Chapter 38: Agents to control Blood Glucose
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? -Glipizide -Metformin -Miglitol -Tolbutamide
Metformin
Detemir Insulin is most likely characterized as which of the following types? -Rapid Acting -Intramuscular Long Acting (Depot) Form -Intermediate Acting -Long Acting -Short Acting -Unknown Mechanism
-Long Acting Long acting insulin covers insulin needs for about one full day. This type is often combined, when needed, with rapid or short acting insulin. Onset is typically within 1 hour, with no peak time as the insulin is delivered at a steady level.
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 -Between 2 PM and 4 PM -Between 10 AM and 12 noon -Between 12 noon and 8 PM
Between 8:30 AM and 9:30 AM
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? -Lipodystrophy -Bradycardia -Hypoglycemia -Hypotension
Hypoglycemia
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. -Do not administer insulin kept at room temperature. -Check for symptoms of myalgia or malaise. -keep prefilled syringes horizontally.
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 lispro (Humalog) -Insulin detemir (Levemir) -Insuline glulisine (Apidra) -Insulin apart (NovoLog) -Insulin glargine (Lantus)
Insulin glargine (Lantus) Insulin detemir (Levemir)
Which of the following medications is associated with intermediate acting insulin? -Metformin (Glucophage) -Insulin Aspart (Novolog) -Isophane NPH (Humulin N) -Glargine (Lantus) -Detemir (Levemir) -Insulin Glulisine (Apidra)
Isophane NPH (Humulin N) is considered intermediate acting because onset of action is delayed and duration is longer. Therefore, this insulin type cannot be administered at mealtime to control postprandial hyperglycemia, but instead is used to provide glycemic control between meals and during the night.
A student asks the nursing instructor what insulin has the quickest therapeutic effect once administered. What would be the best response? -Ultralente (Humulin U Ultralente) -Regular (Humulin R) -NPH (Humulin N) -PZI (Humulin U)
Regular (Humulin R)
A client is admitted to the intensive care unit with diabetic ketoacidosis. The nurse knows that the client will be placed on an intravenous insulin drip. The only type of insulin that can be administered intravenously is: -NPH. -Regular. -Lente. -Ultralente.
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 -External pump -Jet injector -Insulin pen
Subcutaneous injection
Heavy intake of which herb should be avoided by a client who is prescribed an antidiabetic medication? -basil -oregano -garlic -anise
garlic
A nurse should monitor a client taking glimepiride (Amaryl) for which of adverse effects? (Select all that apply.) -Heartburn -Edema -Hypoglycemia -Nausea -Lactic acidosis
-Hypoglycemia -Heartburn -Nausea
Which of the following medications is associated with rapid acting insulin? -Detemir (Levemir) -Regular Insulin (Humulin R) -Insulin Glitar -Arcabose -Insulin Lispro (Humalog) -Chlorpropamide
-Insulin Lispro (Humalog) Insulin lispro (Humalog) is a rapid-acting (15-30 minutes) analog of regular insulin with a short duration (3-6 hours). Because of its rapid onset, it can be administered immediately before eating, or even after eating.
NPH Insulin is most likely characterized as which of the following types? -Short Acting -Long Acting -Intramuscular Long Acting (Depot) Form -Unknown Mechanism -Intermediate Acting -Rapid Acting
-Intermediate Acting Intermediate acting insulin covers insulin needs for about half the day or overnight. It is often combined with rapid or short acting insulin. Onset of action is 1-2 hours, peak within 4-12 hours, and duration lasting 16-24 hours.
The nurse monitoring a client receiving insulin glulisine (Apidra) 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.) -Hard candy -Orange or other fruit juice -Insulin glargine (Lantus) -Insulin detemir (Levemir) -Glucose tablets
-Orange or other fruit juice -Glucose tablets -Hard candy
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 whose type 2 diabetes was diagnosed one week ago -a client whose most recent blood glucose level was 150 mg/dL -a client who received 12 units of Humulin R 45 minutes ago -a client who received 12 units of metformin minutes ago
a client who received 12 units of Humulin R 45 minutes ago
Which factor would prohibit the administration of glipizide? -a diagnosis of hypertension -increase in alkaline phosphatase -allergy to sulfonamides -the ingestion of carbohydrates
allergy to sulfonamides
A nurse is preparing to administer a rapid-acting insulin. Which medication would the nurse most likely administer? -insulin glargine -isophane insulin suspension -insulin lispro -insulin detemir
insulin lispro
When considering the management of diabetic ketoacidosis (DKA), what type of insulin can be administered intravenously? -isophane insulin (NPH) -lispro -regular -insulin glargine
regular
What type of insulin will most likely be administered intravenously to a client with a blood glucose level over 600 mg/dL (33.33 mmol/L)? -ultralente insulin -lente insulin -NPH insulin -regular insulin
regular insulin
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 12 to 24 hours -the past 7 to 10 days -the past 1 or 2 months
the past 3 or 4 months
Which would a nurse identify as an example of a sulfonylurea? -Metformin -Glyburide -Acarbose -Miglitol
Glyburide
When describing the effects of incretins on blood glucose control to a group of students, which would an instructor include? -Increases insulin release -Increases protein building -Increases GI emptying -Increases glucagon release
Increases insulin release
The two major classifications of diabetes are type 1 and type 2. What is a distinguishing characteristic of type 1 diabetes? -Oral agents can control the disease process. -Blood glucose level can be controlled with diet. -It always starts in childhood. -Lifelong exogenous insulin is required.
Lifelong exogenous insulin is required.
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. -Take an oral dose of some form of glucose as soon as possible. -Notify your health care provider immediately. -Stay calm and still until the reaction subsides.
Take an oral dose of some form of glucose as soon as possible.
A client, who is 42 years old and 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." -"I don't like getting this diagnosis, but I know that treatment now can prevent future health consequences." -"From what I've learned, I know that the basic problem is that my pancreas can't keep up with my insulin needs." -"People always tried to encourage me to lose weight, and I suppose they might have been right."
"I'm disappointed, but I take some solace in the fact that I won't ever have to have insulin injections."
What statement would be appropriately included in the teaching concerning type 2 diabetes? -"Regular exercise makes your body better able to use the insulin it produces." -"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." -"If you drink alcohol, it may be necessary for you to increase your oral anti-diabetic medication."
"Regular exercise makes your body better able to use the insulin it produces."
Which of the following medications is associated with long acting insulin? -Insulin Glulisine (Apidra) -Regular Insulin (Humulin R) -Isophane NPH (Humulin N) -Metformin (Glucophage) -Detemir (Levemir) -Insulin Aspart (Novolog)
-Detemir (Levemir) Insulin detemir is a long-acting insulin analog used for basal control of insulin. It is distributed under the trade name Levemir, and has been shown to cause less weight gain or episodes of hypoglycemia than the intermediate-acting insulin NPH. Detemir is indicated only as a subcutaneous injection and should not be mixed with other insulins in the same injection. Do not administer detemir IV or IM. Detemir insulin is a clear solution and should not be given if viscous or cloudy.
Which of the following medications is associated with rapid acting insulin? -Insulin Glitar -Glargine (Lantus) -Regular Insulin (Humulin R) -Isophane NPH (Humulin N) -Insulin Norton -Insulin Glulisine (Apidra)
-Insulin Glulisine -(Apidra) Insulin glulisine (Apidra) is a synthetic analog of natural human insulin with a rapid onset (10-15 minutes) and short duration (3-5 hours). Like insulin lispro and aspart, this drug should be administered close to the time of eating.
Regular Insulin is most likely which of the following types? -Rapid Acting -Long Acting -Short Acting -Intermediate Acting -Intramuscular Long Acting (Depot) Form -Unknown Mechanism
-Short Acting Short acting insulin covers insulin needs for meals eaten within 30-60 minutes as the onset of action is 30-60 minutes, peak action within 2-4 hours, and duration lasting 6-10 hours.
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? -Review and discuss the data contained in the client's written blood glucose log. -Arrange to have the client's random blood glucose measured. -Assess the most recent hemoglobin A1C levels. -Dialogue with the client about implemented management strategies.
Assess the most recent hemoglobin A1C levels.
A nurse is assigned to administer glargine to a patient at a health care facility. What precaution should the nurse take when administering glargine? -Administer insulin that has been refrigerated. -Administer glargine via IV route. -Avoid mixing glargine with other insulin. -Shake the vial vigorously before withdrawing insulin.
Avoid mixing glargine with other insulin.
A client receives regular insulin at 8:00 AM. The nurse would be alert for signs and symptoms of hypoglycemia at which time? -Between 2:00 PM and 4:00 PM -Between 10:00 AM and 12:00 PM -Between 8:30 AM and 9:30 AM -Between 12:00 PM and 8:00 PM
Between 10:00 AM and 12:00 PM
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. -Client's blood glucose demonstrates longstanding hypoglycemia. -Client's blood glucose levels are not consistent. -Client is in good glycemic control.
Client's average blood glucose is above normal.
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? -Mix pramlintide in the same syringe with insulin. -Inject pramlintide in the same site where insulin is administered. -Pramlintide should only be injected in the hip. -Do not give pramlintide in the same site where insulin is administered.
Do not give pramlintide in the same site where insulin is administered.
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? -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. -Insulin is needed because the beta cells of the pancreas are no longer functioning.
Insulin is needed because the beta cells of the pancreas are no longer functioning
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. -If you drink alcohol, it may be necessary to increase your oral antidiabetic medication. -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.
It is possible with weight loss and exercise to discontinue the use of antidiabetic medication. Explanation:
A client prescribed metformin is scheduled to undergo diagnostic testing with the administration of parenteral radiographic contrast media containing iodine. What fact should direct the nurse's plan of care for this client? -The client needs to be encouraged to drink 1 to 2 L of water to flush the contrast media out the kidneys. -The client will be prescribed an extra dose of metformin due to address the contrast material's effect on the body. -The metformin will be temporarily substituted for with insulin, to address the risk of potential kidney failure. -Metformin should be discontinued at least 48 hours before and after diagnostic tests that use contrast medias.
Metformin should be discontinued at least 48 hours before and after diagnostic tests that use contrast medias.
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? -Document family medical history. -Observe the patient for hypoglycemic episodes. -Assess the skin for ulcers, cuts, and sores. -Monitor the patient for lipodystrophy.
Observe the patient for hypoglycemic episodes.
Which of the following medications is associated with short acting insulin? -Detemir (Levemir) -Insulin Aspart (Novolog) -Metformin (Glucophage) -Insulin Glulisine (Apidra) -Glargine (Lantus) -Regular Insulin (Humulin R)
Regular insulin (Humulin R) is unmodified human insulin. For routine treatment of diabetes, it can be administered before meals to control postprandial hyperglycemia or infused subQ to provide basal glycemic control. It is supplied as a clear solution.
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 -Insulin pen -Implantable infusion pump -Jet injector
Subcutaneous injection
A client was diagnosed with type 2 diabetes several months ago and has presented for a scheduled follow-up appointment. Which stated behavior most clearly indicates that the client has established effective health maintenance? -The client exercises two to three times per week. -The client frequently checks his/her blood glucose levels. -The client tells the nurse that he/she has gone on a diet. -The client can describe the differences between type 1 and type 2 diabetes.
The client frequently checks his/her blood glucose levels.
Which of the following medications is associated with long acting insulin? -Metformin (Glucophage) -Isophane NPH (Humulin N) -Glargine (Lantus) -Regular Insulin (Humulin R) -Insulin Aspart (Novolog) -Insulin Glulisine (Apidra)
-Glargine (Lantus) Insulin glargine (Lantus) is usually given once per day to mimic the basal rate of insulin normally in the body as a long acting insulin. Insulin glargine is indicated only as a subcutaneous injection and should not be mixed with other insulins in the same injection. Do not administer insulin glargine IV or IM. Glargine insulin is a clear solution and should not be given if viscous or cloudy.
Which of the following medications is associated with rapid acting insulin? -Glargine (Lantus) -Metformin (Glucophage) -Insulin Aspart (Novolog) -Detemir (Levemir) -Isophane NPH (Humulin N) -Insulin Glitar
-Insulin Aspart (Novolog) Insulin aspart (Novolog) is an analog of human insulin with a rapid onset (10-20 minutes) and short duration (3-5 hours). Due to its rapid onset of action, injections should be made 5-10 minutes before meals.
Insulin Lispro is most likely which of the following types? -Short Acting -Intermediate Acting -Unknown Mechanism -Short Acting -Rapid Acting -Intramuscular Long Acting (Depot) Form
Rapid Acting Rapid acting insulin covers insulin needs for meals eaten at the same time of injection. This type is often combined with longer-acting insulin. Onset of action is 10-30 minutes, peak action of 1-3 hours, and duration lasting 3-6 hours. Rapid onset, quick peak, and short duration.