Antidiabetics

Dawn phenomenon

Hyperglycemia present on awakening, Management: involves increasing betime dose of insulin

somogyi effect

If a client fails to eat her bedtime snack she might experience the Somogyi effect. tThis abrupt drop in the client's blood glucsose level during the night is followed by a false elevation.

The patient experiences the Somogyi effect. Which statement regarding the Somogyi effect does the nurse identify as being true? A.This is a hyperglycemic condition. B.The condition usually occurs immediately after dinner. C.It is a response to excessive insulin. D.Management usually requires increase of the bedtime insulin dose.

ANS: C The Somogyi effect is a response to excessive insulin resulting in a hypoglycemic condition usually occurring in the predawn hours of 2:00 to 4:00 am. A rapid decrease in blood glucose during the nighttime hours stimulates a release of hormones (e.g., cortisol, glucagon, epinephrine) to increase blood glucose by lipolysis, gluconeogenesis, and glycogenolysis, thus creating the Somogyi effect. Management of the Somogyi effect involves monitoring blood glucose between 2:00 am and 4:00 am and reducing the bedtime insulin dosage.

When teaching the patient about the storage of insulin, which statement will the nurse include? A.Keep the insulin in the freezer. B.Warm the insulin in the microwave before administration. C.Do not place insulin in sunlight or a warm environment. D.Open insulin vials lose their strength after one year.

ANS: C Unopened insulin vials are refrigerated until needed. Once an insulin vial has been opened, it may be kept (1) at room temperature for 1 month or (2) in the refrigerator for 3 months. Insulin is less irritating to the tissues when injected at room temperature. Insulin vials should not be put in the freezer. In addition, insulin vials should not be placed in direct sunlight or in a high-temperature area. Prefilled syringes should be stored in the refrigerator and should be used within 1 to 2 weeks. Opened insulin vials lose their strength after approximately 3 months.

Which are appropriate teaching points regarding the administration of metformin (Glucophage)? select all that apply a.do not mix with alcohol b. take with meals c. rotate injection sites d. do not take with a sulfonylurea

a, b

5. The nurse is teaching a patient how to administer insulin. The patient is thin with very little body fat. The nurse will suggest injecting insulin a. by pinching up the skin and injecting straight down. b. in the abdomen only with the needle at a 90-degree angle. c. subcutaneously with the needle at a 45- to 60-degree angle. d. using the thigh and buttocks areas exclusively.

C In a thin person, with little fatty tissue, the needle is inserted at a 45- to 60-degree angle. In other patients, a 45- to 90-degree angle is acceptable. There is no recommendation for preferring one site over another.

15. Which of the following is not an action of insulin? a. promotes conversion of glycogen to glucose b. decreases gastrointestinal absorption of dietary glucose c. enhances protein synthesis d. inhibits lipolysis

b

Exenatide (Byetta): a. facilitates glucose production in type 2 diabetics. b. is administered orally in conjunction with other hypoglycemic agents. c. replaces regular insulin therapy for newly diagnosed type 2 diabetics. d. causes insulin release from the pancreas only when serum glucose levels are high.

D

Which of the following is an example of an oral combination hypoglycemic agent? a. Precose c. Avandia b. Prandin d. Glucovance

D

As glargine (Lantus) is a 24 hour Insulin, there is no need to perform Accu-Checks or have a Sliding Scale order. True False

False

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

ANS: B Lispro should be given 5 minutes before eating because the onset of action is 5 to 15 minutes.

The condition that results from the administration of more insulin than is required to deal with a glucose load is called: a. diabetic coma. c. insulin reaction. b. diabetic ketoacidosis. d. DKA

Insulin reaction (c)

Somogyi effect

a hypoglycemic condition that usually occurs arround 2-4 am, wherein a rapid decrease in blood glucose during the nighttime hours stimulate a release of hormones (cortisol, glucagon, epinephrine) to increase blood glucose by lipolysis, gluconeogenisis, and glycogenesis. Management: involves monitoring between 2-4 am. amd reducing bedtime insulin dosage or having a snack before bed.

__17. Insulin that may be given intravenously is: a. regular. c. PZI. b. NPH. d. semilente.

a regular

A client is scheduled to receive NPH Insulin at 0800. Which is the most preferred time to administer a snack? 0800 1000 1100 1300

1300 the peak time for NPH is 4-12 hours, therefore 1300 is the best time to administer a snack to prevent hypoglycemia

18. A patient who has been taking a sulfonylurea antidiabetic medication will begin taking metformin(Glucophage). The nurse understands that this patient is at increased risk for which condition? a. Hypoglycemia b. Hyperglycemia c. Renal failure d. Respiratory distress

ANS: C Metformin can lead to renal failure. It does not produce hypoglycemia or hyperglycemia. It does not increase the risk of respiratory distress.

All the following statements are true regarding the use of U500 strength insulin except: a. This strength insulin is reserved for clients who take large daily doses of insulin, usually 200 or more units per day. b. This strength insulin is more likely to cause lipodystrophy. c. This is the strength insulin used in insulin pumps. d. This insulin can only be purchased with a prescription.

b

_16. An example of an intermediate-acting insulin is: a. PZI. c. ultralente. b. NPH. d. semilent

b. NPH

11. Advantages of using an insulin pump include: a. that it provides less expensive management for diabetes. b. that the client experiences moderate weight gain. c. that it allows the client flexibility in when and what he or she eats. d. that required training is minimal.

c

Clients who take metformin (Glucophage) should be aware that: a. the drug should be withheld for at least 48 hours prior to use of IV contrast. b. they may self-adjust the dosage of the drug as needed. c. some clients develop metabolic acidosis as an adverse effect of this therapy. d. the drug must be administered continually, even if the client cannot tolerate p.o. medications.

A

Which best describes the action of sulfonylureas? Choose all that apply. inhibits release of insulin from the islet cells inhibits formation of glucose from the liver increases the number of insulin receptors stimulates the release of insulin from the pancreas

inhibits formation of glucose from the liver increases the number of insulin receptors stimulates the release of insulin from the pancreas

What is the peak time of glargine (Lantus) Insulin? 1100 1400 2300 there is no defined peak time of this insulin

there is no defined peak time of this insulin

Which of the following drugs is an example of a "second generation" sulfonylurea agent? a. tolazamide (Tolinase). c. tolbutamide (Orinase). b. acetohexamide (Dymelor). d. glyburide (DiaBeta).

d. glyburide and glipizide

12. A patient who has type 1 diabetes mellitus asks the nurse about using a combination insulin product such as Humalog 75/25. The nurse will tell the patient that use of this product a. depends on individual insulin needs. b. is useful for patient with insulin resistance. c. means less rotation of injection sites. d. requires refrigeration at all times

ANS: A Combination products are convenient because the patient does not have to mix insulin, but the products depend on individual needs, since the doses are fixed. They are not used for patients with insulin resistance. Patients must continue to rotate injection sites. They do not require refrigeration after first use.

17. A patient who has type 2 diabetes mellitus asks the nurse why the provider has changed the oral antidiabetic agent from tolbutamide (Orinase) to glipizide (Glucotrol). The nurse will explain that glipizide a. has a longer duration of action. b. has fewer gastrointestinal side effects. c. may be taken on an as-needed basis. d. results in less hypoglycemic potential.

ANS: A Glipizide is a second-generation oral antidiabetic agent. It has a longer duration of action than the firstgeneration antidiabetic agents such as tolbutamide. It has many gastrointestinal side effects. It is taken once daily, not as needed. It has greater hypoglycemic activity than first-generation antidiabetics.

A patient with type 1 diabetes mellitus is ordered insulin therapy once daily to be administered at bedtime. What is the type of insulin the patient is most likely receiving? A.Insulin glargine B.Lente insulin C.Lispro insulin D.Regular insulin

ANS: A Insulin glargine (Lantus) is long-acting insulin with an onset of 1 hour. It is evenly distributed over a 24-hour duration of action; thus, it is administered once a day, usually at bedtime. Intermediate-acting insulins include neutral-protamine-Hagedorn (NPH), Lente, and Humulin N. Rapid-acting insulins include insulin lispro. Regular insulin is short acting.

A combination insulin of 70/30 means _____ Regular and ____NPH Insulin.

70 NPH, and 30 regular

6. The nurse receives the following order for insulin: IV NPH (Humulin NPH) 10 units. The nurse will perform which action? a. Administer the dose as ordered. b. Clarify the insulin type and route. c. Give the drug subcutaneously. d. Question the insulin dose.

B claridy the insulin type and route Only regular insulin can be given intravenously. The nurse should clarify the order. It is not correct to give Humulin NPH insulin IV. The nurse should not administer the drug by a different route without first discussing with the provider.

2. A patient develops type 2 diabetes mellitus. The nurse will explain that this type of diabetes a. is generally triggered by medications. b. is not as common as type 1 diabetes. c. is often related to heredity and obesity. d. will not require insulin therapy.

C

8. The nurse is teaching a patient about home administration of insulin. The patient will receive regular (Humulin R) and NPH (Humulin NPH) insulin at 0700 every day. What is important to teach this patient? a. Draw up the medications in separate syringes. b. Draw up the NPH insulin first. c. Draw up the regular insulin first. d. Draw up the medications after mixing them in a vial.

C clear-cloudy Patients should be instructed to draw up regular insulin first so that NPH is not mixed into the vial of regular insulin. It is not necessary to use separate syringes. Patients do not mix the medications in a vial.

A patient is prescribed metformin. Which is a side effect/adverse effect common to metformin? A.Seizures B.Constipation C.Bitter or metallic taste D.Polyuria and polydipsia

C. bitter or metallic taste

The form of insulin most similar to human insulin is: a. pork insulin. c. beef/pork insulin combination. b. beef insulin. d. fish insulin

a. pork insulin

12. The mechanism of action of the glitazones, a new class of oral antidiabetic agents, is to: a. block the breakdown of starches. b. sensitize the body to the insulin that is currently present. c. stimulate insulin release in the pancreas. d. assist the pancreas in the production of insulin.

b thiazolidinediones, can be precribed as monotherapy or combined with other therapies. Do not induce hypoglycemic reactiosn if taken alone, they decrease insulin resistance and improve blood glucose control.

. Which of the following is not a symptom usually associated with type 2 (NIDDM) diabetic clients? a. polydipsia c. polyuria b. ketosis d. fatigue

b. ketosis

Clients experiencing diabetic ketoacidosis need to be monitored closely for which electrolyte disturbance? a. hypernatremia c. hypokalemia b. hyponatremia d. hyperkalemia

c, hypokalemia

Clients using a sulfonylurea drug may develop a series of adverse effects if they also use: a. antimicrobial agents. c. alcohol. b. acetaminophen (Tylenol). d. caffeine.

c. alcohol

Clients taking oral hypoglycemic agents: a. never become hypoglycemic enough to require treatment. b. do not develop complications of diabetes. c. need to learn self-care. d. do not need to follow a special diet.

c. need to learn self care

A common name for isophane insulin suspension is: a. lente. c. NPH. b. regular. d. ultralente.

c. nph

When using the abdomen for subcutaneous injections of insulin, the injection should be at least ______ inches from the umbilicus

2 inches

Which needle size would be appropriate for insulin injections on a 5'1" female weighing 110 pounds? Choose all that apply. 21 Gauge 1 1/2 inch 22 Gauge 1 inch 23 Gauge 3/8 inch 25 gauge 5/8 inch

23 Gauge 3/8 inch 25 gauge 5/8 inch

Hypoglycemia in a type 1 diabetic client is most likely related to: a. omission of meals. b. lack of exercise. c. overeating. d. improper measurement of insulin dosage

A

A patient received regular insulin at 7:30 am. At 9:30 am the patient feels slightly hungry and has a dull headache. The nurse should • A.test the patient's blood glucose level. B.ensure that the patient has a meal. C.provide the patient with 4 ounces of orange juice. D.administer the next dose of insulin.

A ANS: A The peak time for regular insulin is 2 to 4 hours. It is most important for the nurse to check the patient's blood glucose level to prevent a possible hypoglycemic reaction (insulin shock).

9. A patient is ordered to receive insulin lispro at mealtimes. The nurse will instruct this patient to administer the medication at which time? a. 5 minutes before eating b. 15 minutes after eating c. 30 minutes before eating d. 10 minutes after eating

A Lispro acts faster than other insulins, and patients should be taught to give this medication not more than 5 minutes before eating.

Which statement by a patient taking glipizide indicates that more teaching is indicated? • A."I will use a new needle every time I take the medication." B."I will take the medication once a day in the morning." C."I will eat my breakfast very soon after taking my Glucotrol." D."This medication stimulates my pancreatic cells to make insulin."

ANS: A Glipizide (Glucotrol) is an oral antidiabetic agent. It is well absorbed from the GI tract and is highly protein-bound. Parenteral administration of this medication is not indicated. All other options are correct.

16. A patient who is unconscious and has a pulse is brought to the emergency department. The patient is wearing a Medic-Alert bracelet indicating type 1 diabetes mellitus. The nurse will anticipate an order to administer a. cardiopulmonary resuscitation (CPR). b. glucagon. c. insulin. d. orange juice.

ANS: B This patient is most likely hypoglycemic and will need a carbohydrate. Glucagon is given parenterally if patients are unable to ingest a carbohydrate, such as orange juice. CPR is not indicated. Insulin will compound the hypoglycemia.

A nurse gives a patient NPH insulin at 8:00 am. At 2:00 pm the nurse finds the patient extremely lethargic but conscious. The patient is diaphoretic and slightly combative. The nurse should • A.call the health care provider. B.ensure that the patient has a meal. C.provide the patient with 4 ounces of orange juice. D.administer the next dose of insulin.

ANS: C NPH is an intermediate-acting insulin that peaks in 6 to 12 hours. Because the patient is conscious, it is most important for the nurse to provide the orange juice to prevent a possible hypoglycemic reaction (insulin shock).

15. Which statement by a patient who will begin using an external insulin pump indicates understanding of this device? a. I will have an increased risk for hypoglycemia. b. I will leave this on when bathing or swimming. c. I will not need to count carbohydrates anymore. d. I will still need to monitor serum glucose.

ANS: D Patients using an insulin pump will still monitor serum glucose and count carbohydrates. The advantage of the pump is that it is programmed to deliver continuous rapid-acting insulin in varying amounts at different times throughout the day. Changes in food intake can alter the risk for hypoglycemia if the pump is not adjusted accordingly. They must be removed when bathing or swimming.

3. A patient who is overweight is being evaluated for diabetes. The patient has a blood glucose level of 160 mg/dL and a hemoglobin A1c of 5.8%. The nurse understands that this patient has which condition? a. Diabetes mellitus b. Hypoglycemia c. Normal blood levels d. Prediabetes

ANS: D Patients with a hemoglobin A1c between 5.7% and 6.4% are considered to have prediabetes. A level of 6.5% or more indicates diabetes. The patient is hyperglycemic.

1. The nurse is teaching a group of nursing students about diabetes. The nurse explains that which type of diabetes is the most common? a. Type 1 diabetes mellitus b. Type 2 diabetes mellitus c. Diabetes insipidus d. Secondary diabetes

B

11. A patient has administered regular insulin 30 minutes prior but has not received a breakfast tray. The patient is experiencing nervousness and tremors. What is the nurses first action? a. Administer glucagon. b. Give the patient orange juice. c. Notify the kitchen to deliver the tray. d. Perform bedside glucose testing.

B The patient is symptomatic and has hypoglycemia. The nurse should give orange juice. Glucagon is given for patients unable to ingest carbohydrates. The kitchen should be notified, and bedside glucose testing should be performed, but only after the patient is given carbohydrates.

A client is to receive Lispro insulin at 0730 AM. What is the next priority action of the nurse? a.administer the other morning medications b.review the client's I/O (intake and output) c. ensure that breakfast is delivered within 15 minutes d. initiate patient teaching regarding self-administration of insulin

C

An initial dose of glucagon given intramuscularly (IM) should be effective: a. immediately. c. in 15-30 minutes. b. in 3-5 minutes. d. in 1 hour.

C

4. The nurse is teaching a patient who is newly diagnosed with type 1 diabetes mellitus about insulin administration. Which statement by the patient indicates a need for further teaching? a. I may use a chosen site daily for up to a week. b. I should give each injection a knuckle length away from a previous injection. c. I will not be concerned about a raised knot under my skin from injecting insulin. d. Insulin is absorbed better from subcutaneous sites on my abdomen.

C Lipohypertrophy is a raised lump or knot on the skin surface caused by repeated injections into the same site, and this can interfere with insulin absorption. Patients are encouraged to use the same site for a week, giving each injection a knuckle length away from the previous injection. Insulin absorption is greater when given in abdomen areas

19. A 45-year-old patient who is overweight has had a diagnosis of type 2 diabetes for 2 years. The patient uses 20 units of insulin per day. The patients fasting blood glucose (FBG) is 190 mg/dL. The patient asks the nurse about using an oral antidiabetic agent. The nurse understands that oral antidiabetic agents a. cannot be used if the patient is overweight. b. cannot be used once a patient requires insulin. c. may be used since this patient meets criteria. d. may not be used since this patients fasting blood glucose is too high.

C Patients who require less than 40 units of insulin per day and who have a fasting blood glucose less than or equal to 200 mg/dL are candidates for oral antidiabetic agents. Being overweight is an indication, not a contraindication.

7. The nurse will administer parenteral insulin to a patient who will receive a mixture of NPH (Humulin NPH) and regular (Humulin R). The nurse will give this medication via which route? a. Intradermal b. Intramuscular c. Intravenous d. Subcutaneous

D

13. The patient asks the nurse about storing insulin. Which response by the nurse is correct? a. All insulin vials must be refrigerated. b. Insulin will last longer if kept in the freezer. c. Opened vials of insulin must be discarded. d. Some combination pens do not require refrigeration.

D ANS: D Some combination pens do not require refrigeration after first use. Storing insulin in the freezer is not recommended. Opened vials may either be kept at room temperature for a month or refrigerated for 3 months.

14. A patient who has insulin-dependent diabetes mellitus must take a glucocorticoid medication for osteoarthritis. When teaching this patient, the nurse will explain that there may be a need to a. decrease the glucocorticoid dose. b. decrease the insulin dose. c. increase the glucocorticoid dose. d. increase the insulin dose.

D Glucocorticoids can cause hyperglycemia, so the insulin dose may need to be increased. Changing the glucocorticoid dose is not recommended. Decreasing the insulin dose will only compound the hyperglycemic effects.

10. The parent of a junior high-school child who has type 1 diabetes asks the nurse if the child can participate in sports. The nurse will tell the parent a. that strenuous exercise is not recommended for children with diabetes. b. that the child must be monitored for hyperglycemia while exercising. c. to administer an extra dose of regular insulin prior to exercise. d. to send a snack with the child to eat just prior to exercise.

D Patients generally need less insulin with increased exercise, so the child should consume a snack to prevent hypoglycemia. Exercise is an integral part of diabetes management. Hypoglycemia is more likely to occur, and extra insulin is not indicated.

9. Which of the following is the correct procedure for mixing two types of insulin in the same syringe? a. Withdraw the regular insulin prior to any other type of insulin. b. Withdraw the regular insulin after other types of insulin. c. Draw each insulin in a separate syringe then combine the two. d. Two types of insulin should not be mixed in the same syringe.

a

_20. In most cases the major nursing goal in working with a diabetic client is to: a. teach the client how to inject insulin. b. help the client become independent in self-care. c. monitor the client's diet. d. help the client avoid insulin reactions.

b.

If a diabetic is found unconscious, and the nurse does not know the reason, it is best to: a. treat for ketoacidosis. b. treat for insulin reaction. c. wait until blood glucose test results have returned from the laboratory. d. delay treating the client until a physician can be summoned.

b. treat for insiulin reaction

19. The sulfonylurea oral hypoglycemic agent that has the longest duration of action is: a. tolbutamide (Orinase). c. chlorpropamide (Diabinese). b. tolazamide (Tolinase). d. acetohexamide (Dymelor).

c

In order to minimize local skin reactions, insulin should be: a. refrigerated. b. injected slowly. c. given in divided doses. d. brought to room temperature before injection.

d. brought to room temp before injection