Antidiabetic 3

NPH (humulin N, Novolin N)

onset 1-2 hours, peak 6-12 hours

regular insulin

onset 30 min, peak 2.5-5 hours

Insulin aspart (rDNA origin) (novolog)

onset 5-15 min, peak 1-3 hours

Lispro (humalog), /Insulin glulisine (apidra)

onset 5-15, peak 30-90 min

Which early symptoms of hypoglycemia does the nurse instruct the patient's family to treat with a fast-acting carbohydrate source? Select all that apply. 1 Confusion 2 Nervousness 3 Tremor 4 Sweating 5 Coma

1 Confusion 2 Nervousness 3 Tremor 4 Sweating Early symptoms of hypoglycemia involve the central nervous system, because the brain needs a constant supply of glucose to function. Hence confusion, nervousness, tremors, and sweating are symptoms seen in patients. When these symptoms occur, the family should have the patient immediately ingest a fast-acting carbohydrate source such as glucagon, milk, or juice. Coma occurs if the patient's glucose levels are not restored.

Which conditions in a patient with diabetes mellitus are indicative of diabetic ketoacidosis? Select all that apply. 1 Extreme hyperglycemia 2 Polyuria 3 Severe hypothermia 4 Extreme thirst 5 Kussmaul breathing

1 Extreme hyperglycemia 2 Polyuria 4 Extreme thirst 5 Kussmaul breathing If the body is unable to produce insulin, fatty acids are used for fuel, which produces ketones as a metabolic by-product. When this happens to a sufficient degree, it results in diabetic ketoacidosis. It involves extreme hyperglycemia, polyuria, extreme thirst, and Kussmaul breathing (deep, rapid, labored, distressed, dyspneac). Hypothermia is seen in cases of hypoglycemia.

Which hormones play a role in regulation of glucose homeostasis? Select all that apply. 1 Insulin 2 Glucagon 3 Glycogen 4 Dextrose 5 Ketone

1 Insulin 2 Glucagon Insulin and glucagon are the hormones produced by the pancreas that play an important role in the regulation of glucose homeostasis. They are responsible for the use, mobilization, and storage of glucose by the body. Excessive glucose in the blood is converted into glycogen and stored in the liver. When the body breaks down fatty acids for fuel, ketones are produced as a metabolic by-product. Dextrose is the simplest form of carbohydrate found in the body.

Which are rapid-acting insulins that can be administered to patients with diabetes mellitus? Select all that apply. 1 Lispro (Humalog) 2 Regular insulin (Humulin R) 3 Aspart (NovoLog) 4 Glulisine (Apidra) 5 Glargine (Lantus)

1 Lispro (Humalog) 3 Aspart (NovoLog) 4 Glulisine (Apidra) Lispro (Humalog), Aspart (NovoLog), and Glulisine (Apidra) are rapid-acting insulins that have an onset of action of 15 minutes. Regular insulin (Humulin R) is a short-acting insulin that has an onset of action of 30 to 60 minutes. Glargine (Lantus) is a long-acting insulin which is dosed every 12 hours depending on the patient's glycemic response.

Which factor contributes to the onset of type 2 diabetes mellitus? 1 Obesity 2 Genetics 3 Viral infection 4 Environmental conditions

1 Obesity Obesity contributes to the onset of type 2 diabetes mellitus. Obesity causes stress in the endoplasmic reticulum, which suppresses the signals of insulin receptors. Genetic factors, viral infections, and environmental conditions are factors that contribute to the onset of type 1 diabetes mellitus.

Which site should be used for injecting insulin for the most consistent absorption? 1 Abdomen 2 Deltoid 3 Vastus lateralis 4 Gluteus maximus

1 Abdomen The abdomen has the most consistent absorption capacity because the blood flow to subcutaneous tissue is not as affected by muscular movements. The deltoid is used for immunization of children and adults. The vastus lateralis is used for immunization of infants. The gluteus maximus is not recommended for injections because of its close proximity to the sciatic nerve and major blood vessels.

What instruction will the nurse give when a patient receiving metformin (Glucophage) therapy will undergo angiography? 1 "Do not take your metformin on the day of the test." 2 "You can take the medication an hour after the test." 3 "There are chances of renal failure after the test." 4 "You blood glucose levels need to be reevaluated."

1 "Do not take your metformin on the day of the test." Angiography uses iodinated (iodine-containing) radiologic contrast media, which interact with metformin and may cause acute renal failure or lactic acidosis. Hence the nurse instructs the patient to discontinue the drug on the day of the test. Metformin can be taken 48 hours after the test to prevent any adverse effects. There are chances of renal failure after the test only if metformin is taken during the test. Blood glucose levels are regularly evaluated in diabetic patients, but it is not a priority in this case.

Which lifestyle changes will the nurse instruct the patient to implement in order to successfully manage diabetes mellitus? Select all that apply. 1 "Reduce the amount of alcohol you consume." 2 "Incorporate daily physical exercise into your life." 3 "Decrease the amount of carbohydrates in your diet." 4 "Restrict potassium and sodium in your diet." 5 "Include rest periods between physical activities."

1 "Reduce the amount of alcohol you consume." 2 "Incorporate daily physical exercise into your life." 3 "Decrease the amount of carbohydrates in your diet." Alcohol is limited because it is broken down into simple carbohydrates and can elevate the patient's blood glucose levels. The patient needs to perform physical exercises every day to help lower glucose levels. The nurse advises the patient to decrease the amount of carbohydrates in the diet to lower blood glucose levels. Potassium and sodium are restricted in cardiac patients. Adequate rest is required for respiratory patients to prevent respiratory complications due to physical activity.

The nurse is teaching a patient who has been prescribed repaglinide (Prandin). Which information will the nurse include in the teaching plan? 1 "You will need to be sure you eat as soon as you take this medication." 2 "This medication is compatible with all of your cardiac medications." 3 "This medication will not cause hypoglycemia."

1 "You will need to be sure you eat as soon as you take this medication." Repaglinide (Prandin) is short-acting. The drug's very fast onset of action allows patients to take the drug with meals and skip a dose when they skip a meal. Prandin interacts with beta-adrenergic blockers as well as other medications. Hypoglycemia is a side effect of this medication, and there are many other possible side effects of this medication.

An operating room nurse prepares a patient who has type 2 diabetes for surgery. Which type of insulin does the nurse administer? 1 Regular insulin (Humulin R) 2 Isophane insulin suspension (NPH insulin) 3 Insulin zinc suspension (Lente Insulin) 4 Insulin glargine (Lantus)

1 Regular insulin (Humulin R) Regular insulin (Humulin R) is the only type of insulin that can be given intravenously. The other variants of insulin, including isophane insulin suspension (NPH insulin), insulin zinc suspension (Lente Insulin), and insulin glargine (Lantus) are administered through the subcutaneous route.

What will the nurse assess for in a patient who is prescribed pioglitazone (Actos), insulin, and a sulfonylurea? 1 Symptoms of congestive heart failure 2 Constant elevated blood glucose levels 3 A pioglitazone-sulfonylurea interaction 4 Interaction between pioglitazone and insulin

1 Symptoms of congestive heart failure Interaction between pioglitazone and insulin Pioglitazone (Actos) increases the risk of heart failure in patients. Hence the nurse needs to assess for the symptoms of heart failure so that the drug can be changed if necessary. Pioglitazone (Actos) is used for the management of type 2 diabetes or elevated glucose levels. Pioglitazone (Actos) can be combined with insulin as well as sulfonylurea for a synergistic effect.

What will the nurse teach a patient who takes isophane suspension (NPH) insulin? 1 "Unused vials can be stored in the refrigerator for 5 months." 2 "You should eat 30 to 45 minutes after taking the NPH insulin." 3 "You need to obtain your blood glucose levels every hour." 4 "Discontinue insulin if you are undergoing diagnostic studies."

2 "You should eat 30 to 45 minutes after taking the NPH insulin." Insulin isophane suspension (NPH) is an intermediate-acting insulin product that has an onset of action of 1 to 2 hours. Hence the nurse instructs the patient to eat meals 30 to 45 minutes before administering the injection. Unused vials are stored in the refrigerator for only 3 months to maintain drug stability. It is not necessary to stop insulin for any diagnostic tests, because insulin does not interact with any agents used in diagnostic tests.

What is the best method of administering glipizide (Glucotrol)? 1 With food 2 30 minutes before a meal 3 15 minutes postprandial 4 At bedtime

2 30 minutes before a meal Glipizide (Glucotrol) is the only sulfonylurea agent that should be administered 30 minutes before a meal. This is because the insulin secreted by the drug corresponds with the elevation in blood glucose concentrations induced by the meal. Food inhibits the absorption of glipizide (Glucotrol). Hence, it cannot be administered with food or in a postprandial stage or at bedtime.

What is the nurse's best action when finding a patient with type 1 diabetes mellitus unresponsive, cold, and clammy? 1 Administer subcutaneous regular insulin immediately. 2 Administer glucagon. 3 Start an insulin drip. 4 Draw blood glucose level and send to the laboratory.

2 Administer glucagon. Glucagon stimulates glycogenolysis, raising serum glucose levels. The patient is showing signs of hypoglycemia. The nurse should not administer any form of inuslin because the patient's blood glucose could further decrease. The nurse should not take the time to send a glucose to the lab before acting, however, a fingerstick blood glucose could help to guide care.

Which insulin will the nurse administer to supplement basal insulin to imitate the pancreatic surge of insulin that accompanies eating? 1 Insulin glargine (Lantus) 2 Insulin glulisine (Apidra) 3 Insulin detemir (Levemir) 4 Neutral protamine Hagedorn (NPH) insulin (Humulin N

2 Insulin glulisine (Apidra) The nurse should administer a rapid-acting form of regular insulin, such as insulin glulisine (Apidra), because the onset of action occurs 15 minutes after its administration. Insulin glargine (Lantus) and insulin detemir (Levemir) are basal insulins. NPH insulin (Humulin N) is an intermediate-acting insulin that would take too long to act in this condition.

The nurse administers insulin to a patient at 8:30 am and knows it will peak about 2.5 hours after administration. Which insulin did the nurse administer if this is true? 1 Insulin lispro (Humalog) 2 Regular insulin (Humulin R) 3 Insulin aspart (Novo-Log) 4 Insulin glulisine (Apidra)

2 Regular insulin (Humulin R) Regular insulin (Humulin R) peaks about 2.5 hours after the drug's administration. If the drug is given at 8:30 am, it will have its peak effects at 11:00, and at that time the nurse would observe for signs of hypoglycemia. Insulin lispro (Humalog), insulin aspart (Novo-Log), and insulin glulisine (Apidra) are all considered rapid-action insulin. The onset of action for these drugs is about 15 minutes and the effects do not last as long as other classes of insulin.

Which antidiabetic drug can be taken in combination with metformin? 1 Miglitol (Glyset) 2 Repaglinide (Prandin) 3 Canagliflozin (Invokana) 4 Pioglitazone HCl (Actos)

2 Repaglinide (Prandin) Repaglinide (Prandin) can be taken in combination with metformin, which increases the beta cell secretion of insulin. Miglitol (Glyset) can be taken in combination with sulfonylurea. Canagliflozin (Invokana) can be taken in combination with exercise and diet to manage diabetes. Pioglitazone HCl (Actos) can be taken in combination with sulfonylureas.

The nurse observes that A1C levels are elevated in a patient who is taking metformin (Glucophage) for type 2 diabetes. Which class of drugs is likely to be prescribed to this patient? 1 Incretin mimetics 2 Sulfonylureas 3 Alpha-glucosidase inhibitors 4 Dipeptidyl peptidase-IV inhibitors

2 Sulfonylureas Sulfonylureas are prescribed to a patient whose A1C levels are elevated even after taking metformin. The drugs bind to specific receptors on beta cells in the pancreas to stimulate the release of insulin. Incretin mimetics are used to reduce postprandial glucagon production. The alpha-glucosidase inhibitors are used to control high postprandial glucose levels. The dipeptidyl peptidase-IV inhibitors are indicated as an adjunct to diet and exercise to improve glycemic control.

Which drug is an example of intermediate-acting first-generation sulfonylurea? 1 Glipizide (Glucotrol) 2 Tolazamide (Tolinase) 3 Tolbutamide (Orinase) 4 Chlorpropamide (Diabinese)

2 Tolazamide (Tolinase) Tolazamide (Tolinase) is an example of an intermediate-acting first-generation sulfonylurea. Glipizide (Glucotrol) is an example of a second-generation sulfonylurea. Tolbutamide (Orinase) is an example of a short-acting first-generation sulfonylurea. Chlorpropamide (Diabinese) is an example of a long-acting first-generation sulfonylurea.

Which statement indicates to the nurse that the patient needs additional teaching on oral hypoglycemic agents? 1 "I will limit my alcohol consumption." 2 "I will report symptoms of fatigue and loss of appetite." 3 "I will take the medication only when I need it." 4 "I will monitor my blood sugar daily."

3 "I will take the medication only when I need it." Oral hypoglycemic agents must be taken on a daily scheduled basis to maintain euglycemia and prevent long-term complications of diabetes. When alcohol is ingested with certain oral hypoglycemic drugs, the hypoglycemic effect can be intensified. The patient may experience fatigue and loss of appetite as side effects of the medication, and these should be reported to the health care provider. The patient needs to closely monitor blood sugar.

What will the nurse teach a patient who is prescribed repaglinide (Prandin) for type 2 diabetes? 1 "Skipping two doses will cause hypoglycemia." 2 "You can skip one dose if you eat three meals." 3 "You need to eat a meal after each dose." 4 "You can take sulfonylureas with repaglinide."

3 "You need to eat a meal after each dose." The nurse instructs the patient to eat a meal after each dose, because skipping a meal can cause hypoglycemia. Skipping two doses of repaglinide will cause hyperglycemia in the patient, because glucose levels will increase. The dose must be taken before each meal, and skipping either the meal or the dose will fluctuate the glucose levels in the body. Repaglinide is not combined with sulfonylureas, because they share a similar mechanism of action.

A patient receives isophane suspension (neutral protamine Hagedorn [NPH]) insulin at 8:00 am. The patient eats breakfast at 8:30 am, lunch at noon, and dinner at 6:00 pm. At what time is this patient at the highest risk for hypoglycemia? 110:00 am 2 2:00 pm 3 5:00 pm 4 8:00 pm

3 5:00 pm Breakfast eaten at 8:30 am would cover the onset of isophane suspension (NPH) insulin, and lunch will cover the 2:00 pm time frame. If the patient does not eat a mid-afternoon snack, however, the NPH insulin may peak just before dinner without sufficient glucose on hand to prevent hypoglycemia.

The nurse is caring for a patient who has been taking metformin (Glucophage) for several months. The patient reports abdominal pain. Upon assessment, the nurse detects an irregular heartbeat. What else will the nurse assess to determine the severity of the patient's condition? 1 Renal function 2 Vitamin B12 levels 3 Blood glucose levels 4 The patient's weight

3 Blood glucose levels Abdominal pain and irregular heartbeat in a patient taking metformin may be indicative of lactic acidosis. If the patient has lactic acidosis, the blood glucose levels will be very high as well. Therefore the nurse needs to assess the patient's blood glucose levels to confirm the condition. Renal function is assessed before administering the drug to prevent renal impairment. Reduction in B12 levels is a less common side effect of metformin. Assessing the patient's weight is not a priority in this case.

A patient with type 1 diabetes mellitus has been ordered insulin aspart (Novolog) 10 units at 7:00 AM. What nursing intervention will the nurse perform after administering this medication? 1 Perform a fingerstick blood sugar test. 2 Have the patient void and dipstick the urine. 3 Ensure the patient starts to eat as the medication is given 4 Flush the IV as the medication is being given

3 Ensure the patient starts to eat as the medication is given Insulin aspart (Novolog) is a rapid-acting insulin that acts in 5 to 15 minutes to decrease the blood glucose level. The patient can be eating as it is administered, or the patient should eat right away. A fingerstick blood glucose test should have been performed prior to the medication being administered. Urine checking is not typically performed. The medication is not given IV, but subcutaneously.

Which clinical sign is most characteristic of diabetic ketoacidosis (hyperglycemic reaction)? 1 Cool extremities 2 Clammy skin 3 Extreme thirst 4 Slurred speech

3 Extreme thirst Diabetic ketoacidosis can cause extreme thirst due to dehydration. Confusion, clammy skin, cool extremities, and slurred speech are signs of hypoglycemic reaction (insulin shock).

Which laboratory test would give the most accurate evidence of a diabetic patient's treatment compliance and glucose management over the past few months? 1 Serum albumin 2 Fasting serum glucose level 3 Glycosylated hemoglobin (HbA1c) 4 2-Hour postprandial blood glucose

3 Glycosylated hemoglobin (HbA1c) HbA1c indicates glucose concentrations over the past 3 to 4 months and thus demonstrates patient compliance and illness management over time. The serum albumin test helps to determine the level of natural protein in blood. The fasting serum glucose test helps to assess whether the patient has elevated blood glucose concentrations. A 2-hour postprandial blood glucose test determines the amount of glucose in the blood after a meal.

Which clinical findings may indicate diabetes mellitus in a patient? 1 Hemoglobin A1C (A1C) level of 5% 2 Hemoglobin A1C (A1C) level less than 5% 3 Hemoglobin A1C (A1C) level greater than 6.5% 4 Hemoglobin A1C (A1C) level between 5.7 and 6.4%

3 Hemoglobin A1C (A1C) level greater than 6.5% A hemoglobin A1C (A1C) level greater than 6.5% is another indication of diabetes mellitus. It indicates that the amount of sugar in the hemoglobin is higher than normal. For diagnostic purposes, an HbA1c level of less than or equal to 5% indicates that the patient does not have diabetes, 5.7% to 6.4% indicates prediabetes, and greater than or equal to 6.5% indicates a diagnosis of diabetes mellitus.

The nurse administers NPH insulin at 8 AM. What intervention is essential for the nurse to perform? 1 Assess the patient for hyperglycemia by 10 AM. 2 Monitor fingerstick at 2 PM. 3 Make sure patient eats by 5 PM. 4 Administer the insulin via IV pump

3 Make sure patient eats by 5 PM. NPH insulin may be peaking just before dinner without sufficient glucose on hand to prevent hypoglycemia. The patient needs to eat by 5 PM. The patient would not be at high risk for hypoglycemia at 10 AM. A fingerstick is not necessary at 2 PM. NPH insulin is not administered via IV pump.

Which drug interacts with insulin and increases the risk for unrecognized hypoglycemia in a patient? 1 Aspirin 2 Thiazide diuretics 3 β-Adrenergic blockers 4 Codeine

3 β-Adrenergic blockers β-Adrenergic blockers block the initial sympathetic response to hypoglycemia; therefore, the patient will not exhibit the initial symptoms of nervousness, diaphoresis, and sweating that typically alert him or her to the onset of hypoglycemia. Thiazide diuretics worsen insulin sensitivity. Aspirin increases glucose tolerance by stimulating insulin secretion. There are no known interactions of codeine and insulin.

A patient newly diagnosed with diabetes asks, "How does insulin normally work in my body?" Which response by the nurse is correct? 1 "It stimulates the pancreas to reabsorb glucose." 2 "It promotes synthesis of amino acids into glucose." 3 "It stimulates the liver to convert glycogen to glucose." 4 "It promotes the passage of glucose into cells for energy."

4 "It promotes the passage of glucose into cells for energy." Insulin promotes the passage of glucose into cells, where it is metabolized for energy. After or during a meal, the glucose that is ingested stimulates the pancreas to secrete insulin. Insulin stimulates the synthesis of proteins and not amino acids. Insulin stimulates the liver to convert glucose to glycogen.

A patient with type 2 diabetes mellitus receives a prescription for metformin (Glucophage). Which finding does the nurse recognize as a contraindication to therapy? 1 Arterial blood pH 7.4 2 Alanine aminotransferase 55 U/L 3 Fasting blood glucose 131 mg/dL 4 Creatinine clearance 1.6 mg/dL

4 Creatinine clearance 1.6 mg/dL The risk of lactic acidosis is greater in a patient with altered renal function. A creatinine clearance level higher than 1.5 mg/dL in males or higher than 1.4 mg/dL in females indicates renal dysfunction. Because metformin (Glucophage) can cause lactic acidosis, the nurse avoids administering the medication to this patient because the kidneys clear excess acid by excreting hydrogen ions and because metformin (Glucophage) is eliminated from the kidneys. The arterial pH is normal. The alanine aminotransferase reading does not constitute a contraindication to metformin (Glucophage) therapy. The increased blood glucose is an indication for therapy.

A patient has a serum glucose concentration of 375 mg/dL, urine output of 450 mL/hr, and an arterial pH of 7.1. The sliding scale requires intravenous insulin for a blood glucose concentration of more than 350 mg/dL. Which type of insulin is the nurse most likely to administer? 1 Insulin lispro (Humalog) 2 Insulin glargine (Lantus) 3 Neutral protamine Hagedorn (NPH) insulin (Humulin N) 4 Regular insulin (Novolin R)

4 Regular insulin (Novolin R) This patient has clinical indicators of diabetic ketoacidosis. The patient would require regular insulin (Novolin R) in its intravenous form to reduce the concentration of serum glucose. The nurse prepares to administer regular insulin (Novolin R) because it is the only insulin that can be administered intravenously. Insulin lispro (Humalog) is a human recombinant rapid-acting insulin analogue. Insulin glargine (Lantus) is a long-acting recombinant DNA-produced insulin analogue, and it provides a constant level of insulin in the body. Insulin isophane suspension, also known as NPH insulin (Humulin N), is the only available intermediate-acting insulin product.

Long acting insulins

Insulin glargine (lantus), insulin detemir (levemir)

Rapid insulins

Insulin lispro (Humalog), Insulin aspart (rDNA origin) (novolog), Insulin glulisine (Apidra)

Short acting insulins

Insuline regular (humulin R), Novolin R, regular insulin)

Intermediate acting insulins

NPH (Humulin N, Novolin N)