Pharm. CH.32

Which insulin can be administered by continuous intravenous (IV) infusion? a. Insulin detemir b. Insulin glargine c. Regular insulin d. Insulin aspart

c. Regular insulin Rationale: Regular insulin is the only insulin used for IV therapy.

What oral hypoglycemic drug has a quick onset and short duration of action, enabling the patient to take the medication 30 minutes before eating and skip the dose if he or she does not eat? a. Acarbose b. Metformin c. Repaglinide d. Pioglitazone

c. Repaglinide Rationale: Repaglinide is known as the "Humalog of oral hypoglycemic drugs." The drug's very fast onset of action allows patients to take the drug with meals and skip a dose when they skip a meal.

Pramlintide is prescribed as supplemental drug therapy to the treatment plan for a patient with type 1 diabetes mellitus. What information would the nurse include when teaching the patient about the action of this medication? a. Pramlintide slows gastric emptying. b. Pramlintide increases glucagon excretion. c. Pramlintide stimulates glucose production. d. Pramlintide corrects insulin receptor sensitivity.

a. Pramlintide slows gastric emptying. Rationale: Pramlintide is a synthetic form of the naturally occurring hormone amylin. It works by slowing gastric emptying, suppressing glucagon secretion and hepatic glucose production, and increasing satiety (sense of having eaten enough). It is only administered via subcutaneously injection.

The patient is prescribed 30 units of regular insulin and 70 units of insulin isophane suspension (NPH insulin) subcutaneously every morning. The nurse would provide what teaching to the patient for insulin administration? a. "Inject the needle at a 30-degree angle." b. "Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin." c. "Rotate sites at least once or twice a week." d. "Use a 23- to 25-gauge syringe with a 1-inch needle to increase insulin absorption."

b. "Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin." Rationale: When insulins are mixed, withdraw the regular insulin (clear) first, followed by withdrawing the NPH insulin (cloudy).

When teaching a patient about insulin glargine, which statement by the nurse about this drug is correct? a. "It is often combined with regular insulin to decrease the number of insulin injections per day." b. "You cannot mix this insulin with regular insulin, you will have to take two injections." c. "You can mix this insulin with NPH insulin to enhance its effects on glucose metabolism." d. "The duration of action for this insulin is 8 to 10 hours, so you will need to take it twice a day."

b. "You cannot mix this insulin with regular insulin, you will have to take two injections." Rationale: Insulin glargine is a long-acting insulin with duration of action up to 24 hours. It should not be mixed with any other insulins. It is usually dosed once daily, but it may be dosed every 12 hours depending on the patient's glycemic response.

Assuming the patient eats breakfast at 8:30 A.M., lunch at noon, and dinner at 6:00 P.M., he or she is at highest risk of hypoglycemia after an 8:00 A.M. dose of NPH insulin at what time? a. 8:00 p.m. b. 2:00 p.m. c. 5:00 p.m. d. 10:00 a.m.

c. 5:00 p.m. Rationale: Breakfast eaten at 8:30 A.M. would cover the onset of NPH insulin, and lunch will cover the 2 P.M. time frame. However, if the patient does not eat a mid-afternoon snack, the NPH insulin may be peaking just before dinner without sufficient glucose on hand to prevent hypoglycemia.

The nurse will instruct the patient to treat hypoglycemia with which drug? a. Propranolol b. Bumetanide c. Glucagon d. Acarbose

c. Glucagon Rationale: Glucagon stimulates glycogenolysis, raising serum glucose levels and is used to treat hypoglycemia.

When caring for a pregnant patient with gestational diabetes, the nurse would question a prescription for which drug? a. NPH insulin b. Insulin glulisine c. Insulin glargine d. Glipizide

d. Glipizide Rationale: Oral antidiabetic drugs are classified as pregnancy B or C drugs and are generally not recommended for pregnant patients.

The nurse is providing education to a patient for the prescription glipizide. The nurse explains this medication is more effective when administered at which time? a. 30 minutes before a meal b. At bedtime c. In the morning d. 15 minutes postprandial

a. 30 minutes before a meal Rationale: Glipizide works best if given 30 minutes before meals. This allows the timing of the insulin secretion induced by the glipizide to correspond to the elevation in the blood glucose level induced by the meal.

Which actions describe the beneficial effects produced by sulfonylurea oral hypoglycemics? (Select all that apply.) a. Inhibit breakdown of insulin by liver b. Increase hepatic glucose production c. Enhance action of insulin in various tissues d. Stimulate insulin secretion from beta cells

a. Inhibit breakdown of insulin by liver c. Enhance action of insulin in various tissues d. Stimulate insulin secretion from beta cells Rationale: The sulfonylureas stimulate insulin secretion from the beta cells of the pancreas; enhance the actions of insulin in muscle, liver, and adipose tissue; and prevent the liver from breaking insulin down as fast as it ordinarily would (reduced hepatic clearance). Increased hepatic glucose production would serve to increase serum glucose levels, the opposite effect of oral hypoglycemic drugs.

Which is a rapid-acting insulin with an onset of action of less than 15 minutes? a. Insulin aspart b. Insulin glargine c. Regular insulin d. Insulin detemir

a. Insulin aspart Rationale: Insulin aspart is a rapid-acting insulin. Insulin glargine and insulin detemir are long-acting insulins. Regular insulin is a short-acting insulin.

Which information would the nurse include in a teaching plan for patients taking oral hypoglycemic drugs? (Select all that apply.) a. Explain dietary changes are not necessary. b. Take your medication only as needed. c. Instruct that it is okay to skip breakfast 1 to 2 times per week. d. Advise to avoid smoking and alcohol consumption. e. Report symptoms of anorexia and fatigue.

d. Advise to avoid smoking and alcohol consumption. e. Report symptoms of anorexia and fatigue. Rationale: Oral hypoglycemic drugs must be taken on a daily scheduled basis to maintain euglycemia and prevent long-term complications of diabetes. Skipping meals can cause low blood glucose levels and should be avoided. Patients with type 2 diabetes mellitus are managed with lifestyle changes.

Which long-acting insulin mimics natural, basal insulin with no peak action and a duration of 24 hours? a. Insulin glulisine b. Insulin glargine c. NPH insulin d. Regular insulin

d. Insulin glargine Rationale: Insulin glargine has a duration of action of 24 hours with no peaks, mimicking the natural, basal insulin secretion of the pancreas.

The nurse is preparing a patient for a computed tomography scan using iodine contrast media. What medication would the nurse question if prescribed 1 day before the scheduled procedure? a. Repaglinide b. Pioglitazone c. Acarbose d. Metformin

d. Metformin Rationale: The concurrent use of metformin with iodinated (iodine-containing) radiologic contrast media has been associated with both acute renal failure and lactic acidosis. Therefore, metformin should be discontinued the day of the test and for at least 48 hours after the patient undergoes any radiologic study that requires the use of such contrast media.