adaptive quizzing ch. 32

A patient with type 2 diabetes mellitus receives a prescription for metformin. Which finding does the nurse recognize as a contraindication to therapy? 1 Arterial blood pH 7.4 2 Creatinine clearance 1.6 mg/dL 3 Alanine aminotransferase 55 U/L 4 Fasting blood glucose 131 mg/dL

Correct2 Creatinine clearance 1.6 mg/dL The risk of lactic acidosis is greater in a patient with altered renal function. A creatinine clearance level higher than 1.5 mg/dL in males or higher than 1.4 mg/dL in females indicates renal dysfunction. Because metformin can cause lactic acidosis, the nurse avoids administering the medication to this patient because the kidneys clear excess acid by excreting hydrogen ions and because metformin is eliminated from the kidneys. The arterial pH is normal. The alanine aminotransferase reading does not constitute a contraindication to metformin therapy. The increased blood glucose is an indication for therapy.

A diabetic woman who receives insulin therapy is breastfeeding her infant. What is the mostlikely reason for her to report a decrease in milk production to the nurse? 1 Large weight gain 2 Interaction of insulin and oral drugs 3 Poor glycemic control of blood sugars 4 Repeated occurrences of hypoglycemia

Correct3 Poor glycemic control of blood sugars Excessive glycemic control in a breastfeeding patient can lead to a decrease in milk production. Hence, the patient's insulin therapy and diet need to be well controlled. Large weight gain may increase fetal complications. Oral diabetic drugs are not prescribed during pregnancy or breastfeeding. Elevated glucose levels indicate hyperglycemia, which can affect the fetus.

A patient is prescribed nateglinide for the treatment of type 2 diabetes. On assessment, the nurse finds that the patient has erratic eating habits. Which is the most important instruction for this patient? 1 "Skip the dose when you skip a meal." 2 "You need to change your eating habits." 3 "Take a dose before bedtime every night." 4 "You need to eat three to four meals every day."

Correct1 "Skip the dose when you skip a meal." The nurse advises the patient to skip the dose if he or she misses a meal, to prevent hypoglycemia. The patient may not change eating habits, and therefore instructing the patient to do so may not be effective in this case. The nateglinide dose is taken only when the patient is planning to consume a meal. Asking the patient to eat three to four meals a day will not be effective in a patient who has erratic eating habits. Topics

What will the nurse instruct a patient who is prescribed repaglinide for type 2 diabetes to do? 1 "You need to eat a meal after each dose." 2 "You can take sulfonylureas with repaglinide." 3 "You can skip one dose if you eat three meals." 4 "Skipping two doses will cause hypoglycemia."

Correct1 "You need to eat a meal after each dose." The nurse instructs the patient to eat a meal after each dose, because skipping a meal can cause hypoglycemia. Repaglinide is not combined with sulfonylureas, because they share a similar mechanism of action. The dose must be taken before each meal, and skipping either the meal or the dose will fluctuate the glucose levels in the body. Skipping two doses of repaglinide will cause hyperglycemia in the patient, because glucose levels will increase.

Which class of medication increases blood glucose levels when administered with insulin? 1 Diuretics 2 Salicylates 3 Sulfa antibiotics 4 Anabolic steroids

Correct1 Diuretics When a diuretic is administered with insulin, an increased blood glucose level will result, because the diuretic antagonizes the effect of insulin. Salicylates, sulfa antibiotics, and anabolic steroids will increase the risk of hypoglycemia when administered with insulin.

Which hormones play a role in the regulation of glucose homeostasis? Select all that apply. 1 Insulin 2 Ketone 3 Dextrose 4 Glucagon 5 Glycogen

Correct1 Insulin Correct4 Glucagon Insulin and glucagon are the two hormones produced by the pancreas that play an important role in the regulation of glucose homeostasis. They are responsible for the use, mobilization, and storage of glucose by the body. When the body breaks down fatty acids for fuel, ketones are produced as a metabolic by-product. Dextrose is the simplest form of carbohydrate found in the body. Excess glucose in the blood is converted into glycogen and stored in the liver.

Which medications inhibit the enzyme alpha-glucosidase in the treatment of type 2 diabetes mellitus? Select all that apply. 1 Miglitol 2 Glipizide 3 Acarbose 4 Nateglinide 5 Pioglitazone

Correct1 Miglitol Correct3 Acarbose Alpha-glucosidase inhibitors are a class of antidiabetic drugs used to inhibit the alpha-glucosidase enzyme. Miglitol andacarbose are drugs that inhibit the alpha-glucosidase enzyme. Glipizide is a sulfonylurea that stimulates the release of insulin. Nateglinide is a glinide that increases insulin secretion. Pioglitazone is a thiazolidinedione that decreases insulin resistance by enhancing the sensitivity of insulin receptors.

A patient who routinely takes regular insulin therapy is prescribed pramlintide, which may increase the patient's risk for hypoglycemia. Which is the best nursing intervention in this case? 1 Reduce the needed insulin dose by 50%. 2 Reduce the needed pramlintide dose by 50%. 3 Obtain a new prescription to change the medication. 4 Give insulin an hour after administering pramlintide.

Correct1 Reduce the needed insulin dose by 50%. The nurse needs to reduce the regularinsulin dose by 50% so that it does not result in hypoglycemia in the patient. Reducing the pramlintide dose may not produce therapeutic effects. It is not necessary to obtain a prescription to change the drug, because a reduction in the insulin dose will help prevent hypoglycemia. Administering insulin an hour after administering pramlintide will not prevent the interaction between the two medications.

A nurse is caring for a patient who has a long history of poorly managed type 2 diabetes mellitus and atherosclerosis. For which complications is the patient at risk? Select all that apply. 1 Stroke 2 Sexual dysfunction 3 Chronic renal failure 4 Myocardial infarction 5 Peripheral vascular disease

Correct1 Stroke Correct4 Myocardial infarction Correct5 Peripheral vascular disease Type 2 diabetes mellitus that is poorly managed can increase the patient's risk for developing atherosclerosis. Stroke, myocardial infarction, and peripheral vascular disease are all possible consequences of atherosclerotic plaque. Capillary damage can result in sexual dysfunction and chronic renal failure.

The nurse observes that A1C levels are elevated in a patient who is taking metformin for type 2 diabetes. Which class of drugs is likely to be prescribed to this patient? 1 Sulfonylureas 2 Incretin mimetics 3 Alpha-glucosidase inhibitors 4 Dipeptidyl peptidase-IV inhibitors

Correct1 Sulfonylureas Sulfonylureas are prescribed to a patient whose A1C levels are elevated even after taking metformin. The drugs bind to specific receptors on beta cells in the pancreas to stimulate the release of insulin. Incretin mimetics are used to reduce postprandial glucagon production. The alpha-glucosidase inhibitors are used to control high postprandial glucose levels. The dipeptidyl peptidase-IV inhibitors are indicated as an adjunct to diet and exercise to improve glycemic control.

The nurse is teaching a patient who has type 1 diabetes mellitus how to prevent hypoglycemia. Which clinical indicators of hypoglycemia will the nurse identify for the patient and family? Select all that apply. 1 Sweating 2 Headache 3 Polyphagia 4 Weight loss 5 Polydipsia 6 Tachycardia

Correct1 Sweating Correct2 Headache Correct6 Tachycardia The effects of hypoglycemia are largely attributable to stimulation of the central nervous system because low blood glucose stresses the body. When hypoglycemia occurs, the sympathetic nervous system responds in an attempt to increase blood glucose. Clinical indicators of hypoglycemia mimic sympathetic nervous system stimulation; they include tachycardia, palpitations, headaches, diaphoresis, and anxiety. Polyphagia, weight loss, and polydipsia are common signs and symptoms of diabetes.

For what will the nurse assess in a patient who is prescribed pioglitazone, insulin, and a sulfonylurea? 1 Symptoms of congestive heart failure 2 Constant elevated blood glucose levels 3 A pioglitazone-sulfonylurea interaction 4 Interaction between pioglitazone and insulin

Correct1 Symptoms of congestive heart failure Pioglitazone increases the risk of heart failure in patients. Hence, the nurse needs to assess for the symptoms of heart failure so that the drug can be changed if necessary. Pioglitazone is used for the management of type 2 diabetes or elevated glucose levels. Pioglitazone can be combined with insulin as well as sulfonylurea for a synergistic effect.

The nurse would include which statement when teaching a patient about insulin glargine? 1 "You can mix this insulin with NPH insulin to enhance its effects." 2 "You cannot mix this insulin with any other insulin in the same syringe." 3 "You should inject this insulin just before meals because it is very fast-acting." 4 "The duration of action for this insulin is approximately 8 to 10 hours, so you will need to take it twice a day."

Correct2 "You cannot mix this insulin with any other insulin in the same syringe." Insulin glargine should not be mixed with any other insulins. It is a long-acting insulin with a duration of action up to 24 hours. The insulin is not fast acting.

Which site should be used for injecting insulin for the most consistent absorption? 1 Deltoid 2 Abdomen 3 Vastus lateralis 4 Gluteus maximus

Correct2 Abdomen The abdomen has the most consistent absorption capacity because the blood flow to subcutaneous tissue is not as affected by muscular movements. The deltoid is used for immunization of children and adults. The vastus lateralis is used for immunization of infants. The gluteus maximus is not recommended for injections because of its close proximity to the sciatic nerve and major blood vessels.

What is the nurse's best action when finding a patient with type 1 diabetes mellitus unresponsive, cold, and clammy? 1 Start an insulin drip. 2 Administer intravenous glucose. 3 Draw blood glucose level and send to the laboratory. 4 Administer subcutaneous regular insulin immediately.

Correct2 Administer intravenous glucose. This patient is showing signs of hypoglycemia. In the hospital setting or when the patient is unconscious, intravenous glucose is an obvious option to treat hypoglycemia. Test-Taking Tip: Look for answers that focus on the patient or that are directed toward the patient's feelings.

What action will the nurse take before administering glucagon to an unconscious patient? 1 Assess the patient's oxygen saturation levels 2 Ensure that the patient is rolled onto one side 3 Initiate cardiopulmonary resuscitation (CPR) 4 Administer an incretin mimetic intravenously

Correct2 Ensure that the patient is rolled onto one side The nurse rolls the patient onto one side because administration of glucagon may induce vomiting. Assessing oxygen saturation levels is a necessity in a patient with respiratory problems. Here the priority is to administer glucagon to the patient as a quick response to severe hypoglycemia. The nurse needs to use cardiopulmonary resuscitation if the patient has cardiac arrest. Intravenous glucose and 50% dextrose in water (D50W) are most often used for treating acute hypoglycemia. Incretin mimetics are administered subcutaneously to lower blood glucose levels. STUDY TIP: Begin studying by setting goals. Make sure they are realistic. A goal of scoring 100% on all exams is not realistic, but scoring an 85% may be a better goal.

A patient has a serum glucose concentration of 375 mg/dL, urine output of 450 mL/hr, and an arterial pH of 7.1. The sliding scale requires intravenous insulin for a blood glucose concentration of more than 350 mg/dL. Which type of insulin is the nurse most likely to administer? 1 Insulin lispro 2 Regular insulin 3 Insulin glargine 4 Neutral protamine Hagedorn (NPH) insulin

Correct2 Regular insulin This patient has clinical indicators of diabetic ketoacidosis. The patient would require regular insulin in its intravenous form to reduce the concentration of serum glucose. The nurse prepares to administer regular insulin because it is the only insulin that can be administered intravenously. Insulin lispro is a human recombinant rapid-acting insulin analogue. Insulin glargine is a long-acting recombinant DNA-produced insulin analogue, and it provides a constant level of insulin in the body. Insulin isophane suspension, also known as NPH insulin, is the only available intermediate-acting insulin product.

Which early symptoms of hypoglycemia does the nurse instruct the patient's family to treat with a fast-acting carbohydrate source? Select all that apply. 1 Coma 2 Tremor 3 Sweating 4 Confusion 5 Irritability

Correct2 Tremor Correct3 Sweating Correct4 Confusion Correct5 Irritability Early symptoms of hypoglycemia involve the central nervous system, because the brain needs a constant supply of glucose to function. Hence, tremors, sweating, confusion, and irritability are symptoms seen in patients. When these symptoms occur, the family should have the patient immediately ingest a fast-acting carbohydrate source such as glucagon, milk, or juice. Coma occurs if the patient's glucose levels are not restored.

What instruction does the nurse give when a patient receiving metformin therapy will undergo angiography? 1 "There are chances of renal failure after the test." 2 "Your blood glucose levels need to be reevaluated." 3 "Do not take your metformin on the day of the test." 4 "You can take the medication an hour after the test."

Correct3 "Do not take your metformin on the day of the test." Angiography uses iodinated (iodine-containing) radiologic contrast media, which interact with metformin and may cause acute renal failure or lactic acidosis. Hence, the nurse instructs the patient to discontinue the drug on the day of the test. There are chances of renal failure after the test only if metformin is taken during the test. Blood glucose levels are regularly evaluated in diabetic patients, but it is not a priority in this case. Metformin can be taken 48 hours after the test to prevent any adverse effects.

A patient with type 1 diabetes mellitus asks, "Why can't I take a sulfonylurea like my friend who has diabetes?" What is the nurse's bestresponse? 1 "You must be mistaken. If your friend has diabetes mellitus, she is taking insulin." 2 "Sulfonylurea will lower your blood sugar too much, and you will be hypoglycemic." 3 "Sulfonylurea increases beta-cell stimulation to secrete insulin, and your beta cells do not contain insulin." 4 "You are unable to store glucose because you do not have insulin, and sulfonylurea helps with glucose storage."

Correct3 "Sulfonylurea increases beta-cell stimulation to secrete insulin, and your beta cells do not contain insulin." Sulfonylurea agents reduce serum glucose levels by increasing beta-cell stimulation for insulin release, decreasing hepatic glucose production and increasing insulin sensitivity. It is administered for type 2 diabetes mellitus but will not be effective in type 1 diabetics. Not all patients with type 2 diabetes require insulin, but patients with type 1 diabetes require insulin.

Which statement by a nursing student about insulin glargine indicates effective learning? 1 "The duration of action of this insulin is about 8 to 10 hours." 2 "You can mix this insulin with Lente insulin to enhance its effects." 3 "You cannot mix this insulin in the same syringe with regular insulin." 4 "This insulin is injected just before meals because it is very fast acting."

Correct3 "You cannot mix this insulin in the same syringe with regular insulin." Insulin glargine should not be mixed with any other insulin. It has a duration of action up to 24 hours. It is given alone because of the low pH of the diluent. It is a long-acting insulin that can be given at bedtime to provide up to 24 hours of insulin coverage.

Which technique is most appropriate regarding mixing insulin when the patient must administer 30 units regular insulin and 70 units NPH insulin in the morning? 1 Use the Z-track method for administration. 2 Draw the medication into two separate syringes but inject it into the same spot. 3 Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin. 4 Administer these insulins at least 10 minutes apart so that you will know when they are working.

Correct3 Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin. Drawing up the regular insulin into the syringe first prevents accidental mixture of NPH insulin into the vial of regular insulin, which could cause an alteration in the onset of action of the regular insulin. Z-track is an intramuscular technique that is not used with insulin. The medications do not have to be in separate syringes and can be administered together.

The laboratory results for a diabetic patient indicate markedly elevated blood glucose levels. After assessing the patient, the nurse obtains a prescription for intravenous insulin therapy from the primary health care provider. Which other assessment finding is present in the patient's reports? 1 Increased weight 2 Extreme onset of hypoglycemia 3 Presence of ketones in the serum 4 High levels of endogenous insulin

Correct3 Presence of ketones in the serum The presence of ketones in the serum along with elevated glucose levels indicates diabetic ketoacidosis. Hence, intravenous insulin therapy is started immediately to prevent acute hyperglycemia, which may cause coma or death. Weight gain is not an emergency in this case and may be caused by other factors, such as congestive heart failure. Extreme hyperglycemia is seen in the patient due to elevated glucose levels. Low levels or lack of endogenous insulin causes diabetic ketoacidosis.

Which lifestyle changes will the nurse instruct the patient to implement to successfully manage diabetes mellitus? Select all that apply. 1 "Restrict potassium and sodium in your diet." 2 "Reduce the amount of alcohol you consume." 3 "Include rest periods between physical activities." 4 "Incorporate daily physical exercise into your life." 5 "Decrease the amount of carbohydrates in your diet."

Correct4 "Incorporate daily physical exercise into your life." Correct5 "Decrease the amount of carbohydrates in your diet." Correct2 "Reduce the amount of alcohol you consume." Alcohol is limited because it is broken down into simple carbohydrates and can elevate the patient's blood glucose levels. The patient needs to perform physical exercises every day to help lower glucose levels. The nurse advises the patient to decrease the amount of carbohydrates in the diet to lower blood glucose levels. Potassium and sodium are restricted in cardiac patients. Adequate rest is required for respiratory patients to prevent respiratory complications due to physical activity.

A patient newly diagnosed with diabetes asks, "How does insulin normally work in my body?" Which response by the nurse is correct? 1 "It stimulates the pancreas to reabsorb glucose." 2 "It promotes synthesis of amino acids into glucose." 3 "It stimulates the liver to convert glycogen to glucose." 4 "It promotes the passage of glucose into cells for energy."

Correct4 "It promotes the passage of glucose into cells for energy." Insulin promotes the passage of glucose into cells, where it is metabolized for energy. After or during a meal, the glucose that is ingested stimulates the pancreas to secrete insulin. Insulin stimulates the synthesis of proteins and not amino acids. Insulin stimulates the liver to convert glucose to glycogen.

The nurse is caring for a patient who has been taking metformin for several months. The patient reports abdominal pain. Upon assessment, the nurse detects an irregular heartbeat. What else will the nurse assess to determine the severity of the patient's condition? 1 Renal function 2 Vitamin B12 levels 3 The patient's weight 4 Blood glucose levels

Correct4 Blood glucose levels Abdominal pain and irregular heartbeat in a patient taking metformin may be indicative of lactic acidosis. If the patient has lactic acidosis, the blood glucose levels will be very high as well. Therefore the nurse needs to assess the patient's blood glucose levels to confirm the condition. Renal function is assessed before administering the drug to prevent renal impairment. Reduction in B12 levels is a less common side effect of metformin. Assessing the patient's weight is not a priority in this case.

Which condition is seen in a patient with hyperosmolar hyperglycemic syndrome (HHS)? 1 Acute pancreatitis 2 Recurrent headaches 3 Insidious weight gain 4 Extreme hyperglycemia

Correct4 Extreme hyperglycemia Extreme hyperglycemia triggers HHS. Acute pancreatitis is an inflammation of the pancreas. This usually happens due to chronic alcohol abuse or due to a gallstone becoming lodged in the pancreatic ducts. Headaches are not caused by HHS. A patient with HHS may have electrolyte imbalances, which may cause dehydration and weight loss, not weight gain.

Which laboratory test would give the mostaccurate evidence of a diabetic patient's treatment compliance and glucose management over the past few months? 1 Serum albumin 2 Fasting serum glucose level 3 2-hour postprandial blood glucose 4 Glycosylated hemoglobin (HbA1C)

Correct4 Glycosylated hemoglobin (HbA1C) HbA1c indicates glucose concentrations over the past 3 to 4 months and thus demonstrates patient compliance and illness management over time. The serum albumin test helps to determine the level of natural protein in blood. The fasting serum glucose test helps to assess whether the patient has elevated blood glucose concentrations. A 2-hour postprandial blood glucose test determines the amount of glucose in the blood after a meal.

A patient with type 1 diabetes mellitus has been ordered insulin aspart 10 units at 7:00 AM. What nursing intervention will the nurse perform after administering this medication? 1 Flush the IV. 2 Perform a fingerstick blood sugar test. 3 Have the patient void and dipstick the urine. 4 Make sure the patient eats breakfast immediately.

Correct4 Make sure the patient eats breakfast immediately. Insulin aspart is a rapid-acting insulin that acts in 15 minutes or less. It is imperative that the patient eat as it starts to work. This medication is given subcutaneously. The patient should have had a fingerstick blood sugar test done before receiving the medication. There is no need to check the urine.

A patient who is obese is newly diagnosed with type 2 diabetes and is instructed to make dietary changes and perform aerobic exercise daily. The patient asks for insulin therapy for prompt management of diabetes. However, the patient is prescribed oral medications for lowering glucose levels. What is the reason for delaying insulin therapy? 1 Insulin therapy is initiated when other methods have failed. 2 Insulin therapy is not generally prescribed for obese patients. 3 Insulin therapy is ineffective without initial oral drug therapy. 4 Insulin therapy may cause congestive heart failure to develop.

correct1 Insulin therapy is initiated when other methods have failed. For patients with Type 2 diabetes mellitus, insulin therapy is usually reserved for when other treatment methods are unsuccessful. It is more important to start oral drug therapy and initiate lifestyle changes as an initial treatment for diabetes mellitus management. Insulin is prescribed for obese patients if the initial drug therapy and lifestyle changes are ineffective in lowering glucose levels. Insulin therapy is used for diabetic management and is used along with oral drug therapy. Insulin therapy does not cause congestive heart failure in patients. It is more a concern in patients who take pioglitazone.