Pharm Exam 2 part 1

A teaching plan for a patient who is taking lispro [Humalog] should include which instruction by the nurse?

"Inject this insulin with your first bite of food, because it is very fast acting." (-onset of action of 15 to 30 minutes with a peak action of about 2 hours -Lispro insulin must be combined with an intermediate- or a long-acting insulin, not regular insulin (which also is a short-duration insulin), for glucose control between meals and at night.)

Your patient needs to eat how much of his plate to recieve nutritional doses of insulin?

1/2 of his carbohydrates

"In treating your patient for hypoglycemia, you should give:"

4 ounces of water with 4 packets of sugar

A patient is scheduled to start taking insulin glargine [Lantus]. On the care plan, a nurse should include which of these outcomes related to the therapeutic effects of the medication?

Blood glucose control for 24 hours

A patient who took NPH insulin at 0800 reports feeling weak and tremulous at 1700. Which action should the nurse take?

Check the patient's capillary blood sugar

Before administering metformin [Glucophage], the nurse should notify the prescriber about which laboratory value?

Creatinine (Cr) level of 2.1 mg/dL (Metformin can reach toxic levels in individuals with renal impairment, which is indicated by a rise in the serum creatinine level.)

Your patient is hypoglycemic, and is NPO, but has a heparin lock. How do you treat him for hypoglycemia?

D50, 12.5 gms STAT via heparin lock

A patient newly diagnosed with type 1 diabetes asks a nurse, "How does insulin normally work in my body?" The nurse explains that normal insulin has which action in the body?

It promotes the passage of glucose into cells for energy.

A patient who has type 2 diabetes is taking repaglinide [Prandin]. Which response should a nurse expect the patient to have if the medication is achieving the desired therapeutic effect?

Promotion of insulin secretion (used as an adjunct to calorie restriction and exercise to maintain glycemic control in patients with type 2 diabetes.)

A patient who has type 2 diabetes has a glycated hemoglobin A1c (HbA1c) of 10%. The nurse should make which change to the nursing care plan?

Refer the patient to a diabetes educator because the result reflects poor glycemic control. (Glycated hemoglobin (HbA1c) is a measure of plasma glucose levels on average over the previous 2- to 3-month period. The target value is 6.5% or lower.)

A patient is taking glipizide [Glucotrol] and a beta-adrenergic medication. A nurse is teaching hypoglycemia awareness and should warn the patient about the presence of which symptom?

Tachycardia

If you patient is receiving a bolus tube feeding, does this patient get nutritional insulin?

Yes, but only if the patient is tolerating the tube feeding and has minimal residual

Glargine is a long acting insulin that is unique because it has a:

a slow sustained action

Your patient is ordered fingersticks AC and HS. He is just made NPO, you will now check his fingersticks:

every 4 hours

"Tom is on Acarbose, and appears hypoglycemic. Your next action is to:"

give oral glucose tablets

Aspart has an onset of action:

immediate

Metformin (Glucophage) works by:

increasing glucose uptake by muscles/fat and decreasing hepatic glucose production

"In giving a dose of insulin each morning, the rationale for rotating the injection within the site is to:"

maintain absorption consistency

Your patient is on Metformin. You suspect that he has lactic acidosis. Signs and symptoms of this can be:

nausea (p686)

Your patient is hypoglycemic, after treating him for hypoglycemia with 4 oz of juice, what do you do next?

notify the prescriber of the hypoglycemia (and document) check the glucose in 15 minutes Once the recheck of the fingerstick is normal (above 70 mg/dl), check glucose every 2 hours x 3

Exenatide (Byetta) works by mimicing the release of incretins. As a nurse you know that it is excreted unchanged in the urine. This is concerning if:

the patient has renal failure

"You suspect that your patient may be exhibiting hyperglycemia, the following is a sign of hyperglycemia"

thirst