Pharm Ch. 38 Prep U

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

B. "I am on the middle school track team."

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? A. Nausea and vomiting B. Dizziness C. Chest pain D. Bloating and diarrhea

D. Bloating and diarrhea

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? A. Regular insulin B. Glucagon C. Diazoxide D. Insulin lispro

B. Glucagon

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

C. Observe the patient for hypoglycemic episodes.

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? A. Impaired glucose tolerance B. Infection C. Poor insulin injection technique D. Widespread changes in the blood vessels

D. Widespread changes in the blood vessels

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? A. Check the dosage with another nurse. B. Administer the insulin to the client. C. Ensure a meal tray is available. D. Check the client's blood sugar again.

A. Check the dosage with another nurse.

Which would a nurse identify as an example of a sulfonylurea? A. Metformin B. Glyburide C. Acarbose D. Miglitol

B. Glyburide

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

D. Meals should be eaten at regular times.

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? A. 10 minutes B. 30 minutes C. 15 minutes D. 60 minutes

C. 15 minutes

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

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

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? A. 06:45 B. 06:00 C. 07:00 D. 06:20

A. 06:45

A patient is taking chlorpropamide. The nurse warns the patient about the possibility of hypoglycemia within approximately which time frame after taking the drug? A. 3 to 4 hours B. 1 to 2 hours C. 2 to 3 hours D. 4 to 5 hours

A. 3 to 4 hours

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? A. Accumulation and hypoglycemia B. Accumulation and hyperglycemic reactions C. Decreased absorption of the sulfonylurea D. Hypersensitivity to sulfonylurea

A. Accumulation and hypoglycemia

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? A. Exogenous insulin is required for life. B. Blood glucose levels can be controlled by diet. C. The disease always starts in childhood. D. Oral agents can control blood sugar.

A. Exogenous insulin is required for life.

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

A. Flushed, dry skin C. Ketones in the urine

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? A. Garlic B. Basil C. Anise D. Oregano

A. Garlic

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. Diaphoresis C. Confusion D. Increased urination E. Increased thirst

A. Headache B. Diaphoresis C. Confusion

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

B. Avoid drinking beer, wine, or liquor. D. Read food labels carefully to look for hidden sources of sugar. E. Use artificial sweeteners instead of sugar in tea and coffee.

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

C. All insulin should be stored in a refrigerator but never frozen.

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 12 noon and 8 PM B. Between 10 AM and 12 noon C. Between 2 PM and 4 PM D. Between 8:30 AM and 9:30 AM

D. Between 8:30 AM and 9:30 AM

A female client is prescribed metformin to decrease her blood glucose levels associated with diabetes mellitus type 2. Which statement accurately describes the action of metformin? A. It decreases intestinal absorption of glucose and improves insulin sensitivity. B. It reduces postprandial glucose levels substantially in combination with insulin. C. It stimulates insulin release from the beta cells of the pancreas. D. It increases intestinal absorption of glucose and improves insulin sensitivity.

A. It decreases intestinal absorption of glucose and improves insulin sensitivity.

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. Have the client drink a glass of orange juice. C. Administer 1 amp of 50% dextrose IV. D. Administer 10 units of regular insulin subcutaneously.

A. Perform a blood sugar analysis.

Which is the best indicator of overall diabetic control? A. Fasting blood glucose levels B. Glycosylated hemoglobin levels C. Absence of acetone in the urine D. 2-hour postprandial blood glucose levels

B. Glycosylated hemoglobin levels

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? A. Pulmonary hypertension B. Hyperglycemia C. Congestive heart failure D. Hypoglycemia

B. Hyperglycemia

When describing the effects of incretins on blood glucose control to a group of students, which would an instructor include? A. Increases glucagon release B. Increases insulin release C. Increases protein building D. Increases GI emptying

B. Increases insulin release

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? A. Glipizide B. Metformin C. Miglitol D. Tolbutamide

B. Metformin

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? A. Storage of glucagon in the cells B. Release of glucagon from the cells C. Entry of glucose into the cells D. Interruption of glucose movement across the membrane

C. Entry of glucose into the cells

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.) A. Anorexia B. Hallucinations C. Impaired mental functioning D. Lethargy E. Irritability

C. Impaired mental functioning D. Lethargy E. Irritability

When administering insulin, what would be most appropriate? A. Shake the vial vigorously to ensure thorough mixing before drawing up the dose. B. Firmly spread the skin of the area of the intended site of injection. C. Insert the needle at a 45-degree angle for injection. D. Massage the injection site firmly after removing the needle and syringe.

C. Insert the needle at a 45-degree angle for injection.

A student asks the nursing instructor what insulin has the quickest therapeutic effect once administered. What would be the best response? A. PZI (Humulin U) B. NPH (Humulin N) C. Regular (Humulin R) D. Ultralente (Humulin U Ultralente)

C. Regular (Humulin R)

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? A. Lente insulin B. NPH insulin C. Regular insulin D. Ultralente insulin

C. Regular insulin

A nurse is caring for a client receiving metformin drug therapy to improve glycemic control. What adverse reaction to the drug should the nurse monitor the client for? A. UTI B. flu symptoms C. asthenia D. back pain

C. asthenia

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? A. "Insulin is used to move carbohydrate particles from the gastrointestinal system to the liver." B. "Insulin is stimulated by the liver to break down proteins and provide the body with nutrients." C. "Insulin causes fat to be broken down to provide energy for the body." D. "Insulin assists glucose molecules to enter the cells of muscle and fat tissues."

D. "Insulin assists glucose molecules to enter the cells of muscle and fat tissues."

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? A. Fruity breath B. Dry skin D. Blurred vision E. Flushing of the face

D. Blurred vision

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? A. Lente B. Regular C. Lispro D. Detemir

D. Detemir

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? A. The client most likely does not exercise enough to control his glucose levels. B. More insulin is needed than that which the client can produce naturally. C. The insulin is more effective in establishing control of blood glucose levels initially. D. Insulin is needed because the beta cells of the pancreas are no longer functioning.

D. Insulin is needed because the beta cells of the pancreas are no longer functioning.

The two major classifications of diabetes are type 1 and type 2. What is a distinguishing characteristic of type 1 diabetes? A. It always starts in childhood. B. Blood glucose level can be controlled with diet. C. Oral agents can control the disease process. D. Lifelong exogenous insulin is required.

D. Lifelong exogenous insulin is required.

A nurse is presenting an educational event at a local senior citizens' club about diabetes. What would the nurse tell the attendees at the event about diabetes? A. It is a complicated disorder that alters the metabolism of glucose. B. It always starts in childhood. C. It sometimes causes widespread changes in the blood vessels. D. It can cause bruising of the tissue all the way to the bone.

A. It is a complicated disorder that alters the metabolism of glucose.

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.) A. Orange or other fruit juice B. Insulin detemir (Levemir) C. Glucose tablets D. Hard candy E. Insulin glargine (Lantus)

A. Orange or other fruit juice C. Glucose tablets D. Hard candy

What is the expected action of sitagliptin on type 2 diabetes? A. It inhibits hydrogen, potassium, and ATPase. B. It slows the rate of inactivation of the incretin hormones. C. It is a synthetically prepared monosodium salt. D. It blocks the S phase of the cell cycle.

B. It slows the rate of inactivation of the incretin hormones.

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? A. Insulin pen B. Subcutaneous injection C. Jet injector D. Implantable infusion pump

B. Subcutaneous injection

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? A. Administer the insulin via insulin pump. B. Administer glucagon by the parenteral route. C. Administer oral antidiabetics to the patient. D. Give oral fluids or candy.

D. Give oral fluids or candy.

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

D. Glargine

Which would be appropriate to include in teaching a client with type 2 diabetes? A. Clients with type 2 diabetes always progress to insulin injections if they do not follow dietary guidelines. B. Until you need to start insulin injections, you do not have to check your blood sugar. C. If you drink alcohol, it may be necessary to increase your oral antidiabetic medication. D. It is possible with weight loss and exercise to discontinue the use of antidiabetic medication.

D. It is possible with weight loss and exercise to discontinue the use of antidiabetic medication.

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

D. Massaging the site after removing the needle

When reviewing the medication list of a client being seen in the clinic, the nurse notes that the client is receiving glipizide. Based on the nurse's understanding, this drug is used to treat: A. hypoglycemia. B. hyperkalemia. C. hypokalemia. D. hyperglycemia.

D. hyperglycemia.

A nurse is preparing to administer a rapid-acting insulin. Which medication would the nurse likely administer? A. insulin glargine B. isophane insulin suspension C. insulin lispro D. insulin detemir

C. insulin lispro

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? A. Arrange to have the client's random blood glucose measured. B. Dialogue with the client about implemented management strategies. C. Review and discuss the data contained in the client's written blood glucose log. D. Assess the most recent hemoglobin A1C levels.

D. Assess the most recent hemoglobin A1C levels.

The nurse is caring for a client who is taking insulin. The nurse suspects the client is experiencing hypoglycemia when the client displays what signs? A. increased pulse rate and fruity smelling breath. B. increased thirst and increased urine output. C. decreased respiratory rate and hot, dry skin. D. weakness, sweating, and decreased mentation.

D. weakness, sweating, and decreased mentation.

When considering the management of diabetic ketoacidosis (DKA), what type of insulin can be administered intravenously? A. regular B. insulin glargine C. isophane insulin (NPH) D. lispro

A. regular

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? A. Tachycardia B. Flatulence C. Myalgia D. Epigastric discomfort

A. Tachycardia

The nurse is interviewing a client who was diagnosed with type 2 diabetes four months ago. The client does not record glucometer readings. What laboratory test does the nurse anticipate the health care provider will order for this client? A. Insulin level B. Stat urine for glucose C. HbA1c D. Fasting blood glucose in the AM

C. HbA1c

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.) A. Regular insulin B. Acarbose (Precose) C. Metformin (Glucophage) D. Chlorpropamide (Diabinese) E. Miglitol (Glyset)

B. Acarbose (Precose) C. Metformin (Glucophage) E. Miglitol (Glyset)

The nurse is caring for a client who has been prescribed glyburide. Which factor, if identified in the client history, would cause the nurse to inform the health care provider of a contraindication to use? A. Increase in alkaline phosphatase B. Allergy to sulfonamides C. A diagnosis of hypertension D. The ingestion of carbohydrates

B. Allergy to sulfonamides

A client's current condition requires rapid reduction of blood sugar levels. Which type of insulin will have the most rapid onset of action? A. Humulin R B. insulin lispro C. isophane (NPH) D. isophane (NPH)

B. insulin lispro

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. a client who received 12 units of metformin minutes ago B. a client whose type 2 diabetes was diagnosed one week ago C. a client whose most recent blood glucose level was 150 mg/dL D. a client who received 12 units of Humulin R 45 minutes ago

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

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? A. Metformin does not cause hypoglycemia. B. Hypoglycemia is only a risk in clients with type 1 diabetes. C. If the client has been taking metformin for more than 3 to 4 weeks, there is no risk for hypoglycemia. D. Overuse of metformin creates a risk for hyperglycemia, not hypoglycemia.

A. Metformin does not cause hypoglycemia.

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.) A. Reinforce instructions on dealing with hypoglycemia. B. Assist the client in making menus that will meet the needs of both the client and the family. C. Instruct the client to go to the emergency department immediately if she develops a cold or upper respiratory infection. D. Watch the client draw up and administer her insulin. E. Encourage the client to check her blood glucose every hour.

A. Reinforce instructions on dealing with hypoglycemia. B. Assist the client in making menus that will meet the needs of both the client and the family. D. Watch the client draw up and administer her insulin.

Which condition must be met in order for glyburide treatment to be effective? A. The client must have functioning pancreatic beta cells. B. The client must have hemoglobin A1C of ≤7%. C. The client must be able to self-administer the medication. D. The client must not have hyperglycemia.

A. The client must have functioning pancreatic beta cells.

As the first-line treatment, a client with type 2 diabetes has tried diet and exercise. When these fail, what may be added as monotherapy or in combination with metformin to control their disease process? A. Thiazolidinediones B. A sitagliptin C. Repaglinide D. An incretin agent

A. Thiazolidinediones

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? A. peripheral neuropathy B. an autoimmune disorder C. hypertension resulting from diabetes D. a diabetes-related infectious process

A. peripheral neuropathy

As the nurse caring for a young child is diagnosed with type 1 diabetes (IDDM), you know that they become at high risk for what and you include assessment and management of this in their care plan? A. Disturbed sleep pattern B. Delayed growth and development C. Self-care deficit D. Anxiety

B. Delayed growth and development

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? A. The client can describe the differences between type 1 and type 2 diabetes. B. The client frequently checks blood glucose levels. C. The client reports having gone on a diet. D. The client exercises two to three times per week.

B. The client frequently checks blood glucose levels.

The nurse educator works at the diabetes clinic. When talking to a class of adolescent diabetics, the educator tells the students that the most recognized signs of diabetes are: A. carbohydrate use and insulin levels. B. hyperglycemia and glycosuria. C. hypoglycemia and glucagon levels. D. protein intake and hyperglycemia.

B. hyperglycemia and glycosuria.

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? A. increased risk for bleeding B. increased risk of lactic acidosis C. increased hypoglycemic effect D. delay in gastric emptying

B. increased risk of lactic acidosis

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. "A fasting blood sugar result of 100 mg/dL (5.55 mmol/L) or more and an A1C of more than 6 on two separate occasions are diagnostic of diabetes." B. "A fasting blood sugar result of 100 mg/dL (5.55 mmol/L) or more on two separate occasions is diagnostic of diabetes." C. "A fasting blood sugar result of 126 mg/dL (6.99 mmol/L) or more on two separate occasions is diagnostic of diabetes." D. "Two consecutive glycosylated hemoglobin (hemoglobin A1C) results of 6 or more are diagnostic of diabetes."

C. "A fasting blood sugar result of 126 mg/dL (6.99 mmol/L) or more on two separate occasions is diagnostic of diabetes."

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? A. "People always tried to encourage me to lose weight, and I suppose they might have been right." B. "I don't like getting this diagnosis, but I know that treatment now can prevent future health consequences." C. "I'm disappointed, but I take some solace in the fact that I won't ever have to have insulin injections." D. "From what I've learned, I know that the basic problem is that my pancreas can't keep up with my insulin needs."

C. "I'm disappointed, but I take some solace in the fact that I won't ever have to have insulin injections."

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? A. Contact the prescriber to obtain an order for 4 more units of regular insulin B. Contact the prescriber to obtain an order for 2 more units of NPH C. Document the finding and check the client's blood glucose level in one hour D. Monitor the client closely for signs and symptoms of hyperglycemia

C. Document the finding and check the client's blood glucose level in one hour

The nurse is preparing to administer 20 units of NPH insulin to a client. Before administering the medication, the nurse should implement which intervention? A. Massage the chosen injection site. B. Assess the client's urine for the presence of glucose. C. Have a colleague confirm the dosage. D. Assess the client's understanding of diabetes.

C. Have a colleague confirm the dosage.

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? A. Keep prefilled syringes horizontally. B. Do not administer insulin kept at room temperature. C. Check for symptoms of myalgia or malaise. D. Inspect the previous injection site for inflammation.

D. Inspect the previous injection site for inflammation.