ch 39 PHARM

Your client is admitted to the intensive care unit with diabetic ketoacidosis. You know that your client will be placed on an intravenous insulin drip. The only type of insulin which can be administered intravenously is: You selected: Regular. Correct Explanation: In general, regular insulin, a short-acting insulin, is used with major surgery or surgery requiring general anesthesia. IV administration of insulin is preferred because it provid ... (more) Question 2: (see full question) A diabetic patient is taking regular and NPH insulin to manage his diabetes. What is the best evaluation tool to measure the overall patient response to the insulin therapy? You selected: Glycosylated hemoglobin (HbAlc) levels Correct Explanation: HbAlc levels provide a 3 month average of glucose levels, which provides the best evaluation tool to measure of the overall patient response to the treatment plan. Blood pressure ... (more) Question 3: (see full question) After teaching a group of students about the various methods for the delivery of insulin, the instructor determines that the teaching was successful when the students identify which method as most commonly used for administration? You selected: Insulin pen Incorrect Correct response: Subcutaneous injection Explanation: Subcutaneous injection currently is the most common method for administering insulin. Question 4: (see full question) When administering insulin, which of the following would be most appropriate? You selected: Insert the needle at a 45-degree angle for injection. Correct Explanation: The vial should be gently rotated and vigorous shaking is to be avoided to ensure uniform suspension of the insulin. Typically the area is pinched to allow access to the loose conn ... (more) Question 5: (see full question) After teaching a class about the various drugs used to control blood glucose, the instructor determines that the teaching was successful when the class identifies which of the following as a biguanide? You selected: Metformin Correct Explanation: Metformin is classified as a biguanide. Miglitol is an alpha-glucosidase inhibitor. Tolbutamide is a first generation sulfonylurea. Glipizide is a second generation sulfonylurea. Question 6: (see full question) A student asks the nursing instructor what insulin has the quickest therapeutic effect once administered. What would be the best response? You selected: NPH (Humulin N) Incorrect Correct response: Regular (Humulin R) Explanation: Regular insulin has the quickest onset of 30-60 minutes. PZI and ultralente have an onset of 4-8 hours. NPH has an onset of 60-90 minutes. Question 7: (see full question) A diabetic patient has just received an insulin pump. What would be important to include in patient teaching? You selected: Check blood glucose frequently. Correct Explanation: The device does have several disadvantages. For example, it is awkward, the tubing poses an increased risk of infection and requires frequent changing, and the patient has to frequ ... (more) Question 8: (see full question) A nurse should take the following steps prior to administering insulin glargine (Lantus) to a client? Select all that apply: You selected: • Check the physician's orders for the type and dosage of insulin. • Mix with short-acting insulin prior to administration. • Check the expiration date on the vial. • Remove all air bubbles from the syringe barrel. Incorrect Correct response: • Check the expiration date on the vial. • Check the physician's orders for the type and dosage of insulin. • Remove all air bubbles from the syringe barrel. Explanation: Prior to administering insulin glargine (Lantus) to a client, the nurse must complete the following pre-administration steps: carefully check the physician's order for the type and ... (more) Question 9: (see full question) Which of the following produce their glucose lowering effect by decreasing insulin resistance and increasing insulin sensitivity? Select all that apply: You selected: • Pioglitazone (Actos) • Metformin (Glucophage) • Rosiglitazone (Avandia) Incorrect Correct response: • Rosiglitazone (Avandia) • Pioglitazone (Actos) Explanation: The thiazolidinediones, rosiglitazone (Avandia) and pioglitazone (Actos), produce their glucose-lowering effect by decreasing insulin resistance and increasing insulin sensitivity. Question 10: (see full question) Which of the following insulin is always clear? (Choose one) You selected: Humulin R Correct Explanation: Regular insulin (Humulin R) is clear, whereas intermediate (Humulin N and Humulin L) and long (Humulin U) acting insulin is cloudy. Question 11: (see full question) The physician prescribes glyburide for Tim, a newly diagnosed type 2 diabetic. The nurse knows that this medication acts by which mechanism? You selected: Produces hypoglycemia by stopping the production of insulin in the liver Incorrect Correct response: Produces hypoglycemia by increasing insulin secretion from the pancreas Explanation: The hypoglycemic action of glyburide results from the stimulation of pancreatic beta cells, leading to increased insulin secretion. Question 12: (see full question) Which of the following is an example of long acting insulin? You selected: Isophane insulin suspension (Humulin N) Incorrect Correct response: Insulin glargine (Lantus) Explanation: Insulin glargine (Lantus) is an example of long acting insulin. Question 13: (see full question) During ongoing assessment of clients receiving insulin detemir (Levemir), the nurse assesses the client for symptoms of hyperglycemia that include which of the following? Select all that apply: You selected: • Confusion • Increased appetite Incorrect Correct response: • Increased thirst • Increased urination • Abdominal pain Explanation: The symptoms of hyperglycemia include drowsiness, dim vision, thirst, nausea, vomiting, abdominal pain, loss of appetite, acetone breath, and excessive urination. Question 14: (see full question) Patients with type 2 diabetes have nonfunctioning beta pancreatic cells. You selected: True Incorrect Correct response: False Explanation: Type 2 diabetes reflects an inability to produce enough insulin as needed or a change in insulin receptor sensitivity. Question 15: (see full question) The nurse is interviewing a client who was diagnosed with type 2 diabetes about four months ago. The client never records glucometer readings but says that everything is just fine. What laboratory test does the nurse anticipate the health care provider will order for this client? You selected: HbA1c Correct Explanation: The nurse anticipates that the glycosylated hemoglobin (HbA1c) will be ordered for this client because it provides an average of the client's blood glucose level for the last three ... (more) Question 16: (see full question) An insulin dependent diabetic is having trouble with hypoglycemia late in the morning. During the health history, the nurse becomes aware of the most likely cause. What would cause the late morning hypoglycemia? You selected: The patient jogs two miles in the morning before he goes to work. Correct Explanation: Physical exercise, such as jogging, changes insulin requirements and may result in a delayed hypoglycemic reaction. The fact that he likes to nap before dinner and has an early lun ... (more) Question 17: (see full question) You are caring for a client taking insulin. You realize the client is experiencing symptoms of hypoglycemia when he displays the following symptoms: You selected: Weakness, sweating, and decreased mentation. Correct Explanation: Symptoms of hypoglycemia include shakiness, dizziness, or light-headedness, sweating, nervousness or irritability, sudden changes in behavior or mood, weakness, pale skin, and hung ... (more) Question 18: (see full question) When learning about type 1 diabetes, what would the student nurses learn is a distinguishing characteristic of this disease? You selected: Exogenous insulin is required for life. Correct Explanation: Type 1 diabetes results from an autoimmune disorder that destroys pancreatic beta cells. Insulin is the only effective treatment for type 1 diabetes because pancreatic beta cells a ... (more) Question 19: (see full question) A nurse is presenting an educational event at a local senior citizens' club about diabetes. What would the nurse tell the attendees at the event about diabetes? You selected: It is a complicated disorder that alters the metabolism of glucose. Correct Explanation: Diabetes is a complicated disorder that alters the metabolism of glucose, fats, and proteins affecting many end organs and causing numerous clinical complications. It is part of th ... (more) Question 20: (see full question) A patient is admitted to the Emergency Department in diabetic ketoacidosis (DKA) with a blood glucose level of 33 mmol/L. The physician orders an initial dose of 25 U insulin IV. Which type of insulin will be administered? You selected: Regular insulin Correct Explanation: Regular insulin is a short-acting insulin that manages the hyperglycemia and hyperkalemia of DKA (diabetic ketoacidosis), which is a life-threatening complication that occurs with ... (more)

Question 1: (see full question) A nurse should take the following steps prior to administering insulin glargine (Lantus) to a client? Select all that apply: You selected: • Remove all air bubbles from the syringe barrel. • Check the expiration date on the vial. Incorrect Correct response: • Check the expiration date on the vial. • Check the physician's orders for the type and dosage of insulin. • Remove all air bubbles from the syringe barrel. Explanation: Prior to administering insulin glargine (Lantus) to a client, the nurse must complete the following pre-administration steps: carefully check the physician's order for the type and ... (more) Question 2: (see full question) A nurse is providing patient education to a 13-year-old girl who was just diagnosed with type 1 diabetes mellitus. Which of the following statements by the patient will alert the nurse that special instructions regarding insulin are necessary? You selected: "My mother is going to give me my insulin." Incorrect Correct response: "I am on the middle school track team." Explanation: Because the patient is on the track team, she will have increased exercise at various times that will require increased insulin and special instructions related to hypoglycemia tha ... (more) Question 3: (see full question) After teaching a group of students about the various methods for the delivery of insulin, the instructor determines that the teaching was successful when the students identify which method as most commonly used for administration? You selected: Subcutaneous injection Correct Explanation: Subcutaneous injection currently is the most common method for administering insulin. Question 4: (see full question) Which of the following drugs help lower blood glucose by increasing the production of insulin by beta cells in the pancreas? Select all that apply: You selected: • Glyburide (Diabeta) • Acarbose (Precose) Incorrect Correct response: • Glyburide (Diabeta) • Glipizide (Glucotrol) Explanation: Sulfonylureas, like glyburide (Diabeta) and glipizide (Glucotrol), help lower blood glucose by increasing the production of insulin by beta cells in the pancreas. Question 5: (see full question) The pathophysiology class is studying diabetes. A student asks the instructor what is considered a sign of a hypoglycemic reaction. The instructor's response would be: You selected: diaphoresis. Correct Explanation: Diaphoresis and cool, clammy skin are signs of hypoglycemia. A fruity breath is seen with ketoacidosis. Flushing of the face is associated with hyperglycemia. Question 6: (see full question) Patients with type 2 diabetes have nonfunctioning beta pancreatic cells. You selected: False Correct Explanation: Type 2 diabetes reflects an inability to produce enough insulin as needed or a change in insulin receptor sensitivity. Question 7: (see full question) What hormone, secreted with insulin, increases satiety and suppresses glucagon secretion? You selected: Aldosterone Incorrect Correct response: Amylin Explanation: Amylin, a hormone secreted with insulin, delays gastric emptying, increases satiety, and suppresses glucagon secretion, thus complementing the effects of insulin on the blood sugar ... (more) Question 8: (see full question) The nurse's assessment of a patient who has presented to the emergency department reveals hyperglycemia. Which of the following types of insulin will have the most rapid effect on the patient's blood sugar levels? You selected: Regular Incorrect Correct response: Aspart Explanation: Aspart has an onset of action of 5 to 10 minutes, making the most rapidly acting insulin. NPH, regular, and 30/70 all take significantly longer to have an effect on blood glucose le ... (more) Question 9: (see full question) During ongoing assessment of clients receiving insulin detemir (Levemir), the nurse assesses the client for symptoms of hypoglycemia that include which of the following? Select all that apply: You selected: • Headache • Increased urination • Diaphoresis • Increased thirst Incorrect Correct response: • Headache • Confusion • Diaphoresis Explanation: The symptoms of hypoglycemia include fatigue, weakness, nervousness, agitation, confusion, headache, diplopia, convulsion, dizziness, unconsciousness, hunger, nausea, diaphoresis, ... (more) Question 10: (see full question) A nurse is caring for a 48-year-old woman who has been hospitalized after injecting the wrong type of insulin. Which of the following signs of hypoglycemia will the nurse be careful to observe for? You selected: Blurred vision Correct Explanation: Blurred or double vision (diplopia), fatigue, trembling, irritability, headache, nausea, numbness, muscle weakness, hunger, tachycardia, sweating, and nervousness are signs of a hy ... (more) Question 11: (see full question) A hospital patient's medication administration record specifies a dose of NPH insulin to be administered subcutaneously at 8 AM. The nurse has checked the patient's blood glucose level prior to administering the drug and it is 55 mg/dl. How should the nurse respond to this assessment finding? You selected: Withhold the insulin and facilitate a dose of intravenous glucagon. Incorrect Correct response: Hold the dose of insulin and consult with the patient's primary care provider. Explanation: When a patient's blood glucose is below 70 mg/dl, it is necessary to use caution when administering insulin. Usually the dose is held until blood sugars rise above this level and th ... (more) Question 12: (see full question) A patient has been noncompliant with his diabetic medication regimen and develops diabetic ketoacidosis. Which of the following would the nurse assess? You selected: Sour breath odor Incorrect Correct response: Deep respirations Explanation: Deep respirations are seen with diabetic ketoacidosis as the body attempts to rid itself of high acid levels. The patient with diabetic ketoacidosis is typically dehydrated. Blood ... (more) Question 13: (see full question) The physician prescribes glyburide for Tim, a newly diagnosed type 2 diabetic. The nurse knows that this medication acts by which mechanism? You selected: Produces hypoglycemia by increasing insulin secretion from the pancreas Correct Explanation: The hypoglycemic action of glyburide results from the stimulation of pancreatic beta cells, leading to increased insulin secretion. Question 14: (see full question) A nurse is caring for a patient receiving metformin drug therapy to improve glycemic control. What adverse reaction to the drug should the nurse monitor the patient for? You selected: UTI infection Incorrect Correct response: Asthenia Explanation: The nurse should monitor the patient for asthenia, which is an adverse reaction to the metformin drug. UTI infection, back pain, and flu symptoms are the adverse reactions to nateg ... (more) Question 15: (see full question) A student asks the nursing instructor what insulin has the quickest therapeutic effect once administered. What would be the best response? You selected: Regular (Humulin R) Correct Explanation: Regular insulin has the quickest onset of 30-60 minutes. PZI and ultralente have an onset of 4-8 hours. NPH has an onset of 60-90 minutes. Question 16: (see full question) What instructions would be important to give to a 50-year-old client with type 2 diabetes who has been switched from glyburide (DiaBeta), a sulfonylurea, to repaglinide, a meglitinide? You selected: "It is less potent, so you will need to take a larger dose." Incorrect Correct response: "It stimulates insulin production, so you need to eat soon after taking the medication." Explanation: Glyburide's onset of action is 2 to 4 hours, and its duration is 24 hours. Repaglinide's onset of action is within 30 minutes, peak is 1 hour, and duration is approximately 3 to 4 ... (more) Question 17: (see full question) The nurse teaching a patient to use a glucometer should emphasize that the most accurate testing site when blood glucose is rapidly changing or if hypoglycemia is suspect is in which of the following? (Choose one) You selected: Finger Correct Explanation: The nurse teaching a patient to use a glucometer should emphasize that the most accurate testing site when blood glucose is rapidly changing or if hypoglycemia is suspect is the fi ... (more) Question 18: (see full question) Which of the following is an example of long acting insulin? You selected: Insulin glargine (Lantus) Correct Explanation: Insulin glargine (Lantus) is an example of long acting insulin. Question 19: (see full question) As a diabetic educator, you are teaching a newly diagnosed diabetic about aspects of the disease process. What would you tell the patient about the body's control of glucose? You selected: It is related to fat and protein metabolism Correct Explanation: The body's control of glucose is intricately related to fat and protein metabolism, balancing energy conservation with energy consumption to maintain homeostasis in a variety of si ... (more) Question 20: (see full question) Which of the following produce their glucose lowering effect by decreasing insulin resistance and increasing insulin sensitivity? Select all that apply: You selected: • Pioglitazone (Actos) • Rosiglitazone (Avandia) Correct Explanation: The thiazolidinediones, rosiglitazone (Avandia) and pioglitazone (Actos), produce their glucose-lowering effect by decreasing insulin resistance and increasing insulin sensitivity.

Question 1: (see full question) The nurse is discussing diabetes with a group of individuals who are at risk for the disease. Which statement by a participant indicates an understanding of the role of insulin in the disease? You selected: "Insulin is stimulated by the liver to break down proteins and provide the body with nutrients." Incorrect Correct response: "Insulin assists glucose molecules to enter the cells of muscle and fat tissues." Explanation: Insulin appears to activate a process that helps glucose molecules enter the cells of striated muscle and adipose tissue. It also stimulates the synthesis of glycogen by the liver, ... (more) Question 2: (see full question) A male patient is to begin glyburide (Diabeta) for type 2 diabetes. Before the drug therapy begins, a priority action by the nurse will be to assess the patient's You selected: use of alcohol. Correct Explanation: The nurse should assess the patient's alcohol consumption before therapy is initiated. Concomitant alcohol use increases the rate of glyburide metabolism and may cause a disulfiram ... (more) Question 3: (see full question) Which of the following are risk factors for type 2 diabetes that a nurse should recognize in a client? Select all that apply: You selected: • Impaired glucose tolerance • Obesity • Younger age Incorrect Correct response: • Impaired glucose tolerance • Obesity • History of gestational diabetes Explanation: A nurse should be able to identify all the risk factors for type 2 diabetes in a client. These include: obesity, older age, family history of diabetes, history of gestational diabe ... (more) Question 4: (see full question) The nurse is caring for a client with type 2 diabetes who is being treated with a regimen called BIDS. The nurse is aware that this regimen consists of what medications? You selected: Sulfonylurea plus metformin Incorrect Correct response: Bedtime insulin plus daytime sulfonylurea Explanation: BIDS stands for bedtime insulin plus daytime sulfonylurea. Question 5: (see full question) Which agent would a nurse expect to administer as a single oral dose in the morning? You selected: Rosiglitazone Correct Explanation: Rosiglitazone would be administered as a single oral dose. Repaglinide is used orally before meals. Exenatide is administered by subcutaneous injection within 60 minutes befo ... (more) Question 6: (see full question) When reviewing sites for insulin administration with a client, which site, if stated by the client as an appropriate site, indicates the need for additional teaching? You selected: Upper arm Incorrect Correct response: Buttocks Explanation: The buttocks would be an inappropriate site for administering insulin subcutaneously. The best sites include the upper arm, abdomen, and upper thigh. Question 7: (see full question) Which of the following would be least appropriate when administering insulin by subcutaneous injection? You selected: Massaging the site after removing the needle Correct Explanation: Gentle pressure should be applied to the injection after the needle is withdrawn. Massaging could contribute to erratic or unpredictable absorption. Question 8: (see full question) Glycosylated hemoglobin measures average blood glucose over what time period? (Choose one) You selected: The past 7 to 10 days Incorrect Correct response: The past 3 or 4 months Explanation: Glycosylated hemoglobin measures glucose control over the past 2 or 3 months. Question 9: (see full question) The nurse is educating a client who is beginning therapy with acarbose and tells the client to take the medication with the first bite of each main meal to help prevent what adverse effect? You selected: Nausea and vomiting Incorrect Correct response: Bloating and diarrhea Explanation: Clients who take acarbose should take the medication with the first bite of each main meal to prevent bloating and diarrhea. Question 10: (see full question) A patient with type 1 diabetes has been admitted to the hospital for orthopedic surgery and the care team anticipates some disruptions to the patient's blood glucose levels in the days following surgery. Which of the following insulin regimens is most likely to achieve adequate glycemic control? You selected: Small doses of long-acting insulin administered four to five times daily Incorrect Correct response: Doses of basal insulin twice daily with regular insulin before each meal Explanation: Subcutaneous insulin therapy for type 1 diabetes frequently consists of daily injections of mixtures of short-acting regular insulin with intermediate-acting insulins; multiple dos ... (more) Question 11: (see full question) During insulin teaching, when should the nurse advise the patient to administer insulin aspart (Apidra)? (Choose one) You selected: 30 to 60 minutes before a meal Incorrect Correct response: Immediately before a meal Explanation: Insulin aspart (Apidra) is given immediately before a meal or within 5 to 10 minutes of beginning a meal. Question 12: (see full question) The following patients are prescribed metformin. Which patient is likely at the greatest risk of having an adverse reaction to metformin? You selected: A pregnant woman Incorrect Correct response: An alcoholic patient Explanation: Hypoglycemia is more common when metformin is administered concomitantly with other oral hypoglycemic agents, if caloric intake is deficient, or if the patient exercises strenuousl ... (more) Question 13: (see full question) Which of the following would a nurse identify as an example of a sulfonylurea? You selected: Glyburide Correct Explanation: Glyburide is an example of a sulfonylurea. Metformin is classified as a biguanide. Acarbose and miglitol are alpha-glucosidase inhibitors. Question 14: (see full question) Regular insulin may be administered intravenously or intramuscularly in an emergency situation. You selected: False Incorrect Correct response: True Explanation: Regular insulin is given IM or IV in emergency situations. Question 15: (see full question) A patient with a recent diagnosis of type 2 diabetes has begun taking metformin. This drug will help the patient achieve adequate blood sugar control through which of the following mechanisms? (Select all that apply) You selected: • Binding excess glucose to adipose tissue • Increasing urinary excretion of glucose • Improving insulin sensitivity Incorrect Correct response: • Decreasing glucose production by the liver • Improving insulin sensitivity • Decreasing glucose absorption in the GI tract Explanation: Metformin decreases hepatic glucose production, decreases intestinal absorption of glucose, and improves insulin sensitivity by increasing peripheral glucose uptake and use in skel ... (more) Question 16: (see full question) A client newly diagnosed with type 1 diabetes asks the nurse why he cannot just take a pill. The nurse would incorporate knowledge of which of the following when responding to this client? You selected: The insulin is more effective in establishing control of blood glucose levels initially. Incorrect Correct response: Insulin is needed because the beta cells of the pancreas are no longer functioning. Explanation: Insulin is needed in type 1 diabetes because the beta cells of the pancreas are no longer functioning. With type 2 diabetes, insulin is produced, but perhaps not enough to mai ... (more) Question 17: (see full question) The nurse is caring for a client who is taking glyburide as treatment for type 2 diabetes mellitus. The physician has added a corticosteroid to this client's medication regimen for treatment of a severe allergic reaction. The nurse knows that this drug combination may cause what adverse effect on this client? You selected: The client is at risk for hyperglycemia. Correct Explanation: Corticosteroids increase insulin needs so the client may develop hyperglycemia. Question 18: (see full question) A patient at a healthcare facility has been prescribed 8 mg of rosiglitazone maleate (Avandia) daily to improve glycemic control. On-hand availability of the drug is in the form of 2 mg tablets. How many tablets of the drug should the nurse administer to the patient? You selected: 4 tablets Correct Explanation: The nurse should administer 4 tablets of rosiglitazone maleate (Avandia) to the patient. Question 19: (see full question) The nurse is reinforcing teaching about acarbose (Precose) to a client with newly diagnosed type 2 diabetes. Which statement by the client indicates a need for further understanding? You selected: "I must take this medication one hour before I eat." Correct Explanation: Acarbose is given three times a day with the first bite of the meal because food increases absorption. It may cause GI effects such as abdominal discomfort, flatulence, and diarrhe ... (more) Question 20: (see full question) A 59-year-old man with type 2 diabetes is prescribed metformin. When the patient returns to the clinic, he reports that he has lost 8 pounds in a month. How should the nurse respond? You selected: "Please continue taking the medication and monitoring your weight. This is an expected outcome of this drug therapy." Correct Explanation: The nurse should advise the patient to continue therapy as prescribed because weight loss is a beneficial adverse effect for type 2 diabetics. The patient need not seek a decrease ... (more)

Question 1: (see full question) What instructions would be important to give to a 50-year-old client with type 2 diabetes who has been switched from glyburide (DiaBeta), a sulfonylurea, to repaglinide, a meglitinide? You selected: "It is less potent, so you will need to take a larger dose." Incorrect Correct response: "It stimulates insulin production, so you need to eat soon after taking the medication." Explanation: Glyburide's onset of action is 2 to 4 hours, and its duration is 24 hours. Repaglinide's onset of action is within 30 minutes, peak is 1 hour, and duration is approximately 3 to 4 ... (more) Question 2: (see full question) A patient is admitted to the Emergency Department in diabetic ketoacidosis (DKA) with a blood glucose level of 33 mmol/L. The physician orders an initial dose of 25 U insulin IV. Which type of insulin will be administered? You selected: NPH insulin Incorrect Correct response: Regular insulin Explanation: Regular insulin is a short-acting insulin that manages the hyperglycemia and hyperkalemia of DKA (diabetic ketoacidosis), which is a life-threatening complication that occurs with ... (more) Question 3: (see full question) A nurse should take the following steps prior to administering insulin glargine (Lantus) to a client? Select all that apply: You selected: • Check the expiration date on the vial. • Remove all air bubbles from the syringe barrel. Incorrect Correct response: • Check the expiration date on the vial. • Check the physician's orders for the type and dosage of insulin. • Remove all air bubbles from the syringe barrel. Explanation: Prior to administering insulin glargine (Lantus) to a client, the nurse must complete the following pre-administration steps: carefully check the physician's order for the type and ... (more) Question 4: (see full question) A diabetic patient has just received an insulin pump. What would be important to include in patient teaching? You selected: Check blood glucose frequently. Correct Explanation: The device does have several disadvantages. For example, it is awkward, the tubing poses an increased risk of infection and requires frequent changing, and the patient has to frequ ... (more) Question 5: (see full question) The nurse is interviewing a client who was diagnosed with type 2 diabetes about four months ago. The client never records glucometer readings but says that everything is just fine. What laboratory test does the nurse anticipate the health care provider will order for this client? You selected: HbA1c Correct Explanation: The nurse anticipates that the glycosylated hemoglobin (HbA1c) will be ordered for this client because it provides an average of the client's blood glucose level for the last three ... (more) Question 6: (see full question) To minimize the risk of adverse effects of glucagon when given to an unconscious diabetic patient, as the patient regains consciousness, the nurse should You selected: administer carbohydrates. Correct Explanation: While it is important to monitor a patient for nausea and vomiting and help him or her into a more comfortable position, it is most important to administer supplemental carbohydrat ... (more) Question 7: (see full question) A hospital patient's medication administration record specifies a dose of NPH insulin to be administered subcutaneously at 8 AM. The nurse has checked the patient's blood glucose level prior to administering the drug and it is 55 mg/dl. How should the nurse respond to this assessment finding? You selected: Hold the dose of insulin and consult with the patient's primary care provider. Correct Explanation: When a patient's blood glucose is below 70 mg/dl, it is necessary to use caution when administering insulin. Usually the dose is held until blood sugars rise above this level and th ... (more) Question 8: (see full question) A diabetic patient is taking regular and NPH insulin to manage his diabetes. What is the best evaluation tool to measure the overall patient response to the insulin therapy? You selected: Glycosylated hemoglobin (HbAlc) levels Correct Explanation: HbAlc levels provide a 3 month average of glucose levels, which provides the best evaluation tool to measure of the overall patient response to the treatment plan. Blood pressure ... (more) 9 (see full question) When administering insulin, which of the following would be most appropriate? You selected: Insert the needle at a 45-degree angle for injection. Correct Explanation: The vial should be gently rotated and vigorous shaking is to be avoided to ensure uniform suspension of the insulin. Typically the area is pinched to allow access to the loose conn ... (more) Question 10: (see full question) Oral anti-diabetic agents can be used in various combinations for what purpose? You selected: Synergistic effects Incorrect Correct response: Additive effects Explanation: There are five types of oral anti-diabetic agents, all of which may be used to treat type 2 diabetes when diet and exercise alone fail to control the disorder. The drugs lower bloo ... (more) Question 11: (see full question) The nurse is preparing to administer a mixture of 12 units regular insulin and 45 units NPH insulin to a client with a blood sugar of 378 mg/dL. After the nurse draws the medication into the syringe, what is the nurse's next action? You selected: Administer the insulin to the client. Incorrect Correct response: Check the dosage with another nurse. Explanation: After preparing the syringe with insulin, the nurse should then have the medication and dosage checked by a second nurse to make sure that it is correct. It is not necessary to rec ... (more) Question 12: (see full question) A 54-year-old client is diagnosed with chronic renal failure and hyperglycemia. He asks if he can be prescribed sulfonylurea because it works well for his friend. If he were to be given sulfonylurea, this client's renal impairment may lead to what effect? You selected: Accumulation and hyperglycemic reactions Incorrect Correct response: Accumulation and hypoglycemia Explanation: Sulfonylureas and their metabolites are excreted mainly by the kidneys; renal impairment may lead to accumulation and hypoglycemia. They should be used cautiously, with close ... (more) Question 13: (see full question) After teaching a class about the various drugs used to control blood glucose, the instructor determines that the teaching was successful when the class identifies which of the following as a biguanide? You selected: Metformin Correct Explanation: Metformin is classified as a biguanide. Miglitol is an alpha-glucosidase inhibitor. Tolbutamide is a first generation sulfonylurea. Glipizide is a second generation sulfonylurea. Question 14: (see full question) After teaching a group of students about sulfonylureas, the instructor determines that the teaching was successful when the students identify which agent as a second-generation sulfonylurea? Select all that apply. You selected: • Pramlintide • Glimepiride Incorrect Correct response: • Glimepiride • Glyburide Explanation: Glimepiride is a second generation sulfonylurea. Glyburide is a second generation sulfonylurea. Tolazamide is a first generation sulfonylurea. Pramlintide is a human amylin agent. ... (more) Question 15: (see full question) The nurse's assessment of a patient who has presented to the emergency department reveals hyperglycemia. Which of the following types of insulin will have the most rapid effect on the patient's blood sugar levels? You selected: Regular Incorrect Correct response: Aspart Explanation: Aspart has an onset of action of 5 to 10 minutes, making the most rapidly acting insulin. NPH, regular, and 30/70 all take significantly longer to have an effect on blood glucose le ... (more) Question 16: (see full question) Glycosylated hemoglobin levels provide reliable evidence of blood glucose control. You selected: True Correct Explanation: Glycosylated hemoglobin levels, or an HbA1c test, provide a 3-month average of glucose levels. Question 17: (see full question) The school nurse identifies more children with type 2 diabetes each year and recognizes that this trend is mainly attributed to what issue? You selected: Obesity and inadequate exercise Correct Explanation: Type 2 diabetes is being increasingly identified in children. This trend is attributed mainly to obesity and inadequate exercise, because most children with type 2 are serious ... (more) Question 18: (see full question) A nurse is working with a newly diagnosed diabetic patient on understanding hypoglycemia and insulin reactions. Which of the following actions would be most important for the patient to understand when planning the response to an insulin reaction? You selected: Notify your physician immediately. Incorrect Correct response: Take an oral dose of some form of glucose as soon as possible. Explanation: The initial action of the patient should be to take some form of oral glucose. It would also be appropriate to call the physician, but this will delay self-treatment and should be ... (more) Question 19: (see full question) When learning about type 1 diabetes, what would the student nurses learn is a distinguishing characteristic of this disease? You selected: Exogenous insulin is required for life. Correct Explanation: Type 1 diabetes results from an autoimmune disorder that destroys pancreatic beta cells. Insulin is the only effective treatment for type 1 diabetes because pancreatic beta cells a ... (more) Question 20: (see full question) An insulin dependent diabetic is having trouble with hypoglycemia late in the morning. During the health history, the nurse becomes aware of the most likely cause. What would cause the late morning hypoglycemia? You selected: The patient jogs two miles in the morning before he goes to work. Correct Explanation: Physical exercise, such as jogging, changes insulin requirements and may result in a delayed hypoglycemic reaction. The fact that he likes to nap before dinner and has an early lun ... (more)