Chapter 38: Agents to Control Blood Glucose Levels - ML5

A client newly diagnosed with type 2 diabetes has attended educational sessions to provide insight into the diagnosis. Which of the client's statements should prompt the nurse to provide further teaching?

"I'm disappointed, but I take some solace in the fact that I won't ever have to have insulin injections." Explanation: Among people with type 2 diabetes, 20% to 30% require exogenous insulin at some point in their lives. Obesity is a major cause, and vigilant treatment can prevent future sequelae. The essence of type 2 diabetes is the pancreas' inability to meet insulin needs

The nurse is caring for a client with diabetes and administered the client's scheduled dose of regular insulin and NPH insulin at 08:00. At 09:30 the nurse checks the client's blood glucose level, which is 140 mg/dL. What is the nurse's best action?

Document the finding and check the client's blood glucose level in one hour Explanation: This client's blood glucose is nominally elevated, which does not necessarily show that the insulin regimen is insufficient. There is no pressing need to contact the provider or to administer more insulin. Documentation and further assessment are the nurse's best course of action. At this level, the client would be unlikely to exhibit signs of hyperglycemia

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. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 38: Agents to Control Blood Glucose Levels, Diabetes Mellitus, p. 637.

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

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

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 Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 38: Agents to Control Blood Glucose Levels, Prototype Summary: Sitagliptin, p. 653

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

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 Explanation: Subcutaneous injection currently is the most common method for administering 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

A nurse is preparing to administer a rapid-acting insulin. Which medication would the nurse 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. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 38: Agents to Control Blood Glucose Levels, Prototype Summary: Insulin, p. 642.

What would alert the nurse to suspect that a client is developing ketoacidosis?

Fruity breath odor Explanation: 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. 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. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 38: Agents to Control Blood Glucose Levels, PATIENT TEACHING FOR M.J., p. 645.

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