Ch. 57 Drugs for Diabetes Mellitus

A nurse caring for a patient who has diabetic ketoacidosis recognizes which characteristics in the patient? (Select all that apply.) Type 2 diabetes Altered fat metabolism leading to ketones Arterial blood pH of 7.35 to 7.45 Sudden onset, triggered by acute illness Plasma osmolality of 300 to 320 mOsm/L

Altered fat metabolism leading to ketones Sudden onset, triggered by acute illness Plasma osmolality of 300 to 320 mOsm/L

A patient who took NPH insulin at 0800 reports feeling weak and tremulous at 1700. Which action should the nurse take? Take the patient's blood pressure. Give the patient's PRN dose of insulin. Check the patient's capillary blood sugar. Advise the patient to lie down with the legs elevated.

Check the patient's capillary blood sugar.

A patient newly diagnosed with type 1 diabetes asks a nurse, "How does insulin normally work in my body?" The nurse explains that normal insulin has which action in the body? It stimulates the pancreas to reabsorb glucose. It promotes the synthesis of amino acids into glucose. It stimulates the liver to convert glycogen to glucose. It promotes the passage of glucose into cells for energy.

It promotes the passage of glucose into cells for energy.

A patient who has type 2 diabetes is taking nateglinide [Starlix]. Which response should a nurse expect the patient to have if the medication is achieving the desired therapeutic effect? Inhibition of carbohydrate digestion Promotion of insulin secretion Decreased insulin resistance Inhibition of ketone formation

Promotion of insulin secretion

A nurse assesses a patient who is taking pramlintide [Symlin] with mealtime insulin. Which finding requires immediate follow-up by the nurse? Skin rash Sweating Itching Pedal edema

Sweating

An adolescent patient recently attended a health fair and had a serum glucose test. The patient telephones the nurse and says, "My level was 125 mg/dL. Does that mean I have diabetes?" What is the nurse's most accurate response? a. "Unless you were fasting for longer than 8 hours, this does not necessarily mean you have diabetes." b. "At this level, you probably have diabetes. You will need an oral glucose tolerance test this week." c. "This level is conclusive evidence that you have diabetes." d. "This level is conclusive evidence that you do not have diabetes."

a. "Unless you were fasting for longer than 8 hours, this does not necessarily mean you have diabetes."

The nurse assesses a newly diagnosed patient for short-term complications of diabetes. What does this assessment include? a. Evaluation for hyperglycemia, hypoglycemia, and ketoacidosis b. Cranial nerve testing for peripheral neuropathy c. Pedal pulse palpation for arterial insufficiency d. Auscultation of the carotids for bruits associated with atherosclerosis

a. Evaluation for hyperglycemia, hypoglycemia, and ketoacidosis

Which statement is correct about the contrast between acarbose and miglitol? a. Miglitol has not been associated with hepatic dysfunction. b. With miglitol, sucrose can be used to treat hypoglycemia. c. Miglitol is less effective in African Americans. d. Miglitol has no gastrointestinal side effects.

a. Miglitol has not been associated with hepatic dysfunction.

The nurse working on a high-acuity medical-surgical unit is prioritizing care for four patients who were just admitted. Which patient should the nurse assess first? a. The NPO patient with a blood glucose level of 80 mg/dL who just received 20 units of 70/30 Novolin insulin b. The patient with a pulse of 58 beats per minute who is about to receive digoxin [Lanoxin] c. The patient with a blood pressure of 136/92 mm Hg who complains of having a headache d. The patient with an allergy to penicillin who is receiving an infusion of vancomycin [Vancocin]

a. The NPO patient with a blood glucose level of 80 mg/dL who just received 20 units of 70/30 Novolin insulin

A patient with type 1 diabetes reports mixing NPH and regular insulin to allow for one injection. What should the nurse tell the patient? a. This is an acceptable practice. b. These two forms of insulin are not compatible and cannot be mixed. c. Mixing these two forms of insulin may increase the overall potency of the products. d. NPH insulin should only be mixed with insulin glargine.

a. This is an acceptable practice.

An elderly patient who has type 2 diabetes has a history of severe hypoglycemia. The patient's spouse asks the nurse what the optimum A1c level is for the patient. Which is correct? a. Between 6.5 and 7.0 b. Below 7.0 c. Below 8.0 d. Between 7.0 and 8.5

c. Below 8.0

A nurse provides dietary counseling for a patient newly diagnosed with type 1 diabetes. Which instruction should be included? a. "You may eat any foods you want and cover the glucose increase with sliding scale, regular insulin." b. "Most of the calories you eat should be in the form of protein to promote fat breakdown and preserve muscle mass." c. "Your total caloric intake should not exceed 1800 calories in a 24-hour period." d. "You should use a carbohydrate counting approach to maintain glycemic control."

d. "You should use a carbohydrate counting approach to maintain glycemic control."

What is the most reliable measure for assessing diabetes control over the preceding 3-month period? a. Self-monitoring blood glucose (SMBG) graph report b. Patient's report c. Fasting blood glucose level d. Glycosylated hemoglobin level

d. Glycosylated hemoglobin level

A patient with type 1 diabetes who takes insulin reports taking propranolol for hypertension. Why is the nurse concerned? a. The beta blocker can cause insulin resistance. b. Using the two agents together increases the risk of ketoacidosis. c. Propranolol increases insulin requirements because of receptor blocking. d. The beta blocker can mask the symptoms of hypoglycemia.

d. The beta blocker can mask the symptoms of hypoglycemia.

Which instruction should the nurse provide when teaching a patient to mix regular insulin and NPH insulin in the same syringe? "Draw up the clear regular insulin first, followed by the cloudy NPH insulin." "It is not necessary to rotate the NPH insulin vial when it is mixed with regular insulin." "The order of drawing up insulin does not matter as long as the insulin is refrigerated." "Rotate subcutaneous injection sites each day among the arm, thigh, and abdomen."

"Draw up the clear regular insulin first, followed by the cloudy NPH insulin."

A patient is scheduled to start taking insulin glargine [Lantus]. On the care plan, a nurse should include which of these outcomes related to the therapeutic effects of the medication? Blood glucose control for 24 hours Mealtime coverage of blood glucose Less frequent blood glucose monitoring Peak effect achieved in 2 to 4 hours

Blood glucose control for 24 hours

A teaching plan for a patient who is taking lispro [Humalog] should include which instruction by the nurse? "Inject this insulin with your first bite of food, because it is very fast acting." "The duration of action for this insulin is about 8 to 10 hours, so you'll need a snack." "This insulin needs to be mixed with regular insulin to enhance the effects." "To achieve tight glycemic control, this is the only type of insulin you'll need."

"Inject this insulin with your first bite of food, because it is very fast acting."

Before administering metformin [Glucophage], the nurse should notify the prescriber about which laboratory value? Creatinine (Cr) level of 2.1 mg/dL Hemoglobin (Hgb) level of 9.5 gm/dL Sodium (Na) level of 131 mEq/dL Platelet count of 120,000/mm3

Creatinine (Cr) level of 2.1 mg/dL

A patient who has type 2 diabetes has a glycated hemoglobin A1c (HbA1c) of 10%. The nurse should make which change to the nursing care plan? Refer the patient to a diabetes educator because the result reflects poor glycemic control. Glycemic control is adequate; no changes are needed. Hypoglycemia is a risk; teach the patient the symptoms. Instruct the patient to limit activity and weekly exercise.

Refer the patient to a diabetes educator because the result reflects poor glycemic control.

A patient is taking glipizide [Glucotrol] and a beta-adrenergic medication. A nurse is teaching hypoglycemia awareness and should warn the patient about the presence of which symptom? Vomiting Muscle cramps Tachycardia Chills

Tachycardia

A nurse is educating the staff nurses about ketoacidosis. To evaluate the group's understanding, the nurse asks, "Which sign or symptom would not be consistent with ketoacidosis?" The group gives which correct answer? a. Blood glucose level of 600 mg/dL b. Blood glucose level of 60 mg/dL c. Acidosis d. Ketones in the urine

b. Blood glucose level of 60 mg/dL

A nurse counsels a patient with diabetes who is starting therapy with an alpha-glucosidase inhibitor. The patient should be educated about the potential for which adverse reactions? (Select all that apply.) a. Hypoglycemia b. Flatulence c. Elevated iron levels in the blood d. Fluid retention e. Diarrhea

b. Flatulence e. Diarrhea

A patient newly diagnosed with diabetes expresses concern about losing her vision. Which interventions should be included in the plan of care to reduce this risk? (Select all that apply.) a. Initiation of reliable contraception to prevent pregnancy b. Ways to reduce hyperglycemic episodes c. Use of a prokinetic drug (eg, metoclopramide) d. Smoking cessation e. Emphasis on the importance of taking antihypertensive drugs consistently

b. Ways to reduce hyperglycemic episodes d. Smoking cessation e. Emphasis on the importance of taking antihypertensive drugs consistently

A patient who has type 2 diabetes will begin taking glipizide [Glucotrol]. Which statement by the patient is concerning to the nurse? a. "I will begin by taking this once daily with breakfast." b. "It is safe to drink grapefruit juice while taking this drug." c. "I may continue to have a glass of wine with dinner." d. "I will need to check my blood sugar once daily or more."

c. "I may continue to have a glass of wine with dinner."

Insulin glargine is prescribed for a hospitalized patient who has diabetes. When will the nurse expect to administer this drug? a. Approximately 15 to 30 minutes before each meal b. In the morning and at 4:00 PM c. Once daily at bedtime d. After meals and at bedtime

c. Once daily at bedtime

A patient with type 1 diabetes recently became pregnant. The nurse plans a blood glucose testing schedule for her. What is the recommended monitoring schedule? a. Before each meal and before bed b. In the morning for a fasting level and at 4:00 PM for the peak level c. Six or seven times a day d. Three times a day, along with urine glucose testing

c. Six or seven times a day

A patient with type 1 diabetes is eating breakfast at 7:30 AM. Blood sugars are on a sliding scale and are ordered before a meal and at bedtime. The patient's blood sugar level is 317 mg/dL. Which formulation of insulin should the nurse prepare to administer? a. No insulin should be administered. b. NPH c. 70/30 mix d. Lispro [Humalog]

d. Lispro [Humalog]

Which statement is accurate about the long-term complications of diabetes? a. Long-term complications are almost always the result of hypoglycemia and ketoacidosis. b. The complication rates for patients with optimally controlled type 2 diabetes are the same as for those whose disease is not optimally controlled. c. Optimal control of type 1 diabetes produces excessive episodes of life-threatening hypoglycemia. d. Optimal control of both types of diabetes reduces the risk of eye, kidney, and nerve damage.

d. Optimal control of both types of diabetes reduces the risk of eye, kidney, and nerve damage.