NUR3125 endocrine/diabetes quiz

acarbose and miglitol are

alpha-glucosidase inhibitors

a hormone secreted with insulin

amylin

what hormone, secreted with insulin, increases satiety and suppresses glucagon secretion?

amylin

type 1 diabetes results from

an autoimmune disorder that destroys pancreatic beta cells

a client who began treatment for type 2 diabetes 8 months ago is now meeting with a diabetic nurse for a scheduled follow-ip. how can the nurse best assess the client's glycemic control since beginning treatment?

assess the most recent hemoglobin A1C levels

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

avoid mixing glargine with other insulin

why cant insulin be given orally

bc it is destroyed by proteolytic enzymes in the GI tract

why is insulin the only effective treatment for type 1 diabetes

bc pancreatic beta cells are unable to secrete endogenous insulin and metabolism is severely impaired

the amount and type of insulin given must

be regulated daily

metformin is classified as a

biguanide

the nurse is educating a client who is beginning therapy with acarbose and tells the client to take the medication with the first bite of each main meal to help prevent what adverse effect?

bloating and diarrhea

caused by small hemorrhages into the skin and may indicate widespread changes in the blood vessels

brown spots on the lower legs of a diabetic patient

the pt should consume ? in association with the oral hypoglycemic agent

carbohydrates

a nurse is caring for a patient with diabetes mellitus who is receiving an oral antidiabetic drug. which of the following ongoing assessments should the nurse perform when caring for this patient?

observe the pt for hypoglycemic episodes

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

if pt is unconscious the nurse should administer

glucose or glucagon parenterally

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

glyburide

health care providers also look at the ? to assess the effectiveness of treatment

glycosylated hemoglobin (hemoglobin A1C)

which is the best indicator of overall diabetic control?

glycosylated hemoglobin levels

before administering a prescribed 20 units of NPH insulin to a client, the nurse should implement which intervention?

have a colleague confirm the dosage

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.)

headache, confusion, diaphoresis

rosiglitazone has been associated with

hepatotoxcitiy and requires monitoring of liver enzymes

DM is characterized by

high blood glucose levels and alterations in the metabolism of fats, proteins, and glucose

today, replacement insulin is

human, derived from genetically altered bacteria

the nurse educator works at the diabetis clinic. when talking to a class of adloescent diabetics, the educator tells the students that the most recognized signs of diabetes are

hyperglycemia and glycosuria

to promote regular absorption

one anatomic area should be selected for regular insulin injection

a client is prescribed sitagliptin. the nurse would expect to administer this drug by which route?

oral

administered to pts with type 2 diabetes

oral antidiabetic drugs

administers to hypoglycemic pt w swallowing and gag reflexes

oral fluids or candly

insulin cannot be given

orally

Sulfonyureas are contraindicated in pts with

hypersensitivity to them, w severe renal or hepatic impairment, and who are pregnant

lactic acidosis causes

hyperventilation, myalgia, malaise, GI sx, or unusual somnolence

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

garlic has been known to cause

hypoglycemia when taken with antidiabetic medications

a nurse is providing client eductaion to a 13 y/o girl who was just diagnosed with type 1 DM. which statement by the client will alert the nurse that special instructions regarding insulin are necessary?

i am on the middle school track team

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

if i forget to take my insulin pen, i will be able to use the one that my wife uses

a client, who is 42 years old and newly diagnosed w type 2 diabetes, has attended educational dessions to provide insight into the dx. which of the client's statements should prompt nurse to provide further teaching?

im disappointed, but i take some solace in the fact that i wont ever have to have insulin injections

common cause of hypoglycemia

imbalance in glucose levels while taking insulin or oral agents

glucose-elevating agents are used to

increase glucose when levels become dangerously low

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

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

increases insulin release

when administering insulin, what would be most appropiate?

insert the needle at a 45 degree angle for injection

a nurse at a health care facility is assigned to administer insulin to the pt. which intervention should the nurse perform before administering each insulin dose?

inspect the previous injection site for inflammation

the only effective treatment for type 1 diabetes

insulin

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

a long acting insulin

insulin glargine

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

a client newly diagnosed with type 1 diabetes asks the nurse why the client cannot just take a pill. the nurse would incorprate what knowledge when responding to this client?

insulin is needed bc the beta cells of the pancreas are no longer functioning

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

a nurse is preparing to administer a rapid acting insulin. which medication would the nurse most likely administer?

insulin lispro

rapid-acting insulin

insulin lispro and insulin aspart

incretins increase

insulin release

administered to special categories of diabetic pts such as pregnant women w diabetes and renal transplantation

insulin through an insulin pump

intermediate-acting insulin

isophane insulin suspension

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

As a diabetic educator, the nurse is teaching a newly diagnosed diabetic about aspects of the disease process. What would the nurse tell the patient about the body's control of glucose?

it is related to fat and protein metabolism

IV administration of insulin is preferred because

it provides more predictable absorption than subcutaneous injections

what is the expected action of sitagliptin on type 2 diabetes?

it slows the rate of inactivation of the incretin hormones

when taking metformin, the client is at risk for

lactic acidoses

the nurse admits a client with type 2 diabetes who takes metformin (glucophage). the nursing diagnosis given is ineffective breathing pattern. what complication of the client's current drug therapy does the nurse believe the client is experiencing?

lactic acidosis

target A1C should be

less than 7%

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

would be used to treat hyperglcyemia

lispro and regular insulin

rosiglitazone is being considered for the treatment of diabetes in an adult male client. before the initiation of rosiglitazone therapy, the nurse should review what laboratory work recently drawn?

liver enzymes

should be checked before starting therapy and every 2 months for 1 year, then periodically

liver function tests

which would be least appropiate when administering insulin by subcutaneous injection?

massaging the site after removing the needle

people who need less than 0.5 units/kg/d

may produce endogenous insulin, or their tissues may be more responsive to insulin bc of exercise and good physical conditions

after teaching a class about various drugs used to control blood glucose, the instructor determines that the teaching was successful when the class identifies what as a biguanide?

metformin

a client prescribed metformin is scheduled to undergo diagnostic testing with the administeration 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

adverse rx observed in pt undergoing pioglitazone HCl drug therapy

myalgia, fatigue, ha

a nurse is caring for a patient diagnosed with type 2 diabetes. what should the nurse inform the pt are risk factors associated w type 2 diabetes?

obesity

a 58 y/o 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?

peripheral neuropathy

typically the area is

pinched to allow access to the loose connective tissue layer

extreme temperatures should be avoided to

prevent the loss of maximum function

the backbone of antidiabetic therapy

proper diet and exercise

growth hormone increases

protein building

insulin promotes

protein synthesis

in times of severe stress

pt's regulated on other antidiabetic agents usually need to be switched to insulin to control blood glucose levels

patients need to learn to...

recognize the signs of hypoglycemia and hyperglycemia to effectively manage their drug therapy

incretins slow

GI emptying

a female client is a newly diagnosed diabetuc. 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?

-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

other antidiabetic agents work to

-slow GI absorption of glucose -increase release of insulin by beta cells -increase insulin receptor site sensitivity -block liver release of glucose and prevent the reabsorption of glucose in the kidney

the client is scheduled to get a breakfast tray at 0700. at what time should the client receive a prescribed dose of insulin lispro?

0645

with short-acting insulins like lispro, aspart, or glulisine, it is important to inject the medication about ? before eating

15 minutes

before administering insulin, client safety requires that

2 nurses always check the dosage

the needle is inserted at a

45 degree angle for subcutaneous administration

only regular insulin is administered

IV

has an onset of 60-90 mins

NPH

have an onset of 4-8 hours

PZI and ultralente

glucose control

a complicated process by various hormones, enzymes, and receptor sites

regular is administered

about 30-60 mins before eating

insulin appears to

activate a process that helps glucose molecules enter the cells of striated muscle and adipose tissue

antidiabetic drugs are

adjuncts to help control blood glucose levels

which strategy will not increase the therapeutic effect of insulin?

all insulin should be stored in a refigerator but never frozen

which factor would prohibit the administration of glipizide?

allergy to sulfonamides

miglitol is an

alpha-glucosidase inhibitor

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 nect action?

check the dosage w another nurse

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

treatment of diabetes involves

control of blood glucose levels using diet and exercise, a combination of other agents to stimulate insulin release or alter glucose absorption, or the injection of replacement insilin

replacement insulin was once obtained from

cow and pig pancreas

pt's need to be carefully monitored to

determine the effectiveness of therapy with these drugs and to prevent inadvertent overdose, which could lead to hyperglycemia

the most common metabolic disorder

diabetes mellitus

can be used to elevate blood glucose levels, but it must be given orally

diazoxide

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 cells

one of the adverse rx observed in pts receiving acetohexamide drugs

epigastric discomfort

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 1-3 days

which medication would a nurse identify as a noninsulin injectable antidiabetic drug?

exenatide

noninsulin injectable antidiabetic drugs

exenatide and pramlintide

an extremely strong hypoglycemic agent

exercise

the best therapy for the prevention of both type 2 diabetes and the metabolic syndrome

exercise

Symptoms of hypoglycemia include:

fatigue, weakness, nervousness, agitation, confusion, headache, diplopia, convulsion, dizziness, uncosciousness, hunger, nausea, diaphiresis, and numbness or tingling of the lips or tongue

tolbutamide is a

first generation sulfonylurea

other diabetic agents include

first-and second generation sulfonylureas, other agents that alter glucose absorption, decrease insulin resistance, or decrease the formation of glucose

adverse rx found in pt receiving metformin drug therapy

flatulence

blood glucose levels vary with...

food intake, exercise, and stress levels, possibly necessitating a change in insulin dose

help determine the therapeutic effect of insulin and overall consistency of diabetic control

frequent monitoring of blood glucose by fingersticks and perioidic determinations of hemoglobin A!C levels

heavy intake of which herb should be avoided by a client who is prescribed an antidiabetic medication?

garlic

amylin delays

gastric emptying

should be applied at the injection site

gentle pressure

should be applied to the inection after the needle is withdrawn

gently pressure

the vial should be

gently rotated and vigorous shaking is to be avoided to ensure uniform suspension of the insulin

a nurse is caring for a patient who has developed a hypoglycemic reaction. which intervention should the nurse perform if swalloing and gag reflexes are present in the pt?

give oral fluids or candy

a man is brough to the ed. he is nonresponsibe, and his blood glucose level is 32 mg/dl. which would the nurse expect to be ordered?

glucagon

the agent of choice to rasie pt's glucose level bc it can be given IV and has an onset of approx 1 min

glucagon

incretins decrease

glucagon release

amylin suppresses

glucagon secretion

the glycosylated hemoglobin indicates

glucose bound to hemoglobin in RBCs when RBCs are exposed to hyperglycemia

a client is admitted to the intensive care unit with diabetic ketoacidosis. the nurse knows that the client will be placed on an intravenous insulin drip. the only type of insulin that can be administered intravenously is

regular

when considering the management of diabetic ketoacidosis, what type of insulin can be administered intravenously?

regular

A student asks the nursing instructor what insulin has the quickest therapeutic effect once administered. What would be the best response?

regular (Humulin R)

what statement would be appropriately included in the teaching concerning type 2 diabetes?

regular exercise makes your body better able to use the insulin it produces

has the quickest onset of 30-60 minutes

regular insulin

used with major surgery or surgery requiring general anesthesia

regular insulin, a short acting insulin

store opened vials of regular insulin at

room temperature

amylin increases

satiety

glipizide is a

second generation sulfonylurea

symptoms of hypoglycemia include

shakiness, dizziness, or light-headedness, sweating, nervousness or irritability, sudden changes in behavior or mood, weakness, pale skin, and hunger

diabetes can cause

significant vascular problems

oral agents

sitagliptin, glipized, and pioglitazone

first- and second-generation sulfonylureas

stimulate the pancreas to release insulin

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

glyburide is an example of a

sulfonylurea

a patient at a health care facility has been prescribed dizoxide for hypoglycemia due to hyperonsulinism. what adverse rx to the drug should the nurse monitor for in the pt?

tachycardia

adverse rx in pt receiving diazoxide drug therapy

tachycardia, CHF, sodium and fluid retention, hyperglycemia, glycosuria

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

insulin replaces the endogenous hormone when...

the body does not produce enough insulin or when there are not enough insulin receptor sites to provide adequate glucose control

insulin helps

the body store fat by preventing its breakdown for energy

bc glucose stays attached the 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

the longer the hyperglycemia lasts

the more glucose binds to the red blood cell and the higher the glycosylated hemoglobin

insulin pens are client-specific bc

the needly may be used multiple times and may be contaminated with blood

the insulin dose is determined by

the number of clicks heard

sulfonylureas work only if

the pancreas has functioning beta cells

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

extra supplies are stored in

the refigerator, not the freezzer

incretins stimulate

the satiety center

insulin stimulates

the synthesis of glycogen by the liver

DM is complicated by many end organ problems. these are related to...

thickening of basement membranes and the resultant decrease in blood flow to these areas

our body stores glucose for use in

times of stress

pt's taking insulin must learn

to inject the drug, properly dispose of needles and syringes, test their blood glucose levels, and recognize the signs of hypoglycemia and hyperglycemia

the client selects the desired units by

turning a dial and listening for a locking ring

insulin is used for

type 1 diabetes and for type 2 diabetes in times of stress or when other therapies have failed

the nurse is caring for a client taking insulin. the nurse realizes the client is experiencing symptoms of hypoglycemia when the client displays:

weakness, sweating, and decreased mentation

a patient with type 1 diabetes has come to the clinic for a routine follow-up appointment, while assessing the pt's skin, the nurse observes brown spots on his lower legs. what might these spots indicate?

widespread changes in the blood vessels

administer regular insulin

with an insulin syringe into an appropiate subcutaneous site