KFarmer SUGAAAARRRRR
The nurse is instructing a client how to take a prescribed pramlintide. Which would be most appropriate? "Give it by subcutaneous injection immediately before your major meals." "Take the drug orally once a day, preferably in the morning." "Give yourself an injection 1 hour before you eat breakfast and dinner." "Take the drug orally with the first bite of each meal."
"Give it by subcutaneous injection immediately before your major meals." Explanation: Pramlintide is administered subcutaneously immediately before major meals. Numerous antidiabetic drugs are taken orally, often once a day in the morning. Exenatide is given subcutaneously within 1 hour before the morning and evening meals. Miglitol should be taken orally with the first bite of each meal.
A nurse is providing patient education to a 13-year-old girl who was just diagnosed with type 1 diabetes mellitus. Which statement by the patient will alert the nurse that special instructions regarding insulin are necessary? "I walk two blocks to school every day." "I am on the middle school track team." "We live in a two-story house." "My mother is going to give me my insulin."
"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 that may come hours after she has ceased exercising. Walking two blocks every day and walking up stairs would not be considered increased physical exercise and would not be a factor. Wanting to have her mother administer the insulin is not uncommon for this age patient, and the nurse would normally instruct both the mother and the daughter in the administration of the drug.
A patient is taking chlorpropamide. The nurse warns the patient about the possibility of hypoglycemia within approximately which time frame after taking the drug? 3 to 4 hours 1 to 2 hours 2 to 3 hours 4 to 5 hours
3 to 4 hours Explanation: Chlorpropamide peaks in 3 to 4 hours, which would be the time for possible hypoglycemia.
A 54-year-old male 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? Accumulation and hypoglycemia Accumulation and hyperglycemic reactions Decreased absorption of the sulfonylurea Hypersensitivity to sulfonylurea
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 monitoring of renal function, in clients with mild to moderate renal impairment and are contraindicated in severe renal impairment.
A female client visits the physician's office after routine labs are drawn. The nurse notes that her A1C is 9. How does the nurse interpret this finding? Client is in good glycemic control. Client's average blood glucose is above normal. Client's blood glucose levels are not consistent. Client's blood glucose demonstrates longstanding hypoglycemia.
Client's average blood glucose is above normal. Explanation: The American Diabetes Association (ADA) suggests a target A1C of less than 7%. A1C should be measured every 3 to 6 months. An A1C of 9 indicates that the client's average blood glucose is consistently above normal.
Insulin binds with and activates receptors on cell membranes. Once insulin-receptor binding occurs, the membranes become highly permeable to glucose. Which action does this enable? Release of glucagon from the cells Entry of glucose into the cells Interruption of glucose movement across the membrane Storage of glucagon in the cells
Entry of glucose into the cells Explanation: After insulin-receptor binding occurs, cell membranes become highly permeable to glucose and allow rapid entry of glucose into the cells.
The nurse is administering an antidiabetic agent by subcutaneous injection within 60 minutes of the patient's breakfast. Which agent would the nurse most likely be administering? Exenatide Rosiglitazone Repaglinide Miglitol
Exenatide Explanation: Exenatide is administered by subcutaneous injection within 60 minutes before morning and evening meals. Rosiglitazone would be administered as a single oral dose. Repaglinide is used orally before meals. Miglitol is given orally with the first bite of each meal.
Which is a non-insulin injectable antidiabetic drug? Exenatide (Byetta) Sitagliptin (Januvia) Glipizide (Glucotrol) Pioglitazone (Actos)
Exenatide (Byetta) Explanation: Exenatide (Byetta) and pramlintide (Symlin) are non-insulin injectable antidiabetic drugs.
Pramlintide is administered orally. True False
False Explanation: Pramlintide is administered by subcutaneous injection
A man is brought to the emergency department. He is nonresponsive, and his blood glucose level is 32 mg/dL. Which would the nurse expect to be ordered? Insulin lispro Glucagon Diazoxide Regular insulin
Glucagon Explanation: The client is significantly hypoglycemic and needs emergency treatment. Glucagon would be the agent of choice to raise the client's glucose level because it can be given intravenously and has an onset of approximately 1 minute. Diazoxide can be used to elevate blood glucose levels, but it must be given orally. Lispro and regular insulin would be used to treat hyperglycemia.
Which would a nurse identify as an example of a sulfonylurea? Glyburide Metformin Acarbose Miglitol
Glyburide Explanation: Glyburide is an example of a sulfonylurea. Metformin is classified as a biguanide. Acarbose and miglitol are alpha-glucosidase inhibitors.
The nurse is caring for a client who is taking a thiazide diuretic, a corticosteroid, and estrogens. The nurse understands that this client is at risk for what condition? Hypoglycemia Pulmonary hypertension Congestive heart failure Hyperglycemia
Hyperglycemia Explanation: Renal insufficiency may increase risks of adverse effects with antidiabetic drugs, and treatment with thiazide diuretics, corticosteroids, estrogens, and other drugs may cause hyperglycemia, thereby increasing dosage requirements for antidiabetic drugs.
A patient is undergoing metformin therapy at a health care facility. The patient is also prescribed glucocorticoids. What effect of interaction of these two drugs should the nurse assess for in the patient? Increased hypoglycemic effect Increased risk for bleeding Increased risk of lactic acidosis Delay in gastric emptying
Increased risk of lactic acidosis Explanation: The nurse should observe an increased risk of lactic acidosis in the patient as an effect of the interaction of metformin and glucocorticoids. Increased hypoglycemic effect is an effect of the interaction of sulfonylureas with anticoagulants, chloramphenicol, clofibrate, fluconazole, histamine H2 antagonists, methyldopa, monoamine oxidase inhibitors (MAOIs), salicylates, sulfonamides, and tricyclic antidepressants. Increased risk for bleeding is an effect of the interaction of oral anticoagulants with anti-infective drugs, and delay in gastric emptying is an effect of the interaction of anticholinergics with anti-infective drugs.
When describing the effects of incretins on blood glucose control to a group of students, which would an instructor include? Increases glucagon release Increases GI emptying Increases insulin release Increases protein building
Increases insulin release Explanation: Incretins increase insulin release, decrease glucagon release, slow GI emptying, and stimulate the satiety center. Growth hormone increases protein building.
A nurse must recognize the duration of insulin as to not cause harm to the client with administration of the improper type of insulin. Which insulins are long-acting insulin? (Select all that apply.) Insulin apart (NovoLog) Insulin lispro (Humalog) Insulin glargine (Lantus) Insulin detemir (Levemir) Insuline glulisine (Apidra)
Insulin glargine (Lantus) Insulin detemir (Levemir) Explanation: Insulin glargine (Lantus) and insulin detemir (Levemir) are long-acting insulins with a duration of 24 hours.
A patient is prescribed sitagliptin. The nurse would expect to administer this drug by which route? Oral Subcutaneous Intramuscular Intravenous
Oral Explanation: Sitagliptin is administered orally.
A female client is prescribed metformin to decrease her blood glucose levels associated with diabetes mellitus type 2. Which statement accurately describes the action of metformin? It stimulates insulin release from the beta cells of the pancreas. It reduces glucose output from the liver. It decreases intestinal absorption of glucose and improves insulin sensitivity. It reduces postprandial glucose levels substantially in combination with insulin.
It decreases intestinal absorption of glucose and improves insulin sensitivity. Explanation: Metformin decreases the intestinal absorption of glucose and improves insulin sensitivity, while glyburide works by stimulating insulin release from the beta cells of the pancreas and reducing glucose output from the liver. On the other hand, postprandial glucose levels substantially are reduced by acarbose and miglitol when administered either alone or in combination with insulin or sulfonylurea.
The nurse is preparing to administer insulin lispro (Humalog) to a client at 7 AM. What is the nurse's top priority intervention related to this medication? Make sure the client's breakfast is available in the next 5-10 minutes. Monitor the client for a hypoglycemic reaction at noon. Cleanse the administration site with soap and water before administration. Have the client lie quietly for 45 minutes.
Make sure the client's breakfast is available in the next 5-10 minutes. Explanation: Insulin lispro has an onset of 5-10 minutes, so it is most important to ensure that there is food for the client after administration. Its peak is 30 min-1.5 hours so blood sugar would be most affected between 7:30 AM and 8:30 AM. Cleansing the site with soap and water is not necessary unless there is visible dirt on the skin, and lying quietly is not an intervention.
The nurse monitoring a client receiving insulin glulisine (Apidra) notices the client has become confused, diaphoretic, and nauseated. The nurse checks the client's blood glucose and it is 60 mg/dL. Which can a nurse give to treat a client with a hypoglycemic episode? (Select all that apply.) Orange or other fruit juice Glucose tablets Insulin glargine (Lantus) Hard candy Insulin detemir (Levemir)
Orange or other fruit juice Glucose tablets Hard candy Explanation: Methods of terminating a hypoglycemic reaction include the administration of one or more of the following: orange or other fruit juice, hard candy or honey, glucose tablets, glucagon, or glucose 10 percent or 50 percent IV.
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? Subcutaneous injection Insulin pen Jet injector Implantable infusion pump
Subcutaneous injection Explanation: Subcutaneous injection currently is the most common method for administering insulin.
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? The client is at risk for hypoglycemia. The client is at risk for hyperglycemia. The client will experience nausea and vomiting. The client will experience rash and fever.
The client is at risk for hyperglycemia
Glycosylated hemoglobin measures average blood glucose over what time period? The past 3 or 4 months The past 7 to 10 days The past 1 or 2 months The past 12 to 24 hours
The past 3 or 4 months Explanation: Glycosylated hemoglobin measures glucose control over the past 2 or 3 months.
Amylin is a peptide hormone secreted with insulin by the beta cells of the pancreas and is important in the regulation of glucose control during the postprandial period. True or false? True False
True Pramlintide (Symlin) is a synthetic analog of amylin, a peptide hormone secreted with insulin by the beta cells of the pancreas, important in the regulation of glucose control during the postprandial period.
A patient with type 1 diabetes has come to the clinic for a routine follow-up appointment. While assessing the patient's skin, the nurse observes brown spots on his lower legs. What might these spots indicate? Infection Impaired glucose tolerance Poor insulin injection technique Widespread changes in the blood vessels
Widespread changes in the blood vessels Explanation: Diabetes can cause significant vascular problems. Brown spots on the lower legs of a diabetic patient are caused by small hemorrhages into the skin and may indicate widespread changes in the blood vessels.
Meglitinides should be administered at what time? 30 minutes before the meal 1 hour before the meal 1 hour after the meal With the first bite of a meal
With the first bite of a meal Explanation: Because meglitinides work quickly and do not stay in the body long, they need to be taken at each meal. By taking the medication at the time of the first bite, the possibility of a hypoglycemic episode is reduced. This allows flexibility for people who do not eat on the same schedule each day.
A home care nurse is caring for several clients with diabetes. The nurse's role in caring for these clients includes: mobilizing community resources. monitoring health status. helping obtain diabetic supplies. all the above tasks.
all the above tasks. Explanation: Some aspects of the nursing role include mobilizing and coordinating health care providers and community resources; teaching and supporting patients and caregivers; monitoring the patient's health status and progress in disease management; assisting the patient to obtain diabetic supplies for monitoring and medication administration; and preventing or solving problems.
A patient is to be administered glipizide (Glucotrol). Which factor would prohibit the administration of glipizide (Glucotrol) to this patient? A diagnosis of hypertension The ingestion of carbohydrates Allergy to sulfonamides Increase in alkaline phosphatase
Allergy to sulfonamides Explanation: Sulfonylureas are contraindicated in patients with hypersensitivity to them, with severe renal or hepatic impairment, and who are pregnant. A diagnosis of hypertension does not cause contraindication of sulfonylureas. The patient should consume carbohydrates in association with the oral hypoglycemic agent. An increase in alkaline phosphatase does not result in the contraindication of glipizide (Glucotrol)
The nurse is providing discharge instructions to a client who has just been diagnosed with type 1 diabetes. What instructions are most important for the client to follow related to diet? (Select all that apply.) Lose 10-15 pounds. Avoid drinking beer, wine, or liquor. Use artificial sweeteners instead of sugar in tea and coffee. Read food labels carefully to look for hidden sources of sugar. If you skip a meal, increase your next insulin dosage.
Avoid drinking beer, wine, or liquor. Use artificial sweeteners instead of sugar in tea and coffee. Read food labels carefully to look for hidden sources of sugar. Explanation: The client should be encouraged to follow a prescribed diet, know how many calories are allowed, and know how to do food exchanges. The client should follow an established meal schedule and avoid skipping meals. If a meal is skipped, the next insulin dose may need to be lowered, not raised. The client should be encouraged to use artificial sweeteners and to read food labels carefully. The client should avoid alcohol, dieting, and commercial weight-loss products.
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 Client who strictly monitors his diet Client who encounters problems drawing up insulin into the syringe Client who has difficulty reading the markings on the syringes
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.
The nurse teaches the male client with type 1 diabetes that insulin needs vary depending upon certain conditions. The client requires additional teaching when he learns that his insulin needs may increase because of what condition? (Select all that apply.) Exercise Fever Anxiety Decreased food intake Stress
Correct response: Exercise Decreased food intake Explanation: Exercise and decreased food intake decrease insulin needs; fever, anxiety, and stress all will increase insulin needs for the client with type 1 diabetes.
Which would the nurse identify as an effect of somatostatin on blood glucose? Decreased glucagon release Increased insulin release Increased GI emptying Decreased insulin sensitivity
Decreased glucagon release Explanation: Somatostatin decreases glucagon release. Somastatin decreases insulin release. Somastatin slows GI emptying. Somastatin does not affect insulin sensitivity.
A patient has been noncompliant with his diabetic medication regimen and develops diabetic ketoacidosis. Which would the nurse assess? Deep respirations Edema Decreased blood glucose levels Sour breath odor
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 glucose levels are typically elevated with diabetic ketoacidosis. A fruity breath odor is indicative of diabetic ketoacidosis.
The nurse is educating a client who will be adding an injection of pramlintide to his insulin regimen. What information is most important for the nurse to share with this client to ensure safe medication administration? Pramlintide should only be injected in the hip. Inject pramlintide in the same site where insulin is administered. Do not give pramlintide in the same site where insulin is administered. Mix pramlintide in the same syringe with insulin.
Do not give pramlintide in the same site where insulin is administered. Explanation: Clients who take pramlintide should not be injected into the same site where insulin is administered.
A nurse at a health care facility is caring for a patient who has been prescribed insulin for the first time. Which preadministration assessment should be performed by the nurse before the first dose of insulin is given? Assess the dental health of the patient Assess for hypoglycemic episodes General assessment of the skin Assess the hearing ability of the patient
General assessment of the skin Explanation: The nurse should perform a general assessment of the skin, mucous membranes, and extremities of the patient 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 patient has not received any insulin or oral antidiabetic drugs. The nurse need not assess the dental health or the hearing ability of the patient as these are not pertinent to insulin administration.
A nurse is caring for a patient who has developed a hypoglycemic reaction. Which intervention should the nurse perform if swallowing and gag reflexes are present in the patient? Administer glucagon by the parenteral route. Administer the insulin via insulin pump. Administer oral antidiabetics to the patient. Give oral fluids or candy.
Give oral fluids or candy. Explanation: The nurse should administer oral fluids or candy to the hypoglycemic patient with swallowing and gag reflexes. If the patient is unconscious the nurse should administer glucose or glucagon parenterally. The nurse should administer insulin through an insulin pump to special categories of diabetic patients, such as pregnant women with diabetes and renal transplantation. Oral antidiabetic drugs are administered to patients with type 2 diabetes.
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? HbA1c Stat urine for glucose Fasting blood glucose in the AM Insulin level
HbA1c 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- to four-month period. It will also tell how well controlled the client's blood glucose is. A stat urine for glucose and an FBG in the AM will only indicate the client's current blood glucose level, not how well it is being controlled. An insulin level will not give the information needed to understand the client's control of blood glucose.
A nurse should monitor a client taking glimepiride (Amaryl) for which of adverse effects? (Select all that apply.) Lactic acidosis Edema Hypoglycemia Heartburn Nausea
Hypoglycemia Heartburn Nausea Explanation: Adverse reactions associated with sulfonylureas, like glimepiride (Amaryl), include hypoglycemia, anorexia, nausea, vomiting, epigastric discomfort, weight gain, heartburn, and various vague neurologic symptoms, such as numbness and weakness of the extremities.
The nurse is explaining the action of exenatide to a patient. Which would the nurse include? Increase in insulin resistance Increase in glucagon release Increase in GI emptying Increase in protein building
Increase in insulin resistance Explanation: Exenatide is an incretin mimetic, which increases insulin release, decreases glucagon release, stimulates the satiety center, and slows GI emptying.
A patient is receiving acarbose. What would the nurse incorporate into the teaching plan for this patient about the action of the drug? Inhibits an enzyme to delay glucose absorption Decreases insulin resistance Binds to potassium channels on pancreatic beta cells Increases the uptake of glucose
Inhibits an enzyme to delay glucose absorption Explanation: Acarbose inhibits alpha glucosidase, an enzyme, thereby delaying the absorption of glucose. Thiazolidinediones, such as rosiglitazone, decrease insulin resistance. Second-generation sulfonylureas bind to potassium channels on the pancreatic beta cells to improve insulin binding to insulin receptors and increase the number of insulin receptors. Biguanides, such as metformin, increase the uptake of glucose.
A nurse at a health care facility is assigned to administer insulin to the patient. Which intervention should the nurse perform before administering each insulin dose? Inspect the previous injection site for inflammation. Keep prefilled syringes horizontally. Check for symptoms of myalgia or malaise. Do not administer insulin kept at room temperature.
Inspect the previous injection site for inflammation. Explanation: The nurse should check the previous injection site before administering each insulin dose. The injection sites should be rotated to prevent lipodystrophy. Prefilled syringes should not be kept horizontally; they should be kept in a vertical or oblique position to avoid plugging the needle. The nurse checks for symptoms of myalgia or malaise when administration of metformin leads to lactic acidosis. Insulin should be kept at room temperature for administration. Insulin is refrigerated if it needs to be stored for up to three months for later use.
A patient is prescribed pramlintide (Symlin). How will it assist in controlling the patient's blood sugar? It slows gastric emptying. It blocks the absorption of food. It absorbs with the insulin. It increases the release of insulin.
It slows gastric emptying. Explanation: Pramlintide slows gastric emptying, helping to regulate the postprandial rise in blood sugar. Pramlintide does not block the absorption of food. Pramlintide is not absorbed by insulin. Pramlintide does not increase the release of insulin.
The nurse admits a client who has been diagnosed with diabetic ketoacidosis, and will look for what assessment findings consistent with this diagnosis? (Select all that apply.) Blood glucose 191 mg/dL Ketones in the urine Lack of thirst Flushed, dry skin Rectal pressure
Ketones in the urine Flushed, dry skin Explanation: Signs/symptoms of DKA include: elevated blood glucose levels (greater than 200 mg/dL); headache; increased thirst; epigastric pain; nausea and vomiting; hot, dry, flushed skin; restlessness; and diaphoresis. The client would not experience rectal pressure.
The nurse admits a client with type 2 diabetes who takes metformin (Glucophage), and indicates that the client has a nursing diagnosis of ineffective breathing pattern. What complication of the client's current drug therapy does the nurse believe the client is experiencing? Respiratory alkalosis Lactic acidosis Fluid overload Hyperkalemia
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.
The nurse is caring for a client, age 77 years, who has type 2 diabetes and chronic kidney disease. Which drugs will be used with great caution in this client? (Select all that apply.) Regular insulin Metformin (Glucophage) Exenatide (Byetta) Chlorpropamide (Diabinese) Miglitol (Glyset)
Metformin (Glucophage) Exenatide (Byetta) Miglitol (Glyset) Explanation: Both non-sulfonylureas and incretin mimetics are contraindicated (or used with great caution) in clients with renal disease. Also, the incretin mimetics should be used cautiously with older adults. Regular insulin and chlorpropamide, which is a sulfonylurea, can be used in clients with renal disease.
A nurse is caring for a patient with diabetes mellitus who is receiving an oral antidiabetic drug. Which of following ongoing assessments should the nurse perform when caring for this patient? Assess the skin for ulcers, cuts, and sores. Observe the patient for hypoglycemic episodes. Monitor the patient for lipodystrophy. Document family medical history.
Observe the patient for hypoglycemic episodes. Explanation: As the ongoing assessment activity, the nurse should observe the patient for hypoglycemic episodes. Documenting family medical history and assessing the patient's skin for ulcers, cuts, and sores on the body is a pre-administration assessment activity performed by the nurse. Lipodystrophy occurs if the sites of insulin injection are not rotated.
A 4-year-old female child is diabetic with a blood glucose level of 120 mg/dL. The child's mother brings her to the physician's office with symptoms of the flu and dehydration. What would the nurse expect the physician to order? Regular sodas, clear juices, and regular gelatin desserts Diet sodas, clear juices, and regular gelatin desserts IV Ringer's solution IV saline 0.9%
Regular sodas, clear juices, and regular gelatin desserts Explanation: During illness, children are highly susceptible to dehydration, and an adequate fluid intake is very important. Many clinicians recommend sugar-containing liquids (e.g., regular sodas, clear juices, regular gelatin desserts) if blood glucose values are lower than 250 mg/dL. If blood glucose values are above 250 mg/dL, diet soda, unsweetened tea, and other fluids without sugar should be given.
Which agent would a nurse expect to administer as a single oral dose in the morning? Repaglinide Rosiglitazone Exenatide Miglitol
Rosiglitazone 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 before morning and evening meals. Miglitol is given with the first bite of each meal.
A female patient has suffered from hypoglycemia twice in the past week. She states she eats one time per day and snacks the rest of the day. What education will the nurse provide for this patient? She should limit her alcohol with meals. She should increase her caloric intake frequently. She should limit her aerobic exercise. She should not eat at sporadic times.
She should not eat at sporadic times. Explanation: A regular dietary intake associated with the administration of insulin or oral hypoglycemic will prevent episodes of hypoglycemia. The patient should limit her alcohol consumption, but alcohol consumption does not contribute to hypoglycemia. The patient should not increase her caloric intake. The patient should coordinate her exercise with her dietary intake, but dietary intake is not the cause of her hypoglycemia.
A nurse is working with a newly diagnosed diabetic patient on understanding hypoglycemia and insulin reactions. Which action would be most important for the patient to understand when planning the response to an insulin reaction? Inject a prescribed dose of insulin as soon as you suspect the reaction is occurring. Stay calm and still until the reaction subsides. Notify your physician immediately. Take an oral dose of some form of glucose as soon as possible.
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 done after the administration of the glucose. Injecting insulin would cause further harm to the patient and is not an option. It is good to stay calm, but the reaction will not subside without intervention.
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 will take this medication three times a day." "I may experience some gas with this medication." "I must take this medication one hour before I eat." "I will check my blood sugar at least three times a day while I am getting used to the medication."
"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.
A 42-year-old male client is prescribed glargine insulin for management of his type 2 diabetes mellitus. The nurse caring for the client develops a teaching plan regarding glargine insulin therapy. Which statement made by the client indicates that the client needs additional teaching? "The insulin is given only once per day, at night." "I must give this insulin alone and not mix with other insulins." "The medication will peak in 3 hours." "I should not administer the insulin if it is cloudy."
"I should not administer the insulin if it is cloudy." Correct response: "The medication will peak in 3 hours." Explanation: Insulin glargine (rDNA) is characterized by a chemical structure that regulates its release from the SC tissue into the circulation, providing a relatively constant glucose-lowering effect with no pronounced peak of action over a 24-hour period. Glargine, unlike NPH, is a clear insulin, similar to regular insulin in its appearance. Extreme caution must be used not to confuse glargine with regular insulin because serious adverse effects, including hypoglycemia, can occur. Glargine must not be diluted or mixed with any other insulin or solution because its onset of action may be delayed, and the solution will become cloudy. Insulin glargine is administered subcutaneously once daily at bedtime.
Which strategy will NOT increase the therapeutic effect of insulin? All insulin should be stored in a refrigerator but never frozen. Insulin should be administered in the subcutaneous tissue. Regular insulin should be administered 30 minutes before meals. Blood glucose levels should be monitored several times per day.
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.
Stress typically results in hypoglycemia. True False
False Explanation: Stress typically leads to increased blood glucose levels due to the sympathetic nervous system control.
A female client is a newly diagnosed diabetic. She is a stay-at-home mother and responsible for meal planning and management of the home. What will the home care nurse teach this client? (Select all that apply.) - Instruct the client to go to the emergency department immediately if she develops a cold or upper respiratory infection. - Assist the client in making menus that will meet the needs of both the client and the family. - Watch the client draw up and administer her insulin. - Reinforce instructions on dealing with hypoglycemia. -Encourage the client to check her blood glucose every hour.
Assist the client in making menus that will meet the needs of both the client and the family. Watch the client draw up and administer her insulin. Reinforce instructions on dealing with hypoglycemia. Explanation: The home care nurse would assist the client and family to know how to plan meals that meet the needs of the client and the family. The nurse would also want to assure that the client knows how to administer insulin correctly and would need to make sure that the client understands how to deal with hypoglycemia.
Which insulin would the nurse need to administer as a separate injection if the order also included NPH insulin? Glargine Regular Lente Lispro
Glargine Explanation: Insulin glargine cannot be mixed in solution with any other insulin.
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? Administer 1 amp of 50% dextrose IV. Administer 10 units of regular insulin subcutaneously. Perform a blood sugar analysis. Have the client drink a glass of orange juice.
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.
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? Administer regular insulin subcutaneously. Give 8 oz orange juice. Place glucose gel between the gums and cheek. Raise the head of the bed.
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.
A patient at a health care facility has been prescribed diazoxide for hypoglycemia due to hyperinsulinism. What adverse reactions to the drug should the nurse monitor for in the patient? Myalgia Tachycardia Flatulence Epigastric discomfort
Tachycardia Explanation: The nurse should monitor for tachycardia, congestive heart failure, sodium and fluid retention, hyperglycemia, and glycosuria as the adverse reactions in the patient receiving diazoxide drug therapy. Myalgia, fatigue, and headache are the adverse reactions observed in patients undergoing pioglitazone HCl drug therapy. Flatulence is one of the adverse reactions found in patients receiving metformin drug therapy. Epigastric discomfort is one of the adverse reactions observed in patients receiving acetohexamide drugs.
