Chapter 42: Antidiabetic Drugs PrepU

1 See full question 2m 45s The female client is scheduled to get her breakfast tray at 0700. At what time should she receive her prescribed dose of NPH insulin?

0630 (6:30 am) Explanation: The dose of medication is based on blood sugar level and must be determined by the health care provider. NPH insulin is injected under the skin 15 or 30 minutes before meals and/or a bedtime snack. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 42: Antidiabetic Drugs, p. 492. Chapter 42: Antidiabetic Drugs - Page 492 Add a Note

11 See full question 33s Which strategy will NOT increase the therapeutic effect of insulin?

All insulin should be stored in a refrigerator but never frozen. Explanation: Store opened vials of regular insulin at room temperature. Extra supplies are stored in the refrigerator, not the freezer. Extreme temperatures (<2°C or >30°C) should be avoided to prevent the loss of maximum function. Administer regular insulin with an insulin syringe into an appropriate subcutaneous site. Regular insulin is administered about 30 to 60 minutes before eating. To promote regular absorption, one anatomic area should be selected for regular insulin injections (e.g., the abdomen). Frequent monitoring of blood glucose by fingersticks and periodic determinations of hemoglobin A1C levels help determine the therapeutic effect of insulin and overall consistency of diabetic control. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 42: Antidiabetic Drugs, p. 496. Chapter 42: Antidiabetic Drugs - Page 496 Add a Note

13 See full question 12s The nurse's assessment of a client who has presented to the emergency department reveals hyperglycemia. Which type of insulin will have the most rapid effect on the client's blood sugar levels?

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 levels. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 42: Antidiabetic Drugs, p. 484. Chapter 42: Antidiabetic Drugs - Page 484 Add a Note

18 See full question 1m 40s A client, being evaluated for diabetes, asks how a blood glucose test is used to diagnosis this disease. What is the nurse's best response?

"A fasting blood sugar result of 126 mg/dL (6.99 mmol/L) or more on two separate occasions is diagnostic of diabetes." Explanation: A major clinical manifestation of hyperglycemia is fasting blood glucose levels exceeding 126 mg/dL (6.99 mmol/L). A person with a fasting blood glucose level between 100 and 125 mg/dL (5.55 to 6.94 mmol/L) is said to have impaired fasting glucose or prediabetes. The normal hemoglobin A1C level is under 7. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 42: Antidiabetic Drugs, p. 490. Chapter 42: Antidiabetic Drugs - Page 490 Add a Note

17 See full question 10s 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?

"I must take this medication one hour before I eat." 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 diarrhea. Clients should be taught to check their blood sugar frequently when first diagnosed to help determine if the medication is effective. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 42: Antidiabetic Drugs, p. 494. Chapter 42: Antidiabetic Drugs - Page 494 Add a Note

13 See full question 11s A client with type 2 diabetes presents at the clinic for a routine follow-up appointment. The client asks the nurse whether she can take the herbal supplement ginseng. What is the correct response by the nurse?

"It increases the risk for low blood glucose levels." Explanation: Clients being treated with antidiabetic therapies are at an increased risk of developing hypoglycemia if they use herbals containing juniper berries, ginseng, garlic, fenugreek, coriander, dandelion root, or celery. If a client uses these therapies, blood glucose levels should be monitored closely and appropriate dose adjustment made in the prescribed drug. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 42: Antidiabetic Drugs, p. 485. Chapter 42: Antidiabetic Drugs - Page 485 Add a Note

11 See full question 36s Which statement by the nurse represents the most appropriate response to the question why a quick-acting sugar given by mouth is better in the regulation of insulin than the use of intravenous glucose for a low blood sugar?

"The ingestion of food allows the digestive tract to stimulate vagal activity and the release of incretins." Explanation: Oral glucose is more effective than intravenous glucose because glucose or food in the digestive tract stimulates vagal activity and induces the release of gastrointestinal hormones called incretins. The combination of insulin and food does not yield a higher blood glucose than intravenous insulin. Food stimulates the vagal nerve activity, but intravenous glucose does not. A statement that indicates that the client is mistaken will belittle the client and should be rephrased. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 42: Antidiabetic Drugs, p. 487. Chapter 42: Antidiabetic Drugs - Page 487 Add a Note

15 See full question 1m 13s What outcome would best indicate the nurse's teaching of a client newly-diagnosed with diabetes was effective and that drug therapy is appropriate?

Blood glucose level is stable with no diabetic complications. Explanation: The single best indicator, and the goal of treatment, is to help the client maintain a stable blood glucose level so as to be able to avoid any complications. For the client to maintain a stable blood glucose level, he needs to understand how to take his medication, to check his blood sugar level, and to follow an appropriate diet, but the best indicator is the stable glucose level. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 42: Antidiabetic Drugs, p. 497. Chapter 42: Antidiabetic Drugs - Page 497 Add a Note

6 See full question 10s A diabetic client has just received an insulin pump. What would be important to include in client teaching?

Check blood glucose frequently. Explanation: The device does have several disadvantages. The tubing is awkward, use of the tubing poses an increased risk of infection and requires frequent changing, and the client has to frequently check blood glucose levels throughout the day to monitor response. The most important factor to teach a client with an insulin pump is to monitor their blood glucose frequently. The client does not need to have their pump calibrated weekly. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 42: Antidiabetic Drugs, p. 494. Chapter 42: Antidiabetic Drugs - Page 494 Add a Note

12 See full question 31s The nurse is aware that premixed insulins (those that contain both regular and NPH insulin) are least effective in what type of client?

Client who has difficulty controlling his diabetes Explanation: Premixed insulins are least effective for clients who have difficulty controlling their diabetes, because it is difficult to individualize the dosages of each type of insulin. It is helpful to clients to use premixed insulin if they have difficulty drawing up their insulin, or seeing the markings on the syringe. The strict monitoring of the diet assists in keeping diabetes in good control. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 42: Antidiabetic Drugs, p. 492. Chapter 42: Antidiabetic Drugs - Page 492 Add a Note

1 See full question 13s A client has been noncompliant with the diabetic medication regimen and develops diabetic ketoacidosis. Which would the nurse assess?

Deep respirations Explanation: Deep respirations are seen with diabetic ketoacidosis as the body attempts to rid itself of high acid levels. The client with diabetic ketoacidosis is typically dehydrated. Blood glucose levels are typically elevated with diabetic ketoacidosis. A fruity breath odor is indicative of diabetic ketoacidosis. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 42: Antidiabetic Drugs, p. 485. Chapter 42: Antidiabetic Drugs - Page 485 Add a Note

16 See full question 23s The nurse is caring for a client with diabetes and administered the client's scheduled dose of regular insulin and NPH insulin at 08:00. At 09:30 the nurse checks the client's blood glucose level, which is 140 mg/dL. What is the nurse's best action?

Document the finding and check the client's blood glucose level in one hour Explanation: This client's blood glucose is nominally elevated, which does not necessarily show that the insulin regimen is insufficient. There is no pressing need to contact the provider or to administer more insulin. Documentation and further assessment are the nurse's best course of action. At this level, the client would be unlikely to exhibit signs of hyperglycemia. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 42: Antidiabetic Drugs, p. 490. Chapter 42: Antidiabetic Drugs - Page 490 Add a Note

12 See full question 1m 15s A client with type 1 diabetes has been admitted to the hospital for orthopedic surgery and the care team anticipates some disruptions to the client's blood glucose levels in the days following surgery. Which insulin regimen is most likely to achieve adequate glycemic control?

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 doses of regular insulin before each meal in association with one or two daily doses of long-acting insulin may also be used. Frequent, fixed doses of rapid-acting or intermediate-acting insulin may result in unsafe blood sugar levels. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 42: Antidiabetic Drugs, p. 494. Chapter 42: Antidiabetic Drugs - Page 494 Add a Note

2 See full question 18s Which insulin would the nurse need to administer as a separate injection if the order also included NPH insulin?

Glargine Explanation: Insulin glargine cannot be mixed in solution with any other insulin. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 42: Antidiabetic Drugs, p. 492. Chapter 42: Antidiabetic Drugs - Page 492 Add a Note

3 See full question 19s 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.)

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. Repaglinide is a meglitinide agent. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 42: Antidiabetic Drugs, p. 499. Chapter 42: Antidiabetic Drugs - Page 499 Add a Note

8 See full question 1m 1s A client is brought to the Emergency Department (ED) with severe hypoglycemia. What drug would the nurse prepare to administer intravenously?

Glucagon (GlucaGen) Explanation: This client will need a glucose-elevating agent. Glucagon will be administered. Diazole is also a glucose-elevating agent but is administered only by the oral route. Insulin would be administered for hyperglycemia. Glyburide is an oral antidiabetic agent, which is a second-generation sulfonylurea and is administered for hyperglycemia. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 42: Antidiabetic Drugs, p. 495. Chapter 42: Antidiabetic Drugs - Page 495 Add a Note

10 See full question 1m 14s A hospital client's medication administration record specifies a dose of NPH insulin to be administered subcutaneously at 8 AM. The nurse has checked the client's blood glucose level prior to administering the drug and it is 55 mg/dL. How should the nurse respond to this assessment finding?

Hold the dose of insulin and consult with the client'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 the provider consulted. Glucagon is unnecessary at this blood sugar level. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 42: Antidiabetic Drugs, p. 490. Chapter 42: Antidiabetic Drugs - Page 490 Add a Note

14 See full question 18s The nurse is caring for an obese, adult woman with little social support who was just diagnosed with type 2 diabetes. When developing this client's plan of care, what is the priority nursing diagnosis?

Imbalanced nutrition: more than body requirements Explanation: The priority with this client is to address her obesity because losing weight may eliminate the problem. The client may need support to cope with the diagnosis but these are not the priority concern. Disturbed sensory perception is not indicated to be a problem at this time. Diabetes creates a risk for infection, but the client's obesity is a priority. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 42: Antidiabetic Drugs, p. 496. Chapter 42: Antidiabetic Drugs - Page 496 Add a Note

19 See full question 37s The nurse is caring for a pregnant client diagnosed with pregnancy-induced diabetes. What antidiabetic agent is best suited for administration to this client?

Insulin Explanation: Insulin therapy is the best choice for clients with diabetes during pregnancy and lactation, which are times of high stress and metabolic demands. Oral antidiabetic medications are contraindicated during pregnancy so metformin, acarbose, and glyburide are not the best choices. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 42: Antidiabetic Drugs, p. 484. Chapter 42: Antidiabetic Drugs - Page 484 Add a Note

7 See full question 21s A client has been prescribed acarbose. What is the advantage of acarbose over alternative drugs?

It delays the digestion of complex carbohydrates. Explanation: Acarbose delays the digestion of complex carbohydrates into glucose and other simple sugars. Acarbose may be combined with insulin or an oral agent, usually a sulfonylurea. The client will still need to remain on a diabetic dietary regime. The drug does not directly prevent acid-base imbalances. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 42: Antidiabetic Drugs, p. 488. Chapter 42: Antidiabetic Drugs - Page 488 Add a Note

10 See full question 24s As a diabetic educator, the nurse is teaching a newly diagnosed diabetic client about aspects of the disease process. What would the nurse tell the client about the body's control of glucose?

It is related to fat and protein metabolism 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 situations. Our body stores glucose for use in times of stress. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 42: Antidiabetic Drugs, pp. 481-482. Chapter 42: Antidiabetic Drugs - Page 481-482 Add a Note

20 See full question 14s What is the expected action of sitagliptin on type 2 diabetes?

It slows the rate of inactivation of the incretin hormones. Explanation: Sitagliptin minimizes the rate of inactivation of the incretin hormones to increase hormone levels and prolong their activity. Sitagliptin does not block the S phase of the cell cycle. Sitagliptin is not a synthetically prepared monosodium salt nor does it inhibit hydrogen, potassium, and ATPase.

16 See full question 30s The nurse admits a client with type 2 diabetes who takes metformin (Glucophage).The nursing diagnosis given is ineffective breathing pattern. What complication of the client's current drug therapy does the nurse believe the client is experiencing?

Lactic acidosis Explanation: When taking metformin, the client is at risk for lactic acidosis, which causes hyperventilation, myalgia, malaise, GI symptoms, or unusual somnolence. Respiratory alkalosis, fluid overload, and hyperkalemia would be unlikely complications with metformin. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 42: Antidiabetic Drugs, p. 490. Chapter 42: Antidiabetic Drugs - Page 490 Add a Note

19 See full question 26s A client has refused a scheduled dose of metformin, stating that he/she is worried about inducing hypoglycemia because his/her blood glucose level is currently 66 mg/dL (3.66 mmol/L). The nurse should convey what teaching points to the client?

Metformin does not cause hypoglycemia. Explanation: Experts prefer to call metformin an antihyperglycemic rather than a hypoglycemic because it does not cause hypoglycemia, even in large doses, when used alone. This fact about metformin makes the other statements inaccurate. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 42: Antidiabetic Drugs, p. 487. Chapter 42: Antidiabetic Drugs - Page 487 Add a Note

2 See full question 11s A female client is diagnosed with type 1 diabetes. She suddenly reports feeling weak, shaky, and dizzy. What should the nurse's first response be?

Perform a blood sugar analysis. Explanation: As long as the client is awake and verbally responsive, check the blood glucose level first. Hypoglycemia can make the client feel weak, confused, irritable, hungry, or tired. Clients may also report sweating or headaches. If the client has any of these symptoms, check the blood glucose. If the level is 70 mg/dL or below, have the client consume 3 or 4 glucose tablets; 1 serving of glucose gel; 1/2 cup of any fruit juice; 1 cup of milk; 1/2 cup of a regular soft drink; several pieces of hard candy; or 1 tablespoon of sugar or honey. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 42: Antidiabetic Drugs, p. 490. Chapter 42: Antidiabetic Drugs - Page 490 Add a Note

18 See full question 14s The nurse walks into the room of a client with type 1 diabetes and finds the client pale and diaphoretic. The client reports a headache and being hungry. Immediately, the client is unable to talk. What is the nurse's immediate intervention for this client?

Place glucose gel between the gums and cheek. Explanation: The client is experiencing hypoglycemia, which presents very suddenly and has symptoms such as fatigue, weakness, nervousness, agitation, confusion, and headache. It may lead to convulsions and unconsciousness. The client's skin is pale, moist, cool, and diaphoretic and the client may report hunger or nausea. The treatment is to give the client something with sugar. The glucose gel would absorb through the client's mucous membranes and would be the optimal way to provide the client with sugar, since the client is no longer able to talk. Eight ounces of orange juice is too much. The client does not need the insulin, which is used for hyperglycemia. Symptoms of this are gradual and include drowsiness, dim vision, thirst, nausea, abdominal pain, loss of appetite, rapid and weak pulse, acetone breath, and skin that is dry, flushed, and warm. Raising the head of the bed is not indicated because there is no evidence of difficulty breathing. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 42: Antidiabetic Drugs, p. 495. Chapter 42: Antidiabetic Drugs - Page 495 Add a Note

15 See full question 19s The nurse is assisting a client in learning insulin self-injection technique. Which way is most helpful for the client to understand how to rotate injection sites?

Provide the client with a manufacturer's template for site rotation. Explanation: The nurse can best explain injection site rotation with templates or numbered charts from insulin manufacturers. The client can use these by marking when each injection is given, helping the client to remember to move to another site. Ink dots may help in the initial teaching but will wash off. A pattern may be helpful but learning self-injection is an intricate process, and it is not likely the client will remember the pattern. The client should be taught to change sites with each injection, not each day. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 42: Antidiabetic Drugs, p. 493. Chapter 42: Antidiabetic Drugs - Page 493 Add a Note

8 See full question 18s A nurse is working with a newly diagnosed diabetic client on understanding hypoglycemia and insulin reactions. Which action would be most important for the client to understand when planning the response to an insulin reaction?

Take an oral dose of some form of glucose as soon as possible. Explanation: The initial action of the client should be to take some form of oral glucose. It would also be appropriate to call the provider, but this will delay self-treatment and should be done after the administration of the glucose. Injecting insulin would cause further harm to the client and is not an option. It is good to stay calm, but the reaction will not subside without intervention. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 42: Antidiabetic Drugs, p. 495. Chapter 42: Antidiabetic Drugs - Page 495 Add a Note

20 See full question 2m 49s A client was diagnosed with type 2 diabetes several months ago and has presented for a scheduled follow-up appointment. Which stated behavior most clearly indicates that the client has established effective health maintenance?

The client frequently checks his/her blood glucose levels. Explanation: Vigilant blood glucose monitoring is imperative in the management of diabetes. This shows effective health maintenance even more clearly than exercising. Dietary modifications must be undertaken with care in people with diabetes to avoid health consequences. Explaining pathophysiology does not necessarily show effective health maintenance.

4 See full question 1m 10s An insulin-dependent diabetic male client 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?

The client jogs two miles in the morning before he goes to work. 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 lunch is unrelated to his hypoglycemia. The client eating oatmeal early in the morning would help stabilize his blood sugars until later in the morning, but the jogging would have a dramatic effect. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 42: Antidiabetic Drugs, p. 496. Chapter 42: Antidiabetic Drugs - Page 496 Add a Note

9 See full question 15s As the first-line treatment, a client with type 2 diabetes has tried diet and exercise. When these fail, what may be added as monotherapy or in combination with metformin to control their disease process?

Thiazolidinediones Explanation: Thiazolidinediones (TZDs) may be used as monotherapy with diet and exercise or in combination with metformin a sulfonylurea, or an incretin agent (sitagliptin). Repaglinide, a sitagliptin, or an incretin agent are incorrect answers for this question. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 42: Antidiabetic Drugs, pp. 486-488. Chapter 42: Antidiabetic Drugs - Page 486-488 Add a Note

5 See full question 26s In what condition is human insulin not recommended for diabetic clients?

Type 2 diabetes controlled by diet Explanation: Insulin is recommended for treatment of type 2 diabetes mellitus in clients whose diabetes cannot be controlled by diet or other agents. If the diabetes can be controlled by diet, the pancreas is still functioning and releasing insulin. Type 2 diabetes is characterized by hyperglycemia and insulin resistance. The hyperglycemia results from increased production of glucose by the liver and decreased uptake of glucose in liver, muscle, and fat cells. Insulin resistance means that higher-than-usual concentrations of insulin are required. Thus, insulin is present, but unable to work effectively at the cellular level. Diet control requires a reduction of ingested calories, which lowers the serum glucose levels. Human insulin can be used in gestational diabetes, type 2 diabetics controlled on oral antidiabetic agents with systemic infection, or type 1 diabetics of many years. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 42: Antidiabetic Drugs, p. 486. Chapter 42: Antidiabetic Drugs - Page 486 Add a Note

17 See full question 12m 49s The nurse is providing care for several clients who have diabetes. Which client should the nurse monitor most closely for signs and symptoms of hypoglycemia?

a client who received 12 units of Humulin R 45 minutes ago Explanation: Administration of regular insulin will create a greater risk for hypoglycemia than metformin, which is used in the treatment of type 2 diabetes. A blood glucose level of 150 mg/dL is nominally elevated, and creates no particular risk for "rebound" hypoglycemia. Clients whose diabetes has been recently diagnosed must be monitored closely, but this does not mean that the client faces a particular risk for hypoglycemia. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 42: Antidiabetic Drugs, p. 484. Chapter 42: Antidiabetic Drugs - Page 484 Add a Note

3 See full question 14s Which medication would a nurse identify as a noninsulin injectable antidiabetic drug?

exenatide Explanation: Exenatide and pramlintide are noninsulin injectable antidiabetic drugs. Sitagliptin, glipizide, and pioglitazone are oral agents. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 42: Antidiabetic Drugs, p. 487. Chapter 42: Antidiabetic Drugs - Page 487 Add a Note

7 See full question 1m 9s A nurse at a health care facility is caring for a client who has been prescribed insulin for the first time. Which preadministration assessments should the nurse perform before the first dose of insulin is given?

general assessment of the skin Explanation: The nurse should perform a general assessment of the skin, mucous membranes, and extremities of the client as a preadministration assessment before giving the first dose of insulin. The nurse need not assess for hypoglycemic episodes before administration of the first dose of insulin since the client has not received any insulin or oral antidiabetic drugs. The nurse need not assess the dental health or the hearing ability of the client as these are not pertinent to insulin administration. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 42: Antidiabetic Drugs, p. 489. Chapter 42: Antidiabetic Drugs - Page 489 Add a Note

6 See full question 11s A nurse instructs a client who is elderly to eat within 30 minutes of the administration of which antidiabetic drugs to prevent hypoglycemia?

glyburide Explanation: A nurse should advise a client, especially an elderly client, to eat within 30 minutes of the administration of sulfonylureas like glyburide to prevent hypoglycemia. Pioglitazone is for type 2 diabetes and is administered three times a day. Metformin is for type 2 diabetes and the client may be instructed to take it two to three times a day with meals. The alpha-glucosidase (α-glucosidase) inhibitor acarbose prevents the after meal surge in blood glucose by delaying the digestion of carbohydrates and absorption of carbohydrates in the intestine and is taken three times a day. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 42: Antidiabetic Drugs, p. 494. Chapter 42: Antidiabetic Drugs - Page 494 Add a Note

5 See full question 10s When teaching a client about insulin administration, the nurse would instruct the client to administer insulin aspart at which time?

immediately before a meal Explanation: Insulin aspart is given immediately before a meal or within 5 to 10 minutes of beginning a meal. Glargine is given subcutaneously once daily at bedtime. Regular insulin is given 30 to 60 minutes before a meal to achieve optimal results. Lispro is given 15 minutes before a meal or immediately after a meal. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 42: Antidiabetic Drugs, p. 491. Chapter 42: Antidiabetic Drugs - Page 491 Add a Note

14 See full question 13s The health care provider prescribes glyburide for a client who is a newly diagnosed type 2 diabetic. The nurse knows that this medication 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. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 42: Antidiabetic Drugs, p. 489. Chapter 42: Antidiabetic Drugs - Page 489 Add a Note

4 See full question 10s After teaching a group of nursing students about insulin, the instructor determines that the teaching was successful when the students identify that insulin is produced by which organ in the human body?

pancreas Explanation: Insulin is produced by the pancreas. The spleen filters the blood and has a role in immunity. When insulin levels are high, glucose is available in the blood, and the liver produces little or no glucose from stored glycogen. When insulin levels are low, there is little circulating glucose, so the liver produces more glucose. Glucose is reabsorbed in the kidney by the sodium-glucose transporter-2 (SGLT-2). This process is decreased by the class of inhibiting drugs, SGLT-2 inhibitors. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 42: Antidiabetic Drugs, p. 481. Chapter 42: Antidiabetic Drugs - Page 481 Add a Note

9 See full question 35s A male client 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 client's:

use of alcohol. Explanation: The nurse should assess the client's alcohol consumption before therapy is initiated. Concomitant alcohol use increases the rate of glyburide metabolism and may cause a disulfiram-like reaction. Even though the client's blood pressure should be assessed, it is not as important as making sure that the client is aware of the serious reaction that alcohol can cause while on glyburide. The amount of salt used in the patient's diet is important as well as the client's potassium level, but not specifically in relation to the use of glyburide. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 42: Antidiabetic Drugs, p. 485. Chapter 42: Antidiabetic Drugs - Page 485 Add a Note