NUR 2144 Pharmacology II Ch 38 - Agents to control blood glucose levels

Which would be appropriate to include in teaching a client with type 2 diabetes?

It is possible with weight loss and exercise to discontinue the use of antidiabetic medication.

The Hba1c blood test is a good measure of overall glucose control because:

It reflects a 3 - month average glucose level in the body ideally 7

A client with a diagnosis of diabetes is prescribed pramlintide. How will this drug assist in controlling the client's blood sugar?

It slows gastric emptying.

What would alert the nurse to suspect that a client is developing ketoacidosis?

Fruity breath odor

The nurse is providing education to a client who has been prescribed therapy with an antidiabetic medication. During teaching, the nurse will caution the client against heavy intake of which herb?

Garlic

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?

Give oral fluids or candy.

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?

Glucagon

Which would a nurse identify as an example of a sulfonylurea?

Glyburide

Which is the best indicator of overall diabetic control?

Glycosylated hemoglobin levels

When considering the management of diabetic ketoacidosis (DKA), what type of insulin can be administered intravenously?

regular

A client receives a dose of insulin lispro at 8 AM. The nurse would be alert for signs and symptoms of hypoglycemia at which time?

Between 8:30 AM and 9:30 AM

What hormone, secreted with insulin, increases satiety and suppresses glucagon secretion?

Amylin

A nurse is preparing to administer a rapid-acting insulin. Which medication would the nurse most likely administer?

insulin lispro

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."

Which medication would a nurse identify as a noninsulin injectable antidiabetic drug?

Exenatide

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."

A nurse is providing client education to a 13-year-old girl who was just diagnosed with type 1 diabetes mellitus. Which statement by the client will alert the nurse that special instructions regarding insulin are necessary?

"I am on the middle school track team."

A client newly diagnosed with type 2 diabetes has attended educational sessions to provide insight into the diagnosis. Which of the client's statements should prompt the nurse to provide further teaching?

"I'm disappointed, but I take some solace in the fact that I won't ever have to have insulin injections."

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?

"Insulin assists glucose molecules to enter the cells of muscle and fat tissues."

A client has been newly diagnosed with type 2 diabetes. What statement would be appropriate for the nurse to include in the teaching?

"Regular exercise makes your body better able to use the insulin it produces."

The client is scheduled to get a breakfast tray at 07:00. At what time should the client receive a prescribed dose of insulin lispro?

06:45

The nurse assesses a client's blood glucose level after administering insulin. Which result would the nurse interpret as indicative of severe hypoglycemia?

34 mg/dL

The nurse is caring for a client who has been prescribed glyburide. Which factor, if identified in the client history, would cause the nurse to inform the health care provider of a contraindication to use?

Allergy to sulfonamides

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

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.)

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.

A nurse is caring for a 48-year-old woman who has been hospitalized after injecting the wrong type of insulin. Which sign of hypoglycemia will the nurse be careful to observe for?

Blurred vision

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?

Check the dosage with another nurse.

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

A female client visits the health care provider's office after routine labs are drawn. The nurse notes that her A1C is 9. How does the nurse interpret this finding?

Client's average blood glucose is above normal.

As the nurse caring for a young child is diagnosed with type 1 diabetes (IDDM), you know that they become at high risk for what and you include assessment and management of this in their care plan?

Delayed growth and development

After teaching a group of students about the various insulin preparations, the instructor determines that the teaching was successful when the students identify that which type of insulin cannot be mixed with other types?

Detemir

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?

Do not give pramlintide in the same site where insulin is administered.

The nurse is interviewing a client who was diagnosed with type 2 diabetes four months ago. The client does not record glucometer readings. What laboratory test does the nurse anticipate the health care provider will order for this client?

HbA1c

A client is receiving acarbose. What would the nurse incorporate into the teaching plan for this client about the action of the drug?

Inhibits an enzyme to delay glucose absorption

When administering insulin, what would be most appropriate?

Insert the needle at a 45-degree angle for injection.

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.

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 glargine (Lantus) Insulin detemir (Levemir)

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

The two major classifications of diabetes are type 1 and type 2. What is a distinguishing characteristic of type 1 diabetes?

Lifelong exogenous insulin is required.

Which would be least appropriate when administering insulin by subcutaneous injection?

Massaging the site after removing the needle

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?

Observe the patient for hypoglycemic episodes.

A client is prescribed sitagliptin. The nurse would expect to administer this drug by which route?

Oral

A client diagnosed with type 1 diabetes suddenly reports feeling weak, shaky, and dizzy. What should be the nurse's initial response?

Perform a blood sugar analysis.

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.

A patient with hyperglycemia will often present with

Polyuria - abnormally large volume of dilute urine Polydipsia - abnormally great thirst Polyphagia - excessive appetitie

A student asks the nursing instructor what insulin has the quickest therapeutic effect once administered. What would be the best response?

Regular (Humulin R)

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.)

Reinforce instructions on dealing with hypoglycemia. 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.

Treatment of diabetes may include:

Replacement therapy with insulin Diet and exercise program

Which agent would a nurse expect to administer as a single oral dose in the morning?

Rosiglitazone

Which condition must be met in order for glyburide treatment to be effective?

The client must have functioning pancreatic beta cells.

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?

Widespread changes in the blood vessels

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

The nurse educator works at the diabetes clinic. When talking to a class of adolescent diabetics, the educator tells the students that the most recognized signs of diabetes are:

hyperglycemia and glycosuria.

When reviewing the medication list of a client being seen in the clinic, the nurse notes that the client is receiving glipizide. Based on the nurse's understanding, this drug is used to treat:

hyperglycemia.

After reviewing information about different insulin preparations, a nursing student demonstrates understanding of the information when the student identifies which medication as an example of a long-acting insulin?

insulin glargine

A client's current condition requires rapid reduction of blood sugar levels. Which type of insulin will have the most rapid onset of action?

insulin lispro

A client with diabetes is undergoing testing for glycosylated hemoglobin. The nurse instructs the client that this test measures average blood glucose over what time period?

the past 3 or 4 months

The demonstration of what symptom would suggest that an insulin-dependent client is experiencing a hypoglycemic reaction? Select all that apply.

weakness diaphoresis mental confusion increased pulse rate

The nurse is caring for a client who is taking insulin. The nurse suspects the client is experiencing hypoglycemia when the client displays what signs?

weakness, sweating, and decreased mentation.

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 medication will peak in 3 hours."

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?

Entry of glucose into the cells

The nurse is working with a client who uses an insulin pump for management of type 1 diabetes. The nurse should remind the client that the needle on the pump needs to be changed how often?

Every 1-3 days

The nurse is providing education to the parents of a child newly diagnosed with type 1 diabetes. What distinguishing characteristic of the disorder does the nurse include in the teaching?

Exogenous insulin is required for life.

The nurse monitoring a client receiving insulin glulisine notices the client has become confused, diaphoretic, and nauseated. The nurse checks the client's blood glucose and it is 60 mg/dL (3.33 mmol/L). Which can a nurse give to treat a client with a hypoglycemic episode? (Select all that apply.)

Glucose tablets Hard candy Orange or other fruit juice

The nurse is preparing to administer 20 units of NPH insulin to a client. Before administering the medication, the nurse should implement which intervention?

Have a colleague confirm the dosage.

The nurse is explaining the action of exenatide to a patient. Which would the nurse include?

Increase in insulin release

When describing the effects of incretins on blood glucose control to a group of students, which would an instructor include?

Increases insulin release

A client newly diagnosed with type 1 diabetes asks the nurse why the client cannot just take a pill. The nurse would incorporate what knowledge when responding to this client?

Insulin is needed because the beta cells of the pancreas are no longer functioning.

The nurse admitted a 4-year-old child with type 1 diabetes mellitus. The nurse educates the parents that hypoglycemia can occur as an adverse effect of insulin. The nurse helps the parents to understand that in young children, hypoglycemia may manifest as what signs or symptoms? (Select all that apply.)

Irritability Impaired mental functioning Lethargy

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?

It is a complicated disorder that alters the metabolism of glucose.

What is the expected action of sitagliptin on type 2 diabetes?

It slows the rate of inactivation of the incretin hormones.

A client, who experienced hypoglycemia twice in the past week, eats one meal per day and snacks the rest of the day. What client education will the nurse provide for a client who reports regularly experiencing hypoglycemic symptoms?

Meals should be eaten at regular times.

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 what as a biguanide?

Metformin

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.

The school nurse identifies more children with type 2 diabetes each year and recognizes that this trend is mainly attributed to what issue?

Obesity and inadequate exercise

The nurse is preparing to administer insulin intravenously to a client with a blood glucose level over 600 mg/dL (33.33 mmol/L). What type of insulin will the nurse most likely give?

Regular insulin

A client diagnosed with diabetic ketoacidosis has been admitted to the intensive care unit. The client is prescribed an intravenous insulin drip, so the nurse knows that what type of insulin will be administered?

Regular.

A nurse is preparing an in-service presentation for a group of staff members on diabetes. Which would the nurse include as the primary delivery system for insulin?

Subcutaneous injection

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

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?

Tachycardia

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.

A client diagnosed with type 2 diabetes several months ago 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 blood glucose levels.

Rosiglitazone is being considered for the treatment of diabetes in an adult client. Before the initiation of rosiglitazone therapy, the nurse should review what laboratory work recently drawn?

liver enzymes

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?

Hyperglycemia

The health care provider has ordered a change of prescription from rapid-acting insulin to an intermediate-acting type. Which adverse effect must the nurse closely monitor for in the client?

Hypoglycemia