Pharm Prep U chapter 38
Glyburide
Which would a nurse identify as an example of a sulfonylurea? Glyburide Metformin Acarbose Miglitol
t is possible with weight loss and exercise to discontinue the use of antidiabetic medication
Which would be appropriate to include in teaching a client with type 2 diabetes? Until you need to start insulin injections, you do not have to check your blood sugar. Clients with type 2 diabetes always progress to insulin injections if they do not follow dietary guidelines. It is possible with weight loss and exercise to discontinue the use of antidiabetic medication. If you drink alcohol, it may be necessary to increase your oral antidiabetic medication
The medication will peak in 3 hours."
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."
Entry of glucose into the cells
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
liver enzymes
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 platelet count d-dimer creatinine
insulin glargine
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 insulin lispro insulin aspart isophane insulin suspension
incretins
Insulin is a hormone released by the pancreatic beta cells in response to a rise in glucose levels and what else? the release of glucagon incretins delayed entry of glucose into cells storage of incretins in cells
weakness, sweating, and decreased mentation.
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? increased pulse rate and fruity smelling breath. decreased respiratory rate and hot, dry skin. weakness, sweating, and decreased mentation. increased thirst and increased urine output.
Administration of a prescribed suppository for the management of nausea Implementation of aspiration precautions Ready access to supplemental oxygen
A client has been prescribed glucagon for the management of hypoglycemia. Which nursing interventions should the nurse be prepared to provide this client for the management of possible adverse effects? Select all that apply. Administration of a prescribed suppository for the management of nausea Implementation of aspiration precautions Monitor for cardiac arrhythmias Provide prescribed analgesic for headache Ready access to supplemental oxygen
oral
A client is prescribed sitagliptin. The nurse would expect to administer this drug by which route? Oral Subcutaneous Intramuscular Intravenous
insulin lispro (insulin lispro has a 15-minute onset of action. NPH, 70/30, and regular insulin have longer onsets of action, a later peak, and a longer duration of action.)
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 isophane (NPH) isophane (NPH) Humulin R
Client's average blood glucose is above normal.
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 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.
Subcutaneous injection
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? Jet injector Insulin pen External pump Subcutaneous injection
Regular (Humulin R)
A student asks the nursing instructor what insulin has the quickest therapeutic effect once administered. What would be the bestresponse? PZI (Humulin U) NPH (Humulin N) Regular (Humulin R) Ultralente (Humulin U Ultralente)
06:45 (With short-acting insulins like lispro, aspart, or glulisine, it is important to inject the medication about 15 minutes before eating.)
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? 06:00 06:20 06:45 07:00
nsulin is needed because the beta cells of the pancreas are no longer functioning.
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? A diagnosis of hypertension The ingestion of carbohydrates Allergy to sulfonamides Increase in alkaline phosphatase
HbA1c
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 Stat urine for glucose Fasting blood glucose in the AM Insulin level
Check the dosage with another nurse.
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? Administer the insulin to the client. Check the dosage with another nurse. Check the client's blood sugar again. Ensure a meal tray is available.
garlic (Garlic has been known to cause hypoglycemia when taken with antidiabetic medications. Anise, basil, and oregano are not noted to carry this risk.)
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 Anise Basil Oregano
Lifelong exogenous insulin is required.
The two major classifications of diabetes are type 1 and type 2. What is a distinguishing characteristic of type 1 diabetes? Blood glucose level can be controlled with diet. Lifelong exogenous insulin is required. Oral agents can control the disease process. It always starts in childhood.
It slows the rate of inactivation of the incretin hormones.
What is the expected action of sitagliptin on type 2 diabetes? It blocks the S phase of the cell cycle. It slows the rate of inactivation of the incretin hormones. It is a synthetically prepared monosodium salt. It inhibits hydrogen, potassium, and ATPase.
regular
When considering the management of diabetic ketoacidosis (DKA), what type of insulin can be administered intravenously? regular isophane insulin (NPH) lispro insulin glargine
hyperglycemia.
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: hypokalemia. hyperkalemia. hypoglycemia. hyperglycemia.
Massaging the site after removing the needle
Which would be least appropriate when administering insulin by subcutaneous injection? Using a 25 gauge 1/2-inch needle Inserting the needle at a 45-degree angle Injecting the insulin slowly Massaging the site after removing the needle
the past 3 or 4 months
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 past 7 to 10 days the past 1 or 2 months the past 12 to 24 hours
Assess the most recent hemoglobin A1C levels.
A client who began treatment for type 2 diabetes 8 months ago is now meeting with a diabetic nurse for a scheduled follow-up. How can the nurse best assess the client's glycemic control since beginning treatment? Assess the most recent hemoglobin A1C levels. Arrange to have the client's random blood glucose measured. Dialogue with the client about implemented management strategies. Review and discuss the data contained in the client's written blood glucose log.
Select one anatomic area for regular insulin injections and then use serial locations within that area.
A nurse is instructing a patient in the administration of regular insulin by the subcutaneous route. Which strategy would the nurse suggest if the goal is to promote absorption of the regular insulin? Rotate injection sites by using the arm one day, the stomach the next day, and the thigh the day after and then repeating the cycle. Select one injection site for regular insulin injections and use it exclusively. Administer the medication 30 to 60 minutes after a meal. Select one anatomic area for regular insulin injections and then use serial locations within that area.
Orange or other fruit juice Glucose tablets hard candy
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.) Orange or other fruit juice Glucose tablets Insulin glargine (Lantus) Hard candy Insulin detemir (Levemir)
Hypoglycemia
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? Bradycardia Lipodystrophy Hypoglycemia Hypotension
Insulin is needed because the beta cells of the pancreas are no longer functionin
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 insulin is more effective in establishing control of blood glucose levels initially. More insulin is needed than that which the client can produce naturally. The client most likely does not exercise enough to control his glucose levels.
"I'm disappointed, but I take some solace in the fact that I won't ever have to have insulin injections."
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 don't like getting this diagnosis, but I know that treatment now can prevent future health consequences." "I'm disappointed, but I take some solace in the fact that I won't ever have to have insulin injections." "People always tried to encourage me to lose weight, and I suppose they might have been right." "From what I've learned, I know that the basic problem is that my pancreas can't keep up with my insulin needs."
Lactic acidosis
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? Deficient fluid volume Lactic acidosis Fluid overload Hyperkalemia
06:45
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? 06:00 06:20 06:45 07:00
Allergy to sulfonamides
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? A diagnosis of hypertension The ingestion of carbohydrates Allergy to sulfonamides Increase in alkaline phosphatase
Inhibits an enzyme to delay glucose absorption
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 Decreases insulin resistance Binds to potassium channels on pancreatic beta cells Increases the uptake of glucose
the past 3 or 4 months
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 past 7 to 10 days the past 1 or 2 months the past 12 to 24 hours
Inspect the previous injection site for inflammation.
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.
Observe the patient for hypoglycemic episodes.
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.
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.
liver enyzmes
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 platelet count d-dimer creatinine
weakness, sweating, and decreased mentation. ( Symptoms of hypoglycemia include shakiness, dizziness or light-headedness, sweating, nervousness or irritability, sudden changes in behavior or mood, weakness, pale skin, and hunger.)
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? increased pulse rate and fruity smelling breath. decreased respiratory rate and hot, dry skin. weakness, sweating, and decreased mentation. increased thirst and increased urine output.
Regular insulin (Regular insulin has rapid onset of action and can be given via IV. It is the drug of choice for acute situations, such as diabetic ketoacidosis. Isophane insulin (NPH) is used for long-term insulin therapy. Lente insulin is an intermediate-acting insulin. Ultralente insulin is a long-acting insulin.)
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? NPH insulin Lente insulin Ultralente insulin Regular insulin
it slows the rate of inactivation of the incretin hormones.
What is the expected action of sitagliptin on type 2 diabetes? It blocks the S phase of the cell cycle. It slows the rate of inactivation of the incretin hormones. It is a synthetically prepared monosodium salt. It inhibits hydrogen, potassium, and ATPase.
It is possible with weight loss and exercise to discontinue the use of antidiabetic medication.
Which would be appropriate to include in teaching a client with type 2 diabetes? Until you need to start insulin injections, you do not have to check your blood sugar. Clients with type 2 diabetes always progress to insulin injections if they do not follow dietary guidelines. It is possible with weight loss and exercise to discontinue the use of antidiabetic medication. If you drink alcohol, it may be necessary to increase your oral antidiabetic medication.
Take an oral dose of some form of glucose as soon as possible.
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? 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 health care provider immediately. Take an oral dose of some form of glucose as soon as possible.
