Karch Chapter 38: Agents to Control Blood Glucose Levels

What best describes type 1 diabetes? (Select all that apply.) A. Insidious onset B. Formally known as noninsulin dependent diabetes mellitus C. Insulin supplementation is required for survival D. Obesity is a risk factor E. Occurs before age 20

C. Insulin supplementation is required for survival E. Occurs before age 20 Type 1 diabetes is formerly known as insulin-dependent diabetes mellitus. It usually has a rapid onset and occurs before age 20. Those with type 1 diabetes produce insulin in insufficient amounts, and therefore must have insulin supplementation to survive. Type 1 diabetes is an autoimmune disorder therefore obesity is not a risk factor.

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. -Check the client's blood sugar again. -Administer the insulin to the client. -Ensure a meal tray is available.

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.

After teaching a group of students about the various insulin preparations, the instructor determines that the teaching was successful when the students identify that which type of insulin cannot be mixed with other types? -Lente -Lispro -Regular -Detemir

Detemir Insulin detemir cannot be mixed in solution with any other drug, including other insulins. Regular, lente, and lispro can be mixed.

Which insulin would the nurse need to administer as a separate injection if the order also included NPH insulin? A. Regular B. Lispro C. Lente D. Glargine

D. Glargine Insulin glargine cannot be mixed in solution with any other insulin.

The nurse is working with a client who uses an insulin pump for management of type 1 diabetes. The nurse should remind the client that the needle on the pump needs to be changed how often? -Every two weeks -Every 1-3 days -Every 5-7 days -Every one month

Every 1-3 days For an insulin pump, the needle is changed every 1 to 3 days.

A client with a diagnosis of diabetes is prescribed pramlintide. How will this drug assist in controlling the client's blood sugar? -It absorbs with the insulin. -It blocks the absorption of food. -It increases the release of insulin. -It slows gastric emptying.

It slows gastric emptying. Pramlintide slows gastric emptying, helping to regulate the postprandial rise in blood sugar. Pramlintide does not block the absorption of food. Pramlintide is not absorbed by insulin nor does it increase the release of insulin.

The nurse is caring for a client who is taking glyburide as treatment for type 2 diabetes mellitus. The health care provider has added a corticosteroid to this client's medication regimen for treatment of a severe allergic reaction. The nurse knows that this drug combination may cause what adverse effect on this client? -hypoglycemia -rash and fever -hyperglycemia -nausea and vomiting

hyperglycemia Corticosteroids increase insulin needs, so the client may develop hyperglycemia.

The nurse is instructing a client how to take a prescribed pramlintide. Which would be mostappropriate? -"Give yourself an injection 1 hour before you eat breakfast and dinner." -"Give it by subcutaneous injection immediately before your major meals." -"Take the drug orally once a day, preferably in the morning." -"Take the drug orally with the first bite of each meal."

-"Give it by subcutaneous injection immediately before your major meals." 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.

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." -"I may experience some gas with this medication." -"I will check my blood sugar at least three times a day while I am getting used to the medication." -"I will take this medication three times a day."

-"I must take this medication one hour before I eat." 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.

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 -insulin lispro -isophane insulin suspension -insulin aspart

insulin glargine 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.

Which medication would a nurse identify as a noninsulin injectable antidiabetic drug? -pioglitazone -glipizide -exenatide -sitagliptin

exenatide Exenatide and pramlintide are noninsulin injectable antidiabetic drugs. Sitagliptin, glipizide, and pioglitazone are oral agents.

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.) -Hallucinations -Lethargy -Anorexia -Impaired mental functioning -Irritability

-Irritability -Impaired mental functioning -Lethargy 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.

A nurse is preparing a syringe that contains regular and NPH insulin. To ensure effectiveness, the nurse would administer the insulins within which time frame? -10 minutes -60 minutes -15 minutes -30 minutes

-15 minutes To ensure therapeutic effectiveness and appropriate suspension of the mixed insulin, the nurse would need to administer the injection within 15 minutes of mixing the insulins in the syringe.

A female client is diagnosed with type 1 diabetes. She suddenly reports feeling weak, shaky, and dizzy. What should the nurse's first response be? A. Perform a blood sugar analysis. B. Administer 10 units of regular insulin subcutaneously. C. Administer 1 amp of 50% dextrose IV. D. Have the client drink a glass of orange juice.

A. Perform a blood sugar analysis. As long as the client is awake and verbally responsive, check the blood glucose level first. Hypoglycemia can make the client feel weak, confused, irritable, hungry, or tired. Clients may also report sweating or headaches. If the client has any of these symptoms, check the blood glucose. If the level is 70 mg/dL or below, have the client consume 3 or 4 glucose tablets; 1 serving of glucose gel; 1/2 cup of any fruit juice; 1 cup of milk; 1/2 cup of a regular soft drink; several pieces of hard candy; or 1 tablespoon of sugar or honey.

A client is receiving acarbose. What would the nurse incorporate into the teaching plan for this client about the action of the drug? A. Increases the uptake of glucose B. Inhibits an enzyme to delay glucose absorption C. Decreases insulin resistance D. Binds to potassium channels on pancreatic beta cells

B. Inhibits an enzyme to delay glucose absorption 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.

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.) A. Insulin zinc suspension (Humulin L) B. Isophane insulin suspension (Novolin N) C. Insulin aspart (NovoLog) D. Insuline glulisine (Apidra) E. Insulin glargine (Lantus)

C. Insulin aspart (NovoLog) D. Insuline 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 factor would prohibit the administration of glipizide? -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 glipizide.

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 -a client whose type 2 diabetes was diagnosed one week ago -a client who received 12 units of metformin minutes ago -a client whose most recent blood glucose level was 150 mg/dL

-a client who received 12 units of Humulin R 45 minutes ago 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.

During ongoing assessment of clients receiving insulin detemir (Levemir), the nurse assesses the client for symptoms of hypoglycemia that include which symptoms? (Select all that apply.) A. Headache B. Increased thirst C. Increased urination D. Confusion E. Diaphoresis

Headache Confusion Diaphoresis 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 explaining the action of exenatide to a patient. Which would the nurse include? -Increase in insulin resistance -Increase in protein building -Increase in glucagon release -Increase in GI emptying

Increase in insulin resistance Exenatide is an incretin mimetic, which increases insulin release, decreases glucagon release, stimulates the satiety center, and slows GI emptying.

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 apart (NovoLog) -Insulin detemir (Levemir) -Insulin lispro (Humalog) -Insuline glulisine (Apidra)

Insulin glargine (Lantus) Insulin detemir (Levemir) Insulin glargine (Lantus) and insulin detemir (Levemir) are long-acting insulins with a duration of 24 hours.

Which agent would a nurse expect to administer as a single oral dose in the morning? -Repaglinide -Rosiglitazone -Miglitol -Exenatide

Rosiglitazone 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.

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? -Myalgia -Tachycardia -Flatulence -Epigastric discomfort

Tachycardia 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 at a health care facility is caring for a client who has been prescribed insulin for the first time. Which preadministration assessments should the nurse perform before the first dose of insulin is given? -general assessment of the skin -assess the hearing ability of the client -assess the dental health of the client -assess for hypoglycemic episodes

general assessment of the skin The nurse should perform a general assessment of the skin, mucous membranes, and extremities of the client 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 client has not received any insulin or oral antidiabetic drugs. The nurse need not assess the dental health or the hearing ability of the client as these are not pertinent to insulin administration.

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? -Infection -Impaired glucose tolerance -Poor insulin injection technique -Widespread changes in the blood vessels

-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 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? -Notify your health care provider immediately. -Stay calm and still until the reaction subsides. -Inject a prescribed dose of insulin as soon as you suspect the reaction is occurring. -Take an oral dose of some form of glucose as soon as possible.

-Take an oral dose of some form of glucose as soon as possible. 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 58-year-old male client, diagnosed with diabetes at age 14, reports having pain in both feet and hands. What is this pain most likely a result of? -hypertension resulting from diabetes -peripheral neuropathy -an autoimmune disorder -a diabetes-related infectious process

-peripheral neuropathy Pain in the feet and hands is related to changes in small blood vessels resulting in neuropathy. The long-term effect of diabetes can result in an infectious process, but the pain described is not indicative of an infection. Latent autoimmune diabetes of the adult has an onset in adulthood and thus is not a long-term disorder. Hypertension is a long-term chronic effect of diabetes but is not what has been described with pain in the feet and hands.

The nurse is providing teaching to a client with type 1 diabetes. The client requires additional teaching when he learns that his insulin needs may increase because of what condition? (Select all that apply.) -Exercise -Stress -Fever -Decreased food intake -Anxiety

-Exercise -Decreased food intake Exercise and decreased food intake decrease insulin needs; fever, anxiety, and stress all will increase insulin needs for the client with type 1 diabetes.

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

-"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 is stimulated by the liver to break down proteins and provide the body with nutrients." -"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 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 42-year-old male client is prescribed glargine insulin for management of his type 2 diabetes mellitus. The nurse caring for the client develops a teaching plan regarding glargine insulin therapy. Which statement made by the client indicates that the client needs additional teaching? -"The medication will peak in 3 hours." -"I should not administer the insulin if it is cloudy." -"The insulin is given only once per day, at night." -"I must give this insulin alone and not mix with other insulins."

-"The medication will peak in 3 hours." Insulin glargine (rDNA) is characterized by a chemical structure that regulates its release from the SC tissue into the circulation, providing a relatively constant glucose-lowering effect with no pronounced peak of action over a 24-hour period. Glargine, unlike NPH, is a clear insulin, similar to regular insulin in its appearance. Extreme caution must be used not to confuse glargine with regular insulin because serious adverse effects, including hypoglycemia, can occur. Glargine must not be diluted or mixed with any other insulin or solution because its onset of action may be delayed, and the solution will become cloudy. Insulin glargine is administered subcutaneously once daily at bedtime.

A 54-year-old male client is diagnosed with chronic renal failure and hyperglycemia. He asks if he can be prescribed sulfonylurea because it works well for his friend. If he were to be given sulfonylurea, this client's renal impairment may lead to what effect? -Accumulation and hyperglycemic reactions -Hypersensitivity to sulfonylurea -Decreased absorption of the sulfonylurea -Accumulation and hypoglycemia

-Accumulation and hypoglycemia Sulfonylureas and their metabolites are excreted mainly by the kidneys; renal impairment may lead to accumulation and hypoglycemia. They should be used cautiously, with close monitoring of renal function, in clients with mild to moderate renal impairment and are contraindicated in severe renal impairment.

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? -Insulin lispro -Diazoxide -Glucagon -Regular insulin

-Glucagon 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 strategy will NOT increase the therapeutic effect of insulin? -Insulin should be administered in the subcutaneous tissue. -Blood glucose levels should be monitored several times per day. -Regular insulin should be administered 30 minutes before meals. -All insulin should be stored in a refrigerator but never frozen.

-All insulin should be stored in a refrigerator but never frozen. Store opened vials of regular insulin at room temperature. Extra supplies are stored in the refrigerator, not the freezer. Extreme temperatures (<2°C or >30°C) should be avoided to prevent the loss of maximum function. Administer regular insulin with an insulin syringe into an appropriate subcutaneous site. Regular insulin is administered about 30 to 60 minutes before eating. To promote regular absorption, one anatomic area should be selected for regular insulin injections (e.g., the abdomen). Frequent monitoring of blood glucose by fingersticks and periodic determinations of hemoglobin A1C levels help determine the therapeutic effect of insulin and overall consistency of diabetic control.

The nurse's assessment of a client who has presented to the emergency department reveals hyperglycemia. Which type of insulin will have the most rapid effect on the client's blood sugar levels? -Regular -30/70 -Aspart -NPH

-Aspart 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.

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.) -Use artificial sweeteners instead of sugar in tea and coffee. -Avoid drinking beer, wine, or liquor. -Read food labels carefully to look for hidden sources of sugar. -Lose 10-15 pounds. -If you skip a meal, increase your next insulin dosage.

-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. 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.

A nurse is assigned to administer glargine to a patient at a health care facility. What precaution should the nurse take when administering glargine? -Administer insulin that has been refrigerated. -Shake the vial vigorously before withdrawing insulin. -Administer glargine via IV route. -Avoid mixing glargine with other insulin.

-Avoid mixing glargine with other insulin. 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.

A client receives regular insulin at 8:00 AM. The nurse would be alert for signs and symptoms of hypoglycemia at which time? -Between 8:30 AM and 9:30 AM -Between 10:00 AM and 12:00 PM -Between 2:00 PM and 4:00 PM -Between 12:00 PM and 8:00 PM

-Between 10:00 AM and 12:00 PM 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 10:00 AM and 12:00 PM. If insulin lispro were administered, peak effects would occur in 30 to 90 minutes or between 8:30 AM and 9:30 AM. If insulin detemir were given, peak effects would occur in 6 to 8 hours, or between 2:00 PM and 4:00 PM. If NPH insulin were given, peak effects would occur in 4 to 12 hours, or between 12:00 PM and 8:00 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? -Flushing of the face -Fruity breath -Blurred vision -Dry skin

-Blurred vision 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 aware that premixed insulins (those that contain both regular and NPH insulin) are least effective in what type of client? -Client who strictly monitors his diet -Client who encounters problems drawing up insulin into the syringe -Client who has difficulty controlling his diabetes -Client who has difficulty reading the markings on the syringes

-Client who has difficulty controlling his diabetes Premixed insulins are least effective for clients who have difficulty controlling their diabetes, because it is difficult to individualize the dosages of each type of insulin. It is helpful to clients to use premixed insulin if they have difficulty drawing up their insulin, or seeing the markings on the syringe. The strict monitoring of the diet assists in keeping diabetes in good control.

A client has been noncompliant with the diabetic medication regimen and develops diabetic ketoacidosis. Which would the nurse assess? -Decreased blood glucose levels -Sour breath odor -Deep respirations -Edema

-Deep respirations Deep respirations are seen with diabetic ketoacidosis as the body attempts to rid itself of high acid levels. The client with diabetic ketoacidosis is typically dehydrated. Blood glucose levels are typically elevated with diabetic ketoacidosis. A fruity breath odor is indicative of diabetic ketoacidosis.

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

-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.

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

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

The nurse is caring for a client who is taking a thiazide diuretic, a corticosteroid, and estrogens. The nurse understands that this client is at risk for what condition? -Hyperglycemia -Pulmonary hypertension -Hypoglycemia -Congestive heart failure

-Hyperglycemia Renal insufficiency may increase risks of adverse effects with antidiabetic drugs, and treatment with thiazide diuretics, corticosteroids, estrogens, and other drugs may cause hyperglycemia, thereby increasing dosage requirements for antidiabetic drugs.

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 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. -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. 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 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. -The insulin is more effective in establishing control of blood glucose levels initially. -More insulin is needed than that which the client can produce naturally. -Insulin is needed because the beta cells of the pancreas are no longer functioning.

-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.

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. -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. -Clients with type 2 diabetes always progress to insulin injections if they do not follow dietary guidelines.

-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 nurse who has admited a client with diabetic ketoacidosis should look for what assessment findings that are consistent with this diagnosis? (Select all that apply.) -Rectal pressure -Ketones in the urine -Blood glucose 191 mg/dL -Somnolence -Flushed, dry skin

-Ketones in the urine -Flushed, dry skin 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 somnolence or rectal pressure.

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? -Alcohol should be limited and taken only with meals. -Meals should be eaten at regular times. -Daily caloric intake should be increased by 200 calories. -Daily snacks should increase protein intake.

-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.

The nurse is caring for an older adult client who has type 2 diabetes and chronic kidney disease. Which drugs will be used with great caution in this client? (Select all that apply.) -Acarbose (Precose) -Chlorpropamide (Diabinese) -Miglitol (Glyset) -Regular insulin -Metformin (Glucophage)

-Metformin (Glucophage) -Acarbose (Precose) -Miglitol (Glyset) Alpha (α)-Glucosidase Inhibitors (AGI) and metformin are contraindicated (or used with great caution) in clients with renal disease. Regular insulin and chlorpropamide, which is a sulfonylurea, can be used in clients with renal disease.

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? -Document family medical history. -Observe the patient for hypoglycemic episodes. -Assess the skin for ulcers, cuts, and sores. -Monitor the patient for lipodystrophy.

-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.

The nurse walks into the room of a client with type 1 diabetes and finds the client pale and diaphoretic. The client reports a headache and being hungry. Immediately, the client is unable to talk. What is the nurse's immediate intervention for this client? -Place glucose gel between the gums and cheek. -Raise the head of the bed. -Give 8 oz orange juice. -Administer regular insulin subcutaneously.

-Place glucose gel between the gums and cheek. The client is experiencing hypoglycemia, which presents very suddenly and has symptoms such as fatigue, weakness, nervousness, agitation, confusion, and headache. It may lead to convulsions and unconsciousness. The client's skin is pale, moist, cool, and diaphoretic and the client may report hunger or nausea. The treatment is to give the client something with sugar. The glucose gel would absorb through the client's mucous membranes and would be the optimal way to provide the client with sugar, since the client is no longer able to talk. Eight ounces of orange juice is too much. The client does not need the insulin, which is used for hyperglycemia. Symptoms of this are gradual and include drowsiness, dim vision, thirst, nausea, abdominal pain, loss of appetite, rapid and weak pulse, acetone breath, and skin that is dry, flushed, and warm. Raising the head of the bed is not indicated because there is no evidence of difficulty breathing.

A nurse is instructing a patient in the administration of regular insulin by the subcutaneous route. Which strategy would the nurse suggest if the goal is to promote absorption of the regular insulin? -Administer the medication 30 to 60 minutes after a meal. -Select one injection site for regular insulin injections and use it exclusively. -Rotate injection sites by using the arm one day, the stomach the next day, and the thigh the day after and then repeating the cycle. -Select one anatomic area for regular insulin injections and then use serial locations within that area.

-Select one anatomic area for regular insulin injections and then use serial locations within that area. To promote the absorption of regular insulin, one anatomic area should be selected for subcutaneous injections. Serial locations within that anatomic area are then chosen to rotate the exact injection site. Injection sites should not be rotated by using different anatomic areas each day, because this would substantially change the absorption of the insulin and the patient's blood glucose levels. Using one injection site regularly may lead to lipodystrophy. Regular insulin is administered about 30 to 60 minutes before eating a meal, not after.

The nurse assesses a client's blood glucose level after administering insulin. Which result would the nurse interpret as indicative of severe hypoglycemia? -65 mg/dL -34 mg/dL -72 mg/dL -48 mg/dL

34 mg/dL Blood glucose levels below 40 mg/dL are indicative of severe 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? A. Between 2 PM and 4 PM B. Between 10 AM and 12 noon C. Between 12 noon and 8 PM D. Between 8:30 AM and 9:30 AM

D. 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.

After teaching a group of students about sulfonylureas, the instructor determines that the teaching was successful when the students identify which agent as a second-generation sulfonylurea? (Select all that apply.) A. Pramlintide B. Repaglinide C. Tolazamide D. Glimepiride C. Glyburide

D. Glimepiride C. Glyburide Glimepiride is a second generation sulfonylurea. Glyburide is a second generation sulfonylurea. Tolazamide is a first generation sulfonylurea. Pramlintide is a human amylin agent. Repaglinide is a meglitinide agent.

Which would the nurse identify as an effect of somatostatin on blood glucose? -Decreased insulin sensitivity -Increased insulin release -Decreased glucagon release -Increased GI emptying

Decreased glucagon release Somatostatin decreases glucagon release. Somastatin decreases insulin release. Somastatin slows GI emptying. Somastatin does not affect insulin sensitivity.

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

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 is receiving metformin therapy at a health care facility. The client is also prescribed glucocorticoids. The nurse would be alert for which adverse reaction due to the interaction of these two drugs? -increased risk of lactic acidosis -increased risk for bleeding -increased hypoglycemic effect -delay in gastric emptying

increased risk of lactic acidosis The nurse should observe an increased risk of lactic acidosis in the client as an effect of the interaction of metformin and glucocorticoids. Increased hypoglycemic effect is an effect of the interaction of sulfonylureas with anticoagulants, chloramphenicol, clofibrate, fluconazole, histamine H2 antagonists, methyldopa, monoamine oxidase inhibitors (MAOIs), salicylates, sulfonamides, and tricyclic antidepressants. Increased risk for bleeding is an effect of the interaction of oral anticoagulants with anti-infective drugs. Delay in gastric emptying is an effect of the interaction of anticholinergics with anti-infective drugs.