Pharmacology Chapter 57 Diabetes

Select the correct statement about the contrast between acarbose and miglitol. 1. Miglitol has not been associated with hepatic dysfunction. 2. With miglitol, sucrose can be used to treat hypoglycemia. 3. Miglitol is less effective for use in African Americans. 4. Miglitol has no gastrointestinal side effects.

1

A patient recently diagnosed with type 2 diabetes asks a nurse, "Why did I get this condition?" Select the nurse's correct response(s). (Select all that apply.) a. "There is a strong family association, so it may be hereditary." b. "The condition is related to autoimmune destruction of the pancreatic cells." c. "The condition is strongly related to obesity." d. "The definitive cause of type 2 diabetes is unknown." e. "The disease is likely after abdominal trauma."

ANS: A, C, D A strong familial association is seen with type 2 diabetes. Most individuals with the disease are obese, and the cause is as yet unknown. Diabetes type 1, not type 2, is related to autoimmune destruction of the No correlation has been shown between abdominal trauma and the development of type 2 diabetes

A patient with type 1 diabetes is eating breakfast at 0730. Blood sugars are on a sliding scale and are ordered AC and HS. The patient's blood sugar level is 317. Which of the following formulations of insulin should the nurse prepare to administer? a. No insulin should be administered. b. NPH c. 70/30 mix d. Regular

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 coverage and is a longer acting insulin. A 70/30 mix is also used for scheduled insulin coverage.

A patient is scheduled to start taking insulin glargine (Lantus). On the care plan, a nurse should include which of these outcomes related to the therapeutic effects of the medication? A) Blood glucose control for 24 hours B) Mealtime coverage of blood glucose C) Less frequent blood glucose monitoring D) Peak effect achieved in 2 to 4 hours

Correct: A Insulin glargine is administered as a once-daily subcutaneous injection for patients with type 1 diabetes. It is used for basal insulin coverage, not mealtime coverage. It has a prolonged duration, up to 24 hours, with no peaks. Blood glucose monitoring is still an essential component to achieve tight glycemic control.

. For the most consistent absorption, into which site should insulin be injected? 1. Abdomen 2. Deltoid 3. Vastus lateralis 4. Gluteus maximus

1

A patient with type 1 diabetes reports mixing NPH and insulin aspart to allow for one injection. The nurse should inform the patient that: 1. this is an acceptable practice. 2. these two forms of insulin are not compatible and cannot be mixed. 3. mixing these two forms of insulin may increase the overall potency of the products. 4. the short-acting agent should be switched to Ultralente if agents are mixed.

1

The nurse assesses a newly diagnosed patient for short-term complications of diabetes. This assessment includes: 1. hyperglycemia, hypoglycemia, and ketoacidosis. 2. cranial nerve testing for peripheral neuropathy. 3. pedal pulse palpation for arterial insufficiency. 4. auscultation of carotids for bruits associated with atherosclerosis.

1

A patient recently diagnosed with type 2 diabetes asks a nurse, "Why did I get this condition?" Select the nurse's correct response. You may select more than one answer. 1. "There is a strong family association, so it may be hereditary." 2. "The condition is related to autoimmune destruction of the pancreatic cells." 3. "The condition is strongly related to obesity." 4. "The definitive cause of type 2 diabetes is unknown." 5. "The disease is likely after abdominal trauma."

1,3,4

A newly diagnosed patient with diabetes expresses concern about losing vision. Which intervention(s) should be included in the plan of care to reduce this risk? You may select more than one answer. 1. The initiation of reliable contraception to avoid pregnancy 2. Ways to reduce hyperglycemic episodes 3. The use of a prokinetic drug such as metoclopramide 4. Smoking cessation 5. The importance of consistently taking antihypertensive drugs

2,4,5

A nurse assesses a patient who is taking pramlintide (Symlin) with mealtime insulin. Which finding requires immediate follow-up by the nurse? A) Skin rash B) Sweating C) Itching D) Pedal edema

Correct: B Pramlintide is a new type of antidiabetic medication used as a supplement to mealtime insulin in patients with type 1 and 2 diabetes. Hypoglycemia, which is manifested by sweating, tremors, and tachycardia, is the adverse reaction of most concern. Skin rash, itching, and edema are not adverse effects of pramlintide.

An adolescent patient recently attended a health fair and had a serum glucose test. This patient telephones the nurse, saying, "My level was 125. Does that mean I have diabetes?" Choose the nurse's most accurate response. 1. "Unless you were fasting for over 8 hours, this does not necessarily mean you have diabetes." 2. "At this level, you probably have diabetes. You will need an oral glucose tolerance test this week." 3. "This level is conclusive evidence that you have diabetes." 4. "This level is conclusive evidence that you do not have diabetes."

1

A 44-year-old type 1 diabetic is brought to the ED with ketoacidosis. The nurse should immediately prepare to administer: 1. subcutaneous insulin. 2. intravenous normal saline in large quantities. 3. dextrose 50% plus thiamine. 4. glucagon.

2

A patient calls from home because of a concern about the appearance of a vial of insulin lispro. The patient reports that the solution appears cloudy. What would be the nurse's best response? 1. "Agitate the solution, and the granules should disperse." 2. "Discard the vial. The solution should be clear." 3. "Proceed with the injection. Drawing the solution into the syringe will mix the particles." 4. "Lispro is always cloudy. Proceed with the injection."

2

A type 2 diabetic patient has been well controlled on a sulfonylurea but has recently been experiencing repeated hypoglycemic reactions. The nurse should assess the patient for: 1. infection. 2. the concomitant use of nonsteroidal antiinflammatory agents. 3. increased emotional stress. 4. a reduced physical activity level.

2

A nurse counsels a diabetic patient starting therapy with an alpha-glucosidase inhibitor. The patient should be educated about the potential for which adverse reaction(s)? You may select more than one answer. 1. Hypoglycemia 2. Flatulence 3. Elevated iron levels in the blood 4. Fluid retention 5. Diarrhea

2,5

. An adolescent patient with type 1 diabetes experiences a severe hypoglycemic reaction in the clinic. Before providing orange juice, the nurse should: 1. start an IV. 2. obtain a stat serum calcium level. 3. check the gag reflex. 4. consult the dietician.

3

A woman with type 1 diabetes has recently become pregnant. The nurse plans a blood glucose testing schedule for her. What is the recommended monitoring schedule? 1. Before each meal and before bed 2. In the morning for a fasting level and at 4 PM for the peak level 3. Six or seven times per day 4. Three times per day, along with urine glucose testing

3

A nurse provides dietary counseling for a patient with newly diagnosed type 1 diabetes. Which instruction should be included? 1. The patient may eat any foods desired and cover the glucose increase with sliding-scale, regular insulin. 2. Most of the calories should be in the form of protein to promote fat breakdown and preserve muscle mass. 3. Total caloric intake should not exceed 1800 calories in a 24-hour period. 4. The majority of calories should be in the form of carbohydrates and monounsaturated fats

4

A patient in the ICU requires intravenous insulin. The nurse is aware that: 1. insulin aspart or glargine can be administered IV. 2. any form of insulin can be used IV at the same dose ordered for subcutaneous administration. 3. insulin should never be given IV, and this order should be questioned. 4. only regular insulin can be administered IV.

4

A type 1 diabetic patient on insulin reports taking propranolol for hypertension. This provokes the concern that: 1. the beta blocker can produce insulin resistance. 2. the two agents used together will increase the risk of ketoacidosis. 3. propranolol will increase insulin requirements because of receptor blocking. 4. the beta blocker can mask the symptoms of hypoglycemia.

4

Select the accurate statement about the long-term complications of diabetes. 1. Long-term complications are almost always the result of hypoglycemia and ketoacidosis. 2. There is no difference in complication rates for patients with type 2 diabetes who are tightly controlled compared with those who are not. 3. Tightly controlling type 1 diabetes produces excessive episodes of life-threatening hypoglycemia. 4. Tightly controlling both types of diabetes reduces the risk of eye, kidney, and nerve damage.

4

When diabetes control over the preceding 3-month period is assessed, what is the most reliable measure? 1. SMBG report graph 2. The patient's report 3. Fasting blood glucose level 4. Glycated hemoglobin level

4

Which client has the highest risk for type 2 diabetes? 1. A 20-year-old man who drinks a can of beer every evening 2. A 35-year-old man with a family history of pancreatic cancer 3. A 50-year-old woman with a family history of type 1 diabetes 4. A 55-year-old woman who is 5'3" tall and weighs 194 lb

4

The nurse manages care for a patient with diabetes who takes metformin. Which laboratory result would cause the greatest concern? a. Elevated creatinine b. Anemia c. Decreased platelets d. Increased iron

ANS: A An increased creatinine level indicates renal dysfunction. This would cause serious concern, because metformin is excreted unchanged by the kidneys, and with renal impairment, metformin can accumulate to toxic levels. Anemia, decreased platelets, and increased iron are secondary concerns that need to be managed; however, the most significant concern is definitely the increased creatinine level, which signals renal dysfunction.

The nurse assesses a newly diagnosed patient for short-term complications of diabetes. This assessment includes 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.

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. Does that mean I have diabetes?" Choose 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 would be considered normal, because it is less than 200 for a random sampling. Also, a person must have positive outcomes on 2 separate days to be diagnosed with diabetes. This patient does not need to have an oral glucose tolerance test, because the 125 reading is so far below 200, which would require further workup. No conclusive evidence indicates that this patient has diabetes, because her random sample is so low, and she has not had two separate tests on different days. However, this also is not conclusive evidence that she does not have diabetes.

For the most consistent absorption, insulin should be injected into which site? a. Abdomen b. Deltoid c. Vastus lateralis d. Gluteus maximus

ANS: A Insulin absorption is fastest and most consistent from injection to injection when the drug is injected into the subcutaneous tissues over the abdomen. Insulin is not injected into muscles such as the deltoid, vastus lateralis, or gluteus maximus.

An operating room nurse prepares a patient with type 2 diabetes for surgery. Which type of insulin will the surgical nurse have available? a. Regular insulin (Humulin R) b. Isophane insulin suspension (NPH insulin) c. Insulin zinc suspension (Lente insulin) d. Insulin glargine (Lantus)

ANS: A Regular insulin would be used, because its effects begin in 30 to 60 minutes, peak in 1 to 5 hours, and last up to 10 hours; this would be effective treatment for an NPO patient experiencing surgery. The onset of action for regular insulin is slower than with the rapid-acting insulins and faster than with the longer acting insulins. The duration of action of NPH is too long for a patient undergoing surgery. Lente insulin is not used in the United States. Insulin glargine is used for glycemic control and has a 24-hour duration of action for people who are eating 3 meals so would not be effective for the NPO patient undergoing surgery.

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 of 80 who just received 20 units of 70/30 Novolin insulin b. The patient with a pulse of 58 who is about to receive digoxin (Lanoxin) c. The patient with a blood pressure of 136/92 with complaints of a headache d. The patient with a mild allergy to penicillin who is receiving an infusion of cefazolin (Ancef)

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, 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, the headache is not life threatening. The patient with the mild PCN allergy probably will not have a reaction to the cefazolin, because the PCN allergy is only mild. It is not a life-threatening situation if the nurse cannot immediately discontinue the cefazolin.

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 Americans. Miglitol has gastrointestinal side effects

A nurse is educating the staff nurses about ketoacidosis. To evaluate the group's understanding, the nurse asks, "Which of the following signs and symptoms would not be consistent with ketoacidosis?" The group gives the correct answer, which is a. a blood glucose of 600. b. a blood glucose of 60. c. acidosis. d. ketones in the urine.

ANS: B A patient with diabetic ketoacidosis (DKA) has a high glucose level (at least 500 or higher), therefore a glucose level of 60 would not be consistent with DKA. A blood glucose level of 600, acidosis, and ketones in the urine are consistent with DKA.

A patient has type 2 diabetes that has been well controlled by a sulfonylurea. However, recently the patient has been experiencing repeated hypoglycemic reactions. The nurse should assess the patient for a. infection. b. concomitant use of nonsteroidal anti-inflammatory agents. c. increased emotional stress. d. reduced physical activity level.

ANS: B A variety of drugs, such as NSAIDs, can intensify hypoglycemic responses to most sulfonylureas and therefore should be avoided by patients taking sulfonylureas. Use of a sulfonylurea does not predispose patients to infection or increased emotional stress or cause them to reduce their physical activity level.

A 44-year-old patient with type 1 diabetes is brought to the emergency department with ketoacidosis. The nurse should immediately prepare to administer a. subcutaneous insulin. b. intravenous normal saline in large quantities. c. dextrose 50% plus thiamine. d. glucagon.

ANS: B DKA is marked by hemoconcentration and shock in addition to ketoacidosis. Therefore, treatment is directed at restoring acceptable plasma glucose levels, correcting acidosis, replacing lost water and sodium, and normalizing potassium levels. IV fluids and electrolyte therapy are started first, and insulin administration is begun as soon as practical afterward. IV saline, therefore, is the first treatment for DKA.

Which patient with diabetes would be a poor candidate for a glitazone? a. A patient with type 2 diabetes b. A cardiac patient in heart failure c. A patient with hypertension d. A patient with elevated high-density lipoproteins

ANS: B Glitazones may increase blood volume and pressure and cause edema. As a result, they pose an added risk for patients who have or are at risk of developing heart failure. Glitazones can be used only for people with type 2 diabetes; they cannot be used for type 1 diabetes. Glitazones can be used in patients with hypertension or high lipid levels, or both.

A patient calls from home, concerned about the appearance of a vial of insulin lispro. The patient reports that the solution appears cloudy. What would be the nurse's best response? a. "Agitate the solution, and the granules should disperse." b. "Discard the vial. The solution should be clear." c. "Proceed with the injection. Drawing the solution into the syringe will mix the particles." d. "Lispro is always cloudy. Proceed with the injection."

ANS: B Lispro is always clear; therefore, if it is cloudy, it should be discarded. Only NPH needs to be agitated so that the granules disperse. However, it does always remain cloudy. The patient should not proceed with the injection and should discard the vial. Lispro is always clear. The patient should not proceed with the injection and should discard the vial.

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 reaction(s)? (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.

A woman 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 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 woman with type 1 diabetes must have frequent blood sugar monitoring (eg, six or seven times a day) to manage both the mother and fetus so that no teratogenic effects occur and damage the fetus. Monitoring the blood sugar level before meals and HS is not significant enough to provide the necessary glycemic control. Morning and 4 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.

Insulin glargine is prescribed for a hospitalized patient who is diabetic. When will the nurse administer this drug? a. Approximately 15 to 30 minutes before each meal b. In the morning and at 4 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, therefore the other answer options are not correct.

A patient with type 1 diabetes who takes insulin reports taking propranolol for hypertension. The nurse is concerned because 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.

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 tightly controlled type 2 diabetes are the same as for those whose disease is not tightly controlled. c. Tightly controlling type 1 diabetes produces excessive episodes of life-threatening hypoglycemia. d. Tightly controlling both types of diabetes reduces the risk of eye, kidney, and nerve damage.

ANS: D In both types of diabetes, tightly controlling 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 tightly controlled. Hypoglycemia does not occur more frequently in patients with tightly controlled type 1 diabetes.

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. "Most of your calories should be in the form of carbohydrates and monounsaturated fats."

ANS: D Most of the calories eaten daily by a person with diabetes should be in the form of carbohydrates and monounsaturated fats. A patient with diabetes cannot eat any foods desired and then cover the glucose increase with a sliding scale of regular insulin. Protein should provide 15% to 20% of the patient's energy intake. 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.

A patient in the ICU requires intravenous insulin. The nurse is aware that a. insulin aspart or glargine can be administered IV. b. any form of insulin can be used IV at the same dose ordered for subcutaneous administration. c. insulin should never be given IV, and this order should be questioned. d. only regular insulin can be administered IV.

ANS: D Only regular insulin can be administered intravenously. Insulin aspart and glargine are administered subcutaneously. Only regular insulin can be given IV. Regular insulin can be given intravenously, therefore this order does not need to be questioned.

To assess diabetes control over the preceding 3-month period, what is the most reliable measure? 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 tell 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.

Which patient has the highest risk for type 2 diabetes? a. A 20-year-old man who drinks a can of beer every evening b. A 35-year-old man with a family history of pancreatic cancer c. A 50-year-old woman with a stressful lifestyle d. A 55-year-old woman who is 5'3" tall and weighs 194 pounds

ANS: D The obese 55-year-old woman has the greatest risk of developing type 2 diabetes. The disease usually begins in middle age and progresses gradually. Obesity is almost always present. A history of alcohol use or pancreatic cancer does not pose as high a risk for the development of type 2 diabetes as does obesity. A stressful lifestyle is not healthy but has not been correlated with the development of type 2 diabetes.

A patient who has type 2 diabetes has a glycated hemoglobin A1c (HbA1c) of 10%. The nurse should make which change to the nursing care plan? A) Refer the patient to a diabetes educator because the result reflects poor glycemic control. B) Glycemic control is adequate; no changes are needed. C) Hypoglycemia is a risk; teach the patient the symptoms. D) Instruct the patient to limit activity and weekly exercise.

Correct: A Glycated hemoglobin (HbA1c) is a measure of plasma glucose levels on average over the previous 2- to 3-month period. The target value is 7% or lower. If it is greater than 7%, a diabetes educator is an additional resource who can facilitate lifestyle, exercise, and medication changes. Hypoglycemia is not a concern, because elevated HbA1c levels indicate poor glycemic control. Exercise should be part of an overall management program, because it counteracts insulin resistance.

A teaching plan for a patient who is taking lispro (Humalog) should include which instruction by the nurse? A) "Inject this insulin with your first bite of food, because it is very fast acting." B) "The duration of action for this insulin is about 8 to 10 hours, so you'll need a snack." C) "This insulin needs to be mixed with regular insulin to enhance the effects." D) "To achieve tight glycemic control, this is the only type of insulin you'll need."

Correct: A Lispro is a rapid-acting insulin and has an onset of action of 15 to 30 minutes with a peak action of about 2 hours, not 8 to 10 hours. Because of its rapid onset, it is administered immediately before a meal or with meals to control the blood glucose rise after meals. Lispro insulin must be combined with an intermediate- or a long-acting insulin, not regular insulin (which also is a short-duration insulin), for glucose control between meals and at night. To achieve tight glycemic control, patients must combine different types of insulin based on their duration of action.

Before administering metformin (Glucophage), the nurse should notify the prescriber about which laboratory value? A) Creatinine (Cr) level of 2.1 mg/dL B) Hemoglobin (Hgb) level of 9.5 gm/dL C) Sodium (Na) level of 131 mEq/dL D) Platelet count of 120,000/mm3

Correct: A Metformin can reach toxic levels in individuals with renal impairment, which is indicated by a rise in the serum creatinine level. The prescriber may need to be notified of the hemoglobin, sodium, and platelet values, but they would not affect the administration of metformin.

Which instruction should the nurse provide when teaching a patient to mix regular insulin and NPH insulin in the same syringe? A) "Draw up the clear regular insulin first, followed by the cloudy NPH insulin." B) "It is not necessary to rotate the NPH insulin vial when it is mixed with regular insulin." C) "The order of drawing up insulin does not matter as long as the insulin is refrigerated." D) "Rotate subcutaneous injection sites each day among the arm, thigh, and abdomen."

Correct: A To ensure a consistent response, only NPH insulin is appropriate for mixing with a short-acting insulin. Unopened vials of insulin should be refrigerated; current vials can be kept at room temperature for up to 1 month. Drawing up the regular insulin into the syringe first prevents accidental mixture of NPH insulin into the vial of regular insulin, which could alter the pharmacokinetics of subsequent doses taken out of the regular insulin vial. NPH insulin is a cloudy solution, and it should always be rotated gently to disperse the particles evenly before loading the syringe. Subcutaneous injections should be made using one region of the body (e.g., the abdomen or thigh) and rotated within that region for 1 month.

A patient who has type 2 diabetes is taking nateglinide (Starlix). Which response should a nurse expect the patient to have if the medication is achieving the desired therapeutic effect? A) Inhibition of carbohydrate digestion B) Promotion of insulin secretion C) Decreased insulin resistance D) Inhibition of ketone formation

Correct: B Nateglinide is a meglitinide medication that acts to increase pancreatic insulin release. It is used as an adjunct to calorie restriction and exercise to maintain glycemic control in patients with type 2 diabetes. It does not act to reduce insulin resistance or inhibit carbohydrate digestion. It should not be used to manage diabetic ketone formation, because its glucose-lowering effects are too slow to be of benefit.

A nurse caring for a patient who has diabetic ketoacidosis recognizes which characteristics in the patient? (Select all that apply.) A) Type 2 diabetes B) Altered fat metabolism leading to ketones C) Arterial blood pH of 7.35 to 7.45 D) Sudden onset, triggered by acute illness E) Plasma osmolality of 300 to 320 mOsm/L

Correct: B, D, E Diabetic ketoacidosis is the most severe manifestation of insulin deficiency in patients with type 1 diabetes. It develops and worsens acutely over several hours to days. Alterations in fat metabolism lead to the production of ketones and ketoacids. Increased ketoacid levels lead to a fall in arterial blood pH below 7.35. Altered glucose metabolism leads to hyperglycemia, water loss, and an elevated plasma osmolality (285 to 295 mOsm/L).

A patient is taking glipizide (Glucotrol) and a beta-adrenergic medication. A nurse is teaching hypoglycemia awareness and should warn the patient about the absence of which symptom? A) Vomiting B) Muscle cramps C) Tachycardia D) Chills

Correct: C Glipizide is a sulfonylurea oral hypoglycemic medication that acts to promote insulin release from the pancreas. Beta-adrenergic blockers can mask early signs of sympathetic system responses to hypoglycemia; the most important of these is tachycardia, which is the most common adverse effect of glipizide. Vomiting, muscle cramps, and chills are not symptoms of activation of the sympathetic nervous system that arise when glucose levels fall.

A patient who took NPH insulin at 0800 reports feeling weak and tremulous at 1700. Which action should the nurse take? A) Take the patient's blood pressure. B) Give the patient's PRN dose of insulin. C) Check the patient's capillary blood sugar. D) Advise the patient to lie down with the legs elevated.

Correct: C The patient is showing symptoms of hypoglycemia at 5 PM. NPH has a peak action of 8 to 10 hours after administration. Based on the duration of action of NPH insulin, the patient's hypoglycemic symptoms are from the 8 AM injection of NPH insulin. An injection of NPH insulin at 2 AM, 1 PM, or 3 PM would not cause hypoglycemic symptoms based on the average duration of action of NPH insulin. Points Earned:

A patient newly diagnosed with type 1 diabetes asks a nurse, "How does insulin normally work in my body?" The nurse explains that normal insulin has which action in the body? A) It stimulates the pancreas to reabsorb glucose. B) It promotes the synthesis of amino acids into glucose. C) It stimulates the liver to convert glycogen to glucose. D) It promotes the passage of glucose into cells for energy.

Correct: D The hormone insulin promotes the passage of glucose into cells, where it is metabolized for energy. Insulin does not stimulate the pancreas to reabsorb glucose or synthesize amino acids into glucose. It does not stimulate the liver to convert glycogen into glucose.