by which route?
Oral Explanation: Sitagliptin is administered orally.
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 Explanation: The nurse should monitor for tachycardia, congestive heart failure, sodium and fluid retention, hyperglycemia, and glycosuria as the adverse reactions in the patient receiving diazoxide drug therapy. Myalgia, fatigue, and headache are the adverse reactions observed in patients undergoing pioglitazone HCl drug therapy. Flatulence is one of the adverse reactions found in patients receiving metformin drug therapy. Epigastric discomfort is one of the adverse reactions observed in patients receiving acetohexamide drugs.
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. Explanation: The initial action of the client should be to take some form of oral glucose. It would also be appropriate to call the provider, but this will delay self-treatment and should be done after the administration of the glucose. Injecting insulin would cause further harm to the client and is not an option. It is good to stay calm, but the reaction will not subside without intervention.
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 Explanation: 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.
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 Explanation: Administration of regular insulin will create a greater risk for hypoglycemia than metformin, which is used in the treatment of type 2 diabetes. A blood glucose level of 150 mg/dL is nominally elevated, and creates no particular risk for "rebound" hypoglycemia. Clients whose diabetes has been recently diagnosed must be monitored closely, but this does not mean that the client faces a particular risk for hypoglycemia.
With what client should the nurse question the administration of human insulin?
a client whose type 2 diabetes is controlled by diet and exercise Explanation: Insulin is recommended for treatment of type 2 diabetes in clients whose diabetes cannot be controlled by diet or other pharmacotherapeutic agents. If the diabetes can be controlled by diet, the pancreas is still functioning and releasing insulin. Human insulin can be used in clients with gestational diabetes or clients with type 1 diabetes of many years standing. The presence of an infection may require the use of insulin in a client whose diabetes is normally controlled by oral medications.
A patient on a fixed income would benefit from a second-generation sulfonylurea to control blood glucose levels. The drug of choice for this patient is
glimepiride.
The client, newly diagnosed with diabetic retinopathy, asks what caused this disorder. What is the nurse's best response?
inability of oxygen to diffuse to tissues in the eye Explanation: The body's inability to effectively cope with carbohydrate, fat, and protein metabolism over a long period of time results in a thickening of the basement membrane in large and small blood vessels. This thickening leads to changes in oxygenation of the lining of the vessels causing damage and narrowing of the vessels. The decreased blood flow through the vessels results in the inability of oxygen to rapidly diffuse across the membrane to the tissues of the eye. The tiny vessels of the eye are narrowed and closed, which causes loss of vision. Increase of aqueous humor is seen in glaucoma. Inability of cell replication and decrease in nerve innervations throughout the eye is not associated with retinopathy.
After reviewing information about different insulin preparations, a nursing student demonstrates understanding of the information when the student identifies which medication as an example of a long-acting insulin?
insulin glargine Explanation: Insulin glargine is an example of a long-acting insulin. Insulin lispro and insulin aspart are rapid-acting insulin. Isophane insulin suspension is an intermediate-acting insulin.
A nurse is preparing to administer a rapid-acting insulin. Which medication would the nurse most likely administer?
insulin lispro Explanation: 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.
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 Explanation: Insulin lispro has a 15-minute onset of action. NPH, 70/30, and regular insulin have longer onsets of action, a later peak, and a longer duration of action.
The HbA1c blood test is a good measure of overall glucose control because
it reflects a 3-month average glucose level in the body.
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 Explanation: 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. Platelets, d-dimer, and tests of renal function are less significant to the safety and efficacy of treatment.
What antidiabetic agent (when prescribed) is approved for the nurse to administer to children 10 years old and older with type 2 diabetes?
metformin Explanation: Metformin is the only oral antidiabetic drug approved for children. It has established dosage for children 10 years of age and older. With the increasing number of children being diagnosed with type 2 diabetes, the use of other agents in children is being tested. Because metformin is the only drug approved for use with children, pioglitazone, repaglinide, and liraglutide would not be appropriate.
A patient with hyperglycemia will present with
polyuria, polydipsia, and polyphagia.
The nurse should question what medication order for a diabetic client who takes insulin to control blood sugar level?
propranolol 10 mg orally t.i.d. Explanation: Propranolol is a beta-blocker and should be avoided in combination with insulin. The blocking of the sympathetic nervous system also blocks many of the signs and symptoms of hypoglycemia, hindering the client's ability to recognize problems. If propranolol must be taken, the nurse will need to teach this client other ways to recognize hypoglycemia. Furosemide, cefaclor, and metoclopramide do not cause drug-drug interactions with insulin.
When considering the management of diabetic ketoacidosis (DKA), what type of insulin can be administered intravenously?
regular Explanation: 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 3 or 4 months Explanation: 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 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 Explanation: 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 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. Explanation: As long as the client is awake and verbally responsive, check the blood glucose level first. Hypoglycemia can make a client feel weak, confused, irritable, hungry, or tired, but assessment must precede interventions; this makes the other options inappropriate.
The long-term alterations in fat, carbohydrate, and protein metabolism associated with diabetes mellitus result in
thickening of the capillary basement membrane.
What instructions should the nurse give to a client with type 2 diabetes who has been switched from glyburide to repaglinide?
"Repaglinide rapidly stimulates insulin production, so you need to eat soon after taking the medication." Explanation: Glyburide is a second-generation sulfonylurea that stimulates insulin release from the beta cells in the pancreas with a 2- to 4-hour onset of action. Repaglinide has an onset of action within 30 minutes with peak effect in 1 hour, and duration of action is approximately 3 to 4 hours. Because repaglinide has a much faster onset of action, it is important the client eats within 15 to 30 minutes after taking the drug to avoid hypoglycemia. Repaglinide is neither more nor less potent, and the two medications are not virtually the same.
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. Explanation: The client should be encouraged to follow a prescribed diet, know how many calories are allowed, and know how to do food exchanges. The client should follow an established meal schedule and avoid skipping meals. If a meal is skipped, the next insulin dose may need to be lowered, not raised. The client should be encouraged to use artificial sweeteners and to read food labels carefully. The client should avoid alcohol, dieting, and commercial weight-loss products.