Pharm ch38
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.
A 58-year-old patient who has been diabetic since age 14 states he has pain in his feet and hands. What is this pain a result of? a) Hypertension b) An infectious process c) Peripheral neuropathy d) An autoimmune disorder
Peripheral neuropathy
When preparing to administer an insulin injection, the nurse would use which sized needle?
25 gauge, ½ inch
Which strategy will NOT increase the therapeutic effect of insulin?
All insulin should be stored in a refrigerator but never frozen.
A client receives regular insulin at 8:00 AM. The nurse would be alert for signs and symptoms of hypoglycemia at which time? a) Between 2:00 PM and 4:00 PM b) Between 10:00 AM and 12:00 PM c) Between 12:00 PM and 8:00 PM d) Between 8:30 AM and 9:30 AM
Between 10 and 12
A client is receiving glipizide as treatment for his type 2 diabetes. The nurse understands that this drug acts by which of the following?
Binding to potassium channels on pancreatic beta cells
A female client visits the physician's office after routine labs are drawn. The nurse notes that her A1C is 9. How does the nurse interpret this finding? a) Client's blood glucose demonstrates longstanding hypoglycemia. b) Client's average blood glucose is above normal. c) Client's blood glucose levels are not consistent. d) Client is in good glycemic control.
Client's average blood glucose is above normal
Which of the following is a non-insulin injectable antidiabetic drug? (Choose one) a) Sitagliptin (Januvia) b) Glipizide (Glucotrol) c) Pioglitazone (Actos) d) Exenatide (Byetta)
Exenatide (Byetta)
A patient is diagnosed with type 1 diabetes. What distinguishing characteristic is associated with type 1 diabetes? a) Exogenous insulin is required for life. b) Oral agents can control blood sugar. c) Blood glucose levels can be controlled by diet. d) It always starts in childhood.
Exogenous insulin is required for life.
Patients with type 2 diabetes have nonfunctioning beta pancreatic cells.
False.
Stress typically results in hypoglycemia.
False.
A man is brought to the emergency department. He is nonresponsive, and his blood glucose level is 32 mg/dL. Which of the following would the nurse expect to be ordered? a) Glucagon b) Regular insulin c) Diazoxide d) Insulin lispro
Glucagon
A nurse at a health care facility is assigned to administer insulin to the patient. Which of the following interventions should the nurse perform before administering each insulin dose?
Inspect the previous injection site for inflammation.
Your client is admitted to the intensive care unit with diabetic ketoacidosis. You know that your client will be placed on an intravenous insulin drip. The only type of insulin which can be administered intravenously is: a) Ultralente. b) Regular. c) NPH. d) Lente.
Regular
A student asks the nursing instructor what insulin has the quickest therapeutic effect once administered. What would be the best response? a) Regular (Humulin R) b) PZI (Humulin U) c) NPH (Humulin N) d) Ultralente (Humulin U Ultralente)
Regular (Humulin R)
A patient is in diabetic ketoacidosis. The patient blood glucose level is over 600. The physician has ordered the patient to receive an initial dose of 25 units of insulin. What type of insulin will be administered intravenously? a) Lente insulin b) Ultralente insulin c) NPH insulin d) Regular insulin
Regular insulin
A nurse is preparing an in-service presentation for a group of staff members on diabetes. Which of the following would the nurse include as the primary delivery system for insulin? a) Jet injector b) External pump c) Insulin pen d) Subcutaneous injection
Subcutaneous injection
After teaching a group of students about the various methods for the delivery of insulin, the instructor determines that the teaching was successful when the students identify which method as most commonly used for administration?
Subcutaneous injection.
Which of the following is an example of long acting insulin?
Insulin glargine (Lantus)
Which of the following is an example of long acting insulin? a) Insulin lispro (Humalog) b) Isophane insulin suspension (Humulin N) c) Insulin glargine (Lantus) d) Insulin aspart (Apidra)
Insulin glargine (Lantus)
Which of the following would alert the nurse to suspect that a client is developing ketoacidosis? a) Fluid retention b) Fruity breath odor c) Blurred vision d) Hunger
Fruity breath odor
Which of the following would a nurse identify as an example of a sulfonylurea? a) Glyburide b) Acarbose c) Metformin d) Miglitol
Glyburide
Which of the following would a nurse identify as an example of a sulfonylurea?
Glyburide.
When administering insulin, which of the following would be most appropriate?
Insert the needle at a 45-degree angle for injection.
The nurse is preparing to administer insulin lispro (Humalog) to a client at 7 AM. What is the nurse's top priority intervention related to this medication? a) Have the client lie quietly for 45 minutes. b) Monitor the client for a hypoglycemic reaction at noon. c) Make sure the client's breakfast is available in the next 5-10 minutes. d) Cleanse the administration site with soap and water before administration.
Make sure the client's breakfast is available in the next 5-10 minutes
A patient has suffered from hypoglycemia twice in the past week. She states she eats one time per day and snacks the rest of the day. What patient education will you provide for this patient?
She should not eat at sporadic times.
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) Tolazamide b) Repaglinide c) Glyburide d) Pramlintide e) Glimepiride
• Glimepiride • Glyburide
Choice Multiple question - Select all answer choices that apply. The nurse monitoring a client receiving insulin glulisine (Apidra) notices the client has become confused, diaphoretic, and nauseated. The nurse checks the client's blood glucose and it is 60 mg/dL. Which of the following can a nurse give to treat a client with a hypoglycemic episode? Select all that apply: a) Insulin detemir (Levemir) b) Glucose tablets c) Orange or other fruit juice d) Hard candy e) Insulin glargine (Lantus)
• Glucose tablets • Hard candy • Orange or other fruit juice
A patient receives a dose of insulin lispro at 8 AM. The nurse would be alert for signs and symptoms of hypoglycemia at which time?
Between 8:30and 9:30 am.
The physician has ordered a change of prescription from rapid-acting insulin to an intermediate-acting type. Which of the following adverse effects must the nurse closely monitor for in the patient? a) Lipodystrophy b) Hypoglycemia c) Bradycardia d) Hypotension
Hypoglycemia
Which of the following would be least appropriate when administering insulin by subcutaneous injection?
Massaging the site after removing the needle
Which of the following would be least appropriate when administering insulin by subcutaneous injection? a) Inserting the needle at a 45-degree angle b) Using a 25 gauge 1/2 -inch needle c) Injecting the insulin slowly d) Massaging the site after removing the needle
Massaging the site after removing the needle
Glycosylated hemoglobin measures average blood glucose over what time period? (Choose one)
The past 3 or 4 months
You are caring for a client taking insulin. You realize the client is experiencing symptoms of hypoglycemia when he displays the following symptoms: a) Decreased respiratory rate and hot, dry skin. b) Increased pulse rate and fruity smelling breath. c) Weakness, sweating, and decreased mentation. d) Increased thirst and increased urine output.
Weakness, sweating, and decreased mentation.
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."
The nurse is educating a newly diagnosed diabetic who must learn how to give himself insulin injections. The nurse tells the client that insulin is absorbed fastest from which area of injection? a) Hip b) Abdomen c) Deltoid d) Thigh
Abdomen
A patient is to be administered glipizide (Glucotrol). Which of the following factors would prohibit the administration of glipizide (Glucotrol) to this patient? a) A diagnosis of hypertension b) The ingestion of carbohydrates c) Increase in alkaline phosphatase d) Allergy to sulfonamides
Allergy to sulfonamides
A nurse is assigned to administer glargine to a patient at a health care facility. What precaution should the nurse take when administering glargine? a) Shake the vial vigorously before withdrawing insulin. b) Administer insulin that has been refrigerated. c) Avoid mixing glargine with other insulin. d) Administer glargine via IV route.
Avoid mixing glargine with other insulin.
A nurse is caring for a 48-year-old woman who has been hospitalized after injecting the wrong type of insulin. Which of the following signs of hypoglycemia will the nurse be careful to observe for?
Blurred Vision.
When reviewing sites for insulin administration with a client, which site, if stated by the client as an appropriate site, indicates the need for additional teaching? a) Upper arm b) Buttocks c) Upper thigh d) Abdomen
Buttocks
When reviewing sites for insulin administration with a client, which site, if stated by the client as an appropriate site, indicates the need for additional teaching?
Buttocks.
A female client visits the physician'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.
The nurse is educating a client who will be adding an injection of pramlintide to his insulin regimen. What information is most important for the nurse to share with this client to ensure safe medication administration? a) Inject pramlintide in the same site where insulin is administered. b) Pramlintide should only be injected in the hip. c) Do not give pramlintide in the same site where insulin is administered. d) Mix pramlintide in the same syringe with insulin.
Clients who take pramlintide should not be injected into the same site where insulin is administered.
The pathophysiology class is studying diabetes. A student asks the instructor what is considered a sign of a hypoglycemic reaction. The instructor's response would be what? a) Diaphoresis b) Flushing of the face c) Dry, flaky skin d) Fruity breath
Diaphoresis
Insulin binds with and activates receptors on cell membranes. Once insulin-receptor binding occurs, the membranes become highly permeable to glucose. Which of the following actions does this enable?
Entry of glucose into the cells
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) Exogenous insulin is required for life. c) Oral agents can control the disease process. d) Blood glucose level can be controlled with diet.
Exogenous insulin is required for life.
Which of the following would alert the nurse to suspect that a client is developing ketoacidosis? a) Hunger b) Blurred vision c) Fruity breath odor d) Fluid retention
Fruity breath odor
A nurse is caring for a patient who has developed a hypoglycemic reaction. Which of the following interventions should the nurse perform if swallowing and gag reflexes are present in the patient?
Give oral fluids or candy.
The nurse is interviewing a client who was diagnosed with type 2 diabetes about four months ago. The client never records glucometer readings but says that everything is just fine. What laboratory test does the nurse anticipate the health care provider will order for this client? a) HbA1c b) Fasting blood glucose in the AM c) Stat urine for glucose d) Insulin level
HbA1c
The physician has ordered a change of prescription from rapid-acting insulin to an intermediate-acting type. Which of the following adverse effects must the nurse closely monitor for in the patient? a) Hypotension b) Bradycardia c) Hypoglycemia d) Lipodystrophy
Hypoglycemia
When administering insulin, which of the following would be most appropriate? a) Massage the injection site firmly after removing the needle and syringe. b) Firmly spread the skin of the area of the intended site of injection. c) Shake the vial vigorously to ensure thorough mixing before drawing up the dose. d) Insert the needle at a 45-degree angle for injection.
Insert the needle at a 45-degree angle for injection.
Which of the following is an example of long acting insulin? a) Isophane insulin suspension (Humulin N) b) Insulin lispro (Humalog) c) Insulin aspart (Apidra) d) Insulin glargine (Lantus)
Insulin glargine (Lantus)
A client newly diagnosed with type 1 diabetes asks the nurse why he cannot just take a pill. The nurse would incorporate knowledge of which of the following when responding to this client?
Insulin is needed because the beta cells of the pancreas are no longer functioning.
Which of the following is an example of rapid acting insulin? (Choose one) a) Insulin Glargine (Lantus) b) Insulin lispro (Humalog) c) Isophane insulin suspension (Humulin N) d) Insulin detemir (Levemir)
Insulin lispro (Humalog)
Which of the following is an example of rapid acting insulin? (Choose one) a) Insulin detemir (Levemir) b) Isophane insulin suspension (Humulin N) c) Insulin Glargine (Lantus) d) Insulin lispro (Humalog)
Insulin lispro (Humalog)
During a teaching session on the care of the diabetic patient, a family member asks why her daughter has a different insulin than her best friend. The nurse should make which of the following statements to explain the differences in insulin? a) "Insulins have different onsets and durations of action." b) "Insulin is prescribed based on the cost." c) "Insulin type is matched with oral hypoglycemic agents." d) "Insulin is prescribed based on the patient's age."
Insulins have different onsets and durations of action
Which of the following would be appropriate to include in teaching your client with type 2 diabetes?
It is possible with weight loss and exercise to discontinue the use of antidiabetic medication.
Which of the following would be appropriate to include in teaching your 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.
It is possible with weight loss and exercise to discontinue the use of antidiabetic meds
The nurse is preparing to administer insulin lispro (Humalog) to a client at 7 AM. What is the nurse's top priority intervention related to this medication?
Make sure the client's breakfast is available in the next 5-10 minutes.
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) Monitor the patient for lipodystrophy. b) Assess the skin for ulcers, cuts, and sores. c) Observe the patient for hypoglycemic episodes. d) Document family medical history.
Observe the patient for hypoglycemic episodes
A patient is prescribed sitagliptin. The nurse would expect to administer this drug by which route?
Oral.
The nurse walks into the room of a client with type 1 diabetes and finds the client pale and diaphoretic. The client is complaining of a headache and of 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.
A patient is in diabetic ketoacidosis. The patient blood glucose level is over 600. The physician has ordered the patient to receive an initial dose of 25 units of insulin. What type of insulin will be administered intravenously?
Regular insulin.
Your client is admitted to the intensive care unit with diabetic ketoacidosis. You know that your client will be placed on an intravenous insulin drip. The only type of insulin which can be administered intravenously is:
Regular.
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) Jet injector c) Subcutaneous injection d) Implantable infusion pump
Subcutaneous injection
An insulin dependent diabetic is having trouble with hypoglycemia late in the morning. During the health history, the nurse becomes aware of the most likely cause. What would cause the late morning hypoglycemia? a) The patient eats oatmeal early in the morning before his morning. b) The patient likes to nap when he comes home from work before his evening meal. c) The patient likes to have an early lunch with his girlfriend. d) The patient jogs two miles in the morning before he goes to work.
The patient jogs 2 miles in the morning before work
Regular insulin may be administered intravenously or intramuscularly in an emergency situation. a) True b) False
True
Amylin is a peptide hormone secreted with insulin by the beta cells of the pancreas and is important in the regulation of glucose control during the postprandial period. True or false?
True.
Glycosylated hemoglobin levels provide reliable evidence of blood glucose control.
True.
Regular insulin may be administered intravenously or intramuscularly in an emergency situation.
True.
You are caring for a client taking insulin. You realize the client is experiencing symptoms of hypoglycemia when he displays the following symptoms: a) Increased pulse rate and fruity smelling breath. b) Decreased respiratory rate and hot, dry skin. c) Weakness, sweating, and decreased mentation. d) Increased thirst and increased urine output.
weakness, sweating, and decreased mentation
Choice Multiple question - Select all answer choices that apply. The nurse is caring for a client age 77 years who has type 2 diabetes and chronic kidney disease. Which drugs will be used with great caution in this client? a) Metformin (Glucophage) b) Exenatide (Byetta) c) Regular insulin d) Chlorpropamide (Diabinese) e) Miglitol (Glyset)
• Metformin (Glucophage) • Exenatide (Byetta) • Miglitol (Glyset)
A nurse should monitor a client taking glimepiride (Amaryl) for which of the following adverse effects? Select all that apply:
• Nausea • Heartburn • Hypoglycemia
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. • Read food labels carefully to look for hidden sources of sugar. • Avoid drinking beer, wine, or liquor.
A nurse is providing patient education to a 13-year-old girl who was just diagnosed with type 1 diabetes mellitus. Which of the following statements by the patient 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? a) "I need to turn the dial on the pen and listen for the locking ring before administering my insulin." b) "I determine my dosage by the number of clicks that I hear." c) "If I forget to take my insulin pen, I will be able to use the one that my wife uses." d) "This will make it easier for me to give my own insulin because of my poor eyesight."
"If I forget to take my insulin pen, I will be able to use the one that my wife uses."
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?
15 minutes.
A client is taking metformin as part of his treatment for diabetes. The nurse would warn the client that he may experience signs and symptoms of hypoglycemia within approximately which time frame? a) 3 hours b) 1 hour c) 2 hours d) 4 hours
2 hours
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 which of the following as a biguanide? a) Tolbutamide b) Metformin c) Miglitol d) Glipizide
Metformin
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 which of the following as a biguanide?
Metformin.
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?
Observe the patient for hypoglycemic episodes.
A 54-year-old 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 hypoglycemia.
When learning about type 1 diabetes, what would the student nurses learn is a distinguishing characteristic of this disease? a) Exogenous insulin is required for life. b) It always starts in childhood. c) Oral agents can control the disease process. d) Blood glucose level can be controlled with diet.
Exogenous insulin is required for life
