Chapter 32 Antidiabetic Drugs
The nurse is teaching a group of patients about management of diabetes. Which statement about basal dosing is correct? a."Basal dosing delivers a constant dose of insulin." b."With basal dosing, you can eat what you want and then give yourself a dose of insulin." c."Glargine insulin is given as a bolus with meals." d."Basal-bolus dosing is the traditional method of managing blood glucose levels."
ANS: A Basal-bolus therapy is the attempt to mimic a healthy pancreas by delivering basal insulin constantly as a basal, and then as needed as a bolus. Glargine insulin is used as a basal dose, not as a bolus with meals. Basal-bolus therapy is a newer therapy; historically, sliding-scale coverage was implemented
A patient is taking a sulfonylurea medication for new-onset type 2 diabetes mellitus. When reviewing potential adverse effects during patient teaching, the nurse will include information about which of these effects? (Select all that apply.) a.Hypoglycemia b.Nausea c.Diarrhea d.Weight gain e.Peripheral edema
ANS: A, B, DThe most common adverse effect of the sulfonylureas is hypoglycemia, the degree to which depends on the dose, eating habits, and presence of hepatic or renal disease. Another predictable adverse effect is weight gain because of the stimulation of insulin secretion. Other adverse effects include skin rash, nausea, epigastric fullness, and heartburn.
A 75-year-old woman with type 2 diabetes has recently been placed on glyburide (Diabeta), 10 mg daily. She asks the nurse when the best time would be to take this medication. What is the nurse's best response a."Take this medication in the morning, 30 minutes before breakfast." b."Take this medication in the evening with a snack." c."This medication needs to be taken after the midday meal." d."It does not matter what time of day you take this medication."
ANS: AGlyburide is taken in the morning, 30 minutes before breakfast. When taken at this time, it hasa longer duration of action, causing a constant amount of insulin to be released. This may be beneficial in controlling blood glucose levels throughout the day
Which action is most appropriate regarding the nurse's administration of a rapid-acting insulinto a hospitalized patient? a.Give it within 15 minutes of mealtime. b.Give it after the meal has been completed. c.Administer it once daily at the time of the midday meal. d.Administer it with a snack before bedtime
ANS: ARapid-acting insulins, such as insulin lispro and insulin aspart, are able to mimic closely the body's natural rapid insulin output after eating a meal; for this reason, both insulins are usually administered within 15 minutes of the patient's mealtime. The other options are incorrect.
The nurse is administering lispro (Humalog) insulin and will keep in mind that this insulin will start to have an effect within which time frame? a.15 minutes b.1 to 2 hours c.80 minutes d.3 to 5 hours
ANS: AThe onset of action for lispro insulin is 15 minutes. The peak plasma concentration is 1 to 2 hours; the elimination half-life is 80 minutes; and the duration of action is 3 to 5 hours
The insulin order reads, "Give 10 units of NPH insulin and 5 units of regular insulin, subcut, every morning before breakfast." Choose the proper syringe for this injection
ANS: B
A patient has been diagnosed with metabolic syndrome and is started on the biguanide metformin (Glucophage). The nurse knows that the purpose of the metformin, in this situation, is which of these? a. To increase the pancreatic secretion of insulin b. To decrease insulin resistance c. To increase blood glucose levels d. To decrease the pancreatic secretion of insulin
ANS: B Metformin decreases glucose production by the liver; decreases intestinal absorption of glucose; and improves insulin receptor sensitivity in the liver, skeletal muscle, and adipose tissue, resulting in decreased insulin resistance. The other options are incorrect
A patient with a history of chronic obstructive pulmonary disease and type 2 diabetes has beentreated for pneumonia for the past week. The patient has been receiving intravenous corticosteroids as well as antibiotics as part of his therapy. At this time, the pneumonia has resolved, but when monitoring the blood glucose levels, the nurse notices that the level is still elevated. What is the best explanation for this elevation? a.The antibiotics may cause an increase in glucose levels. b.The corticosteroids may cause an increase in glucose levels. c.His type 2 diabetes has converted to type 1. d.The hypoxia caused by the chronic obstructive pulmonary disease causes an increased need for insulin
ANS: BCorticosteroids can antagonize the hypoglycemic effects of insulin, resulting in elevated bloodglucose levels. The other options are incorrect
The nurse is preparing to administer insulin intravenously. Which statement about the administration of intravenous insulin is true a.Insulin is never given intravenously. b.Only regular insulin can be administered intravenously. c.Insulin aspart or lispro can be administered intravenously, but there must be a 50% dose reduction. d.Any form of insulin can be administered intravenously at the same dose as that is ordered for subcutaneous administration
ANS: BRegular insulin is the usual insulin product to be dosed via intravenous bolus, intravenous infusion, or even intramuscularly. These routes, especially the intravenous infusion route, are often used in cases of diabetic ketoacidosis, or coma associated with uncontrolled type 1 diabetes.
The nurse is reviewing a patient's medication list and notes that sitagliptin (Januvia) is ordered. The nurse will question an additional order for which drug or drug class? a.glitazone b.insulin c.metformin (Glucophage) d.sulfonylurea
ANS: BSitagliptin is indicated for management of type 2 diabetes either as monotherapy or in combination with metformin, a sulfonylurea, or a glitazone, but not with insulin
After starting treatment for type 2 diabetes mellitus 6 months earlier, a patient is in the office for a follow-up examination. The nurse will monitor which laboratory test to evaluate the patient's adherence to the antidiabetic therapy over the past few months? a.Hemoglobin levels b.Hemoglobin A1C level c.Fingerstick fasting blood glucose level d.Serum insulin levels
ANS: BThe hemoglobin A1C level reflects the patient's adherence to the therapy regimen for several months previously, thus evaluating how well the patient has been doing with diet and drug therapy. The other options are incorrect.
When administering morning medications for a newly admitted patient, the nurse notes that the patient has an allergy to sulfa drugs. There is an order for the sulfonylurea glipizide (Glucotrol). Which action by the nurse is correct? a.Give the drug as ordered 30 minutes before breakfast. b.Hold the drug, and check the order with the prescriber. c.Give a reduced dose of the drug with breakfast. d.Give the drug, and monitor for adverse effects.
ANS: BThere is a potential for cross-allergy in patients who are allergic to sulfonamide antibiotics. Although such an allergy is listed as a contraindication by the manufacturer, most clinicians do prescribe sulfonylureas for such patients. The order needs to be clarified
The nurse knows to administer acarbose (Precose), an alpha-glucosidase inhibitor, at which time? a.30 minutes before breakfast b.With the first bite of each main meal c.30 minutes after breakfast d.Once daily at bedtime
ANS: BWhen an alpha-glucosidase inhibitor is taken with the first bite of a meal, excessive postprandial blood glucose elevation (a glucose spike) can be reduced or prevented
When monitoring a patient's response to oral antidiabetic drugs, the nurse knows that which laboratory result would indicate a therapeutic response? a.Random blood glucose level above 170 mg/dL b.Blood glucose level of less than 50 mg/dL after meals c.Fasting blood glucose level between 70 and 100 mg/dL d.Evening blood glucose level below 80 mg/dL
ANS: CA fasting blood glucose level between 70 and 100 mg/dL indicates a therapeutic response to drugs that decrease glucose levels. The other options are incorrect
When teaching about hypoglycemia, the nurse will make sure that the patient is aware of the early signs of hypoglycemia, including a.hypothermia and seizures. b.nausea and diarrhea. c.confusion and sweating. d.fruity, acetone odor to the breath
ANS: CEarly symptoms of hypoglycemia include the central nervous system (CNS) manifestations ofconfusion, irritability, tremor, and sweating. Hypothermia and seizures are later symptoms of hypoglycemia. The other options are incorrect
The nurse is reviewing instructions for a patient with type 2 diabetes who also takes insulin injections as part of the therapy. The nurse asks the patient, "What should you do if your fasting blood glucose is 47 mg/dL?" Which response by the patient reflects a correct understanding of insulin therapy? a."I will call my doctor right away." b."I will give myself the regular insulin." c."I will take an oral form of glucose." d."I will rest until the symptoms pass.
ANS: CHypoglycemia can be reversed if the patient eats glucose tablets or gel, corn syrup, or honey, or drinks fruit juice or a nondiet soft drink or other quick sources of glucose, which must always be kept at hand. She should not wait for instructions from her physician, nor delay taking the glucose by resting. The regular insulin would only lower her blood glucose levels more.
A patient in the emergency department was showing signs of hypoglycemia and had a fingerstick glucose level of 34 mg/dL. The patient has just become unconscious. What is the nurse's next action? a.Have the patient eat glucose tablets. b.Have the patient consume fruit juice, a nondiet soft drink, or crackers. c.Administer intravenous glucose (50% dextrose). d.Call the lab to order a fasting blood glucose level.
ANS: CIntravenous glucose raises blood glucose levels when the patient is unconscious and unable to take oral forms of glucose
A patient who has type 2 diabetes is scheduled for an oral endoscopy and has been NPO (nothing by mouth) since midnight. What is the best action by the nurse regarding the administration of her oral antidiabetic drugs? a.Administer half the original dose. b.Withhold all medications as ordered. c.Contact the prescriber for further orders. d.Give the medication with a sip of water.
ANS: CWhen the diabetic patient is NPO, the prescriber needs to be contacted for further orders regarding the administration of the oral antidiabetic drugs. The other options are incorrect.
The nurse is teaching a group of patients about self-administration of insulin. What content is important to include? a.Patients need to use the injection site that is the most accessible. b. If two different insulins are ordered, they need to be given in separate injections. c. When mixing insulins, the cloudy (such as NPH) insulin is drawn up into the syringe first. d. When mixing insulins, the clear (such as regular) insulin is drawn up into the syringe first.
ANS: D If mixing insulins in one syringe, the clear (regular) insulin is always drawn up in to the syringe first. Patients always need to rotate injection sites. Mixing of insulins may be ordered
The nurse is teaching a review class to nurses about diabetes mellitus. Which statement by thenurse is correct? a."Patients with type 2 diabetes will never need insulin." b. "Oral antidiabetic drugs are safe for use during pregnancy." c. "Pediatric patients cannot take insulin." d. "Insulin therapy is possible during pregnancy if managed carefully.
ANS: D Oral medications are generally not recommended for pregnant patients because of a lack of firm safety data. For this reason, insulin therapy is the only currently recommended drug therapy for pregnant women with diabetes. Insulin is given to pediatric patients, with extreme care. Patients with type 2 diabetes may require insulin in certain situations or as their disease progresses.
The nurse is teaching patients about self-injection of insulin. Which statement is true regarding injection sites? a.Avoid the abdomen because absorption there is irregular. b.Choose a different site at random for each injection. c.Give the injection in the same area each time. d.Rotate sites within the same location for about 1 week before rotating to a new location
ANS: DPatients taking insulin injections need to be instructed to rotate sites, but to do so within the same location for about 1 week (so that all injections are rotated in one area—for example, theright arm—before rotating to a new location, such as the left arm). Also, each injection needs to be at least to 1 inch away from the previous site
When teaching a patient who is starting metformin (Glucophage), which instruction by the nurse is correct? a."Take metformin if your blood glucose level is above 150 mg/dL." b."Take this 60 minutes after breakfast." c."Take the medication on an empty stomach 1 hour before meals." d."Take the medication with food to reduce gastrointestinal (GI) effects."
ANS: DThe GI adverse effects of metformin can be reduced by administering it with meals. The other options are incorrect