Diabetes Chapter 32

Name two treatments for hypoglycemia in an unconscious patient and when each would be used

-IV glucose (concentration of 50% dextrose in water) -glucagon subcutaneous/ IM injection

A syringe has been prefilled with insulin how long can it be refrigerated for? A) 1 month B) 2 weeks C) 1 week D) 3 months

1 week

A patient is on intermediate acting insulin NPH. What is the onset of action A) 15 min B) 30-60 min C)1-2 hours D) 2-4 hours

1-2 hours

blood glucose levels

70-130

The nurse monitors the client for a hypoglycemic reaction, knowing that NPH insulin peaks in approximately how many hours following administration? A. 1 hour B. 2 to 3 hours C. 8 to 12 hours D. 16 to 24 hours

C. 8 to 12 hours 4-8

Which insulin can be administered by continuous intravenous (IV) infusion? A. Insulin aspart B. Insulin detemir C. Insulin glargine D. Regular insulin

D. Regular insulin

Are peaks prominent in long-acting insulins?

No

A1C goal

less than 6.5%

The patient newly diagnosed with type 2 diabetes mellitus has been ordered insulin glargine (Lantus). What information is essential for the nurse to teach this patient? This medication should be mixed with the regular insulin each morning."' "This medication is very short-acting. You must be sure you eat after injecting it." "This medication is very expensive, but you will be receiving it only a short time." "This medication has a duration of action of 24 hours."

"This medication has a duration of action of 24 hours."

Routes for regular insulin

-IV bolus -IV infusion -IM -SubQ

insulin injections subqu

-perform hand hygiene -choose appropriate syringe -ensure needle size is correct -grasp skinfold between thumb and forefinger and measure from top to bottom -cleanse site of alc wipe (center to outward) -tell patient that he or she will feel a stick as you insert the needle -for average sized patient pinch skin with nondominant hand and inject the needle quickly 45-90; for obese 90 make sure needle is long enough to reach the base of the skinfold; for thin or child use 45 -injections in abdomen must be 2 inches away from umbillicus, stomas, incisions, open wounds - after needle enters skin, grasp lower end of syringe with nondominant hand. Move the dominant hand to the end of the plunger; with dominant hand inject slwoly -withdraw needle quickly, place a swab or sterile gauze pad over the site (no not aspirate) -apply gentle pressure, but do not massage the site -use safety device to cover the needle and dispose in appropariate container -perform hand hygiene -document

The physician orders intravenous (IV) insulin for the client with a blood sugar of 563. The nurse administers insulin lispro (Humalog) intravenously (IV). What does the best evaluation by the nurse reveal? 1. The nurse used the correct insulin. 2. The nurse should have contacted the physician prior to administration .3. The nurse should have used regular insulin (Humulin R). 4. The nurse could have given the insulin subcutaneously.

.3. The nurse should have used regular insulin (Humulin R). Regular insulin is the only insulin that can be given intravenously (IV).

What is the peak time for rapid acting insulin? A) 2-5 hours B) 1-2 hours C) 30-60 min D) 4-8 hours

1 hours

If insulin is in room temperature how long can it be used A) 3 months B) 1 month C) 2 months D) 6 months

1 month

The nurse is teaching a client how to mix regular insulin and NPH insulin in the same syringe. Which action, if performed by the client, indicates the need for further teaching? 1. Withdraws the NPH insulin first 2. Withdraws the regular insulin first 3. Injects air into NPH insulin vial first 4. Injects an amount of air equal to the desired dose of insulin into each vial

1. Withdraws the NPH insulin first

A patient is on a rapid acting insulin called lispro. How long before a meal should the pt take this medication? A) 30 min B) 15 min C) 60 min D) 10 min

15 min needs to eat after injection or else hypoglycemia occurs

What is the onset of action of rapid acting insulin A) 30-60 min B) 15 min C) 1-2 hours D) 5 minutes

15 minutes

The home care nurse visits a client recently diagnosed with diabetes mellitus who is taking Humulin NPH insulin daily. The client asks the nurse how to store the unopened vials of insulin. The nurse should tell the client to take which action?1. Freeze the insulin. 2. Refrigerate the insulin. 3. Store the insulin in a dark, dry place. 4. Keep the insulin at room temperature.

2. Refrigerate the insulin.

A patient is on a regular short acting insulin. What is the peak time? A) 1-2 hours B)2.5 hours C) 15 min D) 10 min

2.5-3 hours

If insulin is stored in the refrigerator hold long can it last? A) 6 months B) 1 month C) 3 months D) 2 months

3 months

A client with type 1 diabetes mellitus calls the nurse to report recurrent episodes of hypoglycemia with exercising. Which statement by the client indicates an inadequateunderstanding of the peak action of NPH insulin and exercise? 1. "The best time for me to exercise is after I eat." 2. "The best time for me to exercise is after breakfast." 3. "The best time for me to exercise is mid- to late afternoon." 4. "The best time for me to exercise is after my morning snack."

3. "The best time for me to exercise is mid- to late afternoon." A hypoglycemic reaction may occur in response to increased exercise. Clients should avoid exercise during the peak time of insulin. NPH insulin peaks at 4 to 12 hours; therefore, afternoon exercise takes place during the peak of the medication.

A patient is on an NPH. How long before eating should the medication be taken? A) 30 minutes B)3-60 minutes C)20 min D) 15 minutes

30-60 minutes

A patient is on an intermediate acting NPH insulin. What is the peak time? A) 1-2 hours B)8 hours C) 2.5 hours D) 15 min

8 hours

A patient is recieving a rapid acting insulin called aspart. Which of the following angles is the injection admnistered at A) 45 B) 30 C) 90 D) 120

90 if pt thin 45

The patient is prescribed 30 units of regular insulin and 70 units of insulin isophane suspension (NPH insulin) subcutaneously every morning. The nurse should provide which instruction to the patient for insulin administration? A. "Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin." B. "Inject the needle at a 30-degree angle." C. "Rotate sites at least once or twice a week." D. "Use a 23- to 25-gauge syringe with a 1-inch needle to increase insulin absorption."

A. "Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin."

The home care nurse visits a client diagnosed with type 1 diabetes mellitus who takes NPH insulin every morning and checks the client's blood glucose level 4 times per day. The client tells the nurse that, yesterday, the late afternoon blood glucose was 60 mg/dL (3.42 mmol/L) and that she "felt funny." Which statement by the client indicates an understanding of this occurrence? A. "I forgot to take my usual afternoon snack yesterday." B. "My blood glucoses are running low because I'm tired." C. "I took less insulin this morning, so I won't feel funny today." D. "I think I 'felt funny' because my insulin was close to expiring."

A. "I forgot to take my usual afternoon snack yesterday."

A client diagnosed with diabetes mellitus receives 8 units of regular insulin subcutaneously at 7:30 am. The nurse should be most alert to signs of hypoglycemia at what time during the day? A. 9:30 am to 11:30 am B. 11:30 am to 1:30 pm C. 1:30 pm to 3:30 pm D. 3:30 pm to 5:30 pm

A. 9:30 am to 11:30 am

The nurse provides information to a client diagnosed with insulin-dependent diabetes mellitus. Which manifestations resulting from a blood glucose level less than 70 mg/dL (4 mmol/L) should the nurse include in the information? Select all that apply. A. Hunger B. Sweating C. Weakness D. Nervousness E. Cool clammy skin F. Increased urinary output

A. Hunger B. Sweating C. Weakness D. Nervousness E. Cool clammy skin

Which long-acting insulin mimics natural, basal insulin with no peak action and a duration of 24 hours?A. Insulin glargine (Lantus) B. Insulin glulisine (Apidra) C. Regular insulin (Humulin R) D. NPH insulin

A. Insulin glargine (Lantus) Insulin glargine has a duration of action of 24 hours with no peaks, mimicking the natural, basal insulin secretion of the pancreas.

Why is NPH administered with regular insulin? A) helps reduce blood sugar B) decreases amounts on injections needed per day C) no reason D) to use up more insulin

B) decreases amounts on injections needed per day

Which is a rapid-acting insulin with an onset of action of less than 15 minutes? A. Insulin glargine (Lantus) B. Insulin aspart (NovoLog) C. Insulin detemir (Levemir) D. Regular insulin (Humulin R)

B. Insulin aspart (NovoLog)

Regular insulin is prescribed for a child diagnosed with type 1 diabetes mellitus. The nurse is planning a teaching session with the child and mother about the onset, peak, and duration times of the insulin. Which information should the nurse provide about this type of insulin? A. Onset of 1 hour from injection time, peak of 30 to 90 minutes later, and duration time of 5 hours B. Onset of 30 minutes from injection time, peak of 2 to 4 hours later, and duration time of 4 to 8 hours C. Onset of 2 to 6 hours from injection time, peak of 4 to 14 hours later, and duration time of 14 to 20 hours D. Onset of 6 to 14 hours from injection time, peak of 10 to 16 hours later, and duration time of 20 to 24 hours

B. Onset of 30 minutes from injection time, peak of 2 to 4 hours later, and duration time of 4 to 8 hours

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? Perform a fingerstick blood sugar test. Have the patient void and dipstick the urine. Make sure the patient eats breakfast immediately. Flush the IV.

Make sure the patient eats breakfast immediately.

gestational diabetes

a form of diabetes mellitus that occurs during some pregnancies

Hypoglycemia

abnormally low level of sugar in the blood less than 70

The nurse would include which statement when teaching a patient about insulin glargine (Lantus)?"You should inject this insulin just before meals because it is very fast-acting." "The duration of action for this insulin is approximately 8 to 10 hours, so you will need to take it twice a day." "You can mix this insulin with Lente insulin to enhance its effects." "You cannot mix this insulin with any other insulin in the same syringe.

"You cannot mix this insulin with any other insulin in the same syringe.

A client is taking Humulin NPH insulin and regular insulin every morning. The nurse should provide which instructions to the client? Select all that apply. 1. Hypoglycemia may be experienced before dinnertime. 2. The insulin dose should be decreased if illness occurs. 3. The insulin should be administered at room temperature. 4. The insulin vial needs to be shaken vigorously to break up the precipitates. 5. The NPH insulin should be drawn into the syringe first, then the regular insulin.

1. Hypoglycemia may be experienced before dinnertime. 3. The insulin should be administered at room temperature.

A patient is on regular insulin. How long before a meal should they take this medication? A) 15 min B) 1 hour C) 30 min D) 10 min

30 min

A patient is on a regular short acting insulin what is the onset of action? A) 15 min B) 1-2 hours C) 30-60 min D) 15-30 min

30-60 min

When teaching a patient about insulin glargine (Lantus), which statement by the nurse about this drug is correct? A. "You can mix this insulin with NPH insulin to enhance its effects on glucose metabolism." B. "You cannot mix this insulin with regular insulin and thus will have to take two injections." C. "It is often combined with regular insulin to decrease the number of insulin injections per day." D. "The duration of action for this insulin is 8 to10 hours, so you will need to take it twice a day."

B. "You cannot mix this insulin with regular insulin and thus will have to take two injections."

A client newly diagnosed with type 1 diabetes mellitus exercises daily. When teaching this client about medication therapy, the nurse tells the client to inject the daily dose of insulin in which location? A. In any site, but after exercise B. Only in the arm before exercise C. In a site that will not be exercised D. Only in the abdomen before exercise

C. In a site that will not be exercised

A patient is in diabetic ketoacidosis. The patient blood glucose level is over 600 mg/dL. The physician has ordered the patient to receive an initial dose of 25 units of insulin intravenously. What type of insulin will most likely be administered? A. Ultralente insulin B. Lente insulin C. Regular insulin D. NPH insulin

C. Regular insulin

The nurse is teaching a client how to mix regular and NPH insulins in the same syringe. Which action should the nurse instruct the client to take? A. Draw up the NPH insulin into the syringe first. B. Keep both bottles in the refrigerator at all times. C. Rotate the NPH insulin bottle in the hands before mixing .D. Take all of the air out of the insulin bottles before mixing

C. Rotate the NPH insulin bottle in the hands before mixing give within 5 minutes of mixing

The nurse is teaching a client how to mix regular and NPH insulins in the same syringe. Which action should the nurse instruct the client to take? A. Draw up the NPH insulin into the syringe first. B. Keep both bottles in the refrigerator at all times. C. Rotate the NPH insulin bottle in the hands before mixing. D. Take all of the air out of the insulin bottles before mixing

C. Rotate the NPH insulin bottle in the hands before mixing. at least one minute

Assuming the patient eats breakfast at 8:30 AM, lunch at noon, and dinner at 6:00 pm, he or she is at highest risk of hypoglycemia after an 8:00 am dose of NPH insulin at what time?A. 10:00 AM B. 2:00 PM C.5:00 PM D. 8:00 PM

C.5:00 PM Breakfast eaten at 8:30 AM would cover the onset of NPH insulin, and lunch will cover the 2 PM time frame. However, if the patient does not eat a mid-afternoon snack, the NPH insulin may be peaking just before dinner without sufficient glucose on hand to prevent hypoglycemia.

The client is prescribed insulin lispro 3 times a day with the amount based on blood glucose levels. Which client statement should indicate to the nurse that the client understood discharge teaching regarding insulin lispro? A. "The medication should be administered 1 hour after each meal." B. "I should spread the 3 daily doses evenly throughout the 24-hour day." C. "Lispro should be taken at least 1 hour before each of my 3 daily meals." D. "I will take the lispro 10 to 15 minutes before I eat my daily three meals.

D. "I will take the lispro 10 to 15 minutes before I eat my daily three meals.

The client's health care provider has prescribed regular insulin 10 units and NPH insulin 20 units subcutaneously every morning. Which nursing action regarding administration of insulin is correct?A. Shake the NPH insulin vial to distribute the suspension. B. Administer each type of insulin using separate syringes. C. Administer both the regular insulin and the NPH insulin at 12:00 noon D. Draw up the regular insulin first, and then the NPH insulin in the same syringe.

D. Draw up the regular insulin first, and then the NPH insulin in the same syringe.

The nurse should throw away Humulin N if it is cloudy. True or False

False The addition of protamine causes the cloudy appearance of intermediate-acting insulins and results in the formulation being a suspension rather than a solution. This is why these insulins must be gently mixed before administering.

Why doesn't insulin glargine have real peak action?

In fact, insulin glargine has no real peak action because it forms slowly dissolving crystals in the subcutaneous tissue.

. A patient with newly diagnosed type 2 diabetes mellitus asks the nurse what ""type 2"" means in relation to diabetes. The nurse explains to the patient that type 2 diabetes differs from type 1 diabetes primarily in that with type 2 diabetes a. the pt is totally dependent on an outside source of insulin b. there is a decreased insulin secretion and cellular resistance to insulin that is produced c. the immune system destroys the pancreatic insulin-producing cells d. the insulin precurosr that is secreted by the pancreas is not activated by the liver

b. there is a decreased insulin secretion and cellular resistance to insulin that is produced

A1C

blood test to provide a 3 month "average blood glucose"

The nurse is reviewing instructions for a patient with type 2 diabetes who also gives herself 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 is correct? 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."

c. "I will take an oral form of glucose."

When teaching about hypoglycemia, the nurse should make sure that the patient is aware of early signs of hypoglycemia including a. hypothermia and seizures b. nausea and diarrhea c. irritability and confusion d. fruity, acetone odor to the breath

c. irritability and confusion

A regular IV infusion of regular insulin is usually given to someone who has A) MI B) coma C) HF D) DKA

coma DKA

The nurse is teaching a group of patients about self-administration of insulin. What teaching is important to include? a. patients should use the injection site that is most accessible b. during times of illness, patients should increase their insulin dosage by 25% c. when mixing insulins, the cloudy (such as NPH) insulin should be drawn up into the syringe first d. when mixing insulins, the clear (such as regular) insulin should be drawn up into the syringe first

d. when mixing insulins, the clear (such as regular) insulin should be drawn up into the syringe first

without adequate restoration of normal blood and CNS glucose levels what can occur A) hyperglycemia B) death C) insomnia D) coma

death and coma

"A client is admitted to the hospital with signs and symptoms of diabetes mellitus. Which findings is the nurse most likely to observe in this client? Select all that apply:" 1. Excessive thirst 2. Weight gain 3. Constipation 4. Excessive hunger 5. Urine retention 6. Frequent, high-volume urination

excessive thirst excessive hunger frequent, high-volume urination

Type 1 DM

genetic disorder that usually occurs early in life when the body does not produce enough insulin or produces very little. A persons immune system is attacking and destroying the insulin that is produced in the pancreas

Basal-bolus regimen

give long-acting insulin to keep the blood glucose from fluctuating and then the short-acting insulin is given when the glucose levles increase above level that is predetermined

A patient is prescribed a long acting insulin. Select all of the following long acting insulins A) lispro B) glargine C) detemir D) NPH

glargine detemir

A patient needs a rapid acting insulin. Which of the following are rapid insulins A) lispro B) glargine C) detemir D) aspart

lispro aspart

A patient is hypoglycemic. Which of the following diet changes should be implimented A) more protein B) less protein C) more carbs D) less carbs

more protein less carbs

Insulin storage includes A) room temp B) hot temp C) cold temp D) do not freeze E)avoid exposure to sunlight F) avoid hot temperatures G) vitals in use should be stored in refrigerator F) vials not in use should be stored in refrigerator

room temp do not freeze avoid exposure to sunlight avoid hot temperatures vials not in use should be stored in refrigerator

later symptoms of hypoglycemia include A) seizures B) tremors C) hyperglycemia D) hypothermia

seizures hypothermia

rapid insulin is used A) sliding scale B) bolus

sliding scale

A patient is hypoglycemic which of the following S+S can we see A) sweating B) hypotension C) tremors D) seizures E) cardiac dysrrythmias F) irritability G) confusion H) cold

sweating tremors seizures irritability confusion cold pale

type 2 diabetes

this disorder usually shows up in adulthood that occurs due to lack of exercise and weight gain

The nurse is monitoring a client who was diagnosed with type 1 diabetes mellitus and is being treated with NPH and regular insulin. Which client complaint(s) would alert the nurse to the presence of a possible hypoglycemic reaction? Select all that apply. 1. Tremors 2. Anorexia 3. Irritability 4. Nervousness 5. Hot, dry skin 6. Muscle cramps

tremors irratibility nervousness

Select all of the following locations insulin should not be administered in A) umbilicus B) upper arm C) anterior thigh D) stoma E) abdominal region F) incisions

umbilicus stoma incisions

Select all of the following locations insulin can be administered in A) umbilicus B) upper arm C) anterior thigh D) stoma E) abdominal region

upper arm anterior thigh abdominal region

A patient is on lispro which is a rapid acting insulin. The main side effect is hypoglycemia. Which can be shown as which of the following S+S A) weight gain (hunger and thirst) B) shock C) weight loss D) lipodystrophy E)brain damage

weight gain increased thirst increased hunger lipodystrophy

sliding scale insulin

• Adjusted doses dependent upon individual blood glucose • Usually done before eating and at bedtime (4 times a day) • Usually utilizes rapid or short-acting insulin