Pharm Diabetes
The nurse is preparing to administer insulin intravenously. Which statement about intravenous insulin is true?
Only Regular insulin can be administered intravenously.
Radioactive iodine-131 is used to treat: a. type 2 diabetes mellitus b. hypoglycemia c. thyroid cancer d. diabetes insipidus
C
Assuming the patient eats breakfast at 8:30 AM, lunch at noon, and dinner at 6:00 PM, he or she is at highest risk of hypoglycemia following an 8:00 AM dose of NPH insulin at what time?
5:00 PM
The patient is prescribed 30 units regular insulin and 70 units NPH insulin subcutaneously every morning. The nurse will provide which instruction to the patient?
"Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin."
A client is diagnosed with type 2 diabetes mellitus. The nurse is aware that which statement is true? a. client is most likely a teenager b. client is most likely a child younger than 10 c. heredity is a major causative factor d. viral infections contribute most to disease development
c
A client is found unconscious with a Medic-Alert bracelet indicating type 1 diabetes mellitus. What is the highest priority nursing intervention? a. Administer insulin. b. Feed the client orange juice. c. Administer glucagon. d. Perform CPR.
c
When monitoring a patient's response to oral antidiabetic drugs, the nurse knows that the laboratory results that would indicate a therapeutic response would be a(n)
fasting blood glucose level between 70 and 100 mg/dL
early signs of hypoglycemia
irritability and confusion
The nurse is reviewing instructions for a patient with type 2 diabetes who also gives herself insulin injections as part of the therapy. The nurse asks the patient, "What should you do if your fasting blood glucose is 47 mg/dL?" Which response by the patient is correct?
"I will take an oral form of glucose."
A 75-year-old woman with type 2 diabetes has recently been placed on GLYBURIDE, 10 mg daily. She asks the nurse when the best time would be to take this medication. What is the nurse's best response?
"Take this medication in the morning, 30 minutes before breakfast."
The nurse is administering LISPRO insulin and should keep in mind that this insulin will start to have an effect within which time frame?
15 minutes
The nurse is providing education to a patient about the time to take glipizide (Glucotrol). For maximum benefit, the nurse will tell the patient to administer glipizide at which time?
30 minutes before a meal
How will the nurse teach the client to mix her insulins when administering 30 units regular insulin and 70 units NPH insulin in the morning? A. Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin. B. Draw the medication into two separate syringes, but inject into the same spot. C. Administer these insulins at least 10 minutes apart, so that you will know when they are working. D. Use the Z-track method for administration.
A
The nurse is teaching a client who has been prescribed repaglinide. What information is the most important for the nurse to include in the teaching plan? A. "You will need to be sure you eat as soon as you take this medication." B. "This medication is compatible with all of your cardiac medications." C. "This medication will not cause hypoglycemia." D. "This medication has no side effects."
A
The client states that he typically takes his glipizide with food. What is the nurse's best intervention? A. Immediately check the client's blood glucose level. B. Inform the client that it is better to take the medication 30 minutes before a meal. C. Inform the client that the medication must be taken 15 minutes after a meal. D. Immediately call the health care provider.
B
The nurse finds a client with type 1 diabetes mellitus unresponsive, cold, and clammy. What is the nurse's best action? A. Administer subcutaneous regular insulin immediately. B. Administer glucagon. C. Start an insulin drip. D. Draw blood glucose level and send to the laboratory
B
The nurse administers NPH insulin at 8 AM. What intervention is essential for the nurse to perform? A. Assess the client for hyperglycemia by 10 AM. B. Monitor fingerstick at 2 PM. C. Make sure client eats by 5 PM. D. Administer the insulin via IV pump.
C
What is the most important information for the nurse to teach the client who has been prescribed an alpha-glucosidase inhibitor? A. "This medication will stimulate pancreatic insulin release." B. "This medication will increase the sensitivity of insulin receptor sites." C. "This medication will delay the absorption of carbohydrates from the intestine." D. "This medication cannot be used in combination with other antidiabetic agents."
C
Which statement indicates that the client needs additional teaching on oral hypoglycemic agents? A. "I will limit my alcohol consumption." B. "I will report symptoms of anorexia and fatigue." C. "I will take the medication only when I need it." D. "I will monitor my blood sugar daily."
C
A patient who has type 2 diabetes is scheduled for a colonoscopy and has been NPO (nothing by mouth) since midnight. She is concerned because her medications are being held. What is the best action regarding the administration of her oral antidiabetic drugs?
Contacting the prescriber for further orders
The nurse would include which statement when teaching a client about insulin glargine? A. "You should inject this insulin just before meals because it is very fast-acting." B. "The duration of action for this insulin is approximately 8 to 10 hours, so you will need to take it twice a day." C. "You can mix this insulin with Lente insulin to enhance its effects." D. "You cannot mix this insulin with any other insulin in the same syringe."
D
A patient in the emergency department was showing signs of HYPOGLYCEMIA and had a fingerstick glucose level of 34 mg/dL. He has just become unconscious. What is the nurse's first action?
Give him intravenous glucose.
Which laboratory test will best reflect the patient's adherence to the antidiabetic therapy over the past few months?
Hemoglobin A1C level
The nurse is administering RAPID ACTING INSULIN. Which statement is true regarding its administration?
It should be given within 15 minutes of the patient beginning a meal.
Pramlintide (Symlin) is added to the treatment plan for a patient with type 1 diabetes. What information about the action of this medication does the nurse include in the patient teaching?
Pramlintide slows gastric emptying.
The nurse is teaching patients about self-injection of insulin. Which statement is true regarding injection sites?
Rotate sites within the same location for about 1 week before rotating to a new location.
A patient with a history of COPD and type 2 diabetes has been treated for pneumonia for the past week. He has been receiving intravenous corticosteroids as well as antibiotics as part of his therapy. At this time, his pneumonia has resolved, but when monitoring his blood glucose levels, the nurse notices that his blood glucose level is still elevated, and he has required small amounts of sliding-scale insulin coverage. What is the best explanation for this elevation?
The corticosteroids may cause an increase in glucose levels.
The nurse knows to administer acarbose (Precose), an alpha-glucosidase inhibitor, at which time?
With the first bite of each main meal
The nurse is teaching a group of patients about self-administration of insulin. What teaching is important to include?
When mixing insulins, the clear (such as Regular) insulin should be drawn up into the syringe first.
A client is ordered to receive insulin glargine (Lantus) insulin. The nurse plans the client's care based on the fact that Lantus: a. does not peak. b. is less expensive. c. is short acting. d. requires multiple injections per day.
a
Antidiabetic drugs are designed to control signs ans symptoms of diabetes mellitus. The nurse primarily expects a decrease in which? a. blood glucose b. Fat metabolism c. Glycogen storage d. Protein mobilization
a
The best candidate for oral antidiabetic therapy is the client who: a. has a fasting glucose level of 180 mg/dl. b. has had a diagnosis of diabetes for 10 years. c. is 10 pounds under his optimal body weight. d. requires 60 units of insulin per day.
a
In administering an insulin injection to a client, the nurse anticipates that the injection of NPH (Humulin N) and regular (Humulin R) insulins will be administered via the _____ route. a. intradermal b. subcutaneous c. intramuscular d. intravenous
b
The client is being treated with Metformin. He is also receiving furosemide. The nurse anticipates that the interaction of the two medications will result in: a. acute kidney failure. b. potentiated hypoglycemia. c. dawn phenomenon. d. potentiated hyperglycemia.
b
The client is being treated with rosiglitazone maleate (Avandia). The highest priority instruction to the client based on treatment with this medication is for the client to: a. increase the intake of calcium. b. use birth control. c. keep a food diary. d. use a respiratory inhaler.
b
The client is scheduled to begin treatment with Metformin. The nurse plans to closely monitor which laboratory values? a. Cardiac enzymes b. Liver function tests c. Complete blood count d. Respiratory function tests
b
The nurse is teaching a client with type 1 diabetes and hypertension. The client currently takes insulin and Inderal. What is the most important information for the nurse to teach this client? A. "Do not take both of these medications at the exact same time." B. "Check your blood glucose four times a day." C. "Check your blood pressure hourly." D. "Call your health care provider if you have nervousness or diaphoresis."
b
When the client is prescribed glipizide (Glucotrol), the nurse knows which side effects/adverse effects may be expected? (select all that apply) a. tachypnea b. Tachycardia c. Increased alertness d. Increased weight gain e. visual disturbances f. hunger
b e f
What is the most important information for the nurse to teach the client who has been prescribed an alpha-glucosidase inhibitor? A. "This medication will stimulate pancreatic insulin release." B. "This medication will increase the sensitivity of insulin receptor sites." C. "This medication will delay the absorption of carbohydrates from the intestine." D. "This medication cannot be used in combination with other antidiabetic agents."
c
A 48-year-old is diagnosed with metabolic syndrome and is started on metformin (Glucophage). The purpose of the metformin, in this situation, is to
decrease insulin resistance.
The nurse will advise the patient to treat hypoglycemia with which drug?
glucagon
A client taking glipizide (Glucotrol) for control of type 2 diabetes mellitus should be cautioned against the use of which of the following? A. Magnesium hydroxide (Milk of Magnesia) B. Hydrocortisone acetate cream C. Calcium supplements D. Alcohol
D
A nurse is caring for a client in an outpatient facility who has been taking acarbose (Precose) for type 2 DM. Which of the following laboratory tests should the nurse plan to monitor? a. WBC b. serum potassium c. platelet count d. liver function tests
D
Desmopressin is used to treat: a. type 2 DM b. hypoglycemia c. thyroid cancer d. diabetes insipidus
D
A client taking hydrocortisone for adrenocortical insufficiency (Addison's disease) is admitted to the hospital for a total hip arthroplasty. Which of the following actions is the highest priority? A. Administration of supplemental doses of hydrocortisone B. Instruction on coughing and deep breathing C. Insertion of an indwelling urinary catheter D. Requesting a referral for physical therapy
A
A nurse is caring for client with a rx for metformin (Glucophage). The nurse should monitor the client for which of the following effects? a. lactic acidosis b. hypoglycemia c. hyperlipidemia d. respiratory alkalosis
A
Clients taking metformin (Glucophage) should be monitored for which of the following? A. Lactic acidosis B. Hypertension. C. Hyperlipidemia. D. Respiratory alkalosis.
A
Desmopressin acetate (DDAVP) is prescribed for the treatment of diabetes insipidus. The nurse monitors the client after medication administration for which therapeutic response? A. Decreased urinary output B. Decreased blood pressure C. Decreased peripheral edema D. Decreased blood glucose leve
A
For the most complete absorption, the recommended site for insulin injection should be into which area of the body? A) Abdomen B) Arm C) Thigh D) Buttocks
A
Glipizide is used to treat: a. type 2 diabetes mellitus b. hypoglycemia c. thyroid cancer d. diabetes insipidus
A
Instruct the patient receiving insulin to watch for and report the following indications of an adverse reaction to insulin? a. palpitations b. weight gain c. low urine output d. constipation
A
Pramlintide (Symlin) is added to the treatment plan for a patient with type 1 diabetes. When teaching the patient about this medication, the nurse recognizes that A) pramlintide slows gastric emptying. B) pramlintide increases glucagon excretion. C) pramlintide works to prevent side effects of insulin. D) pramlintide is an oral drug administered 15 minutes before meals.
A
The nurse is teaching the client how to administer insulin. What information is essential to include in the plan? A. "For the most consistent absorption, inject the insulin into the abdomen." B. "Avoid administering the insulin into your arm." C. "Inject the insulin into an exercising muscle for better absorption." D. "Do not mix any insulins in the same syringe."
A
When administering 30 units regular insulin and 70 units NPH insulin, the nurse will perform which action? A) Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin. B) Inform the patient that mixing insulins will help increase insulin production. C) Rotate sites at least once weekly and label the sites used on a diagram. D) Use a 23- to 25-gauge syringe with a 1-inch needle for maximum absorption.
A
Which long-acting insulin mimics natural, basal insulin with no peak action and a duration of 24 hours? A) insulin glargine (Lantus) B) insulin glulisine (Apidra) C) regular insulin (Humulin R) D) NPH insulin (Humulin N)
A
You are caring for a pt who is taking levoxythroxine (Synthroid) to treat hypothyroidism. The pt reports palpitations, weight loss, and diarrhea. You suspect which of the following effects of this drug? a. hyperthyroidism b. addison's disease c. myxedema d. hyperglycemia
A
You give a pt five units of lispro insulin (Humalog) and 10 units of insulin glargine subcut at 1400. Based on your instructions, the pt should expect her blood glucose level to be lowest at which of the following times? a. 1430 b. 1530 c. 1630 d. 1730
A
Two hours after self-administering regular insulin subcutaneously, the pt contacts you at the provider's office to report that she is sweaty, shaky, and has a rapid pulse. Which of the following actions should you advise her to take? (select all that apply) A. drink 4 oz of orange juice B. Check her blood glucose C. take an oral hypoglycemic D. measure her urine output E. self-administer a long-acting insulin
AB
A patient is about to start taking hydrocortisone (Cortef) to treat adrenocortical insufficiency. You should instruct the pt to do which of the following to help reduce her risk for adverse effects of the drug? (Select all that apply) A. expect lifelong therapy B. carry extra doses of the drug C. expect periodic blood sampling D. urinate q 4 hr E. report increased stress
ABC
When talking with a 30 year old woman who will receive radioactive iodine-131 to treat Graves' disease, you should include which of the following instructions? (Select all that apply). a. report weight gain and edema b. use effective contraception c. allow 2-3 months for full effects d. expect periodic blood sampling e. obtain regular eye examinations
ABCD
Glipizide, an oral antidiabetic, can have adverse effects. Which of the following interventions might need to be taken? (select all that apply) A. Discontinuation of glipizide due to excessive gastrointestinal side effects such as abdominal distention, diarrhea and gas. B. Administer IV glucose if pt is unconscious and is severely hypoglycemic (<70mg/dL blood glucose) C. Treat conscious, hypoglycemic pt with 2 oz of grape juice. D. Monitor carefully for lactic acidosis. E. Monitor hemoglobin and iron levels and discontinue medication if pt becomes anemic
ABCE
Which information should be included in a teaching plan for patients taking oral hypoglycemic drugs? (Select all that apply.) A) Limit your alcohol consumption. B) Report symptoms of anorexia and fatigue. C) Take your medication only as needed. D) Notify your physician if blood glucose levels rise above the level set for you.
ABD
Which actions describe the beneficial effects produced by sulfonylurea oral hypoglycemics? (Select all that apply.) A) Stimulate insulin secretion from beta cells B) Increase hepatic glucose production C) Enhance action of insulin in various tissues D) Inhibit breakdown of insulin by liver
ACD
A nurse is providing teaching to a ct who has an rx for pramlintide (Symlin) for type 1 diabetes mellitus. Which of the following should the nurse include in the teaching? (Select all that apply) a. Take oral medications 1 hr before injection b. use upper arms as preferred injection site c. mix pramlintide with breakfast dose of insulin d. inject pramlintide just before a meal e. discard open vials after 28 days.
ADE
A nurse is providing teaching to a client who is prescribed pramlintide (Symlin) for type 1 diabetes. Which of the following should the nurse include in the teaching? A. "Take oral medications 1 hr before injection." B. "Use upper arms as preferred injection sites." C."Mix medication with breakfast dose of insulin." D. "Freeze unopened vials of medication." E. "Discard open vials after 28 days."
AE
A pt is self-injecting eight units of NPH insulin and four units of regular insulin each day before breakfast. As you show the pt how to self administer insulin, you should include which of the following instructions? (select all that apply) a. draw the regular insulin into the syringe first, then the NPH insulin b. inject the insulin mixture into a large muscle c. discard any unused premixed syringes within 5 days d. use a 5-mL syringe when mixing two types of insulins e. use one syringe to reduce the number of injections
AE
4. The nurse assesses a newly diagnosed patient for short-term complications of diabetes. What does this assessment include? a. Evaluation for hyperglycemia, hypoglycemia, and ketoacidosis b. Cranial nerve testing for peripheral neuropathy c. Pedal pulse palpation for arterial insufficiency d. Auscultation of the carotids for bruits associated with atherosclerosis
ANS: A High blood sugar, low blood sugar, and ketoacidosis are short-term complications of diabetes. Microvascular and macrovascular complications, such as peripheral neuropathy, are long-term complications of diabetes. Arterial insufficiency and atherosclerosis also are long-term complications of diabetes.
7. An adolescent patient recently attended a health fair and had a serum glucose test. The patient telephones the nurse and says, "My level was 125 mg/dL. Does that mean I have diabetes?" What is the nurse's most accurate response? a. "Unless you were fasting for longer than 8 hours, this does not necessarily mean you have diabetes." b. "At this level, you probably have diabetes. You will need an oral glucose tolerance test this week." c. "This level is conclusive evidence that you have diabetes." d. "This level is conclusive evidence that you do not have diabetes."
ANS: A If a person has not fasted for 8 hours, a blood sugar level of 125 mg/dL would be considered normal, because it is less than 200 mg/dL for a random sampling. Also, a person must have positive outcomes on two separate days to be diagnosed with diabetes. This patient does not need to have an oral glucose tolerance test, because the 125 mg/dL reading is so far below 200 mg/dL, which would require further work-up. No conclusive evidence indicates that this patient has diabetes, because the random sample value is so low, and the patient has not had two separate tests on different days. However, this also is not conclusive evidence that the patient does not have diabetes.
10. A patient with type 1 diabetes reports mixing NPH and regular insulin to allow for one injection. What should the nurse tell the patient? a. This is an acceptable practice. b. These two forms of insulin are not compatible and cannot be mixed. c. Mixing these two forms of insulin may increase the overall potency of the products. d. NPH insulin should only be mixed with insulin glargine.
ANS: A NPH insulin is the only insulin suitable for mixing with short-acting insulins, such as insulin aspart [NovoLog]. These insulins are compatible and are mixed frequently for management of diabetics. The overall potency of each insulin is not increased by mixing them. Insulin glargine cannot be mixed with any other insulin for administration.
A nurse is providing teaching to a ct who has type 2 diabetes mellitus and is starting repaglinide (Prandin). Which of the following statements made by the ct indicates understanding of the administration of this medication? a. "I'll take this medication with my meals." b. "I'll take this medication 30 minutes before I eat." c. "I'll take this medication just before I go to bed." d. "I'll take this medication as soon as I wake up in the morning."
B
1. The nurse working on a high-acuity medical-surgical unit is prioritizing care for four patients who were just admitted. Which patient should the nurse assess first? a. The NPO patient with a blood glucose level of 80 mg/dL who just received 20 units of 70/30 Novolin insulin b. The patient with a pulse of 58 beats per minute who is about to receive digoxin [Lanoxin] c. The patient with a blood pressure of 136/92 mm Hg who complains of having a headache d. The patient with an allergy to penicillin who is receiving an infusion of vancomycin [Vancocin]
ANS: A The NPO patient with hypoglycemia who just received 70/30 Novolin insulin takes priority, because this patient needs to consume a good source of glucose immediately or perhaps the NPO status will be discontinued for this shift. The digoxin may be withheld for the patient with a pulse of 58 beats per minute, but this is not a priority action. The patient with a headache needs to be followed up, but because the blood pressure is 136/92 mm Hg, the headache is probably not caused by hypertension. The patient with an allergy to penicillin will not have a reaction to the vancomycin.
13. Which statement is correct about the contrast between acarbose and miglitol? a. Miglitol has not been associated with hepatic dysfunction. b. With miglitol, sucrose can be used to treat hypoglycemia. c. Miglitol is less effective in African Americans. d. Miglitol has no gastrointestinal side effects.
ANS: A Unlike acarbose, miglitol has not been associated with hepatic dysfunction. Sucrose should not be used to treat hypoglycemia with miglitol. Miglitol is more effective in African American patients. Miglitol has gastrointestinal side effects.
3. A nurse is educating the staff nurses about ketoacidosis. To evaluate the group's understanding, the nurse asks, "Which sign or symptom would not be consistent with ketoacidosis?" The group gives which correct answer? a. Blood glucose level of 600 mg/dL b. Blood glucose level of 60 mg/dL c. Acidosis d. Ketones in the urine
ANS: B A patient with diabetic ketoacidosis (DKA) has a high glucose level (at least 500 mg/dL or higher); therefore, a glucose level of 60 mg/dL would not be consistent with DKA. A blood glucose level of 600 mg/dL, acidosis, and ketones in the urine are consistent with DKA.
A patient newly diagnosed with diabetes expresses concern about losing her vision. Which interventions should be included in the plan of care to reduce this risk? (Select all that apply.) a. Initiation of reliable contraception to prevent pregnancy b. Ways to reduce hyperglycemic episodes c. Use of a prokinetic drug (eg, metoclopramide) d. Smoking cessation e. Emphasis on the importance of taking antihypertensive drugs consistently
ANS: B, D, E Tighter glycemic control and fewer hyperglycemic episodes have been correlated with fewer complications. Smoking cessation and strict compliance with any drugs prescribed for hypertension also help reduce the risk of complications. The use of contraception or a prokinetic drug is not related to a reduced risk of vision loss in patients with diabetes.
A nurse counsels a patient with diabetes who is starting therapy with an alpha-glucosidase inhibitor. The patient should be educated about the potential for which adverse reactions? (Select all that apply.) a. Hypoglycemia b. Flatulence c. Elevated iron levels in the blood d. Fluid retention e. Diarrhea
ANS: B, E Acarbose and miglitol frequently cause flatulence, cramps, abdominal distention, borborygmus (rumbling bowel sounds), and diarrhea. Acarbose also can cause liver damage. Neither acarbose nor miglitol causes hypoglycemia, elevated iron levels, or fluid retention.
6. A patient with type 1 diabetes recently became pregnant. The nurse plans a blood glucose testing schedule for her. What is the recommended monitoring schedule? a. Before each meal and before bed b. In the morning for a fasting level and at 4:00 PM for the peak level c. Six or seven times a day d. Three times a day, along with urine glucose testing
ANS: C A pregnant patient with type 1 diabetes must have frequent blood sugar monitoring (eg, six or seven times a day) to manage both the patient and the fetus so that no teratogenic effects occur. Monitoring the blood sugar level before meals and at bedtime is not significant enough to provide the necessary glycemic control. Morning and 4:00 PM monitoring is not enough to provide glycemic control. Urine glucose testing is not sensitive enough to aid glycemic control, and monitoring three times a day is not enough.
14. An elderly patient who has type 2 diabetes has a history of severe hypoglycemia. The patient's spouse asks the nurse what the optimum A1c level is for the patient. Which is correct? a. Between 6.5 and 7.0 b. Below 7.0 c. Below 8.0 d. Between 7.0 and 8.5
ANS: C For patients with a history of severe hypoglycemia and those with a limited life expectancy or advanced micro- and macrovascular complications, the target A1c level should be below 8.0. For most other patients with diabetes, the target is 7.0 and below.
11. Insulin glargine is prescribed for a hospitalized patient who has diabetes. When will the nurse expect to administer this drug? a. Approximately 15 to 30 minutes before each meal b. In the morning and at 4:00 PM c. Once daily at bedtime d. After meals and at bedtime
ANS: C Glargine insulin is indicated for once daily subcutaneous administration to treat adults and children with type 1 diabetes and adults with type 2 diabetes. According to the package labeling, the once-daily injection should be given at bedtime. Glargine insulin should not be given more than once a day, although some patients require bid dosing to achieve a full 24 hours of basal coverage.
15. A patient who has type 2 diabetes will begin taking glipizide [Glucotrol]. Which statement by the patient is concerning to the nurse? a. "I will begin by taking this once daily with breakfast." b. "It is safe to drink grapefruit juice while taking this drug." c. "I may continue to have a glass of wine with dinner." d. "I will need to check my blood sugar once daily or more."
ANS: C Glipizide is a sulfonylurea antidiabetic agent and can cause a disulfiram-like reaction when combined with alcohol. Patients should be taught to avoid alcohol while taking this medication. The initial dosing is once daily with breakfast. There is no drug interaction with grapefruit juice. Patients will need to monitor their blood glucose.
A patient is about to start taking sustained release glipizide (Glucotrol) to treat type 2 diabetes mellitus. Which of the following instructions should you include when talking with the patient about this drug? a. chew the tablet completely before swallowing it b. take it once a day, 30 min before selected meals c. take in the evening before bedtime d. drink 16 oz of water right after taking it
B
Diabetic teaching includes treatment of hypoglycemia with which drug? A) propranolol (Inderal) B) glucagon C) acarbose (Precose) D) bumetanide (Bumex)
B
12. A patient with type 1 diabetes who takes insulin reports taking propranolol for hypertension. Why is the nurse concerned? a. The beta blocker can cause insulin resistance. b. Using the two agents together increases the risk of ketoacidosis. c. Propranolol increases insulin requirements because of receptor blocking. d. The beta blocker can mask the symptoms of hypoglycemia.
ANS: D Beta blockers can delay awareness of and response to hypoglycemia by masking signs associated with stimulation of the sympathetic nervous system (eg, tachycardia, palpitations) that hypoglycemia normally causes. Furthermore, beta blockade impairs glycogenolysis, which is one means by which the body can counteract a fall in blood glucose; beta blockers, therefore, can worsen insulin-induced hypoglycemia. Propranolol does not cause insulin resistance. The incidence of DKA is not increased by concurrent use of propranolol and insulin. Insulin requirements are not increased because of receptor blocking by propranolol.
5. Which statement is accurate about the long-term complications of diabetes? a. Long-term complications are almost always the result of hypoglycemia and ketoacidosis. b. The complication rates for patients with optimally controlled type 2 diabetes are the same as for those whose disease is not optimally controlled. c. Optimal control of type 1 diabetes produces excessive episodes of life-threatening hypoglycemia. d. Optimal control of both types of diabetes reduces the risk of eye, kidney, and nerve damage.
ANS: D In both types of diabetes, optimal control of the disease slows the development of microvascular complications. Short-term complications are more apt to result from hypoglycemia and ketoacidosis. Patients with type 2 diabetes have fewer complications if their blood sugar level is optimally controlled. Hypoglycemia does not occur more frequently in patients with optimally controlled type 1 diabetes.
8. A nurse provides dietary counseling for a patient newly diagnosed with type 1 diabetes. Which instruction should be included? a. "You may eat any foods you want and cover the glucose increase with sliding scale, regular insulin." b. "Most of the calories you eat should be in the form of protein to promote fat breakdown and preserve muscle mass." c. "Your total caloric intake should not exceed 1800 calories in a 24-hour period." d. "You should use a carbohydrate counting approach to maintain glycemic control."
ANS: D Patients with diabetes should be given intensive insulin therapy education using either a carbohydrate counting or experience-based estimation approach in achieving glycemic control. A patient with diabetes cannot eat any foods desired and then cover the glucose increase with a sliding scale of regular insulin. Evidence suggests that there is not an ideal percentage of calories that should be ingested from carbohydrate, fat, or protein. Every patient with diabetes must be assessed individually to determine the number of total calories the person should have daily. The total caloric intake should be spread evenly throughout the day, with meals spaced 4 to 5 hours apart.
2. A patient with type 1 diabetes is eating breakfast at 7:30 AM. Blood sugars are on a sliding scale and are ordered before a meal and at bedtime. The patient's blood sugar level is 317 mg/dL. Which formulation of insulin should the nurse prepare to administer? a. No insulin should be administered. b. NPH c. 70/30 mix d. Lispro [Humalog]
ANS: D Regular insulin is indicated for sliding scale coverage. Insulin is definitely indicated for this high blood sugar level. NPH is used for scheduled insulin doses and is a longer-acting insulin. A 70/30 mix is also used for scheduled insulin coverage.
9. What is the most reliable measure for assessing diabetes control over the preceding 3-month period? a. Self-monitoring blood glucose (SMBG) graph report b. Patient's report c. Fasting blood glucose level d. Glycosylated hemoglobin level
ANS: D The glycosylated hemoglobin level tells much about what the plasma glucose concentration has been, on average, over the previous 2 to 3 months. The SMBG graph report is done by the patient and indicates each blood sugar level the patient has on a daily basis. It is not as reliable as the glycosylated hemoglobin level, because the equipment used might not be accurate and the testing may not reflect actual measurements 100% of the time. The patient's report of blood sugar levels is not considered as accurate as the glycosylated hemoglobin level for the same reason that the SMBG is not. One fasting blood glucose level indicates the patient's blood sugar level for that one time when it was obtained.
A nurse is caring for a client who is prescribed somatropin (Genotropin) to stimulate growth. The nurse should plan to monitor the client's laboratory values for which of the following? A. Anemia B. Hyperglycemia C. Decreased urine specific gravity D. Increased urine amylase
B
A nurse is providing teaching to a client who has type 2 diabetes mellitus and is starting repaglinide (Prandin). Which of the following statements made by the client indicates understanding of the administration of this medication? A. "I'll take this medicine with my meals." B. "I'll take this medicine 30 minutes before I eat." C. "I'll take this medicine just before I go to bed." D. "I'll take this medicine as soon as I wake up in the morning."
B
Glucagon is used to treat: a. type 2 diabetes mellitus b. hypoglycemia c. thyroid cancer d. diabetes insipidus
B
In teaching a pt newly prescribed acarbose (Precose) to control type II diabetes mellitus, which of the follow instructions should not be included: A. "Watch for and report fatigue, pallor and shortness of breath as these are signs of anemia, which is an adverse effect." B. "Take 30 mins before meals, three times a day." C. "Consume glucotabs or dextrose instead of juice if you become hypoglycemic." D. "Dark urine, abdominal pain, vomiting or fatigue could indicate liver dysfunction, an adverse effect of this medication."
B
The nurse is caring for a patient scheduled to undergo a cardiac catheterization procedure utilizing iodine-based contrast material. The nurse would question an order for which medication to be given to this patient the day before the scheduled procedure? A) acarbose (Precose) B) metformin (Glucophage) C) repaglinide (Prandin) D) rosiglitazone (Avandia)
B
To achieve the most beneficial effect, the nurse plans to administer glipizide (Glucotrol) A) with food. B) 30 minutes before a meal. C) 15 minutes postprandial. D) at bedtime.
B
When caring for a patient newly diagnosed with gestational diabetes, the nurse would question an order for which drug? A) insulin glargine (Lantus) B) glipizide (Glucotrol) C) insulin glulisine (Apidra) D) NPH insulin (Humulin N)
B
Which of the following is a rapid-acting insulin with an onset of action of less than 15 minutes? A) insulin glargine (Lantus) B) insulin aspart (Novolog) C) regular insulin (Humulin R) D) insulin detemir (Levemir)
B
Which time frame would be most appropriate for administering sliding-scale Lispro insulin? A. Within 30 minutes of consuming breakfast B. When the breakfast tray is served and ready to eat C. Within 1 hour of obtaining blood glucose measurement D. Within 15 minutes of obtaining blood glucose measurement
B
You are caring for a pt who takes acarbose (Precose) and a sulfonylurea to treat type 2 diabetes mellitus. Which of the following is an indication of an adverse reaction to this drug combination? a. polyuria b. tremors c. bradycardia d. thirst
B
As you speak with your diabetic client about managing her diabetes with regular insulin (Humulin R), you should include which of the following instructions? (Select all that apply) A. self-inject chilled insulin b. carry a carbohydrate snack c. rotate injection sites d. wear a medical alert bracelet e. expect to adjust the dosage during illness
BCDE
A client is prescribed metformin (Glucophage). Which of the following is a side effect/adverse effect common to metformin? A. Seizures B. Constipation C. Bitter or metallic taste D. Polyuria and polydipsia
C
A nurse is caring for a client who is taking levothyroxine (Synthroid). For which of the following should the nurse monitor to identify levothyroxine toxicity? A. Hair loss B. Lethargy C. Weight loss D. Cold intolerance
C
A nurse is teaching clients in an outpatient facility about the use of insulin to treat type 1 diabetes mellitus. For which of the following types of insulin should the nurse tell the cts to expect a peak effect 1-5 hr after administration? a. insulin glargine (Lantus) b. NPH c. regular insulin d. insulin lispro (Humalog)
C
A pt is about to start taking somatotropin (Genotropin). You plan to evaluate the effectiveness of this drug with which of the following assessments? a. level of consciousness b. ECG c. height and weight d. breath sounds and respiratory rate
C
Alpha-glucosidase inhibitors differ from the sulfonylureas in that they A) greatly stimulate pancreatic insulin release. B) greatly increase the sensitivity of insulin receptor sites. C) delay the absorption of glucose, leading to lower glucose levels. D) cannot be used in combination with other antidiabetic drugs.
C
Assuming the patient eats breakfast at 8:30 AM, lunch at noon, and dinner at 6:00 PM, he or she is at highest risk of hypoglycemia following an 8:00 AM dose of NPH insulin at A) 10:00 AM. B) 2:00 PM. C) 5:00 PM. D) 8:00 PM.
C
Which insulin can be administered by continuous intravenous infusion? A) insulin glargine (Lantus) B) insulin aspart (Novolog) C) regular insulin (Humulin R) D) insulin detemir (Levemir)
C
Which 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 (Precose) B) metformin (Glucophage) C) repaglinide (Prandin) D) rosiglitazone (Avandia)
C
Which of the following should be included in a teaching plan for a client newly diagnosed with type 2 diabetes? (Select all that apply.) A. "Check your blood glucose levels less frequently when not feeling well." B. "Take an extra dose of the oral hypoglycemic agent the next day if you miss a dose." C. "Carry a fast-acting glucose source." D. "Eat a snack prior to planned exercise." E. "Inspect feet surfaces daily
CDE
Four clients need to receive morning insulin. Breakfast trays are due in 15 min. A nurse should first administer insulin to which of the following clients? A. Client with a glucose level of 70 mg/dL, scheduled to receive NPH insulin (Humulin N) 3 units B. Client with acglucose level of 90 mg/dL, scheduled to receive Regular insulin (Humulin R) 5 units C. Client with a glucose level of 120 mg/dL, scheduled to receive NPH (Humulin N) 15 units insulin and Regular insulin 6 units D. Client with a glucose level of 170 mg/dL, scheduled to receive lispro insulin (Humalog) 5 unit
D
The client newly diagnosed with type 2 diabetes mellitus has been ordered insulin glargine (Lantus). What information is essential for the nurse to teach this client? A. "This medication should be mixed with the regular insulin each morning." B. "This medication is very short acting. You must be sure you eat after injecting it." C. "This medication is very expensive, but you will be receiving it only a short time." D. "This medication has a duration of action of 24 hours."
D
The nurse is monitoring the client receiving an IV infusion of insulin. What intervention is essential for this client? A. Flush the IV hourly. B. Make sure the client eats every hour. C. Run the drip with D5W. D. Make sure the pump is set to the correct rate.
D
The nurse would include which statement when teaching a patient about insulin glargine? A) "You should inject this insulin just before meals because it is very fast acting." B) "The duration of action for this insulin is approximately 8 to10 hours, so you will need to take it twice a day." C) "You can mix this insulin with NPH insulin to enhance its effects." D) "You cannot mix this insulin with regular insulin and thus will have to take two injections."
D
When talking with a patient about self-administering regular insulin (Humulin R), you should include which of the following instructions? a. shake the vial vigorously b. expect the solution to appear cloudy c. store unopened vials at room temperature d. inject the insulin subcutaneously
D
You are caring for a patient who is taking exenatide (Byetta) to treat type 2 diabetes mellitus. The patient reports severe abdominal pain. You suspect which of the following adverse reactions to this medication? A. Peptic ulcer disease b. hyperkalemia c. hyperglycemia d. pancreatitis
D
The nurse assesses a client for evidence of hypoglycemic reaction. The highest priority nursing intervention is to assess for: a. nervousness and tremors. b. polyuria and polydipsia. c. dry skin. d. extreme thirst.
a
The nurse is monitoring a client for evidence of a hypoglycemic reaction. The client received Humulin R insulin at 7 AM. The nurse anticipates that the client will need to be most closely monitored for evidence of a hypoglycemic reaction at which time? a. 9:00 AM to 11:00 AM b. Noon to 3:00 PM c. 3:00 PM to 6:00 PM d. 8:00 PM to Midnight
a
The nurse notes an order for insulin to be administered intravenously. The nurse recognizes that which insulin is the only type that can safely be administered intravenously? a. Regular (Humulin R) b. Lente (Humulin L) c. NPH (Humulin N) d. Insulin glargine (Lantus)
a
A nurse who is teaching a client how to recognize symptoms of hypoglycemia should include which of the following symptoms is teaching? a. headache b. nervousness c. bradycardia d. sweating e. thirst d. sweet breath odor
a b d
The best candidate for treatment with a combination insulin such as Humulin 70/30 is the client who: a. can use the prepared amount of regular and NPH units. b. can adjust the amount of regular and NPH dosages. c. has difficulty mixing insulins. d. needs to learn how to administer insulins.
a.
A client is newly diagnosed with type 1 diabetes mellitus and requires daily insulin injections. Which instruction should the nurse include in the teaching of insulin administration? a. teach family members to administer glucagon by injection if the client has a hyperglycemic reaction. b. Instruct the client about the necessity for compliance with prescribed insulin therapy. c. teach the client that hypoglycemic reactions are more likely to occur at the onset of action time. d. Instruct the client in the care of insulin container and syringe handling.
b
A client is to receive Humalog (Lispro) insulin at breakfast. The nurse plans to administer the insulin _____ breakfast. a. 30 minutes before b. 5 minutes before c. with d. after
b
A client is to receive insulin before breakfast, and the time of breakfast tray delivery is variable. The nurse knows that which insulin should not be administered until the breakfast tray has arrived and the client is ready to eat? a. Humulin N b. Lispro (Humalog) c. Glargine (Lantus) d. Humulin R
b
A client with type 2 diabetes mellitus is admitted to the hospital with an infection. The client was taking oral hypoglycemic agents and is prescribed insulin in the hospital. What is the highest priority instruction that the nurse can give the client regarding insulin administration? a. Once the client begins to take insulin, she will always be on insulin. b. Infection temporarily increases the need for insulin. c. Hospitalized clients are always prescribed insulin. d. Oral hypoglycemics tend to interact with antibiotics.
b
A client's insulin is administered at 7:00 AM daily. The client is to receive regular and NPH (Humulin N) insulins. The nurse is teaching the client how to prepare the syringe before injection. In preparing the syringe, the client should be taught to: a. withdraw each medication in a separate syringe. b. draw up regular insulin first. c. draw up NPH insulin first. d. recognize that order of medication withdrawal is not a priority.
b
A client is recieving a daily dose of Humulin N insulin at 7:30 AM. The nurse expects the peak effect of this drug to occur at which time? a. 8:15 am b. 10:30 am c. 5:00 pm d. 11:00 om
c
A client with type 1 diabetes mellitus has been ordered insulin aspart (NovoLog) 10 units at 7:00 AM. What nursing intervention will the nurse perform after administering this medication? A. Perform a fingerstick blood sugar test. B. Have the client void and dipstick the urine. C. Make sure the client eats breakfast. D. Flush the IV.
c
The best candidate for treatment with Diazoxide (Proglycem) is the client who is experiencing: a. a hypoglycemic reaction. b. diabetic ketoacidosis. c. hypoglycemia caused by hyperinsulinism. d. insulin resistance reaction.
c
The client is being treated with Humulin N. She also takes an oral contraceptive. The nurse anticipates that the interaction of these two medications will result in which effect? a. Anaphylactic reaction b. Increased effect from the Humulin N c. Decreased effect from the Humulin N d. Neurological damage
c
The client has been started on Metformin (Glucophage). What would be a positive outcome for this client as a result of the medication he is taking? a. Increased serum glucose level following a meal b. Decreased serum glucose level following a meal c. Increased absorption of glucose form the small intestine d. Reduced absorption of glucose from the small intestine
d
The client is being treated with Glipizide. She begins to exhibit difficulty breathing. The nurse recognizes that this may be indicative of a(n) ________ the medication. a. expected side effect of b. anaphylactic reaction to c. symptom that is not related to d. life-threatening reaction to
d
The client is ordered to be treated with glargine (Lantus) insulin. Because of the type of insulin that the client is receiving, the nurse plans a dosage schedule that administers the medication at which time(s)? a. 7:00 AM b. 7:00 AM and 11:00 AM c. 11:00 AM and 9:00 PM d. 9:00 PM
d
The nurse is teaching the client the proper procedure for administration of insulin. The nurse should direct the client to use a _____ syringe. a. 2-mL b. 5-mL c. 40-unit insulin d. 100-unit insulin
d
